Poor Self-reported General Health Research Articles

Tracked and self-reported nighttime smartphone use, general health, and healthcare utilization: results from the SmartSleep Study.

Nighttime smartphone use is an increasing public health concern. We investigated whether nighttime smartphone use is associated with general health and primary healthcare utilization. Four thousand five hundred and twenty individuals (age 35.6 ± 9.7 years, 35% male) provided self-reported information on smartphone use frequency, symptoms of depression, and general health (one-item perceived health and cross-symptom composite score). A subset of the study sample (n = 3221) tracked their nighttime smartphone use. Primary healthcare utilization, i.e. the number of weeks in which at least one service from the patient's general practitioner (GP) was billed in 2020, was extracted from Danish population registries. Statistical analysis comprised logistic and multiple linear regression, controlling for sociodemographics. Three hundred and nineteen individuals (7%) reported using their smartphone almost every night or more. More frequent self-reported nighttime smartphone use was associated with poor general health across all measures. Using the smartphone almost every night or more was associated with 2.8 [95% CI: 1.9, 4.1] fold higher odds of reporting poor health and with an average of 1.4 [95% CI: 0.7, 2.1] additional GP utilizations per year compared to no use. Associations were also found for the cross-symptom composite score across all symptoms. Further adjustment for symptoms of depression attenuated some associations. Smartphone use towards the end of the sleep period (sleep-offset use) was associated with poorer self-reported general health, but not with healthcare utilization. Nighttime smartphone use frequency is associated with poor general health and healthcare utilization. Further studies should investigate the underlying causal structure and nighttime smartphone use as a transdiagnostic intervention target.

Prevalence, trends, and characteristics of polypharmacy among US pregnant women aged 15 to 44 years: NHANES 1999 to 2016.

Polypharmacy has become a major health issue for pregnant woman due to the increased trend of medication use during pregnancy. However, data on medication use in pregnancy are limited since pregnant women are rarely included in clinical trials. Our study aimed to investigate the trends of and characteristics associated with polypharmacy among pregnant women in the US. This study was conducted using data from The National Health and Nutrition Examination Survey in the US. Nine The National Health and Nutrition Examination Survey cycles between 1999 and 2016 were used to identify pregnant women aged 15 to 44 years. Polypharmacy was defined as more than 1 medication prescription used during pregnancy. Descriptive statistics were used to report the prevalence and trends of polypharmacy. Multivariable logistic regression models were used to evaluate characteristics associated with polypharmacy among US pregnant women. Among 3,350,983 US pregnant women, about 7.4% of them (247,525) experienced polypharmacy. The prevalence of polypharmacy increased from 2.8% (1999-2000) to 10.0% (2015-2016) (P < .01) over-the time period examined in this study. Pregnant women were less likely to have experienced polypharmacy than were nonpregnant women (7.4% vs 23.5%, P < .01). Levothyroxine and albuterol were 2 prescriptions commonly taken by pregnant women. Pregnant women who were non-Hispanic white (P < .05) or had asthma (P < .05) or diabetes (P < .01) were more likely to report polypharmacy. Regarding personal characteristics, women with a poor or fair self-reported general health condition (odds ratio: 5.12, 95% confidence interval: 1.23-21.34) and those with chronic conditions (odds ratio: 6.91, 95% confidence interval: 3.08-15.50) were found to be associated with polypharmacy. An increased trend of polypharmacy was found in the US from 1999 to 2016. Non-Hispanic white pregnant women with a poor health status and chronic diseases were at an increased risk of polypharmacy.

