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Is mental health related to ethnicity/race and income in middle-aged females in the general U.S. population?

Sean R Jamieson

Department of Physician Assistant Studies, University of North Texas Health Science Center, Texas, USA

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

Shannon M Swickard

Department of Physician Assistant Studies, University of North Texas Health Science Center, Texas, USA

Abby L Cahill

Department of Physician Assistant Studies, University of North Texas Health Science Center, Texas, USA

Sharonica S Powell

Department of Physician Assistant Studies, University of North Texas Health Science Center, Texas, USA

Kenya Samuels

Department of Physician Assistant Studies, University of North Texas Health Science Center, Texas, USA

Jessica L Hartos

Department of Physician Assistant Studies, University of North Texas Health Science Center, Texas, USA

DOI: 10.15761/FWH.1000148

Article
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Abstract

Purpose: With little research addressing mental health, ethnicity/race, and income within specific gender and age groups, the purpose of this study was to examine whether mental health differs by ethnicity/race and income in middle-aged women in the general population.

Methods: This cross-sectional analysis used 2016 Behavioral Risk Factor Surveillance System data for females ages 40-64 years from Alabama (N=1455), Mississippi (N=1082), North Carolina (N=1215), South Carolina (N=2277), and Tennessee (N=1263). Ordered logistic regression analysis by state was used to assess the relationship between mental health and ethnicity/race and income, while controlling for demographic and health factors.

Results: Over one-third of middle-aged women reported having low to moderate mental health (38-45%), half or more reported white race (54-81%), and more than half reported an income of less than $50,000 per year (52-66%). The results of this study indicated that mental health did not differ significantly by income, but did differ significantly by ethnicity in 3 of 5 states, with white, non-Hispanic middle-aged women reporting more mental health issues. In addition, mental health was related to physical health, tobacco use, and age categories across states.

Conclusion: Overall, mental health differed by ethnicity/race, but not by income, across samples of middle-aged women in the general population. Limitations of this study include an underrepresentation of various ethnicity/race groups. Because over one-third of this target population may have low to moderate mental health, practitioners in a primary care should screen all middle-aged women for mental health, with special consideration for white patients and those 40-55 years of age. In addition, because tobacco use and physical health were moderately- to highly-related to mental health in this target population, practitioners should screen for all if middle-aged females present with any. Any treatment for mental and physical health issues should be coordinated and smoking cessation should be encouraged.

Keywords

mental health, ethnicity, income, middle-aged women

Introduction

Poor mental health is a global issue that leads to more disability worldwide than any other disease (CDC, 2011a). In the United States, over 50% of adults will suffer from at least one mental illness over the course of their lifetime [1]. Research has consistently linked poor mental health with poor physical health, substance abuse, and a variety of other chronic health issues, such as obesity and cardiovascular disease [1-4]. Poor mental health is not just a concern at the individual or family level, but also provides a significant financial burden to society. It has been calculated that people with poor mental health have higher healthcare costs, with the financial burden to the United States being approximately $300 billion [1,2,4].

Research shows that mental health differs by gender, ethnicity/race, and socioeconomic status. Studies have indicated that women are more likely to suffer from mental illness than men [4-9], with the average onset of mental illness in women being between the ages 26-32 [3]. In addition, studies show that African American and Hispanic women are more likely than Caucasian women to have depressive symptoms [10-11]. Studies have also shown a significant relationship between income inequality and poor mental health in the general population [8].

While previous research has shown a relationship between mental health and both ethnicity/race and income, the majority of that research was conducted in specific populations, including veteran women, menopausal women, women with gestational diabetes mellitus, women who spent time in foster care [9-12]. Few studies have assessed this relationship in general populations or by specific age and gender groups. Therefore, the purpose of this study is to examine the relationship between mental health and both income and ethnicity in middle-aged women in the general population.

Methods

Design

This cross-sectional analysis used 2016 data from the Behavioral Risk Factor Surveillance System (BRFSS) conducted by the Center for Disease Control and Prevention (CDC) [13]. The goal of BRFSS is to collect uniform data on health risk behaviors, chronic diseases, health conditions, access to health care, and use of preventative health services linked to the leading causes of death and disability in the United States and U.S. territories. State health departments conduct standardized surveys annually using Random Digit Dialing (RDD) techniques. Participants include adults 18 years who are not monetarily compensated. The CDC compiles all BRFSS data and makes de-identified data available to researchers for secondary data analysis. This study was given exempt status by the Institutional Review Board of The University of North Texas Health Science Center.

