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van den Bekerom L, van Gestel LC, Schoones JW, Bussemaker J, Adriaanse MA. Health behavior interventions among people with lower socio-economic position: a scoping review of behavior change techniques and effectiveness. Health Psychol Behav Med 2024; 12:2365931. [PMID: 38903803 PMCID: PMC11188964 DOI: 10.1080/21642850.2024.2365931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/04/2024] [Indexed: 06/22/2024] Open
Abstract
Background Behavior change interventions can unintendedly widen existing socio-economic health inequalities. Understanding why interventions are (in)effective among people with lower socio-economic position (SEP) is essential. Therefore, this scoping review aims to describe what is reported about the behavior change techniques (BCTs) applied within interventions and their effectiveness in encouraging physical activity and healthy eating, and reducing smoking and alcohol consumption according to SEP. Methods A systematic search was conducted in 12 electronic databases, and 151 studies meeting the eligibility criteria were included and coded for health behavioral outcomes, SEP-operationalization, BCTs (type and number) and effectiveness. Results Findings suggest that approaches for measuring, defining and substantiating lower SEP vary. Current studies of behavior change interventions for people of different SEP do not systematically identify BCTs, making systematic evaluation of BCT effectiveness impossible. The effectiveness of interventions is mainly evaluated by overall intervention outcomes and SEP-moderation effects are mostly not assessed. Conclusion Using different SEP-operationalizations and not specifying BCTs hampers systematic evidence accumulation regarding effective (combinations of) BCTs for the low SEP population. To learn which BCTs effectively improve health behaviors among people with lower SEP, future intervention developers should justify how SEP is operationalized and must systematically describe and examine BCTs.
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Affiliation(s)
- Loes van den Bekerom
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague/Leiden, the Netherlands
| | - Laurens C. van Gestel
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - Jan W. Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, the Netherlands
| | - Jet Bussemaker
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague/Leiden, the Netherlands
- The Institute of Public Administration, Leiden University, Leiden, the Netherlands
| | - Marieke A. Adriaanse
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague/Leiden, the Netherlands
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
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Benaïs M, Duprey M, Federici L, Arnaout M, Mora P, Amouretti M, Bourgeon-Ghittori I, Gaudry S, Garçon P, Reuter D, Geri G, Megarbane B, Lebut J, Mekontso-Dessap A, Ricard JD, da Silva D, de Montmollin E. Association of socioeconomic deprivation with outcomes in critically ill adult patients: an observational prospective multicenter cohort study. Ann Intensive Care 2024; 14:54. [PMID: 38592412 PMCID: PMC11004098 DOI: 10.1186/s13613-024-01279-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/18/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND The influence of socioeconomic deprivation on health inequalities is established, but its effect on critically ill patients remains unclear, due to inconsistent definitions in previous studies. METHODS Prospective multicenter cohort study conducted from March to June 2018 in eight ICUs in the Greater Paris area. All admitted patients aged ≥ 18 years were enrolled. Socioeconomic phenotypes were identified using hierarchical clustering, based on education, health insurance, income, and housing. Association of phenotypes with 180-day mortality was assessed using Cox proportional hazards models. RESULTS A total of 1,748 patients were included. Median age was 62.9 [47.4-74.5] years, 654 (37.4%) patients were female, and median SOFA score was 3 [1-6]. Study population was clustered in five phenotypes with increasing socioeconomic deprivation. Patients from phenotype A (n = 958/1,748, 54.8%) were without socioeconomic deprivation, patients from phenotype B (n = 273/1,748, 15.6%) had only lower education levels, phenotype C patients (n = 117/1,748, 6.7%) had a cumulative burden of 1[1-2] deprivations and all had housing deprivation, phenotype D patients had 2 [1-2] deprivations, all of them with income deprivation, and phenotype E patients (n = 93/1,748, 5.3%) included patients with 3 [2-4] deprivations and included all patients with health insurance deprivation. Patients from phenotypes D and E were younger, had fewer comorbidities, more alcohol and opiate use, and were more frequently admitted due to self-harm diagnoses. Patients from phenotype C (predominant housing deprivation), were more frequently admitted with diagnoses related to chronic respiratory diseases and received more non-invasive positive pressure ventilation. Following adjustment for age, sex, alcohol and opiate use, socioeconomic phenotypes were not associated with increased 180-day mortality: phenotype A (reference); phenotype B (hazard ratio [HR], 0.85; 95% confidence interval CI 0.65-1.12); phenotype C (HR, 0.56; 95% CI 0.34-0.93); phenotype D (HR, 1.09; 95% CI 0.78-1.51); phenotype E (HR, 1.20; 95% CI 0.73-1.96). CONCLUSIONS In a universal health care system, the most deprived socioeconomic phenotypes were not associated with increased 180-day mortality. The most disadvantaged populations exhibit distinct characteristics and medical conditions that may be addressed through targeted public health interventions.
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Affiliation(s)
- Morgan Benaïs
- Service de Médecine Intensive - Réanimation, Hôpital Delafontaine, Saint-Denis, France
| | - Matthieu Duprey
- Service de Réanimation, Grand Hôpital de l'Est Francilien-Site de Marne-la-Vallée, Jossigny, France
| | - Laura Federici
- Service de Réanimation Polyvalente, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Michel Arnaout
- Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Ambroise Paré, Boulogne, France
| | - Pierre Mora
- Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Lariboisière, Paris, France
| | - Marc Amouretti
- Service de Réanimation Polyvalente, Groupe Hospitalier Nord-Essonne, Longjumeau, France
| | - Irma Bourgeon-Ghittori
- Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - Stéphane Gaudry
- DMU ESPRIT, Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Louis Mourier, Colombes, France
| | - Pierre Garçon
- Service de Réanimation, Grand Hôpital de l'Est Francilien-Site de Marne-la-Vallée, Jossigny, France
| | - Danielle Reuter
- Service de Réanimation Polyvalente, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Guillaume Geri
- Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Ambroise Paré, Boulogne, France
| | - Bruno Megarbane
- Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Lariboisière, Paris, France
| | - Jordane Lebut
- Service de Réanimation Polyvalente, Groupe Hospitalier Nord-Essonne, Longjumeau, France
| | - Armand Mekontso-Dessap
- Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - Jean-Damien Ricard
- DMU ESPRIT, Service de Médecine Intensive - Réanimation, AP-HP, Hôpital Louis Mourier, Colombes, France
- IAME, Université Paris Cité and Université Sorbonne Paris Nord, Inserm, 75018, Paris, France
| | - Daniel da Silva
- Service de Médecine Intensive - Réanimation, Hôpital Delafontaine, Saint-Denis, France
| | - Etienne de Montmollin
- Service de Médecine Intensive - Réanimation, Hôpital Delafontaine, Saint-Denis, France.
- IAME, Université Paris Cité and Université Sorbonne Paris Nord, Inserm, 75018, Paris, France.
- Service de Médecine Intensive - Réanimation Infectieuse, AP-HP, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018, Paris, France.
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Al Saleh A, Jamee A, Sulaiman K, Sobhy M, Gamra H, Alkindi F, Benkhedda S, Al-Motarreb A, Amin MI, Almahmeed W, Hammoudeh A, Skouri H, Farhan HA, Al Jarallah M, Fellat N, Panduranga P, Alnajm BK, Abdelhamid M, Refaat R, Amor H, Messaous S, Ahmed HS, Chibane A, AbdulMalek A, Alsagheer NK, Dada S, Mokhtar Z, Ali M, Ullah A, AlBackr H, Alhabib KF. Clinical features, socioeconomic status, management, short and long-term outcomes of patients with acute myocardial infarction: Phase I results of PEACE MENA registry. PLoS One 2024; 19:e0296056. [PMID: 38206951 PMCID: PMC10783754 DOI: 10.1371/journal.pone.0296056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The Program for the Evaluation and Management of Cardiac Events in the Middle East and North Africa (PEACE MENA) is a prospective registry program in Arabian countries that involves in patients with acute myocardial infarction (AMI) or acute heart failure (AHF). METHODS This prospective, multi-center, multi-country study is the first report of the baseline characteristics and outcomes of inpatients with AMI who were enrolled during the first 14-month recruitment phase. We report the clinical characteristics, socioeconomic, educational levels, and management, in-hospital, one month and one-year outcomes. RESULTS Between April 2019 and June 2020, 1377 patients with AMI were enrolled (79.1% males) from 16 Arabian countries. The mean age (± SD) was 58 ± 12 years. Almost half of the population had a net income < $500/month, and 40% had limited education. Nearly half of the cohort had a history of diabetes mellitus, hypertension, or hypercholesterolemia; 53% had STEMI, and almost half (49.7%) underwent a primary percutaneous intervention (PCI) (lowest 4.5% and highest 100%). Thrombolytics were used by 36.2%. (Lowest 6.45% and highest (90.9%). No reperfusion occurred in 13.8% of patients (lowest was 0% and highest 72.7%).Primary PCI was performed less frequently in the lower income group vs. high income group (26.3% vs. 54.7%; P<0.001). Recurrent ischemia occurred more frequently in the low-income group (10.9% vs. 7%; P = 0.018). Re-admission occurred in 9% at 1 month and 30% at 1 year, whereas 1-month mortality was 0.7% and 1-year mortality 4.7%. CONCLUSION In the MENA region, patients with AMI present at a young age and have a high burden of cardiac risk factors. Most of the patients in the registry have a low income and low educational status. There is heterogeneity among key performance indicators of AMI management among various Arabian countries.
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Affiliation(s)
- Ayman Al Saleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Amal Jamee
- Nassar Medical Complex Hospital, Ministry of Health, Khan Younes, Gaza Strip, Palestine
- Al-Quds Hospital, Gaza, Palestine
| | | | - Mohamed Sobhy
- International Cardiac Center (ICC), Alexandria, Egypt
| | - Habib Gamra
- Research Laboratory LR, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Fahad Alkindi
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Salim Benkhedda
- Cardiology Department, Mustapha Hospital, COCRG Laboratory University Benyoucef Benkhedda, Algiers, Algeria
| | | | | | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirate
| | | | - Hadi Skouri
- Cardiology Division, Internal Medicine Department at American University of Beirut Medical Center, Beirut, Lebanon
| | - Hasan A. Farhan
- Iraqi Board for Medical Specializations, Scientific Council of Cardiology. Baghdad Heart Center, Medical City, Baghdad, Iraq
| | | | | | | | | | - Magdy Abdelhamid
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Giza Governorate, Egypt
| | - Rafik Refaat
- International Cardiac Center (ICC), Alexandria, Egypt
| | - Hassen Amor
- Taher Sfar University Hospital, Mahdia, Tunisia
| | - Salma Messaous
- Research Laboratory LR, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | | | - Ahcene Chibane
- Internal Medicine and Cardiology Department, CHU Douéra, Algiers, University Saad Dahlab, Blida, Algeria
| | - Azzouz AbdulMalek
- Cardiology Department, Mustapha Hospital, COCRG Laboratory University Benyoucef Benkhedda, Algiers, Algeria
| | | | - Sobhi Dada
- Hammoud University Medical Center, Saida, Lebanon
| | - Zaki Mokhtar
- King Saud Hospital, Unizah, Qaseem, Saudi Arabia
| | | | - Anhar Ullah
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Hanan AlBackr
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Khalid F. Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
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Græsholt-Knudsen T, Rask CU, Lucas S, Obel C, Bech BH. Parental physical disease severity and severe documented physical child abuse: a prospective cohort study. Eur J Pediatr 2024; 183:357-369. [PMID: 37889291 PMCID: PMC10857964 DOI: 10.1007/s00431-023-05291-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/05/2023] [Accepted: 10/15/2023] [Indexed: 10/28/2023]
Abstract
Successful prevention of physical child abuse is dependent on improvements in risk assessment. The risk of abuse is assumed to increase when family stressors overcome resources. Severe physical disease can increase stress, and parental physical disease has been studied as a risk factor for physical child abuse, but with heterogeneous definitions. This study evaluated the relation between parental physical disease severity and severe documented physical child abuse. Models were based on data on children aged 0-17 years in Denmark between 1997 and 2018, and their parents. Severe documented physical child abuse was modeled as violence against a child registered by either health authorities in treatment or mortality registries, or police authorities in cases confirmed by the courts. Parental physical disease severity was modeled as the sum of Charlson Comorbidity Index scores for the child's parents. The causal connection was examined in two model types: a survival model comparing exposed with non-exposed children, adjusted for covariates at baseline, and a G-model, taking time-varying covariates, including income and parental psychiatric disease into account. Neither model showed an association between parental physical disease severity and severe documented physical child abuse, with RR 0.99 and 95% CI (0.93-1.05) for the survival model and RR 1.08 for the G-model (CI not calculated). Conclusion: In the model studied, parental physical disease severity was not a risk factor for severe documented physical child abuse. Individual categories of physical disease remain to be examined. Trial registration: The study was pre-registered on Open Science Framework, https://osf.io/fh2sr . What is Known: • Parental physical disease severity has been studied previously as a risk indicator of physical child abuse, but based on heterogeneous definitions. • Previous studies have not studied parental physical disease severity preceding physical child abuse. What is New: • Parental severe physical disease was not prospectively associated with severe documented physical child abuse in a survival model, a G-model and a number of sensitivity analyses, respectively. • Results should be replicated in samples from populations without universal health care, and using different categories of disease.
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Affiliation(s)
- Troels Græsholt-Knudsen
- Research Unit for Mental Public Health, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Aarhus, Denmark.
- Department of Forensic Medicine, Palle Juul-Jensens Boulevard 99, Aarhus University, 8200, Aarhus N, Aaurhus, Denmark.
