Stressful life events among women: a rural-urban comparison.

This retrospective comparative study assessed the levels and types of stressful life events among rural versus urban women in Wyoming (n = 157). No significant difference in total life events scores, negative life events scores, positive life events scores, or total number of life events reported was found between the rural and urban samples. Rural women tended to report environmentally related stressors more frequently than urban women, while urban women reported more financially related stressors. The findings suggest that the levels of stress among rural and urban women are comparable, but the types of stressors experienced may vary.     

Stressful life events, smoking behavior, and intentions to smoke among and multiethnic sample of sixth graders

Objectives. Adolescent smoking has been associated with stressful life events. However, few studies have examined the associations between stress, smoking intentions, and smoking behavior among a multiethnic sample of adolescents. Methods. We compiled a checklist of stressful life events relevant to multiethnic youth and administered it to 1,074 sixth-grade students in urban Los Angeles. Results. The most frequently reported stressful events were similar across ethnic groups and generations in the USA: test taking, chores, and arguments with friends. The events reported as the most severe were disturbances in family life, such as: death, arguments between parents, and illness or injury. Whites and Latinos had reported higher levels of ever smoking and intentions to smoke than Asian/Pacific Islanders (PIs). On the positive family-related events scale Latinos scored higher than did whites or Asian/PIs. Whites scored higher than Latinos or Asian/PIs on both negative peer-related and negative personal-related events. Associations were observed between total stress, stressful life events, and smoking behavior and intention to smoke. Total stress was associated with ever smokers, smoking intentions within the next year and in high school over the entire sample. Negative peer-related events were associated with intention to smoke within the next year, among Latinos. Among Asian/PIs negative peer-related events were associated with intention to smoke within the next year and in high school. Negative school-related events were significantly associated with ever smoking and intentions to smoke in the next year and marginally associated with intentions to smoke in high school among children born in the USA whose parents were also born in the USA. Negative peer-related events and positive personal-related events were significantly associated with intentions to smoke in the next year among children born in the USA whose parents were immigrants. Conclusions. Results suggest that negative peer- and school-related events may lead to increased risk of smoking behavior and intentions to smoke among multicultural adolescents.     

Stressful Life Events and Physical Abuse Among Pregnant Women in North Carolina

Objectives: This study estimates the prevalence of stressful life events and physical abuse among North Carolina women prior to infant delivery, and examines potential associations between abuse and the other stressors. Methods: Data were from the North Carolina Pregnancy Risk Assessment Monitoring System, a statewide representative survey of over 2,600 postpartum women. The survey assessed women's sociodemographic characteristics and their experiences of physical abuse and 13 other stressful life events before delivery. The prevalences of each life event and abuse were estimated. Logistic regression modeled the probability of women having high levels of stressful life events in relation to physical abuse and sociodemographics. Results: Most women were married, white, high school graduates, aged 20 or older. The most common stressful life events were residential moves, increased arguing with husbands/partners, family member hospitalizations, financial hardship, and deaths of loved ones. Fourteen percent of women had high levels of stressful events (5 or more), and almost 9% were physically abused. Abuse was positively associated with increased arguing with husbands/partners, physical fighting, having someone close with an alcohol/drug problem, becoming separated/divorced, and financial hardship. Logistic regression analysis showed that a high level of stressful life events was significantly more likely among women abused both before and during pregnancy (OR = 11.94) and among women abused before but not during pregnancy (OR = 14.19). Conclusions: The high frequency of multiple stressful events and abuse in women's lives suggests that women's care providers should ask their patients about these issues, and offer appropriate referral/interventions to those in need.     

