Gendered racism, rooted in the interlocking injustices of racism and sexism, is a contributor to poor mental health; its association with physical health outcomes, however, is not well understood. This study investigates whether gendered racism is associated with disease activity among Black women living with systemic lupus erythematosus (SLE). Data are from the Vascular Aging, Inflammation, and Stress in African American Women's Health Research Study (VISTA; 2017-2023). Analyses were restricted to Black women with SLE (N = 201). Results revealed more frequent gendered racism experiences were associated with greater disease activity; this association was attenuated yet remained significant after adjustment for depressive symptoms. Gendered racism experiences linked to Assumptions of Beauty and Sexual Objectification were most consistently associated with disease activity. Study results underscore the importance of examining intersectional injustice (e.g., gendered racism) as a social determinant of health.
Studies of immigrant health care routinely center less-advantaged persons in Global North contexts; U.S. scholarship frequently examines Latin American immigrants navigating the U.S. health landscape. Little work considers the health care experiences of U.S. citizens as immigrants as they are rarely labeled, analyzed, and debated comparably to less-advantaged immigrants. Instead of naturalizing the American experience as the point of comparison for immigrants, we can invert that dynamic by attending to Americans' experiences as immigrant patients abroad. This inversion generates insight into leaving behind familiar health practices, configurations, and ideologies. Americans in Spain move from an advantaged sending country to a less-wealthy context with superior health care access and outcomes. Through interviews with 41 U.S. citizens in Spain, I explore how Americans unlearn health care avoidance, experience novel possibilities, question internalized logics, and interpret doing care differently. Through studying Americans as immigrants, we see how migration facilitates the reexamination of health-related values, behaviors, and practices.
Cultural capital is theorized to comprise both a declarative (i.e., deliberate/conscious) and a nondeclarative (i.e., automatic/unconscious) element, also referred to as "embodied." While the latter is considered crucial in everyday health-related choices and in explaining why members of the higher strata more often make healthier ones, extant quantitative research has been unable to empirically measure it. This study implemented a novel method that measures nondeclarative cultural capital using implicit association tests and embedded it within a high-quality panel drawn randomly from the official Dutch population register (N = 2,436). Both declarative and nondeclarative cultural capital prove to be independently associated with adherence to dietary guidelines and contribute to the relationship between educational attainment and adherence to dietary guidelines. This analysis more validly tests common theorizing on cultural capital's role in stratified health patterns and suggests it is larger than assumed based on research solely relying on measures of declarative cultural capital.
Examination of cause of death patterns among disabled people is shrouded by death patterns in the general population. To remove this shroud, we focus on multiple causes of death (MCOD) comorbidity patterns between decedents with and without Down syndrome with Alzheimer’s disease or unspecified dementia. Using 2005 to 2019 U.S. MCOD data, we examined comorbidity profiles of adults with (N = 7,936) and without (N = 4,593,118) Down syndrome using the broadest International Classification of Diseases (ICD-10) “List of 113 Selected Causes of Death” (selected cause groups) of death classification scheme as well as the ICD-10 “Specific Conditions” (specific causes). Comparison of these classification schemes revealed that the use of selected cause groups veiled comorbidities common among adults with Down syndrome—choking-related deaths, seizures and hypothyroidism. Results from this study underscore the necessity to change cause of death classifications schemes and/or the reporting of this information to account for differences and to mitigate data inequities.
Using 20,771 participants from the National Longitudinal Study of Adolescent to Adult Health, we examined depressive symptom trajectories by immigrant generation from adolescence to midlife. Depressive symptoms were assessed across five waves using a validated four-item Center for Epidemiologic Studies Depression scale. Linear mixed effects models with a quintic polynomial age trajectory indicated that first- and second-generation immigrants reported higher adolescent symptoms than third-plus-generation peers (first generation: b = .433, p < .001; second generation: b = .476, p < .001) but experienced steeper declines in their 20s (first generation: b = -.030, p < .001; second generation: b = -.027, p < .001). By their 30s, both immigrant generations had fewer symptoms than third-plus-generation peers. Sociodemographic adjustment partially explained the immigrant adolescent disadvantage, whereas the immigrant adult advantage persisted. Depressive symptom disparities thus reverse across the life course, underscoring the need for developmentally and context-sensitive models of immigrant mental health.
Immigrants have similar or higher disability levels than the U.S.-born in later life, which is puzzling given they have a health advantage upon arrival. A popular explanation is that acculturation harms health, but existing evidence is mixed. This study constructs multidimensional acculturation measures (linguistic, residential, marital, civic) using the American Community Survey (N = 958,211) and examines their associations with disability. I find that immigrants indeed lose their health advantage over the U.S.-born between ages 65 and 80, but most acculturation measures predict lower rather than higher disability. Instead, I propose and find evidence for a theory of acculturative discordance , where (1) net of demographic and socioeconomic characteristics, immigrants who are acculturated on some dimensions but not acculturated on others have poorer health and (2) minoritized immigrants experience discordance between their behavioral inclusion into the U.S. society and exposure to structural exclusion and receive more disadvantaged health returns to acculturation than non-Hispanic White immigrants.