Cannabidiol use and perceptions in France: a national survey

BackgroundCannabidiol (CBD), a safe, non-intoxicating cannabis component, is growing in popularity in Europe and worldwide. However, CBD EU regulation is blurry, and consequent labelling and product quality issues may have implications for public health. There is therefore a need to assess the prevalence and perceived harmfulness of CBD use in EU countries, as well as to characterise CBD users. We aimed to do so in the French population.MethodsIn December 2021, an online survey was conducted in a sample respecting the French adult population structure for key demographic variables. Sociodemographic, behavioural and CBD perception data were collected. Three separate regressions were performed to identify correlates of i) having heard of CBD, ii) using CBD, iii) perceived harmfulness of CBD. A hierarchical classification was also performed to identify profiles of CBD users.ResultsThe study sample comprised 1969 adults, of whom 69.2% had heard of CBD and 10.1% used it. Less than half (46.8%) of the former considered it harmful. Having heard of CBD was associated with younger age, being born in France, tobacco use, and cannabis use. CBD use was associated with younger age, tobacco use, cannabis use, poor self-reported general health status, and positive perception of alternative medicines. Cluster analysis revealed four different CBD user profiles based on socio-demographics and behavioural characteristics.ConclusionTen percent of the adults in this French study used CBD, and several user profiles emerged. Our results indirectly advocate clearer European CBD regulations to ensure safe and high-quality products.

Patterns of Atopic Eczema Disease Activity From Birth Through Midlife in 2 British Birth Cohorts

Atopic eczema is characterized by a heterogenous waxing and waning course, with variable age of onset and persistence of symptoms. Distinct patterns of disease activity such as early-onset/resolving and persistent disease have been identified throughout childhood; little is known about patterns into adulthood. This study aimed to identify subtypes of atopic eczema based on patterns of disease activity through mid-adulthood, to examine whether early life risk factors and participant characteristics are associated with these subtypes, and to determine whether subtypes are associated with other atopic diseases and general health in mid-adulthood. This study evaluated members of 2 population-based birth cohorts, the 1958 National Childhood Development Study (NCDS) and the 1970 British Cohort Study (BCS70). Participant data were collected over the period between 1958 and 2016. Data were analyzed over the period between 2018 and 2020. Subtypes of atopic eczema were identified based on self-reported atopic eczema period prevalence at multiple occasions. These subtypes were the outcome in models of early life characteristics and an exposure variable in models of midlife health. Latent class analysis identified 4 subtypes of atopic eczema with distinct patterns of disease activity among 15 939 individuals from the NCDS (51.4% male, 75.4% White) and 14 966 individuals from the BCS70 (51.6% male, 78.8% White): rare/no (88% to 91%), decreasing (4%), increasing (2% to 6%), and persistently high (2% to 3%) probability of reporting prevalent atopic eczema with age. Sex at birth and early life factors, including social class, region of residence, tobacco smoke exposure, and breastfeeding, predicted differences between the 3 atopic eczema subtypes and the infrequent/no atopic eczema group, but only female sex differentiated the high and decreasing probability subtypes (odds ratio [OR], 1.99; 95% CI, 1.66-2.38). Individuals in the high subtype were most likely to experience asthma and rhinitis, and those in the increasing subtype were at higher risk of poor self-reported general (OR, 1.29; 95% CI, 1.09-1.53) and mental (OR 1.45; 95% CI, 1.23-1.72) health in midlife. The findings of this cohort study suggest that extending the window of observation beyond childhood may reveal clear subtypes of atopic eczema based on patterns of disease activity. A newly identified subtype with increasing probability of activity in adulthood warrants additional attention given observed associations with poor self-reported health in midlife.

Oral Health and Psychosocial Predictors of Quality of Life and General Well-Being among Adolescents in Lesotho, Southern Africa.

Background: Adolescents’ quality of life is reported to be significantly associated with physical and social wellbeing. Although adolescents are 30% of the Southern African population, no previous studies have focused on this group in relation to oral health and quality of life. Methods: A 40-item survey and clinical oral examinations were conducted in public schools in Maseru from 10 to 25 August 2016. Simple, bivariate, and multivariate regressions were used to evaluate the associations of oral health and psychosocial factors with self-reported general health status and quality of life. Results: A total of 526 participants, aged 12–19 years old, responded to the survey and participated in the clinical examinations. The majority reported a good (good/very good/excellent) quality of life (84%) and general health (81%). Bivariate results showed that self-reported general health in this population was significantly influenced by age. The presence of toothache and sensitivity in the adolescents were significantly associated with poor (fair/poor) self-reported general health and were found to be the best predictors for self-general health and quality of life. Conclusions: The absence of dental conditions such as toothache and tooth sensitivity can lead to a better perception of general health and Quality of Life in adolescents.

