Urbanicity of residence and depression among adults 50 years and older in Ghana and South Africa: an analysis of the WHO Study on Global AGEing and Adult Health (SAGE).

OBJECTIVES: As the primary cause of disability worldwide, depression is a significant contributor to global morbidity and mortality and often disproportionately affects older adults. Several studies have demonstrated a link between urban residence and depression, but few studies have examined this association among older adult populations, and even fewer have studied it within an African context. Given that African societies are aging and urbanizing at rapid rates, this study aimed to assess the relationship between urbanicity and depression within older adult populations in two African countries. METHOD: Data were drawn from the Ghana and South Africa samples of the World Health Organization Study on Global AGEing and Adult Health (SAGE) wave 1 (2007-2008). Depression over the past 12 months was measured using self-reported treatment and depressive symptoms based on ICD-10 criteria in 4209 Ghanaian and 3148 South African adults aged 50 years and older residing in their current location for over one year. RESULTS: The 12-month prevalence of depression was 7.5% and 4.0% in Ghana and South Africa, respectively; 41.1% and 65.6%, respectively, lived in urban areas. Comparing urban to rural residents, the adjusted odds ratio (OR) for depression in multivariable analysis was 1.13 (95% CI: 0.71-1.79) in South Africa and 0.85 (95% CI: 0.55-1.31) in Ghana. CONCLUSION: Results do not support a significant urban-rural difference in 12-month depression among Ghanaian or South African SAGE participants. Mental health resources in rural areas should therefore be enhanced in these countries for more equitable distributions between the two settings given similar need.

Lack of Reliable Transportation for Daily Living Among Adults: United States, 2022.

Access to transportation may be required for many daily tasks, including going to work, health care visits, and obtaining groceries. Previous research suggests that a lack of transportation, especially among adults who are older, uninsured, and have lower incomes, leads to reduced access to health care, which may then lead to adverse health outcomes (1,2). Using data from the 2022 National Health Interview Survey, this report describes the percentage of adults who lacked reliable transportation for daily living in the past 12 months by selected sociodemographic and geographic characteristics.

Neonatal outcomes after antenatal influenza immunization during the 2009 H1N1 influenza pandemic: impact on preterm birth, birth weight, and small for gestational age birth.

BACKGROUND: Influenza infection during pregnancy is associated with adverse fetal outcomes such as preterm birth and small for gestational age (SGA). Maternal influenza immunization may prevent these adverse infant outcomes during periods of influenza circulation. METHODS: We conducted a retrospective cohort study of live births within Kaiser Permanente (KP) Georgia and Mid-Atlantic States (n = 3327) during the period of 2009 influenza A (H1N1) virus circulation. Primary outcomes were third-trimester preterm birth (27-36 weeks), birth weight, low birth weight (LBW, <2500 g), and SGA. RESULTS: There were 327 (9.8%) preterm, 236 (7.4%) LBW, and 267 (8.4%) SGA births. Among H1N1-vaccinated mothers (n = 1125), there were 86 (7.6%) preterm, 68 (6.4%) LBW, and 99 (9.3%) SGA births, and the mean birth weight was 3308.5 g (95% confidence interval [CI], 3276.6-3340.4). Among unvaccinated mothers (n = 1581), there were 191 (12.1%) preterm, 132 (8.8%) LBW, and 123 (8.2%) SGA births, and the mean birth weight was 3245.3 g (95% CI, 3216.5-3274.2). Infants of H1N1-vaccinated mothers had 37% lower odds of being born preterm than infants of unvaccinated mothers (adjusted odds ratio, 0.63 [95% CI, .47-.84]). The mean birth weight difference between infants of H1N1-vaccinated mothers and infants of unvaccinated mothers was 45.1 g (95% CI, 1.8-88.3). There was no significant association between maternal H1N1 influenza immunization and LBW or SGA. CONCLUSIONS: Pregnant women who received H1N1 influenza vaccine were less likely to give birth preterm, and gave birth to heavier infants. The findings support US vaccine policy choices to prioritize pregnant women during the 2009 influenza A (H1N1) pandemic.

Health Conditions and Health Care Use Among American Indian and Alaska Native Adults by Tribal Land Residential Status: United States, 2019-2021.

