Self-rated health and limiting longstanding illness: inter-relationships with morbidity in early adulthood

Residential mobility according to health status in South Korea's largest metropolitan city during the COVID-19 pandemic using generalized estimating equations for longitudinal data

This study examines whether residential mobility differed according to health status in Seoul, the largest metropolitan city in South Korea, during the COVID-19 pandemic. Before the COVID-19 pandemic, people who moved had better health status in the baseline year than those who did not. However, during the pandemic, the residential mobility of people with poor health status increased, particularly in 2019-2020. This pattern appeared to be driven by the 55-74 age group. The effect of health status on residential mobility was not attenuated, even after adjusting for covariates at multiple levels.

Influenza vaccine coverage and factors associated with non-vaccination among caregiving and care-receiving adults in the Canadian Longitudinal Study on Aging (CLSA)

BACKGROUND

Influenza vaccination is recommended for those at increased risk of influenza complications and their household contacts to help reduce influenza exposure. Adults who require care often experience health issues that could increase the risk of severe influenza and have close contact with caregivers. Assessing influenza vaccination prevalence in caregivers and care recipients can provide important information about uptake.

OBJECTIVES

We aimed to (1) estimate influenza non-vaccination prevalence and (2) assess factors associated with non-vaccination among caregivers aged ≥ 45 years and among care recipients aged ≥ 65 years.

METHODS

We conducted an analysis of cross-sectional data from the Canadian Longitudinal Study on Aging collected 2015-2018. We estimated non-vaccination prevalence and reported adjusted odds ratios with 95% confidence intervals from logistic regression models to identify factors associated with non-vaccination among caregivers and care recipients.

RESULTS

Of the 23,500 CLSA participants who reported providing care, 41.4% (95% CI: 40.8%, 42.0%) reported not receiving influenza vaccine in the previous 12 months. Among the 5,559 participants who reported receiving professional or non-professional care, 24.8% (95% CI: 23.7%, 26.0%) reported not receiving influenza vaccine during the same period. For both groups, the odds of non-vaccination were higher for those who had not visited a family doctor in the past year, were daily smokers, and those who identified as non-white.

DISCUSSION

Identifying groups at high risk of severe influenza and their close contacts can inform public health efforts to reduce the risk of influenza. Our results suggest sub-optimal influenza vaccination uptake among caregivers and care recipients. Efforts are needed to increase influenza vaccination and highlight the direct and indirect benefits for caregiver-care recipient pairs.

CONCLUSION

The proportions of both caregivers and care recipients who had not been vaccinated for influenza was high, despite the benefits of vaccination. Influenza vaccination campaigns could target undervaccinated, high-risk groups to increase coverage.

Higher air pollution exposure in early life is associated with worse health among older adults: A 72-year follow-up study from Scotland

Air pollution increases the risk of mortality and morbidity. However, limited evidence exists on the very long-term associations between early life air pollution exposure and health, as well as on potential pathways. This study explored the relationship between fine particle (PM2.5) exposure at age 3 and limiting long-term illness (LLTI) at ages 55, 65 and 75 using data from the Scottish Longitudinal Study Birth Cohort 1936, a representative administrative cohort study. We found that early life PM2.5 exposure was associated with higher odds of LLTI in mid-to-late adulthood (OR = 1.10, 95% CI: 1.06, 1.14 per 10 μg m-3 increment) among the 2085 participants, with stronger associations among those growing up in disadvantaged families. Path analyses suggested that 15-21% of the association between early life PM2.5 concentrations and LLTI at age 65 (n = 1406) was mediated through childhood cognitive ability, educational qualifications, and adult social position. Future research should capitalise on linked administrative and health data, and explore causal mechanisms between environment and specific health conditions across the life course.

Help overcoming pain early, a brief person-centred intervention for adolescents with chronic pain in a school setting, may improve symptoms of insomnia

Introduction and aims

Chronic pain and symptoms of insomnia affect large numbers of adolescents and early interventions are prioritized. The aim of the current study was to evaluate potential secondary effects of the intervention, Help Overcoming Pain Early (HOPE), on symptoms of insomnia and self-rated health.

Methods

The study included non-randomized aggregated data from the active and control conditions in a previously conducted randomized controlled trial evaluating the efficacy of HOPE, after the participants in the control condition also had received the intervention. Symptoms of insomnia were assessed with the Minimal Insomnia Symptom Scale and self-rated health was assessed with one item, at the start of the intervention, post intervention, and at a six-month follow-up. Baseline variables included age, gender, pain localization, pain impact, school absence and symptoms of depression (assessed with the Center for Epidemiological Studies Depression Scale for Children). Inferential analyzes were performed using Linear Mixed Models (LMM). Effect sizes were evaluated by calculating Cohen's d.

Results

There were statistically significant improvements in symptoms of insomnia at the six-month follow-up, and statistically significant improvements in self-rated health at the end of the intervention and at the six-month follow-up. Effect sizes were small across outcomes and assessments.

Discussion and conclusion

Results illustrated significant but small improvements in symptoms of insomnia and self-rated health in adolescents with chronic pain following the HOPE intervention. Although caution is needed when assessing the findings, results illustrate the potential utility of an accessible brief early intervention in a school context.

Perceived Racial/Ethnic Discrimination, Citizenship Status, and Self-Rated Health Among Immigrant Young Adults

Both racial/ethnic discrimination and citizenship status are manifestations of racism. Few empirical studies have examined the role of multiple stressors and how both stressors are interlinked to influence health among immigrant young adults. Informed by the theory of stress proliferation, the current study seeks to examine the interplay between perceived racial/ethnic discrimination and citizenship status on health. We used the third wave of the Children of Immigrants Longitudinal Study (CILS) to examine the influence of perceived racial/ethnic discrimination and citizenship status on self-rated health (SRH) among immigrant young adults (N = 3344). Perceived racial/ethnic discrimination was initially associated with SRH. After adjusting for both predictors, those experiencing perceived racial/ethnic discrimination and non-citizen youth were less likely to report better health than youth who did not report perceived racial/ethnic discrimination or citizen youth. In fully adjusted multivariate regression models, racial/ethnic discrimination remained significant, while citizenship status was no longer associated with SRH. To test stress proliferation, an interaction term was included to assess whether the relationship between perceived racial/ethnic discrimination and SRH varied by citizenship status. The interaction term was significant; non-citizen young adults who experienced racial/ethnic discrimination were less likely to report better health in comparison to citizen young adults and those who did not report perceived racial/ethnic discrimination. Results suggest that the interplay between perceived racial/ethnic discrimination and citizenship status may be influential for health among immigrant young adults. These findings underscore the need for further assessment of the role of stress proliferation on immigrant young adults' health.

"Now I just need something sweet": Racism, emotional eating, and health among African Americans

BACKGROUND

The Environmental Affordances Model theorizes that systemic racism disproportionately exposes African Americans in the United States to chronic everyday stressors (e.g., individual racism) while simultaneously shaping the availability of coping resources (e.g., fast food outlets) and engagement in self-regulatory strategies (e.g., emotional eating). Greater engagement in self-regulatory strategies is theorized to preserve mental health while contributing to medical morbidities and mortality.

OBJECTIVE

However, few studies have tested the Environmental Affordances Model, limiting our understanding of how the proposed pathways operate in the lives of African Americans.

METHODS

In the present study, the associations between systemic racism (institutional racism, cultural racism, neighborhood disadvantage), chronic everyday stressors (exposure to individual racism), emotional eating, and mental (anxiety symptomatology) and physical (self-rated overall physical health) health are assessed in a sample of 751 African Americans aged 18 to 88.

RESULTS

The path analysis reveals that institutional and cultural racism are both positively associated with individual racism. Neighborhood disadvantage is inversely associated with individual racism. Individual racism is significantly associated with greater anxiety symptomatology but is unrelated to self-rated overall physical health. Institutional and cultural racism are associated with emotional eating although individual racism and neighborhood disadvantage are not. Moreover, engagement in emotional eating exacerbates, rather than mitigates, the impacts of individual racism on anxiety symptomatology.

CONCLUSIONS

We conclude that institutional and cultural racism contribute to individual racism experiences and emotional eating whereas emotional eating exacerbates associations among individual racism and anxiety symptomatology.

