Overweight-years and cancer risk: A prospective study of the association and comparison of predictive performance with body mass index (Atherosclerosis Risk in Communities Study)

Excess body mass index (BMI) is associated with a higher risk of at least 13 cancers, but it is usually measured at a single time point. We tested whether the overweight-years metric, which incorporates exposure time to BMI ≥25 kg/m2 , is associated with cancer risk and compared this with a single BMI measure. We used adulthood BMI readings in the Atherosclerosis Risk in Communities (ARIC) study to derive the overweight-years metric. We calculated associations between the metric and BMI and the risk of cancers using Cox proportional hazards models. Models that either included the metric or BMI were compared using Harrell's C-statistic. We included 13,463 participants, with 3,876 first primary cancers over a mean of 19 years (SD 7) of cancer follow-up. Hazard ratios for obesity-related cancers per standard deviation overweight-years were 1.15 (95% CI: 1.05-1.25) in men and 1.14 (95% CI: 1.08-1.20) in women. The difference in the C-statistic between models that incorporated BMI, or the overweight-years metric was non-significant in men and women. Overweight-years was associated with the risk of obesity-related cancers but did not outperform a single BMI measure in association performance characteristics.

Juvenile Violent Victimization and Adult Criminal Outcomes: The Role of Military Service as a Turning Point in Young Adulthood

Previous research has consistently shown that juvenile violent victimization is associated with an increased risk of future criminal involvement, a phenomenon commonly known as victim-offender overlap. Despite a growing interest in the factors underlying this overlap, potential roles of major life transitions and turning points that may interrupt and reshape the nature of this developmental association have garnered less academic attention. Analyzing nationally representative data from waves I, IV, and V of the National Longitudinal Study of Adolescent to Adult Health (Add Health; n = 10,205), this study investigates the association between juvenile violent victimization and adult criminal outcomes (i.e., violent offending, non-violent offending, arrest, and incarceration) and whether this association is moderated by military service with and without combat experience in young adulthood. Employing a series of logistic regression analyses and adjusting for a host of covariates, measures of selection, and criminogenic traits, we found that juvenile violent victimization was significantly associated with greater odds of violent offending, arrest, and incarceration in adulthood. Among individuals with violent victimization histories, military service with no combat experience was associated with a 16% decrease in the odds of incarceration in adulthood. Combat experience, however, was associated with over seven times greater odds of violent offending in adulthood for these individuals. These findings have important implications for theory, research, and practice, and highlight the relevance of life transitions and turning points in general, and military service in particular, in mitigating or perpetuating the criminogenic impacts of violent victimization in the life course.

How and where does "care" fit within seminal life-course approaches? A narrative review and critical analysis

AIMS

To map the concepts of the caring life-course theory that are used in life-course approaches from different disciplines; establish whether there is a common recognition of, or language used, to describe care in those life-course approaches; and identify the role and contribution of care to the life-course literature.

DESIGN

This discursive paper uses a narrative review process to explore points of convergence and divergence between life-course approaches and the caring life-course theory.

METHODS

Categories for analysis were developed deductively and inductively, focusing on the constructs of fundamental care, capacity and capability, care network, care transition, care trajectory and care biography.

RESULTS

We identified four disciplinary perspectives: (1) life-course sociology; (2) life-course epidemiology; (3) lifespan developmental psychology; and (4) life-course health development. While six core constructs of the caring life-course theory were described, either explicitly or implicitly, in existing life-course approaches, no single approach fully describes the role and contribution of care across the lifespan.

CONCLUSION

Life-course approaches have largely neglected the contribution and role of care in informing the life-course discourse. This review highlights the significance of care beyond traditional healthcare settings and recognizes it as a fundamental human need for well-being and development, which can contribute to existing life-course literature.

IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE

There is a need to understand care as a complex system and embrace a whole-system, life-course approach to enable nurses and other healthcare professionals to provide high-quality, patient-centred care.

IMPACT

Incorporating care within a life-course approach provides opportunities to integrate and deliver care centred around the person, their life transitions, trajectories and care networks, including informal carers and healthcare professionals.

NO PATIENT OR PUBLIC CONTRIBUTION

Patients or members of the public were not involved in this study as it is a discursive paper based on the relevant literature.

Is lifetime abuse forgivable in old age?

Old age is characterized by reflection and a retrospective examination of the multiple meanings of various life experiences, including lifelong abuse. Forgiveness is found to have a salutary effect, especially for older adults. To understand the place and role of forgiveness in the reflective process during aging, we performed a secondary analysis of in-depth, semi-structured interviews (N = 78) with older women survivors of abuse. Inductive thematic analysis was based on concepts developed deductively from the literature review. The findings include three main themes: (1) The dimensions of forgiving: The victim as subject; (2) Being forgiven: Between lost forgiveness and hope; and (3) Self-forgiveness and the aging self. Despite the known salutary effect of forgiveness, we must consider that this is not a universally desirable process. We included the dimension of forgiveness in the study of abuse throughout the older person's life course and identified further complexities in addition to the "forgiveness"/"unforgiveness."

Rethinking immunization programs through the life course approach

The world continues to undergo a profound demographic shift toward increasing longevity -but quality of life is not improving correspondingly. At the same time, countries are taking stock of the negative impacts of the COVID-19 pandemic on national immunization programs. The pandemic exacerbated the declines in vaccination coverage for multiple vaccine-preventable diseases (VPD). To ensure that all persons receive all the vaccines for which they are eligible, it is time to consider how applying a life course approach (LCA) to immunization programs can help reinvigorate and redesign actions for greater vaccine uptake. In this mini review, we present the key concepts and principles of the LCA as applied to national immunization programs. Also, we offer recommendations on how health systems can achieve regional and national goals to ensure all people receive the recommended vaccine doses at every stage of life, thus ensuring the greatest benefits for individuals and societies.

The relationship between mistrust and aggression from childhood to adulthood

The study examined the relationship between mistrust and aggression from childhood to adulthood. The participants resided in Portugal and were tested during middle childhood (Mage = 7.5, SD = 0.81 years, n = 445, 240 male), preadolescence (Mage = 11.92, SD = 0.96 years, n = 431, 200 male), mid-adolescence (Mage = 14.70, SD = 0.91 years, n = 326, 201 male), late adolescence (Mage = 18.14, SD = 1.19 years, n = 410, 216 male), and adulthood (Mage = 26.56, SD = 1.13, years, n = 417, 197 male). Mothers reported the participants' mistrust during childhood and preadolescence on items from the Child Behavior Checklist. Aggression was assessed by standardized self-report measures at each age period. It was found that mistrust was associated with aggression during preadolescence and predicted changes in aggression to mid-adolescence and adulthood. The findings supported the conclusion that mistrust during preadolescence predisposes individuals to show aggression later in the life course.

Life-Course Brain Health as a Determinant of Late-Life Mental Health: American Association for Geriatric Psychiatry Expert Panel Recommendations

This position statement of the Expert Panel on Brain Health of the American Association for Geriatric Psychiatry (AAGP) emphasizes the critical role of life course brain health in shaping mental well-being during the later stages of life. Evidence posits that maintaining optimal brain health earlier in life is crucial for preventing and managing brain aging-related disorders such as dementia/cognitive decline, depression, stroke, and anxiety. We advocate for a holistic approach that integrates medical, psychological, and social frameworks with culturally tailored interventions across the lifespan to promote brain health and overall mental well-being in aging adults across all communities. Furthermore, our statement underscores the significance of prevention, early detection, and intervention in identifying cognitive decline, mood changes, and related mental illness. Action should also be taken to understand and address the needs of communities that traditionally have unequal access to preventive health information and services. By implementing culturally relevant and tailored evidence-based practices and advancing research in geriatric psychiatry, behavioral neurology, and geroscience, we can enhance the quality of life for older adults facing the unique challenges of aging. This position statement emphasizes the intrinsic link between brain health and mental health in aging, urging healthcare professionals, policymakers, and a broader society to prioritize comprehensive strategies that safeguard and promote brain health from birth through later years across all communities. The AAGP Expert Panel has the goal of launching further activities in the coming months and years.

