Health pessimism among black and white adults: the role of interpersonal and institutional maltreatment

Racism, self-rated general health status, and health-related quality of life among Black and Asian Americans

Race is a consequential sociocultural cue in healthcare contexts. Racism is associated with health disparities. Extant research shows significant health inequities between white and Black people. However, little is known about health gaps between or among other racial groups. This study investigated how Blacks and Asian Americans perceive and experience racism in healthcare settings and in general daily life situations, and how these factors relate to their self-rated general health status and health-related quality of life. Findings from an online survey suggest strong similarities and subtle differences between the two racial groups and within the Asian subgroups.

Effects of Prolonged Exposure to Air Pollution and Neighborhood Disadvantage on Self-Rated Health among Adults in the United States: Evidence from the Panel Study of Income Dynamics

BACKGROUND

Although overall air quality has improved in the United States, air pollution remains unevenly distributed across neighborhoods, producing disproportionate environmental burdens for minoritized and socioeconomically disadvantaged residents for whom greater exposure to other structurally rooted neighborhood stressors is also more frequent. These interrelated dynamics and layered vulnerabilities each have well-documented associations with physical and psychological health outcomes; however, much remains unknown about the joint effects of environmental hazards and neighborhood socioeconomic factors on self-reported health status.

OBJECTIVES

We examined the nexus of air pollution exposure, neighborhood socioeconomic disadvantage, and self-rated health (SRH) among adults in the United States.

METHODS

This observational study used individual-level data from the Panel Study of Income Dynamics merged with contextual information, including neighborhood socioeconomic and air pollution data at the census tract and census block levels, spanning the period of 1999-2015. We estimated ordinary least squares regression models predicting SRH by 10-y average exposures to fine particulate matter [particles ≤ 2.5 μ m in aerodynamic diameter (PM 2.5 )] and neighborhood socioeconomic disadvantage while controlling for individual-level correlates of health. We also investigated the interaction effects of air pollution and neighborhood socioeconomic disadvantage on SRH.

RESULTS

On average, respondents in our sample rated their health as 3.41 on a scale of 1 to 5. Respondents in neighborhoods with higher 10-y average PM 2.5 concentrations or socioeconomic disadvantage rated their health more negatively after controlling for covariates [β = - 0.024 (95% CI: - 0.034 , - 0.014 ); β = - 0.107 (95% CI: - 0.163 , - 0.052 ), respectively]. We also found that the deleterious associations of PM 2.5 exposure with SRH were weaker in the context of greater neighborhood socioeconomic disadvantage (β = 0.007 ; 95% CI: 0.002, 0.011).

DISCUSSION

Study results indicate that the effects of air pollution on SRH may be less salient in socioeconomically disadvantaged neighborhoods compared with more advantaged areas, perhaps owing to the presence of other more proximate structurally rooted health risks and vulnerabilities in disinvested areas (e.g., lack of economic resources, health access, healthy food options). This intersection may further underscore the importance of meaningful involvement and political power building among community stakeholders on issues concerning the nexus of environmental and socioeconomic justice, particularly in structurally marginalized communities. https://doi.org/10.1289/EHP11268.

The Impact of Discriminatory Stress on Changes in Posttraumatic Stress Severity at the Intersection of Race/Ethnicity and Gender

Given the diversity of military veterans and growing evidence of ethnoracial disparities in posttraumatic stress disorder (PTSD) within this population, elucidating the role of discrimination-related stress in contributing to these disparities is crucial. We examined the relative impact of discriminatory stress (i.e., due to race/ethnicity, religion, nationality, gender, sexual orientation, or physical appearance) on 6-month changes in PTSD symptom severity among trauma-exposed White (74%), Black (11%) and Hispanic/Latino/a/x (15%) veterans (17% female). PTSD symptoms were measured with the 8-item PTSD Checklist for DSM-5. A measure of the extent to which discrimination has caused stress for the respondent assessed discriminatory stress. Hierarchical regression analyses examined interactions among race/ethnicity, gender and discriminatory stress in predicting six-month changes in PTSD severity. Black and Hispanic/Latino/a/x veterans reported higher baseline PTSD severity and discriminatory stress than White veterans, with some variation by gender. Three-way interactions of race/ethnicity by discriminatory stress by gender were significant, controlling for income, education and age. The relationship between discriminatory stress and increases in PTSD severity was significantly stronger for Black women compared with Black men and did not differ between White men and women. There was also a stronger relationship between discriminatory stress and increases in PTSD severity for Hispanic/Latino/x men as compared to Black men. These findings suggest that discriminatory stress impacts PTSD severity differentially for various ethnoracial/gender groups and highlight the value of applying an intersectional framework that accounts for the synergistic connections among multiple identities to future screening, intervention, and research efforts.

Racial Non-equivalence of Socioeconomic Status and Self-rated Health among African Americans and Whites

Racial health inequities are not fully explained by socioeconomic status (SES) measures like education, income and wealth. The largest inequities are observed among African American and white college graduates suggesting that African Americans do not receive the same health benefits of education. African Americans do not receive the same income and wealth returns of college education as their white counterparts indicating a racial non-equivalence of SES that may affect health inequities. The aim of this study is to determine whether racial non-equivalence of SES mediates race inequities in self-rated health by education and sex. Using data from the 2007-2016 National Health and Nutrition Examination Survey in the United States, the mediation of the associations between race and self-rated health through household income ≥400% federal poverty line, homeownership, and investment income were assessed among college graduates and non-college graduates by sex. Indirect associations were observed among college graduate women (odds = 0.08, standard error (s.e.) = 0.03), and non-college graduate men (odds = 0.14, s.e. = 0.02) and women (odds = 0.06, s.e. = 0.02). Direct associations between race and self-rated health remained after accounting for household income and wealth indicators suggesting that race differences in income and wealth partially mediate racial inequities in self-rated health. This study demonstrates that the racial non-equivalence of SES has implications for health inequities, but the magnitude of indirect associations varied by sex. Other factors like discrimination, health pessimism and segregation should be considered in light of the racial non-equivalence of SES and racial inequities in self-rated health.