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Palle Juul-Jensens Boulevard 175, 8200, Aarhus N, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Olof Palmes Allé 43, 8200, Aarhus N, Aarhus, Denmark
| | - Steven Lucas
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, 751 85, Uppsala, Sweden
| | - Carsten Obel
- Research Unit for Mental Public Health, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Aarhus, Denmark
| | - Bodil Hammer Bech
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Aarhus, Denmark
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Pedroni C, Djuric O, Mancuso P, Navazio A, Pinotti M, Greci M, Giorgi Rossi P. Determinants of survival in patients with chronic heart failure: a population-based study in Reggio Emilia, Italy. ESC Heart Fail 2023; 10:3646-3655. [PMID: 37798817 PMCID: PMC10682897 DOI: 10.1002/ehf2.14557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 08/02/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023] Open
Abstract
AIMS We aim to monitor and improve the quality of the heart failure (HF) integrated assistance model defined by national and regional guidelines and implemented in the province of Reggio Emilia, Italy. Specific aims of the audit were to estimate the prevalence of HF, describe the characteristics of patients with HF and the rate of patients enrolled in the integrated care treated in primary care, and identify socioeconomic and geographic determinants of the 4-year survival of these patients. METHODS AND RESULTS Retrospective analysis of a cohort of prevalent cases of HF, diagnosed before 31 December 2015 in Reggio Emilia, Italy, alive on 1 January 2016, and residing at the time of diagnosis on the provincial territory. Age and sex-adjusted prevalence of HF by area of residence were calculated according to the standard European population 2013. Patients were followed until death or 31 December 2019, whatever came first. The outcome measure of the study was four-year case fatality. Cox proportional hazards models, adjusted for age, sex, and duration of disease were used to determine the association between socio-geographic factors and death. The 4-year case-fatality rate was 36.7%, and it was the highest in the mountains (50.8%) compared with hills (34.6%), lowland (35.4%) and city (37.7%). The prevalence of HF was the lowest in the mountain [149.9, 95% confidence interval (CI) 112.1-187.7] and the highest in the lowland (340.8, 95% CI 308.7-372.9) and city (308, 95% CI 276.0-321.2). Patients living in the mountains had a lower deprivation index, and fewer hospitalizations prior to official diagnosis, although these characteristics were not statistically significant determinants of HF death in multivariate analysis. Behavioural (smoking and obesity) and socio-geographic characteristics (educational level, deprivation index and area of residence) were not significantly associated with mortality in both univariable and multivariable analysis; however, patients who live in mountains (hazard ratio 1.10, 95% CI 0.73-1.66) or hills (hazard ratio 1.11, 95% CI 0.90-1.37) had a slightly higher risk of death than those living in the city. Only 197 (12.1%) of patients in the cohort were enrolled in the integrated care pathway over the course of 4 years. CONCLUSIONS Although clinical determinants outweigh the geographic and behavioural disparities in the survival of patients with CHF treated in primary care, effective prevention strategies are needed to address environmental and socio-geographic inequalities in access to primary care and to hasten equitable linkage to integrated care.
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Affiliation(s)
- Cristina Pedroni
- Direzione delle Professioni Sanitarie, Azienda Unità Sanitaria Locale ‐IRCCS di Reggio EmiliaReggio EmiliaItaly
- Laurea Magistrale in Scienze infermieristiche e OstetricheUniversity of Modena and Reggio EmiliaReggio EmiliaItaly
| | - Olivera Djuric
- Epidemiology UnitAzienda Unità Sanitaria Locale–IRCCS di Reggio EmiliaReggio EmiliaItaly
- Department of Biomedical, Metabolic and Neural Sciences, Centre for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), Public Health UnitUniversity of Modena and Reggio EmiliaReggio EmiliaItaly
| | - Pamela Mancuso
- Epidemiology UnitAzienda Unità Sanitaria Locale–IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Alessandro Navazio
- Division of CardiologyArcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale‐IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Mirco Pinotti
- Risk Management UnitAzienda Unità Sanitaria Locale–IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Marina Greci
- Primary Health Care DepartmentAzienda Unità Sanitaria Locale ‐ IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Paolo Giorgi Rossi
- Epidemiology UnitAzienda Unità Sanitaria Locale–IRCCS di Reggio EmiliaReggio EmiliaItaly
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Bae KR, So WY, Lee SJ. Health Behaviors of Cancer Survivors According to the Employment Status and Occupation: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:2974. [PMID: 37998467 PMCID: PMC10671823 DOI: 10.3390/healthcare11222974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
This study aimed to identify differences in health behaviors according to the employment status and occupation of cancer survivors, as well as to identify risk factors. Using data from the Korea National and Health Nutrition Examination Survey (2008-2018), 1023 cancer survivors aged 19-60 years were classified based on their employment status and occupation, and their health behaviors were comparatively assessed. To investigate the impact of occupational status on the health behaviors of cancer survivors, we performed multivariate adjusted logistic regression analysis. Five hundred fifty-six (54.3%) cancer survivors were engaged in economic activities. After adjusting for various factors, white- and blue-collar workers exhibited an increased risk of obesity. The blue-collar group had a 1.45 times higher risk of non-practice with cancer screening, while the white-collar group had a 0.50 times lower risk of non-practice with health screening. The results provide evidence of the need to support cancer survivors in practicing healthy behaviors according to their employment status and occupation. As cancer survivors' economic activities increase, it is necessary to help them manage their health by predicting any possible health-behavior failures.
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Affiliation(s)
- Ka Ryeong Bae
- Samsung Advanced Institute of Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Republic of Korea;
| | - Wi-Young So
- Sport Medicine Major, College of Humanities and Arts, Korea National University of Transportation, Chungju-si 27469, Republic of Korea;
| | - Su Jung Lee
- School of Nursing, Research Institute of Nursing Science, Hallym University, Chuncheon 24252, Republic of Korea
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Berg L, Landberg J, Thern E. Using repeated measures to study the contribution of alcohol consumption and smoking to the social gradient in all-cause mortality: Results from the Stockholm Public Health Cohort. Drug Alcohol Rev 2023; 42:1850-1859. [PMID: 37830637 DOI: 10.1111/dar.13759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 08/21/2023] [Accepted: 09/17/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION The social gradient in consumption behaviours has been suggested to partly explain health inequalities. The majority of previous studies have only included baseline measurements and not considered potential changes in behaviours over time. The study aimed to investigate the contribution of alcohol consumption and smoking to the social gradient in mortality and to assess whether the use of repeated measurements results in larger attenuations of the main association compared to using single baseline assessments. METHODS Longitudinal survey data from the population-based Stockholm Public Health Cohort from 2006 to 2014 was linked to register data on mortality until 2018 for 13,688 individuals and analysed through Cox regression. RESULTS Low socioeconomic position (SEP) was associated with increased mortality compared with high SEP; hazard ratios 1.56 (95% CI 1.30-1.88) for occupational status and 1.77 (95% CI 1.49-2.11) for education, after adjustment for demographic characteristics. Using repeated measurements, alcohol consumption and smoking explained 44% of the association between occupational status and all-cause mortality. Comparing repeated and baseline measures, the percentage attenuation due to alcohol consumption increased from 11% to 18%, whereas it remained similar for smoking (25-23%). DISCUSSION AND CONCLUSIONS Smoking and alcohol consumption explained a large part of the association between SEP and mortality. Comparing results from time-fixed and time-varying models, there was an increase in overall percentage attenuation that was mainly due to the increased proportion explained by alcohol consumption. Repeated measurements provide a better estimation of the contribution of alcohol consumption, but not smoking, for the association between SEP and mortality.
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Affiliation(s)
- Lisa Berg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Jonas Landberg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Emelie Thern
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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8
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Galicia KE, Haider SD, Reidy LE, Anstadt MJ, Kubasiak JC, Gonzalez RP, Patel PP. Association Between Health Insurance and Outcomes After Traumatic Brain Injury: A National ACS-TQP-PUF Database Study. J Surg Res 2023; 290:16-27. [PMID: 37172499 PMCID: PMC10330247 DOI: 10.1016/j.jss.2023.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/16/2023] [Accepted: 03/26/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION According to the US Census Bureau, roughly 8.6% of the population lacks health care coverage. Increasing evidence suggests that insurance status plays a role in outcomes after trauma. However, its role in the setting of traumatic brain injury (TBI) remains poorly understood. METHODS The Trauma Quality Programs Participant Use Files were queried from 2017 to 2019. All patients with isolated TBI were identified. Isolated TBI was defined as: 1) Head Abbreviated Injury Scale (AIS) > 3 and 2) AIS <3 in all other anatomical regions. Patients dead on arrival, with Head AIS = 6, or missing key data were excluded. Demographic and clinical information was compared between those with and without insurance. Multivariate regressions were used to assess associations between insurance status and TBI outcomes (inhospital mortality, discharge to facility, total ventilator days, Intensive Care Unit length of stay (ICU LOS), and hospital LOS). RESULTS In total, 199,556 patients met inclusion criteria; 18,957 (9.5%) were uninsured. Compared to the insured, uninsured TBI patients were younger with a greater proportion of males. Uninsured patients were less severely injured and less comorbid. Uninsured patients had shorter unadjusted LOS in the ICU and hospital. Yet, uninsured patients experienced greater unadjusted inhospital mortality (12.7% versus 8.4%, P < 0.001). When controlling for covariates, lack of insurance was significantly associated with increased likelihood of mortality (OR 1.62; P < 0.001). This effect was most noticeable in patients with Head AIS = 4 (OR 1.55; P < 0.001) and Head AIS = 5 (OR 1.80; P < 0.001). Lack of insurance was also significantly associated with decreased likelihood of discharge to facility (OR 0.38), decreased ICU LOS (Coeff. -0.61), and decreased hospital LOS (Coeff. -0.82; all P < 0.001). CONCLUSIONS This study demonstrates that insurance status is independently associated with outcome disparities after isolated TBI. Despite the Affordable Care Act (ACA) reform, lack of insurance appears significantly associated with inhospital mortality, decreased likelihood of discharge to facility, and decreased time spent in the ICU and hospital.
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Affiliation(s)
- Kevin E Galicia
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois; Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, Illinois
| | - Sarah D Haider
- Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, Illinois.
| | - Lauren E Reidy
- Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, Illinois
| | - Michael J Anstadt
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - John C Kubasiak
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois; Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, Illinois
| | - Richard P Gonzalez
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois; Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, Illinois
| | - Purvi P Patel
- Department of Surgery, Loyola University Medical Center, Maywood, Illinois
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9
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Shebl FM, Qian Y, Foote JHA, Wattananimitgul N, Reddy KP, Neilan AM, Ciaranello AL, Losina E, Freedberg KA, Hyle EP. The association between all-cause mortality and HIV acquisition risk groups in the United States, 2001-2014. PLoS One 2023; 18:e0290113. [PMID: 37590260 PMCID: PMC10434931 DOI: 10.1371/journal.pone.0290113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVE To investigate associations between all-cause mortality and human immunodeficiency virus (HIV) acquisition risk groups among people without HIV in the United States. METHODS We used data from 23,657 (NHANES) participants (2001-2014) and the Linked Mortality File to classify individuals without known HIV into HIV acquisition risk groups: people who ever injected drugs (ever-PWID); men who have sex with men (MSM); heterosexually active people at increased risk for HIV (HIH), using low income as a proxy for increased risk. We used Cox proportional hazards models to estimate adjusted and unadjusted all-cause mortality hazard ratios (HR) with 95% confidence intervals (CI). RESULTS Compared with sex-specific heterosexually active people at average risk for HIV (HAH), the adjusted HR (95% CI) were: male ever-PWID 1.67 (1.14, 2.46), female ever-PWID 3.50 (2.04, 6.01), MSM 1.51 (1.00, 2.27), male HIH 1.68 (1.04, 2.06), female HIH 2.35 (1.87, 2.95), and male ever-PWID 1.67 (1.14, 2.46). CONCLUSIONS Most people at increased risk for HIV in the US experience higher all-cause mortality than people at average risk. Strategies addressing social determinants that increase HIV risk should be incorporated into HIV prevention and other health promotion programs.
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Affiliation(s)
- Fatma M. Shebl
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, Unite States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Yiqi Qian
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, Unite States of America
| | - Julia H. A. Foote
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, Unite States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Nattanicha Wattananimitgul
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, Unite States of America
| | - Krishna P. Reddy
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, Unite States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Anne M. Neilan
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, Unite States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Andrea L. Ciaranello
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, Unite States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard University Center for AIDS Research (CFAR), Cambridge, Massachusetts, United States of America
| | - Elena Losina
- Harvard University Center for AIDS Research (CFAR), Cambridge, Massachusetts, United States of America
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Kenneth A. Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, Unite States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard University Center for AIDS Research (CFAR), Cambridge, Massachusetts, United States of America
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Emily P. Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, Unite States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard University Center for AIDS Research (CFAR), Cambridge, Massachusetts, United States of America
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10
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Landberg J, Thern E. Is the association between alcohol use and sickness absence modified by socioeconomic position? findings from the Stockholm public health cohort. BMC Public Health 2023; 23:1490. [PMID: 37542206 PMCID: PMC10401735 DOI: 10.1186/s12889-023-16341-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/18/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND The distribution of sickness absence tends to be socially patterned less is however known about the underlying mechanisms and pathways of the social gradient found in sickness absence. The present study aims to investigate (i) if the risk function between average volume of alcohol consumption and sickness absence is modified by socio-economic position (SEP), and (ii) whether such an effect modification can be attributed to differences in drinking patterns and other risk factors including other lifestyle behaviours, health status, and working conditions. METHODS The study was based on data from the Stockholm public health cohort 2006, with an analytical sample of 13 855 respondents aged 18-64 years. Self-reported information on occupational class (a measure of SEP), alcohol consumption, other lifestyle behaviour, health and working conditions was collected from the survey. The outcome of long-term (> 14 days) sickness absence between 2006 and 2008 was obtained from national registers. Negative binomial regression was used to estimate the Incidence Rate Ratios (IRR) with 95% confidence intervals (CI). RESULTS In the initial analyses, heavy drinking manual workers had a 5-fold increased risk of long-term sickness absence compared to non-manual employees who were moderate drinkers, and approximately 60% of the excess risk among heavy drinking manual workers was attributable to an interaction between alcohol use and SEP. Adjusting for working conditions was associated with the largest attenuation of the risk estimate, compared to other lifestyle behaviors and health. In the fully adjusted model, the IRR was further attenuated for the manual workers and the joint effect of SEP and heavy drinking remained in the final model with an attributable proportion of 49%. CONCLUSIONS Individuals in Sweden with lower levels of SEP appear to be more vulnerable to alcohol consumption in relation to sickness absence, where differences in working conditions explained a large part but not all of the differential vulnerability.
