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Imamatsu Y, Tadaka E. Factors associated with health behaviors in preventing non-communicable diseases among older adults living alone in poverty in Japan. Front Public Health 2023; 11:1207334. [PMID: 37744488 PMCID: PMC10514498 DOI: 10.3389/fpubh.2023.1207334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/28/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Older adults who live alone in poverty are highly susceptible to non-communicable diseases and other adverse conditions owing to health disparities resulting from social structures. However, the factors associated with health behavior to prevent non-communicable diseases in this population are rarely explored. The purpose of this study was to identify factors associated with health behavior to prevent non-communicable diseases among older adults living alone in poverty. Methods We conducted a self-administered mail survey covering 2,818 older adults living alone who were receiving public assistance, randomly selected from lists of individuals receiving national public assistance in all 1,250 local social welfare offices across Japan. A total of 1,608 individuals completed the questionnaire, a valid response rate of 57.1%. Respondents' mean age was 74.5 years (standard deviation = 6.7), and 52.9% were women. The study variables included demographic characteristics, scores on a health behavior scale for older adults living alone and receiving public assistance (HBSO), and individual and community-related factors. Results Logistic regression analysis revealed that the individual factor of having a health check-up in the past 12 months [odds ratio (OR): 1.45, 95% confidence interval (CI): 1.10-1.91] and the community-related factors Lubben social network scale score (OR 1.15, 95% CI: 1.12-1.18) and Community Commitment Scale score (OR: 1.04, 95% CI: 1.00-1.08) were significantly associated with HBSO scores. Conclusion To improve health behavior among older adults living alone in poverty in Japan, social structures, such as lowering mental barriers to the detection, treatment, and management of non-communicable diseases and developing human resources, should be changed to provide social support, such that these individuals are not only dependent on family and friends.
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Affiliation(s)
- Yuki Imamatsu
- Department of Community Health Nursing, Graduate School of Medicine, Yokohama City University, Yokohama City, Japan
| | - Etsuko Tadaka
- Department of Community and Public Health Nursing, Graduate School of Health Sciences and Faculty of Medicine, Hokkaido University, Sapporo, Japan
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Caston NE, Waters AR, Williams CP, Biddell C, Spees L, Gallagher K, Angove R, Anderson E, Balch A, Wheeler S, Rocque GB. Patient-reported discrimination among limited-resourced cancer survivors: a brief report. J Psychosoc Oncol 2022; 41:630-641. [PMID: 36519613 PMCID: PMC10617020 DOI: 10.1080/07347332.2022.2154186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Healthcare discrimination has been associated with health disparities including lower cancer screenings, higher medical mistrust, and strained patient-provider relationships. Our study sought to understand patient-reported discrimination among cancer survivors with limited resources living in the United States. DESIGN AND METHODS We used cross-sectional survey data distributed by the Patient Advocate Foundation (PAF) in 12/2020 and 07/2021. Respondents reported source and reason of healthcare discrimination. Age, sex, race and ethnicity, annual household income, Rural-Urban Commuting Area (RUCA), Area Deprivation Index (ADI), employment status, cancer type, and number of comorbidities were independent variables of interest. The association between these variables and patient-reported healthcare discrimination was estimated using risk ratios (RRs) and 95% confidence intervals (CIs) from a multivariable modified Poisson regression model with robust standard errors. FINDINGS A total of 587 cancer survivors were included in our analysis. Most respondents were female (72%) and aged ≥56 (62%); while 33% were Black, Indigenous, or Person of Color. Overall, 23% reported receipt of discrimination, with the majority reporting doctor, nurse, or healthcare provider as the source (58%). Most common reasons for discrimination included disease status (42%), income/ability to pay (36%), and race and ethnicity (17%). In the adjusted model, retired survivors were 62% less likely to report discrimination compared to those employed (RR 0.38; 95% CI 0.23-0.64). Additionally, survivors with ≥3 comorbidities were 86% more likely to report discrimination compared to those survivors with no non-cancer comorbidities (RR 1.86; 95% CI 1.26-2.72). IMPLICATIONS Cancer survivors with limited resources reported substantial discrimination most often from a healthcare provider and most commonly for disease status and income. Discrimination should be mitigated to provide equitable and high-quality cancer care.
