Stress, life events, and socioeconomic disparities in health: results from the Americans' Changing Lives Study

It has been hypothesized that exposure to stress and negative life events is related to poor health outcomes, and that differential exposure to stress plays a role in socioeconomic disparities in health. Data from three waves of the Americans' Changing Lives study (n = 3,617) were analyzed to investigate prospectively the relationship among socioeconomic indicators, five measures of stress/negative life events, and the health outcomes of mortality, functional limitations, and self-rated health. The results revealed that (1) life events and other types of stressors are clearly related to socioeconomic position; (2) a count of negative lifetime events was positively associated with mortality; (3) a higher score on a financial stress scale was predictive of severe/moderate functional limitations and fair/poor self-rated health at wave 3; and (4) a higher score on a parental stress scale was predictive of fair/poor self-rated health at wave 3. The negative effects of low income on functional limitations attenuated to insignificance when waves 1 and 2 stress/life event measures were controlled for, but other socioeconomic disparities in health change remained sizable and significant when adjusted for exposure to stressors. The results support the hypothesis that differential exposure to stress and negative life events is one of many ways in which socioeconomic inequalities in health are produced in society.     

Racial differences in depression trajectories among older women: socioeconomic, family, and health influences

Despite recent increases in life course research on mental illness, important questions remain about the social patterning of, and explanations for, depression trajectories among women in later life. The authors investigate competing theoretical frameworks for the age patterning of depressive symptoms and the physical health, socioeconomic, and family mechanisms differentiating black and white women. Using data from the National Longitudinal Survey of Mature Women, the authors use linear mixed (growth curve) models to estimate trajectories of distress for women aged 52 to 81 years (N = 3,182). The results demonstrate that: (1) there are persistently higher levels of depressive symptoms among black women relative to white women throughout later life; (2) physical health and socioeconomic status account for much of the racial gap in depressive symptoms; and (3) marital status moderates race differences in distress. The findings highlight the importance of physical health, family, and socioeconomic status in racial disparities in mental health.     

Race-Ethnicity and Health Trajectories: Tests of Three Hypotheses across Multiple Groups and Health Outcomes

Racial-ethnic disparities in static levels of health are well documented. Less is known about racial-ethnic differences in age trajectories of health. The few studies on this topic have examined only single health outcomes and focused on black-white disparities. This study extends prior research by using a life course perspective, panel data from the Health and Retirement Study, and multilevel growth curve models to investigate racial-ethnic differences in the trajectories of serious conditions and functional limitations among blacks, Mexican Americans, and whites. We test three hypotheses on the nature of racial-ethnic disparities in health across the life course (aging-as-leveler, persistent inequality, and cumulative disadvantage). Results controlling for mortality selection reveal that support for the hypotheses varies by health outcome, racial-ethnic group, and life stage. Controlling for childhood socioeconomic status, adult social and economic resources, and health behaviors reduces but does not eliminate racial-ethnic disparities in health trajectories.     

Disability and physical activity in late life—research models and approaches

Prevention of disability in late life has become a major public health concern, a key area of ageing research, and also an important target for the development of effective interventions. The increase in life expectancy and the resulting growth of the elderly population are also thought to be driving up the number of elderly people with disabilities. Despite the message that regular moderate physical activity has substantial health benefits even in very old age, older people remain largely sedentary. The most popular theoretical model for researching the development of disability is the disablement process, which is widely used, in the gerontological literature. The main pathway according to this model leads from diseases and injuries to impairments, functional limitations, and disability. This approach has been challenged most particularly by models, which emphasize the social construction and determinants of disability. Numerous physical exercise interventions have aimed at preventing impairments, functional limitations and disability, and at promoting independent living in late life. A review of the results of these interventions shows that exercise can indeed be effective in preventing impairments and functional limitations, but the evidence regarding the prevention of disability and dependency is inconclusive. The inconsistency of the results is related to differences in research models and approaches, cultural and other differences between the populations studied, and variability in research designs and methods, including definitions of key variables. In the future, research-addressing disability in late life needs to focus on the dynamic interactions between individuals and their social, physical, and cultural environment. Furthermore, randomized trials that are larger and longer than most existing studies of physical activity need to be conducted. Additional evidence can also be obtained by well-conducted observational studies focusing on the prevention of progressive disability related to chronic conditions. One of the key areas of development is in improving the definition of both independent (physical activity and exercise) and outcome (functional limitations, disability) variables. A further challenge is presented by the investigation of dose–response relationships, including both beneficial and possible adverse effects of exercise.     

