Understanding the association between socioeconomic status and physical health: do negative emotions play a role?

Relationship With Others and Life Satisfaction in Later Life: Do Gender and Widowhood Make a Difference?

In this study we investigated whether social relationship is a stronger determinant of life satisfaction in older women than in older men, and whether this is more obvious in widowed than in married persons, in a representative sample of Chinese individuals aged 60 or older in Hong Kong (N=1,616). We tested the moderating effect of gender and widowhood by means of a multigroup analysis in structural equation modeling that incorporated other major predictors of life satisfaction. Consistent with predictions, relatedness was much more important for women than for men. Furthermore, relatedness was the most important determinant of life satisfaction in women, regardless of marital status, but it was only a moderate predictor in married men, and even an irrelevant factor in widowers. We discuss the results in terms of how gender roles shape relationship goals, and thus how men and women evaluate life satisfaction differently in the context of relationship with others.

Social support and coronary heart disease: epidemiologic evidence and implications for treatment

OBJECTIVE

The present paper reviews theories of social support and evidence for the role of social support in the development and progression of coronary heart disease (CHD).

METHODS

Articles for the primary review of social support as a risk factor were identified with MEDLINE (1966-2004) and PsychINFO (1872-2004). Reviews of bibliographies also were used to identify relevant articles.

RESULTS

In general, evidence suggests that low social support confers a risk of 1.5 to 2.0 in both healthy populations and in patients with established CHD. However, there is substantial variability in the manner in which social support is conceptualized and measured. In addition, few studies have simultaneously compared differing types of support.

CONCLUSIONS

Although low levels of support are associated with increased risk for CHD events, it is not clear what types of support are most associated with clinical outcomes in healthy persons and CHD patients. The development of a consensus in the conceptualization and measurement of social support is needed to examine which types of support are most likely to be associated with adverse CHD outcomes. There also is little evidence that improving low social support reduces CHD events.

Relation of childhood socioeconomic status and family environment to adult metabolic functioning in the CARDIA study

OBJECTIVE

Low SES and a conflict-ridden, neglectful, or harsh family environment in childhood have been linked to a high rate of physical health disorders in adulthood. The objective of the present investigation was to evaluate a model of the pathways that may help to explain these links and to relate them to metabolic functioning (MF) in the Coronary Artery Risk Development In Young Adults (CARDIA) dataset.

METHODS

Participants (n = 3225) in the year 15 assessment of CARDIA, age 33 to 45 years, completed measures of childhood socioeconomic status (SES), risky early family environment (RF), adult psychosocial functioning (PsyF, a latent factor measured by depression, hostility, positive and negative social contacts), and adult SES. Indicators of the latent factor MF were assessed, specifically, cholesterol, insulin, glucose, triglycerides, and waist circumference.

RESULTS

The overall prevalence of metabolic syndrome was 9.7%. Structural equation modeling indicated that childhood SES and RF are associated with MF via their association with PsyF (standardized path coefficients: childhood SES to RF -0.13, RF to PsyF 0.44, PsyF to MF 0.09, all p < .05), but also directly (coefficient from childhood SES to MF -0.12, p < .05), with good overall model fit. When this model was tested separately for race-sex subgroups, it fit best for white women, fit well for African-American women and white men, but did not fit well for African-American men.

CONCLUSIONS

These results indicate that childhood SES and early family environment contribute to metabolic functioning through pathways of depression, hostility, and poor quality of social contacts.

Socioeconomic Characteristics of the Community in Childhood and Cognition in Old Age

We examined the relation of early life socioeconomic circumstances to cognition in older residents of a biracial urban community. Participants had brief cognitive testing three times at approximately 3-year intervals. At baseline, information about early life household and county socioeconomic level was collected. In mixed-effects models adjusted for age, sex, race, and education, both early life household and county socioeconomic levels were positively associated with baseline level of cognition but unrelated to cognitive decline. The results suggest that socioeconomic conditions in early life are associated with level of cognitive function in old age but not with rate of cognitive decline.

