Socio-economic and psychosocial determinants of smoking and passive smoking in older adults.

OBJECTIVE: To determine the associations of socio-economic and psychosocial factors with active and passive smoking in older adults. METHODS: Using a standard interview method, we examined random samples of 6071 people aged⋝60 years in 5 provinces of China during 2007-2009. RESULTS: World age-standardised prevalence for current and former smoking in men was 45.6% and 20.5%, and in women 11.1% and 4.5%. Current smoking reduced with older age but increased with men, low socioeconomic status (SES), alcohol drinking, being never-married, pessimistic and depressive syndromes. Former smoking was associated with men, secondary school education, a middle-high income, being a businessman, being widowed, less frequencies of visiting children/relatives and friends, and worrying about children. Among 3774 never-smokers, the prevalence of passive smoking was 31.5%, and the risk increased with women, low SES, alcohol drinking, being married, having a religious believe, and daily visiting children/relatives. There were sex differences in the associations, and an interaction effect of education and income on smoking and passive smoking. CONCLUSION: Older Chinese had a higher level of smoking and passive smoking than those in high income countries, reflecting China's failures in controlling smoking. The associations with low SES and different psychosocial aspects and sex differences suggest preventative strategies for active and passive smoking.

Medication Adherence and Blood Pressure Control Among Hypertensive Patients With Coexisting Long-Term Conditions in Primary Care Settings: A Cross-Sectional Analysis.

Hypertension is a typical example of long-term disease posing formidable challenges to health care. One goal of antihypertensive therapy is to achieve optimal blood pressure (BP) control and reduce co-occurring chronic conditions (multimorbidity). This study aimed to assess the influence of multimorbidity on medication adherence, and to explore the association between poor BP control and multimorbidity, with implications for hypertension management.A cross-sectional design with multistage sampling was adopted to recruit Chinese hypertensive patients attending general out-patient clinics from 3 geographic regions in Hong Kong. A modified systemic sampling methodology with 1 patient as a sampling unit was used to recruit consecutive samples in each general out-patient clinic. Data were collected by face-to-face interviews using a standardized protocol. Poor BP control was defined as having systolic BP/diastolic BP ≥130/80 mm Hg for those with diabetes or chronic kidney disease; and ≥140/90 mm Hg for others. Medication adherence was assessed by a validated Chinese version of the Morisky Medication Adherence Scale. A simple unweighted enumeration was adopted to measure the combinations of coexisting long-term conditions. Binary logistic regression analysis was conducted with medication adherence and multimorbidity as outcome variables, respectively, after controlling for effects of patient-level covariates.The prevalence of multimorbidity was 47.4% (95% confidence interval [CI] 45.4%-49.4%) among a total of 2445 hypertensive patients. The proportion of subjects having 0, 1, and ≥2 additional long-term conditions was 52.6%, 29.1%, and 18.3%, respectively. The overall rate of poor adherence to medication was 46.6%, whereas the rate of suboptimal BP control was 48.7%. Albeit the influence of multimorbidity on medication adherence was not found to be statistically significant, patients with poorly controlled BP were more likely to have multimorbidity (adjusted odds ratio 2.07, 95% CI 1.70-2.53, P < 0.001). Diabetes was the most prevalent concomitant long-term condition among hypertensive patients with poor BP control (38.6%, 95% CI 35.8-41.4 vs 19.7%, 95% CI 17.5-21.9 for patients with good BP control, P < 0.001).Multimorbidity was common among hypertensive patients, and was associated with poor BP control. Subjects with coexisting diabetes, heart disease, or chronic kidney disorder should receive more clinical attention to achieve better clinical outcomes.

[Study on the prevalence and risk factors of depressive symptoms among 'empty-nest' and 'non-empty-nest' elderly in four provinces and cities in China].

OBJECTIVE: To investigate the prevalence and determinants of depressive symptoms among 'empty-nest' and 'non-empty-nest' elderly in four cities/provinces. METHODS: 4265 elderly aged 60 and over, were recruited with cluster sampling method in Shanghai, Heilongjiang, Guangdong and Shanxi province and interviewed, using the Geriatric Mental State Schedule and self-developed related questionnaire. RESULTS: (1) The prevalence of depressive symptoms for 'empty-nest' elderly was (8.18%), significantly higher than that for 'non-empty-nest' elderly (P=0.019); (2) the 'empty-nest' elderly had a significantly higher proportion of the following factors: being male, married, with higher income (≥15,000 Yuan/year), living in city, with high education background, under employment etc. than the 'non-empty-nest' elderly (P<0.0001); (3) the 'empty-nest' elderly had significantly higher proportions on good self-rated health status and life (P=0.0001, P<0.0001) as well as heavier health problems and economic difficulties (P=0.001, P=0.002); (4) there were significantly negative associations between depressive symptoms and the following 10 factors: being female, single, having bad self-rated health and life status, having somatic disease≥3, with big health problems in the last two years and loss of dearest persons, community engagement and involvement of religious activities. CONCLUSION: The 'empty-nest' elderly showed higher prevalence of having depressive symptoms than the 'non-empty-nest' elderly. The 'empty-nest' elderly had characteristics as being single, female, having adverse event etc. and should be under greater attention for care.