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PURPOSE: Previous research suggests that job loss in a household during pregnancy may perturb fetal growth. However, this work often cannot rule out unmeasured confounding due to selection into job loss. Recent work using data on exogenous job loss (due to a plant closure) finds that a fathers unexpected job loss during his spouses pregnancy increases the risk of a low weight birth. Using a unique set of linked registries in Denmark, we build on this work and examine whether associations between a fathers unexpected job loss and low birthweight differ by trimester of in utero exposure. We additionally examine trimester-specific associations of job loss with small-for-gestational-age, a proxy for restricted fetal growth, which may cause low birthweight. METHODS: We apply a sibling control design to over 1.4 million live births in Denmark, 1980 to 2017, to examine whether this plausibly exogenous form of job loss corresponds with increased risk of low weight or small-for-gestational-age births, depending on the timing of displacement in the first, second, or third trimester. RESULTS: Results indicate an elevated risk of low birthweight (OR = 1.80, 95% CI: 1.24, 2.62) and small-for-gestational-age (OR = 1.40, 95% CI: 1.02, 1.93) among gestations exposed to job loss in the second trimester of pregnancy. Sensitivity analyses using continuous outcome measures (e.g., birthweight in grams, birthweight for gestational age percentile) and maternal fixed effects analyses produce substantively similar inference. CONCLUSIONS: Findings support the notion that unexpected job loss may affect fetal growth and that the second trimester in particular appears sensitive to this external stressor.

Lockdown policies aimed at decreasing the transmission of COVID-19 showed unintended mental health consequences; however, natural settings may offer a respite for individuals suffering from depression or anxiety symptoms. Previous cross-sectional literature reports protective effects of outdoor exposure on mental health during the COVID-19 pandemic. We longitudinally assess whether green exercise corresponded with a decline in adverse mental health symptoms, controlling for state lockdown policies. We also examine whether the relation differed by state lockdown status. As our exposure variable, we specificized participation in an outdoor walk, jog, or hike (green exercise). We used, as the outcome variable, the 4-item Patient Health Questionnaire (PHQ-4) to measure anxiety and depression symptoms. We utilized the Understanding America Study (UAS), a nationally representative sample of 8253 adults across 50 states in the US, surveyed biweekly between March 10, 2020-May 26, 2021. Linear fixed effect analyses controlled for time-invariant individual factors, as well as employment status, and household income. Regression results indicate a modest decline in PHQ-4 scores of approximately 0.10 (less mental health symptoms) as a function of green exercise, controlling for state lockdown status. We also find a slightly greater protective effect of green exercise on mental health symptoms during state lockdown policies. Additionally, we find that green exercise, as opposed to indoor exercise, corresponds with a decrease in PHQ-4 scores during lockdown. Contact with nature may improve mood and decrease mental health symptoms, especially during stress-inducing periods such as the COVID-19 pandemic. Green exercise as a recommended behavioral intervention may hold relevance for greater public health.

BackgroundResearch documents social and economic antecedents of adverse birth outcomes, which may include involuntary job loss. Previous work on job loss and adverse birth outcomes, however, lacks high-quality individual data on, and variation in, plausibly exogenous job loss during pregnancy and therefore cannot rule out strong confounding.MethodsWe analysed unique linked registries in Denmark, from 1980 to 2017, to examine whether a father's involuntary job loss during his spouse's pregnancy increases the risk of a low-weight (i.e.

BackgroundSome scholars posit that attempts to avert stillbirth among extremely preterm gestations may result in a live birth but an early neonatal death. The literature, however, reports no empirical test of this potential form of left truncation. We examine whether annual cohorts delivered at extremely preterm gestational ages show an inverse correlation between their incidence of stillbirth and early neonatal death.MethodsWe retrieved live birth and infant death information from the California Linked Birth and Infant Death Cohort Files for years 1989 to 2015. We defined the extremely preterm period as delivery from 22 to