Stress,Lifestyle, and Quality of Life in Midlife and Older Australian Women: Results From the Stress and the Health of Women Study

BackgroundChronic psychological stress may pose a serious threat to health, although the mechanisms are not fully understood. This study examines the impact of stress on modifiable lifestyle factors, depressive symptoms, health-related quality of life (HRQOL) and chronic illness in older Australian women.MethodsCross-sectional data were collected from a random sample of 181 older adults aged 60 to 70 years from rural and urban areas of South-East Queensland, Australia. We used structural equation modelling to examine associations between stress, modifiable lifestyle factors, HRQOL, and chronic illness.FindingsParameter estimates show that older women who reported life stressors where they felt helpless and feared for their life (high-magnitude stressors) also reported higher body mass index (p = .03) and more chronic illness (p < .01). In contrast, duration of exposure to life stressors was associated with higher depressive symptom scores (Center for Epidemiologic Studies Depression Scale; p = .02) and sleep disturbance scores (p < .01).ConclusionsOur findings support the link between traumatic personal histories (exposure to high-magnitude stressors) and unhealthy lifestyle factors. Findings highlight the need for more research on how stress reduction, a healthy lifestyle, and positive coping strategies can be used to reduce the effects of high-magnitude stress on HRQOL and chronic illness.     

Alcohol,stress-related factors,and short-term absenteeism among urban transit operators

Transit operators, relative to workers in many other occupations, experience high levels of work-related stress, as documented through neuroendocrine elevations on the job vis-à-vis resting states (J Occup Health Psychol. 1998;3:122–129). Previous research suggests that self-reported job stress is associated with higher levels of alcohol consumption among transit operators (Alcohol Clin Exp Res. 2000;24:1011–1019) and with absenteeism (Working Environment for Local Public Transport Personnel, Stockholm: Swedish Work Environmental Fund, 1982; Work Stress. 1990;4:83–89). The purpose of this study was to examine the interrelationships between alcohol use, stress-related factors (stressful life events, job stressors, and burnout), and short-term absenteeism among a multiethnic cohort of urban transit operators. Self-reported measures of alcohol, stress-related factors, and short-term absenteeism were obtained from a sample (n=1,446) of San Francisco municipal transit operators who participated in the 1993–1995 Municipal Railway Health and Safety Study. Multivariate logistic regression analyses showed that absenteeism among drinkers was associated with risk for alcohol dependence [odds ratio (OR)=2.46, heavy drinking (OR=1.87), alcohol0related harm (OR=2.17), increased drinking since, becoming a transit operator (OR=1.74), and having any problem drinking indicator (OR=1.72). The association between absenteeism and stress-related factors varied by gender and drinking status. Final multivariate models among drinkers indicated that among males, problem drinking (OR=1.82), stressful life events (OR=1.62), and job burnout (OR=1.22) were independently associated with elevated odds of absenteeism. Among female drinkers, only stressful life events (OR=5.17) was significantly associated with elevated odds of absenteeism. Findings suggest that workplace interventions that address both individual and environmental stressors are most likely to have a positive impact on health-related outcomes, including problem drinking, thereby reducing absenteeism.     

Does Rurality Affect Quality of Life Following Treatment for Breast Cancer?

Purpose: The present research examined the extent to which rural residence and social support seeking are associated with quality of life (QOL) among breast cancer patients following chemotherapy. Methods: Female breast cancer patients (n = 46) from communities of varying degrees of rurality in a Midwestern state completed psychological and QOL measures at 1-month postchemotherapy. Analyses assessed the relationships between QOL outcomes, rurality, and social support seeking. Findings: Using age and education as covariates, regression analyses were conducted to determine the extent to which QOL was related to social support seeking and rural/urban residence. Analyses revealed that social support seeking was associated with lower scores on multiple indices of QOL, and it was associated with higher self-reported symptoms of depression. Several significant associations with rural/urban residence were noted as well. Specifically, increasing rurality, as defined by USDA Rural-Urban continuum codes, was associated with lower overall QOL, lower functional well-being, and increased complaints of breast cancer specific symptoms. Conclusions: These findings highlight the relevance of continued efforts to address social support needs among women with a history of breast cancer living in rural and urban communities. They also suggest that individuals in more rural communities may be at risk for lowered QOL in the early period following cancer treatment. Future research is needed to replicate these results with larger and more diverse samples of rural and urban dwelling individuals, and to determine whether these effects may be attributed to identifiable characteristics of rural communities (eg, fewer cancer-related resources).     

