Research article Special Issues

Differential protective effects of Family Income-to-Poverty-Ratio on electronic cigarette, depression, and obesity of Black and White Americans

  • Received: 27 March 2024 Revised: 06 June 2024 Accepted: 17 June 2024 Published: 11 December 2024
  • Background 

    The Family Income-to-Poverty-Ratio (FIPR) is a recognized indicator of socioeconomic status, and influences a wide range of health and behavioral outcomes. Yet, marginalized and racialized groups, particularly Black individuals, may not reap comparable health benefits from their socioeconomic advancements as their non-Hispanic, White counterparts. This discrepancy is indicative of a phenomenon known as the minorities' diminished returns.

    Aims 

    This study investigates the differential impact of the FIPR on depression, obesity, tobacco use, and e-cigarette use between Black and White adults.

    Methods 

    Using data from the 2022 National Health Interview Survey (NHIS), which included 21,354 non-Hispanic adults from both White and Black racial groups, this research employed structural equation modeling to assess the relationship between the FIPR and health outcomes, including depression, obesity, and e-cigarette use.

    Results 

    The analysis identified significant interactions between FIPR and race across all the examined outcomes. Contrary to expectations, the findings suggest that the protective effects of higher income levels on health and healthy behaviors are less pronounced for Black individuals compared to White individuals.

    Conclusion 

    The study underscores the substantial societal and environmental barriers that hinder Black families and individuals from converting their FIPR and socioeconomic resources into concrete health benefits, such as an enhanced mental and physical well-being. To redress these racial health disparities, targeted interventions are crucial, particularly those that focus on bridging the employment and marriage rate gaps caused by educational disparities among Black communities. A comprehensive approach that extends beyond simple access to education is imperative to eliminate the societal obstacles that limit the socioeconomic benefits for Black populations.

    Citation: Shervin Assari. Differential protective effects of Family Income-to-Poverty-Ratio on electronic cigarette, depression, and obesity of Black and White Americans[J]. AIMS Public Health, 2024, 11(4): 1157-1171. doi: 10.3934/publichealth.2024060

    Related Papers:

    [1] Maria Pia Riccio, Gennaro Catone, Rosamaria Siracusano, Luisa Occhiati, Pia Bernardo, Emilia Sarnataro, Giuseppina Corrado, Carmela Bravaccio . Vitamin D deficiency is not related to eating habits in children with Autistic Spectrum Disorder. AIMS Public Health, 2020, 7(4): 792-803. doi: 10.3934/publichealth.2020061
    [2] Anastasia Stathopoulou, Georgios F. Fragkiadakis . Assessment of psychological distress and quality of life of family caregivers caring for patients with chronic diseases at home. AIMS Public Health, 2023, 10(2): 456-468. doi: 10.3934/publichealth.2023032
    [3] Dorota Zarnowiecki, Meaghan S Christian, James Dollman, Natalie Parletta, Charlotte E.L Evans, Janet E Cade . Comparison of school day eating behaviours of 8–11 year old children from Adelaide, South Australia, and London, England
    . AIMS Public Health, 2018, 5(4): 394-410. doi: 10.3934/publichealth.2018.4.394
    [4] Casey T. Harris, Kevin Fitzpatrick, Michael Niño, Priya Thelapurath, Grant Drawve . Examining disparities in the early adoption of Covid-19 personal mitigation across family structures. AIMS Public Health, 2022, 9(3): 589-605. doi: 10.3934/publichealth.2022041
    [5] Christos Sikaras, Maria Tsironi, Sofia Zyga, Aspasia Panagiotou . Anxiety, insomnia and family support in nurses, two years after the onset of the pandemic crisis. AIMS Public Health, 2023, 10(2): 252-267. doi: 10.3934/publichealth.2023019
    [6] Waled Amen Mohammed Ahmed, Sara Boutros Shokai, Insaf Hassan Abduelkhair, Amira Yahia Boshra . Factors Affecting Utilization of Family Planning Services in a Post-Conflict Setting, South Sudan: A Qualitative Study. AIMS Public Health, 2015, 2(4): 655-666. doi: 10.3934/publichealth.2015.4.655
    [7] Erin Nolen, Catherine Cubbin, Mackenzie Brewer . The effect of maternal food insecurity transitions on housing insecurity in a population-based sample of mothers of young children. AIMS Public Health, 2022, 9(1): 1-16. doi: 10.3934/publichealth.2022001
    [8] J. Nwando Olayiwola, Melanie Raffoul . Saving Women, Saving Families: An Ecological Approach to Optimizing the Health of Women Refugees with S.M.A.R.T Primary Care. AIMS Public Health, 2016, 3(2): 357-374. doi: 10.3934/publichealth.2016.2.357
    [9] Dominique Meekers , Raseliarison Ratovonanahary , Tokinirina Andrianantoandro , Hiangotiana Randrianarisoa . Using Survey Data to Identify Opportunities to Reach Women with An Unmet Need for Family Planning: The Example of Madagascar. AIMS Public Health, 2016, 3(3): 629-643. doi: 10.3934/publichealth.2016.3.629
    [10] Argyro Pachi, Maria Anagnostopoulou, Athanasios Antoniou, Styliani Maria Papageorgiou, Effrosyni Tsomaka, Christos Sikaras, Ioannis Ilias, Athanasios Tselebis . Family support, anger and aggression in health workers during the first wave of the pandemic. AIMS Public Health, 2023, 10(3): 524-537. doi: 10.3934/publichealth.2023037
  • Background 