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Affiliation(s)
- Nicole E. Caston
- Division of Hematology and Oncology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Austin R. Waters
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina (UNC), Chapel Hill, NC, USA
| | - Courtney P. Williams
- Division of Hematology and Oncology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Caitlin Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina (UNC), Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC, USA
| | - Lisa Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina (UNC), Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC, USA
| | | | | | | | - Alan Balch
- Patient Advocate Foundation, Hampton, VA, USA
| | - Stephanie Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina (UNC), Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, UNC, Chapel Hill, NC, USA
| | - Gabrielle B. Rocque
- Division of Hematology and Oncology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- O’Neal Comprehensive Cancer Center, UAB, Birmingham, AL, USA
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Antebi-Gruszka N, Friedman AA, Balsam KF. Multiple forms of discrimination, mental distress, and well-being among lesbian, gay, bisexual, and queer individuals: The role of brooding. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022. [DOI: 10.1080/19359705.2022.2089425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Nadav Antebi-Gruszka
- Department of Psychology, Columbia University, New York, New York, USA
- Heartspace Therapy (Private Practice), New York, New York, USA
| | - Ariel A. Friedman
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Kimberly F. Balsam
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
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Vargas SM, Sugarman OK, Tang L, Miranda J, Chung B. Depression at the Intersection of Race/Ethnicity, Sexual Orientation, and Income. JOURNAL OF BISEXUALITY 2022; 21:541-559. [PMID: 39308904 PMCID: PMC11415248 DOI: 10.1080/15299716.2021.2024932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
The current study uses an intersectional framework to examine subgroup differences in the prevalence of depression among a community sample of predominantly low-income, racial/ethnic and sexual minority adults. Between May 2017-June 2018, participants (N=1753) were recruited from and screened for depression in community organizations that predominantly serve sexual minority clients based in Los Angeles, California and New Orleans, Louisiana. Twenty-six percent of people screened for study eligibility met criteria for depression (Patient Health Questionnaire-8≥10). As is true in higher-resourced populations, bisexual (Odds Ratio; OR: 1.50; 95% Confidence Interval; CI: 1.08, 2.09) and queer/questioning (OR: 1.86; 95% CI: 1.08, 3.19) individuals were more likely to be depressed than heterosexual and lesbian/ gay individuals. These differences remained even when accounting for income. No differences in depression were observed between lesbian/gay and heterosexual adults. In terms of racial differences, bisexual Black (OR: .47; 95% CI: 0.21, 1.04) and Hispanic (OR: .51; 95% CI: 0.23, 1.12) adults were marginally less likely to be depressed than bisexual White adults. No racial differences emerged across other sexual orientations. Differences across some sexual minority subgroups may be race-specific, suggesting that intersectional frameworks may be the best way to understand how multiple marginalization affects different subgroups.
