Sexual minority identifiers and their perception of illicit drug use risks in the US: Results from a National Survey.

PURPOSE: This study examined the relationship between sexual identities and perception of risks associated with illicit drug use among a nationally representative sample of US adults. METHODS: We analyzed data from five waves of the National Survey on Drug Use and Health (NSDUH, 2015-2019), with 205,418 adult participants. Six survey questions assessing participants' perceptions of the risks associated with illicit drug use (LSD, heroin, and cocaine) were subjected to principal component analysis. Sex-stratified ordered logistic regressions were used to explore potential disparities in perceptions regarding the risk associated with illicit drug use among sexual minority identifiers. RESULTS: Among male participants, approximately 11.3% and 1.8% of them perceived illicit drug use as moderate and low risks, respectively. About 6.0% of female participants perceived illicit drug use as moderate risk, and 1.1% of female participants perceived it as low risk. The sex-stratified regression models demonstrated that participants who identified as lesbian/gay or bisexual all had higher odds of reporting low perception of illicit drug use risks as compared to their heterosexual counterparts (all p < 0.01). CONCLUSIONS: Illicit drug use prevention strategies should consider risk perception disparities by sexual minority populations.

Correlates of the Veterans Visiting Emergency Departments in Taiwan: A Comparison Before and After the Coronavirus Disease 2019 Pandemic.

BACKGROUND: Taiwan has a substantial number of veterans, but knowledge regarding their emergency department (ED) visits during the coronavirus disease 2019 (COVID-19) pandemic remains limited. This study examined the characteristics of veterans' ED visits during Taiwan's COVID-19 epidemic. METHODS: This was a cross-sectional study conducted at the ED of a large veteran medical center located in Taipei, Taiwan, from May 2018 to October 2021. We analyzed the numbers and features of visits in summer and autumn according to the first wave of the COVID-19 epidemic in Taiwan in 2021. RESULTS: Medical institutions were positively associated with veteran status. Emergency department complaints of trauma (adjusted odds ratio [AOR] = 1.15, 95% CI: 1.06-1.25; summer P < .01) and chest pain/tightness (AOR = 1.65, 95% CI: 1.45-1.87; summer P < .01; AOR = 1.4, 95% CI: 1.26-1.55; P < .01) were associated with increased odds of being a veteran. Triage levels above 2 were positively associated with veteran status in the autumn model (AOR = 1.14, 95% CI: 1.07-1.22; P < .01). Patients hospitalized after ED visits were associated with reduced odds of veteran status (P < .01). Those who spent a long time in the ED were more likely to be veterans than those who spent a shorter time in the ED (P < .01). Veterans were less likely to visit the ED regardless of the time frame of the study period (P < .01), except during the COVID-19 outbreak in the autumn (2019-2020). CONCLUSIONS: The distinctions in ED visits highlighted the individuality of veterans' medical needs. Our findings suggest that the veteran medical system can add to the focus on improving senior-friendly care, fall prevention, quality of life of institutionalized veterans, access for homeless veterans, and care for ambulatory care-sensitive conditions.

Participation in mahjong and the associated smoking and alcohol consumption behaviors among Chinese older adults.

This study examined the relationship of playing mahjong with smoking and alcohol consumption behaviors among Chinese older adults. We used a large and nationally representative dataset, the 8th wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Older adults who were 65 years old or above were included in the final analysis sample (n = 10,954). Multivariable logistic regressions were used to examine the associations of playing mahjong with current and former smoking/alcohol consumption status. Additionally, we used negative binomial and multiple linear regressions to investigate the number of cigarettes smoked per day and the amount of alcohol consumed per day. Compared with older adults who did not play mahjong, those who played mahjong at least once per month were more likely to report both current and prior smoking/alcohol consumption habits (all p < 0.05). The sub-analysis revealed that older adults who played mahjong at least once per week tended to smoke more cigarettes per day (all p < 0.05) than those who did not play mahjong at all. When public health practitioners advocate for the health benefits of playing mahjong, they should also consider its associations with smoking/alcohol consumption behaviors among Chinese older adults.

