Suboptimal Self-rated Health Research Articles

Adverse Childhood Experiences and Suboptimal Self-Rated Health in Adulthood: Exploring Effect Modification by Age, Sex and Race/Ethnicity.

This study examined whether the relationship between adverse childhood experiences (ACEs) and self-rated health among adults in a nationally representative population is modified by age, sex, or race/ethnicity. Cross-sectional study. United States. Data from the 2020 and 2021 Behavioral Risk Factor Surveillance System were obtained from 185731 (weighted N = 47862016) persons 18years or older. The ACE cumulative score (range: 0-11) was calculated using 11 questions about childhood emotional abuse, physical abuse, sexual abuse, and household dysfunction before age 18 and classified as 0 (reference), 1, 2, 3, or ≥4. Self-rated health was divided into (excellent/very good/good [reference]) and suboptimal (fair/poor) categories. Multivariable-adjusted logistic regression was conducted to test for the interaction with age, sex, and race/ethnicity with ACEs. After adjustment for potential confounders, an increasing number of ACEs had statistically significantly higher odds of suboptimal self-rated health in a graded manner except for 1 ACE (1 ACE: aOR:1.09; 95% CI: 1.00-1.20, 2 ACEs: 1.16; 1.03-1.30, 3 ACEs: 1.17; 1.03-1.32 and ≥4 ACEs: 1.39; 1.26-1.53). There was a significant interaction between ACEs and age. Younger age (18-24years) had the strongest association for ≥4 ACEs compared to the older age groups. There was no effect modification by sex or race. ACEs should be considered when creating health-promoting interventions to improve health.

Self-rated health is an independent predictor of subsequent late mortality after blood or marrow transplantation: A Blood or Marrow Transplant Survivor Study report.

The prevalence of suboptimal self-rated health (SRH) and its association with subsequent all-cause and cause-specific mortality after blood or marrow transplantation (BMT) were examined. Study participants were drawn from the multicenter Blood or Marrow Transplant Survivor Study, and included patients who were transplanted between 1974 and 2014 and had survived ≥2 years after BMT. Participants (aged ≥18 years) completed a survey at a median of 9 years from BMT, and were followed for a median of 5.6 years after survey completion. Survivors provided information on sociodemographic factors, chronic health conditions, health behaviors, and SRH (a single-item measure rated as excellent, very good, good, fair, or poor; excellent, very good, and good SRH were classified as good SRH, and fair and poor were classified as suboptimal SRH). The National Death Index Plus and Accurint databases and medical records provided vital status through December 2021. Of 3739 participants, 784 died after survey completion (21%). Overall, 879 BMT survivors (23.5%) reported suboptimal SRH. Pain, low socioeconomic status, psychological distress, lack of exercise, severe/life-threatening chronic health conditions, post-BMT relapse, obesity, smoking, and male sex were associated with suboptimal SRH. BMT survivors who reported suboptimal SRH had a 1.9-fold increased risk of all-cause mortality (95% confidence interval [CI],1.6-2.3), 1.8-fold increased risk of recurrence-related mortality (95% CI,1.4-2.5), and 1.9-fold increased risk of non-recurrence-related mortality (95% CI, 1.4-2.4) compared to those who reported good SRH. This single-item measure could help identify vulnerable subpopulations who could benefit from interventions to mitigate the risk for subsequent mortality.

Self-rated health and its bidirectional relationship with burnout, sleep quality and somatic symptoms in a general adult population

The aim of this study was to investigate how self-rated health (SRH) reflects ongoing ill-health and how SRH is associated with previous ill-health and/or predicts future ill-health such as burnout, disturbed sleep, and somatic symptoms. The study used two waves from the population-based Västerbotten Environmental and Health Study in which 2 336 adult persons participated by answering a questionnaire at two time points three years apart. Hierarchical and logistic regression analyses were conducted, thus treating all variables both continuously (degree) and categorically (case). The analyses were performed both cross-sectionally and longitudinally. The results showed bidirectionality between suboptimal SRH and burnout, disturbed sleep and somatic severity caseness. Moreover, degree of poor SRH was more likely to occur simultaneously to high degrees of burnout and somatic severity than to degree of poor sleep quality. Also, caseness of burnout, disturbed sleep and somatic severity increased the risk of simultaneous suboptimal SRH. Finally, the results showed that degree of burnout three years earlier, predicted degree of poor SRH, and that degree of poor SRH predicted degree of sleep three years later. In conclusion, in a population-based, normal adult sample there is a bidirectional relationship between suboptimal SRH and caseness of burnout, disturbed sleep quality and somatic symptoms, but not between degree of these symptoms. The results can have implications for health care meeting patients complaining about poor general health.