Objective-This report presents estimates for selected health conditions and health care use among American Indian and Alaska Native (AIAN) adults by tribal land residential status.

Demographic Differences in Life Dissatisfaction Among Adults: United States, 2021.

Objective-Previous work has established life satisfaction as an important indicator of overall health and well-being. This report describes differences in life dissatisfaction by selected characteristics, grouped by family income. Methods-Data from the 2021 National Health Interview Survey were used to examine the percentage of adults that were dissatisfied with life by selected demographic characteristics (age, sex, race and Hispanic origin, and nativity status [born in the United States or U.S. territory]), grouped by family income. Results-In 2021, 4.8% of adults were dissatisfied with life. In general, analyses showed significant differences by all selected demographic characteristics among adults with incomes of less than 200% of the federal poverty level. Among this group, men, adults ages 45-64, White non-Hispanic adults, Black non-Hispanic adults, and adults born in the United States were more likely to be dissatisfied with life compared with their counterparts. No significant differences in life dissatisfaction by selected demographic characteristics among adults with incomes greater than 200% of the federal poverty level were observed. Conclusion-This report presents estimates of life dissatisfaction among adults by demographic subgroups and family income. These results highlight the importance of monitoring life dissatisfaction among detailed subgroups grouped by income, in addition to the overall national estimate.

Long COVID in Children: United States, 2022.

While most individuals who contract COVID-19 feel better within a few weeks, others have new, returning, or ongoing symptoms that they did not have before COVID-19, which is often referred to as Long COVID (1). This report describes the percentage of children ages 0-17 years who ever had Long COVID or had Long COVID at the time of interview (currently have Long COVID) based on parent-reported data from the 2022 National Health Interview Survey (NHIS). Long COVID was defined as the presence of symptoms for at least 3 months after having COVID-19 among those who received either a positive test or a doctor's diagnosis of COVID-19.

Long COVID in Adults: United States, 2022.

People who have had COVID-19 may continue to have symptoms or develop new symptoms months after being infected with SARS-CoV-2 (1). This can lead to long-term health and economic impacts on those affected and on society (2). This report uses data from the 2022 National Health Interview Survey to describe the percentage of adults who ever had or had Long COVID at the time of interview (currently have Long COVID) by sociodemographic and geographic characteristics. Long COVID was defined as self-reporting the presence of symptoms for at least 3 months after having COVID-19 among those who reported either a positive test or a doctor's diagnosis of COVID-19.

The perceived neighborhood walking environment and self-reported sleep health in a nationally representative sample of the United States.

Neighborhood environment can influence sleep health; yet, there is a lack of data on specific environment features in nationally representative samples. We used the 2020 National Health Interview Survey to determine associations between perceived built and social environment factors related to pedestrian access (walking paths, sidewalks), amenities (shops, transit stops, entertainment/services, places to relax), and unsafe walking conditions (traffic, crime) and self-reported sleep duration and disturbances. Places to relax and pedestrian access were associated with better sleep health while unsafe walking conditions were associated with worse sleep health. Access to amenities (shops, transit stops, entertainment venues) had null associations with sleep health.

Safety of influenza immunization during pregnancy for the fetus and the neonate.

Since the 1960s, pregnant women in the United States have been recommended to receive influenza vaccine. A maternal concern about the possibility of adverse fetal and neonatal outcomes after the vaccination of pregnant women has been cited as a reason for low maternal influenza vaccination coverage. Recent research has identified benefits to the fetus and neonate after maternal influenza vaccination that have prompted efforts to increase coverage in pregnant women. There is a long history of research findings that highlight the safety of vaccinating pregnant women. This review summarizes nearly 40 years of research on influenza vaccination of pregnant women and the lack of association with adverse fetal or neonatal outcomes. Future research should focus on vaccinations that are given in the first trimester of pregnancy and on product-specific analyses to account for differences in manufacturing processes.

Sleep Difficulties in Adults: United States, 2020.

The American Academy of Sleep Medicine and the Sleep Research Society recommend adults sleep at least 7 hours a night (1); over one-quarter of adults do not meet this recommendation (2). Signs of good sleep quality include taking less time to fall asleep and not waking up often or for long periods (3). This report uses 2020 National Health Interview Survey (NHIS) data to describe the prevalence of sleep difficulties, defined here as trouble falling or staying asleep most days or every day in the past 30 days, among adults in the United States by sociodemographic and geographic characteristics.

