Religious Attendance and the Mobility Trajectories of Older Mexican Americans: An Application of the Growth Mixture Model

Although several studies have examined the association between religious involvement and physical functioning, there is no consistent empirical evidence concerning the true nature of the association. The Hispanic population is also surprisingly understudied in previous work. In this article, we employ seven waves of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to examine the association between religious attendance and performance-based mobility trajectories among older Mexican Americans. Growth mixture estimates reveal three latent classes of mobility trajectories: (1) high, (2) moderate, and (3) low. Multinomial logistic regression estimates show that the odds of being classified as having low mobility (versus high and moderate mobility) are lower for respondents who attend religious services than for respondents who never attend. Religious attendance does not distinguish between moderate and high mobility. Our regression results confirm that religious attendance is associated with favorable mobility trajectories among older Mexican Americans.

Deviating from Religious Norms and the Mental Health of Conservative Protestants

Although numerous studies show that religious involvement is associated with favorable mental health outcomes, research also suggests that religious struggles can be psychologically distressing. Building on previous research, this study examines the psychological consequences of deviating from religious norms among Conservative Protestants. Using data from a statewide probability sample of Texas adults (n = 463), this study tests the hypothesis that Conservative Protestants who fall short of religious norms for attending religious services, reading scripture, and praying will suffer more psychological distress, anxiety, and depressive symptoms than those who meet or exceed religious expectations. Findings indicate that falling short of population average levels for church attendance and reading of religious scripture is associated with higher levels of psychological distress. Interestingly, falling short of population averages for prayer is unrelated to psychological distress, depressive symptoms, and anxiety.

Perceived neighborhood safety and sleep quality: a global analysis of six countries

OBJECTIVE

Building on previous North American and European studies of neighborhood context and sleep quality, we tested whether several self-reported sleep outcomes (sleep duration, insomnia symptoms, sleepiness, lethargy, and overall sleep quality) vary according to the level of perceived neighborhood safety in six countries: Mexico, Ghana, South Africa, India, China, and Russia.

METHODS

Using data (n = 39,590) from Wave I of the World Health Organization's Longitudinal Study on Global Ageing and Adult Health (2007-2010), we estimated a series of multinomial and binary logistic regression equations to model each sleep outcome within each country.

RESULTS

Taken together, our results show that respondents who feel safe from crime and violence in their neighborhoods tend to exhibit more favorable sleep outcomes than respondents who feel less safe. This general pattern is especially pronounced in China and Russia, moderately evident in Mexico, Ghana, and South Africa, and sporadic in India. Perceptions of neighborhood safety are strongly associated with insomnia symptoms and poor sleep quality (past 30 days), moderately associated with sleepiness, lethargy, and poor sleep quality (past 2 days), and inconsistently associated with sleep duration (past two days).

CONCLUSIONS

We show that perceived neighborhood safety is associated with more favorable self-reported sleep outcomes in six understudied countries. Additional research is needed to replicate our findings using longitudinal data, more reliable neighborhood measures, and more direct measures of sleep quality in these and other regions of the world.

Longer lives, sicker lives? Increased longevity and extended disability among Mexican-origin elders

OBJECTIVES

(a) To identify factors associated with different patterns of functional decline in a longitudinal sample of older Mexican-origin individuals, and (b) to determine the proportions of life after age 65 characterized by serious functional impairment.

METHODOLOGY

We use the Hispanic Established Populations for Epidemiologic Studies of the Elderly to examine changes in objective Performance Oriented Mobility Assessments in a cohort of 3,050 Mexican-origin elders initially interviewed in 1993/1994 and recontacted 6 times over 17 years. This sample combined with an additional cohort of 902 individuals 75 and older added at wave 4 in 2004/2005 (combined sample = 3,952) is used in life table analyses to estimate the number of years after 65 characterized by serious functional impairment.

RESULTS

Three distinct patterns of functional decline emerge: (a) high initial functioning followed by decline, but not to the level of disability (48%); (b) moderate initial functioning followed by decline to the level of disability (37.5%); and (c) initial disability followed by continued poor functioning (14.5%). Life table analyses reveal that subjects spent over half of the period after 65 with serious functional limitations. Significant gender and nativity differentials emerge.

DISCUSSION

Protracted morbidity that accompanies increases in life expectancy has serious implications for the physical, social, and economic well-being of older individuals and their families, as well as for health and long-term care policy.

Religious variations in perceived infertility and inconsistent contraceptive use among unmarried young adults in the United States

PURPOSE

In this paper, we examine associations among personal religiosity, perceived infertility, and inconsistent contraceptive use among unmarried young adults (ages 18-29).