Does having ties to people of higher socioeconomic status (SES) yield differential health returns for Black and White people? Guided by the social network perspective, theories of social capital, and the diminishing returns hypothesis, this study uses a stratified probability sample of Indiana residents (N = 2,416) and egocentric network methods to examine this question. Findings reveal significant racial heterogeneity in the nature and magnitude of the association between network SES (operationalized by network members’ education levels) and health. Among White respondents, having higher-SES ties was consistently salubrious. Among Black respondents, results were more complex and heterogeneous: Higher network SES was associated with improved self-rated health but not with improvements in resting heart rate or body mass index. These findings support the notion of diminishing health returns of network SES among Black respondents—specifically for physiological health but not for subjective health. Theoretical and methodological implications of these findings are discussed.
Menopause affects millions of individuals and is a sociologically compelling topic, cross-cutting the subfields of medicine, gender, body, family, and work. Yet to date, little sociological research examines the process. Indeed, menopause is the least studied female reproductive event among pregnancy, childbirth, and menstruation. Thus, in this article, we review the existing social scientific research on menopause in an effort to expose what remains to be studied. Our review begins with literature on the social construction of menopause. We then explore studies of how social meanings shape experiences of menopause. As our analysis reveals, sociologists have a clear picture of the medicalization of menopause and how medical meanings shape experiences. Yet the nuances of this construction are less clear, including how menopausal experiences vary and how menopause relates to the reproductive life course broadly. We conclude by highlighting these and other gaps in the sociological understanding of menopause.
This article explores the reentry and reintegration of Rwandans who were incarcerated for genocide. Previous research indicates that these individuals are experiencing psychological distress, and we analyze the determinants of this distress in this study. Specifically, we assess three waves of longitudinal data following 185 Rwandans whom we interviewed before their release and approximately four months and one year afterward. We find that psychosocial distress generally improved after completing one's sentence. Such improvement can be explained through securing a livelihood, (re)establishing social relationships, and feeling politically integrated. All three pathways have much stronger relationships with the well-being of those who participated in more severe crimes, who also saw starker improvements than those who engaged in less serious crimes. These findings suggest a region-β paradox wherein people cope better when anticipating more severe circumstances, including the difficulties of reentering a society where one is regarded as a genocidaire.
Consistent employment, especially secure, high-wage employment, has well-documented associations with lower risk of later-life morbidity and mortality, and accelerated biological aging may underlie these associations. Although research evaluating employment and accelerated epigenetic aging is growing, questions remain about the implications of chronic work-related exposures for accelerated aging. This study uses longitudinal data from the Health and Retirement Study (HRS) and the 2016 HRS Venous Blood Study (n = 3,000) to evaluate how work-related experiences throughout midlife are associated with accelerated epigenetic aging. Results show that a history of not working for pay and a history of poor work quality (i.e., job insecurity, insufficient work hours, low wages) among workers in midlife are associated with accelerated epigenetic aging in later life. Symptoms of depression and health behaviors partially attenuate these associations. Overall, findings suggest that chronic work-related exposures are critical yet overlooked antecedents of accelerated aging.
Sleep is a critical health behavior that often varies by gender, and most partnered adults sleep with a significant other. Despite growing research on sleep health, little is known about how daily sleep within couples shapes marital dynamics, especially across same- and different-sex relationships. This study uses dyadic diary data from 378 mid- to later-life couples in the United States (N = 756) to examine how respondents' and partners' daily sleep quality are each associated with daily marital strain and whether these associations vary by gender and couple type. Respondent sleep quality predicts lower marital strain for all couple types except for men married to women. Spousal sleep quality is also associated with reduced strain but only for women in different-sex marriages. These women appear uniquely affected by both their own and their partner's sleep, highlighting the importance of dyadic and gender-relational perspectives in understanding links between sleep and relationship dynamics.
Racial discrimination is an important predictor of long-term health outcomes for Black Americans. However, research has not fully examined how the development of psychosocial resources and depressive symptoms throughout the life course impact the long-term relationship between discrimination and physical health. Using data from the Family and Community Health Study (N = 889 for full-information maximum likelihood; n = 520 for listwise deletion), we conducted path modeling to examine whether self-esteem, racial identity, and depressive symptomatology mediate the relationship between racial discrimination in youth and lifetime chronic disease and acute health symptoms for Black Americans. Results indicate significant indirect effects of self-esteem, depressive symptoms, and racial identity on acute health symptoms. Results also show significant indirect effects of self-esteem and depression on lifetime chronic illness. Findings point to the importance of depressive symptomatology and psychosocial resources in shaping the long-term health impacts of youth exposure to racial discrimination.
