Marital status, self-rated health, and mortality: overestimation of health or diminishing protection of marriage?

Effect of widowhood on the risk of disability among the elderly in China

Background

The deteriorating health status of widowed elderly individuals becomes an important restriction factor affecting healthy aging in China. This paper aimed to find effective ways to reduce the risk of disability among the widowed elderly.

Methods

An empirical analysis was conducted by using four surveys from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015, and 2018. A fixed-effects model was performed to estimate the effect of widowhood on the disability risk of the elderly in China and its disparities in different groups, and influencing channels and moderating effects were further investigated.

Results

Widowhood significantly increased the risk of disability, and the results were robust. The risk of disability was higher among those who were male, living in urban areas, educated, and 60-to-70-years-old. Possible channels in the association were psychological stress and unhealthy behavior. Meanwhile, more financial support, contact from children, and social activities decreased the risk of disability.

Conclusion

The health risks of older adults after widowhood can be reduced by concerted efforts from society and government, including promoting the traditional Chinese virtue of filial piety and providing health interventions and social support services.

The Mediation Effect of Perceived Attitudes toward Medical Service on the Association between Public Satisfaction with the Overall Medical Service and Self-Rated Health among the General Population in China: A Cross-Sectional Study

This study aimed to examine the association between public satisfaction with the overall medical service and individuals' self-rated health among 18,852 Chinese adults aged 16-60 years by using data from the 2018 China Family Panel Studies. We further test whether such an association is mediated by perceived attitudes toward the medical service. The logistic regression model is used to explore the association between public satisfaction with the overall medical service and individuals' self-rated health (SRH) outcomes. Mediation analysis was conducted by using the Karlson-Holm-Breen (KHB) method. We found that public satisfaction with the overall medical service was associated with good SRH. Additional results indicated that the association between public satisfaction with the overall medical service and SRH was significantly mediated by perceived attitudes toward the medical service. The degree of mediation is much larger for individuals' satisfaction with the level of medical expertise than for trusting in doctors, attitudes toward medical service problems, and the attitude toward the level of the hospital. Targeted medical policy interventions are designed to promote individuals' perceived attitudes toward the medical service, which might help to improve individuals' health benefits.

Association between poor self-reported health and unmarried status among adults: examining the hypothesis of marriage protection and marriage selection in the Indian context

Background

The link between marital status and health differences has long been a topic of debate. The substantial research on marriage and health has been conducted under two important hypotheses: marital protection and marriage selection. While the majority of evidence on the marriage-health relationship using these hypotheses comes from developed countries, there is a lack of evidence from Asia, particularly from India.

Objectives

The current study examines theoretical frameworks of marriage i.e., marital protection and marriage selection in the Indian setting concurrently, bringing substantial empirical evidence to explore the link between marriage and health, considering this subject in the context of self-reported health (SRH). Secondly, this study will aid in investigating age and gender differences in marriage and health.

Methods

Using the Study on Global AGEing and Adult Health (SAGE), a cohort study of individuals aged 50 years and older with a small section of individuals aged 18 to 49 for comparative reasons, the present study population was 25 years and above individuals with complete marital information. Logistic regressions were employed to explore the connection between marital status and self-reported health. In the marriage protection hypothesis, the follow-up poor SRH was the dependent variable, whereas the initial unmarried status was the independent variable. For the marriage selection effects, initial poor SRH as the independent variable and follow-up unmarried status as the dependent variable had considered.

Results

Examining the marital protection hypothesis, the initial unmarried status (OR: 2.14; CI at 95%: 1.17, 3.92) was associated with the followed-up SRH transition from good to poor between 2007 and 2015 for young men, while initial unmarried status was linked with a lower likelihood of stable good SRH and a higher likelihood of stable poor SRH status across all age categories among women. Focusing on the marriage selection hypothesis, among young men, a significant association exists between the initial poor SRH and departure in marital status from married to unmarried. Young women with initial poor SRH (OR: 0.68; CI at 95%: 0.40, 1.00) had lower odds of stable married. In comparison, women with initially poor SRH, irrespective of age, were more likely to have higher odds of being stably unmarried.

Conclusion

Marriage indeed protects health. There are also shreds of evidence on health-selected marital status in India. Taken together, the aspect of marital protection or marriage selection is gender and age-specific in India. The findings contribute to a more comprehensive understanding of the relationship between marriage and health, which may have significant implications for health-related public policies aimed at unmarried women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14170-0.

Marriage and health: exploring the role of stress overload

BACKGROUND AND OBJECTIVES

The association between marital status and health is well-established, but its causes remain unclear. This study was the first to examine stress overload, the pathogenic form of stress, as a possible explanation.

DESIGN

The study employed a cross-sectional design and convenience sample to explore relationships among stress overload, marital status, social support, and illness.

METHODS

A diverse sample (n = 455), recruited from community and social media sites, completed an anonymous online survey. Included were standardized measures of stress overload (SOS-S), perceived social support (MSPSS), and somatic symptoms (PHQ-15).

RESULTS

Married participants reported lower stress overload levels than those in any other type of relationship (single, in-a-relationship, or cohabiting). They did not differ from the unmarried in overall level of social support, nor did statistically controlling social support or income levels erase the stress overload differential. They also reported lower levels of symptomology than the unmarried. SEM analyses yielded a best-fitting model showing stress overload to partially mediate the link between marital status and symptoms.

CONCLUSIONS

Stress overload is one mechanism that explains the marital health disparity, albeit not the only one. This holds implications for future research and practice focused on personal relationships and well-being.

Exploring the Effects of Gender Differences and Widowhood Status on the Days Spent in Poor Health: A Secondary Data Analysis from India

The majority of research in India has focused on the impact of widowhood on health status and health care use, while little emphasis has been paid to the number of days spent in poor health among widowed population compare to other marital categories. Thus, the current study explores the relationship between widowhood and days spent with poor health outcomes among adults in India. Additionally, gender differences in the relationship between widowhood and days with poor health outcomes are further studied.The research employed nationally representative cross-sectional data from the 75th round (2017-2018) of the National Sample Survey (NSS). To investigate the associations of marital status (married vs widowed) and other factors with days spent in poor health, a negative binomial regression model was used. Additionally, the interaction model of age and widowhood was estimated separately for men and women.The findings suggest that widowed individuals had consistently prolonged days with an illness, limited activity, and confinement to bed. After adjusting for socioeconomic and demographic characteristics, the findings suggested that widowed women (IRR = 1.141, 95% Confidence interval = 1.01-1.29) were more likely to spend days with limited acitivities than married women. The marital status-age interaction indicated that older widowed women were more likely to have days of restricted activity and confinement to bed than married women, but such link is absent for men.In India, the elderly widow often spends her days confined to bed and prolonged days with limited activity. Policymakers and practitioners in public health should develop effective policies and programmes to enhance the health and well-being of widowed women, particularly those from socioeconomically disadvantaged backgrounds.