Physical activity, genes, and lifetime predisposition to chronic disease

This mini-review summarizes the main associations between physical activity and chronic diseases and discusses the basic concepts related to the role of genetic factors in studies evaluating the effects of physical activity/exercise therapy on chronic disease prevention/treatment during the life course. Many observational cohort studies have shown that high physical activity during young adulthood or middle age is associated with reduced later life morbidity, mobility limitations and mortality. Physical activity or exercise therapy has a positive effect on health via many disease-specific mechanisms. The most consistent finding of the various randomized controlled studies conducted to date is that aerobic/functional capacity and/or muscle strength can be improved by exercise training among patients with different chronic diseases. Genes are known to play a role in chronic disease predisposition and to contribute to physical fitness levels, physical activity participation and ageing. Physical fitness, physical activity and health outcomes may be partly due to underlying genetic factors that have a favourable effect on all these traits (genetic pleiotropy). This means that in observational studies, the relationship between baseline activity and the later occurrence of diseases may not be interpreted entirely as causal. Increased knowledge on the role of nuclear genome, mitochondrial genome, epigenetics, telomeres and regulation of gene expression will increase our understanding of their relationships with physical activity and morbidity.     

The urban neighborhood and cognitive functioning in late middle age

This study examines the association of cognitive functioning with urban neighborhood socioeconomic disadvantage and racial/ethnic segregation for a U.S. national sample of persons in late middle age, a time in the life course when cognitive deficits begin to emerge. The key hypothesis is that effects of neighborhood on cognitive functioning are not uniform but are most pronounced among subgroups of the population defined by socioeconomic status and race/ethnicity. Data are from the third wave of the Health and Retirement Survey for the birth cohort of 1931 to 1941, which was 55 to 65 years of age in 1996 (analytic N = 4,525), and the 1990 U.S. Census. Neighborhood socioeconomic disadvantage has an especially large negative impact on cognitive functioning among persons who are themselves poor, an instance of compound disadvantage. These findings have policy implications supporting "upstream" interventions to enhance cognitive functioning, especially among those most adversely affected by neighborhood socioeconomic disadvantage.     

Understanding social factors and inequalities in health: 20th century progress and 21st century prospects

The development of social epidemiology and medical sociology over the last half of the 20th century, in which Leo Reeder played a central role, transformed scientific and popular understanding of the nature and causes of physical health and illness. Viewed in the early 1950s as shaped almost entirely by biological processes and medical care, physical health and illness are now understood to be as much or more a function of social, psychological, and behavioral factors. Utilizing a stress and adaptation conceptual framework, social epidemiology has identified a broad range of psychosocial risk factors for health, most notably: (1) social relationships and support; (2) acute or event-based stress; (3) chronic stress in work and life; and (4) psychological dispositions such as anger/hostility, lack of self-efficacy/control, and negative affect/hopelessness/pessimism, with new risk factors continuing to be identified. However, proliferation of risk factors must be balanced by conceptual integration and causal understanding of the relationships among them, their causes, and consequences. One source of such integration and understanding has been the rediscovery of large and persistent socioeconomic and racial-ethnic disparities in health. Socioeconomic position and race/ethnicity shape individuals' exposure to and experience of virtually all known psychosocial, and well as many environmental and biomedical, risk factors, and these risk factors help to explain the size and persistence of social disparities in health. Improving the socioeconomic position of a broad range of disadvantaged socioeconomic and racial-ethnic strata constitutes a major avenue for reducing exposure to and experience of deleterious risk factors for health, and hence for improving the health of these groups and the overall population. This in turn requires better understanding of the macrosocial forces that influence the socioeconomic position of individuals.     

