Eye of the beholder? Maternal mental health and the quality of infant sleep

Transactional models of parenting and infant sleep call attention to bidirectional associations among parenting, the biosocial environment, and infant sleep behaviors. Although night waking and bedtime fussing are normative during infancy and early childhood, they can be challenging for parents. The current study, conducted in the United States between 2003 and 2009, examined concurrent and longitudinal associations between maternal mental health and infant sleep during the first year. Concurrent associations at 6 and 12 months and longitudinal associations from 6 to 12 months were studied in a non-clinic referred sample of 171 economically and culturally diverse families. Mothers with poorer mental health reported that their infants had more night waking and bedtime distress and were more bothered by these sleep issues. Associations between infant sleep and maternal mental health were moderated by culture (Hispanic/Asian vs. other) and by stressors that included high parenting stress, more stressful life events, and low family income. Individual differences in maternal well-being may color mothers' interpretations of infants' sleep behaviors. It may be prudent to intervene to support maternal mental health when infants are referred for sleep problems.     

Social relationships and health: the relative roles of family functioning and social support.

The associations between social relationships and health have been examined using two major research traditions. Using a social epidemiological approach, much research has shown the beneficial effect of social supports on health and health behaviors. Family interaction research, which has grown out of a more clinical tradition, has shown the complex effects of family functioning on health, particularly mental health. No studies have examined the relative power of these two approaches in explicating the connections between social relationships and health. We hypothesized that social relationships (social support and family functioning) would exert direct and indirect (through depressive symptoms) effects on health behaviors. We also hypothesized that the effects of social relationships on health would be more powerfully explicated by family functioning than by social support. We mailed a pilot survey to a random sample of patients attending a family practice center, including questions on depressive symptoms, cardiovascular health behaviors, demographics, social support using the ISEL scale, and family functioning using the FEICS scale. FEICS is a self-report questionnaire designed to assess family emotional involvement and criticism, the media elements of family expressed emotion. Eighty-three useable responses were obtained. Regression analyses and structural modelling showed both direct and indirect statistically significant paths from social relationships to health behaviors. Family criticism was directly associated (standardized coefficient = 0.29) with depressive symptoms, and family emotional involvement was directly associated with both depressive symptoms (coefficient = 0.35) and healthy cardiovascular behaviors (coefficient = 0.32). The results support the primacy of family functioning factors in understanding the associations among social relationships, mental health, and health behaviors. The contrasting relationships between emotional involvement and depressive symptoms on the one hand and emotional involvement and health behaviors on the other suggest the need for a more complex model to understand the connections between social relationships and health.     

Use of fictional medical television in health sciences education: a systematic review

While medical television programs are popular among health profession trainees, it is not clear to what extent these programs affect their knowledge, perceptions, and/or behaviors. Therefore, we conducted a systematic review of research evaluating associations between program exposure and outcomes. We conducted systematic literature searches in Pubmed, CINAHL, and PsycINFO. Selected studies were required to be scholarly research, involve exposure to fictionalized medical television programming by health professional students, and assess associations between exposure and outcomes. Studies were classified according to quality and factors related to population, exposure, and outcomes. Of 3541 studies identified, 13 met selection criteria. Six studies involved undergraduate medical students, one involved nursing students, two involved both medical and nursing students, two involved medical residents, one involved medical students, residents and attending physicians, and one involved graduate epidemiology students. Mean study quality according to the MERSQI was 8.27. The most commonly assessed television programs were ER and Grey’s Anatomy (six each). Five studies assessed regular viewing habits, and found that fictional medical programs are popular among students and that students recall health topics from episodes. The eight studies that assessed the association with outcomes when using clips as educational tools reported high satisfaction and increased knowledge of the presented health topics. While relatively few published studies have explored influences of fictional medical television on health professional students, those conducted suggest that students often view these television programs independently and that integration of this programming into medical education is feasible and acceptable.     

Depressive symptoms and adolescent eating and health behaviors: a multifaceted view in a population-based sample

BACKGROUND: Previous research has shown significant associations between depression and substance use and eating disordered behaviors. However, no research to date has described associations between depressive symptoms and nutritional intake or physical activity among adolescents in a nonclinical, population-based sample. METHODS: Classroom surveys were completed by 4,734 ethnically diverse, middle- and high school students. Based on their depressive symptom scores, males and females were categorized with low-, moderate-, or high-depressive symptom status. Linear models were used to examine eating and health behavior variables by depressive symptom groups. RESULTS: Depressive symptoms were positively associated with health-compromising attitudes such as perceived barriers to healthy eating and weight concerns, and health-compromising behaviors such as unhealthy weight-control behaviors and substance use, including caffeine. Depressive symptoms were negatively associated with health-promoting behaviors such as eating breakfast, lunch, and dinner. However, most associations between depressive symptoms and dietary micronutrients were not statistically significant. Health-promoting moderate-to-vigorous physical activity was negatively associated with depressive symptoms among males. CONCLUSIONS: Adolescents who report depressive symptoms are at risk for other health-compromising attitudes and behaviors and are also less likely to engage in health-promoting behaviors. Depressive symptoms may be an underlying trait in the expression of health behaviors among adolescents.     

