What are the special needs of chronically ill young people?

Although significant advances have been made in the treatment of serious disease, there remains much scope for assisting young people in adjusting to life with a chronic medical condition. Commonly, chronically ill young people experience lower emotional well being than their healthy peers. Conventional approaches to promoting emotional well being have involved referring young people and their families to an appropriate public mental health service or psychologist/psychiatrist in private practice. However, there is increasing interest in the use of peer support programs. Support groups such as the ChIPS program aim to promote positive adjustment to chronic illness by bring together young people facing similar circumstances. It is maintained that by increasing connections between chronically ill young people, emotional well being can be enhanced.     

Are Fortune 100 companies responsive to chronically ill workers?

We conducted a survey of Fortune 100 companies to determine their response to the growing number of employees with chronic conditions. We found that although all companies cover some services that are particularly beneficial to persons with chronic conditions, gaps in coverage remain. We also found large variations in cost-sharing mechanisms, number of covered visits, and lifetime maximum benefit provisions, which are especially important to persons with chronic conditions. In general, for persons with chronic conditions the benefits offered by these Fortune 100 companies are superior to those offered by Medicare.     

Are the young becoming more disabled?

This paper investigates trends in disability in the U.S. population, particularly among people under age fifty. Even as the elderly have become less disabled, reported disability has risen for younger Americans, especially those ages 30-49. We suggest some possible explanations for rising disability levels, such as obesity, technological advances in medicine, and changing disability insurance laws. Obesity and its attendant disorders seem particularly associated with these trends, although the data are not definitive. Whatever its sources, rising disability among the young could have adverse consequences for public programs such as disability insurance, Medicare, and Medicaid.     

Do HMOs restrict access to health care among the chronically ill?

Health Maintenance Organizations are enrolling an increasing number of people for the delivery of their health care. Observers are asking whether this trend has resulted in the underprovision of health care to vulnerable population groups. This study asks whether HMOs under-provide care to the chronically ill. We use Ronald Andersen's Behavioral Model to derive predictive expectations about the provision of hospital and physician services to the chronically ill. The results indicate that HMOs do not under-provide health care to the chronically ill, compared to traditional fee-for-service insurance arrangements. We further found that HMOs provide more physician services to those in excellent health, compared to those in fee-for-service arrangements.     

Work-related health risks in Europe: Are older workers more vulnerable?

Recent policy reforms in a number of countries are extending working lives and deferring the statutory retirement age. Yet such changes may have profound implications for the well-being of older workers if such individuals are more likely to suffer work-related health problems. Using international data from the European Working Conditions Survey for 2005, we test whether older workers (aged 55–65 years) differ significantly from younger workers across a range of self-reported job-related indicators including health risk perception, mental and physical health, sickness absence, injury and fatigue. We estimate discrete choice (probit) models of the outcomes above for a sample comprising 17,459 individuals in 23 countries, and control for personal, job and work characteristics including exposure to physical, ergonomic and psychosocial risk factors. Our results show that failure to account for both endogeneity and the ‘healthy worker effect’ (sample selection) can lead to misleading inferences. The latter is especially important: only after controlling for selection bias (using a re-weighting approach) do we find older workers are more ‘vulnerable’ than their younger counterparts in the sense of being significantly more likely to perceive each of the various adverse health outcomes above, with the exception of injury. For the remaining indicators, our estimates suggest the magnitude of this difference is substantial: between 5 and 11 percentage points compared with prime age workers, and 8 and 14 points relative to workers aged 15–35, depending on the measure under consideration.     

A comparison of homeless and high-risk young adults: Are they one and the same?

Although experiencing poor parenting has been linked to high-risk behaviors and negative outcomes among different populations, very little research has been conducted on whether inadequate parenting has the same detrimental consequences for homeless and high-risk young adults. As such, this article compares homeless and marginally housed young adults to see if the associations between poor parenting (e.g. lower monitoring, neglect and physical abuse) and negative outcomes including depressive symptoms, victimization, delinquency and substance use are similar for these two groups. The sample consisted of 199 homeless and high-risk young adults from the Midwestern United States. Multivariate results revealed that childhood sexual abuse was correlated with physical and sexual victimization and delinquency among marginally housed young adults. Among homeless individuals, neglect and physical abuse were associated with physical victimization and delinquency, respectively. Caretaker monitoring was linked with delinquency and substance use among both groups. Finally, caretaker substance misuse was related positively with higher levels of substance use, but only among marginally housed individuals. The results are discussed in terms of policy implications.     

