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Hearing loss is highly prevalent in the United States, especially among middle-aged and older adults (Nash et al., 2011). It may affect as many as one in five individuals in [...], Objective: The purpose of this study was to explore the hypothesis that the relationship between hearing problems and cardiovascular disease (CVD) includes a connection to psychological distress. Design: We used generalized structural equation modeling to assess relationships between self-reported measures of hearing problems, psychological distress, and CVD in a pooled sample of 623,416 adult respondents in the 1997-2017 National Health Interview Survey. Hearing status without hearing aids was self-reported on an ordinal scale and further grouped for this study into 3 categories (excellent or good hearing, little or moderate trouble hearing, and a lot of trouble or deaf). Six CVDs (stroke, angina pectoris, hypertension, heart attack, coronary heart disease, or other heart condition/ disease) were incorporated as a latent variable. Psychological distress was evaluated by the Kessler 6 Scale (Kessler et al., 2010). All estimates were population weighted, and standard errors were adjusted for a complex survey design. Results: Nearly 83% reported excellent or good hearing, 14% reported a little or moderate trouble hearing, and 3% reported a lot of trouble hearing or said they were deaf. Hearing problems were positively associated with CVD. Relative to those reporting excellent/good hearing, adults reporting trouble hearing had a higher probability of CVD. Hearing problems were also significantly associated with psychological distress. When psychological distress was applied to the model, positive associations between hearing problems and CVD were attenuated but still significant. Results are consistent with the hypothesis that the connection between self-reported hearing problems and CVD is mediated through psychological distress. Conclusions: The relationship between self-reported hearing problems and CVD is mediated by psychological distress. Further research is needed to identify causal pathways and psychophysiological mechanisms involved in this relationship and to identify effective methods for addressing cardiovascular health-related psychosocial factors in the treatment of hearing impairment.

Introduction Disease dynamics in developing countries are shifting such that morbidity and mortality rates associated with chronic, non-communicable conditions are comparable to communicable diseases [1]. Globalization has introduced the risks [...], Hypertension is a major global public health risk and significant precursor to cardiovascular disease, stroke, diabetes and maternal mortality. A possible strategy to reduce chronic disease in resource-poor areas is social intervention. Research into the possible relationship of social determinants and disease is needed to determine appropriate social interventions. This study aims to determine the association between social capital and hypertension in rural Haitian women. From June to August 2005, 306 women, ages 18-49, who attended one of Hopital Albert Schweitzer's five rural dispensaries as patients or accompanying patients, were interviewed. Individual interviews on social capital, demographics and anthropometrics were conducted. SAS statistical package was used to analyze the data. Groups/networks, personal empowerment, collective action/cooperation and trust components significantly decreased the likelihood of hypertension in multivariate analysis. In an additive model, the ranked index of social capital indicated that each social capital component score above the conceptual midpoint showed a 41 % reduction in the likelihood of hypertension. The findings suggest that interventions aimed to increase components of social capital may significantly lower hypertension. Keywords Social capital * Social networks * Hypertension * Rural health * Women * Haiti

This study examines whether the relationship between acculturation and physical health varies by gender among Mexican Americans, and if the mechanisms that mediate the acculturation-health relationship operate differently by gender. Using the 1998-2007 National Health Interview Study, we construct a composite measure of acculturation and estimate regression models for the total number of health conditions, hypertension, heart disease, and diabetes. Immigrants with the lowest levels of acculturation are the healthiest, but this association is stronger for men. Medical care plays a central role in accounting for gender and acculturation differences across health outcomes--increased access to and utilization of medical care is associated with worse health, which suggests that better health among recent arrivals (particularly men) partially results from their lack of knowledge about their own poor health. Keywords acculturation, gender, hypertension, medical conditions, Mexican American DOI: 10.1177/0022146510386792

