The Potential Explanatory Role of Perceived Stress in Associations Between Subjective Social Status and Health-Related Quality of Life Among Homeless Smokers

Abstract

Homeless individuals smoke at high rates relative to the general population and are at heightened risk of tobacco-related illnesses and poor health-related quality of life (HRQoL). Homeless smokers also report low subjective social status (SSS) or perceived social standing relative to others. SSS may contribute to poor HRQoL, potentially through perceived stress. The current study examined the role of perceived stress in the association of SSS and HRQoL among 227 (70.9% male, M_age = 43.2) homeless smokers. Participants completed self-report measures of SSS, perceived stress, and HRQoL. Perceived stress partially explained the relation between SSS (United States and Community) and HRQoL in covariate-adjusted analyses. Results suggested that perceived stress is a pathway through which SSS contributes to HRQoL among homeless smokers. Findings broaden current understanding of the impact of social disadvantage and perceived stress on HRQoL among homeless smokers.

Keywords

subjective social status perceived stress homeless smokers health-related quality of life

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References

Adler

(2000). MacArthur Research Network on Socioeconomic Status and Health. Retrieved from http://www.macses.ucsf.edu/Research/Psychosocial/subjective.php

Almeida

D. M.

Neupert

S. D.

Banks

S. R.

Serido

(2005). Do daily stress processes account for socioeconomic health disparities? The Journals of Gerontology, Series B: Psychological Sciences & Social Sciences, 60(Special Issue 2), S34-S39.

Andresen

E. M.

Catlin

T. K.

Wyrwich

K. W.

Jackson-Thompson

(2003). Retest reliability of surveillance questions on health related quality of life. Journal of Epidemiology & Community Health, 57, 339-343.

Arozullah

A. M.

Yarnold

P. R.

Bennett

C. L.

Soltysik

R. C.

Wolf

M. S.

Ferreira

R. M.

. . .Denwood

(2007). Development and validation of a short-form, rapid estimate of adult literacy in medicine. Medical Care, 45, 1026-1033.

Baggett

T. P.

Hwang

S. W.

O’Connell

J. J.

Porneala

B. C.

Stringfellow

E. J.

Orav

E. J.

. . .Rigotti

N. A.

(2013). Mortality among homeless adults in Boston: Shifts in causes of death over a 15-year period. Journal of the American Medical Association: Internal Medicine, 173, 189-195.

Baggett

T. P.

O’Connell

J. J.

Singer

D. E.

Rigotti

N. A.

(2010). The unmet health care needs of homeless adults: A national study. American Journal of Public Health, 100, 1326-1333.

Barrow

S. M.

Herman

D. B.

Cordova

Struening

E. L.

(1999). Mortality among homeless shelter residents in New York City. American Journal of Public Health, 89, 529-534.

Buck

D. S.

Brown

C. A.

Mortensen

Riggs

J. W.

Franzini

(2012). Comparing homeless and domiciled patients’ utilization of the Harris County, Texas public hospital system. Journal of Health Care for the Poor and Underserved, 23, 1660-1670.

Businelle

M. S.

Cuate

E. L.

Kesh

Poonawalla

I. B.

Kendzor

D. E.

(2013). Comparing homeless smokers to economically disadvantaged domiciled smokers. American Journal of Public Health, 103(Suppl. 2), S218-S220.

10.

Businelle

M. S.

Poonawalla

I. B.

Kendzor

D. E.

Rios

D. M.

Cuate

E. L.

Savoy

E. J.

. . .Reitzel

L. R.

(2015). Smoking policy change at a homeless shelter: Attitudes and effects. Addictive Behaviors, 40, 51-56.

11.

Centers for Disease Control and Prevention (CDC). (2000). Measuring healthy days: Population assessment of health-related quality of life. Retrieved from http://www.cdc.gov/hrqol/pdfs/mhd.pdf

12.

