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Buffel V, Wouters E, Cullati S, Tancredi S, Van Eeckert N, Van De Velde S. The relation between economic stressors and higher education students' mental health during the initial outbreak of the COVID-19 pandemic. Scand J Public Health 2024; 52:316-328. [PMID: 38179954 DOI: 10.1177/14034948231185938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
AIMS The COVID-19 pandemic has had a large impact on the financial situation of higher education students, disproportionately affecting students with a low socioeconomic status (SES). This raises the question of whether economic stressors related to COVID-19 have aggravated existing socioeconomic inequalities in mental health. This study examined the relationship between economic stressors and students' depressive symptoms, and the role of students' SES and countries' socioeconomic conditions. METHODS Data from the COVID-19 International Student Well-being Study was used for multilevel analyses, with depressive symptoms as dependent variable. Three indicators measured SES: educational level of the parents, ability to borrow money from their social network, and struggling with financial resources prior to COVID-19. RESULTS Students with a low SES had more depressive symptoms, and those not able to borrow money and with parents without higher education were more exposed to a deterioration in their financial situation. Both economic stressors (reduction in working hours and a deterioration of their financial situation) were positively related to depressive symptoms. In addition, the positive relationship between a decrease in working hours and depressive symptoms was stronger in countries with a higher unemployment rate. CONCLUSIONS We observed socioeconomic inequalities in students' mental health, which, in part, can be ascribed to a larger exposure to the economic stressors related to COVID-19 among students' with a low SES. The macroeconomic context also played a role, as the impact of a reduction in working hours on depressive symptoms was stronger in countries with poor economic conditions.
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Affiliation(s)
- Veerle Buffel
- Brussels Institute for Social and Population Studies, Department of Sociology (BRISPO), University of Brussels, Belgium
| | - Edwin Wouters
- Centre for Population, Family, and Health, Department of Sociology, University of Antwerp, Belgium
| | - Stephane Cullati
- Division Quality of care, Department of Readaptation and Geriatrics, Faculty of Medicine, University of Geneva, Switzerland
- Population Health Laboratory (#PopHealthLab), Faculty of Science and Medicine, University of Fribourg, Switzerland
| | - Stefano Tancredi
- Population Health Laboratory (#PopHealthLab), Faculty of Science and Medicine, University of Fribourg, Switzerland
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Nina Van Eeckert
- Centre for Population, Family, and Health, Department of Sociology, University of Antwerp, Belgium
| | - Sarah Van De Velde
- Centre for Population, Family, and Health, Department of Sociology, University of Antwerp, Belgium
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Chase E, Calhoun BH, Khosropour CM, Lee CM, Rhew IC. Trajectories of financial distress during the COVID-19 pandemic and their associations with mental health and substance use outcomes in a cohort of young adults. Appl Psychol Health Well Being 2024; 16:442-459. [PMID: 37821092 PMCID: PMC11006823 DOI: 10.1111/aphw.12498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
The COVID-19 pandemic has led to unprecedented life disruptions among young adults, including increased job insecurity and financial strain. Mental health problems and substance use have also increased during the pandemic, with young adults particularly vulnerable to experiencing these challenges. This study examines trajectories of financial distress among young adults during the pandemic and their associations with depression, anxiety, and hazardous alcohol and cannabis use. Data from 473 young adults (ages 22-29) recruited in the Northwest United States were collected from April/May 2020 to July/August 2021. Financial distress trajectories were identified using growth mixture modeling. Negative binomial models were used to examine associations between financial distress trajectories and distal outcomes of depression, anxiety, alcohol, and cannabis use. Three distinct trajectories were identified, revealing Low, Moderate, and High financial distress experiences. Individuals with "Moderate" and "High" trajectories showed significantly greater depressive and anxiety symptom scores compared with those in the "Low" financial distress trajectory group. Trajectories were not associated with subsequent levels of alcohol or cannabis use. Young adult mental health remains a priority during periods of economic downturn. Providers must be aware of the psychological challenges imposed by financial distress among young adults to address worsening mental health symptoms.
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Affiliation(s)
- Erin Chase
- Department of Epidemiology, University of Washington, 3980 15 Ave NE, Seattle, WA, 98195, USA
| | - Brian H. Calhoun
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Health Risk and Behaviors, University of Washington, Box 357238, Seattle, WA, 98195, USA
| | - Christine M. Khosropour
- Department of Epidemiology, University of Washington, 3980 15 Ave NE, Seattle, WA, 98195, USA
| | - Christine M. Lee
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Health Risk and Behaviors, University of Washington, Box 357238, Seattle, WA, 98195, USA
| | - Isaac C. Rhew
- Department of Epidemiology, University of Washington, 3980 15 Ave NE, Seattle, WA, 98195, USA
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Health Risk and Behaviors, University of Washington, Box 357238, Seattle, WA, 98195, USA
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Hughes K, Bellis MA, Cresswell K, Hill R, Ford K, Hopkins JC. Examining relationships between adverse childhood experiences and coping during the cost-of-living crisis using a national cross-sectional survey in Wales, UK. BMJ Open 2024; 14:e081924. [PMID: 38692715 DOI: 10.1136/bmjopen-2023-081924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) can affect individuals' resilience to stressors and their vulnerability to mental, physical and social harms. This study explored associations between ACEs, financial coping during the cost-of-living crisis and perceived impacts on health and well-being. DESIGN National cross-sectional face-to-face survey. Recruitment used a random quota sample of households stratified by health region and deprivation quintile. SETTING Households in Wales, UK. PARTICIPANTS 1880 Welsh residents aged ≥18 years. MEASURES Outcome variables were perceived inability to cope financially during the cost-of-living crisis; rising costs of living causing substantial distress and anxiety; and self-reported negative impact of rising costs of living on mental health, physical health, family relationships, local levels of antisocial behaviour and violence, and community support. Nine ACEs were measured retrospectively. Socioeconomic and demographic variables included low household income, economic inactivity, residential deprivation and activity limitation. RESULTS The prevalence of all outcomes increased strongly with ACE count. Perceived inability to cope financially during the cost-of-living crisis increased from 14.0% with 0 ACEs to 51.5% with 4+ ACEs. Relationships with ACEs remained after controlling for socioeconomic and demographic factors. Those with 4+ ACEs (vs 0 ACEs) were over three times more likely to perceive they would be unable to cope financially and, correspondingly, almost three times more likely to report substantial distress and anxiety and over three times more likely to report negative impacts on mental health, physical health and family relationships. CONCLUSIONS Socioeconomically deprived populations are recognised to be disproportionately impacted by rising costs of living. Our study identifies a history of ACEs as an additional vulnerability that can affect all socioeconomic groups. Definitions of vulnerability during crises and communications with services on who is most likely to be impacted should consider childhood adversity and history of trauma.
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Affiliation(s)
- Karen Hughes
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, UK
- School of Health Sciences, College of Medicine and Health Sciences, Bangor University, Wrexham, UK
| | - Mark A Bellis
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, UK
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Katie Cresswell
- School of Health Sciences, College of Medicine and Health Sciences, Bangor University, Wrexham, UK
| | - Rebecca Hill
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, UK
| | - Kat Ford
- School of Health Sciences, College of Medicine and Health Sciences, Bangor University, Wrexham, UK
| | - Joanne C Hopkins
- Policy and International Health, World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, UK
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Chan JK, Marzuki AA, Vafa S, Thanaraju A, Yap J, Chan XW, Harris HA, Todi K, Schaefer A. A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during Covid-19: unearthing the potential role of economic concerns and financial strain. BMC Psychol 2024; 12:237. [PMID: 38671542 PMCID: PMC11046828 DOI: 10.1186/s40359-024-01715-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Covid-19 has disrupted the lives of many and resulted in high prevalence rates of mental disorders. Despite a vast amount of research into the social determinants of mental health during Covid-19, little is known about whether the results are consistent with the social gradient in mental health. Here we report a systematic review of studies that investigated how socioeconomic condition (SEC)-a multifaceted construct that measures a person's socioeconomic standing in society, using indicators such as education and income, predicts emotional health (depression and anxiety) risk during the pandemic. Furthermore, we examined which classes of SEC indicators would best predict symptoms of emotional disorders. METHODS Following PRISMA guidelines, we conducted search over six databases, including Scopus, PubMed, etc., between November 4, 2021 and November 11, 2021 for studies that investigated how SEC indicators predict emotional health risks during Covid-19, after obtaining approval from PROSPERO (ID: CRD42021288508). Using Covidence as the platform, 362 articles (324 cross-sectional/repeated cross-sectional and 38 longitudinal) were included in this review according to the eligibility criteria. We categorized SEC indicators into 'actual versus perceived' and 'static versus fluid' classes to explore their differential effects on emotional health. RESULTS Out of the 1479 SEC indicators used in these 362 studies, our results showed that 43.68% of the SEC indicators showed 'expected' results (i.e., higher SEC predicting better emotional health outcomes); 51.86% reported non-significant results and 4.46% reported the reverse. Economic concerns (67.16% expected results) and financial strains (64.16%) emerged as the best predictors while education (26.85%) and living conditions (30.14%) were the worst. CONCLUSIONS This review summarizes how different SEC indicators influenced emotional health risks across 98 countries, with a total of 5,677,007 participants, ranging from high to low-income countries. Our findings showed that not all SEC indicators were strongly predictive of emotional health risks. In fact, over half of the SEC indicators studied showed a null effect. We found that perceived and fluid SEC indicators, particularly economic concerns and financial strain could best predict depressive and anxiety symptoms. These findings have implications for policymakers to further understand how different SEC classes affect mental health during a pandemic in order to tackle associated social issues effectively.