Temporomandibular disorders in an adult population in northern Norway: A cross-sectional study.

ObjectivesThe aim of the study was to assess the prevalence of symptoms indicative of temporomandibular disorders (TMD) in an adult population in Troms County in Northern Norway, as well as the associations between TMD and socio‐demographic factors, dental status, self‐reported general, and oral health as well as oral health related quality of life (OHQoL).MethodsData were collected from a structured questionnaire and a clinical examination of a random sample of almost 2000 adults, 20–79‐year‐old, in Troms County in Northern Norway.ResultsWomen had a higher prevalence of all self‐reported and clinical signs of pain and dysfunction in the temporomandibular complex compared to men. For both genders, sounds from the temporomandibular joint (TMJ) upon clinical examination was the most common symptom, followed by pain to palpation of jaw muscles. Headache was the most common of the self‐reported symptoms and sounds from the TMJ the second most common. Young women had a higher prevalence of self‐reported headache and jaw‐ and face pain compared to middle‐aged and elderly women. TMD‐related symptoms of pain were significantly associated with poor self‐reported general health and correlated with OHQoL as assessed by the oral health impact profile 14 questionnaire.ConclusionBeing women and having moderate to poor self‐reported general health were associated with clinical signs and self‐reported symptoms of pain in the jaw, face and head region. Self‐reported symptoms of TMD correlated more strongly with OHQoL than clinical signs.

Longitudinal Analysis of Work-to-Family Conflict and Self-Reported General Health among Working Parents in Germany.

The combination of work and family roles can lead to work-to-family conflict (WTFC), which may have consequences for the parents’ health. We examined the association between WTFC and self-reported general health among working parents in Germany over time. Data were drawn from wave 6 (2013) and wave 8 (2015) of the German family and relationship panel. It included working persons living together with at least one child in the household (791 mothers and 723 fathers). Using logistic regressions, we estimated the longitudinal effects of WTFC in wave 6 and 8 on self-reported general health in wave 8. Moderating effects of education were also considered. The odds ratio for poor self-reported general health for mothers who developed WTFC in wave 8 compared to mothers who never reported conflicts was 2.4 (95% CI: 1.54–3.68). For fathers with newly emerged WTFC in wave 8, the odds ratio was 1.8 (95% CI: 1.03–3.04). Interactions of WTFC with low education showed no significant effects on self-reported general health, although tendencies show that fathers with lower education are more affected. It remains to be discussed how health-related consequences of WTFC can be reduced e.g., through workplace interventions and reconciliation policies.

Taking the strain? Impact of glaucoma on patients' informal caregivers.

To estimate informal caregiver (ICG) strain in people from a glaucoma clinic. Patients with glaucoma were consecutively identified from a single clinic in England for a cross-sectional postal survey. The sample was deliberately enriched with a number of patients designated as having advanced glaucoma (visual field [VF] mean deviation worse than -12 dB in both eyes). Patients were asked to identify an ICG who recorded a Modified Caregiver Strain Index (MCSI), a validated 13 item instrument scored on a scale of 0-26. Previous research has indicated mean MCSI to be >10 in multiple sclerosis and Parkinson's disease. All participants gave a self-reported measure of general health (EQ5D). Responses from 105 patients (43% of those invited) were analysed; only 38 of the 105 named an ICG. Mean (95% confidence interval [CI]) MCSI was 2.4 (1.3, 3.6) and only three ICGs recorded a MCSI > 7. The percentage of patients with an ICG was much higher in patients with advanced VF loss (82%; 9/11) when compared with those with non-advanced VF loss (31%; 29/94; p = 0.001). Mean (standard deviation) MCSI was considerably inflated in the advanced patients (5.6 [4.9] vs 1.5 [2.2] for non-advanced; p = 0.040). Worsening VF and poorer self-reported general health (EQ5D) of the patient were associated with worsening MCSI. ICG strain, as measured by MCSI, for patients with non-advanced glaucoma is negligible, compared with other chronic disease. ICG strain increases moderately with worsening VFs but this could be partly explained by worse general health in our sample of patients.

