Correlates of HIV Risk Behaviors Among Homeless and Unstably Housed Young Adults

Objectives

Homeless young adults are exposed to multiple risk factors for HIV infection. We identified HIV risk behaviors and their correlates among homeless young adults in Portland, Oregon.

Methods

We conducted a community-based, cross-sectional survey of HIV risk behaviors among homeless young adults aged 18–25 years in 2010. Participants completed three study components: (1) an interviewer-administered survey of HIV risk behaviors; (2) a brief, client-centered HIV risk-based counseling session; and (3) rapid HIV testing.

Results

Among 208 participants, 45.8% identified as racial/ethnic minority groups, 63.8% were male, and 35.7% self-identified as nonheterosexual. Six participants, all from sexual minority groups, had positive HIV screening results (two newly identified, four previously known) for a seropositivity rate of 2.9%. Female sex, belonging to a sexual minority group, frequent traveling between cities, depression, and alcohol use to intoxication were significantly associated with unprotected sex in univariate analysis. Female sex and high perceived risk of HIV were significantly associated with unprotected sex in multivariate analysis.

Conclusions

Our findings support the need for enhanced HIV prevention interventions for homeless young adults.In the Portland, Oregon, metropolitan area, an estimated 1,500–2,000 homeless young people are living on the street (Personal communication, Caitlin Campbell, Homeless Youth Continuum Coordinator, Multnomah County, Oregon, July 2009). Young adults and adolescents are at particularly high risk of human immunodeficiency virus (HIV) infection. In 2008, the Centers for Disease Control and Prevention (CDC) reported that 13% of all new HIV infections in the U.S. occur among people aged 13–24 years.¹ Statistical modeling estimates that approximately half of HIV infections in the U.S. occur before 25 years of age.² The young adult years are accompanied by escalating risk due to sexual contact and initiation of drug use in certain populations.Homeless young people live at the intersection of multiple risk factors and are especially at risk for HIV infection. Up to 35% of homeless young people identify as gay, lesbian, bisexual, or transgender.^3–6 Homeless populations frequently exchange sex for money, drugs, or a place to stay;⁷ have high rates of substance use;⁸ and experience substantial unmet needs for multiple types of health care,⁹ further increasing their risk for HIV infection. Mental illness, such as depression, has been shown to be associated with infrequent condom usage among homeless adolescents in the U.S. Pacific Northwest.¹⁰ In 1994, Allen et al. reported findings from a 16-city CDC-sponsored seroprevalence study that showed an HIV prevalence of 2.3% among runaway young people aged 15–24 years and 3.4% among homeless adults.¹¹ More recent studies demonstrate HIV prevalence proportions of 5%–16% among homeless adolescents and young adults.^12,13An updated account of HIV prevalence among homeless young adults is essential to inform HIV prevention programs, reduce HIV transmission by educating about behaviors that put people at risk for infection, and connect affected people with resources. Additionally, little is known about current risk-taking behaviors among homeless young adults. The purpose of this study was to identify HIV risk behaviors and their correlates among homeless young adults in the Portland, Oregon, metropolitan area.     

Sexting Among Young Adults

PurposeSexting has stirred debate over its legality and safety, but few researchers have documented the relationship between sexting and health. We describe the sexting behavior of young adults in the United States, and examine its association with sexual behavior and psychological well-being.MethodsUsing an adapted Web version of respondent-driven sampling, we recruited a sample of U.S. young adults (aged 18–24 years, N = 3,447). We examined participant sexting behavior using four categories of sexting: (1) nonsexters, (2) receivers, (3) senders, and (4) two-way sexters. We then assessed the relationships between sexting categories and sociodemographic characteristics, sexual behavior, and psychological well-being.ResultsMore than half (57%) of the respondents were nonsexters, 28.2% were two-way sexters, 12.6% were receivers, and 2% were senders. Male respondents were more likely to be receivers than their female counterparts. Sexually active respondents were more likely to be two-way sexters than non–sexually active ones. Among participants who were sexually active in the past 30 days, we found no differences across sexting groups in the number of sexual partners or the number of unprotected sex partners in the past 30 days. We also found no relationship between sexting and psychological well-being.ConclusionsOur results suggest that sexting is not related to sexual risk behavior or psychological well-being. We discuss the findings of this study and propose directions for further research on sexting.     