Regular Bedtimes Among Children Aged 5-17 Years: United States, 2020.

The American Academy of Sleep Medicine recommends 9-12 hours of sleep for children aged 6-12 years and 8-10 hours for those aged 13-18 (1), yet only two-thirds of children meet these recommendations (2). This report uses 2020 National Health Interview Survey (NHIS) data to describe regular bedtimes, defined as going to sleep at the same time most days or every day in a typical school week, among children aged 5-17 years. Estimates are presented by sociodemographic characteristics, family type, Social Vulnerability Index (SVI), family income, and urbanicity of residence.

Dental Care Utilization Among Children Aged 1-17 Years: United States, 2019 and 2020.

The American Academy of Pediatric Dentistry recommends regular preventive dental examinations and cleanings for children starting from the time their first tooth appears or by age 1 year (1). In 2020, dental practices adjusted their services in response to the COVID-19 pandemic, and access to dental care was disrupted for many Americans (2,3). This report uses data from the 2019 and 2020 National Health Interview Survey (NHIS) to describe recent changes in the prevalence of dental examinations or cleanings in the past 12 months among children aged 1-17 years by selected sociodemographic characteristics.

Urgent Care Center and Retail Health Clinic Utilization Among Adults: United States, 2019.

Urgent care centers and health clinics within grocery or retail stores can provide acute health care services for nonemergencies, and they can also provide preventive care services, such as routine vaccinations (1). The availability and utilization of urgent care has risen dramatically in recent years (1,2). This report examines urgent care center and retail health clinic visits among adults in the past 12 months by sex and selected characteristics.

Residence in urban and rural areas over the life course and depression among Ghanaian and South African older adults.

This study assessed associations between depression and urban/rural residence from a life-course perspective within African settings. Data on Ghanaian and South African adults aged 50 years and older were taken from wave 1 of the World Health Organization Study on Global Ageing and Adult Health (SAGE). Neither urbanicity of childhood nor adulthood residence was associated with later-life depression in either country. Significant differences were also not observed for residence changes over the life course, but there were trends in the data suggestive of higher depression prevalence in Ghanaian recent rural-urban migrants and lower prevalence among South African recent urban-rural migrants.

Effect of cognitive and structural social capital on depression among older adults in Ghana: A multilevel cross-sectional analysis.

Evidence from existing studies suggests social capital has mixed effects on depression and other common mental disorders. There is little knowledge of the possible association between social capital and depression among the growing older population in sub-Saharan Africa. This study investigates the effect of cognitive social capital (trust and sense of safety) and structural social capital (social participation or engagement in social activities) on depression among older adults in Ghana. Utilizing multilevel mixed-effect analysis, we investigate the effect of individual-level and neighborhood-level social capital (cognitive and structural) on depression using data from the World Health Organization Study on Global Ageing and Adult Health (WHO-SAGE) survey (Wave 1). The findings show that at an individual level, older adults who felt safe at home were less likely to have depression. We observed mixed results for elements of structural social capital at the individual level. Older adults who frequently engaged in club or group meetings, worked with neighbors and engaged in social outings were more likely to have depression; while attending public meetings and socializing with co-workers were associated with reduced likelihood of having depression. At the neighborhood level, increased trust in neighbors was associated with an increased likelihood of having depression (OR = 1.01, p < 0.05) while higher levels of neighborhood safety and structural social capital were associated with a reduced likelihood of having depression. The findings suggest that the differential associations between elements of social capital and depression may be the result of contextual factors.

Assessing urban-rural differences in the relationship between social capital and depression among Ghanaian and South African older adults.