Work-family conflict, self-reported general health and work-family reconciliation policies in Europe: Results from the European Working Conditions Survey 2015.

The increasing labor market participation of women in Europe leads to many women and men having to reconcile paid work with family work and thus reporting work-family conflict (WFC). WFC is related to different dimensions of health. In the present article, we analyzed the role different reconciliation policies among European countries may play regarding WFC and its association with self-reported health.The analyses are based on data from Eurofound's European Working Conditions Survey 2015. The working populations from 23 European countries aged between 18 and 59 with at least one child up to 18 years of age are included (n = 10,273). Weighted logistic regression was applied to estimate the association between WFC and self-reported general health (SRH). Using multilevel models, country-level variations in the association of individual-level WFC and health were calculated. In a second step, the effect of country-level reconciliation policies on WFC was examined (adjusted for age, sociodemographic and occupational characteristics).The odds ratio for moderate to very poor SRH is 2.5 (95% CI: 1.92–3.34) for mothers with high WFC compared to mothers with low WFC. For fathers with high WFC, the adjusted odds ratio is also 2.5 (95% CI: 1.80–3.37). Between countries, the association between WFC and health is similar. Country-level parental leave policies, the use of formal childcare and mothers’ labor market participation are associated with reduced WFC in Europe.In conclusion, the results reveal a strong association between WFC and SRH in Europe. The multilevel analyses show that certain reconciliation policies have an impact on the prevalence of WFC, with different results for mothers and fathers. Mothers in particular can be supported by sufficient maternal leave and formal care for children. These are tangible policy approaches for reducing WFC and may thus improve health in Europe.

Distinguishing between self-control and perceived control over the environment to understand disadvantaged neighbourhood health and lifestyle outcomes

Objective: The current study aimed to test whether and how self-control and perceived control play a role in health outcomes and lifestyle differences between disadvantaged and non-disadvantaged neighbourhoods.Design: Cross-sectional survey data including demographics was collected from 3758 participants. Main outcome measures: With the survey, self-control, perceived control, health status and lifestyle variables were assessed.Results: Participants in disadvantaged neighbourhoods reported poorer general health, as well as unhealthier lifestyles compared to participants in non-disadvantaged neighbourhoods. Self-control was likewise positively associated with health and lifestyle variables. However, self-control did not differ between participants from different neighbourhoods. Perceived control over the environment mediated between type of neighbourhood and health, with participants from a disadvantaged neighbourhood reporting a lower sense of perceived control, which in turn was associated with poorer self-reported general health and less healthy lifestyle choices.Conclusion: This reveals that perceived control over one’s life and the environment is more important than self-control when explaining health differences between neighbourhoods.

Chewing function, general health and the dentition of older Australian men: The Concord Health and Ageing in Men Project.