The Two Faces of Diversity: The Relationships between Religious Polarization, Religious Fractionalization, and Self-rated Health

A dominant discourse in the social sciences theorizes that religious diversity puts individuals' health at risk via interreligious hostility. However, this discourse overlooks the different subtypes of religious diversity and the moderation of political institutions. To better understand the issue of diversity and health, in this study, we distinguish between two subtypes of religious diversity-polarization and fractionalization-and argue that their impacts on health are heterogeneous. Using a sample of 67,399 individuals from 51 societies drawn from the 2010-2014 wave of the World Values Survey, our multilevel analyses show that religious polarization is negatively associated with individual health, whereas the health effects of religious fractionalization are positive. Moreover, the associations between religious polarization/fractionalization and individual health are found to depend on the democratic level of the state. In more democratic countries, the negative effects of polarization on health are mitigated, and the positive effects of fractionalization are stronger.

Gender and Health: Beyond Binary Categorical Measurement

This study leverages multiple measures of gender from a US national online survey (N = 1,508) to better assess how gender is related to self-rated health. In contrast to research linking feminine behaviors with good health and masculine behaviors with poor health, we find that masculinity is associated with better self-rated health for cisgender men, whereas femininity is associated with better self-rated health for cisgender women. The patterns are similar whether we consider self-identification or how people feel others perceive their gender, though reflected appraisals are most strongly associated with health for cisgender women. We also find that people who report they are seen as gender nonconforming report worse health, but only when this perception does not match their gender identification. Our results demonstrate that multiple measures of gender allow researchers to disentangle how health is not only shaped by gender enactments but also shapes perceptions of gender and gender difference.

Whose Moral Community? Religiosity, Secularity, and Self-rated Health across Communal Religious Contexts

Scholars have long theorized that religious contexts provide health-promoting social integration and regulation. A growing body of literature has documented associations between individual religiosity and health as well as macro-micro linkages between religious contexts, religious participation, and individual health. Using unique data on individuals and county contexts in the United States, this study offers new insight by using multilevel analysis to examine meso-micro relationships between religion and health. We assess whether and how the relationship between individual religiosity and health depends on communal religious contexts. In highly religious contexts, religious individuals are less likely to have poor health, while nonreligious individuals are markedly more likely to have poor health. In less religious contexts, religious and nonreligious individuals report similar levels of health. Consequently, the health gap between religious and nonreligious individuals is largest in religiously devout contexts, primarily due to the negative effects on nonreligious individuals' health in religious contexts.

The Role of Social Context in Racial Disparities in Self-Rated Health

Race disparities in self-rated health in the USA are well-documented, such that African Americans rate their health more poorly than whites. However, after adjusting for health status, socioeconomic status (SES), and health behaviors, residual race differences are observed. This suggests the importance of unmeasured variables. Because African Americans and whites tend to live in differing social contexts, it is possible that accounting for social and environmental conditions may reduce racial disparities in self-rated health. Differences in self-rated health among whites and African Americans were assessed in a low-income, urban integrated community (Exploring Health Disparities in Integrated Communities (EHDIC)) and compared with a national sample (National Health Interview Survey (NHIS)). Controlling for demographics, SES, health insurance, status, and behaviors, African Americans in NHIS had higher odds of reporting fair or poor health (odds ratio [OR] = 1.40, 95% confidence interval [CI] = 1.18-1.66) than whites. In EHDIC, there was no race difference in self-rated health (OR = 0.83, 95% CI = 0.63-1.11). These results demonstrate the importance of social context in understanding race disparities in self-rated health.

Race, Ethnicity, and Self-Rated Health Status in the Behavioral Risk Factor Surveillance System Survey

This study examines the association between race and self-rated health status among Hispanic and non-Hispanic adults in the 2003 Behavioral Risk Factor Surveillance System survey ( N = 241,038). Logistic regression was used to estimate the odds of self-rated health as fair/poor for Hispanic Blacks, Hispanic Whites, and non-Hispanic Blacks as compared with non-Hispanic Whites. This study found that, first, Hispanic Blacks were more likely to rate their health as fair/poor than Hispanic and non-Hispanic Whites, and second, there was no difference between Hispanic and non-Hispanic Blacks. Specifically, when compared with non-Hispanic Whites, Hispanic Blacks and Whites were more likely to report their health as fair/poor. However, this association was stronger for Hispanic Blacks. More careful examination of race among Hispanics is imperative to unmask important health variations.

Self-rated health, objective health, and racial discrimination among African-Americans: Explaining inconsistent findings and testing health pessimism

African-Americans sometimes rate their health as Poor/Fair in the absence of chronic diseases. Theoretically, this lack of correspondence between self-rated health and objective health is due to racial discrimination that results in rating one's health negatively and in terms of social rather than health variables. We tested this Health Pessimism model with 2118 African-Americans. Results revealed that Poor/Fair self-rated health was predicted mostly by objective health for the Low Discrimination group but mostly by demographic variables for the High Discrimination group, in a manner consistent with Health Pessimism. Inconsistencies among prior studies might reflect differences in the prevalence of high discrimination among their samples.

