low-SES Individuals Research Articles

Disparities by Ethnicity and Socioeconomic Status in the Use of Weight Loss Treatments

Prior research suggests that ethnic minorities and individuals of low socioeconomic status (SES) may be more likely to attempt weight loss using unproven methods. Data were from a national, random-digit-dial telephone survey of weight loss practices. Seven modalities of weight loss were examined. Multivariable analysis controlled for clinical and sociodemographic variables (including race/ethnicity, SES, and body mass index), as well as self-perception of weight and weight loss attitudes. In multivariable analysis, African Americans (OR, 1.71; 95% CI, 1.05-2.78; p =.03) and Latinos (OR, 1.69; 95% CI, 1.11-2.60; p = .016) were more likely than Caucasians to report use of over-the-counter (OTC) weight loss supplements. African Americans (OR, 0.39; 95% CI, 0.21-0.71; p = .002) and Latinos (OR, 0.56; CI, 0.33-0.97; p = .038) also were less likely than Caucasians to report use of commercial weight loss programs. Higher-SES individuals were more likely than low-SES persons to report self-directed attempts at weight loss (OR, 1.39; CI, 1.00-1.93; p = .05) and commercial programs (OR, 2.12; CI, 1.51-2.97; p < .001) and less likely to report use of OTC supplements (OR, 0.64; CI, 0.47-0.88]; p = .006). African Americans were more likely than Caucasians to report use of medically supervised programs (OR, 1.74; CI, 1.06-2.86; p = .028). With the exception of medically supervised programs, ethnic minorities and low-SES individuals are generally more likely to report use of unproven methods for weight loss and less likely to report use of potentially beneficial treatments. These findings should be explored in more detail. Use of proven treatments for weight management should be encouraged.

Being Poor and Coping With Stress: Health Behaviors and the Risk of Death

Individuals may cope with perceived stress through unhealthy but often pleasurable behaviors. We examined whether smoking, alcohol use, and physical inactivity moderate the relationship between perceived stress and the risk of death in the US population as a whole and across socioeconomic strata. Data were derived from the 1990 National Health Interview Survey's Health Promotion and Disease Prevention Supplement, which involved a representative sample of the adult US population (n = 40335) and was linked to prospective National Death Index mortality data through 1997. Gompertz hazard models were used to estimate the risk of death. High baseline levels of former smoking and physical inactivity increased the impact of stress on mortality in the general population as well as among those of low socioeconomic status (SES), but not middle or high SES. The combination of high stress levels and high levels of former smoking or physical inactivity is especially harmful among low-SES individuals. Stress, unhealthy behaviors, and low SES independently increase risk of death, and they combine to create a truly disadvantaged segment of the population.

Perceptions of Body Weight Among Older Adults: Analyses of the Intersection of Gender, Race, and Socioeconomic Status

We examine the effects of gender, race, and socioeconomic status (SES) on perceptions of body weight among older adults and the role of status-based differences in BMI in these processes. Data are derived from face-to-face interviews with 1,164 adults aged 65 years and older in the District of Columbia and two counties in Maryland in 2000-2001. With "perceived appropriate weight" as the comparison group, multinomial logistic regression analyses indicate that white adults, women, and high-SES individuals are more likely than black adults, men, and low-SES individuals to describe themselves as overweight or obese. However, these disparities are observed only after statistically adjusting for race, gender, and SES disparities in BMI. Moreover, the positive effect of SES on the likelihood of reporting overweight or obese perceptions is strongest among black women. Among low SES individuals, white women are more likely than men and black women to describe themselves as obese (relative to the "perceived appropriate weight" category). Our observations underscore the importance of taking SES contingencies into account when exploring race-gender differences in perceived body weight. This study further contributes to the literature by documenting the important suppression patterns associated with race, gender, and SES differences in BMI.

Socioeconomic inequalities in depression: a meta-analysis.

Low socioeconomic status (SES) is generally associated with high psychiatric morbidity, more disability, and poorer access to health care. Among psychiatric disorders, depression exhibits a more controversial association with SES. The authors carried out a meta-analysis to evaluate the magnitude, shape, and modifiers of such an association. The search found 51 prevalence studies, five incidence studies, and four persistence studies meeting the criteria. A random effects model was applied to the odds ratio of the lowest SES group compared with the highest, and meta-regression was used to assess the dose-response relation and the influence of covariates. Results indicated that low-SES individuals had higher odds of being depressed (odds ratio = 1.81, p < 0.001), but the odds of a new episode (odds ratio = 1.24, p = 0.004) were lower than the odds of persisting depression (odds ratio = 2.06, p < 0.001). A dose-response relation was observed for education and income. Socioeconomic inequality in depression is heterogeneous and varies according to the way psychiatric disorder is measured, to the definition and measurement of SES, and to contextual features such as region and time. Nonetheless, the authors found compelling evidence for socioeconomic inequality in depression. Strategies for tackling inequality in depression are needed, especially in relation to the course of the disorder.

