The mediating roles of perceived stress and health behaviors in the relation between objective, subjective, and neighborhood socioeconomic status and perceived health

Epigenome-wide association study of long-term psychosocial stress in older adults

Long-term psychosocial stress is strongly associated with negative physical and mental health outcomes, as well as adverse health behaviours; however, little is known about the role that stress plays on the epigenome. One proposed mechanism by which stress affects DNA methylation is through health behaviours. We conducted an epigenome-wide association study (EWAS) of cumulative psychosocial stress (n = 2,689) from the Health and Retirement Study (mean age = 70.4 years), assessing DNA methylation (Illumina Infinium HumanMethylationEPIC Beadchip) at 789,656 CpG sites. For identified CpG sites, we conducted a formal mediation analysis to examine whether smoking, alcohol use, physical activity, and body mass index (BMI) mediate the relationship between stress and DNA methylation. Nine CpG sites were associated with psychosocial stress (all p < 9E-07; FDR q < 0.10). Additionally, health behaviours and/or BMI mediated 9.4% to 21.8% of the relationship between stress and methylation at eight of the nine CpGs. Several of the identified CpGs were in or near genes associated with cardiometabolic traits, psychosocial disorders, inflammation, and smoking. These findings support our hypothesis that psychosocial stress is associated with DNA methylation across the epigenome. Furthermore, specific health behaviours mediate only a modest percentage of this relationship, providing evidence that other mechanisms may link stress and DNA methylation.

The Association of Neighborhood Socioeconomic Status with Executive Function and Processing Speed in Cognitively Normal Mexican American Elders from the Health and Aging Brains Study: Health Disparities Cohort

INTRODUCTION

Neighborhood socioeconomic status (NSES) has been linked with overall health, and this study will evaluate whether NSES is cross-sectionally associated with cognition in non-Hispanic whites (NHWs) and Mexican Americans (MAs) from the Health and Aging Brain: Health Disparities Study (HABS-HD).

METHODS

The HABS-HD is a longitudinal study conducted at the University of North Texas Health Science Center. The final sample analyzed (n = 1,312) were 50 years or older, with unimpaired cognition, and underwent an interview, neuropsychological examination, imaging, and blood draw. NSES was measured using the national area deprivation index (ADI) percentile ranking, which considered socioeconomic variables. Executive function and processing speed were assessed by the trail making tests (A and B) and the digit-symbol substitution test, respectively. Linear regression was used to assess the association of ADI and cognitive measures.

RESULTS

MAs were younger, more likely to be female, less educated, had higher ADI scores, performed worse on trails B (all p < 0.05), and had lower prevalence of APOE4 + when compared to NHWs (p < 0.0001). A higher percentage of MAs lived in the most deprived neighborhoods than NHWs. For NHWs, ADI did not predict trails B or DSS scores, after adjusting for demographic variables and APOE4. For MAs, ADI predicted trails A, trails B, and DSS after adjusting for demographic covariates and APOE4 status.

CONCLUSION

Our study revealed that living in an area of higher deprivation was associated with lower cognitive function in MAs but not in NHWs, which is important to consider in future interventions to slow cognitive decline.

Psychotropic medicine use without current or prior medical advice, storage at home and association with perceived stress in a primary health care setting in Greece

OBJECTIVE

Psychotropic medicines use alters according to socio-economic factors and perceived stress. The study aimed to assess the prevalence of use of psychotropic medicines and supplements (PMS) without medical advice, including storage at home, and its relationship with socio-demographic characteristics and perceived stress in primary care patients.

MATERIALS AND METHODS

A cross-sectional sample of adult attendees in an urban primary care unit in Crete, Greece, were surveyed during regularly scheduled appointments during a three-week period in October 2020. A questionnaire was distributed to investigate PMS use during the last 12 months. The validated Greek version of Perceived Stress Scale (PSS-14) was adopted to measure perceived stress.

RESULTS

Of 263 respondents (mean age 46.3±14.5 years; 66.5% females), 101 (38.4%; 95%CI 33.1-43.7%) recalled having psychotropic medicines stored at home cabinets and 72 (27.4%; 95%CI 22.4-32.3%) reported using PMS without medical advice in the last 12 months.

CONCLUSIONS

This study revealed a high prevalence of PMS use without medical advice, including storage at home. People>59 years of age, experiencing irregular sleep and scoring high in PSS, displayed increased prevalence of storing PMS at home or using them without medical advice. The findings could potentially inform primary care providers to focus on patients most likely to be users of PMS without medical advice.

Measurement of Allostatic Load in Caregivers of Older Hispanic People With Alzheimer Disease and Related Disorders

BACKGROUND

Allostatic load (AL) has been studied in the context of biomarkers that may be affected by environmental and contextual stressors, including social determinants of health. The specific stressor studied here is the provision of caregiving to older persons with Alzheimer disease and related disorders. The aims were to examine the factor structure of stress and nonstress biomarkers, different methods for calculating AL, and the relationship of AL with other variables.

METHODS

Latent variable models were used to examine biomarkers. Regression analyses were performed with the outcomes: AL calculated as percentile-based and clinically-based for both stress and nonstress components. The sample was 187 Hispanic caregivers to individuals with dementia.

RESULTS

The results of the confirmatory factor analyses (CFAs) suggested defining 2 factors: nonstress and stress-related. Performance was better for the CFA results and the associations with covariates when stress and nonstress components were examined separately. Despite some limitations, this is one of the first studies of biomarkers in Hispanic caregivers to patients with dementia. It was possible to explain almost 30% of the variance in the nonstress AL component.

CONCLUSION

It may be important to differentiate among biomarkers indicative of cardiovascular, metabolic, and immune response as contrasted with the more stress-related biomarkers.

Multiple Behavioral Risk Factors As Assets for Chronic Disease Prevention: Observations From Urban Primary Care Settings in Crete, Greece

AIM

This study aimed to assess the health profile of patient-attendees visiting primary healthcare (PHC) practice settings in the midst of the COVID-19 pandemic and to explore the relationships between multiple behavioral risk factors (MBRFs) and consultation-driven health information. Multiple behavioral risk factors involve a variety of unhealthy behaviors that are associated with an increased prevalence of non-communicable diseases (NCDs).

SUBJECTS AND METHODS

The study design was based on a dataset analysis, afterward exploring the feasibility and diagnostic capacity of respiratory morbidity aspects from a study previously conducted. The study dataset contained information regarding socio-demographic characteristics, health habits, clinical information, and reported comorbidities from 183 primary care patient-attendees. A categorical regression analysis was performed, using as a numeric variable the multiple MBRFs (clustering of 0 to four factors) in order to examine relationships with the basic and clinical characteristics of the patient-attendees.

RESULTS

Based on this secondary analysis, it was found that the prevalence of MBRFs is quite common among patient-attendees visiting urban PHC facilities. The prevalence of current smoking, sleep deprivation, increased body weight, and medium/high perceived stress levels were 33.9%, 52.5%, 83.1%, and 35.0%, respectively. An increased occurrence of MBRFs might be significantly predicted by the lower age of patient-attendees (b = -0.221, p = 0.05), by the absence of gray hair at an early age (b = -0.144, p = 0.042), by the physical discomfort during activities (b = 0.191, p = 0.017), or by the lower oxygen saturation (b = -0.184, p = 0.004). Diabetes mellitus (25.1%) was the most prevalent condition, followed by bronchial asthma (18.6%) and depression (15.8%).

CONCLUSIONS

Lower age, absence of premature hair whitening, physical discomfort during activities, and lower oxygen saturation are linked with an increased occurrence of MBRFs, leading to a neglected way of living. Those factors could be used to alert researchers, policymakers, and PHC professionals to act accordingly in order to prevent or early diagnose NCDs.

Effects of neighborhood built environment on cognitive function in older adults: a systematic review

BACKGROUND

In the background of an aging population, the risk of cognitive impairment in the older population is prominent. Exposure to complex neighborhood built environments may be beneficial to the cognitive health of older adults, and the purpose of this study was to systematically review the scientific evidence on the effects of neighborhood built environments on cognitive function in older adults.

METHODS

Keywords and references were searched in Web of Science, Pubmed, PsycINFO, and MEDLINE. Studies examining the relationship between the built environment and cognitive function in older adults were included. The neighborhood built environment as an independent variable was classified according to seven aspects: density, design, diversity, destination accessibility, public transportation distance, blue/green space, and built environment quality. The cognitive function as the dependent variable was classified according to overall cognitive function, domain-specific cognitive function, and incidence of dementia. The quality of the included literature was assessed using the National Institutes of Health's Observational Cohort and Cross-Sectional Study Quality Assessment Tool.

