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Coffman DL, Dziak JJ, Litson K, Chakraborti Y, Piper ME, Li R. A Causal Approach to Functional Mediation Analysis with Application to a Smoking Cessation Intervention. MULTIVARIATE BEHAVIORAL RESEARCH 2023; 58:859-876. [PMID: 36622859 PMCID: PMC10966971 DOI: 10.1080/00273171.2022.2149449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The increase in the use of mobile and wearable devices now allows dense assessment of mediating processes over time. For example, a pharmacological intervention may have an effect on smoking cessation via reductions in momentary withdrawal symptoms. We define and identify the causal direct and indirect effects in terms of potential outcomes on the mean difference and odds ratio scales, and present a method for estimating and testing the indirect effect of a randomized treatment on a distal binary variable as mediated by the nonparametric trajectory of an intensively measured longitudinal variable (e.g., from ecological momentary assessment). Coverage of a bootstrap test for the indirect effect is demonstrated via simulation. An empirical example is presented based on estimating later smoking abstinence from patterns of craving during smoking cessation treatment. We provide an R package, funmediation, available on CRAN at https://cran.r-project.org/web/packages/funmediation/index.html, to conveniently apply this technique. We conclude by discussing possible extensions to multiple mediators and directions for future research.
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Affiliation(s)
- Donna L Coffman
- Department of Epidemiology and Biostatistics, Temple University
| | - John J Dziak
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University
| | - Kaylee Litson
- Instructional Technology & Learning Sciences Department, Utah State University
| | | | - Megan E Piper
- Center for Tobacco Research Intervention, University of Wisconsin
| | - Runze Li
- Department of Statistics, The Pennsylvania State University
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Hobbs M, McLeod GFH, Mackenbach JD, Marek L, Wiki J, Deng B, Eggleton P, Boden JM, Bhubaneswor D, Campbell M, Horwood LJ. Change in the food environment and measured adiposity in adulthood in the Christchurch Health and development birth cohort, Aotearoa, New Zealand: A birth cohort study. Health Place 2023; 83:103078. [PMID: 37517383 DOI: 10.1016/j.healthplace.2023.103078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/11/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023]
Abstract
This study investigated associations between change in the food environment and change in measured body mass index (BMI) and waist circumference (WC) in the Christchurch Health and Development Study (CHDS) birth cohort. Our findings suggest that cohort members who experienced the greatest proportional change towards better access to fast food outlets had the slightly larger increases in BMI and WC. Contrastingly, cohort members who experienced the greatest proportional change towards shorter distance and better access to supermarkets had slightly smaller increases in BMI and WC. Our findings may help explain the changes in BMI and WC at a population level.
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Affiliation(s)
- Matthew Hobbs
- Faculty of Health, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; Te Taiwhenua o Te Hauora - GeoHealth Laboratory, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; The Cluster for Community and Urban Resilience (CURe), University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand.
| | - Geraldine F H McLeod
- Christchurch Health and Development Study, University of Otago - Te Whare Wānanga o Ōtākou, Christchurch, Canterbury, New Zealand
| | - Joreintje D Mackenbach
- Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije University, Amsterdam, the Netherlands; Upstream Team, www.upstreamteam.nl, Amsterdam UMC, Amsterdam, the Netherlands
| | - Lukas Marek
- Faculty of Health, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; Te Taiwhenua o Te Hauora - GeoHealth Laboratory, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand
| | - Jesse Wiki
- Te Taiwhenua o Te Hauora - GeoHealth Laboratory, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland - Waipapa Taumata Rau, Auckland, New Zealand
| | - Bingyu Deng
- Faculty of Health, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; Te Taiwhenua o Te Hauora - GeoHealth Laboratory, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand
| | - Phoebe Eggleton
- Faculty of Health, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; Te Taiwhenua o Te Hauora - GeoHealth Laboratory, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand
| | - Joseph M Boden
- Christchurch Health and Development Study, University of Otago - Te Whare Wānanga o Ōtākou, Christchurch, Canterbury, New Zealand
| | - Dhakal Bhubaneswor
- Christchurch Health and Development Study, University of Otago - Te Whare Wānanga o Ōtākou, Christchurch, Canterbury, New Zealand
| | - Malcolm Campbell
- Te Taiwhenua o Te Hauora - GeoHealth Laboratory, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand; School of Earth and Environment, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, Canterbury, New Zealand
| | - L John Horwood
- Christchurch Health and Development Study, University of Otago - Te Whare Wānanga o Ōtākou, Christchurch, Canterbury, New Zealand
