Kenneth F. Ferraro

Health Trajectories: Long-Term Dynamics Among Black and White Adults

Disability has long been identified as a predictor of self-assessed health, but some studies suggest the opposite causal direction. The aim of this study is to examine the dynamic relationships between physical disability and assessments of health among Black and White adults while simultaneously considering changing morbidity. Research questions include: Do more negative health assessments lead to greater morbidity and physical disability? Do negative health assessments lead to a cycle of health decline over time? These questions were addressed for Black and White respondents over 15 years using data from three waves of the National Health and Nutrition Examination Survey I: Epidemiologic Follow-Up Study. Results from structural equation modeling reveal that self-assessed health predicts subsequent change in health, suggesting a cycle between health problems and negative health assessments for both White and Black adults. In addition, self-assessed health among African Americans declined at a faster rate than was the case for White adults.

Aging and Cumulative Inequality: How Does Inequality Get Under the Skin?

PURPOSE This article draws from cumulative disadvantage and life course theories to develop a new theory for the social scientific study of aging. DESIGN AND METHODS Five axioms of cumulative inequality (CI) theory are articulated to identify how life course trajectories are influenced by early and accumulated inequalities but can be modified by available resources, perceived trajectories, and human agency. RESULTS Although the concept of CI has attracted considerable attention among social scientists, it holds promise for integrating additional disciplinary approaches to the study of aging including, but not limited to, biology, epidemiology, and immunology. The applicability of CI theory to gerontology is illustrated in research on the early origins of adult health. IMPLICATIONS Primary contributions of the theory to gerontology include greater attention to family lineage as a source of inequality; genes, gestation, and childhood as critical to early and enduring inequalities; the onset, duration, and magnitude of exposures to risk and opportunity; and constraints on generalizations arising from cohort-centric studies.

Cumulative Disadvantage and Health: Long-Term Consequences of Obesity?

Drawing from cumulative disadvantage theory, the health consequences of obesity are considered in light of the accumulation of risk factors over the life course. Two forms of compensation are also examined to determine if the risk due to obesity is persistent or modifiable. Analyses make use of data from a national survey to examine the consequences of obesity on disability among respondents 45 years of age or older, tracked across 20 years (N = 4,106). Results from tobit models indicate that obesity, especially when experienced early in life, is consistently related to lower-body disability. The results also show that obesity has long-term health consequences during adulthood, altering the life course in an enduring way. Compensation was not manifest from risk-factor elimination (weight loss), but rather through regular exercise. Although there is evidence for long-term consequences of risk factors on health, the findings suggest that more attention should be given to compensatory mechanisms in the development of cumulative disadvantage theory.

Body mass index and disability in adulthood: a 20-year panel study.

OBJECTIVES This study examined whether body mass index (BMI) or change in BMI raises the risk of disability in adulthood. METHODS The relation between BMI and upper- and lower-body disability was examined among adult subjects from a national longitudinal survey (n = 6833). Tobit regression models were used to examine the effect of BMI on disability 10 and 20 years later. RESULTS Obesity (BMI > or = 30) at baseline or becoming obese during the study was associated with higher levels of upper- and, especially, lower-body disability. In persons who began the study with a BMI of 30 or more and became normal weight, disability was not reduced. Underweight persons (BMI < 18.5) also manifested higher disability in most instances. CONCLUSIONS Disability risk was higher for obese persons, but overweight was not consistently associated with higher disability.

Distress and perceived health: mechanisms of health decline.

Stress is a common experience in modern society, and it can affect both physical and mental health. Recognizing that not all stress is detrimental to health, this research examines the relationship between perceptions of distress and perceived health within a longitudinal framework. Using two waves of a nationally representative panel study, the National Health and Nutrition Examination Survey I (NHANES I), structural equation modeling revealed that distress leads to more negative health perceptions. In addition, perceived health was found to impact distress levels at the following wave suggesting a cycle of decline between distress and perceived health. Finally, perceived health was found to have predictive validity in determining future functional disability even when considering distress.