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Affiliation(s)
- Jee Kei Chan
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia.
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia.
- Sunway University Malaysia, Room: 4-4-11, Jalan Lagoon Selatan, Bandar Sunway, Petaling Jaya, 47500, Selangor, Malaysia.
| | - Aleya A Marzuki
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Samira Vafa
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Arjun Thanaraju
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Jie Yap
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Xiou Wen Chan
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Hanis Atasha Harris
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Khushi Todi
- Department of Psychology, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
| | - Alexandre Schaefer
- Department of Psychology, Sunway University Malaysia, Jalan Universiti, No 5, 47500, Bandar Sunway, Petaling Jaya, Selangor Darul Ehsan, Malaysia
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Beauchemin MP, Solomon S, Michaels CL, McHenry K, Turi E, Khurana R, Sanabria G. Toward identification and intervention to address financial toxicity and unmet health-related social needs among adolescents and emerging adults with cancer and their caregivers: A cross-cultural perspective. Cancer Med 2024; 13:e7197. [PMID: 38659403 PMCID: PMC11043682 DOI: 10.1002/cam4.7197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE We qualitatively explored the unique needs and preferences for financial toxicity screening and interventions to address financial toxicity among adolescents and emerging adults (younger AYAs: 15-25 years) with cancer and their caregivers. METHODS We recruited English- or Spanish-speaking younger AYAs who were treated for cancer within the past 2 years and their caregivers. Semi-structured interviews were conducted to explore preferences for screening and interventional study development to address financial toxicity. The data were coded using conventional content analysis. Codes were reviewed with the study team, and interviews continued until saturation was reached; codes were consolidated into categories and themes during consensus discussions. RESULTS We interviewed 17 participants; nine were younger AYAs. Seven of the 17 preferred to speak Spanish. We identified three cross-cutting themes: burden, support, and routine, consistent, and clear. The burden came in the form of unexpected costs such as transportation to appointments, as well as emotional burdens such as AYAs worrying about how much their family sacrificed for their care or caregivers worrying about the AYA's physical and financial future. Support, in the form of familial, community, healthcare institution, and insurance, was critical to mitigating the effects of financial toxicity in this population. Participants emphasized the importance of meeting individual financial needs by routinely and consistently asking about financial factors and providing clear guidance to navigate these needs. CONCLUSION Younger AYAs and their caregivers experience significant financial challenges and unmet health-related social needs during cancer treatment and often rely on key supports to alleviate these unmet needs. When developing interventions to mitigate financial toxicity, clinicians and health systems should prioritize clear, consistent, and tailorable approaches to support younger AYA cancer survivors and their families.
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Affiliation(s)
- Melissa P. Beauchemin
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Herbert Irving Comprehensive Cancer CenterColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Samrawit Solomon
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Claudia L. Michaels
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Kathryn McHenry
- School of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Eleanor Turi
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Rhea Khurana
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
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Nigatu YT, Elton-Marshall T, Wickens CM, Hamilton HA. The Association of Frequency of Worry About Financial Debt With Substance Use Among Adults in Ontario, Canada. Subst Use Misuse 2024; 59:1190-1199. [PMID: 38514251 DOI: 10.1080/10826084.2024.2330902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND Financial debt and associated stress might increase the risk of substance use problems or exacerbate existing ones. Little evidence is available about the degree of debt stress and its association with substance use. The objective of this study was to examine the associations of the frequency of worry about debt with heavy episodic drinking (HED), daily smoking, e-cigarette use, and cannabis use in the past 30 days. METHODS Data were utilized from the 2020/2022 Monitor study, a repeated cross-sectional survey of adults 18 years and older in Ontario, Canada. The surveys employed a web-based panel survey of 6038 adults and collected data on debt-related stress, HED, tobacco smoking, e-cigarettes, and cannabis use in the past 30 days. Odds ratios (OR) were estimated from logistic regression models accounting for sociodemographic factors. RESULTS Overall, 18.4% of respondents reported that they were worried about their debt most or all of the time. Accounting for household income, educational status, employment status, and other factors, the results revealed that there was a dose-response relationship between the frequency of worry about debt and substance use including daily smoking, e-cigarette use, and cannabis use in the past 30 days compared to those who were not worried at all about their debt. Sex differences were also found in the association between worry about debt and e-cigarette use. CONCLUSIONS The frequency of worry about debt might have an important role in substance use, which suggests that financial well-being is vital in substance use prevention and harm reduction.
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Affiliation(s)
- Yeshambel T Nigatu
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
| | - Tara Elton-Marshall
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Christine M Wickens
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Hayley A Hamilton
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Carlos Chavez FL, Sanchez D, Capielo Rosario C, Han S, Cerezo A, Cadenas GA. COVID-19 Economic and Academic Stress on Mexican American Adolescents' Psychological Distress: Parents as Essential Workers. J Clin Child Adolesc Psychol 2024; 53:37-51. [PMID: 37036440 DOI: 10.1080/15374416.2023.2191283] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
OBJECTIVES In a sample of Mexican American adolescents (N = 398; 51% females; aged 13-17), we examined the associations between psychological distress, COVID-19 household economic stress, COVID-19 academic stress, and whether these associations varied by adolescents' gender and by parents/caregivers' essential worker status. METHOD First, linear regression models assessed the main effects of household economic and academic stress on psychological distress. Second, the moderating effects of gender and parents/caregivers' essential worker status on the association between household economic and academic stress, and psychological distress were examined. Third, the three-way interaction effect of household economic stress, gender, and parents/caregivers' essential worker status on psychological distress as well as the three-way interaction effect of academic stress, gender, and parents/caregivers' essential worker status on psychological distress were calculated. RESULTS Household economic and academic stress were associated with psychological distress. However, these associations did not vary based on adolescents' gender or parents/caregivers' essential worker status. The three-way interaction for household economic stress, parents/caregivers' essential worker status, and gender for psychological distress was significant. Specifically, the effects of household economic stress on psychological distress was worse for boys than girls whose parents/caregivers were essential workers. Furthermore, the three-way interaction among academic stress, parents/caregivers' essential worker status, and gender was significant. Particularly, the effects of academic stress when grades were worse on adolescents' psychological distress was worse for boys than girls whose parents/caregivers were essential workers. CONCLUSION Parents/caregivers' essential worker status was salient among Mexican American adolescents' mental health outcomes during COVID-19, particularly for adolescent boys.
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Affiliation(s)
- Fiorella L Carlos Chavez
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University
| | - Delida Sanchez
- Department of Counseling, Higher Education, and Special Education, University of Maryland
| | | | - SeungYong Han
- Research Initiatives, Support & Engagement (R.I.S.E.). Edson College of Nursing and Health Innovation, Arizona State University
| | - Alison Cerezo
- Department of Counseling, Clinical, and School Psychology, University of California Santa Barbara
| | - German A Cadenas
- Department of Education & Human Services, College of Education, Lehigh University
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Capielo Rosario C, Carlos Chavez FL, Sanchez D, Torres L, Mattwig T, Pituch K. Mental Health Among Puerto Rican Adolescents Living in the United States During the COVID-19 Pandemic. J Clin Child Adolesc Psychol 2024; 53:52-65. [PMID: 38270576 DOI: 10.1080/15374416.2024.2301775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVES The present study examined how different family level (family financial stress, family violence) and individual (food insecurity, gender, race) determinants of health were associated with mental health among Puerto Rican adolescents living in the U.S. during the COVID-19 pandemic. METHOD A sample consisting of 119 Puerto Rican adolescents, aged 13 to 17, was collected via Qualtrics Panels between November 2020 and January 2021. We examined the association between family financial stress experienced during the pandemic and psychological distress. We also evaluated whether the association between family financial stress and psychological distress was moderated by family violence, food insecurity, and the participant's gender and race. RESULTS Findings showed that food insecurity positively predicted psychological distress. Results also showed that participants' race moderated the association between family financial stress and psychological distress. Specifically, we found that while there was a significant positive association between family financial stress and psychological distress among Puerto Rican adolescents who identified as a racial minority, this association was nonsignificant among White Puerto Rican adolescents. CONCLUSION Our research highlights the significant role of COVID-19 related family financial stress and food insecurity on Puerto Rican adolescents' poor mental health during the COVID-19 pandemic.