METHODS

The data for this investigation came from the National Survey of Reproductive and Contraceptive Knowledge (n = 1,695). We used multinomial logistic regression to model perceived infertility, adjusted probabilities to model rationales for perceived infertility, and binary logistic regression to model inconsistent contraceptive use.

RESULTS

Evangelical Protestants were more likely than non-affiliates to believe that they were infertile. Among the young women who indicated some likelihood of infertility, evangelical Protestants were also more likely than their other Protestant or non-Christian faith counterparts to believe that they were infertile because they had unprotected sex without becoming pregnant. Although evangelical Protestants were more likely to exhibit inconsistent contraception use than non-affiliates, we were unable to attribute any portion of this difference to infertility perceptions.

CONCLUSIONS

Whereas most studies of religion and health emphasize the salubrious role of personal religiosity, our results suggest that evangelical Protestants may be especially likely to hold misconceptions about their fertility. Because these misconceptions fail to explain higher rates of inconsistent contraception use among evangelical Protestants, additional research is needed to understand the principles and motives of this unique religious community.

Religious Attendance and Biological Functioning: A Multiple Specification Approach

OBJECTIVE

This study explores the role of religious attendance across a wide range of biological markers.

METHOD

The data are drawn from the National Social Life, Health, and Aging Project to assess continuous and categorical biomarker specifications.

RESULTS

Across specifications, higher levels of attendance are associated with lower levels of pulse rate and overall allostatic load. Depending on the specification, higher levels of attendance are also associated with lower levels of body mass, diastolic blood pressure, C-reactive protein, and Epstein-Barr virus. Attendance is unrelated to dehydroepiandrosterone, systolic blood pressure, and glycosylated hemoglobin across specifications.

DISCUSSION

The study confirms that religious attendance is associated with healthier biological functioning in later life. Additional research is needed to verify these patterns with other data sources and to test viable mediators of the association between religious attendance and biological risk.

Rethinking gender and mental health: a critical analysis of three propositions

In this paper, we critically examine three propositions that are widely (but not universally) accepted in the gender and mental health literature. First, women and men have similar or equal rates of overall psychopathology. Second, affective disorders like anxiety and depression, which are more common among women, and behavioral disorders like substance abuse and antisocial personality, which are more common among men, are functionally equivalent indicators of misery. Finally, women are more likely to respond to stressful conditions with affective disorders while men are more likely to respond to stressful conditions with behavioral disorders. Our review of previous research shows little to no consistent empirical support for any of these propositions. Results from national studies of overall psychopathology or "any disorder" are, at best, mixed and limited to a narrow range of mental health conditions. A comprehensive test of gender differences in overall psychopathology would require a systematic and exhaustive examination of gender differences across the known universe of mental health conditions, but this may be impossible to achieve due to a lack of consensus on the universe, the proliferation of diagnostic categories, and the tendency to pathologize the mental health of women. There is no empirical evidence to suggest that women substitute affective disorders for behavioral disorders or that men substitute behavioral disorders for affective disorders. There is no theory to suggest that affective and behavioral disorders should be treated as comparable indicators of misery. Some studies support the idea that women and men respond to stress in different ways, but most do not. Numerous studies show that women and men respond to stressors with higher levels of emotional distress, substance abuse, and antisocial behavior. We conclude with seven recommendations to advance theory and research and several general reflections on the sociological study of gender and mental health.

Religion and selected health behaviors among Latinos in Texas

Though research has shown that religion provides a protective influence with respect to a number of health-related outcomes, little work has examined its influence on patterns of alcohol (especially binge drinking) and tobacco consumption among Latinos in Texas. Thus, we used a probability sample of Texas adults to test this relationship via logistic regression. Our results revealed that clear distinctions emerge on the basis of both denomination and frequency of attendance. Specifically, Protestants who regularly attend religious services are significantly more likely to be abstainers and to have never smoked, while those with no religious affiliation exhibit relatively unfavorable risk profiles. These findings persist despite a range of socio-demographic controls. Our study supports the assertion that religion may serve as an important protective influence on risky health behaviors.

Reconceptualizing the Association between Food Insufficiency and Body Weight: Distinguishing Hunger from Economic Hardship

What is the association between food insufficiency and body weight? Although common sense would suggest a negative association, research often finds the opposite. We contrast commodity theories of material privation with stress theories, proposing that the seemingly counterintuitive association results from the confounding influence of economic hardship. Because it is a chronic stressor, economic hardship may contribute to overweight. Data from the WCF project of 2,402 disadvantaged women in Chicago, Boston, and San Antonio show that people who experience economic hardship weigh more; and that the true negative association between body weight and food insufficiency-especially going hungry because one cannot afford food-is revealed only after adjustment for economic hardship.

