Diseased state
The importance of full-time work for urban adults' mental and physical health
Lisa Rosenthal et al.
Social Science & Medicine, November 2012, Pages 1692-1696
Abstract:
Unemployment and underemployment have adverse mental and physical health consequences, such as increased stress and depression. Health damaging behaviors like unhealthy eating, smoking, and alcohol use may be used to cope, contributing to chronic disease risk. In this adverse economic climate, it is vital to understand the health implications of unemployment and underemployment as well as underlying mechanisms. A randomized household survey of adults in six low resource communities was conducted in New Haven, Connecticut in 2009, yielding a sample of 1205 (73% participation) racially diverse adults (61% Black, 20% Latino, 12% White) ages 18-65 (61% women). We used ANOVA to test group differences and structural equation modeling to test mediation. 14.5% were unemployed and looking for work, 18.4% worked part-time, 38.2% worked full-time. Those employed full-time reported the least damaging psychological factors and health behaviors: lowest levels of stress and depression, most healthy and least unhealthy eating, most physical activity, and lowest levels of smoking and drinking. Those employed part-time fell in the middle, and those unemployed fell on the unhealthy end of all psychological and behavioral factors. Stress significantly mediated the associations of full-time employment with frequency of unhealthy eating and physical activity, and amount of cigarette smoking and alcohol consumption. Depression significantly mediated the association of full-time employment with frequency of healthy eating. Compared to <10% nationwide, rates of unemployment in this sample were high. Both those unemployed and employed part-time reported adverse health behaviors as compared to those employed full-time, partially mediated by heightened stress and depression. It is vital for the health and well-being of the nation to increase not simply employment, but specifically full-time employment. Provision of mental health services to those unemployed and underemployed should be a priority to promote healthier lifestyles and prevent costly future chronic disease.
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Jay Olshansky et al.
Health Affairs, August 2012, Pages 1803-1813
Abstract:
It has long been known that despite well-documented improvements in longevity for most Americans, alarming disparities persist among racial groups and between the well-educated and those with less education. In this article we update estimates of the impact of race and education on past and present life expectancy, examine trends in disparities from 1990 through 2008, and place observed disparities in the context of a rapidly aging society that is emerging at a time of optimism about the next revolution in longevity. We found that in 2008 US adult men and women with fewer than twelve years of education had life expectancies not much better than those of all adults in the 1950s and 1960s. When race and education are combined, the disparity is even more striking. In 2008 white US men and women with 16 years or more of schooling had life expectancies far greater than black Americans with fewer than 12 years of education - 14.2 years more for white men than black men, and 10.3 years more for white women than black women. These gaps have widened over time and have led to at least two "Americas," if not multiple others, in terms of life expectancy, demarcated by level of education and racial-group membership. The message for policy makers is clear: implement educational enhancements at young, middle, and older ages for people of all races, to reduce the large gap in health and longevity that persists today.
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The New Demographic Transition: Most Gains in Life Expectancy Now Realized Late in Life
Karen Eggleston & Victor Fuchs
Journal of Economic Perspectives, Summer 2012, Pages 137-156
Abstract:
The share of increases in life expectancy realized after age 65 was only about 20 percent at the beginning of the 20th century for the United States and 16 other countries at comparable stages of development; but that share was close to 80 percent by the dawn of the 21st century, and is almost certainly approaching 100 percent asymptotically. This new demographic transition portends a diminished survival effect on working life. For high-income countries at the forefront of the longevity transition, expected lifetime labor force participation as a percent of life expectancy is declining. Innovative policies are needed if societies wish to preserve a positive relationship running from increasing longevity to greater prosperity.
