1
|
Lee EY, Airton L, Jung E, Lim H, Latimer-Cheung A, Szto C, Adams ML, Faulkner G, Ferguson L, Peers D, Phillips S, Yi KJ. Development and validation of the SAFE (Socially Ascribed intersectional identities For Equity) questionnaire. Acta Psychol (Amst) 2024; 245:104235. [PMID: 38531268 DOI: 10.1016/j.actpsy.2024.104235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/14/2024] [Accepted: 03/20/2024] [Indexed: 03/28/2024] Open
Abstract
Traditional questionnaires do not capture the complexity of how people are viewed by others and grouped into categories on the basis of what is inferred (or not) about them. This is critical in applying an intersectionality framework in research because people are negatively impacted because of "who they are" but also based on "how others see them." The purpose of this project was to develop and validate a questionnaire, grounded in intersectionality theory and a nuanced understanding of social position, that can be applied in large-scale, population-based surveys and studies. Drawing on 61 existing quantitative surveys collecting identity-based information and 197 qualitative studies on intersectionality describing the complex ways in which people's social positions are constructed and experienced, we created a draft questionnaire comprising five parts: 1) Sex and Gender, 2) Sexuality and Sexual Orientation, 3) Cultural Context, 4) Disability, Health, and Physical Characteristics, and 5) Socioeconomic Status. A draft of the questionnaire was then reviewed by experts via the Delphi process, which gauged the accessibility of the questionnaire (e.g., language used, length) and the relevance of its content using a 5-point scale and open-ended questions. These responses were ranked, analyzed, and synthesized to refine the questionnaire and, ultimately, to obtain ≥75 % consensus on each questionnaire item and response option. The SAFE questionnaire provides an opportunity to take a significant step forward in advancing our understanding of the complex, intersectional nature of social participation and marginalization.
Collapse
Affiliation(s)
- Eun-Young Lee
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada; Department of Gender Studies, Queen's University, Kingston, ON, Canada.
| | - Lee Airton
- Department of Gender Studies, Queen's University, Kingston, ON, Canada; Faculty of Education, Queen's University, Kingston, ON, Canada
| | - Eun Jung
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Heejun Lim
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Amy Latimer-Cheung
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Courtney Szto
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Mary Louise Adams
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Guy Faulkner
- School of Kinesiology, The University of British Columbia, Vancouver, BC, Canada
| | - Leah Ferguson
- College of Kinesiology, University of Saskatchewan, SK, Canada
| | - Danielle Peers
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, AB, Canada
| | - Susan Phillips
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Kyoung June Yi
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
2
|
Schovsbo SU, Dantoft TM, Thuesen BH, Leth-Møller KB, Eplov LF, Petersen MW, Jørgensen T, Osler M. Social position and functional somatic disorders: The DanFunD study. Scand J Public Health 2023; 51:225-232. [PMID: 34796745 DOI: 10.1177/14034948211056752] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM It is generally accepted that functional somatic disorders (FSDs) are a product of biological, psychological, and social factors. Social position might be part of this complex, but the literature on this issue is currently heterogeneous and inconsistent. The aim of the present study was - in a population-based cohort - to test the hypothesis that lower social position would be associated with higher a risk of FSD. METHOD The association between social position and FSD was examined in a cross-sectional study with various measures of social position (education as measured by vocational training; employment; cohabitation; subjective social status) and delimitations of FSD (irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia, bodily distress syndrome, and symptom profiles). The associations were analyzed using logistic regressions to calculate odds ratios and 95% confidence intervals. Each social measure was analyzed independently and was adjusted for age and sex. RESULTS Lower levels of vocational training, being unemployed, and living alone were associated with higher risk of FSD, regardless of the FSD delimitation. There was also a significant negative association between subjective evaluated social status and FSD. The associations remained after multiple adjustments, and seemed to be strongest for the more severe FSD-types. CONCLUSIONS
Lower social position is associated with higher risk of FSD, especially the more severe FSD delimitations, which might constitute an especially vulnerable group. However, the mechanisms behind the relations remain unknown.
