Representative Sample Of Adults Research Articles

Risk Factors for Hospital Readmission Following Noncardiac Surgery: International Cohort Study.

To determine timing and risk factors associated with readmission within 30 days of discharge following noncardiac surgery. Hospital readmission after noncardiac surgery is costly. Data on the drivers of readmission have largely been derived from single-center studies focused on a single surgical procedure with uncertainty regarding generalizability. We undertook an international (28 centers, 14 countries) prospective cohort study of a representative sample of adults ≥45 years of age who underwent noncardiac surgery. Risk factors for readmission were assessed using Cox regression (ClinicalTrials.gov, NCT00512109). Of 36,657 eligible participants, 2744 (7.5%; 95% confidence interval [CI], 7.2-7.8) were readmitted within 30 days of discharge. Rates of readmission were highest in the first 7 days after discharge and declined over the follow-up period. Multivariable analyses demonstrated that 9 baseline characteristics (eg, cancer treatment in past 6 months; adjusted hazard ratio [HR], 1.44; 95% CI, 1.30-1.59), 5 baseline laboratory and physical measures (eg, estimated glomerular filtration rate or on dialysis; HR, 1.47; 95% CI, 1.24-1.75), 7 surgery types (eg, general surgery; HR, 1.86; 95% CI, 1.61-2.16), 5 index hospitalization events (eg, stroke; HR, 2.21; 95% CI, 1.24-3.94), and 3 other factors (eg, discharge to nursing home; HR, 1.61; 95% CI, 1.33-1.95) were associated with readmission. Readmission following noncardiac surgery is common (1 in 13 patients). We identified perioperative risk factors associated with 30-day readmission that can help frontline clinicians identify which patients are at the highest risk of readmission and target them for preventive measures.

Association between oral health-related quality of life and symptoms of temporomandibular disorder among older adults: A cross-sectional study

ABSTRACT Objective Evaluate the association between oral health-related quality of life (OHRQoL) and self-reported symptoms of TMD. Methods Representative samples of older adults (≥60 years) were included (n = 569). Both TMD symptoms and OHRQoL were assessed by Fonseca Anamnestic Index (FAI) and Oral Health Impact Profile-14 (OHIP-14), respectively. Prevalence (those answering “frequently” or “always” in at least one question), severity (total means scores), and extent (number of questions answered as “frequently” or “always”) of OHRQoL were estimated. Results Overall, 33.4% and 9.5% had mild or moderate/severe TMD symptoms. Those with any symptom of TMD had a prevalence ratio (PR) 38% higher for the worst OHRQoL (95% confidence interval [95%CI]:1.04–1.82) compared to those without TMD symptoms. Worst OHRQoL were observed for those with mild (PR:1.35; 95%CI:1.01–1.81) and moderate/severe TMD (PR:1.53; 95%CI:1.04–2.26). Similar results were detected in the severity and extent of OHRQoL. Conclusion Severity TMD was associated with worse ORHQoL.

Associations between traumatic dental injuries due to violence and various drinking behaviors in Korea: A cross-sectional study.

Various patterns of alcohol consumption are associated with trauma and violence. The aim of this study was to assess the association between traumatic dental injuries (TDI) due to violence and different patterns of alcohol consumption in Korean adults. A cross-sectional study was conducted with representative sample of Korean adults. Among the total participants, 11.8% (6489/58,999) experienced TDI, and 0.9% (520/58,999) experienced TDI due to violence. The associations between various types of alcohol consumption (frequency of drinking, frequency of binge drinking, age of first drinking) and TDI due to violence were assessed using logistic regression analyses. We confirmed differences in the prevalence experience of TDI due to violence with various types of alcohol consumption by confounders (socioeconomic status). All types of drinking (frequency of drinking, frequency of binge drinking, age of first drinking) were strongly associated with TDI due to violence. After adjusting for confounders, those who started drinking at the age of 18 or younger and drank 4 or more days a week (OR: 2.86, 95% CI: 1.68-4.88), those who started drinking at the age of 18 or younger and drank 3 days or less a week (OR: 2.37, 95% CI: 1.40-4.02), and those who started drinking at the age of 18 or younger and binge drinking at least once a week (OR: 3.18, 95% CI: 1.79-5.65) had higher prevalence of TDI due to violence compared to those with no alcohol drinking. This study presents evidence of an association between various types of alcohol consumption and TDI due to violence in Korean adults. These findings suggest the necessity for policies aimed at reducing alcohol consumption, frequency of drinking, and access to drinking especially in adolescent to reduce the prevalence experience of TDI due to violence.

