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Mosallanezhad Z, Sotoudeh GR, Jutengren G, Salavati M, Harms-Ringdahl K, Wikmar LN, Frändin K. A structural equation model of the relation between socioeconomic status, physical activity level, independence and health status in older Iranian people. Arch Gerontol Geriatr 2017; 70:123-129. [PMID: 28131051 DOI: 10.1016/j.archger.2017.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/29/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIM Health status is an independent predictor of mortality, morbidity and functioning in older people. The present study was designed to evaluate the link between socioeconomic status (SES), physical activity (PA), independence (I) and the health status (HS) of older people in Iran, using structural equation modelling. METHODS Using computerized randomly selection, a representative sample of 851 75-year-olds living in Tehran (2007-2008), Iran, was included. Participants answered questions regarding indicators of HS, SES and also PA and I through interviews. Both measurement and conceptual models of our hypotheses were tested using Mplus 5. Maximum-likelihood estimation with robust standard errors (MLR estimator), chi-square tests, the goodness of fit index (and degrees of freedom), as well as the Comparative Fit Index (CFI), and the Root Mean Square Error of Approximation (RSMEA) were used to evaluate the model fit. RESULTS The measurement model yielded a reasonable fit to the data, χ2=110.93, df=38; CFI=0.97; RMSEA=0.047, with 90% C.I.=0.037-0.058. The model fit for the conceptual model was acceptable; χ2=271.64, df=39; CFI=0.91; RMSEA=0.084, with 90% C.I.=0.074-0.093. SES itself was not a direct predictor of HS (β=0.13, p=0.059) but it was a predictor of HS either through affecting PA (β=0.31, p<0.001) or I (β=0.57, p<0.001). CONCLUSION Socioeconomic status appeared to influence health status, not directly but through mediating some behavioral and self-confidence aspects including physical activity and independence in ADL.
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Affiliation(s)
- Zahra Mosallanezhad
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Iranian Research Centre on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Gholam Reza Sotoudeh
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden; Sina Trauma and Surgery Research Center (STSRC), Sina General Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Göran Jutengren
- Department of Work Life and Social Welfare, University of Borås, Sweden
| | - Mahyar Salavati
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Karin Harms-Ringdahl
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lena Nilsson Wikmar
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Academic Primary Healthcare Centre, Stockholm County Council, Stockholm, Sweden
| | - Kerstin Frändin
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Neuropsychiatric Epidemiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Cai J, Coyte PC, Zhao H. Determinants of and socio-economic disparities in self-rated health in China. Int J Equity Health 2017; 16:7. [PMID: 28077141 PMCID: PMC5225569 DOI: 10.1186/s12939-016-0496-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/08/2016] [Indexed: 11/23/2022] Open
Abstract
Background Self-rated health (SRH) is not only used to measure health status and health inequalities, but also as a strong predictor of morbidity and mortality. The purpose of this study was to: 1) evaluate the factors that account for variations in self-rated health among Chinese citizens; and to 2) explore the process through which socio-economic status may impact self-rated health. Methods Data were derived from the Chinese General Social Survey (CGSS) (2013). Determinants of self-rated health were analyzed along four main dimensions: demographic characteristics, socio-economic status, lifestyle, and psychosocial factors. Multivariate odds ratios for good self-rated health were calculated for different variables in order to analyze the determinants. Binary logistic regression analysis was performed to assess the extent to which lifestyle and psychosocial factors explained the association between socio-economic status and self-rated health. Results About 65% of the survey respondents reported good self-rated health. Women, the elderly, married or single respondents and residents of Western China were less likely to report good self-rated health. Respondents who were engaged in work, had higher household income, reported high social class and higher socio-economic status compared with peers were more likely to report good self-rated health. Normal weight and physically active respondents along with those reporting a happy life, no depression, and good relationships with families and friends were related to good self-rated health. We also found the effect of socio-economic status on self-rated health was partly explained by lifestyle and psychosocial factors. Conclusion The present findings support the notion that both socio-economic status and lifestyle as well as psychosocial factors were related with good self-rated health. The interventions targeting these factors could improve the health status of the population. The depression was the most influential predictor of self-rated health, especially for the women and the elderly. Although lifestyle and psychosocial factors explained partly the the association between socio-economic status and health, the reason why socio-economic difference exists in health must be further explored. What’s more, it needs to be further studied why the same determinant has different influence strengths on the health of different groups of people.
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Affiliation(s)
- Jiaoli Cai
- School of Economics, Wuhan University of Technology, 122 Luoshi Road, Wuhan, Hubei Province, 430070, People's Republic of China. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building,155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building,155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
| | - Hongzhong Zhao
- School of Economics, Wuhan University of Technology, 122 Luoshi Road, Wuhan, Hubei Province, 430070, People's Republic of China
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van Zon SK, Bültmann U, Reijneveld SA, de Leon CFM. Functional health decline before and after retirement: A longitudinal analysis of the Health and Retirement Study. Soc Sci Med 2016; 170:26-34. [DOI: 10.1016/j.socscimed.2016.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/02/2016] [Accepted: 10/03/2016] [Indexed: 10/20/2022]
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SOCIOECONOMIC INEQUALITIES IN SELF-REPORTED HEALTH AND PHYSICAL FUNCTIONING IN ARGENTINA: FINDINGS FROM THE NATIONAL SURVEY ON QUALITY OF LIFE OF OLDER ADULTS 2012 (ENCaViAM). J Biosoc Sci 2016; 49:597-610. [PMID: 27825400 DOI: 10.1017/s0021932016000651] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This study aimed to evaluate educational and income inequalities in self-reported health (SRH), and physical functioning (limitations in Activities of Daily Living (ADL)/Instrumental Activities of Daily Living (IADL)), among 60-year-old and older adults in Argentina. Using cross-sectional data from the Argentinian National Survey on Quality of Life of Older Adults 2012 (Encuesta Nacional sobre Calidad de Vida de Adultos Mayores, ENCaViAM), gender-specific socioeconomic inequalities in SRH and ADL and IADL limitations were studied in relation to educational level and household per capita income. The Relative Index of Inequality (RII) - an index of the relative size of socioeconomic inequalities in health - was used. Socioeconomic inequalities in the studied health indicators were found - except for limitations in ADL among women - favouring socially advantaged groups. The results remained largely significant after full adjustment, suggesting that educational and income inequalities, mainly in SRH and IADL, were robust and somehow independent of age, marital status, physical activity, the use of several medications, depression and the occurrence of falls. The findings add to the existing knowledge on the relative size of the socioeconomic inequalities in subjective health indicators among Argentinian older adults, which are to the detriment of lower socioeconomic groups. The results could be used to inform planning interventions aimed at decreasing socioeconomic inequalities in health, to the benefit of socially disadvantaged adults.
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Abstract
For the past quarter century, scientists at the Center for Family Research at the University of Georgia have conducted research designed to promote understanding of normative developmental trajectories among low socioeconomic status African American children, youths, and young adults. In this paper, we describe a recent expansion of this research program using longitudinal, epidemiological studies and randomized prevention trials to test hypotheses about the origins of disease among rural African American youths. The contributions of economic hardship, downward mobility, neighborhood poverty, and racial discrimination to allostatic load and epigenetic aging are illustrated. The health benefits of supportive family relationships in protecting youths from these challenges are also illustrated. A cautionary set of studies is presented showing that some psychosocially resilient youths demonstrate high allostatic loads and accelerated epigenetic aging, suggesting that, for some, "resilience is just skin deep." Finally, we end on an optimistic note by demonstrating that family-centered prevention programs can have health benefits by reducing inflammation, helping to preserve telomere length, and inhibiting epigenetic aging.
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Affiliation(s)
- Gene H. Brody
- Center for Family Research, University of Georgia, Athens, GA 30602-4527 USA
| | - Tianyi Yu
- Center for Family Research, University of Georgia, Athens, GA 30602-4527 USA
| | - Steven R. H. Beach
- Center for Family Research, University of Georgia, Athens, GA 30602-4527 USA
- Department of Psychology, University of Georgia, Athens, GA 30602 USA
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Zimmer Z, Hanson HA, Smith KR. Offspring Socioeconomic Status and Parent Mortality Within a Historical Population. Demography 2016; 53:1583-1603. [PMID: 27664009 PMCID: PMC5086077 DOI: 10.1007/s13524-016-0502-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Considering a network approach to health determinants, we test the hypothesis that benefits of high socioeconomic status (SES) may be transmitted up the generational ladder from offspring to parents. Studies that examine own SES and own health outcomes, or SES of parents and outcomes of young or adolescent children, are common. Those that investigate SES of offspring and their association with parental health are rare. Employing data from a historical population of individuals extracted from a comprehensive population database that links demographic and vital records across generations, this study tests the hypothesis that higher offspring SES associates with lower parental mortality after controlling for parental SES. The sample includes 29,972 individuals born between 1864 and 1883 whose offspring were born between 1886 and 1920. SES is operationalized using Nam-Powers occupational status scores divided into quartiles and a category for farmers. Models assess mortality risk after age 40. Included is a test for whether effects are proportional across parents who died younger and older. Estimated life expectancies across categories of offspring SES conditioned on parental SES are calculated to illustrate specifically how differences in SES relate to differences in years lived. Results indicate a longevity penalty for those whose offspring have low SES and a longevity dividend for those with high-SES offspring. The influence of offspring attributes on well-being of parents points to fluid and myriad linkages between generations.