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Affiliation(s)
- Sylvanna M. Vargas
- Departments of Psychology and Preventive Medicine, University of Southern California, Los Angeles, California, United States
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, United States
| | - Olivia K. Sugarman
- Section of Community and Population Medicine, Department of Internal Medicine, School of Medicine, Louisiana State University Health Sciences Center – New Orleans, Louisiana, United States
- Center for Healthcare Value and Equity, Department of Internal Medicine, School of Medicine, Louisiana State University Health Sciences Center – New Orleans, Louisiana, United States
- Department of Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center – New Orleans, LA, United States
| | - Lingqi Tang
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, United States
| | | | - Jeanne Miranda
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, United States
| | - Bowen Chung
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, United States
- Department of Psychiatry, Harbor-UCLA Medical Center/Los Angeles Biomedical Research Institute, Los Angeles, California, United States
- RAND corporation, David Geffen School of Medicine at the University of California, Los Angeles, California, United States
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Is Loneliness an Undervalued Pathway between Socio-Economic Disadvantage and Health? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910177. [PMID: 34639477 PMCID: PMC8508269 DOI: 10.3390/ijerph181910177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/13/2021] [Accepted: 09/23/2021] [Indexed: 01/06/2023]
Abstract
Loneliness is a growing public health issue. It is more common in disadvantaged groups and has been associated with a range of poor health outcomes. Loneliness may also form an independent pathway between socio-economic disadvantage and poor health. Therefore, the aim of this study was to explore the contribution of loneliness to socio-economic health inequalities. These contributions were studied in a Dutch national sample (n = 445,748 adults (≥19 y.o.)) in Poisson and logistic regression models, controlling for age, gender, marital status, migration background, BMI, alcohol consumption, smoking, and physical activity. Loneliness explained 21% of socioeconomic health inequalities between the lowest and highest socio-economic groups in self-reported chronic disease prevalence, 27% in poorer self-rated health, and 51% in psychological distress. Subgroup analyses revealed that for young adults, loneliness had a larger contribution to socioeconomic gaps in self-rated health (37%) than in 80+-year-olds (16%). Our findings suggest that loneliness may be a social determinant of health, contributing to the socioeconomic health gap independently of well-documented factors such as lifestyles and demographics, in particular for young adults. Public health policies targeting socioeconomic health inequalities could benefit from integrating loneliness into their policies, especially for young adults.
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Isozaki A, Tadaka E. Development of a health behavior scale for older adults living alone receiving public assistance. BMC Public Health 2021; 21:1428. [PMID: 34281517 PMCID: PMC8290590 DOI: 10.1186/s12889-021-11347-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/22/2021] [Indexed: 11/14/2022] Open
Abstract
Background To reduce health disparities, prevention of non-communicable diseases (NCD) by performing desirable health behavior in older adults living alone with low socioeconomic status is an essential strategy in public health. Self-perception of personal power and practical skills for daily health are key elements of desirable health behavior. However, methods for measuring these concepts have not been established. This study aimed to develop a health behavior scale for older adults living alone receiving public assistance (HBSO). Methods The self-administered mail survey covered 2818 older adults living alone receiving public assistance (OAP) randomly selected from the list of people receiving public assistance (Seikatsu-hogo in Japanese) at all 1250 local social welfare offices across Japan. Construct validity was confirmed using confirmatory factor analysis. Internal consistency was calculated using Cronbach’s alpha. The self-efficacy for health promotion scale and Health check-up status were administered to assess the criteria-related validity of the HBSO. Results In total, 1280 participants (response rate: 45.4%) responded, of which 1069 (37.9%) provided valid responses. Confirmatory factor analysis identified 10 items from two factors (self-perception of personal power and practical skills for daily health) with a goodness of fit index of 0.973, adjusted goodness of fit index of 0.953, comparative fit index of 0.954, and root mean square error of approximation of 0.049. Cronbach’s alpha was 0.75. The total HBSO score was significantly positively correlated with the self-efficacy for health promotion scale (r = 0.672, p < 0.001) and the group with health check-up had significantly higher HBSO scores than the group without it (p < 0.001). Conclusions The HBSO is an easy-to-self-administer instrument that is reliable and valid for OAP. The HBSO could facilitate appropriate assessment of OAP who need to improve their health behavior to prevent NCD, and could be used to determine effective support. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11347-x.
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Affiliation(s)
- Ayano Isozaki
- Department of Community Health Nursing, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Etsuko Tadaka
- Department of Community and Public Health Nursing, Graduate School of Health Sciences and Faculty of Medicine, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan.
