Occupational, social, and relationship hazards and psychological distress among low-income workers: implications of the 'inverse hazard law'.

BACKGROUND: Few studies have simultaneously included exposure information on occupational hazards, relationship hazards (eg, intimate partner violence) and social hazards (eg, poverty and racial discrimination), especially among low-income multiracial/ethnic populations. METHODS: A cross-sectional study (2003-2004) of 1202 workers employed at 14 worksites in the greater Boston area of Massachusetts investigated the independent and joint association of occupational, social and relationship hazards with psychological distress (K6 scale). RESULTS: Among this low-income cohort (45% were below the US poverty line), exposure to occupational, social and relationship hazards, per the 'inverse hazard law,' was high: 82% exposed to at least one occupational hazard, 79% to at least one social hazard, and 32% of men and 34% of women, respectively, stated they had been the perpetrator or target of intimate partner violence (IPV). Fully 15.4% had clinically significant psychological distress scores (K6 score ≥ 13). All three types of hazards, and also poverty, were independently associated with increased risk of psychological distress. In models including all three hazards, however, significant associations with psychological distress occurred among men and women for workplace abuse and high exposure to racial discrimination only; among men, for IPV; and among women, for high exposure to occupational hazards, poverty and smoking. CONCLUSIONS: Reckoning with the joint and embodied reality of diverse types of hazards involving how people live and work is necessary for understanding determinants of health status.

Symptoms of reproductive tract infections and mental distress among women in low-income urban neighborhoods of Beirut, Lebanon.

OBJECTIVE: The aim of this study was to examine the association between symptoms of reproductive tract infections (RTIs) and mental distress among women residing in three low-income urban neighborhoods in Greater Beirut. METHODS: A cross-sectional survey of currently married women aged 15-49 years (n = 1506) from the 2003 Urban Health Study was undertaken. The dependent variables were complaining of vaginal discharge, pelvic pain, and pain during intercourse. The main independent variable was mental distress, measured using the General Health Questionnaire-12 (GHQ). Other variables included decision-making power, "comfort" with husband, age, education, income, household wealth, employment, community of residence, displacement by war, presence of chronic disease, reported reproductive health problem, membership in any group, receipt of favor last month, and smoking. Analysis was conducted using logistic regression models on the complaint of any symptom of RTIs and on individual complaints. RESULTS: Forty-two percent of the interviewed women reported at least one symptom of RTIs. Vaginal discharge was the most commonly reported symptom, with 33% of currently married women complaining from it. Mental distress was significantly associated with any reported RTI symptom (odds ratio [OR] = 1.41; 95% confidence interval [CI] = 1.09-1.83), pelvic pain (OR = 2.38; CI = 1.71-3.30), vaginal discharge (OR = 1.35; CI = 1.03-1.77), and pain during intercourse (OR = 2.37; CI = 1.66-3.40) after adjusting for demographic, socioeconomic, and health risk factors. CONCLUSIONS: A significant association between mental distress and reported RTI symptoms was established by this study. A new approach to gynecological morbidity is needed, one that integrates biomedical and psychosocial factors into a unified framework.

Race/ethnicity and breast cancer estrogen receptor status: impact of class, missing data, and modeling assumptions.

OBJECTIVE: To test whether reported associations between race/ethnicity and breast cancer estrogen receptor (ER) status are inflated due to missing ER data, lack of socioeconomic data, and use of the odds ratio (OR) rather than the prevalence ratio (PR). METHODS: We geocoded and added census tract socioeconomic data to all cases of primary invasive breast cancer (n = 42,420) among women diagnosed between 1998 and 2002 in two California cancer registries (San Francisco Bay Area; Los Angeles County) and analyzed the data using log binomial regression. RESULTS: Adjusting for socioeconomic position and tumor characteristics, in models using the imputed data, reduced the PR for the black versus white excess risk of being ER--from 1.76 (95% CI: 1.66, 1.86; adjusted for age and catchment area) to 1.47 (95% CI: 1.38, 1.56). The latter parameter estimate was 16% greater (i.e., 1.56) in models excluding women with missing ER data, and was 43% greater when estimated using the OR (i.e., 1.82). CONCLUSION(S): Studies on race/ethnicity and ER status that fail to account for missing data and socioeconomic data and report the OR are likely to yield inflated estimates of racial/ethnic disparities in ER status.

Demographic and psychosocial profile of smoking among pregnant women in Lebanon: public health implications.

OBJECTIVES: To assess the prevalence and determinants of smoking prior to and during pregnancy in Lebanon. METHODS: A cross-sectional study using two structured instruments. One instrument included information on demographic characteristics, smoking patterns in the index pregnancy and previous pregnancies, use of prenatal health services, stressful life events, and social support during pregnancy. The second was the Arabic General Health Questionnaire (GHQ-12). Women who delivered in 11 randomly selected hospitals in Beirut and its suburbs within 24 hours were asked to consent to participate in the study. The total sample interviewed was 576 women. RESULTS: The prevalence of pre-pregnancy smoking was 32% and 20% for smoking in pregnancy. Considering argileh smoking, the prevalence of tobacco use in pregnancy increased to 27% in Beirut and 25% in the suburbs. Pre-pregnancy smoking was associated with older maternal age [OR = 1.08, 95% CI (1.03, 1.14)], low and medium education [OR = 2.22, 95% CI (1.22,4.04)], increased psychiatric distress [OR = 3.11, 95% CI (1.77,5.46)], and a husband who smoked [OR = 5.00, 95% CI (2.98,8.39)]. Continued smoking during pregnancy was associated with low and medium education [OR = 3.77, 95% CI (1.31, 10.8)], younger age [OR = 1.11, 95% CI (1.02-1.20)], and a heavy pre-pregnancy smoking pattern [OR = 13.9, 95% CI (1.40,137.4)]. CONCLUSION: Policies and programs to eliminate or reduce smoking during pregnancy should be targeted toward young and less educated females and involving the spouse. Obstetricians should promote smoking cessation during pregnancy using evidence-based methods.