Jarron M. Saint Onge

The Relationship Between Major Depression and Nonsuicide Mortality for U.S. Adults: The Importance of Health Behaviors

OBJECTIVESnWe aim to elucidate the role of health behaviors and health conditions in the association between depression and mortality. First, we examine the relationship between major depression and nonsuicide mortality among U.S. adults aged 50 and older. Second, we examine the relationship between major depression and cardiovascular disease and cancer, by baseline disease status. Third, we examine the role of health behaviors as potential mediators of the association between major depression and cause-specific mortality.nnnMETHODSnWe use data from the 1999 National Health Interview Study linked to the 2006 National Death Index (N = 11,369; M age = 65, deaths = 2,162) and Cox proportional hazards models to describe the relationships among major depression, health behaviors (alcohol use, cigarette smoking, physical activity), and nonsuicide mortality. We examine cause-specific mortality (cardiovascular and cancer) by baseline disease status.nnnRESULTSnMajor depression remains associated with a 43% increase in the risk of death over the follow-up period, after we account for sociodemographic characteristics, health behaviors, and health conditions. Major depression is associated with 2.68 times the risk of cardiovascular disease mortality among those who did not have cardiovascular disease at baseline and 1.82 times for those with baseline cardiovascular disease. Health behaviors reduce the hazard ratio by 17% for all nonsuicide mortality, 3% for cardiovascular disease mortality, and 12% for cancer mortality.nnnDISCUSSIONnOur results provide evidence of the important role of health behaviors and health conditions in the depression-mortality relationship and highlight the importance of identifying risk factors for depression among aging adults.

Health lifestyle behaviors among U.S. adults

Existing research that studies individual health behaviors and conceive of behaviors as simplistically reflecting narrow intentions toward health may obscure the social organization of health behaviors. Instead, we examine how eight health behaviors group together to form distinct health behavior niches. Using nationally-representative data from U.S. adults aged 18 and over from the 2004–2009 National Health Interview Survey (NHIS), we use Latent Class Analysis to identify classes of behavior based on smoking status, alcohol use, physical activity, physician visits, and flu vaccination. We identify 7 distinct health behavior classes including concordant health promoting (44%), concordant health compromising (26%), and discordant classes (30%). We find significant race/ethnic, sex, regional, and age differences in class membership. We show that health behavior classes are associated with prospective mortality, suggesting that they are valid representations of health lifestyles. We discuss the implications of our results for sociological theories of health behaviors, as well as for multiple behavior interventions seeking to improve population health.

Associations Between Long-Term Gang Membership and Informal Social Control Processes, Drug Use, and Delinquent Behavior Among Mexican American Youth

Research has found that among juveniles weak ties to informal social control entities such as parents, school, and conventional peers increase the probability of the initiation and continuation of deviant behaviors such as drug use and crime. Given the weak ties of formal social control mechanisms in highly disadvantaged communities, informal social control mechanisms are often an important deterrent that reduce or moderate engagement in deviant behaviors among serious and persistent offenders. This analysis examines the association between long-term gang membership and adolescent informal social control processes, drug use, and delinquency. This research is based on data from a study of 160 Mexican American male gang members between the ages of 16 and 20. Findings suggest that among gang members in this context, commonly studied informal control mechanisms such as the family and schools do not function to deter long-term gang membership that is associated with serious criminal and violent behavior and drug use. The implications for future research on desistance or continuation of antisocial behavior across the life course are discussed.

Insurance denials for cancer clinical trial participation after the Affordable Care Act mandate

The Affordable Care Act (ACA) includes a mandate requiring most private health insurers to cover routine patient care costs for cancer clinical trial participation; however, the impact of this provision on cancer centers’ efforts to accrue patients to clinical trials has not been well described.

Effects of Minority Status and Perceived Discrimination on Mental Health

Based in a minority social stress perspective, this study uses propensity score matching techniques to assess the impact of self-reported discrimination on mental health. Using a sample of 14,609 young adults from the National Longitudinal Study of Adolescentxa0to Adultxa0 Health, we explore whether the effects of discrimination vary across status characteristics (e.g., gender, race/ethnicity, sexual orientation, and body mass), including both majority and minority populations. Further we investigate the heterogeneous effects of discrimination across propensity scores, or probabilities of experiencing discrimination. We find that self-reported discrimination increases the average perceived stress score and depressive symptoms score by roughly ½ standard deviation, but is not related to anxiety. Further, our results show that while all groups are negatively affected by discrimination, the magnitude of the impact is largest among groups with the lowest propensity scores.

