Justin T. Denney

Obesity, SES, and economic development: A test of the reversal hypothesis

Studies of individual countries suggest that socioeconomic status (SES) and weight are positively associated in lower-income countries but negatively associated in higher-income countries. However, this reversal in the direction of the SES-weight relationship and arguments about the underlying causes of the reversal need to be tested with comparable data for a large and diverse set of nations. This study systematically tests the reversal hypothesis using individual- and aggregate-level data for 67 nations representing all regions of the world. In support of the hypothesis, we find not only that the body mass index, being overweight, and being obese rise with national product but also that the associations of SES with these outcomes shift from positive to negative. These findings fit arguments about how health-related, SES-based resources, costs, and values differ across levels of economic development. Although economic and social development can improve health, it can also lead to increasing obesity and widening SES disparities in obesity.

Cross-National Sources of Health Inequality: Education and Tobacco Use in the World Health Survey

The spread of tobacco use from the West to other parts of the world, especially among disadvantaged socioeconomic groups, raises concerns not only about the indisputable harm to global health but also about worsening health inequality. Arguments relating to economic cost and diffusion posit that rising educational disparities in tobacco use—and associated disparities in health and premature mortality—are associated with higher national income and more advanced stages of cigarette diffusion, particularly among younger persons and males. To test these arguments, we use World Health Survey data for 99,661 men and 123,953 women from 50 low-income to upper-middle–income nations. Multilevel logistic regression models show that increases in national income and cigarette diffusion widen educational disparities in smoking among young persons and men but have weaker influences among older persons and women. The results suggest that the social and economic patterns of cigarette adoption across low- and middle-income nations foretell continuing, and perhaps widening, disparities in mortality.

A New Piece of the Puzzle: Sexual Orientation, Gender, and Physical Health Status

Although research has long documented the relevance of gender for health, studies that simultaneously incorporate the relevance of disparate sexual orientation groups are sparse. We address these shortcomings by applying an intersectional perspective to evaluate how sexual orientation and gender intersect to pattern self-rated health status among U.S. adults. Our project aggregated probability samples from the Behavioral Risk Factor Surveillance System (BRFSS) across seven U.S. states between 2005 and 2010, resulting in an analytic sample of 10,128 sexual minority (gay, lesbian, and bisexual) and 405,145 heterosexual adults. Logistic regression models and corresponding predicted probabilities examined how poor self-rated health differed across sexual orientation–by-gender groups, before and after adjustment for established health risk factors. Results reveal distinct patterns among sexual minorities. Initially, bisexual men and women reported the highest—and gay and lesbian adults reported the lowest—rates of poor self-rated health, with heterosexuals in between. Distinct socioeconomic status profiles accounted for large portions of these differences. Furthermore, in baseline and fully adjusted regression models, only among heterosexuals did women report significantly different health from men. Importantly, the findings highlight elevated rates of poor health experienced by bisexual men and women, which are partially attributable to their heightened economic, behavioral, and social disadvantages relative to other groups.

Families, Resources, and Adult Health: Where Do Sexual Minorities Fit?

Extensive research documents the relevance of families and socioeconomic resources to health. This article extends that research to sexual minorities, using 12 years of the National Health Interview Survey (N = 460,459) to examine self-evaluations of health among male and female adults living in same-sex and different-sex relationships. Adjusting for socioeconomic status eliminates differences between same- and different-sex cohabitors so that they have similarly higher odds of poor health relative to married persons. Results by gender reveal that the cohabitation disadvantage for health is more pronounced for different-sex cohabiting women than for men, but little difference exists between same-sex cohabiting men and women. Finally, the presence of children in the home is more protective for women’s than men’s health, but those protections are specific to married women. In all, the results elucidate the importance of relationship type, gender, and the presence of children when evaluating health.

The Levels and Roles of Social and Institutional Support Reported by Survivors of Intimate Partner Abuse

This article explores the roles of social (informal) and institutional (formal) support in the lives of 158 women whose intimate partner abuse (IPA) cases reached the courts in three jurisdictions in the United States.Women were asked who knew about the IPA and their levels of supportiveness. Data analysis includes comparisons across the women in terms of social support and institutional support, and how these were related to the women’s demographic characteristics, whether they were still in a relationship with their abusers, the severity of the violence, and the women’s mental health.

