National Representative Sample Research Articles

Chronic Health Cost Burden in Older Caregivers and non-Caregivers in the United States.

Chronic health conditions affect the physical and financial well-being of millions of older adults, including those who themselves provide care to relatives and friends. As well, certain conditions cost more than others to manage, and older caregivers may be especially at risk of experiencing financial burden from an illness. This study investigated the association between caregiving and longitudinal change in health cost burden by measuring condition-specific expenses in a nationally-representative sample of older caregivers and non-caregivers. Three waves of the Health and Retirement Study (HRS) were used in the analysis. Caregiver socio-demographic and financial status was matched with updated treatment and lost-wage costs for chronic conditions developed by the Milken Institute. Profiles of health cost burden were created for community-dwelling adults 60 years and older who completed the HRS core survey for all three wave years from 2016 through 2020 (N = 10,540). Bivariate and regression analyses were used to examine differences in health cost burden between caregivers and non-caregivers over time. Compared to non-caregivers, caregivers were healthier and less burdened at baseline. Yet, holding other variables constant, caregivers showed steeper increases in chronic condition prevalence and costs over a four-year period after initiating caregiving activities. Findings suggest that whereas older caregivers may appear to select into the caregiving role while healthier, they are more likely to experience increased economic and health burdens over time - both from medical treatment and lost wages - related to chronic conditions.

Emotions associated with the intention to purchase sustainable food: An assessment within and between different animal-sourced food categories.

This study investigates the role of emotions in predicting sustainable food purchase intentions. A national representative sample from Norway (N = 785) was randomly assigned to rate their emotional response to specific food categories: livestock, capture fishery, aquaculture, and hunting. Emotional responses to each food category were of moderate intensity but there were no significant differences between specific animal-sourced foods. Findings from a series of regression analyses showed that egoistic values positively predict the intensity of positive and negative emotions for all food categories. Additionally, it was shown that individual differences in biospheric values (when strong) and hedonic values (when weak) predicted stronger negative emotions. Further analysis showed that negative emotions are the most consistent predictor of willingness to pay for sustainable animal-sourced food. These findings suggest that negative emotions can potentially be leveraged to enhance sustainable animal-sourced food consumption intentions.

Linking common mental disorders and asthma in Brazilian adolescents: a cross-sectional analysis of the ERICA study.

Asthma is a heterogeneous chronic disease of the airways, affecting all age groups, especially children and adolescents. The aim of this study was to evaluate several factors associated with asthma in Brazilian adolescents. Cross-sectional study of a national representative sample of school-based adolescents aged 12-17 years from The Study of Cardiovascular Risk in Adolescents (ERICA) stratified by region and conglomerate by schools. The authors studied the following variables: sociodemographic characteristics, lifestyle, smoking, eating habits, sleeping and mental conditions. Data from 66,567 adolescents were analyzed, 50.2 % of whom were female. Of the total, 52.7 % were between 12 and 14 years old. The overall prevalence of asthma was 14.5 % (95 %CI: 13.6-15.5). Asthma was associated with female sex (PR 1.35; 95 %CI: 1.15-1.57), white skin color (PR 1.25; 95 %CI: 1.04-1.50), private school (PR 1.26; 95 %CI: 1.05-1.52), smoking (PR 1.93; 95 %CI: 1.54-2.38); and alcohol consumption (PR 1.74; 95 %CI: 1.52-2.03). Excessive screen time (PR 1.19; 95 %CI 1.01-1.42) and short sleep duration (PR 1.28; 95 %CI 1.05-1.57) were also associated. Healthy eating habits, such as adolescents who ate breakfast, drank water, and ate meals with their parents, were associated with a lower prevalence of asthma. In relation to comorbidities, asthma was associated with common mental disorders (CMD) (PR 1.94; 95 %CI 1.64-2.27; p < 0,00,001), but not with overweight or obesity (PR 1.09; 95 %CI 0.87-1.38). In the correspondence analysis, CMD was the strongest factor associated with asthma. Asthma was associated with several determinants in Brazilian adolescents, but the association with CMD deserves special attention in this age group.

