Negative Health Behaviors Research Articles

Cluster analysis of risk factors for chronic non-communicable diseases in elderly Brazilians: population-based cross-sectional studies in a rural town

Negative health behaviors incorporated into lifestyle are considered the main risk factors for chronic non-communicable diseases (NCDs) in adults and the elderly. However, the relationship between the aggregation of these factors and the sociodemographic conditions of the elderly needs to be better elucidated. The aim of this study was to analyze the simultaneity of the five risk factors for NCDs in the elderly with low economic status living in a rural city in Brazil, and their association with sociodemographic variables. Cross-sectional study was conducted with elderly people from Family Health Units of the city of Ibicui-Bahia, Brazil, where 310 elderly were enrolled. Rates of physical inactivity in leisure (PIL), alcohol consumption, sedentary behavior, overweight/obesity and tobacco consumption were collected through a questionnaire in an individual interview. The average age among participants was 71.62 (± 8.16) years. The group presenting the five behaviors had high scores in both sexes (men O/E = 242.5; women O/E = 161.7). Among men and women, the highest scores found through clustering of simultaneous NCD risk factors were for the consumption of alcohol with smoking, and physical inactivity with smoking. When analyzing the association between groups and sociodemographic characteristics, men were more physically inactive than women (OR = 0.96, CI = 0.92-0.98) and concomitantly had unhealthy habits (smoking). In conclusion, the elderly are exposed to health risk factors for concurrent CNCDs and the accumulation of these risk factors was not associated with sociodemographic variables, it is suggested that further studies be carried out with the prevalent variables as well as to analyze why the elderly population presents these levels.

Impact of COVID-19 on Older Adults: Changes in Health Access, Health, Socialization and Adaptive Coping Activities

Indirect effects of stay-at-home guidelines may negatively affect mental health by reducing health self-care behaviors and engagement in social participation. This study reports on the impact of the COVID-19 pandemic on community-dwelling older adults’ perceived physical and mental health and everyday health behaviors. 126 older adults participated in a county-wide telephone survey during June-July of 2020, asking about changes in mental and physical health, and adaptations in health behaviors. We investigated the effects of three negative everyday health behavior changes during the pandemic (changes in health services access, perceived changes in health, and increased social isolation) as well as two positive everyday health behaviors (adherence to stay-at-home guidelines to reduce risk, and adaptive coping activities) on mental health and COVID-related distress. Examples of active coping strategies were stockpiling resources, spiritual practices, or outreach to others. Descriptive statistics, bivariate correlations, and multiple regressions characterized the impact of COVID-19 on perceived mental health. Descriptive data included changes in health service access, changes in mental and physical health, reduced social engagement, increased adherence to guidelines, and increased adaptive coping activities. Significant predictors of mental health impact of the pandemic were changes in health service access (β = .18, p < .05), health changes (β = .25, p < .01), and adaptive coping activities (β = .21, p < .05). Findings suggest COVID-19 distress may be alleviated with improved health care access and increased social contact. Mental health challenges may also benefit from increased engagement in adaptive coping activities.

Acculturation Strategies and Pap Screening Uptake among Sub-Saharan African Immigrants (SAIs).

Although regular cervical cancer screening can prevent cervical cancer, screening utilization remains low among immigrant population including sub-Saharan African immigrants (SAIs). Acculturation is a complex process, which can lead to adoption of positive or negative health behaviors from the dominant culture. Acculturation strategies are the varying ways in which individuals seek to go about their acculturation by either maintaining or rejecting their own cultural values ip or accepting or rejecting the host culture’s cultural values. Cervical cancer screening behaviors among SAI women may be influenced by their acculturation strategies. We conducted a secondary analysis of data to examine the relationship between acculturation strategies and Pap screening among 99 SAI women recruited from community settings. Data were collected on Pap screening behavior and acculturation strategy. Traditionalists and Integrationists were the dominant acculturation strategies; 32.3% women were Traditionalists and 67.7% Integrationists. From the logistic regression models, Integrationists had seven times the odds of having ever been screened compared to Traditionalists (OR = 7.08, 95% CI = 1.54–28.91). Cervical cancer screening interventions should prioritize Traditionalists for cancer screening. Acculturation strategies may be used to tailor cancer prevention and control for SAIs. More research among a larger SAI women sample is warranted to further our understanding of Pap screening patterns and acculturation strategies.

