The overall purpose of this project is to identify modifiable risk factors for Alzheimer’s disease and related dementias that influence DNA methylation and dementia status among groups at increased risk for dementia including women, minorities, rural inhabitants, and those with low educational attainment. Our results may provide an opportunity to identify epigenetic components that contribute to the prevalence and risk of dementia that could lead to a mechanistic understanding or targeted interventions that may substantially decrease the burden of Alzheimer’s disease and related dementias in the US population.

This project will examine the short-, medium-, and long-term health, social and economic effects of the COVID-19 pandemic on an underserved and vulnerable population of young adults who have been part of the Fragile Families and Childhood Wellbeing Study since birth along with their primary caregivers who are entering middle age. Moreover, we will incorporate planned linkages to multilevel COVID-19 related health, social, and economic measures to identify how temporal and geographic variations contribute to outcomes of the two-generation sample.

Our objective is to assess the immediate and longer-term effect of the COVID 19 pandemic on the use of long-term services and supports by high-need older adults living in the US and to understand how these impacts differ for those living with Alzheimer’s Disease and Related Dementias (ADRD). We will draw on pre- and post-COVID-19 observations from two large, longitudinal, nationally representative surveys of older Americans, the Health and Retirement Study (HRS) and the National Health and Aging Study (NHATS) and their linkages to geographically based contextual data and to Medicare claims.

We will undertake three specific aims:

1. Evaluate the immediate impact of COVID-19 on a comprehensive set of long-term services and supports, comparing high-need older adults with and without ADRD;
2. Determine whether changes in care arrangements persist beyond the immediate shock of COVID-19 comparing high need older adults with and without ADRD;
3. Assess the consequences of immediate or persistent changes in long-term services and supports measured by unmet needs and claims-based preventable health care utilization for high need older adults with and without ADRD.

While only 16% of people age 65+ engage in recommended physical activity levels, activating social resources may increase physical activity. We propose a social network-based approach that systematically identifies and involves influential agents of change in a community to facilitate physical activity-related information dissemination and behavior change. This project will leverage Go4Life – the National Institute of Aging’s evidence-based physical activity campaign – and capitalize on the strength of social ties. The intervention addresses socio-economically linked health disparities by developing the intervention for use in affordable (HUD subsidized) senior housing.

The project will address three specific aims:

1. Identify agents of change in an affordable senior housing community who and invite them to form a committee to disseminate Go4Life materials through planning, publicizing, and participating in community-wide activities over 12 months.
2. Evaluate intervention feasibility using a mixed methods approach.
3. Establish preliminary network effect on changes in physical activity and identify influential network mechanisms.

This project is the first step in using locally available and low-cost resources to affect behavior change among socio-economically vulnerable senior housing residents. In the short-term, findings will provide preliminary data to conduct a multi-site efficacy trial which will implement and evaluate successful components of the intervention. In the long-term, understanding how to leverage social networks to promote and sustain increases in physical activity will provide key information to advance the science of behavior change as well as reduce health disparities.

Growing evidence suggests that certain racial/ethnic minority groups experience the highest incidence of Alzheimer’s disease and related dementias (ADRD) risk in the US. Longitudinal studies with diverse samples that collect social and behavioral measures in early and midlife hold exceptional promise for identifying modifiable protective factors for cognitive health and life course pathways of ADRD risk. Researchers have that social relations, a multidimensional concept with high intervention potential, predict cognitive health and Alzheimer’s disease and related dementias, though these associations may differ across race/ethnicity. Researchers have not identified: (1) how early and mid-life social relations are associated with ADRD risk in different racial/ethnic groups; and (2) specific aspects of social relations that modify ADRD risk. Characterizing how social relations vary as a function of race/ethnicity and clarifying unique links to ADRD risk will advance the field in terms of theory and intervention.

This project leverages three waves of the Social Relations Study plus a fourth wave of the over-65 sample (which is currently in the field) to examine social relations and ADRD risk across racial/ethnic groups. We are also collecting a new, representative Detroit metropolitan area sample, using the original design, adding Arab Americans to parallel data collection now in the field. Specific aims are:    

• Aim 1: Examine secular trends in social relations and health by race/ethnicity in two adult lifespan regionally representative cohorts.
• Aim 2: Identify aspects of social relations that have the greatest effects on ADRD risk among blacks, whites and Arab Americans.
• Aim 3: Identify longitudinal associations between social relations across the life course and ADRD risk among blacks and whites.

