Cancer in people who identify as lesbian, gay, bisexual, transgender, queer, or gender-nonconforming.

BACKGROUND: Individuals who identify as lesbian, gay, bisexual, transgender, queer, intersex, or gender-nonconforming (LGBTQ+) experience discrimination and minority stress that may lead to elevated cancer risk. METHODS: In the absence of population-based cancer occurrence information for this population, this article comprehensively examines contemporary, age-adjusted cancer risk factor and screening prevalence using data from the National Health Interview Survey, Behavioral Risk Factor Surveillance System, and National Youth Tobacco Survey, and provides a literature review of cancer incidence and barriers to care. RESULTS: Lesbian, gay, and bisexual adults are more likely to smoke cigarettes than heterosexual adults (16% compared to 12% in 2021-2022), with the largest disparity among bisexual women. For example, 34% of bisexual women aged 40-49 years and 24% of those 50 and older smoke compared to 12% and 11%, respectively, of heterosexual women. Smoking is also elevated among youth who identify as lesbian, gay, or bisexual (4%) or transgender (5%) compared to heterosexual or cisgender (1%). Excess body weight is elevated among lesbian and bisexual women (68% vs. 61% among heterosexual women), largely due to higher obesity prevalence among bisexual women (43% vs. 38% among lesbian women and 33% among heterosexual women). Bisexual women also have a higher prevalence of no leisure-time physical activity (35% vs. 28% among heterosexual women), as do transgender individuals (30%-31% vs. 21%-25% among cisgender individuals). Heavier alcohol intake among lesbian, gay, and bisexual individuals is confined to bisexual women, with 14% consuming more than 7 drinks/week versus 6% of heterosexual women. In contrast, prevalence of cancer screening and risk reducing vaccinations in LGBTQ+ individuals is similar to or higher than their heterosexual/cisgender counterparts except for lower cervical and colorectal cancer screening among transgender men. CONCLUSIONS: People within the LGBTQ+ population have a higher prevalence of smoking, obesity, and alcohol consumption compared to heterosexual and cisgender people, suggesting a higher cancer burden. Health systems have an opportunity to help inform these disparities through the routine collection of information on sexual orientation and gender identity to facilitate cancer surveillance and to mitigate them through education to increase awareness of LGBTQ+ health needs.

Correlates of mental health problems among students in Texas alternative high schools and school-level efforts to address mental health.

Students in alternative high schools (AHSs) are an understudied population who experience disproportionate levels of risk factors that contribute to mental health problems. Using logistic regression, we explored associations between mental health problems and risk and protective factors among students in Texas AHSs (n = 515; mean age 17.1 years; 51% female, 78% youth of color, 64% eligible for free/reduced lunch). Principals (n = 14) and lead health educators (n = 14) reported on school-level efforts to address mental health. Students reported, on average, 1.55 of 4 mental health problems in the past year. Logistic regression indicated that greater number of adverse childhood experiences, lower self-esteem, female gender, and sleep disruption (getting <8 h of sleep per night) were common contributors to symptoms of depression, anxiety, suicidal ideation, and PTSD with models showing medium-to-large effects (AUC: 0.73-0.81). We assessed school-level efforts to address mental health using descriptive statistics. At the school level, most (>50%) principals reported having policies and services to support student mental health, with the exception of having mental health/social services staff represented on school health councils (36%) and having Gay-Straight Alliances (21%). Most lead health educators (86%) reported educating AHS students about mental health, and many (57%) reported receiving professional development in mental health. Future research with a larger number of schools is needed to analyze whether school policies are statistically associated with student-level mental health outcomes. Such multi-level research can inform policies and practices for AHS student mental health.

Cannabis use among U.S. adolescents in the era of marijuana legalization: a review of changing use patterns, comorbidity, and health correlates.