Psychological stress perceived with respect to general health among urban Indian women

ABSTRACT Women face many sexist constraints globally, increasing the likelihood of psychological stress and related disorders. The present study explores general health constraints among urban Indian women with respect to stress. A cross-sectional study adhering to “strengthening the reporting of observational studies in epidemiology” (STROBE) guidelines was conducted in urban colonies in Delhi. A wide array of women above 18 years of age was recruited, which included students, working professional as well as housewives. General health issues and health behaviors among women were assessed through a questionnaire and stress was evaluated through Cohen’s perceived stress scale (PSS)-10. Overall 532 women were contacted, among which 306 women (mean age = 28.8 ± 7.52) years participated. There was significant difference in mean PSS-10 scores, mean±standard error = −3.3 ± 0.6 and −3.1 ± 0.6; p < .0001 for irregular periods and dysmenorrhea, respectively. Likewise, there was significant difference (Mean± SE = −8.9 ± 0.7; p < .0001) in stress scores among women with chronic respiratory, gastrointestinal, and musculoskeletal pain symptoms. Changes in eating behavior during stress; prolong sitting/standing; and lack of exercise were categorized as ‘negative health behaviors.’ One-way ANOVA showed significant differences in PSS-10 scores (Mean ±SE = −11.3 ± 0.7; p < .0001) among participants exhibiting all “negative health behaviors.” General health issues, not necessarily diagnosed medical condition can be psychological stressors among urban Indian women. Poor health behaviors adapted by urban Indian women like prolong sitting/standing, changes in eating habits during stress, and lack of exercise are associated with increased perception of stress.

Skeletal muscle quality in 6- and 7-y-old children assessed using bioelectrical impedance analysis

ObjectivesThe condition of skeletal muscles is a key marker of the nutritional status and function of an organism. It is necessary to monitor muscle quality in basic pediatric preventive health care, especially due to the increase in negative health behaviors during a pandemic. The aims of this study were to assess body composition and muscle strength as well as to analyze the relationship between muscle functional quality and impedance parameters in 6- and 7-y-old children. MethodsThe study involved 292 healthy 6- and 7-y-old children. Handgrip strength and bioimpedance parameters were measured. Body composition components, including appendicular skeletal muscle mass, were estimated. Handgrip strength in relation to the appendicular skeletal muscles mass was adopted as an indicator of the muscle functional quality. The relationship between the muscle quality index and impedance parameters was assessed by multiple regression. ResultsA 1-y age difference between the children differentiated not only basic somatic parameters, body composition, and handgrip strength, but also the electrical properties of the tissues. The relative difference in muscle mass between younger and older children was twice that of the muscle strength. A significant regression model of the muscle quality index was obtained, in which reactance and impedance phase angle were strong positive predictors. Adjusted fat mass negatively correlated with the muscle quality. ConclusionsReactance and phase angle are good indicators of the quality of appendicular skeletal muscle in healthy children and can be potentially used in pediatric preventive health care and screening.

Anxiety Sensitivity as a Malleable Mechanistic Target for Prevention Interventions: A Meta-Analysis of the Efficacy of Brief Treatment Interventions.

Anxiety sensitivity (AS) is a transdiagnostic risk factor and potential treatment target for prevention of associated psychopathology and negative health behaviors. We conducted a meta-analysis evaluating the efficacy of brief interventions in at-risk samples for reducing AS and associated clinical/behavioral outcomes (e.g., depression, alcohol use) across 28 studies (1,998 participants). AS targeted interventions, compared to control conditions, evidenced a significant moderate effect size for alleviating AS from pre- to post-treatment (d = 0.54) and approached a large effect size from pre-treatment to short-term follow-up (d = 0.78). The effect size for long-term follow-up did not reach significance (d = 0.29). For clinical/behavioral outcomes, AS interventions demonstrated significant small-to-moderate effect sizes for the three timepoints examined (d's = 0.20-0.41). Our findings help validate AS as a modifiable mechanistic target for prevention efforts.

