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

Socioeconomic inequalities in self-assessed health and food consumption: the mediating roles of daily hassles and the perceived importance of health

BACKGROUND

Urgent daily hassles, which are more common among people with a lower socioeconomic position (SEP), might limit one's ability to address less pressing goals, such as goals related to health promotion. Consequently, health goals may be viewed as less focal, which could jeopardize one's health. This study examined an understudied pathway: whether a higher severity of daily hassles resulted in a lower perceived importance of health and whether these two factors sequentially mediate socioeconomic inequalities in self-assessed health (SAH) and food consumption.

METHODS

A cross-sectional survey among 1,330 Dutch adults was conducted in 2019. Participants self-reported SEP (household income, educational level), the severity of eleven daily hassles (e.g., financial hassles, legal hassles), the perceived importance of health (not being ill, living a long life), SAH, and food consumption. Structural equation modeling was used to examine whether daily hassles and the perceived importance of health sequentially mediated income and educational inequalities in SAH, fruit and vegetable consumption (FVC) and snack consumption.

RESULTS

No evidence of sequential mediation through daily hassles and the perceived importance of health was found. Daily hassles individually mediated income inequalities in SAH (indirect effect: 0.04, total effect: 0.06) and in FVC (indirect effect: 0.02, total effect: 0.09). The perceived importance of not being ill and living a long life both individually mediated educational inequalities in SAH (indirect effects: 0.01 and -0.01, respectively, total effect: 0.07).

CONCLUSIONS

Income inequalities in SAH and FVC were explained by daily hassles, and educational inequalities in SAH were explained by the perceived importance of health. Socioeconomic inequalities may not be sequentially explained by a more severe experience of daily hassles and a lower perceived importance of health. Interventions and policies addressing challenging circumstances associated with a low income may improve SAH and healthy food consumption among lower-income groups.

Changes in Perceived Stress After Yoga, Physical Therapy, and Education Interventions for Chronic Low Back Pain: A Secondary Analysis of a Randomized Controlled Trial

OBJECTIVE

Perceived stress and musculoskeletal pain are common, especially in low-income populations. Studies evaluating treatments to reduce stress in patients with chronic pain are lacking. We aimed to quantify the effect of two evidence-based interventions for chronic low back pain (cLBP), yoga and physical therapy (PT), on perceived stress in adults with cLBP.

METHODS

We used data from an assessor-blinded, parallel-group randomized controlled trial, which recruited predominantly low-income and racially diverse adults with cLBP. Participants (N = 320) were randomly assigned to 12 weeks of yoga, PT, or back pain education. We compared changes in the 10-item Perceived Stress Scale (PSS-10) from baseline to 12- and 52-week follow-up among yoga and PT participants with those receiving education. Subanalyses were conducted for participants with elevated pre-intervention perceived stress (PSS-10 score ≥17). We conducted sensitivity analyses using various imputation methods to account for potential biases in our estimates due to missing data.

RESULTS

Among 248 participants (mean age = 46.4 years, 80% nonwhite) completing all three surveys, yoga and PT showed greater reductions in PSS-10 scores compared with education at 12 weeks (mean between-group difference = -2.6, 95% confidence interval [CI] = -4.5 to -0.66, and mean between-group difference = -2.4, 95% CI = -4.4 to -0.48, respectively). This effect was stronger among participants with elevated pre-intervention perceived stress. Between-group effects had attenuated by 52 weeks. Results were similar in sensitivity analyses.

CONCLUSIONS

Yoga and PT were more effective than back pain education for reducing perceived stress among low-income adults with cLBP.

Associations between Amygdala-Prefrontal Functional Connectivity and Age Depend on Neighborhood Socioeconomic Status

Although severe early life stress has been shown to accelerate the development of frontolimbic resting-state functional connectivity (RSFC), less is known about the effects of socioeconomic disadvantage, a prolonged and multifaceted stressor. In a cross-sectional study of 127 participants aged 5–25, we examined whether lower neighborhood socioeconomic status (SES; measured by Area Deprivation Index and neighborhood poverty and educational attainment) was associated with prematurely reduced amygdala-ventromedial prefrontal cortex (vmPFC) RSFC. We further tested whether neighborhood SES was more predictive than household SES and whether SES effects on connectivity were associated with anxiety symptoms. We found reduced basolateral amygdala-vmPFC RSFC at earlier ages in participants from more disadvantaged neighborhoods; this effect was unique to neighborhood SES and absent for household SES. Furthermore, this reduced connectivity in more disadvantaged youth and increased connectivity in more advantaged youth were associated with less anxiety; children who deviated from the connectivity pattern associated with their neighborhood SES had more anxiety. These results demonstrate that neighborhood socioeconomic disadvantage is associated with accelerated maturation of amygdala-vmPFC RSFC and suggest that the pathophysiology of pediatric anxiety depends on a child’s neighborhood socioeconomic characteristics. Our findings also underscore the importance of examining SES effects in studies of brain development.

Predictors of Alcohol Use in Safety-Net Primary Care: Classism, Religiosity, and Race

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.

Psychometric properties and norm scores of the sleep self report in Dutch children

BACKGROUND

Psychometrically robust questionnaires to assess self-reported sleep problems in children are important since sleep problems can have a major impact on child development. The Sleep Self Report (SSR) is a 26-item self-report tool measuring different sleep domains in children aged 7-12 years. This study aims to evaluate the psychometric properties of the SSR and to provide Dutch norm scores.

METHODS

Children aged 7-12 years from the general population were recruited through a professional market research agency. In this population, structural validity was assessed with confirmatory and exploratory factor analyses, internal consistency was assessed with the Cronbach's alpha coefficient and norm scores were provided. Additionally, children attending outpatient sleep clinics (clinical population) were invited to participate. SSR scores of the general population and the clinical population were compared to establish discriminative validity.

RESULTS

In total, 619 children (mean age: 9.94 ± 1.72 years) from the general population and 34 children (mean age: 9.21 ± 1.63 years) from sleep clinics participated. The 1-factor structure of the SSR was not confirmed with factor analysis. Exploratory analyses did also not yield an appropriate multidimensional structure. Internal consistency of the total score was adequate (Cronbach's alpha: 0.76). The total score distinguished the clinical population from the general population (39.07 ± 5.31 versus 31.61 ± 5.31; P < 0.01).

