Health Behavior Variables Research Articles

Associations between physical activity, long COVID symptom intensity, and perceived health among individuals with long COVID.

Physical activity (PA) is associated with better perceived health among individuals with chronic conditions. However, PA's relationship with perceived health in people with long COVID is unclear and may be modified by long COVID symptom burden. Participants with self-reported long COVID (N = 379) responded to an online survey cross-sectionally assessing PA levels, perceived physical and mental health, and intensity of CDC-defined long COVID symptoms on a 0-100 scale. Linear regression analyses assessed the associations between PA and perceived physical and mental health, after accounting for sociodemographic, health behavior, and long COVID intensity variables, with post-hoc analyses comparing health across PA levels. Increasing levels of PA were associated with increases in perceived physical health (β = 0.27, p < 0.001) and mental health (β = 0.19, p < 0.001) after accounting for sociodemographic and health behavior variables. PA remained significantly associated with perceived physical health (β = 0.15, p < 0.001) but not perceived mental health (β = 0.09, p = 0.067) after the adding long COVID intensity to the model. Insufficiently active and active groups reported significant better physical and mental health than the inactive group (ps < 0.05), while the highly active group did not significantly differ from any other group on perceived physical or mental health (ps > 0.05). Inactive individuals reported significantly greater long COVID symptom burden compared to each other PA level (ps < 0.05). Higher levels of PA may be associated with better physical health among individuals with long COVID, even after accounting for symptom intensity. However, long COVID symptom intensity may confound the relationship between PA and mental health among individuals with long COVID.

89 Associations of active commuting and leisure-time physical activity with mental health symptoms among Finnish adults: a population-based study

Abstract Purpose Active commuting, that is, walking or cycling to work, can improve physical health. Yet, few studies have explored whether it could also enhance mental health. We examined cross-sectional associations of active commuting and, for comparison, leisure-time physical activity with depressive symptoms and psychological distress among Finnish adults. Methods We included 3439 adults (mean age 45.0 years; 51% women) from the FinHealth 2017 Study. Based on their commuting and leisure-time physical activity behaviour, participants were categorised as active or passive commuters and as sedentary, recreationally active, or exercisers and athletes. Logistic regression was used to estimate odds ratios (OR), with 95% confidence intervals (CI), adjusting for major sociodemographic, health behaviour, and physical activity variables. Results Active commuting, as a binary variable, was not associated with mental health outcomes compared to passive commuting. However, in dose-response analyses, high volumes of active commuting (≥ 30 minutes a day) were associated with higher odds of depressive symptoms (OR 1.58, 95% CI 1.18-2.13). Regarding leisure-time physical activity, recreationally active adults had lower odds of depressive symptoms (OR 0.57, 95% CI 0.44-0.73) and psychological distress (OR 0.46, 95% CI 0.32-0.68) compared to sedentary individuals. Similarly, exercisers and athletes had lower odds of depressive symptoms (OR 0.44, 95% CI 0.32-0.61) and lower odds of psychological distress (OR 0.34, 95% CI 0.21-0.55). Conclusions We found leisure-time physical activity, but not active commuting, to be associated with lower odds of mental health symptoms. More research on commuting behaviour is needed to understand the complex relationship between active commuting and mental health.

Jail-Based For-Profit Mental Health Providers and Treatment Engagement After Release.

This study compared mental health treatment engagement among people with serious mental illness after release from jails that had either a for-profit (N=3 jails) or a nonprofit mental health provider (N=7 jails). Across the 10 jails, data were collected in 2019 for 1,238 individuals with serious mental illness. Data included demographic characteristics (age, race-ethnicity, gender, geography, and jail type) and behavioral health variables (previous mental health treatment, psychotropic medication use, substance use, and receipt of jail-based mental health services). Logistic regression was used to predict treatment engagement during the year after release, stratified by type of jail-based mental health provider, in analyses controlled for demographic and behavioral health variables. Almost half (46%, N=573) of the individuals had stayed in jails with a for-profit mental health provider; the other half (54%, N=665) had stayed in jails with a nonprofit provider. In the year after release, 37% (N=458) of all individuals engaged in mental health treatment, and 63% (N=780) did not. Those who had stayed in a jail with a for-profit provider were significantly less likely to engage in mental health treatment during the year after release (AOR=0.59, 95% CI=0.42-0.83, p<0.01), compared with those in jails having a nonprofit provider. Staying in a jail with a for-profit mental health provider was associated with reduced postrelease engagement with community service providers. Less engagement with services during a pivotal time after release may increase behavioral health crises that erode individuals' well-being and may raise downstream costs due to further criminal legal involvement and emergency care use.