Are young adults appreciating the health promotion messages on diet and exercise?

Aim

This study aims to determine if current health promotion messages relating to diet and physical activity are sufficiently targeted towards young adults. In addition, we examine what elements of these messages might be improved to ensure they encourage improved diet and exercise behaviours within this underserved group.

Subject and methods

Using qualitative methods, five focus group discussions (FGDs) and two semi-structured in-depth interviews were conducted among 19 young adults in Aberdeen City. An appropriate topic guide was developed for this purpose. After obtaining consent, all FGDs and interviews were audio-recorded and transcribed verbatim. A thematic analysis was conducted that allowed for emerging themes to be identified from the data. Links between themes were established and key quotes identified.

Results

Five major themes emerged: (1) exposure to health messages over time; (2) chains of healthy or unhealthy behaviours; (3) perceptions and attitudes towards health messages; (4) facilitators and barriers; (5) improving the usability of health messages.

Conclusions

The results demonstrate that young adults did not find current health promotion messages engaging. These messages did not support them in overcoming their perceived barriers, nor were they suitably formatted or located for them. There were suggestions from young adults on how to improve these messages including using social media, presenting messages in more usable forms, and working with larger corporations to make these messages more effective. Tailoring these messages specifically for young adults could improve their diet and exercise behaviours, thereby helping to reduce future obesity levels and co-morbidities within Scotland.

     

Sex,stressful life events,and adult onset depression and alcohol dependence: Are men and women equally vulnerable?

Higher rates of major depression (MD) among females, and of alcohol dependence (AD) among males, are among the most routinely reported findings in psychiatric epidemiology. One of the most often pursued explanations for sex differences in both disorders suggests that males and females have a differential vulnerability to stressors, which is manifested in sex-specific ways (MD for females, AD for males). However, existing evidence in support of this explanation is mixed. In the present study, we investigated sex differences in the association between stressful life events and MD and AD in a large national sample of adults in the United States (n = 32,744) using a prospective design. Logistic regression was used to estimate associations between stressful life events and both MD and AD; sex-specific effects of stress on MD and AD were evaluated by testing interaction terms between sex and stressors in the prediction of both outcomes. The number of stressful life events was predictive of first onset MD and AD. This was true for both males and females, and sex-by-stress interaction terms did not support the hypothesis that sex-specific responses to stressful life events lead to sex differences in first onset of MD and AD among adults. These results indicate the resistance of sex differences in MD and AD to simple explanations, and suggest the need for more nuanced models that incorporate both physiological and social aspects of vulnerability.     

Health insurance disparities among immigrants: are some legal immigrants more vulnerable than others?

This study examined health insurance disparities among recent immigrants. The authors analyzed all working-age adult immigrants between the ages of 18 and 64 using the New Immigrant Survey data collected in 2003.This survey is a cross-sectional interview of recent legal permanent residents on their social, economic, and health status. Respondents were interviewed in English or in their preferred languages. Nearly two-thirds of immigrants were uninsured, in spite of their strong labor force participation. Of the four key classes of immigration--employment based, family sponsored, refugee/asylum program, and diversity program--the diversity program immigrants were least likely to be insured, controlling for a wide array of demographic, human capital, acculturation, and assets-related variables. Strategies to increase health insurance coverage among legal immigrants, especially diversity immigrants, are discussed.     

Declining estimated prevalence of alcohol drinking and smoking among young adults nationally: artifacts of sample undercoverage?

