Social inequalities and exercise during adulthood: toward an ecological perspective.

Grounded in ecological theory, this study examines the association among participation in regular vigorous exercise and social status, aspects of prominent life settings, interactions between life settings, and more proximal individual resources and processes using data from the National Survey of Midlife Development in the United States (N = 3,032). Among women, a higher level of earnings was associated with more vigorous exercise, yet those women with more education had a steeper decline in exercise across adulthood. Among men, those with the lowest level of education had the steepest decline in physical activity across adulthood, and earnings did not affect exercise patterns. Less participation in vigorous exercise among blacks, in contrast to nonblacks, was explained by their tendency to live in less safe neighborhoods and having more functional health problems. Finally, contextual factors from multiple domains were independently associated with participation in regular exercise. Consistent with ecological theory, these results suggest that interventions to promote exercise habits among adults need to consider the independent and interactive effects of multiple contextual factors.

Reconceptualizing the work-family interface: an ecological perspective on the correlates of positive and negative spillover between work and family.

Ecological theory was used to develop a more expanded conceptualization of the work-family interface and to identify significant correlates of multiple dimensions of work-family spillover. Using data from employed adults participating in the National Survey of Midlife Development in the United States (N = 1,986), negative spillover from work to family, positive spillover from work to family, negative spillover from family to work, and positive spillover from family to work were found to be distinct work-family experiences. Analyses indicated that work and family factors that facilitated development (e.g., decision latitude, family support) were associated with less negative and more positive spillover between work and family. By contrast, work and family barriers (e.g., job pressure, family disagreements) were associated with more negative spillover and less positive spillover between work and family. In some cases, results differ significantly by gender.

Socioeconomic status differences in hormone therapy.

Socioeconomic status (SES) is a significant sociodemographic correlate of noncontraceptive hormone therapy, yet multiple dimensions of SES have not been examined systematically in previous studies of hormone therapy. This study examined the lifetime incidence of noncontraceptive hormone therapy, how usage varied by type of reproductive organ surgery, and the bivariate and net associations between a large array of SES indicators and the likelihood of ever using hormones by age 53-54 years in a population sample (n = 3,612) of non-Hispanic white female participants in the Wisconsin Longitudinal Study (1957-1993). Approximately half of the women had ever used noncontraceptive hormones; 38.5% were current users. In multivariate logistic regression analyses, the most robust SES predictor of hormone therapy was a woman's husband's occupational status (higher status associated with higher rates of use), after adjustment for all other measured sociologic and biomedical factors (e.g., other SES measures, other health behaviors, menopausal symptoms, age at menopause, health insurance). The association of hormone therapy with education differed between women who underwent hysterectomy and/or oophorectomy (higher odds for less educated women) and those with intact reproductive organs (lower odds for less educated women). Additionally, a woman's own earnings and household net worth were positive net correlates of noncontraceptive hormone therapy.

Contribution of psychosocial factors to socioeconomic differences in health.

The National Survey of Mid-life Developments in the United States (MIDUS) is one of several studies that demonstrate socioeconomic gradients in mortality during midlife. When MIDUS findings on self-reported health, waist to hip ratio, and psychological well-being were analyzed for their possible roles in generating socioeconomic differences in health, they revealed clear educational gradients for women and men (i.e., higher education predicted better health). Certain potential mediating variables, like household income, parents' education, smoking behavior, and social relations contributed to an explanation of the socioeconomic gradient. In addition, two census-based measures, combined into an area poverty index, independently predicted ill health. The results suggest that a set of both early and current life circumstances cumulatively contribute toward explaining why people of lower socioeconomic status have worse health and lower psychological well-being.

Socioeconomic differences in hysterectomy: the Wisconsin Longitudinal Study.

OBJECTIVES: This study evaluated the relative gross and net predictive value of multiple socioeconomic status indicators for the likelihood of undergoing hysterectomy. METHODS: Data from a sample of Wisconsin Longitudinal Study women respondents (n = 3326) followed for 35 years were analyzed by means of multivariate logistic regression. RESULTS: Women's own higher occupational status and greater family net worth were significant net predictors of a lower likelihood of hysterectomy. Women's own education was a significant bivariate predictor. Mental ability did not account for the education effect. CONCLUSIONS: Higher education's association with a lower rate of hysterectomy is not due to ability, but to the opportunities that more-educated women have for higher-status employment and its health-related benefits. Measures of women's own occupational status should be included in future health surveys.

Social inequalities in health: next questions and converging evidence.

Mortality studies show that social inequalities in health include, but are not confined to, worse health among the poor. There is a social gradient: mortality rises with decreasing socio-economic status. Three large sample studies, one British and two American, brought together for their complementarity in samples, measures, and design, all show similar social gradients for adult men and women in physical and mental morbidity and in psychological well-being. These gradients are observed both with educational and occupational status and are not explained by parents' social status or lack of an intact family during childhood. They are also not accounted for by intelligence measured in school. This suggests that indirect selection cannot account for inequalities in health. Possible mediators that link social position to physical and mental health include smoking and features of psycho-social environment at work and outside.