Jane Rafferty

Reconsidering the Role of Social Disadvantage in Physical and Mental Health: Stressful Life Events, Health Behaviors, Race, and Depression

Prevalence of depression is associated inversely with some indicators of socioeconomic position, and the stress of social disadvantage is hypothesized to mediate this relation. Relative to whites, blacks have a higher burden of most physical health conditions but, unexpectedly, a lower burden of depression. This study evaluated an etiologic model that integrates mental and physical health to account for this counterintuitive patterning. The Baltimore Epidemiologic Catchment Area Study (Maryland, 1993-2004) was used to evaluate the interaction between stress and poor health behaviors (smoking, alcohol use, poor diet, and obesity) and risk of depression 12 years later for 341 blacks and 601 whites. At baseline, blacks engaged in more poor health behaviors and had a lower prevalence of depression compared with whites (5.9% vs. 9.2%). The interaction between health behaviors and stress was nonsignificant for whites (odds ratio (OR = 1.04, 95% confidence interval: 0.98, 1.11); for blacks, the interaction term was significant and negative (β: -0.18, P < 0.014). For blacks, the association between median stress and depression was stronger for those who engaged in zero (OR = 1.34) relative to 1 (OR = 1.12) and ≥2 (OR = 0.94) poor health behaviors. Findings are consistent with the proposed model of mental and physical health disparities.

Enhancing Parenting Skills Among Nonresident African American Fathers as a Strategy for Preventing Youth Risky Behaviors

This study evaluated the effectiveness of a theoretically based, culturally specific family intervention designed to prevent youth risky behaviors by influencing the parenting attitudes and behaviors of nonresident African American fathers and the parent–child interactions, intentions to avoid violence, and aggressive behaviors of their preadolescent sons. A sample of 158 intervention and 129 comparison group families participated. ANCOVA results indicated that the intervention was promising for enhancing parental monitoring, communication about sex, intentions to communicate, race-related socialization practices, and parenting skills satisfaction among fathers. The intervention was also beneficial for sons who reported more monitoring by their fathers, improved communication about sex, and increased intentions to avoid violence. The intervention was not effective in reducing aggressive behaviors among sons. Findings are discussed from a family support perspective, including the need to involve nonresident African American fathers in youth risky behavior prevention efforts.

“White Box” Epidemiology and the Social Neuroscience of Health Behaviors: The Environmental Affordances Model

Crucial advances have been made in our knowledge of the social determinants of health and health behaviors. Existing research on health disparities, however, generally fails to address a known paradox in the literature: While blacks have higher risk of medical morbidity relative to non-Hispanic whites, blacks have lower rates of common stress-related forms of psychopathology such as major depression and anxiety disorders. In this article we propose a new theoretical approach, the Environmental Affordances Model, as an integrative framework for the origins of both physical and mental health disparities. We highlight early empirical support and a growing body of experimental animal and human research on self-regulatory health behaviors and stress coping that is consistent with the proposed framework. We conclude that transdisciplinary approaches, such as the Environmental Affordances Model, are needed to understand the origins of group-based disparities to implement effective solutions to racial and ethnic group inequalities in physical and mental health.

Socioeconomic position, health behaviors, and C-reactive protein: A moderated-mediation analysis

OBJECTIVE We sought to understand the link between low socioeconomic position (SEP) and cardiovascular disease (CVD) by examining the association between SEP, health-related coping behaviors, and C-reactive protein (CRP), an inflammatory marker and independent risk factor for CVD, in a U.S. sample of adults. DESIGN We used a multiple mediation model to evaluate how these behaviors work in concert to influence CRP levels and whether these relationships were moderated by gender and race/ethnicity. MAIN OUTCOME MEASURES CRP levels were divided into two categories: elevated CRP (3.1-10.0 mg/L) and normal CRP (< or =3.0 mg/L). RESULTS Both poverty and low educational attainment were associated with elevated CRP, and these associations were primarily explained through higher levels of smoking and lower levels of exercise. In the education model, poor diet also emerged as a significant mediator. These behaviors accounted for 87.9% of the total effect of education on CRP and 55.8% the total effect of poverty on CRP. We also found significant moderation of these mediated effects by gender and race/ethnicity. CONCLUSION These findings demonstrate the influence of socioeconomically patterned environmental constraints on individual-level health behaviors. Specifically, reducing socioeconomic inequalities may have positive effects on CVD disparities through reducing cigarette smoking and increasing vigorous exercise.

Racial and Ethnic Differences in the Association Between Obesity and Depression in Women

BACKGROUND It is generally accepted that obesity and depression are positively related in women. Very little prior research, however, has examined potential variation in this relationship across different racial/ethnic groups. This paper examines the association between obesity and depression in non-Hispanic White, non-Hispanic Black, and Mexican American women. METHODS The sample included women aged 20 years and older in the 2005-2008 National Health and Nutrition Examination Surveys (n=3666). Logistic regression was used to assess the relationship between obesity and depression syndrome (assessed using the Patient Health Questionnaire-9), after adjusting for covariates. We then investigated whether this association varied by race/ethnicity. RESULTS Overall, obese women showed a 73% greater odds of depression (odds ratio [OR]=1.73; 95% confidence interval [CI]=1.19, 2.53) compared with normal weight women. This association varied significantly, however, by race/ethnicity. The obesity-depression associations for both Black and Mexican American women were different from the positive association found for White women (ORBlack*obese=0.24; 95% CI=0.10,0.54; ORMexican American*obese=0.42; 95% CI=1.04). Among White women, obesity was associated with significantly greater likelihood of depression (OR=2.37; 95% CI=1.41, 4.00) compared to normal weight. Among Black women, although not statistically significant, results are suggestive that obesity was inversely associated with depression (OR=0.56; 95% CI=0.28, 1.12) relative to normal weight. Among Mexican American women, obesity was not associated with depression (OR=1.01; 95% CI=0.59, 1.72). CONCLUSIONS The results reveal that the association between obesity and depression varies by racial/ethnic categorization. White, but not Black or Mexican American women showed a positive association. Next research steps could include examination of factors that vary by race/ethnicity that may link obesity to depression.

