Smoking and quitting behaviour by sexual orientation: a cross-sectional survey of adults in England

Objective: To assess associations between sexual orientation and smoking and quitting behaviour among adults in England. Methods: Data were collected from 112,537 adults (≥16y) participating in a nationally-representative monthly cross-sectional survey between 07/2013 and 02/2019. Sexual orientation was self-reported as heterosexual, bisexual, lesbian/gay, or prefer-not-to-say. Main outcomes were smoking status, e-cigarette use, cigarettes per day, time to first cigarette, motivation to stop smoking, motives for quitting, use of cessation support, and past‐year quit attempts. Associations were analysed separately for men and women using multivariable regression models adjusted for relevant covariates. Results: Smoking prevalence is now similar between gay (21.6%), prefer-not-to-say (20.5%) and heterosexual men (20.0%), and lesbian (18.3%) and heterosexual women (16.9%), but remains higher among bisexual men (28.2%, ORadj 1.41, 95%CI 1.11; 1.79) and bisexual women (29.8%, ORadj 1.64, 95%CI 1.33; 2.03) and lower among prefer-not-to-say women (14.5%, ORadj 0.85, 95%CI 0.72; 0.99). Among smokers, bisexuals were less addicted than heterosexuals, with bisexual men smoking fewer cigarettes per day (Badj -2.41, 95%CI -4.06; -0.75) and bisexual women less likely to start smoking within 30 minutes of waking (ORadj 0.66, 95% CI0.45; 0.95) than heterosexuals. However, motivation to stop smoking and quit attempts did not differ significantly. Conclusions: In England, differences in smoking prevalence among people with different sexual orientations have narrowed, primarily driven by a larger decline in smoking rates among sexual minority groups than heterosexuals. Bisexual men and women remain more likely to smoke but have lower levels of addiction while being no less likely to try to quit

Health Care Providers' Advice on Lifestyle Modification in the US Population: Results from the NHANES 2011-2016

OBJECTIVE: Healthcare providers are encouraged to prescribe lifestyle modifications for preventing and managing obesity and associated chronic conditions. However, the pattern of lifestyle advice provision is unknown. We investigate the prevalence of advised lifestyle modification according to weight status and chronic conditions in a US nationally representative sample. METHODS: Adults 20-64 years (n=11,467) from National Health and Nutrition Examination Study between 2011 and 2016 were analyzed, with weight status, and chronic conditions (high blood pressure, high blood cholesterol, osteoarthritis, coronary heart disease and type 2 diabetes mellitus). Lifestyle modification advice by healthcare providers included increase physical activity/exercise, reduce dietary fat/calories, control/lose weight, and all of above. RESULTS: High blood pressure (32.7%) and cholesterol (29.3%) were highly prevalent compared to osteoarthritis (7.4%), type 2 diabetes (5.7%) and coronary heart disease (3.7%). Those with type 2 diabetes received considerably frequent advice (56.5%; 95%CI: 52.4%-60.6%) than those with high blood pressure (31.4%; 95%CI:29.3%-33.6%) and cholesterol (27.0%; 95%CI:24.9%-29.3%). Prevalence of lifestyle advice exhibited substantial increases with graded BMI and comorbidity (all P<0.001). After adjusting for comorbid conditions, advice were more commonly reported among women, those overweight/obese, non-white, or insured. Remarkably low proportion of overweight (21.4: 95%CI: 18.7-24.3%) and obese (44.2%;95%CI:41.0%-47.4%) adults free of chronic conditions reported receiving any lifestyle advice. CONCLUSION: Prevalence of lifestyle modification advised by healthcare providers is generally low among US adults with chronic conditions, and worryingly low among those without chronic conditions however overweight or obese. Prescribed lifestyle modification is a missing opportunity in implementing sustainably strategies reducing chronic condition burden

The association of grip strength with depressive symptoms and cortisol in hair: A cross-sectional study of older adults

BACKGROUND: Low handgrip strength has been shown to be associated with higher levels of depressive symptoms. One area of mental health that is understudied in relation to grip strength is chronic stress, which can exist independently to depression, or as a comorbidity or precursor to this condition. The present study examined cross-sectional associations between grip strength, an established marker of physical function, and (a) depressive symptoms and (b) chronic stress utilizing hair cortisol concentrations, while accounting for multiple pertinent confounding variables. // METHOD: Data were used from wave 6 (2012/13) of the English Longitudinal Study of Aging, a panel study of older (≥50 years) community-dwelling men and women. Grip strength was measured in kg using a hand-held dynamometer. Depressive symptoms were assessed using the 8-item Center for Epidemiologic Studies Depression scale. Hair cortisol concentrations (pg/mg) were determined from samples of scalp hair and log-transformed for analysis to correct skewness. Associations of grip strength with depressive symptoms and hair cortisol concentration were tested using linear regression models adjusted for age, sex, ethnicity, wealth, smoking status, physical activity, body mass index, limiting long-standing illness, arthritis, diabetes, and hair treatment. // RESULTS: The sample comprised of 3741 participants (mean age 68.4 years, 66.4% female). After adjustment for age and sex, grip strength was significantly and negatively associated with both depressive symptoms (B = -0.038, SE = 0.004, P < 0.001) and hair cortisol (B = -0.003, SE = 0.001, P = 0.029). However, in the fully-adjusted models, both associations were attenuated and only the association with depressive symptoms remained statistically significant (B = -0.015, SE = 0.004, P < 0.001; hair cortisol B = -0.002, SE = 0.001, P = 0.088). // CONCLUSION: In a large sample of older adults in England, grip strength was negatively associated with depressive symptoms. Results were inconclusive regarding the association between grip strength and chronic stress. Further research examining the longitudinal relationships between muscular strength and specific aspects of mental health, while also exploring the neurobiological mechanisms underlying these associations, is warranted before recommendations for policy and practice can be made

