Patient worry and concern associated with referral on the two-week suspected head and neck pathway

Introduction Patient worry and concern of cancer adds to the latent distress associated with referral on the two-week suspected pathway (2WW). For oral cancer, as the conversion rate is in the region of 5-10%, the majority of people will have needless cause for concern.Aim This study aims to report how worried/concerned patients were that the reason for referral might mean that they had cancer and to relate to referral characteristics.Materials/methods All patients referred on the 2WW to two oral and maxillofacial departments in the three months from January to March 2021 were sent a one-off anonymised study-specific post-consultation survey.Results In total, 107 of 353 patients responded to the survey (30%). The response rate increased notably in the older group (p <0.001). The cancer conversion rate overall was 5.4% (19/353), stratified as 2.4% (4/167) for general dental practitioner and 8.1% (15/186) for general medical practitioner (p = 0.02). When asked how worried/concerned they were that the reason for referral might have been for cancer, the response was 'very much' (34%, 33/98), and 'somewhat' (24%, 24/98). Concerns tended to be higher in women and those under 40.Conclusions In recognition of the proportion of patients on the 2WW pathway without cancer who have 'very much worry and concern', it is appropriate to explore ways to alleviate this anxiety, and the best means to achieve this needs careful consideration.

GPS-based activity space exposure to greenness and walkability is associated with increased accelerometer-based physical activity

INTRODUCTION

Built and natural environments may provide opportunities for physical activity. However, studies are limited by primarily using residential addresses to define exposure and self-report to measure physical activity. We quantified associations between global positioning systems (GPS)-based activity space measures of environmental exposure and accelerometer-based physical activity.

METHODS

Using a nationwide sample of working female adults (N = 354), we obtained seven days of GPS and accelerometry data. We created Daily Path Area activity spaces using GPS data and linked these activity spaces to spatial datasets on walkability (EPA Smart Location Database at the Census block group level) and greenness (satellite vegetation at 250 m resolution). We utilized generalized additive models to examine nonlinear associations between activity space exposures and accelerometer-derived physical activity outcomes adjusted for demographic characteristics, socioeconomic factors, and self-rated health.

RESULTS

Higher activity space walkability was associated with higher levels of moderate-vigorous physical activity, and higher activity space greenness was associated with greater numbers of steps per week. No strong relationships were observed for sedentary behavior or light physical activity. Highest levels of moderate-vigorous physical activity were observed for participants with both high walkability and high greenness in their activity spaces.

CONCLUSION

This study contributes evidence that higher levels of physical activity occur in environments with more dense, diverse, and well-connected built environments, and with higher amounts of vegetation. These data suggest that urban planners, landscape architects, and policy makers should implement and evaluate environmental interventions to encourage higher levels of physical activity.

P-581 Live birth rates in women under 38 years old with AMH level &lt; 1.2 ng/ml in in-vitro fertilization/intracytoplasmic sperm injection: arguments for care

Study question

To evaluate the clinical pregnancy and live birth rates in the first IVF/ICSI cycle in women under 38 years old with AMH level &lt; 1.2 ng/ml.

Summary answer

Our findings argue to propose IVF for those patients.

What is known already

Many studies failed to show a predictive impact of AMH levels on the chances of pregnancy, however acceptable pregnancy rates for young women with low AMH levels were observed in IVF/ICSI. The definition of early ovarian failure is based on two classifications, Bologna and Poseidon, where an AMH level of 1.2 ng/ml appears to be the threshold for determining ovarian failure. According to La Marca's curve, this level of 1.2 ng/ml corresponds to an ovarian reserve of a 38 year-old woman.

Study design, size, duration

The primary objective of this study was to compare the live birth rates between these three groups of women. The secondary objective was to compare the rate of positive βhCG level, clinical pregnancy rate and live birth rate in women under 38 years of age during the 1st cycle of IVF+/-ICSI, regardless of whether the AMH is &lt; 1.2 ng/ml or ≥ 1.2 ng/ml.

