Socioeconomic status, John Henryism, and hypertension in blacks and whites

The joint influence of socioeconomic status and John Henryism on risk for elevated blood pressure was examined in a biracial, community sample of 820 adults, aged 21-50 years, who resided in Edgecombe County, North Carolina, and were interviewed in 1983. John Henryism refers to a strong personality predisposition to cope actively with psychosocial environmental stressors. In keeping with an earlier finding for black men, it was hypothesized that the inverse association between socioeconomic status and blood pressure would be stronger for persons who scored high on John Henryism than for persons who scored low. Using race-specific definitions of socioeconomic status, the study found support for the hypothesis among blacks. At low levels of John Henryism, socioeconomic status differences in hypertension prevalence were small (1.6%), whereas at high levels of John Henryism, low socioeconomic status blacks were nearly three times as likely to be hypertensive as higher status blacks (31.4% vs. 11.5%, p = 0.02 for the socioeconomic status X John Henryism interaction term). The findings for systolic and diastolic blood pressures were in a similar direction but did not reach statistical significance. The study hypothesis was not supported among whites. Analyses of the correlates of John Henryism as well as the blood pressure findings are discussed in terms of the different socioeconomic circumstances that characterize the lives of blacks and whites in this rural, southern community.     

Socioeconomic status and risk of multiple myeloma.

A case control study was conducted to test the hypothesis that socioeconomic status is positively associated with multiple myeloma incidence. One hundred and fifty-three myeloma cases and 459 controls were identified at the Duke University Medical Center at Durham, North Carolina. Study members were interviewed regarding indicators of socioeconomic status. The association of myeloma with family income (current and highest), education, occupation, home ownership, dwelling size, and an index of crowding in the home was examined by estimating relative risks. Among these indicators, only home ownership showed any association with multiple myeloma incidence (RR = 1.6, 95% CI: 1.0-2.6). The association of multiple myeloma with socioeconomic status that has been seen in earlier studies may have been due to underascertainment of disease in less advantaged groups. This association is disappearing as access to health care becomes more uniform across socioeconomic groups.     

Preterm birth subtypes among blacks and whites.

The differences in preterm birth between blacks and whites are poorly understood. Our study examined subtypes of moderately preterm delivery (34-36 completed weeks of gestation) and very preterm delivery (20-33 weeks) in blacks and whites using North Carolina birth certificate data for 1988-1989. We divided the causes of preterm birth into three categories: preterm premature rupture of the membranes, indication of pregnancy complication, and idiopathic preterm deliveries. The overall prevalence of preterm birth was 8.0% and 16.7% for whites and blacks, respectively. The entire gestational age distribution of blacks was shifted to earlier ages relative to whites. More highly educated blacks still had higher risks of moderately and very preterm deliveries than less educated whites. Multivariate analysis, controlling for other factors, showed that blacks had 3.3, 2.5, and 3.5 times the risk of whites to have preterm premature rupture of the membranes, complication-related, and idiopathic delivery, respectively, among very preterm births, and 1.6, 1.9, and 2.0 times the risk of whites for moderately preterm births of the same three types.     

Symptoms of depression among blacks and whites.

OBJECTIVES. We sought to examine relationships between sociodemographic indicators of risk and depression symptoms within the Black and White populations. METHODS. In a national probability sample, differences in sex, age, marital status, religion, social class, employment status, urbanicity, and region were evaluated against a Center for Epidemiological Studies Depression Scale score of 16 or greater. Risk factors were identified within the two populations and compared between them. RESULTS. For both races, females were at greater risk for depression than males, and respondents who were formerly married or separated were at greater risk than those who were currently married. Major differences in patterns of risk were also found between the races. Blacks who were 30 to 39 years of age, belonged to non-Western religious groups, and lived in the West were at greater risk than comparable Whites. Blacks who were widowed, members of the middle and lower-middle class, and unemployed were at less risk. CONCLUSIONS. Similarities and differences in patterns of risk were evident. The nature of the differences suggests important divergence in sociocultural and economic experience.     

Socioeconomic status and psychologic distress in adult blacks

Most epidemiologic studies of race and mental health are conducted on regional data sets which contain very small numbers of black respondents. As a result, the amount of data compiled on risk groups within the black population is limited. This paper argues that better information on risk groups can be gathered from special surveys of minority group populations. Data are analyzed from the National Survey of Black Americans, a nationally representative sample of the adult (18 years and older) black population collected in 1979-1980 (n = 2,107). The paper extends prior work on these data by exploring the relation between three socioeconomic status indicators and psychologic distress for different problem situations with an eight-item symptom checklist. Regression analyses revealed that personal income, family income, and a poverty index were all negatively related to distress--but only among respondents who indicated that they were upset because of an economic or physical health problem. These three indicators were positively related to distress among those with an emotional adjustment problem. The implications of these findings for psychiatric epidemiology and preventive intervention programs are discussed.     