Perceived welfare caseworker support and psychological distress among low-income urban women with children

Although some research suggests that the relationship between Child Protective Services workers and their clients may influence client outcomes, little is known about the function of the relationship between welfare or Temporary Assistance for Needy Families caseworkers and their clients. Building on previous research, the authors use 1999 survey data from the Welfare, Children, and Families Project--a probability sample of 853 low-income women with children living in Boston, Chicago, and San Antonio, Texas--to examine the association between perceived welfare caseworker support and psychological distress. Results revealed that women who perceive their welfare caseworker to be interested, caring, and helpful also tend to exhibit lower levels of psychological distress.

Does alcohol consumption exacerbate the mental health consequences of interpersonal violence?

Although studies show that interpersonal violence is associated with poorer mental health, few studies specify the conditions under which victimization can be more or less detrimental to psychological well-being. Building on previous research, the authors test whether the association between interpersonal violence and psychological distress is moderated by alcohol consumption. Our analysis of longitudinal data from the Welfare, Children, and Families project suggests that interpersonal violence is more strongly associated with psychological distress in the context of more frequent intoxication. Programs designed to treat the combination of victimization and heavy alcohol consumption may make unique contributions to the well-being of women.

Perceived neighborhood quality, sleep quality, and health status: evidence from the Survey of the Health of Wisconsin

Why does living in a disadvantaged neighborhood predict poorer mental and physical health? Recent research focusing on the Southwestern United States suggests that disadvantaged neighborhoods favor poor health, in part, because they undermine sleep quality. Building on previous research, we test whether this process extends to the Midwestern United States. Specifically, we use cross-sectional data from the Survey of the Health of Wisconsin (SHOW), a statewide probability sample of Wisconsin adults, to examine whether associations among perceived neighborhood quality (e.g., perceptions of crime, litter, and pleasantness in the neighborhood) and health status (overall self-rated health and depression) are mediated by overall sleep quality (measured as self-rated sleep quality and physician diagnosis of sleep apnea). We find that perceptions of low neighborhood quality are associated with poorer self-rated sleep quality, poorer self-rated health, and more depressive symptoms. We also observe that poorer self-rated sleep quality is associated with poorer self-rated health and more depressive symptoms. Our mediation analyses indicate that self-rated sleep quality partially mediates the link between perceived neighborhood quality and health status. Specifically, self-rated sleep quality explains approximately 20% of the association between neighborhood quality and self-rated health and nearly 19% of the association between neighborhood quality and depression. Taken together, these results confirm previous research and extend the generalizability of the indirect effect of perceived neighborhood context on health status through sleep quality.

Religiosity and adolescent substance use: evidence from the national survey on drug use and health

Prior research indicates that religiosity is associated with lower levels of substance use in adolescence. The extant research, however, is limited by issues related to data quality and analytic strategy. The current research uses the National Survey on Drug Use and Health to further our understanding of the nature of the relationship between religiosity and substance use during adolescence. Results show that religiosity reduces the odds of tobacco use, heavy drinking, prescription drug misuse, marijuana use, and other illicit drug use. These associations are partially explained by respondent and peer attitudes toward substance use and, to a lesser extent, respondent psychological well-being. The influence of respondent substance use attitude is especially pronounced, explaining between 41% (marijuana) and 53% (tobacco) of the association between religiosity and substance use. In fully adjusted models, all mediators account for between 46% (marijuana) and 59% (tobacco) of the association between religiosity and substance use.

Religious attendance and loneliness in later life

PURPOSE OF THE STUDY

Studies show that loneliness is a major risk factor for health issues in later life. Although research suggests that religious involvement can protect against loneliness, explanations for this general pattern are underdeveloped and undertested. In this paper, we propose and test a theoretical model, which suggests that social integration and social support are key mechanisms that link religious attendance and loneliness.

DESIGN AND METHODS

To formally test our theoretical model, we use data from the National Social Life Health and Aging Project (2005/2006), a large national probability sample of older adults aged 57-85 years.

RESULTS

We find that religious attendance is associated with higher levels of social integration and social support and that social integration and social support are associated with lower levels of loneliness. A series of mediation tests confirm our theoretical model.

IMPLICATIONS

Taken together, our results suggest that involvement in religious institutions may protect against loneliness in later life by integrating older adults into larger and more supportive social networks. Future research should test whether these processes are valid across theoretically relevant subgroups.

Religious Doubts and Sleep Quality: Findings from a Nationwide Study of Presbyterians

A growing literature examines the correlates and sequelae of spiritual struggles, such as religious doubts. To date, however, this literature has focused primarily on a handful of mental health outcomes (e.g., symptoms of depression, anxiety, negative affect), while the possible links with other aspects of health and well-being, such as poor or disrupted sleep, have received much less attention. After reviewing relevant theory and previous studies, we analyze data from a nationwide sample of Presbyterian Church (USA) members to test the hypothesis that religious doubts will be inversely associated with overall self-rated sleep quality, and positively associated with the frequency of sleep problems and the use of sleep medications. We also hypothesize that part of this association will be explained by the link between religious doubts and psychological distress. Results offer moderate but consistent support for these predictions. We end with a discussion of the implications of these findings, a brief mention of study limitations, and some suggestions for future research.

