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.     

What are you thinking? Acculturation as an activating event for negative evaluative beliefs among Latinos/as

Negative evaluative beliefs and other cognitive structures have been tied to psychological distress across various populations but have not been sufficiently incorporated into acculturation models. The current study examines the relationships between acculturation and various activating events and mediating sources of support related to negative evaluative beliefs among people of Mexican descent (N = 319). Overall, model variables explained 26% of the variance in negative evaluative beliefs. Acculturation, marital commitment, and social capital associated with friends were negatively related to negative evaluative beliefs. Conversely, single relationship status, marital reward value, psychosocial stressors, and bridging social capital were positively related, and likely serve as activating events for negative evaluative beliefs. Identifying mechanisms related to psychological distress as well as supportive structures may help in constructing interventions that will address the specific needs of different groups. Future research should continue to explore appraisal and associated beliefs in acculturation models to understand why acculturative experiences may become stressful.     

Gender, race-ethnicity, and psychosocial barriers to mental health care: an examination of perceptions and attitudes among adults reporting unmet need

Though researchers have described psychosocial barriers to mental health care-seeking, limited research has examined ways in which gender and race-ethnicity are associated with individuals' perceptions and attitudes. This study investigates correlates of psychosocial barriers to mental health care in a population of adults reporting unmet need for mental health care, focusing on gender and race-ethnicity. Data are from the 2002 National Survey on Drug Use and Health. Multivariate analyses show that non-Latino white male status is positively associated with stigma avoidance and mistrust/fear of the mental health care system. Persons of lower income or educational status are less likely to report negative attitudes towards care. Findings imply a need to reconsider the roles of gender race-ethnicity, and socioeconomic status within investigations of psychosocial barriers to care. Future research should examine the relationships among social status, help-seeking behaviors, and attitudes toward mental health care.     

Race, socioeconomic status, and psychological distress: an examination of differential vulnerability

Using data from a 1985 epidemiological survey of 2,115 adults in Florida, this research has two goals: it tests the proposition that race and SES jointly influence mental health, and it examines the contribution of undesirable life events and economic problems to psychological distress across SES groups. Using multiple indicators of SES and mental health, we found that the evidence for a model of joint influence of race and SES on mental health varied with the measures being used. The most general conclusion is that SES interacts with race to increase psychological symptoms of distress. Partitioning the sample into three SES categories (low, middle, high), we examined the contribution of stressors to the greater distress among lower-SES blacks compared to other blacks and lower-SES whites. Lower-SES blacks are more vulnerable than lower-SES whites to the impact of undesirable events, but they are less vulnerable than lower-SES whites to the impact of economic problems. Lower-SES blacks are more vulnerable than middle-SES blacks to the impact of both discrete events and economic problems. Limitations of the study indicate a need for future longitudinal studies with measures of coping resources and support networks to further our understanding of the race, social class and psychological distress relationship.     

Personality, Negative Interactions, and Mental Health

Research suggests that an individual's personality traits may mediate the relationship between social support and mental health. This study uses two national data sets to test a conceptual model that integrates personality, social support, negative interactions, and psychological distress. Results suggest that, beyond the influence of personality, social support is negatively associated with psychological distress, and negative interactions are positively associated with such distress. The findings also suggest that personality has direct and indirect effects, through social support and negative interactions, on psychological distress. Findings specify how positive and negative facets of relationships and personality influence mental health outcomes.     

Socioeconomic Status,Psychosocial Factors and Health in Urban Guyana

Abstract

This study seeks to understand the relationship between socioeconomic status (SES) and self-reported indicators of physical and mental health in an urban Third World context. The data come from a probability sample of 654 adult residents of Georgetown, Guyana. There is a significant inverse association between formal education and morbidity for four of the six measures of health status. In this research the extent to which self-concept, health behaviors, stress and social ties are linked to health status and SES, and can explain SES differences in health status is explored. Psychosocial factors, especially the self-concept measures (self-esteem and mastery) play a moderate role in accounting for educational differences in health status.     

