Assessing Measurement Properties of Two Single-item General Health Measures

Self-rated health and risk of incident cardiovascular events among individuals with hypertension

BACKGROUND

The relationship between self-rated health (SRH) and cardiovascular events in individuals with hypertension, but without diabetes mellitus, is understudied.

METHODS

We performed a post hoc analysis of data from SPRINT (Systolic Blood Pressure Intervention Trial). SRH was categorized into excellent, very good, good and fair/poor. Using multivariable Cox regression, we estimated hazard ratios and 95% confidence intervals (CIs) for the association of SRH with both all-cause mortality and a composite of cardiovascular events (the primary outcome), which was defined to include myocardial infarction (MI), other acute coronary syndromes, stroke, acute decompensated heart failure, and cardiovascular death.

RESULTS

We included 9319 SPRINT participants (aged 67.9 ± 9 years, 35.6% women) with a median follow-up of 3.8 years. Compared with SRH of excellent, the risk [hazard ratio (95% CI)] of the primary outcome associated with very good, good, and fair/poor SRH was 1.11(0.78-1.56), 1.45 (1.03-2.05), and 1.87(1.28-2.75), respectively. Similarly, compared with SRH of excellent, the risk of all-cause mortality [hazard ratio (95% CI)] associated with very good, good, and fair/poor SRH was 1.13 (0.73-1.76), 1.72 (1.12-2.64), and 2.11 (1.32-3.38), respectively. Less favorable SRH (LF-SRH) was also associated with a higher risk of each component of the primary outcome and serious adverse events (SAE).

CONCLUSION

Among individuals with hypertension, SRH is independently associated with the risk of incident cardiovascular events, all-cause mortality, and SAE. Our study suggest that guidelines should consider the potential significance of including SRH in the clinical history of patients with hypertension.

Associations between sickness behavior, but not inflammatory cytokines, and psychiatric comorbidity in chronic pain

OBJECTIVES

Approximately one in five adults experiences chronic pain, often in co-occurrence with depression, insomnia, anxiety, and lower self-rated health. Elevated levels of cytokines, e.g. tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), interleukin 8 (IL-8), and interleukin 10 (IL-10), have been identified in patients with chronic pain. Depression, insufficient sleep, poor self-rated health, and pain intensity have also been associated with inflammatory biomarkers. This study aimed to investigate the interrelationships between inflammatory biomarkers and depression, insomnia, anxiety, self-rated health, sickness behavior, and pain intensity in patients with chronic pain.

METHODS

Self-report questionnaires and blood samples analyzed for plasma levels of inflammatory biomarkers were collected from 80 adult patients with chronic pain. Associations between inflammatory biomarkers (TNF-α, IL-6, IL-8, IL-10, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)) and depression, insomnia, anxiety, self-rated health, sickness behavior, and pain intensity, were analyzed using bivariate Spearman rank correlation coefficients and regression analyses.

RESULTS

Participants were mainly women (72.5 %), with a mean age of 50.8 years, and a reported mean pain duration of 16.7 years. There were significant correlations between insomnia and CRP (rs =.26, p <.05); sex and ESR (rs =.29, p <.05); age and IL-6 (rs =.29, p <.05) and IL-8 (rs =.30, p <.05); BMI and IL-6 (rs =.50, p <.001), CRP (rs =.63, p <.001) and ESR (rs =.42, p <.001). Ratings of depression were positively and significantly related to ratings of sickness behavior and anxiety (β =.32 and β =.40, respectively), explaining 49 % of the total variance in depression ratings. Insomnia was positively and significantly related to sickness behavior (β =.37) explaining 31 % of the total variance in insomnia ratings. Inflammatory biomarkers, however, did not contribute significantly to the models.

CONCLUSIONS

Participants reported high levels of symptoms, yet the associations between these ratings and the inflammatory biomarkers were either absent or weak. Also, despite high levels of self-reported sickness behavior, overall the inflammatory status remained within the normal range. Ratings of sickness behavior contributed more than inflammatory markers in explaining ratings of depression and insomnia. The present results point to the complexity of chronic pain, and the challenges of identifying biomarkers that explain symptomatology.

Pandemic Loneliness in Healthcare Workers. Does It Predict Later Psychological Distress?

Increased loneliness associated with the COVID-19 pandemic has been widely reported, with healthcare workers at increased risk compared to the general population. Pre-pandemic research indicates that loneliness has long-term detrimental effects on mental well-being, but the effect of loneliness in the context of COVID-19 is not clear. We conducted an online survey of healthcare workers (HCWs) at a large teaching hospital in Sydney, Australia after the peak of the first wave of the pandemic in 2020. Over one-third experienced loneliness at the peak of the first wave. An observed association with high psychological distress in subsequent months was attenuated after adjusting for status of mental well-being during the peak and before the pandemic. Mental well-being during the peak of the pandemic and, to a lesser extent, mental well-being before the pandemic were the strongest predictors of later distress. Increased conflict at home was also predictive of later distress. The mental health of HCWs is an important consideration at any time and is especially so in the face of crises such as the current global pandemic. Strategies to enhance baseline mental well-being and bolster well-being during crisis situations should assist HCWs cope with unexpected stressors and reduce the associated detrimental psychological consequences.

Verbal and pictorial single-item scales are as good as their 10-item counterparts for measuring perceived usability

Single-item scales of perceived usability are attractive due to their efficiency and non-verbal scales are attractive because they enable collecting data from individuals irrespective of their language proficiency. We tested experimentally whether single-item verbal and pictorial scales can compete with their 10-item counterparts at reflecting the difference in usability between well-designed and poorly designed systems. N = 1079 (Experiment 1) and N = 1092 (Experiment 2) participants worked with two systems whose usability was experimentally manipulated. Perceived usability was assessed using the 10-item System Usability Scale, the single-item Adjective Rating Scale, the 10-item Pictorial System Usability Scale and the Pictorial Single-Item Usability Scale. The single-item scales reflect the difference in usability as good as their 10-item counterparts. The pictorial scales are nearly as valid as their verbal counterparts. The single-item Adjective Rating Scale and the Pictorial Single-Item Usability Scale are thus efficient and valid alternatives to their 10-item counterparts.

Use and perceived effectiveness of non-pharmacological home remedies for digestive symptoms: a questionnaire-based survey among primary care patients

BACKGROUND

Patients frequently visit their primary care physician (PCP) for digestive symptoms. We aimed to compile a list of non-pharmacological home remedies (NPHRs) that patients frequently use and find effective so that PCPs can then propose them to their patients with various digestive symptoms.

METHODS

In this questionnaire-based survey on the use and perceived effectiveness of NPHRs for digestive symptoms, 50 randomly selected Swiss or French PCPs consecutively recruited 20-25 patients between March 2020 and July 2021. These patients were given a list of 53 NPHRs previously developed by our research team. They were asked whether they used them (Y/N) and whether they considered them to be ineffective, not very effective, moderately effective, or very effective in treating abdominal pain (14 NPHRs), bloating (2), constipation (5), diarrhoea (10), digestion trouble (12), nausea/vomiting (2) and stomach pain (8). We considered NPHRs to be perceived as effective if patients reported that they were moderately or very effective.

RESULTS

A total of 1,012 patients agreed to participate in the study (participation rate = 84.5%, median age = 52 years, women = 61%). The two most frequently used NPHRs were rice cooking water for diarrhoea (29% of patients) and prunes for constipation (22%). The perceived effectiveness of the NPHRs ranged from 82% (fennel infusions for abdominal pain) to 95% (bicarbonate for stomach pain).

CONCLUSION

Our data could be useful to PCPs interested in proposing NPHRs to their patients suffering from digestive disorders, and more generally to all PCPs interested in learning more about patients' use of NPHRs in primary care.

The impact of safety behavior, perceived risk, and workplace resources on COVID outcomes for U.S. Aircraft Rescue and Firefighting personnel

BACKGROUND

Aircraft rescue and firefighting (ARFF) personnel are first responders located at airports in the United States who provide emergency response, mitigation, evacuation, and rescue of passengers and crew of aircraft at airports. The nature of their work puts ARFF personnel in close contact with travelers on a regular basis and at elevated risk for COVID-19 exposure.

OBJECTIVE

In this study, we focused on safety behavior, perceived risk, and workplace resources to understand COVID-19 outcomes in the early pandemic among the overlooked worker population of ARFF personnel. The goal of this study was to examine how a self-reported positive COVID test were associated with safety behavior, perceived risk, and workplace resources.

METHODS

Cross-sectional survey data were collected among ARFF personnel a year into the COVID-19 pandemic.

RESULTS

Regression results showed that each additional unit increase in perceived susceptibility to COVID-19 was associated with a 133% increase in the odds of testing positive for COVID-19 (OR = 2.33, p <  0.05), and with each additional unit increase in perceived severity level, the odds of getting COVID-19 decreased by 47% (OR = 0.53, p <  0.05).

CONCLUSIONS

Infection control among first responders may be improved by providing relevant information physical and emotional resources, and support that help shape perceptions of risk and adoption of prevention behaviors.