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Glitch in the gradient: Additional education does not uniformly equal better health
Anna Zajacova, Richard Rogers & Vicki Johnson-Lawrence
Social Science & Medicine, forthcoming
Abstract:
While the relationship between education and general health has been firmly established in the literature, surprisingly little research has analyzed individual components of the global health judgments, such as chronic conditions or pain. We present a systematic account of the health gradient for multiple health outcomes by detailed educational categories among U.S. working-age adults. Using the 1997-2010 National Health Interview Surveys (N=204,764), we analyze individual health outcomes ranging from cardiovascular disease to vision problems with a series of logistic regression models. The results at the presecondary and baccalaureate levels are consistent with the health gradient. An unexpected finding occurs among adults with some college but no degree, and those with technical/vocational associate degrees: these groups report more pain and a higher prevalence of a broad range of conditions than high school graduates who never attended college. We discuss several explanations for the observed patterns. The findings challenge the broadly accepted educational gradient in health; additionally, the lower postsecondary groups comprise a quarter of American adults. Jointly, there is a clear research and policy impetus to understand the source of this ‘glitch' in the health gradient.
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Does the perception that stress affects health matter? The association with health and mortality
Abiola Keller et al.
Health Psychology, September 2012, Pages 677-684
Objective: This study sought to examine the relationship among the amount of stress, the perception that stress affects health, and health and mortality outcomes in a nationally representative sample of U.S. adults.
Methods: Data from the 1998 National Health Interview Survey were linked to prospective National Death Index mortality data through 2006. Separate logistic regression models were used to examine the factors associated with current health status and psychological distress. Cox proportional hazard models were used to determine the impact of perceiving that stress affects health on all-cause mortality. Each model specifically examined the interaction between the amount of stress and the perception that stress affects health, controlling for sociodemographic, health behavior, and access to health care factors.
Results: 33.7% of nearly 186 million (unweighted n = 28,753) U.S. adults perceived that stress affected their health a lot or to some extent. Both higher levels of reported stress and the perception that stress affects health were independently associated with an increased likelihood of worse health and mental health outcomes. The amount of stress and the perception that stress affects health interacted such that those who reported a lot of stress and that stress impacted their health a lot had a 43% increased risk of premature death (HR = 1.43, 95% CI [1.2, 1.7]).
Conclusions: High amounts of stress and the perception that stress impacts health are each associated with poor health and mental health. Individuals who perceived that stress affects their health and reported a large amount of stress had an increased risk of premature death.
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Neurodegenerative causes of death among retired National Football League players
Everett Lehman et al.
Neurology, forthcoming
Objective: To analyze neurodegenerative causes of death, specifically Alzheimer disease (AD), Parkinson disease, and amyotrophic lateral sclerosis (ALS), among a cohort of professional football players.
Methods: This was a cohort mortality study of 3,439 National Football League players with at least 5 pension-credited playing seasons from 1959 to 1988. Vital status was ascertained through 2007. For analysis purposes, players were placed into 2 strata based on characteristics of position played: nonspeed players (linemen) and speed players (all other positions except punter/kicker). External comparisons with the US population used standardized mortality ratios (SMRs); internal comparisons between speed and nonspeed player positions used standardized rate ratios (SRRs).
Results: Overall player mortality compared with that of the US population was reduced (SMR 0.53, 95% confidence interval [CI] 0.48-0.59). Neurodegenerative mortality was increased using both underlying cause of death rate files (SMR 2.83, 95% CI 1.36-5.21) and multiple cause of death (MCOD) rate files (SMR 3.26, 95% CI 1.90-5.22). Of the neurodegenerative causes, results were elevated (using MCOD rates) for both ALS (SMR 4.31, 95% CI 1.73-8.87) and AD (SMR 3.86, 95% CI 1.55-7.95). In internal analysis (using MCOD rates), higher neurodegenerative mortality was observed among players in speed positions compared with players in nonspeed positions (SRR 3.29, 95% CI 0.92-11.7).
Conclusions: The neurodegenerative mortality of this cohort is 3 times higher than that of the general US population; that for 2 of the major neurodegenerative subcategories, AD and ALS, is 4 times higher. These results are consistent with recent studies that suggest an increased risk of neurodegenerative disease among football players.
