Impact of Historically Black Colleges and Universities on Late-life Cognition in Black Adults

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PROJECT SUMMARY/ABSTRACT Black-White inequities in Alzheimer’s Disease and Related Dementia (ADRD) are a pressing public health problem: prevalence is almost double for Black adults aged 65-84. ADRD is a leading cause of death in the United States, affecting an estimated 5 million Americans. ADRD is a progressive disease impacting the parts of the brain that control thought, memory, and language. Unlike heart disease and cancer, death rates from ADRD are rising. ADRD prevalence is projected to decrease for White and increase for Black adults over time. Higher education is a strong social determinant of lower ADRD risk. However, large Black-White inequities in ADRD persist at the highest levels of education. Unfortunately, most nationally representative studies on ADRD are comprised of White adults. To address this disparity, we must consider risk factors that impact Black Americans uniquely as opposed to White experiences. Though structural racism is implicated as a fundamental cause of higher education gaps, little is known about if, and to what extent, uniquely Black college experiences influence ADRD risk in Black adults, specifically Historically Black Colleges and Universities (HBCUs). HBCUs are comprised of predominantly Black students (76%) and uplift Black individuals as well as Black communities through economic and cultural empowerment, increased social and political capital, and neighborhood revitalization and pride. Thus, early life exposure to HBCUs is a promising and unexplored mechanism that may improve later-life ADRD outcomes and inequities for Black adults. This K99/R00 study proposal leverages three large, well-established racially diverse national panel datasets to investigate the impact of early life exposure to HBCUs on vascular risk factors of ADRD, late-life incidence of ADRD, and all-cause mortality in Black adults; The Health and Retirement Study (HRS), Reasons for Geographic and Racial Differences in Stroke study (REGARDS), and Project Talent. We will apply quasi-experimental methods to evaluate the causal effects of (1) HBCU attendance and completion compared to a Predominantly White Institution (PWI), (2) early life HBCU proximity compared to a PWI through educational attainment, and (3) state and federal funding policy of HBCUs compared to PWIs during college-aged years. The research plan is complemented by an exceptional multidisciplinary mentorship team at the University of California San Francisco and training activities that build on the candidate’s background in racism-related research by providing new training in (1) life course determinants of ADRD, (2) data harmonization, and (3) causal effects of social and policy measures. The combined research and training plans will prepare the applicant for a successful independent epidemiology research career specializing in the study of structural racism as a social determinant of ADRD and inequities. This study aligns with NIA’s strategy for reducing health disparities and harmonizing population data. Findings from this proposal will provide critical insight into our understanding of uniquely Black college experiences as a source of cognitive resilience for Black adults. OMB No. 0925-0001/0002 (Rev. 03/2020 Approved Through 02/28/2023) Page Continuation Format Page