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Healthcare
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Social Determinants of Health: Differential Exposures vs Differential Effects
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Social Determinants of Health: Differential Exposures vs Differential Effects

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: closed (15 September 2018) | Viewed by 44844

Special Issue Editor

Prof. Dr. Shervin Assari

E-Mail Website
Guest Editor
Department of Psychiatry and School of Public Health, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5295, USA
Interests: depression; race; gender; sex; class
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Social determinants of health (SDHs) are the economic and social conditions, and their distribution among the population thatinfluence individual and group differences in health status. Some examples include race, gender, class, and place, which have major implications for the health of populations. These effects are due to multiple overlapping mechanisms.

Differential exposure and differential vulnerability are two main underlying mechanisms that SDHs get under people’s skin. According to the differential exposure hypothesis, group differences in health are due to group differences in exposure to SDHs or population variations on exposures to risk and protective factors that ultimately shape population health. Based on this hypothesis, differential exposures mediate group differences in health. According to the differential vulnerability hypothesis, group differences in health are due to group differences in vulnerability, and the resilience of groups to risk and protective factors. Based on this hypothesis, group membership not only changes exposures, but also effects.

The Special Issue “Social Determinants of Health: Differential Exposures and Differential Effects” invites state-of-the-art original and review articles on the following topics: 1) decomposing differential exposure or differential vulnerability; 2) additive vs. multiplicative effects; 3) comparison of countries, settings, and regions; 4) testing mediators and moderators; 5) tailoring interventions; and 6) measurement and method issues. Any study that uses large-scale, national samples, with a longitudinal design, is of interest.

Dr. Shervin Assari
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • fundamental causes
  • social determinants
  • health disparities
  • health
  • inequalities
  • race
  • ethnicity
  • gender
  • social class
  • place

Published Papers (7 papers)

