Exploration of Stress and Inflammatory Biomarkers Among Non-Hispanic Black and Hispanic Cancer Survivors.

OBJECTIVES: To evaluate associations among social determinants of health (SDOH), stress, interleukin-6 (IL-6), and quality of life among non-Hispanic Black and Hispanic cancer survivors. SAMPLE & SETTING: Individuals who had completed cancer treatment and did not identify as White (N = 46) were recruited through community partnerships in western Massachusetts and a state cancer registry. METHODS & VARIABLES: This descriptive cross-sectional study used questionnaires and morning salivary samples to collect data between June 2022 and September 2023. RESULTS: Most participants were breast cancer survivors, were female, identified as African American or Black, and reported moderate levels of stress and low physical activity. Cortisol levels were higher among African American or Black participants, those with lower body mass index, and those with less consumption of fruit and vegetables. Higher symptom experience was associated with higher IL-6 levels. No associations were identified between IL-6 and cortisol or perceived stress and cortisol levels. IMPLICATIONS FOR NURSING: Incorporating SDOH in self-reported outcomes, including health behaviors and associated biologic indicators, can facilitate early identification and interventions to improve symptom experience and health outcomes of cancer survivors.

Healthy Behaviors Among Non-Hispanic Black and Hispanic People Affected by Cancer During the Posttreatment Survivorship: A Qualitative Study.

BACKGROUND: There are disparities in health behaviors across racial and ethnic groups. However, limited studies focus on cancer survivors' experiences developing and maintaining healthy behaviors, particularly in non-Hispanic Black (NHB) and Hispanic people. OBJECTIVE: This study aimed to understand the experiences of NHB and Hispanic people affected by cancer in developing and maintaining positive health behaviors beyond a cancer diagnosis. METHODS: The data were collected in a mixed-method study through semistructured interviews with 29 NHB and Hispanic cancer survivors between June and October 2022. Conventional content analysis was used. RESULTS: The lived experiences of cancer survivors were narrated in 3 themes: impact of a cancer diagnosis on oneself, facilitators and barriers to health and health behaviors, and utilization of available sources for health. Facilitators and barriers to health and health behaviors were further explored as biological (eg, symptoms, comorbidities), behavioral (eg, help-seeking behavior, sleep pattern), physical/built (eg, available sources, neighborhood), and sociocultural environment (eg, income, transportation, knowledge, culture, upbringing, household and community composition, social and family network), and healthcare system-related factors (eg, insurance coverage, personal preferences, perceived discrimination, and stigma). CONCLUSION: Non-Hispanic Black and Hispanic people, specifically those living in disadvantaged neighborhoods with limited sources or where they feel discriminated and stereotyped, those with limited income and transportation, and those with physical, social, or mental health problems, seemed to have challenges prioritizing health behaviors and maintaining healthy living. IMPLICATIONS FOR PRACTICE: Biological, behavioral, and psychosocial determinants of health behaviors should be addressed through multilevel collaborations among different levels of partners.

Construct Validation of the Dietary Inflammatory Index (DII) among Young College-Aged Women.

The Dietary Inflammatory Index (DII) is designed to assess the inflammatory potential of the diet. While previous research has utilized DII among college-aged women, no study to date has validated it in this population. We conducted a construct validation of DII among 393 healthy women aged 18-31 years against a robust panel of 14 inflammatory biomarkers, including CRP, IL-1ß, IL-4, IL-6, IL-10, and TNF-α, which were used in the development of DII. Three linear regression models were constructed: (1) an age-adjusted model, (2) the most parsimonious model based on likelihood ratio tests, and (3) a fully adjusted model for age, race, body mass index, waist circumference, physical activity, smoking status, and nonsteroidal anti-inflammatory drug use. DII was derived from the Harvard food frequency questionnaire and categorized into quartiles. Consistent with our hypothesis, DII was negatively and significantly associated with back-transformed IL-10 levels, confirming that a more pro-inflammatory diet was associated with lower levels of an anti-inflammatory cytokine (Model 3: Q4 vs. Q1 ß = 0.62; 95% CI: 0.42, 0.93; p-trend = 0.04). While validated in other populations, DII may not be a suitable tool for assessing the inflammatory potential of the diet among college-aged women.