Sample

The samples for this analysis included females ages 40-64 years in Alabama (N=1455), Mississippi (N=1082), North Carolina (N=1215), South Carolina (N=2277), and Tennessee (N=1263). These states were chosen for their higher proportions of individuals who reported (a) depression and (b) being middle-aged females based on the BRFSS 2016 prevalence survey data maps [14].

Data

Our outcome of interest was mental health status. Originally, mental health status was measured in BRFSS as participants rating the number of “not good” days during the last 30 days including “stress, depression, and problems with emotions” with the number categorized as “low” (0 days), “moderate” (1-13 days), or “high” (14 or more days). For convenience and clarity, we reversed this variable to be a measure of days of “good mental health status” with categories of “low” (less than 16 days), “moderate” (17-29 days), or “high” (30 days). We had two factors of interest, ethnicity/race and income. Ethnicity/race in the BRFSS data was initially categorized as “white, non-Hispanic,” “black, non-Hispanic,” “Hispanic,” “other race, non-Hispanic,” or “multiracial, non-Hispanic.” However, due to small percentages in some categories, we used 3 categories: “white, non-Hispanic”, “black, non-Hispanic”, or “other.” Income was measured as having an income level of “0 to less than $25,000,” “$25,000 to less than $50,000,” or “$50,000 or more.”

The control variables were age, marital status, education level, employment status, physical health status, tobacco use, and alcohol use. Age was categorized as “40-44,” “45-49,” “50-54,” “55-59,” or “60-64.” Marital status was categorized as “yes” or “no” to being currently married. Education level was categorized as “graduated from college/technical school” or “did not graduate college/technical school.” Employment status was categorized as “employed” or “not employed.”  Physical health status was reversed from “not good” to “good” days of physical health in the past 30 days and categorized as “low” (less than 16 days), “moderate” (17-29 days) or “high” (30 days). Tobacco use was measured as “current smoker” or “non-smoker.” Alcohol use was measured as “none” (no use), “light” (less than 1), “moderate” (1-3), or “excessive” (4 or more) for average number of drinks per day [15]. The categories and responses for each variable are listed in Table 1.

Table 1. Participant characteristics by state.

