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Martin MI, Mauer-Vakil D, Borkhoff CM, Parkin PC, Bayoumi I. Connecting families: a qualitative study examining the experiences of parenting young children under financial strain in Ontario, Canada. BMC Public Health 2024; 24:913. [PMID: 38549075 PMCID: PMC10976761 DOI: 10.1186/s12889-024-18463-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/27/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND There is little research investigating the subjective experiences of parenting young children while living in poverty and experiencing financial strain using qualitative methodologies. Therefore, the objective of this study was to employ a qualitative approach to provide a nuanced and balanced view on the topic of parenting young children under financial strain in the Canadian context. METHODS We conducted a qualitative study using semi-structured interviews between July and August 2021 in Kingston, Ontario, Canada. Sixteen participants aged 20-39 self-identified as living under financial strain while parenting a child aged 2-5 years. A qualitative inductive thematic analysis was undertaken with a focus on describing the contents of the data. RESULTS Four major themes emerged from the data: experience of being a parent, impact of financial strain on the family unit, impact of financial strain on the children, and impact of financial strain on the parent. Numerous deleterious physical, mental, and material impacts on the family unit and parent were identified, however parent-perceived impacts of financial strain on their children were minimal. Parents described striking levels of resourcefulness and resiliency in providing the necessities for their families, absorbing the most significant impacts of financial strain through the phenomenon of self-sacrifice. CONCLUSION The impacts of financial strain on families with young children are far reaching. Further research into the impacts of self-sacrifice on parents experiencing financial strain are needed to better understand this issue, and to inform social programming and resources that could help alleviate the deleterious impacts of poverty on parent mental, social, and physical health.
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Affiliation(s)
- Mary I Martin
- Centre for Studies in Primary Care, Queen's University, 220 Bagot St, K7L 5E9, Kingston, ON, P.O. Bag 8888, Canada
| | - Dane Mauer-Vakil
- Centre for Studies in Primary Care, Queen's University, 220 Bagot St, K7L 5E9, Kingston, ON, P.O. Bag 8888, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Cornelia M Borkhoff
- Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and SickKids Research Institute, Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Patricia C Parkin
- Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and SickKids Research Institute, Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Imaan Bayoumi
- Centre for Studies in Primary Care, Queen's University, 220 Bagot St, K7L 5E9, Kingston, ON, P.O. Bag 8888, Canada.
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Elamoshy R, Farag M, Geda N, Feng C. Assessing the impact of COVID-19 on self-reported levels of depression during the pandemic relative to pre-pandemic among Canadian adults. Arch Public Health 2024; 82:29. [PMID: 38449047 PMCID: PMC10918925 DOI: 10.1186/s13690-024-01253-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVES This study aims to assess the impact of COVID-19 related risk factors on self-reported increases in depression among Canadian adults during the pandemic compared to pre-pandemic levels. We aim to investigate the interactive effects of stressors, including social isolation, financial stress, and fear of catching COVID-19, on mental health outcomes. Our study aims to provide insights for the development of prevention and intervention strategies to address the mental health effects of the pandemic by examining the psychological changes attributable to the pandemic and its impact. METHODS This study used data collected from the Mental Health Research Canada online survey during the third wave of COVID-19 (April 20-28, 2021). The study examined the impact of COVID-19 related factors, including social isolation, financial concerns, fear of catching COVID-19, and concerns about paying bills, on self-reported increases in depression. Multivariable logistic regression models were utilized to examine these associations, with adjustments made for potential confounding variables. All statistical analysis was performed using SAS V9.4 (SAS Institute Inc., Cary, NC, USA). RESULTS Participants reporting social isolation, financial concerns, and fear of catching COVID-19 were more likely to report increased depression. An interaction was observed between concerns for paying bills and catching COVID-19 in relation to depression (p = 0.0085). In other words, the effect of concerns about paying bills on depression was stronger for individuals who also had a fear of catching COVID-19, and vice versa. Young adults, females, patients with pre-existing depression, and residents of certain provinces reported higher levels of depression during COVID-19. CONCLUSION Our study underscores the significant impact of the COVID-19 pandemic on mental health, particularly among certain demographic groups. It emphasizes the need for depression screening and increased support for mental health during the pandemic, with a focus on mitigating financial burdens and reducing negative psychological impacts of social isolation. Our findings highlight the complex interplay between different stressors and the need to consider this when designing interventions to support mental health during times of crisis.
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Affiliation(s)
- Rasha Elamoshy
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Marwa Farag
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Nigatu Geda
- College of Development Studies, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Cindy Feng
- Department of Community Health and Epidemiology, Faculty of Medicine, University of Dalhousie, Halifax, NS, Canada.
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Osibogun O, Ogunmoroti O, Turkson-Ocran RA, Okunrintemi V, Kershaw KN, Allen NB, Michos ED. Financial strain is associated with poorer cardiovascular health: The multi-ethnic study of atherosclerosis. Am J Prev Cardiol 2024; 17:100640. [PMID: 38419947 PMCID: PMC10899015 DOI: 10.1016/j.ajpc.2024.100640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/08/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
Objective Psychosocial stress is associated with increased cardiovascular disease (CVD) risk. The relationship between financial strain, a toxic form of psychosocial stress, and ideal cardiovascular health (CVH) is not well established. We examined whether financial strain was associated with poorer CVH in a multi-ethnic cohort free of CVD at baseline. Methods This was a cross-sectional analysis of 6,453 adults aged 45-84 years from the Multi-Ethnic Study of Atherosclerosis. Financial strain was assessed by questionnaire and responses were categorized as yes or no. CVH was measured from 7 metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood glucose and blood pressure). A CVH score of 14 was calculated by assigning points to the categories of each metric (poor = 0 points, intermediate = 1 point, ideal = 2 points). Multinomial logistic regression was used to examine the association of financial strain with the CVH score (inadequate 0-8, average 9-10, and optimal 11-14 points) adjusting for sociodemographic factors, depression and anxiety. Results The mean age (SD) was 62 (10) and 53 % were women. Financial strain was reported by 25 % of participants. Participants who reported financial strain had lower odds of average (OR, 0.82 [95 % CI, 0.71, 0.94]) and optimal (0.73 [0.62, 0.87]) CVH scores. However, in the fully adjusted model, the association was only significant for optimal CVH scores (0.81, [0.68, 0.97]). Conclusion Financial strain was associated with poorer CVH. More research is needed to understand this relationship so the burden of CVD can be decreased, particularly among people experiencing financial hardship.
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Affiliation(s)
- Olatokunbo Osibogun
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Oluseye Ogunmoroti
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Victor Okunrintemi
- Division of Cardiovascular Disease, Houston Methodist Hospital, Houston, TX, USA
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Norrina B. Allen
- Division of Cardiovascular Disease, Houston Methodist Hospital, Houston, TX, USA
| | - Erin D. Michos
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Bather JR, McSorley AMM, Rhodes-Bratton B, Cuevas AG, Rouhani S, Nafiu RT, Harris A, Goodman MS. Love after lockup: examining the role of marriage, social status, and financial stress among formerly incarcerated individuals. Health Justice 2024; 12:7. [PMID: 38400934 PMCID: PMC10893755 DOI: 10.1186/s40352-024-00264-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/15/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Upon reintegration into society, formerly incarcerated individuals (FIIs) experience chronic financial stress due to prolonged unemployment, strained social relationships, and financial obligations. This study examined whether marriage and perceived social status can mitigate financial stress, which is deleterious to the well-being of FIIs. We also assessed whether sociodemographic factors influenced financial stress across marital status. We used cross-sectional data from 588 FIIs, collected in the 2023 Survey of Racism and Public Health. The financial stress outcome (Cronbach's [Formula: see text] = 0.86) comprised of five constructs: psychological distress, financial anxiety, job insecurity, life satisfaction, and financial well-being. Independent variables included marital and social status, age, race/ethnicity, gender identity, educational attainment, employment status, and number of dependents. Multivariable models tested whether financial stress levels differed by marital and perceived social status (individual and interaction effects). Stratified multivariable models assessed whether social status and sociodemographic associations varied by marital status. RESULTS We found that being married/living with a partner (M/LWP, b = -5.2) or having higher social status (b = -2.4) were protective against financial stress. Additionally, the social status effect was more protective among divorced, separated, or widowed participants (b = -2.5) compared to never married (NM, b = -2.2) and M/LWP (b = -1.7) participants. Lower financial stress correlated with Black race and older age, with the age effect being more pronounced among M/LWP participants (b = -9.7) compared to NM participants (b = -7.3). Higher financial stress was associated with woman gender identity (overall sample b = 2.9, NM sample b = 5.1), higher education (M/LWP sample b = 4.4), and having two or more dependents (overall sample b = 2.3, M/LWP sample b = 3.4). CONCLUSIONS We provide novel insights into the interrelationship between marriage, perceived social status, and financial stress among FIIs. Our findings indicate the need for policies and programs which may target the family unit, and not only the individual, to help alleviate the financial burden of FIIs. Finally, programs that offer legal aid to assist in expungement or sealing of criminal records or those offering opportunities for community volunteer work in exchange for vouchers specific to legal debt among FIIs could serve to reduce financial stress and improve social standing.
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Affiliation(s)
- Jemar R Bather
- Center for Anti-Racism, Social Justice & Public Health, New York University School of Global Public Health, 708 Broadway, 9th Floor, New York, NY, 10003, USA.
- Department of Biostatistics, New York University School of Global Public Health, New York, NY, 10003, USA.
| | - Anna-Michelle Marie McSorley
- Center for Anti-Racism, Social Justice & Public Health, New York University School of Global Public Health, 708 Broadway, 9th Floor, New York, NY, 10003, USA
| | - Brennan Rhodes-Bratton
- Center for Anti-Racism, Social Justice & Public Health, New York University School of Global Public Health, 708 Broadway, 9th Floor, New York, NY, 10003, USA
| | - Adolfo G Cuevas
- Center for Anti-Racism, Social Justice & Public Health, New York University School of Global Public Health, 708 Broadway, 9th Floor, New York, NY, 10003, USA
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, 10003, USA
| | - Saba Rouhani
- Center for Anti-Racism, Social Justice & Public Health, New York University School of Global Public Health, 708 Broadway, 9th Floor, New York, NY, 10003, USA
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, 10003, USA
- Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, NY, 10003, USA
| | - Ridwan T Nafiu
- Center for Anti-Racism, Social Justice & Public Health, New York University School of Global Public Health, 708 Broadway, 9th Floor, New York, NY, 10003, USA
- Department of Epidemiology, New York University School of Global Public Health, New York, NY, 10003, USA
| | - Adrian Harris
- Center for Anti-Racism, Social Justice & Public Health, New York University School of Global Public Health, 708 Broadway, 9th Floor, New York, NY, 10003, USA
| | - Melody S Goodman
- Center for Anti-Racism, Social Justice & Public Health, New York University School of Global Public Health, 708 Broadway, 9th Floor, New York, NY, 10003, USA
- Department of Biostatistics, New York University School of Global Public Health, New York, NY, 10003, USA
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Antequera F, Rote S, Cantu P, Angel J. Paying the Price: The Cost of Caregiving for Older Latinos Enrolled in Medicare and Medicaid. Public Policy Aging Rep 2024; 34:18-21. [PMID: 38371942 PMCID: PMC10874179 DOI: 10.1093/ppar/prad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Indexed: 02/20/2024]
Affiliation(s)
- Felipe Antequera
- LBJ School of Public Affairs, The University of Texas at Austin, Austin, Texas, USA
| | - Sunshine Rote
- Kent School of Social Work and Family Science, University of Louisville, Louisville, Kentucky, USA
| | - Phillip Cantu
- Department of Internal Medicine-Geriatrics, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Jacqueline Angel
- LBJ School of Public Affairs, The University of Texas at Austin, Austin, Texas, USA
- Center on Aging and Population Sciences, The University of Texas at Austin, Austin, Texas, USA
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Chai L. Financial Strain and Psychological Distress Among Middle-Aged and Older Adults: A Moderated Mediation Model. J Gerontol Soc Work 2023; 66:1120-1132. [PMID: 37139587 DOI: 10.1080/01634372.2023.2207611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/05/2023]
Abstract
This study investigates the association between financial strain and psychological distress among middle-aged and older adults, exploring how this association is mediated by sleep problems and moderated by marital status. A subsample of 12,095 adults aged 50 and older was selected from the 2018 National Health Interview Survey. Results showed that financial strain was associated with higher psychological distress, and sleep problems partially mediated this association. Marital status moderated the association between sleep problems and psychological distress, and between financial strain and psychological distress, but not between financial strain and sleep problems. These findings partially support the stress-buffering role of marriage. The study offers valuable insights into the complex relationship between financial strain, sleep problems, marital status, and psychological distress among middle-aged and older adults in the United States, highlighting the need for interventions targeting financial stressors and sleep problems, especially for unmarried individuals, to improve mental health outcomes in this population.
