UCSF

Black Americans aged 65 years and older are about twice as likely as White Americans to have dementia. These racial disparities in dementia burden are not completely explained by educational attainment and other health-related risk factors. This may partly be due to the measure of educational attainment not accurately reflecting the varied schooling experiences among racial and ethnic minorities. Given evidence highlighting the importance of education for healthy brain aging, and the well-documented history of school segregation in the early 20th century, evaluating how racially stratified school experiences are associated with cognitive outcomes in late life may illuminate mechanisms driving dementia inequities. This dissertation explores the role of school segregation in shaping cognitive outcomes in older Black adults, aiming to understand how conflicting schooling-related mechanisms, social support and school quality, contribute to these associations.This dissertation uses two data sources to characterize racialized experiences of school segregation and schooling environment across different cognitive outcomes: (1) the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study (2) and the Study of Healthy Aging in African Americans (STAR). Chapter 1 builds upon previous findings by assessing the role of legalized school segregation and assesses different measurement operationalizations to identify if there are timing-specific effects (i.e., in early childhood). Utilizing linear mixed models, we found that exposure to legalized school segregation, irrespective of timing, has lasting impacts on executive function and semantic memory in late life; however, we did not find evidence of an association with rate of cognitive change. In addition, more years spent in a segregated schools (i.e., desegregating at later grades) was associated with a greater magnitude of associations with executive function and semantic memory scores. Chapter 2 aims to further disentangle the established relationship between school segregation and cognitive outcomes by considering the mediating and moderating role of school-based social support. Findings from this study suggest that participants who attended segregated schools were more likely to report having a caring teacher or staff member, compared to those who attended desegregated schools. Although school-based social support did not mediate the associations observed in Chapter 1, we found that the harmful effect estimates associated with segregated school attendance intensified in the absence of a caring teacher or staff member. Finally, Chapter 3 considers whether intervening on school quality could reduce cognitive inequities driven by segregated schooling by utilizing a causal mediation approach. We found that, school quality mediated around 21%-63% of the association of grade-specific segregated school attendance and semantic memory z-scores. However, segregated school attendance in early childhood had direct effects on late-life semantic memory irrespective of school quality. Suggesting that interventions only addressing school quality are not enough to completely bridge cognitive inequities. Together these findings provide important policy implications given that the current racial segregation in schools may be associated with lower school quality for Black children, potentially resulting in persistent racial inequalities in dementia risk as these younger birth cohorts age. My findings suggest that creating institutional frameworks to support increasing the diversity of teachers and staff in schools may help buffer plausible cognitive implications from the structural inequities in segregated schools. Policies should also focus on increasing state-level investment to improve educational quality, particularly among schools primarily serving racial and ethnic minority students. Exclusionary housing practices and economic and racial residential segregation have allowed de facto school segregation to persist to this day. Further highlighting the necessity of addressing and dismantling the current educational and housing systems that start in childhood that are creating a cumulative disadvantage among minoritized people in order to bridge cognitive inequities among older adults.