    The Family Income-to-Poverty-Ratio (FIPR) is a recognized indicator of socioeconomic status, and influences a wide range of health and behavioral outcomes. Yet, marginalized and racialized groups, particularly Black individuals, may not reap comparable health benefits from their socioeconomic advancements as their non-Hispanic, White counterparts. This discrepancy is indicative of a phenomenon known as the minorities' diminished returns.

    Aims 

    This study investigates the differential impact of the FIPR on depression, obesity, tobacco use, and e-cigarette use between Black and White adults.

    Methods 

    Using data from the 2022 National Health Interview Survey (NHIS), which included 21,354 non-Hispanic adults from both White and Black racial groups, this research employed structural equation modeling to assess the relationship between the FIPR and health outcomes, including depression, obesity, and e-cigarette use.

    Results 

    The analysis identified significant interactions between FIPR and race across all the examined outcomes. Contrary to expectations, the findings suggest that the protective effects of higher income levels on health and healthy behaviors are less pronounced for Black individuals compared to White individuals.

    Conclusion 

    The study underscores the substantial societal and environmental barriers that hinder Black families and individuals from converting their FIPR and socioeconomic resources into concrete health benefits, such as an enhanced mental and physical well-being. To redress these racial health disparities, targeted interventions are crucial, particularly those that focus on bridging the employment and marriage rate gaps caused by educational disparities among Black communities. A comprehensive approach that extends beyond simple access to education is imperative to eliminate the societal obstacles that limit the socioeconomic benefits for Black populations.



    Autism Spectrum Disorder (ASD) is a disease described as strongly heterogeneous due to the large number of symptoms which may appear in the child's functioning [1], as well as the variable response of the body to the treatment process [1],[2]. In spite of the fact that the symptoms are multiple and occur with changing intensity, every person with autism presents abnormalities in communication and social interaction [2], exhibits repetitive behaviours, and a limited scope of interests [3],[4]. The onset of the disease occurs in early childhood [3]. Only a minor percentage of people with diagnosed Autism Spectrum Disorder, with mild symptoms (ex. Difficulty in social communication, problematic with adaptation to change, planning difficulty) , are able to live a relatively independent life as adults [2],[3],[5]. The majority (with symptoms of moderate and severe intensity) need the help of their families or social welfare to the end of their lives [2]. Their functioning in adult life depends on the early introduction of intensive therapeutic programmes, modifying the undesirable behaviours, and aimed at teaching social and communication skills [6][8].

    Scientific literature stresses a constant growth in the incidence of the disorder under discussion. For example, data from the Autism and Developmental Disabilities Monitoring Network shows that, in 2012, in the USA, there were twice as many eight-year-old children with diagnosed ASD as only two years earlier, in 2010 [9]. Taking into consideration the whole population of children, in 2000, ASD was reported as occurring in one in every 150 children, and in 2010, in one of every 68 [10]. The causes of this situation are unknown. The scientists believe it is related to greater public awareness of the symptoms of autism, new diagnostic criteria, and possibility of diagnosis at a younger age [11][14]. These are only hypotheses, but they undoubtedly encourage various agencies-medical, social, educational and other to search for effective solutions for supporting people with autism and their families [4].

    The symptoms of autism are recognised in the child's environment quite quickly. Usually, it is the parents who first realise that their child does not achieve the expected milestones in development; his or her development is retarded or stopped [15][17]. At that time, parents observe that their child does not react to their physical affection, does not want to express emotions, often avoids hugging (which is very hard for parents, especially for mothers) and eye contact, and does not want to communicate in any way [15],[16]. Moreover, the child may present atypical behaviours, movements related to a strong need of isolation from its surroundings, which are incomprehensible to the parents [16]. Usually, these include destructive, socially unacceptable behaviours [18]. These symptoms arouse anxiety and feelings of helplessness in the parents and make them seek professional help [15].

    The problems affecting the autistic child affect also the parents. Therefore, it may be said that the autism of a child has considerable implications for its parents [19]. Caring for a child with autism is associated with emotional consequences [20][23]. It has been proved that parents of atypical children experience parental stress much more frequently than the general population [24], as the moment of the child's diagnosis generates strong uncertainty about the future life of the child and the whole family [25],[26].

    The study by Bitsik and Sharpley, conducted on the basis of an analysis of fathers and mothers of ASD children, showed that women are more preoccupied and prone to depression than men caring for their disabled children [27]. Similar results were obtained by Dąbrowska, who indicated that mothers are much more frequently exposed to stress [28][30]. Moreover, it was proved that parents of ASD children are three to five times more vulnerable to depression than parents of neurotypical children [31]. The most commonly used assessment tools for preoccupation and depression [27] of parents include:

    • Self-Rating Depression Scale—SDS [32].
    • Self-Rating Anxiety Scale—SAS [33].
    • Connor-Davidson Resilience Scale—CD-RISC [34].

