Waves Of Survey Research Articles

Norms for the EQ-5D-5L among the general adult population in Alberta, Canada.

To present EQ-5D-5L population norms for the general adult population in Alberta, Canada. We analyzed data from 11 population-based surveys conducted in Alberta between 2012 and 2021. By applying appropriate sampling weights, we estimated normative data for the EQ-5D-5L dimensions, index scores, and visual analogue scale (VAS) scores. This analysis was conducted for the overall population as well as for subgroups categorized by age, sex, provincial health zones, and 17 chronic conditions. The analysis included data from 60,447 respondents (ages 18-99; 51.4% female) across various survey waves, revealing minimal variations in sample characteristics and EQ-5D-5L scores over time. The most frequently reported problems were pain/discomfort (62.2%) and anxiety/depression (41.7%), while 22.5% of respondents reported no issues on any dimension. The mean (SD) EQ-5D-5L index score was 0.845 (0.137), and the mean EQ VAS score was 77.4 (16.7). There was a notable increase in the proportion of reported problems across all dimensions with age, except for anxiety/depression, which showed a decline with advancing age. Females reported slightly more problems across all dimensions compared to males. Individuals with chronic pain had the lowest EQ-5D-5L index scores, followed by those with anxiety and depression, while the lowest EQ VAS scores were observed in individuals with congestive heart failure, kidney disease, and chronic obstructive pulmonary disease. This study provides EQ-5D-5L norms for the adult population in Alberta. These reference values can be used to benchmark patients' outcomes as well as to establish burden of illness in this population and facilitate the interpretation of EQ-5D-5L scores in various applications.

Pre-disaster income inequality and post-disaster mental health: A natural experiment from the 2011 Great East Japan Earthquake and Tsunami

BackgroundWe sought to test the hypothesis that communities with a high degree of income inequality are ill-equipped to deal with crises. Specifically, we tested whether pre-disaster higher income inequality increases the risk of worse mental health conditions in the aftermath of disaster. MethodsWe examined the association between pre-disaster community income inequality and post-disaster mental health outcomes in a prospective cohort study of older adults (≥65 years) who survived the 2011 Great East Japan Earthquake. The baseline survey of participants (completed in 2010) predated the disaster by seven months. Survivors completed three waves of post-disaster surveys in 2013, 2016, and 2019. To assess the level of income inequality, the Gini index was calculated using individual income data in 2010 aggregated to 98 communities (range 0.05–0.50: median = 0.32) and categorized into tertiles (low, middle, high). Depressive symptoms and post-traumatic stress symptoms (PTSS) were assessed in the three post-disaster surveys using validated instruments. Multilevel analysis was conducted adjusting for pre-disaster characteristics. ResultsHigher levels of community income inequality were associated with higher PTSS scores across time (2013: β = 0.14, 95%CI = −0.01, 0.29; 2016: β = 0.16, 95%CI = 0.03, 0.29; 2019: β = 0.12, 95%CI = −0.01, 0.24). The association between income inequality and mental health was partly attenuated by adding the change in social capital to the model (2013: β = 0.14, 95%CI = -0.01, 0.29; 2016: β = 0.15, 95%CI = 0.03, 0.28; 2019: β = 0.11, 95%CI = -0.01, 0.22). ConclusionOur findings suggest that pre-disaster income inequality may explain PTSS symptoms in the aftermath of a disaster, and the relation may be mediated by disaster-related change. Further study to reveal its mechanism is needed for the policy recommendation.

Time Since Injury Is Key to Modeling Trends in Aging and Overall Functioning of Persons With Spinal Cord Injury: A Longitudinal Analysis of a Swiss Community Survey.

The aim of the study is to model the health indicator of functioning for persons with spinal cord injury or disorder living in Switzerland in the long-term context, considering chronological age, time since injury, and age at injury. This is a longitudinal analysis of three waves of a community survey. An interval-scaled functioning metric was constructed using modern test theory. Random effects within-between mixed models were used to investigate trends in functioning over time. Persons with complete injuries have lower levels of functioning than persons with incomplete injuries, and persons with complete tetraplegia have the lowest levels of functioning. The person's age when injured, the level and completeness of the injury, the presence of secondary health conditions, and various combinations of these factors significantly influenced how functioning changed over time. Our study shows that chronological age is not necessarily the best time variable for understanding the aging process of people with spinal cord injury in terms of changes in functioning over time and that modeling functioning over time since injury provides important insights into how functioning of people with complete or incomplete injuries declines with increasing time living with the injury.