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2010.05.045 Byline: David H. Chae (a), Karen D. Lincoln (b), Nancy E. Adler (c), S. Leonard Syme (d) Abstract: Studies examining associations between racial discrimination and cardiovascular health outcomes have been inconsistent, with some studies finding the highest risk of hypertension among African Americans who report no discrimination. A potential explanation of the latter is that hypertension and other cardiovascular problems are fostered by internalization and denial of racial discrimination. To explore this hypothesis, the current study examines the role of internalized negative racial group attitudes in linking experiences of racial discrimination and history of cardiovascular disease among African American men. We predicted a significant interaction between reported discrimination and internalized negative racial group attitudes in predicting cardiovascular disease. Weighted logistic regression analyses were conducted among 1216 African American men from the National Survey of American Life (NSAL; 2001-2003). We found no main effect of racial discrimination in predicting history of cardiovascular disease. However, agreeing with negative beliefs about Blacks was positively associated with cardiovascular disease history, and also moderated the effect of racial discrimination. Reporting racial discrimination was associated with higher risk of cardiovascular disease among African American men who disagreed with negative beliefs about Blacks. However, among African American men who endorsed negative beliefs about Blacks, the risk of cardiovascular disease was greatest among those reporting no discrimination. Findings suggest that racial discrimination and the internalization of negative racial group attitudes are both risk factors for cardiovascular disease among African American men. Furthermore, the combination of internalizing negative beliefs about Blacks and the absence of reported racial discrimination appear to be associated with particularly poor cardiovascular health. Steps to address racial discrimination as well as programs aimed at developing a positive racial group identity may help to improve cardiovascular health among African American men. Author Affiliation: (a) Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Room 512 Atlanta, GA 30322, USA (b) University of Southern California, School of Social Work, 669 West 34th Street, Los Angeles, CA 90089, USA (c) University of California, San Francisco, Center for Health and Community, 3333 California Street, Suite 465, San Francisco, CA 94118, USA (d) University of California, Berkeley, School of Public Health, 570 University Hall, Berkeley, CA 94720, USA Article Note: (footnote) [star] The National Survey of American Life was supported by the National Institute of Mental Health (NIMH; grant U01-MH57716; P.I.: J.S. Jackson) with supplemental support from the Office of Behavioral and Social Science Research at the National Institutes of Health and the University of Michigan. D.H. Chae was supported by the Robert Wood Johnson Health and Society Scholars Program. The preparation of this manuscript was also supported by a grant from NIMH (grant K01-MH69923) for K.D. Lincoln.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.11.019 Byline: Mark S. Kaplan (a), Nathalie Huguet (a), David H. Feeny (b), Bentson H. McFarland (c) Abstract: Hypertension is one of the most common chronic conditions worldwide. There is strong evidence that low socioeconomic status is associated with elevated rates of blood pressure-related cardiovascular disease. Few studies have examined the association between socioeconomic circumstances and hypertension among people aged 65 years and older. The purpose of this study was to examine the relationship between household income and self-reported hypertension prevalence among persons aged 65 and older in the United States and Canada. Data were obtained from the 2002-2003 Joint Canada/United States Survey of Health for 755 Canadian and 1151 US adults aged 65 and older. Aggregate hypertension prevalence rates in the United States and Canada were generally similar (53.8% versus 48.0%). We found a significant inverse linear relationship between household income and the hypertension prevalence rate in the United States, but no evidence of such a relationship in Canada. In Canada, unlike the United States, the burden of hypertension is approximately equal for socioeconomically advantaged and disadvantaged older adults. It is important to consider these findings in the context of long-term and broader institutional policies. Social disparities and barriers to health care access and primary prevention among non-elderly persons in the United States may play a role in the higher hypertension prevalence rate among low-income older adults. Author Affiliation: (a) Portland State University, Portland, OR, United States (b) Kaiser Permanente, Northwest Center for Health Research, OR, United States (c) Oregon Health & Science University, Portland, OR, United States Article Note: (footnote) [star] This research was supported by a grant from the Retirement Research Foundation. All analyses, interpretations, and conclusions based on these data are solely the responsibility of the authors.

