J. Scott Brown

Race-Ethnic Inequality and Psychological Distress: Depressive Symptoms from Adolescence to Young Adulthood.

Social inequality is well established in the mental health of race-ethnic groups, but little is known about this disparity from adolescence to young adulthood. This study examined differences in trajectories of depressive symptoms across 4 race-ethnic groups (Whites, Blacks, Hispanics, and Asians) using 3 waves of the National Longitudinal Study of Adolescent Health. Latent trajectory analyses showed race-ethnic variations among both females and males. Stressors were significantly related to depressive symptoms for all study members, but they accounted for symptom trajectories only among Black males and minority females. Persistent differences in trajectories for Blacks and Whites showed parallel slopes that did not converge over time. Neither background characteristics nor social resources (i.e., social support) altered this gap. However, social support represents a potential equalizer of these race-ethnic differences, owing to the ubiquitous nature of its protective effects.

Black-White Differences in Mortality Compression and Deceleration and the Mortality Crossover Reconsidered

Most studies investigating Black-White differences in mortality patterns have focused exclusively on the well-known crossover but have ignored other aspects of the mortality curves, such as deceleration and compression. Yet compression and deceleration are also important features of mortality curves that may vary by race. In this research, the authors developed models for data from 1972 to 1990 and estimated them using naive and more stringent assumptions about Black data quality. They found that mortality deceleration begins at older ages for Blacks than for Whites but that the ages of deceleration onset are converging. The authors also found that mortality compression is occurring for Blacks but not for Whites and that compression is more apparent for Blacks when data quality is considered. Finally, the authors found that a crossover exists, that the age at crossover is increasing across time, and that the age at crossover is later in adjusted data than in unadjusted data.

Silver Alerts and the Problem of Missing Adults with Dementia

In the months following the introduction of the National AMBER (Americas Missing: Broadcast Emergency Response) Alert plan used to locate missing and abducted children, Silver Alert programs began to emerge. These programs use the same infrastructure and approach to find a different missing population, cognitively impaired older adults. By late 2008, 17 states had enacted Silver Alert policies, and several more planned to take advantage of National Silver Alert grant funding to initiate policies in 2009. To date, however, no research has examined the efficacy of such programs, which have widely varying parameters and criteria to initiate the alerts. In this study, we empirically examine the 17 existing state Silver Alert and related policies. The analysis includes an examination of the varieties of programs: dementia related and AMBER extension, the dates of enactment, the criteria for activation, and the process of activation. We conclude with two salient questions that emerged from the analysis. We examine these questions and make recommendations for future research, including examining whether Silver Alerts are an appropriate response to address the problem of missing adults with dementia or cognitive impairments and examining the costs and benefits of the programs including determining how best to balance efforts to keep cognitively impaired elders safe while keeping their basic human rights of autonomy and empowerment intact.

Programs to Locate Missing and Critically Wandering Elders: A Critical Review and a Call for Multiphasic Evaluation

As America ages, greater numbers of older adults will be living with Alzheimers disease or a related dementia, leading to increased incidence of wandering. Currently there are several initiatives to assist older adults who go missing. We describe and critically examine three prominent and widespread programs: Safe Return, Project Lifesaver, and Silver Alert. Despite their emergence, there has been little research on their effectiveness. More fundamentally, the nature and scope of the missing elder problem is understudied. We call for further research into this issue, as well as assessments of how well such programs balance individual liberties with safety concerns.

A New Approach to Estimating Life Tables with Covariates and Constructing Interval Estimates of Life Table Quantities

Extant approaches to constructing life tables generally rely on the use of population data, and differences between groups defined by discrete characteristics are examined by disaggregating the data before estimation. When sample data are used, few researchers have attempted to include covariates directly in the process of estimation, and fewer still have attempted to construct interval estimates for state expectancies when covariates are used. In this paper, we present a Bayesian approach that is useful for producing interval estimates for single-decrement, multiple-decrement, and multistate life tables. The method involves (1) estimating a hazard or survival model using Bayesian Markov chain Monte Carlo (MCMC) methods to produce a sample from the posterior distribution for the parameters of the model; (2) generating distributions of transition probabilities for selected values of covariates using the sample of model parameters; (3) using these distributions of transition probabilities as inputs for life table construction; and (4) summarizing the distribution of life table quantities. We illustrate the method on data simulated from the Berkeley Mortality Database, data from the National Health and Nutrition Examination Survey (and follow-ups), and data from the National Long Term Care Survey, and we show how the results can be used for hypothesis testing.

Obtaining Multistate Life Table Distributions for Highly Refined Subpopulations from Cross-Sectional Data: A Bayesian Extension of Sullivan's Method

Multistate life table methods are often used to estimate the proportion of remaining life that individuals can expect to spend in various states, such as healthy and unhealthy states. Sullivan’s method is commonly used when panels containing data on transitions are unavailable and true multistate tables cannot be generated. Sullivan’s method requires only cross-sectional mortality data and cross-sectional data indicating prevalence in states of interest. Such data often come from sample surveys, which are widely available. Although the data requirements for Sullivan’s method are minimal, the method is limited in its ability to produce estimates for subpopulations because of limited disaggregation of data in cross-sectional mortality files and small cell sizes in aggregated survey data. In this article, we develop, test, and demonstrate a method that adapts Sullivan’s approach to allow the inclusion of covariates in producing interval estimates of state expectancies for any desired subpopulation that can be specified in the cross-sectional prevalence data. The method involves a three-step process: (1) using Gibbs sampling to sample parameters from a bivariate regression model; (2) using ecological inference for producing transition probability matrices from the Gibbs samples; (3) using standard multistate calculations to convert the transition probability matrices into multistate life tables.

