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Few studies have tracked the long-term mental health outcomes following major disaster. We sought to document the trajectories of depressive symptoms and post-traumatic stress symptoms (PTSS) in the aftermath of the 2011 Great East Japan earthquake and tsunami. A cohort of community-dwelling older adults were followed for 5.5 years after the disaster at 3 waves (2010, 2013 and 2016). Depressive symptoms were measured by the Geriatric Depression Scale Short Form, while PTSS was assessed by the Screening Questionnaire for Disaster Mental Health. We examined the trajectories of mental illness symptoms based on the probabilities of persistence, recovery, and delayed onset. Among people without pre-disaster depressive symptoms, 13.6% had developed depressive symptoms 2.5 years after the disaster. Of these, half of those had recovered and half had persisted at the 5.5 year follow-up. 11.1% of survivors reported post-traumatic stress symptoms in 2013; of these, 58% recovered by 2016, while 4.8% experienced delayed onset. Job loss was associated with persistent PTSS (OR 2.03; 95%CI 1.01-4.12) while a drop in subjective economic status predicted delayed onset of PTSS (OR 2.13; 1.34-3.39). However, disaster-related experiences were unrelated to the trajectory of depressive symptoms at 5.5 years. The probabilities of remission (58%) and delayed onset (5%) of PTSS are consistent with prior disaster research. The experience of job loss and drop in subjective economic status appeared to exert a lingering influence on the persistence or delayed onset of PTSS. Depressive symptoms after the disaster had remitted in roughly half of the survivors after 5.5 years.

Background Whether workplace social capital affects employees’ mental health is debated. We examined the association between work-unit aggregated social capital and incident purchase of psychotropic medications among employees. Methods We used data from the WHALE (Well-being in Hospital Employees) cohort study. The study population comprised 21,711 employees without recent psychotropic purchase-history nested within 2283 work units in the Capital Region of Denmark. Employees were invited to participate in a survey in March 2014 (86% response). We assessed workplace social capital by eight items (covering trust/justice and collaboration) and aggregated the mean of responses up to each work unit and categorized the scores into quartiles. Data on psychotropic purchases (antidepressants and anxiolytics/hypnotics/sedatives) were extracted via linkage to national registers. Using two-level mixed-effects survival models, we analyzed the association between work-unit social capital and psychotropic purchases during a one-year follow-up period adjusting for individual-level workplace social capital. Results Low work-unit social capital was associated with higher purchases of overall psychotropic medications in a dose-response manner (low-versus-high: HR=1.32, 95% CI=1.05–1.65), but this effect attenuated after adjusting for individual-level workplace social capital (HR=1.14, 95% CI=0.88–1.46). Low work-unit social capital was associated with higher purchases of antidepressants (HR=1.78, 95% CI=1.16–2.73) even after adjusting for individual-level workplace social capital (HR=1.69, 95% CI=1.05–2.73). Limitations Medical doctors/dentists were underrepresented in the data on workplace social capital. Conclusions Low work-unit social capital may be associated with higher use of antidepressants among healthcare employees. Interventions to improve social capital could potentially promote mental health at work in the healthcare setting.

PURPOSE: School social capital incorporates the intangible pro-social resources from social networks, including expectations and social norms, found in a school environment. School social capital may influence health behaviors such as smoking. This study examined the association of school social capital with smoking behaviors from childhood into adolescence. METHODS: We used a cohort sampled from 3 U.S. cities for the Healthy Passages Longitudinal Study of Adolescent Health. The primary outcome was cigarette smoking at grade ten (Wave 3). The primary predictor of interest was school social capital at grade five (Wave 1). We included potential covariates at the individual-, school-, and neighborhood-levels at Wave 1. To account for simultaneous clustering in schools and neighborhoods, cross-classified multilevel models (CCMM) were employed. RESULTS: After exclusions and imputations for missing variables, our final sample contained 3,968 students as constituents of 118 schools and 479 neighborhoods. With adjustment for the covariates, school social capital for grade five was negatively associated with cigarette smoking in grade ten. We estimated that a one-standard deviation increase in the school average social capital for grade five is associated with an odds ratio of 0.86 (95% Credible Interval: 0.75-0.98) for school-level smoking in grade ten. CONCLUSIONS: This study suggests that school social capital in late elementary years is associated with reduced smoking behaviors among adolescents in the United States. Influencing school social capital through enrichment of positive social norms and parent/teacher expectations may be a useful strategy to reduce adolescent smoking, with long-term implications for adult health.