Post-traumatic stress disorder and health-related quality of life in female victims of intimate partner violence

The association between post-traumatic stress disorder (PTSD) and health-related quality of life (QOL) in female victims of intimate partner violence (IPV) was examined. The Short-Form Health Survey (SF-36) was used to evaluate health-related QOL. IPV victims with PTSD (IPV/PTSD+; n = 18), IPV victims without PTSD (IPV/PTSD-; n = 22), and a non-abused control group (NA; n = 30) were compared. Multiple Analyses of Covariance (covarying for socioeconomic status and age) indicated that the three groups scored significantly differently on health-related QOL, and the IPV/PTSD- group was significantly more impaired than the NA group. IPV/PTSD+ subjects were significantly more impaired than IPV/PTSD- subjects on physical functioning, mental health, vitality, role limitations due to emotional health, and social functioning. Multiple regression analyses indicated that PTSD severity was a significant statistical predictor of SF-36 mental health composite scores (but not of physical health composite scores), after controlling for depressive symptomatology and extent of physical and psychological abuse.     

The effectiveness of adult day services for disabled older people

Adult day care has attracted a considerable amount of attention among researchers, practitioners, and policymakers. However, there have been few efforts to synthesize empirical results. This paper reviews research that determines the effectiveness of adult day services in improving client functioning, alleviating caregiver stress, and delaying nursing home placement. In addition, the strengths and limitations of the research are considered. This paper concludes with a discussion of policy-relevant issues that must be addressed when determining the effectiveness of adult day services.     

The effect of aging on skeletal-muscle recovery from exercise: possible implications for aging athletes

Recovery from exercise is integral to the physical training process. There is a perception among older athletes that aging negatively affects the recovery process. Plausible arguments for an impaired recovery with aging are a greater susceptibility of older muscle to exercise-induced skeletal-muscle damage and a slower repair and adaptation response. Differences in the physical activity level of the research participants are rarely considered, however. This makes it difficult to differentiate the respective roles of declining physical activity and aging on the recovery process. Furthermore, the type of exercise used to induce damage and monitor recovery is often not indicative of a normal training stimulus for athletes. This review discusses the effects of aging on skeletal-muscle damage and recovery processes and highlights the limitations of many of these studies with respect to older athletes. Future research should use an exercise intervention representative of a normal training stimulus and take the physical activity level of the participants into account.     

Relationships between Early Life Victimization,Antisocial Traits,and Sexual Violence: Executive Functioning as a Mediator

ABSTRACT

Few research studies examine how the relationship between trauma and executive functioning can influence sexual violence among youth. Knight and Sims-Knight (2004) proposed a Developmental Etiological Theory (DET) connecting early life physical and sexual victimization to sexual violence via antisocial traits. Drawing from research that identifies a link between early life victimization and executive functioning, this study tests an adaptation to the DET by including executive functioning as an intervening factor. Using data on adolescents adjudicated of sexual and non-sexual crimes in a western state (N = 200), multiple structural equation models tested direct and indirect relationships between early life sexual, physical victimization, and other adversity, four differential forms of executive functioning, callousness, and sexual violence. Results revealed statistically significant direct pathways between variables of interest and a multi-meditational effect of certain forms of executive functioning and callousness in the relationship between victimization and sexual violence. Treatment and research implications are discussed.     