Discrimination, Chronic Stress, and Mortality Among Black Americans: A Life Course Framework

We use a life course framework to analyze lifetime patterns of mortality among black Americans. Using this framework directs attention to specific questions regarding the potential causes of racial group differentials in mortality, and we hope moves the field toward more comprehensive and testable explanations. The work on aging, the life course, and health has long highlighted the racial crossover effect in late-life mortality (e.g., Johnson 2000). While there are heated debates about the causes of this racial crossover in the United States (e.g., Johnson 2000; Preston et al. 1996), demographers have noted its existence in both cross-sectional population-level data, and in longitudinal panel studies (Johnson 2000). Gibson (Gibson 1991, 1994; Gibson and Jackson 1987) speculated that the racial crossover is based upon a series of mortality sweeps beginning in the black population in midlife, thereby leaving a hardier group of blacks in very older ages whose probability of survival in comparison to whites’ reverses and becomes more favorable.

Likelihood of African American Primary Caregivers and Care Recipients Receiving Assistance From Secondary Caregivers A Rural–Urban Comparison

We examine rural–urban differences in reliance on secondary caregivers for African American female primary caregivers (250 rural, 242 urban) and their care recipients. Logistic regression was used to identify caregiver and care recipient characteristics significantly associated with the likelihood of having a secondary caregiver within rural and urban samples. Post hoc Wald chi-square tests were used to identify significant between-sample differences in regression coefficients. Secondary caregivers were more common in urban than rural contexts. Having a secondary caregiver was more strongly related to primary caregivers’ poorer physical health and nonresidence with care recipients in rural than urban contexts. Findings suggest that policy initiatives, such as the National Family Caregivers Support Act and the cash and counseling model, may benefit rural and urban residents, particularly rural residents as the majority of them lacked secondary caregiver assistance.

Coming unmoored: disproportionate increases in obesity prevalence among young, disadvantaged white women.

Since the 1980s, older, low‐educated White women experienced an unprecedented decrease in life expectancy. We investigated whether a similar phenomenon was evident among younger women for obesity.

The combined effects of genetic risk and perceived discrimination on blood pressure among African Americans in the Jackson Heart Study

Abstract Both genomics and environmental stressors play a significant role in increases in blood pressure (BP). In an attempt to further explain the hypertension (HTN) disparity among African Americans (AA), both genetic underpinnings (selected candidate genes) and stress due to perceived racial discrimination (as reported in the literature) have independently been linked to increased BP among AAs. Although Gene x Environment interactions on BP have been examined, the environmental component of these investigations has focused more on lifestyle behaviors such as smoking, diet, and physical activity, and less on psychosocial stressors such as perceived discrimination. The present study uses candidate gene analyses to identify the relationship between Everyday Discrimination (ED) and Major Life Discrimination (MLD) with increases in systolic BP (SBP) and diastolic BP (DBP) among AA in the Jackson Heart Study. Multiple linear regression models reveal no association between discrimination and BP after adjusting for age, sex, body mass index (BMI), antihypertensive medication use, and current smoking status. Subsequent candidate gene analysis identified 5 SNPs (rs7602215, rs3771724, rs1006502, rs1791926, and rs2258119) that interacted with perceived discrimination and SBP, and 3 SNPs (rs2034454, rs7602215, and rs3771724) that interacted with perceived discrimination and DBP. Most notably, there was a significant SNP × discrimination interaction for 2 SNPs on the SLC4A5 gene: rs3771724 (MLD: SBP P = .034, DBP P = .031; ED: DBP: P = .016) and rs1006502 (MLD: SBP P = .034, DBP P = .030; ED: DBP P = .015). This study supports the idea that SNP × discrimination interactions combine to influence clinically relevant traits such as BP. Replication with similar epidemiological samples is required to ascertain the role of genes and psychosocial stressors in the development and expression of high BP in this understudied population.

Chronicity and Mental Health Service Utilization for Anxiety, Mood, and Substance Use Disorders among Black Men in the United States; Ethnicity and Nativity Differences

This study investigated ethnic and nativity differences in the chronicity and treatment of psychiatric disorders of African American and Caribbean Black men in the U.S. Data were analyzed from the National Survey of American Life, a population-based study which included 1859 self-identified Black men (1222 African American, 176 Caribbean Black men born within the U.S., and 461 Caribbean Black men born outside the U.S.). Lifetime and twelve-month prevalence of DSM-IV mood, anxiety, and substance use disorders (including Bipolar I and Dysthmia), disorder chronicity, and rate of mental health services use among those meeting criteria for a lifetime psychiatric disorder were examined. Logistic regression models were employed to determine ethnic differences in chronicity, and treatment utilization for disorders. While rates of DSM-IV disorders were generally low in this community sample of Black men, their disorders were chronic and remained untreated. Caribbean Black men born in the U.S. had higher prevalence of Post-Traumatic Stress Disorder, Major Depressive Disorder, and Alcohol Abuse Disorder compared with African American men. Foreign born Caribbean Black men experienced greater chronicity in Social Phobia and Generalized Anxiety Disorder compared to other Black Men. Utilization of mental health service was low for all groups of Black Men, but lowest for the foreign born Caribbean Black men. Results underscore the large unmet needs of both African American and Caribbean Black men in the United States. Results also highlight the role of ethnicity and nativity in mental disorder chronicity and mental health service utilization patterns of Black men.