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ObjectiveMarriage is considered to protect health via multiple mechanisms, but this effect may have weakened as marriage has become deinstitutionalized in the United States. This article tests for cross‐cohort decline in the protective effect of marriage.MethodsChange in the association between marital status and subjective general health over three birth cohorts was estimated using the 1984–2011 Panel Study of Income Dynamics (N = 12,373). Analyses included least‐squares, random‐effects, and fixed‐effects regression models, representing increasingly conservative approaches to ruling out selection bias.ResultsDespite associations between marriage and better health among both men and women, estimated by least‐squares and random‐effects regression, the fixed‐effects models found health improvement relative to remaining unmarried only in very long (≥10 year) marriages, and only among women. This effect was completely attenuated among women in the youngest birth cohort.ConclusionThe modest benefit of marriage for women's subjective health has eroded in recent cohorts.

We document patterns of intermarriage between immigrants and natives during a period of unprecedented growth in the size and diversity of America's foreign-born population. Roughly one in six U.S. marriages today involve immigrants and a large share includes U.S.-born partners. Ethno-racial background clearly shapes trajectories of immigrant social integration. White immigrants are far more likely than other groups to marry U.S.-born natives, mostly other whites. Black immigrants are much less likely to marry black natives or out-marry with other groups. Intermarriage is also linked with other well-known proxies of social integration—educational attainment, length of time in the country, and naturalization status. Classifying America's largest immigrant groups (e.g., Chinese and Mexican) into broad panethnic groups (e.g., Asians and Hispanics) hides substantial diversity in the processes of marital assimilation and social integration across national origin groups.

Health insurance stability among children with adverse childhood experiences (ACEs) is essential for accessing health care services. This cross-sectional study used an extensive, multi-year, nationally representative database of children aged 0 to 17 to examine the association between ACE scores and continuous or intermittent lack of health insurance over a 12-month period. Secondary outcomes were reported reasons for coverage gaps. Compared with children having 0 ACEs, those with 4+ ACEs had a higher likelihood of being part-year uninsured rather than year-round private insured (relative risk ratio [RRR]: 4.20; 95% CI: 3.25, 5.43), year-round public insured (RRR: 1.37; 95% CI: 1.06, 1.76), or year-round uninsured (RRR: 2.28; 95% confidence interval [CI]: 1.63, 3.21). Among children who experienced part-year or year-round uninsurance, a higher ACE score was associated with a greater likelihood of coverage gap due to difficulties with the application or renewal process. Policy changes to reduce administrative burdens may improve health insurance stability and access to health care among children who endure ACEs.

AbstractSocial determinants of health (SDH) have emerged as a major area of emphasis in medicine over the last 30 years. While increasing interest in SDH has led to a proliferation of literature on this topic, it is unclear whether the medical evidence base on SDH has assimilated contributions from other disciplines. We analyzed interdisciplinary contributions to the medical evidence base on SDH, using a bibliographic analysis of highly cited literature reviews. Medical review articles from 1990 to 2020 were queried using the Scopus database, with a keyword search in the title and abstract for "social determinants of health." The top 100 most highly cited articles were sampled for inclusion, and references in each review were screened to identify journal articles published in other disciplines. An initial Scopus search identified 502 eligible reviews. After reviewing the top 100 most highly cited articles, 40 articles published between 2000 and 2017 met our inclusion criteria. and received between 33 and 940 citations. These reviews included references to a median of 41 journal articles (interquartile range [IQR]: 25, 67), of which a median of 11 was from public health journals (IQR: 6, 18) and 4 were from other social science fields (IQR: 1, 11). On multivariable analysis, more recent reviews incorporated more sources from public health but not from other social science fields. Relevant SDH scholarship from sociology and related fields is not being integrated into the evidence base directed at clinician audiences and may be underutilized in shaping policy and practice in these areas.

A Correction to this paper has been published: https://doi.org/10.1007/s40615-021-01002-x

AbstractWhite privilege can be often overlooked and poorly understood in academic medicine, by those who wield it, and by those who suffer from its deleterious effects. Dr. Peggy McIntosh, a leader in research on equity and diversity in education, described white privilege as a set of unearned benefits that white people have based on being born white in a culture that favors the white race. White people have privilege because it was given to them by other white people, and it was taken by claiming superiority over people of color, starting before the European colonizations of Africa, Asia, and the Americas, and continuing through the present day. Many white people come from impoverished communities, suffer from socioeconomic disadvantage, and struggle with unemployment. They may also suffer from inadequate housing and limited education. Because they are white, they still benefit from privilege and positive stereotypes associated with light skin color. As our nation reckons with the murders of unarmed Black people by police, recognizing that many white people have been allies and agents of change forBlack and other minority people, discussing how the power of white privilege can be shared is needed. The authors discuss the power of white privilege and how that power can be shared to promote change in academic medicine.

AbstractIn participating states, Medicaid expansion under the Affordable Care Act (ACA) increased availability of health insurance to low‐income young adults. We examined the impact of Medicaid expansion on low‐income families' knowledge of how adolescents ages 12‐17 would obtain insurance coverage upon transitioning to adulthood, compared to families in states that did not expand Medicaid. Based on 2016‐2019 data from the National Survey of Children's Health, caregivers in Medicaid‐expansion states were more likely to report knowing how their adolescents would have continued coverage, compared to caregivers in states that opted out of Medicaid expansion (odds ratio [OR]: 1.34; 95% confidence interval [CI]: 1.06, 1.70; p = 0.016). The association was strongest for adolescents currently covered by public insurance (OR: 1.50; 95% CI: 1.10, 2.05; p = 0.011), indicating that expansion of public insurance eligibility among adults can help with planning the transition to adult health care for publicly‐insured adolescents.