Soil warming alters nitrogen cycling in a New England forest: implications for ecosystem function and structure

Global climate change is expected to affect terrestrial ecosystems in a variety of ways. Some of the more well-studied effects include the biogeochemical feedbacks to the climate system that can either increase or decrease the atmospheric load of greenhouse gases such as carbon dioxide and nitrous oxide. Less well-studied are the effects of climate change on the linkages between soil and plant processes. Here, we report the effects of soil warming on these linkages observed in a large field manipulation of a deciduous forest in southern New England, USA, where soil was continuously warmed 5°C above ambient for 7 years. Over this period, we have observed significant changes to the nitrogen cycle that have the potential to affect tree species composition in the long term. Since the start of the experiment, we have documented a 45% average annual increase in net nitrogen mineralization and a three-fold increase in nitrification such that in years 5 through 7, 25% of the nitrogen mineralized is then nitrified. The warming-induced increase of available nitrogen resulted in increases in the foliar nitrogen content and the relative growth rate of trees in the warmed area. Acer rubrum (red maple) trees have responded the most after 7 years of warming, with the greatest increases in both foliar nitrogen content and relative growth rates. Our study suggests that considering species-specific responses to increases in nitrogen availability and changes in nitrogen form is important in predicting future forest composition and feedbacks to the climate system.

Household disrepair and the mental health of low-income urban women

We employ longitudinal survey data from the Welfare, Children, and Families project (1999, 2001) to examine the effects of household disrepair (e.g., living with leaky structures, busted plumbing, broken windows, and pests) on psychological distress among low-income urban women with children. Building on previous research, we adjust for related housing concepts, neighborhood disorder, financial hardship, and a host of relevant background factors. We also formally test the mediating influences of social support and self-esteem. Our cross-sectional analysis indicated that household disrepair is positively associated with recent symptoms of psychological distress. Our longitudinal change score analysis demonstrates two important patterns. First, women living with household disrepair at baseline are not necessarily vulnerable to increases in symptoms of psychological distress over the 2-year study period. Second, women who report an increase in disrepair over the study period are also likely to report a concurrent increase in symptoms of distress. Although social support and self-esteem favor mental health in our cross-sectional and longitudinal analyses, these psychosocial resources fail to mediate or explain the association between disrepair and distress.

Does sleep quality mediate the association between neighborhood disorder and self-rated physical health?

OBJECTIVES

We examine the association between perceived neighborhood disorder and self-rated physical health. Building on previous research, we test whether this association is mediated by sleep quality.

METHODS

We use data from the 2004 Survey of Texas Adults (n=1323) to estimate a series of ordinary least squares regression models. We formally assess mediation by testing for significant changes in the effect of neighborhood disorder before and after adjusting for sleep quality.

RESULTS

We find that residence in a neighborhood that is perceived as noisy, unclean, and crime-ridden is associated with poorer self-rated physical health, even with controls for irregular exercise, poor diet quality, smoking, binge drinking, obesity and a host of relevant sociodemographic factors. Our results also indicate that the relationship between neighborhood disorder and self-rated physical health is partially mediated by lower sleep quality.

CONCLUSION

Targeted interventions designed to promote sleep quality in disadvantaged neighborhoods may help to improve the physical health of residents in the short-term. Policies aimed at solving the problem of neighborhood disorder are needed to support sleep quality and physical health in the long-term.

Victimization in early life and mental health in adulthood: an examination of the mediating and moderating influences of psychosocial resources

Although numerous studies have documented the long-term effects of childhood victimization on mental health in adulthood, few have directly examined potential mediators and moderators of this association. Using data from the Welfare, Children, and Families project (1999)-a probability sample of 2,402 predominantly black and Hispanic low-income women with children living in Boston, Chicago, and San Antonio-we predict psychological distress in adulthood with measures of physical assault and sexual coercion before age 18. Building on previous research, we test the mediating and moderating influences of emotional support, instrumental support, and self-esteem. Although we observe no indirect effects of physical assault, the effect of sexual coercion is partially mediated by instrumental support and self-esteem. We also find that the effects of physical assault and sexual coercion are moderated (buffered) by emotional support and self-esteem.