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Affiliation(s)
- Jonas Landberg
- Department of Public Health Sciences, Stockholm University, 106 91 Stockholm, Stockholm, Sweden.
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
| | - Emelie Thern
- Department of Public Health Sciences, Stockholm University, 106 91 Stockholm, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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11
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Oliván-Blázquez B, Lear-Claveras A, Samper-Pardo M, León-Herrera S, Magallón-Botaya R. Worsening of alcohol abuse disorder in a Spanish population during the first twelve months of the COVID-19 pandemic and associated factors: retrospective, ecological and community study. BMC Psychiatry 2023; 23:504. [PMID: 37438682 DOI: 10.1186/s12888-023-04993-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/01/2023] [Indexed: 07/14/2023] Open
Abstract
PURPOSE To analyse: (1) Changes in clinical parameters and in the use of social healthcare resources by patients with alcohol abuse disorder between the six months prior to the start of the pandemic and the first year of the pandemic. (2) The factors related to a worsening of clinical parameters among patients with alcohol abuse disorder. METHODS A retrospective and observational study of a population who have been diagnosed with alcohol abuse disorders according to their primary health care (PHC) electronic medical records was performed. The total sample was made up of 11,384 patients. The variables (sociodemographic variables, chronic comorbidities, analytical parameters related to alcohol abuse disorder, COVID-19 infection, and use of healthcare resources) were collected in three different time periods: (i) six months before the onset of the strict lockdown, (ii) six months following the end of lockdown and (iii) from six to twelve months after the end of lockdown. Paired Student's T-test and a multivariate logistic regression were performed. RESULTS Along the first year after the onset of the pandemic, between 44% and 54% of the patients suffered a decline in every clinical parameter. The number of PHC nursing, GP visits and social worker visits reduced significantly. As regards the associated factors related to deterioration of alcohol abuse disorder, being younger than 40 years old, having an income of over 18,000 euros/year and not having visited the social worker were associated with a worsening of the disorder. CONCLUSIONS These results suggest that the impact of COVID-19 on this group has been high, and the social care offered to these patients plays a significant role in minimising the repercussions of the pandemic.
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Affiliation(s)
- Bárbara Oliván-Blázquez
- Aragonese Research Group in Primary Care (Grupo Aragonés de Investigación en Atención Primaria/GAIAP), Institute for Health Research Aragon (IISAragon), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, 08007, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, 50.009, Spain
| | - Ana Lear-Claveras
- Aragonese Research Group in Primary Care (Grupo Aragonés de Investigación en Atención Primaria/GAIAP), Institute for Health Research Aragon (IISAragon), Zaragoza, Spain
| | - Mario Samper-Pardo
- Aragonese Research Group in Primary Care (Grupo Aragonés de Investigación en Atención Primaria/GAIAP), Institute for Health Research Aragon (IISAragon), Zaragoza, Spain.
| | - Sandra León-Herrera
- Aragonese Research Group in Primary Care (Grupo Aragonés de Investigación en Atención Primaria/GAIAP), Institute for Health Research Aragon (IISAragon), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, 50.009, Spain
| | - Rosa Magallón-Botaya
- Aragonese Research Group in Primary Care (Grupo Aragonés de Investigación en Atención Primaria/GAIAP), Institute for Health Research Aragon (IISAragon), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, 08007, Spain
- Department of Medicine, University of Zaragoza, Zaragoza, Spain
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12
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Puka K, Kilian C, Zhu Y, Mulia N, Buckley C, Lasserre AM, Rehm J, Probst C. Can lifestyle factors explain racial and ethnic inequalities in all-cause mortality among US adults? RESEARCH SQUARE 2023:rs.3.rs-2701139. [PMID: 37090619 PMCID: PMC10120755 DOI: 10.21203/rs.3.rs-2701139/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Background: Racial and ethnic inequalities in all-cause mortality exist, and individual-level lifestyle factors have been proposed to contribute to these inequalities. In this study, we evaluate the extent to which the association between race and ethnicity and all-cause mortality can be explained by differences in the exposure and vulnerability to harmful effects of different lifestyle factors. Methods: The 1997-2014 cross-sectional, annual US National Health Interview Survey (NHIS) linked to the 2015 National Death Index was used. NHIS reported on race and ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic/Latinx), lifestyle factors (alcohol use, smoking, body mass index, physical inactivity), and covariates (sex, age, education, marital status, survey year). Causal mediation using an additive hazard and marginal structural approach was used. Results: 465,073 adults (18-85 years) were followed 8.9 years (SD:5.3); 49,804 deaths were observed. Relative to White adults, Black adults experienced 21.7 (men; 95%CI: 19.9, 23.5) and 11.5 (women; 95%CI: 10.1, 12.9) additional deaths per 10,000 person-years whereas Hispanic/Latinx women experienced 9.3 (95%CI: 8.1, 10.5) fewer deaths per 10,000 person-years; no statistically significant differences were identified between White and Hispanic/Latinx men. Notably, these differences in mortality were partially explained by both differential exposure and differential vulnerability to these lifestyle factors among Black women, while different effects of individual lifestyle factors canceled each other out among Black men and Hispanic/Latinx women. Conclusions: Lifestyle factors provide some explanation for racial and ethnic inequalities in all-cause mortality. Greater attention to structural, life course, healthcare, and other factors is needed to understand determinants of inequalities in mortality and advance health equity.
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Affiliation(s)
- Klajdi Puka
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH)
| | - Carolin Kilian
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH)
| | | | | | | | | | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH)
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH)
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13
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Al-Haifi AR, Al-Awadhi BA, Bumaryoum NY, Alajmi FA, Ashkanani RH, Al-Hazzaa HM. The association between academic performance indicators and lifestyle behaviors among Kuwaiti college students. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:27. [PMID: 37016438 PMCID: PMC10071657 DOI: 10.1186/s41043-023-00370-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/24/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Lifestyle behaviors are developed during young adulthood and carried through life. Accordingly, early detection of unhealthy behaviors can help prevent the increase in non-communicable diseases in the population. College students are an especially vulnerable group who, upon entering a new environment, tend to engage in unhealthy behaviors. OBJECTIVE The present study aims to evaluate the lifestyle behaviors of Kuwaiti college students and their association with markers of academic achievements. METHODS One thousand two hundred fifty-nine students participated in the present study and answered an online questionnaire pertaining to their sociodemographic status, academic performance indicators, body weight and height, and lifestyle behaviors. Data were collected from November 2020 to February 2021. RESULTS Results of the present study showed that obesity was significantly more prevalent among male participants than among females even though males were more physically active. Alternatively, females had a greater grade point average in college, slept more, and had more screen time. Interestingly, we were unable to detect a significant correlation between lifestyle behaviors and academic achievements. CONCLUSION The observed differences in body mass index between genders may have been attributed to energy intake rather than energy expenditure.
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Affiliation(s)
- Ahmad R Al-Haifi
- Department of Food and Nutrition Sciences, College of Health Sciences, PAAET, Showaikh, Kuwait.
| | - Balqees A Al-Awadhi
- Department of Food and Nutrition Sciences, College of Health Sciences, PAAET, Showaikh, Kuwait
| | - Nayef Y Bumaryoum
- Department of Food and Nutrition Sciences, College of Health Sciences, PAAET, Showaikh, Kuwait
| | - Fahhad A Alajmi
- Department of Food and Nutrition Sciences, College of Health Sciences, PAAET, Showaikh, Kuwait
| | - Rasha H Ashkanani
- Department of Home Economics, Basic Education Collage, PAAET, Showaikh, Kuwait
| | - Hazzaa M Al-Hazzaa
- Lifestyle and Health Research Center, Health Sciences Research Center, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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14
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Farrell SF, Kho PF, Lundberg M, Campos AI, Rentería ME, de Zoete RMJ, Sterling M, Ngo TT, Cuéllar-Partida G. A Shared Genetic Signature for Common Chronic Pain Conditions and its Impact on Biopsychosocial Traits. THE JOURNAL OF PAIN 2023; 24:369-386. [PMID: 36252619 DOI: 10.1016/j.jpain.2022.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/28/2022] [Accepted: 10/06/2022] [Indexed: 11/11/2022]
Abstract
The multiple comorbidities & dimensions of chronic pain present a formidable challenge in disentangling its aetiology. Here, we performed genome-wide association studies of 8 chronic pain types using UK Biobank data (N =4,037-79,089 cases; N = 239,125 controls), followed by bivariate linkage disequilibrium-score regression and latent causal variable analyses to determine (respectively) their genetic correlations and genetic causal proportion (GCP) parameters with 1,492 other complex traits. We report evidence of a shared genetic signature across chronic pain types as their genetic correlations and GCP directions were broadly consistent across an array of biopsychosocial traits. Across 5,942 significant genetic correlations, 570 trait pairs could be explained by a causal association (|GCP| >0.6; 5% false discovery rate), including 82 traits affected by pain while 410 contributed to an increased risk of chronic pain (cf. 78 with a decreased risk) such as certain somatic pathologies (eg, musculoskeletal), psychiatric traits (eg, depression), socioeconomic factors (eg, occupation) and medical comorbidities (eg, cardiovascular disease). This data-driven phenome-wide association analysis has demonstrated a novel and efficient strategy for identifying genetically supported risk & protective traits to enhance the design of interventional trials targeting underlying causal factors and accelerate the development of more effective treatments with broader clinical utility. PERSPECTIVE: Through large-scale phenome-wide association analyses of >1,400 biopsychosocial traits, this article provides evidence for a shared genetic signature across 8 common chronic pain types. It lays the foundation for further translational studies focused on identifying causal genetic variants and pathophysiological pathways to develop novel diagnostic & therapeutic technologies and strategies.
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Affiliation(s)
- Scott F Farrell
- RECOVER Injury Research Centre, The University of Queensland, Herston, Queensland, Australia; NHMRC Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Queensland, Australia; Tess Cramond Pain & Research Centre, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia.
| | - Pik-Fang Kho
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; Molecular Cancer Epidemiology Laboratory, Population Health Program, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia; School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mischa Lundberg
- UQ Diamantina Institute, The University of Queensland & Translational Research Institute, Woolloongabba, Queensland, Australia; Transformational Bioinformatics, CSIRO Health & Biosecurity, North Ryde, New South Wales, Australia
| | - Adrián I Campos
- Institute for Molecular Bioscience, The University of Queensland, St Lucia, Queensland, Australia; Genetic Epidemiology Laboratory, Mental Health & Neuroscience Program, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Miguel E Rentería
- Genetic Epidemiology Laboratory, Mental Health & Neuroscience Program, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Rutger M J de Zoete
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, South Australia, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, The University of Queensland, Herston, Queensland, Australia; NHMRC Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Herston, Queensland, Australia
| | - Trung Thanh Ngo
- RECOVER Injury Research Centre, The University of Queensland, Herston, Queensland, Australia
| | - Gabriel Cuéllar-Partida
- UQ Diamantina Institute, The University of Queensland & Translational Research Institute, Woolloongabba, Queensland, Australia
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15
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Paping DE, Oosterloo BC, El Marroun H, Homans NC, Baatenburg de Jong RJ, van der Schroeff MP, Vroegop JL. Risk Factors For Hearing Decline From Childhood To Early Adolescence. Laryngoscope 2023; 133:389-395. [PMID: 35587728 PMCID: PMC10084436 DOI: 10.1002/lary.30207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To identify risk factors of hearing decline between 9 and 13 years of age. The risk factors examined included sociodemographic, health, and lifestyle-related factors. METHODS This study was embedded within a population-based prospective cohort study from fetal life onwards in the Netherlands. Pure-tone audiometry and tympanometry were performed at the age of 9 and 13 years. The hearing decline was defined as an increase in low-frequency or high-frequency pure-tone average of at least 5 dB in one of both ears. Multivariable logistic regression was performed to examine the association of possible risk factors with hearing decline. The study was conducted from April 2012 to October 2015, and from April 2016 to September 2019. RESULTS Of the 3,508 participants included, 7.8% demonstrated a hearing decline in the low frequencies, and 11.3% in the high frequencies. Participants who reported alcohol consumption were more likely to have a hearing decline in the low frequencies (OR 1.5, 95% CI 1.1; 2.0). Moreover, a lower educational level was associated with an increased odds of having a hearing decline in the high frequencies (OR 1.4, 95% CI 1.0; 1.8). Age, sex, household income, personal music player use, and body mass index were not associated with hearing decline. CONCLUSION Educational level and risky behavior were significantly associated with hearing decline from childhood to early adolescence. The findings of the present study can help in the design of public health interventions to prevent hearing loss at a young age. LEVEL OF EVIDENCE 2 (prospective cohort study) Laryngoscope, 133:389-395, 2023.
