Excellent Self-rated Health Research Articles

Is subjective well-being independently associated with mortality? A 14-year prospective cohort study in a representative sample of 25 139 US men and women

ObjectivesTo examine whether the inverse association of subjective well-being with mortality is independent of self-rated health and socioeconomic status in healthy adults.DesignA population-based prospective cohort study based on an in-person...

Specific types of sports and exercise group participation and socio-psychological health in older people

ABSTRACTOlder people who engage in sports and exercise in a group render greater benefits for socio-psychological aspects compared to exercising alone. The aim of this study was to identify the prevalence of specific types of sports and exercise groups and the association with self-rated health, depressive symptoms, and frequency of laughter among community-dwelling older people. We used cross-sectional data from the 2016 Japan Gerontological Evaluation Study and analysed 63,465 males and 68,497 females aged ≥65 years. The top three most popular types among males were golf (11.3%), walking (8.4%), and ground golf (6.3%). Among females, the top three were fitness exercises (13.8%), walking (8.3%), and weight exercises (6.2%). After adjusting for potential confounders, engaging in golf with a group was significantly related with excellent self-rated health (prevalence ratio, PR, 1.31 in male and 1.78 in female), low depressive symptoms (PR, 0.70 and 0.71), and a high frequency of laughter (PR, 1.12 and 1.13). Among females, walking displayed a significant relationship with all three characteristics (PR, 1.23, 0.79, and 1.06, respectively). Golf in older males and walking in older females might be the first choice for an effective programme to spread sports and exercise groups within the older Japanese community.

Trends in excellent self-rated healthamong adolescents: A comparative Nordic study

Background: Excellent self-rated health (SRH) can be seen as an important component of positive health among adolescents. The aim of this paper is to examine time trends of excellent health among a ...

Relative Income and Life Satisfaction among Chinese Adults

Life satisfaction is a key component of people’s subjective well-being. This study assessed the relationship between relative income and life satisfaction among Chinese adults, using data from a cross-sectional survey. Individual-level data (N = 1369) came from the 2016 China Genuine Progress indicator Survey (CGPiS) conducted in Beijing and Chengdu, China. Ordered logistic regressions were performed to examine the relationship between relative income and life satisfaction among CGPiS adult respondents. Respondents’ life satisfaction was positively associated with relative income in comparison to their relatives and friends but not associated with relative income in comparison to their residing community and city. Subgroup analyses replicated the findings among male respondents and respondents with good or excellent self-rated health. In contrast, female respondents’ life satisfaction was positively associated with relative income in comparison to their city of residence, but not associated with relative income in comparison to their relatives, friends, and residing community. Life satisfaction among those with poor or fair self-rated health was not associated with any of the four dimensions of relative income. Relative income in comparison to relatives and friends was positively associated with life satisfaction in Chinese adults. Future studies adopting a longitudinal or experimental design are warranted to replicate the findings.

Excellent Self-Rated Health Associated With Activities of Higher Intensities: A Compositional Data Analysis Approach

This study investigates the association between self-rated health and the time spent in sedentary behavior (SB), low light-intensity physical activity (LLPA), high light-intensity physical activity (HLPA), and moderate to vigorous physical activity (MVPA), by controlling for demographics, socioeconomic status, and chronic diseases. A total of 1665 participants (55% women) completed a questionnaire about demographics, chronic diseases, and anthropometric characteristics and provided objective physical activity data on time in SB, LLPA, HLPA, and MVPA, using an ActiGraph 7164 accelerometer. Association between self-rated health and activity data was explored in a compositional data analysis. The multinomial logistic regression analysis showed a significantly lower time spent in MVPA in proportion to time in other movement behaviors (SB, LLPA, and HLPA) for participants who rated their health as alright or poor compared with excellent (P < .001). Participants with poor, compared with excellent health, spent about a third of the time in MVPA (17 vs 50min), marginally higher time in HLPA (134 vs 125min), more time in LLPA (324 vs 300min), and similar time in SB (383 vs 383min), accounting for confounders and time in other movement behaviors. Promoting MVPA, as opposed to time in other movement behaviors, is suggested to be beneficial for excellent self-rated health.

