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Assari S, Zare H. Handing Money to the Poor Is Never Enough: The Impact of Marginalization-Related Diminished Returns. GLOBAL JOURNAL OF EPIDEMIOLOGY AND INFECTIOUS DISEASE 2024; 4:34-43. [PMID: 39220144 PMCID: PMC11364258 DOI: 10.31586/gjeid.2024.1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Recent US studies such as Baby's First Years have again demonstrated that unconditional cash transfers and guaranteed income do not lead to significant improvements in the health, economic status, and well-being of individuals living in poverty. In this perspective article we review the emerging literature on this topic and offer explanations for the observed outcomes. We then apply the theory and empirical evidence on marginalization-related diminished returns (MDRs) also called minorities diminished returns (MDRs) to elucidate the weak or null effects of cash transfers in the lives of marginalized populations. According to the MDR theory, marginalization not only reduces access to resources but also reduces their utility. Individuals who experience long-term poverty and marginalization exhibit smaller than expected benefits from new resources, such as cash, in adulthood. This is due to the deeply entrenched structural barriers and systemic discrimination that persist throughout their lives. The existing literature suggests that socioeconomic changes in adulthood have limited impact on the health and well-being of populations that have been raised in poverty. This is because the advantages of increased socioeconomic status (SES) are often undermined by ongoing marginalization and limited access to supportive resources and opportunities. As a result, simply providing cash transfers is insufficient to create substantial and lasting improvements in the lives of those living in poverty. To address these challenges, we recommend a multifaceted approach that includes childhood poverty prevention, interventions aimed at reducing marginalization, and comprehensive multi-sector strategies. By focusing on early intervention and addressing the root causes of poverty and marginalization, we can create more effective and sustainable solutions to improve health and well-being among disadvantaged populations. This holistic approach recognizes the complexity of poverty and the necessity of addressing both immediate needs and long-term structural barriers to achieve meaningful change.
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Affiliation(s)
- Shervin Assari
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
- Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States
- Marginalization-Related Diminished Returns (MDRs) Center, Los Angeles, CA, United States
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- School of Business, University of Maryland Global Campus (UMGC), College Park, United States
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Assari S. Parental Education and Children’s Sleep Problems: Minorities’ Diminished Returns. INTERNATIONAL JOURNAL OF EPIDEMIOLOGIC RESEARCH 2021. [DOI: 10.34172/ijer.2021.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background and aims: While increased parental education reduces children’s sleep problems, less is known about racial variation in such protection. According to Minorities’ Diminished Returns (MDRs) theory, economic resources such as parental education show weaker health effects for minority groups such as Blacks and Latinos than non-Latino Whites, which is due to racism and social stratification. In this study, we investigated the association between parental education and children’s sleep problems, as a proxy of sleep problems, by race. Methods: This cross-sectional study included 11718 American children aged 9-10. All participants were recruited to the Adolescent Brain Cognitive Development (ABCD) study. The independent variable was parental education, a five-level nominal variable. The dependent variable – sleep problems, was a continuous variable. Race/ethnicity was the effect modifier. Age, sex, and marital status were the covariates. Mixed-effects regression models were used for data analysis. Results: Parental education was associated with children’s sleep problems. However, there was a weaker inverse association seen in non-Latino Black and Latino families compared to non-Latino White families. This was documented by a significant statistical interaction between race and ethnicity and parental education on children’s sleep problems. Conclusion: Diminished protective effect of parental education on children’s sleep problems for non-Latino Black and Latino families compared to non-Latino White families is similar to the MDRs in other domains. Worse than expected sleep may contribute to higher-than-expected health risks of middle-class Black and Latino children.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA, USA