Racial and Ethnic Disparities and Prevalence in Prescription Drug Misuse, Illicit Drug Use, and Combination of Both Behaviors in the United States.

This study examines racial and ethnic disparities and prevalence in prescription drug misuse, illicit drug use, and the combination of both behaviors in the United States. Using five waves of the National Survey on Drug Use and Health (NSDUH, 2015-2019; n = 276,884), a multinomial logistic regression model estimated the outcomes of prescription drug misuse, illicit drug use, and the combination of both behaviors. Participants' age was considered as an interaction effect. Approximately 5.4%, 2.9%, and 2.5% misused prescription drug, used illicit drug, or had both behaviors, respectively. Compared with White participants, Black (AOR = 0.69, 99.9 CI: 0.61, 0.79) and Asian (AOR = 0.60, 99.9% CI: 0.42, 0.87) participants had significantly lower odds of reporting prescription drug misuse. Individuals who were classified as others had higher odds of reporting illicit drug use (AOR = 1.31; 99.9% CI: 1.05, 1.64), compared with White participants. Black (AOR = 0.40, 99.9% CI: 0.29, 0.56) and Hispanic (AOR = 0.71, 99.9% CI: 0.55, 0.91) participants were significantly less likely to have both prescription drug misuse and illicit drug use behaviors. Interaction analysis showed that Black participants between 18 and 49 years old were less likely to participate in prescription drug misuse. However, Black participants who were 50 years of age or above were more likely to engage in illicit drug use and the combination of both prescription drug misuse and illicit drug use (all p < 0.001). Hispanic adult participants between 18 and 49 years old were more likely to engage in illicit drug use. Successful intervention and cessation programs may consider the cultural and age disparities among different racial and ethnic groups.

Associations of Smoking and Alcohol Consumption with Loneliness, Depression, and Loss of Interest Among Chinese Older Males and Females.

As China experiences a rapidly aging population, the prevalence of Chinese older adults suffering from mental health issues also increases. Because cigarette smoking and alcohol consumption are two major public health concerns in China, we examined smoking and alcohol consumption status with loneliness, depression, and loss of interest among Chinese older adults. Panel data were extracted from the Chinese Longitudinal Healthy Longevity Survey, and older adults were selected as the final study sample (age ≥ 65) from two different time points (the 2011-2012 and 2014 waves). We analyzed Chinese older men and women with the adoption of panel logistic regression models to study mental health measurements of loneliness, depression, and loss of interest. Among males, compared with non-alcohol users, former alcohol users had higher odds of reporting depression (adjusted odds ratio [AOR] = 1.39, 95% CI: 1.01, 1.91; p < 0.05), while current alcohol users did not. Current and former smoking statuses were positively associated with depression (all p < 0.05). However, only current smoking status was positively associated with loss of interest (p < 0.05). Among females, former alcohol consumption was positively associated with loneliness, and current alcohol consumption was positively associated with depression. Health practitioners should evaluate the roles of smoking and alcohol consumption on Chinese older adults' mental health measurements in the long term.

A 10-year Trend of Sleeping Patterns, Geographical, and Community Disparities Among Chinese Older Adults.

This study examined the trend and geographical/community disparities of sleeping patterns among Chinese older adults. We included older adults from four waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS; n = 25,672; age ≥65). We used a multivariable logistic regression model to examine sleep quality (not good versus good), and a multinomial logistic regression model to assess daily sleep duration (7-8 hr, <7 hr, >8 hr). Older adults from the Central/South and the West regions were less likely to report good sleep quality (AOR [adjusted odds ratio] = .63, 95% CI: .55, .72 and AOR = .80, 95% CI: .70, .93, respectively) while the Northeastern residents reported better sleep quality (AOR = 1.51, 95% CI: 1.27, 1.79), compared with Northern residents. Older adults from Central/South and West were more likely to obtain less than 7 hr of sleep. Public health interventions are necessary to improve the sleep of Chinese older adults.

Functional disabilities and changes in sleep quality and duration among older adults: results from a longitudinal study in China, 2005-2014.