Trends in use of cigarettes and e-cigarettes among young adults who had smoked in adolescence: 2017–2022

BackgroundThis study considers recent trends in combustible and e-cigarette use among US young adults who smoked cigarettes in adolescence, who are the originating source of most adults who smoke.MethodsData come...

Healthiness, appearance, or fashion? The drivers behind the sushi popularity in Italy.

Italy is witnessing an unprecedented success for sushi even if Italian consumers have a historical reluctance towards eating raw fish. It is important to understand what is behind this major shift in preferences, since it may set an example for the process of adoption of global products and/or diets. To this aim, we investigated which food motives drive sushi consumption (i.e. health, mood, convenience, sensory appeal, natural content, price, weight control, familiarity, and ethical concern), including also individual factors (i.e., social norms, food neophobia, traceability) on a national representative sample of 798 consumers. Data analysis yielded that social norms were the main drivers behind sushi consumption, while sensory appeal, price and neophobia reduced sushi frequency consumption. Traceability was associated with naturalness, and ethical concern, and hindered sushi consumption frequency. These results may pave the way for forthcoming marketing strategies and policies aimed at promoting the consumption of novel, healthy and sustainable food.

Racial and Ethnic Disparities in Child Abuse Identification and Inpatient Treatment

Child abuse is a leading cause of morbidity in early childhood. Accurate detection remains challenging. To describe racial and ethnic disproportionalities in suspicion for child abuse (SCA) in pediatric patients admitted after traumatic injury. This retrospective, multicenter cross-sectional study performed between 2022 and 2024 examined a representative national sample of children and adolescents (aged <18 years) admitted for pediatric trauma indications from 2006 to 2019. Data were from the Kids' Inpatient Database (KID), the largest publicly available all-payer pediatric inpatient care database. Patient demographics, injury severity, and hospitalization characteristics were classified by race and ethnicity and compared using univariate and multivariate regression. Statistical analysis was performed between March 2022 and October 2024. The SCA subgroup was identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes corresponding to child and adolescent maltreatment. The primary outcome was the racial and ethnic composition of pediatric patients admitted after traumatic injury with SCA vs those without SCA. Among the weighted total of 634 309 pediatric patients with complete data included in the study, 13 579 patients had injuries attributable to SCA (SCA subgroup; mean [SD] age, 1.70 [0.04] years; 7650 male [56.3%]; 2868 Black [21.1%], 2293, Hispanic [16.9%], and 5675 White [41.8%]) and 620 730 patients did not (non-SCA subgroup; mean [SD] age, 9.70 [0.01] years; 395 158 male [63.7%]; 86 376 Black [13.9%], 108 406 Hispanic [17.5%], and 298 748 White [48.1%]). The racial and ethnic distribution of the non-SCA subgroup was similar to that of the 2010 US Census. In the SCA subgroup, Black patients (odds ratio [OR], 1.75; 95% CI, 1.65-1.85; P < .001) and Hispanic patients were overrepresented (OR, 1.11; 95% CI, 1.05-1.18; P < .001) and White patients were underrepresented compared with the Census. After controlling for socioeconomic factors and hospital characteristics among 504 365 (weighted) observations in White, Black, and Hispanic patients (493 530 patients without and 10 835 patients with SCA), Black race remained an independent risk factor associated with SCA (OR, 1.10; 95% CI, 1.03-1.17; P = .004), whereas Hispanic race was found to be a protective factor associated with decreased odds of SCA (OR, 0.71; 95% CI, 0.67-0.76; P < .001). Compared with White patients in the SCA subgroup, Black patients had a 26.5% (95% CI, 11.0%-44.3%) longer length of stay (P < .001) for mild to moderate injuries and a 40.1% (95% CI, 16.4%-68.5%) longer length of stay (P < .001) for serious injury. In this study, Black children and adolescents were suspected to have experienced child abuse at higher rates than children and adolescents of other racial and ethnic backgrounds. More research is necessary to understand the origins of these disparities to reduce them in child abuse identification.