Decriminalization, medicalization, and legalization of cannabis use by a majority of U.S. states over the past 25 years have dramatically shifted societal perceptions and use patterns among Americans. How marijuana policy changes have affected population-wide health of U.S. youth and what the downstream public health implications of marijuana legalization are topics of significant debate. Cannabis remains the most commonly used federally illicit psychoactive drug by U.S. adolescents and is the main drug for which U.S. youth present for substance use treatment. Converging evidence indicates that adolescent-onset cannabis exposure is associated with short- and possibly long-term impairments in cognition, worse academic/vocational outcomes, and increased prevalence of psychotic, mood, and addictive disorders. Odds of negative developmental outcomes are increased in youth with early-onset, persistent, high frequency, and high-potency Δ-9-THC cannabis use, suggesting dose-dependent relationships. Cannabis use disorders are treatable conditions with clear childhood antecedents that respond to targeted prevention and early intervention strategies. This review indicates that marijuana policy changes have had mixed effects on U.S. adolescent health including potential benefits from decriminalization and negative health outcomes evidenced by increases in cannabis-related motor vehicle accidents, emergency department visits, and hospitalizations. Federal and state legislatures should apply a public health framework and consider the possible downstream effects of marijuana policy change on paediatric health.

Empirically derived lifespan polytraumatization typologies: A systematic review.

CONTEXT: Polytraumatization classes based on trauma endorsement patterns relate to distinct clinical outcomes. Person-centered approaches robustly evaluate the nature, and construct validity of polytraumatization classes. OBJECTIVE: Our review examined evidence for the nature and construct validity of lifespan polytraumatization typologies. DATA SOURCES: In September 2016, we searched Pubmed, PSYCINFO, PSYC ARTICLES, Academic Search Complete, PILPTS, Web of Science, CINAHL, Medline, PsycEXTRA, and PBSC. Search terms included "latent profile," "latent class," "latent analysis," "person-centered," "polytrauma," "polyvictimization," "traumatization," "lifetime," "cooccurring," "complex," "typology," "multidimensional," "sequential," "multiple," "subtype," "(re)victimization," "cumulative," "maltreatment," "abuse," and "stressor." Inclusionary criteria included: peer-reviewed; latent class/latent profile analyses (LCA/LPA) of lifespan polytrauma classes; adult samples of size greater than 200; only trauma types as LCA/LPA indicators; mental health correlates of typologies; and individual-level trauma assessment. Of 1,397 articles, nine met inclusion criteria. DATA EXTRACTION: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, research assistants completed a secondary reference search, and independently extracted data with standardized coding forms. RESULTS: Three-class (n = 5) or four-class (n = 4) solutions were found. Seven studies found a class characterized by higher trauma endorsement (high-trauma). All studies found a class characterized by lower trauma endorsement (low-trauma), and predominance of specific traumas (specific-trauma; e.g., childhood maltreatment). High-trauma versus low-trauma classes and specific-trauma versus low-trauma classes differed on mental health correlates. CONCLUSION: Evidence supports the prevalence of a high-trauma class experiencing poorer mental health, and the detrimental impact of aggregated interpersonal and other traumas. We highlight the clinical importance of addressing polytraumatization classes, and comprehensively assessing the impact of all traumas.

A Systematic Review of Family Victimization Experiences Among Sexual Minority Youth.

Sexual minority youth experience substantially higher rates of family victimization than their heterosexual peers. No systematic review has yet identified the predictors and consequences in this vulnerable population of childhood abuse, exposure to sibling abuse and domestic violence, and sibling aggression. This systematic review aims to (a) describe differences in these family victimization rates by sexual orientation, gender, and race/ethnicity; (b) identify potential sexual minority and non-sexual minority-specific risk factors; and (c) identify physical, mental, and behavioral health and extrafamilial victimization correlates. The systematic review, which followed PRISMA guidelines, yielded 32 articles that met study inclusion criteria. Rates of childhood physical, sexual, and emotional abuse were consistently higher for sexual minority youth than for their heterosexual peers. Bisexual youth appear to be at greater risk for physical abuse than their gay and lesbian peers. Younger age at sexual minority milestones (first awareness, disclosure, and same-sex sexual contact) and higher levels of sexual minority-specific (sexuality disclosure, gender non-conformity) and non-sexual minority-specific (delinquent behaviors, parental drinking) risk factors were associated with higher rates of family victimization. Sexual minorities who experienced some form of childhood abuse reported more frequent physical (higher rates of HIV, higher BMIs, lower levels of perceived health), mental (higher rates of depression, PTSD symptoms, experiential avoidance, internalized homophobia), and behavioral (higher rates of suicidality, substance misuse, earlier sexual debut, unprotected anal sex) health problems relative to heterosexual or non-abused sexual minority peers. Sexual minority females who experienced childhood physical or sexual abuse were at greater risk than abused sexual minority males for sexual assault later in life. We conclude this systematic review with recommendations for future research, including the necessity for longitudinal research that utilizes a poly-victimization conceptual framework to identify the developmental pathways connecting risk factors, different types of family victimization, and health and extrafamilial victimization consequences.

