The mediating roles of perceived stress and health behaviors in the relation between objective, subjective, and neighborhood socioeconomic status and perceived health

Theresa E Senn, Jennifer L Walsh, Michael P Carey, Theresa E Senn, Jennifer L Walsh, Michael P Carey

Abstract

Background: Objective, subjective, and neighborhood socioeconomic status (SES) are associated with perceived health, morbidity, and mortality.

Purpose: We investigated whether perceived stress and health behaviors mediated the relation between the three types of SES and perceived health.

Methods: Participants (N = 508) attending a public clinic completed a computerized survey assessing objective SES (income, education, employment); health behaviors; perceived stress; and perceived health. They also indicated their social standing relative to others (subjective SES) and provided their current address to determine neighborhood SES.

Results: In a structural equation model including all three SES types, lower objective and subjective SES were related to poorer perceived health. When mediators were included in the model, there were significant indirect effects of (a) SES on health through stress and (b) SES on health through stress and health-compromising behaviors.

Conclusions: Interventions to reduce the impact of stressors could improve the health of socioeconomically disadvantaged individuals.

Conflict of interest statement

Authors Statement of Conflict of Interest and Adherence to Ethical Standards: Author Senn, Author Walsh, and Author Carey declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committees on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Figures

Figure 1
Figure 1
Structural equation model showing associations between SES constructs, perceived stress, health compromising behaviors, and perceived health. Standardized regression coefficients are reported. Control variables included age, sex, and race. Dashed lines represent non-significant paths.