Social participation, loneliness, and physical inactivity over time: evidence from SHARE.

We aimed to explore the reciprocal effects of social participation, loneliness, and physical inactivity over a period of 6 years in a representative sample of European adults over 50 years old. A longitudinal study with a six-year follow-up period was conducted. Four waves of the Survey of Health, Ageing and Retirement in Europe project were used. This study includes 64,887 participants from Europe and Israel, who were aged 50 or older at the first time. The relationship between participation in social activities, loneliness and physical inactivity was analyzed, controlling for age, gender, and disability. A series of cross-lagged panel models (CLPMs) were applied to analyze the relationships among these variables. A CLPM with equal autoregressive cross-lagged effects across waves was the best fit to the data (χ2 = 7137.8, CFI = .972, RMSEA = .049, SRMR = .036). The autoregressive effects for the three variables showed high stability across waves, and all the cross-lagged effects in the model were statistically significant. Social activity and physical inactivity maintained a strong negative cross-lagged effect, while their cross-lagged effects on loneliness were comparatively smaller. Social activity had a positive cross-lagged effect on loneliness, while physical inactivity had a negative cross-lagged effect on loneliness. These findings highlight the importance of promoting physical activity and social participation and addressing loneliness through targeted interventions in older adults.

Does Neighborhood Social Cohesion Influence Participation in Routine Cancer Screening? Findings From a Representative Sample of Adults in South Florida.

Neighborhood social cohesion (NSC) has been associated with a variety of health outcomes, but limited research has examined its impact on behaviors that support cancer control. The purpose of this study was to examine associations between NSC and guideline-concordant breast, cervical and colorectal cancer screening. Data are from a cross-sectional survey administered to 716 adults in South Florida from 2019 to 2020. The analytic samples included adults eligible for breast (n = 134), cervical (n = 195), and colorectal cancer (n = 265) screening. NSC was measured using a validated 5-item instrument. Associations between NSC and guideline-concordant screening were examined using multivariable logistic regression. In fully adjusted analyses, the odds of guideline-concordant breast cancer screening increased by 86% for every unit increase in NSC (aOR = 1.86; 95% CI, 1.03-3.36). NSC was not statistically significantly associated with guideline-concordant cervical cancer screening (aOR = 0.86; 95% CI, 0.54-1.38) or colorectal cancer screening (aOR = 1.29; 95% CI, 0.81-2.04). These findings suggest that NSC supports some screening behaviors, namely, mammography use. To better understand heterogeneous relationships between NSC and utilization of preventive care services such as cancer screening, more research is needed that disaggregates effects by sex, age, race/ethnicity, and socioeconomic status.

Cannabidiol use in France in 2022: Results from a nationwide representative sample of adults.

Cannabidiol (CBD) is a non-intoxicating cannabis compound found in diverse commercial products worldwide. However, its use may not be fully harmless. Accordingly, it is important to document the prevalence of CBD use and user characteristics in the general population. We conducted a nationwide survey from a random sample of adults living in France using computer-assisted telephone interviews between 2 March and 9 July 2022. We estimated the prevalence of CBD awareness and CBD use, and explored the different routes of administration. We also performed logistic regression models to identify factors associated with past-year CBD use. Based on data from 3229 participants, we estimated that 71.0% (95% confidence interval) (69.0-73.0) of the French adult population had heard of CBD, and 10.1% (8.7-11.4) had used it in the previous year. Past-year CBD use was associated with younger age, a higher educational level, not living in a middle-sized urban unit, tobacco consumption and e-cigarette use. The most common route of administration was smoking (56.1%). Past-year CBD use prevalence in France appeared to be as high as that for cannabis. Proper prevention, regulation and control of CBD products is necessary to ensure that people have access to safe and high-quality products. Reliable information on CBD should be sought and disseminated, especially regarding the harms associated with smoking the compound.

