Subjective social status and maternal health in a low income urban population

Moderated moderation modelling of subjective social status, pocket money and depressive symptoms of university students in Ghana

Introduction

Although the relationship between subjective social status and depression in university students has been well-established, this association could be seen as a spurious one. Previous studies have shown that key variables like financial resources and age could play key roles in explaining the variances in social status and mental health outcomes. In this research, we assessed the complex interrelationships between subjective social status, financial resources at their disposal and depressive symptoms among university students within their young and middle adulthood stages.

Methods

A cross-sectional survey was conducted in a university in Ghana to sample 1134 university students through accidental sampling. The McArthur Scale and WHO-5 Well-being measure were used for the data collection.

Results

The results revealed that higher levels of subjective social status were associated with lower levels of depression. It was further found that the interaction between students' pocket money and age played unique roles in the relationship between subjective social status and depression.

Conclusion

The study findings call on stakeholders in education to explore funding opportunities and to examine ways of empowering parents (financially) to adequately support the students. Health educationists and promoters, including psychologists, school counsellors and parents could compliment these efforts by helping to train and empower students through self-regulation or management skills to help improve their well-being. Continuous efforts are required to improve the financial status and mental health of students.

Relationships between early-life family poverty and relative socioeconomic status with gestational diabetes, preeclampsia, and hypertensive disorders of pregnancy later in life

PURPOSE

Low early-life absolute and relative socioeconomic status (SES) may contribute to socioeconomic disparities in pregnancy complications (i.e., gestational diabetes mellitus [GDM], preeclampsia/eclampsia [PE], hypertensive disorders of pregnancy [HDP; preeclampsia/eclampsia, gestational hypertension, chronic hypertension]), but their independent associations with pregnancy complications have not been studied. This study investigated associations of early-life poverty and relative SES with risks of GDM, PE, and HDP.

METHODS

National Longitudinal Study of Adolescent to Adult Health data were used (GDM n = 802; PE n = 813; HDP n = 801). Objective poverty was defined as wave I low-income or receipt of federal nutrition assistance benefits. Relative SES was self-reported at wave V (ages 33-39) by asking whether the participant's family was financially worse off than average when growing up. Logistic regressions assessed relationships between poverty, relative SES, and self-reported lifetime diagnoses of GDM, PE, or HDP.

RESULTS

Lifetime prevalences of GDM, PE, and HDP were 9.23%, 12.00%, and 21.93%, respectively. Low relative SES (odds ratio: 2.04 [1.07, 3.89]) and poverty (odds ratio: 1.81 [0.97, 3.38]) were independently associated with GDM but not with PE or HDP.

CONCLUSIONS

Early-life poverty and relative SES are associated with GDM; understanding the mechanisms underlying these associations may help identify novel intervention targets to reduce socioeconomic disparities in GDM.

Women's negative childbirth experiences and socioeconomic factors: Results from the Babies Born better survey

OBJECTIVE

To investigate the association between women's socioeconomic status and overall childbirth experience and to explore how women reporting an overall negative birth experience describe their experiences of intrapartum care.

METHODS

We used both quantitative and qualitative data from the Babies Born Better (B3) survey version 2, including a total of 8317 women. First, we performed regression analyses to explore the association between women's socioeconomic status and labour and birth experience, and then a thematic analysis of three open-ended questions from women reporting a negative childbirth experience (n = 917).

RESULTS

In total 11.7% reported an overall negative labour and birth experience. The adjusted odds ratio (OR) of a negative childbirth experience was elevated for women with non-tertiary education, for unemployed, students and not married or cohabiting. Women with lower subjective living standard had an adjusted OR of 1.70 (95% CI 1.44-2.00) for a negative birth experience, compared with those with average subjective living standard. The qualitative analysis generated three themes: 1) Uncompassionate care: lack of sensitivity and empathy, 2) Impersonal care: feeling objectified, and 3) Critical situations: feeling unsafe and loss of control.

CONCLUSION

Important socioeconomic disparities in women's childbirth experiences exist even in the Norwegian setting. Women reporting a negative childbirth experience described disrespect and mistreatment as well as experiences of insufficient attention and lack of awareness of individual and emotional needs during childbirth. The study shows that women with lower socioeconomic status are more exposed to these types of experiences during labour and birth.

TWEETABLE ABSTRACT

Women with lower socioeconomic status are more exposed to negative experiences during labour and birth.

Socioeconomic status and depressive symptoms and suicidality: The role of subjective social status

BACKGROUND

Low socioeconomic status (SES) confers access to material resources and social standing and is an established risk factor of both depressive symptoms and suicidality. Subjective social status (SSS) assesses how people perceive their position within the social hierarchy and has been proposed to impact mental health. This study examined the relationship between SES and depressive symptoms and suicidality and tested whether SSS mediated these associations.

METHODS

This study drew on publicly available survey data from the US National Longitudinal Study of Adolescent to Adult Health (Add Health). Participants were surveyed at baseline in 2008 (N = 4948; aged 28.8 years) and at followed up in 2016-2018 (N = 3509; aged 37.8 years). SES was gauged using personal and household income, assets, education, and job prestige. SSS was assessed using the MacArthur Scale. Depressive symptoms were assessed using four-items from the Centre for Epidemiological Studies Scale of Depression (CESD) and participants reported suicidal ideation and suicide attempts in the past year.

