Judith D. Weissman

The study objective was to examine the mental health of children during a time period that included the COVID-19 Lockdown. The sample included a cross-section of children aged 2 to 17 years (2019; n = 4, 194; 2020; n = 5,172), from the National Health Interview Survey. In multivariate models, survey years 2020 and 2019 were compared for significant changes in anxiety, depression, and social behaviors in children after adjustment for sociodemographic variables. Bivariate analysis also examined sociodemographic characteristics, health care utilization by anxiety, depression, and social behaviors, and examined differences in anxiety and depression from 2019 to 2020. In multivariate models, there was an increased risk of anxiety ((AOR = 1.3(1.0, 1.6)), depression ((AOR = 1.2 (1.0, 1.4)) and difficult social behaviors (AOR = 1.2 (1.0, 1.4) in children from 2019 to 2020. Girls were at increased risk compared to boys for anxiety and depression ((anxiety; AOR = 1.4 (1.2, 1.8), depression; AOR = 1.2 (1.0, 1.3)), however, girls were at decreased risk compared to boys for uncontrolled social behaviors (AOR = 0.51 (0.43, 0.61)). White children were at increased risk for anxiety and depression compared to all other race and ethnic groups. High rates of anxiety, depression and difficult social behaviors that preexisted the Covid-19 Lock Down, continued or increased during the Lockdown. Effective public health interventions could prevent further declines in mental health, and a potential trajectory into adulthood of poor physical and mental health.

Purpose This cross-sectional study examined the relationship between indicators of workplace financial stress and obesity among working adults. Methods Respondents were sampled from the 2021 National Health Interview Survey. Adults were included if they worked in the last week were between 18 to 65 years (n = 14, 976). A multivariable model predicted having obesity using the following the independent variables: working full time, defined as working 35 hours per week or more, working while sick, perceived likelihood of job loss, food insecurity and sociodemographic characteristics. The multivariable model was based on bivariate analyses comparing these variables, and serious psychological distress to having obesity and the number of chronic health conditions. Results At the bivariate level 6.5% of full-time workers had food insecurity, and 9.1% perceived they were fairly or somewhat likely to lose their job and 45% with obesity had serious psychological distress. In a multivariable model, there was a positive association between obesity and full-time employment (AOR = 1.5 CI = 1.3, 1.7), workers perceptions of being fairly or somewhat likely to lose their job (AOR = 1.2 CI = 1.0, 1.4), and obesity and food insecurity (AOR = 1.2 CI = 1.0, 1.4) after adjusting for sociodemographic characteristics. Conclusions Working adults with obesity likely work full time, have serious psychological distress, and perceive a likely job loss. Despite working full time, many adults experienced food insecurity.

Purpose This cross-sectional study examined the relationship between indicators of workplace financial stress and obesity among working adults.Methods Respondents were sampled from the 2021 National Health Interview Survey. Adults were included if they worked in the last week were between 18 to 65 years (n = 14, 976). A multivariable model predicted having obesity using the following the independent variables: working full time, defined as working 35 hours per week or more, working while sick, perceived likelihood of job loss, food insecurity and sociodemographic characteristics. The multivariable model was based on bivariate analyses comparing these variables, and serious psychological distress to having obesity and the number of chronic health conditions.Results At the bivariate level 6.5% of full-time workers had food insecurity, and 9.1% perceived they were fairly likely or somewhat likely to lose their job and 45% had serious psychological distress. In a multivariable model, there was a positive association between obesity and full-time employment (AOR = 1.5 CI = 1.3, 1.7), workers perceptions of being fairly or somewhat likely to lose their job (AOR = 1.2 CI = 1.0, 1.4), and obesity and food insecurity (AOR = 1.2 CI = 1.0, 1.4) after adjusting for sociodemographic characteristics.Conclusions The relationship between having obesity and working full time, serious psychological distress, perceptions about job loss and food insecurity suggests that employment may be stressful. Despite working full time, many adults experienced food insecurity. Suggestions for increasing the safety net for workers to protect against financial and work instability are discussed.

Objectives This study examined COVID-19’s impact in the 2020 compared to 2019 survey years on preventive medical care utilization. Research Design Using a cross-sectional sample of adults aged 18 years and over (2019; n = 31,997; 2020; n = 31,568), from the National Health Interview Survey, multivariable models compared 2020 to 2019 survey years for receiving diabetes screening blood tests, well-care visits, and physical therapy. An additional multivariable model predicted not having medical care due to the COVID-19 pandemic in the 2020 2020 survey year. Results In the 2020 versus 2019 survey years, the likelihood lowered for receiving a blood test for diabetes screening (aOR .83 CI = .76, .90). There was a lowered likelihood for a well care visits (aOR = .98 CI = .84, 1.1) and physical therapy (aOR = .97 CI = .89, 1.0). Black (aOR = .62 CI = .51, .75), Hispanic (aOR = .62 CI = .51, .75) and Asian (aOR .67 CI = .53, .86) adults had a lowered likelihood of having physical therapy compared to White adults. Having no insurance coverage lowered the likelihood of getting all three indicators of preventive medical care. There was a higher likelihood of not getting medical care due to COVID-19 in the 2020 survey year (aOR = 1.7 CI = 1.3, 2.1) with Medicaid compared to private coverage. Conclusions Use of preventive medical care lowered in the pandemic. Race and ethnicity and not having any coverage contributed to not receiving preventive care. Medicaid appeared to increase utilization of preventive medical care but not acute medical care.