Cigarette smoking and cessation behaviors among urban blacks and whites

Smoking behaviors among blacks and whites were studied in a population-based sample of 2,626 residents of Minneapolis-St. Paul, MN. More blacks than whites were found to be smokers, before and after adjusting for age and education differences. More whites than blacks were former smokers, but the prevalence of those who had never smoked was comparable for whites and blacks. Among smokers, the mean number of cigarettes smoked per day was lower among blacks than whites, but more blacks were found to smoke cigarettes with high "tar" (dry particulate matter) and nicotine content. Men smokers were found to smoke more than women smokers, young people smoked more than older people, and those with a high school education or less smoked more than those with more than a high school education. Smoking cessation behavior consisted mostly of a variety of strategies that began with reducing cigarette consumption, followed by changing to lower tar brands, attempting to quit, and actually quitting. In general, a higher percentage of whites than blacks reported smoking cessation behaviors. A greater percentage of white than black women had tried cigarette brands lower in tar and nicotine within the previous year. Among men, a lower percentage of black than white smokers had tried quitting, and fewer black men planned to quit in the future. Blacks appeared to lag behind whites in their efforts to quit smoking. Smoking behavior continues to be problematic for both blacks and whites. Studies are needed to explain better the racial differences in smoking and smoking cessation behaviors, and to facilitate programs to encourage cessation.     

Blood pressure differences between blacks and whites in relation to body size among US children and adolescents

No large national studies of ethnic differences in blood pressure among children accounting for body size differences have been published, to the authors' knowledge. This report details the similarities and differences in systolic and diastolic blood pressures between Black children and White children in the United States and examines the effects of age, sex, and body size on ethnic differences in blood pressure levels. Standardized measurements of seated systolic and diastolic pressures from eight large epidemiologic studies published between 1978 and 1991 that included measurements of 47,196 children on 68,556 occasions for systolic pressure and for 38,184 children on 52,053 occasions for diastolic pressure were used; 51 percent (24,048 children) were boys and 37 percent (17,466 children) were Black. Overall, there appear to be few substantive ethnic differences in either systolic or diastolic pressure during childhood and adolescence. The differences that were observed were small, inconsistent, and often explained by differences in body size. There was an ethnic group-body mass index (BMI) interaction that resulted in these findings that at lower levels of BMI Blacks have higher blood pressure and more hypertension than do Whites, but that at the highest levels of BMI, Whites have more hypertension (systolic or diastolic pressure) than do Blacks.     

Association of selenium status and blood glutathione concentrations in blacks and whites

Selenium deficiency has been linked with increased cancer risk and, in some studies, selenium supplementation was protective against certain cancers. Previous studies have suggested that selenium chemoprevention may involve reduced oxidative stress through enhanced glutathione (GSH). Our objectives were to examine the relationships between selenium and GSH in the blood and the modifying effects of race and sex in free-living adults and individuals supplemented with selenium. Plasma selenium concentrations and free and bound GSH concentrations and γ-glutamyl cysteine ligase (GCL) activity in the blood were measured in 336 healthy adults (161 Blacks, 175 Whites). Plasma selenium and blood GSH were also measured in 36 healthy men from our previously conducted placebo-controlled trial of selenium-enriched yeast (247 μg/day for 9 mo). In free-living adults, selenium concentrations were associated with increased blood GSH concentration and GCL activity (P < 0.05). Further, selenium was significantly higher in Whites than in Blacks (P < 0.01). After 9 mo of supplementation, plasma selenium increased 114% in Whites and 50% in Blacks (P < 0.05), and blood GSH increased 35% in Whites (P < 0.05) but was unchanged in Blacks. These results indicate a direct association between selenium and GSH in the blood of both free-living and selenium-supplemented individuals, with race being an important modifying factor.     

Obesity affects nursing-care facility admission among whites but not blacks

OBJECTIVE: This study examines whether obese individuals have a greater rate of nursing care facility admission than normal weight individuals. RESEARCH METHODS AND PROCEDURES: Data from the National Health and Nutrition Examination Survey Epidemiological Follow-up Survey were analyzed. Cox proportional hazards models were used to examine the relationship between baseline weight status and subsequent time to first nursing home admission while adjusting for sex, age, race, marital status, height, presence of children, smoking status, education, region, urban residence, income, and physical activity. RESULTS: Of 5960 adults 45 to 74 years old, 989 individuals were admitted to a nursing care facility over the subsequent 20 years. Body mass index (BMI) was studied using five categories: < 18.5, 18.5 to <25, 25.0 to <30, 30.0 to <35, > or =35 kg/m(2). The effects of BMI differed by race: compared with those with a BMI of 18.5 to < 25 kg/m(2), adults with a BMI > or =30 kg/m(2) or a BMI <18.5 kg/m(2) had a greater rate of nursing home admission in whites, whereas no relationship was found in blacks. The inclusion of time to death with nursing home admission as a joint outcome yielded similar results. DISCUSSION: The large increase in the prevalence of obesity coupled with the rapid expansion of the number of older Americans will likely increase the demand for nursing facility use. More research is needed to understand differences in factors related to nursing home admission among ethnic groups.     

