SOCY 4052 - Exam 2
What is Geronimus's "Weathering" hypothesis and what evidence was discussed in class?
A measure of physiological processes defined by biomarkers, indicates the stress the body is under Allostatic load in excess has been seen as accelerating to age Probability of having high allostatic load is greater for lack population than white Whites reach 55, black 10 years prior for when they reach allostatic load on average High effort coping for Blacks causes greater weathering —> earlier age to reach allostatic load Telomeres have been used as a biological indicator of aging Stressors associated with perceived stress and poverty contributed to black and white differences in telomere length Chronic stress is altering physiological states that create metabolic issues The human body can be weathered down by stressors Allostatic load: high blood pressure, high cholesterol Probability of having a high allostatic load is much higher among black Americans White Americans reach allostatic load around the age of 50
Does the income-longevity association vary by place across the US? If so, how?
According to Chetty, it depends. People in the top percentiles of wealth are wealthy no matter where they live, even if they migrate, but longevity varies across place if you're in the lowest percentiles of wealth/in debt/impoverished To be rich in America means that your life expectancy doesn't differ in relation to where you live, but if you are considered on the lower end of the household income percentile, then location matters
Neighborhood poverty levels into which Black and white infants are born (mid-20th century vs. end of 20th century)
Among infants born during the civil rights era, what was the neighborhood composition that black infants were born into? Born into neighborhoods where 20-30% of households are in poverty 4% white infants born into poverty neighborhoods Not much has changed in terms of which neighborhoods black or white infants are being born into
What are some examples of policies and institutional practices that contribute to women's exclusion and marginalization in population health sciences?
As a group - women have been excluded and marginalized for centuries. The United States has denied women access to education, the right to own property, and the right to vote. The United States has also denied women bodily autonomy through forced and coerced sterilizations and psychiatric treatments These policies and practices especially affected women who were racially marginalized, women who were poorer, and women with disabilities US women today have more economic and political power than in the past but they still remain underrepresented
Education can affect health through other SES (i.e., income, wealth attainment), but how might education affect health through non-SES pathways (e.g., creativity/self-autonomy/personal control)?
Autonomy of work is linear and greater in unemployed people than employed, though people with more years of education do have elevated autonomy as compared to people with fewer years of education Creativity (which is more important for health than autonomy) within work steadily increases and is higher for employed people who have more years of education than people who have less education and than people who are not employed (though people who are not employed still experience greater creative experience than unemployed people with less educational experience) Employees with greater control over their own activities have better health. People who are employed give up some control over their own activities for pay, yet employment is associated with better health
Trends in educational disparities in US adult mortality and whether they are narrowing, widening, or staying the same
Black women and men have stagnation in mortality decreases with educational income; huge disparity compared to white women and men - this disparity is widening The "remaining years of life for US Adults at age 25 by educational attainment and gender" bar graph shown in class showcased how there is a huge 12 year life expectancy gap between less than high school graduates and having a graduate degree when it comes to women When we look at graphs showcasing population age 25 and over by educational attainment from 1940-2021 it showcases that the proportion of the US that has less than high school diploma has been on a downward decline. The proportion of educated population is getting bigger, and so is life expectancy The differences are WIDENING over time; people with higher education are doing better over time; change is across both time and birth, but more so birth cohorts
Hatzenbuehler et al. - What is "structural stigma"?
Co-occurrence of labeling, stereotyping, separation, status loss, and discrimination in a context in which power is exercised Structural stigma as societal level conditions, cultural norms, and institutional policies that constrain the opportunities, resources and wellbeing of the stigmatized Labeling and exclusionary practices that happen in policies and institutional practices that can cause psychological distress that increase anxiety, stress, and loss of hope.
How obesity patterns compare to patterns/trends in diabetes, heart disease, stroke
Diabetes mortality is highest in Mississippi - but there's also high rates across the entire US Colorado has very low diabetes mortality rates - reduction in diabetes mortality in mountain areas Heart disease mortality clusters in South but low in pacific northwest ;lower overall death among women than men; adults over 50 are more likely to develop and die from cardiovascular disease than older adults in other countries, US death rates from ischemic heart disease is the second highest among the 17 peer countries Stroke mortality: heart disease, stroke, cardiovascular disease increasing a bit; high rates in South
According to Heckman, when/where in the life course is it most beneficial to intervene with education?
