Psychological distress and cardiovascular disease: results from the 2002 National Health Interview Survey.

AIMS: The objective of this study was to examine the burden of psychological distress among individuals with different forms of heart disease in a large representative sample of adults. METHODS AND RESULTS: Data were obtained from the 2002 National Health Interview Survey, which is a large annual survey of the US non-institutionalized civilian population. Psychological distress was assessed with a standardized questionnaire (K6) and heart disease diagnoses were based on self-report. Among non-diseased individuals, the estimated prevalence of psychological distress was 2.8%, whereas the estimates were 10, 6.4, and 4.1% among those with congestive heart failure (CHF), myocardial infarction (MI), and coronary heart disease (CHD), respectively. Over 1 million individuals with one or more of these conditions are estimated to experience psychological distress. However, only 31-35% of the participants with heart disease and psychological distress have visited a mental health professional. The logistic regression model results indicate that MI (OR 2.0, 95% CI 1.4-3.0) and CHF (OR 3.1, 95% CI 1.8-5.1) are significantly associated with psychological distress. CONCLUSION: These findings imply that psychological distress is a significant comorbidity of cardiovascular disease. Other investigations have demonstrated a link between psychological distress and morbidity and mortality. Taken together, these findings provide the impetus for future investigations that assess the role that a medical and mental health care professional intervention may have in altering these outcomes when targeted at this distress.     

Use of complementary and alternative medicine by persons with arthritis: results of the National Health Interview Survey

OBJECTIVE: To compare the complementary and alternative medicine (CAM) used by adults ages 45 years and older with and without arthritis, and to investigate the prevalence and predictors of CAM use by persons who report being told by a doctor they had arthritis. METHODS: Data from the 2002 National Health Interview Survey with a supplemental section on CAM use were analyzed. Data on overall use and use by 4 CAM modalities were calculated by arthritis status. CAM use for treatment of any health condition, including arthritis, was calculated and compared by arthritis status. Logistic regression was used to identify predictors of CAM use among persons with arthritis. RESULTS: Overall use of CAM and use of 3 of 4 major CAM categories were higher for persons who reported doctor-diagnosed arthritis compared with those without arthritis. Biologically based therapies were the most frequently reported modalities. Although persons with arthritis were more likely than those without arthritis to report using CAM for treatment, most of their CAM use was for conditions other than arthritis. Joint pain and poor functional status were the most common predictors of CAM modalities among persons with arthritis. CONCLUSION: Health care providers of persons with arthritis should be aware that CAM use is common among their patients. A complete medication history is needed to obtain information on CAM use for all conditions.     

Cigarette smoking and alcohol use as predictors of HIV testing in the United States: results from the 2010 National Health Interview Survey

We examined the association between HIV risk perception and HIV testing among cigarette smokers, alcohol users, dual consumers of cigarette and alcohol, and abstainers. Data were analyzed from the 2010 National Health Interview Survey of the full sample of 22,946 and separately for 1547 African Americans. Multivariate logistic regression analysis revealed that alcohol users and dual consumers were significantly more likely to perceive themselves to be at risk of acquiring HIV. Cigarette smokers and alcohol users who considered themselves to be at risk for HIV and dual consumers who reported no perceived HIV risk were more likely to have been tested for HIV than abstainers who perceived no risk of acquiring HIV. Among African Americans, dual consumers and cigarette smokers only who perceived themselves at risk for HIV were more likely to have been tested for HIV than abstainers who perceived no risk of HIV infection. This study demonstrated that among the full sample and African Americans, cigarette smoking and alcohol use were significantly associated with HIV testing regardless of HIV risk perceptions.     

Prevalence and correlates of arthritis-attributable work limitation in the US population among persons ages 18-64: 2002 National Health Interview Survey Data

OBJECTIVE: To estimate the national prevalence of arthritis-attributable work limitation (AAWL) among persons ages 18-64 with doctor-diagnosed arthritis and examine correlates of AAWL. METHODS: Using the 2002 National Health Interview Survey, we estimated the prevalence of AAWL (limited in whether individuals work, the type of work they do, or the amount of work they do) and correlates of AAWL in univariable and multivariable-adjusted logistic regression analyses. Survey data were analyzed in SAS and SUDAAN to account for the complex sample design. RESULTS: A total of 5.3% of all US adults ages 18-64 reported AAWL; in this age group, AAWL is reported by approximately 30% of those who report arthritis. The prevalence of AAWL was highest among people ages 45-64 years (10.2%), women (6.3%), non-Hispanic blacks (7.7%), people with less than a high school education (8.6%), and those with an annual household income <$20,000 (12.6%). AAWL was substantially increased among people with arthritis-attributable activity limitations (multivariable-adjusted odds ratio [OR] 9.1, 95% confidence interval [95% CI] 7.1-11.6). The multivariable-adjusted likelihood of AAWL was moderately higher among non-Hispanic blacks (OR 1.6, 95% CI 1.2-2.3), Hispanics (OR 1.8, 95% CI 1.2-2.6), and people with high levels of functional/social/leisure limitations (OR 1.8, 95% CI 1.4-2.3) and was decreased among those with a college education (OR 0.6, 95% CI 0.4-0.8). CONCLUSION: AAWL is highly prevalent, affecting millions of Americans and one-third of adults with doctor-diagnosed arthritis. Findings suggest the need for more targeted research to better understand the natural history, success of interventions, and effects of policy on AAWL. Public health interventions, including self-management education programs, may be effective in countering AAWL.     

