Are psychosocial factors mediators of socioeconomic status and health connections?

Socioeconomic status, alcohol use and the role of social support and neighbourhood environment among individuals meeting criteria for a mental health problem: a cross-sectional study

PURPOSE

Indicators of socioeconomic status (SES), such as education and occupational grade, are known to be associated with alcohol use but this has not been examined among individuals with a mental health problem. This study developed latent classes of SES, their associations with alcohol use, and examined the indirect effect via social support and neighbourhood environment.

METHODS

A secondary analysis of the 2014 Adult Psychiatric Morbidity Survey was conducted among participants with a mental health problem (N = 1,436). SES classes were determined using a range of indicators. Alcohol use was measured using the Alcohol Use Disorder Identification Test. Social support and neighbourhood neighbourhood environment were measured using validated questionnaires. A latent class analysis was conducted to develop SES classes. Multinomial logistic regression examined associations of SES and alcohol use. Structural equation models tested indirect effects via social support and neighbourhood environment.

RESULTS

A four-class model of SES was best-fitting; "economically inactive,GCSE-level and lower educated,social renters", "intermediate/routine occupation,GCSE-level educated,mixed owner/renters", "retired, no formal education,homeowners", and "professional occupation,degree-level educated,homeowners". Compared to "professional occupation,degree-level educated, homeowners", SES classes were more likely to be non-drinkers; odds were highest for "economically inactive,GCSE-level and lower educated,social renters" (OR = 4.96,95%CI 3.10-7.93). "Retired, no formal education,homeowners" were less likely to be hazardous drinkers (OR = 0.35,95%CI 0.20-0.59). Associations between "economically inactive,GCSE-level and lower educated,social renters" and "retired, no formal education,homeowners" and non- and harmful drinking via social support and neighbourhood environment were significant.

CONCLUSIONS

In contrast to the alcohol harms paradox, among individuals with a mental health problem, lower SES groups were more likely to be non-drinkers while no associations with harmful drinking were found. There is also a need to examine the alcohol harms paradox in the context of the area in which they live.

Psychosocial factors mediate social inequalities in health-related quality of life among children and adolescents

BACKGROUND

The present analysis aimed to assess the mediating role of psychosocial and behavioural factors in socio-economic inequalities in health-related quality of life (HRQoL) among children and adolescents.

METHODS

Cross-sectional data was drawn from the randomly selected SEROCoV-KIDS cohort study in Geneva, Switzerland. Associations of socio-economic conditions (parents' highest education, household financial situation) with HRQoL, psychosocial (parent-child relationship, school difficulties, friends, extracurricular activities) and behavioural factors (screen time, physical activity, green spaces time, sleep duration), along with associations of psychosocial and behavioural factors with HRQoL, were evaluated with generalized estimating equations. Counterfactual mediation analyses were conducted to test pathways linking socio-economic conditions to HRQoL.

RESULTS

Of 965 children and 816 adolescents, those with disadvantaged financial circumstances were more likely to have a poor HRQoL (adjusted Odds Ratio [aOR]: 3.80; 95% confidence interval [CI]: 1.96-7.36 and aOR: 3.66; 95%CI: 2.06-6.52, respectively). Psychosocial characteristics mediated 25% (95%CI: 5-70%) and 40% (95%CI: 18-63%) of financial disparities in HRQoL among children and adolescents, respectively. Health behaviours were weakly patterned by socio-economic conditions and did not contribute to financial differences in HRQoL.

CONCLUSIONS

These findings provide empirical evidence for mechanisms explaining socio-economic disparities in child HRQoL and could inform interventions aimed to tackle health inequalities.

Socioeconomic status affects amputation and mortality rates in necrotizing fasciitis patients

PURPOSE

Necrotizing fasciitis (NF) is a rare, but rapidly progressing bacterial infection of the subcutaneous tissues and muscular fascia with high rates of morbidity and mortality. Our study aims to determine if socioeconomic status (SES) is a predictor of outcomes in NF.

METHODS

A retrospective review was conducted of patients diagnosed with NF at our institution. Demographic information, insurance status, medical and surgical history, vitals, ASA score, blood laboratory values, surgical procedure information, and outcomes prior to patient discharge were collected. Patient zip codes were utilized to obtain median household incomes at the time of the patient's surgical procedure to determine SES. Patients without complete data in their medical record were excluded. Initial descriptive statistics and logistic regression models were performed.

RESULTS

We identified 196 patients (mean age 50.13 ± 13.03 years, 31.6% female) for inclusion. Mortality rate was 15.3% (n = 30) and 33.7% (n = 66) underwent amputation. Mortality rate was not significantly different across income brackets. Lower income brackets had higher rates of amputation than higher income brackets (p < 0.05). A logistic regression models showed the rate of amputation decreases by 29% for every $10,000 increment in median household income and ASA score decreased by 0.15 units for every $10,000 increase in median household income.

CONCLUSIONS

Amputation rates in cases of NF are significantly higher in lower SES groups than higher SES groups. Patients with perivascular disease in lower SES groups were more likely to experience serious complications of NF than their counterparts in higher SES groups.

Do poor psychosocial resources mediate health inequalities in type 2 diabetes mellitus? Findings from the Maastricht study

Low socioeconomic position (SEP) has been identified as a risk factor for type 2 diabetes mellitus (T2DM), and psychosocial resources might be on the pathway in this association. We examined two poor psychosocial resources, low control beliefs and inferiority beliefs, that might link low SEP with T2DM. 8292 participants aged 40-75 living in Southern Netherlands participated in The Maastricht Study starting from September 2010 to October 2020 and were followed up to 10 years with annual questionnaires. SEP (education, income, occupation), low control beliefs, inferiority beliefs, and (pre)diabetes by oral glucose tolerance test were measured at baseline. Incident T2DM was self-reported per annum. We analysed the mediating roles of poor psychosocial resources by using counterfactual mediation analysis. People with low SEP had more often prevalent and incident T2DM (e.g. low education: HR = 2.13, 95%CI: 1.53-2.97). Low control beliefs and high inferiority beliefs were more common among people with low SEP. Moreover, low control beliefs and high inferiority beliefs were risk factors for T2DM (e.g. low control beliefs: HR = 1.50, 95%CI: 1.08-2.09). The relationship between SEP and T2DM was partially mediated by control beliefs (8.0-13.6%) and inferiority beliefs (2.2-4.5%). We conclude that poor psychosocial resources are important in socioeconomic inequalities in diabetes. Researchers and practitioners should consider the psychosocial profile of people with lower SEP, as such a profile might interfere with the development, treatment, and prevention of T2DM. Further research should explore how poor psychosocial resources interact with chronic stress in relation to socioeconomic health inequalities.

Adolescent behavioral problems, preterm/low birth weight children and adult life success in a prospective Australian birth cohort study

BACKGROUND

Preterm and/or low birthweight (PT/LBW) is predictive of a range of adverse adult outcomes, including lower employment, educational attainment, and mental wellbeing, and higher welfare receipt. Existing studies, however, on PT/LBW and adult psychosocial risks are often limited by low statistical power. Studies also fail to examine potential child or adolescent pathways leading to later adult adversity. Using a life course framework, we examine how adolescent problem behaviors may moderate the association between PT/LBW and a multidimensional measure of life success at age 30 to potentially address these limitations.

METHODS

We analyze 2044 respondents from a Brisbane, Australia cohort followed from birth in1981-1984 through age 30. We examine moderation patterns using obstetric birth outcomes for weight and gestation, measures of problem behaviors from the Child Behavioral Checklist at age 14, and measures of educational attainment and life success at 30 using multivariable normal and ordered logistic regression.

RESULTS

Associations between PT/LBW and life success was found to be moderated by adolescent problem behaviors in six scales, including CBCL internalizing, externalizing, and total problems (all p < 0.01). In comparison, associations between LBW and educational attainment illustrate how a single-dimensional measure may yield null results.

CONCLUSION

For PT/LBW, adolescent problem behaviors increase risk of lower life success at age 30. Compared to analysis of singular outcomes, the incorporation of multidimensional measures of adult wellbeing, paired with identification of risk and protective factors for adult life success as children develop over the lifespan, may further advance existing research and interventions for PT/LBW children.

