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Why should health psychologists care about socioeconomic status?

Why should health psychologists care about socioeconomic status?. Karen A. Matthews, Ph.D. Low education associated with:. high BP high cholesterol high insulin high 2-hour glucose ever smoker low consumption alcohol physical inactivity high BMI history of hysterectomy*

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Why should health psychologists care about socioeconomic status?

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  1. Why should health psychologists care about socioeconomic status? Karen A. Matthews, Ph.D.

  2. Low education associated with: • high BP • high cholesterol • high insulin • high 2-hour glucose • ever smoker • low consumption alcohol • physical inactivity • high BMI • history of hysterectomy* • taking medications for chronic conditions* *ineligible • Matthews et al., Am J Epidemiol. 129: 1132-1144, 1989.

  3. Low education associated with: • not discussing anger • high (trait) anger • high anger-in • high depression symptoms • low social support • high pessimism • Matthews et al. , Am J Epidemiol. 129: 1132-1144, 1989.

  4. Why should we care about SES? • Selection of study populations • Understand limits of generalizability of findings • Evaluation of psychosocial processes that may mediate or moderate associations between SES and health • Designing targeted interventions on health-damaging processes associated with poor health Matthews KA: Health Psychology 8:641-648, 1989.

  5. Questions: 1. What is the definition of SES and how is it measured? 2. What are the relationships between SES and health? When does the association start in the life span? • Why is SES related to health? • What can be done?

  6. Socioeconomic Status: One’s social position linked to both access to resources and prestige in a social hierarchy. Common Measures: • Education • Occupational rank • Income Other Measures: • Wealth (savings, material resources) • Subjective rank • Childhood SES • Income loss/gain

  7. Median Net Worth in 1991 by Monthly Household Income Quintiles for Whites, Blacks, and Hispanics Eller TJ: Household wealth and asset ownership; 1991. US Bureau of Census, Current Population Reports, P70-34. Washington, D.C.: US GPO, 1994.

  8. Measures can be taken at an individual, neighborhood, or national Level

  9. Davey-Smith, et al. BMJ. 1992, 304:431-434.

  10. All-Cause Mortality by IncomeNLMS, 25+ years SMR (O/E) Rogot, et al. 1992

  11. Association of CHD among Black and White Women aged 45-54 by State in 1994 against Race-Specific Educational Attainment CHD mortality (410-414, 429.2) among women aged 45-54 (/100,000) Race black white Percent of not-a-high-school graduate J Womens Health Gend Based Med, 2000; 9: 545-558

  12. Chronic Conditions More Prevalent Among Those with <12 Year of Education NHS, 1989: 65 + years Series 10, No. 129

  13. Odds Ratio of Life Time Psychiatric Disorders from National Comorbidity Study Comparing Those < 19K and > 70K Affective Disorder Anxiety Disorder Substance Abuse Antisocial Personality 3 Disorders Kessler, Arch Gen Psychiatry, 1994

  14. Explanations for SES-Health Link • Poor health causes lowering of SES • Poverty is all that matters • Poor quality health care • Toxic environments • Low intelligence • Adverse health behaviors • High stress environments • Low resources

  15. Risk of Subsequent Income Loss (<$25K) in Depressed (> 16 CES-D) Compared with Non-depressed Participantsin CARDIA (N=2781) Whooley et al., Annals of Internal Medicine, in press

  16. Prevalence of Health Problems in Children Percentage SES (lowest to highest) Psychol Bull 128:295-329, 2002

  17. Is the association between educational • attainment and adult health due in part to poor health in childhood limiting achievement? Children’s Health Children’s Education Duration & Quality Adult Health Risk Parental Education

  18. Low education of mother associated with: • Low birth weight in Whites, Blacks, American Indians or Alaska Natives, not Hispanics • Teenage births in all groups • No prenatal care during first trimester in all groups Health, United States, 1998, with Socioeconomic Status and Health Chartbook

  19. Relationships between SES in Childhood and Health at 26 years: Dunedin Birth Cohort Lancet 2002; 360:1640-1645

  20. Variations in Age-26 Health Outcomes as a Function of Alcohol Dependence and Waist:Hip Ratio % Alcohol Dependence Mean Waist:Hip Ratio Lancet 360:1640-1645, 2002

  21. Adjusted Hazard Ratios for Low Relative to High SES for CVD Mortality in Alameda County Study Beebe-Dimmer: Am J Epidemiol 159:481-490, 2004.

  22. Only in America…

  23. Threat of or actual loss/harm Potential for or actual benefit/ gain Negative emotion and cognition Positive emotion and cognition E B Risk for atherosclerosis and CHD Low SES Access to resources Position in social hierarchy A D Reserve Capacity Tangible Interpersonal Intrapersonal C Time The Reserve Capacity Model Reserve Capacity Tangible Interpersonal Intrapersonal Gallo & Matthews. Psychol Bull 129:10-51, 2003.

  24. What is Reserve Capacity?Resource bank containing: • Tangible, e.g., financial and material goods. • Interpersonal, e.g., availability of social support, positive relationships. • Intrapersonal, e.g., cognitive and social skill, sense of mastery, positive expectations.

  25. Confronting Adversity • Fewer resources associated with greater susceptibility to negative effects of adversity. • Experiencing the negative effects of adversity leads to further depletion of resources or to not adding further to the resource bank.

  26. Correlations between SES Indices, Ethnicity, and Life Events Categories among Children J Ped Psychol 27:575-583, 2002

  27. Negative Interpretations as a Potential Factor in SES-Health Link • Low SES persons grow up in unpredictable, stressful environments. • This may lead to a propensity toward interpreting the world as a threatening place that requires constant vigilance. • Thus, low SES persons may interpret a wide range of stimuli, including ambiguous ones, as potentially threatening.

  28. Negative Outcome: • A popular girl walks up to you and asks why you didn’t attend her party last night. You hadn’t known there was a party. This girl tells you that she told another classmate of yours to tell you about the party Ambiguous Outcome: • You are shopping and a clerk asks to take your back pack and count the clothing articles that you will try on. The security guard and clerk chat and the clerk asks if you would like to keep anything. You say no and start toward the door. The clerk puts your articles back on the rack and stops abruptly, asking the guard where you are. How do you think it happened that this person…? How would you feel in that situation?

  29. Correlations among SES, Interpretations and Cynical Attitudes *p < .05 **p < .01 Chen & Matthews, 2001.

  30. Mean SBP among Adolescents with Negative Interpretation Scores SBP

  31. Mean Night Time Heart Rate HR Quartile of Negative Interpretation Scores

  32. Mean Ambulatory SBP by Neighborhood Percent of Poverty SBP

  33. What can be done? • Direct effects on SES thru enhanced education, job training, redistributions of income • Indirect effects on pathways: • Health behaviors • Sense of purpose and commitment • Stress exposure and coping

  34. Summary 1. SES is a multi-dimensional construct • SES is strongly correlated with health • SES associations begin early in life • Many reasons why • Plausible psychological connections • Things can be done.

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