Midterm 3 Flashcards
(143 cards)
1
Q
Basic Patterns in Racial Disparities:
A
- Found from birth to death
- Disparities in mortality are found in varying causes of death
- Disparities are dynamic: some have grown over time, but a few have declined or, indeed, disappeared
2
Q
Suspected Mechanisms of Racial Disparities:
A
- Socioeconomic advantages, including SES and subsequent health behavior
- Differences in the effects of these advantages
- Institutions that perpetuate disadvantages
- Genetics
3
Q
Most studies investigating racial disparities are based upon ____________.
A
self-identified race/ethnicity
4
Q
What does it mean that self-identified race/ethnicity is a surrogate of many things?
A
Self-identified race is indicative of culture, genetics, and the social determinants of health. All of these things impact health or disease.
5
Q
Are the genetics of populations different?
A
There is a case to be made for genetic differences across the world. Take for example certain genetic diseases that are specifically inflicting a race such as Tay Sachs in Ashkenazi Jews. However, the value of continental race as a classification is limited.
Human genetic variation does not naturally aggregate into subgroups that match human conceptions of racial categories.
6
Q
What are examples of diseases that impact specific races?
A
Tay Sachs - Ashkenzai Jews
Sickle Cell Anemia - African Americans
Crohn’s Disease - Japanese
7
Q
Why isn’t there a great basis for continental race classification?
A
Because the molecular variance when the world is split into 7 regions is 3.6%
8
Q
Life expectancy of white and black males at birth over time (does the disparity increase or decrease?):
A
1900:
White Male- 46.6
Black Male- 32.5
Difference = 14.1
1950:
White Male- 66.5
Black Male- 59.1
Difference = 7.4
2007:
White Male- 75.9
Black Male- 70
Difference = 5.9
The disparity is decreasing over time (albeit the rate is slowing).
9
Q
Life expectancy of white and black females at birth over time (does the disparity increase or decrease?):
A
1900:
White Female- 48.7
Black Female- 33.5
Difference = 15.2
1950:
White Female- 72.2
Black Female- 62.9
Difference = 9.3
2007:
White Female- 80.8
Black Female- 76.8
Difference = 4
Disparity is decreasing over time
10
Q
Disparity Mortality trends:
A
- Disparity gap in life expectancy at birth is closing over time, albeit at a slower rate.
- Gap in life expectancy at birth used to be wider for women but now is wider for men.
- Gap in life expectancy at 65 is still present. Shows that this disparity is seen at all ages. The difference is smaller than for life expectancy at birth.
11
Q
Trend between black female and white male life expectancy at birth:
A
Black female life expectancy only just recently went above white male. They had been equal for some time (which is messed up considering females live longer)
12
Q
What are period effects?
A
Time periods where improvements are much slower versus time where improvement is rapid.
13
Q
What is crossover?
A
That as age increases a certain point comes where the death rate of whites (in both sexes) surpasses the death rate of minorities.
Survival of the fittest?
There is poor data quality among older African Americans
14
Q
What are the 1 and 2 leading causes of death in all races?
A
Diseases of the Heart
Malignant Neoplasms
15
Q
Trends with leading causes of death by race:
A
- Blacks are disproportionately affected by assault and homicide
- Whites are disproportionately affected by Alzheimer’s Disease
- Blacks are disproportionately affected by HIV
16
Q
What conditions are more important in their contribution to racial disparities in health?
A
- Cardiovascular Disease
- HIV
- Trauma
- Diabetes
17
Q
Trends with infant mortality rates among races:
A
- Blacks have an extremely high infant mortality rate in comparison to whites and all other races
- Hispanics grouped together have the same infant mortality rate to whites, however when broken into specific ethnic groups some Hispanic groups have much higher infant mortality
- Asian Pacific Islander similar to white
- American Indian/Alaskan Native has higher infant mortality than Whites
18
Q
What is the relationship between size of disparity and severity of disease?
