Health psychology: what is an unhealthy environment and how does it get under the skin?

Socioeconomic position in childhood and cancer in adulthood: a rapid-review

Background

The relationship of childhood socioeconomic position (SEP) to adult cancer has been inconsistent in the literature and there has been no review summarising the current evidence focused solely on cancer outcomes.

Methods and results

We performed a rapid review of the literature, which identified 22 publications from 13 studies, primarily in the UK and northern European countries that specifically analysed individual measures of SEP in childhood and cancer outcomes in adulthood. Most of these studies adjusted for adult SEP as a critical mediator of the relationship of interest.

Conclusions

Results confirm that childhood socioeconomic circumstances have a strong influence on stomach cancer and are likely to contribute, along with adult circumstances, to lung cancer through cumulative exposure to smoking. There was also some evidence of increased risk of colorectal, liver, cervical and pancreatic cancers with lower childhood SEP in large studies, but small numbers of cancer deaths made these estimates imprecise. Gaps in knowledge and potential policy implications are presented.

Neighborhood Environment is Associated with Overweight and Obesity, Particularly in Older Residents: Results from Cross-Sectional Study in Dutch Municipality

We explored whether overweight and obesity were associated with the physical and social environment at neighborhood level. Data from Maastricht municipality survey (The Netherlands) were used (n = 9771 adults). Multinomial regression models were computed (outcome being normal weight, overweight, or obese). We found inconsistent associations between neighborhood social and physical environment characteristics and overweight and obesity in the total sample. The effects were more consistent and stronger for older residents (>65) and obesity as an outcome. Better scores on traffic nuisance, green space, social cohesion, nuisance, and safety were associated with lower odds of obesity among elderly (OR ranged between 0.71 [95% CI 0.44 to 0.93] to 0.85 [95% CI 0.74 to 0.96] for each point of improvement in neighborhood social and physical environment (scale 0-10)). We showed that there are neighborhood-level factors that are associated with obesity, particularly in elderly residents. These could be targeted in preventive strategies outside health care settings.

A State-Level Analysis of Social and Structural Factors and HIV Outcomes Among Men Who Have Sex With Men in the United States

We apply a social determinants of health model to examine the association of select social and structural influences on AIDS diagnosis rates among men who have sex with men (MSM) in the U.S. states. Secondary data for key social and structural variables were acquired and analyzed. Standard descriptive and inferential statistics were used to examine bivariate and multivariate associations of selected social and structural variables with estimated rate of Stage 3 HIV infection (AIDS) per 100,000 MSM in 2010. We found that living in states with a higher demographic density of lesbian, gay, bisexual, and transgender persons is independently associated with lower AIDS diagnosis rates among MSM. In addition, we found that greater income inequality and higher syphilis rates among men were associated with greater AIDS diagnosis rates among MSM, which may be attributable to state policy environments that underinvest in social goods that benefit population health, and to the fact that ulcerative sexually-transmitted infections increase biological risk of HIV transmission and acquisition. To end the epidemic in the U.S., it will be critical to identify and address state-level social and structural factors that may be associated with adverse HIV outcomes for MSM.

Intimate Partner Violence and Subsequent Depression: Examining the Roles of Neighborhood Supportive Mechanisms

This study examines the direct effects of neighborhood supportive mechanisms (e.g., collective efficacy, social cohesion, social networks) on depressive symptoms among females as well as their moderating effects on the impact of IPV on subsequent depressive symptoms. A multilevel, multivariate Rasch model was used with data from the Project on Human Development in Chicago Neighborhoods to assess the existence of IPV and later susceptibility of depressive symptoms among 2959 adult females in 80 neighborhoods. Results indicate that neighborhood collective efficacy, social cohesion, social interactions, and the number of friends and family in the neighborhood reduce the likelihood that females experience depressive symptoms. However, living in areas with high proportions of friends and relatives exacerbates the impact of IPV on females' subsequent depressive symptoms. The findings indicate that neighborhood supportive mechanisms impact interpersonal outcomes in both direct and moderating ways, although direct effects were more pronounced for depression than moderating effects. Future research should continue to examine the positive and potentially mitigating influences of neighborhoods in order to better understand for whom and under which circumstances violent relationships and mental health are influenced by contextual factors.

Greater Leisure Time Physical Activity Is Associated with Lower Allostatic Load in White, Black, and Mexican American Midlife Women: Findings from the National Health and Nutrition Examination Survey, 1999 through 2004

BACKGROUND

Allostatic load is a useful construct to understand how social and environmental conditions get under the skin to affect health. To date, few studies have examined health-enhancing lifestyle behaviors and their potential benefits in reducing allostatic load. The purpose of this study was to investigate the contributions of leisure time physical activity on level of allostatic load among White, Black, and Mexican American midlife women.

METHODS

Data were from the National Health and Nutrition Examination Survey, 1999 through 2004 (n = 1,680, women ages 40-59). All analyses were weighted. Negative binomial regression was used to model a summative count measure of allostatic load (M = 2.30). Models were also computed to estimate adjusted predicted allostatic load for given levels of physical activity, and by race/ethnicity for each age category (40-44, 45-49, 50-54, 55-59), controlling for other demographics and medication use.

FINDINGS

Higher levels of physical activity were associated significantly with lower levels of allostatic load, independent of demographics. Compared with White women ages 40 to 44, all other racial/ethnic-by-age groups had significantly higher allostatic load. Higher socioeconomic status was associated with a lower allostatic load. Adjusted prediction models demonstrated associations between greater levels of physical activity and lower allostatic load for all ages and racial/ethnic groups.

CONCLUSIONS

Our findings suggest physical activity may ameliorate some of the effects of cumulative physiological dysregulation and subsequent disease burden in midlife women. Programs and policies that encourage and promote healthy aging and provide opportunities for a diversity of women to engage in health-enhancing lifestyle practices such as physical activity are recommended.