Differences we see in adulthood SES can actually be seen as early as age 6 with family income More advantageous families show higher score percentiles in mathematics than those in lowest quartiles Huge payoff if you intervene earlier Intervention costs more with later age
Evidence for the wealth-mortality association (especially compared to other indicators of SES?)
Glei data and study Hazard ratios - how many times higher is one's mortality risk compared to another person Kids from poorer backgrounds have 70% higher mortality risk than kids with higher SES People that have 0 assets relative to someone who has 300k is 3.3 times more likely to die between ages 26-65 "Most (but not all) previous research finds that the association between high neighborhood SES and health is positive. Beyond this, the association of health with neighborhood SES is tenuous, inconsistent, and often insignificant. In other words, the health of individuals living in high SES neighborhoods benefits from the resources of their neighborhoods, but it is less clear if the health of those living in low SES neighborhoods is harmed. There is Mounting evidence that SES is causally related to population health in the US Wider SES disparities in U.S. population health
Evidence for alternative explanations of Racial/ethnic differences in U.S. health and mortality: SES, stress, marginalization, exclusion, stigmatization
Half of racial ethnic differences in mortality are explained by SES - stratification of SES is partly via racism, not just basic income inequality SES describes ½ to ⅔ of reasons for disparity Marginalization - incarceration, GI bill, highway construction Allostatic load, ambient racism (non violent racism or non explicit), Tatum resource, chronic stressors of being poor and black in America (allostatic load - physiological response to stressors from systemic racism, can literally produce wear and tear on body and speed of aging process)
How did Hatzenbuehler et al. measure the pernicious health effects of structural stigma in the population
He tried to advance the structural stigma Ex. he looked at 13 outcomes of psychological well being and among lesbian, gay, and bi people living in states with these advancements, things like anxiety and stress uptick. In states that don't experience these amendments they didn't have this stress
How population composition complicates research on trends in place-based differences in health and mortality
Healthy migrant effect; population composition and its health/mortality is heavily influenced by migration Ex: 1/4 of Ohio's population aren't originally from Ohio; another is that the Spanish population in the US overperforms in health and longevity so it may suggest that the population is overall more healthy due to these migrants coming in healthy The mixture of population influences life expectancy Bloomberg stated that NYC was a better place to love among others because people were living longer, but the real explanation is "while many other pluses and minuses enter into the comparison, immigrants are playing the role in the longer lives New Yorkers"
Recent drug-overdose trends and how they vary by regions/states
Highest concentration of drug overdose is in north east cluster of Ohio, Pennsylvania, and West Virginia and then less concentrated in areas like Maine, Kentucky, Tennessee, Indiana, Missouri, Louisiana, and then slightly dispersed in Arizona and New Mexico Americans lose more years of life to alcohol and other drugs than other countries, even when deaths from drunk driving are excluded
What is the leading cause of death among pregnant or postpartum women in the United States?
Homicide is a leading cause of death for girls and young women overall, and for pregnant or postpartum women in particular
What is the "gender paradox" in health/mortality?
In general, better health among men relative to women but better longevity in women Women have worse self-reported health and pain but high life expectancy; they report more non-mortality causing ailments like headaches and lower back pain purely due to higher rates of exposure (not just because they're women)
Why has the income-mortality association been so difficult to study?
Longevity largely varies among geographical location for people who are impoverished; could be a reflection of each location's population composition rather then connection between income and mortality; people also don't like to share personal income details - so there are no good estimates through survey-based data Only an insight from IRS returns recently (2015 Cheddy) We don't have a population registry like other high-income countries
In what U.S. health and mortality outcomes are gender differences largest?
Masculinity at young ages is the greatest contributor to gender differences Young male populations are at most risk
What is the contribution of cigarette smoking to male-female differences in the U.S. mortality? (Wang & Preston / Ho & Elo)
Men tended to smoke earlier and now we're starting to see a drop. A lot of the closure in the gap is due to this People with higher SES were the first to start smoking and also the first to stop
Levels and trends in U.S. inequality
Most common pattern in levels and trends in inequality is that white people, especially men, get better treatment than minorities
Ross et al findings about role of education in gender differences and the paradox
Narrowing gender differences when you get to high education Closes gender disadvantages for women and health and for men in mortality Low levels of education has higher gender difference between reporting health while high levels of education have an almost closed gap in gendered reporting of health Increase of SES tends to close gender gap in mortality risk for men and women as well but it increase for racial/ethnic data
Reiker et al - Gender health differences by CVD, autoimmune diseases, mental health?
