Subjective Socioeconomic Status Moderates the Association between Discrimination and Depression in African American Youth.

Background: Most of the literature on the association between socioeconomic status (SES) and health is focused on the protective effects of SES. However, a growing literature suggests that high SES may also operate as a vulnerability factor. Aims: Using a national sample of African American youth, this study compared the effects of perceived discrimination on major depressive disorder (MDD) based on SES. Methods: The current cross-sectional study included 810 African American youth who participated in the National Survey of American Life-Adolescent supplement. The independent variable was perceived discrimination. Lifetime, 12-month, and 30-day MDD were the dependent variables. Age and gender were covariates. Three SES indicators (subjective SES, income, and poverty index) were moderators. We used logistic regressions for data analysis. Results: Perceived discrimination was associated with higher risk of lifetime, 12-month, and 30-day MDD. Interactions were found between subjective SES and perceived discrimination on lifetime, 12-month, and 30-day MDD, suggesting a stronger effect of perceived discrimination in youth with high subjective SES. Objective measures of SES (income and poverty index) did not interact with perceived discrimination on MDD. Conclusion: While perceived discrimination is a universally harmful risk factor for MDD, its effect may depend on the SES of the individual. Findings suggest that high subjective SES may operate as a vulnerability factor for African American youth.

Does Discrimination Explain High Risk of Depression among High-Income African American Men?

Background: Higher socioeconomic status is known to decrease the risk for poor mental health overall. However, African American males of higher socioeconomic status (SES) are at an increased risk for having a major depressive episode (MDE). It is not known whether perceived discrimination (PD) explains this risk. The current study used nationally representative data to explore the role of PD in explaining the association between high-SES and having MDE among African American men. Methods: The National Survey of American Life (NSAL), 2003, included 4461 American adults including 1271 African American men. SES indicators (i.e., household income, educational attainment, employment status, and marital status) were the independent variables. 12-month MDE measured using the Composite International Diagnostic Interview (CIDI) was the outcome. Age, gender, and region were the covariates. PD was the potential mediator. For data analysis, we used logistic regression. Results: Among African American men, household income was positively associated with odds of 12-month MDE. The positive association between household income and odds of MDE remained unchanged after adding PD to the model, suggesting that PD may not explain why high-income African American men are at a higher risk of MDE. Conclusions: Perceived discrimination does not explain the increased risk for depression among African American males of higher SES. Future research should explore the role of other potential mechanisms such as stress, coping, social isolation, and/or negative social interaction that may increase psychological costs of upward social mobility for African American males.

Self-Rated Health and Glycemic Control in Type 2 Diabetes: Race by Gender Differences.

BACKGROUND: Although some studies have shown a link between self-rated health (SRH) and glycemic control in type 2 diabetes (DM), other studies have failed to support this association. The purpose of this study was to determine whether these equivocal findings can be explained by specific interactions between gender, race, and SRH, as suggested by the intersectionality literature. METHODS: This cross-sectional study included 287 patients with DM (85 Black men, 78 Black women, 64 White men, and 60 White women). After adjusting for demographic and medical factors, we regressed HbA1c on SRH with and without interactions between gender, race, and SRH. We conducted additional subgroup analyses to further characterize gender by race group differences. RESULTS: Although there was no main effect of SRH upon HbA1c (b = .16, 95% CI: .08-.39), we found a significant interaction between gender and SRH on HbA1c (b = -.50, 95% CI: -.97 to -.03). In race by gender-stratified models, SRH (b = .53, 95% CI: .00-1.07) was associated with HbA1c in Black men. SRH was not associated with HbA1c in White men, White women, or Black women. CONCLUSION: Combined race and gender differences may exist in the link between SRH and glycemic control in DM. Specifically, Black men with DM may be more attuned to the relationship between their overall health and their glycemic control.

Educational Attainment Promotes Fruit and Vegetable Intake for Whites but Not Blacks.

