Utilization of Mental Health Services by Minority Urban Adults: Psychosocial Predictors

Although most mental disorders have their first onset by young adulthood, there are few longitudinal studies of these problems and related help-seeking behavior. The present study examined some early and current predictors of the use of mental health services among African-American and Puerto Rican participants in their mid-30s. The 674 participants (52.8 % African Americans, 47.2 % Puerto Ricans; 60.1 % women) in this study were first seen in 1990 when the participants attended schools serving the East Harlem area of New York City. A structural equation model controlling for the participants’ gender, educational level in emerging adulthood, and age at the most recent data collection showed significant standardized pathways from both ethnicity (β = −0.28; z = −4.82; p < 0.001) and psychological symptoms (β = 0.15; z = 2.41; p < 0.05), both measured in emerging adulthood, to smoking in the early 30s. That, in turn, was associated with certain physical diseases and symptoms (i.e., respiratory) in the mid-30s (β = 0.16; z = 2.59; p < 0.05). These physical diseases and symptoms had a cross-sectional association with family financial difficulty in the mid-30s (β = 0.21; z = 4.53; p < 0.001), which in turn also had a cross-sectional association with psychiatric disorders (β = 0.30; z = 5.30; p < 0.001). Psychiatric disorders had a cross-sectional association with mental health services utilization (β = 0.65; z = 13.25; p < 0.001). Additional pathways from the other domains to mental health services utilization in the mid-30s were also supported by the mediating role of psychiatric disorders. Results obtained from this research offer theoretical and practical information regarding the processes leading to the use of mental health services.     

Income Inequality and Mortality: Results From a Longitudinal Study of Older Residents of S?o Paulo,Brazil

Objectives. We determined whether community-level income inequality was associated with mortality among a cohort of older adults in São Paulo, Brazil.Methods. We analyzed the Health, Well-Being, and Aging (SABE) survey, a sample of community-dwelling older adults in São Paulo (2000–2007). We used survival analysis to examine the relationship between income inequality and risk for mortality among older individuals living in 49 districts of São Paulo.Results. Compared with individuals living in the most equal districts (lowest Gini quintile), rates of mortality were higher for those living in the second (adjusted hazard ratio [AHR] = 1.44, 95% confidence interval [CI] = 0.87, 2.41), third (AHR = 1.96, 95% CI = 1.20, 3.20), fourth (AHR = 1.34, 95% CI = 0.81, 2.20), and fifth quintile (AHR = 1.74, 95% CI = 1.10, 2.74). When we imputed missing data and used poststratification weights, the adjusted hazard ratios for quintiles 2 through 5 were 1.72 (95% CI = 1.13, 2.63), 1.41 (95% CI = 0.99, 2.05), 1.13 (95% = 0.75, 1.70) and 1.30 (95% CI = 0.90, 1.89), respectively.Conclusions. We did not find a dose–response relationship between area-level income inequality and mortality. Our findings could be consistent with either a threshold association of income inequality and mortality or little overall association.The distribution of incomes in society has been hypothesized to influence a population’s health status.1 Unequal societies tend to have a greater number of people in poverty who lack access to resources (e.g., health care and preventive measures) to achieve good health. Unequal conditions are also more apt to generate invidious social comparisons that lead to frustration and stress.2 A more contentious claim made by a growing number of researchers is that unequal societies are damaging to the health of everybody—the poor as well as the comfortably well-off.1 The putative mechanism for this effect is that income inequality erodes social solidarity. Reduced social cohesion in turn hampers a society’s ability to provide for many kinds of public goods, such as education, health care, and public health infrastructure.3 For example, when the wealthiest members of society begin to purchase education for their children through private means, or purchase their health care through private channels, there is a corresponding clamor to cut taxes on the rich (since they are no longer benefiting from subscribing to the publicly financed system). Falling tax revenues eventually lead to reduced social spending and declining quality of public institutions for the rest of society.Although the detailed mechanisms through which growing inequality harms society need to be sketched out more fully, considerable evidence has accumulated on the association between income inequality and the health of individuals. Multilevel analyses have demonstrated that there is an excess risk of morbidity and mortality associated with living in a society with high levels of income inequality, even after adjustment for the confounding effects of individual income.4 In other words, there appears to be a contextual influence of income inequality on the health of individuals, over and above their personal socioeconomic circumstances.Kondo et al.5 conducted a meta-analysis of all multilevel studies linking income distribution to health, which included 9 longitudinal studies and 18 cross-sectional studies. In the pooled analysis of the prospective cohort studies, the authors reported that each 0.05-unit increment in the Gini index (a summary measure of income inequality) was associated with a 7.8% excess risk of all-cause mortality. Nonetheless, data remain sparse from Latin America, where the degree of income inequality is among the highest in the world. Previous studies have looked at the association between income inequality and health in Chile6 and Brazil,7,8 but these have been cross-sectional or ecological. In addition, debate continues concerning what kinds of individuals are most vulnerable to the harmful effects of income inequality. In the US National Longitudinal Mortality Study,9 the association between higher income inequality and increased mortality risk was shown only among working-age individuals; among older individuals (> 65 years), there was no such association.We address 2 gaps in the literature. We provide a longitudinal test of the association between community-level income inequality and mortality in São Paulo, Brazil, a country with one of the highest degrees of income inequality in the world. We also provide a test of the income inequality hypothesis in a predominantly elderly population.     