Daily interpersonal coping strategies: Implications for self-reported well-being and cortisol

An important pathway by which relationships influence health may involve how people cope with interpersonal tensions. This study examined whether same day and prior day avoidance and engagement in arguments are differentially associated with self-reported well-being (emotional, physical) and diurnal cortisol patterns. Participants from Wave 2 of the National Study of Daily Experiences (NSDE; N =1512; ages 33-84, 57% women), completed daily phone interviews for eight consecutive days and provided useable saliva samples that were assayed for cortisol for four of those days at specific times: waking, 30 minutes after waking, before lunch, and bedtime. Multilevel models revealed same day arguments were associated with lower well-being (higher negative affect, lower positive affect) than same day avoidance or no tension. In contrast, previous day avoidance was associated with lower next day well-being (higher negative affect, more physical symptoms) and higher next day cortisol than having no interpersonal tension the previous day. Arguments have greater same day consequences for well-being, whereas avoided arguments have greater next day consequences, which may indicate delayed effects of avoidance.

The Community Child Health Network Life Stress Interview: a brief chronic stress measure for community health research

BACKGROUND AND OBJECTIVES

Chronic stress is implicated in many theories as a contributor to a wide range of physical and mental health problems. The current study describes the development of a chronic stress measure that was based on the UCLA Life Stress Interview (LSI) and adapted in collaboration with community partners for use in a large community health study of low-income, ethnically diverse parents of infants in the USA (Community Child Health Network [CCHN]). We describe the instrument, its purpose and adaptations, implementation, and results of a reliability study in a subsample of the larger study cohort.

DESIGN AND METHODS

Interviews with 272 mothers were included in the present study. Chronic stress was assessed using the CCHN LSI, an instrument designed for administration by trained community interviewers to assess four domains of chronic stress, each rated by interviewers.

RESULTS

Significant correlations ranging from small to moderate in size between chronic stress scores on this measure, other measures of stress, biomarkers of allostatic load, and mental health provide initial evidence of construct and concurrent validity. Reliability data for interviewer ratings are also provided.

CONCLUSIONS

This relatively brief interview (15 minutes) is available for use and may be a valuable tool for researchers seeking to measure chronic stress reliably and validly in future studies with time constraints.

Where there's smoke: Cigarette use, social acceptability, and spatial approaches to multilevel modeling

I contribute to understandings of how context is related to individual outcomes by assessing the added value of combining multilevel and spatial modeling techniques. This methodological approach leads to substantive contributions to the smoking literature, including improved clarity on the central contextual factors and the examination of one manifestation of the social acceptability hypothesis. For this analysis I use restricted-use natality data from the Vital Statistics, and county-level data from the 2005-9 ACS. Critically, the results suggest that spatial considerations are still relevant in a multilevel framework. In addition, I argue that spatial processes help explain the relationships linking racial/ethnic minority concentration to lower overall odds of smoking.

A Longitudinal Investigation of Race, Socioeconomic Status, and Psychosocial Mediators of Allostatic Load in Midlife Women: Findings From the Study of Women's Health Across the Nation

OBJECTIVES

This research sought to assess racial and socioeconomic status (SES) differences in level and change in allostatic load (AL) over time in midlife women and to test whether psychosocial factors mediate these relationships. These factors were discrimination, perceived stress, and hostility.

METHODS

Longitudinal data obtained from the Study of Women's Health Across the Nation were used (n = 2063; mean age at baseline = 46.0 years). Latent growth curve models evaluated the impact of demographic, menopausal, and psychosocial variables on level and change in AL for 8 years.

RESULTS

Direct effects: high levels of discrimination and hostility significantly predicted higher AL (path coefficients = 0.05 and 0.05, respectively). High perceived stress significantly predicted a faster rate of increase of AL (path coefficient = 0.06). Racial and SES differentials were present, with African American race (path coefficient = 0.23), low income (path coefficient = -0.15), and low education (path coefficient = -0.08) significantly predicting high AL level. Indirect effects: significant indirect effects were found for African American race, less income, and lower education through higher discrimination, perceived stress, and hostility on level and rate of AL.

CONCLUSIONS

This was one of the first studies that investigated AL over multiple periods, and results supported AL as a cumulative phenomenon, affected by multiple psychosocial and demographic factors. The results suggest the complex ways in which race, SES, and psychosocial factors operate to influence AL.

Transnational, social, and neighborhood ties and smoking among Latino immigrants: does gender matter?

OBJECTIVES

We examined whether transnational ties, social ties, and neighborhood ties were independently associated with current smoking status among Latino immigrants. We also tested interactions to determine whether these associations were moderated by gender.

METHODS

We conducted a series of weighted logistic regression analyses (i.e., economic remittances, number of return visits, friend support, family support, and neighborhood cohesion) using the Latino immigrant subsample (n = 1629) of the National Latino and Asian American Study in 2002 and 2003.

RESULTS

The number of past-year return visits to the country-of-origin was positively associated with current smoker status. Gender moderated the association between economic remittances, friend support, and smoking. Remittance behavior had a protective association with smoking, and this association was particularly pronounced for Latino immigrant women. Friendship support lowered the odds of smoking among men, but not women.

CONCLUSIONS

Our results underscore the growing importance of transnational networks for understanding Latino immigrant health and the gendered patterns of the associations between social ties, transnational ties, and health risk behaviors.

The dynamic relationship between social support and HIV-related stigma in rural Uganda

BACKGROUND

Cross-sectional studies show that human immunodeficiency virus (HIV) stigma is negatively correlated with social support.

PURPOSE

The purpose of this study is to examine the bidirectional relationship between social support and HIV stigma.