A
Largest disparities exist in the leading causes of death
In diseases like the flu and pneumonia the small disparities that existed have been virtually eliminated
Size if disparity basically increases with severity of disease
19
Q
What can eliminate a large disparity?
A
The application of a widely diffused technology can eliminate a large disparity in health because variations in motivation, knowledge, and resources play a smaller role in such cases.
P sure this is how the flu disparity was eliminated.
20
Q
Relationship between race and self reported health:
A
Blacks report worse self rated health across the board
21
Q
Morbidity trends by race
A
Blacks have more than whites:
- High Blood Pressure
- Diabetes
- Heart Conditions (in women specifically)
- Stroke (in men specifically)
- Arthritis
- Asthma
- Stomach Ulcers
- Kidney and bladder issues
Whites have more than blacks:
- Cancer (even moreso in women, about equal for men)
- Lung Disease
- Heart Conditions (in men specifically)
- High Cholesterol
- Poor eye sight
- Back Problems
- Emotional and psych problems
22
Q
Relationship between mental illness and race
A
Hispanics and non-Hispanic Blacks had lower risk for common internalizing disorders
There is apparently a presence of “protecting factors” that originate from childhood. Have greater persistance
23
Q
Relationship between race and sources of care:
A
Racial differences in the quality of care and source of care, but not necessarily the amount of care.
Shocking, whites go to private doctors 92% whereas Blacks go to private doctors 77% and then have a mix of family health centers, hospital outpatient department and a bit more ER than whites
24
Q
Explain race differences in morbidity:
A
Behavior vs. SES
Blacks have a higher relative risk for many big diseases (SES impacts behavior)
Recall results regarding SES and mortality
(Blacks are more uninsured)
25
Explain race mortality differences:
* But It’s Not All SES for Mortality
* Difference at all levels of education
* Double jeopardy of low SES and racial/ethnic minority status
* Minorities have fewer returns to SES
26
Explain birthweight differences:
Education, marriage, and assorted risk factors explain 64% of the black-white difference, but don’t explain the whole thing
–Model 2 adds controls for census tract
–Model 3 adds education, nativity, marital status, and age
–Model 4 adds health behaviors
27
Impact of discrimination on health studies:
Some weaknesses
–Many use primitive measures of discrimination
–More research on mental health than physical health (and, even there, more research on non-specific distress)
–Little contextual information: other kinds of stress, coping
Some results
–Generally has a deleterious effect consistent with that of other stressors
-Non-linear responses: u-shaped relationship with blood pressure
28
Results from MIDUS Study:
Blacks have a higher lifetime prevalence of discrimination in all categories (such as denied a bank loan, received inferior healthcare, etc.)
They also report higher day to day discrimination
29
Reasons for discrimination trends:
Blacks get most reported racial discrimination
| Whites cite gender, SES, appearance more
30
Studies of discrimination in health
May explain only a fraction of the association between race and health, although seems to have powerful effects
Coping appears to play an important role
–Racial/ethnic identity
–Social support
–Confrontation rather than passive acceptance
31
When does the rise in the number of prisoners and ex prisoners happen?
1970
32
Current prison stats, number of former prisoners,
Current: 2.5 million in prison and on parole
–2% of adult males (2004)
–6.6% of black adult males (2004)
Former: 5.2 million former prisoners
Total: 7.7 million in 2010
–3.4% of adult population (2010)
–5.5% of adult males (2004)
–17% of black adult males (2004)
33
Lifetime risk of incarceration trends:
- More educated less likely
| - Race obv
34
Why did prison rates go up after 1970?
significant rise in crime, war on drugs, mandatory sentencing, etc bc across the board, there isn't an age group or type of offense that's increased
Crime rates went up
Arrest rates went down
Incarceration rates went up
35
What are the health effects of incarceration?
Immediate effects
•Infectious disease
•Trauma
•Prison health care
```
Long-term effects
•Marital instability
•Unemployment and slow wage growth
•Uninsurance
•Discrimination
```
36
What are the effects of imprisonment on employment?
