Mental Health and Access to Medical Care in Patients with Chronic Cardiovascular Conditions: An Analysis of the Behavior Risk Factor Surveillance System

Introduction. Poor mental health is associated with worse outcomes for chronic diseases. It is unclear whether mental illness predisposes to difficulties with healthcare access. Methods. Using a combined dataset of the 2016-2019 behavioral risk factor surveillance system, we included individuals who reported a chronic cardiovascular condition. Weighted multivariable logistic regression analyses were used to explore the association between domains of mental health and measures of healthcare access including delaying medical care, > 1 year since last routine checkup, lack of a primary care physician (PCP), and cost-related medication nonadherence (CRMNA). Results. Among 1,747, 397 participants, 27% had a chronic cardiovascular condition, 12% had clinical depression, and 12% had poor mental health. Those with poor mental health (OR 3.20 [3.08 – 3.33]) and clinical depression (OR 2.43 [2.35 – 2.52]) were more likely to report delays in medical care. Those with greater stress frequency (OR 8.47 [6.84 -10.49] stressed all of the time), lower levels of emotional support received (OR 3.07 [2.21 – 4.26] rarely get needed emotional support), and greater life dissatisfaction (6.66 [4.14 – 10.70] very dissatisfied) reported greater delays in medical care. Conclusions. Individuals with poor mental health have greater difficulty accessing medical care independent of socioeconomic variables.

Adverse Childhood Experiences and Subjective Cognitive Decline in the US

Objective The aim of this study was to determine the association between adverse childhood experiences (ACEs) and subjective cognitive decline (SCD) among a representative sample of the adult US population. Methods Data were obtained from the 2019 Behavioral Risk Factor Surveillance System ( N = 82,688, ≥45 years). Adverse childhood experiences included sexual, physical/psychological and environmental ACEs, and a score. Multivariable logistic regression was used to determine the association between ACEs and SCD, and SCD-related outcomes. Results Sexual (adjusted OR (aOR: 2.83; 95% CI: 2.42–3.31)), physical/psychological (aOR: 2.05; 95% CI: 1.83–2.29), and environmental (aOR: 1.94; 95% CI: 1.74–2.16) ACEs were associated with SCD in the past year. There was also a dose-response relationship between ACE score and SCD. Conclusion ACEs were associated with SCD. Interventions to maximize cognitive health in aging and prevent future cognitive impairment should consider the potential role of ACEs among affected populations.

Overall and Sex-Specific Risk Factors for Subjective Cognitive Decline: Findings From the 2015–2018 Behavioral Risk Factor Surveillance System Survey

Background Prior research indicates that at least 35% of Alzheimer’s disease and related dementia risk may be amenable to prevention. Subjective cognitive decline is often the first indication of preclinical dementia, with the risk of subsequent Alzheimer’s disease in such individuals being greater in women than men. We wished to understand how modifiable factors are associated with subjective cognitive decline, and whether differences exist by sex. Methods Data were collected from men and women (45 years and older) who completed the U.S. Behavioral Risk Factor Surveillance System Cognitive Decline Module (2015–2018), n=216,838. We calculated population attributable fractions for subjective cognitive decline, stratified by sex, of the following factors: limited education, deafness, social isolation, depression, smoking, physical inactivity, obesity, hypertension, and diabetes. Our models were adjusted for age, race, income, employment, marital and Veteran status, and accounted for communality among risk factors. Results The final study sample included more women (53.7%) than men, but both had a similar prevalence of subjective cognitive decline (10.6% of women versus 11.2% of men). Women and men had nearly equivalent overall population attributable fractions to explain subjective cognitive decline (39.7% for women versus 41.3% for men). The top three contributing risk factors were social isolation, depression, and hypertension, which explained three-quarters of the overall population attributable fraction. Conclusions While we did not identify any differences in modifiable factors between men and women contributing to subjective cognitive decline, other factors including reproductive or endocrinological health history or biological factors that interact with sex to modify risk warrant further research.

The Pursuit of Happiness: A Calculation of the Hidden Costs of Being Black in the 21st Century

There is no shortage of evidence documenting glaring disparities on important socioeconomic and health indicators between White and Black Americans. Persistent racial disparities are the consequence of a historic system of structural racism. Given ongoing inequities in nearly every realm of American life, we aim to calculate the contemporary cost of racial inequity. We contribute to a growing body of literature concerning the “hidden cost” of being Black by employing a novel methodological approach and centering a paradigm of intersectionality ( Crenshaw, 1991 ; Shapiro, 2004 ). Specifically, we account for the disparities in health and income between Blacks and Whites by using the compensating and equivalent surplus frameworks to calculate willingness to accept (WTA) and willingness to pay (WTP) estimates. We estimate the WTP to avoid the disparity in health, income, and wellbeing between Black and White Americans, to be between approximately $38,000 and $45,000 per year per person using the Behavioral Risk Factor Surveillance System as well as the General Social Survey, respectively. These estimates can be interpreted as the annual willingness to pay by an average White person to avoid the disparities in income and health experienced by the average Black person.

Prevalence and Predictors of Home Health Care Workers’ General, Physical, and Mental Health: Findings From the 2014‒2018 Behavioral Risk Factor Surveillance System

Objectives. To determine the prevalence and predictors of US home health care workers’ (HHWs’) self-reported general, physical, and mental health. Methods. Using the 2014–2018 Behavioral Risk Factor Surveillance System, we analyzed the characteristics and health of 2987 HHWs (weighted n = 659 000) compared with 2 similar low-wage worker groups (health care aides and health care support workers, not working in the home). We conducted multivariable logistic regression to determine which characteristics predicted HHWs’ health. Results. Overall, 26.6% of HHWs had fair or poor general health, 14.1% had poor physical health, and 20.9% had poor mental health; the prevalence of each outcome was significantly higher than that of the comparison groups. Among HHWs, certain factors, such as low household income, an inability to see a doctor because of cost, and a history of depression, were associated with all 3 aspects of suboptimal health. Conclusions. HHWs had worse general, physical, and mental health compared with low-wage workers not in home health. Public Health Implications. Increased attention to the health of HHWs by public health experts and policymakers is warranted. In addition, targeted interventions appropriate to their specific health needs may be required. (Am J Public Health. 2021;111(12):2239–2250. https://doi.org/10.2105/AJPH.2021.306512 )

Caregivers' Cannabis Use: Does Burden Lead to Blunts?

Research on risky health behaviors among caregivers is limited. In this paper, we examine the association between informal caregiving and marijuana use and whether this association varies by age. Using data from Behavioral Risk Factor Surveillance System (2016-2019), a multivariable logistic regression model compared marijuana use in “caregivers” and “expectant caregivers.” We stratified the analyses by age and also assessed the association between caregiving intensity and marijuana use. Among younger individuals (18-49 years), informal caregiving was associated with higher odds of marijuana use. In this group, higher prevalence of marijuana use was positively associated with care intensity. There was no detectable association between caregiving and marijuana use among older individuals (50 years or older). Health behaviors among caregivers differ by age. Combined exposure to informal caregiving and marijuana in young adulthood may lead to adverse long-term health consequences. Immediate effects of marijuana use may negatively influence care recipient outcomes.