The ability of self-rated health status to predict mortality was tested with data from the National Health and Nutrition Examination Survey (NHANES-I) Epidemiologic FollowUp Study (NHEFS), conducted from 1971-84. The sample consists of adult NHANES-I respondents ages years (N = 6,440) for whom data from a comprehensive physical examination at the initial interview and survival status at follow-up are available. Self-rated health consists of the response to the single item, "Would you say
How do neighborhoods affect the health of residents? We propose that the impact of neighborhood disorder on self-reported health is mediated by psychological and physiological distress. We hypothesize a stress process in which chronic stressors in the environment give rise to a psychological and physiological stress response that ultimately affects health. The exogenous variable of interest is the neighborhood where disadvantaged persons live, which may expose them to chronic stressors in the form of crime, trouble, harassment, and other potentially distressing signs of disorder and decay. The mediator is the stress response that occurs in the body and brain. Of interest here is a psychological stress response in the form of fearful anxiety and depression, and a physiological stress response in the form of signs and symptoms of autonomic arousal, such as dizziness, chest pains, trouble breathing, nausea, upset stomach, and weakness. The outcome is poor health. This model is supported using data from the Welfare, Children, and Families project, a sample of 2,402 disadvantaged women in disadvantaged neighborhoods in Chicago, Boston, and San Antonio.
This paper presents a theoretical framework for understanding the impact of culture on the processes of symptom recognition, labeling, and help-seeking and consequently on large-scale epidemiological studies involving different ethnic groups. We begin with the assumption that the subjective experience of illness is culture-bound and that the cognitive and linguistic categories of illness characteristic of any culture constrain the interpretative and behavioral options available to individuals in response to symptoms. We hypothesize the existence of learned cognitive structures, through which bodily experiences are filtered, that influence the interpretation of deviations from culturally-defined physical and mental health norms. Certain contradictory findings concerning the self-reported health of Mexican Americans are discussed in order to illustrate the impact of culture on perceived health status.
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