Potential barriers to seeking human immunodeficiency virus testing among adults in the United States: data from the 1998 National Health Interview Survey

To assess potential barriers to seeking human immunodeficiency virus (HIV) testing among adults in the United States, data from the 1998 National Health Interview Survey (NHIS) were analyzed. The NHIS is a multistage cluster survey of the United States noninstitutionalized civilian population ages 18 years or older. The 1998 NHIS survey was conducted using the computer-assisted personal interview. Of a nationally representative sample (n = 32,440) of the U.S. noninstitutionalized civilian population, 21,410 (66%) have never been tested for HIV, 9,728 (30%) have been tested, and 1302 (4%) did not complete the survey or refused to answer the question. Among individuals who completed the survey, men (odds ratio [OR]: 1.08, 95% confidence interval [CI] = 1.04, 1,22), individuals ages 50 years or older (OR: 4.01, 95% CI = 3.16, 5.08), or 18-19 years (OR: 2.12, 95% CI = 1.71, 2.63), those who had "up to 11 grade" level of education (OR: 2.16, 95% CI = 1.74, 2.63), those who lived in nonmetropolitan areas (OR: 1.21, 95% CI = 1.14, 1.28), or lived in the Midwest (1.34, 95% CI = 1.24, 1.43) were significantly more likely than their counterparts to have not sought HIV testing. Among individuals who have never been tested for HIV, 58% had no particular reason, 38% felt they were not at risk of contracting HIV, whereas less than 1% feared adverse consequences. The high proportion of adults who never tested for HIV after two decades of HIV epidemic underscores the need for new approaches to fight the spread of HIV infection in the United States.     

Asthma Incidence: Data from the National Health Interview Survey, 1980-1996

Objective. To obtain historical estimates of US asthma incidence from 17 years of health survey data. Methods. The 1980 through 1996 National Health Interview Survey contained a question asking about the time of asthma onset in persons with asthma. Annual past year incidence estimates were calculated from self-reports of asthma status. Results. Incidence increased from 2.5 per 1,000 (SE 0.37) in 1980 to 6.0 per 1,000 (SE 0.75) in 1996. Incidence increased faster in children than in adults and increased in females but not in males during this time. Conclusion. These findings suggest that increasing asthma incidence contributed to the increasing prevalence during this time.     

Prevalence and correlates of arthritis‐attributable work limitation in the US population among persons ages 18–64: 2002 National Health Interview Survey Data

Objective

To estimate the national prevalence of arthritis‐attributable work limitation (AAWL) among persons ages 18–64 with doctor‐diagnosed arthritis and examine correlates of AAWL.

Methods

Using the 2002 National Health Interview Survey, we estimated the prevalence of AAWL (limited in whether individuals work, the type of work they do, or the amount of work they do) and correlates of AAWL in univariable and multivariable‐adjusted logistic regression analyses. Survey data were analyzed in SAS and SUDAAN to account for the complex sample design.

Results

A total of 5.3% of all US adults ages 18–64 reported AAWL; in this age group, AAWL is reported by ～30% of those who report arthritis. The prevalence of AAWL was highest among people ages 45–64 years (10.2%), women (6.3%), non‐Hispanic blacks (7.7%), people with less than a high school education (8.6%), and those with an annual household income <$20,000 (12.6%). AAWL was substantially increased among people with arthritis‐attributable activity limitations (multivariable‐adjusted odds ratio [OR] 9.1, 95% confidence interval [95% CI] 7.1–11.6). The multivariable‐adjusted likelihood of AAWL was moderately higher among non‐Hispanic blacks (OR 1.6, 95% CI 1.2–2.3), Hispanics (OR 1.8, 95% CI 1.2–2.6), and people with high levels of functional/social/leisure limitations (OR 1.8, 95% CI 1.4–2.3) and was decreased among those with a college education (OR 0.6, 95% CI 0.4–0.8).