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Affiliation(s)
- Zachary Zimmer
- Department of Family Studies & Gerontology, and Canada Research Chair in Global Aging and Community, Mount Saint Vincent University, Halifax, Nova Scotia, Canada.
| | - Heidi A Hanson
- Department of Family and Preventive Medicine, Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Ken R Smith
- Department of Family and Consumer Studies and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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Kreuter MW, McQueen A, Boyum S, Fu Q. Unmet basic needs and health intervention effectiveness in low-income populations. Prev Med 2016; 91:70-75. [PMID: 27496395 PMCID: PMC5050133 DOI: 10.1016/j.ypmed.2016.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 04/20/2016] [Accepted: 08/02/2016] [Indexed: 12/29/2022]
Abstract
In the face of unmet basic needs, low SES adults are less likely to obtain needed preventive health services. The study objective was to understand how these hardships may cluster and how the effectiveness of different health-focused interventions might vary across vulnerable population sub-groups with different basic needs profiles. From June 2010-2012, a random sample of low-income adult callers to Missouri 2-1-1 completed a cancer risk assessment and received up to 3 health referrals for needed services (mammography, pap testing, colonoscopy, HPV vaccination, smoking cessation and smoke-free home policies). Participants received either a verbal referral only (N=365), verbal referral+tailored print reminder (N=372), or verbal referral+navigator (N=353). Participants reported their unmet basic needs at baseline and contacts with health referrals at 1-month post-intervention. We examined latent classes of unmet basic needs using SAS. Logistic regression examined the association between latent classes and contacting a health referral, by intervention condition. A 3 class solution best fit the data. For participants with relatively more unmet needs (C2) and those with money needs (C3), the navigator intervention was more effective than the tailored or verbal referral only conditions in leading to health referrals contacts. For participants with fewer unmet basic needs (C1), the tailored intervention was as effective as the navigator intervention. The distribution and nature of unmet basic needs in this sample of low-income adults was heterogeneous, and those with the greatest needs benefitted most from a more intensive navigator intervention in helping them seek needed preventive health services.
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Affiliation(s)
- Matthew W Kreuter
- Washington University, School of Social Work, Campus Box 1196, 1 Brookings Dr., St. Louis, MO 63130, United States.
| | - Amy McQueen
- Washington University, School of Medicine, Campus Box 8005, 4523 Clayton Ave., St. Louis, MO 63110, United States.
| | - Sonia Boyum
- Washington University, School of Social Work, Campus Box 1196, 1 Brookings Dr., St. Louis, MO 63130, United States.
| | - Qiang Fu
- Saint Louis University, College for Public Health and Social Justice, Salus Center Room 480, 3545 Lafayette Ave., St. Louis, MO 63104, United States.
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Kahng SK, Dunkle RE, Jackson JS. The Relationship Between the Trajectory of Body Mass Index and Health Trajectory Among Older Adults. Res Aging 2016. [DOI: 10.1177/0164027503258734] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Little is known about the cross-sectional or longitudinal relationships between body weight and health at older ages. Using multilevel modeling analyses, this study examined the trajectories of body mass index (BMI), chronic health conditions (CHC), and functional disability (FD); factors associated with the trajectories; and the relationships between the trajectories. The sample of elders aged 65 and older participated in the Americans Changing Lives longitudinal study. Participants showed decreasing BMI and increasing CHCand FD with time. Current smokers presented lowerBMI at Wave 1 and showed a slower decrease inBMIover time than those who never smoked. Obesity was associated with more CHC and greater FDatWave 1 but did not influence their changes. Elders who experienced a slower decrease in BMI showed a slower increase in CHC and FD; the change in health was not related to the change in BMI.
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Choi E, Tang F, Kim SG, Turk P. Longitudinal Relationships Between Productive Activities and Functional Health in Later Years. Int J Aging Hum Dev 2016; 83:418-40. [PMID: 27461262 DOI: 10.1177/0091415016657557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined the longitudinal relationships between functional health in later years and three types of productive activities: volunteering, full-time, and part-time work. Using the data from five waves (2000–2008) of the Health and Retirement Study, we applied multivariate latent growth curve modeling to examine the longitudinal relationships among individuals 50 or over. Functional health was measured by limitations in activities of daily living. Individuals who volunteered, worked either full time or part time exhibited a slower decline in functional health than nonparticipants. Significant associations were also found between initial functional health and longitudinal changes in productive activity participation. This study provides additional support for the benefits of productive activities later in life; engagement in volunteering and employment are indeed associated with better functional health in middle and old age.
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Affiliation(s)
- Eunhee Choi
- School of Social Work, Colorado State University, Fort Collins, CO, USA
| | - Fengyan Tang
- School of Social Work, University of Pittsburgh, PA, USA
| | - Sung-Geun Kim
- Korea Institute of Public Administration, Seoul, Republic of Korea
| | - Phillip Turk
- Department of Statistics, Colorado State University, Fort Collins, USA
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Muntaner C, Gomez MB. Anti-Egalitarianism, Legitimizing Myths, Racism, and “Neo-McCarthyism” in Social Epidemiology and Public Health: A Review of Sally Satel's PC, M.D. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016. [DOI: 10.2190/m2vh-bk9k-f8v4-581h] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sally Satel's PC, M.D.: How Political Correctness Is Corrupting Medicine constitutes an attempt to weaken the influence of egalitarian and antiracist scholarship in contemporary public health. This book has been widely distributed and has received many positive reviews in academia and the general press. Surprisingly, Satel has enlisted the direct or indirect support of prominent public health academics. The authors' critical review of this book indicates that Satel uses a combination of tactics to convince the reader of the danger involved in egalitarian public health efforts. Among them are insults, traditional “red baiting” tactics, “triangulation,” exaggeration, emotionally charged examples, omissions, and a strong appeal to individual responsibility to explain social inequalities in health. PC, M.D. reveals a scientific and ideological conflict over the determinants of health in populations that takes place within and outside the public health discipline. Efforts such as PC, M.D. suggest that social epidemiologists and other egalitarian public health scholars are having some impact in shaping how the public views health disparities.
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61
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Adler NE, Snibbe AC. The Role of Psychosocial Processes in Explaining the Gradient Between Socioeconomic Status and Health. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2016. [DOI: 10.1111/1467-8721.01245] [Citation(s) in RCA: 236] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The gradient between socioeconomic status (SES) and health is well established: Many measures of health show that health increases as SES increases. However, the mechanisms underlying this association are not well understood. Behavioral, cognitive, and affective tendencies that develop in response to the greater psychosocial stress encountered in low-SES environments may partially mediate the impact of SES on health. Although these tendencies might be helpful for coping in the short term, over time they may contribute to the development of allostatic load, which increases vulnerability to disease. Debate remains regarding the direction of causation between SES and health, the impact of income inequality, the interaction of SES with race-ethnicity and gender, and the effects of SES over the life course.
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Affiliation(s)
- Nancy E. Adler
- Health Psychology Program, Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Alana Conner Snibbe
- Health Psychology Program, Department of Psychiatry, University of California, San Francisco, San Francisco, California
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Brown TH, Richardson LJ, Hargrove TW, Thomas CS. Using Multiple-hierarchy Stratification and Life Course Approaches to Understand Health Inequalities: The Intersecting Consequences of Race, Gender, SES, and Age. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2016; 57:200-22. [PMID: 27284076 PMCID: PMC4905600 DOI: 10.1177/0022146516645165] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This study examines how the intersecting consequences of race-ethnicity, gender, socioeconomics status (SES), and age influence health inequality. We draw on multiple-hierarchy stratification and life course perspectives to address two main research questions. First, does racial-ethnic stratification of health vary by gender and/or SES? More specifically, are the joint health consequences of racial-ethnic, gender, and socioeconomic stratification additive or multiplicative? Second, does this combined inequality in health decrease, remain stable, or increase between middle and late life? We use panel data from the Health and Retirement Study (N = 12,976) to investigate between- and within-group differences in in self-rated health among whites, blacks, and Mexican Americans. Findings indicate that the effects of racial-ethnic, gender, and SES stratification are interactive, resulting in the greatest racial-ethnic inequalities in health among women and those with higher levels of SES. Furthermore, racial-ethnic/gender/SES inequalities in health tend to decline with age. These results are broadly consistent with intersectionality and aging-as-leveler hypotheses.