Variables

Alabama

Mississippi

North Carolina

South Carolina

Tennessee

N=1,455

N=1,082

N=1,215

N=2,277

N=1,263

N

%

N

%

N

%

N

%

N

%

Mental Health Status

1455

100

1082

100

1215

100

2277

100

1263

100

High

804

55

642

59

749

62

1301

57

705

56

Moderate

392

27

251

23

263

22

571

25

296

23

Low

259

18

189

17

203

17

405

18

262

21

Ethnicity/Race

1442

99

1073

99

1205

99

2229

98

1255

99

White, non-Hispanic

939

65

576

54

815

68

1356

61

1018

81

Black, non-Hispanic

436

30

475

44

266

22

741

33

184

15

Other

67

5

22

2

124

10

132

6

53

4

Income Level

1455

100

1082

100

1215

100

2277

100

1263

100

0 to <$25,000

523

36

449

42

352

29

760

33

411

33

$25,000 to <$50,000

306

21

269

25

281

23

521

23

328

26

$50,000+

626

43

364

34

582

48

996

44

524

41

Age

1455

100

1082

100

1215

100

2277

100

1263

100

40-44 years old

236

16

165

15

188

15

256

11

156

12

45-49 years old

220

15

196

18

221

18

355

16

245

19

50-54 years old

329

23

199

18

269

22

506

22

274

22

55-59 years old

331

23

245

23

269

22

531

23

257

20

60-64 years old

339

23

277

26

268

22

629

28

331

26

Marital Status

1455

100

1082

100

1215

100

2277

100

1263

100

Married

793

55

524

48

675

56

1239

54

721

57

Unmarried

662

45

558

52

540

44

1038

46

542

43

Educational Level

1454

100

1082

100

1215

100

2277

100

1261

100

Graduated college
/technical school

444

31

334

31

505

21

622

27

395

31

Did not graduate
college /technical school

992

68

748

69

710

58

1490

65

849

67

Employment Status

1451

100

1081

100

1214

100

2270

100

1260

100

Employed

765

53

584

54

735

61

1279

56

711

56

Unemployed

686

47

497

46

479

39

991

44

549

44

Physical Health Status

1438

99

1059

98

1207

99

2238

98

1241

98

High

745

52

617

58

735

61

1257

56

637

51

Moderate

397

28

253

24

263

22

560

25

332

27

Low

296

21

189

18

209

17

421

19

272

22

Tobacco Use

1425

98

1059

98

1204

99

2237

98

1224

97

Current Smoker

281

20

211

20

233

19

420

19

310

25

Non-smoker

1144

80

848

80

971

81

1817

81

914

75

Alcohol Use

1417

97

1057

98

1178

97

2216

97

1232

98

None

886

63

718

68

640

54

1218

55

760

62

Light

210

15

150

14

161

14

298

13

162

13

Moderate

175

12

81

8

155

13

351

16

157

13

Excessive

146

10

108

10

222

19

349

16

153

12

Analysis

Frequency distributions were used to assess sample characteristics and to identify any issues with the distribution of variables. Data analysis was conducted separately by state to determine patterns among variable relations across similar samples. Similar results in 3 or more of 5 states were considered consistent evidence for relations. Ordered logistic regression by state was used to assess the relationship between mental health status and both ethnicity/race and income level after controlling for age, marital status, education level, employment status, physical health status, tobacco use, and alcohol use. An ordered logistic regression model is used to estimate a relationship between an ordinal dependent variable and a set of independent variables. The proportional odds produced for each IV relates “proportionally” or equally applies to comparisons of DV groups greater than k versus those who are in groups less than or equal to k, where k is any level of the response variable. Therefore, the interpretation of an associated OR is that for a one unit change in the predictor variable, the odds for a group that is greater than k versus less than or equal to k are the proportional odds times larger. The adjusted results for mental health outcomes are shown in Table 2. Any observations with missing data for any variables were excluded from the adjusted analysis. All analyses were conducted in STATA 15 (©1985-2017 Statcorp LLC).

Table 2. Results of ordered logistic regression analysis.

Predicting Mental Health
(high vs. moderate vs. low) 

