The findings have implications for improving ethnic and socioeconomic disparities in physical and mental health through attention to social cohesion among neighborhood residents.

Objective-Socioeconomic disparities in pain may be attributable both greater frequency in stressful financial events, as well as greater vulnerability to economic hardship, for those at the lower end of the socioeconomic spectrum. This study investigated the effects of economic hardship and daily financial worry on daily pain among women with a chronic musculoskeletal condition.Design-The sample consisted of 250 women with osteoarthritis (N=105), Fibromyalgia (N=46), or both (N=99). During an initial assessment, participants' chronic pain diagnosis, level of economic hardship, and demographic information were ascertained. Over 30 days, daily diary assessments recorded daily financial worries and daily pain severity. Hypotheses were tested using multilevel modeling for repeated measures in SAS PROC MIXED. Main Outcome Measure-Daily pain severity.Results-Results indicated that both conditions of economic hardship and daily ratings of financial worry had significant detrimental effects on daily pain. Participants with greater levels of financial stress had greater pain in response to daily financial worries than their counterparts with little or no financial stress. Further, participants in the sample who were not employed and who reported higher levels of financial stress exhibited the most pain reactivity in response to daily financial worries.Conclusion-Financial stress was associated not only with greater exposure to daily financial worries, but also with greater vulnerability to pain on days when daily financial worries were experienced.Keywords economic hardship; chronic pain; socioeconomic disparities; women Individuals at lower socioeconomic levels have demonstrated greater morbidity and mortality across a broad array of diseases when compared to individuals at higher socioeconomic levels (Adler, Boyce, Chesney, Cohen, Folkman, Kahn, & Syme, 1994;Gallo, Bogart, Vranceanu, & Matthews, 2005;Marmot, 2004), including heart disease, stroke, lung disease, HIV-related disease, tuberculosis, suicide, accidents, and arthritis Correspondence concerning this article should be addressed to: Rebeca Rios, Ph.D., Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224. Phone: (410) 550-5744; fax (410) 550-8161; rrios2@jhmi.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/hea NIH Public Access (Adler & Ostrove, 1999;Marmot, 2004). Investigators have begun to articulate what characterizes the everyday processes and experiences in daily life that would help to explain these social class dis...

"Etiquette-based medicine" was infrequently practiced by this sample of hospitalist physicians. Improving performance of etiquette-based medicine may improve patient satisfaction.