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Marc Egeth & Robert Kurzban
Evolutionary Psychology, August 2012, Pages 602-610
Abstract:
A new method is proposed for controlling mosquito-borne diseases. In particular, instead of trying to kill mosquitoes, we suggest provisioning them with food from artificial feeders. Because mosquito populations are frequently limited by ecological factors other than blood meals, such as the availability of egg-laying sites, feeding mosquitoes would not necessarily increase the total number of mosquitoes, but could reduce the number of human-drawn mosquito meals. Like mosquito traps, feeders could divert biting mosquitoes away from people by means of lures, but, after diversion, prevent subsequent human bites by satiating the mosquitoes instead of killing them. Mosquito feeders might reduce the problem of the evolution of resistance to control: in an ecology with mosquito feeders, which provide safe and abundant calories for adult female mosquitoes, there could be selection for preferring (rather than avoiding) feeders, which could eventually lead to a population of feeder-preferring mosquitoes. Artificial feeders also offer the chance to introduce novel elements into the mosquito diet, such as anti- malarial or other anti-parasitic agents. Feeders might directly reduce human bites and harnesses the power of natural selection by selectively favoring feeder-preferring (rather than trap-resistant) mosquitoes.
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Older Men Who Use Computers Have Lower Risk of Dementia
Osvaldo Almeida et al.
PLoS ONE, August 2012
Objective: To determine if older men who use computers have lower risk of developing dementia.
Methods: Cohort study of 5506 community-dwelling men aged 69 to 87 years followed for up to 8.5 years. Use of computers measured as daily, weekly, less than weekly and never. Participants also reported their use of email, internet, word processors, games or other computer activities. The primary outcome was the incidence of ICD-10 diagnosis of dementia as recorded by the Western Australian Data Linkage System.
Results: 1857/5506 (33.7%) men reported using computers and 347 (6.3%) received a diagnosis of dementia during an average follow up of 6.0 years (range: 6 months to 8.5 years). The hazard ratio (HR) of dementia was lower among computer users than non-users (HR = 0.62, 95%CI = 0.47-0.81, after adjustment for age, educational attainment, size of social network, and presence of depression or of significant clinical morbidity). The HR of dementia appeared to decrease with increasing frequency of computer use: 0.68 (95%CI = 0.41-1.13), 0.61 (95%CI = 0.39-0.94) and 0.59 (95%CI = 0.40-0.87) for less than weekly, at least weekly and daily. The HR of dementia was 0.66 (95%CI = 0.50-0.86) after the analysis was further adjusted for baseline cognitive function, as measured by the Mini-Mental State Examination.
Conclusion: Older men who use computers have lower risk of receiving a diagnosis of dementia up to 8.5 years later. Randomised trials are required to determine if the observed associations are causal.
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Marc Klemp & Jacob Weisdorf
European Review of Economic History, August 2012, Pages 233-246
Abstract:
This paper explores the long-term impact on mortality of exposure to hardship in early-life. Using survival analysis, we demonstrate that birth during the great English famine of the late 1720s entailed an increased death risk throughout life among those who survived the famine years. Using demographic data from the Cambridge Group's Population History of England, we find the death risk at age 10 among the most exposed group - children born to English Midlands families of a lower socioeconomic rank - is up to 66 percent higher than that of the control group (children of similar background born in the 5 years following the famine). This corresponds to a loss of life expectancy of more than 12 years. However, evidence does not suggest that children born in the 5 years prior to the famine suffered increased death risk.