    The aim of the paper is to evaluate the functioning of families with an ASD child and compare it to the functioning of families with neurotypical children. The degree of flexibility, cohesion and level of communication enables the family to be classified either as healthy or dysfunctional.

    The study was approved by Bioethics Committee of the Poznan Univeristy of Medical Sciences (approval number: 1223/17) and Australian New Zealand Clinical Trials Registry (ANZCTR) number ACTRN12618000598280.

    The study was performed using (Flexibility and Cohesion Evaluation Scales, FACES-IV) questionnaire by David H. Olson, in its Polish form, developed by Andrzej Margasiński. The questionnaire consists of sixty-two statements, to which the subject responds in a 5-degree scale, from strongly disagree to strongly agree. The statements are divided into eight sub-scales. Six of them are the main sub-scales of David H. Olson's Circumplex Model of the two dimensions of family functioning: cohesion and flexibility (Balanced Cohesion, Disengaged, Unmeshed, Balanced Flexibility, Rigid, Chaotic). The two remaining sub-scales measure family communication (which is the third dimension of the Circumplex Model) and family satisfaction. Apart from sub-scale results, it is possible to calculate three complex ratios: Cohesion Ratio, Flexibility Ratio and Total Circumplex Ratio, which reflects the degree to which family functioning is healthy [35].

    The tool used is based on the Circumplex Model, which focuses on three crucial dimensions of family functioning: cohesion, flexibility and communication. Cohesion means the emotional bonding that family members have towards one another. Flexibility of relationships is defined as the quality and expression of leadership and organization, role relationships, and relationships rules and negotiations [36]. The communication dimension is viewed as a facilitating dimension that helps families alter their levels of cohesion and flexibility. The intensity of cohesion and flexibility of family relationships may have two basic levels: balanced or unbalanced. Unbalanced cohesion may mean extremely high cohesion level (unmeshed relationships) or an extremely low cohesion level (disengaged relationships, lack of bonding). On the other hand, unbalanced flexibility may mean extremely high (chaotic family relationships) or extremely low (rigid family relationships) flexibility levels. The main hypothesis of the model says that there is a positive relationship between a balanced cohesion level, balanced flexibility level, and healthy family functioning, as well as a positive relationships between unbalanced cohesion level, unbalanced flexibility level and problematic family functioning [36].

    The third basic dimension of D. H. Olson's Circumplex Model, which influences both flexibility and cohesion, is communication [37]. This refers to the skill of providing the family members with information, plans and emotions. This dimension is also defined as the positive communication skills utilized in the couple or family system[38].

    Cluster analysis of data obtained from studies, using Flexibility and Cohesion Evaluation Scales, resulted in distinguishing six family types: Balanced, Cohesively Rigid, Flexibly Disengaged, Mid-range, Rigidly Disengaged and Unbalanced [35]. The Balanced type is characterised by the highest scores on the balanced sub-scales and the lowest scores on the remaining sub-scales. The Cohesively Rigid type is characterised by high scores in the balanced cohesion and rigid sub-scales, moderate enmeshed scores, and low disengaged and chaos scores. The Flexibly Disengaged type is characterised by high scores on the Balanced Flexibility and Disengaged sub-scales, and low scores on the Rigid sub-scale The Mid-range type is characterised by moderate scores on all of the sub-scales, with the exception of the disengaged sub-scale, where the score is usually low. The Rigidly Disengaged type is characterised by high scores on all of the sub-scales other than Cohesion, where moderate to low scores are characteristic. The Unbalanced type is characterised by high scores on all four of the unbalanced scales: Disengaged, Unmeshed, Rigid and Chaotic, and low scores on the two balanced scales: Balanced Cohesion and Balanced Flexibility. These families are assumed to experience the greatest difficulties and be the most problematic in terms of their functioning. It is estimated that this is the family type most often looking for therapy [35].

    The study with Flexibility and Cohesion Evaluation Scales, by David H. Olson, in its Polish adaptation by Andrzej Margasiński, included 70 parents of ASD children, and 70 parents with children without diagnosed ASD, as the control group. The study was performed in January and February 2018. The study used inclusion criteria: (1). parents aged 25–45; (2). children without comorbidities; (3). diagnosis of autism in children.

    In order to compare FACES IV results obtained by the parents of ASD children and the control group, an independent samples t-test for equality of means was performed, and the statistical significance of the obtained differences was assessed.

    The analysis of the Balanced Cohesion sub-scale indicated that the parents of children with autism achieve lower FACES-IV results in the Balanced Cohesion sub-scale than the control group. The study covered 140 observations. The significance level of Levene's test indicates that the results should be interpreted with the assumed equality of variance. The p-value for the t-test for difference of means is 0.002; therefore, the means in both groups differ in a statistically significant way. The results are presented in Table 1.