A growing concern in public health surveillance surveys that rely on random digit dialing for sampling is the exclusion of adults in cell-phone-only households. The purpose of this study was to examine whether recent increases in wireless substitution have affected estimates of tobacco and alcohol use in the Behavioral Risk Factor Surveillance System (BRFSS) in a subpopulation with notable cell-phone usage (i.e., young adults). BRFSS data from 2001-2005 were examined. Analyses were limited to participants aged 18-24 years, and the sample contained approximately 18,500 persons in each year. Prevalence estimates were generated with SUDAAN software for three health behaviors: cigarette smoking, binge drinking, and heavy alcohol consumption. In addition, the authors examined sample completeness for young adults relative to US Census estimates. Overall, prevalences of all three health behaviors among young adults were fairly stable between 2001 and 2003 but significantly decreased between 2003 and 2005. These trends are not replicated in national surveys that use area probability samples. The authors found a declining trend in the sample completeness ratio for young adults; it declined from 0.32 in 2001 to 0.15 in 2005. Given the high prevalence of wireless substitution among young adults and the declining sample completeness ratio, the authors suspect that the observed decreases in prevalence are artifacts of undercoverage.     

Unemployment and psychosocial adjustment in young adults: causation or selection?

This study investigates the relationships between unemployment following school leaving and psychosocial adjustment problems (mental health, substance use, crime, suicidal behaviours and teenage pregnancy) in a birth cohort of over 1000 New Zealand born young people. The data were gathered during the course of the Christchurch Health and Development Study (CHDS). The CHDS is a longitudinal study of a birth cohort of 1265 children born in the Christchurch (NZ) urban region who have been studied from birth to age 21. Data were gathered by personal interview on: (a) exposure to unemployment and (b) personal adjustment over the period from age 16 to age 21. Measures of personal adjustment included mental health (depression, anxiety), substance use, crime, suicidal behaviours and (for females) teenage pregnancy. Data were analysed using a fixed effects regression model that took into account both observed and non-observed sources of confounding and the possibility of reverse causal associations between personal adjustment and unemployment. Before adjustment for confounding and reverse causality there were significant (p < 0.001) associations between exposure to unemployment and measures of mental health, substance use, crime, suicidal behaviours and teenage pregnancy. Adjustment for confounding factors and reverse causality reduced these associations quite substantially and after control for sources of confounding a number of associations became nonsignificant. Nonetheless, after such control, exposure to unemployment remained significantly (p < 0.05) associated with suicidal ideation, substance abuse and criminal behaviours. It is concluded that, in part, the associations between unemployment and personal adjustment are spurious and reflect the presence of confounding factors that are related to both unemployment and adjustment. Nonetheless, the findings suggest that exposure to unemployment may be associated with increased risks of suicidal thoughts, crime and substance use.     

Seroepidemiology of Epstein−Barr virus and cytomegalovirus among Israeli male young adults

PurposeTo assess the seroprevalence and seroconversion of Epstein?Barr virus (EBV) and cytomegalovirus (CMV) Immunoglobulin G (IgG) antibodies and identify associated socioeconomic and smoking variables among male young adults in Israel, to explore health disparities and aid prevention efforts.MethodsA population-based seroprevalence study of EBV and CMV IgG antibodies in a systematic sample of Israeli males upon recruitment to mandatory military service during 1994–2004. Associations between socioeconomic and smoking variables and the seroprevalence of EBV/CMV were evaluated, controlling for possible confounders. A subset of seronegative subjects was assessed for seroconversion upon discharge from military service.ResultsOverall seroprevalence rates were 87% for EBV and 59% for CMV. An association between the seroprevalence of EBV and CMV was observed. Seroconversion was 56% for EBV as compared with 31% for CMV. Lower paternal education was found to be associated with both EBV and CMV seroprevalence. Lower socioeconomic status, North African origin, and urban residence were found to be associated with CMV seropositivity, as was smoking for EBV seropositivity.ConclusionsSocioeconomic disparities exist in the seroprevalence rates of CMV and EBV among Israeli male young adults. The results of the study could aid public health efforts and determine target populations when a vaccine becomes available.     

