Self-reported Information Research Articles

Drinking water source and exposure to regulated water contaminants in the California Teachers Study cohort.

Pollutants including metals/metalloids, nitrate, disinfection byproducts, and volatile organic compounds contaminate federally regulated community water systems (CWS) and unregulated domestic wells across the United States. Exposures and associated health effects, particularly at levels below regulatory limits, are understudied. We described drinking water sources and exposures for the California Teachers Study (CTS), a prospective cohort of female California teachers and administrators. Participants' geocoded addresses at enrollment (1995-1996) were linked to CWS service area boundaries and monitoring data (N = 115,206, 92%); we computed average (1990-2015) concentrations of arsenic, uranium, nitrate, gross alpha (GA), five haloacetic acids (HAA5), total trihalomethanes (TTHM), trichloroethylene (TCE), and tetrachloroethylene (PCE). We used generalized linear regression to estimate geometric mean ratios of CWS exposures across demographic subgroups and neighborhood characteristics. Self-reported drinking water source and consumption at follow-up (2017-2019) were also described. Medians (interquartile ranges) of average concentrations of all contaminants were below regulatory limits: arsenic: 1.03 (0.54,1.71) µg/L, uranium: 3.48 (1.01,6.18) µg/L, GA: 2.21 (1.32,3.67) pCi/L, nitrate: 0.54 (0.20,1.97) mg/L, HAA5: 8.67 (2.98,14.70) µg/L, and TTHM: 12.86 (4.58,21.95) µg/L. Among those who lived within a CWS boundary and self-reported drinking water information (2017-2019), approximately 74% self-reported their water source as municipal, 15% bottled, 2% private well, 4% other, and 5% did not know/missing. Spatially linked water source was largely consistent with self-reported source at follow-up (2017-2019). Relative to non-Hispanic white participants, average arsenic, uranium, GA, and nitrate concentrations were higher for Black, Hispanic and Native American participants. Relative to participants living in census block groups in the lowest socioeconomic status (SES) quartile, participants in higher SES quartiles had lower arsenic/uranium/GA/nitrate, and higher HAA5/TTHM. Non-metropolitan participants had higher arsenic/uranium/nitrate, and metropolitan participants had higher HAA5/TTHM. Though average water contaminant levels were mostly below regulatory limits in this large cohort of California women, we observed heterogeneity in exposures across sociodemographic subgroups and neighborhood characteristics. These data will be used to support future assessments of drinking water exposures and disease risk.

Effect of elevated depressive symptoms during adolescence on health-related quality of life in young adulthood-a six-year cohort study with repeated exposure measurements.

Depression is a major contributor of young people's burden of disease. In this study we aim to estimate the effect of elevated depressive symptoms on physical health-related quality of life. We used self-reported information from the prospective BELLA cohort study, which included adolescents selected from the general population in Germany. The baseline assessment (2003-2006) and the 1-, 2-, and 6-year follow-up waves provide the data basis. The baseline study population consisted of 1,460 adolescents between the ages of 12 and 17 who, according to their caregivers, did not suffer from depression. The primary outcome, as measured by the physical component score (PCS) of the SF-36 at a 6-year follow-up (range: 0-100), is physical health-related quality of life. The exposure of interest is depressive symptoms, as measured by the Center for Epidemiological Studies Depression Scale for Children (CES-DC) at baseline, 1-year follow-up and 2-year follow-ups (range: 0-60). We dichotomized the exposure into subthreshold (≤15) and elevated depressive symptoms (>15). For the main analyses we considered a cumulative index for elevated depressive symptoms across the three time points (range: 0-3). Considered confounders are sex, age, socioeconomic status, migrant background, social support, anxiety symptoms, physical activity, chronic diseases, and sleeping problems. We used multiple imputation to account for missing values. Within each imputed dataset, we applied inverse probability weighting (IPW) to estimate the effect of the cumulative index for elevated depressive symptoms at baseline, 1- and 2-year follow-up on physical health-related quality of life at 6-year follow-up. We derived 95% confidence intervals by bootstrapping. After adjusting with IPW, the effect of the cumulative index per one unit increase of elevated depressive symptoms on the physical component score was -1.71 (95% CI: -3.51 to -0.04). The adjusted effect estimates of single exposure of elevated depressive symptoms on physical health-related quality of life were -0.83 (95% CI: -3.69 to 1.87) at baseline, -2.96 (95% CI: -4.94 to -0.52) at 1-year follow-up and -1.32 (95% CI: -3.85 to 1.15) at 2-year follow-up. Findings suggest that elevated depressive symptoms during adolescence decrease physical health-related quality of life in young adulthood.