Racism has dominated the social fabric of American society since its founding. African-American males have been the focal point for various forms of racism given their perception as threatening. Exacerbated by media images the threatening perceptions of African-American males result in racist victimization during encounters with law enforcement agencies for otherwise law abiding citizens. Based upon the constant prevalence of racism in public life African-American males suffer from abnormally high blood pressure. The result is a health risk manifested by a correlation between skin color and hypertension. Social scientists are all but unaware of this phenomenon. Solution to the problem will require more informed research and the elimination of racism in total. Keywords Racism * Health risk * African-American males * Hypertension * Skin color

This paper examines socioeconomic (socioeconomic status, SES) disparities in self-rated health and hypertension among 29,816 US adults aged 25 and older using data from the 2001 wave of the National Health Interview Survey. Our purpose is to examine how influential measures of social support and social integration are for each health outcome, and whether support and integration operate by mediating, or buffering, the effects of SES on health. Multivariate regression models show no significant influence of emotional support, but do indicate that many aspects of social integration are directly associated with self-rated health and hypertension, although these measures do not mediate the relationship between SES and health. However, interaction tests show substantial evidence that measures of social integration buffer some of the negative effects of low SES, particularly the negative influence of not working on self-rated health. In addition, findings indicate potential evidence of help-seeking behavior among adults who did not finish high school or who report financial barriers to medical care. Overall, our findings suggest that social programs designed to foster social integration (e.g., free or low-cost bus fare to promote visits with friends and family) may improve health among persons with low levels of education, who are not working, or who have problems accessing medical care because of financial problems. Keywords: Health disparities; Socioeconomic status; Social support; Social integration; Self-rated health; Hypertension; USA

In a population-based, cross-sectional study of 310 treated hypertensives (HT) and 288 matched normotensive controls (NT), social and biological variables were investigated. HT comprised a higher proportion of individuals in lower socioeconomic strata (P < 0.001) and lower social class distribution (defined by occupation and educational level) than NT. However, lower estimated risks (odds ratios, OR) for hypertension were found in lower social strata than in higher ones for most biological variables. This does not support the hypothesis of an increased general susceptibility in lower social classes to standard risk factors as a main factor behind the higher prevalence of hypertension, in as much as the ORs for most variables were not higher in the lower classes than in the higher ones. Thus, there may exist some, as yet undefined, and more specific risk factors for hypertension which are more prevalent in lower social strata. Interestingly, it was demonstrated that the prevention potential regarding intervention against biological risk factors had about the same magnitude in the different social strata.

Chronic illness exerts a lasting and pervasive influence on personal experience of the world. It is commonly viewed as a phenomenon to be coped with, requiring an adaptive response on the part of an individual. Chronic illness, however, is a culturally-influenced tool which in itself can be used to organize and implement an adaptive response to personal experience. Employing Hallowell's concept of the self in the behavioral environment, the uses of a chronic folk illness, 'high-pertension', for personal adaptation are discussed. Data from research on health beliefs about hypertension and illness behavior in a sample of 60 older African-American women in New Orleans are presented. 'High-pertension', a chronic folk illness related to the biomedical 'hypertension', and involving blood and 'nerves', is described. Health beliefs and illness behavior associated with high-pertension are considered as part of an individual's total effort at adaptation within the behavioral environment. These points are made: (1) Chronic illness can be used as a means to express one's self in relation to the behavioral environment. (2) Chronic illness can be used to manipulate and manage the relation of self to environment. (3) Chronic illness can be used to legitimize and announce role change. These uses are available to the individual by virtue of social interaction, cultural precedent and the chronicity and meaning of the illness itself. For persons in a severely stressed, constrained, and disadvantaged social position, as are many older African-American women, chronic illness offers one of the few means of controlling the behavioral environment available to the individual. Although in anthropology and biology we speak of adaptation in terms of human groups, we are ultimately considering person-environment fit, that is, personal adaptation. Chronic illness can be a part of a culturally-influenced adaptive response.