To describe the associations between chewing function with oral health and certain general health characteristics, in a population of community-dwelling older Australian men. Analysis of data obtained from a cross-sectional analysis of the 4th wave of the Concord Health and Ageing in Men Project cohort of 614 participants, 524 whom were dentate, aged 78years and over. Their chewing capacity was assessed using three main indicators: capacity to chew eleven food items ranging from boiled eggs through to fresh carrots and nuts; discomfort when eating; and interruption of meals. Associations with chewing were tested for dentate vs edentate participants, numbers of teeth present, active dental disease and key general health conditions such as disabilities, comorbidities and cognitive status. Log binomial regression models adjusted for age, country of birth, income, education and marital status. Prevalence ratios and 95% confidence intervals were estimated. Twenty-one per cent of participants could not eat hard foods, while 23.1% reported discomfort when eating, and 8.8% reported interrupted meals when eating. There was a threefold difference in the capacity of dentate men to chew firm meat over that of edentulous men (95% CI, 2.0-4.9); a 2.5 times greater likelihood of edentate men reporting discomfort when eating (95% CI: 1.5-4.3); and 1.9 times greater likelihood of edentate participants reporting having meals interrupted (95% CI: 1.4-2.6). Chewing/eating difficulties were associated with both dental status (number of teeth, active dental caries) and self-rated dental health. Fewer than 20 teeth and the presence of active coronal or root decay were associated with more discomfort when eating. General health conditions associated with chewing function included disability, physical activity, comorbidities, cognitive status and depression. Older men's self-rated oral health and general health perceptions were also associated with aspects of chewing function. Poorer self-reported oral health was associated with inability to eat hard foods (95% CI: 1.3-2.7) and with discomfort when eating (95% CI: 2.6-5.1), while poorer self-reported general health was associated with discomfort when eating (95% CI: 1.2-2.2). Falling rates of edentulism may lead to improved chewing and eating function in older men. Maintaining 20 or more natural teeth, and preventing active coronal and root caries should enhance chewing function and promote self-reported health and oral health. Lower capacity to chew hard foods and a higher reporting of discomfort when eating is associated with co-morbidity in older Australian men.

Domestic gardens and self-reported health: a national population study

BackgroundThere is a growing recognition of the health benefits of the natural environment. Whilst domestic gardens account for a significant proportion of greenspace in urban areas, few studies, and no population level studies, have investigated their potential health benefits. With gardens offering immediate interaction with nature on our doorsteps, we hypothesise that garden size will affect general health—with smaller domestic gardens associated with poorer health.MethodsA small area ecological design was undertaken using two separate analyses based on data from the 2001 and 2011 UK census. The urban population of England was classified into ‘quintiles’ based on deprivation (Index of Multiple Deprivation) and average garden size (Generalised Land Use Database). Self-reported general health was obtained from the UK population census. We controlled for greenspace exposure, population density, air pollution, house prices, smoking, and geographic location. Models were stratified to explore the associations.ResultsSmaller domestic gardens were associated with a higher prevalence of self-reported poor health. The adjusted prevalence ratio of poor self-reported general health for the quintile with smallest average garden size was 1.13 (95% CI 1.12–1.14) relative to the quintile with the largest gardens. Additionally, the analysis suggested that income-related inequalities in health were greater in areas with smaller gardens. The adjusted prevalence ratio for poor self-reported general health for the most income deprived quintile compared against the least deprived was 1.72 (95% CI 1.64–1.79) in the areas with the smallest gardens, compared to 1.31 (95% CI 1.21–1.42) in areas with the largest gardens.ConclusionsResidents of areas with small domestic gardens have the highest levels of poor health/health inequality related to income deprivation. Although causality needs to be confirmed, the implications for new housing are that adequate garden sizes may be an important means of reducing socioeconomic health inequalities. These findings suggest that the trend for continued urban densification and new housing with minimal gardens could have adverse impacts on health.

Assessing the influence of working hours on general health by migrant status and family structure: the case of Ecuadorian-, Colombian-, and Spanish-born workers in Spain.