Physical Health: CVD, Autoimmune CVD : about 8-9% of men suffer from this, 6-7% of women will (it is the leading cause of death, causing about ⅓ of them globally) Recent history of CVD excludes women so risk factors by gender have been assumed to be the same Women have greater risk of autoimmune diseases by about 2-3x Mental Health: Depression, Substance Abuse Overall prevalence of psychological stress is same for men and women but the expressions of them are very different
What environmental health factors did the Shorter Lives, Poorer Health report emphasize as important at shaping U.S. health outcomes?
Physical environmental factors may include: air pollution, proximity to toxic cites, access to resources, community design, etc. Social environmental factors: those related to safety, violence, and social disorder in general, and more specific factors related to the type, quality, and stability of social connections Spatial distribution of environmental factors: levels of residential segregation shape environmental differences across neighborhoods Environmental factors that affect physical activity and access to healthy foods may help explain the differences in obesity and related conditions between the US and other high income countries Some evidence suggests that some environmental factors that could affect the US health disadvantage are worse or more inequitably distributed in the US than other high income countries
County differences in specific causes of death and how they have changed over time - diabetes
Rates for diabetes have increased over time
Why is a single measure of SES unlikely to capture all the dimensions of social class and their effects on health and longevity?
SES looks at education, income, occupational prestige, and wealth- we look at all of these dimensions because these categories tend to cluster together; intergenerational transfer of wealth influences other dimensions which makes it hard to isolate and look at one dimension; these dimensions also constantly change throughout life; can't reduce SES to single measure because they operate in so many different areas in our life
Definitional differences between Socioeconomic Status vs. Social Class
SES: differences between groups and individuals in the possession of highly valued societal resources; educational attainment Social Class: rigid hierarchy carried from generation to generation, individuals relationship to the means of production
How racial/ethnic identity is measured in the United States and the differences in education, income, and wealth attainment of Role of residential segregation, incarceration, GI Bill, etc
Takeaway: it is important to know that interpersonal racism exists and impacts people's stress and health, but the insidious ways in which institutions are set up and have been set up suggest that there is institutional racism and there is a culture baked in Example: redlining or med school (the ideal patient or student was often centered on whiteness and males) The reference group, patients we practice on, or the tests that we make are focused on the white body
How do life expectancy trends among U.S. women compare to trends in other high income countries?
The health of women in the U.S. compares poorly to the health of women in other high income countries
How do maternal mortality rates vary by education and race/ethnicity in the United States?
The rate of maternal mortality in the United States compares poorly to that of other high-income countries and has risen over the past few decades Pregnancy-related mortality rates (i.e., pregnancy-related deaths per 100,000 live births) from 2007 to 2016 are about three times higher among Black women (40.8) compared with White women (12.7) There's less mortality for educated pregnant women
Why it might be important to consider the intersection between gender-class and race class in health and mortality?
Transferring SES is much easier for certain groups What is normative for one cohort is very different for another In the stuck and place research, you see that white folks in Chicago, regardless of SES showed social mobility and were able to move away whereas the black populations regardless of SES either stayed in low income areas or stayed in place. It's important to think of the intersection because just knowing someone's class or gender will give you a general sense of the influence of health on mortality but combined you can think of it as a dual disadvantage. If you are poor and black in Chicago you will do worse than being poor an white in Chicago
How might cultural racism be understood as a framework/support for institutional racism?
We need to measure ways that cultural racism is observed Smog - socially toxic environment Redlining and other policies requires whiteness as the standard The framework for standardizing systemic racism requires cultural racism as a scaffold - white centric system
Why were the 1970s and 1980s a pivotal period for research on women's health?
Women's health activism, buttressed by feminist activism, gained momentum as advocates argued that medical research overlooked many aspects of women's health by focusing narrowly on reproductive health. So in 1985 they called more attention to how sex helps shape because finally people realized that scientific data on women's health wasn't being collected
"Ambient" racism and Cultural racism (Cogburn)
"Ambient nature of cultural racism can make it challenging to measure" Effectively integrating cultural racism into empirical re-search examining racial inequities in health will require both a reimagining of existing measures as well as measurement innovation Establishing links between structural and cultural racism is imperative to reveal how cultural processes obscure the role of structures and institutions in the production of racial inequities in health.
