Differences In Prevalence Research Articles

Increased prevalence of depression and anxiety among adults initiating antiretroviral therapy during the COVID-19 pandemic in Shinyanga region, Tanzania

BackgroundConcerns about the interconnected relationship between HIV and mental health were heightened during the COVID-19 pandemic. This study assessed whether there were temporal changes in the mental health status of people living with HIV presenting for care in Shinyanga region, Tanzania. Specifically, we compared the prevalence of depression and anxiety before and during COVID-19, with the goal of describing the changing needs, if any, to person-centered HIV services.MethodsWe analyzed baseline data from two randomized controlled trials of adults initiating ART in Shinyanga region, Tanzania between April-December 2018 (pre-COVID-19 period, n = 530) and May 2021-March 2022 (COVID-19 period, n = 542), respectively. We compared three mental health indicators that were similarly measured in both surveys: loss of interest in things, hopelessness about the future, and uncontrolled worrying. We also examined depression and anxiety which were measured using the Hopkins Symptom Checklist-25 in the pre-COVID-19 period and the Patient Health Questionnaire-4 in the COVID-19 period, respectively, and classified as binary indicators per each scale’s threshold. We estimated prevalence differences (PD) in adverse mental health status before and during the COVID-19 pandemic, using stabilized inverse probability of treatment weighting to adjust for underlying differences in the two study populations.ResultsWe found significant temporal increases in the prevalence of feeling ‘a lot’ and ‘extreme’ loss of interest in things [‘a lot’ PD: 38, CI 34,41; ‘extreme’ PD: 9, CI 8,12)], hopelessness about the future [‘ a lot’ PD: 46, CI 43,49; ‘extreme’ PD: 4, CI 3,6], and uncontrolled worrying [‘ a lot’ PD: 34, CI 31,37; ‘extreme’ PD: 2, CI 0,4] during the COVID-19 pandemic. We also found substantially higher prevalence of depression [PD: 38, CI 34,42] and anxiety [PD: 41, CI 37,45].ConclusionsAfter applying a quasi-experimental weighting approach, the prevalence of depression and anxiety symptoms among those starting ART during COVID-19 was much higher than before the pandemic. Although depression and anxiety were measured using different, validated scales, the concurrent increases in similarly measured mental health indicators lends confidence to these findings and warrants further research to assess the possible influence of COVID-19 on mental health among adults living with HIV.Trial Registration NCT03351556, registered November 24, 2017; NCT04201353, registered December 17, 2019.

Differences in influenza vaccination by gender identity and state-level gender equity policies: Behavioral Risk Factor Surveillance System, 2015–2019

BackgroundIt is estimated that there are one million transgender and over 340,000 gender non-conforming people in the United States, many of whom face significant health disparities including access to healthcare. Although previous studies have reported greater vaccine uptake in women compared to men, national-level estimates of influenza vaccine uptake among transgender and non-binary people are unknown. This study aims to characterize differences in influenza vaccine uptake by gender identity and examine associations between vaccination status and state-level gender equity policies. MethodsWe used cross-sectional data from adults participating in the 2015–2019 United States Behavioral Risk Factors Surveillance System surveys. Weighted prevalence differences (PDs) and associated confidence intervals (CIs) of being unvaccinated against influenza by self-reported gender identity were estimated using generalized linear regression models. ResultsCompared to cisgender women (unvaccinated prevalence = 57.3%), the prevalence of being unvaccinated was significantly higher among cisgender men (64.4%; PD = 7.0 per 100, 95% CI: 6.7–7.4), transgender women (65.4%; PD = 8.1 per 100, 95% CI 4.0–12.2), transgender men (64.6%; PD = 7.3 per 100, 95% CI: 2.7–11.8), and gender non-conforming individuals (64.6%; PD = 7.2 per 100, 95% CI: 1.3–13.2). This pattern was similar among individuals living in states with protective versus restrictive gender equity policies. ConclusionsOur results identified a disparity in influenza vaccine uptake among individuals across the gender spectrum. To improve vaccine equity, future research should explore barriers to and facilitators of vaccine uptake by gender identity, which could inform policies and health promotion interventions to improve uptake co-designed and implemented with the transgender and non-binary communities.