Collapse
Affiliation(s)
- Signe U Schovsbo
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Denmark
| | - Thomas M Dantoft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Denmark
| | - Betina H Thuesen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Denmark
| | - Katja B Leth-Møller
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Denmark
| | - Lene F Eplov
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Denmark
| | - Marie W Petersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Denmark.,Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Denmark.,Faculty of Medicine, Aalborg University, Denmark
| | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Denmark.,Section for Epidemiology, University of Copenhagen, Denmark
| |
Collapse
|
3
|
Applebaum JW, McDonald SE, Zsembik BA. Longitudinal associations between allostatic load, pet ownership, and socioeconomic position among U.S. adults aged 50. SSM Popul Health 2023; 21:101344. [PMID: 36684398 DOI: 10.1016/j.ssmph.2023.101344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/15/2022] [Accepted: 01/13/2023] [Indexed: 01/15/2023] Open
Abstract
It is hypothesized that pets provide benefits to human health by buffering the deleterious effects of stress, but varying exposure to chronic stress via social position is rarely considered in these conceptual and empirical models. Allostatic load is an index of biological and physical measures that represents cumulative wear and tear on the body via chronic stress exposure. In this study, we use the 2006-2016 waves of the Health and Retirement Study, a nationally representative, longitudinal panel survey of adults aged 50+ in the United States, to test whether and to what extent pet ownership has an impact on allostatic load, and whether pet ownership moderates the effects of socioeconomic position on allostatic load. Linear mixed effects regression models revealed that pet owners had significantly lower allostatic load scores than those who do not own pets; however, after adjusting for socioeconomic position (i.e., wealth, education, race, ethnicity, gender, marital status), the effect of pet ownership was no longer significant. We estimated a series of models stratified by sociodemographic groups to test moderation effects. Among those who had a high school education, pet owners had lower allostatic load scores, whereas among those who had attended some college, pet owners had higher scores. Among those who were aged 80+, pet owners had higher scores than those who did not own pets. These findings suggest that the magnitude of the effect of pet ownership on allostatic load may not be sufficient to counteract experiences of high chronic stress as experienced by lower-status groups. Supporting the human-animal bond may contribute to improving older adult population health if paired with efforts to address the underlying causes of population health disparities.
Collapse
|
4
|
Misiak B, Stańczykiewicz B, Pawlak A, Szewczuk-Bogusławska M, Samochowiec J, Samochowiec A, Tyburski E, Juster RP. Adverse childhood experiences and low socioeconomic status with respect to allostatic load in adulthood: A systematic review. Psychoneuroendocrinology 2022; 136:105602. [PMID: 34861465 DOI: 10.1016/j.psyneuen.2021.105602] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/05/2021] [Accepted: 11/18/2021] [Indexed: 12/25/2022]
Abstract
Early-life psychosocial stress primes a number of health risk behaviors, and contributes to the development of various mental and somatic disorders in adulthood. It has been reported that adverse childhood experiences (ACEs) and low socioeconomic status (SES) might be associated with allostatic load (AL) in adulthood. In turn, elevated AL index has been found to predict a number of unfavorable health outcomes. Therefore, we aimed to perform a systematic review of studies investigating the association of ACEs and childhood SES with AL in adult populations. Independent online searches covered the publication period up to 20th Jun 2021. A total of 27 studies were included in qualitative synthesis. The majority of eligible studies showed that ACEs (14 out of 19 studies recording ACEs, 73.7%) and low childhood SES (11 out of 12 studies recording childhood SES, 91.7%) are associated with elevated AL in adults. However, several processes were found to mediate or moderate this association. These include educational attainments, social support, health behaviors, adult stress, post-traumatic stress disorder, coping strategies and aging. Moreover, a substantial methodological heterogeneity of approaches to calculating the AL index was observed. Apart from reports from overlapping samples, none of eligible studies used the same set of biomarkers. Findings from this systematic review imply that early-life psychosocial stress might have a lasting impact on biological dysregulations captured by the AL index. Future studies need to explore whether the association between early-life stress and the AL index accounts for the development of specific health outcomes.
