The Latent Dimensions of Poor Self-Rated Health: How Chronic Diseases,Functional and Emotional Dimensions Interact Influencing Self-Rated Health in Italian Elderly

Self-Rated Health (SRH) is becoming one of the most popular indicator of population health. Nevertheless, a limited understanding still remains about the elements to which individuals refer when evaluating their health and how those elements act and interact in the evaluation process. In this study we use a structural equation model with latent variables to identify direct and indirect influences of various health dimensions (chronic morbidity, functional abilities and emotional health) and socio-demographic covariates (age, gender and education) on poor SRH. The sample consists of 25,183 Italian elderly aged 65 years and over, interviewed in the 2005 National Health Interview Survey. The results have pointed out the higher direct effect of psychological and emotional health on SRH, while the higher total effect is caused by chronic morbidity, which influences SRH both directly and altering functional and emotional health. Growing older, being a woman and having a low education negatively impacts on SRH. However, this is almost completely the result of the indirect effect exerted by the covariates, while their direct effect is not significant (gender), negative (age) or very modest (education).     

Unpacking Self-Rated Health and Quality of Life in Older Adults and Elderly in India: A Structural Equation Modelling Approach

The Study on global AGEing and adult health (SAGE) aims at improving empirical understanding of the health and well-being of older adults in low- and middle-income countries. A total of 321 adults aged 50 years and older were interviewed in rural Pune district, India, in 2007. We used Structural Equation Modelling (SEM) to examine the pathways through which social factors, functional disability, risk behaviours, and chronic disease experience influence self-rated health (SRH) and quality of life (QOL) amongst older adults in India. Both SRH and QOL worsened with increased age (indirect effect) and limitations in functional ability (direct effect). QOL, socio-economic status (SES), and social networking had no significant effect on SRH. Smoking was associated with the presence of at least one chronic illness, but this did not have a statistically significant effect on SRH. Higher social networking was seen amongst the better educated and those with regular income, which in turn positively affected the QOL rating. QOL had a direct, but statistically not significant, effect on SRH. In conclusion, the indirect effects of age on SRH mediated through functional ability, and the effects of SES on QOL mediated through social networking, provide new understanding of how age and socio-economic status affect SRH and QOL. By allowing for measurement errors, solving for collinearity in predictor variables by integrating them into measurement models, and specifying causal dependencies between the underlying latent constructs, SEM provides a strong link between theory and empirics.     

Re-evaluating gender differences in self-rated health: The importance of cohort

Research examining gender differences in self-rated health (SRH) has typically not distinguished between age and cohort-related changes in the health of men and women over time. Using longitudinal data from the Panel Study of Income Dynamics, this study finds gender diffegrences in SRH may actually be an artifact of cohort. Prior to examining health across cohorts, women reported worse health than men. With the introduction of cohort to the models, no gender difference was found except in the earliest cohort (born 1924–1933). Historical context is therefore critical to understanding the health trajectories of women and men, which are not uniform across cohorts.     

Which Life Domains Impact Most on Self-Rated Health? A Cross-Cultural Study of Switzerland and its Neighbors

General life satisfaction (GLS) is a strong health correlate and can be conceptualized as an aggregate of satisfactions in different life domains and as a proxy for quality of life. Little is known about which life domains—measured as domain satisfactions—contribute most to GLS and are the best predictors of self-rated health (SRH) and whether these associations differ between countries and/or language areas. We used stepwise logistic regression models to investigate how domain satisfactions, GLS and SRH are interrelated and compared German-speaking and French/Italian-speaking Switzerland with the corresponding neighboring countries of Germany, Austria, France and Italy. The associations of domain satisfactions with GLS and SRH varied significantly in magnitude and between countries and language areas. GLS was strongly related to self-rated health in all populations, but more so in the German-speaking than the French/Italian-speaking regions. Adjusted for all domain satisfactions, satisfaction with one’s financial situation and job satisfaction showed independent effects on SRH and were the most important predictors of GLS, although no clear geographical pattern emerged. Domain-specific satisfactions were similarly associated with GLS and SRH, but the strength of the association varied between German-, French- and Italian-speaking populations. Any similarity between Swiss language areas and neighboring countries was limited to German-speaking populations. Country- and language-specific life domain satisfactions may provide useful pointers for targeting policies in the respective domains.     