Systematic Review of Easy-to-Learn Behavioral Interventions for Dietary Changes Among Young Adults

IntroductionImproving the diet quality of young adults may support chronic disease prevention. The approaches used and efficacy of promoting small dietary behavior changes through easy-to-learn (ETL) interventions (requiring no more than 1 hour to teach the behavior) among young adults have not yet been systematically reviewed.MethodsFollowing Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 2 independent electronic searches across 6 databases were conducted to identify any articles describing ETL interventions among young adults (aged 18–35 years) and reporting dietary intake outcomes.ResultsAmong 9,538 articles identified, 9 studies met eligibility criteria. Five studies reported significant improvement in the selected dietary outcome. Of these, 3 studies used an implementation intentions approach, in which participants were given or asked to write out a simple dietary behavior directive and carry it on their person. Less than half of included studies were rated as positive for overall quality.DiscussionThe available evidence suggests that ETL interventions targeting the dietary behaviors of young adults may be effective in improving dietary intake. Limitations of included studies were lack of follow-up after the intervention period and low generalizability.Implications for Research and PracticeFurther dietary intervention studies targeting young adults should systematically evaluate the efficacy of ETL intervention approaches among diverse samples.     

Using Encoding and Retrieval Strategies to Improve 24-hour Dietary Recalls Among Older Adults

Objective To examine whether using an encoding strategy and/or providing more support at the time of retrieval improves the accuracy of 24-hour dietary recalls among the elderly.Design Posttest-only control group design.Setting The sample was recruited through advertisements and at senior centers and a low-income apartment building in rural central Pennsylvania.Subjects Study participants were 21 men and 73 women aged 58 years old and older. Everyone completed the study.Intervention The treatment group was unobtrusively guided in use of an encoding strategy before consuming the prepared meal.Main outcome measures A 24-hour dietary recall and recognition tests were administered the next day for the foods consumed at the meal and for serving sizes of 5 of the foods. Memory tests were also administered.Statistical analyses performed Linear regression was used to examine differences between the treatment and control groups and to identify variables that explained variation in the number of foods correctly recalled or recognized. The χ² test was used to examine correct vs incorrect recall or recognition of the serving sizes of the 5 foods between the groups and to identify explanatory variables for this task.Results Subjects remembered more foods when they used an encoding strategy and when recognition replaced free recall; they performed best when both strategies were used. Use of this encoding strategy did not improve accurate recall or recognition of serving sizes of 5 foods; however, performances did improve when recognition replaced free recall.Conclusions Among older adults, use of an encoding strategy and provision of support at the time of retrieval enhances memory of foods consumed but not of amounts consumed. To strengthen memory of foods consumed, older adults need to perform effortful memory tasks when they are eating. J Diet Assoc. 1998;98:989-994.     

Impact of Denture Usage Patterns on Dietary Quality and Food Avoidance Among Older Adults

This study categorizes older adults living in rural areas by denture status, assesses the frequency of wearing dentures during meals, and determines whether denture status or use is associated with dietary quality or the number of foods avoided. A multi-ethnic population-based sample of adults ≥60 years (N = 635) in the rural United States was interviewed. Survey included denture use, removing dentures before eating, and foods avoided due to oral health problems. Dietary intakes were converted into Healthy Eating Index-2005 scores. Sixty percent wore removable dentures of some type; 55% never, 27% sometimes, and 18% always removed dentures when eating. More frequent removal was associated with lower dietary quality and more foods avoided. Those with severe tooth loss had the lowest dietary quality and avoided the most foods. Many rural older adults wear dentures. Learning how they adapt to denture use will offer insight into their nutritional self-management and help explain differences in dietary quality.     

