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Objectives. We explored the relationship between social isolation and mortality in a nationally representative US sample and compared the predictive power of social isolation with that of traditional clinical risk factors. Methods. We used data on 16 849 adults from the Third National Health and Nutrition Examination Survey and the National Death Index. Predictor variables were 4 social isolation factors and a composite index. Comparison predictors included smoking, obesity, elevated blood pressure, and high cholesterol. Unadjusted Kaplan–Meier tables and Cox proportional hazards regression models controlling for sociodemographic characteristics were used to predict mortality. Results. Socially isolated men and women had worse unadjusted survival curves than less socially isolated individuals. Cox models revealed that social isolation predicted mortality for both genders, as did smoking and high blood pressure. Among men, individual social predictors included being unmarried, participating infrequently in religious activities, and lacking club or organization affiliations; among women, significant predictors were being unmarried, infrequent social contact, and participating infrequently in religious activities. Conclusions. The strength of social isolation as a predictor of mortality is similar to that of well-documented clinical risk factors. Our results suggest the importance of assessing patients’ level of social isolation.

Vacations enable people to help one another, spend time together in pleasant contexts, and renew relational resources. Reasoning that these shared activities spread social and psychological benefits through social networks, we hypothesized that increase in the number of vacationing workers engenders nonlinear decline in psychological distress at the population level. We applied time-series methods to aggregate data on monthly dispensation of antidepressants to the Swedish population for the 147 months starting January 1993. We obtained the data from the pharmacy corporation allied with the national health care system and from governmental sources. Dispensation of antidepressants declined logarithmically with increase in the number of vacationing workers, for men and women alike. The associations held among people beyond retirement age as well as people of working age, further evidence that vacation benefits spread beyond vacationing workers. The results bear on the social regulation of time for restoration as a general determinant of population health.

The past quarter century has seen an explosion of concern about widening health inequities in the United States and worldwide. These inequities are central to the research mission in 2 arenas of public health: social epidemiology and community-engaged interventions. Yet only modest success has been achieved in eliminating health inequities. We advocate dialogue and reciprocal learning between researchers with these 2 perspectives to enhance emerging transdisciplinary language, support new approaches to identifying research questions, and apply integrated theories and methods. We recommend ways to promote transdisciplinary training, practice, and research through creative academic opportunities as well as new funding and structural mechanisms.

This study examines the shape of social class gradients for substance use among Mexican adolescents. Substance use and objective and subjective indicators of social class were assessed in house-to-house surveys conducted with 7614 Mexican adolescents in 2004. The sample was designed to be representative of the poorest urban communities in seven Mexican states. The prevalence of current smoking was 16.8%, alcohol consumption was 30.2%, and drug use was 4.6%. Multiple logistic regressions are used to estimate the associations of objective indicators of socioeconomic status (SES) and subjective social status (SSS)-at both community and societal levels-and smoking, alcohol and drug use. Adolescents who perceived themselves as higher in social status in reference to their local community reported more smoking and drinking. Our findings were similar when we used objective measures of SES, such as maternal education and total monthly household expenditures per person. In contrast, adolescents who perceived that they had high social standing in reference to Mexican society as a whole were less likely to report being current smokers and drinkers. We found no significant association between social status and drug use. Research into how adolescents perceive themselves in reference to their peer communities may help strengthen programs and policies aimed at promoting health in vulnerable adolescent populations.

It is well known that people in racial and ethnic minority groups and in lower social-class positions have higher morbidity and mortality rates from virtually every disease. To effectively deal with the problem, we will need to adopt a more appropriate conceptual model that focuses on the fundamental determinants of health, we will need to understand how important this is for all Americans as a society, and we will need to better deal with the issues people care about: their children, homes, jobs, safety, education, families, retirement, and future prospects.