Assessing the Personal Negative Impacts of Hooking Up Experienced by College Students: Gender Differences and Mental Health

Hooking up is a normative behavior among college students that is associated with a range of positive and negative consequences. While previous research has primarily focused on women’s negative experiences of hooking up, the current study explored the relationships among hooking up behaviors, psychological distress, and a broad range of negative effects of hooking up in both male and female college students. Using a multisite sample of college students, we developed the 14-item Negative Impact of Hookups Inventory (NIHI) to assess negative health outcomes, emotional responses, and social consequences associated with hooking up. Unprotected sex and having more hookup partners were associated with greater negative experiences of hooking up. Contrary to expectations, there were no gender differences in the total number of negative hookup effects, although men reported more frequent hookups. In addition, negative impacts of hooking up were positively associated with psychological distress regardless of gender. The NIHI may offer a useful tool to assess the negative impacts of hooking up. Understanding students’ hookup experiences is an important step toward developing targeted health interventions related to hooking up behavior in young adult populations.     

Social capital and psychological distress

The author proposes a conceptual model to explain the diverse roles of social capital--resources embedded in social networks--in the social production of health. Using a unique national U.S. sample, the author estimated a path analysis model to examine the direct and indirect effects of social capital on psychological distress and its intervening effects on the relationships between other structural antecedents and psychological distress. The results show that social capital is inversely associated with psychological distress, and part of that effect is indirect through subjective social status. Social capital also acts as an intervening mechanism to link seven social factors (age, gender, race-ethnicity, education, occupational prestige, annual family income, and voluntary participation) with psychological distress. This study develops the theory of social capital as network resources and demonstrates the complex functions of social capital as a distinct social determinant of health.     

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.     

Resilience in Non-Offending Mothers of Children Who Have Reported Experiencing Sexual Abuse

Growing evidence shows that non-offending mothers experience significant loss and trauma following their child reporting experiencing sexual abuse. Maternal support offered to sexually abused children following disclosure can be a crucial factor in children’s recovery. Although mothers are often seen as playing a central role in facilitating the recovery of their sexually abused child, there has been little focus on their own needs and profiles. This present study aimed to increase our understanding of the diversity of profiles of non-offending mothers of sexually abused children by exploring the differences in psychosocial traits of non-offending mothers (N = 68; age range 28–67 years) reporting higher and lower resilience.

The mediating role of these psychosocial factors on the relationship between resilience and psychological distress will also be explored. Results found that non-offending mothers in the higher resilience group reported higher levels of positive reappraisal, self-compassion, social support, and significantly lower levels of psychological distress compared to non-offending mothers in the lower resilience group. Additionally, multiple mediation analysis indicated positive reappraisal, self-compassion, and social support to be significant mediators of the relationship between resilience and psychological distress. Increased levels of self-compassion and social support were found to be predictive of lowered psychological distress, while increased positive reappraisal predicted increased psychological distress. The findings of the present study provide support for the targeting of the psychosocial factors such as self-compassion, social support, and positive reappraisal in interventions for non-offending mothers in an effort to promote resilience.     

Results of an Interdisciplinary Intervention to Improve the Psychosocial Well-Being and Physical Functioning of African American Grandmothers Raising Grandchildren

ABSTRACT

This paper describes the effects of an interdisciplinary intervention designed to enhance family adaptation toward stress of grandmothers raising grandchildren by improving their psychosocial well-being and physical functioning. Participants were predominantly low-income, African American grandmothers raising one or more grandchildren in parent-absent households in an urban area in the southeast. The intervention consisted of social work and nursing case management, participation in monthly support groups, and parenting classes, as well as legal service referrals for those seeking custody or adoption of their grandchildren.