Effects of socioEconomic status (SES) information on cognitive ability inferences: When low-SES students make use of a self-threatening stereotype

Two studies tested whether students' socioeconomic status (SES) and academic achievement level moderate their use of the SES stereotype (i.e., the belief that the low-SES individuals are intellectually inferior to their high-SES counterparts). In Study 1, low versus high achievers with a low versus a high SES were given social class information (derived from a pilot study) about several targets and were then asked to infer these targets' memory ability. In Study 2, participants were given memory performance information about several targets and were then asked to infer these targets' possessions and cultural activities (i.e., SES indicators). In both studies, only the low-SES students generated stereotype-consistent inferences.

Growth of specific muscle strength between 6 and 18 years in contrasting socioeconomic conditions

The influence of sex, age, and socioeconomic conditions on specific grip strength of 6-18-year-old individuals was studied among 1,704 males and 1,956 females belonging to the so-called "Cape Coloured" community in the western part of South Africa. Half of the participants of both sexes came from communities in the Greater Cape Town area where living conditions are comparable to those of middle-class First World communities (high SES). The other half came from the poorest rural communities of Klein Karoo (low SES). Arm circumferences, triceps skinfold thickness, and grip strength of the right and of the left hand were greater in individuals from high SES at all ages. Females within each SES group had skinfolds thicker than males, especially at older ages, and were weaker. Specific grip strength (SS), estimated as grip strength per unit area of cross section of the fat-free arm, increased with age in each group, was greater in males, and was significantly lower in low SES groups, than in the high SES ones, especially during and after puberty. It seems that SES difference in SS will persist into adulthood. Sexual differences in SS can be attributed to hormonal differences; while the SS increase with age and the difference between SES groups find no clear explanation in current theories of muscle growth and development. Since the speed of neuromuscular reaction observed in our participants is slower among low SES individuals, it seems that the difference in neuromuscular control of strength may be responsible for our findings. Differences in muscle metabolism and hormonal regulation must also be considered.

College Completion among Students from High Schools Located in Large Metropolitan Areas

This study uses High School and Beyond third follow-up data to analyze college completion rates for graduates of high schools located in the country's largest metropolitan areas. First, it examines the effects of race and socioeconomic status (SES) on degree attainment prospects. Next, three high school characteristics--high school type (public or private), high school location within the metropolitan area (city or suburb), and high school racial composition--and two academic measures (high school grades and scores on a standardized test) are introduced in order to see whether these measures account for race and SES differences. Finally, three stages of completing college--application, entry for those who apply, and graduation for those who enter--are analyzed separately in an attempt to pinpoint when the determinants of degree completion have their impact. The findings indicate that differences attributable to SES and high school racial composition persist, with low-SES individuals and those from high schools with lower percentages of whites experiencing lower graduation rates, even when students' postsecondary educational plans, academic ability, and college entry are controlled. Most students who desire to obtain a college degree are at least able to apply to college and attend some classes. However, once in college, persisting to graduation proves more problematic.

Psychiatric and medical problems in rural communities

Abstract To delineate the health needs of rural communities, this household survey of 713 adults in nine rural counties of the southern United States examined: (1) the prevalence of psychiatric impairment and of various medical problems in the rural population, (2) demographic correlates of psychiatric and medical problems, and (3) the interplay between psychiatric and medical problems. A 70-minute interview provided data on psychiatric symptoms (HOS, CES-D, and GWB scales), chronic medical problems, self-ratings of health, days of work missed, and demographic characteristics. Approximately 12% of the rural adults were psychiatrically impaired, with impairment higher among females, non-married, and low SES individuals. Medical problems were reported most frequently by females, older, and less educated respondents. Older and low SES respondents also perceived themselves to be in poorer health. Chronic medical problems were strongly associated with psychiatric impairment. When the effects of medical problems were controlled, education was much less strongly related to psychiatric impairment and higher levels of impairment were observed among younger respondents. The data suggest that the differential prevalence of psychiatric symptoms among lower class and older individuals may reflect the differential prevalence of medical problems in those groups. Implications for both health screening and planning of rural health care delivery systems are discussed.

Psychiatric and medical problems in rural communities

To delineate the health needs of rural communities, this household survey of 713 adults in nine rural counties of the southern United States examined: (1) the prevalence of psychiatric impairment and of various medical problems in the rural population, (2) demographic correlates of psychiatric and medical problems, and (3) the interplay between psychiatric and medical problems. A 70-minute interview provided data on psychiatric symptoms (HOS, CES-D, and GWB scales), chronic medical problems, self-ratings of health, days of work missed, and demographic characteristics. Approximately 12% of the rural adults were psychiatrically impaired, with impairment higher among females, non-married, and low SES individuals. Medical problems were reported most frequently by females, older, and less educated respondents. Older and low SES respondents also perceived themselves to be in poorer health. Chronic medical problems were strongly associated with psychiatric impairment. When the effects of medical problems were controlled, education was much less strongly related to psychiatric impairment and higher levels of impairment were observed among younger respondents. The data suggest that the differential prevalence of psychiatric symptoms among lower class and older individuals may reflect the differential prevalence of medical problems in those groups. Implications for both health screening and planning of rural health care delivery systems are discussed.