Rural-Urban Variation in the Association of Adolescent Violence and Handgun Carrying in the United States, 2002-2019

Adolescent handgun carrying is associated with increased risk of firearm-related violence. Most evidence on adolescent handgun carrying is from urban areas, but these findings may not generalize to rural areas. To examine differences in associations of adolescent interpersonal violence with handgun carrying across the rural-urban continuum. This cross-sectional study used nationally representative data from the US National Survey on Drug Use and Health among adolescents aged 12 to 17 years from 2002 to 2019 to estimate time-varying prevalence ratios (PRs) and prevalence differences (PDs) between interpersonal violence and handgun carrying across the rural-urban continuum. Analyses were conducted in April to July 2022. Any past-year serious fighting, group fighting, and attacking with intent to harm. Any past-year handgun carrying. Associations were estimated within county rural-urban strata using the US Department of Agriculture's Rural-Urban Continuum Codes. In each year, the sample included a weighted count of almost 25 million adolescents, with 50.9% (95% CI, 50.2%-51.6%) males and 24.7% (95% CI, 23.8%-25.6%) Hispanic adolescents, 13.5% (95% CI, 12.8%-14.2%) non-Hispanic Black adolescents, and 51.8% (95% CI, 50.8%-52.8%) non-Hispanic White adolescents in 2019. More rural counties had less racial and ethnic diversity. For example, 81.1% (95% CI, 75.9%-85.4%) of adolescents were non-Hispanic White in the most rural counties vs 43.1% (95% CI, 41.7%-44.6%) of adolescents were non-Hispanic White in the most urban counties in 2019. Adolescent handgun carrying increased over time, with the largest increases in the most rural counties, where the prevalence of adolescent handgun carrying increased from 5.2% (95% CI, 3.8%-7.0%) in 2003 to 12.4% (95% CI, 8.9%-16.9%) in 2019. PRs for the association of violence and handgun carrying were greater in more urban counties. For example, in the most urban counties in 2019, adolescents involved in a group fight had 3.7 (95% CI, 2.9-4.8) times the prevalence of handgun carrying vs those not involved in a group fight; this PR was 3.1 (95% CI, 1.6-5.6) in the most rural counties. PDs were similar and, in some cases, larger in rural areas. For example, in the most urban counties in 2019, handgun carrying prevalence was 7.5% (95% CI, 5.7%-9.5%) higher among adolescents who were involved in a group fight compared with those who were not; this PD was 21.8% (95% CI, 8.2%-37.8%) in the most rural counties, where handgun carrying was more common. This cross-sectional study found that associations of interpersonal violence with handgun carrying were stronger in relative terms in urban areas than in rural areas; however, a higher percentage of rural than urban adolescents carried handguns, resulting in a greater absolute prevalence of handgun carrying associated with violence in rural areas than in urban areas. These findings suggest opportunities for preventing handgun carrying-related harms may differ between rural and urban communities.

Joint effects of individual socioeconomic status and residential neighborhood context on vaginal microbiome composition.

The vaginal microbiome is a dynamic ecosystem that is important for women's health. Its composition has been associated with risk for menopausal symptoms, sexually transmitted infections, gynecologic cancer, and preterm birth. Conventional risk factors for a vaginal microbiome linked with these adverse health outcomes include sexual behaviors, hygiene practices, individual social factors, and stress levels. However, there has been limited research on socio-contextual determinants, and whether neighborhood context modifies the association with individual socioeconomic factors. Socioeconomically diverse pregnant African American women in Atlanta, Georgia (n = 439) provided residential addresses and first trimester vaginal swab samples, which underwent sequencing, taxonomic classification, and assignment into mutually exclusive CST (community state types) via hierarchical clustering. Linear probability models were used to estimate prevalence differences (PD) for the associations of neighborhood factors with vaginal microbiome CST and to evaluate for additive interaction with maternal level of education, health insurance type, and recruitment hospital. Factors such as higher (vs. lower) maternal education, private (vs. public) insurance, and private (vs. public) hospital were associated with higher prevalence of Lactobacillus-dominant vaginal microbiome CSTs typically associated with better health outcomes. When considering the joint effects of these individual socioeconomic status and residential neighborhood factors on vaginal microbiome CST, most combinations showed a greater than additive effect among the doubly exposed; however, in the case of local income homogeneity and local racial homogeneity, there was evidence of a crossover effect between those with less-advantaged individual socioeconomic status and those with more-advantaged individual socioeconomic status. Compared to women at the public hospital who lived in economically diverse neighborhoods, women at the private hospital who lived in economically diverse neighborhoods had a 21.9% higher prevalence of Lactobacillus-dominant CSTs, while women at the private hospital who lived in less economically diverse neighborhoods (the doubly exposed) had only an 11.7% higher prevalence of Lactobacillus-dominant CSTs, showing a crossover effect (interaction term p-value = 0.004). In this study, aspects of residential neighborhood context were experienced differently by women on the basis of their individual resources, and the joint effects of these exposures on vaginal microbiome CST showed a departure from simple additivity for some factors.