Sharp drop in receiving a callback for a job if they were imprisoned. There is also racial inequity here because there’s a 40% difference between whites who get called back and blacks who do not
This was determined from audit studies in which checkbox on an app was what told the interviewer or using a parole officer as a reference or having work experience in prison
The wage difference between those with and without a record is large and grows with age (i.e., cumulative disadvantage)
37
Effects of current incarceration on health:
Mortality in prisons is low for African Americans
| Medical treatment often improves during incarceration
38
What are some considerations for prison healthcare?
–Quality varies from state to state
–Nominal copayment, garnished from prison wages
–Universal exam upon admission, but frequency varies thereafter
–Service provision sensitive to overcrowding
But many inmates are uninsured prior to admission
–Black Uninsurance: 19.7%
–White Uninsurance: 10.7%
–
39
How many years of life lost after spending time in prison on average?
US Pop you’re looking at 6 years of life lost.
40
Effects on later mortality once you're released:
Risk of mortality among released inmates is–3.5 times higher than the state average
–Especially high 1-2 weeks after release
–Leading causes were drug overdose, cardiovascular disease, homicide, and suicide
41
Effects of incarceration on morbidity:
Incarceration is linked with stress-related disorders and infectious disease, but not other conditions
-Effects emerge only after release
42
Treatment disparities across race:
Found across a wide range of disease areas and clinical services
Found across a range of clinical settings (e.g., public and private hospitals, teaching and non-teaching hospitals), although some hospitals are clearly better than others
43
On medicare blacks typically receive services ___________ whites on medicare
less than
44
What are some explanations for why blacks on medicare receive/use less services?
* Differences in access
* Racial mismatching
* Different underlying disease severity
* Different patient preferences
45
Racial Matching
having a doctor of the same race
If stereotypes are perpetuated by residential segregation, then racial matching may matter
If stereotypes are perpetuated at medical schools, then both minority and white physicians are biased
Blacks and Hispanics seek care from physicians of their own race because of personal preference and language, not solely because of geographic accessibility
Blacks are least likely
46
Patient preference vs race
little race difference
Understanding what someone would go to seek care for
47
For Black men mortality higher out of prison than inside. Why?
o Prison guarantees healthcare
| o Risk of violent death is likely higher outside of prison than inside of prison
48
Results of study with patients of different races and genders presenting with chest pain:
1. No race difference in physicians estimate of likelihood of coronary heart disease
2. Race and sex mattered for cardiac catheterization referral (type of chest pain mattered too), personality had nothing to do with it
49
What are the four general encounters of the clinical mechanism?
1. Unobserved Heterogeneity
2. Prejudice: being less willing to interact with minorities, a negative attitude or affect
3. Clinical Uncertainty: interpreting a symptom of illness as less reliable
4. Stereotyping: holding a belief that minorities are less likely to comply
50
What is the gender and health paradox?
That women have lower mortality and higher morbidity
- Although women are living longer, they report worse self rated health than men and they typically are sicker during their lifetime
51
How has the gap in life expectancy between men and women changed?
Went from 7 years in 1990 to 5.2 years in 2004
| it's narrowing
52
What makes up women's morbidity?
–Chronic diseases (20-30%)
–Short-term disability: 25% more days
–Long-term disability: 40% more whole days in bed
53
Trends in gender gap in life expectancy at birth
- From 1940-1990 we have an especially large difference in life expectancy at birth
- From 1900-1930 there is a very small sex difference in life expectancy
o Why? Could be that men are dying from accidents more?
54
The difference in male and female life expectancy is declining but it is currently _________ as the race difference in life expectancy
the same
55
What are the two leading causes of death in men and women in 2005?
Heart disease and malignant neoplasms
- Leading causes of death are the same between men and women, not always seen in other racial disparities
56
Trends in causes of death between men and women:
o Suicide deaths are considerably more common in men than women. It makes their top 10 and it doesn’t make the list for women
o Alzheimer’s disease is more prevalent in women than men – this is because it is a disease that you have to age into and men aren’t necessarily getting to that age
o Diabetes and unintentional injuries are slightly more common in men than in women
57
What is parody?
when ratio = 1
| would indicate that men and women have the exact same death rate from a certain cause
58
Who has higher risk in a lot of causes of death?