An internet forum analysis of stigma power perceptions among women seeking fertility treatment in the United States

Infertility is a condition that affects nearly 30 percent of women aged 25-44 in the United States. Though past research has addressed the stigmatization of infertility, few have done so in the context of stigma management between fertile and infertile women. In order to assess evidence of felt and enacted stigma, we employed a thematic content analysis of felt and enacted stigma in an online infertility forum, Fertile Thoughts, to analyze 432 initial threads by women in various stages of the treatment-seeking process. We showed that infertile women are frequently stigmatized for their infertility or childlessness and coped through a variety of mechanisms including backstage joshing and social withdrawal. We also found that infertile women appeared to challenge and stigmatize pregnant women for perceived immoral behaviors or lower social status. We argue that while the effects of stigma power are frequently perceived and felt in relationships between infertile women and their fertile peers, the direction of the enacted stigma is related to social standing and feelings of fairness and reinforces perceived expressions of deserved motherhood in the United States.

Biological Risk and Infection Profiles of Young Adult Male Mexican American Gang Members

Objectives: Little research has examined the long-term health consequences of gang affiliation among Mexican Americans. The objectives of this study were to (1) measure biological indicators of cardiovascular and metabolic risk, as well as prevalence of sexually transmitted infections (STIs), in a sample of Mexican American men aged 25-40 who were affiliated with gangs as adolescents and (2) compare those indicators with a comparable national sample of Latino men. Methods: Using bivariate analyses, we compared blood pressure, body mass index, 4 metabolic and cardiovascular indicators, and 4 infections for 179 Mexican American formerly gang-affiliated men in San Antonio, Texas, and 155 Mexican American men from the National Health and Nutrition Examination Survey. We used multivariate models to estimate adjusted risk scores for each sample controlling for age, marital status, and education. Results: Compared with men in the national sample, the unadjusted results showed that men in the gang-affiliated sample had significantly higher mean systolic blood pressure (125.6 vs 120.0u2009 mm Hg, P = .001), diastolic blood pressure (81.4 vs 71.1u2009mm Hg, P < .001), and C-reactive protein (5.9 vs 3.6 mg/L, P = .04), and a significantly lower mean total cholesterol (164.2 vs 205.5 mg/dL, P < .001) and low-density lipoprotein cholesterol (91.1 vs 120.1 mg/dL, P < .001). Compared with men in the national sample, more men in the gang-affiliated sample had herpes simplex virus type 2 (64/174 [36.8%] vs 18/147 [12.2%], P < .001), chlamydia (10/176 [5.7%] vs 1/135 [0.7%], P = .02), and hepatitis C virus (85/173 [49.1%] vs 0, P < .001). The gang-affiliated sample had a significantly higher adjusted risk score than the national sample (1.5 vs 1.1, P = .003). Conclusions: Gang-affiliated Mexican American men had significant disparities in biological risk indicators and STIs, which can lead to long-term health implications and highlight the need for tailored prevention strategies. Long-term exposure to psychosocial stressors and subsequent systemic inflammation may also increase the risk for physiological and psychological dysregulation and detrimental chronic health conditions in this population.

Locales of Trust: How Two Forms of Community Trust are Associated with Mothers’ Self-Rated Health in Indonesia

Objectives Social trust and access to social capital serve as important mechanisms to offset gender disparities in health in low-middle-income countries (LMICs) such as Indonesia. Indonesian women may have fewer opportunities to create strong social ties outside her social sphere and thus may benefit particularly from individual-level thin trust because generalized trust lowers barriers to gaining social support. We examined the role of thin trust and thick trust, two unique forms of social trust, to better understand the links between individual- and community-level trust and maternal health. Thin trust represents generalized trust in community members while thick trust represents strong and longstanding trusting relationships. Methods We employed nationally representative data from Wave 5 of the Indonesian Family Life Survey collected in 2014–2015 (nu2009=u20097276) to identify relationships between social trust and the self-rated health (SRH) of women in Indonesia, net of both individual- and community-level controls. Results We found evidence that both thick and thin trust benefit women’s health but operate at different levels. While thick trust decreased likelihoods of poor SRH at the community level, thin trust was associated with lower likelihoods of poor SRH at the individual level. Conclusions for Practice We argue that for women in LMICs, trust provides an important mechanism through which women potentially access both tangible and immaterial resources that positively influence health outcomes.

The Influence of Informal Social Control Processes on Drug Trajectories and Delinquent Behavior Among Mexican American Gang Members

Mexican American youth represent one of the fastest growing subpopulations with persons of Mexican origin comprising approximately 65 % of the Hispanic population in the United States (U.S. Census Bureau 2008). Mexican Americans also represent a disproportionate percentage of both substance using and gang populations (Valdez and Sifaneck 2004). In part, this may be due to both a young Mexican American age composition that reflects immigration patterns and an age-graded proclivity towards adolescent substance use and gang membership. In addition, due to socioeconomic disadvantages, Mexican American youth may be at an elevated risk for compromised social bonds and subsequent delinquent behaviors. This chapter employs a life course perspective to examine the extent that adolescent informal social control processes mediate the relationship between gang memberships and adolescent delinquent behavior in a population of young Mexican Americans.