BACKGROUND: Although the protective effects of socioeconomic status (SES) on health behaviors are well-known, according to the minorities' diminished return theory, the health return of SES, particularly educational attainment, is systemically smaller for minorities than Whites. Aims. The current study explored Black-White differences in the effects of educational attainment and income on the consumption of fruits and vegetables. METHODS: This cross-sectional study used the Health Information National Trends Survey (HINTS) 2017 (n = 3217). HINTS is a nationally representative survey of American adults. The current analysis included 2277 adults who were either non-Hispanic White (n = 1868; 82%) or non-Hispanic Black (n = 409; 18%). The independent variables in this study were SES (educational attainment and income). The dependent variable was consumption of fruits and vegetables. Race was the focal moderator. RESULTS: In the overall sample, high educational attainment and income were associated with higher consumption of fruits and vegetables. Race moderated the effect of educational attainment but not income on the consumption of fruits and vegetables. CONCLUSION: In line with the past research in the United States, Whites constantly gain more health benefits from the very same educational attainment than Blacks. The health gain from income is more equal across races than the health gain from educational attainment. Such diminished returns may be due to racism across institutions in the United States.

Income Gradient in Renal Disease Mortality in the United States.

BACKGROUND: Non-communicable diseases and associated mortality follow a social gradient and chronic kidney disease is not an exception to this rule. Intermediate behavioral and medical factors that may explain such social gradients are, however, still unknown. OBJECTIVES: Using nationally representative data in the United States, this study was conducted to investigate the mediating effect of medical and behavioral risk factors on the association between socioeconomic status (SES) and renal disease mortality. PATIENTS AND METHODS: Americans' Changing Lives Study (ACL), 1986-2011, is a 25-year nationally representative prospective cohort study. ACL followed 3,361 adults for up to 25 years. Income, education, and unemployment were the main predictors of interest. Death due to renal disease was the main outcome. Health behaviors (smoking, drinking, and exercise) and medical risk factors (diabetes, hypertension, and obesity) were the mediators. Cox proportional hazards models were used for data analysis. RESULTS: Higher income (HR = 0.75; 95% CI = 0.62-0.89) was associated with lower risk of death due to renal disease over the 25-year follow-up period. Although health behaviors and medical risk factors at baseline were also predictors of the outcome, they failed to explain the effect of income on death due to renal disease. That is, income was associated with death due to renal disease above and beyond all potential mediators including behavioral and medical risk factors. CONCLUSION: Socioeconomic inequalities in the United States cause disparities in renal disease mortality; however, such differences are not due to health behaviors (smoking and drinking) and medical risk factors (hypertension and diabetes). To reduce disparities in renal disease mortality in the United States, policies should go beyond health behaviors and medical risk factors. While programs should help low-income individuals maintain exercise and avoid smoking, reduction of income disparities should be regarded as a strategy for reduction of disparities in renal disease mortality. By increasing minimum pay and minimizing the income gap, we may reduce disparities in renal disease mortality.

Positive and Negative Affect More Concurrent among Blacks than Whites.

BACKGROUND: While positive and negative affect are inversely linked, people may experience and report both positive and negative emotions simultaneously. However, it is unknown if race alters the magnitude of the association between positive and negative affect. The current study compared Black and White Americans for the association between positive and negative affect. METHODS: We used data from MIDUS (Midlife in the United States), a national study of Americans with an age range of 25 to 75. A total number of 7108 individuals were followed for 10 years from 1995 to 2004. Positive and negative affect was measured at baseline (1995) and follow-up (2004). Demographic (age and gender), socioeconomic (education and income) as well as health (self-rated health, chronic medical conditions, and body mass index) factors measured at baseline were covariates. A series of linear regressions were used to test the moderating effect of race on the reciprocal association between positive and negative affect at baseline and over time, net of covariates. RESULTS: In the pooled sample, positive and negative affect showed inverse correlation at baseline and over time, net of covariates. Blacks and Whites differed in the magnitude of the association between positive and negative affect, with weaker inverse associations among Blacks compared to Whites, beyond all covariates. CONCLUSION: Weaker reciprocal association between positive and negative affect in Blacks compared to Whites has implications for cross-racial measurement of affect and mood, including depression. Depression screening programs should be aware that race alters the concordance between positive and negative affect domains and that Blacks endorse higher levels of positive affect compared to Whites in the presence of high negative affect.

Discrimination and Psychological Distress: Gender Differences among Arab Americans.