RESULTS

Both low SES and SSS were associated with elevated levels of depressive symptoms, suicidal ideation, and suicide attempts in cross-sectional and prospective analyses. SSS explained 27 % of the association between SES and depressive symptoms, 51 % of the relationship between SES and suicidal ideation, and 37 % of the link between SES and suicide attempts on average.

CONCLUSIONS

These findings contribute to understanding the long-term effects of SSS and suggest that perceptions of status may be a key mechanism through which low SES forecasts the development of depressive symptoms and suicidality.

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 7. The empowering effect of Care Groups

BACKGROUND

While there is extensive published evidence regarding the effectiveness of the Care Group Approach in promoting community-wide health behavior change, there is no published evidence regarding its empowering effect on its participants. Our study aimed to understand if the Care Group Approach as applied in the Curamericas/Guatemala Maternal and Child Health Project in isolated rural mountainous communities in Guatemala produced evidence of empowerment among the female participants. This is the seventh of 10 papers describing the expanded Census-Based, Impact-Oriented (CBIO+) Approach in improving the health and well-being of mothers and children in the rural highlands of the Department of Huehuetenango, Guatemala.

METHODS

We conducted semi-structured individual and group interviews with 96 female Care Group participants -including Level-1 Care Group Promoters, Care Group Volunteers, and Self-Help Group participants. The participants were from six communities - two from each of the three municipalities making up the Project Area. Data were analyzed both using deductive thematic and by exploring the following social constructs: perceived social status, self-efficacy, decision-making autonomy, and formation of social capital.

RESULTS

The findings supported the hypothesis that Care Group participation was an empowering process. The primary themes that emerged included increased respect accorded to women in the community, women's willingness and ability to make decisions and their confidence in making those decisions, and the development of stronger bonds among Care Group members, with other community members, and with community leaders.

CONCLUSION

Through increased theoretical and practical knowledge about important maternal and child health matters and through the social experience of obtaining this knowledge and sharing it with other community members, participation in the Care Group Approach empowered participants to make positive health behavior changes for themselves and for their children and families. This, in turn, led many participants to become more engaged in community activities for improved health and beyond, thereby enhancing social capital in the community. We conclude that the Care Group Approach, as applied in this setting, has made it possible for marginalized indigenous women living in a male-dominated society to become more empowered.

Prenatal subjective social status and birth weight

PURPOSE

Subjective social status (SSS), perceived social standing relative to others, has been associated with health status, independent of objective socioeconomic status (SES). Few studies have examined the relationship of prenatal maternal SSS with birth outcomes. We evaluated the association of SSS in pregnancy with low birth weight (LBW) and high birth weight (HBW).

METHODS

A total of 378 pregnant women rated their SSS from 1 (low) to 10 (high) compared to others in the United States (SSS-US) and compared to their community (SSS-Comm). Multivariable logistic regression was used to examine the relationship between SSS and odds of LBW or HBW.

RESULTS

Higher SSS-US was associated with lower odds of HBW in unadjusted models (OR 0.76, 95% CI 0.60-0.96; p < 0.05); this relationship persisted after controlling for objective SES, health, and demographic factors (OR 0.73, 95% CI 0.53-0.99; p < 0.05). Neither SSS measure was associated with LBW.

CONCLUSIONS

Pregnant women who view themselves as having lower status than others in the US have greater odds of HBW, over and above the influence of factors known to be associated with birth weight. SSS, a brief and non-stigmatizing measure, might help identify women at elevated social risk for adverse birth outcomes.

Growing up unequal: Objective and subjective economic disparities and authoritarian parenting

BACKGROUND

Although there is evidence of economic disparities in parents' financial and time investments in children, little existing empirical work has considered the disparities in authoritarian parenting, a risk for child maltreatment. Similarly, existing research has largely focused on the role of objective markers of socioeconomic status (SES), although perceived subjective social status (SSS) may be equally powerful in shaping disparities in parenting behaviors.

DATA

This article draws on 30 years of General Social Survey data to examine the association between objective socioeconomic status and subjective social status and parents' endorsement of authoritarian parenting practices.

METHODS

We model the association between parents' SES and SSS and approval of authoritarian parenting practices estimated with odds ratios from logistic regressions and examine parental race as a potential moderator.

RESULTS

We find that SES and SSS are both associated with increased odds of endorsing authoritarian parenting, that SSS-based disparities are independent of SES, and that white parents' parenting may be more influenced by both SES and SSS than Black parents' parenting.

CONCLUSIONS

This work provides evidence that SES not only drives gaps in parental investments in children, but also gaps in their endorsement of authoritarian parenting. This is important because authoritarian parenting is not only directly associated with adverse outcomes for children, but is also associated with an increased risk for child maltreatment. It also expands the existing literature by showing that subjective measures of social status are important and distinct from objective measures of SES, and that these associations vary by race.