Associations Between Age-Related Hearing Loss, Cognitive Impairment, and Multiple Chronic Conditions in a Group Care Setting.

PURPOSE: The purpose of this study was to explore the relationships between hearing loss, cognitive status, and a range of health outcomes over a period of 2 years in a sample of older adults who are enrolled in Program of All-Inclusive Care for the Elderly, which is a Medicare/Medicaid beneficiary program for individuals who are nursing home eligible but living in the community at time of enrollment. METHOD: The sample (N = 144) includes a diverse (47% White/non-Hispanic, 35% Black/African American, and 16% Latin/Hispanic) group of adults ranging from 55 to 93 years old. We used medical chart data to measure respondents' cognitive and health status, including chronic conditions and hospital use. Hearing status was measured once at the beginning of the 2-year review period. We used logistic regression and negative binomial hurdle models for analyses. We used latent class analysis (LCA) to explore the extent to which respondents cluster into a set of "health profiles" characterized by their hearing, cognitive status, and health conditions. RESULTS: We found that hearing loss is weakly associated with heart disease and diabetes and associated with cerebrovascular disease and falls; cognitive impairment is also associated with cerebrovascular disease and the number of falls. LCA indicates that respondents cluster into a variety of health profiles with a consistent pairing of hearing loss and depression. CONCLUSIONS: The results are largely consistent with associations reported in epidemiological studies that include age-related hearing loss. Of particular interest in this study is the LCA that suggested that all of the profiles associated with a high likelihood of hearing loss included a high risk of depression. The co-occurrence of these two factors highlights the need to identify and treat hearing loss in older adults, especially as part of the treatment plan for individuals with depressive symptoms.

Relationship between Non-Energy-Adjusted and Energy-Adjusted Dietary Inflammatory Index and the Healthy Eating Index-2015: an analysis of the National Health and Nutrition Examination Survey (NHANES) 2015-2018.

OBJECTIVES: Acknowledging the association between diet and systemic inflammation, the Dietary Inflammatory Index (DII®) and the Energy-Adjusted DII (E-DIITM) were developed to categorize diet from anti- to pro-inflammatory. The purpose of this study was to evaluate differences in the relationship between DII and E-DII against the Healthy Eating Index (HEI) to assess the use of energy-adjustment when analyzing the inflammatory potential of the diet. METHODS: This cross-sectional secondary data analysis included 5289 adults participating in the National Health and Nutrition Examination Survey (NHANES) between 2015 and 2018. DII and E-DII scores were calculated and grouped into quartiles. Multivariable linear regression was used to evaluate the association between HEI with DII and E-DII separately, adjusting for age, gender, race/ethnicity, education, family-to-poverty ratio and body mass index. Bootstrap methods were used to estimate the difference between coefficients for E-DII and DII from their respective models. RESULTS: Results suggest that HEI scores were significantly lower between quartile 2 and quartile 1 of DII scores (Q2 vs. Q1: ß(SE) = -7.45(0.54), p < 0.05) and quartile 3 and quartile 4 against quartile 1 of E-DII scores (Q3 vs. Q1: ß(SE) = -16.56(0.65), p < 0.05 and Q4 vs. Q1: ß(SE) = -24.93(0.87), p < 0.05) in unadjusted models. Similar results were observed in adjusted models (HEI and DII Q3 vs. Q1: ß(SE) = -10.68(0.82), p = 0.049; HEI and E-DII Q2 vs. Q1: ß(SE) = -9.14(0.64) and Q3 vs. Q1: ß(SE) = -15.76(0.44) and Q4 vs. Q1: ß(SE) = -23.77(0.58), p < 0.05). Further, 52% of the variance in HEI scores was explained by the E-DII in both adjusted and unadjusted models (R2 = 0.52). In contrast, 17% of the variance in HEI score is explained by the DII in the unadjusted model (R2 = 0.17), yet this increased to 26% of the variance in the adjusted model (R2 = 0.26). The difference between HEI scores for the first versus the fourth quartile of DII scores (-15.64) was significantly larger than the difference between HEI scores for the first versus the fourth quartile of E-DII scores (-25.90; bootstrap estimated 95% CI: 53.41-62.41). CONCLUSIONS: Use of an inflammatory index along with the HEI may provide further understanding into relationships between dietary quality by nutrient and food group consumption on the inflammatory potential of the diet.