Men
o Some of these ratios are much higher, we can see this in suicide and homicide for men. Men’s risk for several causes of death are heightened in comparison to women.
59
Leading cancers in men versus women:
Men:
1. Prostate
2. Lung
3. Colon
Women:
1. Breast
2. Lung
3. Colon
60
Who has higher mortality from cancer men or women?
Men, still number 2 cause in both
61
At what age does a sex difference in self rated health emerge?
o A difference in self rated health among men and women emerges at around age 13 – right around puberty
62
Why do women have more hospital visits?
They're having babies
63
Women report ___________ rates of pain than men
higher
-they have way more headaches and arthritis. Think critically if its pain its women. They're more depressed too.
64
Trend in reporting pain in men and women:
o Women and men are reporting more pain, but their gap between them is remaining consistent
65
What is the leading cause of disease related disability for women in the world?
Depression
66
What is the higher risk for depression in women due to?
o Higher prevalence is due to higher risk of first onset not differential persistence or recurrence
o The risk is not due to pregnancy or motherhood but rather emerges in adulthood
67
Why the Paradox between the higher rates of pain in women but their longevity in comparison to men?
Innate biological factors
- Reproductive problems account for a small percent
- Men’s prostate troubles start late in life
Health behaviors may contribute
– men may have worse health behaviors than women
-Health behaviors of women may promote longevity but it doesn’t reduce their pain
Reporting differences
- Doctors visits and self rated health
- Men have a higher threshold for pain (?)
- A lot of these surveys are premised on the idea that the physicians have diagnosed you. Women visit the doctor more than men and therefore have more medical knowledge.
Acquired risks
- different occupations, income, education
- health behaviors
- psychosocial risks
The healthcare system
- Not just that women go to a doctor more, but men and women may have different experiences when they go to the doctor
- There could be gender biases – women’s reports of pain or symptoms may be minimized. Doctors may be quicker to diagnose depression in women than men
68
What disease would you be most likely to report poor health?
Stomach cancer
69
Gender and exercise:
Men exercise more
70
Gender and cholesterol:
♣ Men in the ages 20-44 report higher cholesterol than women
| ♣ However at ages higher than that women report higher cholesterol than men
71
Who is more likely to say they keep their emotions to themselves?
Men are 1.36 times more likely than women to say they keep their emotions to themselves.
72
Where is the largest gender difference for doctors visits?
The largest gender difference in visit rates occurs among adults 18–44 years of age, largely due to care associated with reproduction.
73
Gender gap and smoking:
Decline of gender differences in smoking has diminished sex difference in life expectancy
* Much of the excess mortality is found for smoking-related illnesses, like emphysema
* Sex differences in smoking have declined
* Women had a rapid increase but still lower than average number of years as a smoker before age 40, they’ve plateaued. Men on the other hand increased, remained stagnant, and now are decreasing the average number of years they spend as a cigarette smoker. This is where the decline in difference comes from
74
What do counterfactuals indicate about the gender gap?
• Counterfactuals- based on age/period/cohort model
o A lot of the adverse health behaviors that are associated with the male gender can be attributed to some of the mortality gap between them
75
Physician Behavior as Bias in the Healthcare System
* More “silent” cases of MI among women
| * Especially pronounced disjuncture at younger ages, when estrogen is presumed to be protective
76
1 in _____ women will die of heart disease
| 1 in _____ women will die of breast cancer
2, 9
77
Women's risk for heart disease _______ as she gets older
increases. Regardless of the protective effects of estrogen
78
Experiment relating to doctor diagnosing a woman with heart disease
♣ An experiment- 30 year old patient and 60 year old patient (2 extremes pre menopausal and post menopausal) for each sex, testing to see if a physician can recognize coronary heart disease. All symptoms are presenting exactly the same in all of the patients
• At older ages the sex differential is eliminated with the 60 year old patients
• The sex differential is large with the younger patients
• Even when all symptoms are exactly the same, physicians see cardiac conditions less in younger women.