Subjective social status, COVID-19 health worries, and mental health symptoms in perinatal women

Pregnant women and those who have recently given birth are considered an at-risk population during the COVID-19 pandemic with regards to the impact of both general stress and pandemic-related stressors. The extent to which subjective social status (SSS), one's perception of relative standing compared to others in a social hierarchy, might mitigate the effects of COVID-19-related health worries on mental health has not yet been reported, despite SSS often outperforming socioeconomic status as a predictor of various health outcomes including depression. This cross-sectional survey study tested the moderating effect of SSS on association between COVID-19- related health worries and mental health symptoms (depressive and generalized anxiety) among a sample of 1,637 perinatal women from the United States who took part in the Perinatal Experiences and COVID-19 Effects (PEACE) Study between May 2020 and June 2021. We found that high subjective social status was protective against depressive symptoms when self-reported COVID-19-related worry was low. When COVID-19-related worry was high, subjective social status was no longer influential. Higher levels of COVID-19-related health worries were associated with more anxiety symptoms, and higher subjective social status did not moderate anxiety symptomatology at either level of COVID-19-related worry. Although higher SSS has historically been protective against mental health decline, in the context of the COVID-19 pandemic it may not be sufficiently protective against anxiety, or against depression for those who experience high levels of worry regarding the effects of COVID-19 on health.

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We assessed perinatal women for mental health symptoms and subjective social status.

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High subjective social status protected against depression when COVID worry was low.

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When COVID worry was high, subjective social status didn't protect against depression.

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COVID-19-related health worries were associated with more anxiety symptoms.

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High subjective social status was not protective against anxiety symptoms.

Subjective social status and allostatic load in mothers 1 year after birth

OBJECTIVE

Subjective social status (SSS) refers to an individual's perception of relative social rank. We tested associations between SSS and allostatic load, a multisystem index of physiological dysregulation, in a sample of women 1 year after the birth of a child.

METHOD

Participants (n = 1,168) in the Community Child Health Network study were recruited in five sites across the United States shortly after the birth of a child. SSS was assessed at 6 months after birth using the MacArthur Scale of Subjective Social Status. Participants also reported household income and years of education completed. Biomarkers were assessed and allostatic load was calculated by assigning one point for each of 10 biomarkers above clinical cutoffs at a subsequent visit approximately 6 months later. Multiple linear regression analyses tested associations of SSS with allostatic load, adjusting for socioeconomic (SES) indicators of household income, years of education, and other covariates (race/ethnicity, relationship status, maternal age, and study site). We also tested interactions between each of the objective SES measures and SSS.

RESULTS

Higher SSS predicted lower subsequent allostatic load independent of household income, education, and other covariates. Associations between SSS and allostatic load were strongest at higher levels of income and education.

CONCLUSIONS

Study findings demonstrate associations between perceptions of relative social standing and wear-and-tear on multiple physiological systems above and beyond indicators of objective SES, suggesting that psychosocial aspects of lower status may contribute to the gradient between social status and health. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Determinants of maternal health four weeks after delivery: cross-sectional findings from the KUNO-kids health study

BACKGROUND

The aim of this study was to examine the interaction of a multitude of socio-economic, lifestyle, environmental, psychosocial and birth related determinants and their effect on maternal health four weeks after delivery.

METHODS

We used data from a German birth cohort study, the KUNO-Kids health study. Social determinants, as well as the self-rated maternal health and the physical and mental health status of mothers (indicated by means of the SF-12-questionnaire) were assessed through standardized questionnaires and personal interviews right after delivery and four weeks later. Linear regression models were calculated to determine the relationship between influencing factors and health outcomes.

RESULTS

1428 women were included in the analysis. Maternal self-rated health showed significant positive associations with breastfeeding (B (regression coefficient) 2.67; 0.86-4.48 (95% Confidence interval)) and estimating one's child as rather healthy (B 0.27; 0.19-0.34) and negative associations with social and emotional strains (B -3.50; -5.11- -1.88), obesity (B -2.56; -4.69- -0.42), having experienced a C-section (B -1.73; -3.23- -0.23), a positive history of somatic diseases (B -2.14; -3.53- -0.74), parental stress (B -0.39; -0.66- -0.11) and education of more than ten years (B -2.42; -3.95- -0.90). Maternal physical health status showed significant negative associations with age (B -0.13; -0.25- -0.01), employment before maternity leave (B -1.90; -3.59- -0.21), social and emotional strains (B -1.50; -2.67- -0.34), parental stress (B -0.28; -0.45- -0.12), C-section (B -4.06; -5.12- -2.99), having the first child (B -2.03; -3.09- -0.97) and a history of somatic diseases (B -2.00; -2.99- -1.01). Maternal mental health status showed significant positive associations with education of more than 10 years (B 2.27; 0.98-3.56) and a high level of social support (B 1.20; 0.06-2.34), while social and emotional strains (B -4.16; -5.48- -2.84) and parental stress (B -0.70; -0.92- -0.47) were negatively associated.

CONCLUSIONS

We identified important protective factors for maternal health four weeks after delivery, such as a high level of social support. However, parental stress and social and emotional strains in particular seem to have a negative influence on maternal health. These findings have public health relevance.

