Time perspective and socioeconomic status: A link to socioeconomic disparities in health?

Time perspective is a measure of the degree to which one's thinking is motivated by considerations of the future, present, or past. Time perspective has been proposed as a potential mediator of socioeconomic disparities in health because it has been associated with health behaviors and is presumed to vary with socioeconomic status. In this cross-sectional community-based survey of respondents recruited from hair salons and barber shops in a suburb of Washington DC, we examined the association between time perspective and both education level and occupation. We asked participants (N = 525) to complete a questionnaire that included three subscales (future, present-fatalistic, and present-hedonistic) of the Zimbardo Time Perspective Inventory. Participants with more formal education and those with professional occupations had higher scores on the future time perspective subscale, and lower scores on the present-fatalistic subscale, than participants with less formal education or a non-professional occupation. Present-fatalistic scores were also higher among participants whose parents had less formal education. Present-hedonistic scores were not associated with either education level or professional occupation. Time perspective scores were not independently associated with the likelihood of obesity, smoking, or exercise. In this community sample, future time perspective was associated with current socioeconomic status, and past-fatalistic time perspective was associated with both current and childhood socioeconomic status.     

城镇化、社会经济地位与居民健康差距

利用1991—2015年“中国健康与营养调查”数据,实证考察城镇化、社会经济地位与居民健康差距之间的关系。研究发现：(1)城镇化影响居民健康。城镇化会显著增加居民的四周患病率,与慢性病患病率和患病数量存在先降后增的关系。(2)城镇化扩大了不同社会经济地位居民之间的健康差距,城镇化对社会经济地位较低居民健康的负面影响更大。(3)机制分析表明,城镇化主要通过生活方式改变、心理压力增大以及肥胖等渠道影响居民的健康状况。因此,在推进新型城镇化和实施“健康中国”战略的背景下,应关注城镇化所带来的健康分配效应,警惕城镇化进程中可能出现的“健康陷阱”。     

Disentangling race and socioeconomic status: A key to understanding health inequalities

This article addresses one of the most vexing problems facing health disparities researchers, the confounding of race and socioeconomic status. This article does the following: (1) it outlines the magnitude of confounding between race and socioeconomic status; (2) it demonstrates problems caused by this confounding; (3) it examines the degree to which race disparities are a function of socioecomic status; and (4) it discusses considerations for advancing research on health disparities after accounting for the confounding of race and socioeconomic status.     

The role of health-related behaviors in the socioeconomic disparities in oral health

This study aimed to examine the socioeconomic disparities in health-related behaviors and to assess if behaviors eliminate socioeconomic disparities in oral health in a nationally representative sample of adult Americans. Data are from the US Third National Health and Nutrition Examination Survey (1988–1994). Behaviors were indicated by smoking, dental visits, frequency of eating fresh fruits and vegetables and extent of calculus, used as a marker for oral hygiene. Oral health outcomes were gingival bleeding, loss of periodontal attachment, tooth loss and perceived oral health. Education and income indicated socioeconomic position. Sex, age, ethnicity, dental insurance and diabetes were adjusted for in the regression analysis. Regression analysis was used to assess socioeconomic disparities in behaviors. Regression models adjusting and not adjusting for behaviors were compared to assess the change in socioeconomic disparities in oral health. The results showed clear socioeconomic disparities in all behaviors. After adjusting for behaviors, the association between oral health and socioeconomic indicators attenuated but did not disappear. These findings imply that improvement in health-related behaviors may lessen, but not eliminate socioeconomic disparities in oral health, and suggest the presence of more complex determinants of these disparities which should be addressed by oral health preventive policies.     

Intergenerational health disparities: socioeconomic status, women's health conditions, and child behavior problems

OBJECTIVE: Relatively little is known about the intergenerational mechanisms that lead to social disparities in child health. We examined whether the association between low socioeconomic status (SES) and child behavior problems is mediated by maternal health conditions and behavior. METHODS: Prospective cohort data (1979-1998) on 2,677 children and their mothers were obtained from the National Longitudinal Survey of Youth. SES, the Child Behavior Problems Index (BPI), and maternal smoking, depressive symptoms, and alcohol use before, during, and after pregnancy were examined. RESULTS: Lower income and lower maternal education were associated with increased child BPI scores. Adjustment for maternal smoking, depressive symptoms, and alcohol use attenuated the associations between SES and child BPI by 26% to 49%. These maternal health conditions often occurred together, persisted over time, and were associated with the mother's own childhood SES and pre-pregnancy health. CONCLUSIONS: Social disparities in women's health conditions may help shape the likelihood of behavior problems in the subsequent generation. Improved public health programs and services for disadvantaged women across the lifecourse may not only address their own urgent health needs, but reduce social disparities in the health and well-being of their children.     