CONCLUSIONS

An appropriate structure of the SSR was not found with factor analyses in this Dutch population. The adequate internal consistency indicates that the total score can be interpreted as a measure of overall sleep problems. The SSR also shows good discriminative validity. We recommend the total score to assess overall sleep problems and item scores to evaluate specific sleep issues and to follow up children's sleep longitudinally, as opposite changes in different item scores may not reflect in the total score. Further research on the development of multidimensional psychometrically sound pediatric sleep self-reports is of major importance.

Protective psychosocial factors and dental caries in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Psychosocial protective factors include dispositional and family attributes that may reduce the occurrence of dental caries.

AIM

This review analysed the evidence on the relationship between protective psychosocial factors and dental caries in children and adolescents.

DESIGN

Primary studies involving children and adolescents were searched in the following electronic databases: Medline, SCOPUS, LILACS, SciELO, and Web of Science. The reference lists were also screened. Protective psychosocial factor descriptors were in accordance with the salutogenic theory. The outcome was clinical measure of dental caries. Quality assessments were performed using the Newcastle-Ottawa scale.

RESULTS

The final search resulted in 35 studies, including 7 cohort, one case-control, and 27 cross-sectional studies. Most studies were of moderate quality. Meta-analyses revealed that low parental internal locus of control (cohort studies: OR = 1.42, 95% CI: 1.20-1.64; cross-sectional studies: OR = 1.30, 95% CI: 1.19-1.41), high parental external chance (OR = 1.20, 95% CI: 1.10-1.29), and high maternal sense of coherence (OR = 0.77, 95% CI: 0.62-0.93) were associated with dental caries in children. High social support (OR = 0.81, 95% CI: 0.68-0.93) and greater self-efficacy (OR = 1.50, 95% CI: 1.12-1.22) were also associated with dental caries in adolescents.

CONCLUSIONS

The current evidence suggests that some salutogenic factors are important protective factors of dental caries during childhood and adolescence.

Associations between psychological stress and smoking, drinking, obesity, and high blood pressure in an upper middle-income country in the African region

The direction and magnitude of the associations between cardiovascular risk factors (CVRFs) and psychological stress continue to be debated, and no data are available from surveys in the African region. In this study, we examine the associations between CVRFs and psychological stress in the Seychelles, a rapidly developing small island state in the African region. A survey was conducted in 1,240 adults aged 25-64 years representative of the Seychelles. Participants were asked to rank psychological stress that they had experienced during the past 12 months in four domains: work, social life, financial situation, and environment around home. CVRFs (high blood pressure, tobacco use, alcohol drinking, and obesity) were assessed using standard procedures. Psychological stress was associated with age, sex, and socioeconomic status. Overall, there were only few consistent associations between psychological stress and CVRFs, adjusting for age, sex, and socioeconomic status. Social stress was associated with smoking, drinking, and obesity, and there were marginal associations between stress at work and drinking, and between financial stress, and smoking and drinking. Psychological stress was not associated with high blood pressure. These findings suggest that psychological stress should be considered in cardiovascular disease prevention and control strategies.

Organizational downsizing and alcohol use: A national study of U.S. workers during the Great Recession

Organizational downsizing, which represents the reduction of an organization's workforce, results in a stressful work environment for those who survive the downsizing. However, we know little about the association between surviving an organizational downsizing and employee alcohol use. This study explored the association between exposure to organizational downsizing and four dimensions of alcohol use during the Great Recession. Also explored were the moderating influences of length of recession exposure, state drinking culture, gender, age, education, family income, and financial demands. Data for this study came from a national telephone survey of U.S. workers that was conducted from December 2008 to April 2011 (N=2296). The results revealed that exposure to organizational downsizing was positively associated with usual frequency of drinking, number of drinks consumed per usual drinking occasion, and both the frequency of binge drinking and drinking to intoxication. Length of exposure to the recession moderated the association between organizational downsizing exposure and usual number of drinks consumed. The conditional effects revealed that this association became stronger as length of exposure to the recession increased. Furthermore, age moderated the associations between organizational downsizing exposure and the usual number of drinks consumed and the frequency of binge drinking and intoxication. The conditional effects revealed that these associations were positive and significant among young survivors (ages 40 or younger), but were nonsignificant among middle-aged survivors (over 40years of age). State drinking culture, gender, education, family income, and financial demands did not moderate the associations between organizational downsizing exposure and alcohol use.

The mediating effect of effort-reward imbalance in household and family work on the relationship between education and women's health

Occupational stress as a key determinant for explaining health inequalities has been well established while the impact of stress related to family work has rarely been considered. This study investigates whether stress in household and family work may contribute to health inequalities in women. We used a population-based sample of German mothers (n = 3129) to determine the total, direct and indirect effects of education on somatic complaints by means of OLS regression-based mediation models. Inference about indirect effects was determined by 95% bias corrected bootstrap confidence intervals. Education was assessed by a measure combining school education and vocational training. Stress was measured using the adopted effort-reward-imbalance (ERI) questionnaire for household and family work. The von Zerssen list of somatic complaints was used as measure of subjective health. We found a significant total effect of education on somatic complaints (p ≤ 0.001) as well as significant indirect effects through 'effort' (p = 0.006) and 'reward' in household and family work (p ≤ 0.001). However, the subscales of ERI pointed into different directions: while levels of 'effort' increased with women's educational attainment, levels of distress related to low 'reward' decreased with higher levels of education. Our findings suggest that the effect of women's education on somatic complaints is mediated through stress related to low reward for household and family work. In particular, lack of 'societal esteem' for household and family work contributed to health disadvantages in lower educated mothers. We conclude that research on health inequality would benefit from taking stressful experiences in household and family work greater into account.

[Musculoskeletal pain and occupational vulnerability in municipal public sector workers in Belo Horizonte, Brazil]

This article seeks to describe the profile of workers in the municipal public sector in relation to the occurrence of self-reported musculoskeletal pain (MSP). In 2009, a cross-sectional study was conducted in Belo Horizonte that assessed sociodemographic characteristics, functional health status, habits and quality of life, through a self-applied questionnaire. We used the Grade of Membership method (GoM) to define the profiles and the degree of belonging to each particular profile. Three reference profiles were identified: worker with pain; worker without pain, non-respondents. Given the reference profiles, the typology of association between work and self-reported occurrence of MSP classified 89.9% of the sample. The typology was organized into five profiles: mixed (4.1%); sick worker (12.0%); worker more vulnerable to MSP (16.9%); worker less vulnerable to MSP (22.6%); healthy worker (34.3%). The analysis made it possible to clarify the connections between MSP and the physical and psychosocial factors at work in the municipal public service, indicating avenues for further reflection on the inequities in musculoskeletal health and occupational vulnerability.