Significant inverse associations exist between HEI and both DII® and E-DII^TM scores among a sample of American adults using NHANES 2015­2018 data.HEI scores were the highest in the first E-DII quartile compared to the first DII quartile.Use of an inflammatory index along with the HEI provides further understanding of the associations between diet quality as described by nutrient content and consumption of specific food groups on inflammation and inflammatory-related chronic diseases.

Association of the Dietary Inflammatory Index with Depressive Symptoms among Pre- and Post-Menopausal Women: Findings from the National Health and Nutrition Examination Survey (NHANES) 2005-2010.

During their lifetime, 20% of US women experience depression. Studies have indicated that a high Dietary Inflammatory Index (DII) score is associated with high C-reactive protein (CRP) levels and depression. No previous study has compared the association of the DII with different measures of depression (e.g., somatic, cognitive) among pre- and post-menopausal women. We used data from 2512 pre-menopausal and 2392 post-menopausal women from the National Health and Nutrition Examination Survey (NHANES) 2005−2010 database. We ran linear and logistic regression models to compare the association of the DII with survey-measured depression among pre- and post-menopausal women. We further assessed the mediation effect of CRP on the association of the DII and depression, using structural equation modeling. The odds of experiencing depression among pre-menopausal women was higher for all DII quartiles compared to the reference group (i.e., DII Q1), with an odds ratio (OR) of 3.2, 5.0, and 6.3 for Q2, Q3, and Q4, respectively (p < 0.05). Among post-menopausal women, only Q4 had 110% higher odds of experiencing depression compared to Q1 (p = 0.027). No mediation effect of CRP was found between DII and any of our depression outcome measures. Our findings suggest that lifestyle habits, such as diet, may have a stronger influence on mental health among pre-menopausal women than post-menopausal women.

State Policies, Racial Disparities, and Income Support: A Way to Address Infant Outcomes and the Persistent Black-White Gap?

Low birth weight and preterm births vary by state, and Black mothers typically face twice the risk that their white counterparts do. This gap reflects an accumulation of psychosocial and material exposures that include interpersonal racism, differential experience with area-level deprivation such as residential segregation, and other harmful exposures that the authors refer to as "institutional" or "structural" racism. The authors use logistic regression models and a dataset that includes all births from 1994 to 2017 as well as five state policies from this period-Aid to Families with Dependent Children/Temporary Aid for Needy Families, housing assistance, Medicaid, minimum wage, and the earned income tax credit (EITC)-to examine whether these state social policies, designed to provide a financial safety net, are associated with risk reduction of low birth weight and preterm birth to Black and white mothers, and whether variations in state generosity attenuate the racial inequalities in birth outcomes. The authors also examine whether the relationship between state policies and racial inequalities in birth outcomes is moderated by the education level of the mother. We find that the EITC reduces the risk of low birth weight and preterm birth for Black mothers. The impact is much less consistent for white mothers. For both Black and white mothers, the benefits to birth outcomes are larger for mothers with less education.

The dietary inflammatory index is inversely associated with depression, which is minimally mediated by C-reactive protein.