Self-Rated Health and Lifestyle/Food Habits in Japanese Junior High School Students

Adolescence is a crucial period for health status formation. Adolescence is the period during which health-related behaviours, such as nutrition-related behaviours and physical activities, are developed. Self-rated health (SRH) assessment during adolescence is strongly associated with general well-being and psychosomatic symptoms. The current study investigated the relationship between SRH and lifestyle, eating habits and attitudes toward food among junior high school students. A total of 438 students aged 13&amp;ndash;15 years and their parents in the Hyogo prefecture of Japan participated in this study. Questionnaires were distributed to the students, who attempted them at home with their parents and returned them via Freepost envelopes. The questionnaires comprised the SRH assessment, lifestyle information, an unidentifiable description of the subject and their guardian&amp;rsquo;s SRH, and 39 parameters regarding food-related habits and attitudes. The &amp;chi;2 test or Fisher&amp;rsquo;s exact test were employed to assess any associations between the independent variables and SRH at a 5% level of significance. The differences between the healthy and unhealthy SRH groups were examined for all significant items using a logistic regression analysis after adjusting for sex and age. Of the participants, 188 (42.9%) returned both completed questionnaires. Among the respondents, 53.2% reported feeling very healthy. SRH assessment did not significantly differ with sex, age or school. Eleven parameters were significantly associated with SRH (P &amp;lt; 0.05 by &amp;chi;2 test). The guardians&amp;rsquo; SRH had no association with the students&amp;rsquo; SRH. The excellent SRH group had no headaches [odd&amp;rsquo;s ratio (OR): 1.68; confidence interval (CI): 1.29&amp;ndash;2.18], went to bed early [OR: 1.88; CI: 1.17&amp;ndash;3.02], liked home-cooked meals to a greater extent [OR: 2.55; CI: 1.54&amp;ndash;4.22], and had good exercise habits [OR: 2.98; CI: 1.27&amp;ndash;6.99] compared with the very good to poor SRH group. High SRH was strongly associated with going to bed early, not having headaches, liking home-cooked meals, and having good exercise habits among Japanese junior high school students.

Health-related predictors of cancer registry-notified cancer of unknown primary site (CUP)

BackgroundThe relationship between comorbid disease and health service use and risk of cancer of unknown primary site (CUP) is uncertain. MethodsA prospective cohort of 266,724 people aged 45 years and over in New South Wales, Australia. Baseline questionnaire data were linked to cancer registration, health service records 4–27 months prior to diagnosis, and mortality data. We compared individuals with incident registry-notified CUP (n = 327; 90% C80) to two sets of randomly selected controls (3:1): (i) incident metastatic cancer of known primary site (n = 977) and (ii) general cohort population (n = 981). We used conditional logistic regression to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). ResultsIn fully adjusted models incorporating sociodemographic and lifestyle factors, people with cancer registry-notified CUP were more likely to have fair compared with excellent self-rated overall health (OR 1.78, 95% CI 1.01–3.14) and less likely to self-report anxiety (OR 0.48, 95% CI 0.24−0.97) than those registered with metastatic cancer of known primary. Compared to general cohort population controls, people registered with CUP were more likely to have poor rather than excellent self-rated overall health (OR 6.22, 95% CI 1.35–28.6), less likely to self-report anxiety (OR 0.28, 95% CI 0.12−0.63), and more likely to have a history of diabetes (OR 1.89, 95% CI 1.15–3.10) or cancer (OR 1.62, 95% CI 1.03–2.57). Neither tertiary nor community-based health service use independently predicted CUP risk. ConclusionLow self-rated health may be a flag for undiagnosed cancer, and an investigation of its clinical utility in primary care appears warranted.