Universal Family-Focused Intervention with Young Adolescents: Effects on Health-Risking Sexual Behaviors and STDs Among Young Adults

Considering the prevalence and consequences of health-risking sexual behaviors (HRSBs) and STDs among young adults, their prevention is a public health priority. Emerging etiological and prevention outcome literatures suggested study of the long-term effects of universal family-focused interventions on young adult HRSBs and STDs. Although earlier studies have demonstrated intervention impact on adolescent substance misuse, no study has examined universal family-focused intervention effects on young adult HRSBs and STDs via reductions in adolescent misuse. Sixth grade students and their families enrolled in 33 rural Midwestern schools were randomly assigned to experimental conditions. Self-report questionnaires provided data at pretest (Ns?=?238, 221, and 208 for the Iowa Strengthening Families Program [ISFP], Preparing for the Drug Free Years [PDFY], and control groups, respectively), with seven data points through young adulthood (age 21). In latent growth modeling, three young adult HRSB measures (number of sexual partners, condom use, substance use with sex) and lifetime STDs were specified as distal outcomes mediated by adolescent substance initiation growth factors (average level and rate of change). Results showed that the models fit the data and, except for condom use, there were significant indirect effects, with a higher frequency of significant findings for ISFP. The model additions of direct intervention effects on young adult outcomes generally were not supported, consistent with a model positing that long-term intervention effects on young adult HRSBs and STDs outcomes are indirect. As an indication of the practical significance of long-term effects, analyses revealed relative reduction rates ranging from 6 % to 46 % for significant outcomes.     

Universal Family-Focused Intervention with Young Adolescents: Effects on Health-Risking Sexual Behaviors and STDs Among Young Adults

Considering the prevalence and consequences of health-risking sexual behaviors (HRSBs) and STDs among young adults, their prevention is a public health priority. Emerging etiological and prevention outcome literatures suggested study of the long-term effects of universal family-focused interventions on young adult HRSBs and STDs. Although earlier studies have demonstrated intervention impact on adolescent substance misuse, no study has examined universal family-focused intervention effects on young adult HRSBs and STDs via reductions in adolescent misuse. Sixth grade students and their families enrolled in 33 rural Midwestern schools were randomly assigned to experimental conditions. Self-report questionnaires provided data at pretest (Ns = 238, 221, and 208 for the Iowa Strengthening Families Program [ISFP], Preparing for the Drug Free Years [PDFY], and control groups, respectively), with seven data points through young adulthood (age 21). In latent growth modeling, three young adult HRSB measures (number of sexual partners, condom use, substance use with sex) and lifetime STDs were specified as distal outcomes mediated by adolescent substance initiation growth factors (average level and rate of change). Results showed that the models fit the data and, except for condom use, there were significant indirect effects, with a higher frequency of significant findings for ISFP. The model additions of direct intervention effects on young adult outcomes generally were not supported, consistent with a model positing that long-term intervention effects on young adult HRSBs and STDs outcomes are indirect. As an indication of the practical significance of long-term effects, analyses revealed relative reduction rates ranging from 6 % to 46 % for significant outcomes.

     

Whole Grain Nutrition Education Program Improves Whole Grain Knowledge and Behaviors Among Community-Residing Older Adults

U.S. older adults are not meeting the recommendation for whole grain (WG) intake. This pilot study determined the influence that a WG nutrition education program for community-residing adults aged 60?+?years has on WG knowledge and behaviors. The program included WG education and discussion, participation in hands-on activities and taste testing. Participants were mostly white, females. Total grain and WG dietary intake frequencies (WG frequency; p?≤?0.001), and “knowledge score” increased from PRE to POST (p?≤?0.001). Participants in PowerPoint-based classes had a higher “knowledge scores” at POST (p?=?0.002). Nearly all (n?=?139, 88.5%) intended to eat more WG foods, with almost two-thirds (n?=?93, 59.3%) reporting a “strong” intention to do so. There was a positive association between strength of intention to eat WG foods and “WG frequency” at POST (r?=?0.435, p?≤?0.001). Results suggest that this WG program is an effective strategy for improving WG knowledge and behaviors among older adults.     