Collapse
Affiliation(s)
- Błażej Misiak
- Department of Psychiatry, Division of Consultation Psychiatry and Neuroscience, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland.
| | - Bartłomiej Stańczykiewicz
- Department of Nervous System Diseases, Wroclaw Medical University, Bartla 5 Street, 51-618 Wroclaw, Poland
| | - Andrzej Pawlak
- Department of Nervous System Diseases, Wroclaw Medical University, Bartla 5 Street, 51-618 Wroclaw, Poland
| | | | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-457 Szczecin, Poland
| | - Agnieszka Samochowiec
- Department of Clinical Psychology, Institute of Psychology, University of Szczecin, Krakowska 69 Street, 71-017 Szczecin, Poland
| | - Ernest Tyburski
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-457 Szczecin, Poland; SWPS University of Social Sciences and Humanities, Institute of Psychology, Kutrzeby 10 Street, 61-719 Poznan, Poland
| | - Robert-Paul Juster
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, 7331 Hochelaga, FS-145-12, Montreal, Canada
| |
Collapse
|
5
|
Chesterman A, de Battista M, Causse E. Effects of social position and household affordances on COVID-19 lockdown resilience and coping. J Environ Psychol 2021; 78:101687. [PMID: 34584327 PMCID: PMC8460355 DOI: 10.1016/j.jenvp.2021.101687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 06/12/2021] [Accepted: 09/09/2021] [Indexed: 05/03/2023]
Abstract
In France, the COVID-19 pandemic and ensuing lockdown measures have created unprecedented circumstances that increase stress and anxiety, thus leading individuals experiencing home confinement to adopt various coping strategies that contribute to building resilience. Given the novelty and recency of the COVID-19 lockdown, factors of coping and resilience in this specific context of home confinement remain undefined. Based on some recent observations, we conducted a study on a convenience sample in France (N = 809) in order to investigate two potential factors of lockdown resilience and coping: social position and household affordances, while also exploring some complementary hypotheses based on the literature. Social position and household affordances were identified as significant predictors of lockdown coping and resilience, and low social position was found to coincide with less social support coping strategies. Results are discussed in relation to the theory and the limits identified in this study. Recommendations are made for potential second waves of COVID-19 spread or similar pandemics in the future.
Collapse
Affiliation(s)
- A Chesterman
- i2ml Foundation, 30000 Nîmes (France) / CRP-CPO Laboratory (E.A. 7273), Picardie Jules Verne University, 80025, Amiens, France
| | - M de Battista
- i2ml Foundation, 30000 Nîmes (France) / CHROME Laboratory (E.A. 7352), Nîmes University, 30000, Nîmes, France
| | - E Causse
- CHROME Laboratory (E.A. 7352), Nîmes University, 30000, Nîmes, France
| |
Collapse
|
6
|
de Vries E, Kaufman TML, Veenstra R, Laninga-Wijnen L, Huitsing G. Bullying and Victimization Trajectories in the First Years of Secondary Education: Implications for Status and Affection. J Youth Adolesc 2021; 50:1995-2006. [PMID: 33464443 DOI: 10.1007/s10964-020-01385-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 11/12/2022]
Abstract
Bullying is known to be associated with social status, but it remains unclear how bullying involvement over time relates to social position (status and affection), especially in the first years at a new school. The aim of this study was to investigate whether (the development of) bullying and victimization was related to the attainment of status (perceived popularity) and affection (friendships, acceptance, rejection) in the first years of secondary education (six waves). Using longitudinal data spanning the first- and second year of secondary education of 824 adolescents (51.5% girls; Mage T1 = 12.54, SD = 0.45) in the SNARE-study, joint bullying and victimization trajectories were estimated using parallel Latent Class Growth Analysis (LCGA). The four trajectories (decreasing bully, stable high bully, decreasing victim, uninvolved) were related to adolescents’ social position using multigroup analysis that examined differences in slope and intercepts (T1 and T6) of social positions, and indicated that the relative social position of the different joint trajectories was determined at the start of secondary education and did not change over time, with one exception: adolescents continuing bullying were besides being popular also increasingly rejected over time. Although bullying is functional behavior that serves to optimize adolescents’ social position, anti-bullying interventions may account for the increasing lack of affection that may hinder bullies’ long-term social development.
