Loneliness and associated factors among middle-aged and older adults: cross-sectional and longitudinal survey results from the HAALSI cohort in South Africa.

OBJECTIVES: Longitudinal studies on chronic loneliness and before and during the COVID-19 pandemic are lacking in Africa. The study aimed to estimate the prevalence and associated factors of loneliness and chronic loneliness using cross-sectional and longitudinal data from middle-aged and older adults from rural South Africa. METHOD: The analysis utilized data from the South African 7-year longitudinal Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) (analytic sample: n = 3,418, aged 40 years and older). Loneliness was assessed with a single and 3-item measure. RESULTS: The proportion of loneliness was 19.5% in the 2021/2022 survey, the incidence of chronic loneliness (having loneliness in wave 2 and 3, and free of loneliness in wave 1) was 18.9%, and the 7-year incidence of loneliness was 41.0%. Comparing the 2019 (pre-COVID-19) to 2021/2022 (during COVID-19 pandemic) surveys participants experienced a significant reduction of loneliness. In cross-sectional and/or longitudinal analyses, we found that younger age, living alone, food insecurity, lack of social engagement, depressed mood, poor life satisfaction, poor sleep quality, impaired cognition, poor self-rated health, functional disability, underweight, obesity, and not living with HIV were associated with a higher prevalence, incidence and/or increases in loneliness. CONCLUSION: One in five aging adults had acute or chronic loneliness. Several social, mental, and physical health factors were identified as associated with loneliness.

Dental service utilization in the general adult population in Bangladesh.

OBJECTIVES: With the help of a national community-based survey, the analysis aimed to estimate the number of adults in Bangladesh who used dental services (DSU). METHODS: The 8185 participants (18-69 years old) in the Bangladesh cross-sectional STEPS survey in 2018 provided national data for analysis. Predisposing, enabling, and need factors for DSU were included in the interview data, physical examinations, and biochemical analyses. To estimate the DSU (last 12 months) predictors, Poisson regression was employed. RESULTS: Seven out of 10 participants (71.0%) had never DSU, 13.2% within the past 12 months, and 15.9% more than 12 months ago. In terms of predisposing factors, the final model showed a negative relationship between past 12-month DSU and living in the northern region (adjusted prevalence ratio-APR: 0.75, 95% CI: 0.59, 0.96). The enabling factors of living in an urban area (APR: 1.19, 95% CI: 1.01, 1.41) and seeing a doctor or other healthcare provider within the previous year (APR: 1.37, 95% CI: 1.08, 1.74) were positively correlated with DSU. In terms of need factors, dental pain (APR: 15.37, 95% CI: 9.68, 24.40), multimorbidity (APR: 1.26, 95% CI: 1.02, 1.55), oral health impact (OHI) speech problem (APR: 1.35, 95% CI: 1.13, 1.63), and OHI felt tense (APR: 1.34, 95% CI: 1.10, 1.64) were positively associated with DSU. CONCLUSIONS: A low proportion of participants had DSU in the past 12 months and several associated factors were identified.

Tobacco use and heavy episodic drinking among persons aged 18-69 years in Bolivia in 2019.

OBJECTIVES: The aim of this study was to estimate the prevalence and sociodemographic factors associated with tobacco use and heavy episodic drinking (TUHED), current tobacco use only (TU), and current heavy episodic drinking only (HED) among people 18-69 years in Bolivia in 2019. STUDY DESIGN: Cross-sectional study. METHODS: The analysis used cross-sectional data from Bolivia's STEPS 2019 survey; 4472 individuals answered questions about substance use and socio-demographic information. RESULTS: The sample included 50.2% women and 49.8% men, 52.1% had secondary or higher education, 48.6% were Mestizo and 28.0% Quechua. The prevalence of TUHD was 6.0% (10.5% for men, 1.6% for women), TU 12.2% (20.0% for men, 4.4% for women), and HED 11.2% (13.4% for men and 9.1% for women). Male sex increased the risk of TU, HED and TUHED and belonging to the Amara ethnic group decreased the risk of TU and TUHED. Higher education was increased the odds of HED and among women of TUHED. Urban residence increased the risk of TUHED and among women of HED. For women, unemployment was associated with TU and marriage or cohabitation was inversely associated with TU, and for men, belonging to another ethnic group (such as Castellano or Tacana) increased the risk of TU and TUHED. CONCLUSION: More than 10% of the general adult population in Bolivia participated in TU and HED, and among men in TUHED. Various factors associated with the different categories of substance use were identified.