Association Between Self-rated Health, Coronary Artery Calcium Scores, and Atherosclerotic Cardiovascular Disease Risk

The interplay of self-rated health (SRH), coronary artery calcium (CAC) scores, and cardiovascular risk is poorly described. To assess the degree of correlation between SRH and CAC, to determine whether these measures are complementary for risk prediction, and to assess the incremental value of the addition of SRH to established risk tools. The Multi-Ethnic Study of Atherosclerosis (MESA) is a large population-based prospective cohort study of adults aged 45 to 84 years who were recruited from 6 US communities. A total of 6764 participants without baseline cardiovascular disease (CVD) were included in the analysis. Data were collected from July 2000 through August 2002. Follow-up was completed by December 2013, and data were analyzed from October 2018 to December 2018. The EVGGFP (excellent, very good, good, fair, and poor) self-assessment of overall health (assessed before the baseline study examination) and CAC score. The EVGGFP rating was categorized as poor/fair, good, very good, or excellent. Hard coronary heart disease (CHD) events, hard CVD events, and all-cause mortality during a median follow-up of 13.2 years (interquartile range, 12.7-13.7 years). Among the study population of 6764 participants, the mean (SD) age was 62.1 (10.2) years, and 52.9% were women. The EVGGFP rating was strongly associated with age, sex, race/ethnicity, educational and income levels, healthy diet and physical activity, and cardiovascular risk factors. Despite encapsulating many risk variables, no correlation (r = -0.007; P = .57) or association between EVGGFP and the presence (χ2 = 0.84; P = .84) or severity (χ2 = 4.64; P = .86) of CAC was found. During follow-up, 1161 deaths, 637 hard CVD events, and 405 hard CHD events were recorded. In models adjusted for age, sex, race/ethnicity, and CAC, participants who reported excellent health had a 45% lower risk of CVD (hazard ratio [HR], 0.55; 95% CI, 0.39-0.77) and a 42% lower risk of CHD (HR, 0.58; 95% CI, 0.37-0.90) compared with those who reported poor/fair health. Participants in the excellent SRH category who had any CAC had markedly elevated risk of hard CHD (HR, 6.19; 95% CI, 2.1-18.3) and CVD (HR, 6.50; 95% CI, 2.7-15.6) events compared with those with a CAC score of 0. The addition of the EVGGFP rating to CAC improved the area under the curve (C statistic) for CHD events (0.725 vs 0.734; P = .007), CVD events (0.693 vs 0.706; P < .001), and all-cause mortality (0.685 vs 0.707; P < .001). However, the addition of the EVGGFP rating to the combination of CAC and atherosclerotic CVD risk score did not significantly improve C statistics for CHD events (0.751 vs 0.753; P = .39), CVD events (0.739 vs 0.741; P = .18), or all-cause mortality (0.779 vs 0.781; P = .13). Although SRH and CAC integrate many risk variables, this study suggests that they are poorly correlated and have complementary predictive utility. A perception of excellent health does not obviate the need for definitive assessment of CVD risk, whereas fair/poor perceived health may serve as a risk enhancer, arguing for advanced risk assessment in selected clinical scenarios.

Refining caregiver vulnerability for clinical practice: determinants of self-rated health in spousal dementia caregivers