How can inequalities in mortality be reduced? A quantitative analysis of 6 risk factors in 21 European populations

BACKGROUND

Socioeconomic inequalities in mortality are one of the greatest challenges for health policy in all European countries, but the potential for reducing these inequalities is unclear. We therefore quantified the impact of equalizing the distribution of six risk factors for mortality: smoking, overweight, lack of physical exercise, lack of social participation, low income, and economic inactivity.

METHODS

We collected and harmonized data on mortality and risk factors by educational level for 21 European populations in the early 2000s. The impact of the risk factors on mortality in each educational group was determined using Population Attributable Fractions. We estimated the impact on inequalities in mortality of two scenarios: a theoretical upward levelling scenario in which inequalities in the risk factor were completely eliminated, and a more realistic best practice scenario, in which inequalities in the risk factor were reduced to those seen in the country with the smallest inequalities for that risk factor.

FINDINGS

In general, upward levelling of inequalities in smoking, low income and economic inactivity hold the greatest potential for reducing inequalities in mortality. While the importance of low income is similar across Europe, smoking is more important in the North and East, and overweight in the South. On the basis of best practice scenarios the potential for reducing inequalities in mortality is often smaller, but still substantial in many countries for smoking and physical inactivity.

INTERPRETATION

Theoretically, there is a great potential for reducing inequalities in mortality in most European countries, for example by equity-oriented tobacco control policies, income redistribution and employment policies. Although it is necessary to achieve substantial degrees of upward levelling to make a notable difference for inequalities in mortality, the existence of best practice countries with more favourable distributions for some of these risk factors suggests that this is feasible.

Do stressful events account for the link between socioeconomic status and mental health?

BACKGROUND

The purpose of this study was to prospectively examine the relationships between socioeconomic status (SES), demographic variables and mental health and to determine whether number of life stressors mediated these relationships.

METHODS

Wave 1 (2001-02) and 2 (2004-05) data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n = 34,459) were used in the current study. Controlling for wave 1 mental health, a mediation model was tested to determine the relative impact of socioeconomic and demographic variables (all measured at wave 1) on mental health 3 years later (wave 2). The number of life stressors experienced in the 12 months prior to wave 1, assessed at wave 1, was evaluated as the mediator.

RESULTS

Findings indicated that SES, age, race/ethnicity, gender and marital status independently predicted changes in mental health ratings at wave 2. In addition, the number of life stressors mediated the relation between socioeconomic and demographic variables and mental health. Exposure to life stressors helps to explain commonly reported socioeconomic and demographic disparities in mental health.

CONCLUSIONS

Findings may suggest that reducing exposure to stressors and/or improving coping with life stressors may both improve mental health and reduce health disparities.

Perceived discrimination and psychological distress among Asian Americans: does education matter?

Using data from the National Latino and Asian American Study, this work examines if and how perceived everyday discrimination is associated with psychological distress among Asian Americans and whether this association varies by important structural factors as education and place of education. Findings reveal that perception of discrimination is associated with increased levels of psychological distress. Most importantly, education moderates the discrimination-distress association such that the detrimental effect of discrimination is stronger for Asian Americans with college or more levels of education than for Asian Americans with less than college levels of education. Place of education further conditions the moderating effect of education: The foreign-educated Asian Americans with higher levels of education are affected most negatively by discrimination compared to others. This study highlights (1) the significant joint role of education and place of education in conditioning the relationship between perceived discrimination and psychological distress, and (2) unique features of education in improving our understanding of Asian Americans' mental health.

Can negative life events and coping style help explain socioeconomic differences in perceived stress among adolescents? A cross-sectional study based on the West Jutland cohort study

Background

Previous research suggests that perceived stress in adolescence is socially patterned, but that this relationship may depend on the measure of socioeconomic status (SES) used. This study examines if social gradients in perceived stress, negative life events, and coping exist amongst Danish adolescents, and, if life events and coping strategies can partly account for an association between SES and perceived stress. These relationships are studied separately for two different measures of SES.

Methods

Questionnaire data were collected from 3054 14–15 year old youths (83% response rate) during baseline measurement in the West Jutland birth cohort study. Parents were identified via the Central Office of Civil Registration in which the respondents are linked to their parents or guardians via their CPR-number, a personal identification number given to everyone in Denmark. The study employs data from two independent sources, adolescent self-report data (stress, life events and coping) and national registers (parental educational level, household income and confounder variables). Ordinary Least Squares regression estimated the effects of parental SES, negative life events and coping on perceived stress. Analyses were stratified by gender.

Results

Girls reported more perceived stress than boys. SES accounted for a small but significant amount of the variance in perceived stress. Lower parental education and lower household income were associated with higher stress levels irrespective of gender, but the social gradient was strongest amongst girls when parents’ education was used to measure SES, and strongest for boys when income was used. Life events and coping were also found to be associated with SES and both mediated part of the SES-perceived stress relationship. In general, the social gradient in perceived stress was accounted for by the study variables to a higher degree among girls than among boys.

Conclusions

Lower parental education and household income are associated with higher levels of perceived stress amongst Danish adolescents. Furthermore, both life events and coping appear to mediate this relation. Gender differences in the ways SES and stress are related may exist.

A randomized controlled trial of combined exercise and psycho-education for low-SES women: short- and long-term outcomes in the reduction of stress and depressive symptoms

Exercise may have both a preventive and a therapeutic impact on mental health problems. The Exercise without Worries intervention aims to reduce stress and depressive symptoms in low-SES women by means of a group-based program combining physical exercise and psycho-education. Between September 2005 and May 2008, 161 Dutch low-SES women with elevated stress or depressive symptom levels were randomly assigned to the combined exercise/psycho-education intervention (EP), exercise only (E) or a waiting list control condition (WLC). The E condition provided low to moderate intensity stretching, strength, flexibility, and body focused training as well as relaxation, while the EP program integrated the exercise with cognitive-behavioral techniques. Depressive symptoms (CES-D) and perceived stress (PSS) were measured before and immediately after the intervention and at 2, 6 and 12 month follow-up. Multilevel linear mixed-effects models revealed no differential patterns in reduction of CES-D or PSS scores between the EP, E and WLC groups on the short (post-test and 2 month follow-up) or long term (6 and 12 months follow-up). Depressive symptom outcomes were moderated by initial depressive symptom scores: women from the EP and E groups with fewer initial symptoms benefited from participation on the short term. Further, women in the EP and E groups with the lowest educational level reported more stress reduction at post-test than women with higher educational levels. In the overall target population of low-SES women, no indications were found that the Exercise without Worries course reduced depressive symptom and stress levels on the short or long term. The findings do suggest, however, that exercise alone or in combination with psycho-education may be a viable prevention option for certain groups of disadvantaged women. Especially those low-SES women with less severe initial problems or those with low educational attainment should be targeted for future depression prevention practice.