Are obese adolescents and young adults at higher risk for mental disorders? A community survey

OBJECTIVE: Associations between body mass index (BMI) and mental disorders meeting Axis-I diagnoses according to the Diagnostic and Statistical Manual for Mental Disorders IV (DSM-IV) were investigated in The Early Developmental Stages of Psychopathology Study in a large population-based sample, which included adolescents and young adults of both genders for the first time. RESEARCH METHODS AND PROCEDURES: A total of 3021 German subjects ranging from 14 to 24 years of age were assessed for specific DSM-IV diagnoses derived from a modified version of the standardized Composite International Diagnostic Interview, and general psychological disturbances, using the Symptom Checklist-90-Revised. BMI percentiles for age and gender were calculated to avoid systematic bias in the BMI distribution resulting from the young age range represented in the sample. Additionally, subjects with a lifetime diagnosis of any eating disorder were excluded from statistical analysis to control the confounding effect of body weight-related eating disorders on associations between BMI and psychopathology. RESULTS: The results based on logistic regression analyses and MANOVAs demonstrate that the BMI is not associated with mental disorders or general psychopathologies. There were no significant associations between BMI and mood, anxiety, substance, and somatoform disorders, a result that contrasts with almost all previous clinical studies. Additionally, in contrast to clinical investigations and most epidemiological studies, neither obesity nor underweight was significantly associated with any kind of general psychopathology. DISCUSSION: The overall finding that obesity is not significantly related to marked psychopathology in the general German population of adolescents and young adults has important clinical implications.     

Are immigrants and descendants with ill health more prone to unemployment? Evidence from 18 European countries

Objective: Previous research has established that both ill health and minority status are associated with unemployment. Less is known, however, about the interplay between having ill health and being from minority background. The present study examines whether immigrants and descendants with ill health are particularly prone to unemployment during an economic downturn in Europe.

Design: The European Union Statistics on Income and Living Conditions (EU-SILC) cross-sectional data material is utilized, and linear probability models are estimated. The analysis is run for countries in which the two minority samples are acceptably large (N?≥?100), resulting in 18 included European countries. The year 2011 is chosen because it is possible to identify both immigrants and descendants in EU-SILC due to a module on intergenerational transfer of disadvantages.

Results: The results indicate – as expected – that both ill health and minority status are independently related to higher unemployment likelihood. Immigrants and descendants with ill health, however, are not particularly likely to be unemployed. This finding is robust to a number of sensitivity tests, and the empirical pattern is very similar across the 18 included countries.

Conclusion: Both minority status and ill health are associated with high unemployment probability in Europe. However, there does not seem to exist a ‘double disadvantage’ for immigrants and descendants with ill health, which is in line with a human capital perspective on how employers evaluate potential employees. Both a non-native-sounding name and bad health status are interpreted as a risk factor, but there is no reason to expect ill health to lower the productivity level more if the applicant is a descendant or immigrant.     

Late life disability and experienced wellbeing: Are economic resources a buffer?

BackgroundDisablement has been linked to compromised wellbeing in later life, but whether material resources buffer these negative effects is unclear.ObjectiveDrawing upon conceptual models of stress and coping, we analyze experienced wellbeing data from time diary interviews with adults ages 60 and older. We expect that experienced wellbeing will be influenced by each stage of the disablement process and that higher income and wealth will buffer the negative effects of disability on experienced wellbeing. Because income is a better reflection of one's liquid resources while assets reflect lifetime accumulation, we expect income to be a more substantial buffer than assets.MethodsWe use the Disability and Use of Time Supplement to the Panel Study of Income Dynamics (N = 1607). We consider several measures of the disablement process (activity limitations, impairment severity, duration of limiting condition) and history of work limitation and evaluate both pre-tax income and net worth quartiles. We estimate a series of multi-level regression models that account for clustering of individuals within couples. We calculate the marginal effects of disability on wellbeing at different quartiles of economic resources.ResultsWe find that impairment severity is associated with worse experienced wellbeing before and after adjusting for covariates, and income buffers these negative effects for those in the middle-income quartiles.ConclusionsFuture research should further explore the mechanisms through which income buffers the negative effects of impairment severity and specify the accommodations that enable economically disadvantaged and advantaged older adults alike to withstand physical declines while maintaining wellbeing.     