Black Americans are more likely to have high blood pressure (hypertension) than whites. Although access to health care, social class, diet, and other risk factors account for some of this difference, the exact reasons for the disparity are not known. There may also be a genetic predisposition to salt sensitivity or other factors that lead to hypertension. Two assumptions must be true if there is a genetic component: there must be a gene or group of genes that increase susceptibility, and this gene or genes must occur more frequently among blacks than whites. If there is a genetic component to high blood pressure among blacks, darker skinned blacks would presumably tend to have higher mean blood pressure than those with lighter skin. Data for 457 black Americans who were studied between 1972 and 1974 were analyzed to determine the effect of skin color, socioeconomic class, and other variables. Previous studies have come up with conflicting results, but many were flawed. A common failing was to measure skin color of the face, a poor indication of actual skin color after years of exposure. In this study, darker skin and higher blood pressure co-occurred among those of lower socioeconomic status, but for those of higher economic status, there was no association. Perhaps those at a lower socioeconomic level, skin color is a cause of psychosocial stress because of racism in this society. There seems to be a similar relationship between those with an 'active coping style,' who are less likely than others to have normal blood pressure. Diet or socioeconomic stress may also interact with a genetic tendency that is more common among blacks with darker skin color. (Consumer Summary produced by Reliance Medical Information, Inc.)

A comparison of the relative usefulness of a standardized measure of global perceived social support (Procidano and Heller, 1983) with a health-specific index showed that the latter was a better predictor of compliance for a sample consisting mostly of older female hyperthensives. However, the relationship of support and compliance to actual health, as measured by blood pressure levels at two times separated by 3 to 6 months, was found to be weak. The hypothesis that the degree of fit between preference for social support and amount of perceived support would affect compliance was not upheld. A model of social support as the positive reaction of others to patients with good health status was proposed as an alternative or complement to the prevalent model in which support is viewed as an antecedent of compliance, and eventually, of improved health.

Introduction Active travel (walking, bicycling, and use of public transport) is increasingly being promoted as an integral component of strategies to increase physical activity levels and address the growing burden [...], Background: Increasing active travel (walking, bicycling, and public transport) is promoted as a key strategy to increase physical activity and reduce the growing burden of noncommunicable diseases (NCDs) globally. Little is known about patterns of active travel or associated cardiovascular health benefits in low- and middle-income countries. This study examines mode and duration of travel to work in rural and urban India and associations between active travel and overweight, hypertension, and diabetes. Methods and Findings: Cross-sectional study of 3,902 participants (1,366 rural, 2,536 urban) in the Indian Migration Study. Associations between mode and duration of active travel and cardiovascular risk factors were assessed using random-effect logistic regression models adjusting for age, sex, caste, standard of living, occupation, factory location, leisure time physical activity, daily fat intake, smoking status, and alcohol use. Rural dwellers were significantly more likely to bicycle (68.3% versus 15.9°%;p Conclusions: Walking and bicycling to work was associated with reduced cardiovascular risk in the Indian population. Efforts to increase active travel in urban areas and halt declines in rural areas should be integral to strategies to maintain healthy weight and prevent NCDs in India. Please see later in the article for the Editors' Summary.

The class character of medicine is most easily discerned in the inequitable organization of health services. Capital's shaping of the patterns of disease and our medical/scientific responses is less apparent but equally strong. We illustrate this point by reviewing some recent history of cardiovascular diseases and therapies. Hitherto unknown afflictions have become commonplace. Our diagnostic and therapeutic concepts are the crystallization of a long history of scientific effort--an effort dominated and directed by capitalist imperatives. The work of the clinician rests on this scientific substrate, and recognition or rejection of its class nature provides a potential basis for a new medical science but not the needed results. The socialist transformation of medicine will require a recognition of the capitalist specificity of current science, and the painstaking construction of alternative modes of thought.

Social support is generally thought to facilitate adherence to recommended treatment regimens. Despite a well-documented tradition of social support among African Americans, much of the existing research indicates a very limited level of adherence, especially to dietary modification. To account for this seeming contradiction, forty-one rural-dwelling African Americans with hypertension age 65+ participated in a series of structured and semi-structured interviews. Results indicate that 1) informants perceived themselves to be well-supported by family and friends; 2) most informants have achieved a moderate to high level of dietary adherence; and 3) no statistically significant relationship existed between perceived social support and dietary adherence. The discussion focuses on three reasons for this lack of association, including: 1) modest sample size; 2) informants' identification of helpful others who defied standard evaluations of support; and 3) incremental and gradual dietary changes that required little need for social support.