Self-reported Physical Health Research Articles

Perceived stress trajectories from age 25 to 50 years

Trajectories of perceived stress from the transition to adulthood (age 25), during young adulthood (age 32), and into midlife (ages 43 and 50) were examined with four waves of longitudinal survey data (N = 688; 49% female, 37% with a university degree, 86% White). We explored how between- and within-person variation in perceived stress was associated with age 50 psychological well-being (life satisfaction and eudaimonic well-being), self-reported physical health, career satisfaction, and intimate partnership satisfaction. Growth curve analyses revealed stress followed a linear decreasing trajectory from the transition to adulthood into midlife with substantial variability underlying the average pattern. Between- and within-person variation in perceived stress was associated with midlife functioning. Those with lower initial levels of and more decline in perceived stress reported better psychological and physical health and higher relationship satisfaction at age 50 compared to those with initially higher perceived stress and less decline over time. Higher than one’s own average perceived stress at ages 25, 32, 43, and 50 years was associated with lower psychological and physical health and intimate partnership satisfaction at age 50. These results support key contentions of developmental theory and may prove useful when designing interventions aimed at promoting well-being in midlife.

The Precision in Psychiatry (PIP) study: Testing an internet-based methodology for accelerating research in treatment prediction and personalisation

BackgroundEvidence-based treatments for depression exist but not all patients benefit from them. Efforts to develop predictive models that can assist clinicians in allocating treatments are ongoing, but there are major issues with acquiring the volume and breadth of data needed to train these models. We examined the feasibility, tolerability, patient characteristics, and data quality of a novel protocol for internet-based treatment research in psychiatry that may help advance this field.MethodsA fully internet-based protocol was used to gather repeated observational data from patient cohorts receiving internet-based cognitive behavioural therapy (iCBT) (N = 600) or antidepressant medication treatment (N = 110). At baseline, participants provided > 600 data points of self-report data, spanning socio-demographics, lifestyle, physical health, clinical and other psychological variables and completed 4 cognitive tests. They were followed weekly and completed another detailed clinical and cognitive assessment at week 4. In this paper, we describe our study design, the demographic and clinical characteristics of participants, their treatment adherence, study retention and compliance, the quality of the data gathered, and qualitative feedback from patients on study design and implementation.ResultsParticipant retention was 92% at week 3 and 84% for the final assessment. The relatively short study duration of 4 weeks was sufficient to reveal early treatment effects; there were significant reductions in 11 transdiagnostic psychiatric symptoms assessed, with the largest improvement seen for depression. Most participants (66%) reported being distracted at some point during the study, 11% failed 1 or more attention checks and 3% consumed an intoxicating substance. Data quality was nonetheless high, with near perfect 4-week test retest reliability for self-reported height (ICC = 0.97).ConclusionsAn internet-based methodology can be used efficiently to gather large amounts of detailed patient data during iCBT and antidepressant treatment. Recruitment was rapid, retention was relatively high and data quality was good. This paper provides a template methodology for future internet-based treatment studies, showing that such an approach facilitates data collection at a scale required for machine learning and other data-intensive methods that hope to deliver algorithmic tools that can aid clinical decision-making in psychiatry.

Technology engagement is associated with higher perceived physical well-being in stroke patients prescribed smartwatches for atrial fibrillation detection.

Increasing ownership of smartphones among Americans provides an opportunity to use these technologies to manage medical conditions. We examine the influence of baseline smartwatch ownership on changes in self-reported anxiety, patient engagement, and health-related quality of life when prescribed smartwatch for AF detection. We performed a post-hoc secondary analysis of the Pulsewatch study (NCT03761394), a clinical trial in which 120 participants were randomized to receive a smartwatch-smartphone app dyad and ECG patch monitor compared to an ECG patch monitor alone to establish the accuracy of the smartwatch-smartphone app dyad for detection of AF. At baseline, 14 days, and 44 days, participants completed the Generalized Anxiety Disorder-7 survey, the Health Survey SF-12, and the Consumer Health Activation Index. Mixed-effects linear regression models using repeated measures with anxiety, patient activation, physical and mental health status as outcomes were used to examine their association with smartwatch ownership at baseline. Ninety-six participants, primarily White with high income and tertiary education, were randomized to receive a study smartwatch-smartphone dyad. Twenty-four (25%) participants previously owned a smartwatch. Compared to those who did not previously own a smartwatch, smartwatch owners reported significant greater increase in their self-reported physical health (β = 5.07, P < 0.05), no differences in anxiety (β = 0.92, P = 0.33), mental health (β = -2.42, P = 0.16), or patient activation (β = 1.86, P = 0.54). Participants who own a smartwatch at baseline reported a greater positive change in self-reported physical health, but not in anxiety, patient activation, or self-reported mental health over the study period.