Depression affects 8% of adults in America and is one of the leading causes of disability in Western countries. The dietary inflammatory index (DII) has previously been reported to be associated with inflammation and depression. However, no study to date has looked at the potential mediating effect of inflammation on the association of DII and depression. We hypothesized that the association of DII and depression would be both statistically and clinically mediated substantially by inflammation. We assessed these associations using the cross-sectional National Health and Nutrition Examination Survey (NHANES) 2005-2010 database. Our analysis included 10,022 participants aged 20 years and older. Inflammation was assessed with C-reactive protein (CRP) levels. Diet was measured using two 24 hour dietary recalls. Depression was assessed using the 9-item Patient Health Questionnaire (PHQ-9), which has a score range of 0 to 27, with the higher score showing more severe depressive symptoms. Comparing the highest to lowest DII quartiles, the mean score difference for depression was 0.47 units (95% CI 0.24-0.70, P-trend <.001) in the multivariable adjusted model. In the sex-stratified models, the results remained significant only among females, with the mean score difference of 0.72 (95% CI 0.34-1.10, P-trend <.001). CRP mediated 3.6% of the association between DII and depression in the total population in the fully adjusted model, which was statistically significant (P-trend <.001) but not clinically significant. No mediation association was found in the sex-stratified models. Further studies are needed to assess the associations with various inflammatory biomarkers in larger and more diverse populations.

Physician Referrals During Prenatal Care.

OBJECTIVE: Referrals are an important component of patient care, and have been increasing over time. During pregnancy, people have intensive contact with the healthcare system, but little is known about the involvement of different physicians for pregnant patients during this period. This study examines referral patterns during prenatal care visits. METHODS: Using the 2006-2015 National Ambulatory Medical Care Survey and national birth certificate data, we estimate the number of referrals per pregnancy from prenatal care visits with OB/GYN and family medicine physicians. We use multivariable regression analysis to compare the probability of receiving a referral during a prenatal visit for visits with family medicine and OB/GYN physicians, controlling for visit, patient, and physician characteristics. Analyses are weighted to make results nationally representative. RESULTS: 224,335,436 prenatal visits over 19,893,015 pregnancies were included; 60% of these visits were covered by private insurance. On average, 0.3 referrals are made per pregnancy (95% confidence interval [CI] 0.22, 0.38). A prenatal visit with an OB was 5.5% points less likely to result in a referral than a visit with a family medicine physician, controlling for other characteristics. CONCLUSIONS: Referrals are relatively common in prenatal care, and are more commonly initiated by family medicine physicians than by OB/GYNs. Understanding the contribution of multiple clinicians to a pregnant person's health during the prenatal period and how coordination among clinicians impacts care receipt is an important next step. As healthcare becomes more specialized, better understanding care teams of individuals during the perinatal period is important for improving prenatal care.

Educational and Type of Day Differences in Mothers' Time Availability for Child Care and Housework.

OBJECTIVE: The authors analyzed variation by education and type of day in the "time availability" association between U.S. mothers' paid work hours and housework and child care, types of work that vary by their urgency, affect, and symbolic meaning. BACKGROUND: Research shows a stronger negative association of women's work hours with housework than child care, and interprets this as evidence to show mothers prioritize child care over housework. The authors extend this work by determining if associations of work hours with partnered mothers' housework and child care differ by college education and type of day. METHOD: The authors used ordinary least squares regression on weekend and weekday time diaries of partnered mothers aged 18-65 (N = 22,816) from the 2003-2018 American Time Use Survey (https://timeuse.ipums.org/). RESULTS: Authors found negative associations of mothers' work hours with weekday housework and child care. They found a negative association of college degrees with weekday housework but a positive association with child care that attenuates at longer work hours. The negative work hour association, and the education gap in predicted child care time, persisted on weekends. Work hour and education associations with weekend housework were positive, and the education gap widened at longer work hours. CONCLUSION: The "time availability" constraint of employment hours applies to child care and housework, even among mothers with college degrees. Education differences in unpaid work, particularly child care, are most evident on weekends.

Associations between teacher expectations and racial disproportionality in discipline referrals.

We explored the racial discipline gap and sought to understand the extent to which elementary school teachers' (N = 33; Grades K-6) expectations for their students' (N = 496) future outcomes predicted racial discipline disproportionality. We used multilevel models, and Ordinary Least Squares (OLS) regression with standardized errors corrected, to examine associations between teacher expectations of academic and behavioral student outcomes and patterns of office discipline referrals (ODRs) for the year. Results showed disproportionate ODR outcomes for Black students in comparison to White students. Additionally, we found that students held to lower expectations by their teachers received more ODRs than peers rated highly by their teachers, regardless of race. We also found that for every unit teacher expectations increased, the ODR disparity between Black, Latinx, and White students decreased. Lastly, multilevel models exploring teacher expectations of student outcomes explained approximately 21% of the difference in ODRs between Black and White peers.

