The research described in this proposal seeks to continue and expand upon the Americans' Changing Lives (ACL) Study. The ACL, which was started in 1986, is a nationally-representative longitudinal study of a broad range of behavioral and psychosocial determinants of population health, and the role of these factors in understanding and reducing social inequalities in health. This proposal extends the ACL study beyond its recently-completed 4th wave of data collection into exciting new avenues of analysis, including new analytic opportunities using merged individual data and contextual data regarding the social environment. The six specific aims of this proposal are: 1) to extend mortality follow-up and tracking of the ACL study sample to 20 years using the National Death Index; 2) to extend longitudinal analyses of ACL data across its 4 waves, including analyses of the ability of socioeconomic and psychosocial risk factors to explain mortality, health change and health disparities over time, and investigation of the extent to which people of differing social position are approaching a """"""""compression of morbidity""""""""; 3) to perform cross-sectional analyses of the association of new measures added to the recent 4th wave with socioeconomic differentials in health, and prospective analyses of the relationship between these new measures and subsequent mortality; 4) to conduct focused analyses of cancer and cardiovascular disease as major causes of death; 5) to achieve a better understanding of how certain aspects of the social environment, including community socioeconomic status and concentrated disadvantage, contribute to population health and health disparities; and 6) to perform focused analyses of racial differences in health status and in the psychosocial determinants of health. In sum, this proposal seeks to further enhance the ACL study by extending mortality follow-up to over 20 years, by linking ACL data with a social environment data (from U.S. decennial Censuses), and by performing a large number of analyses to investigate the socioeconomic and psychosocial determinants of health and health disparities, and the ways in which health changes with age over the adult life course. Much of the proposed research represents the first long-term prospective investigation of these issues in a national sample.
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