We propose a novel approach to test the fundamental cause theory (FCT) by analyzing the association between socioeconomic status (SES), as measured by the order titles "brothers" and "padres," and mortality in 2,421 German Catholic monks born between 1840 and 1959. This quasi-experiment allows us to study the effect of SES on mortality in a population with largely standardized living conditions. Mortality analyses based on Kaplan-Meier product limit estimation show that there were no statistically significant survival differences between the high and lower SES monks. This holds for all birth cohorts, indicating that monastic life offers health protection for monks with a lower SES regardless the disease patterns, causes of death, or main risk factors in a given period. These findings support the FCT: Whereas SES-related differences in mortality are a widely confirmed finding in the general population, a context with largely standardized conditions eliminates the importance of SES-related resources.

College education features prominently in research on determinants of deaths from substance use disorders and self-harm-outcomes collectively referred to as "deaths of despair" (DoD). Limited attention has been given to whether the protective effects of college education on indicators of despair vary by individuals' likelihood of college completion. We use data from the National Longitudinal Study of Adolescent to Adult Health for 6,145 individuals to test whether the protective effects of college completion on precursors to DoD vary according to individuals' propensity to attain a college degree. Understanding whether the benefits of college education differ depending on the propensity to complete it is important for designing effective educational policies. Using the heterogeneous treatment effects approach, we find that individuals with a relatively low propensity for graduating from college but who complete it have a lower likelihood of depressive symptoms, binge drinking, prescription drug abuse, and hard drug use.

Although research has identified how stressors are related to either physical or cognitive function in later life, we bridge these literatures by examining dual functionality (neither physical nor cognitive impairment) among Black, White, and Hispanic adults. Using data from the Health and Retirement Study (2006-2016), we investigated whether stressors and resources during childhood and adulthood are related to functional loss at baseline and longitudinally. Analyses revealed that lifetime trauma was associated with dual functionality impairment at baseline, but childhood stressors and everyday discrimination were prospectively associated with loss of dual functionality. Black and foreign-born Hispanic adults experienced earlier loss of dual functionality than White adults, and the effect of childhood stressors on the transition to impairment occurred earlier for U.S.-born Hispanic adults. Findings reveal the influence of exposures in childhood and adulthood on functional health in later life-and how resources may be a counterbalance to functional loss.

Black Americans experience the death of a parent much earlier in the life course than White Americans on average. However, studies have not considered whether the cardiovascular health consequences of early parental death vary by race. Using data from the National Longitudinal Study of Adolescent to Adult Health, we explore associations between early parental death and cardiovascular disease (CVD) risk in early to mid-adulthood (N = 4,193). We find that the death of a parent during childhood or adolescence (ages 0-17) or the transition to adulthood (ages 18-27) is associated with increased CVD risk for Black Americans, whereas parental death following the transition to adulthood (ages 28+) undermines cardiovascular health for both Black Americans and White Americans. These findings illustrate how a stress and life course perspective can help inform strategies aimed at addressing both the unequal burden of bereavement and high cardiovascular risk faced by Black Americans.

Although there is robust evidence that socioeconomic position influences later-life cognitive function, two issues limit knowledge regarding the nature and magnitude of these relationships and potential policy interventions. First, most social science research tends to treat cognition as a unitary concept despite evidence that cognitive outcomes are not interchangeable. Second, most biomedical research focuses exclusively on education, with limited attention to economic resources despite robust social science theoretical and empirical rationales for their role. Relatedly, there has been limited attention to how these relationships may vary across cohorts, even as educational and economic contexts have changed. Using the Health and Retirement Study (N = 36,494), we show that failing to attend to different facets of cognition, socioeconomic resources, and cohort differences leads to underestimates in the magnitude of educational and economic disparities in cognitive function and decline. This has important implications for appropriate policy interventions to address these disparities.

Although clinicians have been the focus of research on trust in health care, much of the health guidance Americans receive occurs outside clinical settings. School-based health education is one such setting. Given the importance of interpersonal dynamics to clinicians' work, trust likely features heavily in achieving health educators' outcomes. This study asks: How do health educators approach building trust with students? In interviews with 39 sexual health educators in Ohio and Illinois, I find that educators report several strategies that they use in their attempt to build student trust: They use personal anecdotes and informality to distinguish themselves from teachers; adjust their approach based on their race, gender, or age if they perceive these identities impede trust; and emphasize lessons are factual when facing pushback. My findings reveal key differences in how clinicians and nonclinical professionals approach trust and more broadly, how organizational factors impact health professionals' approach to trust.

The "countervailing powers" framework conceptualizes health care as an arena for power contests among key stakeholders, drawing attention to the moves, countermoves, and alliances that have challenged physicians' dominance since the 1970s. Here, we focus on one of the lesser known micro-level consequences of such forces for physicians: emotional distress. We draw on 145 interviews with frontline physicians across four U.S. cities during the COVID-19 pandemic to trace physicians' experiences with three countervailing forces: the state, health care organizations, and patients. We find that threats to physician dominance eroded physicians' sense of mastery (perceived personal control) at work, thereby prompting emotional distress, including anger and moral conflict. Conversely, in certain cases, acts of resistance may have helped increase mastery, thus moderating distress. Our findings advance the countervailing powers framework by elucidating some of the micro-level, personal consequences of macro-level power struggles and offer practical implications for understanding contemporary threats to physician dominance.

