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Globally, the prevalence of adolescent sexual intercourse and violence is high. However, to date, no study has investigated the association between violence and sexual behavior in a large representative sample of adolescents, while multicountry studies are also lacking. The objective was thus to examine the relationship between being physically attacked and physical fighting with sexual intercourse, multiple sexual partners, and non-condom use among adolescents aged 12 to 15 years from 43 low- and middle-income countries. Cross-sectional data from 127,513 adolescents participating in the Global School-based Student Health Survey 2003-2016 were analyzed. Data on being physically attacked and physical fighting were assessed through self-report. Data on sexual behavior were collected as follows: (a) ever having had intercourse; among those who reported having had intercourse, (b) multiple (=2) lifetime sexual partners, and (c) condom use in last sexual intercourse. Data were analyzed using multivariable logistic regression analysis with violence as the exposure and sexual behavior as the outcome, with odds ratios being estimated. Physical attack was dose-dependently and significantly associated with all three sexual behavior outcomes with it being associated with 1.42 (95% confidence interval [CI] = [1.16, 1.74]), 2.13 (95% CI = [1.39, 3.27]), and 1.48 (95% CI = [1.10, 2.00]) times higher odds for sexual intercourse, condom non-use, and multiple sex partners, respectively, when the highest category was compared with the lowest (i.e., =4 times vs. 0 times). As for physical fights, compared with not being in a fight in the past 12 months, being in a fight =4 times was associated with 2.34 (95% CI = [2.03, 2.70]) and 1.98 (95% CI = [1.56, 2.52]) times higher odds for sexual intercourse and multiple sex partners, respectively. In conclusion, in a large global sample of adolescents, physical attack and physical fight were associated with greater risk of engaging in sexual behavior. Multidimensional government programs and policies addressing violence in young adolescents may lead to reduction in early sexual debut and other risky sexual behavior.

PURPOSE: There is a paucity of literature identifying factors that influence the back and neck pain (BNP)-workplace absenteeism relationship. Therefore, this study aimed to investigate the association between BNP and workplace absenteeism and potential mediating variables in a large sample of the US population. METHODS: Nationally representative data collected in 2019 from the RAND American Life Panel (ALP) were used for this retrospective study. Workplace absenteeism was defined as the number of days of absence in the past 12 months for health-related reasons (count variable), while BNP corresponded to the presence of back pain due to spinal stenosis, back pain due to other causes, or neck pain (dichotomous variable). Control variables included sex, age, ethnicity, marital status, education, occupation, annual family income, health insurance, obesity, and diabetes. There were eight influential variables (depression, anxiety, sleep disorder, alcohol dependence, opioid dependence, walking difficulty, standing difficulty, and sitting difficulty). The association between BNP and workplace absenteeism was analyzed using a negative binomial regression model. RESULTS: There were 1,471 adults aged 22-83 years included in this study (52.9% of men; mean [standard deviation] age 44.5 [13.0] years). After adjusting for control variables, BNP was positively and significantly associated with workplace absenteeism (incidence rate ratio = 1.40, 95% confidence interval: 1.07-1.83). Walking, standing, and sitting difficulties individually explained between 24 and 43% of this association. CONCLUSIONS: Workplace interventions focusing on the management of BNP and overcoming difficulties in walking, standing, and sitting, potentially utilizing exercise, therapy, and ergonomic interventions, may prevent absenteeism.

BACKGROUND: There is a scarcity of literature on the association between physical multimorbidity (i.e., =2 chronic physical conditions) and depression among older adults, especially from low- and middle-income countries (LMICs). In addition, the mediators in this association are largely unknown. Therefore, we aimed to examine this association among adults aged =50 years from six LMICs (China, Ghana, India, Mexico, Russia, and South Africa), and to identify potential mediators. METHODS: Cross-sectional, nationally representative data from the Study on Global Ageing and Adult Health were analyzed. Depression was defined as past-12 months DSM-IV depression or receiving depression treatment in the last 12 months. Information on 11 chronic physical conditions were obtained. Multivariable logistic regression and mediation analyses were conducted. RESULTS: Data on 34,129 individuals aged =50 years were analyzed [mean (SD) age 62.4 (16.0) years; maximum 114 years; 52.1% females]. Compared to no chronic conditions, 2, 3, 4, and =5 chronic conditions were associated with 2.55 (95% CI = 1.90-3.42), 3.12 (95% CI = 2.25-4.34), 5.68 (95% CI = 4.02-8.03), and 8.39 (95% CI = 5.87-12.00) times higher odds for depression. Pain/discomfort (% mediated 39.0%), sleep/energy (33.2%), mobility (27.5%), cognition (13.8%), perceived stress (7.3%), disability (6.7%), loneliness (5.5%), and food insecurity (1.5%) were found to be significant mediators in the association between physical multimorbidity and depression. CONCLUSIONS: Older adults with physical multimorbidity are at increased odds of depression in LMICs. Future studies should assess whether addressing the identified potential mediators in people with physical multimorbidity can lead to reduction in depression in this population.