Moving beyond Likert and Traditional Forced-Choice Scales: A Comprehensive Investigation of the Graded Forced-Choice Format

The graded forced-choice (FC) format has recently emerged as an alternative that may preserve the advantages and overcome the issues of the dichotomous FC measures. The current study presented the first large-scale evaluation of the performance of three types of FC measures (FC2, FC4 and FC5 with 2, 4 and 5 response options, respectively) and compared their performance to their Likert (LK) counterparts (LK2, LK4, and LK5) on (1) psychometric properties, (2) respondent reactions, and (3) susceptibility to response styles. Results showed that, compared to LK measures with the same number of response options, the three FC scales provided better support for the hypothesized factor structure, were perceived as more faking-resistant and cognitive demanding, and were less susceptible to response styles. FC4/5 and LK4/5 demonstrated similarly good reliability, while LK2 provided more reliable scores than FC2. When compared across the three FC measures, FC4 and FC5 displayed comparable psychometric performance and respondent reactions. FC4 exhibited a moderate presence of extreme response style, while FC5 had a weak presence of both extreme and middle response styles. Based on these findings, the study recommends the use of graded FC over dichotomous FC and LK, particularly FC5 when extreme response style is a concern.

An mHealth Intervention Promoting Physical Activity and Healthy Eating in a Family Setting (SMARTFAMILY): Randomized Controlled Trial

BACKGROUND

Numerous smartphone apps are targeting physical activity (PA) and healthy eating (HE), but empirical evidence on their effectiveness for the initialization and maintenance of behavior change, especially in children and adolescents, is still limited. Social settings influence individual behavior; therefore, core settings such as the family need to be considered when designing mobile health (mHealth) apps.

OBJECTIVE

The purpose of this study was to evaluate the effectiveness of a theory- and evidence-based mHealth intervention (called SMARTFAMILY [SF]) targeting PA and HE in a collective family-based setting.

METHODS

A smartphone app based on behavior change theories and techniques was developed, implemented, and evaluated with a cluster randomized controlled trial in a collective family setting. Baseline (t0) and postintervention (t1) measurements included PA (self-reported and accelerometry) and HE measurements (self-reported fruit and vegetable intake) as primary outcomes. Secondary outcomes (self-reported) were intrinsic motivation, behavior-specific self-efficacy, and the family health climate. Between t0 and t1, families of the intervention group (IG) used the SF app individually and collaboratively for 3 consecutive weeks, whereas families in the control group (CG) received no treatment. Four weeks following t1, a follow-up assessment (t2) was completed by participants, consisting of all questionnaire items to assess the stability of the intervention effects. Multilevel analyses were implemented in R (R Foundation for Statistical Computing) to acknowledge the hierarchical structure of persons (level 1) clustered in families (level 2).

RESULTS

Overall, 48 families (CG: n=22, 46%, with 68 participants and IG: n=26, 54%, with 88 participants) were recruited for the study. Two families (CG: n=1, 2%, with 4 participants and IG: n=1, 2%, with 4 participants) chose to drop out of the study owing to personal reasons before t0. Overall, no evidence for meaningful and statistically significant increases in PA and HE levels of the intervention were observed in our physically active study participants (all P>.30).

CONCLUSIONS

Despite incorporating behavior change techniques rooted in family life and psychological theories, the SF intervention did not yield significant increases in PA and HE levels among the participants. The results of the study were mainly limited by the physically active participants and the large age range of children and adolescents. Enhancing intervention effectiveness may involve incorporating health literacy, just-in-time adaptive interventions, and more advanced features in future app development. Further research is needed to better understand intervention engagement and tailor mHealth interventions to individuals for enhanced effectiveness in primary prevention efforts.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00010415; https://drks.de/search/en/trial/DRKS00010415.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/20534.

[On the Potential of Prevention Counselors in the Primary Care Setting: Evaluation Study of an Intervention in the State of Brandenburg (Germany)]

PURPOSE OF THE STUDY

The study investigates the extent to which medical assistants can support primary prevention measures in family practices as prevention advisors.

METHODS

Between July 2019 and December 2020, preventive measures were implemented by trained prevention counselors in general practitioners' practices in a rural region in Brandenburg. They consisted of longer-term support for individuals in lifestyle changes in the areas of "nutrition", "exercise" and "relaxation". The accompanying process and outcome evaluation included pre-post comparisons of selected medical parameters as well as the investigation of possible changes in health literacy and health-related quality of life using standardized questionnaires (HeiQ-Core, SF-12v2). Furthermore, thematic analyses of training documents, participant surveys using a questionnaire, two focus groups with prevention counselors, and five interviews with study participants were conducted.

RESULTS

Four primary care practices and two health care facilities were recruited and seven health care workers were trained as prevention counselors. Thirty-eight individuals were enrolled in the prevention program. Although overall counseling sessions were conducted according to training specifications, various individual as well as structural barriers ensured low uptake of the intervention.

CONCLUSIONS

The extent to which preventive measures adapted to the individual can be successfully established in primary care practices with the help of health care workers trained as prevention counselors depends strongly on the respective practice structures as well as the patient clientele. Temporal integration and coordination of the activities of prevention advisors in the daily practice routine seems to be likely to lead to success in interventions of the kind evaluated here.

Why is concealment associated with health and wellbeing? An investigation of potential mechanisms

RATIONALE

Many members of stigmatized groups face health and wellbeing deficits relative to their non-stigmatized peers. Ample evidence suggests that one method used by some members of stigmatized groups to manage the stigma they face-concealing their stigmatized identities-may contribute to these health and wellbeing disparities. However, precisely why concealment may contribute to these disparities is less clear.

OBJECTIVE

The present work seeks to identify and distinguish between plausible explanations for why concealment may contribute to worse health and wellbeing.

METHODS

In the present work, we explore a large number of plausible mechanisms that may explain why concealment is associated with worse health and wellbeing. In three studies (N = 2304) using cross-sectional (Studies 1 and 2) and longitudinal (Study 3) methods, participants were recruited from an online recruitment pool (Studies 1-3) and from an institutional recruitment pool (Study 2). Participants reported on their concealment, health and wellbeing, and constructs related to plausible explanations for the relationships between concealment and health and wellbeing.

RESULTS

We find that concealment is associated with worse health and wellbeing, with generally small effect sizes. We further find that lower feelings of belonging, less social support, and lower self-esteem are the most plausible mechanisms for explaining why concealment is associated with worse health and wellbeing. When between- and within-subjects effects were distinguishable (i.e., Study 3), we observed only between-subjects relationships.

CONCLUSION

Because people's choices to engage in self-protection through concealment should be respected, potential avenues for intervention to reduce minority health disparities may be more appropriately targeted at the mechanisms that account for why concealment may undermine health and wellbeing than at concealment itself. The present work makes strides towards identifying those mechanisms and thus towards addressing them.

Causal Assessment of Income Inequality on Self-Rated Health and All-Cause Mortality: A Systematic Review and Meta-Analysis

Policy Points Income is thought to impact a broad range of health outcomes. However, whether income inequality (how unequal the distribution of income is in a population) has an additional impact on health is extensively debated. Studies that use multilevel data, which have recently increased in popularity, are necessary to separate the contextual effects of income inequality on health from the effects of individual income on health. Our systematic review found only small associations between income inequality and poor self-rated health and all-cause mortality. The available evidence does not suggest causality, although it remains methodologically flawed and limited, with very few studies using natural experimental approaches or examining income inequality at the national level.

CONTEXT

Whether income inequality has a direct effect on health or is only associated because of the effect of individual income has long been debated. We aimed to understand the association between income inequality and self-rated health (SRH) and all-cause mortality (mortality) and assess if these relationships are likely to be causal.

METHODS

We searched Medline, ISI Web of Science, Embase, and EconLit (PROSPERO: CRD42021252791) for studies considering income inequality and SRH or mortality using multilevel data and adjusting for individual-level socioeconomic position. We calculated pooled odds ratios (ORs) for poor SRH and relative risk ratios (RRs) for mortality from random-effects meta-analyses. We critically appraised included studies using the Risk of Bias in Nonrandomized Studies - of Interventions tool. We assessed certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework and causality using Bradford Hill (BH) viewpoints.

FINDINGS

The primary meta-analyses included 2,916,576 participants in 38 cross-sectional studies assessing SRH and 10,727,470 participants in 14 cohort studies of mortality. Per 0.05-unit increase in the Gini coefficient, a measure of income inequality, the ORs and RRs (95% confidence intervals) for SRH and mortality were 1.06 (1.03-1.08) and 1.02 (1.00-1.04), respectively. A total of 63.2% of SRH and 50.0% of mortality studies were at serious risk of bias (RoB), resulting in very low and low certainty ratings, respectively. For SRH and mortality, we did not identify relevant evidence to assess the specificity or, for SRH only, the experiment BH viewpoints; evidence for strength of association and dose-response gradient was inconclusive because of the high RoB; we found evidence in support of temporality and plausibility.

CONCLUSIONS

Increased income inequality is only marginally associated with SRH and mortality, but the current evidence base is too methodologically limited to support a causal relationship. To address the gaps we identified, future research should focus on income inequality measured at the national level and addressing confounding with natural experiment approaches.

Determining the Right Levels of Health Coaching and Heart Rate Variability Biofeedback in a Workplace Behavior Change Intervention: Multiphase Optimization Strategy Preparation Study

BACKGROUND

Work-related stress is associated with poor job performance and negative health outcomes. Changing health behaviors through corporate wellness programs can improve physical and mental health and help employees manage stress. This project sought to pilot the potential addition of brief coaching and biofeedback to an 8-week web-based self-help program to improve employee stress using the multiphase optimization strategy.

