Identifying the exposures or interventions that exacerbate or ameliorate racial health disparities is one of social epidemiology’s fundamental goals. Introducing an interaction term between race and an exposure into a statistical model is commonly utilized in the epidemiologic literature to assess racial health disparities and the potential viability of a targeted health intervention. However, researchers may attribute too much authority to the interaction term and inadvertently ignore other salient information regarding the health disparity. In this article, we highlight empirical examples from the literature demonstrating limitations of over-reliance on interaction terms in health disparities research; we further suggest approaches for moving beyond interaction terms when assessing these disparities. We promote a comprehensive framework of three guiding questions for disparity investigation, suggesting examination of the group-specific differences in 1) outcome prevalence, 2) exposure prevalence, and 3) effect size. Our framework allows for better assessment of meaningful differences in population health and the resulting implications for interventions, demonstrating that interaction terms alone do not provide sufficient means for determining how disparities arise. The widespread adoption of this more comprehensive approach has the potential to dramatically enhance understanding of the patterning of health and disease and the drivers of health disparities.

The vulnerability of fathers to psychological distress during the pregnancy after a stillbirth needs to be recognised.

Purpose of review Recent literature on racial or ethnic discrimination and mental health was reviewed to assess the current science and identify key areas of emphasis for social epidemiology. Objectives of this review were to: 1) Determine whether there have been advancements in the measurement and analysis of perceived discrimination; 2) Identify the use of theories and/or frameworks in perceived discrimination and mental health research; and 3) Assess the extent to which stress buffers are being considered and evaluated in the existing literature. Recent findings Metrics and analytic approaches used to assess discrimination remain largely unchanged. Theory and/or frameworks such as the stress and coping framework continue to be underused in majority of the studies. Adolescents and young adults experiencing racial/ethnic discrimination were at greater risk of adverse mental health outcomes, and the accumulation of stressors over the life course may have an aggregate impact on mental health. Some growth seems evident in studies examining the mediation and moderation of stress buffers and other key factors with the findings suggesting a reduction in the effects of discrimination on mental health. Summary Discrimination scales should consider the multiple social identities of a person, the context where the exposure occurs, how the stressor manifests specifically in adolescents, the historical traumas, and cumulative exposure. Life course theory and intersectionality may help guide future work. Despite existing research, gaps remain in in elucidating the effects of racial and ethnic discrimination on mental health, signaling an opportunity and a call to social epidemiologists to engage in interdisciplinary research to speed research progress.

Study Objectives Most epidemiological studies assess sleep duration using questionnaires. Interpreting this information requires understanding the extent to which self-reported habitual sleep reflects objectively assessed sleep duration, particularly among African Americans, who disproportionately experience poor sleep health. Methods Among African-American participants of the Jackson Heart Sleep Study, we investigated differences in questionnaire-based self-assessed average sleep duration and self-assessed wake-bed time differences compared to actigraphy-based assessments of total sleep time (TST) and average time in bed (TIB). Linear regression models provided estimates of concordance between actigraphy-based and self-reported sleep duration. Results Among 821 adults, self-assessed average sleep duration was lower than self-assessed wake-bed time differences (6.4 ± 1.4 vs. 7.5 ± 1.7 h, p < 0.0001). Mean actigraphy-based TST was 6.6 ± 1.2 h, and actigraphy-based average TIB was 7.6 ± 1.2 h. Self-assessed average sleep duration and actigraphy-based TST were moderately correlated (r = 0.28, p < 0.0001). Self-assessed average sleep duration underestimated actigraphy-based TST by −30.7 min (95% confidence intervals [CI]: −36.5 to −24.9). In contrast, self-assessed wake-bed time differences overestimated actigraphy-based TST by 45.1 min (95% CI: 38.6–51.5). In subgroup analyses, self-assessed average sleep duration underestimated actigraphy-based measures most strongly among participants with insomnia symptoms. Conclusions Among African Americans, self-assessed average sleep duration underestimated objectively measured sleep while self-assessed wake-bed time differences overestimated objectively measured sleep. Sleep measurement property differences should be considered when investigating disparities in sleep and evaluating their associations with health outcomes.