What does Cogburn mean when she discusses cultural racism as a socially toxic "smog" that can affect psychosocial stress of racialized/marginalized populations?
"Tatum likens cultural racism to smog that is both thickly visible and so ordinary that it becomes as if we are "breathing it in" The socio-ecological concept of social toxicity describes threats experienced during childhood (eg, exposure to violence, traumatic experiences, and social dysfunction) as "social and culturalpoisons,"52 comparing them to environmental pollutants. The social environment can be so socially and culturally polluted that the "me react of living in society is dangerous to the health and well-being of children and adolescents" 52 and arguably continues to pose a threat well beyond childhood. This more atmospheric form of cultural racism may serve a distinct role in producing racial inequities in health, perhaps significantly contributing to the weathering of physiological systems, psychological stress, and other observed racial disparities in health across the life course
Why must social class - and its effects on adult health - be understood in tandem with childhood health status? (Palloni)
(1) early health status must have nontrivial impacts on the allocation of individuals by social classes or SES positions, directly or indirectly 2) to the extent that early health status is determined by parental socioeconomic standing and perhaps also parental health status, an individual's life chances are constrained by the social class into which he or she is born; and, following from the first two propositions (3) early health status is a mechanism through which social classes and social inequalities are reproduced over time
What types of studies/evidence has been offered to suggest that SES "causality affects" health and mortality
1) Economics studies of education and health (Lawrence 2017) -Studies show even when they're are underlying factors, getting an education still has something to do with wealth 2) Natural experiments...laws to increase mandatory schooling (IIeras-Muney) Found a large and positive correlation between education and health; huge direct effects on childhood effects that also spill over into the parents of the kids 3) Genetically-informed studies of education health - Direct measures of genes (boardman et al 2015) and twins studies (Behrman et al 2011; Warren et al 2019) 4) Experimental data (Hickman et al 2014) -Looks at populations that implement things like head start certain areas are set up for better attainment trajectories
The arguments and explanations forwarded by Montez and colleagues: state-level "structures"
1) US life expectancy since 1980s has not kept up with its high-income peer countries (and in most years has been falling since 2014) 2) widening disparities in life expectancy across US states (as in the example of Connecticut vs. Oklahoma and NY Mississippi mentioned in previous slide) Montez's main argument is that these trends are grounded in changes in policies and political landscaped across states since the 1980s - so we have to think about structure Structures: Retrenchment of labor protections Restrictions on abortion Loosened gun laws Shrinking investments in K-12 and higher education Gutting of local economies (e.g., manufacturing)
How can cultural racism be understood as a distinct dimension of racism (normalization/centering of "whiteness")? -Symbolic Boundaries, Status Hierarchies, Collective Imaginaries
1) symbolic boundaries (marginalization) Whiteness at center of standardization and evaluation - beauty, medical, employee/student norms are examples of structures built around whiteness Delineating these will help measure the extent of influence on cultural racism 2) Status hierarchies (principles determining status/prestige) Underlying assumption that immigrants will assimilate to dominant white culture - "converting" immigrants to "superior" western lifestyle NBA dress code - downplay aspects of black culture Marginalized groups bound by law but not protected; non marginalized people protected by law but not bound by it 3) Collective imaginaries (symbols, myths, narratives) "Higher geographic concentrations of anti-black sentiment have been associated with all-cause mortality for Blacks, specifically heart disease, cancer, stroke, as well as Black-white health disparities in access to health care and rate of death due to circulatory disease"
Case and Paxon's explanation for gender paradox
Behavioral differences, evidence for biological differences, evidence for social-structural/psychological differences, "second-shift" and gendered caregiving Disease profiles that are more likely to be reported (ex. Depression, headaches) reflect one's likelihood to report low health(women) but these diseases do not normally lead to death Not a gender difference in response to diseases but a difference in prevalence of these diseases (more in women) Things like back pain don't lead to greater risk of death There is not a gender difference in response to disease or condition but there is a gender difference in the prevalence in the types of diseases each gender gets
What biological, psychosocial, behavioral, and social-structural factors might influence the paradox?