Collapse
|
7
|
Platt JM, Bates LM, Jager J, McLaughlin KA, Keyes KM. Changes in the depression gender gap from 1992 to 2014: Cohort effects and mediation by gendered social position. Soc Sci Med 2020; 258:113088. [PMID: 32540513 PMCID: PMC7377349 DOI: 10.1016/j.socscimed.2020.113088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
The depression gap (i.e., higher rates of depression among women than men) represents an important mental health disparity in the US. Differences in gendered social position (i.e., the roles, responsibilities, and opportunities available to women and men), which have been changing since the mid-20th Century may contribute to this gender gap. The present study examined the evidence for a changing depression gap across birth cohorts and tested the extent to which any changes over time were mediated by changes in relative social position between women and men. Data were from the National Longitudinal Surveys. The depression gap was defined as differences in mean CESD scores for women vs. men. The analytic sample included 13,666 respondents interviewed from 1992 to 2014. Hierarchical mixed models estimated the magnitude of the gender depression gap over time, its association with 10-year birth cohort (range: 1957-1994), and whether any variation was mediated by ratios among women relative to men of obtaining a college degree, being employed full-time, and the average number of hours spent doing housework per week, three indicators of gendered social position. There was a linear decrease in the depression gap by 0.18 points across birth cohort (95% CI = -0.26, -0.10). The results of the mediation analysis estimated that an increasing ratio of college degree attainment mediated 39% of the gender depression gap across cohorts (95% CI = 0.18, 0.78). There was no evidence of mediation due to changing employment or housework ratios. These findings partially support the hypothesis that the depression gap is changing over time and is meaningfully related to the social environment. Understanding the social causes of the depression gap can illuminate the fundamental processes through which depression disparities may be perpetuated or attenuated over time and may aid in the identification of strategies to reduce them.
Collapse
Affiliation(s)
- Jonathan M Platt
- Department of Epidemiology, Columbia University, New York, NY, USA.
| | - Lisa M Bates
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Justin Jager
- Department of Psychology Arizona State University, Tempe, AZ, USA
| | | | | |
Collapse
|
8
|
Svendsen MT, Bak CK, Sørensen K, Pelikan J, Riddersholm SJ, Skals RK, Mortensen RN, Maindal HT, Bøggild H, Nielsen G, Torp-Pedersen C. Associations of health literacy with socioeconomic position, health risk behavior, and health status: a large national population-based survey among Danish adults. BMC Public Health 2020; 20:565. [PMID: 32345275 PMCID: PMC7187482 DOI: 10.1186/s12889-020-08498-8] [Citation(s) in RCA: 172] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 03/10/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Health literacy concerns the ability of citizens to meet the complex demands of health in modern society. Data on the distribution of health literacy in general populations and how health literacy impacts health behavior and general health remains scarce. The present study aims to investigate the prevalence of health literacy levels and associations of health literacy with socioeconomic position, health risk behavior, and health status at a population level. METHODS A nationwide cross-sectional survey linked to administrative registry data was applied to a randomly selected sample of 15,728 Danish individuals aged ≥25 years. By the short form HLS-EU-Q16 health literacy was measured for the domains of healthcare, disease prevention, and health promotion. Adjusted multinomial logistic regression analyses were used to estimate associations of health literacy with demographic and socioeconomic characteristics, health risk behavior (physical activity, smoking, alcohol consumption, body weight), and health status (sickness benefits, self-assessed health). RESULTS Overall, 9007 (57.3%) individuals responded to the survey. Nearly 4 in 10 respondents faced difficulties in accessing, understanding, appraising, and applying health information. Notably, 8.18% presented with inadequate health literacy and 30.94% with problematic health literacy. Adjusted for potential confounders, regression analyses showed that males, younger individuals, immigrants, individuals with basic education or income below the national average, and individuals receiving social benefits had substantially higher odds of inadequate health literacy. Among health behavior factors (smoking, high alcohol consumption, and inactivity), only physical behavior [sedentary: OR: 2.31 (95% CI: 1.81; 2.95)] was associated with inadequate health literacy in the adjusted models. The long-term health risk indicator body-weight showed that individuals with obesity [OR: 1.78 (95% CI: 1.39; 2.28)] had significantly higher odds of lower health literacy scores. Poor self-assessed health [OR: 4.03 (95% CI: 3.26; 5.00)] and payments of sickness absence compensation benefits [OR: 1.74 (95% CI: 1.35; 2.23)] were associated with lower health literacy scores. CONCLUSIONS Despite a relatively highly educated population, the prevalence of inadequate health literacy is high. Inadequate health literacy is strongly associated with a low socioeconomic position, poor health status, inactivity, and overweight, but to a lesser extent with health behavior factors such as smoking and high alcohol consumption.