PURPOSE: We examined the associations of activities of daily living (ADL) and instrumental activities of daily living (IADL) with changes in sleep-related measurements among Chinese older adults from 2005 to 2014. METHODS: Four waves of longitudinal data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS; 2005-2014; n = 42,417) were used. Two sleep-related measurements were included: sleep quality and meeting the recommended daily sleep duration (7-8 h). We used Cox two-state regression models to examine the different states of sleep quality and duration. RESULTS: Approximately 43.6% of observations were between 81 and 95 years old, and 35.9% were between 65 and 80 years old. Around 54.8% of observations were female. Older adults with more ADL and IADL limitations had a higher risk of experiencing declines in sleep quality and the transition from meeting to not meeting the recommended sleep duration over time (all p < 0.01). CONCLUSION: ADL and IADL limitations are significant risk factors for the development of sleep-related issues over time among Chinese older adults. Functional limitations need to be included in intervention strategies focused on sleep hygiene and studies examining changes in sleep patterns over time.

Transition of Living Arrangement and Cognitive Impairment Status among Chinese Older Adults: Are They Associated?

Background and Objectives: Living arrangement is a crucial factor for older adults' health. It is even more critical for Chinese older adults due to the tradition of filial piety. With the aging of China's population, the prevalence of cognitive impairment among older adults has increased. This study examines the association between living arrangement transition and cognitive function among Chinese older adults. Materials and Methods: Using three waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS; 2008-2009, 2011-2012, and 2014), we analyzed data for older adults (age ≥ 65) who lived with other household members and reported good cognitive function or mild cognitive impairment when they participated in the survey. Multistate Cox regression was employed to study changes in cognitive function. Results: Older adults who transitioned to living alone had lower risk of cognitive impairment (hazard ratio (HR) = 0.66, 95% CI: 0.52, 0.83; p < 0.01), compared with those who continued to live with other household members. Moving into an institution was also not associated with cognitive impairment. Conclusions: With older adults' transition to living alone, public health practitioners or social workers might educate them on the benefits of such a living arrangement for cognitive function.

Regional and Geographical Disparities in Body Mass Index (BMI) Among Chinese Older Adults: The Chinese Longitudinal Healthy Longevity Survey.

This study examined the regional and geographical disparities in body mass index (BMI) among Chinese older adults. Using panel data from the Chinese Longitudinal Healthy Longevity Survey, participants included 3,740 older adults (age ≥ 65 years) who answered all three waves of the survey (2009-2014). Sex-stratified and multistate Cox regression was used to examine the disparities in BMI change. Results showed that both older males and older females who resided in the central-south had lower rates of weight change from nonobese to obese, compared with those from the east. Older females from urban regions had higher rate of weight change from nonobese to obese, compared with rural participants (hazard ratio [HR]: 1.35, 95% confidence interval [CI] = [1.13, 1.60]; p < .01). However, there were no disparities between urban and rural areas among older males (p > .05). These results provided practical implications for regional and geographical disparities in BMI among Chinese older adults.

Rural-urban disparities in smoking patterns among Chinese adults: a social-ecological approach.

China has a long history of smoking behavior. Currently, nearly 26% of Chinese citizens smoke daily. This research used a nationally representative database to study the urban and rural disparities on smoking patterns applying the social-ecological model. Using the 2011 China Health and Nutrition Survey, the study sample included adult participants who were at least 18 years of age (n = 12,688). A subanalysis was carried out to investigate smoking cessation duration among smoking quitters (n = 519). Multinomial logistic regression was used to examine participants' smoking status. Zero-inflated negative binomial regression was applied to investigate participants' number of cigarettes smoked per day, and multivariable logistic regression was used to examine nondaily smoking behavior. Negative binomial regression was carried out to assess the duration of smoking cessation for individuals who quit smoking. Urban residents had lower odds of reporting current smoking status (AOR [adjusted odds ratio] = 0.83, 95% CI [0.74, 0.95]) as compared to rural residents. Urban residents also had higher odds of reporting nondaily smoking status (AOR = 1.17, 95% CI [1.04, 1.32]) and smoked fewer cigarettes per day (IRR [incidence rate ratio] = 0.93, 95% CI [0.89, 0.98]) as compared to rural participants. The disparity between urban and rural areas was not observed for smoking cessation duration. Further efforts should target the disparity between urban and rural regions regarding smoking prevention.