Stress exposure, perceived stress, protective psychosocial factors, and health status in Ukraine after the full-scale invasion

The concept of stress as a cause of ill health has received much attention in social sciences. The distinction between stress exposure and perceived stress emphasizes the importance of cognitive dimension of stress. This quantitative study (N = 213) conducted in Ukraine in November 2022 collected self-reported cognitive data on stress exposure, perceived stress, and self-rated heath. The goals of the study included (1) testing if stress exposure and perceived stress differ in terms of breadth and depth of their impact; (2) isolating psychosocial factors that reduce stress; and (3) testing if individuals who have relocated within Ukraine or abroad to escape the war had worse health outcomes than those who remained at their domiciles. The results suggest that while perceived stress was a stronger predictor of negative health outcomes, optimism and social support served as protective psychosocial factors. Having moved abroad predicted higher stress levels and more adverse health symptoms.

Income rank and depressive symptoms among employees in Germany - A 5-year cross-lagged panel analysis

Background/Objective

Socioeconomic disparities in mental health are well-established. Previous research suggests that relative income rank is associated with depressive symptoms above and beyond absolute income. This study aimed to investigate the predictive value of income rank for future depressive symptoms while accounting for absolute income. Exploring potential reverse pathways from depressive symptoms to income rank was a secondary objective.

Method

A two-wave cross-lagged panel design with a 5-year follow-up was used to analyze data for income rank, absolute income, and two dimensions of depressive symptoms (i.e., cognitive-affective and somatic symptoms) from initially 4,201 employees. Income rank was calculated for reference groups, based on the same gender, the same 5-year age band, and the same occupational skill level.

Results

Lower income rank at baseline predicted a higher severity of cognitive-affective depressive symptoms at five-year follow-up, even after adjusting for absolute income. In contrast, income rank did not demonstrate a significant unique longitudinal association with somatic depressive symptoms when simultaneously taking absolute income into account. There was no evidence for the assumption that depressive symptoms are predictive for future income rank (i.e., reverse pathway).

Conclusions

Cognitive-affective symptoms of depression might be particularly responsive to social comparisons and a relatively low social rank.

Association of Sociodemographic Factors with Surgical Management of Hepatoblastoma and Hepatocellular Carcinoma in Children

OBJECTIVE

To evaluate for disparities in surgical care among US children with hepatoblastoma (HB) and hepatocellular carcinoma (HCC).

STUDY DESIGN

In this retrospective National Cancer Database study (2004-2015), children aged <18 years with HB or HCC were included. Multivariable mixed-effects logistic regression was used to evaluate the association of sociodemographic factors (age, sex, race and ethnicity, insurance status, income, proximity to treating hospital) with the odds of undergoing surgical treatment after adjusting for disease-related factors (tumor size, metastasis, comorbidities) and hospital-level effects. Subgroup analyses by tumor histology were performed.

RESULTS

A total of 811 children were included (HB: 80.9%; HCC: 19.1%), of which 610 (75.2%) underwent surgical treatment. Following adjustment, decreased odds of undergoing surgical treatment were associated with Black race (OR: 0.46 vs White, 95% CI [95% CI]: 0.26-0.80, P = .01), and having Medicaid (OR: 0.58 vs private, 95% CI: 0.38-0.88, P = .01) or no insurance (OR: 0.33 vs private, 95% CI: 0.13-0.80, P = .02). In children with HB, Black race was associated with decreased odds of undergoing surgical treatment (OR: 0.47 vs White, 95% CI: 0.25-0.89, P = .02). In children with HCC, Medicaid (OR: 0.10 vs private, 95% CI: 0.03-0.35, P < .001), or no insurance status (OR: 0.10 vs private, 95% CI: 0.01-0.83, P = .03) were associated with decreased odds of undergoing surgical treatment. Other than metastatic disease, no additional factors were associated with likelihood of surgical treatment in any group.

CONCLUSIONS

Black race and having Medicaid or no insurance are independently associated with decreased odds of surgical treatment in children with HB and HCC, respectively. These children may be less likely to undergo curative surgery for their liver cancer.

Do compassion and self-compassion moderate the relationship between childhood socioeconomic position and adulthood body composition?

The study aims to investigate the associations of compassion and self-compassion with body composition, and whether adulthood compassion and self-compassion moderate the relationship between childhood SEP and adulthood body composition. The participants came from the Northern Finland Birth Cohort 1986 Study (n = 789, 52.1% women), with a mean age of 34.0 years. Compassion and self-compassion were measured with the Dispositional Positive Emotions Scale and Self-Compassion Scale-Short Form, respectively. Body composition was assessed using anthropometric and body fat measurements at a clinic. Childhood SEP included parental occupation, education, and employment. The results showed that high compassion was associated with three out of the five body composition measurements, namely lower waist circumference (B = -0.960, p = 0.039, 95% CI: -1.870; -0.498), body fat percentage (B = -0.693, p = 0.030, 95% CI: -1.317; -0.069), and fat mass index (B = -0.325, p = 0.023, 95% CI: -0.605; -0.044) (adjusted for sex, and childhood and adulthood SEP) but not with body mass index or waist-to-hip ratio. Self-compassion was not associated with body composition. Neither compassion nor self-compassion moderated the association between childhood SEP and adulthood body composition, as the interaction effects were not significant. Therefore, the dispositions did not protect against the negative effects of childhood SEP on adulthood body composition. High other-directed compassion may be, however, associated with healthier body composition.

Social Dysfunction and Apathy: Transdiagnostic Domains in Late-Life Cognitive Disorders

Social dysfunction is a maladaptive process of coping, problem solving, and achieving one's goals. A new definition of apathy was cross-linked to social dysfunction, with a reduced goal-directed behavior and social interaction as a separate dimension. We hypothesized that these two neuropsychiatric symptoms may be included in the mild behavioral impairment diagnostic framework, operationalizing and standardizing late-life neuropsychiatric symptom assessment, to improve risk determination of dementia. Social dysfunction and apathy were transdiagnostic and prodromic for late-life cognitive disorders. A transdiagnostic approach could provide a useful mean for a better understanding of apathy and related conditions such as social behavior.

Predictions from standard epidemiological models of consequences of segregating and isolating vulnerable people into care facilities

OBJECTIVES

Since the declaration of the COVID-19 pandemic, many governments have imposed policies to reduce contacts between people who are presumed to be particularly vulnerable to dying from respiratory illnesses and the rest of the population. These policies typically address vulnerable individuals concentrated in centralized care facilities and entail limiting social contacts with visitors, staff members, and other care home residents. We use a standard epidemiological model to investigate the impact of such circumstances on the predicted infectious disease attack rates, for interacting robust and vulnerable populations.

METHODS

We implement a general susceptible-infectious-recovered (SIR) compartmental model with two populations: robust and vulnerable. The key model parameters are the per-individual frequencies of within-group (robust-robust and vulnerable-vulnerable) and between-group (robust-vulnerable and vulnerable-robust) infectious-susceptible contacts and the recovery times of individuals in the two groups, which can be significantly longer for vulnerable people.

RESULTS

Across a large range of possible model parameters including degrees of segregation versus intermingling of vulnerable and robust individuals, we find that concentrating the most vulnerable into centralized care facilities virtually always increases the infectious disease attack rate in the vulnerable group, without significant benefit to the robust group.

CONCLUSIONS

Isolated care homes of vulnerable residents are predicted to be the worst possible mixing circumstances for reducing harm in epidemic or pandemic conditions.

The heart of Detroit study: a window into urban middle-aged and older African Americans' daily lives to understand psychosocial determinants of cardiovascular disease risk

BACKGROUND

Cardiovascular disease disproportionately affects African Americans. Psychosocial factors, including the experience of and emotional reactivity to racism and interpersonal stressors, contribute to the etiology and progression of cardiovascular disease through effects on health behaviors, stress-responsive neuroendocrine axes, and immune processes. The full pathway and complexities of these associations remain underexamined in African Americans. The Heart of Detroit Study aims to identify and model the biopsychosocial pathways that influence cardiovascular disease risk in a sample of urban middle-aged and older African American adults.

METHODS

The proposed sample will be composed of 500 African American adults between the ages of 55 and 75 from the Detroit urban area. This longitudinal study will consist of two waves of data collection, two years apart. Biomarkers of stress, inflammation, and cardiovascular surrogate endpoints (i.e., heart rate variability and blood pressure) will be collected at each wave. Ecological momentary assessments will characterize momentary and daily experiences of stress, affect, and health behaviors during the first wave. A proposed subsample of 60 individuals will also complete an in-depth qualitative interview to contextualize quantitative results. The central hypothesis of this project is that interpersonal stressors predict poor cardiovascular outcomes, cumulative physiological stress, poor sleep, and inflammation by altering daily affect, daily health behaviors, and daily physiological stress.

DISCUSSION

This study will provide insight into the biopsychosocial pathways through which experiences of stress and discrimination increase cardiovascular disease risk over micro and macro time scales among urban African American adults. Its discoveries will guide the design of future contextualized, time-sensitive, and culturally tailored behavioral interventions to reduce racial disparities in cardiovascular disease risk.