Association between modifiable lifestyle pattern and periodontitis: a cross-sectional study based on NHANES

BackgroundPeriodontitis can be avoided with a healthy lifestyle. However, studies have only looked at one lifestyle, ignoring the connection between lifestyle patterns and periodontitis. The purpose of this study was to look at the association between modifiable lifestyle patterns and periodontitis.MethodsData were obtained from the National Health and Nutrition Examination Survey in 2009–2010 and 2011–2012. Smoke, drink, exercise, sleep duration, oral exams, and self-rated oral health were all lifestyle factors. The CDC/AAP classification/case definition was used to evaluate periodontitis. Drawing upon latent class analysis, distinct patterns of lifestyle were identified, with each participant exclusively affiliated with a single pattern. The association between lifestyle classes and periodontitis was then examined using ordinal logistic regression.Results4686 (52%) of the total 9034 participants, with a mean age of 54.08, were women. Three lifestyle latent classes were found by fitting 2–10 models: “Class 1” (52%), " Class 2” (13%), and " Class 3” (35%). The “Class 1” displayed a prevalence of oral examination (75%), favorable self-rated oral health (92%), and engagement in physical activity (50%). The ‘Class 2’ exhibited the lowest alcohol consumption (64%) and smoking rates (73%) but the highest prevalence of physical inactivity (98%). The ‘Class 3’ showed a tendency for smoking (72%), alcohol consumption (78%), shorter sleep duration (50%), absence of oral examinations (75%), and suboptimal self-rated oral health (68%). The influencing variables for the latent classes of lifestyle were age, education, and poverty level. Periodontitis risk may rise by 24% for each additional unhealthy lifestyle practiced by participants (OR = 1.24, 95% CI: 1.18–1.31). The ‘Class 3’ (OR = 1.80, 95% CI: 1.52–2.13) had a greater risk of periodontitis compared to the ‘Class 1’.ConclusionsOur analysis revealed that unhealthy lifestyle patterns are associated with periodontitis. These different lifestyle patterns need to be taken into account when developing public health interventions and clinical care.

Lifetime exposure to unemployment and prior working conditions are associated with retiree's health: A retrospective study in a large population-based French cohort

It is unclear whether unemployment exposure, as well as working conditions, can have sustained effects on the health of retirees who are no longer exposed. The aim of the present study is to investigate this issue in 29,281 French retirees from the CONSTANCES cohort in whom the prevalence of suboptimal self-rated health, disability for routine tasks, cardiovascular diseases and cancers is assessed according to lifetime exposure to unemployment and prior working conditions. The analyses are performed retrospectively using multivariable logistic regression models with adjustment for potential confounders such as sex, birth year, parental histories of cardiovascular disease and cancer, social position, retirement age and duration. High lifetime exposure to unemployment is associated with an increased prevalence of suboptimal self-rated health (adjusted odds ratio (95% CI), 1.39 (1.23–1.57)), disability for routine tasks (1.41 (1.26–1.57)) and several cardiovascular diseases including stroke (1.66 (1.19–2.31)), myocardial infarction (1.65 (1.18–2.31)) and peripheral arterial disease (2.38 (1.46–3.90)). Bad prior working conditions are associated with an increased prevalence of disability for routine tasks (1.17 (1.04–1.33)) and cancers (1.27 (1.04–1.54)), notably prostate cancer (1.60 (1.01–2.64)). These findings suggest that unemployment and working conditions have long-term health effects that may cumulate over lifetime, emphasizing that risk evaluation and preventive strategies in retirees, as in workers, should take into account the life-course of individuals in addition to traditional risk factors.