Household structure and dietary diversity among older adults in rural and urban China: a cross-sectional study

BackgroundHousehold structure can significantly affect older adults’ eating behaviours and diet quality. However, the difference in dietary diversity in various household structures in urban and rural has rarely been investigated. This study aimed to investigate the association between household structure and dietary diversity among older Chinese adults and examine whether the association differed by urban and rural.MethodsThe study used data from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The participants were individuals aged 60 and over with available dietary and household structure data. Dietary diversity was defined as ‘high’ if respondents had a dietary diversity score (DDS) above the mean value. Household structures were classified into four mutually exclusive categories: (1) living alone; (2) spouse only; (3) at least with a great/grandchild(ren); (4) non-empty-nested. Binary logistic regression was applied to investigate the association between household structures and dietary diversity.ResultsNon-empty-nested older adults had the highest probability (OR = 1.64, 95% CI = 1.44–1.87) of having high dietary diversity. People who only lived with their spouse and at least lived with a great/grandchild(ren) were 1.45 (OR = 1.45, 95% CI = 1.23–1.71) and 1.23 (OR = 1.23, 95% CI = 1.08–1.41) times as likely to have diverse diets than older adults who lived alone. The difference in dietary diversity among various household structures is more evident in urban than rural areas. Solo-living older adults were the most disadvantaged regarding dietary diversity in urban and rural areas.ConclusionsHousehold structures are significantly associated with dietary diversity among older Chinese adults aged 60 years and over. The findings emphasise the need to reduce nutritional inequality, encourage dietary diversity, and consider both the household structures and residences when providing health intervention programs to the older population.

The effects of environmental innovations on labor productivity: how does it pay to be green

ABSTRACT Due to growing environmental concerns, environmental innovations (EIs) have gained prominence in firms’ strategies. This study delves into the productivity effects of regulation-driven environmental innovations using data from four Finnish Community Innovation Survey (CIS) waves. Instrumental variable estimation controls for the endogeneity of voluntary and regulation-driven EIs in a novel way. Our results support the prior findings on the strong Porter hypothesis that environmental regulation improves performance. However, the results also hint at a delay before environmental innovations translate into higher productivity. We also find that regulation-driven EIs improve performance in services. Small firms do not benefit relatively less, although they are inclined to do fewer voluntary EIs. Environmental regulation may favor firms in the Nordic context due to firms being close to the industry frontier.

Psychological Distress Changes During COVID-19: A Belgian Cohort Study On Psychosocial Factors

Abstract Longitudinal studies have identified an increase in psychological distress across the general population during the COVID-19 pandemic. Nevertheless, the trajectories of mental health outcomes exhibit variations, suggesting potential associations with psychosocial individual factors. This paper identifies the factors of this individual trajectory of psychological distress during the COVID-19 pandemic. Five waves of a prospective cohort survey were conducted with a convenience sample of the general population in Belgium between March 2020 and November 2021 (n = 4,550). Psychological distress was measured using the GHQ-12. Individual covariates included socioeconomic factors (age, gender, level of education), psychological factors (loneliness, social support, and social activities), and factors related to the virus and the lockdown measures (exposure to COVID-19 and survey wave). Multilevel models were used for analysis. Women and young people experienced more pronounced fluctuations in their risk of psychological distress across study waves, experiencing both increases and decreases. We found that individual variance in psychological distress breaks down into two components, respectively 43% for psychosocial factors (time-invariant) and 57% for the survey waves (time-variant) variation. A significant share of the time-invariant difference in psychological distress over COVID-19 is associated with loneliness, social support, and social activities. Loneliness emerged as the most important interpersonal factor associated with psychological distress. The change in psychological distress was mainly associated with psychosocial factors rather than with pandemic-related dynamics (e.g. survey waves). These findings suggest that mitigation policies aiming at controlling the pandemic should focus more on addressing specific individual vulnerabilities rather than solely responding to the fluctuations within pandemic waves to decrease their detrimental impact on mental health.

