Non-married Individuals Research Articles

Impact of Ambient Temperature on Mortality Burden and Spatial Heterogeneity in 16 Prefecture-Level Cities of a Low-Latitude Plateau Area in Yunnan Province: Time-Series Study.

The relation between climate change and human health has become one of the major worldwide public health issues. However, the evidence for low-latitude plateau regions is limited, where the climate is unique and diverse with a complex geography and topography. This study aimed to evaluate the effect of ambient temperature on the mortality burden of nonaccidental deaths in Yunnan Province and to further explore its spatial heterogeneity among different regions. We collected mortality and meteorological data from all 129 counties in Yunnan Province from 2014 to 2020, and 16 prefecture-level cities were analyzed as units. A distributed lagged nonlinear model was used to estimate the effect of temperature exposure on years of life lost (YLL) for nonaccidental deaths in each prefecture-level city. The attributable fraction of YLL due to ambient temperature was calculated. A multivariate meta-analysis was used to obtain an overall aggregated estimate of effects, and spatial heterogeneity among 16 prefecture-level cities was evaluated by adjusting the city-specific geographical characteristics, demographic characteristics, economic factors, and health resources factors. The temperature-YLL association was nonlinear and followed slide-shaped curves in all regions. The cumulative cold and heat effect estimates along lag 0-21 days on YLL for nonaccidental deaths were 403.16 (95% empirical confidence interval [eCI] 148.14-615.18) and 247.83 (95% eCI 45.73-418.85), respectively. The attributable fraction for nonaccidental mortality due to daily mean temperature was 7.45% (95% eCI 3.73%-10.38%). Cold temperature was responsible for most of the mortality burden (4.61%, 95% eCI 1.70-7.04), whereas the burden due to heat was 2.84% (95% eCI 0.58-4.83). The vulnerable subpopulations include male individuals, people aged <75 years, people with education below junior college level, farmers, nonmarried individuals, and ethnic minorities. In the cause-specific subgroup analysis, the total attributable fraction (%) for mean temperature was 13.97% (95% eCI 6.70-14.02) for heart disease, 11.12% (95% eCI 2.52-16.82) for respiratory disease, 10.85% (95% eCI 6.70-14.02) for cardiovascular disease, and 10.13% (95% eCI 6.03-13.18) for stroke. The attributable risk of cold effect for cardiovascular disease was higher than that for respiratory disease cause of death (9.71% vs 4.54%). Furthermore, we found 48.2% heterogeneity in the effect of mean temperature on YLL after considering the inherent characteristics of the 16 prefecture-level cities, with urbanization rate accounting for the highest proportion of heterogeneity (15.7%) among urban characteristics. This study suggests that the cold effect dominated the total effect of temperature on mortality burden in Yunnan Province, and its effect was heterogeneous among different regions, which provides a basis for spatial planning and health policy formulation for disease prevention.

A prospective cohort study of factors associated with longevity in older adults in 10 areas of China