Decline in positive future orientations among adolescents during covid-19: The role of socioeconomic status, parental support, and sense of control

INTRODUCTION

Before coronavirus disease (covid-19), adolescents from a lower socioeconomic status (SES) background tend to have less positive future orientations, receive less parental support, and have a weaker sense of control than adolescents from a higher SES background. The covid-19 pandemic has potentially increased the socioeconomic gaps in positive future orientations, parental support, and sense of control among adolescents who are currently in vocational education. As societies are aiming to return back to precovid norms, certain groups of adolescents might require more attention for ensuring a stable future than others.

METHODS

Two-wave questionnaire data of 689 Dutch adolescents (Mage  = 17.8; 56% female) from the Youth Got Talent project was analyzed. Latent Change Score models are a relatively novel approach that allows two-wave data to estimate associations between precovid predictor variables and changes in outcome variables from before to during covid-19 (e.g., SES, positive future orientations, parental support, and sense of control). Analyses were preregistered.

RESULTS

The precovid socioeconomic differences in adolescent's positive future orientations and sense of control remained stable during covid-19, whereas the socioeconomic difference in parental support decreased during covid-19. A decline in parental support, an increase in sense of control, and more covid-19 hardships were associated with an increase in future orientations.

CONCLUSION

The covid-19 situation has not substantially increased socioeconomic differences in positive future orientations and sense of control, but did decrease socioeconomic differences in parental support among adolescents. Short-term policies should aim to facilitate parental support and positive future orientations to all adolescents who experienced a decline, while also long-term focusing on the more consistent socioeconomic difference in sense of control among adolescents.

Socioeconomic status and subjective well-being: The mediating role of class identity and social activities

BACKGROUND

Subjective well-being has a significant impact on an individual's physical and mental health. Socioeconomic status, class identity, and social activity participation play important roles in subjective well-being. Therefore, the aim of this study was to uncover the mechanisms through which these factors influence subjective well-being.

METHODS

A total of 1926 valid samples were recruited using the Chinese General Social Survey 2021 (CGSS 2021). The Chinese Citizen's Subjective Well-Being Scale (SWBS-CC) was employed to assess subjective well-being. Socioeconomic status was measured using income and education, and class identity and social activity participation were measured using Likert scales. Pearson correlation analysis and the chain mediation model were conducted to explore the relationship between these factors. Finally, the Bootstrap method was used to examine the path coefficients.

RESULTS

A significant correlation was found between socioeconomic status, class identity, social activity, and subjective well-being (p < 0.01). The indirect effect of socioeconomic status on subjective well-being mediated by class identity was 0.351 (95% CI: 0.721, 1.587), while the indirect effect of socioeconomic status on subjective well-being mediated by social activity was 0.380 (95% CI: 0.059, 0.240). The effect mediated by both class status and social activities was 0.011 (95% CI: 0.010, 0.093).

CONCLUSIONS

The study showed that socioeconomic status, class identity, and social activity had significant effects on subjective well-being. Class identity and social activity partially mediated the effects of socioeconomic status on subjective well-being, and they had a chain mediating effect between socioeconomic status and subjective well-being. Therefore, policymakers have the opportunity to enhance subjective well-being in lower socioeconomic status groups by promoting individual class identity and encouraging greater social activity participation.

Adolescent Psychosocial Adjustment during COVID-19: An Intensive Longitudinal Study

OBJECTIVE

COVID-19 has presented threats to adolescents' psychosocial well-being, especially for those from economically disadvantaged backgrounds. This longitudinal study aimed to identify which social (i.e., family conflict, parental social support, peer social support), emotional (i.e., COVID-19 health-related stress), and physical (i.e., sleep quality, food security) factors influence adolescents' same- and next-day affect and misconduct and whether these factors functioned differently by adolescents' economic status.

METHOD

Daily-diary approaches were used to collect 12,033 assessments over 29 days from a nationwide sample of American adolescents (n =546; Mage = 15.0; 40% male; 43% Black, 37% White, 10% Latinx, 8% Asian American, and 3% Native American; 61% low-income) at the onset of the COVID-19 pandemic.

RESULTS

Peer support, parent support, and sleep quality operated as promotive factors, whereas parent-child conflict and COVID-19 health-related stress operated as risk factors. Although these links were consistent for adolescents irrespective of economic status, low-income adolescents experienced more conflict with parents, more COVID-19 health-related stress, less peer support, and lower sleep quality than higher-income adolescents. Food insecurity was connected to decreased same- and next-day negative affect for low-income adolescents only. Low-income adolescents also displayed greater negative affect in response to increased daily health-related stress relative to higher-income adolescents.

CONCLUSION

These results highlight the role of proximal processes in shaping adolescent adjustment and delineate key factors influencing youth psychosocial well-being in the context of COVID-19. By understanding adolescents' responses to stressors at the onset of the pandemic, practitioners and healthcare providers can make evidence-based decisions regarding clinical treatment and intervention planning for youth most at risk for developmental maladjustment.

Change in sense of coherence mediates the association between economic recession and mortality among middle-aged men: A population-based cohort study from Eastern Finland

A financial recession has been associated with a decrease in all-cause mortality, but little is known about how psychosocial fluctuations in stress tolerance or orientation to life affect this association. Sense of Coherence (SOC) is a core construct in the Salutogenic Model of Health and is determined by generalized resistance resources and measures one's orientation to life by comprehensibility, manageability, and meaningfulness. We followed the mortality of a cohort of middle-aged Finnish men (n = 854) from the 1980s to the end of 2019. The cohort baseline was stratified into four age groups at baseline: 42, 48, 54, and 60. SOC was measured twice, at the baseline and at the 11-year follow-up visit. Between these SOC measurements, Finland confronted a deep financial recession, the effects of which were examined at the follow-up visit by questionnaires related to economic hardship (sum of nine items) and experience of the recession (one item). Using age group, marital status, employment status, and education as covariates, the change in SOC mediated both the economic hardship and the experience of recession relations to mortality: the indirect effects -19.57 (95% CI -43.23 to -0.92), and -26.82 (95% CI -59.52 to -0.61), respectively. Every one-point increase in economic hardship predicted about 2 and a half weeks shorter life expectancy, and those who experienced very strong disadvantages of economic recession had about 3 and a half months lower life expectancy by the end of 2019 than those who fully avoided the disadvantages. Furthermore, the younger age groups, 42 and 48, experienced the recession more severely than the older groups, 54 and 60. We conclude that following how orientation to life changes among middle-aged might be an informative approach after a recession.

Exploring the relationship between multiple dimensions of subjective socioeconomic status and self-reported physical and mental health: the mediating role of affect

Introduction

This study aimed to investigate the predictive effects of two types of subjective socioeconomic status on self-reported physical and mental health. Specifically, we examined the MacArthur Scale (MacArthur) which measures perceived socioeconomic rank in the society and a novel scale called ComSim, which assessed how participants compared themselves socioeconomically to others coming from a similar socioeconomic background. We also considered the influence of income, education, and personal relative deprivation (PRD) in these analyses. Additionally, we explored whether these effects were mediated through negative and positive affect.

Methods

The data were collected through a cross-sectional, two-wave survey of 294 women and 294 men, with a mean age 41.6 years. Participants were recruited via an online platform.

Results

The results from multivariate regression models revealed that socioeconomic status measured with both the MacArthur Scale and ComSim significantly predicted both self-reported health measures, whereas income and education did not predict any of these measures in the full multivariate models. PRD only predicted self-reported mental health. Mediation analyses showed that negative and positive affect mediated the relationships between socioeconomic status measured by ComSim and self-reported health measures.

Discussion

These findings are discussed in the context of the similarity hypothesis of social comparison theory. The results underscore the importance of considering multiple dimensions when examining socioeconomic health disparities.

Socioeconomic status and social anxiety: attentional control as a key missing variable?

BACKGROUND AND OBJECTIVES

The aim was to examine the role of attentional control as a psychological factor involved in socioeconomic status-related mental health differences, and specifically in social anxiety. Based on the literature on socioeconomic status differences in cognitive abilities and attentional control theory, we hypothesized that attentional control would account for the relation between socioeconomic status and social anxiety. We tested this hypothesis in an integrative model also including trait anxiety and subjective socioeconomic status.

DESIGN

Cross-sectional.

METHOD

Online, 439 French adults were recruited via social media. They completed self-reported measures of attentional control, objective socioeconomic status, subjective socioeconomic status, social anxiety, and trait anxiety.