Mismatch: a comparative study of vitamin D status in British-Bangladeshi migrants

Background and objectivesLow levels of vitamin D among dark-skinned migrants to northern latitudes and increased risks for associated pathologies illustrate an evolutionary mismatch between an environment of high ultraviolet (UV) radiation to which such migrants are adapted and the low UV environment to which they migrate. Recently, low levels of vitamin D have also been associated with higher risks for contracting COVID-19. South Asians in the UK have higher risk for low vitamin D levels. In this study, we assessed vitamin D status of British-Bangladeshi migrants compared with white British residents and Bangladeshis still living in Bangladesh (‘sedentees’).MethodologyThe cross-sectional study compared serum vitamin D levels among 149 women aged 35–59, comprising British-Bangladeshi migrants (n = 50), white British neighbors (n = 54) and Bangladeshi sedentees (n = 45). Analyses comprised multivariate models to assess serum levels of 25-hydroxyvitamin D (25(OH)D), and associations with anthropometric, lifestyle, health and migration factors.ResultsVitamin D levels in Bangladeshi migrants were very low: mean 25(OH)D = 32.2 nmol/L ± 13.0, with 29% of migrants classified as deficient (<25 nmol/L) and 94% deficient or insufficient (≤50 nmol/L). Mean levels of vitamin D were significantly lower among British-Bangladeshis compared with Bangladeshi sedentees (50.9 nmol/L ± 13.3, P < 0.001) and were also lower than in white British women (55.3 nmol/L ± 20.9). Lower levels of vitamin D were associated with increased body mass index and low iron status.Conclusions and implicationsWe conclude that lower exposure to sunlight in the UK reduces vitamin D levels in Bangladeshi migrants. Recommending supplements could prevent potentially adverse health outcomes associated with vitamin D deficiency.Lay SummaryVitamin D deficiency is one example of mismatch between an evolved trait and novel environments. Here we compare vitamin D status of dark-skinned British-Bangladeshi migrants in the UK to Bangladeshis in Bangladesh and white British individuals. Migrants had lower levels of vitamin D and are at risk for associated pathologies.     

Racial/Ethnic Disparities in Hypertension Prevalence: Reconsidering the Role of Chronic Stress

Objectives. We investigated the association between anticipatory stress, also known as racism-related vigilance, and hypertension prevalence in Black, Hispanic, and White adults.Methods. We used data from the Chicago Community Adult Health Study, a population-representative sample of adults (n = 3105) surveyed in 2001 to 2003, to regress hypertension prevalence on the interaction between race/ethnicity and vigilance in logit models.Results. Blacks reported the highest vigilance levels. For Blacks, each unit increase in vigilance (range = 0–12) was associated with a 4% increase in the odds of hypertension (odds ratio [OR] = 1.04; 95% confidence interval [CI] = 1.00, 1.09). Hispanics showed a similar but nonsignificant association (OR = 1.05; 95% CI = 0.99, 1.12), and Whites showed no association (OR = 0.95; 95% CI = 0.87, 1.03).Conclusions. Vigilance may represent an important and unique source of chronic stress that contributes to the well-documented higher prevalence of hypertension among Blacks than Whites; it is a possible contributor to hypertension among Hispanics but not Whites.Racial and ethnic disparities in hypertension are some of the most widely studied and consequential sources of social disparities in health in the United States.1–3 For example, recent prevalence estimates show that roughly 40% of Black adults but only 30% of White adults have hypertension.4 In addition, the incidence of hypertension occurs at younger ages for Blacks than Whites.1 These disparities are reflected in the larger burden of hypertension-related health and economic costs carried by non-White than White Americans. For example, mortality rates attributable to hypertension are roughly 15 deaths per 100 000 people for White men and women; the mortality rate for Black women is 40 per 100 000 and more than 50 per 100 000 for Black men.5 Among all health conditions, hypertension accounts for the greatest portion of disparities in years of lost life.6 Economically speaking, if Black Americans had the hypertension prevalence of White Americans, about $400 million would be saved in out-of-pocket health care expenses, about $2 billion would be saved in private insurance costs, and $375 million would be saved from Medicare and Medicaid—per year.7Despite the tremendous amount of research devoted to clarifying the factors that generate these disparities, most studies find that they persist after adjustment for a wide range of socioeconomic, behavioral, and biomedical risk factors.8 In fact, although disparities exist for several of these risk factors (e.g., socioeconomic status), numerous studies have shown no disparities in many others (e.g., smoking, obesity for men, lipid profile).2 Despite substantial investment in interventions to eliminate hypertension disparities, evidence suggests that these disparities have actually grown over the past few decades,9 suggesting that numerous unknown factors drive disparities in hypertension.3     