Leisure-Time Sedentary Behavior, Alcohol Consumption, and Sexual Intercourse Among Adolescents Aged 12-15 Years in 19 Countries From Africa, the Americas, and Asia

BACKGROUND: The association between sedentary behavior and sexual behavior has not been investigated among adolescents. // AIM: The aim of this study was to: (i) investigate the association between leisure-time sedentary behavior and sexual intercourse, and (ii) test for mediation by alcohol consumption, drug use, physical activity, bullying victimization, parental support/ monitoring, loneliness, and depressive symptoms in a large global sample of young adolescents. // METHODS: Data were analyzed from 34,674 adolescents aged 12-15 years participating in the Global School-based Student Health Survey. Participants reported the number of hours spent in leisure-time sedentary behavior on a typical day (8 hours). Data on alcohol consumption, drug use, physical activity, bullying victimization, parental support/monitoring, loneliness, and depressive symptoms were considered as potential mediators. // OUTCOME: Participants reported whether or not they had sexual intercourse in the past 12 months (yes/no). // RESULTS: The prevalence of past 12-month sexual intercourse was 11.9%, whereas the prevalence of 8 hours per day of leisure-time sedentary behavior were 26.7%, 35.6%, 21.4%, 11.5%, and 4.9%, respectively. There was a dose-dependent relationship between sedentary behavior and odds of reporting sexual intercourse: compared with 8 hours/day of sedentary behavior were 1.12 (0.94-1.33), 1.22 (1.01-1.48), 1.34 (1.08-1.66), and 1.76 (1.37-2.27), respectively. There was no significant interaction by sex. The largest proportion of the association between sedentary behavior and sexual intercourse was explained by alcohol use (% mediated 21.2%), with other factors explaining an additional 11.2%. // CLINICAL TRANSLATION: Interventions to reduce leisure-time sedentary and/or alcohol consumption may contribute to a reduction in the proportion of adolescents engaging in sexual intercourse at a young age. The strengths and limitations of this study are the large, representative sample of adolescents from 19 countries. However, the cross-sectional design means causality or temporal associations could not be established. // CONCLUSIONS: In young adolescents, leisure-time sedentary behavior is positively associated with odds of having sexual intercourse in both boys and girls, in a dose-dependent manner. Alcohol consumption seems to be a key mediator of this relationship

Characteristics and effectiveness of co-designed mental health interventions in primary care for people experiencing homelessness: a systematic review

People experiencing homelessness (PEH) face a disproportionately high prevalence of adverse mental health outcomes compared with the non-homeless population and are known to utilize primary healthcare services less frequently while seeking help in emergency care facilities. Given that primary health services are more efficient and cost-saving, services with a focus on mental health that are co-designed with the participation of users can tackle this problem. Hence, we aimed to synthesize the current evidence of such interventions to assess and summarize the characteristics and effectiveness of co-designed primary mental healthcare services geared towards adult PEH. Out of a total of 10,428 identified records, four articles were found to be eligible to be included in this review. Our findings show that co-designed interventions positively impacted PEH’s mental health and housing situation or reduced hospital and emergency department admissions and increased primary care utilization. Therefore, co-designed mental health interventions appear a promising way of providing PEH with continued access to primary mental healthcare. However, as co-designed mental health interventions for PEH can improve overall mental health, quality of life, housing, and acute service utilization, more research is needed

Ethnic Differences in Magnesium Intake in U.S. Older Adults: Findings from NHANES 2005–2016

Magnesium plays a crucial role in hundreds of bodily processes relevant to aging, but consumption of dietary magnesium intake has been shown to be inadequate in a large proportion of older adults. Identifying groups at risk of low magnesium intake is important for informing targeted advice. Using data from the National Health and Nutrition Examination Survey (NHANES) 2005–2016, we examined the association between ethnicity (Caucasian/African American/Hispanic/other) and magnesium intake in a large representative sample of U.S. older adults (≥65 y, n = 5682, mean (SD) 72.9 (0.10) y). Analyses adjusted for total energy intake and a range of relevant covariates. Overall, 83.3% of participants were not meeting the recommended level of dietary magnesium intake, ranging from 78.1% of other ethnic groups to 90.6% of African Americans. In the fully adjusted model, magnesium intake was lower among African American older adults (−13.0 mg/d, 95% CI: −18.8 to −7.2), and higher among Hispanics (14.0 mg/d, 95% CI: 7.5 to 20.5) and those from other ethnic groups (17.2, 95% CI: 3.8 to 30.5) compared with Caucasian older adults. These results highlight the need for targeted interventions to increase magnesium intake in U.S. older adults, with a focus on African Americans, in order to reduce the burden of morbidity and ethnic inequalities in health in later life