Accelerometer-measured physical activity and sedentary behavior in nonagenarians: Associations with self-reported physical activity, anthropometric, sociodemographic, health and cognitive characteristics.

Research on device-based physical activity in the oldest-old adults is scarce. We examined accelerometer-measured physical activity and sedentary behavior in nonagenarians. We also investigated how the accelerometer characteristics associate with nonagenarians' self-reported physical activity, anthropometric, sociodemographic, health and cognitive characteristics. Nonagenarians from a population-based cohort study (N = 38, mean age 91.2) used accelerometers during the waking hours for seven days. They also participated in a health survey and cognitive telephone interview. The Wald test and Pearson and polyserial correlations were used to analyze the data. The participants' average day consisted of 2931 steps, 11 minutes of moderate-to-vigorous physical activity and 13.6 hours of sedentary time. Physical activity bouts less than 3 minutes per day and sedentary time bouts of 20-60 minutes per day were the most common. No sex differences were found. Many accelerometer-measured and self-reported physical activity characteristics correlated positively (correlations ≥0.34, p-values <0.05). The low levels of many accelerometer-measured physical activity characteristics associated with low education (correlations ≥0.25, p-values <0.05), dizziness (correlations ≤-0.42, p-values <0.01) and fear of falling (correlations ≤-0.45, p-values <0.01). Fear of falling was also associated with accelerometer-measured sedentary behavior characteristics (correlations -0.42 or ≥0.43). Nonagenarians were mostly sedentary and low in physical activity, but individual variability existed. Accelerometer-measured and self-reported physical activity had a good consistency. Education, dizziness and fear of falling were consistently related to accelerometer-measured characteristics in nonagenarians.

Evaluating resilience in response to COVID-19 pandemic stressors among veteran mental health outpatients.

There is a public health need to understand mental health vulnerabilities to COVID-19 pandemic-related stressors and promote resilience among high-risk populations with preexisting psychiatric conditions. Recent cross-sectional studies suggest increases in mental health distress (e.g., depression and anxiety) during the pandemic. The present study expands upon these emerging findings using longitudinal latent modeling and hierarchical linear regressions. Consistent with the developmental psychopathology literature on resilience, we distinguished between promotive or risk (i.e., main effect), and protective or vulnerability (i.e., moderation) effects on mental health during the pandemic. At a large medical center, 398 veterans receiving outpatient mental health care provided prepandemic (Time 1) and during pandemic (Time 2) assessments of mental and physical health-related distress. Additional Time 2 questionnaires assessed pandemic-related stressors and positive behavioral adaptations in the summer of 2020. As expected, total stressor scores predicted longitudinal worsening of self-reported mental (β = -.205) and physical health (β = -.217). Positive behavioral adaptations enacted during the pandemic moderated and protected against stressor effects on mental health (β = .160). In addition, the presence of substance use disorders moderated and conferred vulnerability to stressor effects on physical health (β = -.158). Thus, higher COVID-19 pandemic stressor exposure may have exacerbated mental and physical health distress among veterans with common forms of psychopathology. Nevertheless, behavioral activation, purposeful maintenance of social connections, and focused treatment for substance misuse may be important intervention targets for reducing the longitudinal impact of pandemic stressors and enhancing resilience among people with mental illness. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Socioeconomic position and physical and mental health among middle-aged and older adults: Cross-sectional and longitudinal results from a national community sample in Thailand