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The relationship between perceived discrimination and wellbeing in impoverished college students: a moderated mediation model of self-esteem and belief in a just world. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01981-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Joseph A, Prasad S, Hynan LS, Chren MM, Chong B. Differences in quality of life in patients with cutaneous lupus erythematosus with varying income levels. Lupus 2021; 30:972-980. [PMID: 33663251 DOI: 10.1177/0961203321999724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cutaneous lupus erythematosus (CLE) is an autoimmune photosensitive skin condition. The impact of income on quality of life has been incompletely characterized in CLE. OBJECTIVES We aimed to assess how annual income affects quality of life among CLE patients. METHODS In this cross-sectional study of 238 patients with CLE, relationships between predictor variables including annual income and each SKINDEX-29 + 3 subdomain were identified using univariate and multivariable analyses. In addition, answers to individual SKINDEX-29 + 3 questions were compared across income groups. Clinical factors in patients making less than <10,000 USD (N = 85) with worse SKINDEX-29 + 3 scores were also identified by univariate and multivariable analyses. RESULTS Patients making <10,000 USD annually experienced worse quality of life across multiple SKINDEX-29 + 3 subdomains (p < 0.05). These patients specifically experienced poorer quality of life relating to social isolation and self-consciousness. (p < 0.001). Among those making <10,000 USD, predictors for worse quality of life included females, smokers, and those with higher skin disease activity were identified (p < 0.05).Limitations: This is a single center study. Income was also self-reported and could not be verified. CONCLUSIONS Lower income is related to poorer quality of life in patients with CLE. Specifically, patients experience limitations regarding social isolation and self-consciousness.
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Affiliation(s)
- Adrienne Joseph
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Smriti Prasad
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Linda S Hynan
- Department of Population and Data Sciences and Psychiatry, University of Texas at Southwestern , Dallas, TX, USA Medical Center
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin Chong
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
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9
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Predictors of Alcohol Use in Safety-Net Primary Care: Classism, Religiosity, and Race. JOURNAL OF ADDICTION 2020; 2020:5916318. [PMID: 32612865 PMCID: PMC7317315 DOI: 10.1155/2020/5916318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 04/07/2020] [Accepted: 05/27/2020] [Indexed: 11/18/2022]
Abstract
Class-based discrimination may impact problematic drinking in low-income populations, which may be buffered by personal religiosity. However, little is known how race may impact this association. The purpose of this study was to examine racial differences in the effect of class-based discrimination on problematic drinking as moderated by comfort with God and determine if there were conditional direct effects of class-based discrimination on problematic drinking by race. In this cross-sectional study, participants (N = 189) were patients of an urban, safety-net primary care clinic who completed questionnaires assessing experiences of class-based discrimination, attitudes toward God, and alcohol use. Data were collected from 2015 to 2016 and analyzed using the Hayes PROCESS macro. There was a significant main effect for class-based discrimination predicting problematic drinking. Two-way interaction analyses identified a significant comfort with God by race interaction with greater comfort with God associated with less problematic drinking among white but not black respondents. Conditional direct effects showed that experiences of class-based discrimination were associated with problematic drinking at low and moderate but not high levels of comfort with God in black participants, whereas none were observed for white participants. This study provides insight on how personal religiosity, class-based discrimination, and race may intertwine to shape problematic alcohol use in primarily low-income, urban patients. Clinicians' awareness of risk and protective factors, as well as how race tempers the effects of such factors, is vital in providing better care for this population.
