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In recent decades there has been an increasing interest in understanding the role of social and physical contexts in influencing health behaviors and outcomes. This is especially true for weight, which is considered to be highly dependent on environmental factors. The evidence linking neighborhood characteristics to weight in the United States, however, is mixed. Many studies in this area are hampered by cross sectional designs and a limited scope, insofar as they investigate only one dimension of neighborhood context. It is also unclear to what extent neighborhood characteristics account for racial/ethnic disparities in weight. Using longitudinal data from the Los Angeles Family and Neighborhood Survey (L.A. FANS), we compare patterns of weight change between Hispanics and other racial and ethnic groups in order to evaluate whether we observe a pattern of unhealthy assimilation in weight among Hispanic immigrants and to identify differences in the rate at which different groups gain weight over time. We also explore the extent to which patterns of weight change are related to a wider range of community characteristics. We find that weight increases across all groups between the two study waves of L.A. FANS and that the increases are significant except for Asians/Pacific Islanders. With respect to differences in the pace of weight change, second and higher generation Hispanic women and black men gain weight more rapidly than their first generation Hispanic counterparts. Although the evidence presented indicates that first generation Hispanics gain weight, we do not find evidence for convergence in weight since the U.S.-born gain weight at a more rapid rate. The inclusion of community-level variables does not alter the relationships between the race, ethnicity, and immigrant generation categories and weight change. Of the six types of community characteristics considered, only collective efficacy is consistently and significantly associated with weight change, although the protective effect of neighborhood collective efficacy is seen only among women.

Although the relationship between socioeconomic status (SES) and health is well-established in Western industrialized countries, few studies have examined this association in developing countries, particularly among older cohorts. We use the Mexican Health and Aging Study (MHAS), a nationally representative survey of Mexicans age 50 and older, to investigate the linkages between three indicators of SES (education, income, and wealth) and a set of health outcomes and behaviors in more and less urban areas of Mexico. We consider three measures of current health (self-rated health and two measures of physical functioning) and three behavioral indicators (obesity, smoking, and alcohol consumption). In urban areas, we find patterns similar to those in industrialized countries: higher SES individuals are more likely to report better health than their lower SES counterparts, regardless of the SES measure considered. In contrast, we find few significant SES-health associations in less urban areas. The results for health behaviors are generally similar between the two areas of residence. One exception is the education obesity relationship. Our results suggest that education is a protective factor for obesity in urban areas and a risk factor in less urban areas. Contrary to patterns in the industrialized world, income is associated with higher rates of obesity, smoking, and excessive alcohol consumption. We also evaluate age and sex differences in the SES health relationship among older Mexicans. The results suggest that further economic development in Mexico may lead to a widening of socioeconomic inequalities in health. The study also provides insight into why socioeconomic gradients in health are weak among Mexican-Americans and underscores the importance of understanding health inequalities in Latin America for research on Hispanic health patterns in the US. Keywords: Mexico: Socioeconomic status; Health: Health inequalities: Older adults; Area

Despite the health and survival advantages of Hispanics relative to non-Hispanic whites in the USA, Hispanics report themselves to be in worse health than whites. Prior research indicates that these ethnic differences in self-rated health (SRH), measured by a simple question asking individuals to assess their overall health status, persist in the presence of an extensive set of explanatory variables. In this paper we use data from the first wave of the Los Angeles Family and Neighborhood Survey (L.A.FANS-1) to test three hypotheses regarding Hispanic-white differences in SRH. We evaluate whether poorer health reports among Hispanics result from: (1) acculturation and language-related differences in reports; (2) measures of socioeconomic status (SES) that are often omitted in other studies; and (3) somatization of emotional distress by Hispanics. Our results provide new insights into the validity of these explanations and suggest avenues for future research. First, they underscore the importance of language of interview over other measures of acculturation, suggesting that translation issues between the Spanish and English versions of the SRH question may give rise to some of the differences. Second, adjustment for SES--especially years of schooling--narrows, but does not eliminate, the gap between whites' and Hispanics' SRH. Finally, although respondents who are depressed are more likely to report poor SRH, this study provides little evidence to support the somatization hypothesis. The second wave of L.A.FANS incorporates new questions that are likely to permit more in-depth assessments of these hypotheses in future analyses. Keywords: Race; Ethnicity; Hispanic; Self-rated health; Perceptions of health; Immigration; USA