BackgroundThe Kingdom of Saudi Arabia (KSA), as part of its 2030 National Transformation Program, set a goal of transforming the healthcare sector to increase access to, and improve the quality and efficiency of, health services. To assist with the workforce planning component, we projected the needed number of physicians and nurses into 2030. We developed a new needs-based methodology since previous global benchmarks of health worker concentration may not apply to the KSA.MethodsWe constructed an epidemiologic "needs-based" model that takes into account the health needs of the KSA population, cost-effective treatment service delivery models, and worker productivity. This model relied heavily on up-to-date epidemiologic and workforce surveys in the KSA. We used demographic population projections to estimate the number of nurses and physicians needed to provide this core set of services into 2030. We also assessed several alternative scenarios and policy decisions related to scaling, task-shifting, and enhanced public health campaigns.ResultsWhen projected to 2030, the baseline needs-based estimate is approximately 75,000 workers (5788 physicians and 69,399 nurses). This workforce equates to 2.05 physicians and nurses per 1000 population. Alternative models based on different scenarios and policy decisions indicate that the actual needs for physicians and nurses may range from 1.64 to 3.05 per 1000 population in 2030.ConclusionsBased on our projections, the KSA will not face a needs-based health worker shortage in 2030. However, alternative model projections raise important policy and planning issues regarding various strategies the KSA may pursue in improving quality and efficiency of the existing workforce. More broadly, where country-level data are available, our needs-based strategy can serve as a useful step-by-step workforce planning tool to complement more economic demand-based workforce projections.

The "omnibus" hypothesis, as forwarded by Ford and Dzewaltowski (2008), asserts that poor-quality food environments differentially affect low- and high-socioeconomic status (SES) populations. Accordingly, we examine, in a large sample of non-Hispanic (NH) black women, whether low access to healthy food corresponds with increased risk of obesity among residents of low- and high-poverty neighborhoods. In addition, we analyze whether any discovered association between low-food access and obesity appears stronger in neighborhoods with a high proportion of black residents. We retrieved body mass index (BMI) data for 97,366 NH black women residing in 6258 neighborhoods from the California Department of Public Health birth files for years 2007-2010. We linked BMI data with census tract-level data on neighborhood food access from the 2010 Food Access Research Atlas and neighborhood poverty and black composition from the 2006-2010 American Community Survey 5-year estimates. We applied generalized estimating equation methods that permit analysis of clustered data within neighborhoods. Methods also controlled for individual-level characteristics which might confound the relation between food access and obesity, including health insurance status, age, education, and parity. Results indicate that low-food access does not impact risk of obesity among NH black women residing in low-poverty neighborhoods. However, low-food access varies positively with risk of obesity in high-poverty neighborhoods. Moreover, the association between low-food access and obesity appears stronger in high-poverty, high-black composition neighborhoods, relative to high-poverty, low-black composition neighborhoods. Our findings support the omnibus hypothesis and indicate a potential interaction between factors in the local food and social environments on an individual's risk of obesity.

Housing-mobility programs and housing choice vouchers provide low-income families with a potentially transformative opportunity to move to low-poverty neighborhoods. However, families often face barriers to attaining upward residential mobility; poor health may be one important barrier, although few studies have examined this hypothesis. We used the experimental Moving to Opportunity for Fair Housing Demonstration Project (MTO) Study, constructed residential trajectories, and linked neighborhood opportunity measures to over 14,000 addresses of 3526 families across 7 years. We used latent growth curve longitudinal models to test how baseline health modified effects of MTO housing voucher treatment on neighborhood opportunity trajectories. Results show that poor baseline health adversely influenced how the voucher induced upward mobility. Voucher receipt strongly promoted residential mobility if families were healthy; moreover, the low-poverty neighborhood voucher plus counseling treatment promoted higher-opportunity neighborhood attainment than controls, regardless of the baseline health of the family. However, families with health vulnerabilities did not retain the same initial neighborhood gains conferred by the housing choice voucher (HCV) treatment as families without health vulnerabilities. These results suggest that housing counseling may be one necessary element to expand neighborhood choice into higher-opportunity neighborhoods for families with health challenges. Providing housing vouchers alone is insufficient to promote low-income-family high-opportunity moves, for families who have disabilities or special needs. The implications of these results point to scaling up housing-mobility programs, to provide tailored support for low-income families to use HCVs to make high-opportunity moves, which is particularly necessary for families with health challenges. [ABSTRACT FROM AUTHOR]