Stressful Life Events Around the Time of Unplanned Pregnancy and Women’s Health: Exploratory Findings from a National Sample

Objective Little is known about how women’s social context of unintended pregnancy, particularly adverse social circumstances, relates to their general health and wellbeing. We explored associations between stressful life events around the time of unintended pregnancy and physical and mental health. Methods Data are drawn from a national probability study of 1078 U.S. women aged 18–55. Our internet-based survey measured 14 different stressful life events occurring at the time of unintended pregnancy (operationalized as an additive index score), chronic disease and mental health conditions, and current health and wellbeing symptoms (standardized perceived health, depression, stress, and discrimination scales). Multivariable regression modeled relationships between stressful life events and health conditions/symptoms while controlling for sociodemographic and reproductive covariates. Results Among ever-pregnant women (N?=?695), stressful life events were associated with all adverse health outcomes/symptoms in unadjusted analyses. In multivariable models, higher stressful life event scores were positively associated with chronic disease (aOR 1.21, CI 1.03–1.41) and mental health (aOR 1.42, CI 1.23–1.64) conditions, higher depression (B 0.37, CI 0.19–0.55), stress (B 0.32, CI 0.22–0.42), and discrimination (B 0.74, CI 0.45–1.04) scores, and negatively associated with ≥?very good perceived health (aOR 0.84, CI 0.73–0.97). Stressful life event effects were strongest for emotional and partner-related sub-scores. Conclusion Women with adverse social circumstances surrounding their unintended pregnancy experienced poorer health. Findings suggest that reproductive health should be considered in the broader context of women’s health and wellbeing and have implications for integrated models of care that address women’s family planning needs, mental and physical health, and social environments.     

绍兴市部分初中生应激性生活事件现状及影响因素

了解绍兴市初中生应激性生活事件现状及其影响因素,为干预措施的制定提供依据.方法 采用分层整群随机抽样的方法,运用中学生生活事件多维评定问卷对分层整群随机抽取的绍兴市3 397名初中生进行调查.结果 中学生应激性生活事件发生率前5位的依次为考试成绩不理想(72.21%)、达不到教师的期望(66.79%)、偏科(64.41%)、父母唠叨(56.20%)和挨父母的骂(40.80%).多因素Logistic回归分析显示,城市学校、非独生子女、初二年级、初三年级、学习负担重是中学生应激性生活事件发生的危险因素(B值分别为0.234,0.210,0.317,0.364,1.195,P值均<0.05),亲密朋友个数多是中学生应激性生活事件发生的保护因素(P<0.01).结论 绍兴市中学生应激性生活事件不容乐观.针对中学生不同特点,亟需开展干预措施.     

新疆伊犁地区儿童青少年应激性生活事件及影响因素分析

目的 了解新疆伊犁地区儿童青少年应激性生活事件的现状以及影响因素,为新疆儿童青少年健康干预提供支持。方法 采用分层整群抽样的方法在新疆伊犁地区4个县市随机抽取3442名初中学生进行生活事件多维评定问卷的调查。结果 新疆伊犁地区初中学生男生应激性生活事件5个维度及总维度得分均低于女生,并且在恋爱与性维度方面差异有统计学意义(t值为-6.383,P值＜0.01)。随着年级升高,应激性生活事件各维度得分呈现上升趋势,并且均存在统计学意义(F值分别为31.468、27.542、11.346、17.446、27.158、54.689,P值均＜0.01)。logistic回归分析表明,城市、非独生子女、初二年级、初三年级、学业负担较重是导致应激性生活事件发生的危险性因素(B值为0.235、0.211、0.318、0.366、1.196,P值均＜0.05),具有1~2个、3~5个、5个以上亲密的朋友是保护因素(B值为-0.619、-0.964、-1.077,P值均＜0.01)。结论 新疆伊犁地区初中生应激性生活事件不容乐观,今后应结合本地区中学生特点及实际进行有效的干预和引导。     