Racial/Ethnic Composition, Social Disorganization, and Offsite Alcohol Availability in San Diego County, California*

We draw upon social disorganization theory to examine the effects of community characteristics on the distribution of offsite alcohol outlets in San Diego County, California. Of particular interest is whether alcohol availability varies according to neighborhood racial/ethnic composition once measures of social disorganization (socioeconomic disadvantage, residential instability, and racial/ethnic heterogeneity) are controlled. Using data from the 1990 Census and 1993 alcohol license reports, we estimate a series of negative binomial regression models with corrections for spatial autocorrelation. The results show that percent Asian is associated with lower offsite alcohol outlet density. Once socioeconomic disadvantage is controlled, percent Latino is related to lower alcohol availability. Although similar suppressor patterns are observed, percent Black is generally unrelated to outlet density. Consistent with social disorganization theory, socioeconomic disadvantage and residential instability predict increased alcohol availability. Neighborhood racial/ethnic composition is either unrelated or inversely related to outlet density once social disorganization and other neighborhood characteristics are taken into account.

Blessed assurance: religion, anxiety, and tranquility among US adults

A growing body of research investigates the possible relationships between religion and mental health. After developing a series of arguments linking various aspects of religion with anxiety and tranquility, we test relevant hypotheses using data from the 1996 Genera Social Survey. Results show that frequency of religious attendance and the belief in an afterlife are inversely associated with feelings of anxiety and positively associated with feelings of tranquility. However, frequency of prayer has no direct association with either outcome. Strong beliefs in the pervasiveness of sin are positively linked with anxiety but unrelated to tranquility. Finally, belief in an afterlife and frequency of prayer buffer the adverse effects of poor health and financial decline on anxiety. Implications of these find ings are discussed along with study limitations and promising directions for future research.

The long-term health consequences of relationship violence in adulthood: an examination of low-income women from Boston, Chicago, and San Antonio

OBJECTIVES

We examined the long-term health consequences of relationship violence in adulthood.

METHODS

Using data from the Welfare, Children, and Families project (1999 and 2001), a probability sample of 2402 low-income women with children living in disadvantaged neighborhoods in Boston, Massachusetts; Chicago, Illinois; and San Antonio, Texas, we predicted changes in the frequency of intoxication, psychological distress, and self-rated health over 2 years with baseline measures of relationship violence and a host of relevant background variables.

RESULTS

Our analyses showed that psychological aggression predicted increases in psychological distress, whereas minor physical assault and sexual coercion predicted increases in the frequency of intoxication. There was no evidence to suggest that relationship violence in adulthood predicted changes in self-rated health.

CONCLUSIONS

Experiences with relationship violence beyond the formative and developmental years of childhood and adolescence can have far-reaching effects on the health status of disadvantaged urban women.

Subjective control and health among Mexican-origin elders in Mexico and the United States: structural considerations in comparative research

OBJECTIVES

This study examines the joint impact of psychological and structural factors on Mexican and Mexican American elders' sense of personal control over important aspects of their lives and health in Mexico and the United States.

METHODS

We employ the Mexican Health and Aging Study (MHAS) and the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) to explore patterns of association among structural factors, personal characteristics, indicators of material and physical vulnerability, and expressed locus of control.

RESULTS

The results suggest that an older individual's sense of personal control over important aspects of his or her life, including health, reflects real material and social resources in addition to individual predispositions. In Mexico, only the most privileged segment of the population has health insurance, and coverage increases one's sense of personal control. In the United States, on the other hand, Medicare guarantees basic coverage to the vast majority of Mexican Americans over 65, reducing its impact on one's sense of control.

DISCUSSION

Psychological characteristics affect older individuals' sense of personal control over aspects of their health, but the effects are mediated by the economic and health services context in which they are expressed.

Relationship violence and frequency of intoxication among low-income urban women

Using data from the Welfare, Children, and Families project (1999), a probability sample of 2,280 low-income women with children living in low-income neighborhoods in Boston, Chicago, and San Antonio, we examine the effects of relationship violence before age 18 and in the past year on frequency of adult intoxication. Results obtained from a series of ordered logistic regression models suggest that sexual coercion before age 18 and minor and severe physical assault in the past year are independently associated with greater frequency of intoxication, net of a range of sociodemographic controls. The study's limitations are noted.

Religious Involvement and the Intoxication Trajectories of Low Income Urban Women

Although prior research has made significant contributions to our understanding of the risk factors associated with increased alcohol consumption in disadvantaged urban neighborhoods, very little is known about the resources that help residents to resist the countless circumstances and conditions that sustain these systems of alcohol abuse. Building on prior research, we use data from the Welfare, Children, and Families project, a probability sample of 2,402 lowincome women with children living in lowincome neighborhoods in Boston, Chicago, and San Antonio, to test whether religious involvement is protective against intoxication. Results obtained from ordered logistic regression models indicate that regular religious attendance is associated with lower levels of intoxication over two years.