Disability-related inequalities in health and well-being are mediated by barriers to participation faced by people with disability. A causal mediation analysis

Large inequalities in health and well-being exist between people with and without disability, in part due to poor socio-economic circumstances, and potentially also related to societal factors including issues associated with accessibility and participation. To better understand the contribution of societal factors, we used a unique longitudinal survey of disability in Great Britain to quantify the extent to which barriers to participation contribute to poorer health and well-being. We used data from 2354 individuals who participated in three waves of the Life Opportunities Survey between 2009 and 2014 and compared five health and well-being outcomes (self-rated health, anxiousness, life satisfaction, life worth, happiness) between adults who acquired an impairment and those who remained disability-free. Causal mediation analysis was conducted to quantify how much of the effect of disability acquisition on each outcome was explained by barriers to participation in employment, economic life, transport, community, leisure and civic activities, social contact, and accessibility. People who recently acquired a disability had poorer health and well-being compared to people with no disability. Barriers to participation explained 15% of inequalities in self-rated health, 28% for anxiousness, 32% for life satisfaction, 37% for life worth, and 70% for happiness. A substantial proportion of the inequalities in health and well-being experienced by people with recently acquired disability were socially produced, driven by barriers to participation in different life domains. Furthermore, there was evidence that barriers to participation mediated the effect of well-being measured to a greater extent than the more clinically aligned measures, self-reported health and anxiousness. These findings highlight modifiable factors amenable to public health interventions that could lead to substantial improvements in health and well-being for people with disability.

Influenza vaccine coverage and factors associated with non-vaccination among adults at high risk for severe outcomes: An analysis of the Canadian Longitudinal Study on Aging

Background

Influenza vaccination is recommended in Canada for older adults and those with underlying health conditions due to their increased risk of severe outcomes. Further research is needed to identify who within these groups is not receiving influenza vaccine to identify opportunities to increase coverage.

Objectives

We aimed to 1) estimate influenza non-vaccination prevalence and 2) assess factors associated with non-vaccination among Canadian adults aged ≥65 and adults aged 46–64 with ≥1 chronic medical condition (CMC) due to their high risk of severe influenza outcomes.

Methods

We conducted a secondary analysis of cross-sectional data collected from 2015–2018 among participants of the Canadian Longitudinal Study on Aging. For both groups of interest, we estimated non-vaccination prevalence and used logistic regression models to identify factors associated with non-vaccination. We report adjusted odds ratios and 95% confidence intervals for the investigated variables.

Results

Overall, 29.5% (95% CI: 28.9%, 30.1%) of the 23,226 participants aged ≥65 years and 50.4% (95% CI: 49.4%, 51.3%) of the 11,250 participants aged 46–64 years with ≥1 CMC reported not receiving an influenza vaccination in the past 12 months. For both groups, lack of recent contact with a family doctor and current smoking were independently associated with non-vaccination.

Discussion

Influenza vaccination helps prevent severe influenza outcomes. Yet, half of adults aged 46–64 years with ≥1 CMC and more than one-quarter of all adults aged ≥65 years did not receive a recommended influenza vaccine in the year prior to the survey. Innovation in vaccination campaigns for routinely recommended vaccines, especially among those without annual family doctor visits, may improve coverage.

Conclusion

Influenza vaccination coverage among Canadian adults aged 46–64 years with ≥1 CMC and adults aged ≥65 years remains suboptimal. Vaccination campaigns targeting those at high risk of severe outcomes without routine physician engagement should be evaluated to improve uptake.

Grip Strength Trajectories and Cognition in English and Chilean Older Adults: A Cross-Cohort Study

Growing evidence about the link between cognitive and physical decline suggests the early changes in physical functioning as a potential biomarker for cognitive impairment. Thus, we compared grip-strength trajectories over 12-16 years in three groups classified according to their cognitive status (two stable patterns, normal and impaired cognitive performance, and a declining pattern) in two representative UK and Chilean older adult samples. The samples consisted of 7069 UK (ELSA) and 1363 Chilean participants (ALEXANDROS). Linear Mixed models were performed. Adjustments included socio-demographics and health variables. The Declined and Impaired group had significantly lower grip-strength at baseline when compared to the Non-Impaired. In ELSA, the Declined and Impaired showed a faster decline in their grip strength compared to the Non-Impaired group but differences disappeared in the fully adjusted models. In ALEXANDROS, the differences were only found between the Declined and Non-Impaired and they were partially attenuated by covariates. Our study provides robust evidence of the association between grip strength and cognitive performance and how socio-economic factors might be key to understanding this association and their variability across countries. This has implications for future epidemiological research, as hand-grip strength measurements have the potential to be used as an indicator of cognitive performance.

Health selection on self-rated health and the healthy migrant effect: Baseline and 1-year results from the health of Philippine Emigrants Study

Studies of migration and health focus on a "healthy migrant effect" whereby migrants are healthier than individuals not migrating. Health selection remains the popular explanation of this phenomenon. However, studies are mixed on whether selection occurs and typically examine migrants post-departure. This study used a novel pre-migration dataset to identify which health and social domains differ between migrants and their non-migrant counterparts and their contribution to explaining variance in self-rated health by migrant status at pre-migration and 1-year later. Data were used from the baseline and 1-year follow-up of the Health of Philippine Emigrants Study (HoPES). We used multivariable ordinary least squares regression to examine differences in self-rated health between migrants to the U.S. and a comparable group of non-migrants at baseline (premigration) and one year later, accounting for seven domains: physical health, mental health, health behavior, demographics, socioeconomic factors and healthcare utilization, psychosocial factors, and social desirability. A migrant advantage was present for self-rated health at baseline and 1-year. Accounting for all domains, migrants reported better self-rated health compared to non-migrants both at baseline (β = 0.32; 95% CI = 0.22, 0.43) and at 1-year (β = 0.28; 95% CI = 0.10, 0.46). Migrant status, health behavior, and mental health accounted for most of the variance in self-rated health both at baseline and 1-year follow-up. This analysis provides evidence of migrant health selection and nuanced understanding to what is being captured by self-rated health in studies of migrant health that should be considered in future research.

The association of a past childbirth experience with a variety of early physical and mental symptoms in subsequent pregnancies

BACKGROUND

Some women have a perceived negative experience of childbirth due to various reasons- e.g., obstetric complications or the feeling of loss of control. We do not know enough about the effects of a perceived negative experience of a childbirth on a woman's subsequent pregnancies. The aim of this study was to investigate whether a previously perceived negative childbirth experience affects a woman's physical and mental well-being in a later pregnancy.

METHODS

A prospective cohort study in Danish general practice, based on information about women's childbirth experiences from the Pregnancy Health Record filled in by the general practitioner (GP) and data from an electronic questionnaire completed by the women.

RESULTS

A total of 1288 women were included in the analysis. Women who had given birth before were found to have a significantly higher risk of experiencing nausea, varicose veins and uterine contractions, and a lower risk of pelvic cavity pain in the current pregnancy. Women having given birth before were significantly more likely to assess their physical fitness as poor and to experience poor well-being. Women with a perceived negative experience of childbirth had more sleep problems and a higher prevalence of poor self-rated health than women with unproblematic childbirth experience.

CONCLUSION

This study showed that women with a previously perceived negative experience of childbirth are affected according to their mental health in their subsequent pregnancy.

Poor worker’s long working hours paradox: evidence from the Korea National Health and Nutrition Examination Survey, 2013-2018

Background

Because income and working hours are closely related, the health impact of working hours can vary according to economic status. This study aimed to investigate the relationship between working hours and the risk of poor self-rated health according to household income level.

Methods

We used the data from the Korea National Health and Nutrition Examination Survey VI and VII. The information on working hours and self-rated health was obtained from the questionnaire. After stratifying by household income level, the risk of poor self-rated health for long working hour group (≥ 52 hours a week), compared to the 35–51 working hour group as a reference, were calculated using multiple logistic regression.

Results

Long working hours increased the risk of poor self-rated health in the group with the highest income, but not in the group with the lowest income. On the other hand, the overall weighted prevalence of poor self-rated health was higher in the low-income group.

Conclusions

The relationship between long working hours and the risk of poor self-rated health varied by household income level. This phenomenon, in which the health effects of long working hours appear to diminish in low-income households can be referred to as the ‘poor worker’s long working hours paradox’. Our findings suggest that the recent working hour restriction policy implemented by the Korean government should be promoted, together with a basic wage preservation to improve workers’ general health and well-being.

