Despite rising suicide rates in the United States, we know little about how people experience suicidality and how they access healing from suicidality. Using semistructured interviews with 102 suicide survivors-those who have seriously considered and/or attempted suicide-I ask: How do suicide survivors make sense of suicide disclosures, and what generates healing from suicidality? Using a micro-sociological Durkheimian framework, these data suggest that when suicide disclosures share two elements, narrative freedom and an empathetic audience, they facilitate social integration and thereby promote healing. Narrative freedom occurs when survivors have the agency to construct their own disclosures; an empathetic audience receives disclosures with understanding. Together, these two characteristics promote a micro-sociological social integration, which, in turn, facilitates healing from suicidality. These findings contribute to the sociology of suicide by applying Durkheim's integration at the interpersonal level and highlighting the social factors that promote healing rather than solely risk.

We characterize the way human immunodeficiency virus (HIV) stigma hinders HIV conversations and testing. Using grounded theory principles, we analyzed in-depth interviews of the experiences of select Philippine key populations (groups with high HIV burden) and their families: 19 men who have sex with men (KPM), 16 transgender women (KPW), and 16 parents of KPM/W. Results show how KPM/W protect the state of being respected by others (management of social standing), a task they engage in by strategically modulating behavior in different life domains, including when considering HIV conversations and testing. Our results specify the management of social standing as an object being threatened by stigma and as a process making KPM/W behavior susceptible to the influence of HIV stigma, even for KPM/W who may not possess the mark of positive serostatus. This raises questions about the theorizing of stigma, which traditionally has focused on the susceptibility of marked but not unmarked individuals.

Research demonstrates that perceived discrimination negatively impacts health. Yet there is conflicting evidence about how an individual's definition of discrimination-separate from their experience of discrimination-shapes health disparities. Using a nationally representative survey experiment in which participants (N = 2,000) are asked to evaluate nine different scenarios of potential discrimination, we find that how a person labels these discrimination scenarios is significantly related to their self-rated health, even after controlling for sociodemographic factors. U.S. adults who are more likely to label the event as discrimination in cases where it is intentional have comparatively worse self-rated health, whereas those who are more likely to label discrimination in cases where it affects more powerful groups (White people, men, and the wealthy) have comparatively better self-rated health-even though they are not experiencing the discrimination themselves. We argue that these findings have important implications for how health researchers measure discrimination's health effects.

Although some people feel that medication reveals a more authentic version of themselves, others question whether medication alters their true personality and behavior. Interrogating these effects occurs at all ages, yet knowing and defining oneself also represents a milestone toward becoming an adult. How do individuals conceptualize the relationship between medication and authenticity at different life stages? I examine perceptions of hormonal contraception and menopausal hormone therapies to answer this question. In interviews with 60 cisgender women across the United States, I find that younger women conceptualized hormonal contraception in emerging adulthood as a threat to knowing and being their authentic self. Meanwhile, women in midlife largely understood hormones used during perimenopause and menopause to recover authenticity. I argue that life stage interacts with how women perceive the effects of synthetic hormones. These findings emphasize the importance of the pursuit of authenticity for patterns of medication use more broadly.

The John Henryism hypothesis (JHH) suggests high John Henryism may adversely affect the health of individuals with low socioeconomic status (SES). Although prevalent among Black Americans, its impact on Black women's mental health across ethnic subgroups remains understudied. Using National Survey of American Life data (2001-2003), a factor analysis and negative binomial regression examined John Henryism patterns and psychological distress among 1,209 African American and 371 Caribbean Black women. Distinct factor structures indicated the need for group-specific versions of John Henryism variables to capture its role within each population. The analysis found no direct link between John Henryism and distress for either group. However, after accounting for sociodemographic factors and stressors, high John Henryism was associated with lower distress among Caribbean Black women. Evidence supporting the JHH was found only among Caribbean Black women, where John Henryism was protective for those with low and moderate SES but unrelated to distress for high-SES individuals.

This study investigates whether local social capital (neighbor networks and norms of trust/reciprocity) buffered the impact of mixing/mobility restrictions on psychological distress during the COVID-19 pandemic. It draws on two nationally representative panel surveys: the UK Household Longitudinal Study (UKHLS) Mainstage survey (n = 31,805 person-observations) and UKHLS COVID-19 survey (n = 22,933 person-observations), a subsample of the Mainstage survey respondents followed during the pandemic. Individual-level and (prepandemic/peripandemic) contextual-level local social capital indicators are tested. Longitudinal fixed-effects analyses indicate that distress increased with the onset of mixing restrictions, and peripandemic psychological distress increased more in areas experiencing greater spatial immobility (measured using Google spatial mobility data). However, increases in distress were significantly smaller among individuals reporting both higher individual and contextual social capital. Differences in social contact or neighborhood social support did not explain social capital's buffering role. Results suggest social capital be considered a key element of crisis preparedness.