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Research

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11 pages, 248 KiB  
Article
Allostatic Load Biomarker Associations with Depressive Symptoms Vary among US Black and White Women and Men
by Ganga S. Bey, Bill M. Jesdale, Christine M. Ulbricht, Eric O. Mick and Sharina D. Person
Healthcare 2018, 6(3), 105; https://doi.org/10.3390/healthcare6030105 - 28 Aug 2018
Cited by 22 | Viewed by 5017
Abstract
The prevalence and severity of depression differ in women and men and across racial groups. Psychosocial factors such as chronic stress have been proposed as contributors, but causes of this variation are not fully understood. Allostatic load, a measure of the physiological burden [...] Read more.
The prevalence and severity of depression differ in women and men and across racial groups. Psychosocial factors such as chronic stress have been proposed as contributors, but causes of this variation are not fully understood. Allostatic load, a measure of the physiological burden of chronic stress, is known to be associated with depression. Using data from the National Health and Nutrition Examination Survey 2005–2010, we examined the associations of nine allostatic load biomarkers with depression among US black and white adults aged 18–64 years (n = 6431). Depressive symptoms were assessed using the Patient Health Questionaire-9; logistic models estimated adjusted odds of depression based on allostatic load biomarkers. High-risk levels of c-reactive protein were significantly associated with increased odds of depression among white women (adjusted odds ratio (aOR) = 1.7, 95% CI: 1.1–2.5) and men (aOR = 1.8, 95% CI: 1.1–2.8) but not black women (aOR = 0.8, 95% CI: 0.6–1.1) or men (aOR = 0.9, 95% CI: 0.5–1.5). Among black men, hypertension (aOR = 1.7, 95% CI: 1.1–2.7) and adverse serum albumin levels (aOR = 1.7, 95% CI: 1.0–2.9) predicted depression, while high total cholesterol was associated with depression among black women (aOR = 1.6, 95% CI: 1.0–2.7). The associations between allostatic load biomarkers and depression varies with gendered race, suggesting that, despite consistent symptomatology, underlying disease mechanisms may differ between these groups. Full article
(This article belongs to the Special Issue Social Determinants of Health: Differential Exposures vs Differential Effects)
13 pages, 265 KiB  
Article
Poverty Status and Childhood Asthma in White and Black Families: National Survey of Children’s Health
by Shervin Assari and Maryam Moghani Lankarani
Healthcare 2018, 6(2), 62; https://doi.org/10.3390/healthcare6020062 - 12 Jun 2018
Cited by 69 | Viewed by 11363
Abstract
Background: Living above the poverty line reduces the risk of physical illnesses, including childhood asthma (CA). Minorities’ Diminished Return theory, however, suggests that the protective effects of socioeconomic status (SES) on health are weaker for racial minorities than White families. It is unknown [...] Read more.
Background: Living above the poverty line reduces the risk of physical illnesses, including childhood asthma (CA). Minorities’ Diminished Return theory, however, suggests that the protective effects of socioeconomic status (SES) on health are weaker for racial minorities than White families. It is unknown whether the association between SES and CA differs for White and Black families. Aims: Using a national sample, the current study compared Black and White families for the association between living above the poverty line and CA. Methods: Data came from the National Survey of Children’s Health (NSCH), 2003–2004, a national telephone survey. A total of 86,537 Black or White families with children (17 years old or younger) were included in the study. This sample was composed of 76,403 White (88.29%) and 10,134 Black (11.71%) families. Family SES (living above the poverty line) was the independent variable. The outcome was CA, reported by the parent. Age, gender, and childhood obesity were the covariates. Race was conceptualized as the moderator. A number of multivariable logistic regressions were used in the pooled sample and specific to each race for data analysis. Results: In the pooled sample, living above the poverty line was associated with lower odds of CA. An interaction was found between race and living above the poverty line on odds of CA, indicating a smaller association for Black compared to White families. Although race-stratified logistic regressions showed negative associations between living above the poverty line and CA in both White and Black families, the magnitude of this negative association was larger for White than Black families. Conclusions: The health gain from living above the poverty line may be smaller for Black than White families. Due to the existing Minorities’ Diminished Return, policies that merely reduce the racial gap in SES may not be sufficient in eliminating racial health disparities in the United States. Public policies must go beyond reducing poverty to address structural and environmental risk factors that disproportionately impact Blacks’ health. Policies should help Black families gain health as they gain upward social mobility. As they are more likely to face societal and structural barriers, multi-level interventions are needed for the health promotion of Blacks. Full article
(This article belongs to the Special Issue Social Determinants of Health: Differential Exposures vs Differential Effects)
11 pages, 249 KiB  