METHODS

We collected quarterly data from a cohort of 422 people living with HIV in Uganda, followed for a median of 2.1 years. We used multilevel regression to model the contemporaneous and 3-month-lagged associations between social support and both enacted and internalized stigma.

RESULTS

Lagged enacted stigma was negatively correlated with emotional and instrumental social support, and lagged instrumental social support was negatively correlated with enacted stigma. Internalized stigma and emotional social support had reciprocal lagged associations.

CONCLUSIONS

Interventions to reduce enacted stigma may strengthen social support for people living with HIV. Improved social support may in turn have a protective influence against future enacted and internalized stigma.

Distinguishing the race-specific effects of income inequality and mortality in U.S. metropolitan areas

In the United States, the association between income inequality and mortality has been fairly consistent. However, few studies have explicitly examined the impact of race. Studies that have either stratified outcomes by race or conducted analyses within race-specific groups suggest that the income inequality/mortality relation may differ for blacks and whites. The factors explaining the association may also differ for the two groups. Multivariate ordinary least squares regression analysis was used to examine associations between study variables. We used three measures of income inequality to examine the association between income inequality and age-adjusted all-cause mortality among blacks and whites separately. We also examined the role of racial residential segregation and concentrated poverty in explaining associations among groups. Metropolitan areas were included if they had a population of at least 100,000 and were at least 10 percent black. There was a positive income inequality/mortality association among blacks and an inverse association among whites. Racial residential segregation completely attenuated the income inequality/mortality relationship for blacks, but was not significant among whites. Concentrated poverty was a significant predictor of mortality rates in both groups but did not confound associations. The implications of these findings and directions for future research are discussed.

Neighborhood adversity, child health, and the role for community development

Despite medical advances, childhood health and well-being have not been broadly achieved due to rising chronic diseases and conditions related to child poverty. Family and neighborhood living conditions can have lasting consequences for health, with community adversity affecting health outcomes in significant part through stress response and increased allostatic load. Exposure to this "toxic stress" influences gene expression and brain development with direct and indirect negative consequences for health. Ensuring healthy child development requires improving conditions in distressed, high-poverty neighborhoods by reducing children's exposure to neighborhood stressors and supporting good family and caregiver functioning. The community development industry invests more than $200 billion annually in low-income neighborhoods, with the goal of improving living conditions for residents. The most impactful investments have transformed neighborhoods by integrating across sectors to address both the built environment and the social and service environment. By addressing many facets of the social determinants of health at once, these efforts suggest substantial results for children, but health outcomes generally have not been considered or evaluated. Increased partnership between the health sector and community development can bring health outcomes explicitly into focus for community development investments, help optimize intervention strategies for health, and provide natural experiments to build the evidence base for holistic interventions for disadvantaged children. The problems and potential solutions are beyond the scope of practicing pediatricians, but the community development sector stands ready to engage in shared efforts to improve the health and development of our most at-risk children.

A workplace intervention improves sleep: results from the randomized controlled Work, Family, and Health Study

STUDY OBJECTIVES

The Work, Family, and Health Network Study tested the hypothesis that a workplace intervention designed to increase family-supportive supervision and employee control over work time improves actigraphic measures of sleep quantity and quality.

DESIGN

Cluster-randomized trial.

SETTING

A global information technology firm.

PARTICIPANTS

US employees at an information technology firm.

INTERVENTIONS

Randomly selected clusters of managers and employees participated in a 3-month, social, and organizational change process intended to reduce work-family conflict. The intervention included interactive sessions with facilitated discussions, role playing, and games. Managers completed training in family-supportive supervision.

MEASUREMENTS AND RESULTS

Primary outcomes of total sleep time (sleep duration) and wake after sleep onset (sleep quality) were collected from week-long actigraphy recordings at baseline and 12 months. Secondary outcomes included self-reported sleep insufficiency and insomnia symptoms. Twelve-month interviews were completed by 701 (93% retention), of whom 595 (85%) completed actigraphy. Restricting analyses to participants with e3 valid days of actigraphy yielded a sample of 473-474 for intervention effectiveness analyses. Actigraphy-measured sleep duration was 8 min/d greater among intervention employees relative to controls (P < .05). Sleep insufficiency was reduced among intervention employees (P = .002). Wake after sleep onset and insomnia symptoms were not different between groups. Path models indicated that increased control over work hours and subsequent reductions in work-family conflict mediated the improvement in sleep sufficiency.

CONCLUSIONS

The workplace intervention did not overtly address sleep, yet intervention employees slept 8 min/d more and reported greater sleep sufficiency. Interventions should address environmental and psychosocial causes of sleep deficiency, including workplace factors.

Cumulative Effect of Psychosocial Factors in Youth on Ideal Cardiovascular Health in Adulthood

Background—

The American Heart Association has defined a new metric of ideal cardiovascular health as part of its 2020 Impact Goals. We examined whether psychosocial factors in youth predict ideal cardiovascular health in adulthood.

Methods and Results—

Participants were 477 men and 612 women from the nationwide Cardiovascular Risk in Young Finns Study. Psychosocial factors were measured from cohorts 3 to 18 years of age at the baseline of the study, and ideal cardiovascular health was examined 27 years later in adulthood. The summary measure of psychosocial factors in youth comprised socioeconomic factors, emotional factors, parental health behaviors, stressful events, self-regulation of the child, and social adjustment of the child. There was a positive association between a higher number of favorable psychosocial factors in youth and greater ideal cardiovascular health index in adulthood (β=0.16; P <0.001) that persisted after adjustment for age, sex, medication use, and cardiovascular risk factors in childhood (β=0.15; P <0.001). The association was monotonic, suggesting that each increment in favorable psychosocial factors was associated with improvement in cardiovascular health. Of the specific psychosocial factors, a favorable socioeconomic environment (β=0.12; P <0.001) and participants’ self-regulatory behavior (β=0.07; P =0.004) were the strongest predictors of ideal cardiovascular health in adulthood.