RESULTS

Using Structural Equation Modelling, findings showed a positive association between objective (but not subjective) socioeconomic status and attentional control, which in turn was related to social anxiety. Exploratory analyses showed that only income, as objective socioeconomic status indicator, was associated with attentional control.

CONCLUSIONS

The current study is the first to support that low socioeconomic status individuals report less attentional control and more social anxiety symptoms. This suggests that attentional control is a psychological factor involved in social anxiety inequalities.

Childhood socioeconomic position and cardiometabolic risk in young adulthood- the impact of mental health

BACKGROUND

Low socioeconomic position in childhood is associated with greater cardiometabolic disease risk later in life. The aim of the current study is to examine the mediating impact of mental health on the association between childhood socioeconomic position and cardiometabolic disease risk in young adulthood.

METHODS

We used a combination of national registers, longitudinal questionnaire-data and clinical measurements from a sub-sample (N = 259) of a Danish youth cohort. Childhood socioeconomic position was indicated by the educational level of the mother and the father at age 14. Mental health was measured by four different symptom scales at four age-points (age 15, 18, 21 and 28), and combined into one global score. Cardiometabolic disease risk was measured by nine biomarkers at age 28-30 and combined into one global score by sample-specific z-scores. We conducted analyses within the causal inference framework and evaluated the associations using nested counterfactuals.

RESULTS

We found an inverse association between childhood socioeconomic position and cardiometabolic disease risk in young adulthood. The proportion of the association which was mediated by mental health was 10 (95% CI: -4; 24) % and 12 (95% CI: -4; 28) % using educational level of the mother and the father as indicator, respectively.

CONCLUSIONS

Accumulated poorer mental health in childhood, youth and early adulthood partially explained the association between low childhood socioeconomic position and increased cardiometabolic disease risk in young adulthood. The results of the causal inference analyses rely on the underlying assumptions and correct depiction of the DAG. Since these are not all testable, we cannot exclude violations that potentially could bias the estimates. If the findings can be replicated, this would support a causal relationship and direct potentials for intervention. However, the findings point to a potential for intervention in young age in order to impede the translation of childhood social stratification into later cardiometabolic disease risk disparities.

Cumulative Risk Evaluation of Phthalates Under TSCA

The U.S. Environmental Protection Agency (EPA) is currently conducting separate Toxic Substances Control Act (TSCA) risk evaluations for seven phthalates: dibutyl phthalate (DBP), butyl benzyl phthalate (BBP), di(2-ethylhexyl) phthalate (DEHP), diisobutyl phthalate (DIBP), dicyclohexyl phthalate (DCHP), di-isodecyl phthalate (DIDP), and diisononyl phthalate (DINP). Phthalates are highly abundant plastic additives used primarily to soften materials and make them flexible, and biomonitoring shows widespread human exposure to a mixture of phthalates. Evidence supports biological additivity of phthalate mixture exposures, including the enhancement of toxicity affecting common biological targets. Risk estimates based on individual phthalate exposure may not be protective of public health. Thus, a cumulative risk approach is warranted. While EPA initially did not signal that it would incorporate cumulative risk assessment (CRA) as part of its current risk evaluation for the seven phthalates, the agency recently announced that it is reconsidering if CRA for phthalates would be appropriate. Based on our review of existing chemical mixtures risk assessment guidance, current TSCA scoping documents for the seven phthalates, and pertinent peer-reviewed literature, we delineate a CRA approach that EPA can easily implement for phthalates. The strategy for using CRA to inform TSCA risk evaluation for existing chemicals is based upon integrative physiology and a common adverse health outcome algorithm for identifying and grouping relevant nonchemical and chemical stressors. We recommend adjustments for how hazard indices (HIs) or margins of exposure (MOEs) based on CRA are interpreted for determining "unreasonable risk" under TSCA.

The relationship between Chinese adults' self-assessments of family social status in childhood and depression: A moderated mediation model

BACKGROUND

Using the data from a large-scale Chinese national survey, this study aimed to explore the underlying mechanisms between Chinese adults' self-assessments of family social status in childhood and depression.

METHODS

The research data was from the China Family Panel Studies (CFPS) in 2020. We selected 13,430 Chinese adults aged 16-60 as participants, and used the PROCESS macro program to conduct moderated mediation analysis.

RESULTS

Chinese adults' self-assessments of family social status in childhood had a statistically significant negative predictive effect on depression. The sharing frequency of WeChat Moments played a partial mediating role in the relationship between self-assessment of family social status in childhood and depression. Furthermore, social trust moderated the direct effect of mediation model. Age moderated the second half of the mediation model, and the effect was statistically significant in the younger population (young people), but not in the older population (middle-aged people).

LIMITATIONS

This was a cross-sectional study and no causal conclusions could be drawn.

CONCLUSIONS

Chinese adults' self-assessment of family social status in childhood could affect depression in adulthood through sharing frequency of WeChat Moments. People with higher social trust can effectively buffer the adverse effect of self-assessed low family social status in childhood on depression. Age moderated the relationship between sharing frequency of WeChat Moments and depression, but this moderating effect was only significant in the younger population.

Neighbourhood socio-economic status and positive affectivity among older residents in Germany: a cross-sectional analysis with data from the Heinz Nixdorf Recall Study

BACKGROUND

Physical and social neighbourhood characteristics can vary according to the neighbourhood socio-economic status (SES) and influence residents' perceptions, behaviours and health outcomes both positively and negatively. Neighbourhood SES has been shown to be predictive of mental health, which is relevant for healthy ageing and prevention of dementia or depression. Positive affectivity (PA) is an established indicator of mental health and might indicate a positive emotional response to neighbourhood characteristics. In this study, we focussed on the association of neighbourhood SES with PA among older residents in Germany and considered social integration and environmental perceptions in this association.

METHODS

We used questionnaire-based data of the ongoing population-based Heinz Nixdorf Recall Study for our cross-sectional analysis, complemented by secondary data on social welfare rates in the neighbourhood of residents' address. PA was assessed using the Positive and Negative Affect Schedule (PANAS) in 2016. Linear regression models were performed to estimate the associations and adjusted for socio-demographic variables.

RESULTS

Higher social welfare rates were associated with lower PA scores. The strongest negative association from the crude model (b = -1.916, 95%-CI [-2.997, -0.835]) was reduced after controlling for socio-demographic variables (b = -1.429, 95%-CI [-2.511, -0.346]). Social integration factors (b = -1.199, 95%-CI [-2.276, -0.121]) and perceived environmental factors (b = -0.875, 95%-CI [-1.971, 0.221]) additionally diminished the association of social welfare rates with PA in the full model (b = -0.945, 95%-CI [-2.037, 0.147]).

CONCLUSION

Our results suggest that neighbourhoods have an influence on the occurrence and the extent of PA. Public health interventions that address socio-economic disadvantage in the neighbourhood environment could be an effective and far-reaching way to reduce the risk of depression and depressive symptoms due to low PA in older residents.

Religiosity and Physical Health of Middle–Old Aged African Americans: The Linking Role of Self-Control

Objective: This study examined a psychological process (i.e., sense of control) that links religiosity to self-reported physical health in older African Americans. Methods: Two waves of data from 231 middle–old aged African Americans (AAs) were used to test two specific hypotheses: (a) religiosity influences changes in sense of control middle–old aged AAs, and (b) sense of control influences changes in global physical health in middle–old aged AAs. The analysis used two modeling approaches: (a) an autoregressive cross-lagged modeland (b) a parallel growth/change model. Results: The results of both types of models showed that religiosity positively influenced changes in sense of control and that sense of control positively influenced changes in physical health in middle–old aged AAs over time. Discussion: These findings provide evidence that sense of control links religiosity to physical health in older African Americans. The theoretical and practical implications of the findings are discussed.

Rainbows over the world's public health: determinants of health models in the past, present, and future

The need to visualise the complexity of the determinants of population health and their interactions inspired the development of the rainbow model. In this commentary we chronicle how variations of this model have emerged, including the initial models of Haglund and Svanström (1982), Dahlgren and Whitehead (1991), and the Östgöta model (2014), and we illustrate how these models have been influential in both public health and beyond. All these models have strong Nordic connections and are thus an important Nordic contribution to public health. Further, these models have underpinned and facilitated other examples of Nordic leadership in public health, including practical efforts to address health inequalities and design new health policy approaches.

Apart from documenting the emergence of rainbow models and their wide range of contemporary uses, we examine a range of criticisms levelled at these models – including limitations in methodological development and in scope. We propose the time is ripe for an updated generic determinants of health model, one that elucidates and preserves the core value in older models, while recognising the developments that have occurred over the past decades in our understanding of the determinants of health. We conclude with an example of a generic model that fulfills the general purposes of a determinants of health model while maintaining the necessary scope for further adjustments to be made in the future, as well as adjustments to location or context-specific purposes, in education, research, health promotion and beyond.

