Handbook of Psychology

Socioeconomic Status 555

of the mechanisms linking these factors to increased health
risk is still incomplete, it should be pointed out that diseases
can be prevented or effectively treated long before causative
mechanisms are understood. For example, the cessation of
tobacco chewing to prevent oral cancer was discovered in

1915. However, it was not until 1974 that NI-nitrosornicotine
      was discovered as the causal agent of oral cancer (Wynder,
      1998). Thus, it comes as no surprise that, without a complete
      understanding of the mechanisms, several behavioral inter-
      ventions designed to improve health have been quite success-
      ful. Generally, most behavioral interventions are conducted
      with male participants, leading several authors to caution
      against generalizing results obtained from male samples. The
      need for gender-speci“c interventions may be most obvious
      for those focusing on social support and work stress. For
      example, social support interventions often seek to elicit the
      support from a person•s partner. This strategy may be effec-
      tive for men, who tend to see their spouses as their primary
      source of social support, but not for women, whose primary
      source of social support consists of friends and family mem-
      bers (New England Research Institutes, 1997). Thus, solicit-
      ing social support from one•s partner may not be the best
      strategy for women and could even lead to exacerbated stress
      responses, as suggested by Kirschbaum et al.•s (1995)
      “ndings.
      Similarly, interventions designed to reduce work stress
      that have been shown to be effective with men may not gen-
      eralize to women, because women•s work situations differ
      from those of men. Because of the unequal division of labor
      at home, married women who are employed full time have a
      greater total workload than men. Thus, compared to men in
      similar positions, women are more stressed by their greater
      unpaid work load (as indicated, for example, by higher nor-
      epinephrine levels; Lundberg & Frankenhaeuser, 1999).
      Furthermore, there is evidence that the same job positions are
      more stressful for women than for men. In a sample of em-
      ployed men and women in high-ranking positions, Lundberg
      and Frankenhaeuser report the largest gender difference in
      response to the question, •Do you have to perform better than
      a colleague of the opposite sex to have the same chance of
      promotion?Ž Most of the women, but none of the men, agreed
      with this statement (Lundberg & Frankenhaeuser, 1999).
      With regard to treatment, gender-speci“c approaches also
      appear to be indicated. For example, it has been suggested
      that female heart disease patients may be able to reverse
      coronary atherosclerosis by making fewer lifestyle changes
      than male heart disease patients (Ornish et al., 1990). How-
      ever, large-scale clinical trials including women and men rep-
      resenting more sociodemograpically diverse populations are
      needed to evaluate the effectiveness of behavioral treatments.
      One promising attempt toward this end is the behavioral

intervention entitled •Enhancing Recovery in Coronary

Heart DiseaseŽ (ENRICHD) Patients Study. This study is a

major multicenter, randomized clinical trial that is currently

testing the effects of a psychosocial intervention, aimed at de-

creasing depression and increasing social support, on rein-

farction and mortality in 3,000 post-Miocardial Infarction

(MI) patients at high psychosocial risk (i.e., depressed and/or

socially isolated patients). The study, in which 50% of the

patients will be women, will be completed in 2001 and will

provide valuable information on the role of emotions in heart

disease among both women and men from more sociodemo-

graphically diverse backgrounds.

In summary, behavioral interventions designed to increase

social support, decrease negative emotions, and improve

lifestyle behaviors and coping skills in both women and men

are clearly indicated. However, given the many situational

differences between men•s and women•s lives, the design of

gender-speci“c interventions may be required to yield ef fec-

tive outcomes.

SOCIOECONOMIC STATUS

The health of the United States population has improved ap-

preciably during the past two centuries. Concomitant with

these improvements, however, clinically signi“cant dif fer-

ences in health outcomes by socioeconomic status (SES)

have persisted (Liao, McGee, Kaufman, Cao, & Cooper,

1999; Pappas, Queen, Hadden, & Fisher, 1993). Although the

voluminous research literature examining the relationship

between SES and health outcomes precludes a detailed

analysis of the topic here, a number of reviews have exam-

ined this body of literature and are suggested for further

reading (N. Anderson & Armstead, 1995; Krieger, Rowley,

Herman, Avery, & Phillips, 1993; Krieger, Williams, &

Moss, 1997; Marmot & Feeney, 1997; Marmot, Kogevinas,

& Elston, 1987; West, 1997; D. Williams & Collins, 1995).

This section brie”y (a) reviews how SES has been assessed

and the methodological limitations associated with the as-

sessment of SES; (b) discusses the association between

SES and health status; (c) examines the interactions among

ethnicity, SES, and health; (d) explores the relationships

between SES and biobehavioral/psychosocial risk and pro-

tective factors, as well as SES and behavioral prevention and

treatment approaches; and (e) concludes with suggestions for

future research on mechanism linking SES and health.

Assessment of SES

At least three factors currently retard our understanding of the

relationship between SES and health status. First, opposed to