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Affiliation(s)
- Danique E Paping
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.,The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Berthe C Oosterloo
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.,The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hanan El Marroun
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Nienke C Homans
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rob J Baatenburg de Jong
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marc P van der Schroeff
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.,The Generation R Study Group, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jantien L Vroegop
- Department of Otorhinolaryngology, Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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16
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Salmani S, Mousavi SH, Navardi S, Hosseinzadeh F, Pashaeypoor S. The barriers and facilitators to health-promoting lifestyle behaviors among people with multiple sclerosis during the coronavirus disease 2019 pandemic: a content analysis study. BMC Neurol 2022; 22:490. [PMID: 36536302 PMCID: PMC9761038 DOI: 10.1186/s12883-022-03019-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND AIM Health-promoting lifestyle behaviors (HPLBs) have a significant impact on disease management among people with multiple sclerosis (MS). However, the coronavirus disease 2019 (COVID-19) pandemic has significantly affected lifestyle of all individuals, particularly patients with chronic diseases. The present study aimed to explore the barriers and facilitators to HPLBs among people with MS during the COVID-19 pandemic. METHODS This qualitative study was conducted in Iran. Participants were sixteen people with MS purposively selected from the central MS clinic of a referral specialty neuroscience hospital in Tehran, Iran. Data were collected via in-depth semi-structured face-to-face interviews and concurrently analyzed through conventional content analysis. FINDINGS The mean of participants' age was 37.93 years and most participants were female (81.25%). The major barriers to HPLBs were lack of knowledge, limited access to resources, and poor health status, while the major facilitators were attention to inner abilities and social support. CONCLUSION Many different factors such as lack of knowledge, limited access to resources, poor health status, awareness, and social support can influence engagement in HPLBs among people with MS. Healthcare authorities and policymakers need to use quality educational and supportive interventions to improve knowledge, health literacy, perceived support, self-efficacy, and self-care ability among people with MS during the COVID-19 pandemic.
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Affiliation(s)
- Soheileddin Salmani
- grid.411705.60000 0001 0166 0922Department of Nursing, Rozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Hossein Mousavi
- grid.411705.60000 0001 0166 0922School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Navardi
- grid.411705.60000 0001 0166 0922Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hosseinzadeh
- grid.411705.60000 0001 0166 0922Department of Community Health Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahzad Pashaeypoor
- grid.411705.60000 0001 0166 0922Department of Community Health and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran ,grid.411705.60000 0001 0166 0922Community Based Participatory Research Center, Iranian Institute for Reduction of High – Risk Behaviors,, Tehran University of Medical Sciences, Tehran, Iran
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17
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Contribution of smoking towards the association between socioeconomic position and dementia: 32-year follow-up of the Whitehall II prospective cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2022; 23:100516. [PMID: 36189426 PMCID: PMC9523395 DOI: 10.1016/j.lanepe.2022.100516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background There is consistent evidence of social inequalities in dementia but the mechanisms underlying this association remain unclear. We examined the role of smoking in midlife in socioeconomic differences in dementia at older ages. Methods Analyses were based on 9951 (67% men) participants, median age 44.3 [IQR=39.6, 50.3] years at baseline in 1985-1988, from the Whitehall II cohort study. Socioeconomic position (SEP) and smoking (smoking status (current, ex-, never-smoker), pack years of smoking, and smoking history score (combining status and pack-years)) were measured at baseline. Counterfactual mediation analysis was used to examine the contribution of smoking to the association between SEP and dementia. Findings During a median follow-up of 31.6 (IQR 31.1, 32.6) years, 628 participants were diagnosed with dementia and 2110 died. Analyses adjusted for age, sex, ethnicity, education, and SEP showed smokers (hazard ratio [HR] 1.36 [95% CI 1.10-1.68]) but not ex-smokers (HR 0.95 [95% CI 0.79-1.14]) to have a higher risk of dementia compared to never-smokers; similar results for smoking were obtained for pack-years of smoking and smoking history score. Mediation analysis showed low SEP to be associated with higher risk of dementia (HRs between 1.97 and 2.02, depending on the measure of smoking in the model); estimate for the mediation effect was 16% for smoking status (Indirect Effect HR 1.09 [95% CI 1.03-1.15]), 7% for pack-years of smoking (Indirect Effect HR 1.03 [95% CI 1.01-1.06]) and 11% for smoking history score (Indirect Effect HR 1.06 [95% CI 1.02-1.10]). Interpretation Our findings suggest that part of the social inequalities in dementia is mediated by smoking. Funding NIH.
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18
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Avila JC, Lee S, Osuoha E, Maglalang DD, Sokolovsky A, Ahluwalia JS. Socioeconomic status across the life course and smoking cessation among older adult smokers in the U.S. Addict Behav 2022; 135:107454. [PMID: 35964392 PMCID: PMC9639006 DOI: 10.1016/j.addbeh.2022.107454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Socioeconomic status (SES) at different stages of the life course impacts late-life health. However, whether SES across the life course impacts smoking cessation in late-life is not known. PURPOSE Assess how life course SES impacts smoking cessation among older smokers. METHODS We identified 5,124 smokers, 50 years and older, from the 1998 to 2018 waves of the Health and Retirement Study. The outcome was self-reported smoking cessation. The main exposure was life course SES, defined as: low child and low adult SES (persistent low); low child, high adult SES (upward mobility); high child, low adult SES (downward mobility); and high child, high adult SES (persistent high). A multilevel mixed-effect logistic model was used to examine how life course SES predicts smoking cessation at age 65 and over time, adjusted for covariates. RESULTS Compared to those with persistent high SES, those with persistent low SES, upward and downward SES were more likely to be Hispanic or non-Hispanic Black. The adjusted results showed that at age 65, compared to those with persistent high SES, those with persistent low SES (OR= 0.69, 95 % CI = [0.51-0.92]), upward SES (OR= 0.49, [0.32-0.75]), and downward SES (OR= 0.55, [0.40-0.76]) were less likely to quit. However, as age increased, only those with downward or persistent low SES were significantly less likely to quit compared to those with persistent high SES. DISCUSSION Social mobility of SES from childhood to adulthood significantly impacts smoking cessation. Both stages of the life course should be considered to understand smoking behaviors.
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Affiliation(s)
- Jaqueline C Avila
- Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, School of Public Health, Brown University, United States.
| | - Sangah Lee
- Department of Epidemiology, School of Public Health, Brown University, United States
| | - Ezinwa Osuoha
- Department if Science and Technology Studies, Cornell University, United States
| | - Dale Dagar Maglalang
- Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, School of Public Health, Brown University, United States
| | - Alexander Sokolovsky
- Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, School of Public Health, Brown University, United States
| | - Jasjit S Ahluwalia
- Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, School of Public Health, Brown University, United States; Department of Medicine, Alpert School of Medicine, Brown University, United States; Brown Cancer Center, Brown University, United States
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19
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Kwon RH, Jung M. Associations Between Conventional Healthy Behaviors and Social Distancing During the COVID-19 Pandemic: Evidence From the 2020 Community Health Survey in Korea. J Prev Med Public Health 2022; 55:568-577. [PMID: 36475322 DOI: 10.3961/jpmph.22.351] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Many studies have shown that social distancing, as a non-pharmaceutical intervention (NPI) that is one of the various measures against coronavirus disease 2019 (COVID-19), is an effective preventive measure to suppress the spread of infectious diseases. This study explored the relationships between traditional health-related behaviors in Korea and social distancing practices during the COVID-19 pandemic. METHODS Data were obtained from the 2020 Community Health Survey conducted by the Korea Disease Control and Prevention Agency (n=98 149). The dependent variable was the degree of social distancing practice to cope with the COVID-19 epidemic. Independent variables included health-risk behaviors and health-promoting behaviors. The moderators were vaccination and unmet medical needs. Predictors affecting the practice of social distancing were identified through hierarchical multiple logistic regression analysis. RESULTS Smokers (adjusted odds ratio [aOR], 0.924) and frequent drinkers (aOR, 0.933) were more likely not to practice social distancing. A greater degree of physical activity was associated with a higher likelihood of practicing social distancing (aOR, 1.029). People who were vaccinated against influenza were more likely to practice social distancing than those who were not (aOR, 1.150). However, people with unmet medical needs were less likely to practice social distancing than those who did not experience unmet medical needs (aOR, 0.757). CONCLUSIONS Social distancing practices were related to traditional health behaviors such as smoking, drinking, and physical activity. Their patterns showed a clustering effect of health inequality. Therefore, when establishing a strategy to strengthen social distancing, a strategy to protect the vulnerable should be considered concomitantly.
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Affiliation(s)
- Rang Hee Kwon
- Department of Health Science, Dongduk Women's University College of Natural Science, Seoul, Korea
| | - Minsoo Jung
- Department of Health Science, Dongduk Women's University College of Natural Science, Seoul, Korea.,Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA
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Dierx JAJ, Kasper HDP. The magnitude and importance of perceived health dimensions define effective tailor-made health-promoting interventions per targeted socioeconomic group. Front Public Health 2022; 10:849013. [PMID: 36324452 PMCID: PMC9618935 DOI: 10.3389/fpubh.2022.849013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 09/06/2022] [Indexed: 01/21/2023] Open
Abstract
Recent insights and developments on health and society urge a critical look at the positive relationship between socioeconomic status (SES) and health. We challenge the notions that it is sufficient to distinguish only between two groups of SES (low and high) and that only overall health is taken into account. A new grouping of SES was developed based on both income and education, resulting in six SES groups. Health was defined in terms of a new positive health concept, operationalized into six health dimensions generating a measure of total general health (TGH). Next, six socioeconomic and demographic determinants of health were included. Linear regression, T-tests and one-way ANOVA were applied to investigate the relationships in a Dutch sample. A subjective way to measure health was applied: self-rated health (SRH). As a result, four out of six dimensions of health determined TGH: bodily functions, daily functioning, quality of life, and social and societal participation. Three out of six socioeconomic and demographic determinants impacted TGH: housing situation, age, and difficulties meeting financial obligations. While this is the general picture for the entire sample, there were interesting similarities and differences between the six SES groups. The similarities lie in the positive impact of the evaluation of bodily functions and daily functioning on TGH in all SES groups. The other dimensions affected TGH in some groups, and some dimensions only in one SES group. None of the socioeconomic and demographic determinants affected TGH in all SES groups. New insights on health inequalities are provided. It is concluded, first that the well-known positive relationship between SES and health is confirmed in this study. Second, further refining the health concept into six dimensions provides more detailed insights on which dimensions impact health the most. The subjective approach applied offers more refined information to better understand which health issues really matter to people. This yields new insights to develop tailor-made interventions aimed at increasing healthy behaviour in specific societal groups.
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Affiliation(s)
- John A. J. Dierx
- Department of Caring Society, Research Group Living in Motion, Avans University of Applied Science, Breda, Netherlands,*Correspondence: John A. J. Dierx
| | - Hans D. P. Kasper
- Department of Marketing and Market Research, Maastricht University School of Business and Economics, Maastricht University, Maastricht, Netherlands
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21
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Knight EL. Two Routes to Status, One Route to Health: Trait Dominance and Prestige Differentially Associate with Self-reported Stress and Health in Two US University Populations. ADAPTIVE HUMAN BEHAVIOR AND PHYSIOLOGY 2022; 8:461-488. [PMID: 36034092 PMCID: PMC9395955 DOI: 10.1007/s40750-022-00199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 12/03/2022]
Abstract
Objective Social status has been extensively linked to stress and health outcomes. However, two routes by which status can be earned – dominance and prestige – may not uniformly relate to lower stress and better health because of inherent behavioral and stress-exposure differences in these two routes. Methods In one exploratory and two preregistered studies, participants (total N = 978) self-reported their trait dominance and prestige and self-reported several stress and health outcomes. Results The meta-effects evident across the three studies indicate that higher trait dominance was associated with worse outcomes – higher stress, poorer physical and mental health, poorer behavioral health, poorer life satisfaction, higher negative affect (range of absolute values of non-zero correlations, |r| = [0.074, 0.315], ps < 0.021) – and higher trait prestige was associated with better outcomes – lower stress, better physical and mental health, better behavioral health, better life satisfaction, higher positive and lower negative mood (|r| = [0.134, 0.478], ps < 0.001). These effects remained evident (with few exceptions) after controlling for socioeconomic status, other status-relevant traits, or self-enhancing motives; associations with behavior relevant to the COVID19 pandemic generally were not robust. Conclusions This work indicates that evolved traits related to the preferred route by which status is earned likely impact self-reported stress and health outcomes. Future research is necessary to examine physiological and other objective indicators of stress and health in more diverse populations. Supplementary Information The online version contains supplementary material available at 10.1007/s40750-022-00199-3.
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22
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COVID-19 and health inequality: the nexus of race, income and mortality in New York City. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE 2022. [DOI: 10.1108/ijhrh-05-2021-0110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose
The purpose of this paper is to evaluate socioeconomic factors related to COVID-19 mortality rates in New York City (NYC) to understand the connections between socioeconomic variables, including race and income and the disease.
Design/methodology/approach
Using multivariable negative binomial regression, the association between health and mortality disparities related to COVID-19 and socioeconomic conditions is evaluated. The authors obtained ZIP code-level data from the NYC Department of Health and Mental Hygiene and the US Census Bureau.
Findings
This study concludes that the mortality rate rises in areas with a higher proportion of Hispanic and Black residents, whereas areas with higher income rates had lower mortality associated with COVID-19, among over 18,000 confirmed deaths in NYC.
Originality/value
The paper highlights the impacts of social, racial and wealth disparities in mortality rates. It brings to focus the importance of targeted policies regarding these disparities to alleviate health inequality among marginalized communities and to reduce disease mortality.
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Masum M, Sparks J. Labor force status as a buffer against mortality risks associated with alcohol consumption: A study of adult U.S. women, 2001-2015. Prev Med 2022; 161:107139. [PMID: 35809823 PMCID: PMC9507174 DOI: 10.1016/j.ypmed.2022.107139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/05/2022] [Accepted: 07/02/2022] [Indexed: 11/25/2022]
Abstract
The association between women's labor force participation, their alcohol consumption patterns, and mortality risk is unclear. This study assessed all-cause mortality risk among women in the United States, considering their labor force status and alcohol drinking. This study used discrete-time hazard models to examine this association using 2001-2015 National Health Interview Survey-Linked Mortality Files (NHIS-LMF) data (n = 147,714) for women aged 25 to 65 with 5725 deaths in this sample. Complex survey-weighted adjustments and E-values calculations were used to limit quantitative and observational biases. Alcohol consumption and labor force status together lead to substantial mortality risks. There is a statistically significant mortality risk among unemployed women (HR 2.15, 95% CI 1.18-3.91) and women not in labor force (HR 2.38, 95% CI 1.87-3.01). In the stratified models, non-Hispanic blacks (HR 1.48, 95% CI 1.30-1.67) and Asians (HR 1.93, 95% CI 1.54-2.44) have heightened mortality risks borne out of employment. Women with higher psychological distress have a 26% higher risk of all-cause mortality when not in labor force. With the help of cross-sectional data, this study demonstrates that women not in labor force and unemployed women are more likely to be affected by their drinking habits, and their employment status is associated with lower mortality risk. Further research should be focused on cause-specific mortality, gender roles and norms, reasons for unemployment, and comorbidities using more recent data, causal modeling techniques, and an extended mortality follow-up period.