BackgroundCaregivers of a family member with a chronic disability or illness such as dementia are at increased risk for chronic disease. There are many factors that contribute to dementia caregiver vulnerability and these factors can be challenging to assess in clinical settings. Self-rated health (SRH) is an independent measure of survival and physical health in the elderly. As an inclusive measure of health, SRH has been proposed as a reliable way to assess a patient’s general health in primary care. Therefore, we sought to identify determinants of poor/fair SRH versus categories of at least good SRH in informal caregivers.MethodsIn a cross-sectional study, we examined 134 elderly (≥55 years) providing in-home care for a spouse with dementia who rated their own health with a single-item question: “In general, would you say your health is excellent, very good, good, fair or poor?”. In a multivariable model, we compared caregivers with poor/fair SRH to those with good, very good, or excellent SRH on demographics, health characteristics (health behaviors, physical health indicators, psychosocial factors) and caregiving-specific stress (a composite index/total of four caregiving-specific stressors: years of caregiving, dementia severity, care recipient functional impairment and perceived caregiver burden).ResultsCompared with caregivers who rated their own health as either good (31.3%), very good (38.8%) or excellent (14.2%), caregivers with poor/fair SRH (15.7%) were more likely to have lower physical function and total greater caregiving-specific stress. More years of caregiving, severe dementia and care recipient functional impairment, but not perceived caregiver burden, were also more likely among caregivers with poor/fair SRH. Additionally, high negative affect and low positive affect were more likely in caregivers with poor/fair vs. good or excellent and very good or excellent SRH, respectively.ConclusionsCaregivers with poor/fair SRH were characterized by higher levels of medical comorbidity, low physical function, high negative, but low positive affect and longer duration of caregiving, as well as more severe dementia and greater functional impairment of the care recipient. These findings suggest that caregivers need to be more closely evaluated and targeted for preventive interventions in clinical practice.Trial RegistrationClinicalTrials.gov registration number: NCT02317523.

Association between pesticide exposure intensity and self-rated health among greenhouse vegetable farmers in Ningxia, China.

BackgroundSelf-rated health (SRH) has been shown to be a stronger comprehensive predictor of health status than the clinical record. Although an association between specific pesticide exposures and health conditions has been reported in different populations, data on the relationship between pesticides exposure intensity (PEI) and SRH in greenhouse farmers is scarce. The aim of the current study was to evaluate this association among vegetable greenhouse farmers in Yinchuan City, western China.MethodsThree consecutive cross-sectional studies were conducted in the years 2015, 2016 and 2017. Face-to-face interviews by trained investigators, using questionnaires, were performed. PEI was calculated by a validated method and then categorized into high, middle and low groups. SRH was measured via a single ten-point scale question and then divided into excellent (score >5) and poor SRH (score ≤5). A multivariable logistic regression model was used to evaluate the association. Meanwhile, the dose-response and interaction effects were estimated.ResultsA steady association between high PEI and poor SRH (OR: 1.55, 95% CI: 1.05–2.28 in the full model) was identified. Although high PEI was significantly associated with poor SRH in males and the Han ethnicity group, no significant association was found with poor SRH in females or those of Hui ethnicity. Interaction effects of education level and frequency of breakfast with PEI were determined (Pinteraction = 0.04 and 0.02, respectively); synergistic enhanced effects for poor SRH were observed.ConclusionThese findings indicate that high PEI might be associated with poor SRH among vegetable greenhouse farmers. A lower education level and never eating breakfast contributed to an increased likelihood of poor SRH in those with high PEI. The local government should be making great efforts to promote healthy behaviors and improve protection awareness.

The association between life satisfaction, vitality, self-rated health, and risk of cancer.

Only few prospective studies have been conducted on the contribution of quality of life-related factors to the risk of cancer. The aim of this study was to investigate the prospective associations of three quality of life-related factors with the risk of cancer; life satisfaction, vitality, and self-rated health. In 2009-2011, 7189 participants in the Copenhagen Aging and Midlife Biobank were asked to rate their life satisfaction, their vitality, and their health. The study population was followed until the end of 2015 for registration of cancer in the Danish National Patient Register. During the follow-up period, cancer was diagnosed in 312 individuals. Life satisfaction was not associated with the risk of cancer. Vitality was significantly associated with the risk of cancer, but the association became non-significant after adjustment for age, sex, socioeconomic position, and lifestyle factors. However, when additionally adjusting for life satisfaction, individuals who rated their vitality as low had a hazard ratio of 1.46 (95% confidence interval [CI] 1.04-2.07) for the development of cancer. Individuals who rated their health as poor had a hazard ratio of 1.70 (95% CI 1.27-2.26) for the development of cancer, compared with individuals with good, very good, or excellent self-rated health. The association remained significant after adjustment for basic confounders, life satisfaction, and vitality. A better grasp of the significance of quality of life-related factors for the risk of cancer may be of great importance to population-based cancer prevention that aims to target early risk factors for development of cancer across widespread cancer sites.