山东某地农村人群自杀未遂危险因素的病例-对照分析和随访研究

为预防自杀行为 ,并为制定必要的可行的干预措施提供科学的依据 ,利用在山东某地区调查的病例 -对照研究资料和随访研究资料 ,应用多因素Logistic回归模型进行分析 ,寻找影响自杀未遂的危险因素。结果显示 :自杀未遂行为的发生与急性应激强度大、患精神病和冲动性人格特征呈正相关 ;与生命质量和家庭亲密度呈负相关。研究提示 :①负性生活事件是农村人群自杀未遂最重要的危险因素 ,其次是患精神疾病 ;②冲动性人格特征也是自杀未遂重要的独立危险因素之一 ;③我国农村人群不同于西方国家的“精神病自杀模式” ,应该制定相应的针对性自杀预防措施     

Disparities in Receipt of Breast and Cervical Cancer Screening for Rural Women Age 18 to 64 with Disabilities

BackgroundPrevious research has found breast and cervical cancer screening disparities between women with and without disabilities, and between women living in rural versus urban areas. Living in a rural area may add to the barriers women with disabilities experience when attempting to obtain screening for breast and cervical cancer. The purpose of this study was to examine the combination of disability status and rurality in association with receipt of breast and cervical cancer screening among women age 18 to 64 in the United States.MethodsWe conducted cross-sectional analyses of data from the Medical Expenditure Panel Survey, using pooled annual data files from 2002 through 2008. We compared recent receipt of breast and cervical cancer screening among four groups: 1) urban women without disabilities, 2) urban women with disabilities, 3) rural women without disabilities, and 4) rural women with disabilities.FindingsOverall, women with disabilities were less likely to be up to date with mammograms and Pap tests compared with women with no disabilities. Similarly, women in rural areas were less likely to have received breast or cervical cancer screening within recommended timeframes. Women who both had a disability and lived in a rural area were the least likely to be current with screening.ConclusionsOur findings suggest that living in rural regions compounds disparities in receipt of cancer screening among women with disabilities. Increased attention is needed to improve receipt of cancer screening among rural women with disabilities.     

Determinants of mental illness in a rural Ethiopian adult population

A cross-sectional survey was conducted on 2000 adult Ethiopians living in rural communities to determine firstly the prevalence of mental illness and secondly its association with stress and demographic variables. The Self-Reporting Questionnaire developed by WHO experts was used as the measure of mental illness. A modified version of the Holmes-Rahe Social Readjustment Scale was the measure of stress. Respondents were interviewed in their homes. Those experiencing 11 or more of the 20 neurotic symptoms and 3 or more of the 4 psychotic symptoms were considered mentally ill. Despite the use of high cut-off points for identifying potential cases, the prevalence of mental illness was 17.2%--neurotic 11.2% and psychotic 6.0%. This is higher than earlier reports for Ethiopia, but comparable to rates found in other African countries. Mental illness scores were most strongly associated with stress in that the odds of experiencing 6 or more stressful life events in the past year were 2.7 times greater for neurotics and 2.1 times greater for psychotics. In addition, neuroses and psychoses were significantly associated with a family history of mental illness and with being divorced, separated or widowed. Neurosis alone was also associated with chronic illness, females, those between the ages of 35 and 44, and illiteracy. These findings were discussed in terms of their relevance for identifying high stress groups and thus for preventing mental illness through community activities.     

Life events as risk factors for myocardial infarction: a pilot case-control study in Kolkata, India

This case-control study was conducted in the Cardiology Department of Medical College, Kolkata, India, during 2000-2001, to explore the link between stressful life events and subsequent myocardial infarction (MI). One hundred consecutive confirmed MI patients were selected as a case group. One hundred age-, sex- and income-matched controls were selected from visitors other than relatives who attended these patients. The subjects were interviewed and asked to rate 61 life events with a number between 0 and 20. They also noted which of these they had experienced in the last one year. The main exposure variables included life events as per E.S. Paykel, smoking, alcohol consumption, chewing of tobacco, marital status, literacy, employment, and monthly per-capita income. The results showed that an MI patient was likely to experience 4.16 stressful life events, which were twice as much as the control group (2.24). The total stress score was the highest for serious personal illness followed by illness of family members and unemployment for the MI patients. For the controls, conflict between husband and wife, death of friends, and personal illness had the highest total stress score. The mean stress score for the MI patients was 35.5 compared to 17.35 among the controls. The MI subjects were more likely to have experienced stressful life events than the controls.     