The influence of social and cultural practices on maternal mortality: a qualitative study from South Punjab, Pakistan

Background

A disproportionately high rate of maternal deaths is reported in developing and underdeveloped regions of the world. Much of this is associated with social and cultural factors, which form barriers to women utilizing appropriate maternal healthcare. A huge body of research is available on maternal mortality in developing countries. Nevertheless, there is a lack of literature on the socio-cultural factors leading to maternal mortality within the context of the Three Delays Model. The current study aims to explore socio-cultural factors leading to a delay in seeking care in maternal healthcare in South Punjab, Pakistan.

Methods

We used a qualitative method and performed three types of data collection with different target groups: (1) 60 key informant interviews with gynaecologists, (2) four focus group discussions with Lady Health Workers (LHWs), and (3) ten case studies among family members of deceased mothers. The study was conducted in Dera Ghazi Khan, situated in South Punjab, Pakistan. The data was analysed with the help of thematic analysis.

Results

The study identified that delay in seeking care—and the potentially resulting maternal mortality—is more likely to occur in Pakistan due to certain social and cultural factors. Poor socioeconomic status, limited knowledge about maternal care, and financial constraints among rural people were the main barriers to seeking care. The low status of women and male domination keeps women less empowered. The preference for traditional birth attendants results in maternal deaths. In addition, early marriages and lack of family planning, which are deeply entrenched in cultural values, religion and traditions—e.g., the influence of traditional or spiritual healers—prevented young girls from obtaining maternal healthcare.

Conclusion

The prevalence of high maternal mortality is deeply alarming in Pakistan. The uphill struggle to reduce deaths among pregnant women is firmly rooted in addressing certain socio-cultural practices, which create constraints for women seeking maternal care. The focus on poverty reduction and enhancing decision-making power is essential for supporting women’s right to medical care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-021-01151-6.

Round the world, many women are dying because of complications during pregnancy or in childbirth. These deaths are more frequent in developing and underdeveloped countries. Some reasons for this are related to social and cultural factors, which form barriers to women using appropriate maternal healthcare. Therefore, this study aims to explore socio-cultural factors leading to a delay in seeking maternal healthcare in South Punjab, Pakistan.

We interviewed a variety of people to get an overview of this topic: (1) 60 interviews were conducted with gynaecologists, (2) we performed four focus group discussions with eight to ten Lady Health Workers providing maternal healthcare, and (3) we talked with family members of mothers who had died.

The study shows that delays in seeking care are related to poor socioeconomic status, limited knowledge about maternal care, and low incomes of rural people. The low status of women and male domination keeps women less empowered. In addition, early marriages and lack of family planning due to cultural values, religion and traditions stopped young girls from getting maternal healthcare.

The number of new mothers who die is very worrying in Pakistan. One of the important tasks for reducing deaths among pregnant women is to address certain socio-cultural practices. It is very important to reduce poverty and improve decision-making power to make sure women can use their right to medical care.

Maternal Experience of Multiple Hardships and Fetal Growth: Extending Environmental Mixtures Methodology to Social Exposures

BACKGROUND

Women can be exposed to a multitude of hardships before and during pregnancy that may affect fetal growth, but previous approaches have not analyzed them jointly as social exposure mixtures.

METHODS

We evaluated the independent, mutually adjusted, and pairwise joint associations between self-reported hardships and birthweight for gestational age z-scores in the Chemicals in Our Bodies-2 prospective birth cohort (N = 510) using G-computation. We examined financial hardship, food insecurity, job strain, poor neighborhood environment, low community standing, caregiving, high burden of stressful life events, and unplanned pregnancy collected via questionnaire administered in the second trimester of pregnancy. We used propensity scores to ensure our analyses had sufficient data support and estimated absolute differences in outcomes.

RESULTS

Food insecurity was most strongly associated with reduced birthweight for gestational age z-scores individually, with an absolute difference of -0.16, 95% confidence interval (CI) -0.45, 0.14. We observed an unexpected increase in z-scores associated with poor perceived neighborhood environment (0.18, 95% CI -0.04, 0.41). Accounting for coexposures resulted in similar findings. The pairwise joint effects were strongest for food insecurity in combination with unplanned pregnancy (-0.45, 95% CI -0.93, 0.02) and stressful life events (-0.42, 95% CI -0.90, 0.05). Poor neighborhood environment in combination with caregiving was associated with an increase in z-scores (0.47, 95% CI -0.01, 0.95).

CONCLUSIONS

Our results are consistent with the hypothesis that experiencing food insecurity during pregnancy, alone and in combination with stressful life events and unplanned pregnancy, may affect fetal growth.

Social rank theory of depression: A systematic review of self-perceptions of social rank and their relationship with depressive symptoms and suicide risk

BACKGROUND

Depression can be debilitating, as well as a risk factor for self-harm and suicide. Social rank theory (SRT) suggests depression stems from feelings of defeat and entrapment that ensue from experiencing oneself to be of lower rank than others. This study aims to review the literature investigating the relationship between self-perceptions of social rank and depressive symptoms or suicidal ideation/behaviour.

METHODS

A keyword search of three psychological and medical databases was completed (Psychinfo, Medline, Web of Knowledge). Studies were quality assessed using established criteria.