Association Between Workplace Social Capital and Absolute Presenteeism: A Multilevel Study in a Chinese Context.

The aim of this study was to investigate the association between workplace social capital (WSC) and presenteeism in a Chinese context. We conducted a cross-sectional study in Shanghai, China, from December 2016 to March 2017. Totally, 2380 workers were randomly sampled through a two-stage sampling procedure. Validated and psychometrically tested measures were used to assess job stress, self-rated health and absolute presenteeism (AP), and WSC. Job stress [unstandardized coefficients, B:1.83, 95% confidence interval (95% CI): 0.43 to 3.24] was positively associated with AP. Compared with participants with excellent self-rated health, those with very good, good, and general self-rated health had gradationally higher levels of AP. High individual-level WSC (B: -6.32; 95% CI: -7.62 to -5.02) and workplace-level WSC (B: -4.43; 95% CI: -7.44 to -1.42) were negatively associated with AP. Interventions on promoting workers' health, decreasing job stress, and enhancing WSC may contribute to decreasing AP in Chinese workplaces.

Objective vs. Subjective Health in Very Advanced Ages: Looking for Discordance in Centenarians.

Background: Living beyond 100 years of age is associated with several functional and health constraints but their impact depends on one's perception of the situation. Associations between self-rated health (SRH) with sociodemographic and psychosocial variables have been explored in several studies, revealing that one's health appraisal depends of factors beyond the objective health condition. There is a large body of literature concerning SRH in later life but lack of evidence about centenarians' perception of health and its associated factors, which could increase the available knowledge on the strengths and resources individuals in very advanced ages have for facing daily life limitations.Objective and Methods: This study aims to analyse the relationship between subjective and objective health status in a sample of centenarians (n = 127). Subjective health was assessed by a single-item health measure, and objective health by considering the number of reported diseases and a functional capacity scale (BADL and IADL). Main health characteristics are described as well as examined the association between objective and subjective health.Results: 46.5% of the sample has a good, very good, or excellent appraisal of their own health. SRH was associated (p < 0.05) with BADL and IADL scores and with the total number of diagnosis; when analyzing SRH according to the level of functional capacity, results revealed that most individuals with severe and moderate dependence have a reasonable to excellent SRH (p > 0.05).Conclusion: Having diseases and functional dependence at 100 years old may not mean to have a bad SRH. The high variability in SRH and the discordance between objective and subjective measures are a proof of centenarian's capacity of adaptation and the existence of individual resources, which may be decisive for one' perception and handling of health situation at such an advanced age.

Self-Rated Health Status and Risk of Incident Stroke in 0.5 Million Chinese Adults: The China Kadoorie Biobank Study

Background and purposeSelf-rated health (SRH) is a consistent and strong predictor of all-cause and cardiovascular mortality in various populations. However, the associations between SRH measures and risk of first-ever or recurrent stroke were rarely explored. We thus aim to prospectively investigate the associations between SRH measures and risk of total and subtypes of stroke in Chinese population. MethodsA total of 494,113 participants from the China Kadoorie Biobank without prior heart diseases or cancer (486,541 without stroke and 7,572 with stroke) were followed from baseline (2004 to 2008) until December 31, 2013. General and age-comparative SRH were obtained from baseline questionnaires. First-ever stroke or recurrent events were ascertained through linkage to disease registry system and health insurance data. ResultsWe identified 27,662 first-ever stroke and 2,909 recurrent events during an average of 7.0 years of follow-up. Compared with excellent general SRH, the hazard ratios (HRs) and 95% confidence intervals (CIs) for first-ever stroke associated with good, fair, and poor general SRH were 1.04 (1.00 to 1.08), 1.19 (1.15 to 1.23), and 1.49 (1.42 to 1.56) in the multivariate model, respectively. Compared with better age-comparative SRH, the HRs (95% CIs) of same and worse age-comparative SRH were 1.13 (1.10 to 1.17) and 1.51 (1.45 to 1.58), respectively. The relations of SRH measures with ischemic stroke, hemorrhagic stroke, and recurrent stroke were similar to that with total first-ever stroke. However, the magnitude of associations was much stronger for fatal stroke than for non-fatal stroke. ConclusionsThis large-scale prospective cohort suggests that self-perceived health status is associated with incident stroke, regardless of stroke subtype.