Objective: To evaluate the associations of sociodemographic characteristics and lifestyle factors with longevity status in older adults in China. Methods: After excluding those born after 31st December 1938, a total of 51 870 older adults from the China Kadoorie Biobank (CKB) were included. The attained age was defined according to the survival age or age on 31st December 2018. According to the attained age, the old persons were categorized into non-longevity (died before age 80 years) and longevity (attained age ≥80 years). The longevity group was further divided into two groups: longevity with death occurring before 2019, and longevity and survival to 2019. The information about socio-demographic characteristics and lifestyles was collected at the 2004-2008 baseline survey. Multinomial logistic regression models were used to analyze the associations between exposure factors and outcomes by taking the non-longevity group as the reference group. Results: A total of 51 870 older adults aged 65-79 years in the baseline survey were included for analysis. During a follow-up for (10.2±3.5) years, 38 841 participants were longevity, and 30 354 participants still survived at the end of 2018. Compared to men, rural populations, non-married individuals, those with an annual household income of less than 10 000 yuan, and those with education levels of primary school or below, the adjusted ORs(95%CI) for longevity and survival to 2019 in women, urban residents, married individuals, those with annual household incomes ≥20 000 yuan, and those with education levels of college or university were 1.68 (1.58-1.78), 1.69 (1.61-1.78), 1.15 (1.10-1.21), 1.44 (1.36-1.53), and 1.32 (1.19-1.48), respectively. The OR (95%CI) for longevity and survival to 2019 was 1.09 (1.08-1.10) for those with an increase of 4 MET-hour/day in total physical activity level. With those who never or almost never smoked, had no alcohol drinking every week, had normal weight (BMI: 18.5-23.9 kg/m2), and WC <85 cm (man)/<80 cm (woman) as the reference groups, the ORs(95%CI) of longevity and survival to 2019 were 0.64 (0.60-0.69) for those smoking ≥20 cigarettes per day, 1.29 (1.14-1.46) for those with alcohol drinking every week, 1.13 (1.01-1.26) for those with pure alcohol drinking <30 g per day, 0.56 (0.52-0.61) for those being underweight, 1.27 (1.19-1.36) for those being overweight, 1.23 (1.11-1.36) for those with obesity, and 0.86 (0.79-0.93) for those with central obesity. Further stratified analysis by WC was performed. In the older adults with WC <85 cm (man)/<80 cm (woman), the ORs (95%CI) of longevity and survival was 1.80 (1.69-1.92) for those with each 5 kg/m2 increase in BMI and 1.02 (0.96-1.08) for those with WC ≥85 cm (man)/≥80 cm (woman). There was a statistically significant difference in the association between BMI and longevity between the two WC groups (interaction test P<0.001). Conclusion: This study showed that women, the married, those with higher socioeconomic status and education level, and those with healthy lifestyles were more likely to achieve longevity.

Groundwork-Based Research to Design Application SCC - Building a Sustainable Community for Children in Mountainous Area

Children’s clothing is a prime example of fast fashion, as their continuous growth requires frequent purchases. This not only impacts the environment but also puts financial strain on parents. Concurrently, many highland children lack essential material and educational resources, contributing to poverty in the region. To address these challenges, local authorities urgently require a sustainable solution that supports children, communities, and localities, fostering comprehensive development. The project development criteria are evaluated based on the United Nations’ 17 sustainable development goals (SDGs). Data was collected through an online survey of 50 married individuals, 162 non-married individuals, and interviews with those who have organized events for children in the highlands. Additionally, insights were obtained from three children from disadvantaged areas. The results indicate that all target groups show a keen interest in social activities for children. Parents facing difficulties accessing charities, and the lack of effective collaboration between charities and local authorities, hinders sustainable development efforts.&#x0D; Keywords: children, SDG, social sustainabilty, community

The role of positive psychological wellbeing in walking speed differences among married and unmarried English older adults

Objectives: Walking speed has been identified as an important indicator of functional independence and survival among older adults, with marital status being related to walking speed differences. We explored explanatory factors, with a focus on positive psychological wellbeing, in walking speed differences between married and non-married individuals in later life. Methods: We used wave 8 (2016/17) cross-sectional data from adults aged 60–79 years who participated in the English Longitudinal Study of Ageing (n = 3,743). An Oaxaca-Blinder decomposition was used to compute walking speed differences between married and unmarried individuals, and the portion of those differences that could be explained by characteristic differences in those groups, particularly wellbeing. Results: Overall, married individuals had walking speeds that were 0.073 m/s (95% confidence interval: 0.055–0.092 m/s) faster than their unmarried counterparts. This was primarily driven by differences between the married and separated/divorced group, and the widowed group. Included covariates explained roughly 89% of the overall walking speed difference. Positive psychological wellbeing consistently explained a significant portion of walking speed differences, ranging between 7% to 18% across comparisons. Conclusion: Although wealth has been previously found to partially explain walking speed differences by marital status, we found that positive psychological wellbeing also demonstrated pertinence to these differences.

The effect of marital status on life expectancy: Is cohabitation as protective as marriage?