The impact of social deprivation on chronic back pain outcomes

Chronic low back pain is the commonest cause of disability for adults of working age. It is a complex problem frequently encapsulated as a bio-psychosocial issue, yet the social element has received less attention than it deserves, particularly for low-income and socially deprived patients. Rehabilitation programmes are often based on increasing function through cognitive and behavioural techniques, which, for many reasons, may be less effective for the socially disadvantaged. In this paper we discuss the potential barriers to successful rehabilitation in socially deprived groups and we look at possible factors that may need to be considered when designing interventions.

Racial/ethnic differences in adolescents' physical symptoms

This study was conducted to establish race/ethnic-specific prevalence for 10 physical symptoms in American youths and to examine the extent to which socioeconomic status and depressive symptoms explained racial differences in those symptoms. This descriptive study was based on a cross-sectional analysis of survey data from Wave I of the National Longitudinal Study of Adolescent Health including a school-based sample of over 20,000 adolescents in Grades 7 through 12. Self-reported physical symptoms during the past 12 months were examined. White youths reported the highest frequency of headaches, musculoskeletal pain, and dizziness; feeling hot, chest pain, cold sweats, and urinary symptoms were more common in Black youths. The three symptoms reported by Whites remained significant after controlling for family income and depressive symptoms, whereas racial differences in the four symptoms prominent in Blacks were accounted for by family income and depressive symptoms. Findings highlight racial differences in symptom types and in psychosocial factors contributing to physical symptoms in adolescents and warn against health-care providers' stereotyping associations between physical symptoms and socioeconomic status.

Predictors of physical health: toward an integrated model of genetic and environmental antecedents

People in higher-income groups tend to experience better physical health, yet this does not appear to be the direct result of access to medical care. This has prompted a search for psychological factors more likely to be present in high-income environments that might help to explain the relationship. Physical health has been associated with a number of such psychological measures including positive affect and well-being, negative affect and neuroticism, positive social relationships, and perceived control. Building from recent findings of moderation of genetic variance in physical health by income and perceived control, we explore the genetic and environmental relationships among all these variables in a nationwide U.S. twin sample. These relationships suggest possible mechanisms by which psychological characteristics, behaviors, physical health, and environmental circumstances could be influenced by common groups of genes with varying degrees of activity in different environments. We discuss the implications of such mechanisms for differential expression of genetic variation in the population and suggest ways in which consideration of such effects can inform gerontology research.

Socioeconomic status, resources, psychological experiences, and emotional responses: a test of the reserve capacity model

The current study used ecological momentary assessment to test several tenets of the reserve capacity model (L.C. Gallo & K. A. Matthews, 2003). Women (N = 108) with varying socioeconomic status (SES) monitored positive and negative psychosocial experiences and emotions across 2 days. Measures of intrapsychic and social resources were aggregated to represent the reserve capacity available to manage stress. Lower SES was associated with less perceived control and positive affect and more social strain. Control and strain contributed to the association between SES and positive affect. Lower SES elicited greater positive but not negative emotional reactivity to psychosocial experiences. Women with low SES had fewer resources relative to those with higher SES, and resources contributed to the association between SES and daily experiences.

Role of socialization in explaining social inequalities in health

This paper argues that social selection, materialist/structural and cultural/behavioural explanations for social inequalities in health are related to each other through the mechanism of socialization, seen here as a process through which societies shape patterns of behaviour and being that then affect health. Socialization involves the inter- and intragenerational transfer of attitudes, beliefs and behaviours. Parallels between socialization theory and Bourdieu's concept of habitus are also drawn, and the implications for social epidemiology are discussed. Four key areas that would benefit from research within the socialization framework are identified: health behaviours, psychological vulnerability, social skills and future time perspective.

