John P. Barile

Weight and health-related quality of life: The moderating role of weight discrimination and internalized weight bias

OBJECTIVES Obesity is an increasingly prevalent public health concern, with associated medical comorbidities and impairment in health-related quality of life (HRQoL). Obese women are frequently victims of weight-related discrimination. The HRQoL impairments among obese people could be related to this discrimination and to internalized weight bias. Design We examined the potential moderating role of discrimination (from others) and self-directed (internalized) weight-based discrimination in the association between body mass index (BMI) and HRQoL. METHODS Eighty-one women (mean age=41.1years; mean BMI=43.40kg/m(2), 97% Caucasian) completed valid and reliable measures of weight bias internalization (weight bias internalization scale), perceived discrimination by others (everyday discrimination scale) and both physical and mental HRQoL (SF-36 Health Survey). Multiple regression analysis was used to test whether internalized weight bias or discrimination moderated the association between BMI and the summary scores for physical and mental HRQoL, controlling for age. RESULTS Significant associations were found between BMI and discrimination (r=.36, p=.002), between internalized weight bias and both mental (r=.61, p<.001) and physical HRQoL (r=.45, p<.001), and between discrimination and physical HRQoL (r=.29, p=.014). A statistically significant interaction was found between BMI and internalized weight bias (b=-.21, SE=.10, p<0.05) in accounting for the variance in physical HRQoL. CONCLUSIONS The association between higher BMI and poorer physical HRQoL was found only in individuals reporting high levels of internalized weight bias. Self-discrimination among overweight individuals may be a critical factor in their physical health impairment.

Health-Related Quality of Life Among Older Adults With and Without Functional Limitations

OBJECTIVES We examined factors that influence health-related quality of life (HRQOL) among individuals aged 50 years and older with and without functional limitations. METHODS We analyzed data from the 2009 Behavioral Risk Factor Surveillance System to assess associations among demographic characteristics, health care access and utilization indicators, modifiable health behaviors, and HRQOL characterized by recent physically and mentally unhealthy days in those with and those without functional limitations. We defined functional limitations as activity limitations owing to physical, mental, or emotional health or as the need for special equipment because of health. RESULTS Age, medical care costs, leisure-time physical activity, and smoking were strongly associated with both physically and mentally unhealthy days among those with functional limitations. Among those without functional limitations, the direction of the effects was similar, but the size of the effects was substantially smaller. CONCLUSIONS The availability of lower cost medical care, increasing leisure-time physical activity, and reducing rates of cigarette smoking will improve population HRQOL among older adults with and without functional limitations. These factors provide valuable information for determining future public health priorities.

Monitoring population health for Healthy People 2020: evaluation of the NIH PROMIS Global Health, CDC Healthy Days, and satisfaction with life instruments

PurposeHealthy People 2020 identified health-related quality of life and well-being (WB) as indicators of population health for the next decade. This study examined the measurement properties of the NIH PROMIS® Global Health Scale, the CDC Healthy Days items, and associations with the Satisfaction with Life Scale.MethodsA total of 4,184 adults completed the Porter Novelli’s HealthStyles mailed survey. Physical and mental health (9 items from PROMIS Global Scale and 3 items from CDC Healthy days measure), and 4 WB factor items were tested for measurement equivalence using multiple-group confirmatory factor analysis.ResultsThe CDC items accounted for similar variance as the PROMIS items on physical and mental health factors; both factors were moderately correlated with WB. Measurement invariance was supported across gender and age; the magnitude of some factor loadings differed between those with and without a chronic medical condition.ConclusionsThe PROMIS, CDC, and WB items all performed well. The PROMIS items captured a broad range of functioning across the entire continuum of physical and mental health, while the CDC items appear appropriate for assessing burden of disease for chronic conditions and are brief and easily interpretable. All three measures under study appear to be appropriate measures for monitoring several aspects of the Healthy People 2020 goals and objectives.

Activities of daily living, chronic medical conditions, and health-related quality of life in older adults

This study investigated associations between chronic medical conditions, activities of daily living (ADL), and health-related quality of life (HRQOL). Our findings suggest that the number of ADL limitations reported by older adults is associated with their HRQOL. Findings from our analyses also suggest that the association between having multiple comorbid conditions and HRQOL is stronger for those with no ADL limitations than those with at least some limitations. These data will aid practitioners in determining the relative importance of chronic medical conditions and ADL limitations on HRQOL and demonstrate how ADL limitations and comorbid conditions may differentially impact HRQOL.