RESULTS

A total of 56 studies were included that met the inclusion criteria, including 31 cross-sectional studies, 23 longitudinal studies, 1 cross-sectional study design combined with a case-control design, and 1 longitudinal study design combined with a case-control design. Most of the studies reviewed indicate that the built environment factors that were positively associated with cognitive function in older adults were population density, street connectivity, walkability, number of public transportation stops around the residence, land use mix, neighborhood resources, green space, and quality of the neighborhood built environment. Built environment factors that were negatively associated with cognitive function in older adults were street integration, distance from residence to main road. The relationship between residential density, destination accessibility, and blue space with cognitive function in older adults needs to be further explored.

CONCLUSION

Preliminary evidence suggests an association between the neighborhood built environment and cognitive function in older adults. The causal relationship between the built environment and cognitive function can be further explored in the future using standardized and combined subjective and objective assessment methods, and longitudinal or quasi-experimental study designs. For public health interventions on the cognitive health of older adults, it is recommended that relevant authorities include the neighborhood built environment in their intervention programs.

Do financial constraint and perceived stress modify the effects of food tax schemes on food purchases: moderation analyses in a virtual supermarket experiment

OBJECTIVE

To investigate whether financial constraint and perceived stress modify the effects of food-related taxes on the healthiness of food purchases.

DESIGN

Moderation analyses were conducted with data from a trial where participants were randomly exposed to: a control condition with regular food prices, an sugar-sweetened beverage (SSB) tax condition with a two-tiered levy on the sugar content in SSB (5-8 g/100 ml: €0·21 per l and ≥8 g/100 ml: €0·28 per l) or a nutrient profiling tax condition where products with Nutri-Score D or E were taxed at a 20 percent level. Outcome measures were overall healthiness of food purchases (%), energy content (kcal) and SSB purchases (litres). Effect modification was analysed by adding interaction terms between conditions and self-reported financial constraint or perceived stress in regression models. Outcomes for each combination of condition and level of effect modifier were visualised.

SETTING

Virtual supermarket.

PARTICIPANTS

Dutch adults (n 386).

RESULTS

Financial constraint or perceived stress did not significantly modify the effects of food-related taxes on the outcomes. Descriptive analyses suggest that in the control condition, the overall healthiness of food purchases was lowest, and SSB purchases were highest among those with moderate/high levels of financial constraint. Compared with the control condition, in a nutrient profiling tax condition, the overall healthiness of food purchases was higher and SSB purchases were lower, especially among those with moderate/high levels of financial constraint. Such patterns were not observed for perceived stress.

CONCLUSION

Further studies with larger samples are recommended to assess whether food-related taxes differentially affect food purchases of subgroups.

Investigating the effects of rurality on stress, subjective well-being, and weight-related outcomes

Purpose

Rates of obesity are significantly higher for those living in a rural versus urban setting. High levels of stress and low levels of subjective well-being (SWB) have been linked to poor weight-related behaviors and outcomes, but it is unclear if these relationships differ as a function of rurality. This study investigated the extent to which living in a rural versus urban county ("rurality") moderated associations between stress / subjective wellbeing (predictors) and diet quality, dietary intake of added sugars, physical activity, and BMI (outcomes).

Methods

Participants were recruited from urban (n = 355) and rural (n = 347) counties in Washington State and self-reported psychological, demographic, and food frequency questionnaires while physical activity behavior was measured objectively.

Findings

After controlling for relevant covariates, levels of stress were positively associated with added sugar intake for those living in the urban county while this relationship was non-significant for those residing in the rural county. Similarly, SWB was negatively associated with added sugar intake, but only for urban residents. County of residence was also found to moderate the relationship between SWB and BMI. Higher SWB was inversely associated with BMI for those living in the urban county while no relationship was observed for rural county residents.

Conclusions

These findings support the hypothesis that the relationships between stress / SWB and weight function differentially based on the rurality of the residing county. This work adds to the growing body of literature highlighting the role stress and SWB play in the rural obesity disparity.

The double burden of precariousness: linking housing, employment, and perceived stress - a cross-sectional study

Employment precariousness is widely recognised as a social determinant of health and a chronic stressor. Yet precariousness extends beyond employment, into other aspects of life. Using a multidimensional social pathways approach, this study examines the synergistic effects of employment and housing precariousness on self-perceived stress. This study uses the PRESSED dataset (N = 255) derived from the Barcelona Health Survey, which collects data on stress using the Perceived Stress Scale (PSS). Employment precariousness was operationalized using the Employment Precariousness Scale (EPRES) and a multidimensional indicator of housing precariousness was constructed. Generalized structural equation modelling was used to estimate associations between these indicators and self-perceived stress measured by Perceived Stress Survey (PSS), after accounting for sociodemographic variables. Employment and housing precariousness were positively associated with self-perceived stress (OR = 3.23 ; p = 0.002) (OR = 4.28 ; p = 0.065) respectively. The mediating effect of housing precariousness accounted for 16% of the total effect of employment precariousness on stress after controlling for sociodemographic variables. Furthermore, we find that both precarious conditions were unequally distributed by age, sex educational level, and place of birth in the sample. We conclude that employment and housing precariousness are important chronic stressors and that a social pathway approach is needed.

Associations between maternal stress and infant resting brain activity among families residing in poverty in the U.S

Growing evidence suggests that maternal experiences of stress shape children's functional brain activity in the first years of life. Individuals living in poverty are more likely to experience stress from a variety of sources. However, it is unclear how stress is related to resting brain activity among children born into poverty. The present study examines whether infants born into households experiencing poverty show differences in brain activity associated with maternal reports of experiencing stress. The analytic sample comprised 247 mother-infant dyads who completed maternal questionnaires characterizing stress, and for whom recordings of infant resting brain activity were obtained at 1 year of age (M=12.93 months, SD=1.66; 50% female). Mothers (40% Black, non-Hispanic, 40% Hispanic, 12% White, non-Hispanic) who reported higher stress had infants who showed more resting brain activity in the lower end of the frequency spectrum (relative theta power) and less resting brain activity in the middle range of the frequency spectrum (relative alpha power). While statistically detectable at the whole-brain level, follow-up exploratory analyses revealed that these effects were most apparent in electrodes over frontal and parietal regions of the brain. These findings held after adjusting for a variety of potentially confounding variables. Altogether, the present study suggests that, among families experiencing low economic resources, maternal reports of stress are associated with differences in patterns of infant resting brain activity during the first year of life.

COVID-19's shadow on families: A structural equation model of parental stress, family relationships, and child wellbeing

The present study seeks to contribute to developmental science in emergencies by investigating associations between COVID-19 pandemic-related stressors, parents' stress, family relationships, and child wellbeing. In doing so, we build on recent research that generalizes the assumptions of the Family Stress Model beyond direct economic stressors of households to macro-contextual stressors that operate at the societal level. In the case of our study, these stressors relate to the COVID-19 pandemic, such as health risks and confinement-related stresses. Participants were 783 parents of young children (75% female, Mage = 34.61 years) residing in the United Arab Emirates. They completed an online survey in Fall 2020 and Spring 2021, measuring how the pandemic impacted their lives and the lives of their child (Mage = 47.54 months). A subsample of parents (n = 96) completed the survey for two children. Structural equation modeling showed that pandemic-related stressors contributed to higher stress among parents which, in turn, resulted in lower parent-reported child wellbeing at various times during the pandemic. Family relationships mediated the association between parents' stress and child wellbeing. The present study contributes to our understanding on how large-scale disruption due to COVID-19 pandemic-related stressors gets inside the family, the strength and direction of associations (concurrently and over time), and the timing of mechanisms that impact family processes. The results highlight the need to support families with young children in managing disruptions due to emergencies, such as a global public health crisis, and to determine ways of preventing longstanding consequences on family structures and children's lives.

Unmet Social Needs and Pediatric Asthma Severity in an Urban Primary Care Setting

OBJECTIVE

Community-level social determinants of health impact asthma outcomes among children; however, individual patient's priorities are not often included in designing social care interventions. Identifying connections between patient-prioritized unmet social needs and asthma severity status may allow for improved patient-centered approaches to asthma management. In this analysis, we examined the association between unmet social needs and asthma severity in an urban population of children. We hypothesized that those with a greater number of unmet social needs would report a more severe asthma status.

METHODS

We conducted a secondary analysis of 4887 patients screened for unmet social needs and asthma severity status. Bivariate associations and adjusted logistic regression modeling were used to assess the association between unmet social needs and asthma severity.

RESULTS

Persistent asthma severity status was associated with several unmet social needs, including housing quality and stability, lack of money for food, transportation, and healthcare costs. In the multivariable analysis, having 3 or more unmet social needs was associated with a 59% greater odds of persistent asthma status (CI, 1.18-2.14; P = .002), and having 2 unmet social needs was associated with a 33% greater odds of persistent asthma status (CI, 1.00-1.78; P = .05).

CONCLUSIONS

Unmet social needs were associated with asthma severity status, with a greater number of unmet social needs associated with greater odds of severe asthma status. Additional studies are warranted to further evaluate the temporal relationship between unmet social needs and how they may compound one another in their relationship with asthma severity.

