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  1. Article ; Online: Educational disparities in adult health across U.S. states

    Jennifer Karas Montez / Kent Jason Cheng

    Frontiers in Public Health, Vol

    Larger disparities reflect economic factors

    2022  Volume 10

    Abstract: IntroductionEducation level is positively associated with adult health in the United States. However, new research shows that the association is stronger in some U.S. states than others, and that states with stronger associations also tend to have poorer ...

    Abstract IntroductionEducation level is positively associated with adult health in the United States. However, new research shows that the association is stronger in some U.S. states than others, and that states with stronger associations also tend to have poorer overall levels of health. Understanding why educational disparities in health are larger in some states than others can advance knowledge of the major drivers of these disparities, between individuals and states. To that end, this study examined how key mechanisms (economic conditions, health behaviors, family, healthcare) help explain the education-health association in each state and whether they do so systematically.MethodsUsing data on over 1.7 million adults ages 25–64 in the 2011–2018 Behavioral Risk Factor Surveillance System, we estimated the association between education level and self-rated health in each state, net of age, sex, race/ethnicity, and calendar year. We then estimated the contribution of economic, behavioral, family, and healthcare mechanisms to the association in each state.ResultsThe strength of the education-health association differed markedly across states and was strongest in the Midwest and South. Collectively, the mechanisms accounted for most of the association in all states, from 55% of it in North Dakota to 73% in Oklahoma. Economic (employment, income) and behavioral (smoking, obesity) mechanisms were key, but their contribution to the association differed systematically across states. In states with stronger education-health associations, economic conditions were the dominant mechanism linking education to health, but in states with weaker associations, the contribution of economic mechanisms waned and that of behavioral mechanisms rose.DiscussionMeaningful reductions in educational disparities in health, and overall improvements in health, may come from prioritizing access to employment and livable income among adults without a 4-year college degree, particularly in Southern and Midwestern states.
    Keywords education ; health ; disparities ; fundamental cause ; U.S. states ; Public aspects of medicine ; RA1-1270
    Subject code 360
    Language English
    Publishing date 2022-08-01T00:00:00Z
    Publisher Frontiers Media S.A.
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: U.S. State Policy Contexts and Physical Health among Midlife Adults

    Blakelee R. Kemp / Jacob M. Grumbach / Jennifer Karas Montez

    Socius, Vol

    2022  Volume 8

    Abstract: The authors examine how state policy contexts may have contributed to unfavorable adult health in recent decades, using merged individual-level data from the 1993–2016 Behavioral Risk Factor Surveillance System ( n = 2,166,835) and 15 state-level policy ... ...

    Abstract The authors examine how state policy contexts may have contributed to unfavorable adult health in recent decades, using merged individual-level data from the 1993–2016 Behavioral Risk Factor Surveillance System ( n = 2,166,835) and 15 state-level policy domains measured annually on a conservative-to-liberal continuum. The authors examine associations between policy domains and health among adults 45 to 64 years old and assess how much of the associations are accounted for by adults’ socioeconomic, behavioral and lifestyle, and family factors. A more liberal version of the civil rights domain was associated with better health. It was disproportionately important for less educated adults and women, and its association with adult health was partly accounted for by educational attainment, employment, and income. Environment, gun safety, and marijuana policy domains were, to a lesser degree, predictors of health in some model specifications. In sum, health improvements require a greater focus on macro-level factors that shape the conditions in which people live.
    Keywords Social Sciences ; H ; Sociology (General) ; HM401-1281
    Subject code 360
    Language English
    Publishing date 2022-04-01T00:00:00Z
    Publisher SAGE Publishing
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Why Does the Importance of Education for Health Differ across the United States?

    Blakelee R. Kemp / Jennifer Karas Montez

    Socius, Vol

    2020  Volume 6

    Abstract: The positive association between educational attainment and adult health (“the gradient”) is stronger in some areas of the United States than in others. Explanations for the geographic pattern have not been rigorously investigated. Grounded in a ... ...