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Affiliation(s)
| | | | | | - Courtney S Thomas
- University of California-Los Angeles, Los Angeles, CA, USA, and University of Kentucky, Lexington, KY, USA
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63
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Read S, Grundy E, Foverskov E. Socio-economic position and subjective health and well-being among older people in Europe: a systematic narrative review. Aging Ment Health 2016; 20:529-42. [PMID: 25806655 PMCID: PMC4784497 DOI: 10.1080/13607863.2015.1023766] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Previous studies of older European populations have established that disability and morbidity vary with indicators of socio-economic position (SEP). We undertook a systematic narrative review of the literature to ascertain to what extent there is evidence of similar inequalities in the subjective health and well-being of older people in Europe. METHOD Relevant original research articles were searched for using Medline, Global Health, Embase, Social Policy and Practice, Cinahl, Web of Science and International Bibliography of the Social Sciences (IBSS). We included studies of SEP and indicators of subjective health and well-being (self-rated health; life satisfaction; quality of life) conducted since 1991 using population-based samples of older people in Europe and published 1995-2013. RESULTS A total of 71 studies were identified. Poorer SEP was associated with poorer subjective health and well-being. Associations varied somewhat depending on the SEP measure and subjective health and well-being outcome used. Associations were weaker when social support and health-related behaviours were adjusted for suggesting that these factors mediate the relationship between SEP and subjective health and well-being. Associations tended to be weaker in the oldest age groups. The patterns of associations by gender were not consistent and tended to diminish after adjusting for indicators of health and life circumstances. CONCLUSION The results of this systematic narrative review of the literature demonstrate the importance of social influences on later life subjective health and well-being and indicate areas which need further investigation, such as more studies from Eastern Europe, more longitudinal studies and more research on the role of mediating factors.
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Affiliation(s)
- Sanna Read
- Department of Social Policy, London School of Economics and Political Science, London, United Kingdom,Corresponding author.
| | - Emily Grundy
- Department of Social Policy, London School of Economics and Political Science, London, United Kingdom
| | - Else Foverskov
- Department of Social Policy, London School of Economics and Political Science, London, United Kingdom
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Liverani S, Lavigne A, Blangiardo M. Modelling collinear and spatially correlated data. Spat Spatiotemporal Epidemiol 2016; 18:63-73. [PMID: 27494961 DOI: 10.1016/j.sste.2016.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/23/2016] [Accepted: 04/05/2016] [Indexed: 02/05/2023]
Abstract
In this work we present a statistical approach to distinguish and interpret the complex relationship between several predictors and a response variable at the small area level, in the presence of (i) high correlation between the predictors and (ii) spatial correlation for the response. Covariates which are highly correlated create collinearity problems when used in a standard multiple regression model. Many methods have been proposed in the literature to address this issue. A very common approach is to create an index which aggregates all the highly correlated variables of interest. For example, it is well known that there is a relationship between social deprivation measured through the Multiple Deprivation Index (IMD) and air pollution; this index is then used as a confounder in assessing the effect of air pollution on health outcomes (e.g. respiratory hospital admissions or mortality). However it would be more informative to look specifically at each domain of the IMD and at its relationship with air pollution to better understand its role as a confounder in the epidemiological analyses. In this paper we illustrate how the complex relationships between the domains of IMD and air pollution can be deconstructed and analysed using profile regression, a Bayesian non-parametric model for clustering responses and covariates simultaneously. Moreover, we include an intrinsic spatial conditional autoregressive (ICAR) term to account for the spatial correlation of the response variable.
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Affiliation(s)
- Silvia Liverani
- Department of Mathematics, Brunel University London, Uxbridge UB8 3PH, UK; Medical Research Centre Biostatistics Unit, Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge CB2 0SR, UK; MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, 2 Norfolk Place, London W2 8PG, UK.
| | - Aurore Lavigne
- Université Lille 3, UFR MIME, Domaine universitaire du Pont de Bois, BP 60149 59653 Villeneuve d'ascq Cedex, France.
| | - Marta Blangiardo
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, 2 Norfolk Place, London W2 8PG, UK.
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65
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Bonaccio M, Di Castelnuovo A, Costanzo S, Persichillo M, Donati MB, de Gaetano G, Iacoviello L. Interaction between education and income on the risk of all-cause mortality: prospective results from the MOLI-SANI study. Int J Public Health 2016; 61:765-76. [DOI: 10.1007/s00038-016-0822-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 10/21/2022] Open
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An education gradient in health, a health gradient in education, or a confounded gradient in both? Soc Sci Med 2016; 154:18-27. [PMID: 26943010 DOI: 10.1016/j.socscimed.2016.02.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 02/13/2016] [Accepted: 02/17/2016] [Indexed: 11/21/2022]
Abstract
There is a positive gradient associating educational attainment with health, yet the explanation for this gradient is not clear. Does higher education improve health (causation)? Do the healthy become highly educated (selection)? Or do good health and high educational attainment both result from advantages established early in the life course (confounding)? This study evaluates these competing explanations by tracking changes in educational attainment and Self-rated Health (SRH) from age 15 to age 31 in the National Longitudinal Study of Youth, 1997 cohort. Ordinal logistic regression confirms that high-SRH adolescents are more likely to become highly educated. This is partly because adolescent SRH is associated with early advantages including adolescents' academic performance, college plans, and family background (confounding); however, net of these confounders adolescent SRH still predicts adult educational attainment (selection). Fixed-effects longitudinal regression shows that educational attainment has little causal effect on SRH at age 31. Completion of a high school diploma or associate's degree has no effect on SRH, while completion of a bachelor's or graduate degree have effects that, though significant, are quite small (less than 0.1 points on a 5-point scale). While it is possible that educational attainment would have greater effect on health at older ages, at age 31 what we see is a health gradient in education, shaped primarily by selection and confounding rather than by a causal effect of education on health.
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67
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Fu R, Noguchi H. Does Marriage Make Us Healthier? Inter-Country Comparative Evidence from China, Japan, and Korea. PLoS One 2016; 11:e0148990. [PMID: 26862896 PMCID: PMC4749249 DOI: 10.1371/journal.pone.0148990] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 01/26/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study focuses on East Asian countries and investigates the difference in the marriage premium on the health-marriage protection effect (MPE) between younger and older generations and the intra-couple education concordance effect (ECE) on the health of married individuals. This study used inter-country comparative data from China, Japan, and Korea. METHODS This study focused on individuals (n = 7,938) in China, Japan, and Korea who were sampled from the 2010 East Asian Social Survey. To investigate MPE and ECE, four health indicators were utilized: a physical and mental components summary (PCS and MCS), self-rated health status (Dself), and happiness level (Dhappy). Ordinary least squares regression was conducted by country- and gender-specific subsamples. RESULTS We found that the MPE on PCS, MCS, and Dself was more significant for the older generation than for the younger generation in both China and Japan, whereas the results were inconclusive in Korea. With regard to the ECE on happiness (Dhappy), for both men and women, couples tend to be happier when both the husband and the wife are well educated ("higher balanced marriage") compared to couples with a lower level of educational achievement ("lower balanced marriage"). Significant benefits from a "higher balanced marriage" on MCS and Dself were observed for women only. In contrast, no statistically significant differences in health status were observed between "higher balanced marriage" couples and couples with different levels of educational achievements ("upward marriage" or "downward marriage"). CONCLUSIONS This study found that (1) the MPE was more significant for the older generation, and (2) the health gap, particularly the happiness gap, between higher- and lower-balanced married couples was significant. The inter-country comparative findings are useful to explain how the role of marriage (and therefore of family) on health has been diluted due to the progress of industrialization and modernization.
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Affiliation(s)
- Rong Fu
- Graduate School of Economics, Waseda University, Tokyo, Japan
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- * E-mail:
| | - Haruko Noguchi
- Faculty of Political Science and Economics, Waseda University, Tokyo, Japan
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Harris JK, Beatty K, Leider JP, Knudson A, Anderson BL, Meit M. The Double Disparity Facing Rural Local Health Departments. Annu Rev Public Health 2016; 37:167-84. [PMID: 26735428 DOI: 10.1146/annurev-publhealth-031914-122755] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities.