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Assari S, Boyce S. Resting-State Functional Connectivity between Putamen and Salience Network and Childhood Body Mass Index. Neurol Int 2021; 13:85-101. [PMID: 33806587 PMCID: PMC8006001 DOI: 10.3390/neurolint13010009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Although the putamen has a significant role in reward-seeking and motivated behaviors, including eating and food-seeking, minorities' diminished returns (MDRs) suggest that individual-level risk and protective factors have weaker effects for Non-Hispanic Black than Non-Hispanic White individuals. However, limited research is available on the relevance of MDRs in terms of the role of putamen functional connectivity on body mass index (BMI). PURPOSE Building on the MDRs framework and conceptualizing race and socioeconomic status (SES) indicators as social constructs, we explored racial and SES differences in the associations between putamen functional connectivity to the salience network and children's BMI. METHODS For this cross-sectional study, we used functional magnetic resonance imaging (fMRI) data of 6473 9-10-year-old Non-Hispanic Black and Non-Hispanic White children from the Adolescent Brain Cognitive Development (ABCD) study. The primary independent variable was putamen functional connectivity to the salience network, measured by fMRI. The primary outcome was the children's BMI. Age, sex, neighborhood income, and family structure were the covariates. Race, family structure, parental education, and household income were potential moderators. For data analysis, we used mixed-effect models in the overall sample and by race. RESULTS Higher right putamen functional connectivity to the salience network was associated with higher BMI in Non-Hispanic White children. The same association was missing for Non-Hispanic Black children. While there was no overall association in the pooled sample, a significant interaction was found, suggesting that the association between right putamen functional connectivity to the salience network and children's BMI was modified by race. Compared to Non-Hispanic White children, Non-Hispanic Black children showed a weaker association between right putamen functional connectivity to the salience network and BMI. While parental education and household income did not moderate our association of interest, marital status altered the associations between putamen functional connectivity to the salience network and children's BMI. These patterns were observed for right but not left putamen. Other/Mixed Race children also showed a pattern similar to Non-Hispanic Black children. CONCLUSIONS The association between right putamen functional connectivity to the salience network and children's BMI may depend on race and marital status but not parental education and household income. While right putamen functional connectivity to the salience network is associated with Non-Hispanic White children's BMI, Non-Hispanic Black children' BMI remains high regardless of their putamen functional connectivity to the salience network. This finding is in line with MDRs, which attributes diminished effects of individual-risk and protective factors for Non-Hispanic Black children to racism, stratification, and segregation.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
- Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Shanika Boyce
- Department of Pediatrics, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA;
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Assari S, Ayoubian A, Caldwell CH. Comparison of European, African, Asian, and Other/Mixed Race American Children for the Association Between Household Income and Perceived Discrimination. INTERNATIONAL JOURNAL OF TRAVEL MEDICINE AND GLOBAL HEALTH 2020; 9:31-38. [PMID: 34307699 DOI: 10.34172/ijtmgh.2021.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction Perceived discrimination is one of the reasons behind racial/ethnic health disparities. However, less is known about racial and ethnic groups differ in social determinants of discrimination. This study aimed to compare the association between household income and perceived discrimination among American children of different racial/ethnic groups. Methods The Adolescent Brain Cognitive Development (ABCD) study, a national longitudinal study, followed 4383 children 9-10 years old who were either European American, African American, Asian American, or mixed/other race for one year. We compared racial and ethnic groups for the association between baseline household income and perceived discrimination at the end of one year follow up. We used ANOVA and linear regression for data analysis. The outcome was perceived discrimination. The predictor was household income. Covariates were age, gender, and parental marital status. The moderator was race/ethnicity. Results In the total sample, high household income was associated with less perceived discrimination. There was an interaction between race and household income, suggesting a difference in the association between household income and perceived discrimination between African American and European American children. The inverse association between household income and perceived discrimination was weaker for African American than European American children. Conclusion High-income African American children are not well protected against perceived discrimination. High exposure to perceived discrimination may explain the worse expected health and development of middle-class African American children. As discrimination is a major social determinant of health, the results have considerable implications for public and health policy.