References

    1. Adler NE, Rehkoph DH. U.S. disparities in health: Descriptions, causes, and mechanisms. Annu Rev Public Health. 2008;29:235–252.
    1. Adler NE, Boyce T, Chesney MA, et al. Socioeconomic status and health: The challenge of the gradient. Am Psychol. 1994;49:15–24.
    1. Taylor SE, Repetti RL. Health psychology: What is an unhealthy environment and how does it get under the skin? Annu Rev Psychol. 1997;48:411–447.
    1. House JS, Williams DR. Understanding and reducing socioeconomic and racial/ethnic disparities in health. In: Hofrichter R, editor. Health and social justice: Politics, ideology, and inequity in the distribution of disease. San Francisco: Jossey-Bass; 2003. pp. 89–131.
    1. Preston SH, Elo IT. Are educational differentials in adult mortality increasing in the United States? J Aging Health. 1995;7:476–496.
    1. Pappas G, Queen S, Hadden W, Fisher G. The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med. 1993;329:103–109.
    1. Mulatu MS, Schooler C. Casual connections between socio-economic status and health: Reciprocal effects and mediating mechanisms. J Health Soc Behav. 2002;43:22–41.
    1. Chen E, Paterson LQ. Neighborhood, family, and subjective socioeconomic status: How do they relate to adolescent health? Health Psychol. 2006;25:704–714.
    1. Malmstrom M, Sundquist J, Johansson S. Neighborhood environment and self-reported health status: A multilevel analysis. Am J Public Health. 1999;89:1181–1186.
    1. Feldman PJ, Steptoe A. How neighborhoods and physical functioning are related: The roles of neighborhood socioeconomic status, perceived neighborhood strain, and individual health risk factors. Ann Behav Med. 2004;27:91–99.
    1. Jaffe DH, Eisenbach Z, Neumark YD, Manor O. Individual, household and neighborhood socioeconomic status and mortality: A study of absolute and relative deprivation. Soc Sci Med. 2005;60:989–997.
    1. Robert SA. Community-level socioeconomic status effects on adult health. J Health Soc Behav. 1998;39:18–37.
    1. Malmstrom M, Johansson S, Sundquist J. A hierarchical analysis of long-term illness and mortality in socially deprived areas. Soc Sci Med. 2001;53:265–275.
    1. Jones K, Duncan C. Individuals and their ecologies: Analysing the geography of chronic illness within a multilevel modelling framework. Health Place. 1995;1:27–40.
    1. Bosma H, van de Mheen HD, Borsboom GJJM, Mackenbach JP. Neighborhood socioeconomic status and all-cause mortality. Am J Epidemiol. 2001;153:363–371.
    1. Singh-Manoux A, Adler NE, Marmot MG. Subjective social status: Its determinants and its association with measures of ill-health in the Whitehall II study. Soc Sci Med. 2003;56:1321–1333.
    1. Singh-Manoux A, Marmot MG, Adler NE. Does subjective social status predict health and change in health status better than objective status? Psychosom Med. 2005;67:855–861.
    1. Cohen S, Adler N, Alper CM, et al. Objective and subjective socioeconomic status and susceptibility to the common cold. Health Psychol. 2008;27:268–274.
    1. Demakakos P, Nazroo J, Breeze E, Marmot M. Socioeconomic status and health: The role of subjective social status. Soc Sci Med. 2008;67:330–340.
    1. Goldman N. Social inequalities in health: Disentangling the underlying mechanisms. Ann N Y Acad Sci. 2001;954:118–139.
    1. Chandola T, Clarke P, Morris JN, Blane D. Pathways between education and health: A casual modelling approach. J Roy Stat Soc A. 2006;169:337–359.
    1. Anderson NB, Armstead CA. Toward Understanding the association of socioeconomic status and health: A new challenge for the biopsychosocial approach. Psychosom Med. 1995;57 :213–225.
    1. Chen E, Miller GE. Socioeconomic status and health: Mediating and moderating factors. Annu Rev Clin Psycho. 2013;9:8.1–8.28.
    1. Ellen IG, Mijanovich T, Dillman K. Neighborhood effects on health: Exploring the links and assessing the evidence. J Urban Aff. 2001;23:391–408.
    1. Steptoe A, Feldman PJ. Neighborhood problems as sources of chronic stress: Development of a measure of neighborhood problems, and associations with socioeconomic status and health. Ann Behav Med. 2001;23:177–185.
    1. Wen M, Hawkley LC, Cacioppo JT. Objective and perceived neighborhood environment, individual SES and psychosocial factors, and self-rated health: An analysis of older adults in Cook County, Illinois. Soc Sci Med. 2006;63:2575–2590.
    1. Evans GW, Kantrowitz E. Socioeconomic status and health: The potential role of environmental risk exposure. Annu Rev Public Health. 2002;23:301–331.
    1. Gordon-Larsen P, Nelson MC, Page P, Popkin BM. Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics. 2006;117:417–424.
    1. Estabrooks PA, Lee RE, Gyuresik NC. Resources for physical activity participation: Does availability and accessibility differ by neighborhood socioeconomic status? Ann Behav Med. 2003;25:100–104.