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Melissa McInerney & Jennifer Mellor
Journal of Health Economics, September 2012, Pages 744-751
Abstract:
A number of studies report that U.S. state mortality rates, particularly for the elderly, decline during economic downturns. Further, several prior studies use microdata to show that as state unemployment rates rise, physical health improves, unhealthy behaviors decrease, and medical care use declines. We use data on elderly mortality rates and data from the Medicare Current Beneficiary Survey from a time period that encompasses the start of the Great Recession. We find that elderly mortality is countercyclical during most of the 1994 to 2008 period. Further, as unemployment rates rise, seniors report worse mental health and are no more likely to engage in healthier behaviors. We find suggestive evidence that inpatient utilization increases perhaps because of an increased physician willingness to accept Medicare patients. Our findings suggest that either elderly individuals respond differently to recessions than do working age adults, or that the relationship between unemployment and health has changed.
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Denise Janicki Deverts et al.
Brain, Behavior, and Immunity, October 2012, Pages 1128-1135
Abstract:
Better health is a well-documented benefit of having a higher socioeconomic status (SES). Inflammation may be one pathway through which SES influences health. Using 2658 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study, we examine whether two measures of SES assessed at baseline (mean age, 32 ± 4 years) - years of education and household income - predict change in C-reactive protein (CRP) concentrations over the course of 13 years. We also examine whether four health-related behaviors - smoking, fruit and vegetable consumption, physical activity, and alcohol consumption - mediate the prospective association of SES with CRP. Both higher education and household income predicted smaller increases in CRP over the 13 years of follow-up independent of age, sex, race, CARDIA center, body mass, medical diagnoses, medications, and hormone use (among women). Associations did not differ by race or sex. When examined in separate analyses, smoking and fruit and vegetable intake each accounted for a significant proportion of the respective effects of education and household income on CRP change, and physical activity a significant proportion of the effect of household income. These findings suggest that poor health behaviors among persons of lower socioeconomic status can have long-term effects on inflammation.
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Amy Schulz et al.
American Journal of Public Health, September 2012, Pages 1706-1714
Objectives: We examined relationships between neighborhood poverty and allostatic load in a low- to moderate-income multiracial urban community. We tested the hypothesis that neighborhood poverty is associated with allostatic load, controlling for household poverty. We also examined the hypotheses that this association was mediated by psychosocial stress and health-related behaviors.
Methods: We conducted multilevel analyses using cross-sectional data from a probability sample survey in Detroit, Michigan (n = 919) and the 2000 US Census. The outcome measure was allostatic load. Independent variables included neighborhood and household poverty, psychosocial stress, and health-related behaviors. Covariates included neighborhood and individual demographic characteristics.
Results: Neighborhood poverty was positively associated with allostatic load (P < .05), independent of household poverty and controlling for potential confounders. Relationships between neighborhood poverty were mediated by self-reported neighborhood environment stress but not by health-related behaviors.
Conclusions: Neighborhood poverty is associated with wear and tear on physiological systems, and this relationship is mediated through psychosocial stress. These relationships are evident after accounting for household poverty levels. Efforts to promote health equity should focus on neighborhood poverty, associated stressful environmental conditions, and household poverty.
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Natalie Slopen et al.
PLoS ONE, July 2012
Objectives: Research about work-related stressors and cardiovascular disease (CVD) has produced mixed findings. Moreover, a paucity of data exists regarding the long-term associations between job strain and job insecurity and CVD among women.
Methods: We used Cox proportional hazard models to examine the relationship between job strain, job insecurity, and incident CVD over 10 years of follow-up among 22,086 participants in the Women's Health Study (mean age 57±5 years).
Results: During 10 years of follow-up there were 170 myocardial infarctions (MI), 163 ischemic strokes, 440 coronary revascularizations, and 52 CVD deaths. In models adjusted for age, race, education, and income, women with high job strain (high demand, low control) were 38% more likely to experience a CVD event than their counterparts who reported low job strain (low demand, high control; Rate Ratio (RR) = 1.38, 95% Confidence Interval (CI) = 1.08-1.77), and women with active jobs (high demand, high control) were 38% more likely to experience a CVD event relative to women who reported low job strain (95% CI = 1.07-1.77). Outcome-specific analyses revealed that high job strain predicted non-fatal myocardial infarction (RR = 1.67, CI = 1.04-2.70), and coronary revascularization (RR = 1.41, CI = 1.05-1.90). No evidence of an association between job insecurity and long-term CVD risk was observed.