Behavioral: part of the story involves "external" causes of death - accidents, homicide, and suicide - and the fact that men are more likely to die from these causes of death than women" (H&H, 166) Internalizing (depression, anxiety) among women vs externalizing (abuse substances, violence, self-harm) Biological: sex differences in genetic, physiologies, anatomies, hormones Social-structural: status, patriarchy, misogyny, power Psychological: gendered stress and coping, caregiving, social support Behavioral: health-related actions (e.g., exercise, diet, substance abuse)
Are the changes in the education-mortality association changing over time periods or birth cohorts?
Birth cohorts (can be both period and cohort - but we most often look at cohort measures) Relationship between education and mortality displayed in 4 graphs: white men, black men, white women, and black women. For white men and women, each birth cohort that has education beyond high school sees less and less deaths per 100,000 people; for black men and women, the level of educational attainment does not have as steep of an effect across cohorts - rates of mortality per 100,000 people showed very little decline
How do temporal and spatial variation in life expectancy differences between male and female populations implicate gender as a bigger factor for longevity than sex?
Differences in male female life expectancy gap, hormones don't change that much in 30 years so the social system and political forces in gender are causing that change Big spatial differences in male and female life expectancies Biological differences cannot account for these differences because the can't have changed drastically enough to explain the gaps Structural differences in access to resources that shape health profiles for women vs men
The education-mortality gradient and what it "looks" like (i.e., the "functional form")
Each year of additional education positions you to have a longer life expectancy; high school diploma is a huge factor, there's a big difference between only having a diploma and then having an additional year of education on top of graduating high school Graph shown in class has two separate lines, one starting at high odds of death with little decline if only diploma is achieved, second line starts at mid odds of death and, as more education is obtained post-diploma, the line declines closer to the low odds of death area Going from 0-11 years of schooling, there is a gradient that positions you for lower mortality. There is a huge drop in death rates with a high school degree, emphasizing the premium of high school degree is a big factor Any college advances you more than no college at all; education comes before all others and increases health and mortality
Personal control and stress theory- As discussed by Mirowsky and Ross (i.e., education affecting personal control, personal control affecting depression)
Education The positive effect that education has on health is pervasive, cumulative, and self-reinforcing More education = better health More education = fewer reports of poor health, poor mental health, physical health, anxiety, depression, anger, fear, etc. Personal control The Americana lifestyle has three elements, unless we actively work against them, that affect human life Displacing human energy with mechanical energy Displacing household food production with mechanical food production (fast food) Displacing health maintenance with health dependency If we change these three aspects, then we are able to have personal control and reduce rates of depression
The SES indicators that are most often used in studies of SES and health - name them
Education - usually in years and/or degrees (and quality, content, and type of schools, etc) Occupation - usually a person's current job (longest job, covert occupation into a score, full/part time, jobless, work conditions and extent of creativity) Income - personal, household, who in household, hourly/weekly/monthly/yearly, IRS records, cash income, missing data (people don't typically like to divulge this information) Wealth - what a person owns (do they know?) debt, parent's wealth
The SES indicators that are most often used in studies of SES and health - why? preferences for one over others?
Educational level precedes income, employment, and wealth; so higher educational attainment usually yields longer life expectancy but it's also important to examine nuanced situations where minorities may not benefit from higher education or be able to attain higher education
Tobin et al.: Black-white differences in Mastery, Self-esteem, Social Support and how these differences vary by SES
Graph 1: looking at SES with mastery, self esteem, and social support. Black pop has a level mastery of self control; the white population there is an incredibly high gradient. Low education = low education. Higher SES does not translate to mastery for blacks but it is consistent across the board Graph 2: Higher you go in SES usually the lower you are for control for black people Graph 3: peculiar it doesn't affect black people's mental health
What are Palloni's suggestions for measuring/defining child health status? Measuring/defining social class? Existing limitations?
