Neighborhood disadvantage, disorder, and health.

We examine the question of whether living in a disadvantaged neighborhood damages health, over and above the impact of personal socioeconomic characteristics. We hypothesize that (1) health correlates negatively with neighborhood disadvantage adjusting for personal disadvantage, and that (2) neighborhood disorder mediates the association, (3) partly because disorder and the fear associated with it discourage walking and (4) partly because they directly impair health. Data are from the 1995 Community, Crime, and Health survey, a probability sample of 2,482 adults in Illinois, with linked information about the respondent's census tract. We find that residents of disadvantaged neighborhoods have worse health (worse self-reported health and physical functioning and more chronic conditions) than residents of more advantaged neighborhoods. The association is mediated entirely by perceived neighborhood disorder and the resulting fear. It is not mediated by limitation of outdoor physical activity. The daily stress associated with living in a neighborhood where danger, trouble, crime and incivility are common apparently damages health. We call for a bio-demography of stress that links chronic exposure to threatening conditions faced by disadvantaged individuals in disadvantaged neighborhoods with physiological responses that may impair health.

Age and the effect of economic hardship on depression.

The amount of depression associated with economic hardship among adults may depend on age. This study tests alternative hypotheses about the interaction. The first asserts that the amount of depression associated with economic hardship decreases with older age because of maturity and experience. The second, the opposite, asserts that the amount increases with older age because of increasingly limited future opportunities for recovery. The study analyzes data from 2,592 households in the 1995 and 1998 telephone survey of Aging, Status, and the Sense of Control (ASOC). Regression analyses find that the amount of depression associated with economic hardship decreases with older age, both cross-sectionally and over time. No model shows an increase with age in the depression associated with economic hardship. However, regressions do show that not having household wage income or having a disabling or life threatening chronic disease increases the depression associated with economic hardship. Those interactions somewhat suppress the moderating effect of older age on the association between economic hardship and depression.

Relationships among postconcussional-type symptoms, depression, and anxiety in neurologically normal young adults and victims of mild brain injury.

This study investigated the relationship between self-reports of postconcussional symptoms, depression, and anxiety in neurologically normal young adults and recovered victims of mild head injuries (MHI). The participants were 496 young adults with no history of MHI or depression, 56 neurologically normal individuals with clinical depression, and 40 people with history of MHI. All completed the Beaumont Postconcussional Index (BPCI), Beck Depression Inventory-II (BDI-II), and the Beck Anxiety Inventory (BAI). Groups were compared on frequency and severity of postconcussional symptoms, as well as general symptoms. Analysis revealed high correlations between scores on the Postconcussional Index (PCI) and the BDI-II (r=0.68) as well as between PCI and BAI (r=0.64). Correlations between BDI-II, BAI, and the General Symptom Index (GSI) were modest, but significant (r=0.44 and 0.48, respectively). MHI participants reported minimally higher scores on the PCI than the normative group. However, depressed individuals exhibited substantially higher endorsement of PCI symptoms and modestly higher endorsement of GSI symptoms than either the normative or MHI groups. The potential rule that depression can have in producing, exacerbating, and maintaining PCS-like symptoms must be considered when evaluating and treating victims of MHI.

Does medical insurance contribute to socioeconomic differentials in health?

Both access to insurance and health itself vary widely by socioeconomic status (SES). Are socioeconomic variations in health linked to insurance coverage or to factors that lie outside the medical care arena? Data from the Aging, Status, and the Sense of Control Survey were the basis of a representative U.S. national telephone survey conducted in 1995, and again in 1998. The results showed that persons with private insurance do not differ significantly from the uninsured in their self-reported health, physical functioning, or number of chronic conditions, whereas persons with public insurance report significantly worse health and more chronic conditions than the uninsured. These longitudinal results hold with adjustment for baseline health, SES, change in social status, and the hazard of attrition. Medical insurance does not mediate any associations between SES and health. Medical insurance of all kinds, however, does reduce difficulties in paying medical bills, and Medicaid is associated with more doctor visits and prescription drugs.

Neighborhood disorder, fear, and mistrust: the buffering role of social ties with neighbors.