RESULTS

An initial 1290 records were identified. After application of inclusion and exclusion criteria, 70 remained measuring depressive symptoms (n = 68), self-harm (n = 3) and suicidal ideation (n = 3). The main measures assessing social rank were the social comparison scale (SCS; n = 32) and subjective social status (SSS, n = 32), with six additional papers including another measure of social rank. In univariate analyses, as perceptions of social rank decreased, depressive symptoms (and suicidal ideation/self-harm) increased. Multivariate analyses indicated that social rank may act as a psychosocial mechanism to explain the relationship between social factors (in particular socio-economic status) and depressive symptoms. Additionally, psychological variables, such as rumination or self-esteem, may mediate or moderate the relationship between social rank and depressive or suicidal symptoms.

LIMITATIONS

Study quality was variable and 89% of studies were cross-sectional.

CONCLUSIONS

Although more prospective research is required, this review highlights the importance of understanding an individual's perception of their social position compared to others as it may lead to an enhanced understanding of the aetiology of depressive disorders.

Making meaning from money: Subjective social status and young children's behavior problems

While early exposure to poverty has been linked to decrements in children's behavior through underlying pathways of parenting stress and depression, extant research has typically relied on the use of objective measures of socioeconomic status (SES) to test these associations. However, children's development may be shaped by the ways that parents perceive social class, which may operate independently and differentially from objective SES. Using structural equation modeling, the present study explores relationships between parents' ratings of subjective social status (SSS), objective indicators of SES (income-to-needs ratio, education, employment status), and young children's (ages 0-3) behavior problems among 173 low-income families living in an urban area in the northeast United States. In addition, we consider whether parents' stress and depression underlie these associations. Results demonstrate negative relationships from both objective SES and SSS to parents' well-being. Moreover, in keeping with the Family Stress Model, we find that both SES and SSS are related to children's adjustment via parents' stress and depression; parents who have lower levels of education, are not employed, and who report lower SSS also report higher levels of stress, which in turn is related to higher levels of children's behavior problems. To our knowledge, this is the first study to test assumptions of the Family Stress Model using both subjective and objective indicators of social status, and one of few studies exploring linkages between parents' perceptions of SSS and children's behavior problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The relationship between caregivers' subjective social status and asthma symptoms and management for urban children

OBJECTIVE

Subjective social status (SSS) is a person's perception of his/her social standing among others. We explored the relationship between caregivers' SSS and asthma symptoms, visits, and medication use among children with persistent asthma.

METHODS

We analyzed baseline data of children (3-10 years) from the SB-TEAM trial in Rochester, NY. Using a modified MacArthur Scale of SSS, caregivers rated themselves "a lot worse off" to "a lot better off" compared to 4 groups (e.g., neighbors). "Low SSS" was defined by a response of "a lot worse off" or "somewhat worse off" for any of the referent groups. Caregivers reported their child's asthma symptoms, healthcare visits for asthma, and medication use. Bivariate and multivariate statistics were used.

RESULTS

We found that, of the 230 children enrolled (participation rate:78%, 62% Black, 72% Medicaid), 29% of caregivers had low SSS. Caregivers with low SSS had more depressive symptoms (46% vs. 28%) and lower social support (69.1 vs. 77.7). In multivariable analyses, children of caregivers with low SSS had fewer symptom-free days/2 weeks (5.8 vs. 7.9, p = .01). While they were more likely to have a routine asthma visit in the past year (35% vs. 23%, adjusted p = .03), there was no difference in their use of preventive medication.

CONCLUSIONS

Many caregivers of children with persistent asthma report low SSS. While children of these caregivers had fewer symptom-free days, they were not more likely to use preventive medications. Efforts are needed to support these caregivers to ensure optimal preventive care and reduce morbidity.

Subjective Social Status and Psychological Distress in Mothers of Young Children

Introduction Perceptions of social standing have increasingly well-documented relationships with health. Higher subjective social status (SSS) is associated with better psychological well-being among women, and mothers of newborns. The relationship between SSS and psychological distress among mothers of young children, however, is largely unknown. SSS may provide insight into aspects of maternal functioning that are relevant to parenting capacity, as well as insight into future health; in addition, SSS is brief, and may be perceived as less intrusive than other measures of socioeconomic status or mental health. We evaluated the relationship between SSS and psychological distress among mothers of 5-year-old children from diverse socioeconomic backgrounds. Methods One hundred and sixty-two mothers of 5-year old children, who participated in a study of child self-regulation, completed surveys that assessed sociodemographics, mental health, and perceived social support. The MacArthur Scale of SSS used pictures of ten-rung ladders to assess respondents' social position in relation to the US (SES ladder) and their community (community ladder). Quantile regression models were used to assess the relationship between maternal psychological distress (perceived social support, depressive symptoms, anxiety) and the ladders (individually and together), adjusting for maternal age, race, education, and number of children. To examine whether the SSS-health relationships differed by race, the models were also stratified by race. Results Community ladder ranking was positively associated with social support (β = 1.34, SE = 0.33, p < .001), and negatively associated with depressive symptoms (β = -1.34, SE = 0.52, p < .05). SES ladder ranking was positively associated with social support (β = 1.17, SE = 0.52, p < .05). Findings in the full sample were driven by more robust relationships between psychological distress and community SSS among Black/African-American mothers. Discussion The findings suggest that perceived social standing in one's community is associated with maternal psychological well-being. Community SSS may be particularly influential for Black/African-American mothers' well-being.

