Health lifestyles are a well-theorized mechanism perpetuating health and social inequalities, but empirical research has not yet documented crucial aspects: (1) health lifestyles' collective nature or content beyond behaviors and (2) how people choose among available lifestyles in their social contexts. We conducted interviews, observations, and focus groups with families in two middle- to upper-middle-class communities. Contemporary class-privileged parenting involves constructing an individualized health lifestyle reliant on an expansive understanding of health and composed of parents' identities and narratives, children's health behaviors and identity expressions, and community norms. Children's predominant health lifestyles in our sample vary by focus on parent versus child identity expression and on future achievements versus present well-being. Parents expect health lifestyles to influence future socioeconomic attainment and health inequalities. Understanding how health lifestyles encompass more than behaviors and are locally contextualized and how people choose them within structural constraints can inform research and policy.

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.

Marital dissolution is a stressful transition that can lead to unhealthy coping strategies, including smoking and drinking. Using fixed effect linear probability models to assess health behavior changes, we analyzed 6,607 women and 6,689 men in the Household, Income, and Labour Dynamics in Australia data set who were either continuously married or experienced marital separation between 2002 and 2020. We observed 1,376 separations (744 women, 632 men). We found that drinking and smoking increases leading to and in the year of separation, with variability by gender, education, and parenthood status. From Cox proportional hazards models, we showed that among individuals who smoked (N = 337) or drank (N = 756) in the year of separation, cessation was most likely for the highly educated and/or women. Unhealthy coping mechanisms throughout marital dissolution suggests a need for targeted support to those separating, especially for men and those with children and lower education.

For decades, sociological research has examined the role of stigma in contributing to health disparities, yet such research seldom grapples with the interplay between individuals and structures. There is a particular paucity of research on abortion that concurrently examines individual experiences with stigma and structural barriers. In this article, we use telehealth abortion as a case, which now accounts for one in five abortions in the United States. We conducted 30 interviews and approach the data using a structural stigma framework in tandem with conceptualizations of felt, internalized, and enacted stigma. Findings advance a sociological theory of structural abortion stigma: a combination of structural barriers, internalized beliefs, and interpersonal shame. Telehealth reduces structural barriers to abortion and mitigates internal and interpersonal experiences of stigma. The latter is achieved by the ability to avoid the traditional abortion clinic, which many interviewees view as the site where stigma is produced and experienced.

During the COVID-19 pandemic in the United States, the success of public health authorities' strategies to curb the spread of the virus hinged on individuals' voluntary compliance with their directives. This study considers how two components of the cultural authority of public health influenced compliance with health guidelines during the pandemic: (1) individuals' views of public health officials as legitimate and (2) the shared value of health. I also examine the influence of other basic values, alongside health, on pandemic behavior. Data come from an original survey of 1,356 U.S. adults collected online in spring 2022. Findings reveal the pivotal role of perceived legitimacy of public health authorities in motivating compliance, even when considering perceived threat of the virus, political orientation, and other contextual factors. Results provide insight into why people complied with health guidelines by indicating how variation in individuals' value priorities influenced behavior.

Although structural sexism in state-level institutions is harmful to women's and men's health, less is known about how micro-level structural sexism relates to well-being. Using the 2017 and 2021 Gallup Values and Beliefs of the American Public surveys (N = 1,501 in 2017; N = 1,248 in 2021), we investigate diverse approaches to internalized sexism. Although we find no significant associations with self-rated health, gender traditionalism is linked to greater depressive and anxiety symptoms for women and men, providing the first population evidence for its universal harm in the United States. Although benevolent sexism shows no associations with mental well-being, hostile sexism is linked to greater symptoms among men. A diminished sense of mastery consistently accounts for these relationships, showing promise as a potential mechanism. These findings are suppressed by political conservatism and religious involvement, both of which lead to reporting greater-rather than diminished-well-being.

In recent decades, naturalization rates among U.S. immigrants have surged as many seek citizenship to regain lost rights and protections. However, the impact of naturalization on immigrants' life outcomes, such as health, remains underexplored in academic research. Challenges arising from selection processes complicate the interpretation of any observed health disparities between naturalized citizens and noncitizens. To address this gap, we link restricted-use data from the 2000 U.S. census to individual Social Security records on citizenship change and death, enabling a 20-year observation of naturalization and mortality. Results from discrete-time hazard analysis of mortality risk reveals a significant protective health effect from naturalization, which increases in magnitude among long-term naturalized citizens. The effect is particularly strong across older ages and among groups with lower education, refugee entry status, Hispanic origin, and health limitations. These findings suggest that naturalization represents an important but stratifying source of institutional support for socially vulnerable immigrants.

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.

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.

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.

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.

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.