Associations between commute mode use and self-rated health and work ability among Finnish public sector employees.

To determine the extent to which level of active commute mode use is associated with self-rated health and work ability. The data were sourced from the Finnish Public Sector Study survey in 2020 (n = 38,223). The associations between active commuting - assessed with the frequency of using active commute modes - and self-rated health and work ability were examined with negative binomial regression analyses. Passive commuting and low-to-moderate levels of active commuting were compared with active commuting, and the models were adjusted for sociodemographic factors, working time mode, and lifestyle risk factors. We also assessed separate associations between walking and cycling as a mode of commuting by additionally considering the commuting distance and the outcomes. After adjustment, when using active commuters as a reference, passive commuters had a 1.23-fold (95% confidence intervals (CI) 1.19 to 1.29) risk of suboptimal self-rated health and a 1.18-fold (95% CI 1.13 to 1.22) risk of suboptimal work ability. More frequent and/or longer distance by foot and especially by bicycle, was positively associated with health and work ability. Never commuting by bicycle was associated with a 1.65-fold (95% CI 1.55 to 1.74) risk of suboptimal health and a 1.27-fold (95% CI 1.21 to 1.34) risk of suboptimal work ability when using high-dose bicycle commuting as a reference. Passive commuting was associated with suboptimal self-rated health and suboptimal work ability. Our results suggest that using active commute modes, particularly cycling, may be beneficial for employee health and work ability.

Can a Single General Self-Rated Health Question Mirror Social Determinant of Health?

Self-rated health (SRH) indicator is widely used and recommended in health research as a standard indicator for measuring health in different populations. This paper reports SRH of employees at Tehran University of Medical Sciences (TUMS), Tehran, Iran; and its related factors. We used the TUMS Employee's Cohort Study (TEC) data, collected from September 2017 to August 2019. SRH of 2158 employees were assessed using a single question. Univariate and multivariate logistic regression were performed to determine factors associated with sub-optimal SRH. Overall, 14.9% (n = 321) of respondents rated their health as sub-optimal. Differences were observed with subgroups. Women, lower socioeconomic status (SES), experiences of more economic fluctuation conditions and lower reading scores could predict sub-optimal SRH variations in crude and adjusted regression analyses. The age, social capital, work experience and employment status could predict sub-optimal SRH variations only in crude regression analyses (P<0.05). Differences in SRH report reflected differences in socioeconomic conditions. The biggest gap was observed between people of different SES (five times). Considering that SRH reflected socioeconomic characteristics of individuals, it may be considered as a quick, non-expensive, and simple way of identifying groups in need of addressing their social determinants of health.

Independent and joint effects of sleep duration and sleep quality on suboptimal self-rated health in medical students: A cross-sectional study.

ObjectiveStudies on the association between sleep behavior and health often ignored the confounding effects of biorhythm-related factors. This study aims to explore the independent and joint effects of sleep duration and sleep quality on suboptimal self-rated health (SRH) in medical students.MethodsCross-sectional study. Proportional stratified cluster sampling was used to randomly recruit students from various medical specialties at a medical university in eastern China. Our questionnaire mainly included information on basic demographic characteristics, SRH, sleep behavior, and biorhythm-related factors. The independent and joint effects of sleep duration and sleep quality on suboptimal SRH were assessed by logistic regression after controlling for potential confounders.ResultsOf 1,524 medical students (mean age = 19.9 years, SD = 1.2 years; 59.1% female), 652 (42.8%) had suboptimal SRH. Most medical students (51.5%) slept for 7 h/night, followed by ≥8 (29.1%) and ≤ 6 h (19.4%). After adjusting for basic demographic characteristics and biorhythm-related factors, compared with students who slept for ≥8 h/night, the adjusted ORs (95%CI) for those who slept 7 and ≤ 6 h/night were 1.36 (1.03, 1.81) and 2.28 (1.60, 3.26), respectively (P < 0.001 for trend); compared with those who had good sleep quality, the adjusted ORs (95%CI) for those who had fair and poor sleep quality were 4.12 (3.11, 5.45) and 11.60 (6.57, 20.46), respectively (P < 0.001 for trend). Further, compared with those who slept for ≥8 h/night and good sleep quality, those who slept ≤ 6 h and poor sleep quality had the highest odds of suboptimal SRH (OR 24.25, 95%CI 8.73, 67.34).ConclusionsShort sleep and poor sleep quality were independently and jointly associated with higher odds of suboptimal SRH among medical students.

