Linear trend or graded association: an international study of objective and subjective socioeconomic inequalities in self-rated health

Abstract

Despite the well-documented socioeconomic inequalities in health, it is less known about how objective and subjective socioeconomic statuses (SES) are related to self-rated health (SRH) in an international context. Using data from the 2007 International Social Survey Program (ISSP) that included 33 countries across six continents (N?=?40,049), we found that for objective SES, either education or income, or both were related to SRH as general linear trends (i.e., higher SES was associated with better SRH as a general trend) rather than graded associations (i.e., adjacent levels of SES were associated with SRH in a dose–response relationship). After controlling for subjective SES, the magnitude of the associations between objective SES and SRH reduced, whereas the associations between subjective SES and SRH remained strong in nearly all countries. Findings suggested that more rigorous analyses are needed to clearly describe the SES-health associations, and future international research should expand to include subjective measures of SES.     

Racial/Ethnic Disparities in Health: The Role of Lifestyle,Education, Income,and Wealth

Abstract

This article addresses the persistent relationship between race/ethnicity, SES, health-related lifestyle behaviors, and self-reported health using data from the 1995 National Health Interview Survey and its topical supplements. Through a series of models, we found that both SES (education, income, home ownership, and house and business monetary value) and health-related lifestyle behaviors (physical activity, nutrition awareness, and smoking) contribute to racial/ethnic disparities in self-reported health. Further, the impact of education on smoking behavior and self-reported health differs by race/ethnicity, with non-Hispanic whites receiving greater health benefits from education than African Americans and Hispanics. Although SES and lifestyle behaviors are indirect paths through which race/ethnicity affects health, the relationship between SES and health also is shaped by racial/ethnic status.     

Socioeconomic status,psychosocial factors and health in urban Guyana

Individuals of higher socioeconomic status live longer and enjoy better physical and mental health relative to individuals of lower social status. Socioeconomic status differences in health status persist over time. This paper examines the association between socioeconomic status, psychosocial factors, and health in Georgetown, Guyana. The major causes of death are cardiovascular and cerebrovascular disease; life expectancy at birth is 67.3 years for males and 72.3 years for females; and the infant mortality rate is 44 per 1000 live births. Data for the study were drawn from a probability sample of 654 adult residents of Georgetown. A significant inverse association was found between formal education and morbidity for four of the six measures of health status. The authors investigated the extent to which self-concept, health behaviors, stress, and social ties are linked to health status and socioeconomic status, and can explain socioeconomic status differences in health status. Psychosocial factors, especially the self-concept measures of self-esteem and mastery, were found to play a moderate role in accounting for educational differences in health status.     

Factors influencing college women's contraceptive behavior: An application of the integrative model of behavioral prediction

Objective: This study investigated variables within the Integrative Model of Behavioral Prediction (IMBP) as well as differences across socioeconomic status (SES) levels within the context of inconsistent contraceptive use among college women. Participants: A nonprobability sample of 515 female college students completed an Internet-based survey between November 2014 and February 2015. Methods: Respondents were asked about their contraception use, knowledge and information sources, demographic information, and IMBP factors, including attitudes, norms, and perceived behavioral control (PBC). Results: While overall attitudes, norms, PBC, and intentions for contraceptive use were high, only 46.8% of women used contraception consistently. Data also revealed only moderate levels of knowledge about contraception. While there were no differences across SES levels for attitudes, PBC, norms or knowledge, SES levels did differ in sources used to acquire contraceptive information. Conclusions: This study highlights the need to consider where college women acquire contraceptive information which is associated with SES.     

Effects of urbanism,race, and class on happiness and physical health

The joint effects of urbanism, race, and socioeconomic status on self reported health and happiness are studied. Relationships of “neighborhood fear” and unemployment with health and happiness are also studied within different urban/rural race‐class categories. It is hypothesized that 1) lower socioeconomic status (SES) blacks residing in central cities will report the poorest health and lowest happiness and 2) “neighborhood fear” and unemployment will be most strongly related to health and happiness among central city lower SES blacks. The sample is pooled data from the 1972–1983 National Opinion Research Center (NORC) General Social Surveys. Findings indicate that urbanism has a modest negative relationship to happiness, but low SES urban blacks are not uniquely low in happiness. Contrary to the central city hypothesis, neighborhood fear is most strongly related to health among suburban blacks with less than high school or high school graduation attainment. A relative deprivation explanation is advanced. Unemployment negatively relates to the happiness of blacks and whites in a variety of urban‐SES‐race categories.     