The critical temporalities of serial migration and family social reproduction in Southeast Asia

The prevailing neoliberal labour migration regime in Asia is underpinned by principles of enforced transience: the overwhelming majority of migrants - particularly those seeking low-skilled, low-waged work - are admitted into host nation-states on the basis of short-term, time-bound contracts, with little or no possibility of family reunification or permanent settlement at the destination. As families go transnational, 'family times' become inextricably intertwined with the 'times of migration' (Cwerner, 2001). In this context, for many migrant-sending families in Southeast Asian source countries such as Indonesia and the Philippines, parental migration as a strategy for migrating out of poverty or for socio-economic advancement requires the left-behind family to resiliently absorb the uncertainties of parental leaving and returning. Based on research on Indonesian and Filipino rural households (studied from 2008 through 2017) including paired life-story interviews with parental/non-parental adult carers and children, the article investigates the crucial links between the time construct of seriality in migration on the one hand, and the temporal structure of family based social reproduction on the other. It first focuses on how serial migration produces, and is produced by, spiraling needs and expanding aspirations, hence creating its own momentum for continuity. The paper then explores how competing temporal logics create difficult choices for migrants, leading to the recalibration of priorities within constrained resources. By drawing attention to the co-existence of and contradictions between multiple temporalities in the lives of migrants and their families, a critical temporalities framework yields new insights in understanding the social reproduction of families in a migratory context.

A Narrative Review of the Association between Prematurity and Attention-Deficit/Hyperactivity Disorder and Accompanying Inequities across the Life-Course

Preterm birth is associated with an increased risk of neurodevelopmental and neurobehavioral impairments including attention-deficit/hyperactivity disorder (ADHD), the most common neurobehavioral disorder of childhood. In this narrative review, we examine the known associations between prematurity and ADHD and highlight the impact of both prematurity and ADHD on multiple domains across the pediatric life-course. We develop a framework for understanding the health services journey of individuals with ADHD to access appropriate services and treatments for ADHD, the "ADHD Care Cascade". We then discuss the many racial and ethnic inequities that affect the risk of preterm birth as well as the steps along the "ADHD Care Cascade". By using a life-course approach, we highlight the ways in which inequities are layered over time to magnify the neurodevelopmental impact of preterm birth on the most vulnerable children across the life-course.

Young Adult Cancer Care Partners: A Theoretical Description of an Emerging Population with Unique Needs

As the U.S. population's demographics shift, young U.S. adults are increasingly engaged in informal caregiving for aging generations. Yet, there is little research on the unique experiences and needs of young adults who take on caregiving roles for adult cancer patients. Herein we demonstrate through a theoretical description that young adult cancer care partners deserve distinct recognition in the cancer control continuum given the psychological, physical, financial, and social features unique to their cancer experience.

Major depressive disorder as a moderator of the relationship between heavy-episodic drinking and anxiety symptoms

BACKGROUND

Major depressive disorder and heavy-episodic drinking are risk factors for the development of anxiety. However, the interactive effect between these constructs for predicting anxiety symptoms remains understudied.

AIMS

This study sought to examine how major depressive disorder moderates the relationship between heavy-episodic drinking frequency and the development of anxiety symptoms in adolescence and emerging adulthood among a sample of justice-involved youth, with expectations that the salience of this relationship may differ based on life-course stage.

METHODS

Several waves of the Pathways to Desistance study were analyzed. Poisson regression with robust standard errors was used to test the direct and interactive effects of major depressive disorder and heavy-episodic drinking frequency on anxiety symptoms at follow-up in adolescence and emerging adulthood separately.

RESULTS

Results indicated that there was a significant negative interaction between major depressive disorder and heavy-episodic drinking frequency for predicting anxiety scores in both adolescence and emerging adulthood, though the results for adolescence were more robust.

CONCLUSIONS

These results suggest youth without major depressive disorder that engage in heavy-episodic drinking may be a priority population for treating anxiety issues, but that ceiling effects may limit the impact of the behavior on anxiety on youth with major depressive disorder.

Situating the Pandemic in the Life-Course: Older Adults' Perspectives on the Challenges and Positives of the COVID-19 Pandemic

Older adults experienced the highest rates of infections and deaths and significant social isolation during the COVID-19 pandemic. While these negative impacts are important to address, the positive outcomes among older adults during the pandemic are equally important. A survey was distributed to adults aged 65 or older living in St. Louis, Missouri from August 2020 through March 2021 to characterize the challenges and positives they found during the pandemic. A total of 103 older adults participated. Compared to previous times in their lives, a majority of participants felt the pandemic had been more disruptive (62%) and more confusing (78%) and a majority were more worried (58%) and more afraid of dying (53%) during the pandemic. The most common positives were increased emotional well-being (23% of responses) and stronger personal connections (20% of responses). This ability to identify positive outcomes of the pandemic demonstrates the resilience of older adults and counters the ageist narrative that dominated the dialogue early in the pandemic, which depicted older adults as weak, vulnerable, and dispensable. As the pandemic evolves, nurturing and leveraging these positives will be key to combatting the cycle of fear and restrictions that the pandemic could bring.

Investigating the Joint Effect of Allostatic Load among Lesbian, Gay, and Bisexual Adults with Risk of Cancer Mortality

Sexual minorities (SM) have higher chronic physiologic stress as indicated by allostatic load (AL), which may be explained in part by consistent experiences of discriminatory practices. This is one of the first studies to examine the joint effects of SM status and AL on the association with long-term risk for cancer death. Retrospective analyses were conducted on 12,470 participants using National Health and Nutrition Examination Survey (NHANES) from years 2001 through 2010 linked with the National Death Index through December 31, 2019. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) of cancer deaths between groups of SM (those reporting as gay, lesbian, bisexual, or having same-sex sexual partners) status and AL. SM adults living with high AL (n = 326) had a 2-fold increased risk of cancer death (aHR: 2.55, 95% CI: 1.40-4.65) when compared to straight/heterosexual adults living with low AL (n = 6674). Among those living with high AL, SM (n = 326) had a 2-fold increased risk of cancer death (aHR: 2.26, 95% CI: 1.33-3.84) when compared to straight/heterosexual adults with high AL (n = 4957). SM with high AL have an increased risk of cancer mortality. These findings highlight important implications for promoting a focused agenda on cancer prevention with strategies that reduce chronic stress for SM adults.

Socioeconomic differences in older adults' unplanned hospital admissions: the role of health status and social network

BACKGROUND

the socioeconomic distribution of unplanned hospital admissions in older adults is poorly understood. We compared associations of two life-course measures of socioeconomic status (SES) with unplanned hospital admissions while comprehensively accounting for health, and examined the role of social network in this association.

METHODS

in 2,862 community-dwelling adults aged 60+ in Sweden, we derived (i) an aggregate life-course SES measure grouping individuals into Low, Middle or High SES based on a summative score, and (ii) a latent class measure that additionally identified a Mixed SES group, characterised by financial difficulties in childhood and old age. The health assessment combined measures of morbidity and functioning. The social network measure included social connections and support components. Negative binomial models estimated the change in hospital admissions over 4 years in relation to SES. Stratification and statistical interaction assessed effect modification by social network.

