The effect of subjective and objective social class on health-related quality of life: new paradigm using longitudinal analysis

Help-Seeking Buffers the Impact of Grief on Quality of Life: A Study of Loss During the COVID-19 Pandemic

The COVID-19 pandemic has presented a global challenge for anticipating the support and treatment needs of bereaved individuals. However, no studies have examined how mourners have been coping with grief and which strategies may buffer negative mental health consequences. We examined the various coping strategies being used and which strategies best support quality of life. Participants completed self-report measures of demographic and loss-related characteristics, grief symptoms, quality of life (QOL), and coping strategies used. Despite help-seeking being one of the least endorsed coping strategies used, help-seeking was the only coping strategy that buffered the impact of grief on QOL for individuals with high grief severity. Results support predictions that grief may become a global mental health concern requiring increased accessibility and availability of grief therapies and professional supports for bereaved individuals during and in the aftermath of the pandemic.

Analysis of Factors Influencing the Willingness of Chinese Older Adults to Use mHealth Devices: Nationwide Cross-Sectional Survey Study

BACKGROUND

In addition to standard older adult care services, mobile medical devices have proved to be an effective tool for controlling the health of older adults. However, little is known about the variables driving the acceptance of these gadgets and the willingness of older adults in China to use them.

OBJECTIVE

This study aims to explore the factors that affect the use of mobile health (mHealth) devices by older adults in China, focusing on individual, social, and family influences.

METHODS

The Psychology and Behavior Investigation of Chinese Residents survey database provided the data for this study. The survey was conducted in 148 Chinese cities between June 20 and August 31, 2022. The parameters linked to older persons' desire to use mobile medical devices were determined by this study using a combination model of multiple stepwise linear regression and a classification and regression tree decision tree.

RESULTS

In total, 4085 older adults took part in the poll. On a scale of 0 to 100, the average score for willingness to adopt mHealth devices was 63.70 (SD 25.11). The results of the multiple stepwise linear regression showed that having a postgraduate degree and higher (β=.040; P=.007), being unemployed (β=.037; P=.02), having a high social status (β=.085; P<.001), possessing high health literacy (β=.089; P<.001), demonstrating high self-efficacy (β=.043; P=.02), not living with children (β=.0340; P=.02), having a household per capita monthly income of >Y4000 (US $550) (β=.048; P=.002), experiencing high perceived social support (β=.096; P<.001), reporting a high quality of life (β=.149; P<.001), having higher levels of family communication (β=-.071; P<.001), having an identity bubble (β=.085; P<.001), not having chronic diseases (β=.049; P=.001), and experiencing mild depression (β=-.035; P=.02) were associated with older adults' willingness to use mHealth devices. The classification and regression tree decision tree model's findings demonstrated that the primary determinants of older adults' desire to use mHealth devices are quality of life, identity bubble, social status, health literacy, family health, and perceived social support.

CONCLUSIONS

This study uses the Andersen Healthcare Utilization Model to investigate the effects of demand variables, enabling resources, and predisposing traits on older persons' propensity to use mHealth devices. These results offer reference data for the marketing and use of mHealth devices for older individuals in the future. The ultimate goal of this strategy is to create a balanced and harmonious integration of technology and humanistic care.

Socioeconomic status and subjective well-being: The mediating role of class identity and social activities

BACKGROUND

Subjective well-being has a significant impact on an individual's physical and mental health. Socioeconomic status, class identity, and social activity participation play important roles in subjective well-being. Therefore, the aim of this study was to uncover the mechanisms through which these factors influence subjective well-being.

METHODS

A total of 1926 valid samples were recruited using the Chinese General Social Survey 2021 (CGSS 2021). The Chinese Citizen's Subjective Well-Being Scale (SWBS-CC) was employed to assess subjective well-being. Socioeconomic status was measured using income and education, and class identity and social activity participation were measured using Likert scales. Pearson correlation analysis and the chain mediation model were conducted to explore the relationship between these factors. Finally, the Bootstrap method was used to examine the path coefficients.

RESULTS

A significant correlation was found between socioeconomic status, class identity, social activity, and subjective well-being (p < 0.01). The indirect effect of socioeconomic status on subjective well-being mediated by class identity was 0.351 (95% CI: 0.721, 1.587), while the indirect effect of socioeconomic status on subjective well-being mediated by social activity was 0.380 (95% CI: 0.059, 0.240). The effect mediated by both class status and social activities was 0.011 (95% CI: 0.010, 0.093).