Burnout of the US midwifery workforce and the role of practice environment

ObjectivesTo determine the prevalence of burnout among the midwifery workforce and the association between fixed personal and practice characteristics and modifiable organizational factors, specifically practice environment, to burnout among midwives in the United States.Data SourcePrimary data collection was conducted via an online survey of the complete national roster of certified nurse‐midwives and certified midwives over 3 weeks in April 2017.Study DesignThe study was a cross‐sectional observational survey consisting of 95 items about personal and practice characteristics, respondents'' practice environments, and professional burnout.Data Collection MethodsThe inclusion criterion was actively practicing midwifery in the United States. Data were analyzed with bivariate analyses to determine the association between personal and practice characteristics and burnout. A hierarchal multilinear regression evaluated the interrelationship between personal and practice characteristics, practice environment, and burnout.Principal FindingsOf the almost one third (30.9%) of certified nurse‐midwives and certified midwives who responded to the survey, 40.6% met criteria for burnout. Weak negative correlations existed between burnout and indicators of career longevity: age (r(2256) = −0.09, p < 0.01), years as a midwife (r(2267) = −0.07, p = 0.01), and years with employer (r(2271) = −0.05, p = 0.02). There were significant relationships between burnout score and patient workload indicators: patients per day in outpatient setting (F(5,2292) = 13.995, p < 0.01), birth volume (F(3,1864) = 8.35, p < 0.01), and patient acuity (F(2,2295) = 20.21, p < 0.01). When the practice environment was entered into the model with personal and practice characteristics, the explained variance increased from 6.4% to 26.5% (F(20,1478) = 27.98, p < 0.01).ConclusionsOur findings suggested that a key driver of burnout among US midwives was the practice environment, specifically practice leadership and participation and support for the midwifery model of care. Structural and personal characteristics contributed less to burnout score than the practice environment, implying that prevention of burnout may be achieved through organizational support and does not require structural changes to the provision of perinatal health.     

Health and happiness: cross-sectional household surveys in Finland,Poland and Spain

Objective

To explore the associations between health and how people evaluate and experience their lives.

Methods

We analysed data from nationally-representative household surveys originally conducted in 2011–2012 in Finland, Poland and Spain. These surveys provided information on 10 800 adults, for whom experienced well-being was measured using the Day Reconstruction Method and evaluative well-being was measured with the Cantril Self-Anchoring Striving Scale. Health status was assessed by questions in eight domains including mobility and self-care. We used multiple linear regression, structural equation models and multiple indicators/multiple causes models to explore factors associated with experienced and evaluative well-being.

Findings

The multiple indicator/multiple causes model conducted over the pooled sample showed that respondents with younger age (effect size, β = 0.19), with higher levels of education (β = −0.12), a history of depression (β = −0.17), poor health status (β = 0.29) or poor cognitive functioning (β = 0.09) reported worse experienced well-being. Additional factors associated with worse evaluative well-being were male sex (β = −0.03), not living with a partner (β = 0.07), and lower occupational (β = −0.07) or income levels (β = 0.08). Health status was the factor most strongly correlated with both experienced and evaluative well-being, even after controlling for a history of depression, age, income and other sociodemographic variables.

Conclusion

Health status is an important correlate of well-being. Therefore, strategies to improve population health would also improve people’s well-being.     

Appropriateness of COVID-19 public health guidelines for an Alberta First Nations community

ObjectivesThe First Nations people experience significant challenges that may influence the ability to follow COVID-19 public health directives on-reserve. This study aimed to describe experiences, perceptions and circumstances of an Alberta First Nations community, related to COVID-19 public health advice. We hypothesized that many challenges ensued when following and implementing advice from public health experts.MethodsWith First Nations leadership and staff, an online cross-sectional survey was deployed between April 24 and June 25, 2020. It assessed the appropriateness of public health advice to curb COVID-19 within this large First Nations community. Both quantitative and qualitative data were captured and described.ResultsA total of 106 adults living on-reserve responded; over 80% were female. Difficulty accessing food was significant by employment status (p = 0.0004). Those people with lower income found accessing food (p = 0.0190) and getting essential medical care (p = 0.0060), clothing (p = 0.0280) and transportation (p = 0.0027) more difficult. Some respondents described lost income associated with COVID-19 experiences, as well as difficulties accessing essential supplies. Respondents found “proper handwashing” most easy (98%) and “keeping a distance of 2 m from others” most difficult (23%). Many respondents found following public health advice within their personal domain easy and put “family safety” first but experienced some difficulties when navigating social aspects and obligations, particularly when unable to control the actions of others. People stated wanting clear information, but were sometimes critical of the COVID-19 response.ConclusionFirst Nations people face many additional challenges within the COVID-19 response, driven in part by ongoing issues related to significant societal, economic, and systemic factors.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00579-4.     