Investigating Self-rated Health Among Health Workers During COVID-19 Pandemic in Northwest Iran

Background: Health promotion among health workers requires appropriate evidence of relevant determinants. Objective: This study was conducted to investigate the relationship between mental health and its measured covariates with self-rated health (SRH) among health workers during the COVID-19 pandemic in northwest Iran. Methods: In this cross-sectional study, we recruited 569 health workers from three educational hospitals of Qazvin University of Medical Sciences, Iran. From July 1 to September 5 (2020), participants were asked to provide demographic and clinical information and to complete the symptom checklist 90 (SCL-90) questionnaire. The relationship between suboptimal SRH with each of the SCL-90 domains and measured covariates were analyzed using logistic regression models. Findings: The Mean±SD age of participants was 34.73(7.95) years. A total of 148 health workers (26%) reported their suboptimal SRH, which was higher in women (odds ratio [OR]: 1.98; 95% confidence interval [CI]: 1.21, 3.24), as well as among participants without physical activity (OR: 2.14; 95% CI: 1.35, 3.39). Depression (OR: 2.13; 95% CI: 1.64, 2.77) and anxiety (OR: 3.76; 95% CI: 2.78, 5.09) showed significantly higher odds of suboptimal SRH. Also, other SCL-90 domains indicated a positive association with suboptimal SRH during the COVID-19 pandemic. Conclusion: Mental health, gender, and physical activity were significant variables related to SRH. The current findings suggest that we should pay attention to mental health problems and other important covariates during the COVID-19 epidemic. Hence, policymakers should consider this issue in health promotion programs for health workers.

Predictive capacity of self-rated health on all-cause mortality in Spain: differences across sex, age and educational level

BackgroundPublished evidence on self-rated health’s capacity to predict mortality and its variability across subpopulations lacks consistency. Our objective is to evaluate this predictive association and whether/how it varies by sex,...

Does working beyond the statutory retirement age have an impact on health and functional capacity? The Finnish Retirement and Aging cohort study

ObjectiveThis study aimed to compare the development of self-rated health, psychological distress and physical functioning between those retired on time and those who continued working beyond the individual retirement age.MethodsThe...

The role of mental health, academic stress, academic achievement, and physical activity on self-rated health among adolescents in Iran: A multilevel analysis.

BACKGROUND:Health promotion of adolescents requires appropriate evidences of its determinants. The aim of this study was to investigate predictors of self-rated health (SRH) among adolescents in Qazvin, Iran.MATERIALS AND METHODS:In this descriptive cross-sectional study, with a multistage sampling method, we recruited 1740 adolescents aged 12–19 years from 53 schools in Qazvin, Iran (2018). We used the Strengths and Difficulties Questionnaire and Adolescents’ Academic Stress Questionnaire for data collection. The analysis was conducted using a multilevel logistic regression model. Gender, educational period, and socioeconomic status were considered as confounders.RESULTS:Almost 21% of the adolescents reported their SRH suboptimal. Suboptimal SRH was higher in girls and older adolescents. Mental health disorders and academic stress had a positive association with SRH. However, this association was negative for academic achievement and physical activity. The interaction between mental health disorders and academic stress with SRH had a significant association in a crud regression model.CONCLUSION:Mental health, academic stress, academic achievement, and physical activity were important predictors for SRH. Interventions that focus on promoting mental health, academic stress, academic achievement, and physical activity such as physical activity for 1 h and each day for 3 days per week can improve SRH in adolescents. Hence, policymakers should pay more attention to this issue in health promotion programs of adolescents.