BACKGROUND: Despite the existing knowledge on the association between discrimination and poor mental health, very few studies have explored gender differences in this association in Arab Americans. OBJECTIVE: The current study aimed to investigate whether gender moderates the association between the experience of discrimination and psychological distress in a representative sample of Arab Americans in Michigan. METHODS: Using data from the Detroit Arab American Study (DAAS), 2003, this study recruited Arab Americans (337 males, 385 females) living in Michigan, United States. The main independent variable was discrimination. The main outcome was psychological distress. Covariates included demographic factors (age), socioeconomic status (education, employment, and income), and immigration characteristics (nativity and years living in United States). Gender was the focal moderator. We used multivariable regression with and without discrimination × gender interaction term. RESULTS: In the pooled sample, discrimination was positively associated with psychological distress [B = 0.62, 95% confidence interval (CI) = 0.22-1.03, p = 0.003]. We found a significant gender × discrimination interaction in the pooled sample (B = 0.79, 95% CI = 0.01-1.59, p = 0.050), suggesting a stronger association in males than females. In our gender-specific model, higher discrimination was associated with higher psychological distress among male (B = 0.87, 95% CI = 0.33-1.42, p = 0.002) but not female (B = 0.18, 95% CI = -0.43 to 0.78, p = 0.567) Arab Americans. CONCLUSION: While discrimination is associated with poor mental health, a stronger link between discrimination and psychological symptoms may exist in male compared to female Arab Americans. While efforts should be made to universally reduce discrimination, screening for discrimination may be a more salient component of mental health care for male than female Arab Americans.

Demographic and Socioeconomic Determinants of Physical and Mental Self-rated Health Across 10 Ethnic Groups in the United States.

BACKGROUND AND AIMS: The aim of this study was to explore ethnic differences in demographic and socioeconomic determinants of poor physical and mental self-rated health (SRH) in the United States. METHODS: We used data from the Collaborative Psychiatric Epidemiology Surveys (CPES) 2001-2003, which included a national household probability sample of 18237 individuals including 520 Vietnamese, 508 Filipino, 600 Chinese, 656 other Asian, 577 Cuban, 495 Puerto Rican, 1442 Mexican, 1106 other Hispanic, 4746 African American, and 7587 non-Latino Whites. Demographic factors (age and gender), socioeconomic factors (education and income), body mass index (BMI), and physical and mental SRH were measured. Pearson correlation was used to explore correlates of physical and mental SRH across ethnic groups. RESULTS: While age was positively associated with poor physical SRH, ethnic groups differed in the effect of age on mental SRH. Age was positively associated with mental SRH among Vietnamese, Filipino, Chinese, Cuban, Puerto Rican, and African American individuals, but this was not so for other Asians, Mexicans, other Hispanics, and non-Hispanic Whites. Chinese and Cubans were the only groups where female gender was associated with poor physical and mental SRH. With other Asians being an exception, education and income were protective against poor physical and mental SRH in all ethnic groups. Ethnic groups also differed in how their mental and physical SRH reflect BMI. CONCLUSION: Demographic and socioeconomic determinants of physical and mental SRH vary across ethnic groups. Poor physical and mental SRH are differently shaped by social determinants across ethnic groups. These ethnic differences may cause bias in health measurement in ethnically diverse populations.

Race by Gender Group Differences in the Protective Effects of Socioeconomic Factors Against Sustained Health Problems Across Five Domains.

BACKGROUND: Despite the existing literature on the central role of socioeconomic status (SES; education and income) for maintaining health, less is known about group differences in this effect. Built on the intersectionality approach, this study compared race by gender groups for the effects of baseline education and income on sustained health problems in five domains: depressive symptoms, insomnia, physical inactivity, body mass index (BMI), and self-rated health (SRH). METHODS: Data came from waves 7, 8, and 10 of the Health and Retirement Study (HRS), which were collected in 2004, 2006, and 2010, respectively. The study followed 37,495 white and black men and women above age 50 for up to 6 years. This number included 12,495 white men, 15,581 white women, 3839 black men, and 5580 black women. Individuals reported their depressive symptoms (Center for Epidemiological Studies-Depression (CES-D) 11), insomnia, physical inactivity, BMI, and SRH across all waves. Multigroup structural equation modeling (SEM) was used to compare black men, black women, white men, and white women for the effects of education and income in 2004 on sustained health problems from 2004 to 2010. RESULTS: In the pooled sample, higher education and income at baseline were associated with lower sustained health problems across all five domains. However, race by gender group differences were found in the effects of education and income on sustained insomnia, physical inactivity, and BMI, but not depressive symptoms and SRH. The protective effects of education against insomnia, physical inactivity, and BMI were not found for black men. For black women, the effect of education on BMI was not found. Income had a protective effect against sustained high BMI among white and black women but not white and black men. CONCLUSION: The intersection of race and gender alters the protective effects of social determinants on sustained health problems such as insomnia, physical inactivity, and BMI. Social groups particularly vary in the operant mechanisms by which SES contributes to maintaining health over time. The health effects are less universal for education than income. Race by gender groups differ more in SES determinants of BMI, insomnia, and physical inactivity than depressive symptoms and SRH.