BACKGROUND: The aims of the present study were to examine prospective associations of multimorbidity (i.e., =2 chronic conditions) at baseline with incident and persistent anxiety over a two-year follow-up period among Irish older adults, and to quantify the extent to which sleep, pain, and disability mediate the multimorbidity-anxiety relationship. METHODS: Data from The Irish Longitudinal Study on Aging (TILDA) conducted between 2009 and 2011 with a follow-up after two years were analyzed. The baseline survey was anxiety referred to score?=?8 on the anxiety section of the Hospital Anxiety and Depression Scale. Lifetime diagnosis of 14 chronic conditions was obtained. Outcomes were incident and persistent anxiety at two-year follow-up. RESULTS: Data on 5871 adults aged =50?years at baseline were analyzed [Mean (SD) age 63.3 (9.0) years; 51.2% women]. After adjustment for potential confounders, compared to no chronic physical conditions at baseline, =3 chronic conditions were associated with a significant 1.89 (95% CI?=?1.16-3.08) times higher risk for new onset anxiety at follow-up. Furthermore, having 1, 2, and =3 conditions at baseline were associated with significant 1.48 (95% CI 1.02, 2.14), 1.74 (95% CI 1.19, 2.53), and 1.84 (95% CI 1.27, 2.68) times higher risk for persistent anxiety at follow-up. Sleep problems, pain, and disability were identified as significant mediators, explaining 22.9%-37.8% of the associations. CONCLUSION: Multimorbidity was associated with both new onset and persistent anxiety among Irish older adults. Future interventional studies should examine whether addressing the identified mediators may lead to lower risk for incident or persistent anxiety among those with physical multimorbidity.

BACKGROUND: Physical multimorbidity (i.e., =2 chronic conditions) may induce feelings of wish to die (WTD), but there is limited literature on this topic, while the mediators in this association are largely unknown. Thus, the aim of the present study was to investigate this association and its mediators among older Irish adults.; METHODS: Cross-sectional, nationally representative data from Wave 1 of the Irish Longitudinal Study on Ageing 2009-2011 were analyzed. Information on self-reported lifetime diagnosis of 14 chronic physical conditions were obtained. WTD was defined as answering affirmatively to the question "In the last month, have you felt that you would rather be dead?" Multivariable logistic regression and mediation analyses were conducted.; RESULTS: Data on 2941 adults aged =65years [mean (SD) age 73.2 (5.2) years; 45.0% males] were analyzed. Physical multimorbidity was associated with 3.39 (95%CI 1.58, 7.28) times higher odds for WTD. This association was largely explained by pain (% mediated 28.1%), followed by depression (19.4%), sleep problems (18.4%), perceived stress (13.0%), loneliness (10.4%), anxiety (8.1%), and disability (7.2%).; CONCLUSIONS: Multimorbidity was associated with increased odds for WTD among Irish older adults. Addressing the identified mediators may contribute to reducing feelings of WTD among older adults with multimorbidity. Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

PURPOSE: Informal caregivers may be at high risk for psychotic experiences (PE) due to caregiving related stress, sleep issues, or other potential mechanisms, but this has not been previously investigated in the general adult population. Thus, we examined the association between caregiving and PE, and its mediators, in a large sample of adults from 48 low- and middle-income countries (LMICs). METHODS: Cross-sectional, community-based data from the World Health Organization (WHO) World Health Survey were analyzed. Informal caregivers referred to those who provided help to a relative or friend (adult or child) in the past year, because this person has a long-term physical or mental illness or disability, or is getting old and weak. PE were assessed using the WHO Composite International Diagnostic Interview psychosis screen. Multivariable logistic regression and mediation analyses were conducted. RESULTS: Data on 224,842 individuals were analyzed. The mean (SD) age was 38.3 (16.0) years (range 18-120 years) and 50.7% were females. After adjustment for age, sex, and country, in the overall sample, caregiving was associated with 1.67 (95%CI = 1.56-1.79) times higher odds for PE. Sleep/energy explained the largest proportion of the association between caregiving and PE (13.9%), followed by pain/discomfort (11.5%), perceived stress (7.6%), depression (6.2%), and cognition (3.5%). CONCLUSION: Caregivers in LMICs are at higher risk of PE. Future studies are warranted to gain a further understanding of the underlying mechanisms, and to assess whether addressing the identified mediators can lead to lower risk for PE among caregivers.

OBJECTIVES: Problem gambling is associated with multiple detrimental health outcomes. However, to date, no study has investigated the association between problem gambling and functional disability. Therefore, the aim of this study was to investigate the association between problem gambling and functional disability in a UK nationally representative sample. METHODS: Cross-sectional data from the 2007 Adult Psychiatric Morbidity Survey were analyzed. Problem gambling was assessed using a questionnaire including 10 DSM-IV criteria, whereas functional disability referred to at least 1 difficulty in 1 of 7 activities of daily living and instrumental activities of daily living. Control variables included sociodemographic factors, smoking status, alcohol dependence, drug use, the number of chronic physical conditions, depression, and anxiety disorder. The problem gambling-functional disability relationship was studied using a logistic regression model. RESULTS: This study included 6941 adults aged =16 years (51.2% women; mean [SD] age 46.3 [18.6] years). The prevalence of functional disability was significantly higher in the at-risk problem gambling/problem gambling group than in the no problem gambling group (46.2% vs 32.1%, P value < 0.001). After adjusting for control variables, both at-risk problem gambling (OR = 1.55, 95% CI = 1.03-2.35) and problem gambling (OR = 3.05, 95% CI = 1.09-8.52) were positively and significantly associated with functional disability. CONCLUSIONS: In this large representative sample of UK adults, problem gambling was associated with higher odds for functional disability. If confirmed with longitudinal studies, these results suggest that those suffering from problem gambling should receive targeted intervention to aid in the prevention of functional disability.