Sex differences in Cannabis use disorder and associated psychosocial problems among US adults, 2012–2013

While men show greater prevalence of cannabis use disorder (CUD) than women, whether cannabis use frequency drives this difference is unknown, and little is known about sex differences in problems associated with CUD. We therefore assessed the association of CUD with sex, adjusted for frequency of use, and compared the association of psychosocial and health-related problems with CUD between men and women. We included US adults age ≥ 18 who reported past-year cannabis use in the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (n = 3701). Cannabis use frequency, DSM-5 CUD and problems (interpersonal, financial, legal, health-related) were assessed. Associations between psychosocial problems, sex and DSM-5 CUD were assessed using prevalence differences (PD) and 95% confidence intervals (CI) from logistic regression models, controlling for demographics and cannabis use frequency, and effect modification by sex was assessed. We found that the prevalence of CUD among men versus women was not significantly greater after adjusting for use frequency. Women had significantly higher prevalence of interpersonal, financial and health-related problems than men, adjusting for frequency of use. Women showed significantly greater association of CUD with interpersonal problems with a boss or co-workers (p < 0.05) and a neighbor, relative or friend (p < 0.05) compared to men. Lack of sex differences in CUD after adjusting for frequency of use suggests use frequency may be an important target of CUD prevention efforts. CUD showed stronger associations for interpersonal problems among women than men, suggesting the need for particular emphasis on treating interpersonal problems related to cannabis use among women.

100. Differences in influenza vaccination by gender identity and state-level gender equity policies: Data from the Behavioral Risk Factor Surveillance System, 2015-2019

Abstract Background It is estimated that 1.4 million people identify as transgender and over 700,000 people identify as non-binary in the United States, many of whom face significant health disparities impacting health care access. Although previous studies have reported greater vaccine uptake in women compared to men, national-level estimates of influenza vaccine uptake among transgender and non-binary people are unknown. This study aims to characterize differences in influenza vaccination by gender identity and examine associations between vaccination status and state-based gender equality policies. Methods We used cross-sectional data from adults aged 18 and older who participated in the 2015-2019 United States Behavioral Risk Factors Surveillance System surveys. Weighted prevalence differences (PDs) and associated confidence intervals (CIs) of being unvaccinated against influenza by self-reported gender identity were estimated using generalized linear regression models. We identified state policies on gender identity (Figure 1) as a potential effect modifier a priori and assessed through stratification. Figure 1.U.S. states implementing the SOGI module in Behavioral Risk Factors Surveillance System between 2015-2019, classified as having restrictive versus protective policies on gender equality (N = 38) Results A total of 1,016,012 individuals met the inclusion criteria. Compared to cisgender women (unvaccinated prevalence=57.3%), the prevalence of being unvaccinated was significantly higher among cisgender men (64.4%; PD=7.0 per 100, 95% CI: 6.7-7.4), transgender women (65.4%; PD=8.1 per 100, 95% CI: 4.0-12.2), transgender men (64.6%; PD=7.3 per 100, 95% CI: 2.7-11.8), and non-binary individuals (64.6%; PD=7.2 per 100, 95% CI: 1.3-13.2). This pattern was similar among individuals living in protective states with more favorable gender-related policies compared to restrictive states with less favorable policies (Figure 2). Figure 2.Weighted prevalence of U.S. adults unvaccinated against influenza by gender identity, Behavioral Risk Factors Surveillance System, 2015-2019 Conclusion Our results provide evidence of a disparity in influenza vaccine uptake by gender identity. To improve vaccine uptake among transgender and non-binary individuals, future research should focus on identifying barriers to and facilitators of vaccination by gender identity. These findings could be used to inform policies and public health interventions to improve vaccine uptake co-designed and implemented in partnership with the transgender and non-binary communities. Disclosures All Authors: No reported disclosures.

Prevalence of essential newborn care in home and facility births in the Peruvian Amazon: analysis of census data from programme evaluation in three remote districts of the Loreto region

Essential newborn care (ENC) covers optimal breastfeeding, thermal care, and hygienic cord care. These practices are fundamental to save newborn lives. Despite neonatal mortality remaining high in some parts of Peru, no comprehensive data on ENC is available. We sought to estimate the prevalence of ENC and assess differences between facility and home births in the remote Peruvian Amazon. We used baseline data from a household census of rural communities of three districts in Loreto region, collected as part of the evaluation of a maternal-neonatal health (MNH) programme. Women between 15 and 49 years with a live birth in the last 12 months were invited to complete a questionnaire about MNH-related care and ENC. Prevalence of ENC was calculated for all births and disaggregated by place of birth. Adjusted prevalence differences (PD) were post-estimated from logistic regression models on the effect of place of birth on ENC. All 79 rural communities with a population of 14,474 were censused. Among 324 (>99%) women interviewed, 70% gave birth at home, most (93%) without skilled birth assistance. Among all births, prevalence was lowest for immediate skin-to-skin contact (24%), colostrum feeding (47%), and early breastfeeding (64%). ENC was consistently lower in home compared to facility births. After adjusting for confounders, largest PD were found for immediate skin-to-skin contact (50% [95% CI: 38-62]), colostrum feeding (26% [16-36]), and clean cord care (23% [14-32]). ENC prevalence in facilities ranged between 58 and 93%; delayed bathing was lower compared to home births (-19% [-31 to-7]). Low prevalence of ENC practices among home births in a setting with high neonatal mortality and difficult access to quality care in facilities suggests potential for a community-based intervention to promote ENC practices at home, along with promotion of healthcare seeking and simultaneous strengthening of routine facility care. Grand Challenges Canada and Peruvian National Council of Science, Technology, and Technology Innovation.