Co-Creation of a School-Based Motor Competence and Mental Health Intervention: Move Well, Feel Good

Low motor competence (MC) and inhibited psychosocial development are associated with mental health difficulties. Improving children's MC through school-based physical activity interventions emphasising psychosocial development may therefore be a mechanism for promoting positive mental health. This study describes and provides reflective insights into the co-creation of 'Move Well Feel Good', a primary school physical activity intervention to improve children's MC and mental health. Class teachers, school leaders, physical activity specialists, and children (aged 8-9 years) participated in a series of co-creation workshops. Stakeholders' knowledge and experiences were integrated with existing research evidence using creative methods (e.g., post-it note tasks, worksheets, and drawings) to facilitate discussion. The co-creation process culminated in stakeholder consensus voting for one of three proposed intervention ideas. Children cited physical and mental health benefits, enjoyment with friends, and high perceived competence as motives for being physically active. Opportunities to develop MC across the different segments of the school day were identified by adult stakeholders, who perceived children's lack of resilience, an overloaded curriculum, and poor parental support for physical activity as barriers to intervention implementation. The chosen intervention idea received six out of a possible twelve votes. Co-creation projects are specific to the contexts in which they are implemented. This study reinforces the complex nature of school-based intervention development and highlights the value of engaging with stakeholders in co-creation processes.

Helping low-income smokers quit: findings from a randomized controlled trial comparing specialized quitline services with and without social needs navigation

Background

Quitting smoking is especially challenging for low-income smokers due to high stress, high smoking prevalence around them, and limited support for quitting. This study aimed to determine whether any of three interventions designed specifically for low-income smokers would be more effective than standard tobacco quitline services: a specialized quitline, the specialized quitline with social needs navigation, or the standard quitline with social needs navigation.

Methods

Using a randomized 2 × 2 factorial design, low-income daily cigarette smokers (n = 1944) in Missouri, USA who called a helpline seeking assistance with food, rent or other social needs were assigned to receive Standard Quitline alone (n = 485), Standard Quitline + Social Needs Navigation (n = 484), Specialized Quitline alone (n = 485), or Specialized Quitline + Social Needs Navigation (n = 490). The target sample size was 2000, 500 per group. The main outcome was 7-day self-reported point prevalence abstinence at 6-month follow-up. Multiple imputation was used to impute outcomes for those missing data at 6-month follow-up. Binary logistic regression analyses were used to assess differences between study groups.

Findings

Participants were recruited from June 2017 to November 2020; most were African American (1111 [58%]) or White (666 [35%]), female (1396 [72%]), and reported <$10,000 (957 [51%]) or <$20,000 (1529 [82%]) annual pre-tax household income. At 6-month follow-up (58% retention), 101 participants in the Standard Quitline group reported 7-day point prevalence abstinence (20.8% of those assigned at baseline, 38.1% after imputation). Quit rates in the Specialized Quitline (90 quitters, 18.6%, 38.1%) and Specialized Quitline + Social Needs Navigation (103 quitters, 21.0%, 39.8%) were not different from the Standard Quitline. Quit rates for Standard Quitline + Social Needs Navigation (74 quitters, 15.3%, 30.1%) were significantly lower than Standard Quitline (OR = 0.70, 95% CI = 0.50-0.98).

Interpretation

A specialized version of a state tobacco quitline was no more effective than standard quitline services in helping low-income smokers quit. Adding social needs navigation to a standard quitline decreased its effectiveness.

Trial registration

ClinicalTrials.gov Identifier: NCT03194958.

Funding

National Cancer Institute: R01CA201429.

Relations among Socioeconomic Status, Perceived Stress, and the Home Language Environment

While socioeconomic disparities in the home language environment have been well established, the mechanisms explaining these disparities are poorly understood. One plausible mechanism is heightened stress. The current study investigated whether maternal perceived stress was 1) associated with measures of the home language environment, and 2) mediated the relation between socioeconomic disparities and the home language environment. Data from three independent studies were analyzed, which together comprised 322 mother-child dyads. Two studies included mothers and their six- to twelve-month-old infants (N = 227). The third included mothers and their five- to nine-year-old children (N = 95). Mothers reported their educational attainment, income, and stress. Language Environment Analysis (LENA) measured the home language environment. As has been previously reported, socioeconomic disparities were observed in adult words and conversational turns. Stress did not mediate these associations, nor was it associated with adult words or conversational turns. Alternate mechanisms for future exploration are discussed.

Rural-Urban disparities in self-reported physical/mental multimorbidity: A cross-sectional study of self-reported mental health and physical health among working age adults in the U.S

Purpose

Self-rated physical health (SRPH) and self-rated mental health (SRMH) are both linked to excess morbidity and premature mortality and can vary across rural and urban contexts. This can be particularly problematic for rural residents who have less access to important health care infrastructure. In this paper, we assess the prevalence of and rural-urban disparities at the intersection of SRPH and SRMH, specifically self-rated physical/mental multimorbidity (SRPMM) overall and across rural-urban contexts.

Methods

Using a cross-sectional demographically representative national dataset of over 4000 working age adults in the U.S., we expose rural-urban differences in the prevalence of SRPMM and explore individual-level factors that may explain this disparity.

Results

Approximately 15 percent of working age adults reported SRPMM, but rural adults were at higher risk than their urban counterparts. However, this disadvantage disappeared for remote rural working-age adults and was attenuated for metro-adjacent rural working-age adults when we controlled for the fact that rural adults had lower household incomes.

Conclusion

Findings reveal a higher risk of SRPMM among rural adults, in part because of lower incomes among this group. This work acts as the foundation for facilitating research on and addressing rural-urban disparities in SRPMM.

The Interactive Effects of Education and Social Support on Cognition in African Americans

Objectives: This study examines whether the effects of receiving and providing social support on cognition differ by education. Methods: Data from 602 African American adults (48-95 years) enrolled in the Baltimore Study of Black Aging-Patterns of Cognitive Aging were analyzed using multiple linear regression. Results: We found no main effects of receiving or providing social support on global cognition. Main effects for receiving or providing social support on memory were detected. Further, a significant moderation effect was observed for memory, such that received social support was more strongly associated with higher working memory among less-educated individuals than those with high levels of education, adjusting for age, sex, marital status, chronic conditions, and depressive symptoms. Discussion: Study findings demonstrate that social support and education have joint effects on memory outcomes, highlighting the importance of considering psychosocial protective factors that might alleviate, reduce, or even eliminate cognitive health disparities in African Americans.

[Adverse childhood experiences, sociodemographic characteristics, and depressive symptoms in adolescents in a municipality in Rio de Janeiro, Brazil]

The study aimed to identify patterns in adverse childhood experiences among teenage schoolchildren in a municipality (county) in Rio de Janeiro State, Brazil, according to sociodemographic characteristics (sex, skin color, and socioeconomic status) and depressive symptoms. It adopted a cross-sectional design with a sample of 1,117 teenage schoolchildren 13 to 19 years of age in São Gonçalo, Rio de Janeiro State. Depression was assessed with the Childhood Depression Inventory, and adverse childhood experiences were investigated. The study used bivariate analyses and multiple correspondence analysis (MCA) of adverse childhood experiences, sociodemographic variables (sex, skin color, socioeconomic status), and depressive symptoms. The results reveal the organization of eight groups: lower-income female children and adolescents and adverse childhood experiences related to the environment; boys, with higher socioeconomic status, and not having experienced adverse childhood experiences; adolescents with depressive symptoms and adverse childhood experiences against themselves or their families; white adolescents, with depressive symptoms, and that had not experienced adverse childhood experiences; black, brown, Asian-descendant, and indigenous adolescents that had adverse experiences in the family and community; adolescents that had lost their father and/or mother from death, and lack of food at home; adolescents that had experienced psychological violence; and adolescents with a history of sexual experiences involving their parents. The findings call attention to the need for close and early attention to exposure to adverse childhood experiences to care for these youngsters, intervene, and mitigate the negative effects both at present, over the course of life, and in future generations.

Sex Differences in Comorbidity Combinations in the Swedish Population

High comorbidity rates, especially mental–physical comorbidity, constitute an increasing health care burden, with women and men being differentially affected. To gain an overview of comorbidity rates stratified by sex across a range of different conditions, this study examines comorbidity patterns within and between cardiovascular, pulmonary, skin, endocrine, digestive, urogenital, musculoskeletal, neurological diseases, and psychiatric conditions. Self-report data from the LifeGene cohort of 31,825 participants from the general Swedish population (62.5% female, 18–84 years) were analyzed. Pairwise comorbidity rates of 54 self-reported conditions in women and men and adjusted odds ratios (ORs) for their comparison were calculated. Overall, the rate of pairwise disease combinations with significant comorbidity was higher in women than men (14.36% vs. 9.40%). Among psychiatric conditions, this rate was considerably high, with 41.76% in women and 39.01% in men. The highest percentages of elevated mental–physical comorbidity in women were found for musculoskeletal diseases (21.43%), digestive diseases (20.71%), and skin diseases (13.39%); in men, for musculoskeletal diseases (14.29%), neurological diseases (11.22%), and digestive diseases (10%). Implications include the need for integrating mental and physical health care services and a shift from a disease-centered to an individualized, patient-centered focus in clinical care.