National impact of a constraining regulatory framework on pregabalin dispensations in France, 2020–2022

BackgroundPregabalin is a drug approved for neuropathic pain, epilepsy and general anxiety disorder. However, pregabalin is also an increasing cause of diversion and misuse, and, for this reason, the French health authorities have decided in 2021 to classify it as a narcotic drug, requiring secured prescription pads. Our study aimed to evaluate the impact of this measure on pregabalin dispensation patterns. MethodsUsing data from a national representative sample of 12,690 French community pharmacies, we assessed the impact of the new regulatory framework, implemented in June 2021, on the total monthly quantity of pregabalin dispensed by conducting an interrupted time-series (ITS) analysis. We built a counterfactual model to predict what would have happened without the intervention. We conducted the same analyses in the subsample of pregabalin dispensations exceeding the maximum recommended dosage of 600 mg per day. Additionally, we compared (1) the number of pregabalin dispensations (2) the co-dispensing of opioids and/or benzodiazepines one year before and one year after the regulation. ResultsFollowing the regulatory change, there was an immediate and significant drop of 38,475,375 mg (95 %CI [-66,931,799 mg; -10,018,951 mg] in pregabalin dispensations. This decline continued in the following months, with a decrease of 4,788,107 mg (95 %CI: [-8,888,326 mg; -687,888 mg] per month. The counterfactual model predicted that, without the intervention, there would have been no notable change in pregabalin dispensations. The ITS analyses showed no significant change in pregabalin dispensations following the new regulation for the subsample with doses exceeding 600 mg per day. Concurrently, there was a significant decrease in co-dispensing of opioids (18.4 % pre-regulation versus 11.6 % post-regulation, p < 0.001) and benzodiazepines (21.4 % pre-regulation versus 11.7 % post-regulation, p < 0.001). ConclusionThe constraining regulation adopted in 2021 by the French health authorities significantly curtailed total pregabalin dispensing in community pharmacies. Our findings underscore the importance of regulatory measures to limit the misuse of a prescribed medication.

Association between perceived olfactory dysfunction and all-cause mortality in Chinese adults: A prospective community-based study.

Olfactory dysfunction has been suggested to be associated with all-cause mortality. Yet, there is a lack of large-scale cohorts to study this relationship. Using data from the Kailuan cohort, we assessed 97 327 Chinese adults for perceived olfactory dysfunction at baseline and gathered mortality data from government records. We used Cox proportional hazards regression models to analyse the risk of all-cause mortality associated with perceived olfactory dysfunction, yielding hazard ratios (HRs) and 95% confidence intervals (CIs) with adjustment for multiple potential confounders. Over a median follow-up of 6.4-year, we recorded a total of 3903 deaths. Individuals reporting perceived olfactory dysfunction had a higher risk of mortality (adjusted HR = 1.42; 95% CI = 1.02-2.00) compared to those without the dysfunction. In sensitivity analyses, we found similar results after excluding participants with pre-existing obesity, cardiovascular diseases, those younger than 50 years old, individuals diagnosed with cancer or stroke during follow-up, and those who died within two years of follow-up. Perceived olfactory dysfunction was associated with a high risk of all-cause mortality among Chinese adults. Our study is limited by failure to include a national-representative sample and misclassification of exposure assessment due to use of a subjective question to assess olfactory dysfunction. Further studies with objective are warranted to replicate our findings and understand the underlying mechanisms.