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Affiliation(s)
- Muntasir Masum
- Prevention Research Center, The Pennsylvania State University, 314 Biobehavioral Health Building, University Park, PA 16802, United States.
| | - Johnelle Sparks
- Department of Demography, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, United States
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Budhwani H, Naar S. Training Providers in Motivational Interviewing to Promote Behavior Change. Pediatr Clin North Am 2022; 69:779-794. [PMID: 35934499 PMCID: PMC9833492 DOI: 10.1016/j.pcl.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Motivational Interviewing (MI) is a highly specified behavior change communication approach to improve patient-provider relationships, provider communication, and patient health outcomes. Because MI is built on a foundation of patient autonomy support, a feature known to positively influence behavior change during adolescence and emerging adulthood, MI is an evidence-based framework that can inform interventions targeting improvements in health outcomes among youth. MI can be difficult to implement with adequate fidelity, because learning MI requires time and commitment from busy providers with competing priorities. This review addresses best practices for implementing MI within adolescent serving medical settings (eg, pediatrics, family practices, rural health clinics, community health organizations, and so forth), including an orientation to MI, examples of efficacious interventions that were developed leveraging MI, and consideration for the design of training programs that include ongoing support to maximize the likelihood of sustainment.
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Affiliation(s)
- Henna Budhwani
- Department of Health Policy and Organization, University of Alabama at Birmingham (UAB), School of Public Health (SOPH), Birmingham, AL, USA; Florida State University College of Medicine (FSU), Center for Translational Behavioral Science (CTBScience), Tallahassee, FL, USA.
| | - Sylvie Naar
- Florida State University College of Medicine (FSU), Center for Translational Behavioral Science (CTBScience), Tallahassee, FL, USA
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25
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Guimond AJ, Shiba K, Kim ES, Kubzansky LD. Sense of purpose in life and inflammation in healthy older adults: A longitudinal study. Psychoneuroendocrinology 2022; 141:105746. [PMID: 35364478 PMCID: PMC9149071 DOI: 10.1016/j.psyneuen.2022.105746] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/10/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND A higher sense of purpose in life has been linked with reduced risk of age-related chronic health conditions that share elevated inflammation as a key risk factor (e.g., neurodegenerative diseases, heart disease, and diabetes). While prior research has documented cross-sectional associations between higher sense of purpose and lower inflammation, few studies have examined the association between purpose and changes in inflammation over time. OBJECTIVE We tested if a higher sense of purpose was prospectively associated with lower likelihood of developing unhealthy C-reactive protein levels in older adults who initially had healthy CRP levels (i.e., <3 ug/mL). METHODS Participants were 6925 adults aged > 50 in the Health and Retirement Study who were followed for 8 years. Participants completed the purpose in life subscale of the Ryff Psychological Well-being Scales at study baseline in 2006/2008. CRP was obtained from blood spots collected at baseline and after 4 and 8 years of follow-up. Pooled logistic regression estimated discrete-time hazard ratios (HR) and 95% confidence intervals (CI) for the association between baseline purpose and onset of unhealthy CRP levels (>3 ug/mL). RESULTS There was no strong evidence of an association between baseline continuous purpose scores and onset of unhealthy CRP levels over time in the overall analytic sample. In sex-stratified models, higher purpose was associated with lower hazards of developing unhealthy CRP levels among men, while associations were null in women (e.g., in sociodemographics-adjusted model, men: HR=0.89, 95% CI: 0.79-0.99; women: HR=0.96, 95% CI: 0.85-1.08; interaction between continuous purpose scores and sex p = 0.15). CONCLUSIONS Findings suggest that a higher versus lower sense of purpose is associated with lower inflammation levels in older men. In specific populations, purpose may serve as a novel target for future interventions aimed at reducing inflammation.
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Affiliation(s)
- Anne-Josee Guimond
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, Massachusetts, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Koichiro Shiba
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA
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Tedaldi E, Armon C, Li J, Mahnken J, Simoncini G, Palella F, Carlson K, Buchacz K. A Heavy Burden: Preexisting Physical and Psychiatric Comorbidities and Differential Increases Among Male and Female Participants After Initiating Antiretroviral Therapy in the HIV Outpatient Study, 2008-2018. AIDS Res Hum Retroviruses 2022; 38:519-529. [PMID: 35451335 DOI: 10.1089/aid.2021.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Attention to non-AIDS comorbidities is increasingly important in the HIV care and management in the United States. We sought to assess comorbidities before and after antiretroviral therapy (ART) initiation among persons with HIV (PWH). Using the 2008-2018 HIV Outpatient Study (HOPS) data, we assessed changes in prevalence of physical and psychiatric comorbidities, by sex, among participants initiating ART. Cox proportional hazards models were fit to investigate factors associated with the first documented occurrence of key comorbidities, adjusting for demographics and other covariates, including insurance type, CD4+ cell count, ART regimen, and smoking status. Among 1,236 participants who initiated ART (median age 36 years, CD4 cell count 375 cells/mm3), 79% were male, 66% non-white, 44% publicly insured, 53% ever smoked, 33% had substance use history, and 22% had body mass index ≥30 kg/m2. Among females, the percentages with at least one condition were: at ART start, 72% had a physical and 42% a psychiatric comorbidity, and after a median of 6.1 years of follow-up, these were 87% and 63%, respectively. Among males, the percentages with at least one condition were: at ART start, 61% had a physical and 32% a psychiatric comorbidity, and after a median of 4.6 years of follow-up, these were 82% and 53%, respectively. In multivariable Cox proportional hazards analyses, increasing age and higher viral loads (VL) were associated with most physical comorbidities, and being a current/former smoker and higher VL were associated with all psychiatric comorbidities analyzed. HOPS participants already had a substantial burden of physical and psychiatric comorbidities at the time of ART initiation. With advancing age, PWH who initiate ART experience a clinically significant increase in the burden of chronic non-HIV comorbidities that warrants continued surveillance, prevention, and treatment.
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Affiliation(s)
- Ellen Tedaldi
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Carl Armon
- Cerner Corporation, Kansas City, Missouri, USA
| | - Jun Li
- Division of HIV/AIDS Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Gina Simoncini
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Frank Palella
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Kate Buchacz
- Division of HIV/AIDS Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Mezuk B, Kalesnikava V, Spears E, Kirk K, Rafferty J, Del Toro J. Self-Regulatory Coping Behaviors and Stress Reactivity: Exploring the Environmental Affordance Model of Health Disparities. J Aging Health 2022; 34:307-319. [DOI: 10.1177/08982643221085403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To explore the relationship between self-regulatory coping behaviors (SRCB) and hypothalamic pituitary adrenal (HPA) stress reactivity. Methods Data came from the Richmond Stress and Sugar Study (n=125, median age: 57 years, 46% non-Hispanic White, 48% African American). The relationships between 11 SRCB (“health-harming” [e.g., smoking] and “health-promoting” [e.g., exercising]) with HPA stress reactivity, indicated by salivary cortisol response to the Trier Social Stress Test, was assessed using multi-level modeling. Results Health-harming and health-promoting SRCB were positively correlated (+0.33, p<0.001). Several individual behaviors were related to HPA stress reactivity, for example, smoking and meditation were associated with shallower increases in cortisol (smoking: −13.0%, 95%CI: −20.9% to −4.3%; meditation: −14.0%, 95%CI: −22.0% to −5.1%). However, SRCB summary measures were unrelated to stress reactivity. Discussion Health-harming and health-promoting SRCB are inter-related. Specific behaviors, rather than groupings as health-harming versus -promoting, are related to HPA stress reactivity.
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Affiliation(s)
- Briana Mezuk
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Viktoryia Kalesnikava
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Erica Spears
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Keri Kirk
- Department of Family Medicine, MedStar Georgetown University Hospital, Georgetown University, Washington DC, USA
| | - Jane Rafferty
- Research Center for Group Dynamics, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Juan Del Toro
- Learning Research and Development Center, University of Pittsburgh, Pittsburgh, PA, USA
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Joshi S, Garlapati C, Aneja R. Epigenetic Determinants of Racial Disparity in Breast Cancer: Looking beyond Genetic Alterations. Cancers (Basel) 2022; 14:cancers14081903. [PMID: 35454810 PMCID: PMC9025441 DOI: 10.3390/cancers14081903] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary A substantial disparity in breast cancer incidence and mortality exists between African American (AA) and European American (EA) women. However, the basis for these disparities is poorly understood. In this article, we describe that gene–environment interactions mediated through epigenetic modifications may play a significant role in racial disparities in BC incidence and outcomes. Our in silico analyses and an in-depth literature survey suggest that there exists a significant difference in epigenetic patterns between AA and EA women with breast cancer. Herein, we describe the environmental factors that contribute to these epigenetic changes, which may underlie the disparate racial burden in patients with breast cancer. We suggest that AA women with higher basal epigenetic changes, may have higher pre-disposition to cancer onset, and an aggressive disease course. Pre-existing racial differences in epigenetic profiles of breast tissues raises the possibility of examining these profiles for early diagnosis. Abstract Breast cancer (BC) is the most commonly diagnosed cancer in women. Despite advancements in BC screening, prevention, and treatment, BC incidence and mortality remain high among African American (AA) women. Compared with European American (EA) women, AA women tend to be diagnosed with more advanced and aggressive tumors and exhibit worse survival outcomes. Most studies investigating the determinants of racial disparities in BC have focused on genetic factors associated with African ancestry. However, various environmental and social stressors over an individual’s life course can also shape racial stratification in BC. These social and environmental exposures result in long-term changes in gene expression mediated by epigenetic mechanisms. Epigenetics is often portrayed as an intersection of socially patterned stress and genetic expression. The enduring nature of epigenetic changes makes them suitable for studying the effects of different environmental exposures over an individual’s life course on gene expression. The role of differential social and environmental exposures in racial disparities in BC suggests varied epigenetic profiles or signatures associated with specific BC subtypes in AA and EA women. These epigenetic profiles in EA and AA women could be used as biomarkers for early BC diagnosis and disease prognosis and may prove valuable for the development of targeted therapies for BC. This review article discusses the current state of knowledge regarding epigenetic differences between AA and EA women with BC. We also discuss the role of socio-environmental factors, including psychosocial stress, environmental toxicants, and dietary factors, in delineating the different epigenetic profiles in AA and EA patients with BC.
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Affiliation(s)
- Shriya Joshi
- Department of Biology, Georgia State University, Atlanta, GA 30303, USA; (S.J.); (C.G.)
| | | | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, GA 30303, USA; (S.J.); (C.G.)
- Department of Clinical and Diagnostics Sciences, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Correspondence: or
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Shahzad S, Younas A, Ali P. Social justice education in nursing: An integrative review of teaching and learning approaches and students' and educators' experiences. NURSE EDUCATION TODAY 2022; 110:105272. [PMID: 35092915 DOI: 10.1016/j.nedt.2022.105272] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/11/2021] [Accepted: 01/16/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To synthesize literature about teaching social justice to nursing students and identify approaches for effective teaching of social justice issues in nursing education. DESIGN An integrative review. DATA SOURCES Literature was searched in CINAHL, PubMed, Scopus, Science Direct, and OVID databases. In total, 32 articles were assessed for full-text eligibility, and 18 articles published from January 2011 until August 2021 were critically appraised and reviewed. REVIEW METHODS Articles were appraised using Mixed Methods Appraisal Tool. Data analysis and synthesis were completed using literature summary tables, constant comparative analysis, and thematic synthesis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines were followed for reporting. RESULTS Two themes: Teaching Approaches Fostering Student Learning of Social Justice and Capabilities Promoting Effective Teaching and Learning about Social Justice were generated. The teaching and learning approaches included experiential, reflective and case based. The necessary capabilities to foster social justice education were intrapersonal assessment and collaboration of educators and students. CONCLUSIONS Participating in interactive, group, and relational simulations and service-learning, interpersonal dialogues, and collaborative work in critical community-based pedagogies has the potential to develop students' competencies to practice social justice in their everyday practice. Nurse educators should be mindful of personal biases and competencies concerning social justice and take proactive steps to develop competencies for effectively teaching students. Nurse educators can implement teaching strategies integrating real clinical cases to improve students learning of social justice and impartial care for vulnerable populations.
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Affiliation(s)
| | - Ahtisham Younas
- Swat College of Nursing, Mingora, Swat, Pakistan; Faculty of Nursing, Memorial University of Newfoundland, Canada.
| | - Parveen Ali
- University of Sheffield, Sheffield, South Yorkshire, UK; Sheffiled University Interpersonal Violence Research Group, The University of Sheffiled SEAS, Sheffield, UK
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Greenwood J, Zurek KI, Grimm JM, Wi CI, Vogel JT, Garrison GM. Association of a housing based individual socioeconomic status measure with diabetic control in primary care practices. Prim Care Diabetes 2022; 16:78-83. [PMID: 34802978 DOI: 10.1016/j.pcd.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/12/2021] [Accepted: 10/05/2021] [Indexed: 11/26/2022]
Abstract
AIMS Socioeconomic status (SES) is an important variable that impacts healthcare outcomes. However, grouped SES data is not always representative of all members and it is difficult to obtain individual level data. A validated individual housing-based measure termed HOUSES is available, but has not been studied in diabetes. We hypothesize that patients in the lowest HOUSES quartile are associated with worse diabetic control as measured by the D5. METHODS A retrospective cohort study of 5463 patients with diabetes in 5 patient centered medical home practices in southeast Minnesota was conducted. HOUSES is a validated, standardized housing-based SES measure constructed from publicly available county assessor's office data. Diabetic control was assessed by the D5 (HgbA1c < 8, BP < 140/90, statin use, nonsmoking status, and antiplatelet therapy). RESULTS In the lowest HOUSES quartile, more patients had an uncontrolled D5 (56.4%) than any of the other quartiles (49.2%, 49.8%, 49.6% respectively, p < 0.001). A multivariate analysis shows the adjusted odds of D5 control for patients in the 2nd, 3rd or 4th HOUSES quartiles as opposed to the 1st quartile are 1.28, 1.21, and 1.20, respectively. CONCLUSION Lower SES as represented by the first quartile of HOUSES index, is associated with lower odds of D5 control and thus worse diabetic outcomes. Using the HOUSES index to identify these individuals in a patient centered medical home might prove useful in deciding where to focus diabetic control efforts.