Although working from home (WFH) is promoted as a policy supporting work-life balance, whether it benefits mental health remains unclear. Few studies have examined how these effects vary across social groups or addressed selection issues complicating causal inference. We use two-way fixed-effects models to analyze changes in mental health scores, measured with the 12-item General Health Questionnaire, among 39,863 participants in the UK Household Longitudinal Study (2009-2023). We reduce selection bias by using an occupation-level WFH measure derived from the UK Labour Force Survey. Before March 2020, increased WFH in men's occupations improved their mental health. For women, it benefited those in routine jobs but worsened outcomes for professionals. The pattern reversed from March 2020, with WFH positively impacting the mental health of professional women but not that of men or women in routine jobs. These findings highlight the importance of social positions and institutional contexts in shaping the mental health effects of WFH.
In the United States, grandparents who live with and provide primary care to their grandchildren have emerged as a particularly vulnerable group since the 1990s. Using confidential data from the U.S. Census Bureau and Social Security Administration, this study linked individuals ages 50 years or older from the 2000 census long-form sample to their death records from 2000 to 2019 (weighted N = 64,027,000) and examined the longitudinal association between coresident grandparenting status and mortality for non-Hispanic White, non-Hispanic Black, Hispanic, and Asian individuals. We found consistently higher rates of mortality for White coresident grandparents and lower rates for Asian coresident grandparents, regardless of the duration of primary caregiving, compared to their peers without coresident grandchildren. We also found increased risks of mortality among Hispanic long-term primary caregivers but reduced risks among Black short-term primary caregivers compared to their peers without coresident grandchildren.
Professionals increasingly encounter tools aimed at rationalizing and standardizing their work. Existing research largely conceptualizes their responses to these tools on a continuum from professional resistance to managerial control. But the institutional logics perspective and emerging empirical evidence suggest more varied responses and diverse, possibly non-zero-sum, outcomes. Using survey data from 1,116 physicians in China's public hospitals, we systematically examined physicians' reactions to pathway implementation and the impacts on clinical autonomy and job satisfaction. Cluster analysis identified four response types: (a) ignoring, where physicians avoided pathways and maintained autonomy; (b) coerced, where imposed pathways reduced autonomy and satisfaction; (c) decoupling, where pathways were adopted superficially, preserving autonomy; and (d) embracing, where physicians actively participated in pathway implementation and enforcement, experiencing high satisfaction and autonomy. The findings help broaden the conceptualization of professionals' reactions to rationalizing tools, uncover multiple pathways to clinical autonomy, and illustrate how professionals navigate institutional complexity in ever-evolving environments.
A burgeoning literature links state policies to health care access/use, yet little research has explored whether state policies relate to the distribution of health care itself. Drawing on census microdata and state policy data from 1960 to 2019, I investigate whether state policy liberalism shapes workforce availability and diversity. First, I find that states in New England and the Middle Atlantic have persistently benefited from larger workforces compared to those in the East South Central and Pacific, with Black and foreign-born workers disproportionately represented in "workforce disadvantaged" states. Second, I show that an increase in policy liberalism is associated with reductions in states' total health care, physician, and nursing workforces; Black and foreign-born physician and nursing workforces; and foreign-born medical assistant/health aide workforces. Taking a political economy approach toward understanding the (mal)distribution of U.S. health care sheds light on a "two-tiered" system that both reflects and reifies existing geographic inequities in population health.
Although extensive research examines the individual- and household-level determinants of racialized disability patterns, the roles of state political and policy contexts have received less attention. Merging more than a decade of data from the American Community Survey (N = 7,928,386) to data on state politics and economic and social welfare policies, we use two-way fixed-effects models to investigate the links between state political and policy contexts and disability risks, considering whether these links vary across race and race-sex groups. Results show that (1) state contexts diverged dramatically over the period, (2) more liberal political contexts and generous economic and social safety net policies were generally associated with reduced disability risks, and (3) state contexts were strongly associated with the disability of White people, but results were more mixed for Black people, especially Black women. This study highlights the salience of state politics and policy for understanding and redressing racialized disability patterns.
Medicalized birth experiences are associated with poor outcomes for people of color. Nonclinical birthworkers, such as doulas, have been identified as a solution to this inequity. With this reliance on birthworkers of color to reverse racial maternal health disparities, how do these individuals experience birthwork? Drawing from interviews with 24 birthworkers of color in the United States from November 2021 through April 2024, we reveal the weight of birthwork endured by this group. We situate these individuals' experiences within scholarship on burnout, emotional labor, racialized labor, and theories on mothering to explain the concept of "racialized burnout." Racialized burnout refers to a multifaceted process borne out of unequal racialized and gendered experiences encountered by birthworkers of color. Racialized burnout also acts as a producer of racial inequity within the maternal health field; as individuals of color encounter racialized burnout, they are at increased risk of leaving maternal health work.
