Socioeconomic Status and Health: What is the role of Reserve Capacity?

ABSTRACT— A robust, linear association between socioeconomic status (SES) and health has been identified across many populations and health outcomes. This relationship is typically monotonic, so that each step down the SES hierarchy brings increased vulnerability to disease and premature mortality. Despite growing attention to health disparities, scientists and policymakers have made little progress toward confronting their causes and implementing effective solutions. Using the reserve capacity model ( Gallo & Matthews, 2003 ) as an organizing framework, the current article examines the contribution of resilient psychosocial resources to socioeconomic disparities in physical health. Findings suggest that deficient psychosocial resources, such as low perceptions of control and social support, may be one of many factors that connect low SES with poor health. Additional research is needed to test these relationships and their underlying mechanisms, to consider interventions to enhance reserve capacity, and to evaluate the efficacy of such efforts in fostering resilience to socioeconomic hardship.     

A Genetics Primer for Social Health Research

The recently completed sequencing of the human genome heralds a new era in the study of social influences upon health. Because the interactions between genes and the environment are bidirectional, expertise in the areas of psychosocial processes and health behaviors will be necessary for elucidating how genes, behavior, and the environment interact to affect health outcomes. For investigators whose primary background is in social health research, the terminology used by geneticists may seem like a foreign language. To help navigate this foreign territory, the nature of genetic variation and gene action is presented in non‐technical terms using the serotonin transporter gene as an example because it is thought to influence sensitivity to the social environment. In addition, we describe several methodological pitfalls to be avoided when associating genetic variation with psychosocial and behavioral risk factors for poor health outcomes.     

Psychosocial Perspectives on Pregnancy: Prenatal Maternal Stress and Coping

Pregnancy is a momentous life event experienced by most women that involves biomedical and psychosocial changes that are potentially stressful. High levels of maternal stress in pregnancy contribute to adverse fetal, infant, child, and adult outcomes, including cognitive, emotional, neurodevelopmental, and physical health effects. This article discusses definition, measurement, and effects of stress in pregnancy and describes current research questions such as whether the timing or pattern of prenatal stress accentuates its effects and whether prenatal stress accounts for ethnic disparities in adverse birth outcomes in the United States. We review research on the ways that women cope with prenatal stress and research examining associations of coping with maternal emotional state, health, and birth outcomes. Additionally, we describe important factors that improve women's psychosocial adaptation to pregnancy, their health, and their birth outcomes, specifically trait optimism, social support, and physical activity, and we emphasize interventions that utilize these factors.     

从毕生发展的视角看健康的贫富差距

健康的贫富差距是所有个体从出生到死亡都需要面对的现实, 也是全球所有国家都存在的社会问题。目前已经有相当的理论和实证研究尝试从毕生发展的视角理解健康的贫富差距。在毕生发展研究中, 健康的贫富差距有其独特的概念和测量方式。该领域重要的理论包括累积优(劣)势假设、累积不公平模型和社会阶层文化周期模型。研究者就儿童期、青少年期、成年期和老年期的健康贫富差距开展了大量的实证研究。未来毕生发展研究和实践的可能方向包括早年和当前社会经济地位的交互作用、社会经济地位的稳定特征和情境效应、跨领域实践干预等。毕生发展视角的健康贫富差距研究有助于理解健康贫富差距的发展根源和形成过程, 是促进国民健康和开展健康公平实践工作的理论基础。     

Acculturation and Latino Adolescent Mental Health: Integration of Individual,Environmental, and Family Influences

In order to address the mental health disparities that exist for Latino adolescents in the United States, psychologists must understand specific factors that contribute to the high risk of mental health problems in Latino youth. Given the significant percentage of Latino youth who are immigrants or the children of immigrants, acculturation is a key factor in understanding mental health among this population. However, limitations in the conceptualization and measurement of acculturation have led to conflicting findings in the literature. Thus, the goal of the current review is to examine and critique research linking acculturation and mental health outcomes for Latino youth, as well as to integrate individual, environmental, and family influences of this relationship. An integrated theoretical model is presented and implications for clinical practice and future directions are discussed.     