What Does It Mean When We Screen? A Closer Examination of Perinatal Depression and Psychosocial Risk Screening Within One MCH Home Visiting Program

Perinatal depression screening has become an imperative for maternal and child health (MCH) home visitation programs. However, contextual life experiences and situational life stress may be equally important in determining program response. As one component of a larger research study with an urban MCH home visitation program, we examined the results from multiple measures of depression and anxiety symptoms, social support and stressful life events in a sample of 30 newly enrolled program participants. We compared commonly used tools in identifying women who were “at risk” for perinatal depression. The analysis used published and agency practice cut-off scores, examined correlations between measures, and reflected on the role of stressful life events in this assessment. In this low-income, predominantly African-American sample, the assessed tools were inconsistent in identifying “at risk” women for perinatal depression, ranging from 22 % (Edinburgh Perinatal Depression Scale) to 75 % (Center for Epidemiological Studies, Depression Scale) depending on the instrument. Depression and anxiety were correlated across most measures, although provider-collected data did not correlate as anticipated with other measures. The combination of screening for perinatal depression and stressful life events offered an additional perspective on possible symptom alleviation and psychosocial intervention that could occur within the home visiting program. Our experience suggests that introducing a brief inventory of stressful life events accompanying perinatal depression screening allowed for a more comprehensive understanding of women’s experiences than perinatal depression screening alone. We encourage psychosocial risk screening which integrates assessment of social support, stressful life events and perinatal depression symptoms.     

Urban-rural differences in self-reported limiting long-term illness in Scotland

BACKGROUND: Previous research suggests that there are significant differences in health between urban and rural areas. The aim of this study is to describe the pattern and magnitude of urban-rural variation in health in Scotland and to examine the factors associated with health inequalities in urban and rural areas. METHODS: The data used in this study were limiting long-term illness (LLTI) and socio-economic data collected by the 1991 Census. A rurality indicator was created using Scottish Household Survey rurality classifications. Multilevel Poisson regression modelling was carried out with LLTI as a health indicator for each type of rurality within Scotland. A variety of socio-economic factors were investigated for each rurality. RESULTS: Areas with the highest Standardized Illness Ratios (SIRs) (>125) are predominantly urban whereas the lowest SIRs (<75) are found in both urban and rural areas. Rural communities are more heterogeneous than urban areas in terms of their social make-up with relation to health; however, when these areas are split according to minor road length and different socio-economic factors are added, the model fit for each new model is improved and the reduction in total variation is comparable with that of the urban models. CONCLUSION: These findings suggest that rural areas should not be treated as a homogeneous group but should be subdivided into rural types.     

Norm values for the Generic Children's Quality of Life Measure (GCQ) from a large school-based sample

This study aimed to assess the quality of life of a population sample of schoolchildren. The Generic Children's Quality of Life Measure (GCQ) has been developed to allow comparison between chronically ill children and the general child population. The measure assesses how the child views his or her life and also how they would like it to be. Quality of life is measured as the discrepancy between the two viewpoints. This large community-based survey aimed to establish GCQ norm values for children aged 6–14 years. The children were from a sample of schools stratified by geographical location and social need: rural affluent, rural low affluence, urban affluent and urban low affluence. 720 completed questionnaires were analysed. The scores were normally distributed with a wide range. The GCQ showed an acceptable reliability with a Cronbach's α of 0.75. The quality of life score was not correlated with age (r = −0.02, p = 0.64) nor with the deprivation score of the area in which the children lived (r = −0.026, p = 0.49). There were no significant differences between the scores by gender (p = 0.22) nor by rural/urban location (p = 0.60). Normative values were established. The GCQ is suitable for using with children over a large age range (6–14 years) without the scores being confounded by the age, gender, affluence or geographical location. This revised version was published online in June 2006 with corrections to the Cover Date.     