Adolescent and adult time trends in US hallucinogen use, 2002-19: any use, and use of ecstasy, LSD and PCP.

Hallucinogen use is potentially harmful. Information on whether such use has increased in recent decades is lacking. This study assessed overall and age-specific time trends in the prevalence of 12-month hallucinogen use in the US general population. Cross-sectional. Data from the US National Survey on Drug Use and Health, 2002-19. Respondents aged ≥ 12 years (n = 1 006 051). Predictors were continuous years. Outcome variables included any hallucinogen use and use of lysergic acid diethylamide (LSD), ecstasy and phencyclidine (PCP) in the past year. Socio-demographic variables (gender, age, race/ethnicity, educational level and family income) were covariates. Overall, hallucinogen use increased between 2015 and 2019 [prevalence difference (PD) = +0.44, P< 0.05]. Since 2002, hallucinogen use has increased in adults aged ≥ 26 years (PD, 2002-14 = +0.24, P< 0.05; PD, 2015-19 = +0.45, P< 0.001) and decreased in adolescents aged 12-17 years (PD, 2002-14 = -1.60, P< 0.0001; PD, 2015-19 = -0.73, P< 0.001). Ecstasy use has decreased in adolescents (PD, 2002-14 = -0.56, P< 0.001), adults aged 18-25 years (PD, 2015-19 = -0.96, P< 0.01) and ≥ 26 years (PD, 2015-19 = -0.13, P< 0.05). LSD use between 2002 and 2019 increased overall (PD = +0.71, P< 0.0001) and in all age groups (12-17: PD = +0.67, P< 0.001; 18-25: PD = +3.12, P< 0.0001; ≥ 26: PD = +0.36, P< 0.0001). Conversely, PCP use between 2002 and 2019 decreased overall (PD = -0.06, P< 0.001), in adolescents (PD = -0.24, P< 0.001) and young adults (PD = -0.32, P< 0.0001). Since 2002, hallucinogen use in the United States has decreased among adolescents but increased in adults and is now estimated to affect more than 3 million adults aged 26+ years and more than 5.5 million adults aged 18+ years.

Associations between WASH-related violence and depressive symptoms in adolescent girls and young women in South Africa (HPTN 068): a cross-sectional analysis

ObjectiveThere is a lack of research on experiences of WASH-related violence. This study aims to quantify the association between experience or worry of violence when using the toilet or collecting...

Evaluation of a menstrual hygiene intervention in urban and rural schools in Bangladesh: a pilot study

Girls’ menstrual experiences impact their social and educational participation, physical and psychological health. We conducted a pilot study to assess the acceptability and feasibility of a multi-component intervention intended to support menstruating girls; improve menstrual care knowledge, practices, and comfort; and increase school attendance.We conducted a pre/post evaluation of a 6-month pilot intervention in four schools (2 urban, 2 rural) in Dhaka, Bangladesh. We selected 527 schoolgirls (grades 5 to 10; aged 10 to 17 years) for a baseline survey and 528 girls at endline. The intervention included: 1) Menstrual Hygiene Management (MHM) packs– reusable cloth pads, underwear, carry bags and menstrual cycle tracking calendars, 2) education curriculum- pictorial flipcharts, puberty related-booklets, and teachers’ training to deliver puberty and MHM sessions, 3) maintenance- improvements to school sanitation, provision of disposable pads in the school office, provision of chute disposal systems for disposable pads, and gender committees to promote a gender-friendly school environment and maintenance of intervention facilities. We estimated intervention uptake and intervention effect by calculating prevalence differences and 95% confidence intervals using fixed-effects logistic regression.The intervention uptake was more than 85% for most indicators; 100% reported receiving puberty education, 85% received MHM packs, and 92% received booklets. Reusable cloth pads uptake was 34% by endline compared with 0% at baseline. Knowledge about menstrual physiology and knowledge of recommended menstrual management practices significantly improved from baseline to endline. Reported improvements included more frequent changing of menstrual materials (4.2 times/day at endline vs. 3.4 times/day at baseline), increased use of recommended disposal methods (prevalence difference (PD): 8%; 95% Confidence Interval: 1, 14), and fewer staining incidents (PD: − 12%; 95% CI: − 22, − 1). More girls reported being satisfied with their menstrual materials (59% at endline vs. 46% at baseline, p < 0.005) and thought school facilities were adequate for menstrual management at endline compared to baseline (54% vs. 8%, p < 0.001). At endline, 64% girls disagreed/strongly disagreed that they felt anxious at school due to menstruation, compared to 33% at baseline (p < 0.001). Sixty-five percent girls disagreed/strongly disagreed about feeling distracted or trouble concentrating in class at endline, compared to 41% at baseline (p < 0.001). Self-reported absences decreased slightly (PD: − 8%; 95% CI: − 14, − 2).Uptake of cloth pads, improved maintenance and disposal of menstrual materials, and reduced anxiety at school suggest acceptability and feasibility of the intervention aiming to create a supportive school environment.