• Recommend over the counter antacids to men more than women, they recommend to quit smoking more to men than women
♣ Another experiment- study of 256 doctors who watched videotapes of a patient who presents all the symptoms of CHD
• Men are given more tests, even though physicians are less confident about diagnosis among women
•
********Confluence of gender and age produce sex difference********
79
Rules of life in the network:
o We shape our networks-
♣ We choose our friends and relationships
o Our network shapes us-
o Our friends affect us-
♣ Our friends can change our health behavior.
♣ If you surround yourself with friends who binge drink you are more likely to binge drink
o Our friends’ friends; friends affect us (hyperdyadic spread over three nodes)
♣ The entire social network affects us.
o The network has a life of its own
Example is how married couples often die within a short period of time in regard to one another
80
What is the relationship between social integration and mortality?
• Social Integration Matters for Longevity
o Social isolation is related to mortality
o Effects as large as cigarette smoking
o Operates through many causes of death
o This means having friendships in general correlates to how long you can live (not necessarily related to the depth of those friendships though)
81
The Classic Study of Social Integration and Mortality - Berkman and Syme 1979-
♣ 9 year follow up of people residing in Alameda County, CA
♣ The socially isolated have relative risks of mortality more than 2 times that of the integrated
♣ Control for health status at time 1, SES, smoking, drinking, obesity, physical activity, and health care (what makes the study compelling)
♣ Wealthy people are assumed to have more friends, obese folks have a harder time with social encounters, but this study controlled for these confounding factors
82
Buffering Hypothesis:
•Main effect: support affects health regardless
•Stress-buffering: social support reduces the effects of stress or pathogens on health
–Stress-buffering effects might be especially strong
–Some argue social support is beneficial for those suffering adversity but does not play a role in health for those without highly stressful demands.
83
For those with no major life events _____________
support makes no difference. Support ameliorates stress, but you have to actually have stress in the first place.
84
Support and the Common Cold
o Adults with more social roles develop the cold less.
♣ 1-3 roles 60%
♣ 4-5 roles 45%
♣ 6+ roles 35%
o Social integration makes you more robust to the common cold
o Some evidence that extreme isolation has especially strong effects
85
Reasons social support could be bad:
–The cost of dependence
–The possibility of emotional contagion
–Friends can encourage bad behavior
–Can you die of a broken heart?
86
Invisible Support
-We value independence, so we like it when people support us but we don't necessarily want it to be public support. Needs to be something small like cleaning the apartment -- NY Bar Exam and spouses example
87
Experience sampling method
using alerts to prompt respondents to record their feelings
88
It is better to be socially integrated into a ____________
system where everyone is happier
89
Drinking and college roommates
If you're a male you'd be more likely to binge drink if your roommate binge drank in high school. In females the relationship wasn't significant
- no effect on marijuana use
- students who did not engage in these behaviors in high school had no effect
90
Depression and college roommates
If your roommate is depressed then you are more likely to be
91
The Marriage/Widowhood Effect
o Marriage decreases mortality and the death of a spouse increases mortality
o Marriage adds 7 years to a man’s life and 2 years to a woman’s = more benefit than most medical treatments
o After the death of their wife, men are 30 to 100% more likely to die during the year
o Divorce is better than having never been married (never married has highest mortality)
92
Why is there a gap between mortalities of married and widowed men?
* Men have less support outside of their marriage than do women
* Men tend to marry younger women who pass first
* It is more traumatic because women expect men to die first
93
Homophily
the tendency of individuals to associate and bond with similar others
Homophily in race and ethnicity creates the strongest divides in our personal environments, with age, religion, education, occupation, and gender following in roughly that order
94
Homogamy
the fit marry the fit, the unfit marry the unfit
95
Confounding
spouses are exposed to the same things
96
Causal effect
marriage promotes healthy behaviors, widowhood is an enormous stressor
97
How do we test Homogamy?