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Affiliation(s)
| | | | - Delida Sanchez
- Department of Counseling, Higher Education, and Special Education, University of Maryland
| | | | | | - Keenan Pituch
- College of Nursing and Health Innovation, Arizona State University
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Lai S, Lu L, Shen C, Yan A, Lei Y, Zhou Z, Wang Y. Income loss and subsequent poor psychological well-being among the Chinese population during the early COVID-19 pandemic. Int J Equity Health 2023; 22:219. [PMID: 37848883 PMCID: PMC10583462 DOI: 10.1186/s12939-023-02022-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had major ramifications for health and the economy at both the individual and collective levels. This study examined exogenous negative changes in household income and their implications on psychological well-being (PWB) among the Chinese population during the COVID-19 pandemic. METHODS Data were drawn from the early China COVID-19 Survey, a cross-sectional anonymous online survey administered to the general population in China. Self-reported PWB was measured using a 5-point Likert scale with five questions related to the participants' recent psychological state. Hierarchical multiple linear regression was employed to examine whether income loss during the COVID-19 pandemic was associated with poor psychological health. RESULTS This study included 8,428 adults, of which 90% had suffered from a moderate or severe loss of household income due to the early COVID-19 pandemic. Those who had experienced moderate or severe loss of income scored significantly lower on psychological well-being than those who did not experience income loss (19.96 or 18.07 vs. 21.46; P < 0.001); after controlling for confounders, income loss was negatively associated with PWB scores (moderate income loss: B = - 0.603, P < 0.001; severe income loss: B = - 1.261, P < 0.001). An interaction effect existed between the degree of income loss and pre-pandemic income groups. Specifically, participants in the middle-income group who had suffered severe income loss scored the lowest on PWB (B = - 1.529, P < 0.001). There was also a main effect on income loss, such that participants with varying degrees of income loss differed across five dimensions, including anhedonia, sleep problems, irritability or anger, difficulty with concentration, and repeated disturbing dreams related to COVID-19. CONCLUSIONS Income loss during the pandemic has had detrimental consequences on psychological well-being, and the magnitude of the impact of income loss on psychological well-being varied according to previous income levels. Future policy efforts should be directed toward improving the psychological well-being of the economically vulnerable and helping them recover from lost income in the shortest time possible.
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Affiliation(s)
- Sha Lai
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Li Lu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Alice Yan
- Division of Research Patient Care Services, Stanford Health Care, Palo Alto, CA, 94305, USA
| | - Yanjun Lei
- Department of Pathogenic Microbiology and Immunology, School of Basic Medical Sciences, Xi'an Jiaotong University, Xi'an, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
| | - Youfa Wang
- School of Public Health, Global Health Institute, Xi'an Jiaotong University Health Science Center, Xi'an, China.
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Xiao SX, Korous KM, Hewitt SL, Nguyen D. Family economic pressure and early adolescents' prosocial behavior: The importance of considering the types of prosocial behavior. J Adolesc 2023; 95:1220-1231. [PMID: 37211871 DOI: 10.1002/jad.12196] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/23/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Prior research findings are mixed regarding whether prosocial behavior is positively or negatively related to socioeconomic status and its correlates, such as economic pressure. This may be due to the lack of considerations for the type of prosocial behavior. AIMS In this study, we aimed to examine how six types of prosocial behavior (i.e., public, anonymous, compliant, emotional, dire, and altruistic) are related to economic pressure among early adolescents. We hypothesized that family economic pressure would be associated with each type of prosocial behavior in differing ways. MATERIALS & METHODS Participants were 11-14 years old (N = 143, Mage = 12.2 years, SDage = 0.87, 63 boys, 1 trans-identified boy, 55 girls), early adolescents and their parents. Among them, 54.6% were non-Hispanic/Latinx (NH/L) White, 23.8% were NH/L Black, 11.2% were NH/L Asian, 2.1% were NH/L Multiracial, and 8.4% were Hispanic/Latinx. Parents reported family economic pressure and adolescents' six types of prosocial behavior. RESULTS Path analysis revealed that economic pressure was negatively associated with emotional and dire prosocial behavior over and above age, gender, and race/ethnicity. Family economic pressure was unrelated to public, anonymous, compliant, and altruistic prosocial behavior. DISCUSSION These findings show some support for the Family Stress Model, such that economic stress might hinder youth's prosocial development. At the same time, youth may have similar levels of certain types of prosocial behavior regardless of their family's economic pressure. CONCLUSION This research provided insight into the complex relation between economic pressure and youth's prosocial behavior which varies depending on the type of behavior.
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Affiliation(s)
- Sonya Xinyue Xiao
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, Arizona, USA
| | | | - Sarah L Hewitt
- School of Social and Behavioral Sciences, Arizona State University, Phoenix, Arizona, USA
| | - Diana Nguyen
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, Arizona, USA
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11
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Wu VS, Benedict C, Friedman DN, Watson SE, Anglade E, Zeitler MS, Chino F, Thom B. Do discussions of financial burdens decrease long-term financial toxicity in adolescent and young adult cancer survivors? Support Care Cancer 2023; 31:434. [PMID: 37395811 DOI: 10.1007/s00520-023-07822-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE This study aims to evaluate the associations between patient-provider cost discussions with patient-reported out-of-pocket (OOP) spending and long-term financial toxicity (FT) among adolescent and young adult (AYA; 15-39 years old) cancer survivors. METHODS Using a cross-sectional survey, we assessed the themes and quality of patient discussions with providers about financial needs and general survivorship preparation, quantified patients' levels of FT, and evaluated patient-reported OOP spending. We determined the association between cancer treatment cost discussion and FT using multivariable analysis. In a subset of survivors (n = 18), we conducted qualitative interviews and used thematic analysis to characterize responses. RESULTS Two hundred forty-seven AYA survivors completed the survey at a mean of 7 years post treatment and with a median COST score of 13. 70% of AYA survivors did not recall having any cost discussion about their cancer treatment with a provider. Having any cost discussion with a provider was associated with decreased FT (β = 3.00; p = 0.02) but not associated with reduced OOP spending (χ2 = 3.77; p = 0.44). In a second adjusted model, with OOP spending included as a covariate, OOP spending was a significant predictor of FT (β = - 1.40; p = 0.002). Key qualitative themes included survivors' frustration about the lack of communication related to financial issues throughout treatment and in survivorship, feeling unprepared, and reluctance to seek help. CONCLUSION AYA patients are not fully informed about the costs of cancer care and FT; the dearth of cost discussions between patients and providers may represent a missed opportunity to reduce costs.
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Affiliation(s)
- Victoria S Wu
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Catherine Benedict
- Stanford University School of Medicine, Stanford Cancer Institute, Palo Alto, CA, USA
| | - Danielle N Friedman
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Fumiko Chino
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bridgette Thom
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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12
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Qiu Z, Yao L, Jiang J. Financial toxicity assessment and associated factors analysis of patients with cancer in China. Support Care Cancer 2023; 31:264. [PMID: 37058171 PMCID: PMC10101818 DOI: 10.1007/s00520-023-07714-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/28/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE Cancer-related expenditures present a lasting economic burden on patients and their families and may exert long-term adverse effects on the patients' life and quality of life. In this study, the comprehensive score for financial toxicity (COST) was used to investigate the financial toxicity (FT) levels and related risk factors in Chinese patients with cancer. METHODS Quantitative data were collected through a questionnaire covering three aspects: sociodemographic information, economic and behavioral cost-coping strategies, and the COST scale. Univariate and multivariate analyses were performed to identify factors associated with FT. RESULTS According to 594 completed questionnaires, the COST score ranged 0-41, with a median of 18 (mean±SD, 17.98±7.978). Over 80% of patients with cancer reported at least moderate FT (COST score <26). A multivariate model showed that urban residents, coverage by other health insurance policies, and higher household income and consumption expenditures were significantly associated with higher COST scores, indicative of lower FT. The middle-aged (45-59 years old), higher out-of-pocket (OOP) medication expenditures and hospitalizations, borrowed money, and forgone treatment were all significantly associated with lower COST scores, indicating higher FT. CONCLUSION Severe FT was associated with sociodemographic factors among Chinese patients with cancer, family financial factors, and economic and behavioral cost-coping strategies. Government should identify and manage the patients with high-risk characteristics of FT and work out better health policies for them.