CONCLUSIONS

The study showed that socioeconomic status, class identity, and social activity had significant effects on subjective well-being. Class identity and social activity partially mediated the effects of socioeconomic status on subjective well-being, and they had a chain mediating effect between socioeconomic status and subjective well-being. Therefore, policymakers have the opportunity to enhance subjective well-being in lower socioeconomic status groups by promoting individual class identity and encouraging greater social activity participation.

Ambient air pollution and the health-related quality of life of older adults: Evidence from Shandong China

Ambient air pollution is a major public health concern impacting all aspects of human health. There is a lack of studies on the impact of ambient air pollution on health-related quality of life (HRQoL) of older Chinese adults. Our study answers two questions: How concentrations of ambient air pollutants are associated with HRQoL among older adults in China and, second, what are the possible mechanisms through which ambient air pollution affects HRQoL. From the 2018 National Health Service Survey, we sampled 5717 aged 65 years or older residents for the eastern province of Shandong, China. Data on individual exposures to PM_2.5 and PM₁₀ (particulate matter with diameter less than or equal to 2.5 μm and 10 μm) and sulfur dioxide (SO₂) were collected from the ChinaHighAirPollutants (CHAP) datasets. Mixed-effects Tobit regression models and mixed-effects ordered Probit regression models were employed to examine the associations of long-term exposure to ambient air pollution with the European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L) scale comprising mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Socioeconomic, demographic and behavioral factors relating to HRQoL were also examined. The results show that for each 1 μg/m³ increase, EQ-5D-3L scores fell 0.002 for PM_2.5; 0.001 for PM₁₀ and 0.002 for SO₂. Long term exposure to PM_2.5, PM₁₀ and SO₂ were also associated with increased prevalence of pain/discomfort and anxiety/depression. The reduced HRQoL effects of ambient air pollution were exacerbated by higher socioeconomic status (affluent, urban and higher level of education). Our findings suggested that HRQoL of older Chinese adults was not only associated with demographic, socioeconomic, and health-related factors, but also negatively correlated with air pollution, especially through increased pain/discomfort and anxiety/depression. The paper proposes policy recommendations.

Subjective social status and health among older adults in China: the longitudinal mediating role of social trust

BACKGROUND

From a developmental perspective, this study explored the interplays between subjective social status (SSS), social trust (ST), and health status measured by self-rated health (SRH) among older adults in the context of China. It also tested the longitudinal mediation of ST between SSS and SRH.

METHODS

After excluding samples with missing values, we analyzed 4,877 individual responses from those aged 60 years or older, extracted from the China Family Panel Studies (CFPS) data in 2014, 2016, and 2018. We used latent growth modeling to test the hypothesized relationships among their SSS, ST, and SRH.

RESULTS

Latent growth modeling based on bootstrapping showed that the SSS, ST, and SRH of older adults all increased linearly and that the mechanism of SSS acted on the SRH as follows: the initial level of SSS indirectly influenced the initial level and the growth rate of the SRH, respectively, through the initial level of ST, and the initial level and growth rate of SSS played an indirect role in the growth rate of the SRH through the growth rate of ST.

CONCLUSION

The findings have practical implications for promoting health for older adults and realizing active aging in China. Therefore, we recommend establishing a family-centered and community-supported social support system for those with lower social status among older adults and a friendly community environment with various social, cultural, and recreational activities to improve the ST among older adults, thereby improving their health.

Association Between Paid Work and Health-Related Quality of Life Among Community-Dwelling Older Adults: The Sukagawa Study

In this study, we aimed to determine whether paid work has an impact on health-related quality of life (HRQOL) among older adults. Over three years, we longitudinally collected data from 5,260 community-dwelling older adults aged 75 years or older from a city in Japan. We assessed HRQOL using the Short-Form-8. We estimated the mean difference between the physical component summary (PCS) and the mental component summary (MCS) scores, which were stratified based on gender using multivariate, generalized estimating equation models. We further conducted a subgroup analysis based on the participants' occupational backgrounds. Engagement in paid work was associated with increased MCS scores across both genders and with increased PCS scores among women. In the subgroup analysis, only women who had previously worked as managerial workers showed an inverse association with MCS scores. In this population, engagement in paid work may be a crucial factor associated with well-being.

Patterns and predictors of adolescent life change during the COVID-19 pandemic: a person-centered approach

The present study investigated patterns of adolescent life changes across multiple life domains and utilized a holistic-interactionistic perspective to examine their individual, familial, and societal correlates with a sample of 2544 Chinese parent-adolescent dyads. Adolescents were aged from 10 to 19 years old (50.16% girls). Latent profile analysis revealed five life change profiles, including three improved profiles at various degrees, one unchanged profile, and one worsened profile. The majority of adolescents had an improved or unchanged life. Multinomial logistic regression analyses found that most of the individual, familial, and societal factors predicted the group memberships. Notably, parent-adolescent conflict was a significant factor that predicted memberships of all patterns. These findings show the resilience of adolescents and indicate the need for policies and interventions that consider the holistic nature of adolescents' person-context system, especially during a global crisis such as the COVID-19 pandemic.