Physical and mental health inequalities between native and immigrant Swedes

To study health inequalities between native and immigrant Swedes, we investigated differences in self‐rated health (SRH), mental wellbeing (MW), common symptoms (CS), and persistent illness (PI), and if socioeconomic status (SES), negative status inconsistency, or social support could account for such differences. A secondary analysis was conducted on questionnaire data from a random adult population sample of 4,023 individuals and register data from Statistics Sweden. χ² tests and binary logistic regressions were used to identify health differences and study these after accounting for explanatory variables. Compared with natives, immigrants more commonly reported negative status inconsistency, poorer SES, and poorer social support as well as poor SRH, very poor MW, and high level of CS but not PI. Significant differences were accounted for by work‐related factors and social support. We encourage future research to address how pre‐ and peri‐migration factors relate to immigrants’ post‐migration SES, social support, and health status.

Policy Implications

• Given the relationship between work‐related factors (employment status, hours worked per week, and income) and all health outcomes in this study, labour market interventions that facilitate the integration of immigrants into the labour market, and into occupations that better correspond with their capacity, will arguably have public health benefits.
• Feelings of loneliness was, in our study, important in accounting for immigrants’ poorer self‐rated health compared with natives’. Therefore, we endorse interventions that facilitate immigrants’ social networking and integration and thereby reduce feelings of loneliness.
• Common physical and mental symptoms may be important indicators of health and we, thus, suggest these to be taken into account when developing ill‐health prevention programmes.

     

How SES May Figure in Perceptions of Zika Risks and in Preventive Action

abstract

The present study intended to determine how the socioeconomic status (SES) of citizens and public health communications help explain citizens’ risk perception and actions taken during Zika virus outbreaks in 2016. We used data from a nationally representative study conducted in March 2016 by the Associated Press–National Opinion Research Center to analyze 831 American adult responses regarding Zika. We found that respondent risk perception and actions taken diminished as SES level rose. Risk perception was also found to mediate preventive actions’ associations. To quell the global spread of emerging infectious diseases (EIDs) like Zika, health organizations worldwide must understand how SES contributes to Zika (and other future EIDs) risk perception and preventive action. A more compelling form of public health communications must be developed that takes into account the impact made on future outbreaks and infections by these higher-SES “risk assessments.”     

Student Nurse Education in a University Health Center

Abstract

Objective: This study assessed the association between ethnicity and family socioeconomic status (SES) as it relates to the prevalence of vaginal douching among female undergraduates in a university community. Participants and Methods: This was a cross-sectional survey conducted between September 2011 and February 2012 among 1,535 female undergraduates using a semistructured behavioral questionnaire adapted by the authors from previous research related to vaginal douching practice. Results: The overall prevalence of vaginal douching was 79.35% and the practice was significantly associated with the mother's age, ethnicity, low SES (educational level, occupation, and monthly income), and area of residence. The father's age and SES were statistically nonsignificant. Conclusion: Ethnicity and low SES of mothers were significantly associated with a higher prevalence of douching in daughters. These factors should be considered among others in any intervention to discourage vaginal douching among college women.     

Causal connections between socio-economic status and health: reciprocal effects and mediating mechanisms

Using structural equation modeling techniques on data from a nationally representative longitudinal survey, we first explored the reciprocal relationships between socio-economic status (SES) and health status. We then estimated the degree to which health-related lifestyles/behaviors and psychosocial distress are mediating mechanisms of these relationships. As predicted, SES positively affects health, and health positively affects SES. Although the causal path from SES to health is stronger than the reverse, these findings confirmed the hypothesis that both social causation and health selection contribute to social inequalities in health. In terms of the mediating mechanisms through which SES and health affect each other, more than a third of the overall SES-health relationship was accounted for by health-related lifestyles/behaviors and psychosocial distress. A notable part of the effect of SES on health is due to differences in psychological distress, with the effects of health-related lifestyles/behaviors being much smaller. On the other hand, in terms of the effects of health on SES, differences in weight and sleeping behavior are more important than psychological distress.     

Socioeconomic Status and Health Disparity in the United States

Abstract

Low socioeconomic status (SES) has been associated with high rates of many chronic diseases. This study was a cluster analysis of data from 9,830 adults in the 1994-96 Continuing Survey of Food Intakes by the Individuals (1994-96 CSFII) in order to characterize more fully the biologic and social factors that might be associated with chronic diseases. The study employed cluster analysis to define three SES groups (low, middle, and high) based on income, education, age, gender, and race. A significant increase was found in self-reported diabetes, hypertension, heart disease, obesity, and stroke across these groups, being highest in the lowest SES group. Results revealed that health disparity in the U.S. may be substantial, with some population groups bearing a disproportionate burden of chronic diseases.     