-Hazard ratio associated with when your ex wife dies isn’t significant in comparison to hazard ratio associated with when your current wife dies.
98
_________ alcohol consumption is more sensitive to marriage than _________
Men's, women's
99
What do quality of care indicators suggest about widowhood?
-Caregiving and acute bereavement during the transition to widowhood appear to distract individuals from taking care of their own health care needs in the short run
100
Node in a social network
each individual
101
Tie in a social network
connection between the nodes
102
Directed tie in social network
connection moves in one direction
103
Mutual tie in social network
connection moves in both directions
104
centrality in social network
degree of connection with others
105
Ego-perceived friend
you believe someone is your friend when they don’t see you as a friend
106
Social distance and relationship trend
o Friends you have a stronger relationship with will have a greater impact on your behavior than friends you have more casual relationships with
107
Does an ego perceived friend or a mutual friend have more impact on your social behavior?
mutual
108
Are we influenced more by our opposite sex friends or same sex friends?
Same sex friends
109
The spread of happiness
o A person is 15% more likely to be happy if connected directly to a happy person, 10% for a friend of a friend, and 6% for a friend of a friend of a friend
The same is seen in depression though
110
Socially closed schools and virginity pledges
Socially closed schools: schools where the overwhelming majority of adolescents’ friendships are within school
For socially closed schools where no other pledgers are present, pledgers are much less likely than others to experience sexual debut. Where many other pledgers are present, pledgers’ transition rate is higher than that of pledgers in schools with few pledgers.
Basically if a lot of people are pledging way more people would break the pledge
111
Socially open schools and virginity pledges
Socially open- friends names aren’t just in the high school
In socially open schools, pledging delays intercourse only if there is an interacting community of pledgers.
112
When is the only time pledge as an identity movement works?
only works when it is nonnormative, which allows it to be part of their identity (contrast with social control effect)
113
Does pledging make you more or less likely to get tested or report infection?
Less
114
Does pledging make you more or less likely to use contraception?
Less
115
Spanning tree
Spanning tree: a long chain of interconnections that stretches across a population
used to discuss adolescent sex networks
There are many individuals at the end of small branches in the large component who have only one partner.
STD risk is not simply a matter of number of partners.
116
What social norm creates the spanning tree trend in adolescent sex networks?
Persons do not date the former (or current) partner of their former (or current) partner
117
What is a core in a network of infectors?
A core is a group of high activity-level actors (e.g., those with multiple partners) who interact frequently and pass infection to one another and diffuse infection out to a less densely connected population
118
Why should interventions target every kind of actor in a spanning tree model?
Even if there is a core the significant branching is fragile and you might not reach the most individuals without.
119
Stress proliferation:
one stressor leads to others (e.g., divorce, incarceration)
120
Programming mechanisms:
effects during sensitive development periods (including specific prenatal periods), often early in life, have long-term consequences
121
Preston Study:
Death risks are positively correlated over the life course
| Factors predictive of survival: farm background, literate parents, living in a two-parent household
122
Month of Birth and Depression
o Month of Birth should be independent from mental health
o However, there are some blips in months of birth that have higher rates of depression
♣ Nutrition of mother at certain times of year
• Undernourished in-utero, a birth cohort effect
♣ Higher rates of infection at certain times of year
123
Barker Hypothesis
♣ Fetus adapts to undernutrition by metabolic change and redistribution of blood flow to brain, referred to as the thrifty phenotype
♣ Programmed changes may be related to heart disease, stroke, and diabetes in later life.
♣ Example is birthweight related to mortality ratio from coronary heart disease
•
124
Why is it that if a baby has a birthweight lower than 9.5 they have a lower likelihood of dying from coronary heart disease?
Babies with a birthweight of 9.5 have a lower likelihood of dying from coronary heart disease
• This is because babies of lower and higher weight categories that experience increased risk often have to adapt to the nutrition conditions that caused their weight at the cost of other health detriments that may link to coronary heart disease
♣ There could be other confounding factors that correlate environments such as if a mother smokes that increases the risk of coronary heart disease as an adult.