Volunteering in Middle and Later Life: Is Health a Benefit, Barrier or Both?

The positive association between volunteering and health has been widely interpreted as evidence of the salutary effect of volunteering during adulthood. Using three waves of data from a national survey, this study uses structural equation models to examine the relationships among volunteering, functional limitations, and depressive symptoms during middle and later adulthood. The findings reveal a salutary effect of volunteering in later life as well as a compensatory mechanism. By contrast, only a barrier mechanism was uncovered in middle age: Depressive symptoms decreased volunteer participation over time. The results demonstrate life course variation in the relationship between volunteering and health and suggest greater attention to selection processes in the study of social engagement and health.

Double jeopardy to health hypothesis for African Americans : Analysis and critique

Considerable research on minority health has examined whether members of a minority group experience more rapid health declines than the White majority when both groups reach later life. Researchers have sought to determine if being both old and a member of a minority creates a double disadvantage to health. The primary purpose of this research is to test the double jeopardy to health hypothesis among Black and White Americans using data from a 15-year panel study of adults: National Health and Nutrition Examination Survey I: Epidemiological Follow-up Study (NHEFS). African Americans have poorer health at all three times on a variety of health status measures, but no evidence for double jeopardy was uncovered. There were important racial differences for change in health status but Black Americans of all ages -- including Black older adults -- suffered from growing disability and more negative ratings of health. Black adults are more likely to develop serious illness, and their ratings of health decline more rapidly than is the case for White respondents. While there is little support for the double jeopardy hypothesis as originally stated, there is overwhelming evidence to show that the health of Black Americans of all ages declines at a faster rate. The formulation of the double jeopardy hypothesis is critiqued on several points: ontogenetic fallacy, attribution of discrimination, and selective mortality.

Does Religion Influence Adult Health

The effect of religion on health status was examined with a national sample of noninstitutionalized adults. Particular attention was given to assessing the effects of religious affiliation and religiosity especially practice on subjective health status. Respondents of all ages with a more conservative religious affiliation manifested poorer health than did those with a more liberal affiliation. However, higher levels of religious practice were positively associated with better health, regardless of age. The results show that religion may have both positive and negative effects on health, although in this research the positive effect was stronger.

Neighborhood residential segregation and physical health among Hispanic Americans: good, bad, or benign?

Although considerable evidence shows that residential segregation is deleterious to the health of African Americans, findings regarding segregation and health for Hispanic Americans are inconsistent. Competing hypotheses regarding the effects of neighborhood segregation on health are tested with data from Puerto Rican and Mexican American residents of Chicago. Multilevel analyses reveal that segregation is associated with more health problems for Puerto Rican Americans but not for Mexican Americans. In addition, the relationship between segregation and health was conditioned by generational status for Mexican Americans: Second- or later-generation Mexican Americans living in highly segregated neighborhoods had better health than first-generation Mexican Americans in such neighborhoods. These findings reveal that residential segregation has differential effects across Hispanic groups and suggest that a high degree of contact with Mexican Americans promotes health by facilitating flow of informal health resources and social support.

The Stigma of Obesity Does Perceived Weight Discrimination Affect Identity and Physical Health

Obesity is widely recognized as a health risk, but it also represents a disadvantaged social position. Viewing body weight within the framework of stigma and its effects on life chances, we examine how perceived weight-based discrimination influences identity and physical health. Using national survey data with a 10-year longitudinal follow-up, we consider whether perceptions of weight discrimination shape weight perceptions, whether perceived weight discrimination exacerbates the health risks of obesity, and whether weight perceptions are the mechanism explaining why perceived weight discrimination is damaging to health. Perceived weight discrimination is found to be harmful, increasing the health risks of obesity associated with functional disability and, to a lesser degree, self-rated health. Findings also reveal that weight-based stigma shapes weight perceptions, which mediate the relationship between perceived discrimination and health.