We capitalize on an existing longitudinal cohort study of detailed social relations in a diverse lifespan sample. Adding cognitive and genetic measures, as well as extending racial/ethnic group comparisons to include Arab Americans in a new regionally representative sample provides a novel opportunity to study modifiable factors in midlife for ADRD risk. This project’s findings will provide key information to develop strategies using the influential resource of social relations to reduce disparities. Further, the project sets the stage for a newly representative longitudinal study of racial/ethnic disparities in ADRD risk.

The Panel Study of Income Dynamics (PSID) is a longitudinal survey of a nationally representative sample of U.S. families that began in 1968. As of 2020, it has collected data on the same families and their descendants for 41 waves over 52 years. In the 1990s, PSID began collecting rich and detailed data on children born into these families as part of the original PSID Child Development Supplement (CDS) and, starting in the mid-2000s, has closely followed these children’s transition across the young adult years through the biennial PSID Transition into Adulthood Supplement (TAS). Young adults in PSID families become members of the Core PSID themselves and receive the full biennial interview when they form their own economically independent households, and then the study follows them for the rest of their lives.

In order to continue capturing the transition into adulthood for all PSID children, the TAS will conduct two waves of data collection in 2021 and 2023. A major portion of the TAS samples will comprise of young adults who previously participated in CDS. Participants in CDS include those from the original study, which began collecting detailed and extensive data on children in PSID families in 1997 on a cohort of children aged 0-12 years, as well as the new CDS, fielded in 2014 and 2019. This ongoing study is collecting information on all children aged 0-17 years in PSID families born after the launch of the original CDS. The 2021 and 2023 waves of the TAS will also include many respondents who have participated in one or more prior waves of TAS, allowing us to trace their transition into adulthood.

Our specific aims are to collect approximately 70 minutes of information in 2021 and 2023 from all PSID youth aged 18-28 years and to document and distribute these data through the publicly available and free PSID Online Data Center. In 2019, the TAS adopted a mixed-mode design using internet interviewing as well as computer-assisted telephone interviewing to collect new retrospective content. We are building on this revision by collecting data on childhood circumstances and exposures and new information on young adult transitions in key domains such as family formation and change, health, and living arrangements. We are conducting interviews with approximately 3,800 young adults in 2021 and 2023. These data are vital for our understanding of the contemporary transition from adolescence into adulthood within its intergenerational family context. By augmenting the panel information in the CDS and Core PSID, this project will provide a rich CDS-TAS-PSID panel of children from birth and preschool through primary and secondary school and then through entry into the world of work or of higher education in conjunction with early family formation. Although a full and detailed panel from birth to young adulthood is valuable in its own right, the information on these individuals will grow further as they continue in Core PSID for the rest of their lives.

The Child Development Supplement (CDS) is an integral and on-going component of the Panel Study of Income Dynamics (PSID), a longitudinal survey of a nationally representative sample of U.S. families that began in 1968. With data collected on the same families and their descendants for 41 waves over 52 years (as of 2020), PSID is a cornerstone for empirical social science research in the U.S. Through its long-term measures of economic and social wellbeing, and based on its weighted representative sample of U.S. families that now includes two major immigrant refresher samples, the study has advanced research on the dynamics of social, economic, demographic, and health processes and their interrelationships. Five waves of CDS have been conducted: three on the original cohort of children born between 1985 and 1997 (in 1997, 2002/2003, and 2007/2008) and two waves (in 2014 and 2019) on the next generation of PSID children who were born between 1997 and 2019.

This project has two specific aims. The first is to design and field a follow-up wave of CDS in 2021, collecting re-interview data on children aged 2-17 years who participated in CDS-19, through interviews with primary caregivers and older children aged 12-17 years. The second specific aim is to process, document, and distribute the new CDS-21 data, with scale composites, generated variables, and individual-level links to detailed school data from the National Center for Education Statistics. The 2021 wave of CDS will, in conjunction with data from CDS-14 and CDS-19, provide unique and valuable prospective panel data to study the effects of the Covid-19 pandemic, lockdown, and recession. The study will provide comprehensive and rich information on a large, nationally representative sample of children that includes an over-sample of African Americans and a new refresher sample of children in immigrant families. These data will be available free of charge through the PSID Online Data Center, which provides customized extracts and codebooks, detailed study documentation, and comprehensive user education and support.