State-level climate, anti-discrimination law, and sexual minority health status: An ecological study

How social and legal climate influence LGB health is an under-studied topic. In response, this study examines whether the lesbian/gay/bisexual (LGB) climate index and presence of anti-discrimination law show population health significance for U.S. sexual minorities. The LGB climate index uses survey data collected between 2012 and 2013 to gauge states' support of lesbian, gay, and bisexual individuals, whereas anti-discrimination law captures any state-level law that makes it illegal to discriminate because of sexual orientation in employment, housing, and public accommodations. We merge these two contextual measures with 2011–2015 Behavioral Risk Factor Surveillance System (BRFSS) aggregated, individual-level survey data, from which we generate three measures of state-level rates: excellent self-rated health, routine health care utilization, and health insurance among self-identified lesbian/gay and bisexual adults. We find that the LGB climate index associates positively with rates of excellent self-rated health, routine health care utilization, and health insurance—but only for states with anti-discrimination laws, and only among lesbian/gay adults. Analyses confirm salubrious synergism between a sexually-minority-friendly climate and anti-discrimination law—together these two contextual measures interact to protect lesbian/gay population health.

Can smartphones measure momentary quality of life and participation? A proof of concept using experience sampling surveys with university students.

Understanding quality of life and participation is a key aspect of occupational therapy research. The use of smartphones to deliver experience-sampling surveys may provide an accessible way to monitor these outcomes. This study used smartphone-based experience sampling methods (ESM) to investigate factors influencing momentary quality of life (mQOL) of university students. A convenience sample of students at an Australian university participated. Using a custom smartphone application, ESM surveys were sent six to eight times, every second day, over a week. Participants indicated their mQOL, occupational participation, occupational enjoyment, social context and location via surveys and provided demographic and health information in a single self-report questionnaire. The relationship between mQOL and variables was analysed at the survey level using logistic regression. Forty students completed 391 surveys. Higher mQOL was significantly related to participation in productive occupations (z=3.48; P=0.001), moderate (z=4.00; P<0.001) or high occupational enjoyment (z=7.06; P<0.001), being with someone (z=2.15, P=0.031), being at home (z=2.49; P=0.013) and an excellent self-rated health status (z=2.35; P=0.019). The magnitude of differences in mQOL was small. This study suggests that mQOL amongst university students relates to personal, environmental and occupational factors. The use of smartphone-based ESM appears to be a practical approach for investigating participation and QOL. Further research utilising a more diverse sample, analysing at the individual level, and using ESM in conjunction with other methodologies is recommended.

Optimistic and pessimistic self-assessment of own diets is associated with age, self-rated health and weight status in Danish adults