ABSTRACT The aim of this study was to assess the physical and mental health status of middle-aged and older adults in relation to socioeconomic status in Thailand, both in a cross-sectional and longitudinal study. We analyze national cross-sectional and longitudinal data from the Health, Aging, and Retirement in Thailand (HART) study in 2015 and 2017. Health outcome measures included 1) physical chronic disease, 2) probable depression, 3) self-rated physical health, and 4) self-rated mental health.The cross-sectional sample included 5,616 participants and the longitudinal sample included 3,708 participants. The oldest group (≥75 years) had a lower prevalence of high income 7.9%, compared to the middle-aged group (45–59 years) 43.2%, had a higher prevalence of no education (14.8%) compared to the middle-aged group (2.0%), and had a lower prevalence of employed (11.9%) compared to the middle-aged group (80.6%). In cross-sectional analysis, we found that higher income, employed and higher education was associated with better self-reported physical health among two or all three age groups, and with better self-reported mental status among one, two or three age groups. Lower income, not employed, and lower education were associated with physical comorbidity among one or two of the younger age groups. Lower income, but not employment status and education, were associated with probable depression among two of the younger age groups. Furthermore, in longitudinal analysis of the health outcomes, we found that higher income, employed and higher education were associated with better self-reported physical and mental health among two or all three age groups, and lower income, and not employed but not lower education were associated with physical comorbidity counts and depression scores among two or all three age groups. The results show that a significant gap in physical and mental health status between middle-aged and older adults in Thailand can be attributed to a lower socioeconomic status. To address the effects of both aging and lower socioeconomic status, interventions that improve economic and health status are indicated.

Effect of a Remotely Delivered Self-directed Behavioral Intervention on Body Weight and Physical Health Status Among Adults With Obesity

The effectiveness of remotely delivered, self-directed, weight loss programs in routine clinical practice is largely unknown. To test whether a self-directed, remotely administered behavioral lifestyle intervention improves weight and self-reported general health status compared with usual care. In this randomized clinical trial, 511 adults with a body mass index (BMI) of 30 or more and less than 45 (based on electronic health record [EHR] weight and height), were enrolled from 30 Veterans Health Administration (VHA) sites between February 15, 2018, and December 18, 2018 (final follow-up February 18, 2021). Participants were randomly assigned to the intervention group (n = 254) or the control group (n = 257). Both received usual care. Participants randomized to the intervention received Diabetes Prevention Program-based self-directed videos, handouts, and coaching messages via an online platform or US mail for 12 months. Coprimary outcomes were weight measured in primary care and recorded in the EHR and self-reported general health status using the Medical Outcomes Study 12-Item Short Form Health Survey (SF-12) physical component score (PCS; higher scores are better [range, 0-100]) at the 12-month follow-up. The between-group minimal clinically important differences are 3 kg for weight and 5 points for the SF-12 PCS. Linear mixed models used weights and SF-12 PCS measured at either time point, with participants analyzed according to randomization assignment. Statistical significance for each coprimary outcome was based on a 2-sided α level of .025. Among 511 participants randomized (mean age, 57.4 [SD, 13.9] years; 231 female [45%]), 429 (84.0%) had EHR-based weights and 410 (80.2%) had SF-12 PCS data at 12 months. The unadjusted mean weight at 12 months declined from 102.7 kg to 99.8 kg in the intervention group compared with 101.9 kg to 101.0 kg in the control group (adjusted between-group mean difference, -1.93 [97.5% CI, -3.24 to -0.61]; P = .001). At 12 months, the unadjusted mean SF-12 PCS scores declined from 44.8 to 44.3 among intervention participants compared with 44.5 to 43.2 among control participants (adjusted between-group mean difference, intervention minus control, 0.69 [97.5% CI, -1.11 to 2.49]; P = .39). Cardiovascular events represented the highest percentage of serious adverse events, accounting for 25% of events in the intervention group and 35% in the control group. Among adults with obesity, a remotely delivered self-directed, behavioral lifestyle intervention, compared with usual care, resulted in statistically significantly greater weight loss at 12 months, although the difference was not clinically important. There was no significant difference in self-reported general physical health status at 12 months. ClinicalTrials.gov Identifier: NCT03260140.