Mechanisms Linking Stressful Life Events and Mental Health Problems in a Prospective,Community-Based Sample of Adolescents

PurposeStressful life events represent potent risk factors for the development of internalizing symptoms among adolescents. However the mechanisms linking stress to adolescent psychopathology remain inadequately understood. This study examined the role of emotion dysregulation as a mechanism linking stress to changes in internalizing symptoms among adolescents.MethodsThis study used a short-term longitudinal design. Stressful life events were assessed in a large diverse sample of adolescents (N = 1065), and emotion dysregulation and symptomatology outcomes were assessed at two subsequent time points. Structural equation modeling was used to examine the role of emotion dysregulation as a mediator of the association between stress and subsequent changes in internalizing symptoms.ResultsEmotion dysregulation mediated the relationship between stressful life events and changes in internalizing symptoms over time. Sobel's test indicated a significant indirect effect of stressful life events on subsequent symptoms of depression (z = 5.05, p < .001) and anxiety (z = 4.95, p < .001) through emotion dysregulation.ConclusionsStressful life events appear to disrupt the adaptive processing of emotion among adolescents. Emotion dysregulation represents an intrapersonal mechanism linking stress to poor mental health outcomes. The implications for preventive interventions are discussed.     

Rural adolescent alcohol, tobacco, and illicit drug use: a comparison of students in Victoria, Australia, and Washington State, United States

Purpose: There are inconsistent research findings regarding the impact of rurality on adolescent alcohol, tobacco, and illicit substance use. Therefore, the current study reports on the effect of rurality on alcohol, tobacco, and illicit drug use among adolescents in 2 state representative samples in 2 countries, Washington State (WA) in the United States and Victoria (VIC) in Australia. Participants: The International Youth Development Study (IYDS) recruited representative samples of students from Grade 7 (aged 12 to 13 years) and Grade 9 (aged 14 to 15) in both states. A total of 3,729 students responded to questions about alcohol, tobacco, cannabis, and other illicit substance use (n_VIC= 1,852; n_WA= 1,877). In each state, males and females were equally represented and ages ranged from 12 to 15 years. Methods: Data were analyzed to compare lifetime and current (past 30 days) substance use for students located in census areas classified as urban, large or small town, and rural. Findings were adjusted for school clustering and weighted to compare prevalence at median age 14 years. Findings: Rates of lifetime and current alcohol, tobacco, and cannabis use were significantly higher in rural compared to urban students in both states (odds ratio for current substance use = 1.31). Conclusions: In both Washington State and Victoria, early adolescent rural students use substances more frequently than their urban counterparts. Future studies should examine factors that place rural adolescents at risk for alcohol, tobacco, and illicit drug use.     

Is universal health coverage the practical expression of the right to health care?

Background

Public stigma against family members of people with mental illness is a negative attitude by the public which blame family members for the mental illness of their relatives. Family stigma can result in self social restrictions, delay in treatment seeking and poor quality of life. This study aimed at investigating the degree and correlates of family stigma.

Methods

A quantitative cross-sectional house to house survey was conducted among 845 randomly selected urban and rural community members in the Gilgel Gibe Field Research Center, Southwest Ethiopia. An interviewer administered and pre-tested questionnaire adapted from other studies was used to measure the degree of family stigma and to determine its correlates. Data entry was done by using EPI-DATA and the analysis was performed using STATA software. Unadjusted and adjusted linear regression analysis was done to identify the correlates of family stigma.

Results

Among the total 845 respondents, 81.18% were female. On a range of 1 to 5 score, the mean family stigma score was 2.16 (±0.49). In a multivariate analysis, rural residents had significantly higher stigma scores (std. β?=?0.43, P?<?0.001) than urban residents. As the number of perceived signs (std. β?=?-0.07, P?<?0.05), perceived supernatural (std. β?=?-0.12, P?<?0.01) and psychosocial and biological (std. β?=?-0.11, P?<?0.01) explanations of mental illness increased, the stigma scores decreased significantly. High supernatural explanation of mental illness was significantly correlated with lower stigma among individuals with lower level of exposure to people with mental illness (PWMI). On the other hand, high exposure to PWMI was significantly associated with lower stigma among respondents who had high education. Stigma scores increased with increasing income among respondents who had lower educational status.

Conclusions

Our findings revealed moderate level of family stigma. Place of residence, perceived signs and explanations of mental illness were independent correlates of public stigma against family members of people with mental illness. Therefore, mental health communication programs to inform explanations and signs of mental illness need to be implemented.