Association between the transition to metabolically unhealthy obesity and lifestyle behavior: A nationwide cohort study.

To identify the characteristics of individuals transitioning from metabolically healthy obesity (MHO) to unhealthy obesity and the factors influencing the change. This is a nationwide cohort study using data from the National Health Insurance Service in South Korea. Individuals with obesity but metabolically healthy in 2009 and 2010 and those still obese 4 years later were selected. Sociodemographic, physical, metabolic, and health behavior variables were collected, and logistic regression was used to find an association with the transition. We analyzed 1,564,467 individuals, observing significant differences in all variables and the transition from MHO to unhealthy obesity. Among males, the transition was associated with smoking and drinking positively and physical activity negatively. Among females, drinking demonstrated a negative correlation. Regardless of age, regular exercise was negatively associated with the transition for all individuals. Except for older adults, all age groups showed a positive correlation with smoking and drinking. Considering the significant factors in the transition, it is essential to develop and implement interventions varied by gender and age to delay and prevent the change in metabolic status. The necessity of developing interventions enables individuals to engage in regular exercise, regardless of age and gender.

Prevalence and associated factors of premature ejaculation and erectile dysfunction in young, single men who have sex with men in Lima, Peru.

While there is literature on erectile dysfunction (ED) and premature ejaculation (PE) in men, conclusive evidence regarding these sexual health issues and potential associated factors in the young, single men who have sex with men (MSM) population is lacking. The study sought to determine the prevalence and factors associated with PE and ED in young single MSM in the capital of Peru. This was an analytical cross-sectional study in MSM using an online questionnaire. The presence of ED and PE was assessed using the 5-item International Index of Erectile Function and 5-item Premature Ejaculation Diagnostic Tool questionnaires, respectively. In addition, their association with personal, physical health, and sexual behavior variables was evaluated. Prevalence ratios (PRs) were estimated through regression models. Premature ejaculation and Erectile dysfunction in MSM. Of 315 participants, most were between 20 to 29years of age (71.8%), 43.5% identified as homosexual, 59.1% had between 2 and 5 sexual partners, and 40.6% reported that the duration of their sexual relationship was between 1 and 12months. The prevalence of ED was 53.3% (95% confidence interval [CI], 47.66%-58.95%), and PE was present in 8.3% (95% CI, 5.46%-11.86%). Factors associated with a higher prevalence of ED were having between 6 and 9 sexual partners (PR, 1.48; 95% CI, 1.05-2.11) and having a sexual relationship lasting 13 to 24months (PR, 0.70; 95% CI, 0.50-0.98). Furthermore, for each additional year from the onset of the first sexual encounter with another man, the prevalence of PE increased by 7% (PR, 1.07; 95% CI, 1.02-1.13). These findings suggest that there is a relationship between an increased number of sexual partners and a higher prevalence of ED. It also suggests that relationships that last for some time may have a protective effect against ED. Strengths include the use of validated instruments, adequate sample size, robust multivariate analysis, and being one of the few studies in Latin America assessing PE and ED in the MSM population. Limitations include the cross-sectional design, nonprobability sampling, and access to participants. Having more sexual partners is associated with increased ED, while relationships lasting 13 to 24months are associated with decreased ED. Each additional year from the onset of the first sexual relationship increases the prevalence of PE. These findings can guide the design of health policies and programs tailored to the MSM community to enhance their well-being and sexual quality of life.