Cohort Profile: Understanding socioeconomic inequalities in health and health behaviours: the GLOBE study

The main aim of the Gezondheid en Levens Omstandigheden Bevolking Eindhoven en omstreken (GLOBE) study (the letters of whose name represent the first letters of the Dutch acronym for Health and Living Conditions of the Population of Eindhoven and surroundings) is to quantitatively assess mechanisms and factors explaining socio-economic inequalities in health in the Netherlands. Baseline data for the study were collected by postal survey in 1991 among 18,973 respondents ranging in age from 15-75 years from the city of Eindhoven and its surrounding municipalities. Subsamples (total N=5667) were interviewed and/or surveyed in 1991, 1997, 2004 (also including a new sample), and most recently in 2011. Information was asked on indicators of socio-economic position, a range of potential explanatory factors (material, behavioural, psychosocial, and environmental) and health outcomes. From 2004 onwards, special emphasis was given to the identification of physical, social, and cultural environmental factors in the explanation of socio-economic inequalities in health behaviours. Information from the baseline postal survey onwards can and has been linked to several registries of causes of death, hospital admissions, and cancer. Researchers are cordially invited to contact the project leader (f.vanlenthe@erasmusmc.nl) to propose research based on the data.

The contribution of stress to the social patterning of clinical and subclinical CVD risk factors in African Americans: the Jackson Heart Study

It is often hypothesized that psychosocial stress may contribute to associations of socioeconomic position (SEP) with risk factors for cardiovascular disease (CVD). However, few studies have investigated this hypothesis among African Americans, who may be more frequently exposed to stressors due to social and economic circumstances. Cross-sectional data from the Jackson Heart Study (JHS), a large population-based cohort of African Americans, were used to examine the contributions of stressors to the association of SEP with selected cardiovascular (CVD) risk factors and subclinical atherosclerotic disease. Among women, higher income was associated with lower prevalence of hypertension, obesity, diabetes and carotid plaque and lower levels of stress. Higher stress levels were also weakly, albeit positively, associated with hypertension, diabetes, and obesity, but not with plaque. Adjustment for the stress measures reduced the associations of income with hypertension, diabetes and obesity by a small amount that was comparable to, or larger, than the reduction observed after adjustment for behavioral risk factors. In men, high income was associated with lower prevalence of diabetes and stressors were not consistently associated with any of the outcomes examined. Overall, modest mediation effects of stressors were observed for diabetes (15.9%), hypertension (9.7%), and obesity (5.1%) among women but only results for diabetes were statistically significant. No mediation effects of stressors were observed in men. Our results suggest that stressors may partially contribute to associations of SEP with diabetes and possibly hypertension and obesity in African American women. Further research with appropriate study designs and data is needed to understand the dynamic and interacting effects of stressors and behaviors on CVD outcomes as well as sex differences in these effects.

The mismatch between high effort and low reward in household and family work predicts impaired health among mothers

BACKGROUND

So far, Siegrist's model of effort-reward imbalance (ERI) has been tested almost exclusively for paid employment. This article reports results on a newly developed questionnaire measuring ERI in unpaid household and family work.

METHODS

Using data of a population-based sample of 3129 German mothers, logistic regression analyses were performed to test the following three main assumptions: (i) high effort combined with low reward in household and family work increases the risk of poor health; (ii) a high level of overcommitment may enhance the risk of poor health; and (iii) mothers reporting an extrinsic high ERI and a high level of overcommitment have an even higher risk of poor health.

RESULTS

ERI was significantly related to self-rated health, somatic complaints and mental health. A high level of overcommitment increased the risk of poor health, whereas ERI and overcommitment combined was associated with the highest risk of poor health. Statistically significant synergy effects of combined exposure of ERI and overcommitment were found for 'anxiety'.

CONCLUSIONS

With some limitations, all three assumptions underlying the ERI model were confirmed. Thus, we conclude that ERI is applicable to domestic work and may provide an explanatory framework to assess stress experiences in mothers.

Correlates of socio-economic inequalities in women's television viewing: a study of intrapersonal, social and environmental mediators

Introduction

Socio-economically disadvantaged women are at a greater risk of spending excess time engaged in television viewing, a behavior linked to several adverse health outcomes. However, the factors which explain socio-economic differences in television viewing are unknown. This study aimed to investigate the contribution of intrapersonal, social and environmental factors to mediating socio-economic (educational) inequalities in women's television viewing.

Methods

Cross-sectional data were provided by 1,554 women (aged 18-65) who participated in the 'Socio-economic Status and Activity in Women study' of 2004. Based on an ecological framework, women self-reported their socio-economic position (highest education level), television viewing, as well as a number of potential intrapersonal (enjoyment of television viewing, preference for leisure-time sedentary behavior, depression, stress, weight status), social (social participation, interpersonal trust, social cohesion, social support for physical activity from friends and from family) and physical activity environmental factors (safety, aesthetics, distance to places of interest, and distance to physical activity facilities).

Results

Multiple mediating analyses showed that two intrapersonal factors (enjoyment of television viewing and weight status) and two social factors (social cohesion and social support from friends for physical activity) partly explained the educational inequalities in women's television viewing. No physical activity environmental factors mediated educational variations in television viewing.

Conclusions

Acknowledging the cross-sectional nature of this study, these findings suggest that health promotion interventions aimed at reducing educational inequalities in television viewing should focus on intrapersonal and social strategies, particularly providing enjoyable alternatives to television viewing, weight-loss/management information, increasing social cohesion in the neighborhood and promoting friend support for activity.

Applying the effort-reward imbalance model to household and family work: a population-based study of German mothers

Background

This paper reports on results of a newly developed questionnaire for the assessment of effort-reward imbalance (ERI) in unpaid household and family work. Methods: Using a cross-sectional population-based survey of German mothers (n = 3129) the dimensional structure of the theoretical ERI model was validated by means of Confirmatory Factor Analysis (CFA). Analyses of Variance were computed to examine relationships between ERI and social factors and health outcomes.

