A “Swiss paradox” in the United States? Level of spatial aggregation changes the association between income inequality and morbidity for older Americans

Although a preponderance of research indicates that increased income inequality negatively impacts population health, several international studies found that a greater income inequality was associated with better population health when measured on a fine geographic level of aggregation. This finding is known as a “Swiss paradox”. To date, no studies have examined variability in the associations between income inequality and health outcomes by spatial aggregation level in the US. Therefore, this study examined associations between income inequality (Gini index, GI) and population health by geographic level using a large, nationally representative dataset of older adults. We geographically linked respondents’ county data from the 2012 Behavioral Risk Factor Surveillance System to 2012 American Community Survey data. Using generalized linear models, we estimated the association between GI decile on the state and county levels and five population health outcomes (diabetes, obesity, smoking, sedentary lifestyle and self-rated health), accounting for confounders and complex sampling. Although state-level GI was not significantly associated with obesity rates (b = − 0.245, 95% CI − 0.497, 0.008), there was a significant, negative association between county-level GI and obesity rates (b = − 0.416, 95% CI − 0.629, − 0.202). State-level GI also associated with an increased diabetes rate (b = 0.304, 95% CI 0.063, 0.546), but the association was not significant for county-level GI and diabetes rate (b = − 0.101, 95% CI − 0.305, 0.104). Associations between both county-level GI and state-level GI and current smoking status were also not significant. These findings show the associations between income inequality and health vary by spatial aggregation level and challenge the preponderance of evidence suggesting that income inequality is consistently associated with worse health. Further research is needed to understand the nuances behind these observed associations to design informed policies and programs designed to reduce socioeconomic health inequities among older adults

Health-Related and Sociodemographic Correlates of Meeting the Muscle Strengthening Exercise Recommendations in Middle-Aged and Older Adults with and without Disabilities

ut disabilities Shirit Kamil-Rosenberg, Mary L. Greaney & Carol Ewing Garber Sport Sciences for Health (2020)Cite this article 51 Accesses 4 Altmetric Metricsdetails Abstract Purpose To identify sociodemographic and health correlates of meeting the muscle strengthening (MS) exercise recommendations in middle-aged and older adults by disability status. Methods Respondents from the 2011 Behavioral Risk Factor Surveillance System were stratified by disability status (with disability, without disability), age [ages 45–64 (middle-aged), 65 + years of age (older adults)] and whether they met MS recommendations (yes, no). Two logistic regression models were run to evaluate whether perceived health status and sociodemographic characteristics were associated with meeting the MS recommendations by disability status. Results The sample included 477,662. Middle-aged persons were 20% more likely than older adults to meet the MS recommendations. Persons with a disability were less likely to meet muscle strengthening recommendations compared with those without. Persons with a disability who reported having poor health were ~ 65% less likely to meet the MS recommendation than those reporting excellent health. Furthermore, those with a disability and with one or more chronic diseases were nearly 40% less likely to meet the MS recommendation than no disability. Among respondents without disability, being Black and being a healthy weight or underweight increased the odds of meeting the MS recommendations. Conclusion Several health and sociodemographic factors were associated with not meeting MS recommendations. Persons with disability and poor health, had the lowest likelihood of participation. Studies are needed to understand whether improving MS exercise behavior may attenuate functional limitations associated with chronic diseases and aging

Community-based social determinants of three measures of mortality in Rhode Island cities and towns