Distinct age and self-rated health crossover mortality effects for African Americans: Evidence from a national cohort study

The predictive effects of age and self-rated health (SRH) on all-cause mortality are known to differ across race and ethnic groups. African American adults have higher mortality rates than Whites at younger ages, but this mortality disparity diminishes with advancing age and may "crossover" at about 75-80 years of age, when African Americans may show lower mortality rates. This pattern of findings reflects a lower overall association between age and mortality for African Americans than for Whites, and health-related mechanisms are typically cited as the reason for this age-based crossover mortality effect. However, a lower association between poor SRH and mortality has also been found for African Americans than for Whites, and it is not known if the reduced age and SRH associations with mortality for African Americans reflect independent or overlapping mechanisms. This study examined these two mortality predictors simultaneously in a large epidemiological study of 12,181 African Americans and 17,436 Whites. Participants were 45 or more years of age when they enrolled in the national REasons for Geographic and Racial Differences in Stroke (REGARDS) study between 2003 and 2007. Consistent with previous studies, African Americans had poorer SRH than Whites even after adjusting for demographic and health history covariates. Survival analysis models indicated statistically significant and independent race*age, race*SRH, and age*SRH interaction effects on all-cause mortality over an average 9-year follow-up period. Advanced age and poorer SRH were both weaker mortality risk factors for African Americans than for Whites. These two effects were distinct and presumably tapped different causal mechanisms. This calls into question the health-related explanation for the age-based mortality crossover effect and suggests that other mechanisms, including behavioral, social, and cultural factors, should be considered in efforts to better understand the age-based mortality crossover effect and other longevity disparities.

Predictive Strength of Self-Rated Health for Mortality Risk Among Older Adults in the United States: Does It Differ by Race and Ethnicity?

Self-rated health (SRH) is widely used to capture racial and ethnic disparities in health. It is therefore critical to understand whether individuals with different racial and ethnic backgrounds assess their SRH differently. Despite the high overall predictive validity of SRH for subsequent mortality, few studies paid attention to potential variations by race and ethnicity. This study examines racial and ethnic differences in the predictive validity of SRH for subsequent mortality risk among older adults (55-84) by estimating Cox Proportional Hazard models using data from the National Health Interview Surveys Linked Mortality Files (1989-2006; N = 289,432). Results indicate that SRH predicts mortality risk less well for non-Hispanic Blacks and Hispanics than non-Hispanic Whites. Three proposed mechanisms-socioeconomic status, immigration status, and cause of death-explain only a modest proportion of the variation. These results suggest that individuals from different racial and ethnic groups may evaluate their heath differently, and thus caution is necessary when using SRH to estimate racial and ethnic health disparities.

Self-Rated Health Across Race, Ethnicity, and Immigration Status for US Adolescents and Young Adults

PURPOSE

Health disparities research seeks to understand and eliminate differences in health based on social status. Self-rated health is often used to document health disparities across racial/ethnic and immigrant groups, yet its validity for such comparative research has not been established. To be useful in disparities research, self-rated health must measure the same construct in all groups, that is, a given level of self-rated health should reflect the same level of mental and physical health in each group. This study asks, Is the relationship between self-rated health and four indicators of health status--body mass index, chronic conditions, functional limitations, and depressive symptoms--similar for adolescents and young adults of different races/ethnicities and immigrant generations?

METHODS

Ordinary least squares regression was used to examine associations of self-rated health with the four indicators of health status both cross-sectionally and longitudinally using four waves of the National Longitudinal Study of Adolescent to Adult Health.

RESULTS

Health indicators explained similar amounts of variance in self-rated health for all racial/ethnic and immigrant generation groups. The cross-sectional association between the health indicators and self-rated health did not vary across groups. The longitudinal association between depressive symptoms and chronic conditions and self-rated health also did not differ across groups. However, an increase in body mass index was associated more negatively with later self-rated health for Asians than for whites or blacks.

CONCLUSIONS

Self-rated health is valid for disparities research in large, population-based surveys of US adolescents and young adults. In many of these surveys self-rated health is the only measure of health.

Baseline Religion Involvement Predicts Subsequent Salivary Cortisol Levels Among Male But not Female Black Youth

BACKGROUND

Compared to Whites, Blacks are exposed to higher levels of chronic stress in the United States. As a result, major Black-White differences exist in the baseline and response of cortisol. Yet, the potential association between baseline religiosity and subsequent cortisol levels of Blacks are not known.

OBJECTIVES

In the current study we aimed to determine the association between baseline religious behaviors and daytime salivary cortisol level among male and female Black youth.

MATERIALS AND METHODS

With a longitudinal design, data came from wave 1 (1994) and wave 6 (2000) of a cohort from an urban area in the Midwest of the United States. The study followed 227 Black adolescents (109 males and 118 females) for six years. Socio-demographics and religious behaviors (frequency of participation in religious activities) were measured at baseline. Base morning cortisol level at wave 6 was the outcome. We fitted a linear regression model to test the association between baseline religiosity at wave 1 and cortisol level at wave 6, while baseline age, socio-economics, and psychological symptoms were controlled.