Chronic Medical Conditions and Negative Affect; Racial Variation in Reciprocal Associations Over Time.

BACKGROUND: The Black-White health paradox can be defined as lower frequency of depression despite higher prevalence of economic and social adversities as well as chronic medical conditions (CMC) among American Blacks compared to American Whites. Based on this paradox, the CMC - depressive symptoms link is expected to be weaker among Blacks than Whites. We conducted a 10-year longitudinal study to compare Blacks and Whites for bidirectional associations between number of CMC and negative affect over time. METHODS: We used data from the MIDUS (Midlife in the United States), a nationally representative longitudinal study of American adults. A total number of 7,108 individuals with an age range of 25-75 years (N = 7,108) were followed for 10 years from 1995 to 2004. Age, gender, and socioeconomic status (education and income) were measured at baseline. Negative affect and CMC were measured at baseline (1995) and end of follow up (2004). Race was the moderator. Linear regression was used to test the moderating effect of race on the reciprocal associations between CMC and negative affect, net of covariates. RESULTS: In the pooled sample, while baseline CMC was predictive of an increase in negative affect over time, baseline negative affect was also predictive of an increase in CMC. We found interactions between race and baseline CMC on change in depressive symptoms, as well as race with negative affect on CMC change, suggesting that the associations between CMC and negative affect are stronger for Whites in comparison to Blacks. CONCLUSION: Blacks and Whites differ in reciprocal links between CMC and negative affect over time. This finding replicates recent studies on differential links between psychosocial factors and physical health based on race. Findings may help us better understand how Black-White health paradox develops across mid and later life.

Association Between Stressful Life Events and Depression; Intersection of Race and Gender.

BACKGROUND: Although stressful life events (SLEs) and depression are associated, we do not know if the intersection of race and gender modifies the magnitude of this link. Using a nationally representative sample of adults in the USA, we tested if the association between SLE and major depressive episode (MDE) depends on the intersection of race and gender. METHODS: Data came from the National Survey of American Life (NSAL), 2003, a cross-sectional survey that enrolled 5899 adults including 5008 Blacks (African-Americans or Caribbean Blacks), and 891 Non-Hispanic Whites. Logistic regression was used for data analysis. Stressful life events (past 30 days) was the independent variable, 12-month MDE was the dependent variable, and age, educational level, marital status, employment, and region of country were controls. RESULTS: In the pooled sample, SLE was associated with MDE above and beyond all covariates, without the SLE × race interaction term being significant. Among men, the SLE × race interaction was significant, suggesting a stronger association between SLE and MDE among White men compared to Black men. Such interaction between SLE × race could not be found among women. CONCLUSIONS: The association between SLE and depression may be stronger for White men than Black men; however, this link does not differ between White and Black women. More research is needed to better understand the mechanism behind race by gender variation in the stress-depression link.

Race and Urbanity Alter the Protective Effect of Education but not Income on Mortality.

BACKGROUND: Although the effects of socioeconomic status (SES) on mortality are well established, these effects may vary based on contextual factors such as race and place. Using 25-year follow-up data of a nationally representative sample of adults in the U.S., this study had two aims: (1) to explore separate, additive, and multiplicative effects of race and place (urbanity) on mortality and (2) to test the effects of education and income on all-cause mortality based on race and place. METHODS: The Americans' Changing Lives (ACL) Study followed Whites and Blacks 25 years and older from 1986 until 2011. The focal predictors were baseline SES (education and income) collected in 1986. The main outcome was time until death due to all causes from 1986 until 2011. Age, gender, behaviors (smoking and exercise), and health (chronic medical conditions, self-rated health, and depressive symptoms) at baseline were potential confounders. A series of survey Cox proportional hazard models were used to test protective effects of education and income on mortality based on race and urbanity. RESULTS: Race and place had separate but not additive or multiplicative effects on mortality. Higher education and income were protective against all-cause mortality in the pooled sample. Race and urbanity significantly interacted with baseline education but not income on all-cause mortality, suggesting that the protective effect of education but not income depend on race and place. While the protective effect of education were fully explained by baseline health status, the effect of income remained significant beyond health. CONCLUSION: In the U.S., the health return associated with education depends on race and place. This finding suggests that populations differently benefit from SES resources, particularly education. Differential effect of education on employment and health care may explain the different protective effect of education based on race and place. Findings support the "diminishing returns" hypothesis for Blacks.