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Affiliation(s)
- Zenghui Qiu
- The School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lan Yao
- The School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junnan Jiang
- The School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
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13
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Cheng CHE, Thomas Tobin CS, Weiss JW. Psychological distress, social context, and gender patterns in obesity among a multiethnic sample of U.S. college students. J Am Coll Health 2022; 70:1615-1623. [PMID: 33048648 DOI: 10.1080/07448481.2020.1817032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 06/11/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Abstract
Objective: The growing prevalence of obesity among college students is a major public health issue, as over one-third are overweight or obese. This study used gender-stratified multivariate analyses to examine psychological distress and social contextual factors as key determinants of obesity. Participants: Students of a large public university in Southern California (N = 2392). Methods: In-class survey administered across various departments and general education courses. Results: Among females, distress (OR = 1.02) and sophomores (OR = 1.87) were associated with increased odds of obesity; Greek life (OR = 0.53) was associated with decreased odds of obesity. Among males, distress was not associated with obesity (OR = 1.00); financial strain (OR = 1.16) was associated with increased odds of obesity. Conclusions: There are gendered patterns in obesity risk with social context having potentially protective effects among women. Enhancing psychological wellbeing as well as creating gender- and context-specific interventions may be an effective strategy to address the rising rates of obesity among the college population.
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Affiliation(s)
- Chia-Hsin Emily Cheng
- Department of Psychology, California State University, Fullerton, California, USA
- Fielding School of Public Health, University of California, Los Angeles, California, USA
| | | | - Jie W Weiss
- Department of Public Health, California State University, Fullerton, California, USA
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14
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Li D, Suresh M, Abbondanza T, Vaidya A, Bancos I. The Impact of the COVID-19 Pandemic on Self-Reported Outcomes in Patients With Adrenal Insufficiency. J Clin Endocrinol Metab 2021; 106:e2469-e2479. [PMID: 34042985 PMCID: PMC8194854 DOI: 10.1210/clinem/dgab334] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Indexed: 12/15/2022]
Abstract
CONTEXT The COVID-19 pandemic has impacted healthcare environment. OBJECTIVE To determine the impact of the pandemic on self-reported outcomes in patients with adrenal insufficiency (AI). DESIGN AND SETTING Prospective longitudinal survey study at 2 tertiary centers. PARTICIPANTS Patients with AI. INTERVENTION Patient-centered questionnaire. MAIN OUTCOME MEASURES Depression Anxiety Stress Scales-21, Short Form-36, and AI self-management. RESULTS Of 342 patients, 157 (46%) had primary AI, 109 (32%) had secondary AI, and 76 (22%) had glucocorticoid-induced AI. When compared to prepandemic, daily glucocorticoid dose and number of adrenal crises did not change. However, patients reported a higher financial impact from AI (34% vs 23%, P = 0.006) and difficulty accessing medical care (31% vs 7%, P < 0.0001) during the pandemic. A third of patients reported difficulty managing AI during the pandemic. After adjusting for duration and subtypes of AI, younger patients [odds ratio (OR) 2.3, CI 95% 1.3-4.1], women (OR 3.7, CI 95% 1.9-7.1), poor healthcare access(OR 4.2, CI 95% 2.3-7.7), lack of good insurance support (OR 2.8, CI 95% 1.3-5.9), and those with a higher financial impact (OR 2.3, CI 95% 1.3-4.3) reported greater difficulties managing AI. Patients were more likely to report a higher anxiety score (≥8) if they found managing AI challenging during the pandemic (OR 3.0, CI 95% 1.3-6.9), and had lower Physical Component Summary (OR 4.9, CI 95% 2.2-11.0) and Mental Component Summary (OR 4.1, CI 95% 1.8-9.5) scores prior to the pandemic. CONCLUSIONS A third of patients with AI reported difficulties with management of AI during the pandemic, particularly in younger patients, women, and those with poor healthcare access.
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Affiliation(s)
- Dingfeng Li
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Malavika Suresh
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Tiffany Abbondanza
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Boston, MA, USA
| | - Anand Vaidya
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Boston, MA, USA
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA
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15
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O'Hara NN, Kringos DS, Slobogean GP, Degani Y, Klazinga NS. Patients Place More of an Emphasis on Physical Recovery Than Return to Work or Financial Recovery. Clin Orthop Relat Res 2021; 479:1333-1343. [PMID: 33239518 PMCID: PMC8133069 DOI: 10.1097/corr.0000000000001583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/02/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Value-based healthcare models aim to incentivize healthcare providers to offer interventions that address determinants of health. Understanding patient priorities for physical and socioeconomic recovery after injury can help determine which services and resources are most useful to patients. QUESTIONS/PURPOSES (1) Do trauma patients consistently identify a specific aspect/domain of recovery as being most important at 6 weeks, 6 months, and 12 months after an injury? (2) Does the relative importance of those domains change within the first year after injury? (3) Are differences in priorities greater between patients than for a given patient over time? (4) Are different recovery priorities associated with identifiable biopsychosocial factors? METHODS Between June 2018 and December 2018, 504 adult patients with fractures of the extremities or pelvis were surgically treated at the study site. For this prospective longitudinal study, we purposefully sampled patients from 6 of the 12 orthopaedic attendings' postoperative clinics. The participating surgeons surgically treated 243 adult patients with fractures of the extremities or pelvis. Five percent (11 of 243) of patients met inclusion criteria but missed their appointments during the 6-week recruitment window and could not be consented. We excluded 4% (9 of 243) of patients with a traumatic brain injury, 1% (2) of patients with a spinal cord injury, and 5% (12) of non-English-speaking patients (4% Spanish speaking [10]; 1% other languages [2]). Eighty-six percent of eligible patients (209 of 243) were approached for consent, and 5% (11 of 209) of those patients refused to participate. All remaining 198 patients consented and completed the baseline survey; 83% (164 of 198 patients) completed at least 6 months of follow-up, and 68% (134 of 198 patients) completed the 12-month assessment. The study participants' mean age was 44 ± 17 years, and 63% (125 of 198) were men. The primary outcome was the patient's recovery priorities, assessed at 6 weeks, 6 months, and 12 months after fracture using a discrete choice experiment. Discrete choice experiments are a well-established method for eliciting decisional preferences. In this technique, respondents are presented with a series of hypothetical scenarios, described by a set of plausible attributes or outcomes, and asked to select their preferred scenario. We used hierarchical Bayesian modeling to calculate individual-level estimates of the relative importance of physical recovery, work-related recovery, and disability benefits, based on the discrete choice experiment responses. The hierarchical Bayesian model improves upon more commonly used regression techniques by accounting for the observed response patterns of individual patients and the sequence of scenarios presented in the discrete choice experiment when calculating the model estimates. We computed the coefficient of variation for the three recovery domains and compared the between-patient versus within-patient differences using asymptotic tests. Separate prognostic models were fit for each of the study's three recovery domains to assess marginal changes in the importance of the recovery domain based on patient characteristics and factors that remained constant over the study (such as sex or preinjury work status) and patient characteristics and factors that varied over the study (including current work status or patient-reported health status). We previously published the 6-week results. This paper expands upon the prior publication to evaluate longitudinal changes in patient recovery priorities. RESULTS Physical recovery was the respondents' main priority at all three timepoints, representing 60% ± 9% of their overall concern. Work-related recovery and access to disability benefits were of secondary importance and were associated with 27% ± 6% and 13% ± 7% of the patients' concern, respectively. The patients' concern for physical recovery was 6% (95% CrI 4% to 7%) higher at 12 months after fracture that at 6 weeks postfracture. The mean concern for work-related recovery increased by 7% (95% CrI 6% to 8%) from 6 weeks to 6 months after injury. The mean importance of disability benefits increased by 2% (95% CrI 1% to 4%) from 6 weeks to 6 months and remained 2% higher (95% CrI 0% to 3%) at 12 months after the injury. Differences in priorities were greater within a given patient over time than between patients as measured using the coefficient of variation (physical recovery [245% versus 7%; p < 0.001], work-related recovery [678% versus 12%; p < 0.001], and disability benefits [620% versus 33%; p < 0.001]. There was limited evidence that biopsychosocial factors were associated with variation in recovery priorities. Patients' concern for physical recovery was 2% higher for every 10-point increase in their Patient-reported Outcome Measure Information System (PROMIS) physical health status score (95% CrI 1% to 3%). A 10-point increase in the patient's PROMIS mental health status score was associated with a 1% increase in concern for work-related recovery (95% CrI 0% to 2%). CONCLUSION Work-related recovery and accessing disability benefits were a secondary concern compared with physical recovery in the 12 months after injury for patients with fractures. However, the importance of work-related recovery was elevated after the subacute phase. Priorities were highly variable within a given patient in the year after injury compared with between-patient differences. Given this variation, orthopaedic surgeons should consider assessing and reassessing the socioeconomic well-being of their patients throughout their continuum of care. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Nathan N O'Hara
