Abstract
To date, there is no scientific consensus on whether insomnia symptoms increase mortality risk. We investigated longitudinal associations between time-varying insomnia symptoms (difficulty ...initiating sleep, difficulty maintaining sleep, early-morning awakening, and nonrestorative sleep) and all-cause mortality among middle-aged and older adults during 14 years of follow-up. Data were obtained from 2004 through 2018 survey waves of the Health and Retirement Study in the United States for a population-representative sample of 15 511 respondents who were ≥50 years old in 2004. Respondents were interviewed biennially and followed through the end of the 2018 survey wave for the outcome. Marginal structural discrete-time survival analyses were employed to account for time-varying confounding and selection bias. Of the 15 511 cohort respondents (mean ±SD age at baseline, 63.7 ±10.2 years; 56.0% females), 5878 (31.9%) died during follow-up. At baseline (2004), 41.6% reported experiencing at least one insomnia symptom. Respondents who experienced one (HR = 1.11; 95% CI: 1.03–1.20), two (HR = 1.12; 95% CI: 1.01–1.23), three (HR = 1.15; 95% CI: 1.05–1.27), or four (HR = 1.32; 95% CI: 1.12–1.56) insomnia symptoms had on average a higher hazard of all-cause mortality, compared to those who were symptom-free. For each insomnia symptom, respondents who experienced difficulty initiating sleep (HR = 1.12; 95% CI: 1.02–1.22), early-morning awakening (HR = 1.09; 95% CI: 1.01–1.18), and nonrestorative sleep (HR = 1.17; 95% CI: 1.09–1.26), had a higher hazard of all-cause mortality compared to those not experiencing the symptom. The findings demonstrate significant associations between insomnia symptoms and all-cause mortality, both on a cumulative scale and independently, except for difficulty maintaining sleep. Further research should investigate the underlying mechanisms linking insomnia symptoms and mortality.
Recently, multiple health organizations and advocacy groups have pushed for giving an R-rating for movies depicting tobacco imagery. This study examined several predictors of U.S. adults’ opinion ...toward an R-rating policy for movies depicting cigarette smoking. We used data from the Health Information National Trends Survey (2020 cycle), for a nationally representative sample of 3,865 US adults (aged ≥ 18). The outcome variable was opinion toward an R-rating policy (support, neutral, and oppose) for movies depicting cigarette smoking. A weighted adjusted multinomial logistic regression analysis with comparisons of support versus oppose, support versus neutral, and neutral versus oppose was performed. About 48.2% of respondents were supportive of, 31.1% were neutral toward, and 20.7% were opposed to an R-rating policy. Adults aged 50 to 64 years (adjusted odds ratio aOR = 2.28, p = .008) and ≥65 years (aOR = 4.54, p <.001) (vs. 18–34 years) were more likely to support the R-rating policy than oppose it. Non-Hispanic Black respondents (vs. non-Hispanic Whites) were 1.74 times more likely to support than oppose the policy (aOR = 1.74, p = .04), whereas adults with a household annual income of US$75,000 or more (vs. <$20,000) and those with moderate (vs. liberal) political viewpoints were more likely to be neutral than oppose the policy. Former and current e-cigarette users (vs. never users) were less likely to support than oppose the policy. Tailored messaging addressing the rationale behind R-rating policy should be directed towards communities based on age, race/ethnicity, household income, e-cigarette usage, and political ideologies.
It is essential for at-risk women to be screened for breast and cervical cancer in a timely manner. Despite a growing interest in the role of health information technology including personal health ...records (PHRs) to improve quality and outcomes in health care, less is known about the effectiveness of PHRs to promote breast and cervical cancer screening among women with a family history of cancer (FHC). We examined the association between access to PHRs and the use of a recommended mammography and a Pap smear testing among women with a FHC using data from the 2015 Health Information National Trends Survey (HINTS 4-cycle 4) and the 2016 Area Health Resource Files. The study sample was comprised of 1250 women aged 20–75 years with a FHC, a subsample of 3677 survey respondents. Of the 1250 women, 64.96% received a mammogram, and 75.44% underwent a Pap testing. Among women with a FHC, there was a significant and positive association between access to PHRs and the receipt of a mammogram (adjusted odds ratio (aOR) 4.20; 95% CI, 2.23–7.94;
p
< .001) and a Pap testing (aOR 3.13; 95% CI, 1.56–6.28;
p
< .01). Our findings suggest that at-risk women can benefit from greater access to PHRs. Policymakers should consider incentivizing providers and healthcare organizations who provide access to PHRs to their patients as well as developing programs that can help improve access to PHRs among at-risk women.
Background
Chronic medical conditions (CCs) are leading causes of morbidity and mortality in the United States. Strategies to control CCs include targeting unhealthy behaviors, often through the use ...of patient empowerment tools, such as mobile health (mHealth) technology. However, no conclusive evidence exists that mHealth applications (apps) are effective among individuals with CCs for chronic disease self-management.