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Affiliation(s)
- Shervin Assari
- Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA.,Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Ali Ayoubian
- National Center for Health Insurance Research, Iran Health Insurance Organization, Tehran, Iran
| | - Cleopatra H Caldwell
- Department of Health Behavior and Health Education, University of Michigan, University of Michigan, Ann Arbor, MI 48109, USA.,Center for Research on Ethnicity, Culture, and Health, University of Michigan, University of Michigan, Ann Arbor, MI 48109, USA
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Assari S. Mental Rotation in American Children: Diminished Returns of Parental Education in Black Families. Pediatr Rep 2020; 12:130-141. [PMID: 33233814 PMCID: PMC7717656 DOI: 10.3390/pediatric12030028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 01/07/2023] Open
Abstract
Background: While parental education and family socioeconomic status (SES) are associated with an increase in children's cognitive functioning, and less is known about racial variation in these effects. Minorities' Diminished Returns (MDRs) suggest that, under racism and social stratification, family SES and particularly parental education show weaker effects on children's tangible outcomes for marginalized, racialized, and minoritized families, particularly Blacks, compared to Whites. Aim: We conducted this study to compare the effect of parental education on children's mental rotation abilities, as an important aspect of cognitive function, by race. Methods: This cross-sectional study included 11,135 9-10-year-old American children. Data came from baseline of the Adolescent Brain Cognitive Development (ABCD) study. The independent variable was parental education. The dependent variable, mental rotation, was measured by the Little Man Task. Ethnicity, gender, age, marital status, and household income were the covariates. Results: Parental education was positively associated with mental rotation. However, parental education showed a weaker association with mental rotation in Black than in White families. This was documented by a significant interaction between race and parental education on children's efficiency score. Conclusion: Parental education shows a weaker correlation with mental rotation of Black rather than White children, which is probably because of racism, social stratification, and discrimination. This finding is in line with the MDRs phenomenon and suggests that marginalization and racism may interfere with the influences of parental assets and resources and Black American children's development.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA; ; Tel.: +1-734-232-0445; Fax: +1-734-615-8739
- Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
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Abstract
While increased household income is associated with overall decreased screen time for children, less is known about the effect of racial variation on this association. According to Minorities' Diminished Returns (MDRs) theory, family income and other economic resources show weaker association with children's developmental, behavioral, and health outcomes for racialized groups such as black families, due to the effect of racism and social stratification. In this study, we investigated the association, by race, between family income and children's screen time, as a proxy of screen time. This longitudinal study followed 15,022 American children aged 9-11 over a 1-year period. The data came from the baseline of the Adolescent Brain Cognitive Development (ABCD) study. The independent variable was family income, and it was categorized as a three-level nominal variable. The dependent variable, screen time, was a continuous variable. Ethnicity, gender, parental education, and marital status were the covariates. The results showed that family income was inversely associated with children's screen time. However, there was a weaker inverse association seen in black families when compared with white families. This was documented by a significant statistical interaction between race and family income on children's screen time. Diminished association between family income and children's screen time for black families, compared with white families, is similar to MDRs and reflects a health risk to high-income black children. In a society where race and skin color determine opportunities and treatment by society, children from middle class black families remain at risk across multiple domains. We should not assume that income similarly promotes the health of all racial and ethnic groups. Addressing health and behavioral inequalities requires interventions that go beyond equalizing socioeconomic resources for black families. Marginalization, racism, and poverty interfere with the normal family income-related development of American children.
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Assari S. Age-Related Decline in Children's Reward Sensitivity: Blacks' Diminished Returns. RESEARCH IN HEALTH SCIENCE 2020; 5:112-128. [PMID: 33274304 DOI: 10.22158/rhs.v5n3p112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND It is important to study the correlates of reward sensitivity since it predicts high-risk behaviors. While ageing reduces children's reward sensitivity and its associated risk taking, there is more to find out about racial differences in regard to the effect of age on reward sensitivity. Minorities' Diminished Returns (MDRs) suggest that resources and assets show weaker effects on Black children than White children. AIM We compared White children to Black children as for the effects of age on reward sensitivity. METHODS This cross-sectional study included 10533 American children who participated in the baseline of the Adolescent Brain Cognitive Development (ABCD) study. The independent variable was age, while the dependent variable was reward sensitivity as captured by the behavioral approach/behavioral avoidance system (BAS-BIS). Gender, parental education, marital status, parental education, and household income were the covariates. RESULTS Higher age was associated with less reward sensitivity. A significant interaction was found between race and age when it comes to children's reward sensitivity. It suggested that age is associated with a smaller gain in terms of reduced reward sensitivity in Black children than White children. CONCLUSION Age is more likely to reduce reward sensitivity in White children than Black children. This finding is in line with MDRs, and may be due to social racism, segregation, stratification, and discrimination.