RESULTS

In the pooled sample, frequency of participation in religious activities at baseline was negatively associated with mean cortisol level at follow up (r = -0.29, P > 0.01) among all, males (r = -0.38, P > 0.01), but not females (r = -.20, P > 0.05). Frequency of participation in religious activities remained a significant predictor of subsequent cortisol level (b = -0.283, 95% CI = -.107 - -0.022) while the effect of age, socioeconomics, and psychological symptoms were controlled. We could only find such an association among male Black youth (b = -0.368, 95% CI = -0.148 - -0.024) but not female Black youth (b = -0.229, 95% CI = -.113 - 0.011).

CONCLUSIONS

Religiosity has been used as a coping mechanism among Blacks. Religiosity may also be related to stress regulation among Black youth. Future studies need to test complex associations between race, sex, religiosity, chronic stress, coping, and function of hypothalamo-pituitary-adrenal (HPA). It is not known whether male Black youth who are and those who are not religious differently cope with stress associated with daily discrimination and living in disadvantaged neighborhoods.

Discrimination in Healthcare Settings is Associated with Disability in Older Adults: Health and Retirement Study, 2008-2012

BACKGROUND

As our society ages, improving medical care for an older population will be crucial. Discrimination in healthcare may contribute to substandard experiences with the healthcare system, increasing the burden of poor health in older adults. Few studies have focused on the presence of healthcare discrimination and its effects on older adults.

OBJECTIVE

We aimed to examine the relationship between healthcare discrimination and new or worsened disability.

DESIGN

This was a longitudinal analysis of data from the nationally representative Health and Retirement Study administered in 2008 with follow-up through 2012.

PARTICIPANTS

Six thousand and seventeen adults over the age of 50 years (mean age 67 years, 56.3 % female, 83.1 % white) were included in this study.

MAIN MEASURES

Healthcare discrimination assessed by a 2008 report of receiving poorer service or treatment than other people by doctors or hospitals (never, less than a year=infrequent; more than once a year=frequent). Outcome was self-report of new or worsened disability by 2012 (difficulty or dependence in any of six activities of daily living). We used a Cox proportional hazards model adjusting for age, race/ethnicity, gender, net worth, education, depression, high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, and healthcare utilization in the past 2 years.

KEY RESULTS

In all, 12.6 % experienced discrimination infrequently and 5.9 % frequently. Almost one-third of participants (29 %) reporting frequent healthcare discrimination developed new or worsened disability over 4 years, compared to 16.8 % of those who infrequently and 14.7 % of those who never experienced healthcare discrimination (p < 0.001). In multivariate analyses, compared to no discrimination, frequent healthcare discrimination was associated with new or worsened disability over 4 years (aHR = 1.63, 95 % CI 1.16-2.27).

CONCLUSIONS

One out of five adults over the age of 50 years experiences discrimination in healthcare settings. One in 17 experience frequent healthcare discrimination, and this is associated with new or worsened disability by 4 years. Future research should focus on the mechanisms by which healthcare discrimination influences disability in older adults to promote better health outcomes for an aging population.

INTERSECTING SELF-REPORTED MOBILITY AND GAIT SPEED TO CREATEA MULTI-DIMENSIONAL MEASURE OF AMBULATION: THE "AMBULATION SPEED-ENDURANCE" (ASE) TYPOLOGY

BACKGROUND

Assessing mobility through readily available and affordable protocols may help advance public health by providing early detection and implementing intervention therapies aimed at mitigating the progression from physiological vitality to disability at older ages. Until now, little attention has been given to how self-reported mobility (SRM) and gait speed can be combined in a categorization scheme.

OBJECTIVES

The specific aim of this report is to introduce the Ambulation Speed-Endurance (ASE) Typology to the literature-a classification system that intersects SRM and gait speed to create a multi-dimensional measure of ambulation.

DESIGN

Cross-sectional.

SETTING

Community-dwelling older adults in the United States.

PARTICIPANTS

Evidence is provided from the National Health and Aging Trends Study (NHATS) that community-dwelling older adults (n=5,403) may be found in each of the ASE Typologies. The discussion is complimented by investigating the cross-sectional predictors of a "Discrepancy Score" (measure of gap between speed and endurance) amongst those with gait speeds < 0.99 m/sec (n=4,521).

RESULTS

Multivariable linear regression results indicate level of severity in speed-endurance discrepancy is higher amongst: non-Latino-Blacks (β=0.48); Latinos (β=0.42); older ages; and lower educated. Models also show that severity in speed-endurance discrepancy is lower amongst: females (β=-0.38); those with higher body mass index; with more chronic health conditions; and poorer self-rated health.

CONCLUSION

Research should continue to investigate how to optimize SRM.

Breaking barriers and building bridges: understanding the pervasive needs of older LGBT adults and the value of social work in health care

Given the rise in the aging population and the increased use of health care services, there is a demand for awareness and training that targets underserved populations such as older lesbian, gay, bisexual, and transgender (LGBT) adults. Older LGBT adults are 5 times less likely to access health care and social services (King, 2009). Ethically responsible health service delivery is needed to capitalize on the strengths and capabilities of older LGBT adults and is vital for combating existing health disparities. Social workers aim to prevent ongoing gaps in care for older LGBT adults that can lead to negative individual and social consequences.

Financial strain and self-rated health among Black adults

OBJECTIVES

To explore associations between financial strain and self-rated health among 1341 black adults.

METHODS

Associations were investigated using a covariate-adjusted linear regression model. Mediation (via stress and/or depressive symptoms) was explored in additional models using a nonparametric bootstrapping procedure.

RESULTS

Higher financial strain was associated with poorer self-rated health (p < .001). Stress and depressive symptoms were each significant mediators of this relation in both single and multiple mediator models (p values < .05).