Beyond Dichotomy: Understanding Violent Offending and Victimization Among Immigrant Youths

ABSTRACT Research has suggested a pattern of lower levels of crime and victimization among first-generation immigrants than subsequent generations. A distinct drawback of most previous research is its focus on the premise of immigrants as either aggressive offenders or submissive victims. Little is known about the co-occurrence of these roles among immigrant groups. Using a longitudinal, national representative sample of school-aged adolescents in the U.S. this study provides an empirical assessment of how generational differences in violent offending and victimization vary when the victim-offender is considered a group separate from victim only and offender only. The findings of this study shed light on our understanding of the often-understudied topic of the victim – offender overlap among immigrant adolescents and can help identify specific targets for anti-violence/victimization intervention and prevention programs.

Service Quality and Patient Satisfaction of Internet Hospitals in China: Cross-Sectional Evaluation With the Service Quality Questionnaire.

Internet hospitals, which refer to service platforms that integrate consultation, prescription, payment, and drug delivery based on hospital entities, have been developing at a rapid pace in China since 2014. However, assessments regarding their service quality and patient satisfaction have not been well developed. There is an urgent need to comprehensively evaluate and improve the service quality of internet hospitals. This study aims to investigate the current status of patients' use of internet hospitals, as well as familiarity and willingness to use internet hospitals, to evaluate patients' expected and perceived service qualities of internet hospitals using the Chinese version of the Service Quality Questionnaire (SERVQUAL-C) with a national representative sample, and to explore the association between service quality of internet hospitals and patients' overall satisfaction toward associated medical platforms. This cross-sectional survey was conducted through face-to-face or digital interviews from June to September 2022. A total of 1481 outpatient participants (635 men and 846 women; mean age 33.22, SD 13.22). Participants reported their use of internet hospitals, and then rated their expectations and perceptions of service quality toward internet hospitals via the SERVQUAL-C, along with their demographic information. Among the surveyed participants, 51.2% (n=758) of participants had used internet hospital service or services. Use varied across age, education level, and annual income. Although the majority of them (n=826, 55.8%) did not know internet hospital services well, 68.1% (n=1009) of participants expressed the willingness to adopt this service. Service quality evaluation revealed that the perceived service quality did not match with the expectation, especially the responsiveness dimension. Important-performance analysis results further alerted that reliable diagnosis, prompt response, clear feedback pathway, and active feedback handling were typically the services awaiting substantial improvement. More importantly, multiple linear regressions revealed that familiarity and willingness to use internet hospital services were significant predictors of satisfaction, above and over tangibles, reliability, and empathy service perspectives, and demographic characteristics such as gender, age, education level, and annual income. In the future, internet hospitals should focus more on how to narrow the gaps between the expected and perceived service quality. Promotion of internet hospitals should also be facilitated to increase patients' familiarity with and willingness to use these services.

Limited Congruence: Citizens’ Attitudes and Party Rhetoric About Referendums and Deliberative Practices

Both citizens and political parties refer to novel participatory practices in the contemporary crisis of representative democracy. Survey data indicate a growing demand for such practices within the electorate, while political parties have also begun discussing them more frequently. However, previous studies on citizens’ attitudes and parties’ discourse on democratic innovations rarely speak to each other. It remains unclear whether citizens’ attitudes and parties’ discourse are congruent. This article seeks to address this gap in the literature and analyses the extent to which political parties reflect citizens’ attitudes towards referendums and citizens’ deliberation in their manifestos. We cover 15 political parties in Germany and the UK. Our analysis uses party manifesto data between 2010 and 2024, and data from surveys conducted on national representative samples. Our findings reveal that political parties and citizens rarely have congruent approaches towards referendums and deliberative practices. People’s enthusiasm about referendums is hardly reflected in parties’ rhetoric, but the latter reacts gradually to the public appetite for deliberation. There are visible differences between opposition parties and those in government.