Purpose Five health practices are recognized to be essential for the prevention of chronic disease, viz. avoiding smoking, drinking in moderation, healthy diet, regular physical activity, and adequate sleep. However, how much of these behaviors contribute to socioeconomic disparities in health continues to be debated–some claim “hardly any,” while others say “nearly all.” Methods The data were from the NHANES 2015–16. Selected outcomes were self-rated health, hypertension, cardiovascular disease, and diabetes. Socioeconomic status was measured by education and household income. We implemented Oaxaca–Blinder decomposition to examine the extent to which socioeconomic inequalities in health could be explained by socioeconomic differences in adherence to health practices. Results 55%–90% of education-based inequalities in hypertension (89%), cardiovascular diseases (56%), and diabetes (75%) could be explained by health practices–especially current smoking and overweight. By contrast, most income-related inequalities in health outcomes could not be explained by health practices. Conclusions How much heath practices can account for socioeconomic inequalities in health depends on the indicator of socioeconomic status. Educational disparities in health is explained by the higher prevalence of smoking and overweight in educationally disadvantaged groups. However, income-related gaps in health may require further consideration besides lifestyle modification.

Purpose In the United States (U.S.), southern states have the highest HIV incidence. Uptake of pre-exposure prophylaxis (PrEP) has been slow among Black people, particularly in the South. We know little about how area-level HIV risk influences one's willingness to use PrEP. Methods 169 Black participants across 142 ZIP codes in the South completed the 2016 National Survey on HIV in the Black Community. We performed log-binomial regression to estimate the prevalence risk associated with residing in the upper 25th percentile of increases in new HIV diagnosis (2014–2015) within ZIP code and an individual's willingness to use PrEP, adjusting for individual and area-level covariates. Results Participants were 68% female, mean age of 36 years, and 24% willing to use PrEP. Among the ZIP codes, 23% were within Atlanta, GA. The median increase in new HIV diagnoses was 25 per 100,000 population from 2014 to 2015 (IQR, 14–49). Participants living in ZIP codes within the upper 25th (compared-to-lower 75th) percentile of new HIV diagnoses were more willing to use PrEP (adjusted prevalence ratio (aPR) = 2.02, 95% CI = 1.06–3.86, P = .03). Area-level socioeconomic factors attenuated that association (aPR = 1.63, 95% CI = 0.78–3.39, P = .19). Conclusions Area-level factors may influence PrEP uptake among Black people in the South.

Study objectivesWhile sleep apnea has been associated with cardiovascular disease (CVD) risk factors in white individuals in the U.S., these associations in Chinese and Korean Americans are less well-understood, particularly how these associations vary by age, gender, Asian origin, obesity, chronic conditions, and daytime sleepiness.MethodsWe used a sample of Chinese and Korean Americans ages 50-75 (n = 394) from the Baltimore-Washington DC Metropolitan Area to examine the associations of high risk (HR) sleep apnea with diagnoseable hypercholesterolemia and diabetes, as well as the following biomarkers: total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol/HDL-C ratio, triglycerides, and glucose (non-fasting). Poisson models included demographic factors, socioeconomic status, and body mass index (BMI). We tested for potential effect modifiers.ResultsHR-sleep apnea was associated with higher LDL-C level (β = 14.56, p < 0.05) and higher total cholesterol/HDL ratio (β = 0.64, p < 0.01). Younger respondents had higher levels of triglycerides associated with HR-sleep apnea than older respondents. For men, HR-sleep apnea was associated with higher total cholesterol, total cholesterol/HDL-C ratio, and triglycerides. Obese and overweight respondents had positive associations between HR-sleep apnea and total cholesterol, total cholesterol/HDL ratio, and triglycerides, while underweight/normal weight individuals did not. The interactions between snoring and daytime sleepiness were associated with hypercholesterolemia and diabetes.ConclusionsThis study demonstrates associations between sleep apnea risk and dyslipidemia among Chinese and Korean Americans. Associations were particularly pronounced among younger, male, overweight/obese, and sicker individuals. Future research should examine how to improve sleep health in Asian American populations to improve CVD risk.