INTRODUCTION: Research has demonstrated benefits of social capital on depression, but variations in this relationship by geographic characteristics such as urbanicity have rarely been investigated. METHODS: Using survey data on 4,209 Ghanaian and 3,148 South African adults aged 50 and above from the World Health Organization (WHO) Study on Global AGEing and Adult Health (SAGE), exploratory and confirmatory factor analyses were conducted to extract dimensions of social capital from survey items. Structural equation models with the extracted factors were then used to estimate the associations between social capital and depression in each sample and assess differences between urban and rural settings with measurement and structural invariance tests. RESULTS: Factor analyses suggested three dimensions of social capital representing community engagement, sociability, and trust. Urbanicity did not substantially modify the effects of social capital on depression in either setting, but urban-rural differences in the measurement and level of social capital were observed. Urban Ghanaian older adults were less socially integrated and trusting than older rural residents (standardized mean difference: -0.28, -0.24, and -0.38 for community engagement, sociability, and trust, respectively) while urban South African older adults appeared less engaged in community activities but significantly more trusting and socially active informally than older rural residents (standardized mean difference: -0.33, 0.30, and 0.17 for community engagement, sociability, and trust, respectively). Moreover, while trust was associated with a lower risk of depression in South Africa overall, sociability and trust were associated with an increased risk of depression in Ghana. CONCLUSIONS: Results indicate that the composition and average levels of social capital differ between urban and rural older adult residents in Ghana and South Africa although urban-rural differences in the strength of the association between social capital and depression were not substantial. Furthermore, the associations between social capital and depression are context-specific and are not uniformly beneficial.

Using the Bayesian Improved Surname Geocoding Method (BISG) to create a working classification of race and ethnicity in a diverse managed care population: a validation study.

OBJECTIVE: To validate classification of race/ethnicity based on the Bayesian Improved Surname Geocoding method (BISG) and assess variations in validity by gender and age. DATA SOURCES/STUDY SETTING: Secondary data on members of Kaiser Permanente Georgia, an integrated managed care organization, through 2010. STUDY DESIGN: For 191,494 members with self-reported race/ethnicity, probabilities for belonging to each of six race/ethnicity categories predicted from the BISG algorithm were used to assign individuals to a race/ethnicity category over a range of cutoffs greater than a probability of 0.50. Overall as well as gender- and age-stratified sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Receiver operating characteristic (ROC) curves were generated and used to identify optimal cutoffs for race/ethnicity assignment. PRINCIPAL FINDINGS: The overall cutoffs for assignment that optimized sensitivity and specificity ranged from 0.50 to 0.57 for the four main racial/ethnic categories (White, Black, Asian/Pacific Islander, Hispanic). Corresponding sensitivity, specificity, PPV, and NPV ranged from 64.4 to 81.4 percent, 80.8 to 99.7 percent, 75.0 to 91.6 percent, and 79.4 to 98.0 percent, respectively. Accuracy of assignment was better among males and individuals of 65 years or older. CONCLUSIONS: BISG may be useful for classifying race/ethnicity of health plan members when needed for health care studies.

Effectiveness of pneumococcal conjugate vaccine in infants by maternal influenza vaccination status.

BACKGROUND: Influenza virus infection can predispose patients to secondary pneumococcal infections. Children are at greatest risk for pneumococcal infection in the first year of life and are not considered fully protected by pneumococcal conjugate vaccine (PCV) until their third dose at 6 months of age. Infants less than 6 months cannot receive influenza vaccination, though maternal influenza vaccination can protect infants. METHODS: We conducted a retrospective cohort study of 9807 mother-infant pairs enrolled in a managed care organization for infants born June 1, 2002, to December 31, 2009. Exposure was assessed for receipt of infant PCV only and the combination of PCV and maternal influenza vaccine (trivalent inactivated vaccine). Outcomes of interest were acute otitis media and medically attended acute respiratory infection in the first year of life. We estimated the adjusted incidence of illness, incidence rate ratios and vaccine effectiveness using the ratio of incidence rate ratios between the periods of noncirculating influenza and that of at least local influenza circulation. RESULTS: For medically attended acute respiratory infection, vaccine effectiveness for the combination of trivalent inactivated vaccine and PCV was 39.6% (95% confidence interval [CI]: 31.6%-46.7%) and for PCV only was 29.8% (95% CI: 11.4%-44.3%). For acute otitis media, vaccine effectiveness for the combination of trivalent inactivated vaccine and PCV was 47.9% (95% CI: 42%-53.3%) and for PCV only was 37.6% (95% CI: 23.1%-49.4%). CONCLUSION: In infants, the combination of maternal influenza vaccine and infant pneumococcal conjugate vaccination confers greater protection from acute otitis media infections and medically attended acute respiratory infections than does PCV alone.