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Gazard B, Chui Z, Harber-Aschan L, MacCrimmon S, Bakolis I, Rimes K, Hotopf M, Hatch SL. Barrier or stressor? The role of discrimination experiences in health service use. BMC Public Health 2018; 18:1354. [PMID: 30526564 PMCID: PMC6286602 DOI: 10.1186/s12889-018-6267-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/26/2018] [Indexed: 01/01/2023] Open
Abstract
Background Discrimination is a well-established stressor that is substantially associated with poor health and a known contributor to health inequalities. However, the role of discrimination in health service use is less explored. This study will take an intersectional approach to investigate differences in health service use and examine the role of discrimination experiences. Methods Data on health service use were assessed in a diverse inner London sample of 1052 participants in the South East London Community Health (SELCoH) Study. Latent class analysis (LCA) was used to define classes of intersectional social status using multiple indicators of socioeconomic status (SES), ethnicity and migration status. Adjusted associations between intersectional social status and discrimination experiences with health service use indicators are presented. Results Using latent class analysis allowed us to identify an intersectional social status characterized by multiple disadvantage that was associated with decreased secondary physical health service use and a class characterized by both privilege and disadvantage that was associated with increased health service use for mental disorder after controlling for age, gender and health status. Anticipated discrimination was also associated with increased service use for mental disorder in adjusted models. There was no evidence to suggest that discrimination experiences were acting as a barrier to health service use. Conclusions This study highlights the complex ways in which discrimination experiences may increase the need for health services whilst also highlighting differences in health service use at the intersection of ethnicity, migration status and SES. Findings from this study illustrate the importance of measuring multiple levels of discrimination and taking an intersectional approach for health service use research.
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Affiliation(s)
- Billy Gazard
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK.
| | - Zoe Chui
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK
| | - Lisa Harber-Aschan
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Shirlee MacCrimmon
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK
| | - Ioannis Bakolis
- Centre for Implementation Science, Health Services and Population Research Department, Psychology and Neuroscience, Institute of Psychiatry, King's College London, London, UK.,Department of Biostatistics and Health Informatics, Psychology and Neuroscience, Institute of Psychiatry, King's College London, London, UK
| | - Katharine Rimes
- Psychology and Neuroscience, King's College London, Psychology, Institute of Psychiatry, London, UK
| | - Matthew Hotopf
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephani L Hatch
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK
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Simons AMW, Houkes I, Koster A, Groffen DAI, Bosma H. The silent burden of stigmatisation: a qualitative study among Dutch people with a low socioeconomic position. BMC Public Health 2018; 18:443. [PMID: 29614987 PMCID: PMC5883403 DOI: 10.1186/s12889-018-5210-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/23/2018] [Indexed: 11/17/2022] Open
Abstract
Background In-depth qualitative research into perceived socioeconomic position-related stigmatisation among people living at the lower end of our socioeconomic hierarchy is necessary for getting more insight in the possible downside of living in an increasingly meritocratic and individualistic society. Methods Seventeen interviews were conducted among a group of Dutch people with a low socioeconomic position to examine their experiences with stigmatisation, how they coped with it and what they perceived as consequences. Results Social reactions perceived by participants related to being inferior, being physically recognisable as a poor person, and being responsible for their own financial problems. Participants with less experience of living in poverty, a heterogeneous social network and greater sense of financial responsibility seemed to be more aware of stigmas than people with long-term experience of poverty, a homogeneous social network and less sense of financial responsibility. Perceived stigmatisation mainly had emotional consequences. To maintain a certain level of self-respect, participants tried to escape from reality, showed their strengths or confronted other people who expressed negative attitudes towards them. Conclusion Despite the good intentions of policies to enhance self-reliance, responsibility and active citizenship, these policies and related societal beliefs might affect people at the lower end of our socioeconomic hierarchies by making them feel inferior, ashamed and blamed, especially when they cannot meet societal expectations or when they feel treated disrespectfully, unjustly or unequally by social workers or volunteers of charity organisations.