Urban park use and self-reported physical, mental, and social health during the COVID-19 pandemic: An on-site survey in Beijing, China

The COVID-19 pandemic created unprecedented challenges for people’s health. Studies have demonstrated the positive impact of urban green spaces, particularly urban parks, on physical and mental health. However, few studies have evaluated social health, which is a component of human health, and more understanding of the relationship between urban parks and human health during the COVID-19 pandemic is required. This study examined the effects of urban parks on people’s health using a canonical correlation model. Physical, mental, and social health were the dependent health variables, and five factors related to urban parks were the independent variables. This study investigated 22 urban parks inside the Forth Ring Road in Beijing, China using a questionnaire survey. The results demonstrated a positive association between urban parks and human health during the pandemic. Distance to the parks, park area, and park size were positively correlated with physical, mental, and social health. Furthermore, frequency and duration of visits to urban parks were positively associated with mental health and contact with neighbors. The health effects of urban park use varied with park types and locations’ urbanization background. These findings can provide insights for health-oriented urban park planning and construction.

Health literacy, financial insecurity and health outcomes among people living with HIV in Australia

It is well documented that lower socio-economic status is associated with poorer health outcomes, while health literacy is considered important for improving health. What is less clear, is the extent to which greater health literacy can improve health outcomes among people for whom poverty or financial insecurity are important barriers to health. The paper presents findings from an Australian survey of people living with HIV (PLHIV) (N = 835) in which we explored the relationship between financial insecurity and health outcomes, looking at the extent to which health literacy mediates this relationship. The study drew on a comprehensive definition of health literacy, measuring participant's confidence to communicate with healthcare providers, navigate the health system and take an active stance in relation to their health. Findings showed that financial insecurity was associated with lower health literacy and poorer self-reported physical and mental health. Health literacy mediated 16.2% of the effect of financial insecurity on physical health scores and 16.6% of the effect of financial insecurity on mental health scores. This suggests that programmes which seek to build health literacy among PLHIV may improve health outcomes among PLHIV who are struggling financially. Health literacy programmes are likely to be effective if they build confidence and resourcefulness among people to engage with health information, decision-making and care.

Higher comorbidity burden is associated with lower self-reported quality of life after stroke.

This study assesses the association of comorbidity burden and polypharmacy with self-reported quality of life after stroke. We performed a post-hoc analysis of a prospective, single-center, observational study of outcome evaluation by patient-reported outcome measures in stroke clinical practice. Consecutive patients with acute ischemic stroke (AIS) were enrolled and self-reported health-related quality of life (HrQoL) was assessed 90 days after acute stroke using the Patient-reported Outcomes Measurement Information System 10-Question Short-Form (PROMIS-10). Comorbidities at baseline were assessed by the Charlson Comorbidity Index (CCI). Polypharmacy was defined as medication intake of ≥5 at baseline. We used linear regression analysis to study the association of CCI, polypharmacy and other clinical covariates with HrQoL after stroke. Of 781 patients (median age 76 years, 48.4% female) enrolled, 30.2% had a CCI Score ≥2, and 31.5% presented with polypharmacy. At follow up, 71 (9.1%) had died. In 409 (52.4%) reached for outcome evaluation, Global Physical Health T-Score was 43.8 ± 10 and Global Mental Health T-Score was 43.5 ± 8.76, indicating lower HrQoL than the average population. A CCI Score ≥2, higher NIHSS Score, female sex, dependency on others for dressing, toileting and mobility before index stroke, atrial fibrillation and hypertension were independent predictors of worse physical and mental health outcomes, while polypharmacy was not. In patients with AIS, high comorbidity burden and polypharmacy are frequent. Comorbidity burden at admission is independently associated with worse self-reported physical and mental health three months after stroke.

Associations among enacted weight stigma, weight self-stigma, and multiple physical health outcomes, healthcare utilization, and selected health behaviors.