OBJECTIVE

This study aims to determine which candidate components will be tested in a later optimization phase and at what dose they will be tested, examine the feasibility and acceptability of delivering the different components, investigate whether the outcomes can be feasibly measured, and review evidence to build a conceptual model before the optimization phase.

METHODS

The study was positioned within the preparation phase of the multiphase optimization strategy. It is a 2×2×2×2 design with 4 components: 2 types of health coaching and 2 types of biofeedback. All components were tested by turning them on or off. A total of 16 adult office workers (mean age 40, SD 14.3 years; n=15 women) completed an 8-week self-paced web-based stress management and health behavior change program and were randomly assigned to 1 of the 16 conditions, created from a combination of the 4 candidate components. Assessments included web analytics, surveys, and interviews regarding program recommendations, likes, and dislikes.

RESULTS

Findings from the interviews provided suggestions to improve the intervention (eg, separating wellness from stress content) and trial conduct (eg, streamlining the onboarding process). On average, participants logged into the wellness program 83 times (range 36-291), with 75% (12/16) participant retention and 67% (8/12) survey completion. There were no reported problems with coaching or obtaining data from interviews or apps. The interview findings suggested potential mediators to include and assess in a future conceptual model.

CONCLUSIONS

The results provided areas to improve the intervention content and trial methods. Instead of progressing to the next scheduled large-scale optimization phase, our plan to iterate through a second preparation phase after making changes to the protocol, apps, and corporate coaching partner.

Poor health disparities among racialized students in a Canadian university

OBJECTIVE

The short report aims to examine differences in self-rated general health across racialized post-secondary students at a university in Ontario, Canada.

METHODS

Binary logistic regression analysis was used to examine poor health as an outcome among racialized students as whole, as well as across Asian, South Asian, Afro-Caribbean and Middle Eastern student groups in comparison to white Caucasian post-secondary students.

RESULTS

After adjusting for several covariates, racialized students as a whole had 2.43 times the odds of reporting poor general health compared to white Caucasian students. Asian (OR = 2.77; CI = 1.84-4.18; p < 0.05) and South Asian (OR = 2.52; CI = 1.56-4.08; p < 0.05) students were significantly more likely to report poor health compared to white Caucasian students.

CONCLUSION

The findings call for further attention to the health needs of racialized post-secondary students living in Canada and creating campuses where diverse student populations feel safe and systemically included.

Alternative combusted tobacco product and multiple tobacco product use among individuals with serious mental illness enrolled in a large pragmatic randomized controlled trial

OBJECTIVE

Use of combustible alternative tobacco products (ATPs; e.g., little cigars, loose tobacco, multiple tobacco product types [TPTs]) is increasingly common. Inexpensive, combusted ATPs (e.g little cigars) are predominantly marketed to lower-income communities. Prevalence of combusted ATP use among those with serious mental illness (SMI) is unknown.

METHODS

We examined rates and correlates of combusted ATP use and association with tobacco abstinence in a secondary analysis of a single-cohort (N = 1007) trial of tobacco-smoking adults with SMI and severe SMI-related functional impairment. The parent study aimed to test a community-health worker-delivered intervention for promoting smoking cessation among adults with SMI. Participants were surveyed at baseline on demographic and smoking characteristics including combusted TPT (cigarettes, cigars/little cigars, loose tobacco), and breath carbon-monoxide (CO). CO-verified 7-day point-prevalence tobacco abstinence was assessed at Year 2.

RESULTS

At baseline, 59% of participants reported using cigarettes only, 25% multiple (>1) combusted TPTs, 12% cigars/little cigars only, and 4% loose tobacco (e.g., "rollies", pipes) only. Those reporting any ATP use at baseline had higher expired CO concentration and reported using more tobacco products per day than exclusive cigarette users (p's < 0.05). ATP use was not associated with abstinence in adjusted logistic regression models (p's > 0.05).

CONCLUSIONS

Use of ATPs was associated with use of more tobacco products per day and greater tobacco toxicant exposure than exclusive cigarette use in this population. Future policy efforts work to change preferential taxation policies (e.g., lower taxation for cigar products) and disproportionate marketing of ATPs to lower-income communities.

Almost 2 years into the COVID-19 pandemic: an update on parental stress, parent mental health, and the occurrence of child maltreatment

Increased parental stress, poorer mental health, and an increase in the occurrence of child maltreatment (CM) have been reported in earlier phases of the COVID-19 pandemic. However, data from later phases of the pandemic are not yet available. We conducted a cross-sectional, representative survey among 1087 parents (48.8% female; mean age 41.72 years, SD = 9.15) in Germany in December 2021. Data were compared to a previous representative sample, assessed in August 2020 (N = 1024), and to normative scores of the outcome measures. Predictors for the occurrence of CM were analyzed by logistic regression. Pandemic-related stress and general stress were higher and physical and mental health were poorer in the December 2021 sample than in the August 2020 sample. Occurrence rates of CM varied between 5 and 56%. Verbal emotional abuse (n = 607, 56%), witnessing domestic violence (n = 446, 41%), and emotional neglect (n = 435, 40%) were most frequently reported. For these subtypes, parental risk for alcohol abuse (OR 2.1-2.7) and parental recent experience of violence (OR 2.1-5.1) were the strongest predictors. Across all subtypes of CM, parents reporting child maltreatment showed poorer scores on all stress outcomes, with medium-large-effect sizes. Results confirm a high burden within the families, almost 2 years into the pandemic. Occurrence rates of a broad spectrum of CM subtypes raise further concerns for the well-being of children. Family-oriented intervention efforts are needed to stabilize families and provide targeted support. Longitudinal studies are needed for a description of families at risk for poorer outcomes.

Development and Validation of the Single-Item Mindfulness Scale (SIMS)

Mindfulness is a focused attention to and acceptance of present experiences. Although several reliable and valid multi-item measures of trait mindfulness exist, researchers may sometimes want a short and quick measure of mindfulness. In this project, we developed and validated the Single-Item Mindfulness Scale (SIMS) to assess trait mindfulness. We conducted eight studies involving 3,125 adult and adolescent participants. The studies consisted of cross-sectional, short longitudinal, and daily diary designs. We first developed the wording of the SIMS in Studies 1 and 2 and then examined the validity and reliability in Studies 3-8. The SIMS was found to be reliable and valid. It correlated with several multi-item measures of mindfulness at effect sizes in the medium to large range. It also correlated in expected ways with variables known to be related to existing multi-item measures of mindfulness such as self-compassion, anxiety, negative affect, positive affect, depression, neuroticism, empathy, prosocial behavior, and self-consciousness. Furthermore, it correlated positively with daily reports of mindfulness in a two-week diary study. Although existing multi-item trait mindfulness scales should be used, when possible, the SIMS is recommended in situations when time, question quantity, or researcher focus is constrained.

A Longitudinal Test of the Conservative-Liberal Well-Being Gap

In this article, we test if conservatism predicts psychological well-being longitudinally. We based the study on previous findings showing that conservatives score higher on different measures of well-being, such as life satisfaction and happiness. Most explanations in the literature have assumed that conservatism antecedes well-being without considering the alternative-that well-being may predict conservatism. In Study 1, using multilevel cross-lagged panel models with a two-wave longitudinal sample consisting of data from 19 countries (N = 8,740), we found that conservatism did not predict well-being over time. We found similar results in Study 2 (N = 2,554), using random-intercept cross-lagged panel models with a four-wave longitudinal sample from Chile. We discuss the main implications of these results for the literature examining the association between conservatism and well-being.

With a little help from my friends: adopting a P-E fit perspective in understanding the value of organizational learning climate for sustainable employability

Purpose

The objective of our study was to investigate how organizational learning climate (measured as developmental opportunities and team support for learning), career commitment, and age are related to employees' self-perceived employability, vitality and work ability (e.g., their sustainable employability). Our study adopted a P-E fit perspective building upon the notion that sustainable employability is a function of both the person (P) and the environment (E) and tests a three-way interaction between organizational learning climate, career commitment, and age.

Design

In total, 211 members of the support staff of a Dutch university completed a survey. Hierarchical stepwise regression analysis was used to analyze the data.

Findings

Only one of the two dimensions of organizational learning climate that we measured, namely the developmental opportunities, appeared to be associated with all indicators of sustainable employability. Career commitment only had a direct positive relationship with vitality. Age was negatively related to self-perceived employability and to work ability, but not to vitality. The relationship between developmental opportunities and vitality was negatively influenced by career commitment (a negative two-way interaction effect), while a positive three-way interaction effect was found between career commitment, age, and development opportunities, and with self-perceived employability as the outcome.

Theoretical and practical implications

Our findings confirmed the relevance of adopting a P-E fit perspective on sustainable employability, and of considering the possible role of age in this. It requires more detailed analyses in future research to unravel the role of age in the shared responsibility for sustainable employability. In practice, the results of our study imply that organizations should provide all employees with a working context that facilitates learning, however, with a special focus on older employees, for whom it is a particular challenge to protect their sustainable employability, possibly due to age-related stereotyping.