Results

CFA revealed good psychometric properties indicating that the subscale 'effort' is based on one latent factor and the subscale 'reward' is composed of four dimensions: 'intrinsic value of family and household work', 'societal esteem', 'recognition from the partner', and 'affection from the child(ren)'. About 19.3% of mothers perceived lack of reciprocity and 23.8% showed high rates of overcommitment in terms of inability to withdraw from household and family obligations. Socially disadvantaged mothers were at higher risk of ERI, in particular with respect to the perception of low societal esteem. Gender inequality in the division of household and family work and work-family conflict accounted most for ERI in household and family work. Analogous to ERI in paid work we could demonstrate that ERI affects self-rated health, somatic complaints, mental health and, to some extent, hypertension.

Conclusions

The newly developed questionnaire demonstrates satisfied validity and promising results for extending the ERI model to household and family work.

What accounts for depressive symptoms among mothers?: the impact of socioeconomic status, family structure and psychosocial stress

OBJECTIVES

Based on a cross-sectional population survey of 3,129 women with minor children, it was analyzed how socioeconomic status, family structure and perceived psychosocial stress are linked and how they contributed to women's self-reported depressive symptoms.

METHODS

Pearson's χ(2) test and multi-factor analysis of variance were used for investigating relationships between social status, family characteristics and psychosocial stress. Logistic regression models were computed for estimating their impact on depressive symptoms.

RESULTS

Mothers having more than two children, early mothers and single mothers were prone to socioeconomic disadvantages. Low income was associated with higher psychosocial stress, however also an inverse social gradient was found indicating increased psychosocial stress among higher educated mothers. Having a youngest child below 16 years and low income increased while being a housewife was associated with decreased risks of depressive symptoms. Psychosocial stress, in particular due to family demands, conflicts with (former) partner and loneliness revealed to be highly relevant for depressive symptoms.

CONCLUSIONS

The findings are pointing to the importance of life-phase specific stressors for explaining depressive symptoms among mothers.

Social inequality and health: the role of social capital

The aim of the article is to examine whether and to what degree the unequal distribution of social capital in the population explains the relationship between socioeconomic position and health in Norway. Theoretical insight and empirical evidence seem to suggest that social capital mediates the effect of socioeconomic position on health outcomes. However, only a few studies have addressed this question and those that have done so have used few and simple indicators of social capital. This study is based on a nationwide cross-sectional survey (N = 3190) commissioned by Statistics Norway. The survey was designed to cover a comprehensive set of variables measuring different aspects of the theoretical construct of social capital. Two health outcomes, self-perceived health and longstanding illness, were analysed. The results showed that the mediating role of social capital between socioeconomic position and health was negligible for both health outcomes. After controlling for socio-demographic variables and socioeconomic position, only neighbourhood satisfaction and generalised trust showed a significant association with self-perceived health, whereas none of the social capital variables had any significant association with longstanding illness. Some theoretical and methodological implications of the results are discussed.

Does education buffer the impact of disability on psychological distress?

This paper investigates whether education buffers the impact of physical disability on psychological distress. It further investigates what makes education helpful, by examining whether cognitive ability and occupational class can explain the buffering effect of education. Two waves of the 1958 British National Child Development Study are used to test the hypothesis that the onset of a physical disability in early adulthood (age 23 to 33) has a smaller effect on psychological distress among higher educated people. In total 423 respondents (4.6%) experienced the onset of a physical disability between the ages of 23 and 33. We find that a higher educational level cushions the psychology impact of disability. Cognitive ability and occupational class protect against the effect of a disability too. The education buffer arises in part because individuals with a higher level of education have more cognitive abilities, but the better social position of those with higher levels of education appears to be of greater importance. Implications of these findings for the social gradient in health are discussed.

Poor social relations and adverse health behaviour: stronger associations in low socioeconomic groups?

OBJECTIVE

Poor social relations are supposed to contribute to adverse health behaviour. We examined this association and the role of low socio-economic position.

METHODS

We regressed health behaviour on composite variables of the two exposures of social relations and socio-economic position (SEP). Social relations included networks and support; health behaviour was analysed in terms of smoking, poor nutrition and physical inactivity; socio-economic position comprised of income and education. Cross sectional data from a population based epidemiological study in German (4,814 men and women aged 45-75) was analysed.

RESULTS

Among the indicators for social relations, social isolation was consistently associated with adverse health behaviour; social support showed modest effect. A combination of poor social relations and low SEP displayed stronger (additive) associations with adverse health behaviour than each factor alone. However, superadditivity was excluded.

CONCLUSION

Given the important role of health adverse behaviour in chronic disease development, results underline the relevance of social environment and socio-economic structure in Public Health interventions.

Social capital, gender and self-rated health. Evidence from the Moscow Health Survey 2004

The state of public health in Russia is undoubtedly poor compared with other European countries. The health crisis that has characterised the transition period has been attributed to a number of factors, with an increasing interest being focused on the impact of social capital - or the lack of it. However, there have been relatively few studies of the relation between social capital and health in Russia, and especially in Moscow. The aim of this study is to examine the relationship between social capital and self-rated health in Greater Moscow. The study draws on data from the Moscow Health Survey 2004, where 1190 Muscovites were interviewed. Our results indicate that among women, there is no relationship between any form of social capital and self-rated health. However, an association was detected between social capital outside the family and men's self-rated health. Men who rarely or never visit friends and acquaintances are significantly more likely to report less than good health than those who visit more often. Likewise, men who are not members of any voluntary associations have significantly higher odds of reporting poorer health than those who are, while social capital in the family does not seem to be of importance at all. We suggest that these findings might be due to the different gender roles in Russia, and the different socializing patterns and values embedded in them. In addition, different forms of social capital provide access to different forms of resources, influence, and support. They also imply different obligations. These differences are highly relevant for health outcomes, both in Moscow and elsewhere.

[Study of the healthcare background and psychosocial environment of the Maghrebian immigrant population in Catalonia [Spain]]

INTRODUCTION

The aim of this study was to gather information on the healthcare background and social environment of the Maghrebian immigrant population in Catalonia in order to guide the management and provision of social services and the work of the organizations supporting this collective.

METHODS

To gather data, we used a questionnaire exploring healthcare and social variables, including stressors and social support. Data collection was performed by pollsters in Arabic.

RESULTS

We performed 403 interviews. Most interviewees had a health card providing access to public healthcare and knew where to access healthcare. The most frequently used services were primary care and emergency departments. In primary care, almost all of the interviewees were provided explanations, but 30% were unable to understand them properly. Health professionals seemed to have inadequate awareness of cultural and religious differences. Work, housing, distance from the family, and legal status were stressful factors for more than half of this population. Social support was low. Three quarters of the interviewees felt lonely. More than half of this population had completely or partially fulfilled their expectations of migration, while 11% felt they were in a worse situation.