Centers for Disease Control and Prevention (CDC). (2009). Health-related quality of life. Retrieved from http://www.cdc.gov/hrqol/data/tables/table1a.htm

13.

Centers for Disease Control and Prevention (CDC). (2013). Behavioral Risk Factor Surveillance Survey. Retrieved from http://www.cdc.gov/brfss/questionnaires/pdf-ques/2013%20BRFSS_English.pdf

14.

Chandola

Clarke

Morris

Blane

(2006). Pathways between education and health: A causal modelling approach. Journal of the Royal Statistical Society: Series A (Statistics in Society), 169, 337-359.

15.

Chang

H.-L.

Fisher

F. D.

Reitzel

L. R.

Kendzor

D. E.

Nguyen

M. A. H.

Businelle

M. S.

(2015). Subjective sleep inadequacy and self-rated health among homeless adults. American Journal of Health Behavior, 39, 14-21.

16.

Cohen

Kamarck

Mermelstein

(1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385-396.

17.

Collingwood

(2012). The relationship between mental and physical health. Psych Central. Retrieved from http://psychcentral.com/lib/the-relationship-between-mental-and-physical-health/

18.

Crosby

R. D.

Kolotkin

R. L.

Williams

G. R.

(2003). Defining clinically meaningful change in health-related quality of life. Journal of Clinical Epidemiology, 56, 395-407.

19.

Davis

J. M.

Fleming

M. F.

Bonus

K. A.

Baker

T. B.

(2007). A pilot study on mindfulness based stress reduction for smokers. BMC Complementary & Alternative Medicine, 7(1), Article 2.

20.

Demakakos

Nazroo

Breeze

Marmot

(2008). Socioeconomic status and health: The role of subjective social status. Social Science & Medicine, 67, 330-340.

21.

do V Camelo

Giatti

Barreto

S. M.

(2014). Subjective social status, self-rated health and tobacco smoking: Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Journal of Health Psychology, 19, 1388-1399.

22.

Euteneuer

(2014). Subjective social status and health. Current Opinion in Psychiatry, 27, 337-343.

23.

Fazel

Geddes

J. R.

Kushel

(2014). The health of homeless people in high-income countries: Descriptive epidemiology, health consequences, and clinical and policy recommendations. The Lancet, 384, 1529-1540.

24.

Franzini

Fernandez-Esquer

M. E.

(2006). The association of subjective social status and health in low-income Mexican-origin individuals in Texas. Social Science & Medicine, 63, 788-804.

25.

Gadermann

A. M.

Hubley

A. M.

Russell

L. B.

Palepu

(2014). Subjective health-related quality of life in homeless and vulnerably housed individuals and its relationship with self-reported physical and mental health status. Social Indicators Research, 116, 341-352.

26.

Garey

Reitzel

L. R.

Bakhshaie

Kendzor

D. E.

Zvolensky

M. J.

Businelle

M. S.

(2015). Subjective social status and readiness to quit among homeless smokers. American Journal of Health Behavior, 39, 157-166.

27.

Grossman

Niemann

Schmidt

Walach

(2004). Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic Research, 57, 35-43.

28.

Hayes

A. F.

(2009). Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs, 76, 408-420.

29.

Hayes

A. F.

(2013). Methodology in the Social Sciences. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York, NY: Guilford Press.

30.

Hwang

S. W.

(2001). Homelessness and health. Canadian Medical Association Journal, 164, 229-233.

31.

Hwang

S. W.

Orav

E. J.

O’Connell

J. J.

Lebow

J. M.

Brennan

T. A.

(1997). Causes of death in homeless adults in Boston. Annals of Internal Medicine, 126, 625-628.

32.

Hwang

S. W.

Wilkins

Tjepkema

O’Campo

P. J.

Dunn

J. R.

(2009). Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study. British Medical Journal, 339.

33.

Idler

E. L.

Benyamini

(1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38, 21-37.

34.