German population norms of the preference to solitude scale and its correlates.

AIM: Our first aim was to present norm values for the Preference for Solitude Scale by sex, age, and other sociodemographic groups. Our second aim was to evaluate the correlates of preference for solitude. METHODS: Data were collected in August/September 2023 from a sample of individuals (N = 5000) living in Germany aged 18 to 74 years (ensuring representativeness in terms of sex, age group and federal state for the German general adult population). The established and valid Preference for Solitude Scale (range 0 to 12, with higher values reflecting a stronger preference for solitude) was used to quantify the preference for solitude. Norm values were provided by sex and age groups. Multiple linear regressions were used to examine the correlates of preference for solitude. RESULTS: Average preference for solitude score was 7.6 (SD = 3.0; 0 to 12). The average score was 7.3 (SD = 3.0) among males and 7.9 (SD = 2.9) among females. Regressions showed that a stronger preference for solitude was associated with being female (ß = .51, p < .001), being older (e.g., being 40 to 49 years compared to 18 to 29 years, ß = .85, p < .001), being single (e.g., divorced compared to being single, ß = -.78, p < .01), higher level of education (secondary education compared to primary education, ß = .43, p < .01), never been a smoker (e.g., daily smoker compared to never smokers, ß = -.61, p < .001), absence of alcohol consumption (e.g., drinking once a week compared to never drinking, ß = -1.09, p < .001), no sports activity (e.g., 2-4 hours per week compared to no sports activity, ß = -.60, p < .001), poorer self-rated health (ß = .28, p < .001) and more depressive symptoms (ß = .05, p < .001). Sex-stratified regressions yielded similar results. CONCLUSION: Norm values provided in this study can be used as a benchmark for comparison with other countries and can guide further research dealing with preferences for solitude. We demonstrated the importance of several sociodemographic factors (e.g., marital status), lifestyle-related factors (e.g., sports activity), and health-related factors (e.g., depressive symptoms) for the preference for solitude. Such knowledge about the correlates of preference for solitude may help to characterize them. This is essential to ensure a good balance between social interaction and being alone. This is important because preference for solitude is associated with poor self-rated health and depression, but also with healthy behaviors such as abstaining from smoking and drinking.

Longitudinal Associations Between Food Insecurity and Mental Health in Aging Adults in South Africa.

OBJECTIVES: The aim of this study was to assess the longitudinal unidirectional and bidirectional associations between food insecurity and mental health among aging adults in South Africa. METHODS: The analysis utilized data from the South African 7-year longitudinal Health and Ageing in Africa (HAALSI) study. RESULTS: The proportion of food insecurity was 20.2% in 2015, 24.1% in 2019 and 18.4% in 2021/2022. Food insecurity was positively associated depressive symptoms, poor life satisfaction, poor sleep quality, PTSD, loneliness, impaired cognition, and current tobacco use. Compared to without food insecurity in all three study waves, having food insecurity in one wave and/or two to three waves was positively associated with incident depressive symptoms, incident poor life satisfaction, incident poor sleep quality, incident PTSD, incident loneliness, incident current tobacco use, and incident current heavy alcohol use. PTSD, impaired cognition, current tobacco use and current heavy alcohol use were positively associated with incident food insecurity. CONCLUSION: We found that food insecurity was unidirectionally associated with depressive symptoms, poor life satisfaction, poor sleep quality and loneliness, and bidirectionally associated with PTSD, impaired cognition, current tobacco use and current heavy alcohol use. CLINICAL IMPLICATIONS: Enhanced screening and management of food insecurity may reduce mental ill-health in South Africa.

Age-related Disparities in Pan-Cancer Mortality and Causes of Death: Analysis of Surveillance, Epidemiology, and End Results (SEER) Data.