Alabama

Mississippi

North Carolina

South Carolina

Tennessee

AOR

95% CI

AOR

95% CI 

AOR

95% CI

AOR

95% CI 

AOR

95% CI

Low 

High 

Low 

High

Low

High

Low 

High

Low

High

Ethnicity/Race

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  White, non-Hispanic

ref

-

-

ref

-

-

ref

-

-

ref

-

-

ref

-

-

  Black, non-Hispanic

1.44

1.09

1.89

1.29

0.96

1.73

1.53

1.11

2.11

1.49

1.20

1.85

1.17

0.82

1.68

  Other

0.84

0.50

1.40

2.01

0.72

5.61

1.35

0.87

2.10

1.34

0.90

2.01

1.01

0.57

1.79

Income Level

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  $0 to <$25,000

ref

-

-

ref

-

-

ref

-

-

ref

-

-

ref

-

-

  $25,000 to <$50,000

1.55

1.12

2.15

0.90

0.64

1.29

0.80

0.56

1.15

1.53

1.17

1.99

1.27

0.89

1.82

  $50,000+

1.37

0.96

1.96

1.16

0.76

1.75

0.99

0.67

1.46

1.54

1.15

2.06

1.63

1.10

2.43

Age

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

40-44 years old

ref

-

-

ref

-

-

ref

-

-

ref

-

-

ref

-

-

45-49 years old

0.94

0.64

1.40

1.07

0.70

1.65

1.26

0.82

1.92

1.24

0.88

1.73

1.24

0.81

1.90

50-54 years old

1.20

0.83

1.72

1.55

1.00

2.41

1.02

0.68

1.52

1.35

0.98

1.84

1.35

0.89

2.07

55-59 years old

1.16

0.80

1.66

1.69

1.11

2.58

1.20

0.80

1.81

1.55

1.13

2.13

1.76

1.14

2.72

60-64 years old

1.73

1.19

2.52

1.96

1.28

2.98

1.73

1.13

2.64

2.05

1.49

2.82

2.49

1.63

3.80

Marital Status

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  Unmarried

ref

-

-

ref

-

-

ref

-

-

ref

-

-

ref

-

-

  Married

1.21

0.92

1.60

1.38

1.02

1.87

1.53

1.15

2.04

1.35

1.10

1.66

1.25

0.93

1.66

Educational Level

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  Did not graduate college
/technical school

ref

-

-

ref

-

-

ref

-

-

ref

-

-

ref

-

-

Graduated college
/technical school

1.36

1.04

1.79

1.24

0.90

1.71

1.04

0.78

1.38

1.01

0.81

1.25

0.88

0.65

1.18

Employment Status

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Unemployed

ref

-

-

ref

-

-

ref

-

-

ref

-

-

ref

-

-

Employed

1.25

0.97

1.63

1.73

1.28

2.34

1.43

1.07

1.91

1.11

0.90

1.37

1.34

1.01

1.77

Physical Health Status

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Low

ref

-

-

ref

-

-

ref

-

-

ref

-

-

ref

-

-

Moderate

1.76

2.01

3.80

2.36

1.60

3.50

2.38

1.63

3.46

3.20

2.44

4.21

2.92

2.07

4.14

High

8.01

5.80

11.06

6.50

4.42

9.55

8.02

5.59

11.50

8.69

6.59

11.35

8.00

5.62

11.38

Tobacco Use

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  Non-smoker

ref

-

-

ref

-

-

ref

-

-

ref

-

-

ref

-

-

  Current smoker

0.55

0.41

0.73

0.84

0.60

1.18

0.53

0.38

0.72

0.70

0.55

0.89

0.68

0.51

0.90

Alcohol Use

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

None

ref

-

-

ref

-

-

ref

-

-

ref

-

-

ref

-

-

Light

0.69

0.50

0.94

1.01

0.69

1.49

0.94

0.65

1.37

0.77

0.59

1.01

0.83

0.58

1.19

Moderate

0.85

0.59

1.20

0.68

0.41

1.12

0.88

0.60

1.29

0.98

0.75

1.28

1.12

0.77

1.64

Excessive

0.76

0.51

1.13

0.54

0.35

0.85

1.00

0.70

1.41

0.66

0.50

0.86

0.69

0.46

1.04

Note. AOR=adjusted odds ratio; 95% CI=95% confidence intervals; ref=referent group; boldface indicates significance (AORs with 95% CI that do not include 1.00 are significant)

Results

Descriptive

Table 1 lists participant characteristics for females ages 40-64 in Alabama, Mississippi, North Carolina, South Carolina, and Tennessee. Across states, over one-third of participants reported low (17-21%) or moderate (22-27%) mental health in the last 30 days. For ethnicity, the majority reported their race as white (54-81%). For income, more than half reported having an income of less than $50,000 per year (52-66%). For demographic factors, about half of women reported their age as 55-64 (44-51%) and about half reported being unmarried (43-52%). For socioeconomic status, about one third reported graduating college or technical school (21-31%) and the majority reported being employed (53-61%). For health-related factors, the majority reported high physical health in last 30 days (51-61%), most reported not smoking (75-81%), and more than half reported no alcohol use (54-68%).

Adjusted

As shown in Table 2, the results of ordered logistic regression analysis for middle aged females in Alabama, North Carolina, South Carolina, and Tennessee indicated that after controlling for all other variables in the model, mental health was significantly and consistently related to ethnicity/race. In 3 out of 5 states, black women were about 1.5 times more likely to report each successive level of mental health compared to white, non-Hispanic women. In addition, compared to their referent groups, the following participants in at least 3 out of 5 states were more likely to report each successive level of mental health: those who were 55-59 years old, those who were 60-64 years old, those who reported moderate physical health in the last 30 days, and those who reported high physical health in the last 30 days. In contrast, current smokers in 4 out of 5 states were less likely to report each successive level of mental health compared to non-smokers.