Measuring Psychological Response to Pandemics: Further Psychometric Investigation of the COVID Stress Scales

The COVID Stress Scales (CSS; Taylor et al., 2020b) were developed as a measure of stress related to any pandemic, making it a valuable self-report measure for potential future large-scale infectious disease outbreaks. Although the initial validation study of the CSS indicated evidence of its psychometric strength, further assessment is warranted of the measure’s retest reliability, the long-term stability of its five-factor structure, discriminant validity, and its relationship with pandemic-related risk and precautionary behaviors. We examined these psychometric elements of the CSS using longitudinal data collected from a nationally representative sample of adults (N = 205) during the COVID-19 pandemic. Results indicate moderate retest reliability that is consistent with changing rates of morbidity. Results also support the five-factor structure and demonstrate convergent validity, discriminant validity, and the ability to predict relevant behavioral responses to an active pandemic. Use of the CSS for future pandemics is discussed.

“Using behavioral insights to inform the COVID-19 vaccine response in Kosovo[1]: Population perceptions and interventions”

ObjectiveUnderstand population perceptions in Kosovo[1] regarding COVID-19 vaccination to inform the pandemic response. MethodsFive rounds of a cross-sectional survey in representative samples of adults during 2020–2021. Analysis includes descriptive statistics, hierarchical cluster analysis, segmentation and logistic regressions. ResultsSelf-reported intention to vaccinate increased after the introduction of COVID-19 vaccines in Kosovo.[1] In less than one year, vaccination intentions increased from 36% to 66% of those unvaccinated. Predictors for vaccine intentions included gender, age, trust in health authorities. Segmentation analysis identified population segments that had high vaccine nintentions but low uptake, informing messages and campaign initiatives designed to translate intentions into behavior. ConclusionIdentifying people's perceptions and behavior is essential to support evidence-based policy making, especially during outbreak response. InnovationBI is an innovative focus of research in Kosovo [1] where little BI data had been collected prior, and provided a unique understanding of population views, attitudes and behaviors related to COVID-19. These findings were not only essential for an evidence-based pandemic response but also laid the foundation for future broad application of BI to inform interventions that seek to enable, support and promote health-related behaviurs in Kosovo[1]

Ethnic inequality between Arabs and Jews in Israel in global life satisfaction: A social determinants examination among young adults.

Global life satisfaction (GLS), a core construct of subjective well-being, plays a vital role in positive development among young adults. Persistent inequality in subjective well-being across minority versus majority groups is a growing public health concern. However, research evidence on the minority-majority disparity in GLS among representative samples of young adults is scarce. Based on national data from Israel (N = 2,405), this study examines (a) the association of multiple forms of economic (not in education, employment, or training status, subjective socioeconomic status indicators), social-relational (trust, discrimination, loneliness), and environmental determinants (neighborhood conditions) with GLS among young adults from a minority-majority (Israeli Arabs-Israeli Jews) perspective; (b) whether minority-majority disparity in GLS can be explained by differential health returns for the determinants considered across participants from the two groups; (c) whether minority-majority disparities in GLS persist when controlling for these determinants, suggesting the effect of ethnicity per se. Significant disparities in GLS by ethnicity were found, with young Arab adults far less likely to be satisfied or very satisfied with their lives. Hierarchical logistic regression indicated that economic, social-relational, and environmental determinants shape GLS, but these factors do not eliminate the adverse effect of minority status on GLS. While social-relational and environmental factors uniformly affect GLS across minority and majority participants, economic factors were less influential among the Arab minority, suggesting lower health returns for economic resources among young Arab adults. Implications for policies aimed at promoting health equity and social justice are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cardiovascular Disease Burden in Persons with Mental Illness: Comparison between a U.S. Psychiatry Outpatient Sample and a U.S. General Population Sample