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Affiliation(s)
- Jenine K Harris
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130;
| | - Kate Beatty
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, Tennessee 37614;
| | - J P Leider
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland 21205;
| | - Alana Knudson
- Public Health Department.,NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
| | - Britta L Anderson
- NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
| | - Michael Meit
- Public Health Department.,NORC Walsh Center for Rural Health Analysis, University of Chicago, Chicago, Illinois 60637; , ,
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Guarnizo-Herreño CC, Tsakos G, Sheiham A, Marmot MG, Kawachi I, Watt RG. Austin Powers bites back: a cross sectional comparison of US and English national oral health surveys. BMJ 2015; 351:h6543. [PMID: 26676027 PMCID: PMC4681766 DOI: 10.1136/bmj.h6543] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare oral health in the US and England and to assess levels of educational and income related oral health inequalities between both countries. DESIGN Cross sectional analysis of US and English national surveys. SETTING Non-institutionalised adults living in their own homes. PARTICIPANTS Oral health measures and socioeconomic indicators were assessed in nationally representative samples: the Adult Dental Health Survey 2009 for England, and the US National Health and Nutrition Examination Survey 2005-08. Adults aged ≥25 years were included in analyses with samples of 8719 (England) and 9786 (US) for analyses by education, and 7184 (England) and 9094 (US) for analyses by income. MAIN OUTCOME MEASURES Number of missing teeth, self rated oral health, and oral impacts on daily life were outcomes. Educational attainment and household income were used as socioeconomic indicators. Age standardised estimates of oral health were compared between countries and across educational and income groups. Regression models were fitted, and relative and absolute inequalities were measured using the relative index of inequality (RII) and the slope index of inequality (SII). RESULTS The mean number of missing teeth was significantly higher in the US (7.31 (standard error 0.15)) than in England (6.97 (0.09)), while oral impacts were higher in England. There was evidence of significant social gradients in oral health in both countries, although differences in oral health by socioeconomic position varied according to the oral health measure used. Consistently higher RII and SII values were found in the US than in England, particularly for self rated oral health. RII estimates for self rated oral health by education were 3.67 (95% confidence interval 3.23 to 4.17) in the US and 1.83 (1.59 to 2.11) in England. In turn, SII values were 42.55 (38.14 to 46.96) in the US and 18.43 (14.01 to 22.85) in England. CONCLUSIONS The oral health of US citizens is not better than the English, and there are consistently wider educational and income oral health inequalities in the US compared with England.
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Affiliation(s)
- Carol C Guarnizo-Herreño
- Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
| | - Aubrey Sheiham
- Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
| | - Michael G Marmot
- Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts 02115, USA
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
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Kim JH, Yoo KB, Park EC, Lee SG, Kim TH. Combined effects of education level and perceived social class on self-rated health and life satisfaction: Results of Korean labor and income panel study wave 8-wave 15. Health Qual Life Outcomes 2015; 13:178. [PMID: 26526467 PMCID: PMC4630931 DOI: 10.1186/s12955-015-0375-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 10/29/2015] [Indexed: 11/25/2022] Open
Abstract
Background To examine the combined effects of education level and perceived social class on self-rated health and life satisfaction in South Korea. Methods We used data drawn from the 8 to 15th wave of the Korean Labor and Income Panel Study (KLIPS). Using wave 8 at baseline, data included 11,175 individuals. We performed a longitudinal analysis at baseline estimating the prevalence of self-rated health and life satisfaction among individuals by education level (high, middle, and low education level) and perceived social class (high, middle, and low social class). Results For self-rated health, odds ratio (OR) of individuals with low education and low perceived social class was 0.604 times lower (95 % CI: 0.555–0.656) and the OR of individuals with low education and middle perceived social class was 0.853 time lower (95 % CI: 0.790–0.922) when compared to individuals with high education and high perceived social class. For life satisfaction, OR of individuals with low education and low perceived social class was 0.068 times lower (95 % CI: 0.063–0.074) and the OR of individuals with middle education and middle perceived social class was 0.235 time lower (95 % CI: 0.221–0.251) compared to individuals with high education and high perceived social class. Conclusions This study shows that the combined effects of education level and perceived social class associated with self-rated health and life satisfaction. Our study suggests increasing education level and perceived social class. Additionally, it will be important to develop multi-dimensional measurement tools including education level and subjective social class. Electronic supplementary material The online version of this article (doi:10.1186/s12955-015-0375-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jae-Hyun Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea. .,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
| | - Ki-Bong Yoo
- Department of Healthcare Management, Eulji University, Sungnam, Republic of Korea.
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. .,Department of Hospital management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
| | - Sang Gyu Lee
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea. .,Department of Hospital management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
| | - Tae Hyun Kim
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea. .,Department of Hospital management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea.
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A closer look at the rural-urban health disparities: Insights from four major diseases in the Commonwealth of Virginia. Soc Sci Med 2015. [DOI: 10.1016/j.socscimed.2015.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Nadimpalli SB, James BD, Yu L, Cothran F, Barnes LL. The association between discrimination and depressive symptoms among older African Americans: the role of psychological and social factors. Exp Aging Res 2015; 41:1-24. [PMID: 25494668 DOI: 10.1080/0361073x.2015.978201] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
UNLABELLED BACKGROUND/STUDY CONTEXT: Several studies have demonstrated a link between perceived discrimination and depression in ethnic minority groups, yet most have focused on younger or middle-aged African Americans and little is known about factors that may moderate the relationship. METHODS Participants were 487 older African Americans (60-98 years old) enrolled in the Minority Aging Research Study. Discrimination, depressive symptoms, and psychological and social resources were assessed via interview using validated measures. Ordinal logistic regression models were used to assess (1) the main relationship between discrimination and depression and (2) resilience, purpose in life, social isolation, and social networks as potential moderators of this relationship. RESULTS In models adjusted for age, sex, education, and income, perceived discrimination was positively associated with depressive symptoms (odds ratio [OR]: 1.20, 95% confidence interval [CI]: 1.10-1.31; p < .001). However, there was no evidence of effect modification by resilience, purpose in life, social isolation, or social networks (all ps ≤ .05). CONCLUSION Findings provide support for accumulating evidence on the adverse mental health effects of discrimination among older African Americans. Because the association was not modified by psychological or social factors, these findings do not support a role for a buffering effect of resources on discrimination and depressive symptoms. Further studies are needed to examine a wider range of coping resources among older adults.
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Guy BS, Henson JLN, Dotson MJ. Characteristics of consumers likely and unlikely to participate in medical tourism. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2015. [DOI: 10.1179/2047971914y.0000000076] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Critical review of the evidence for the connection between education and health: A guide for exploration of the causal pathways. ACTA ACUST UNITED AC 2015. [DOI: 10.1108/s0275-4959(2009)0000027009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Cherpitel CJ, Ye Y, Bond J, Zemore SE, Borges G, Greenfield TK. Border effects on DSM-5 alcohol use disorders on both sides of the U.S.-Mexico border. Drug Alcohol Depend 2015; 148:172-9. [PMID: 25649987 PMCID: PMC4330123 DOI: 10.1016/j.drugalcdep.2015.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 11/26/2014] [Accepted: 01/03/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little epidemiological evidence exists on alcohol use and related problems along the U.S.-Mexico border, although the borderlands have been the focus of recent media attention related to the escalating drug/violence "epidemic". In the present study, the relationship of proximity of living at the border and alcohol use disorders (AUDs) is analyzed from the U.S.-Mexico Study on Alcohol and Related Conditions (UMSARC). METHODS Household surveys were conducted on 2336 Mexican Americans in Texas (771 in a non-border city and 1565 from three border cities located in the three poorest counties in the U.S.) and 2460 Mexicans from the states of Nuevo Leon and Tamaulipas in Mexico (811 in a non-border city and 1649 from three cities which are sister cities to the Texas border sites). RESULTS Among current drinkers, prevalence of AUD was marginally greater (p<0.10) at the U.S. border compared to the non-border, but the opposite was true in Mexico (p<0.001), and these trends continued on both sides across volume and 5+ drinking days. Prevalence was greater in Laredo/Nuevo Laredo relative to their respective sister city counterparts on the same side. Border effects appeared greater for males than females in the U.S. and the opposite in Mexico. CONCLUSION The data suggest that border proximity may affect AUD in both the U.S. and Mexico, but in the opposite direction, and may be related to the relative perceived or actual stress of living in the respective communities.
