Search

Abstract: Objective: We examined whether prenatal mindfulness training was associated with lower depressive symptoms through 18‐months postpartum compared to treatment as usual (TAU). Method: A controlled, quasi‐experimental trial compared prenatal mindfulness training (MMT) to TAU. We collected depressive symptom data at post‐intervention, 6‐, and 18‐months postpartum. Latent profile analysis identified depressive symptom profiles, and multinomial logistic regression examined whether treatment condition predicted profile. Results: Three depressive symptom severity profiles emerged: none/minimal, mild, and moderate. Adjusting for relevant covariates, MMT participants were less likely than TAU participants to be in the moderate profile than the none/minimal profile (OR = 0.13, 95% CI = 0.03‐0.54, p = .005). Conclusions: Prenatal mindfulness training may have benefits for depressive symptoms during the transition to parenthood. [ABSTRACT FROM AUTHOR]

Abstract: Children growing up in poverty are at heightened risk for poor health. Researchers have identified some mechanisms responsible for this association but we know less about how children are affected by growing up in communities, schools, and countries with varying levels of income inequality. In this article, we summarize what is known about the association between children's well‐being and income inequality, and outline three challenges that increasing levels of income inequality may pose to children from low‐income families. We also discuss implications for research and policy. [ABSTRACT FROM AUTHOR]

Introduction Few studies have examined prenatal mood as a means to identify women at risk for negative childbirth experiences. We explore associations between prenatal mood and birth perceptions in a socioeconomically diverse, American sample. Methods We conducted a prospective study of 136 predominantly low-income and ethnic minority women of mixed parity. Prenatal measures of perceived stress, pregnancy-related anxiety, and depressive symptoms were used to predict maternal perceptions of birth experiences 1 month postpartum, using the childbirth experience questionnaire ( CEQ; 1). Results After adjusting for sociodemographic variables and mode of delivery, higher third-trimester stress predicted worse CEQ total scores. This association was predominantly explained by two CEQ domains: own capacity (e.g., feelings of control and capability), and perceived safety. Pregnancy-related anxiety and depressive symptoms correlated with perceived stress, though neither independently predicted birth experience. An unplanned cesarean delivery was associated with a worse CEQ total score. Vaginal delivery predicted greater perceived safety. Altogether, sociodemographic covariates, mode of delivery, and prenatal mood accounted for 35 percent of the variance in birth experience ( p < 0.001). Discussion Our finding that prenatal stress explains a significant and likely clinically meaningful proportion of the variance in birth experience suggests that women perceive and recall their birth experiences through a lens that is partially determined by preexisting personal circumstances and emotional reserves. Since childbirth perceptions have implications for maternal and child health, patient satisfaction, and health care expenditures, these findings warrant consideration of prenatal stress screening to target intervention for women at risk for negative birth experiences. [ABSTRACT FROM AUTHOR]