Conclusion: High strain and active jobs, but not job insecurity, were related to increased CVD risk among women. Both job strain and job insecurity were significantly related to CVD risk factors. With the increase of women in the workforce, these data emphasize the importance of addressing job strain in CVD prevention efforts among working women.
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Driving Under the (Cellular) Influence
Saurabh Bhargava & Vikram Pathania
American Economic Journal: Economic Policy, forthcoming
Abstract:
Previous research in the laboratory and by epidemiologists has compared the danger of cell phone use while driving to that of illicit levels of alcohol. This paper investigates the causal link between driver cell phone use and crash rates by exploiting a natural experiment -- the discontinuity in marginal pricing at 9pm on weekdays from 2002 to 2005 when cellular plans transitioned from "peak" to "off-peak" pricing. We first document that the pricing threshold induced a 7.2% jump on Mondays to Thursdays in call likelihood for a large and proprietary sample of drivers in California from 2005. Two additional datasets of nationwide calls affirm the price sensitivity of cell phone users. We next document the corresponding change in the crash rate for California as well as the eight additional states for which we have the universe of crash data. Using a period prior to the prevalence of 9pm plans as a comparison group, we find no evidence for a relative rise in crashes after 9pm on Mondays to Thursdays in 2005, or during an extended period from 2002 to 2005. Our preferred estimates imply an upper bound in the odds ratio of crash risk associated with cell phone use of 3.0, which rejects the findings of most existing research including the 4.3 asserted in the influential paper by Redelmeier and Tibshirani (1997). A panel analysis of regional trends in cell phone ownership and legislation banning driver cell phone use confirms our basic result. We present possible explanations for this counterintuitive finding and discuss implications for policy.
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John Robert Warren et al.
Social Science & Medicine, October 2012, Pages 1531-1538
Abstract:
We use family fixed-effects models to estimate the impact of childhood health on adult literacy, labor force outcomes, and marital status among pairs of white brothers observed as children in the 1880 U.S. Census and then as adults in the 1900-1930 Censuses. Given our focus on the 19th century, we observed a wider array of infectious, chronic, and traumatic health problems than is observed using data that are more recent; our results thus provide some insights into circumstances in modern developing countries where similar health problems are more frequently observed. Compared to their healthy siblings, sick brothers were less likely to be located (and thus more likely to be dead) 20-50 years after their 1880 enumeration. Sick brothers were also less likely to be literate, to have ever been married, and to have reported an occupation. However, among those with occupations, sick and healthy brothers tended to do similar kinds of work. We discuss the implications of our results for research on the impact of childhood health on socioeconomic outcomes in developed and developing countries.
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Predicting Adult Physical Illness From Infant Attachment: A Prospective Longitudinal Study
Jennifer Puig et al.
Health Psychology, forthcoming
Objective: Recent epidemiological and longitudinal studies indicate that attachment relationships may be a significant predictor of physical health in adulthood. This study is among the few to prospectively link attachment classifications assessed in infancy to physical health outcomes 30 years later in adulthood, controlling for various health-related confounds.
Methods: Participants were 163 individuals involved in a 32-year longitudinal study of risk and adaptation who have been followed since birth. Attachment classifications were assessed at ages 12 and 18 months using the Ainsworth Strange Situation Procedure. Stability of attachment security was derived from these assessments. At age 32, participants completed a questionnaire asking about the presence of or treatment for current physical illnesses.