Results indicated that there were statistically significant differences in the direction predicted for psychological distress, family resources, social support, and family coping, but not physical health. These findings suggest that the intervention positively affected the psychosocial well-being of grandmothers raising grandchildren. Implications for practice, policy, and research are discussed. doi:10.1300/J194v05n03_04     

Socioeconomic Status and Patterns of Parent–Adolescent Interactions

This study investigated reciprocity in parent–adolescent interactions among 102 families from lower or higher socioeconomic status (SES) backgrounds. Negative behaviors between parents and adolescents were more reciprocal (strongly correlated) in higher SES than lower SES families, and this reciprocity correlated with higher family relationship quality. Lower SES families exhibited reciprocity related to withdrawn behaviors. Reciprocity of these behaviors also correlated with higher relationship quality. Results suggest that SES differences provide insights into a more complex understanding of family relationships within contexts, and importantly, suggest that different types of reciprocity may each have its own adaptive value in families from different SES backgrounds.     

Attachment Styles and Self‐Image in Turkish Adolescents

The purpose of this article is to examine the attachment styles and the relation of these styles to the self‐image in Turkish adolescents. The study included 378 adolescents (196 females and 182 males) from high schools with different socioeconomic status (SES) who were administered Relationship Scale Questionnaires and Offer Self‐Image Questionnaires. The findings indicate that adolescents from a low SES had significantly low scores on self‐image scales compared with those from high and middle SES. It was found that secure attachment patterns affect social relationships and superior adjustment aspects of self‐image positively. The results of this study show that attachment patterns play an important role in the development of the self‐image, which is a crucial psychological structure gained in adolescence.     

Race and psychological distress: the South african stress and health study

We analyze data from the South African Stress and Health Study, a nationally representative in-person psychiatric epidemiologic survey of 4,351 adults conducted as part of the World Mental Health Survey Initiative between January 2002 and June 2004. All blacks (Africans, Coloreds, and Indians) initially report higher levels of non-specific distress and anger/hostility than whites. Access to socioeconomic resources helps explain differences in non-specific distress between Coloreds and whites and Indians and whites. However, only when social stressors are considered do we find few differences in psychological distress (i.e., non-specific distress and anger/hostility) between Africans and whites. In addition, self-esteem and mastery have independent effects on non-specific distress and anger/hostility, but differences between Coloreds and whites in feelings of anger/hostility are not completely explained by self-esteem and mastery. The findings contribute to the international body of work on social stress theory, challenge underlying assumptions of the minority status perspective, and raise a series of questions regarding mental health disparities among South Africans.     

Gender differences in symptoms of depression among adolescents.

In this paper, we examine sources of gender differences in depressive symptoms among adolescents. Using data collected from a self-administered survey of 306 high school students, we examine differences in the impact of life events, psychosocial resources, and parent-child relationships on levels of psychological distress. Our results confirm a substantial gender difference in level of psychological distress. Moreover, analyses indicate that this gender difference may be due largely to higher levels of self-esteem among males and a tendency for adolescents to perceive their fathers to be overprotective. There is, however, also evidence that other psychosocial resources and parent-child relationships are implicated in this gender difference. We also present analyses to support our contention that parent-child relationships have important effects on the development of psychosocial resources of adolescents that, in turn, influence levels of depressive symptoms.     

Socioeconomic Status,Family Processes,and Individual Development

Research during the past decade shows that social class or socioeconomic status (SES) is related to satisfaction and stability in romantic unions, the quality of parent‐child relationships, and a range of developmental outcomes for adults and children. This review focuses on evidence regarding potential mechanisms proposed to account for these associations. Research findings reported during the past decade demonstrate support for an interactionist model of the relationship between SES and family life, which incorporates assumptions from both the social causation and social selection perspectives. This review concludes with recommendations for future research on SES, family processes, and individual development in terms of important theoretical and methodological issues yet to be addressed.     

