Showing papers by "James S. House published in 2011"

Language of Interview, Self-Rated Health, and the Other Latino Health Puzzle

Abstract: Objectives. We investigated whether the conventional Spanish translation of the self-rated health survey question helps explain why Latinos' self-rated health is worse than Whites' despite more objective health measures showing them to be as healthy as or healthier than are Whites.Methods. We analyzed the relationship between language of interview and self-rated health in the Chicago Community Adult Health Study (2001–2003) and the 2003 Behavioral Risk Factor Surveillance System.Results. Being interviewed in Spanish was associated with significantly higher odds of rating health as fair or poor in both data sets. Moreover, adjusting for language of interview substantially reduced the gap between Whites and Latinos. Spanish-language interviewees were more likely to rate their health as fair (regular in Spanish) than as any other choice, and this preference was strongest when compared with categories representing better health (good, very good, and excellent).Conclusions. Our findings suggest that translatio...

Neighborhood Context and Social Disparities in Cumulative Biological Risk Factors

Abstract: A growing body of research demonstrates that having multiple adverse biological risk factors – such as hypertension, obesity, high blood sugar, and elevated cholesterol – increases the risk of morbidity, functional and cognitive decline, and mortality (1-16). Such research also suggests that racial/ethnic minority groups and people with lower levels of education and income tend to accumulate more biological risk factors (4, 6, 9, 10, 17-20), making the cumulative toll of such “wear and tear” to the body a potentially critical, though not yet widely recognized, facet of health disparities in the United States. In an influential essay on the pathways from stress to disease, McEwen and Stellar (21) coined the term allostatic load to describe the harmful effects of physiological response patterns that can ensue from prolonged exposure to stressful environments or being highly reactive to stressors. They described a process in which the body responds to physical, psychosocial, and environmental stressors by producing hormones and neurotransmitters that help the body respond to stress by coordinating physiological responses across multiple biological systems, thus achieving stability through change (22). In the face of severe or prolonged stress, dysfunctions can result from physiological systems being activated too frequently, not having a chance to return to their setpoints, or ceasing to activate adequately. Moreover, dysfunctions of one physiological system can spillover into related systems. For example, exposure to stress can trigger surges in blood pressure, which in turn can accelerate atherosclerosis or interact with metabolic processes to produce Type II diabetes (22). Thus, the theory of allostatic load offers a framework for understanding not only the pathways between stress and disease but also how physiological pathologies can spread across systems and cumulatively affect health. There is a growing literature on how to measure allostatic load in population-based research. Most studies of this kind create indices of allostatic load from biomarkers of metabolic, inflammatory, cardiovascular, and neuroendocrine processes. There is substantial variation across studies in how many biomarkers are included in such indices, which physiological systems are represented, and how the indices are formulated [for a comprehensive review, see Juster, McEwen, and Lupien (23)]. In this study we follow an approach similar to prior studies but use the term “cumulative biological risk” (CBR) rather than allostatic load to describe indices of this kind to acknowledge that they are indirect indicators (at best) of the underlying processes that generate allostatic load. That is, like other studies, we do not have measures of primary stress mediators and instead have secondary outcomes that reflect adaptive physiological responses to stress and other adverse stimuli but which also can arise from other etiologies. Although some scholars use the term “allostatic load” in reference to similar measures, we did not want to give readers the impression that we were directly operationalizing the concept of allostatic load and thus preferred the term CBR. It is worth noting that metabolic syndrome describes a cluster of risk factors that overlaps considerably with those in our measure of CBR, although conceptually allostatic load addresses a broader array of systems in dysregulation. Both of these concepts describe a potentially interrelated set of physiological conditions that may have cumulative and interactive effects on health. Several studies show that racial/ethnic minorities and/or people of lower social status experience a greater accumulation of biological risk factors (11, 24). For example, in an analysis of the Normative Aging Study (24), Kubzansky and colleagues found that respondents with lower levels of education experienced higher levels of cumulative biological risk. In Weinstein and colleagues’ study using both the MacArthur Study of Successful Aging and Taiwan Social Environment and Biomarkers of Aging Study (SEBAS) cohorts (25), income and education were inversely related to CBR. Likewise, higher levels of education and income were associated with lower CBR in Seeman and colleagues’ (26) analysis of the National Health and Nutrition Examination Study (NHANES III). Respondents with a poverty-income ratio less than 1.85 were more likely than the non-poor to have high CBR in Geronimus and colleagues’ analysis of NHANES III, and they also found racial differences in CBR, with higher risks for respondents in the non-poor black category compared to poor whites (6). Several other studies have also shown that blacks (6, 9, 19, 26) and Hispanics (9, 19) have significantly more risks than whites, independent of education and income. Neighborhood environments are often invoked as a possible explanation for social disparities in health. In their study of NHANES III, Bird and colleagues (27) found that neighborhood socioeconomic status was associated with a higher count of biological risks after adjustment for age, gender, race/ethnicity, marital status, nativity, education, and an income to poverty ratio. Merkin and colleagues (28) expanded on the analysis by Bird and colleagues, using models stratified by race/ethnicity to show that the relationship between neighborhood disadvantage and CBR is strongest among blacks and, to a lesser extent, Mexican Americans. Neither study assessed the degree to which neighborhood factors explain racial/ethnic differences in CBR; Merkin and colleagues cite insufficient overlap in the distribution of neighborhood disadvantage between blacks and whites as an obstacle to such an analysis using the NHANES data (28). Thus, to date, no study has provided a systematic account of how much individual-level disparities are a function of or conditioned by neighborhood context (29). This paper (1) assesses the contribution of neighborhood environments to racial/ethnic and socioeconomic disparities in CBR, using data from a population-based study of adults in Chicago, and (2) shows that the relationship between neighborhood socioeconomic position and CBR may be driven less by the factors that indicate neighborhood disadvantage (e.g., aggregate income levels and rates of poverty, unemployment, public assistance) and more by factors that may be more indicative of relative neighborhood affluence (e.g., aggregate education levels, occupational composition, and home values).