RESULTS

adjusting for health and social network, unplanned hospitalisation rates were higher for the latent Low SES and Mixed SES group (incidence rate ratio [IRR] = 1.38, 95% confidence interval [CI]: 1.12-1.69, P = 0.002; IRR = 2.06, 95% CI: 1.44-2.94, P < 0.001; respectively; ref: High SES). Mixed SES was at a substantially greater risk of unplanned hospital admissions among those with poor (and not rich) social network (IRR: 2.43, 95% CI: 1.44-4.07; ref: High SES), but the statistical interaction test was non-significant (P = 0.493).

CONCLUSION

socioeconomic distributions of older adults' unplanned hospitalisations were largely driven by health, although considering SES dynamics across life can reveal at-risk sub-populations. Financially disadvantaged older adults might benefit from interventions aimed at improving their social network.

Investigating the Association between Educational Attainment and Allostatic Load with Risk of Cancer Mortality among African American Women

Background African American (AA) women navigate the world with multiple intersecting marginalized identities. Accordingly, AA women have higher cumulative stress burden or allostatic load (AL) compared to other women. AL correlates with poorer health outcomes and increased risk of cancer death. However, research indicates AA women with a college degree or higher have lower AL than AA women with less than a high school diploma. We examined whether educational attainment differences and AL status in AA women are associated with long-term risk of cancer mortality. Methods We performed a retrospective analysis among 4,677 AA women respondents using National Health and Nutrition Examination Survey (NHANES) data from 1988 through 2010 with follow up data through December 31, 2019. We fit Cox proportional hazards models to estimate adjusted hazard ratios (aHRs) of cancer death between educational attainment/AL (adjusted for age, sociodemographic, and health factors). Results AA women with less than a high school diploma living with high AL had nearly a 3-fold increased risk (unadjusted HR: 2.98; 95%C CI: 1.24â€"7.15) of cancer death compared to AA college graduates living with low AL. However, after adjusting for age, the increased risk of cancer death in those with less than a high school diploma and high AL attenuated (age-adjusted HR: 1.11; 95% CI: .45-2.74). Conclusions Differences in educational attainment and AL in AA women were not associated with increased risk of cancer mortality when adjusted for age. Previous studies have shown that increased allostatic load is associated with increased risk of cancer death. However, for African American women, higher educational attainment does not modify the risk of cancer mortality. The benefits that may come along with higher education such as increased access to medical care and better medical literacy do not change the risk of cancer mortality in AA women.

Association between psychological distress trajectories from adolescence to midlife and mental health during the pandemic: evidence from two British birth cohorts

BACKGROUND

This paper examined whether distinct life-course trajectories of psychological distress from adolescence to midlife were associated with poorer mental health outcomes during the pandemic.

METHODS

We present a secondary analysis of two nationally representative British birth cohorts, the 1958 National Child Development Study (NCDS) and 1970 British Cohort Study (BCS70). We used latent variable mixture models to identify pre-pandemic longitudinal trajectories of psychological distress and a modified Poisson model with robust standard errors to estimate associations with psychological distress, life satisfaction and loneliness at different points during the pandemic.

RESULTS

Our analysis identified five distinct pre-pandemic trajectories of psychological distress in both cohorts. All trajectories with prior symptoms of psychological distress irrespective of age of onset, severity and chronicity were associated with a greater relative risk of poorer mental health outcomes during the pandemic and the probability of poorer mental health associated with psychological distress trajectories remained fairly constant. The relationship was not fully attenuated when most recent pre-pandemic psychological distress and other midlife factors were controlled for.

CONCLUSIONS

Whilst life-course trajectories with any prior symptoms of psychological distress put individuals at greater risk of poor mental health outcomes during the pandemic, those with chronic and more recent occurrences were at highest risk. In addition, prior poor mental health during the adult life-course may mean individuals are less resilient to shocks, such as pandemics. Our findings show the importance of considering heterogeneous mental health trajectories across the life-course in the general population in addition to population average trends.

Researching Time and Ageism: Applications of Qualitative Longitudinal Research to the Field

Interest in ageism research has grown immensely since the term was coined. Despite methodological innovations to study ageism in different settings and the application of different methods and methodologies to the topic, qualitative longitudinal studies investigating ageism are still underrepresented in the field. Through qualitative longitudinal interview data with four individuals of the same age, this study explored the applications of qualitative longitudinal research on ageism, highlighting its potential benefits and challenges to the multidisciplinary study of ageism and to gerontological research. The paper presents four distinctively different narratives through which individuals "do," "undo," and "challenge" ageism in their interview dialogues over time. Doing this underlines the importance of understanding the heterogeneity and intersectionality among encounters, expressions, and dynamics of ageism. The paper concludes with a discussion of the potential contributions that qualitative longitudinal research makes to ageism research and policy.

The rocky road of 55 years of change in the relationship of cardiovascular risk factors to cognition

The mixed evidence that high levels of cardiovascular risk factors (CVRF) are associated with lower cognitive test scores of may be due to confounding of age across studies. We pooled and harmonized individual-level data (30,967 persons, age range 42-96y) from five prospective cohorts to examine the trajectories of betas estimating 1-year-age associations of a cognitive outcome (Digit Symbol Substitution Test; DSST) to five CVRF: systolic and e blood pressure, total cholesterol, fasting glucose and body mass index. Linear and quadratic piecewise regression models were fit to the trajectory patterns of these betas. The trajectories showed with each 1-year age increment, higher CVRF were associated with lower DSST, but associations attenuated toward zero as age increased. In addition, the pattern across age of each CVRF-DSST trajectory ranged from linear to non-liner. Without accounting for participant age in cohort comparisons, conclusions about the potential benefit on cognitive function of modifiable CVRF control will continue to be mixed and lead to delays in developing prevention programs.

Changes in the adult consequences of adolescent mental ill-health: findings from the 1958 and 1970 British birth cohorts

BACKGROUND

Adolescent mental health difficulties are increasing over time. However, it is not known whether their adulthood health and socio-economic sequelae are changing over time.

METHODS

Participants (N = 31 349) are from two prospective national birth cohort studies: 1958 National Child Development Study (n = 16 091) and the 1970 British Cohort Study (n = 15 258). Adolescent mental health was operationalised both as traditional internalising and externalising factors and a hierarchical bi-factor. Associations between adolescent psychopathology and age 42 health and wellbeing (mental health, general health, life satisfaction), social (cohabitation, voting behaviour) and economic (education and employment) outcomes are estimated using linear and logistic multivariable regressions across cohorts, controlling for a wide range of early life potential confounding factors.

RESULTS

The prevalence of adolescent mental health difficulties increased and their associations with midlife health, wellbeing, social and economic outcomes became more severe or remained similar between those born in 1958 and 1970. For instance, a stronger association with adolescent mental health difficulties was found for those born in 1970 for midlife psychological distress [odds ratio (OR) 1970 = 1.82 (1.65-1.99), OR 1958 = 1.60 (1.43-1.79)], cohabitation [OR 1970 = 0.64 (0.59-0.70), OR 1958 = 0.79 (0.72-0.87)], and professional occupations [OR 1970 = 0.75 (0.67-0.84), OR 1958 = 1.05 (0.88-1.24)]. The associations of externalising symptoms with later outcomes were mainly explained by their shared variance with internalising symptoms.

CONCLUSION

The widening of mental health-based inequalities in midlife outcomes further supports the need to recognise that secular increases in adolescent mental health symptoms is a public health challenge with measurable negative consequences through the life-course. Increased public health efforts to minimise adverse outcomes are needed.