Article
Ethnic Variations in Psychosocial and Health Correlates of Eating Disorders
by Shervin Assari and Mariana R. DeFreitas
Healthcare 2018, 6(2), 38; https://doi.org/10.3390/healthcare6020038 - 25 Apr 2018
Cited by 9 | Viewed by 4531
Abstract
The aim of this study is to explore ethnic variations in psychosocial and health correlates of eating disorders in the United States, Specifically, we compared associations between gender, socioeconomic status (SES), body mass index (BMI), physical and mental self-rated health (SRH), and major [...] Read more.
The aim of this study is to explore ethnic variations in psychosocial and health correlates of eating disorders in the United States, Specifically, we compared associations between gender, socioeconomic status (SES), body mass index (BMI), physical and mental self-rated health (SRH), and major depressive disorder (MDD) with eating disorders (EDs) across 10 different ethnic groups in the United States. Data was obtained from the Collaborative Psychiatric Epidemiology Surveys (CPES), a national household probability sample collected in 2001–2003. Data for this study included a sample of 17,729 individuals with the following ethnic profile: 520 Vietnamese, 508 Filipino, 600 Chinese, 656 Other Asian, 577 Cuban, 495 Puerto Rican, 1442 Mexican, 1106 Other Hispanic, 4746 African American, and 7587 Non-Latino Whites. Gender, SES (education and income), BMI, SRH, MDD, and presence of EDs were measured across different ethnic groups. Logistic regression analysis was conducted for each ethnic group with lifetime EDs as the main outcome. Ethnic group varied in psychosocial and health correlates of EDs. In most ethnic groups, gender and SES were not associated with EDs. In almost all ethnic groups, EDs were associated with MDD and BMI. EDs were found to be associated with SRH in half of the ethnic groups studied. The associations between gender, SES, BMI, SRH, MDD, and EDs vary across different ethnic groups. These differences must be considered in further studies and in clinical practice in order to improve our approach towards diagnosis and treatment of EDs. Full article
(This article belongs to the Special Issue Social Determinants of Health: Differential Exposures vs Differential Effects)
12 pages, 298 KiB  
Article
High Income Protects Whites but Not African Americans against Risk of Depression
by Shervin Assari
Healthcare 2018, 6(2), 37; https://doi.org/10.3390/healthcare6020037 - 23 Apr 2018
Cited by 68 | Viewed by 7655
Abstract
Background: Built on the Blacks’ diminished return theory, defined as smaller effects of socioeconomic status (SES) on a wide range of health outcomes for African Americans compared to Whites, the current study compared African Americans and Whites for the association between household income [...] Read more.
Background: Built on the Blacks’ diminished return theory, defined as smaller effects of socioeconomic status (SES) on a wide range of health outcomes for African Americans compared to Whites, the current study compared African Americans and Whites for the association between household income and risk of lifetime, 12-month, and 30-day major depressive disorder (MDD). Methods: For the current cross-sectional study, we used data from the Collaborative Psychiatric Epidemiology Surveys (CPES), 2001–2003. With a nationally representative sampling, CPES included 4746 non-Hispanic African Americans and 7587 non-Hispanic Whites. The dependent variables were lifetime, 12-month, and 30-day MDD, measured using Composite International Diagnostic Interview (CIDI). The independent variable was household income. Age, gender, education, chronic medical conditions, and obesity were covariates. Race was the focal moderator. Logistic regression models were used to test the protective effects of household income against MDD in the overall sample and also by race. Results: In the overall sample, household income was inversely associated with the risk of 12-month and 30-day MDD. We found a significant interaction between race and household income on 12-month and 30-day MDD, suggesting a smaller protective effect of household income against MDD for African Americans compared to Whites. Conclusion: In line with the Blacks’ diminished return theory, household income better protects Whites than African Americans against MDD. The contribution of diminished return of SES as an underlying mechanism behind racial disparities in health in the United States is often overlooked. Additional research is needed on why and how SES resources generate smaller health gain among minority groups. Full article
(This article belongs to the Special Issue Social Determinants of Health: Differential Exposures vs Differential Effects)
9 pages, 256 KiB  
Article
Depressive Symptoms Increase the Risk of Mortality for White but Not Black Older Adults
by Shervin Assari
Healthcare 2018, 6(2), 36; https://doi.org/10.3390/healthcare6020036 - 23 Apr 2018
Cited by 7 | Viewed by 3828
Abstract
Introduction. Long-term studies have shown that depressive symptoms predict the risk of mortality. However, it is unknown if this effect is present in shorter time intervals. In addition, recent research suggests that the salience of the negative affect on the risk of mortality [...] Read more.