Is subjective social status a unique correlate of physical health? A meta-analysis

OBJECTIVE

Both social stratification (e.g., social rank) as well as economic resources (e.g., income) are thought to contribute to socioeconomic health disparities. It has been proposed that subjective socioeconomic status (an individual's perception of his or her hierarchical rank) provides increased predictive utility for physical health over and above more traditional, well-researched socioeconomic constructs such as education, occupation, and income.

METHOD

PsycINFO and PubMed databases were systematically searched for studies examining the association of subjective socioeconomic status (SES) and physical health adjusting for at least 1 measure of objective SES. The final sample included 31 studies and 99 unique effects. Meta-analyses were performed to: (a) estimate the overlap among subjective and objective indicators of SES and (b) estimate the cumulative association of subjective SES with physical health adjusting for objective SES. Potential moderators such as race and type of health indicator assessed (global self-reports vs. more specific and biologically based indicators) were also examined.

RESULTS

Across samples, subjective SES shows moderate overlap with objective indicators of SES, but associations are much stronger in Whites than Blacks. Subjective SES evidenced a unique cumulative association with physical health in adults, above and beyond traditional objective indicators of SES (Z = .07, SE = .01, p < .05). This association was stronger for self-rated health than for biologically based and symptom-specific measures of health. Almost all available data were cross-sectional and do not allow for strong causal inference.

CONCLUSIONS

Subjective SES may provide unique information relevant to understanding disparities in health, especially self-rated health. (PsycINFO Database Record

Main causes of death in Dande, Angola: results from Verbal Autopsies of deaths occurring during 2009-2012

Background

The Dande Health and Demographic Surveillance System (HDSS) located in Bengo Province, Angola, covers nearly 65,500 residents living in approximately 19,800 households. This study aims to describe the main causes of deaths (CoD) occurred within the HDSS, from 2009 to 2012, and to explore associations between demographic or socioeconomic factors and broad mortality groups (Group I—Communicable diseases, maternal, perinatal and nutritional conditions; Group II—Non-communicable diseases; Group III—Injuries; IND—Indeterminate).

Methods

Verbal Autopsies (VA) were performed after death identification during routine HDSS visits.

Associations between broad groups of CoD and sex, age, education, socioeconomic position, place of residence and place of death, were explored using chi-square tests and fitting logistic regression models.

Results

From a total of 1488 deaths registered, 1009 verbal autopsies were performed and 798 of these were assigned a CoD based on the 10^th revision of the International Classification of Diseases (ICD-10).

Mortality was led by CD (61.0 %), followed by IND (18.3 %), NCD (11.6 %) and INJ (9.1 %). Intestinal infectious diseases, malnutrition and acute respiratory infections were the main contributors to under-five mortality (44.2 %). Malaria was the most common CoD among children under 15 years old (38.6 %). Tuberculosis, traffic accidents and malaria led the CoD among adults aged 15–49 (13.5 %, 10.5 % and 8.0 % respectively). Among adults aged 50 or more, diseases of the circulatory system (23.2 %) were the major CoD, followed by tuberculosis (8.2 %) and malaria (7.7 %). CD were more frequent CoD among less educated people (adjusted odds ratio, 95 % confidence interval for none vs. 5 or more years of school: 1.68, 1.04–2.72).

Conclusion

Infectious diseases were the leading CoD in this region. Verbal autopsies proved useful to identify the main CoD, being an important tool in settings where vital statistics are scarce and death registration systems have limitations.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3365-6) contains supplementary material, which is available to authorized users.

Racial Disparities in Low Birthweight Risk: an Examination of Stress Predictors

OBJECTIVE

This paper describes racial disparities in low birthweight (LBW) risk between Black women and White women and examines the relationship between race and stressors such as socioeconomic factors, access to health care, and social and health characteristics.

METHODS

We analyzed data from the National Survey of Family Growth dataset collected in the USA between 2006 and 2010 (N = 1516). Multivariate logistic regression models were performed.

RESULTS

Prevalence of LBW was 5.6 % for pregnancies among White women and 12.2 % among Black women. Black women who had a LBW baby had a lower socioeconomic status (e.g., received assistance to pay for delivery of the baby and public assistance in the prior year). Black women who had a LBW baby were more likely to have reported having good health compared with White women (67.8 vs. 45.1 %, p < .10). Pregnancies of Black women were 2.6 times more likely (odds ratio (OR) = 2.33; 95 % confidence interval (CI), 1.12-6.04) to result in a LBW baby than pregnancies among White women. Pregnancies of women in the income group of 300 % or higher than the poverty level were less likely to be associated with a LBW baby than those among women in the 150-299 % income group (p < .10). Obese women were less likely to have LBW children than those who were underweight or normal weight (p < .10). Among pregnancies of White mothers (n = 943), the only significant variable was self-reported health status. White women who reported having poorer health were 3.7 times more likely to have LBW than those who reported having better health (p < .10). Among Black mothers, the only predictor that was negatively associated with an increased likelihood of having a LBW baby was the SES stressor related to receiving public assistance.

CONCLUSION

Racial differences between Black and White women were observed in LBW risk based on socioeconomic factors. We analyzed a large number of stressors, but racial differences remained even after taking these stressors into account. Future policies and research should continually address these differences to decrease LBW risk within and across racial groups.