A comparison of the health of older Hispanics in the United States and Mexico: methodological challenges

OBJECTIVE

This study compares various dimensions of physical and emotional health between older Mexican-origin individuals in the United States and in Mexico.

METHOD

The samples are drawn from the Mexican Health and Aging Study (MHAS) and the Hispanic Established Epidemiologic Study of the Elderly (H-EPESE) and include 3,875 Mexican residents with no history of residence in the United States and 2,734 Mexican-origin individuals 65 and older who live in the southwestern United States.

RESULTS

Both immigrant and native-born Mexican-origin elders in the United States report more chronic conditions than elderly Mexicans, but they report fewer symptoms of psychological distress. Longer residence in the United States is associated with higher body mass index scores.

DISCUSSION

The discussion addresses the possibility that access to care influences reports of diagnosed conditions and touches on issues of comparability in cross-cultural research and the difficulty in clearly distinguishing cultural and system-level factors in the production and measurement of health.

Religious involvement and healthy lifestyles: evidence from the survey of Texas adults

BACKGROUND

Although research shows that religious involvement is associated with a wide range of individual health behaviors, it has yet to be determined whether the effect of religious involvement extends to an overall pattern of regular health practices that may constitute a lifestyle.

PURPOSE

Building on prior research, we test whether religious individuals tend to engage in healthier lifestyles than individuals who are less religious.

METHODS

Using data collected from a statewide probability sample of 1,369 Texas adults, we estimate a series of ordinary least squares regression models to assess the net effect of religious involvement on overall healthy lifestyle scores.

RESULTS

The results of our study indicate that religious individuals do tend to engage in healthier lifestyles, and this pattern is similar for men and women and across race/ethnic groups. We also find some evidence to suggest that the association between religious involvement and healthy lifestyles may be less pronounced in old age.

CONCLUSIONS

Assuming that religious involvement is associated with healthier lifestyles, additional research is needed to account for these patterns. Future studies should also consider whether healthy lifestyles may serve as a mechanism through which religious involvement might favor health and longevity.

Relationship violence and psychological distress among low-income urban women

In this paper, we examined the association between relationship violence and psychological distress among low-income urban women. Extending prior research, we considered the effects of relationship violence within the context of other chronic stressors that are common in the lives of these women. Using data from the Welfare, Children, and Families project (1999), a probability sample of 2,402 low-income women with children living in low-income neighborhoods in Boston, Chicago, and San Antonio, we predicted psychological distress with multiple measures of relationship violence, a wide range of sociodemographic variables, and several chronic stressors. Our results show that relationship violence is associated with higher levels of economic hardship, neighborhood disorder, and household disrepair. We also find that relationship violence is associated with higher levels of psychological distress, net of these other chronic stressors. Finally, we observe that the effects of relationship violence do not vary according to the chronic stressors under study. Because the adverse effects of relationship violence are similar for women despite other adverse circumstances, interventions and treatment efforts focused exclusively on relationship violence may make a unique contribution to the psychological well-being of low-income urban women.

Gender-specific trends in educational attainment and self-rated health, 1972-2002

OBJECTIVES

We tested whether self-rated health has improved over time (1972-2002) for women and men. We also considered the degree to which historical gains in educational attainment help to explain any observed trends.

METHODS

Using 21 years of repeated cross-sectional data from the General Social Survey, we estimated a series of ordered logistic regression models predicting self-rated health.

RESULTS

Our results show that women's health status has steadily improved over the 30-year period under study, and these improvements are largely explained by gains in educational attainment. We also found that the health trend for men is nonlinear, suggesting significant fluctuations in health status over time.

CONCLUSIONS

Based on the linear health status trend and strong mediation pattern for women, and the nonlinear health status trend for men, women have benefited more than men, in terms of self-rated health, from increased educational attainment.

Religious attendance and the health behaviors of Texas adults

OBJECTIVE

The purpose of this study is to test whether religious involvement is associated with a broad range of health behaviors.

METHOD

We employ data from the 2004 Survey of Texas Adults, a statewide probability sample of 1504 Texas adults. Using these data, we estimate a series of logistic regression models to assess the net effects of religious attendance on 12 health behaviors.

RESULTS

Our results show that regular religious attendance (especially weekly attendance) is associated with a wide range of healthy behaviors, including preventive care use, vitamin use, infrequent bar attendance, seatbelt use, walking, strenuous exercise, sound sleep quality, never smoking, and moderate drinking.

CONCLUSION

If religious involvement is associated with healthy behaviors, additional studies are needed to account for these associations. Future research might also consider health behaviors other than drinking and smoking as potential mechanisms through which religious involvement might benefit health and prolong life.

