Educational Attainment and Self-Rated Oral Health among American Older Adults: Hispanics’ Diminished Returns

Assari, Shervin; Bazargan, Mohsen

doi:10.3390/dj7040097

Cited by 14 publications

(11 citation statements)

References 38 publications

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“…As education is more distal than employment, and due to labor market discrimination, education may generate worse employment and occupations for non-Hispanic Blacks than for non-Hispanic Whites; the MDRs of education may be due in part to MDRs of employment. Previous work has also shown diminished health returns of employment [32] for substance use and life expectancy for non-Hispanic Blacks [59] and Hispanics [54,65].…”

Section: Discussionmentioning

confidence: 99%

Non-Hispanic Black Americans’ Diminished Protective Effects of Educational Attainment and Employment against Cardiometabolic Diseases: NHANES 1999-2016

Zare¹,

Assari²

2021

austinjpublichealthepidemiol

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Background: While Socioeconomic Status (SES) indicators such as educational attainment and employment are among the major drivers of health and illness, the health returns of SES indicators may differ across racial groups. Built on the Marginalization-Related Diminished Returns framework (MDRs) that refers to weaker health effects of SES indicators for marginalized and minoritized groups than non-Hispanic White people, we conducted this study with two aims: First, to test the association between educational attainment and employment with Cardio Metabolic Diseases (CMDs), and second, to test racial variations in these associations. Methods: This cross-sectional study used the National Health and Nutrition Examination Survey (NHANES 1999-2016) data. Participants included 29,230 adults who were either non-Hispanic White or non-Hispanic Black. We measured the following: race, demographic factors (age and sex, and marital status), SES (educational attainment and employment), behaviors (smoking, drinking, and exercise), health insurance, and CMDs (diabetes, stroke, hypertension, and congestive heart failure). Weighted Poisson regression models were used in Stata to adjust for the complex sample design of the NHANES. Models without and with interactions were performed in the pooled sample. We also ran racestratified models. Results: Overall, high educational attainment and employment showed inverse associations with some CMDs. As documented by statistical interactions between race and our SES indicators, we observed weaker inverse associations between educational attainment and employment with some CMDs. Racestratified models also confirmed our main analysis; however, the results varied across CMD conditions. Conclusion: We observed that SES indicators such as educational attainment and employment have differential associations for racial groups. Compared to non-Hispanic White people, non-Hispanic Black people remain at CMDs risk across the full SES spectrum. This finding is in line with the MDRs framework and may be due to the structural racism, social stratification, and marginalization of non-Hispanic Black Americans.

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Section: Discussionmentioning

confidence: 99%

Non-Hispanic Black Americans’ Diminished Protective Effects of Educational Attainment and Employment against Cardiometabolic Diseases: NHANES 1999-2016

Zare¹,

Assari²

2021

austinjpublichealthepidemiol

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“…12,13 Low educational attainment is positively correlated with poor oral health awareness. 14 Poverty and low educational attainment are more likely to predispose individuals to oral health-compromising behaviours like poor uptake of preventive oral health care. 12,14 A consequence of poor oral health service delivery systems is restricted access to oral health care especially preventive oral health care.…”

Section: Introductionmentioning

confidence: 99%

“…14 Poverty and low educational attainment are more likely to predispose individuals to oral health-compromising behaviours like poor uptake of preventive oral health care. 12,14 A consequence of poor oral health service delivery systems is restricted access to oral health care especially preventive oral health care. 12 Hence, populations characterized by poverty and poor oral health service delivery systems are vulnerable to suboptimal oral health.…”

Section: Introductionmentioning

confidence: 99%

“…12 Hence, populations characterized by poverty and poor oral health service delivery systems are vulnerable to suboptimal oral health. 12,14 Persons affected by conflicts or human right violations may suffer displacements from their place of residence, thereby becoming displaced. 15 Persons who are displaced within the borders of a state are referred to as internally displaced persons (IDP).…”

Section: Introductionmentioning

confidence: 99%

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Oral disease burden amongst residents of an internally displaced persons camp in Nigeria