Binge drinking is a substantial and growing health problem. Community norms about drinking and drunkenness may influence individual drinking problems. Using data from the New York Social Environment Study (n = 4,000) conducted in 2005, the authors examined the relation between aspects of the neighborhood drinking culture and individual alcohol use. They applied methods to address social stratification and social selection, both of which are challenges to interpreting neighborhood research. In adjusted models, permissive neighborhood drinking norms were associated with moderate drinking (odds ratio (OR) = 1.28, 95% confidence interval (CI): 1.05, 1.55) but not binge drinking; however, social network and individual drinking norms accounted for this association. By contrast, permissive neighborhood drunkenness norms were associated with more moderate drinking (OR = 1.20, 95% CI: 1.03, 1.39) and binge drinking (OR = 1.92, 95% CI: 1.44, 2.56); the binge drinking association remained after adjustment for social network and individual drunkenness norms (OR = 1.58, 95% CI: 1.20, 2.08). Drunkenness norms were more strongly associated with binge drinking for women than for men (p(interaction) = 0.006). Propensity distributions and adjustment for drinking history suggested that social stratification and social selection, respectively, were not plausible explanations for the observed results. Analyses that consider social and structural factors that shape harmful drinking may inform efforts targeting the problematic aspects of alcohol consumption.

Objectives. There is a critical need for effective, large-scale health communication programs to support parents of children aged 0–5 years. We evaluated the effectiveness of the Kit for New Parents, a multimedia health and parenting resource now distributed annually to 500000 parents in California. Methods. In this quasi-experimental study, 462 mothers in the intervention group and 1011 mothers in the comparison group, recruited from prenatal and postnatal programs, completed a baseline interview about health-relevant parenting knowledge, and mothers in the intervention group received the kit. Both groups were reinterviewed 2 months later. At 14-months postbaseline, 350 mothers in the intervention group and a sample of 414 mothers who had equivalent demographic characteristics (comparison group) were interviewed about parenting knowledge and practices. Results. Of the mothers in the intervention group, 87% reported using the kit within 2 months after receiving it, and 53% had shared it with their partner. At both follow-ups, mothers in the intervention group showed greater gains in knowledge and reported better practices at 14 months than did mothers in the comparison group. Gains were greater for prenatal recipients and for Spanish speakers. Providers considered the kit a valuable resource for their parenting programs. Conclusions. The kit is an effective, low-cost, statewide health intervention for parents.

Purpose. To investigate relationships between adolescents' current alcohol, tobacco, and marijuana use; perceptions of neighborhood disorder; and sense of hope. Design. Questionnaires were administered to a nonrandom sample of middle school students during the spring of 1999. Subjects. The ethnically and geographically diverse sample (n = 369), from a range of low socioeconomic status backgrounds, was considered to be at high risk for alcohol, tobacco, and other drug use because of previous enrollment in low socioeconomic status elementary schools. Measures. Alcohol, tobacco, and marijuana use were dichotomized into current and never/no use. Six variables described neighborhood social disorder. Sense of hope was assessed using the Children's Hope Scale. Results. Statistically significant relationships were found between perceived neighborhood disorder and current alcohol (p = .01), tobacco (p = .001), and marijuana (p < .001) use. A statistically significant and independent relationship was found between sense of hope and current alcohol (p = .02), tobacco (p = .02), and marijuana (p = .06) use. Results indicated linear trends in participants' increased use of alcohol, tobacco, and marijuana and (1) perception of higher neighborhood disorder and (2) lower sense of hope. Conclusion. Substance use prevention programs for youth might usefully be directed not only to agdolescents but also to the neighborhoods in which they live. Additionally, it would be important to emphasize creating safer neighborhood environments that support the development of a stronger sense of hope for the future.