This research adopts an analytical spatial perspective to explain ethno-national health inequality between Palestinians and Jews in Israel. The work identifies the forces that instigated and maintained the spatial segregation of Palestinians and elaborates the role of segregation in generating health gaps between Palestinians and Jews. The analysis suggests a novel conceptualization of two types of segregation: (a) exclusion from the center and confinement to the periphery and (b) segregation within the geographic periphery. Using administrative data on COVID-19 incidence, hospitalization, and death and various health indicators for localities, I devise a decomposition method that evaluates the relative contribution of each type of segregation to the total health gap. The findings indicate that the segregation of Palestinians from the center and their confinement to peripheral regions are crucial determinants of their poor health outcomes and that the segregation of the Palestinian community within the geographic periphery also contributes to poorer health.

Most research on the strong relationship between education and cognitive aging has focused on years of schooling. Using data from the Wisconsin Longitudinal Study-a sample of White persons born in 1939-we explored whether greater curricular rigor in high school was also associated with better cognitive function in later life. We estimated multilevel structural equation models in data from 2,749 participants who attended 308 Wisconsin high schools, graduating in 1957. Independent of academic ability and performance and school-level financial and material resources, a more rigorous high school curriculum was associated with significantly better global cognitive functioning in 2020, when most participants were 81 years old. There was also a significant mediation via eventual degree attainment. The mediation was moderated such that men and participants from high socioeconomic status families benefited most from a rigorous curriculum. We discuss implications for modern educational policy.

Few studies examine how high-achieving Black women navigate chronic reproductive health morbidities. Black women are disproportionately more likely to experience uterine fibroids, with earlier onset and more severe symptoms. This study leverages a national mixed-methods data set of Black women academics to examine how they describe symptomatic fibroids impacting their careers and lives. We find that participants (1) actively coped by engaging in superwoman schema, (2) postponed treatment due to the demands of their tenure-track position, and (3) normalized pain. Our findings suggest a potentially high prevalence of uterine fibroids among Black women faculty, that symptomatic fibroids were an impediment to some women's careers, and that women with symptomatic fibroids often identified expectations of their careers as an impediment to seeking timely treatment. We provide insights for how highly educated, successful Black women cope and navigate career stress coupled with challenges resulting from chronic reproductive health morbidities.

The contextual predictors of mortality in the United States are well documented, but the COVID-19 pandemic may have upended those associations. Informed by the social history of disease framework (SHDF), this study examined how the importance of county contexts on adult deaths from all causes, drug poisonings, and COVID-19-related causes fluctuated during the pandemic. Using 2018 to 2021 vital statistics data, for each quarter, we estimated associations between county-level deaths among adults ages 25 to 64 and prepandemic county-level contexts (economic conditions, racial-ethnic composition, population health profile, and physician supply). The pandemic significantly elevated the importance of county contexts-particularly median household income and counties' preexisting health profile-on all-cause and drug poisoning deaths. The elevated importance of household income may be long-lasting. Contextual inequalities in COVID-19-related deaths rose and then fell, as the SHDF predicts, but rose again along with socio-political disruptions. The findings support and extend the SHDF.

The debt collection industry in the United States has grown in tandem with rising indebtedness. Prior research on debt and mental health mainly treats debt as a resource and liability rather than a power relationship between creditors and debtors. We study the mental health consequences of debt collection pressure using data from the National Longitudinal Survey of Youth-1997 Cohort (N = 7,236). Drawing on stress theory and health power resources theory, we posit collection pressure as a relational stressor that undermines well-being through negative interactions with debt collectors, financial strain, role strain, and stigma. We find that more than one out of every three young adults in this cohort faced debt collection pressure by around age 40, with higher rates among low-income and Black young adults. Individual fixed-effects and lagged dependent variable regression models indicate that debt collection pressure is associated with increased psychological distress, with more severe consequences among low-income young adults.

This article examines variables that predict mental health care enrollment and engagement among refugees. The authors explore a mental health care model designed to identify mental health needs early among refugee arrivals that may interfere with adjustment and overall health outcomes using data from a Midwest refugee resettlement program. Using ecological models of mental distress and theories on help-seeking behaviors, the authors used logistic and count regressions to predict enrollment in mental health care services and utilization rates. Gender, nationality, and presenting problems were significant predictors of enrollment and length of engagement in services. The findings provide guidance to practitioners and resettlement agencies on refugee mental health and opportunities to increasing access and engagement in mental health care.