Participants/materials, setting, methods

We analyzed the first cycle of IVF/ICSI in women under 38 years old with AMH level &lt; 1.2 ng/ml under long GnRH agonist or GnRH antagonist protocols. We classified the women into three groups: group A: AMH &lt; 0.4 ng/ml; group B: AMH: 0.4 to 0.8 ng/ml; group C: AMH &gt; 0.8 ng/ml.

Main results and the role of chance

Between January 2017 and September 2020, we retained 227 cycles for analysis (group A: 50 cycles, B: 85 cycles and C: 92 cycles). No significant difference was found between the three groups for clinical pregnancy and live birth rates, either per stimulation cycle, oocyte puncture or embryo transfer. Thus, the birth rates per embryo transfer are 23.5% in group A, 25.4% in group B and 28.1% in group C. When we compared the two groups of women under 38 years of age during the 1st cycle of IVF+/-ICSI, according to AMH levels &lt; 1.2 ng/ml (n: 227) or ≥ 1.2 ng/ml (n: 325), the only significant difference was the positive βhCG level rate per oocyte puncture (p &lt; 0.01). Biochemical pregnancy rates were significantly different in women with AMH &lt; 1.2 ng/ml (40.8%) compared to those with AMH ≥ 1.2 ng/ml (16.6%; p &lt; 0.01), but the rate of first trimester miscarriage was identical in both groups (14.6% and 6.1% respectively).

Limitations, reasons for caution

Our retrospective study and the small sample size limited the level of scientific proof. The woman and male ages were significantly different between the AMH groups, but these data lead to reduce the impact of low AMHs on pregnancy rates.

Wider implications of the findings

The young age of the women (&lt; 38 y.o) reassures about the oocyte quality, but a low level of AMH may raise concerns about a lower quantitative oocyte yield, leading to accelerated management of the couple in IVF/ICSI.

Trial registration number

B2020CE.43

Transcriptional changes in the peripheral blood leukocytes from Brangus cattle before and after tick challenge with Rhipicephalus australis

Background

Disease emergence and production loss caused by cattle tick infestations have focused attention on genetic selection strategies to breed beef cattle with increased tick resistance. However, the mechanisms behind host responses to tick infestation have not been fully characterised. Hence, this study examined gene expression profiles of peripheral blood leukocytes from tick-naive Brangus steers (Bos taurus x Bos indicus) at 0, 3, and 12 weeks following artificial tick challenge experiments with Rhipicephalus australis larvae. The aim of the study was to investigate the effect of tick infestation on host leukocyte response to explore genes associated with the expression of high and low host resistance to ticks.

Results

Animals with high (HR, n = 5) and low (LR, n = 5) host resistance were identified after repeated tick challenge. A total of 3644 unique differentially expressed genes (FDR < 0.05) were identified in the comparison of tick-exposed (both HR and LR) and tick-naive steers for the 3-week and 12-week infestation period. Enrichment analyses showed genes were involved in leukocyte chemotaxis, coagulation, and inflammatory response. The IL-17 signalling, and cytokine-cytokine interactions pathways appeared to be relevant in protection and immunopathology to tick challenge. Comparison of HR and LR phenotypes at timepoints of weeks 0, 3, and 12 showed there were 69, 8, and 4 differentially expressed genes, respectively. Most of these genes were related to immune, tissue remodelling, and angiogenesis functions, suggesting this is relevant in the development of resistance or susceptibility to tick challenge.

Conclusions

This study showed the effect of tick infestation on Brangus cattle with variable phenotypes of host resistance to R. australis ticks. Steers responded to infestation by expressing leukocyte genes related to chemotaxis, cytokine secretion, and inflammatory response. The altered expression of genes from the bovine MHC complex in highly resistant animals at pre- and post- infestation stages also supports the relevance of this genomic region for disease resilience. Overall, this study offers a resource of leukocyte gene expression data on matched tick-naive and tick-infested steers relevant for the improvement of tick resistance in composite cattle.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12864-022-08686-3.

