title: Race by Gender Group Differences in the Protective Effects of Socioeconomic Factors Against Sustained Health Problems Across Five Domains.
abstract: BACKGROUND
  Despite the existing literature on the central role of socioeconomic status (SES; education and income) for maintaining health, less is known about group differences in this effect. Built on the intersectionality approach, this study compared race by gender groups for the effects of baseline education and income on sustained health problems in five domains: depressive symptoms, insomnia, physical inactivity, body mass index (BMI), and self-rated health (SRH).
  
  
  METHODS
  Data came from waves 7, 8, and 10 of the Health and Retirement Study (HRS), which were collected in 2004, 2006, and 2010, respectively. The study followed 37,495 white and black men and women above age 50 for up to 6 years. This number included 12,495 white men, 15,581 white women, 3839 black men, and 5580 black women. Individuals reported their depressive symptoms (Center for Epidemiological Studies-Depression (CES-D) 11), insomnia, physical inactivity, BMI, and SRH across all waves. Multigroup structural equation modeling (SEM) was used to compare black men, black women, white men, and white women for the effects of education and income in 2004 on sustained health problems from 2004 to 2010.
  
  
  RESULTS
  In the pooled sample, higher education and income at baseline were associated with lower sustained health problems across all five domains. However, race by gender group differences were found in the effects of education and income on sustained insomnia, physical inactivity, and BMI, but not depressive symptoms and SRH. The protective effects of education against insomnia, physical inactivity, and BMI were not found for black men. For black women, the effect of education on BMI was not found. Income had a protective effect against sustained high BMI among white and black women but not white and black men.
  
  
  CONCLUSIONS
  The intersection of race and gender alters the protective effects of social determinants on sustained health problems such as insomnia, physical inactivity, and BMI. Social groups particularly vary in the operant mechanisms by which SES contributes to maintaining health over time. The health effects are less universal for education than income. Race by gender groups differ more in SES determinants of BMI, insomnia, and physical inactivity than depressive symptoms and SRH.
authors.affiliation: Department of Psychiatry, University of Michigan, 4250 Plymouth Road, SPC 5763, Ann Arbor, MI, 48109-2700, USA. assari@umich.edu.|Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI, USA. assari@umich.edu.
authors.forename: Shervin
authors.initials: S
authors.lastname: Assari
authors.affiliation: Academy of Applied Pharmaceutical Sciences, Toronto, ON, Canada.
authors.forename: Amirmasoud
authors.initials: A
authors.lastname: Nikahd
authors.affiliation: Shahrekord University of Medical Sciences, Shahrekord, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Malekahmadi
authors.affiliation: Medicine and Health Promotion Institute, Tehran, Iran.
authors.forename: Maryam Moghani
authors.initials: MM
authors.lastname: Lankarani
authors.affiliation: Tehran University of Medical Sciences, Tehran, Iran.|Qom University of Medical Sciences, Qom, Iran.
authors.forename: Hadi
authors.initials: H
authors.lastname: Zamanian
keywords: Activity; Blacks; Body mass index; Depression; Education; Ethnic groups; Gender; Income; Obesity; Whites