The purpose of this study was to analyze the relationship between working hours (WHs) and the likelihood of poor self-reported general health (SRGH) in the first data wave from a cohort of immigrant and native workers in Spain. Cross-sectional analyses from a prospective cohort study. Data were drawn from the first wave of the Platform of Longitudinal Studies on Immigrant Families. The selected sample was composed of 217 immigrant workers and 89 native-born workers. We explored differences by immigrant status and family structure, assessing prevalences and Poisson regression models; an additional analysis explored statistically optimized work hour cut points. Highest prevalence of poor SRGH (72.7%) was reported by immigrant, single-parent workers working >40 WH/week. Immigrant single-parent families were more likely to report poor SRGH for three WH categories: ≤20 WH/week (prevalence ratio [PR]=3.3, 95% confidence interval [CI] 1.6-7.2), >30-≤40 WH/week (PR=2.8, 95% CI 1.3-6.4), and >40 WH/week (PR=4.2, 95% CI 1.8-10.1). In two-parent families, immigrants working standard hours (i.e. >30-≤40) and native-born workers in the highest and lowest categories of WHs (i.e. ≤20 and>40) had similar PRs for poor SRGH compared with native-born workers working standard hours. Findings suggested that native-born workers residing in two-parent families were able to work more than 10h longer per week than immigrant workers before reporting equivalent prevalences of poor SRGH. Differences in the association of WHs and poor SRGH among immigrants in Spain seem to be explained by family structure, which suggests that the influence of WHs on health differentially affects vulnerable groups, such as immigrant workers residing in single-parent families.

Missed Work Due to Occupational Illness among Hispanic Horse Workers.

Occupational illnesses are inadequately reported for agriculture, an industry dominated by a vulnerable Hispanic population and high fatal and nonfatal injury rates. Work-related illnesses can contribute to missed work, caused by a combination of personal and work factors, with costs to the individual, employer, and society. To better understand agricultural occupational illnesses, 225 Hispanic horse workers were interviewed via community-based convenience sampling. Descriptive statistics, bivariate analyses, and log binomial regression modeling were used to: (1) describe the prevalence of missed work due to work-related illnesses among Hispanic horse workers, (2) examine work-related and personal factors associated with missed work, and (3) identify health symptoms and work-related characteristics potentially associated with missed work. Key findings reveal that having at least one child (PR = 1.71, 95% CI = 1.03, 2.84), having poor self-reported general health (PR = 0.72, 95% CI = 0.48, 1.08), experiencing stress during a typical workday (PR = 2.58, 95% CI = 1.25, 5.32), or spending less time with horses (PR = 1.87, 95% CI = 1.15, 3.05) are significant predictors of missing work. Interventions can be designed to identify workers most susceptible to missing work and provide resources to reduce absenteeism. Future research should examine work-related illness in agricultural horse production, including personal and work-related factors, in order to diminish occupational health disparities among these workers, who are more likely to be employed in hazardous agricultural work.

Targeting weight loss interventions to reduce cardiovascular complications of type 2 diabetes: a machine learning-based post-hoc analysis of heterogeneous treatment effects in the Look AHEAD trial

The Action for Health in Diabetes (Look AHEAD) trial investigated whether long-term cardiovascular disease morbidity and mortality could be reduced through a weight loss intervention among people with type 2 diabetes. Despite finding no significant reduction in cardiovascular events on average, it is possible that some subpopulations might have derived benefit. In this post-hoc analysis, we test the hypothesis that the overall neutral average treatment effect in the trial masked important heterogeneous treatment effects (HTEs) from intensive weight loss interventions. We used causal forest modelling, which identifies HTEs, using a random half of the trial data (the training set). We applied Cox proportional hazards models to test the potential HTEs on the remaining half of the data (the testing set). The analysis was deemed exempt from review by the Columbia University Institutional Review Board, Protocol ID# AAAO3003. Between Aug 22, 2001, and April 30, 2004, 5145 patients with type 2 diabetes were enrolled in the Look AHEAD randomised controlled trial, of whom 4901 were included in the The National Institute of Diabetes and Digestive and Kidney Diseases Repository and included in our analyses: 2450 for model development and 2451 in the testing dataset. Baseline HbA1c and self-reported general health distinguished participants who differentially benefited from the intervention. Cox models for the primary composite cardiovascular outcome revealed a number needed to treat of 28·9 to prevent 1 event over 9·6 years among participants with HbA1c 6·8% or higher, or both HbA1c less than 6·8% and Short Form Health Survey (SF-36) general health score of 48 or more (2101 [86%] of 2451 participants in the testing dataset; 167 [16%] of 1046 primary outcome events for intervention vs 205 [19%] of 1055 for control, absolute risk reduction of 3·46%, 95% CI 0·21-6·73%, p=0·038) By contrast, participants with HbA1c less than 6·8% and baseline SF-36 general health score of less than 48 (350 [14%] of 2451 participants in the testing data; 27 [16%] of 171 primary outcome events for intervention vs 15 [8%] of 179 primary outcome events for control) had an absolute risk increase of the primary outcome of 7·41% (0·60 to 14·22, p=0·003). Look AHEAD participants with moderately or poorly controlled diabetes (HbA1c 6·8% or higher) and subjects with well controlled diabetes (HbA1c less than 6·8%) and good self-reported health (85% of the overall study population) averted cardiovascular events from a behavioural intervention aimed at weight loss. However, 15% of participants with well controlled diabetes and poor self-reported general health experienced negative effects that rendered the overall study outcome neutral. HbA1c and a short questionnaire on general health might identify people with type 2 diabetes likely to derive benefit from an intensive lifestyle intervention aimed at weight loss. None.