This study examined the relationship among enacted weight stigma, weight self-stigma, and multiple health outcomes. Weight stigma, a stressor experienced across all body sizes, may contribute to poorer physical health outcomes by activating the nervous and endocrine system or by triggering counterproductive health behaviors like lower physical activity, maladaptive eating patterns, and delayed health care, as well as provider bias that may cause a medical concern to be discounted. While associations of weight stigma with mental health issues are well documented, less is known about its association with physical health. We enrolled 3821 adults who completed an online survey assessing enacted weight stigma, weight self-stigma, multiple self-reported physical health outcomes, healthcare utilization, and selected health behaviors. After controlling for BMI, health care delay or avoidance, sedentary behavior, and selected demographic characteristics, enacted weight stigma, significantly increased the odds of six physical health problems including hypertension (OR 1.36; CI 1.08, 1.72), hyperglycemia (OR 1.73; CI 1.29, 2.31), thyroid disorder, (OR 1.65; CI 1.27, 2.13), any arthritis (OR 1.70; CI 1.27, 2.26), non-arthritic chronic pain (OR 1.76; CI 1.4, 2.29), and infertility (OR 1.53; CI 1.14, 2.05). Weight self-stigma significantly increased the odds for three physical health problems including hypertension (OR 1.43; CI 1.16, 1.76), hyperglycemia (OR 1.37; CI 1.03, 1.81), and non-arthritic chronic pain (OR 1.5; CI 1.2,1.87). Enacted stigma was associated with more than a four-fold increase in odds of believing that a medical concern was disregarded by a health care provider. In this study, enacted stigma and weight self-stigma were independently associated with heightened risk for multiple physical health problems, as well as, believing health concerns were discounted by providers. Reducing weight stigma may be an important component of managing multiple physical health conditions.

Perceptions of Freshwater Algal Blooms, Causes and Health among New Brunswick Lakefront Property Owners.

Changes to water conditions due to eutrophication and climate change have resulted in the proliferation of algae blooms in freshwater and marine environments globally, including in Canadian lakes. We developed and administered an online survey to evaluate the awareness of these blooms and the perceptions of health risks in a sample of New Brunswick waterfront cottage and homeowners. The survey was distributed to lake and cottage associations in New Brunswick and was completed by 186 eligible respondents (18 years of age or older). Participants were asked about the water quality of their lake, awareness about algae blooms, sociodemographic and cottage characteristics, and to complete a self-rated measure of physical and mental health. While approximately 73% of participants reported that the quality of their lake water was good or very good, 41% indicated a concern about algae blooms. We found no differences in self-reported physical or mental health between those who were aware of algae blooms at their cottage and those who were not (p > 0.05). Participants expressed concerns about the impacts of algae blooms on the health of their pets, and wildlife. While climate change was the most frequently identified cause of algae blooms, there was substantial heterogeneity in the responses. In addition, the reporting of the presence and frequency of algae bloom varied between respondents who lived on the same lake. Taken together, the findings from our survey suggest that cottage owners in New Brunswick are aware and concerned about the impacts of algae blooms, however, there is a need to provide additional information to them about the occurrence and causes of these blooms.

Study protocol for the Multiple Symptoms Study 3: a pragmatic, randomised controlled trial of a clinic for patients with persistent (medically unexplained) physical symptoms

IntroductionPersistent physical symptoms (which cannot be adequately attributed to physical disease) affect around 1 million people (2% of adults) in the UK. They affect patients’ quality of life and account...

Effect of Patient-Reported Preprocedural Physical and Mental Health on 10-Year Mortality After Percutaneous or Surgical Coronary Revascularization.

