Greenspace, stress, and health: how is epigenetics involved?

Most expositions of the association between green space and overall health and well-being focus on psychosocial mechanisms. However, discussions of the biological underpinnings of the exposure to green space and health implications are limited. In this paper, we highlight the role epigenetics plays in the manifestation or suppression of stress, in addition to some of the proposed epigenetic mechanisms through which green space mitigates stress. The Health: Epigenetics, Greenspace and Stress (HEGS) model is introduced to explicate this association, and suggestions for research to build the evidence base in this area are discussed.

RACIAL AND ETHNIC DIFFERENCES IN LUNG CANCER SCREENING ELIGIBILITY AND HEALTH CARE UTILIZATION AMONG OLDER SMOKERS

The United States Preventive Task Force (USPSTF) expanded the lung cancer screening guidelines with low-dose CT scan (LDCT) to narrow racial and ethnic screening disparities. However, there is a need to examine if eligible individuals can access and use health care. The objective was to examine racial and ethnic differences in LDCT eligibility and health services access and utilization among LDCT-eligible individuals. Data comes from adults 50 to 80 years old in the 2018 Health and Retirement Study (HRS), with at least a 20 pack-year smoking history who currently smoke, or have quit < 15 years ago (n=7,624). The outcomes were LDCT eligibility, access to health care (health insurance and usual place of care), and health care use (visits to the doctor). White individuals were more likely to be LDCT eligible than Black and Hispanic individuals. Among those LDCT eligible, Hispanic individuals were less likely to have insurance (OR:0.43, [95%CI: 0.21; 0.86]) and to visit the doctor than White individuals (OR: 0.38 [0.19; 0.76]). Compared to White individuals, Black individuals were more likely to say their usual place of care was the ER or “other” place (OR: 2.65 [1.63; 3.32] and Hispanic individuals were more likely to say they do not have a usual place of care (OR: 1.94 [1.10; 3.41]). Expanding the criteria for lung cancer screening may not be enough to reduce racial and ethnic disparities. More efforts should address racial and ethnic disparities in the implementation of lung cancer screening, including access and use of health care.

Anti-tumor necrosis factor drug responses and skin-blood DNA methylation age: Relationships in moderate-to-severe psoriasis

Studies have examined the utility of DNA methylation as a biomarker of psoriasis treatment responses, but investigations of treatment responses with Skin-Blood DNA methylation age (SkinBloodAge)-a methylation-based measure of health designed using skin tissues-are lacking. Using a HumanMethylation450 BeadChip blood DNA methylation data set from 70 white patients who presented with moderate-to-severe plaque psoriasis and were treated with anti-tumor necrosis factor (TNF) agents in Madrid, Spain, we examined the cross-sectional relationships of SkinBloodAge with anti-TNF treatment responses. Partial responders had a 7.2-year higher mean SkinBloodAge than excellent responders (P = .03). In linear regression models adjusted for chronological age, sex and anti-TNF agents - on average - partial responders had a 2.65-year higher SkinBloodAge than excellent responders (95%CI: 0.44, 4.86, P = .02). This relationship was attenuated in a sensitivity analysis adjusting for white blood cells including known T-cell mediators of psoriasis pathophysiology (β = 1.91-years, 95%CI: -0.50, 4.32, P = .12). Overall, our study suggests that partial responders to anti-TNF therapy have higher SkinBloodAges when compared to excellent responders. Although these findings still need to be confirmed more broadly, they further suggest that SkinBloodAge may be a useful treatment response biomarker that can be incorporated with other blood tests before anti-TNF therapy initiation in moderate-to-severe psoriasis patients.