Collapse
Affiliation(s)
- Majbritt Tang Svendsen
- Department of Cardiology, North Denmark Regional Hospital, Bispensgade 37, 9800 Hjørring, Denmark
- Centre for Clinical Research, North Denmark Regional Hospital / Clinical Institute of Medicine, Aalborg University , Hjørring, Denmark
| | - Carsten Kronborg Bak
- Department of Research and Development, University College South, Kolding, Denmark
| | | | | | - Signe Juul Riddersholm
- Department of Anesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Regitze Kuhr Skals
- Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | | | - Helle Terkildsen Maindal
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Aarhus, Denmark
| | - Henrik Bøggild
- Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Gitte Nielsen
- Department of Cardiology, North Denmark Regional Hospital, Bispensgade 37, 9800 Hjørring, Denmark
| | - Christian Torp-Pedersen
- Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| |
Collapse
|
9
|
Rausch C, Liang Y, Bültmann U, de Rooij SE, Johnell K, Laflamme L, Möller J. Social position and geriatric syndromes among Swedish older people: a population-based study. BMC Geriatr 2019; 19:267. [PMID: 31615441 DOI: 10.1186/s12877-019-1295-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/26/2019] [Indexed: 01/12/2023] Open
Abstract
Background Older people with a low social position are at higher risk of poor health outcomes compared to those with a higher social position. Whether lower social position also increases the risk of geriatric syndromes (GSs) remains to be determined. This study investigates the association of social position with GSs among older community-dwellers. Methods Three consecutive population-based health surveys in 2006, 2010 and 2014 among older community-dwellers (age 65–84 years) in Stockholm County were combined (n = 17,612) and linked with Swedish administrative registry information. Social position was assessed using registry information (i.e. education, country of origin and civil status) and by self-reports (i.e. type of housing and financial stress). GSs were assessed by self-reports of the following conditions: insomnia, urinary incontinence, functional decline, falls, depressive disorder, hearing or vision problems. Binomial logistic regression analyses were used to estimate the association between social position and GSs after adjusting for age, sex, health status, health behavior and social stress. Results The prevalence of GSs was 70.0%, but varied across GSs and ranged from 1.9% for depression to 39.1% for insomnia. Living in rented accommodation, being born outside the Nordic countries, being widowed or divorced were associated with GS presence. Financial stress was most strongly associated with GSs (adjusted odds ratio, 2.59; 95% CI, 2.13–3.15). Conclusion GSs are highly prevalent among older Swedish community-dwellers with wide variations across syndromes and strong association with all measures of social position, most strikingly that of experiencing financial stress.
Collapse
|
10
|
Abstract
As currently conceived, precision public health is at risk of becoming precision medicine at a population level. This paper outlines a framework for precision public health that, in contrast to its current operationalisation, is consistent with public health principles because it integrates factors at all levels, while illuminating social position as a fundamental determinant of health and health inequities. We review conceptual foundations of public health, outline a proposed framework for precision public health and describe its operationalisation within research and practice. Social position shapes individuals' unequal experiences of the social determinants of health. Thus, in our formulation, precision public health investigates how multiple dimensions of social position interact to confer health risk differently for precisely defined population subgroups according to the social contexts in which they are embedded, while considering relevant biological and behavioural factors. It leverages this information to uncover the precise and intersecting social structures that pattern health outcomes, and to identify actionable interventions within the social contexts of affected groups. We contend that studies informed by this framework offer greater potential to improve health than current conceptualisations of precision public health that do not address root causes. Moreover, expanding beyond master categories of social position and operationalising these categories in more precise ways across time and place can enrich public health research through greater attention to the heterogeneity of social positions, their causes and health effects, leading to the identification of points of intervention that are specific enough to be useful in reducing health inequities. Failure to attend to this level of particularity may mask the true nature of health risk, the causal mechanisms at play and appropriate interventions. Conceptualised thus, precision public health is a research endeavour with much to offer by way of understanding and intervening on the causes of poor health and health inequities.As currently conceived, precision public health is at risk of becoming precision medicine at a population level. This paper outlines a framework for precision public health that, in contrast to its current operationalization, is consistent with public health principles because it integrates factors at all levels, while illuminating social position as a fundamental determinant of health and health inequities. We review conceptual foundations of public health, outline a proposed framework for precision public health and describe its operationalization within research and practice. Social position shapes individuals' unequal experiences of the social determinants of health. Thus, in our formulation, precision public health investigates how multiple dimensions of social position interact to confer health risk differently for precisely defined population subgroups according to the social contexts in which they are embedded, while considering relevant biological and behavioural factors. It leverages this information to uncover the precise and intersecting social structures that pattern health outcomes, and to identify actionable interventions within the social contexts of affected groups. We contend that studies informed by this framework offer greater potential to improve health than current conceptualizations of precision public health that do not address root causes. Moreover, expanding beyond master categories of social position and operationalizing these categories in more precise ways across time and place can enrich public health research through greater attention to the heterogeneity of social positions, their causes and health effects, leading to identification of points of intervention that are specific enough to be useful in reducing health inequities. Failure to attend to this level of particularity may mask the true nature of health risk, the causal mechanisms at play and appropriate interventions. Conceptualized thus, precision public health is a research endeavour with much to offer by way of understanding and intervening on the causes of poor health and health inequities.