Originality

Our study adopted a P-E fit perspective on sustainable employability and examined the association between organizational learning climate and all three components of sustainable employability: self-perceived employability, vitality and work ability. Moreover, it investigated whether and how the employee's career commitment and age influence this relationship.

Trajectories of self-rated health among community-dwelling individuals with depressive symptoms: A latent class growth analysis

BACKGROUND

This study identified differences between individuals with and without depression regarding demographic and socioeconomic variables, health behavior, health status, health care utilization, and self-rated health (SRH) to identify the depressed group's SRH trajectories.

METHODS

Data of individuals with (n = 589) and without (n = 6856) depression aged ≥20 from the 2013-2017 Korean Health Panel were analyzed. A chi-square test and t-tests examined differences in demographic and socioeconomic variables, health behaviors, health status, health care utilization, and the mean of SRH. Latent Growth Curve and Latent Class Growth Modeling identified SRH development trajectories and the most suitable latent classes explaining the trajectories, respectively. Multinomial logistic regression determined the predicting factors that classified latent classes.

RESULTS

The depressed group had a lower mean SRH than the non-depressed group among most variables. Three latent classes were identified, each showing different SRH trajectories. Body-mass index and pain/discomfort were predicting factors for the "poor" classes compared with the "moderate-stable" class; older age, less national health insurance, less physical activity, more pain/discomfort, and more hospitalization were predictors for the "poor-stable" class. The depressed group's mean SRH was "poor."

LIMITATIONS

Latent Class Growth Modeling in individuals with depression was based on experimental data; however, it needed to review other sample data to identify similar types of latent classes to those suggested in the current study.

CONCLUSIONS

Predictors of the "poor-stable" class that were identified in this study can contribute to the formulation of intervention plans for the health and welfare of individuals with depression.

Developing a Single-Item General Self-Efficacy Scale: An Initial Study

General self-efficacy represents the global sense of personal capability across various situations and tasks. The aim of the present study was to develop and validate a single-item general self-efficacy scale which balances practical demands and psychometric concerns. The psychometric properties of the proposed Single-Item General Self-Efficacy Scale (GSE-SI) were examined among 231 Singaporean adults. Results based on three statistical methods demonstrated good reliability (.594 .607 and .726, respectively, M = .642), as compared with the reliability scores from other single-item scales. It also showed satisfactory criterion-related validity evidence (i.e., correlation with a multiple-item general self-efficacy scale, r = .795). Validity evidence based on relationships with other constructs was supported by the correlations between the scores of general self-efficacy and the scores of six relevant constructs (i.e., positive correlations with life satisfaction and positive emotions, negative correlations with negative emotions, task and perceived stress, and illness symptoms). More importantly, the GSE-SI and multiple-item scale scores showed consistent correlation patterns with their relevant constructs. Both GSE-SI and multiple-item scale scores significantly discriminated between the three clusters in a similar pattern. The present results show that the GSE-SI is a reliable and valid measure of general self-efficacy and can be recommended in future research to complement the constraints of multiple-item scales.

Adherence to social distancing during the Covid-19 pandemic in Italy: The role of autonomous motivation and defiance

To maintain social distancing in the long term, in the current COVID-19 scenario, people's motivation must be strong and of high quality. Many governments adopted measures enforcing social distancing. Enforcement, however, can produce feelings of defiance and backfiring effects. The present work aims at investigating the relationship between autonomous motivation and intentions to maintain social distancing, through adherence to recommendations and feelings of defiance. A sample of 502 Italian residents, from different parts of Italy, completed an online survey assessing their present behavior, levels of autonomous motivation and feelings of defiance, as well as intentions to observe social distancing in the short and long term. Results support the hypotheses that autonomous motivation is related to stronger intentions to maintain social distancing, particularly in the long term, and that feelings of defiance mediate this relationship. These results underline importance of promoting understanding and internalizing reasons for social distancing, beyond norms.

Low-voltage electrical accidents, immediate reactions and acute health care associated with self-reported general health 4 years later

BACKGROUND AND AIMS

Electricians frequently experience low-voltage electrical accidents. Some such accidents involve long-term negative health consequences. Early identification of victims at risk for long-term injury may improve acute medical treatment and long-term follow-up. This study aimed to determine acute exposure, health effects and treatment associated with general health ≥ 2 years after low-voltage electrical accidents.

METHODS

In a cross-sectional study, 89 male electricians who had experienced an electrical accident between 1994 and 2001 participated in a 2003 follow-up health examination. They were identified from a registry of low-voltage electrical accidents and included in the study. Based on exposure descriptions in the original accident reports, they were stratified into the following three groups: a current arc accident group (N = 34, mean age 38.8 years [standard deviation, SD = 12.2, range = 21-59]) and two groups with the passage of current through the body, either fixed to the current source ("no-let-go" group; N = 35, mean age 34.0 years [SD = 10.5, range = 21-57]) or not ("let-go" group; N = 20, mean age = 38.7 years [SD = 10.3, range = 21-63]). They retrospectively described acute reactions and assessed their current general health at the health examination. Multivariate linear regression, ordinal logistic regression and Fisher's exact test were used to compare acute reactions with health at follow-up in each exposure group.

RESULTS

The multivariate analysis indicated that after accidents with the passage of current through the body, severe acute headache (β = - 0.56, p = 0.013), years since the accident (β = - 0.16, p = 0.017) and the accident being perceived as frightening (β = - 0.48, p = 0.040) were negatively associated with general health ≥ 2 years later (R² = 0.25, p = 0.002). If the exposure included a no-let-go experience, then acute severe body numbness (β = - 0.53, p = 0.029) was also negatively associated with general health (R² = 0.38, p = 0.002). Without such experience, only acute confusion (β = - 0.90, p = 0.029) was negatively associated with the health at follow-up (R² = 0.24, p = 0.029). In univariate analyses, after the passage of current through the body, acute dizziness (p = 0.029), apathy (p = 0.028), confusion (p = 0.007) and irregular heartbeat (p ≤ 0.05) were associated with poor long-term general health. The no-let-go group, more often than the let-go group, reported panic (p = 0.001), fear of death (p = 0.029), confusion (p = 0.014), exhaustion (p = 0.009), bodily numbness (p = 0.013) and immediate unconsciousness (p = 0.019). Acute symptoms beyond the first day after a current arc accident were associated with poor long-term general health (p = 0.015).

DISCUSSION AND CONCLUSIONS

The acute reactions negatively associated with general health ≥ 2 years after low-voltage electrical accidents should alert the clinician in the acute phase after an electrical accident to the risk of developing negative long-term health effects. Future studies should specify long-term health beyond the concept of general health.

Associations between Poorer Mental Health with Work-Related Effort, Reward, and Overcommitment among a Sample of Formal US Solid Waste Workers during the COVID-19 Pandemic

Background

Effort-reward imbalance (ERI) and overcommitment at work have been associated poorer mental health. However, nonlinear and nonadditive effects have not been investigated previously.

Methods

The association between effort, reward, and overcommitment with odds of poorer mental health was examined among a sample of 68 formal United States waste workers (87% male). Traditional, logistic regression and Bayesian Kernel machine regression (BKMR) modeling was conducted. Models controlled for age, education level, race, gender, union status, and physical health status.

Results

The traditional, logistic regression found only overcommitment was significantly associated with poorer mental health (IQR increase: OR = 6.7; 95% CI: 1.7 to 25.5) when controlling for effort and reward (or ERI alone). Results from the BKMR showed that a simultaneous IQR increase in higher effort, lower reward, and higher overcommitment was associated with 6.6 (95% CI: 1.7 to 33.4) times significantly higher odds of poorer mental health. An IQR increase in overcommitment was associated with 5.6 (95% CI: 1.6 to 24.9) times significantly higher odds of poorer mental health when controlling for effort and reward. Higher effort and lower reward at work may not always be associated with poorer mental health but rather they may have an inverse, U-shaped relationship with mental health. No interaction between effort, reward, or overcommitment was observed.

Conclusion

When taking into the consideration the relationship between effort, reward, and overcommitment, overcommitment may be most indicative of poorer mental health. Organizations should assess their workers' perceptions of overcommitment to target potential areas of improvement to enhance mental health outcomes.

Relationships between weight bias internalization and biopsychosocial health outcomes: A prospective study in Chinese adolescents

OBJECTIVE

An extensive literature has documented the deleterious effects of weight bias internalization (WBI) on biopsychosocial health outcomes. Still, this research is largely confined to the Western context. Furthermore, few studies have explored associations between WBI and biopsychosocial health outcomes, including in non-Western adolescent populations.

METHOD

The present study explored the longitudinal relationships between WBI and body dissatisfaction, disordered eating, psychosocial impairment related to eating disorder features, and psychological and physical well-being in a sample (N = 1549; aged 11-18 years at baseline) of Chinese adolescents. Relationships between study variables were examined between two waves of data measurement (Time 1, baseline, and Time 2, 6-month). Cross-lagged and multivariate models were used to explore prospective relationships between WBI and biopsychosocial correlates.

RESULTS

Bidirectional relationships were observed between WBI and biopsychosocial correlates in Chinese adolescents. Adjusting for covariates and other predictor variables, higher body dissatisfaction, disordered eating, psychosocial impairment, and psychological distress at Time 1 predicted higher WBI at Time 2. Furthermore, higher WBI at Time 1 predicted higher body dissatisfaction, disordered eating, psychosocial impairment, and psychological distress at Time 2.