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Affiliation(s)
- Jason Greenwood
- Department of Family Medicine, Mayo Clinic, Rochester, MN, United States
| | - Kaitlyn I Zurek
- Department of Family Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jade M Grimm
- Department of Family Medicine, Mayo Clinic, Rochester, MN, United States
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States; Precision Population Science Lab, Mayo Clinic, Rochester, MN, United States
| | - John T Vogel
- Department of Family Medicine, Mayo Clinic, Rochester, MN, United States
| | - Gregory M Garrison
- Department of Family Medicine, Mayo Clinic, Rochester, MN, United States.
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Borger TN, Puleo GE, Rivera Rivera JN, Montgomery D, Bowling WR, Burris JL. A descriptive study of cervical cancer survivors' persistent smoking behavior and perceived barriers to quitting. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2022; 36:109-116. [PMID: 33764090 PMCID: PMC8463620 DOI: 10.1037/adb0000692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Cervical cancer survivors (CCS) tend to smoke cigarettes at rates much higher than other cancer survivors and women in the general population. However, few studies take a deep dive into the smoking behavior of cervical cancer survivors and none focus on the barriers they experience related to smoking cessation. This study aimed to describe CCS' tobacco use characteristics, quit attempts, and barriers to quit success. METHOD In a concurrent mixed-method design, 50 CCS (94% White nonHispanic) who were diagnosed in the past 5 years and were current smokers at diagnosis provided data via standardized questionnaire and semi-structured interview. RESULTS More than three-quarters of participants were current smokers at the time of study participation, 25.6% of whom also reported noncigarette tobacco use (e.g., electronic cigarette, cigar, snus). Seventy percent of participants reported making at least one 24 hr quit attempt postdiagnosis, with 61.5% of current smokers preferring to quit without professional advice or counseling and 51.3% preferring to quit without medication assistance. Four themes emerged regarding barriers to smoking cessation: motivation and readiness; confidence and uncertainty; triggers; and social and environmental factors. CONCLUSIONS The rate of smoking in CCS is remarkably high, which may partly be explained by negative attitudes toward and low use of evidence-based treatment as well as multi-level barriers to smoking cessation. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Tia N. Borger
- Department of Psychology, University of Kentucky, Lexington KY, USA
| | | | | | | | | | - Jessica L. Burris
- Department of Psychology, University of Kentucky, Lexington KY, USA,Markey Cancer Center, University of Kentucky, Lexington KY, USA
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Sudharsanan N, Bijlsma MJ. Educational note: causal decomposition of population health differences using Monte Carlo integration and the g-formula. Int J Epidemiol 2022; 50:2098-2107. [PMID: 34999885 PMCID: PMC8743135 DOI: 10.1093/ije/dyab090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/14/2022] Open
Abstract
One key objective of the population health sciences is to understand why one social group has different levels of health and well-being compared with another. Whereas several methods have been developed in economics, sociology, demography, and epidemiology to answer these types of questions, a recent method introduced by Jackson and VanderWeele (2018) provided an update to decompositions by anchoring them within causal inference theory. In this paper, we demonstrate how to implement the causal decomposition using Monte Carlo integration and the parametric g-formula. Causal decomposition can help to identify the sources of differences across populations and provide researchers with a way to move beyond estimating inequalities to explaining them and determining what can be done to reduce health disparities. Our implementation approach can easily and flexibly be applied for different types of outcome and explanatory variables without having to derive decomposition equations. We describe the concepts of the approach and the practical steps and considerations needed to implement it. We then walk through a worked example in which we investigate the contribution of smoking to sex differences in mortality in South Korea. For this example, we provide both pseudocode and R code using our package, cfdecomp. Ultimately, we outline how to implement a very general decomposition algorithm that is grounded in counterfactual theory but still easy to apply to a wide range of situations.
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Affiliation(s)
| | - Maarten J Bijlsma
- Laboratory of Population Health, Max Planck Institute for Demographic Research, Germany
- Groningen Research Institute of Pharmacy, Unit Pharmacotherapy, -Epidemiology & -Economics (PTEE), University of Groningen, the Netherlands
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Capaldi DM, Tiberio SS, Kerr DCR, Owen LD. Associations of Cannabis Use across Adolescence and Early Adulthood With Health and Psychosocial Adjustment in Early Adulthood and Midadulthood in Men. Subst Abuse 2022; 16:11782218221096154. [PMID: 35677294 PMCID: PMC9168876 DOI: 10.1177/11782218221096154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/06/2022] [Indexed: 11/15/2022]
Abstract
Background: Associations between men’s prior cannabis use and their physical and
psychosocial adjustment were examined using prospective data across
adolescence (ages 13-20 years), early adulthood (ages 20-30 years), and
midadulthood (ages 30-38 years). The theoretical framework was based in
developmental-contextual and lifespan approaches. Method: Models were tested using men in the Oregon Youth Study who had been studied
since ages 9 to 10 years and who, in childhood, lived in neighborhoods with
higher than average rates of delinquency. Cannabis use in adolescence was
used to predict early adult outcomes (and early adult use to midadult
outcomes). In addition, a set of covariates was added to the models,
including childhood risk factors assessed at age 9 years (ie, family
socioeconomic status; externalizing behaviors; and if available, the
childhood proxy for the outcome [eg, age 9 intelligence scale]) and alcohol
use in adolescence (or early adulthood). physical health outcomes included
accidental injuries, problems resulting from a prior injury, body mass
index, self-report health, and also pain and cardiovascular risk (blood
pressure and pulse rate) in midadulthood. Psychosocial outcomes included
income, housing insecurity, intelligence, depressive symptoms, psychosis
symptoms, hostility/aggression, social problems, and attention problems. Results: Whereas there was almost no prediction from prior cannabis use to the
physical health outcomes, there were comprehensive associations of cannabis
use from the prior developmental period and psychosocial outcomes in both
early adulthood and midadulthood. Conclusion: Cannabis use in prior developmental periods was associated with a broad range
of types of poor psychosocial adjustment in adulthood.
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Affiliation(s)
- Deborah M Capaldi
- Deborah M Capaldi, Oregon Social Learning
Center, 10 Shelton McMurphey Blvd, Eugene, OR 97401, USA.
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Shahzad S, Ali N, Younas A, Tayaben JL. Challenges and approaches to transcultural care: An integrative review of nurses' and nursing students' experiences. J Prof Nurs 2021; 37:1119-1131. [PMID: 34887030 DOI: 10.1016/j.profnurs.2021.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Provision of transcultural care is an essential nursing competency. It is important to comprehensively understand the challenges nurses and nursing students face while striving to provide transcultural care in clinical settings. PURPOSE The purpose of this review was to develop a comprehensive understanding of nurses' and nursing students' challenges and approaches to the provision of transcultural care to people with diverse ethnicities. METHODS An integrative review was conducted. Literature was searched within five databases, and 30 studies published from January 2010 to January 2021 were reviewed and appraised using mixed methods critical appraisal tool. Literature summary tables and inductive approaches were used for data extraction and synthesis. RESULTS The challenges to the provision of transcultural care were intrapersonal struggle, cultural conflicts, varied expressions of pain and suffering, and navigation of personal and organizational constraints. Addressing these challenges required nurses and students to practice self-criticism and tolerate differences, develop interpersonal and psychological skills, and collaborate with peers and patients' families. CONCLUSIONS Provision of transcultural care is a complex task for nurses and students because of different interpretation of personal and organizational factors. Health care institutions should proactively provide resources to nurses and students to strengthen their interpersonal and psychological skills to provide effective transcultural care.
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Affiliation(s)
| | - Nizar Ali
- Prime Institute of Health Sciences, Islamabad, Pakistan; PAEC General Hospital Islamabad, Pakistan
| | - Ahtisham Younas
- Swat College of Nursing, Mingora Swat, Pakistan; Faculty of Nursing, Memorial University of Newfoundland, Canada.
| | - Jude L Tayaben
- College of Nursing, Benguet State University @ La Trinidad, Philippines
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Xu F, Wheaton AG, Liu Y, Lu H, Greenlund KJ. Higher Prevalence of Health-Risk Factors Among US Adults With Unmet Health Care Needs Due to Cost, 2016. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:E19-E27. [PMID: 31305323 PMCID: PMC10498391 DOI: 10.1097/phh.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Adults with unmet health care needs (UHCN) due to cost have fewer opportunities to receive behavioral counseling in clinical settings, which may be associated with a higher likelihood of having health-risk behaviors. OBJECTIVE This study assessed associations between UHCN and health-risk factors. DESIGN/SETTING We used 2016 Behavioral Risk Factor Surveillance System data to calculate age-adjusted weighted prevalence of 5 health-risk factors by UHCN and insurance status and to assess the association of UHCN with these factors using multivariable logistic regression. PARTICIPANTS US adults aged 18 to 64 years who participated in the survey (N = 301 035). MAIN OUTCOME MEASURES Five health-risk factors: obesity, current cigarette smoking, excessive alcohol use, sleeping less than 7 hours per 24-hour period, and no leisure-time physical activity within the past month. RESULTS In 2016, among adults aged 18 to 64 years, 11.2% of those with insurance and 40.1% of those without insurance (both age-adjusted) had UHCN. In both study populations, compared with adults with no UHCN, adults reporting UHCN were more likely to be a current cigarette smoker, report excessive alcohol use, and sleep less than 7 hours per 24-hour period. The prevalence of 3 or more health-risk factors was higher among adults with UHCN than among adults without UHCN (adults with insurance: adjusted prevalence ratio = 1.40; 95% confidence interval = 1.33-1.48; adults without insurance: adjusted prevalence ratio = 1.39; 95% confidence interval = 1.27-1.53). CONCLUSIONS Unmet health care needs was associated with more health-risk factors regardless of insurance status. Addressing cost barriers to behavioral counseling may be one approach to consider when seeking to reduce health-risk behaviors among high-risk populations.
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Affiliation(s)
- Fang Xu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Chrystoja BR, Monteiro MG, Owe G, Gawryszewski VP, Rehm J, Shield K. Mortality in the Americas from 2013 to 2015 resulting from diseases, conditions and injuries which are 100% alcohol-attributable. Addiction 2021; 116:2685-2696. [PMID: 33844362 DOI: 10.1111/add.15475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/26/2020] [Accepted: 02/24/2021] [Indexed: 12/13/2022]
Abstract
AIMS To describe mortality in the Americas from 2013 to 2015 inclusive resulting from diseases, conditions and injuries which are 100% attributable to alcohol consumption. DESIGN AND SETTING Mortality registry, population-based study. The data come from 30 of the 35 countries of the Americas for the triennium of 2013 to 2015. PARTICIPANTS AND CASES A total of 18 673 791 deaths coded by three-digit ICD-10 codes were analyzed. MEASUREMENTS Cause (underlying), and age-specific and age-adjusted mortality rates were calculated by sex and country. FINDINGS From 2013 to 2015 inclusive, among 30 of the 35 countries of the Americas, an average of 85 032 deaths per year were entirely attributable to alcohol. Men accounted for 83.1% of all 100% alcohol-attributable deaths, and death rates were higher for men than for women across all countries; however, the ratios of 100% alcohol-attributable deaths by sex varied by country. The majority of all 100% alcohol-attributable deaths occurred among those aged under 60 years (64.9%) and were due to liver disease (63.9%) followed by neuropsychiatric disorders (27.4%). Age-adjusted 100% alcohol-attributable mortality rates were highest in Nicaragua (23.2 per 100 000) and Guatemala (19.0 per 100 000), although the majority of all 100% alcohol-attributable deaths occurred in the United States 36.9%), Brazil (24.8%), and Mexico (18.4%). CONCLUSIONS From 2013 to 2015, more than 85 000 deaths in the Americas were 100% attributable to alcohol. Most of those occurred in people under 60 years and the highest mortality rates occurred in the United States, Brazil and Mexico.
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Affiliation(s)
- Bethany R Chrystoja
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,World Health Organization and Pan American Health Organization Collaborating Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Maristela G Monteiro
- Mental Health and Substance Use Unit, Noncommunicable Diseases and Mental Health Department, Pan American Health Organization, Washington, DC, USA
| | - Glory Owe
- Mental Health and Substance Use Unit, Noncommunicable Diseases and Mental Health Department, Pan American Health Organization, Washington, DC, USA
| | - Vilma Pinheiro Gawryszewski
- Health Analysis and Equity Metrics Unit, Evidence and Intelligence for Action in Health Department, Pan American Health Organization, Washington, DC, USA
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,World Health Organization and Pan American Health Organization Collaborating Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,Institute of Clinical Psychology and Psychotherapy and Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Kevin Shield
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,World Health Organization and Pan American Health Organization Collaborating Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Pothisiri W, Prasitsiriphon O, Saikia N, Aekplakorn W. Education and grip strength among older Thai adults: A mediation analysis on health-related behaviours. SSM Popul Health 2021; 15:100894. [PMID: 34458550 PMCID: PMC8379495 DOI: 10.1016/j.ssmph.2021.100894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/04/2021] [Accepted: 08/07/2021] [Indexed: 01/16/2023] Open
Abstract
Abstract. BACKGROUND Previous studies have investigated the effect of differential educational attainment at younger ages on health disparities among older adults, but how such an effect can be attenuated remains understudied. This study examines the mediating effects of four health-related behaviours, namely smoking, alcohol drinking, healthy eating, and physical activity, on the relationship between older adults' education and grip strength. METHODS The study used data from 7,064 individuals aged 60 years and older who participated in the 2009 National Health Examination Survey of Thailand. To examine the relationships among education, health behaviours, and grip strength, multivariate regressions were performed following Baron and Kenny's approach. Generalized Structural Equation Modelling (SEM) was utilized to quantify the mediating effects. RESULTS All else being equal, education is positively associated with stronger grip for both genders. The mediation analyses demonstrate that health-related behaviour plays an important role in the relationship between education and grip strength; however, the extent to which it mediates the effect of education varies with the type of health behaviour and between genders. Not smoking and engaging in physical activity can partly explain the relationship between education and grip strength in older men. Meanwhile, the consumption of fruits and vegetables and participation in regular physical activity significantly mediate the effect of education on grip strength in older women. CONCLUSION Our study reaffirms the importance of educational opportunity in earlier life and recommends health-related behavioural modifications to improve health status in low-educated older adults.