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Affiliation(s)
- Lei Chai
- Department of Sociology, University of Toronto, Toronto, Ontario, Canada
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Van Houtven CH, Miller KEM, James HJ, Blunt R, Zhang W, Mariani AC, Rose S, Alolod GP, Wilson-Genderson M, Smith VA, Thomson MD, Siminoff LA. Economic costs of family caregiving for persons with advanced stage cancer: a longitudinal cohort study. J Cancer Surviv 2023:10.1007/s11764-023-01462-6. [PMID: 37823982 DOI: 10.1007/s11764-023-01462-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/05/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE To form a multifaceted picture of family caregiver economic costs in advanced cancer. METHODS A multi-site cohort study collected prospective longitudinal data from caregivers of patients with advanced solid tumor cancers. Caregiver survey and out-of-pocket (OOP) receipt data were collected biweekly in-person for up to 24 weeks. Economic cost measures attributed to caregiving were as follows: amount of OOP costs, debt accrual, perceived economic situation, and working for pay. Descriptive analysis illustrates economic outcomes over time. Generalized linear mixed effects models asses the association of objective burden and economic outcomes, controlling for subjective burden and other factors. Objective burden is number of activities and instrumental activities of daily living (ADL/IADL) tasks, all caregiving tasks, and amount of time spent caregiving over 24 h. RESULTS One hundred ninety-eight caregivers, 41% identifying as Black, were followed for a mean period of 16 weeks. Median 2-week out-of-pocket costs were $111. One-third of caregivers incurred debt to care for the patient and 24% reported being in an adverse economic situation. Whereas 49.5% reported working at study visit 1, 28.6% of caregivers at the last study visit reported working. In adjusted analysis, a higher number of caregiving tasks overall and ADL/IADL tasks specifically were associated with lower out-of-pocket expenses, a lower likelihood of working, and a higher likelihood of incurring debt and reporting an adverse economic situation. CONCLUSIONS Most caregivers of cancer patients with advanced stage disease experienced direct and indirect economic costs. IMPLICATIONS FOR CANCER SURVIVORS Results support the need to find solutions to lessen economic costs for caregivers of persons with advanced cancer.
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Affiliation(s)
- Courtney Harold Van Houtven
- Department of Population Health Sciences, Duke University, 215 Morris Street, Durham, NC, 27701, USA.
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA.
- Duke-Margolis Center for Health Policy, Washington, DC, USA.
| | - Katherine E M Miller
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, USA
| | - Hailey J James
- RTI International, 3040 Cornwallis Road, Durham, NC, 27709, USA
| | - Ryan Blunt
- Department of Social and Behavioral Sciences, Temple University, 1700 N. Broad Street, Philadelphia, PA, 19121, USA
| | - Wenhan Zhang
- Department of Population Health Sciences, Duke University, 215 Morris Street, Durham, NC, 27701, USA
| | - Abigail Cadua Mariani
- Department of Health Behavior and Policy, Virginia Commonwealth University, 830 E. Main Street, Richmond, VA, 23219, USA
| | - Sydney Rose
- Department of Social and Behavioral Sciences, Temple University, 1700 N. Broad Street, Philadelphia, PA, 19121, USA
| | - Gerard P Alolod
- Department of Social and Behavioral Sciences, Temple University, 1700 N. Broad Street, Philadelphia, PA, 19121, USA
| | - Maureen Wilson-Genderson
- Department of Social and Behavioral Sciences, Temple University, 1700 N. Broad Street, Philadelphia, PA, 19121, USA
| | - Valerie A Smith
- Department of Population Health Sciences, Duke University, 215 Morris Street, Durham, NC, 27701, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, 27705, USA
| | - Maria D Thomson
- Department of Health Behavior and Policy, Virginia Commonwealth University, 830 E. Main Street, Richmond, VA, 23219, USA
| | - Laura A Siminoff
- Department of Social and Behavioral Sciences, Temple University, 1700 N. Broad Street, Philadelphia, PA, 19121, USA
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Kanhai GA, Chang DF. Factors Contributing to West Indian American Depression. J Immigr Minor Health 2023; 25:979-989. [PMID: 36456840 PMCID: PMC9714766 DOI: 10.1007/s10903-022-01434-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 12/05/2022]
Abstract
This study explored factors that mediate the relationship between subjective wellbeing and depression in a sample of West Indian American immigrants. An intersectional theoretical framework was used to identify the relative contribution of psychological stressors-perceived discrimination, financial strain and acculturative stress-that mediate the relationship between subjective wellbeing and depression. A geographically diverse sample was recruited by an online survey (N = 255), consisting of 138 men, 115 women, 173 Indo-West Indians and 82 Afro-West Indians. Path analysis was used to identify the relative contribution of psychological stressors. Acculturative stress and financial strain were both statistically significant predictors of depression. Financial strain was identified as the major mediator between subjective wellbeing and depression in West Indian Americans. West Indian Americans are vulnerable to financial strain and acculturative stress. These sources of psychological stress are important contributors to depression in the community. More research is needed to clarify these relationships.
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Affiliation(s)
- Gregory A. Kanhai
- The New School for Social Research, Department of Psychology, 80 Fifth Avenue, New York, NY 10011 USA
| | - Doris F. Chang
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY 10011 USA
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Jaffar N, Mohd Faizal S, Selamat Z, Alias N. Muslim young adults' financial strain and financial stress during the COVID-19 pandemic: The moderating role of religiosity. Heliyon 2023; 9:e21047. [PMID: 37876443 PMCID: PMC10590929 DOI: 10.1016/j.heliyon.2023.e21047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/26/2023] Open
Abstract
The COVID-19 pandemic affected everyone's lives and general well-being worldwide, including young adults. Young adulthood is marked by a shift in various social areas including acquiring financial independence. As the pandemic was an exceptional scenario in all nations, there is a research gap in analysing how it would affect financial experiences of young adults, particularly the Muslim young adults. These individuals may face financial stress as a result of the COVID-19 pandemic due to their high level of financial strain. Furthermore, little is still known about the role that religiosity may play in the relationship between the financial strain and financial stress, notably during the pandemic. The objectives of this study were to examine the level of financial strain and financial stress of Muslim young adults, assess the effect of financial strain on financial stress of Muslim young adults and investigate the moderating effect of religiosity on the relationship between Muslim young adults' financial strain and financial stress during the COVID-19 pandemic. A survey of 230 Muslim young adults was conducted in Malaysia. Results showed that thirty percent of Muslim young adults fell under high level of financial strain while majority of them fell under high level of financial stress. Additionally, financial strain had a significant positive effect on the financial stress of Muslim young adults. This means that the more financially strained, the more Muslim young adults experienced financial stress during the COVID-19 pandemic. Religiosity, however, did not moderate the relationship between financial strain and financial stress. These results highlighted the significance of comprehending the level of financial strain and financial stress experienced by Muslim young adults during the COVID-19 pandemic. The results provided relevant parties insights in developing strategies for Muslim young adults to manage financial strain and financial stress to reduce the negative effect of the COVID-19 pandemic.
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Affiliation(s)
- Nahariah Jaffar
- School of Economics and Management, Xiamen University Malaysia, 43900 Sepang, Selangor, Malaysia
| | - Sellywati Mohd Faizal
- Faculty of Management, Multimedia University, Persiaran Multimedia, 63100 Cyberjaya, Selangor, Malaysia
| | - Zarehan Selamat
- Faculty of Management, Multimedia University, Persiaran Multimedia, 63100 Cyberjaya, Selangor, Malaysia
| | - Norazlan Alias
- Faculty of Economics and Management, Universiti Kebangsaan Malaysia, 43600 Bandar Baru Bangi, Selangor, Malaysia
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Gibbons RA, Sprong S, Chzhen Y. Growing Up in the Great Recession: The Effects of Three Dimensions of Economic Well-being on Child Behavioral Difficulties from Ages 3 to 17. J Youth Adolesc 2023; 52:1024-1038. [PMID: 36637707 PMCID: PMC9838443 DOI: 10.1007/s10964-022-01721-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 01/14/2023]
Abstract
Empirical research into the relationship between economic well-being and child outcomes has been limited by its cross-sectional nature, or its narrow focus on predominantly financial aspects of economic well-being. This article attempts to overcome these shortcomings by using data from the Growing Up in Ireland Cohort98 (age: 9-17; N = 5,748; female: 51.4%) and Cohort08 studies (age: 3-9 years; N = 7,208; female: 49.8%), which cover a period of large macroeconomic fluctuation (2007-2017). This fluctuation makes a robust fixed effects analysis feasible, allowing for economic well-being effects to be isolated by controlling for all time-invariant confounders. The article uses three different measures of economic well-being (subjective financial strain, material deprivation, income) to explore how distinct forms of economic well-being affect child behavior. The results suggest that household income is not related to behavioral difficulties, whereas subjective financial strain is predictive of externalized behavioral difficulties in adolescent boys. Material deprivation is predictive of externalized behavioral difficulties in adolescent boys and internalized behavioral difficulties in younger boys, but has no effect on girls' behavioral outcomes. The findings indicate that the relationship between economic well-being and child behavioral outcomes is complex, and requires multi-dimensional measures of economic well-being to accurately ascertain the different effects.
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Affiliation(s)
- Ryan Alberto Gibbons
- Department of Sociology, Trinity College Dublin, The University of Dublin, Dublin, Ireland.
| | - Stefanie Sprong
- Department of Sociology, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Yekaterina Chzhen
- Department of Sociology, Trinity College Dublin, The University of Dublin, Dublin, Ireland
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Nykiforuk CIJ, Belon AP, de Leeuw E, Harris P, Allen-Scott L, Atkey K, Glenn NM, Hyshka E, Jaques K, Kongats K, Montesanti S, Nieuwendyk LM, Pabayo R, Springett J, Yashadhana A. An action-oriented public health framework to reduce financial strain and promote financial wellbeing in high-income countries. Int J Equity Health 2023; 22:66. [PMID: 37055742 PMCID: PMC10099014 DOI: 10.1186/s12939-023-01877-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 03/28/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Perceived financial security impacts physical, mental, and social health and overall wellbeing at community and population levels. Public health action on this dynamic is even more critical now that the COVID-19 pandemic has exacerbated financial strain and reduced financial wellbeing. Yet, public health literature on this topic is limited. Initiatives targeting financial strain and financial wellbeing and their deterministic effects on equity in health and living conditions are missing. Our research-practice collaborative project addresses this gap in knowledge and intervention through an action-oriented public health framework for initiatives targeting financial strain and wellbeing. METHODS The Framework was developed using a multi-step methodology that involved review of theoretical and empirical evidence alongside input from a panel of experts from Australia and Canada. In an integrated knowledge translation approach, academics (n = 14) and a diverse group of experts from government and non-profit sectors (n = 22) were engaged throughout the project via workshops, one-on-one dialogues, and questionnaires. RESULTS The validated Framework provides organizations and governments with guidance for the design, implementation, and assessment of diverse financial wellbeing- and financial strain-related initiatives. It presents 17 priority actionable areas (i.e., entry points for action) likely to have long-lasting, positive effects on people's financial circumstances, contributing to improved financial wellbeing and health. The 17 entry points relate to five domains: Government (All Levels), Organizational & Political Culture, Socioeconomic & Political Context, Social & Cultural Circumstances, and Life Circumstances. CONCLUSIONS The Framework reveals the intersectionality of root causes and consequences of financial strain and poor financial wellbeing, while also reinforcing the need for tailored actions to promote socioeconomic and health equity for all people. The dynamic, systemic interplay of the entry points illustrated in the Framework suggest opportunities for multi-sectoral, collaborative action across government and organizations towards systems change and the prevention of unintended negative impacts of initiatives.
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Affiliation(s)
- Candace I. J. Nykiforuk
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Ana Paula Belon
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Evelyne de Leeuw
- Centre for Primary Health Care & Equity, University of New South Wales, Level 3, AGSM, UNSW, Sydney, NSW 2052 Australia
| | - Patrick Harris
- Centre for Health Equity, Training, Research & Evaluation (CHETRE), Part of the UNSW Sydney Research Centre for Primary Health Care & Equity, A Unit of Population Health, South Western Sydney Local Health District, NSW Health, Ingham Institute, Liverpool Hospital Locked Bag 7103, NSW, Liverpool, BC 1871 Australia
| | - Lisa Allen-Scott
- Provincial Population and Public Health, Alberta Health Services, 2210, 2nd Street SW, Calgary, AB T2S 3C3 Canada
| | - Kayla Atkey
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Nicole M. Glenn
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Elaine Hyshka
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Karla Jaques
- Centre for Health Equity, Training, Research & Evaluation (CHETRE), Part of the UNSW Sydney Research Centre for Primary Health Care & Equity, A Unit of Population Health, South Western Sydney Local Health District, NSW Health, Ingham Institute, Liverpool Hospital Locked Bag 7103, NSW, Liverpool, BC 1871 Australia
| | - Krystyna Kongats
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Stephanie Montesanti
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Laura M. Nieuwendyk
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Roman Pabayo
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Jane Springett
- Centre for Healthy Communities, School of Public Health, University of Alberta, ECHA 3-300, 11405-87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Aryati Yashadhana
- Centre for Primary Health Care & Equity, University of New South Wales, Level 3, AGSM, UNSW, Sydney, NSW 2052 Australia
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Kelly C, White LL, Scott SG, Feigelson HS, Burnett-Hartman AN. Social risk factors among individuals with a history of cancer during the COVID-19 pandemic. J Cancer Surviv 2023; 17:309-317. [PMID: 35921058 PMCID: PMC9362166 DOI: 10.1007/s11764-022-01235-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/08/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The coronavirus disease (COVID-19) pandemic and its economic consequences may disproportionately impact cancer survivors and their overall health-related quality of life. The objective of this study was to examine whether cancer survivors experienced higher levels of financial strain or food insecurity compared to those without a history of cancer. METHODS Kaiser Permanente Research Bank (KPRB) study participants were invited to complete a series of electronic surveys starting April 2020 to assess the impact of the COVID-19 pandemic. Participants who completed the initial survey and one follow-up survey were included. The odds of financial strain and food insecurity in those with and without a history of cancer were estimated using multinomial logistic regression. RESULTS Cancer survivors (n = 16,231) had lower odds of reporting "somewhat hard" (AOR = 0.77) and "very hard" (AOR = 0.67) financial strain, and food insecurity "sometimes" (AOR = 0.70) and "often" (AOR = 0.55) compared to those with no history of cancer (n = 88,409). Non-Hispanic (NH) Black and Hispanic cancer survivors had higher odds compared to NH Whites of reporting financial strain and food insecurity. Smokers and those with multiple comorbidities had higher odds of reporting financial strain and food insecurity among cancer survivors. CONCLUSIONS While cancer survivors overall did not report greater financial strain or food insecurity than individuals without a history of cancer, subsets of cancer survivors are experiencing greater social risks during the pandemic and should be prioritized for screening for social risk factors. IMPLICATIONS FOR CANCER SURVIVORS Incorporating screening for social risk factors into care coordination workflows for subsets of cancer survivors should be a priority.