Conclusion

AAWL is highly prevalent, affecting millions of Americans and one‐third of adults with doctor‐diagnosed arthritis. Findings suggest the need for more targeted research to better understand the natural history, success of interventions, and effects of policy on AAWL. Public health interventions, including self‐management education programs, may be effective in countering AAWL.     

Correlates of HIV testing among women in Malawi: results from the 2006 Multiple Indicator Cluster Survey

We report a study of women 15-49 years aimed at assessing correlates of HIV testing and having received test results in a nationally representative survey of women in Malawi. A total of 26 259 women were recruited into the study, of whom 3712 (14.1%) had ever been tested for HIV infection and received their results. We found that age and education were not significantly associated with HIV testing but marital status, wealth, region were. Contrary to our expectations that women who had delivered a child were more likely to have been ever tested when accessing prenatal and intra-partum care, we found that women who had delivered a child in the 2 years before the survey were less likely to have ever been tested. We suggest that by 2006 when the survey was conducted, prenatal and intra-partum care were not important avenues for HIV testing in Malawi.     

Work losses related to inflammatory bowel disease in the United States: results from the National Health Interview Survey

BACKGROUND: U.S. studies using varying methodologies have reported different estimates for the indirect, or nonmedical cost per person with inflammatory bowel disease (IBD). Our analysis contributes to this literature by using the 1999 sample of the National Health Interview Survey (NHIS) to estimate the work-loss effect of IBD on work in the United States and the associated cost to society. METHODS: A weighted logistic regression model was used to estimate the OR of being out of the labor force as determined by predictive variables, including having been diagnosed with IBD, with or without symptoms. Controls included health status indicators and demographic variables. For those people in the labor force, a second analysis was performed to determine the relative influence of the same variables on working less than 12 months versus the entire year. SUDAAN 8.0 was used to generate population estimates, systematically correcting for survey design. RESULTS: Of IBD patients who had experienced symptoms in the past 12 months, 31.5% reported being out of the labor force (OR = 2.14, relative to the non-IBD group). We estimated the excess in the nonparticipation rate attributable to IBD with symptoms in the past 12 months in the United States to be 12.3%. Based on this, the indirect cost of nonparticipation attributable to IBD in 1998/1999 was more than $3.6 billion U.S. dollars (USD) or $5228 USD per person with IBD and symptoms. According to the second weighted logistic regression, for those who are in the labor force, having IBD had no association with the duration of work. CONCLUSIONS: By using directly observed data in our analysis, this method of estimation can be used to predict the overall paid-employment burden of IBD.     

Barriers to HIV-testing among Hispanics in the United States: analysis of the National Health Interview Survey, 2000

Data from the 2000 National Health Interview Survey (NHIS) were analyzed to explore barriers to HIV testing, and intentions to be tested among a nationally representative sample (n = 4,261) of the different Hispanic subgroups living in the United States. Weighted proportions and variances accounting for the complex sample design of the NHIS were estimated using the Taylor series linearization method. Regression estimates are expressed as odds ratios and their 95% confidence intervals. Two thirds of sampled Hispanics had never been tested for HIV (excluding blood donations) and 88% expressed no intention to do so in the near future. Many of the factors that influence the likelihood of having been tested in the past also impact on future HIV testing intentions including age, Hispanic subgroup, high-risk status, and self-perceived HIV risk. Compared to Puerto Ricans, Mexicans (odds ratio [OR] = 1.59, 1.1-2.3) and Mexican/Americans (OR = 1.61, 1.1-2.3) were more likely to never have been tested and Cubans were notably more likely to report negative future testing intentions (OR = 5.63, 2.5-12.8). Among Hispanics who reported high-risk status or high/medium self-perceived HIV risk, more than one quarter had never undergone testing and expressed no intention of doing so in the near future. Recognition of the HIV testing barriers identified in this study is valuable for the development and refinement of current strategies that aim to increase HIV testing practices in the heterogeneous U.S. Hispanic population.     

Age, race, and ethnicity in the use of complementary and alternative medicine for health self-management: evidence from the 2002 National Health Interview Survey

OBJECTIVES: Determine if complementary and alternative medicine (CAM) use for treating existing conditions and for health maintenance differs by age and ethnicity. METHODS: Data from the 2002 National Health Interview Survey were used to operationalize distinct types of CAM in terms of (a) no use, (b) use for treatment only, (c) use for prevention only, and (d) use for both treatment and prevention. Differences in CAM use by age and ethnicity were examined using SUDAAN to adjust for design effects. RESULTS: Associations of age with CAM use are curvilinear but differed by ethnicity. Some types of CAM are used primarily for treatment; others are used for health maintenance. DISCUSSION: CAM use is one component of adults' overall approach to health self-management. Patterns of CAM use by age and ethnicity likely reflect differences in CAM availability and prevailing public health policies when adults began making their own health-related decisions.     