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Affiliation(s)
- Wiraporn Pothisiri
- College of Population Studies, Chulalongkorn University, Pathumwan, Bangkok, Thailand
| | - Orawan Prasitsiriphon
- Health Insurance System Research Office, Health System Research Institute, Bang Khen, Nonthaburi, Thailand
| | - Nandita Saikia
- Population Studies Centre for the Study of Regional Development (CSRD), Jawaharlal Nehru University, New Delhi, India
| | - Wichai Aekplakorn
- Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
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Shi J, Tarkiainen L, Martikainen P, van Raalte A. The impact of income definitions on mortality inequalities. SSM Popul Health 2021; 15:100915. [PMID: 34527804 PMCID: PMC8433258 DOI: 10.1016/j.ssmph.2021.100915] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022] Open
Abstract
Income is a strong predictor of adult mortality. Measuring income is not as simple as it may sound. It can be conceptualized at the individual or the household level, with the former better reflecting an individual's earning ability, and the latter better capturing living standards. Furthermore, respondents are often grouped into income categories based on their positions in the income distribution, and this operationalization can be done on the basis of age-specific or total population income distributions. In this study, we look at how four combinations of different conceptualizations (individual vs. household) and operationalizations (age-specific vs. total population) of income can affect mortality inequality estimates. Using Finnish registry data, we constructed period life tables for ages 25+ from 1996 to 2017 by gender and for four income definitions. The results indicated that the slope index of inequality for life expectancy varied by 1.1-5.7 years between income definitions, with larger differences observed for women than for men. The overall age patterns of relative index of inequality for mortality rates yielded by the four definitions were similar, but the levels differed. The period trends across income definitions were consistent for men, but not for women. We conclude that researchers should pay particular attention to the choice of the income definitions when analyzing the association between income and mortality, and when comparing the magnitude of inequality across studies and over time.
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Affiliation(s)
- Jiaxin Shi
- Max Planck Institute for Demographic Research, Rostock, Germany
- Leverhulme Centre for Demographic Science, Department of Sociology, University of Oxford, Oxford, United Kingdom
| | - Lasse Tarkiainen
- Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Max Planck Institute for Demographic Research, Rostock, Germany
- Population Research Unit, University of Helsinki, Helsinki, Finland
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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Socioeconomic disparities and risk of hypertension among older Americans: the Health and Retirement Study. J Hypertens 2021; 39:2497-2505. [PMID: 34387572 DOI: 10.1097/hjh.0000000000002959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reducing hypertension represents a critical point of intervention to lower the burden of cardiovascular disease worldwide. Although the relationship between lower socioeconomic status and higher rates of hypertension is well documented, most of the evidence comes from prevalence studies involving young adult population. AIM To investigate the independent association of wealth, education and income with incident hypertension among older adults living in the United States. METHODS This cohort study included 16 587 individuals aged 50 years and older, free of hypertension and cardiovascular disease at baseline from the Health and Retirement Study over the period 1992-2014. We used Cox proportional hazards models to examine longitudinal associations between wealth, education, and income at baseline and self-reported diagnosis of incident hypertension. RESULTS During a median follow-up of 7.8 years, 6817 participants declared an occurrence of hypertension (incidence rate: 45.3 [95% confidence interval (CI) = 44.2-46.4] per 1000 person-years). Overall, those in low as compared with high socioeconomic status groups had a higher risk of developing hypertension in late life. In particular, adjusted hazard ratios [95% CI] across decreasing wealth quartiles were 1.0 (reference), 0.97 [0.88-1.08], 1.17 [1.05-1.30], and 1.20 [1.07-1.35] in men, and 1.0 (reference), 1.28 [1.17-1.41], 1.21 [1.09-1.33], and 1.28 [1.16-1.42] in women. In multivariate analyses, wealth remained strongly associated with incident hypertension among women after accounting for other socioeconomic, behavioral and anthropometric risk factors. CONCLUSIONS Socioeconomic status, especially wealth, is a strong independent predictor of incident hypertension in older adults. Our findings support population-based interventions tailored to those in disadvantaged socioeconomic groups to reduce the risk of hypertension.
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Younas A, Shahzad S. Emphasizing the need to integrate and teach sociocultural determinants of health in undergraduate nursing curricula. NURSE EDUCATION TODAY 2021; 103:104943. [PMID: 34023730 DOI: 10.1016/j.nedt.2021.104943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/27/2021] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
Sociocultural determinants affect health and illness experiences, care choices, and preferences of patients. Nursing curricula include limited content about sociocultural determinants of health in clinical courses. Nevertheless, nursing students must be prepared to understand the complexities of nursing practice beyond acute care and to examine the influence of sociocultural determinants and their linkages to health behaviors of various patient populations. The purpose of this discussion is to emphasize the need for greater integration and teaching of social determinants of health in undergraduate nursing curricula.
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Affiliation(s)
- Ahtisham Younas
- Memorial University of Newfoundland, Canada; Swat College of Nursing, Swat, Pakistan.
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Liu Q, Huang S, Qu X, Yin A. The status of health promotion lifestyle and its related factors in Shandong Province, China. BMC Public Health 2021; 21:1146. [PMID: 34130669 PMCID: PMC8207564 DOI: 10.1186/s12889-021-11152-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study aims to explore the status of Shandong Province, China residents' health promotion lifestyle and its influencing factors, especially to explore how health attitude affects health promotion lifestyle, thus can make targeted recommendations for health promotion in China and similar areas. METHODS 1800 adults were selected from urban and rural areas of Shandong Province, China, using multistage stratified, cluster random sampling method. A survey was conducted face-to-face from March to May, 2018, using Health Promotion Lifestyle Profile and Health Attitude Questionnaire. The between-group measured data were compared by One-way ANOVA or t-tests. The correlation between the health attitude and health promotion lifestyle was examined by Pearson correlation. Logistic regression model was used to examine the related factors influencing health promotion lifestyle. Health promotion lifestyle is the dependent variable, and gender, education level, annual family per capita income and health attitude are the independent variables. RESULTS The mean (SD) of HPLP-IICR total score of the participants was 82.12(16.63). 54.50% of the participants had poor or average health promotion lifestyle, while 45.50% had good or excellent health promotion lifestyle. Significant differences existed in health promotion lifestyle among different gender, education level, income level, marital status, and health attitude (Ps < 0.001). Multivariable Logistic regression model found that male (OR = 0.35, 95% CI: 0.12-0.34), high school education level (OR = 0.57, 95% CI:0.17-0.41), junior middle school & below (OR = 0.42; 95% CI:0.12-0.33), annual family per capita income with < 10,000 CNY (OR = 2.53, 95% CI:1.24-2.06; OR = 2.14, 95% CI:1.08-3.12), low health affection (OR = 0.39, 95% CI:2.15-4.22), and low health behavioral intention (OR = 0.21; 95% CI: 2.33-5.29) were statistically significant correlates of average or poor health promotion lifestyle. CONCLUSIONS The health lifestyle needs to be further promoted in Shandong Province, China. The government and social sectors are encouraged to make more efforts to improve the accessibility and quality of health services. Meanwhile, individual responsibility cannot be ignored as well. More affective factors and operable measures should be added to enhance health affection and health behavioral intention, so as to enhance health promotion lifestyle.
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Affiliation(s)
- Qianqian Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
- Student Counseling Center, Shandong University, Jinan, 250100, China
| | - Shusheng Huang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Xiaoyuan Qu
- School of Nursing and Health, Henan University, Kaifeng, 475000, China
| | - Aitian Yin
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China.
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A Cross-Sectional Audit of Nutrition and Health Claims on Dairy Yoghurts in Supermarkets of the Illawarra Region of New South Wales, Australia. Nutrients 2021; 13:nu13061835. [PMID: 34072130 PMCID: PMC8229526 DOI: 10.3390/nu13061835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022] Open
Abstract
Health and nutrition claims are used by consumers to guide purchasing decisions. In consequence, monitoring and evaluation of such claims to ensure they are accurate and transparent is required. The aim of this study was to investigate the use of nutrition and health claims on dairy-yoghurt products within select Australian supermarkets and assess their compliance with the revised Food Standards Code (FSC). Nutrition, health, and related claims on yoghurt products were assessed in a cross-sectional audit of five supermarkets in the Illawarra region of New South Wales. Claim prevalence, type, and compliance were assessed and products were compared against current rating measures. A total of n = 340 dairy yoghurt products were identified. Most products (97.9%) carried at least one nutrition and/or health claim, with nutrition-content claims (93.9%) the most prevalent. Most products (n = 277) met the nutrient profiling scoring criterion; while 87.9% of products did not carry the health star rating. Almost all claims surveyed (97.4%) were compliant with the FSC. Health and nutrition claims are highly prevalent across yoghurt categories, with the majority of these compliant with regulations. The ambiguity surrounding the wording and context of claims challenges researchers to investigate consumers’ interpretations of health messaging within the food environment.
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Ozieh MN, Garacci E, Walker RJ, Palatnik A, Egede LE. The cumulative impact of social determinants of health factors on mortality in adults with diabetes and chronic kidney disease. BMC Nephrol 2021; 22:76. [PMID: 33639878 PMCID: PMC7916298 DOI: 10.1186/s12882-021-02277-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/15/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A growing body of evidence supports the potential role of social determinants of health on health outcomes. However, few studies have examined the cumulative effect of social determinants of health on health outcomes in adults with chronic kidney disease (CKD) with or without diabetes. This study examined the cumulative impact of social determinants of health on mortality in U.S. adults with CKD and diabetes. METHODS We analyzed data from National Health and Nutrition Examination Surveys (2005-2014) for 1376 adults age 20 and older (representing 7,579,967 U.S. adults) with CKD and diabetes. The primary outcome was all-cause mortality. CKD was based on estimated glomerular filtration rate and albuminuria. Diabetes was based on self-report or Hemoglobin A1c of ≥6.5%. Social determinants of health measures included family income to poverty ratio level, depression based on PHQ-9 score and food insecurity based on Food Security Survey Module. A dichotomous social determinant measure (absence vs presence of ≥1 adverse social determinants) and a cumulative social determinant score ranging from 0 to 3 was constructed based on all three measures. Cox proportional models were used to estimate the association between social determinants of health factors and mortality while controlling for covariates. RESULTS Cumulative and dichotomous social determinants of health score were significantly associated with mortality after adjusting for demographics, lifestyle variables, glycemic control and comorbidities (HR = 1.41, 95%CI 1.18-1.68 and HR = 1.41, 95%CI 1.08-1.84, respectively). When investigating social determinants of health variables separately, after adjusting for covariates, depression (HR = 1.52, 95%CI 1.10-1.83) was significantly and independently associated with mortality, however, poverty and food insecurity were not statistically significant. CONCLUSIONS Specific social determinants of health factors such as depression increase mortality in adults with chronic kidney disease and diabetes. Our findings suggest that interventions are needed to address adverse determinants of health in this population.
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Affiliation(s)
- Mukoso N Ozieh
- Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA.
- Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA.
| | - Emma Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Anna Palatnik
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Wang A, Kho AN, Black B, French DD. Determining the feasibility of an index of the social determinants of health using data from public sources. Inform Health Soc Care 2021; 46:205-217. [PMID: 33632053 DOI: 10.1080/17538157.2021.1880413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Examining the feasibility of developing an index measure for the social determinants of health using public data is needed. We examined these characteristics at the ZIP code in California and New York using public data extracted from the US Census, American Community Survey, the USDA Food Research Access Atlas, and the Dartmouth Atlas. We conducted a retrospective study from 2000 to 2017. The main outcome was a novel index measure representing six domains (economic stability, neighborhood and physical environment, education, community and social context, food access, and health care) and encompassing 13 items. The index measure at the ZIP code was created using principal component analysis, normalized to "0" worse and "1" better in California (ZIP codes n = 1,447 to 1,515) and New York (ZIP codes n = 1,211 to 1,298). We assessed the reliability and conducted a nonparametric comparison to the Robert Wood Johnson Foundation County Health Rankings, Area Deprivation Index, Social Deprivation Index, and GINI Index. These measures shared similarities and differences with the novel measure. Mapping of this novel measure showed regional variation. As a result, developing a universal social determinants of health measure is feasible and more research is needed to link it to health outcomes.