A Systematic Review and Meta-Analysis of Mobile Phone Messaging Intervention on Vaccine Preventable Diseases

The re-emerging of vaccine preventable diseases is a global public health burgeoning issue. The incompleteness of vaccination or low uptake rate is due to low awareness of the importance of vaccines, forgetfulness, poor counselling, and health education from the healthcare providers. Mobile phone messaging reminder was one of the most studied interventions to overcome these problems in the last decade due to increasing usage of mobile phones in daily living activities. Therefore the aim of this study was to analyse the effectiveness of mobile phone messaging intervention on vaccination programmes of preventable diseases worldwide. Methods. A systematic literature search of randomised controlled trials on Cochrane database that were published for the past 10 years was done; in which 10 articles were selected for critical appraisal and qualitative synthesis. Out of the 10 articles, 9 articles were selected and proceeded with meta-analysis based on GRADE risk of bias assessment. Results. The overall vaccination coverage of mobile phone messaging in the intervention group was higher than the control group [61,586 (47.7%) versus 61,571(45.7%)] with significant pooled vaccination prevalence difference (PD) of 0.02 (CI 0.01, 0.03). In the subgroup analysis, the pooled PD of childhood vaccination coverage was not significant although significant pooled PD of 0.03 (CI 0.01, 0.04) was detected in the influenza vaccination coverage. Conclusion. This review and meta-analysis have strengthened the evidence that mobile phone messaging is an effective intervention method to increase vaccination coverage, especially for influenza vaccination. However, its effect on childhood vaccination coverage was inconclusive and needed more high quality research. Key words: mobile phone messaging; vaccine preventable illnesses; meta analysis; influenza

Heavy episodic drinking and HIV disclosure by HIV treatment status among People with HIV in IeDEA Cameroon.

Heavy alcohol use is common among people with HIV (PWH), leading to sub-optimal HIV care outcomes. Yet, heavy episodic drinking (HED) is not routinely addressed within most HIV clinics in sub-Saharan Africa. HIV disclosure may provide social support, potentially reducing HED to cope with HIV. We examined the prevalence of HED and HIV disclosure by antiretroviral treatment (ART) status among PWH receiving HIV care in Cameroon. We analyzed routine HIV clinical data augmented with systematic alcohol use data among adult PWH receiving HIV care in three regional hospitals from January 2016 to March 2020. Recent HED prevalence was examined across PWH by ART status: those not on ART, recent ART initiators (ART initiation ≤30 days prior), and ART users (ART initiation >30 days prior); and by gender. We used log-binomial regression to estimate prevalence differences (PD) between HIV disclosure and recent HED by ART status. Among 12,517 PWH in care, 16.4% (95%CI: 15.7, 17.0) reported recent HED. HED was reported among 21.2% (95%CI: 16.0, 26.3) of those not on ART, 24.5% (95%CI: 23.1, 26.0) of recent ART initiators, and 12.9% (95%CI: 12.2, 13.6) of ART users. Regardless of ART status, men were more likely than women to report HED. Those who disclosed HIV status had a lower HED prevalence than those who had not disclosed (aPD: -0.07; 95%CI: -0.10, -0.05) and not modified by gender. The prevalence of recent HED was high among PWH in care. HED prevalence was highest among men and recent ART initiators. Longitudinal analyses should explore how HIV disclosure may support PWH in reducing or abstaining from HED through social support. Systematic HED screening and referral to care should be included in routine HIV clinical care, particularly for men, to improve engagement in the HIV care continuum in Cameroon.