DISCUSSION

Weight bias internalization and psychosocial correlates were interrelated across time in Chinese adolescents. Improving WBI might be promising in the prevention of eating and body image disturbances and diminished psychosocial well-being. Similarly, reducing eating and body image disturbances and improving psychosocial well-being might be useful prevention targets in reducing WBI in Chinese adolescents.

PUBLIC SIGNIFICANCE

The present study represents an initial effort to explore bidirectional relationships between WBI and biopsychosocial health outcomes in Chinese adolescents. Findings suggest bidirectional relationships between WBI and psychosocial variables, highlighting the potential utility of incorporating WBI interventions into eating pathology and poor psychosocial well-being prevention designs for Chinese adolescents.

Caring again: Support for parent caregivers of wounded, ill, and/or injured adult children veterans

BACKGROUND

Parents often provide care to adult children veterans with polytrauma, traumatic brain injury, and/or post-traumatic stress disorder.

OBJECTIVE

This two-arm randomized clinical trial compared interventions to help parent caregivers improve their depression, anxiety, and burden and manage care by decreasing troubling and concerning behaviors.

METHODS

Interventions were six one-hour structured one-on-one behavioral sessions (REACH) or six 30-minute prerecorded online educational webinars. Both focused on knowledge, strategies for care, and coping, but REACH sessions were targeted, interactive, and skills-based. Quantitative and qualitative data were collected by telephone. Quantitative analyses included chi-squared test or independent samples t-test and repeated measures mixed linear modeling, with theme development for qualitative data.

RESULTS

There were 163 parent caregivers, mostly mothers. During six months, participants in both arms improved significantly in depression, anxiety, burden, and reported veteran troubling and concerning behaviors. REACH caregivers showed a group by time improvement in concerning behaviors. Benefits included resources, self-reflection, not feeling alone, new skills, improved self-efficacy, and helping others. Specific concerns include exclusion from military and veteran care briefings and concern for the future.

CONCLUSION

The positive response to both interventions provides opportunities for organizations with varying resources to provide support for parent caregivers. Interventions need to be targeted to parents' particular concerns and needs.

Rural-Urban disparities in self-reported physical/mental multimorbidity: A cross-sectional study of self-reported mental health and physical health among working age adults in the U.S

Purpose

Self-rated physical health (SRPH) and self-rated mental health (SRMH) are both linked to excess morbidity and premature mortality and can vary across rural and urban contexts. This can be particularly problematic for rural residents who have less access to important health care infrastructure. In this paper, we assess the prevalence of and rural-urban disparities at the intersection of SRPH and SRMH, specifically self-rated physical/mental multimorbidity (SRPMM) overall and across rural-urban contexts.

Methods

Using a cross-sectional demographically representative national dataset of over 4000 working age adults in the U.S., we expose rural-urban differences in the prevalence of SRPMM and explore individual-level factors that may explain this disparity.

Results

Approximately 15 percent of working age adults reported SRPMM, but rural adults were at higher risk than their urban counterparts. However, this disadvantage disappeared for remote rural working-age adults and was attenuated for metro-adjacent rural working-age adults when we controlled for the fact that rural adults had lower household incomes.

Conclusion

Findings reveal a higher risk of SRPMM among rural adults, in part because of lower incomes among this group. This work acts as the foundation for facilitating research on and addressing rural-urban disparities in SRPMM.

National work-family policies: Multilevel effects on employee reactions to work/family conflict

BACKGROUND: Despite considerable differences in national work-family (WF) policies offered in countries around the world, research concerning the implications of such policies for employee reactions to work-family and family-work conflict (WFC/FWC) is limited. OBJECTIVE: The current study examines the contextual role of country-level national WF policies as a moderator of the relationships between individual-level WFC/FWC and job stress, job satisfaction, turnover intentions, organizational commitment, and general health. METHODS: Using archival data sources, the ISSP Work Orientations Survey (2015) and the WORLD Policy Analysis Center Adults Labor Database (2014), multilevel analyses tested the predicted cross-level interaction effect in a sample of 49,637 individuals (54% female; M age = 48 years) nested across 36 countries. RESULTS: Results were largely counter to expectations: while more supportive national WF policies attenuated the positive relationship between FWC and job stress, it exacerbated the negative relationships between WFC and organizational commitment, WFC and job stress, and FWC and general health. CONCLUSIONS: Our study responds to calls to consider phenomena functioning at multiple levels of analysis. While reactions were more negative in countries with more robust national-level policies, it suggests an unexpected dark side of such policies. That is, it may not be enough to legislate the availability of national-level policies; it may also be needed to ensure that such policies are meeting employees’ needs.

Ethnic Differences in Socioeconomic and Health Determinants Related to Self-Rated Health Status: A Study on Community-Dwelling Israeli Jews and Arabs in Old Age

Self-rated health (SRH) is widely used as a proxy for general health status. In old age, SRH has been found to be a strong predictor of morbidity, physical functioning, recovery from illness, use of health services, and mortality. This study was designed to examine differences in socioeconomic and health determinants related to self-rated health status among community-dwelling Jews and Arabs aged 65+ years. Cross-sectional data from 2011 on such Jews and Arabs were extracted from reprehensive National Surveys. The association between socioeconomic and health factors with poor SRH was estimated using three hierarchical logistic regression models. The majority of the respondents were Jews (86%), with a mean age of 73.1 (±6.3) years. The study revealed that older Arabs are disadvantaged according to almost every socioeconomic and health indicator compared to Jews. Poor SRH was significantly associated with age (OR = 1.03, p = 0.002), ethnicity (Jews OR = 2.62, p < 0.001), unemployment/retirement (OR = 2.03, p < 0.001), low income (OR = 3.03, p < 0.001), low education (OR = 1.37, p = 0.013), absence of physical activity (OR = 2.17, p < 0.001), dentures (OR = 1.40, p = 0.002), and prevalence of one or more chronic diseases (OR = 4.06, p < 0.001). The findings therefore indicated that these factors need to be detected and focused on by health professionals in order to improve the population's general health status.

Initial Assessment of a Brief Health, Fitness, and Spirituality Survey for Epidemiological Research: A Pilot Study

Background

Not many population-based health studies include items to assess both fitness and spirituality concepts. Therefore, the purpose of this study was to examine initial data of a brief health, fitness, and spirituality survey for epidemiological research.

Methods

This first phase pilot study used data from N = 56 adults 18+ years of age via electronic questionnaire. Measures of general health, fitness, physical activity (PA), body mass index (BMI), religiosity, and happiness were assessed. Reliability analyses were employed for PA, religiosity, and happiness scales. Validity coefficients were computed to evaluate convergence between scale scores and related measures. Finally, difference in health was examined between different levels of fitness to evaluate known groups discrimination.

Results

Respondents were middle-aged (Mean = 50.5 yr, SD = 14.3), majority white (69.5%, SD = 6.2), with relatively low BMI (Mean = 25.3, SD = 5.3). All three scales showed internal consistency reliability of α = 0.93, α = 0.89, and KR-20 = 0.56 for religiosity, happiness, and PA, respectively. Furthermore, scores converged (ps < 0.05) between fitness and PA (r = 0.43), health (r = 0.66), BMI (r = -0.28), and happiness (r = 0.25). Finally, health scores were significantly greater for high fitness versus low fitness in both male (p < 0.001) and female (p = 0.015) populations.

Conclusion

Results from this study indicate that a brief health, fitness, and spirituality survey can reliably measure its intended traits. A single-item of self-assessed fitness in particular has promise for large scale epidemiological research.

Adaptation and Preliminary Validation of the Fear of Coronavirus Vaccination Scale in the Prospective Study among a Representative Sample of Polish, Israeli, Slovenian, and German Adults during the COVID-19 Pandemic

Although concerns about harm and side effects are among the most important factors determining vaccine hesitancy, research on the fear of vaccination is sparse. The purpose of this study is a validation the Fear of Coronavirus Vaccination Scale (FoCVVS), adapted from the Fear of COVID-19 Scale. A representative sample of 1723 young adults aged 20-40 from Poland, Israel, Slovenia, and Germany participated during two time-points of the third COVID-19 pandemic wave. The online survey included demographic variables and several well-being dimensions, including gender, vaccination status, fear of coronavirus (FoCV-19S), physical health (GSRH), life satisfaction (SWLS), and perceived stress (PSS-10), anxiety (GAD-7), and depression (PHQ-9). Exploratory factor analysis (EFA) was performed at T1, and confirmatory analysis (CFA) at T2. The second-order two-factor structure demonstrated the best fit and very good discriminant and convergent validation. The general factor of the FoCVVS included two subscales assessing the emotional and physiological symptoms of fear of vaccination. Unvaccinated people showed higher levels of fear of vaccination than those vaccinated. A vaccination status, fear of vaccination T1, and fear of COVID-19 T1 were significant predictors of fear of vaccination T2. Vaccination-promoting programs should be focused on decreasing fear and enhancing the beneficial effects of vaccination.