Experiences of oral health: before, during and after becoming a regular user of GC Tooth Mousse Plus®

BACKGROUND

Clinical trials and laboratory studies from around the world have shown that GC Tooth Mousse Plus® (TMP) is effective in protecting teeth from tooth decay and erosion, buffering dental plaque pH, remineralising white spot lesions and reducing dentine hypersensitivity. However, no other study has assessed the experiences of oral health, before, during and after individuals becoming regular users of TMP. The aim of this study was to identify how participants' oral health status changed after introducing TMP into their oral hygiene routine.

METHODS

A qualitative study using Charmaz's grounded theory methodology was conducted. Fifteen purposively sampled regular users of TMP were interviewed. Transcripts were analysed after each interview. Data analysis consisted of transcript coding, detailed memo writing, and data interpretation.

RESULTS

Participants described their experiences of oral health and disease, before, during and after introducing TMP into their daily oral hygiene routine, together with the historical, biological, financial, psychosocial, and habitual dimensions of their experiences. Before becoming a regular user of TMP, participants described themselves as having a damaged mouth with vulnerable teeth, dry mouth, and sensitivity. Various aspects of participants' histories were relevant, such as, family history and history of oral disease. Having a damaged mouth with vulnerable teeth, dry mouth and sensitivity was explained by those elements. Despite some initial barriers, once being prescribed TMP by a dental professional, a three-fold process of change was initiated: starting a new oral hygiene routine, persevering daily, and experiencing reinforcing outcomes. This process led to a fundamental lifestyle change. Participants transitioned from having a damaged mouth with vulnerable teeth to having a comfortable mouth with strong teeth; at the same time participants felt empowered by this newly found status of being able to keep their teeth for life. Barriers and facilitators for incorporating TMP on daily oral hygiene routine were also identified.

CONCLUSIONS

Participants valued having a comfortable mouth with strong teeth, which did not require repeated restorations. Seeing concrete results in their mouths and experiencing a more comfortable mouth boosted adherence to daily applications of TMP, which was maintained over time.

Caste, Religion, and Mental Health in India

The relationship between mental health and social disadvantage in low- and middle-income countries is poorly understood. Our study contributes the first population-level analysis of mental health disparities in India, where the two marginalized groups that we study constitute a population larger than that of the USA. Applying two complementary empirical strategies to data on 10,125 adults interviewed by the World Health Organisation's Survey of Global Ageing and Adult Health (WHO-SAGE), we document and standardize gaps in self-reported mental health between the dominant social group (higher caste Hindus) and two marginalized social groups (Scheduled Castes and Muslims). We find that differences in socioeconomic status cannot fully explain the large disparities in mental health that we document, especially for Muslims. Our results highlight the need for research to understand the causes and consequences of mental health disparities in India, and for policies to move beyond redistribution and address discrimination against Scheduled Castes and Muslims.

Social inequalities in heat-attributable mortality in the city of Turin, northwest of Italy: a time series analysis from 1982 to 2018

BACKGROUND

Understanding context specific heat-health risks in urban areas is important, especially given anticipated severe increases in summer temperatures due to climate change effects. We investigate social inequalities in the association between daily temperatures and mortality in summer in the city of Turin for the period 1982-2018 among different social and demographic groups such as sex, age, educational level, marital status and household occupants.

METHODS

Mortality data are represented by individual all-cause mortality counts for the summer months between 1982 and 2018. Socioeconomic level and daily mean temperature were assigned to each deceased. A time series Poisson regression with distributed lag non-linear models was fitted to capture the complex nonlinear dependency between daily mortality and temperature in summer. The mortality risk due to heat is represented by the Relative Risk (RR) at the 99th percentile of daily summer temperatures for each population subgroup.

RESULTS

All-cause mortality risk is higher among women (1.88; 95% CI = 1.77, 2.00) and the elderly (2.13; 95% CI = 1.94, 2.33). With regard to education, the highest significant effects for men is observed among higher education levels (1.66; 95% CI = 1.38, 1.99), while risks for women is higher for the lower educational level (1.93; 95% CI = 1.79, 2.08). Results on marital status highlighted a stronger association for widower in men (1.66; 95% CI = 1.38, 2.00) and for separated and divorced in women (2.11; 95% CI = 1.51, 2.94). The risk ratio of household occupants reveals a stronger association for men who lived alone (1.61; 95% CI = 1.39, 1.86), while for women results are almost equivalent between alone and not alone groups.

CONCLUSIONS

The associations between heat and mortality is unequal across different aspects of social vulnerability, and, inter alia, factors influencing the population vulnerability to temperatures can be related to demographic, social, and economic aspects. A number of issues are identified and recommendations for the prioritisation of further research are provided. A better knowledge of these effect modifiers is needed to identify the axes of social inequality across the most vulnerable population sub-groups.

Widowhood and mortality: a Danish nationwide register-based cohort study

AIMS

Widowed people have increased mortality compared to married people of the same age. Although most widowed people are of older age, few studies include the oldest old. As life expectancy is increasing, knowledge of widowhood into older age is needed. This study aimed to examine mortality and widowhood in older age by comparing mortality in widowed and married people by sex, age, time since spousal loss and cause of death.

METHODS

A Danish register-based matched cohort study of 10% of widowed persons ⩾65 years in the years 2000-2009. For each randomly drawn widowed person, five married persons were matched on sex and age. Mortality rate ratios (MRR) were calculated using Poisson regression, and stratified according to sex and 5-year age intervals. MRRs were furthermore calculated by time since spousal loss and by specific cause of death.

RESULTS

The study included 82 130 persons contributing with 642 914.8 person-years. The overall MRR between widowed and married persons with up to 16 years of follow-up was 1.25 (95% CI 1.23-1.28). At age ⩾95 years for men, and ⩾90 years for women, no differences in mortality rates were seen between widowed and married persons. Mortality in widowed persons was increased for most specific causes of death, with the highest MRR from external causes (MRR 1.53 [1.35-1.74]) and endocrine diseases (MRR 1.51 [1.34-1.70]).