Collapse
Affiliation(s)
- Dana Lee Olstad
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lynn McIntyre
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
11
|
Waldhauer J, Kuntz B, Lampert T. [Differences in subjective health, mental health, and health behavior among 11- to 17-year-olds at secondary schools in Germany : Results of the German health interview and examination survey for children and adolescents: first follow-up (KiGGS Wave 1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:374-384. [PMID: 29470591 DOI: 10.1007/s00103-018-2704-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Social inequalities in health can already be found among children and adolescents to the disadvantage of socially deprived population groups. This paper aims to detect, whether differences in subjective health, mental health and health behavior among young people are due to the secondary school type attended and whether these associations exist independently of the family's socioeconomic position (SEP). METHODS The data basis was the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 1, 2009-2012). Data of 11- to 17-year-old girls and boys (n = 4665) who attend different types of secondary schools in Germany were analyzed. The dependent variables were self-rated health, findings of the Strengths and Difficulties Questionnaire (SDQ) for the detection of psychological abnormalities, as well as self-reported information regarding leisure sport, tobacco, and alcohol consumption. Prevalence and odds ratios (ORs) based on logistic regressions are shown. RESULTS For the majority of the examined indicators, it can be shown that adolescents in lower secondary schools are more likely to report worse self-rated health and mental problems and engage in unhealthy behavior than peers in grammar schools ("Gymnasium"). The differences decrease after controlling for family's SEP but mostly remain statistically significant. Adolescents who don't attend grammar schools are most strongly disadvantaged in terms of inattention/hyperactivity for both gender (OR: 2.29 [1.70-3.08]), smoking among girls (2.91 [1.85-4.57]) and physical inactivity (no leisure sport) among boys (OR: 2.71 [1.85-3.95]). DISCUSSION Unequal health opportunities should be viewed in relation to people's living conditions. For adolescents, school constitutes an important setting for learning, experience, and health. The results indicate divergent needs of school-based health promotion and prevention regarding differences among gender and type of school.
Collapse
Affiliation(s)
- Julia Waldhauer
- Fachgebiet Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland.
| | - Benjamin Kuntz
- Fachgebiet Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| | - Thomas Lampert
- Fachgebiet Soziale Determinanten der Gesundheit, Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
| |
Collapse
|
12
|
Martinez-Parra AG, Abadía-Barrero CE, Murata C, Méndez Ramírez I, Méndez Gómez-Humaran I. Social Class for Collective Health Research: A Conceptual and Empirical Challenge. Glob Public Health 2018; 14:977-995. [PMID: 30407893 DOI: 10.1080/17441692.2018.1541098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Social Determination of Health (SDH)/Collective Health is a Latin American framework that sees the Marxist core concept of social class as fundamental for understanding health inequalities. In contrast to social stratification approaches, Marxist proposals seek to understand health as part of the historical transformations of capitalism's mode of production. In this article we aim to analyze the relationship between social class and health inequalities using data from the IV Oral Health National Study in Colombia. We conducted hierarchical cluster analyses to classify the population in five class positions and three living conditions clusters, which reflect how the spheres of production and social reproduction relate to social classes in Colombia. To measure oral health we use DMFT, as well as care and treatment needs indexes. Through variance analysis models we found that people from more exploited class positions and worse living conditions have more active disease and higher treatment needs. Despite technical and conceptual challenges, we conclude that a social class analytical framework can be operationalised via the interrelated spheres of production and social reproduction, which sheds light on the relationship between health inequalities and the class structure of the capitalist system.