Impact of the COVID-19 Pandemic on the Health Status and Behaviors of Adults in Korea: National Cross-sectional Web-Based Self-report Survey.

BackgroundThe COVID-19 pandemic has radically shifted living practices, thereby influencing changes in the health status and behaviors of every person.ObjectiveThe aim of this study was to investigate the impact of COVID-19 on the self-reported health status and health behaviors along with any associated factors in adults in the Republic of Korea wherein no stringent lockdown measures were implemented during the pandemic.MethodsWe conducted a web-based self-reported survey from November 2020 to December 2020. The study participants (N=2097) were identified through quota sampling by age, sex, and geographical regions among residents aged 19 years or older in Korea. The survey collected information on basic demographics, changes in self-reported health status, and health behaviors during the COVID-19 pandemic. Self-reported health status and health behaviors were categorized into 3 groups: unchanged, improved, or worsened. A chi-square test and logistic regression analyses were conducted.ResultsWith regard to changes in the self-reported health status, the majority (1478/2097, 70.5%) of the participants reported that their health was unchanged, while 20% (420/2097) of the participants reported having worser health after the COVID-19 outbreak. With regard to changes in health behaviors, the proportion of participants who increased tobacco consumption was similar to that of those who decreased tobacco consumption (110/545, 20.2% vs 106/545, 19.5%, respectively), while the proportion of those who decreased their drinking frequency was more than twice as many as those who increased their drinking frequency (578/1603, 36.1% vs 270/1603, 16.8%, respectively). Further, those who decreased their exercising frequency were more than those who increased their exercising frequency (333/823, 15.9% vs 211/823, 10%, respectively). The factor that had the greatest influence on lifestyle was age. In the subgroup analysis, the group aged 20-29 years had the highest number of individuals with both a worsened (100/377, 26.5%) and an improved (218/377, 15.7%) health status. Further, individuals aged 20-29 years had greater odds of increased smoking (6.44, 95% CI 2.15-19.32), increased alcohol use (4.64, 95% CI 2.60-8.28), and decreased moderate or higher intensity aerobic exercise (3.39, 95% CI 1.82-6.33) compared to individuals aged 60 years and older. Younger adults showed deteriorated health behaviors, while older adults showed improved health behaviors.ConclusionsThe health status and the behavior of the majority of the Koreans were not found to be heavily affected by the COVID-19 outbreak. However, in some cases, changes in health status or health behavior were identified. This study highlighted that some groups were overwhelmingly affected by COVID-19 compared to others. Certain groups reported experiencing both worsening and improving health, while other groups reported unchanged health status. Age was the most influential factor for behavior change; in particular, the younger generation’s negative health behaviors need more attention in terms of public health. As COVID-19 prolongs, public health interventions for vulnerable groups may be needed.

Quantitative assessment of sitting time in ambulant adults with Muscular Dystrophy.