Alcohol drinking in one's thirties and forties is associated with body mass index in men, but not in women: A longitudinal analysis of the 1970 British Cohort Study

Our objective was to investigate longitudinal associations between alcohol drinking and body mass index (BMI). Alcohol drinking (exposure), BMI (outcome), smoking habit, occupation, longstanding illness, and leisure time physical activity (potential confounders) were assessed at ages 30, 34, 42, and 46 in the 1970 British Birth Cohort Study. Multilevel models were used to cope with the problem of correlated observations. There were 15,708 observations in 5931 men and 14,077 observations in 5656 women. Drinking was associated with BMI in men. According to the regression coefficients, BMI was expected to increase by 0.36 (95% confidence interval: 0.11, 0.60) kg/m² per year in men who drank once a week and by 0.40 (0.14, 0.15) kg/m² per year in men who drank most days. In ten years, BMI was expected to increase by 5.4 kg/m² in men who drank and by 2.9 kg/m² in men who drank and were physically active. Drinking was not associated with BMI in women. Rather, BMI was expected to increase by 0.25 (0.07, 0.43) kg/m² per year in women who were former smokers. In ten years, BMI was expected to increase by 4.3 kg/m² in women who were former smokers and by 0.8 kg/m² in women who were former smokers and who were physically active. Associations between drinking and BMI were similar after further adjustment for problematic drinking and diet. These longitudinal data suggest that drinking is associated with BMI in men and that drinking is not associated with BMI in women independent of other lifestyle risk factors.

Self-Rated Health Among Patients With Severe Traumatic Brain Injury and Their Close Relatives: The Role of Posttraumatic Stress Symptoms

OBJECTIVE

Severe traumatic brain injury (sTBI) is accompanied by significant declines in self-rated health (SRH). Although such deteriorations in SRH are related to various consequences of sTBI, the effect of posttraumatic reactions (i.e., posttraumatic stress [PTS] symptoms) has been tested insufficiently to date, especially among civilians. The present investigation is based on Trajectories of Recovery After Severe Traumatic brain injury-Matters In families (TRAST-MI), a unique study among civilians with sTBI and their families. Previous research revealed that civilian sTBI has effects beyond the injured patient, influencing their close relatives as well. The aim of this study was to assess the association between PTS symptoms and SRH among patients with civilian sTBI and their close relatives.

METHODS

Patients with sTBI (assessed by an Abbreviated Injury Scale of the head region score >3) and their close relatives participated in TRAST-MI. One hundred twenty-six patient-relative dyads were assessed at 3, 6, and 12 months after the injury.

RESULTS

Multilevel modeling revealed that patients' PTS symptoms were associated with consequent SRH (slope = 0.42; p < .001), and relatives' PTS symptoms were associated with their respective SRH (slope = 0.2; p = .012).

CONCLUSIONS

The findings of this study reveal that SRH of both patients with sTBI and their relatives are negatively affected by their own PTS symptoms. These findings underline the understanding that sTBI is not merely a medical trauma but rather a comprehensive psychosocial trauma, which has consequences for the whole family system.

Association between Depression, Lifestyles, Sleep Quality and Sense of Coherence in a Population with Cardiovascular Risk

People with cardiovascular risk have more depression than the general population. Depression and cardiovascular risk have been commonly linked to lower sense of coherence (SOC) values, unhealthy lifestyles, and poor sleep quality. The aim of this study was to analyze the association between depression, health-related lifestyles, sleep quality, and SOC in a population with cardiovascular risk. A cross-sectional study was conducted in 310 participants (aged 35–75 years) with cardiovascular risk. Sociodemographic and anthropometric characteristics, cardiovascular risk, SOC score, depression levels, sleep quality, and lifestyles (physical activity, diet quality (measured as the adherence to the Mediterranean diet), and tobacco and alcohol consumption) were determined. The regression analysis showed significant associations between depression levels and sex (odds ratio (OR): 2.29; 95% CI: 1.29, 4.07), diet (OR: 0.85; 95% CI: 0.73, 0.99), body mass index (BMI) (OR: 1.06; 95% CI: 1.01, 1.12), cardiovascular disease (CVD) (OR: 2.55; 95% CI: 1.18, 5.48), sleep quality (OR: 0.26; 95% CI: 0.15, 0.46), and SOC (OR: 0.96; 95% CI: 0.94, 0.98). Protective effects of male sex, a lower BMI, no CVD, a higher adherence to the Mediterranean diet, a high sleep quality, and a higher SOC were found. In conclusion, among lifestyles determined, only diet was associated with depression levels. SOC and sleep quality were also found as significant predictors for depression levels.

A comparison of the four healthy days measures (HRQOL-4) with a single measure of self-rated general health in a population-based health survey in New York City

Background

Data on health-related quality of life (HRQOL) can be used to track health disparities, assess the impact of chronic diseases, and predict mortality. The Centers for Disease Control and Prevention’s “Healthy Days Measures” (HRQOL-4) assesses four key domains: self-rated general health, physical health, mental health, and activity limitations. The domains are not easily combined to summarize overall HRQOL, and some evidence suggests that self-rated general health may be an adequate proxy indicator for overall HRQOL. This study compares self-rated general health as a solitary measure of HRQOL with two summary indices of the HRQOL-4 as a predictor of adverse health conditions in a representative sample of adult New York City residents.

Methods

The 2017 NYC Social Determinants of Health survey implemented by the New York City Department of Health and Mental Hygiene collected data from a representative sample of New Yorkers (n = 2335) via phone, mail, and web. We compared the information criteria and predictive power of self-rated general health with two alternative summary indices of the HRQOL-4 in predicting self-reported health conditions (hypertension, diabetes, obesity, non-specific psychological distress, and a summary indicator for at least one those four morbidities).

Results

Overall, 19.1% (95% CI: 16.9, 21.5) of respondents reported that they had fair or poor general health. Self-rated general health was significantly associated with days of poor physical health, poor mental health, and activity limitations (p < 0.001 for each). While the Akaike and Bayesian information criteria suggested that the summary indices of the HRQOL-4 produced marginally better models for predicting adverse health conditions, self-rated general health had slightly higher predictive power than did the summary indices in all models of physical health outcomes as measured by Tjur’s pseudo-R² and the area under the curve.

Conclusion

We found very small differences between self-rated general health and the summary indices of the HRQOL-4 in predicting health conditions, suggesting self-rated general health is an appropriate proxy measure of overall HRQOL. Because it can be measured with a single question rather than four, it might be the most simple, efficient, and cost-effective method of summarizing HRQOL in large population-based surveys.

Importance of lifestyle, stress, and chronic diseases in self-rated health of Korean doctors

The quality of medical services and the health of patients can be guaranteed when the doctors are healthy. In this study, we used the data from the 2016 Korean Physician Survey and analyzed the relationship of lifestyle, stress, and chronic diseases status with the self-rated health of Korean doctors. Among 7,631 doctors in Korea, 2,336 (30.6%) reported their self-rated health as ‘good’, 4,462 (58.5%) as ‘moderate’, and 833 (10.9%) as ‘bad’. The multinominal logistic regression analysis, showed that factors related to the self-rated health were age, type of healthcare facility, smoking, exercise, sleep duration, stress, and chronic diseases status. Since doctors’ lifestyle, stress, and chronic disease status were closely related to their self-rated health, it is imperative to prepare measures to protect doctors’ health in an intensive medical environment, where too many patients require treatment, due to the characteristics of the medical system in Korea.

The Psychological Impact of the COVID-19 Epidemic on Guangdong College Students: The Difference Between Seeking and Not Seeking Psychological Help

Background

Coronavirus disease 2019 (COVID-19) has considerably psychologically impacted Chinese college students. Several types of online mental health services were widely implemented for college students during the outbreak. This study investigated the relationship between college students' mental health status and psychological help-seeking behavior to test the phases-decision-making model (PDM).

Methods

A cross-sectional survey was conducted among college students in Guangdong Province using an online platform. In total, 4,164 students were assigned to the "counseling group" or "non-counseling group" according to whether they had sought psychological help because of the COVID-19 outbreak; the groups were matched based on age, sex, and grade. Demographics, perceived mental health, and experience with seeking psychological help were recorded. Fear, depression, and trauma were assessed by the COVID-19 Fear Screening Scale, Patient Health Questionnaire, and Impact of Event Scale-6.

Results

The fear, depression, and trauma scores were significantly higher in the counseling group than in the non-counseling group (P _s < 0.001). Fear (OR = 1.27, p < 0.001), depression (OR = 1.02, p = 0.032), trauma (OR = 1.08, p < 0.001), poor perceived mental health status (OR = 3.61, p = 0.001), and experience with seeking psychological help (OR = 7.06, p < 0.001) increased the odds of seeking psychological help.

Conclusion

During the COVID-19 epidemic, the rate of psychological help-seeking was still low, and college students in poor psychological condition sought psychological counseling more. Fear, depression, trauma, experience with seeking psychological help, and perceived mental health can effectively predict psychological help-seeking behavior. These findings emphasized the importance of closely monitoring college students' psychological status, providing psychological intervention, and improving the probability of seeking psychological help.