Conclusions—

The findings suggest a dose-response association between favorable psychosocial factors in youth and cardiovascular health in adulthood, as defined by the American Heart Association metrics. The effect seems to persist throughout the range of cardiovascular health, potentially shifting the population distribution of cardiovascular health rather than simply having effects in a high-risk population.

The role of social support and social context on the incidence of attempted suicide among adolescents living in extremely impoverished communities

PURPOSE

Evaluate the impact of social support and social context on suicide attempt in disadvantaged adolescents, and calculate that longitudinal risk of suicide attempt.

METHODS

Seven thousand two hundred ninety-nine adolescents were used to evaluate the effect of social support and context on suicide attempt, and to estimate the overall risk of suicide attempt.

RESULTS

Increased peer support reduced the risk of suicide attempt, and increased perceived inevitability of violence led to an increase in risk among 9-year-old children. As children age, the effect of overall peer support remains consistent, while there is a reduction in the effect of inevitability of violence. Approximately 36% of extremely impoverished adolescents attempt suicide by the age of 19.

CONCLUSIONS

The current study provides insight into the nature of suicide attempt within a grossly understudied population. Social support and social context have an important impact on suicidal behavior in extremely disadvantaged adolescents.

The role of the residential neighborhood in linking youths' family poverty trajectory to decreased feelings of safety at school

Although disadvantaged youth are more likely to be victimized at school, victimization only partly explains their decreased feelings of safety at school. We applied a socioecological approach to test the hypotheses that the experience of poverty is associated with decreased feelings of safety at school, and that residential neighborhood features partly mediate the relationship between poverty and feeling less safe at school. This study draws on the Québec Longitudinal Study of Child Development (QLSCD) which began in 1998 with a representative population-based cohort of 2,120 5-month old infants (49.1% female) and their primary caregiver. The study also includes measures of ego-centred residential neighborhood exposures (based on a 500 m circular buffer zone surrounding the family's residential postal code) derived from a spatial data infrastructure. We used latent growth modeling to estimate youth's family poverty trajectory from age 5 months to 13 years, and structural equation modeling to test our hypotheses. The results suggest that youth experiencing chronic and later-childhood poverty felt less safe at school in part because they lived in neighborhoods that their parents described as being disorderly (e.g., demarked by the presence of garbage, drug use and groups of trouble-makers). These neighborhoods also tended to have less greenery (e.g., trees, parks) and more lone-parent households. Neighborhood features did not help explain the relationship between early-childhood poverty and feeling less safe at school. The findings suggest that targeting residential neighborhood features such as greenery and disorder could improve youth's felt safety at school, particularly for those experiencing chronic and later-childhood poverty.

Structural stigma and hypothalamic-pituitary-adrenocortical axis reactivity in lesbian, gay, and bisexual young adults

BACKGROUND

Youth exposed to extreme adverse life conditions have blunted cortisol responses to stress.

PURPOSE

This study aims to examine whether growing up in highly stigmatizing environments similarly shapes stigmatized individuals' physiological responses to identity-related stress.

METHODS

We recruited 74 lesbian, gay, and bisexual young adults (mean age = 23.68) from 24 states with varying levels of structural stigma surrounding homosexuality. State-level structural stigma was coded based on several dimensions, including policies that exclude sexual minorities from social institutions (e.g., same-sex marriage). Participants were exposed to a laboratory stressor, the Trier Social Stress Test (TSST), and neuroendocrine measures were collected.

RESULTS

Lesbian, gay, and bisexual young adults who were raised in highly stigmatizing environments as adolescents evidenced a blunted cortisol response following the TSST compared to those from low-stigma environments.

CONCLUSIONS

The stress of growing up in environments that target gays and lesbians for social exclusion may exert biological effects that are similar to traumatic life experiences.

Experimental Evidence That Low Social Status is Most Toxic to Well-being When Internalized

What makes low social status toxic to well-being? To internalize social status is to believe the self is responsible for it. We hypothesized that the more people internalize low subjective social status, the more their basic psychological needs are thwarted. Experiment 1 randomly assigned participants to imagine themselves in low, middle, or high social status and assessed their subjective social status internalization by independent ratings. The more participants internalized low status, the more they reported their basic psychological needs were thwarted. This effect did not appear among their higher status counterparts. Experiment 2 replicated and extended these findings using a behavioral manipulation of subjective social status and a self-report measure of internalization. We discuss implications for basic and action research.

DOES LOWER SUBJECTIVE SOCIAL STATUS YIELD RISKIER BIOMARKER PROFILES?

Both objective and, more recently, subjective measures of low social status have been linked to poor health outcomes. It is unclear, however, through which precise physiological mechanisms such standing may influence health, although it has been proposed that those of lower status may have biomarker profiles that are more dysregulated (and hence pose a greater risk for poorer health). The main objective of this study was to investigate whether lower subjective social standing is associated with riskier neuroendocrine biomarker profiles. Data were from the Social Environment and Biomarkers of Aging Study (SEBAS), a nationally representative survey of Taiwanese men and women (ages 54-91) conducted in Taiwan in 2000. Five neuroendocrine markers (cortisol, dehydroepiandrosterone sulphate (DHEAS), adrenaline, noradrenaline and dopamine) were analysed both separately and collectively in an index termed neuroendocrine allostatic load (NAL) in relation to status - both self-reported and as measured through objective socioeconomic status (SES) indicators. For the biomarker DHEAS, some connection was found between its levels and the measures of status, but for the other markers and the NAL index almost no connection was found. The overall negative finding of this paper would be further supported with more and different measures of neuroendocrine system function and a reordering of the subjective social status questions in the survey such that the one probing about status in the community (that has no prompt) was asked before the one probing about status in all of Taiwan (which has a SES prompt).