The Importance of Spousal Education for the Self-Rated Health of Married Adults in the United States

Education’s benefits for individuals’ health are well documented, but it is unclear whether health benefits also accrue from the education of others in important social relationships. We assess the extent to which individuals’ own education combines with their spouse’s education to influence self-rated health among married persons aged 25 and older in the United States (N = 337,846) with pooled data from the 1997–2010 National Health Interview Survey. Results from age- and gender-specific models revealed that own education and spouse’s education each share an inverse association with fair/poor self-rated health among married men and women. Controlling for spousal education substantially attenuated the association between individuals’ own education and fair/poor self-rated health and the reduction in this association was greater for married women than married men. The results also suggest that husbands’ education is more important for wives’ self-rated health than vice versa. Spousal education particularly was important for married women aged 45–64. Overall, the results imply that individuals’ own education and spousal education combine to influence self-rated health within marriage. The results highlight the importance of shared resources in marriage for producing health.     

The Association Between Perceived Income Inequality and Subjective Well-being: Evidence from a Social Survey in Japan

Previous studies have shown that income inequality in society is negatively associated with individuals subjective well-being (SWB), such as their perceived happiness and self-rated health (SRH). However, it is not realistic to assume that individuals have precise information about actual income distribution measured by the Gini coefficient or other statistical measures. In the current study, we examined how perceived income inequality, rather than actual inequality, was associated with SWB, using cross-sectional data collected from a nationwide, Internet survey conducted in Japan (N = 10,432). We also examined how this association was confounded by individuals’ objective and subjective income status, considering the possibility that individuals with lower income status are more inclined to both perceive income inequality and feel unhappy/unhealthy. In our analysis, we focused on the perception of widening income inequality (as perceived income inequality), perceived happiness and SRH (as SWB), and household income and living standards compared with 1 year ago and compared with others (as income status). We also controlled for personality traits. We obtained three key findings: (1) perceived income inequality was negatively associated with SWB; (2) both perceived income inequality and SWB were associated with income status; and (3) the association between perceived income inequality and SWB was attenuated after controlling for income status, but not fully for perceived happiness. These findings suggest that perceived income inequality, which links actual income inequality to SWB, should be further studied.     

Quality of Life as Medicine: Interventions that Induce Salutogenesis. A Review of the Literature

This paper reviews the medical (salutogenic) effect of interventions that aim to improve quality of life. Review of studies where the global quality of life in chronically ill patients was improved independently of subjective and objective factors (like physical and mental health, yearly income, education, social network, self-esteem, sexual ability and problems or work). The methods used were subtypes of integrative medicine (non-drug CAM) like mind body medicine, body psychotherapy, clinical holistic medicine, consciousness-based medicine and sexology. In about 20 papers on QOL as medicine, in cancer, coronary heart disease, chronic pain, mental illness, sexual dysfunction, low self-esteem, low working ability and poor QOL, the most successful intervention strategy seems to be to create a maternal, infantile bonding induced by a combination of conversation therapy and bodywork. The papers examined the treatments of over 2,000 chronically ill or dysfunctional patients and more than 20 different types of health problems. Global QOL measured by SEQOL, QOL5, QOL1, self-rated physical health, self-rated mental health, self-rated sexual functioning, anorgasmia, genital pain, self-rated working ability, self-rated relation to self, well-being, life-satisfaction, happiness, fulfillment of needs, experience of temporal and spatial domains, expression of life’s potentials, and objective functioning. We found “QOL as medicine” able in the treatment of physical disorders and illnesses including chronic pain (Number Needed to Treat (NNT) = 1–3, Number Needed to Harm (NNH) > 500), in mental illness (NNT = 1–3, NNH > 500), in sexual dysfunctions (NNT = 1–2, NNH > 1,000), self-rated low working ability (NNT = 2, NNH > 500), and self-rated low QOL (NNT = 2, NNH > 2,000). We found that QOL improving interventions helped or cured 30–90% of the patients, typically within one year, independent of the type of health problem. “QOL as medicine” seems to be able in improving chronic mental, somatic and sexual health issues without side effects.     