Menopause marks the end of female reproductive capacity. It is defined as the point after cessation of the menstrual cycle for 12 months (Nursat et al., 2008). Awareness about menopause has increased over the last decade, yet studies have shown that women still lack knowledge regarding the subject. Likewise, awareness of women between the age of 40–65 on the potential role of physical activity prior to and during menopause in women is unclear. Women (n = 162) aged 40–65 years completed a survey rating their knowledge, answered fact-based questions and reported their experiences of menopause. Their levels of, and beliefs on, the role physical activity on symptoms and menopause associated disease risk were also collected. Women reported their confidence in their current knowledge level at 67% reflecting 37% higher rating than an estimate of their knowledge 10 years ago. Their factual knowledge score was 56%. Knowledge was primarily gained through friends and family and almost half (46%) had not spoken to a healthcare professional. Frustration was expressed with lack of knowledge and support of healthcare and others. Women using HRT (44%) had mixed attitudes towards its role. A high proportion were active and felt that physical activity can help manage symptoms and impact long-term health consequences of menopause. Menopause education strategies for women, healthcare professionals and others need to be improved. Lack of education may be causing women to struggle and feel negatively towards this life stage. Physical activity was viewed positively for the symptoms and a treatment during menopause and long-term health. [ABSTRACT FROM AUTHOR]

Prior research based on Swedish data suggests that collective optimism, as measured by monthly incidence of suicides, correlates inversely with selection in utero against male twins in a population. We test this finding in the US, which reports the highest suicide rate of all high-income countries, and examine whether monthly changes in overall suicides precede changes in the ratio of male twin to male singleton live births. Consistent with prior work, we also examine as a key independent variable, suicides among women aged 15−49 years. We retrieved monthly data on suicides and the ratio of male twin to singleton live births from CDC WONDER, 2003 to 2019, and applied Box-Jenkins iterative time-series routines to detect and remove autocorrelation from both series. Results indicate that a 1% increase in monthly change in overall suicides precedes a 0.005 unit decline in male twin live births ratio 6 months later (coefficient = −.005, p value =.004). Results remain robust to use of suicides among reproductive-aged women as the independent variable (coefficient = −.0012, p value =.014). Our study lends external validity to prior research and supports the notion that a decline in collective optimism corresponds with greater selection in utero. [ABSTRACT FROM AUTHOR]

This article explores the importance of nature exposure in the modern era and the potential health benefits associated with it. It acknowledges the shift from a natural, outdoor lifestyle to one dominated by urban environments, which has limited access to nature, particularly for certain socioeconomic and racial/ethnic groups. The article emphasizes the negative consequences of reduced nature exposure on mental and physical health. It introduces two new technologies, NatureScoreTM and NatureDoseTM, which aim to quantify and promote nature exposure for health promotion purposes. NatureScoreTM is a dataset and tool that estimates the amount and quality of nature at any location, while NatureDoseTM is a mobile app that tracks an individual's daily or weekly exposure to nature. These technologies provide convenient and accurate ways to measure nature exposure and may help researchers understand the benefits of nature exposure and promote its use for health promotion. NatureDoseTM is a smartphone app that passively monitors a person's time spent indoors, outdoors, and outdoors in nature. The app uses the smartphone's sensors, geolocation, and a dataset called NatureScoreTM to determine the user's location and the amount of nature within a 1-km buffer. It assigns full nature exposure time credit when a user is outdoors in a designated natural area, and partial credit when they are outdoors but not in a natural area. The app also allows users to set a weekly goal for time spent outdoors in nature and tracks their progress. It has potential uses for clinicians, researchers, and policymakers, such as setting [Extracted from the article]

Objectives: Research on historical populations in Europe finds that infectious disease epidemics appear to induce predictable cycles in age‐specific mortality. We know little, however, about whether such cycles also occurred in less dense founder populations of North America. We used high‐quality data on the Quebecois population from 1680 to 1798 to examine the extent to which age‐specific mortality showed predictable epidemic cycles. We further examined whether environmental pressures—temperature, lack of precipitation, or crop failure—may have set the stage for the emergence of epidemics. Methods: We applied autoregressive, integrated, moving average time series methods to annual counts of period mortality for the following age groups: < 1 year, 1 to < 5 years, 5 to < 15 years, 15 to < 50 years, and 50 years and above. These methods controlled for other patterns (e.g., trend) before empirically identifying cycles. Results: Results indicate a strong seven‐year cycle in mortality among infants and children under seven years of age. Warm temperatures (across Quebec overall) and relatively dry years (in Eastern Quebec) also predicted an increased risk of mortality in infancy and childhood, although these environmental variables appear to act independently of the epidemic cycle pattern. Discussion: Findings indicate a strong seven‐year epidemic cycle in historical Quebec which afflicted naïve birth cohorts not previously exposed to the prior epidemic. We contend that smallpox epidemics likely contributed to this cycle. The seven‐year cycle occurred only in the latter half of the test period (post 1740) with increasing size of the colony and population concentration in urban areas. [ABSTRACT FROM AUTHOR]