The effect of sociodemographic factors on energy intake by time of day in the Italian over-50 population: a multilevel approach

Chrononutrition studies the effect of timing, regularity and frequency of eating on body metabolism and health. Diurnal eating patterns may be obtained based on time-of-day and regularity and its association with health outcomes investigated in national representative samples(1,2).In this study we focus on the Italian population over 50 and we aim to study how their sociodemographic characteristics, such as sex, civil and professional status, geographical area of residence, affect their energy intake at different times of the day.We used INRAN-SCAI national representative survey conducted in 2005/2006(3), including sociodemographic information from questionnaires and 3-day-diet-diaries on 1317 over-50 subjects. The energy intake has been aggregated according to Italian dietary habits into 6 time-slots (6-9am/9am-12/12-3pm/3-7pm/7-10pm/10pm-6am). For each time-slot, we applied multilevel analysis including 3 levels (repeated measures within individuals, between individuals and due to specific sociodemographic strata), to estimate the respective components of intake variability. The third-level stratification resulted in 40 clusters based on sex, professional status, geographic region of residence and civil status. The study further applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)(4) to analyze how sociodemographic factors influence daily calorie intake, comparing two mixed effect models, one “null” model including also fixed effects of other potential confounders (age, smoking, alcohol, total intake) as well as the day of data collection, and one “main” model, which, additionally, included the main effects for the variables determining the strata.In terms of fixed effects, results showed significant energy intake variations in energy at different time-slots, depending on the area of residence (on average 47 kcal less at breakfast and 164 kcal more at lunch in the South compared to North-West, p&lt;0.001) and data collection day (122kcal more at lunch on the third day falling in the weekend, compared to first day in the week, p&lt;0.001). Furthermore, people who worked (on average 29 kcal more at dinner) and those who didn’t live alone (26 kcal more at lunch) tended to consume more calories during some main meal times while those living alone were more likely to have out-of-meal eating patterns (13 kcal more at afternoon and night snacking times).MAIHDA demonstrated that only dinner and night times had an intersectional effect, i.e. 56% and 86% percent of their variability respectively was not explained by main effects and was therefore attributable to the interaction among sex, region, professional and civil status.Our study offered a detailed description of how selected social and demographic factors were related to dietary behaviors held during the 24-hours. The findings are critical for crafting tailored nutritional advice to help mitigate the health threats faced by an aging population. The analysis will be extended to more recent survey samples of the Italian population, when available.

Lobectomy Is Not Associated With Improved Survival as Compared to Segmentectomy in Early-Stage Lung Cancer Patients With Visceral Pleural Invasion

ObjectiveThe purpose of this study is to utilize a representative national sample to compare survival outcomes of patients with visceral pleural invasion (VPI) who underwent either a lobectomy or a segmentectomy. MethodsNational Cancer Database from 2010 to 2019 was utilized. Patients with tumor size ≤ 2 cm, with VPI, non–small cell lung cancer (NSCLC), with a known vital status were included in the study. A propensity match analysis was performed to compare VPI patients undergoing either lobectomy or segmentectomy. ResultsOf the 66,181 patients who met the inclusion criteria, 6,575 (9.9%) had VPI. In postmatch analysis, there was no significant difference in 5-year survival in patients whose cancer had VPI and underwent either lobectomy or segmentectomy (76 [77.1%] vs. 71 [65.7%]; P = .23). Patients who underwent lobectomy and had VPI had poorer 5-year survival compared to patients who underwent a lobectomy and did not have VPI (1,154 [73.7%] vs. 1,240 [78.5%]; P < .001). There was no difference in 5-year survival between patients who underwent a segmentectomy and had VPI and patients who underwent a segmentectomy and did not have VPI (71 [65.7%] vs. 79 [71.0%]; P = .36). ConclusionA lobectomy was not associated with improved survival as compared to patients who underwent a segmentectomy in patients with early-stage NSCLC with VPI. VPI remains a poor prognostic factor for survival regardless of the procedure performed. This data would indicate that the presence of VPI should not be a determining factor in the anatomic lung resection selected in patients with small, early-stage NSCLC.