Therapists’ Experiences of Self-Transcendence: An Interpretative Phenomenological Analysis

This study examines how seven counselors and psychotherapists in Aotearoa New Zealand made sense of their self-transcendent experiences (STE), and discussed how they see these experiences influencing their therapeutic approaches. The term “self-transcendent experience” is defined as a short-lived peak event that achieves a perceived connection beyond one’s sense of self, which can be difficult to describe in words. It is assumed that when STE occurs in the lives of psychologically healthy individuals, its aftermath is associated with increased well-being. Applying interpretative phenomenological analysis (IPA) to seven semi-structured interviews, this study attempts to make interpretative sense of how participants understand transcendent phenomena. Results point to an interplay between participants’ perceived meaning of STE and its context, defined as the confluence of interpersonal and intrapersonal characteristics of lived experience preceding, during, and following the event. Participants couch ineffable phenomena of STE within more communicable narratives of grief and loss, shifting identity, struggling with insecurity, and undergoing transformational growth. Findings point to the role of intuitive states during therapy, where participants receive “pictures or sensations” and “pings of information.” Some participants reported sensing deep connection with clients, suggesting states of relational depth during therapy might be conceived of as low-key STE.

Benefits of Increasing Greenness on All-Cause Mortality in the Largest Metropolitan Areas of the United States Within the Past Two Decades

Across the United States, cities are creating sustainability and climate action plans (CAPs) that call to increase local vegetation. These greening initiatives have the potential to not only benefit the environment but also human health. In epidemiologic literature, greenness has a protective effect on mortality through various direct and indirect pathways. We aimed to assess how an increase in greenness could decrease mortality in the largest urban areas in the United States. We conducted a nationwide quantitative health impact assessment to estimate the predicted reduction in mortality associated with an increase in greenness across two decades (2000, 2010, and 2019). Using a recently published exposure-response function, Landsat 30 m 16-day satellite imagery from April to September, and publicly available county-level mortality data from the CDC, we calculated the age-adjusted reduction in all-cause mortality for those 65 years and older within 35 of the most populated metropolitan areas. We estimated that between 34,000 and 38,000 all-cause deaths could have been reduced in 2000, 2010, and 2019 with a local increase in green vegetation by 0.1 unit across the most populated metropolitan areas. We found that overall greenness increased across time with a 2.86% increase from 2000 to 2010 to 11.11% from 2010 to 2019. These results can be used to support CAPs by providing a quantitative assessment to the impact local greening initiatives can have on mortality. Urban planners and local governments can use these findings to calculate the co-benefits of local CAPs through a public health lens and support policy development.

Long-term aircraft noise exposure and risk of hypertension in the Nurses' Health Studies

BACKGROUND

Aircraft noise can affect populations living near airports. Chronic exposure to aircraft noise has been associated with cardiovascular disease, including hypertension. However, previous studies have been limited in their ability to characterize noise exposures over time and to adequately control for confounders.

OBJECTIVES

The aim of this study was to examine the association between aircraft noise and incident hypertension in two cohorts of female nurses, using aircraft noise exposure estimates with high spatial resolution over a 20-year period.

METHODS

We obtained contour maps of modeled aircraft noise levels over time for 90 U.S. airports and linked them with geocoded addresses of participants in the Nurses' Health Study (NHS) and Nurses' Health Study II (NHS II) to assign noise exposure for 1994-2014 and 1995-2013, respectively. We used time-varying Cox proportional hazards models to estimate hypertension risk associated with time-varying noise exposure (dichotomized at 45 and 55 dB(A)), adjusting for fixed and time-varying confounders. Results from both cohorts were pooled via random effects meta-analysis.