CONCLUSIONS

Financial strain may contribute to poorer health among black adults, partially via greater stress and depressive symptoms. Potential theoretical, intervention, and policy implications are discussed. Future studies with longitudinal designs are needed to confirm these results.

The pathways from perceived discrimination to self-rated health: an investigation of the roles of distrust, social capital, and health behaviors

Although there has been extensive research on the adverse impacts of perceived discrimination on health, it remains unclear how perceived discrimination gets under the skin. This paper develops a comprehensive structural equation model (SEM) by incorporating both the direct effects of perceived discrimination on self-rated health (SRH), a powerful predictor for many health outcomes, and the indirect effects of perceived discrimination on SRH through health care system distrust, neighborhood social capital, and health behaviors and health conditions. Applying SEM to 9880 adults (aged between 18 and 100) in the 2008 Southeastern Pennsylvania Household Health Survey, we not only confirmed the positive and direct association between discrimination and poor or fair SRH, but also verified two underlying mechanisms: 1) perceived discrimination is associated with lower neighborhood social capital, which further contributes to poor or fair SRH; and 2) perceived discrimination is related to risky behaviors (e.g., reduced physical activity and sleep quality, and intensified smoking) that lead to worse health conditions, and then result in poor or fair SRH. Moreover, we found that perceived discrimination is negatively associated with health care system distrust, but did not find a significant relationship between distrust and poor or fair SRH.

Racial differences in depression in the United States: how do subgroup analyses inform a paradox?

PURPOSE

Non-Hispanic Blacks in the US have lower rates of major depression than non-Hispanic Whites, in national household samples. This has been termed a "paradox," as Blacks suffer greater exposure to social stressors, a risk factor for depression. Subgroup analyses can inform hypotheses to explain this paradox. For example, it has been suggested that selection bias in household samples undercounts depression in Blacks; if selection is driving the paradox, Black-White differences should be most pronounced among young men with low education.

METHODS

We examined Black-White differences in lifetime major depression in subgroups defined simultaneously by sex, age, and education using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and the Collaborative Psychiatric Epidemiology Surveys (CPES).

RESULTS

In NESARC and CPES, Blacks had lower odds than Whites of lifetime major depression in 21 and 23 subgroups, respectively, of 24. All statistically significant differences were in subgroups favoring Blacks, and lower odds in Blacks were more pronounced among those with more education.

CONCLUSIONS

These results suggest that hypotheses to explain the paradox must posit global mechanisms that pertain to all subgroups defined by sex, age, and education. Results do not lend support for the selection bias hypothesis.

Is self-rated health comparable between non-Hispanic whites and Hispanics? Evidence from the health and retirement study

OBJECTIVES

Using subsequent all-cause mortality as a yardstick for retrospective health, this study assessed the comparability of self-rated health (SRH) between non-Hispanic whites and Hispanics.

METHODS

Based on longitudinal data from 6,870 white and 886 Hispanic respondents aged between 51 and 61 in the 1992 Health and Retirement Study, we related SRH in 1992 to risk of mortality in the 1992-2008 period. Logit models were used to predict white-Hispanic differences in reporting fair or poor SRH. Survival curves and cox proportional hazard models were estimated to assess whether and the extent to which the SRH-mortality association differs between non-Hispanic whites and Hispanics.

RESULTS

Hispanic respondents reported worse SRH than whites at the baseline, yet they had similar risk of mortality as whites in the 1992-2008 period. Overall, Hispanics rated their health more pessimistically than whites. This was especially the case for Hispanics who rated their health fair or poor at the baseline, whereas their presumed health conditions, as reflected by subsequent risk of mortality, should be considerably better than their white counterparts.

DISCUSSION

Health disparities between whites and Hispanics aged between 51 and 61 will be overestimated if the assessment has been solely based on differences in SRH between the two groups. Findings from this study call for caution in relying on SRH to quantify and explain health disparities between non-Hispanic whites and Hispanics in the United States.

The influence of ethnicity and gender on the association between measured obesity and cardiorespiratory fitness with self-rated overweight, physical activity and health

BACKGROUND

Little is known about how ethnicity may influence how self-rated physical activity (PA) and obesity relates to measured obesity, cardiorespiratory fitness and self-rated health.

AIMS

To examine the influence of ethnicity on the association between: (1) self-rated and measured obesity; (2) self-reported PA and cardiorespiratory fitness; and (3) obesity and PA with self-rated health.

METHODS

Data from NHANES 1999-2004 (2,981 adults) was used.

RESULTS

Compared to white and overweight black men, Hispanic men were less likely to consider themselves overweight (OR = 0.36-0.56). Compared to white men, black active men were more likely to report being more active than their peers (OR = 1.44) but were less likely to be fit (OR = 0.74). Black active women and non-white overweight women were less likely to self-rate as having very good or excellent health as compared to white women with similar self-reported and measured health factors.

CONCLUSIONS

Ethnicity and gender influence how self-rated and measured health factors interrelate.

Theory-guided selection of discrimination measures for racial/ ethnic health disparities research among older adults

OBJECTIVE

Discrimination may contribute to health disparities among older adults. Existing measures of perceived discrimination have provided important insights but may have limitations when used in studies of older adults. This article illustrates the process of assessing the appropriateness of existing measures for theory-based research on perceived discrimination and health.

METHOD

First, we describe three theoretical frameworks that are relevant to the study of perceived discrimination and health-stress-process models, life course models, and the Public Health Critical Race (PHCR) praxis. We then review four widely-used measures of discrimination, comparing their content and describing how well they address key aspects of each framework, and discussing potential areas of modification.