Household- and employment-related risk factors for depressive symptoms during the COVID-19 pandemic

ObjectivesThe COVID-19 pandemic has generated multiple psychological stressors, which may increase the prevalence of depressive symptoms. Utilizing Canadian survey data, this study assessed household- and employment-related risk factors for depressive symptoms during the pandemic.MethodsA sample of 1005 English-speaking Canadian adults aged 18+ years completed a web-based survey after physical distancing measures were implemented across Canada. Hierarchical binary logistic regression analyses were conducted to examine the associations of depressive symptoms with household- (household size, presence of children, residence locale) and employment-related (job with high risk of COVID-19 exposure, working from home, laid off/not working, financial worry) risk factors, controlling for demographic factors (gender, age, education, income).ResultsAbout 20.4% of the sample reported depressive symptoms at least 3 days per week. The odds of experiencing depressive symptoms 3+ days in the past week were higher among women (AOR = 1.67, p = 0.002) and younger adults (18–29 years AOR = 2.62, p < 0.001). After adjusting for demographic variables, the odds of experiencing depressive symptoms were higher in households with 4+ persons (AOR = 1.88, p = 0.01), in households with children aged 6 to 12 years (AOR = 1.98, p = 0.02), among those with a job at high risk for exposure to COVID-19 (AOR = 1.82, p = 0.01), and those experiencing financial worry due to COVID-19 (‘very worried’ AOR = 8.00, p < 0.001).ConclusionPandemic responses must include resources for mental health interventions. Additionally, further research is needed to track mental health trajectories and inform the development, targeting, and implementation of appropriate mental health prevention and treatment interventions.     

Weight bias and support of public health policies

ObjectivesPublic health policies have been proposed to help address prevalent Canadian obesity rates. Along with the increase in obesity prevalence, explicit weight bias is also rampant in Western society. This paper aimed to assess the association between explicit weight bias attitudes and Canadian public support of these policy recommendations.MethodsCanadian adults (N = 903; 51% female; BMI = 27.3 ± 7.0 kg/m²) completed an online survey measuring explicit weight bias, using the three subscales of the Anti-Fat Attitudes Questionnaire: Willpower (belief in weight controllability), Fear of fat (fear of gaining weight), and Dislike (antipathy towards people with obesity). Whether these subscales were associated with policy support was assessed with logistic regression. Analyses were adjusted for age, race, gender, and income.ResultsPublic support of policy recommendations ranged from 53% to 90%. Explicit weight bias was primarily expressed through a fear of weight gain and the belief that weight gain was within the individual’s control based on willpower. Although the Dislike subscale was associated with lower support for several policies that enable or guide individual choice in behaviour change, the Willpower and Fear of fat subscales were associated with greater support for similar policies.ConclusionThis study contributes to evidence-informed public health action by describing public support of public health policies and demonstrating an association between explicit weight bias and public support. A higher total explicit weight bias score increased the odds of supporting primarily less intrusive policies. However, dislike of individuals with obesity was associated with decreased odds of supporting many policies.     

Neighborhood-Based Socioeconomic Position and Risk of Oral Clefts Among Offspring

Objectives. We determined the association between maternal neighborhood socioeconomic position (SEP) and the risk of cleft lip with or without cleft palate (CL±P) or cleft palate alone (CP) in offspring.Methods. We obtained information on CL±P (n = 2555) and CP (n = 1112) cases and unaffected controls (n = 14 735) among infants delivered during 1999 to 2008 from the Texas Birth Defects Registry. Neighborhood SEP variables, drawn from the 2000 US Census, included census tract-level poverty, education, unemployment, occupation, housing, and crowding, from which we created a composite neighborhood deprivation index (NDI). We used mixed-effects logistic regression to evaluate neighborhood SEP and oral clefts.Results. Mothers with CL±P-affected offspring were more likely to live in high-NDI (adverse) areas than mothers with unaffected offspring (odds ratio [OR] = 1.20, 95% confidence interval [CI] = 1.05, 1.37). This association was strongest among Hispanic mothers (OR = 1.32, 95% CI = 1.07, 1.62). No associations were observed with CP.Conclusions. Using data from one of the world’s largest active surveillance birth defects registries, we found that adverse neighborhood SEP is modestly associated with CL±P, especially among Hispanics. These findings may have important implications for health disparities prevention.Birth defects are the leading cause of infant mortality in the United States,1 and more than 65% are of unknown origin.2 Oral clefts are among the most common of these conditions, occurring in approximately 1.7 per 1000 live births in the United States.3 Oral clefts are complex structural malformations of the oral cavity, the lips, or both and include cleft lip with or without cleft palate (CL±P) and cleft palate alone (CP). Children with oral clefts have deficits in speech, hearing, and cognition, and they have higher morbidity and mortality throughout life compared with their unaffected contemporaries.4 Despite their frequency and clinical importance, little is known about the etiologies of CL±P and CP, and there are currently few strategies for reducing their prevalence.Although some cases of CL±P and CP occur in association with known genetic syndromes, approximately 80% are nonsyndromic.5 Previous studies of nonsyndromic oral clefts have identified only a few confirmed risk factors, including family history and specific genes or chromosome regions (e.g., IRF6 and 8q24),6,7 infant race/ethnicity and sex,8 maternal smoking during pregnancy,9 lack of maternal multivitamin use in early pregnancy,10 and maternal use of antiepileptic drugs or folic acid antagonists during pregnancy.11 Because these factors do not account for the majority of oral cleft risk,4 studies aimed at identifying novel risk factors or confirming suspected risk factors are strongly warranted.One factor that requires additional attention is neighborhood socioeconomic position (SEP). Neighborhood SEP is a measure of community-level social status, and although it is often correlated with individual SEP, there is evidence that neighborhood SEP captures aspects of health disparities missed by individual-level measures and may be an independent risk factor for health outcomes.12–14 For example, neighborhood SEP may account for physical and social environments that may have an impact on health outcomes.14 Several studies have demonstrated an association between individual SEP and oral clefts;15–17 however, studies evaluating neighborhood SEP and oral clefts have yielded inconsistent findings.18–20 Therefore, we evaluated the association between neighborhood SEP factors and the risk of CL±P and CP among offspring in Texas for the period of 1999 to 2008 using a large sample of oral cleft cases identified from the Texas Birth Defects Registry, one of the largest population-based birth defects registries in the world. The unique Texas population allowed for the independent assessment of Hispanic mothers. In addition, we used statistical methods to account for group-level variables.     