- N. N. O'Hara, G. P. Slobogean, Y. Degani, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- N. N. O'Hara, D. S. Kringos, N. S. Klazinga, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Dionne S Kringos
- N. N. O'Hara, G. P. Slobogean, Y. Degani, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- N. N. O'Hara, D. S. Kringos, N. S. Klazinga, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Gerard P Slobogean
- N. N. O'Hara, G. P. Slobogean, Y. Degani, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- N. N. O'Hara, D. S. Kringos, N. S. Klazinga, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Yasmin Degani
- N. N. O'Hara, G. P. Slobogean, Y. Degani, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- N. N. O'Hara, D. S. Kringos, N. S. Klazinga, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Niek S Klazinga
- N. N. O'Hara, G. P. Slobogean, Y. Degani, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- N. N. O'Hara, D. S. Kringos, N. S. Klazinga, Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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16
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Rodriguez LM, Litt DM, Stewart SH. COVID-19 psychological and financial stress and their links to drinking: A dyadic analysis in romantic couples. Psychol Addict Behav 2021; 35:377-390. [PMID: 34096760 DOI: 10.1037/adb0000724] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: The COVID-19 pandemic has been an unprecedented event for the entire world. Stay-at-home orders, many children being taught at home, health anxieties, and the subsequent economic downturn have collectively resulted in significant stress. Recent work has established that some individuals report drinking more in response to experiencing pandemic-related stress, but data has largely been limited to individuals and to psychological stress. Methods: This research investigated how own (actor) and partner psychological and financial stress about the pandemic were associated with alcohol consumption, high-intensity drinking frequency, coping motives, and alcohol-related problems in a sample of 118 couples during the month of July 2020. We also explored whether own (actor) and partner effects were moderated by gender. Results: Results using indistinguishable Actor-partner interdependence models (APIMs) demonstrated that own psychological stress was associated with higher scores on all drinking indices, and own financial stress was associated with higher coping motives and alcohol-related problems. Partner psychological and financial stress was related to own greater endorsement of coping motives, and partner financial stress was related to own greater endorsement of alcohol-related problems. In APIMs with mixed-sex couples, men's psychological and financial stress were positively related to both his own and his partner's drinks per week, high-intensity drinking, and coping motives. Men's financial stress was also positively related to his own and his partner's alcohol-related problems. Conclusions: Results provide considerable insight into couple dynamics related to pandemic stress and have direct implications for alcohol prevention and treatment efforts as we navigate this serious crisis. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Dana M Litt
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center
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17
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Kuo WC, Oakley LD, Brown RL, Hagen EW, Barnet JH, Peppard PE, Bratzke LC. Gender Differences in the Relationship Between Financial Stress and Metabolic Abnormalities. Nurs Res 2021; 70:123-131. [PMID: 33630535 PMCID: PMC8106736 DOI: 10.1097/nnr.0000000000000489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Financial stress is associated with higher prevalence of metabolic abnormalities and cardiovascular disease, but the extent to which this association differs by type of metabolic abnormalities or gender is unclear. OBJECTIVES The study aims were (a) to examine the association between financial stress and the prevalence of common metabolic abnormalities and (b) to test the association for gender differences. METHODS A cross-sectional secondary analysis was conducted using data from the Retirement and Sleep Trajectories study, an ancillary study of the Wisconsin Sleep Cohort study. Composite indicator structural equation alpha modeling with a stacking approach was applied in the data analysis. RESULTS After controlling for covariates, financial stress was positively associated with the prevalence of abdominal obesity, metabolic syndrome, and dyslipidemia, with significant gender differences. Among men, financial stress was positively associated with the prevalence of hypertriglyceridemia. Among women, financial stress was positively associated with the prevalence of prediabetes, abdominal obesity, metabolic syndrome, and dyslipidemia. CONCLUSION Men living with financial stress are more likely to have hypertriglyceridemia, a specific metabolic abnormality and risk factor for acute cardiovascular events. However, financial stress in women is associated with a broader array of metabolic abnormalities (e.g., dyslipidemia, prediabetes, abdominal obesity, metabolic syndrome), highlighting a potential risk of multiple chronic conditions later in life.
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Affiliation(s)
- Wan-chin Kuo
- University of Wisconsin–Madison, School of Nursing, Madison, WI
| | - Linda D. Oakley
- University of Wisconsin–Madison, School of Nursing, Madison, WI
| | - Roger L. Brown
- University of Wisconsin–Madison, School of Nursing, Madison, WI
| | - Erika W. Hagen
- University of Wisconsin–Madison, School of Medicine and Public Health, Department of Population Health Science, Madison, WI
| | - Jodi H. Barnet
- University of Wisconsin–Madison, School of Medicine and Public Health, Department of Population Health Science, Madison, WI
| | - Paul E. Peppard
- University of Wisconsin–Madison, School of Medicine and Public Health, Department of Population Health Science, Madison, WI
| | - Lisa C. Bratzke
- University of Wisconsin–Madison, School of Nursing, Madison, WI
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18
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Guha A, Dey AK, Al-Kindi S, Miller PE, Ghosh AK, Banerjee A, Lopez-Mattei J, Desai NR, Patel B, Oliveira GH, de Lima M, Fradley M, Addison D. Socio-Economic Burden of Myocardial Infarction Among Cancer Patients. Am J Cardiol 2021; 141:16-22. [PMID: 33217349 DOI: 10.1016/j.amjcard.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 01/25/2023]
Abstract
Cancer patients face a higher risk of future myocardial infarction (MI), even after completion of anticancer therapies. MI is a critical source of physical and financial stress in noncancer patients, but its impacts associated with cancer patients also saddled with the worry (stress) of potential reoccurrence is unknown. Therefore, we aimed to quantify MI's stress and financial burden after surviving cancer and compare to those never diagnosed with cancer. Utilizing cross-sectional national survey data from 2013 to 2018 derived from publicly available United States datasets, the National Health Interview Survey , and economic data from the National Inpatient Sample , we compared the socio-economic outcomes in those with MI by cancer-status. We adjusted for social, demographic, and clinical factors. Overall, 19,504 (10.2%) of the 189,836 National Health Interview Survey responders reported having cancer for more than 1 year. There was an increased prevalence of MI in cancer survivors compared with noncancer patients (8.8% vs 3.2%, p <0.001). MI was associated with increased financial worry, food insecurity, and financial burden of medical bills (p <0.001, respectively); however, concurrent cancer did not seem to be an effect modifier (p >0.05). There was no difference in annual residual family income by cancer status; however, 3 lowest deciles of residual income representing 21.1% cancer-survivor with MI had a residual income of <$9,000. MI continues to represent an immense source of financial and perceived stress. In conclusion, although cancer patients face a higher risk of subsequent MI, this does not appear to advance their reported stress significantly.