Results: Binary logistic regression analyses controlling for health-related confounds at age 32 indicated that individuals who were insecurely attached (i.e., anxious-resistant or anxious-avoidant) during infancy were more likely to report an inflammation-based illness in adulthood than those classified as securely attached during infancy. There also was a trend whereby individuals classified as anxious-resistant reported more nonspecific symptoms in adulthood than those classified as either anxious-avoidant or secure. Individuals who were continuously insecure during infancy were more likely to report all types of physical illness in adulthood.
Conclusion: These findings reveal the lasting effect of early interpersonal relationships on physical health and suggests that infancy may be a fruitful point for prevention efforts. The widespread influence that attachment has on endogenous and exogenous health-related processes may make it particularly potent in the prevention of later physical health problems.
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Paid Sick Leave and Nonfatal Occupational Injuries
Abay Asfaw, Regina Pana-Cryan & Roger Rosa American
Journal of Public Health, September 2012, Pages e59-e64
Objectives: We examined the association between US workers' access to paid sick leave and the incidence of nonfatal occupational injuries from the employer's perspective. We also examined this association in different industries and occupations.
Methods: We developed a theoretical framework to examine the business value of offering paid sick leave. Data from the National Health Interview Survey were used to test the hypothesis that offering paid sick leave is associated with a reduced incidence of occupational injuries. We used data on approximately 38 000 working adults to estimate a multivariate model.
Results: With all other variables held constant, workers with access to paid sick leave were 28% (95% confidence interval = 0.52, 0.99) less likely than workers without access to paid sick leave to be injured. The association between the availability of paid sick leave and the incidence of occupational injuries varied across sectors and occupations, with the greatest differences occurring in high-risk sectors and occupations.
Conclusions: Our findings suggest that, similar to other investments in worker safety and health, introducing or expanding paid sick leave programs might help businesses reduce the incidence of nonfatal occupational injuries, particularly in high-risk sectors and occupations.
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Mary Jo Larson et al.
Medical Care, September 2012, Pages 821-828
Background: U.S. Armed Forces members and spouses report increased stress associated with combat deployment. It is unknown, however, whether these deployment stressors lead to increased dependent medication use and health care utilization.
Objective: To determine whether the deployment of Army active duty members (sponsors) is associated with changes in dependent health care utilization.
Design: A quasi-experimental, pre-post study of health care patterns of more than 55,000 nonpregnant spouses and 137,000 children of deployed sponsors and a comparison group of dependents.
Measures: Changes in dependent total utilization in the military health system, and separately in military-provided and purchased care services in the year following the sponsors' deployment month for office visit services (generalist, specialist); emergency department visits; institutional stays; psychotropic medication (any, antidepressant, antianxiety, antistimulant classes).
Results: Sponsor deployment was associated with net increased use of specialist office visits (relative percent change 4.2% spouses; 8.8% children), antidepressants (6.7% spouses; 17.2% children), and antianxiety medications (14.2% spouses; 10.0% children; P<0.01) adjusting for group differences. Deployment was consistently associated with increased use of purchased care services, partially, or fully offset by decreased use of military treatment facilities.
Conclusions: These results suggest that emotional or behavioral issues are contributing to increased specialist visits and reliance on medications during sponsors' deployments. A shift to receipt of services from civilian settings raises questions about coordination of care when families temporarily relocate, family preferences, and military provider capacity during deployment phases. Findings have important implications for the military health system and community providers who serve military families, especially those with children.
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Lead Policy and Academic Performance: Insights from Massachusetts
Jessica Wolpaw Reyes
NBER Working Paper, August 2012
Abstract:
Childhood exposure to even low levels of lead can adversely affect neurodevelopment, behavior, and cognitive performance. This paper investigates the link between lead exposure and student achievement in Massachusetts. Panel data analysis is conducted at the school-cohort level for children born between 1991 and 2000 and attending 3rd and 4th grades between 2000 and 2009 at more than 1,000 public elementary schools in the state. Massachusetts is well-suited for this analysis both because it has been a leader in the reduction of childhood lead levels and also because it has mandated standardized achievement tests in public elementary schools for almost two decades. The paper finds that elevated levels of blood lead in early childhood adversely impact standardized test performance, even when controlling for community and school characteristics. The results imply that public health policy that reduced childhood lead levels in the 1990s was responsible for modest but statistically significant improvements in test performance in the 2000s, lowering the share of children scoring unsatisfactory on standardized tests by 1 to 2 percentage points. Public health policy targeting lead thus has clear potential to improve academic performance, with particular promise for children in low income communities.
