Social class, psychological disorder, and the nature of the psychopathologic indicator.
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STUDY OBJECTIVE: To describe and compare magnitude of class inequalities in women's health detected with four occupation-based class measures: individual, conventional household (male dominant), gender neutral household, and combined household. DESIGN: Cross sectional study, using health data obtained by physical examination, laboratory analysis, and self report. SETTING: A large pre-paid health maintenance organisation in Oakland, CA (US). PARTICIPANTS: 686 women (90% white) enrolled in Examination II of the Kaiser Permanente Women Twins Study (1989-1990). MAIN RESULTS: The proportion of women categorised as "working class" equalled 45, 30, and 21 per cent, respectively, for the individual level, gender neutral household, and conventional household class measures. Class inequalities in health, comparing women categorised as working class with non-working class, generally were stronger using the gender neutral household class measure, compared with the conventional household or individual class measure; in the case of "fair or poor" health, the respective odds ratios and 95% confidence intervals (adjusted for age and marital status) were 1.9 (1.1, 3.4), 1.5 (0.9, 2.5), and 1.3 (0.8, 2.2), while for high post-load glucose levels, they were 1.7 (1.1, 2.6), 1.2 (0.8, 1.7), and 1.3 (0.9, 1.8). The combined household class measure yielded effect estimates comparable to those of the gender neutral household class measure but with less precision, because of smaller strata. CONCLUSIONS: Epidemiological studies concerning class inequalities in women's health should use the gender neutral household class measure or, if sample size is sufficiently large, the combined household class measure.
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In Munich, 1477 employees (868 males and 609 females) of a large industrial firm were examined with regard to coronary heart disease risk factors. The known risk factors--overweight, disorders of the lipometabolism, diabetes, cigarette smoking, hypertension, pathologic ECG, physical inactivity--as well as certain somatic complaints and mental stress were checked for their distribution within the various social levels. With the exception of cigarette smoking among women and professional worries among men, in both sexes the members of the upper social group are less burdened with danger factors than the average. Aside from high blood pressure and disorders of the lipometabolism, which predominate in males in the middle layers, and cigarette smoking, which prevails among females in the upper social group, the risk factors pile up in the lowest social level. Our results will be discussed and compared with other studies.
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Craving and relapse are complex, poorly understood phenomena. A distinctive and baffling characteristic of the disease of chemical dependency is the continuing impulse to use alcohol and/or other drugs, even after lengthy periods of sobriety. This article discusses relapse prevention, focusing on public-sector chemically dependent women. Relapse among these women must be seen in the total context of their lives. Poverty and social disorganization do not directly cause relapse, but problems related to daily life under such conditions represent significant risk factors. The Eagleville Hospital treatment model and relapse prevention programs are described, and it is noted that public-sector women typically present with problems related to being raised in addicted households, residing in drug-saturated inner-city environments, deficits in child-rearing skills, destructive (often abusive) relationships with men, social interactions involving other substance abusers, few (if any) work skills, minimal educational achievement, low self-esteem, and poor self-image. A case study illustrates the course of treatment and relapse prevention efforts with a typical public-sector chemically dependent woman.
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