Later life health optimism,pessimism and realism: Psychosocial contributors and health correlates

Prior research has established positive outcomes of health optimism (appraising one's health as good despite poor objective health (OH)) and negative outcomes of health pessimism (appraising health as poor despite good OH), yet little is known about their contributors. We examined the role of psychosocial factors (life event stress, depression, dispositional optimism, perceived social support) in health realism (appraising health in accordance with OH), optimism and pessimism among 489 older men and women. We then accounted for the psychosocial factors when examining multiple health correlates of health realism, optimism and pessimism. Controlling for age, gender and income, regression results indicate that depression and social support were associated with less health optimism, while dispositional optimism was associated with greater health optimism among those in poor OH. Dispositional optimism was associated with less health pessimism and life event stress was associated with greater pessimism among those in good OH. Beyond the effects of the psychosocial factors, structural equation model results indicate that health optimism was positively associated with healthy behaviours and perceived control over one's health; health pessimism was associated with poorer perceived health care management. Health optimism and pessimism have different psychosocial contributors and health correlates, validating the health congruence approach to later life well-being, health and survival.     

Later life health optimism, pessimism and realism: psychosocial contributors and health correlates

Prior research has established positive outcomes of health optimism (appraising one's health as good despite poor objective health (OH)) and negative outcomes of health pessimism (appraising health as poor despite good OH), yet little is known about their contributors. We examined the role of psychosocial factors (life event stress, depression, dispositional optimism, perceived social support) in health realism (appraising health in accordance with OH), optimism and pessimism among 489 older men and women. We then accounted for the psychosocial factors when examining multiple health correlates of health realism, optimism and pessimism. Controlling for age, gender and income, regression results indicate that depression and social support were associated with less health optimism, while dispositional optimism was associated with greater health optimism among those in poor OH. Dispositional optimism was associated with less health pessimism and life event stress was associated with greater pessimism among those in good OH. Beyond the effects of the psychosocial factors, structural equation model results indicate that health optimism was positively associated with healthy behaviours and perceived control over one's health; health pessimism was associated with poorer perceived health care management. Health optimism and pessimism have different psychosocial contributors and health correlates, validating the health congruence approach to later life well-being, health and survival.     

Post-traumatic Stress Disorder among child perpetrators and victims of violence from the Northern Uganda civil war: Findings from the WAYS study

War experiences are known risk factors for post-traumatic stress disorder (PTSD) and other poor psychosocial outcomes. This study aimed to assess the extent to which perpetrating violence (operationalised as intentional and unintentional killing or mutilation) and being a victim of violence (operationalised as being a victim of violence, e. g., witnessing violence, injuries, torture) predict PTSD and other psychosocial outcomes independently in war-affected youth of Northern Uganda. Data on war experiences, PTSD, psychosocial problems, and socio-demographic characteristics were collected from the youth formerly abducted by the Ugandan Lord’s Resistance Army (LRA) at baseline (mean age = 22.39 years; SD = 10.47) and at follow-up (mean age = 23.52 years; SD = 9.28) using self-report questionnaires. On average, the participants spent 3.13 years in captivity (SD = 2.99) and were abducted at 14.14 years of age (SD = 4.21). Regression models were fitted to predict PTSD and psychosocial outcomes from perpetrating violence controlling for being a victim of violence and demographic characteristics. Thirty-seven percent (n = 168) reported killing or being responsible for killing while in rebel captivity. After adjusting for being a victim of violence, perpetrating violence remained a statistically significant predictor of PTSD and poor psychosocial outcomes such as depression, anxiety, somatic complaints, psychotic symptoms, and conduct problems. Among war-affected youth returning from LRA captivity, perpetrating violence may just be as toxic a risk factor for PTSD and other psychosocial outcomes as being a victim of violence. Mental health workers should consider both the effects of being a victim of violence and perpetrating violence in treatment planning.     