Tackling physical inactivity in Scandinavia: a narrative review of reviews supplemented by expert interviews

Aims: This study aims to identify physical inactivity-related challenges and motives, based on reviews and supplemented by expert interviews with Danish national experts on physical inactivity, providing a general discussion of the subject ultimately generating knowledge useable in a Scandinavian context. Methods: This study is framed as a narrative review of scientific review literature on physical inactivity, limited to the general population. The review is supplemented by expert interviews with Danish national experts on physical inactivity. We used thematic coding of the included reviews, while using hermeneutic interpretation analysis for the expert interviews. Results: Based on 11 included reviews, we highlighted four themes based on our analysis of reviews: (a) socioeconomic determinants of physical activity; (b) life-course perspective; (c) physical inactivity and older adults aged 60+ years; and (d) intervention recommendations. The supplementary expert interviews revealed three additional themes: (a) the individual history with physical activity; (b) sporting organisation importance; and (c) society responsibility for physical inactivity. Conclusions: Collectively this study concludes, based on review and expert interviews, that a number of determinants and correlations for physical inactivity affect the individual from various socioecological levels. Based on this review, we suggest moving beyond the 'upstream' public health approach of randomised controlled trials and consider complex interventions targeting physical inactivity from several levels. Physical inactivity should be acknowledged as a 'wicked problem' that requires a systems-based approach instead of a single quick fix. Future work with physical inactivity would profit from focus on the life-course perspective, sporting clubs' responsiveness and physical literacy.

A conceptual framework for selecting appropriate populations for public health interventions

This article suggests a conceptual framework for choice of target populations for public health interventions. In short, who should benefit? Taking the seminal work of Geoffrey Rose on "individuals at risk" versus the "whole population approach" as a point of departure, we explore later contributions. Frohlich and Potvin introduced the notion of "vulnerable populations" applying relevant social determinants as the defining selection criterion. Other interventions focus on a "physical space" (spatial demarcations) such as a neighborhood as a means to define intervention populations. As an addition to these criteria, we suggest that the life-course perspective entails an alternative means of selecting target populations based on a "temporal" perspective. A focus on the various age phases ranging from fetal life and infancy to old age may guide selection of population segments for targeted public health interventions. Each of the selection criteria has advantages and disadvantages when used for primary, secondary, or tertiary prevention. Thus, the conceptual framework may guide informed decisions in public health planning and research regarding precision prevention versus various approaches to complex community-based interventions.

The agency of fertility plans

Fertility plans are a prominent area for agency research, and are a clear example of a misalignment between resources and agency capacity. We relied both on the idea of conversion factors of the Capability Approach and the pragmatist tradition of temporal-oriented agency to propose a framework for the study of fertility agency as the conversion process of resources into plans and behavior. We outlined said framework by using a unique dataset on fertility plans composed of open and closed questions from an Italian sample. Economic factors and imaginaries related to children and family represented the vast majority of (hindering and enabling) conversion factors. The notion of conversion factors is crucial for disentangling the network of heterogeneous elements involved in fertility agency: it allows focus to be shifted from structural factors related to social position and psychological characteristics to more situated elements that enable agency capacity.

Diabetes, disability, and dementia risk: Results from the Hispanic Established Populations for the Epidemiologic Studies of the Elderly (H-EPESE)

BACKGROUND

Emerging research has elucidated pathophysiological relationships among diabetes, disability, cognitive impairment, and incident dementia. However, the relationships between diabetes, disability, and dementia have been largely underexamined in Latino populations, which have a disproportionate prevalence of diabetes and its complications.

AIMS

This study examines diabetes as a risk factor for subsequent disability and dementia risk in a Mexican-origin older adult sample.

METHODS

The data are drawn from eight waves (1993-2013) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE; N = 3,050, mean age at baseline = 73.6 (±6.8)). Respondents' diabetes status at baseline was ascertained by self-report. Disability was assessed using eight functional domains assessed through the Lawton Instrumental Activities of Daily Living (IADL) Scale. Dementia risk was assessed using a Mini-Mental Status Exam (MMSE) score below 18 and the need for aid with at least two IADLs. We used multivariable Cox proportional hazards models to predict the relation between diabetes and time to disability, cognitive impairment, and incident dementia, adjusting for age at migration, socioeconomic status, acculturation, and health status.

RESULTS

At baseline, diabetes prevalence was 28.1%, and 37.7% had IADL disability. Diabetes was associated with a higher risk of developing dementia (Hazard Ratio (HR) = 1.22, p < .001) over the approximetely 20 year study period. In addition, immigrants who migrated at age 50 or older had a higher dementia risk (HR = 1.35, p = .01) when compared to their US-born counterpart.

CONCLUSION

Our results highlight the importance of better characterizing the role of diabetes and nativity in the co-occurrence of disability and dementia risk.

Education matters: longitudinal pathways to mid-life heavy drinking in a national cohort of black Americans

AIMS

To estimate longitudinal pathways from childhood socio-economic position (SEP) to educational attainment and mid-life heavy drinking in black Americans in order to identify potential points of early intervention to reduce risk for alcohol-related problems in adulthood.

DESIGN, SETTING AND PARTICIPANTS

Data are from 1299 black Americans in the US National Longitudinal Survey of Youth, followed from 1979 (aged 15-19 years) to 2012. Given gender differences in factors related to education and alcohol outcomes, gender-stratified path models were analyzed.

MEASUREMENTS

Youth socio-economic indicators included parental education (approximating childhood SEP) and adolescent poverty duration. Education-related measures included high-poverty school, perceived school safety, academic problems, suspension from school, educational expectations and educational attainment. Adulthood measures included repeated unemployment, poverty duration and mean frequency of heavy drinking (six or more drinks/day) in young adulthood and mid-life. Covariates included age, dual-parent household, marital status, early drinking onset and family history of alcohol problems.

FINDINGS

For both genders, two main pathways originating from low childhood SEP flowed to educational attainment through (1) educational expectations and (2) suspension and from educational attainment to mid-life heavy drinking [total indirect effect = 0.131, 95% confidence interval (CI) = 0.072-0.197 for women and 0.080, 95% CI = 0.035-0.139 for men]. For both genders, adolescent poverty (standardized βs ≥ 0.139), academic problems (βs ≥ 0.221) and school suspension (βs ≥ 0.166) were significantly (Ps < 0.05) related to lower educational expectations. In adulthood, educational attainment was indirectly protective against mid-life heavy drinking through its significant effects (Ps < 0.05) on young adult heavy drinking for both genders (βs ≤ -0.204) and economic hardships for women (βs ≤ -0.372).

CONCLUSIONS

Low childhood socio-economic position among black Americans appears to be associated with subsequent, adverse socio-economic and school experiences that lead to lower educational attainment and, ultimately, greater heavy drinking at mid-life. Interventions that mitigate these earlier, adverse experiences might have indirect effects on mid-life heavy drinking.

The Survey of the Health of Wisconsin (SHOW) Program: An Infrastructure for Advancing Population Health

Introduction

The Survey of the Health of Wisconsin (SHOW) was established in 2008 by the University of Wisconsin (UW) School of Medicine and Public Health (SMPH) with the goals of (1) providing a timely and accurate picture of the health of the state residents; and (2) serving as an agile resource infrastructure for ancillary studies. Today, the SHOW program continues to serve as a unique and vital population health research infrastructure for advancing public health.