Discussion

The purpose of this study was to examine whether mental health differs by ethnicity/race and income in middle-aged women in the general population. To the best of our knowledge, this is the first study to focus solely on this target population. The results of adjusted statistics showed that mental health in middle-aged women differed significantly by ethnicity/race. In our study, black women were more likely to report each successive level of mental health compared to white women. However, our findings differ from previous research that indicate that black women are more likely to show depressive symptoms compared to other ethnicities/races [10,11]. The differences may be attributable to the special populations assessed in prior studies, including veteran women, menopausal women, and women with gestational diabetes mellitus. Furthermore, our research found no consistent relationship between mental health and income, which is similar to the results of a previous review study [8] that showed that only 1 of 9 studies showed consistent associations between income inequality and poor mental health, while the others showed mixed results or no associations.

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In addition, our study showed consistent findings for older participants (ages 55-59 and 60-64) to be were more likely to report each successive level of mental health when compared to the younger participants (ages 40-44). Such results may be related to the variation in lifestyles, socioeconomic factors, and/or stressors that each age group may experience. Our study also showed that women who reported moderate or high physical health were more likely to report each successive level of mental health, which is similar to findings of prior research [1,4]. Furthermore, our study showed that smokers were less likely to report each successive level of mental health, which is consistent with previous research in other populations [1-4].

Limitations

The use of BRFSS data provided large representative samples in which to assess variable relations. However, particular ethnicities/races were not well-represented among our sample. Future studies should assess relations between mental health and income within various ethnicity/race groups to determine whether patterns or relations are similar.  In addition, for mental health we had no information on symptom severity or management strategies, including medication use, and it would have been beneficial to have information on participants’ social support and current stressors, which may also affect mental health [10]. Future research should include health management, stress, and social support as related to mental health in various age and ethnicity/race groups among middle-aged women.

Recommendations

The results of this population-based study may be generalizable to middle-aged women ages 40-64 in a primary care setting. Within this target population, practitioners may expect a moderate proportion of women with low to moderate mental health. Thus, practitioners should screen mental health in all women ages 40-64, especially white women and the younger ages of this target population. Practitioners may also expect a moderate proportion of women with low to moderate physical health in this target population. Because physical health was highly related to mental health, providers should screen for any comorbid health conditions to determine symptom severity and management strategies, and provide education and coordinated treatment as needed. In addition, providers might expect a low proportion of middle-aged women to smoke, but given its moderate relations with mental health, providers should screen for both in patients who present with either. Patient education and smoking cessation resources should be provided.

References

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  2. Centers for Disease Control and Prevention (CDC) (2011a) Mental Illness Surveillance among Adults in the United States. Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/su6003a1.htm?s_cid=su6003a1_w.
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  8. Ribeiro WS, Bauer A, Andrade MCR, York-Smith M, Pan PM, et al. (2017) Income inequality and mental illness-related morbidity and resilience: A systematic review and meta-analysis. Lancet Psychiatry 4: 554-562. [Crossref]
  9. Villegas S, Pecora PJ (2012) Mental health outcomes for adults in foster care as children: An analysis by ethnicity. Children Youth Serv Rev 34: 1448-1458.
  10. Bromberger JT, Harlow S, Avis N, Kravitz HM, Cordal A (2004) Racial/ethnic differences in the prevalence of depressive symptoms among middle-aged women: The study of women’s health across the nation (SWAN). Am J Public Health 94: 1378-1385. [Crossref]
  11. Walmer R, Huynh J, Wenger J, Ankers E, Mantha AB, et al. (2015) Mental health disorders subsequent to gestational diabetes mellitus differ by ethnicity/race. Depress Anxiety 32: 774-782. [Crossref]
  12. Carter A, Borrero S, Wessel C, Washington DL, Bean-Mayberry B, et al. (2016) Racial and ethnic health care disparities among women in the veterans affairs healthcare system: A systematic review. Womens Health Issues 26: 401-409. [Crossref]
  13. Centers for Disease Control & Prevention (CDC) (2014) About BFRSS. Available at https://www.cdc.gov/brfss/about/brfss_faq.htm.
  14. Centers for Disease Control & Prevention (CDC) (2016) BRFSS Prevalence & Trends Data. Avaliable at: https://www.cdc.gov/brfss/brfssprevalence/index.html
  15. Centers for Disease Control and Prevention (CDC) (2018) Alcohol and Public Health: Frequently Asked Questions. Available at: https://www.cdc.gov/alcohol/faqs.htm.