RESULTS

In meta-analyses of parsimonious and fully-adjusted models with aircraft noise dichotomized at 45 dB(A), hazard ratios (HR) for hypertension incidence were 1.04 (95% CI: 1.00, 1.07) and 1.03 (95% CI: 0.99, 1.07), respectively. When dichotomized at 55 dB(A), HRs were 1.10 (95% CI: 1.01, 1.19) and 1.07 (95% CI: 0.98, 1.15), respectively. After conducting fully-adjusted sensitivity analyses limited to years in which particulate matter (PM) was obtained, we observed similar findings. In NHS, the PM-unadjusted HR was 1.01 (95% CI: 0.90, 1.14) and PM-adjusted HR was 1.01 (95% CI: 0.89, 1.14); in NHS II, the PM-unadjusted HR was 1.08 (95% CI: 0.96, 1.22) and the PM-adjusted HR was 1.08 (95% CI: 0.95, 1.21). Overall, in these cohorts, we found marginally suggestive evidence of a positive association between aircraft noise exposure and hypertension.

Linking Individual-Level Facebook Posts With Psychological and Health Data in an Epidemiological Cohort: Feasibility Study

BACKGROUND

Psychological factors (eg, depression) and related biological and behavioral responses are associated with numerous physical health outcomes. Most research in this area relies on self-reported assessments of psychological factors, which are difficult to scale because they may be expensive and time-consuming. Investigators are increasingly interested in using social media as a novel and convenient platform for obtaining information rapidly in large populations.

OBJECTIVE

We evaluated the feasibility of obtaining Facebook data from a large ongoing cohort study of midlife and older women, which may be used to assess psychological functioning efficiently with low cost.

METHODS

This study was conducted with participants in the Nurses' Health Study II (NHSII), which was initiated in 1989 with biennial follow-ups. Facebook does not share data readily; therefore, we developed procedures to enable women to download and transfer their Facebook data to cohort servers (for linkage with other study data they have provided). Since privacy is a critical concern when collecting individual-level data, we partnered with a third-party software developer, Digi.me, to enable participants to obtain their own Facebook data and to send it securely to our research team. In 2020, we invited a subset of the 18,519 NHSII participants (aged 56-73 years) via email to participate. Women were selected if they reported on the 2017-2018 questionnaire that they regularly posted on Facebook and were still active cohort participants. We included an exit survey for those who chose not to participate in order to gauge the reasons for nonparticipation.

RESULTS

We invited 309 women to participate. Few women signed the consent form (n=52), and only 3 used the Digi.me app to download and transfer their Facebook data. This low participation rate was observed despite modifying our protocol between waves of recruitment, including by (1) excluding active health care workers, who might be less available to participate due to the pandemic, (2) developing a Frequently Asked Questions factsheet to provide more information regarding the protocol, and (3) simplifying the instructions for using the Digi.me app. On our exit survey, the reasons most commonly reported for not participating were concerns regarding data privacy and hesitation sharing personal Facebook posts. The low participation rate suggests that obtaining individual-level Facebook data in a cohort of middle-aged and older women may be challenging.

CONCLUSIONS

In this cohort of midlife and older women who were actively participating for over three decades, we were largely unable to obtain permission to access individual-level data from participants' Facebook accounts. Despite working with a third-party developer to customize an app to implement safeguards for privacy, data privacy remained a key concern in these women. Future studies aiming to leverage individual-level social media data should explore alternate populations or means of sharing social media data.

Impact of neighborhood socioeconomic status, income segregation, and greenness on blood biomarkers of inflammation

BACKGROUND

Neighborhood deprivation is linked with inflammation, which may explain poorer health across populations. Behavioral risk factors are assumed to largely mediate these relationships, but few studies have examined this. We examined three neighborhood contextual factors that could exert direct effects on inflammation: (1) neighborhood socioeconomic status, (2) an index of concentration at extremes (that measures segregation), and (3) surrounding vegetation (greenness).