Heavy Drinking and Social and Health Factors in University Students from 24 Low, Middle Income and Emerging Economy Countries.

The aim of this study was to investigate heavy drinking and social and health correlates in university students in low, middle income and emerging economy countries. Using anonymous questionnaires, data were collected in a cross-sectional survey of 17,590 undergraduate university students (mean age 20.8, SD 2.9) from 25 universities in 24 countries across Asia, Africa and the Americas. Overall, 71.6 % were non-drinkers, 17.1 % moderate and 11.3 % heavy alcohol drinkers (14.2 % in men and 9.2 % in women) in the past 2 weeks. In a multivariate logistic regression analysis, older age, poorer family background, living in a higher income country, weak beliefs in the importance of limiting alcohol use, higher country per capita alcohol consumption, other substance use (tobacco and illicit drug use), and poor life satisfaction was associated with heavy drinking. Addressing health beliefs and co-occurring addictive behaviors may be crucial in the prevention of heavy drinking in this population.

Mild small-for-gestational-age as a non-negligible risk factor for short stature.

Risk of subsequent short stature remains unclear among mild small-for-gestational-age (SGA) infants with birthweight <10th percentile and ≥-2 standard deviations. In this multicenter cohort study in Japan, height was found to be <-2 standard deviations at 3 years old even in 18 % of mild-SGA infants.

Changes in Cardiorespiratory Fitness and Probability of Developing Abdominal Obesity at One and Two Years.

Low cardiorespiratory fitness (CRF) is associated with an increased risk of developing abdominal obesity (AO), but it is not known if and/or how changes in CRF affect AO. We examined the relationship between changes in CRF and the risk of developing AO. This is a retrospective observational study of a cohort of 1883 sedentary patients, who had participated in a clinical trial of physical activity promotion carried out in Spain (2003-2007). These data were not used in the clinical trial. At baseline, they were free of cardiovascular disease, hypertension, diabetes, dyslipidemia, and/or AO; with an indirect VO2max measurement; 19-80 years old; and 62% were women. All the measures were repeated at 6, 12, and 24 months. The exposure factor was the change in CRF at 6 or 12 months, categorized in these groups: unfit-unfit, unfit-fit, fit-unfit, and fit-fit. We considered fit and unfit participants as those with VO2max values in the high tertile, and in the moderate or low tertiles, respectively. The main outcome measure was the risk of developing AO at one and two years, as defined by waist circumference >102 (men) and >88 (women) cm. At two years, 10.5% of the participants had developed AO: 13.5% in the unfit-unfit group of change at 6 months; 10.3% in the unfit-fit group (adjusted odds ratio (AOR) 0.86; 95% confidence interval (CI) 0.49-1.52); 2.6% in the fit-unfit group (AOR 0.13; 95%CI 0.03-0.61); and 6.0% in the fit-fit group (AOR 0.47; 95%CI 0.26-0.84). Those who stayed fit at 6 months decreased the probability of developing abdominal obesity at two years.

Medication Adherence Among Patients of Type II Diabetes Mellitus and Its Associated Risk Factors: A Cross-Sectional Study in a Tertiary Care Hospital of Eastern India.