BACKGROUND: We aimed to investigate associations of unclean cooking fuels with depression and anxiety symptoms in a large sample of adults aged =65years from six low- and middle-income countries (LMICs).; METHODS: Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Unclean cooking fuel referred to kerosene/paraffin, coal/charcoal, wood, agriculture/crop, animal dung, and shrubs/grass. Depression referred to DSM-IV depression based on past 12-month symptoms or receiving depression treatment in the last 12months. Anxiety symptoms referred to severe/extreme problems with worry or anxiety in the past 30days. Multivariable logistic regression analysis and meta-analysis were conducted.; RESULTS: Data on 14,585 people aged =65years were analyzed [mean (SD) age 72.6 (11.5) years; maximum age 114years; 55.0% females]. After adjustment for potential confounders, unclean cooking fuel was associated with a significant 2.52 (95%CI=1.66-3.82) times higher odds for depression with a low level of between-country heterogeneity (I2=0.0%). For anxiety symptoms, unclean fuel use was not significantly associated with anxiety symptoms (OR=1.13; 95%CI=0.77-1.68; I2=0.0%).; LIMITATIONS: 1. Cross-sectional design. 2. Self-reported measures. 3. No information about outdoor pollution exposure, personal exposure, and smoke composition of different cooking fuels.; CONCLUSIONS: Unclean cooking fuel was significantly associated with higher odds for depression, but not anxiety, with little observed variability between settings. Findings from the present study provide further support and call for action in appropriate implementation of the United Nations Sustainable Goal 7, which advocates affordable, reliable, sustainable, and modern energy for all. Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

Food insecurity has been shown to be associated with fast-food consumption. However, to date, studies on this specific topic are scarce. Therefore, the aim of the present study was to investigate the association between food insecurity and fast-food consumption in adolescents aged 12-15 years from sixty-eight countries (seven low-income, twenty-seven lower middle-income, twenty upper middle-income, fourteen high-income countries). Cross-sectional, school-based data from the Global School-based Student Health Survey were analysed. Data on past 30-d food insecurity (hunger) and fast-food consumption in the past 7 d were collected. Multivariable logistic regression and meta-analysis were conducted to assess associations. Models were adjusted for age, sex and BMI. There were 180 164 adolescents aged 12-15 years (mean age 13·8 (sd 1·0) years; 50·8 % boys) included in the analysis. Overall, severe food insecurity (i.e. hungry because there was not enough food in home most of the time or always) was associated with 1·17 (95 % CI 1·08, 1·26) times higher odds for fast-food consumption. The estimates pooled by country-income levels were significant in low-income countries (adjusted OR (aOR) = 1·30; 95 % CI 1·05, 1·60), lower middle-income countries (aOR = 1·15; 95 % CI 1·02, 1·29) and upper middle-income countries (aOR = 1·26; 95 % CI 1·07, 1·49), but not in high-income countries (aOR = 1·04; 95 % CI 0·88, 1·23). The mere co-occurrence of food insecurity and fast-food consumption is of public health importance. To tackle this issue, a strong governmental and societal approach is required to utilise effective methods as demonstrated in some high-income countries such as the implementation of food banks and the adoption of free school meals.

BACKGROUND: Physical inactivity is strongly associated with obesity, which in turn is a major risk factor for many non-communicable diseases. We examined associations between physical inactivity and obesity in Spanish adults with vision and hearing difficulties and explored differences between men and women. METHODS: Data from the Spanish National Health Survey 2017 were analyzed [n = 23 089 adults (15-103 years, mean age 53.4 ± 18.9 years, 45.9% men)]. Participants self-reported difficulties in seeing and hearing. Physical inactivity (exposure) was evaluated with the International Physical Activity Questionnaire Short Form. Obesity (outcome) was defined as body mass index =30 kg m-2 based on self-reported weight and height. The association between physical inactivity and obesity was assessed with multivariable logistic regression in people with difficulties seeing and hearing, adjusting for significant covariates. RESULTS: Multivariable logistic regression analyses showed that the association between physical inactivity and obesity was stronger in those with difficulty hearing (OR 1.778, 95% CI 1.215-2.602) compared with difficulty seeing (OR 1.375, 95% CI 1.076-1.756). Gender-stratified analyses showed significant association between physical inactivity and obesity in men who reported difficulty hearing (OR 2.319, 95% CI 1.441-3.735) and difficulty seeing (OR 1.556, 95% CI 1.079-2.244), but not in women. CONCLUSIONS: A significant association between physical inactivity and obesity was observed in Spanish men with vision and hearing difficulties. Physical activity has an important role in the prevention of obesity in men with seeing and hearing difficulties. Active steps should be taken to encourage physical activity to reduce the risk of obesity in people with sensory impairments.

Objective: This study aimed to explore gender differences in the associations between cataracts and self-reported depression and chronic anxiety in Spanish adults with diabetes. Methods: Cross-sectional data from the Spanish Health Survey 2017 were analyzed. Inclusion criterion was a positive response to the question "Have you ever been diagnosed with diabetes?" Diabetes, cataracts, depression and chronic anxiety were based on self-reported lifetime diagnosis. Multivariable logistic regression was conducted to assess the association between cataracts and depression or anxiety among respondents with diabetes, stratifying by gender. Results: Out of a total 23,089 respondents, 2,266 people self-reported suffering from diabetes (50.2% women; average age 69.7 ± 12.7 years; age range 15-98 years). In people with diabetes, the presence of cataracts was associated with significantly higher odds for depression (OR = 1.655; 95% CI = 1.295-2.115). Gender-stratified analyses showed that only women with cataracts were significantly associated with higher odds for depression (OR = 1.762; 95% CI = 1.307-2.374) and chronic anxiety (OR = 1.519; 95% CI = 1.067-2.163). Conclusion: Cataracts are a significant risk factor for depression and chronic anxiety in Spanish women with diabetes, but not in men. Women with both diabetes and cataracts require assessment for depression and chronic anxiety, and possibly earlier interventions in order to reduce the potential risk of further mental health complications.