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Affiliation(s)
- Cheryl Kelly
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S Parker Rd, Ste 200, Aurora, CO, 80014, USA.
| | - Larissa Lee White
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S Parker Rd, Ste 200, Aurora, CO, 80014, USA
| | - Shauna Goldberg Scott
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S Parker Rd, Ste 200, Aurora, CO, 80014, USA
| | - Heather Spencer Feigelson
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S Parker Rd, Ste 200, Aurora, CO, 80014, USA
| | - Andrea N Burnett-Hartman
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S Parker Rd, Ste 200, Aurora, CO, 80014, USA
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Santoyo-Olsson J, Stewart AL, Nápoles AM. Financial strain, neighborhood cohesion, and health-related quality of life among rural and urban Spanish-speaking Latina breast cancer survivors. J Cancer Surviv 2023:10.1007/s11764-023-01369-2. [PMID: 36991270 DOI: 10.1007/s11764-023-01369-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/18/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE Among Latina breast cancer survivors, explore associations between rural/urban residence and health-related quality of life (HRQL), and whether associations are moderated by financial strain and low neighborhood cohesion. METHODS We combined baseline data from two randomized controlled trials of a stress management intervention conducted among 151 urban and 153 rural dwelling Latinas with nonmetastatic breast cancer. Generalized linear models estimated associations between rural/urban status and HRQL (overall, emotional, social-family, physical, and functional well-being), and we examined moderation effects of financial strain and low neighborhood cohesion, controlling for age, marital status, and breast cancer characteristics. RESULTS Rural women reported better emotional (β = 1.85; 95% CI = 0.37, 3.33), functional (β = 2.23; 95% CI = 0.69, 3.77), and overall (β = 5.68; 95% CI = 1.12, 10.25) well-being than urban women, regardless of degree of financial strain or neighborhood cohesion; moderation effects were not statistically significant. Financial strain was inversely associated with emotional (β = -2.34; 95% CI = 3.63, -1.05), physical (β = -2.56; 95% CI = -4.12, -1.01), functional (β = -1.61; 95% CI = -2.96, -0.26), and overall (β = -6.67; 95% CI = -10.96, -2.98) well-being. Low neighborhood cohesion was inversely associated with emotional (β = -1.27; 95% CI = -2.50, -0.04), social-family (β = -1.72; 95% CI = -3.02, -0.42), functional (β = -1.63; 95% CI = -2.92, -0.34), and overall (β = -5.95; 95% CI = 9.76, -2.14) well-being. CONCLUSIONS Rural Latina breast cancer survivors reported better emotional, functional and overall well-being than their urban counterparts. Greater financial strain and less neighborhood cohesion were associated with worse HRQL on most domains regardless of rural/urban context. IMPLICATIONS FOR CANCER SURVIVORS Interventions that focus on increasing perceived neighborhood cohesion and reducing or better managing financial strain, could help improve Latina cancer survivors' well-being.
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Affiliation(s)
- Jasmine Santoyo-Olsson
- University of California San Francisco, Division of Internal Medicine, 490 Illinois Street, 9th floor, Box 0856, San Francisco, CA, 94158, USA.
- University of California Berkeley, School of Public Health, 2121 Berkeley Way, Room 5302, Berkeley, CA, 94720, USA.
| | - Anita L Stewart
- University of California San Francisco, Institute for Health & Aging, Center for Aging in Diverse Communities, 490 Illinois Street, 12th floor, Box 0646, San Francisco, CA, 94158, USA
| | - Anna María Nápoles
- Division of Intramural Research, National Institute On Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD, 20892, USA
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Tsuchiya K, Bacong AM, de Castro AB, Gee GC. Visa type and financial strain on depressive symptoms among Filipino migrants to the United States. J Migr Health 2023; 7:100155. [PMID: 36755688 PMCID: PMC9900610 DOI: 10.1016/j.jmh.2023.100155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 10/15/2022] [Accepted: 01/22/2023] [Indexed: 01/24/2023] Open
Abstract
Migrants have been theorized to be healthier than their non-migrant counterparts; however, there is limited examination of health selection using binational data and how selection occurs, particularly for mental health outcomes. This study examines the role of visa status and financial strain as critical factors for mental health selection among Filipino migrants to the U.S. and non-migrants who remain in the Philippines. We used the baseline data from the Health of Philippine Emigrants Study (HoPES; n = 1631) to compare depressive symptoms between non-migrants and migrants who were both surveyed prior to their departure to the U.S. We assessed depressive symptoms using linear regression by migration status, financial strain, and by visa categories including fiancée/marriage, unlimited family reunification, limited family reunification, and employment. Overall, all migrants reported lower depressive symptoms than non-migrants; however, depressive symptoms varied by visa type. Fiancée/marriage migrants had lower depressive symptoms than compared to limited family reunification migrants. Additionally, those who reported financial strain had higher depressive symptoms than those without any financial strain. We find that migrants were positively selected for mental health using a unique sample of Filipino migrants before they left for the U.S.
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Affiliation(s)
- Kazumi Tsuchiya
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, United States
| | - Adrian M. Bacong
- Center for Asian Health Research and Education, Stanford University, 291 Campus Drive, Stanford, CA 94305, United States
| | - A B de Castro
- School of Nursing, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States
| | - Gilbert C. Gee
- Department of Community Health Sciences, Fielding School of Public Health, University of California, 650 Charles E Young Dr S, Los Angeles, CA 90095, United States
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Dreher A, Yusuf R, Ashraf H, Ahmed SAKS, Strümpell C, Loerbroks A. Work-family conflict, financial issues and their association with self-reported health complaints among ready-made garment workers in Bangladesh: a cross-sectional study. Int Arch Occup Environ Health 2022; 96:483-496. [PMID: 36480083 PMCID: PMC9734729 DOI: 10.1007/s00420-022-01942-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study aims to quantify the degree of work-family conflict (WFC) and financial issues among ready-made garment (RMG) workers in Bangladesh and to investigate their potential associations with self-reported health outcomes. METHODS We conducted a cross-sectional survey among 1118 RMG workers in labor colonies in Dhaka, Bangladesh, in February and March 2021. Descriptive analyses were performed to characterize WFC (i.e., family life disturbing the job or facing problems in family due to the job) and financial issues (i.e., savings, debt, financial obligations, financial support). We ran multivariable Poisson regression models to examine possible associations between WFC and financial issues and workers' health (self-reported general health and 10 specific health complaints). RESULTS We found low levels of WFC, low levels of savings, moderate levels of debt, and high levels of financial obligations: virtually all workers agreed they had to keep their job to financially support their spouse, children or other relatives. Only about a third of workers expected they would be able to receive financial support in case of a job loss. Work-family conflict was positively associated with poor health but not consistently with specific symptoms. Financial support was negatively associated, whereas being indebted was weakly positively associated with poor health. CONCLUSIONS Our findings suggest low levels of WFC among RMG workers but high levels of financial obligations. Work-family conflict was positively associated with poor health, but not consistently with specific symptoms. Being indebted was weakly positively associated with poor health. Future prospective studies are needed to confirm these findings.
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Affiliation(s)
- Annegret Dreher
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Rita Yusuf
- International Center for Biotechnology and Health (ICBH), Center for Health Population and Development (CHPD), Independent University, Dhaka, Bangladesh
| | - Hasan Ashraf
- Department of Anthropology, Jahangirnagar University, Dhaka, Bangladesh
| | - Syed A K Shifat Ahmed
- International Center for Biotechnology and Health (ICBH), Center for Health Population and Development (CHPD), Independent University, Dhaka, Bangladesh
| | - Christian Strümpell
- Institute of Social and Cultural Anthropology, University of Hamburg, Hamburg, Germany
| | - Adrian Loerbroks
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
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Argabright ST, Tran KT, Visoki E, DiDomenico GE, Moore TM, Barzilay R. COVID-19-related financial strain and adolescent mental health. Lancet Reg Health Am 2022; 16:100391. [PMID: 36405885 DOI: 10.1016/j.lana.2022.100391] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/14/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022]
Abstract
Background The COVID-19 pandemic and associated responses have induced a host of crises worldwide, including an economic recession and a global mental health crisis. The specific effects of recession on youth mental health are understudied. We aimed to examine the mechanisms by which pandemic-related financial strain may affect mental health in a diverse sample of American adolescents. Methods We analyzed data from the Adolescent Brain Cognitive Development Study (ABCD Study®), a large, longitudinal study of diverse US adolescents which collected data before and during the pandemic (N = 9,720, mean age 12.9 years, 18.2% Black). Linear mixed-effects models tested associations of financial strain (parent-reported household wage loss and youth-reported financial stress) with depressive symptomatology over time, covarying for multiple confounders including pre-pandemic socioeconomic status and psychopathology, and pandemic-related environmental factors. Longitudinal mediation analyses examined potential mechanisms leading from wage loss to youth mental health. Findings Financial strain was highly prevalent, especially among low-income participants, with >70% of the total sample reporting lost wages. Both wage loss and subjective financial stress were associated with depressive symptomatology over time (Estimate = 0.04, P = 0.014; Estimate = 0.17, P < 0.001; respectively). The association between financial stress and depressive symptomatology was robust to the addition of multiple environmental confounders (Estimate = 0.16, P < 0.001). Both family-level (family conflict) and individual-level (financial stress) factors mediated the relationship between wage loss and depressive symptomatology. Interpretation The financial effects of COVID-19 (and worldwide responses to it) have taken a significant toll on youth mental health. In families that lost wages, youth-reported financial stress and familial factors mediated the relationship between wage loss and mental health over time. Findings highlight financial stress as a key driver of youth mental health burden and identify familial factors as critical targets for intervention to mitigate mental health risks in periods of economic crises. Funding This study was supported by the National Institute of Mental Health [grant numbers K23MH120437 (RB), R01MH117014 (TMM)]; the Lifespan Brain Institute of Children's Hospital of Philadelphia and Penn Medicine, University of Pennsylvania.
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Balzarini RN, Muise A, Zoppolat G, Gesselman AN, Lehmiller JJ, Garcia JR, Slatcher RB, Mark KP. Sexual Desire in the Time of COVID-19: How COVID-Related Stressors Are Associated with Sexual Desire in Romantic Relationships. Arch Sex Behav 2022; 51:3823-3838. [PMID: 36100726 PMCID: PMC9469826 DOI: 10.1007/s10508-022-02365-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic and the resulting social distancing measures have caused widespread social and economic disruptions, resulting in spikes in unemployment and financial instability, along with drastic changes to people's ability to feel socially connected. Many of the changes resulting from the COVID-19 pandemic are risk factors for depressive symptoms, which are associated with lower levels of sexual desire. The current research (N = 4,993) examined whether responses to external stressors brought on by COVID-19 (i.e., financial concern, worry, loneliness, stress) were associated with sexual desire among a multi-national sample of people in relationships (Studies 1-2), and whether this association was, in part, due to reports of depressive symptoms (Study 2). In the period immediately following the onset of the pandemic, more financial concern (Study 1) and worry (Study 2) were associated with higher sexual desire, while other factors, like stress (Studies 1-2), were associated with lower desire. We also followed a subset of participants every two weeks during the initial stages of the pandemic and at times when people reported greater stress, loneliness, financial strain, or worry than their average, they reported greater depressive symptoms, which was, in turn, associated with lower sexual desire. Results suggest that the social isolation and stress resulting from the COVID-19 pandemic have mixed associations with sexual desire at the onset of the pandemic. But over time, when people report heightened COVID-related stressors, they tend to report lower sexual desire for their partner, in part because these stressors are associated with more depressive symptoms.
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Affiliation(s)
- Rhonda N Balzarini
- Department of Psychology, Texas State University, San Marcos, TX, 78666, USA.
- The Kinsey Institute, Indiana University, Bloomington, IN, USA.
| | - Amy Muise
- Department of Psychology, York University, Toronto, ON, Canada
| | - Giulia Zoppolat
- Department of Experimental and Applied Psychology, Vrije University, Amsterdam, Netherlands
| | | | | | - Justin R Garcia
- The Kinsey Institute, Indiana University, Bloomington, IN, USA
- Department of Gender Studies, Indiana University, Bloomington, IN, USA
| | | | - Kristen P Mark
- The Kinsey Institute, Indiana University, Bloomington, IN, USA
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
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Lin HF, Postmus JL, Hu H, Stylianou AM. IPV Experiences and Financial Strain Over Time: Insights from the Blinder-Oaxaca Decomposition Analysis. J Fam Econ Issues 2022; 44:434-446. [PMID: 35529309 PMCID: PMC9067895 DOI: 10.1007/s10834-022-09847-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 05/11/2023]
Abstract
Financial strain is one hardship faced by female survivors of intimate partner violence (IPV) that is often overlooked. This paper examined the relationships between multiple forms of abuse-with a focus on economic abuse-and financial strain. Guided by stress process model, this study tested two hypotheses: (1) economic abuse is associated with financial strain more than other types of IPV; and (2) decreased economic abuse relates to financial strain over time. The study sample consists of 229 female IPV survivors who participated in a longitudinal, randomized controlled study evaluating an economic empowerment curriculum. Results from regression models suggest that physical abuse and economic abuse were significantly and positively associated with the magnitude of financial strain. Oaxaca-Blinder decomposition was used to partition the mean differences of financial strain over time that was mainly attributed to the decrease in economic and physical abuse (78%). Particularly, the decrease of economic abuse contributed to over half (58%) of the decrease in financial strain over time. Advocates should assess survivors' risk of economic abuse, evaluate financial strain, and utilize financial safety planning skills to help survivors build economic security and independence. In addition, policy makers should address issues concerning economic security among female IPV survivors.