Multiple Chronic Medical Conditions and Health-Related Quality of Life in Older Adults, 2004–2006

Introduction Understanding longitudinal relationships among multiple chronic conditions, limitations in activities of daily living, and health-related quality of life is important for identifying potential opportunities for health promotion and disease prevention among older adults. Methods This study assessed longitudinal associations between multiple chronic conditions and limitations in activities of daily living on health-related quality of life among older adults (≥65 years) from 2004 through 2006, using data from the Medicare Health Outcomes Survey (N = 27,334). Results Using a longitudinal path model, we found the numbers of chronic conditions at baseline and 2-year follow-up were independently associated with more limitations in activities of daily living at 2-year follow-up. In addition, more limitations in activities of daily living at 2-year follow-up were associated with worse health-related quality of life during the follow-up time period. The association between multiple chronic conditions and indices of health-related quality of life was mediated by changes in limitations in activities of daily living. Conclusion Both baseline and new multiple chronic conditions led to worse health in terms of activities of daily living and health-related quality of life and should be considered important outcomes to intervene on for improved long-term health. In addition, public health practitioners should consider addressing classes of multiple chronic conditions by using interventions designed to reduce the emergence of multiple chronic conditions, such as physical activity, reductions in smoking rates, and improved and coordinated access to health care services.

Thimerosal Exposure in Early Life and Neuropsychological Outcomes 7–10 Years Later

OBJECTIVE The authors used a public use data set to investigate associations between the receipt of thimerosal-containing vaccines and immune globulins early in life and neuropsychological outcomes assessed at 7-10 years. METHODS The data were originally created by evaluating 1,047 children ages 7-10 years and their biological mothers. This study developed seven latent neuropsychological factors and regressed them on a comprehensive set of covariates and thimerosal exposure variables. RESULTS The authors found no statistically significant associations between thimerosal exposure from vaccines early in life and six of the seven latent constructs. There was a small, but statistically significant association between early thimerosal exposure and the presence of tics in boys. CONCLUSIONS This finding should be interpreted with caution due to limitations in the measurement of tics and the limited biological plausibility regarding a causal relationship.

Time-series analyses of count data to estimate the burden of seasonal infectious diseases.

In this issue of epidemiology, Goldstein and colleagues present “a new statistical method for estimating influenza-related mortality” using recent US mortality and influenza data sources. They propose that their method is an advance over previous methods for estimating influenza disease burden. Strengths of their approach include: (1) the accommodation of nonlinear mortality effects of specific influenza types and subtypes over time; (2) the use of a logical method to model exposure to influenza; and (3) an assessment of autocorrelation in the time series. There are also some limitations, which include (1) questionable statistical assumptions in the use of linear regression models for weekly data with low frequency counts; (2) neglect of recent advances in time-series modeling; (3) a complex and nonparsimonious model; and (4) lack of comparisons of influenza-associated mortality estimates with those from the published literature using similar outcomes.

English Proficiency and Peer Interethnic Relations as Predictors of Math Achievement among Latino and Asian Immigrant Students.

Studies show math achievement to be the best predictor of entering post-secondary education. However, less is known about the predictors of math achievement, particularly among immigrant youth. This study examined English proficiency and peer interethnic relations as predictors of mathematics achievement among Latino and Asian high school students, postulating an interaction between the predictors and mediation by academic motivation. A multilevel moderated-mediation model was used to analyze data from a national sample of 2113 non-native English speaking Latino and Asian students attending high school in the U.S. We found that higher academic motivation mediated the relationship between English proficiency during their sophomore year and gains in senior math achievement scores for both Asian and Latino students. For Latino students however, this indirect path was only significant for students whose perceptions of positive peer interethnic relations at school were average or above average.

Number of antigens in early childhood vaccines and neuropsychological outcomes at age 7–10 years

Concerns have been raised that children may be receiving too many immunizations under the recommended schedule in the USA. We used a publicly available dataset to evaluate the association between antibody‐stimulating proteins and polysaccharides from early childhood vaccines and neuropsychological outcomes at age 7–10 years.

Multilevel Measurement of Dimensions of Collaborative Functioning in a Network of Collaboratives that Promote Child and Family Well-Being

Evaluating collaboration between community partners presents a series of methodological challenges (Roussos and Fawcett in Annu Rev Public Health 21:369–402, 2000; Yin and Kaftarian 1997), one of which is selection of the appropriate level of analysis. When data are collected from multiple members of multiple settings, multilevel analysis techniques should be used. Multilevel confirmatory factor analysis (MCFA) is an analytic approach that incorporates the advantages of latent variable measurement modeling and multilevel modeling for nested data. This study utilizes MCFA on data obtained from an evaluation survey of collaborative functioning provided to members of 157 community collaboratives in Georgia. This study presents a well-fitting measurement model that includes five dimensions of collaborative functioning, and a structural component with individual- and collaborative-level covariates. Findings suggest that members’ role and meeting attendance significantly predicted their assessment of collaboration at the individual level, and that tenure of collaborative leaders predicted the overall functioning of the collaborative at the collaborative level. Dimensionality of collaborative functioning and implications of potentially substantial measurement biases associated with selection of respondents are addressed.