The effect of college degree attainment on neurodegenerative symptoms in genetically at-risk women

Using longitudinal data, the present study examined the association between college degree attainment and the manifestation of neurodegenerative symptoms among women (n = 93) at elevated genetic risk. The neurodegenerative symptoms investigated in this study are due to FXTAS (Fragile X-associated Tremor/Ataxia Syndrome), a condition with onset after age 50. Those at risk for FXTAS have a mutation of a single gene found on the X chromosome. FXTAS is characterized by intention tremor, gait ataxia, executive function deficits, memory issues, and neuropathy. College degree attainment has been shown to provide neuroprotective effects in the general population, delaying the development of neurodegenerative conditions such as Alzheimer's disease. For this reason, college degree attainment is a potentially salient resource for those at risk of FXTAS. The results of the present research indicated significantly more severe FXTAS symptoms in women who did not attain a college degree as compared with those who were college graduates, although the two groups were similar in age, genetic risk, household income, health behaviors, and general health problems. Furthermore, symptoms in those who did not attain a college degree worsened over the 9-year study period at a significantly faster rate than the college graduates. The association between college degree attainment and FXTAS symptoms was significantly mediated by depression, which was lower among the graduates than those who did not attain a college degree. Thus, the present research is an example of how a sociodemographic factor can mitigate neurodegenerative conditions in genetically at-risk adults.

The Effect of Social Determinants of Health on Telemedicine Access During the COVID-19 Pandemic

Social determinants of health contribute to inequalities in access to care and inferior outcomes in pediatric populations. Before the coronavirus disease 2019 (COVID-19) pandemic, telemedicine was shown to be an effective tool to bridge the gap between health care providers and rural or underserved populations. The pandemic has rapidly changed the current landscape of health care. Telemedicine has played a critical role in health care delivery between providers and patients because of the need for social distancing. That being said, it has become apparent that SDOH have affected access to telemedicine for communities that already suffer from inequities in health care access. Solutions directed toward addressing issues such as lack of broadband access, digital literacy and language barriers, and obstacles within the health care system are crucial to ensure telemedicine access is equitable for all patients and does not contribute toward worsening health care disparities. [Pediatr Ann. 2022;51(8):e311-e315.].

How Childhood Socioeconomic Status Impacts Adult Food Preference: The Mediating Role of Stress and Trait Appetite

Prior research has shown that adults who were raised in a low socioeconomic status (SES) environment are more likely to desire energy-dense foods. Research has also shown a positive correlation between current stress levels and the desire for energy-dense foods. We hypothesized that stress and trait appetite mediate the relationship between childhood SES and the desire for low and high-energy-dense foods. In this study, 311 adults participated in an online experiment in which they were shown images of five food items from each of the six major food categories (vegetables, fruits, grains, dairy, meat/poultry, and sweets) and rated how desirable each food item is. Next, we asked a series of questions that identified the participant’s sex, early childhood socioeconomic conditions, and current stress level. We also identified whether the participants had a trait or state eating personality. A path analysis was used to confirm the hypothesis that stress plays a mediating role between SES and food preference, and that an orderly relationship exists between these variables. The results show the hypothesis was supported and that the results were statistically significant. Specifically, the results show that the desire for low and high-energy-dense foods is indirectly influenced by one’s early childhood environment, and that food desirability is mediated by both stress and trait appetite. In addition, this analysis showed that in some situations, stress can both increase and decrease the desire for high-energy-dense foods. These findings also contribute to our understanding of how environmental conditions (safe and harsh environments) affect appetite and the desire for low and high-energy-dense foods. It also provided a deeper understanding of how these food choices can be adaptive under different ecological conditions.

Pandemics, policy, and the power of paradigm: will COVID-19 lead to a new scientific revolution?

Critical historical analysis of the 19th-century cholera and 21st-century coronavirus-19 (COVID-19) pandemics suggests that in conflicts over pandemic-mitigation policies, the professional backgrounds of principal opponents reveal dominant and minority scientific paradigms, presaging possible epistemological shifts. Epistemic conflict over cholera helped spur biomedical expertise as the dominant paradigm for U.S. public health science and policy beginning in the 20th century. This paradigm was reflected in federal government reliance on infectious disease physicians as the primary scientific decision makers in the COVID-19 pandemic. Similarly, epistemic conflict over challenges to behavioral and social well-being in 2020 may highlight discordance between the dominant biomedical paradigm used in making federal policy and the inherently holistic impact of that policy on population health, suggesting need for a new paradigm of multidisciplinary scientific engagement. Because population-wide public health initiatives affect many aspects of health-physiological, psychological, behavioral, and social-that are best measured and interpreted by experts in these respective fields, multidisciplinary scientific engagement would facilitate optimal, holistic evaluation of policy benefits and harms. This multidisciplinary approach, analogous to that currently recommended in medical management of chronic disease, would advance epidemiological research to inform evidence-based policy for public health crises in which U.S. population-wide interventions are contemplated.

Psychosocial-Behavioral Phenotyping: A Novel Precision Health Approach to Modeling Behavioral, Psychological, and Social Determinants of Health Using Machine Learning

BACKGROUND

The context in which a behavioral intervention is delivered is an important source of variability and systematic approaches are needed to identify and quantify contextual factors that may influence intervention efficacy. Machine learning-based phenotyping methods can contribute to a new precision health paradigm by informing personalized behavior interventions. Two primary goals of precision health, identifying population subgroups and highlighting behavioral intervention targets, can be addressed with psychosocial-behavioral phenotypes. We propose a method for psychosocial-behavioral phenotyping that models social determinants of health in addition to individual-level psychological and behavioral factors.

PURPOSE

To demonstrate a novel application of machine learning for psychosocial-behavioral phenotyping, the identification of subgroups with similar combinations of psychosocial characteristics.

METHODS

In this secondary analysis of psychosocial and behavioral data from a community cohort (n = 5,883), we optimized a multichannel mixed membership model (MC3M) using Bayesian inference to identify psychosocial-behavioral phenotypes and used logistic regression to determine which phenotypes were associated with elevated weight status (BMI ≥ 25kg/m2).

RESULTS

We identified 20 psychosocial-behavioral phenotypes. Phenotypes were conceptually consistent as well as discriminative; most participants had only one active phenotype. Two phenotypes were significantly positively associated with elevated weight status; four phenotypes were significantly negatively associated. Each phenotype suggested different contextual considerations for intervention design.

CONCLUSIONS

By depicting the complexity of psychological and social determinants of health while also providing actionable insight about similarities and differences among members of the same community, psychosocial-behavioral phenotypes can identify potential intervention targets in context.

Responses to social inequality across the life span: The role of social status and upward mobility beliefs

Economic inequality has been consistently rising in recent decades in many Western countries including Germany. This is a pressing issue as greater economic inequality within a society has detrimental consequences for well-being, social stability, productivity, and even life expectancy. However, little is known about how individuals of different ages experience and respond to social inequality across adulthood. Because status differences are perceived as more malleable in young adulthood (i.e., young adults can expect to move up the social ladder) and only manifest across adulthood, we predicted that negative emotional reactions to the perceived standing in the social hierarchy should become increasingly pronounced with age. Consistently, a first study based on a national representative sample in Germany ( N = 2,542; 18–91 years) confirmed that subjective social status had a much stronger effect on the acceptance of social inequality among middle-aged and older, as compared with younger, adults. In a second experimental study ( N = 387; 18–89 years), participants of any age responded with negative emotional reactions when rising inequality was made salient. However, subjective social status moderated this effect only in middle-aged and older, but not younger, adults. Finally, a third experimental study ( N = 605; 18–82 years) showed that, compared with middle-aged and older adults, younger adults maintained stronger upward mobility beliefs that accounted for the age-differential effects of subjective social status on negative emotional reactivity to rising inequality. We discuss the central role of upward mobility beliefs for individuals’ responses to social inequality across the adult life span.

Effect of socioeconomic status on the physical and mental health of the elderly: the mediating effect of social participation

BACKGROUND

Previous studies have demonstrated the effect of socioeconomic status on the health status of the elderly. Nevertheless, the specific dimensions of the effect and the mechanism await further investigation. In this study, socioeconomic status was divided into three dimensions and we used social participation as the mediation variable to investigate the specific path of effect.