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Affiliation(s)
- Hsiu-Fen Lin
- School of Social Work, Arizona State University, 411 N. Central Ave. Suite 800, Phoenix, AZ 85004 USA
| | - Judy L. Postmus
- School of Social Work, University of Maryland, College Park, MD USA
| | - Hongwei Hu
- School of Public Administration and Policy, Renmin University of China, Beijing, China
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Jung H, Kwon YD, Noh JW. Financial burden of catastrophic health expenditure on households with chronic diseases: financial ratio analysis. BMC Health Serv Res 2022; 22:568. [PMID: 35477404 PMCID: PMC9047277 DOI: 10.1186/s12913-022-07922-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 04/08/2022] [Indexed: 11/28/2022] Open
Abstract
Background The financial status of households is vulnerable to chronic diseases which entail high medical expenses and income loss. Financial strain can be assessed by four indicators: a household surplus indicator, the liquid asset/debt ratio, a solvency indicator, and a liquidity indicator. We investigated the association between catastrophic health expenditure (CHE) and financial ratio indicators in households with chronic diseases in South Korea. Methods This study applied thresholds to the financial ratios to determine the financial strain. We conducted multiple logistic regression analyses to determine whether CHE is associated with financial strain. Furthermore, we analyzed the relationship between CHE and basic financial indicators, absolute finance size, using multiple linear regression. Results When CHE occurred, all financial ratio indicators deteriorated. However, this was not due to decreases in the absolute size of wealth and income, but rather the relative balance between finances. In particular, the loss of liquid assets was a major factor in the deterioration. In addition, all types of labor-related income deteriorated; only private transfer income increased. Conclusions This study revealed that CHE in households with chronic diseases negatively impacts household finances. It was found that financial coping strategies are only resource consuming. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07922-6.
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Affiliation(s)
- Hyunwoo Jung
- Post Doc, Department of Health Administration, Graduate School·BK21 Graduate Program of Developing Glocal Experts in Health Policy and Management, Yonsei University, Wonju, South Korea
| | - Young Dae Kwon
- Department of Humanities and Social Medicine, College of Medicine and Catholic Institute, for Healthcare Management, The Catholic University of Korea, Seoul, South Korea
| | - Jin-Won Noh
- Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, South Korea.
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Johnson L. Exploring factors associated with pregnant women's experiences of material hardship during COVID-19: a cross-sectional Qualtrics survey in the United States. BMC Pregnancy Childbirth 2021; 21:755. [PMID: 34749686 PMCID: PMC8573078 DOI: 10.1186/s12884-021-04234-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 10/19/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has exacerbated the financial insecurity of women and their families globally. Some studies have explored the impact of financial strain among pregnant women, in particular, during the pandemic. However, less is known about the factors associated with pregnant women's experiences of material hardship. METHODS This cross-sectional study used a non-probability sample to examine the factors associated with pregnant women's experiences of material hardship during the COVID-19 pandemic. In January 2021, 183 pregnant women living in the United States participated in an online Qualtrics panel survey. In addition to socio-demographic characteristics, individuals were asked about their finances and predictors of financial well-being, mental health symptoms, and intimate partner violence (IPV) experiences. Chi-square analysis and one-way ANOVA were used to examine whether women's experiences with material hardship and associated factors differed by income level (i.e., less than $20,000; $20,000 to $60,000; more than $60,000). Ordinary least squares regression was used to calculate unadjusted and adjusted estimates. RESULTS Study findings showed that the majority of women in the sample experienced at least one form of material hardship in the past year. Individuals with an annual household income less than $20,000 reported the highest average number of material hardships experienced (M = 3.7, SD = 2.8). Compared to women with household incomes less than $20,000, women with incomes of more than $60,000 reported significantly fewer material hardships, less financial strain, and higher levels of financial support, economic self-efficacy, and economic-self-sufficiency. Women with incomes of $60,000 or more also reported significantly lower levels of psychological abuse, and a smaller percentage met the cut-off for anxiety. Economic self-sufficiency, financial strain, posttraumatic stress disorder, and economic abuse were all significantly associated with material hardship. CONCLUSIONS A contribution of this study is that it highlights the significant, positive association between economic abuse, a unique form of IPV, and material hardship among pregnant women during the pandemic. These findings suggest the need for policy and practice interventions that help to ameliorate the financial insecurity experienced by some pregnant women, as well as respond to associated bidirectional vulnerabilities (e.g., mental health symptoms, experiences of IPV).
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Affiliation(s)
- Laura Johnson
- School of Social Work, Temple University, Ritter Annex Room 543, 1301 Cecil B. Moore Avenue, Philadelphia, PA, 19122, USA.
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Hertz-Palmor N, Moore TM, Gothelf D, DiDomenico GE, Dekel I, Greenberg DM, Brown LA, Matalon N, Visoki E, White LK, Himes MM, Schwartz-Lifshitz M, Gross R, Gur RC, Gur RE, Pessach IM, Barzilay R. Association among income loss, financial strain and depressive symptoms during COVID-19: Evidence from two longitudinal studies. J Affect Disord 2021; 291:1-8. [PMID: 34022550 PMCID: PMC8460400 DOI: 10.1016/j.jad.2021.04.054] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/14/2021] [Accepted: 04/23/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND COVID-19 pandemic has major ramifications for global health and economy, with growing concerns about economic recession and implications for mental health. Here we investigated the associations between pandemic-related income loss with financial strain and mental health trajectories over a 1-month course, in two independent cohorts. METHODS Two independent studies were conducted in the U.S and in Israel at the beginning of the outbreak (March-April 2020, T1; study I: N = 2904, study II: N = 1267) and at a 1-month follow-up (T2; study I: N = 1318, study II: N = 241). Mixed-effects models were applied to assess associations among COVID-19-related income loss, financial strain, and pandemic-related worries about health, with anxiety and depression, controlling for multiple covariates including pre-COVID-19 income. RESULTS In both studies, income loss and financial strain were associated with greater depressive symptoms at T1, above and beyond T1 anxiety, worries about health, and pre-COVID-19 income. Worsening of income loss was associated with exacerbation of depression at T2 in both studies. Worsening of subjective financial strain was associated with exacerbation of depression at T2 in one study (US). CONCLUSIONS Income loss and financial strain were uniquely associated with depressive symptoms and their exacerbation over time, above and beyond pandemic-related anxiety. In times when a myriad of stressors are affecting mental health worldwide, our findings reveal specific links between the economic impact of COVID-19 and psychiatric outcomes.
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Affiliation(s)
- Nimrod Hertz-Palmor
- Sheba Medical Center, Ramat Gan, Israel; School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Tyler M Moore
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA; Lifespan Brain Institute of the Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - Doron Gothelf
- Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Grace E DiDomenico
- Lifespan Brain Institute of the Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - Idit Dekel
- Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David M Greenberg
- Interdisciplinary Department of Social Sciences and Department of Music, Bar-Ilan University, Ramat Gan, Israel
| | - Lily A Brown
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA
| | - Noam Matalon
- Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elina Visoki
- Lifespan Brain Institute of the Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - Lauren K White
- Lifespan Brain Institute of the Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - Megan M Himes
- Lifespan Brain Institute of the Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | | | - Raz Gross
- Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ruben C Gur
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA; Lifespan Brain Institute of the Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
| | - Raquel E Gur
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA; Lifespan Brain Institute of the Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA; Children's Hospital of Philadelphia Department of Child Adolescent Psychiatry and Behavioral Sciences, Philadelphia, PA, USA
| | - Itai M Pessach
- Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Barzilay
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA; Lifespan Brain Institute of the Children's Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA; Children's Hospital of Philadelphia Department of Child Adolescent Psychiatry and Behavioral Sciences, Philadelphia, PA, USA.
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22
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Samuel LJ, Wright R, Granbom M, Taylor JL, Hupp C, Roberts Lavigne LC, Szanton SL. Community-dwelling older adults who are low-income and disabled weathering financial challenges. Geriatr Nurs 2021; 42:901-7. [PMID: 34098443 DOI: 10.1016/j.gerinurse.2021.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/20/2022]
Abstract
Despite interventions aiming to improve outcomes among older adults experiencing financial challenges, the challenges and strategies employed to handle them are poorly understood. This study examined the experiences of financial challenges among low-income adults aged ≥65 years. Eleven semi-structured interviews were analyzed using thematic analyses. An overarching theme was "I guess it balances", capturing attempts to maintain hope and proactively address challenges despite stress, uncertainty and limitations. Balancing was demonstrated within four domains, including cognitive bandwidth ("think a lot" versus "I don't dwell on that"), emotional experience ("depressing" versus "be thankful"), learned resilience ("that was a shock" versus "there's always a way"), and meeting daily needs ("we learned to do without" versus "take a dollar and stretch it"). Participants described being weathered by challenges and using predominately high-effort coping strategies to weather the challenges. These findings call for strengthening the safety net for older adults facing financial challenges.
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23
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Abstract
Background Due to ongoing expenses for both short-term and long-term needs for health services, people with chronic diseases tend to struggle with financial hardship. Health insurance is employed as a useful tool in aiding people to solve such financial strain. This study aims to examine and compare the impacts of public and private health insurance on solving financial barriers for people with chronic diseases. Methods This research obtained an outpatient sample consisted of 1739 individuals and an inpatient sample consisted of 1034 individuals. We employed a Chi-square test and a two-sample T-test to explore differences in financial strain and insurance status between people with chronic diseases and those without. Then we adopted binary logistic regression technique to assess the impacts of different types of health insurance on outpatient and inpatient financial strain for people with chronic diseases. Results Our research has five key findings: first, people with chronic diseases were more likely to experience both the outpatient and inpatient financial strain (P < 0.01); second, public health insurance was found to reduce the outpatient financial strain; third, private health insurance was found to positively associate with inpatient financial barriers; fourth, Urban Employment Insurance (UEI) was expected to reduce both the outpatient and inpatient financial barriers, while self-paid private insurance (SPI) was positively associated with inpatient financial barriers; and fifth, income was identified as a positive predictor of having outpatient and inpatient financial strain. Conclusions Public health insurance has the potential to reduce the outpatient financial strain for people with chronic diseases. Private health insurance was identified as a positive predictor of inpatient financial strain for people with chronic diseases. Policy should be proposed to promote the capacity of public health insurance and explore the potential effects of private health insurance on solving the inpatient financial barriers faced by people with chronic diseases in China.
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Affiliation(s)
- Zixuan Peng
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Li Zhu
- School of Political Science and Public Administration, Guangxi University for Nationalities, Nanning, China.
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24
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Han DH, Seo DC. Financial strain and electronic nicotine delivery systems use among U.S. young adults: A longitudinal panel analysis, 2013-2018. Addict Behav 2021; 114:106716. [PMID: 33109395 DOI: 10.1016/j.addbeh.2020.106716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/26/2020] [Accepted: 10/13/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Financial strain is associated with an increased likelihood of cigarette smoking, but less is known about its association with electronic nicotine delivery systems (ENDS) use. This study examined longitudinal associations of financial strain with ENDS use behaviors among young adults. METHODS We analyzed in 2020 four waves (2013-2018) of the Population Assessment of Tobacco and Health, a nationally representative longitudinal study. A total of 5740 U.S. young adults (aged 18-24 years at baseline) had matched data for all four waves. We used generalized linear mixed modeling which accounts for correlations between repeated measures. Weighted logistic regressions assessed the association between financial strain and three different types of ENDS use behaviors (i.e., everyday, some-day, and experimental use), adjusting for major confounders including poverty, mental health symptoms, and other substance use behaviors. RESULTS Frequency and proportion of everyday ENDS use showed a linear increase over time whereas some-day and experimental uses showed quadratic trends, increasing with a peak at Wave 2 and then decreasing over time. Financial strain prospectively predicted some-day (adjusted odds ratio [AOR] = 1.32; 95% CI = 1.03-1.69) and experimental (AOR = 1.25; 95% CI = 1.02-1.52) ENDS use, but not everyday use. CONCLUSIONS The findings of the current study indicate the need for distinctly different approaches for non-daily ENDS users from daily users. Our findings further suggest that ENDS use prevention and cessation efforts should consider financial strain of young adults particularly for non-daily users to thwart them from progressing towards nicotine dependence and long-term use.