Article Type

Research Article

Publication history

Received date: May 31, 2018
Accepted date: June 21, 2018
Published date: June 25, 2018

Copyright

© 2018 Jamieson SR. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation

Jamieson SR (2018) Is mental health related to ethnicity/race and income in middle-aged females in the general U.S. population?. Front Womens Health 3: DOI: 10.15761/FWH.1000148

Corresponding author

Jessica L Hartos

Department of Physician Assistant Studies, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, Texas, USA

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

Table 1. Participant characteristics by state.

Variables

Alabama

Mississippi

North Carolina

South Carolina

Tennessee

N=1,455

N=1,082

N=1,215

N=2,277

N=1,263

N

%

N

%

N

%

N

%

N

%

Mental Health Status

1455

100

1082

100

1215

100

2277

100

1263

100

High

804

55

642

59

749

62

1301

57

705

56

Moderate

392

27

251

23

263

22

571

25

296

23

Low

259

18

189

17

203

17

405

18

262

21

Ethnicity/Race

1442

99

1073

99

1205

99

2229

98

1255

99

White, non-Hispanic

939

65

576

54

815

68

1356

61

1018

81

Black, non-Hispanic

436

30

475

44

266

22

741

33

184

15

Other

67

5

22

2

124

10

132

6

53

4

Income Level

1455

100

1082

100

1215

100

2277

100

1263

100

0 to <$25,000

523

36

449

42

352

29

760

33

411

33

$25,000 to <$50,000

306

21

269

25

281

23

521

23

328

26

$50,000+

626

43

364

34

582

48

996

44

524

41

Age

1455

100

1082

100

1215

100

2277

100

1263

100

40-44 years old

236

16

165

15

188

15

256

11

156

12

45-49 years old

220

15

196

18

221

18

355

16

245

19

50-54 years old

329

23

199

18

269

22

506

22

274

22

55-59 years old

331

23

245

23

269

22

531

23

257

20

60-64 years old

339

23

277

26

268

22

629

28

331

26

Marital Status

1455

100

1082

100

1215

100

2277

100

1263

100

Married

793

55

524

48

675

56

1239

54

721

57

Unmarried

662

45

558

52

540

44

1038

46

542

43

Educational Level

1454

100

1082

100

1215

100

2277

100

1261

100

Graduated college
/technical school

444

31

334

31

505

21

622

27

395

31

Did not graduate
college /technical school

992

68

748

69

710

58

1490

65

849

67

Employment Status

1451

100

1081

100

1214

100

2270

100

1260

100

Employed

765

53

584

54

735

61

1279

56

711

56

Unemployed

686

47

497

46

479

39

991

44

549

44

Physical Health Status

1438

99

1059

98

1207

99

2238

98

1241

98

High

745

52

617

58

735

61

1257

56

637

51

Moderate

397

28

253

24

263

22

560

25

332

27

Low

296

21

189

18

209

17

421

19

272

22

Tobacco Use

1425

98

1059

98

1204

99

2237

98

1224

97

Current Smoker

281

20

211

20

233

19

420

19

310

25

Non-smoker

1144

80

848

80

971

81

1817

81

914

75

Alcohol Use

1417

97

1057

98

1178

97

2216

97

1232

98

None

886

63

718

68

640

54

1218

55

760

62

Light

210

15

150

14

161

14

298

13

162

13

Moderate

175

12

81

8

155

13

351

16

157

13

Excessive

146

10

108

10

222

19

349

16

153

12

Table 2. Results of ordered logistic regression analysis.