METHODS

Using the 2018 Waves of Chinese Longitudinal Healthy Longevity Survey (CLHLS) dataset, a total of 10,197 effective samples of the elderly over 65 years old were screened out. Socioeconomic status included income, education level, and main occupation before retirement. The physical health and mental health of the elderly was measured by the Instrumental Activities of Daily Living Scale and the Minimum Mental State Examination, respectively. The social participation of the elderly was the mediation variable, including group exercise, organized social activities and interacting with friends. Omnibus mediation effect analysis was adopted to examine the mediation effect and mediation analysis was completed using the SPSS PROCESS program.

RESULTS

First, the results showed that when the income gap between the elderly reached a certain level, there was a significant difference in health status. Significant differences existed in health status amongst with different education levels. There was no sufficient evidence to show that occupation has a significant effect on the physical health. But when the dependent variable was mental health, the effect was significant. Second, group exercise mediated 64.11% (a_ib = 0.24, 95% CI [0.17,0.3]) and up to 20.44% (a_ib = 0.12, 95% CI [0.07,0.17]) of the disparity in physical and mental health due to income gap, respectively. And it could mediate the effect up to 56.30% (a_ib = 0.62, 95% CI [0.52,0.73]) and 17.87% (a_ib = 0.50, 95% CI [0.4,0.61]) of education on physical and mental health status, respectively. The proportion of relative mediation effect of occupation was up to 28.74% (a_ib = 0.19, 95% CI [0.13,0.25]) on mental health. Interacting with friends mediated only on the path that the education affected the health status of the elderly. The proportion was up to 33.72% (a_ib = 0.29, 95% CI [0.16,0.44]). The relative mediation effect of organized social activities on the health gap caused by income or education level gap was significant at some levels. The proportion was up to 21.20% (a_ib = 0.33, 95% CI [0.26,0.4]).

CONCLUSION

The SES of the elderly including relatively large income gap, different education levels and occupational categories could indeed have a significant effect on health status of the elderly, and the reason why this effect existed could be partly explained by the mediation effect of social participation. Policymakers should pay more attention to the social participation of the elderly.

Relationship between social support and incident hypertension in the Jackson Heart Study: a cohort study

OBJECTIVES

Social support may be an important mitigating factor against adverse cardiovascular outcomes by facilitating health-promoting behaviours or by buffering against the negative effects of stress. This study examined the association of social support with incident hypertension.

DESIGN

Prospective cohort study.

SETTING

We evaluated the association of social support with incident hypertension among participants in the Jackson Heart Study, a community-based cohort of African Americans.

PARTICIPANTS

This study included African American adults, who were free of hypertension at baseline (2000-2004). Functional social support, structural social support and satisfaction with social support were assessed at baseline among 1516, 1240 and 1503 participants, respectively.

OUTCOME MEASURES

Incident hypertension was assessed at follow-up examinations in 2005-2008 and 2009-2013. Incident hypertension was defined by the first visit with systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg or self-reported antihypertensive medication use. Multivariable Poisson regression was used to estimate the association of baseline social support with incident hypertension, adjusting for relevant confounders.

RESULTS

At baseline, the mean age of participants was 50 years and 64% were men. During a median follow-up time of 6.9 years, 54% of participants developed hypertension. A high level of functional social support was associated with lower risk of incident hypertension (incident rate ratio 0.64, (95% CI 0.41 to 0.97)), compared with a low level of functional social support. Level of structural social support and satisfaction with social support were not associated with hypertension risk.

CONCLUSIONS

These results suggest that greater functional support may be associated with a lower risk of incident hypertension.

Are stress-related pathways of social status differentiation more important determinants of health inequities in countries with higher levels of income inequality?

We explored socioeconomic gradients in self-rated overall health (SROH) using indicators of materialist (educational attainment and perceived income adequacy) and psychosocial perspectives (subjective social status (SSS)) among adults living in countries with varying levels of income inequality, and the importance of psychosocial stress in mediating these associations. If psychosocial processes at the individual and societal levels correspond, associations between SSS and SROH should be higher among adults in countries with higher income inequality, and psychosocial stress should be a more important mediator of these associations. We used multigroup structural equation models to analyse cross-sectional data from the International Food Policy Study of adults (n = 22,824) in Australia, Canada, Mexico, the UK and the United States. Associations between SSS and SROH were not higher in more unequal countries, nor was psychosocial stress a more important mediator of these associations. Inequities in SROH in more unequal countries may not predominantly reflect stress-related pathways of social status differentiation.

Association of Neighborhood-Level Socioeconomic Measures With Cognition and Dementia Risk in Australian Adults

IMPORTANCE

Up to 40% of dementia cases are potentially preventable; therefore, it is important to identify high-risk groups to whom resources could be targeted for maximal impact in preventing late-life dementia. The association of neighborhood-level socioeconomic status (SES) with cognition and dementia risk is not well known, particularly in midlife when late-life dementia may still be preventable through established interventions, such as blood pressure management.

OBJECTIVE

To examine whether neighborhood-level SES is associated with differences in cognitive performance and dementia risk scores.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study analyzed data collected between November 17, 2016, and April 14, 2020, from 4656 participants in the longitudinal population-based Healthy Brain Project cohort. This large online cohort comprised community-dwelling individuals geographically dispersed across Australia. Participants were aged 40 to 70 years without dementia or other major neurological conditions.

EXPOSURES

Neighborhood-level SES was computed by matching participants' residential addresses to the Australian Bureau of Statistics Index of Relative Socio-economic Advantage and Disadvantage (IRSAD). Postcodes provided by each participant were used to derive an IRSAD score that ranked participants according to deciles of neighborhood-level SES (range, 1-10, with higher deciles indicating greater socioeconomic advantage); neighborhoods in deciles 1 to 7 were considered to have low or intermediate SES, and neighborhoods in deciles 8 to 10 were considered to have high SES.

MAIN OUTCOMES AND MEASURES

Dementia risk estimated using the dementia risk score from the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) tool (n = 4656) and cognitive composite scores for memory and attention measured by the Cogstate Brief Battery (n = 2181).

RESULTS

Of 4656 participants (mean [SD] age, 56.1 [7.2] years; 3445 women [74.0%]), 2688 individuals (57.7%) lived in areas with high neighborhood-level SES (IRSAD decile ≥8), and 1968 (42.3%) lived in areas with low or intermediate neighborhood-level SES (IRSAD decile <8), with 1263 individuals (27.1%) residing in rural or regional areas. A total of 6 participants (0.1%) identified as African, 121 (2.6%) as Asian, 57 (1.2%) as Indigenous Australian, 24 (0.5%) as Latin American, 9 (0.2%) as Pacific Islander, 3671 (78.8%) as White or European, and 768 (16.5%) indicated other race (not specified). Each decile unit increase in neighborhood-level SES was associated with a lower CAIDE dementia risk score after adjustment for race and rurality (β [SE] = -0.070 [0.019]; P = .004). Each decile unit increase was also associated with better memory (β [SE] = 0.022 [0.006]; P = .006) but not with better attention (β [SE] = 0.009 [0.007]; P = .34), as measured by Cogstate Brief Battery composite z scores after adjustment for age, sex, race, years of education, and rurality. When comparing memory performance between individuals with IRSAD scores higher and lower than decile 8, neighborhood-level SES interacted with age (F1-2171 = 6.33; P = .02) and CAIDE dementia risk scores (F1-2173 = 4.02; P = .08). Differences in memory between neighborhood-level SES categories were larger among participants who were older and had a higher risk of dementia.

CONCLUSIONS AND RELEVANCE

In this study, higher neighborhood-level SES was associated with better memory and lower dementia risk scores. These results suggest that efforts to lower dementia risk factors in disadvantaged areas are needed to curtail the increasing burden of dementia and that inclusion of individuals living in areas with lower SES in research on dementia is warranted to improve understanding and potential interventions.

Factors Affecting Depression in Middle-Aged and Elderly Men Living Alone: A Cross-Sectional Path Analysis Model

The main objectives of this cross-sectional study were to determine the relationship between socioeconomic status (SES) and depression and to estimate the mediating effects of social network satisfaction, self-esteem, and perceived health status among middle-aged and elderly men living alone, based on the reserve capacity model. Secondary data from a sample of 394 middle-aged and elderly men aged 45 years or older from the 15th Korea Welfare Panel Study (KOWEPS) were analyzed. A path analysis model was constructed to evaluate the relationship among SES, social network satisfaction, self-esteem, perceived health status, and depression. The path analysis exhibited significant direct effects of social network satisfaction, self-esteem, and perceived health status on depression and significant indirect effects of SES on depression. There was no direct effect of SES on depression. Social network satisfaction and self-esteem had significant mediating effects of SES on depression. Among middle-aged and elderly men, intrapersonal reserves, which are psychosocial factors including social network satisfaction, self-esteem, and perceived health status, showed more association with depression than tangible reserves such as SES. This suggests that interventions promoting self-esteem and perceived health status could prevent depression.