Introduction. Long-term studies have shown that depressive symptoms predict the risk of mortality. However, it is unknown if this effect is present in shorter time intervals. In addition, recent research suggests that the salience of the negative affect on the risk of mortality is not similar across racial groups. The current study uses data from a national study of Black and White older adults to examine racial differences in the effect of baseline depressive symptoms on mortality risk over three years in the United States. Methods. This study used a longitudinal prospective design and followed 1493 older adults who were either White (n = 759) or Black (n = 734) for three years from 2001 to 2004. Depressive symptoms measured at baseline was the independent variable. Demographic factors, socio-economic characteristics (education, income, marital status), health behaviors (smoking and drinking), and health (self-rated health) measured at baseline in 2001 were covariates. The dependent variable was all-cause mortality between 2001 and 2004. Race was the moderator. Logistic regressions were used for data analysis. Results. In the pooled sample, high depressive symptoms at baseline were not associated with the three-year risk of mortality. In the pooled sample, we found a significant interaction between race and depressive symptoms on mortality, suggesting a stronger effect for Whites in comparison to Blacks. In race stratified models, depressive symptoms at baseline were predictive of mortality risk for Whites, but not Blacks. Conclusions. In the United States, Black-White differences exist in the effects of depressive symptoms on mortality risk in older adults. White older adults may be more vulnerable to the effects of depressive symptoms on mortality risk. Full article
(This article belongs to the Special Issue Social Determinants of Health: Differential Exposures vs Differential Effects)
13 pages, 216 KiB  
Article
Ethnic and Gender Differences in Family Social Support among Black Adolescents
by Christina J. Cross, Robert Joseph Taylor and Linda M. Chatters
Healthcare 2018, 6(1), 20; https://doi.org/10.3390/healthcare6010020 - 02 Mar 2018
Cited by 10 | Viewed by 5353
Abstract
This study examines black adolescents’ reports of the most helpful types of social support that they receive from and provide to family members, and whether family support exchanges vary by ethnicity (African American vs. Black Caribbean) and gender. Data for this study are [...] Read more.
This study examines black adolescents’ reports of the most helpful types of social support that they receive from and provide to family members, and whether family support exchanges vary by ethnicity (African American vs. Black Caribbean) and gender. Data for this study are from the National Survey of American Life Adolescent Supplement (NSAL-A), a national, probability sample of African American and Black Caribbean youth (ages 13–17). Overall, youth reported financial support, followed by emotional assistance and practical support as the most helpful types of support that they received. Practical and emotional assistance characterized the most commonly reported types of support that they provided to family members. Black Caribbean adolescents were more likely than African American adolescents to report financial and practical assistance as the most helpful types of support that they received from family members; no ethnic differences were observed in the provision of support to relatives. There were no significant gender differences in the receipt of support, but adolescent girls reported greater involvement in providing emotional support and caregiving than adolescent boys. The results of this paper reveal that African American and Black Caribbean adolescents are involved in a complex pattern of reciprocal support exchanges with their extended family members. Study findings also reinforce the importance of research focused on racial/ethnic and gender differences in family support exchanges in order to develop a more nuanced understanding of family support behaviors within these groups. Full article
(This article belongs to the Special Issue Social Determinants of Health: Differential Exposures vs Differential Effects)

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8 pages, 212 KiB  
Commentary
Filling the Gaps in Adolescent Care and School Health Policy-Tackling Health Disparities through Sports Medicine Integration
by Kemba Noel-London, Anthony Breitbach and Rhonda Belue
Healthcare 2018, 6(4), 132; https://doi.org/10.3390/healthcare6040132 - 13 Nov 2018
Cited by 6 | Viewed by 5021
Abstract
The School-Based Health Centre (SBHC) model of healthcare delivery in community health is designed to address the unique needs of adolescents. Through a collaborative interprofessional approach, they aim to provide comprehensive care with the goal of reducing health disparities in underserved, at-risk adolescents. [...] Read more.
The School-Based Health Centre (SBHC) model of healthcare delivery in community health is designed to address the unique needs of adolescents. Through a collaborative interprofessional approach, they aim to provide comprehensive care with the goal of reducing health disparities in underserved, at-risk adolescents. Integration of sports medicine health professionals is a novel approach to increasing available services, as well as patient utilization, while addressing multiple public health issues, including lack of athletic training services for youth athletes. Full article
(This article belongs to the Special Issue Social Determinants of Health: Differential Exposures vs Differential Effects)
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