Methods
We used data from the Health Information National Trends Survey (HINTS 5, Cycle 1, 2017). A sample of 1864 non-institutionalized US adults (≥18 years) who had a smartphone and/or a tablet computer and at least one CC was analyzed. Using multivariable logistic regressions, we assessed predisposing, enabling, and need predictors of three health-promoting behaviors (HPBs): tracking progress on a health-related goal, making a health-related decision, and health-related discussions with a care provider among smart device and mHealth apps owners.
Results
Compared to those without mHealth apps, individuals with mHealth apps had significantly higher odds of using their smart devices to track progress on a health-related goal (adjusted odds ratio (aOR) 8.74, 95% confidence interval (CI): 5.66–13.50, P < .001), to make a health-related decision (aOR 1.77, 95% CI: 1.16–2.71, P < .01) and in health-related discussions with care providers (aOR 2.0, 95% CI: 1.26–3.19, P < .01). Other significant factors of at least one type of HPB among smart device and mHealth apps users were age, gender, education, occupational status, having a regular provider, and self-rated general health.
Conclusion
mHealth apps are associated with increased rates of HPB among individuals with CCs. However, certain groups, like older adults, are most affected by a digital divide where they have lower access to mHealth apps and thus are not able to take advantage of these tools. Rigorous randomized clinical trials among various segments of the population and different health conditions are needed to establish the effectiveness of these mHealth apps. Healthcare providers should encourage validated mHealth apps for patients with CCs.
Objective
To examine longitudinal associations between time‐varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early‐morning awakenings, and nonrestorative sleep) ...and all‐cause health care services utilization (HSU), including overnight hospital stays, nursing home stays, and home health care services among middle‐aged and older adults.
Data Sources
The Health and Retirement Study (HRS), a nationwide, population‐representative survey of primarily middle‐aged and older adults in the United States.
Study Design
This study is an analysis of prospective data from the HRS for a cohort of 13,168 adults (aged ≥50 years; females = 57.7%). Study participants were followed for 16 years. This study focuses on the associations between time‐varying insomnia symptoms, both cumulatively and independently, and repeated HSUs. A marginal structural modeling approach was used to capture time‐varying biological, psycho‐cognitive, and behavioral health factors, and to adjust for selection bias such as differential loss to follow‐up. Generalized estimating equations were employed to compute average marginal effects and their 95% confidence intervals.
Data Collection/Extraction Methods
We extracted longitudinal data from 2002 through 2018 waves of the HRS.
Principal Findings
Experiencing higher numbers of insomnia symptoms on a cumulative scale was associated with higher probabilities of HSU. For instance, the likelihood of overnight hospital stays for individuals reporting one symptom increased from 4.7 percentage points on average (95% CI: 3.7–5.6, p < 0.001), to 13.9 percentage points (95% CI: 10.3–17.5, p < 0.001) for those reporting four symptoms, relative to individuals experiencing no insomnia symptoms. Further, experiencing each of difficulty initiating and maintaining sleep, and nonrestorative sleep, as standalone symptoms, was associated with a higher likelihood of HSU when compared to those not experiencing the symptoms.
Conclusions
The results demonstrate the potential consequences and adverse impacts of insomnia symptoms on HSU among middle‐aged and older adults. Future investigations should focus on the underlying causes and health systems pathways linking insomnia symptoms to HSU.
Purpose
The current study investigates associations between mHealth apps and healthcare decision-making and health communication among informal caregivers in the US.
Design
Cross-sectional study ...employing secondary data.
Setting
The Health Information National Trends Survey (HINTS5, Cycles 2 through 4, 2018 – 2020).
Sample
Self-identified informal caregivers (n = 1386; had mHealth apps = 61.3%, female = 63.2%, some college or more in education = 80.3%) who reported owning at least a smartphone or a tablet computer (i.e., ownership of a “smart device”).
Measures
Sociodemographic characteristics, reports of having mHealth apps, smart device utilization in healthcare decision-making and health communication.
Analysis
Accounting for the complex design features of the HINTS data, we constructed multiple hierarchical logistic regressions to compute adjusted odds ratios (aOR) and their 95% confidence intervals (CI).
Results
Compared to caregivers without mHealth apps, those with the apps had higher odds of utilizing their smart devices to make a health-related decision, such as how to treat a disease or a medical condition (aOR = 1.65; 95% CI: 1.13-2.39, P < .01), or engage in health-related discussions with a healthcare provider (aOR = 2.36; 95% CI: 1.54-3.61, P < .001).
Conclusion
Having mHealth apps was associated with a higher likelihood of using smart devices in healthcare decision-making and health communication by informal caregivers. Empowering caregivers to make informed health-related decisions and communicate effectively with healthcare providers are both crucial to health promotion and well-being. Future studies should investigate facilitators as well as barriers to using mHealth apps and smart devices in health-promoting strategies involving informal caregivers.