Agency and Mental Health: A Transition to Adulthood Paradox

Building on calls within the health literature for a deeper engagement with the concept of agency, we utilize nationally representative survey data from the National Longitudinal Study of Adolescent to Adult Health (N = 13,592) to develop an empirical conception of the traditional treatment of health agency focused on two social psychological constructs that build upon current foci on personal control within the stress process model: (1) “subjective vitality” and (2) a forward-looking orientation (“optimism”). We find an interesting paradox: adolescents with higher health-based agency early in the transition to adulthood have significantly higher status attainment (occupational and educational) outcomes, but early mental health advantages disappear over the transition to adulthood. This suggests that while subjective beliefs about health agency put adolescents on trajectories toward higher socioeconomic status, they also set them up for declines in mental health due to unachieved expectations. There seem to be objective upsides and subjective downsides of possessing greater agency in adolescence.

Demography of Disability

The study of mortality was the foundation on which the discipline of demography was built. Over the past several decades, mortality research has expanded to include not only consideration of the remaining years of life individuals in contemporary society can expect to have but also consideration of the quality of that remaining life individuals can anticipate. A key determinant of quality of life, especially in later life, is health. In later life, it is expected that health declines and so a major concern of demographers has become the assessment of the prevalence of poor health at both individual and societal levels. Aside from health conditions that threaten survival, in later life a key issue is physical limitation that arises in part from health conditions that result from natural processes of aging and the social context within which they are experienced. At older ages, eyesight and hearing fade, joints stiffen and weaken, circulation becomes impaired, lung capacity declines, bone density diminishes and as a result, the prevalence of overall physical limitations tends to increase. Not all individuals experience declines in functioning but many do. The demography of disability is primarily concerned with understanding this decline in later-life functioning and is increasingly focused on inter-individual differences (i.e., heterogeneity) in this process. Since the 1970s, the demography of disability has emerged in part as a response to declining mortality in developed countries. In brief, extended longevity has allowed chronic illnesses and their accompanying physical limitations to become major concerns for researchers, especially given that most developed countries are experiencing rapid population aging with its associated financial costs in the form of medical and rehabilitative care. In this chapter, we discuss the major issues in the demography of disability, including the current theoretical perspectives on disability in the field, the measurement of disability in demographic research, the modeling strategies employed by researchers, heterogeneity in disability across demographic indicators and the current state of knowledge regarding disability in the developed world. Our focus in this chapter largely excludes the study of disability in the developing world, because to date most research has focused on disability that has accompanied the rapid life expectancy gains seen in the developed world. Prior to the drastic increase in life expectancy seen in the developed world since WWII, old-age disability prevalence was quite low. It has only been the rapid increase in life expectancy that has brought the demography of disability to the forefront of research and policy.

Chapter 8 – Stratification and Inequality Over the Life Course

Publisher Summary Social scientists have long been concerned with stratification and inequality in human societies. A comprehensive understanding of stratification and inequality implicitly requires a life course approach and much of the historical research on inequality has implicitly adopted a life course view. There have been major changes both within the field of stratification and outside this domain that have ultimately led to a more explicit and broader life course focus. Development includes the recognition that inequalities in health, educational attainment, earnings, and wealth are simultaneously the causes and consequences of stratification both within and between generations. This chapter discusses the expansion of stratification research in the 1960s and 1970s to include sex and race as predictors of socioeconomic differences. The emergence of a life course perspective in the 1980s and its explicit integration into stratification research coupled with the acquisition of longitudinal data that make life course research possible is shown. A conceptual diagram illustrates the complexities of researching stratification from a life course perspective and highlights the breadth of contemporary research investigating various components of this diagram. Recent research focuses on differentiating within-individual change across the individual life course from between-individual differences both within the life course and across birth cohorts and/or periods. Studies of inequality must continue to use and develop advanced statistical techniques designed to address life course research questions using longitudinal data.

Does cohort matter in the association between education, health literacy and health in the USA?

Summary Growing empirical evidence supports the generally positive relationship between education, health literacy and health outcomes. However, little is known about cohort in this relationship. This study examined the role of cohort defined by 10-year age period in the association between educational attainment, health literacy and self-rated health. The data were obtained from the 2003 National Assessment of Adult Literacy survey restricted file. Focusing on nationally representative community-dwelling adults age 25 years and older, self-rated health was modeled as a function of health literacy, educational attainment, cohorts (defined by 10-year age periods), other demographic characteristics and socio-economic status. While the youngest cohort was positively associated with self-rated health, middle-age cohorts were more likely to have lower self-rated health (compared with the age 65 years and older cohort). Interestingly, age was no longer statistically significant after adjusting for cohort and other covariates. Recognition of possible cohort effects in education, health literacy and health should be reflected in future health literacy research and intervention programs for addressing health disparities in the USA.