Alzheimer’s disease and related dementias (ADRD), a leading cause of disability among older adults, has become a critical public health concern. The clock-drawing test, which measures multiple aspects of cognitive function including comprehension, visual spatial abilities, executive function and memory, has been widely used as a screening tool to detect dementia in clinical research, epidemiologic studies, and panel surveys. The test asks subjects to draw a clock, typically with hands showing ten after 11, and then assigns either a binary (e.g. normal vs. abnormal) or ordinal (e.g. 0 to 5) score. An important limitation in large-scale studies is that the test requires manual coding, which could result in biases if coders interpret and implement coding rules in different ways.

Several small-scale studies have explored the use of machine learning methods to automate clock-drawing test coding. Such studies, which have had limited success with ordinal coding, have used methods that are not designed specifically for complex image classification and are less effective than deep learning neural networks, a new and promising area of machine learning. More recently, machine-learning methods have been applied to digital clock-drawing testing, a form of the clock-drawing test that uses a digital pen and tablet. Despite some promising results on small-scale data, thus far these studies have only attempted to code binary categories.

This project develops advanced deep learning neural network models to create and evaluate an intelligent clock-drawing test Clock Scoring system – CloSco – that will automatically code test images. We will use a large, publicly available repository of clock-drawing test images from the 2011-2019 National Health and Aging Trends Study (NHATS), a panel study of Medicare beneficiaries ages 65 and older funded by the National Institute on Aging. Specifically, we will:

1. Develop an automated clock-drawing test coding system for both ordinal and continuous scores;
2. Evaluate the performance of the CloSco system and investigate the value of continuous scoring for dementia classification and longitudinal test models; and
3. Prepare and disseminate NHATS public-use files and documentation with ordinal and continuous clock-drawing test codes assigned using CloSco along with the CloSco deep learning neural network program.

If successful, the DLNN programs may offer a model for automating coding of other widely available drawing tests used to evaluate a variety of cognitive functions.

A growing literature documents Black-White inequalities in sleep deficiencies with Black adults experiencing less sleep and lower sleep quality compared to White adults. Because sleep hygiene is tightly linked to health, racial inequalities in sleep deficiencies may be a key determinant of racial inequalities in health.

Racial inequalities in work-related stress may be a crucial, but understudied driver of sleep inequalities and ultimately, health inequalities. As with all racial groups, the majority of Black men and women are in the labor force; however, compared to White adults, Black adults spend more time in the workplace, are more likely to hold multiple jobs, and twice as likely to hold two full-time jobs. Further compared to White adults, Black adults tend to be in occupations that are objectively more stressful, where they have less control and greater physical and emotional demands, and to report greater levels of stress at work.

While work-related stress has been linked to sleep deficiencies, there is a need to examine more racially-salient forms of stress such as vigilance, or the thoughts and behaviors in which Black Americans may engage in order to navigate everyday spaces such as the workplace. A substantial qualitative literature indicates that Black adults regularly anticipate and worry about potential encounters in everyday life such as being followed in stores or having assumptions made about their intellect or character. Vigilance may be particularly important for sleep inequalities because it captures a racially-salient and prevalent form of stress with characteristics that interfere with sleep quality and duration, including: (a) anticipatory stress, which predicts increased biological stress even in the absence of a stressful event; and (b) ruminative stress, which can transform acute situations into chronic sources of stress.

Using both real world and laboratory settings, we are collecting data from 500 Black men and women to capture both momentary work-related stressful experiences and chronic work-related stress. We are examining the linkages between racially-salient, work-related stress, captured through ecological momentary assessments, and sleep deficiencies, captured through self-report and actigraphy. The workplace is particularly relevant for racial inequalities in health due to focus on economic upward mobility among Black Americans and the growth of diversity, equity, and inclusion initiatives that may widen inequalities due to the need for vigilance as Black workers join predominantly White workplaces.