    Table 1.  The sub-scales in the group of parents of children with ASD vs. parents of neurotypical children.
    Group N Average P-value
    Balanced Cohesion sub-scale (STEN) Autism 70 5.2000 21,843
    Control group 70 6.3571 22,135
    Balanced Flexibility sub-scale (STEN) Autism 70 5.6857 20,820
    Control group 70 6.2143 19,478
    Disengaged sub-scale (STEN) Autism 70 7.2857 18,583
    Control group 70 6.4143 18,217
    Unmeshed sub-scale (STEN) Autism 70 6.8857 20,610
    Control group 70 5.4857 18,077
    Rigid sub-scale (STEN) Autism 70 6.9143 17,672
    Control group 70 6.6857 17,573
    Chaotic sub-scale (STEN) Autism 70 6.7143 18,893
    Control group 70 6.0143 19,597
    Family Communication sub-scale (STEN) Autism 70 5.3857 24,215
    Control group 70 6.1714 24,846
    Family Satisfaction sub-scale (STEN) Autism 70 6.3143 24,586
    Control group 70 7.2857 21,274

     | Show Table
    DownLoad: CSV

    • Balanced flexibility sub-scale The p-value for the t-test for difference of means is 0.123; therefore, the means in both groups do not differ in a statistically significant way.
    • Disengaged sub-scale The p-value for the t-test for difference of means is 0.006; therefore, the means in both groups differ in a statistically significant way.
    • Unmeshed sub-scale The p-value for the t-test for difference of means is 0.000; therefore, the means in both groups differ in a statistically significant way.
    • Rigid sub-scale The p-value for the t-test for difference of means is 0.444; therefore, the means in both groups do not differ in a statistically significant way.
    • Chaotic sub-scale The p-value for the t-test for difference of means is 0.033; therefore, the means in both groups differ in a statistically significant way.
    • Family communication sub-scale The p-value for the t-test for difference of means is 0.060; therefore, the means in both groups do not differ in a statistically significant way.
    • Family satisfaction sub-scale The p-value for the t-test for difference of means is 0.014; therefore, the means in both groups differ in a statistically significant way.

    The analyses within the group of parents of ASD children did not show any statistically significant differences in FACES-IV due to socio-demographic variables.

    Research into parental stress levels showed that parents of children with ASD have greater uncertainty, stress and depression levels than parents of neurotypical children [39][43] and also parents of children with other disabilities [44],[45]. Similar results can be observed in the comparison between the stress levels of parents of ASD children and the general population [21],[43],[46][49].

    The most significant factor generating parenting stress are the ASD symptoms in their children [31]. Among the most frequent symptoms contributing to parental stress, scientists enumerate impaired cognitive functions and impaired social reactions, which directly correspond to the emergence of parental stress, anxiety and depression [50][53]. Other aspects of autism which may induce parental stress are: the level of functioning of the child, the child's age, the dysfunction of adaptive behaviours, agammaession, tantrums, and self-inflicted injuries [21],[54][57].

    However, it is emphasized that there is no social understanding of the characteristics of ASD, due to which, both the parents and the ASD children themselves, are subject to more severe social criticism. The specific behaviours of ASD patients are often perceived as parenting errors [31]. What is even more important, it is considered that parental stress factors come exclusively from outside of this social group and not from the personality and behavioural models of the parents themselves [31],[58]. Important factors influencing the development of parental stress and burn-out include lack of activity of mothers of ASD children outside the home in comparison to mothers of neurotypical children, who can spend much more of their free time outside the family, in a stress-free environment [59]. Similar conclusions were made in other studies, which, apart from isolation factors, also identified the phenomenon of “self-blaming” mothers, who burden themselves with blame for their child's difficulties [60],[61]. Another aspect of parental stress, described in the literature, is escaping from the problems related to the child's disability, visible as its difficult behaviours [62].

    The assessment of parental stress showed that over a half (55.8%) of fathers feel overwhelming helplessness one to five times a month. On the other hand, over 70% of mothers experience this feeling one to five times a month. The results of this study confirmed earlier research into anxiety and depression in parents, conducted by the same authors on a group of parents in Australia [27],[63].

    Another study focused on the parents of children with diagnosed ASD. The research into parental stress showed that the majority of the subjects agreed to the statements that “caring for a child takes a lot of time and energy” and “the behaviour of my child embarrasses and stresses me”. In the area of social support, the majority of the subjects agreed with the statements “the members of my family rely on me” and “I cannot rely on the members of my family”. As far as the area of self-efficacy is concerned, the majority marked the answer “try another solution if the first one did not bring expected results”. The study described showed that there are multiple sources of parental stress and that its level is influenced by all members of the ADS child's family, including parents, siblings, and grandparents. It was also shown that, despite the difficulties and problems, the caregivers of ASD children have social support and can cope with difficult situations [64].