BACKGROUND: Little is known about the relationship between sarcopenia and mild cognitive impairment (MCI) in low- and middle-income countries (LMICs). OBJECTIVE: This study aimed to investigate this association among community-dwelling adults aged=65 years from six LMICs. METHODS: Cross-sectional, nationally representative data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. These data were obtained in China, Ghana, India, Mexico, Russia, and South Africa in 2007-2010. Participants were considered to have sarcopenia if they had low skeletal muscle mass (i.e., lower skeletal mass index) and a weak handgrip strength. MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. Multivariable logistic regression analysis was conducted to assess associations. RESULTS: The final analytical sample consisted of 12,912 individuals aged=65 years with preservation in functional abilities without stroke (mean [standard deviation] age 72.2 [10.8] years; 45.2% males). The overall prevalence of sarcopenia and MCI were 11.3% and 18.1%, respectively. After adjusting for potential confounders, there was a positive association between sarcopenia and MCI in all countries (i.e., odds ratio [OR] > 1) with the exception of South Africa, and the overall estimate was OR = 1.60 (95% confidence interval [CI] = 1.32-1.93) with a low level of between-country heterogeneity (I2 = 0.0%). CONCLUSION: There was a positive association between sarcopenia and MCI in this sample of older adults living in LMICs. Causality should be assessed in future longitudinal research, while the utility of sarcopenia as a marker of MCI should also be investigated.

OBJECTIVE: To assess the association between sexual orientation and functional limitations in a large representative sample of the English population. DESIGN: Cross-sectional. SETTING: Data were from the 2007 Adult Psychiatric Morbidity Survey. PARTICIPANTS: A total of 7403 adults aged 16-95 years (51.4% female; mean age, 46.3±18.6y) were included in the present study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Sexual orientation was assessed using 2 items adapted from the Kinsey scale and was dichotomized into heterosexual and sexual minority orientation. Functional limitations were assessed using 7 activities of daily living (ADL) and instrumental activities of daily living (IADL). Functional limitations were defined as at least 1 difficulty in 1 of 7 ADL and IADL. Adjusted logistic regression analyses were conducted to investigate the association between sexual orientation (independent variable) and functional limitations (dependent variable). RESULTS: The level of sexual minority orientation and prevalence of functional limitations in the sample was 7.1% and 32.9%, respectively. After adjusting for several potential confounders, sexual minority orientation was positively and significantly associated with functional limitations (odds ratio, 1.51; 95% confidence interval, 1.18-1.95; reference group: heterosexual orientation). CONCLUSIONS: Based on the findings of this study, interventions aiming to prevent against and/or manage/reduce functional limitations in sexual minorities are needed. More research is also warranted to better understand mediators (eg, obesity, cognitive complaints, psychiatric disorders) involved in the sexual orientation-functional limitation relationship.

INTRODUCTION: Previous studies on the diabetes-edentulism relationship have yielded conflicting results. Therefore, the goal of this study was to investigate the association between diabetes and edentulism, and their joint effects on health status in adults from 40 low and middle-income countries (LMICs). RESEARCH DESIGN AND METHODS: Data from the World Health Survey were used for this cross-sectional study (2002-2004). Forty countries (18 low-income and 22 middle-income countries) were included. Edentulism and diabetes were assessed using yes-no questions based on self-report. Health status was assessed in seven different domains (self-care, pain/discomfort, cognition, interpersonal activities, sleep/energy, affect, and perceived stress). The association between diabetes (exposure) and edentulism (outcome) was analyzed using multivariable logistic regression models, while their joint effects on health status were assessed using multivariable linear regression models. RESULTS: There were 175 814 adults aged =18 years included in this study (mean (SD) age 38.4 (16.0) years; 49.3% men). Overall, the prevalence of edentulism was 6.0% and diabetes was 2.9%. There was a positive and significant association between diabetes and edentulism in the overall sample (OR=1.40, 95% CI 1.18 to 1.66), in low-income countries (OR=1.78, 95% CI 1.21 to 2.62) and in middle-income countries (OR=1.24, 95% CI 1.04 to 1.47). In addition, people with comorbid diabetes and edentulism had worse health status in the domains of cognition, sleep/energy, and perceived stress, compared with those with diabetes only. CONCLUSIONS: Diabetes was positively associated with edentulism in this sample of more than 175 000 individuals living in LMICs. Providing oral care to individuals with diabetes may potentially lead to a reduction in their risk of edentulism.

Limited literature has investigated the association between food insecurity and sarcopenia in low- and middle-income countries (LMICs). Therefore, the aim of the present study was to investigate the association between food insecurity and sarcopenia among adults aged =65 years in six LMICs. Community-based cross-sectional data of the Study on Global Ageing and Adult Health were analyzed. Sarcopenia was defined as the presence of low skeletal muscle mass based on indirect population formula, and either slow gait or low handgrip strength. In the past, 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted. The final sample consisted of 14,585 individuals aged =65 years (mean (SD) age 72.6 (11.5) years; 55.0% females). The prevalence of sarcopenia among those with no food insecurity was 13.0% but this increased to 24.4% among those with severe food insecurity. After adjustment for potential confounders, compared to no food insecurity, severe food insecurity was associated with 2.05 (95%CI = 1.12-3.73) times higher odds for sarcopenia. In this large representative sample of older adults from multiple LMICs, it was found that severe food insecurity is associated with higher odds for sarcopenia. Addressing food insecurity in such settings may be an effective strategy to curb the high prevalence of sarcopenia in LMICs.