The Identification of a Threshold of Long Work Hours for Predicting Elevated Risks of Adverse Health Outcomes.

Working long hours has been associated with adverse health outcomes. However, a definition of long work hours relative to adverse health risk has not been established. Repeated measures of work hours among approximately 2,000 participants from the Panel Study of Income Dynamics (1986-2011), conducted in the United States, were retrospectively analyzed to derive statistically optimized cutpoints of long work hours that best predicted three health outcomes. Work-hours cutpoints were assessed for model fit, calibration, and discrimination separately for the outcomes of poor self-reported general health, incident cardiovascular disease, and incident cancer. For each outcome, the work-hours threshold that best predicted increased risk was 52 hours per week or more for a minimum of 10 years. Workers exposed at this level had a higher risk of poor self-reported general health (relative risk (RR)=1.28; 95% confidence interval (CI): 1.06, 1.53), cardiovascular disease (RR=1.42; 95% CI: 1.24, 1.63), and cancer (RR=1.62; 95% CI: 1.22, 2.17) compared with those working 35-51 hours per week for the same duration. This study provides the first health risk-based definition of long work hours. Further examination of the predictive power of this cutpoint on other health outcomes and in other study populations is needed.

An investigation of mental health in migrant workers in an enterprise

Objective: To investigate the mental health status in migrant workers in a labor-intensive enterprise and related influencing factors. Methods: Typical sampling was used to perform an investigation in 910 migrant workers in a large foreign-funded labor-intensive enterprise in Shenzhen, China. All the respondents gave informed consent and completed the questionnaire independently and anonymously. The self-reported mental health status was evaluated using the Beck Anxiety Inventory, Beck Depression Inventory, and General Health Questionnaire. Results: Of all the migrant workers in this enterprise, 7.2% had a positive self-reported anxiety symptom, 25.4% had a moderate or severe self-reported depression symptom, and 76.4% had a poor self-reported general health status. Age had significant influence on the self-reported depression symptom (χ2=21.968, P<0.05) ; age did not have significant influence on the self-reported anxiety and general health status (χ2=6.616、12.498, both P>0.05) . The knowledge of occupational hazards had significant influence on mental health status (χ2Depression=47.289, χ2General health=21.087, both P<0.05) . The feeling of work had significant influence on self-reported depression and general health status (χ2Depression=52.406, χ2General health=17.327, both P<0.05) . Attention to self mental health had significant influence on self-reported depression (χ2=17.714, P<0.05) , and whether the person wanted to learn the knowledge of mental health had significant influence on self-reported anxiety (χ2= 6.145, P<0.05) . Conclusion: The self-reported mental health status in migrant workers is poor and is associated with age, worry about exposure to occupational hazard factors, emphasis on mental health knowledge, and a focus on personal mental health. Therefore, targeted occupational health education and occupational mental health education should be strengthened.