Health behaviors, risk factors, and health indicators associated with cigarette use in Mexican Americans: results from the Hispanic HANES.

BACKGROUND: Cigarette smokers often engage in other, potentially deleterious, health behaviors. Such behaviors have not been well documented in Mexican American smokers. METHODS: Data from the Southwestern sample of the Hispanic Health and Nutrition Examination Survey (HHANES) were employed to investigate differences in health behaviors, risk factors and health indicators between cigarette smokers and nonsmokers among Mexican Americans. Differences between those smoking less than 10 and 10 or more cigarettes per day were also examined by age group and gender. RESULTS: Positive associations between smoking status and heavy coffee and alcohol consumption were found across gender and age groups. Less consistent was the finding that smokers weighed less than nonsmokers. Lower systolic and diastolic blood pressures in middle-aged smokers, and higher levels of depressive symptomatology among smoking women were found. Those smoking 10 or more cigarettes per day were more likely to report heavy coffee consumption, with younger men reporting greater activity limitation due to poor health. Middle-aged men and women in the 10+ category were generally in better health than lighter smokers. CONCLUSIONS: Modest associations between cigarette smoking, health behaviors and risk factors found in other studies were confirmed in this Mexican American population. Few significant associations between smoking and health status were noted.     

Patterns of health behavior in U.S. adults

BACKGROUND: Associations between health-related behaviors are important for two reasons. First, disease prevention and health promotion depend on understanding both prevalence of health behaviors and associations among such behaviors. Second, behaviors may have synergistic effects on disease risk. METHODS: We document patterns of adherence to recommendations concerning five behaviors (physical activity, tobacco use, alcohol consumption, fruit and vegetable consumption, and dietary fat intake) in U.S. adults (n = 15,425) using data from the Third National Health and Nutrition Examination Survey. Division of individuals into categories associated with adherence or nonadherence to lifestyle recommendations results in 32 patterns of adherence/nonadherence. RESULTS: Proportions of U.S. adults with 21 of 32 behavior patterns characterized here deviated from proportions expected if health behaviors are independent of each other. The two extreme patterns, all adherence (5.9%) and all nonadherence (4.9%), were found in about double the proportion expected. Age, gender, race/ethnicity, education, and income were associated with a number of patterns, including the two extremes. CONCLUSIONS: This analysis of behavior patterns highlights population subgroups of public health importance, provides a benchmark for studies of multivariate associations between health behaviors, and supports a multidimensional model of health behavior.     

High-risk health behaviors associated with various dietary patterns.

We have previously identified dietary patterns among 1,475 male and 780 female normal healthy control subjects in a case-control study of cancer at various sites. In this paper we examine the presence, among persons exhibiting these dietary patterns, of individual health behaviors that may contribute to risks for cancer. Specifically we examine trimming of separable fat from meats, fats used in cooking and as additions to foods, alcohol consumption, and smoking. Results indicate that men and women differ in possession of these high-risk behaviors. Women are more likely to trim fat from meat, consume less alcohol, and have lower exposures to smoking. Their dietary patterns are more independent of the fats used. Several eating patterns are positively associated with total fat intake but differ in their associations with high-risk behaviors. These data suggest that assessing risk associated with dietary patterns sheds more light on disease relationships than studies of single nutrients.     

Risk taking and recurrent health symptoms in Canadian adolescents

OBJECTIVE: Psychosomatic health symptoms are commonly experienced by young people and are associated with chronic health problems. This study examines reports of psychosomatic health symptoms during adolescence, and associations between adolescent risk-taking and the occurrence of these symptoms. METHOD: A cross-sectional national health survey was performed in 2001/02 and involved 1746 young Canadians. Principal components analyses were used to derive a multiple risk-taking score. Multi-level regression models with individual participants (1st level) nested in schools (2nd level) were used to examine associations between individual then multiple risk-taking behaviors and psychosomatic symptoms. RESULTS: 37% of males and 48% of female students reported psychological health symptoms > once per week, while 30% of males and 41% of females reported somatic health symptoms. Strong associations were observed between individual risk-taking behaviors (cannabis use, other illicit drug use, drunkenness, smoking, unprotected sex) and psychosomatic health symptoms. A risk gradient was observed between multiple risk behaviors and these health symptoms. Youth who engaged in high levels of risk-taking behavior were two to four times more likely to report health symptoms. CONCLUSION: Adolescent lifestyles that include risk-taking behavior are strongly associated with the occurrence of psychosomatic health symptoms. Collectively, these measures are useful clinical indicators of adolescent health status.     