Education and Alcohol Consumption among Older Americans; Black-White Differences.

PURPOSE: Although the link between education and alcohol consumption is known, limited information exists on racial differences in this link. We conducted the current study to test Black-White differences in the association between education and alcohol consumption among older adults in the U.S. METHODS: This cross-sectional survey enrolled 1,493 Black (n = 734) and White (n = 759) older adults (age 66 or more) in U.S. Data came from the Religion, Aging, and Health Survey, 2001. Race, demographics, socioeconomics, and alcohol consumption were measured. Independent variable was education level. Outcome was alcohol consumption. Race was the focal moderator. Logistic regression was used for data analysis. RESULTS: Education was positively associated with ever drinking in the pooled sample. However, race interacted with education level on drinking, suggesting a smaller effect of education on drinking for Blacks compared to Whites. Among Whites, high-school graduation and college graduation were associated with increased odds of ever drinking, net of covariates. Among Blacks, high-school graduation, but not college graduation, was associated with ever drinking. CONCLUSION: Blacks and Whites differ in how socioeconomic status (i.e., education) shapes behaviors, especially health behaviors (i.e., drinking). How race modifies consequences and correlates of social determinants of health is not yet clear. College graduation may result in the same level of change to the social network and income of race group members. Weaker effect of education on health of Blacks may be due to the structural role of race and racism that has resulted in lower job availability and pay for Blacks.

Depressive Symptoms Are Associated with More Hopelessness among White than Black Older Adults.

BACKGROUND: Hopelessness is a core component of depression. Our information is, however, very limited on ethnic variations in the magnitude of the link between depression and hopelessness. Using a national sample of older adults in United States, we compared Blacks and Whites for the magnitude of the association between depressive symptoms and hopelessness. METHODS: With a cross-sectional design, we used baseline data of the Religion, Aging, and Health Survey, 2001. Linear regression models were used for data analysis. Depressive symptoms (CES-D) and hopelessness were conceptualized as independent and dependent variables in different models, respectively. Demographic factors (age and gender), socioeconomic status (education and marital status), and health (self-rated health) were covariates. Ethnicity was the moderator. RESULTS: In the pooled sample, higher depressive symptoms were predictive of hopelessness, above and beyond all covariates. We also found significant interactions suggesting that the association between depressive symptoms and hopelessness is weaker among Blacks compared to Whites. In ethnic-specific models, there were significant associations between depressive symptoms and hopelessness among Whites but not Blacks. CONCLUSION: Depressive symptoms accompany more hopelessness among Whites than Blacks. This finding may explain why Blacks with depression have a lower tendency to commit suicide. Future research should test whether or not Whites with depression better respond to psychotherapies and cognitive behavioral therapies that focus on hope enhancement. This finding may explain differential correlates of depression based on race and ethnicity.

Stressful Life Events and Risk of Depression 25 Years Later: Race and Gender Differences.

BACKGROUND: Although stressful life events (SLEs) predict subsequent risk of developing a major depressive episode (MDE), limited information exists on whether or not race and gender alters the predictive role of SLE on risk of MDE over a long-term period. The current study explored race and gender differences in the long-term predictive role of SLE at baseline (1986) on subsequent risk of MDE 25 years later (2011) in a nationally representative cohort in the United States. METHODS: Using a life course epidemiological approach, this longitudinal study borrowed data from the Americans' Changing Lives (ACL) Study 1986-2011. Main predictor of interest was baseline SLE over the last 3 years measured at 1986. Main outcome was risk of MDE [Composite International Diagnostic Interview (CIDI)] 25 years later (2011). Covariates included demographics, socioeconomics, depressive symptoms [Center for Epidemiological Studies-Depression Scale (CES-D)], chronic medical conditions, and health behaviors measured at baseline (1986). Gender and race were the focal moderators. We employed logistic regressions in the pooled sample, and specific to race and gender, to test whether or not SLE × race and SLE × gender interactions are significant. RESULTS: In the pooled sample, baseline SLE (1986) predicted risk of MDE 25 years later (2011). We also found a gender by SLE interaction, suggesting a stronger predictive role of SLE for subsequent clinical depression for men compared to women. Race did not modify the predictive role of SLE on subsequent risk of MDE 25 years later. CONCLUSION: How SLE predicts MDE 25 years later differs for men and women, with a stronger predictive role for men compared to women. More research is needed to better understand the complex links between gender, sex, stress, and depression.