Black and low-income neighborhoods tend to have higher concentrations of fast-food restaurants and low produce supply stores. Limited access to and consumption of nutrient-rich foods is associated with poor health outcomes. Given the realities of food access, many members within the Black communities grow food as a strategy of resistance to food apartheid, and for the healing and self-determination that agriculture offers. In this paper, we unpack the history of Black people, agriculture, and land in the United States. In addition to our brief historical review, we conduct a descriptive epidemiologic study of community food-growing spaces, food access, and neighborhood racial composition in present day Philadelphia. We leverage one of the few existing datasets that systematically documents community food-growing locations throughout a major US city. By applying spatial regression techniques, we use conditional autoregressive models to determine if there are spatial associations between Black neighborhoods, poverty, food access, and urban agriculture in Philadelphia. Fully adjusted spatial models showed significant associations between Black neighborhoods and urban agriculture (RR: 1.28, 95% CI = 1.03, 1.59) and poverty and urban agriculture (RR: 1.27, 95% CI = 1.1, 1.46). The association between low food access and the presence of urban agriculture was generally increased across neighborhoods with a higher proportion of Black residents. These results show that Philadelphia neighborhoods with higher populations of Black people and neighborhoods with lower incomes, on average, tend to have more community gardens and urban farms. While the garden data is non-temporal and non-causal, one possible explanation for these findings, in alignment with what Philadelphia growers have claimed, is that urban agriculture may be a manifestation of collective agency and community resistance in Black and low-income communities, particularly in neighborhoods with low food access.

Cannabis celebration day, also known as “420 day”, takes place at 4:20pm on April 20 every year. The objective of this paper is to study whether there is an increase in road traffic collisions in Great Britain on that day. We used daily car crash data resulting in death or injury from all 51 local police forces covering Great Britain over the period 2011–2015. We compared crashes from 4:20pm onwards on April 20 to control days on the same day of the week in the preceding and succeeding two weeks, using panel data econometric models. On the average cannabis celebration day in Britain, there were an additional 23 police-reported collisions compared to control days, corresponding to a 17.9% increase in the relative risk of collision.

Objective Studies have documented the salience of social networks for a range of health outcomes and behaviors among adolescents, but sleep has received far less attention. We examined whether adolescents' network positions relative to cohesive friendship groups and popularity among peers are associated with their sleep behaviors and whether the associations differ by gender. Methods We analyzed friendship data on 2,550 adolescents from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to identify participants' network group positions (member, isolate, liaison) and popularity (number of friendship nominations received). Respondents provided self-reports of sleep duration, insomnia symptoms, and sleep insufficiency. We evaluated the relationships between respondents' group positions and popularity with their sleep behaviors using linear and Poisson regression, adjusting for socio-demographics, self-rated health, smoking and drinking status, integration in non-peer contexts (school, family, and religion), and friends' sleep. Results Results from the total sample show that liaisons report increased risk of sleep insufficiency compared to group members. Higher popularity status is associated with shorter sleep duration and greater sleep insufficiency. Stratifying by gender, popular girls report shorter sleep duration (β = -2.68 min for each additional friendship nomination; 95% CI [-4.75, -.61]) and greater sleep insufficiency (RR = 1.04; 95% CI [1.01, 1.07]) compared to less popular girls. Girls who are liaisons experience more sleep insufficiency (RR = 1.28; 95% CI [1.07, 1.53]) compared to group member girls. In contrast, isolated boys reported more insomnia symptoms (RR = 2.19; 95% CI [1.20, 3.98]) compared to group members. Conclusion Popularity may have hidden costs for girls' sleep, while social isolation seems to be detrimental for boys' sleep. These results suggest that a social network perspective is valuable for studying sleep health and might inform targeted interventions to improve adolescents' sleep outcomes.

