Self-esteem, stress and self-rated health in family planning clinic patients

Ethnic Discrimination and Self-rated Health among Hispanic Emerging Adults: Examining the Moderating Effects of Self-esteem and Resilience

Exposure to ethnic discrimination has been conceptualized as a sociocultural stressor that is associated with lower self-rated health. However, this association remains understudied among Hispanics and less is known about constructs that may mitigate the effects of ethnic discrimination on self-rated health. Accordingly, this study aimed to (a) examine the association between ethnic discrimination and self-rated health among Hispanic emerging adults (ages 18-25), and (b) examine the extent to which self-esteem and resilience may moderate this association. A convenience sample of 200 Hispanic emerging adults from Arizona (n=99) and Florida (n=101) was recruited to complete a cross-sectional survey. Data were analyzed using hierarchical multiple regression and moderation analyses. Results indicate that higher ethnic discrimination was associated with lower self-rated health. Moderation analyses indicated that self-esteem functioned as a moderator that weakened the association between ethnic discrimination and self-rated health; however, resilience did not function similarly as a moderator. This study adds to the limited literature on ethnic discrimination and self-rated health among Hispanics and highlights that psychological factors, such as enhancing self-esteem, may help buffer the adverse effects of ethnic discrimination on health outcomes.

Does informal caregiving affect self-esteem? Results from a population-based study of individuals aged 40 and over in Germany from 2002 to 2014

BACKGROUND

While it is known that informal caregiving is associated with care-derived self-esteem cross-sectionally, little is known about the impact of informal caregiving on general self-esteem longitudinally. Thus, we aimed at examining whether informal caregiving affects general self-esteem using a longitudinal approach.

METHODS

Data were gathered from a population-based sample of community-dwelling individuals aged 40 and over in Germany from 2002 to 2014 (n = 21 271). General self-esteem was quantified using the Rosenberg scale. Individuals were asked whether they provide informal care regularly.

RESULTS

Fixed effects regressions showed no significant effect of informal caregiving on general self-esteem longitudinally. General self-esteem decreased with increasing morbidity, increasing age, decreasing social ties, whereas it was not associated with changes in employment status, marital status and body mass index. Additional models showed that decreases in self-esteem were associated with decreases in functional health and increases in depressive symptoms.

CONCLUSION

Our longitudinal study emphasises that the occurrence of informal caregiving did not affect general self-esteem longitudinally. Further research is needed in other cultural settings using panel data methods.

Cigarettes and self-rated health among online university students

An increasing number of university students are earning their degrees online. Thus far, the determinants of health among online university students have not been studied. The purpose of this cross-sectional internet survey was to test the association between behavioral risk factors and self-rated health in a diverse sample of online university students. Cigarette smoking was associated with lower odds of good self-rated health (OR = 0.27, P < 0.01). Compared to having zero days of mental distress, 14 or more days of mental distress was associated with lower odds of good self-rated health (OR = 0.08, P < 0.05). White students had lower odds of reporting good self-rated health compared to African-American students (OR = 0.35, P < 0.05). Health education, screening and health promotion programs should be developed for online students.

Household income and spiritual well-being but not body mass index as determinants of poor self-rated health among African American adolescents

Very little is known about predictors of subjective health status among African American adolescents. This study was designed to determine whether selected anthropometric, psychological, lifestyle behavioral, and structural variables predicted poor self-rated general health in a cross-sectional nonclinical sample of 310 female African American adolescents, 14-18 years old. The odds of reporting poor self-rated health were 2-3 times greater for African American teens from lower socioeconomic households when compared to teens residing in higher socioeconomic households and for those reporting infrequent participation in activities that promote spiritual well-being compared to those who participate more frequently in activities that enhance spiritual health. Findings indicate that socioeconomic level and engagement in behaviors that enhance healthy spirituality appear to be the most salient predictors of self-rated health. In addition to biodiversity considerations that influence perceptions of health status, culturally focused interventions should integrate variables shown to influence self-rated health among African American teens. These inclusions may inform a more integrated understanding of health, health outcomes, and health disparities in this vulnerable population.

Self-assessed disability and self-rated health among rural villagers in Peru: a brief report

CONTEXT

Risks for poor self-rated overall health in rural areas of developing nations have not been thoroughly investigated.

PURPOSE

The objective of this study was to assess potential risk factors for poor self-rated health among rural villagers in Peru.