Religious attendance and cognitive functioning among older Mexican Americans

Research shows that social engagement reduces the probability of cognitive decline in late life. The purpose of this study was to test whether religious attendance, a major source of social engagement for many older individuals, is associated with slower rates of cognitive decline among older Mexican Americans. Using four waves of data collected from a sample of 3,050 older Mexican-origin individuals, we estimated a series of linear growth curve models to assess the effects of religious attendance on cognitive functioning trajectories. We used the Mini-Mental State Examination to measure cognitive functioning. Our central finding is that religious attendance is associated with slower rates of cognitive decline among older Mexican Americans. Specifically, respondents who attend church monthly, weekly, and more than weekly tend to exhibit slower rates of cognitive decline than those who do not attend church.

Neighborhood disorder, psychological distress, and heavy drinking

Studies show that residents of disadvantaged neighborhoods drink more heavily than residents of more affluent neighborhoods. However, explanations for this association are not well developed. Using data collected from a sample of low-income women with children from Boston, Chicago, and San Antonio, we explore the possibility that perceptions of neighborhood disorder encourage heavy drinking. Drawing on Conger's (Q. J. Stud. Alcohol 17 (1956) 296) tension reduction hypothesis, we propose that the stress of living in a neighborhood characterized by problems with drugs, crime, teen pregnancy, unemployment, idle youth, abandoned houses, and unresponsive police can be psychologically distressing and lead some people to consume alcohol as a means of palliative escape, to regulate feelings of anxiety and depression. In support of the tension reduction hypothesis, we find that the positive association between neighborhood disorder and heavy drinking is largely mediated by anxiety and depression.

Neighborhood disorder, psychophysiological distress, and health

How do neighborhoods affect the health of residents? We propose that the impact of neighborhood disorder on self-reported health is mediated by psychological and physiological distress. We hypothesize a stress process in which chronic stressors in the environment give rise to a psychological and physiological stress response that ultimately affects health. The exogenous variable of interest is the neighborhood where disadvantaged persons live, which may expose them to chronic stressors in the form of crime, trouble, harassment, and other potentially distressing signs of disorder and decay. The mediator is the stress response that occurs in the body and brain. Of interest here is a psychological stress response in the form of fearful anxiety and depression, and a physiological stress response in the form of signs and symptoms of autonomic arousal, such as dizziness, chest pains, trouble breathing, nausea, upset stomach, and weakness. The outcome is poor health. This model is supported using data from the Welfare, Children, and Families project, a sample of 2,402 disadvantaged women in disadvantaged neighborhoods in Chicago, Boston, and San Antonio.

Religious attendance and mortality: an 8-year follow-up of older Mexican Americans

OBJECTIVE

Studies in the area of religion and mortality are based primarily on data derived from samples of predominantly non-Hispanic Whites. Given the importance of religion in the lives of Hispanics living in the United States, particularly older Hispanics, we examine the effects of religious attendance on mortality risk among Mexican Americans aged 65 and older.

METHODS

We employ data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly to predict the risk of all-cause mortality over an 8-year follow-up period.

RESULT

Overall, the results show that those who attend church once per week exhibit a 32% reduction in the risk of mortality as compared with those who never attend religious services. Moreover, the benefits of weekly attendance persist with controls for sociodemographic characteristics, cardiovascular health, activities of daily living, cognitive functioning, physical mobility and functioning, social support, health behaviors, mental health, and subjective health.

DISCUSSION

Our findings suggest that weekly church attendance may reduce the risk of mortality among older Mexican Americans. Future research should focus on identifying other potential mediators of the relationship between religious involvement and mortality risk in the Mexican-origin population.

Barriers to domestic violence screening in the pediatric setting

OBJECTIVE

By surveying practitioners in our community, we hoped to determine what pediatricians and family physicians (FPs) perceive as barriers to the American Academy of Pediatrics (AAP) Recommendation on Domestic Violence Screening.

BACKGROUND

When screened in the pediatric setting, as many as 40% of mothers will disclose domestic violence (DV) by their partner. Recognizing the profound effects of DV on children, the AAP recently recommended that all practitioners incorporate DV screening as a part of routine anticipatory guidance. Yet, there is little information about whether pediatricians have the training, the time to screen, or understand the magnitude of this problem.

DESIGN/METHODS

A 22-question survey about attitudes, training, and current DV screening practice was sent to all general pediatricians and FPs with admitting privileges to Children's Hospital Medical Center in Cincinnati, Ohio. A copy of the AAP recommendation on screening was included. The vast majority of practitioners with an appreciable pediatric practice in the surrounding tri-state area of 1.8 million people have privileges at the institution.