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Lauren Hale et al.
Social Science & Medicine, forthcoming
Abstract:
Why does living in a disadvantaged neighborhood predict poorer mental and physical health? Recent research focusing on the Southwestern United States suggests that disadvantaged neighborhoods favor poor health, in part, because they undermine sleep quality. Building on previous research, we test whether this process extends to the Midwestern United States. Specifically, we use cross-sectional data from the Survey of the Health of Wisconsin (SHOW), a statewide probability sample of Wisconsin adults, to examine whether associations among perceived neighborhood quality (e.g., perceptions of crime, litter, and pleasantness in the neighborhood) and health status (overall self-rated health and depression) are mediated by overall sleep quality (measured as self-rated sleep quality and physician diagnosis of sleep apnea). We find that respondents who report lower neighborhood quality tend to report poorer overall self-rated health and more depressive symptoms than respondents who report higher neighborhood quality. Low self-rated sleep quality is also associated with poorer overall self-rated health and more depressive symptoms, and overall self-rated sleep quality was found to partially mediate the link between perceived neighborhood quality and health status. Overall, self-rated sleep quality explains approximately 20% of the association between neighborhood quality and overall self-rated health and nearly 19% of the association between neighborhood quality and depression. Taken together, these results confirm previous research and extend the generalizability of the indirect effect of perceived neighborhood context on health status through perceived sleep quality.
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The Impact of Oral Health on the Academic Performance of Disadvantaged Children
Hazem Seirawan, Sharon Faust & Roseann Mulligan
American Journal of Public Health, September 2012, Pages 1729-1734
Objectives: We measured the impact of dental diseases on the academic performance of disadvantaged children by sociodemographic characteristics and access to care determinants
Methods: We performed clinical dental examinations on 1495 disadvantaged elementary and high school students from Los Angeles County public schools. We matched data with academic achievement and attendance data provided by the school district and linked these to the child's social determinants of oral health and the impact of oral health on the child's school and the parents' school or work absences.
Results: Students with toothaches were almost 4 times more likely to have a low grade point average. About 11% of students with inaccessible needed dental care missed school compared with 4% of those with access. Per 100 elementary and high school-aged children, 58 and 80 school hours, respectively, are missed annually. Parents averaged 2.5 absent days from work or school per year because of their children's dental problems.
Conclusions: Oral health affects students' academic performance. Studies are needed that unbundle the clinical, socioeconomic, and cultural challenges associated with this epidemic of dental disease in children.
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Beware of Being Unaware: Racial/Ethnic Disparities in Chronic Illness in the USA
Pinka Chatterji, Heesoo Joo & Kajal Lahiri
Health Economics, September 2012, Pages 1040-1060
Abstract:
We study racial/ethnic disparities in awareness of chronic diseases using biomarker data from the 2006 Health and Retirement Study. We explore two alternative definitions of awareness and estimate a trivariate probit model with selection, which accounts for common, unmeasured factors underlying the following: (1) self-reporting chronic disease; (2) participating in biomarker collection; and (3) having disease, conditional on participating in biomarker collection. Our findings suggest that current estimates of racial/ethnic disparities in chronic disease are sensitive to selection, and also to the definition of disease awareness used. We find that African-Americans are less likely to be unaware of having hypertension than non-Latino whites, but the magnitude of this effect falls appreciably after we account for selection. Accounting for selection, we find that African-Americans and Latinos are more likely to be unaware of having diabetes compared to non-Latino whites. These findings are based on a widely used definition of awareness - the likelihood of self-reporting disease among those who have disease. When we use an alternative definition of awareness, which considers an individual to be unaware if he or she actually has the disease conditional on self-reporting not having it, we find higher levels of unawareness among racial/ethnic minorities versus non-Latino whites for both hypertension and diabetes.