Cannabis can provide patients benefits for pain and symptom management, improve their functionality, and enhance their well-being. Yet restrictive medical cannabis programs can limit these potential benefits. This article draws on four years of research into Minnesota's medical cannabis program-one of the most restrictive in the United States-including in-depth interviews with patients and a survey of health care professionals. Drawing on the new materialist concepts of Deleuze and Guattari, this article analyzes (a) the benefits patients in Minnesota's medical cannabis program derive from cannabis, (b) how program restrictions mediate access to cannabis and its derived benefits, and (c) some key ways in which medical and criminal justice institutional authorities are reconfigured around medical cannabis. I show how the imperative to authoritatively govern "dangerous drugs" persists in consequential ways as the War on Drugs shifts toward a medicalized, criminalized, and commercial-legalized mixed regime.

Patient-centered care is widely cited as a component of quality contraceptive health care, but its operationalization in clinical interaction is contested. This article examines patient-centered care as an interactional phenomenon using the case of patient dissatisfaction with side effects of hormonal contraceptive medications. Drawing on transcript data from 109 tape-recorded reproductive health visits, I find that provider responses to treatment dissatisfaction range from patient-centered to relatively authoritarian. Providers typically offer patient-centered responses that validate patient experiences and integrate them into contraceptive counseling and method selection. At the same time, explicit communication about patients' contraceptive priorities is rare. In its absence, providers use patient-centered communication to smooth the interactional path toward uptake of highly effective hormonal methods, mostly ignoring the possibility that some patients may prefer less effective methods. Patient-centered contraceptive care was circumscribed by the clinical goal of pregnancy prevention.

This article examines how U.S. immigration law extends into the health care safety net, enacting medical legal violence that diminishes noncitizens' health chances and transforms clinical practices. Drawing on interviews with health care workers in three U.S. states from 2015 to 2020, I ask how federal citizenship-based exclusions within an already stratified health care system shape the clinical trajectories of noncitizens in safety-net institutions. Focusing specifically on cancer care, I find that increasingly anti-immigrant federal policies often reshape clinical practices toward noncitizens with a complex, life-threatening condition as they approach a "specialty care cliff" by (1) creating time penalties that keep many noncitizens in a protracted state of injury and (2) deterring noncitizens from seeking care through threats of immigration enforcement. Through these processes, medical legal violence also creates the potential for moral injury among health care workers, who must adapt clinical practices in response to socio-legal boundaries of belonging.

Scholars cite racist political-economic systems as drivers of health inequities in the United States (i.e., racial capitalism). But does racial capitalism generate health inequities? I address this open question within the historical context of predatory lending during the 2008 financial crisis. Relevant hypotheses are tested with multiple waves of data from Black and White participants of the National Longitudinal Study of Adolescent to Adult Health (N = 8,877). Across socioeconomic strata, I find that Black participants report higher rates of foreclosure, eviction, repossession, delinquent bills, lost income, and new debts in the wake of the financial crisis. Using structural equation and quasi-experimental models, I then show that Black participants also self-report rapid health declines and increases in prescription drug abuse throughout this period, much of which is explained by chronic financial stress. I conclude that racial capitalism can generate health inequities by ensnaring Black Americans in a toxic web of financial exploitation and stress proliferation.

There are competing perspectives on the impact of Hispanic immigrants' social networks on health; the Hispanic health paradox views networks as sources of resilience, whereas the tenuous ties perspective views networks as sources of risk. In this study, I explore the effect of networks on health by examining three network pathways: social capital, social bonding, and network stress. Using egocentric social network data from the VidaSana Study, a survey of 547 Hispanic immigrants in Indiana, I investigate how each network pathway is associated with physical health, mental health, and health care utilization. Results show that networks with greater capital, namely, more network health knowledge, promote physical health and health care access, whereas social bonding, operationalized as close and dense networks, benefits mental health and health care utilization. Network stress contributes to worse mental health yet improved health care access. Implications for social networks and health research among the Hispanics and more broadly are discussed.

With most scholarly attention directed toward understanding the stigma experiences of individuals with mental illness, less attention has been given to associative stigma: an understudied form of social exclusion and devaluation experienced by the social ties of stigmatized individuals. This study advances scholarly understanding of associative stigma by drawing on social network methods to better illuminate how the quantity and quality of social relationships with those dealing with mental illness impact experiences of perceived discrimination. Using a nationally representative sample from the General Social Survey, I find that (1) knowing more people with mental illness, (2) having more core (friends and family members) versus peripheral ties, and (3) having ties who are most at risk of facing public stigma themselves (e.g., stereotype-confirming ties) are associated with greater perceived discrimination experiences. Taken together, these findings shed light on how pervasive associative stigma truly is.

This study employs multichannel sequence analysis of data from the Survey of Health, Ageing, and Retirement in Europe to explore variations in the association between work-family life trajectories and women's mental health across European cohorts born between 1924 and 1965 within different policy contexts. It finds that trajectories characterized by prolonged employment and delayed familial commitments are generally associated with increased depressive symptoms. Notably, the strength of this association varies significantly across cohorts and is notably moderated by defamilization policies. These policies, which aim to reduce dependency on family for managing social risks, buffer mental health challenges in traditional family roles but are less effective for women in trajectories with delayed family formation. This investigation highlights the nuanced ways in which historical and cultural contexts alongside policy environments shape mental health outcomes at various life stages, offering valuable insights into our understanding of health disparities across the life course, with an emphasis on exposure to changing institutions.