Measuring should include factors in utero/gestation, such as placental growth, exposure to harmful/unbalanced hormonal environments, toxins, drug residues, infectious diseases (such as rubella), and deviations from an adequate supply of micronutrients, exposure/contraction of illnesses (some acute), such as rheumatic heart fever, and others chronic, such as allergies/asthma; Identify more-transient and apparently harmless episodes of infections, some of them with rather striking long-term effective not treated in a timely/appropriate manner Parental SES continues to matter after all the other factors the researcher can measure are controlled for (income, occupation, and education) Defines social class as a position in a hierarchy usually endowed with material, social, symbolic, and ideological resources The case for early health status is largely understated in part because the measures for early health status are so primitive that they probably capture no more than what is extreme
How homicides and suicides contribute to state patterns in U.S. deaths from firearms
Most firearm mortalities are due to self inflicted injury (such as suicide), second most common type of mortality from firearms is homicide Southern state clustering of homicide mortality via firearm Firearm mortality in Mountain Western states is highly related to suicide - account for about 50% homicides in US Account for 70% suicides Adolescents and young adults have died at higher rates from traffic accidents and homicide than their counterparts in other countries
Patrick Sharkey's research titled, "Stuck in Place" which illustrated the reproduction of residential segregation via selective mobility (especially via white flight)
Not much has changed in which neighborhoods black or white infants are being born White flight patterns - cycle amongst themselves White non poor moves to other white non poor areas
Recent obesity trends and variation across regions/states
Obesity data/rates in 1990 showed that in most states the percent of obesity adults was never more than 14.9%, with most states being in the 10-14.9% range and some even being in the 0-9.9% range; Mississippi had the highest percentage at 15-19.9% In 2019, however, most of the US has obesity percentages of either 30-34.9% or, for states like LA, MS, AL, AR, MO, IA, and ND, the percentage is 35%+. Most of the Western states (and NY/other states near NY) it's in the 25-29.9% range) Smaller rates in Pacific Northwest Smallest rates in Rocky Mountains and California Insufficient data in some states- gray Colorado has lower obesity rates than other states Highest obesity rate among high income countries. From age 20 on, US adults have among the highest prevalence rates of diabetes
Race differences in SES mobility: for example, how is mobility among white men different than mobility among Black men?
One central way that racism is revealed and enacted, and racial stratification in resources is created, is through racial residential segregation, which is the separation of racial and ethnic groups in housing. Residential segregation patterns in US are also a reflection to people's preferences and responses to selective mobility Highlighted how black pops. Regardless of whether poor or non-poor are "stuck in place." They either move within their own area or to non-poor areas where black residents reside. They don't move out of Chicago or to white areas White non poor move out of Chicago (white flight pattern) or cycle within each other Black and other minority auditors are shown fewer and different homes and neighborhoods and receive less financial assistance and less agreeable financial terms than White, but otherwise socioeconomically identical, auditors. Segregation creates spatial and socioeconomic mobility traps for minority groups. And residents in segregated neighborhoods are nearly always subject to distinctly unequal institutions, opportunities, services, social networks, environmental risks and hazards, and levels of crime
County differences in specific causes of death and how they have changed over time - drug-related and substance abuse disorders
Opioid epidemic - one study found that the clearest cause of rising rates of mortality among the middle-aged whites was drug-related mortality Rate of deaths from drug overdoses increased by 188.6% among White women between 1999 and 20120 but only by 55.3% among Black women, 50% among Asian women, and 68% among Hispanic women over the same period, resulting in the flipping of the racial disparity for this cause of death between 1999 and 2013. By 2010, the death rate from drug overdoses was higher among White women than all other groups except American Indian/Alaska Native women
Region/state differences in the health outcomes highlighted by the Shorter Lives/Poorer Health Report
Places have a causal effect on residents → location contributes to health outcomes If trends in poor health outcomes aren't reversed , the US will continue to fall further behind comparable countries on health outcomes and mortality Even highly advantaged Americans have worse health outcomes compared to their counterparts in other high income countries The US faces worse in 9 health domains: Adverse birth outcomes, Injuries and homicides, adolescent pregnancy and sexually transmitted infections, HIV and AIDS, drug related mortality, obesity and diabetes, heart disease, chronic lung disease, and disability
County differences in specific causes of death and how they have changed over time - cardiovascular diseases
Rates have dropped and are narrowing across time
Difference between sex and gender and the implications for health differences between men and women
Sex = nature gender = nurture Today, the NIH continues to emphasize the importance of gender inclusion and sex as a biological variable in clinical research. The NIH is also engaged in efforts to improve health among sexual and gender minority populations, adopt intersectional and structural approaches to health disparities, improve maternal mortality and rates of chronic disease among women, and more. The ORWH remains a key advocate for advancing a women's health agenda across institutes at the NIH.
What is Rieker et al.'s "Constrained Choice" theory and how is it helpful for understanding gender differences in health outcomes?