Exploring anxiety and depression trends: insights from the BELHEALTH cohort 2022-2024 in Belgium

Abstract Background The swift impact of the COVID-19 pandemic and ensuing restrictions on the mental health of the Belgian population prompted the need for a sustainable system to monitor its evolution. Repeated COVID-19 surveys were conducted between 2020 and 2022 to address this issue, followed by the launch of the BELHEALTH cohort project. Our study aims to analyze the trajectory of anxiety and depression at the post-pandemic period, using data from five waves of the BELHEALTH longitudinal surveys from October 2022 to March 2024. High-risk groups and the potential of social support and resilience to mitigate anxiety and depression were explored. Methods The BELHEALTH follow-up cohort of around 7,300 Belgian residents uses online surveys to assess anxiety (with the GAD-7), and depression (with the PHQ-9). The analyses were performed using linear mixed models on the 3,676 individuals who participated in all five waves. Results Preliminary results indicated that more people were affected by anxiety in October 2022 (16%) compared to June 2023 (14%), while depression rates were lower in October 2022 (13%) compared to February 2023 (14%) and March 2024 (15%). However, the trajectory of mental health varied across demographic subgroups, with worse outcomes observed among unemployed and younger individuals, as well as those living alone, in the Walloon Region (South of Belgium). Overall, people with a low level of resilience or a low level of social support exhibited higher odds of experiencing depression. Conclusions Reducing these social inequities in mental health necessitates the development of structural prevention measures and interventions at the regional level. These measures should target factors such as unemployment, which is particularly prevalent among younger individuals and those living in Wallonia. Additionally, fostering protective factors such as social support and resilience is crucial for mitigating mental health inequalities over time. Key messages • Monitoring mental health and its determinants remains crucial to identify and address social inequities, tailor interventions, and support vulnerable populations. • Unemployed, younger people, and those residing in the Walloon region are at particular risk.

Socioeconomic inequalities in substance use among Norwegian adolescents between 2014 and 2022

Abstract Background Increasing use of substances is observed among adolescents in recent years. Early onset of substance use dramatically increases the risk of substance use disorder, dependence, and poorer psychological, social, and physical health, and is thus a public health concern. We explore trends in socioeconomic inequalities in past year use of cannabis and other illicit drugs between 2014 and 2022 among Norwegian adolescents. Methods This study is based on data retrieved from five waves of the nationwide Norwegian Ungdata survey (2014-2022) among adolescents attending upper secondary education (N = 282,259; 51 % girls). Trends in socioeconomic inequalities were assessed using the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). Results The use of cannabis and other illicit drugs increased among boys (from 13% to 19%, and from 2% to 5%, respectively) and girls (from 8% to 14%, and from 1% to 3%, respectively) between 2014 and 2022. Higher prevalence’s was observed among the least affluence girls between 2020 and 2022, both in absolute and relative terms (SII: 0.01 to 0.06, RII: 0.97 to 1.52, p < 0.001). No inequalities were observed among boys during this time. While relative and absolute inequalities in use of other illicit drugs decreased in boys, absolute inequalities increased in girls. Boys were more likely than girls to have used cannabis and other illicit drugs, although the gender gap in cannabis use narrowed slightly during the study period. Conclusions Our data suggest increasing use of cannabis and other illicit drugs among Norwegian adolescent boys and girls between 2014 and 2022. Future studies should examine the potential causes of increasing substance use as a basis for understanding, and distinguishing between, the many intertwining factors that influence adolescent drug use behaviors. Key messages • The use of cannabis and other illicit drugs increased between 2014 and 2022 among Norwegian boys and girls. • While inequalities in the use of cannabis and ither illicit drug use increased in girls, small or no inequalities was observed among boys.

