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Racial Disparities in Health Among College-Educated African Americans: Can Attendance at Historically Black Colleges or Universities Reduce the Risk of Metabolic Syndrome in Midlife?

ABSTRACT: We expand on existing understandings of health disparities among middle-class African Americans by examining how the postsecondary educational context gives rise to the unequal distribution of health. We used panel data (1994-2009) from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to estimate whether the risk of developing metabolic syndrome by midlife significantly differs for African Americans who attended Historically Black College or Universities (HBCUs) versus predominantly White institutions. We found that HBCU enrollment was associated with a 35% reduction in the odds of metabolic syndrome. Furthermore, we demonstrate that HBCU attendees who grew up in more segregated environments experienced the greatest reductions in the likelihood of developing metabolic syndrome. Our results underscore the important role that HBCUs play in the lives of African Americans and suggest their impacts go far beyond traditional benchmarks of socioeconomic achievement to include key health outcomes.

SUBMITTER: Colen CG

PROVIDER: S-EPMC8024041 | biostudies-literature | 2021 Apr

REPOSITORIES: biostudies-literature

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Racial Disparities in Health Among College-Educated African Americans: Can Attendance at Historically Black Colleges or Universities Reduce the Risk of Metabolic Syndrome in Midlife?

Colen Cynthia G CG Pinchak Nicolo P NP Barnett Kierra S KS

American journal of epidemiology 20210401 4

We expand on existing understandings of health disparities among middle-class African Americans by examining how the postsecondary educational context gives rise to the unequal distribution of health. We used panel data (1994-2009) from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to estimate whether the risk of developing metabolic syndrome by midlife significantly differs for African Americans who attended Historically Black College or Universities (HBCUs) versus ...[more]

PMID: 33150382

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Project description:ImportanceThere remains a lack of representation of Black physicians in the physician workforce despite decades of national efforts to increase diversity. Historically Black Colleges and Universities (HBCUs) contribute to increasing representation in the workforce in the US. There is limited literature exploring the experiences of HBCU premedical students navigating the journey to medical school.ObjectiveTo examine barriers to and facilitators of medical school matriculation among Black students by exploring the perspectives of premedical student advisers at HBCUs.Design, setting, and participantsIn this qualitative study, HBCU advisers participated in a focus group in October 2019 or in semistructured interviews from January 2020 to March 2021. Using purposive sampling, premedical student advisers were recruited from different educational backgrounds and geographic locations and conducted 1-on-1 interviews. Data analysis was performed from March 2021 to March 2022.Main outcomes and measuresThe main outcome was the experiences of HBCU premedical students navigating to medical school from the perspective of premedical advisers. An inductive approach to generate codes from the interviews and the focus groups was applied by reviewing transcripts and noting concepts and themes associated with advising strategies and student experiences.ResultsAmong the 26 participants, 18 (69.2%) were female, 13 (50.0%) had a doctorate degree, and 8 (30.8%) had more than 10 years of experience as advisers. Participants described 3 major themes: (1) the complex institutional relationship dynamics between undergraduate HBCUs and medical schools, (2) concerns about preferential treatment for students from predominantly white undergraduate schools when accessing clinical shadowing opportunities, and (3) the "it takes a village mindset" emphasizing family and peer involvement.Conclusions and relevanceIn this qualitative study, barriers to medical school matriculation included concerns for the preferential treatment of students from predominantly white institutions when engaging with medical schools and a lack of access to clinical opportunities for HBCU students. The findings suggest that medical schools should continue to build collaborative partnerships with HBCUs to ensure equitable access to opportunities that prepare students for medical school.

Project description:Predicting the admission scores of colleges and universities is significant for high school graduates in the College Entrance Examination in China (which is also called “Gaokao” for short). The practice of parallel application for the students after Gaokao not only puts forward a question about how students could make the best of their scores and make the best choice, but also results in the strong competition among different colleges and universities, with the institutions all striving to admit high-performing students in this examination. However, existing prevailing prediction algorithms and models of the admission score of the colleges and universities based on machine learning methods do not take such competitive relationship into consideration, but simply make predictions for individual college or university, causing low predication accuracy and poor generalization capability. This paper intends to analyze such competitive relationship by extracting the important features (e.g., project, location and score discrepancy) of colleges and universities. A novel competition model incorporating the coarse clustering is thus proposed to make the predictions for colleges and universities in a same cluster. By using Gaokao data of Shanxi province in China from 2016 to 2019, we testify the proposed model in comparison with several benchmark methods. The experimental results show that the precision within the error of 3 points and 5 points are 7.3% and 2.8% higher respectively than the second-best algorithm. It has proven that the competition model has the capability to fit the competitive relationship, thus improving the predication accuracy to a large extent. Theoretically, the method proposed could provide a more advanced and comprehensive view about the analysis of factors that may influence the admission score of higher institutions. Practically, the model proposed with high accuracy could help the students make the best of their scores and apply for the college and universities more scientifically.