Race, Depressive Symptoms, and All-Cause Mortality in the United States.

PURPOSE: Despite the well-established association between baseline depressive symptoms and risk of all cause-mortality, limited information exists on racial differences in the residual effects of baseline depressive symptoms above and beyond socioeconomic status (SES) and physical health on this link. The current study compared Blacks and Whites for the residual effects of depressive symptoms over SES and health on risk of long-term all-cause mortality in the U.S. METHODS: Data were obtained from the Americans' Changing Lives Study, a nationally representative longitudinal cohort of U.S. adults with up to 25 years of follow-up. The study followed 3,361 Blacks and Whites for all-cause mortality between 1986 and 2011. The main predictor of interest was baseline depressive symptoms measured at 1986 using an 11-item Center for Epidemiological Studies-Depression scale. Covariates included baseline demographics (age and gender), SES (education and income), and health [chronic medical conditions (CMCs), self-rated health (SRH), and body mass index (BMI)] measured at 1986. Race (Black versus White) was the focal moderator. We ran a series of Cox proportional hazard models in the pooled sample and also stratified by race. RESULTS: In the pooled sample, higher depressive symptoms at baseline were associated with higher risk of all-cause mortality except when the CMC, SRH, and BMI were added to the model. In this later model, race interacted with baseline depressive symptoms, suggesting a larger effect of depressive symptoms on mortality among Whites compared to Blacks. Among Whites, depressive symptoms were associated with increased risk of mortality, after controlling for SES but not after controlling for health (CMC, SRH, and BMI). Among Blacks, depressive symptoms were not associated with mortality before health was introduced to the model. After controlling for health, baseline depressive symptoms showed an inverse association with all-cause mortality among Blacks. Although the effect of baseline depressive symptoms on mortality disappeared after controlling for health among Whites, SRH did not interfere (confound) with the effect of depressive symptoms on mortality among Blacks. CONCLUSION: The effect of depressive symptoms on increased risk of all-cause mortality, which existed among Whites, could not be found for Blacks. In addition, race may modify the roles that SES and health play regarding the link between depressive symptoms and mortality over a long period of time.

Black-white difference in long-term predictive power of self-rated health on all-cause mortality in United States.

PURPOSE: Despite the well-established association between self-rated health (SRH) and mortality, limited information exists on Black-White differences in this link. Using a nationally representative sample of adults in the United States, the present study had four aims: (1) to assess whether the association between baseline SRH and all-cause mortality over a long follow-up differs for blacks and whites, (2) to test whether any race difference in the SRH-mortality link depends on how the SRH variable is treated (e.g., nominal, dichotomous, continuous), (3) to test if the SRH-mortality link or any differences in the association by race are explained by differences in objective health measures (chronic medical conditions [CMC]), and (4) to assess whether these associations vary by gender. METHODS: Data came from the Americans' Changing Lives Study, a nationally representative longitudinal cohort of U.S. adults 25 years and older with up to 25 years of follow-up. The study followed 3361 blacks or whites for all-cause mortality between 1986 and 2011. The predictor of interest was a single-item measure of SRH in 1986, treated as a nominal, dichotomous (fair/poor vs. excellent/very good/good), and continuous variable. Confounders included baseline age, education, income, depressive symptoms, and CMC. Race (black vs. white) was the focal effect modifier. We ran Cox proportional hazard models for the pooled sample and also stratified by race and gender, before and after adjusting for CMC. RESULTS: Regardless of how SRH was treated and for both men and women, we found significant interactions between race and SRH, indicating a stronger predictive role of SRH for all-cause mortality among whites compared to blacks. Before adjustment for chronic medical conditions, lower SRH was associated with higher risk of mortality among blacks and whites, but after adjustment, the SRH-mortality association was no longer significant among blacks. CONCLUSIONS: Baseline SRH continues to predict long-term mortality among white but not black Americans after adjustment for chronic medical conditions at baseline, and these patterns are similar for men and women. Future research should test whether the differential predictive validity of SRH across race groups arises because SRH reflects different aspects of health of black and white Americans.