Methods

SHOW currently includes 5,846 adult and 980 minor participants recruited between 2008 and 2019 in four primary waves. WAVE I (2008–2013) includes annual statewide representative samples of 3,380 adults ages 21 to 74 years. WAVE II (2014–2016) is a triannual statewide sample of 1,957 adults (age ≥18 years) and 645 children (age 0–17). WAVE III (2017) consists of follow-up of 725 adults from the WAVE I and baseline surveys of 222 children in selected households. WAVEs II and III include stool samples collected as part of an ancillary study in a subset of 784 individuals. WAVE IV consists of 517 adults and 113 children recruited from traditionally under-represented populations in biomedical research including African Americans and Hispanics in Milwaukee, Wisconsin.

Findings to Date

The SHOW resource provides unique spatially granular and timely data to examine the intersectionality of multiple social determinants and population health. SHOW includes a large biorepository and extensive health data collected in a geographically diverse urban and rural population. Over 60 studies have been published covering a broad range of topics including, urban and rural disparities in cardio-metabolic disease and cancer, objective physical activity, sleep, green-space and mental health, transcriptomics, the gut microbiome, antibiotic resistance, air pollution, concentrated animal feeding operations and heavy metal exposures.

Discussion

The SHOW cohort and resource is available for continued follow-up and ancillary studies including longitudinal public health monitoring, translational biomedical research, environmental health, aging, microbiome and COVID-19 research.

Diet Diversity Through the Life-Course as an Opportunity Toward Food Allergy Prevention

The prevalence of food allergies (FA) is increasing worldwide. Generally, the onset of allergies, including FA, begins in early childhood and may persist and/or develop through the life-course. Even though epidemiological studies have focused mainly on children, allergies can also occur for the first-time during adulthood. Within the prolongation of life, it is expected that allergies will be encountered more often even in older people. Recent findings suggest that an early exposure to diverse food antigens may promote the development of immune tolerance. Accordingly, diet diversity during the first year of life or even earlier may have a positive impact on the prevention of allergies. The anti-inflammatory properties of some dietary nutrients may positively contribute to a tolerogenic immune environment too. Diet diversity is associated with a more favorable microbiome, and increasing evidence suggests a promising role of gut microbiota manipulation in inducing immune tolerance. Unjustified avoidance of allergenic foods may expose to intakes of some nutrients below recommended levels through the life-course, even more in cases of self-diagnosis and treatment of presumed forms of food intolerance. Nutritional strategies including the early exposure to a variety of food antigens are a promising area of research for preventive purposes through the life-course possibly extending positive outcomes to older stages. The aim of this paper is to highlight the role of diet diversity in preventing the development of FA starting in early life, as well as to provide an overview of the main strategies to prevent related nutritional issues throughout the life-course.

The Relationship Between the Development of General Offending and Intimate Partner Violence Perpetration in Young Adulthood

This study examined how patterns in general offending relate to the occurrence of and likelihood of persistence in intimate partner violence (IPV) perpetration in young adulthood. The study used longitudinal data from the cohort of 18 year olds from the Project on Human Development in Chicago Neighborhoods study. Self-reported offending was measured in all three waves, and data on IPV were collected in Waves 1 and 3. Group-based trajectory modeling identified three distinct general offending trajectory groups: non-offenders, low-rate offenders, and high-rate offenders. The majority of respondents engaged in psychological IPV perpetration, and half of all young adults reported physical IPV, but prevalence rates decreased over the waves. Binary logistic regression analyses showed that those involved in offending, especially those who showed a diverse offending pattern, were at increased risk of perpetrating psychological and (severe) physical IPV, as well as to show persistence in the different forms of IPV perpetration. The findings highlight an important overlap between general crime and IPV perpetration. In recognition that IPV is often part of a broader pattern of antisocial behavior, interventions should focus on interrupting the criminal careers of all young offenders to reduce the prevalence and harms of IPV.

The role of education and income for cognitive functioning in old age: A cross-country comparison

OBJECTIVES

Previous studies have shown that higher education promotes cognitive health. This effect, however, is embedded in the living conditions of a particular country. Since it is not clear to what extent the country and its specific living standards are necessary preconditions for the observed effect, we investigated whether the impact of education and income on cognitive functioning differs between countries.

METHODS

Analyses were based on harmonized data from the World Health Organization's multi-country Study on global AGEing and adult health, the Health and Retirement Study, and the Survey of Health, Ageing and Retirement in Europe of over 85,000 individuals aged 50 years and older. Analyses were conducted via multivariate regression analyses and structural equation modeling adjusted for age, gender, marital status, health status, and depression.

RESULTS

The effect of education was twice as large as the effect of income on cognitive functioning and indirectly moderated the effect of income on cognitive functioning. The effect sizes varied strongly between countries. The country's gross domestic product per capita seems to influence cognitive functioning.

CONCLUSIONS

Our findings indicate that education has a dominant effect on cognitive functioning in people aged 50 years and older, which might even offset the adverse implications of living with low income on cognitive health. Therefore, expanding efforts to achieve universal education are essential to mitigate health disparities due to low income and early life disadvantages, including chances for good cognitive functioning over the life-span.

Harmonisation and Between-Country Differences of the Lifetime of Experiences Questionnaire in Older Adults

Background: The Lifetime of Experiences Questionnaire (LEQ) assesses complex mental activity across the life-course and has been associated with brain and cognitive health. The different education systems and occupation classifications across countries represent a challenge for international comparisons. The objectives of this study were four-fold: to adapt and harmonise the LEQ across four European countries, assess its validity across countries, explore its association with brain and cognition and begin to investigate between-country differences in life-course mental activities. Method: The LEQ was administered to 359 cognitively unimpaired older adults (mean age and education: 71.2, 13.2 years) from IMAP and EU-funded Medit-Ageing projects. Education systems, classification of occupations and scoring guidelines were adapted to allow comparisons between France, Germany, Spain and United Kingdom. We assessed the LEQ's (i) concurrent validity with a similar instrument (cognitive activities questionnaire - CAQ) and its structural validity by testing the factors' structure across countries, (ii) we investigated its association with cognition and neuroimaging, and (iii) compared its scores between countries. Results: The LEQ showed moderate to strong positive associations with the CAQ and revealed a stable multidimensional structure across countries that was similar to the original LEQ. The LEQ was positively associated with global cognition. Between-country differences were observed in leisure activities across the life-course. Conclusions: The LEQ is a promising tool for assessing the multidimensional construct of cognitive reserve and can be used to measure socio-behavioural determinants of cognitive reserve in older adults across countries. Longitudinal studies are warranted to test further its clinical utility.

Stability of psychopathy in a prospective longitudinal study: Results from the Cambridge Study in delinquent development

To further understand psychopathy within a Developmental and Life-Course Criminology perspective, the current article investigates the stability and change in psychopathy from childhood to middle age. The Cambridge Study in delinquent development is a prospective longitudinal study of 411 males, where psychopathy was coded based on contemporanously collected data from young people and in adulthood. Psychopathy in middle age was assessed in a medical interview. The findings indicate a high degree of stability of psychopathy across the life-course. To explain stability and change, childhood factors that might predict this were investigated. Few factors were related to stability and change across the life-course. Poor supervision, poor housing, a large family, and having a convicted father were associated with any change. A depressed mother was associated with a later decrease in psychopathy. This investigation has implications not only for the downward extension of psychopathy to childhood, but also for the understanding of the development of criminal and antisocial behavior.