AbstractIt is well-known that marital status is an important predictor for life expectancy. However, non-married individuals are often misclassified as singles which ignores the heterogeneity within the group. This paper shows the importance of distinguishing between types of singles, and in particular whether they are cohabiting, when predicting life expectancies. We use unique and detailed longitudinal register data to track marital status throughout the individual's lifetime. We find that all types of singles consistently benefit from living with a spouse, i.e., after divorce, becoming widower or being never married. This result holds for both men and women. For certain types of cohabiting singles we reject significant differences in life expectancy compared to married individuals. Finally, we use a case study to show that, like married individuals, all types of singles that cohabit also serve as informal caregivers and have the potential to limit the end-of-life long-term care expenditure levels.

Workplace infection control measures and romantic activities of workers during COVID-19 pandemic: A prospective cohort study in Japan.

Due to the COVID-19 pandemic, non-married people are at high risk of loneliness. With social interactions restricted, it is important for non-married people to acquire a new romantic partner for their mental health and quality of life. We hypothesized that infection control efforts in the workplace influence people's social interactions, including romantic activities. We conducted an internet-based prospective cohort study from December 2020 (baseline) to December 2021, using self-administered questionnaires. Briefly, 27,036 workers completed the questionnaires at baseline, and when followed up after 1 year, 18,560 (68.7%) participated. A total of 6,486 non-married individuals with no romantic relationship at baseline were included in the analysis. At baseline they were asked about the implementation of infection control measures in the workplace, and at follow-up they were asked about activities they performed with a view to romantic relationships during the period from baseline to follow-up. Compared to workers in workplaces with no infection control measures, the odds ratio (OR) associated with romance-related activities for those in workplaces with seven or more infection control measures was 1.90 (95% CI: 1.45-2.48, p < 0.001), and the OR associated with having a new romantic partner was 1.79 (95% CI: 1.20-2.66, p = 0.004). Under the COVID-19 pandemic, the implementation of infection control measures in the workplace and the expressed satisfaction with those measures promoted romantic relationships among non-married, single individuals.

Household Socioeconomic Determinants of Clean Cooking Program in Ecuador

ABSTRACT Ecuador is a developing South American country that has highly subsidized liquid petroleum gas (LPG) since 1974. Between 2015 and 2020, LPG subsidies amounted to 260 M USD annually. In 2014, the Ecuadorean government implemented a clean cooking program, to encourage the replacement of LPG with electricity, mainly through induction stoves. However, the engagement rate in this program was lower than initially expected. This work investigates the socioeconomic and sociodemographic determinants of using various cooking technologies in Ecuador, including induction stoves. We use official Ecuadorian household surveys from 2015 to 2017 to gather information on gender, age, marital status, educational level, ethnicity, income family, family size, urban area, and province of residence. We then perform two econometric analyses, one using a probit model to study the determinants of having an induction stove, and the other employing a multilogit model to investigate the sociodemographic characteristics associated with the use of different cooking technologies, namely LPG, firewood, and electricity. Our results indicate that non-married individuals, Indigenous people, the poor, and those living in rooms or apartments with poor housing conditions show the lowest likelihood of having an induction stove. Moreover, the most disadvantaged groups still prefer firewood instead of the highly subsidized LPG barrels. We also find important differences across provinces. Our results give rise to several policy recommendations. Clean cooking programs should have a more regional approach and consider specific subsidies for the most disadvantaged groups. Moreover, the successful implementation of clean cooking programs may require the implementation of specific social programs targeting households that still use firewood. Otherwise, these clean cooking programs may become regressive and only benefit the wealthier households.