CONCLUSIONS

Widowhood was associated with increased mortality in older age for both men and women until age ⩾95 and ⩾90 years, respectively. Increased mortality was observed for almost all causes of death.

Health Behavior Profiles of Korean Baby Boomers

This study identified profiles of health behaviors among Korean baby boomers and examined a set of individual characteristics associated with these latent profiles. We analyzed a sample of 4,047 middle-aged adults (aged 53–61) from the Korean Baby Boomer Panel Study (2014). Latent profile analysis was used to uncover distinct health behavior profiles, and multinomial regression was performed to investigate the associations between health behavior profiles and predisposing, enabling, and need factors—following from the behavioral models of health behaviors and health services use. Five profiles of health behaviors were identified: (a) low-risk and high-preventive behaviors (50%), (b) low-risk and low-preventive behaviors (35%), (c) moderate-risk and moderate-preventive behaviors (7%), (d) moderate-risk and high-preventive behaviors (6%), and (e) high-risk and low-preventive behaviors (2%). Further, individuals with more enabling and need characteristics, indicated by higher socioeconomic status and greater health concerns, were more likely to engage in healthier profiles.

Influence of oral health literacy on dissatisfaction with oral health among older people

OBJECTIVE

To investigate the influence of oral health literacy (OHL) and associated factors on dissatisfaction with oral health (DOH) among older people.

BACKGROUND

Oral health literacy is a recent field of research that has been considered an important mediator between socioeconomic variables and oral health outcomes. However, there are few studies with older people.

MATERIALS AND METHODS

A cross-sectional study was conducted with 535 non-institutionalised older people aged 60-100 years from Brazil. Individuals completed a questionnaire on general health, sociodemographic information and usual reason for dental visit. OHL was assessed using the Health Literacy in Dentistry questionnaire (HeLD-14), validated in Brazil. DOH was the outcome of interest. Poisson regression with robust standard errors was applied as a statistical model to estimate bivariate and multivariable relationships of DOH with OHL after adjusting for sex, age, social characteristics and general health using the P-value of ≤ .05.

RESULTS

The overall prevalence of DOH was 21.1%. Multivariable regression analysis showed that older people with low OHL (HeLD-14 score ≤35) had 1.28 times the odds of having DOH than those with high OHL (HeLD14 score >46), after adjusting for sociodemographic, economic and health outcomes.

CONCLUSIONS

Dissatisfaction with oral health in older people is a complex issue associated with OHL, social and behavioural factors. Health services should give greater attention to developing health literacy competences in older adults in order to empower them to achieve optimal oral health.

The role of education in the association between self-rated health and levels of C-reactive protein: a cross-sectional study in rural areas of China

OBJECTIVES

This study aims to examine the association between self-rated health (SRH) and levels of C-reactive protein (CRP) among adults aged 45 to 101 years old in rural areas of China, and to explore the role of education in the association.

DESIGN

Cross-sectional study.

SETTING

The study population was derived from two databases in China: Nanping project (NP) and the China Health and Retirement Longitudinal Study (CHARLS).

PARTICIPANTS

There were 646 participants from a rural area of Nanping (NP) and 8555 rural participants from a national representative sample of China (CHARLS).

METHODS

CRP was measured using a high sensitivity sandwich enzyme immunoassay in the NP and immunoturbidimetric assay in the CHARLS. SRH was assessed by SRH questionnaires and categorised into good and poor. Education was measured by the maximum years of schooling and dichotomised into illiterate and literate. Multivariate linear regression models were used to study the associations.

RESULTS

Compared to people with good SRH, those with poor SRH had higher levels of CRP in NP (β=0.16, 95% CI -0.02 to 0.34) and in CHARLS (β=0.07, 95% CI 0.02 to 0.11) after adjusting for potential confounders. Similar findings were observed in the pooled population (β=0.08, 95% CI 0.03 to 0.12), especially in men (β=0.13, 95% CI 0.06 to 0.20) and in literate people (β=0.12, 95% CI 0.06 to 0.18).

CONCLUSION

Poor SRH may be a predicator of elevated levels of CRP among middle-aged and older people in rural areas, especially in men and literate people.

Link between perceived oral and general health status among Yemeni adult dental patients

BACKGROUND

Self-perceived health is an essential measure of health status and even a paramount predictor of mortality. So long as it is said that oral health (OH) and general health (GH) are mirrors to each other. This study sought to determine how Yemeni adults rate their OH and GH, whether such a self-rating influenced by some potential risk factors, and whether both ratings (OH and GH) are correlated.

METHODS

A sample of 587 Yemeni dental patients aged 20 years and over were consecutively recruited. A structured interview form was used covering the following variables: age, gender, marital status, educational level, presence of dental prosthesis (DP), smoking and Qat chewing habits as independent variables, along with questions on "perceived oral health (POH)" and "perceived general health (PGH)" as dependent variables. The bivariate and multiple ordinal regression analyses were applied at P-value < 0.05.

RESULTS

Most of participants were women (73.6%), and married (71.4%), and more than half of them were young adults (58.2%), with high educational levels (53.3%), and not having DP. Only 310 participants responded to the questions on smoking and Qat chewing habits. Of these, 88.5% were non-smokers and 62.1% were Qat non-chewers. Up to 50% of the participants reported their POH as poor or fair, while lower proportions of participants (17%) reported their PGH as such. Younger age (compared to elders), high education levels (compared to primary education) and being single (compared to married) significantly revealed better levels of POH, while high education levels and being females significantly revealed better levels of PGH. Smoking and Qat chewing habits were found to have no effect on the perception of POH or PGH. POH and PGH were found to be significantly correlated (r = 0.486; P < 0.001).

CONCLUSION

Higher levels of oral health problems can be anticipated among patients who perceive poor general health, and vice versa. The age, marital status and education were independent determinants of POH, while the gender and education were independent determinants of PGH.

Correlates of health care use among White and minority men and women with diabetes: An NHANES study

AIMS

The current study sought to identify patient-level factors related to health care use among White and minority men and women with diabetes.