From 9 to 91: health promotion through the life-course-illuminating the inner child

A life-course perspective is according to the World Health Organization about increasing the effectiveness of health promotion interventions at all ages. This targets the needs of human beings throughout their life. Descriptions of the phenomenon of the inner child invite the possibility that it may be of help when promoting health throughout the life-course. The aim was to describe and understand schoolchildren's, adults and older person's experiences of childhood in connection to health and well-being in the present and through the life-course, illuminating the inner child. The research strategy used was a secondary analysis of the original transcribed data from three Swedish studies investigating new questions. In total, 53 individuals aged 9-91, 20 school children, 20 adults and 13 older persons were interviewed about childhood experiences. The schoolchildren were invited to create a drawing, and to narrate about it during the interview. The main question in the secondary analysis was 'How do the participants' narrations about childhood experiences illuminate the inner child, useful for health promotion through the life-course?' The findings showed the importance of a secure atmosphere and trusting relationships, indicating that experiences during childhood can help us to adapt and pass along life lessons across generations. There were narratives about play as an activity where they learned to promote a healthy childhood, struggle for independence and learning how to be responsible when growing up. Dimensions of mental, social and existential well-being can be seen as examples of the inner child's role in health promotion through the life-course.

Intergenerational Commensality: A Critical Discussion on Non-Familial Age Groups Eating Together

Connecting intergenerational relationships and commensality has been a neglected area in research and conceptual development within both food and life-course studies. This has been especially true of relations beyond the family. Here, public and private settings are explored in order to examine the relationship between eating together and generationally intelligent empathy. This is to help the discovery of spaces where different generations can interact positively around food and mealtimes. Contemporary social and public health challenges include: to adapt to increased longevity and to build solidarity between generations; to repair the relations between generations arising from institutional segregation; and to increase experiences of generational connection and social inclusion. As age-based cohorts are led to see themselves as separate from each other, we must find ways of building and negotiating new complementary roles for different parts of the life-course. Commensality, eating together at the same table provides an important cultural location and opportunity around which complementary understandings between generations may be built. A new framework is proposed to help identify and critically examine the variables underpinning non-familial intergenerational commensal spaces.

Reproduction, Life-course and Vital Conjunctures in the Context of Austerity

Reproduction is a considerable concern in contemporary Europe and has attracted growing academic interest in the context of austerity. This paper brings together literature on social reproduction, the life-course and vital conjunctures, and develops innovative methodologies to understand reproduction in the context of everyday life in austerity. Using biographical vignettes from family ethnographies, themes of welfare restructuring, debt and care responsibilities emerge. Empirical insights explore social reproduction and defaulted futures, indebtedness and indecision as reproductive conjuncture, and incongruous biographies and absent possibilities. Conclusions call for further research on the relationship between reproductive futures and austerity, and methodological experimentation.

Migrant health penalty: evidence of higher mortality risk among internal migrants in sub-Saharan Africa

Background: Despite the greater attention given to international migration, internal migration accounts for the majority of movements globally. However, research on the effects of internal migration on health is limited, with this relationship examined predominantly in urban settings among working-age adults, neglecting rural populations and younger and older ages.

Objectives: Using longitudinal data from 29 mostly rural sub-Saharan African Health and Demographic Surveillance Systems (HDSS), this study aims to explore life-course differences in mortality according to migration status and duration of residence.

MethodsCox proportional hazards models are employed to analyse the relationship between migration and mortality in the 29 HDSS areas. The analytical sample includes 3 836,173 people and the analysis spans 25 years, from 1990 to 2015. We examine the risk of death by sex across five broad age groups (from ages 1 to 80), and consider recent and past in- and return migrants.

Results: In-migrants have a higher risk of mortality compared to permanent rural residents, with return migrants at greater risk than in-migrants across all age-groups. Female migrants have lower survival chances than males, with greater variability by age. Risk of dying is highest among recent return migrant females aged 30–59: 1.86 (95% CI 1.69–2.06) times that of permanent residents. Only among males aged 15–29 who move to urban areas is there evidence of a ‘healthy migrant’ effect (HR = 0.62, 95% CI 0.51–0.77). There is clear evidence of an adaptation effect across all ages, with the risk of mortality reducing with duration following migration.

Conclusions: Findings suggest that adult internal migrants, particularly females, suffer greater health disadvantages associated with migration. Policy makers should focus on improving migrant’s interface with health services, and support the development of health education and promotion interventions to create awareness of localised health risks for migrants.

Effects of Pandemic on Feelings of Depression in Italy: The Role of Age, Gender, and Individual Experiences During the First Lockdown

The restrictions to physical contacts that have been imposed in different countries to deal with the coronavirus disease 2019 (COVID-19) pandemic may have contributed to an increase in feelings of depression on top of other negative consequences of the pandemic. This study examines the consequences of the COVID-19 pandemic on feelings of depression using original data collected in Italy between April 14 and 24, 2020. Quota sampling (N = 3,026) was performed to target the population of 18+ and, together with post-stratification weights, permitted obtaining a representative sample of the Italian population with respect to key sociodemographic factors. We find that 47% of the respondents have increased depressive feelings during the Covid-19 lockdown. Adopting a life-course perspective, we revealed great heterogeneity in feelings of depression consequences by age, gender, and difficulties experienced during the first national lockdown. Identifying groups of population at higher risk of suffering from feelings of depression as a result of COVID-19 is crucial to limit indirect long-term consequences of the pandemic.

Joint Effort towards Preventing Nutritional Deficiencies at the Extremes of Life during COVID-19

The COVID-19 (Coronavirus disease 2019) pandemic is posing a threat to communities and healthcare systems worldwide. Malnutrition, in all its forms, may negatively impact the susceptibility and severity of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection in both children and older adults. Both undernutrition and obesity have been evoked as conditions associated with a higher susceptibility to the infection and poor prognosis. In turn, the COVID-19 infection may worsen the nutritional status through highly catabolic conditions, exposing individuals to the risk of malnutrition, muscle wasting, and nutritional deficiencies. Accordingly, the relationship between malnutrition and COVID-19 is likely to be bidirectional. Furthermore, the modification of nutritional behaviors and physical activity, required to limit the spread of the virus, are posing a challenge to health at both the extremes of life. Thus far, even the most advanced healthcare systems have failed to address the alarming consequences of malnutrition posed by this pandemic. If not properly addressed, we may run the risk that new and old generations will experience the consequences of COVID-19 related malnutrition.

Adult obesity and mid-life physical functioning in two British birth cohorts: investigating the mediating role of physical inactivity

Background

Associations between obesity and physical inactivity are bi-directional. Both are associated with physical functioning (PF, ability to perform physical tasks of daily living) but whether obesity influences PF via inactivity is unknown. We investigated whether mid-adult obesity trajectories were associated with subsequent PF and mediated by inactivity.

Methods

Body mass index (BMI; kg/m²) and inactivity were recorded at: 36, 43, 53 and 60–64 years in the 1946 Medical Research Council (MRC) National Survey of Health and Development (1946-NSHD; n = 2427), and at 33, 42 and 50 years in the 1958 National Child Development Study (1958-NCDS; n = 8674). Poor PF was defined as the lowest (gender and cohort-specific) 10% on the Short-form 36 Physical Component Summary subscale at 60–64 years (1946-NSHD) and 50 years (1958-NCDS). Estimated randomized-interventional-analogue natural direct (rNDE) and indirect (rNIE) effects of obesity trajectories on PF via inactivity are expressed as risk ratios [overall total effect (rTE) is rNDE multiplied by rNIE].

Results

In both cohorts, most individuals (∼68%) were never obese in adulthood, 16–30% became obese and ≤11% were always obese. In 1946-NSHD, rTE of incident obesity at 43 years (vs never) on poor PF was 2.32 (1.13, 3.51); at 53 years it was 1.53 (0.91, 2.15). rNIEs via inactivity were 1.02 (0.97, 1.07) and 1.02 (0.99, 1.04), respectively. Estimated rTE of persistent obesity from 36 years was 2.91 (1.14, 4.69), with rNIE of 1.03 (0.96, 1.10). In 1958-NCDS, patterns of association were similar, albeit weaker.

