Ning Hsieh’s research while affiliated with Michigan State University and other places

Not all U.S. populations have equal access to a primary care provider (PCP). This study presents one of the first population-based evidence of inequities in access to PCPs at the intersection of race/ethnicity, sexual orientation, and gender. We analyzed pooled data from the Behavioral Risk Factor Surveillance System from 2016 to 2021 across 42 states and 1 territory in the United States. The final sample encompassed 1,142,344 respondents aged 18 and older. Logistic regression models, stratified by gender spectrum, were estimated to compare predicted probabilities of having a PCP across 20 sexual and racial/ethnic identity groups. Among those on the feminine spectrum, most sexual minorities of color exhibited lower rates of having a PCP compared to heterosexual White individuals. Even when sociodemographic and health factors were accounted for, PCP access disadvantages remained significant in some groups of Native and Hispanic sexual minorities. Among sexual minorities of color on the masculine spectrum, inequities were less prominent, and sociodemographic and health factors nearly explained all their disadvantages. Sexual orientation, gender, and race/ethnicity intersect to shape the access to PCPs. Future research, policy designs, and clinical practices should adopt an intersectional approach to achieve a better understanding of healthcare inequities and to reduce inequities.

Objectives Recent studies have found that perceived discrimination as a chronic stressor predicts poorer cognitive health. However, little research has investigated how social relationships as potential intervening mechanisms may mitigate or exacerbate this association. Using a nationally representative sample of U.S. older adults, this study examined how the existence and quality of four types of relationships—with a partner, children, other family members, and friends—may modify the impact of perceived discrimination on incident dementia. Methods We analyzed data from the 2006–2016 Health and Retirement Study (N=12,236) using discrete-time event history models with competing risks. We used perceived discrimination, social relationships, and their interactions at the baseline to predict the risk of incident dementia in the follow-ups. Results Perceived discrimination predicted a higher risk of incident dementia in the follow-ups. Although having a partner or not did not modify this association, partnership support attenuated the negative effects of discrimination on incident dementia. Neither the existence nor quality of relationships with children, other family members, or friends modified the association. Discussion Our findings imply that intimate partnership plays a critical role in coping with discrimination and, consequently, influencing the cognitive health of older adults. While perceived discrimination is a significant risk factor for the incidence of dementia, better partnership quality may attenuate this association. Policies that eliminate discrimination and interventions that strengthen intimate partnership may facilitate better cognitive health in late life.

Widowhood has been identified as a risk factor for cognitive decline and dementia. Yet less is known about the protective and exacerbating factors of cognitive decline following widowhood. This study examines the roles of friendship characteristics in moderating the negative effect of spousal loss on cognition for older Americans. Drawing on data from the 2006-2018 Health and Retirement Study, we aim to answer two questions: 1) whether friendship network and quality moderate the association between spousal loss and cognitive decline in late life; 2) whether the moderating effect of friendship characteristics on cognition differ for men and women. Cognitive trajectories were assessed every other year from 2006 to 2018 (in total 7 waves). Friend characteristics were assessed in the 2006 psychosocial questionnaire and included the number of close friends, contact frequency, and support and strain from friends. The analytical sample comprised 3,636 respondents aged 50 and older who were married in 2006 and participated in the psychosocial questionnaire. Among the final sample, 370 lost spouses between 2006 and 2010, and 3,266 remained married throughout the observation period. Preliminary results from latent growth curve models showed that several characteristics of friendship including contact frequency and strain from friends are significantly associated with cognitive function at baseline. Furthermore, strain from friends interacted with widowhood status and gender to shape cognitive trajectories. Specifically, higher friendship strain was associated with a faster cognitive decline for the widowed but not for the married a pattern observed only among men but not women

Objective This study examines the long‐observed marital advantage in happiness during the COVID‐19 pandemic. Background The COVID‐19 pandemic may have altered the marital advantage in happiness due to changes in social integration processes. However, this has not been explored in previous studies. Method Data were from the COVID‐19 substudy of the National Social Life, Health, and Aging Project ( N = 2622). A series of regressions were estimated to understand marital status differences in pandemic happiness and changes in relationships with nonresident family and friends. Karlson–Holm–Breen mediation analysis was conducted to examine whether relationships with nonresident family and friends explained the marital association with pandemic happiness. Results From pre‐pandemic to pandemic, married respondents experienced a greater increase in unhappiness than unmarried counterparts, narrowing happiness gaps. However, unmarried individuals, including cohabiting, divorced, widowed, and never married individuals, continued to report higher levels of unhappiness during the pandemic than married peers. These differences primarily stemmed from pre‐pandemic happiness. After controlling for pre‐pandemic happiness, cohabiting, widowed, and never married older adults did not significantly differ from their married counterparts in reporting unhappiness during the pandemic. In contrast, divorced individuals remained consistently more unhappy than married individuals during the pandemic, mainly due to deteriorated relationship quality with nonresident family. Conclusion During a global crisis, it is crucial for policymakers, healthcare providers, and researchers to develop innovative interventions to promote happiness and healthy aging among all older adults, paying special attention to those who are divorced.