METHODS

Using blood samples and addresses collected from prospective cohorts of 7,930 male (1990-1994) and 16,183 female (1986-1990) health professionals with at least one inflammatory marker, we prospectively linked neighborhood contextual factors to inflammatory biomarkers (adiponectin, C-reactive protein, interleukin-6, soluble tumor necrosis factor receptor-2). Log-transformed, z-scaled component measures were used to calculate an inflammation score. Neighborhood socioeconomic status and index of concentration of extremes were obtained from the 1990 decennial census and linked to participant addresses. Surrounding greenness was assessed from satellite data and focal statistics were applied to generate exposures within 270 m and 1230 m of the participants' address. We fit multiple linear regression models adjusting for demographic, clinical, and behavioral risk factors.

RESULTS

Higher neighborhood socioeconomic status was associated with lower inflammation score in women (β for interquartile range increase = -27.7%, 95% CI: -34.9%, -19.8%) and men (β = -21.2%, 95% CI: -31.0%, -10.1%). Similarly, participants in neighborhoods with higher concentrations of high-income households were associated with lower inflammation score in women (β = -27.8%, 95% CI: -35.8%, -18.7%) and men (β = -16.4%, 95% CI: -29.7%, -0.56%). Surrounding greenness within 270 m of each participant's address was associated with lower inflammation score in women (β = -18.9%, 95% CI: -28.9%, -7.4%) but not men. Results were robust to sensitivity analyses to assess unmeasured confounding and selection bias.

DISCUSSION

Our findings support the hypothesis that adverse neighborhood environments may contribute to inflammation through pathways independent of behavioral risk factors, including psychosocial stress and toxic environments.

Residential Green Space and Cognitive Function in a Large Cohort of Middle-Aged Women

Importance

Green space can decelerate cognitive decline by supporting physical activity, psychological restoration, or reducing exposure to air pollution. However, existing studies on the association of green space with cognitive decline are limited.

Objective

To examine whether residential green space was associated with cognitive function in middle-aged women.

Design, Setting, and Participants

Starting in 1989, the Nurses' Health Study II enrolled 116 429 female nurses aged 25 to 42 years residing in the US. In 2014 to 2016, 40 082 women were invited to complete an online cognitive battery. This cohort study analyzed women who had data on both green space exposure and cognitive measures. Data analysis was conducted from June to October 2021.

Exposures

Residential exposure to green space was assessed using the Normalized Difference Vegetation Index, a satellite-derived indicator of the quantity of ground vegetation. Landsat satellite data at 270-m and 1230-m buffers around each participants' residential addresses in 2013 were used.

Main Outcomes and Measures

In 2014 to 2016, cognitive function was measured using a self-administered online battery, the Cogstate Brief Battery, consisting of 4 tasks measuring psychomotor speed, attention, learning, and working memory; 3 composite scores, averaging together all tasks, psychomotor speed/attention, and learning/working memory, were created. In addition, the study evaluated potential mediators, including air pollution, depression, and physical activity.

Results

The analytical sample included 13 594 women, of whom 13 293 (98%) were White. Mean (SD) age was 61.2 (4.6) years. In models adjusted for age at assessment, race, childhood, adulthood, and neighborhood socioeconomic status, green space was associated with higher scores on the global Cogstate composite (mean difference per IQR in green space, 0.05; 95% CI, 0.02 to 0.07), and psychomotor speed/attention (mean difference in score, 0.05 standard units; 95% CI, 0.02 to 0.08). This difference in scores is similar to the difference observed in women 1 year apart in age in the data. By contrast, there was no association between green space and learning/working memory (mean difference, 0.0300; 95% CI, -0.0003 to 0.0500).

Conclusions and Relevance

These findings suggest that increasing residential green space may be associated with modest benefits in cognition in middle-aged women.