Gender and race differences in the predictors of daily health practices among older adults

Preventive health behaviors are crucial for older adults' well-being. This study examined the factors that influence the practice of positive daily health behaviors over time in a sample of older adults (N = 1266) and investigated whether explanatory factors differ by health behavior, gender or race. Physical activity, weight maintenance, smoking, alcohol consumption and sleep patterns were examined as dependent variables. Independent variables included demographic characteristics, baseline health behavior, health status variables, psychological factors and social network characteristics. Results indicate that age and health status are important predictors of preventive health behaviors. However, the factors that predict preventive health behaviors vary by behavior, gender and race. The independent variables included in this study were most successful in explaining cigarette smoking and weight maintenance, and least successful in explaining amount of sleep. In addition, results suggest that social network variables are particularly influential for women's health behaviors, while health status is more influential among men. Greater education predicts better health behaviors among whites, while formal social integration seems particularly important for the health behaviors of older black women. These results indicate that examining older adults' health behaviors by race and gender leads to a fuller understanding of these behaviors.     

A prospective study of health, life-style and psychosocial predictors of self-rated health

The aim of this study was to investigate what psychosocial predictors, life-style factors and health behaviors in early adulthood are of importance for self-ratings of health after the age of 45. Like-sexed adult twins born 1926–1950 (n = 16,080) from the Swedish Twin Registry that participated in a questionnaire in 1973 and in a telephone interview conducted between 1998 and 2002 were included. Exposure data was collected in 1973 and information on self-rated health and covariates was collected at the second contact 25 years later. Logistic regression using Generalized Estimating Equations was used to evaluate the associations. Conditional logistic regression was used to control for familial and genetic effects in the sample. Pain, lack of exercise, smoking, obesity, unemployment, perceived stress and personality are associated with future poor self-rated health, after controlling for age, sex, illness, education and socio-economic status. Familial and genetic effects influence the associations between recurrent headache, exercise, obesity, and poor self-rated health. Overall, these findings provide support for long-term effects of health behavior and psychosocial risk factors on poor self-ratings of health, beyond the influence of obvious health consequences such as disorders or illnesses. Genetic and familial factors are of importance only for some of these associations.     

Religious attendance and the health behaviors of Texas adults

OBJECTIVE: The purpose of this study is to test whether religious involvement is associated with a broad range of health behaviors. METHOD: We employ data from the 2004 Survey of Texas Adults, a statewide probability sample of 1504 Texas adults. Using these data, we estimate a series of logistic regression models to assess the net effects of religious attendance on 12 health behaviors. RESULTS: Our results show that regular religious attendance (especially weekly attendance) is associated with a wide range of healthy behaviors, including preventive care use, vitamin use, infrequent bar attendance, seatbelt use, walking, strenuous exercise, sound sleep quality, never smoking, and moderate drinking. CONCLUSION: If religious involvement is associated with healthy behaviors, additional studies are needed to account for these associations. Future research might also consider health behaviors other than drinking and smoking as potential mechanisms through which religious involvement might benefit health and prolong life.     

Examining the health information-seeking behaviors of Korean Americans

Many Korean Americans suffer from high levels of cancer incidence and have low cancer screening rates. A significant number of Korean Americans lack adequate information about cancer screening tests. However, little is known about their health behaviors. This article examines exposure to mass media and health information-seeking behaviors for Korean Americans, and their associations with demographic characteristics influencing variations in exposure to the different health information and trust in health information sources. The authors gathered data for this study using a cross-sectional, community-based survey conducted in the Washington, DC, metropolitan area during 2006 and 2007. It was administered to 254 Korean Americans who were 40 years of age or older. This study is part of the first health-related program of research to study exposure to mass media, health and cancer information sources, and seeking preferences and experiences of Korean Americans. Results indicated that Korean ethnic media sources and Internet are important sources used regularly. Age, years of education completed, and English proficiency levels for Korean Americans significantly predicted the likelihood of their Internet use. Low-income Korean Americans with less education were more likely to seek health information in Korean ethnic magazines and newspapers, whereas Korean Americans with higher education and English proficiency were more likely to seek information online. The most trusted source of health information among respondents was from a doctor or other health care professional. Future research should be conducted to determine whether physicians are actually used as a primary source for health information.     