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25
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Nisar QA, Haider S, Ali F, Naz S, Ryu K. Depletion of psychological, financial, and social resources in the hospitality sector during the pandemic. Int J Hosp Manag 2021; 93:102794. [PMID: 33519016 PMCID: PMC7833097 DOI: 10.1016/j.ijhm.2020.102794] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/09/2020] [Accepted: 11/24/2020] [Indexed: 05/25/2023]
Abstract
This study details how psychological, financial, and social factors shape employee deviant interpersonal behaviors during a pandemic. Data were collected with a survey of 372 front-line employees of hotels and analyzed with PLS-SEM. The findings showed social disconnectedness and perceived risk of unemployment leads to perceived isolation, which further creates depression in employees. The findings also showed that depression is positively related to employee deviance. Financial strain is a major cause of perceived isolation, depression, and deviant behaviors among front-line employees. Results also proved that social support reduces fear of isolation, depression, and employee deviance. This study provides guidelines that hotels need to understand the psychological stance of employees and design policies to overcome employee perceived fears and psychological disorders.
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Affiliation(s)
- Qasim Ali Nisar
- Faculty of Business and Management Sciences, The Superior College, Lahore, Pakistan
| | - Shahbaz Haider
- School of Business Management, University Utara Malaysia, Sintok, Malaysia
| | - Faizan Ali
- School of Hospitality and Tourism Management, University of South Florida, Sarasota, FL, 34243, United States
| | - Shumaila Naz
- Faculty of Business and Management Sciences, The Superior College, Lahore, Pakistan
| | - Kisang Ryu
- College of Hospitality and Tourism Management, Sejong University, South Korea
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26
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Beenackers MA, Vermaire JH, van Dommelen P, Schuller AA. Experiencing Financial Strain and Clinically Assessed Caries Experience in Dentate Adults Aged 25-44 Years: An Exploration of Potential Pathways. Caries Res 2020; 55:63-72. [PMID: 33352549 DOI: 10.1159/000511466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 09/06/2020] [Indexed: 11/19/2022] Open
Abstract
Large socioeconomic inequalities still exist in oral health. It is already known that oral health-related behaviour may contribute to these inequalities, but why people with a lower socioeconomic position behave less healthily is not easily understood. A possible explanation that integrates insights on health behaviour, stress, and financial resources is the pathway of behavioural responses to financial strain. The aim of this study was to assess to what extent financial strain is associated with clinically assessed caries experience in a population-based study of dentate adults, independently of other socioeconomic indicators. Furthermore, the potential mediating pathways of oral health-related behaviours (oral hygiene, dietary habits, preventive dental visits) were explored. Dentate participants, aged 25-44 years, taking part in a survey on oral health and preventive behaviour in the Netherlands in 2013 were clinically examined on - among others - caries experience (DMFS index) and level of oral hygiene (OHI-s index). Financial strain, frequency of tooth brushing, dietary habits, attendance of (preventive) dental visits in the past year, and demographic variables were assessed via questionnaires. Negative binomial hurdle models were used to study the association between financial strain and DMFS and between oral health behavioural indicators and DMFS. Although it was observed that experiencing financial strain did not seem to affect whether there is any caries experience or not, among those having any caries (DMFS >0) suffering from financial strain was associated with a higher caries prevalence, independent of educational level and income. None of the studied potential mediators could explain this association.
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Affiliation(s)
- Mariëlle A Beenackers
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands,
| | - Jan H Vermaire
- Department of Child Health, TNO, Netherlands Organisation for Applied Scientific Research, Leiden, The Netherlands.,Centre for Dentistry and Oral Hygiene, University Medical Centre Groningen, Groningen, The Netherlands
| | - Paula van Dommelen
- Department of Child Health, TNO, Netherlands Organisation for Applied Scientific Research, Leiden, The Netherlands
| | - Annemarie A Schuller
- Department of Child Health, TNO, Netherlands Organisation for Applied Scientific Research, Leiden, The Netherlands.,Centre for Dentistry and Oral Hygiene, University Medical Centre Groningen, Groningen, The Netherlands
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27
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Longo CJ, Fitch MI, Banfield L, Hanly P, Yabroff KR, Sharp L. Financial toxicity associated with a cancer diagnosis in publicly funded healthcare countries: a systematic review. Support Care Cancer 2020; 28:4645-4665. [PMID: 32653957 DOI: 10.1007/s00520-020-05620-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/07/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Financial toxicity related to cancer diagnosis and treatment is a common issue in developed countries. We seek to systematically summarize the extent of the issue in very high development index countries with publicly funded healthcare. METHODS We identified articles published Jan 1, 2005, to March 7, 2019, describing financial burden/toxicity experienced by cancer patients and/or informal caregivers using OVID Medline Embase and PsychInfo, CINAHL, Business Source Complete, and EconLit databases. Only English language peer-reviewed full papers describing studies conducted in very high development index countries with predominantly publicly funded healthcare were eligible (excluded the USA). All stages of the review were evaluated in teams of two researchers excepting the final data extraction (CJL only). RESULTS The searches identified 7117 unique articles, 32 of which were eligible. Studies were undertaken in Canada, Australia, Ireland, UK, Germany, Denmark, Malaysia, Finland, France, South Korea, and the Netherlands. Eighteen studies reported patient/caregiver out-of-pocket costs (range US$17-US$506/month), 18 studies reported patient/caregiver lost income (range 17.6-67.3%), 14 studies reported patient/caregiver travel and accommodation costs (range US$8-US$393/month), and 6 studies reported financial stress (range 41-48%), strain (range 7-39%), or financial burden/distress/toxicity among patients/caregivers (range 22-27%). The majority of studies focused on patients, with some including caregivers. Financial toxicity was greater in those with early disease and/or more severe cancers. CONCLUSIONS Despite government-funded universal public healthcare, financial toxicity is an issue for cancer patients and their families. Although levels of toxicity vary between countries, the findings suggest financial protection appears to be inadequate in many countries.
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Affiliation(s)
- Christopher J Longo
- Health Policy and Management, DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada.
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - Paul Hanly
- National College of Ireland, Dublin, Ireland
| | - K Robin Yabroff
- Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
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28
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Abstract
BACKGROUND AND OBJECTIVES Age-associated financial vulnerability was introduced because it was increasingly recognized that cognitively intact older adults experienced changes that rendered them financially vulnerable. In this study, we attempt to apply the construct of Age-Associated Financial Vulnerability to a measure of Perceived Financial Vulnerability and whether this perceived vulnerability is predicted by risk factors from the 4 categorical domains used to define Age-Associated Financial Vulnerability's impact. RESEARCH DESIGN AND METHODS This study was part of the Health and Retirement Study (HRS) survey in 2018. The survey contained 7 experimental module items of Perceived Financial Vulnerability. One thousand three hundred fourteen participants completed the Perceived Financial Vulnerability measure. The sample was drawn from Waves 13 and 14 of the HRS (2016 and 2018, respectively). The measurement of Perceived Financial Vulnerability was developed on the basis of 7 questions assessing financial awareness and psychological vulnerability items regarding personal finance that were included in the 2018 HRS data collection. Predictors included measures of cognition, function/health, depression, and wealth. Predictor measures from 2016 were regressed on 2018 Perceived Financial Vulnerability scores. RESULTS Six items of Perceived Financial Vulnerability had psychometric properties acceptable for a new measure. Responses revealed variability in Perceived Financial Vulnerability. Overall, 18% of variance was accounted for and measures from cognition, depression, assets, and functional abilities were all unique and significant predictors. DISCUSSION AND IMPLICATIONS This study represents both a conceptual and empirical contribution to our understanding of older adult's perceptions of financial vulnerability. The high levels of Perceived Financial Vulnerability found in this normative sample underscore the importance of context in understanding people's economic behaviors. For instance, more than one half of the sample indicated that they wished they had someone to talk to about their finances. This desire to talk with others is normative and yet often underappreciated.
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Affiliation(s)
- Peter A Lichtenberg
- Institute of Gerontology and Department of Psychology, Wayne State University, Detroit, Michigan
| | - Daniel Paulson
- Department of Psychology, University of Central Florida, Orlando
| | - S Duke Han
- Departments of Family Medicine, Neurology, and Psychology and School of Gerontology Keck School of Medicine, University of Southern California, Los Angeles
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29
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Adams DR, Williams NJ, Becker-Haimes EM, Skriner L, Shaffer L, DeWitt K, Neimark G, Jones DT, Beidas RS. Therapist Financial Strain and Turnover: Interactions with System-Level Implementation of Evidence-Based Practices. Adm Policy Ment Health 2020; 46:713-723. [PMID: 31203492 DOI: 10.1007/s10488-019-00949-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Therapist turnover is a major problem in community mental health. Financial strain, which is composed of cognitive, emotional, and behavioral responses to the experience of economic hardship, is an understudied antecedent of therapist turnover given the tumultuous financial environment in community mental health. We prospectively examined the relationship between therapist financial strain and turnover in 247 therapists in 28 community mental health agencies. We expected greater therapist financial strain to predict higher turnover and participation in a system-funded evidence-based practice (EBP) training initiative to alleviate this effect. Controlling for covariates, financial strain predicted therapist turnover (OR 1.12, p = .045), but not for therapists who participated in an EBP training initiative. Reducing financial strain and/or promoting EBP implementation may be levers to reduce turnover.
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Affiliation(s)
- Danielle R Adams
- School of Social Service Administration, University of Chicago, Chicago, IL, USA.,Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Office 3015, Philadelphia, PA, 19104, USA
| | | | - Emily M Becker-Haimes
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Office 3015, Philadelphia, PA, 19104, USA.,Hall-Mercer Community Mental Health Center, Philadelphia, PA, USA
| | - Laura Skriner
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Office 3015, Philadelphia, PA, 19104, USA.,Evidence-Based Practitioners of New Jersey, Summit, NJ, USA
| | - Lauren Shaffer
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Office 3015, Philadelphia, PA, 19104, USA.,University of Texas, Southwestern, TX, Dallas, USA
| | - Kathryn DeWitt
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Office 3015, Philadelphia, PA, 19104, USA.,Qualtrics, Provo, UT, USA
| | | | | | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Office 3015, Philadelphia, PA, 19104, USA. .,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA.
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30
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Samuel LJ, Szanton SL, Wolff JL, Ornstein KA, Parker LJ, Gitlin LN. Socioeconomic disparities in six-year incident dementia in a nationally representative cohort of U.S. older adults: an examination of financial resources. BMC Geriatr 2020; 20:156. [PMID: 32370792 PMCID: PMC7201761 DOI: 10.1186/s12877-020-01553-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 04/12/2020] [Indexed: 11/18/2022] Open
Abstract
Background Less educational training is consistently associated with incident dementia among older adults, but associations between income and financial strain with incident dementia have not been well tested in national samples. This is an important gap because, like education, financial resources are potentially modifiable by policy change and strengthening the social safety net. This study tested whether financial resources (income and financial strain) predict six-year incident dementia independent of education and occupation. Methods The National Health and Aging Trends Study is a prospective cohort study that recruited a nationally representative sample of U.S. Medicare beneficiaries aged ≥65 years. Incident dementia (2013 to 2018) was classified based on diagnosis, cognitive test scores or proxy-reported changes among participants dementia-free in 2012 (n = 3785). Baseline socioeconomic measures included income to poverty ratio (analyzed separately for those < 500% vs. ≥500% poverty threshold), financial strain, education and history of professional occupation. Discrete time survival analysis applied survey weights to account for study design and nonresponse. Coefficients were standardized to compare the strength of associations across the four socioeconomic measures. Results Adjusting for socioeconomic measures, demographic characteristics, home ownership, retirement, chronic conditions, smoking, BMI and depressive symptoms, higher income (hazard OR = 0.84, 95% CI: 0.74, 0.95 among those < 500% poverty) and higher education (hOR = 0.73, 95% CI: 0.65, 0.83) were associated with lower odds, and financial strain with higher odds (hOR = 1.20, 95% CI: 1.09, 1.31), of incident dementia. Conclusion Low income and greater financial strain predict incident dementia among older adults and associations are comparable to those of low education among U.S. older adults. Interventions to mitigate financial strain through improving access to economic opportunity and strengthening safety net programs and improving access to them in low income groups may complement other ongoing efforts to prevent dementia.
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Affiliation(s)
- Laura J Samuel
- Johns Hopkins University School of Nursing, 525 North Wolfe St., Rm 426, Baltimore, MD, 21205, USA.
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, 525 North Wolfe St., Rm 426, Baltimore, MD, 21205, USA.,Johns Hopkins Bloomberg School of Public Health Department of Health Policy and Management, Baltimore, USA
| | - Jennifer L Wolff
- Johns Hopkins Bloomberg School of Public Health Department of Health Policy and Management, Baltimore, USA
| | - Katherine A Ornstein
- Icahn School of Medicine at Mount Sinai, Department of Geriatrics and Palliative Medicine and Institute for Translational Epidemiology, New York, USA
| | - Lauren J Parker
- Johns Hopkins Bloomberg School of Public Health Department of Health, Behavior and Society, New York, USA
| | - Laura N Gitlin
- Johns Hopkins University School of Nursing, 525 North Wolfe St., Rm 426, Baltimore, MD, 21205, USA.,Drexel University College of Nursing and Health Professions, Philadelphia, USA
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31
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Samuel LJ, Szanton SL, Seplaki CL, Cudjoe TKM, Thorpe RJ, Agree EM. Longitudinal and reciprocal associations between financial strain, home characteristics and mobility in the National Health and Aging Trends Study. BMC Geriatr 2019. [PMID: 31791252 DOI: 10.1186/s12877‐019‐1340‐7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Older adults need homes that suit their physical capacity. Financial strain may limit home repairs and modifications and prompt relocations; repairing, relocating or modifying may increase financial strain. Likewise, reciprocal relationships may exist between financial strain and home characteristics and mobility; financial strain and home characteristics may influence mobility and mobility declines may increase financial strain, limit home repairs and modifications and prompt relocations. We test cross-lagged associations between financial strain, home disorder, relocation, home modifications and mobility. METHODS In the National Health and Aging Trends Study, ability to complete a walking test, speed among those able to complete, financial strain, home disorder, relocating and modifying the home were recorded annually for 3 years (2012-2014). Structural equation models separately examined ability to walk and walking speed among those able, accounting for sociodemographic characteristics, social support, health prior health characteristics and autoregressive effects. Sampling weights accounted for the complex survey design and non-response over time. RESULTS In both models (n = 3234 and n = 2467), financial strain predicted greater home disorder and vice versa, but cross-lagged associations were not found with relocating and modifications. Greater home disorder predicted lower odds of ability to walk and slower speed among those able. Financial strain and home modifications predicted lower odds of ability to walk. Also, faster walking speed predicted lower odds of subsequent financial strain and lower subsequent home disorder scores and ability to walk predicted less subsequent home disorder and lower odds of relocating. CONCLUSIONS Home disorder links financial strain with reduced mobility in a national sample of U.S. older adults. Cross-lagged associations between financial strain and home disorder and between home disorder and mobility suggest reciprocal effects that may accumulate over time. Also, financial strain, reduced mobility, relocations and modifications predicted greater home disorder. Together, these results highlight home disorder as a social determinant of mobility for older adults. Greater attention should be given to repairing and modifying home environments and supporting stable housing for older adults with financial strain.