Association between sexual orientation and subjective cognitive complaints in the general population in England

There is a scarcity of literature investigating the association between minority sexual orientations and subjective cognitive complaints (SCC). Therefore, the aim of this study was to investigate the association between identifying as a sexual minority and SCC in a large sample of adults from England. The study further aimed to identify the extent to which the association could be explained by several behavioral, psychological and clinical factors. Cross-sectional data from the 2007 Adult Psychiatric Morbidity Survey (APMS) were analyzed. Sexual orientation was dichotomized into heterosexual and sexual minority orientation. SCC referred to subjective concentration and memory complaints. Control variables included sex, age, ethnicity, marital status, education, employment, and income. Influential factors included smoking status, alcohol dependence, perceived stress, the number of stressful life events, depression, any anxiety disorder, sleep problems, and obesity. This study included 7,400 participants (51.4% women; mean [standard deviation] age 46.3 [18.6] years). After adjusting for control variables, sexual minority orientation was positively and significantly associated with subjective concentration (OR = 1.40, 95% CI = 1.12–1.76) but not memory complaints (OR = 1.19, 95% CI = 0.96–1.47). The number of stressful life events, sleep problems and any anxiety disorder explained 13.4%, 11.0% and 10.9% of the association between sexual orientation and subjective concentration complaints, respectively. In this large sample of English adults, identifying as a sexual minority was significantly associated with subjective concentration complaints, while stressful life events, sleep problems, and anxiety explained a large proportion of the association. Targeted interventions towards sexual minority groups to reduce SCC may be warranted

Association between food insecurity and depression among older adults from low‐ and middle‐income countries

Background: To examine the association between self‐reported food insecurity and depression in 34,129 individuals aged ≥50 years from six low‐ and middle‐income countries (LMICs) (China, Ghana, India, Mexico, Russia, and South Africa). Methods: Cross‐sectional, community‐based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Self‐reported past 12‐month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview were used for the endorsement of past 12‐month DSM‐IV depression. Multivariable logistic regression analysis and meta‐analysis were conducted to assess associations. Results: In total, 34,129 individuals aged ≥50 years [mean (SD) age, 62.4 (16.0) years; 52.1% females] were included in the analysis. Overall, the prevalence of moderate and severe food insecurity was 6.7% and 5.1%, respectively, while the prevalence of depression was 6.0%. Meta‐analyses based on countrywise estimates showed that overall, moderate food insecurity (vs. no food insecurity) is associated with a nonsignificant 1.69 (95% confidence interval [CI] = 0.82–3.48) times higher odds for depression, while severe food insecurity is significantly associated with 2.43 (95% CI = 1.65–3.57) times higher odds for depression. Conclusions: In this large representative sample of older adults from six LMICs, those with severe food insecurity were over two times more likely to suffer from depression (compared with no food insecurity). Utilizing lay health counselors and psychological interventions may be effective mechanisms to reduce depression among food‐insecure populations. Interventions to address food insecurity (e.g., supplemental nutrition programs) may reduce depression at the population level but future longitudinal studies are warranted

Changes in health-related behaviours and mental health in a UK public sample during the first set of COVID-19 public health restrictions

Public health restrictions, in response to the COVID-19 pandemic, have had potentially wide-ranging, unintended effects on health-related behaviours such as diet and physical activity and also affected mental health due to reduced social interactions. This study explored how health-related behaviours and mental health were impacted in a sample of the UK public during the COVID-19 pandemic. Two online surveys were administered in the UK, one within the first three months of the restrictions (Timepoints 1 (involving pre-pandemic recall) and 2) and another ten weeks later (Timepoint 3). Moderate-vigorous physical activity (MVPA), sitting time, screen time and sexual activity were self-reported. Diet was assessed using the Dietary Instrument for Nutri-tion Education questionnaire. Mental health was measured using the short-form Warwick-Edinburgh Mental Well-being Scale and Becks’ Anxiety and Depression Inventories. Differences between timepoints were explored using the Friedman, Wilcoxon signed-rank, McNemar and McNemar-Bowker tests. 296 adults (74% under 65 years old; 65% female) provided data across all timepoints. Between T1 and T2, MVPA, time outdoors and sexual activity decreased while sitting and screen time increased (p<0.05). Between T2 and T3, saturated fat intake, MVPA, time out-doors, and mental wellbeing increased while sitting, screen time and anxiety symptoms decreased (p<0.05). This study found that depending on the level of COVID-19 public health restrictions in place, there appeared to be a varying impact on different health-related behaviours and mental health. As countries emerge from restrictions, it will be prudent to direct necessary resources to address these important public health issues