Neighborhood disadvantage and biological aging biomarkers among breast cancer patients

Living in a disadvantaged neighborhood is associated with adverse clinical outcomes among breast cancer patients, but the underlying pathway is still unclear. Limited evidence has suggested that accelerated biological aging may play an important role. In this study, using a sub-sample of 906 women with newly diagnosed breast cancer at M.D. Anderson, we examined whether levels of selected markers of biological aging (e.g., allostatic load, telomere length, and global DNA methylation) were affected by neighborhood disadvantage. The Area Deprivation Index was used to determine the neighborhood disadvantage. Based on the median ADI at the national level, the study population was divided into low and high ADI groups. Overall, breast cancer patients from the high ADI group were more likely to be younger and non-Hispanic Black than those from the low ADI group (P < 0.001, respectively). They were also more likely to have higher grade and poorly differentiated breast tumors (P = 0.029 and 0.019, respectively). For the relationship with markers, compared to the low ADI group, high ADI group had higher median levels of allostatic load (P = 0.046) and lower median levels of global DNA methylation (P < 0.001). Compared to their counterparts, those from the high ADI group were 20% more likely to have increased allostatic load and 51% less likely to have increased levels of global DNA methylation. In summary, we observed that levels of allostatic load and global DNA methylation are influenced by neighborhood disadvantage among breast cancer patients.

Establishing a Framework for Gathering Structural and Social Determinants of Health in Alzheimer's Disease Research Centers

Structural and social determinants of health (SSDoH) are environmental conditions in which individuals are born, live, learn, work, play, worship, and age that affect health, functioning, and quality-of-life outcomes across the life course. Growing evidence suggests that SSDoH can help to explain heterogeneity in outcomes in Alzheimer's disease and Alzheimer's disease and related dementias (AD/ADRD) research and clinical practice. The National Institute on Aging has prioritized collecting SSDoH data to elucidate disease mechanisms and aid discovery of disease-modifying treatments. However, a major nexus of AD/ADRD research, the national network of Alzheimer's Disease Research Centers (ADRCs), collects few SSDoH data. We describe a framework for feasibly gathering and modeling SSDoH data across ADRCs. We lay out key constructs, their measures, and empirical evidence for their importance in elucidating disease and prevention mechanisms. Toward a goal of translation, the framework proposes a modular structure with a core set of measures and options for adjunctive modules. We describe considerations for measuring SSDoH in existing geographically and culturally diverse research cohorts. We also outline a rationale for universal implementation of a set of SSDoH measures and juxtapose the approach with alternatives aimed at collecting SSDoH data.

Associations among stress and language and socioemotional development in a low-income sample

Stress has been linked with children's socioemotional problems and lower language scores, particularly among children raised in socioeconomically disadvantaged circumstances. Much of the work examining the relations among stress, language, and socioemotional functioning have relied on assessments of a single dimension of maternal stress. However, stress can stem from different sources, and people may appraise stressors differently. Taking a dimensional approach, this manuscript characterizes stress in multiple ways: as an overall composite; across the constructs of psychological appraisal vs. environmental stressors; and the independent contributions of a variety assessments. Data are from 548 mother-infant dyads (M = 13.14 months, SD = 2.11) who served as the control group for a poverty reduction clinical trial. Mothers completed questionnaires regarding the different types of stresses they may have experienced, as well as their children's language and socioemotional development. Results indicate that, collectively, higher maternal report of stress is associated with lower reports of children's socioemotional and language development. In addition, maternal psychological appraisals of stress were associated with both socioemotional and language development, whereas reports of environmental stressors were only associated with socioemotional development. Together, these findings suggest that maternal reports of stress are associated with lower maternal report of child development among low-income children.

Optimism as a protective factor against the psychological impact of COVID-19 pandemic through its effects on perceived stress and infection stress anticipation

The 2019 coronavirus disease (COVID-19) and the recommended social isolation presented a challenge to people's mental health status. Optimism is a psychological factor that plays a key role in the evaluation of stressful situations. The purpose of this study was to investigate the mediating role of perceived stress and Covid-19-related stress anticipation in the relationship between optimism and post-traumatic stress symptoms. Our sample included 1015 participants ranging in age from 18 to 79 years, 80% of whom were Spaniards. At the beginning of the worldwide pandemic, participants were confined to their homes for at least seven days and completed an online survey measuring various sociodemographic and psychological variables. We found an indirect effect of optimism on intrusion and hyperarousal through perceived stress and stress anticipation. In addition, we observed an indirect effect of optimism on avoidance through perceived stress. Finally, the results showed a significant indirect effect of optimism on the total post-traumatic stress symptoms score through perceived stress and stress anticipation. Our results indicate that positive beliefs inherent to optimism are related to less psychological impact of the COVID-19 outbreak.

Individual, community, and structural factors associated with linkage to HIV care among people diagnosed with HIV in Tennessee

OBJECTIVE

We assessed trends and identified individual- and county-level factors associated with individual linkage to HIV care in Tennessee (TN).

METHODS

TN residents diagnosed with HIV from 2012-2016 were included in the analysis (n = 3,751). Individuals were assigned county-level factors based on county of residence at the time of diagnosis. Linkage was defined by the first CD4 or HIV RNA test date after HIV diagnosis. We used modified Poisson regression to estimate probability of 30-day linkage to care at the individual-level and the contribution of individual and county-level factors to this outcome.

RESULTS

Both MSM (aRR 1.23, 95%CI 0.98-1.55) and women who reported heterosexual sex risk factors (aRR 1.39, 95%CI 1.18-1.65) were more likely to link to care within 30-days than heterosexual males. Non-Hispanic Black individuals had poorer linkage than White individuals (aRR 0.77, 95%CI 0.71-0.83). County-level mentally unhealthy days were negatively associated with linkage (aRR 0.63, 95%CI: 0.40-0.99).

CONCLUSIONS

Racial disparities in linkage to care persist at both individual and county levels, even when adjusting for county-level social determinants of health. These findings suggest a need for structural interventions to address both structural racism and mental health needs to improve linkage to care and minimize racial disparities in HIV outcomes.

Are stress-related pathways of social status differentiation more important determinants of health inequities in countries with higher levels of income inequality?

We explored socioeconomic gradients in self-rated overall health (SROH) using indicators of materialist (educational attainment and perceived income adequacy) and psychosocial perspectives (subjective social status (SSS)) among adults living in countries with varying levels of income inequality, and the importance of psychosocial stress in mediating these associations. If psychosocial processes at the individual and societal levels correspond, associations between SSS and SROH should be higher among adults in countries with higher income inequality, and psychosocial stress should be a more important mediator of these associations. We used multigroup structural equation models to analyse cross-sectional data from the International Food Policy Study of adults (n = 22,824) in Australia, Canada, Mexico, the UK and the United States. Associations between SSS and SROH were not higher in more unequal countries, nor was psychosocial stress a more important mediator of these associations. Inequities in SROH in more unequal countries may not predominantly reflect stress-related pathways of social status differentiation.

Subjective Socioeconomic Status, Cognitive Abilities, and Personal Control: Associations With Health Behaviours

Objective

To examine subjective and objective socioeconomic status (SSES and OSES, respectively) as predictors, cognitive abilities as confounders, and personal control perceptions as mediators of health behaviours.

Design

A cross-sectional study including 197 participants aged 30–50 years, recruited from the crowd-working platform, Prolific.

Main Outcome Measure

The Good Health Practices Scale, a 16-item inventory of health behaviours.

Results

SSES was the most important predictor of health behaviours (beta = 0.19, p &lt; 0.01). Among the OSES indicators, education (beta = 0.16, p &lt; 0.05), but not income, predicted health behaviours. Intelligence (r = −0.16, p &lt; 0.05) and memory (r = −0.22, p &lt; 0.01) were negatively correlated with health-promoting behaviours, and the effect of memory was upheld in the multivariate model (beta = −0.17, p &lt; 0.05). Personal control perceptions (mastery and constraints) did not act as mediators.

Conclusion

SSES predicted health behaviours beyond OSES. The effect of socioeconomic indicators was not confounded by cognitive abilities. Surprisingly, cognitive abilities were negatively associated with health-promoting behaviours. Future research should emphasise SSES as a predictor of health behaviours. Delineating the psychological mechanisms linking SSES with health behaviours would be a valuable contribution toward improved understanding of socioeconomic disparities in health behaviours.