Distinct patterns of comorbidity prior to diagnosis of incident systemic lupus erythematosus in the Danish population

The objective of this study was to assess the cumulative prevalence of pre-existing comorbidities among patients diagnosed with systemic lupus erythematosus (SLE) in Denmark. The study included patients aged ≥18 years at the index date set to the date of first registration of SLE in the Danish National Patient Registry (DNPR) between 1996 and 2018. Up to 19 age- and sex-matched general population comparators per case were selected. Comorbidity diagnoses were retrieved from the DNPR based on International Classification of Diseases codes. We estimated cumulative prevalence of various comorbidities among cases and comparators, prevalence differences (PDs), and prevalence ratios (PRs), with PDs and PRs adjusted for age and sex, at the index date and 1, 2, 5, and 10 years before the index date. We identified 3,010 SLE cases and 57,046 comparators (mean age at index date: 47.3 years). Most comorbidities occurred more often in SLE patients versus comparators at the index date and up to 10 years before. Overrepresented comorbidities in SLE patients 10 years before SLE diagnosis included neuropsychiatric, cardiovascular, and venous thromboembolic diseases; PDs (95% CI) were 2.3% (1.4–3.3%), 1.3% (0.6–1.9%), and 1.1% (0.6–1.5%), respectively; corresponding PRs (95% CI) were 1.5 (1.3–1.8), 1.7 (1.4–2.1), and 4.3 (3.1–6.1). We found a higher prevalence of multiple comorbidities—not only at the time of SLE diagnosis but likewise during the 10-year pre-diagnosis period—among individuals with SLE. These findings underscore the importance of early clinical vigilance toward comorbidities starting in the diagnostic phase of SLE.

The association between three key social determinants of health and life dissatisfaction: A 2017 behavioral risk factor surveillance system analysis

Poor health outcomes disproportionately impact certain populations in the United States owing to the inequitable distribution of social determinants of health (SDOH). Using the 2017 Behavioral Risk Factor Surveillance System (BRFSS), we estimated the association of three adverse SDOH (housing insecurity, food insecurity, and financial instability) with life dissatisfaction. Participants were from Wisconsin, Minnesota, and Ohio, the only states that included the SDOH and Emotional Support and Life Satisfaction modules (n = 25,850). Six percent of respondents reported life dissatisfaction. Those who reported housing insecurity (Prevalence difference (PD) = 14.2 per 100, 95% CI [7.6, 20.7]), food insecurity (PD = 10.9 [7.1, 14.7]), and financial instability (PD = 5.6 [4.9, 6.3]) had higher prevalence of life dissatisfaction. The differences in prevalence of life dissatisfaction, comparing those with and without an adverse SDOH, decreased with increased emotional support (for housing insecurity, food insecurity, and financial instability, respectively: low support, PD = 30.2 [11.6, 48.8], 22.1 [11.6, 32.6], 16.4 [12.0, 20.8]; high support, PD = 4.8 [−2.9, 12.6], 4.8 [0.0, 9.7], 1.7 [1.1, 2.3]). Participants with frequent mental distress (FMD) had greater prevalence differences than those without FMD (for housing insecurity, food insecurity, and financial instability, respectively: with FMD, PD = 15.4 [7.5, 23.3], 10.7 [4.7, 16.7], 14.4 [9.6, 19.3]; without FMD, PD = 6.1 [−0.5, 12.5], 5.3 [1.6, 9.0], 2.5 [2.0, 3.0]). Social determinants may not only influence physical health but also have an impact on psychological well-being. This impact may be altered by levels of emotional support and FMD.

Dominant correlates of depressive disorders and effects on quality of life among older adults in low- and middle-income countries: Further analysis of WHO study on Global Ageing and Adult Health

Background: Poor quality of life (QoL) disrupts social functioning, fulfilment of basic needs, and is associated with depressive disorder (DD). Objective: We answered the question of whether there is a common risk factor for DD across six low- and middle-income countries (LMICs) and determined whether this risk factor can be ranked consistently as the most important predictor of DD in all six LMICs. We estimated the effect of DD on QoL for each country and meta-analyzed the results to generate a pooled effect estimate of DD on QoL in the six LMICs. Methods: We used data from the WHO Study on Global Ageing and Adult Health (SAGE). This study involved a total of 35,164 older adults aged ≥ 50 yr. in six LMICs: China, 13,408; Ghana, 4,305; India, 7,108; Mexico, 2,309; Russian Federation, 3,763; and South Africa, 3,842. We conducted an extensive literature review to select the list of 58 potential risk factors associated with DD. We used double selection Least Absolute Shrinkage and Selection Operator Poisson regression model to identify country-specific risk factors associated with DD. Weighted dominance analysis (WDA) was performed to determine the most important risk factor of DD. To estimate the effect of DD on QoL, we used inverse probability weighting Poisson regression adjustment for each country, and meta-analysis techniques for a pooled estimate of the overall effect. Results: The risk factors for DD were generally country specific. However, asthma was the most common and the most important predictor of DD across all six SAGE countries. In Ghana, the prevalence of DD among older adults who have been diagnosed with asthma or have experienced symptoms of asthma in the 12 months preceding the survey was 14 times that among those without asthma or asymptomatic of asthma [Adjusted Prevalence Ratio (aPR), 14.46, 95% confidence interval (CI): 10.47 - 19.97; p &lt; 0.001]. Similarly, it was 14 times in South Africa (aPR, 14.6; 95% CI: 8.18 - 26.14; p &lt; 0.00) but in Mexico, it was 4 times (aPR, 4.39; 95% CI: 3.00 - 6.42; p &lt; 0.001) and in China (aPR, 5.99; 95% CI: 4.32 - 8.31; p &lt; 0.001) and Russia (aPR, 5.90; 95% CI: 3.9 - 9.0; p &lt; 0.001), it was 6 times. In India, it was 5 times (aPR=5.1; 95% CI: 4.3 - 6.0; p &lt; 0.001. Generally, there was evidence of 8% increase in poor QoL due to the presence of DD (Pooled estimate, 0.08; 95% CI: 6.0 – 12; p &lt; 0.001). Specifically, in China, there was evidence of 12% increase in poor QoL that could be attributed to DD (prevalence difference (PD), 0.12; 95% CI: 0.07 - 0.18; p &lt; 0.001). In India (PD, 0.08; 95% CI: 0.04 - 0.13; p &lt; 0.01) and Russian Federation (PD, 0.08; 95% CI: 0.01 - 0.15; p &lt; 0.01), there was evidence of 8% increase in poor QoL. Although, there was some increase in poor QoL in Mexico, Ghana, and South Africa due to DD, the increase was not statistically significant. Conclusion: Although different factors could explain the prevalence of DD among older adults in the six LMICs, it was evident that asthma patients amongst this population were at a higher risk of DD. Clinical evaluation and potential diagnosis and treatment of DD among older adults who present with asthma could potentially enhance their QoL