This paper proposes that individuals who report that they live in neighborhoods characterized by disorder--by crime, vandalism, graffiti, danger, noise, dirt, and drugs--have high levels of fear and mistrust. It further proposes that an individual's alliances and connections with neighbors can buffer the negative effects of living in a neighborhood characterized by disorder on fear and mistrust. Results from a representative sample of 2482 Illinois residents collected by telephone in 1995 support the propositions. Living in a neighborhood with a lot of perceived disorder significantly affects mistrust and the fear of victimization, adjusting for sociodemographic characteristics. Perceived neighborhood disorder and social ties significantly interact: informal social ties with neighbors reduce the fear- and mistrust-producing effects of disorder. However, formal participation in neighborhood organizations shows little buffering effect.

Walking, exercising, and smoking: does neighborhood matter?

Neighborhood context could affect health behaviors because of structure or contagion. We expected that residents of US neighborhoods where a high percentage of residents are poor and do not have college degrees would be more likely to smoke and less likely to walk and exercise. We examined the hypotheses using multi-level data in which survey information from a representative sample of Illinois residents is linked to census-tract information about poverty and education in their neighborhood. Contrary to expectations we found that residents of poor neighborhoods were more likely to walk than those in less disadvantaged places, adjusting for individual poverty, household income, education, race, ethnicity, sex, age, and marital status. This was the case despite the fact that residents of poor neighborhoods were more afraid to leave the house and feared being victimized on the streets. Consistent with expectations we found that residents of neighborhoods where a high percentage of residents are college educated are more likely to walk. Thus, the two aspects of neighborhood socioeconomic status had opposite effects on walking. Neighborhood context had no effect on the likelihood of exercising strenuously. Men in poor neighborhoods were more likely to smoke than those in less disadvantaged places, but neighborhood context had no significant effect on women's likelihood of smoking.

Refining the association between education and health: the effects of quantity, credential, and selectivity.

We refine the established association between education and health by distinguishing three aspects of a person's education (quantity, credential, and selectivity) and by examining the mechanisms through which they may correlate with health. Data are from the 1995 Aging, Status, and the Sense of Control Survey, a representative U.S. national telephone survey of 2,593 respondents aged 18 to 95, with an oversample of elderly. Results show that physical functioning and perceived health increase significantly with years of formal education and with college selectivity for those with a bachelor's or higher degree, adjusting for age, sex, race, marital status, and parental education. The credential of a college degree has no net association with physical functioning and perceived health beyond the amount attributable to the additional years of schooling. Of the three aspects of education, years of schooling has the largest effect. Most of that association appears attributable to its correlation with work and economic conditions, social psychological resources, and health lifestyle. A large portion of the net association of college selectivity with physical functioning and perceived health appears attributable to health lifestyle.

Monograph: reassessment of human cancer risk of aldrin/dieldrin.

In 1987, the US Environmental Protection Agency (EPA) classified aldrin and dieldrin as category B2 carcinogens, i.e. probable human carcinogens, based largely on the increase in liver tumors in mice fed either organochlorine insecticide. At that date, the relevant epidemiology was deemed inadequate to influence the cancer risk assessment. More time has now elapsed since early exposures of manufacturing workers to aldrin/dieldrin; therefore, updated epidemiological data possess more power to detect exposure-related differences in cancer risk and mortality. Also, recent experimental studies provide a plausible mode of action to explain the mouse specificity of dieldrin-induced hepatocarcinogenesis and call into question the relevance of this activity to human cancer risk. This monograph places this new information within the historic and current perspectives of human cancer risk assessment, including EPA's 1996 Proposed Guidelines for Carcinogen Risk Assessment. Updated epidemiological studies of manufacturing workers in which lifetime exposures to aldrin/dieldrin have been quantified do not indicate increased mortality or cancer risk. In fact, at the middle range of exposures, there is evidence of a decrease in both mortality from all causes and cancer. Recent experimental studies indicate that dieldrin-induced hepatocarcinogenesis in mice occurs through a nongenotoxic mode of action, in which the slow oxidative metabolism of dieldrin is accompanied by an increased production of reactive oxygen species, depletion of hepatic antioxidant defenses (particularly alpha-tocopherol), and peroxidation of liver lipids. Dieldrin-induced oxidative stress or its sequelae apparently result in modulation of gene expression that favors expansion of initiated mouse, but not rat, liver cells; thus, dieldrin acts as a nongenotoxic promoter/accelerator of background liver tumorigenesis in the mouse. Within the framework of EPA's Proposed Guidelines for Carcinogen Risk Assessment, it is proposed that the most appropriate cancer risk descriptor for aldrin/dieldrin, relating to the mouse liver tumor response, is 'not likely a human carcinogen', a descriptor consistent with the example of phenobarbital cited by EPA.