Neurocognitive Impairment in Post-COVID-19 Condition in Adults: Narrative Review of the Current Literature.

The severe acute respiratory syndrome coronavirus 2 virus has, up to the time of this article, resulted in >770 million cases of COVID-19 illness worldwide, and approximately 7 million deaths, including >1.1 million in the United States. Although defined as a respiratory virus, early in the pandemic, it became apparent that considerable numbers of people recovering from COVID-19 illness experienced persistence or new onset of multi-system health problems, including neurologic and cognitive and behavioral health concerns. Persistent multi-system health problems are defined as Post-COVID-19 Condition (PCC), Post-Acute Sequelae of COVID-19, or Long COVID. A significant number of those with PCC report cognitive problems. This paper reviews the current state of scientific knowledge on persisting cognitive symptoms in adults following COVID-19 illness. A brief history is provided of the emergence of concerns about persisting cognitive problems following COVID-19 illness and the definition of PCC. Methodologic factors that complicate clear understanding of PCC are reviewed. The review then examines research on patterns of cognitive impairment that have been found, factors that may contribute to increased risk, behavioral health variables, and interventions being used to ameliorate persisting symptoms. Finally, recommendations are made about ways neuropsychologists can improve the quality of existing research.

Prevalence of mental health symptoms and potential risk factors among Austrian psychotherapists

This research focused on the intricacies of mental health within the psychotherapist community, a domain currently understudied. A recent study suggests a better overall mental health profile for Austrian psychotherapists compared to the general population. However, a substantial proportion of psychotherapists still exhibited scores beyond the cut-off for clinically significant mental disorders, potentially undermining the efficacy of patient outcomes. A cross-sectional study was conducted between April to June 2023, enrolling a cohort of 502 Austrian psychotherapists (79.7% female; mean age: 53.4 ± 9.26 years). The analysis leveraged indicators for symptoms of depression (PHQ-2), anxiety (GAD-2), insomnia (ISI-2), stress (PSS-4), and overall well-being (WHO-5). Key correlations were revealed using multivariable logistic regressions incorporating sociodemographic, work-related, and health behavior variables. Mental health symptoms in psychotherapists were associated with lower income, lesser physical activity, employment in outpatient facilities, less experience in the field, and a smaller patient load. Notably, physical activity emerged as a significant protective component, underscoring regular exercise as a vital self-care routine for psychotherapists. Adequate income also presented as a crucial contributor to mental health stability. These findings augment our understanding of the complex dynamics influencing psychotherapists' mental health, potentially enhancing their well-being and optimizing professional output.

The association between stress and multiple long-term conditions: A cohort study

BackgroundStress is an important predictor of long-term conditions. We examine whether hair cortisol (a biomarker of stress) is associated with incidence and accumulation of multiple long-term conditions (MLTC). MethodsWe included data from 4295 individuals aged ≥50 years within the English Longitudinal Study of Ageing dataset with data on hair cortisol, sociodemographic and health behaviour variables. Cox proportional hazards models were used to quantify the association between hair cortisol at baseline and accumulation of MLTC between 2012 and 2013 and 2018–2019, both for individuals with and without MLTC at baseline. ResultsOur cohort included 1458 (34.0%) individuals who accumulated MLTC between 2012 and 2013 and 2018–2019. The proportion of individuals with zero, 1, and ≥ 2 conditions at baseline who accumulated MLTC were 12.0% (n = 127), 40.4% (n = 520), and 41.7% (n = 811), respectively. Higher cortisol levels were associated with higher risk of accumulation of MLTC in both unadjusted [HR:1.15(1.05–1.25)] and models adjusted for sociodemographic and health behaviours [HR:1.12(1.02–1.22)]. For individuals without MLTC at baseline, higher cortisol levels were significantly associated with higher risk of developing MLTC in unadjusted [HR: 1.20(1.05–1.36)] and adjusted models [HR: 1.16(1.02–1.32)]. ConclusionThe study provides the first evidence of the role of stress in the development and accumulation of MLTC. This modifiable risk factor could be targeted to reduce the risk of MLTC. However, further work is needed to better understand the mechanisms and pathways that link stress and accumulation of MLTC.