Studies across Europe and the US report that childhood socioeconomic disadvantage is associated with poorer health in adulthood. By contrast, a study in Japan suggests that childhood socioeconomic disadvantage may be positive for adult health. In this paper, we assess the association between intergenerational income mobility and self-rated health in Japan, using detailed childhood income data for 1610 men and 1885 women aged 30–49 years. We use an instrumental variable approach to identify the causal effect of upward income mobility on adult health. We find that low father's income during childhood is associated with smoking and alcohol consumption in adult life for both men and women. For men, upward income mobility was associated with worse health. Certain behavioural choices related to income mobility, such as long working hours, may have detrimental health effects.

Purpose The purpose of this study was to investigate the association of early social environment with Kawasaki disease (KD). Methods We analyzed the data of children aged up to 10 years derived from the 21st Century Longitudinal Survey in Newborns (n = 41,872) in Japan. Parental education, total household income, and family size were obtained via a questionnaire at 0.5 years after birth. Physician's diagnosis of KD during the past year was surveyed via a questionnaire for caregiver with children aged up to 10 years. We used Cox proportional hazards modeling to examine the risk factors for KD onset. Results Children born in households with an annual income of JPY 10 million or more were 1.76 times more likely to have KD onset compared with children born in households with an income of less than JPY 4 million (hazard ratio: 1.76, 95% confidence interval [CI]: 1.15–2.69). Children born in households with three or less persons were 1.62 times more likely to have KD onset compared with those born in households with six or more persons (95% CI: 1.10–2.40). The children who were born in urban municipalities also showed higher risk of KD onset compared with those born in rural municipalities (hazard ratio: 1.55, 95% CI: 1.06–2.26). Conclusions Higher household income, smaller family size, and urbanization at birth were associated with increased KD incidence. This study, however, did not find a significant association between lack of exposure to infection in early life and onset of KD.

Health communication inequality is one of the potential mechanisms linking socioeconomic status (SES) to health disparities. To our knowledge, no previous study has examined the association between exposure to health information and mortality. We analyzed 3-year follow-up cohort data from the Japan Gerontological Evaluation Study (JAGES), involving 8544 males and 9698 females aged 65 years or older, to examine associations between exposure to health information via different types of media and mortality. The baseline survey was conducted from October to December 2013 in 21 municipalities in Japan. Adjusted for health conditions, health behaviors, and other potential confounders, Cox proportional hazards models were used to estimate hazard ratios (HRs) of all-cause mortality. Over a mean of 3.2 years of follow-up, 956 deaths occurred. Among females, receiving health information from TV programs was associated with lower mortality (HR = 0.90; 95% confidence interval [CI] = 0.83, 0.98). By contrast, there were no significant associations among males. Our findings suggest that improving the accuracy of health information delivered via television might be beneficial.

RationalePrevious research has shown that uncertainty can affect mental health, and that unemployment and economic recessions are associated with increased suicide rates.ObjectiveThe objective of this article was to examine whether daily fluctuations in economic uncertainty can result in short-term spikes in the number of suicides. While existing evidence has focused on medium- and long-term effects of economic conditions on suicide, this study examined immediate daily deviations from the background general trend.MethodsWe used daily suicide data from England and Wales that were matched to a daily economic policy uncertainty index over the period 2001–2015. We followed an econometric approach to examine the impact of uncertainty on suicides, controlling for unemployment rates.ResultsWe found that a spike in daily economic uncertainty leads to an immediate, yet short-lived, impact on suicides. A one-day lag also has a positive effect, but there is no effect on subsequent days. The impact appears to be stronger for males than for females. Results are robust to different empirical approaches and model specifications.ConclusionsOverall, our study suggests that economic uncertainty may lead to an increase in the risk of suicide. This immediate effect indicates that uncertainty acts as a trigger, and is unlikely to be the sole cause of suicide, which reflects existing evidence on the impulsive nature of some suicides. This highlights the need to reduce ‘access to means’, and the importance of the timing of suicide prevention measures.