Stress levels affecting psychological and physical responses lead to dysregulation and dysfunction of vascular and immune responses "We view constrained choice as a platform for prevention where the intention is to create a different kind of health conciousness...one that recognizes the role of gender constraints" Decisions made and actions taken at the family, work, community, and government levels shape in different ways men's and women's opportunities throughout their lives. Based on those opportunities, individuals make choices — from where to live and what job to take to how to care for children and elderly parents - Constrained choice is wider recognition of contributing factors between men and women beyond resources Stress levels affecting psychological and physical responses lead to dysregulation and dysfunction of vascular and immune responses. We view it as a platform for prevention where the intention is to create a different kind of health consciousness; one that recognizes the role of gender constraints
Personal Control and Stress Theory
Strongly associated with SES Regardless of educational attainment younger people tend to have a high sense of control, but every level sees a drop as they get further into age Higher levels of sense of self control are associated with lower levels of depression Sense of success and wellbeing is less oriented around SES for black Americans than white Americans Personal control is strongly associated with SES and the link to mental health is very strong It has been argued that SES has less impact on Black Americans mental health/self esteem as compared to white Americans
Recent trends in U.S. sexually transmitted infections
Syphilis rates for women aged 25-29 are at their highest in 2020 and beyond compared to 2011 The same goes for men aged 25-29; lowest rates for men and women in 2020 is among age groups 15-19 Chlamydia rates for women 15-24 highest in south-eastern region of states and Alaska Gonorrhea rates for women (15-24) also highest in south (and slightly north) eastern states Overall increase in STI incidence, especially in South Men are 3 to 4 times higher rates for STIs Higher rates in the South US adolescents have had the highest rate of pregnancies and are more likely to acquire STI's Highest incidence of AIDS and highest prevalence of HIV
Region/state differences in teen birth rates and how they contrast with national trends in teen birth rates
Teen birth rates highest in almost all southern states Birth rate among 18 to 19 years was at an all time high in the 50s and 60s Today, teen birth is still highest among 18-19 y/o but only around 30 teen births happen per 1,000 women, compared to nearly 180 in the 50s/60s - there's been a dramatic drop Lowest rates in North East while higher rates are in deep south Astronomically higher across the board from 2005 Looking at national data, (GRAPH), 1950-2018 High drops across the 60s Increase access to contraception
How income and wealth inequality in the United States has changed since the 1980s (especially since the Great Recession)
The U.S has effectively lost its middle class There is no wealth generation in the U.S except for those in the upper class This makes education, jobs, and income even more important since those in the lower class no longer have anything to fall back The richest families are the only group who have gained wealth since the Great Recession
Evidence for income differences in mortality? Changes in the income-mortality association over time?
The change has increased over time Chetty income and longevity graph - men and women at the highest income percentiles have a very small gap in longevity, with women's expected age at death (for 40 years of age) is slightly higher than men's; for men and women in the lowest percentiles, however, the gap is much larger Data: women in bottom 1% have an expected age of death of 78.8 and 88.9 in top 1% of income' men in bottom 1% have an expected age of death of 72.7 and 87.3 in top 1% There's also data available for income and longevity based on place - people in the top percentile of income all have higher expected ages of death pretty much regardless of where they live, but people in the lowest income percentiles have very large disparities based on where they live, with New York bein the highest and Detroit being the lowest
Why the association between SES and health is a major topic of research?
The relationship of SES and health is not straightforward, to many things need to be research and explained: Need to understand if education, occupational status, income, or wealth are more important than the other in influencing health and longevity SES-health relationship is characterized by thorny issues of causality Life course timing of SES-health relationship is not well understood SES-health relationship differs across time, place, and population subgroups
What did Short & Zacher highlight as ongoing challenges in research on women's health?
There are 5 main challenges highlighted: 1) The conflation on women's health and reproductive health 2) Emphasis on (dichotomized) sex differences 3) Essentialist frames that default to biological explanation 4) Inadequate incorporation of structural, physical, cultural, and interactional dynamics 5) Limited incorporation of intersectional approaches
According to Mirowsky and Ross, what comprises the "default American lifestyle" and how can education be used to override this default lifestyle?