Measuring socioeconomic status/position in studies of racial/ethnic disparities: maternal and infant health

OBJECTIVE: Theoretical and empiric considerations raise concerns about how socioeconomic status/position (abbreviated here as SES) is often measured in health research. The authors aimed to guide the use of two common socioeconomic indicators, education and income, in studies of racial/ethnic disparities in low birthweight, delayed prenatal care, unintended pregnancy, and breastfeeding intention. METHODS: Data from a statewide postpartum survey in California (N = 10,055) were linked to birth certificates. Overall and by race/ethnicity, the authors examined: (a) correlations among several measures of education and income; (b) associations between each SES measure and health indicator; and (c) racial/ethnic disparities in the health indicators "adjusting" for different SES measures. RESULTS: Education-income correlations were moderate and varied by race/ethnicity. Racial/ethnic associations with the health indicators varied by SES measure, how SES was specified, and by health indicator. CONCLUSIONS: Conclusions about the role of race/ethnicity could vary with how SES is measured. Education is not an acceptable proxy for income in studies of ethnically diverse populations of childbearing women. SES measures generally should be outcome- and population-specific, and chosen on explicit conceptual grounds; researchers should test multiple theoretically appropriate measures and consider how conclusions might vary with how SES is measured. Researchers should recognize the difficulty of measuring SES and interpret findings accordingly.     

Patient satisfaction with health care providers in South Africa: the influences of race and socioeconomic status.

OBJECTIVE: The first democratic government elected in South Africa in 1994 inherited huge inequalities in health status and health provision across all sections of the population. This study set out to assess, 4 years later, the influence of race and socioeconomic status (SES) on perceived quality of care from health care providers. DESIGN: A 1998 countrywide survey of 3820 households assessed many aspects of health care delivery, including levels of satisfaction with health care providers among different segments of South African society. RESULTS: Fifty-one percent (n = 1953) of the respondents had attended a primary care facility in the year preceding the interview and were retained in the analysis. Both race and SES were significant predictors of levels of satisfaction with the services of the health care provider, after adjusting for gender, age, and type of facility visited. White and high SES respondents were about 1.5 times more likely to report excellent service compared with Black and low SES respondents, respectively. CONCLUSION: In South Africa, race and SES are not synonymous and can no longer be considered reliable proxy indicators of one another. Each has distinct and significant but different degrees of association with client satisfaction. Any assessment of equity-driven health policy in South Africa should consider the impacts of both race and SES on client satisfaction as one of the indicators of success.     

Understanding the routinised inclusion of race, socioeconomic status and sex in epidemiology: the utility of concepts from technoscience studies

Abstract The multifactorial model of disease causation constitutes the dominant conceptual framework underwriting the epidemiology of chronic illness. Under this rubric, factors correlated with disease are analysed at the individual level; accordingly, race, social class and gender are routinely conceptualised and incorporated into epidemiological research as individualised measures of racial category, socioeconomic status and sex. This paper employs three concepts from the field of technoscience studies to elucidate how epidemiological constructions about bodily ‘differences’ are infused with authority and legitimacy. The multifactorial model and accompanying representations of race, class and gender can be usefully conceptualised as a black box ( Latour 1987 , Latour and Woolgar 1986 ), in which individualised inputs to epidemiological studies are routinised while the interior workings of the black box – how exactly ‘differences’ come to affect health – are taken for granted. Second, processes of triangulation ( Star 1985, 1986 ) are evident, as results from multiple lines of research on an array of different diseases are used to enhance the stability of the multifactorial model and associated constructions of ‘difference’. A final illuminating technoscience concept is that of the boundary object ( Star and Griesemer 1989 ), whose dual properties of conceptual flexibility and integrity help in understanding the proliferation and institutionalisation of epidemiological methods of studying race, class and sex/gender in chronic disease.     

父母社会经济地位与儿童问题行为的关系:父母生育年龄的中介作用

目的 探讨父母生育年龄对父母社会经济地位与儿童问题行为的中介作用。方法 采取分层整群抽样方法,选取蚌埠市2所幼儿园和2所小学的1-3年级共834名儿童及其父母为研究对象进行问卷调查。儿童的问题行为通过长处和困难问卷进行评估,父母社会经济地位通过社会经济地位量表进行评估。采用多元线性回归和Bootstrap法构建并检验父母生育年龄对父母社会经济地位与儿童问题行为的中介效应。结果 母亲的社会经济地位(β=-0.109,P=0.003)和生育年龄(β=-0.096,P=0.007)均与儿童多动-注意不能呈负相关,母亲社会经济地位与母亲生育年龄则呈正相关(β=0.236,P<0.001)。母亲生育年龄对母亲社会经济地位和儿童多动-注意不能的部分中介效应为-0.059 (95%CI:-0.110--0.018,P=0.007)。结论 较高的母亲社会经济地位可以减少儿童多动-注意不能的发生。父母在努力提高家庭经济收入的同时,应努力提升自己的教养水平,注意儿童问题行为的发生。     

Early origins of health disparities: Burden of infection,health, and socioeconomic status in U.S. children