The mediating roles of perceived stress and health behaviors in the relation between objective, subjective, and neighborhood socioeconomic status and perceived health

BACKGROUND

Objective, subjective, and neighborhood socioeconomic status (SES) are associated with perceived health, morbidity, and mortality.

PURPOSE

We investigated whether perceived stress and health behaviors mediated the relation between the three types of SES and perceived health.

METHODS

Participants (N = 508) attending a public clinic completed a computerized survey assessing objective SES (income, education, employment); health behaviors; perceived stress; and perceived health. They also indicated their social standing relative to others (subjective SES) and provided their current address to determine neighborhood SES.

RESULTS

In a structural equation model including all three SES types, lower objective and subjective SES were related to poorer perceived health. When mediators were included in the model, there were significant indirect effects of (a) SES on health through stress and (b) SES on health through stress and health-compromising behaviors.

CONCLUSIONS

Interventions to reduce the impact of stressors could improve the health of socioeconomically disadvantaged individuals.

Personality, well-being, and health

A lifespan perspective on personality and health uncovers new causal pathways and provides a deeper, more nuanced approach to interventions. It is unproven that happiness is a direct cause of good health or that negative emotion, worry, and depression are significant direct causes of disease. Instead, depression-related characteristics are likely often reflective of an already-deteriorating trajectory. It is also unproven that challenging work in a demanding environment usually brings long-term health risks; on the contrary, individual strivings for accomplishment and persistent dedication to one's career or community often are associated with sizeable health benefits. Overall, a substantial body of recent research reveals that conscientiousness plays a very significant role in health, with implications across the lifespan. Much more caution is warranted before policy makers offer narrow health recommendations based on short-term or correlational findings. Attention should be shifted to individual trajectories and pathways to health and well-being.

The relationship between helplessness and the child's asthma symptoms: the role of social support

OBJECTIVE

Objectives of this study were to survey parents and children independently regarding feelings of helplessness specific to asthma and to examine the relationship between helplessness and the child's symptom-free days.

METHODS

Parent-child dyads (children 7-12 years) from Rochester, NY were enrolled (November 2011-August 2012) from general pediatric clinics, pulmonary clinics, an Emergency Department, and area youth and asthma programs. Assessments included demographics, symptoms, ratings of helplessness related to asthma and parent social support. A multivariate linear regression was conducted to examine the relationship between feelings of helplessness and symptoms-free days: post hoc analysis assessed the moderating role of social support.

RESULTS

Overall, 107 parent-child dyads enrolled (participation rate: 72%); 104 were included in analysis. Most children were male (58%), 7-9 years (58%) and White (46%). The child's feelings of helplessness scores were positively correlated with symptom-free days indicating less feelings of helplessness as symptom-free days increased (rs = 0.273, p = 0.01). In a stratified analysis, among parents who reported minimal social support (<1 sources of support), child's helplessness scores were positively correlated with symptom-free days (rs = 0.335, p = 0.02). Conversely, among parents reporting >2 supports, no relationship was found (rs = 0.195, p = 0.15).

CONCLUSIONS

This study found less feelings of helplessness among children with asthma as symptom-free days increased. Social support appears to moderate this relationship; however further studies to confirm these findings are needed.

The role of historical Persian gardens on the health status of contemporary urban residents: gardens and health status of contemporary urban residents

The inherent economic and social challenges in major cities have been known to foster stress among the urban population. Frequent stress over long periods may well have serious damaging outcomes, resulting in ailments such as burnout syndrome, sleeplessness and exhaustion, depression, feelings of panic, among others. Therefore, providing access to resources that may enable people to cope with the stress of urban life has become a crucial phenomenon in the twentieth century. Increasing empirical evidence indicates that the presence of natural areas can contribute to enhancing the quality of life in many ways. This study examines two historical Persian gardens from the residents' perspective in well-known, historic cities of Iran: Isfahan and Kerman. The data were collected through questionnaires (n = 252), semi-structured interviews (n = 20), and visual observation techniques. The findings demonstrate that nature, diversity and the gardens' historical background, and coherence motivate the residents' frequent visits to the gardens, which help to address their social, psychological, and physical needs. In addition, the residents' involvements and the variety of experiences that occur in the gardens lead to the creation of deeper meanings and values associated with the gardens. Subsequently, these construct functional and emotional attachment that evokes a sense of place and identity and may contribute to society's health and well-being.

Evidence of accelerated aging among African Americans and its implications for mortality

Blacks experience morbidity and mortality earlier in the life course compared to whites. Such premature declines in health may be indicative of an acceleration of the aging process. The current study uses data on 7644 black and white participants, ages 30 and above, from the third National Health and Nutrition Examination Survey, to compare the biological ages of blacks and whites as indicated from a combination of ten biomarkers and to determine if such differences in biological age relative to chronological age account for racial disparities in mortality. At a specified chronological age, blacks are approximately 3 years older biologically than whites. Differences in biological age between blacks and whites appear to increase up until ages 60-65 and then decline, presumably due to mortality selection. Finally, differences in biological age were found to completely account for higher levels of all-cause, cardiovascular and cancer mortality among blacks. Overall, these results suggest that being black is associated with significantly higher biological age at a given chronological age and that this is a pathway to early death both overall and from the major age-related diseases.