Perinatal Depression and Anxiety in Women with and without Human Immunodeficiency Virus Infection

BACKGROUND

Untreated depression and anxiety during the perinatal period have significant consequences on maternal and infant health; however, few studies have examined perinatal depression and perinatal anxiety in women with human immunodeficiency virus (HIV) infection. The current study prospectively examined the prevalence of prenatal and postpartum depression and anxiety, and emotional support from family and friends, as well as childhood sexual abuse in women with and without HIV infection.

METHODS

Between July 2009 and January 2013, 258 pregnant women receiving care in a Philadelphia hospital were enrolled, with 162 completing both the prenatal and postpartum portions of the study. The Center for Epidemiological Studies-Depression Scale (CES-D), and the State-Trait Anxiety Inventory for Adults were used to measure depression and anxiety symptoms, respectively. An independent samples t test and multiple linear regressions were used to determine associations among depression, anxiety, and pregnancy-related variables.

RESULTS

Forty-nine participants (30%) were living with HIV; 113 (70%) were HIV negative. CES-D scores did not differ prenatally (p = .131) or postpartum (p = .156) between women with and without HIV. Prenatal state anxiety scores were higher in women with HIV (p = .02) but there were no differences postpartum (p = .432). In a multiple linear regression, trait anxiety predicted postpartum anxiety in the full sample (p < .001) and childhood sexual abuse predicted postpartum depression among women with HIV (p = .021).

CONCLUSIONS

These findings highlight the importance of identifying and treating perinatal depression and anxiety early in the prenatal period. Results also emphasize the need for providers to be aware of childhood sexual abuse as a potential correlate for depression in women with HIV.

Incorporation of socioeconomic status indicators into policies for the meaningful use of electronic health records

Socioeconomic status (SES) has an important effect on health. Individuals with lower SES experience more chronic disease, are less likely to receive preventive care, and have shorter life expectancies. As the Affordable Care Act is implemented and increasing numbers of previously uninsured people gain access to health care, the imperative to recognize patients' SES and develop health initiatives that account for the social determinants of health increases. Health care providers across the nation are adopting electronic health records (EHRs). Policies such as Meaningful Use offer opportunities systematically to incorporate the collection of standardized SES indicators into EHRs in ways that improve health, increase the understanding of the relationship between SES and health, and inform future policies. This paper examines the use of SES indicators in research, national surveys, and federal programs and finds adding an income question is the most feasible and optimal SES indicator for the inclusion in EHRs.

Role of stress in low birthweight disparities between black and white women: a population-based study

AIM

This study examines the role of stress in low birthweight (LBW) risk in Black and White women in the United States.

METHODS

Data from the 1998-2000 Fragile Family and Child Wellbeing Study were used (n = 3869). We included several self-reported conditions which we categorised as stressors (i.e. socio-economic conditions, health behaviours, access to quality care and cultural factors), then we used logistic regression models to analyse the role of stressors in explaining the health disparities in LBW.

RESULTS

Most women were unmarried (59% for White women and 87% for Black women). Among unmarried White women, the only stressor associated with a higher likelihood of LBW was smoking (odds ratio (OR) = 2.0, 95% confidence interval (CI) (1.2, 3.3)). Among unmarried Black women, smoking (OR = 1.7, 95% CI (1.2, 2.3)), drug use (OR = 1.7, 95% CI (1.0, 2.6)), paying for the baby's birth with government resources (OR = 1.6, 95% CI (1.1, 2.4)) and religious affiliation (OR = 1.6, 95% CI (1.0, 2.5)) were associated with higher likelihood of LBW. Among married White women, older age (OR = 1.1, 95% CI (1.0, 1.2)), smoking (OR = 5.2, 95% CI (1.7, 15.5)), using governmental resources to pay for birth (OR = 3.6, 95% CI (1.0, 12.4)) and living in governmental housing (OR = 9.1, 95% CI (2.0, 41.1)) were associated with higher likelihood of LBW. No stressors were statistically significant for married Black women.

CONCLUSION

We analysed a large number of stressors at the individual, household and societal levels and found differences on the stressors among Black and White women. However, the stressors included in the analyses did not fully explain the racial disparities in LBW.

Subjective social status and depression symptoms: a prospective study of women with noncancerous pelvic problems

OBJECTIVE

Subjective social status (SSS) may be a stronger determinant of health than objective measures of socioeconomic status. We sought to examine the effect of community and national SSS on symptoms of depression in a racially/ethnically diverse sample of adult women with noncancerous uterine conditions.

METHODS

We conducted a secondary analysis of data obtained from 634 women who enrolled in the Study of Pelvic Problems, Hysterectomy, and Intervention Alternatives (SOPHIA) in 2003 and 2004. SOPHIA was a longitudinal study of women aged 31 to 54 who were experiencing abnormal uterine bleeding, symptomatic fibroids, or pelvic pain. The primary outcome for this analysis consisted of symptoms suggesting major or other depressive disorder, as measured by the Patient Health Questionnaire-9, 2 years after study enrollment. We hypothesized that women who had low community and national SSS at baseline, as measured by the MacArthur SSS ladder, would be at higher risk of experiencing symptoms of depression at follow-up.