Examining weather-related factors on physical activity levels of children from rural communities

ObjectiveThe objective was to examine the influence of weather on moderate-to-vigorous physical activity (MVPA) and light physical activity (LPA) levels of children aged 8–14 years from rural communities, an understudied Canadian population.MethodsChildren (n = 90) from four communities in rural Northwestern Ontario participated in this study between September and December 2016. Children’s MVPA and LPA were measured using an Actical accelerometer and demographic data were gathered from surveys of children and their parents. Weather data were collected from the closest weather station. Cross-classified regression models were used to assess the relationship between weather and children’s MVPA and LPA.ResultsBoys accumulated more MVPA than girls (b = 26.38, p < 0.01), children were more active on weekdays as compared with weekends (b = − 16.23, p < 0.01), children were less active on days with precipitation (b = − 22.88, p < 0.01), and higher temperature led to a significant increase in MVPA (b = 1.33, p  < 0.01). As children aged, they accumulated less LPA (b = − 9.36, p < 0.01) and children who perceived they had higher levels of physical functioning got more LPA (b = 25.18, p = 0.02). Similar to MVPA, children had higher levels of LPA on weekdays (b = − 37.24, p < 0.01) as compared to weekend days and children accumulated less LPA (b = −50.01, p < 0.01) on days with rain.ConclusionThe study findings indicate that weather influences rural children’s MVPA and LPA. Future research is necessary to incorporate these findings into interventions to increase rural children’s overall PA levels and improve their overall health.Electronic supplementary materialThe online version of this article (10.17269/s41997-020-00324-3) contains supplementary material, which is available to authorized users.     

Job Strain and Health-Related Lifestyle: Findings From an Individual-Participant Meta-Analysis of 118?000 Working Adults

Objectives. We examined the associations of job strain, an indicator of work-related stress, with overall unhealthy and healthy lifestyles.Methods. We conducted a meta-analysis of individual-level data from 11 European studies (cross-sectional data: n = 118 701; longitudinal data: n = 43 971). We analyzed job strain as a set of binary (job strain vs no job strain) and categorical (high job strain, active job, passive job, and low job strain) variables. Factors used to define healthy and unhealthy lifestyles were body mass index, smoking, alcohol intake, and leisure-time physical activity.Results. Individuals with job strain were more likely than those with no job strain to have 4 unhealthy lifestyle factors (odds ratio [OR] = 1.25; 95% confidence interval [CI] = 1.12, 1.39) and less likely to have 4 healthy lifestyle factors (OR = 0.89; 95% CI = 0.80, 0.99). The odds of adopting a healthy lifestyle during study follow-up were lower among individuals with high job strain than among those with low job strain (OR = 0.88; 95% CI = 0.81, 0.96).Conclusions. Work-related stress is associated with unhealthy lifestyles and the absence of stress is associated with healthy lifestyles, but longitudinal analyses suggest no straightforward cause–effect relationship between work-related stress and lifestyle.Behavior-related modifiable health risk factors, such as smoking and physical inactivity, are major contributors to the noncommunicable disease burden and mortality worldwide.1 These factors tend to cluster at the population level, with some people having multiple health risk factors (an overall unhealthy lifestyle) and others having multiple health-promoting factors (an overall healthy lifestyle)2,3; the causes of this clustering are not well understood, however. Work-related psychosocial stress may be one (possibly modifiable) factor influencing or contributing to adoption or maintenance of a healthy or unhealthy lifestyle. For instance, some people who experience stress may not find time to exercise or eat a healthy diet, or they may attempt to alleviate stress by smoking or drinking excessive amounts of alcohol, whereas others may choose healthy behaviors (e.g., exercise) as a way of coping with stress.4Work and workplace-related issues are common sources of stress. A better understanding of the association between work-related stress and overall health-related lifestyle is important because there is evidence from studies of cardiovascular diseases and cancer that combinations of lifestyle risk factors may induce larger risks of adverse health outcomes than the sum of the separate effects of the same factors2,5–7; there is also evidence that the co-occurrence of multiple healthy lifestyle factors has a protective effect against many diseases, including stroke and cancer.8–10 Psychosocial stress at work has been shown to be associated with individual unhealthy lifestyle factors such as smoking,11–14 heavy alcohol consumption,15–17 physical inactivity,18–21 and obesity.22–26 However, the relationship between work-related stress and the co-occurrence of healthy and unhealthy lifestyle factors remains poorly understood.We investigated the associations of work-related psychosocial stress, operationalized as job strain, with overall healthy and unhealthy lifestyles, operationalized as the co-occurrence of unhealthy and healthy lifestyle factors. We hypothesized that the association between job strain and health-related lifestyles would be stronger than the association between job strain and each individual unhealthy lifestyle factor. To examine these issues, we conducted a meta-analysis of data from 11 prospective European cohort studies.     