Collapse
Affiliation(s)
- Adriana Gisela Martinez-Parra
- a Doctorado en Ciencias en Salud Colectiva , Universidad Autónoma Metropolitana - Unidad Xochimilco , Mexico City , Mexico
| | | | - Chiharu Murata
- c Departamento de Metodología de la investigación , Instituto Nacional de Pediatría , Mexico City , Mexico.,d Departamento de sistemas biologicos , Universidad Autónoma Metropolitana - Unidad Xochimilco , Mexico City , Mexico
| | - Ignacio Méndez Ramírez
- e Instituto de Investigaciones en Matemáticas Aplicadas y Sistemas , Universidad Nacional Autónoma de México , Mexico City , Mexico
| | | |
Collapse
|
13
|
Abstract
Purpose The purpose of this paper is to examine how knowledge exchange between academics and clinicians in Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) is influenced by their social position based on their symbolic and social capitals, that is, their personal professional status and connections to high-status professional peers, knowledge brokers, and unfamiliar professional peers. Design/methodology/approach Using an online survey, the author triangulates the cross-sectional measurement of the effects of academic and clinicians' social position in the initial and later phases of CLAHRCs with the longitudinal measurement of these effects over a two-year period. Findings First, academics and clinicians with a higher personal professional status are more likely to develop joint networks and decision making both in the early and later phases of a CLAHRC. Second, academics and clinicians who are more connected to higher status occupational peers are more likely to develop joint networks in the early phase of a knowledge exchange partnership but are less likely to become engaged in joint networks over time. Third, involvement of knowledge brokers in the networks of academics and clinicians is likely to facilitate their inter-professional networking only in the later partnership phase. Practical implications Academics and clinicians' capitals have a distinctive influence on knowledge exchange in the early and later phases of CLAHRCs and on a change in knowledge exchange over a two-year period. Originality/value Prior research on CLAHRCs has examined how knowledge exchange between academics and clinicians can be encouraged by the creation of shared governance mechanisms. The author advances this research by highlighting the role of their social position in facilitating knowledge exchange.
Collapse
Affiliation(s)
- Girts Racko
- Warwick Business School, University of Warwick , Coventry, UK
| |
Collapse
|
14
|
Landstedt E, Brydsten A, Hammarström A, Virtanen P, Almquist YB. The role of social position and depressive symptoms in adolescence for life-course trajectories of education and work: a cohort study. BMC Public Health 2016; 16:1169. [PMID: 27863527 PMCID: PMC5116205 DOI: 10.1186/s12889-016-3820-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/04/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND While a vast amount of studies confirm the social reproduction of class and status from one generation to the next, less is known about the role of health in the child generation for these processes. Research has shown that particularly mental distress in adolescence is important for future life chances. This study aimed to examine the importance of parental socioeconomic position and depressive symptoms in youth for life-course trajectories of education and labour market attachment among men and women. METHODS Based on four waves of questionnaire data from the Northern Swedish Cohort (n = 1,001), consisting of individuals born in 1965, three steps of gender-separate analyses were undertaken. First, the individual trajectories of education and labour market attachment from age 18 to 42 were mapped through sequence analysis. Second, cluster analysis was used to identify typical trajectories. Third, two indicators of parental socioeconomic position - occupational class and employment status - and depressive symptoms at age 16 were used in multinomial regression analyses to predict adult life-course trajectories. RESULTS Four typical trajectories were identified for men, of which three were characterised by stable employment and various lengths of education, and the fourth reflected a more unstable situation. Among women, five trajectories emerged, characterised by more instability compared to men. Low parental occupational class and unemployment were significantly associated with a higher risk of ending up in less advantaged trajectories for men while, for women, this was only the case for occupational class. Youth levels of depressive symptoms did not significantly differ across the trajectories. CONCLUSIONS This study found support for the intergenerational reproduction of social position, particularly when measured in terms of parental occupational class. Youth depressive symptoms did not show clear differences across types of trajectories, subsequently impeding such symptoms to trigger any selection processes. While this could be a consequence of the specific framework of the current study, it may also suggest that depressive symptoms in youth are not a root cause for the more complex processes through which how social position develops across life. The possible impact of welfare and labour market policies is discussed.