Positive cardiovascular health: longitudinal investigation of sustained health behavior in a cross-lagged model.

Our study focuses on the role of psychological states in the development of cardiovascular disease (CVD) and explores the potential of positive psychological factors in reducing CVD risk. While existing research has predominantly examined negative mental states and risk behavior, this longitudinal study takes a novel approach by investigating positive psychological wellbeing and its impact on sustained health behavior. The research involved participants (n = 502) with medium to high cardiovascular risk who underwent a comprehensive risk assessment in 2012, followed by written risk communication. Health behavior and psychological variables were measured in 2012 and 2019. A cross-lagged panel was employed to repeat measures of a cardiovascular health index with latent factors. Results indicated an excellent fit for the model (RMSEA = 0.0644, CFI = 0.936, TLI = 0.921, SRMR = 0.050), with significant associations between the observed variables (p < 0.05) and created latent factors. Furthermore, the model implied significant bivariate correlations (p < 0.05) between latent constructs of sustained health behavior and positive psychological states in 2012 and 2019. A significant regression relationship between Health Awareness Index 2012 and 2019, between Psychological wellbeing in 2012 and 2019 (B = 1.103 p = 0.038), latent factors could be identified (B = 1.103 p = 0.038) using cross-lagged panel model. Results highlighted the importance of cardiovascular health awareness, subjective risk perception, and self-directed efforts in facilitating health behavior change. Relationships between psychological wellbeing and health awareness emphasize that positive experiences and reinforcement are crucial in sustaining optimal health behavior. Our findings offer a new perspective on cardiovascular risk screening and preventive interventions. Extending cardiovascular risk screening with psychological measures may broaden prevention opportunities by including psychological elements reinforcing positive psychological states. The findings suggest that an effective prevention program must consider stabilizing and maintaining positive psychological states to achieve lasting improvements in cardiovascular health.

Physical Health-Related Quality of Life in Relation to Mediterranean Diet Adherence in a Sample of Greek Asthma Patients: A Pilot Study.

The role of nutrition in the management of asthma in obese patients is of increasing interest due to their limited response to inhaled corticosteroids. Some studies note that through diet and lifestyle, there can be an improvement in asthma control. The aim of the present study was to investigate the adherence to the Mediterranean Diet and its association with asthma severity and quality of life in patients with bronchial asthma. This is a cross-sectional study of 85 patients (70.6% female), with a mean age of 57 years, from the General University Hospital of Larissa and, more specifically, patients of the outpatient asthma clinic. Data were collected with the use of specific questionnaires. In relation to BMI, 12.9% of participants were of a normal weight, 45.9% were overweight, 25.9% were obese level I, 5.9% were obese level II, and 9.4% were in the morbidly obese range. Based on the Med Diet Score (ranging from 21 to 35), most participants (85.9%) reported moderate adherence to the Mediterranean Diet. Further analysis examined the correlations of the PCS-12 score with the frequency of consumption of each of the 11 food categories, as well as all demographic and health behavior variables. The ranked correlations indicated a significant relationship between PCS-12 score and Med Diet adherence and the consumption of alcoholic beverages (r = 0.437, p < 0.05), in accordance with the Mediterranean Diet suggestions, as well as a negative relationship with BMI score (r = -0.454, p < 0.010). Moreover, significant correlations were also present between the physical quality of life and AQLQ score and work type, as well as gender, age, and marital status. The results of our study showed a high rate of obesity in patients with asthma at the General University Hospital of Larissa and moderate adherence to the Mediterranean Diet. Increased BMI and alcoholic beverage consumption in asthma patients were significant predictors of lower physical health-related quality of life. In conclusion, personal and society-level interventions are required to effectively address obesity and poor diet in patients with asthma.