Comprehensive analysis of mortality and causes of death (COD) in cancers was of importance to conduct intervention strategies. The current study aimed to investigate the mortality rate and COD among cancers, and to explore the disparities between age. Initially, cancer patients diagnosed between 2010 and 2019 from the surveillance, epidemiology, and end results (SEER) database were extracted. Then, frequencies and percentage of deaths, and mortality rate in different age groups were calculated. Meanwhile, age distribution of different COD across tumor types was illustrated while the standardized mortality ratios (SMR) stratified by age were calculated and visualized. A total of 2,670,403 death records were included and digestive system cancer (688,953 death cases) was the most common primary cancer type. The mortality rate increased by 5.6% annually in total death, 4.0% in cancer-specific death and 10.9% in non-cancer cause. As for cancer-specific death, the age distribution varied among different primary tumor types due to prone age and prognosis of cancer. The top five non-cancer causes in patients older than 50 were cardiovascular and cerebrovascular disease, other causes, COPD and associated conditions, diabetes as well as Alzheimer. The SMRs of these causes were higher among younger patients and gradually dropped in older age groups. Mortality and COD of cancer patients were heterogeneous in age group due to primary tumor types, prone age and prognosis of cancer. Our study conducted that non-cancer COD was a critical part in clinical practice as well as cancer-specific death. Individualized treatment and clinical intervention should be made after fully considering of the risk factor for death in different diagnosis ages and tumor types.

Rural-urban health differences among aging adults in India.

Background: The aim of this study was to determine the rural-urban health differences among aging adults in India. Methods: The national cross-sectional data of 67,489 individuals (≥45 years) in 2017-2018 from 35 states and union territories of India (excluding Sikkim) in 2017-2018 were analysed. Various sociodemographic data, well-being indicators, lifestyle factors and physical conditions were assessed by face-to-face interviews and physical measurement. Univariable and multivariable logistic regression was utilized to assess the predictors between residence status (rural dweller, urban migrant, and urban dweller) and various health indicator outcomes. Results: Majority (70.4 %) of the participants lived in rural areas, 10.3 % were urban migrants and 19.3 % urban dwellers. In the multivariable logistic regression analysis, urban migrants and urban dwellers had a higher self-rated health status, cognitive functioning, physical inactivity, overweight or obesity and abdominal obesity than rural dwellers, while urban migrants and/or urban dwellers had lower functional disability, insomnia symptoms, current smokeless tobacco use, current smoking, heavy episodic drinking and underweight than rural dwellers. Furthermore, urban migrants and/or urban dwellers had higher odds of diabetes, hypertension, heart disease, cancer, high cholesterol than rural dwellers, while urban migrants and/or urban dwellers had lower odds of persistent headaches, major injury, recurrent fall, physical pain, periodontal disease, vision impairment, and gastrointestinal problems than rural dwellers. Conclusion: Among 30 health indicators assessed, 16 had an urban migrant and/or urban dweller advantage, 8 had urban migrant and/or urban dweller penalty, and 6 did not differ between rural-urban groups. Public health promotion and health care should address differing health care needs of rural and urban middle-aged and older adults.

Suicidal behaviour among adults in Cabo Verde in 2020.

BACKGROUND: The aim of the investigation was to evaluate past 12-month suicidal behaviour (PSB) among adults in Cabo Verde. METHODS: Data from 4,563 adults (mean age 41.4 years) that participated in the 2020 Cabo Verde STEPS survey were analysed. RESULTS: Results indicate that the proportion of PSB (attempt 0.6%, plan 1.5% and ideation 3.3%) was 3.7% (2.4% men/5.0% women). In adjusted logistic regression analysis, younger age, female sex, unemployed, widowed or divorced, alcohol family problem, heart attack, angina or stroke, current smokeless tobacco use and low fruit/vegetable intake were associated with PSB. CONCLUSION: Almost 4% of participants had PSB and several associated factors were identified that can guide public health interventions.

Longitudinal Correlates of Grandparenting with Depressive Symptoms and Poor Sleep Quality Among Middle-Aged and Older Women and Men in South Africa.

OBJECTIVES: The study aimed to assess the impact of grandparenting on incident depressive symptoms and incident poor sleep quality among aging women and men in rural South Africa. METHODS: This longitudinal community study enrolled 3,237 adults (≥40 years) from the "Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI)." MEASUREMENTS: Grandparenting was assessed by self-report at wave 1, and depressive symptoms and poor sleep quality at waves 1 and 2. Outcomes were incident depressive symptoms and incident poor sleep quality at wave 2. Logistic regression was utilized to estimate the associations between grandparenting and incident depressive symptoms and incident poor sleep quality. RESULTS: Almost half of the grandfathers (44.6%) and 68.4% of the grandmothers were parenting 7/days/week. In the final adjusted models, among grandmothers, compared to 0 days/week grandparenting, 7 days/week grandparenting reduced the odds of incident depressive symptoms (AOR: 0.71, 95% CI: 0.55 to 0.91) and reduced the odds of incident poor sleep quality (AOR: 0.58, 95% CI: 0.40 to 0.82). CONCLUSION: Grandparenting significantly reduced poor mental health among grandmothers but not among grandfathers. CLINICAL IMPLICATIONS: Practitioners may encourage grandparent caregiving, among grandmothers, to reduce poor mental health in South Africa.