    1. Brady SS, Matthews KA. The influence of socioeconomic status and ethnicity on adolescents’ exposure to stressful life events. J Pediatr Psychol. 2002;27:575–583.
    1. Almeida DM, Shevaun DN, Banks SR, Serido J. Do daily stress processes account for socioeconomic health disparities? J Gerentol. 2005;60B:34–39.
    1. Baum A, Garofalo JP, Yali AM. Socioeconomic status and chronic stress: Does stress account for SES effects on health? Ann N Y Acad Sci. 1999;896:131–144.
    1. Sapolsky RM. The influence of social hierarchy on primate health. Science. 2005;308:648–652.
    1. Tamashiro KLK, Nguyen MMN, Sakai RR. Social stress: From rodents to primates. Front Neuroendocrinol. 2005;26:27–40.
    1. McEwen BS. Protective and damaging effects of stress mediators. N Engl J Med. 1998;338:171–179.
    1. Kubzansky LD, Kawachi I, Sparrow D. Socioeconomic status, hostility, and risk factor clustering in the normative aging study: Any help from the concept of allostatic load? Ann Behav Med. 1999;21:330–338.
    1. Evans GW, Kim P. Childhood poverty and young adults’ allostatic load: The mediating role of childhood cumulative risk exposure. Psychol Sci. 2012;23:979–983.
    1. Karlamangla AS, Singer BS, Seeman TE. Reduction in allostatic load in older adults is associated with lower all-cause mortality risk: MacArthur studies of successful aging. Psychosom Med. 2006;68:500–507.
    1. Seeman TE, McEwen BS, Rowe JW, Singer BS. Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging. Proc Natl Acad Sci U S A. 2001;98:4770–4775.
    1. Crimmins EM, Johnston ML, Hayward M, Seeman T. Age differences in allostatic load: An index of frailty. In: Yi Z, Crimmins EM, Carriere Y, Robine JM, editors. Longer life and healthy aging. Netherlands: Springer; 2006. pp. 111–126.
    1. Orpana HM, Lemyre L, Kelly S. Do stressors explain the association between income and declines in self-rated health? A longitudinal analysis of the national population health survey. Int J Behav Med. 2007;14:40–47.
    1. Stringhini S, Sabia S, Shipley M, et al. Association of socioeconomic position with health behaviors and mortality. J Am Med Assoc. 2010;303:1159–1166.
    1. Lynch JW, Kaplan GA, Salonen JT. Why do poor people behave poorly? Variation in adult health behaviors and psychosocial characteristics by stages of the socioeconomic lifecourse. Soc Sci Med. 1997;44:809–819.
    1. Hanson MD, Chen E. Socioeconomic status and health behaviors in adolescence: A review of the literature. J Behav Med. 2007;30:263–285.
    1. Walsh JL, Senn TE, Carey MP. Longitudinal associations between health behaviors and mental health in low-income adults. Transl Behav Med. 2013;3:104–113.
    1. Lee RE, Cubbin C. Neighborhood context and youth cardiovascular health behaviors. Am J Public Health. 2002;92:428–436.
    1. Ghaed SG, Gallo LC. Subjective social status, objective socioeconomic status, and cardiovascular risk in women. Health Psychol. 2007;26:668–674.
    1. Robert SA. Neighborhood socioeconomic context and adult health: The mediating role of individual health behaviors and psychosocial factors. Ann N Y Acad Sci. 1999;896:465–468.
    1. Rheingold AA, Acierno R, Resnick HS. Trauma, posttraumatic stress disorder, and health risk behaviors. In: Schnurr PP, Green BL, editors. Trauma and health: Physical health consequences of exposure to extreme stress. Washington: American Psychological Association; 2005. pp. 217–243.
    1. Gallo LC, Matthews KA. Understanding the association between socioeconomic status and physical health: Do negative emotions play a role? Psychol Bull. 2003;129:10–51.
    1. Carey MP, Senn TE, Coury-Doniger P, et al. Optimizing the scientific yield from a randomized controlled trial (RCT): Evaluating two behavioral interventions and assessment reactivity with a single trial. Contemp Clin Trials. 2013;36:135–146.
    1. Adler NE, Epel ES, Castellazzo G, Ickovics JR. Relationship of subjective and objective social status with psychological and physiological functioning: Preliminary data in healthy white women. Health Psychol. 2000;19:586–592.
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–396.
    1. Roberti JW, Harrington LN, Storch EA. Further psychometric support for the 10-item version of the Perceived Stress Scale. Journal of College Counseling. 2006;9:135–147.
    1. Sharp LK, Kimmel LG, Kee R, Saltoun C, Chang C. Assessing the Perceived Stress Scale for African American adults with asthma and low literacy. Journal of Asthma. 2007;44 :311–316.
    1. Kline RB. Principles and practice of structural equation modeling. New York: Guilford; 2011.
    1. Heinrich KM, Maddock J. Multiple health behaviors in an ethnically diverse sample of adults with risk factors for cardiovascular disease. Perm J. 2011;15:12–18.