Allostatic load in the US general population: Race and educational intersection

ObjectivesEducational attainment is a protective factor against poor health, but high educational attainment has a weaker effect on black people than on white people; this pattern has been called marginalization-related diminished returns (MDRs). Using a national sample of white people and black people 25 years and above, this study estimates the association between high educational attainment and allostatic load between black people and white people, and within each group. Study designThis cross-sectional study uses data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016, including 2761 black people and 7058 white people. The outcome variable of interest was the Allostatic Load Scale (AL). We created the allostatic load scale by using 8 biomarkers, then created a binary variable (if ALS≥4 as 1 and ALS<4 as 0) to present elevated AL. MethodsWe used several weighted modified Poisson regression models controlling for educational attainment (a predictor) and race (a moderator variable), age, sex, and marital status. We also controlled the models for smoking and drinking status as health behavior variables. As a sensitivity analysis, we ran several sets of regression analysis using the AL scale as a continuous outcome variable. ResultsWe found an inverse association between AL and educational attainment. The interaction between race and education has resulted in an inverse association between AL and educational attainment, with a weaker association in black people than in white people. We found similar findings by running regression models with AL as a continuous variable. ConclusionsWe observed a weaker association between educational attainment and AL in black people than in white people, suggesting that educational attainment has more robust protection against allostatic load for white people than black people.

Prevalence of mental health symptoms and potential risk factors among Austrian veterinary medicine students

Although the poor mental health of veterinarians has been reported in different countries, no data exist on mental health in Austrian veterinary students. This study aimed to provide first data on a broad range of mental health indicators in Austrian veterinary students, compare these data with the Austrian general population, and explore factors associated with poor mental health. A total of 29.1% (n = 430; 85.8% female; mean age: 23.14 ± 3.69 years) of the total Austrian veterinary student population (N = 1477 students; 82.1% females) took part in an online survey conducted from November 2022 to January 2023. Indicators of mental health were symptoms of depression (PHQ-9), anxiety (GAD-7), insomnia (ISI-7), stress (PSS-4), alcohol abuse (CAGE) and disordered eating (SCOFF). Compared to the general Austrian population a higher proportion of veterinary students exceeded the cut-offs for clinically relevant mental health symptoms (P < 0.05). A total of 55.3% of participating veterinary students exceeded the cut-off for moderate depressive symptoms, 52.6% for moderate anxiety symptoms, 20.9% for clinically relevant insomnia symptoms, 79.3% for high-stress symptoms, 22.8% for symptoms of alcohol abuse and 38.6% for symptoms of disordered eating. Multivariable logistic regression including several sociodemographic, health behavior, and study-related variables as predictors revealed that mental health symptoms in veterinary students were associated with female gender, older age, low physical activity, high smartphone usage, and desired specification in small animal or wildlife medicine. In conclusion, Austrian veterinary students experience a high mental health burden. The teaching of coping skills and strategies to improve mental hygiene should be implemented in the curricula of veterinary education to improve mental health in the veterinary profession.

Health Behaviors Before and After the Implementation of a Health Community Organization: Gangwon's Health-Plus Community Program.

Community organization is a resident-led movement aimed at creating fundamental social changes in the community by resolving its problems through the organized power of its residents. This study evaluated the effectiveness of health community organization (HCO), Gangwon's Health-Plus community program, implemented from 2013 to 2019 on residents' health behaviors. This study had a before-and-after design using 2011-2019 Korea Community Health Survey data. To compare the 3-year periods before and after HCO implementation, the study targeted areas where the HCO had been implemented for 4 years or longer. Therefore, a total of 4512 individuals from 11 areas with HCO start years from 2013 to 2016 were included. Complex sample multi-logistic regression analysis adjusting for demographic characteristics (sex, age, residential area, income level, education level, and HCO start year) was conducted. HCO implementation was associated with decreased current smoking (adjusted odds ratio [aOR], 0.73; 95% confidence interval [CI], 0.57 to 0.95) and subjective stress recognition (aOR, 0.79; 95% CI, 0.64 to 0.97). Additionally, the HCO was associated with increased walking exercise practice (aOR, 1.39; 95% CI, 1.13 to 1.71), and attempts to control weight (aOR, 1.36; 95% CI, 1.12 to 1.64). No significant negative changes were observed in other health behavior variables. The HCO seems to have contributed to improving community health indicators. In the future, a follow-up study that analyzes only the effectiveness of the HCO through structured quasi-experimental studies will be needed.