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Mark Rapaport, Pamela Schettler & Catherine Bresee
Journal of Alternative and Complementary Medicine, August 2012, Pages 789-797
Objectives: This study gathers preliminary data about the biologic effects of repeated Swedish massage therapy compared to a light-touch control condition.
Design: The study design was a 5-week comparison of repeated Swedish massage and light touch on oxytocin (OT), arginine-vasopressin (AVP), adrenal corticotropin hormone (ACTH), cortisol (CORT), circulating phenotypic lymphocyte markers, and mitogen-stimulated cytokine function.
Setting: The setting was an outpatient research unit in an academic medical center.
Participants: The study subjects were medically and psychiatrically healthy young adults.
Intervention: The study comprised 45 minutes of Swedish massage or light touch, using highly specified and identical protocols, either weekly or twice weekly for 5 weeks.
Outcome measures: The outcome measures were mean differences between massage and light touch on OT, AVP, ACTH, CORT, lymphocyte markers, and cytokine levels.
Results: Compared to the touch control condition, weekly Swedish massage stimulated a sustained pattern of increased circulating phenotypic lymphocyte markers and decreased mitogen-stimulated cytokine production, similar to what was previously reported for a single massage session, while having minimal effect on hypothalamic-pituitary-adrenal function. Twice-weekly massage produced a different response pattern with increased OT levels, decreased AVP, and decreased CORT but little effect on circulating lymphocyte phenotypic markers and a slight increase in mitogen-stimulated interferon-γ, tumor necrosis factor-α, interleukin (IL)-1b and IL-2 levels, suggesting increased production of pro-inflammatory cytokines.
Conclusions: There are sustained cumulative biologic actions for the massage and touch interventions that persist for several days or a week, and these differ profoundly depending on the dosage (frequency) of sessions. Confirmatory studies in larger samples are needed.
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The relative importance of psychosocial factors in arthritis: Findings from 10,509 Australian women
Melissa Harris et al.
Journal of Psychosomatic Research, forthcoming
Objective: To determine the relative importance of psychosocial factors in arthritis diagnosis in an ageing cohort of Australian women.
Methods: This study focused on 10,509 women from the 1946-1951 cohort who responded to questions on arthritis in the fifth mailed population-based survey of the Australian Longitudinal Study on Women's Health conducted in 2007.
Results: Arthritis was characterised by widespread psychosocial concerns, particularly relating to chronic stress and poor mental health. Univariate analyses revealed that in comparison to women without stress, women with moderate/high stress levels had a 2.5-fold increase in reporting arthritis. Experiencing ongoing negative interpersonal life events concerning illness of a family member/close friend and relationship difficulties was also associated with a 1.4-fold increase in the reporting of arthritis. Likewise, significantly reduced levels of optimism and perceived social support were noted (all associations p < .001). Psychiatric diagnosis was also associated with a two-fold increase in having arthritis (p < .001). Following adjustment for behavioural, demographic and health-related characteristics, anxiety was the only psychosocial factor associated with arthritis (OR=1.4, 95% CI=1.2, 1.7; p < .001).
Conclusion: This study examined, epidemiologically, the relative importance of psychosocial factors in arthritis in an ageing cohort of Australian women. The findings from this population-based study indicate that women with arthritis are more likely to report a range of psychosocial-related problems, particularly with regard to chronic stress perception and anxiety. Longitudinal analyses are required to examine the processes by which stress and psychosocial factors may contribute to arthritis risk and poor adaptation in terms of health-related quality of life.