Exploring the bidirectional associations between loneliness and cognitive functioning over 10 years: the English longitudinal study of ageing

BACKGROUND

As the population ages, cognitive decline and dementia have become major health concerns in the UK. Loneliness has been linked to cognitive decline, but the reverse causality of this association remains unclear. This study aims to examine whether there is a bidirectional relationship between loneliness and cognitive function in older English adults (age 50 years and over) over a 10-year follow-up.

METHODS

Data came from a nationally representative sample of 5885 participants in the English Longitudinal Study of Ageing (ELSA), free of stroke or dementia and followed every 2 years up to wave 7 (2014-15). At each wave, cognitive function was measured with word recall and verbal fluency tests, and loneliness was measured with the abridged version of the revised UCLA Loneliness Scale. Bivariate dual change score models were used to assess the multivariate associations between loneliness and cognitive function, used interchangeably as exposures and outcomes.

RESULTS

Greater loneliness at baseline was associated with poorer memory [β intercept = -0.03, standard error (SE) = 0.01, P  =  0.016] and verbal fluency (β intercept = -0.01, SE  =  001, P =  0.027) at baseline, and with a stronger linear rate of decline in both memory (β linear slope = -0.07, SE  =  001, P  ≤ 0.001) and verbal fluency (β linear slope = -0.09, SE  =  0.03, P =  0.003) over a 10-year follow-up period, although the performance on verbal fluency did not change substantially on average over this period. We also found that higher baseline memory, but not verbal fluency, predicted a slower change in loneliness (β linear slope = -0.01, SE  =  001, P =  0.004) and that a linear decline in memory was associated with an acceleration in loneliness (β quadratic slope = -0.02, SE  =  001, P  ≤ 0.001) during follow-up.

CONCLUSIONS

Higher loneliness is associated with poorer cognitive function at baseline and contributes to a worsening in memory and verbal fluency over a decade. These factors seem, however, to be partially intertwined, since baseline memory and its rate of decline also contribute to an increase in loneliness over time.

Association of Positive Affect Instability With All-Cause Mortality in Older Adults in England

IMPORTANCE

There is increasing recognition that positive affective states have a protective association for all-cause mortality. However, positive states of happiness and excitement vary over time, and little is known about the association of fluctuations in positive affect with survival.

OBJECTIVE

To investigate the association of positive affect instability, conceptualized as fluctuations in momentary positive affect, with mortality in a population-based sample of older adults in England.

DESIGN, SETTING, AND PARTICIPANTS

This survey study used data from a longitudinal survey collected in wave 2 (2004) of the English Longitudinal Study of Ageing, a nationally representative sample of older men and women living in England, with follow-up continuing until March 2018. Participants included people aged 50 years or older at recruitment. Data were analyzed from September 2019 to April 2020.

MAIN OUTCOMES AND MEASURES

The main outcome was all-cause mortality. Positive and negative affect were measured at 4 time points over the course of 1 day: soon after waking, 30 minutes after waking, at 7:00 pm, and at bedtime.

RESULTS

Data were analyzed from 3834 participants (mean [SD] age at baseline, 64.0 [7.4] years; 2082 [54.3%] women) with a mean (SD) follow-up of 12.25 (2.60) years. Adjusting for demographic characteristics, baseline illness, health behaviors, and mean level and instability in negative affect, Cox proportional hazards regression showed that high positive affect instability was associated with greater mortality, with a hazard ratio of 1.25 (95% CI, 1.04-1.49; P = .02). Associations did not differ by age, suggesting that the increased mortality risk associated with high positive affect instability was not restricted to older ages.

CONCLUSION AND RELEVANCE

These findings suggest that temporal fluctuations in positive affect were associated with mortality risk in older adults. These findings illustrate the value of incorporating dynamic assessments of positive affect in distal health outcomes such as mortality.

Self-rated health in adolescence as a predictor of 'multi-illness' in early adulthood: A prospective registry-based Norwegian HUNT study

Self-rated health (SRH) is a marker of future health and a possible predictor of future multimorbidity, which is a major challenge for population health and health care. There is a lack of studies on adolescent SRH and patterns of health problems across the transitional period from adolescence to early adulthood. Therefore, this study aimed to identify groups of people with similar health problems in early adulthood and explore the predictive value of adolescent SRH on the group classification after a period of 10–19 years. Data from 8828 adolescents participating in the Young HUNT-1 survey (1995–1997) were linked to the Norwegian registry of general practitioner (GP) claims, which includes diagnoses recorded in GP consultations in 2006–2014. We used latent class analysis (LCA) to identify groups of patients with similar health problems in early adulthood and explored SRH as a predictor of class membership using latent class regression, adjusting for baseline chronic disease, frequency of health care attendance, sex and age. The mean age at baseline was 16 years, and 50% of the participants were female. SRH was reported as very good by 28%, good by 61% and not good by 11%. We identified five groups of patient classification (classes): Healthy (35%), Infections and general problems (26%), Musculoskeletal problems (21%), Psychological problems (6%) and Multi-illness (13%). We found a gradual increase in the probability of belonging to the Healthy class with better SRH, and an inverse pattern for the Psychological and Multi-illness classes. This pattern remained after adjusting for baseline variables. In conclusion, there is a clear association between adolescent SRH and the risk of having multi-illness in early adulthood, seen as a proxy for later multimorbidity. This finding warrants greater attention to SRH in adolescence as a possible indicator in targeted prevention of future health problems.

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Adolescent self-rated health (SRH) predicted health problems 10–19 years later.

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Patients were classified into five groups with similar patterns of health problems.

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Better SRH increased the probability of adults belonging to the healthiest group.

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Not good SRH tripled the risk for multi-illness compared to very good SRH.

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Low SRH in adolescence is a possible predictor of multimorbidity in adulthood.

Posttraumatic Stress Disorder, Social Support and Coping Among Afghan Refugees in Canada

Posttraumatic-stress-disorder (PTSD) is one of the common mental health conditions among Afghan refugees resettled in developed countries. The current study explores how social support, coping and other factors correlate with PTSD in this population. A survey was conducted with 49 adult Afghan refugees (males 41%, female 59%) who completed Harvard Trauma Questionnaire during their visit to a Community Health Centre in Toronto. Bivariate analysis and structural-equation-modeling (SEM) were used to examine associations and pathways between PTSD and other variables. Mean PTSD score was 2.53 (SD 0.92) with 53% showing symptoms of PTSD which was significantly associated with age, unemployment, social support and self-rated health. SEM showed that higher social support scores were significantly associated with lower PTSD scores, and the effect of coping and English language were mediated through social support. The high prevalence of PTSD, its association with social support and self-rated health are important issues to be considered for refugee resettlement programs.

How do combinations of unhealthy behaviors relate to attitudinal factors and subjective health among the adult population in the Netherlands?

Background

Health behaviours like smoking, nutrition, alcohol consumption and physical activity (SNAP) are often studied separately, while combinations can be particularly harmful. This study aims to contribute to a better understanding of lifestyle choices by studying the prevalence of (combinations of) unhealthy SNAP behaviours in relation to attitudinal factors (time orientation, risk attitude) and subjective health (self-rated health, life expectancy) among the adult Dutch population.

Methods

In total 1006 respondents, representative of the Dutch adult population (18–75 years) in terms of sex, age, and education, were drawn from a panel in 2016. They completed an online questionnaire. Groups comparisons and logistic regression analyses (crude and adjusted) were applied to analyse (combinations of) SNAP behaviours in relation to time orientation (using the Consideration of Future Consequences scale comprising Immediate (CFC-I) and Future (CFC-F) scales) and risk attitude (Health-Risk Attitude Scale; HRAS-6), as well as subjective health (visual analogue scale and subjective life expectancy).

Results

In the analyses, 989 respondents (51% men, average 52 years, 22% low, 48% middle, and 30% high educated) were included. About 8% of respondents engaged in four unhealthy SNAP behaviours and 18% in none. Self-rated health varied from 5.5 to 7.6 in these groups, whilst subjective life expectancy ranged between 73.7 and 85.5 years. Logistic regression analyses, adjusted for socio-demographic variables, showed that smoking, excessive drinking and combining two or more unhealthy SNAP behaviours were significantly associated with CFC-I scores, which increased the odds by 30%, 18% and 19%, respectively. Only physical inactivity was significantly associated with CFC-F scores, which increased the odds by 20%. Three out of the four SNAP behaviours were significantly associated with HRAS-6, which increased the odds between 6% and 12%. An unhealthy diet, excessive drinking, and physical inactivity were significantly associated with SRH, which decreased the odds by 11%. Only smoking was significantly associated with subjective life expectancy, which decreased the odds by 3%.