Sweetener Preference Among Non-Institutionalized Older Adults

The purpose of this study is to determine the ability of a group of older adults to distinguish between a new artificial sweetener (Sweet OneR) and sucrose and to determine a sweetener preference among older adults. Participants (n = 112), 56-90 yrs. sampled a plain low-fat blended cottage cheese and iced tea sweetened with either sucrose or Sweet OneR arranged in a triangle test format. Participants also sampled four low-fat vanilla puddings sweetened with sucrose, EqualR, Sweet'n LowR, and Sweet OneR and ranked them according to preference. Results show participants are able to tell the difference between sucrose and the new artificial sweetener Sweet OneR in the iced tea drinks. Rank order results show this sample preferred EqualR and sucrose as sweeteners. The ability to taste sweetness remains high in aging. Enhancing sweetness without added calories would aid nutritional well being of the elderly.     

Dietary Fat Reduction Behaviors among African American,American Indian,and White Older Adults with Diabetes

Dietary self-management of diabetes is often difficult for older adults to practice, particularly in rural communities. We describe patterns and correlates of dietary fat reduction among older rural adults with diabetes of any type. In-home interviews were conducted with a multiethnic random sample of 701 adults 65 years and older with diabetes from two North Carolina counties. The Fat and Fiber Behavior Questionnaire was used to measure dietary behaviors. Separate multiple linear regressions assessed effects of gender, ethnicity, and diabetes education. In general, scores were more favorable for practices that involved modifying food preparation (e.g., avoiding frying) and less favorable for practices that involved changing foods consumed (e.g., substituting fruits and vegetables as desserts or snacks). American Indians and African Americans had less favorable scores than whites, and diabetes education was associated with greater fat restriction for women than men. Older men and ethnic minorities with diabetes should be targeted for dietary change education.     

Substance Use, Mental Illness and Violence: The Co-Occurrence of Problem Behaviors Among Young Adults

A paucity of research exists in which the co-occurrence of substance use, mental illness, and violence in young adults is examined. Concurrently, there is also a lack of research explicating the contribution of theoretically based risk factors for these problematic outcomes in this population. This lack of both outcome and explanatory research equally affects the utility of theories and interventions for this population. This article utilizes a sample of N?=?633 21-year-olds to examine the prevalence of (1) violence and substance use, (2) mental illness (i.e., mood and anxiety disorders) and substance use, and (3) the use of multiple substances and investigates the relationship between various social determinants and said outcomes. Overall, the prevalence rates for the comorbid conditions were low; although on average males had higher rates than did females. Individual attitudes, perceived opportunities, and recent stressful life events were associated with the co-occurrence of outcomes. Implications for behavioral health are explored.     

Weight Control Behaviors and Dietary Intake among Adolescents and Young Adults: Longitudinal Findings from Project EAT

Background

Cross-sectional research has found that dieting during adolesence and the use of extreme weight control behaviors are related to less healthful dietary patterns; however, little is known regarding longitudinal relationships.

Objective

To describe patterns of weight control behavior over 5 years and examine relationships with nutritional outcomes in adolescents and young adults.

Design

Population-based, longitudinal study in Minnesota. Youth completed Time 1 surveys in 1998-1999, and Time 2 surveys were completed in 2003-2004.

Subjects/setting

The Project EAT (Eating Among Teens) survey and the Youth and Adolescent Food Frequency Questionnaire were completed by 1,242 females and 1,007 males in school classrooms at Time 1 and by mail at Time 2.

Outcome measures and statistical analyses performed

Generalized linear modeling was used to predict each Time 2 outcome of interest (ie, meal and snack frequencies and dietary intake) across patterns of healthful and unhealthful weight control behavior (ie, never-engaging, stopping, starting, and persisting).

Results

Approximately 45% of females and 17% of males reported persistent use of unhealthful weight control behaviors at both time points. Persisting to use only healthful weight control behaviors was reported by 10% of females and 15% of males. Among females, persistent use of unhealthful weight control behavior was associated (P<0.05) with measures of poorer dietary intake (eg, lower intakes of calcium and vegetables) and less frequent meals, whereas persistent use of healthful weight control behavior was associated with measures (P<0.05) of better dietary intake (eg, less fast food and fewer sugar-sweetened drinks). Among males, few associations were observed between dietary intake and either unhealthful or healthful weight control behavior.