On the Relationship between Hearing and Cognitive Limitations: Evidence from 51 Countries

Objective: This study extends prior findings by looking at the relationship between hearing acuity and cognitive difficulties in 51 nations. Methods: We draw on data from the Integrated Public Use Microdata International Series available at the Institute for Social Research and Data Innovation at the University of Minnesota. For all countries where data are available, bivariate relationships between hearing and cognitive problems are examined using correlation coefficients (Rs) and multivariate relationships using linear regression techniques (betas), controlling for age, gender, marital status, and education. Results: For all 51 countries, the R between hearing problems and cognitive problems is 0.334 (p < .001); the multivariate beta is 0.316 (p < .001). Regional results are also statistically significant. Discussion: The relationship between hearing and memory appears to be universal, and practitioners must carefully assess and treat their client's hearing disabilities before they can expect them to remember any information.

Socioeconomic position and quality of life among older people: The mediating role of social support

Social support can obscure social gradients in health, but its role as a mediator between socioeconomic position (SEP) and quality of life (QoL) in older populations remains unknown. We aimed to examine to what extent social support mediates the association between SEP and overall QoL among older adults (aged 60-84 years). We studied a population-based cohort of 585 noninstitutionalized adults in Porto, Portugal, who were evaluated in 2009. Education, occupation, and perceived income adequacy were used as SEP indicators. The WHOQOL-OLD was used to determine overall QoL. Social support was assessed using the Multidimensional Scale of Perceived Social Support. Path analysis was conducted to quantify direct, indirect, and total effects of SEP on QoL. There was a positive total effect of education on QoL (β = 0.28; 95% CI: 0.05-0.48). In this model, we found an indirect effect through social support (β = 0.15; 95% CI: 0.05-0.26), explaining 54% of the pathway between education and QoL. A similar pattern was identified for the association between occupation and QoL. Perceived income adequacy had a total effect of 2.74 (95% CI: 1.68-3.93) on QoL. Although an indirect effect through social support was found (β = 0.98; 95% CI: 0.42-1.55), a direct effect from this variable remained (β = 1.76; 95% CI: 0.65-2.90). Social support can be a mechanism through which SEP impacts the QoL of older people. Strengthening social support ties may attenuate the impact of social inequalities and improve the QoL of this population.

Poverty and other correlates of obesity and underweight among 7-year-olds from Croatia and Montenegro

OBJECTIVES

This study aimed at investigating poverty and other correlates of childhood underweight and obesity in two urban regions with lower (Podgorica, Montenegro) and higher economic development (Osijek, Croatia).

STUDY DESIGN

Comparative study.

METHODS

A comparative study was conducted on 693 children (52% boys), aged 7 years old (224 from Podgorica and 469 from Osijek). Parents completed the study-specific questionnaire on relevant factors for children's nutritional status. We measured children's height and weight and calculated their body mass index (BMI). International Obesity Task Force cut-off values of BMI were used to assess children's nutritional status. Subjective social position was assessed by the Mac Arthur scale.

RESULTS

There were more underweight children in Osijek compared with Podgorica, both among boys (5.5% vs. 1.6%) and girls (6.9% vs. 1.0%). Obesity was more frequent in Podgorica than Osijek, both among boys (11.3% vs. 5.9%) and girls (10.0% vs. 4.3%). However, poverty in two cities diminished observed differences in children's nutritional status. The odds for child underweight decreased by 12.2%, while the odds for obesity increased by 3.6% per each paternal BMI unit. The frequency of child obesity was lowered per each step higher on the Mac Arthur scale and with breastfeeding by 23.2% and 68.0%, respectively.

CONCLUSIONS

We show that a higher economic development is related to less obese children but more underweight children. However, poverty seems to impact nutritionally all children equally, regardless of the regional economic development. Paternal and not maternal BMI is relevant for both extremes in children's nutritional status. Breastfeeding and higher social position independently protect from child obesity.

Quality of life of parents of very preterm infants 4 months after birth: a mixed methods study

Background

Knowledge about parental quality of life (QoL) is paramount to family-centred and integrated healthcare on prematurity, but evidence is limited. We aimed to explore mothers’ and fathers’ perspectives about their QoL 4 months after a very preterm childbirth.

