Effect of Financial Stress and Positive Financial Behaviors on Cost-Related Nonadherence to Health Regimens Among Adults in a Community-Based Setting.

INTRODUCTION: Little is known about the role of positive financial behaviors (behaviors that allow maintenance of financial stability with financial resources) in mitigating cost-related nonadherence (CRN) to health regimens. This study examined the relationships between positive financial behaviors, financial stress, and CRN. METHODS: Data came from the 2011 Speak to Your Health! Community Survey (n = 1,234). Descriptive statistics were computed to examine financial stress and CRN, by chronic condition and health insurance status. We used multivariate logistic regression models to examine the relationship between positive financial behaviors and financial stress and their interaction on a composite score of CRN, controlling for health insurance status, educational level, age, marital status, number of chronic conditions, and employment status. RESULTS: Thirty percent of the sample engaged in CRN. Participants reported moderate financial stress (mean, 13.85; standard deviation [SD] = 6.97), and moderate positive financial behavior (mean, 8.84; SD = 3.24). Participants with employer-sponsored insurance, Medicaid, Medicare, the Genesee Health Plan, high blood pressure, asthma, and diabetes had the highest proportion of CRN. The relationship between financial stress and CRN was not significantly different between those who reported lower versus higher levels of positive financial behavior (P = .32). Greater financial stress was associated with a greater likelihood of CRN (odds ratio [OR] = 2.49; 95% confidence interval [CI], 2.08-2.99). Higher level of positive financial behavior was associated with a lower likelihood of CRN (OR = 0.80; 95% CI, 0.67-0.94). CONCLUSION: Financial literacy as a means of promoting positive financial behavior may help reduce CRN. An intervention strategy focused on improving financial literacy may be relevant for high-risk groups who report high levels of financial stress.

Racial/ethnic and gender differences in the association between depressive symptoms and higher body mass index.

AIM: The study investigated the socio-demographic differences in the association between depressive symptoms and higher body mass index (BMI). SUBJECTS AND METHODS: In Genesee County, Michigan, random samples of households were drawn from all residential census tracts. The Speak to Your Health! Survey was administered among adults aged 18 years and older in these households. To conduct this cross-sectional study, data from three waves of survey data collection (2007, 2009 and 2011) were combined resulting in a sample of 3381 adults. Self-reported height and weight were used to calculate BMI. Depressive symptoms were assessed with Brief Symptoms Inventory items. Socio-demographic factors included age, race/ethnicity, gender and education. RESULTS: Using stepwise linear regression, gender (ß = 0.04, P = 0.02) and the interaction terms of race/ethnicity × depressive symptoms (ß = 0.15, P < 0.001) and gender × depressive symptoms (ß = 0.05, P = 0.01) uniquely predicted BMI. CONCLUSION: Women had a higher BMI than men, and depressive symptoms were more strongly associated with BMI among African Americans and women than among non-Latino Whites and men. Tailored interventions to alleviate depressive symptoms in African Americans and females may help decrease racial/ethnic and gender differences in depressive symptoms and obesity.

Relationships Among Disease, Social Support, and Perceived Health: A Lifespan Approach.

We examined the relationship between the cumulative presence of major disease (cancer, stroke, diabetes, heart disease, and hypertension), social support, and self-reported general and emotional well-being in a community representative sample of predominantly White and African American respondents (N = 1349). Across all ages, greater presence of disease predicted poorer reported general health, and predicted lower emotional well-being for respondents 40 and above. In contrast, social support predicted better-reported general and emotional well-being.We predicted that different types of social support (blood relatives, children, friends, community members) would be relatively more important for health in different age groups based on a lifespan or life stage model. This hypothesis was supported; across all ages, social support was related to better reported general and emotional health, but sources of support differed by age. Broadly, those in younger age groups tended to list familial members as their strongest sources of support, whereas older group members listed their friends and community members. As a whole, social support mediated the effect of disease on reported wellbeing,however, moderated mediation by type of support was not significant. The results are consistent with a lifespan approach to changing social ties throughout the life course.

Knowledge, confidence, and reported behaviors that promote safe water drinking among women of reproductive age.

Introduction: Drinking lead contaminated water during pregnancy is associated with infant mortality. All women of reproductive age are advised by health agencies to adhere to healthy behaviors due to the chance of unintended pregnancy. Our objectives are to understand knowledge, confidence, and reported behaviors that promote safe water drinking and prevent lead exposure among women of reproductive age. Methods: A survey among females of reproductive age from the University of Michigan - Flint was administered. A total of 83 females who wished to become pregnant one day participated. Results: Low levels of knowledge, confidence, and reported preventative health behaviors related to safe water drinking and lead exposure prevention existed. Specifically, 71.1% of respondents (59 of 83) were not at all or were somewhat confident in their ability to choose an appropriate lead water filter. Most participants rated their knowledge on how to decrease exposure to lead during pregnancy as poor/fair. No statistically significant differences were detected between respondents residing inside and outside of the city of Flint, Michigan for most variables assessed. Conclusion: While the small sample size is a limitation, the study adds to an area of scarce research. Despite widespread media attention and resources directed toward reducing the negative health effects of lead exposure following the Flint Water Crisis, significant gaps in knowledge related to safe water drinking remain. Interventions are needed to increase knowledge, confidence, and healthy behaviors that promote safe water drinking among women of reproductive age.

Poor tap water quality experiences and poor sleep quality during the Flint, Michigan Municipal Water Crisis.

OBJECTIVES: After inadequate official response to community concerns over water quality following changes in Flint's municipal water supply, this study sought evidence for a relationship between water quality and community mental health. DESIGN: The Speak to Your Health Community Survey is a community-based participatory component of the health surveillance system in Genesee County, Michigan. This cross-sectional survey recruits participants from every residential Census Tract of the county and strives for demographic representativeness. RESULTS: Respondents (n=834) rated their tap water quality (taste, smell, appearance) as poor (36%), fair (18%), good (20%), very good (17%), and excellent (10%). They rated their sleep quality as poor (12%), fair (28%), good (39%), very good (18%), and excellent (4%), and had an average (SD) sleep length of 408(90) minutes. Controlling for age, sex, years of education, and whether respondents were African American and Hispanic/Latino/a, lower perceived tap water quality was associated with lower sleep quality and shorter sleep length. CONCLUSION: Results indicate that adverse health conditions related to the water crisis extend beyond lead poisoning in children and include deterioration of sleep conditions among adult residents.