Overeducation,Skills and Wage Penalty: Evidence for Spain Using PIAAC Data

Despite well documented high levels of socioeconomic inequalities, health gradients by socioeconomic status (SES) in contemporary China have been reported to be limited. Using data from the 2010–2012 China Family Panel Studies, we reexamine associations between three sets of SES—human capital, material conditions, and political capital—and self-rated health among Chinese adults 18–70 years old, capitalizing on anchoring vignette data to adjust for reporting heterogeneity. We find strong evidence of substantial variations in reporting behaviors by education, cognition, and family wealth but not by family income or political capital. Failing to correct for reporting heterogeneity can bias the estimates of SES gradients in self-rated health as much as nearly 40 %. After vignette adjustment, we find significantly positive associations of education, family income, wealth, and political capital with self-rated health. Individuals’ cognitive capacity, however, does not predict self-rated health.     

Determinants of adults’ solo living in Canada: a longitudinal perspective

We examine the demographic, socio-economic and socio-cultural factors that underlie solo-living at mid-adult ages. Both individual and community level factors are analysed. The analysis is based on the longitudinal panel data of the Canadian Survey of Labour and Income Dynamics in 1996–2001, 1999–2004, 2002–2008 and 2005–2010, and census data at the Census District level for 1996, 2001 and 2006. A two-level discrete-time survival model is used within a 6 year observational window for each panel. The analysis starts with persons aged 35–59 who were living alone at the outset of a given panel and follows their departure from this status over the following 6 years. For both men and women, the older respondents, those who have been living solo for a longer time, those who are not in the labour force, and those living in apartments, are more likely to continue living alone. Women are more likely to keep their initial one person household status compared to men in general. In particular, women with medium education (non-university post-secondary certification) are more likely to continue living alone, while for men it is those unemployed who are more likely to remain in the solo-living status. Moreover, persons with lower health status are more likely to continue living by themselves, in comparison to those with excellent health status.

     

From the Editor

This study examined risk factors associated with self-reported health (SRH) in a genetically informative sample of older African American female twins. An interview was conducted with a national sample of 180 African American female twin pairs. Questions included: SRH, demographics, health behaviors, chronic diseases, and functional status. SRH was dichotomized into negative (fair/poor) and positive (good/very good/excellent). Logistic regression for clustered data was used to estimate the odds ratios and 95% confidence intervals. In multivariable analyses, IADL limitations (OR?=?1.5, 95% CI?=?1.7–2.0) and a chronic disease index (OR?=?1.9, 95% CI?=?1.4–2.5) were associated with negative SRH. In multivariate within-twin pair analysis, controlling for genetics/shared familial environment, IADLs (OR?=?1.8, 95% CI?=?1.1–2.7), and increasing numbers of chronic diseases (OR?=?2.0, 95% CI?=?1.3–3.2) remained significantly associated with negative SRH.     

Acculturation and Self-rated Health Among Asian Immigrants: The Role of Gender and Age