Exposures to potentially psychologically traumatic events among Royal Canadian Mounted Police.

Royal Canadian Mounted Police (RCMP) are among the public safety sectors reporting the highest exposures to diverse potentially psychologically traumatic events (PPTEs), which contribute to the risk of developing mental health disorders. Current increases in prevalence of mental health disorders among RCMP are substantial and warrant updated prevalence estimates of PPTE exposures. The objective of the present study was to provide updated estimates of lifetime PPTE exposures among RCMP and assess for associations with mental disorders and sociodemographic variables. Participants (n = 1,348) completed a survey assessing self-reported sociodemographic information, PPTE exposures as measured by the Life Events Checklist for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) Extended, and mental health disorder symptoms. Participants reported exposure to more PPTE types (∼13) than previous samples of RCMP (∼11) and public safety personnel (PSP) (∼11). Prevalence for all the PPTE types was statistically significantly higher for the current sample than previously reported samples of PSP and RCMP, and higher than the Canadian general population. Participants reported highest exposures through any modality (i.e., directly or indirectly) to sudden violent death (98.3%), physical assault (97.9%), serious transport accident (97.0%), sudden accidental death (96.7%), and assault with a weapon (93.7%). Most PPTEs were statistically significantly associated with screening positive for posttraumatic stress disorder, major depressive disorder, generalized anxiety disorder, social anxiety disorder, and panic disorder, but not alcohol use disorder. Increased PPTE exposures reported by current participants compared to a previous sample of RCMP, coupled with the observed associations between PPTE exposures and mental health disorders, highlights the need for further resources and support for RCMP to mitigate and manage the impact of PPTEs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Digital violence in schools: a unified theory and structural equation model to counteract cyberbullying

Purpose This study aims to investigate the dynamics of cyberbullying among minority youths, focusing on its increasing prevalence in the digital realm, which does not necessitate technical expertise from the offenders. It explores a shift from conventional bully characteristics to individuals assuming new digital personas, merging traditional criminology with flag theory to analyze violent behavior online, specifically in educational environments, and studying the correlation between low self-control, affiliations with delinquent peers and the likelihood of cyberbullying occurrences. Design/methodology/approach The research uses structural equation modeling to examine survey data from 237 eleventh-grade students in St. Louis public schools, focusing on the relationships between cyberbullying, low self-control and association with delinquent peers within a comprehensive theoretical framework that includes the flag theory and demographic factors, as well as using multigroup analysis to investigate racial dynamics and confirming indirect effects using bootstrapping techniques. Findings The research establishes strong connections between low self-control, delinquent peer involvement, and cyberbullying, supporting the flag theory in digital violence contexts, while also showing that low self-control and peer engagement play a mediating role in cyberbullying incidents among minority youth, with racial composition having no significant impact on these dynamics. Research limitations/implications The study is restricted by its focus on a particular geographical area, in conjunction with its reliance on self-reported information obtained exclusively from a specific age group. This specificity raises concerns about the applicability of the findings to diverse populations. Furthermore, the study’s dependence on a three-item assessment for cyberbullying, combined with the challenges encountered in achieving complete scalar invariance during multigroup analysis, emphasizes the need for more precise measurement tools and improved methodological frameworks. Practical implications This research discloses actionable insights fundamental to the advancement of cyberbullying prevention strategies. The finding that the connection between race and the effects of peer association and self-control on cyberbullying is minimal suggests that these interventions can be generally applied, transcending racial boundaries. Moreover, identifying self-control as a critical intermediary offers fresh avenues for cybercrime research, shifting the conventional focus from established predictors. By zeroing in on peer influence as a fundamental element, this study provides innovative angles to bolster the understanding of digital violence mitigation in educational settings. Social implications This research emphasizes the urgent concern of cyberbullying among minority youths, along with its psychological and academic impacts. By elucidating the interaction between personal traits and social networks, the findings can guide comprehensive strategies aimed at cultivating safer digital spaces and bolstering social wellness within educational frameworks. Originality/value This research presents an original and ground-breaking method that combines various theories in criminology specifically in the context of cyberbullying among minority youths. By proposing a new and redefined role for self-control, which is not seen as the common main predictor but rather as a crucial mediator, this study provides fresh insights into the dynamics of cyber aggression. Through the detailed examination of the flag theory framework, the study uncovers the complex reciprocal relationship between self-control and peer engagement, revealing previously overlooked mechanisms in a broader landscape of digital violence.