Conclusions

Health professionals should guide youth who have weight concerns by encouraging healthful eating habits to achieve or maintain appropriate weight and nutrition goals.     

Ventilatory Function in Young Adults and Dietary Antioxidant Intake

Dietary antioxidants may protect against poor ventilatory function. We assessed the relation between ventilatory function and antioxidant components of diet in young Chileans. Forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), and the ratio FEV₁/FVC were measured in 1232 adults aged 22–28 years, using a Vitalograph device. Dietary intake was ascertained with a food frequency questionnaire (FFQ) designed for this study, from which nutrient and flavonoid intakes were estimated. Dietary patterns were derived with Principal Component Analysis (PCA). After controlling for potential confounders, dietary intake of total catechins was positively associated with FVC (Regression coefficient (RC) of highest vs. lowest quintile of intake 0.07; 95% CI 0.01 to 0.15; p per trend 0.006). Total fruit intake was related to FVC (RC of highest vs. lowest quintile 0.08; 95% CI 0.003 to 0.15; p per trend 0.02). Intake of omega 3 fatty acids was associated with a higher FEV₁ (RC for highest vs. lowest quintile 0.08; 95% CI 0.01 to 0.15 L; p per trend 0.02) and with FVC 0.08 (RC in highest vs. lowest quintile of intake 0.08, 95% CI 0.001 to 0.16; p per trend 0.04). Our results show that fresh fruits, flavonoids, and omega 3 fatty acids may contribute to maintain ventilatory function.     

Health Attitudes, Beliefs, and Risk Behaviors Among Adolescents and Young Adults With Type 1 Diabetes

Decision making about engaging in health-promoting and health-compromising behaviors among adolescents and young adults with type 1 diabetes is an important but understudied topic. The purpose of this study was to describe the health attitudes, beliefs, risk behaviors, and general psychological functioning of adolescents and young adults with diabetes and to compare these psychosocial aspects of health to those of adolescents and young adults without diabetes. Fifty-three adolescents and young adults with type 1 diabetes and 53 demographically matched controls were recruited from 2 pediatric teaching hospitals and administered a confidential self-report questionnaire consisting of individual survey items and standardized scales. Compared to healthy adolescents and young adults, adolescents and young adults with diabetes had more frequent thoughts about health and sickness, rated their health as poorer, viewed smoking as less addictive, reported greater symptoms of depression, and reported greater exposure to smoking in their households, but less smoking experimentation. Poorer metabolic control was associated with decreased physical activity. Additional research on the design and implementation of diabetes-specific cardiovascular disorder and tobacco control programs for adolescents and young adults is warranted.     

Dietary Changes Favorably Affect Bone Remodeling in Older Adults

OBJECTIVE: To determine whether dietary counseling to increase milk intake could produce useful changes in the calcium economy and what, if any, other nutrition-related changes might be produced. DESIGN: Randomized, open trial. SUBJECTS/SETTING: Two hundred four healthy men and women, aged 55 to 85 years, who habitually consumed fewer than 1.5 servings of dairy foods per day. Six academic health centers in the United States. INTERVENTION: Subjects were instructed to consume 3 servings per day of nonfat milk or 1% milk as a part of their daily diets, or to maintain their usual diets, for a 12-week intervention period, which followed 4 weeks of baseline observations. MAIN OUTCOME MEASURES: Energy and nutrient intake assessed from milk intake logs and 3-day food records; serum calciotrophic hormone levels at baseline and at 8 and 12 weeks; urinary excretion of calcium and N-telopeptide at 12 weeks. STATISTICAL ANALYSES: Repeated-measures analysis of variance. RESULTS: In the milk-supplemented group, calcium intake increased by 729 +/- 45 mg/day (mean +/- standard error), serum parathyroid hormone level decreased by approximately 9%, and urinary excretion of N-telopeptide, a bone resorption marker, decreased by 13%. Urine calcium excretion increased in milk-supplemented subjects by 21 +/- 7.6 mg/day (mean +/- standard error), less than half the amount predicted to be absorbed from the increment in calcium intake. All of these changes were significantly different from baseline values in the milk group and from the corresponding changes in the control group. Bone-specific alkaline phosphatase level (a bone formation marker) fell by approximately 9% in both groups. Serum level of insulin-like growth factor-1 (IGF-1) rose by 10% in the milk group (P < .001), and the level of insulin-like growth factor binding protein-4 (IGFBP-4) fell slightly (1.9%) in the milk group and rose significantly (7.9%) in the control group (P < .05). APPLICATIONS/CONCLUSIONS: The changes observed in the calcium economy through consumption of food sources of calcium are similar in kind and extent to those reported previously for calcium supplement tablets. The increase in IGF-1 level and the decrease in IBFBP-4 level are new observations that are beneficial for bone health. Important improvements in skeletal metabolism can feasibly occur in older adults by consumption of food sources of calcium. Dietitians can be confident that food works, and that desired calcium intakes can be achieved using food sources.     