Inequality of higher educational opportunity – the role of circumstances among the Jordanian people

ABSTRACT This paper investigates the role of background circumstances in shaping individuals’ opportunities in higher education in Jordan, for the whole population as well as for key subpopulations using both of the publicly available waves of the Jordan Labor Market Panel Survey (2010 and 2016). My findings suggest that higher education attainment and the mean years of completed education have expanded for the whole population, as well as for all subgroups. Unequal opportunities in higher education are relatively moderate in Jordan and are mainly explained by parental education, father’s occupation, and sector of work, with much less impact from gender, number of siblings, and the region of birth.

The connection between social capital and Chinese public health: an analysis of six Chinese general social surveys

This study examines the connection between social capital and the perceived health status for the Chinese public. Extending from previous research that uses unrepresentative samples, the current project analyzes nationally representative samples of approximately 60,000 respondents. The data are drawn from six waves of the Chinese General Social Survey conducted in 2010, 2012, 2013, 2015, 2017, and 2018, respectively. The multilevel regression approach is used for statistical estimation. Findings show a consistent pattern that social capital, encompassing social network and generalized trust, is positively related to one’s perceived health status across these years. In addition, the moderating impact of personal capital on the link between social capital and perceived health status is identified. Social capital has a greater health impact on those with lower personal capital than those with higher personal capital. This study complements current literature and has implications for public health policies.

Trends in non-daily cigarette smoking in England, 2006–2024

BackgroundCigarette smoking is incredibly harmful, even for people who do not smoke every day. This study aimed to estimate trends in non-daily smoking in England between 2006 and 2024, how these differed across population subgroups, and to explore changes in the profile of non-daily smokers in terms of their sociodemographic and smoking characteristics and vaping and alcohol consumption.MethodsData were collected monthly between November 2006 and April 2024 as part of a nationally representative, repeat cross-sectional survey of adults (≥ 18 years; n = 353,711). We used logistic regression to estimate associations between survey wave and non-daily smoking and used descriptive statistics to characterise the profile of non-daily smokers across 3-year periods.ResultsThe proportion who smoked non-daily was relatively stable between November 2006 and November 2013, at an average of 10.5% [10.1–10.9%] of cigarette smokers, then increased to 27.2% [26.0–28.4%] of cigarette smokers (4.0% [3.7–4.2%] of adults) by April 2024. This increase was particularly pronounced among younger adults (e.g. reaching 52.8%, 20.4%, and 14.4% of 18-, 45-, and 65-year-old cigarette smokers by April 2024) and those who vape (reaching 34.2% among vapers vs. 23.1% among non-vapers). Over time, there were reductions in non-daily smokers’ mean weekly cigarette consumption (from 34.3 in 2006–2009 to 21.1 in 2021–2024), urges to smoke (e.g. the proportion reporting no urges increased from 29.2 to 38.0%), and motivation to stop smoking (e.g. the proportion highly motivated to quit within the next 3 months decreased from 30.8 to 21.0%).ConclusionsAn increasing proportion of adults in England who smoke cigarettes do not smoke every day, particularly younger adults. Although non-daily smokers report smoking fewer cigarettes and weaker urges to smoke than they used to, which may make it easier for them to stop smoking, they appear to be decreasingly motivated to quit.

Comparing role of religion in perception of the COVID-19 vaccines in Africa and Asia Pacific

BackgroundIn the midst of the global COVID-19 vaccine distribution challenge, religion stands out as a key determinant of vaccine hesitancy and health choices. Notably, the multifaceted religious environments of Africa and the Asia Pacific remain under-researched in this context.MethodsUtilizing data from two survey waves conducted between 2021 and 2022, this cross-sectional study investigated the effects of religious beliefs on perceptions of compatibility between religion and vaccines and COVID-19 vaccine acceptance in Africa and Asia Pacific. Logistic regression models were employed, with interaction terms between socio-economic factors incorporated to account for variations among diverse subpopulations.ResultsAmong the eight religious groups identified, Atheists and Buddhists in the Asia Pacific exhibit the lowest agreement, with fewer than 60% acknowledging the religious compatibility of vaccines. Willingness to accept vaccines, however, is consistently higher in Asia Pacific by at least four percentage points compared to Africa, with the disparity widening further in the second wave. Impacts of education on vaccine perceptions vary across religious groups, while acknowledging vaccine compatibility with religion positively contributed to vaccine acceptance. Dynamics between region, religion, and other socio-demographic factors have changed substantially over time. All but Atheists and Muslims exhibit a higher propensity to endorse vaccines during Survey Wave 2.ConclusionsOur study reveals complex, context-dependent connections between vaccine attitudes and religion and the heterogeneous effects of time and education among different religious affiliations. Understanding the underlying drivers of these temporal variations helps inform tailored approaches aimed at addressing vaccine hesitancy, promoting vaccine uptake, and improving the well-being of each religious group.