Clinical and anatomical characteristics are often considered key factors in deciding between percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with complex coronary artery disease (CAD) such as left-main CAD or 3-vessel disease. However, little is known about the interaction between self-reported preprocedural physical/mental health and clinical outcomes after revascularization. This subgroup analysis of the SYNTAXES trial (SYNTAX Extended Survival), which is the extended follow-up of the randomized SYNTAX trial (Synergy Between PCI With Taxus and Cardiac Surgery) comparing PCI with CABG in patients with left-main CAD or 3-vessel disease, stratified patients by terciles of Physical (PCS) or Mental Component Summary (MCS) scores derived from the preprocedural 36-Item Short Form Health Survey, with higher PCS and MCS scores representing better physical and mental health, respectively. The primary end point was all-cause death at 10 years. A total of 1656 patients with preprocedural 36-Item Short Form Health Survey data were included in the present study. Both higher PCS and MCS were independently associated with lower 10-year mortality (10-point increase in PCS adjusted hazard ratio, 0.84 [95% CI, 0.73-0.97]; P=0.021; in MCS adjusted hazard ratio, 0.85 [95% CI, 0.76-0.95]; P=0.005). A significant survival benefit with CABG over PCI was observed in the highest PCS (>45.5) and MCS (>52.3) terciles with significant treatment-by-subgroup interactions (PCS Pinteraction=0.033, MCS Pinteraction=0.015). In patients with both high PCS (>45.5) and MCS (>52.3), 10-year mortality was significantly higher with PCI compared with CABG (30.5% versus 12.2%; hazard ratio, 2.87 [95% CI, 1.55-5.30]; P=0.001), whereas among those with low PCS (≤45.5) or low MCS (≤52.3), there were no significant differences in 10-year mortality between PCI and CABG, resulting in a significant treatment-by-subgroup interaction (Pinteraction=0.002). Among patients with left-main CAD or 3-vessel disease, patient-reported preprocedural physical and mental health status was strongly associated with long-term mortality and modified the relative treatment effects of PCI versus CABG. Patients with the best physical and mental health had better 10-year survival with CABG compared with PCI. Assessment of self-reported physical and mental health is important when selecting the optimal revascularization strategy. URL: https://www. gov; SYNTAXES Unique identifier: NCT03417050. URL: https://www. gov; SYNTAX Unique identifier: NCT00114972.

Self-reported physical and emotional health among left behind children in Lithuania. A pilot study

Abstract Background Left behind children (LBC) are children living with caregivers, while their parents work abroad. In recent decades Lithuania had lost ¼ of its population due to emigration, but the prevalence of LBC and their health needs are not sufficiently studied. The aim of study was to evaluate the association between self-reported health, emotional and behavioural difficulties between LBC and non-LBC. Methods The cross-sectional study was approved by the Biomedical Research Ethics Committee, No. 2021/11-1378-861. In March 2022, this pilot study collected data from adolescents aged 12-17 years at three randomly selected schools from the migration affected regions. Parents and children provided informed consent to participate in pilot study. Self-reported measures collected from the participants: Strengths, and Difficulties Questionnaire (Goodman, 2005) and a questionnaire on demographics and on the health situation. Chi2 tests and logistic regression were calculated by using Stata (version 15.1). Results The sample consisted of 127 children (mean age 15.2, SD 1.27; 54 boys, 72 girls) including 39 LBC. Mostly fathers left to work abroad (n = 36), but majority of children (n = 36) regularly communicated remotely with their migrated parents. Binary logistic regression results show that LBC children tend to evaluate their health as ‘poor, ‘bad', or ‘very bad’ (OR 2,33; 95CI [1,02-5,33]). There were no differences for emotional and behavioural problems. Preliminary results from multiple regression model showed that children with self-reported emotional/behavioural difficulties (OR 3,06; 95CI [1,12-7,84]), females (OR 4,99;95CI [1,55-16,13]) and LBC (OR 2,44; 95CI 0,95-6,25]) more likely evaluate their health as ‘poor', ‘bad’ or ‘very bad’ (likelihood-ratio test=23,72; model p &amp;lt; 0.001). Conclusions This pilot study found negative association between parental migration and children’s self-reported health. However, a more comprehensive study with a larger sample size is needed. Key messages • Pilot study suggests negative association between parents migration and children’s self-reported health. • More comprehensive study in bigger sample for the emotional/behavioural/communication difficulties between left behind children needs to be done.

Mental and physical health correlates of the psychological impact of the first wave of COVID-19 among general population of Pakistan.