Mediating Effect of Perceived Overweight on the Association between Actual Obesity and Intention for Weight Control; Role of Race, Ethnicity, and Gender.

BACKGROUND: Although obesity is expected to be associated with intention to reduce weight, this effect may be through perceived overweight. This study tested if perceived overweight mediates the association between actual obesity and intention to control weight in groups based on the intersection of race and gender. For this purpose, we compared Non-Hispanic White men, Non-Hispanic White women, African American men, African American women, Caribbean Black men, and Caribbean Black women. METHODS: National Survey of American Life, 2001-2003 included 5,810 American adults (3516 African Americans, 1415 Caribbean Blacks, and 879 Non-Hispanic Whites). Weight control intention was entered as the main outcome. In the first step, we fitted race/gender specific logistic regression models with the intention for weight control as outcome, body mass index as predictor and sociodemographics as covariates. In the next step, to test mediation, we added perceived weight to the model. RESULTS: Obesity was positively associated with intention for weight control among all race × gender groups. Perceived overweight fully mediated the association between actual obesity and intention for weight control among Non-Hispanic White women, African American men, and Caribbean Black men. The mediation was only partial for Non-Hispanic White men, African American women, and Caribbean Black women. CONCLUSIONS: The complex relation between actual weight, perceived weight, and weight control intentions depends on the intersection of race and gender. Perceived overweight plays a more salient role for Non-Hispanic White women and Black men than White men and Black women. Weight loss programs may benefit from being tailored based on race and gender. This finding also sheds more light to the disproportionately high rate of obesity among Black women in US.

The Association Between Obesity and Weight Loss Intention Weaker Among Blacks and Men than Whites and Women.

INTRODUCTION: Although obesity is associated with weight loss intention, the magnitude of this association may differ across various populations. Using a nationally representative data of the United States, this study tested the variation of the association between obesity and weight loss intention based on race and gender. METHODS: Data came from the National Survey of American Life (NSAL), 2001-2003, which enrolled 5,810 nationally representative sample of adults (3,516 African Americans, 1,415 Caribbean Blacks, and 879 Non-Hispanic Whites). Socio-demographics, body mass index (BMI), and weight loss intention were measured. We fitted logistic regression models in the pooled sample with weight loss intention as outcome, obesity (BMI > 30) as predictor, while the effect of covariates were controlled. To test our moderation hypotheses, we entered race * obesity and gender * obesity interactions to the model. RESULTS: Although the association between obesity and weight loss intention was significant among both race and gender groups, the magnitude of the association between obesity and weight loss intention was larger for women than men and Whites than Blacks. That means individuals with obesity have less intention for weight loss if they are Black or men. CONCLUSION: The link between obesity and weight loss intention depends on race and gender. Weight loss intention may not increase in response to obesity among Blacks and men, compared to Whites and women. Healthy weight programs in the United States may benefit from tailoring based on race and gender.

Does Multi-morbidity Mediate the Effect of Socioeconomics on Self-rated Health? Cross-country Differences.

BACKGROUND: This study explored cross-country differences in how multi-morbidity explains the effects of socioeconomic characteristics on self-rated health. METHODS: The study borrowed data from the Research on Early Life and Aging Trends and Effects. Participants were 44,530 individuals (age > 65 years) who were sampled from 15 countries (i.e. United States, China, India, Russia, Costa Rica, Puerto Rico, Mexico, Argentina, Barbados, Brazil, Chile, Cuba, Uruguay, Ghana and South Africa). Multi-morbidity was measured as number of chronic medical conditions. In Model I, main effects of socioeconomic factors on self-rated health were calculated using country-specific logistic regressions. In Model II, number of chronic conditions were also added to the models to find changes in coefficients for demographic and socioeconomic factors. RESULTS: In the United States, number of chronic medical conditions explained the effect of income on subjective health. In Puerto Rico, number of chronic medical conditions explained the effect of marital status on subjective health. In Costa Rica, Argentina, Barbados, Cuba, and Uruguay, number of chronic medical conditions explained gender disparities in subjective health. In China, Mexico, Brazil, Russia, Chile, India, Ghana and South Africa, number of chronic medical conditions did not explain the effect of demographic or socioeconomic factors on subjective health. CONCLUSIONS: Multi-morbidity explains the effect of demographic and socioeconomic factors on subjective health in some but not other countries. Further research is needed.