The Social Structuring of Mental Health over the Adult Life Course: Advancing Theory in the Sociology of Aging

Abstract: The sociology of aging draws on a broad array of theoretical perspectives from several disciplines, but rarely has it developed its own. We build on past work to advance and empirically test a model of mental health framed in terms of structural theorizing and situated within the life course perspective. Whereas most prior research has been based on cross-sectional data, we utilize four waves of data from a nationally representative sample of American adults (Americans' Changing Lives Study) collected prospectively over a 15-year period and find that education, employment and marital status, as well as their consequences for income and health, effectively explain the increase in depressive symptoms after age 65. We also found significant cohort differences in age trajectories of mental health that were partly explained by historical increases in education. We demonstrate that a purely structural theory can take us far in explaining later life mental health.

The Unequal Burden of Weight Gain: An Intersectional Approach to Understanding Social Disparities in BMI Trajectories from 1986 to 2001/2002

Abstract: The implications of recent weight gain trends for widening social disparities in body weight in the United States are unclear. Using an intersectional approach to studying inequality, and the longitudinal and nationally representative American's Changing Lives study (19862001/2002), we examine social disparities in body mass index trajectories during a time of rapid weight gain in the United States. Results reveal complex interactive effects of gender, race, socioeconomic position and age, and provide evidence for increasing social disparities, particularly among younger adults. Most notably, among individuals who aged from 25-39 to 45-54 during the study interval, low-educated and low-income black women experienced the greatest increase in BMI, while high-educated and high-income white men experienced the least BMI growth. These new findings highlight the importance of investigating changing disparities in weight intersectionally, using multiple dimensions of inequality as well as age, and also presage increasing BMI disparities in the U.S. adult population.

Education and Levels of Salivary Cortisol Over the Day in US Adults

Abstract: Background Dysregulation of the hypothalamic–pituitary–adrenal axis is hypothesized to be an important pathway linking socioeconomic position and chronic disease.

Social security and mortality: The role of income support policies and population health in the United States

Abstract: Social Security is the most important and effective income support program ever introduced in the United States, alleviating the burden of poverty for millions of elderly Americans. We explored the possible role of Social Security in reducing mortality among the elderly. In support of this hypothesis, we found that declines in mortality among the elderly exceeded those among younger age groups following the initial implementation of Social Security in 1940, and also in the periods following marked improvements in Social Security benefits via legislation and indexing of benefits that occurred between the mid-1960s and the early 1970s. A better understanding of the link between Social Security and health status among the elderly would add a significant and missing dimension to the public discourse over the future of Social Security, and the potential role of income support programs in reducing health-related socioeconomic disparities and improving population health.

Health Disparities Among Older Adults: Life Course Influences and Policy Solutions

Abstract: Publisher Summary Attention to health disparities in the US has focused primarily on racial and ethnic differences in health, highlighting the disadvantaged health status of most racial/ethnic minorities, and the unequal access to and quality of care received by many racial/ ethnic minorities. This chapter focuses on SEP: health disparities by education, income, and occupation, and their importance over the life course. It highlights how disadvantages across multiple social statuses, particularly by SEP, race, and gender, combine to produce large health disparities among older adults. It explores what has been learned about how to address health disparities at older ages by focusing on social and economic policies for older adults. The importance of focusing on “upstream” factors, such as SEP, as opposed to “downstream” solutions, such as access to medical care or behavioral interventions is analyzed. Although there has been growing attention to the existence and persistence of health disparities in the US, much remains unknown about what generates these disparities and how policies can intervene to reduce them. Further research on the effects of social welfare supports on the health of elderly Americans could advance both the public policy agenda and basic scientific understanding of the relationship between SEP and health.

LanguageofInterview,Self-RatedHealth,andtheOther LatinoHealthPuzzle

Abstract: Objectives. We investigated whether the conventional Spanish translation of the self-rated health survey question helps explain why Latinos’ self-rated health is worse than Whites’ despite more objective health measures showing them to be as healthy as or healthier than are Whites. Methods. We analyzed the relationship between language of interview and self-rated health in the Chicago Community Adult Health Study (2001–2003) and the 2003 Behavioral Risk Factor Surveillance System. Results. Being interviewed in Spanish was associated with significantly higher odds of rating health as fair or poor in both data sets. Moreover, adjusting for language of interview substantially reduced the gap between Whites and Latinos. Spanish-language interviewees were more likely to rate their health as fair (regular in Spanish) than as any other choice, and this preference was strongest when compared with categories representing better health (good, very good, and excellent). Conclusions. Our findings suggest that translation of the English word ‘‘fair’’ to regular induces Spanish-language respondents to report poorer health than they would in English. Self-rated health should be interpreted with caution, especially in racial/ethnic comparisons, and research should explore alternative translations. (Am J Public Health. 2011;101:1306–1313. doi:10.2105/AJPH.2009. 175455)