Public attitudes towards immigrants: A curious case of Croatia

AbstractThe Croatian population has been subjected to violent ethnic conflicts during the war in the 1990s and has more recently experienced large‐scale irregular and refugee migrations, as well as a notable increase in regular labour migration. Using data from the most recent wave of the European Social Survey, we have conducted an analysis of Croatian attitudes towards immigrants. Our study found that, despite Croatia's history of ethnic conflict and ongoing changes in its migration system, the Croatian population still exhibits relatively low levels of negative attitudes towards immigrants compared to other Eastern European countries. With regards to individual determinants of attitudes, one of the biggest surprizes is that political party preferences play a minor role in explaining attitudes towards immigrants. We discuss our findings and conclude that there is an urgent need for better theoretical and empirical framework for understanding illiberal tendencies in Eastern European societies, particularly within the current context of rapidly worsening security situation in Europe.

Widowhood Shock, Family Reconstruction, and Mild Cognitive Impairment Among Older Adults: A Prospective Cohort Study.

Mild cognitive impairment (MCI), especially among widowed older adults, is increasingly urging public concern. This study aimed to investigate the association of widowhood, remarriage, and widowed life characteristics with the MCI risk among Chinese older adults. With an average age of 86.49 ± 10.20, a sample of 5377 participants aged between 65 and 116 was collected from four waves of the Chinese Longitudinal Healthy Longevity Survey between 2008 and 2018. Cox proportional hazards models and restricted cubic spline models were employed to estimate and plot the associations. Results showed that widowhood is associated with an increasing MCI risk, which could not be alleviated by remarriage. This negative impact was pronounced among women and those at older age. The association of living alone duration after widowhood and MCI onset displayed an inverse U-shape, with a peak risk at the 10th year. These findings have practical implications for pointing out the most vulnerable groups to MCI.

Levels of Satisfaction and Regret With Gender-Affirming Medical Care in Adolescence

There is a need to improve the evidence base for gender-affirming medical care provided to adolescents, including the experiences of those who have received this care. To examine rates of satisfaction, regret, and continuity of care in adolescents who received puberty blockers and/or gender-affirming hormones as part of gender-affirming medical care. This survey study used the 2023 online survey wave of an ongoing longitudinal study, the Trans Youth Project, among a community-based sample of transgender youth and their parents initially recruited throughout the US and Canada between 2013 and 2017. The satisfaction and regret data include responses from a youth or their parent representing 87% of the youth aged 12 years or older in the cohort who have received gender-affirming medical care (235 of 269 youths). Of these, 220 completed the 2023 survey (main sample); information about continuity of care was available for all youth. Data analysis was performed from April to August 2024. Satisfaction, regret, and continuity of care following puberty blockers or suppression and/or gender-affirming hormones. Self- or parent-reported satisfaction or regret with gender-affirming care and continuation of care. Among the 220 youths in the main sample (mean [SD] age, 16.07 [2.40] years; 30 [14%] multiracial, non-Hispanic; 18 [8%] White, Hispanic; 155 [70%] White, non-Hispanic; 17 [8%] other race and ethnicity, including Asian, Black [Hispanic and non-Hispanic], Hispanic with unknown race, multiracial Hispanic, or Native American; gender at last interaction: 68 [31%] boys, 132 [60%] girls, 20 [9%] gender diverse, eg, nonbinary) and their parents, very high levels of satisfaction and low levels of regret with puberty blockers and gender-affirming hormones as well as high levels of continuation of care were reported. Of these 220 respondents in the main sample, 9 were regretful of having received blockers (n = 8) and/or hormones (n = 3; 2 of these individuals reported regret with both), of whom 4 have stopped all gender-affirming medical care and 1 has continued to receive blockers but plans to stop. The 4 others have continued care, suggesting that regret is not synonymous with stopping care. The findings suggest that youth accessing puberty blockers and hormones as part of gender-affirming care tend to be satisfied with and not regretful of that care several years later. While regret was rare, these experiences need to be better understood.