Repeated exposure to high ICT demands at work, and development of suboptimal self-rated health: findings from a 4-year follow-up of the SLOSH study

PurposeThe knowledge about the association between Information and Communication Technology (ICT) demands at work and self-rated health (SRH) is insufficient. The aim of this study was to examine the association between repeated exposure to high ICT demands at work, and risk of suboptimal SRH, and to determine modifications by sex or socioeconomic position (SEP).MethodsA prospective design was used, including repeated measurement of ICT demands at work, measured 2 years apart. SRH was measured at baseline and at follow-up after 4 years. The data were derived from the Swedish Longitudinal Occupational Survey of Health (SLOSH), including 4468 gainfully employees (1941 men, 2527 women) with good SRH at baseline.ResultsIn the total study sample, repeated exposure to high ICT demands at work was associated with suboptimal SRH at follow-up (OR 1.34 [CI 1.06–1.70]), adjusted for age, sex, SEP, health behaviours, BMI, job strain and social support. An interaction between ICT demands and sex was observed (p = 0.010). The risk was only present in men (OR 1.53 [CI 1.09–2.16]), and not in women (OR 1.17 [CI 0.85–1.62]). The risk of suboptimal SRH after consistently high ICT demands at work was most elevated in participants with high SEP (OR 1.68 [CI 1.02–2.79]), adjusted for age, sex, health behaviours, BMI and job strain. However, no significant interaction between ICT demands and SEP regarding SRH was observed.ConclusionRepeated exposure to high ICT demands at work was associated with suboptimal SRH at follow-up, and the association was modified by sex.

Can a poor psychosocial work environment and insufficient organizational resources explain the higher risk of ill-health and sickness absence in human service occupations? Evidence from a Swedish national cohort.

The aim of this study was to investigate differences in burnout, self-rated health (SRH) and sickness absence between human service occupations (HSOs) and other occupations, and whether they can be attributed to differences in psychosocial work environment and organizational resources. Data were derived from the Swedish Longitudinal Occupational Survey of Health, an approximately representative sample of the Swedish working population ( n = 4408). Employment in HSOs, psychosocial work environment and organizational resources in 2012 predicted relative risks of sickness absence, burnout and suboptimal SRH in 2014 using modified Poisson regressions. The psychosocial work factors' and organizational resource variables' relative importance were estimated by adding them to the models one by one, and with population attributable fractions (PAFs). Employment in HSOs was associated with a higher risk of sickness absence and the risk was explained by psychosocial and organizational factors, particularly high emotional demands, low work-time control and exposure to workplace violence. Employment in HSOs was not associated with burnout after sociodemographic factors were adjusted for, and furthermore not with SRH. A lower risk of suboptimal SRH was found in HSOs than in other occupations with equivalent psychosocial work environment and organizational resources. PAFs indicated that psychosocial work environment and organizational resource improvements could lead to morbidity reductions for all outcomes; emotional demands were more important in HSOs. HSOs had higher risks of sickness absence and burnout than other occupations. The most important work factors to address were high emotional demands, low work-time control, and exposure to workplace violence.

Mental well-being and job satisfaction among general practitioners: a nationwide cross-sectional survey in Denmark

BackgroundPoor mental well-being and low job satisfaction among physicians can have significant negative implications for the physicians and their patients and may also reduce the cost efficiency in health care. Mental distress is increasingly common in physicians, including general practitioners (GPs). This study aimed to examine mental well-being and job satisfaction among Danish GPs and potential associations with age, gender and practice organisation.MethodsData was collected in a nationwide questionnaire survey among Danish GPs in 2016. Register data on GPs and their patient populations was used to explore differences between respondents and non-respondents. Associations were estimated using multivariate logistic regression analysis.ResultsOf 3350 eligible GPs, 1697 (50.7%) responded. Lower response rate was associated with increasing numbers of comorbid, aging or deprived patients. About half of participating GPs presented with at least one burnout symptom; 30.6% had high emotional exhaustion, 21.0% high depersonalisation and 36.6% low personal accomplishment. About a quarter (26.2%) experienced more than one of these symptoms, and 10.4% experienced all of them. Poor work-life balance was reported by 16.2%, low job satisfaction by 22.1%, high perceived stress by 20.6% and poor general well-being by 18.6%. Constructs were overlapping; 8.4% had poor overall mental health, which was characterized by poor general well-being, high stress and ≥ 2 burnout symptoms. In contrast, 24.6% had no burnout symptoms and reported high levels of general well-being and job satisfaction. Male GPs more often than female GPs reported low job satisfaction, depersonalisation, complete burnout and poor overall mental health. Middle-aged (46–59 years) GPs had higher risk of low job satisfaction, burnout and suboptimal self-rated health than GPs in other age groups. GPs in solo practices more often assessed the work-life balance as poor than GPs in group practices.ConclusionThe prevalence of poor mental well-being and low job satisfaction was generally high, particularly among mid-career GPs and male GPs. Approximately 8% was substantially distressed, and approximately 25% reported positive mental well-being and job satisfaction, which shows huge variation in the mental well-being among Danish GPs. The results call for targeted interventions to improve mental well-being and job satisfaction among GPs.