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Norris T, Blodgett J, Rogers N, Hamer M, Pinto Pereira S. Obesity in early adulthood and physical functioning in mid-life: Investigating the mediating role of c-reactive protein. Brain Behav Immun 2022; 102:325-332. [PMID: 35301057 PMCID: PMC9048926 DOI: 10.1016/j.bbi.2022.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/07/2022] [Accepted: 03/12/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Obesity in adulthood is associated with reduced physical functioning (PF) at older ages. However, mechanisms underpinning this association are not well understood. We investigated whether and the extent to which C-reactive protein (CRP) mediates the association between early-adult obesity and mid-life PF. METHODS We used data from 8495 participants in the 1958 British birth cohort study. Body mass index (BMI), CRP and PF were measured at 33, 45 and 50y, respectively. Poor PF was defined as the lowest (sex-specific) 10% on the Short-form 36 Physical Functioning subscale. We accounted for prospectively measured confounders in early-life (e.g., social class at birth) and in mid-adulthood (e.g., 42y comorbidities). We decomposed the total effect of early-adult obesity on mid-life PF into direct and indirect (via CRP) effects, by employing a mediation analysis based on parametric g-computation. RESULTS The estimated total effect of obesity at 33y on poor PF at 50y, expressed as an odds ratio (OR), was 2.41 (95% CI: 1.89, 3.08). The direct effect of obesity on poor PF (i.e., not operating via CRP), was 1.97 (95% CI: 1.51, 2.56), with an indirect effect of 1.23 (95% CI: 1.10, 1.37). As such, the proportion of the total effect which was mediated by the effect of obesity on CRP at 45y, was 23.27% (95% CI: 8.64%, 37.90%). CONCLUSION Obesity in early-adulthood was associated with over twice the odds of poor PF in mid-life, with approximately 23% of the obesity effect operating via a downstream effect on CRP. As current younger generations are likely to spend greater proportions of their life course in older age and with obesity, both of which are associated with poor PF, there is an urgent need to identify mechanisms, and thus potential modifiable intermediaries, linking obesity to poor PF.
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Affiliation(s)
- T. Norris
- Institute of Sport, Exercise and Health, Division of Surgery and Interventional Science, Faculty of Medical Sciences, UCL, London, United Kingdom
| | - J.M. Blodgett
- Institute of Sport, Exercise and Health, Division of Surgery and Interventional Science, Faculty of Medical Sciences, UCL, London, United Kingdom
| | - N.T. Rogers
- Centre for Diet and Activity Research, MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - M. Hamer
- Institute of Sport, Exercise and Health, Division of Surgery and Interventional Science, Faculty of Medical Sciences, UCL, London, United Kingdom
| | - S.M. Pinto Pereira
- Institute of Sport, Exercise and Health, Division of Surgery and Interventional Science, Faculty of Medical Sciences, UCL, London, United Kingdom,Corresponding author at: Institute of Sport, Exercise and Health, Division of Surgery and Interventional Science, Faculty of Medical Sciences, UCL, London, United Kingdom.
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Feter N, Leite JS, Umpierre D, Caputo EL, Rombaldi AJ. Multimorbidity and leisure-time physical activity over the life course: a population-based birth cohort study. BMC Public Health 2021; 21:700. [PMID: 33836716 PMCID: PMC8033277 DOI: 10.1186/s12889-021-10719-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/28/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND We aimed to test which life course model best described the association between leisure-time physical activity (LTPA) and multimorbidity at age 55. We analyzed data from birth to age 55 using the database from the 1958 National Child Development Survey. METHODS Multimorbidity was considered as the presence of more than one chronic condition. LTPA was measured through questionnaires from 1965 (age 7) to 2013 (age 55), which were applied in eight different occasions. We compared the fit of a series of nested adjusted logistic regression models (representing either the critical, accumulation or sensitive period models) with a fully saturated model. Data were reported as odds ratio (OR) and 95% confidence interval (CI). RESULTS From an eligible sample of 15,613 cohort members, 9137 were interviewed in the latest sweep (58.5%). Men were more physically active than women at ages 11, 16, and 23 (p < 0.001). LTPA every day in the week was more frequent in women than men in ages 33, 42, and 50 (p < 0.001). The prevalence of multimorbidity at age 55 was 33.0% (n = 2778). The sensitive analysis revealed that LTPA during adolescence (OR: 0.83; 95% CI: 0.70, 0.98) and mid adult life (age 50 and 55; OR: 0.82; 95%CI: 0.69, 0.98) have a stronger effect on the risk for multimorbidity at age 55 considering all other life stages in the model. Also, adolescence showed a critical independent effect on the risk for multimorbidity (OR: 0.82; 95%CI: 0.70, 0.97). No difference was found between those models. CONCLUSIONS These data support the notion of a protective physical activity "legacy" at early ages of childhood against multimorbidity at older ages. We highlight the need for LTPA promotion through intervention tailored especially on schooling and older ages in order to reduce the burden of multimorbidity.