Association of marital status and access to dental care among the Japanese population: a cross-sectional study

BackgroundHealth disparities according to marital status have been reported worldwide. Although spouses provide an important social network that influences heath behaviors, limited studies have examined the association between marital status and access to dental care. Therefore, this study aimed to analyze the association between marital status and access to dental care.MethodsA secondary analysis of the 2013 Comprehensive Survey of Living Conditions in Japan which is a national survey, was performed in this study. Out of 367,766 respondents, 4111 respondents, aged over 40 years who selected oral symptoms as their most concerning subjective symptom were recruited as participants. The independent variable of interest was marital status—married or non-married (single, divorced, widowed); and the dependent variable was access to dental care. We performed Poisson regression analyses stratified by sex with adjustment for age, educational status, employment, equivalent household expenditure, and smoking habits.ResultsAmong respondents who reported oral symptoms, 3024 were married, and 1087 were non-married. Further, 29.4% and 40.4% of married and non-married men, respectively, did not receive dental treatment for their symptoms. Meanwhile, 27.5% and 25.0% of married and non-married women, respectively, did not receive dental treatment for their symptoms. The prevalence ratio for not receiving dental treatment was significantly higher among non-married men (prevalence ratio: 1.33; 95% confidence interval: 1.14–1.56) than among married men. However, no significant association was observed among women.ConclusionsNon-married men were highly unlikely to receive dental treatment than married men, while no significant association was observed among women. The results implicate the importance of implementing a public dental health policy for protecting the dental health of non-married individuals.

Carbohydrate-to-Fiber Ratio, a Marker of Dietary Intake, as an Indicator of Depressive Symptoms.

Objective: The aim of this study is to evaluate the association between a marker of dietary intake, the carbohydrate-to-fiber (CF) ratio, and moderate-to-severe depressive symptoms.Design: Cross-sectional study.Setting: National Health and Nutrition Examination Survey (NHANES) database from 2013-2016.Participants: Individuals 18 years and older were included. Participants with total energy intake outside of three standard deviations of the mean, pregnant or breastfeeding women, and those with missing data were excluded.Measurements: The main independent variable, CF ratio, was generated using corresponding variables in NHANES and divided into quartiles. The main outcome was depressive symptoms using the Patient Health Questionnaire-9. Unadjusted and adjusted logistic regression analyses were used to calculate odds ratios and their corresponding 95% confidence interval (CI). Results: Among all participants (n=9,728), 8.3% reported to have moderate-to-severe depressive symptoms (n=833). The highest proportion of depressive symptoms was reported in respondents in quartile 4 (Q4), with the highest CF ratio (13.0%; p<0.001). After adjustment, the odds of depressive symptoms significantly increased in Q4 of the CF ratio compared with Q1 (adjusted odds ratio 1.4, 95% CI 1.0-1.9). The prevalence of depressive symptoms significantly increased in females, lower federal poverty levels, non-married individuals, smokers, and hypertension patients. Conclusion: This nationally representative sample suggests that a higher CF dietary intake ratio increases the risk of moderate-to-severe depressive symptoms. These results suggest that the CF ratio may help clinicians and patients evaluate their dietary risk for depressive symptoms. Further prospective studies are needed to validate this ratio as a dietary measurement.

Investigating Rurality as a Risk Factor for State and Trait Hopelessness in Hospitalized Patients With Ischemic Heart Disease.

BackgroundRurality and hopelessness are each associated with increased mortality in adults with ischemic heart disease (IHD), yet there is no known research examining rurality as a risk factor for hopelessness in patients with IHD. This study evaluated rurality as a risk factor for state and trait hopelessness in adults hospitalized with IHD in samples drawn from the Great Lakes and Great Plains regions of the United States.Methods and ResultsA descriptive cross‐sectional design was used. Data were collected from 628 patients hospitalized for IHD in the Great Lakes (n=516) and Great Plains (n=112). Rural–Urban Commuting Area codes were used to stratify study participants by level of rurality. Levels of state hopelessness (measured by the State‐Trait Hopelessness Scale) were higher in rural patients (58.8% versus 48.8%; odds ratio [OR], 1.50; 95% CI, 1.03–2.18), a difference that remained statistically significant after adjusting for demographics, depression severity (measured by the Patient Health Questionnaire–8), and physical functioning (measured by the Duke Activity Status Index; OR, 1.59; 95% CI, 1.06–2.40; P=0.026). There was evidence of an interaction between marital status and rurality on state hopelessness after accounting for covariates (P=0.02). Nonmarried individuals had an increased prevalence of state hopelessness (nonmarried 72.0% versus married 52.0%) in rural areas (P=0.03).ConclusionsRural patients with IHD, particularly those who are nonmarried, may be at higher risk for state hopelessness compared with patients with IHD living in urban settings. Understanding rurality differences is important in identifying subgroups most at risk for hopelessness.RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT04498975.