DISCUSSION

Using theory to guide measure selection can help improve understanding of how perceived discrimination may contribute to racial/ethnic health disparities among older adults.

The association between parent's health and the educational attainment of their children

In this paper we compare the educational attainment of adults who had relatively unhealthy parents when they were adolescents to those whose parents were relatively healthy during this time of their lives. We use data from the National Longitudinal Study of Adolescent Health (n = 13,556) to show that U.S. adolescents whose parents described their health as "fair" or "poor" at Wave 1 of the study were more likely to drop out of high school compared to those whose parents reported better levels of health. We do not observe any association between parental health and the likelihood of attending college among those who graduated from high school, however we do show that completing college (among college attendees) is more likely among those whose parents reported better health when they were adolescents. This association persists despite a wide range of statistical controls including socioeconomic status of the household, the physical and mental health status of the respondent, the grade point average of the respondent, the health behaviors of parents, as well as parental time investment. These findings add an important intergenerational component to research on the relationship between socioeconomic status and health.

Adherence to a community-based exercise program is a strong predictor of improved back pain status in older adults: an observational study

OBJECTIVES

To identify factors that were predictive of improved pain status among older adults with chronic back pain participating in the Adaptive Physical Activity (APA) program and to identify factors that were predictive of adherence to APA.

METHODS

An observational cohort study of 392 older adults (ages 50 to 88) with chronic back pain participating in APA for 12 months. APA was a community-based group exercise program given for 1-hour, twice weekly, in local gyms. Primary outcome measures were improved pain based on a global rating of change evaluation and adherence to the APA program (defined as participation in >75% of exercise sessions). Potential predictor variables were entered into multivariate logistic regression models to determine the most accurate set of variables for predicting improved pain and adherence.

RESULTS

Presence of depressive symptoms, poor self-rated health and adherence to APA were the best predictors of improved pain status, with adherence being the strongest predictor [odds ratio: 13.88 (95% confidence interval: 8.17, 23.59)]. Better physical function, longer pain duration, and positive rating of the trainer were all positively associated with adherence to APA; whereas poor self-rated health and further distance from the gym were inversely associated.

CONCLUSIONS

Given that adherence to APA is the key predictor of improved back pain, future efforts should focus on strategies to improve adherence. Our data suggest that enhanced training of exercise trainers, development of separate classes for people with different functional levels, and use of psychosocial interventions to reduce health pessimism and depression may be potential targets for improving adherence.

Exploring differences in self-rated health among Blacks, Whites, Mexicans, and Puerto Ricans

OBJECTIVES

Self-rated health (SRH) is a robust predictor of subsequent health and mortality. Although age, gender, and race differences in SRH have been explored, less work has examined ethnic differences, particularly in the US.

DESIGN

The current study uses representative data from six Chicago communities to compare levels and determinants of fair-poor health for Blacks, Whites, Mexicans, and Puerto Ricans (n=1311).

RESULTS

Mexicans and Puerto Ricans were at least three times more likely to report fair or poor health than Whites, while African-Americans were over twice as likely. In adjusted logistic regression models, only Mexicans remain significantly more likely to report fair-poor health than Whites (OR = 4.3, CI = 1.8-9.8). However, this effect disappears when controlling for acculturation. No variable predicted poor subjective health for all groups, though depression was associated with poor health for most.

CONCLUSION

Together, these analyses suggest that the single item measure of SRH might not be appropriate for comparing health status across members of different race/ethnic groups. More research is needed to understand what factors influence how an individual perceives his or her health.

Discrepancies in the concordance of self-reported vision status and visual acuity in the Salisbury Eye Evaluation Study

PURPOSE

To examine the association between self-rated vision and distance visual acuity by race and other factors.

DESIGN

Cross-sectional analysis within a longitudinal, population-based cohort study.

PARTICIPANTS AND CONTROLS

Two thousand five hundred twenty individuals, 65 to 84 years of age, including 666 black participants and 1854 white participants.

METHODS

All participants reported their self-rated vision score. Binocular distance visual acuity was assessed. Based on the level of visual acuity and the self-reported vision score, participants were placed into concordant and discrepant groups.

MAIN OUTCOME MEASURES

Multinomial logistic regression models were used to examine the characteristics associated with concordant and discrepant groups.

RESULTS

Black participants were more likely to be represented in the discordant group that reported good vision but had acuity worse than 20/40. In the multivariate analysis, a per-year decrement in years of education received increased the odds of being in both discrepant groups, one that reported good vision but had a visual acuity worse than 20/40 (odds ratio, 1.21; P<0.0001) and the other discrepant group that reported bad vision but had a visual acuity of 20/40 or better (odds ratio, 1.04; P<0.0001). A per-year decrement in years of education received also seemed to explain the excess risk of black race in the discrepant group that reported good vision but had a visual acuity worse than 20/40.

CONCLUSIONS

Given the socioeconomically driven discrepancies in self-reported vision status, self-reported vision status should be used cautiously in surveillance surveys, especially when assessing vision inequalities between socioeconomic groups.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Does self-reported health bias the measurement of health inequalities in U.S. adults? Evidence using anchoring vignettes from the Health and Retirement Study

OBJECTIVES

Measurement of health inequalities based on self-reports may be biased if individuals use response scales in systematically different ways. We use anchoring vignettes to test and adjust for reporting differences by education, race/ethnicity, and gender in self-reported health in 6 domains (pain, sleep, mobility, memory, shortness of breath, and depression).