    The scientific literature also includes works devoted to the role of stress resilience and self-efficacy in parents of ASD children. One of them analyses the group under discussion. The study was conducted using the Satisfaction With Life Scale (SWLS) [65], the Coping Strategy Inventory (CSI) [66], and the Coping with Stress Self-Efficacy Scale (CSSES) [67]. The results confirm that bringing up a child influences coping strategies and the sense of self-efficacy. Therefore, stress has an impact on the level of satisfaction with life of parents of ASD children. The scientists found differences depending on the parent's sex, stating that the primary goal of a woman is the sense of self-efficacy, while men put problem solving in the first place [67][72]. It was also shown that, together with the ageing of ASD parents, the social support for these families decreases, as does cognitive restructuring [69],[73],[74].

    The results of many studies prove that the sense of self-efficacy contributes to higher life satisfaction. Moreover, the sense of self-efficacy correlates positively with resilience strategies (problem solving and cognitive restructuring) and negatively with dysfunctional strategies (social isolation, wishful thinking, self-criticism) [60],[69],[75][79].

    It is worth mentioning the study conducted by Bitsik et al. (2017), analysing daily cortisol levels in parents of ASD children. Cortisol is called the neurohormone of stress [57],[80]. Cortisol levels were measured via the analysis of the subjects' saliva. It is estimated that cortisol is present in this material for about 10 minutes from the occurrence of the stress factor [81]. It was proved that, in 129 subjects, the levels of cortisol drop in accordance with the circadian rhythm. At the same time, the studies proved that self-inflicted injuries in children with ASD may be a stress-provoking factor in parents [57],[82].

    In order to reduce parental stress, parents of ASD children are recommended to introduce effective mitigation of autism symptoms [83]. It is emphasized that only successful reduction of ASD symptoms in the child may improve the well-being of the whole family [84]. Long-term stress may have drastic health consequences on parents of ASD children [31]. Support groups for parents of ASD children are one of the forms of therapy aimed at coping with stress and preventing burn-out [85].

    (1). It has been established that the parents of children with autism achieve lower results in the balanced cohesion sub-scale than the control group.

    (2). The parents of ASD children obtained higher scores in the disengaged sub-scale than the control group.

    (3). Furthermore, in the unmeshed sub-scale, their scores were higher than in the control group.

    (4). In the chaotic sub-scale, the parents of ASD children obtained higher scores than the control group.

    (5). It was found out that the family satisfaction level in parents of ASD children is lower than in the control group.

    (6). In the balanced flexibility, rigid and family communication sub-scales, there were no statistically significant differences between the parents of ASD children and the parents from the control group.

    (7). In parents of ASD children, the scores in all unbalanced sub-scales were higher than in families with children without autism (even if in some of differences were not statistically significant) while the scores in the balanced sub-scales were lower.

    (8). The STEN analysis of mean results of the parents of ASD children does not show extreme results in the scales studied, their results remain in the mid-range values (with the assumption that the middle of the STEN scale is 5.5 and the standard deviation is 2).

    (9). In families with ASD children, there is a higher risk of the unbalanced or rigidly disengaged family type than in families with neurotypical children.

    This may be a significant result, suggesting the risk of the occurrence of a disturbed family system, functioning in families with children with ASD, which should be a trigger for providing these families with early family functioning diagnosis and consequent support and therapy.


    Acknowledgments



    This study is supported by funds provided by The Regents of the University of California, Tobacco-Related Diseases Research Program, Grant Number no T32IR5355.

    Conflict of interest



    Shervin Assari is an editorial board member for AIMS Public Health, and he's also guest editor of AIMS Public Health Special Issue, and was not involved in the editorial review or the decision to publish this article. The author declares that there are no competing interests.