Assessing the Determinants of Quality of Life and the Impact on HIV Prevention Measures among HIV-Negative and Status-Unknown Young Men Who Have Sex with Men: A Study in Two U.S. Metropolitan Areas

Young men who have sex with men (YMSM) in the United States (U.S.) are disproportionally burdened by HIV and experience adverse social determinants of health. Minimal research has examined quality of life (QoL) and psychosocial/behavioral determinants among HIV-negative or status-unknown YMSM. We conducted a study with YMSM from two U.S. cities to assess their QoL scores, and whether specific QoL domains (e.g., physical, psychological, social, and environment) were associated with their demographics, psychosocial determinants, behavioral risk factors, and HIV prevention measures. Black YMSM, YMSM of low socioeconomic status (below high school education, income < $20,000, and lack of health insurance), and YMSM who did not disclose their sexual orientation had the lowest QoL scores across all domains. Substance use and unprotected anal intercourse were negatively associated with men’s physical/psychosocial health. Housing/food instability and perceived stress were among the strongest predictors of lower QoL in all domains. Higher physical/psychological and environment QoL scores were associated with a higher likelihood of HIV testing and PrEP use. The identification of YMSM within these demographic, behavioral, and psychosocial sub-groups is important for targeted intervention to enhance their well-being and engagement with HIV prevention.

Validation of the Beirut Distress Scale (BDS-10), a short version of BDS-22, to assess psychological distress among the Lebanese population

PURPOSE

To develop and validate a short version of the Beirut Distress Scale (BDS-22), the BDS-10, in the Lebanese population, and evaluate the association between psychological distress and other mental disorders.

METHODS

A total of 2260 participants was enrolled in this cross-sectional study (January-July 2019).

RESULTS

Items converged over a solution of two factors (Factor 1 = Mood, affect and cognitive symptoms; Factor 2 = Physical symptoms; total variance explained = 64.51%). A significantly high correlation was found between BDS-10 and BDS-22 (r = 0.963, p < 0.001). Higher depression, anxiety, and insomnia were significantly associated with higher stress (higher BDS-10 and BDS-22 scores).

PRACTICE IMPLICATIONS

This new short tool is valid and reliable to screen for psychological distress, influencing mood and affect, and physical and cognitive functions.

Stress, depression, sleep problems and unmet social needs: Baseline characteristics of low-income smokers in a randomized cessation trial

BACKGROUND

Low-income Americans smoke cigarettes at higher rates and quit less than other groups.

METHODS

To increase their engagement in and success using evidence-based cessation methods, we tested two interventions using a 2x2 randomized factorial design: (1) telephone navigation to reduce financial strain and address social needs such as food, rent and utility payment; and (2) a specialized tobacco quitline designed for low-income smokers. From June 2017 to November 2020, we enrolled 1,944 low-income smokers in Missouri, USA, recruited through the Missouri 2-1-1 helpline, into the trial. This paper describes recruitment, key characteristics and life circumstances of this high-risk population.

RESULTS

After eligibility screening, 1,944 participants completed baseline and were randomized. Participants were racially diverse (58% African American), poor (51% < $10,000 annual pre-tax household income) and many reported less than high school education (30%). They reported a mean of 2.5 unmet social needs, especially childcare and paying bills, had high rates of stress, depressive symptoms and sleep problems, and most were in fair or poor health. There were few differences between these variables, and no differences between tobacco use and cessation variables, across the four study groups and between participants recruited pre and during the COVID-19 pandemic.

CONCLUSIONS

Trial recruitment through the 2-1-1 helpline is feasible for reaching a population of low-income smokers. Low-income smokers face myriad daily challenges beyond quitting smoking. Cessation interventions need to account for and address these life circumstances.

TRIAL REGISTRATION

Clinicaltrials.gov NCT03194958.

Family's Subjective Economic Status and Children's Matrix Reasoning: Blacks' Diminished Returns

BACKGROUND

Due to a pattern known as Marginalization-related Diminished Returns (MDRs), historically oppressed non-Hispanic Black Americans show weaker effects of economic status on health and development, when compared to socially privileged non-Hispanic White Americans. Such MDRs are also documented for the effects of economic status on the school performance of non-Hispanic Black children. However, the existing knowledge is minimal on similar diminished returns on children's intelligence.

AIM

To compare racial and ethnic groups for the effect of subjective economic status on children's cognitive performance, we compared non-Hispanic White and non-Hispanic Black children for the effects of subjective economic status on children's matrix reasoning.

METHODS

This cross-sectional study included 7898 children from the Adolescent Brain Cognitive Development (ABCD) study. The predictor variable was subjective economic status, which was treated as a continuous measure. The primary outcome was children's matrix reasoning, a domain of cognitive performance, measured by the Wechsler Intelligence Scales for Children-IV (WISC-V) matrix reasoning total score.

RESULTS

Overall, high subjective economic status was associated with higher matrix reasoning score. Race showed a statistically significant interaction with subjective economic status on children's matrix reasoning score. This interaction suggested that high subjective economic status has a smaller boosting effect on increasing matrix reasoning score for non-Hispanic Black children relative to non-Hispanic White children.

CONCLUSION

The degree by which subjective economic status correlates with matrix reasoning score, an important domain of cognitive performance, depends on race and racialization. Non-Hispanic Black children may show weaker gains in matrix reasoning from their subjective economic status than their non-Hispanic White counterparts. To minimize the racial gap in cognitive performance, we need to address diminished returns that occur as a result of the racialization of racial and ethnic minority children. Not only should we equalize economic status, but also increase the marginal returns of economic status for racial minorities, particularly non-Hispanic Black families. Such efforts require public policies that go beyond access and also consider how we can empower non-Hispanic Black communities and families so they can more effectively leverage and utilize their economic resources to secure measurable and tangible outcomes. Structural and societal barriers such as residential and school segregation may hinder non-Hispanic Black children from receiving the full effects of their family-level economic status on a variety of outcomes, including their cognitive performance.

Income disparity and utilization of cardiovascular preventive care services among U.S. adults

•

Low income individuals are less likely to receive smoking cessation counseling.

•

Low income individuals are less likely to have their blood pressure checked.

•

Low income individuals are less likely to be receive exercise counseling.

•

Low income individuals are less likely to receive dietary counseling.

•

Low income individuals are less likely to have their cholesterol levels checked.

Objective

: Associations between income disparity and utilization of cardiovascular disease (CVD) preventive care services, such as receipt of lifestyle advice and screening for CVD risk factors in populations with and without CVD, are not well understood. The purpose of this study was to evaluate associations between income and utilization of CVD-preventive services among U.S. adults.

Methods

: We included adults ≥18 years with and without CVD from the 2006 to 2015 Medical Expenditure Panel Survey. We categorized participants as high-income (>400% of federal poverty level [FPL]), middle income (200–400% of FPL), low-income (125–200% of FPL) and very low (VL)-income (<125% of FPL). We used logistic regression to compare the likelihood of receiving CVD-preventive services by income strata, adjusting for sociodemographic factors and comorbidities.

Results

: The study included 185,081 participants (representing 194.6 million U.S. adults) without CVD, and 32,862 participants (representing 37 million U.S. adults) with CVD. VL-income adults without CVD were less likely than high-income adults to have blood pressure measured within past 2 years [odds ratio [OR] 0.41 (95% confidence interval [CI] 0.37–0.45)] or cholesterol levels checked within past 5 years [0.36 (0.33–0.38)] or receive counseling about diet modifications [0.77 (0.74–0.81)], exercise [0.81 (0.77–0.85)], or smoking cessation [0.71 (0.63–0.79)] within past year. VL-income adults with CVD were also less likely to have blood pressure [0.32 (0.22–0.46)] or cholesterol [0.33 (0.26–0.42)] checked and receive counseling about exercise [0.84 (0.76–0.93)] or smoking cessation [0.78 (0.61–0.99)]. Additional subgroup analyses restricted to participants who had seen a healthcare provider within the preceding 12 months, as well as secondary analyses stratified by sex, race and ethnicity, showed similar disparities between high-income and VL-income participants.

Conclusions

: VL-income adults were less likely to be screened for CVD risk factors or receive CVD-prevention counseling than high-income adults, regardless of CVD status. More work must be done to reduce disparities in access to and utilization of CVD-preventive services among adults in different income groups.

Evaluating the Effect of Parent-Child Interactive Groups in a School-Based Parent Training Program: Parenting Behavior, Parenting Stress and Sense of Competence

The Exploring Together program is a group-based parent training program that comprises separate parent, child, and teacher components, and a combined parent-child interactive component. A cluster-randomized trial design was used to compare the Exploring Together program with (Exploring Together; ET) and without (Exploring Together-Adapted; ET-Adapted) the parent-child interactive component. One hundred and thirty-six parents and their children (aged 5-10 years) with externalizing and/or internalizing problems participated in the trial, recruited from primary schools. There was a significant reduction in negative parenting behavior across both treatment groups (ET and ET-Adapted) but no significant improvement in positive parenting behaviors. Parenting self-efficacy improved significantly across both treatment groups however there was no significant change in parenting satisfaction or parenting stress. There was no consistent evidence of superiority of one version of the Exploring Together program over the other. Further investigation regarding treatment dosage and mastery of parenting skills associated with the program is warranted.

