Psychology 415; Social Basis of Health Behavior SES & Health 1 1 Core issues in SES effects  Self-selection / “drift” hypothesis  Role of physical / infectious / environmental v. ψ causes  Race controlling for SES: 1 st generation middle class may still harbor stresses & behavioral patterns common to lower SES community More than half of U.S. households sampled experienced an increase of 50% or a decrease of more than 33% in monthly income in 1984 (U.S. Bureau of the Census, 1996). Experiencing a single marked income drop during a 5-year period resulted in a 30% increase in mortality risk, whereas two or more decreases predicted a 70% increase in mortality risk (Duncan, 1996). (Gallo et al., 2003)

Psychology 415; Social Basis of Health Behavior SES & Health 1 2 What is SES?  Income  Assessment problems  Income  social rank disparities (“professor syndrome”)  Occupation  Housewives, retired, students, currently unemployed  Illness  loss of occupational standing  Education  Most reliable indicator?  Strong predictor of smoking, all cause mortality  Other indicators  Insurance status  Strongest predictor of HIV infection  Neighborhood indicators  Home ownership (mobility proxy), median income & education, % single-family homes, % homeowners…  Predicts beyond Σ individual effects

Psychology 415; Social Basis of Health Behavior SES & Health 1 3 What is “negative emotion”?  Orthogonality  bipolarity debate  Negative affect  “macrophage” model of depression & health  Positive affect  key to range of health behaviors  Separation of arousal (“activity”) v. Valence  Cf: serotonin hypothesis re: impulsivity v. depression  Time frame  “State” v. “Trait”  Momentary / daily v. enduring  Specificity issue: NA v. depression  Depression  Hopelessness  Anxiety  Hostility / anger  Diagnostic v. Dimensional models Key assessment (& conceptual) issue

Psychology 415; Social Basis of Health Behavior SES & Health 1 4 Stress: Environment & “Allostatic load” Daily hassles  Density / crowding  Transportation  Isolation & child rearing  Cultural differences (?)  Simple resource availability Nutritional environment Violence Ψ characteristics (?)  Hopelessness / helplessness  Anger / hostility Physical toxicity (environmental racism) Chronic untreated MH problems Inadequate coping resources Hostile / unavailable services Untreated illness

Psychology 415; Social Basis of Health Behavior SES & Health 1 5 Affect regulation Direct Environmental Path:  Exposure to violence / instability  depression, anxiety  Availability (& modeling) of health risk behavior Chronic stress  inhibited capacity for affect regulation?  Shifts in HPA reactivity? Stress – diathesis:  Epigenetics  Exacerbation of pathogenic traits:  Sensation seeking  Male-linked etoh.

Psychology 415; Social Basis of Health Behavior SES & Health 1 6 Coping Instrumental v. avoidant / affective coping:  Exogenous moderator (“diathesis”)?  Perceived environmental controllability  Availability of avoidant v. instrumental coping resources Chronic high arousal & affect regulation?  HPA reactivity  “Illness behavior” Social capitol  Mediator of linear SES effect  Access to support  Dominance hierarchy  “Personal control”  Helplessness v. “executive monkey (x stability). Chronic regulatory demands  Lower baseline regulatory capacity (?)  Chronic depletion of capacity

Psychology 415; Social Basis of Health Behavior SES & Health 1 7 Health services Disparities in service availability  MSM data  Cardiac data:  Lower incidence, higher mortality  Late diagnosis & treatment Helplessness / depression or avoidant coping  lower service use

Psychology 415; Social Basis of Health Behavior SES & Health 1 8 Basic mechanisms: Stress  PTB Dunkel-Schetter, C. (2009). Stress Processes in Pregnancy and Preterm Birth. [Article]. Current Directions in Psychological Science, 18(4),

Psychology 415; Social Basis of Health Behavior SES & Health 1 9 Separation, pro-inflammatory cytokines & “depression” Hennessy, M. B., Schiml-Webb, P. A., & Deak, T. (2009). Separation, Sickness, and Depression: A New Perspective on an Old Animal Model. [Article]. Current Directions in Psychological Science, 18(4), Acute Maternal Separation HPA activation  arousal  Active search behavior Chronic pro-inflammatory cytokines Chronic Separation “Passive” stage (Illness behavior, depression) Exogenous anti-inflammatory cytokines

Psychology 415; Social Basis of Health Behavior SES & Health 1 10 Gallo: “reserve capacity”