Associations of alcohol consumption status with activities of daily living among older adults in China.

BACKGROUND: With the rapid growth of the elderly population and public health challenges in China, concerns arise related to disability associated with activities of daily living (ADLs) and alcohol consumption status. This study assesses the relationships of alcohol consumption status with basic daily activities among Chinese older adults. METHODS: A total of 5,133 participants aged 60 years or above from three waves of the Chinese Longitudinal Healthy Longevity Survey (2009, 2012, and 2014) were analyzed. Independent ADL items included bathing, dressing, toileting, indoor moving, continence, and feeding (without others' assistance). Multilevel ordered logistic regression model estimation was used to examine the results of total scores based on the Katz index. Multilevel logistic regression models also were estimated to study each index item separately to examine differences across each of the six ADLs. Additional confirmatory factor analysis (CFA) was performed to examine the validity of the index. RESULTS: Preliminary CFA showed that most items had good factor loadings (>0.700), except for continence (0.256) and feeding (0.481). Based on the ordered regression model, former (AOR = 0.412, 95% CI: 0.294, 0.579, p < 0.001) and non-alcohol consumption (AOR = 0.598, 95% CI: 0.447, 0.800, p < 0.001) were negatively associated with the total score. Non-alcohol consumption status was negatively associated with ADL items separately (all ps < 0.05), with the exceptions of continence and feeding. CONCLUSION: Alcohol consumption may be associated with Chinese older adults' better ADLs. However, further clinical or experimental trials are needed to examine the impact of alcohol consumption on older adults' ADLs.

Associations of staple food consumption and types of cooking oil with waist circumference and body mass index in older Chinese men and women: a panel analysis.

BACKGROUND: The dietary landscape has changed rapidly in China in the past few decades. This research investigates the associations of older adults' choices and consumption of staple foods and cooking oils with obesity-related measurements. METHODS: Panel data were extracted from the Chinese Longitudinal Health Longevity Survey from 3253 older participants with 6506 observations. Ordinary least squares and ordered logistic regression models were estimated with the outcomes of obesity determined by waist circumference (WC) and body mass index (BMI), respectively. RESULTS: Older men who consumed wheat had wider WCs (ß=2.84 [95% confidence interval {CI} 1.55 to 4.13], p<0.01) and higher BMIs (adjusted odds ratio 1.74 [95% CI 1.40 to 2.17], p<0.01) than those who preferred rice. Female participants who used animal-based cooking oil had lower WCs and BMIs than their counterparts who consumed vegetable-based cooking oil. Increased consumption of staple foods was associated with increased rates of obesity in both sexes. CONCLUSION: Dieticians and nutritionists should design appropriate dietary plans to help reduce obesity and chronic diseases among older Chinese adults. Further clinical trials are needed to continue investigating this topic.

Associations of dietary habits and sleep in older adults: a 9-year follow-up cohort study.

PURPOSE: China has faced rapid growth of its older adult population, shifting dietary landscape, and sleep-related problems. However, knowledge regarding the associations of dietary behavior on sleep-related outcomes with longitudinal data remains limited. This study investigates the relationships of dietary habits with sleep quality and duration. METHODS: Using data from the Chinese Longitudinal Health Longevity Survey (CLHLS), older adults were included in the 9-year span between 2005 and 2014 (age ≥ 60; n = 62,552). Self-reported dietary habits, sleep quality, and sleep duration (hours) were assessed. Four types of dietary behaviors were identified: vegetables, fruits, egg, and meat. Cox proportional hazard models were used to explore the potential association between dietary habits and sleep status. The outcomes were self-reported sleep quality and sufficient sleep duration (7-8 h daily). RESULTS: In the study sample, the median age was 87 years old, and approximately 57.2% of the study participants were female. More than 60% of the older adult population had good quality sleep, and almost 40% of participants slept 7-8 h a day. In the fully adjusted Cox models, daily fruits, meat, and egg consumption were positively associated with sleep quality (all p < 0.05). Compared with participants who rarely consumed or did not consume vegetables, more frequent consumption was positively associated with sufficient sleep duration (all p < 0.0001) but was not associated with sleep quality. CONCLUSION: Older adults should be aware that sleep quality and duration might be related to their dietary habits.