Medical surveillance for hematological disorders among active and retired oil refinery workers.

Ten-year (1985-1995) results of an expanded medical surveillance program of 2475 active employees and retirees of an oil refinery and petrochemical complex in Illinois are presented. At the end of the program, 116 participants with persistent abnormalities of complete blood cell count had been referred for hematologic evaluation, and most were found to have benign conditions. Fifteen of the 116 were referred for bone marrow and cytogenetic studies. All of the referred active employees (seven) were found to have completely normal bone marrows with no evidence of any myelopathic process. Among the eight retirees, two had normal bone marrows, one was diagnosed with Philadelphia chromosome-positive chronic myelogenous leukemia, one declined to participate, and four were diagnosed to have myelodysplastic syndrome (MDS) of various subtypes. A total of eight cases of MDS were identified, including six cases among program participants and two cases among nonparticipants. The MDS standardized incidence ratio of 1.26 (95% confidence interval = 0.54-2.47) was not statistically significant, and there was virtually no increase of MDS in persons less than 80 years of age (4 observed and 3.8 expected). This MDS increase was entirely from program participants, probably because of intensive follow-up and diagnostic screening. Routine surveillance of complete blood cell count information did not identify any new cases of leukemia or MDS in active employees. These findings suggest that the utility of expanded medical surveillance program in this population is very limited.

Consequences of retirement activities for distress and the sense of personal control.

We compare retirement with full-time employment on four forms of engaging activity and examine the consequences of retirement activities for the sense of control and psychological distress. We use a 1995 U.S. national telephone probability sample of 2,592 respondents with an oversample of persons aged sixty and older. In comparison to the activities of full-time employees, those of retirees are more alienating on some aspects but more engaging on others. Retiree activities are more routine, provide less of a chance to learn new things, provide less positive social interaction with others, and they are especially unlikely to involve problem-solving. However, retirees' activities are also equally enjoyable and more autonomous compared to those of full-time workers. Autonomous activities, fulfilling activities which are enjoyable and provide the opportunity to learn new things, and integrated activities are all positively associated with a sense of control and negatively associated with psychological distress. However, solving problems is associated with both high levels of control and high levels of distress. Retirees have a significantly lower sense of control than do full-time employees, in large part because of the characteristics of their daily activities. At the same time, retirees do not have significantly higher levels of psychological distress.

Education and the subjective quality of life.

We examine whether education influences subjective quality of life. If it does, what are the mechanisms by which education affects well-being? We propose that education improves well-being because it increases access to nonalienated paid work and economic resources that increase the sense of control over life, as well as access to stable social relationships, especially marriage, that increase social support. We examine the relationship between education and a variety of indicators of subjective quality of life-depression, anxiety, anger, aches and pains, malaise, and dissatisfaction. Using two representative national samples collected in 1990 and 1995, we find that the well educated have lower levels of emotional distress (including depression, anxiety, and anger) and physical distress (including aches and pains and malaise), but they do not have lower levels of dissatisfaction. Education reduces distress largely by way of paid work, nonalienated work, and economic resources, which are associated with high personal control; but the extent to which it reduces distress by way of marriage and social support is much more modest. We contrast distress and dissatisfaction as indicators of the subjective quality of life.

A mortality study of oil refinery and petrochemical employees.