The primary aim was to assess the role of mental and physical health of COVID-19 and its psychological impact in the general population of Pakistan during the first wave of COVID-19. It was hypothesized that there would be a significant predictive association among socio-demographic variables, psychological impact and mental health status resulting from COVID-19, and poor self-reported physical health would be significantly associated with adverse psychological impact and poor mental health status because of COVID-19. A cross-sectional survey research design was used in which 1,361 respondents were sampled online during lockdown imposed in the country. The Impact of Events Scale-Revised (IES-R) was used to assess the psychological impact of COVID-19, and the Depression Anxiety Stress Scales (DASS-21) was used to assess participants' mental health status. 18% of the respondents reported moderate to severe event-specific distress, 22.6% reported moderate to severely extreme depression, 29% reported moderate to extreme anxiety, and 12.1% reported moderate to extreme stress. Female gender, having graduate-level education, currently studying, and self-reported physical symptoms (persistent fever, chills, headache, cough, breathing difficulty, dizziness, and sore throat) were significantly associated with higher levels of psychological impact exhibited through higher scores on the IES-R and poorer mental health status exhibited through higher scores on the DASS-21 (Depression, Anxiety, and Stress Subscales).

Self-Reported Health of Working-Age Refugees, Immigrants, and the Canadian-Born

Canada has a rapidly growing refugee population, yet, there are limited research studies on the physical health of working-age refugees in comparison to the health of immigrants and Canadian-born individuals. Investigating social capital and acculturation measures may provide important insights into the factors associated with good self-reported health and this may help to inform health promotion strategies for refugees in Canada. A secondary analysis was conducted on data collected from the Canadian General Social Survey 27 (GSS-27) comparing a sample of refugees (n = 753), immigrants (n = 5,063), and Canadian-born (n = 11,266) respondents between the ages of 15 and 64. Both bivariate and logistic regression analyses were conducted. Self-reported physical health, dichotomized into poor versus good, was the outcome of interest. The self-reported physical health status of refugees, immigrants, and Canadian-born respondents was comparable. Visible minority status was not significantly associated with self-reported health status. Among refugees, the likelihood of reporting good health was associated with being a woman, being married/common-law, being involved in a social group/organization, and having more than half of one’s friends who spoke a different mother tongue than the respondent. Refugees, however, were less likely to have a confidant and be involved in social groups/organizations as compared to immigrants or those born in Canada. The odds of reporting good health were significantly lower among those who had experienced discrimination within the last five years. Social capital and acculturation may be protective of the self-reported health of refugees in Canada. Initiatives to support refugees’ social connections are therefore warranted.

When cancer survivors are also caregivers: well-being of "dual-role" cancer survivors.

As the life expectancy of cancer survivors continues to improve, cancer survivors start or resume their life roles as caregivers themselves. We aim to assess the associations between caregiving, cancer diagnosis, and self-reported well-being. Data were obtained from the Behavioral Risk Factor Surveillance System (BRFSS) 2016, 2018, and 2020. Outcomes included self-reported general health, physical health, mental health, depression, physical inactivity, and poor sleep. Weighted multivariable logistic regression models were used to calculate self-reported well-being's adjusted odds ratio (aOR). Comparable to the proportion of caregivers in the general population, approximately 1 out of 5 cancer survivors were caregivers to others. Individuals with dual roles were significantly more likely to report poor general health (aOR = 2.45; 95%CI: 1.46-4.11), physical health (aOR = 2.17; 95%CI: 1.32-3.56), mental health (aOR = 2.47; 95%CI: 1.31-4.64), depression (aOR = 1.64; 95%CI: 1.15-2.41), physical inactivity (aOR = 1.56; 95%CI: 1.05-2.31), and poor sleep (aOR = 1.48; 95%CI: 1.00-2.19) than the general population. Differential impacts of an additional cancer diagnosis on the well-being of caregivers were observed by sex, race, and time since cancer diagnosis. Nearly four million cancer survivors in the USA are concomitant caregivers. Individuals with dual roles reported diminished well-being across a variety of measures than caregivers only. Significant unmet health and psychosocial needs exist among individuals with dual roles. Our findings urge for increased awareness of this additional role/responsibility in cancer survivors and provide direct evidence for healthcare providers and policymakers to develop substantial support from the structural level.