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Affiliation(s)
- Audrey M W Simons
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands.
| | - Inge Houkes
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Annemarie Koster
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
| | - Daniëlle A I Groffen
- Department of Data Collection, Statistics Netherlands (CBS), P.O. Box 4481, 6401, CZ, Heerlen, the Netherlands
| | - Hans Bosma
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands
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Predictors of decline in self-reported health: addressing non-ignorable dropout in longitudinal studies of aging. Eur J Ageing 2017; 15:211-220. [PMID: 29867305 PMCID: PMC5971030 DOI: 10.1007/s10433-017-0448-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Predictors of decline in health in older populations have been investigated in multiple studies before. Most longitudinal studies of aging, however, assume that dropout at follow-up is ignorable (missing at random) given a set of observed characteristics at baseline. The objective of this study was to address non-ignorable dropout in investigating predictors of declining self-reported health (SRH) in older populations (50 years or older) in Sweden, the Netherlands, and Italy. We used the SHARE panel survey, and since only 2895 out of the original 5657 participants in the survey 2004 were followed up in 2013, we studied whether the results were sensitive to the expectation that those dropping out have a higher proportion of decliners in SRH. We found that older age and a greater number of chronic diseases were positively associated with a decline in self-reported health in the three countries studies here. Maximum grip strength was associated with decline in self-reported health in Sweden and Italy, and self-reported limitations in normal activities due to health problems were associated with decline in self-reported health in Sweden. These results were not sensitive to non-ignorable dropout. On the other hand, although obesity was associated with decline in a complete case analysis, this result was not confirmed when performing a sensitivity analysis to non-ignorable dropout. The findings, thereby, contribute to the literature in understanding the robustness of longitudinal study results to non-ignorable dropout while considering three different population samples in Europe.
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Zilioli S, Imami L, Ong AD, Lumley MA, Gruenewald T. Discrimination and anger control as pathways linking socioeconomic disadvantage to allostatic load in midlife. J Psychosom Res 2017; 103:83-90. [PMID: 29167051 DOI: 10.1016/j.jpsychores.2017.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 07/01/2017] [Accepted: 10/08/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Recent evidence suggests that experiences of discrimination contribute to socioeconomic status health disparities. The current study examined if the experience and regulation of anger-an expected emotional response to discrimination-serves as an explanatory factor for the previously documented links between socioeconomic disadvantage (SED), discrimination, and allostatic load. METHODS Data were drawn from the second wave of the Midlife in the United States (MIDUS) study and included 909 adults who participated in the biomarkers subproject. RESULTS Results revealed that perceived discrimination was associated with higher levels of allostatic load. Furthermore, we found evidence that perceived discrimination and anger control sequentially explained the relationship between SED and allostatic load, such that greater discrimination was associated with lower levels of anger control, which, in turn accounted for the effects of discrimination on allostatic load. These results remained significant after controlling for negative affect, positive affect, other forms of anger expression, as well as demographic covariates. CONCLUSIONS Our findings suggest that low anger control may be an important psychological pathway through which experiences of discrimination influence health.
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Affiliation(s)
- Samuele Zilioli
- Department of Psychology, Wayne State University, United States; Department of Family Medicine and Public Health Sciences, Wayne State University, United States.
| | - Ledina Imami
- Department of Psychology, Wayne State University, United States.
| | - Anthony D Ong
- Department of Human Development, Cornell University, United States; Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, United States.
| | - Mark A Lumley
- Department of Psychology, Wayne State University, United States.
| | - Tara Gruenewald
- Department of Psychology, Chapman University, United States.
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14
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Simons AMW, Koster A, Groffen DAI, Bosma H. Perceived classism and its relation with socioeconomic status, health, health behaviours and perceived inferiority: the Dutch Longitudinal Internet Studies for the Social Sciences (LISS) panel. Int J Public Health 2017; 62:433-440. [PMID: 27572684 PMCID: PMC5397436 DOI: 10.1007/s00038-016-0880-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 07/08/2016] [Accepted: 08/16/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Classism might be the downside of the prevailing ideologies of individual responsibility for success. However, since studies into perceived classism have mainly been qualitative, little is known about its association with socioeconomic status, health, health behaviours and perceived inferiority, especially in more egalitarian countries. This study, therefore, examined the associations of perceived classism with socioeconomic status, health, health behaviours and perceived inferiority. METHODS We used cross-sectional data (2012/2013) from the Dutch Longitudinal Internet Studies for the Social Sciences (LISS) (n = 1540; age 16-90; 46.9 % men). RESULTS We found that classism was perceived by 18.2 % of the participants, with the lowest income and occupation group most likely to perceive classism (22.0 and 27.5 %, respectively). Perceived classism was significantly associated with poor health (e.g. self-rated health OR = 2.44, 95 % CI = 1.76-3.38) and feelings of inferiority (e.g. shame OR = 4.64, 95 % CI = 3.08-6.98). No significant associations were found with health behaviours. CONCLUSIONS To further examine the role of perceived classism for socioeconomic differences in health and its association with country-level socioeconomic inequalities, prevailing ideologies, and objective opportunities for social mobility, we recommend more longitudinal and international studies with comparable measures of perceived classism.