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Affiliation(s)
- Cheryl J Cherpitel
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608, United States.
| | - Yu Ye
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608, United States
| | - Jason Bond
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608, United States
| | - Sarah E Zemore
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608, United States
| | - Guilherme Borges
- National Institute of Psychiatry, Autonomous Metropolitan University of Mexico, Mexico City, Mexico
| | - Thomas K Greenfield
- Alcohol Research Group, 6475 Christie Avenue, Suite 400, Emeryville, CA 94608, United States
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Samuel LJ, Glass TA, Thorpe RJ, Szanton SL, Roth DL. Household and neighborhood conditions partially account for associations between education and physical capacity in the National Health and Aging Trends Study. Soc Sci Med 2015; 128:67-75. [PMID: 25594954 DOI: 10.1016/j.socscimed.2015.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Socioeconomic resources, such as education, prevent disability but are not readily modifiable. We tested the hypothesis that household and neighborhood conditions, which may be modifiable, partially account for associations between education and physical capacity in a population-based sample of older adults. The National Health and Aging Trends Study measured education (<high school, high school, some college, and ≥Bachelor's), household and neighborhood conditions, using a 16-item environmental checklist and a 3-item social cohesion scale, and physical capacity with the Short Physical Performance Battery (SPPB), grip strength and peak expiratory flow. Structural equation models were used to decompose total educational effects into direct effects and indirect effects via household and neighborhood conditions, using sample weights and adjusting for age, sex, race/ethnicity, marital status, household size, BMI, self-reported health, and number of medical conditions in 6874 community-dwelling participants. Education was directly associated with SPPB scores (β = 0.055, p < 0.05) and peak flow (β = 0.095, p < 0.05), but not grip strength. Also, indirect effects were found for household disorder with SPPB scores (β = 0.013, p < 0.05), grip strength (β = 0.007, p < 0.05), and peak flow (β = 0.010, p < 0.05). Indirect effects were also found for street disorder with SPPB scores (β = 0.012, p < 0.05). Indirect effects of household and neighborhood conditions accounted for approximately 35%, 27% and 14% of the total association between education and SPPB scores, grip strength level, and peak expiratory flow level, respectively. Household disorder and street disorder partially accounted for educational disparities in physical capacity. However, educational disparities in SPPB scores and peak expiratory flow persisted after accounting for household and neighborhood conditions and chronic conditions, suggesting additional pathways. Interventions and policies aiming to support aging in place should consider addressing household-level and street-level disorder.
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Affiliation(s)
- Laura J Samuel
- Johns Hopkins University, Department of Epidemiology, Center on Aging and Health, 2024 East Monument St., Suite 2-700, Baltimore, MD 21205, USA.
| | - Thomas A Glass
- Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe St., E6144, Baltimore, MD 21205, USA.
| | - Roland J Thorpe
- Johns Hopkins University, Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 North Broadway, Baltimore, MD 21205, USA.
| | - Sarah L Szanton
- Johns Hopkins University, School of Nursing and Bloomberg School of Public Health, Department of Health Policy and Management, 525 North Wolfe Street #424, Baltimore, MD 21205, USA.
| | - David L Roth
- Johns Hopkins Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Department of Medicine, Center on Aging and Health, 2024 East Monument St., Suite 2-700, Baltimore, MD 21205, USA.
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Mehta NK, House JS, Elliott MR. Dynamics of health behaviours and socioeconomic differences in mortality in the USA. J Epidemiol Community Health 2015; 69:416-22. [PMID: 25563741 DOI: 10.1136/jech-2014-204248] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 12/09/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND To measure the explanatory role of behavioural factors to educational and income disparities in mortality among US adults (ages 25+). METHODS Data were from four waves of the American Changing Lives Study (N=3617). There were 1832 deaths between 1986 and 2011. Smoking, physical activity, alcohol and body mass index were examined. RESULTS Those with 0-11 years of schooling had an 88% (95% CI 48% to 139%) increased risk of dying compared to those with 16+years of schooling. Behavioural factors explained 41% (95% CI 26% to 55%) and 50% (95% CI 30% to 70%) of this excess in models that treated behavioural factors as fixed (single point in time) and time varying (repeated), respectively. The lowest income group (bottom 20th centile) had a 209% (95% CI 172% to 256%) increased risk of dying relative to the highest income group (top 40th centile). Behavioural factors explained 24% (fixed, 95% CI 13% to 35%) and 39% (repeated, 95% CI 22% to 56%) of this difference. Analyses of deaths by causes indicated that behavioural factors were more consequential to disparities in cardiovascular mortality, explaining up to 83% of educational differences, compared to cancer and other death causes. CONCLUSIONS Behavioural factors are one of a number of factors which explain socioeconomic mortality disparities, but their estimated explanatory role depends on a number of parameters including the socioeconomic status measure examined, the cause of death and age. In this nationally representative sample, findings based on repeated measures did not warrant a re-evaluation of earlier estimates.
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Affiliation(s)
- Neil K Mehta
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - James S House
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael R Elliott
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA Biostatistics Department, University of Michigan, Ann Arbor, Michigan, USA
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Burton-Jeangros C, Cullati S, Sacker A, Blane D. Introduction. A LIFE COURSE PERSPECTIVE ON HEALTH TRAJECTORIES AND TRANSITIONS 2015. [DOI: 10.1007/978-3-319-20484-0_1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Hu Y, Pikhart H, Malyutina S, Pajak A, Kubinova R, Nikitin Y, Peasey A, Marmot M, Bobak M. Alcohol consumption and physical functioning among middle-aged and older adults in Central and Eastern Europe: results from the HAPIEE study. Age Ageing 2015; 44:84-9. [PMID: 24982097 PMCID: PMC4255613 DOI: 10.1093/ageing/afu083] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: light-to-moderate drinking is apparently associated with a decreased risk of physical limitations in middle-aged and older adults. Objective: to investigate the association between alcohol consumption and physical limitations in Eastern European populations. Study design: a cross-sectional survey of 28,783 randomly selected residents (45–69 years) in Novosibirsk (Russia), Krakow (Poland) and seven towns of Czech Republic. Methods: physical limitations were defined as <75% of optimal physical functioning using the Physical Functioning (PF-10) Subscale of the Short-Form-36 questionnaire. Alcohol consumption was assessed by a graduated frequency questionnaire, and problem drinking was defined as ≥2 positive responses on the CAGE questionnaire. In the Russian sample, past drinking was also assessed. Results: the odds of physical limitations were highest among non-drinkers, decreased with increasing drinking frequency, annual consumption and average drinking quantity and were not associated with problem drinking. The adjusted odds ratio (OR) of physical limitations in non-drinkers versus regular moderate drinkers was 1.61 (95% confidence interval: 1.48–1.75). In the Russian sample with past drinking available, the adjusted OR in those who stopped drinking for health reasons versus continuing drinkers was 3.19 (2.58–3.95); ORs in lifetime abstainers, former drinkers for non-health reasons and reduced drinkers for health reasons were 1.27 (1.02–1.57), 1.48 (1.18–1.85) and 2.40 (2.05–2.81), respectively. Conclusion: this study found an inverse association between alcohol consumption and physical limitations. The high odds of physical limitations in non-drinkers can be largely explained by poor health of former drinkers. The apparently protective effect of heavier drinking was partly due to less healthy former heavy drinkers who moved to lower drinking categories.
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Affiliation(s)
- Yaoyue Hu
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Hynek Pikhart
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Sofia Malyutina
- Institute of Internal and Preventive Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russian Federation Novosibirsk State Medical University, Novosibirsk, Russian Federation
| | - Andrzej Pajak
- Collegium Medicum, Jagiellonian University, Krakow, Poland
| | | | - Yuri Nikitin
- Institute of Internal and Preventive Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russian Federation
| | - Anne Peasey
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Michael Marmot
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, UK
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Evaluation of integrated psychological services in a university-based primary care clinic. J Clin Psychol Med Settings 2014; 21:19-32. [PMID: 24165929 DOI: 10.1007/s10880-013-9378-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Primary care is increasingly moving toward integration of psychological services; however few studies have been conducted to test the efficacy of such an integrated approach. This paper presents a program evaluation of psychological services provided by doctoral trainees in clinical and counseling psychology within a primary care clinic at an urban academic medical center. It includes: (1) a description of the program, including types of patients served, their presenting problems, and treatments administered and; (2) evidence of the impact of behavioral health services on primary care patients' emotional adjustment and progress on behavioral goals. Intake and follow-up measures of depression, anxiety, smoking, insomnia, chronic pain, and weight loss were collected on 452 adult patients (mean age = 52; 59 % African-American; 35 % uninsured) who were provided brief interventions (mean visits = 2.2) over a 16-month period. Although conclusions are limited by the lack of a control or comparison group, preliminary findings indicate that the integrated behavioral health services provided were effective. Implications and future directions are discussed.