Background. Cardiovascular disease (CVD) and depression are the leading causes of disability in the U.S. Using electronic health record data, we describe the CVD burden among persons with mental illness enrolled in the Penn State Psychiatry Clinical Assessment and Rating Evaluation System (PCARES) Registry between 2015 and 2020. Methods. CVD burden assessment included prevalence of CVD conditions (any major CVD or individual CVD risk factors), indicated medication prescriptions for CVD risk factors, and mean levels of body mass index (BMI, kg/m2), glycosylated hemoglobin (HbA1C, %), glucose (mg/dl), and lipids (mg/dl). We compared the CVD burden between the PCARES sample to a representative sample of adults from the U.S. general population (NHANES 2013-2016) using one-sample chi-square/t-tests for proportions/means. The CVD burden in NHANES participants was adjusted to PCARES age, race, and sex statistics. Results. The PCARES sample (N=3556) had a mean (SE) age of 42.4 (0.3) years and comprised 63.0% women, 85.0% non-Hispanic Caucasians, and 41.0% with major depressive disorder. CVD burden was higher in the PCARES sample compared to NHANES participants for any major CVD (8.6% vs. 4.6%), diabetes (18.4% vs. 10.4%), BMI (30.3 vs. 28.3), HbA1C (6.1 vs. 5.6), cholesterol (185.6 vs. 181.7), triglycerides (153.3 vs. 136.1), and indicated antihypertensive (94.3% vs. 76.9%) and cholesterol-lowering (49.5% vs. 36.7%) medications (Bonferroni-corrected p=0.03 for each outcome). The CVD burden was lower in the PCARES sample compared to NHANES participants for hypertension (45.9% vs. 50.4%), dyslipidemia (43.2% vs. 61.9%), HDL-C (48.4 vs. 41.4), and LDL-C (107.9 vs. 112.0) (Bonferroni-corrected p=0.03 for each outcome). Glucose levels (110.9 vs. 111.9) and indicated antidiabetic medications (87.4% vs. 86.6%) were similar in the two samples (p>0.05). Conclusions. The CVD burden was higher in persons with mental illness compared to the U.S. general population. Integrated mental and physical healthcare services could reduce long-term disability among persons with mental illness.

Food insecurity, inflammation, and immune function among older US adults: Findings from the health and Retirement study

BackgroundFood insecurity (FI) is a pressing public health concern among older adults and has been associated with adverse cardiovascular outcomes. Greater systemic inflammation may provide a pathway to explain these associations, but few studies have examined the link between FI and markers of inflammation. Thus, the objective of the present study was to evaluate the associations between FI and multiple inflammatory and immune functioning biomarkers using a nationally representative study of US adults aged > 50 years. MethodParticipants (n = 3,924) were drawn from the longitudinal Health and Retirement Study (HRS). Household FI was assessed using the six-item Short Form Food Security Survey Module from the 2013 HRS Health Care and Nutrition Study. Markers of inflammation (neutrophil–lymphocyte ratio, albumin, hs-CRP, IL6, IL10, IL-1Ra, sTNFR-1, and TGFβ-1) and immune functioning (CMV) were collected during the 2016 HRS Venous Blood Study. Multivariate logistic and linear regression models were used to evaluate associations between household FI and inflammatory and immune functioning biomarkers, adjusting for individual and household sociodemographic characteristics. ResultsThe weighted prevalence of FI was 18.8 %. Age and sex-adjusted mean showed that FI was associated with higher levels of inflammation and impaired immune functioning (Ps-value < 0.05). Older adults with FI had higher mean levels of albumin, hs-CRP, IL6, IL10, IL-1Ra, TGFß-1, and CMV seronegative and borderline (Ps-value < 0.05). Multivariate-adjusted regression model showed that FI was associated with high-risk categories of hs-CRP (OR 1.34, 95 % CI 1.06, 1.68), IL-6 (OR 1.66, 95 % CI 1.28, 2.14), IL-1Ra (OR 0.67, 95 % CI 0.48, 0.93), TGFß-1 (OR 1.87, 95 % CI 1.45, 2.42), seronegativity for CMV (OR 0.48, 95 % CI 0.35, 0.64). ConclusionIn this nationally representative sample of older adults, FI was positively associated with multiple markers of systemic inflammation and impaired immune functioning. Public health efforts that directly work to reduce FI among older adults are warranted and may result in further improvements in their health and well-being.