    [1] Semega J, Kollar M, Creamer J, et al. (2017) Income and poverty in the United States: 2016. Current population reports .
    [2] Costa M (2002) A multidimensional approach to the measurement of poverty. Luxemburgo: Iriss (IRISS Working papers series, 2002–05).
    [3] Dearing E, McCartney K, Taylor BA (2001) Change in family income-to-needs matters more for children with less. Child Dev 72: 1779-1793. https://doi.org/10.1111/1467-8624.00378
    [4] Gennetian LA, Castells N, Morris PA (2010) Meeting the basic needs of children: Does income matter?. Child Youth Serv Rev 32: 1138-1148. https://doi.org/10.1016/j.childyouth.2010.03.004
    [5] Ecob R, Smith GD (1999) Income and health: what is the nature of the relationship?. Soc Sci Med 48: 693-705. https://doi.org/10.1016/S0277-9536(98)00385-2
    [6] Sculpher MJ, O'Brien BJ (2000) Income effects of reduced health and health effects of reduced income: implications for health-state valuation. Med Decis Making 20: 207-215. https://doi.org/10.1177/0272989X0002000206
    [7] Robinson MA, Cheng TC (2014) Exploring physical health of African Americans: A social determinant model. J Hum Behav Soc Envi 24: 899-909. https://doi.org/10.1080/10911359.2014.914993
    [8] Ciapponi A, Organization WH Systematic review of the link between tobacco and poverty (2014).
    [9] Geyer S (2011) Income, income, or income? The effects of different income measures on health in a national survey. J Epidemiol Community Health 65: 491-496. https://doi.org/10.1136/jech.2009.103390
    [10] Barsha RAA, Assari S, Hossain MB, et al. (2023) Black Americans' Diminished Return of Educational Attainment on Tobacco Use in Baltimore City. J Racial Ethn Health Disparities 10: 3178-3187. https://doi.org/10.1007/s40615-023-01805-0
    [11] Assari S, Cobb S, Saqib M, et al. (2020) Diminished returns of educational attainment on heart disease among Black Americans. Open Cardiovasc Med J 14: 5-12. https://doi.org/10.2174/1874192402014010005
    [12] Assari S, Lapeyrouse LM, Neighbors HW (2018) Income and Self-Rated Mental Health: Diminished Returns for High Income Black Americans. Behav Sci 8: 50. https://doi.org/10.3390/bs8050050
    [13] Assari S (2018) Diminished Economic Return of Socioeconomic Status for Black Families. Soc Sci 7: 74. https://doi.org/10.3390/socsci7050074
    [14] Braveman P (2023) The social determinants of health and health disparities. New York, NY: Oxford University Press. https://doi.org/10.1093/oso/9780190624118.001.0001
    [15] Braveman PA, Cubbin C, Egerter S, et al. (2010) Socioeconomic disparities in health in the United States: what the patterns tell us. Am J Public Health 100: S186-S196. https://doi.org/10.2105/AJPH.2009.166082
    [16] Braveman PA, Cubbin C, Egerter S, et al. (2005) Socioeconomic status in health research: one size does not fit all. Jama 294: 2879-2888. https://doi.org/10.1001/jama.294.22.2879
    [17] Ross CE, Mirowsky J (2011) The interaction of personal and parental education on health. Soc Sci Med 72: 591-599. https://doi.org/10.1016/j.socscimed.2010.11.028
    [18] Ross CE, Mirowsky J (1999) Refining the association between education and health: the effects of quantity, credential, and selectivity. Demography 36: 445-460. https://doi.org/10.2307/2648083
    [19] Williams DT (2023) Racism and the mechanisms maintaining racial stratification in Black families. J Fam Theor Rev 15: 206-218. https://doi.org/10.1111/jftr.12511
    [20] Williams DR, Lawrence JA, Davis BA (2019) Racism and health: evidence and needed research. Annu Rev Public Health 40: 105-125. https://doi.org/10.1146/annurev-publhealth-040218-043750
    [21] Gee GC, Hing A, Mohammed S, et al. (2019) Racism and the Life Course: Taking Time Seriously. Am J Public Health 109: S43-S47. https://doi.org/10.2105/AJPH.2018.304766
    [22] Williams DR (1999) Race, socioeconomic status, and health the added effects of racism and discrimination. Ann N Y Acad Sci 896: 173-188. https://doi.org/10.1111/j.1749-6632.1999.tb08114.x
    [23] Phelan JC, Link BG (2015) Is racism a fundamental cause of inequalities in health?. Annu Rev Sociol 41: 311-330. https://doi.org/10.1146/annurev-soc-073014-112305
    [24] Assari G, Zare H, Assari S (2024) Walking the Divide: A Public Health Journey from Manhattan to Harlem. J Soc Math Hum Eng Sci 3: 7-15. https://doi.org/10.31586/jsmhes.2024.1018
    [25] Chae DH, Clouston S, Hatzenbuehler ML, et al. (2015) Association between an internet-based measure of area racism and black mortality. PLoS One 10: e0122963. https://doi.org/10.1371/journal.pone.0122963
    [26] Krieger N (2021) Structural racism, health inequities, and the two-edged sword of data: structural problems require structural solutions. Front Public Health 9: 655447. https://doi.org/10.3389/fpubh.2021.655447
    [27] Bailey ZD, Krieger N, Agenor M, et al. (2017) Structural racism and health inequities in the USA: evidence and interventions. Lancet 389: 1453-1463. https://doi.org/10.1016/S0140-6736(17)30569-X
    [28] Krieger N (2003) Does racism harm health? Did child abuse exist before 1962? On explicit questions, critical science, and current controversies: an ecosocial perspective. Am J Public Health 93: 194-199. https://doi.org/10.2105/AJPH.93.2.194
    [29] Krieger N (2000) Epidemiology, racism, and health: the case of low birth weight. Epidemiology 11: 237-239. https://doi.org/10.1097/00001648-200005000-00001
    [30] Gee GC, Hicken MT (2021) Structural racism: the rules and relations of inequity. Ethn Dis 31: 293. https://doi.org/10.18865/ed.31.S1.293
    [31] Paradies Y, Priest N, Ben J, et al. (2013) Racism as a determinant of health: a protocol for conducting a systematic review and meta-analysis. Syst Rev 2: 85. https://doi.org/10.1186/2046-4053-2-85
    [32] Gee GC, Walsemann KM, Brondolo E (2012) A life course perspective on how racism may be related to health inequities. Am J Public Health 102: 967-974. https://doi.org/10.2105/AJPH.2012.300666
    [33] Gee GC, Ford CL (2011) Structural racism and health inequities: Old issues, New Directions1. Du Bois Rev 8: 115-132. https://doi.org/10.1017/S1742058X11000130
    [34] Assari S, Caldwell CH (2021) Racism, diminished returns of socioeconomic resources, and Black middle-income children's health paradox. JAMA Pediatr 175: 1287-1288. https://doi.org/10.1001/jamapediatrics.2021.3277
    [35] Assari S, Zare H (2024) The Cost of Opportunity: Anti-Black Discrimination in High Resource Settings. J Biomed Life Sci 4: 92-110. https://doi.org/10.31586/jbls.2024.1128