METHODS

A sample of 447 of non-pregnant individuals with diabetes, ages 18-64, was drawn from the 2015-2016 National Health and Nutrition Examination Surveys dataset. Poisson regression models tested associations between health care use and self-rated health, depression, medical comorbidities, body mass index, marital status, number of children, income, insurance coverage, and age, stratified by gender and racial/ethnic minority status.

RESULTS

Poorer self-rated health was the only significant correlate of increased health care use among White men with diabetes whereas income and insurance were significant correlates of increased use among minority men. Among White and minority women, higher levels of depression and being single were correlated with greater health care use. Comorbid medical conditions and insurance coverage were also related to use among minority women.

CONCLUSIONS

Among individuals with diabetes, health care use among White men appeared to be driven by subjective health whereas financial factors were critical among minority men. Family structure and mental health were instrumentally associated with health care use among all women. These factors can be targeted to promote equitable access to care.

Wealth Inequality as a Predictor of Subjective Health, Happiness and Life Satisfaction among Nepalese Women

Socioeconomic status has shown to be associated with subjective health, well-being, satisfaction with overall life and estimation of happiness. The body of research concerning the question of whether higher economic status leads to better health and well-being are mostly from developed countries. The present study was therefore conducted among women in Nepal with an aim to investigate whether household wealth status is associated with satisfaction about (1) self-reported health, (2) happiness, and (3) life overall. Methods: Subjects were 5226 Nepalese women aged between 15 and 24 years. Cross-sectional data were extracted from round 5 of the Nepal Multiple Indicator Cluster Survey (NMICS), conducted in 2014, and analyzed using chi-square tests of association, bivariate and multivariable regression methods. Results: Wealth status was significantly associated with satisfaction about health, estimation of happiness and satisfaction. Compared with women in the poorest households, the odds of positive estimation about overall happiness were respectively 30% higher for poorer (p < 0.0001; 95% CI = 1.653⁻3.190), 80% higher for middle (p = 0.001; 95% CI = 1.294⁻2.522), 64% higher for richer (p = 0.006; 95% CI = 1.155⁻2.326), and 40% higher for richest households. The odds of reporting satisfaction about life were respectively 97% higher for poorer (p < 0.0001; 95% CI = 1.680⁻2.317), 41% higher for middle (p < 0.0001; 95% CI = 1.165⁻1.715), 62% higher for richer (p < 0.0001; 95% CI = 1.313⁻2.003), and 31% higher for richest households (p = 0.043; 95% CI = 1.008⁻1.700). Conclusion: Our results conclude that women in households with lower wealth status report poorer subjective health, quality of life and happiness. However, the findings need to be interpreted in light of the existing sociocultural conditions mediating the role of household wealth status on women's lives.

Health and Union Dissolution among Parenting Couples: Differences by Gender and Marital Status

Poor health may destabilize romantic unions by impeding fulfillment of family responsibilities, increasing stress, and causing financial strain. We hypothesized that the associations of health characteristics with union stability for parenting couples vary by the gender of the partner in poor health and the couple's marital status because of gender and marital status differences in family responsibilities and health-related coping behaviors. Using longitudinal data from the Fragile Families and Child Wellbeing Study (n = 2,997), we examined how three health measures predicted union dissolution for urban married and cohabiting couples with young children. Fathers' depression at baseline predicted dissolution for all parenting couples, as did either partner developing depression between baseline and the following interview. For married parents, fathers' health-related work limitations and mothers' poor self-rated health also predicted dissolution. Associations between health conditions and dissolution differ by gender and marital status, possibly reflecting varying social norms about family responsibilities.

[Effects of drug use and anxiety on premature ejaculation in a sample of Spanish drug addicts]

INTRODUCTION

Premature ejaculation may be due to many factors and one of them may be drug use.

AIMS

The main objective of this study is to show how drug abuse affects the ejaculatory response, keeping in mind the different substances consumed, the level of anxiety and the period of withdrawal.

METHOD

Two samples were used, one for men who were addicted to drugs (N=925) and one of non-consumers (N=82). Both samples were selected from 28 treatment centers. The Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaire and the State Anxiety Trait Questionnaire (STAI) were used.

RESULTS

The results show that men with a history of consumption obtain higher percentages in premature ejaculation compared to non-users (44.3%> 15.9%) and also higher mean scores in anxiety (State Anxiety=19.83>11, 89; Trait Anxiety=25.66>12.39). These differences were statistically significant (P=.000). The results confirm that the withdrawal period does not improve ejaculatory response and having a partner does not work as a protective factor in premature ejaculation.

CONCLUSIONS

Men with a history of drug use are more likely to suffer from premature ejaculation and higher levels of anxiety, which does not improve during the period of withdrawal, leading to the belief that drug users have personality traits that facilitate premature ejaculation and/or that the neurological damages caused by the drugs contribute to a decrease in the intravaginal ejaculatory latency, issues that should be studied in future investigations.

Mass incarceration, race inequality, and health: Expanding concepts and assessing impacts on well-being

We explore race differences in how individuals experience mass incarceration, as well as in mass incarceration's impacts on measures of well-being that are recognized as major social determinants of health. We draw on baseline data from a sample of 302 men and women recently released from prison/jail or placed directly onto probation in New Haven, Connecticut (CT) for drug related offenses and followed at 6-month intervals for two years (2011-2014). We describe race differences in experiences of mass incarceration and in its impacts on well-being; and we conduct mediation analyses to analyze relationships among race, mass incarceration, and well-being. Blacks reported fewer adult convictions than whites, but an average of 2.5 more adult incarcerations. Blacks were more likely to have been incarcerated as a juvenile, spent time in a juvenile facility and in an adult facility as a juvenile, been on parole, and experienced multiple forms of surveillance. Whites were more likely to report being caught by the police doing something illegal but let go. Blacks were more likely to report any impact of incarceration on education, and dropping out of school, leaving a job, leaving their longest job, and becoming estranged from a family member due to incarceration. Whites were more likely to avoid getting needed health or social services for fear of arrest. Overall, Blacks reported a larger number of impacts of criminal justice involvement on well-being than whites. Number of adult incarcerations and of surveillance types, and being incarcerated as a juvenile, each mediated the relationship among race, mass incarceration, and well-being. Though more research is necessary, experiences of mass incarceration appear to vary by race and these differences, in turn, have implications for interventions aimed at addressing the impacts of mass incarceration on health and well-being.