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Affiliation(s)
- L J Samuel
- Johns Hopkins University School of Nursing, 525 North Wolfe St., Rm 426, Baltimore, MD, 21205, USA.
| | - S L Szanton
- Department of Health Policy and Management, Johns Hopkins University School of Nursing and Bloomberg School of Public Health, Baltimore, USA
| | - C L Seplaki
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, USA
| | - T K M Cudjoe
- Department of Medicine, Johns Hopkins Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Baltimore, USA
| | - R J Thorpe
- Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, and Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - E M Agree
- Department of Sociology and Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, USA
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32
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Samuel LJ, Szanton SL, Seplaki CL, Cudjoe TKM, Thorpe RJ, Agree EM. Longitudinal and reciprocal associations between financial strain, home characteristics and mobility in the National Health and Aging Trends Study. BMC Geriatr 2019; 19:338. [PMID: 31791252 PMCID: PMC6888936 DOI: 10.1186/s12877-019-1340-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/31/2019] [Indexed: 11/12/2022] Open
Abstract
Background Older adults need homes that suit their physical capacity. Financial strain may limit home repairs and modifications and prompt relocations; repairing, relocating or modifying may increase financial strain. Likewise, reciprocal relationships may exist between financial strain and home characteristics and mobility; financial strain and home characteristics may influence mobility and mobility declines may increase financial strain, limit home repairs and modifications and prompt relocations. We test cross-lagged associations between financial strain, home disorder, relocation, home modifications and mobility. Methods In the National Health and Aging Trends Study, ability to complete a walking test, speed among those able to complete, financial strain, home disorder, relocating and modifying the home were recorded annually for 3 years (2012–2014). Structural equation models separately examined ability to walk and walking speed among those able, accounting for sociodemographic characteristics, social support, health prior health characteristics and autoregressive effects. Sampling weights accounted for the complex survey design and non-response over time. Results In both models (n = 3234 and n = 2467), financial strain predicted greater home disorder and vice versa, but cross-lagged associations were not found with relocating and modifications. Greater home disorder predicted lower odds of ability to walk and slower speed among those able. Financial strain and home modifications predicted lower odds of ability to walk. Also, faster walking speed predicted lower odds of subsequent financial strain and lower subsequent home disorder scores and ability to walk predicted less subsequent home disorder and lower odds of relocating. Conclusions Home disorder links financial strain with reduced mobility in a national sample of U.S. older adults. Cross-lagged associations between financial strain and home disorder and between home disorder and mobility suggest reciprocal effects that may accumulate over time. Also, financial strain, reduced mobility, relocations and modifications predicted greater home disorder. Together, these results highlight home disorder as a social determinant of mobility for older adults. Greater attention should be given to repairing and modifying home environments and supporting stable housing for older adults with financial strain.
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Affiliation(s)
- L J Samuel
- Johns Hopkins University School of Nursing, 525 North Wolfe St., Rm 426, Baltimore, MD, 21205, USA.
| | - S L Szanton
- Department of Health Policy and Management, Johns Hopkins University School of Nursing and Bloomberg School of Public Health, Baltimore, USA
| | - C L Seplaki
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, USA
| | - T K M Cudjoe
- Department of Medicine, Johns Hopkins Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Baltimore, USA
| | - R J Thorpe
- Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, and Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - E M Agree
- Department of Sociology and Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, USA
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Warth J, Puth MT, Tillmann J, Porz J, Zier U, Weckbecker K, Münster E. Over-indebtedness and its association with pain and pain medication use. Prev Med Rep 2019; 16:100987. [PMID: 31534901 PMCID: PMC6744525 DOI: 10.1016/j.pmedr.2019.100987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 08/26/2019] [Accepted: 09/05/2019] [Indexed: 11/25/2022] Open
Abstract
In developed countries, millions of households are over-indebted, and the number continues to rise. Studies have found an increased risk of adverse health effects among individuals that cannot cover payment obligations with available assets persistently. However, little is known about the role of over-indebtedness in pain. This study examined the association between over-indebtedness and pain and pain medication use. A cross-sectional study conducted among over-indebted individuals in 70 debt advisory centres in Germany (OID-survey; n = 699) was linked to the nationally representative German Health Interview and Examination Survey for Adults (DEGS1; n = 7987). Descriptive statistics and logistic regression analyses were used to examine the association between over-indebtedness and pain and pain medication use among participants with valid data on both outcome variables (n = 7560). Pain was experienced by over-indebted individuals more frequently (71.3%) compared to the general population (59.6%) whereas the prevalence of pain medication use was similar in both samples (DEGS1 12.6% vs. OID-survey 13.1%). Over-indebtedness significantly increased the odds of pain (aOR 1.30; 95%-CI 1.07-1.59) after adjusting for socioeconomic, demographic and health factors. The over-indebted were significantly less likely to use pain medication compared to the general population after adjustment (aOR 0.76; 95%-CI 0.58-0.99). Taking over-indebtedness into account as risk factor for pain and restricted pain medication use in research and clinical practice will help to advance the understanding of pain disparities, develop suitable interventions for preventive action and promote accessible pain management among those at risk.
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Affiliation(s)
- Jacqueline Warth
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Marie-Therese Puth
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Judith Tillmann
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Johannes Porz
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Ulrike Zier
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Eva Münster
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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Topor A, Stefansson CG, Denhov A, Bülow P, Andersson G. Recovery and economy; salary and allowances: a 10-year follow-up of income for persons diagnosed with first-time psychosis. Soc Psychiatry Psychiatr Epidemiol 2019; 54:919-26. [PMID: 30631889 DOI: 10.1007/s00127-019-01655-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Persons with severe mental health problems (SMHP) point out financial strain as one of their main problems. De-institutionalisation in welfare countries has aimed at normalisation of their living conditions. The aim of the study was to follow the changes in income and source of income during a 10-year period for persons with a first-time psychosis diagnosis (FTPD). METHODS Data were gathered from different registers. Data from persons with FTPD were compared to data on the general population. Two groups with different recovery paths were also compared: one group without contact with the mental health services during the last five consecutive years of the 10-year follow-up, and the other with contact with both 24/7 and community-based services during the same period. RESULTS SMHP led to poverty, even if the financial effects of SMHP were attenuated by welfare interventions. Even a recovery path associated with work did not resolve the inequalities generated by SMHP. CONCLUSIONS Attention should be paid to the risks of confusing the effects of poverty with symptoms of SMHP and thus pathologizing poverty and its impact on human beings. Adequate interventions should consider to improve the financial situation of persons with SMHP.
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Warth J, Puth MT, Tillmann J, Porz J, Zier U, Weckbecker K, Münster E. Over-indebtedness and its association with sleep and sleep medication use. BMC Public Health 2019; 19:957. [PMID: 31315596 PMCID: PMC6637586 DOI: 10.1186/s12889-019-7231-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 06/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over-indebtedness is currently rising in high-income countries. Millions of citizens are confronted with the persistent situation when household income and assets are insufficient to cover payment obligations and living expenses. Previous research shows that over-indebtedness increases the risk of various adverse health effects. However, its association with sleep problems has not yet been examined. The objective of this study was to investigate the association between over-indebtedness and sleep problems and sleep medication use. METHODS A cross-sectional study on over-indebtedness (OID survey) was conducted in 70 debt advisory centres in Germany in 2017 that included 699 over-indebted respondents. The survey data were combined with the nationally representative German Health Interview and Examination Survey for Adults (DEGS1; n = 7987). We limited analyses to participants with complete data on all sleep variables (OID: n = 538, DEGS1: n = 7447). Descriptive analyses and logistic regression analyses were used to examine the association between over-indebtedness and difficulty initiating and maintaining sleep, and sleep medication use. RESULTS A higher prevalence of sleep problems and sleep medication use was observed among over-indebted individuals compared to the general population. After adjustment for socio-economic and health factors (age, sex, education, marital status, employment status, subjective health status and mental illness), over-indebtedness significantly increased the risk of difficulties with sleep onset (adjusted odds ratio (aOR) 1.79, 95%-confidence interval (CI) 1.45-2.21), sleep maintenance (aOR 1.45, 95%-CI 1.17-1.80) and sleep medication use (aOR 3.94, 95%-CI 2.96-5.24). CONCLUSIONS Evidence suggests a strong association between over-indebtedness and poor sleep and sleep medication use independent of conventional socioeconomic measures. Considering over-indebtedness in both research and health care practice will help to advance the understanding of sleep disparities, and facilitate interventions for those at risk. TRIAL REGISTRATION German Clinical Trials Register: DRKS00013100 (OID survey, ArSemü); Date of registration: 23.10.2017; Date of enrolment of the first participant: 18.07.2017, retrospectively registered.
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Affiliation(s)
- Jacqueline Warth
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Marie-Therese Puth
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Judith Tillmann
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Johannes Porz
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Ulrike Zier
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Klaus Weckbecker
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Eva Münster
- Institute of General Practice and Family Medicine, University of Bonn, Universitätsklinikum Bonn AöR, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
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Ferrante G, Fasanelli F, Gigantesco A, Ferracin E, Contoli B, Costa G, Gargiulo L, Marra M, Masocco M, Minardi V, Violani C, Zengarini N, d'Errico A, Ricceri F. Is the association between precarious employment and mental health mediated by economic difficulties in males? Results from two Italian studies. BMC Public Health 2019; 19:869. [PMID: 31269944 PMCID: PMC6609380 DOI: 10.1186/s12889-019-7243-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/26/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Flexible employment is increasing across Europe and recent studies show an association with poor mental health. The goal of the current study is to examine this association in the Italian population to assess the possible mediating role of financial strain. METHODS Data were obtained by two Italian cross-sectional studies (PASSI and HIS) aimed at monitoring the general population health status, health behaviours and determinants. Mental health status was assessed using alternatively two validated questionnaires (the PHQ-2 and the MCS-12 score) and Poisson regression models were performed to assess if precarious work was associated with poor mental health. A formal mediation analysis was conducted to evaluate if the association between precarious work and mental health was mediated by financial strain. RESULTS The analyses were performed on 31,948 subjects in PASSI and on 21,894 subjects in HIS. A nearly two-fold risk of depression and poor mental health was found among precarious workers, compared to workers with a permanent contract, which was strongly mediated by financial strain. CONCLUSIONS Even with the limitations of a cross-sectional design, this research supports that precarious employment contributes through financial strain to reduce the mental health related quality of life and to increase mental disorders such as symptoms of depression or dysthymia. This suggests that when stability in work cannot be guaranteed, it would be appropriate to intervene on the wages of precarious jobs and to provide social safety nets for ensuring adequate income.
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Affiliation(s)
- Gianluigi Ferrante
- National Centre for Drug Research and Evaluation, National Institute of Health (ISS), Rome, Italy
- Epidemiologia&Precariato, Group for the study of precarious work of the Italian Association of Epidemiology (AIE), Rome, Italy
| | - Francesca Fasanelli
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and University of Turin, Turin, Italy
| | - Antonella Gigantesco
- Centre of Behavioural Sciences and Mental Health, Italian National Institute of Health (ISS), Rome, Italy
| | - Elisa Ferracin
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy
| | - Benedetta Contoli
- National Center for Disease Prevention and Health Promotion, National Institute of Health (ISS), Rome, Italy
| | - Giuseppe Costa
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy
- Department of Clinical and Biological Sciences, University of Turin , Grugliasco (TO), Italy
| | | | - Michele Marra
- Epidemiologia&Precariato, Group for the study of precarious work of the Italian Association of Epidemiology (AIE), Rome, Italy
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy
| | - Maria Masocco
- National Center for Disease Prevention and Health Promotion, National Institute of Health (ISS), Rome, Italy
| | - Valentina Minardi
- National Center for Disease Prevention and Health Promotion, National Institute of Health (ISS), Rome, Italy
| | - Cristiano Violani
- Department of Psychology, Faculty of Medicine and Psychology, University Sapienza, Rome, Italy
| | - Nicolás Zengarini
- Epidemiologia&Precariato, Group for the study of precarious work of the Italian Association of Epidemiology (AIE), Rome, Italy
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy
| | - Angelo d'Errico
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy
| | - Fulvio Ricceri
- Epidemiologia&Precariato, Group for the study of precarious work of the Italian Association of Epidemiology (AIE), Rome, Italy.