Older Adults’ Age-Related Communication and Routine Dietary Habits

ABSTRACT

Using the communicative ecology model of successful aging (CEMSA), this study examined whether or not older adults’ ways of communicating about a variety of age-related issues (e.g., making age-related excuses for their shortcomings, teasing other people about their age) predict older adults’ dietary habits. Participants were classified as engaged, bantering, and disengaged agers based on their own patterns of age-related communication. The probability of being an engaged ager positively predicted fruit consumption and negatively predicted soft drink consumption. The probability of being a bantering ager negatively predicted vegetable consumption. Results suggest the potential to expand the CEMSA’s boundary conditions to include routine dietary habits. Future researchers can build on these findings by utilizing additional methods to assess dietary habits and testing whether or not dietary habits mediate the associations between age-related communication and a variety of health problems.     

Health Attitudes,Beliefs, and Risk Behaviors Among Adolescents and Young Adults With Type 1 Diabetes

Decision making about engaging in health-promoting and health-compromising behaviors among adolescents and young adults with type 1 diabetes is an important but understudied topic. The purpose of this study was to describe the health attitudes, beliefs, risk behaviors, and general psychological functioning of adolescents and young adults with diabetes and to compare these psychosocial aspects of health to those of adolescents and young adults without diabetes. Fifty-three adolescents and young adults with type 1 diabetes and 53 demographically matched controls were recruited from 2 pediatric teaching hospitals and administered a confidential self-report questionnaire consisting of individual survey items and standardized scales. Compared to healthy adolescents and young adults, adolescents and young adults with diabetes had more frequent thoughts about health and sickness, rated their health as poorer, viewed smoking as less addictive, reported greater symptoms of depression, and reported greater exposure to smoking in their households, but less smoking experimentation. Poorer metabolic control was associated with decreased physical activity. Additional research on the design and implementation of diabetes-specific cardiovascular disorder and tobacco control programs for adolescents and young adults is warranted.     