Partnership trajectories and cardiovascular health in late life of older adults in England and Germany

Objectives

Previous studies have shown marital status differences in incidence and prevalence of cardiovascular disease and cardiovascular mortality. This study examines the consequences of partnership on biomarkers related to cardiovascular health of older men and women in Germany and England (C-reactive protein, HbA1c, systolic and diastolic blood pressure; and total cholesterol).

Methods

Data used is from older adults (60 +) from the German Survey of Health and Retirement Europe SHARE (n=955) and the English Longitudinal Study of Ageing ELSA (n=9707). Life course partnership is measured using the timing (age at first partnership), quantum (number of partnerships) and partnership trajectory. OLS for C-reactive protein, logistic regressions for systolic and diastolic blood pressure, and multinomial logistic regressions for cholesterol are used to investigate the associations between life course partnership characteristics and biomarkers, accounting for early age socioeconomic and health conditions.

Results

Timing of first partnership is associated with poor cardiovascular health in England, number of partnership transitions with poor health in Germany, and partnership trajectories are associated with cardiovascular health both in Germany and England. Men in trajectories with multiple marriages have higher CRP, and are more likely to have elevated systolic and diastolic BP. Trajectories containing single marital disruption for men and women are no longer associated with poor health after accounting for selection effects of childhood conditions. Respondents in widowed partnership trajectories have poorer cardiovascular health compared to those in intact committed relationships, whereas cohabitation trajectories do not differ in the associations with biomarkers from those in intact marriage.

Conclusion

The results offer better understanding of the pathways through which family events and processes are linked to health and support the hypothesis that adversity related to partnerships over the life course accumulates and contributes to worse cardiovascular health in later life measured by objective health measures.

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This study investigates the longitudinal accumulated effects of partnership on cardiovascular health using haemostatic and inflammatory biomarkers in later-life, C-reactive protein, HbA1c, systolic and diastolic blood pressure; and total cholesterol.

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Based on life course theory of cumulative disadvantage, the study finds support that the benefits and risks of marital status accumulate over the life-course. The effects are visible on biomarkers of older adults in both Germany and England in models that account for conditions in early life, health behaviors in adult life and sociodemographic factors.

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Data used is from older adults (60 +) form the German Survey of Health and Retirement Europe SHARE (n=955) and the English Longitudinal Study of Ageing ELSA (n=9707). Life course partnership is measured using the timing (age at first partnership), quantum (number of partnerships) and partnership sequence type.

Self-reported health behaviors, including sleep, correlate with doctor-informed medical conditions: data from the 2011 Health Related Behaviors Survey of U.S. Active Duty Military Personnel

BACKGROUND

Health behaviors and cardiometabolic disease risk factors may differ between military and civilian populations; therefore, in U.S. active duty military personnel, we assessed relationships between demographic characteristics, self-reported health behaviors, and doctor-informed medical conditions.

METHODS

Data were self-reported by 27,034 active duty military and Coast Guard personnel who responded to the 2011 Department of Defense Health Related Behaviors Survey. Multivariate linear and logistic regressions were used to estimate cross-sectional associations between (1) demographic characteristics (age, sex, service branch, marital status, children, race/ethnicity, pay grade) and self-reported behaviors (exercise, diet, smoking, alcohol, sleep); (2) demographic characteristics and doctor-informed medical conditions (hypertension, hypercholesterolemia, low high density lipoprotein (HDL) cholesterol, hyperglycemia) and overweight/obesity; and (3) behaviors and doctor-informed medical conditions.

RESULTS

Among respondents (age 29.9 ± 0.1 years, 14.7% female), females reported higher intake than men of fruit, vegetables, and dairy; those with higher education reported higher intakes of whole grains; those currently married and/or residing with children reported higher intake of starches. Older age and female sex were associated with higher odds (ORs 1.25 to 12.54 versus the youngest age group) of overweight/obesity. Older age and female sex were also associated with lower odds (ORs 0.29 to 0.65 versus male sex) of doctor-informed medical conditions, except for blood glucose, for which females had higher odds. Those currently married had higher odds of high cholesterol and overweight/obesity, and separated/divorced/widowed respondents had higher odds of high blood pressure and high cholesterol. Short sleep duration (< 5 versus 7-8 h/night) was associated with higher odds (ORs 1.36to 2.22) of any given doctor-informed medical condition. Strength training was associated with lower probability of high cholesterol, high triglycerides, and low HDL, and higher probability of overweight/obesity. Dietary factors were variably associated with doctor-informed medical conditions and overweight/obesity.

CONCLUSIONS

This study observed pronounced associations between health behaviors-especially sleep-and medical conditions, thus adding to evidence that sleep is a critical, potentially modifiable behavior within this population. When possible, adequate sleep should continue to be promoted as an important part of overall health and wellness throughout the military community.

Predictive Factors for Postoperative Follow-up: Which Patients are Prone to Loss to Follow-up After Spinal Surgery?

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

To find out the predictive factors for the failure to follow-up in patients who underwent spinal surgery.

SUMMARY OF BACKGROUND DATA

Causes for loss to follow-up range from geographical accessibility to dissatisfaction with surgeons. There were few reports that investigated loss to follow-up after spinal surgery.

METHODS

A total of 649 patients who underwent laminectomy and 193 patients who underwent L4-L5 fusion from August 2006 to August 2013 were enrolled in this retrospective study. In each surgical group, demographic data and comorbidities as assessed by the Charlson index were investigated and analyzed for correlation with follow-up. The between-group difference of failure to follow-up was also evaluated.

RESULTS

The fusion group (n=193) was more likely to follow-up and the between-group difference was statistically significant (P=0.047). In the laminectomy group (n=649), 271 patients (41.8%) made regular hospital visits. Those who were male, had a spouse, or had fewer comorbidities were less prone to loss to follow-up (P<0.001). Other parameters including age, number of spinal segments operated on during surgery, distance from home to hospital, income, education level, and whether or not patients exercised were also significantly correlated with follow-up compliance (P>0.05). In contrast, 51.8% (n=100) of patients who underwent fusion had regular follow-ups. The fusion group showed a statistical difference in follow-up rate based only on sex (P=0.002).

CONCLUSIONS

Our study shows that patients who underwent decompression alone were less likely to attend follow-up than were patients who underwent fusion surgery. Whereas the factors correlated with loss to follow-up after laminectomy alone were sex, marital status, and number of comorbidities, the only predictor after fusion was male sex. Sex was the only shared risk factor for loss to follow-up.