RESULTS

After 2 mailings, 310 (57%) of 547 of questionnaires were returned. The majority of practitioners (64%) were unaware of the AAP recommendation, but 51% of practitioners screened at least high-risk families for DV and 49% had identified a case of DV in their practice. Still, only 8.5% routinely screened for DV and 74% had received no specific DV training. Fifty-eight percent of practitioners estimated the incidence of DV to be <5% in their practice. The most commonly perceived barriers to screening were lack of education (61%), office protocol (60%), time (59%), and support staff (55%). FPs were significantly more likely to have DV training (64% vs 21%), more likely to screen at least high-risk women (79% vs 56%), and more likely to have identified a case of DV (92% vs 40%) than pediatricians. FPs were less likely to cite lack of education (46% vs 65%) and lack of time (50% vs 61%) than pediatricians. Physicians licensed in Ohio were less likely to have specific domestic violence training (23% vs 60%) as compared with Kentucky physicians, where domestic violence education is required for licensing. Kentucky physicians were less likely to cite lack of education as barrier to DV screening (20% vs 62%). When comparing the characteristics of those who screen to those who do not, those with DV training were 10.9 times (odds adjusted ratio) more likely to screen.

CONCLUSIONS

Practitioners grossly underestimate the incidence of DV in their practices. Lack of education including knowledge of screening recommendations is a barrier to DV screening by pediatricians. Greater efforts are needed to educate pediatricians on DV for the AAP recommendations to be accepted.domestic violence, child abuse, screening, physician attitude.

Screening for domestic violence in the community pediatric setting

OBJECTIVE

Children exposed to domestic violence (DV) can experience a variety of adverse effects such as behavior disorders, developmental delay, and child abuse. Recently, the American Academy of Pediatrics recommended that all pediatricians incorporate screening for DV as a part of anticipatory guidance. To date, however, there is little information on how likely women are to disclose DV or whether there are any benefits to screening in the pediatric office setting. The purpose of our pilot study was to gain an understanding of whether screening for DV in the pediatric office setting could be helpful to abused women and their children.

METHODS

During a 3-month period, 92% of the women who accompanied their children for a well-child visit to a hospital-based suburban pediatrician were asked about violence in the home with a six-question screening tool.

RESULTS

Of the 154 women screened, 47 (31%) revealed DV at some time in their lives. Twenty-five women (17%) reported DV within the past 2 years and were reported to the mandated state agency. There were 5 episodes of child abuse reported of which two had not been previously reported. Interestingly, there were 5 women injured during their most recent pregnancy and who had separated from their abusive partner, but no legal action had been taken to protect them from their partner's return. There was no significant difference in the incidence of DV reported in families with Medicaid (37%) versus private insurance (20%). Before routine DV screening in our office, only one previous DV report had been made in 4 years.

CONCLUSIONS

Our preliminary results suggest that many women will reveal DV when screened in the pediatric office setting. Also, there is a subgroup of women, those with young children who have recently separated from their partners, who may particularly benefit from DV screening.

Temporal association of substance abuse and self-esteem

By an independent t test, mean scores on the Tennessee Self-concept Scale for 17 patients who had just begun rehabilitation for substance abuse and 8 subjects who had been in the recovery program for 1 year or longer were statistically significantly different, the former group scoring lower.

Attitudes and practices of physicians caring for HIV-infected children

OBJECTIVE

The objective of our study was to describe the practices and attitudes of physicians who manage children with HIV infection.

METHODS

A 32-question survey was sent to the medical directors of 256 pediatric HIV centers.

RESULTS

Fifty-four percent of centers responded. Seventy-two percent of practitioners had been involved in HIV-related care for more than 5 years. The most common subspecialities of respondents were infectious diseases (37%) and general pediatrics (28%). Although 65% of respondents found their HIV practice more stressful than their other responsibilities, the majority of physicians (65%) felt that their HIV-related responsibilities enhanced their careers. Sixty-eight percent had some concern about contracting HIV and 24% had been exposed to HIV by needle stick injury. Polymerase chain reaction and HIV culture were the main diagnostic tests used, 78 and 62%, respectively. Trimethoprim/sulfamethoxazole for prophylaxis against Pneumocystis carinii pneumonia and zidovudine therapy for primary HIV infection were the first line drugs used by almost all respondents. Only 9% were using intravenous immunoglobulin routinely. Fifty-two percent routinely advocated zidovudine for prophylaxis of HIV infection with needle stick injury. Eighty-three percent of those surveyed thought that all pregnant women should be tested for HIV and 88% advocated treating mother/infant pairs with zidovudine if the mother is HIV-infected.

CONCLUSIONS

While HIV practitioners find their work stressful, the majority feel their careers are enhanced by their HIV-related work. There is agreement among most practitioners with regards to diagnostic tests, first-line drug therapies and the limited use of intravenous immunoglobulin. The vast majority of physicians advocate testing pregnant women for HIV infection and treating the mother/ infant pair with zidovudine if the mother is infected.