Latina breast cancer survivors' lived experiences: diagnosis, treatment, and beyond

Latina breast cancer survivors are not benefiting from advances in psychosocial interventions. Despite their greater breast cancer burden, there is a dearth of information about this population. This qualitative study examined the experiences of 18 immigrant Latina breast cancer survivors along the survivorship continuum, from diagnosis to long-term survivorship. The authors conducted separate focus groups with women in the acute, reentry, and long-term survivorship stages. Through grounded theory analysis, the authors uncovered 5 themes of experience: perceptions of psychological well-being, impact of diagnosis, impact of treatment, need for social support, and development of new attitudes. Some themes were applicable across all survivorship stages, whereas others were more salient at a particular stage. Within themes, the authors identified experiences reported in the general literature (i.e., the debilitating effect of chemotherapy) and distinct cultural experiences (i.e., fear that a cancer diagnosis leads to certain death). Results suggest that treatments tailored for each survivorship stage are more likely to be effective than generic interventions. These findings have the potential to lessen health disparities in utilization of psychosocial treatments by Latina breast cancer survivors.     

Identifying Perceived Neighborhood Stressors Across Diverse Communities in New York City

There is growing interest in the role of psychosocial stress in health disparities. Identifying which social stressors are most important to community residents is critical for accurately incorporating stressor exposures into health research. Using a community‐academic partnered approach, we designed a multi‐community study across the five boroughs of New York City to characterize resident perceptions of key neighborhood stressors. We conducted 14 community focus groups; two to three in each borough, with one adolescent group and one Spanish‐speaking group per borough. We then used systematic content analysis and participant ranking data to describe prominent neighborhood stressors and identify dominant themes. Three inter‐related themes regarding the social and structural sources of stressful experiences were most commonly identified across neighborhoods: (1) physical disorder and perceived neglect, (2) harassment by police and perceived safety and (3) gentrification and racial discrimination. Our findings suggest that multiple sources of distress, including social, political, physical and economic factors, should be considered when investigating health effects of community stressor exposures and psychological distress. Community expertise is essential for comprehensively characterizing the range of neighborhood stressors that may be implicated in psychosocial exposure pathways.     

Socio-demographic factors intensifying male mating competition exacerbate male mortality rates

Sex differences in mortality rates stem from a complex set of genetic, physiological, psychological, and social causes whose influences and interconnections are best understood in an integrative evolutionary life history framework. Although there are multiple levels of mechanisms contributing to sex based disparities in mortality rates, the intensity of male mating competition in a population may have a crucial role in shaping the level of excess male mortality. The degree of variation and skew in male reproductive success may shape the intensity of male mating competition, leading to riskier behavioral and physiological strategies. This study examines three socio-demographic factors related to variation in human male reproductive success; polygyny, economic inequality, and the population ratio of reproductively viable men to women across nations with available data. The degrees of economic inequality and polygyny explained unique portions in the sex difference in mortality rates, these predictors accounted for 53% of the variance. The population ratio of reproductively viable men to women did not explain any additional variance. These results demonstrate the association between social conditions and health outcomes in modern nations, as well as the power of an evolutionary life history framework for understanding important social issues.     

Ethnic Differences in Health Behaviors Among College Students

Ethnic minority groups in the U.S. show significant health disparities, likely arising in part from psychosocial influences on health behaviors. This study explores how ethnicity and acculturation relate to health behaviors among 521 college students. Participants completed a questionnaire assessing eating habits (eating vegetables, fruits, and salads vs. French fries and hamburgers), preventative health behaviors (physical exams, dental visits, exercise), and health-harming behaviors (smoking, drinking), as well as a modified acculturation scale ( Marin et al., 1987 ). Results showed that ethnicity and acculturation likely have both positive and negative effects on health behaviors. Despite equality of education, conceptually meaningful group differences in health behaviors were revealed, pointing toward future research on modifying the psychosocial aspects of ethnic health disparities.     