Background: The maintenance of optimal body weight is a crucial component in health and quality of life. However, little is known about weight distribution and trends among people with disabilities. This study in South Korea examined the 10-year trends of weight and prevalence of underweight, overweight and obesity according to disability grade and types compared with those without disabilities. Methods: We linked national disability registration data with national cancer screening program data. Age-standardized prevalence of underweight and obesity were analyzed for each year during the period 2008 to 2017, according to the presence, type, and severity of disabilities. Risk of underweight, overweight, obesity, and severe obesity were examined by multinomial logistic regression after adjusting for socio-demographic and clinical variables as of 2017. Findings: People with disabilities (both male and female) had a higher risk of underweight compared to those without disability (OR 1·41, 95% CI 1·38-1·44, and OR 1·31, 95% CI 1·28-1·34, respectively), especially in those with severe disabilities (OR 2·00, 95% CI 1·94-2·06 in male, and OR 1·83, 95% CI 1·77-1·89 in female, respectively). The age-standardized prevalence of severe obesity (BMI ≥30·0 kg/m2 ) was also higher in people with disability, and the disparity relative to people without disability widened from 1·8% in 2008 to 3·7% in 2017. Women with disabilities are more likely to be obese than those without disabilities regardless of disability severity (OR 1·40, 95% CI 1·38-1·41). The risk of severe obesity was also more prominent in women with disabilities (OR 2·08, 95% CI 2·05-2·11). Interpretation: Physical, mental and developmental disabilities were significantly associated with higher prevalence of obesity as well as underweight. The intersection of female gender, severe disability, and mental/developmental disabilities was associated with risk of severe obesity. Simultaneous efforts are needed to enhance food security as well as weight control and exercise for people with disabilities. Funding Statement: This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean Ministry of Science and ICT (MSIT) (No. 2019R1A2C1087507 and 2021R1C1C2008683) and the Korean Ministry of Education (No. 2019R1D1A3A03103862). Declaration of Interests: We declare no competing interests. Ethics Approval Statement: The study protocol was approved by the Institutional Review Board of Chungbuk National University (CBNU-201910- BMETC-946-01)

Summary: Background: Having a purpose in life has been linked to improved health and wellbeing; however, it remains unknown whether having “Ikigai”—a related but broader concept in Japan—is also beneficial for various physical and psychosocial outcomes. Methods: Using data from a nationwide longitudinal study of Japanese older adults aged ≥65 years, we examined the associations between having Ikigai in 2013 and a wide range of subsequent outcomes assessed in 2016 across two databases (n = 6,441 and n = 8,041), including dimensions of physical health, health behavior, psychological distress, social wellbeing, subjective wellbeing, and pro-social/altruistic behaviors. We adjusted for sociodemographic characteristics and the outcome values (whenever data were available) in the prior wave (2010). Findings: Having Ikigai (vs. not having Ikigai) was associated with a 31% lower risk of developing functional disability [95% confidence interval (CI) for risk ratio: 0.58, 0.82] and 36% lower risk of developing dementia [95% CI for risk ratio: 0.48, 0.86] during the three-year follow-up. Having Ikigai was associated with decreased depressive symptoms and hopelessness as well as higher happiness, life satisfaction, instrumental activity of daily living, and certain social outcomes (e.g., more frequent participation in hobby clubs). Some of these associations were stronger for men than women, and among individuals with high socioeconomic status (p-values for effect measure modification

Background: Disparities in the diagnosis, treatment, and survival of prostate cancer (PC) patients according to disability status have not been widely investigated. Methods: A retrospective cohort study using disability registration data linked to Korean National Health Insurance and national cancer registry data. 7,924 PC patients with disabilities and 34,188 age-matched PC patients without disability were included. Results: While stage distribution at diagnosis was similar, unknown stage was more common in patients with severe disabilities compared to those without disabilities (18·1% vs. 16·2%, respectively). People with disabilities were less likely to undergo surgery (33·1% vs. 38·6%, respectively; adjusted odds ratio [aOR] 0.79, 95% confidence interval [CI] 0.74-0.84), and more likely to receive androgen deprivation therapy (ADT) (57·9% vs. 55.0%, respectively; aOR 1·10, 95% CI 1·04-1·16) compared to those without disabilities. This was more evident for people with severe brain/mental impairment (aORs 0·29 for surgery; 1·52 for ADT). Patients with disabilities had higher overall mortality (adjusted hazard ratio [aHR] 1·20; 95% CI, 1·15-1·25), but only slightly higher PC-specific mortality after adjustment for patient factors and treatment (aHR 1·11, 95% CI 1·04-1·18) than people without disability. Interpretation: PC patients with disabilities underwent less staging work-up and were more likely to receive ADT than surgical treatment. Overall mortality of PC patients with disabilities was greater than those of PC patients without disability, but PC-specific mortality was only slightly worse. Unequal clinical care in this vulnerable population suggests the presence of disability-related barriers that need to be addressed. Funding Statement: This work was supported by an R&D grant (No. 2016007) from the Korea National Rehabilitation Center Research Institute, Ministry of Health & Welfare, and the National Research Foundation of Korea(NRF) grant funded by the Ministry of Education (No.2016R1D1A3B03931142) and by the Korea government(MSIT) (No. 2019R1H1A2080180, 2019R1A2C1087507). Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: Institutional Review Board approval was obtained from Chungbuk National University (IRB No. CBNU-201708-BM-501-01).