Project description:ImportanceDespite much higher health care expenditure than comparable countries, striking racial and ethnic disparities exist in obstetric outcomes in the United States. A multifaceted exploration of the factors influencing these disparities, including the legacy of structural racism, is important to improve health outcomes for all.ObjectiveTo characterize the association of the historic racially discriminatory home loan practice of redlining with disparities in modern obstetric outcomes.Design, setting, and participantsIn this retrospective cohort study of a 9-county birth certificate database in the Finger Lakes region of New York state from 2005 to 2018, modern obstetric outcomes were matched with regions classified by the federal government for mortgage loan servicing based on racially discriminatory criteria from the 1940 Home Owners' Loan Corporation map (HOLC; also known as the redline map). Patients with a live birth recorded in the data system with a recorded home zip code within the historic HOLC categories were included. Data were analyzed from July to December 2019.ExposureRegions previously categorized by historic, racially discriminatory criteria.Main outcomes and measuresEach HOLC area was analyzed for the primary outcome of preterm birth and secondary outcomes of obstetric and medical complications, with logistic regression to address regional and patient-level covariates.ResultsFrom 2005 until 2018, there were 64 804 live births within the 15 zip codes overlaying historic HOLC regions. Prevalence of preterm birth increased with decreasing HOLC categories, from the lowest overall preterm birth rate of 217 of 2873 births (7.55%) in the zip code historically defined as "Best" or "Still Desirable" and the highest overall preterm birth rate of 427 of 3449 births (12.38%) in the zip code historically defined as "Hazardous." These associations with preterm birth remained significant in logistic regression controlling for poverty levels and educational attainment (adjusted odds ratio, 1.46; 95% CI, 1.08-1.97) and parental race (adjusted odds ratio, 1.38; 95% CI, 1.25-1.53).Conclusions and relevanceIn this cohort study, the linkage of historic and modern community data sets with an obstetric data set offered the opportunity to characterize modern obstetric disparities associated with a system of historic inequity. The persistence of these findings after correcting for contemporary community socioeconomic characteristics suggest potential influences of a system of profound structural inequity that ripple forward in time, with impacts that extend beyond measurable socioeconomic inequity.

Project description:IntroductionBlack students attending predominantly White institutions (PWIs) versus historically Black colleges and universities (HBCUs) report more harmful discrimination and develop worse mental health outcomes, potentially offsetting the established benefits of college for lowering dementia incidence.MethodsBlack participants in two cohorts (the Kaiser Healthy Aging and Diverse Life Experiences [KHANDLE] and the Study of Healthy Aging in African Americans [STAR]) who had attended college (N = 716) self-reported the college name (classified as HBCU vs. PWI) and completed three waves of executive function (EF) and verbal episodic memory (VEM) assessments. HBCU effects on cognitive level and decline were estimated using adjusted linear mixed-effects models.ResultsHBCU (vs. PWI) attendees averaged better EF (β = 0.05 [-0.22, 0.32]) and VEM (β = 0.21 [-0.06, 0.46]) at age 70 though neither association was statistically significant. HBCU attendance was associated with slightly faster VEM decline (β = -0.03 [-0.05, 0.00]).DiscussionHarmonized analyses with larger studies are needed to estimate important effects of HBCU attendance.HighlightsHigher education is robustly linked to lower dementia risk, yet Black-White inequities persist among college-educated adults. Black students attending predominantly White institutions (PWIs) versus historically Black colleges and universities (HBCUs) report more harmful discrimination and develop worse mental health outcomes, which may offset the established benefits of college for lowering dementia incidence. HBCU (vs. non-HBCU) attendees averaged better executive function and verbal episodic memory (VEM) at average age 70, though confidence intervals were wide and associations were not statistically significant, and averaged slightly faster decline in VEM. Harmonized analyses using larger nationally representative studies are likely needed to avoid underestimating the health effects of HBCU attendance.

Dataset Information

Racial Disparities in Health Among College-Educated African Americans: Can Attendance at Historically Black Colleges or Universities Reduce the Risk of Metabolic Syndrome in Midlife?

Publications

Racial Disparities in Health Among College-Educated African Americans: Can Attendance at Historically Black Colleges or Universities Reduce the Risk of Metabolic Syndrome in Midlife?

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