C/EBPbeta represses p53 to promote cell survival downstream of DNA damage independent of oncogenic Ras and p19(Arf).

CCAAT/enhancer-binding protein-beta (C/EBPbeta) is a mediator of cell survival and tumorigenesis. When C/EBPbeta(-/-) mice are treated with carcinogens that produce oncogenic Ras mutations in keratinocytes, they respond with abnormally elevated keratinocyte apoptosis and a block in skin tumorigenesis. Although this aberrant carcinogen-induced apoptosis results from abnormal upregulation of p53, it is not known whether upregulated p53 results from oncogenic Ras and its ability to induce p19(Arf) and/or activate DNA-damage response pathways or from direct carcinogen-induced DNA damage. We report that p19(Arf) is dramatically elevated in C/EBPbeta(-/-) epidermis and that C/EBPbeta represses a p19(Arf) promoter reporter. To determine whether p19(Arf) is responsible for the proapoptotic phenotype in C/EBPbeta(-/-) mice, C/EBPbeta(-/-);p19(Arf-/-) mice were generated. C/EBPbeta(-/-);p19(Arf-/-) mice responded to carcinogen treatment with increased p53 and apoptosis, indicating p19(Arf) is not essential. To ascertain whether oncogenic Ras activation induces aberrant p53 and apoptosis in C/EBPbeta(-/-) epidermis, we generated K14-ER:Ras;C/EBPbeta(-/-) mice. Oncogenic Ras activation induced by 4-hydroxytamoxifen did not produce increased p53 or apoptosis. Finally, when C/EBPbeta(-/-) mice were treated with differing types of DNA-damaging agents, including alkylating chemotherapeutic agents, they displayed aberrant levels of p53 and apoptosis. These results indicate that C/EBPbeta represses p53 to promote cell survival downstream of DNA damage and suggest that inhibition of C/EBPbeta may be a target for cancer cotherapy to increase the efficacy of alkylating chemotherapeutic agents.

Relational pathways between socioeconomic position and cardiovascular risk in a multiethnic urban sample: complexities and their implications for improving health in economically disadvantaged populations.

BACKGROUND: The study was designed to provide evidence of a cascade effect linking socioeconomic position to anthropometric indicators of cardiovascular disease (CVD) risk through effects on psychosocial stress, psychological distress and health-related behaviours, and consider implications for disease prevention and health promotion. METHODS: A cross-sectional stratified two-stage probability sample of occupied housing units in three areas of Detroit, Michigan, was used in the study. 919 adults aged > or =25 years completed the survey (mean age 46.3; 53% annual household income <$20 000; 57% non-Hispanic black, 22% Latino, 19% non-Hispanic white). Variables included self-report (eg, psychosocial stress, depressive symptoms, health behaviours) and anthropometric measurements (eg, waist circumference, height, weight). The main outcome variables were depressive symptoms, smoking status, physical activity, body mass index and waist circumference. RESULTS: Income was inversely associated with depressive symptoms, likelihood of current smoking, physical inactivity and waist circumference. These relationships were partly or fully mediated by psychosocial stress. A suppressor effect of current smoking on the relationship between depressive symptoms and waist circumference was found. Independent effects of psychosocial stress and psychological distress on current smoking and waist circumference were found, above and beyond the mediated pathways. CONCLUSIONS: The results suggest that relatively modest improvements in the income of economically disadvantaged people can set in motion a cascade of effects, simultaneously reducing exposure to stressful life conditions, improving mental well-being, increasing health-promoting behaviours and reducing anthropometric risks associated with CVD. Such interventions offer important opportunities to improve population health and reduce health disparities.

Psychological adjustment to sudden and anticipated spousal loss among older widowed persons.

OBJECTIVES: This study examined if older adults' psychological adjustment to widowhood varies based on whether the death was sudden or anticipated and if these effects are mediated by death context characteristics (e.g., predeath caregiving, nursing home use, spouse's age at death, and couple's communication about the death). METHODS: The effects of forewarning on multiple indicators of mental health and grief were examined in a sample of 210 widowed persons who participated in the Changing Lives of Older Couples (CLOC) study. The CLOC is a probability sample of 1,532 married individuals aged 65 and older for whom baseline information was collected in 1987-88, with widowed persons reinterviewed 6, 18, and 48 months after spousal loss. RESULTS: Forewarning did not affect depression, anger, shock, or overall grief 6 or 18 months after the loss. Prolonged forewarning was associated with elevated anxiety both 6 and 18 months after the death. Sudden spousal death elevated survivors' intrusive thoughts at the 6-month follow-up only. Sudden death was associated with slightly higher levels of yearning among women but significantly lower yearning among men both 6 and 18 months after the loss. DISCUSSION: The findings call into question the widespread belief that grief is more severe if death is sudden and suggest a more complex relationship between bereavement and circumstances of spousal death.