CONCLUSIONS

The main areas for improvement are the provision of information on conditions of healthcare access, promotion of social interaction, the use of associations for immigrants especially during the first phases of the migration process and facilitating religious activities. Health professionals should be provided with training in intercultural issues.

Determinants of Self-Rated Health Items With Different Points of Reference

Objective: This study assessed whether three commonly used self-rated health (SRH) items (global, age-comparative, and self-comparative) are equivalent measures of health perception for older adults. Method: Regression analyses were used to simultaneously contrast the associations between physical, psychological, and social factors relating to health for three SRH items, in a large ( N = 2,034) population-based sample of older adults (65 years and older) from the Australian Longitudinal Study of Aging. Results: Health perceptions were more positive for the age-comparative SRH measure, compared to the pessimistic ratings of the self-comparative measure, particularly for the oldest-old adults. Different patterns of associations between the health factors and SRH measures were found. Discussion: These results show the three SRH items are not equivalent measures of health and cannot be used interchangeably. The reference point of the SRH item has a considerable influence on health perceptions of older adults as it encapsulates unique health information.

Violence and Asthma: A Review

Recent research shows that exposure to community violence is, directly and indirectly, associated with asthma. This article reviews the findings on the impact of violence on asthma, and the pathways for the association of violence and asthma are suggested: 1) exposure to violence is directly associated with asthma, mainly through dysregulation of sympathetic-adrenal-medullary (SAM) and hypothalamic-pituitary-adrenal (HPA) axis, 2) exposure to violence is associated with the change of susceptibility of outdoor air pollution on asthma, probably through the change of an immune response, and 3) behavioral change due to exposure to violence (e.g. keeping children indoors) leads to more exposure to indoor pollutants. The suggested framework may be useful to develop health policy on asthma in high-violence communities.

Theoretical explanations for social inequalities in oral health

Social inequalities in health and oral health continue to present a major challenge to public health. Progress towards the development of interventions to reduce health inequalities is currently being hampered by an incomplete understanding of the causes of inequalities in health. This paper aims to provide oral health researchers with an overview of four current explanations for inequalities in oral health and to suggest further areas of research needed to advance our understanding of the causes of social inequalities in oral health.

Age, SES, and health: a population level analysis of health inequalities over the lifecourse

This paper tests two competing hypotheses on the relationship between age, SES, and health inequality at the cohort/population level. The accumulation hypothesis predicts that the level of SES-based health inequality, and consequently the overall level of health inequality, within a cohort progressively increases as it ages. The divergence-convergence hypothesis predicts that these inequalities increase only up to early-old age then decrease. Data from a Canadian national health survey are used in this study, and are adjusted for SES-biases in mortality. Bootstrap methods are employed to assess the statistical precision and significance of the results. The Gini coefficient is used to estimate change in the overall level of health inequality with age, and the Concentration coefficient estimates the contribution of SES-based health inequalities to this change. Health is measured using the Health Utilities Index, and income and education provide the measure of SES. First, the findings show that the Gini coefficient progressively increases from 0.048 (95% CI: 0.045, 0.051) at ages 15-29 to 0.147 (95% CI: 0.131, 0.163) at ages 80+. Second, the data reveal that health inequalities between SES groups (Concentration coefficients for income and education) tend to follow a similar pattern of divergence. Together these findings provide support for the accumulation hypothesis. A notable implication of the study's findings is that the level of health inequality increases when compensating for age-specific socio-economic differences in mortality. These selective effects of mortality should be considered in future research on health inequalities and the lifecourse.

Elderly immigrants and the saga of welfare reform

In 1996 Congress enacted legislation which, among other things, substantially cut off Supplemental Security Income payments and food stamps for present and future legal alien residents of the United States, and made it much harder for them to qualify for Medicaid. For low-income elderly immigrants, who constituted more than two-thirds of aliens on SSI, the adverse and potential impacts were substantial in terms of economic hardship and access to health care. In the months that followed, their plight received significant attention from the media and state and local politicians who now had greater economic and social responsibilities thrust upon them. One year later, Congress restored SSI benefits only for aliens who been receiving them before August 22, 1996 and made it easier for them to qualify for Medicaid. Food stamp benefits, however, were not restored. The limited scope of this restoration of benefits means that many of today's older immigrants, as well as those in the future, will be faced with serious problems in meeting their basic income and health care needs.

Cause-specific hospital admission and mortality among working men: association with socioeconomic circumstances in childhood and adult life, and the mediating role of daily stress

BACKGROUND

The aim of this study was to investigate the association of childhood and adulthood social class with the occurrence of specific diseases, including those not associated with a high mortality rate, and to investigate daily stress as the mechanism for that part of any association which cannot be accounted for by established risk factors.

METHODS

This was a prospective cohort study with 25 years of follow-up for cause-specific morbidity and mortality. A total of 5577 Scottish men were recruited from 27 workplaces in the West of Scotland. Childhood social class was determined from the occupation held by the individual's father, and adulthood social class from the individual's occupation at enrolment. Daily stress was measured at enrolment using the Reeder Stress Inventory.

RESULTS

Health differentials were found for cardiovascular diseases, lung cancer, peptic ulcer, asthma, accidents and violence, alcohol-related diseases, and perhaps psychiatric illness. Adulthood circumstances were associated with the incidence of most diseases in adulthood, the exception being stroke, which was strongly associated with less privileged circumstances in childhood. Both childhood and adulthood circumstances contributed to the incidence of coronary heart disease. Daily stress did not underlie any of these associations once the influence of established risk factors had been taken into account.

CONCLUSIONS

Socioeconomic circumstances in childhood and adulthood both contribute to health differentials in adulthood, the relative contributions depending upon the particular disease. Where known risk factors explained only part of the excess of a disease among individuals raised or living in less-privileged circumstances, there was no evidence to suggest that daily stress was the reason for the unexplained excess.

Socioeconomic status, resources, psychological experiences, and emotional responses: a test of the reserve capacity model

The current study used ecological momentary assessment to test several tenets of the reserve capacity model (L.C. Gallo & K. A. Matthews, 2003). Women (N = 108) with varying socioeconomic status (SES) monitored positive and negative psychosocial experiences and emotions across 2 days. Measures of intrapsychic and social resources were aggregated to represent the reserve capacity available to manage stress. Lower SES was associated with less perceived control and positive affect and more social strain. Control and strain contributed to the association between SES and positive affect. Lower SES elicited greater positive but not negative emotional reactivity to psychosocial experiences. Women with low SES had fewer resources relative to those with higher SES, and resources contributed to the association between SES and daily experiences.