The invisible barrier: Neighbourhood poverty and integration of immigrants in Canada

The rise of poverty among industrial nations including Canada since the late 1980s has resulted in a higher number of neighbourhoods with a high poverty rate, which in turn has led to an increase in the occurrence of other social ills such as poor educational and health care services, high crime, and high unemployment rates. The combination of these social ills and the social isolation experienced by those in extremely poor neighbourhoods has given rise to a particular lifestyle and subculture, closely related to Lewis’ (1971) notion of the culture of poverty. An examination of 1996 census tract data in Canada shows that immigrants are more likely than non-immigrants to live in neighbourhoods with high rates of poverty. We argue that such an overrepresentation can have serious consequences for the process of integration of immigrants, as it acts as an invisible barrier to their economic success, and can hamper their children’s ambitions.     

Beyond emotional benefits: Physical activity and sedentary behaviour affect psychosocial resources through emotions

Physical activity is known to improve emotional experiences, and positive emotions have been shown to lead to important life outcomes, including the development of psychosocial resources. In contrast, time spent sedentary may negatively impact emotional experiences and, consequently, erode psychosocial resources. Two studies tested whether activity independently influenced emotions and psychosocial resources, and whether activity indirectly influenced psychosocial resources through emotional experiences. Using cross-sectional (Study 1a) and longitudinal (Study 1b) methods, we found that time spent physically active independently predicted emotions and psychosocial resources. Mediation analyses suggested that emotions may account for the relation between activity and psychosocial resources. The improved emotional experiences associated with physical activity may help individuals build psychosocial resources known to improve mental health. Study 1a provided first indicators to suggest that, in contrast, sedentary behaviour may reduce positive emotions, which could in turn lead to decrements in psychosocial resources.     

Building cardiovascular disease competence in an urban poor Ghanaian community: A social psychology of participation approach

This paper describes conceptual, methodological, and practical insights from a longitudinal social psychological project that aims to build cardiovascular disease (CVD) competence in a poor community in Accra, Ghana's capital. Informed by a social psychology of participation approach, mixed method data included qualitative interviews and household surveys from over 500 community members, including people living with diabetes, hypertension, and stroke, their caregivers, health care providers, and GIS mapping of pluralistic health systems, food vending sites, bars, and physical activity spaces. Data analysis was informed by the diagnosis‐psychosocial intervention‐reflexivity framework proposed by Guareschi and Jovchelovitch. The community had a high prevalence of CVD and risk factors, and CVD knowledge was cognitive polyphasic. The environment was obesogenic, alcohol promoting, and medically pluralistic. These factors shaped CVD experiences and eclectic treatment seeking behaviours. Psychosocial interventions included establishing a self‐help group and community screening and education. Applying the “AIDS‐competent communities” model proposed by Campbell and colleagues, we outline the psychosocial features of CVD competence that are relatively easy to implement, albeit with funds and labour, and those that are difficult. We offer a reflexive analysis of four challenges that future activities will address: social protection, increasing men's participation, connecting national health policy to community needs, and sustaining the project.     

Workplace Deviance as a Possible “Maladaptive Coping” Behavior Displayed in Association with Workplace Stressors

ABSTRACT

The Threat Appraisal and Coping Theory suggests that in response to environmental stressors, individuals sometimes display “maladaptive coping” behaviors that may vent frustration immediately but worsen later psychosocial well-being. For example, employees exposed to workplace stressors may vent their frustration with workplace deviance including intentional poor performance, abuse of organizational resources, disrespect, and disruption of co-workers, but such workplace deviance may worsen their later psychological well-being. The present study examined workplace deviance as a possible “maladaptive coping” behavior displayed by 293 university employees (74.7% female; 90.4% White; mean age = 45.8 years; 43 administrators, 127 staff, 84 faculty). When three workplace stressors (high demand, low control, low support) were compared for their association with workplace deviance, only low support was significant. Furthermore, workplace deviance was significantly associated with negative psychosocial outcomes [poor self-esteem, health concerns, anger, post-traumatic stress disorder (PTSD) symptoms, poor job satisfaction, work-home conflict]. Finally, bootstrapping mediational analysis revealed that workplace deviance was a significant mediator between low support and each of the negative psychosocial outcomes. Results support the idea that workplace deviance is an example of “maladaptive coping” behavior that, when displayed in response to perceptions of low support from supervisors and co-workers, is associated with worse psychosocial outcomes for employees who display it. Stress reduction programs could educate employees that displaying workplace deviance in response to workplace stressors may harm their psychosocial well-being. Such programs could also guide employees to more “adaptive coping” behaviors in response to workplace stressors (such as seeking social support, exercise, and yoga).     