Results from a prospective mortality surveillance of 3803 refinery and petrochemical workers at a Shell Oil Company facility in Louisiana are presented. This report includes employees who worked more than 6 months before January 1, 1994 and pensioners who were alive as of January 1, 1973. Vital status was ascertained through 1993. Regardless of the comparison population used to calculate expected numbers (United States, Louisiana, or the surrounding tri-parish area), significantly fewer deaths were observed for all causes combined, all malignant neoplasms, heart disease, nonmalignant respiratory disease, and cirrhosis of the liver among male employees after 10 or more years' latency. With the United States as comparison, the all causes combined standardized mortality ratio (SMR) was 0.72 (95% confidence interval [CI] = 0.65 to 0.79), and the SMR for all cancer was 0.75 (95% CI = 0.61 to 0.92). The brain cancer rate for this group was nonsignificantly increased, with five observed deaths and three expected deaths, whereas mortality from leukemia was consistently lower than expected. The overall favorable mortality experienced by employees at this refinery and chemical plant is probably a result of a combination of factors, such as the healthy worker effect, relatively low risks related to the workplace, and the beneficial effects of continuing employment.

Illness absence at an oil refinery and petrochemical plant.

Results from a prospective illness-absence surveillance of refinery and petrochemical workers from 1986 through 1994 are presented. Illness absence data for this study were extracted from the morbidity section of the Shell Oil Company's Health Surveillance System, which includes records of all illness absences in excess of 5 days. The majority of employees (59%) had no illness absence during the 9-year period studied. The 13% of the population who had three or more absences accounted for 63% of the total illness absence episodes and 62% of the total work days lost. Frequency rate and duration of absence increased with increasing age. The increased illness absence was associated with the presence of known health risk factors, such as smoking, elevated blood pressure, high cholesterol, and obesity. For example, obese women had a twofold increased illness absence rate compared with nonobese women and the rate for male smokers doubled that of nonsmoking men. These health risk factors are also more common among employees with three or more absences than those with fewer or no absences. The goal of this analysis is to quantify the impact of illness absence to develop disease prevention strategies to maximize good health in employees and to minimize both the frequency and duration of illness absence.

Fundamental analysis in research on well-being: distress and the sense of control.

Fundamental analysis defines the basic terms of social and behavioral research. It usually follows the rule "one concept to a measure." However, some responses inherently reflect more than one underlying attribute, as when a test score reflects both knowledge of the subject and practice with taking tests. The standard methods of fundamental analysis break down in the presence of such cross-cutting factors. In this article, we discuss two instances of confusion and disagreement among social and behavioral scientists generated by the effects of cross-cutting factors on critical measures. In the first instance, a tendency to agree with the statements of others can make beliefs about personal control over events and outcomes seem unrelated to beliefs about control by chance, fate, or powerful others. The tendency to agree correlates positively with age. In the second instance, emotional expressiveness can make the frequency or intensity of sadness seem unrelated to the frequency or intensity of happiness. Women, who make up the large majority of older Americans, express themselves more freely than men. The apparent disjointedness of internal and external attributions of control, or of positive and negative emotions, results from methods assuming that the response to each question reflects one and only one underlying factor. Cross-cutting factor models eliminate the bias and confusion produced by response tendencies and help isolate and define the essential dimensions of response.

A novel DNA repair response is induced in human cells exposed to ionizing radiation at the G1/S-phase border.

We have discovered a novel DNA repair response which is induced in cells irradiated with gamma rays at the G1/S-phase border. The induction of this repair response occurs at a stage in the cell cycle when overall levels of excision repair are reduced compared to cells irradiated in either S phase, G2/M phase or exponential growth. The induced repair is characterized by the formation of very long excision repair patches (VLERP) containing at least 150 nucleotides compared to the constitutive repair patches that are 3-5 nucleotides. These VLERP appear to be produced in response to a DNA lesion specific to ionizing radiation since they were not observed in cells irradiated with UV radiation at G1/S phase. The formation of VLERP requires both the nucleotide excision repair pathway, since they are absent in irradiated xeroderma pigmentosum group A cells, and the synthesis of new protein and mRNA. The time course for the induction of the VLERP shows an initial delay of 2 h, followed by a steady increase for up to 12 h after irradiation. By comparison, the production of the constitutive short repair patches shows an initial rapid production which levels out after 4 h.

Identification of a potential role for the adventitia in vascular lesion formation after balloon overstretch injury of porcine coronary arteries.