Association of Attending a High-Performing High School With Substance Use Disorder Rate and Health Outcomes in Young Adults

Interventions directly targeting social factors, such as education, may have the potential to greatly improve health. To examine the association of attending a high-performing public charter high school with rates of substance use disorder and physical and mental health. This cohort study used the random school admissions lottery system of high-performing public charter high schools in low-income neighborhoods of Los Angeles, California, to examine the health outcomes of students who applied to at least 1 of 5 of these high schools. Participants attended 147 different high schools and were randomly selected from those who won the admissions lottery (intervention group) and those who were placed on a waiting list (control group). Participants were surveyed at the end of grade 8 through transition into grade 9 and then from grade 10 through 3 years after high school completion (at age 21 years). Surveys were conducted from March 2013 through November 2021. Attendance at a high-performing public charter high school. Self-reported alcohol use disorder and cannabis misuse, delinquent behaviors, physical and mental health, and body mass index. Of the 1270 participants at baseline (mean [SD] age, 14.2 [0.47] years; 668 female individuals [52.6%]). The control group included 576 individuals (45.4%), and 694 individuals (54.6%) were in the intervention group. Both groups were similar in almost all characteristics at baseline, and the median (IQR) follow-up was 6.4 (6.0-6.7) years. Participants attending a high-performing public charter high school had a 53.33% lower rate of hazardous or dependent alcohol use disorder compared with those in the control group (5.43% vs 11.64%; difference, -6.21% [95% CI, -11.87% to -0.55%]; P = .03). Among male participants, the intervention group had a 42.05% lower rate of self-reported fair or poor physical health (13.33% vs 23.01%; difference, -9.67% [95% CI, -18.30% to -1.05%]; P = .03) and a 32.94% lower rate of obesity or overweight (29.28% vs 43.67%; difference, -14.38% [95% CI, -25.74% to -3.02%]; P = .02) compared with the control group. Among female participants, attending a high-performing public charter high school was associated with worse physical health outcomes (30.29% vs 13.47% reporting fair or poor health; difference, 16.82% [95% CI, 0.36% to 33.28%]; P = .045) and higher rates of overweight or obesity (52.20% vs 32.91%; difference, 19.30% [95% CI, 3.37% to 35.22%]; P = .02) at age 21 years. Few differences in mental health outcomes were observed. Adjusting for educational outcomes did not significantly change these findings. Results of this study suggest that attending a high-performing public charter high school was associated with lower rates of substance use disorder independent of academic achievement. Physical health and obesity outcomes were also better but only for young men; the intervention group had worse physical health outcomes among young women for unclear reasons. Schools are a potent social determinant of health and an important target for future health interventions.

Water insecurity, self-reported physical health, and objective measures of biological health in the Peruvian Amazon.

This study examines the associations between water insecurity, self-reported physical health, and objective measures of biological health among 225 Awajún adults (107 women; 118 men) living in the Peruvian Amazon, a "water-abundant" region. A survey, which included multiple measures of self-reported physical health, and objective measures of biological health such as blood pressure and nutritional and immune biomarkers. Greater water insecurity was associated with multiple measures of self-reported physical health, including higher incidence of reported diarrhea, nausea, back pain, headaches, chest pain, fatigue, dizziness, overall poor perceived health, and "being sick." These symptoms align with the physical strain associated with water acquisition and with drinking contaminated water. A significant association between higher water insecurity and lower systolic blood pressure emerged, which may be linked to dehydration. None of the other biomarkers, including those for nutrition, infection, and stress were significantly associated with water insecurity scores. These analyses add to the growing body of research examining the associations between water insecurity and health. Biocultural anthropologists are well-positioned to continue probing these connections. Future research will investigate relationships between measures of water insecurity and biomarkers for gastrointestinal infection and inflammation in water-scarce and water-abundant contexts.