Emotional signatures of climate policy support

The optimal emotional tone for climate communication has been debated by scholars and the press, but little is known about the effects of emotions on different types of policy support. In this paper we examine multiple discrete emotions people experience in reaction to climate change, and assess the strength of these emotions as predictors of support for different types of mitigation and adaptation policies. Using multi-wave, cross-sectional, nationally representative samples of American adults, we test whether guilt, anger, hope, fear, and sadness are uniquely associated with support for different types of climate policies. Guilt is most strongly related to support for personally costly policies, hope to support for proactive policies, and fear to support for regulatory policies. This research suggests that communicators should consider how their climate campaign’s emotional tone aligns with their policy goals.

Financial Well-Being and Social Service Use among a Nationally Representative Sample of Sexual and Gender Minority Adults

Financial Well-Being and Social Service Use among a Nationally Representative Sample of Sexual and Gender Minority Adults

Childhood Adversity and Offense-Supportive Cognitions Among Czech Adults with a Sexual Interest in Violence or Children.

Individuals with paraphilic interests in sexual violence or children may be more likely to sexually offend if they possess offense-supportive cognitions. These cognitions may develop in response to childhood adversity. However, this idea is largely based on research in men convicted of sexual offenses and may not generalize to non-incarcerated adults with paraphilic interests. In a sample of 178 adults screened for paraphilic interests in violence or children (from the general Czech population), we hypothesized that childhood sexual abuse and emotional neglect would be associated with offense-supportive cognitions about rape and child molestation. Participants came from a nationally representative sample of Czech adults and were selected if they self-reported high levels of sexual interest in violence and/or children. Participants completed an online survey with self-report measures of sexual orientation, offense-supportive cognitions (Bumby RAPE and MOLEST scales), and childhood sexual abuse and emotional neglect (Childhood Trauma Questionnaire). Controlling for gender, age, and sexual orientation, we found that both rape-supportive cognitions and child molestation-supportive cognitions were significantly associated with higher levels of childhood sexual abuse, but not emotional neglect. These findings indicate that childhood sexual abuse may lead to offense-supportive cognitions among men and women with paraphilia.

Casting a wider net: A national survey of Australian attitudes to marine protected areas

Marine protected areas (MPAs) are a key international conservation strategy to regulate human pressures on marine environments and are central to marine management in Australia. Public support is considered crucial to the success of MPAs in achieving the long-term conservation of nature, yet how the broader Australian public understands and values MPAs is not well understood. Previous research has explored attitudes of direct and proximate stakeholder groups or focused on specific regions. Human connections to marine environments, however, are not limited to direct use nor confined to single geographies. We surveyed a nationally representative sample of Australian adults (n = 1049) to explore how the broader public understand, connect to, and value Australia’s marine environments and MPAs. To the best of our knowledge, this is the first study to investigate general attitudes to Australia’s total MPA system and interconnected marine environments with a nationally representative sample to provide an aggregated overview of Australian public attitudes. Most Australians (53%) acknowledge that they have a knowledge gap regarding the restrictions, requirements, and protections of MPAs as they apply in the Australian context, while 37% incorrectly believe that all MPAs offer uniform protections that, for example, prohibit the extraction of natural resources. Australians want to see an expansion of MPA coverage to represent 73% of Australian waters. Australians value the intrinsic biospheric characteristics of marine environments and want to see marine life as the focus when designing MPAs, above instrumental dimensions including industry and recreation. This study provides important insights for policymakers and managers in meeting broader public expectations in the expansion of Australia’s marine protections.