Lifestyle factors and incident functional disability among a rural ageing population in South Africa.

OBJECTIVE: The study aimed to assess the relationship between lifestyle factors and incident functional disability in South Africa. METHODS: Longitudinal data (N = 4113) from two consecutive waves in 2014/2015 and 2018/2019 in Agincourt, South Africa, were analysed. RESULTS: Moderate sedentary behaviour (AOR: 1.84, 95% CI: 1.31-2.58) and being overweight (AOR: 1.61, 95% CI: 1.10-2.36) increased the odds of incident functional disability among men. Moderate and high sedentary behaviour (AOR: 1.83, 95% CI: 1.31, 2.57, and AOR: 1.83, 95% CI: 1.08-3.10) increased the odds, and frequent fruit intake (AOR: 0.41, 95% CI: 0.19-0.91) and moderate physical activity (AOR: 0.47, 95% CI: 0.30-0.75) decreased the odds of incident functional disability among women. CONCLUSIONS: Sedentary behaviour and being overweight increased odds, and physical activity and frequent fruit intake decreased odds of incident functional disability among ageing men and/or women in South Africa.

Chronic conditions and incident and persistent depressive symptoms among ageing adults in rural South Africa.

The study aimed to assess associations between chronic diseases and incident and persistent depressive symptoms (DSs) in a cohort study of ageing adults in South Africa. Participants in the baseline survey (in 2014/2015) were 5,059 persons (≥40 years) and at follow-up 4,176 (in 2018/2019). DSs were measured with the Center for Epidemiological Studies Depression scale. Logistic regression was used to estimate the associations between chronic conditions and incident and persistent DS. The prevalence of DS at baseline was 15.5%, incident DS (without DS and/or PTSD at baseline) was 25.1% and persistent DS (DS at both baseline and follow-up) was 4.8%. In unadjusted logistic regression analysis, diabetes had higher odds of incident DS. Participants with baseline heart attack/stroke/angina, dyslipidemia, tuberculosis, chronic bronchitis, kidney disease and three or more chronic conditions had a higher probability of persistent DS. In conclusion, of the eight chronic conditions evaluated, only diabetes (in unadjusted analysis) was associated with incident DS, and five chronic conditions (heart attack/stroke/angina, dyslipidaemia, tuberculosis, chronic bronchitis and kidney disease) and three or more chronic conditions were associated with persistent DS.

Associations of history of intimate partner violence with mental ill-health and lifestyle factors in middle-aged and older men and women in South Africa.

OBJECTIVES: The aim of this study was to assess the association between history of intimate partner violence (IPV) exposure and mental and lifestyle factors among middle-aged and older men and women in rural South Africa. METHODS: The analysis utilized data from wave 3 of the longitudinal Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) (n = 3,707, median age 66 years, range 46-118 years). History of IPV was assessed with five questions on physical, sexual, psychological, and economic IPV. Logistic regression was used to assess the association between history of IPV exposure and mental and lifestyle factors. RESULTS: Among men 7.8% and among women 10.9% reported a history of IPV. In terms of mental health outcomes, in the final adjusted model, among men, exposure to 1 and/or 2-4 types of IPV were associated with depressive symptoms, insomnia symptoms, PTSD, and loneliness, while among women, exposure to 1 and/or 2-4 types of IPV was associated with insomnia symptoms and PTSD. In terms of lifestyle outcomes, in the final adjusted model, among men, 2-4 types of IPV were associated current tobacco use, current heavy alcohol use, inadequate fruit intake, and food insecurity, and among women, 1 and/or 2-4 types of IPV were associated with soft drink intake, and food insecurity. CONCLUSION: We found that lifetime exposure to IPV was associated with several mental and lifestyle factors in middle-aged and older men and women. Enhanced screening and treatment of IPV may reduce poor mental and health risk behavior among this aging male and female population in South Africa.

Marital status, marital transition and health behaviour and mental health outcomes among middle-aged and older adults in Thailand: A national longitudinal study.