A life course approach: research orientations and future challenges

The need to study lifelong changes in health and functioning has resulted in increasing emphasis on a life course approach in different fields of inquiry. The aim of this approach is to explore how biological, psychological, and social risk factor trajectories, acting across the entire life course, influence age-related diseases, functional decline, and disability. The importance of the first years of life upon later development and adult characteristics was generally recognized already in the first half of the twentieth century, but it was not until the 1990s that different strands of medical and social research converge in the field of life course epidemiology, in which epidemiological processes are approached using different models such as biological programming, critical periods, pathways, and accumulation. The biological programming model holds that organ development in utero and early infancy determines the maximum functional capacity that an individual can attain and influences the development of certain chronic diseases later in life. The critical period model extends the idea to include child development and key social transitions over the entire life course. The pathway model focuses on the cumulative effect of life events along the developmental trajectories, with early advantage or disadvantage setting a person on a pathway to a later etiologically important exposure. The accumulation model describes the underlying social, behavioral, and biological processes that drive the impact of the life course on health. The growing focus on life course determinants of aging also has implications for studies of long-term changes in physical activity and their role in determining both gains and losses of health and functioning with aging. A life course approach presents great challenges for the continued development of testable theoretical models and effective study design and analysis.     

Race,Ethnicity, and Culture in Studies of Families in Context

Family scholars have developed a greater sensitivity to the relative neglect of families of color in research. However, there are a number of limitations in the research on families of color; specifically, race and ethnicity are often confounded with socioeconomic indicators and community of residence. This makes it difficult to identify the true effects of ethnicity and culture. In addition, race and ethnicity may interact with chronic poverty in such a way as to further interfere with and reduce life opportunities. Here we discuss some of the theoretical and conceptual issues pertaining to race, ethnicity, and culture as they affect family functioning and children's development. In addition, we introduce a collection of papers that address family functioning and children's development among families who are diverse ethnically, racially, socioeconomically, and by geographical location and community. The issues posed in this paper and in the Special Section challenge the field to reconsider how we study families and child development from culturally grounded perspectives.     

The Effectiveness of Adult Day Services for Disabled Older People

Abstract

Adult day care has attracted a considerable amount of attention among researchers, practitioners, and policymakers. However, there have been few efforts to synthesize empirical results. This paper reviews research that determines the effectiveness of adult day services in improving client functioning, alleviating caregiver stress, and delaying nursing home placement. In addition, the strengths and limitations of the research are considered. This paper concludes with a discussion of policy-relevant issues that must be addressed when determining the effectiveness of adult day services.     

Socioeconomic status and cumulative disadvantage processes across the life course: implications for health outcomes

Given the complexity surrounding various interactions among health determinants and the challenge of being able to adequately describe the dynamic processes through which health determinants have their effects, the purpose of this paper is to provide a conceptual overview demonstrating the effects of socioeconomic status and cumulative disadvantage on producing health disparities across the life course. The idea underlying cumulative disadvantage is that socioeconomic-based health inequalities will increase across the life course, mostly because of differential exposure to risk factors and access to protective resources. The advantage of life course sociology is its consideration of early life experiences, and the social and historical context of their occurrences, as important contingencies in producing these systematic socioeconomic differences in health gradients.     

Education and the changing shape of the income gradient in health

Research on the social determinants of health has increasingly sought to understand the relative importance of different features of socioeconomic status. Much of the ensuing debate has wavered between education and income, with recent research leaning increasingly toward income. This research has not, however, consistently explored interactions between different features of socioeconomic status and, in trying to understand the independent effects of different components of socioeconomic status, may have missed important features of socioeconomic position. With an eye toward examining how features of socioeconomic status combine and coalesce, this paper examines variation in the income-health association by level of education. Theories derived both from medical sociology and health economics suggest synergistic interactions between income and education, but they are unclear as to the direction and magnitude of these interactions. Results from two large and nationally representative data sets (the 1996-1997 Community Tracking Study and the 1972-2000 General Social Survey) indicate that the positive relationship between income and health varies substantially in both its strength and shape by level of education. Education improves health, and its effects are larger at lower levels of income. Moreover, education reduces the strength and curvature of the income-health relationship. Consequently, those with more education have better health for all levels of income, and fewer income-based disparities exist among the well educated than among the less well educated. The linear "gradient" relationship between income and health is, thus, more characteristic of groups with higher levels of education. Additional analyses indicate that these interactions existed in the United States in each of the last three decades. The results are discussed in light of theory regarding the perpetuation of health disparities, as well as current debates regarding the apparent incompatibility of distributive versus aggregative goals in health policy.     

