Self-ratings of health (SRH) indicate current health-related quality of life and independently predict mortality. Studies show the SRH of older adults appears less influenced by physical health than the SRH of younger adults. But if physical health accounts less for the SRH of older adults, what factors take its place? To understand the relative contributions of social, emotional, and physical states to SRH by age, we analyzed data from the National Health Interview Survey 2006 to 2011 ( N = 153,341). In age-stratified regressions, physical health and functional limitations declined as correlates of SRH for older age strata, while social factors, such as gender and race, increased in importance. Oaxaca-Blinder decomposition showed that if younger respondents had similar health conditions, they would rate their health more poorly than current cohorts of older adults do. The declining influence of physical health on SRH in old age appears to be due in part to displacement by social factors.
Studies from the social and health sciences have tended to view the household as the locus of access to and distribution of care, resources, monitoring and modeling for children’s wellbeing. Obesity may present a special case for the study of investments in children, being a component of health for which more of certain inputs may not lead to better outcomes. We expanded on common measures of household structure in the child health literature by considering co-residence and relatedness of parents, grandparents, other relatives, and other children. Data were from a longitudinal sample of 6,700 children participating in the Early Childhood Longitudinal Study Kindergarten Class of 1998–99 (ECLS-K), the largest U.S. national dataset with measures of child anthropometrics and household structure at seven time-points over nine years. We used lagged survey-adjusted regressions to estimate associations between household structure and subsequent changes in children’s weight between ages 5 and 14 years in terms of BMI gain and incident obesity. Adjusting for household structure more thoroughly, children living in households with two parents rather than one parent did not experience advantages in terms of less excess weight gain or lower incidence of obesity during elementary and middle school. Children living with a grandmother gained more weight than children not living with a grandmother. Living with siblings and with non-related adults was associated with less weight gain. These findings corroborate a scenario in which, for health problems associated with caloric surplus, classic household factors have more complex associations with child wellbeing.
Latinx people living in the U.S. report a disproportionately high prevalence of diabetes. This project builds on the existing social determinants of diabetes literature by examining factors associated with a greater likelihood of diabetes and investigates factors correlated with the Latinx/non-Latinx disparity. This project studies the adult sample (18 and older) from the 2010–2018 IPUMS Health: National Health Interview Survey (NHIS) data. Logistic regression analyses are used to examine the patterns between reporting Latinx identity and reporting diabetes with additional subgroup analyses of the Latinx and non-Latinx groups. Then, Oaxaca-Blinder decomposition is used to examine the patterns explaining the difference in self-reported diabetes between the Latinx and non-Latinx population for the whole sample and by age group. The logistic regression analyses show that after adjusting for age and other key social determinants of health, Latinx individuals are approximately 64.5% (OR 1.645, [95% CI, 1.536–1.760]) more likely to report being diagnosed with diabetes than non-Latinx individuals. Individual characteristics of age, race, and smoking behaviors are identified as suppressors of the gap, and conversely, characteristics of income, education, and BMI all contribute to the Latinx diabetes disparity gap. The Oaxaca-Blinder decomposition results show that the measured social determinants of health characteristics explain a meaningful amount of the Latinx diabetes gap. Importantly, differences in education and income (which are more immediately actionable policy areas) make larger contributions to the gap than BMI or other health behaviors.
What explains mayors’ collaboration with nongovernmental organizations in delivering public goods and services? While some successful collaborations are established, in other cases the call for NGOs to coordinate with governments goes unheeded. Collaboration minimizes the duplication of effort, maximizes information sharing, and builds capacity. Given the scholarly consensus on the importance of collaboration, we know little about it at local levels, where it may matter most. This article focuses on Bolivia, a country with deep decentralization reforms and an active NGO sector. It utilizes survey data on mayors from 2007 to provide insight into the variation in NGO–local government collaboration across a country. It argues that political context is important: mayoral turnover, greater community group engagement, and more municipal resources deter collaboration. The findings illustrate the strategic interplay between state and nonstate actors and explain the uneven geographies of partnerships in governance.
American Indians experience disparities in cancer screening, stage at disease diagnoses, and 5-year cancer survival. This study investigates how health literacy and health numeracy may be linked to cancer screening behaviors of Zuni Pueblo members using a survey exploring screening behaviors related to breast, cervical, and colorectal cancers. As part of a larger community-based cancer prevention and control project, Zuni Health Initiative staff conducted surveys from October 2020 through April 2021 of 281 participants (men ages 50–75 and women ages 21–75) from the Zuni Pueblo. Bivariate and multivariable analyses investigated associations between health literacy/numeracy measures and cancer screening behaviors. Bivariate analyses showed some associations between distinct measures of health literacy/numeracy and colorectal cancer (CRC) screening, including both colonoscopy (health literacy) and fecal occult blood testing (FOBT) (health numeracy), as well as cervical cancer screening (health literacy). There were no statistically significant associations between health literacy/numeracy measures and mammogram screening for breast cancer. In multivariable analyses, there were no consistent patterns between health literacy/numeracy and screening for any cancer. There are some individual findings worth noting, such as statistically significant findings for health numeracy and FOBT (those reporting lower health numeracy were less likely to report FOBT). An important finding of this study is that questions used to assess health literacy/numeracy did not identify associations aligned with previous research. We reflect on the ways the “standard” questions may not be sufficiently tailored to the Zuni experience and may contribute to health equity barriers.
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