Socioeconomic disparities in health change in a longitudinal study of US adults: the role of health-risk behaviors.

This study investigated the hypothesis that socioeconomic differences in health status change can largely be explained by the higher prevalence of individual health-risk behaviors among those of lower socioeconomic position. Data were from the Americans' Changing Lives study, a longitudinal survey of 3,617 adults representative of the US non-institutionalized population in 1986. The authors examined associations between income and education in 1986, and physical functioning and self-rated health in 1994, adjusted for baseline health status, using a multinomial logistic regression framework that considered mortality and survey nonresponse as competing risks. Covariates included age, sex, race, cigarette smoking, alcohol consumption, physical activity, and Body Mass Index. Both income and education were strong predictors of poor health outcomes. The four health-risk behaviors under study statistically explained only a modest portion of the socioeconomic differences in health at follow-up. For example, after adjustment for baseline health status, those in the lowest income group at baseline had odds of moderate/severe functional impairment in 1994 of 2.11 (95% C.I.: 1.40, 3.20) in an unadjusted model and 1.89 (95% C.I.: 1.23, 2.89) in a model adjusted for health-risk behaviors. The results suggest that the higher prevalence of major health-risk behaviors among those in lower socioeconomic strata is not the dominant mediating mechanism that can explain socioeconomic disparities in health status among US adults.

Excess mortality among urban residents: how much, for whom, and why?

OBJECTIVES: The goals of this study were to estimate prospective mortality risks of city residence, specify how these risks vary by population subgroup, and explore possible explanations. METHODS: Data were derived from a probability sample of 3617 adults in the coterminous United States and analyzed via cross-tabular and Cox proportional hazards methods. RESULTS: After adjustment for baseline sociodemographic and health variables, city residents had a mortality hazard rate ratio of 1.62 (95% confidence interval [CI] = 1.21, 2.18) relative to rural/small-town residents; suburbanites had an intermediate but not significantly elevated hazard rate ratio. This urban mortality risk was significant among men (hazard rate ratio: 2.25), especially non-Black men, but not among women. Among Black men, and to some degree Black women, suburban residence carried the greatest risk. All risks were most evident for those younger than 65 years. CONCLUSIONS: The mortality risk of city residence, at least among men, rivals that of major psychosocial risk factors such as race, low income, smoking, and social isolation and merits comparable attention in research and policy.

Marital quality and psychological adjustment to widowhood among older adults: a longitudinal analysis.

OBJECTIVES: This study examined whether psychological adjustment to widowhood is affected by three aspects of marital quality--warmth, conflict, and instrumental dependence-assessed prior to the loss. METHODS: The Changing Lives of Older Couples (CLOC) is a prospective study of a two-stage area probability sample of 1,532 married individuals aged 65 and older. The CLOC includes baseline data on marital quality and mental health and data on grief, anxiety, and depression collected 6, 18, and 48 months after spousal loss. RESULTS: Widowhood was associated with elevated anxiety among those who were highly dependent on their spouses and lower levels of anxiety among those who were not dependent on their spouses. Levels of yearning were lower for widowed persons whose relationships were conflicted at baseline and higher for those reporting high levels of marital closeness and dependence on their spouses. Women who relied on their husbands for instrumental support had significantly higher levels of yearning than men who depended on their wives. DISCUSSION: The findings contradict the widespread belief that grief is more severe if the marriage was conflicted and suggest a more complex relationship between bereavement and characteristics of the marriage.

Volunteering and mortality among older adults: findings from a national sample.

OBJECTIVES: Although a number of authors have proposed that older volunteers should benefit in terms of better health and well-being, few researchers have examined the issue empirically to see whether this is true. The purpose of this article is to build on this literature by empirically examining the association between volunteering and mortality among older adults. METHODS: Using data from a nationally representative sample, we use Cox proportional hazards regression to estimate the effects of volunteering on the rate of mortality among persons aged 65 and older. RESULTS: We find that volunteering has a protective effect on mortality among those who volunteered for one organization or for forty hours or less over the past year. We further find that the protective effects of volunteering are strongest for respondents who report low levels of informal social interaction and who do not live alone. DISCUSSION: We discuss the possibility that the curvilinear relationship we observe between volunteering and mortality is due to a combination of factors, including self-identity, role strain, and meaningfulness. Other research using more precise data is needed to determine whether these ideas are supportable.