Multiple contexts of exposure: Activity spaces, residential neighborhoods, and self-rated health

Although health researchers have made progress in detecting place effects on health, existing work has largely focused on the local residential neighborhood and has lacked a temporal dimension. Little research has integrated both time and space to understand how exposure to multiple contexts - where adults live, work, shop, worship, and seek healthcare - influence and shape health and well-being. This study uses novel longitudinal data from the Los Angeles Family and Neighborhood Survey to delve deeper into the relationship between context and health by considering residential and activity space neighborhoods weighted by the amount of time spent in these contexts. Results from multilevel cross-classified logistic models indicate that contextual exposure to disadvantage, residential or non-residential, is independently associated with a higher likelihood of reporting poor or fair health. We also find support for a contextual incongruence hypothesis. For example, adults living in the most disadvantaged neighborhoods are more likely to report poor or fair health when they spend time in more advantaged neighborhoods than in more disadvantaged ones, while residents of more advantaged neighborhoods report worse health when they spend time in more disadvantaged areas. Our results suggest that certain types of place-based cumulative exposures are associated with a sense of relative neighborhood deprivation that potentially manifests in worse health ratings.

The social side of accidental death

Mortality from unintentional injuries, or accidents, represents major and understudied causes of death in the United States. Epidemiological studies show social factors, such as socioeconomic and marital status, relate with accidental death. But social theories posit a central role for social statuses on mortality risk, stipulating greater relevance for causes of death that have been medically determined to be more preventable than others. These bodies of work are merged to examine deaths from unintentional injuries using 20years of nationally representative survey data, linked to prospective mortality. Results indicate that socially disadvantaged persons were significantly more likely to die from the most preventable and equally likely to die from the least preventable accidental deaths over the follow-up, compared to their more advantaged counterparts. This study extends our knowledge of the social contributors to a leading cause of death that may have substantial implications on overall disparities in length of life.

Comprehensive Neighborhood Portraits and Child Asthma Disparities

Objectives Previous research has established links between child, family, and neighborhood disadvantages and child asthma. We add to this literature by first characterizing neighborhoods in Houston, TX by demographic, economic, and air quality characteristics to establish differences in pediatric asthma diagnoses across neighborhoods. Second, we identify the relative risk of social, economic, and environmental risk factors for child asthma diagnoses. Methods We geocoded and linked electronic pediatric medical records to neighborhood-level social and economic indicators. Using latent profile modeling techniques, we identified Advantaged, Middle-class, and Disadvantaged neighborhoods. We then used a modified version of the Blinder-Oaxaca regression decomposition method to examine differences in asthma diagnoses across children in these different neighborhoods. Results Both compositional (the characteristics of the children and the ambient air quality in the neighborhood) and associational (the relationship between child and air quality characteristics and asthma) differences within the distinctive neighborhood contexts influence asthma outcomes. For example, unequal exposure to PM2.5 and O3 among children in Disadvantaged and Middle-class neighborhoods contribute to asthma diagnosis disparities within these contexts. For children in Disadvantaged and Advantaged neighborhoods, associational differences between racial/ethnic and socioeconomic characteristics and asthma diagnoses explain a significant proportion of the gap. Conclusions for Practice Our results provide evidence that differential exposure to pollution and protective factors associated with non-Hispanic White children and children from affluent families contribute to asthma disparities between neighborhoods. Future researchers should consider social and racial inequalities as more proximate drivers, not merely as associated, with asthma disparities in children.

Does neighborhood social and environmental context impact race/ethnic disparities in childhood asthma?

Abstract Utilizing over 140,000 geocoded medical records for a diverse sample of children ages 2–12 living in Houston, Texas, we examine whether a comprehensive set of neighborhood social and environmental characteristics explain racial and ethnic disparities in childhood asthma. Adjusting for all individual risk factors, as well as neighborhood concentrated disadvantage, particulate matter, ozone concentration, and race/ethnic composition, reduced but did not fully attenuate the higher odds of asthma diagnosis among black (OR=2.59, 95% CI=2.39, 2.80), Hispanic (OR=1.22, 95% CI=1.14, 1.32) and Asian (OR=1.18, 95% CI=1.04, 1.33) children relative to whites.

Home and away: Area socioeconomic disadvantage and obesity risk

Abstract Although residential context is linked to obesity risk, less is known about how the additional places where we work, shop, play, and worship may influence that risk. We employ longitudinal data from the Los Angeles Family and Neighborhood Survey (LAFANS) to derive time‐weighted measures of exposure to home and activity space contexts to ascertain the impacts of each on obesity risk for adults. Results show that increased exposure to socioeconomic disadvantage in the residential neighborhood significantly increases obesity risk, and although activity space disadvantage does not directly influence obesity, it reduces the association between residential disadvantage and obesity. We further explore the ways in which residential and activity space disadvantages may interact to influence obesity and discuss the value of integrating personal exposure and activity space contexts to better understand how places contribute to individual health risks. HighlightsResidential socioeconomic disadvantage is associated with obesity risk.Activity space socioeconomic disadvantage does not predict obesity.Not accounting for activity spaces may overestimate residential effects on health.