Associations of job strain and working overtime with adverse health behaviors and obesity: evidence from the Whitehall II Study, Helsinki Health Study, and the Japanese Civil Servants Study

Adverse health behaviors and obesity are key determinants of major chronic diseases. Evidence on work-related determinants of these behavioral risk factors is inconclusive, and comparative studies are especially lacking. We aimed to examine the associations between job strain, working overtime, adverse health behaviors, and obesity among 45-60-year-old white-collar employees of the Whitehall II Study from London (n=3,397), Helsinki Health Study (n=6,070), and the Japanese Civil Servants Study (n=2,213). Comparable data from all three cohorts were pooled, and logistic regression analysis was used, stratified by cohort and sex. Models were adjusted for age, occupational class, and marital status. Outcomes were unhealthy food habits, physical inactivity, heavy drinking, smoking, and obesity. In London, men reporting passive work were more likely to be physically inactive. A similar association was repeated among women in Helsinki. Additionally, high job strain was associated with physical inactivity among men in London and women in Helsinki. In London, women reporting passive work were less likely to be heavy drinkers and smokers. In Japan, men working overtime reported less smoking, whereas those with high job strain were more likely to smoke. Among men in Helsinki the association between working overtime and non-smoking was also suggested, but it reached statistical significance in the age-adjusted model only. Obesity was associated with working overtime among women in London. In conclusion, job strain and working overtime had some, albeit mostly weak and inconsistent, associations with adverse health behaviors and obesity in these middle-aged white-collar employee cohorts from Britain, Finland, and Japan.     

Covariance of adolescent health behaviors: the Class of 1989 study

The purpose of this paper is to add to the growing body of knowledgeregarding the clustering or covariation of health behaviorsin adolescents. Patterns of smoking, healthy eating and activitylevels were examined through a self-report survey using serialcross-sectional samples of students over 7 years (sixth to 12thgrade). The students represented were participants in the Classof 89 study, a component of the Minnesota Heart Health Program.Comparisons are made between males and females as well as byreference and intervention communities. Bi-variate and multivariateresults suggest that not only do associations exist betweenhealth behaviors, but the associations strengthen over time.After the eighth grade, students reporting lower activity patternsas well as those making fewer healthy food choices also exhibita higher weekly smoking prevalence. The multivariate analysespoint to a risk profile where smoking, poor food choices andlower activity patterns cluster. The results point to the importanceof early health education in order to foster the developmentof a positive health profile prior to consolidation of unhealthfulbehaviors. Comprehensive school-based health education is alsorecommended as a way to promote the importance and developmentof a healthy lifestyle across multiple behaviors.     

Understanding the non-stationary associations between distrust of the health care system, health conditions, and self-rated health in the elderly: a geographically weighted regression approach

The goals of this study are to explore whether health condition is an antecedent extraneous factor for the relationship between health care system distrust and self-rated health among the elderly, and to investigate if the associations among these variables are place-specific. We used logistic geographically weighted regression to analyze data on an elderly sample residents in the Philadelphia metropolitan area. We found that the health conditions of the elderly account for the association between high distrust and poor/fair self-rated health and that the distrust/self-rated health relationship varied spatially. This finding suggests that a place-centered perspective can inform distrust/self-rated health research.     

Cross-cultural surveys of adolescent health and behavior: progress and problems

Adolescent health surveys administered in different countries or regions often are described as cross-cultural. Although most include youth of different ethnic and cultural groups, few attempt to define these constructs or to collect data that allow their characterization. This paper explores four challenges shared by large-scale surveys of adolescent health-related behaviors and beliefs. First, adolescent health investigators have used the terms culture and ethnicity loosely. The growing interest in contextual analysis demands standardization of the definitions as they apply to adolescents, followed by correct usage of the terms. Hypotheses regarding the associations between race, ethnicity, culture, health-related behaviors, and health outcomes should be clearly stated and incorporated into conceptual models. Second, cross-cultural analyses are interpretable only when the study designs and sampling methods provide adequate representation of cultural and ethnic minorities and when the survey items allow differentiation of factors related to race, ethnicity, culture, and socioeconomic factors. Third, cross-cultural research may expose traditions, beliefs, and behaviors that are supported by one population yet criticized by another. Investigators must recognize their own personal biases and must work collaboratively to analyze and interpret their data correctly. Fourth, generalizations about cultural/ethnic comparisons can evoke powerful emotional reactions. Interpretation and dissemination of research findings should be done sensitively and with the help of experts from the cultural/ethnic groups that have been studied.     