The Influence of Religiosity/Spirituality on Sex Life Satisfaction and Sexual Frequency: Insights from the Baylor Religion Survey

Prior literature has generally found either a null or positive association between sex life satisfaction and religiosity. However, different studies have used various measures of religiosity and have focused on different demographics along the dimensions of age, marital status, and gender, limiting what can be determined in terms of moderating and cross-demographic effects. This shortcoming is germane because it may explain the differing findings in the literature. This study drew on the nationally representative 2017 Baylor Religion Survey (N = 1501) to test relationships among sex life satisfaction, sexual frequency, and a variety of different religious measures while testing for demographic moderators. Results suggest that religion and spirituality have a strong and significant association with sex life satisfaction while controlling for basic sociodemographic variables, and that this relationship is consistent across marital status, age, and gender. The positive association between religion and sexual frequency appeared to be limited to more intrinsic, personal forms such as self-rated spirituality and frequency of prayer. This association did not exist for non-married individuals, however, and among non-marrieds those who attend religious services more reported lower sexual frequency. Possible explanations for these results are discussed.

Cognitive decline is not influenced by the marital status or living arrangements in community-dwelling adults living in a rural setting. A population-based prospective cohort study

Little is known on factors influencing cognitive decline in rural communities. Using the Atahualpa Project cohort, we aimed to assess whether the marital status or living arrangements influenced cognitive decline in community-dwelling adults living in an Ecuadorian rural village. The study included 629 Atahualpa residents aged ≥40 years who had a follow-up Montreal Cognitive Assessment (MoCA) repeated at least one year after baseline. Multivariate longitudinal linear models were fitted to assess differences between the marital status and living arrangements and cognitive decline (as the outcome). A total of 411 participants were married. The remaining 218 were either single, divorced or widowed (191 of them lived with family members and the others lived alone). Enrolled individuals contributed 2088.4 person-years of follow-up (mean: 3.3 ± 1.1 years). The mean baseline MoCA was 22.1 ± 4.5 points and the follow-up MoCA was 20.6 ± 4.8 points (p = 0.001). Overall, 394 (63%) individuals had lower MoCA scores at follow-up. A fully-adjusted longitudinal linear model showed no differences in MoCA decline across married and non-married individuals (β: −0.15; 95% C.I.: −0.55 – 0.26; p = 0.477). When the subset of non-married individuals was taken into account for analyses, multivariate longitudinal linear models showed no differences in the severity of cognitive decline across individuals living alone versus those living with family members (β: 0.28; 95% C.I.: −0.68 – 1.24; p = 0.572). In this study, the marital status or living arrangements had no influence on cognitive decline in the follow-up.

Burden of non-accidental mortality attributable to ambient temperatures: a time series study in a high plateau area of southwest China

ObjectiveTo examine the total non-accidental mortality burden attributable to ambient temperatures and assess the effect modification of the burden by specific causes of death and individual characteristics in a high...

Expatriates' identity salience, work stressors, and work–nonwork conflict: Moderating role of gender and marital status

Drawing from identity theory, we proposed individuals with high work salience experienced high work stressors (interpersonal conflict, workhours, and workload), resulting in positive work‐nonwork conflict (WNWC), and individuals with high nonwork salience experienced lower work stressors, resulting in negative WNWC. Furthermore, we tested for the moderating role of gender and marital status in the relationship. The sample for this study consisted of 415 Indian expatriates working in the U.S. information technology (IT) industry. Findings supported the proposed model where work stressors completely conditioned the relationship between work/nonwork salience and WNWC. Work‐salient men worked longer hours compared to work‐salient women and were more prone to WNWC. In married individuals (in both work‐ and nonwork‐salient individuals), increased workload was positively associated with WNWC and long working hours were negatively associated with WNWC. These findings further suggested nonmarried individuals faced more WNWC when compared to married individuals when managing long working hours. Therefore, being married does not necessarily lead to higher levels of all forms of WNWC. Additionally, the participants in this study identified themselves to be more nonwork‐salient. We argue that identity salience predicts role behavioral intentions and emphasize the importance of differentiating expatriates based on their salience. This in turn could help organizations contextualize various challenges faced by work‐ and nonwork‐salient individuals and manage issues in a cost‐effective manner.