Background: The etiologic role of biomechanical factors for low back injury (LBI) needs to be confirmed in prospective studies that control for psychosocial factors. Methods: Complete baseline information on 1,233 vehicle operators was gathered during medical examinations and by questionnaire. First LBI during 7.5 years of follow-up was ascertained from insurance records. Hazard ratios and etiologic fractions were analyzed with Cox regression models stratified by injury severity and controlling for age, sex, height, weight, ethnicity, and biomechanical and psychosocial job factors. Severe LBI was defined as medically diagnosed postlaminectomy syndrome, spinal stenosis, herniated lumbar disc, sciatica, or spinal instability. Results: An exponential dose-response relationship was found between weekly driving hours and incidence of first LBI. Indicators of physical workload were more strongly associated with more severe low back injuries compared to less severe injuries. Rates of severe LBI increased 39% for every 10-hr increase in weekly driving (hazard ratio 1.39, 95% confidence interval 1.15-1.68). Higher risks of severe LBI were also found among operators performing heavy physical labor on cable cars (hazard ratio 2.76, 95% confidence intervals 1.24-614) or reporting more ergonomic problems at baseline HR for upper quartile 1.65 (95% confidence interval 1.08-2.50). Estimates of etiologic fractions suggest that reduction of ergonomic problems to the low level currently experienced by 25% of drivers would result in a 19% reduction of severe LBI among all drivers. A change from full- (more than 30 hr) to part-time driving (20-30 hr) could reduce the number of severe LBI by 59%, although this gain would be reduced to 28% at the company level if injuries expected among additional employees, hired to maintain full service are included. Conclusions: Duration of professional driving and ergonomic problems are independent and preventable risk factors for LBI even after adjustment for psychosocial factors. (C) 2004 Wiley-Liss, Inc.

To assess whether alcohol, tobacco, and other drug (ATOD) use in elementary school may have serious implications for continued ATOD use in middle school and beyond.Longitudinal analyses were conducted on questionnaire data from 331 middle school students who had previously provided ATOD-use data during elementary school. Non-school personnel administered questionnaires in three participating school districts in three different states. The sample of students was ethnically and geographically diverse, including students from a range of low socioeconomic status backgrounds living in rural, urban or inner-city environments.Middle school alcohol use was almost three times as likely to occur if alcohol use had occurred in elementary school (OR = 2.94, p.001). Elementary school use of tobacco and marijuana also greatly increased the likelihood of middle school use (OR = 5.35, p.001 and OR = 4.25, p.05, respectively).Early use of ATOD is associated with greatly increased odds of later use, which has important implications for the timing of drug prevention programs. Preventive interventions designed for use in pediatric practice settings should commence no later than elementary school, during the middle childhood years.

SUMMARY With the rapid rise in health care costs, it has become imperative that departments of health services find effective and affordable ways to prevent disease and promote health. During the past 20 years, most of the major educational interventions in the US designed to prevent disease by changing behavior have not been as successful as expected. At the same time, there is increasing evidence that community participation, a central feature of the ‘new public health’, is a powerful component of the programs that have been successful. In this paper, we describe and evaluate an intervention that heavily involves the community. The Wellness Guide is a comprehensive health promotion guide developed with community participation to improve the wellness knowledge, attitudes and behaviors of recipients. 100 000 copies of The Guide in English

Educational attainment is a well-established social determinant of health. It affects health through many mechanisms such as neural development, biological aging, health literacy and health behaviors, sense of control and empowerment, and life chances. Education—from preschool to beyond college—is also one of the social determinants of health for which there are clear policy pathways for intervention. We reviewed evidence from studies of early childhood, kindergarten through 12th grade, and higher education to identify which components of educational policies and programs are essential for good health outcomes. We have discussed implications for public health interventions and health equity.

The present study assessed the relationship between anger expression and health outcomes in a sample of 1,407 San Francisco bus drivers. When controlling for a variety of health-risk factors, the results of multiple logistic regression analyses revealed significant positive associations between high levels of suppressed as well as expressed anger and gastrointestinal, respiratory, and musculoskeletal problems, with one exception (viz., the relationship between expressed anger and gastrointestinal problems was only marginally significant [p = .09]). Although both modes of anger expression were related to these health problems for men, none of the associations were significant for women. The results do not support the view that suppressed anger is more detrimental to health than expressed anger but rather suggest that both modes of coping with anger may increase vulnerability to disease in men.

