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Biomedical subjects

Nancy E Adler

Publications and source records attributed to Nancy E Adler.

30 records · Page 2Linked to original sources
PubMed2003

Coping style as a predictor of health and well-being across the first year of medical school.

Medical students in their 1st year (N=71) were assessed prior to starting training and at year's end. Coping styles reported at baseline were strongly related to coping styles at the end of the year. Students' physical health and psychological well-being declined over the course of the year. The greater the students' use of both problem-focused coping and approach emotion-focused coping, the less their physical health deteriorated. Psychological well-being at year's end was more strongly related to baseline functioning, and coping style did not predict change. This study demonstrated the utility of measuring coping style and the predictive ability of coping on physical health in a healthy sample.

Adaptation, Psychological↗
PubMed2003

Impact of objective and subjective social status on obesity in a biracial cohort of adolescents.

OBJECTIVE: To characterize the associations between socioeconomic status (SES), two levels of subjective social status (SSS), and adolescent obesity. RESEARCH METHODS AND PROCEDURES: Cross-sectional study of 1491 black and white adolescents attending public school in a suburban school district in Greater Cincinnati, Ohio. BMI > or =95th percentile derived from measured height and weight defined overweight. Students rated SSS on separate 10-point scales for society and school. A parent provided information on parent education and household income for SES. RESULTS: Although there were no sex differences in SES, black students were more likely to come from families with less well-educated parents and lower incomes (p < 0.001). Black girls had the lowest societal SSS (p = 0.003), lowest school SSS (p = 0.046), and highest BMI (p < 0.001). Prevalence of overweight was highest among black girls (26.0%) and boys (26.2%), intermediate for white boys (17.2%), and least for white girls (11.6%). Logistic regression modeling revealed that parent education, household income, and school SSS were each associated with overweight. In a fully adjusted model, school SSS retained its association to overweight (odds ratio, 1.16; 95% CI, 1.06,1.26) independent of SES. The association of school SSS was strongest among white girls, intermediate for white and black boys, and absent for black girls. DISCUSSION: Perceptions of social stratification are independently associated with overweight. There were important racial and sex differences in the social status-overweight association. SSS in the more immediate, local reference group, the school, had the strongest association to overweight.

Adolescent↗
PubMed2003

An assessment of the validity of adolescent self-reported smoking using three biological indicators.

This research examined the validity of self-reports of adolescent smoking and explored factors that may influence agreement between self-reported smoking and biological indicators. Data were obtained from 1,881 adolescents as part of a household probability study in the southeastern United States. Adolescents aged 12-14 years reported their tobacco use and provided breath and saliva samples. The sensitivity and specificity of self-reports of smoking were calculated with measures of carbon monoxide, salivary cotinine, and salivary thiocyanate as standards. When the self-report items were compatible with the half-life of the biological indicator, and values were adjusted for smokeless tobacco use, sensitivity varied widely (carbon monoxide, 38%; cotinine, 81%-87%; thiocyanate, 80%). The range for specificity was more constrained (carbon monoxide, 98%; cotinine, 98%; thiocyanate, 80%). Sensitivity of self-report was influenced by the biological indicator examined and the timeframe of questions on smoking. Specificity of self-report was influenced by the biological indicator examined and use of other tobacco products. Overall, sensitivity and specificity were highest when recent smoking was assessed and when cotinine was the standard and smokeless tobacco use was considered. Examination of inhalation patterns suggested that detection of smoking may be influenced by recency of smoking and whether the adolescent smoker inhales. Assessments of individual adolescents' smoking were most accurate when smoking was recent and when cotinine was used and smokeless tobacco could be identified. Prevalence estimates of smoking were similar with self-reports and cotinine.

Adolescent↗
PubMed2002

Relative power between sexual partners and condom use among adolescents.

PURPOSE: To examine how the relative power of adolescent sexual partners in the domain of emotional intimacy is related to condom use. METHODS: Interviewed 228 adolescents who visited an STD clinic in San Francisco. Adolescents were aged 14-19 years, 69% were female, and they were ethnically diverse. We developed a measure of relative power in the domain of emotional intimacy, by adapting five items from existing measures and developing three items ourselves. The partner who had less desire for emotional intimacy was considered to have more power in that domain. We also measured relative decision-making power. Data were analyzed using logistic regression and Student's t-tests. RESULTS: Adolescents who had more power than their partners in the domain of emotional intimacy were more likely to get their way about condom use than adolescents who had less power in this domain. Decision-making power was not related to whether adolescents got their way about condom use. Young men reported greater emotional intimacy power and greater decision-making power than young women. However, gender was not related to getting one's way about condom use. CONCLUSIONS: The results suggest the importance of assessing relative power in the sexual relationships of adolescents when predicting condom use.