Marital status integration and suicide: A meta-analysis and meta-regression

Marital status is an index of the phenomenon of social integration within social structures and has long been identified as an important predictor suicide. However, previous meta-analyses have focused only on a particular marital status, or not sufficiently explored moderators. A meta-analysis of observational studies was conducted to explore the relationships between marital status and suicide and to understand the important moderating factors in this association. Electronic databases were searched to identify studies conducted between January 1, 2000 and June 30, 2016. We performed a meta-analysis, subgroup analysis, and meta-regression of 170 suicide risk estimates from 36 publications. Using random effects model with adjustment for covariates, the study found that the suicide risk for non-married versus married was OR = 1.92 (95% CI: 1.75–2.12). The suicide risk was higher for non-married individuals aged <65 years than for those aged ≥65 years, and higher for men than for women. According to the results of stratified analysis by gender, non-married men exhibited a greater risk of suicide than their married counterparts in all sub-analyses, but women aged 65 years or older showed no significant association between marital status and suicide. The suicide risk in divorced individuals was higher than for non-married individuals in both men and women. The meta-regression showed that gender, age, and sample size affected between-study variation. The results of the study indicated that non-married individuals have an aggregate higher suicide risk than married ones. In addition, gender and age were confirmed as important moderating factors in the relationship between marital status and suicide.

Religion and Relationship Quality Among Cohabiting and Dating Couples

Despite research on religion and marriage, little is known about the role of religion in the relationships of nonmarried couples. This study addresses two questions: (a) Do various dimensions of religious involvement—shared religious beliefs, affiliation and attendance, and theistic sanctification—influence the relationship satisfaction and marital expectations of dating and cohabiting individuals? (b) Is the association mediated by positive and negative relationship behaviors by the respondent and/or partner? We investigate these questions using the National Survey of Religion and Family Life, a nationwide sample of working-age adults, aged 18 to 59 years ( n = 468) with oversamples of African Americans and Latinos. Various dimensions of religious involvement are positively associated with the relationship satisfaction and expectations to marry among nonmarried individuals. Positive and negative relationship behaviors slightly diminish the link between religion and (a) relationship satisfaction and (b) expectations of marriage. Several implications and promising directions for future research are discussed.

Life transitions and leisure activity engagement in later life: findings from the Consumption and Activities Mail Survey (CAMS)

ABSTRACTThis study examined engagement in leisure activities among older adults, specifically focusing on how life transition factors in later life, including retirement and marital status, are associated with leisure activity engagement using a national sample of older American men and women. We conducted multiple regression analyses with a sample of 5,405 individuals (2,318 men; 3,087 women) from the Consumption and Activities Mail Survey, a supplementary sample of the Health and Retirement Study. We analysed activity engagement in each of four domains of leisure activities: mental, physical, social and religious. Retirement status was categorised into three groups: working (referent), completely retired and partly retired. Marital status was categorised into four groups: married (referent), divorced or separated, widowed and never married. We found an overall trend of a positive relationship between retirement and leisure activity engagement, which suggests that retirement provides a chance for older adults to participate in leisure activities after withdrawal from the labour force. The overall trend of a negative relationship between non-married status and leisure activity engagement suggests that the loss or absence of a spouse may serve as a barrier to participate in leisure activities. Nevertheless, variation among retirees and non-married individuals suggests future studies should compare completely and partly retired individuals or those who are widowed, divorced or separated, or never married to elucidate distinguishable leisure activity profiles.

