Financial strain and self-rated health among Black adults
| Autor: | Felicia D. Fisher, David W. Wetter, Pragati S. Advani, Lorraine R. Reitzel, Adolfo G. Cuevas, Lorna H. McNeill, Elaine J. Savoy, Nga Nguyen |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Gerontology
Adult Male Health (social science) Social Psychology Health Status Race and health Article Diagnostic Self Evaluation Surveys and Questionnaires Health care Confidence Intervals Humans Social determinants of health Longitudinal Studies Socioeconomic status Self-rated health business.industry Depression Public Health Environmental and Occupational Health Middle Aged Health equity Infant mortality Black or African American Social Class Linear Models Female Self Report business Psychology Psychosocial Stress Psychological Demography |
| Zdroj: | American journal of health behavior. 38(3) |
| ISSN: | 1945-7359 |
| Popis: | Health disparities among Black adults have been an ongoing problem in the United States.1 For example, prevalence and mortality rates are higher among Black adults for heart disease, cancer, and stroke as compared to other ethnic groups.2–4 Blacks also have higher rates of HIV/AIDS than their White counterparts, and 2.3 times the infant mortality rate.4 These health disparities are reflected in perceived health status as well, with Black adults reporting substantially poorer self-reported health when compared to Whites.5 Self-reported health has been consistently linked to premature mortality and chronic conditions such as diabetes and heart disease, which particularly affect Black adults.6,7 Socioeconomic status (SES) has been linked to the health disparities experienced by Blacks. Relative to those at the higher end of the SES spectrum, individuals of lower SES experience comparatively worse health outcomes.8–10 Unfortunately, Blacks may be at particular risk for experiencing the negative ramifications of low SES on health, given that they tend to have lower SES than individuals of other race/ethnicities in this country.11 However, although a few studies have linked low SES with poorer health outcomes and higher mortality rates among Black adults,6,11 there remains debate on exactly how SES affects health. Previous studies have suggested that individuals of low SES may lack sufficient funds to satisfy basic needs and experience decreased access to healthcare and a lower quality of healthcare, potentially as a result of income inadequacy.12,13 Consequently, because income inadequacy may be a mechanism underlying the relations between low SES and negative health outcomes, it is of interest to better understand relations between income inadequacy and health status. Income inadequacy, also known as financial strain, represents an individual’s unfavorable subjective perception of their income to needs ratio.14 As such, perceptions of financial strain can vary widely among individuals of low income (based on their needs), and can be relevant to individuals across the SES spectrum.15 Several studies have examined the relations between financial strain and health. Results indicate that financial strain is positively correlated with poor health outcomes such as early disability, increased psychological stress, chronic health conditions, and even mortality.16,17 For instance, using retrospective data about economic adversities experienced over a lifetime, one study found that long-term financial strain at the poverty level was associated with a variety of negative health outcomes in an older adult and elderly population of 1167 adults, including over 400 Black men and women.17 Another study also found a strong correlation between financial strain at the poverty level and poor health among a sample of 699 middle-aged Black twins.16 A third study found that as exposure to negative financial situations increased, the risk for poor self-rated health increased, as well as the risk for depressed mood, stress, smoking, and drug use in a sample of 1,506 urban emergency department patients, with over 50% of the sample under the age of 35 and overall 39% of whom were Black.18 However, no previous studies have examined the association of financial strain and self-rated health within a large sample of Blacks, with a diverse age range and wide-ranging spectrum of incomes. Since financial strain can be relevant to any period of life, not just older age, understanding more about the association between financial strain and self-rated health in diverse Black samples of adults is important.8 A neo-materialistic perspective suggests that inadequate access to resources accounts for the relation between financial strain and poor health.19–21 This approach posits that the social determinants of health affect one’s living conditions, which in turn influences health. However, conceptual models linking low SES (more generally) to poorer health and less desirable health behaviors have proposed that psychosocial mechanisms such as depression and stress might underlie these relations. For example, Gallo and Matthews reviewed the extant literature and found a correlation between lower SES and negative emotions and attitudes, particularly depressive symptoms.22 Research suggests that these negative emotions in turn have an adverse effect on health outcomes such as cardiovascular morbidity.22 In addition, studies have found that people with low SES face more chronically negative and stressful life events, which are also interpreted more negatively.22 Relevant to financial strain in particular, several studies have argued that those with lower SES have less material and psychological resources to manage these stressors, which may lead to increased susceptibility to future stresses.7,22 Although the aforementioned conceptual models make reference to objective SES indicators such as income, education, and/or occupation, similar pathways have been suggested to underlie relations between financial strain and poor self-rated health.23 This psychosocial perspective suggests that financial strain impacts health over time through chronic over-activation of physiologic systems related to stress (ie, increased allostatic load), which lead to assorted negative systemic effects.16,23,24 However, to the best of our knowledge, no previous studies have addressed the potential indirect effects of stress and depressive symptoms on the association between financial strain and self-rated health among a large sample of Black adults. The purpose of the current study was to examine the relationship between financial strain and self-rated health in a large church-based sample of Black adults, while controlling for several important covariates including age, sex, partner status, income, education, and employment status. A secondary aim of the current study was to assess whether relations between financial strain and self-rated health were mediated by depressive symptoms and/or stress. Although at least one previous study has investigated the association between financial strain and self-rated health among Black adults (among middle-aged twins, in that case),16 more research is needed among Blacks of diverse ages and financial means. Based on the previous literature in this area, we hypothesized that greater financial strain would be associated with worse self-rated health, and that stress and depressive symptoms would underlie this association. |
| Databáze: | OpenAIRE |
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