BackgroundCurrent investigations into physical behaviour in Muscular Dystrophy (MD) have focussed largely on physical activity (PA). Negative health behaviours such as sedentary behaviour (Physical Behaviour) and sitting time (Posture Classification) are widely recognised to negatively influence health, but by contrast are poorly reported, yet could be easier behaviours to modify.Methods14 ambulant men with MD and 12 healthy controls (CTRL) subjects completed 7-days of free-living with wrist-worn accelerometry, assessing physical behaviour (SB or PA) and Posture Classification (Sitting or Standing), presented at absolute (minutes) or relative (% Waking Hours). Participant body composition (Fat Mass and Fat Free Mass) were assessed by Bioelectrical Impedance, while functional status was assessed by 10 m walk test and a functional scale (Swinyard Scale).ResultsAbsolute Sedentary Behaviour (2.2 Hours, p = 0.025) and Sitting Time (1.9 Hours, p = 0.030 was greater in adults with MD compared to CTRL and Absolute Physical Activity (3.4 Hours, p < 0.001) and Standing Time (3.2 Hours, p < 0.001) was lower in adults with MD compared to CTRL. Absolute hours of SB was associated with Fat Mass (Kg) (R = 0.643, p < 0.05) in ambulatory adults with MD,DiscussionThis study has demonstrated increased Sedentary Behaviour (2.2 hours) and Sitting time (1.9 Hours) in adults with MD compared to healthy controls. Extended waking hours in sitting and SB raises concerns with regards to progression of potential cardio-metabolic diseases and co-morbidities in MD.

Relationship of Problematic Smartphone Use, Sleep Quality, and Daytime Fatigue Among Quarantined Medical Students During the COVID-19 Pandemic.

Background: The COVID-19 pandemic brought about great transformation to medical education mode. Although mobile communication devices played a crucial role in online learning among quarantined university students, the potential smartphone addition problems, negative health behaviors, and psychological symptoms need considerable attention. This study examined the relationship of problematic smartphone use (PSU), sleep quality, and daytime fatigue among medical students.Methods: A web-based survey was conducted in six polyclinic hospitals in Beijing between February and May 2020. 1016 participants (26.01 ± 2.46 years, 65.16% female) completed self-report measurements including Short Version Smartphone Addiction Scale (SAS-SV), Athens Insomnia Scale (AIS), and Subjective Fatigue Scale (FS). Spearman correlation coefficients and multiple regression models were used to analyze the association among PSU, sleep quality, and daytime fatigue. We used structural equation modeling to test the mediating effect of sleep quality between PSU and daytime fatigue.Results: 49.70% of the participants had PSU. Significant positive correlations were found among SAS-SV, AIS, and FS scores (r = 0.35–0.61, PS < 0.001). Subjects with PSU were more likely to report sleep disturbance (β = 1.07, P < 0.001, OR = 2.91, 95%CI = 2.17–3.91), physical fatigue (β = 1.16, P < 0.001, OR = 3.18, 95%CI = 2.45–4.15), and mental fatigue (β = 0.88, P < 0.001, OR = 2.42, 95%CI = 1.86–3.14). The indirect effect of PSU on physical fatigue and mental fatigue mediated by sleep quality accounted for 50.03 and 45.43% of the total effect, respectively.Conclusions: PSU was significantly associated with sleep disturbance and fatigue among medical students during the COVID-19 pandemic. Sleep quality mediated the relationship between PSU and daytime fatigue. Our results provide valuable information for maintaining medical students' health status and constructing online education structures.

Well-being, Perceived Stress and Their Relations with Health-Relevant Behaviours Among Italian Medical Students: a Cross-Sectional Study at Sapienza University of Rome

Medical education is widely known to be demanding and stressful, with elevated levels of anxiety and depression among medical students. This study aims at examining well-being, perceived stress and quality of life in a sample of Italian first-year medical students in order to investigate the relations between these variables and individual characteristics and behaviours. An anonymous cross-sectional questionnaire was administered to a sample of 407 Italian first-year medical students. Psychological well-being, perceived stress and quality of life were assessed using standardised questionnaires PGWBI, PSS, SF-12. Data were analysed with multivariate statistical methods. Significant differences in PGWBI, PSS and SF-12 scores were found between males and females (with poorer scores for females), between smokers and non-smokers (with poorer scores for smokers) and between students who reported cannabis use in their lifetime and students who did not (with poorer scores for those who smoked cannabis). Logistic regression showed that gender (OR 0.38, 95% CI 0.24–0.61), reported cannabis use (OR 1.82, 95% CI 1.07–3.09) and regular physical exercise (OR 0.54, 95% CI 0.34–0.86) were significant predictors of distress. In summary, this study shows that female medical students and students who reported negative health behaviours and sporadic drug use reported lower psychological well-being and quality of life and higher stress, while positive health behaviours might prevent distress.