Using the 2002–2003 National Latino and Asian American Study (NLAAS), we examine the relationship between acculturation and poor-to-fair self-rated health (SRH) among Asian immigrants (N?=?1639). Using latent class analysis, we construct a multidimensional measure of acculturation that considers dimensions of involvement in U.S. culture as well as attachment to Asian ethnic cultures and identify three classes of Asian immigrants: the assimilated, who most strongly adhere to U.S. culture; the integrated, who align with both U.S. and Asian ethnic cultures; and the separated, who are almost exclusively attached to Asian ethnic cultures. Logistic regression results revealed that among the pooled sample of Asian immigrant adults, the separated are significantly more likely to report poor-to-fair SRH than the assimilated. We then tested for gender and age differences in the acculturation–SRH relationship, and found that stratifying by gender yields noticeably different patterns. Among Asian immigrant women, the probability of reporting poor-to-fair SRH increases with age for the separated and the integrated, while it declines with age for the assimilated. Conversely, among Asian immigrant men, the probability of reporting poor-to-fair SRH increases most steeply with age for the assimilated, while it is shallower for the separated and the integrated. Future research should continue to develop a dynamic understanding of acculturation and examine its association with other health outcomes, including how these relationships differ across subsets of immigrant groups.

     

Comparing Veteran and Non-veteran Racial Disparities in Mid-life Health and Well-being

Using National Longitudinal Survey of Youth 1979 data on mid-life physical health, mental health, and self-esteem, I examine inter- and intra-racial disparities in health and well-being among veteran and non-veteran men (N = 2440). After controlling for selectivity into the military via propensity weighting, I find that black veterans have higher self-esteem than white veterans and comparable black non-veterans, but white veterans have similar mid-life self-esteem as their non-veteran counterparts. I find no evidence of disparities in health for depressive symptoms and self-rated health after taking selection into military service into account. The results suggest that aspects of military service may increase blacks’ self-esteem, possibly due to less discrimination and more opportunity.     

Sense of Community Belonging and Health in Canada: A Regional Analysis

This article investigates the association between sense of community belonging and health among settlements of different size and across the urban to rural continuum in Canada. Using data from the recent 2007/08 Canadian Community Health Survey (CCHS), the objective is to identify the major health, social and geographic determinants of sense of community belonging and to consider policy options aimed at improving sense of belonging among certain segments of the population. The research found a significant and consistent association between sense of belonging and health, particularly mental health, even when controlling for geography and socio-economic status. At the same time, sense of community belonging improved progressively across the urban to rural continuum with remarkably high levels of belonging evident in the outer most regions of Canada. Despite the health deficit that exists in rural and small-town Canada, the paper postulates that these communities are able to overcome health challenges to create conditions conducive to a positive sense of belonging. Overall, sense of belonging was also found to be highest among seniors, people residing in single-detached homes and among couples with children and was lowest among youth, residents of high-rise apartments and among single-parents. Finally, in the context of addressing deficiencies in sense of belonging, the paper examines several recent policy developments aimed at improving mental health services in Canada.     

我国人口流动中的健康选择机制研究

利用2008年中国流动与健康调查数据,对农村留守人口、农村外出返乡人口、乡城流动人口以及城镇居民等不同流动特征群体之间的健康差异进行比较,并系统检验了我国人口流动过程中的两种健康选择机制——"健康移民"(healthy migrant)效应和"三文鱼偏误"(salmon bias)效应。模型分析结果表明,我国人口流动存在着较为明显的"健康移民"和"三文鱼偏误"选择效应。在控制被访者的年龄、性别、主要社会经济特征以及相关健康行为后,流动人口自评一般健康、慢性病状况、经常性身体不适和肺活量等健康指标显著优于农村留守人口,乡城流动人口患有慢性病和出现经常性身体不适的可能性也显著低于农村返乡人口。在控制相关变量后,乡城流动人口与城镇居民的健康状况(除慢性病和心率过高症状外)不存在显著差别。     

Helpless Dependents or Active Independents: A Cluster Analysis of Elders in China

The current study aimed to gain a better understanding of Chinese seniors’ demographic information as well as their attitudes toward old-age support as an indicator for their subjective well-being related to their retirement preparation. Particularly, the variation of demographic and attitudinal characteristics within the population was examined. The data was based on a sample of the Chinese senior population, aged 60 and over in 2006 from 20 provinces and metropolitan areas in China. A two-step cluster analysis was used in the current study and the auto-clustering algorithm indicated a two-cluster solution. Both demographic information and attitudinal responses were used for the clusters. The results showed that Chinese seniors’ attitudinal and behavioral traits were relevant to the classification with regard to their retirement preparedness. The current study demonstrated that Chinese seniors were a heterogeneous group that could be divided into two basic, distinct segments, namely, helpless dependents and active independents. Each different group of seniors may raise different key issues in meeting their needs for retirement management.     