Although prior research identifies many social determinants of dementia, few studies look upstream toward dementia's macrosocial correlates, and fewer still consider macrosocial conditions in early life. This study focuses on state policy contexts in adolescence and, specifically, on state policy liberalism, defined as the overarching conservative-liberal orientation of state policies. We link panel data from a nationally representative sample of 6,410 U.S. adults ages 65 to 80 in the 2000 wave of the Health and Retirement Study with longitudinal data on state policy liberalism extending back in time to when respondents were young. Discrete-time hazard models examine relationships between state policy liberalism and the development of dementia from 2000 to 2016. Results show that more liberal state policy contexts in adolescence are associated with lower dementia risk in older age. Policy contexts over the life course and especially in early life warrant further exploration as macrosocial determinants of dementia.

This study examined how structural ableism, conceptualized through the social determinants of health framework, impacts health outcomes among people with disabilities. Using multilevel regression analysis with data from the 2020 National Survey on Health and Disability (N = 2,175) paired with state-level indicators from the 2019 American Community Survey, it investigated associations between state-level disparities (in educational attainment, income, health insurance coverage, housing accessibility, and public transportation access) and self-rated health and functional limitation. Results demonstrated that structural ableism operates through distinct pathways for each health outcome. Income, health insurance, and transportation gaps by disability status at the state level significantly predicted self-rated health, and health insurance and housing gaps were the strongest predictors of functional limitation. The findings provide empirical evidence that state-level arrangements create systematic patterns of health advantage or disadvantage that transcend individual experiences, emphasizing the need to address structural barriers associated with disability.

In the context of strong cultural beliefs associated with the American Dream, a prominent body of scholarship asserts that traits such as intelligence, self-confidence, and self-control play a pivotal role in the life course emergence of health inequalities by race and socioeconomic status (SES). We use prospectively ascertained data from approximately 50-year-old Black and White study participants (N = 605) whose mothers were recruited when pregnant with the participant. Follow-up into adulthood provided measures of cognitive and noncognitive traits, SES, and health needed to test trait explanations. Results show no evidence that traits are independently associated with adult health when SES is controlled or that they account for race or SES inequalities in health. Although the American Dream emphasizes individual traits as key factors shaping life outcomes, our results suggest the need to look elsewhere to understand why health inequalities by race and SES are such prominent social facts.

Childhood family structures are crucial for long-term health and well-being. However, the effects of an increasingly common family structure-multigenerational households comprising a child, parent(s), and grandparent(s)-remained underexplored. Using panel data from the National Longitudinal Survey of Youth 1979 and its young adult sample (N = 8,230), we examine trajectories of psychological distress among White, Black, and Hispanic adolescents and young adults across three dimensions of early life multigenerational coresidence: presence, duration, and onset. We find that Hispanic children who lived in multigenerational households, especially those beginning coresidence before age 1, reported steeper declines in distress and improved mental health over time. By contrast, multigenerational coresidence was consistently associated with higher distress levels among White adolescents and young adults. We do not find evidence of an association between multigenerational coresidence and Black children's mental health trajectories. These findings highlight potential racial patterns and add to our understanding of racial disparities in health.

"Consult your child's pediatrician for guidance"-this is a refrain parents hear repeatedly. Drawing on 43 interviews with 11 pediatricians and 32 parents of minor children, I find that many parents turn to pediatric providers to help them resolve a wide range of everyday anxieties related to childrearing. Many pediatricians, in turn, view providing substantial emotional support to parents as a central component of their jobs. I conceptualize this dynamic as a process of "emotional fortification." In working to emotionally fortify parents, pediatricians strive to foster a sense of calm and boost parental confidence. Through these interactions, parents can accumulate valuable emotional resources, including reduced stress and increased feelings of efficacy. Not all parents are equally positioned to reap these advantages, however. Here, I examine how emotional fortification, an undertheorized outcome of emotional labor, is sought and provided during pediatric health care encounters while considering how inequalities shape this process.

The mechanisms generating skin-tone-based health inequities among ethnic Black Americans remain poorly understood. To address this gap, our study advances a novel biopsychosocial model of embodied colorism-related distress. We test this model with survey and biomarker data from a community sample of working-age Black adults from Nashville, Tennessee (2011-2014; N = 627). Relying on self-rated, interviewer-rated, and discordant skin tone measures, our analyses reveal that Black adults who perceive themselves as dark-skinned tend to have a lower sense of mattering and shorter telomeres, a biomarker of accelerated cellular degradation and aging, relative to their peers who perceive their skin to be lighter. These patterns hold across various social contexts and regardless of interviewer-rated skin tone, indicating that subjective skin tone may be a particularly robust gauge of colorism-related stress processes. Our study reveals critical and previously unexplored biopsychosocial mechanisms linking colorism to health inequity.

This study draws on longitudinal data from the Health and Retirement Study (2008-2020) to investigate the dynamic bidirectional relationship between physical and mental health, focusing on socioeconomic disparities. Dynamic panel models reveal significant bidirectional associations between measures of physical and mental health for both positive and negative health indicators, but the magnitude varies by education and wealth. Specifically, the interconnection between indicators of negative physical and mental health (i.e., functional limitations and depression symptoms) is stronger among the socioeconomically disadvantaged, whereas the relationship between indicators of positive physical and mental health (i.e., physical activity and positive affect) is stronger at higher levels of wealth (although not education). By disentangling the bidirectional association between physical and mental health, these results imply an important process of the reproduction and perpetuation of health inequalities.