Diminished returns of educational attainment on life satisfaction among Black and Latino older adults transitioning into retirement

BackgroundThis paper investigates the intricate relationship between race/ethnicity, educational attainment, and life satisfaction among middle-aged and older adults in the United States. Guided by the theory of Minorities' Diminished Returns (MDRs), positing that returns on educational attainment are attenuated for minoritized populations, this study aims to explore racial/ethnic disparities in the impact of educational attainment on the life satisfaction of middle-aged and older adults. MethodsThis was a secondary analysis of existing data. Utilizing data from the Health and Retirement Study (HRS), we employed a longitudinal design with a nationally representative sample of middle-aged and older adults in the United States. Key variables of interest included educational attainment, race/ethnicity, and average life satisfaction from wave 9–15 (20–30 years later). Statistical analysis included regression models to assess the associations between educational attainment and life satisfaction overall and by race and ethnicity. ResultsOverall, 5274 participants entered our analysis and were followed for up to 30 years. Our initial findings revealed a positive association between educational attainment and life satisfaction. Subsequently, we identified significant interactions between race/ethnicity and educational attainment, indicating notable racial and ethnic differences in the impact of educational attainment on life satisfaction. The effects of baseline on future educational attainment and life satisfaction were weaker for Black and Latino than non-Latino White counterparts. ConclusionsIn accordance with the Minorities' Diminished Returns theory, Black and Latino middle-aged and older adults experience a less pronounced positive impact of educational attainment on life satisfaction compared to their Non-Latino and White counterparts. There are non-additive complex interplay between educational attainment and race and ethnicity on subjective well-being of middle-aged and older adults. The identified disparities in the returns of educational attainment underscore the critical need to recognize and address structural barriers that contribute to the diminished returns of educational attainment for Black and Latino populations.

Patterns of Antibiotic Use, Knowledge, and Perceptions among Jordanian Population: A Cross-sectional Study

Background: Practices concerning antibiotic use have detrimental impacts on body immunity, bacterial resistance, and the overall health of the general population. Misconceptions regarding antibiotic use can lead to improper use and malpractice, posing numerous health threats. Objectives: This study aims to assess the knowledge, practices, and awareness of Jordanian adults about antibiotics. This includes an analysis of their understanding of antibiotic uses and the sources from which they acquire such knowledge. Methods: A representative sample of Jordanian adults was invited to participate in an online survey distributed through social media platforms. Key findings: The results showed that 77.6% of the participants had received an antibiotic at least once in the past 12 months. About two thirds reported no problems with using a different brand name (alternative) for the prescribed antibiotic. The majority of respondents trust the decisions made by pharmacists. Moreover, participants with higher ages, female participants, those with a higher level of education, uninsured participants, and those with a medicine-related degree showed better antibiotic knowledge compared to others (P&lt;0.05 for all). Conclusion: There is a good level of antibiotic-related knowledge amongst Jordanian adults. However, prevalent misconceptions and improper use also exist, indicating the need for focused attention on correcting such practices that might adversely impact the health of the community as a whole.

Intrinsic capacity and hospitalization among older adults: a nationally representative cross-sectional study.

Monitoring intrinsic capacity (IC) in community-dwelling older people can be potentially used to alert for adverse health outcomes. However, whether there is an association between IC and hospitalization has yet to be fully explored. This study aimed to investigate the association of the IC composite measure and its 5 domains with hospitalization in the previous year and length of hospital stay. We conducted cross-sectional analyses using data from a representative sample of community-dwelling adults (≥ 65years). We assessed the IC domains (vitality, locomotor, cognitive, sensory, and psychological) using validated self-reported information and performance tests. We calculated standardized estimated scores (z scores) for IC composite measure and domains and conducted multivariate logistic and ordinal regressions. The primary outcomes were hospitalizations in the previous year and length of hospital stay. In a sample of 5354 participants (mean age = 73 ± 6years), we found that participants with high IC composite z scores were less likely to have experienced hospitalization in the previous year (OR = 0.51; 95% CI = 0.44-0.58). Among those who were hospitalized, high IC scores were associated with short stays (OR = 0.87; 95% CI = 0.80-0.95). Cognitive and psychological domains were associated with hospitalizations, and the locomotor domain was related to length of hospital stay. The vitality domain was associated with both outcomes. IC as a composite measure was associated with previous hospitalizations and length of stay. IC can help clinicians identify older people prone to adverse outcomes, prompting preventive integrated care interventions.