LEVEL OF EVIDENCE

Level III.

The Paradoxical Impact of Companionship on the Mental Health of Older African American Men

Objectives

African Americans comprise 9% of the 46 million U.S. adults over age 65. Two thirds of older African American men (AAM) reside with companions. This study investigated the assumption that frequent contact with companions confers mainly health-related benefits for AAM.

Methods

Utilizing secondary data from the National Alzheimer's Coordinating Center, the relationship between older AAM's mental health and related conditions (depression, anxiety, and sleep disturbances), companion living arrangements, and frequency of contact with the participants for 3,423 older AAM and their 1,161 companions, was examined.

Results

The mean age of participants and companions was 74 years and 90% of AAM lived in a private residence. Logistic regression models indicated that an increased risk for anxiety was found when companions lived in (OR = 1.66), called daily (OR = 1.089), or visited daily (OR = 1.079). Finally, AAM had an increased likelihood of nonmedical sleep disturbances when companions lived in (OR = 1.67), called daily (1.105), or visited daily (1.078).

Discussion

The frequency of contact with companions may be consequential for select mental health outcomes and associated physiological conditions for older AAM; the timing of contact requires further investigation.

Associations among stress, gender, sources of social support, and health in emerging adults

This study aimed to examine how sources of social support intersect with stress and health by testing two theoretical models. Three relationship-specific sources of social support (family, friends, and romantic partners) and two health indicators (self-rated physical health and depressive symptoms) were investigated. The sample consisted of 636 emerging adults attending college (age range: 18-25). Results suggest that only support from family was a stress-buffer, in that it buffered the adverse association between stress and depressive symptoms. Holding stress constant, only support from family was related to self-rated physical health and only support from friends or romantic partners was associated with depressive symptoms. There were no gender differences in the mean levels of self-rated physical health and depressive symptoms. However, gender moderations were found, in that the positive relationship between friends support and physical health was observed only in women, that the association between friends support and depressive symptoms was greater in men than in women, and that family support buffered the negative relationship between stress and physical health only in men. Findings of this study suggest that the associations among stress, social support, and health vary by the sources of support, the health outcome, and gender.

Factors Associated with Inaccurate Self-Reporting of Olfactory Dysfunction in Older US Adults

Self-reported olfactory function has poor sensitivity (i.e., people with measured olfactory dysfunction are unlikely to accurately report it). We aimed to identify factors associated with lack of awareness of smell dysfunction. Objective odor identification was evaluated using a validated 5-item test in respondents from the National Social Life, Health, and Aging Project, a representative sample of home-dwelling, US adults ages 57-85 (n = 1468). Self-reported olfaction was assessed with a 5-point Likert scale. Using multivariate logistic regression, we tested factors that might influence inaccuracy of self-reported olfaction, including age, gender, race/ethnicity, education, marital status, cognition, comorbidity, smoking, depression, anxiety, self-rated mental and physical health, and social activity. Among older US adults, 12.4% reported their sense of smell as fair or poor, while 22.0% had objective olfactory dysfunction (≤3 items correct out of 5). Among those with measured olfactory dysfunction, 74.2% did not recognize it; these individuals were more likely to be older, Black, never married, and to have worse cognitive function compared to individuals who recognized their dysfunction (P < 0.05, all). Individuals who lacked awareness of their olfactory dysfunction had the greatest cognitive impairment at 5-year follow-up, followed by individuals aware of their dysfunction and finally normosmics (P < 0.001). Older Americans with measured olfactory dysfunction are unlikely to report it, and those who lack awareness of this dysfunction have distinct demographic, social, and cognitive characteristics. Therefore, clinicians should objectively test patients. Individuals who lack awareness of their olfactory dysfunction have poor cognitive outcomes and should receive additional clinical scrutiny.

Research in and Prospects for the Measurement of Health Using Self-Rated Health

Self-rated health (SRH)-for example, "in general would you say your health is excellent, very good, good, fair, or poor?"-is the most widely used measure of health across a range of survey research studies. This paper synthesizes extant research and provides a framework for future research on the measurement of health using SRH, focusing on four interrelated topics: the factors that influence respondents' health ratings, the survey measurement features of SRH, how SRH answers are analyzed, and the stated purpose of SRH as a proxy for more objective health or as a perception of health. Extant research on the health, psychological, and social factors influencing respondents' SRH answers is reviewed, as is research concerned with the survey measurement features of SRH that influence how respondents rate their health. The synthesis proposes a framework for future research that focuses on further explicating the factors that underlie respondents' SRH answers and improving features of SRH measurement and analysis in ways that are consistent with the various goals of the researchers who both collect and analyze the data.

Race, Marital History, and Risks for Stroke in US Older Adults

Stroke is among the leading causes of disability and death in the United States, and racial differences are greater for stroke than for all other major chronic diseases. Considering the equally sizeable racial disparities in marital life and associated risks across adulthood, the current study hypothesizes that black-white differences in marital history play an important role in the large racial inequalities in the incidence of stroke. The major objective are to (i) demonstrate how marital history is associated with the incidence of stroke, (ii) examine how marital factors mediate and/or moderate racial disparities in stroke, and (iii) examine the factors that may explain the associations. Using retrospective and prospective data from the Health and Retirement Study (n = 23,289), the results show that non-Hispanic (NH) blacks have significantly higher rates of marital instability, greater numbers of health-risk factors, and substantially higher rates of stroke compared with NH whites. Contrary to the cumulative disadvantage hypothesis, findings from discrete-time-hazard models show that the effects of marital history are more pronounced for NH whites than for NH blacks. Risks for stroke were significantly higher in NH whites who were currently divorced, remarried, and widowed, as well as in those with a history of divorce or widowhood, compared with NH whites who were continuously married. In NH blacks, risks for stroke were elevated only in those who had either never married or had been widowed-with no significant risks attributable to divorce. The potential mechanisms underlying the associations are assessed, and the implications of the findings are discussed.

Determinants of self-rated health in an Irish deprived suburban population - a cross sectional face-to-face household survey

Background

Self-rated health (SRH) is amongst the most frequently assessed health perceptions in epidemiological research. While there is a growing understanding of the role of SRH, a paradigm model has yet to be widely accepted with recent studies concluding that further work is required in determining whether there are important predictors of SRH yet to be highlighted. The aim of this paper is to determine what health and non-health related factors were associated with SRH in a suburban deprived population in Dublin, Ireland.