Prevalence and factors associated with undernutrition and anaemia among school children in Durbete Town,northwest Ethiopia

Background

Information about risk factors of undernutrition and anaemia is useful to design appropriate strategies to control the health problems. In this study, the prevalence and factors associated with undernutrition and anaemia were assessed among school children in Abchikeli and Ayalew Mekonnen Elementary Schools, northwest Ethiopia, in February and March 2010.

Methods

A cross-sectional study was carried out among 384 school children. Stool samples were examined using single Kato-Katz slide and nutritional status was determined using anthropometry technique. A pre-tested standardized questionnaire was used to gather information on the socio-demographic and the socio-economic status of the school children. Multivariate logistic regression analysis was used to quantify the association of intestinal helminth infection and socio-demographic and socio-economic factors with undernutrition and anaemia.

Results

Out of 384 children examined, 32.3 % were undernourished (27.1 % underweight and 11.2 % stunted) and 10.7 % were anaemic. The odds of stunting were approximately seven times higher in children of ages 10 to 14 [Adjusted Odds Ratio (AOR) = 6.93, 95 % CI = 2.60, 18.46] and 2.5 times higher in males [AOR = 2.50, 95 % CI = 1.24, 5.07] than children of ages 5 to 9 and females, respectively. The odds of underweight was three times higher in children who did not wash their hands before eating compared to those who did wash their hands [AOR = 3.13, 95 % CI = 1.19, 8.17]. The chance of anaemia was nine times higher in children who were infected with hookworms compared to those who were not infected with any helminth species [AOR = 8.87, 95 % CI = 2.28, 34.58]. The odds of being undernourished and anemic were similar among children with different socio-economic status.

Conclusions

Undernutrition and anaemia are public health problems of school-age children in Durbete Town. Health education and provision of additional food supplements would be important to reduce the problem of undernutrition among school-age children in the town. Deworming of children in the town would also have additional impact on reducing the level of anaemia.     

Social Competence and Obesity in Elementary School

Objectives. We examined the relationship between children’s weight and social competence.Methods. We used data from the third- and fifth-grade waves of the nationally representative Early Childhood Longitudinal Study, Kindergarten Class of 1998–1999 (n = 8346) to examine changes in children’s weight and social competence.Results. Obesity in third grade was not associated with subsequent changes in social competence between third and fifth grade, but social competence in third grade was associated with subsequent development of obesity. Among normal-weight children, having higher social competence in third grade was associated with lower odds of becoming overweight (odds ratio [OR] = 0.80 ±0.09; P < .05) or obese (OR = 0.20 ±0.08; P < .001). In addition, obese children with higher social competence were more likely to lose weight between third and fifth grade (OR = 1.43 ±0.25; P < .05).Conclusions. Obesity and impaired social competence often occur together and have serious implications for children''s well-being. More knowledge about how weight and social competence affect one another could inform interventions to promote children’s social development and reduce obesity.Nearly one third of US children are overweight or obese.1 Previous studies have observed greater victimization and exclusion among obese children2–4 and negative social and emotional consequences of such treatment from peers, including low self-esteem and depression.5–9 Despite these documented links between obesity and impaired social well-being, little is known about the relationship between obesity and social competence—the set of skills and behaviors necessary for appropriate and positive social interaction. It may be that obese children, who endure significantly more teasing and victimization by their peers,2,10 are at a disadvantage in developing the appropriate self-confidence necessary for social competence. At the same time, it may be that low social competence increases risk of obesity, because unhealthy behaviors may result from social stress and social isolation.11–14     

Unequal coverage of nutrition and health interventions for women and children in seven countries