Nondisease factors affected trajectories of disability in a prospective study

OBJECTIVE

To examine nondisease factors, including sociodemographic variables, health behaviors and psychosocial factors as determinants of trajectories of disability.

STUDY DESIGN AND SETTING

We used a classification of 10 trajectories of disability based on a multiround prospective study design; nine trajectories grouped survivors with a similar level and time course of disability, one included all deaths. Multinomial logistic regression was used to assess associations between these trajectories and a wide range of nondisease factors.

RESULTS

Correcting for age, sex, and four chronic diseases, we found that sociodemographic factors (education and income), health behaviors (leisure-time physical activity and BMI), and psychosocial factors (locus of control, neuroticism, and active problem focusing) were significantly associated with the trajectories of disability. Moreover, our results pointed to factors associated with disability trajectories that were characterized by sudden increase (external locus of control and, to a lesser extent, BMI), strong fluctuations (neuroticism, BMI, external locus of control), or high severity (leisure-time physical inactivity) of disability.

CONCLUSION

A wide range of nondisease factors is associated with the trajectories of disability. Preventing obesity, developing a more internal locus of control, and increasing physical activity could contribute to preventing trajectories characterized by rapid decline, large fluctuations or severe disability. Understanding the role of these factors should receive high priority.

Explaining the social gradient in health in Canada: using the National Population Health Survey to examine the role of stressors

Understanding the mechanisms that explain the pervasive association between socioeconomic status and health has been identified as an important area of research. Using the 1994-1995 National Population Health Survey, this study examines whether exposure to psychosocial stressors may be one mediating mechanism of the social gradient in health. Data were obtained including indicators of socioeconomic status (SES); exposure to recent life events and chronic stressors; and self-rated health status. Results showed a clear gradient in poor self-rated health with decreasing SES. Higher exposure to stressors across several domains was also observed with decreasing SES. Exposure to stressors was further associated with poor self-rated health, above and beyond adjusting for SES. Across income adequacy groups, exposure to stressors accounted for 16% to 26% of the relationship between income group and poor self-rated health among men and for 6% to 15% among women, suggesting that exposure to psychosocial stressors may be one of the mediators underlying the higher prevalence of poor self-rated health within lower socioeconomic groups.

The role of psychosocial factors in explaining socio-economic differences in mobility decline in a chronically ill population: results from the GLOBE study

In chronically ill patients, mobility develops more unfavorably in persons with low socio-economic status (SES) than in their better-off counterparts. Using longitudinal data from the Dutch GLOBE study (a study of health and living conditions in Eindhoven and its surroundings), the present study examines whether psychosocial factors can explain socio-economic differences in mobility decline, independent of disease severity, co-morbidity, and health-related behavior in a chronically ill population. Data were from 1384 men and woman, aged 15-74 years, suffering from at least one of the four chronic diseases: asthma/COPD, heart disease, diabetes mellitus, and low back pain. Three indicators of SES were used: education, occupational class, and income. Change in physical mobility between 1991 and 1997 was measured with the Nottingham Health Profile (NHP). Psychosocial factors were measured extensively and included life events, long-term difficulties, coping styles, social support, and personality characteristics. Low occupational level and low income predicted an increased risk of mobility decline in comparison to people with a higher occupational level and income, even after controlling for sociodemographics, disease severity, co-morbidity, and health-related behavior. Additional adjustment for psychosocial factors hardly reduced the SES-related odds ratios of mobility decline. We conclude that psychosocial factors (and also health-related behaviors, disease severity and co-morbidity) cannot explain socio-economic differences in mobility decline in a chronically ill population. Our findings will not give us new tools for prevention and intervention strategies in order to reduce physical disability and particularly the SES differences therein.

Socioeconomic inequalities in mobility decline in chronic disease groups (asthma/COPD, heart disease, diabetes mellitus, low back pain): only a minor role for disease severity and comorbidity

OBJECTIVE

This study examined the association between socioeconomic status and mobility decline and whether this could be explained by disease severity and comorbidity in four different chronic disease groups (asthma/COPD, heart disease, diabetes mellitus, and low back pain). It is not clear, whether the adverse course of physical functioning in persons with a low socioeconomic status can be explained by a higher prevalence of more severe disease or comorbidity in these persons.

DESIGN

Dutch GLOBE study: prospective cohort study.

SETTING

Region of Eindhoven (south east of the Netherlands).

PARTICIPANTS

1384 persons suffering from at least one of the four chronic diseases were selected. The number of respondents in each group was: asthma/COPD 465, heart disease 788, diabetes mellitus 137, and low back pain 707. There were 580 respondents who suffered from more than one condition.

MAIN RESULTS

Odds ratios of mobility decline between 1991 and 1997, adjusted for age, sex, marital status, and baseline mobility, were significantly higher in low socioeconomic groups in comparison with high socioeconomic groups. Only very little of this association could be explained by the higher disease severity and comorbidity in these patients. Findings were similar in patients with asthma/COPD, heart disease, diabetes mellitus, and chronic low back pain.

CONCLUSION

These findings indicate that to reduce physical disabilities and particularly the socioeconomic differences therein, it may not be sufficient to solely intervene upon the risks of severe disease and comorbidities.

Do socioeconomic gradients in women's health widen over time and with age?

A population-based study was conducted to investigate changes over time in women's well-being and health service use by socio-economic status and whether these varied by age. Data from 12,328 mid-age women (aged 45-50 years in 1996) and 10,430 older women (aged 70-75 years) from the Australian Longitudinal Study on Women's Health were analysed. The main outcome measures were changes in the eight dimensions of the Short Form General Health Survey (SF-36) adjusted for baseline scores, lifestyle and behavioural factors; health care utilisation at Survey 2; and rate of deaths (older cohort only). Cross-sectional analyses showed clear socioeconomic differentials in well-being for both cohorts. Differential changes in health across tertiles of socioeconomic status (SES) were more evident in the mid-age cohort than in the older cohort. For the mid-aged women in the low SES tertile, declines in physical functioning (adjusted mean change of -2.4, standard error (SE) 1.1) and general health perceptions (-1.5, SE 1.1) were larger than the high SES group (physical functioning -0.8 SE 1.1, general health perceptions -0.8 SE 1.2). In the older cohort, changes in SF-36 scores over time were similar for all SES groups but women in the high SES group had lower death rates than women in the low SES group (relative risk: 0.79, 95% confidence interval 0.64-0.98). Findings suggest that SES differentials in physical health seem to widen during women's mid-adult years but narrow in older age. Nevertheless, SES remains an important predictor of health, health service use and mortality in older Australian women.