Negative life events vary by neighborhood and mediate the relation between neighborhood context and psychological well-being

Researchers have speculated that negative life events are more common in troubled neighborhoods, amplifying adverse effects on health. Using a clustered representative sample of Chicago residents (2001-03; n = 3,105) from the Chicago Community Adult Health Survey, we provide the first documentation that negative life events are highly geographically clustered compared to health outcomes. Associations between neighborhood context and negative life events were also found to vary by event type. We then demonstrate the power of a contextualized approach by testing path models in which life events mediate the relation between neighborhood characteristics and health outcomes, including self-rated health, anxiety, and depression. The indirect paths between neighborhood conditions and health through negative life event exposure are highly significant and large compared to the direct paths from neighborhood conditions to health. Our results indicate that neighborhood conditions can have acute as well as chronic effects on health, and that negative life events are a powerful mechanism by which context may influence health.

Racism, segregation, and risk of obesity in the Black Women's Health Study

We assessed the relation of experiences of racism to the incidence of obesity and the modifying impact of residential racial segregation in the Black Women's Health Study, a follow-up study of US black women. Racism scores were created from 8 questions asked in 1997 and 2009 about the frequency of "everyday" racism (e.g., "people act as if you are dishonest") and of "lifetime" racism (e.g., unfair treatment on the job). Residential segregation was measured by linking participant addresses to 2000 and 2010 US Census block group data on the percent of black residents. We used Cox proportional hazard models to estimate incidence rate ratios and 95% confidence intervals. Based on 4,315 incident cases of obesity identified from 1997 through 2009, both everyday racism and lifetime racism were positively associated with increased incidence. The incidence rate ratios for women who were in the highest category of everyday racism or lifetime racism in both 1997 and 2009, relative to those in the lowest category, were 1.69 (95% confidence interval: 1.45, 1.96; Ptrend < 0.01) and 1.38 (95% confidence interval: 1.15, 1.66; Ptrend < 0.01), respectively. These associations were not modified by residential segregation. These results suggest that racism contributes to the higher incidence of obesity among African American women.

Racial segregation and maternal smoking during pregnancy: a multilevel analysis using the racial segregation interaction index

Drawing from both the place stratification and ethnic enclave perspectives, we use multilevel modeling to investigate the relationships between women's race/ethnicity (i.e., non-Hispanic white, non-Hispanic black, Asian, and Hispanic) and maternal smoking during pregnancy, and examine if these relationships are moderated by racial segregation in the continental United States. The results show that increased interaction with whites is associated with increased probability of maternal smoking during pregnancy, and racial segregation moderates the relationships between race/ethnicity and maternal smoking. Specifically, living in a less racially segregated area is related to a lower probability of smoking during pregnancy for black women, but it could double and almost triple the probability of smoking for Asian women and Hispanic women, respectively. Our findings provide empirical evidence for both the place stratification and ethnic enclave perspectives.

Physical activity and body mass index: the contribution of age and workplace characteristics

BACKGROUND

The workplace is an important domain for adults, and many effective interventions targeting physical activity and weight reduction have been implemented in the workplace. However, the U.S. workforce is aging, and few studies have examined the relationship of BMI, physical activity, and age as they relate to workplace characteristics.

PURPOSE

This paper reports on the distribution of physical activity and BMI by age in a population of hospital-based healthcare workers and investigates the relationships among workplace characteristics, physical activity, and BMI.

METHODS

Data from a survey of patient care workers in two large academic hospitals in the Boston area were collected in late 2009 and analyzed in early 2013.

RESULTS

In multivariate models, workers reporting greater decision latitude (OR=1.02, 95% CI=1.01, 1.03) and job flexibility (OR=1.05, 95% CI=1.01, 1.10) reported greater physical activity. Overweight and obesity increased with age (p<0.01), even after adjusting for workplace characteristics. Sleep deficiency (OR=1.56, 95% CI=1.15, 2.12) and workplace harassment (OR=1.62, 95% CI=1.20, 2.18) were also associated with obesity.

CONCLUSIONS

These findings underscore the persistent impact of the work environment for workers of all ages. Based on these results, programs or policies aimed at improving the work environment, especially decision latitude, job flexibility, and workplace harassment should be included in the design of worksite-based health promotion interventions targeting physical activity or obesity.

The role of physical activity and heart rate variability for the control of work related stress

Physical activity (PA) and exercise are often used as tools to reduce stress and therefore the risk for developing cardiovascular diseases (CVD). Meanwhile, heart rate variability (HRV) has been utilized to assess both stress and PA or exercise influences. The objective of the present review was to examine the current literature in regards to workplace stress, PA/exercise and HRV to encourage further studies. We considered original articles from known databases (PubMed, ISI Web of Knowledge) over the last 10 years that examined these important factors. A total of seven studies were identified with workplace stress strongly associated with reduced HRV in workers. Longitudinal workplace PA interventions may provide a means to improve worker stress levels and potentially cardiovascular risk with mechanisms still to be clarified. Future studies are recommended to identify the impact of PA, exercise, and fitness on stress levels and HRV in workers and their subsequent influence on cardiovascular health.

Associations between birth health, maternal employment, and child care arrangement among a community sample of mothers with young children

Although a large body of literature exists on how different types of child care arrangements affect a child's subsequent health and sociocognitive development, little is known about the relationship between birth health and subsequent decisions regarding type of nonparental child care as well as how this relationship might be influenced by maternal employment. This study used data from the Los Angeles Families and Neighborhoods Survey (L.A.FANS). Mothers of 864 children (ages 0-5) provided information regarding birth weight, maternal evaluation of a child's birth health, child's current health, maternal employment, type of child care arrangement chosen, and a variety of socioeconomic variables. Child care options included parental care, relative care, nonrelative care, and daycare center. Multivariate analyses found that birth weight and subjective rating of birth health had similar effects on child care arrangement. After controlling for a child's age and current health condition, multinomial logit analyses found that mothers with children with poorer birth health are more likely to use nonrelative and daycare centers than parental care when compared to mothers with children with better birth health. The magnitude of these relationships diminished when adjusting for maternal employment. Working mothers were significantly more likely to use nonparental child care than nonemployed mothers. Results suggest that a child's health early in life is significantly but indirectly related to subsequent decisions regarding child care arrangements, and this association is influenced by maternal employment. Development of social policy aimed at improving child care service should take maternal and family backgrounds into consideration.