Is Extremely High Life Satisfaction During Adolescence Advantageous?

This study examined whether extremely high life satisfaction was associated with adaptive functioning or maladaptive functioning. Six hundred ninety-eight secondary level students completed the Students’ Life Satisfaction Scale [Huebner, 1991a, School Psychology International, 12, pp. 231–240], Youth Self-Report of the Child Behavior Checklist [Achenbach and Edelbrock, 1991, Child Behavior Checklist and Youth Self-Report, Burlington, VT], Abbreviated Junior Eysenck Personality Questionnaire [Francis, 1996, Personality and Individual Differences, 21, pp. 835–844], Self-Efficacy Questionnaire for Children (Muris, 2001, Journal of Psychopathology and Behavioral Assesment, 23(3), pp. 145–149], and the Child and Adolescent Social Support Scale (Malecki and Demaray, 2002, Psychology in Schools, 39, pp. 1–18]. Three groups of students were created based on their life satisfaction reports: very high (top 10%), average (middle 25%), and very low (lowest 10%). Compared to students with average life satisfaction, students with very high life satisfaction had higher levels on all indicators of adaptive psychosocial functioning, except extraversion. Moreover, students with very high satisfaction had the lowest scores on all measures of emotional and behavioral problems. However, rates of clinical levels of behavior problems did not differ significantly between the very high and average groups. Finally, several necessary, but not sufficient factors for very high life satisfaction were identified. Taken together, the findings support the notion that very high life satisfaction is associated with positive psychosocial functioning. Furthermore, adolescents’ reports of their life satisfaction revealed differences in adjustment that were not captured by measures of psychopathology.     

Does Multiracial Matter? A Study of Racial Disparities in Self-Rated Health

How do self-identified multiracial adults fit into documented patterns of racial health disparities? We assess whether the health status of adults who view themselves as multiracial is distinctive from that of adults who maintain a single-race identity, by using a seven-year (2001–2007) pooled sample of the Behavioral Risk Factor Surveillance System (BRFSS). We explore racial differences in self-rated health between whites and several single and multiracial adults with binary logistic regression analyses and investigate whether placing these groups into a self-reported “best race” category alters patterns of health disparities. We propose four hypotheses that predict how the self-rated health status of specific multiracial groups compares with their respective component single-race counterparts, and we find substantial complexity in that no one explanatory model applies to all multiracial combinations. We also find that placing multiracial groups into a single “best race” category likely obscures the pattern of health disparities for selected groups because some multiracial adults (e.g., American Indians) tend to identify with single-race groups whose health experience they do not share.     

Perceived Quality of Life and Self-Rated Health among First-Year University Students

This study compares health status and qualityof life assessments of first-year universitystudents with those of their same-age workingcounterparts. Subjects and materials for eachgroup were gathered in 1999 from twocross-sectional data sets from the Swedishregion of Östergötland, covering malesand females aged 20–34 years. Subjects'perceived quality of life (QoL) and self-ratedhealth (SRH) were assessed on a 10-point scale(Ladder scale) and a five-point scale,respectively. Gender-based comparison revealedthat, for both males and females, first-yearuniversity students' average perceived QoL waslower than that of their working counterparts(p < 0.0001 in all instances). A higherproportion of students than expected ratedtheir health as ``average' or as ``low'(p < 0.0001). Perceived QoL was significantlycorrelated with SRH in both groups. Differencesin perceived QoL and SRH exist between studentsand their full-time working peers, and thedeterminants of these differences deservesgreater attention. Knowledge of thedeterminants of SRH and perceived QoL amonguniversity students might then be translatedinto sound and effective public-health practiceand intervention programs.