Parental incarceration and child physical health outcomes from infancy to adulthood: A critical review and multilevel model of potential pathways.

There are currently 2.2 million people incarcerated in U.S. prisons and jails, representing a 500% increase over the past 40 years. An emerging literature suggests the impact of mass incarceration extends beyond the prison, jail, or detention center to the families of incarcerated individuals. Less scholarship has considered consequences of parental incarceration for their children's physical health. We conduct a critical review of the literature investigating an association between parental incarceration and children's physical health outcomes from infancy to adulthood. Studies varied substantially in study design, sample composition, and methodological approach. Most studies suggest an association between parental incarceration and adverse physical health outcomes. Evidence is more consistent for outcomes such as infant and child mortality, lower healthcare access, and negative health behaviors and more mixed for measures such as self-reported/general health. We propose a multilevel model of mechanistic pathways to stimulate future research on the potential pathways through which parental incarceration could influence children's physical health.

Affective variability and childhood abuse increase the risk for nonsuicidal self-injury following psychiatric hospitalization.

Childhood abuse is associated with myriad negative behavioral health outcomes, including nonsuicidal self-injury (NSSI). Models aimed at understanding the mechanism whereby childhood abuse may exert negative effects frequently highlight alterations or dysregulations in experienced affect, particularly during times of stress. The period immediately following discharge from psychiatric hospitalization represents a time of risk for individuals experiencing NSSI. We aimed to investigate the extent to which childhood abuse predicts affective variability and examine whether affective variability predicts who will experience NSSI thoughts or behaviors in the 6 months following hospital discharge. Participants were adults (N = 133) engaged in a 3-week ecological momentary assessment study immediately following psychiatric hospitalization who returned for a 6-month follow-up. Location scale modeling (LSM) was used to model the impact of childhood abuse on affect variability; estimates of affect variability were then resampled and examined as risk factors for NSSI at follow-up. Overall, individuals who experienced childhood abuse reported lower positive affect intensity. Participants exposed to emotional and sexual abuse reported less between-person variability in positive affect, and those who experienced sexual abuse evidenced higher between-person variability in negative affect. Models indicated that higher overall negative affect was associated with a higher NSSI risk, ORs ∼ 1.82-2.10 even after accounting for childhood abuse and lifetime NSSI. These findings indicate the importance of in vivo affect as a critical influence on behavior during high-risk periods, reinforcing the need to move beyond traditional cross-sectional approaches of assessment, analysis, and treatment.

From expert to coach: health coaching to support behavior change within physical therapist practice

ABSTRACT Background: Negative health behaviors are a significant risk factor for non-communicable diseases (NCDs) and are responsible for 40–50% of the burden of disease in the US population. Physical therapists (PTs) have the capacity to effect behavior change in their patients to reduce their risk of disease and promote health. Competence in health behavior change is recommended for physical therapists. One way to achieve this competence is by learning and adopting a health coaching approach. Objectives: To provide a theoretical and practical approach to applying a health coaching approach in physical therapist clinical practice. Methods: 1) Describe a health coaching approach to facilitating behavior change; 2) present behavior change theories, communication strategies, and models underpinning health coaching; and 3) provide suggestions for ways PTs can integrate health coaching in clinical practice. Results: Health coaching is a dynamic and collaborative approach to health behavior change that harnesses the patient’s or client’s values and strengths to realize their goals for health. Conclusion: Adopting a health coaching approach may enhance adherence to physical therapists' recommendations as well as improve health outcomes.