Nutritional habits of blacks and whites

Epidemiologic investigations have implicated various dietary practices in the etiology of prostatic and esophageal cancer. These factors may contribute to differences in cancer incidence observed between blacks and whites in the United States. Data from the Health and Nutrition Examination Survey are reviewed to explore the possibility that excess disease rates in nonwhites may be attributed to differing dietary practices. These data are of some value in explaining differences in cancer incidence between blacks and whites and are of special value as exploratory tools pointing toward fruitful areas of future research.     

Socioeconomic status and mortality among the elderly: findings from four US communities

The effect of socioeconomic status (SES) on mortality was examined in the community-dwelling elderly. Data were obtained from four population-based studies that enrolled elderly residents of four US communities (East Boston, Massachusetts; New Haven, Connecticut; east-central Iowa; and the Piedmont region of North Carolina) and followed them for 9 years, starting in 1982 or 1986. Higher SES, whether measured by education, by household income, or by occupational prestige, was generally associated with lower mortality. However, the pattern of findings varied by gender and by community. For men, all three SES indicators were associated with mortality in the majority of cohorts. For women, this was true only for income. SES-mortality associations were attenuated but not eliminated after adjustment for behavior and health status. SES-mortality associations were stronger in New Haven and North Carolina than in East Boston and Iowa. The latter communities are more homogeneous with respect to ethnicity, urbanization, and occupational history than the former. Future research should investigate the relative validity of traditional SES measures for men and women and develop more balanced assessment methods. These findings also suggest that it is important to consider not only individual characteristics but also community attributes that mediate or modify the pathways through which socioeconomic conditions may influence health.     

The effect of primary care physician supply and income inequality on mortality among blacks and whites in US metropolitan areas

OBJECTIVES: This study assessed whether income inequality and primary care physician supply have a different effect on mortality among Blacks compared with Whites. METHODS: We conducted a multivariate ecologic analysis of 1990 data from 273 US metropolitan areas. RESULTS: Both income inequality and primary care physician supply were significantly associated with White mortality (P < .01). After the inclusion of the socioeconomic status covariates, the effect of income inequality on Black mortality remained significant (P < .01), but the effect of primary care physician supply was no longer significant (P > .10), particularly in areas with high income inequality. CONCLUSIONS: Improvement in population health requires addressing socioeconomic determinants of health, including income inequality and primary care availability and access.     

The sex offenses of blacks and whites

Little is currently known about differences in the sex offenses of blacks and whites in the United States. Many major studies of sexual behavior and of sex offenders have purposely excluded data on blacks. This paper presents comparative data on 47 black and 47 white sex offenders in terms of the nature of the offense and victim characteristics. It was found that black offenders were more likely than white offenders to engage in vaginal intercourse with their victims, showed a trend to use force in their offenses, and were more likely to select adult female victims. These differences, however, appear to be due primarily to class rather than racial differences. Limitations of these data are discussed.This study was conducted under the auspices of the Atascadero State Hospital Research Department.     

Neighborhood socioeconomic status and fruit and vegetable intake among whites, blacks, and Mexican Americans in the United States

BACKGROUND: Socioeconomic and racial-ethnic disparities in health status across the United States are large and persistent. Obesity rates are rising faster in black and Hispanic populations than in white populations, and they foreshadow even greater disparities in chronic illnesses such as diabetes and cardiovascular disease in years to come. Factors that influence dietary intake of fruit and vegetables in these populations are only partly understood. OBJECTIVES: We examined associations between fruit and vegetable intake and neighborhood socioeconomic status (SES), analyzed whether neighborhood SES explains racial differences in intake, and explored the extent to which neighborhood SES has differential effects by race-ethnicity of US adults. DESIGN: Using geocoded residential addresses from the Third National Health and Nutrition Examination Survey, we merged individual-level data with county and census tract-level US Census data. We estimated 3-level hierarchical models predicting fruit and vegetable intake with individual characteristics and an index of neighborhood SES as explanatory variables. RESULTS: Neighborhood SES was positively associated with fruit and vegetable intake: a 1-SD increase in the neighborhood SES index was associated with consumption of nearly 2 additional servings of fruit and vegetables per week. Neighborhood SES explained some of the black-white disparity in fruit and vegetable intake and was differentially associated with fruit and vegetable intake among whites, blacks, and Mexican Americans. CONCLUSIONS: The positive association of neighborhood SES with fruit and vegetable intake is one important pathway through which the social environment of neighborhoods affects population health and nutrition for whites, blacks, and Hispanics in the United States.