Background: Efforts to understand and address the causes of place-based health disparities have focused primarily on understanding the social determinants of health on a large geographic level, such as the region, state, or county. However, there is a growing need to assess and understand how place-based characteristics at smaller geographic areas relate to of local place-based neighborhood characteristics on population health. Therefore, the objective of this study was to evaluate the magnitude of the associations between social determinants of health and life expectancy (LE) and related measures on the community level. Methods: LE at birth (LE0), remaining LE at age 65 (LE65), and age-specific mortality rates (ASMR) were calculated from mortality data (2009–2011) collected by the Rhode Island Department of Health (RIDoH) using abridged life table methods for each RI city/town. The city/town-specific LE and ASMR were linked to data collected by the US Census, RIDoH, the Federal Bureau of Investigation, and other databases that include information about multiple social, environmental, and demographic determinants of health. Bivariate correlations between city/town-level LE0, LE65, and ASMR and social determinants: demographics, household composition, income and poverty, education, environment, food insecurity, crime, transportation, and rural-urban status were examined. Results: LE0 (range: 75.9–83.3 years) was strongly associated with the percent of the population with a graduate/professional degree (r = 0.687, p \u3c  0.001), violent crime rate (r = − 0.598, p \u3c  0.001), and per capita income (r = 0.553, p \u3c  0.001). Similar results were observed for ASMR: ASMR was associated with the percent of the population with a graduate/professional degree (r = − 0.596, p \u3c  0.001), violent crime rate (r = 0.450, p = 0.005), and per capita income (r = − 0.533, p \u3c 0.001). The associations between LE65 and social determinants were more attenuated. Of note, none of the measures (LE0, LE65, or ASMR) were associated with any of the race/ethnicity variables. Conclusions: There are several important place-based characteristics associated with mortality (LE and ASMR) among RI cities/towns. Additionally, some communities had unexpectedly high LE and low ASMR, despite poor social indicators

Exploring Changes in Caregiver Burden and Caregiving Intensity due to COVID-19

This study explored self-reported changes in caregiving intensity (CI) and caregiver burden (CB) among informal caregivers due to the COVID-19 pandemic overall and by gender. Informal caregivers for someone age 50+ completed a survey via Amazon’s MTurk in June 2020. Participants reported changes in CI and CB due to COVID-19 and provided demographic information. Multinomial logistic regression models assessed changes in CI and CB attributed to the COVID-19 pandemic overall and by gender. The sample (n = 835) was 68.5% male and had an average age of 34 years (SD 9.8); 55.7% had increased CI, and 53.1% had increased CB attributed to the pandemic. Increased CB due to COVID-19 was associated with increased CI (OR 5.67, 95% CI 3.92–8.00). Male caregivers with decreased CI due to COVID-19 were nearly seven times as likely as those with no change in CI to have reduced CB due to COVID-19 (OR 6.91, 95% CI 3.29–14.52). Women with decreased CI due to COVID-19 were over eight times as likely to have reduced CB due to COVID (OR 8.30, 95% CI 2.66–25.91). Results indicate that many caregivers experienced increases in CI and CB since the start of the COVID-19 pandemic, and that these changes are complex and vary by gender

Healthcare Provider Counselling for Weight Management Behaviours among Adults with Overweight or Obesity: A Cross-sectional Analysis of National Health and Nutrition Examination Survey, 2011–2018

Objectives To determine if adults with overweight or obesity received counselling from their healthcare providers (HCPs) to lose weight and/or adopt healthful behaviours associated with weight loss, and whether they took action on their HCPs’ recommendations. Design Cross-sectional analysis of 2011–2018 National Health and Nutrition Examination Survey (NHANES) data. Sample NHANES respondents aged 18+ who were overweight/obese and had seen an HCP in the previous 12 months (n=13 158). Methods Respondents reported if their HCPs recommended they control/lose weight, increase exercise/physical activity (PA) and/or reduce fat/calorie intake, and if they adopted the offered recommendation(s). Weighted logistic regression models examined receipt of HCP counselling by sex, age, race/ethnicity, and weight status accounting for demographic characteristics and complex sampling. Similar analyses examined reported adoption of HCPs’ recommendations. Results The sample was 53.1% women, 45.0% were overweight and 55.0% had obesity. In total, 40.4% received counselling to control/lose weight, 49.5% to increase exercise/PA and 38.9% to reduce fat/calorie intake. The following groups were less likely (p\u3c0.001) to receive counselling: men; younger adults (aged 18–39) versus middle-aged (aged 40–64) and older adults (aged 65+); White versus Black and Hispanic respondents; overweight respondents versus respondents with obesity. Approximately half of those advised to make changes reported doing so (53.6% controlled/lost weight, 57.3% increased exercise/PA, 51.8% reduced fat/calorie intake). Differences in the adoption of recommendations were identified by sex, age group, race/ethnicity and weight status (all p\u3c0.05); women, middle-aged and older adults, Black and Hispanic respondents and individuals with obesity were more likely to adopt one or more recommendations. Conclusion Most respondents did not receive HCP counselling, and approximately half of those who received counselling reported taking action. HCPs may need training to provide counselling and to offer recommendations tailored to the social contexts of populations less likely to adopt weight control related recommendations