O-160 Age at menarche is a marker for increased time to pregnancy

Abstract Study question Is age at menarche a marker for increased time to pregnancy later in life? Summary answer Very early (<11 years) and very late (>15 years) menarche is associated with decreased fecundability. What is known already Several factors such as age, body mass-index and gynecological diseases influence female fecundability. Early or late menarche is associated with increased risk of several negative health outcomes later in life. Previous studies have shown conflicting results regarding if age at menarche is associated with time to pregnancy, a measure of female fecundability. Study design, size, duration 82 471 pregnant women with complete, self-reported information on age at menarche and time to pregnancy were included in a large retrospective cohort study between 1999 and 2008. Participants/materials, setting, methods Among 67 613 women with planned pregnancies participating in the Norwegian Mother, Father and Child Cohort Study we calculated fecundability ratios which indicate the cycle-specific probability of conception, by categories of age at menarche. We adjusted for pre-pregnancy body mass index, highest completed or ongoing education level and age at initiation of trying to conceive. Main results and the role of chance We observed a 9% lower probability of conception during any given menstrual cycle up to 12 cycles in women with very early (<11 years) menarche, and a 4% lower probability among those with very late (>15 years) menarche compared to women with onset of menarche in the reference category (12-14 years). Among women with menarche <11 years the adjusted fecundability ratio was 0.91 (95% CI: 0.86-0.96) and among women with menarche >15 years the adjusted fecundability ratio was 0.96 (95% CI: 0.92-0.99). Limitations, reasons for caution We didn’t have information about partner characteristics such as sperm quality, nor data on early life exposures such as early nutrition and pre-menarcheal body mass index. Since all participants were pregnant, the results could have limited generalizability to those who never conceive. Wider implications of the findings By identifying reduced fecundability as yet another negative health outcome associated with very early or very late menarche, the results from this study further underline the clinical importance of age at menarche as a readily available marker for later reproductive health. Trial registration number not applicable

Myocardial infarction & C-reactive protein levels among Mexican adults with arthritis: Findings from the Mexican Health and Aging Study

BackgroundStudies of adult populations in high-income countries have found an association between arthritis and myocardial infarction (MI) due to high levels of systemic inflammation. Our objectives were to examine the association between arthritis and MI among Mexican adults and to assess the mediating effect of C-reactive protein (CRP) on this association. MethodsData came from the 2012, 2015, and 2018 observation waves of the Mexican Health and Aging Study. Our sample included 11,707 participants aged 50 and older with no prior MI before 2012. We used self-reported information for arthritis, joint pain, medication use, and limitations to daily activities in 2012. Logistic regression was used to model the association between arthritis and self-reported MI in 2015 or 2018. We used a sub-sample of 1602 participants to assess the mediating effect of CRP. ResultsIn the full sample, participants with arthritis that limited their daily activities had higher odds of MI than participants with no arthritis (OR = 1.40; 95 % CI = 1.04–1.88). In the sub-sample, arthritis that limited daily activities was associated with higher mean CRP (5.2 mg/dL; 95 % CI = 4.10–6.21) than arthritis with no limitations (3.5 mg/dL; 95 % CI = 2.93–4.01). However, CRP levels had a small mediating effect, and the relationship between arthritis with physical limitations and MI remained statistically significant. ConclusionMexican adults with arthritis that limits their daily activities are at an increased risk for MI. Continued research is needed to identify factors that contribute to this increased risk.

Adherence to The Mediterranean Dietary Pattern and Associated Factors Among Adolescents: a Cross-sectional Study from Portugal