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Bjornstrom EE, Kuhl DC. A different look at the epidemiological paradox: Self-rated health, perceived social cohesion, and neighborhood immigrant context. Soc Sci Med 2014; 120:118-25. [DOI: 10.1016/j.socscimed.2014.09.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 09/05/2014] [Accepted: 09/08/2014] [Indexed: 12/29/2022]
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Tabatabai MA, Kengwoung-Keumo JJ, Eby WM, Bae S, Guemmegne JT, Manne U, Fouad M, Partridge EE, Singh KP. Disparities in cervical cancer mortality rates as determined by the longitudinal hyperbolastic mixed-effects type II model. PLoS One 2014; 9:e107242. [PMID: 25226583 PMCID: PMC4167327 DOI: 10.1371/journal.pone.0107242] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 08/01/2014] [Indexed: 12/29/2022] Open
Abstract
Background The main purpose of this study was to model and analyze the dynamics of cervical cancer mortality rates for African American (Black) and White women residing in 13 states located in the eastern half of the United States of America from 1975 through 2010. Methods The cervical cancer mortality rates of the Surveillance, Epidemiology, and End Results (SEER) were used to model and analyze the dynamics of cervical cancer mortality. A longitudinal hyperbolastic mixed-effects type II model was used to model the cervical cancer mortality data and SAS PROC NLMIXED and Mathematica were utilized to perform the computations. Results Despite decreasing trends in cervical cancer mortality rates for both races, racial disparities in mortality rates still exist. In all 13 states, Black women had higher mortality rates at all times. The degree of disparities and pace of decline in mortality rates over time differed among these states. Determining the paces of decline over 36 years showed that Tennessee had the most rapid decline in cervical cancer mortality for Black women, and Mississippi had the most rapid decline for White Women. In contrast, slow declines in cervical cancer mortality were noted for Black women in Florida and for White women in Maryland. Conclusions In all 13 states, cervical cancer mortality rates for both racial groups have fallen. Disparities in the pace of decline in mortality rates in these states may be due to differences in the rates of screening for cervical cancers. Of note, the gap in cervical cancer mortality rates between Black women and White women is narrowing.
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Affiliation(s)
- Mohammad A. Tabatabai
- School of Graduate Studies and Research, Meharry Medical College, Nashville, Tennessee, United States of America
| | | | - Wayne M. Eby
- Department of Mathematics, New Jersey City University, Jersey City, New Jersey, United States of America
| | - Sejong Bae
- Division of Preventive Medicine and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Juliette T. Guemmegne
- Department of Economics, University of New Mexico, Albuquerque, New Mexico, United States of America
| | - Upender Manne
- Department of Pathology and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Mona Fouad
- Division of Preventive Medicine and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Edward E. Partridge
- Department of Obstetrics & Gynecology and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Karan P. Singh
- Division of Preventive Medicine and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- * E-mail:
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Christensen U, Krølner R, Nilsson CJ, Lyngbye PW, Hougaard CØ, Nygaard E, Thielen K, Holstein BE, Avlund K, Lund R. Addressing social inequality in aging by the Danish occupational social class measurement. J Aging Health 2014; 26:106-27. [PMID: 24584263 DOI: 10.1177/0898264314522894] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To present the Danish Occupational Social Class (DOSC) measurement as a measure of socioeconomic position (SEP) applicable in a late midlife population, and to analyze associations of this measure with three aging-related outcomes in midlife, adjusting for education. METHOD Systematic coding procedures of the DOSC measurement were applied to 7,084 participants from the Copenhagen Aging and Midlife Biobank (CAMB) survey. We examined the association of this measure of SEP with chronic conditions, self-rated health, and mobility in logistic regression analyses, adjusting for school education in the final analysis. RESULTS The measure of SEP showed a strong social gradient along the social classes in terms of prevalence of chronic conditions, poor self-rated health, and mobility limitations. Adjusting for school education attenuated the association only to a minor degree. DISCUSSION The DOSC measure was associated with aging-related outcomes in a midlife Danish population, and is, thus, well suited for future epidemiological research on social inequalities in health and aging.
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Beck AN, Finch BK, Lin SF, Hummer RA, Masters RK. Racial disparities in self-rated health: trends, explanatory factors, and the changing role of socio-demographics. Soc Sci Med 2014; 104:163-77. [PMID: 24581075 PMCID: PMC4002582 DOI: 10.1016/j.socscimed.2013.11.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 11/07/2013] [Accepted: 11/12/2013] [Indexed: 11/18/2022]
Abstract
This paper uses data from the U.S. National Health Interview Surveys (N = 1,513,097) to describe and explain temporal patterns in black-white health disparities with models that simultaneously consider the unique effects of age, period, and cohort. First, we employ cross-classified random effects age-period-cohort (APC) models to document black-white disparities in self-rated health across temporal dimensions. Second, we use decomposition techniques to shed light on the extent to which socio-economic shifts in cohort composition explain the age and period adjusted racial health disparities across successive birth cohorts. Third, we examine the extent to which exogenous conditions at the time of birth help explain the racial disparities across successive cohorts. Results show that black-white disparities are wider among the pre-1935 cohorts for women, falling thereafter; disparities for men exhibit a similar pattern but exhibit narrowing among cohorts born earlier in the century. Differences in socioeconomic composition consistently contribute to racial health disparities across cohorts; notably, marital status differences by race emerge as an increasingly important explanatory factor in more recent cohorts for women whereas employment differences by race emerge as increasingly salient in more recent cohorts for men. Finally, our cohort characteristics models suggest that cohort economic conditions at the time of birth (percent large family, farm or Southern birth) help explain racial disparities in health for both men and women.
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Affiliation(s)
- Audrey N Beck
- San Diego State University, San Diego, CA 92123, USA.
| | | | - Shih-Fan Lin
- San Diego State University, San Diego, CA 92123, USA
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85
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Nilsson CJ, Siersma V, Mänty M, Avlund K, Vass M, Lund R. Mobility decline in old age: the combined effect of mobility-related fatigue and socioeconomic position. J Epidemiol Community Health 2014; 68:510-5. [DOI: 10.1136/jech-2013-203060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Shimotsu ST, Jones-Webb RJ, Lytle LA, MacLehose RF, Nelson TF, Forster JL. The relationships among socioeconomic status, fruit and vegetable intake, and alcohol consumption. Am J Health Promot 2013; 27:21-8. [PMID: 22950922 DOI: 10.4278/ajhp.110311-quan-108] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE We examined the relationships among fruit and vegetable intake, alcohol consumption, and socioeconomic status (SES). We hypothesized that fruit and vegetable consumption would be inversely associated with alcohol consumption and the relationship would differ by SES. DESIGN A cross-sectional analysis. SETTING Large, urban Midwestern county. SUBJECTS A unique, racially/ethnically diverse sample of 9959 adults (response rate: 66.3%). MEASURES Fruit and vegetable intake was measured using two items that assessed servings per day. Alcohol consumption was measured in terms of volume of alcohol consumed and binge drinking. Individual measures of SES included education and household income. ANALYSIS Weighted multivariate linear and Poisson regression were used to estimate effects. RESULTS The relationship between fruit and vegetable intake and alcohol consumption varied by SES. Those with lower household incomes who consumed five or more servings of fruits and vegetables per day were less likely to engage in binge drinking relative to those consuming zero to one servings of fruits and vegetables per day (risk ratio = .66; 95% confidence interval: .46, .95). No association was observed for higher-household-income individuals. CONCLUSION We observed an inverse relationship between fruit and vegetable consumption and alcohol intake in those with lower household incomes but not in those with higher household incomes. Results suggest that the relationship between diet and alcohol consumption may be more relevant in populations with more restricted economic choices. Results are, however, based on cross-sectional data.
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Affiliation(s)
- Scott T Shimotsu
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota 55415, USA
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87
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Shaw BA, McGeever K, Vasquez E, Agahi N, Fors S. Socioeconomic inequalities in health after age 50: are health risk behaviors to blame? Soc Sci Med 2013; 101:52-60. [PMID: 24560224 DOI: 10.1016/j.socscimed.2013.10.040] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 10/25/2013] [Accepted: 10/29/2013] [Indexed: 11/25/2022]
Abstract
Recent studies indicate that socioeconomic inequalities in health extend into the elderly population, even within the most highly developed welfare states. One potential explanation for socioeconomic inequalities in health focuses on the role of health behaviors, but little is known about the degree to which health behaviors account for health inequalities among older adults, in particular. Using data from the Health and Retirement Study (N = 19,245), this study examined the degree to which four behavioral risk factors - smoking, obesity, physical inactivity, and heavy drinking - are associated with socioeconomic position among adults aged 51 and older, and whether these behaviors mediate socioeconomic differences in mortality, and the onset of disability among those who were disability-free at baseline, over a 10-year period from 1998 to 2008. Results indicate that the odds of both smoking and physical inactivity are higher among persons with lower wealth, with similar stratification in obesity, but primarily among women. The odds of heavy drinking decrease at lower levels of wealth. Significant socioeconomic inequalities in mortality and disability onset are apparent among older men and women; however, the role that health behaviors play in accounting for these inequalities differs by age and gender. For example, these health behaviors account for between 23 and 45% of the mortality disparities among men and middle aged women, but only about 5% of the disparities found among women over 65 years. Meanwhile, these health behaviors appear to account for about 33% of the disparities in disability onset found among women survivors, and about 9-14% among men survivors. These findings suggest that within the U.S. elderly population, behavioral risks such as smoking and physical inactivity contribute moderately to maintaining socioeconomic inequalities in health. As such, promoting healthier lifestyles among the socioeconomically disadvantaged older adults should help to reduce later life health inequalities.