Anxiety and Depression Symptom Level and Psychotherapy Use Among Music and Art Students Compared to the General Student Population.

Purpose: Previous epidemiological studies have shown higher levels of anxiety and depressive symptoms among professional musicians, compared to the general workforce. Similar findings have been observed for psychotherapy use among musicians. To date, large-scale investigations of prevalence rates among music and arts students are lacking.Methods: Eight hundred and eighty students from music and arts institutions and faculties were derived from a national health student survey for higher education in Norway (the SHoT study). They were compared to a sample of the general student population (n = 48,729). We used logistic regression analysis, adjusting for age, sex, and semesters of study.Results: Music and arts students reported higher rates of anxiety [OR 1.60 (1.38–1.85), Prevalence difference (PD) 9.6 (6.3–12.8)] and depression symptoms [OR 1.41 (1.22–1.62), PD 7.9 (4.5–11.2)] compared to the general student force. Similar patterns were observed for self-reported mental disorders [OR 1.71 (1.46–2.01), PD 8.1 (5.3–11.0)], as well as psychotherapy use [OR 1.91 (1.60–2.29), PD 7.4 (4.9–9.9)] in music and arts students.Conclusions: Our findings are consistent with studies comparing musicians to the general workforce, and indicate that challenges also exist at student level, and not only after becoming a professional in the performing arts, which is important when planning health-related measures. These findings have the potential to inform on health promotion and services in the educational system.

Widening Socioeconomic Inequalities in Smoking in Japan, 2001-2016.

BackgroundJapan is one of the world’s largest tobacco epidemic countries but few studies have focused on socioeconomic inequalities. We aimed to examine whether socioeconomic inequalities in smoking have reduced in Japan in recent times.MethodsWe analyzed data from the Comprehensive Survey of Living Conditions, a large nationally representative survey conducted every 3 years (n ≈ 700,000 per year) in Japan, during 2001–2016. Age-standardized smoking prevalence was computed based on occupational class and educational level. We calculated smoking prevalence difference (PD) and ratio (PR) of (a) manual workers versus upper non-manual workers and (b) low versus high educational level. The slope index of inequality (SII) and relative index inequality (RII) by educational level were used as inequality measures.ResultsOverall smoking prevalence (25–64 years) decreased from 56.0% to 38.4% among men and from 17.0% to 13.0% among women during 2001–2016. The PD between manual and upper non-manual workers (25–64 years) increased from 11.9% (95% confidence interval [CI], 11.0–12.9%) to 14.6% (95% CI, 13.5–15.6%) during 2001–2016. In 2016, smoking prevalence (25–64 years) for low, middle, and highly educated individuals were 57.8%, 43.9%, and 27.8% for men, and 34.7%, 15.9%, and 5.6% for women, respectively. SII and RII by educational level increased among both sexes. Larger socioeconomic differences in smoking prevalence were observed in younger generations, which suggests that socioeconomic inequalities in smoking evolve in a cohort pattern.ConclusionsSocioeconomic inequalities in smoking widened between 2001 and 2016 in Japan, which indicates that health inequalities will continue to exist in near future.

Pain, cannabis use, and physical and mental health indicators among veterans and nonveterans: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III.