A qualitative study conducted in the USA exploring Latino fathers’ beliefs, attitudes and practices related to their young children’s eating, physical activity and sedentary behaviours

Objective: Increasing evidence documents fathers’ influential role in their children’s eating, physical activity (PA) and sedentary behaviours (SB). We aimed to expand limited existing research examining fathers’ influence in these areas by exploring Latino fathers’ beliefs, attitudes and practices related to eating, PA and SB of their young children. Designs: Seven focus group discussions were conducted in Spanish with Latino fathers (n 28) of children aged 2–8 years. Audio recordings were transcribed and translated verbatim without identifiers. Data were analysed using thematic analysis to identify key concepts and themes using NVivo 11 software. Results: Fathers expressed positive beliefs and attitudes about the importance of healthy eating for their young children, themselves and their families. Nevertheless, the majority reported familial practices including eating out, getting take-out, etc. that have been linked to increased obesity risk among Latino children. Fathers were more involved and engaged in children’s PA than eating and feeding. However, several fathers reported engaging predominantly in sedentary activities with their children, appeared permissive of children’s sedentary habits and struggled to set limits on children’s screen-time. Conclusions: We provide new information on Latino fathers’ beliefs and child feeding and PA practices that may provide important targets for interventions aimed at promoting healthful eating and PA behaviours of Latino children. Future research should further quantify the influence of Latino fathers’ parenting styles and practices on development of children’s eating, PA and SB. This information is needed to identify risk factors amenable to interventions and to design culturally appropriate parenting and family-based interventions targeting Latino children’s home environment and designed to meet this ethnic group’s specific needs

Factors Affecting Surgical Decisions in Newly Diagnosed Young Women with Early-Stage Breast Cancer

Given that young women with breast cancer often have concerns and priorities attributable to their life stage, we conducted a series of interviews to better understanding the surgical decision-making experience among women diagnosed at age ≤40. Women spoke of how the potential effect of an extended recovery was affecting their decision and, in some cases, contributing to decisional conflict. Several women described their worry of leaving cancer cells behind; others cited the need for continued surveillance as a consideration. Attention to situational anxiety and concerns about recurrence are warranted to ensure that decisions are made in a supportive and patient-centered setting

Racial/Ethnic Disparities in US Adolescents’ Dietary Quality and Its Modification by Weight-Related Factors and Physical Activity

There are well-known disparities in the prevalence of obesity across racial-ethnic groups, although the behavioral and psychological factors driving these disparities are less well understood. Therefore, the objectives of this study were: (1) to examine differences in dietary quality by race/ethnicity and weight-related variables [body mass index (BMI), weight loss attempt, and weight dissatisfaction] and physical activity (PA) using the Health Eating Index-2015 (HEI-2015); and (2) to investigate the interactions and independent associations of race/ethnicity, weight-related variables and PA on dietary quality. Data for adolescents aged 12–19 years (n = 3373) were abstracted from the 2007–2014 National Health and Nutrition and Examination Survey and analyzed using multiple PROC SURVEYREG, adjusting for demographics and accounting for complex sampling. Analyses determined that Hispanic males had better overall HEI-2015 scores than non-Hispanic whites (48.4 ± 0.5 vs. 45.7 ± 0.6, p = 0.003) or blacks (48.4 ± 0.5 vs. 45.5 ± 0.5, p \u3c 0.001). Hispanic females also had better dietary quality than non-Hispanic whites (50.2 ± 0.4 vs. 47.5 ± 0.5, p \u3c 0.001) and blacks (50.2 ± 0.4 vs. 47.1 ± 0.5, p \u3c 0.001). Meeting the PA recommendation modified racial/ethnic differences in dietary quality for females (p = 0.011) and this was primarily driven by the associations among non-Hispanic white females (ΔR2 = 2.6%, p = 0.0004). The study identified racial/ethnic and gender differences among adolescents in factors that may promote obesity. Results may be useful for obesity prevention efforts designed to reduce health disparities in adolescents