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Affiliation(s)
- Andrew Wang
- Institute for Public Health and Medicine, Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Institute for Public Health and Medicine, Center for Health Information Partnerships, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Abel N Kho
- Institute for Public Health and Medicine, Center for Health Information Partnerships, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Bernard Black
- Pritzker School of Law, Northwestern University, Chicago, Illinois, USA.,Kellogg School of Management, Northwestern University, Chicago, Illinois, USA
| | - Dustin D French
- Institute for Public Health and Medicine, Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,U.S. Department of Veterans Affairs, Health Services Research and Development, Hines, Illinois, USA
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Thompson A, Pirmohamed M. Associations between occupation and heavy alcohol consumption in UK adults aged 40-69 years: a cross-sectional study using the UK Biobank. BMC Public Health 2021; 21:190. [PMID: 33622282 PMCID: PMC7903617 DOI: 10.1186/s12889-021-10208-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 01/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the relationship between occupation and alcohol use offers opportunities to provide health promotion programmes based on evidence of need. We aimed to determine associations between occupation and heavy alcohol consumption in working individuals aged 40-69 years. METHODS A cross-sectional study was conducted using 100,817 people from the UK Biobank: 17,907 participants categorised as heavy drinkers, defined as > 35 units/week for women and > 50 units/week for men, and 82,910 drinking controls. Prevalence ratios (PRs) and 95% CIs were calculated for gender-specific heavy drinking in 353 occupations using Standard Occupational Classification, V.2000. RESULTS Seventy-seven occupations were associated with level of alcohol consumption in drinkers. The largest ratios for heavy drinkers were observed for publicans and managers of licenced premises (PR = 2.81, 95%CI 2.52-3.14); industrial cleaning process occupations (PR = 2.09, 1.33-3.28); and plasterers (PR = 2.07, 1.66-2.59). Clergy (PR = 0.20, 0.13-0.32); physicists, geologists and meteorologists (PR = 0.40, 0.25-0.65); and medical practitioners (PR = 0.40, 0.32-0.50) were least likely to be heavy drinkers. There was evidence of gender-specific outcomes with the proportion of jobs associated with heavy drinking accounted for by skilled trade occupations being 0.44 for males and 0.05 for females, and 0.10 for males and 0.40 for females when considering managers and senior officials. CONCLUSIONS In the largest study of its kind, we found evidence for associations between a wider variety of occupations and the risk of heavy alcohol consumption than identified previously, particularly in females, although causality cannot be assumed. These results help determine which jobs and broader employment sectors may benefit most from prevention programmes.
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Affiliation(s)
- Andrew Thompson
- Wolfson Centre for Personalised Medicine, Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK.
- MRC Centre for Drug Safety Science, Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK.
- Liverpool Centre for Alcohol Research, University of Liverpool, Liverpool, UK.
| | - Munir Pirmohamed
- Wolfson Centre for Personalised Medicine, Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK
- MRC Centre for Drug Safety Science, Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, UK
- Liverpool Centre for Alcohol Research, University of Liverpool, Liverpool, UK
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Brosso SN, Sheeran P, Lazard AJ, Muscatell KA. Harnessing Neuroimaging to Reduce Socioeconomic Disparities in Chronic Disease: A Conceptual Framework for Improving Health Messaging. Front Hum Neurosci 2021; 15:576749. [PMID: 33633551 PMCID: PMC7901919 DOI: 10.3389/fnhum.2021.576749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/07/2021] [Indexed: 11/24/2022] Open
Abstract
Socioeconomic status (SES)-related health disparities persist for numerous chronic diseases, with lower-SES individuals exhibiting greater risk of morbidity and mortality compared to their higher-SES counterparts. One likely contributor is disparities in health messaging efforts, which are currently less effective for motivating health behavior change among those lower in SES. Drawing on communication neuroscience and social neuroscience research, we describe a conceptual framework to improve health messaging effectiveness in lower SES communities. The framework is based on evidence that health-message-induced activity in the ventral striatum (VS) and subdivisions of the medial pre-frontal cortex (MPFC) predicts behavior change. Additionally, we draw from social neuroscience work showing that activity in these regions during valuation and the processing of self-related vs. social information, differs as a function of SES. Bringing together these previously disparate lines of work, we argue that health messages emphasizing the benefits to close others (vs. the self) of engaging in behavior change will be more effective among lower SES individuals. We also outline a research agenda based on our framework. Ultimately, we hope that this framework utilizing a “brain-as-predictor” approach generates novel insights about the neural underpinnings of message-induced behavior change among lower SES individuals, and helps to close the gap in SES-based health disparities by harnessing the power of neuroimaging.
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Affiliation(s)
- Samantha N Brosso
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Allison J Lazard
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Keely A Muscatell
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Møller S, Wissenberg M, Starkopf L, Kragholm K, Hansen SM, Ringgren KB, Folke F, Andersen J, Malta Hansen C, Lippert F, Koeber L, Gislason GH, Torp-Pedersen C, Gerds TA. Socioeconomic disparities in prehospital factors and survival after out-of-hospital cardiac arrest. Heart 2021; 107:627-634. [PMID: 33419881 DOI: 10.1136/heartjnl-2020-317761] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/13/2020] [Accepted: 11/30/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE It remains unknown whether patient socioeconomic factors affect interventions and survival after out-of-hospital cardiac arrest (OHCA), and whether a socioeconomic effect on bystander interventions affects survival. Therefore, this study examined patient socioeconomic disparities in prehospital factors and survival. METHODS From the Danish Cardiac Arrest Registry, patients with OHCA ≥30 years were identified, 2001-2014, and divided into quartiles of household income (highest, high, low, lowest). Associations between income and bystander cardiopulmonary resuscitation (CPR) and 30-day survival with bystander CPR as mediator were analysed by logistic regression and mediation analysis in private witnessed, public witnessed, private unwitnessed and public unwitnessed arrests, adjusted for confounders. RESULTS We included 21 480 patients. Highest income patients were younger, had higher education and were less comorbid relative to lowest income patients. They had higher odds for bystander CPR with the biggest difference in private unwitnessed arrests (OR 1.74, 95% CI 1.47 to 2.05). For 30-day survival, the biggest differences were in public witnessed arrests with 26.0% (95% CI 22.4% to 29.7%) higher survival in highest income compared with lowest income patients. Had bystander CPR been the same for lowest income as for highest income patients, then survival would be 25.3% (95% CI 21.5% to 29.0%) higher in highest income compared with lowest income patients, resulting in elimination of 0.79% (95% CI 0.08% to 1.50%) of the income disparity in survival. Similar trends but smaller were observed in low and high-income patients, the other three subgroups and with education instead of income. From 2002 to 2014, increases were observed in both CPR and survival in all income groups. CONCLUSION Overall, lower socioeconomic status was associated with poorer prehospital factors and survival after OHCA that was not explained by patient or cardiac arrest-related factors.
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Affiliation(s)
- Sidsel Møller
- Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Mads Wissenberg
- Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Liis Starkopf
- Section of Biostatistics, Faculty of Health and Medical Sciences, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Steen M Hansen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Fredrik Folke
- Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark.,Copenhagen Emergency Medical Services, Ballerup, Denmark
| | | | - Carolina Malta Hansen
- Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark.,Copenhagen Emergency Medical Services, Ballerup, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Ballerup, Denmark
| | - Lars Koeber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Thomas A Gerds
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
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Glei DA, Lee C, Weinstein M. Socioeconomic disparities in U.S. mortality: The role of smoking and alcohol/drug abuse. SSM Popul Health 2020; 12:100699. [PMID: 33335972 PMCID: PMC7734303 DOI: 10.1016/j.ssmph.2020.100699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/22/2020] [Accepted: 11/18/2020] [Indexed: 11/21/2022] Open
Abstract
Prior studies have identified smoking as a key driver of socioeconomic disparities in U.S. mortality, but the growing drug epidemic leads us to question whether drug abuse is exacerbating those disparities, particularly for mortality from external causes. We use data from a national survey of midlife Americans to evaluate socioeconomic disparities in all-cause and cause-specific mortality over an 18-year period (1995-2013). Then, we use marginal structural modeling to quantify the indirect effects of smoking and alcohol/drug abuse in mediating those disparities. Our results demonstrate that alcohol/drug abuse makes little contribution to socioeconomic disparities in all-cause mortality, probably because the prevalence of substance abuse is low and socioeconomic differences in abuse are small, especially at older ages when most Americans die. Smoking prevalence is much higher than drug/alcohol abuse and socioeconomic differentials in smoking are large and have widened among younger cohorts. Not surprisingly, smoking accounts for the majority (62%) of the socioeconomic disparity in mortality from smoking-related diseases, but smoking also makes a substantial contribution to cardiovascular (38%) and all-cause mortality (34%). Based on the observed cohort patterns of smoking, we predict that smoking will further widen SES disparities in all-cause mortality until at least 2045 for men and even later for women. Although we cannot yet determine the mortality consequences of recent widening of the socioeconomic disparities in drug abuse, social inequalities in mortality are likely to grow even wider over the coming decades as the legacy of smoking and the recent drug epidemic take their toll.
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Affiliation(s)
- Dana A. Glei
- Center for Population and Health, Georgetown University, 5985 San Aleso Court, Santa Rosa, 95409-3912, CA, USA
| | - Chioun Lee
- Department of Sociology, University of California, 1207 Watkins Hall, Riverside, 92521, CA, USA
| | - Maxine Weinstein
- Center for Population and Health, Georgetown University, 312 Healy Hall, 37th & O Streets, 20057-1197, Washington, DC, NW, USA
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Zissimopoulou O, Leontidou E, Tsiptsios D, Manolis A, Ioannides D, Trypsiani I, Steiropoulos P, Constantinidis TC, Tripsianis G, Nena E. Association of Family Income with Health Indices and Healthcare Utilization in a Large Sample of Residents in Northern Greece. MAEDICA 2020; 15:490-502. [PMID: 33603907 PMCID: PMC7879352 DOI: 10.26574/maedica.2020.15.4.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective:To describe the impact of subjects' family income, which was used as a proxy for socioeconomic status, with health characteristics and healthcare utilization of a large representative sample of population in Northern Greece, taking into account several socio-demographic characteristics and health behaviors of the participants. Material and method:Eight hundred and twelve participants (43.7% males) with a mean age of 49.±14.8 years (range 19-83 years), from the area of Thrace, Greece, were enrolled in this cross-sectional populational study. A two-stage stratified sampling scheme was used and subjects were classified, according to the net mean monthly household income, into three financial levels: low .1000 Euro; medium 1001-2000 Euro; and high >2000 Euro. Self-reported questionnaires for socio-demographic, lifestyle and health related characteristics were collected. Sleep characteristics, utilizing Epworth Sleepiness Scale, Athens Insomnia Scale, Pittsburgh Sleep Quality Index and Berlin Questionnaire, and mental health, using Zung Self-rating Anxiety Scale and Beck Depression Inventory have been also assessed. Results:The majority of participants belonged to the lower income level (476 subjects, 58.6%). Lower income level was associated with a higher prevalence of high alcohol consumption (p=0.030), low adherence to Mediterranean diet (p=0.016), low physical activity (p<0.001) and either short or long nocturnal sleep duration (p<0.001). After adjusting for all socio-demographic and lifestyle characteristics, subjects with low income had a higher risk for anxiety (aOR=1.97, p=0.017), depression (aOR=4.88, p<0.001), dyslipidemia (aOR=2.50, p=0.007), diabetes (aOR=3.58, p<0.001), obesity (aOR=1.97, p=0.038), cardiovascular disease (aOR=3.04, p=0.015) and sleep disorders, as well as for primary (aOR=3.56, p=0.017) and secondary (aOR=2.49, p=0.010) healthcare utilization compared to subjects with high income. Conclusion:Low income is an important factor, which adversely affects the health of individuals via different pathways such as adaptation of harmful everyday habits. Large-scale prospective cohort studies are necessary to verify these associations in a methodologically more robust way.
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Affiliation(s)
- Orestia Zissimopoulou
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Eleni Leontidou
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Tsiptsios
- Neurophysiology Department, South Tyneside & Sunderland NHS Foundation Trust, Sunderland, United Kingdom
| | - Apostolos Manolis
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Ioanna Trypsiani
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Theodoros C Constantinidis
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Gregory Tripsianis
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Evangelia Nena
- Laboratory of Social Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Raude J, Lecrique JM, Lasbeur L, Leon C, Guignard R, du Roscoät E, Arwidson P. Determinants of Preventive Behaviors in Response to the COVID-19 Pandemic in France: Comparing the Sociocultural, Psychosocial, and Social Cognitive Explanations. Front Psychol 2020; 11:584500. [PMID: 33329241 PMCID: PMC7734102 DOI: 10.3389/fpsyg.2020.584500] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/06/2020] [Indexed: 12/22/2022] Open
Abstract
In absence of effective pharmaceutical treatments, the individual's compliance with a series of behavioral recommendations provided by the public health authorities play a critical role in the control and prevention of SARS-CoV2 infection. However, we still do not know much about the rate and determinants of adoption of the recommended health behaviors. This paper examines the compliance with the main behavioral recommendations, and compares sociocultural, psychosocial, and social cognitive explanations for its variation in the French population. Based on the current literature, these 3 categories of factors were identified as potential determinants of individual differences in the health preventive behaviors. The data used for these analyses are drawn from 2 cross-sectional studies (N = 2,000 in survey 1 and 2,003 in survey 2) conducted after the lockdown and before the peak of the COVID-19 epidemic in France. The participants were drawn from a larger internet consumer panel where recruitment was stratified to generate a socio-demographically representative sample of the French adult population. Overall, the results show a very high rate of compliance with the behavioral recommendations among the participants. A hierarchical regression analysis was then performed to assess the potential explanatory power of these approaches in complying with these recommendations by successively entering sociocultural factors, psychosocial factors, social cognitive factors in the model. Only the inclusion of the cognitive variables substantially increased the explained variance of the self-reported adoption of preventive behaviors (R 2 change = 23% in survey 1 and 2), providing better support for the social cognitive than the sociocultural and psychosocial explanations.
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Affiliation(s)
- Jocelyn Raude
- EHESP School of Public Health, Rennes, France
- Unite des Virus Emergents (UVE: Aix-Marseille Univ – IRD 190 – Inserm 1207 – IHU Mediterranee Infection), Marseille, France
| | | | | | | | | | - Enguerrand du Roscoät
- Santé publique France, Saint Maurice, France
- Laboratoire Parisien de Psychologie Sociale (LAPPS), EA 4386, Université Paris Ouest Nanterre-La Défense, Nanterre, France
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