Variation in health and well-being parameters: cross-country and temporal aspects

BACKGROUND: The coronavirus epidemic has stimulated large-scale structural and socio-economic changes throughout the world and led to increased attention to the problem of health in general. But has the epidemic affected the change in the attitude of people of different ages to their health, the perception of various parameters of subjective well-being? The article presents a comparative analysis of a number of assessments (about the level of happiness, satisfaction with income, healthcare, safety, communication, life, attitude towards people, etc.) of respondents from Europe and Central Asia for the period 2006–2021. AIM: The goal is to assess changes that have occurred over a 15-year time interval in relation to health and social determinants of well-being, to determine possible directions for changing the current situation. METHODS: To achieve this goal, the results of the tenth wave of the international comparative European Social Survey, conducted in 2021 (32 countries), were used in comparison with data from the third wave, conducted in 2006 (25 countries). The impact of the pandemic on the health of children and adolescents aged 11–15 years was based on materials from the international Health Behavior in School-Aged Children 2021–2022 in 44 countries in Europe and Central Asia. RESULTS: Despite the difficulties, dictated by the coronavirus, over the period 2006–2021 in most European countries stability in the perception of the world of work and the healthcare institution has been maintained, the psychological situation related to the safety of living has improved, and life satisfaction has increased. According to most of the parameters considered, Russians are outsiders among European countries; however, Russians’ responses to 7 indicators of health and well-being (out of 12) show positive changes. The results of studies of the health of children and adolescents during the pandemic and post-pandemic periods indicate significant negative consequences, mainly related to mental health. CONCLUSION: It is necessary to increase the attention of Russian government bodies to the health and well-being of Russians, first of all, to children and adolescents.

Differential associations between experiences of contraceptive care and subsequent contraceptive access and preferences among family planning patients by racial and ethnic identity: Evidence from Arizona, Iowa, and Wisconsin.

While many frameworks exist for building person-centered and equitable systems of contraceptive care, evidence indicates that the reality of patients' experiences of care is often not in alignment with these ideals. Historical and current contexts of racism in the healthcare system contribute to negative perceptions and experiences of care, as well as reduced care-seeking behavior, for those who identify as Black, Indigenous, and people of color (BIPOC). Our objective in this analysis is to examine whether people's past experiences of contraceptive care are a driver of subsequent barriers to contraceptive access, and whether this relationship differs across racial and ethnic identity. We draw on panel data from five waves of surveys collected between 2018-2023 among patients ages fifteen and older seeking family planning care at sites that receive public funding for these services in Arizona, Iowa, and Wisconsin. Overall and stratified by race/ethnicity, we examine cross-sectional and longitudinal associations between patients' experiences of high-quality, person-centered contraceptive care and three contraceptive access outcomes: use of preferred contraception, satisfaction with contraceptive method, and experience of no barriers to accessing preferred contraception. We find longitudinal associations between patients experiencing higher-quality, more person-centered contraceptive care and subsequent satisfaction with contraceptive methods. Among non-Hispanic white-identifying patients, we find similar associations between shifting to higher-quality contraceptive care and use of preferred contraception, but we find no statistical relationship between experiencing higher-quality care and subsequent contraceptive outcomes for patients who identify as Black, Indigenous, or Person of Color (BIPOC). Highlighting the dissonance between clinical guidance for quality contraceptive care and patient experiences of care, and especially whether similar experiences across racial and ethnic identity lead to differential outcomes, is a crucial step toward bringing contraceptive care systems into alignment with principles of sexual and reproductive health equity.

A lack of food for thought: Midlife food insecurity and its association with subsequent cognitive ability of Older Americans.

