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      Socioeconomic Status and Health: Mediating and Moderating Factors

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      Annual Review of Clinical Psychology

      Annual Reviews

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          Abstract

          Health disparities (differences in health by socioeconomic groups) are a pressing issue in our society. This article provides an overview of a multilevel approach that seeks to understand the mechanisms underlying health disparities by considering factors at the individual, family, and neighborhood levels. In addition, we describe an approach to connecting these factors to various levels of biological processes (systemic inflammation, cellular processes, and genomic pathways) that drive disease pathophysiology. In the second half of the article, we address the question of why some low-socioeconomic-status (low-SES) individuals manage to maintain good physical health. We identify naturally occurring psychosocial factors that help buffer these individuals from adverse physiological responses and pathogenic processes leading to chronic disease. What is protective for low-SES individuals is not the same as what is protective for high-SES individuals, and this needs to be taken into account in interventions aimed at reducing health disparities.

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          Most cited references 98

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          The impact of economic hardship on black families and children: psychological distress, parenting, and socioemotional development.

           V McLoyd (1990)
          Family processes affecting the socioemotional functioning of children living in poor families and families experiencing economic decline are reviewed. Black children are of primary interest in the article because they experience disproportionate shares of the burden of poverty and economic loss and are at substantially higher risk than white children of experiencing attendant socioemotional problems. It is argued that (a) poverty and economic loss diminish the capacity for supportive, consistent, and involved parenting and render parents more vulnerable to the debilitating effects of negative life events, (b) a major mediator of the link between economic hardship and parenting behavior is psychological distress deriving from an excess of negative life events, undesirable chronic conditions, and the absence and disruption of marital bonds, (c) economic hardship adversely affects children's socioemotional functioning in part through its impact on the parent's behavior toward the child, and (d) father-child relations under conditions of economic hardship depend on the quality of relations between the mother and father. The extent to which psychological distress is a source of race differences in parenting behavior is considered. Finally, attention is given to the mechanisms by which parents' social networks reduce emotional strain, lessen the tendency toward punitive, coercive, and inconsistent parenting behavior, and, in turn, foster positive socioemotional development in economically deprived children.
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            Socioeconomic Disparities in Health Behaviors.

            The inverse relationships between socioeconomic status (SES) and unhealthy behaviors such as tobacco use, physical inactivity, and poor nutrition have been well demonstrated empirically but encompass diverse underlying causal mechanisms. These mechanisms have special theoretical importance because disparities in health behaviors, unlike disparities in many other components of health, involve something more than the ability to use income to purchase good health. Based on a review of broad literatures in sociology, economics, and public health, we classify explanations of higher smoking, lower exercise, poorer diet, and excess weight among low-SES persons into nine broad groups that specify related but conceptually distinct mechanisms. The lack of clear support for any one explanation suggests that the literature on SES disparities in health and health behaviors can do more to design studies that better test for the importance of the varied mechanisms.
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              Socioeconomic disparities in health in the United States: what the patterns tell us.

              We aimed to describe socioeconomic disparities in the United States across multiple health indicators and socioeconomic groups. Using recent national data on 5 child (infant mortality, health status, activity limitation, healthy eating, sedentary adolescents) and 6 adult (life expectancy, health status, activity limitation, heart disease, diabetes, obesity) health indicators, we examined indicator rates across multiple income or education categories, overall and within racial/ethnic groups. Those with the lowest income and who were least educated were consistently least healthy, but for most indicators, even groups with intermediate income and education levels were less healthy than the wealthiest and most educated. Gradient patterns were seen often among non-Hispanic Blacks and Whites but less consistently among Hispanics. Health in the United States is often, though not invariably, patterned strongly along both socioeconomic and racial/ethnic lines, suggesting links between hierarchies of social advantage and health. Worse health among the most socially disadvantaged argues for policies prioritizing those groups, but pervasive gradient patterns also indicate a need to address a wider socioeconomic spectrum-which may help garner political support. Routine health reporting should examine socioeconomic and racial/ethnic disparity patterns, jointly and separately.
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                Author and article information

                Journal
                Annual Review of Clinical Psychology
                Annu. Rev. Clin. Psychol.
                Annual Reviews
                1548-5943
                1548-5951
                March 28 2013
                March 28 2013
                : 9
                : 1
                : 723-749
                Affiliations
                [1 ]Department of Psychology, Northwestern University, Evanston, Illinois 60208; email:
                Article
                10.1146/annurev-clinpsy-050212-185634
                23245339
                © 2013

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