A Human Well-Being Perspective to the Measurement of Quality of Life: Findings From the City of Delhi

This study employs Amartya Sen’s Capability Approach to assess the quality of life of people in Delhi. Despite recording the highest per capita income in the country, Delhi remains a city-state of many inequalities causing huge disparities in the living conditions of the rich and the poor. Here I assess peoples’ perception of these disparities using five sets of well-being dimensions; psychological distress, social interactions and leisure activities, sheltering conditions, health status, and economic status & working conditions. Using a stratified random sample of 330 households (1,267 individuals aged atleast 18 years) and plurality of well-being dimensions, survey responses are quantified using fuzzy set theory, an approach designed to handle inexact and fuzzy outcomes. The results show that around 31 % of Delhi’s population is deprived of social interactions and leisure activities, over 25 % of people have very poor health status and around 14 % have very poor economic and working conditions. Education, in particular, is found to play an important role in improving the well-being of individuals. Higher levels of education are associated with higher levels of well-being achievement. The findings from this analysis should make a strong case for supplementing economic indicators with other indicators of well-being.     

Social relationships,stressful life events,and self-reported physical health: Genetic and environmental influences

Abstract

This study investigates how the associations between self-reported health, stressful life events, and social relationships are mediated by genetic and environmental influences and how much of the variance in health is in common with variation in these psychosocial factors. The analyses are based on questionnaire data from 576 pairs of twins reared apart and twins reared together. The data revealed that for men environmental influences were solely important for variation in the psychosocial measures and were the primary mediators of the relationship with health. For women, on the other hand, a substantial portion of the variance in the psychosocial factors was due to genetic influences and these influences also contributed to the bulk of the correlations with health. The gender differences for the relationships and their mediation indicate that what should be regarded as a psychosocial factor of importance for health might differ between genders.     

Relationship Distress as a Mediator of Adverse Childhood Experiences and Health: Implications for Clinical Practice with Economically Vulnerable Racial and Ethnic Minorities

Adverse childhood experiences (ACE) are interpersonal sources of distress negatively correlated with physical and mental health, as well as maladaptive intimate partner conflict strategies in adulthood. Economically vulnerable racial and ethnic minorities report the greatest disparities in exposure to ACE, as well as relationship distress and health. Yet, little is known about the connections between ACE, relationship distress, and health. We therefore tested a theoretical model for the mediating role of relationship distress to explain the ACE‐health connection with a sample (N = 96) predominantly racial/ethnic minorities (87%) with low income. We applied partial least squares structural equation modeling with bootstrapping (N = 500). Relationship distress strengthened the predictive relationship between ACE and health, and accounted for 42% of the variance in health. The results provide preliminary support for relationship distress as a social determinant of health disparities with implications for interdisciplinary health intervention.     

African-American Women’s Conceptualizations of Health Disparities: A Community-Based Participatory Research Approach

Health disparities among African-American families represent a significant social problem. Nationally, African-American infants have dramatically worse birth outcomes than other racial and ethnic groups. A Community-Based Participatory Research approach was utilized to engage community residents. This study examined participants’ definitions of infant mortality, views on the community impact of infant mortality, and strengths and vulnerabilities in the health care service delivery system. Qualitative data were gathered in a rural North Florida community where health education groups are conducted. Eight focus groups were arranged with African-American women (n = 46), ranging in age from 14 to 35, who were pregnant, parenting children under the age of two. Respondents poignantly described personal experiences of loss associated with infant mortality. They indicated awareness of problems related to lack of accessibility and availability of medical and social services. The use of social-ecological theory and implications for policy and social justice are discussed.