Individual and community socioeconomic status : impact on mental health in individuals with arthritis

Peer reviewedPublisher PD

Perceptions of Individual and Community Environmental Influences on Fruit and Vegetable Intake, North Carolina, 2004

Introduction: Increases in obesity and other chronic conditions continue to fuel efforts for lifestyle behavior changes. However, many strategies do not address the impact of environment on lifestyle behaviors, particularly healthy dietary intake. This study explored the perceptions of environment on intake of fruits and vegetables in a cohort of 2,479 people recruited from 22 family practices in North Carolina. Methods: Participants were administered a health and social demographic survey. Formative assessment was conducted on a subsample of 32 people by using focus groups, semistructured individual interviews, community mapping, and photographs. Interviews and discussions were transcribed and content was analyzed using ATLAS.ti version 5. Survey data were evaluated for means, frequencies, and group differences. Results: The 2,479 participants had a mean age of 52.8 years, mean body mass index (BMI) of 29.4, and were predominantly female, white, married, and high school graduates. The 32 subsample participants were older, heavier, and less educated. Some prevalent perceptions about contextual factors related to dietary intake included taste-bud fatigue (boredom with commonly eaten foods), life stresses, lack of forethought in meal planning, current health status, economic status, the ability to garden, lifetime dietary exposure, concerns about food safety, contradictory nutrition messages from the media, and variable work schedules. Conclusion: Perceptions about intake of fruits and vegetables intake are influenced by individual (intrinsic) and community (extrinsic) environmental factors. We suggest approaches for influencing behavior and changing perceptions using available resources

What Community Resources Do Older Community-Dwelling Adults Use to Manage Their Osteoarthritis? A Formative Examination

Community resources can influence health outcomes, yet little research has examined how older individuals use community resources for osteoarthritis (OA) management. Six focus groups were conducted with 37 community-dwelling older adult African Americans and Caucasians who self-reported OA and resided in Johnston County, North Carolina. Descriptive analyses and qualitative constant comparison methodology revealed individuals use local recreational facilities, senior centers, shopping centers, religious organizations, medical providers, pharmacies and their social network for OA management. Participants also identified environmental characteristics (e.g., sidewalk conditions, curb-cuts, handicapped parking, automatic doors) that both facilitated and hindered use of community resources for OA management. Identified resources and environmental characteristics were organized around Corbin & Strauss framework tasks: medical/behavioral, role, and emotional management. As older Americans live with multiple chronic diseases, better understanding of what community resources are used for disease management may help improve the health of community-dwelling adults, both with and without OA

Coping with Prescription Medication Costs: a Cross-sectional Look at Strategies Used and Associations with the Physical and Psychosocial Health of Individuals with Arthritis

Prescription medication costs increase financial burden, often leading individuals to engage in intentional nonadherence. Little is known about what specific medication cost-coping strategies individuals with arthritis employ

Associations of perceived neighborhood environment on health status outcomes in persons with arthritis

To examine the association between four aspects of the perceived neighborhood environment (aesthetics, walkability, safety, and social cohesion) and health status outcomes in a cohort of North Carolinians with self-report arthritis, after adjustment for individual and neighborhood SES covariates

Associations of educational attainment, occupation and community poverty with knee osteoarthritis in the Johnston County (North Carolina) osteoarthritis project

Abstract: Introduction: The purpose of this study was to examine data from the Johnston County Osteoarthritis (OA) Project for independent associations of educational attainment, occupation and community poverty with tibiofemoral knee OA. Methods: A cross-sectional analysis was conducted on 3,591 individuals (66% Caucasian and 34% African American). Educational attainment ( 25%) were examined separately and together in logistic models adjusting for covariates of age, gender, race, body mass index (BMI), smoking, knee injury and occupational activity score. Outcomes were presence of radiographic knee OA (rOA), symptomatic knee OA (sxOA), bilateral rOA and bilateral sxOA. Results: When all three socioeconomic status (SES) variables were analyzed simultaneously, low educational attainment was significantly associated with rOA (odds ratio (OR) = 1.44, 95% confidence interval (CI) 1.20, 1.73), bilateral rOA (OR = 1.43, 95% CI 1.13, 1.81), and sxOA (OR = 1.66, 95% CI 1.34, 2.06), after adjusting for covariates. Independently, living in a community of high household poverty rate was associated with rOA (OR = 1.83, 95% CI 1.43, 2.36), bilateral rOA (OR = 1.56, 95% CI 1.12, 2.16), and sxOA (OR = 1.36, 95% CI 1.00, 1.83). Occupation had no significant independent association beyond educational attainment and community poverty. Conclusions: Both educational attainment and community SES were independently associated with knee OA after adjusting for primary risk factors for knee OA

Health-Related Quality of Life in Adults From 17 Family Practice Clinics in North Carolina

Introduction: We examined health-related quality of life (HRQOL) in white and African American patients based on their own and their community's socioeconomic status. Methods: Participants were 4,565 adults recruited from 17 family physician practices in urban and rural areas of North Carolina. Education was used as a proxy for individual socioeconomic status, and the census block-group poverty level was used as a proxy for community socioeconomic status. HRQOL measures were the 12-Item Short Form Survey Instrument, physical component summary (PCS) and mental component summary (MCS), and 3 Centers for Disease Control and Prevention HRQOL healthy days measures. Multilevel analyses examined independent associations of individual and community poverty level with HRQOL, adjusting for demographics and clustering by family practice. Analyses were stratified by race and were conducted on subgroups of arthritis and cardiovascular disease patients. Results: Among whites, all 5 HRQOL measures were significantly associated with the lowest individual socioeconomic status, and 4 HRQOL measures were associated with the lowest community socioeconomic status (MCS being the exception). Among African Americans, 4 HRQOL measures were significantly associated with the lowest individual socioeconomic status and the lowest community socioeconomic status (PCS being the exception). Arthritis and cardiovascular disease subgroup analyses showed generally analogous findings. Conclusion: Better HRQOL measures generally were associated with low levels of community poverty and high levels of education, emphasizing the need for further exploration of factors that influence health