Natural disasters, such as earthquakes, can have deleterious consequences for physical and psychological health. In this study, we investigate variability in resilience to depressive symptoms in the aftermath of a massive earthquake that struck Taiwan in 1999. We analyze data on 1160 older individuals from a national, longitudinal survey with interviews before and after the earthquake. This survey contains extensive information on physical and cognitive function, depressive symptoms, socio-demographic characteristics and earthquake-related exposure and experiences. We estimate regression models to identify risk factors associated with he presence of depressive symptoms after the disaster, controlling for health status and the presence of depressive symptoms beforehand. We pay special attention to how socio-demographic factors moderate the psychological impact of the earthquake. Results indicate that persons of low socioeconomic status (SES), socially isolated individuals, and women reported higher levels of depressive symptoms than their respective counterparts, as did persons who experienced damage to their homes. The psychological effects of damage were strongest among those aged 54-70. The findings suggest that people who experience damage to their home during a disaster are at risk of experiencing depressive symptoms, with the elderly being more resilient than the near-elderly. Keywords: Earthquake; Depressive symptoms; Taiwan; Socioeconomic status; Age

Despite the increasing evidence linking aspects of the social environment to a range of health outcomes, important questions remain concerning the precise mechanisms or pathways through which social circumstances exert their influence. Biological pathways are one important area of current research interest. Using data from the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan, we examined relationships between social environment characteristics and an index of cumulative biological dysregulation ('allostatic load.'' AL) in near elderly (NE) (aged 54-70) and elderly Taiwanese (aged 71+). Longitudinal data on levels of social integration and extent of social support were used to predict cumulative AL at the final survey year. Linear regression analyses revealed that among the NE, presence of a spouse between 1996 and 2000 was associated with lower AL in 2000 among men, but not women. Among the elderly, ties with close friends and/or neighbors were found to be significantly related to lower AL for both men and women. Perceived qualities of these social relationships did not show consistent associations with AL. This relatively modest set of significant relationships stands in contrast to somewhat stronger patterns of findings from studies in Western societies. Cross-cultural differences between Western societies and an East Asian society such as Taiwan raise the intriguing possibility that contextual, normative influences on social experience affect the patterns of association between features of these social worlds and the physiological substrates of health. Keywords: Allostatic load; Social relationships; Social support; Taiwan

This study examines factors associated with the use of biomedical care during pregnancy in Guatemala, focusing on the extent to which complications in an ongoing or previous pregnancy affect a woman's decisions to seek care. The findings, based on multilevel models, suggest that obstetrical need, as well as demographic, social, and cultural factors, are important predictors of pregnancy care. In contrast, measures of availability and access to health services have modest effects. The results also suggest the importance of unobserved variables-such as quality of care-in explaining women's decisions about pregnancy care. These results imply that improving proximity to biomedical services is unlikely to have a dramatic impact on utilization in the absence of additional changes that improve the quality of care or reduce barriers to access. Moreover, current efforts aimed at incorporating midwives into the formal health-care system may need to extend their focus beyond the modification of midwife practices to consider the provision of culturally appropriate, high-quality services by traditional and biomedical providers alike.

In an effort to reduce infant and maternal morbidity and mortality in developing countries, the World Health Organization has promoted the training of traditional birth attendants (midwives) and their incorporation into the formal health care system. In this paper, we examine several aspects of the integration of traditional and biomedical maternity care that are likely to reflect the quality of care received by Guatemalan women. Specifically, we examine the extent to which women combine traditional and biomedical pregnancy care, the frequency with which midwives refer women to biomedical providers, the content and quality of care offered by midwives, and the effects of midwife training programs on referral practices and quality of care. The analysis is based on data from the 1995 Guatemalan Survey of Family Health. The results offer a mixed assessment of the efficacy of midwife training programs. For example, although trained midwives are much more likely than other midwives to refer their clients to biomedical providers, most pregnant women do not see a biomedical provider, and the quality of midwife care, as defined and measured in this study, is similar between trained and untrained midwives. Keywords: Pregnancy; Prenatal care; Birth; Midwifery; Traditional birth attendant; Guatemala

This paper uses the 1995 Guatemalan Survey of Family Health (EGSF) to analyze the relationship between child illness and health seeking behavior. The EGSF contains detailed calendar data on the nature and timing of illness and treatment behavior for children age five and below; extensive information about the characteristics of mothers, families and communities; and data on the accessibility of traditional and biomedical providers within and near the community. The analysis is based on 870 children who began a diarrheal or respiratory illness during a 2-week period prior to interview. Estimates are derived from a multinomial logit model of the probability of seeing a specific type of provider on a given day of illness, as a function of characteristics of the illness, child, mother, and community. The results indicate that modern medical care plays a major role in the treatment of infectious illness among children in rural Guatemala. The symptoms associated with the illness, their perceived severity, and mother's beliefs about their causes are important determinants of whether a child is brought to a provider and the type of provider visited. Poverty is a serious constraint on a family's choices about how to treat children's illnesses, whereas education and ethnicity have little effect on treatment behavior when income is held constant. In addition, the availability of modern health facilities within the community--both government-sponsored facilities and private doctors--has a substantial impact on the type of providers sought to treat children's illnesses. Keywords: Diarrhea; Acute respiratory infection; Health interview survey; Treatment; Providers; Child illness; Guatemala