IntroductionGiven the increasing number of people in Spain struggling to pay housing-related costs during the economic recession, it is important to assess the health status of these communities as compared to the general population and to better understand the different housing dimensions that are related with poor mental health. This study aims to describe the housing conditions and health status of a sample of people assisted by Caritas Barcelona (Spain) and living in inadequate housing and/or struggling to pay their rent or mortgage, to compare the health outcomes of this population with those of the overall population of Barcelona, and to analyze the association between housing dimensions and mental health.MethodsWe used a cross-sectional design. The participating adults (n = 320) and children (n = 177) were those living in the dioceses of Barcelona, Sant Feliu and Terrassa (Spain) in 2012 and assisted by Cáritas. They were asked to answer to three questionnaires on housing and health conditions. Eight health related variables were used to compare participants with Barcelona’s residents and associations between housing conditions and poor mental health were examined with multivariate logistic regression models.ResultsIn Barcelona, people seeking Caritas’s help and facing serious housing problems had a much poorer health status than the general population, even when compared to those belonging to the most deprived social classes. For example, 69.4 % of adult participants had poor mental health compared to 11.5 % male and 15.2 % female Barcelona residents. Moreover, housing conditions were associated with poor mental health.ConclusionsThis study has shown how, in a country hit by the financial recession, those people facing housing problems have much worse health compared to the general population.

Purpose: Urinary incontinence is frequently underreported and underdiagnosed in the clinical setting. We analyzed 12 years of data from a large, nationally representative sample of women in the United States to assess the prevalence, severity, and daily impact of urinary incontinence and its subtypes at the population level. Materials and Methods: We analyzed data from 15,003 women aged 20 years who participated in the 2005e2016 National Health and Nutrition Examination Survey. We estimated the prevalence of urinary incontinence in the prior year, overall and by subtype (stress, urgency or mixed). Among women with urinary incontinence, we additionally assessed symptom severity using the validated 4-level Incontinence Severity Index, as well as impact on daily activities. Results: The 2005e2016 prevalence of any urinary incontinence was 53%; 16% of women had mixed urinary incontinence, 26% had stress only and 10% had urgency only. While urgency urinary incontinence and mixed urinary incontinence were highest among women aged 60 years, stress urinary incontinence was highest among women aged 40e59 years. NonHispanic Black women had higher prevalence of urgency urinary incontinence and lower prevalence of stress urinary incontinence compared to other racial/ethnic groups. Of women with urinary incontinence, 30% reported moderate or severe symptoms, which were more common among older than younger women. In addition, 24% of women with urinary incontinence reported that the condition affected their daily activities. Conclusions: Our study demonstrates a high prevalence of urinary incontinence among a nationally representative population of women in the United States, with many reporting that urinary incontinence affected their daily activities. Age and racial/ethnic trends varied by urinary incontinence subtype.

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Objective Despite growing evidence that discrimination may contribute to poor mental health, few studies have assessed this association among US Latinos. Furthermore, the interaction between discrimination and educational attainment in shaping Latino mental health is virtually unexplored. This study aims to examine the association between perceived discrimination and depressive symptoms and the modifying role of education among a population of Mexican-origin adults. Design We utilized population-based data from 629 Mexican-origin adults (mean age=52.8 years) participating the Niños Lifestyle and Diabetes Study (2013–2014). Perceived discrimination was defined as responding “sometimes” or “often” to at least one item on the 9-item Everyday Discrimination Scale. High depressive symptoms were defined as scoring ≥10 on the CESD-10. We used log-binomial and linear-binomial models to estimate prevalence ratios (PR) and prevalence differences (PD), respectively, of high depressive symptoms for levels of perceived discrimination. Final models were adjusted for age, sex, education, cultural orientation, and nativity. General estimating equations were employed to account for within-family clustering. Results Prevalence of perceived discrimination and high depressive symptoms were 49.5% and 29.2%, respectively. Participants experiencing discrimination had higher depressive symptom prevalence than those never or rarely experiencing discrimination [PR=1.94, 95% confidence interval (CI): 1.46–2.58; PD=0.19, 95% CI: 0.12–0.27]. The strength of this association varied by education level. The association between discrimination and depressive symptoms was stronger among those with >12 years of education (PR=2.69; PD=0.24) compared to those with ≤12 years of education (PR=1.36; PD=0.09). Conclusion US Latinos suffer a high burden of depressive symptoms, and discrimination may be an important driver of this burden. Our results suggest that effortful coping strategies, such as achieving high education despite high perceived discrimination, may magnify discrimination’s adverse effect on Latino mental health.