Have the Chinese Older Adults Received Adequate Healthcare Services since the 2009 Health Reform? Examining the Socioeconomic Disparity in Receiving Adequate Healthcare.

China launched a comprehensive health reform in 2009, as part of the central government's plan to improve its healthcare system. This study investigates the associations of socioeconomic status with receiving adequate healthcare services among Chinese older adults following the 2009 health reform. Using the 6th and the 7th waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a repeated cross-sectional study design was adopted (n = 9305). Firth's logistic regression models were used for statistical analysis. In the fully adjusted model, being non-married was negatively associated with adequate healthcare services (adjusted odds ratio (AOR) = 0.68, 95% confidence interval (CI): 0.54, 0.86). Higher levels of income were positively associated with adequate healthcare services (all ps < 0.05). Participants who relied on non-urban social insurance plans all had lower odds of receiving adequate healthcare services (all ps < 0.01), compared with older adults who used the urban employment basic medical insurance (UEBMI). However, disparities regarding education and urban-rural differences were not observed in the full model. As China is pushing for further reforms, vulnerable population groups, such as non-married or more impoverished older adults, should be assisted in receiving adequate healthcare services.

Trends and sociodemographic factors of e-cigarette use among adult daily smokers in South Korea.

OBJECTIVE: Previous studies have identified the sociodemographic factors associated with e-cigarette use among adolescents in South Korea. However, literature regarding e-cigarette use among adult smokers remains limited in South Korea. METHODS: Applying four waves (2013-2016) of The Korea National Health and Nutrition Examination Survey (n = 3227), sociodemographic factors were included in the multivariable logistic regression model to study their relationships with e-cigarette use among adult daily smokers. RESULTS: E-cigarette use increased from approximately 21.2% to 34.6% from 2013 to 2016, respectively. Females had lower odds of e-cigarette use (adjusted odds ratio [AOR] = 0.76; 95% CI, 0.58-0.99, P < .05) compared with males. Older age was negatively associated with e-cigarette use experience (all Ps < .01). Daily smokers with high school education or above all had higher odds of using e-cigarettes compared those with elementary school education (all Ps < .05). CONCLUSION: As this study examined the trends of e-cigarette use and factors associated with e-cigarette use among adult daily smokers in South Korea, further research is needed to investigate the long-term effect of e-cigarette use on smoking cessation in South Korea as well as other Asian countries.

Examining the Associations of Smoking Behavior and Obesity Among Older Adults in China: Should We Consider Food Consumption Behaviors?

Objective: This research investigates the associations between smoking frequency and body mass index (BMI) among older adults in China with and without the inclusion of food consumption behaviors. Method: Applying three waves of the Chinese Longitudinal Healthy Longevity Survey (2009, 2012, and 2014), with 12,312 observations from 4,104 participants, gender-stratified panel ordered logistic regressions were performed. Food consumption included intake frequency and types of fruits, vegetables, staple food, cooking oil, and meat. Results: Among male older adults, more frequent smoking behavior was associated with lower BMI with the inclusion of food consumption behaviors. However, more frequent smoking behavior was not associated with BMI among female participants with the inclusion of food consumption behaviors. Former smoking status was not associated with BMI in all models. Discussion: The findings suggest the need of food consumption behaviors when researchers study the associations between smoking frequency and obesity. Gender gaps also should be considered.

Living Arrangements and Sleep-Related Outcomes Among Older Adults in China : A Panel Analytic Approach.

It has been discussed previously that older adults' living arrangements are associated with mortality. This study investigated the relationships between older adults' living arrangements and sleep-related outcomes in China. The nationally representative sample included 4,731 participants who participated on two different occasions, with a total of 9,462 observations (2012 and 2014 waves). Panel logistic regression and panel ordinary least squares regression models were estimated with outcomes of sleep quality and average hours of sleep daily, respectively. Approximately 62% of individuals reported good quality of sleep. We observed that older adults who lived with family members had 17% greater odds of reporting good quality of sleep (adjusted odds ratio = 1.17, 95% confidence interval [1.03, 1.34], p < .05) and reported longer sleep duration daily (ß = .334, standard error = .069, p < .01), compared with those who lived alone. Social support is needed to strengthen the residential relationship, especially with family members.