INTRODUCTION: The Mediterranean Dietary Pattern is one of the healthiest dietary models, being associated with several health benefits. However, in recent years, this pattern has been abandoned by adolescents in Mediterranean countries. OBJECTIVES: To determine and analyze the adherence to the Mediterranean Dietary Pattern and its associated factors in a sample of adolescents from a city in the north of Portugal. METHODOLOGY: Cross-sectional study. The data was collected via a stratified one-stage cluster sampling of adolescents (10 to 19 years old) from a city in the north of Portugal. The Mediterranean Diet Quality Index (KIDMED Index) was self-administered to evaluate the adherence to the Mediterranean Dietary Pattern among adolescents. Participants self-reported information about sociodemographic, anthropometric and lifestyle characteristics. Logistic regression was performed to identify the predictors of high adherence to the Mediterranean Dietary Pattern. RESULTS: Most adolescents had a low/moderate adherence to the Mediterranean Dietary Pattern (63.2%). Logistic regression modelling indicated that age and parents’ educational level were the utmost factors positively related to the possibility of high Mediterranean Dietary Pattern adherence. Sex, school location, body mass index and number of household members did not significantly predict high Mediterranean Dietary Pattern adherence. CONCLUSIONS: These results highlight the importance of the parents’ education level in adolescents’ Mediterranean Dietary Pattern adherence, allowing the identification of the priority groups for a possible intervention, namely, younger adolescents and those whose parents have lower educational level.

A self-reported symptom-based decision-making model helps to rule out outpatient cases at low risk for CRC before colonoscopy

ObjectivesEffective exclusion of low-risk symptomatic outpatient cases for colorectal cancer (CRC) remains diagnostic challenges. We aimed to develop a self-reported symptom-based decision-making model for application in outpatient scenarios. MethodsIn total, 8233 symptomatic cases at risk for CRC, as judged by outpatient physicians, were involved in this study at seven medical centers. A decision-making model was constructed using 60 self-reported symptom parameters collected from the questionnaire. Further internal and external validation cohorts were built to evaluate the discriminatory power of the CRC model. The discriminatory power of the CRC model was assessed by the C-index and calibration plot. After that, the clinical utility and user experience of the CRC model were evaluated. ResultsNine symptom parameters were identified as valuable predictors used for modeling. Internal and external validation cohorts verified the adequate discriminatory power of the CRC model. In the clinical application step, all 17 physicians found the model easy to grasp, 99.9 % of the patients were satisfied with the survey form. Application of this model detected all CRC cases. The total consistency ratio of outpatient cases undergoing colonoscopy was 81.4 %. None of the low-risk patients defined by the CRC model had been diagnosed with CRC. ConclusionThis multicenter study developed and validated a simple and user-friendly decision-making model covering self-reported information. The CRC model has been demonstrated to perform well in terms of rapid outpatient decision-making scenarios and clinical utility, particularly because it can better rule out low-risk outpatient cases.

Sedentary behaviour among elderly patients after total knee arthroplasty and its influencing factors

To understand the status of sedentary behaviour in elderly patients after total knee arthroplasty and analyse its influencing factors so as to provide a reference for developing targeted interventions. Conveniently selected elderly patients undergoing total knee arthroplasty (> 6 months) in a tertiary hospital in Jiangsu Province were investigated using a general information questionnaire, the Charlson Comorbidity Index, patients’ self-reported sedentary behaviour information, the WOMAC Score, The Groningen Orthopaedic Social Support Scale, and Lee’s Fatigue. The median daily sedentary time was 5.5 h (4.5 h, 6.625 h) in 166 elderly patients after total knee arthroplasty, of whom 82 (49.40%) showed sedentary behaviour (≥ 6 h per day). Logistic regression analysis showed that being retired/unemployed (OR = 8.550, 95% CI 1.732–42.207, P = 0.0084), having a CCI score ≥ 3 (OR = 9.018, 95% CI 1.288–63.119, P < 0.0001), having high WOMAC scores (OR = 1.783, 95% CI 1.419–2.238, P < 0.0001), having a high social support score (OR = 1.155, 95% CI 1.031–1.294, P = 0.0130), and having a fatigue score ≥ 5 (OR = 4.848, 95% CI 1.084–21.682, P = 0.0389) made patients more likely to be sedentary. The sedentary time of elderly patients after total knee arthroplasty is long, and sedentary behaviour is common among them. Healthcare professionals should develop targeted sedentary behaviour interventions based on the influencing factors of sedentary behaviour in order to reduce the occurrence of sedentary behaviour in elderly patients after total knee arthroplasty.

Association between self-reported visual symptoms (suggesting cataract) and self-reported fall-related injury among adults aged ≥ 65 years from five low- and middle-income countries.