Bad Cholesterol Build-Up: Traditional Channel as Viable Alternative for Health Communication in Rural Areas

The increasing occurrence of cardiovascular illness usually associated with bad cholesterol build up in Nigeria. Against this backdrop, the study x-rayed the issue of bad cholesterol build up viz a viz traditional channel of communication as the most effective option for carrying out sensitization campaigns about possible ways to curb it health implications. The study was a conceptual study which is based on literature review and built into it; Understanding Bad Cholesterol Build Up, The Place of Rural Dwellers in Health Communication and Behaviour Change Campaigns, Exploring the African Traditional Media: Effective platform for Rural Health Communication and Behaviour Change and Advantages of Folk Media as useful channel for Disseminating Messages on the Dangers of Bad Cholesterol. Based on the literature review, the study concludes that sadly, irrespective of the effectiveness of folk media in changing negative social health behaviours in rural Africa, it has not been recognized in most Western literature as a very efficient means of reaching the rural communities with messages that will help them get informed, aware and knowledgeable about hazardous health challenges like bad cholesterol build-up.

The social and physical consequences of weight stigma in obese adolescents – primary care view

Negative attitudes regarding obese adolescents are learned early in life. Weight stigmatizing experiences occur frequently in the context of personal relationships with peers, teachers, family members, and health professionals. Adolescents’ weight stigma is insufficiently considered in the obesity’s management, and this contributes to negative health outcomes and behaviors that act as obesogenic factors into adulthood. Primary care professionals provide opportunity for translating expert recommendations for healthy behavior changes of obese adolescents, having facilities and staff to implement them in the community. However, comprehensive programs for controlling body weight and stigmatizing obese adolescents are not sufficiently addressed in primary care because they require psycho-educational skills development and dedicated time. In the framework of the curricular reform of the family medicine residency program a study design in the community served by the family physician trainer and carried out with the family medicine residents involvement was included. We describe an integrative community-based educational program dedicated to the social and physical health consequences of obese adolescents’ weight stigma that should be implemented in primary care. Conclusions. Psycho-educational skills development in the future family doctors training will lead to greater efficacy in addressing emotional needs of obese adolescents. Their increased involvement in counseling parents will help better cope with their children's eating disorders and weight-based victimization.

Health Determinants among North Americans Experiencing Homelessness and Traumatic Brain Injury: A Scoping Review.

Traumatic brain injury (TBI) in those experiencing homelessness has been described in recent literature as a contributor to increased morbidity, decreased functional independence, and early mortality. In this systematically conducted scoping review, we aimed to better delineate the health determinants—as defined by Health Canada/Centers for Disease Control and Prevention (CDC)—associated with TBI in North Americans experiencing homelessness. BIOSIS, MEDLINE, CINAHL, EMBASE, SCOPUS, and Global Health were searched from inception to December 30, 2020. Gray literature search consisted of relevant meeting proceedings. A two-step process was undertaken, assessing title/abstract and full articles, respectively, based on inclusion/exclusion criteria, leading to the final 20 articles included in the review. Data were abstracted, assessing the aims, literature quality, and bias. Five health determinants displayed strong associations with TBI in those North Americans experiencing homelessness, including male gender, poor physical environment, negative personal health behaviors, adverse childhood experiences (ACEs), and low educational attainment. In those studies displaying a comparator population experiencing homelessness without TBI, the TBI group displayed trends toward increased disparity in Health Canada and CDC defined health determinants. Most studies suffered from moderate limitations. There are associations between male gender, poor physical environment, negative personal health behaviors, ACEs, and limited education in those experiencing homelessness and TBI. The results suggest that those experiencing homelessness with TBI in North America suffer poorer health consequences than those without TBI. Future research on TBI in North Americans experiencing homelessness should focus on health determinants as potential areas for intervention, which may lead to improved outcomes for those experiencing both homelessness and TBI.

COVID-19 stressors, wellbeing and health behaviours: a cross-sectional study.