METHOD

Using data from the 2006 U.S. Health and Retirement Study (HRS) and the 2007 Disability Vignette Survey, we estimated generalized ordered probit models of the respondent's rating of each vignette character's health problem, allowing cut-points to vary by age, gender, education, and race/ethnicity. We then used one-step hierarchical ordered probit (HOPIT) models to jointly estimate the respondent's cut-points from the vignettes and the severity of the respondent's own health problems based on these vignette cut-points.

RESULTS

We found strong evidence of reporting differences by age, gender, education, and race/ethnicity, with the magnitude depending on the specific health domain. Overall, traditional models not accounting for reporting differences underestimated the magnitude of health inequalities by education and race/ethnicity.

DISCUSSION

These results suggest caution in relying on self-reported health measures to quantify and explain health disparities by socioeconomic status and race/ethnicity/ethnicity in the United States. The findings support expansion of the use of anchoring vignettes to properly account for reporting differences in self-reports of health.

Health Subjectivities and Labor Market Participation

Decisions around retirement and continued labor market participation are of great significance for those who make them, as well as policy makers, researchers, welfare states, and pension programs. The literature acknowledges the multifaceted nature of these choices and particularly the interaction of key variables—job satisfaction, financial status, caring responsibilities, spouse’s plans, and health. This article explores this latter factor, challenging assumptions that it can be treated as an unproblematic independent variable. Analyzing qualitative data from interviews with 96 people approaching or in the midst of retirement, the subjective experience of health and its effect on decisions was strongly evident. The socialized context—as shaped at societal, organizational, household, and individual-life-historical levels—was crucial in understanding how similar symptoms of morbidity resulted in widely varying decisions/outcomes. Direct interpersonal experiences, shaped by social structures, were useful in explaining the prevalence of health pessimism, despite general increases in life expectancy.

Stress trajectories, health behaviors, and the mental health of black and white young adults

This paper uses data from the National Longitudinal Study of Adolescent Health to examine the mental health of non-Hispanic black and white young adults in the US. We use latent growth curve modeling to characterize the typical stress trajectories experienced by black and white young adults spanning the bulk of their lives. We identify the following four stress trajectories: 1) relatively stress free; 2) stress peak at age 15 and a subsequent decline; 3) stress peak at age 17 and a subsequent decline; and 4) a moderately high chronic stress. Results indicate that black adolescents have significantly higher risk of being in all three of the stressful classes compared to white adolescents. Stress exposure is strongly associated with depression and the race differences in stress profiles account for a modest amount of the observed race differences in mental health. We do not observe any race differences in behavioral responses to stressors; black youth are no more likely than white youth to engage in poor health behaviors (e.g., smoking, drinking, or obesity) in response to stress. We provide tentative support for the notion that poor health behaviors partially reduce the association between stress and depression for blacks but not whites. These findings contribute to unresolved issues regarding mental and physical health disparities among blacks and whites.

Racial differences in the association between self-rated health status and objective clinical measures among participants in the BARI 2D trial

OBJECTIVES

We explored whether and how race shapes perceived health status in patients with type 2 diabetes mellitus and coronary artery disease.

METHODS

We analyzed self-rated health (fair or poor versus good, very good, or excellent) and associated clinical risk factors among 866 White and 333 Black participants in the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial.

RESULTS

Michigan Neuropathy Screening Instrument scores, regular exercise, and employment were associated with higher self-rated health (P < .05). Blacks were more likely than were Whites to rate their health as fair or poor (adjusted odds ratio [OR] = 1.88; 95% confidence interval [CI] = 1.38, 2.57; P < .001). Among Whites but not Blacks, a clinical history of myocardial infarction (OR = 1.61; 95% CI = 1.12, 2.31; P < .001) and insulin use (OR = 1.62; 95% CI = 1.10, 2.38; P = .01) was associated with a fair or poor rating. A post-high school education was related to poorer self-rated health among Blacks (OR = 1.86; 95% CI = 1.07, 3.24; P < .001).

CONCLUSIONS

Symptomatic clinical factors played a proportionally larger role in self-assessment of health among Whites with diabetes and coronary artery disease than among Blacks with the same conditions.

Racial differences in self-rated health at similar levels of physical functioning: an examination of health pessimism in the health, aging, and body composition study

BACKGROUND

The health pessimism hypothesis suggests that Black elders are more pessimistic about health than Whites and therefore tend to report lower self-rated health (SRH) at comparable health status. The current analysis examined the factors associated with SRH and tested the health pessimism hypothesis among older adults at similar levels of physical functioning.

METHODS

The study example included 2,729 Health, Aging, and Body Composition study participants aged 70-79 years. We used hierarchical logistic regression to examine the association between race and SRH while adjusting for demographic, physical health, and psychosocial factors. The analyses were repeated for participants at similar levels of objective functioning to test the health pessimism hypothesis.

RESULTS

The association between race and SRH remained independent of physical and psychosocial health variables, with Whites being 3.7 times more likely than Black elders to report favorable SRH. This association was significant at each level of physical functioning and greater at the higher (odds ratio [OR] = 5.5) versus lower (OR = 2.2) levels of functioning.

CONCLUSIONS

The results suggest greater health pessimism among Black elders and expand previous work by including objective functioning in multidimensional models to deconstruct race variations in the SRH of older adults.

Self-rated health and race among Hispanic and non-Hispanic adults

OBJECTIVE

To investigate the association between race and self-rated health among Hispanics and non-Hispanics using data from the National Health Interview Survey 2000-2003.