What Are the Health Consequences of Upward Mobility?

Health disparities by socioeconomic status (SES) have been extensively documented, but less is known about the physical health implications of achieving upward mobility. This article critically reviews the evolving literature in this area, concluding that upward mobility is associated with a trade-off, whereby economic success and positive mental health in adulthood can come at the expense of physical health, a pattern termed skin-deep resilience. We consider explanations for this phenomenon, including prolonged high striving, competing demands between the environments upwardly mobile individuals seek to enter and their environments of origin, cultural mismatches between adaptive strategies from their childhood environments and those that are valued in higher-SES environments, and the sense of alienation, lack of belonging, and discrimination that upwardly mobile individuals face as they move into spaces set up by and for high-SES groups. These stressors are hypothesized to lead to unhealthy behaviors and a dysregulation of biological systems, with implications for cardiometabolic health.

Social Epidemiology: Past, Present, and Future

In a context where epidemiologic research has been heavily influenced by a biomedical and individualistic approach, the naming of “social epidemiology” allowed explicit emphasis on the social production of disease as a powerful explanatory paradigm and as critically important for interventions to improve population health. This review briefly highlights key substantive areas of focus in social epidemiology over the past 30 years, reflects on major advances and insights, and identifies challenges and possible future directions. Future opportunities for social epidemiology include grounding research in theoretically based and systemic conceptual models of the fundamental social drivers of health; implementing a scientifically rigorous yet realistic approach to drawing conclusions about social causes; using complementary methods to generate valid explanations and identify effective actions; leveraging the power of harmonization, replication, and big data; extending interdisciplinarity and diversity; advancing emerging critical approaches to understanding the health impacts of systemic racism and its policy implications; going global; and embracing a broad approach to generating socially useful research.

Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Links Between Socioeconomic Status, Daily Depressive Affect, Diurnal Cortisol Patterns, and All-Cause Mortality

OBJECTIVE

Socioeconomic status (SES) remains a robust risk factor for mortality. Various theoretical models postulate that lower SES is associated with higher negative affect, which then initiates a cascade of physiological disturbances that contribute to illness and early mortality. However, few studies have explicitly investigated the interplay between psychological and biological factors in determining SES disparities in mortality. This study examined the role of daily negative affect and cortisol secretion in explaining the SES-mortality link in a large sample of US adults.

METHODS

Using data from the Midlife in the United States study (n = 1735, mean [standard deviation] age = 56.40 [12.10] years, 56.4% female), we tested longitudinal associations between SES, daily negative affect, daily cortisol levels, and all-cause mortality 13 years later. Daily negative affect was classified into three clusters reflecting depressive affect, anxiety, and anger.

RESULTS

Higher SES was linked to a lower risk of all-cause mortality (hazard ratio = 0.94, 95% confidence interval = 0.90 to 0.97). Furthermore, there was a sequential link between higher SES and lower mortality through lower daily depressive affect and a steeper ("healthier") diurnal cortisol slope (indirect effect = -0.0007, 95% confidence interval = -0.0014 to -0.0002). Daily anxiety and anger were not associated with cortisol levels or mortality (p values > .05).

CONCLUSIONS

These findings suggest that daily negative emotional experiences and the hypothalamic-pituitary-adrenal axis functioning may constitute important psychological and physiological pathways underlying the link between SES and all-cause mortality.

Mindfulness and Mobile Health for Quitting Smoking: A Qualitative Study Among Predominantly African American Adults with Low Socioeconomic Status

Low-income and African American adults experience severe tobacco-related health disparities. Mindfulness-based interventions show promise for promoting smoking cessation, but most mindfulness research has focused on higher income, Caucasian samples. "iQuit Mindfully" is a personalized, interactive text messaging program that teaches mindfulness for smoking cessation. This qualitative study sought feedback from predominantly low-income African American smokers, to improve the intervention for this priority population. After receiving 8 weekly group sessions of Mindfulness-Based Addiction Treatment for smoking cessation and between-session iQuit Mindfully text messages, participants (N=32) completed semi-structured interviews. Participants were adult cigarette smokers (90.6% African American, 62.6% annual income <$30,000, mean age 45.1 [±12.9]). Interviews inquired about participants' experiences with and suggestions for improving iQuit Mindfully, including message content, number, and timing. Interviews were audio-recorded, transcribed verbatim, and coded by a team of 5 coders in NVivo. The coding manual was developed based on response categories from the interview guide and themes emerging from the data. Themes were organized into a conceptual model of factors related to engagement with the mHealth program. Response categories included helpful aspects (e.g., themes of social support, mindfulness, personalization); unhelpful/disliked aspects (e.g., too many/repetitive messages); links between in-person sessions and texts; and suggestions (e.g., changes to number/timing and more personalization). Findings provide insight into participants' day-to-day experiences with iQuit Mindfully and suggest ways to improve mHealth programs among low-income and African American adults.

Associations between indicators of socioeconomic position and DNA methylation: a scoping review

BACKGROUND

Socioeconomic position (SEP) is a major determinant of health across the life course. Yet, little is known about the biological mechanisms explaining this relationship. One possibility widely pursued in the scientific literature is that SEP becomes biologically embedded through epigenetic processes such as DNA methylation (DNAm), wherein the socioeconomic environment causes no alteration in the DNA sequence but modifies gene activity in ways that shape health.

METHODS

To understand the evidence supporting a potential SEP-DNAm link, we performed a scoping review of published empirical findings on the association between SEP assessed from prenatal development to adulthood and DNAm measured across the life course, with an emphasis on exploring how the developmental timing, duration, and type of SEP exposure influenced DNAm.

RESULTS

Across the 37 identified studies, we found that: (1) SEP-related DNAm signatures varied across the timing, duration, and type of SEP indicator; (2) however, longitudinal studies examining repeated SEP and DNAm measures are generally lacking; and (3) prior studies are conceptually and methodologically diverse, limiting the interpretability of findings across studies with respect to these three SEP features.

CONCLUSIONS

Given the complex relationship between SEP and DNAm across the lifespan, these findings underscore the importance of analyzing SEP features, including timing, duration, and type. To guide future research, we highlight additional research gaps and propose four recommendations to further unravel the relationship between SEP and DNAm.

Changes in the role of explanatory factors for socioeconomic inequalities in physical performance: a comparative study of three birth cohorts

BACKGROUND

Due to societal changes and changes in the availability of health promoting factors, explanatory factors of socioeconomic inequalities in health (SIH) may change with time. We investigate differences in the relative importance of behavioural, social and psychological factors for explaining inequalities in physical performance between three birth cohorts.

METHODS

Data came from N = 988, N = 1002, and N = 1023 adults aged 55-64 years, collected in 1992, 2002 and 2012 as part of the Longitudinal Aging Study Amsterdam. Physical performance was measured by three performance tests. We included lifestyle factors (physical activity, smoking, alcohol use and Body Mass Index (BMI)); social factors (network size, network complexity, divorce, social support); and psychological factors (mastery, self-efficacy and neuroticism). In multi-group mediation models, we tested whether the strength of indirect effects from socioeconomic position (SEP) via the explanatory factors to health differed between birth cohorts. Stronger indirect effects indicate an increase in the importance; weaker indirect effects indicate a decrease in importance.

RESULTS

Absolute SIH were present and similar across cohorts. The strength of indirect effects of SEP on physical performance through smoking, binge alcohol use, emotional support and mastery increased across cohorts. The indirect effects of BMI, network size, self-efficacy and neuroticism were similar across cohorts.

CONCLUSIONS

Inequalities in smoking, binge alcohol use, emotional support and mastery may have become more important for explaining SIH in recent cohorts of middle-aged adults. Policies that aim to reduce socioeconomic inequalities may need to adapt their targets of intervention to changing mechanisms in order to reduce SIH.

Socioeconomic status and parent perceptions about the costs and benefits of youth sport

Objectives

Describe what costs and benefits parents across the socioeconomic spectrum weight most heavily when making decisions about sport participation for their children.

Method

Cross-sectional survey of a nationally representative online panel of parents of children between the ages of 5 and 18 (n = 1025, 52% response rate). Parents rated the importance of a series of potential costs and benefits of youth sport and these responses were compared across tertiles of per capita family income. We first examined the association between family income tertiles and cost and benefit variables. Model-based cluster analysis was then used to identity homogeneous groups of responses to costs and benefits.