Economic distress and mental health: The role of family coping resources and behaviors

Relationships among economic distress, family coping resources and behaviors, and mental health are examined among a sample of 203 married men and 207 married women. Economic distress is negatively associated with mental health. Although family coping resources are lower among those experiencing economic distress and are generally positively related to mental health, their role as mediators of relationships between economic distress and mental health is limited. Economic distress is positively related to family coping behaviors. However, these behaviors do not have positive relationships with mental health and do not counteract the effects of economic distress on mental health. Some coping resources and behaviors have buffering effects on relationships between economic distress and mental health while others have exacerbating effects.This article is a revision of a paper presented at the annual meeting of the American Sociological Association, August, 1986. The research was supported by grant 84–164 from the Office of Program Evaluation and Research, Ohio Department of Mental Health. Additional support was provided by the Office of Computing Activities, University of Dayton.Patricia Voydanoff is Director of the Center for the Study of Family Development, University of Dayton. Dr. Voydanoff holds a Ph.D. in Sociology from Wayne State University. Her research interests include work and family life and coping with economic distress.Brenda W. Donnelly is a Research Associate at the Center for the Study of Family Development, University of Dayton. Dr. Donnelly received her Ph.D. from the University of Delaware. She is currently conducting research on adolescent childbearing and religion and family life.     

Social Integration and Mental Well-Being Among Jail Inmates

Although social integration has consistently been linked to mental well-being among the general population, this relationship has not been explored for persons confined in total institutions. Jails, in particular, represent unique conditions that have the potential to alter the traditional relationship between social ties and mental health. Although previously unexamined, social ties maintained by jail inmates outside and inside of the institution are commonly presumed to weaken some of the adverse effects of a stressful environment and positively influence mental health. The current study explores the impact of social integration on mental well-being among 198 male and female inmates incarcerated in a large county jail. The impact of marital status, parental status, and social support (both inside and outside of the jail) on various dimensions of mental health was examined. The results indicate that rather than promoting mental well-being, social relationships inside and outside of the institution are associated with higher levels of distress. Specifically, married inmates report higher levels of depression and anxiety, and inmates with close social relationships inside of the jail report higher levels of hostility, although gender differences in these patterns are evident. The results of this study suggest that social integration may play a different role for persons incarcerated in total institutions than among the general population due to the unique conditions of social stigmatization and separation from support networks.     

Cross-Cultural Perspectives on Illness and Wellness: Implications for Depression1

The purpose of this research is to determine the relationships among race, socioeconomic status (SES) and depressive symptomatology. Contrary to the findings of over 20 years ofpsychiatric epidemiology, two research teams have recently reported that Blacks, primarily those oflow SES, are significantly more depressed than Whites occupying the same status. Using the same epidemiologic field survey data as one of these research groups (Whites = 1,648; Blacks = 450), the issues of race, SES, and depression are reopened for examination. Depressive symptomatology was measured by the Florida Health Study Depression Scale. The findings indicated that, in general, Blacks had significantly higher levels of depressive symptomatology than Whites. However, these differences were eliminated once SES, a composite of occupational status, education, and household income, was statistically controlled. Race, in other words, was not found to be an independent predictor of depression. The author concludes that poverty is hazardous to one's psychological well-being and that race, by itself, is merely a proxy for socioeconomic status. In addition, methodological issues associated with the conceptualization and opera~ tionalization of socioeconomic status and mental health constructs such as depression are explored.     

The Social Stratification of Older Adults' Preparations for End-of-Life Health Care

I use data from the Wisconsin Longitudinal Study (n = 4,971) to evaluate the extent to which socioeconomic status affects three health-related (living will, durable power of attorney for health care, and discussions) and one financial (will) component of end-of-life planning. Net worth is positively associated with all four types of planning, after demographic, health, and psychological characteristics are controlled. Low rates of health-related planning among persons with low or negative assets are largely accounted for by the fact that they are less likely to execute a will, an action that triggers health-related preparations. Rates of health-related planning alone are higher among recently hospitalized persons, whereas financial planning only is more commonly done by homeowners and those with richer assets. The results suggest that economically advantaged persons engage in end-of-life planning as a two-pronged strategy entailing financial and health-related preparations. Implications for health policy, practice, and theory are discussed.