METHODS

A door-to-door survey of villagers residing in the Pampas Grande region in Peru, which is in the Andes Mountains, yielded complete data for 337 adults.

FINDINGS

Adjusting for age and gender using multiple logistic regression analysis revealed that having self-reported disabilities was inversely and independently related to good self-rated health (OR 0.48 [95% CI, 0.26-0.88]). Joint pain also was related to self-rated health (OR 0.23 [95% CI, 0.13-0.41]).

CONCLUSIONS

Increasing access to affordable, effective analgesics may reduce this disparity. Health agencies should consider these actions as possible planning priorities for the region.

Comparing diverse health promotion programs using overall self-rated health as a common metric

Health promotion programs may target a variety of behaviors including weight loss, exercise, stress, nutrition, or other risk factors. Comparing the outcomes of diverse programs is hampered by the absence of a common metric. Overall self-rated health has been used as a health outcome measure in population studies and in some primary care studies, but its potential use to monitor the outcomes of health programs is unexplored. The purpose of this study was to compare the outcomes of 4 health promotion programs using change in overall self-rated health as a common metric. Program-specific metrics used were weight change, change in minutes of exercise, change in stress management activities, and change in healthy nutrition practices. We found that, although all of our lifestyle interventions positively affected the program-specific metrics, only the weight loss and exercise programs showed improvement in specific metrics correlated with improvements in overall self-rated health.

Self-rated health--what does it capture at 1 year after childbirth? Investigation of a survey question employing thinkaloud interviews

AIM

This paper reports an investigation of how the survey question 'How would you summarize your state of health at present' is interpreted and what it captures when asked at 1 year after childbirth.

BACKGROUND

Self-rated health measured by a single item question is a well-established patient outcome as it predicts morbidity and the use of health services. However, there is limited understanding of what the question captures in early motherhood.

METHOD

A qualitative design combining data collection by means of a short form, concurrent and retrospective thinkaloud interviews, and a semi-structured interview, with 26 Swedish women during 2005 was employed. The text was analysed by qualitative content analysis. A theoretical framework describing four cognitive tasks usually performed when a respondent answers a survey question guided the analysis: interpretation of the question, retrieval of information, forming a judgement and giving a response.

FINDINGS

The questions of self-rated health left open for the new mothers to evaluate what was most important for her. It captured a woman's total life situation, such as family functioning and well-being, relationship with partner, combining motherhood and professional work, energy, physical symptoms and emotional problems affecting daily life, stressful life events, chronic disease with ongoing symptoms, body image, physical exercise and happiness. Neither childbirth-related events nor childbirth-related symptoms were included in the responses. Less than 'good' self-rated health represented a high burden of health problems.

CONCLUSION

Our results showed that the question on self-rated health was a measure of women's general health and well-being in their present life situation, but it did not seem to measure recovery after childbirth specifically.

Exercise and self-rated health in adult primary care patients

BACKGROUND

Clinical guidelines call for more exercise than many patients are willing to undertake. More modest goals are more acceptable but may not improve overall self-rated health (SRH) in primary care patients. Furthermore, whether exercise should be measured in minutes per week, times per week, or both is unclear.

DESIGN

A random sample of 939 primary care patients met criteria for the study. Exercise was measured in self-reported minutes and times per week. Multiple logistic regression analysis was used to test for the independent effects of minutes and times per week of exercise on SRH in primary care patients.

RESULTS

Exercising 1 to 150 minutes per week was independently related to good SRH (odds ratio = 3.41, confidence interval = 1.73-6.73) as was exercising 151 to 300 minutes per week (odds ratio = 4.13, confidence interval = 1.45-11.71). The number of exercise times per week was not significant.

CONCLUSIONS

In our sample of relatively healthy primary care patients, exercising 1 to 300 minutes per week appears to promote good SRH.

Validity of overall self-rated health as an outcome measure in small samples: a pilot study involving a case series

OBJECTIVE

A single-item measure of overall self-rated health (SRH) commonly is used in population surveys, but has not been used in small pilot projects. The purpose of this study was to assess the validity of SRH in small samples.