A257 PANCREATIC CANCER TREATMENT AND END OF LIFE OUTCOMES: A POPULATION BASED COHORT STUDY

Background

Patients with pancreatic cancer face challenging decisions regarding treatment choices following their diagnosis and often lack data on end-of-life (EOL) outcomes. Without the available information, older patients may be undertreated, dying earlier than they would have with treatment, while others may be overtreated and exposed to aggressive measures with harmful side effects.

Aims

To describe survival and EOL outcomes among pancreatic cancer patients based on index cancer treatment, disease stage, and patient characteristics.

Methods

We conducted a population based cohort study in Ontario, Canada of patients who died from April 2010 to December 2017 and were diagnosed with pancreatic cancer prior to death. We used administrative databases to collect data on demographics, baseline health status, treatments, and outcomes. The primary exposure was index cancer treatment (no treatment, radiation, chemotherapy alone, surgery alone, and surgery with chemotherapy). The primary outcomes were mortality, health care encounters per 30 days in the last six months of life, and palliative care visits per 30 days within the last six months of life. Secondary outcomes were location of death (institution vs. community), hospitalization within the last 30 days of life, and receipt of chemotherapy within the last 30 days of life. We estimated the association between the exposure and outcomes using multivariable models, adjusting for demographics, comorbidities, and cancer stage. Hazard ratios, adjusted mean differences, and odds ratios were reported with 95% confidence intervals.

Results

Our cohort included 9950 adults with a median age at diagnosis of 78. 56% received no index treatment, 5% underwent radiation, 27% underwent chemotherapy alone, 7% underwent surgery alone, and 6% underwent surgery and chemotherapy. In the multivariable regression (Table and Figure), radiation, chemotherapy alone, surgery alone, and surgery with chemotherapy were all associated with decreased mortality and fewer healthcare encounters. All groups except radiation were associated with fewer palliative care visits. All treatment groups were associated with lower odds of institutional death and hospitalization within the last 30 days of life, and higher odds of chemotherapy within the last 30 days of life.

Conclusions

Our data, the first to provide EOL outcome estimates based on index cancer treatment, can help patients make initial treatment decisions after a diagnosis of pancreatic cancer.

Multivariable regression analyses predicting primary and secondary outcomes

Funding Agencies

CIHR

Sociodemographic Patterns of Exposure to Civil Aircraft Noise in the United States

BACKGROUND

Communities with lower socioeconomic status and higher prevalence of racial/ethnic minority populations are often more exposed to environmental pollutants. Although studies have shown associations between aircraft noise and property values and various health outcomes, little is known about how aircraft noise exposures are sociodemographically patterned.

OBJECTIVE

Our aim was to describe characteristics of populations exposed to aviation noise by race/ethnicity, education, and income in the United States.

METHODS

Aircraft noise contours characterized as day-night average sound level (DNL) were developed for 90 U.S. airports in 2010 for DNL ≥45 dB(A) in 1-dB(A) increments. We compared characteristics of exposed U.S. Census block groups at three thresholds (≥45, ≥55, and ≥65 dB(A)), assigned on the basis of the block group land area being ≥50% within the threshold, vs. unexposed block groups near study airports. Comparisons were made across block group race/ethnicity, education, and income categories within the study areas (n=4,031-74,253). We performed both multinomial and other various multivariable regression approaches, including models controlling for airport and models with random intercepts specifying within-airport effects and adjusting for airport-level means.

RESULTS

Aggregated across multiple airports, block groups with a higher Hispanic population had higher odds of being exposed to aircraft noise. For example, the multinomial analysis showed that a 10-percentage point increase in a block group's Hispanic population was associated with an increased odds ratio of 39% (95% CI: 25%, 54%) of being exposed to ≥65 dB(A) compared with block groups exposed to <45 dB(A). Block groups with higher proportions of residents with only a high school education had higher odds of being exposed to aircraft noise. Results were robust across multiple regression approaches; however, there was substantial heterogeneity across airports.

DISCUSSION

These results suggest that across U.S. airports, there is indication of sociodemographic disparities in noise exposures. https://doi.org/10.1289/EHP9307.