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Affiliation(s)
- Avirup Guha
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio; Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio
| | - Amit Kumar Dey
- National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Sadeer Al-Kindi
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio
| | - P Elliott Miller
- Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut; Yale National Clinician Scholars Program, New Haven, Connecticut
| | - Arjun K Ghosh
- Cardio-Oncology Service, Bart's Heart Centre and University College London Hospital, Hatter Cardiovascular Institute, London, United Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Juan Lopez-Mattei
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nihar R Desai
- Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, New Haven, Connecticut
| | - Brijesh Patel
- Division of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Guilherme H Oliveira
- Cardio-Oncology Program, Division of Cardiovascular Medicine, University of South Florida Morsani College of Medicine and H. Lee Moffitt Cancer Center and Research Institute and, Tampa, Florida
| | - Marcos de Lima
- Adult Hematologic Malignancies and Stem Cell Transplant Program, Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Michael Fradley
- Cardio-Oncology Program, Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, Pennysylvania
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, Ohio; Cancer Control Program, Department of Internal Medicine, Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
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19
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Neppl TK, Diggs ON, Wickrama KAS, Walker O'Neal C. Pathways of the family stress model in midlife on physical health in later adulthood. J Fam Psychol 2021; 35:22-32. [PMID: 32437202 PMCID: PMC8324077 DOI: 10.1037/fam0000714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The current study examined economic adversity and physical health outcomes in line with the family stress model (FSM) for husbands and wives in enduring marriages. Data came from 243 husbands and wives who participated from early middle to later adulthood. Assessments included observational and self-report measures. Economic hardship and economic pressure were assessed in early middle adulthood. Feelings of hostility and observed harsh couple interaction were examined in middle adulthood, and physical impairment was assessed in later adulthood. Results indicated that economic hardship related to economic pressure. In addition, economic pressure indirectly related to physical impairment via hostility and harsh couple interaction. For husbands, economic pressure was also directly associated with their own physical impairment in later adulthood. Finally, economic pressure was indirectly associated with husband to wife harsh couple interaction through wife hostility. Similarly, economic pressure was indirectly associated with wife to husband harsh couple interaction through husband hostility. Results suggest that economic adversity as experienced in early middle adulthood has long-term health consequences into later adulthood. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Tricia K Neppl
- Department of Human Development and Family Studies, Iowa State University
| | - Olivia N Diggs
- Department of Human Development and Family Studies, Iowa State University
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20
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Yan S, Xu R, Stratton TD, Kavcic V, Luo D, Hou F, Bi F, Jiao R, Song K, Jiang Y. Sex differences and psychological stress: responses to the COVID-19 pandemic in China. BMC Public Health 2021; 21:79. [PMID: 33413224 DOI: 10.1101/2020.04.29.20084061] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/16/2020] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND About 83,000 COVID-19 patients were confirmed in China up to May 2020. Amid the well-documented threats to physical health, the effects of this public health crisis - and the varied efforts to contain its spread - have altered individuals' "normal" daily functioning. These impacts on social, psychological, and emotional well-being remain relatively unexplored - in particular, the ways in which Chinese men and women experience and respond to potential behavioral stressors. Our study investigated sex differences in psychological stress, emotional reactions, and behavioral responses to COVID-19 and related threats among Chinese residents. METHODS In late February (2020), an anonymous online questionnaire was disseminated via WeChat, a popular social media platform in China. The cross-sectional study utilized a non-probabilistic "snowball" or convenience sampling of residents from various provinces and regions of China. Basic demographic characteristics (e.g., age and gender) - along with residential living arrangements and conditions - were measured along with psychological stress and emotional responses to the COVID-19 pandemic. RESULTS Three thousand eighty-eight questionnaires were returned: 1749 females (56.6%) and 1339 males (43.4%). The mean stress level,as measured by a visual analog scale, was 3.4 (SD = 2.4) - but differed significantly by sex. Besides sex, factors positively associated with stress included: age (< 45 years), employment (unsteady income, unemployed), risk of infection (exposureto COVID-19, completed medical observation), difficulties encountered (diseases, work/study, financial, mental), and related behaviors (higher desire for COVID-19 knowledge, more time concerning on the COVID-19 outbreak). "Protective" factors included frequent contact with colleagues, calmness of mood comparing with the pre-pandemic, and psychological resilience. Males and females also differed significantly in adapting to current living/working, conditions, responding to run a fever, and needing psychological support services. CONCLUSIONS The self-reported stress of Chinese residents related to the COVID-19 pandemic was significantly related to sex, age, employment, resilience and coping styles. Future responses to such public health threats may wish to provide sex- and/or age-appropriate supports for psychological health and emotional well-being to those at greatest risk of experiencing stress.
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Affiliation(s)
- Shiyan Yan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Rui Xu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
| | - Terry D Stratton
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, 40536, USA
| | - Voyko Kavcic
- Institute of Gerontology, Wayne State University, Detroit, MI, 48202, USA
| | - Dan Luo
- School of Public Health, Central South University, Changsha, 410078, Hunan, China
| | - Fengsu Hou
- Shenzhen Kangning Hospital, Guangzhou, 518020, China
| | - Fengying Bi
- School of Public Health, Central South University, Changsha, 410078, Hunan, China
| | - Rong Jiao
- The First Clinical College, Hainan Meidical University, Haikou, 570100, China
| | - Kangxing Song
- The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Yang Jiang
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, 40536, USA
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21
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Yan S, Xu R, Stratton TD, Kavcic V, Luo D, Hou F, Bi F, Jiao R, Song K, Jiang Y. Sex differences and psychological stress: responses to the COVID-19 pandemic in China. BMC Public Health 2021; 21:79. [PMID: 33413224 PMCID: PMC7789895 DOI: 10.1186/s12889-020-10085-w] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/16/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND About 83,000 COVID-19 patients were confirmed in China up to May 2020. Amid the well-documented threats to physical health, the effects of this public health crisis - and the varied efforts to contain its spread - have altered individuals' "normal" daily functioning. These impacts on social, psychological, and emotional well-being remain relatively unexplored - in particular, the ways in which Chinese men and women experience and respond to potential behavioral stressors. Our study investigated sex differences in psychological stress, emotional reactions, and behavioral responses to COVID-19 and related threats among Chinese residents. METHODS In late February (2020), an anonymous online questionnaire was disseminated via WeChat, a popular social media platform in China. The cross-sectional study utilized a non-probabilistic "snowball" or convenience sampling of residents from various provinces and regions of China. Basic demographic characteristics (e.g., age and gender) - along with residential living arrangements and conditions - were measured along with psychological stress and emotional responses to the COVID-19 pandemic. RESULTS Three thousand eighty-eight questionnaires were returned: 1749 females (56.6%) and 1339 males (43.4%). The mean stress level,as measured by a visual analog scale, was 3.4 (SD = 2.4) - but differed significantly by sex. Besides sex, factors positively associated with stress included: age (< 45 years), employment (unsteady income, unemployed), risk of infection (exposureto COVID-19, completed medical observation), difficulties encountered (diseases, work/study, financial, mental), and related behaviors (higher desire for COVID-19 knowledge, more time concerning on the COVID-19 outbreak). "Protective" factors included frequent contact with colleagues, calmness of mood comparing with the pre-pandemic, and psychological resilience. Males and females also differed significantly in adapting to current living/working, conditions, responding to run a fever, and needing psychological support services. CONCLUSIONS The self-reported stress of Chinese residents related to the COVID-19 pandemic was significantly related to sex, age, employment, resilience and coping styles. Future responses to such public health threats may wish to provide sex- and/or age-appropriate supports for psychological health and emotional well-being to those at greatest risk of experiencing stress.
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Affiliation(s)
- Shiyan Yan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Rui Xu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
| | - Terry D Stratton
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, 40536, USA
| | - Voyko Kavcic
- Institute of Gerontology, Wayne State University, Detroit, MI, 48202, USA
| | - Dan Luo
- School of Public Health, Central South University, Changsha, 410078, Hunan, China
| | - Fengsu Hou
- Shenzhen Kangning Hospital, Guangzhou, 518020, China
| | - Fengying Bi
- School of Public Health, Central South University, Changsha, 410078, Hunan, China
| | - Rong Jiao
- The First Clinical College, Hainan Meidical University, Haikou, 570100, China
| | - Kangxing Song
- The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Yang Jiang
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, 40536, USA
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Abstract
Being wrongfully accused of criminal offences can lead to serious negative consequences to those wrongfully accused and their families. However, there is little research on the psychological and psychosocial impacts of wrongful accusations. We conducted a systematic literature review to collate the existing literature, searching four electronic literature databases and reference lists of relevant articles. Data were extracted from 20 relevant papers, and thematic analysis was conducted on the data. Eight main themes were identified: loss of identity; stigma; psychological and physical health; relationships with others; attitudes towards the justice system; impact on finances and employment; traumatic experiences in custody; and adjustment difficulties. The psychological consequences of wrongful accusations appear to affect the lives of those accused seriously, even after exoneration or overturning of convictions. Strategies for improving public perception of wrongful convictions should be explored, and specific mental-health systems should be established to support those who are wrongfully accused.
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Affiliation(s)
| | - Neil Greenberg
- Neil Greenberg, The Health Protection Research Unit, King’s College London, Weston Education Centre, Cutcombe Road, LondonSE5 9RJ, UK.
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23
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Jones SMW, Henrikson NB, Panattoni L, Syrjala KL, Shankaran V. A theoretical model of financial burden after cancer diagnosis. Future Oncol 2020; 16:3095-3105. [PMID: 32976048 PMCID: PMC7787147 DOI: 10.2217/fon-2020-0547] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/10/2020] [Indexed: 11/21/2022] Open
Abstract
Current models of financial burden after cancer do not adequately define types of financial burden, moderators or causes. We propose a new theoretical model to address these gaps. This model delineates the components of financial burden as material and psychological as well as healthcare-specific (affording treatment) versus general (affording necessities). Psychological financial burden is further divided into worry about future costs and rumination about past and current financial burden. The model hypothesizes costs and employment changes as causes, and moderators include precancer socioeconomic status and post-diagnosis factors. The model outlines outcomes affected by financial burden, including depression and mortality. Theoretically derived measures of financial burden, interventions and policy changes to address the causes of financial burden in cancer are needed.