Cataracts may increase risk for falls but studies on this topic from low- and middle-income countries (LMICs) are scarce. Therefore, we examined the cross-sectional association between self-reported visual symptoms (suggesting cataract) and self-reported injurious falls in nationally representative samples of adults aged ≥ 65 years from five LMICs (China, Ghana, India, Mexico, and Russia). Data from the WHO Study on global AGEing and adult health (SAGE) were analysed. Self-reported information on past 12-month fall-related injury and cataract based on symptoms were collected. Multivariable logistic regression and meta-analyses were conducted to assess associations. Data on 13,101 people aged ≥ 65 years were analysed [mean (SD) age 72.5 (11.3) years; 45.2% males]. The overall prevalence of self-reported fall-related injury and visual symptoms (suggesting cataract) were 4.9% and 29.4%, respectively. There was a positive association between self-reported visual symptoms (suggesting cataract) and fall-related injury (i.e., OR > 1) in all five countries but statistical significance was reached in three: China (OR = 1.60; 95% CI = 1.08-2.35), India (OR = 1.96; 95% CI = 1.15-3.35), and Russia (OR = 3.58; 95% CI = 2.06-6.24). The pooled OR including all five countries based on a meta-analysis was OR = 1.88 (95% CI = 1.32-2.68). Self-reported visual symptoms (suggesting cataract) were associated with higher odds for self-reported injurious falls among older adults in LMICs. Expanding availability of cataract surgery in LMICs may also have the additional benefit of reducing falls among older people.

Healthy lifestyle and prostate cancer risk in the Million Veteran Program.

This study aims to assess the impact of healthy lifestyle on prostate cancer (PCa) risk in a diverse population. Data for 281,923 men from the Million Veteran Program (MVP), a nationwide, health system-based cohort study, were analyzed. Self-reported information at enrollment included smoking status, exercise, diet, family history of PCa, and race/ethnicity. Body mass index (BMI) was obtained from clinical records. Genetic risk was assessed via a validated polygenic score. Cox proportional hazards models were used to assess associations with PCa outcomes. After accounting for ancestry, family history, and genetic risk, smoking was associated with an increased risk of metastatic PCa (hazard ratio [HR], 1.83; 95% confidence interval [CI], 1.64-2.02; p<10-16) and fatal PCa (HR, 2.73; 95% CI, 2.36-3.25; p<10-16). Exercise was associated with a reduced risk of fatal PCa (HR, 0.86; 95% CI, 0.76-0.98; p=.03). Higher BMI was associated with a slightly reduced risk of fatal PCa, and diet score was not independently associated with any end point. Association with exercise was strongest among those who had nonmetastatic PCa at MVP enrollment. Absolute reductions in the risk of fatal PCa via lifestyle factors were greatest among men of African ancestry (1.7% for nonsmokers vs. 6.1% for smokers) or high genetic risk (1.4% for nonsmokers vs. 4.3% for smokers). Healthy lifestyle is minimally related to the overall risk of developing PCa but is associated with a substantially reduced risk of dying from PCa. In multivariable analyses, both exercise and not smoking remain independently associated with reduced metastatic and fatal PCa.

Development of an Electronic Health Record Self-Referral Tool for Lung Cancer Screening: One-Group Posttest Study.

Approximately 14 million individuals in the United States are eligible for lung cancer screening (LCS), but only 5.8% completed screening in 2021. Given the low uptake despite the potential great health benefit of LCS, interventions aimed at increasing uptake are warranted. The use of a patient-facing electronic health record (EHR) patient portal direct messaging tool offers a new opportunity to both engage eligible patients in preventative screening and provide a unique referral pathway for tobacco treatment. This study sought to develop and pilot an EHR patient-facing self-referral tool for an established LCS program in an academic medical center. Guided by constructs of the Health Belief Model associated with LCS uptake (eg, knowledge and self-efficacy), formative development of an EHR-delivered engagement message, infographic, and self-referring survey was conducted. The survey submits eligible self-reported patient information to a scheduler for the LCS program. The materials were pretested using an interviewer-administered mixed methods survey captured through venue-day-time sampling in 5 network-affiliated pulmonology clinics. Materials were then integrated into the secure patient messaging feature in the EHR system. Next, a one-group posttest quality improvement pilot test was conducted. A total of 17 individuals presenting for lung screening shared-decision visits completed the pretest survey. More than half were newly referred for LCS (n=10, 60%), and the remaining were returning patients. When asked if they would use a self-referring tool through their EHR messaging portal, 94% (n=16) reported yes. In it, 15 participants provided oral feedback that led to refinement in the tool and infographic prior to pilot-testing. When the initial application of the tool was sent to a convenience sample of 150 random patients, 13% (n=20) opened the self-referring survey. Of the 20 who completed the pilot survey, 45% (n=9) were eligible for LCS based on self-reported smoking data. A total of 3 self-referring individuals scheduled an LCS. Pretest and initial application data suggest this tool is a positive stimulus to trigger the decision-making process to engage in a self-referral process to LCS among eligible patients. This self-referral tool may increase the number of patients engaging in LCS and could also be used to aid in self-referral to other preventative health screenings. This tool has implications for clinical practice. Tobacco treatment clinical services or health care systems should consider using EHR messaging for LCS self-referral. This approach may be cost-effective to improve LCS engagement and uptake. Additional referral pathways could be built into this EHR tool to not only refer patients who currently smoke to LCS but also simultaneously trigger a referral to clinical tobacco treatment.