Are older adults' home exposures to secondhand smoking during earlier life stages associated with current health status and life satisfaction in China? A multilevel approach.

Secondhand smoking (SHS) has become a critical challenge in Chinese society, and progress on SHS prevention remains unknown. There is little knowledge targeting Chinese older adults generally to investigate the associations between SHS exposure experiences during earlier life stages and health-related measurements. Using cross-sectional data from a nationally representative data set, the 2014 wave of the Chinese Longitudinal Healthy Longevity Survey (n = 4,414), multilevel logistic regression models with random effects for Chinese provinces were used for analyses. Two health-related measurements included self-reported health status and life satisfaction. All regression models included the same set of predictors and covariates with socioeconomic factors and basic biological information. Approximately 40% and 47% of older adults reported SHS exposure in childhood and in younger adulthood at home, respectively. Older adults with SHS exposure in childhood had lower odds of reporting better health status, compared with those who did not have such exposure (adjusted odds ratio [AOR] = 0.69, 95% CI [0.55, 0.86], p < .01). However, life satisfaction was not associated with any SHS exposure experiences. Policy makers and public health practitioners should continue to investigate the long-term effect of SHS exposure on human health, including older adults. Policy regarding SHS prevention should be enhanced.

Correlates of alcohol consumption and alcohol dependence among older adults in contemporary China: Results from the Chinese Longitudinal Healthy Longevity Survey.

China has one of the world's largest populations using alcohol. With the trend of increasing alcohol consumption and the rapid growth of its aging population, China has faced imminent public health challenges in the past few decades. This research study aims to investigate determinants related to alcohol consumption behaviors or alcohol dependence among older adults (age ≥60) in China. Using the Chinese Longitudinal Healthy Longevity Survey from 2000 to 2014 waves (n = 35,377), we estimated multivariable logistic regression models to examine the factors associated with current alcohol consumption status, alcohol consumption experience, daily consumption, and alcohol dependence. Of all respondents between 2000 and 2014, 5.7% were current alcohol users, 20.3% reported alcohol use experience, 3.3% used alcohol daily, and approximately 1.1% reported alcohol dependence. Current smoking status, health status, and respondents' gender were associated with all alcohol-related behaviors (p < .05). In addition, older adults from newer waves had higher odds of becoming daily alcohol consumers and having alcohol dependence, compared with older adults in the 2000 wave. Older adults living in an institution had lower odds of becoming current alcohol users, compared with those living with household members. Older adults residing in eastern regions had higher odds of becoming current alcohol users, compared with northern residents. Rural residents had higher odds of reporting alcohol use patterns (p < .01), except alcohol use experience. Future public health interventions and promotional strategies should focus on regional and community disparities in China.

Is preventive care utilization associated with lower outpatient and inpatient health-care expenses among Chinese older adults? A longitudinal analysis.

BACKGROUND: China has made major improvements to its health-care system since the early 21st century. However, the effectiveness of preventive care utilization on health-care costs remains limited. This study seeks to understand the effect of preventive care utilization on outpatient and inpatient health-care expenses. METHODS: With the use of the Chinese Longitudinal Healthy Longevity Survey with older adults who were 65 years old or above (n = 2828), Tobit regression models were estimated to examine the association of preventive care utilization and expenses with medical treatments. Preventive care utilization in the previous wave was used to predict health-care costs for treatments in the next wave. Propensity score matching was used to reduce potentially confounding factors. FINDINGS: Results indicated that preventive care utilization was positively associated with outpatient health care among Chinese older adults (ß = 231.8, standard error [SE] = 71.5, P < .01). The association between preventive care utilization and inpatient health-care expenses was not significant. CONCLUSIONS: Despite the results from previous studies suggesting that preventive care utilization can help reduce health-care expenses, this study does not support such a claim among Chinese older adults. The long-term association between preventive care utilization and health-care expenses for treatment should be studied further.