Objective Body mass index (BMI) and intelligence quotient (IQ) are associated. We examined whether this association varied by birth cohort. Methods Among 37,414 Danish conscripts, the association between BMI and IQ overall and by birth cohort was examined. IQ was measured by the Børge Prien's Prøve (BPP) group intelligence test score. Results Compared with men of normal BMI, mean differences (95% CI [confidence interval]) in BPP score were −0.6 (−1.1;-0.1) for underweight men; −0.8 (−1.1;-0.5) for overweight men; and −2.0 (−2.4;-1.5) for men with obesity. Crude prevalence ratios (95% CI) for low cognitive scores associated with obesity were, respectively, 1.52 (1.24; 1.85), 1.64 (1.32; 2.04), 1.56 (1.38; 1.76), and 1.35 (1.18; 1.54) among men born in 1955, 1965-1969, 1970-1979, and 1980-1984. Confounding by familial BMI or IQ could not be controlled. Conclusions The association between BMI and IQ is subject to secular trends. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of a pharmacy benefit change on mail order pharmacy (MOP) uptake.Data Sources/study Setting: Race-stratified, random sample of diabetes patients in an integrated health care delivery system.Study Design: In this natural experiment, we studied the impact of a pharmacy benefit change that conditionally discounted medications if patients used MOP and prepaid two copayments. We compared MOP uptake among those exposed to the benefit change (n = 2,442) and the reference group with no benefit change (n = 8,148), and estimated differential MOP uptake across social strata using a difference-in-differences framework.Data Collection/extraction Methods: Ascertained MOP uptake (initiation among previous nonusers).Principal Findings: Thirty percent of patients started using MOP after receiving the benefit change versus 9 percent uptake among the reference group (p < .0001). After adjustment, there was a 26 percentage point greater MOP uptake (benefit change effect). This benefit change effect was significantly smaller among patients with inadequate health literacy (15 percent less), limited English proficiency (14 percent less), and among Latinos and Asians (24 and 16 percent less compared to Caucasians).Conclusions: Conditionally discounting medications delivered by MOP effectively stimulated MOP uptake overall, but it unintentionally widened previously existing social gaps in MOP use because it stimulated less MOP uptake in vulnerable populations. [ABSTRACT FROM AUTHOR]

This study investigates the dynamic interplay between teacher-child relationship quality and children's behaviors across kindergarten and first grade to predict academic competence in first grade. Using a sample of 338 ethnically diverse 5-year-old children, nested path analytic models were conducted to examine bidirectional pathways between children's behaviors and teacher-child relationship quality. Low self-regulation in kindergarten fall, as indexed by inattention and impulsive behaviors, predicted more conflict with teachers in kindergarten spring and this effect persisted into first grade. Conflict and low self-regulation jointly predicted decreases in school engagement which in turn predicted first-grade academic competence. Findings illustrate the importance of considering transactions between self-regulation, teacher-child relationship quality, and school engagement in predicting academic competence. [ABSTRACT FROM AUTHOR]

In this paper, the director and the administrator of the MacArthur Network on Socioeconomic Status and Health reflect on the evolution of the network. Against the backdrop of the science of “team science,” they describe the history and process of the network including the forging of a group agenda, the development of a creative, productive group working style, and the outcomes arising from these processes. [ABSTRACT FROM AUTHOR]

Over the past two decades, exponential growth of empirical research has fueled markedly increased concern about health disparities. In this paper, we show the progression of research on socioeconomic status (SES) and health through several eras. The first era reflected an implicit threshold model of the association of poverty and health. The second era produced evidence for a graded association between SES and health where each improvement in education, income, occupation, or wealth is associated with better health outcomes. Moving from description of the association to exploration of pathways, the third era focused on mechanisms linking SES and health, whereas the fourth era expanded on mechanisms to consider multilevel influences, and a fifth era added a focus on interactions among factors, not just their main effects or contributions as mediators. Questions from earlier eras remain active areas of research, while later eras add depth and complexity. [ABSTRACT FROM AUTHOR]

An association between higher educational attainment and better health status has been repeatedly reported in the literature. Similarly, thousands of studies have found a relationship between higher income and better health. However, whether these repeated observations amount to causality remains a challenge, not least because of the practical limitations of randomizing people to receive different amounts of money or schooling. In this essay, we review the potential causal mechanisms linking schooling and income to health, and discuss the twin challenges to causal inference in observational studies, in other words, reverse causation and omitted variable bias. We provide a survey of the empirical attempts to identify the causal effects of schooling and income on health, including natural experiments. There is evidence to suggest that schooling is causally related to improvements in health outcomes. Evidence also suggests that raising the incomes of the poor leads to improvement in their health outcomes. Much remains unknown beyond these crude findings, however; for example, what type of education matters for health, or whether there is a difference between the health impacts of temporary income shocks versus changes in long-term income. [ABSTRACT FROM AUTHOR]

A preface to the periodical "The Biology of Disadvantage: Socioeconomic Status and Health" is presented.