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy.
- Department of Clinical and Biological Sciences, University of Turin , Grugliasco (TO), Italy.
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Rogers CJ, Forster M, Unger JB. Ethnic variations in the relationship between multiple stress domains and use of several types of tobacco/nicotine products among a diverse sample of adults. Addict Behav Rep 2018; 7:96-102. [PMID: 29892703 PMCID: PMC5993881 DOI: 10.1016/j.abrep.2018.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 10/31/2022] Open
Abstract
Introduction Financial strain and discrimination are consistent predictors of negative health outcomes and maladaptive coping behaviors, including tobacco use. Although there is considerable information exploring stress and smoking, limited research has examined the relationship between patterns of stress domains and specific tobacco/nicotine product use. Even fewer studies have assessed ethnic variations in these relationships. Methods This study investigated the relationship between discrimination and financial strain and current tobacco/nicotine product use and explored the ethnic variation in these relationships among diverse sample of US adults (N = 1068). Separate logistic regression models assessed associations between stress domains and tobacco/nicotine product use, adjusting for covariates (e.g., age, gender, race/ethnicity, and household income). Due to statistically significant differences, the final set of models was stratified by race/ethnicity. Results Higher levels of discrimination were associated with higher odds of all three tobacco/nicotine product categories. Financial strain was positively associated with combustible tobacco and combined tobacco/nicotine product use. Financial strain was especially risky for Non-Hispanic Whites (AOR:1.191, 95%CI:1.083-1.309) and Blacks/African Americans (AOR:1.542, 95%CI:1.106-2.148), as compared to other groups, whereas discrimination was most detrimental for Asians/Pacific Islanders (AOR:3.827, 95%CI:1.832-7.997) and Hispanics/Latinas/Latinos (AOR:2.517, 95%CI:1.603-3.952). Conclusions Findings suggest discrimination and financial stressors are risk factors for use of multiple tobacco/nicotine products, highlighting the importance of prevention research that accounts for these stressors. Because ethnic groups may respond differently to stress/strain, prevention research needs to identify cultural values, beliefs, and coping strategies that can buffer the negative consequences of discrimination and financial stressors.
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Affiliation(s)
- Christopher J Rogers
- Department of Health Sciences, California State University, Northridge. 18111 Nordhoff St. Northridge, California, CA 91330, United States
| | - Myriam Forster
- Department of Health Sciences, California State University, Northridge. 18111 Nordhoff St. Northridge, California, CA 91330, United States
| | - Jennifer B Unger
- Tobacco Center of Regulatory Science, Department of Preventive Medicine, University of Southern California, Keck School, Los Angeles, CA, United States
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Koltai J, Bierman A, Schieman S. Financial circumstances, mastery, and mental health: Taking unobserved time-stable influences into account. Soc Sci Med 2018; 202:108-16. [PMID: 29522902 DOI: 10.1016/j.socscimed.2018.01.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This paper examines whether low income and subjective financial strain are associated with mental health, as well as whether mastery weakens this association. We analyze three waves of a large sample of Canadians and utilize random and fixed effects regression strategies to assess bias introduced by unobserved time-stable confounders. In random effects models, both low income and subjective financial strain are associated with distress and anger. In fixed effects models that control for all time-stable confounders, the effect of low income is reduced to non-significance for both outcomes. The effect of subjective strain is also reduced in fixed effects models, but remained statistically significant. Sobel tests indicated that the effect of subjective strain on mental health is transmitted through mastery, but this indirect path is modest in magnitude. When interactions are tested, mastery weakens the association between subjective strain and distress, and this effect is robust to the influence of time-stable controls, but mastery does not buffer the subjective strain-anger relationship in either random or fixed-effects models. Finally, moving below the low income threshold increases anger for low mastery individuals, but seems to reduce anger when moving below the low income threshold is coupled with increases in mastery. Collectively, our findings demonstrate the importance of assessing the influence of unobserved time-stable confounders in stress research. Further, discrepancies in the moderating role of mastery reinforce calls for the assessment of multiple outcomes in mental health research.
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Kendzor DE, Businelle MS, Waters AF, Frank SG, Hébert ET. Financial strain indirectly influences smoking cessation through withdrawal symptom severity. Drug Alcohol Depend 2018; 183:55-61. [PMID: 29227838 DOI: 10.1016/j.drugalcdep.2017.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/10/2017] [Accepted: 10/17/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Financial strain has an adverse impact on smoking cessation. However, the mechanisms through which financial strain influences cessation remain unclear. The purpose of the current study was to determine whether financial strain indirectly influenced smoking cessation through withdrawal symptom severity. METHODS Participants (N=139) were primarily Black (63.3%) and female (57.6%) adults enrolled in a smoking cessation program at a safety-net hospital. A self-report financial strain questionnaire was completed one week prior to the scheduled quit date, and the Wisconsin Smoking Withdrawal Scale (WSWS) was completed on the day after the scheduled quit date. Biochemically-verified 7-day point prevalence abstinence was assessed four weeks after the scheduled quit date. Adjusted mediation analyses were conducted using the PROCESS macro for SPSS to evaluate the indirect effects of financial strain on smoking cessation via post-quit withdrawal symptom severity. RESULTS Analyses indicated a significant indirect effect of financial strain on smoking cessation through total withdrawal symptom severity, B=0.027; 95% CI (0.003, 0.066); and specifically anger, B=0.035; 95% CI (0.008, 0.074), anxiety, B=0.021; 95% CI (0.001, 0.051), and sleep symptoms, B=0.015; 95% CI (0.005, 0.043). Greater pre-quit financial strain was associated with greater post-quit withdrawal symptom severity, which increased the likelihood of non-abstinence 4 weeks after the scheduled quit attempt. The direct effect of financial strain on smoking cessation was not significant in any of the mediation models. CONCLUSIONS Findings: suggest that withdrawal severity is an underlying mechanism through which financial strain influences smoking cessation.
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Affiliation(s)
- Darla E Kendzor
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Stephenson Cancer Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA.
| | - Michael S Businelle
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Stephenson Cancer Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA.
| | - Aaron F Waters
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA, 70803, USA.
| | - Summer G Frank
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Stephenson Cancer Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA.
| | - Emily T Hébert
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Stephenson Cancer Center, Oklahoma Tobacco Research Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA.
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Robles Z, Anjum S, Garey L, Kauffman BY, Rodríguez-Cano R, Langdon KJ, Neighbors C, Reitzel LR, Zvolensky MJ. Financial strain and cognitive-based smoking processes: The explanatory role of depressive symptoms among adult daily smokers. Addict Behav 2017; 70:18-22. [PMID: 28161618 PMCID: PMC10041799 DOI: 10.1016/j.addbeh.2017.01.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/10/2017] [Accepted: 01/24/2017] [Indexed: 11/29/2022]
Abstract
Little work has focused on the underlying mechanisms that may link financial strain and smoking processes. The current study tested the hypothesis that financial strain would exert an indirect effect on cognitive-based smoking processes via depressive symptoms. Three clinically significant dependent variables linked to the maintenance of smoking were evaluated: negative affect reduction motives, negative mood abstinence expectancies, and perceived barriers for quitting. Participants included 102 adult daily smokers (Mage=33.0years, SD=13.60; 35.3% female) recruited from the community to participate in a self-guided (unaided; no psychological or pharmacological intervention) smoking cessation study. Results indicated that depressive symptoms explain, in part, the relation between financial strain and smoking motives for negative affect reduction, negative mood abstinence expectancies, and perceived barriers for quitting. Results indicate that smoking interventions for individuals with high levels of financial strain may potentially benefit from the addition of therapeutic tactics aimed at reducing depression.
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Affiliation(s)
- Zuzuky Robles
- Department of Psychology, Roosevelt University, Chicago, IL, United States
| | - Sahar Anjum
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Brooke Y Kauffman
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Rubén Rodríguez-Cano
- Smoking Cessation and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Kirsten J Langdon
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
| | - Clayton Neighbors
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Lorraine R Reitzel
- Department of Psychological, Health & Learning Sciences, Houston, TX, United States
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, United States; Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, United States.
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Schrock JM, Adler NE, Epel ES, Nuru-Jeter AM, Lin J, Blackburn EH, Taylor RJ, Chae DH. Socioeconomic Status, Financial Strain, and Leukocyte Telomere Length in a Sample of African American Midlife Men. J Racial Ethn Health Disparities 2017. [PMID: 28634877 DOI: 10.1007/s40615-017-0388-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND African American men in the USA experience poorer aging-related health outcomes compared to their White counterparts, partially due to socioeconomic disparities along racial lines. Greater exposure to socioeconomic strains among African American men may adversely impact health and aging at the cellular level, as indexed by shorter leukocyte telomere length (LTL). This study examined associations between socioeconomic factors and LTL among African American men in midlife, a life course stage when heterogeneity in both health and socioeconomic status are particularly pronounced. METHODS Using multinomial logistic regression, we examined associations between multiple measures of SES and tertiles of LTL in a sample of 92 African American men between 30 to 50 years of age. RESULTS Reports of greater financial strain were associated with higher odds of short versus medium LTL (odds ratio (OR)=2.21, p = 0.03). Higher income was associated with lower odds of short versus medium telomeres (OR=0.97, p = 0.04). Exploratory analyses revealed a significant interaction between educational attainment and employment status (χ 2 = 4.07, p = 0.04), with greater education associated with lower odds of short versus long telomeres only among those not employed (OR=0.10, p = 0.040). CONCLUSION Cellular aging associated with multiple dimensions of socioeconomic adversity may contribute to poor aging-related health outcomes among African American men. Subjective appraisal of financial difficulty may impact LTL independently of objective dimensions of SES. Self-appraised success in fulfilling traditionally masculine gender roles, including being an economic provider, may be a particularly salient aspect of identity for African American men and have implications for cellular aging in this population.
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Affiliation(s)
- Joshua M Schrock
- Department of Anthropology, University of Oregon, 1218 University of Oregon, Eugene, OR, 97403, USA.
| | - Nancy E Adler
- Department of Psychiatry and Center for Health and Community, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | - Elissa S Epel
- Department of Psychiatry and Center for Health and Community, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | - Amani M Nuru-Jeter
- Divisions of Community Health Sciences and Epidemiology, University of California, Berkeley, Berkeley, CA, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | - Elizabeth H Blackburn
- Department of Biochemistry and Biophysics, University of California, San Francisco, School of Medicine, San Francisco, CA, USA.,Department of Microbiology and Immunology, University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | | | - David H Chae
- Department of Human Development & Family Studies, College of Human Sciences, Auburn University, Auburn, AL, USA
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Prentice C, McKillop D, French D. How financial strain affects health: Evidence from the Dutch National Bank Household Survey. Soc Sci Med 2017; 178:127-135. [PMID: 28214723 DOI: 10.1016/j.socscimed.2017.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/19/2016] [Accepted: 02/03/2017] [Indexed: 01/25/2023]
Abstract
The mechanisms by which financial strain affects health are not well understood. In this paper, we conduct a longitudinal mediation analysis of the Dutch National Bank Household Survey. To quantify the relative importance of biological and nonbiological pathways from financial strain to health, we consider smoking, heavy drinking and being overweight as plausible behavioural responses to financial strain but find that only 4.9% of the response of self-reported health to financial strain is mediated by these behaviours. Further analysis indicates that although financial strain increases impulsivity this has little effect on unhealthy behaviours. Economic stresses therefore appear to be distinct from other forms of stress in the relatively minor influence of nonbiological pathways to ill-health.
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Affiliation(s)
- Carla Prentice
- Queen's Management School, Queen's University Belfast, Northern Ireland, UK
| | - Donal McKillop
- Queen's Management School, Queen's University Belfast, Northern Ireland, UK
| | - Declan French
- Queen's Management School, Queen's University Belfast, Northern Ireland, UK.
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Mitchell AM, Christian LM. Financial strain and birth weight: the mediating role of psychological distress. Arch Womens Ment Health 2017; 20:201-208. [PMID: 27957597 PMCID: PMC5239729 DOI: 10.1007/s00737-016-0696-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/22/2016] [Indexed: 01/26/2023]
Abstract
The effects of financial strain during pregnancy have received limited attention. In addition, data examining the pathways by which SES indicators contribute to birth weight are lacking. The objective of the current study was to examine the potential pathway of psychological distress in the relationship between financial strain and birth weight. Participants consisted of 138 pregnant women who completed measures assessing financial strain, depressive symptoms, pregnancy-specific distress, perceived stress, and general anxiety during pregnancy (mean gestational age = 18.5, SD = 7.2). Birth outcome data were obtained via medical record review. Simple and parallel mediation models were conducted using PROCESS. Simple mediation models showed that depressive symptoms (95% CI -24.65, -0.90) and pregnancy-specific distress (95% CI -37.31, -5.91), but not perceived stress (95% CI -31.17, 4.69) or anxiety (95% CI -25.84, 5.57), served as mediators in the relationship between financial strain and birth weight. When depressive symptoms and pregnancy-specific distress were included in the same mediation model, only pregnancy-specific distress remained significant. Financial strain was positively associated with all facets of psychological distress and negatively associated with birth weight during pregnancy. The current study demonstrated the mechanistic role of pregnancy-specific distress in the link between financial strain and birth weight in a racially diverse sample. Interventions targeting pregnancy-specific distress may mitigate the effects of financial strain on birth weight. Studies examining whether pregnancy-specific distress accounts for the relationship between other types of stressor exposures and birth weight would be informative.
