Socioeconomic status and stress in Mexican-American women: a multi-method perspective.

Stress is a hypothesized pathway in socioeconomic status (SES)-physical health associations, but the available empirical data are inconsistent. In part, this may reflect discrepancies in the approach to measuring stress across studies, and differences in the nature of SES-stress associations across demographic groups. We examined associations of SES (education, income) with general and domain-specific chronic stressors, stressful life events, perceived stress, and stressful daily experiences in 318 Mexican-American women (40-65 years old). Women with higher SES reported lower perceived stress and fewer low-control experiences in everyday life (ps < .05), but greater chronic stress (education only, p < .05). Domain-specific analyses showed negative associations of income with chronic housing and financial stress (ps < .05), but positive associations of SES with chronic work and caregiving stress (all ps < .05 except for income and caregiving stress, p < .10). Sensitivity analyses showed that most SES-stress associations were consistent across acculturation levels. Future research should adopt a multi-dimensional assessment approach to better understand links among SES, stress, and physical health, and should consider the sociodemographic context in conceptualizing the role of stress in SES-related health inequalities.

Individual and neighborhood socioeconomic status and inflammation in Mexican American women: what is the role of obesity?

OBJECTIVE: Inflammation may represent a biological mechanism underlying associations of socioeconomic status (SES) with cardiovascular disease. We examined relationships of individual and neighborhood SES with inflammatory markers in Mexican American women and evaluated contributions of obesity and related heath behaviors to these associations. METHODS: Two hundred eighty-four Mexican American women (mean age = 49.74 years) were recruited from socioeconomically diverse South San Diego communities. Women completed measures of sociodemographic characteristics and health behaviors, and underwent a physical examination with fasting blood draw for assay of plasma C-reactive protein (CRP), interleukin 6 (IL-6), and soluble intercellular adhesion molecule 1 (sICAM-1). Neighborhood SES was extracted from the US Census Bureau 2000 database. RESULTS: In multilevel models, a 1-standard deviation higher individual or neighborhood SES related to a 27.35% and 23.56% lower CRP level (p values < .01), a 7.04% and 5.32% lower sICAM-1 level (p values < .05), and a 10.46% (p < .05) and 2.40% lower IL-6 level (not significant), respectively. Controlling for individual SES, a 1-standard deviation higher neighborhood SES related to a 18.05% lower CRP level (p = .07). Differences in body mass index, waist circumference, and dietary fat consumption contributed significantly to SES-inflammation associations. CONCLUSIONS: The findings support a link between SES and inflammatory markers in Mexican American women and implicate obesity and dietary fat in these associations. Additional effects of neighborhood SES were not statistically significant; however, these findings should be viewed tentatively due to the small sample size to evaluate contextual effects. Trial Registration ClinicalTrials.gov identifier: NCT00387166.

Associations between socioeconomic status and catecholamine levels vary by acculturation status in Mexican-American women.

BACKGROUND: Lower socioeconomic status (SES) is associated with poorer health, possibly through activation of the sympathetic nervous system. PURPOSE: This study aimed to examine the association between SES and catecholamine levels, and variations by acculturation. METHODS: Three hundred one Mexican-American women underwent examination with a 12-h urine collection. Analyses tested associations of SES, acculturation (language and nativity), and their interaction with norepinephrine (NOREPI) and epinephrine (EPI). RESULTS: No main effects for SES or the acculturation indicators emerged. Fully adjusted models revealed a significant SES by language interaction for NOREPI (p< .01) and EPI (p< .05), and a SES by nativity interaction approached significance for NOREPI (p= .05). Simple slope analyses revealed that higher SES related to lower catecholamine levels in Spanish-speaking women, and higher NOREPI in English-speaking women. Although nonsignificant, similar patterns were observed for nativity. CONCLUSIONS: Associations between SES and catecholamines may vary by acculturation, and cultural factors should be considered when examining SES health effects in Hispanics.

Do socioeconomic gradients in subclinical atherosclerosis vary according to acculturation level? Analyses of Mexican-Americans in the multi-ethnic study of atherosclerosis.