This chapter discusses the current evidence base for policies that could address socioeconomic status (SES) health gradients in the United States. The present volume has documented an enormous amount of research on the linkages between SES and health, but there are still relatively few studies that rigorously establish the effectiveness of particular policies or interventions in reducing those gradients. Given the difficulty in developing randomized evidence for many types of interventions related to social determinants of health, we argue for conducting policy analysis from a Bayesian perspective. This Bayesian approach combines information on best available theory and evidence regarding probable health benefits and costs of an intervention, providing a framework that also incorporates the probable costs of inaction. The second half of the chapter adopts a ladder metaphor to classify policies and interventions that could reduce SES gradients in population health. Using this framework, we consider the evidence base for various types of policies, focusing primarily on the social determinants of health, under the rubric that “all policy is health policy.” We conclude by discussing promising strategies for future strengthening of the evidence base for policy, including the role of health impact assessment. [ABSTRACT FROM AUTHOR]

This study examined the direct and interactive effects of stress reactivity and family adversity on socioemotional and cognitive development in three hundred and thirty-eight 5- to 6-year-old children. Neurobiological stress reactivity was measured as respiratory sinus arrhythmia and salivary cortisol responses to social, cognitive, sensory, and emotional challenges. Adaptation was assessed using child, parent, and teacher reports of externalizing symptoms, prosocial behaviors, school engagement, and academic competence. Results revealed significant interactions between reactivity and adversity. High stress reactivity was associated with more maladaptive outcomes in the context of high adversity but with better adaption in the context of low adversity. The findings corroborate a reconceptualization of stress reactivity as biological sensitivity to context by showing that high reactivity can both hinder and promote adaptive functioning. [ABSTRACT FROM AUTHOR]

Context: The rise in obesity in the United States may slow or even reverse the long-term trend of increasing life expectancy. Like many risk factors for disease, obesity results from behavior and shows a social gradient. Especially among women, obesity is more common among lower-income individuals, those with less education, and some ethnic/racial minorities. Methods: This article examines the underlying assumptions and implications for policy and the interventions of the two predominant models used to explain the causes of obesity and also suggests a synthesis that avoids “blaming the victim” while acknowledging the role of individuals' health behaviors in weight maintenance. Findings: (1) The medical model focuses primarily on treatment, addressing individuals' personal behaviors as the cause of their obesity. An underlying assumption is that as independent agents, individuals make informed choices. Interventions are providing information and motivating individuals to modify their behaviors. (2) The public health model concentrates more on prevention and sees the roots of obesity in an obesogenic environment awash in influences that lead individuals to engage in health-damaging behaviors. Interventions are modifying environmental forces through social policies. (3) There is a tension between empowering individuals to manage their weight through diet and exercise and blaming them for failure to do so. Patterns of obesity by race/ethnicity and socioeconomic status highlight this tension. (4) Environments differ in their health-promoting resources; for example, poorer communities have fewer supermarkets, more fast-food outlets, and fewer accessible and safe recreational opportunities. Conclusions: A social justice perspective facilitates a synthesis of both models. This article proposes the concept of “behavioral justice” to convey the principle that individuals are responsible for engaging in health-promoting behaviors but should be held accountable only when they have adequate resources to do so. This perspective maintains both individuals' control and accountability for behaviors and society's responsibility to provide health-promoting environments. [ABSTRACT FROM AUTHOR]

CONTEXT: Adolescents behave differently with main and casual sexual partners. These differences in behavior may be due to how adolescents perceive main and casual partners, but may also be informed by which types of partners adolescents have had experience with. METHODS: Data were collected in interviews with 276 sexually experienced STD clinic attendees in 1996-1998. Chi-square tests and one-way analyses of variance were conducted to compare risk and protective variables among groups with different types of partner experience (main only, casual only, main and casual). Post hoc analyses determined differences between pairs of groups. RESULTS: Adolescents with different partner-type experiences evidenced different risk and protective factors. For example, adolescents who had had only main partners perceived a greater risk of contracting STDs from both main and casual partners than those who had had both partner types. Women in the casual-only group were the least likely to have been pregnant. Adolescents who had had main and casual partners intended a significantly shorter delay in initiating sex with a new main partner than did those in the main-only group; they also more strongly intended to have a side partner than did those who had had only main partners. CONCLUSIONS: The design of risk reduction and prevention interventions for at-risk sexually experienced adolescents ought to consider adolescents' sexual partner-type experiences and tailor messages to capitalize on associated protective factors and address or minimize associated risk factors. [ABSTRACT FROM AUTHOR]