OBJECTIVES: To assess the association between far vision impairment (objective and subjective) and perceived stress among older adults from six low- and middle-income countries (LMICs, i.e., China, Ghana, India, Mexico, Russia, and South Africa). METHODS: Data from the WHO Study on global AGEing and adult health were analyzed. Objective visual acuity was measured using the tumbling E LogMAR chart and was used as a four-category variable (no, mild, moderate, and severe visual impairment). Subjective visual impairment referred to difficulty in seeing and recognizing an object or a person across the road. Using two questions from the Perceived Stress Scale, a perceived stress variable was computed, and ranged from 0 (lowest stress) to 100 (highest stress). Multivariable linear regression with perceived stress as the outcome was conducted. RESULTS: Data on 14,585 adults aged =65 years [mean (SD) age 72.6 (11.5) years; 55.0% females] were analyzed. Only severe objective visual impairment (versus no visual impairment) was significantly associated with higher levels of stress (b = 6.91; 95% CI = 0.94-12.89). In terms of subjective visual impairment, compared with no visual impairment, mild (b = 2.67; 95% CI = 0.56-4.78), moderate (b = 8.18; 95% CI = 5.84-10.52), and severe (b = 11.86; 95% CI = 9.11-14.61) visual impairment were associated with significantly higher levels of perceived stress. CONCLUSIONS: This large study showed that far vision impairment was associated with increased perceived stress levels among older adults in LMICs. Increased availability of eye care services may reduce stress among those with visual impairment in LMICs, while more research is needed to better characterize the directionality of the far vision impairment-perceived stress relationship.

OBJECTIVE: Individually, vision and hearing impairments have been linked to higher levels of anxiety and depression. We investigated the effect of dual sensory impairment (difficulty seeing and hearing) in a large representative sample of Spanish adults. METHODS: Data from a total of 23,089 adults (age range: 15-103 years, 45.9% men) from the Spanish National Health Survey 2017 were analyzed. Self-reported difficulty of seeing and hearing (exposures), and depression and chronic anxiety (outcomes) were analyzed. Multivariable logistic regression was assessed for difficulty with vision alone, hearing alone and with difficulty with both, adjusting for gender, age, marital status, living as a couple, education, smoking, alcohol consumption, BMI, physical activity, use of glasses/contact lenses, and hearing aid. RESULTS: Visual difficulty, hearing difficulty, and dual difficulties were all associated with significantly higher odds for depression (ORs 2.367, 2.098, and 3.852, respectively) and for chronic anxiety (ORs 1.983, 1.942, and 3.385, respectively). Dual sensory difficulty was associated with higher odds ratios for depression and anxiety when compared to either impairment alone. CONCLUSION: Dual sensory difficulty is associated with significantly higher odds of anxiety and depression when compared to either vision or hearing difficulty alone. Appropriate interventions are needed to address any reversible causes of vision and hearing as well as anxiety and depression in people in these specific groups.

OBJECTIVE: We investigated cross-sectional gender-specific associations with vision, hearing and both (dual) impairment with depression and chronic anxiety using a large representative sample of Spanish adults. METHODS: The present study utilised data from the Spanish National Health Survey 2017. A total of 23,089 adults (15-103 years, 45.9% men) participated in this survey. Participants self-reported whether they had suffered depression and/or anxiety, and also whether they experience vision, hearing and both vision/hearing (dual) impairment. Multivariable logistic regression analyses were conducted to assess the associations between the three types of sensory impairment and anxiety or depression, in men and women. RESULTS: Across the whole sample (n=23,089) the prevalence of depression and anxiety was between 2.00-2.56 times higher in women compared to men. Dual sensory impairment (hearing and vision) was associated with higher levels of depression (OR = 2.980, 95% CI 2.170-4.091) and anxiety (OR = 2.636, 95% CI 1.902-3.653) compared to single sensory impairment. Stratified associations by gender showed higher odd ratios for women with dual sensory loss (3.488 for depression and 3.478 for anxiety) compared to men (2.773 for depression and 1.803 for anxiety). CONCLUSIONS: Dual sensory impairment (hearing and seeing) is are associated with increased depression and anxiety. Women with dual sensory impairment showed stronger associations compared to men among adults in Spain. Interventions are needed to address vision and/or hearing impairment in order to reduce anxiety and depression especially in women. This article is protected by copyright. All rights reserved.

BACKGROUND: The goal of this study was to investigate the association between several oral health outcomes and cancer in adults living in Spain. METHODS: Data from the Spanish National Health Survey 2017 were analysed. Seven oral health outcomes (dental caries, dental extraction, dental filling, gingival bleeding, tooth movement, dental material and missing tooth) were assessed with questions with 'yes' and 'no' options. Cancer was assessed and defined with the following yes-no question: 'Have you ever been diagnosed with malignant tumours?'. The relationship of each oral health outcome and the number of poor oral health outcomes with cancer was studied in regression models adjusted for sex, age, marital status, education, smoking and alcohol consumption. RESULTS: This study included 23 089 participants aged 15-103 years [45.9% of males; mean (standard deviation) age 53.4 (18.9) years]. The prevalence of cancer was 5.0% in the overall population. After adjusting for several potential confounding factors, all oral health outcomes except missing tooth were significantly and positively associated with cancer [odds ratios (ORs) ranging from 1.15 for dental filling to 1.48 for dental extraction]. In addition, there was a positive and significant association between the number of poor oral health outcomes and cancer (OR = 1.16, 95% confidence interval = 1.11-1.22). CONCLUSIONS: On a nationally representative sample of 23 089 participants in Spain, poorer oral health outcomes were found in participants with history of cancer, with positive associations between several oral health outcomes as well as the number of poor oral health outcomes and cancer.