Conclusions

Longer duration of obesity was associated with increased risk of poor PF. Inactivity played a small mediating role. Findings reinforce the importance of preventing and delaying obesity onset to protect against poor PF.

Birthweight, lifetime obesity and physical functioning in mid-adulthood: a nationwide birth cohort study

BACKGROUND

Evidence is scant on long-term implications of childhood obesity and body mass index (BMI) gains over the life-course for poor physical functioning (PF). The objective was to establish whether (i) birthweight and BMI across the life-course, (ii) BMI gains at specific life-stages and (iii) age of obesity onset were associated with PF at 50 y.

METHODS

In the 1958 British birth cohort (n = 8674), BMI (kg/m2) was calculated using height and weight [measured (7, 11, 16, 33 and 45 y); self-reported (23 and 50 y)]. PF was assessed at 50 y using the validated PF subscale of the Short-form 36 survey; the bottom (gender-specific) 10% was classified as poor PF. Missing data were imputed via multiple imputation. Associations were examined using logistic regression, adjusting for health and social factors.

RESULTS

Birthweight was not associated with PF. At each adult age, odds of poor PF were highest for obese (vs normal), e.g. for 23 y obesity the odds ratio (OR)adjusted for poor PF was 2.28 (1.34, 3.91) and 2.67 (1.72, 4.14) in males and females respectively. BMI gains were associated with poor PF, e.g. for females, ORadjusted per standard deviation (SD) in BMI gain 16-23 y was 1.28 (1.13, 1.46); for BMI gains 45-50 y it was 1.36 (1.11, 1.65). Longer duration of obesity was associated with poor PF, e.g. in males, ORadjusted was 2.32 (1.26, 4.29) for childhood obesity onset and 1.50 (1.16, 1.96) for mid-adulthood onset (vs never obese, P-trend < 0.001).

CONCLUSION

Obesity, BMI gains, and earlier obesity onset were associated with poor PF in mid-adulthood, reinforcing the importance of preventing and delaying obesity onset.

Apolipoprotein E e4 allele status and later-life depression in the Lothian Birth Cohort 1936

BACKGROUND

Previous results have been mixed regarding the role of the apolipoprotein E e4 (APOE e4) allele in later-life depression: some studies note that carriers experience greater symptoms and increased risk while others find no such association. However, there are few prospective, population-based studies of the APOE e4-depression association and fewer that examine depressive symptom trajectory and depression risk longitudinally. We examined the association between APOE e4 allele status and longitudinal change in depressive symptoms and depression risk in later-life, over a 12-year follow-up period.

METHODS

We used data from 690 participants of the Lothian Birth Cohort 1936 who took part in the Scottish Mental Survey 1947 (aged 11) and were followed-up in later-life over five waves from 2004 to 2019 (aged 70-82). We used APOE e4 allele status to predict longitudinal change in depressive symptom scores and risk of depression (defined by a symptom score threshold or use of depression-related medication). Models were adjusted for sex, childhood cognitive ability, childhood social class, education, adult social class, smoking status and functional limitations at baseline.

RESULTS

Depressive symptom scores increased with age. Once adjusted for covariates, APOE e4 allele status did not significantly predict symptom score trajectories or depression risk. Greater functional limitations at baseline significantly predicted poorer symptom score trajectories and increased depression risk (defined by medications). APOE e4 allele status did not significantly moderate the contribution of sex, education or functional limitations.

CONCLUSIONS

There was no evidence that APOE e4 carriers experience an increased risk for later-life depression.

Friends' childhood adversity and long-term implications for substance misuse: a prospective Swedish cohort study

BACKGROUND AND AIMS

Although an individual's childhood adversity is predictive of later substance misuse, the effect of adversity within an individual's friendship network has not been established. The current study aims to estimate the strength of the association between exposure to childhood adversity among individuals' friends at the onset of adolescence, relative to individuals' own exposure to childhood adversity, and hospitalization for substance misuse between young adulthood and retirement.

DESIGN

Prospective cohort study.

SETTING

Stockholm, Sweden.

PARTICIPANTS

Individuals born in 1953, living in Stockholm in 1963, and who nominated three best friends in the 6th grade school class (n = 7180; females = 3709, males = 3471), followed to 2016.

MEASUREMENTS

The outcome was hospitalization with a main or secondary diagnosis attributed to substance misuse, reflected in Swedish inpatient records (ages 19-63 years). Five indicators of childhood adversity (ages 0-12 years) were operationalized into composite measures for individuals and their friends, respectively. Friendships were identified using sociometric data collected in the school class setting (age 13 years).

FINDINGS

Individuals' own childhood adversity does not predict childhood adversity among friends (P > 0.05). Childhood adversity among friends is independently associated with an increased risk of an individual's later substance misuse [hazard ratio (HR) = 1.17, 95% confidence interval (CI) = 1.09-1.24], independently of an individual's own childhood adversity (HR = 1.47, 95% CI = 1.34-1.61). However, childhood adversity among friends does not moderate the association between individuals' own childhood adversity and later substance misuse.

CONCLUSIONS

Within a birth cohort of individuals born in 1950s Stockholm, Sweden, childhood adversity among an individual's friends appears to predict the individual's substance misuse in later life independently of an individual's own exposure to childhood adversity.

Diabetes prevalence and risk factors of early-onset adult diabetes: results from the Indonesian family life survey

BACKGROUND

Diabetes is increasing rapidly in South-East Asia. Studies have reported typical risk factors associated with all-age adult diabetes and highlighted the roles of economic transition and childhood development factors in diabetes in later life. However, little is known about whether these factors were associated with young adult diabetes risk.

OBJECTIVES

The study has two main aims: (1) estimate diabetes prevalence among adult participants of the Indonesian Family Life Survey (IFLS), and (2) identify childhood development factors associated with early-onset adult diabetes (diagnosed between age 20 and 40) in Indonesia.

METHODS

Data were taken from adults participating in 4th and 5th IFLS (in 2007 and 2014) and linked to childhood history from previous surveys. Diabetes was ascertained from self-report and HbA1c testing in a subsample. Diabetes prevalence rates were estimated by age and source of diagnosis. Cox regression analysis was applied to assess potential risk factors for early-onset adult diabetes.

RESULTS

A total of 34,767 participants were included in the study. Crude total prevalence estimate from self-report was 2,3% and increased with age. Including HbA1c measurements yielded nearly eight times higher prevalence estimates, depending on age. The proportion of yet undiagnosed cases is considerably higher in young age groups. Regression analyses showed that urban childhood residence and high education increased early-onset diabetes risk by 50-70%. Sex, childhood general health, socio-economic level and starvation exposure were not associated with early-onset diabetes risk.

CONCLUSION

Remarkable differences between diabetes prevalence rates based on self-report and HbA1c measurement indicated the need for better diagnosis, especially in young adults. Urban childhood residence and high education increased early-onset adult diabetes risk. Incorporating these factors and diabetes awareness in existing child health programs, together with screening of individuals at risk, could improve early diabetes detection and prevention strategies among young urban Indonesian adults.