Conclusion

Our findings suggest that attitudinal factors and subjective health are relevant in the context of understanding unhealthy SNAP behaviours and their clustering. This emphasizes the relevance of a holistic approach to health prevention rather than focusing on a single unhealthy SNAP behaviour.

Cluster Analysis of Health-Related Lifestyles in University Students

Health-related lifestyles in young adults are a public health concern because they affect the risk for developing noncommunicable diseases. Although unhealthy lifestyles tend to cluster together, most studies have analyzed their effects as independent factors. This study assessed the prevalence, association, and clustering of health-related lifestyles (smoking, alcohol consumption, physical activity, and quality of diet) among university students. This cross-sectional study examined a sample of student participants from the University of the Balearic Islands (n = 444; 67.8% females; mean age: 23.1 years). A self-reported questionnaire was used to assess health-related lifestyles. Men that consumed more alcohol, had less healthy diets, were more likely to be overweight, and performed more physical activity. Women had a higher prevalence of low weight and performed less physical activity. Physical activity had a negative association with time using a computer (OR: 0.85; 95% CI: 0.76, 0.95) and a positive association with adherence to the Mediterranean diet (OR: 1.16; 95% CI: 1.02, 1.32). Adherence to the Mediterranean diet had a negative association with tobacco consumption (OR: 0.52; 95% CI: 0.30, 0.91), and positive associations with having breakfast every day (OR: 1.70; 95% CI: 1.05, 2.76) and consuming more daily meals (OR: 1.43; 95% CI: 1.10, 1.87). Cluster analysis indicated the presence of three distinct groups: Unhealthy lifestyles with moderate risk; unhealthy lifestyles with high risk; and healthy lifestyles with low risk. Health promotion interventions in the university environment that focus on multiple lifestyles could have a greater effect than interventions that target any single lifestyle.

The cumulative effect of living with disability on mental health in working-age adults: an analysis using marginal structural models

PURPOSE

Previous studies have shown that acquiring a disability is associated with a reduction in mental health, but they have not considered the cumulative impact of having a disability on mental health. We used acquisition of a non-psychological disability to estimate the association of each additional year lived with disability on mental health (measured using the Mental Component Summary score of the Short Form Health Survey).

METHODS

We used the first 13 waves of data (years 2001-2013) from the Household, Income and Labour Dynamics in Australia Survey. The sample included 4113 working-age (18-65 years) adults who were disability-free at waves 1 and 2. We fitted marginal structural models with inverse probability weights to estimate the association of each additional year of living with disability on mental health, employing multiple imputation to handle the missing data.

RESULTS

Of the 4113 participants, 7.7 percent acquired a disability. On average, each additional year lived with disability was associated with a decrease in the mean Mental Component Summary score (β = - 0.42; 95% CI - 0.71, - 0.14).

CONCLUSIONS

This study provides evidence that each additional year lived with non-psychological disability is associated with a decline in mental health among working-age Australians.

Reorienting health systems to care for people with HIV beyond viral suppression

The effectiveness of antiretroviral therapy and its increasing availability globally means that millions of people living with HIV now have a much longer life expectancy. However, people living with HIV have disproportionately high incidence of major comorbidities and reduced health-related quality of life. Health systems must respond to this situation by pioneering care and service delivery models that promote wellness rather than mere survival. In this Series paper, we review evidence about the emerging challenges of the care of people with HIV beyond viral suppression and identify four priority areas for action: integrating HIV services and non-HIV services, reducing HIV-related discrimination in health-care settings, identifying indicators to monitor health systems' progress toward new goals, and catalysing new forms of civil society engagement in the more broadly focused HIV response that is now needed worldwide. Furthermore, in the context of an increasing burden of chronic diseases, we must consider the shift that is underway in the HIV field in relation to burgeoning policy and programmatic efforts to promote healthy ageing.

Patient-reported outcomes to enhance person-centred HIV care

Quality of life has been proposed as the fourth 90 to complement the UNAIDS 90-90-90 targets to monitor the global HIV response, highlighting a need to address the holistic needs of people living with HIV beyond viral suppression. This proposal has instigated a wider discussion about the use of patient-reported outcomes (PROs) to improve the treatment and care of an ageing HIV population with increasing comorbidities and a disproportionate burden of social problems. PROs can provide a first-hand assessment of the impact of HIV treatment and care on patients' quality of life, including symptoms. The field of PRO measures is rapidly expanding but still no gold standard exists, raising concerns about tool selection. Challenges also remain in the collection, interpretation, and use of PRO data to improve the performance of the health system. An emerging concern is how to adapt PROs to different sociocultural and geographical settings.

Health-related behaviours and their relationship with self-rated health among Canadian adults

BACKGROUND

Self-rated health (SRH) is a commonly used survey measure as a substitute for a clinical measure of health, which has demonstrated validity and reliability in a variety of populations. The referents that individuals incorporate into their self-evaluations have been shown to include health-related behaviours, though these relationships are not static. Our purpose was to describe and test for relationships between health-related behaviours and SRH among Canadian adults.

METHODS

We used pooled data from the Canadian Health Measures Surveys Cycles 3 (2012-13) and 4 (2014-15). All men and non-pregnant women aged 18 years and older were included (n = 6,789). We used binary logistic regression to test for relationships between health-related behaviours and SRH, including smoking status, adequate fruit and vegetable intake, inadequate sleep, alcohol use, and adequate physical activity.

RESULTS

The majority of respondents rated their health as good, very good, or excellent, though differences in SRH were found according to age group, highest level of household education, and income adequacy. Inadequate sleep was most strongly associated with poorer SRH among men and women combined, as compared to other health-related behaviours. Among women only, those who report heavy episodic drinking (OR, 2.64) or daily drinking (OR, 3.51) rated their health better, as compared to women who report low-risk alcohol use.

CONCLUSIONS

Sleep quality is an important predictor of SRH for both men and women. Second, sex/gender differences must be considered in strategies to address alcohol use, as we may not be fully appreciating potentially health-affirming qualities associated with alcohol use among women.

The roles of non-cognitive and cognitive skills in the life course development of adult health inequalities

Previous research has suggested that greater cognitive skill is protective against the development of socioeconomic health inequalities across the life course, but the relative role of non-cognitive skills has been less investigated in this context. Using the prospective UK 1958 National Child Development Study (N = 18,558), higher factor scores for adolescent non-cognitive skills (NCS; i.e. a combination of work habits and pro-social behaviours) and mean cognitive skill (CS) at age 16 were examined with a path analysis model in relation to socioeconomic status (SES) across the life course (at ages 16, 33 and 50) and poor self-reported health at age 50. Adjusting for adolescent NCS explained over a third of the association between education and health, but the path between social class at age 50 and health was unaffected. Adjustment for CS explained larger proportions of the paths to adult health inequalities; and paths between CS and SES across the life course were stronger than the same paths with NCS. However, NCS was still independently associated with paths to later health inequalities in fully adjusted models, and both types of skill had equivalent inverse direct effects with poor health (OR: 0.82 [95% CI 0.73,0.93] vs 0.83 [0.72,0.96], respectively). Since NCS retained independent associations with SES and health across the life course, they could be a target for policies aimed at ameliorating the production of health inequalities for a wide range of children, regardless of their cognitive skill.

The role of emotional eating in the links between racial discrimination and physical and mental health

The environmental affordances (EA) model posits that maladaptive self-regulatory strategies (e.g., emotional eating) directly and indirectly heighten African Americans' risk for downstream medical morbidities while also potentially mitigating the psychological impact of stressors. We empirically tested the full EA model. In doing so, we investigated the associations among racial discrimination, depressive symptomatology, and physical health proxies as well as the intervening role of emotional eating in these associations among 150 African Americans aged 18-27. The increased frequency of experiencing racial discrimination was significantly associated with poorer self-reported health, greater depressive symptomatology, and more emotional eating. There was no significant association between emotional eating and physical health and emotional eating did not mediate the relation between racial discrimination and physical health. Finally, racial discrimination was associated with depressive symptomatology, but only among African Americans with mean or high levels of emotional eating.

How Have You Been? or ¿Como estás?: Does Language of Interview Influences Self-Rated Health Among Hispanic Subgroups?