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Affiliation(s)
- Audrey M W Simons
- Department of Social Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Annemarie Koster
- Department of Social Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Daniëlle A I Groffen
- Department of Social Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Préau M, Laguette V, March L, Rabaud C, Hardel L, Protopopescu C, Granier P, Pierret J, Leport C, Raffi F. Discussing HIV Status: Is It Easier After 10 Years of Antiretroviral Treatment? The ANRS CO8 APROCO-COPILOTE Cohort. AIDS Behav 2017; 21:118-128. [PMID: 26910336 DOI: 10.1007/s10461-016-1328-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study's objective was to explore the factors associated with the belief (or not) by people living with HIV that it is easier to talk about their seropositivity 10 years after initiating a protease inhibitor-containing ART. All patients in the ANRS CO8 APROCO-COPILOTE cohort who completed a self-administered questionnaire at 10 years of follow-up were included in this study. Forty-four percent of patients declared that discussing their seropositivity with their family was easier 10 years later, while 28 % declared this was true for discussing their status with a new sexual partner. Having a low socioeconomic status, not receiving social support from a steady partner and declaring a low number of discomforting symptoms 12 months after PI initiation were all independently associated with less difficulty in discussing seropositivity. This study highlights the difficulties in disclosing HIV 10 years after PI initiation, and the important influence of psychosocial factors and patients' daily-life experience on disclosure.
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Logie CH, Jenkinson JIR, Earnshaw V, Tharao W, Loutfy MR. A Structural Equation Model of HIV-Related Stigma, Racial Discrimination, Housing Insecurity and Wellbeing among African and Caribbean Black Women Living with HIV in Ontario, Canada. PLoS One 2016; 11:e0162826. [PMID: 27669510 PMCID: PMC5036880 DOI: 10.1371/journal.pone.0162826] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 08/29/2016] [Indexed: 01/15/2023] Open
Abstract
African and Caribbean Black women in Canada have new HIV infection rates 7 times higher than their white counterparts. This overrepresentation is situated in structural contexts of inequities that result in social, economic and health disparities among African and Caribbean Black populations. Economic insecurity is a distal driver of HIV vulnerability, reducing access to HIV testing, prevention and care. Less is known about how economic insecurity indicators, such as housing security, continue to influence the lives of women living with HIV following HIV-positive diagnoses. The aim of this study was to test a conceptual model of the pathways linking HIV-related stigma, racial discrimination, housing insecurity, and wellbeing (depression, social support, self-rated health). We implemented a cross-sectional survey with African and Caribbean Black women living with HIV in 5 Ontario cities, and included 157 participants with complete data in the analyses. We conducted structural equation modeling using maximum likelihood estimation to evaluate the hypothesized conceptual model. One-fifth (22.5%; n = 39) of participants reported housing insecurity. As hypothesized, racial discrimination had significant direct effects on: HIV-related stigma, depression and social support, and an indirect effect on self-rated health via HIV-related stigma. HIV-related stigma and housing insecurity had direct effects on depression and social support, and HIV-related stigma had a direct effect on self-rated health. The model fit the data well: χ2 (45, n = 154) = 54.28, p = 0.387; CFI = 0.997; TLI = 0.996; RMSEA = 0.016. Findings highlight the need to address housing insecurity and intersecting forms of stigma and discrimination among African and Caribbean Black women living with HIV. Understanding the complex relationships between housing insecurity, HIV-related stigma, racial discrimination, and wellbeing can inform multi-level interventions to reduce stigma and enhance health.