The Mull Hypothesis: is cannabis use contributing to high tobacco use prevalence among young North Coast males?

Men aged 25-34 years, in North Coast NSW, have higher documented smoking rates than elsewhere in the state. The present paper explores potential causes of elevated smoking rates in this population and proposes that tobacco dependence resulting from 'mulling' (mixing) cannabis with tobacco may be contributing.     

Hepatitis B vaccination coverage rates among adults in rural China: Are economic barriers relevant?

Background

Hepatitis B virus (HBV) infections cause major health problems in China. The Expanded Program of Immunization has succeeded in reducing infection rates among infants and children, but HBV vaccination coverage rates among adults remain low.

Objective

The objective was to investigate how individual adult HBV vaccination decisions are influenced by economic factors, socioeconomic status, and demographic characteristics, and to assess how potential vaccination policies could affect HBV vaccination coverage rates among adults.

Methods

We interviewed 22,618 adults, aged 15–59 years, from 7948 households, in 45 villages from 7 provinces. A questionnaire was used to collect information. The actual vaccine status was modeled using a polychotomous logistic regression with three outcomes; unvaccinated, partial vaccination, and complete vaccination. A subsample of unvaccinated adults gave responses to a hypothetical vaccination policy that offered HBV vaccination free of charge and various amounts of money to compensate for direct and indirect vaccination-related costs.

Results

The polychotomous logistic regression results suggest that vaccination user fees, time needed to get a vaccination, and vaccination-related travel costs were negatively associated with HBV vaccination coverage rates. Higher income was associated with higher coverage rates, and coverage rates decrease with age, with no significant difference between the genders. In the subsample that responded to the hypothetical policy, 55–72% (depending on the amount of money offered as compensation) stated they would accept a vaccination if it was offered free of charge.

Conclusions

Our polychotomous logistic regression results suggest that higher HBV vaccination coverage rates among adults are obtainable and that user fees, time needed to get a vaccination, and travel costs have acted as economic barriers to vaccination. This is supported by the responses to the hypothetical policy, which suggest that adult coverage rates could surge if HBV vaccine is offered at no cost.     

Are resilience and perceived stress related to social support and housing stability among homeless adults with mental illness?

Perceived stress has been associated with adverse health outcomes. Although people experiencing homelessness often report multiple acute and chronic stressors, research on resilience and perceived stress on the general homeless population is limited. This longitudinal study examined homeless adults with mental illness who were part of a 24‐month trial of Housing First to explore: (a) changes in levels of resilience and perceived stress during the trial, and (b) the association between levels of resilience and perceived stress with measures of social support, social functioning and percentage of days stably housed over the study period. This longitudinal study (2009–2013) that used trial data included 575 participants in Toronto, Ontario. Of these individuals, 507 were included in this study. Connor‐Davidson Resilience Scale and Perceived Stress Scales (PSS) measured the two outcomes, resilience and perceived stress. Time (baseline, 12 and 24 months), housing stability and three measures of social support and social functioning were the main predictors. A longitudinal analysis was done with repeated measures analysis of resilience and perceived stress using linear mixed models with random intercepts. Mean resilience scores increased (baseline: 5.1 [95% CI: 4.9, 5.2], 12 months: 5.5 [95% CI: 5.3, 5.7], 24 months: 5.6 [95% CI: 5.4, 5.8]), and PSS scores decreased (baseline: 22.3 [95% CI: 21.5, 23.0], 24 months: 18.6 [95% CI: 17.9, 19.4]). In the multivariable analyses, increased resilience was associated with higher scores on the three social support and social functioning measures, (estimates = 0.12, 0.04, 0.02) but not percentage days stably housed. Lower PSS scores were associated with higher scores on all three social support and social functioning measures (?0.20, ?0.33, ?0.21) and higher percentages of days stably housed (?0.015). Strong social support and social functioning may minimise the harmful effects of stressful life events on homeless individuals by increasing resilience and reducing stress. Interventions to help homeless people build appropriate support networks should be delivered in parallel to efforts that increase housing stability.