To compare the association between subjective ladder ranking and health measures with the association between objective indices and health measures in older Taiwanese men and women.Cross-sectional study.A population-representative sample of elderly and nearly elderly men and women in Taiwan.The study included 991 participants from the Social Environment and Biomarkers of Aging Study in Taiwan.The information collected included demographic characteristics; subjective ladder score of SES; objective measures of SES, including education, income, and occupation; health behaviors; health-related variables such as self-rated health, basic activity of daily living difficulties, instrumental activity of daily living (IADL) difficulties, and physical activity difficulties; and depression score.Low ladder score was associated with poorer self-rated health and more reported IADL and physical activity difficulties, even after adjustment for objective measures of SES and other covariates. The multiply adjusted odds ratio for a one-quartile difference in ladder score and worse self-rated health was 1.19 (95% confidence interval=1.06–1.33). The associations between subjective ladder ranking and health status were generally stronger in those who had 6 years or less of education than in those who received more education.A simple subjective assessment of one's ranking on the social hierarchy was associated with self-rated health and physical functional status in an older ethnic Chinese population. The associations were independent of the effects of traditional objective measures of SES, such as education, income, and occupation. [ABSTRACT FROM AUTHOR]

The article focuses on the definition of different types of pregnancy. The scientific study of abortion has been burdened by the fact that it is a procedure about which individuals have strong feelings. Deeply held beliefs and assumptions may affect research in this area more than in others, influencing which questions are asked about abortion and the ways in which questions are framed. In addition, abortion inevitably occurs in the context of pregnancy, and assumptions and beliefs about the nature of such pregnancies can also influence research. Because of this, it is particularly important to make explicit the assumptions underlying different research approaches. This article considers some of the definitional and measurement issues regarding pregnancy characteristics as they relate to the study of abortion, and their implications for research on psychological responses of women following abortion. The definitions provided in this article are based on a psychological perspective, and differ from those commonly used in surveys by demographers and sociologists.

More than most medical procedures, abortion is embedded in a social context that has implications for psychological reactions of patients. Following a brief history of legislation and research on abortion, correlates of post-abortion reponses are reviewed. A social-psychological framework is suggested which views abortion as a stress experience. Responses to the experience will be a function of the nature and meaning of the pregnancy to the individual woman, her defensive and coping style, and the social environment surrounding the abortion experience. Psychological effects of the procedure on the partner and on health professionals who perform abortions are also considered. [ABSTRACT FROM AUTHOR]

This chapter discusses the current evidence base for policies that could address socioeconomic status (SES) health gradients in the United States. The present volume has documented an enormous amount of research on the linkages between SES and health, but there are still relatively few studies that rigorously establish the effectiveness of particular policies or interventions in reducing those gradients. Given the difficulty in developing randomized evidence for many types of interventions related to social determinants of health, we argue for conducting policy analysis from a Bayesian perspective. This Bayesian approach combines information on best available theory and evidence regarding probable health benefits and costs of an intervention, providing a framework that also incorporates the probable costs of inaction. The second half of the chapter adopts a ladder metaphor to classify policies and interventions that could reduce SES gradients in population health. Using this framework, we consider the evidence base for various types of policies, focusing primarily on the social determinants of health, under the rubric that “all policy is health policy.” We conclude by discussing promising strategies for future strengthening of the evidence base for policy, including the role of health impact assessment. [ABSTRACT FROM AUTHOR]