BACKGROUND: In the present series of experiments, we examined the onset of cell proliferation and growth factor expression after balloon overstretch injury to porcine coronary arteries. METHODS AND RESULTS: Domestic juvenile swine underwent balloon overstretch injury to the left anterior descending and circumflex coronary arteries with standard percutaneous transluminal coronary angioplasty balloon catheters. To identify proliferating cells, 5-bromo-2-deoxyuridine (BrDU) was administered over a period of 24 hours before the animals were killed at either 1, 3, 7, or 14 days after injury. Immunohistochemistry was performed with monoclonal antibodies to BrDU and smooth muscle cell markers. Three days after injury, a large number of proliferating cells were located in the adventitia, with significantly fewer positive cells found in the media and lumen. Seven days after injury, proliferating cells were found primarily in the neointima, extending along the luminal surface. In situ hybridization for PDGF A-chain and beta-receptor mRNAs revealed that the expression of these two genes was closely correlated with the sites of proliferation at each time point. Studies in which BrDU was injected between days 2 and 3 and the animals were killed on day 14 suggested that the proliferating adventitial cells may migrate into the neointima. CONCLUSIONS: These data suggest that adventitial myofibroblasts contribute to the process of vascular lesion formation by proliferating, synthesizing growth factors, and possibly migrating into the neointima. Increased synthesis of alpha-smooth muscle actin observed in the adventitial cells after arterial injury may constrict the injured vessel and contribute to the process of arterial remodeling and late lumen loss after angioplasty.

Mortality study of employees with potential exposure to epichlorohydrin: a 10 year update.

OBJECTIVES: A 10 year extension of follow up (up to 1993) of 863 employees who had potential exposure to epichlorohydrin at two chemical plants between May 1948 and December 1965 was conducted to further evaluate the previously reported potential association between exposure to epichlorohydrin and heart disease. METHODS: The mortality observed was compared with that expected from the death rates from the local male population where these chemical plants are located. Workers were assigned to one of five exposure categories based on their job with the highest level of potential exposure. Vital status was ascertained to the end of 1993. RESULTS: Among diseases of particular interest, there were no excess deaths from heart disease (standardised mortality ratio (SMR) 63.3), lung cancer (SMR 63.8), or non-malignant respiratory disease (SMR 37.7) for employees with 20 or more years after first exposure. Based on the level of potential exposure to epichlorohydrin, mortality for heart disease was slightly higher (SMR 75.7, 95% confidence interval (95% CI) 51.8-106.7) in the moderate to heavy exposure group than in the none to light exposure group (SMR 59.5, 95% CI 37.7-89.3); this difference is well within the range of random variation. The SMR for heart disease was 90.4 among employees who had both probable exposure to allyl chloride and moderate to heavy exposure to epichlorohydrin, although it was 88.1 among employees who had moderate to heavy potential exposure to epichlorohydrin but no exposure to allyl chloride. CONCLUSIONS: This study does not support an association between exposure to epichlorohydrin and heart disease or lung cancer. There were no additional deaths from leukaemia in this update; the raised SMR for leukaemia noted in the previous study has substantially decreased from 500.0 to 161.3 (95% CI 33.2-471.0) and is not significant. The overall mortality and cancer mortality of employees potentially exposed to epichlorohydrin continued to be lower than that of the local population.

Education, age, and the cumulative advantage in health.

The positive association between educational attainment and health is well established, but the way in which the education-based gap in health varies with age is not. Do the health advantages of high educational attainment and disadvantages of low educational attainment diverge or converge with age? The cumulative advantage perspective predicts a diverging SES gap in health with age, but past evidence does not allow us to accept or reject the hypothesis. We address this issue in two samples, cross-sectionally and over time, with three health measures. The first data set consists of a 1990 telephone interview of a national probability sample of U.S. households. There are 2,031 respondents, aged 18 to 90. The second is a national probability sample of U.S. households in which 2,436 respondents aged 20 to 64 were interviewed by telephone in 1979 and reinterviewed in 1980. We find that the gap in self-reported health, in physical functioning, and in physical well-being among people with high and low educational attainment increases with age. The health advantage of the well educated is larger in older age groups than in younger. Health advantages of high income and disadvantages of low income also diverge with age, but household income does not explain education's positive effect.