Do the psychosocial risks associated with television viewing increase mortality? Evidence from the 2008 General Social Survey-National Death Index dataset

BACKGROUND

Television viewing is associated with an increased risk of mortality, which could be caused by a sedentary lifestyle, the content of television programming (e.g., cigarette product placement or stress-inducing content), or both.

METHODS

We examined the relationship between self-reported hours of television viewing and mortality risk over 30 years in a representative sample of the American adult population using the 2008 General Social Survey-National Death Index dataset. We also explored the intervening variable effect of various emotional states (e.g., happiness) and beliefs (e.g., trust in government) of the relationship between television viewing and mortality.

RESULTS

We find that, for each additional hour of viewing, mortality risks increased 4%. Given the mean duration of television viewing in our sample, this amounted to about 1.2 years of life expectancy in the United States. This association was tempered by a number of potential psychosocial mediators, including self-reported measures of happiness, social capital, or confidence in institutions. Although none of these were clinically significant, the combined mediation power was statistically significant (P < .001).

CONCLUSIONS

Television viewing among healthy adults is correlated with premature mortality in a nationally representative sample of U.S. adults, and this association may be partially mediated by programming content related to beliefs or affective states. However, this mediation effect is the result of many small changes in psychosocial states rather than large effects from a few factors.

Contributions of attachment theory and research: a framework for future research, translation, and policy

Attachment theory has been generating creative and impactful research for almost half a century. In this article we focus on the documented antecedents and consequences of individual differences in infant attachment patterns, suggesting topics for further theoretical clarification, research, clinical interventions, and policy applications. We pay particular attention to the concept of cognitive "working models" and to neural and physiological mechanisms through which early attachment experiences contribute to later functioning. We consider adult caregiving behavior that predicts infant attachment patterns, and the still-mysterious "transmission gap" between parental Adult Attachment Interview classifications and infant Strange Situation classifications. We also review connections between attachment and (a) child psychopathology; (b) neurobiology; (c) health and immune function; (d) empathy, compassion, and altruism; (e) school readiness; and (f) culture. We conclude with clinical-translational and public policy applications of attachment research that could reduce the occurrence and maintenance of insecure attachment during infancy and beyond. Our goal is to inspire researchers to continue advancing the field by finding new ways to tackle long-standing questions and by generating and testing novel hypotheses.

Social environmental effects on gene regulation

Social environmental conditions, particularly the experience of social adversity, have long been connected with health and mortality in humans and other social mammals. Efforts to identify the physiological basis for these effects have historically focused on their neurological, endocrinological, and immunological consequences. Recently, this search has been extended to understanding the role of gene regulation in sensing, mediating, and determining susceptibility to social environmental variation. Studies in laboratory rodents, captive primates, and human populations have revealed correlations between social conditions and the regulation of a large number of genes, some of which are likely causal. Gene expression responses to the social environment are, in turn, mediated by a set of underlying regulatory mechanisms, of which epigenetic marks are the best studied to date. Importantly, a number of genes involved in the response to the social environment are also associated with susceptibility to other external stressors, as well as certain diseases. Hence, gene regulatory studies are a promising avenue for understanding, and potentially developing strategies to address, the effects of social adversity on health.

Shedding Light on the Mechanisms Underlying Health Disparities Through Community Participatory Methods: The Stress Pathway

Health disparities are large and persistent gaps in the rates of disease and death between racial/ethnic and socioeconomic status subgroups in the population. Stress is a major pathway hypothesized to explain such disparities. The Eunice Kennedy Shriver National Institute of Child Health and Human Development formed a community/research collaborative-the Community Child Health Network-to investigate disparities in maternal and child health in five high-risk communities. Using community participation methods, we enrolled a large cohort of African American/Black, Latino/Hispanic, and non-Hispanic/White mothers and fathers of newborns at the time of birth and followed them over 2 years. A majority had household incomes near or below the federal poverty level. Home interviews yielded detailed information regarding multiple types of stress such as major life events and many forms of chronic stress including racism. Several forms of stress varied markedly by racial/ethnic group and income, with decreasing stress as income increased among Caucasians but not among African Americans; other forms of stress varied by race/ethnicity or poverty alone. We conclude that greater sophistication in studying the many forms of stress and community partnership is necessary to uncover the mechanisms underlying health disparities in poor and ethnic-minority families and to implement community health interventions.

Structural stigma and hypothalamic-pituitary-adrenocortical axis reactivity in lesbian, gay, and bisexual young adults

BACKGROUND

Youth exposed to extreme adverse life conditions have blunted cortisol responses to stress.

PURPOSE

This study aims to examine whether growing up in highly stigmatizing environments similarly shapes stigmatized individuals' physiological responses to identity-related stress.

METHODS

We recruited 74 lesbian, gay, and bisexual young adults (mean age = 23.68) from 24 states with varying levels of structural stigma surrounding homosexuality. State-level structural stigma was coded based on several dimensions, including policies that exclude sexual minorities from social institutions (e.g., same-sex marriage). Participants were exposed to a laboratory stressor, the Trier Social Stress Test (TSST), and neuroendocrine measures were collected.

RESULTS

Lesbian, gay, and bisexual young adults who were raised in highly stigmatizing environments as adolescents evidenced a blunted cortisol response following the TSST compared to those from low-stigma environments.

CONCLUSIONS

The stress of growing up in environments that target gays and lesbians for social exclusion may exert biological effects that are similar to traumatic life experiences.