Three prescriptions are made to improve behavioral pediatrics research: (1) Focus behavioral pediatrics on preventive research from environmental and social perspectives. (2) Ground research questions more extensively within a conceptual framework. (3) Enhance research quality with reliable, valid measurement. Conceptual and methodological improvements in research will facilitate integration of the multidisciplinary, multimethodological, and multitheoretical scope of behavioral pediatrics and further its contributions to science.

An inverse association between socioeconomic status, as measured by years of education, and blood pressure has been reported in a number of studies. However, two secular trends may have changed the nature of this relation: a higher mean level of education in the population and intervention for high blood pressure in the community. Given that education is the most commonly used indicator of social class and measurement is a critical issue in epidemiologic research, a study was initiated to examine the validity of education for predicting blood pressure among 11,554 examined persons aged 25-74 years from the Second National Health and Nutrition Examination Survey (1976-1980) or the Hispanic Health and Nutrition Examination Survey (1982-1984). In univariate analysis, a consistent, inverse association between education and blood pressure was found for whites and blacks, but not for Mexican Americans. After adjustment for age and body mass, the effect persisted only for systolic blood pressure in whites. The association of education and blood pressure was positive in Mexican-American females. Education was inversely related to hypertensive status in whites and in black females. These findings suggest that information on education may be of little value for identifying populations at risk of high blood pressure, particularly if age and body mass are known. However, information on education may be of considerable value in the design and implementation of appropriate interventions.

Studies of the association between type A behavior and coronary heart disease have yielded inconsistent findings. A possible explanation for these inconsistent findings is that type A behavior is simply a marker for other behaviors that are truly related to coronary heart disease. Hostility is one such behavior that has been found in several recent studies to predict coronary heart disease and coronary atherosclerosis; however, several other studies have found null results. In the present study, the predictive power of hostility was tested in a study population of hospitalized men (n = 118) and women (n = 40) scheduled for coronary angiography. Potential coronary risk behaviors were assessed in the angiography patients and they were given the type A Structured Interview. Hostility was measured with the Cook-Medley Hostility Inventory and the Behavior Pattern Hostility Index, a measure of hostility derived from the type A Structured Interview. No significant positive associations were found for either Cook-Medley hostility or behavior pattern hostility and coronary occlusion. This was true whether hostility or coronary occlusion was treated as a dichotomous variable or as a continuous variable. In fact, most of the observed associations were opposite to the predicted direction, although none was statistically significant. Replicating cutpoints of the Cook-Medley Hostility Inventory used in other studies that have reported positive associations with coronary heart disease also yielded null findings. The association between hostility and coronary occlusion was slightly modified by age and sex, but the interaction coefficients were not significant. The sample size yielded adequate statistical power to detect the hypothesized associations, and there was no evidence that selection bias, measurement error, or unexamined confounding accounted for the null findings. These results failed to confirm some earlier reports showing a positive association between hostility and coronary artery disease.

It is now well established that inequalities in income lead to high morbidity and mortality rates. Certain explanations for this phenomenon are explored: (1) Instead of income inequalities causing disease, the inequalities are determined by powerful cultural forces. (2) The rich get richer and the poor get poorer. (3) Wealthier people can buy the means to protect their health. (4) Poorer people suffer not from poverty, but from relative deprivation. (5) Those with the weakest genes drift into the lower income groups. It is difficult to develop interventions directed to these possibilities. The concept of “control and destiny” is a possible explanation for the relation between inequalities and disease; unlike the other explanations, this idea is amenable to intervention.

Epidemiologic studies of blood pressure have been conducted for over twenty-five years, but the results of this research can only be described as modest. The basic epidemiologic and demographic description of blood pressure distributions in human populations remains problematic and psychosocial studies have not yielded clear and solid hypotheses pointing the way to future research. There is no doubt that blood pressures vary among and between population groups, and there seems little doubt that variations in life-style are associated with these differences. It is puzzling that we have failed to discern systematic and patterned relationships among these variables. It is suggested that a more useful approach to research in this field would be to distinguish factors that affect general susceptibility to becoming ill from those that initiate or maintain particular disease states.