Methods

A cross sectional face-to-face household survey was conducted. Sampling consisted of random cluster sampling in 13 electoral divisions, with a sampling frame of 420 houses. Demographic information relating to the primary carer was collected. Health status of the primary carer was measured through SRH. Household level data included the presence or absence of persons with a chronic disease, persons who smoked, persons with a disability and healthcare utilisation of general practitioner and hospital level services. A logistic regression model was utilised in the analysis whereby the odds of primary carers with poor SRH were compared to the odds of carers with good SRH taking health and non-health related factors into account.

Results

Of the 420 households invited to participate a total of 343 were interviewed (81.6 % response rate). Nearly half of the primary carers indicated their health as being ‘good’ (n = 158/342; 46.2 %).

Adjusting for the effects of other factors, the odds of primary carers with second level education were increased for having poor SRH in comparison to the odds of those with third level education (OR 3.96, 95 % CI (1.44, 11.63)). The odds of primary carers who were renting from the Council were increased for having poor SRH compared to the odds for those who owned their own property (OR 3.09, 95 % CI (1.31, 7.62)). The odds of primary carers that were unemployed (OR 3.91, 95 % CI 1.56, 10.25)) or retired, ill or unable to work (OR 4.06, 95 % CI (1.49, 11.61)) were higher for having poor SRH than the odds of those in employment. If any resident of the household had a chronic illness then the odds of the primary carer were increased for having poor SRH compared to the odds for a primary carer in a household where no resident had a chronic illness (OR 4.78, 95 % CI (2.09, 11.64)). If any resident of the household used the local hospital, the odds of the primary carer were increased for having poor SRH compared to the odds for the primary carer in a household where no resident used the local hospital (OR 2.01, 95 % CI (1.00, 4.14)).

Conclusions

SRH is affected by both health and non-health related factors. SRH is an easy to administer question that can identify vulnerable people who are at risk of poor health.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3442-x) contains supplementary material, which is available to authorized users.

Rural Residency has a Protective Effect and Marriage is a Risk Factor for NAFLD

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is considered the leading cause of liver disease worldwide. Although many previous studies have evaluated the potential risk factors of NAFLD, few studies have determined the effect of residency or marriage status on NAFLD.

OBJECTIVES

We aim to evaluate whether residency and marriage status increased the risk factors for NAFLD.

MATERIALS AND METHODS

We utilized data from 5,052 participants, 18 years and older, from a cohort study conducted using 6,140 participants in northern Iran. The population was divided into 16 subgroups according to sex and age; the age groups had an interval of 10 years. We randomly selected the subjects from each subgroup in proportion to the size of each subpopulation group. Logistic regression analyses were conducted on NAFLD as an outcome of marriage status, residency (rural vs. urban), and other potential risk factors.

RESULTS

We found that NAFLD had an inverse association with rural living in men (OR = 0.513, 0.422 - 0.622, P value < 0.001) and women (OR = 0.431, 0.345 - 0.539, P value < 0.001). Furthermore, we determined that NAFLD had a direct association with marriage status for men (OR = 2.770, 2.004 - 3.831, P value < 0.001) and women (OR = 1.241, 1.033 - 1.490, P value = 0.0209).

CONCLUSIONS

While rural living has a protective effect on NAFLD, marriage may be a potential risk factor for this condition.

Self-rated Health and Internet Addiction in Iranian Medical Sciences Students; Prevalence, Risk Factors and Complications

INTRODUCTION

Self-rated health is a brief measure for general health. It is a comprehensive and sensitive index for prediction of health in future. Due to the high internet usage in medical students, the current study designed to evaluate the self-rated health (SRH) in relationship with internet addiction risk factors in medical students.

METHODS

This cross sectional study conducted on 254 students of Qom University of Medical Sciences 2014. Participants selected by two stage sampling method including stratified and simple random sampling. The Young's questionnaire of internet addiction and SRH question used for data collection. Chi-square, t-test, and logistic regression used in data analysis.

RESULTS

More than 79.9% of students reported their general health good and very good. The student's mean score of general health was higher than the average. In addition, the prevalence of internet addiction was 28.7%. An inverse significant correlation observed between SRH and internet addiction score (r=-0.198, p=0.002). Using internet for Entertainment, using private Email and chat rooms were the most important predictors of affecting to internet addiction. Moreover, internet addiction is the most predictors of SRH and increased the odds of bad SRH.

CONCLUSION

The good SRH of medical students was higher than general population but in health faculty' students were lower than others. Due to the effect of internet addiction on SRH and increasing trend of internet use in medical students, as well as low age of participants, attention to psychological aspects and the job expectancy in future, can effective on increasing the good SRH.

Gender Differences in Marital Status Moderation of Genetic and Environmental Influences on Subjective Health

From the IGEMS Consortium, data were available from 26,579 individuals aged 23 to 102 years on 3 subjective health items: self-rated health (SRH), health compared to others (COMP), and impact of health on activities (ACT). Marital status was a marker of environmental resources that may moderate genetic and environmental influences on subjective health. Results differed for the 3 subjective health items, indicating that they do not tap the same construct. Although there was little impact of marital status on variance components for women, marital status was a significant modifier of variance in all 3 subjective health measures for men. For both SRH and ACT, single men demonstrated greater shared and nonshared environmental variance than married men. For the COMP variable, genetic variance was greater for single men vs. married men. Results suggest gender differences in the role of marriage as a source of resources that are associated with subjective health.

Determinants of Poor Self-rated Health in Korean Adults With Diabetes

Objectives:

Self-rated health is a measure of perceived health widely used in epidemiological studies. Our study investigated the determinants of poor self-rated health in middle-aged Korean adults with diabetes.

Methods:

A cross-sectional study was conducted based on the Health Examinees Study. A total of 9759 adults aged 40 to 69 years who reported having physician-diagnosed diabetes were analyzed with regard to a range of health determinants, including sociodemographic, lifestyle, psychosocial, and physical variables, in association with self-rated health status using multivariate logistic regression models. A p-value <0.05 was considered to indicate statistical significance.

