title: Factors associated with self-reported health: implications for screening level community-based health and environmental studies.
abstract: Advocates for environmental justice, local, state, and national public health officials, exposure scientists, need broad-based health indices to identify vulnerable communities. Longitudinal studies show that perception of current health status predicts subsequent mortality, suggesting that self-reported health (SRH) may be useful in screening-level community assessments. This paper evaluates whether SRH is an appropriate surrogate indicator of health status by evaluating relationships between SRH and sociodemographic, lifestyle, and health care factors as well as serological indicators of nutrition, health risk, and environmental exposures.
  
  
  
  Data were combined from the 2003-2006 National Health and Nutrition Examination Surveys for 1372 nonsmoking 20-50 year olds. Ordinal and binary logistic regression was used to estimate odds ratios and 95 % confidence intervals of reporting poorer health based on measures of nutrition, health condition, environmental contaminants, and sociodemographic, health care, and lifestyle factors.
  
  
  
  Poorer SRH was associated with several serological measures of nutrition, health condition, and biomarkers of toluene, cadmium, lead, and mercury exposure. Race/ethnicity, income, education, access to health care, food security, exercise, poor mental and physical health, prescription drug use, and multiple health outcome measures (e.g., diabetes, thyroid problems, asthma) were also associated with poorer SRH.
  
  
  
  Based on the many significant associations between SRH and serological assays of health risk, sociodemographic measures, health care access and utilization, and lifestyle factors, SRH appears to be a useful health indicator with potential relevance for screening level community-based health and environmental studies.
authors.affiliation: Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Mail Drop: 58C, Research Triangle Park, NC, 27711, USA.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Gallagher
authors.affiliation: Oak Ridge Institute for Science and Education, Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Mail Drop: 58C, Research Triangle Park, NC, 27711, USA.
authors.forename: Adrien A
authors.initials: AA
authors.lastname: Wilkie
authors.affiliation: Sociology Department, Whitman College, 345 Boyer Ave, Walla Walla, WA, 99362, USA.
authors.forename: Alissa
authors.initials: A
authors.lastname: Cordner
authors.affiliation: Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Mail Drop: 58C, Research Triangle Park, NC, 27711, USA.
authors.forename: Edward E
authors.initials: EE
authors.lastname: Hudgens
authors.affiliation: Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Mail Drop: 58C, Research Triangle Park, NC, 27711, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Ghio
authors.affiliation: Westat, 1600 Research Blvd, Rockville, MD, 20850, USA.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Birch
authors.affiliation: Environmental Public Health Division, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Mail Drop: 58C, Research Triangle Park, NC, 27711, USA. Wade.Tim@epa.gov.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Wade
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D059026:Diagnostic Self Evaluation; D004777:Environment; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D057566:Self Report; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Clinical measures; Metal mixtures analyses; NHANES; Screening level health assessment; Self-reported health