    [36] Braveman PA, Heck K, Egerter S, et al. (2015) The role of socioeconomic factors in black–white disparities in preterm birth. Am J Public Health 105: 694-702. https://doi.org/10.2105/AJPH.2014.302008
    [37] Kaufman JS, Cooper RS, McGee DL (1997) Socioeconomic status and health in blacks and whites: the problem of residual confounding and the resiliency of race. Epidemiology 8: 621-628. https://doi.org/10.1097/00001648-199710000-00002
    [38] Kaufman JS (2008) Epidemiologic analysis of racial/ethnic disparities: some fundamental issues and a cautionary example. Soc Sci Med 66: 1659-1669. https://doi.org/10.1016/j.socscimed.2007.11.046
    [39] Assari S, Najand B, Sheikhattari P (2024) Household income and subsequent youth tobacco initiation: Minorities' Diminished Returns. J Med Surg Public Health 2: 100063. https://doi.org/10.1016/j.glmedi.2024.100063
    [40] Assari S (2024) Diminished returns of educational attainment on life satisfaction among Black and Latino older adults transitioning into retirement. J Med Surg Public Health 2: 100091. https://doi.org/10.1016/j.glmedi.2024.100091
    [41] Assari S, Zare H (2024) Black-White Gap Across Levels of Educational Childhood Opportunities: Findings from the ABCD Study. Open J Educ Res 4: 365. https://doi.org/10.31586/ojer.2024.1124
    [42] Danziger S, Sandefur GD, Weinberg DH (1994) Confronting poverty: Prescriptions for change.Harvard University Press.
    [43] Danziger S, Corcoran M, Danziger S, H (2000) Work, income, and material hardship after welfare reform. J Consum Aff 34: 6-30. https://doi.org/10.1111/j.1745-6606.2000.tb00081.x
    [44] Danziger S, Gottschalk P (2004) Diverging fortunes: Trends in poverty and inequality.Russell Sage Foundation New York.
    [45] Danziger SK, Danziger S (1993) Child poverty and public policy: Toward a comprehensive antipoverty agenda. Daedalus 122: 57-84.
    [46] Danziger S (2007) Fighting poverty revisited: What did researchers know 40 years ago? What do we know today. Focus 25: 3-11.
    [47] Aten B (1996) Some Poverty Lines are More Equal Than Others. Champagn-Urbana: University of Illinois.
    [48] Fisher GM (1992) The development and history of the poverty thresholds. Soc Sec Bull 55: 3.
    [49] Assari S (2018) Life Expectancy Gain Due to Employment Status Depends on Race, Gender, Education, and Their Intersections. J Racial Ethn Health Disparities 5: 375-386. https://doi.org/10.1007/s40615-017-0381-x
    [50] Choi K, Jones JT, Ruybal AL, et al. (2023) Trends in Education-Related Smoking Disparities Among US Black or African American and White Adults: Intersections of Race, Sex, and Region. Nicotine Tob Res 25: 718-728. https://doi.org/10.1093/ntr/ntac238
    [51] Navarro V (1989) Race or class, or race and class. Int J Health Serv 19: 311-314. https://doi.org/10.2190/CNUH-67T0-RLBT-FMCA
    [52] Navarro V (1990) Race or class versus race and class: mortality differentials in the United States. Lancet 336: 1238-1240. https://doi.org/10.1016/0140-6736(90)92846-A
    [53] Navarro V (1991) Race or class or race and class: growing mortality differentials in the United States. Int J Health Serv 21: 229-235. https://doi.org/10.2190/5WXM-QK9K-PTMQ-T1FG
    [54] Laaksonen M, Rahkonen O, Martikainen P (2005) Socioeconomic position and self-rated health: the contribution of childhood socioeconomic circumstances, adult socioeconomic status, and material resources. Am J Public Health 95: 1403-1409. https://doi.org/10.2105/AJPH.2004.047969
    [55] Drakopoulos S, Lakioti E, Theodossiou I (2011) Childhood socioeconomic deprivation and later adulthood health. Int J Soc Econ 38: 23-38. https://doi.org/10.1108/03068291111091945
    [56] Galobardes B, Lynch JW, Davey Smith G (2004) Childhood socioeconomic circumstances and cause-specific mortality in adulthood: systematic review and interpretation. Epidemiol Rev 26: 7-21. https://doi.org/10.1093/epirev/mxh008
    [57] Assari S, Caldwell CH (2018) High risk of depression in high-income african american boys. J Racial Ethn Health Disparities 5: 808-819. https://doi.org/10.1007/s40615-017-0426-1
    [58] Babey SH, Hastert TA, Wolstein J, et al. (2010) Income disparities in obesity trends among California adolescents. Am J Public Health 100: 2149-2155. https://doi.org/10.2105/AJPH.2010.192641
    [59] Bell CN, Thorpe RJ (2020) Association between Income and Obesity in Black Men: The Role of Work-Life Interference. Ethn Dis 30: 629-636. https://doi.org/10.18865/ed.30.4.629
    [60] Bjornstrom EE (2011) An examination of the relationship between neighborhood income inequality, social resources, and obesity in Los Angeles county. Am J Health Promot 26: 109-115. https://doi.org/10.4278/ajhp.100326-QUAN-93
    [61] El-Sayed AM, Scarborough P, Galea S (2012) Socioeconomic inequalities in childhood obesity in the United Kingdom: a systematic review of the literature. Obes Facts 5: 671-692. https://doi.org/10.1159/000343611
    [62] Fan JX, Wen M, Li K (2020) Associations between obesity and neighborhood socioeconomic status: Variations by gender and family income status. SSM Popul Health 10: 100529. https://doi.org/10.1016/j.ssmph.2019.100529
    [63] Assari S, Boyce S, Bazargan M, et al. (2019) Unequal Protective Effects of Parental Educational Attainment on the Body Mass Index of Black and White Youth. Int J Environ Res Public Health 16: 3641. https://doi.org/10.3390/ijerph16193641
    [64] Haustein KO (2006) Smoking and poverty. Eur J Cardiovasc Prev Rehabil 13: 312-318. https://doi.org/10.1097/01.hjr.0000199495.23838.58
    [65] Hayes C, Kearney M, O'Carroll H, et al. (2016) Patterns of Smoking Behaviour in Low-Income Pregnant Women: A Cohort Study of Differential Effects on Infant Birth Weight. Int J Environ Res Public Health 13: 1060. https://doi.org/10.3390/ijerph13111060
    [66] Leventhal AM, Bello MS, Galstyan E, et al. (2019) Association of cumulative socioeconomic and health-related disadvantage with disparities in smoking prevalence in the United States, 2008 to 2017. JAMA Intern Med 179: 777-785. https://doi.org/10.1001/jamainternmed.2019.0192
    [67] Loretan CG, Wang TW, Watson CV, et al. (2022) Disparities in Current Cigarette Smoking Among US Adults With Mental Health Conditions. Prev Chronic Dis 19: E87. https://doi.org/10.5888/pcd19.220184
    [68] Assari S, Boyce S, Caldwell CH, et al. (2020) Parent Education and Future Transition to Cigarette Smoking: Latinos' Diminished Returns. Front Pediatr 8: 457. https://doi.org/10.3389/fped.2020.00457
    [69] Assari S (2018) Health disparities due to diminished return among black Americans: Public policy solutions. Soc Iss Policy Rev 12: 112-145. https://doi.org/10.1111/sipr.12042
  • This article has been cited by:

    1. Gwendoline DESQUENNE GODFREY, Naomi DOWNES, Emilie CAPPE, A Systematic Review of Family Functioning in Families of Children on the Autism Spectrum, 2023, 0162-3257, 10.1007/s10803-022-05830-6
    2. Emma Chad-Friedman, Karen A. Kuhlthau, Rachel A. Millstein, Giselle K. Perez, Christina M. Luberto, Lara Traeger, Jacqueline Proszynski, Elyse Park, Characteristics and Experiences of Parents of Children with Learning and Attention Disabilities and Autism Spectrum Disorder: A Mixed Methods Study, 2022, 30, 1066-4807, 427, 10.1177/10664807211052304
    3. Anna Kostiukow, Piotr Poniewierski, Dominika Janowska, Włodzimierz Samborski, Levels of happiness and depression in parents of children with autism spectrum disorder in Poland, 2021, 81, 0065-1400, 279, 10.21307/ane-2021-026
    4. Talal E. Alhuzimi, Family Functioning and Strengths in Families of Children With Autism Spectrum Disorder in Saudi Arabia, 2024, 32, 1066-4807, 230, 10.1177/10664807231217061
    5. Fátima El‐Bouhali‐Abdellaoui, Núria Voltas, Paula Morales‐Hidalgo, Josefa Canals, Examining the Relationship Between Parental Broader Autism Phenotype Traits, Offspring Autism, and Parental Mental Health, 2024, 1939-3792, 10.1002/aur.3295
  • Reader Comments
  • © 2024 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)
通讯作者: 陈斌, bchen63@163.com
  • 1. 

    沈阳化工大学材料科学与工程学院 沈阳 110142

  1. 本站搜索
  2. 百度学术搜索
  3. 万方数据库搜索
  4. CNKI搜索

Metrics

Article views(642) PDF downloads(29) Cited by(0)

Figures and Tables

Figures(2)  /  Tables(4)

Other Articles By Authors

/

DownLoad:  Full-Size Img  PowerPoint
Return
Return

Catalog