BACKGROUND: Type 2 diabetes mellitus is a major public health problem. Adherence to anti-diabetic medications improves glycaemic control, which in turn prevents complications as well as reduces out-of-pocket expenditure. The World Health Organization highlights that the impact of interventions directed to improve adherence has far greater implications than specific medical interventions. There are several factors that contribute to poor adherence. Not many studies have been conducted to explore adherence to diabetes medications in eastern India. OBJECTIVES: To measure medication adherence among patients suffering from diabetes. To determine the various risk factors influencing adherence to medication. To find out the association of health-related quality of life with adherence to medication. METHODOLOGY: A hospital-based cross-sectional study was conducted in the outpatient Department of General Medicine and Endocrinology of a tertiary care hospital in eastern India from January to March 2020. Adult subjects, who were diagnosed with type 2 diabetes mellitus for at least six months, were interviewed using a pretested, structured questionnaire containing 8-item Morisky Medication Adherence Scale (MMAS-8) to determine adherence to diabetic medications. Data were analysed in SPSS version 27 (IBM Corp., Armonk, NY, USA). RESULTS: The mean age of the 331 participants interviewed was 53.40 (SD 11.0) years and the majority were males (57.1%). Medication adherence of 34.14% (n=113) was found among the subjects. Having any comorbidity, positive family history of diabetes and the habit of current alcohol intake increased the odds of poor adherence by 3.26 times, 1.88 times, and 2.35 times respectively in binary logistic regression analysis. Those following a diabetic diet had a protective effect, decreasing poor medication adherence by 79.6%. Poor medication adherence increased by 1.077 times with every one-day increase in unhealthy days. CONCLUSION: The medication adherence was 34.14% and as compared to other similar studies medication adherence in the study population was poor and was associated with unhealthy days.

Microcephaly and Associated Risk Factors in Newborns: A Systematic Review and Meta-Analysis Study.

Congenital microcephaly is caused by a multitude of drivers affecting maternal−fetal health during pregnancy. It is a rare outcome in high-income industrial countries where microcephaly rates are in the range of 0.3−0.9 per 1000 newborns. Prevalence of microcephaly varies considerably across developing countries and can go as high as 58 cases per 1000 live births in pregnancies exposed to infection by Zika virus (ZIKV). Not only ZIKV-infected pregnancies, but other drivers can modulate the occurrence and severity of this outcome. Here, we sought to test the ZIKV−microcephaly association vs. competing hypotheses using a meta-analysis with 8341 microcephaly cases pooled from 10,250,994 newborns in the Americas, Africa, and Asia. Analysis of risk ratios (RR) showed teratogens the most likely microcephaly-associated risk factor (RR = 3.43; 95%-CI 2.69−4.38; p-value < 0.0001), while the statistical significance of the ZIKV−microcephaly association was marginal (RR = 2.12; 95%-CI 1.01−4.48; p-value = 0.048). Other congenital infections showed strong but variable associations with microcephaly (RR = 15.24; 95%-CI 1.74−133.70; p-value = 0.014). Microcephaly cases were associated with impoverished socioeconomic settings, but this association was statistically non-significant (RR = 2.75; 95%-CI 0.55−13.78; p-value = 0.22). The marginal ZIKV−microcephaly association and statistical significance of the competing hypotheses suggest maternal ZIKV infection might not be a cause of microcephaly alone.

Firearm exposure and the health of high-risk intimate partner violence victims.

RATIONALE: The negative physical and mental health consequences of intimate partner violence (IPV) have been well-documented, as those who are exposed to trauma experience more physical health issues. Further, an abuser's direct access to a firearm drastically increases the risk for fatality, which can exacerbate ongoing stress and trauma in an abusive relationship. However, very little research has investigated the intersection of exposure to firearms and adverse health outcomes in the context of IPV. OBJECTIVE: This study investigates the sensitivity of firearm exposure in IPV contexts by examining if abusive partner firearm ownership-regardless of actual use of a gun in the abuse-is associated with negative health outcomes. METHODS: The research team administered questionnaires to IPV victims (N = 215) from six domestic violence shelters across rural and urban locations in a single state. RESULTS: Having an abusive partner who owned a firearm was associated with significantly worse physical health-above and beyond IPV experienced in the relationship. Even so, IPV involving firearms was not significantly associated with physical health beyond partner firearm ownership. The relationship between partner firearm ownership and negative health outcomes was primarily attenuated by sleep disturbances among victims. CONCLUSIONS: The results provide initial information about the role that firearms play in adverse victim health beyond injuries (e.g., gunshot wounds) and fatalities.