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Affiliation(s)
- Salene MW Jones
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, King County, Washington 98101, USA
| | - Laura Panattoni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
| | - Karen L Syrjala
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
| | - Veena Shankaran
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
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24
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Elbogen EB, Lanier M, Montgomery AE, Strickland S, Wagner HR, Tsai J. Financial Strain and Suicide Attempts in a Nationally Representative Sample of US Adults. Am J Epidemiol 2020; 189:1266-1274. [PMID: 32696055 DOI: 10.1093/aje/kwaa146] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/29/2020] [Accepted: 06/13/2020] [Indexed: 02/01/2023] Open
Abstract
Although research has identified many suicide risk factors, the relationship between financial strain and suicide has received less attention. Using data representative of the US adult population (n = 34,653) from wave 1 (2001-2002) and wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions, we investigated the association between financial strain-financial debt/crisis, unemployment, past homelessness, and lower income-and subsequent suicide attempts and suicidal ideation. Multivariable logistic regression controlling for demographic and clinical covariates showed that cumulative financial strain was predictive of suicide attempts between waves 1 and 2 (odds ratio (OR) = 1.53, 95% confidence interval (CI): 1.32, 1.77). Wave 1 financial debt/crisis (OR = 1.58, 95% CI: 1.06, 2.34), unemployment (OR = 1.52, 95% CI: 1.10, 2.10), past homelessness (OR = 1.50, 95% CI: 1.03, 2.17), and lower income (OR = 1.51, 95% CI: 1.01, 2.25) were each associated with subsequent suicide attempts. Respondents endorsing these 4 financial-strain variables had 20 times higher predicted probability of attempting suicide compared with respondents endorsing none of these variables. Analyses yielded similar results examining suicidal ideation. Financial strain accumulated from multiple sources (debt, housing instability, unemployment, and low income) should be considered for optimal assessment, management, and prevention of suicide.
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Mouzon DM, Taylor RJ, Nguyen AW, Ifatunji MA, Chatters LM. Everyday Discrimination Typologies Among Older African Americans: Gender and Socioeconomic Status. J Gerontol B Psychol Sci Soc Sci 2020; 75:1951-1960. [PMID: 31294454 PMCID: PMC8060986 DOI: 10.1093/geronb/gbz088] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Discrimination is associated with several negative social, economic, and health consequences. Past research focuses on the impact of discrimination while less is known about both the type and correlates of discrimination, particularly among older adults. METHODS Using the National Survey of American Life, we used latent class analysis to identify discrimination typologies (frequency and type) among African Americans aged 55 and older. We then used multinomial logistic regression to identify demographic correlates of discrimination types, including a statistical interaction between gender and educational attainment. RESULTS We identified three discrimination typologies. Increasing age was associated with lower probability of belonging to the high discrimination and disrespect and condescension subtypes. Men and non-Southern residents were most likely to belong in the high discrimination subtype. Higher levels of education increased the probability of belonging in the high discrimination and disrespect and condescension subtypes for older men, but not women. DISCUSSION Older African American men, particularly those with more education, are vulnerable to both high-frequency discrimination and discrimination characterized by disrespect and condescension. This finding suggests that, for men with more years of education, increased exposure to discrimination reflects efforts to maintain social hierarchies (male target hypothesis).
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Affiliation(s)
- Dawne M Mouzon
- Edward J. Bloustein School of Planning and Public Policy, Rutgers, The State University of New Jersey, New Brunswick
| | - Robert Joseph Taylor
- School of Social Work, University of Michigan, Ann Arbor
- Institute for Social Research, Program for Research on Black Americans, University of Michigan, Ann Arbor
| | - Ann W Nguyen
- Jack, Joseph and Morton Mandel School of Applied Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Mosi Adesina Ifatunji
- Department of Sociology, Institute for African American Research and Carolina Population Center, University of North Carolina, Chapel Hill
| | - Linda M Chatters
- School of Social Work, University of Michigan, Ann Arbor
- Institute for Social Research, Program for Research on Black Americans, University of Michigan, Ann Arbor
- School of Public Health, University of Michigan, Ann Arbor
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26
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Boen C. Death by a Thousand Cuts: Stress Exposure and Black-White Disparities in Physiological Functioning in Late Life. J Gerontol B Psychol Sci Soc Sci 2020; 75:1937-1950. [PMID: 31127845 PMCID: PMC7566970 DOI: 10.1093/geronb/gbz068] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This paper investigates Black-White differences in stress-including diverse measures of chronic, acute, discrimination-related, and cumulative stress exposure-and examines whether race differences in these stress measures mediate Black-White disparities in C-reactive protein (CRP) and metabolic dysregulation in later life. METHODS Using data from the Health and Retirement Study (HRS) (2004-2012), this study uses stepwise ordinary least squares (OLS) regression models to examine the prospective associations between multiple stressors-including traumatic and stressful life events, financial strain, chronic stress, everyday and major life discrimination, and measures of cumulative stress burden-and CRP and metabolic dysregulation. Mediation analyses assessed the contribution of stress exposure to Black-White disparities in the outcomes. RESULTS Blacks experienced more stress than Whites across domains of stress, and stress exposure was strongly associated with CRP and metabolic dysregulation. Race differences in financial strain, everyday and major life discrimination, and cumulative stress burden mediated Black-White gaps in the outcomes, with measures of cumulative stress burden mediating the greatest proportion of the racial disparities. DISCUSSION The "thousand cuts" that Blacks experience from their cumulative stress exposure across domains of social life throughout the life course accelerate their physiological deterioration relative to Whites and play a critical role in racial health disparities at older ages.
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Affiliation(s)
- Courtney Boen
- Department of Sociology, Population Studies Center, and Population Aging Research Center, University of Pennsylvania, Philadelphia
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27
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Sengoelge M, Solberg Ø, Nissen A, Saboonchi F. Exploring Social and Financial Hardship, Mental Health Problems and the Role of Social Support in Asylum Seekers Using Structural Equation Modelling. Int J Environ Res Public Health 2020; 17:E6948. [PMID: 32977521 PMCID: PMC7579644 DOI: 10.3390/ijerph17196948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/16/2020] [Accepted: 09/18/2020] [Indexed: 11/16/2022]
Abstract
Asylum seekers are exposed to a range of social and financial difficulties suggested to adversely impact mental health. Uprooted social networks and living conditions during the asylum seeking process potentially predispose this population to low access to social support. The aim of this study was to examine the relationship between social and financial hardship and mental health problems, and assess the potential mediating role of social support among asylum seekers. Cross sectional survey data from a cohort of asylum seekers in Sweden (N = 455) were subjected to structural equation modelling for examining hypothesized pathways between social and financial hardship, common mental health problems (CMHPs) and social support. Fit indices showed adequate to excellent fit of the examined models with CMHPs as the outcome (all CFI ≥ 0.951, RMSEA < 0.05, SRMR < 0.056). CMHPs were positively regressed on social and financial hardship (B = 0.786, S = 0.102, p < 0.001) and negatively regressed on social support (B = -0.103, SE = 0.032, p = 0.001). Social support mediated the association between social and financial hardship and CMHPs (effect estimate = 0.075, 95% CI = 0.032-0.136). The results point to the importance of social and living conditions of asylum seekers and indicate that social support is both socially patterned and may act as a mitigating resource to inform interventions and policies.
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Affiliation(s)
- Mathilde Sengoelge
- Department of Health Sciences, Red Cross University College, 141 57 Huddinge, Sweden; (Ø.S.); (A.N.); (F.S.)
| | - Øivind Solberg
- Department of Health Sciences, Red Cross University College, 141 57 Huddinge, Sweden; (Ø.S.); (A.N.); (F.S.)
- Division for Implementation and Treatment Research, Norwegian Centre for Violence and Traumatic Stress Studies, 0484 Oslo, Norway
| | - Alexander Nissen
- Department of Health Sciences, Red Cross University College, 141 57 Huddinge, Sweden; (Ø.S.); (A.N.); (F.S.)
- Division for Implementation and Treatment Research, Norwegian Centre for Violence and Traumatic Stress Studies, 0484 Oslo, Norway
| | - Fredrik Saboonchi
- Department of Health Sciences, Red Cross University College, 141 57 Huddinge, Sweden; (Ø.S.); (A.N.); (F.S.)
- Division of Insurance Medicine, Department of Clinical Neuroscience, 171 77 Stockholm, Sweden
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28
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Abstract
Objective: The experience of cancer-related financial stress was examined within the developmental context of emerging adulthood.Methodological approach: This study is a secondary analysis of data drawn from two samples of testicular or hematologic cancer survivors. In-depth interviews from 52 emerging adult (EA) cancer survivors, ages 18-29, were coded by combining thematic analysis with an abductive approach.Findings: Emergent themes included some common to most age groups, including worries about medical costs and availability of health insurance, as well as specific age-related concerns, such as fertility preservation. Financial stress appeared to interrupt developmental tasks of emerging adulthood, including completing an education, establishing independence, and managing relationships. Surprisingly, financial stress was experienced as a benefit for some participants.Conclusion: Financial stress affects EA cancer survivors in unique ways. To provide support, health professionals should consider survivors' developmental life stage to understand their financial stress, and ultimately, to improve quality of life.