Recent work in biodemography has suggested that lifetime exposure to infection and inflammation may be an important determinant of later-life morbidity and mortality. Early exposure to infections during critical periods can predispose individuals to chronic disease, in part through the reallocation of energy away from development needed for immune and inflammatory responses. Furthermore, markers of inflammation are known to vary by socioeconomic status in adults and may contribute to overall socioeconomic health inequalities, but little is known about how the sources of this inflammation differ over the life course. This paper uses novel biomarker data from the Third National Health and Nutrition Examination Survey (NHANES III) to test the association of the burden of common chronic infections (Helicobacter pylori (H. pylori), cytomegalovirus (CMV), herpes simplex virus-1 (HSV-1), hepatitis A and hepatitis B) with height-for-age and asthma/chronic respiratory conditions in U.S. children ages 6 and older, and the association of these chronic infections to children's socioeconomic status. A higher burden of infection is found to be associated with lower height-for-age as well as an increased likelihood of asthma net of race/ethnicity, family income, and parental education. Children with lower family income, lower parental education, and non-white race/ethnicity have a higher likelihood of infection with several individual pathogens as well as the overall burden of infection. Differential exposure and/or susceptibility to infections may be one mechanism through which early social factors get embodied and shape later-life health outcomes.     

Race and self assessed health status: the role of socioeconomic factors in the USA.

STUDY OBJECTIVE: To estimate relative odds ratios and to ascertain the relative contribution of each socioeconomic covariate in explaining racial disparities in self assessed health status (for example, global health perceptions and functional limitations of daily activities). DESIGN: National representative data from the 1987-88 national survey of families and households, a multistage, stratified probability sample of non-institutionalised American adults age 19 and older, were used. Logistic regression models enabled a multistage building strategy to be used in the analyses. PARTICIPANTS AND SETTING: The study included three racial groups: whites (n = 9419), blacks (n = 2391), and Hispanics (n = 1004). While face to face interviews were carried out with each respondent, some portions of the interview were self administered to collect sensitive information. MAIN RESULTS: Compared with whites, blacks and Hispanics were more likely to assess health as poor and report having functional limitations of daily activities. Socioeconomic factors tended to play a different role in explaining racial disparities in self assessed health status. In global health, education tended to play a significant role in accounting for health disparities between whites and Hispanics. In functional limitations, none of the covariates explained racial differences for blacks, whereas for Hispanics, education and marital status explained racial differences. CONCLUSIONS: The debate over whether race is a proxy for socioeconomic conditions or race influences health independent of socioeconomic factors depends on the measure of health and racial group included in the study. Future studies should examine separately the differential impacts of various socioeconomic factors on varying domains of health.     

The role of social support and integration for understanding socioeconomic disparities in self-rated health and hypertension

This paper examines socioeconomic (socioeconomic status, SES) disparities in self-rated health and hypertension among 29,816 US adults aged 25 and older using data from the 2001 wave of the National Health Interview Survey. Our purpose is to examine how influential measures of social support and social integration are for each health outcome, and whether support and integration operate by mediating, or buffering, the effects of SES on health. Multivariate regression models show no significant influence of emotional support, but do indicate that many aspects of social integration are directly associated with self-rated health and hypertension, although these measures do not mediate the relationship between SES and health. However, interaction tests show substantial evidence that measures of social integration buffer some of the negative effects of low SES, particularly the negative influence of not working on self-rated health. In addition, findings indicate potential evidence of help-seeking behavior among adults who did not finish high school or who report financial barriers to medical care. Overall, our findings suggest that social programs designed to foster social integration (e.g., free or low-cost bus fare to promote visits with friends and family) may improve health among persons with low levels of education, who are not working, or who have problems accessing medical care because of financial problems.     

Methods and software for estimating health disparities: the case of children's oral health

The National Center for Health Statistics recently issued a monograph with 11 guidelines for reporting health disparities. However, guidelines on confidence intervals (CIs) cannot be readily implemented with the complex sample surveys often used for disease surveillance. In the United States, dental caries (decay) is the most common chronic childhood disease-5 times more common than asthma. Racial/ethnic minorities, immigrants, and persons of lower socioeconomic position (SEP) have a greater prevalence of caries. The authors provide methods for applying National Center for Health Statistics guidelines to complex sample surveys (health disparity indices and absolute and relative difference measures assessing associations of race/ethnicity and SEP to health outcomes with CIs); illustrate the application of those methods to children's untreated caries; provide relevant software; and report results from a simulation varying prevalence. They use data on untreated caries from the California Oral Health Needs Assessment of Children 2004-2005 and school percentage of participation in free/reduced-price lunch programs to illustrate the methods. Absolute and relative measures, the Slope Index of Inequality, the Relative Index of Inequality (mean and ratio), and the Health Concentration Index were estimated. Taylor series linearization and rescaling bootstrap methods were used to estimate CIs. Oral health differed significantly between White children and all non-White children and was significantly related to SEP.