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Affiliation(s)
- Benjamin A Shaw
- School of Public Health, University at Albany, One University Place, Rensselaer, NY 12144, USA.
| | - Kelly McGeever
- School of Public Health, University at Albany, One University Place, Rensselaer, NY 12144, USA.
| | - Elizabeth Vasquez
- School of Public Health, University at Albany, One University Place, Rensselaer, NY 12144, USA.
| | - Neda Agahi
- Aging Research Center, Karolinska Institutet/Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden.
| | - Stefan Fors
- Aging Research Center, Karolinska Institutet/Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden.
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88
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Badland H, Turrell G, Giles-Corti B. Who does well where? Exploring how self-rated health differs across diverse people and neighborhoods. Health Place 2013; 22:82-9. [DOI: 10.1016/j.healthplace.2013.03.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 02/25/2013] [Accepted: 03/17/2013] [Indexed: 10/27/2022]
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89
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Mezuk B, Abdou CM, Hudson D, Kershaw KN, Rafferty JA, Lee H, Jackson JS. "White Box" Epidemiology and the Social Neuroscience of Health Behaviors: The Environmental Affordances Model. SOCIETY AND MENTAL HEALTH 2013; 3:10.1177/2156869313480892. [PMID: 24224131 PMCID: PMC3820104 DOI: 10.1177/2156869313480892] [Citation(s) in RCA: 167] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Crucial advances have been made in our knowledge of the social determinants of health and health behaviors. Existing research on health disparities, however, generally fails to address a known paradox in the literature: While blacks have higher risk of medical morbidity relative to non-Hispanic whites, blacks have lower rates of common stress-related forms of psychopathology such as major depression and anxiety disorders. In this article we propose a new theoretical approach, the Environmental Affordances Model, as an integrative framework for the origins of both physical and mental health disparities. We highlight early empirical support and a growing body of experimental animal and human research on self-regulatory health behaviors and stress coping that is consistent with the proposed framework. We conclude that transdisciplinary approaches, such as the Environmental Affordances Model, are needed to understand the origins of group-based disparities to implement effective solutions to racial and ethnic group inequalities in physical and mental health.
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Affiliation(s)
- Briana Mezuk
- Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, VA, USA
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Cleopatra M. Abdou
- Leonard Davis School of Gerontology, Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Darrell Hudson
- The Brown School, Washington University–St. Louis, St. Louis, MO, USA
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jane A. Rafferty
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Hedwig Lee
- Department of Sociology, University of Washington, Seattle, WA, USA
| | - James S. Jackson
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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90
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Brody GH, Yu T, Chen E, Miller GE, Kogan SM, Beach SRH. Is resilience only skin deep?: rural African Americans' socioeconomic status-related risk and competence in preadolescence and psychological adjustment and allostatic load at age 19. Psychol Sci 2013; 24:1285-93. [PMID: 23722980 DOI: 10.1177/0956797612471954] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Many African American youth may develop high levels of allostatic load, a measure of physiological wear and tear on the body, by developing psychosocial competence under conditions of high risk related to socioeconomic status (SES). The current study was designed to test this hypothesis, which is based on John Henryism theory. In a representative sample of 489 African American youth living in the rural South, cumulative SES-related risks and teacher-reported competence were assessed at ages 11 to 13; depressive symptoms, externalizing behavior, and allostatic load were assessed at age 19. The data revealed that rural African American preadolescents who evinced high psychosocial competence under conditions of high cumulative SES-related risk displayed low levels of adjustment problems along with high allostatic load at age 19. These results suggest that, for many rural African Americans, resilience may indeed be only "skin deep."
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Affiliation(s)
- Gene H Brody
- Center for Family Research, University of Georgia, GA 30602-4527 USA
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91
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Brody GH, Yu T, Chen YF, Kogan SM, Evans GW, Beach SRH, Windle M, Simons RL, Gerrard M, Gibbons FX, Philibert RA. Cumulative socioeconomic status risk, allostatic load, and adjustment: a prospective latent profile analysis with contextual and genetic protective factors. Dev Psychol 2013; 49:913-27. [PMID: 22709130 PMCID: PMC3492547 DOI: 10.1037/a0028847] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The health disparities literature has identified a common pattern among middle-aged African Americans that includes high rates of chronic disease along with low rates of psychiatric disorders despite exposure to high levels of cumulative socioeconomic status (SES) risk. The current study was designed to test hypotheses about the developmental precursors to this pattern. Hypotheses were tested with a representative sample of 443 African American youths living in the rural South. Cumulative SES risk and protective processes were assessed at ages 11-13 years; psychological adjustment was assessed at ages 14-18 years; genotyping at the 5-HTTLPR was conducted at age 16 years; and allostatic load (AL) was assessed at age 19 years. A latent profile analysis identified 5 profiles that evinced distinct patterns of SES risk, AL, and psychological adjustment, with 2 relatively large profiles designated as focal profiles: a physical health vulnerability profile characterized by high SES risk/high AL/low adjustment problems, and a resilient profile characterized by high SES risk/low AL/low adjustment problems. The physical health vulnerability profile mirrored the pattern found in the adult health disparities literature. Multinomial logistic regression analyses indicated that carrying an s allele at the 5-HTTLPR and receiving less peer support distinguished the physical health vulnerability profile from the resilient profile. Protective parenting and planful self-regulation distinguished both focal profiles from the other 3 profiles. The results suggest the public health importance of preventive interventions that enhance coping and reduce the effects of stress across childhood and adolescence.
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Affiliation(s)
- Gene H Brody
- Institute for Behavioral Research, Center for Family Research, University of Georgia, Athens, Georgia 30602-4527, USA.
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92
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Pandey A, Ladusingh L. Socioeconomic Correlates of Gender Differential in Poor Health Status Among Older Adults in India. J Appl Gerontol 2013; 34:879-905. [PMID: 24652876 DOI: 10.1177/0733464813481850] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 02/10/2013] [Indexed: 11/17/2022] Open
Abstract
Assessment of the health status of the older adults can go a long way in controlling the disease burden and monitoring the path to healthy aging in India. In the absence of a population-based clinical survey to collect data on morbidities and other health conditions through biomarkers, self-rated health by nationally representative older population is used for understanding factors contributing to the gender differential in health status. Socioeconomic status is the most important factor explaining 59% of the gender gap in self-assessed health among older adults. The vulnerability of older women in terms of educational attainment, occupational status, and economic dependency is responsible for the higher level of poor self-assessed health. The gender gap in self-assessed poor health among older Indian adults, which perpetuates over the life course resulting in severe health disadvantages at old age can be reduced considerably through social empowerment and gender sensitive public policies.
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Affiliation(s)
- Anamika Pandey
- International Institute for Population Sciences, Deonar, Mumbai, India
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93
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Williams JS, Cunich M, Byles J. The impact of socioeconomic status on changes in the general and mental health of women over time: evidence from a longitudinal study of Australian women. Int J Equity Health 2013; 12:25. [PMID: 23570377 PMCID: PMC3635960 DOI: 10.1186/1475-9276-12-25] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 03/18/2013] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Generally, men and women of higher socioeconomic status (SES) have better health. Little is known about how socioeconomic factors are associated with changes in health as women progress through mid-life. This study uses data from six survey waves (1996 to 2010) of the Australian Longitudinal Study on Women's Health (ALSWH) to examine associations between SES and changes in the general health and mental health of a cohort of women progressing in years from 45-50 to 59-64. METHODS Participants were 12,709 women (born 1946-51) in the ALSWH. Outcome measures were the general health and mental health subscales of the Medical Outcomes Study Short Form 36 Questionnaire (SF-36). The measure of SES was derived from factor analysis of responses to questions in the ALSWH baseline survey (1996) on school leaving age, highest qualifications, and current or last occupation. Multi-level random coefficient models, adjusted for socio-demographic factors and health behaviors, were used to analyze repeated measures of general health and mental health. Survey year accounted for changes in factors across time. In the first set of analyses we investigated associations between the SES index, used as a "continuous" variable, and general health and mental health changes over time. To illuminate the impact of different levels of SES on health, a second analysis was conducted in which SES scores were grouped into three approximately equal sized categories or "tertiles" as reported in an earlier ALSWH study. The least square means of general and mental health scores from the longitudinal models were plotted for the three SES tertiles. RESULTS The longitudinal analysis showed that, after adjusting for the effects of time and possible confounders, the general (mental) health of this cohort of mid-aged women declined (increased) over time. Higher SES women reported better health than lower SES women, and SES significantly modified the effects of time on both general and mental health in favor of higher SES women. CONCLUSIONS This study contributes to our current understanding of how socioeconomic and demographic factors, health behaviors and time impact on changes in the general and mental health of women progressing in years from 45-50 to 59-64.