Gender and the socioeconomic gradient in mortality.

Despite considerable evidence documenting a strong and persistent relationship between socioeconomic position and mortality, recent research suggests that this association may be weaker among women. In our examination of gender differences in the socioeconomic gradient in mortality, we argue that this inconsistency arises from the failure to consider the ways in which gender is a fundamental constituent of socioeconomic position. The data used are from the Panel Study of Income Dynamics. Respondents, including all household heads and their partners, aged 29 years and older in 1972 (N = 5,665; 56% female), were followed until 1991, death, or attrition. Discrete time event history analysis was used to examine the predictors of death between 1972 and 1991. Of the key socioeconomic predictors, years of education was measured at baseline, while earned income was a time-varying covariate. We find no gender differences in the effect of respondents' own socioeconomic positions on their mortality risk. However, increasing spousal income raises men's odds of dying, while the opposite is true for women. Our results raise questions about the prevailing view that the socioeconomic gradient in mortality is weaker among women. Moreover, gender differences in the effects of spousal earnings on mortality risk suggest that their labor market rewards have fundamentally different meanings for women and men.

Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults.

CONTEXT: A prominent hypothesis regarding social inequalities in mortality is that the elevated risk among the socioeconomically disadvantaged is largely due to the higher prevalence of health risk behaviors among those with lower levels of education and income. OBJECTIVE: To investigate the degree to which 4 behavioral risk factors (cigarette smoking, alcohol drinking, sedentary lifestyle, and relative body weight) explain the observed association between socioeconomic characteristics and all-cause mortality. DESIGN: Longitudinal survey study investigating the impact of education, income, and health behaviors on the risk of dying within the next 7.5 years. PARTICIPANTS: A nationally representative sample of 3617 adult women and men participating in the Americans' Changing Lives survey. MAIN OUTCOME MEASURE: All-cause mortality verified through the National Death Index and death certificate reviews. RESULTS: Educational differences in mortality were explained in full by the strong association between education and income. Controlling for age, sex, race, urbanicity, and education, the hazard rate ratio of mortality was 3.22 (95% confidence interval [CI], 2.01-5.16) for those in the lowest-income group and 2.34 (95% CI, 1.49-3.67) for those in the middle-income group. When health risk behaviors were considered, the risk of dying was still significantly elevated for the lowest-income group (hazard rate ratio, 2.77; 95% CI, 1.74-4.42) and the middle-income group (hazard rate ratio, 2.14; 95% CI, 1.38-3.25). CONCLUSION: Although reducing the prevalence of health risk behaviors in low-income populations is an important public health goal, socioeconomic differences in mortality are due to a wider array of factors and, therefore, would persist even with improved health behaviors among the disadvantaged.

Education and income differentials in breast and cervical cancer screening. Policy implications for rural women.

OBJECTIVES: Despite substantial evidence of socioeconomic differences in the use of breast and cervical cancer screening, the mechanisms explaining these differences, and therefore their policy implications are not well understood. We investigated the way that education and income influence rural women's use of mammograms and Pap tests, including financial barriers to medical care, knowledge and attitudinal barriers, and nonfinancial factors related to health-care access. METHODS: Data were from a population-based telephone survey of 2,346 rural Wisconsin women aged 40 years and older. Logistic regression analyses and simulation exercises were conducted. RESULTS: The strongest barriers to screening in this rural population were nonfinancial impediments to access. Removing economic barriers did not lead to significant increases in screening when other types of barriers were present. CONCLUSIONS: Policies and interventions that focus on the most visible differences that exist between rural women of differing socioeconomic levels (ie, differences in the ability to afford health services) and do not simultaneously address knowledge, attitudinal, and health-care access barriers will fall short of their goal to increase breast and cervical cancer screening.

SES differentials in health by age and alternative indicators of SES.

Despite the general persistence and even increase of strong socioeconomic status (SES) differentials in health in the United States, research suggests that SES differentials in health may diminish or become nonexistent at older ages. However, most research has used only limited measures of SES (e.g. education, income), and has not thoroughly investigated intra-elderly age differences in this trend. The current study investigates how SES differentials in health vary by age in the United States, using fairly detailed age categories (through ages 85+), and 2 alternative indicators (home ownership and liquid assets) of a major additional dimension of SES, financial assets, which may be especially important at older ages. We address (a) how strongly financial assets are associated with health, considered both alone and net of education and income; (b) if the health effects of financial assets vary by age; and, more specifically, (c) if their effects are especially pronounced in older age, again considered both alone and net of or relative to education and income. Results show that financial assets, especially liquid assets, considered both alone and net of education and income, are associated with health throughout adulthood and old age, at least until ages 85+. Furthermore, financial assets remain associated with health until quite late in life and become more important relative to education and income at older ages for some measures of health.