DESIGN

We used data from a prospective, observational weight-loss project to compare change in SRH with change in body weight and physical activity (PA) (minutes) over 30 days (n = 34). Body mass index at baseline ranged from 25.5 to 50.4 (mean = 36.1, median = 34.6). SRH was self-assessed using the following question: How would you rate your health overall? Results An increase in weight was associated with a reduction in SRH (r = 0.37, P = 0.03). An increase in PA was associated with improved SRH (r = 0.39, P = 0.02).

CONCLUSIONS

A single-item SRH measure may be an efficient method for measuring programme outcomes, and may also be useful for comparing the relative effectiveness of different programmes in pilot projects and quality improvement studies.

A Patient-Centered Decision Rule for Referral of Patients to Weight-Loss Programs

BACKGROUND

The obesity epidemic threatens to shorten life expectancy and reduce the quality of life for large segments of the population. The purpose of this study was to develop a decision rule for referral to a weight-loss program on the basis of the relationship between body mass index (BMI) and self-rated overall health.

METHODS

We employed a patient satisfaction survey of family medicine patients treated in Mayo Clinic in Rochester, Minnesota, linked with medical record information, to test the theory that, in primary care patients, BMI exhibits an inverse and independent relationship with overall self-rated health after adjusting for age, gender, marital status, and cigarette smoking. Interviews were linked to medical records for 679 adult patients.

RESULTS

Adjusting for age and other confounders using multiple logistic regression analysis revealed that overweight (BMI = 25-30 kg/m(2)) was not a risk factor for poor self-rated health and only BMI above 35 kg/m(2) was significantly related to poor overall health (adjusted odds ratio = 0.33, confidence interval = 0.17-0.64, P = .0012).

CONCLUSIONS

Quality improvement programs should monitor whether obesity is being addressed in clinical settings. A patient-centered decision rule for addressing obesity could involve referral of patients whose BMI is above 35 kg/m(2) to weight management programs, monitoring of patients whose BMI scores are between 30 and 35 kg/m(2), and encouragement of patients whose BMI is above 25 kg/m(2) to avoid weight gain.

Risk factors for poor self-rated health in women at 2 months and 1 year after childbirth

OBJECTIVE

To investigate risk factors for poor self-rated health (SRH) in primiparous and multiparous women 2 months and 1 year after childbirth in a nationwide Swedish sample.

METHODS

Women were recruited at their first booking visit at 593 (97%) antenatal clinics in Sweden during 3 weeks evenly spread over 1 year (1999-2000). Data were collected by questionnaires in early pregnancy, 2 months and 1 year after childbirth, and from the Medical Birth Register. In total, 2424 women filled in all the questionnaires, including a global question on SRH. The representativity of the sample was assessed by comparison with the total Swedish birth cohort of 1999. Data were analyzed by logistic regression analysis.

RESULTS

Physical problems, such as tiredness, musculoskeletal symptoms, and abdominal pain, and emotional problems, such as depressive symptoms, increased the risk of poor SRH in both primiparas and multiparas at one or both time points. Infant-related risk factors in both groups were negative experience of breastfeeding (2 months) and infant sleeping problems (1 year), and prematurity was a risk factor in primiparas at 2 months. Insufficient social support increased the risk in multiparas. In primiparas, outcome of labor, such as negative birth experience after operative delivery, was associated with poor SRH at 1 year and perineal pain at 2 months.

CONCLUSIONS

A new mother's SRH is associated with her life situation. Ongoing physical and emotional problems, lack of support, and infant factors seem more important than sociodemographic background. Mode of delivery and childbirth experience may have a longterm effect on SRH.

Walkability and self-rated health in primary care patients

Background

The objective of this study was to investigate the relationship between perceived walkability and overall self-rated health among patients who use community-based clinics.

Methods

A cross-sectional survey was distributed to a convenience sample in three community clinics. Forms were completed by 793 clinic patients. Multiple logistic regression analysis was to control for the effects of demographic variables and lifestyles.

Results

Perceiving the availability of places to walk was related to better self-rated health. The most important places were work (OR = 3.2), community center (OR = 3.12), park (OR = 2.45) and day care (OR = 2.05). Respondents who said they had zero (OR = .27) or one (OR = .49) place to walk were significantly less healthy than persons who said they had five or more places to walk.

Conclusion

Persons who perceived that they had no place to walk were significantly less healthy than persons who thought they had at least one place to walk (OR = .39). Support for walkable neighborhoods and education of patients about options for walking may be in the best interests of community medicine patients.