Delay in the Effect of Restricting Community Mobility on the Spread of COVID-19 During the First Wave in the United States

Background

It remains unclear how changes in human mobility shaped the transmission dynamic of coronavirus disease 2019 (COVID-19) during its first wave in the United States.

Methods

By coupling a Bayesian hierarchical spatiotemporal model with reported case data and Google mobility data at the county level, we found that changes in movement were associated with notable changes in reported COVID-19 incidence rates about 5 to 7 weeks later.

Results

Among all movement types, residential stay was the most influential driver of COVID-19 incidence rate, with a 10% increase 7 weeks ago reducing the disease incidence rate by 13% (95% credible interval, 6%-20%). A 10% increase in movement from home to workplaces, retail and recreation stores, public transit, grocery stores, and pharmacies 7 weeks ago was associated with an increase of 5%-8% in the COVID-10 incidence rate. In contrast, parks-related movement showed minimal impact.

Conclusions

Policy-makers should anticipate such a delay when planning intervention strategies restricting human movement.

Early-Life Exposure to Green Space and Mid-Childhood Cognition in the Project Viva Cohort, Massachusetts

The association between early-life greenness and child cognition is not well understood. Using prospective data from Project Viva (n = 857) from 1999-2010, we examined associations of early-life greenness exposure with mid-childhood cognition. We estimated residential greenness at birth, early childhood (median age 3.1 years), and mid-childhood (7.8 years) using 30-m resolution Landsat satellite imagery (normalized difference vegetation index). In early childhood and mid-childhood, we administered standardized assessments of verbal and nonverbal intelligence, visual-motor abilities, and visual memory. We used natural splines to examine associations of early life-course greenness with mid-childhood cognition, adjusting for age, sex, race, income, neighborhood socioeconomic status, maternal intelligence, and parental education. At lower levels of greenness (greenness <0.6), greenness exposure at early childhood was associated with a 0.48% increase in nonverbal intelligence and 2.64% increase in visual memory in mid-childhood. The association between early-childhood greenness and mid-childhood visual memory was observed after further adjusting for early childhood cognition and across different methodologies, while the association with nonverbal intelligence was not. No other associations between early life-course greenness and mid-childhood cognition were found. Early childhood greenness was nonlinearly associated with higher mid-childhood visual memory. Our findings highlight the importance of nonlinear associations between greenness and cognition.

Optimism and risk of mortality among African-Americans: The Jackson heart study

Optimism is associated with reduced mortality risk among Whites, but evidence for this relationship is limited among African-Americans, whose life expectancy is shorter than Whites. This study examined the association between optimism and mortality rate in African-Americans. Data were from African-American women (n = 2652) and men (n = 1444) in the United States from the Jackson Heart Study. Optimism was measured using the Life Orientation Test-Revised at the baseline period (2000-2004), and mortality data were obtained until 2018. Using Cox proportional hazards models, we estimated hazard ratios (HRs) of mortality by optimism level, controlling for sociodemographic factors, depressive symptoms, health conditions, and health behaviors. In secondary analyses, we evaluated potential effect modification by sex, age, income, and education. Higher optimism was related to lower mortality rates (HR = 0.85, 95% confidence interval [CI] = 0.74, 0.99), controlling for sociodemographic factors and depressive symptoms. After further adjusting for health conditions and health behaviors, associations were slightly attenuated (HR = 0.89; 95%CI = 0.77, 1.02). Stronger associations between optimism and mortality were observed in men, among those with higher income or education, and with age ≤ 55 (all p's for interaction terms <0.06). In summary, optimism was associated with lower mortality rates among African-Americans in the Jackson Heart Study. Effect modification by sociodemographic factors should be further explored in additional research considering optimism and mortality in diverse populations. Positive factors, such as optimism, may provide important health assets that can complement ongoing public health efforts to reduce health disparities, which have traditionally focused primarily on risk factors.