Parental emotional warmth and psychological Suzhi as mediators between socioeconomic status and problem behaviours in Chinese children

ObjectiveThis study investigated psychological mechanisms underlying the relationship between family socioeconomic status (SES) and problem behaviours in Chinese children.MethodsParticipants were 1128 children (556 females) from two Chinese elementary schools, aged 8–13 years (M = 10.82, SD = 1.26), attending the 3rd–6th grades. Children provided self-report on parental emotional warmth and psychological suzhi, whereas parents reported on SES and problem behaviours.ResultsData analyses, including structural equation modelling (SEM)—employed to test a three-path mediation effect of parental emotional warmth and psychological suzhi after controlling for gender and grade—revealed that: (1) SES, parental emotional warmth, and psychological suzhi were negatively correlated with children's problem behaviours; (2) SES indirectly affected children's psychological suzhi through parental emotional warmth; (3) psychological suzhi mediated the relation between parental emotional warmth and problem behaviours; and (4) children belonging to families with low SES were less likely to receive emotional support from their parents. This significantly predicted low psychological suzhi levels, which in turn negatively affected problem behaviours.ConclusionsStrategies that help parents provide warmth and support and those that help children improve psychological suzhi may help reduce problem behaviours in vulnerable groups.     

Assessing God Locus of Control as a Factor in College Students’ Alcohol Use and Sexual Behavior

Abstract. Objectives: This study explored God locus of control beliefs (ie, God's control over behavior) regarding their influence on alcohol use and sexual behavior as an alternative religiosity measure to religious behaviors, which does not capture perceived influence of religiosity. Additionally, demographic differences in religious beliefs were explored. Methods: College students aged 18–24 (N = 324) completed a survey between April 2012 and March 2013. Principal components and multivariate analyses were conducted. Results: Findings suggest that measures provide reliable, valid data from college students. God locus of control is linked to not consuming alcohol or engaging in sex. There were differences regarding relationship status and religious denomination. Conclusions: God locus of control beliefs are an appropriate construct for collecting data about college students’ religiosity. Furthermore, health educators at faith-based institutions could incorporate this construct into their programming, encouraging abstinence but also behaving responsibly for those who do drink and are sexually experienced.     

Socioeconomic and Gender Health Disparities in Diabetes: The Lower Middle Income Case of Ghana

While literature theorizing the relationship between socioeconomic status (SES), gender, and health outcomes is robust in high‐income countries, there is less scholarship examining how SES affects men and women in lower middle income countries (LMICs). Focusing on the LMIC case of Ghana, I use Wave 1 of the World Health Organization Study on Global Aging and Adult Health (SAGE) to examine the relationship between SES and diabetes among Ghanaian women and men. Specifically, I examine how key SES measures such as educational attainment, employment status, and income singly and collectively predict the odds of diabetes for Ghanaian men and women. I also examine the explanatory value of the reversal hypothesis, which posits that those of high SES experience higher rates of non‐communicable diseases. Overall, I find that while Ghanaian men experience increased odds of diabetes with increased education, Ghanaian women have higher odds of diabetes compared to men regardless of educational attainment. Understanding health patterns in LMICs like Ghana is important for sociological inquiry on health disparities seeking to incorporate more global perspectives.     

Disparities in Access to Health Care Among Middle-Aged and Older Adults with Disabilities

Disability is increasing among middle-aged adults and, reversing earlier trends, increasing among older adults as well. Disability is experienced disproportionately by Black and lower socioeconomic status (SES) individuals. We used Medical Expenditure Panel Survey data to examine health care disparities in access to health care for middle-aged (31 to 64 years of age) and older (65+ years of age) adults with disabilities by race and ethnicity, education, and income (n = 13,174). Using logistic regression, we examined three measures of potential (e.g., usual source of care), and three measures of realized (e.g., counseling related to smoking) access. Middle-aged and older minority individuals with disabilities had lower relative risks of having usual sources of care and higher relative risks of having suboptimal usual sources of care (e.g., a place rather than a person) than White adults with disabilities. There were SES effects observed for middle-aged adults with disabilities across most measures that were, for certain measures, more pronounced than SES effects among older adults with disabilities. These findings are important, since health resources (e.g., a usual source of care) may mediate relations among disability, morbidity, and mortality. Policy actions that may mitigate the disparities we observed include financial incentives to support access to an optimal usual source of care and mechanisms to foster behavioral interventions related to smoking and exercise. Ensuring that these actions address the specific concerns of individuals with disabilities, such as physical accessibility and provider cultural competency, is essential.     