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.,Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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Assari S. Parental Education and Nucleus Accumbens Response to Reward Anticipation: Minorities' Diminished Returns. ACTA ACUST UNITED AC 2020; 2:132-153. [PMID: 34308362 DOI: 10.22158/assc.v2n4p132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Considerable research has documented the effects of race and socioeconomic status (SES) on reward-seeking behaviors; however, less is known about the multiplicative effects of race and family SES on brain response to reward anticipation. Marginalization-related Diminished Returns (MDRs) suggest that family SES would show weaker effects on brain development of children in non-White families than in White families. Objective To test race by SES variation in Nucleus Accumbens (NAcc) response to reward anticipation (NAcc-RA) among American children. Methods For this cross-sectional analysis, data came from the Adolescent Brain Cognitive Development (ABCD) study which included 6,419, 9-10 year old children. The independent variable was parental education. The moderator was race. The primary outcome was the right NAcc-RA. Age, sex, ethnicity, household income, and family structure were the covariates. We used mixed effects regression models that adjusted for the nested nature of the ABCD data. Results While high parental education was associated with a higher amount of right NAcc-RA, this effect was stronger for White than non-White children. This finding was evident in the observed interactions between race and parental education on the right NAcc-RA. Discussion For American children, NAcc-RA is not shaped by race or family SES, but by their intersection. As a result of the interaction between race and SES (diminished return of SES for non-Whites), middle-class racial minority children may remain susceptible to high-risk behaviors. Disparities in high-risk behaviors in children should not be reduced to economic disparities. Structural inequalities may reduce the return of SES resources for non-White families.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles Drew University, Los Angeles, CA 90059, USA.,Department of Urban Public Health, Charles Drew University, Los Angeles, CA 90059, USA
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Assari S. Dimensional Change Card Sorting of American Children: Marginalization-Related Diminished Returns of Age. CHILDREN AND TEENAGERS 2020; 3:72-92. [PMID: 33299967 DOI: 10.22158/ct.v3n2p72] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND While age is associated with an increase in cognitive flexibility and executive functioning as a result of normal development during childhood, less is known about the effect of racial variation in children's age-related cognitive development. The Marginalization-related Diminished Returns (MDRs) phenomenon suggests that, under racism, social stratification, segregation, and discrimination, individual-level economic and non-economic resources and assets show weaker effects on children's development for marginalized, racialized, and minoritized families. AIM We conducted this study to compare racial groups of children for age-related changes in their card sorting abilities. METHODS This cross-sectional study included 10,414 9-10-year-old American children. Data came from the Adolescent Brain Cognitive Development (ABCD) study. The independent variable was age, a continuous variable measured in months. The dependent variable was dimensional change card sort (DCCS) score, which reflected cognitive flexibility, and was measured by the NIH Dimensional Change Card Sort. Ethnicity, sex, parental education, and marital status were the covariates. RESULTS Older age was associated with higher DCCS score, reflecting a higher card-sorting ability and cognitive flexibility. However, age showed a weaker association with DCCS for Black than for White children. This was documented by a significantly negative interaction between race and age on children's DCCS scores. CONCLUSION Age shows a weaker correlation with the cognitive flexibility of Black than of White children. A similar pattern can be seen when comparing low-income with high-income children. Conceptualizing race as a social factor that alters normal childhood development is a finding that is in line with MDRs. Marginalization due to social stratification and racism interfere with the normal age-related cognitive development of American children.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA.,Department of Urban Public Health, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA
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Assari S. Social Determinants of Delayed Gratification among American Children. CASPIAN JOURNAL OF NEUROLOGICAL SCIENCES 2020; 6:181-189. [PMID: 33215045 DOI: 10.32598/cjns.6.22.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A wide array of socioeconomic status (SES) indicators tend to show differential effects for members of diverse social groups. Limited knowledge exists on ethnic variation in the effects of family income on delay discounting which is predictor of risk behaviors. OBJECTIVES This study tested whether the effect of family income on delayed gratification differs between Latino and non-Latino children. METHODS AND MATERIALS In this cross-sectional analytical study, data came from wave one of the Adolescent Brain Cognitive Development (ABCD) study which included 3903 non-Latino or Latino Black or White American children between ages 9 and 10 years old. The predictor was family income. Data were collected in 21 sits in the US in 2018. The outcome was children's delay discounting. We measured delay discounting, which reflected individuals' tendency to assign less value to remote outcomes and rewards (inversely correlated with delayed gratification). Using SPSS 22.0, linear regression was used for data analysis. RESULTS According to our pooled sample regression, higher family income was associated with lower children delay discounting (Beta= -0.05, p = .021). We found a significant interaction between family income and ethnicity, suggesting that the association between family income and delay discounting is stronger for Latino than non-Latino children (Beta= -0.09, p = .043). CONCLUSIONS Not all ethnic disparities are due to SES gaps; differential returns of socioeconomic status indicators, such as family income, across diverse social groups also contribute to ethnic disparities in health.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R. Drew University, Los Angeles, CA 90059, USA
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