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Affiliation(s)
- Amanda M. Mitchell
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH,Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Lisa M. Christian
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH,Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH,Department of Psychology, The Ohio State University, The Ohio State University, Columbus, OH,Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH
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Stacey T, Prady S, Haith-Cooper M, Downe S, Simpson N, Pickett K. Ethno-Specific Risk Factors for Adverse Pregnancy Outcomes: Findings from the Born in Bradford Cohort Study. Matern Child Health J 2016; 20:1394-404. [PMID: 26983444 PMCID: PMC4909785 DOI: 10.1007/s10995-016-1936-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Preterm birth (PTB) and small for gestational age (SGA) are major causes of perinatal mortality and morbidity. Previous studies indicated a range of risk factors associated with these poor outcomes, including maternal psychosocial and economic wellbeing. This paper will explore a range of psycho-social and economic factors in an ethnically diverse population. Methods The UK's Born in Bradford cohort study recruited pregnant women attending a routine antenatal appointment at 26-28 weeks' gestation at the Bradford Royal Infirmary (2007-2010). This analysis includes 9680 women with singleton live births who completed the baseline questionnaire. Data regarding maternal socio-demographic and mental health were recorded. Outcome data were collected prospectively, and analysed using multivariate regression models. The primary outcomes measured were: PTB (<37 weeks' gestation) and SGA (<10th customised centile). Results After adjustment for socio-demographic and medical factors, financial strain was associated with a 45 % increase in PTB (OR 1.45: 95 % CI 1.06-1.98). Contrary to expectation, maternal distress in Pakistani women was negatively associated with SGA (OR 0.65: CI 0.48-0.88). Obesity in White British women was protective for PTB (OR 0.67: CI 0.45-0.98). Previously recognized risk factors, such as smoking in pregnancy and hypertension, were confirmed. Conclusions This study confirms known risk factors for PTB and SGA, along with a new variable of interest, financial strain. It also reveals a difference in the risk factors between ethnicities. In order to develop appropriate targeted preventative strategies to improve perinatal outcome in disadvantaged groups, a greater understanding of ethno-specific risk factors is required.
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Affiliation(s)
- Tomasina Stacey
- />School of Healthcare, University of Leeds, Leeds, LS2 9JT UK
| | - Stephanie Prady
- />Department of Health Sciences, University of York, Heslington, York, Yorkshire YO10 5DD UK
| | - Melanie Haith-Cooper
- />School of Health Studies, University of Bradford, Richmond Road, Bradford, Yorkshire BD7 1DP UK
| | - Soo Downe
- />School of Health, University of Central Lancashire, Brook Building, Preston, PR1 2HE UK
| | - Nigel Simpson
- />Department of Women’s and Children’s Health, Level 9, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL UK
| | - Kate Pickett
- />Department of Health Sciences, University of York, Heslington, York, Yorkshire YO10 5DD UK
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Downing J. The health effects of the foreclosure crisis and unaffordable housing: A systematic review and explanation of evidence. Soc Sci Med 2016; 162:88-96. [PMID: 27343818 DOI: 10.1016/j.socscimed.2016.06.014] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/27/2016] [Accepted: 06/10/2016] [Indexed: 11/24/2022]
Abstract
The foreclosure crisis was detrimental to the financial well-being of many households, yet the non-economic consequences are still poorly understood. This systematic review aims to understand the direct and spillover effect of foreclosures on several health-related outcomes by synthesizing evidence from 40 studies. First, this study identifies research gaps using a schema to organize studies by line of inquiry, health-related outcome, and measure of homeowner financial distress. In order to provide context for the findings, four pathways - stress, effect-budgeting, frustration-aggression, and trust - evoked in the literature are described to explain the relationship between foreclosures and health. The research suggests that experiencing a foreclosure and living near foreclosures are associated with poor psychological and behavioral morbidities, namely anxiety and violent behavior, and declining health utilization. Evidence is sparse on suicide, substance abuse, somatic morbidities, and mortality. Future research is needed to fill the gaps and explicitly test the mechanisms proposed.
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Tøge AG. Health effects of unemployment in Europe (2008-2011): a longitudinal analysis of income and financial strain as mediating factors. Int J Equity Health 2016; 15:75. [PMID: 27154492 PMCID: PMC4858892 DOI: 10.1186/s12939-016-0360-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/24/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Unemployment has a number of negative consequences, such as decreased income and poor self-rated health. However, the relationships between unemployment, income, and health are not fully understood. Longitudinal studies have investigated the health effect of unemployment and income separately, but the mediating role of income remains to be scrutinized. Using longitudinal data and methods, this paper investigates whether the effect of unemployment on self-rated health (SRH) is mediated by income, financial strain and unemployment benefits. METHODS The analyses use data from the longitudinal panel of European Union Statistics on Income and Living Conditions (EU-SILC) over the 4 years of 2008 to 2011. Individual fixed effects models are applied, estimating the longitudinal change in SRH as people move from employment to unemployment, and investigating whether this change is reduced after controlling for possible mediating mechanisms, absolute income change, relative income change, relative income rank, income deprivation, financial strain, and unemployment benefits. RESULTS Becoming unemployed is associated with decreased SRH (-0.048, SE 0.012). This decrease is 19 % weaker (-0.039, SE 0.010) after controlling for change in financial strain. Absolute and relative changes in household equalized income, as well as changes in relative rank and transitions into income deprivation, are not found to be associated with change in SRH. CONCLUSIONS Financial strain is found to be a potential mediator of the individual health effect of unemployment, while neither absolute income, relative income, relative rank, income deprivation nor unemployment benefits are found to be mediators of this relationship.
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Affiliation(s)
- Anne Grete Tøge
- Department of Social Work, Child Welfare and Social Policy, Faculty of Social Sciences, Oslo and Akershus University College of Applied Sciences, P.O. Box 4, St. Olavs plass, NO-0130, Oslo, Norway.
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Córdoba-Doña JA, Escolar-Pujolar A, San Sebastián M, Gustafsson PE. How are the employed and unemployed affected by the economic crisis in Spain? Educational inequalities, life conditions and mental health in a context of high unemployment. BMC Public Health 2016; 16:267. [PMID: 26979336 PMCID: PMC4791891 DOI: 10.1186/s12889-016-2934-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 03/08/2016] [Indexed: 04/03/2023] Open
Abstract
Background Despite an increasing number of studies on the factors mediating the impact of the economic recession on mental health, research beyond the individual employment status is scarce. Our objectives were to investigate in which ways the mental health of employed and unemployed populations is differently affected by the current economic recession along the educational scale and to examine whether financial strain and social support explain these effects of the crisis. Methods A repeated cross-sectional study, using two waves of the Andalusian Health Survey in 2007 (pre-crisis) and 2011–2012 (crisis). A population aged between 19 and 64 years was selected. The dependent variable was the Mental Component Summary of the SF-12 questionnaire. We performed Poisson regression models stratified by working status, with period, educational level, financial strain and social support as independent variables. We examined interactions between period and educational level. Age, sex, main earner, cohabitation and partner's working status were considered as covariates. Results The study included 3210 individuals (1185 women) in 2007 and 3633 individuals (1486 women) in 2011–2012. In working individuals the prevalence of poor mental health increased for secondary and complete primary studies groups during crisis compared to the pre-crisis period, while it decreased significantly in the university study group (PR = 0.76, 95 % CI: 0.58–0.99). However, in unemployed individuals prevalence ratios for poor mental health increased significantly only in the secondary studies group (PR = 1.73, 95 % CI: 1.06–2.83). Financial strain and social support yielded consistent associations with mental health in all subgroups. Only financial strain could partly explain the crisis effect on mental health among the unemployed. Conclusions Our study supports the finding that current economic recession is associated with poorer mental health differentially according to labour market status and educational level. Those with secondary studies may be at risk in times of economic recession. In connection with this, emerging educational inequalities in mental health among the employed population were observed. Our research also suggests a partial mediating role of financial strain for the effects of crisis on poor mental health among the unemployed. Good social support appears to buffer poor mental health in all subgroups but not specifically during crisis period. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2934-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Juan Antonio Córdoba-Doña
- Delegación Territorial de Igualdad, Salud y Políticas Sociales de Andalucía, Avda María Auxiliadora 2, 11009, Cádiz, Spain. .,Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE-901 85, Umeå, Sweden.
| | - Antonio Escolar-Pujolar
- Delegación Territorial de Igualdad, Salud y Políticas Sociales de Andalucía, Avda María Auxiliadora 2, 11009, Cádiz, Spain
| | - Miguel San Sebastián
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE-901 85, Umeå, Sweden
| | - Per E Gustafsson
- Department of Public Health and Clinical Medicine, Social Medicine, Umeå University, SE-901 85, Umeå, Sweden
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Camacho-Thompson DE, Gillen-O'Neel C, Gonzales NA, Fuligni AJ. Financial Strain, Major Family Life Events, and Parental Academic Involvement During Adolescence. J Youth Adolesc 2016; 45:1065-74. [PMID: 26951508 DOI: 10.1007/s10964-016-0443-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/13/2016] [Indexed: 12/21/2022]
Abstract
Parental academic involvement-whether through school participation and communication, or supervision and assistance at home-often has been cited as a way to enhance academic achievement. Yet, little is known about how the financial and life pressures faced by families can compromise parents' ability to become involved in their adolescents' education. In the current study, these dynamics were examined among Mexican-origin families, who often may face challenging financial and familial circumstances, and whose students may have more difficulty in secondary school. Parents of Mexican-origin ninth and tenth grade students from two high schools in Los Angeles (N = 428; 50 % female) completed quantitative interviews. The results revealed that financial strain predicted less involvement at school, and major family life events predicted less involvement at home, even after controlling for potentially confounding factors. Moreover, both of the associations between parental stress and parental academic involvement were mediated by lower levels of relationship quality between parents and adolescents, but not by conflict within the parent-adolescent dyad or parental depressive and somatic symptoms. The findings suggest that stress may limit parents' ability to become involved their adolescents' education, and highlight the importance of understanding family dynamics when examining parental academic involvement among Mexican-origin families.
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Wilkinson LR. Financial Strain and Mental Health Among Older Adults During the Great Recession. J Gerontol B Psychol Sci Soc Sci 2016; 71:745-54. [PMID: 26843395 DOI: 10.1093/geronb/gbw001] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/03/2016] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The economic recession has garnered the interest of many scholars, with much attention being drawn to how the recession has affected labor force participation, household wealth, and even retirement decisions. Certainly, the Great Recession has influenced the financial well-being of older adults, but has it had discernible effects on mental health? METHOD This study draws on 5,366 respondents from the Health and Retirement Study (2006-2010) to examine objective and subjective measures of financial well-being in the period surrounding the Great Recession. Guided by cumulative inequality theory, this research investigates whether the economic downturn contributed to worsening anxiety and depressive symptoms over a 4-year period. RESULTS Results from linear fixed effects models reveal that decreases in objective financial resources were associated with increased financial strain during the Great Recession. Unlike the objective indicators, however, financial strain was a strong and robust predictor of worsening mental health between 2006 and 2010. DISCUSSION Building on prior research, this study elucidates the factors that shape financial strain and provides evidence that the Great Recession not only affected the financial well-being of older adults but also had adverse effects on mental health.
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Reitzel LR, Langdon KJ, Nguyen NT, Zvolensky MJ. Financial strain and smoking cessation among men and women within a self-guided quit attempt. Addict Behav 2015; 47:66-9. [PMID: 25879712 DOI: 10.1016/j.addbeh.2015.03.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/07/2015] [Accepted: 03/29/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Financial strain, defined as an unfavorable asset-to-needs ratio, has been associated with reduced odds of smoking cessation in the context of a structured clinical study providing cessation assistance. This study reports on a secondary data analysis that assessed the association of financial strain and biochemically-verified smoking abstinence within a structured clinical study of smokers making a self-guided cessation attempt. METHODS Participants (N=58; 65.5% men) were enrolled in a study about anxiety sensitivity and smoking cessation whereby they were instructed to initiate a self-guided quit attempt. Relations between financial strain and biochemically-verified smoking abstinence on the quit day and at Days 3, 7, 14, 28, and 90 post-quit were assessed using generalized estimating equations controlling for age, sex, race, education, partner status, pre-quit cigarettes smoked per day, and time. RESULTS Associations between financial strain and abstinence in the whole sample were marginal (aOR=.94, 95% CI=.87-1.01, observations=293; p=.07). However, sex was a significant moderator: greater financial strain was associated with lower odds of abstinence for men (aOR=.90, 95% CI=.80-1.00, observations=201; p=.05), but not women (aOR=1.05, 95% CI=.91-1.21, observations=92; p=.48). CONCLUSIONS Results indicated that financial strain was associated with lower odds of cessation among men undergoing a self-guided quit attempt in the context of a structured clinical study. These data suggest that financial strain may be an important socioeconomic determinant of smoking cessation and support its relevance for better understanding socioeconomic-based smoking-related health disparities. Future work may benefit by exploring sex-specific models of financial strain in the context of smoking cessation.
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Affiliation(s)
- Lorraine R Reitzel
- The University of Houston, College of Education, Department of Psychological, Health, & Learning Sciences, 491 Farish Hall, Houston, TX 77204-5029, USA.
| | - Kirsten J Langdon
- The National Center for PTSD, Women's Health Sciences Division, VA Boston Healthcare System, Boston University School of Medicine, Boston, MA 02118, USA
| | | | - Michael J Zvolensky
- The University of Houston, College of Liberal Arts and Social Sciences, Department of Psychology, 126 Heyne Building, Suite 104, Houston, TX 77204, USA
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