What is a representative brain? Neuroscience meets population science

The last decades of neuroscience research have produced immense progress in the methods available to understand brain structure and function. Social, cognitive, clinical, affective, economic, communication, and developmental neurosciences have begun to map the relationships between neuro-psychological processes and behavioral outcomes, yielding a new understanding of human behavior and promising interventions. However, a limitation of this fast moving research is that most findings are based on small samples of convenience. Furthermore, our understanding of individual differences may be distorted by unrepresentative samples, undermining findings regarding brain-behavior mechanisms. These limitations are issues that social demographers, epidemiologists, and other population scientists have tackled, with solutions that can be applied to neuroscience. By contrast, nearly all social science disciplines, including social demography, sociology, political science, economics, communication science, and psychology, make assumptions about processes that involve the brain, but have incorporated neural measures to differing, and often limited, degrees; many still treat the brain as a black box. In this article, we describe and promote a perspective--population neuroscience--that leverages interdisciplinary expertise to (i) emphasize the importance of sampling to more clearly define the relevant populations and sampling strategies needed when using neuroscience methods to address such questions; and (ii) deepen understanding of mechanisms within population science by providing insight regarding underlying neural mechanisms. Doing so will increase our confidence in the generalizability of the findings. We provide examples to illustrate the population neuroscience approach for specific types of research questions and discuss the potential for theoretical and applied advances from this approach across areas.

Childhood abuse, parental warmth, and adult multisystem biological risk in the Coronary Artery Risk Development in Young Adults study

Childhood abuse increases adult risk for morbidity and mortality. Less clear is how this "toxic" stress becomes embedded to influence health decades later, and whether protective factors guard against these effects. Early biological embedding is hypothesized to occur through programming of the neural circuitry that influences physiological response patterns to subsequent stress, causing wear and tear across multiple regulatory systems. To examine this hypothesis, we related reports of childhood abuse to a comprehensive 18-biomarker measure of multisystem risk and also examined whether presence of a loving parental figure buffers against the impact of childhood abuse on adult risk. A total of 756 subjects (45.8% white, 42.7% male) participated in this ancillary substudy of the Coronary Artery Risk Development in Young Adults Study. Childhood stress was determined by using the Risky Families Questionnaire, a well-validated retrospective self-report scale. Linear regression models adjusting for age, sex, race, parental education, and oral contraceptive use found a significant positive relationship between reports of childhood abuse and multisystem health risks [B (SE) = 0.68 (0.16); P < 0.001]. Inversely, higher amounts of reported parental warmth and affection during childhood was associated with lower multisystem health risks [B (SE) = -0.40 (0.14); P < 0.005]. A significant interaction of abuse and warmth (P < 0.05) was found, such that individuals reporting low levels of love and affection and high levels of abuse in childhood had the highest multisystem risk in adulthood.

Spatial Polygamy and Contextual Exposures (SPACEs): Promoting Activity Space Approaches in Research on Place and Health

Exposure science has developed rapidly and there is an increasing call for greater precision in the measurement of individual exposures across space and time. Social science interest in an individual's environmental exposure, broadly conceived, has arguably been quite limited conceptually and methodologically. Indeed, we appear to lag behind our exposure science colleagues in our theories, data, and methods. In this paper we discuss a framework based on the concept of spatial polygamy to demonstrate the need to collect new forms of data on human spatial behavior and contextual exposures across time and space. Adopting new data and methods will be essential if we want to better understand social inequality in terms of exposure to health risks and access to health resources. We discuss the opportunities and challenges focusing on the potential seemingly offered by focusing on human mobility, and specifically the utilization of activity space concepts and data. A goal of the paper is to spatialize social and health science concepts and research practice vis-a-vis the complexity of exposure. The paper concludes with some recommendations for future research focusing on theoretical and conceptual development, promoting research on new types of places and human movement, the dynamic nature of contexts, and on training. "When we elect wittingly or unwittingly, to work within a level … we tend to discern or construct - whichever emphasis you prefer - only those kinds of systems whose elements are confined to that level."Otis Dudley Duncan (1961, p. 141)."…despite the new ranges created by improved transportation, local government units have tended to remain medieval in size."Torsten Hägerstrand (1970, p.18)"A detective investigating a crime needs both tools and understanding. If he has no fingerprint powder, he will fail to find fingerprints on most surfaces. If he does not understand where the criminal is likely to have put his fingers, he will not look in the right places. Equally, the analyst of data needs both tools and understanding."John Tukey (1977, p.1)"When we observe the environment, we necessarily do so on only a limited number of scales."Simon Levin (1992, p. 1945)There is a desperate need to develop methods with the same precision for an individual's environmental exposure as we have for an individual's genome … even a partial, targeted understanding of exposure can provide substantial advantages."Christopher Wild (2005, p.1848).

Bad Jobs, Bad Health? How Work and Working Conditions Contribute to Health Disparities

In this review, we touch on a broad array of ways that work is linked to health and health disparities for individuals and societies. First focusing on the health of individuals, we discuss the health differences between those who do and do not work for pay, and review key positive and negative exposures that can generate health disparities among the employed. These include both psychosocial factors like the benefits of a high status job or the burden of perceived job insecurity, as well as physical exposures to dangerous working conditions like asbestos or rotating shift work. We also provide a discussion of the ways differential exposure to these aspects of work contributes to social disparities in health within and across generations. Analytic complexities in assessing the link between work and health for individuals, such as health selection, are also discussed. We then touch on several contextual level associations between work and the health of populations, discussing the importance of the occupational structure in a given society, the policy environment that prevails there, and the oscillations of the macroeconomy for generating societal disparities in health. We close with a discussion of four areas and associated recommendations that draw on this corpus of knowledge but would push the research on work, health and inequality toward even greater scholarly and policy relevance.