Life-course financial strain and health in African–Americans
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szanton2010 - p. 2
Financial strain, while related to income, measures the balance of income to need (Szanton et al., 2008). Financial strain has been consistently associated with poor health outcomes. For example, it is related to mortality (Szanton et al., 2008),
szanton2010 - p. 2
While measuring financial strain in adulthood is valuable, we hypothesized that including measurement of childhood financial strain would add value based on findings that the related but distinct phenomenon of enduring poverty, from childhood through adulthood, is more deleterious to health than intermittent poverty
szanton2010 - p. 2
The objectives of this analysis are framed by the cumulative disadvantage theory. Cumulative disadvantage theory helps explain intra-cohort differentiation (Dannefer, 1987) by emphasizing early risk factors that shape trajectories not only for proximal outcomes but also distal ones. Early risk factors set children on a path of accumulating disadvantage. This disadvantage compounds over time by setting individuals up for subsequent increased risks.
szanton2010 - p. 2
Those who have examined the relationship between financial strain and health have focused on two different types of pathways: the psychosocial (Kahn & Pearlin, 2006) and the neomaterial (Krieger, Chen, Coull, & Selby, 2005) both of which can be situated in a cumulative disadvantage context.
szanton2010 - p. 3
We are convinced by both approaches and suggest they are at least additive if not multiplicative. For example, if a child has frequent asthma attacks due to chronic stressors, the lack of access to medical care would be even more deleterious than if she had only frequent asthma attacks or only inadequate access to preventive health care.
szanton2010 - p. 3
The objective of the present analysis was to contribute to the understanding of the relationship between life-course financial strain and four different health outcomes in a population-based cohort of African Americans.
szanton2010 - p. 3
How is childhood financial strain and/or adult financial strain associated with physical disability, lung function, cognition and depression in African American adults? (2) Is lifecourse financial strain associated with physical disability, lung function, cognition and depression in African-American adults?
szanton2010 - p. 3
Data for these analyses were obtained from the Carolina African American Twin Study of Aging (CAATSA) (K. E. Whitfield, Brandon, Wiggins, Vogler, & McClearn, 2003). The CAATSA was designed to examine the health status, cognitive functioning, and physical and psychosocial functioning of adult African American twins. This population-based sample of participants was identified from birth records between the years of 1913 and 1975 from 23 vital statistics offices in North Carolina counties, U.S.A.
szanton2010 - p. 4
Childhood financial strain was measured with the question: “How well off was your family when you were growing up? The five possible responses were: “Not getting by,” “Barely getting by,” “Doing OK,” “Doing well,” “Very well off.”
szanton2010 - p. 4
Financial strain in adulthood was measured by the response to the question, “How well does your income cover your needs?” There were four possible responses: “Not very well,” “Poorly, but I get by,” “Pretty well,” “Very well.”
szanton2010 - p. 4
We then combined the data on childhood and adult financial strain to create the life-course financial strain variable. We created four mutually distinct financial strain categories, which we viewed as progressing from most to least detrimental: (1) childhood financial strain/adult financial strain, (2) child financial strain/no adult financial strain, (3) no childhood strain/adult financial strain, and (4) no childhood financial strain/no adult financial strain.
szanton2010 - p. 5
Disability: The disability measure was based on the participant’s report of difficulty in performing one or more of seven basic activities of daily living (ADLs): eating, dressing, grooming, walking, bathing, using the toilet, and transferring in and out of bed
szanton2010 - p. 5
Lung function: Lung function was measured using a Mini-Wright peak flow meter to assess the peak expiratory flow (PEF) for each individual.
szanton2010 - p. 5
Cognition was assessed using the Telephone Interview of Cognitive Status (TICS) administered in person (Brandt & Spencer, 1988). The TICS is highly related to the Mini Mental Status Examination (MMSE) (r=0.94), which is the most commonly used measure of mental status.
szanton2010 - p. 5
Depressive symptomatology was assessed using the 11-item version of the Center for Epidemiologic Studies-Depression (CES-D) scale, which is designed to assess frequency and severity of depressive symptoms during the previous week
szanton2010 - p. 6
Because the sample consisted of adult twin pairs, the independence of observations assumption was not upheld, making standard regression procedures inappropriate. Therefore, to account for twin-pair dependency both in the outcome and covariates, a multilevel model approach was employed using xtreg, xtlogit, and ologit with a cluster option (STATA, Inc., College Station, TX). This multilevel approach assumed that each participant was nested within a twin pair and allowed for a varying degree of covariation among twins depending on their twin status