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Affiliation(s)
- Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Jesse I. R. Jenkinson
- Dalla Lana School of Public Health, Social and Behavioural Health Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Valerie Earnshaw
- Human Development and Family Studies, University of Delaware, Newark, Delaware, United States
| | - Wangari Tharao
- Women’s Health in Women’s Hands Community Health Centre, Toronto, Ontario, Canada
| | - Mona R. Loutfy
- Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
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Bao Z, Chen C, Zhang W, Zhu J, Jiang Y, Lai X. Family economic hardship and Chinese adolescents' sleep quality: A moderated mediation model involving perceived economic discrimination and coping strategy. J Adolesc 2016; 50:81-90. [DOI: 10.1016/j.adolescence.2016.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
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Crews DC, Kuczmarski MF, Miller ER, Zonderman AB, Evans MK, Powe NR. Dietary habits, poverty, and chronic kidney disease in an urban population. J Ren Nutr 2015; 25:103-10. [PMID: 25238697 PMCID: PMC4339637 DOI: 10.1053/j.jrn.2014.07.008] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/20/2014] [Accepted: 07/22/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Poverty is associated with chronic kidney disease (CKD) in the United States and worldwide. Poor dietary habits may contribute to this disparity. STUDY DESIGN Cross-sectional study. SETTING AND PARTICIPANTS A total of 2,058 community-dwelling adults aged 30 to 64 years residing in Baltimore City, Maryland. PREDICTORS Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet. DASH scoring based on 9 target nutrients (total fat, saturated fat, protein, fiber, cholesterol, calcium, magnesium, sodium, and potassium); adherence defined as score ≥4.5 of maximum possible score of 9. Poverty (self-reported household income <125% of 2004 Department of Health and Human Services guideline) and nonpoverty (≥125% of guideline). OUTCOMES AND MEASUREMENTS CKD defined as estimated glomerular filtration rate <60 mL/minute/1.73 m(2) (CKD epidemiology collaboration equation). Multivariable logistic regression was used to calculate adjusted odds ratios (AORs) for relation of DASH score tertile and CKD, stratified by poverty status. RESULTS Among 2,058 participants (mean age 48 years; 57% black; 44% male; 42% with poverty), median DASH score was low, 1.5 (interquartile range, 1-2.5). Only 5.4% were adherent. Poverty, male sex, black race, and smoking were more prevalent among the lower DASH score tertiles, whereas higher education and regular health care were more prevalent among the highest DASH score tertile (P < .05 for all). Fiber, calcium, magnesium, and potassium intake were lower, and cholesterol higher, among the poverty compared with nonpoverty group (P < .05 for all), with no difference in sodium intake. A total of 5.6% of the poverty and 3.8% of the nonpoverty group had CKD (P = .05). The lowest DASH tertile (compared with the highest) was associated with more CKD among the poverty (AOR 3.15, 95% confidence interval 1.51-6.56), but not among the nonpoverty group (AOR 0.73, 95% confidence interval 0.37-1.43; P interaction = .001). CONCLUSIONS Poor dietary habits are strongly associated with CKD among the urban poor and may represent a target for interventions aimed at reducing disparities in CKD.
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Affiliation(s)
- Deidra C Crews
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | | | - Edgar R Miller
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Neil R Powe
- Department of Medicine, San Francisco General Hospital, University of California at San Francisco, San Francisco, California
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Simons AMW, Groffen DAI, Bosma H. Socio-economic inequalities in all-cause mortality in Europe: an exploration of the role of heightened social mobility. Eur J Public Health 2013; 23:1010-2. [DOI: 10.1093/eurpub/ckt145] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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