OBJECTIVE: To examine whether the association between socioeconomic position (SEP) and subclinical atherosclerosis in Mexican-Americans would be moderated by acculturation. Although SEP shows a consistent, inverse relationship with cardiovascular disease (CVD) risk in westernized non-Hispanic white populations, the relationship in ethnic minorities, including Hispanics, is often weak or even reversed (i.e., worse health with higher SEP). METHODS: Participants were 801 Hispanics of Mexican origin (49.6% = female; average age = 60.47 years) from the Multi-Ethnic Study of Atherosclerosis cohort who underwent computed tomography of the chest for coronary artery calcium (CAC) and thoracic aortic calcium (TAC). SEP was represented by a composite of self-reported education and income. Acculturation was a composite score, including language spoken at home, generation, and years of "exposure" to U.S. culture. RESULTS: Small but statistically significant SEP by acculturation interaction effects were identified in relation to prevalent CAC, prevalent TAC, and extent of TAC (all p < .05). Follow-up analyses revealed that the direction of the SEP gradient on detectable CAC changed as individuals progressed from low to high acculturation. Specifically, the association between SEP and calcification was positive at low levels of acculturation (i.e., a "reversed" gradient), and negative in circumstances of high acculturation (i.e., the expected, protective effect of higher SEP). CONCLUSIONS: The findings support the utility of examining SEP and acculturation simultaneously, and of disaggregating large ethnic groupings (e.g., "Hispanic") into meaningful subgroups to better understand health risks.

Socioeconomic status, psychosocial resources and risk, and cardiometabolic risk in Mexican-American women.

OBJECTIVES: The current study examined the contributions of psychosocial factors to the association between socioeconomic status (SES) and metabolic syndrome (MetSyn) risk, in a randomly selected community cohort of 304 middle-aged (40-65 years old) Mexican-American women, a population at elevated cardiometabolic risk. METHODS: Participants underwent a clinical exam and measures of demographic factors and psychosocial resource (i.e., personal and social resources) and risk (i.e., negative emotions and cognitions) variables. Confirmatory factor analysis (CFA) and structural equation models (SEMs) were performed in the total sample and in more- and less-U.S.-acculturated women (defined by language preference) separately. RESULTS: CFAs revealed single latent constructs for SES (i.e., income, education) and psychosocial resources/risk. Three-factor solution was identified, with blood pressure (systolic diastolic), lipids (high-density lipoprotein cholesterol triglycerides), and metabolic variables (glucose waist circumference) forming separate factors. SEMs showed that an indirect effects model with SES relating to MetSyn factors through psychosocial resources/risk provided a reasonable descriptive and statistical fit in the full and more-acculturated sample (root mean square error of approximation [RMSEA] and standardized root-mean-square residual < .08); fit in the less-acculturated sample was marginal according to RMSEA = .09. A significant mediated path from low SES to higher waist circumference/fasting glucose via lower psychosocial resources/higher psychosocial risk was identified in the overall and more-acculturated samples (p < .05). CONCLUSIONS: In this cohort of healthy, middle-aged Mexican-American women, contributions of psychosocial factors to SES-MetSyn associations were limited to the core underlying metabolic mechanisms, and to more-U.S.-acculturated women.

Socioeconomic Status and Health: What is the role of Reserve Capacity?

A robust, linear association between socioeconomic status (SES) and health has been identified across many populations and endpoints. This relationship is typically monotonic, so that each step down the SES hierarchy brings increased vulnerability to disease and premature mortality. Despite growing attention to health disparities, scientists and policy makers have made little progress toward confronting their causes and implementing effective solutions. Using the Reserve Capacity Model (Gallo & Matthews, 2003) as an organizing framework, the current article examines the contribution of resilient psychosocial resources to socioeconomic disparities in physical health. Findings suggest that deficient psychosocial resources, such as low perceptions of control and social support, may be one of many factors that connect low SES with poor health. Additional research is needed to test these relationships and their underlying mechanisms, to consider interventions to enhance reserve capacity, and to evaluate the efficacy of such efforts in fostering resilience to socioeconomic hardship.

Education, psychosocial resources, and metabolic syndrome variables in Latinas.

BACKGROUND: Individuals with low socioeconomic position (SEP) and Latino ethnicity are at high risk for the metabolic syndrome. In part, this may reflect that these populations benefit from fewer resilient resources to manage stressful environments, resulting in accentuated psychological and physiological costs (1). PURPOSE: We examined the direct effects of educational attainment (an indicator of SEP) and psychosocial resources on metabolic syndrome variables, and tested indirect effects of education, via resources. METHODS: Participants were 145 middle-aged (M=47.07 years) Latinas recruited from health clinics along the California-Mexico border. Women completed assessments of demographics and resilient resources; metabolic syndrome variables were measured (blood pressure [BP], waist circumference [WC]) or abstracted from medical charts (lipids, glucose). RESULTS: Women with less education reported fewer psychosocial resources (DeltaR2=.14, p<.0001) and showed a higher risk profile on measures of BP, WC, and plasma glucose (3-7% of variance explained, all ps<.05), relative to those with more education. Resources independently predicted lower WCs (DeltaR2=.07, p<.05). Education exerted an indirect effect (p<.05) through resources on WC, a core factor underlying the metabolic syndrome. CONCLUSIONS: Additional research is warranted to further explore the roles of resilient resources in relationships among SEP, metabolic risk factors, and chronic disease processes.