Relationships Among Active Engagement in Life Activities and Quality of Life for Assisted-Living Residents

This cross-sectional research explored the relationships between active engagement in life activities (leisure, social, and instrumental activities of daily living) and quality of life for seniors aged 65 and older residing in assisted living facilities. It is increasingly recognized that active participation in diverse physical, cognitive, and social activities can promote older adults’ quality of life, including physical and mental health, but there is limited information about this in the population of residents in assisted living facilities. It is estimated that there are one million older adults residing in assisted living facilities, making assisted living facilities a rapidly growing segment of senior housing. Older adults who relocate to assisted living facilities commonly experience lifestyle changes, often related to their altered physical and social environment, reduced demands regarding household chores and meal preparation, and new opportunities for recreation and socialization. In this study, interviews were conducted with 131 ambulatory residents from assisted living facilities in the New York City metropolitan area using the 55-Item Activity Checklist, SF-36v2, Life Satisfaction Index-Z, and demographic questions. Results found significant low to moderate correlations between retained engagement in life activities (leisure, social, and instrumental activities of daily living) and life satisfaction, and several quality of life domains, including physical functioning, mental health, general health, and vitality. Older adults continued to engage in a greater percentage of everyday life activities they identified as important. This data supports exploration of client-centered activity programs to promote participation of residents in assisted living facilities in diverse activities to both maintain resident functional abilities and manage functional decline.     

Neighborhood structural disadvantage,collective efficacy,and self-rated physical health in an urban setting

Our analyses examine the role neighborhood structural characteristics--including concentrated disadvantage, residential instability, and immigrant concentration--as well as collective efficacy in promoting physical health among neighborhood residents. Using data from the 1990 census, the 1994 Project on Human Development in Chicago Neighborhoods Community Survey, and the 1991-2000 Metropolitan Chicago Information Center-Metro Survey, we model the effects of individual and neighborhood level factors on self-rated physical health employing hierarchical ordered logit models. First, we find that neighborhood socioeconomic disadvantage is not significantly related to self-rated physical health when individual level demographic and health background are controlled. Second, individuals residing in neighborhoods with higher levels of collective efficacy report better overall health. Finally, socioeconomic disadvantage and collective efficacy condition the positive effects of individual level education on physical health.     

Physical activity in the life of a woman with cerebral palsy: physiotherapy,social exclusion,competence, and intimacy

Although physical activity can have substantial mental and physical health benefits, people with cerebral palsy usually lead sedentary lives. To understand, at an individual level, this inactivity, we interviewed a 29-year-old minimally active woman with cerebral palsy (Alana) about the meanings and experiences of physical activity throughout her life. Using a case-study approach, we found that Alana had adverse childhood experiences with physical activity, including: having to perform difficult, and sometimes painful, physiotherapy; wearing callipers to assist her walking; demonstrating limited competence at physical activity; being excluded from physical education and other organised physical activity at school; and feeling socially isolated from her classmates. These experiences seemed to contribute to feelings of difference/inferiority and the subsequent avoidance of physical activity, which, in turn, might have contributed to premature functional decline. Physical activity levels in people with cerebral palsy might be increased through focusing on enhancing childhood experiences.     

Understanding Sexual Minority Health Disparities in Rural Areas

This article reviews research from several disciplines including sociology, psychology, and public health to examine recent inconsistencies in findings of rural/urban health disparities among sexual minority populations. Previous work has found that sexual minorities (lesbian, gay, and bisexual individuals) report worse health than their heterosexual counterparts on many physical and mental health measures. To understand this occurrence, scholars have situated these findings most often within either minority stress or fundamental cause frameworks. These theories attribute health differences to unique stressors and stigmatization experienced by sexual minorities within a heteronormative social climate. This review provides an overview of specific health disparities by gender and sexual orientation, critically examines research on rural/urban health differences among sexual minorities, and offers three avenues for future research to help remedy the inconsistent results of previous rural/urban sexual minority health disparities research. Discussions of the ‘rural effect,’ rural social support resources, and the importance of geographic region for health are included as opportunities to further social scientific research on sexual minority health disparities.