There has been a displacement of human energy with mechanical (cars,public transportation etc) household food production with industrial food production, displacing health maintenance with medical dependency (treat the ailment, but not the underlying condition) Americans have to actively work to override these displacements →requires education Being aware of these things, to work to attain a healthier lifestyle Education's effect on health is pervasive, cumulative, and self-reinforcing Those who have a lower education may be stuck defaulting to the more dependent American lifestyle
What is "Relative Income Thesis" and is it supported by empirical evidence?
There is not much evidence to support the "Relative Income Thesis" Inequality in itself and ones relative social position, can be its own source of stress Low self-esteem, depression, lack of social control The relative income thesis documented that within the UK system, being in poverty isn't the only thing that might elevate poor health and lead to death. Inequality in itself can lead to poor health because people are making relative comparisons to people above them and below them. (ones relative position can lead to ones poor health) Inequality can actually be a source of poor health
Potential shortcomings of Montez and others' state-centric approach to understanding U.S. mortality trends
They didn't account for the churning of population composition that occurs over time - causing any measurements to be composed of high rates of mortality among older people who are being replaced by younger, healthier, and wealthier people Place doesn't change health - composition of population changes health stats of population in given place, and Montez analysis didn't account for this "Healthy Migrant effect"
Montez and colleagues: state power increasing
Two major movements 1) Devolution transferring of federal oversights and fiscal responsibilities to states (1994 midterm congressional elections) Shrinking of federal government Transfer of authority to states (for social and health services) Rely on state tax systems, which are typically more regressive than federal systems De-regulate industries 2) New brand of state preemption laws: prohibit or severely restrict local governments from legislating on certain issues Local areas in some states can't set their own anti-tobacco laws, gun control laws, or minimum wage, labor rights, or paid family leave
Montez and colleagues: the different policies they focus on
US State Polarization & Policymaking: US life expectancy since the 1980s has not kept up with higher-income peer countries (and in most years had been falling since 2014) Widening disparities in life expectancy across US states (as in the example of Connecticut vs. Oklahoma & NY vs. Mississippi mentioned) These trends are grounded in major changes in policies and political landscapes across states since the 1980s... we need to think about the structure
State Differences in U.S life expectancy trends
US life expectancy since the 1980s has not kept up with higher-income peer countries (and in most years had been falling since 2014) Widening disparities in life expectancy across US states (as in the example of Connecticut vs. Oklahoma & NY vs. Mississippi mentioned) NYC has higher life expectancy than places like Mississippi but we aren't taking into account the fact NYC reflects its foreign born citizens
County differences in specific causes of death and how they have changed over time - cancer (neoplasms)
US ranks in last place on 5 rates that include the mortality rates from all causes, infectious and parasitic diseases, diseases of the genitourinary system, pregnancy and childbirth-related causes, and external causes; US also ranks among the bottom four on an additional seven measures; the united states only ranks in top 10 for the death rate from neoplasms/cancer
What is "social mobility" and what does Palloni (2006) mean when he characterizes social categories as "sticky"?
We are assigned to social categories at birth (gender, racial/ethnic identity, SES, class, immigrant status) and they tend to stick - meaning we are more likely to stay in our social category and status assigned at birth "If one uses the estimated range of .4 to .6 and agnostically accepts the middle value, it is impossible to escape the conclusion that there is a lot of "stickiness" in income across generations, namely, that one's income tends to remain within bounds determined by one's parents' income." In summary, there is no evidence of recent significant improvements in social mobility, and there is considerable inertia or rigidity in the strati cation system.
How do life course perspectives challenge the association between SES and health in adulthood? (see Cockerham/Palloni/Hummer and Hamilton discuss "social causation" vs. "social selection")
We know education can influence income and then wealth, this link is challenged when we take a life course perspective Something could be affecting both education and health (violence, malnutrition, loss of a parent...) These things can set off differential trajectories and have effects on adulthood The ability to say causation is between adult education and adult health is challenging- so we can't be confident the association is causal Social selection: who is in the high education and who is in the low education Adult education —> adult health idea challenged when looking at life course perspectives Early life experience (birth weight, exposure diseases, trauma such as violence and neglect) that are disruptive causes differential trajectories of educational attainment and also have lasting effects, so unless we can account for these factors we cannot be confident of the causality of adult educational attainment on adult health Selection effect have to do with high vs low education and who is a part of which - highly select on good health and material resources - those with high education are select with good childhood and early life - those who have low educational attainment tend to be select on adverse child events