OBJECTIVES: The aim of this study was to assess the longitudinal association between marital status, marital transition, mental ill-health, and health risk behaviours among middle-aged and older adults in Thailand. METHODS: We analyzed prospective cohort data of participants 45 years and older from three consecutive waves in 2015, 2017, and in 2020 (analytic sample, n = 2863) of the Health, Aging and Retirement in Thailand (HART) study. Sociodemographic and health variables were assessed by self-report. RESULTS: Being single was positively associated with current smoking among men and transitioning to widowed or divorced was associated with incident current smoking among women. Divorced or separated was positively associated with current alcohol use among men and transitioning to marriage was associated with incident alcohol use among women. Being single or widowed was positively associated with underweight and negatively associated with obesity among women. Men who were divorced, single, or widowed had higher odds of having depressive symptoms and among women, transitioning to being widowed or divorced or separated was associated with incident depressive symptoms. Among both men and women, being divorced, single or widowed were positively associated with poor quality of life/happiness, and among men being divorced, single or widowed was positively associated with loneliness, and among women, being single or widowed was positively associated with loneliness. Among men, being single was positively associated with having an emotional or psychiatric disorder. CONCLUSION: We found among men and/or women that being unmarried was associated with several health risk behaviours and mental-ill health indicators.

Stakeholder-Informed Solutions To Address Barriers for Alcohol Screening and Brief Intervention in Thai Hypertension Care.

Premature deaths from NCDs disproportionately affect people in low- and middle-income countries. Since alcohol use is one of the most common causes of reversible hypertension, interventions targeting alcohol use may be a feasible and effective low-cost approach to synergistically reduce the prevalence of harmful drinking and high blood pressure. This study sought to identify key factors in successfully implementing alcohol use screening and brief intervention in hypertension care in Thailand. For this purpose, we surveyed participants (NRound 1 = 91, NRound 2 = 27) from three different groups of Thai stakeholders (policy- and decisionmakers, primary healthcare practitioners, and patients diagnosed with hypertension) in a two-round stakeholder elicitation. In round 1, we identified limited resources, lack of clear guidelines for lifestyle intervention, stigmatization, and inconsistent monitoring of patients' alcohol use as important barriers. In round 2, we sought to elicit solutions for the barriers identified in round 1. While stakeholders emphasized the need for adaptability to existing realities in Thai primary healthcare such as a high workload and limited digitization, they favorably evaluated a digital alcohol assessment tool with integrated, tailored advice for brief intervention as a potential scalable solution. Findings suggest that as one possible route to reduce the NCD burden caused by hypertension in Thailand, primary healthcare services may be enhanced by digital tools that support resource-effective, intuitive, and seamless delivery of alcohol screening and brief intervention.

Prevalence and correlates of unintentional nonfatal injuries among school-going adolescents in Central America.

OBJECTIVES: The aim of this study is to report on the frequency of serious physical injuries (SPI) among adolescents in Central America during the previous decade, 2009-2018. METHODS: In total, 15,807 school adolescents (14.4 years mean age; SD=1.4) from six Central American countries participated in cross-sectional Global School-based Student Health Surveys in 2009-2018 (ranging from 1,779 students in Honduras in 2012 to 4,374 students in Guatemala in 2015). RESULTS: The prevalence of SPI was 33.8 % (22.9 % once, 7.4 % 2 or 3 times and 3.6 % 4 or more times), ranging from 31.8 % in Guatemala to 45.0 % in Belize and 45.6 % in Panama. The most frequent causes of SPI included fall (11.4 %, ranging from 6.9 % in Costa Rica to 15.6 % in Panama), and the type of SPI was fracture/dislocation (5.7 %, ranging from 4.3 % in Costa Rica to 6.7 % in Panama). In adjusted Poisson regression, male sex, food insecurity, a history of alcohol intoxication, soft drink consumption, fast food intake, truancy, multiple sexual partners, psychological distress, physical fight, physically attacked, bullied, and suicide attempt were significantly associated with a higher number of injury event counts. CONCLUSIONS: Overall, about one in three adolescents in Central America had sustained unintentional injuries in the past 12 months and several contributing factors were identified which if addressed could aid injury prevention among adolescents.

Prevalence and correlates of psychological distress among national community-based adult populations in Nauru, Tukelau and Tuvalu.