BACKGROUND: Data on the association between visual difficulty and physical activity (PA) from low- and middle-income countries (LMICs) are scarce. Thus, the aim of the study was to investigate the association between visual difficulty and PA among adults from 36 LMICs, and to assess the mediators in this association. METHODS: Cross-sectional, community-based, predominantly nationally representative data from the World Health Survey were analysed. The final sample included 199,110 individuals aged =18 years [mean (SD) age 38.6 (16.1) years; 49.4% males]. Visual difficulty referred to having severe/extreme difficulties in seeing and recognizing a person that the participant knows across the road. Low PA was defined as not complying with PA recommendations of 150 min of moderate-vigorous PA per week. Multivariable logistic regression, meta-analysis, and mediation analysis were conducted to assess associations. RESULTS: Meta-analysis based on country-wise multivariable logistic regression analysis showed that overall, visual difficulty is associated with a 1.53 (95% CI = 1.38-1.71) times higher odds for low PA. Particularly strong associations were observed in males (OR = 1.72; 95% CI = 1.45-2.05) and adults aged =65 years (OR = 1.95; 95% CI = 1.67-2.29). Interpersonal activities, cognition, and sleep/energy explained >10% of the association between visual difficulty and low PA. CONCLUSIONS: In conclusion, we found evidence that especially in the case of males and older adults with visual difficulties in LMICs, there were low levels of engagement with PA. Addressing issues such as interpersonal activities, cognition, and sleep/energy in people with visual difficulties may increase levels of PA.

BACKGROUND: Data on the association between obesogenic behaviours and bullying victimization among adolescents are scarce from low- and middle-income countries. OBJECTIVES: To assess the associations between obesogenic behaviours and bullying victimization in 54 low- and middle-income countries. METHODS: Cross-sectional data from the global school-based student health survey were analyzed. Data on bullying victimization and obesogenic behaviours were collected. The association between bullying victimization and the different types of obesogenic behaviour (anxiety-induced insomnia, fast-food consumption, carbonated soft-drink consumption, no physical activity and sedentary behaviour) were assessed by country-wise multivariable logistic regression analysis adjusting for age, sex, food insecurity and obesity with obesogenic behaviours being the outcome. RESULT: The sample consisted of 153 929 students aged 12 to 15 years [mean (SD) age 13.8 (1.0) years; 49.3% girls]. Overall, bullying victimization (vs no bullying victimization) was significantly associated with greater odds for all types of obesogenic behaviour with the exception of physical activity, which showed an inverse association. Specifically, the ORs (95% CIs) were: anxiety-induced sleep problems 2.65 (2.43-2.88); fast-food consumption 1.36 (1.27-1.44); carbonated soft-drink consumption 1.14 (1.08-1.21); no physical activity 0.84 (0.79-0.89); and sedentary behaviour 1.34 (1.25-1.43). CONCLUSION: In this large representative sample of adolescents from low- and middle-income countries, bullying victimization was found to be associated with several, but not all, obesogenic behaviours.

GOAL: The aim of this study was to analyze the association between chronic gingivitis and subsequent depression in patients aged =14 years who were followed up in general practices in the UK. METHODS: This study included patients aged =14 years who had received an initial diagnosis of chronic gingivitis in one of 256 general practices in the United Kingdom between January 2000 and December 2016 (index date). Patients without chronic gingivitis were matched (1:1) to those with chronic gingivitis by sex, age, index year, treating physician, and Charlson Comorbidity Index (CCI). For patients without chronic gingivitis, the index date was a randomly selected visit date between 2000 and 2016. The association between chronic gingivitis and the incidence of depression was investigated using Kaplan-Meier curves and Cox regression analyses. RESULTS: This study included 6544 patients with chronic gingivitis and 6544 patients without chronic gingivitis [49.2% were women; mean (standard deviation) age 40.3 (19.1) years]. A total of 16.3% of individuals with chronic gingivitis and 8.8% of those without chronic gingivitis received an initial diagnosis of depression within 10 years of the index date (log-rank p-value65 years. CONCLUSIONS: Our study demonstrated an association between chronic gingivitis and subsequent depression.

This is a cross-sectional study evaluating the associations of self-reported moderate to vigorous physical activity, and sedentary behavior with depressive, anxiety, and co-occurring depressive and anxiety symptoms (D&A) in self-isolating Brazilians during the COVID-19 pandemic. Depressive and anxiety symptoms were collected using the Beck Depression and Anxiety Inventories (BDI and BAI). Among the 937 participants (females=72.3%), those performing ≥30 min/day of moderate to vigorous or ≥15 min/day of vigorous physical activity had lower odds of prevalent depressive, anxiety, and co-occurring D&A symptoms. Those spending ≥10 h/day sedentary were more likely to have depressive symptoms.