This paper reports language differences in poor/fair self-rated health (SRH) among adults from six Hispanic groups in the United States. Data are from the cross-sectional 1997-2013 National Health Interview Survey (NHIS). The total sample of Hispanic adults with valid information for the variables considered in the study (n = 156,374) included Mexican-Americans (Mex-Am; n = 43,628), Mexicans (n = 55,057), Puerto Ricans (n = 14,631), Cubans (n = 8,041), Dominicans (from Dominican Republican, n = 4,359) and Other Hispanics (n = 30,658). We compared percentage of the population that reported poor/fair SRH among Hispanic individuals by language of interview and across origins using bivariate tests of association. Multivariable logistic regression analysis was used to study the odds of reporting poor/fair SRH based on language among the overall population and each group. Among the six Hispanic origins Puerto Ricans (15.92%), Cubans (16.36%) and Dominicans (15.32%) reported poor/fair SRH at higher levels than the overall sample (12.32%). In the logistic regression model adjusting potential covariates, those interviewed in Spanish were at higher odds of reporting poor/fair SRH than those interviewed in English (OR = 1.47, p < 0.0001). In the stratified analysis, Mexican-Americans were the only group where language of interview did not affect the odds of reporting poor/fair SRH. There are differences by Hispanic origin for reporting poor/fair SRH, and also by language of interview. Achieving accurate measurement of health status among Hispanics is a concern for all researchers, in particular those who study differences in health status by race/ethnicity in the United States. Future, research should account for Hispanic background and language of interviews.

Words hurt: Political rhetoric, emotions/affect, and psychological well-being among Mexican-origin youth

We examined the effect of political rhetoric on the targets of that rhetoric. Drawing from scholarship on anti-Mexican and anti-immigrant rhetoric found readily in various media and scholarship on emotions, we tested four hypotheses. Hypotheses 1 and 2 predicted that positive and negative political rhetoric would increase and decrease positive and negative emotions, respectively. Hypotheses 3 and 4 then predicted that emotional responses to positive or negative political rhetoric would influence perceived stress, subjective health, and subjective well-being. Data collection occurred between August 2016 and June 2017 at a university in California. A sample of 280 Mexican-origin youth, defined broadly as having at least one ancestor born in Mexico or the participant themselves born in Mexico, participated in an experiment where they were randomly assigned to one of three study conditions: viewing (1) positive or (2) negative political rhetoric about immigrants and Latinos in general, or (3) neutral rhetoric as a control condition before providing qualitative responses to open-ended questions and completing measures of positive and negative affect, perceived stress, subjective health, and subjective well-being. Qualitative responses indicated that negative and positive political rhetoric elicited a range of negative emotions and positive emotions, respectively. Quantitative analysis with independent samples t-tests, ANOVA, and linear regression models found that negative political rhetoric elicited higher negative affect than positive and neutral rhetoric, and positive rhetoric elicited higher positive affect than negative and neutral rhetoric. Negative emotional responses, in turn, were associated with participants' higher perceived stress, lower subjective health and lower subjective well-being. Conversely, positive emotional responses were associated with lower perceived stress, higher subjective health, and higher subjective well-being. Positive political rhetoric, by eliciting positive emotions, can have a salubrious effect. Altogether, these findings suggest that political rhetoric matters for the targets of that rhetoric.

The association between visual impairment and dental care utilization in the Korean elderly

INTRODUCTION

Individuals with visual impairment cannot recognize early-stage oral diseases, thus fail to receive prompt treatment.

AIMS

To evaluate the association between visual impairment and dental care utilization in patients aged ≥65 years.

DESIGN

Retrospective analysis.

MATERIALS AND METHODS

We analyzed annual pooled data collected by the Korean Health Panel between 2011 and 2014; a total of 1472 patients and 13,285 dental visits were analyzed. Visual impairment was categorized as follows: normal vision, moderate vision impairment, and severe vision impairment. Dental treatments were categorized as conservative, prosthodontic, implant, periodontal, surgical, preventive, or others. All data were statistically analyzed using a negative binomial regression.

MAIN OUTCOME MEASURE

Frequency of dental care utilization.

RESULTS

Approximately 50% of the subjects had visual impairment. The frequency of dental care utilization for patients with severe vision impairment was 41% less than patients with normal vision. The dental care utilization for implant treatment was two times higher and periodontal treatment was 1.7 times lower than the conservative treatments among patients who reported moderate and severe vision impairment, respectively.

CONCLUSIONS

Visual impairment has a negative association with dental care utilization among older adults. It is imperative to implement systematic interventions to prevent visual impairment from becoming a barrier to dental care in this population.

Associations between social isolation, loneliness, and objective physical activity in older men and women

Background

The impact of social isolation and loneliness on health risk may be mediated by a combination of direct biological processes and lifestyle factors. This study tested the hypothesis that social isolation and loneliness are associated with less objective physical activity and more sedentary behavior in older adults.

Methods

Wrist-mounted accelerometers were worn over 7 days by 267 community-based men (n = 136) and women (n = 131) aged 50–81 years (mean 66.01), taking part in the English Longitudinal Study of Ageing (ELSA; wave 6, 2012–13). Associations between social isolation or loneliness and objective activity were analyzed using linear regressions, with total activity counts and time spent in sedentary behavior and light and moderate/vigorous activity as the outcome variables. Social isolation and loneliness were assessed with standard questionnaires, and poor health, mobility limitations and depressive symptoms were included as covariates.

Results

Total 24 h activity counts were lower in isolated compared with non-isolated respondents independently of gender, age, socioeconomic status, marital status, smoking, alcohol consumption, self-rated health, limiting longstanding illness, mobility limitations, depressive symptoms, and loneliness (β = − 0.130, p = 0.028). Time spent in sedentary behavior over the day and evening was greater in isolated participants (β = 0.143, p = 0.013), while light (β = − 0.143, p = 0.015) and moderate/vigorous (β = − 0.112, p = 0.051) physical activity were less frequent. Physical activity was greater on weekdays than weekend days, but associations with social isolation were similar. Loneliness was not associated with physical activity or sedentary behavior in multivariable analysis.

Conclusions

These findings suggest that greater social isolation in older men and women is related to reduced everyday objective physical activity and greater sedentary time. Differences in physical activity may contribute to the increased risk of ill-health and poor wellbeing associated with isolation.

The Impact of Age on Income-Related Health Status Inequalities from Birth to Adolescence: A Systematic Review with Cross-Country Comparisons

OBJECTIVES

To examine the effect of age on associations between household income and overall health from birth to adolescence, and whether age patterns vary by country. It is uncertain whether income-related health inequalities remain stable, widen, or narrow as children age, which impacts optimal timing of equity-focused interventions.

STUDY DESIGN

Systematic review (CRD42016038583) of MEDLINE, Embase, PsycINFO, CINAHL, SocINDEX (full-text), and EconLit (full-text) to April 2017. We included observational studies and trials in children and adolescents (0-18 years of age), examining age differences in associations between income and overall health (self-rated, clinician-rated, proxy-rated). One reviewer extracted data; 2 evaluated risk of bias.

RESULTS

Thirty-eight articles containing 43 studies (30 cross-sectional, 13 cohort) were identified, from high-income (n = 39) and middle-income (n = 4) countries. In the US (n = 21), positive income-health associations emerged in early childhood, and these inequalities typically widened progressively into adolescence. Relative to 0- to 3-year-olds, ratios of income-health coefficients ranged from 1.10-3.71 for 4-8 years of age, 1.26-3.86 for 9-12 years of age, 1.36-6.71 for 13-17 years. In the United Kingdom and Ireland (n = 8), inequalities emerged in early-to-mid childhood, but age patterns were less consistent. In other high-income countries (Australia, Canada, France, Germany, Japan, Republic of Korea), inequalities mostly persisted or widened with age. In middle-income countries, inequalities appeared to narrow (Indonesia n = 2) or persist (Brazil n = 2) with age. Limitations are unclear/high risk of bias and dataset overlap for some studies.

CONCLUSIONS

In many countries, income-related health status inequalities persist or widen as children age. Interventions that improve health equity early in the life-course are needed.

One 'knows': self-rated health and telomere length among ex-prisoners of war

OBJECTIVE

Ill-health and early mortality are amongst the most significant ramifications of trauma. Furthermore, trauma alters the subjective perception and experience of the body. The aim of this study is to examine the extent to which deteriorations in perceived health among traumatised individuals are associated with cellular health as manifested in telomere length.

METHODS

Specifically, 88 former prisoners of war (ex-POWs) evaluated their health (self-rated health; SRH) at 18 (T1), 35 (T2) and 42 (T3) years after the war, and were assessed for telomere length at T3. Health behaviour, BMI, morbidity and PTSD were also examined at T3.

RESULTS

The findings demonstrated that SRH was cross-sectionally correlated with telomere length. Furthermore, a significant sequential indirect effect was found, in which worse SRH in T1 was associated with shorter telomere length at T3, through worse SRH at T2 and at T3.

CONCLUSIONS

These findings demonstrate that long-term deteriorations in the subjective evaluations of health are implicated in actual cellular health among individuals exposed to trauma.