ObjectiveTo examine inequalities and opportunity gaps in co-coverage of health and nutrition interventions in seven countries.MethodsWe used data from the most recent (2015–2018) demographic and health surveys of mothers with children younger than 5 years in Afghanistan (n = 19 632), Bangladesh (n = 5051), India (n = 184 641), Maldives (n = 2368), Nepal (n = 3998), Pakistan (n = 8285) and Sri Lanka (n = 7138). We estimated co-coverage for a set of eight health and eight nutrition interventions and assessed within-country inequalities in co-coverage by wealth and geography. We examined opportunity gaps by comparing coverage of nutrition interventions with coverage of their corresponding health delivery platforms.FindingsOnly 15% of 231 113 mother–child pairs received all eight health interventions (weighted percentage). The percentage of mother–child pairs who received no nutrition interventions was highest in Pakistan (25%). Wealth gaps (richest versus poorest) for co-coverage of health interventions were largest for Pakistan (slope index of inequality: 62 percentage points) and Afghanistan (38 percentage points). Wealth gaps for co-coverage of nutrition interventions were highest in India (32 percentage points) and Bangladesh (20 percentage points). Coverage of nutrition interventions was lower than for associated health interventions, with opportunity gaps ranging from 4 to 54 percentage points.ConclusionCo-coverage of health and nutrition interventions is far from optimal and disproportionately affects poor households in south Asia. Policy and programming efforts should pay attention to closing coverage, equity and opportunity gaps, and improving nutrition delivery through health-care and other delivery platforms.     

Greater chronic morbidity is associated with greater fatigue in six countries: A case of evolutionary mismatch?

Background and objectivesHuman susceptibility to chronic non-communicable disease may be explained, in part, by mismatches between our evolved biology and contemporary environmental conditions. Disease-induced fatigue may function to reduce physical activity during acute infection, thereby making more energy available to mount an effective immune response. However, fatigue in the context of chronic disease may be maladaptive because long-term reductions in physical activity increase risks of disease progression and the acquisition of additional morbidities. Here, we test whether cumulative chronic morbidity is associated with subjective fatigue.MethodologyWe constructed a cumulative chronic morbidity score using self-reported diagnoses and algorithm-based assessments, and a subjective fatigue score based on four questionnaire items using cross-sectional survey data from the Study on global AGEing and adult health, which features large samples of adults from six countries (China, Ghana, India, Mexico, Russia and South Africa).ResultsIn a mixed-effects linear model with participants nested in countries (N = 32 455), greater cumulative chronic morbidity is associated with greater subjective fatigue (β = 0.34, SE = 0.005, P < 2e−16). This association replicates within each country and is robust to adjustment for key sociodemographic and physical covariates (sex, age, household wealth, physical function score, habitual physical activity, BMI and BMI²).Conclusions and implicationsFatigue is a common but perhaps maladaptive neuropsychological response to chronic morbidity. Disease-induced fatigue may mediate a self-perpetuating cycle, in which chronic morbidity reduces physical activity, and less physical activity increases cumulative chronic morbidity. Longitudinal research is needed to test whether chronic morbidity, fatigue and physical activity form a cyclical feedback loop. Lay Summary: Fatigue during acute illness may promote recovery, but persistent fatigue in the context of chronic disease may make matters worse. We present evidence from six countries that more chronic disease is associated with more fatigue. This fatigue may reduce physical activity, which increases risks of acquiring additional chronic health problems.     

The effects of a mobile application for patient participation to improve patient safety

BackgroundPatient participation in patient safety activities in care processes is a fundamental element of safer care. Patients play an important role in preventing patient safety incidents and improving health outcomes. Therefore, healthcare providers need to develop and provide educational materials and actionable tools for patient participation.ObjectivesThis study aimed to develop a mobile application for health consumers'' participation and evaluate the effect of the mobile application on improving health consumers'' participation in patient safety.MethodsA quasi‐experimental design was adopted. We developed a mobile application on the basis of a needs assessment, literature review, compilation of patient safety topics, and validity testing of the application. The target population included Korean adults aged between 30 and 65 years who had visited a medical institution more than once within the most recent 6 months. The intervention group received patient participation training by using the mobile application, Application for Patient Participation in Safety Enhancement, for 2 months. The primary outcome variables were patient safety knowledge, self‐efficacy of participation, willingness to participate and experience of patient participation in patient safety activities. End‐user satisfaction was assessed using a questionnaire. To assess participants'' experiences with the intervention, qualitative data were collected through a focus group interview and open‐ended responses to an end‐user satisfaction survey.ResultsThe intervention group (n = 60) had significantly higher overall average scores than the control group (n = 37) with regard to patient safety knowledge (p < .001), self‐efficacy of participation (p = .001), willingness to participate (p = .010) and experience of participation (p = .038) in the post‐survey. The total mean end‐user satisfaction score was 3.56 ± 0.60. The participants expressed the realization that patients could play an important role in improving patient safety.ConclusionsThis study demonstrated that educating health consumers through a mobile application with useful information improves patient participation in patient safety activities. Educational materials and patient participation tools could motivate health consumers'' health‐related behaviours.Patient or Public ContributionPatients were involved during the programme development and evaluation.     