The social stratification of aging and health.

The way health varies with age is importantly stratified by socioeconomic status (SES)--specifically, education and income. Prior theory and cross-sectional data suggest that among higher SES persons the onset of health problems is usually postponed until rather late in life, while health declines are prevalent in lower SES groups by middle age. Thus, SES differences in health are small in early adulthood, but increase with age until relatively late in life, when they diminish due to selection or greater equalization of health risks and protections. The present paper strengthens our causal and interpretive understanding of these phenomena by showing: (1) that results previously reported for indices of SES hold separately for education and income; (2) that the interaction between age and SES (i.e., education or income) in predicting health can be substantially explained by the greater exposure of lower SES persons to a wide range of psychosocial risk factors to health, especially in middle and early old age, and, to a lesser degree, the greater impact of these risk factors on health with age; and (3) that results (1) and (2) generally hold in short-term longitudinal as well as in cross-sectional data. Implications for science and policy in the areas of aging, health, and social stratification are discussed.

Chronic job insecurity among automobile workers: effects on job satisfaction and health.

Work conditions characterized by uncertainty and ambiguity are potential stressors for employees. One such stressor is job insecurity. This longitudinal study of 207 automobile manufacturing workers indicates that chronic job insecurity is predictive of changes over time in both job satisfaction and physical symptoms. Extended periods of job insecurity decrease job satisfaction and increase physical symptomatology, over and above the effects of job insecurity at any single point in time. These results indicate that job insecurity acts as a chronic stressor whose effects become more potent as the time of exposure increases. Worksite health professionals should develop strategies for reducing the impact of job insecurity on employee well-being, particularly in industries where employment opportunities are declining.

The relationship between age and depressive symptoms in two national surveys.

There is inconsistency in the literature on the relationship between age and depressive symptoms. Although a careful review shows that some of this inconsistency can be reconciled by recognizing the nonlinear relationship (Newmann, 1989), 2 additional issues remain unclear. One is that most previous studies used depression screening scales that contain somatic items that could introduce an age bias. The other is that most previous studies combined samples of men and women even though there is evidence that the sex difference in depressive symptoms varies with age. These 2 issues are addressed in this article, using analyzed data from 2 large national surveys. There is a consistent, but quite modest, nonlinear association between age, somatic, and nonsomatic depressive symptoms in both surveys. There is no significant sex difference in the age curves.

Factors facilitating adjustment to unemployment: implications for intervention.

Conducted a community survey in the Fall of 1984 in a sample of high unemployment blue-collar census tracts in southeastern Michigan. Results of earlier analyses using these data showed that involuntarily unemployed workers had significantly elevated levels of depression, anxiety, somatization, and self-reported physical illness relative to a stably employed comparison group (Kessler, House, & Turner, 1987). Results presented in this paper document that this relationship is modified by social support (as measured by social integration and the availability of a confidant), self-concept, and various coping processes. Further analyses allowed us to determine the way in which these modifiers operate. The modifying effects of social support and coping operate primarily by buffering the impact of unemployment-related financial strain on the health outcomes. Self-concept operates primarily by attenuating vulnerability to other stressful life events. The implications of these results for the design and implementation of preventive interventions are discussed.

Relation of work and retirement to health and well-being in older age.

Patterns of labor-force participation were studied with a broad array of indicators of physical and psychological well-being. The sheer amount of work--whether people work and, if so, how many hours they work--shows little relationship to health and well-being. Drawing on scattered existing research and theory, it is hypothesized and found that persons whose patterns of labor-force participation (or nonparticipation) reflect their personal preference report higher levels of physical and psychological well-being than do those whose level of labor-force involvement is constrained by other factors. The results do not differ by gender, age (65 years and older vs. 55-64 years), or occupation (professional vs. clerical or sales vs. blue-collar workers). Data are from 1,339 respondents 55 years of age or older in the Americans' Changing Lives Survey, a large national, cross-sectional survey of Americans 25 years of age and older with an oversample of those 60 years of age and older, and are analyzed by ordinary least squares multiple regression.