Attitudes on participation in clinical drug trials: A nationally representative survey of older adults with multimorbidity.

Older adults with multimorbidity are under-represented in clinical drug trials. Their inclusion will not increase unless they are willing and able to participate. Data on motivators and barriers to participation in trials of new medications of older adults with multimorbidity are needed. Cross-sectional internet and telephone survey of a nationally representative sample of adults ≥65 years with ≥3 chronic conditions (NORC University of Chicago Amerispeak Panel) conducted from March-April, 2023 to determine motivators and barriers to drug trial participation, described graphically and using statistics. Surveyed 1318 (1142 Internet, 176 phone) with mean age 72.3 ± 6.3 (SD), 52% women; race: 83% White, 10% Black or African American, 5% Hispanic or Latino, 1.1% Asian; 4.4 ± 1.9 chronic conditions (of 16 queried), taking 7.5 ± 3.3 medications. Barriers included fear of side effects (48%), taking too many medications (44%), placebo (44%), mobility (33%), bathroom needs (25%), hearing (19%), eyesight (15%), video visits (33%; higher in women, Black or African-American respondents, and those ≥80 years). Sixty-five percent would join all in-person trials, 49% would join all-video trials. Travel >1 h was difficult for 66%, most difficult for women. Trust was a concern in 25% of Black respondents. Caregiving responsibilities or lack of time were not obstacles. Participants were most likely to consider a drug trial for a problem they have (63%) versus prevention (44%) and if invited by a physician (80%) or University healthcare system (58%). Getting better care was ranked very important (79%) followed by helping others (57%). Major concerns of older patients with multimorbidity about participation in drug trials are potential side effects, taking too many medicines, and video visits. Physicians have the greatest influence on decisions and in-person visits are preferred. Proposed changes in trial design to increase enrollment of under-represented older adults may not align with patient-reported preferences.

The role of subjective, interpersonal, and structural social isolation in 12-month and lifetime anxiety disorders

BackgroundAnxiety disorders are among the most prevalent psychiatric conditions worldwide, and the incidence of anxiety disorders among adults in the U.S. have increased over the last decade. Anxiety disorders can have debilitating effects on multiple areas of functioning and quality of life. Recently, social isolation has emerged as an important public health problem associated with worse health and well-being outcomes. Research on the connection between social isolation and mental health has found that multiple dimensions of social isolation may negatively impact mental health, but few inquiries have focused on the association between social isolation and anxiety. This study examined the relationships between multiple dimensions of social isolation and anxiety disorders in a nationally representative sample of adults aged 18 and older.MethodsThe sample includes 6082 individuals from the National Survey of American Life. This study examined whether three different dimensions of social isolation—subjective, interpersonal, and structural—were associated with 12-month and lifetime anxiety disorders (any anxiety disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and agoraphobia (AG). Logistic regressions were used to test the associations between the three social isolation variables and the anxiety outcomes.ResultsThis study found that of the three dimensions of social isolation, subjective isolation was most consistently related to both lifetime and 12-month anxiety disorders. Those who were subjectively isolated had increased odds of meeting criteria for any anxiety disorder, PTSD, GAD, PD, and AG over the past 12 months and throughout their lifetimes. Structural isolation was negatively associated with lifetime and 12-month AG.ConclusionsPublic health approaches should include mental health and primary care providers and need to target social isolation, especially subjective isolation, which may be key in preventing anxiety disorders and the worsening of anxiety disorders. Future public health research is needed on how and in what ways the differing dimensions of social isolation impact mental health.