We use an ongoing longitudinal survey of elderly Taiwanese to examine the linkages among health, the social environment, and exposure to life challenge. Data from three waves of the survey provide measures of social hierarchy, social connection, life challenge, and health outcomes. On the basis of multinomial and binomial logistic models, we explore the effects of social factors and challenge on being unhealthy or deceased at follow-up. The estimates indicate that poor health status at follow-up is associated with (1) low socioeconomic status, not having any living children, limited networks of friends, and low participation in social activities; and (2) three life challenges--chronic financial problems, excessive demands placed by close relatives and friends, and having a spouse in poor health. Respondents facing several challenges or having multiple negative attributes in their social environment are especially likely to be unhealthy at follow-up, although negative attributes appear to be counteracted by positive ones. Many findings from Western societies extend to this Taiwanese population. However, some aspects of social connection and challenge hypothesized to affect health fail to reveal a significant association. The analysis identifies differences between men and women in the effects of specific challenges on health, but sex differences in the effects of socioeconomic status and social connection on health are not significant. Keywords: Social environment; Gender; Elderly; Stress; Socioeconomic status; Taiwan

Many studies have documented a longevity advantage for married persons relative to their unmarried counterparts in all age groups. However, these studies have failed to determine whether the advantage experienced by married elderly persons arises mostly from selection and causal processes which operated at younger ages. This paper employs data from the Longitudinal Study of Aging (1984-1990) to explore whether marital status continues to exert any influence on health and mortality at the older ages. In the presence of an extensive set of controls for health status at the baseline survey, a series of logistic models are used to determine: (1) the magnitude of marital status effects on disability and on mortality, among older males and older females; and (2) the extent to which the social environment and economic status of the elderly can account for the existing disability and mortality differences by marital status. Key words - marital status, health and mortality among elderly

Immunization against major childhood diseases has been an essential component of health policies in developing countries. However, despite its importance and the efforts invested by many organizations in promoting immunization programs, consistent and accurate measurement of immunization coverage has not yet been achieved. In this paper, we explore the implications of alternative methods of measuring immunization coverage rates in Guatemala, using data from the 1987 Encuesta Nacional de Salud Materno Infantil, and we consider the dangers of making inferences about levels and trends in coverage from cross-sectional data. The results indicate that (1) service statistics may well lead to overestimates of coverage; (2) survey estimates derived from health cards can also produce severely biased estimates; and (3) in spite of problems associated with maternal recall, mothers' reports of their children's vaccination status probably result in substantially improved estimates of immunization coverage.

Recent research has demonstrated that mortality patterns by marital status in Japan are different from corresponding patterns in other industrialized countries. Most notably, the magnitude of the excess mortality experienced by single Japanese has been staggering. For example, estimates of life expectancy for the mid-1900s indicate that single Japanese men and women had life expectancies between 15 and 20 years lower than their married counterparts. In addition, gender differences among single Japanese have been smaller than elsewhere, while those among divorced persons have been unanticipatedly large; and, the excess mortality of the Japanese single population has been decreasing over the past few decades in contrast to generally increasing differentials elsewhere. In this paper, we use a variety of data sources to explore several explanations for these unique mortality patterns in Japan. Undeniably, the traditional Japanese system of arranged marriages makes the process of selecting a spouse a significant factor. Evidence from anthropological studies and attitudinal surveys indicates that marriage is likely to have been and probably continues to be more selective with regard to underlying health characteristics in Japan than in other industrialized countries. However, causal explanations related to the importance of marriage and the family in Japanese society may also be responsible for the relatively high mortality experienced by singles and by divorced men.

The objective of this analysis is to determine whether useful information on birthweight can be obtained from a restrospective survey. The 1986 Peru Demographic Health Survey collected both numerical weights (in grams) and subjective assessments of relative size at birth, for infants born during 1981-86. Simple tabulations suggest that reports of both measures are of reasonably high quality. However, a more detailed analysis demonstrates that exclusion of the large proportion (almost one-third) of missing response on numerical weights can lead to biases in the resulting estimates of the incidence and correlates of low birthweight, of the level of infant mortality, and probably of the relative risk of mortality for low birthweight infants. The results emphasize the necessity of collecting data on the relative size of infants, in addition to information on numerical weights, in populations in which a substantial fraction of infants are born outside the formal health system. The subjective assessments allow the analyst to examine the extent to which infants with missing numerical weights are select and to assess the degree of bias in estimates which are based on the subsample of births with reported weights.