Pilot 2
Briana Mezuk Ratliff, Robert Wood Johnson Health & Society Scholar
Email: bmezuk@vcu.edu
Briana Mezuk is a Robert Wood Johnson Health and Society Scholar. In 2007 she completed her doctoral degree in Mental Health from Johns Hopkins School of Public Health. In 2004/5 she was the Project Coordinator for the fourth wave of the Baltimore Epidemiologic Catchment Area Study, a 23-year prospective cohort study of health and mental health, which helped inspire her interest in lifespan health research. Her dissertation examined the relationships between depressive disorders and metabolic conditions associated with aging, specifically type 2 diabetes and osteoporosis, using this cohort.
The overall goals of Briana’s research are (a) to study the epidemiologic determinants of health and functioning over the life course and (b) to inform interventions, in both clinical and community settings, that use this insight to reduce the incidence and mitigate the consequences of mental disorders. Her long-term research interests are three-fold: (1) To understand the interface between behavior and physiology in order to integrate social, psychological and biological approaches to understanding health and illness over the life course, (2) To explore the multiple pathways linking psychiatric and physiological disorders, particularly chronic conditions such as cardiovascular disease and diabetes, and (3) To inform interventions which reflect an integrative approach to health to effectively reduce the burden of mental disorders.
The goal of her CIAHD pilot project is to examine how characteristics of work-life, such as decision latitude and workplace discrimination, shape health during the retirement transition. The baby boomer generation is the largest cohort of Americans to move through the retirement transition to date, and there is only limited research on how work-life characteristics affect health during retirement and how those relationships vary by race/ethnicity. Research on these relationships is needed to inform both employment and health policies for current and future generations
ABSTRACT
The influence of work-related and financial stressors, workplace discrimination, and retirement on blood pressure in older adults: a focus on the effects of race and age-cohort
(B. Mezuk PI)
(1-year pilot)
Epidemiology has a long history of examining the effects of work-life stressors on health, particularly blood pressure. There has been, however, less research on the retirement transition or the potential lingering effects of these work-life stressors on health. Additionally, little attention has been given to how those relationships vary by age cohort and race/ethnicity. Trends in employment status, including the transitions to retirement and work-stoppage in later life, vary significantly across racial groups. For example, compared to whites, African Americans and Hispanics are more likely to experience involuntary job loss in the years immediately preceding (and likely eventuating in) retirement. Given the instability associated with lower-wage, lower-skill employment that many racial minorities engage in (due in part to lower educational attainment and subsequently more restricted employment opportunities), it has been argued that “retirement” as it is commonly conceived (e.g., a period of consumption and leisure after career employment) is not a salient event for these groups. The experience of retirement also differs by race. For example, racial/ethnic minorities in the U.S. tend to rely on Social Security (SS) for retirement benefits more heavily than non-Hispanic whites, with approximately 33% of African Americans and Hispanics using SS for 100% of their retirement income compared to 16% of whites.
In addition to adapting to new roles and expectations, retirement and/or work-stoppage in older age may signal a break from work-life stressors. Exposure to work-life stressors, such as limited decision latitude, time-pressure, long work-hours, effort-reward imbalance, job insecurity, and workplace discrimination, has been linked to poor health status, including problem drinking, mental “burnout,” high blood pressure, and cardiovascular disease. However, there is suggestive evidence that work-life stressors may have residual effects even after employment has ceased. This transition may also reflect an alleviation of income-related stressors (e.g., the very act of retirement may signal an accumulation of wealth) or, alternatively, a period of increased financial concerns due to living on a fixed and possibly reduced income. Financial stressors, particularly the accumulation and/or persistence of such stressors, have also been linked to poor health status in older age. This proposal will use the Health and Retirement (HRS) survey, a national population-based open cohort of U.S. adults aged 50 and up, to investigate the effect of stressors (financial stress, work-life stress and workplace discrimination) and employment status on high blood pressure.
The specific aims of this proposal are to:
1. Examine how the effects of financial stressors, work-related stressors, and workplace discrimination on high blood pressure vary across age cohorts
2. Evaluate whether the age cohort patterns of the effects of financial stressors, work-related stressors, and workplace discrimination on high blood pressure vary by racial/ethnic group
3. Investigate the longitudinal influence of retirement (both voluntary and involuntary) and unemployment on the effect of financial and work-related stressors and workplace discrimination on high blood pressure across age cohorts and racial/ethnic groups
Utility of the life course framework for investigating health disparities The life course approach focuses on age-graded patterns of events and how those events are linked to historical time, social position, and social roles. While this framework has been utilized by researchers in the study of psychopathology for many decades, its application to the study of health disparities is relatively new. Much of the variation in health status is patterned by socioeconomic status. Employment status and characteristics of work life are important components of socioeconomically-patterned health disparities. Work-life offers a unique “strategic domain” for life course psychosocial stress research because employment is intrinsically linked to other social spheres across the lifespan, including educational attainment, interactions with friends and family, and socioeconomic position. The transition from work to retirement or unemployment in older age has numerous potential meanings for both the individual and their social environment. Retirement and work-stoppage in older age may have different implications for health depending on expectedness and voluntariness of the employment status change, but the effects of this change may also vary by age, cohort, race, sex, and employment history. The life course approach specifically interrogates these factors by focusing on time (both intrapersonal and historical), context (economic, social, and personal), and process (trajectories and lagged effects).