Nnawuihe

Otakhoigbogie

2021

Nig J Dent Res

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Objective: To assess the prevalence of oral diseases and conditions amongst residents of an isolated camp that caters for internally displaced persons to define their oral health need in order to facilitate surveillance and planning of interventional programmes. Methods: A cross-sectional study carried out among randomly selected residents of a camp at Uhogua village forest reserve, Edo State, Nigeria. Socio-demographic data was obtained using an interviewer-administered questionnaire. Oral examination was carried out under natural illumination using mouth mirror, wooden spatula and blunt dental explorer. Oral hygiene was graded using Simplified Oral Hygiene Index. Diagnoses of caries and periodontal disease were according to the World Health Organization criteria. Clinical diagnosis of oral lesions/conditions was by visual inspection. IBM SPSS version 25.0 was used for descriptive and inferential analysis at 95% confidence interval with p set at < 0.05 significance. Results: The mean age of the 437 study participants was 15.81 ± 8.42 with a range of 4 - 71 years. Males (43.0%), females (57.0%) and participants with primary education (78.7%). Only 3.4% of the study participants had good oral hygiene and 11.9% of the group had periodontal pockets. Dental caries prevalence was 19.7%. The DMFT/dmft index value was 0.33/0.13 with PUFA/pufa score of 0.06/0.02. However, 35.0% of permanent teeth and 79.0% of deciduous teeth had evidence of dento-oral infection and ulceration. The prevalence of oral ulcers (1.8%), leukoplakia (2.1%), erythroplakia (0.5%), oral candidiasis (5.3%), cleft palate (0.2%) and traumatic dental injury (4.3%). were noted. Lower educational attainment was associated with presence of periodontal pockets (p=0.029) and dental caries (p=0.004). Conclusion: Poor oral hygiene was prevalent in this group. Although the prevalence of oral diseases and conditions were low in comparison with previous local studies, many of the carious lesions had signs of dento-oral infections. Improved access to education with a significant oral health education content and preventive oral health services are recommended strategies in reducing the oral health challenges of this group.

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“…Whether these diminished returns of education on various health outcomes remain in middle-aged and older adults and whether these patterns remain the same over a long period are still unclear [31]. Most of this literature is on the comparison of non-Hispanic Whites and non-Hispanic Blacks, and less is known about comparisons between Hispanics and non-Hispanics [32][33][34]. Moreover, almost nothing is known on how Hispanic and non-Hispanic older adults vary in the long-term effects of education on the burden of depressive symptoms.…”

Section: Introductionmentioning

confidence: 99%

Combined Effects of Ethnicity and Education on Burden of Depressive Symptoms over 24 Years in Middle-Aged and Older Adults in the United States

Assari

2020

Brain Sciences

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Ethnicity and educational attainment are among the major social determinants of depression in the general population. While high education credentials protect individuals against depressive symptoms, this protection may be weaker for ethnic minority groups such as Hispanic Whites compared to the majority group (non-Hispanic Whites). Built on marginalization-related diminished returns (MDRs), the current study used 24-year follow-up data from a nationally representative sample of middle-aged and older adults to explore ethnic variation in the protective effect of education levels against the burden of depressive symptoms over time. Data for this analysis were borrowed from the Health and Retirement Study (HRS 1992–ongoing), a nationally representative longitudinal study. HRS followed 8314 middle-aged and older adults (50+ years old) for up to 24 years. From this number, 763 (9.2%) were Hispanic White, and 7551 (90.8%) were non-Hispanic White Americans. Education level was the independent variable. We had two outcomes. Firstly, using cluster analysis, individuals were categorized to low- and high-risk groups (regarding the burden of depressive symptoms over 24 years); secondly, average depressive symptoms were observed over the 24 years of follow up. Age and gender were the covariates. Ethnicity was the moderator. Linear and logistic regression were used for analysis. Logistic regression showed that, overall, high educational credentials reduced the odds of chronic depressive symptoms over the 24 years of follow-up. Linear regression also showed that higher years of education were associated with lower average depressive symptoms over time. Both models showed statistically significant interactions between ethnicity and graduation, indicating a smaller protective effect of high education against depressive symptoms over the 24 years of follow-up time among Hispanic with respect to non-Hispanic White people. In line with the MDRs, highly educated Hispanic White Americans remain at high risk for depressive symptoms, a risk that is unexpected given their education. The burden of depressive symptoms, however, is lowest for highly educated non-Hispanic White Americans. Policies that exclusively focus on equalizing educational gaps across ethnic groups may fail to eliminate the ethnic gap in the burden of chronic depressive symptoms, given the diminished marginal health return of education for ethnic minorities. Public policies must equalize not only education but also educational quality across ethnic groups. This aim would require addressing structural and environmental barriers that are disproportionately more common in the lives of ethnic minorities across education levels. Future research should test how contextual factors, residential segregation, school segregation, labor market practices, childhood poverty, and education quality in urban schools reduce the health return of educational attainment for highly educated ethnic minorities such as Hispanics.

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Educational Attainment and Self-Rated Oral Health among American Older Adults: Hispanics’ Diminished Returns

Cited by 14 publications

References 38 publications

Non-Hispanic Black Americans’ Diminished Protective Effects of Educational Attainment and Employment against Cardiometabolic Diseases: NHANES 1999-2016

Non-Hispanic Black Americans’ Diminished Protective Effects of Educational Attainment and Employment against Cardiometabolic Diseases: NHANES 1999-2016

Oral disease burden amongst residents of an internally displaced persons camp in Nigeria

Combined Effects of Ethnicity and Education on Burden of Depressive Symptoms over 24 Years in Middle-Aged and Older Adults in the United States

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