240 Community Participant-based Study Design: Use of Virtual Focus Groups to Explore Acceptability of a Cooking Intervention among African-American Women Living in Washington, D.C.

OBJECTIVES/GOALS: African-Americans are at increased risk for nutrition disparities; home cooking is a strategy to optimize dietary quality. to develop a cooking intervention, a mixed-methods community-based participatory, acceptability study was conducted to understand cooking behaviors, options for intervention content, and implementation factors. METHODS/STUDY POPULATION: Self-identified African-American adults were recruited from a larger community-based study within Washington, D.C. Five moderated virtual focus groups with four participants in each group were conducted in March and April of 2021. A semi-structured moderator’s guide focused on cooking, meal habits, food choices, and the proposed cooking intervention was utilized. Qualitative data collected were verbatim transcriptions and notes from research team members. Thematic analysis was conducted using an iterative process among research team members. Participant validation interviews were conducted following the research team analysis. Electronic self-administered surveys were used to measure demographic, food environment, cooking behavior, health behavior, and psychosocial variables. RESULTS/ANTICIPATED RESULTS: Study participants (n=20 females, mean age 60.1 years) lived in low-food resource neighborhoods but reported high food security (n=14). Barriers to the intervention included traveling distances to other neighborhoods for produce, poor quality of vegetables and fruit within neighborhood stores, lack of trustworthiness from neighborhood store experiences, perception of decreased cooking skills, and competing priorities related to time and weekday schedules. Motivators included health promotion for self, family, community, and enjoyment from cooking. Virtual or in-person sessions were suggested. Intervention options included costs of recipe ingredients, using recipes with ingredient flexibility, nutrition information, and provisioning of or compensation for ingredients used in virtual classes. DISCUSSION/SIGNIFICANCE: Use of virtual focus groups for a participant-based design of a cooking intervention among African American adults living in low-food access neighborhoods provided acceptability results that were food and home environments contextual and provided barriers and motivators to participation and implementation of behavior from the intervention.

Socioeconomic Background and Self-Reported Sleep Quality in Older Adults during the COVID-19 Pandemic: An Analysis of the English Longitudinal Study of Ageing (ELSA).

The COVID-19 pandemic negatively impacted sleep quality. However, research regarding older adults' sleep quality during the pandemic has been limited. This study examined the association between socioeconomic background (SEB) and older adults' sleep quality during the COVID-19 pandemic. Data on 7040 adults aged ≥50 were acquired from a COVID-19 sub-study of the English Longitudinal Study of Ageing (ELSA). SEB was operationalized using educational attainment, previous financial situation, and concern about the future financial situation. Sociodemographic, mental health, physical health, and health behavior variables were included as covariates. Chi-squared tests and binary logistic regression were used to examine associations between SEB and sleep quality. Lower educational attainment and greater financial hardship and concerns were associated with poor sleep quality. The relationship between educational attainment and sleep quality was explained by the financial variables, while the relationship between previous financial difficulties and sleep quality was explained by physical health and health behavior variables. Greater financial concerns about the future, poor mental health, and poor physical health were independent risk factors for poor sleep quality in older adults during the pandemic. Healthcare professionals and service providers should consider these issues when supporting older patients with sleep problems and in promoting health and wellness.