Adolescent↗
PubMedDate not supplied

Socioeconomic status and health: the role of sleep.

OBJECTIVE: Examine the role of sleep in the relationship between socioeconomic status (SES) and health. METHOD: Self-reported measures of income and education, sleep quantity and quality, and mental and physical health were obtained in a community sample of 1139 adults. RESULTS: More education was associated with higher income (p <.001), and higher income was associated with better physical health (p <.001) and psychological outcomes (p <.001). The effects of income on both mental and physical health were mediated by sleep quality (p values <.01), and sleep quantity was related to both measures of health (p values <.01) but to neither index of SES. CONCLUSION: Sleep quality may play a mediating role in translating SES into mental and physical well-being, and income seems to mediate the effect of education on sleep and, in turn, health.

Adolescent↗
PubMedDate not supplied

Social inequalities in biomarkers of cardiovascular risk in adolescence.

OBJECTIVE: Cardiovascular disease, which begins early in life but often is not manifest until adulthood, is the nation's leading cause of mortality. Social inequalities in cardiovascular disease are pervasive, yet the process by which they accrue is poorly understood. The objective of this study was to explore the associations between socioeconomic status, a range of biomarkers reflective of cardiovascular risks, and a cumulative physiological risk score among adolescents. METHODS: Non-Hispanic black and white high school students (N = 758) in a suburban Midwestern public school district had a physical examination to measure height, weight, and waist circumference and a fasting morning blood sample drawn to assess cortisol, insulin, glucose, glycosylated hemoglobin, fibrinogen, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, and triglycerides. A cumulative risk score was created from these physiological measures and waist circumference. Information on parent education and household income was obtained from a parent in a separate survey. Generalized estimating equation models were used to assess the association of parent education to the risks and the cumulative risk score adjusting for age, gender, and race. RESULTS: Lower parent education was associated with higher insulin, higher glucose, greater insulin resistance, higher LDL cholesterol, lower HDL cholesterol, higher waist circumference, and higher body mass index (p <.05 for all), but not cortisol, fibrinogen, glycosylated hemoglobin, or triglycerides in adjusted analyses. Cumulative risk scores ranged from 0 to 7 and were highly skewed; the median risk score was 1. A total of 7.4% had risk scores of 4 or more. Lower parent education was also associated with higher cumulative risk score (p <.001) and this association was maintained after adjustment for body mass index. Risk scores were highest, on average, among those with insulin levels greater than 1 standard deviation above the mean (mean risk score = 3.2, standard error = 0.18, median = 3). CONCLUSION: Lower parent education is associated with multiple metabolic risks and cumulative risk in adolescents, suggesting that there is a strong intergenerational transfer of education's influence on cardiovascular health. Our data imply that regulation of insulin may be a key factor underlying the influence of lower parent education on cardiovascular health early in the life course.

Adolescent↗
PubMedDate not supplied

Depressive symptoms are associated with blunted cortisol stress responses in very low-income women.

OBJECTIVE: The purpose of this study was to examine the association between depressive symptoms and salivary cortisol responses to stress in a high-risk population of very poor Mexican women. METHODS: Adult women (N = 1109) between the ages of 18 and 44 years (mean age, 29) were identified in a house-to-house survey in low-income areas (income <20th percentile nationally) of urban Mexico. An interview containing the Spanish version of the Center for Epidemiologic Studies--Depression Scale (CES-D) was administered to all women. The naturalistic stressor was defined as the unexpected arrival of a team of researchers at the participants' homes followed by an in-depth interview and physical assessment, with saliva samples taken at time of arrival (baseline), 25 minutes, and 50 minutes after arrival. RESULTS: The mean CES-D score was 19.42 (range, 0-53). Results of hierarchical linear modeling analyses revealed no effect of depressive symptoms on baseline salivary cortisol levels. However, a significant depressive symptom by time interaction revealed that women with elevations in depressive symptoms (CES-D scores = 35) failed to exhibit a cortisol response to the stressor. In contrast, in women with lower CES-D scores, cortisol levels significantly increased in response to the stressor. CONCLUSION: Consistent with research on individuals with major depressive disorder, results of this study demonstrate that women with very high levels of depressive symptoms exhibit blunted cortisol responses to a naturalistic psychological stressor. Results also contribute to previous research by generalizing findings to a high risk, underserved population of women.