RESULTS

Women with low community SSS had an increased odds of experiencing depression symptoms 2 years later compared with women with high SSS, after adjusting for age, pelvic problem impact and baseline depression (odds ratio, 2.93; 95% CI, 1.11-7.77). Odds remained elevated after further adjusting for income and education. Results for the national ladder were not significant.

CONCLUSION

Low perceived community social status is predictive of symptoms suggestive of major or other depressive disorder among women with noncancerous uterine conditions. Asking about perceived community social status can help clinicians to identify patients who may be at increased risk for depressive disorders. Asking about perceived national social status does not seem to add value beyond that provided by income and education.

Environmental inequality in exposures to airborne particulate matter components in the United States

BACKGROUND

Growing evidence indicates that toxicity of fine particulate matter ≤ 2.5 μm in diameter (PM2.5) differs by chemical component. Exposure to components may differ by population.

OBJECTIVES

We investigated whether exposures to PM2.5 components differ by race/ethnicity, age, and socioeconomic status (SES).

METHODS

Long-term exposures (2000 through 2006) were estimated for 215 U.S. census tracts for PM2.5 and for 14 PM2.5 components. Population-weighted exposures were combined to generate overall estimated exposures by race/ethnicity, education, poverty status, employment, age, and earnings. We compared population characteristics for tracts with and without PM2.5 component monitors.

RESULTS

Larger disparities in estimated exposures were observed for components than for PM2.5 total mass. For race/ethnicity, whites generally had the lowest exposures. Non-Hispanic blacks had higher exposures than did whites for 13 of the 14 components. Hispanics generally had the highest exposures (e.g., 152% higher than whites for chlorine, 94% higher for aluminum). Young persons (0-19 years of age) had levels as high as or higher than other ages for all exposures except sulfate. Persons with lower SES had higher estimated exposures, with some exceptions. For example, a 10% increase in the proportion unemployed was associated with a 20.0% increase in vanadium and an 18.3% increase in elemental carbon. Census tracts with monitors had more non-Hispanic blacks, lower education and earnings, and higher unemployment and poverty than did tracts without monitors.

CONCLUSIONS

Exposures to PM2.5 components differed by race/ethnicity, age, and SES. If some components are more toxic than others, certain populations are likely to suffer higher health burdens. Demographics differed between populations covered and not covered by monitors.

Small-for-gestational-age births in pregnant women with HIV, due to severity of HIV disease, not antiretroviral therapy

OBJECTIVES

To determine rate and factors associated with small-for-gestational-age (SGA) births to women with HIV.

METHODS

Prospective data were collected from 183 pregnant women with HIV in an urban HIV prenatal clinic, 2000-2011. An SGA birth was defined as less than the 10th or 3rd percentile of birth weight distribution based upon cut points developed using national vital record data. Bivariate analysis utilized chi-squared and t-tests, and multiple logistic regression analyses were used.

RESULTS

The prevalence of SGA was 31.2% at the 10th and 12.6% at the 3rd percentile. SGA at the 10th (OR 2.77; 95% CI, 1.28-5.97) and 3rd (OR 3.64; 95% CI, 1.12-11.76) percentiles was associated with cigarette smoking. Women with CD4 count>200 cells/mm3 at the first prenatal visit were less likely to have an SGA birth at the 3rd percentile (OR 0.29; 95% CI, 0.10-0.86). Women taking NNRTI were less likely to have an SGA infant at the 10th (OR 0.28; 95% CI, 0.10-0.75) and 3rd (OR 0.16; 95% CI, 0.03-0.91) percentiles compared to those women on PIs.

CONCLUSIONS

In this cohort with high rates of SGA, severity of HIV disease, not ART, was associated with SGA births after adjusting for sociodemographic, medication, and disease severity.

Subjective social status and psychosocial and metabolic risk factors for cardiovascular disease among African Americans in the Jackson Heart Study

Subjective social status has been shown to be inversely associated with multiple cardiovascular risk factors, independent of objective social status. However, few studies have examined this association among African Americans and the results have been mixed. Additionally, the influence of discrimination on this relationship has not been explored. Using baseline data (2000-2004) from the Jackson Heart Study, an African American cohort from the U.S. South (N=5301), we quantified the association of subjective social status with selected cardiovascular risk factors: depressive symptoms, perceived stress, waist circumference, insulin resistance and prevalence of diabetes. We contrasted the strength of the associations of these outcomes with subjective versus objective social status and examined whether perceived discrimination confounded or modified these associations. Subjective social status was measured using two 10-rung "ladders," using the U.S. and the community as referent groups. Objective social status was measured using annual family income and years of schooling completed. Gender-specific multivariable linear and logistic regression models were fit to examine associations. Subjective and objective measures were weakly positively correlated. Independent of objective measures, subjective social status was significantly inversely associated with depressive symptoms (men and women) and insulin resistance (women). The associations of subjective social status with the outcomes were modest and generally similar to the objective measures. We did not find evidence that perceived racial discrimination strongly confounded or modified the association of subjective social status with the outcomes. Subjective social status was related to depressive symptoms but not consistently to stress or metabolic risk factors in African Americans.