Anthropometric and Behavioral Measures Related to Mindfulness in College Students

Abstract

Objective: To determine whether mindfulness is associated with physical and behavioral measures in first semester college students. Participants: Male and female first year college students (n = 75) from the University of Rhode Island. Methods: Height, weight, waist circumference (WC), and blood pressure were assessed and online questionnaires were completed. Independent t tests and Pearson correlations were utilized for analysis. Results: The less mindful group had a higher WC than the more mindful group. Correlations were seen between mindfulness and weight-related behaviors. Conclusions: Mindfulness can impact health status of first year college students, particularly with behavioral measures that have been found to effect weight status. However, additional research is needed focusing on mindfulness as a potential weight gain prevention technique for first year college students in order to decrease chronic disease prevalence.     

Socioeconomic Status and Body Mass Index in Canada: Exploring Measures and Mechanisms

We examine the relationship between socioeconomic status (SES), sociodemographic characteristics, lifestyle behaviors (fruit and vegetable intake, exercise, smoking, and alcohol consumption), and body mass index (BMI) using the Canadian Community Health Survey 2.1. We explore two different measures of SES, education and income, to elucidate material and cultural explanations of the SES‐BMI relationship. Results vary significantly by gender, highlighting the complexity of the relationship between SES, sociodemographic and lifestyle factors, and BMI. We suggest that body weight is still a gendered status symbol, and that cultural and psychosocial factors may be more important than material factors in perpetuating this health inequality.     

How Migrant Status Affects Health Beyond Socioeconomic Status: Evidence from Austria

The debate on health inequalities usually focuses on the interplay between socioeconomic status (SES) and health, where it is widely accepted that the former influences the latter. However, little is known on whether the influence of SES on health is sufficient to explain the observed lower health statuses among various migrant groups in European countries. This paper presents a model that integrates the influences of SES and migrant status on health and tests its implications empirically for Austria. Several ordered logit regressions are performed, whose results show that particular migrant groups are disadvantaged with respect to health. In addition, the overall influence of migrant status on health is considerably stronger for women than for men, while health status of men is influenced by interactions between migrant status and occupational status.     

A Multilevel Analysis of Gender Differences in Psychological Distress Over Time

Females have higher rates of depression than males, a disparity that emerges in adolescence and persists into adulthood. This study uses hierarchical linear modeling to assess the effects of school context on gender differences in depressive symptoms among adolescents based on two waves of data from the National Longitudinal Study of Adolescent Health (N=9,709 teens, 127 schools). Analysis indicates significant school‐level variation in both overall symptom levels and the average gender gap in depression net of prior symptoms and individual‐level covariates. Aggregate levels of depressive symptomatology were positively associated with contextual‐level socioeconomic status (SES) disadvantage. A cross‐level contingency emerged for the relationship between gender and depressive symptoms with school SES and aggregate perceived community safety such that the gender “gap” was most apparent in contexts characterized by low SES disadvantage and high levels of perceived safety. These results highlight the importance of context to understanding the development of mental health disparities.     

Gender and Socioeconomic Status Differences in First and Second Marriage Formation

In this article, we address how first and second marriages are formed by asking whether SES has similar effects on first and second marriage entry. Like many studies of first marriage, we focus on gender, socioeconomic characteristics (education, income, and employment status), and gender differences in the effect of SES. To examine this question, we use the NLSY79 (n = 12,231 never‐married and 3,695 divorced persons), discrete‐time logistic regression, and heterogeneous choice models to test for statistically significant differences by gender and between first and second marriages. Our models show gender differences in first and second marriage entry, that the effect of SES on marriage entry differs between first and second marriage, and that the interaction between gender and SES has a unique association with marital entry for never‐ and previously married individuals. Our results have implications for understanding marriage formation, stratification across the life course, and the well‐being of divorced persons who remarry.     

Examining area- and individual-level differences in suicide ideation severity and suicide attempt among youth

Youth suicide is a pressing problem and suicide rates are not equally distributed across geographic areas or socioeconomic status (SES). Death by suicide is often preceded factors including hopelessness and suicide ideation, planning, and attempt. The current study examined area- and individual-level differences in suicide ideation severity and suicide attempt in a state-representative sample of youth from 2019 (N = 78,740) and 2021 (N = 61,396). Youth from higher SES and rural areas showed lower suicide ideation severity and odds of suicide attempt. After including individual-level covariates, SES differences in ideation severity and suicide attempt persisted for 2019 but not 2021. Rural differences for ideation severity persisted across years but not for suicide attempt. Further research on geographic variation in suicide risk is needed.