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Affiliation(s)
- Jennifer Stewart Williams
- Research Centre for Gender Health & Ageing, Faculty of Health, University of Newcastle, HMRI Building, Callaghan, NSW, 2308, Australia
| | - Michelle Cunich
- Sydney School of Public Health Room 314, A-27 Edward Ford Building University of Sydney, Sydney, NSW, 2006, Australia
| | - Julie Byles
- Research Centre for Gender Health & Ageing, Faculty of Health, University of Newcastle, HMRI Building, Callaghan, NSW, 2308, Australia
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94
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Baum N. Jewish Israeli social workers' responses to ethnic health inequality. QUALITATIVE HEALTH RESEARCH 2013; 23:507-516. [PMID: 23258114 DOI: 10.1177/1049732312470214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this study I explored the perceptions and responses of Jewish Israeli social workers to the health inequalities facing their Arab clients. Findings drawn from face-to-face, in-depth interviews with 26 Jewish Israeli social workers employed in the health field show that they were highly aware of the health inequalities. Although they uniformly insisted that there was no discrimination in the hospitals where they were employed, they observed extensive structural and individual discrimination outside the hospital and linguistic and sociocultural impediments to health equality within it. The discrimination provoked feelings of anger and moral outrage, guilt, and shame. Both the discrimination and the linguistic and sociocultural impediments filled them with frustration and led them, both individually and in concert with colleagues, to try to alleviate, circumvent, correct, or compensate for the impediments. Suggestions are made for practice and further research.
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95
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Krause JS, Saunders LL, DiPiro ND, Reed KS. Theoretical Risk and Prevention Model for Secondary Health Conditions and Mortality After SCI: 15 Years of Research. Top Spinal Cord Inj Rehabil 2013; 19:15-24. [PMID: 23459002 DOI: 10.1310/sci1901-15] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND To successfully prevent secondary health conditions (SHCs) and promote longevity after spinal cord injury (SCI), we must first understand the risk factors precipitating their occurrence and develop strategies to address these risk factors. Conceptual models may aid in identifying the nature of SHCs and guide research, clinical practice, and the development of prevention strategies. OBJECTIVE Our purpose is to review and refine an existing theoretical risk and prevention model (TRPM) as a means of classifying risk and protective factors for SHCs and mortality after SCI and for identifying points of intervention. METHODS We describe conceptual work within the field of SCI research and SHCs, including a description of the TRPM, a review of research using the TRPM, and conceptual enhancements to the TRPM based on previous research. CONCLUSIONS The enhanced TRPM directs research to the timing and chronicity of the SHCs and their relationship with overall health and physiologic decline. Future research should identify differences in the nature of SHCs, the extent to which they relate to risk and protective factors, and the degree to which they may be prevented with appropriate research-based strategies.
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Affiliation(s)
- James S Krause
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina , Charleston, South Carolina
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96
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Gass E, Bezold MP. Generation Y, shifting funding structures, and health care reform: reconceiving the public health paradigm through social work. SOCIAL WORK IN PUBLIC HEALTH 2013; 28:685-693. [PMID: 24074132 DOI: 10.1080/19371918.2011.619460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Public health agencies are facing a convergence of forces that require a reexamination of the existing paradigm. The need to replace an aging workforce with a new generation that possesses a different worldview, in the context of budget austerity, will be challenging. In addition, the uncertainty of health care reform poses a challenge for public health leadership. This "perfect storm" provides the opportunity for the social work paradigm to come in and fill the void.
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Affiliation(s)
- Eric Gass
- a City of Milwaukee Health Department and Zilber School of Public Health , University of Wisconsin Milwaukee , Milwaukee , Wisconsin , USA
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97
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Abstract
This study relates consumers' attitudes toward medical tourism to a number of consumer characteristics, such as age, education, income, and insurance status. Principal components analysis of the attitudes of 289 consumers from various communities of North Carolina resulted in three attitude-related factors: economic, treatment-related, and travel-related. Major findings include: (a) the uninsured and low-income consumers are more sensitive to economic factors than the insured and the middle-income consumers; (b) the 51- to 64-year-olds are less motivated by economic factors than young adults; (c) surprisingly, the better one's health, the more one is motivated by treatment-related factors.
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Affiliation(s)
- Lydia L Gan
- Department of Economics, Finance, and Decision Sciences, School of Business, University of North Carolina at Pembroke, Pembroke, North Carolina 28372-1510, USA.
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98
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Fors S, Agahi N, Shaw BA. Paying the price? The impact of smoking and obesity on health inequalities in later life. Scand J Public Health 2012; 41:134-41. [DOI: 10.1177/1403494812468966] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: The aims of the study are twofold: (i) to explore the impact of socioeconomic position, as measured 13 years earlier, on cognitive functioning and mobility impairment in later life, and (ii) to explore the extent to which obesity and smoking status can explain socioeconomic inequalities in cognitive and mobility impairments in later life. Methods: Data from a nationally representative sample of Swedish adults aged 56–76 in 1991 who were re-interviewed 13 years later in 2004, was analysed to explore the impact of socioeconomic position, smoking, and obesity on cognitive and physical functioning in late life. Results: The results showed that both smoking and obesity in late mid-life were stratified by socioeconomic position. Moreover, the results showed significant associations between socioeconomic position and both cognitive and physical functioning in later life. However, these inequalities in late life function could only partially be explained by the socioeconomic differences in smoking and obesity. Conclusions: The findings of this study suggest that socioeconomic differences in the rates of smoking and obesity may explain some, but not all, of the socioeconomic inequalities in physical and cognitive functioning during old age.
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Affiliation(s)
- Stefan Fors
- Aging Research Center, Karolinska Institutet and Stockholm University, Sweden
- Department of Social Work, Stockholm University, Sweden
| | - Neda Agahi
- Aging Research Center, Karolinska Institutet and Stockholm University, Sweden
| | - Benjamin A Shaw
- Department of Health Policy, Management and Behavior, School of Public Health, University at Albany, USA
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99
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Nunes APN, Barreto SM, Gonçalves LG. [Social relations and self- rated health: the ageing and health project]. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2012; 15:415-28. [PMID: 22782107 DOI: 10.1590/s1415-790x2012000200019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 03/26/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To investigate the association between social relationships and self-perceived health in the elderly. METHODS cross-sectional study of a representative sample of elderly individuals covered by the Family Health Program and residents in an area of high health vulnerability in Belo Horizonte, MG. Information was obtained through structured interviews. Factors associated with poor or very poor self-perceived health were identified by multiple logistic regression analysis. RESULTS 363 out of 371 eligible elderly participated; 17.1% of elderly self-perceived their health as poor. There was a positive dose-response relationship between poor self-perceived health and the number of chronic diseases and the degree of difficulty to perform daily life activities. Elderly individuals who perceived their personal relationships as bad and who could not count on anyone if they became bedridden were more likely to self-rate their health as poor. Working was negatively associated with self-perceived poor health. CONCLUSION The results confirm the multidimensional structure of self-perceived health including the issues related to health and social relationships. Our results strengthen the role of social relations on health.
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100
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Jarvandi S, Yan Y, Schootman M. Income disparity and risk of death: the importance of health behaviors and other mediating factors. PLoS One 2012; 7:e49929. [PMID: 23185488 PMCID: PMC3501486 DOI: 10.1371/journal.pone.0049929] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 10/15/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Income disparities in mortality are profound in the United States, but reasons for this remain largely unexplained. The objective of this study was to assess the effects of health behaviors, and other mediating pathways, separately and simultaneously, including health insurance, health status, and inflammation, in the association between income and mortality. METHODS This study used data from 9925 individuals aged 20 years or older who participated in the 1999-2004 National Health and Nutrition Examination Survey (NHANES) and were followed up through December 31, 2006 for mortality. The outcome measures were all-cause and CVD/diabetes mortality. During follow-up 505 persons died, including 196 deaths due to CVD or diabetes. RESULTS After adjusting for age, sex, education, and race/ethnicity, risk of death was higher in low-income than high-income group for both all-cause mortality (Hazard ratio [HR], 1.98; 95% confidence interval [CI]: 1.37, 2.85) and cardiovascular disease (CVD)/diabetes mortality (HR, 3.68; 95% CI: 1.64, 8.27). The combination of the four pathways attenuated 58% of the association between income and all-cause mortality and 35% of that of CVD/diabetes mortality. Health behaviors attenuated the risk of all-cause and CVD/diabetes mortality by 30% and 21%, respectively, in the low-income group. Health status attenuated 39% of all-cause mortality and 18% of CVD/diabetes mortality, whereas, health insurance and inflammation accounted for only a small portion of the income-associated mortality (≤6%). CONCLUSION Excess mortality associated with lower income can be largely accounted for by poor health status and unhealthy behaviors. Future studies should address behavioral modification, as well as possible strategies to improve health status in low-income people.
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Affiliation(s)
- Soghra Jarvandi
- Division of Health Behavior Research, Washington University School of Medicine, Saint Louis, MO, USA.
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