The structure and functional correlates of social support networks of people in advanced old age living in chosen urban and rural areas in Poland: a cross-sectional study.

The purpose of the study was to identify the different types of social support networks (SSNs) among community-dwelling people aged 75+ years in selected areas of Poland, and to evaluate any associations between the network type and demographic and health variables of the population studied. The two most prevalent SSN types identified using the Practitioner Assessment of Network Type were "family dependent" (35.8%) and "locally integrated" (32.2%). "Local self-contained" (6.4%), "wider community focused" (2.8%) and "private restricted" (5.6%) SSNs were observed less frequently. In 17.2% of cases, it was not possible to identify the type of network unequivocally. Older people with a locally integrated SSN, in contrast to the family dependent type, were generally younger, living alone, and less likely to be homebound, rate their health as poor, suffer from depression or dementia, and had lower levels of functional disability. Locally integrated SSNs are recognized in the literature as being the most robust in terms of facilitating well-being and providing sufficient support to help maintain the older person in the community. This may reflect the higher levels of independence of older people able to sustain these support networks, which are then transformed into family-dependent types as their health deteriorates, but confirmation of this would require prospective studies. An improved understanding of the prevalence of different types of social networks among older people in Poland would help to guide a systematic approach to recognizing unmet needs in this population and provide crucial information in the planning of formal services.

Identifying health correlates of intimate partner violence against pregnant women.

PURPOSE: Violence against women during pregnancy is a serious public health concern due to its significant adverse health consequences for both the mother and the baby. This study aims to systematically identify common health problems and synergistic health correlates of intimate partner violence (IPV) that specifically affect pregnant women. METHODS: We mine large-scale electronic health record (EHR) data from the IBM Explorys database to identify health problems that are prevalent in both IPV and pregnancy populations, as well those that are synergistically associated with the presence of IPV during pregnancy. For this purpose, we develop methods that enhance the statistical reliability of identified patterns by constructing confidence intervals that take into account systematic bias and measurement errors in addition to the variance in estimation. RESULTS: We identify with high confidence 668 and 2750 terms that are respectively prevalent in respectively IPV and pregnancy populations. Of these terms, 279 are common. We also identify 16 synergistic health correlates with high confidence. Our results suggest that mental health, substance abuse, and genitourinary complications are prevalent among pregnant women exposed to IPV. The synergistic terms we identify reveal potential conditions that can be direct consequences of trauma (e.g., tibial fracture), long-term health consequences (e.g., chronic rhinitis), markers associated with the demograhics of affected populations (e.g., acne), and risk factors that potentially increase vulnerability during pregnancy (e.g., disorders of attention and motor control). CONCLUSIONS: Our results indicate that IPV significantly affects the well-being of pregnant women in multiple ways. The findings of this study can be useful for screening of IPV in pregnant women. Finally, the methodology presented here can also be useful for investigating the synergy between other medical conditions using EHR databases with privacy constraints.

Prevalence and risk factors associated with falls among community-dwelling and institutionalized older adults in Indonesia.