The School-Ladder Effect: Subjective Socioeconomic Status and Diurnal Cortisol Profile Among Adolescents

OBJECTIVE

Subjective socioeconomic status (SES) is a well-established psychosocial determinant of adolescents' self-report health. However, whether low subjective SES is associated with stress-related physiological risks (e.g., dysregulations in the hypothalamic-pituitary-adrenal axis activity) remains uncertain. This study examined the impact of subjective SES with different reference groups (i.e., perception of family SES relative to other students in the school versus other people in the city) on adolescents' diurnal cortisol profiles.

METHODS

A sample of 255 adolescents (aged 11-14 years; 53.7% boys) completed a battery of psychological scales, including school-referenced subjective SES and city-referenced subjective SES. Diurnal cortisol was assessed by collecting saliva samples four times a day across two consecutive days. Four cortisol parameters (cortisol at awakening, cortisol awakening response [CAR], cortisol slope, and total cortisol secretion [area under the curve with respect to ground {AUCg}]) were derived.

RESULTS

Higher levels of school-referenced subjective SES were associated with higher cortisol levels at awakening (β = 0.0483, standard error [SE] = 0.0219, p = .028), steeper cortisol slopes (β = -0.0036, SE = 0.0017, p = .034), and higher cortisol AUCg (b = 0.50, SE = 0.24, p = .036), but not with CAR (p = .77), after adjusting for covariates. In contrast, city-referenced subjective SES was not associated with any of the cortisol parameters (cortisol at awakening [p = .90], CAR [p = .74], cortisol slope [p = .84], and cortisol AUCg [p = .68]).

CONCLUSIONS

Our findings highlight the importance of the reference group for subjective SES and provide a further understanding of socioeconomic disparities in adolescents' stress physiology.

Stress-Related Poor Diet Quality Does Not Explain Socioeconomic Inequities in Health: A Structural Equation Mediation Analysis of Gender-Specific Pathways

BACKGROUND

Psychosocial stress and diet quality individually mediate associations between socioeconomic position (SEP) and health; however, it is not known whether they jointly mediate these associations. This is an important question because stress-related unhealthy eating is often invoked as an explanation for diet-related health inequities, particularly among women, seemingly with no empirical justification.

OBJECTIVE

This study examined whether psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women and men.

DESIGN

Multiple mediating pathways were modeled using data from the cross-sectional International Food Policy Study.

PARTICIPANTS AND SETTING

Data were collected from 5,645 adults (aged 18 years or older) in Canada during 2018 and 2019.

MAIN OUTCOME MEASURES

Participants reported SEP using indicators of materialist (educational attainment and perceived income adequacy) and psychosocial pathways (subjective social status), along with psychosocial stress, dietary intake (to assess overall diet quality via Healthy Eating Index-2015 scores), and self-rated health.

STATISTICAL ANALYSES PERFORMED

Structural equation modeling modeled pathways linking SEP (ie, educational attainment, perceived income adequacy, and subjective social status) with self-rated health mediated by psychosocial stress and diet quality, stratified by gender.

RESULTS

There was no evidence that psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women or men. Diet quality mediated associations between educational attainment and self-rated health in women and men, with some evidence that it mediated associations between subjective social status and self-rated health in men (P = 0.051). Psychosocial stress mediated associations between perceived income adequacy and self-rated health in women and men, and between subjective social status and self-rated health in women.

CONCLUSIONS

Although often invoked as an explanation for diet-related health inequities, stress-related poor diet quality did not mediate associations between SEP and self-rated health in women or men. Psychosocial stress and diet quality individually mediated some of these associations, with some differences by gender.

Health-Related Quality of Life (HRQoL) Outcomes Following Injury in Childhood and Adolescence Using EuroQol (EQ-5D) Responses with Pooled Longitudinal Data

BACKGROUND

Injury is a leading contributor to the global disease burden in children, affecting their health-related quality of life (HRQoL)-yet valid estimates of burden are absent.

METHODS

This study pooled longitudinal data from five cohort studies of pediatric injury survivors (5-17 years) at baseline, 1-, 4-, 6-, 12-, and 24- months (n = 2334). HRQoL post-injury was measured using the 3-level EQ-5D utility score (EQ-5D) and five health states (mobility, self-care, activity, pain, anxiety and depression (anxiety)).

RESULTS

Mean EQ-5D post-injury did not return to baseline level (0.95) by 24 months (0.88) and was lower for females over time (-0.04, 95%CI -0.05, -0.02). A decreased adjusted risk ratio over time (ARR) was observed for intentional injuries (pain: 0.85, 95%CI 0.73,0.98; anxiety: 0.62, 95%CI 0.49,0.78); spinal cord injuries (mobility: 0.61, 95%CI 0.45,0.83), self-care: 0.76, 95%CI 0.63,0.91, activity: 0.64, 95%CI 0.47,0.88); moderate/severe traumatic brain injury (activity: 0.83, 95%CI 0.71,0.96). ARRs were also low for certain fractures, with various health states affected.

CONCLUSIONS

HRQoL outcomes over time for children and adolescents post-injury differed across key demographic and injury related attributes. HRQoL did not reach levels consistent with full health by 24 months with recovery plateauing from 6 to 24 months. Tailored interventions are required to respond to the varying post-injury recovery trajectories in this population.

Increased income over time predicts better self-perceived mental health only at a population level but not for individual changes: An analysis of a longitudinal cohort using cross-lagged models

BACKGROUND

The literature identifies a strong relationship between mental health and income, but there is little research that clarifies the directional association between household income and self-perceived mental health (SPMH) overtime either at between-perso+n or within-person levels. This study investigates whether higher income predicts better SPMH overtime and poor SPMH predicts lower income overtime both at between-person or within-person levels.

METHODS

Data analyzed was from the Montreal Southwest Social and Psychiatric Epidemiology Catchment Area study (ZEPSOM), a longitudinal community-based cohort. The baseline survey was conducted in 2007/8 with follow-up every two years. We traced a total of 3464 participants over a period of 8 years. To examine the associations between income and SPMH at both between-person or within-person levels, cross-lagged panel models (CLPMs) and random intercept cross-lagged panel models (RI-CLPMs) were used. Gender and age effects were examined using multiple group analyses. Complete case analyses evaluated the findings' robustness.

RESULTS

At between-person levels, higher household income predicted higher SPMH, but not vice versa. These associations were stronger among men and older adults. At within-person levels, higher income did not predict higher SPMH. No significant gender- or age- group differences were observed. Complete case analyses supported the findings.

LIMITATIONS

Loss to follow-up may affect the generalizability of the research findings.

CONCLUSIONS

This study suggests that higher household income predicts higher SPMH at between-person levels. Policy and programs aiming at promoting mental health should focus on low-income individuals, especially men and older adults.

Black-White racial health disparities in inflammation and physical health: Cumulative stress, social isolation, and health behaviors

Black Americans have vastly increased odds and earlier onsets of stress- and age-related disease compared to White Americans. However, what contributes to these racial health disparities remains poorly understood. Using a sample of 1577 older adults (32.7% Black; ages 55-65 at baseline), we examined whether stress, health behaviors, social isolation, and inflammation are associated with racial disparities in self-reported physical health. A latent cumulative stress factor and unique stress-domain specific factors were modeled by applying bifactor confirmatory analysis to assessments across the lifespan (i.e., childhood maltreatment, trauma exposure, discrimination, stressful life events, and indices of socioeconomic status). Physical health, health behavior, and social isolation were assessed using self-report. Interleukin-6 (IL-6) and C-reactive protein (CRP) were assayed from morning fasting serum samples; a z-scored inflammation index was formed across these 2 cytokines. A parallel serial mediational model tested whether race (i.e., Black/White) is indirectly associated with health through the following 3 independent pathways: (1) cumulative stress to preventative health behaviors (e.g., healthy eating) to inflammation, (2) cumulative stress to risky health behaviors (e.g., substance use) to inflammation; and (3) cumulative stress to social isolation to inflammation. There were significant indirect effects between race and self-reported physical health through cumulative stress, preventative health behaviors, and inflammation (B = -0.02, 95% CI: -0.05, -0.01). Specifically, Black Americans were exposed to greater cumulative stress, which was associated with reduced engagement in preventative health behaviors, which was, in turn, associated with greater inflammation and reduced physical health. A unique SES factor also indirectly linked race to physical health through preventative health behaviors. Cumulative stress exposure and unique aspects of socioeconomic status are indirectly associated with Black-White racial health disparities through behavioral (i.e., preventative health behavior) and biological (i.e., inflammation) factors. Culturally responsive evidence-based interventions that enhance engagement in preventative health behaviors are needed to directly confront health disparities. Ultimately, large scale anti-racist public policies that reduce cumulative stress burden (e.g., a living wage, universal healthcare) may best attenuate racial health disparities.