Exposure to violence may be associated with increased risk for obesogenic behavior among adolescents but studies providing a global perspective are lacking. The aim of this work was to assess the relationship between violence and obesogenic behaviors among young adolescents from 62 countries. Cross-sectional data from the Global School-based Student Health Survey 2009-2016 were analyzed. Information on violence (intentional injury, physical attack, physical fight) and obesogenic behavior (anxiety-induced sleep problems, low physical activity, sedentary behavior, fast-food consumption, carbonated soft-drink consumption) were self-reported. Associations were analyzed using meta-analysis based on country-wise multivariable logistic regression analyses. A total of 165,380 adolescents aged 12-15?years [mean (SD) age 13.8 (1.0) years; 50.9% boys] were included in the analysis. All types of violence were positively associated with higher odds for all types of obesogenic behavior with the exception of low physical activity. Associations were particularly pronounced for anxiety-induced insomnia. In contrast, intentional injury (OR?=?0.72; 95%CI?=?0.64-0.81) and physical fight (OR?=?0.90; 95%CI?=?0.86-0.95) were associated with lower odds for low physical activity. In this large global sample of adolescents, exposure to violence was associated with all obesogenic behaviors apart from low physical activity. Multidimensional government programs and policies addressing exposure to violence among young adolescents may lead to reduction in obesogenic behavior and hence curtail the global obesity epidemic.

BACKGROUND: Identifying correlates of sexual behavior among young adolescents is critical for preventing adverse outcomes linked to such behavior. AIM: This study examined the relationship of bullying victimization with sexual intercourse, multiple sexual partners, and non-condom use in adolescents aged 12-15 years across 53 countries. METHODS: Cross-sectional data from 145,342 adolescents aged 12-15 years participating in the Global School-based Student Health Survey 2003-2016 were analyzed. Data on bullying victimization were assessed by the question "During the past 30 days, on how many days were you bullied?" OUTCOMES: Data on several sexual behaviors were collected: (i) ever having had intercourse, among those who reported having had intercourse; (ii) multiple (=2) lifetime sexual partners; and (iii) condom use in last sexual intercourse. RESULTS: Multivariable logistic regression analyses were used to assess the associations. The overall prevalence of any bullying in the past 30 days and lifetime sexual intercourse were 28.8% and 13.1%, respectively. Compared with those who were not bullied in the past 30 days, those who were bullied for 20-30 days were 2.08 (95% CI = 1.65-2.63), 1.70 (95% CI = 1.10-2.63), and 1.72 (95% CI = 1.12-2.67) times more likely to report sexual intercourse, non-condom use, and multiple sex partners, respectively. CLINICAL IMPLICATIONS: This study provides further evidence that bullying victimization is a global phenomenon and interventions are required to reduce its prevalence and unwanted consequences. STRENGTHS & LIMITATIONS: The main strength was the large sample of young adolescents across 53 countries. However, findings from the present study should be interpreted in light of its limitations. First, the study was cross-sectional in nature and thus the direction of the association cannot be established. Second, the data only included young adolescents who attend school. Third, data were self-reported and thus reporting bias may exist. Fourth, the measure of sexual activity used was not able to distinguish between penetrative and nonpenetrative sex. Fifth, adolescents who are victims of bullying may also be exposed to other types of violence such as child maltreatment and sexual assaults, for which data were not available. Finally, the present data set did not contain data on sexual orientation. CONCLUSION: These findings highlight the need for interventions either acting to educate about the potential negative consequences or to prevent risky sexual behavior in young adolescents who experience bullying victimization. Smith L, Grabovac I, Jacob L, et al. Bullying Victimization and Sexual Behavior Among Adolescents Aged 12-15 Years From 53 Countries: A Global Perspective. J Sex Med 2020;17:2148-2155.

BACKGROUND: The aim was to assess the impact of COVID-19 self-isolation/social distancing on mental health, and potential correlates, among a sample of the UK population. METHODS: A cross-sectional study. Mental health was measured using the Beck Anxiety and Depression Inventory. Mental wellbeing was measured using The Short Warwick-Edinburgh Mental Well-being Scale. Data collected on predictors included sex, age, marital status, employment, annual income, region, current smoking, current alcohol consumption, physical multimorbidity, any physical symptoms experienced during self-isolation/social distancing, and the number of days of self-isolation/social distancing. The association between potential predictors and poor mental health was studied using a multivariable logistic regression. RESULTS: 932 participants were included. Factors associated with poor mental health were sex (reference: male; female: OR=1.89, 95%CI=1.34-2.68), age (18-24 years: reference;45-54 years: OR=0.27, 95%CI=0.14-0.53; 55-64 years: OR=0.24, 95%CI=0.12-0.47; 65-74years: OR=0.10, 95% CI=0.05-0.22; and =75years: OR=0.08,95% CI=0.03-0.24),annual income (