Involvement in alcohol-related verbal or physical aggression. Does social status matter?

Introduction–The analyses (1) assessed the association between social status variables and aggression when controlling for volume of alcohol consumption and episodic heavy drinking (EHD), (2) tested whether social status moderates the association between volume or EHD and verbal as well as physical aggression, and (3) investigated whether EHD moderates the effect of volume on aggression.MethodsSwedish Alcohol Monitoring Survey (2003 to 2011); N=104,316 current drinkers; response rate: 51 to 38%. Alcohol-related aggression was defined as involvement in a quarrel or physical fight while drinking. Social status was defined as the highest education, monthly income and marital status.ResultsThe associations between social status variables and aggression showed mixed results. Verbal aggression was associated with education in males and with marital status in both genders. Physical aggression was associated with education in both genders. No associations with aggression were found for income. With few exceptions, these associations remained significant when controlling for drinking patterns; social status did not moderate the association between drinking and aggression; EHD moderated the effect of volume on physical aggression in males.ConclusionsGroups of lower educated and non-married individuals experience verbal or physical aggression over and above different levels of consumption. Individual differences in aggression vulnerability rather than differences in aggression predisposition account for higher risks of aggression in these groups.

Mental Health Service Use Among Adults With Suicide Ideation, Plans, or Attempts: Results From a National Survey.

Despite the existence of efficacious interventions that reduce suicide risk, connecting high-risk individuals with care remains a problem. Little is known about factors that may be associated with service use and nonuse among suicidal adults. This study aimed to identify correlates of mental health service use among adults reporting past-year ideation, plans, or attempts. Data from the 2013 National Survey on Drug Use and Health (NSDUH) were analyzed to identify correlates of mental health service use among a nationally representative sample of adults reporting past-year suicide ideation (N=2,126), plans (N=690), or attempts (N=345). Findings were compared with results for individuals reporting no past-year suicidality (N=35,106). Approximately 50% of adults with past-year ideation, plans, or attempts reported contact with any type of mental health services in the past year. Individuals who were more likely to have connected with services in the past year included females, non-Hispanic whites, those in worse general medical health, and those with a more severe clinical picture (that is, presence of serious psychological distress or a past-year diagnosis of a major depressive episode). Among the groups with suicide ideation, plans, or attempts, no significant differences in service use emerged between veterans and nonveterans or between married and nonmarried individuals. Findings underscore the low rates of service use among adults at elevated risk of suicide and reveal possible avenues by which to increase treatment engagement in this population. Additional research is warranted to examine correlates of service use within a prospective design.

Vulnerability to extreme heat by socio-demographic characteristics and area green space among the elderly in Michigan, 1990–2007

ObjectivesWe examined how individual and area socio-demographic characteristics independently modified the extreme heat (EH)-mortality association among elderly residents of 8 Michigan cities, May–September, 1990–2007. MethodsIn a time-stratified case-crossover design, we regressed cause-specific mortality against EH (indicator for 4-day mean, minimum, maximum or apparent temperature above 97th or 99th percentiles). We examined effect modification with interactions between EH and personal marital status, age, race, sex and education and ZIP-code percent “non-green space” (National Land Cover Dataset), age, race, income, education, living alone, and housing age (U.S. Census). ResultsIn models including multiple effect modifiers, the odds of cardiovascular mortality during EH (99th percentile threshold) vs. non-EH were higher among non-married individuals (1.21, 95% CI=1.14–1.28 vs. 0.98, 95% CI=0.90–1.07 among married individuals) and individuals in ZIP codes with high (91%) non-green space (1.17, 95% CI=1.06–1.29 vs. 0.98, 95% CI=0.89–1.07 among individuals in ZIP codes with low (39%) non-green space). Results suggested that housing age may also be an effect modifier. For the EH-respiratory mortality association, the results were inconsistent between temperature metrics and percentile thresholds of EH but largely insignificant. ConclusionsGreen space, housing and social isolation may independently enhance elderly peoples' heat-related cardiovascular mortality vulnerability. Local adaptation efforts should target areas and populations at greater risk.