The aim of this study was to analyse concordance between Danish adults’ recorded diet quality and their own assessment of the healthiness and to examine socio-demographic, health and behavioural characteristics associated with an optimistic or pessimistic self-assessment.Data were derived from The Danish National Survey of Diet and Physical Activity 2011–2013 and included a random sample of 3014 adults (18–75 y). Diet quality was evaluated on the basis of seven-day pre-coded food diaries and categorised ‘unhealthy’, ‘somewhat healthy’ and ‘healthy’. Self-assessment of the healthiness of own diets was registered via personal interviews and categorised healthy enough ‘to a high degree’, ‘to some degree’ or ‘not at all/only partly’. Highly and somewhat optimistic self-assessment, respectively, were defined as assessing own diets as healthy enough to a high degree or to some degree while having unhealthy diets. Highly and somewhat pessimistic self-assessment, respectively, were defined as assessing own diets as not healthy enough or healthy enough to some degree while having healthy diets. Multiple logistic regression models were used to examine characteristics associated with optimistic and pessimistic self-assessments, respectively.Among individuals with unhealthy diets, 13% were highly optimistic and 42% somewhat optimistic about the healthiness of their diets. Among individuals with healthy diets, 14% were highly pessimistic and 51% somewhat pessimistic about the healthiness of their diets. Highly optimistic self-assessment was associated with increasing age, excellent self-rated health, normal weight and a moderate activity level. Highly pessimistic self-assessment was associated with decreasing age, good self-rated health and being obese. The findings indicate that people seem to use personal health characteristics as important references when assessing the healthiness of their diets.

Factors related to receipt of non-cancer-related transurethral prostatectomy: findings from a large prospective study of 106 769 middle-aged and older Australian men

BackgroundTransurethral prostatectomy (TURP) is a common surgical intervention for chronic lower urinary tract symptoms (LUTS). Little large-scale evidence exists on factors related to receipt of non-cancer-related TURP.MethodsA prospective study of...

Social Capital, Perceived Economic Affluence, and Smoking During Adolescence: A Cross-Sectional Study

ABSTRACTBackground: Smoking is among the health risk behaviors taken up by many adolescents with lifelong consequences and associations with multiple health risk behaviors. Smoking and smoking initiation in adolescence involves an interaction between micro-, meso-, and macro systems, including neighborhoods and the greater community. Objectives: To examine the associations of individual social and economic capital with self-reported health, life satisfaction, and smoking behavior in adolescents. Methods: Using a multistage random sampling of junior high school students (16–18 years old) in Crete, Greece, 703 adolescents (90.2% 16 years old; 55.6% girls, participation rate 84.2%) completed an anonymous questionnaire based on HBSC study and the Youth Social Capital Scale (YSCS) during April–June 2008. Multiple logistic regression models were performed adjusted for potential confounders. Results: Adolescents with high participation in their neighborhoods and communities (higher structural social capital) displayed lower odds for daily smoking; those feeling unsafe (lower cognitive social capital) were at greater odds of daily smoking. Adolescents with less friends and acquaintances had lower odds of having tried tobacco products. Smoking was not related to any economic capital variables (perceived affluence, paternal and maternal employment status). Adolescents with low/medium versus high total social capital were at higher odds for low life satisfaction and fair/bad versus excellent self-rated health. Conclusions/Importance: Social capital theory may provide a better understanding in identifying the social context that is protective or harmful to adolescents' smoking. Public health organizations at all levels need to incorporate social capital theory in their interventions.

Predictors of Poor Response to Depression Treatment in Primary Care.

Depression is pervasive and costly, and the majority of depression is treated in primary care. The objective of this study was to identify patient characteristics predictive of poor depression outcomes in primary care clinics. This observational study followed 792 patients receiving usual care for depression in 83 clinics across Minnesota for at least six months between 2008 and 2010. The primary outcome was an ordinal outcome of remission or response without remission ("response") six months after the start of treatment. The outcome was assessed via telephone administration of the Patient Health Questionnaire-9. Associations of patient characteristics with the primary outcome were assessed by using ordinal logistic regression. The majority of patients were female, Caucasian, and employed, and most had some college education and good, very good, or excellent self-rated health. At baseline, 32% had mild depression, 40% moderate depression, 20% moderately severe depression, and 8% severe depression. One-third of patients had psychotherapy or psychiatric care in addition to antidepressant medications. At six months, only 47% of patients obtained depression remission or response. Patients were significantly less likely to experience remission or response if they rated their health as poor or fair or if they were unemployed and were more likely to achieve remission or response if they were younger or had mild depression. Patients with poor or fair health or who were unemployed were less likely to respond to usual depression care and may be good candidates for limited, but potentially more effective, intensive treatment resources for depression.