OBJECTIVES: To compare levels of physical activity and sedentary time in a representative sample of US adolescents and adults with and without visual impairment. DESIGN: Cross-sectional analyses were carried out using data from the National Health and Nutrition Examination Survey. PARTICIPANTS: The study population consisted of 6001 participants (adolescents n=1766, adults n=4235). The present analysis aggregated data from 2003 to 2004 and 2005-2006. MEASURES: Objective physical activity and sedentary behaviour assessment was conducted over 7 days. Distance visual acuity was measured for each eye in all participants 12 years and older. Participants' vision was categorised as: normal vision, uncorrected refractive error, non-refractive visual impairment. We estimated the sex-specific linear associations between presenting vision and objectively measured physical activity and sedentary patterns using adjusted generalised linear models in adolescents and adults. RESULTS AND CONCLUSIONS: Adolescents with uncorrected refractive error and non-refractive visual impairment did not accumulate higher levels of sedentary time or lower levels of moderate-to-vigorous physical activity (MVPA) compared with those with normal vision. We observed no association between vision status and accelerometer measured MVPA in adults aged 20-49 years. We observed more time spent sedentary among females 20-49 years old with non-refractive visual impairment compared with those presenting normal vision (mean difference 329.8 min/week, 95% CI: 12.5 to 647.0). Adults 50 years and older with non-refractive visual impairment appeared to accumulate less lifestyle physical activity, particularly in women (mean difference -82.8 min/week, 95% CI: -147.8 to -17.8). Adult women with non-refractive visual impairment have lower levels of lifestyle physical activity and higher levels of sedentary time than those with normal vision. Taken together, these findings highlight the need for interventions to promote physical activity and reduce sedentary time in adult populations with visual impairment, specifically adult women.

AIMS: To investigate the relationship between cannabis use and two sexual behaviors (ever had sex, multiple partners) in a large representative sample of adolescents aged 12-15?years from 21 low- and-middle income countries. METHODS: Data from 84,867 adolescents aged 12-15?years participating in the Global School-based Student Health Survey were analyzed. Participants reported lifetime frequency of cannabis use (analyzed as 0, 1-2, 3-19 or?=?20 times), whether they had ever had sexual intercourse (yes/no) and, if yes, their lifetime number of sexual partners. We used multivariable logistic regression to analyze associations, adjusting for a range of relevant covariates. RESULTS: 12.7% of the sample reported having had sexual intercourse, and of these adolescents, 53.1% had had multiple sexual partners. The prevalence of lifetime cannabis use of 1-2 times, 3-19 times, and?=?20 times were 1.1%, 1.2%, and 0.4%, respectively. Those who reported using cannabis 1-2 times, 3-9 times, and?=?20 times had 2.32 (95%CI?=?1.47-3.65), 2.34 (95%CI?=?1.34-4.07), and 5.45 (95%CI?=?2.22-13.40) times higher odds of having had sexual intercourse than those who had never used cannabis. Among those who had ever had sexual intercourse, the respective odds ratios (95%CIs) for having multiple sexual partners were 1.56 (0.93-2.62), 1.70 (0.92-3.14), and 5.66 (2.97-10.82). There were no significant interactions by sex for these associations. CONCLUSIONS: Adolescents from LMIC who use cannabis are more likely to have ever had sexual intercourse than those who do not. Among those who have had sexual intercourse, those who use cannabis are more likely to have had multiple sexual partners.

Magnesium plays a crucial role in hundreds of bodily processes relevant to aging, but consumption of dietary magnesium intake has been shown to be inadequate in a large proportion of older adults. Identifying groups at risk of low magnesium intake is important for informing targeted advice. Using data from the National Health and Nutrition Examination Survey (NHANES) 2005&ndash, 2016, we examined the association between ethnicity (Caucasian/African American/Hispanic/other) and magnesium intake in a large representative sample of U.S. older adults (&ge, 65 y, n = 5682, mean (SD) 72.9 (0.10) y). Analyses adjusted for total energy intake and a range of relevant covariates. Overall, 83.3% of participants were not meeting the recommended level of dietary magnesium intake, ranging from 78.1% of other ethnic groups to 90.6% of African Americans. In the fully adjusted model, magnesium intake was lower among African American older adults (&minus, 13.0 mg/d, 95% CI: &minus, 18.8 to &minus, 7.2), and higher among Hispanics (14.0 mg/d, 95% CI: 7.5 to 20.5) and those from other ethnic groups (17.2, 95% CI: 3.8 to 30.5) compared with Caucasian older adults. These results highlight the need for targeted interventions to increase magnesium intake in U.S. older adults, with a focus on African Americans, in order to reduce the burden of morbidity and ethnic inequalities in health in later life.

BACKGROUND: We evaluated the associations of handgrip strength and cognitive function in cancer survivors = 60 years old using data from the National Health and Nutrition Examination Survey (NHANES). METHODS: Data in two waves of NHANES (2011-2014) were aggregated. Handgrip strength in kilogram (kg) was defined as the maximum value achieved using either hand. Two cognitive function tests were conducted among adults 60 years and older. The Animal Fluency Test (AFT) examines categorical verbal fluency (a component of executive function), and the Digital Symbol Substitution test (DSST) assesses processing speed, sustained attention, and working memory. Survey analysis procedures were used to account for the complex sampling design of the NHANES. Multiple linear regression models were used to estimate associations of handgrip strength with cognitive test scores, adjusting for confounders (age, gender, race/ethnicity, education, marital status, smoking status, depressive symptoms and leisure time physical activity). RESULTS: Among 383 cancer survivors (58.5% women, mean age = 70.9 years, mean BMI = 29.3 kg/m2), prevalent cancer types were breast (22.9%), prostate (16.4%), colon (6.9%) and cervix (6.2%). In women, each increase in kg of handgrip strength was associated with 0.20 (95% CI: 0.08 to 0.33) higher score on AFT and 0.83 (95% CI: 0.30 to 1.35) higher score on DSST. In men, we observed an inverted U-shape association where cognitive function peaked at handgrip strength of 40-42 kg. CONCLUSIONS: Handgrip strength, a modifiable factor, appears to be associated with aspects of cognitive functions in cancer survivors. Prospective studies are needed to address their causal relationship.