Parents' Perceived Neighborhood Safety and Children's Cognitive Performance: Complexities by Race, Ethnicity, and Cognitive Domain

BACKGROUND AIM

To examine racial/ethnic variations in the effect of parents' subjective neighborhood safety on children's cognitive performance.

METHODS

This cross-sectional study included 10,027 children from the Adolescent Brain Cognitive Development (ABCD) study. The exposure variable was parents' subjective neighborhood safety. The outcomes were three domains of children's cognitive performance: general cognitive performance, executive functioning, and learning/memory. We used mixed-effects regression models for data analysis.

RESULTS

Overall, parents' subjective neighborhood safety was positively associated with children's executive functioning, but not general cognitive performance or learning/memory. Higher parents' subjective neighborhood safety had a more positive influence on the executive functioning of non-Hispanic White than Asian American children. Higher parents' subjective neighborhood safety was associated with higher general cognitive performance and learning/memory for non-White children relative to non-Hispanic White children.

CONCLUSION

The race/ethnicity of children moderates the association between neighborhood safety and cognitive performance. This becomes more complicated, as the patterns seem to differ across race/ethnicity and cognitive domains. It is unknown whether the observed racial/ethnic variations in the effect of neighborhood safety on cognitive performance are due to neighborhood characteristics such as residential segregation. Addressing neighborhood inequalities is needed if we wish to reduce racial/ethnic inequities in the cognitive development of children.

Financial difficulties and patient-reported outcomes among patients with advanced heart failure

PURPOSE

Management of congestive heart failure (CHF) is associated with high health care costs and financial difficulties for patients. We aimed to comprehensively assess the association between financial difficulties and patients' quality of life (QOL) (physical, emotional, social and spiritual), perceived health care quality, and perception of being a burden to the family among patients with CHF; and to assess whether perceived control over stress moderated these associations.

METHODS

This was a cross-sectional study of 250 patients using the baseline data of the Singapore Cohort of Patients with Advanced Heart Failure (SCOPAH). Patients had class 3 or 4 CHF symptoms based on the New York Heart Association and were recruited between July 2017 and August 2019. We used a 3-item questionnaire to measure financial difficulties among patients. We used multivariable linear/ordered logistic regressions to test associations between financial difficulties and each dependent variable.

RESULTS

41% of participants reported financial difficulties. A higher financial difficulties score (range: 0-6, higher score indicating greater difficulty) was associated with lower QOL (emotional, social, and spiritual) and perceived health care coordination, and a higher likelihood of patients perceiving themselves to being a burden to family (all p < 0.05) CONCLUSION: Patients with financial difficulties are vulnerable to poor outcomes. Heart failure clinics should directly assess patients' financial difficulties to help guide treatment-related discussions and to identify patients vulnerable to poor QOL.

Problematic social media use and mental health (depression, anxiety, and insomnia) among Lebanese adults: Any mediating effect of stress?

PURPOSE

To examine the association between problematic social media use with depression, anxiety, insomnia, and stress in a sample of young Lebanese adults.

METHODS

This cross-sectional study was achieved between January and May 2019; 466 out of 600 adults completed the questionnaire.

RESULTS

Higher problematic social media use was significantly associated with higher depression, anxiety, and insomnia, but not stress. Stress mediated the relation between depression, anxiety, insomnia, and problematic social media use.

PRACTICAL IMPLICATIONS

This study showed that problematic social media use was associated with psychological disorders. Additional research is needed to identify and describe the potential causality between the use of social media and various mental health issues and the interplay between the social media network and other mental health factors.

Parental Education and Left Lateral Orbitofrontal Cortical Activity during N-Back Task: An fMRI Study of American Adolescents

Introduction. The Orbitofrontal Cortex (OFC) is a cortical structure that has implications in cognition, memory, reward anticipation, outcome evaluation, decision making, and learning. As such, OFC activity correlates with these cognitive brain abilities. Despite research suggesting race and socioeconomic status (SES) indicators such as parental education may be associated with OFC activity, limited knowledge exists on multiplicative effects of race and parental education on OFC activity and associated cognitive ability. Purpose. Using functional brain imaging data from the Adolescent Brain Cognitive Development (ABCD) study, we tested the multiplicative effects of race and parental education on left lateral OFC activity during an N-Back task. In our study, we used a sociological rather than biological theory that conceptualizes race and SES as proxies of access to the opportunity structure and exposure to social adversities rather than innate and non-modifiable brain differences. We explored racial variation in the effect of parental educational attainment, a primary indicator of SES, on left lateral OFC activity during an N-Back task between Black and White 9–10 years old adolescents. Methods. The ABCD study is a national, landmark, multi-center brain imaging investigation of American adolescents. The total sample was 4290 9–10 years old Black or White adolescents. The independent variables were SES indicators, namely family income, parental education, and neighborhood income. The primary outcome was the average beta weight for N-Back (2 back versus 0 back contrast) in ASEG ROI left OFC activity, measured by functional Magnetic Resonance Imaging (fMRI) during an N-Back task. Ethnicity, age, sex, subjective SES, and family structure were the study covariates. For data analysis, we used linear regression models. Results. In White but not Black adolescents, parental education was associated with higher left lateral OFC activity during the N-Back task. In the pooled sample, we found a significant interaction between race and parental education on the outcome, suggesting that high parental education is associated with a larger increase in left OFC activity of White than Black adolescents. Conclusions. For American adolescents, race and SES jointly influence left lateral OFC activity correlated with cognition, memory, decision making, and learning. Given the central role of left lateral OFC activity in learning and memory, our finding calls for additional research on contextual factors that reduce the gain of SES for Black adolescents. Cognitive inequalities are not merely due to the additive effects of race and SES but also its multiplicative effects.

Socioeconomic Status and Health-Compromising Behaviour: Is it All About Perception?

Socioeconomic status (SES) is associated with many health issues and health-compromising behaviour (HCB). Most research is based on objective indicators of SES, even though subjective SES, someone’s perception of their social standing, is also related to health. Moreover, perceptions of health and HCB might also be of importance. Therefore, this study examined the relationship between both objective and subjective SES and perceived health and HCB respectively, and the role of perceptions of HCB. 326 respondents completed measures of objective and subjective SES, perceived health, HCB and perceptions of HCB. Results showed objective and subjective SES were related to perceived health. Only subjective SES was related to HCB, while for objective SES a moderating effect of perceiving HCB as typically high or low SES was found. Not only objective SES, but especially perceptions of SES and HCB are associated with someone feeling healthy and engaging in HCB. Health interventions should try to tackle perceptions of SES and HCB, either by invalidating current SES related perceptions or by emphasizing new healthy perceptions.

Socioeconomic position and quality of life among Colombian hypertensive patients: The mediating effect of perceived stress

This study aimed to assess the relationships between socioeconomic position, perceived stress and Health Related Quality of Life (HRQoL) of patients with hypertension. Data were obtained using the baseline survey of 258 patients from the Social Determinants and Inequities in the Control of Blood Hypertension Program (ProDSICHA). HRQoL was measured with SF-8 Health Survey. Socioeconomic position was measured using education, and the MacArthur Scale. Stress was measured with Perceived Stress Scale. A higher educational level was associated with a higher perception of stress (Coeff = 0.78, p = 0.019). Also, a lower position in the community was associated with a higher perception of stress (Coeff = −0.56, p = 0.027). A higher level of perceived stress was associated with a higher level of mental health (Coeff = 0.64, p = 0.000). No statistical differences were found in the relations between socioeconomic position and physical HRQoL. These findings warrant further research to understand the role of socioeconomic position in physical HRQoL.

Subjective Family Socioeconomic Status and Peer Relationships: Mediating Roles of Self-Esteem and Perceived Stress

This study explored the relationships between subjective family socioeconomic status (FSES), self-esteem, perceived stress, and perceived peer relationships among Chinese adolescents. A total of 1,353 adolescents (age range: 15-19 years) were asked to complete a questionnaire. Mediation analysis revealed that subjective FSES influenced perceived peer relationships in three ways: first, through the mediating effect of perceived stress; second, through the mediating effect of self-esteem; and third, through the serial mediating effects of perceived stress and self-esteem. The results remained significant after controlling for parental education. In addition, a contrast analysis showed no significant differences in the mediating effects of self-esteem and perceived stress. Thus, we suggest that steps should be taken to improve adolescents' self-esteem and reduce their stress through training interventions and preventive measures, to help them improve their perceived peer relationships and reduce adverse effects associated with low subjective FSES.