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Affiliation(s)
| | | | | | - Tracey A. Revenson
- The Graduate Center, City University of New York
- Hunter College, City University of New York
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29
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Hueniken K, Douglas CM, Jethwa AR, Mirshams M, Eng L, Hope A, Chepeha DB, Goldstein DP, Ringash J, Hansen A, Martino R, Li M, Liu G, Xu W, de Almeida JR. Measuring financial toxicity incurred after treatment of head and neck cancer: Development and validation of the Financial Index of Toxicity questionnaire. Cancer 2020; 126:4042-4050. [PMID: 32603521 DOI: 10.1002/cncr.33032] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/14/2020] [Accepted: 05/09/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND The treatment of head and neck cancer (HNC) may cause significant financial toxicity to patients. Herein, the authors have presented the development and validation of the Financial Index of Toxicity (FIT) instrument. METHODS Items were generated using literature review and were based on expert opinion. In item reduction, items with factor loadings of a magnitude <0.3 in exploratory factor analysis and inverse correlations (r < 0) in test-retest analysis were eliminated. Retained items constituted the FIT. Reliability tests included internal consistency (Cronbach α) and test-retest reliability (intraclass correlation). Validity was tested using the Spearman rho by comparing FIT scores with baseline income, posttreatment lost income, and the Financial Concerns subscale of the Social Difficulties Inventory. Responsiveness analysis compared change in income and change in FIT between 12 and 24 months. RESULTS A total of 14 items were generated and subsequently reduced to 9 items comprising 3 domains identified on exploratory factor analysis: financial stress, financial strain, and lost productivity. The FIT was administered to 430 patients with HNC at 12 to 24 months after treatment. Internal consistency was good (α = .77). Test-retest reliability was satisfactory (intraclass correlation, 0.70). Concurrent validation demonstrated mild to strong correlations between the FIT and Social Difficulties Inventory Money Matters subscale (Spearman rho, 0.26-0.61; P < .05). FIT scores were found to be inversely correlated with baseline household income (Spearman rho, -0.34; P < .001) and positively correlated with lost income (Spearman rho, 0.24; P < .001). Change in income was negatively correlated with change in FIT over time (Spearman rho, -0.25; P = .04). CONCLUSIONS The 9-item FIT demonstrated internal and test-retest reliability as well as concurrent and construct validity. Prospective testing in patients with HNC who were treated at other facilities is needed to further establish its responsiveness and generalizability.
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Affiliation(s)
- Katrina Hueniken
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Catriona M Douglas
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ashok R Jethwa
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Maryam Mirshams
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Lawson Eng
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Douglas B Chepeha
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Hansen
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Rosemary Martino
- Department of Speech-Language Pathology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Madeline Li
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Epidemiology, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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30
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Rangchian M, Nezami S, Jafari Seresht D, Larki-Harchegani A. Pharmacy students' level of financial literacy and its differences among students with various career intentions. Curr Pharm Teach Learn 2020; 12:671-679. [PMID: 32482269 DOI: 10.1016/j.cptl.2019.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 07/06/2019] [Accepted: 10/17/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Many pharmacy students will work at managerial positions after graduation, so policymakers' awareness from their level of financial literacy and intentions regarding their future career field and path might be helpful to identify existing gaps and needed interventions. The purpose of this study was to assess the level of financial literacy among pharmacy students and their intentions regarding career path and field. METHODS Data were gathered in early 2018 using a questionnaire which consisted of three parts: questions on financial literacy, career intentions, and participants' characteristics. Data analysis included descriptive analysis, comparison of the level of financial literacy and career intention among different demographic groups, as well as the comparison of the level of financial literacy among students preferring various career fields and paths. RESULTS A total of 173 usable questionnaires were gathered. Significant differences were observed in terms of the level of financial literacy between various groups of students' personal income, term of education, and history of receiving finance-related information from people around them. Students showed more weakness in responding to questions related to investment. It was also revealed that students with higher scores in financial literacy gave priority to fast entrance to the job market compared to other suggested career paths. CONCLUSIONS Although improvement in all aspects of financial literacy seem required for the studied population, more weakness was observed in terms of investment questions. Community pharmacy and rapid entrance to the work market were the preferred career field and path, respectively.
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Affiliation(s)
- Maryam Rangchian
- Hamadan University of Medical Sciences School of Pharmacy, Shahid Fahmideh Boulevard, Hamadan, Iran.
| | - Sara Nezami
- Hamadan University of Medical Sciences School of Pharmacy, Shahid Fahmideh Boulevard, Hamadan, Iran
| | - Davood Jafari Seresht
- Bu-Ali Sina University, Department of Economics, Shahid Fahmideh Boulevard, Hamedan, Iran
| | - Amir Larki-Harchegani
- Hamadan University of Medical Sciences School of Pharmacy, Shahid Fahmideh Boulevard, Hamadan, Iran
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31
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Schwab-Reese LM, Parker EA, Peek-Asa C. The Interaction of Dopamine Genes and Financial Stressors to Predict Adulthood Intimate Partner Violence Perpetration. J Interpers Violence 2020; 35:1251-1268. [PMID: 29294665 DOI: 10.1177/0886260517696841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Three dopamine genes (DAT1, DRD2, and DRD4) have been associated with interpersonal delinquency, aggression, and violence when individuals experience adverse environmental exposures. Guided by the catalyst model of aggression, risk alleles identified in previous studies were hypothesized to be associated with intimate partner violence (IPV) perpetration in the presence of financial stressors, a possible environmental trigger. This hypothesis was tested using weighted, clustered logistic regression with data from the National Longitudinal Study of Adolescent to Adult Health. The direct effects DAT1, DRD2, and DRD4 on IPV perpetration, and the interaction of DAT1, DRD2, and DRD4 and financial stressors on IPV perpetration were assessed. Due to cell size, only White men and women were included in this analysis. Increasing number of financial stressors was associated with increased odds of IPV perpetration, regardless of DAT1, DRD2, and DRD4 alleles. As predicted, increasing number of financial stressors was more strongly associated with IPV perpetration among individuals with high-risk DAT1 alleles, than individuals with low-risk alleles. However, this relationship was inverted for DRD2. Although there was still a significant interaction between DRD2 and financial stressors, individuals with low-risk alleles had higher odds of IPV perpetration in the presence of financial stressors. A similar, nonsignificant relationship was found for DRD4. These findings indicate that these genes may interact differently with environmental exposures and types of violent behavior. In addition, the findings may, if replicated, suggest dopamine plays a different role in IPV perpetration compared with other forms of aggression and violence.
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Meernik C, Kirchhoff AC, Anderson C, Edwards TP, Deal AM, Baggett CD, Kushi LH, Chao CR, Nichols HB. Material and psychological financial hardship related to employment disruption among female adolescent and young adult cancer survivors. Cancer 2020; 127:137-148. [PMID: 33043464 PMCID: PMC7736150 DOI: 10.1002/cncr.33190] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The importance of addressing adverse financial effects of cancer among adolescents and young adults (AYAs) is paramount as survival improves. In the current study, the authors examined whether cancer-related employment disruption was associated with financial hardship among female AYA cancer survivors in North Carolina and California. METHODS AYA cancer survivors identified through the North Carolina Central Cancer Registry and the Kaiser Permanente Northern/Southern California tumor registries responded to an online survey. Disrupted employment was defined as reducing hours, taking temporary leave, or stopping work completely because of cancer. Financial hardship was defined as material conditions or psychological distress related to cancer. Descriptive statistics and chi-square tests were used to characterize the invited sample and survey respondents. Marginal structural binomial regression models were used to estimate prevalence differences (PDs) and 95% confidence intervals (95% CIs). RESULTS Among 1328 women employed at the time of their diagnosis, women were a median age of 34 years at the time of diagnosis and 7 years from diagnosis at the time of the survey and approximately 32% experienced employment disruption. A substantial percentage reported financial hardship related to material conditions (27%) or psychological distress (50%). In adjusted analyses, women with disrupted employment had a 17% higher burden of material conditions (95% CI, 10%-23%) and an 8% higher burden of psychological distress (95% CI, 1%-16%) compared with those without disruption. CONCLUSIONS Financial hardship related to employment disruption among female AYA cancer survivors can be substantial. Interventions to promote job maintenance and transition back to the workforce after treatment, as well as improved workplace accommodations and benefits, present an opportunity to improve cancer survivorship.
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Affiliation(s)
- Clare Meernik
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health
| | - Anne C Kirchhoff
- University of Utah Health, Huntsman Cancer Institute
- Huntsman Cancer Institute, Department of Pediatrics, University of Utah
| | | | - Teresa P Edwards
- University of North Carolina at Chapel Hill, H.W. Odum Institute for Research in Social Science
| | - Allison M Deal
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center
| | | | | | | | - Hazel B Nichols
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health
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