Age-specific trends in health-related quality of life among US adults: Findings from National Health and Nutrition Examination Survey, 2001-2016

Purpose Health-related quality of life (HRQoL) is an important indicator of population health, yet no age-specific trend analyses in HRQoL have been conducted with a nationally representative sample since 2004. Therefore, to address this gap, an age-specific trend analysis of HRQoL was conducted using National Health and Nutrition Examination Surveys (NHANES) data. Methods NHANES 2001–2016 data (8 cycles) were examined to evaluate trends in HRQoL by age group (young adults: 21–39, middle-aged: 40–64, older adults: 65+). HRQoL was assessed by self-reported health (SRH) and number of physically unhealthy, mentally unhealthy, and inactive days to due to physical or mental health in the past 30 days. Multiple linear or logistic regression analyses explored trends in HRQoL by age group, adjusting for demographics over time. Results Analysis revealed increasing fair/poor SRH over time for the entire sample (β = 0.34, 95% CI 0.08, 0.60, p = 0.011). However, age-specific analysis identified a bi-annual increase in fair/poor SRH only among young adults (β = 0.49, 95% CI 0.22, 0.76, p \u3c 0.001) and a decrease among older adults (β = − 0.60, 95% CI − 1.14, − 0.06, p = 0.03). Closer inspection revealed increasing fair/poor SRH increased among young women (β = 0.52, 95% CI 0.11, 0.93, p = 0.013) and young men (β = 0.46, 95% CI 0.04, 0.88, p = 0.03) but decreased among older women (β = − 0.81, 95% CI − 1.59, − 0.03, p = 0.042) over time. Analyses also determined that there was a trend for a decreasing number of physically unhealthy days among young adults (p \u3c 0.001), although no trends were observed for the other HRQoL items. Conclusions Although there was a significant trend over time for increasing fair/poor SRH when considering the entire sample, this trend was not consistent between age groups or sexes. Given increasing fair/poor SRH among young adults, there is a need to understand and address factors relating to HRQoL among this age group

Sociocultural and interpersonal influences on latina women’s beliefs, attitudes, and experiences with gestational weight gain

Latinos are the largest and fastest-growing minority group in the U.S., and Latina women represent the largest portion of minority births, having the highest birth rate in the U.S. for over 20 years. In addition, Latina women are at increased risk of entering pregnancy being overweight or having obesity and gaining excess gestational weight. Excess gestational weight gain (GWG) has short- and long-term adverse health outcomes for the woman and her child. Although culturally tailored interventions show promise toward promoting healthy GWG among Latina women, findings from current interventions have had mixed results, suggesting the need for further tailoring to meet the needs of this heterogeneous population group. This qualitative study was designed to explore first-time pregnant, low-income Latina women’s beliefs, attitudes, and experiences with GWG. The study employed qualitative research using semi-structured interviews conducted with 23 first-time pregnant Latina women between 22 and 36 weeks of gestation. Interviews were conducted by trained bilingual staff, transcribed verbatim, and analyzed using thematic analysis. Results showed that participants were uncertain if their GWG was within a healthy range. Although the majority of participants knew that GWG should be limited, they were not sure what the amount should be. In addition, the majority of participants reported attitudes of acceptance of and resignation to excessive GWG as being part of pregnancy. Several women appeared to believe that they did not have control over their weight gain during pregnancy. Moreover, analysis identified that sociocultural and interpersonal factors such as social support influence the beliefs, attitudes, and experiences with GWG of the low-income, majority immigrant Latina women who participated in this study. Study findings can be used to further tailor prenatal care practices and interventions aimed at altering modifiable risk factors associated with excess GWG among Latinas. Future interventions designed for low-income, immigrant Latina women that consider sociocultural influences on women’s beliefs and attitudes related to GWG, as well as the influence of social support networks on women’s health behaviors during pregnancy, will likely be more effective in preventing excessive GWG