Beyond the social gradient: the role of lifelong socioeconomic status in older adults' health trajectories

Inequalities in older adults' health rarely consider life-course aspects of socioeconomic status (SES). We examined the association between lifelong SES and old-age health trajectories, and explored the role of lifestyle factors and depressive symptoms in this association. We followed 2760 adults aged 60+ from the Swedish National Study on Care and Aging, Kungsholmen. SES groups were derived using latent class analysis incorporating seven socioeconomic measures spanning childhood, midlife, and late life. We measured health using the Health Assessment Tool, which combines gait speed, cognition, multimorbidity, and disability. Linear mixed models were used to estimate health trajectories. Four SES groups were identified: High (34.9%), Middle (40.2%), Low (21.2%), and Mixed (3.8%). The Mixed group reported greater financial difficulties in childhood and older age, but varying SES attainment in midlife. Baseline health scores indicated that Mixed SES experienced substantial cognitive and physical deficits 12 years earlier than the High SES group. Compared to the High SES group, the Mixed SES group had the fastest health deterioration (β×time=-0.07, 95% CI:-0.11,-0.02); other groups followed a gradient (High>Middle>Low). Lifestyle factors and depressive symptoms attenuated the gradient but did not explain Mixed group's health disadvantage. Life-long SES measures are crucial for understanding older adults' health inequalities.

Rare Disease Research Partnership (RAinDRoP): a collaborative approach to identify research priorities for rare diseases in Ireland

Background:

Rare diseases are individually rare, but collectively these conditions are common. Research on rare diseases are currently focused on disease-specific needs rather than a life-course perspective. The Rare Disease Research Partnership (RAinDRoP) was established in 2018 to bring together a wide variety of diverse voices in the rare disease community in Ireland and form a research partnership.

Methods:

A participatory multiple phase approach was used to identify research priorities for rare diseases. The research process involved three main phases: Phase I, Public Consultation Survey(PCS); Phase II, Research Prioritisation Workshop (RPW); Phase III, Public Prioritisation Ranking Survey (PRS). The time frame for the entire study was from November 2018 to June 2019.

Results:

In total, 240 individuals completed the phase I, of which only 96 survey participants provided information on their background,  32% (n=31) self-identified as a person living with a rare disease(s). One thousand and fifteen statements were collected, which reflected issues and shared challenges in rare diseases. MSExcel was used to gain frequencies and percentages. Phase II was focused on three main themes (1) Route to Diagnosis (2) Living with Rare Disease (3) Integrated and Palliative Care. 42 participants engaged at each workshop. Seventy-five individuals completed the phase III prioritisation ranking survey and ranked the top 15 research priorities.  The top five priorities were (1)Support at the time of diagnosis, (2) Diagnostic test for rare diseases (3)Education and training (4) Patient voice (5) Data sharing and integration of services for rare diseases.

Conclusions:

The research priorities identified here for rare diseases were developed jointly in collaboration with patients, families, healthcare professionals and policymakers. So, we encourage researchers, funding bodies and other stakeholders to use this priority list as a guiding document for future research work to improve the health and lives of people living with rare diseases.

Association between Breastfeeding and DNA Methylation over the Life Course: Findings from the Avon Longitudinal Study of Parents and Children (ALSPAC)

Background: Breastfeeding is associated with short and long-term health benefits. Long-term effects might be mediated by epigenetic mechanisms, yet the literature on this topic is scarce. We performed the first epigenome-wide association study of infant feeding, comparing breastfed vs non-breastfed children. We measured DNA methylation in children from peripheral blood collected in childhood (age 7 years, N = 640) and adolescence (age 15–17 years, N = 709) within the Accessible Resource for Integrated Epigenomic Studies (ARIES) project, part of the larger Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Cord blood methylation (N = 702) was used as a negative control for potential pre-natal residual confounding. Results: Two differentially-methylated sites presented directionally-consistent associations with breastfeeding at ages 7 and 15–17 years, but not at birth. Twelve differentially-methylated regions in relation to breastfeeding were identified, and for three of them there was evidence of directional concordance between ages 7 and 15–17 years, but not between birth and age 7 years. Conclusions: Our findings indicate that DNA methylation in childhood and adolescence may be predicted by breastfeeding, but further studies with sufficiently large samples for replication are required to identify robust associations.

Persistent offenders and adolescence-limited offenders: Differences in life-courses

BACKGROUND AND AIMS

As our previous study indicated, almost half of juvenile delinquents continued offending in adulthood, while the rest ceased to do so. We compared these groups with each other and with non-offenders in the life-course use of alcohol, identity development and life situation.

METHODS

Based on the Jyväskylä Longitudinal Study of Personality and Social Development, four groups were formed at age 42 for men and women: persistent, adolescence-limited and adult-onset offenders and non-offenders. Longitudinal data (N = 369; 53% males) have been collected at ages 8, 14, 20, 27, 36, 42 and 50.

RESULTS

Persistent offending, but not adolescence-limited offending, was associated with the accumulation of problems in adulthood and an elevated risk of death before age 54. For males, persistent offending was associated with heavy drinking from adolescence to middle age, diffuse identity, high divorce rates and poverty. For females, persistent offending was associated with heavy drinking in adulthood and a higher rate of being outside the workforce in middle age. In males, adolescence-limited offending was associated with more controlled drinking in adulthood, and in females, with early divorce from the partner and advanced identity.

CONCLUSIONS

Detecting the risks of the accumulation of problems and potential for positive transitions of juvenile delinquents until middle age will be important for prevention and treatment.

Exploring the School-to-Prison Pipeline: How School Suspensions Influence Incarceration During Young Adulthood

A growing body of research has evoked the life-course perspective to understand how experiences in school relate to a wide range of longer term life outcomes. This is perhaps best typified by the notion of the school-to-prison pipeline which refers to a process by which youth who experience punitive punishment in schools are increasingly enmeshed within the criminal justice system. While this metaphor is commonly accepted, few studies have examined the extent to which exclusionary school discipline significantly alters pathways toward incarceration as youth transition into young adulthood. Applying a life-course perspective and leveraging 15 waves of data from the National Longitudinal Survey of Youth 1997, this study examines how school suspensions influence the odds of imprisonment during young adulthood. Mixed-effects longitudinal models demonstrate that receiving a suspension serves as a key turning point toward increased odds of incarceration, even after accounting for key covariates including levels of criminal offending. However, results show that repeated suspensions do not appear to confer additional risk of incarceration. Results carry implications for the ways in which school punishment impacts youths' life-course.

Putting epigenetic biomarkers to the test for clinical trials

Reliable biomarkers are needed to test the effectiveness of interventions intended to improve health and extend lifespan.

Age at puberty and accelerometer-measured physical activity: Findings from two independent UK cohorts

BACKGROUND

It is unclear if puberty timing influences future physical activity (PA).

AIM

To investigate the association of puberty timing with PA across adolescence and adulthood.

SUBJECTS AND METHODS

Data were from two British cohorts. Participants from an adolescent birth cohort (females = 2349, males = 1720) prospectively reported age at menarche and voice break and had PA recorded by Actigraph accelerometers at ages 14 years and 16 years. A cohort of middle-aged and older adults (40-70 years; females = 48,282; males = 36,112) recalled their age at puberty and had PA (mean acceleration; mg) measured by AxivityAX3 accelerometers.

RESULTS

After adjustment for age, education, smoking and BMI, per 1-year older age at menarche was associated with higher mean counts/minute at age 14 years (0.07 SD counts/minute; 95% CI = 0.04-0.11) with associations attenuated at age 16 years (0.02; -0.03-0.07). Differences in mean acceleration per older year at menarche were close to the null in women aged 40-49 years (0.02 mg; 0.01-0.03), 50-59 years (0.01; 0.00-0.02) and 60-70 years (0.01; 0.00-0.01). Age at voice break and PA associations were close to the null in both cohorts.

CONCLUSION

We found a positive association between puberty timing and PA in females which weakened at older ages and limited evidence of an association at any age in males.