Impact of household income on acute decompensated heart failure outcomes: national representative sample

Abstract Background The clinical outcomes of ADHF have been extensively studied; however, the impact of household income still needs to be better understood. This study aimed to elucidate the relationship between household income and outcomes in patients with ADHF. Methods This national retrospective cohort study used data from the 2016-2020 National Inpatient Database, focusing on patients admitted with ADHF. We stratified the cohort into two groups based on the median household income: below $50k and above $86k. The selection criteria included patients aged ≥ 18 years diagnosed with ADHF, excluding those with incomplete income data. The primary outcome was all-cause inpatient mortality, with a length of stay (LOS) and total hospital charges as secondary outcomes. Statistical analysis employed logistic and linear regressions adjusted for confounders, with the significance level set at p&amp;lt;0.05. We accounted for missing data using multiple imputation analyses. Results 1,123,024 patients admitted with ADHF met the inclusion criteria. We divided the groups into two cohorts: low-income (64%, N=718,735) and high-income (36%, N=404,289). No increase in mortality was identified (adjusted aOR: 1.05; p = 0.212). The study revealed that high-income patients had marginally longer average LOS (5.62 days vs. 5.35 days, p &amp;lt; 0.0001) and higher hospital charges ($62,512.46 vs. $49,440.14, p &amp;lt; 0.0001) compared to their low-income counterparts. Low-income patients exhibited a higher prevalence of hypertension and obesity, whereas high-income individuals were more affected by atrial fibrillation and hyperlipidemia (hypertension and obesity, p &amp;lt; 0.0001; atrial fibrillation, p &amp;lt; 0.0001). Conclusion In this national retrospective cohort of patients admitted for ADHF over five years, income did not affect mortality. However, LOS and total charges were affected by the median household income.

Prevalence and sociodemographic correlates of COVID-19 vaccine acceptance in 20 European countries

Abstract Our study aimed to analyze the prevalence and socio-economic factors associated with COVID-19 vaccine hesitancy using individual data from representative national samples of 20 European countries. Data from round 10 of the European Social Survey, collected from May 2021 to September 2022, were analyzed. Prevalence (with a 95% confidence interval (CI 95%)) of participants’ intention to get vaccinated against COVID-19 was calculated. Crude differences in vaccine hesitancy proportions across sociodemographic strata were assessed using the Chi-square test. There were 31,771 adult participants (46.0 % men). The percentage of those hesitant (i.e. those who were not already vaccinated and intended not to be) toward the COVID-19 vaccine was 18.0% (CI 95% 17.6 - 18.4). Men and women were equally hesitant (18.0% vs. 18.0%, p = 0.93). There were differences between those under 40 (22.9%), adults between 40 and 59 (18.1%), and those over 60 (14.3%, p &amp;lt; 0.001). The unemployed had a higher proportion of hesitancy (32.9%) compared to the employed (17.4%), retirees (14.8%), and students (21.1%, p &amp;lt; 0.001). People living in rural areas have higher levels of hesitancy compared to those in urban areas (19.3% vs. 17.3%, p &amp;lt; 0.001). The estimates indicate that the highest prevalence of vaccine hesitancy was in Bulgaria (61.6%), Slovenia (40.4%) and Slovakia (30.7%), while Iceland (2.3%), Portugal (3.6%) and Italy (4.0%) had the lowest. Our study confirms high prevalence and high variability of hesitancy towards COVID-19 vaccines in Europe and identify groups for potential targeted interventions.