Methods

This is a cross-sectional mixed methods study using a convergent design. Parents of very preterm infants were systematically recruited at all level III neonatal intensive care units in the Northern health region of Portugal for one year. Four months after childbirth, 61 mothers and 56 fathers filled-in the World Health Organization Quality of Life – BREF Inventory, and 26 couples were interviewed. Linear regression models were computed to assess the association between participants’ characteristics and the QoL. Qualitative data were thematically analysed.

Results

A quantitative analysis revealed that the perception of QoL was not significantly different by gender. QoL scores increased slightly from the environment (Mean (SD): 72.1 (14.2)) to the psychological domains (Mean (SD): 78.7 (14.4)). All scores were influenced by psychological characteristics. Socioeconomic position influenced both parents’ perceptions concerning the environment domain, and maternal physical and psychological QoL. Infant-related factors were associated with overall QoL among women and with the physical, psychological, social and environment domains among men. Qualitative findings indicated accommodation mechanisms that intertwine the focus on constraining factors (surveillance, sleep disturbances, non-supportive healthcare policies, hygienization) with facilitating factors (social support, accessibility/quality of healthcare, opportunities for developing parental skills). These processes were anchored in child-centredness and a framework that construct hierarchies of hope and expectations about infant’s health and development.

Conclusions

To capture parental QoL using mixed methods raises awareness for developing intersectoral family-centred policies, integrated health services and focused-interventions to decrease the disempowering effects of surveillance and hygienization.

Relationship between Tobacco Craving and Quality of Life among French Students: Results of a Cross-Sectional Study

BACKGROUND

Understanding the factors leading to smoking cessation is of primary importance in reducing the death burden. Recently introduced in the DSM-5, craving is a potentially promising mechanism involved in relapse, but its articulation with quality of life and deprivation on tobacco student's consumers has never been investigated.

OBJECTIVES

Our study explores the relationship between tobacco craving and sub-dimensions of quality of life when controlling effect of deprivation on a youth population with tobacco consumption.

METHOD

Comparison between deprived and non-deprived students were conducted with online questionnaires on demographic data, level of dependency, perceived quality of life, deprivation and craving. Multivariate linear regression with backward procedure was conducted to assess the predictive validity of these variables on craving. Finally, Bayesian analysis was conducted to evaluate the model proposed by the regression.

RESULTS

One hundred and seventy-four participants were included. Craving was significantly correlated with all the other variables and increases when the level of deprivation rises, while it decreases when physical health improves. These results are confirmed by Bayesian linear regression. Conclusions/Importance: Environmental and social factors are usually overlooked when it comes to understanding individuals, deeply rooted biological mechanisms such as craving. Working on physical health is of interest to diminished craving and improves the quality of life during smoking cessation and thereby to support success on the student population. Consequences for the triadic neurocognitive model of addiction are discussed.

Stigma and Health-Related Quality of Life in Sexual Minorities

INTRODUCTION

Stigma against sexual minorities is well documented, but its long-term consequences for health-related quality of life (HRQL) are unknown. This study examined stigma-related predictors of sexual orientation disparities in HRQL and their contribution to young adult HRQL disparities.

METHODS

In 2013, participants (N=7,304, aged 18-31 years) reported sexual orientation (completely heterosexual [CH], mostly heterosexual, bisexual, and lesbian/gay). The EQ5D-5L, preference weighted for the U.S. population, was used to assess HRQL (range, -0.109 [worse than dead] to 1 [full health]). In prior waves conducted during adolescence, participants reported past-year bullying victimization (range, 1 [never] to 5 [several times/week]) and subjective social status (SSS) in their school (range, 1 [top] to 10 [bottom]). Analyses conducted in 2016 used longitudinal, multivariable linear and logistic regression to assess the contribution of bullying victimization and SSS in adolescence to sexual orientation disparities in HRQL in young adulthood, controlling for confounders and stratified by gender.

RESULTS

Compared with CHs, both female and male sexual minorities reported more bullying victimization and lower SSS in adolescence and lower HRQL in young adulthood (HRQL score among women: mostly heterosexual, 0.878; bisexual, 0.839; lesbian, 0.848; CH, 0.913; HRQL score among men: mostly heterosexual, 0.877; bisexual, 0.882; gay, 0.890; CH, 0.925; all p-values <0.05). When bullying and SSS were added into multivariable models, orientation group effect estimates were attenuated substantially, suggesting bullying and lower SSS in adolescence partly explained HRQL disparities in young adulthood.

CONCLUSIONS

Stigma-related experiences in adolescence may have lasting adverse effects on sexual minority health in adulthood.