Jamal

Agaku

I. T.

O’Connor

King

B. A.

Kenemer

J. B.

Neff

(2014). Current cigarette smoking among adults—United States, 2005-2013. Morbidity and Mortality Weekly Report, 63(47), 1108-1112.

35.

Kelley

(2005). The effects of nonnormal distributions on confidence intervals around the standardized mean difference: Bootstrap and parametric confidence intervals. Educational and Psychological Measurement, 65, 51-69.

36.

Kendzor

D. E.

Reitzel

L. R.

Businelle

M. S.

(2015). Characterizing stressors and modifiable health risk factors among homeless smokers: An exploratory pilot study. Health Education & Behavior, 42, 642-647. doi:10.1177/1090198114565664

37.

Kirby

K. N.

Gerlanc

(2013). BootES: An R package for bootstrap confidence intervals on effect sizes. Behavior Research Methods, 45, 905-927.

38.

Kushel

M. B.

Vittinghoff

Haas

J. S.

(2001). Factors associated with the health care utilization of homeless persons. Journal of the American Medical Association, 285, 200-206.

39.

Larimer

M. E.

Malone

D. K.

Garner

M. D.

Atkins

D. C.

Burlingham

Lonczak

H. S.

. . .Hobson

W. G.

(2009). Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. Journal of the American Medical Association, 301, 1349-1357.

40.

Larson

C. O.

(2002). Use of the SF-12 instrument for measuring the health of homeless persons. Health Services Research, 37, 733-750.

41.

Metro Dallas Homeless Alliance. (2014). 2013 point-in-time homeless count and census (2013 PIT Count Report). Retrieved from http://www.mdhadallas.org/dallascollin-county-coc-tx-600/

42.

Moisiuc

Reitzel

L. R.

Kendzor

D. E.

Childress

Businelle

M. S.

(2015). Determinants of social status among homeless adults. American Journal of Health Behavior, 39, 148-156.

43.

Okuyemi

K. S.

Goldade

Whembolua

G.-L.

Thomas

J. L.

Eischen

Guo

. . .Resnicow

(2013). Smoking characteristics and comorbidities in the power to quit randomized clinical trial for homeless smokers. Nicotine & Tobacco Research, 15, 22-28.

44.

Oliveira

N. L.

Goldberg

J. P.

(2002). The nutrition status of women and children who are homeless. Nutrition Today, 37(2), 70-77.

45.

Ostrove

J. M.

Adler

N. E.

Kuppermann

Washington

A. E.

(2000). Objective and subjective assessments of socioeconomic status and their relationship to self-rated health in an ethnically diverse sample of pregnant women. Health Psychology, 19, 613-618.

46.

Preacher

K. J.

Hayes

A. F.

(2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers, 36, 717-731.

47.

Preacher

K. J.

Hayes

A. F.

(2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879-891.

48.

Reitzel

L. R.

Buchanan

T. S.

Nguyen

Ahluwalia

J. S.

(2014). Associations of subjective social status with nondaily and daily smoking. American Journal of Health Behavior, 38, 245-253.

49.

Reitzel

L. R.

Businelle

M. S.

Kendzor

D. E.

Cao

Castro

. . .Wetter

D. W.

(2011). Subjective social status predicts long-term smoking abstinence. BMC Public Health, 11(1), Article 135.

50.

Reitzel

L. R.

Kendzor

D. E.

Cao

Businelle

M. S.

(2014). Subjective social status predicts quit day abstinence among homeless smokers. American Journal of Health Promotion, 29, 43-45.

51.

Reitzel

L. R.

Mazas

C. A.

Cofta-Woerpel

Cao

Businelle

M. S.

. . .Wetter

D. W.

(2010). Subjective social status affects smoking abstinence during acute withdrawal through affective mediators. Addiction, 105, 928-936.

52.

Reitzel

L. R.

Nguyen

Strong

L. L.

Wetter

D. W.

McNeill

L. H.

(2013). Subjective social status and health behaviors among African Americans. American Journal of Health Behavior, 37, 104-111.