Perceived racism may partially explain the gap in health between Aboriginal and non-Aboriginal Victorians: A cross-sectional population based study

Background

There is a persistent gap in the health of Aboriginal Victorians compared with non-Aboriginal Victorians, where Aboriginal Victorians have poorer health. Currently, the most commonly touted explanation for this gap revolves around health behaviours known as ‘lifestyle risk factors’. Yet the gap in health is similarly matched by persistent gaps in social and economic outcomes that reflect past and ongoing discrimination of Aboriginal peoples across Australia. Perceived racism has been implicated as a key determinant of the gap in health between Indigenous and non-Indigenous peoples across the world. We sought to determine the contribution of perceived racism to the gap in health and how this compared with the contribution of lifestyle risk factors and other determinants of health such as socioeconomic status.

Methods

We combined data from 2011, 2012 and 2014 Victorian Population Health Surveys (VPHS) to obtain a sample size of 33,833 Victorian adults, including 387 Aboriginal adults. The VPHS is a population-representative, cross-sectional, computer-assisted telephone interview survey conducted annually. Using logistic regression, poor self-reported health status was the dependent variable and Aboriginal status was the primary independent variable of interest. Secondary independent variables included age, sex, perceived racism, socioeconomic status, and lifestyle risk factors.

Results

Aboriginal Victorians were almost twice as likely as non-Aboriginal Victorians to report poor health; OR=1.9 (95% confidence interval; 1.3–2.6). Perceived racism explained 34% of the gap in self-reported health status between Aboriginal and non-Aboriginal Victorians, followed by: smoking (32%), unhealthy bodyweight (20%), socioeconomic status (15%), excessive consumption of alcohol (13%), and abstinence from alcohol consumption (13%). In contrast, physical inactivity made no contribution. Together, perceived racism and smoking explained 58% of the gap, while all secondary independent variables explained 82% of the gap.

Conclusions

Perceived racism may be an independent health risk factor that explains more than a third of the health gap between Aboriginal and non-Aboriginal Victorians; equivalent in strength to smoking. The recognised failure of the Australian government’s Closing the Gap strategy may be due in part to the failure to consider other determinants of the health gap beyond the lifestyle risk factors, namely racism, which may act to damage health through multiple pathways at multiple points along the causal chain.

•

Aboriginal Victorians have poorer health than their non-Aboriginal counterparts.

•

Racism explained more than a third of the gap in self-reported health status.

•

Racism may be a health risk factor that is equivalent in strength to smoking.

•

Racism and smoking explained 58% of the gap in self-reported health status.

•

The failure of policies to reduce the health gap may be due to not addressing racism.

Developing an openly accessible multi-dimensional small area index of 'Access to Healthy Assets and Hazards' for Great Britain, 2016

Health geographers have been long concerned with understanding how the accessibility of individuals to certain environmental features may influence health and wellbeing. Such insights are increasingly being adopted by policy makers for designing healthy neighbourhoods. To support and inform decision making, there is a need for small area national level data. This paper details the creation of a suite of open access health indicators, including a novel multidimensional index summarising 14 health-related features of neighbourhoods for Great Britain. We find no association of our overall index with physical health measures, but a significant association to mental wellbeing.

Loneliness in Older Adults Living with HIV

We conducted a cross-sectional study among HIV-positive adults age ≥ 50 in San Francisco to evaluate the frequency of loneliness, characteristics of those who reported loneliness, and the association of loneliness with functional impairment and health-related quality of life (HRQoL). Participants (N = 356) were predominately male (85%); 57% were white; median age was 56. 58% reported any loneliness symptoms with 24% reporting mild, 22% moderate and 12% severe loneliness. Lonely participants were more likely to report depression, alcohol and tobacco use, and have fewer relationships. In unadjusted models, loneliness was associated with functional impairment and poor HRQoL. In adjusted models, low income and depression remained associated with poor HRQoL, while low income, higher VACS index and depression were associated with functional impairment. A comprehensive care approach, incorporating mental health and psychosocial assessments with more traditional clinical assessments, will be needed to improve health outcomes for the aging HIV-positive population.

European health inequality through the 'Great Recession': social policy matters

This paper investigates the association between the Great Recession and educational inequalities in self-rated general health in 25 European countries. We investigate four different indicators related to economic recession: GDP; unemployment; austerity and a 'crisis' indicator signifying severe simultaneous drops in GDP and welfare generosity. We also assess the extent to which health inequality changes can be attributed to changes in the economic conditions and social capital in the European populations. The paper uses data from the European Social Survey (2002-2014). The analyses include both cross-sectional and lagged associations using multilevel linear regression models with country fixed effects. This approach allows us to identify health inequality changes net of all time-invariant differences between countries. GDP drops and increasing unemployment were associated with decreasing health inequalities. Austerity, however, was related to increasing health inequalities, an association that grew stronger with time. The strongest increase in health inequality was found for the more robust 'crisis' indicator. Changes in trust, social relationships and in the experience of economic hardship of the populations accounted for much of the increase in health inequality. The paper concludes that social policy has an important role in the development of health inequalities, particularly during times of economic crisis.

Adolescent self-rated health predicts general practice attendance in adulthood: Results from the Young-HUNT1 survey

AIMS

Self-rated health (SRH) is a predictor of future health. However, the association between SRH in adolescence and health problems and health care utilization in adulthood has rarely been investigated. The aim of this study was to examine adolescent SRH as a predictor of general practitioner consultations in adulthood.

METHODS

SRH was registered in the Young-HUNT1 survey in 1995-1997 ( N=8828, mean age 16 years, 88% participation rate). General practitioner consultations during 2006-2014 were obtained from a national claims database. The predictive value of adolescent SRH on general practitioner consultations in adulthood was analysed by regression models estimating the relative risks (RR) for the total number of consultations and consultations for psychological, gastrointestinal, musculoskeletal or respiratory problems. Age, sex and baseline measures of chronic disease and health care attendance were used as the adjusting variables.

RESULTS

SRH was reported as 'very good' by 28.4%, 'good' by 60.6% and 'not good' by 11.0% of the respondents. The increases in consultation rates were 21% (RR 1.21, 95% CI 1.15-1.27) and 52% (RR 1.52, 95% CI 1.40-1.64) when comparing respondents with 'very good' SRH to those with 'good' and 'not good' SRH, respectively. We also demonstrated a dose-response association between adolescent SRH and general practitioner consultations for psychological, gastrointestinal, musculoskeletal or respiratory problems.

CONCLUSIONS

SRH in adolescence is a predictor for general practitioner consultations in adult life. Previous research shows that SRH is influenced by factors such as well-being, health behaviour, functional status and body satisfaction. Intervention studies are needed to evaluate whether population-based and clinical interventions can improve SRH by improving these factors among adolescents.

Associations Between Household Secondhand Smoke Exposure and Health Problems Among Non-Smoking Adolescents in the Republic of Korea

This study examined the association between household secondhand smoke exposure (HSHSE) and health status among non-smoking adolescents in Korea using two subsamples obtained from nationally representative cross-sectional secondary data: males (n = 25,653) and females (n = 31,187). Two self-reported HSHSE measures included exposure to household secondhand smoke during the week before the survey (yes or no) and number of days of HSHSE (1-7 days); and five self-reported health problems included asthma, perceived stress, depression, suicidal ideation, and self-rated health. For each subsample, this study performed (1) multivariate logistic regressions to examine HSHSE effects on asthma, depression, and suicidal ideation; and (2) multiple linear regressions to examine HSHSE effects on perceived stress and self-rated health. The rate and number of days of HSHSE were significantly higher among females (30.1% and 3.4 days) than among males (25.9% and 3.1 days). In both subsamples, HSHSE was associated with all five health problems (ORs 1.15-1.32; βs: 0.04-0.14). An increase in the number of days of HSHSE was positively associated with (1) greater perceived stress and poorer self-rated health in both subsamples (βs: 0.01-0.04), and (2) greater odds of asthma, depression, and suicidal ideation in the female subsample (ORs 1.03-1.12). Given the findings related to the strong associations (1) between HSHSE and physical, mental, and general health problems; and (2) between days of HSHSE and a greater number of health problems in females, health professionals should actively implement interventions that encourage adult smokers to stop smoking in their homes.