Personality development: stability and change

In this review, we evaluate four topics in the study of personality development where discernible progress has been made since 1995 (the last time the area of personality development was reviewed in this series). We (a) evaluate research about the structure of personality in childhood and in adulthood, with special attention to possible developmental changes in the lower-order components of broad traits; (b) summarize new directions in behavioral genetic studies of personality; (c) synthesize evidence from longitudinal studies to pinpoint where and when in the life course personality change is most likely to occur; and (d) document which personality traits influence social relationships, status attainment, and health, and the mechanisms by which these personality effects come about. In each of these four areas, we note gaps and identify priorities for further research.

Socioeconomic disparities in health: the impact of pharmacotherapy

Along with age and gender, socioeconomic status is a fundamental driver of health. This review discusses the meaning of socioeconomic status and how it influences health across a person's life. Particular attention is paid to the role of psychosocial stress and self-determination. Through various pathways, socioeconomic status may affect biologic aging. This review also discusses the implications of the socioeconomic status-health relationship for understanding international differences in population health such as differences in life expectancy. The review concludes with a discussion of the implications of these findings for national policies and the potential impact of pharmacotherapy.

The BCPT symptom scales: a measure of physical symptoms for women diagnosed with or at risk for breast cancer

BACKGROUND

Documentation of concurrent and late side effects of medical interventions to prevent and treat breast cancer is important in research and clinical practice. We used the Breast Cancer Prevention Trial (BCPT) Symptom Checklist to develop an instrument (BCPT Symptom Scales) that could be used to assess side effects and to examine correlates of the derived symptom dimensions among patient populations.

METHODS

Exploratory and confirmatory factor analyses were conducted using data from the 42-item BCPT Symptom Checklist completed by four distinct patient populations (N = 2208) who had previously been diagnosed with breast cancer or were at risk for the disease. We examined associations among the resulting BCPT Symptom Scales and demographic and cancer-related variables and a widely used measure of health-related quality of life.

RESULTS

Exploratory and confirmatory factor analyses revealed eight factors corresponding to physical symptoms associated with cancer treatment, chemoprevention, menopause, and normal aging: hot flashes, nausea, bladder control, vaginal problems, musculoskeletal pain, cognitive problems, weight problems, and arm problems. On the derived BCPT Symptom Scales, women reported somewhat higher mean scores on scales for hot flashes, pain, and weight problems than on scales for the other symptoms. Demographic and cancer-related variables accounted for up to 15% of the interindividual variance in how women responded to the symptom scales. The most consistent predictors of reporting greater symptoms included lower education level and previous receipt of chemotherapy.

CONCLUSIONS

Meaningful symptom dimensions, identified across four samples of women, were associated with demographic and breast cancer-related variables. The BCPT Symptom Scales offer a valuable refinement of the original BCPT Symptom Checklist to assess side effects associated with the treatment and prevention of breast cancer.

Anger, Anxiety, and Depression as Risk Factors for Cardiovascular Disease: The Problems and Implications of Overlapping Affective Dispositions

Several recent reviews have identified 3 affective dispositions--depression, anxiety, and anger-hostility--as putative risk factors for coronary heart disease. There are, however, mixed and negative results. Following a critical summary of epidemiological findings, the present article discusses the construct and measurement overlap among the 3 negative affects. Recognition of the overlap necessitates the development of more complex affect-disease models and has implications for the interpretation of prior studies, statistical analyses, prevention, and intervention in health psychology and behavioral medicine. The overlap among the 3 negative dispositions also leaves open the possibility that a general disposition toward negative affectivity may be more important for disease risk than any specific negative affect.

Marijuana use and later problems: when frequency of recent use explains age of initiation effects (and when it does not)

Tobacco, alcohol, and marijuana are among the most commonly used drugs during adolescence. Initiation of marijuana use typically peaks at age 15, with risk of initiation continuing throughout adolescence. The goal of the current study was to prospectively examine the influence of age of marijuana initiation on four outcomes: physical health, mental health, illicit drug use other than marijuana, and marijuana-use related consequences at age 18. We controlled for several important predictors of adolescent drug use and its associated consequences, including demographics, social bonding variables, personality variables, and recent use of marijuana. Baseline survey data were collected in 1984 at grade 7 and follow up surveys were conducted at grades 8, 9, 10, and 12 (N = 2079). This initiates-only sample was 47% female, 66% White, 11% African American, 13% Hispanic, 5% Asian, and 5% other race or ethnicity. Findings indicated that age of initiation predicted marijuana consequences and other illicit drug use after controlling for demographic, social, and behavioral factors. However, once frequency of recent marijuana use was included in the models, age of initiation was only associated with other illicit drug use. Both primary and secondary prevention are needed to curb marijuana use and its associated harms.

