Lecture 8

Question 1

The Whitehall Studies (1967-1988)

Answer 1

Series of longitudinal studies investigating social determinants of health in British civil servants (government employees), all of whom are ranked yet have equal access to health care.

Question 2

The Whitehall Studies (1967-1988) - higher ranking was associated with…

Answer 2

higher life expectancy and lower incidence/risk factors of many diseases (in a gradient-like relationship)

Question 3

The Whitehall Studies (1967-1988) - gradiant pattern can be explained by… (2)

Answer 3

Stress and cortisol were proposed as primary mechanisms to explain these gradients

Question 4

The Status-Health Relationship: it has been found that low status associates with…

Answer 4

increased morbidity and mortality, lower quality of life

Question 5

The Status-Health Relationship: key mechanism between low status and dec. morbidity/mortality?

Answer 5

CHRONIC STRESS

Question 6

Low SES, Appraisal, and Coping

Answer 6

• Low-SES individuals report more frequent stressful life events and more chronic stressors
• Fewer resources, less effective coping
• Poverty is a chronic stressor

Question 7

Low SES and Allostatic Load

Answer 7

The burden of coping with limited resources and greater negative life events results in increased allostatic load on individuals at lower ends of the socioeconomic gradient.

Question 8

Low SES and Allostatic Load - what are among the most potent stressors (2)

Answer 8

Social ordering and dominance hierarchies are among the most potent stressors.

Question 9

Biological Embedding Model

Answer 9

Childhood adversity gets programmed into the immune system through multiple mechanisms, including epigenetics

Question 10

– What’s the Impact on the Group? –

Question 11

Among rich countries, higher income inequality (i.e., larger gap between rich and poor) is associated with…

Answer 11

• Lower life expectancy, higher rates of mental illness, higher crime, lower well-being, etc.
• Even the rich in more unequal countries are worse off (on average) than the rich in more equal countries. (^^ basically it is bad for everyone)

Question 12

Primary Mechanism(s)? - How exactly is social inequality having a negative impact? 2 factors

Answer 12

• heightened levels of competition in a society.
• social evaluation anxiety – increased stress due to greater threats to self-esteem, social status, social distrust, and fear of judgment.

Question 13

– Minority Stress and Stigma –

Question 14

Minority Stress Model

Answer 14

Stigma, prejudice, and discrimination create a hostile social environment

Question 15

Minority Stress Model - hostile social environment leads to…

Answer 15

increased stress for minoritized people and increased incidence of disease and illness.

Question 16

Specific sources of stress vary, but include… 3

Answer 16

• direct experiences of discrimination, prejudice, harassment. social stigma; internalized bias and stigma
• rejection and expectations of rejection
• hiding or concealing identity (esp. 2SLGBTQIA+ people)

Question 17

Minoritized people are also more likely to…

+ living condition

Answer 17

• Live in poverty…
• Discrimination and marginalization are common barriers for minoritized people seeking to escape poverty

Question 18

Racism and Health

Answer 18

Relationship between racism and a variety of mental and physical health outcomes

Question 19

Racism and Health - mechanisms?

institutional + personal?

Answer 19

Institutional racism limits resources and opportunities (which then impacts health, leads to stress), while personal experiences of racism increase stress over time.

Question 20

Factors in Resilience - what two components are correlated with greater resilience to poor health outcomes

Answer 20

In racialized groups (e.g., African Americans), subjective social status and perceived social support are correlated with greater resilience to poor health outcomes

Question 21

_ and _ are also correlated with heightened resilience in Black youth

Answer 21

Racial socialization (i.e., learning about race and racism; the place of one’s race in society) and racial identity are also correlated with heightened resilience in Black youth

Question 22

Factors in Resilience - findings also suggest that…

Answer 22

racial identity clarity also matters

Question 23

Trans Stigma and Health - what environment is most impactful?

Answer 23

immediate social environment

Question 24

Among trans youth and adults, psychological well-being (including lower risk of suicidal ideation) is associated with… (3)

Answer 24

• personal control
• support-seeking and social support
• positive reappraisal

Question 25

In a randomized clinical trial, early access to _ (for adults) resulted in a significant drop in _

Answer 25

In a randomized clinical trial, early access to **gender-affirming care** (for adults) resulted in a significant drop in **suicidal ideation**