OBJECTIVE: To assess the prevalence and social and health correlates of falls and fall risk in a sample of community-dwelling and institutionalized older Indonesians. METHODS: This cross-sectional study was conducted July-August 2018 in three regions in Indonesia. Adults aged 60 years and above (n=427) were recruited via random sampling from community clinics and public and private elderly homes. They responded to interview-administered questions and provided measurements on sociodemographics and various health variables, including falls and fall risk. Fall risk was assessed with the STEADI (Stopping Elderly Accidents, Deaths, & Injuries) screen. Multivariable logistic regression was conducted to estimate associations with fall and fall risk. RESULTS: In the year immediately preceding the study, 29.0% of participants had suffered a fall. Approximately one-third of women (31.1%) and one-fifth of men (20.4%) reported a fall in the past year, and 25.4% of community dwellers and 32.7% of institutionalized older adults had fallen. The overall proportion of fall risk was 45.4%, 49.0% among women, 38.0% among men, 50.5% in the institutionalized setting, and 40.4% in the community setting. In adjusted logistic regression analysis, older age (OR: 1.89, CI: 1.06, 3.37), private elderly home setting (OR:2.04, CI: 1.10, 3.78), and being female (OR: 0.49, CI: 0.30, 0.82) were associated with falls in the preceding 12 months. Older age (80-102 years) (OR: 2.55, CI: 1.46, 4.46), private elderly home residence (OR: 2.24, CI: 1.19, 4.21), lack of education (OR: 0.51, CI: 0.28, 0.93), memory problems (OR: 1.81, CI: 1.09, 2.99), and arthritis (OR: 2.97, CI: 1.26, 7.00) were associated with fall risk by the STEADI screen. In stratified analysis by setting, being female (OR: 0.49, CI: 0.25, 0.95) and living in urban areas (OR: 1.97, CI: 1.03, 3.76) were associated with falls in the institutionalized setting, and having near vision problems (OR: 2.32, CI: 1.09, 4.93) was associated with falls in the community setting. Older age (OR: 2.87, CI: 1.36, 6.07) was associated with fall risk in the institutionalized setting, and rural residence (OR: 0.37, CI: 0.15, 0.93) and having a joint disorder or arthritis (OR: 4.82, CI: 1.28, 16.61) were associated with fall risk in the community setting. CONCLUSION: A high proportion of older adults in community and institutional care in Indonesia have fallen or were at risk of falling in the preceding 12 months. Health variables for fall and fall risk were identified for the population overall and for specific populations in the home care and community setting that could help in designing fall-prevention strategies.

Mental Health Correlates of Financial Mistreatment in the National Elder Mistreatment Study Wave II.

Objective: Whereas prevalence of elder financial mistreatment has received increased attention over the past decade, health and mental health correlates are rarely studied. Thus, the potential relevance of financial abuse to mental health and perceived health is relatively unknown, and the objective of this article is to illustrate this relationship. Method: The second wave of the National Elder Mistreatment Study used random digit dialing telephone survey methodology to assess both recent financial mistreatment and its potential mental health correlates (i.e., diagnoses of depression, posttraumatic stress disorder [PTSD], generalized anxiety disorder [GAD], and self-ratings of physical health) in 774 older adults. Results: The study indicated that past-year Wave II financial mistreatment was associated with significantly increased likelihood of depression, PTSD, GAD, and poor self-rated health; and financial mistreatment perpetrated by family members was associated with particularly increased risk of depression. Discussion: Assessment of mental health is relevant and important in cases of financial abuse.

Child sexual abuse as reported by Israeli adolescents: social and health related correlates.

The objectives of the study were to assess the prevalence of child sexual abuse (CSA) in a nation-wide representative sample of 14-17 year old Israeli adolescents, and to examine the associations between CSA, socio-demographic correlates and various measures of physical and mental health. The study population consisted of 906 mother-adolescent dyads, belonging to a community based, representative sample of Israeli 14-17 year olds, interviewed in 2004-5. Response rate was 68%. Subjects provided demographic data, and information about CSA, physical symptoms, body image, well-being and use of mental health services. DAWBA was used to obtain information regarding mental disorders and suicidality. SDQ was used to obtain data on bullying. Statistical analyses were conducted using an SPSS-17 complex sample analysis module and multivariate analyses were conducted to assess the associations between CSA and risk factors and social and health related correlates. Findings show that CSA was reported by 3.3% of adolescents. Higher risk of exposure to CSA was found among girls, among adolescents living in a one-parent household and among adolescents with a chronic disability. In multivariate models adjusting for gender, learning disabilities and depression, CSA was associated with suicidal attempts, stomach ache, dizziness, sleep problems, well being at home and bullying behaviors. No association was found with suicidal ideation or other physical symptoms. Our findings confirm that the associations between CSA and different outcomes vary depending on the socio-psychological context, and underline the importance of addressing the complexity of variables associated with CSA.