Household Income and Children's Depressive Symptoms: Immigrants' Diminished Returns

Introduction

Relative to socially privileged groups, socially marginalized people experience weaker health effects of household income and other economic resources, a pattern known as Minorities' Diminished Returns (MDRs). These MDRs are frequently seen in racial and ethnic minorities, but less is known about the relevance of such MDRs in immigrant families. To investigate the MDRs of household income on children's depression as a function of immigration, we compared non-immigrant and immigrant children for the effect of household income on children's depressive symptoms.

Methods

This cross-sectional study was conducted across multiple cities in the United States. Baseline data from the Adolescent Brain Cognitive Development (ABCD) study collected in 2018 was used. A total of 6,412 children between the ages of 9-10-year-old were included. The predictor variable was household income. The primary outcome was children's depression measured by the Child Behavior Checklist (CBCL). Race, ethnicity, age, sex, parental marital status, parental employment, and financial difficulties were the covariates. Immigration status was the effect modifier.

Results

Overall, high household income was associated with lower children's depressive symptoms. Immigration status showed a statistically significant interaction with household income on children's depression. This interaction term suggested that high household income has a smaller protective effect against depression for immigrant children than non-immigrant children.

Conclusion

The protective effect of household income against children's depression is diminished for immigrant than non-immigrant children.

Association of Neighborhood Deprivation With Epigenetic Aging Using 4 Clock Metrics

IMPORTANCE

Neighborhood deprivation is associated with age-related disease, mortality, and reduced life expectancy. However, biological pathways underlying these associations are not well understood.

OBJECTIVE

To evaluate the association between neighborhood deprivation and epigenetic measures of age acceleration and genome-wide methylation.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used data from the Sister Study, a prospective cohort study comprising 50 884 women living in the US and Puerto Rico aged 35 to 74 years at enrollment who had a sister with breast cancer but had not had breast cancer themselves. Cohort enrollment occurred between July 2003 and March 2009. Participants completed a computer-assisted telephone interview on demographic, socioeconomic, lifestyle, and residential factors and provided anthropometric measures and peripheral blood samples at a home examination. DNA methylation data obtained for 2630 non-Hispanic White women selected for a case-cohort study in 2014 were used in this cross-sectional analysis. DNA methylation was measured using the HumanMethylation450 BeadChips in whole blood samples collected at baseline. Data analysis for this study was performed from October 17, 2019, to August 27, 2020.

EXPOSURES

Each participants' primary address was linked to an established index of neighborhood deprivation.

MAIN OUTCOMES AND MEASURES

Epigenetic age was estimated using 4 epigenetic clocks (Horvath, Hannum, PhenoAge, and GrimAge). Age acceleration was determined using residuals from regressing chronologic age on each of the 4 epigenetic age metrics. Linear regression was used to estimate associations between neighborhood deprivation and epigenetic age acceleration as well as DNA methylation at individual cytosine-guanine sites across the genome.

RESULTS

Mean (SD) age of the 2630 participants was 56.9 (8.7) years. Those with the greatest (>75th percentile) vs least (≤25th percentile) neighborhood deprivation had higher epigenetic age acceleration estimated by Hannum (β = 0.23; 95% CI, 0.01-0.45), PhenoAge (β = 0.28; 95% CI, 0.06-.50), and GrimAge (β = 0.37; 95% CI, 0.12-0.62). Increasing US quartiles of neighborhood deprivation exhibited a trend with Hannum, PhenoAge, and GrimAge. For example, GrimAge showed a significant dose-response (P test for trend <.001) as follows: level 2 vs level 1 (β = 0.30; 95% CI, 0.17-0.42), level 3 vs level 1 (β = 0.35; 95% CI, 0.19-0.50), and level 4 vs level 1 (β = 0.37; 95% CI, 0.12-0.62). Neighborhood deprivation was found to be associated with 3 cytosine-phosphate-guanine sites, with 1 of these annotated to a known gene MAOB (P = 9.71 × 10-08).

CONCLUSIONS AND RELEVANCE

The findings of this study suggest that residing in a neighborhood with a higher deprivation index appears to be reflected by methylation-based markers of aging.

Effects of physical activity and stress on the relationship between social capital and quality of life among breast cancer survivors

This study aims to investigate the serial multiple mediation of physical activity and perceived stress in the relationship between individual social capital and quality of life (QOL) in breast cancer survivors (BCSs). This study was conducted among 520 BCSs between March and April 2017 in Shanghai, China. Data were collected using the Individual Social Capital Scale, the Health-Promoting Lifestyle Profile-II, the Perceived Stress Scale-14 and the EORTC QLQ-C30. Ordinary least-squares regression and the bootstrap method was used to test the significance of the serial multiple mediation model. The serial-multiple mediations of physical activity and perceived stress were found significant in the relationship of QOL with all five dimensions of individual social capital. The separate mediations of two single mediating variables were found significant in the relationship of QOL with control over life and feeling about the community. In the relationship of QOL with social participation, social network and social support, the separate mediation of physical activity was significant, while the separate mediation of perceived stress was not significant. A multidisciplinary team approach and a variety of delivery systems are needed to address the social, physical and psychological issues for improving QOL among BCSs.

Parental Human Capital and Adolescents' Executive Function: Immigrants' Diminished Returns

Racial minorities, particularly non-Hispanic Blacks in the US, experience weaker effects of family socioeconomic position (SEP) on tangible outcomes, a pattern called Minorities' Diminished Returns (MDRs). These MDRs are frequently shown for the effects of family SEP on immigrant adolescents' school performance. As a result of these MDRs, immigrant adolescents from high SEP families show worse than expected cognitive outcomes, including but not limited to poor school performance. However, the existing knowledge is minimal about the role of executive function in explaining diminished returns of family SEP on adolescents' outcomes. To investigate racial differences in the effects of parental human capital on adolescents' executive function, we compared non-Hispanic White non-immigrant and immigrant adolescents for the effect of parental human capital on adolescents' executive function. This was a cross-sectional analysis that included 2,723 non-twin non-Hispanic White adolescents from the Adolescent Brain Cognitive Development (ABCD) study. The independent variable was parental human capital (parental educational attainment), treated as a continuous measure with a higher score reflecting higher subjective socioeconomic status. The primary outcome was adolescents' executive function measured by the stop-signal task (SST). Age, sex, parental marital status, parental employment, family income, and financial difficulties. Immigration status was the effect modifier. Overall, high parental human capital was associated with higher task-based executive function. Immigration status showed statistically significant interactions with parental human capital on adolescents' executive function outcomes. This interaction term suggested that high parental human capital has a smaller effect on increasing immigrants' executive function compared to non-immigrant adolescents. The boosting effect of parental human capital on executive function is diminished for immigrants compared to non-immigrant adolescents. To minimize the inequalities in executive function-related outcomes such as school performance, we need to address the diminishing returns of existing resources for immigrants. Not only should we equalize groups based on their SEP but also equalize the marginal returns of their existing SEP. Such efforts require public policies that aim for equal processes. As such, social policies should address structural and societal barriers such as xenophobia, segregation, racism, and discrimination that hinder immigrant families' ability to effectively utilize their resources. In a fair society, immigrant and non-immigrant families should be equally able to leverage their SEP resources and turn them into tangible outcomes.

Race, Socioeconomic Status, and Sex Hormones among Male and Female American Adolescents

Although early sexual initiation and childbearing are major barriers against the upward social mobility of American adolescents, particularly those who belong to a low socioeconomic status (SES) and racial minorities such as Blacks, less is known on how SES and race correlate with adolescents' sex hormones. An understanding of the associations between race and SES with adolescents' sex hormones may help better understand why racial, and SES gaps exist in sexual risk behaviors and teen pregnancies. To extend the existing knowledge on social patterning of adolescents' sex hormones, in the current study, we studied social patterning of sex hormones in a national sample of male and female American adolescents, with a particular interest in the role of race and SES. For this cross-sectional study, data came from the baseline data (wave 1) of the Adolescent Brain Cognitive Development (ABCD) study, a national longitudinal prospective study of American adolescents. This analysis included 717 male and 576 female non-Hispanic White or Black adolescents ages 9-10. The dependent variables were sex hormones (testosterone for males and estradiol for females). Independent variables were age, race, family marital status, parental education, and financial difficulties. For data analysis, linear regression models were used. Age, race, parental education, and financial difficulties were associated with estradiol in female and testosterone levels in male adolescents. Associations were not identical for males and females, but the patterns were mainly similar. Low SES explained why race is associated with higher estradiol in female adolescents. Marital status of the family did not correlate with any of the sex hormones. Being Black and low SES were associated with a higher level of sex hormones in male and female adolescents. This information may help us understand the social patterning of sexual initiation and childbearing. Addressing racial and economic inequalities in early puberty, sexual initiation, and childbearing is an essential part of closing the racial and economic gaps in the US.