Influenza and pneumonia vaccines can reduce morbidities and mortality associated with infectious diseases among older adults. Food security, good nutrition, and high-quality diets are critical for ...the wellbeing of older adults. However, little is known about the relationship between food insecurity and use of preventive health services, such as influenza and pneumonia vaccinations, among older adults. In this study, we analyzed data on 40,555 adults aged ≥ 65 years from the 2014–2018 National Health Interview Survey in the United States. Through multiple hierarchical logistic regression models, we investigated the associations between food insecurity and influenza and pneumonia vaccines uptake in this population. We found that, during 2014–2018, about 12.6 million (5.3%) adults aged ≥ 65 years lived in food-insecure households in the United States. Of those, 60.6% reported getting an influenza vaccine in the past 12 months, and 54.2% reported ever getting a pneumonia vaccine. Compared to food-secure older adults, food-insecure individuals were not significantly different in terms of influenza vaccine uptake. However, they were 25% less likely to have ever gotten a pneumonia vaccine (adjusted odds ratio = 0.75, 95% CI 0.65–0.86,
P
< .001). Efforts should be made to develop strategies to improve immunization rates among food-insecure older adults. Healthcare providers could routinely assess their vaccination status and screen them for food insecurity. Also, community level screening and intervention programs should target food-insecure older adults, who often face structural disadvantages. Future studies could explore and identify the underlying predictive factors contributing to low pneumonia vaccination rates among food-insecure older adults.
The Affordable Care Act (ACA) was enacted to enhance access to care primarily among nonelderly and low-income populations; however, several provisions addressed key determinants of emergency ...department (ED) and inpatient visits among Medicare beneficiaries over age 65 years. We take stock of the overall changes in these visits among older Medicare beneficiaries, focusing on those with multiple chronic conditions (MCCs), and provide a nationally representative post-reform update.
We analyzed a sample of 32,919 older adults (65+) on Medicare from the 2006-2015 Medical Expenditure Panel Survey (MEPS). Using a survey-weighted two-part model, we examined changes in ED visits, inpatient visits, and length of stay (LOS) by MCC status, before (2006-2010), during (2011-2013), and after the ACA (2014-2015).
Prior to the ACA, 18.1% of Medicare older adults had ≥1 ED visit, whereas 17.1% had ≥1 inpatient visits, with an average of 5.1 nights/visit. Following ACA reforms, among those with 2+ chronic conditions, the rate of ever having an ED visit increased by 4.3 percentage points 95% confidence intervals CI: 2.5, 6.1, p < 0.01, whereas the rate of inpatient visits decreased by 1.4 percentage points 95%CI: - 2.9, 0.2, p < 0.1, after multivariable adjustment.
We found sizable increases in ED visits and nontrivial decreases in inpatient visits among older Medicare beneficiaries with MCCs, underscoring the continuing need for improving access to and quality of care among older adults with MCCs to decrease reliance on the ED and reduce preventable hospitalizations.
This study examines contribution of substance use (including alcohol, cannabinoids, stimulants, narcotics, depressants, and hallucinogens) on the probability of drivers being at-fault for a crash on ...U.S. public roads, with specific emphasis on older adult drivers.
Data from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System (FARS) for the years 2010-2018 were employed for 87,060 drivers (43,530 two-vehicle crash pairs) involved in two moving vehicle crashes. The quasi-induced exposure (QIE) method was used to compute the relative crash involvement ratios (CIRs) for each relevant substance and illicit drug. Mixed-effect generalized linear regression models were fit to examine the effect of substance use on the probability of a driver being at-fault for a crash.
There were 75.51% males and 73.88% Non-Hispanic Whites in our sample. The CIR for those aged 70-79 years was 1.17, and more than double (2.56) for the ≥80 years old drivers, while being relatively low among drivers of ages 20 to 69. Substance use, in general, disproportionately increased the probability of being at-fault during a crash, regardless of driver's age. Though older drivers are less likely than other age groups to report substance use, presence of substances among older drivers increased the probability of their being at-fault two to four times during a crash across almost all substances. The regression models, after adjusting for driver's sex, road grade, weather, light conditions, distraction, and speeding at time of crash, revealed that older drug-impaired drivers were twice as likely to be at fault in a fatal crash (aOR = 1.947; 95% CI = 1.821, 2.082; <0.0001) compared to their middle-aged counterparts. Similarly, most substance use categories were responsible for the probabilities of higher CIRs among the drivers.
These findings necessitate continued efforts to bring awareness to the deadly consequences of "drugged driving," especially among older adult drivers.
Health literacy is critical for cancer patients as they must understand complex procedures or treatment options. Caregivers’ health literacy also plays a crucial role in caring for cancer patients. ...Low health literacy is associated with low adherence to medications, poor health status, and increased health care costs. There is a growing interest in the use of mobile health applications (apps) to improve health literacy. Mobile health apps can empower underserved cancer patients and their caregivers by providing features or functionalities to enhance interactive patient-provider communication and to understand medical information more readily. Despite the potentiality of improving health literacy through mobile health apps, there exist several related concerns: no equal access to mobile technology, no familiarity or knowledge of using mobile health apps, and privacy and security concerns. These elements should be taken into account for health policy making and mobile apps design and development. Importantly, mobile apps should be developed with the goal of achieving a high range of user access by considering all health literacy level and various cultural and linguistic needs.
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