The 50-59 age group in the U.S. experience higher levels of food insecurity (FI) compared to older adults. While previous research has identified an association between FI and cognition outcomes in older populations, limited research has examined midlife as a specific food insecurity exposure window and the association of this hardship with long-run cognition outcomes. Utilizing 14 waves of Health and Retirement Survey (HRS) data (1995-2020), I applied mixed-effects models to assess the relationship between midlife FI exposure and later-life cognitive function, controlling for childhood disadvantages and other health-related and sociodemographic characteristics. Findings indicate that both cumulative FI duration and ever experiencing FI during ages 50-59 are significantly associated with subsequent cognitive decline. Specifically, ever experiencing food insecurity during midlife was linked to a decrease in cognitive function by 0.07 standard units (95% CI, -0.13 to -0.003; P<0.05). In addition, each additional year of FI exposure during midlife was associated with a reduction in cognitive function by 0.01 standard units (95% CI, -0.03 to -0.003; P<0.05). These associations remained robust even after accounting for a range of potential confounders and covariates. The findings support the cumulative inequality model, suggesting that midlife food insecurity is a significant predictor of lower cognitive function in later life. Both the timing and extent of FI during midlife are crucial factors in shaping cognitive health outcomes. Policy interventions targeting food insecurity in the 50-59 age group could play a pivotal role in promoting healthy aging and mitigating cognitive decline in older adulthood.

Examining the Relationship Between Internet Use and Depressive Symptoms Among Older Adults: Analyses of Mediators and Moderators

ABSTRACT Objectives The study aimed to investigate the influence mechanism underlying the relationship between Internet use and depressive symptoms in Chinese older adults. Methods Data were derived from the 2018 wave of China Longitudinal Aging Social Survey. Mediation and moderation analyses were conducted using Ordinary list squares (OLS) regression analysis. To address potential endogenous issues, we employed the Propensity Score Matching (PSM) method to explore the association between Internet use and depressive symptoms. Results Our findings indicate that Internet use can significantly reduce depressive symptoms and enhance mental health of older adults. Loneliness mediated the relationship between Internet use and depressive symptoms among older adults, while socioeconomic status (SES) moderated this relationship. Furthermore, the four purposes of Internet use, namely online chatting, information searching, recreational activities, consumption and investment, were negatively associated with loneliness and depressive symptoms among older adults. Conclusions The findings emphasize the positive effects of Internet use on the mental health outcomes of older adults. Clinical Implications The proper use of the Internet possesses considerable promise for clinical rehabilitation, targeting the enhancement of the mental health outcomes of older adults during their later life.

Long-term effects of establishing outpatient pooling funds on financial protection: Empirical evidence from a quasi-natural experiment in China.

A limited benefit package for outpatient care in Chinese universal health coverage led to high out-of-pocket outpatient payments, and even medical impoverishment. The outpatient pooling fund model was introduced in China's Urban Employee Basic Medical Insurance to reduce cost-sharing for outpatient care. This study attempts to examine the dynamic effects of the outpatient pooling scheme on financial risk protection for its enrollees. A total of 18,097 individual-level observations covering 52 prefectures were extracted from six waves of China Health and Nutrition Survey (2000-2015). The difference-in-differences model with multiple periods and event study were employed to investigate the dynamic effects of reform on catastrophic health expenditure (CHE) and impoverishing health expenditure (IHE) and potential mechanisms. Our results showed outpatient pooling scheme generated a significant effect on reducing the probability of incurring CHE (β=-0.004, 95% CI=-0.009 to -0.006) and IHE (β=-0.007, 95% CI=-0.012 to -0.001), especially for elderly people over 60years old. The realization of this effect may depend on the reduction of outpatient cost-sharing, increased outpatient care utilization, as well as decreased inpatient care utilization after reform. However, event study found the effectiveness of outpatient pooling reducing CHE and IHE occurrences appeared to be weak even insignificant in more recent years relative to the initial years of policy implementation. Establishing an outpatient pooling system iseffective to alleviate the financial risk caused by healthexpenditures in China. Optimising health service deliveryaimed at enhancing health insurance purchasing efficiencyare deemed imperative for sustaining the policy effectiveness.