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Affiliation(s)
- Natan Feter
- Postgraduate Program in Physical Education, Universidade Federal de Pelotas, Rua Luís de Camões, 625, Pelotas, 96055630, Brazil.
- GEEAF - Physical Activity Epidemiology Research Group, Universidade Federal de Pelotas, Rua Luís de Camões, 625, Pelotas, 96055630, Brazil.
- Centre for Research on Exercise, Physical Activity and Health (CRExPAH), School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, 4067, Australia.
| | - Jayne S Leite
- Postgraduate Program in Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Daniel Umpierre
- Postgraduate Program in Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Health Technology Assessment Institute, Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Department of Public Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Eduardo L Caputo
- Postgraduate Program in Physical Education, Universidade Federal de Pelotas, Rua Luís de Camões, 625, Pelotas, 96055630, Brazil
- GEEAF - Physical Activity Epidemiology Research Group, Universidade Federal de Pelotas, Rua Luís de Camões, 625, Pelotas, 96055630, Brazil
| | - Airton J Rombaldi
- Postgraduate Program in Physical Education, Universidade Federal de Pelotas, Rua Luís de Camões, 625, Pelotas, 96055630, Brazil
- GEEAF - Physical Activity Epidemiology Research Group, Universidade Federal de Pelotas, Rua Luís de Camões, 625, Pelotas, 96055630, Brazil
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Bédard A, Li Z, Ait-hadad W, Camargo CA, Leynaert B, Pison C, Dumas O, Varraso R. The Role of Nutritional Factors in Asthma: Challenges and Opportunities for Epidemiological Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063013. [PMID: 33804200 PMCID: PMC7999662 DOI: 10.3390/ijerph18063013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 12/12/2022]
Abstract
The prevalence of asthma has nearly doubled over the last decades. Twentieth century changes in environmental and lifestyle factors, including changes in dietary habits, physical activity and the obesity epidemic, have been suggested to play a role in the increase of asthma prevalence and uncontrolled asthma worldwide. A large body of evidence has suggested that obesity is a likely risk factor for asthma, but mechanisms are still unclear. Regarding diet and physical activity, the literature remains inconclusive. Although the investigation of nutritional factors as a whole (i.e., the “diet, physical activity and body composition” triad) is highly relevant in terms of understanding underlying mechanisms, as well as designing effective public health interventions, their combined effects across the life course has not received a lot of attention. In this review, we discuss the state of the art regarding the role of nutritional factors in asthma, for each window of exposure. We focus on the methodological and conceptual challenges encountered in the investigation of the complex time-dependent interrelations between nutritional factors and asthma and its control, and their interaction with other determinants of asthma. Lastly, we provide guidance on how to address these challenges, as well as suggestions for future research.
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Affiliation(s)
- Annabelle Bédard
- Université Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France; (W.A.-h.); (B.L.); (O.D.); (R.V.)
- Correspondence:
| | - Zhen Li
- Clinical Research Centre, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 200092, China;
| | - Wassila Ait-hadad
- Université Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France; (W.A.-h.); (B.L.); (O.D.); (R.V.)
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;
| | - Bénédicte Leynaert
- Université Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France; (W.A.-h.); (B.L.); (O.D.); (R.V.)
| | - Christophe Pison
- Service Hospitalier Universitaire Pneumologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Laboratoire de Bioénergétique Fondamentale et Appliquée, Inserm 1055, Université Grenoble Alpes, 38400 Grenoble, France;
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France; (W.A.-h.); (B.L.); (O.D.); (R.V.)
| | - Raphaëlle Varraso
- Université Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France; (W.A.-h.); (B.L.); (O.D.); (R.V.)
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