Background: Using the linked administrative database in Korea, we sought to investigate 1) whether there are disparities in liver cancer screening according to degree and type of disability and 2) temporal trends in liver cancer screening among people with disabilities. Methods: We linked national disability registration data with national cancer screening data. We analyzed age-standardized participation rates for each year during the 2006-2015 period according to presence, type, and severity of disability. We also examined factors associated with liver cancer screening by multivariate logistic regression using the most current data (2014-2015). Findings: The age- and sex-adjusted screening rate for liver cancer in people with disabilities increased from 25.7% in 2006 to 49.6% in 2015 (change: +23.9%); however, during the same period, screening rate among people without disabilities increased from 24.9 to 54.5% (change: +29.6%). As a result, disparities in liver cancer screening increased over time. The screening participation rate among people with disabilities was 12% lower than among people without disabilities (adjusted OR [aOR] 0.88, 95% confidence interval [CI], 0.87-0.89). Screening rates were markedly lower among people with severe disabilities (aOR 0.71, 95% CI 0.70-0.72) and people with renal disease (aOR 0.43, 95% CI 0.41-0.45), brain injuries (aOR 0.60, 95% CI 0.58-0.62), ostomy problems (aOR 0.60, 95% CI 0.53-0.68), and intellectual disabilities (aOR 0.69, 95% CI 0.66-0.73). Interpretation: Despite the availability of a national liver cancer screening program, a marked disparity was found in liver cancer screening participation, especially among people with severe disabilities, renal disease, or brain-related or mental disabilities. Funding Statement: This work was supported by the R&D grant (No. 2016007) on rehabilitation by Korea National Rehabilitation Center Research Institute, Ministry of Health & Welfare, and the National Research Foundation of Korea(NRF) grant funded by the Ministry of Education (No.2016R1D1A3B03931142) and by the Korea government(MSIT) (No. 2019R1H1A2080180, 2019R1A2C1087507) and by the Ministry of Science, ICT, & Future Planning (No. 2016R1A2B4011045). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Our study was approved by the Institutional Review Board of Chungbuk National University (CBNU-201708-BM-501-01).

BACKGROUND: Hydroxychloroquine (HCQ) is the standard of care medication for most SLE patients, however nonadherence is common. We investigated longitudinal patterns and predictors of nonadherence to HCQ in a U.S. SLE cohort of HCQ initiators. METHODS: We used Medicaid data from 28 states to identify adults 18–65 years with prevalent SLE. We included HCQ initiators following ≥6 months without use, and required ≥1 year of follow-up after first dispensing (index date). We used the proportion of days covered (PDC) to describe overall HCQ adherence (