Objectives: Public health interventions to prevent financial stressors and reduce chronic pain and high-impact chronic pain (HICP) are important to potentially improve the health of the US population. The objectives of our study were to provide an update on the prevalence of chronic pain and HICP and to examine relationships between financial stressors and pain. Methods: We used data from a cross-sectional sample of adults aged ≥18 years (n = 31 997) collected by the 2019 National Health Interview Survey. We constructed bivariate and multivariate models to examine chronic pain and HICP in relation to financial worries, employment with wages, income, sociodemographic characteristics, number of chronic health conditions, and body mass index. Results: In fully adjusted multivariate regression models, having no employment with wages was strongly associated with increased risk for chronic pain (adjusted odds ratio [aOR] = 1.3; 95% CI, 1.2-1.5) and HICP (aOR = 1.6; 95% CI, 1.4-1.9). Worries about paying medical bills was associated with chronic pain (aOR = 1.1; 95% CI, 1.0-1.2) and HICP (aOR = 1.1; 95% CI, 1.0-1.3). Being unable to pay medical bills was associated with chronic pain (aOR = 2.1; 95% CI, 1.9-2.3) and HICP (aOR = 2.3; 95% CI, 2.0-2.6). Compared with having more income, having less income relative to the federal poverty level was associated with increased risk for chronic pain and HICP. Conclusions: We found a strong relationship between financial worries, employment for wages, income, and self-reported chronic pain and HICP independent of poor physical health and body mass index. Interventions to reduce chronic pain and HICP should address economic instability and financial stressors.

The CDC cautioned against prescribing opioids for long-term chronic pain because opioid use disorder (OUD) risk was greater compared to short-term use for acute pain. The study objective was to describe rates and characteristics of respondents prescribed opioids for long-term chronic and short-term acute pain. National Health Interview Survey respondents for 2019 aged 18 years and over were examined (n = 31,997). Bivariate and multivariable models demonstrated opioid use for long-term and acute pain relative to sociodemographic characteristics. About 12.3% of US adults took opioids in the last 12 months, and among those with chronic pain who had been prescribed opioids in the last 3 months, over half took opioids every day. The odds of taking opioids for long-term chronic pain decreased with increasing income and increased with advancing age. Opioid prescribing diverged from CDC recommendations. Less affluent older adults may be at increased risk for OUD.

Economic recessions have been well studied in relationship to poor mental health. However, subjective financial worries have not been examined relative to serious psychological distress (SPD), a measure of poor mental health. Adults 18 to 64 years in the cross-sectional 2016 National Health Interview Survey (n = 24,126) were examined for worries about paying for bills, serious medical events, expected medical costs, retirement, children’s college tuition and maintaining a standard of living; by sociodemographic such as sex and race/ethnicity. Over 50% of adults reported two or more financial worries. In multivariate models, financial worries were associated with SPD. White adults at the lowest education level had the greatest proportion with SPD compared with all other race/ethnic groups. Women had greater risk for SPD and for each financial worry compared with men. Financial worries were prevalent in U.S. adults, were associated with increased risk for SPD, and varied by sex.

Serious Psychological Distress (SPD) is a measure of mental health associated with poor functioning. This study identified sociodemographic risk factors for SPD, among veterans using Veterans Health Administration (VHA), TRICARE or the Civilian Health and Medical Programs for Uniformed Services (CHAMP) (all referred herein as VA coverage) and compared risk factors for SPD to non-veterans. VA coverage offers preventative care and treatment for illnesses and injuries to veterans with the aim of improving their quality of life. Veterans with and with no SPD, using VA coverage aged 18 to 64 years were sampled from the 2016 National Health Interview Survey (NHIS) (n = 525 total, n = 48 veterans with serious psychological distress) were compared to each other and to non-veterans sampled from the NHIS (n = 24,121 total and n = 1055 with serious psychological distress), by sex, age group, race/ethnicity, education level, living arrangements, education level, number of chronic health conditions, and region of residence. The greatest proportion of veterans with SPD were female, middle aged (45–64 years), white, had less than a high school education, and lived alone or with other adults (compared to those living with a spouse/partner). The greatest proportion of veterans with SPD lived in the Southern and Western U.S. regions, and the smallest proportion lived in the Northeastern U.S. region. Hispanic and white veterans were at increased risk for SPD relative to black veterans, and relative to their same race/ethnic counterparts in the non-veteran civilian population. Additional analyses suggest that veterans with SPD experience greater barriers to care compared to veterans without SPD. Further research is warranted to examine access to mental and physical health care providers in U.S. regions with the greatest proportions of veterans with SPD. Particular attention is needed for female veterans due to their high rates of SPD relative to male veterans.