    Abstract The positive association between educational attainment and adult health (“the gradient”) is stronger in some areas of the United States than in others. Explanations for the geographic pattern have not been rigorously investigated. Grounded in a contextual and life-course perspective, the aim of this study is to assess childhood circumstances (e.g., childhood health, compulsory schooling laws) and adult circumstances (e.g., wealth, lifestyles, economic policies) as potential explanations. Using data on U.S.-born adults aged 50 to 59 years at baseline ( n = 13,095) and followed for up to 16 years across the 1998 to 2014 waves of the Health and Retirement Study, the authors examined how and why educational gradients in morbidity, functioning, and mortality vary across nine U.S. regions. The findings indicate that the gradient is stronger in some areas than others partly because of geographic differences in childhood socioeconomic conditions and health, but mostly because of geographic differences in adult circumstances such as wealth, lifestyles, and economic and tobacco policies.
    Keywords Social Sciences ; H ; Sociology (General) ; HM401-1281
    Subject code 360
    Language English
    Publishing date 2020-01-01T00:00:00Z
    Publisher SAGE Publishing
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Explaining inequalities in women's mortality between U.S. States

    Jennifer Karas Montez / Anna Zajacova / Mark D. Hayward

    SSM: Population Health, Vol 2, Iss , Pp 561-

    2016  Volume 571

    Abstract: Inequalities in women's mortality between U.S. states are large and growing. It is unknown whether they reflect differences between states in their population characteristics, contextual characteristics, or both. This study systematically examines the ... ...

    Abstract Inequalities in women's mortality between U.S. states are large and growing. It is unknown whether they reflect differences between states in their population characteristics, contextual characteristics, or both. This study systematically examines the large inequalities in women's mortality between U.S. states using a multilevel approach. It focuses on “fundamental” social determinants of mortality at the individual and state levels as potential explanations. We analyze data from the 2013 public-use National Longitudinal Mortality Study on women aged 45–89 years and estimate multilevel logistic regression models. The models include women's personal characteristics (age, race/ethnicity, education, employment, income, and marriage) and states’ contextual characteristics (economic environment, social cohesion, sociopolitical orientation, physical infrastructure, and tobacco environment). We found that variation in women's mortality across states was significant (p<0.001). Adjusting for women's personal characteristics explained 30% of the variation. Additionally adjusting for states’ contextual characteristics explained 62% of the variation; the most important characteristics were social cohesion and economic conditions. No significant mortality differences between any two states remained after accounting for individual and contextual characteristics. Supplementary analyses of men indicate that state contexts have stronger and more pernicious consequences for women than men. Taken together, the findings underscore the importance of ‘bringing context back in’ and taking a multilevel approach when investigating geographic inequalities in U.S. mortality. Keywords: Mortality, Gender, Inequality, Social determinants, U.S. states, Multilevel
    Keywords Public aspects of medicine ; RA1-1270 ; Social sciences (General) ; H1-99
    Language English
    Publishing date 2016-12-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article ; Online: U.S. state policy contexts and mortality of working-age adults.

    Jennifer Karas Montez / Nader Mehri / Shannon M Monnat / Jason Beckfield / Derek Chapman / Jacob M Grumbach / Mark D Hayward / Steven H Woolf / Anna Zajacova

    PLoS ONE, Vol 17, Iss 10, p e

    2022  Volume 0275466

    Abstract: The rise in working-age mortality rates in the United States in recent decades largely reflects stalled declines in cardiovascular disease (CVD) mortality alongside rising mortality from alcohol-induced causes, suicide, and drug poisoning; and it has ... ...

    Abstract The rise in working-age mortality rates in the United States in recent decades largely reflects stalled declines in cardiovascular disease (CVD) mortality alongside rising mortality from alcohol-induced causes, suicide, and drug poisoning; and it has been especially severe in some U.S. states. Building on recent work, this study examined whether U.S. state policy contexts may be a central explanation. We modeled the associations between working-age mortality rates and state policies during 1999 to 2019. We used annual data from the 1999-2019 National Vital Statistics System to calculate state-level age-adjusted mortality rates for deaths from all causes and from CVD, alcohol-induced causes, suicide, and drug poisoning among adults ages 25-64 years. We merged that data with annual state-level data on eight policy domains, such as labor and taxes, where each domain was scored on a 0-1 conservative-to-liberal continuum. Results show that the policy domains were associated with working-age mortality. More conservative marijuana policies and more liberal policies on the environment, gun safety, labor, economic taxes, and tobacco taxes in a state were associated with lower mortality in that state. Especially strong associations were observed between certain domains and specific causes of death: between the gun safety domain and suicide mortality among men, between the labor domain and alcohol-induced mortality, and between both the economic tax and tobacco tax domains and CVD mortality. Simulations indicate that changing all policy domains in all states to a fully liberal orientation might have saved 171,030 lives in 2019, while changing them to a fully conservative orientation might have cost 217,635 lives.
    Keywords Medicine ; R ; Science ; Q
    Subject code 310
    Language English
    Publishing date 2022-01-01T00:00:00Z
    Publisher Public Library of Science (PLoS)
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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