Despite evidence of immigrants' mental health advantage over natives, it remains unclear how this advantage evolves over the life course and what mechanisms underlie it. Using 28 years of longitudinal data from the Health and Retirement Study (1992-2020), this study shows that immigrants report lower levels of depression than natives in their 50s; however, this advantage declines with age and reverses around the mid-60s, when immigrants exhibit higher levels of depression. The pattern holds across ethnoracial and gender groups. Analyses of premigration and postmigration factors suggest that childhood environments-such as trauma, family structure, parental warmth, and financial conditions-play little role. Instead, vulnerability to joblessness and financial insecurity, discrimination, reduced social support, and neighborhood alienation account for about 80% of immigrants' steeper increase in depression. Notably, the erosion of immigrants' mental health advantage appears unrelated to their declining physical health advantage, indicating distinct mechanisms behind these trajectories.

A rich literature explores connections between the criminal-legal and health care systems, yet little is known about how law enforcement gathers information in medical settings or how these practices shape criminal-legal outcomes for patients. We address these gaps through a thematic analysis of criminal court files from 31 cases involving pregnancy loss from 2022 to 2024. Our analysis identifies three overlapping, informal "gates" through which information moves from health care settings to investigators: (1) investigatory initiations by health care workers, (2) disclosures of protected health information, and (3) law enforcement's physical access to patients in clinical spaces. These data reveal a porous boundary between the health care and the criminal-legal systems that reflects the deep entwinement of state power, medical practice, and social control in reproductive health care. In identifying these gates, our findings indicate that formal criminalization in cases involving pregnancy loss frequently depends on informal information sharing across institutional boundaries.

Gendered racism, rooted in the interlocking injustices of racism and sexism, is a contributor to poor mental health; its association with physical health outcomes, however, is not well understood. This study investigates whether gendered racism is associated with disease activity among Black women living with systemic lupus erythematosus (SLE). Data are from the Vascular Aging, Inflammation, and Stress in African American Women's Health Research Study (VISTA; 2017-2023). Analyses were restricted to Black women with SLE (N = 201). Results revealed more frequent gendered racism experiences were associated with greater disease activity; this association was attenuated yet remained significant after adjustment for depressive symptoms. Gendered racism experiences linked to Assumptions of Beauty and Sexual Objectification were most consistently associated with disease activity. Study results underscore the importance of examining intersectional injustice (e.g., gendered racism) as a social determinant of health.

The commercialization and corporatization of U.S. health care have intensified bureaucratic and economic constraints on clinical decision-making. Drawing on data from a 21-month ethnography of hospital-based clinicians, we introduce clinical advocacy as the often invisible work clinicians undertake to secure care that they judge medically appropriate when third parties external to the patient-provider relationship restrict medical practice. We identify four recurrent strategies of clinical advocacy: directly appealing to decision makers, altering medical records, manipulating hospital stays, and changing medical treatment. While these tactics can unlock lifesaving medical resources, they also come with negative consequences for patients in terms of medical risks and widening inequalities; for providers in terms of administrative burden, burnout, stress, and interprofessional conflict; and for the health care system in terms of inefficiencies and waste. We argue that clinical advocacy reflects a shift in institutional arrangements in which physicians increasingly function as frontline safeguards against third-party profit maximization.

Both pre- and post-Dobbs research has found that policies restricting abortion access are associated with an increased risk of adverse maternal and fetal outcomes. Previous research demonstrates stigma within reproductive health as a fundamental cause of health inequalities. In this study, we differentiate between state-level policies that restrict access to care compared to policies that foster uncertainty, stigmatize, or induce shame among abortion seekers through mandated counseling. Using data from the Pregnancy Risk Assessment Monitoring System survey (2011-2019), we estimate general linear models (N = 307,692) showing that for each additional shame-inducing abortion policy in a state's mandated counseling laws, birthing people were 3% more likely to have a preterm birth (risk ratio [RR] = 1.03; p < 0.01) and to give birth to a low-birth-weight baby (RR = 1.03; p < 0.001). We argue that the association between shame-inducing policy measures and adverse birth outcomes reflects an understudied feature of structural sexism that shapes reproductive health outcomes.

There is a broader tendency to understand research on minority mental health using a "they" versus "us" historical backdrop. Across time, the "minority paradox" emerged as a contemporary example of the way othering has positioned research to better understand why minorities have the same or better mental health rather than why non-Latino whites have poor mental health. I examined the association between racioethnicity and the lifetime prevalence of mental disorder using data from the Collaborative Psychiatric Epidemiology Studies (N = 19,840). Most racioethnic minorities had lower prevalence of mood, anxiety, and substance use disorder than non-Latino whites, a pattern consistent with decades of past and contemporary research. I argue a more appropriate label of these research findings would be a "white mental disorder paradox" rather than a minority paradox and provide recommendations for future research that could help explain poor mental health reported by non-Latino whites and adults of Puerto Rican descent.

Studies of immigrant health care routinely center less-advantaged persons in Global North contexts; U.S. scholarship frequently examines Latin American immigrants navigating the U.S. health landscape. Little work considers the health care experiences of U.S. citizens as immigrants as they are rarely labeled, analyzed, and debated comparably to less-advantaged immigrants. Instead of naturalizing the American experience as the point of comparison for immigrants, we can invert that dynamic by attending to Americans' experiences as immigrant patients abroad. This inversion generates insight into leaving behind familiar health practices, configurations, and ideologies. Americans in Spain move from an advantaged sending country to a less-wealthy context with superior health care access and outcomes. Through interviews with 41 U.S. citizens in Spain, I explore how Americans unlearn health care avoidance, experience novel possibilities, question internalized logics, and interpret doing care differently. Through studying Americans as immigrants, we see how migration facilitates the reexamination of health-related values, behaviors, and practices.