Results

In all income tertiles, the top two benefits of sport were the same: having fun and being physically active. Sport as a means of keeping children out of trouble was very important for 64% of low-income parents as compared to 40% of high-income parents. Obtaining a college athletic scholarship was very important for 26% of low-income parents, as compared to 8% of high-income parents. Relative rankings of potential costs were similar by income tertile, with risk of concussion and other injury and the impact of sport on schoolwork prioritized across tertiles.

Conclusions

Parents prioritized fun and fitness in sport, and were concerned about injury and the impact of sport on academics. Lower income parents were the most likely to view keeping their child out of trouble, and the potential for a college athletics scholarship, as benefits of sport. Efforts to support parental decision making should be grounded in an understanding that family preferences are contextually constrained. While all parents should be appropriately informed about the potential costs and benefits they are weighting in their sports-related decision making, such family-focused efforts should be balanced with the recognition that structural change is needed to address income-related concerns about sport participation.

Psychological, social and cognitive resources and the mental wellbeing of the poor

Our study takes advantage of unique data to quantify deficits in the psychosocial and cognitive resources of an extremely vulnerable subpopulation–those experiencing housing vulnerability–in an advanced, high-income country (Australia). Groups such as these are often impossible to study using nationally representative data sources because they make up a small share of the overall population. We show that those experiencing housing vulnerability sleep less well, have more limited cognitive functioning, and less social capital than do those in the general population. They are also less emotionally stable, less conscientious, more external, and more risk tolerant. Collectively, these deficits in psychosocial and cognitive resources account for between 24–42% of their reduced life satisfaction and their increased mental distress and loneliness. These traits also account for a large proportion of the gap in mental wellbeing across different levels of housing vulnerability.

Stress-Related Poor Diet Quality Does Not Explain Socioeconomic Inequities in Health: A Structural Equation Mediation Analysis of Gender-Specific Pathways

BACKGROUND

Psychosocial stress and diet quality individually mediate associations between socioeconomic position (SEP) and health; however, it is not known whether they jointly mediate these associations. This is an important question because stress-related unhealthy eating is often invoked as an explanation for diet-related health inequities, particularly among women, seemingly with no empirical justification.

OBJECTIVE

This study examined whether psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women and men.

DESIGN

Multiple mediating pathways were modeled using data from the cross-sectional International Food Policy Study.

PARTICIPANTS AND SETTING

Data were collected from 5,645 adults (aged 18 years or older) in Canada during 2018 and 2019.

MAIN OUTCOME MEASURES

Participants reported SEP using indicators of materialist (educational attainment and perceived income adequacy) and psychosocial pathways (subjective social status), along with psychosocial stress, dietary intake (to assess overall diet quality via Healthy Eating Index-2015 scores), and self-rated health.

STATISTICAL ANALYSES PERFORMED

Structural equation modeling modeled pathways linking SEP (ie, educational attainment, perceived income adequacy, and subjective social status) with self-rated health mediated by psychosocial stress and diet quality, stratified by gender.

RESULTS

There was no evidence that psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women or men. Diet quality mediated associations between educational attainment and self-rated health in women and men, with some evidence that it mediated associations between subjective social status and self-rated health in men (P = 0.051). Psychosocial stress mediated associations between perceived income adequacy and self-rated health in women and men, and between subjective social status and self-rated health in women.

CONCLUSIONS

Although often invoked as an explanation for diet-related health inequities, stress-related poor diet quality did not mediate associations between SEP and self-rated health in women or men. Psychosocial stress and diet quality individually mediated some of these associations, with some differences by gender.

Mental Health as a Mediator of the Association Between Educational Inequality and Cardiovascular Disease: A Mendelian Randomization Study

Background Education is inversely associated with cardiovascular disease (CVD). Several mediators of this have been established; however, a proportion of the protective effect remains unaccounted for. Mental health is a proposed mediator, but current evidence is mixed and subject to bias from confounding factors and reverse causation. Mendelian randomization is an instrumental variable technique that uses genetic proxies for exposures and mediators to reduce such bias. Methods and Results We performed logistic regression and 2-step Mendelian randomization analyses using UK Biobank data and genetic summary statistics to investigate whether educational attainment affects risk of mental health disorders. We then performed mediation analyses to explore whether mental health disorders mediate the association between educational attainment and cardiovascular risk. Higher levels of educational attainment were associated with reduced depression, anxiety, and CVD in observational analyses (odds ratio [OR], 0.79 [95% CI, 0.77-0.81], 0.76 [95% CI, 0.73-0.79], and 0.75 [95% CI, 0.74-0.76], respectively), and Mendelian randomization analyses provided evidence of causality (OR, 0.72 [95% CI, 0.67-0.77], 0.50 [95% CI, 0.42-0.59], and 0.62 [95% CI, 0.58-0.66], respectively). Both anxiety and depression were associated with CVD in observational analyses (OR, 1.63 [95% CI, 1.49-1.79] and 1.70 [95% CI, 1.59-1.82], respectively) but only depression showed evidence of causality in the Mendelian randomization analyses (OR, 1.09; 95% CI, 1.03-1.15). An estimated 2% of the total protective effect of education on CVD was mediated by depression. Conclusions Higher levels of educational attainment protect against mental health disorders, and reduced depression accounts for a small proportion of the total protective effect of education on CVD.

Racial Disparities in Adverse Cardiovascular Outcomes After a Myocardial Infarction in Young or Middle-Aged Patients

Background

Black patients tend to develop coronary artery disease at a younger age than other groups. Previous data on racial disparities in outcomes of myocardial infarction (MI) have been inconsistent and limited to older populations. Our objective was to investigate racial differences in the outcome of MI among young and middle‐aged patients and the role played by socioeconomic, psychosocial, and clinical differences.

Methods and Results

We studied 313 participants (65% non‐Hispanic Black) <61 years old hospitalized for confirmed type 1 MI at Emory‐affiliated hospitals and followed them for 5 years. We used Cox proportional‐hazard models to estimate the association of race with a composite end point of recurrent MI, stroke, heart failure, or cardiovascular death after adjusting for demographic, socioeceonomic status, psychological, and clinical risk factors. The mean age was 50 years, and 50% were women. Compared with non‐Black patients, Black patients had lower socioeconomic status and more clinical and psychosocial risk factors but less angiographic coronary artery disease. The 5‐year incidence of cardiovascular events was higher in Black (35%) compared to non‐Black patients (19%): hazard ratio (HR) 2.1, 95% CI, 1.3 to 3.6. Adjustment for socioeconomic status weakened the association (HR 1.3, 95% CI, 0.8–2.4) more than adjustment for clinical and psychological risk factors. A lower income explained 46% of the race‐related disparity in outcome.

Conclusions

Among young and middle‐aged adult survivors of an MI, Black patients have a 2‐fold higher risk of adverse outcomes, which is largely driven by upstream socioeconomic factors rather than downstream psychological and clinical risk factors.

Barriers and facilitators to physical education, sport, and physical activity program participation among children and adolescents with psychiatric disorders: a systematic review

Children and adolescents with heterogeneous psychiatric disorders, of whom over 50% have a second psychiatric comorbidity, have low rates of physical activity and experience unique challenges to engaging in community-based exercise programming, school-based physical education programming, and targeted physical activity interventions. This contributes to elevated rates of gross and fine motor delays, lower mood and self-regulation, and increased risk of chronic diseases such as obesity and type 2 diabetes. Perform a systematic scoping review of the literature to assess known barriers to and facilitators of engaging in physical activity programming among children and adolescents with heterogeneous and/or comorbid psychiatric disorders, in order to improve engagement among this population in real world intervention settings. Systematic Boolean diagnostic and physical activity search terms were entered into PubMed, MEDLINE, PsycINFO and Web of Science for English-language studies published between 2005 and 2020, examining barriers and facilitators for common psychiatric diagnoses and general psychiatric population's engagement in physical activity, physical education, sports, or exercise interventions. Two reviewers independently reviewed titles, abstracts and full articles to determine inclusion. A total of 5,198 articles were returned; 39 relating to children and adolescents were qualified for full-text review. After review, 24 studies were included addressing barriers and facilitators across multiple diagnoses; 7 studies were quantitative, 10 were qualitative, and 7 were mixed methods. Major barriers included low motivation, low self-efficacy, depleted parental reserve capacity, social isolation, lack of staff training, and safety concerns. Major facilitators included peer support/engagement, exergames, supportive parental behaviors, and inclusive/adaptive programming. Numerous barriers and facilitators to physical activity have been identified which should inform community, school, clinical, and research intervention program design. Further research is needed to develop effective strategies that address the challenges to inclusion that children and adolescents with heterogeneous and/or comorbid psychiatric disorders face.