Job characteristics, occupational status, and ambulatory cardiovascular activity in women

BACKGROUND

Prior research concerning the effects of occupational status and work stress on ambulatory blood pressure (AmBP) has seldom included women, and available results are equivocal. Moreover, the concurrent effects of occupational status and job characteristics have rarely been investigated. Some research is consistent with the idea that stressful job characteristics are especially detrimental to health in low-status workers, creating a cumulative physiological burden.

PURPOSE

To examine the independent and joint effects of occupational status and perceived demands, control, and social support at work on AmBP and heart rate (HR) in women.

METHODS

One hundred eight women (M age = 41.07 years) wore an AmBP monitor for 2 days and completed a self-report assessment of job control, demands, and support (i.e., Karesek et al.'s Job Content Questionnaire).

RESULTS

After controlling for numerous potential confounds, occupational status and job characteristics accounted for 18% and 22% of the inter-individual variability in ambulatory systolic blood pressure (SBP) and HR, respectively. Occupational status independently predicted ambulatory cardiovascular activity and interacted with job characteristics, particularly in relation to SBP.

CONCLUSIONS

Inasmuch as ambulatory SBP and HR predict future cardiovascular morbidity and mortality, women with both lower status occupations and stressful job circumstances could be at disproportionately high cardiovascular risk.

Personality and mortality in old age

We examined the relation of personality to mortality in 883 older Catholic clergy members (69% women). At baseline, they completed the NEO Five-Factor Inventory, which assesses the five principal dimensions of personality. They were followed for a mean of 5.1 years, during which 182 deaths occurred. Risk of death was nearly doubled in those with a high neuroticism score (90th percentile) compared with a low score (10th percentile) and was approximately halved in those with a high conscientiousness score compared with a low score. Findings for extraversion were mixed, and neither agreeableness nor openness was strongly related to mortality. The results suggest that personality is associated with mortality in old age.

What are the costs of marital conflict and dissolution to children's physical health?

Do parental marital conflict and dissolution influence the risk trajectory of children's physical health risk? This paper reviews evidence addressing this question in the context of understanding how early environmental adversities may trigger a succession of risks that lead to poor health in childhood and greater risk for chronic health problems in adulthood. We first review existing evidence linking marital conflict and dissolution to offspring's physical health outcomes. Next, we provide evidence supporting biopsychosocial pathways that may link marital conflict and dissolution with accelerated health risk trajectories across the lifespan. Specifically, we posit that consequential to the stresses associated with marital conflict and disruption, parenting practices are compromised, leading to offspring deficits in affective, behavioral, and cognitive domains. These deficits, in turn, are hypothesized to increase health risk through poor health behaviors and by altering physiological stress-response systems, including neuroendocrine, cardiovascular, and neurotransmitter functioning. On the basis of the available direct evidence and theoretically plausible pathways, it appears that there is a cost of marital conflict and disruption to children's health; however, more comprehensive investigations are needed to further elucidate this relationship. In the final section, we address limitations in the current literature and identify research that is needed to better evaluate the association between marital conflict and dissolution and children's physical health.