Adolescent↗
PubMedDate not supplied

Does subjective social status predict health and change in health status better than objective status?

OBJECTIVE: To examine, among middle-aged individuals, if subjective socioeconomic status (SES) predicts health status and change in health status over time better than objective SES. METHODS: Data are from the Whitehall II study, a prospective study of British civil servants. SES data are drawn from Phase 5 (1997-1999) of the study and health data from Phases 5 and 6 (2000-2001). Physical and mental component scores from the Short Form 36, the General Health Questionnaire, and self-rated health were used to assess health status. Multiple linear regressions were used to examine the relationship between SES and health and change in health status. RESULTS: Complete data were available on 5486 people. Results show both measures of SES to be global measures of SES. Both measures of SES were significantly associated with health outcomes and with decline in health status over time. However, when both objective and subjective measures of SES are entered simultaneously in the model to predict change in health status, it was only the latter that continues to be significantly associated with health and changes in health. CONCLUSIONS: Subjective SES is a better predictor of health status and decline in health status over time in middle-aged adults. These results are discussed in terms of three possible explanations: subjective SES is a more precise measure of social position, the results provide support for the hierarchy-health hypothesis, and the results could be an artifact of common method variance.

Adult↗
PubMedDate not supplied

Socioeconomic disparities in health: pathways and policies.

Socioeconomic status (SES) underlies three major determinants of health: health care, environmental exposure, and health behavior. In addition, chronic stress associated with lower SES may also increase morbidity and mortality. Reducing SES disparities in health will require policy initiatives addressing the components of socioeconomic status (income, education, and occupation) as well as the pathways by which these affect health. Lessons for U.S. policy approaches are taken from the Acheson Commission in England, which was charged with reducing health disparities in that country.

Delivery of Health Care↗
PubMedDate not supplied

Out of sight, out of mind: why doesn't widespread clinical quality failure command our attention?

This paper examines the tolerance by all stakeholders of increasingly well documented evidence of serious and widespread clinical quality failure in the United States. Using research evidence from psychology, it describes specific cognitive and motivational impediments to the perception of quality failure-those shared by all stakeholders and those particularly relevant to patients and their families and to health care professionals. The authors endorse efforts by the National Quality Forum and others to make quality failure more publicly visible. They also point to the pivotal role of health care industry leaders in sustaining focus on a problem that inherently resists visibility.

Attitude of Health Personnel↗
PubMedDate not supplied

The trade-off between hormonal contraceptives and condoms among adolescents.

CONTEXT: Adolescents' dual use of condoms and hormonal contraceptives is low, and the motivations underlying their decisions to combine contraceptives are not understood. METHODS: To examine how pregnancy concerns, sexually transmitted disease (STD) concerns and type of sexual partner influence contraceptive use, we recruited 436 sexually experienced adolescents from two clinics. In structured interviews, we asked adolescents to describe their recent partners, their method use, and their pregnancy and STD concerns. Data were analyzed using logistic regression. RESULTS: The odds that adolescents used condoms with main partners were significantly lower among those who used hormonal contraceptives than among nonusers of these methods (odds ratios, 0.4 for young women and 0.3 for young men). With casual partners, no association existed between adolescents' condom and hormonal contraceptive use. Concerns about pregnancy and STDs influenced this association for women with main partners. Among young women who perceived pregnancy as more negative, hormonal contraceptive users had reduced odds of using condoms (0.1). No association existed between use of the two methods among young women whose view of pregnancy was less negative. Young women who perceived themselves to be less at risk of acquiring an STD had reduced odds of using condoms if they were using hormonal contraceptives (0.2). Among young women who perceived themselves to be more at risk of acquiring an STD, no association existed. CONCLUSIONS: Adolescents trade off between hormonal contraceptives and condoms according to partner type and perceived risks. Adolescents' dual-method use may improve if providers tailor counseling to adolescents' perceived risk of STDs and pregnancy, and if they address prevention of both as a related decision.

Adolescent↗