健康危险因素与个体健康间的结构方程模型

目的探索健康危险因素与个体健康间的潜在关系,以及各潜变量对测量指标的影响。方法利用健康风险评估调查问卷调查西安市某三级甲等医院健康体检人群。构建健康危险因素与个体健康间的结构方程模型,解释不同因子间的相互作用及其对总体健康的效应权重。结果健康行为与健康意识之间呈显著正相关。健康行为对躯体健康的直接效用为0.85,健康意识不仅直接作用躯体健康,而且通过对心理健康的影响对躯体健康产生间接效应,总效应达0.78。结论健康行为、健康意识均是可控的健康危险因素,对躯体健康、心理健康产生一定影响。通过改变这些可控因素可以提高人们整体健康水平。     

Adverse health conditions and health risk behaviors associated with intimate partner violence--United States, 2005

Intimate partner violence (IPV) is defined as threatened, attempted, or completed physical or sexual violence or emotional abuse by a current or former intimate partner. IPV can be committed by a spouse, an ex-spouse, a current or former boyfriend or girlfriend, or a dating partner. Each year, IPV results in an estimated 1,200 deaths and 2 million injuries among women and nearly 600,000 injuries among men. In addition to the risk for death and injury, IPV has been associated with certain adverse health conditions and health risk behaviors. To gather additional information regarding the prevalence of IPV and to assess the association between IPV and selected adverse health conditions and health risk behaviors, CDC included IPV-related questions in an optional module of the 2005 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report describes the results of that survey, which indicated that persons who report having experienced IPV during their lifetimes also are more likely to report current adverse health conditions and health risk behaviors. Although a causal link between IPV and adverse health conditions cannot be inferred from these results, they underscore the need for IPV assessment in health-care settings. In addition, the results indicate a need for secondary intervention strategies to address the health-related needs of IPV victims and reduce their risk for subsequent adverse health conditions and health risk behaviors.     

Early childhood economic disadvantage and the health of Hispanic children

This research provides a longitudinal view of early childhood economic deprivation and its associations with health among young Hispanic children born in the United States. Of additional interest is whether economic deprivation is associated with child health similarly across all Hispanic children or whether associations differ by maternal nativity or country of origin. Fragile Families and Child Wellbeing data and multinomial logistic regression are used to estimate the effects of total years in poverty, material hardship, and lack of health insurance on Hispanic children's health status at age 5 and change in health status between ages 1 and 5. Results show that multiple measures of early childhood economic deprivation have additive negative associations with Hispanic child health, and that living more years in poverty is associated with declining health status among young Hispanic children. Interaction effects indicate that early childhood poverty has stronger associations with lower age 5 health status and declining health between ages 1 and 5 for children with foreign-born Hispanic mothers than for those with native-born Hispanic mothers. No differences were found in the associations between economic deprivation and child health by maternal country of origin. These results suggest an important role of economic resources for protecting Hispanic child health, and that poor Hispanic children with immigrant mothers may be at particularly high risk of developing health problems as they move out of infancy and into early childhood.     

Poverty, wealth inequality and health among older adults in rural Cambodia

Little research exists on health determinants among adults living in economically deprived regions despite the fact that these areas comprise a good part of the world. This paper examines the distribution of wealth then tests associations between wealth inequality and a variety of health outcomes, among older adults, in one of the world's poorest regions--rural Cambodia. Data from the 2004 Survey of the Elderly in Cambodia are employed. Using a disablement framework to conceptualize health, associations between four health components and a wealth inequality measure are tested. The wealth inequality measure is based on an index that operationalizes wealth as ownership of household assets and household structural components. Results confirm difficult economic conditions in rural Cambodia. The lowest wealth quintile lives in households that own nothing, while the next quintiles are only slightly better off. Nevertheless, logistic regressions that adjust for other covariates indicate heterogeneity in health across quintiles that appear qualitatively similar, with the bottom quintiles reporting the most health problems. An exception is disability, which presents a U-shaped association. It is difficult to determine mechanisms behind the relationship using cross-sectional data, but the paper speculates on possible causal directions, both from wealth to health and vice-versa. The analysis suggests the ability to generalize the relationship between wealth inequality and health to extremely poor populations as a very small difference in wealth makes a relatively large difference with respect to health associations among those in meager surroundings.