53.

Reitzel

L. R.

Vidrine

J. I.

Mullen

P. D.

Velasquez

M. M.

Cinciripini

P. M.

. . .Wetter

D. W.

(2007). The influence of subjective social status on vulnerability to postpartum smoking among young pregnant women. American Journal of Public Health, 97, 1476-1482.

54.

Rizzo

V. M.

Kintner

(2013). The utility of the Behavioral Risk Factor Surveillance System (BRFSS) in testing quality of life theory: An evaluation using structural equation modeling. Quality of Life Research, 22, 987-995.

55.

Roth

Robbins

(2004). Mindfulness-based stress reduction and health-related quality of life: Findings from a bilingual inner-city patient population. Psychosomatic Medicine, 66, 113-123.

56.

Saban

K. L.

Mathews

H. L.

DeVon

H. A.

Janusek

L. W.

(2014). Epigenetics and social context: Implications for disparity in cardiovascular disease. Aging and Disease, 5, 346-355.

57.

Senn

T. E.

Walsh

J. L.

Carey

M. P.

(2014). The mediating roles of perceived stress and health behaviors in the relation between objective, subjective, and neighborhood socioeconomic status and perceived health. Annals of Behavioral Medicine, 48, 215-224.

58.

Singh-Manoux

(2003). Psychosocial factors and public health. Journal of Epidemiology & Community Health, 57, 553-556.

59.

Singh-Manoux

Marmot

M. G.

(2005). Role of socialization in explaining social inequalities in health. Social Science & Medicine, 60, 2129-2133.

60.

Singh-Manoux

Marmot

M. G.

Adler

N. E.

(2005). Does subjective social status predict health and change in health status better than objective status? Psychosomatic Medicine, 67, 855-861.

61.

Smith

B. W.

Shelley

B. M.

Dalen

Wiggins

Tooley

Bernard

(2008). A pilot study comparing the effects of mindfulness-based and cognitive-behavioral stress reduction. The Journal of Alternative and Complementary Medicine, 14, 251-258.

62.

Sobel

D. S.

(1995). Rethinking medicine: Improving health outcomes with cost-effective psychosocial interventions. Psychosomatic Medicine, 57, 234-244.

63.

Strine

T. W.

Okoro

C. A.

Chapman

D. P.

Balluz

L. S.

Ford

E. S.

Ajani

U. A.

Mokdad

A. H.

(2005). Health-related quality of life and health risk behaviors among smokers. American Journal of Preventive Medicine, 28, 182-187.

64.

Substance Abuse and Mental Health Services Administration. (2011). Current statistics on the prevalence and characteristics of people experiencing homelessness in the United States. Retrieved from http://homeless.samhsa.gov/ResourceFiles/hrc_factsheet.pdf

65.

Tsai

Rosenheck

R. A.

Culhane

D. P.

Artiga

(2013). Medicaid expansion: Chronically homeless adults will need targeted enrollment and access to a broad range of services. Health Affairs, 32, 1552-1559.

66.

Tsemberis

Eisenberg

R. F.

(2000). Pathways to housing: Supported housing for street-dwelling homeless individuals with psychiatric disabilities. Psychiatric Services, 51, 487-493.

67.

Whembolua

G.-L.

Davis

J. T.

Reitzel

L. R.

Guo

Thomas

J. L.

Goldade

K. R.

. . .Ahluwalia

J. S.

(2012). Subjective social status predicts smoking abstinence among light smokers. American Journal of Health Behavior, 36, 639-646.

68.

Wilson

I. B.

Cleary

P. D.

(1995). Linking clinical variables with health-related quality of life: A conceptual model of patient outcomes. Journal of the American Medical Association, 273, 59-65.

69.

Zhao

Lynch

J. G.

Chen

(2010). Reconsidering Baron and Kenny: Myths and truths about mediation analysis. Journal of Consumer Research, 37, 197-206.