AIMS: The aim of the study was to estimate the prevalence and correlates of psychological distress (PD) in three small Pacific Island countries. METHOD: National cross-sectional data (pooled sample N = 3,088, 18-69 years) of participants from the STEPS surveys in Nauru (2015/16; N = 1382), Tukelau (2014; N = 554) and Tuvalu (2015; N = 1152) were analysed. RESULTS: In the pooled sample 30.4% participants had PD (⩾20 scores), 18.1% mild (20-24 scores), 7.8% moderate (25-29 scores) and 4.4% severe (30-50 scores) PD. The prevalence of PD in Nauru was 41.5%, in Tukelau 5.0% and in Tuvalu 22.7%. In the adjusted logistic regression analysis with the pooled sample, younger age (18-39 years), alcohol family problems, heart attack/stroke, current smoking, high salt intake and high sedentary behaviour were positively associated with PD, while male sex and being from Tukelau and Tuvalu were negatively associated with PD. CONCLUSION: Almost one in three participants reported PD and several associated factors were found that can be targeted in population interventions.

Health risk behaviour and persistent and incident depression among middle-aged and older adults in South Africa.

The aim of this study was to assess the association between five health risk behaviours and persistent and incident depressive symptoms in a longitudinal study in South Africa. The sample included 5059 men and women (≥40 years) in 2014/2015, and 4176 in 2018/2019 of the 'Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa'. Depressive symptoms were assessed with the Centre for Epidemiologic Studies Depression scale. Multivariable logistic regression analysis was conducted to assess the associations between five health risk behaviours and persistent and incident depressive symptoms. Results indicate that 5.0% of participants had depressive symptoms at both wave 1 and 2 (persistent depressive symptoms), and 27.9% had incident depressive symptoms in wave 2. Higher education and moderate baseline physical activity were negatively associated and those with cardiovascular disease were positively associated with persistent depressive symptoms. Middle wealth index was negative, and being HIV positive and baseline tobacco use were positively associated with incident depressive symptoms. In conclusion, of five health risk behaviours assessed (inadequate fruit/vegetable intake, alcohol dependence, tobacco use, physical activity, and sedentary behaviour), only moderate physical activity was protective against persistent depressive symptoms, and tobacco use was associated with incident depressive symptoms.

Impact of Somatic Conditions and Lifestyle Behaviours on Depressive Symptoms and Low Life Satisfaction among Middle-Aged and Older Adult Men in South Africa.

Objective: The purpose of this study was to assess the association between somatic disorders, lifestyle factors, incident and persistent depressive symptoms, and low life satisfaction in a longitudinal study in South Africa. Methods: We analyzed longitudinal data from two consecutive waves, 2346 men aged 40 years or older in 2014/2015 in wave 1 and 1864 men of wave 1 in 2018/2019 in wave 2 of the "Health and Ageing in Africa: A Longitudinal Study of an International Network for the Demographic Evaluation of Populations and their Health (INDEPTH) Community in South Africa (HAALSI)". Results: In total, 360 of 1932 male participants without depressive symptoms in wave 1 (24.3%) had incident depressive symptoms in wave 2 and 77 of 349 men had depressive symptoms in both waves 1 and 2 (persistent depressive symptoms). In all, 457 of 1258 male participants without low life satisfaction in Wave 1 (47.6%) had incident low life satisfaction in Wave 2, and 360 of 998 men had low life satisfaction at both Wave 1 and 2 (persistent low life satisfaction). In the unadjusted logistic regression analysis, having kidney disease and living with HIV had greater odds of incident depressive symptoms. In adjusted analysis, alcohol dependence (Adjusted Odds Ratio-AOR: 4.54, 95% Confidence Interval-CI: 1.05-19.66) was positively correlated and 1-7 and 8-11 years of education (AOR: 0.45, 95% CI: 0.27-0.74, and AOR: 0.20, 95% CI: 0.07-0.54, respectively) were negatively associated with persistent depressive symptoms. Increasing age increased the odds (AOR: 1.03, 95% CI: 1.01-1.04), while higher education (≥12 years) (AOR: 0.50, 95% CI: 0.33-0.76), and high physical activity (AOR: 0.68, 95% CI: 0.52-0.89) decreased the odds of incident low life satisfaction. Increasing age (AOR: 1.03, 95% CI: 1.02-1.04) and tobacco use (AOR: 1.64, 95% CI: 1.23-2.19) increased the odds and high physical activity (AOR: 0.73, 95% CI: 0.56-0.96) decreased the odds of persistent low life satisfaction. Conclusions: Of the seven chronic conditions and five lifestyle factors evaluated, alcohol dependence increased the odds of persistent depressive symptoms and low physical activity, and tobacco use increased the odds of incident and/or persistent low life satisfaction among men in rural South Africa.

