Perceived discrimination and health outcomes among middle-aged and older adults in India: results of a national survey in 2017–2018

Background The study aimed to estimate the associations between perceived discrimination and poor physical health, poor mental health, and health risk behaviours in middle-aged and older adults in a national population survey in India. Methods The sample included 72,262 middle-aged and older adults from a cross-sectional national community dwelling survey in India in 2017–2018. Results The prevalence of moderate (1–2 types) perceived discrimination was 10.7%, and high (3–6 types) perceived discrimination was 6.6%. In the final adjusted logistic, linear or Poisson regression analyses, moderate and/or high perceived discrimination was significantly positively associated with poor mental health (low life satisfaction, poor cognitive functioning, insomnia symptoms, and depressive symptoms), poor physical health (pain conditions count, and functional limitations), and health risk behaviours (heavy episodic drinking and physical inactivity). Conclusion Perceived discrimination is associated with poor mental health, poor physical health, and health risk behaviour, emphasising the need to consider perceived discrimination in various physical and mental health contexts.

Health risk behaviours among people with severe mental ill health during the COVID-19 pandemic: Analysis of linked cohort data

Background People with severe mental ill health (SMI) experience a mortality gap of 15–20 years. COVID-19 has amplified population health inequalities, and there is concern that people with SMI will be disproportionately affected. Understanding how health risk behaviours have changed during the pandemic is important when developing strategies to mitigate future increases in health inequalities. Methods We sampled from an existing cohort of people with SMI. Researchers contacted participants by phone or post to invite them to take part in a survey about how the pandemic had affected them. We asked people about their health risk behaviours and how these had changed during the pandemic. We created an index of changed behaviours, comprising dietary factors, smoking, lack of exercise, and drinking patterns. By creating data linkages, we compared their responses during pandemic restrictions to responses they gave prior to the pandemic. Outcomes 367 people provided health risk data. The mean age of the participants was 50.5 (range = 20 to 86, SD ± 15.69) with 51.0% male and 77.4% white British. 47.5% of participants reported taking less physical activity during the pandemic and of those who smoke 54.5% reported smoking more heavily. Self-reported deterioration in physical health was significantly associated with an increase in health risk behaviours (adjusted OR for physical health 1.59, 95%CI 1.22–2.07; adjusted OR for Age 0.99, 95%CI 0.98–1.00). Interpretation COVID-19 is likely to amplify health inequalities for people with SMI. Health services should target health risk behaviours for people with SMI to mitigate the immediate and long lasting impacts of the COVID-19 pandemic.

Teacher-rated school leadership and adolescent gambling: a study of schools in Stockholm, Sweden

Background So-called “effective schools” are characterised by features such as a strong and purposeful school leadership and a favourable school ethos. A prior study showed that a school's degree of teacher-rated ethos was inversely associated with student gambling and risk gambling. Building on these findings, the current study aims to examine the associations that teachers' ratings of the school leadership share with gambling and risk gambling among students in the second grade of upper secondary school in Stockholm (ages 17-18 years). Methods Data were drawn from two separate surveys performed in 2016: the Stockholm School Survey (SSS) and the Stockholm Teacher Survey (STS), with information collected amongst 5,191 students and 1,061 teachers in 46 upper secondary schools. Gambling and risk gambling was measured by student self-reports in the STS. School leadership was assessed by teachers' responses to ten items in the STS, which were added to an index and aggregated to the school level. School-level information from administrative registers was also linked to the data. The statistical method was two-level binary logistic regression analysis. Results Teachers' average ratings of the school leadership were inversely associated with both gambling (OR 0.96, 95% CI 0.93-0.998, p = 0.039) and risk gambling (OR 0.94, 95% CI 0.89-0.99, p = 0.031) among upper secondary students, whilst adjusting for sociodemographic characteristics at the student and the school level. Conclusions The findings lend further support to the assumption that characteristics of effective schools at different levels of the school organisation may reduce students' inclination to engage in health risk behaviours. Key messages Teachers’ ratings of the school leadership were inversely associated with student gambling and risk gambling, whilst adjusting for student- and school-level sociodemographic characteristics. The findings indicate that a strong school leadership, being one key feature of effective schools, may reduce students’ inclination to engage in health risk behaviours.