Lack of supportive leadership behavior predicts suboptimal self-rated health independent of job strain after 10years of follow-up: findings from the population-based MONICA/KORA study.

Emerging cross-sectional research has identified lack of supportive leadership behavior (SLB) as a risk factor for workforce health. However, prospective evidence is hitherto lacking. SLB denotes support in difficult situations, recognition and feedback on work tasks. This study aims to determine the effect of SLB on suboptimal self-rated health (SRH) after 10years considering potential moderators such as ages, sex, occupation and job strain. The sample included 884 employed participants drawn from the population-based prospective MONICA/KORA Study. SLB, SRH, as well as job strain were assessed by questionnaire. Logistic regressions estimated odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for the effect of SLB at baseline on suboptimal SRH at follow-up. Analyses were adjusted for age, gender, lifestyle (alcohol, smoking, physical activity), socioeconomic status as well as for SRH and job strain at baseline. Lack of SLB was associated with suboptimal SRH at baseline [OR 2.00, (95% CI 1.19-3.46)] and at follow-up [OR 2.33, (95% CI 1.40-3.89)]. Additional adjustment for job strain did not substantially alter this association [OR 2.06, (95% CI 1.20-3.52)]. However, interactions between SLB and job strain as well as gender became evident, indicating moderating influences on the association between SLB and SRH. Lack of supportive leadership was associated with suboptimal SRH at 10 years' follow-up in men, even if SRH at baseline and other risk factors were taken into account. This effect is likely to be moderated by job strain.

Elevated Mortality and Associated Social Determinants of Health in a Community-Based Sample of People Living with HIV in Ontario, Canada: Findings from the Positive Spaces, Healthy Places (PSHP) Study

We examined social determinants of health associated with all-cause mortality among 602 people living with HIV/AIDS in Ontario, Canada. Mortality status was verified at 1-, 3-, and 5-year follow-up visits with information obtained from proxies (family members, partners, and friends), obituaries, and local AIDS memorial lists. Of the 454 people for whom mortality information was available, 53 individuals died yielding a crude mortality rate of 22.3 deaths per 1000 person-years, a rate substantially higher than the rate in the general population (6.8 per 1000 population). Experiencing both homelessness and incarceration independently predicted high risk of mortality among men who have sex with men (MSM) while suboptimal self-rated general health at previous visit predicted higher greater risk of mortality in both MSM and women and heterosexual men. Homelessness and incarceration may contribute to HIV disease progression and mortality. Intensive case management that increases retention in care and facilitates linkage to housing services may help to reduce excess deaths among people with HIV.

Changes in Sleep Difficulties During the Transition to Statutory Retirement.