Chronic pain is associated with mental and physical health difficulties and is prevalent among veterans. Cannabis has been put forth as a treatment for chronic pain, and changes in laws, attitudes, and use patterns have occurred over the past 2 decades. Differences in prevalence of nonmedical cannabis use and cannabis use disorder (CUD) were examined across 2 groups: veterans or nonveterans and those reporting or not reporting recent pain. Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013; n = 36,309) were analyzed using logistic regression. Prevalence differences (PDs) for 3 cannabis outcomes (1) past-year nonmedical cannabis use, (2) frequent (≥3 times a week) nonmedical use, and (3) DSM-5 CUD were estimated for those reporting recent moderate to severe pain (veterans or nonveterans) and veterans reporting or not reporting recent pain. Difference in differences was calculated to investigate PDs on outcomes associated with residence in a state with medical cannabis laws (MCLs). Associations between physical and mental health and cannabis variables were tested. The results indicated that the prevalence of recent pain was greater among veterans (PD = 7.25%, 95% confidence interval (CI) [4.90-9.60]). Among veterans, the prevalence of frequent cannabis use was greater among those with pain (PD = 1.92%, 98% CI [0.21-3.63]), and among veterans residing in a state with MCLs, the prevalence of CUD was greater among those reporting recent pain (PD = 3.88%, 98% CI [0.36-7.39]). Findings failed to support the hypothesis that cannabis use improves mental or physical health for veterans with pain. Providers treating veterans with pain in MCL states should monitor such patients closely for CUD.

Time trends of socioeconomic inequalities in adolescent smoking in Okinawa, Japan, 2008\u20132016: a repeated cross-sectional study

BackgroundSmoking among Japanese adolescents has decreased noticeably. However, little is known whether the decreasing trend in adolescent smoking can be seen across all socioeconomic status (SES) groups. This study aimed to examine trends in socioeconomic inequalities in smoking among Japanese adolescents between 2008 and 2016.MethodsWe conducted a repeated cross-sectional study using data from three surveys of high school students in Okinawa, Japan, in 2008, 2012, and 2016. The study participants consisted of 7902 students in grades 10 through 12 (15–18 years). Smoking was assessed as current cigarette use. SES indicators included familial SES (parental education and family structure) and student’s own SES (school type). To evaluate absolute and relative inequalities, prevalence differences (PDs) and ratios (PRs) between low and high SES groups were estimated. The slope index of inequality (SII) and relative index of inequality (RII) were also calculated.ResultsSmoking prevalence among boys and girls significantly declined from 11.5% and 6.2% in 2008 to 4.7% and 1.9% in 2016, respectively. Similar decreasing trends in smoking were found among most of the SES groups. The PDs and SII for parental education in boys and family structure in girls decreased over time while those for school type persisted among boys and girls. The PRs and RII for school type in boys increased while those for other SES indicators among both sexes remained stable over time.ConclusionsSmoking among Japanese adolescents has been declining and time trends of socioeconomic inequalities in smoking varied by absolute and relative measures. Further policies and/or interventions to reduce smoking inequalities should focus on the context of schools, especially in vocational high schools.

Racial/Ethnic and Income Disparities in the Prevalence of Comorbidities that Are Associated With Risk for Severe COVID-19 Among Adults Receiving HIV Care, United States, 2014-2019.

Health inequities among people with HIV may be compounded by disparities in the prevalence of comorbidities associated with an increased risk of severe illness from COVID-19. Complex sample survey designed to produce nationally representative estimates of behavioral and clinical characteristics of adults with diagnosed HIV in the United States. We estimated the prevalence of having ≥1 diagnosed comorbidity associated with severe illness from COVID-19 and prevalence differences (PDs) by race/ethnicity, income level, and type of health insurance. We considered PDs ≥5 percentage points to be meaningful from a public health perspective. An estimated 37.9% [95% confidence interval (CI): 36.6 to 39.2] of adults receiving HIV care had ≥1 diagnosed comorbidity associated with severe illness from COVID-19. Compared with non-Hispanic Whites, non-Hispanic Blacks or African Americans were more likely [adjusted PD, 7.8 percentage points (95% CI: 5.7 to 10.0)] and non-Hispanic Asians were less likely [adjusted PD, -13.7 percentage points (95% CI: -22.3 to -5.0)] to have ≥1 diagnosed comorbidity after adjusting for age differences. There were no meaningful differences between non-Hispanic Whites and adults in other racial/ethnic groups. Those with low income were more likely to have ≥1 diagnosed comorbidity [PD, 7.3 percentage points (95% CI: 5.1 to 9.4)]. Among adults receiving HIV care, non-Hispanic Blacks and those with low income were more likely to have ≥1 diagnosed comorbidity associated with severe COVID-19. Building health equity among people with HIV during the COVID-19 pandemic may require reducing the impact of comorbidities in heavily affected communities.