Results:

We found that negative psychosocial conditions, including frequent stress events and severe distress according to the psychosocial well-being index, were most strongly associated with poor self-rated health (odds ratio [OR]_{Frequent stress events}, 5.40; 95% confidence interval [CI], 4.63 to 6.29; OR_{Severe distress}, 11.08; 95% CI, 8.77 to 14.00). Moreover, younger age and being underweight or obese were shown to be associated with poor self-rated health. Physical factors relating to participants’ medical history of diabetes, such as a younger age at diagnosis, a longer duration of diabetes, insulin therapy, hemoglobin A_1clevels of 6.5% or more, and comorbidities, were other correlates of poor reported health.

Conclusions:

Our findings suggest that, in addition to medical variables, unfavorable socioeconomic factors, and adverse lifestyle behaviors, younger age, being underweight or obese, and psychosocial stress could be distinc factors in predicting negative perceived health status in Korean adults with diabetes.

Life-Course Partnership Status and Biomarkers in Midlife: Evidence From the 1958 British Birth Cohort

OBJECTIVES

We examined the association between trajectories of partnership status over the life course and objectively measured health indicators in midlife.

METHODS

We used data from 4 waves (1981, 1991, 2000, and 2002-2004) of the British National Child Development Study (NCDS), a prospective cohort study that includes all people born in Britain during 1 week in March 1958 (n = 18 558).

RESULTS

After controlling for selection attributable to early-life and early-adulthood characteristics, we found that life-course trajectories of partnership status were associated with hemostatic and inflammatory markers, the prevalence of metabolic syndrome and respiratory function in midlife. Never marrying or cohabiting was negatively associated with health in midlife for both genders, but the effect was more pronounced in men. Women who had married in their late 20s or early 30s and remained married had the best health in midlife. Men and women in cohabiting unions had midlife health outcomes similar to those in formal marriages.

CONCLUSIONS

Partnership status over the life course has a cumulative effect on a wide range of objectively measured health indicators in midlife.

Influence of substance use on the erectile response in a sample of drug users

Erectile dysfunction in men may be due to multiple causes, including anxiety and substance abuse. The main objective of this study is to know how it affects the continued use of addictive substances in the erectile response, taking into account not only the type of substances consumed, but also other variables that may influence on sexual response, such as the time of withdrawal, anxiety and sexual attitude. Two samples were used, one for males (n = 925) who had a history of substance use and another one for males (n = 82) with no history of substance abuse. Both populations were selected by a cluster sampling of 27 Spanish provinces. The GRISS, SOS and STAI questionnaires were used. The results indicate that men with a history of consumption obtained a higher percentage of dysfunction in the erectile dysfunction questionnaire GRISS scale than those who have a history of consumption (36.69% vs.15.85%) who also have higher scores on state anxiety (19.83 vs.11.89) and trait anxiety (25.66 vs.12.39) and lowest in erotophilia (86.85 vs. 97.29) was statistically significant difference. It is also proved that the time of withdrawal does not help ex drug users improve their erectile response.

Advancing research on racial-ethnic health disparities: improving measurement equivalence in studies with diverse samples

To conduct meaningful, epidemiologic research on racial-ethnic health disparities, racial-ethnic samples must be rendered equivalent on other social status and contextual variables via statistical controls of those extraneous factors. The racial-ethnic groups must also be equally familiar with and have similar responses to the methods and measures used to collect health data, must have equal opportunity to participate in the research, and must be equally representative of their respective populations. In the absence of such measurement equivalence, studies of racial-ethnic health disparities are confounded by a plethora of unmeasured, uncontrolled correlates of race-ethnicity. Those correlates render the samples, methods, and measures incomparable across racial-ethnic groups, and diminish the ability to attribute health differences discovered to race-ethnicity vs. to its correlates. This paper reviews the non-equivalent yet normative samples, methodologies and measures used in epidemiologic studies of racial-ethnic health disparities, and provides concrete suggestions for improving sample, method, and scalar measurement equivalence.

Individual and province inequalities in health among older people in China: evidence and policy implications

This paper uses multi-level modelling to analyse data from the nationally-representative Chinese Health and Retirement Longitudinal Study (CHARLS) in order to investigate the characteristics associated with poor health among older people, including individual and household characteristics as well as the characteristics of the provinces in which the older person lives (contextual effects). The results show that older Chinese women, rural residents, those with an education level lower than high school, without individual income sources, who are ex-smokers, and those from poor economic status households are more likely to report disability and poor self-rated health. Differentials in the health outcomes remain substantial between provinces even after controlling for a number of individual and household characteristics.

How valid are self-reports of illness-related absence? Evidence from a university employee health management program

The present study uses a focused approach to compare self-reported versus administratively recorded measures of absences related to health or illness. To date, the few studies that focus on this topic produced mixed results. To help shed light on this issue, the present research has 2 related objectives: (1) examine how highly correlated self-reported and administratively recorded measures of absences related to health or illness might be, and (2) how each measure predicts various aspects of health. Using data from the 2012 StayWell® Health Management health risk appraisal (HRA) and 1 year (2011) of administratively recorded timekeeping data, bivariate analyses for continuous variables and generalized linear modeling for variables with greater than 2 response categories were used. For the multivariate analyses, linear regression models controlling for sex, age, race, income, job status, and campus location were calculated for the continuous outcomes (ie, self-rated health and chronic conditions). Results indicate that self-reported and administratively recorded absences related to health or illness were moderately correlated (correlation coefficient of 0.47). In addition, each measure functioned similarly (in direction and magnitude) to predict health outcomes. Both greater self-reported and recorded illness-related absenteeism was associated with poorer self-rated health and greater numbers of chronic conditions. These results suggest that self-rated illness-related absenteeism may be a reasonable way to assess various program outcomes meaningful to employers, particularly if administratively recorded measures are unavailable or too time consuming or expensive to analyze.

Employment hardships and single mothers' self-rated health: evidence from the panel study of income dynamics

Using a national sample of single mothers from the 2007 and 2009 waves of the Panel Study of Income Dynamics, this study examined the effects of multiple employment statuses on the selfrated health of single mothers during the recent economic recession. Unlike other studies, the current study minimized selection bias by controlling for prior self-rated health, in addition to other predisposing factors, enabling factors, and need factors. We found that underemployment, but not unemployment, is associated with lower levels of self-rated health of single mothers. Results further indicate that the 25-39 age range (compared to the 18-24 age range), lower family income, prior lower self-rated health, more chronic diseases, and binge drinking place single mothers at an increased risk of lower levels of self-rated health. In contrast, strength-building physical activity is significantly associated with higher levels of self-rated health. Implications for health care policy and social work practice are drawn from the results.