Predicting Mental Health
(high vs. moderate vs. low) 

Alabama

Mississippi

North Carolina

South Carolina

Tennessee

AOR

95% CI

AOR

95% CI 

AOR

95% CI

AOR

95% CI 

AOR

95% CI

Low 

High 

Low 

High

Low

High

Low 

High

Low

High

Ethnicity/Race

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  White, non-Hispanic

ref

-

-

ref

-

-

ref

-

-

ref

-

-

ref

-

-

  Black, non-Hispanic

1.44

1.09

1.89

1.29

0.96

1.73

1.53

1.11

2.11

1.49

1.20

1.85

1.17

0.82

1.68

  Other

0.84

0.50

1.40

2.01

0.72

5.61

1.35

0.87

2.10

1.34

0.90

2.01

1.01

0.57

1.79

Income Level

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  $0 to <$25,000

ref

-

-

ref

-

-

ref

-

-

ref

-

-

ref

-

-

  $25,000 to <$50,000

1.55

1.12

2.15

0.90

0.64

1.29

0.80

0.56

1.15

1.53

1.17

1.99

1.27

0.89

1.82

  $50,000+

1.37

0.96

1.96

1.16

0.76

1.75

0.99

0.67

1.46

1.54

1.15

2.06

1.63

1.10

2.43

Age

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

40-44 years old

ref

-

-

ref

-

-

ref

-

-

ref

-

-

ref

-

-

45-49 years old

0.94

0.64

1.40

1.07

0.70

1.65

1.26

0.82

1.92

1.24

0.88

1.73

1.24

0.81

1.90

50-54 years old

1.20

0.83

1.72

1.55

1.00

2.41

1.02

0.68

1.52

1.35

0.98

1.84

1.35

0.89

2.07

55-59 years old

1.16

0.80

1.66

1.69

1.11

2.58

1.20

0.80

1.81

1.55

1.13

2.13

1.76

1.14

2.72

60-64 years old

1.73

1.19

2.52

1.96

1.28

2.98

1.73

1.13

2.64

2.05

1.49

2.82

2.49

1.63

3.80

Marital Status

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  Unmarried

ref

-

-

ref

-

-

ref

-

-

ref

-

-

ref

-

-

  Married

1.21

0.92

1.60

1.38

1.02

1.87

1.53

1.15

2.04

1.35

1.10

1.66

1.25

0.93

1.66

Educational Level

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  Did not graduate college
/technical school

ref

-

-

ref

-

-

ref

-

-

ref

-

-

ref

-

-

Graduated college
/technical school

1.36

1.04

1.79

1.24

0.90

1.71

1.04

0.78

1.38

1.01

0.81

1.25

0.88

0.65

1.18

Employment Status

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Unemployed

ref

-

-

ref

-

-

ref

-

-

ref

-

-

ref

-

-

Employed

1.25

0.97

1.63

1.73

1.28

2.34

1.43

1.07

1.91

1.11

0.90

1.37

1.34

1.01

1.77

Physical Health Status

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Low

ref

-

-

ref

-

-

ref

-

-

ref

-

-

ref

-

-

Moderate

1.76

2.01

3.80

2.36

1.60

3.50

2.38

1.63

3.46

3.20

2.44

4.21

2.92

2.07

4.14

High

8.01

5.80

11.06

6.50

4.42

9.55

8.02

5.59

11.50

8.69

6.59

11.35

8.00

5.62

11.38

Tobacco Use

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  Non-smoker

ref

-

-

ref

-

-

ref

-

-

ref

-

-

ref

-

-

  Current smoker

0.55

0.41

0.73

0.84

0.60

1.18

0.53

0.38

0.72

0.70

0.55

0.89

0.68

0.51

0.90

Alcohol Use

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

None

ref

-

-

ref

-

-

ref

-

-

ref

-

-

ref

-

-

Light

0.69

0.50

0.94

1.01

0.69

1.49

0.94

0.65

1.37

0.77

0.59

1.01

0.83

0.58

1.19

Moderate

0.85

0.59

1.20

0.68

0.41

1.12

0.88

0.60

1.29

0.98

0.75

1.28

1.12

0.77

1.64

Excessive

0.76

0.51

1.13

0.54

0.35

0.85

1.00

0.70

1.41

0.66

0.50

0.86

0.69

0.46

1.04

Note. AOR=adjusted odds ratio; 95% CI=95% confidence intervals; ref=referent group; boldface indicates significance (AORs with 95% CI that do not include 1.00 are significant)