Exclusionary immigration laws and policies have been shown to produce adverse mental health outcomes. However, less work has traced the processes through which mental health experiences arise and how undocumented college students employ their agency to protect their mental health. Drawing on 66 in-depth interviews, I build on my interviewees' descriptions of mental health as a rollercoaster to illustrate how their stress process is shaped by immigration laws and students' agency. I find that ever-changing and unpredictable immigration laws and policies promote feelings of emotional distress. However, students utilize their agency to uplift themselves and support their psychological well-being. Yet despite their actions, emotional distress and psychological well-being coexist in students' everyday lives. Ultimately, I argue that students' agency supports their psychological well-being, but the immigration law and policy context they are embedded in limits their efforts and instead places them in a perilous emotional rollercoaster.

Despite awareness of racial-ethnic health inequalities in the United States, research on racial-ethnic differences in mothers' mental health remains scarce. Using data from the Early Childhood Longitudinal Study: 2010-2011 Kindergarten (N = 8,495), this study employs the stress process model to explore racial-ethnic differences in mothers' parenting stress and its associations with depression. To capture the multidimensionality of mothers' parenting stress, I conduct latent profile analysis to identify five types of parenting stress. Mothers' distributions across different types of parenting stress vary by race-ethnicity even when their overall parenting stress levels are similar. The relationships between each type of parenting stress and depression also differ by race-ethnicity. The findings underscore the need to consider different dimensions and types of parenting stress mothers face when studying racial-ethnic disparities in the mental health consequences of motherhood and exploring social inequalities in the relationship between stress and depression.

Although raising children with serious conditions is known to be associated with poorer parental well-being, recent research following a life course perspective highlights how these associations accumulate over time. Expanding this perspective on long-term dynamics of this parental experience, this study examined how three conceptualizations of the "intensity" of this parental role-caregiving duration, cumulative transitions into this role, and the number of affected children-shaped maternal physical health in midlife. Fixed-effects modeling of panel data from the National Longitudinal Survey of Youth 1979 (n = 8,305) revealed that all three dimensions significantly predicted poorer maternal physical health, with particular salience for cumulative transitions and the number of affected children. These associations were generally weaker when mothers had higher income or greater labor force participation, although such buffering effects applied more consistently to labor force participation and specifically to repeated transitions and mothers of two (vs. one) affected children.

The Healthcare Equality Index (HEI) evaluates compliance with LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender diverse individuals) inclusion in U.S. health care facilities and is associated with greater patient satisfaction. We examined how hospitals' metropolitan location and state-level LGBTQ+ health care policies are associated with voluntary HEI participation and performance. This cross-sectional study analyzed 6,120 U.S. hospitals from the 2022 American Hospital Association Annual Survey. Multilevel logistic regression assessed the relationship and varying impact of metropolitan status and state policies on HEI participation and HEI Leader status (highest performance). State policies had a stronger positive association with nonmetropolitan hospitals. Each additional policy increased HEI participation odds by 58% for nonmetropolitan hospitals (adjusted odds ratio [aOR] = 1.58; 95% confidence interval [CI] = 1.19, 2.10) and 21% for metropolitan hospitals (aOR = 1.21; 95% CI = 1.02, 1.43). No significant associations with HEI Leader status were observed. Strengthening LGBTQ+ inclusive state policies may encourage hospitals, particularly in nonmetropolitan areas, to adopt LGBTQ+ inclusion initiatives.

Higher education can expose young people to various health challenges, yet potential disparities in health across academic disciplines remain underexplored. This study analyzes panel data on self-rated health of 14,022 German university students across nine subject groups employing both random- and fixed-effects regression models to examine selection and potential causal mechanisms. The results show that students of medicine and health sciences reported consistently good health throughout their studies. By contrast, law students exhibited the highest initial health scores but experienced the steepest decline over time. Students in arts and humanities started with the lowest health scores, but no significant change was observed during their studies. Although initial health inequalities suggest selection effects, the observed within-change heterogeneity raises the possibility that academic majors influence student health trajectories. Field specialization could represent an important dimension of health inequality in higher education, potentially extending into later life stages.

A gap in the literature on social determinants of cognitive aging is the lack of focus on the interplay of cognitively stimulating environments across the life course. This study uses a life course perspective to propose and examine potential interaction and mediation effects between early and later life stimulating environments. Using rich cognitive assessments and egocentric network data from the state-representative Person to Person Health Interview Study (N = 685) conducted in Indiana, we find that associations between social bridging network (later life stimulating environments) and cognitive outcomes are strongest for people with less than a high school education (early life stimulating environments), constituting a moderating compensatory leveling effect rather than an added protection effect. Regarding mediation, we find no evidence of a cumulative (dis)advantage effect in the context of cognitive aging. Overall, this study presents a useful theoretical framework to study the interplay of cognitively stimulating environments across the life course.