Excoriation (skin picking) disorder in Israeli University students: prevalence and associated mental health correlates.

OBJECTIVE: The purpose of the study was to examine the prevalence of excoriation (skin picking) disorder (SPD) and associated physical and mental health correlates in a sample of Israeli university students. METHODS: Five thousand Israeli students were given questionnaires screening for SPD, depression, obsessive-compulsive disorder, body dysmorphic disorder and disruptive, impulse control and conduct disorders. A total of 2176 participants (43.6%) responded and were included in the analysis. Mean age was 25.1 ± 4.8 (range 17-60) years, and 64.3% were female. RESULTS: The proportion of students who were screened positive for SPD was 3.03%, with a nearly equal gender distribution (3.0% in females and 3.1% in males). There was a trend toward significantly higher rates of psychiatric problems such as generalized anxiety, compulsive sexual behavior and eating disorders in these students. Within the group of students screening positive for SPD, alcohol intake was higher in male students, while female students perceived themselves as less attractive. No association was found between depression and SPD. A high prevalence rate of skin picking was found within first-degree family members of the participants screening positive for SPD. CONCLUSIONS: Clinicians and public health officials within university settings should screen for SPD as it is common and associated with psychosocial dysfunction.

Prevalence and risk factors associated with falls among community-dwelling and institutionalized older adults in Indonesia

@#Objective: To assess the prevalence and social and health correlates of falls and fall risk in a sample of community-dwelling and institutionalized older Indonesians. Methods: Tis cross-sectional study was conducted July–August 2018 in three regions in Indonesia. Adults aged 60 years and above (n=427) were recruited via random sampling from community clinics and public and private elderly homes. Tey responded to interview-administered questions and provided measurements on sociodemographics and various health variables, including falls and fall risk. Fall risk was assessed with the STEADI (Stopping Elderly Accidents, Deaths, & Injuries) screen. Multivariable logistic regression was conducted to estimate associations with fall and fall risk. Results: In the year immediately preceding the study, 29.0% of participants had sufered a fall. Approximately one-third of women (31.1%) and one-ffth of men (20.4%) reported a fall in the past year, and 25.4% of community dwellers and 32.7% of institutionalized older adults had fallen. Te overall proportion of fall risk was 45.4%, 49.0% among women, 38.0% among men, 50.5% in the institutionalized setting, and 40.4% in the community setting. In adjusted logistic regression analysis, older age (OR: 1.89, CI: 1.06, 3.37), private elderly home setting (OR:2.04, CI: 1.10, 3.78), and being female (OR: 0.49, CI: 0.30, 0.82) were associated with falls in the preceding 12 months. Older age (80-102 years) (OR: 2.55, CI: 1.46, 4.46), private elderly home residence (OR: 2.24, CI: 1.19, 4.21), lack of education (OR: 0.51, CI: 0.28, 0.93), memory problems (OR: 1.81, CI: 1.09, 2.99), and arthritis (OR: 2.97, CI: 1.26, 7.00) were associated with fall risk by the STEADI screen. In stratifed analysis by setting, being female (OR: 0.49, CI: 0.25, 0.95) and living in urban areas (OR: 1.97, CI: 1.03, 3.76) were associated with falls in the institutionalized setting, and having near vision problems (OR: 2.32, CI: 1.09, 4.93) was associated with falls in the community setting. Older age (OR: 2.87, CI: 1.36, 6.07) was associated with fall risk in the institutionalized setting, and rural residence (OR: 0.37, CI: 0.15, 0.93) and having a joint disorder or arthritis (OR: 4.82, CI: 1.28, 16.61) were associated with fall risk in the community setting. Conclusion: A high proportion of older adults in community and institutional care in Indonesia have fallen or were at risk of falling in the preceding 12 months. Health variables for fall and fall risk were identifed for the population overall and for specifc populations in the home care and community setting that could help in designing fall-prevention strategies.