125
Trends in Blood Lead Levels in Children Age 1 to 5
* Differences exist between racial groups
* African American children have the highest lead concentration in their blood, followed by whites, then Hispanics
* Kids who have a higher exposure to lead are more impulsive, they have a higher BMI, and score higher on scales of anxiety and depression
126
What would put you at a greater risk for lead exposure?
* Older metro areas have a very high risk
* High lead in Philadelphia soil – even if there are high SES neighborhoods they still see this trend
* Strongly correlated with poverty and age of housing
127
True or False: Lead exposure when you are young impacts adult health outcomes (even in small amounts)
True
It has an impact on behavioral health as well
128
How do offending and lead relate?
Years where more children were exposed to lead saw roughly 10ish years later higher crime rates. It makes it look like African Americans decided to commit more crimes but it has to do with their lead exposure.
129
Vulnerabilities that are studied through looking at birth cohorts:
–Culling: killing the sickest, leaving the healthiest (In Amsterdam, the mortality rate in 1945 was more than doubled compared with 1939)
–Selective fertility: long famines make fertility more selective
–Redistribution of food rations within households, supplementation from the black market, or foraging in the countryside could introduce error
130
The Dutch Famine
In October 1944, the German army blockaded food supplies to the Netherlands to punish the Dutch for assisting the Allied invasion of Europe
If you were pregnant during this time your baby could have suffered in the long run
o Maternal malnutrition during gestation may permanently effect adult health without affecting the size of the baby at birth
o This implies that adaptations that allow the baby to grow may have adverse consequences. CHD may be the price paid for successful adaptations to an adverse intra-uterine environment.
♣ Individuals who were exposed during early gestation had much more self reported poor health (10.3%). Compare that to individuals born before the famine (4.5%) and individuals born after the famine (5.3%)
131
The Dutch Famine and an Antisocial Personality
o In the 1960s, when surviving Dutch male children born during the period 1944 to 1946 reached their 18th birthday, they were summoned for military service and received physical, psychiatric, and psychological examinations
o Men exposed to famine exhibited increased risk for ASPD
In general when it comes to nervous system disorders:
o Dutch famine impacted the neurological balance of individuals born with their gestation during the famine
132
1918 Flu Pandemic
–Affected 25 million people, but mortality was low relative to famines
–Struck without warning and dissipated quickly
Fetal health is found to affect nearly every socioeconomic outcome recorded in the 1960, 1970, and 1980 censuses
♣ Impacts educational attainment
♣ Impacts social mobility
133
What impacts adult health the most?
Parent's SES
134
What is evidence that Barker effects can be offset?
- Subsequent weight gain
| - Good maternal care
135
If there is a protective effect of upward social mobility, then.....
adults who rise in the socioeconomic status hierarchy (“upwardly mobile”) should be in better health than those who remain in low socioeconomic status conditions from childhood to adulthood (“persistently low”)
136
Social origins hypothesis
children who grow up in low-socioeconomic status households should have poorer health in adulthood, relative to children who grow up in high-socioeconomic status homes, regardless of their respective adult socioeconomic status
137
How does the US relate to its peer countries with respect to social mobility?
It has lowest social mobility
| lowest probability of a bottom fifth percentile baby growing up to reach the top fifth in SES
138
Trends in social mobility:
o As time goes on, it was believed that relative mobility should increase (ex. American education system is more accessible). However, data is showing that relative mobility is flat/decreasing.
139
What is the impact of college education on social mobility?
♣ Correlation between parents income and adult income of children is weaker among the college education
♣ Though children from high income families are more likely to go to college
140
Who has the largest racial gap men or women?
Men
141
Who has made the most progress in life expectancy over time?
Black women
142
William and Sternthal
Challenged and problematized the biological understanding of race
Emphasized the primacy of social structure and context as determinants of racial differences in disease.
They have contributed to our understanding of the multiple ways in which racism affects health
Enhanced our understanding of the ways in which migration history and status can affect health
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What plays a role in making the continental theory for genes look good?
sampling bias