Socioeconomic Inequalities in Health in Older Adults in Brazil and England

Objectives. We examined socioeconomic inequalities in health among older adults in England and Brazil.Methods. We analyzed nationally representative samples of residents aged 50 years and older in 2008 data from the Brazilian National Household Survey (n = 75 527) and the English Longitudinal Study of Ageing (n = 9589). We estimated prevalence ratios for self-rated health, functional limitations, and reported chronic diseases, by education level and household income tertiles.Results. Brazilians reported worse health than did English respondents. Country-specific differences were higher among the poorest, but also affected the wealthiest persons. We observed a strong inverse gradient of similar magnitude across education and household income levels for most health indicators in each country. Prevalence ratios (lowest vs highest education level) of poor self-rated health were 3.24 in Brazil and 3.50 in England; having 2 or more functional limitations, 1.81 in Brazil and 1.96 in England; and having 1 or more diseases, 1.14 in Brazil and 1.36 in England.Conclusions. Socioeconomic inequalities in health affect both populations, despite a less pronounced absolute difference in household income and education in Brazil than in England.Inequalities in socioeconomic status (SES) are important determinants of health disparities in high-, middle-, and low-income cou ntries.1 Comparisons among countries can help to identify both commonalities among pathways linking socioeconomic and health inequalities and opportunities for their reduction. However, few international studies have compared the relationship between indicators of SES and health outcomes in older adults, and they were conducted in higher-income member countries of the Organisation for Economic Co-operation and Development.2,3 These studies showed that older adults in England are healthier than their US counterparts despite a larger gross national product and per capita health care expenditures that are 2 to 3 times as high in the United States as in England. Both countries have a socioeconomic gradient in health, with the worst health among those at the bottom of the socioeconomic hierarchy.2,3Socioeconomic inequalities are more prominent in most middle- and low-income countries,4 and life expectancy has increased much faster in these countries than in richer ones.5 Life expectancy between 1960 and 1999 increased 24% in Latin America and the Caribbean and 12% in high-income Organisation for Economic Co-operation and Development countries.5 This demographic transition is generating populations with unprecedented numbers of older adults exposed to significant social inequalities. Assessing the relationship between SES and health inequalities in these societies therefore provides an opportunity to broaden our understanding of SES and health gradients.Brazil is the world’s fifth most populous nation, with more than 190 million inhabitants6 and one of the world’s highest levels of income inequality (2009 Gini coefficient = 0.54).4 Although poverty rates fell from 42% to 21% between 1990 and 2009, 40 million Brazilians are still considered to be poor and 13 million, extremely poor.7 Life expectancy is 72.9 years (79.8 years in England), and Brazil ranks 73rd in the world on the Human Development Index (England is 26th).8 Health inequalities among elderly Brazilians (aged ≥ 65 years) are remarkable. Individuals in the lowest household income quintile report worse health, more functional limitations, fewer doctor and dentist visits, and higher hospitalization rates than do wealthier respondents.9 Even small differences in household income are correlated with inequalities in reported illnesses and biological markers of disease among older people.10We used data from nationally representative surveys in Brazil and in England to examine health variations in older adults by income and education. To our knowledge, this was the first study to compare these 2 populations and to assess the relative magnitude of SES-based inequalities among older adults in 2 countries with very different social, political, demographic, and economic contexts.     

Socioeconomic Inequalities in Self-Rated Health Among Middle-Aged and Older Adults

Despite increased attention to health disparities in the United States, few studies have examined the impact of socioeconomic inequalities on self-rated health over time. Using data from the Health and Retirement Study, this article investigates socioeconomic inequalities in self-rated health among middle-aged and older adults. The findings indicated that higher level of income, assets, and education, and having private health insurance predicted better self-rated health. In particular, increases in income or assets predicted slower decline in self-rated health. Interestingly, economic status had greater impact on females' decline in self-rated health. Blacks were less likely to suffer rapid decline in self-rated health than were whites. The findings led to the conclusion that health disparities should be understood as the interplay of socioeconomic status, gender, and race/ethnicity.     

Disability Pensions Among Young Adults in Vocational Rehabilitation

Objectives Lack of work-participation and early disability pensions (DP’s) among young adults are increasing public health problems in most western European countries. The present study investigated determinants of early DP in young adults in vocational rehabilitation. Methods Data from 928 young adults (aged 18–40 years) attending a vocational rehabilitation program was linked to DP’s recorded in the Norwegian Labor and Welfare Organization registries (1992–2010) and later compared to a group of 65 employees (workers). We used logistic regression to estimate the odds ratio for entitlement to DP following rehabilitation, adjusting for socio-demographical, psychosocial and health-behavior factors. Results Significant differences in socio-demographical, psychosocial and health-behavior factors were found between the rehabilitation group and workers. A total of 60 individuals (6.5 %) were granted a DP during follow-up. Increase in age, teenage parenthood, single status, as well as low education level and not being employed were found to be the strongest independent determinants of DP. Conclusion Poor social relations (being lone), early childbearing and weak connection to working life contributed to increase in risk of DP’s among young adults in vocational rehabilitation, also after adjusting for education level. These findings are important in the prevention of early disability retirements among young adults and should be considered in the development of targeted interventions aimed at individuals particularly at risk of not being integrated into future work lives.