Associations of Work-Family Conflict with Family-Specific, Work-Specific, and Well-Being-Related Variables in a Sample of Polish and Ukrainian Adults during the Second Wave of the COVID-19 Pandemic: A Cross-Sectional Study

The conflict between work and family demands increased during the COVID-19 pandemic due to changes in lifestyle related to the lockdown. This study examines the associations between work-family conflict (WFC) and family-work conflict (FWC) with work-specific, family-specific, and well-being-related variables during the second wave of the COVID-19 pandemic. The results may be used in practice to improve the well-being of employees by adjusting home-based work and family areas of life to dynamic changes during the pandemic. The sample of 736 adults from Poland (53.26%) and Ukraine (46.74%), aged between 19 and 72 (M = 39.40; SD = 10.80), participated in the study. The cross-sectional study was performed using an online survey, including sociodemographic variables, measures of WFC, time pressure, remote work assessment (RWAS), physical health (GSRH), life satisfaction (SWLS), perceived stress (PSS-10), anxiety (GAD-7), and depression (PHQ-9). This study showed numerous inter-group differences in all variables across the country, gender, relationship status, parenthood, caring for children under 12, and remote working status. A high WFC is more likely among Polish workers (than Ukrainian workers), people with a low level of self-perceived time pressure, and high symptoms of stress. Caring for children under 12, low self-perceived time pressure, and high stress can predict FWC. Various paths lead from perceived stress via WFC and FWC, physical health, anxiety, and depression to life satisfaction, as suggested by the structural equation modeling analysis. Parents of children under 12 and women are the most vulnerable groups for increased WFC, FWC, and worse mental health and well-being. Prevention programs should focus on reducing stress, anxiety, and work demands in these adult populations. A unique contribution to the existing knowledge revealed patterns of associations between WFC and FWC in relation to well-being dimensions in a cross-cultural context during the pandemic.

Cohort Profile: The Assessing Economic Transitions (ASSET) Study-A Community-Based Mixed-Methods Study of Economic Engagement among Inner-City Residents

The Assessing Economic Transitions (ASSET) study was established to identify relationships between economic engagement, health and well-being in inner-city populations given that research in this area is currently underdeveloped. This paper describes the objectives, design, and characteristics of the ASSET study cohort, an open prospective cohort which aims to provide data on opportunities for addressing economic engagement in an inner-city drug-using population in Vancouver, Canada. Participants complete interviewer-administered surveys quarterly. A subset of participants complete nested semi-structured qualitative interviews semi-annually. Between April 2019 and May 2022, the study enrolled 257 participants ages 19 years or older (median age: 51; 40% Indigenous, 11.6% non-Indigenous people of colour; 39% cis-gender women, 3.9% transgender, genderqueer, or two-spirit) and 41 qualitative participants. At baseline, all participants reported past daily drug use, with 27% currently using opioids daily, and 20% currently using stimulants daily. In the three months prior to baseline, more participants undertook informal income generation (75%) than formal employment (50%). Employed participants largely had casual jobs (42%) or jobs with part-time/varied hours (35%). Nested qualitative studies will focus on how inner-city populations experience economic engagement. The resulting evidence will inform policy and programmatic initiatives to address socioeconomic drivers of health and well-being.

Network Analysis of Well-Being Dimensions in Vaccinated and Unvaccinated Samples of University Students from Poland during the Fourth Wave of the COVID-19 Pandemic

Although numerous studies investigated the predictors of vaccination intention and decision, little is known about the relationship between vaccination and well-being. This study compares the physical and mental health dimensions among vaccinated and unvaccinated people. In a cross-sectional online survey, 706 university students from Poland (mean age of 23 years, 76% of women) participated in this study during the fourth pandemic wave (November–December 2021). Standardized questionnaires with a Likert response scale were included in the survey to measure spirituality, exposure to the COVID-19 pandemic, perceived physical health, stress, coronavirus-related PTSD, fear of COVID-19, anxiety, depression, and life satisfaction. Consistent with the fuzzy-trace theory, the unvaccinated sample was younger and scored significantly lower than the vaccinated group in exposure to COVID-19, perceived physical health, stress, coronavirus-related PTSD, fear of COVID-19, and depression, while higher in life satisfaction. The network analysis showed that mental health plays a crucial role in both groups, with the central influence of anxiety and stress on depression and life satisfaction. The message on vaccination to university students should focus on the benefits of vaccination in maintaining the status quo of good health and well-being. Campus prevention programs should primarily aim to reduce anxiety, stress, and negative emotions by teaching students coping strategies, relaxation techniques, and mindfulness.

Health and labor force participation among older workers in Switzerland: a growth curve analysis

This study investigated how individual trajectories of self-rated health (SRH) and working hours among older workers in Switzerland are interrelated and how this relationship varies based on occupation. We used data from the Swiss Household Panel to analyze the long-term trajectories of older workers measured in terms of working hours and SRH. The sample included more than 4000 workers aged 50 to 65(men)/64(women). We ran a bivariate response multilevel model for growth that allowed the examination of between- and within-individual changes over time. On a between-individual level, we found that the upper non-manual workers were the most heterogeneous occupational group in terms of working hours and the lower non-manual workers were the most heterogeneous occupational group in terms of health. Within all occupational groups, we found a significant relationship between the level of working hours and level of SRH. The individual-level statistics showed consistently strongest effects for manual workers. This result confirms our hypothesis that labor force participation in individuals of the manual occupational group is more sensitive to their health status. Our findings contribute to the debate regarding the importance of older workers' health in the context of the extension of working life.

A Path Model for Subjective Well-Being during the Second Wave of the COVID-19 Pandemic: A Comparative Study among Polish and Ukrainian University Students

Background: Previous studies showed several associations between physical and mental health dimensions and well-being. This study aims to examine a complex path model explaining the life satisfaction of university students from Poland and Ukraine during the second wave of the COVID-19 pandemic. Methods: The cross-sectional web-based study was performed in November 2020 using Google Forms. The conventional sample of 3230 university students from Poland (n = 1581) and Ukraine (n = 1649), aged 18–59 (M = 21.40, SD = 3.46), with 59% women, participated in the study. We used standardized questionnaires to measure life satisfaction (SWLS), self-reported physical health (GSRH), perceived stress (PSS-10), coronavirus-related PTSD (PCL-S), anxiety (GAD-7), and depression (PHQ-9). We also developed some questions to assess the exposure to the COVID-19 pandemic, positive effects of the pandemic, religiosity, and physical activity (PA). Results: We found a high prevalence of stress, coronavirus-related PTSD, anxiety, and depression and a low level of life satisfaction and physical health. Polish students, women, and those with insufficient PA levels reported worse physical and mental health than Ukrainians, men, and those who exercised sufficiently during the pandemic. Low perceived stress can directly predict life satisfaction, anxiety, and depression. Low stress also leads to better physical health, sufficient PA levels, high religiosity, and more perceived positive effects of the pandemic. Several indirect effects between particular variables and life satisfaction were also found in the path model. Conclusions: The target group for campus prevention programs is Polish university students, women, and people with insufficient PA levels. Intervention and prevention programs should focus on coping strategies and techniques for improving mental and physical health.

Long Work Hours, Overtime, and Worker Health Impairment: A Cross-Sectional Study among Stone, Sand, and Gravel Mine Workers

Background: Research has shown that long work hours and overtime are associated with health impairment, including stress, burnout, and overall health. However, this has not been thoroughly assessed among stone, sand, and gravel mine workers. As such, this study examined whether significant differences in stress, burnout, and overall health existed among workers that worked different hours each week. Methods: ANOVA analyses were completed for the outcome variables (stress, burnout, and health status). Each analysis included three categorical independent variables: age, sex, and work hours. Age and sex were control variables. BMI was added to the health status analysis as an additional control variable. Results: There were significant differences between work hour groups for all three outcomes. Post hoc analyses determined that workers working >60 h/week had more stress, more burnout, and lower health. Differences were not found between age or sex. There were no differences in health status for different BMI groups, but the interaction of BMI and work hours was significant. Conclusions: Working more than 60 h per week was problematic. Mine and safety administrators should enact programs to protect and promote worker health, particularly among those working long hours, especially if more than 60 h per week.

Valuing the impact of self-rated health and instrumental support on life satisfaction among the chinese population

Background

Research has highlighted that satisfaction in health, and instrumental support (IS) are key areas of life affecting an individual’s wellbeing. Many social and public health initiatives use these two intervention mechanisms to improve individual’s wellbeing. For the purpose of cost-benefit assessment, there has been growing interest in expressing these intervention effects in economic terms. However, only a handful of studies have ever estimated these effects in economic terms, none of which examined them in a Chinese context. The aim of this study is to extend this line of valuation work to the Chinese population, estimating the implicit willingness-to-pays on the effects of improving individuals’ self-rated health (SRH) status and IS on their life satisfaction (LS).

Methods

Using data from a two-wave representative panel survey in Hong Kong (n = 1,109), this study conducted a cross-lagged analysis with a structural equation modelling technique to examine the causal effects of SRH and IS on LS. The use of this cross-lagged approach was an effort to minimise the endogeneity problem. Then, substituting the respective estimates to the formulae of compensating surplus, the marginal rate of substitution of SRH and IS with respect to individual’s equivalised monthly household income (HI) were estimated and were then expressed as the implicit willingness-to-pays on the effect of improving individuals’ SRH and IS on their LS.