Does a Short Interim Between Two Pregnancies Adversely Influence Maternal Outcome – A Study From South Punjab

Objective: To explore the impact of short interpregnancy intervals on maternal healthcare utilization and access in the context of South Punjab. Methodology: This cross-sectional study was done at gynae and OBS department of Combined Military Hospital Multan from October 2019 to April 2020. Women of reproductive age group (18-42 years) who had at least one previous pregnancy and women had a recorded interpregnancy interval (time between the last delivery and conception of the current pregnancy (&lt; 18 months) were included. The interpregnancy interval was calculated as the time between the date of delivery of the previous pregnancy and the date of conception of the current pregnancy, based on participants' self-reported information and/or available medical records. Maternal health outcomes were assessed, including obstetric complications like preterm birth, low birth weight, anemia, premature rupture of membranes PROM and postpartum hemorrhage PPH. All the information was entered and analyzed using SPSS version 26. Results: Overall mean age of the patients was 29.23 ± 2.11 years. Majority of patients had a gestational age greater than 38 weeks (61.1%), and resided in rural areas (66.1%). Additionally, a significant proportion of patients were illiterate (69.5%). PROM was found in 40.20% of the patients, 13.0% women had developed PPH and preterm deliveries were occurred in 19.70% of the women. Maternal adverse outcomes including PROM, PPH and preterm deliveries were statistically insignificant according to maternal age, parity and obesity (p-&lt;0.05). Conclusion: A short interval of less than 18 months between pregnancies has been identified as a factor contributing to increased risks of PROM, PPH, and preterm births. This implies that repeated unplanned pregnancies with short intervals may elevate the likelihood of adverse maternal outcomes.

Insomnia in Germany—massively inadequate care?

AbstractPeople suffering from chronic insomnia are at an increased risk of physical and mental illness. The absenteeism rate for people with sleep disorders in Germany is more than twice as high as for people without. Therefore, appropriate diagnosis and treatment of sleep disorders is a considerable medical and social necessity.The aim of this prospectively planned analysis is to describe self-reported effects of insomnia in everyday life and the current medical treatment situation in Germany.Data from a demographically representative sample of adults from the German participants in the National Health and Wellness Survey 2020 (N = 10,034) were analysed. Information was collected from respondents who reported insomnia confirmed by a physician (n = 532). The severity of insomnia at the time of the interview was assessed using the Insomnia Severity Index. Health status and quality of life were assessed using EQ-5D and SF-36, and work productivity and work impairment using the Work Productivity and Activity Impact Questionnaire.The median duration of illness was 5 years. About 50% of the respondents reported moderate to severe insomnia. Around 70% of those affected had never taken a prescription medication for their insomnia, and most of them said that they had never been recommended a prescription medication by a physician to treat their sleep disorder. Their health status, self-reported morbidity and quality of life were impaired compared with the general population.People with insomnia have worse health than those without insomnia. A significant proportion of those affected are currently not offered prescription medication. Even if the reasons for this lack of care cannot be clearly determined based on self-reported information, the data indicate an inadequate and relevant care deficit for chronic insomnia in Germany.