The motivation to control and the origin of mind: Exploring the life–mind joint point in the Tree of Knowledge System

The evolved function of brain, cognitive, affective, conscious-psychological, and behavioral systems is to enable animals to attempt to gain control of the social (e.g., mates), biological (e.g., prey), and physical (e.g., nesting spots) resources that have tended to covary with survival and reproductive outcomes during the species' evolutionary history. These resources generate information patterns that range from invariant to variant. Invariant information is consistent across generations and within lifetimes (e.g., the prototypical shape of a human face) and is associated with modular brain and cognitive systems that coalesce around the domains of folk psychology, folk biology, and folk physics. The processing of information in these domains is implicit and results in automatic bottom-up behavioral responses. Variant information varies across generations and within lifetimes (e.g., as in social dynamics) and is associated with plastic brain and cognitive systems and explicit, consciously driven top-down behavioral responses. The fundamentals of this motivation-to-control model are outlined and links are made to Henriques' (2004) Tree of Knowledge System and Behavioral Investment Theory.

Marital status, marital quality, and atherosclerotic burden in postmenopausal women

Marriage confers health benefits for men, but the evidence for women is less consistent. Inconsistent findings may be attributed, in part, to the confounding of marital status and marital quality.

OBJECTIVES

The authors examined whether women in satisfying marriages evidence lesser atherosclerosis relative to women in low-satisfying marriages and relative to unmarried women.

MATERIALS AND METHODS

Three hundred ninety-three women from the Healthy Women Study participated in this study. Marital status and quality were assessed at baseline when women were premenopausal. Cardiovascular risk factors were also assessed at baseline to determine potential mediators. Markers of atherosclerotic burden--B-Mode ultrasound measures of intima-media thickness and plaque in the carotid arteries and electron beam computed tomography assessments of calcification in the aorta and coronary arteries--were performed, on average, 11 years and 14 years later, respectively. A subset of women underwent a second ultrasound scan approximately 3 years after their first scan.

RESULTS

Women in satisfying marriages had the least atherosclerosis in the carotid arteries and aorta, especially relative to those in low-satisfying marriages. Women in satisfying marriages also tended to show less rapid progression of carotid atherosclerosis relative to women in low-satisfying marriages. Women who did not have a partner had intermediate levels of atherosclerosis. Risk factors measured at baseline contributed to the differences between the satisfied and low-satisfied groups, but not those between the satisfied and unmarried groups.

CONCLUSIONS

High-quality marriages may protect against cardiovascular disease for women. Studies concerning marriage and cardiovascular health in women should, therefore, concurrently examine marital quality and marital status.

Chronic stress burden, discrimination, and subclinical carotid artery disease in African American and Caucasian women

This study examined the association between a composite index of stress that included measures of life events, ongoing stress, discrimination, and economic hardship and subclinical carotid disease among 109 African America and 225 Caucasian premenopausal women. African Americans reported more chronic stress and had higher carotid intima-media thickness (IMT) as compared with Caucasians. Among African Americans only, the composite stress index and unfair treatment were associated with higher IMT. These effects were partially mediated by biological risk factors. African American who reported experiencing racial discrimination had marginally more carotid plaque than did those who did not report experiencing racial discrimination. The results suggest that African Americans may be particularly vulnerable to the burden of chronic stress.

Effect of verbal self-disclosure on natural killer cell activity: moderating influence of cynical hostility

One objective of the present research was to examine the immunological effects of self-disclosing personal information regarding a traumatic or stressful experience. A second objective was to examine the hypothesis that the effect of self-disclosure on immune function is moderated by individual differences in cynical hostility. Forty-three male college undergraduates, classified as high or low on the Cook-Medley Hostility scale were randomly assigned to either a verbal self-disclosure or a nondisclosure discussion condition. Task-induced change in natural killer (NK) cell activity (i.e., cytotoxicity) served as the dependent variable. As predicted, a significant interaction between discussion condition and hostility was obtained. Among subjects in the self-disclosure condition, high hostility subjects exhibited a significantly greater increase in NK cell cytotoxicity than low hostility subjects. The effect of self-disclosure on NK cell activity is moderated by an individual's level of cynical hostility. The greater short term enhancement in NK cell activity observed for hostile persons is a likely correlate of a more pronounced acute arousal response elicited by the self-disclosure task.