Results

The cross-lagged analysis ascertained the causal effects of SRH (β = 0.074, 95% Confidence Interval: 0.021, 0.127) and IS (β = 0.107, 95% Confidence Interval: 0.042, 0.171) on individuals’ satisfaction with life. Translating into the concept of compensating surplus, the implicit monetary values of improving the sample’s SRH from “poor health” to “excellent health” and their perceived IS from “little support” to “a lot of support” are equivalent to an increase in their equivalised monthly HI by US$1,536 and US$1,523 respectively.

Conclusions

This study is the first to derive the implicit monetary values of SRH and IS on individual’s LS in a predominantly Chinese society, and it has implications for the cost-benefit assessment in wellbeing initiatives within the population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13626-7.

Self-reported Adverse Childhood Experiences Among Custodial Grandmothers: Frequencies, Patterns, and Correlates

Given the scarce past research on custodial grandparents' early life circumstances, we investigated frequencies, patterns, and predictors of 14 adverse childhood experiences (ACEs) reported by 355 custodial grandmothers (CGMs). Predominant ACEs were bullying (54.6%), verbal abuse (51.5%), physical abuse (45.4%), and living with a substance abuser (41.1%). Only 11% of CGMs reported 0 ACEs, whereas 52.4% reported >4. Latent class analyses yielded three classes of ACE exposure: minimal (54.1%), physical/emotional abuse (25.9%), and complex (20.0%). Age was the only demographic factor related to ACE class, with the complex class being younger than the other two. MANCOVAs with age as a covariate revealed that different ACE profiles have unique impacts on CGMs' physical and psychological well-being. We conclude that ACEs are highly prevalent among CGMs and a serious public health concern. Future research addressing ACEs among CGMs is critical in order to support these caregivers and promote resilience in custodial grandfamilies.

Healthcare Utilization and Smoking among South Carolina’s Long-Term Uninsured

Cigarette smoking and tobacco-related health conditions have continued to rise among persons of low social economic status. This study explored the association between healthcare utilization and smoking among the long-term uninsured (LTU). The sample consisted of South Carolina residents who had been without healthcare insurance for at least 24 months. Multivariable logistic regression was used to estimate differences in the likelihood of delaying healthcare due to cost and/or not filling a needed prescription between smokers and non-smokers. Among LTU, smoking was a significant predictor of delaying healthcare at the 10% level (AOR = 1.36, 95% CI = 0.99–1.86); the sensitivity analysis strengthened this association at the 5% level (AOR = 1.43, 95% CI = 1.06–1.93). Smoking was a significant predictor of not filling needed prescriptions (AOR = 1.44, 95% CI = 1.06–1.96). While neglected healthcare utilization was common among the LTU, this problem was more severe among smokers. The wider gap in access to healthcare services among the LTU, especially LTU who smoke, warrants further attention from the research community and policy makers.

Self-Rated Health Among Italian Immigrants Living in Norway: A Cross-Sectional Study

Background

Most studies on immigrant health focus on immigrant groups coming from extra-European and/or low-income countries. Little attention is given to self-rated health (SRH) in the context EU/EEA migration. To know more about health among European immigrants can provide new insights related to social determinants of health in the migration context. Using the case of Italian immigrants in Norway, the aim of this study was to (i) examine the levels of SRH among Italian immigrants in Norway as compared with the Norwegian and the Italian population, (ii) examine the extent to which the Italian immigrant perceived that moving to Norway had a positive or negative impact on their SRH; and (iii) identify the most important factors predicting SRH among Italian immigrants in Norway.

Methods

A cross-sectional survey was conducted among adult Italian immigrants in Norway (n = 321). To enhance the sample's representativeness, the original dataset was oversampled to match the proportion of key sociodemographic characteristics of the reference population using the ADASYN method (oversampled n = 531). A one-sample Chi-squared was performed to compare the Italian immigrants' SRH with figures on the Norwegian and Italian populations according to Eurostat statistics. A machine-learning approach was used to identify the most important predictors of SRH among Italian immigrants.

Results

Most of the respondents (69%) rated their SRH as "good" or "very good". This figure was not significantly different with the Norwegian population, nor to the Italians living in Italy. A slight majority (55%) perceived that their health would have been the same if they continued living in Italy, while 23% perceived a negative impact. The machine-learning model selected 17 variables as relevant in predicting SRH. Among these, Age, Food habits, and Years of permanence in Norway were the variables with the highest level of importance, followed by Trust in people, Educational level, and Health literacy.

Conclusions

Italian immigrants in Norway can be considered as part of a "new mobility" of high educated people. SHR is shaped by several interconnected factors. Although this study relates specifically to Italian immigrants, the findings may be extended to other immigrant populations in similar contexts.

A Cross-Sectional Study Analyzing Predictors of Perceived Stress Among Elementary School Teachers During the COVID-19 Pandemic

INTRODUCTION

Teaching is a stressful occupation due to high-stake job demands and limited resources, which were exacerbated during the initial phase of the COVID-19 pandemic. Our study assessed the prevalence of perceived stress and explored its predictors among elementary school teachers employed at schools serving predominantly low-income populations in five cities in the United States.

METHOD

Our study analyzed the data among selected schools that were collected through the Brighter Bites teacher survey which comprised items measuring sociodemographic characteristics, perceived stress, perceived general health, food insecurity, and concerns regarding social determinants of health needs. The predictors of perceived stress were examined using generalized linear mixed models (GLMMs) with schools as the random variable.

FINDINGS

A total of 685 teachers were included in the analysis (84.9% female, 38.1% Hispanic, 57.6% <5 years of teaching experience). Most (85.4%) of the teachers stated they were stressed "sometimes"/"often." Results from adjusted GLMM showed that teachers who were food insecure (adjusted odds ratio [AOR]: 2.33, confidence interval [CI]: [1.63, 3.35]), those who had concerns regarding financial stability (2.68 [1.91, 3.75]), food availability (1.69 [1.15, 2.48]), food affordability (2.27 [1.57, 3.28]), availability/affordability of housing (2.21 [1.33, 3.67]), access to childcare (1.76 [1.06, 2.92]), and access to a clinic/doctor (1.60 [1.10, 2.33]) were at significantly greater odds of reporting perceived stress.

CONCLUSION/APPLICATION FOR PRACTICE

Our study demonstrates the heightened impact of COVID-19 on the mental well-being of teachers across a wide range of social needs. Stress management and additional social service programs are suggested to support teachers to mitigate pandemic impact.

Self-assessed health status and associated mortality in endocarditis: secondary findings from the POET trial

PURPOSE

Self-assessed poor health status is associated with increased risk of mortality in several cardiovascular conditions, but has not been investigated in patients with endocarditis. We examined health status and mortality in patients with endocarditis.

METHODS

This is a re-specified substudy of the randomized POET endocarditis trial, which included 400 patients. Patients completed the single-question self-assessed health status from the Short-Form 36 questionnaire at time of randomization and were categorized as having poor or non-poor (excellent/very good, good, or fair) health status. Self-assessed health status and all-cause mortality were examined by a Cox regression model.

RESULTS

Self-assessed health status was completed by 266 (67%) patients with a mean age of 68.0 years (± 11.8), 54 (20%) were females, and 86 (32%) had one or more major concurrent medical conditions besides endocarditis. The self-assessed health status distribution was poor (n = 21, 8%) and non-poor (n = 245, 92%). The median follow-up was 3.3 years and death occurred in 9 (43%) and 48 (20%) patients reporting poor and non-poor health status, respectively, and mortality rates [mortality/100 person-years, 95% confidence interval (CI)] were 18.1 (95% CI 9.4-34.8) and 5.4 (95% CI 4.1-7.2), i.e., the crude hazard ratio for death was 3.4 (95% CI: 1.7-7.0, p < 0.01).

CONCLUSION

Self-assessed poor health status compared with non-poor health status as assessed by a single question was associated with a threefold increased long-term mortality in patients with endocarditis. POET ClinicalTrials.gov number, NCT01375257.

TRIAL REGISTRY

POET ClinicalTrials.gov number, NCT01375257.

Evaluating the clinical benefit of brain-computer interfaces for control of a personal computer

Brain-computer interfaces (BCIs) enabling the control of a personal computer could provide myriad benefits to individuals with disabilities including paralysis. However, to realize this potential, these BCIs must gain regulatory approval and be made clinically available beyond research participation. Therefore, a transition from engineering-oriented to clinically oriented outcome measures will be required in the evaluation of BCIs. This review examined how to assess the clinical benefit of BCIs for the control of a personal computer. We report that: 1) a variety of different patient-reported outcome measures can be used to evaluate improvements in how a patient feels, and we offer some considerations that should guide instrument selection. 2) Activities of daily living can be assessed to demonstrate improvements in how a patient functions, however, new instruments that are sensitive to increases in functional independence via the ability to perform digital tasks may be needed. 3) Benefits to how a patient survives has not previously been evaluated, but establishing patient-initiated communication channels using BCIs might facilitate quantifiable improvements in health outcomes.

Making Europe health literate: including older adults in sparsely populated Arctic areas

Background

Older people have been identified as having lower health literacy (HL) than the general population average. Living in sparsely populated Arctic regions involves unique health challenges that may influence HL. The research aim was to explore the level of HL, its problematic dimensions, and its association with the selection of contextual factors among older adults living in sparsely populated areas in Northern Iceland.