Incidence and Determinants of COVID-19 Among People Who Smoke (2018–2021): Findings From the ITC EUREST-PLUS Spain Surveys

ObjectiveTo estimate the cumulative incidence of COVID-19 and its determinants among a nationally representative sample of adults from Spain who smoke. MethodsThis is a prospective cohort study that uses data from two waves (Wave 2 in 2018 and Wave 3 in 2021) of the ITC EUREST-PLUS Spain Survey. At baseline (Wave 1 in 2016), all respondents were adults (aged ≥18) who smoked. In total, 1008 respondents participated in Wave 2, and 570 out of 888 eligible participants were followed up in Wave 3 (64.2%). We estimated the cumulative incidence and the relative risk of COVID-19 (RR) and 95% confidence intervals (CI) during follow-up using self-reported information on sociodemographic, smoking-related and health-related characteristics and identified associated factors using multivariable Poisson models with robust variance adjusted for the independent variables. ResultsThe overall cumulative incidence of self-reported COVID-19 was 5.9% (95% CI: 3.9–8.0%), with no significant differences between males (6.3%; 95% CI: 3.6–9.0%) and females (5.6%; 95% CI: 3.2–8.0%). After adjusting for age, sex, and educational level, COVID-19 incidence was positively associated with moderate nicotine dependence (RR: 2.37; 95% CI: 1.04–5.40) and negatively associated with having a partner who smoked (RR: 0.12; 95% CI: 0.03–0.42), and having friends but not a partner who smoked (RR: 0.28; 95% CI: 0.14–0.56). ConclusionThe correlates of having had COVID-19 among people who smoke should be considered when tailoring information and targeted non-pharmacological preventive measures.

The cigarette market in Brazil: new evidence on illicit practices from the 2019 National Health Survey

ObjectiveTo explore new evidence on illicit practices, such as selling legal brands below the minimum legal price (MLP), and smugglers selling illicit brands at or above the MLP.MethodsFor the first...

Association between perceived quality of care and social isolation among cancer survivors in the US.

e23182 Background: Though social isolation has been linked to poorer survival outcomes among cancer survivors, studies assessing its association with perceived quality of care have not been explored in this population. We examined the association between perceived quality of care and self-reported social isolation among cancer survivors. Methods: Cross-sectional analyses were conducted using the Health Information National Trends Survey (HINTS) data collected from a nationally representative population of US adults from March to November 2022. Social isolation was assessed with the self-reported Patient-Reported Outcomes Measurement Information System (PROMIS) Social Isolation Short Form. Multiple linear regression models were used to examine the association between perceived quality of care and self-reported social isolation among cancer survivors. Other factors associated with social isolation in this population were also assessed. Results: In the adjusted analyses, social isolation scores were 6.3 points (95% CI: 2.30–10.28) higher among cancer survivors who reported fair/poor quality health care relative to those that reported excellent/very good/good quality of care. When compared to Non-Hispanic White cancer survivors, Non-Hispanic Blacks (β: –2.96; 95% CI: –5.35– –0.57) and Hispanic survivors (β: –4.06; 95% CI: –7.71– –0.40) had lower social isolation scores. Cancer survivors who were married or cohabiting had 3.3 points (95% CI: –6.01– –0.55) lower social isolation scores relative to single cancer survivors. Cancer survivors with high school or less education had lower isolation scores (β: –2.03; 95% CI: –4.00– –0.07) than those with some college education or more and those with an income of $50,000 or higher reported lower isolation scores (β: –2.19; 95% CI: –4.17– –0.21) than their counterparts earning less than $50,000. Furthermore, those with a diagnosis of depression or anxiety had 5.2 points (95%: 3.23–7.21) higher social isolation scores than cancer survivors without depression/anxiety. Conclusions: Fair or poor quality of care was associated with higher social isolation among cancer survivors. Additionally, race/ethnicity, marital status, level of education, income, and depression/anxiety were correlated with social isolation. To reduce the impact of social isolation and improve the health outcomes of cancer survivors, healthcare providers need to prioritize delivering holistic care, promote social connectivity and incorporate mental health screening and referrals into standard care practices.

The mental health-related barriers and benefits to exercise in adults with and without chronic pain

BackgroundQualitative evidence points to the importance of both mental health-related barriers and benefits to exercise in chronic pain, yet this bidirectional relationship has not been established quantitatively. Methods89 adults with chronic pain (75 female, Age: M = 34.7, SD=13.2), and 89 demographically-matched individuals without chronic pain (73 female, Age: M = 32.0, SD=13.3) self-reported demographic and health information, mental health-related barriers and benefits to exercise, and leisure-time exercise activity. ResultsAdults with chronic pain had significantly higher scores on mental health-related barriers to exercise, and lower leisure-time exercise participation than adults without chronic pain. The groups did not differ on mental health-related benefits of exercise scores. Benefits scores positively predicted exercise, yet there was a significant negative interaction between pain and benefit scores, indicating a weaker positive relationship between benefits and exercise for adults with chronic pain than for those without chronic pain. Barrier scores significantly negatively predicted exercise engagement, but did not interact significantly with chronic pain. ConclusionMental health-related barriers and benefits to exercise are important considerations when prescribing exercise for adults with chronic pain. Adults with chronic pain may require individualised support to address mental health-related barriers to leisure-time exercise.