Socio-economic inequalities in health expectancy in Belgium

Various international studies have demonstrated socio-economic differences in health. Linking the 1991 Census to the National Register and using the Health Interview Survey 1997 has enabled assessment of the association between the level of education and health in Belgium using the composite indicator 'health expectancy'. The Sullivan method was used to calculate health expectancy on the basis of current probability of death and prevalence of perceived health. Two measures of educational attainment were used: absolute educational attainment and the position on a relative hierarchical educational scale obtained by a regression-based method. The latter measure enables international comparisons. Differences in health expectancy by education were spread over the whole range of the educational hierarchy, and were consistently larger among females than males. At 25 years of age, the difference in health expectancy between different levels of education reached up to 17.8 and 24.7 years in males and females, respectively. Compared with people with the highest educational attainment, males and females at the lowest level of education spent more than 10 and 20 additional years in poor perceived health, respectively. Between ages 25 and 75 years, the difference in health expectancy between people with the lowest and highest levels of education was 17 years among males and 21 years among females. Compared with people at the top of the relative educational scale, males and females at the bottom of the scale had 13.6 and 19.7 additional years in poor perceived health, respectively. The conclusions of this study in Belgium are consistent with studies in other countries. People with a low level of education have shorter lives than people with a higher level of education. They also have fewer years in good perceived health, and can expect more years in poor health in their shorter lives. The inequality in health expectancy seems to be greater in females than males.

Social determinants and their unequal distribution: clarifying policy understandings

Public health policy in older industrialized societies is being reconfigured to improve population health and to address inequalities in the social distribution of health. The concept of social determinants is central to these policies, with tackling the social influences on health seen as a way to reduce health inequalities. But the social factors promoting and undermining the health of individuals and populations should not be confused with the social processes underlying their unequal distribution. This distinction is important because, despite better health and improvement in health determinants, social disparities persist. The article argues that more emphasis on social inequalities is required for a determinants-oriented approach to be able to inform policies to address health inequalities.

Socioeconomic status, stress, and immune markers in adolescents with asthma

OBJECTIVE

Previous research has demonstrated links between low socioeconomic status (SES) and clinical asthma outcomes, as well as links between stress and asthma. The objective of this study was to test whether adolescents with asthma from different SES backgrounds differed in biological profiles relevant to asthma, including immune and cortisol measures. The second objective was to test whether psychological stress and control beliefs could explain these differences.

MATERIALS AND METHODS

Adolescents with persistent asthma from either low (N= 18) or high (N= 12) SES neighborhoods were interviewed about their stress experiences (chronic stress, acute life events, interpretations of ambiguous life events) and control beliefs. Blood was drawn to assess immune (cytokines, eosinophils, IgE) and neuroendocrine (cortisol) markers associated with asthma.

RESULTS

Adolescents in the low SES group had significantly higher levels of a stimulated cytokine associated with a Th-2 immune response (IL-5), higher levels of a stimulated cytokine associated with a Th-1 immune response (IFN-gamma), and marginally lower morning cortisol values compared with the high SES group. Low SES adolescents also had greater stress experiences and lower beliefs about control over their health. Statistical mediational analyses revealed that stress and control beliefs partially explained the relationship between SES and IL-5/IFN-gamma.

CONCLUSION

Our finding that low SES was associated with elevations in certain immune responses (IL-5/IFN-gamma) in adolescents with asthma suggests the importance of further exploration into relationships between SES and Th-2/Th-1 responses in asthma. Our findings also suggest that psychological stress and control beliefs may provide one explanation for links between SES and immune responses in childhood asthma.

Hostility, unemployment and health status: testing three theoretical models

This study examined three theoretical models of hostility, health and life context. According to the psychosocial vulnerability hypothesis, there is an interaction between hostility and adverse conditions. The increased health risk in hostile individuals is assumed to stem from their lower ability to benefit from existing psychosocial resources. The second hypothesis, called here the social context model, considers adverse conditions as an antecedent of both hostility and health problems. The third model states that hostility is a predictor of being selected to adverse conditions involving risk to health (the selection hypothesis). The results from a survey of a population-based random sample (2153 non-institutionalized citizens aged 18-64 years) in Finland, showed that hostile men had a high prevalence of non-optimal health, irrespective of employment status. In non-hostile men, employment was associated with better health than unemployment. This association between hostility and unemployment was not found in women. Corresponding findings were obtained from a 1959-born cohort of 311 individuals followed up for 27 years. The combination of high hostility at school age and unemployment in adulthood had an additive effect on poor health in adult men but not in adult women. Hostility in childhood was not significantly associated with unemployment in adulthood. Thus, this study supported the psychosocial vulnerability model in men.

Participation in recreational physical activity: why do socioeconomic groups differ?

This qualitative study explored how influences on recreational physical activity (RPA) were patterned by socioeconomic position. Face-to-face interviews were conducted with 10 males and 10 females in three socioeconomic groups (N = 60). Influences salient across all groups included previous opportunities, physical health. social assistance. safety. environmental aesthetics and urban design, physical and health benefits, and barriers of self-consciousness, low skill, and weather/time of year. Influences more salient to the high socioeconomic group included social benefits, achieving a balanced lifestyle, and the barrier of an unpredictable lifestyle. Influences more salient to the high and mid socioeconomic groups included efficacy, perceived need, activity demands, affiliation, emotional benefits, and the barrier of competing demands. Influences more salient to the low socioeconomic group included poor health and barriers of inconvenient access and low personal functioning. Data suggest that efforts to increase RPA in the population should include both general and socioeconomically targeted strategies.

Chronic stress and the social patterning of women's health in Canada

Existing research on the social patterning of women's health draws attention to the significance of social roles and socioeconomic position. Although we know a great deal about health differences according to the occupancy of these positions, we know a lot less about why such patterns exist. This paper addresses this gap by examining the pathways through which social structure is linked to health using data from a 1994 Canadian national probability sample of women, aged 25-64 years. We begin by charting differences in women's self-rated ill-health, distress, and reports of long-standing health conditions by socioeconomic position and social role occupation. We then assess the extent to which these patterns can be understood in relation to the chronic stress arising from these social locations. Socioeconomic position, assessed by housing tenure, education, and household income, was positively related to health. Employment enhanced women's health, as did being currently married and a mother living with children. The ongoing stressors that distinguish the experiences of various structural locations accounted for some of the health effects of social structure, particularly for socioeconomic position. However, chronic stress was largely irrelevant to the pathways linking social roles to health. In fact, employed women and parents living with children enjoyed better health despite their greater stress.