Cultural capital is theorized to comprise both a declarative (i.e., deliberate/conscious) and a nondeclarative (i.e., automatic/unconscious) element, also referred to as "embodied." While the latter is considered crucial in everyday health-related choices and in explaining why members of the higher strata more often make healthier ones, extant quantitative research has been unable to empirically measure it. This study implemented a novel method that measures nondeclarative cultural capital using implicit association tests and embedded it within a high-quality panel drawn randomly from the official Dutch population register (N = 2,436). Both declarative and nondeclarative cultural capital prove to be independently associated with adherence to dietary guidelines and contribute to the relationship between educational attainment and adherence to dietary guidelines. This analysis more validly tests common theorizing on cultural capital's role in stratified health patterns and suggests it is larger than assumed based on research solely relying on measures of declarative cultural capital.

This study examines the relationship between early-life bilingualism and midlife cognitive health. Using data from the 1980, 1982, and 2021 waves of High School and Beyond: 1980 (N ≈ 13,980), we find that bilingual adults show higher midlife cognition scores, but the association weakens after adjusting for early-life academic achievement and educational expectations. Becoming bilingual before school entry is not associated with stronger midlife cognition than monolingualism or becoming bilingual after school entry. English-first bilingual speakers do not exhibit better midlife cognition than either English monolingual speakers or non-English-first bilingual speakers. By situating the debate about the cognitive benefits of bilingualism within broader educational and stratification contexts, our results highlight early-life educational inequalities as a key mechanism driving the apparent relationship between early-life bilingualism and midlife cognition.

This study examines the independent and interactive effects of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) on adolescent substance use. Guided by resilience theory, we analyze data from the 2024 Florida Youth Substance Abuse Survey, a representative sample of 18,962 high school students. Negative binomial regression models indicate that greater ACE exposure is significantly associated with increased substance use, whereas greater PCE exposure is associated with decreased substance use. Although the interaction between ACEs and PCEs is statistically significant, analyses of predicted counts and average marginal effects suggest that the moderating effect is modest rather than strongly protective. PCEs decrease overall substance use but do not substantially attenuate the association between ACE exposure and substance use. These findings clarify how compensatory and buffering processes operate differently in shaping adolescent health behavior.

By analyzing 3,094 U.S. counties from 2015 to 2019, this study examines spatial spillover effects of state policy environments on county-level mortality rates. I developed a weighted spatial difference score that captures relative policy contrasts between neighboring states and geographic proximity to borders. Consistent with prior studies, more liberal state policies are associated with significantly lower mortality rates. After considering spatial spillovers, I found that counties experience cross-border spillovers based on policy differences with neighbors: Those bordering states with relatively more liberal policies showed lower mortality than their own policies predict, while those bordering states with relatively more conservative policies showed higher mortality (11.8 additional deaths per 100,000 per 1 SD of policy contrast). Importantly, conventional models ignoring spatial spillovers underestimated direct policy effects by 24.8%, systematically undervaluing policy interventions' true health returns.

Using 20,771 participants from the National Longitudinal Study of Adolescent to Adult Health, we examined depressive symptom trajectories by immigrant generation from adolescence to midlife. Depressive symptoms were assessed across five waves using a validated four-item Center for Epidemiologic Studies Depression scale. Linear mixed effects models with a quintic polynomial age trajectory indicated that first- and second-generation immigrants reported higher adolescent symptoms than third-plus-generation peers (first generation: b = .433, p < .001; second generation: b = .476, p < .001) but experienced steeper declines in their 20s (first generation: b = -.030, p < .001; second generation: b = -.027, p < .001). By their 30s, both immigrant generations had fewer symptoms than third-plus-generation peers. Sociodemographic adjustment partially explained the immigrant adolescent disadvantage, whereas the immigrant adult advantage persisted. Depressive symptom disparities thus reverse across the life course, underscoring the need for developmentally and context-sensitive models of immigrant mental health.

Examination of cause of death patterns among disabled people is shrouded by death patterns in the general population. To remove this shroud, we focus on multiple causes of death (MCOD) comorbidity patterns between decedents with and without Down syndrome with Alzheimer's disease or unspecified dementia. Using 2005 to 2019 U.S. MCOD data, we examined comorbidity profiles of adults with (N = 7,936) and without (N = 4,593,118) Down syndrome using the broadest International Classification of Diseases (ICD-10) "List of 113 Selected Causes of Death" (selected cause groups) of death classification scheme as well as the ICD-10 "Specific Conditions" (specific causes). Comparison of these classification schemes revealed that the use of selected cause groups veiled comorbidities common among adults with Down syndrome-choking-related deaths, seizures and hypothyroidism. Results from this study underscore the necessity to change cause of death classifications schemes and/or the reporting of this information to account for differences and to mitigate data inequities.

Immigrants have similar or higher disability levels than the U.S.-born in later life, which is puzzling given they have a health advantage upon arrival. A popular explanation is that acculturation harms health, but existing evidence is mixed. This study constructs multidimensional acculturation measures (linguistic, residential, marital, civic) using the American Community Survey (N = 958,211) and examines their associations with disability. I find that immigrants indeed lose their health advantage over the U.S.-born between ages 65 and 80, but most acculturation measures predict lower rather than higher disability. Instead, I propose and find evidence for a theory of acculturative discordance, where (1) net of demographic and socioeconomic characteristics, immigrants who are acculturated on some dimensions but not acculturated on others have poorer health and (2) minoritized immigrants experience discordance between their behavioral inclusion into the U.S. society and exposure to structural exclusion and receive more disadvantaged health returns to acculturation than non-Hispanic White immigrants.