Method

This was a cross-sectional study based on a stratified random sample from the national register of one urban town and two rural areas. The study included 175 participants (57.9% participation rate) who were community-dwelling (40% rural) and aged 65–92 years (M 74.2 ± SD 6.3), 43% of whom were women. Data were collected in 2017-2018 via face-to-face interviews, which included the standardised European Health Literacy Survey Questionnaire-short version (HLS-EU-Q16) with a score range from 0 to 16 (low-high HL).

Results

The level of HL ranged from 6–16 (M 13.25, SD ± 2.41) with 65% having sufficient HL (score 13–16), 31.3% problematic HL (score 9–12) and 3.7% inadequate HL (score 0–8). Most problematic dimension of HL was within the domains of disease prevention and health promotion related to information in the media. Univariate linear regression revealed that better HL was associated with more education (p=0.001), more resiliency (p=0.001), driving a car (p=0.006), good access to health care- (p=0.005) and medical service (p=0.027), younger age (p=0.005), adequate income (p=0.044) and less depression (p=0.006). Multivariable analysis showed that more education (p=0.014) and driving a car (p=0.017) were independent predictors of better HL.

Conclusion

Difficulties in HL concern information in the media. HL was strongly associated with education and driving a car however, not with urban-rural residency. Mobility and access should be considered for improving HL of older people.

General and comparative self-rated health in chronic stroke: an important outcome measure for health professionals

BACKGROUND

After a stroke, several aspects of health and function may influence how individuals perceive their own health. However, self-rated health (SRH), as well as its relationship with functioning, has been little explored in individuals with stroke. The aims of this study were to determine how individuals with chronic post-stroke disabilities evaluate their health, considering general, time- and age-comparative SRH questions and to investigate whether SRH measures would be influenced by the following health and functioning domains: mental/physical functions and personal factors.

METHODS

Sixty-nine individuals with chronic post-stroke disabilities answered the three types of SRH questions and were assessed regarding depressive symptoms (emotional function domain), physical activity levels (physical function domain), and engagement in physical activity practice (personal factor domain). Subjects were divided into the following groups: good/poor for the general SRH question; better, similar, and "worse" for both time- and age-comparative questions. Between-group differences in the three domains for each SRH question were investigated (α = 5%).

RESULTS

General SRH was rated as good by 73% of the participants. Time- and age-comparative SRH was rated as better by 36% and 47% and as similar by 31% and 28% of the subjects, respectively. Significant between-group differences in emotional function were found for both the general and age-comparative questions. For the time-comparative question, significant differences were only observed for physical function.

CONCLUSION

SRH evaluation differed in individuals with chronic post-stroke disabilities according to the types of questions and health/functioning domains.

Gender roles and selection mechanisms across contexts: a comparative analysis of the relationship between unemployment, self-perceived health and gender

Health literature shows that unemployment has a gendered effect on health. However, whether men or women are more affected and why remains unclear. We assume that unemployment harms women less than men because of two mechanisms: social roles theories and health selection. First, the availability and centrality in individuals' lives of roles other than employment may reduce the detrimental effect of unemployment for women. Second, the gendered impact of unemployment on health results from the different ways selection mechanisms operate across genders. Moreover, these two mechanisms may operate differently in different contexts - for example, across different gender regimes. We investigate this by pursuing a three-step comparative approach. The analysis relies on EU-SILC data covering Italy and Sweden for 2004 to 2015 and SOEP data for Germany (1995-2017) and applies correlated dynamic random-effects probit models. While we find weak support for the role of health selection in shaping the relations between unemployment, health, and gender, our empirical results are in line with the hypothesis of a larger gendered effect in older (vs younger) cohorts, western (vs eastern) Germany and Italy (vs. Sweden). Future empirical research needs to directly address the role of gender regimes in moderating such complex relationships.

Family Violence Associated with Self-Rated Health, Satisfaction With Life, and Health Service Use in Primary Care Older Adults

We aimed to document in primary care older adults the relationship between family violence (FV) and mental and physical health, satisfaction with life, and health service use, by gender. The study sample included data from 1,658 older adults recruited in primary care practices, in one of the largest health regions in the province of Quebec. The presence of FV (partner/spouse, adult child) was assessed with the 21-item Family Violence Scale (FVS) adapted from the conflicts Tactics Scale 2. Self-rated mental health (SRMH) and self-rated physical health (SRPH) were assessed with single-item measures. Satisfaction with life (SWL) was measured using a validated French version of the SWL scale. Health service use over a 2-year period included outpatient consultations (number), emergency department (ED) visits (yes/no), and hospitalizations (yes/no). Multi-level logistic and Poisson's regression models were conducted to assess study outcomes as a function of FV. Analyses were stratified by perpetrator and gender. There was an association between FV and SRMH in women (OR = 0.41, 95% CI = [0.27, 0.62]), and SWL in both men and women (B = -5.74, 95% CI = [-6.71, -4.76]; B = -10.07, 95% CI = [-14.16, -5.98], respectively). Significant associations were found in women between FV and ED visits (OR = 1.45, 95% CI = [1.12, 1.18]), hospitalizations (OR = 1.36, 95% CI = [1.32, 1.43]), and outpatient consultations (RR = 1.25, 95% CI = [1.19, 1.30]). SWL moderated the association between FV and likelihood of hospitalization. Gender differences were observed between FV and SRMH and SWL. FV was associated with increased health service use in women but not men. These gender differences may suggest stigma-related barriers to health service use. Victims of violence with higher SWL had a lower likelihood of being hospitalized. Public health programs aimed at increasing awareness of the different types of FV and interventions aiming to improve resilience in victims are needed.

Post-Traumatic Growth in Parents following Their Child's Death in a Pediatric Intensive Care Unit

Background: Although bereaved parents suffer greatly, some may experience positive change referred to as post-traumatic growth. Objective: Explore the extent to which parents perceive post-traumatic growth after their child's death in a pediatric intensive care unit (PICU), and associated factors. Design: Longitudinal parent survey conducted 6 and 13 months after a child's death. Surveys included the Post-traumatic Growth Inventory-Short Form (PTGI-SF), a 10-item measure with range of 0-50 where higher scores indicate more post-traumatic growth. Surveys also included the Inventory of Complicated Grief (ICG), the Patient Health Questionnaire-8 (PHQ-8) for depression, the Short Post-Traumatic Stress Disorder Rating Interview (SPRINT), a single item on perceived overall health, and sociodemographics. Setting/Subjects: One hundred fifty-seven parents of 104 children who died in 1 of 8 PICUs affiliated with the U.S. Collaborative Pediatric Critical Care Research Network. Results: Of participating parents, 62.4% were female, 71.6% White, 82.7% married, and 89.2% had at least a high school education. Mean PTGI-SF scores were 27.5 ± 12.52 (range 5-50) at 6 months and 28.6 ± 11.52 (range 2-49) at 13 months (p = 0.181). On multivariate modeling, higher education (compared with those not completing high school) and higher 6-month ICG scores (reflecting more complicated grief symptoms) were associated with lower 13-month PTGI-SF scores (p = 0.005 and 0.033, respectively). Conclusion: Parents bereaved by their child's PICU death perceive a moderate degree of post-traumatic growth in the first 13 months after the death however variability is wide. Education level and complicated grief symptoms may influence parents' perception of post-traumatic growth.

Changes in mental health during three waves of the COVID-19 pandemic: a repeated cross-sectional study among polish university students

BACKGROUND

Research indicates that mental health worsened during the Coronavirus crisis, in particular among women and university students. However, few longitudinal studies have so far investigated the changes in mental health outcomes across three subsequent waves of the COVID-19 pandemic. Therefore, this study aims to examine changes in mental health among university students.

METHODS

A total of 1,961university students from Poland, at mean age 23.23 years (SD = 3.16, 57.47% of women) were included in this repeated cross-sectional study across three waves of the COVID-19 pandemic: W1 (n = 657), W2 (n = 654), and W3 (n = 650). They completed the online survey with the Generalized Anxiety Disorder (GAD-7), Perceived Stress Scale (PSS-10), General Self-Rated Health (GSRH), and Satisfaction with Life Scale (SWLS), as well as sociodemographic variables.

RESULTS

The prevalence of people at high risk of anxiety and perceived stress, poorer physical health, and low life satisfaction changed significantly across three waves of the COVID-19 pandemic. The results of the two-way ANOVA showed that both the wave (W1<W2<W3) and gender (men<women) had a significant impact on the level of anxiety. Statistically significant changes in perceived stress were found between pandemic waves (W1>W2, W1>W3), and genders (men<women). Self-reported physical health significantly deteriorated in W3 compared to W1 and W2 (W1>W3, W2>W3), and was significantly worse in women than in men. The level of life satisfaction also decreased significantly in W3 (W1>W3, W2>W3), but did not differ between men and women. High GAD risk was presented two times more frequently among women and people who subjectively assessed their health as poor, three times more likely in participants dissatisfied with their lives, and seven times more probably in persons with high-stress levels.

CONCLUSIONS

The results of this study consistently indicate (using parametric and non-parametric statistical analysis) that there are significant differences in mental health problems across three waves of the COVID-19 pandemic. It suggests that pandemic waves should be considered in future review studies and meta-analyses. Furthermore, these findings indicate a potential role for prevention and intervention programs aimed at alleviating life satisfaction and subjective assessment of health and improving coping skills to reduce stress and anxiety.