Gender differences in the impact of job mobility on earnings: The role of occupational segregation.

In recent years, researchers have begun to explore the extent to which the impact of switching firms (inter-firm mobility) on wages varies between men and women. Using data from the NLSY79 from 1979 to 2012, this paper extends existing research by exploring how occupational segregation and individual level factors contribute to gender differences in the impact of voluntary inter-firm mobility on wages. The paper also examines how patterns vary depending on education level. Findings suggest that men without a college education receive greater wage gains from voluntary inter-firm mobility than similarly educated women although there is no overall gender difference for individuals with a bachelor's degree. The wage returns to voluntary inter-firm mobility for both men and women increase as a function of the male representation in the occupation. For individuals without a college education, the male premium to voluntary inter-firm mobility is largest in highly male dominated occupations. However, women with a bachelor's degree employed in highly male dominated occupations use voluntary inter-firm mobility to narrow the gender wage gap.

Measuring Five Dimensions of Religiosity across Adolescence.

This paper theorizes and tests a latent variable model of adolescent religiosity in which five dimensions of religiosity are interrelated: religious beliefs, religious exclusivity, external religiosity, private practice, and religious salience. Research often theorizes overlapping and independent influences of single items or dimensions of religiosity on outcomes such as adolescent sexual behavior, but rarely operationalizes the dimensions in a measurement model accounting for their associations with each other and across time. We use longitudinal structural equation modeling (SEM) with latent variables to analyze data from two waves of the National Study of Youth and Religion. We test our hypothesized measurement model as compared to four alternate measurement models and find that our proposed model maintains superior fit. We then discuss the associations between the five dimensions of religiosity we measure and how these change over time. Our findings suggest how future research might better operationalize multiple dimensions of religiosity in studies of the influence of religion in adolescence.

Postmarital Living Arrangements in Historically Patrilocal Settings: Integrating Household Fission and Migration Perspectives.

This study integrates theory and research on household fission (or partition) and migration to better understand living arrangements following marriage, especially in historically patrilocal and primarily agricultural settings. Using panel data from the Chitwan Valley Family Study to analyze the sequential decision-making process that influences men's living arrangements subsequent to first marriage, we demonstrate the importance of distinguishing among extended family living, temporary migration, and the establishment of an independent household. We find that community economic characteristics, such as access to markets or employment, as well as household wealth affect the initial decision to leave the natal home. Household resources and use of farmland, along with the young men's own education, media exposure, travel, and marital behavior, influence the decision to make the departure from the natal home permanent. Our findings explain why previous results regarding household fission and those focused on migration have provided such mixed results, and we establish a new framework for thinking about how families and individuals manage living situations.

The consequences of job displacement for health: moderating influences of economic conditions and educational attainment.

This paper examines the impact of worker displacement on health in the United States from 1975-2004, especially the extent to which the impact of displacement on health varies according to the economic conditions in the year of displacement and the education level of the displaced worker. Findings from ordered probit and fixed effects models suggest that the negative impact of displacement on health is exacerbated by a higher unemployment rate at the time of displacement and for displaced workers with a college degree.

Period effects, cohort effects, and the narrowing gender wage gap.

Despite the abundance of sociological research on the gender wage gap, questions remain. In particular, the role of cohorts is under investigated. Using data from the Current Population Survey, we use age-period-cohort analysis to uniquely estimate age, period, and cohort effects on the gender wage gap. The narrowing of the gender wage gap that occurred between 1975 and 2009 is largely due to cohort effects. Since the mid-1990s, the gender wage gap has continued to close absent of period effects. While gains in female wages contributed to declines in the gender wage gap for cohorts born before 1950, for later cohorts the narrowing of the gender wage gap is primarily a result of declines in male wages.