Following the implementation of pandemic response measures, concerns arose regarding the impact for population health and wellbeing. This study reports findings from a survey (N=2510) conducted in Warwickshire (UK) during August and September 2020, and for the first time investigates behaviours which may worsen or mitigate the association between COVID-19-related stressors and wellbeing. Increased stressors were associated with lower mental wellbeing and higher loneliness. Participants with a mental health condition reported lower wellbeing, as did younger groups, women and participants not in employment. To cope with restrictions, more participants engaged in healthier behaviours over unhealthy behaviours, and relaxing reduced the association between stressors and poor wellbeing. Some participants reported increasing alcohol and unhealthy dietary behaviours to cope with restrictions, however, these behaviours did not mitigate the impact of COVID-19 stressors and were instead negatively associated with wellbeing. Around half of participants helped neighbours during the pandemic, a behaviour positively associated with wellbeing particularly among older adults. These findings contribute understanding about how various positive and negative health behaviours may mitigate or worsen the impact of COVID-19 on wellbeing, and how public health interventions may effectively target behaviours and groups in similar populations.

Associations between Socioeconomic Status and Health-Related Quality of Life in Patients with AL Amyloidosis

Introduction: Socioeconomic status (SES) can affect health-related quality of life (HRQoL) through a variety of mechanisms, including poor access to healthcare, physical and mental health comorbidities, low levels of health literacy or health activation, and consequent negative health behaviors. The impact of low SES on HRQoL of patients with AL amyloidosis, however, has not been well described. AL amyloidosis is a rare, complex disease associated with significant organ dysfunction, disability, and death. Although patients with AL amyloidosis report significant HRQoL impairments, it is likely that patients in lower SES groups report even greater deficits. The aim of this study was to assess the impact of SES on HRQoL in AL amyloidosis patients.Methods: This was a cross-sectional, observational study. A total of 1,289 patients with AL amyloidosis were evaluated at the Amyloidosis Center at Boston University between 1994 and 2014 and completed the SF-36v1 Health Survey within seven days of their initial evaluation. The SF-36v1 assessed HRQoL across eight domains and two component summary measures: physical functioning (PF); role limitations due to physical health problems (RP); bodily pain (BP); general health (GH); vitality (VT); social functioning (SF); role limitations due to emotional health problems (RE); mental health (MH); and physical (PCS) and mental (MCS) component summaries. SES was based on patients' occupation type (ie, professional/managerial positions vs. other occupations, including administrative/clerical, service, blue-collar, and farming positions vs. retired vs. disability) and educational attainment (≤ high school diploma versus > a high school diploma). Regression models using each SF-36v1 domain or summary score as a dependent variable were fit to examine whether there was an association between SES and HRQoL, independent of other demographic and clinical characteristics including type of organ involvement, multi-organ involvement, eligibility for stem cell transplantation, and time since diagnosis. Adjusted least-square means for each SF-36v1 domain and summary were obtained from two sets of models using educational or occupational group as the measure of SES. Established minimally important differences (MIDs) were used to determine whether differences in adjusted mean scores across groups were also clinically meaningful.Results: The mean age of the population was 61.6 years and the average time since diagnosis was 7.3 months. Based on multivariable models, patients with fewer years of education reported worse HRQoL impairment (i.e., significantly worse scores for all SF-36v1 domain and summary scores) compared to patients with more education (p < 0.05 for all) [Figure 1]. With the exception of GH, MH, and MCS, differences by educational attainment all exceeded the threshold of 1 MID.In multivariable models using occupation as the independent variable for SES, SF-36v1 scores also differed significantly by occupation (Figure 2). Relative to scores among patients with professional/managerial occupations: •Patients in other occupations reported statistically (p < 0.05 for all) and clinically (i.e. exceeding 1 MID) significant deficits on all SF-36v1 scores.•Patients on disability also exhibited significantly worse SF-36v1 scores (p < 0.05 for all). Deficits exceeded 1 MID for all scores. For PF, VT, and PCS, these differences exceeded 2 MIDs.•Retired patients reported only significant deficits for PF and RP (p < 0.05 for both); however these differences did not meet the threshold for an MID.Conclusions: Patients from lower SES groups, defined in terms of education or employment, had poorer HRQoL as compared to those with more years of education or professional/managerial positions. These relationships were independent of other clinical variables that served as proxies for disease severity. Outreach efforts designed to increase the understanding of the disease among community-based clinicians should highlight the additional HRQoL burden and potential need for more comprehensive care among patients in lower SES groups. As treatments of AL amyloidosis and healthcare resource utilization can be costly, future research should examine whether SES is associated with costs associated with treatment, type of health care received, and consequently HRQoL.Supported by Amyloid Research Fund at BUMC and a grant from Prothena Biosciences Inc. [Display omitted] DisclosuresMcCausland:Optum: Employment; Prothena Biosciences: Research Funding. White:Prothena Biosciences: Research Funding; Optum: Employment. Yokota:Optum: Employment; Prothena Biosciences: Research Funding. Quock:Prothena Biosciences Inc: Employment, Other: Stockholder. Bayliss:Optum: Employment; Prothena Biosciences: Research Funding.