Giving to Others and the Association Between Stress and Mortality

Objectives. We sought to test the hypothesis that providing help to others predicts a reduced association between stress and mortality.Methods. We examined data from participants (n = 846) in a study in the Detroit, Michigan, area. Participants completed baseline interviews that assessed past-year stressful events and whether the participant had provided tangible assistance to friends or family members. Participant mortality and time to death was monitored for 5 years by way of newspaper obituaries and monthly state death-record tapes.Results. When we adjusted for age, baseline health and functioning, and key psychosocial variables, Cox proportional hazard models for mortality revealed a significant interaction between helping behavior and stressful events (hazard ratio [HR] = 0.58; P < .05; 95% confidence interval [CI] = 0.35, 0.98). Specifically, stress did not predict mortality risk among individuals who provided help to others in the past year (HR = 0.96; 95% CI = 0.79, 1.18), but stress did predict mortality among those who did not provide help to others (HR = 1.30; P < .05; 95% CI = 1.05, 1.62).Conclusions. Helping others predicted reduced mortality specifically by buffering the association between stress and mortality.In a seminal review published more than 20 years ago, House et al. described the strong association between social connections and physical health.1 The researchers concluded that socially isolated people, compared with those with strong social ties, were at substantially increased risk of mortality and morbidity. In fact, the magnitude of the association between social isolation and mortality was comparable to that for high blood pressure, smoking, and sedentary lifestyle, even after statistical controls for other known risk factors such as baseline health. Despite the robustness of this effect, it remains unclear what aspects of the social environment influence physical health outcomes.One hypothesized link between social connections and health is that the social support people receive from their network of friends and loved ones may “buffer” against the detrimental physical consequences of psychosocial stress.2,3 Indeed, stressful life events have long been established to be a predictor of increased mortality risk.4,5 However, the social support hypothesis has not been consistently supported in empirical studies. Although some empirical studies suggest health benefits of received social support—and at least 1 indicates that these benefits accrue via stress buffering6—a meta-analytic review concluded that the overall relationship between receiving support and health outcomes “may not be considered significant or generalizable.”^7(p352) This may be why House, in 2001, concluded that after nearly 2 decades of empirical work, very little is known about how social connectivity, as opposed to isolation, translates into physical health outcomes.8The failure of the social support hypothesis to account for the links between social connectedness and health8 has prompted research on whether health may be associated with the other side of social interactions—namely, the provision of help and support to others. Providing help to others appears to promote the helper’s health, even when there is statistical control for plausible confounds such as baseline physical health and functioning or receiving support from others. For example, volunteering predicts increased self-rated health and longevity.9–13 In a similar way, providing aid to a relationship partner predicts reduced morbidity and mortality.14–16Given the robust associations between support provision and health, it is possible that support provision may have stress-buffering effects even if the receipt of support does not. To date, health research has not explicitly tested this hypothesis; however, providing help to others has psychological and physiological correlates that may buffer against stress. For example, helping leads to improved mood,17,18 which itself may act as a stress buffer.19 In addition, caring for loved ones, in particular, may draw on the functioning of neural and hormonal mechanisms that support parenting behavior20–22—that is, the caregiving behavioral system.23,24 Several hormones and neurochemicals associated with the caregiving system, including oxytocin, prolactin, and endogenous opioids, have known stress-reducing effects.20,25–29Laboratory and field studies provide preliminary evidence consistent with the prediction that providing help or support may act as a physiological stress buffer. Communicating affection to a relationship partner has been shown to predict reduced perceived stress, lowered baseline cortisol levels,30,31 and faster recovery from peak cortisol levels following lab stressors.32 In a similar way, experimentally manipulated helping predicts reduced cardiovascular reactivity to and faster cardiovascular recovery from laboratory stressors (written communication from Stephanie L. Brown, October 3, 2008). In addition, field studies indicate that engaging in helping behavior may buffer the effects of stress-related constructs on health-related outcomes. For example, engaging in helping behavior versus not doing so predicts lessened associations between grief and subsequent depression,33 financial difficulties and mortality,34 and functional limitations and mortality.35Research to date has not specifically examined whether providing help or support to others can buffer the associations between psychosocial stress and physical health outcomes. We sought to do so by using survey data from the Changing Lives of Older Couples (CLOC) study. The CLOC data set included 5-year survival data on a sample of 846 older adults along with baseline measures of helping, past-year stressful events, and potential confounds (e.g., demographic and socioeconomic factors, baseline health and well-being, personality, and social support receipt), allowing for a test of the stress-buffering role of prosocial behavior. We hypothesized that exposure to a recent stressful life event would moderate the association between helping behavior and mortality and vice versa. That is, we predicted that helping behavior would most strongly predict reduced mortality among individuals exposed to significant stress compared with those not exposed.