Driven by need, shaped by access: Heterogeneity in patient profiles and patterns of service utilization in patients with alcohol use disorders

BackgroundPatients with alcohol-use disorders (AUDs) are highly heterogenous and account for an increasing proportion of general medical hospital visits. However, many patients with AUDs do not present with severe medical or psychiatric needs requiring immediate attention. There may be a mismatch between some patients’ needs and the available services, potentially driving re-admissions and re-encounters. The current study aims to identify subgroups of AUD patients and predict differences in patterns of healthcare service use (HSU) over time. MethodsLatent class analysis (LCA) was conducted using hospital data incorporating sociodemographic, health behavior, clinical, and service use variables to identify subtypes of AUD patients, then class membership was used to predict patterns of HSU. Results. Four classes were identified with the following characteristics: (1) Patients with acute medical injuries (30 %); (2) Patients with socioeconomic and psychiatric risk factors, (11 %); (3) Patients with chronic AUD with primarily non-psychiatric medical needs (18 %); and (4) Patients with primary AUDs with low medical-treatment complexity (40 %). Negative binomial models showed that Class 4 patients accounted for the highest frequency of service use, including significantly higher rates of emergency department reencounters at 30 days and 12 months. ConclusionsThe profile and patterns of HSU exhibited by patients in class 4 suggest that these patients have needs which are not currently being addressed in the emergency department. These have implications for how resources are allocated to meet the needs of patients with AUDs, including those who make frequent visits to the emergency department without high acuity medical needs.

Abstract P171: Associations Between Metals and Allostatic Load Among Non-Hispanic Asians and Non-Hispanic Whites From the National Health and Nutrition Examination Survey: 2015-2020

Introduction: Environmental metal exposure has been linked with multi-system toxicity and elevated stress hormones, and high metal concentrations have been observed among Asian Americans. Metal exposure may also increase Allostatic Load (AL), or physiologic “wear-and-tear” on the body. Hypothesis: Metal biomarker concentration is associated with high AL among non-Hispanic Asian (NHA) and non-Hispanic White (NHW) adults. Methods: AL scores were calculated based on 9 biomarkers representing cardiovascular, metabolic, and immune system function using data from the National Health and Nutrition Examination Survey (2015-2020). High AL was defined as having ≥3 high-risk biomarkers based on empirically defined thresholds. Lead, cadmium, and mercury were quantified in blood while arsenic, monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) were measured in urine. Metal concentrations were categorized into empirically-defined sample tertiles. Survey-weighted logistic regression analyses controlled for demographic, socioeconomic, and health behavior variables. Analyses were also stratified by NHA and NHW. Results: The study sample consisted of 5,012 adults [mean age: 50.4, SE: 0.5] (21.6% foreign-born NHA, 2.7% US-born NHA, and 75.7% NHW). Prevalence of high AL was 38.2% among NHW, 32.4% among foreign-born NHA, and 19.3% among US-born NHA. Metal exposure demonstrated heterogenous relationships with AL ( Table ). Individuals in the highest tertile of cadmium exposure had 38% greater odds of having high AL than those in the lowest tertile, however this association was attenuated after controlling for socioeconomic status and health behaviors. Lead, mercury, arsenic, DMA, and MMA were associated with lower odds of high AL. Relationships were similar when stratified by NHW and NHA. Conclusion: The association between metals and AL differs by metal type in our study population. Future studies should explore the mechanistic pathways between high metal exposure and AL.

Bidirectional Comorbid Associations between Back Pain and Major Depression in US Adults.

Low back pain and depression have been globally recognized as key public health problems and they are considered co-morbid conditions. This study explores both cross-sectional and longitudinal comorbid associations between back pain and major depression in the adult population in the United States. We used data from the Midlife in the United States survey (MIDUS), linking MIDUS II and III with a sample size of 2358. Logistic regression and Poisson regression models were used. The cross-sectional analysis showed significant associations between back pain and major depression. The longitudinal analysis indicated that back pain at baseline was prospectively associated with major depression at follow-up (PR 1.96, CI: 1.41, 2.74), controlling for health behavioral and demographic variables. Major depression at baseline was also prospectively associated with back pain at follow-up (PR 1.48, CI: 1.04, 2.13), controlling for a set of related confounders. These findings of a bidirectional comorbid association fill a gap in the current understanding of these comorbid conditions and could have clinical implications for the management and prevention of both depression and low back pain.