Association between long work hours and poor self‐reported general health among Latin American immigrant and native workers in the United States and Spain

The relationship between hours worked per week and self-reported general health (SRGH) has not been assessed in Latin American immigrant and native workers across host countries. Cross-sectional study of the association between long work hours (LWH) (i.e., >51 hr per week) and poor SRGH using data from 2,626 workers in the United States (immigrants = 10.4%) and 8,306 workers in Spain (immigrants = 4.1%). Both countries' natives working >51 hr per week had increased odds of reporting poor SRGH compared to those working fewer hours (U.S.: OR = 1.59; 95%CI = 1.01-2.49; Spain: OR = 2.17; 95%CI = 1.71-2.75); when stratified by sex, increased odds also were observed among immigrant female workers in Spain (OR = 3.47; 95%CI = 1.15-10.5). LWH were associated with differential health outcomes in populations of native and Latin American immigrant workers in the United States and Spain, which may reflect social or occupational inequalities in general or resulting from the 2008 financial crisis. Am. J. Ind. Med. 59:1105-1111, 2016. © 2016 Wiley Periodicals, Inc.

G492 Health in adolescence influences educational attainments and life chances: longitudinal associations in the longitudinal study of young people in england (LSYPE)

Aims Education is recognised as a social determinant of health with poor academic attainment linked to poorer health. Reverse causal pathways have been largely overlooked. Likewise, exploration of risk factors for youth unemployment have rarely examined the impact of poor adolescent health. This study longitudinally examines causal pathways from poor adolescent health to low academic attainment and unemployment in young adulthood. Methods We used nationally-representative data from the Longitudinal Study of Young People in England (LSYPE; Wave 1, age 13 N=15,770). Having a chronic condition, poor mental health and poor self-reported general health were assessed between ages 13 and 15. Outcome variables included poor academic performance (non-attainment of expected academic proficiency based on mandated school examinations) at age 16 and NEET status (not in education, employment or training) at age 19. We examined associations between health and subsequent outcomes, and conducted mediator analyses to assess the proportion of the association attributable to hypothesised mediators including school absences, classroom behaviour, truancy, social exclusion, health behaviours and psychological distress. Results Poor mental and general health and long-term conditions predicted low educational attainment at age 16. Poor mental health and poor general health (but not long-term conditions) predicted unemployment. Social exclusion was a consistent mediating variable. Long-term absences mediated associations between general health and mental health and later outcomes whereas school behaviour, truancy and substance use were significant mediators for general health and mental health. Conclusion Poor adolescent health disrupts educational and employment pathways. Due to the economic and social costs of educational underachievement and unemployment, policy interventions should focus on improving outcomes for unhealthy adolescents.

Assessment of trade-offs made by people due to financial stress from medical care in the USA

Objectives This study aims to understand how do socio-demographic and personal factors impact the trade-offs people make in daily life in the USA due to problems in paying medical bills. Methods This study used the 2007 wave of the Health Tracking Household Survey (HTHS) data. The unit of analysis was an individual. The dependent variable was the level of trade-off. A cumulative logit model measured the effect of independent variables on the dependent variable, which was ordinal. Key findings Pre-tax family income, out-of-pocket spending for medical care during past 12 months, perceived health status, type of family, ethnicity and age had significant impact on level of trade-off experienced by individuals. Odds of making severe trade-offs increased significantly for people with low income, poor self-reported general health status, higher out-of pocket medical expenditure and single parents. Compared to white people, African-Americans were worse affected because of problems in paying medical bills. Younger people made a higher level of trade-off compared to older people because of medical debt. Conclusions Problems in paying medical bills forced people to forgo basic necessities of life, which could impact the nutritional status, access to health care and living condition of people. A higher level of trade-offs in daily life could potentially affect the health of an individual in the long run. Poor people were worst affected because of medical debt. This study could prompt policy makers to provide more support to indigent people, people with higher out-of-pocket medical expenses and those with poor health conditions to ensure adequate access to basic necessities of life.