Longitudinal associations of loneliness with mental ill-health, physical ill-health, lifestyle factors and mortality in ageing adults in Thailand.

OBJECTIVES: The aim of this study was to assess the longitudinal association between loneliness, mental and physical ill-health indicators, lifestyle factors and mortality among middle-aged and older adults in Thailand. METHODS: We analyzed prospective cohort data of participants 45 years and older from three consecutive waves in 2015 (n = 5616), 2017 (n = 3600), and in 2020 (n = 2863) of the Health, Aging and Retirement in Thailand (HART) study. Loneliness was assessed with a single item. To assess the longitudinal associations between loneliness and health outcomes between 2015 (baseline), 2017 (first follow-up) and 2020 (second follow-up), we conducted Generalized Estimating Equations analysis (GEE). RESULTS: The proportion of loneliness was 21.6% in 2015, 23.8% in 2017 and 21.3% in 2020. In the adjusted GEE logistic regression model, loneliness was positively associated with mental ill-health (poor self-rated mental health status, poor quality of life/happiness, depressive symptoms, and insomnia symptoms), physical ill-health (poor self-rated physical health status, hypertension, kidney disease, osteoporosis, and ADL disability), and lifestyle factors (physical inactivity, and having underweight). Furthermore, in adjusted Cox proportional hazards regression, loneliness was associated with mortality. In adjusted logistic regression, compared to without loneliness in all three study waves, having loneliness in one wave and/or two to three waves was positively associated with incident mental ill-health (incident poor self-rated mental health status, incident poor quality of life/happiness, incident depressive symptoms, and incident insomnia symptoms), incident physical ill-health (incident poor self-rated physical health status, incident diabetes, incident kidney disease, and incident ADL disability), and incident lifestyle factors (having incident underweight). CONCLUSION: We found that loneliness was associated with several mental and physical ill-health indicators, lifestyle factors and mortality. Enhanced screening and treatment of loneliness may reduce mental and physical ill-health indicators in Thailand.

High sedentary behavior and low physical activity among adults in Afghanistan: results from a national cross-sectional survey.

Objective: The study aimed to evaluate the prevalence and correlates of sedentary behavior and combination of sedentary behavior and low physical activity among adults in Afghanistan in 2018. Methods: This was a national representative cross-sectional study. The study utilized the data from Afghanistan STEPS survey 2018, where 3,956 adults (ages between 18 and 69 years) were interviewed at community-dwelling level. Using the Global Physical Activity Questionnaire, we have calculated the sedentary behavior and physical inactivity. Logistic regression was applied to investigate factors associated high sedentary behavior and low physical activity. Results: Approximately half of the participants (49.8%) exhibited high levels of sedentary behavior, 40.3% low physical activity and 23.5% had both high sedentary behavior and low physical activity. Adjusted logistic regression analysis revealed that individuals who were employed (AOR: 0.34, 95% CI: 0.13-0.88) or self-employed (AOR: 0.60, 95% CI: 0.38-0.94) had significantly lower odds of both high SB and low physical activity than those whose work status was unpaid. Furthermore, older age (AOR: 1.75, 95% CI: 1.35-2.28), urban residence (AOR: 3.17, 95% CI: 1.72-6.05), having 4 or 5 adult household members (AOR: 1.77, 95% CI: 1.21-2.58) and being underweight (AOR: 1.78, 95% CI: 1.02-3.12) were found to be associated with high sedentary behavior. Moreover, factors such as female sex, having 4 or 5 or 6 or more adult household members, urban residence, overweight, and diabetes were positively associated, and male sex (AOR: 0.24, 95% CI: 0.12-0.51), being employed (AOR: 0.34, 95% CI: 0.13-0.88) or self-employed (AOR: 0.60, 95% CI: 0.38-0.94) were negatively associated with the occurrence of combination of high sedentary behavior and low physical activity. Conclusion: Half of the participants had high sedentary behavior, and one in four had both high sedentary behavior and low physical activity together. These findings emphasize the importance of targeted interventions aimed at reducing sedentary behavior and promoting physical activity, particularly among vulnerable populations such as females, individuals from lower socioeconomic background, urban residents, and those with chronic conditions. Addressing these factors can contribute to improving public health outcomes and reducing negative health impacts of sedentary behavior in Afghanistan.