Health care research has long overlooked the intersection of multiple social inequalities. This study examines influenza vaccination inequities at the intersection of sexuality, gender, and race-ethnicity. Using data from the 2013 to 2018 National Health Interview Survey (N = 166,908), the study shows that sexual, gender, and racial-ethnic identities jointly shaped flu vaccination. Specifically, White gay men had the highest vaccination rate (56%), while Black bisexual women had the lowest rate (23%). Across Black, Hispanic, and White individuals, sexual minority women had lower vaccination rates than heterosexual women, but sexual minority men had higher or similar vaccination rates than heterosexual men. Economic enabling, noneconomic enabling, and need-based factors together explained a substantial portion of these gaps. However, they cannot explain all the disadvantages faced by Black lesbian, bisexual, and heterosexual women and Black heterosexual men. Findings offer new evidence of hidden health care inequities and inform health policies from an intersectional perspective.

Individual health is affected not only by characteristics and behaviors of the individual, but also by the environment in which the individual lives. Although neighborhood effects are well-established in the health literature, whether these effects are different for sexual minority populations is unknown. There is evidence that the neighborhoods in which sexual minorities reside are distinct from those in which heterosexuals reside, which could give rise to differential neighborhood effects. This research uses restricted data from the National Center for Health Statistics Research Data Center—which include neighborhood identifiers—to investigate health-relevant differences between the neighborhoods in which heterosexuals and sexual minorities reside. We also provide preliminary evidence on whether neighborhood effects explain any or all the disparities in health behaviors or health outcomes between sexual minority and heterosexual populations or mediate or moderate the effects of other covariates in explaining these disparities.

Previous research has suggested that unmarried persons may be disadvantaged in personal networks and social support. However, little is known about whether the quantity and quality of social relationships differ by marital status among older Americans. Using data from the 2006 and 2008 psychosocial questionnaires of the Health and Retirement Study, we examined the quantity and frequency of contact of three types of social relationships (i.e., friends, children, and family members) as well as the quality of these ties across six marital status groups (i.e., first married, remarried, cohabiting, divorced/separated, widowed, and never married). Our analytic sample included 13,087 respondents aged 51 and above. Multiple linear regression was used for the analysis. Our results show significant differences in social relationships by marital status. In terms of relationships with friends, compared to first-married persons, all the unmarried groups (except the cohabitors) had more frequent contact with their friends and reported greater support as well as greater strain from their friends, controlling for demographic covariates. Remarried persons and cohabitors were largely similar to their first-married counterparts except that both had fewer friends they felt close to, and the cohabitors also reported greater strain with their friends. In terms of relationships with children, all the unmarried groups except for widowed persons had fewer children they felt close to. All the unmarried groups were also disadvantaged in contact frequency and perceived social support from their children. Remarried persons were significantly disadvantaged compared to first-married persons in contact frequency and relationship quality with their children. These associations were largely robust when health and socioeconomic conditions were controlled for. In terms of relationships with family members, there were only a few significant differences across marital status groups. Our findings show the crucial role of marital status in shaping social relationships in later life.

Introduction: Although religiosity is known to predict lower suicide risk among the general population, it is unclear how different aspects of religiosity such as religious beliefs and attendance are associated with suicide risk among sexual minorities relative to heterosexual populations. Methods: Analyzing nationally representative data from the 2016-2019 National Survey on Drug Use and Health in 2022 (N=163,995), this study conducted logistic regressions to link suicidal ideation, plans, and attempts with religious beliefs and attendance. Moderation analyses were used to assess how religiosity is differentially linked to suicide risk among heterosexual, gay/lesbian, and bisexual males and females. Results: Although higher religiosity is consistently associated with lower suicide risk among heterosexual people, the effects of religiosity may be less beneficial or even harmful among sexual minorities. Specifically, religious attendance is associated with lower odds of suicidal ideation, plans, and attempts among heterosexual people, but it is also related to higher odds among gay/lesbian and bisexual people. In addition, religious beliefs are associated with lower odds of suicidal plans and attempts among heterosexual people, but this association is significantly weaker for bisexual people. These findings are more pronounced among gay males and bisexual females. Conclusions: Using population-based data, this study shows that the relationships between religiosity and suicide risk vary by sexual orientation and gender and that religious beliefs and religious attendance are differentially associated with suicide risk among sexual minorities. Future research should continue to explore how various aspects of religious participation may influence the mental health of diverse sexual minority communities.

Objectives: Marital and intimate partner relationships are some of the most important social ties that shape older adults' health and well-being. This paper provides analytic guidelines for the couple data in Round 2 (2010-2011) and Round 3 (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP) to encourage more research on marriage and partnership in late life. Method: First, we describe the recruitment of couples and outline how to identify partners in the data sets. Second, we provide descriptive information about the couple sample. Third, we offer guidance for analyzing the dyadic data cross-sectionally and longitudinally. Results: Round 2 interviewed all primary respondents and a sample of their current cohabiting partners and spouses (n = 955 couples). In Round 3, NSHAP reinterviewed the primary respondents and partners who participated in Round 2 (Cohort 1; n = 621 couples) and recruited a new sample of age-eligible adults along with any cohabiting romantic partners (Cohort 2; n = 766 couples). Couples can be identified using a household ID variable in Round 2 and a partner ID variable in Round 3. Demographic characteristics of the couple sample vary by round and cohort. Discussion: Researchers can use data from either round to conduct cross-sectional dyadic analyses to examine issues faced by older couples. A common strategy for couple analysis is the actor-partner interdependence model. With 2 rounds of couple-level data, researchers may consider using cross-lagged models in their research.