Collapse
Affiliation(s)
- Evelina Landstedt
- Department of Public Health and Clincial Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anna Brydsten
- Department of Public Health and Clincial Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anne Hammarström
- Department of Public Health and Clincial Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Pekka Virtanen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Ylva B. Almquist
- Centre for Health Equity Studies (CHESS) Stockholm University/Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
15
|
Kwate NOA, Goodman MS. An empirical analysis of White privilege, social position and health. Soc Sci Med 2014; 116:150-60. [PMID: 25014267 DOI: 10.1016/j.socscimed.2014.05.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/28/2014] [Accepted: 05/25/2014] [Indexed: 10/25/2022]
Abstract
Accumulated evidence has demonstrated that social position matters for health. Those with greater socioeconomic resources and greater perceived standing in the social hierarchy have better health than those with fewer resources and lower perceived standing. Race is another salient axis by which health is stratified in the U.S., but few studies have examined the benefit of White privilege. In this paper, we investigated how perceptions of inequality and subjective and objective social status affected the health and well-being of N = 630 White residents in three Boston neighborhoods lying on a social gradient differentiated by race, ethnicity, income and prestige. Outcomes were self-rated health, dental health, and happiness. Results suggested that: neighborhood residence was not associated with health after controlling for individual level factors (e.g., positive ratings of the neighborhood, education level); objective measures of socioeconomic status were associated with better self-reported and dental health, but subjective assessments of social position were more strongly associated; and White residents living in the two wealthiest neighborhoods, and who perceived Black families as welcome in their neighborhoods enjoyed better health than those who believed them to be less welcome. However, those who lived in the least wealthy and most diverse neighborhood fared worse when reporting Black families to be welcome. These results suggest that White privilege and relative social position interact to shape health outcomes.
Collapse
Affiliation(s)
- Naa Oyo A Kwate
- Departments of Human Ecology and Africana Studies, Rutgers, The State University of New Jersey, 55 Dudley Rd, Cook Office Building, New Brunswick, NJ 08901-8520, USA.
| | - Melody S Goodman
- Division of Public Health Sciences Department of Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO 63110, USA
| |
Collapse
|
16
|
Wrona D, Listowska M, Kubera M, Glac W, Grembecka B, Plucińska K, Majkutewicz I, Podlacha M. Effects of chronic desipramine pretreatment on open field-induced suppression of blood natural killer cell activity and cytokine response depend on the rat's behavioral characteristics. J Neuroimmunol 2013; 268:13-24. [PMID: 24461377 DOI: 10.1016/j.jneuroim.2013.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 09/28/2013] [Accepted: 10/03/2013] [Indexed: 11/26/2022]
Abstract
Effects of 14 consecutive day exposure to desipramine (10mg/kg i.p.), by itself or following chronic open field (OF) exposure, on subsequent neuroimmunological effects of acute (30 min) OF stress and the involvement of individual differences in response to novelty or social position in the anti-depressive responsiveness were investigated. Chronic desipramine pretreatment did not protect against OF stress-induced suppression of blood anti-tumor natural killer cell activity but increased plasma interleukin-10 and decreased interferon-γ and corticosterone concentration. These effects were particularly dangerous for the animals with increased responsivity to stress (desipramine alone) or with low behavioral activity (desipramine after chronic stress).
Collapse
Affiliation(s)
- Danuta Wrona
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308 Gdańsk, Poland.
| | - Magdalena Listowska
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308 Gdańsk, Poland
| | - Marta Kubera
- Department of Experimental Neuroendocrinology, Institute of Pharmacology, PAS, Smętna 12, 31-343 Kraków, Poland
| | - Wojciech Glac
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308 Gdańsk, Poland
| | - Beata Grembecka
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308 Gdańsk, Poland
| | - Karolina Plucińska
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308 Gdańsk, Poland
| | - Irena Majkutewicz
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308 Gdańsk, Poland
| | - Magdalena Podlacha
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308 Gdańsk, Poland
| |
Collapse
|