Distress,depression and anxiety among persons seeking HIV testing

We investigated psychological distress and symptoms of depression and anxiety among 485 South Africans seeking HIV testing. The mean scores of the sample were 45.78 (SD?=?16.81) on the Hopkins Symptom Checklist; 15.8 (SD?=?12.4) on the Beck Depression Inventory and 12.44 (SD?=?13.00) on the Beck Anxiety Inventory, which fell in the elevated, mild and low ranges on these instruments, respectively. For more than a third of participants, symptoms of depression and clinically significant distress were at least moderate and in some cases severe, indicating that they may have benefitted from psychological help. We make the case that symptoms of depression and distress are common among persons seeking HIV testing and are therefore not a consequence of an HIV-positive test result.     

Cannabis use and dependence among Australian adults: results from the National Survey of Mental Health and Wellbeing

Aims. To examine: (i) the prevalence of cannabis use and DSM-IV cannabis dependence among Australian adults, and (ii) correlates of level of cannabis involvement. Design. Cross-sectional survey assessing substance use and DSM-IV substance use disorders (abuse and dependence). Setting and participants. A household survey of a nationally representative sample of 10 641 Australians aged 18 years and older. Measurements. Trained interviewers administered a structured, modified version of the Composite International Diagnostic Interview (CIDI). Findings. In the past 12 months, 2.2% (95%CI:1.8, 2.6) of adults were diagnosed with DSM-IV cannabis use disorder, comprising cannabis dependence (1.5%; 95%CI: 1.2, 1.8) and cannabis abuse (0.7%, 95%CI: 0.6, 0.8). Almost one-third of cannabis users (31.7%; 95%CI: 27.7, 35.7) met criteria for cannabis dependence (21%; 95%CI: 16.7, 25.3) and abuse (10.7%; 95%CI: 8.0, 13.4). Multinomial logistic regression revealed that compared to non-dependent cannabis users, non-users were more likely to be female, aged 25 + years, out of the labour force and married/ de facto , and displayed lower levels of co-morbidity. In contrast, dependent cannabis users were more likely to be 18-24 years old, unemployed, and displayed higher levels of co-morbidity than non-dependent users. Conclusions. Cannabis use disorders affect approximately 300 000 Australian adults. A better understanding of the factors associated with cannabis dependence may help identify groups who have difficulties controlling use and aid the development of strategies for reducing cannabis-related harm.     

Functional limitations among home health care users in the National Health Interview Survey Supplement on Aging.

A case-control study compared home health care (HHC) users from the 1984 Supplement on Aging to users of other community services and of no community service, matched on age and gender. Examination of specific activities of daily living (ADLs), instrumental activities of daily living (IADLs), and sociodemographic variables showed that HHC users were significantly more limited than controls in every ADL and IADL. In multivariate analyses, HHC use was significantly associated with three ADLs (dressing, going outside, bathing), two IADLs (shopping, heavy housework), and poor health status.     

Associations of alcohol consumption and mental health with the prevalence of arthritis among US adults: data from the 2012 National Health Interview Survey

The findings of association between alcohol consumption and arthritis are mixed while little is known about age differences in the associations of mental health and behavioral factors with arthritis. This study aimed to estimate the prevalence and associated factors of arthritis among US adults using data from the 2012 National Health Interview Survey. In total, 8,229 adults with arthritis and 26,256 controls were selected from the adult respondents. Weighted univariate and multiple logistic regression analyses were used to estimate the odds ratios (ORs) with 95 % confidence intervals. The overall prevalence of arthritis was 22.1 %. The prevalence increased with age (6.8, 29.6, and 47.9 % for 18–49, 50–64, and 65+ years of age, respectively). The prevalence of mental problems was higher in cases than controls [4 vs. 1 % for serious psychological distress (SPD), 29 vs. 16 % for anxiety, and 26 vs. 11 % for depression, respectively]. Multiple logistic regression analyses showed that being female, older age, smoking, alcohol consumption, obesity, SPD, depression, and anxiety were positively associated with arthritis. Stratified by age, SPD was associated with arthritis only in young adults (18–49 years old) while the ORs of anxiety and depression with arthritis decreased as age increased. Alcohol consumption revealed stronger associations in middle-aged adults and elderly. Using a large nationally representative sample in the USA, alcohol consumption, smoking, SPD, anxiety, and depression were associated with arthritis, and the associations varied across different age groups.