    1. De Vries H, van’t Reit J, Spigt M, et al. Clusters of lifestyle behaviors: Results from the Dutch SMILE study. Prev Med. 2008;46:203–208.
    1. Dufour MC. What is moderate drinking? Defining “drinks” and drinking levels. Alc Res Hlth. 1999;1999:5–14.
    1. Carey MP, Senn TE, Vanable PA, Coury-Doniger P, Urban MA. Brief and intensive behavioral interventions to promote sexual risk reduction among STD clinic patients: Results from a randomized controlled trial. AIDS Behav. 2010;14:504–517.
    1. Carey MP, Vanable PA, Senn TE, Coury-Doniger P, Urban MA. Evaluating a two-step approach to sexual risk reduction in a publicly-funded STI clinic: Rationale, design, and baseline data from the Health Improvement Project-Rochester (HIP-R) Contemp Clin Trials. 2008;29 :569–586.
    1. van der Ploeg HP, Chey T, Korda RJ, Banks E, Bauman A. Sitting time and all-cause mortality risk in 222,497 Australian adults. Arch Intern Med. 2012;172:494–500.
    1. Donovan JE, Jessor R, Costa FM. Adolescent health behavior and conventionality-unconventionality: An extension of problem-behavior therapy. Health Psychol. 1991;10:52–61.
    1. Gallant MP, Connell CM. Neuroticism and depressive symptoms among spouse caregivers: Do health behaviors mediate this relationship? Psychol Aging. 2003;18:587–592.
    1. Stewart AL, Hays RD, Ware JE. The MOS Short-Form General Health Survey. Med Care. 1988;26:724–735.
    1. Idler EL, Benyamini Y. Self-rated health and mortality: A review of twenty-seven community studies. J Health Soc Behav. 1997;38:21–37.
    1. Little TD. Longitudinal structural equation modeling. New York: Guilford; 2013.
    1. Muthén LK, Muthén BO. Mplus user’s guide. 7. Los Angeles, CA: Muthén & Muthén; 1998–2013.
    1. Bentler PM. Comparative fit indexes in structural models. Psychol Bull. 1990;107:238.
    1. Tucker LR, Lewis C. A reliability coefficient for maximum likelihood factor analysis. Psychometrika. 1973;38:1–10.
    1. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Modeling. 1999;6:1–55.
    1. Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40:879–891.
    1. Asparouhov T, Muthen B. Weighted least squares estimation with missing data. from .
    1. Miller GE, Chen E, Parker KJ. Psychological stress in childhood and susceptibility to the chronic diseases of aging: Moving toward a model of behavioral and biological mechanisms. Psychol Bull. 2011;137:959–997.
    1. Woolf SH, Aron L, editors. US Health in international perspective: Shorter lives, poorer health. Washington, DC: The National Academies Press; 2013.
    1. Roysamb E, Tambs K, Reichborn-Kjennerud T, Neale MC, Harris JR. Happiness and health: Environmental and genetic contributions to the relationship between subjective well-being, perceived health, and somatic illness. Journal of Personality and Social Psychology. 2003;85:1136–1146.
    1. Barsky AJ, Cleary PD, Klerman GL. Determinants of perceived health status of medical outpatients. Soc Sci Med. 1992;34:1147–1154.
    1. Des Jarlais DC, Paone D, Milliken J, et al. Audio-computer interviewing to measure risk behavior for HIV among injecting drug users: A quasi-randomised trial. Lancet. 1999;353:1657–1661.
    1. Perlis TE, Des Jarlais DC, Friedman SR, Arasteh K, Turner CF. Audio-computerized self-interviewing versus face-to-face interviewing for research data collection at drug abuse treatment programs. Addiction. 2004;99:885–896.
    1. Fairchild AJ, MacKinnon DP. A general model for testing mediation and moderation effects. Prev Sci. 2009;10:87–99.
    1. Fox JW. Social class, mental illness, and social mobility: The social selection-drift hypothesis for serious mental illness. J Health Soc Behav. 1990;31:344–353.
    1. Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits: A meta-analysis. J Psychosom Res. 2004;57:35–43.
    1. Smith BW, Shelley BM, Dalen J, et al. A pilot study comparing the effects of mindfulness-based and cognitive-behavioral stress reduction. J Alternative Compl Med. 2008;14 :251–258.
    1. Regehr C, Glancy D, Pitts A. Interventions to reduce stress in university students: A review and meta-analysis. J Affect Disord. 2013;148:1–11.
    1. Nyklicek I, Mommersteeg PMC, Van Beugen S, Ramakers C. Mindfulness-based stress reduction and physiological activity during acute stress: A randomized controlled trial. Health Psychol. in press.
    1. Greeson JM. Mindfulness research update: 2008. Compl Health Pract Rev. 2009;14:10–18.
    1. Palta P, Page G, Piferi RL, et al. Evaluation of a mindfulness-based intervention program to decrease blood pressure in low-income AfricanfAmerican older adults. Journal of Urban Health. 2012;89:308–316.

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