Impact of the COVID-19 pandemic on lifestyle’s behaviours of school-aged children in Portugal

Abstract Background COVID-19 pandemic impacted children’s daily routines. Based on this, WHO Collaborating Centre for Nutrition and Childhood Obesity in collaboration with WHO Regional Office for Europe coordinated the study about the impact of COVID-19 on lifestyle’s behaviours of school-age children in Europe, where 17 Member States participated, including Portugal. Methods Cross-sectional study was conducted within the sixth round of COSI Portugal, following a WHO common methodological protocol, during 2021-2022 school year. A national representative sample of families with children 6-8 years old were included and asked to report on variables comparing two periods: pre and during the COVID-19 pandemic. Results 5139 families participated. 11.4% reported a worsening of their perceived wealth and the percentage of fathers and mothers working full- or part-time decreased (74.6% to 68.7% and 70.6% to 59.6%, respectively) during pandemic. Children’s consumption of sweets (19.4%), savoury snacks (13.8%), fruit (11.9%) and vegetables (7.1%) increased, and sugary soft drinks (13.8%) decreased during pandemic. Family behaviours with the highest increases during pandemic were “eating together as a family” (35.4%), “cooking meals together with your child” (33.6%), “buying food in large quantities” (33.6%) and “eating home-cooked meals” (29.1%). Approximately, one in four parents reported children’s physical activity decreased and almost one in two reported an increase in recreational screen time. Parents who perceived their child as overweight during pandemic doubled (f7.9% to 14.6%). Children’s well-being behaviours that worsened more during pandemic were “having fun with friends” (44.3%), “got on well at school” (27.9%), “feel full of energy” (23.8%) and “feel fit and well” (22.2%). Conclusions These observations underscore the need to “build back better” post-pandemic with a focus on preventing and controlling childhood obesity and its determinants. Key messages • Portuguese children experienced negative impacts of the pandemic in their lifestyle behaviours, particularly on their physical health and well-being, with a report of a poorer socioeconomic situation. • This study and its findings give us a first-of-its-kind view into the physical and mental outcomes of the pandemic on school-aged children with a focus on the long-term, high-risk disease of obesity

Limited critical and communicative health literacy is related to poorer health among older adults

Abstract Background Health literacy-related challenges are expected to increase with age due to a discrepancy between individual capacity and health care demands. Knowledge about associations between health literacy and age-related health outcomes among older adults is scarce. This is important to address and promote optimal health in older adults. The study aims to investigate the association between health literacy and health status among older adults and explore differences between the younger old and the oldest old adults. Methods Cross-sectional study using SWEOLD population-based data from 2022, a national representative sample of people 77+ years in Sweden. Univariate and multivariate logistic regression analysis assessed associations between communicative- and critical health literacy and health outcomes. Models were adjusted for age, sex, and socioeconomic status, and stratified by age. Results Significant adjusted associations were found between inadequate and problematic health literacy and less than good self-rated health (OR 2.64, 95%CI: 1.61-4.33; 2.11, 95%CI: 1.40.3.17), and requiring assistance with medicine management (OR 5.26, 95%CI: 2.67-10.38, 2.14, 95%CI 1.08-4.22). Among the younger old (77-84 years) inadequate and problematic HL was associated with having lifestyle-related conditions (OR 1.77, 95%CI: 1.07-2.93, 2.75, 95%CI: 1.33-2.71). Among the oldest old (85+), inadequate health literacy was associated with higher likelihood of poor activities of daily living (ADL) (OR 4.48, 95%CI: 1.99-10.07) and frailty (OR 3.51, 95%CI: 1.43-8.47). Level of frailty increases earlier in age for individuals with limited HL than among those with sufficient HL. Conclusions Limited health literacy is a prevalent issue in the older population and is associated with negative health-related outcomes. To mitigate development of poor health and frailty and to promote healthy ageing, care organisations need to meet the needs of this population in a health literacy friendly way. Key messages • Limited health literacy among the older population is associated with several negative health-related outcomes. • Care organisations need to work actively to mitigate the development of poor health while promoting healthy aging among the older population in a health literacy-friendly and age sensitive manner.

Sanitation ladder in rural and urban India: can subsidy from the Swachh Bharat Mission ensure transition to safely managed toilets?