Work and family transitions and the self-rated health of young women in South Africa

Understanding the transition to adulthood has important implications for supporting young adults and understanding the roots of diversity in wellbeing later in life. In South Africa, the end of Apartheid means today's youth are experiencing their transition to adulthood in a changed social and political context which offers opportunities compared to the past but also threats. This paper presents the first national level analysis of the patterning of key transitions (completion of education, entry into the labour force, motherhood and marriage or cohabitation), and the association between the different pathways and health amongst young women. With the use of longitudinal data from the South African National Income Dynamics Study (2008-2015), this paper employs sequence analysis to identify common pathways to adulthood amongst women aged 15-17 years at baseline (n = 429) and logistic regression modelling to examine the association between these pathways and self-rated health. The sequence analysis identified five pathways: 1. 'Non-activity commonly followed by motherhood', 2. 'Pathway from school, motherhood then work', 3. 'Motherhood combined with schooling', 4. 'Motherhood after schooling', and 5. 'Schooling to non-activity'. After controlling for baseline socio-economic and demographic characteristics and health, the regression results show young women who followed pathways characterised by early motherhood and economic inactivity (1, 3 and 4) had poorer self-rated health compared to women whose pathways were characterised by combining motherhood and economic activity (2) and young women who were yet to become economically active or mothers (5). Therefore, policies should seek to prevent adolescent childbearing, support young mothers to continue their educational careers and enable mothers in work and seeking work to balance their work and care responsibilities. Further, the findings highlight the value of taking a holistic approach to health and provide further evidence for the need to consider work-family balance in the development agenda.

Do flexible work policies improve parents' health? A natural experiment based on the UK Millennium Cohort Study

BACKGROUND

There is limited evidence of the impact of policies to promote work-family balance on family health. Exploiting the introduction of the UK Flexible Working Act (2003), we examined whether a policy that grants parents the right to request flexible work influences their health and well-being.

METHODS

Using the UK Millennium Cohort Study, we focus on 6424 mothers employed in 2001-2002, when the cohort child was 9 months old, until their child's seventh birthday. We used a difference-in-differences (DiD) approach to compare changes in outcomes before and after the policy among mothers most likely to benefit and mothers unlikely to benefit from the policy.

RESULTS

Flexible working increased in a small group of mothers (n=548) whose employer did not offer work flexibility before the reform (treatment group). By contrast, among mothers whose employer already offered flexible work before the reform (control group, n=5810), there was little change or a slight decline in flexible working. DiD estimates suggest that the policy was associated with an increase in flexible working (37.5 percentage points, 95% CI 32.9 to 41.6), but it had no impact on self-rated health (-1.6 percentage points, 95% CI -4.4 to 1.1), long-term illness (-1.87 percentage points, 95% CI -4.3 to 0.5) or life satisfaction scores (β=0.04, 95% CI -0.08 to 0.16).

CONCLUSION

The Flexible Working Act increased flexible working only among a small group of mothers who had not yet the right to request work flexibility, but it had no impact on their health and well-being. Policies promoting work flexibility may require stronger incentives for both parents and employers.

Ethnic inequalities in health between Arabs and Jews in Israel: the relative contribution of individual-level factors and the living environment

OBJECTIVES

Ethnic inequalities in health (EIH) are unjust public health problem that emerge across societies. In Israel, despite uniform healthcare coverage, marked EIH persist between Arabs and Jews.

METHODS

We draw on the ecosocial approach to examine the relative contributions of individual socioeconomic status (SES), psychosocial and health behavioral factors, and the living environment (neighborhood problems, social capital, and social participation) to explaining ethnic differences in self-rated health (SRH). Data were derived from two nationwide studies conducted in 2004-2005 of stratified samples of Arabs (N = 902) and Jews (N = 1087).

RESULTS

Poor SRH was significantly higher among Arabs after adjustment for age and gender [odds ratio and 95% confidence interval (CI) = 1.94 (1.57-2.40)]. This association was reversed following adjustment for all possible mediators: OR (95% CI) = 0.70(0.53-0.92). The relative contribution of SES and the living environment was sizable, each attenuating the EIH by 40%, psychosocial factors by 25%, and health behaviors by 16%.

CONCLUSIONS

Arabs in Israel have poorer SRH than Jews. Polices to reduce this inequality should mainly focus on improving the SES and the living conditions of the Arabs, which might enhance health behaviors and well-being.

Unmet need for social care among older people

Understanding the nature and extent of unmet need for social care among older people is a critical policy priority in the United Kingdom and beyond, as national governments juggle the provision of adequate social care for a growing older population with competing funding priorities. Several factors can heighten the experience of unmet need among older people, for instance their family environment, and their health and socio-economic status. This paper contributes empirical evidence on the patterns of unmet need for social care among older people in England today, focusing on the individual characteristics associated with experiencing unmet need in relation to mobility tasks, activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The results show that about 55 per cent of older individuals with an ADL difficulty had unmet need, compared to 24 per cent of those with an IADL difficulty and 80 per cent of those with a mobility difficulty. Characteristics reflecting greater vulnerability were more strongly associated with the risk of experiencing unmet need for ADLs, and such vulnerability was greater for particular ADLs (e.g. bathing), and for a higher number of ADLs. The findings reaffirm the complexity of conceptualising and empirically investigating unmet need in later life, and add to our understanding of the challenges of providing adequate and appropriate social care to older people.

Comparisons of depression, anxiety, well-being, and perceptions of the built environment amongst adults seeking social, intermediate and market-rent accommodation in the former London Olympic Athletes' Village

The Examining Neighbourhood Activities in Built Living Environments in London (ENABLE London) study provides a unique opportunity to examine differences in mental health and well-being amongst adults seeking social, intermediate (affordable rent), and market-rent housing in a purpose built neighbourhood (East Village, the former London 2012 Olympic Athletes' Village), specifically designed to encourage positive health behaviours. Multi-level logistic regression models examined baseline differences in levels of depression, anxiety and well-being across the housing groups. Compared with the intermediate group, those seeking social housing were more likely to be depressed, anxious and had poorer well-being after adjustment for demographic and health status variables. Further adjustments for neighbourhood perceptions suggest that compared with the intermediate group, perceived neighbourhood characteristics may be an important determinant of depression amongst those seeking social housing, and lower levels of happiness the previous day amongst those seeking market-rent housing. These findings add to the extensive literature on inequalities in health, and provide a strong basis for future longitudinal work that will examine change in depression, anxiety and well-being after moving into East Village, where those seeking social housing potentially have the most to gain.

A fuzzy set approach to economic crisis, austerity and public health. Part II: How are configurations of crisis and austerity related to changes in population health across Europe?

AIMS

Based on the ideal type classification of European countries done in Part I of this paper, Part II explores whether the real 'danger' to public health is the interplay between austerity and crisis, rather than recession itself.

METHODS

We constructed two fuzzy sets of changes in population health based on a pooled file of European Union Statistics on Income and Living Conditions (EU-SILC) data (2008 and 2013) including 29 European countries. The linear probability analyses of 'limiting long-standing illness' and 'less than good' health were restricted to the age group 20-64 years. We performed fuzzy set qualitative comparative analysis (fsQCA) and studied whether configurations of 'severe crisis' and 'austerity' were linked to changes in population health.

RESULTS

Overall, the results of this fsQCA do not support the 'crisis-austerity' thesis. Results on 'less than good' health were highly inconsistent, while results on 'limiting long-standing illness', contrary to the thesis, showed a two-path model. Countries with either no severe crisis or no austerity were subsets of the set of countries that experienced deteriorated health. Results also show that several countries combined both paths.

CONCLUSIONS

This fuzzy set analysis does not support Stuckler and Basu's 'crisis-austerity' thesis, as those European countries that experienced recession and austerity were not consistently the countries with deteriorating health. There may be multiple reasons for this result, including analytical approach and operationalization of key concepts, but also resilient forces such as family support. We suggest more research on the topic based on more recent data and possibly other, or more, dimensions of austerity.

The impact of child and family stressors on the self-rated health of mothers of children with autism spectrum disorder: Associations with depressed mood over a 12-year period

Employing a cohort sequential design and multilevel modeling, the effects of child and family stressors and maternal depressed mood on the self-rated health of 110 mothers of children with autism spectrum disorder were assessed over a 12-year period when children in the study were 7–19 years old. Findings indicate a significant decline in self-rated health over time. In addition, child and family stressors, as well as maternal depressed mood, exerted significant between-persons effects on self-rated health such that mothers who reported more stressors and depressed mood across the study period were less likely to rate themselves in better health across that period. In addition, a significant within-person relationship between maternal depressed mood and self-rated health was found, indicating that at times when mothers reported higher levels of depressed mood than usual (their personal average across the study), they were significantly less likely to report better self-rated health. Finally, maternal depressed mood partially mediated the between-persons effects of child and family stressors on self-rated health such that increased stressors led to increased maternal depressed mood which, in turn, led to poorer maternal self-rated health. Findings suggest that chronic stressors erode maternal health over time and that depression may be an important mechanism linking stressors to decreased maternal health.