This study examined changes in sleep during the transition from full-time work to statutory retirement. Both the prevalence of any sleep difficulty and the prevalence of specific sleep difficulties, such as difficulties falling asleep, difficulties maintaining sleep, waking up too early in the morning, and nonrestorative sleep, were examined. Data from the Finnish Public Sector study were used. The study population consisted of 5,807 Finnish public sector employees who retired on statutory basis between 2000 and 2011. The participants responded on the Jenkins Sleep Problem Scale Questionnaire before and after retirement in surveys conducted every 4 years. At the last study wave before retirement, 30% of the participants had sleep difficulties. Prevalence of any sleep difficulty decreased during the retirement transition: the risk ratio (RR) for having sleep difficulties in the first study wave following retirement compared with the last study wave preceding retirement was 0.89 (95% confidence interval [CI] 0.85-0.94). During the retirement transition, both waking up too early in the morning (RR = 0.76, 95% CI 0.69-0.82) and nonrestorative sleep (RR = 0.47, 95% CI 0.42-0.53) decreased, whereas there was no change in difficulties falling asleep or difficulties maintaining sleep. The decreases in sleep difficulties occurred primarily among those with psychological distress, suboptimal self-rated health, short sleep duration, and job strain before retirement. These longitudinal data suggest that transition to statutory retirement is associated with a decrease in sleep difficulties, especially waking up too early in the morning and nonrestorative sleep.

Patterns of marijuana and tobacco use associated with suboptimal self-rated health among US adult ever users of marijuana.

The purpose of this study was to examine the patterns of marijuana and tobacco use and their associations with suboptimal self-rated health (SRH) among US adults who reported “ever, even once, using marijuana or hashish.”Data came from the 2009–2012 National Health and Nutrition Examination Survey, restricting to respondents aged 20 years and older who reported using marijuana at least once in their lifetime (n = 3,210). We assessed the age-adjusted prevalence of mutually exclusive groups of regular (at least once a month for more than one year) and non-regular marijuana smoking by current (serum cotinine ≥ 3.08 ng/mL) and not current use of tobacco. Suboptimal SRH status was defined as “fair” or “poor” in response to the question “Would you say that in general your health is excellent, very good, good, fair, or poor?” We produced prevalence ratios with multivariable log-linear regression models.Among ever users of marijuana, the age-adjusted prevalence of regular marijuana smoking with current tobacco use, non-regular marijuana smoking with current tobacco use, and regular marijuana smoking without current tobacco use was 24.7%, 15.2%, and 21.1%, respectively. When compared to non-regular marijuana smokers without current tobacco use, the adjusted prevalence ratio for reporting suboptimal SRH was 1.98 (95% CI: 1.50–2.61), 1.82 (95% CI: 1.40–2.37), and 1.34 (95% CI: 1.05–1.69), respectively.In conclusion, among adult ever users of marijuana, current tobacco use is high and strongly associated with suboptimal SRH; regular marijuana smoking with or without current tobacco use is significantly associated with suboptimal SRH.

Body mass index as a predictor of healthy and disease-free life expectancy between ages 50 and 75: a multicohort study

Background:While many studies have shown associations between obesity and increased risk of morbidity and mortality, little comparable information is available on how body mass index (BMI) impacts health expectancy. We examined associations of BMI with healthy and chronic disease-free life expectancy in four European cohort studies.Methods:Data were drawn from repeated waves of cohort studies in England, Finland, France and Sweden. BMI was categorized into four groups from normal weight (18.5–24.9 kg m−2) to obesity class II (⩾35 kg m−2). Health expectancy was estimated with two health indicators: sub-optimal self-rated health and having a chronic disease (cardiovascular disease, cancer, respiratory disease and diabetes). Multistate life table models were used to estimate sex-specific healthy life expectancy and chronic disease-free life expectancy from ages 50 to 75 years for each BMI category.Results:The proportion of life spent in good perceived health between ages 50 and 75 progressively decreased with increasing BMI from 81% in normal weight men and women to 53% in men and women with class II obesity which corresponds to an average 7-year difference in absolute terms. The proportion of life between ages 50 and 75 years without chronic diseases decreased from 62 and 65% in normal weight men and women and to 29 and 36% in men and women with class II obesity, respectively. This corresponds to an average 9 more years without chronic diseases in normal weight men and 7 more years in normal weight women between ages 50 and 75 years compared to class II obese men and women. No consistent differences were observed between cohorts.Conclusions:Excess BMI is associated with substantially shorter healthy and chronic disease-free life expectancy, suggesting that tackling obesity would increase years lived in good health in populations.