Abstract 165: Nationwide Seasonal Variations And Increases In Incidence Of Intracerebral Hemorrhage And Acute Ischemic Stroke: An Analysis Of Pre-pandemic 16-year National Data

Introduction: There is paucity of evidence on long-term nationwide trends and seasonal variation in incidence of Intracerebral Hemorrhage (ICH) and Acute Ischemic Stroke (AIS). Methods: Using the Nationwide Inpatient Sample (2004 - 2019), we identified adults (≥ 18 years) discharged with primary diagnosis of ICH and AIS. We aggregated hospitalizations across quarters: Jan - Mar (Q1); Apr - Jun (Q2); Jul - Sep (Q3) and Oct - Dec (Q4). We used survey weights to calculate nationally representative estimates of quarter-specific incidence across age, sex, and race/ethnicity sub-cohorts and obtained time-specific denominators from the US Census Bureau. We calculated per quarter incidence rate (IR) across Q1-Q4 and Q2-Q3. We used multivariable Poisson regression model to report the adjusted incidence rate ratio (aIRR) and 95% confidence interval (CI) for the differences in quarterly incidence between Q1Q4 and Q2Q3. Results: Across 16 years, 985 959 ICH and 7 067 178 AIS hospitalizations were evaluated. The average quarterly crude IR of ICH in Q1Q4 of 6 per 100 000 was higher than the average rate of 5.4 per 100 000 observed in Q2Q3 (aIRR, CI: 1.10, 1.09 - 1.10). However, for AIS the average quarterly IR of ICH in Q1Q4 (41.2 per 100 000) was similar to the incidence rate in Q2Q3 (41.2 per 100 000) (aIRR, CI: 1.00, 1.00 - 1.00). Furthermore, we observed that average quarterly incidence is increasing overtime (aIRR, CI) for both ICH (1.01, 1.01 - 1.01) and AIS (1.03, 1.03 -1.03). The aIRR and CI for age, race, and sex are provided in the figure. Conclusion: Both stroke phenotypes demonstrate an increasing nationwide incidence. However, unlike AIS, ICH incidence is consistently and significantly higher in the months of October to March. Additional evaluation of factors such as holiday stress, seasonal variations in health behaviors (diet, physical activity, medication adherence) and physiological parameters (blood pressure, blood viscosity, fibrinogen, and cholesterol levels) is warranted.

The trends and determinants of seasonal influenza vaccination after cardiovascular events in Canada: a repeated, pan-Canadian, cross-sectional study.

Annual influenza vaccination is recommended for individuals with a history of cardiovascular disease (CVD) events. We aimed to examine (1) the time trends for influenza vaccination among Canadians with a CVD event history between 2009 and 2018, and (2) the determinants of receiving the vaccination in this population over the same period. We used data from the Canadian Community Health Survey (CCHS). The study sample included respondents from 2009 to 2018 who were 30 years of age or more with a CVD event (heart attack or stroke) and who indicated their flu vaccination status. Weighted analysis was used to determine the trend of vaccination rate. We used linear regression analysis to examine the trend and multivariate logistic regression analysis to examine determinants of influenza vaccination, including sociodemographic factors, clinical characteristics, health behaviour and health system variables. Over the study period, in our sample of 42 400, the influenza vaccination rate was overall stable around 58.9%. Several determinants for vaccination were identified, including older age (adjusted odds ratio [aOR] = 4.28; 95% confidence interval [95% CI]: 4.24-4.32], having a regular health care provider (aOR = 2.39; 95% CI: 2.37-2.41), and being a nonsmoker (aOR = 1.48; 95% CI: 1.47-1.49). Factors associated with decreased likelihood of vaccination included working full time (aOR = 0.72; 95% CI: 0.72-0.72). Influenza vaccination is still at less than the recommended level in patients with CVD. Future research should consider the impact of interventions to improve vaccination uptake in this population.