METHODS

This analysis was limited to Hispanic and non-Hispanic whites and blacks > or =18 years of age. The outcome was self-rated health. The main independent variable was race/ethnicity, and potential confounders included sociodemographic characteristics, access to care, health behaviors, and comorbidities.

RESULTS

Non-Hispanic blacks exhibited the highest prevalence of fair/poor self-rated health compared to their white counterparts. In the adjusted analyses, compared to non-Hispanic whites, non-Hispanic blacks (OR: 1.21; 95% CI: 1.16-1.43), Hispanic whites (OR: 1.32; 95% CI: 1.14-1.52) and blacks (OR: 2.19; 95% CI: 1.07-4.49) were more likely to rate their health as fair/poor. There was no difference in self-rated health between Hispanic and non-Hispanic blacks.

DISCUSSION

This study underscores the importance of accounting for the racial heterogeneity among Hispanics when presenting health data. Ignoring race could mask health variations among Hispanics.

Religiousness and Longitudinal Trajectories in Elders' Functional Status

The purpose of this study was to examine the effects of religiousness on the trajectories of difficulties with activities of daily living (ADLs) and instrumental ADLs (IADLs) in community-dwelling older adults over a three-year period. Seven waves of data from the University of Alabama at Birmingham Study of Aging were analyzed using a hierarchical linear modeling method. The study was based on the 784 participants who completed interviews every six months between December 1999 and February 2004. Frequent religious service attendance was associated with fewer ADL difficulties and IADL difficulties at baseline. Furthermore, religious service attendance predicted slower increases for frequent churchgoers and steeper increases for less frequent churchgoers in IADL difficulties, controlling for variables related to demographics and resources. Religious service attendance was independently associated with ADL and IADL difficulties cross-sectionally. However, significant protective effects of religious service attendance were identified longitudinally only for the IADL trajectory.

Self-rated health appraisal as cultural and identity process: African American elders' health and evaluative rationales

PURPOSE

We explored self-rated health by using a meaning-centered theoretical foundation. Self-appraisals, such as self-rated health, reflect a cultural process of identity formation, whereby identities are multiple, simultaneously individual and collective, and produced by specific historical formations. Anthropological research in Philadelphia determined (a) how African American elders appraise their health, and (b) how health evaluations reflect cultural and historical experiences within a community.

DESIGN AND METHODS

We interviewed and observed 35 adults aged 65 to 80, stratified by gender and self-rated health. We validated theme analysis of focused interview questions against the larger data set of field notes and transcripts.

RESULTS

Health appraisal reflected a complex process of adaptation and identity. Criteria for health included: independent functioning, physical condition, control and responsibility for health, and overall feeling. Evaluative rationales that shaped health appraisals were comparisons, restricted possibilities for self-evaluation, and ways of handling adversity. Evaluative rationales mitigated undesirable health identities (including low self-reported health) and provided mechanisms for claiming desired health identities despite adversity.

IMPLICATIONS

Describing the criteria and evaluative rationales underlying self-appraisals of health extends current understandings of self-rated health and illustrates the sociohistorical context of individual assessments of well-being.

Health status, activity limitations, and disability in work and housework among Latinos and non-Latinos with arthritis: an analysis of national data

OBJECTIVE

To document disparities in health status, activity limitations, and disability in work and housework between Latinos and non-Latino whites with arthritis. We examined whether sociodemographic factors (age, income, and education) account for the disparities between the ethnic groups, and whether comorbid conditions, disease duration, health care utilization, and functional abilities predict health status, activity limitations, and work and housework disability after controlling for sociodemographic variables.

METHODS

We analyzed data from the Condition file of the 1994 National Health Interview Survey on Disability, Phase I.

RESULTS

The risk of worse health, activity limitations, and work and housework disability was >2 times greater among Latinos compared with non-Latino whites. In the regression models accounting for potential confounders, Latino ethnicity remained significantly associated with poorer health status, but not activity limitations or disability in work or housekeeping. Of the socioeconomic status variables, education had a significant protective effect on work disability and health status. Comorbid conditions and health care utilization increased the likelihood of worse health, activity limitations, and work disability. Limitations in physical function were associated with poorer health and disability in work and homemaking.

CONCLUSION

Social status differences between Latinos and non-Latinos may account for disparities in activity limitations and disability in work and housework. Education may provide various health benefits, including access to a range of occupations that do not require physical demands. The findings help to address the great gap in knowledge concerning factors related to the health and disability status of Latinos with arthritis.

A systematic review of empirical research on self-reported racism and health

This paper reviews 138 empirical quantitative population-based studies of self-reported racism and health. These studies show an association between self-reported racism and ill health for oppressed racial groups after adjustment for a range of confounders. The strongest and most consistent findings are for negative mental health outcomes and health-related behaviours, with weaker associations existing for positive mental health outcomes, self-assessed health status, and physical health outcomes. Most studies in this emerging field have been published in the past 5 years and have been limited by a dearth of cohort studies, a lack of psychometrically validated exposure instruments, poor conceptualization and definition of racism, conflation of racism with stress, and debate about the aetiologically relevant period for self-reported racism. Future research should examine the psychometric validity of racism instruments and include these instruments, along with objectively measured health outcomes, in existing large-scale survey vehicles as well as longitudinal studies and studies involving children. There is also a need to gain a better understanding of the perception, attribution, and reporting of racism, to investigate the pathways via which self-reported racism affects health, the interplay between mental and physical health outcomes, and exposure to intra-racial, internalized, and systemic racism. Ensuring the quality of studies in this field will allow future research to reveal the complex role that racism plays as a determinant of population health.