Self-Reported Social Determinants of Health and Area-Level Social Vulnerability

Many health care systems are investing resources in identifying social determinants of health (SDoH) needs and facilitating interventions among the populations they serve. Because self-reported SDoH information is lacking, area-level measures are often used to estimate needs and direct resources. To describe the large-scale deployment of SDoH assessments by a health system and determine the extent to which self-reported SDoH needs identified therein are associated with census tract-level social vulnerability measured using the Social Vulnerability Index (SVI). This cross-sectional study assessed SDoH needs between January 1, 2020, and April 30, 2023, in both payer and clinical care settings. Modalities included telephonic outreach, face-to-face clinical interactions, self-entry into a tablet or kiosk, and web-based survey tools. Participants included individuals who responded to the assessment and had sufficient information for census tract identification. Respondents included both Highmark Health Plan members and nonmembers. Health plan members responded to the assessment through health plan programs or platforms, and both members and nonmembers responded to assessments during inpatient or outpatient encounters with the affiliated health system. Overall and domain-specific SDoH needs self-reported through assessments, and severity and complexity of needs identified. Residential social vulnerability measures included overall SVI and the 4 conceptual themes comprising overall SVI. In total, 841 874 assessments were recorded for 401 697 individuals (55.1% women; median [IQR] age, 55 [41-70] years). Social determinants of health needs were identified in 120 769 assessments (14.3%). Across all SDoH domains, increasing SVI was associated with a higher positivity rate (eg, 11.2% of those residing in the lowest-risk SVI quintile reported a need compared with 22.7% among those residing in the highest-risk quintile). Associations varied by SDoH domain and SVI theme. After adjusting for demographic and screening characteristics, odds of positive screening among those residing in the highest-risk SVI quintile were 1.74 (95% CI, 1.62-1.86) to 3.73 (95% CI, 3.48-4.00) times the odds among those residing in lowest risk quintile. In this cross-sectional study, the overall level of SDoH needs generally corresponded to area-level vulnerability. Some SDoH domains appeared far more sensitive to community characteristics than others. Notably, even among individuals from the highest-risk areas, the positive screening rate was roughly 1 in 4. These findings underscore the importance of individual-level SDoH data for service provision planning and health services research.

The association between oral health literacy and oral health-related behaviours among female adolescents in the Kingdom of Saudi Arabia: A cross-sectional study

ObjectivesOral health literacy (OHL) is suggested as an important denominator of oral health. This study aimed to identify ways to improve oral health by exploring the association between oral health literacy and oral health-related behaviours among female adolescents in the Eastern Province of the Kingdom of Saudi Arabia (KSA). MethodsThis cross-sectional study assessed OHL among 1,889 10th grade female students in the Eastern Province of the KSA. OHL was assessed using an Arabic version of the short version of the Health Literacy in Dentistry scale (A-HeLD-14). Self-reported socio-demographic information and oral health-related behaviours (toothbrushing, dental attendance, and sugary diet consumption) were also collected. The relationship between OHL and oral health-related behaviours was investigated using binary logistic regression, adjusted for socio-demographic information. ResultsThe binary logistic regression analyses showed that poor OHL was significantly associated with infrequent toothbrushing (p < 0.001) and irregular dental attendance (p = 0.005) but not with consumption of sugary diets. All A-HeLD-14 domains were significantly associated with infrequent toothbrushing, and the domains concerning access, receptivity, and financial barriers were significantly associated with irregular dental attendance. The highest odds ratios (ORs) for infrequent toothbrushing were found in the domains of receptivity (OR = 4.19) and understanding (OR = 3.85) and for irregular dental attendance in the financial barriers (OR = 1.61) and access (OR = 1.49) domains, followed by the receptivity domain (OR = 1.35). ConclusionPoor OHL was significantly associated with infrequent toothbrushing and irregular dental attendance. Interventions focusing on OHL are warranted to improve oral health-related behaviours and thereby oral health in the population. The aspects that seem most vital to target are improved access to dental care, including the reduction ofeconomic barriers, as well as increased awareness of oral health in the population.