ABSTRACT The Swachh Bharat Mission, globally the biggest public programme to support sanitation, has focused on subsidised construction of household toilets in rural areas, while aiming for solid waste disposal and behavioural changes in urban areas. In spite of that, India witnesses a huge gap from the SDGs related to usage of safely managed sanitation associated with more environment- responsive technology and hygiene management. The hierarchical sanitation ladder identifies fivecategories of toilets, namely, safely managed, basic, limited, unimproved, and open defecation. This study attempts to contribute to the existing literature by locating the empirical estimation of the sanitation ladder in India across both rural and urban settings, using nationally representative unit-level National Sample Survey data. Results find that only 38% of urban and 6% of rural households in India use safely managed toilets. Also, using logistic regression, the study posits that receiving subsidy for toilet construction can significantly improve usage of safely managed toilets along the ladder only among the poorest urbanclass and the factor is generally more potent in rural areas. The findings identify that there is hardly any benefit in subsidizing the middle-income class and hence highlight a need to redesign the subsidy-driven sanitation policy.

Self-compassion improves barrier self-efficacy and subsequently physical activity: A test of longitudinal mediation using a representative sample of the United Kingdom.

Self-compassion, which directs the awareness of suffering, sympathetic concerns and caring motives towards oneself, is an important psychological quality and resource for health and well-being. In the context of physical activity, self-compassion can help individuals overcome obstacles, recuperate from a setback or a lapse and engage in regular physical activity. The present research was the first to examine the longitudinal effects of self-compassion on physical activity and the mediation role of barrier self-efficacy of such effects. We recruited a national representative sample of 654 UK adults and followed them over three timepoints across 9 months. At each time point, participants completed an online survey assessing levels of state self-compassion, barrier self-efficacy and physical activity behaviours. We examined the longitudinal effects of self-compassion on physical activity and the mediation role of barrier self-efficacy. Baseline state self-compassion consistently correlated with physical activity levels at Times 2 and 3. Barrier self-efficacy at Time 2 mediated the longitudinal effect of baseline state self-compassion on Time 3 physical activity, after controlling for within- (e.g., Time 1 on Time 2 self-compassion) and between-person variations (e.g., covariance of self-compassion and physical activity within a timepoint). Adopting a self-compassionate mind facilitates engagement and maintenance of physical activity. Future studies could consider accelerometer-based physical activity measures and develop and validate a more context-specific state self-compassion measure tailored for physical activity contexts. Researchers and practitioners should consider incorporating self-compassion to future interventions and education programmes for promoting physical activity.

Association Between Disability and Suicide Mortality in the Spanish Community-Dwelling Adult Population. A Population-Based Follow-Up Study.

To assess the association of disability with suicide mortality, separately for women and men by age group. Information was obtained from a representative national sample of 161,809 community-dwelling adults (≥18years). Participants contributed to follow-up time from baseline interview (2008) until suicide, death by other causes, or 2017. We calculated, by sex, standardized suicide mortality differences (SSMD), comparing persons with and without disabilities standardized to sociodemographic distribution of disability population. 29 women died by suicide during 800,754 person-years follow-up and 97 men during 735,709 person-years. Among women with disabilities, SSMD (95% Confidence interval) per 100,000 person-years at 5years was 54.4 deaths (-17.2 to 126.1) [100.0 (-27.4 to 227.4) in women <65years and -4.8 (-27.3 to 17.7) in women ≥65 years (P homogeneity = 0.11)]. Among men, SSMD increased by 122.2 deaths (4.1 to 240.3) [37.2 (-40.2 to 114.6) in men <65years and 74.7 (-51.8 to 200.5) in men ≥65years (P homogeneity = 0.62)]. Suicide risk was higher in women and men with disability. In women higher risk was only notable for those <65. Men presented similar effects in both age groups. Nevertheless, due to imprecision of estimates, results should be viewed cautiously.