The importance of psychosocial stressors for socio-economic inequalities in perceived health

Socioeconomic status and health: the role of sleep

OBJECTIVE

Examine the role of sleep in the relationship between socioeconomic status (SES) and health.

METHOD

Self-reported measures of income and education, sleep quantity and quality, and mental and physical health were obtained in a community sample of 1139 adults.

RESULTS

More education was associated with higher income (p <.001), and higher income was associated with better physical health (p <.001) and psychological outcomes (p <.001). The effects of income on both mental and physical health were mediated by sleep quality (p values <.01), and sleep quantity was related to both measures of health (p values <.01) but to neither index of SES.

CONCLUSION

Sleep quality may play a mediating role in translating SES into mental and physical well-being, and income seems to mediate the effect of education on sleep and, in turn, health.

Neighborhood problems as sources of chronic stress: development of a measure of neighborhood problems, and associations with socioeconomic status and health

The impact of the residential neighborhood on health and well-being is being increasingly recognized in behavioral medicine, with evidence for neighborhood-level effects that are independent of the individual characteristics of residents. This study addressed the possibility that the effects of neighborhood are due in part to exposure to community-wide stressors rather than variations inprotective factors such as social capital. A questionnaire survey including a 10-item neighborhood problems scale and measures of self-reported health, health behaviors, and social capital was completed by 419 residents of 18 higher socioeconomic status (SES) neighborhoods and 235 residents of 19 lower SES neighborhoods. Data were analyzed using regression and multilevel methods. Neighborhood problem scores were greater in lower than higher SES neighborhoods, positively associated with individual deprivation, and negatively correlated with social capital. Neighborhood problems were not related to smoking, diet, alcohol consumption, or physical activity. However, neighborhood problems were associated with poor self-rated health, psychological distress on the General Health Questionnaire, and impaired physical function, independent of age, sex, neighborhood SES, individual deprivation, and social capital. Adjusted odds ratios for the highest versus lowest neighborhood problem quartiles ranged from 2.05 (confidence interval = 1.15-3.69) for poor self-rated health to 3.07 (1.63-5.79) for impairedphysical function. The results provide preliminary evidence that residential neighborhood problems constitute sources of chronic stress that may increase risk ofpoor health.

A prospective study of the impact of stress on quality of life: an investigation of low-income individuals with hypertension

The role that major and minor life events play in the quality of life in low-income hypertensives was examined. Participants were randomly recruited from 2 primary care clinics at a public medical center. The study utilized a prospective design. Participants were determined to have hypertension and were being treated with antihypertensive medication prior to and throughout the duration of the study. Participants were administered the Life Experiences Survey and the Weekly Stress Inventory repeatedly during Year 1 to assess major and minor stress, respectively. Participants were repeatedly administered the RAND 36-Item Health Survey during Year 2 to assess quality of life. Usable data were obtained from 183 patients. Analyses revealed that major and minor stress were significant predictors of all measured domains of quality of life, even after age and number of chronic illnesses were statistically controlled. Minor stress contributed uniquely to the prediction of each dimension of quality of life even when age, number of chronic illnesses, and major life events were accounted for. Findings suggest that stress has a significant, persistent impact on the quality of life of low-income patients with established hypertension. These findings extend prior research that has examined the impact of medications on quality of life and suggest that stress needs to be accounted for as well.

Neighborhood socioeconomic status and all-cause mortality

This study sought to determine the contribution of neighborhood socioeconomic status to all-cause mortality and to explore its correlates. As part of the longitudinal "Gezondheid en LevensOmstandigheden Bevolking en omstreken" (GLOBE) study in the Netherlands, 8,506 randomly selected men and women aged 15-74 years from 86 neighborhoods in the city of Eindhoven reported on their socioeconomic status in the 1991 baseline survey. During the 6-year follow-up, 487 persons died. Neighborhood socioeconomic status was derived from individual reports on socioeconomic status. Its effect on mortality was stringently controlled for four individual-level socioeconomic indicators. Persons living in a neighborhood with a high percentage of unemployed/disabled or poor persons had a higher mortality risk than did those living in a neighborhood with a low percentage of unemployed/disabled or poor persons. This was independent of individual socioeconomic characteristics, including individual unemployment/disability or reports of severe financial problems. Educational and occupational neighborhood indicators were similarly, but less strongly, related to mortality. The prevalence of poor housing conditions, social disintegration, and unhealthy psychologic profiles and behaviors was higher in neighborhoods with a low socioeconomic status. Contextual effects of socioeconomic status may thus be due to one or more of these specific circumstances. The findings indicate potential public health benefits of modifying socioeconomic characteristics of areas.

Educational differences in self-rated health during the Russian transition. Evidence from Taganrog 1993-1994

In the beginning of 1992, in order to do away with the ruins of the old communist system once and for all, radical economic reforms--'shock therapy'--were introduced in Russia. However, there are winners and losers in the Russian transition from communism to market economy and democracy. The aim of the study is to investigate whether there are educational differences in self-rated health among the citizens of Taganrog in 1993-94. If there are indeed differences, the second aim is to investigate whether they can be explained by variations in specific social, economic and psychological circumstances, which are known to be affected by the present social and economic transformation in Russia. The analysed survey was carried out in a middle-sized Russian city, Taganrog, in late 1993 and early 1994. It was conducted by means of face-to-face interviews, with a sampling frame consisting of dwellings selected from an official register and stratified by type and size. The analysed sample consists of 2372 respondents, aged 25-54 years, in 1414 households. Data were analysed in logistic regressions with self-rated health as a dichotomised outcome variable. The results show that those with less than compulsory education reported poor health twice as often as the highest-educated group. Material prosperity and relations within the family were important for self-rated health and explained to a certain degree the educational health differences. Lower educational groups now live under conditions often characterised by economic hardship, family conflicts, etc., and consequently also poor health.

Socioeconomic status and chronic stress. Does stress account for SES effects on health?

Socioeconomic status (SES) is an important predictor of a range of health and illness outcomes. Research seeking to identify the extent to which this often-reported effect is due to protective benefits of higher SES or to toxic elements of lower social status has not yielded consistent or conclusive findings. A relatively novel hypothesis is that these effects are due to chronic stress that is associated with SES; lower SES is reliably associated with a number of important social and environmental conditions that contribute to chronic stress burden, including crowding, crime, noise pollution, discrimination, and other hazards or stressors. In other words, chronic stress may capture much of the variance in health and social outcomes associated with harmful aspects of lower social status. Low SES is generally associated with distress, prevalence of mental health problems, and with health-impairing behaviors that are also related to stress. Research targeting this hypothesis is needed to determine the extent to which stress is a pathway linking SES and health.