Purpose: Previous research suggests that job loss in a household during pregnancy may perturb fetal growth. However, this work often cannot rule out unmeasured confounding due to selection into job loss. Recent work using data on exogenous job loss (due to a plant closure) finds that a father's unexpected job loss during his spouse's pregnancy increases the risk of a low weight birth. Using a unique set of linked registries in Denmark, we build on this work and examine whether associations between a father's unexpected job loss and low birthweight differ by trimester of in utero exposure. We additionally examine trimester-specific associations of job loss with small-for-gestational-age, a proxy for restricted fetal growth, which may cause low birthweight., Methods: We apply a sibling control design to over 1.4 million live births in Denmark, 1980 to 2017, to examine whether this plausibly exogenous form of job loss corresponds with increased risk of low weight or small-for-gestational-age births, depending on the timing of displacement in the first, second, or third trimester., Results: Results indicate an elevated risk of low birthweight (OR = 1.80, 95% CI: 1.24, 2.62) and small-for-gestational-age (OR = 1.40, 95% CI: 1.02, 1.93) among gestations exposed to job loss in the second trimester of pregnancy. Sensitivity analyses using continuous outcome measures (e.g., birthweight in grams, birthweight for gestational age percentile) and maternal fixed effects analyses produce substantively similar inference., Conclusions: Findings support the notion that unexpected job loss may affect fetal growth and that the second trimester in particular appears sensitive to this external stressor., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Lockdown policies aimed at decreasing the transmission of COVID-19 showed unintended mental health consequences; however, natural settings may offer a respite for individuals suffering from depression or anxiety symptoms. Previous cross-sectional literature reports protective effects of outdoor exposure on mental health during the COVID-19 pandemic. We longitudinally assess whether green exercise corresponded with a decline in adverse mental health symptoms, controlling for state lockdown policies. We also examine whether the relation differed by state lockdown status. As our exposure variable, we specificized participation in an outdoor walk, jog, or hike (green exercise). We used, as the outcome variable, the 4-item Patient Health Questionnaire (PHQ-4) to measure anxiety and depression symptoms. We utilized the Understanding America Study (UAS), a nationally representative sample of 8253 adults across 50 states in the US, surveyed biweekly between March 10, 2020-May 26, 2021. Linear fixed effect analyses controlled for time-invariant individual factors, as well as employment status, and household income. Regression results indicate a modest decline in PHQ-4 scores of approximately 0.10 (less mental health symptoms) as a function of green exercise, controlling for state lockdown status. We also find a slightly greater protective effect of green exercise on mental health symptoms during state lockdown policies. Additionally, we find that green exercise, as opposed to indoor exercise, corresponds with a decrease in PHQ-4 scores during lockdown. Contact with nature may improve mood and decrease mental health symptoms, especially during stress-inducing periods such as the COVID-19 pandemic. Green exercise as a recommended behavioral intervention may hold relevance for greater public health., Competing Interests: The authors of this paper do not report any financial disclosures., (© 2022 Elsevier Ltd. All rights reserved.)

The "omnibus" hypothesis, as forwarded by Ford and Dzewaltowski (2008), asserts that poor-quality food environments differentially affect low- and high-socioeconomic status (SES) populations. Accordingly, we examine, in a large sample of non-Hispanic (NH) black women, whether low access to healthy food corresponds with increased risk of obesity among residents of low- and high-poverty neighborhoods. In addition, we analyze whether any discovered association between low-food access and obesity appears stronger in neighborhoods with a high proportion of black residents. We retrieved body mass index (BMI) data for 97,366 NH black women residing in 6258 neighborhoods from the California Department of Public Health birth files for years 2007-2010. We linked BMI data with census tract-level data on neighborhood food access from the 2010 Food Access Research Atlas and neighborhood poverty and black composition from the 2006-2010 American Community Survey 5-year estimates. We applied generalized estimating equation methods that permit analysis of clustered data within neighborhoods. Methods also controlled for individual-level characteristics which might confound the relation between food access and obesity, including health insurance status, age, education, and parity. Results indicate that low-food access does not impact risk of obesity among NH black women residing in low-poverty neighborhoods. However, low-food access varies positively with risk of obesity in high-poverty neighborhoods. Moreover, the association between low-food access and obesity appears stronger in high-poverty, high-black composition neighborhoods, relative to high-poverty, low-black composition neighborhoods. Our findings support the omnibus hypothesis and indicate a potential interaction between factors in the local food and social environments on an individual's risk of obesity.