Use of Electronic Cigarettes and Other Tobacco Products Among Active Component Services Members.

e-cigarettes have been touted as a safer alternative to classic cigarettes and other combustible tobacco products. However, a growing body of evidence finds that any risk reduction associated with e-cigarette use is eliminated when individuals use "both" e-cigarettes and other tobacco products. Recent analyses from the Health Related Behaviors Survey suggest that rates of e-cigarette use are higher among active component service members than in the general population. However, little is known about the frequency and health behaviors associated with the dual use of e-cigarettes and other tobacco products among service members. Using data from the 2018 Health Related Behaviors Survey, this paper investigates whether active component service members who use both e-cigarettes and other tobacco products are more likely to engage in other types of substance use or negative health behaviors. We find that the dual use of e-cigarettes and other tobacco products is associated with poorer physical and mental health, higher rates of alcohol misuse, and higher rates of insufficient sleep. The association between the dual use of e-cigarettes and tobacco products suggests that these individuals represent an important target group for health-related resources and attention in DoD.

Decomposition of income-related inequality in health check-ups services participation among elderly individuals across the 2008 financial crisis in Taiwan.

Encouraging citizens to use health checkup services is a health promotion strategy. In nations with aging populations, ensuring equitable use of health check-ups by senior citizens is a public health concern. The objective of this research was to quantify income-related inequality and its effect on the use of health checkup services in Taiwan during the 2007-2008 global financial crisis. We used the 2005 and 2009 datasets of the Taiwan National Health Interview Surveys to assess how income-related inequality influenced health check-up use among older adults in Taiwan during the 2007-2008 financial crisis. Corrected concentration indices (CCIs) were calculated and decomposed to determine the influences of explanatory variables. The dependent variable was whether participants had used free senior health check-ups in the past year, and the determinant factors were health behavior, health situation, socioeconomic and demographic factors, and area health care resources accessibility factors. The study assessed 2,460 older adults from the 2005 dataset and 2,514 such individuals from the 2009 dataset. The utilization of health check-ups increased from 21.6% in 2005 to 34.0% in 2009. Income-related inequality in the use of health check-up services was generally tilted toward the higher income individuals among both women and men in 2005 and 2009, and income-related inequality decreased among women group and increased among men group with non significantly from 2005 to 2009 (women: CCI decreased from.0738 in 2005 to.0658 in 2009; men: CCI increased from.1068 in 2005 to.1256 in 2009). We analyzed the effect of explanatory factors on men's and women's intention to use health check-ups by using a probit model. After controlling for other factors, we determined that income significantly influenced women's health check-up service use in 2005 and men's in 2005 and 2009. Positive health behavior significantly increased health check-up services use among men and women group after the financial crisis, and negative health behavior significantly reduced health check-ups use among men across financial crisis. The 2008 global financial crisis strengthened the effect on health check-ups use of income-related inequality of elderly men, especially in older adults with negative health behaviors. Elderly men with negative health behaviors tended to contribute more income-related inequality in use health check-up services after the financial crisis. Health promotion initiatives should focus their efforts on elderly men with negative health behaviors.