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Social determinants of health (SDoH), factors related to the conditions in which people are born, live, work, play, age, and the systems that shape the conditions of daily life, have emerged as key drivers of health and health disparities. 1 , 2  A strong body of research supports that SDoH are associated with cardiovascular risk factors and outcomes, independently or in conjunction with more traditionally recognized risk factors. As a result, efforts to improve cardiovascular health are predicated on improved understanding of the impact of SDoH on cardiovascular disease (CVD) over the life course.

The developmental origins of disparities in common mental disorders

Health Contextualized: Inequalities in Physiological Function at the Intersection of Race, Skin Color, and Place

OBJECTIVE: Children exposed to institutional rearing often exhibit problems across a broad array of developmental domains. We compared the consequences of long-term, high-quality foster care versus standard institution-based care, which began in early childhood on cardiometabolic and immune markers assessed at the time of adolescence. METHODS: The Bucharest Early Intervention Project is a longitudinal investigation of children institutionalized during early childhood (ages 6 to 30 months at baseline) who were subsequently randomized to either high-quality foster care or continued institutional care. At the age of 16 years, 127 respondents participated in a biomarker collection protocol, including 44 institutionalized children randomly assigned to receive care as usual, 41 institutionalized children randomized to be removed from institutional care and placed in high-quality foster care in infancy, and a control group of 42 demographically matched children raised in biological families. Outcomes included body mass index (BMI), systolic and diastolic blood pressure, C-reactive protein, interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor α, glycosylated hemoglobin A1c, and Epstein-Barr virus antibody titers. RESULTS: Early institutional rearing was not associated with differences in cardiometabolic or immune markers. Randomization to foster care and age of placement into foster care were also unrelated to these markers, with the exception of BMI z-score, where children assigned to care as usual had lower BMI z-scores relative to children assigned to foster care (-0.23 versus 0.08, p = .06), and older age at placement was associated with lower BMI (β = -0.07, p = .03). CONCLUSIONS: The impact of institutional rearing on measures of cardiometabolic health and immune system functioning is either absent or not evident until later in development. These findings provide new insights into the biological embedding of adversity and how it varies developmentally and across regulatory systems and adversity type.

Having first reached epidemic proportions in coastal metropolitan areas, COVID-19 has spread 4 around the country. Reported case rates vary across counties from zero to 125 per thousand 5 population (around a state prison in the rural county of Trousdale, Tennessee). Overall, rural 6 counties are underrepresented relative to their share of the population, but a growing proportion 7 of all daily cases and deaths have been reported in rural counties. This analysis uses daily 8 reports for all counties to present the trends and distribution of COVID-19 cases and deaths in 9 rural counties, from late March to May 16, 2020. I describe the relationship between population 10 density and case rates in rural and non-rural counties. Then I focus on noteworthy outbreaks 11 linked to prisons, meat and poultry plants, and nursing homes, many of which are linked to 12 high concentrations of Hispanic, American Indian, and Black populations. The growing 13 epidemic in rural counties is apparently driven by outbreaks concentrated in these institutional 14 settings, which are conducive to transmission. The impact of the epidemic in rural areas may 15 be heightened due to their weaker health infrastructure and more vulnerable populations, 16 especially due to age, socioeconomic status, and health conditions. As a result, the epidemic 17 may contribute to the ongoing decline of health, economic, and social conditions in rural areas.

Objectives:  We examined changes in  health care access  and utilization associated with the Patient Protection and  Affordable Care Act  (ACA) for different Asian American subgroups relative to non-Latino whites (whites). Research Design:  Using 2003–2017 California Health Interview Survey data, we examined changes in 4  health care access  measures and 2 utilization measures among whites and 7 Asian American subgroups. We estimated the unadjusted and adjusted percentage point changes on the absolute scale from the pre-ACA to post-ACA periods. Adjusted estimates were obtained from multivariable logistic regression models that controlled for predisposing, enabling, and need factors. We also estimated the pre-ACA to post-ACA changes between whites and Asian American subgroups using a difference-in-difference approach. Results:  After the ACA was implemented, uninsurance decreased among all Asian American subgroups, but improvements in disparities relative to whites in these measures were limited. In particular, Koreans had the largest absolute reduction in uninsurance (−16.8 percentage points) and were the only subgroup with a significant reduction in terms of disparities relative to whites (−10.1 percentage points). However, little or no improvement was observed in the other 3 access measures (having a usual source of care, delayed medical care in past year, or delayed prescription drug use in past year) and 2 utilization measures (having a physician visit or emergency department visit in past year). Conclusions:  Despite coverage gains among Asian American subgroups, especially Koreans, disparities in access and utilization persisted across all Asian American subgroups.

We study how consumers make brand choices when they have limited information. In a market of experience goods with frequent product entry and exit, consumers face two types of information problems: first, they have limited information about a product’s existence; second, even if they know a product exists, they do not have full information about its quality until they purchase and consume it. In this chapter, we incorporate purchase experience and brand advertising as two sources of information and examine how consumers use them in a dynamic process. The model is estimated using the Nielsen Homescan data in Los Angeles, which consist of grocery shopping history for 1,402 households over 6 years. Taking ready-to-eat cereal as an example, we find that consumers learn about new products quickly and form strong habits. More specifically, advertising has a significant effect in informing consumers of a product’s existence and signaling product quality. However, advertising’s prestige effect is not significant. We also find that incorporating limited information about a product’s existence leads to larger estimates of the price elasticity. Based on the structural estimates, we simulate consumer choices under three counterfactual experiments to evaluate brand marketing strategies and a policy on banning children-oriented cereal advertising. Simulation suggests that the advertising ban encourages consumers to consume less sugar and more fiber, but their expenditures are also higher because they switch to family and adult brands, which are more expensive.

Faculty Associate Philip Cohen points to male smoking habits as an important factor in understanding the relative longevity of women