OBJECTIVE: To investigate the possible effects of middle and high school racial composition on later reporting of lifetime non-medical use of prescription painkillers (NMUPP) in young adulthood, and to explore whether there is evidence of variability by individual race/ethnicity in such effects.METHODS: Using data from Wave 1 (1994/5) of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we categorized the sample's 52 middle schools and 80 high schools as majority (>50%) non-Hispanic white, majority non-Hispanic black, or neither. We used two-level hierarchical modeling to explore associations between individual- and school-level race at Wave 1 and lifetime prescription painkiller misuse reported at Wave 4. We included a cross-level interaction between individual race and school racial composition to assess variability in school-level associations by race.RESULTS: Overall crude prevalence of lifetime NMUPP in majority white schools (17.9%) was over three times that of prevalence in majority black schools (4.8%), and also higher than prevalence in schools neither predominantly black nor predominantly white (12.4%). Lifetime misuse among blacks in majority white schools was more prevalent (5.2%) than among blacks in black schools (2.8%), as was misuse among whites in white schools (19.3%) compared to their white peers in black schools (15.7%). Two-level random intercept Poisson regression results suggest that attendance in a majority black secondary school lowered a participant's risk of lifetime NMUPP (compared to attending a majority white school: RR=0.66, p = 0.03). Compared to blacks in black schools, blacks in white schools had twice the risk of prescription painkiller misuse (p = 0.004) over a decade later, and whites in white schools had 5.5 times the risk (p = 0.01). The risk ratio comparing whites in black schools to whites in white schools was not significant (RR: 1.30; p = 0.37).CONCLUSIONS: We found evidence of an effect of school racial composition on the risk of misusing prescription painkillers over a decade later, over and above individual race, with higher risk of misuse reported among participants who had attended white schools. Black participants who had attended predominantly white schools were, on average, twice as likely to report lifetime misuse of prescription painkillers compared to blacks who had attended black schools.

Background Socioeconomic inequalities in female cancer incidence have previously been undocumented in Japan. Methods Using a nationwide inpatient dataset (1984–2016) in Japan, we identified 143,806 female cancer cases and 703,157 controls matched for sex, age, admission date, and admitting hospital, and performed a hospital-based matched case-control study. Based on standardized national classification, we categorized patients’ socioeconomic status (SES) by occupational class (blue-collar, service, professional, manager), cross-classified by industry sector (blue-collar, service, white-collar). Using blue-collar workers in blue-collar industries as the reference group, we estimated the odds ratio (OR) for each cancer incidence using conditional logistic regression with multiple imputation, adjusted for major modifiable risk factors (smoking, alcohol consumption). Results We identified lower risks among higher-SES women for common and overall cancers: e.g., ORs for managers in blue-collar industries were 0.67 (95% confidence interval [CI], 0.46–0.98) for stomach cancer and 0.40 (95% CI, 0.19–0.86) for lung cancer. Higher risks with higher SES were evident for breast cancer: the OR for professionals in service industries was 1.60 (95% CI, 1.29–1.98). With some cancers, homemakers showed a similar trend to subjects with higher SES; however, the magnitude of the OR was weaker than those with higher SES. Conclusions Even after controlling for major modifiable risk factors, socioeconomic inequalities were evident for female cancer incidence in Japan., Highlights • Socioeconomic status is considered as a fundamental determinant for cancer risk. • Occupational inequalities in female cancer incidence remain sparse in Japan. • Higher-occupational class women had lower risks of stomach and lung cancer. • Higher-occupational class women had higher risk of breast cancer. • Even after controlling for major modifiable risk factors, the association remained.

Introduction There is little known about the association between non-parental care in early childhood and attention-deficit/hyperactivity disorder (ADHD) symptoms in preschoolers. Therefore, we examined the association between childcare from grandparents/babysitters during infancy/preschool and ADHD symptoms in preschoolers. Methods Using stratified random sampling, we developed a sample comprising 1597 parents of children aged 1.6–7 years who were enrolled in preschool in rural and urban areas of China. Parental reports of ADHD symptoms were assessed using the preschool version of the ADHD Rating scale-IV. A regression analysis was used to examine the association between childcare from grandparents/babysitters and ADHD symptoms. Results Childcare from grandparents during infancy was associated with ADHD symptoms in childhood (β = 1.03, P < 0.0001). Significant associations between grandparental care and ADHD symptoms were also observed in children from families with more than one child (β = 0.64, P = 0.0035) and children living in rural areas (β = -0.78, P = 0.0032). A babysitter as the primary child caregiver in preschool was especially strongly correlated with ADHD symptoms in girls (β = 7.95, P = 0.0042). Moreover, region was strong factor associated with ADHD symptoms without adjustment for the non-parental caregivers’ age and education, whereas family income was not strongly associated with ADHD symptoms. Conclusion Non-parental caregiving (i.e., from grandparents or babysitters) in early childhood was associated with more ADHD symptoms in children. Certain characteristics in children, such as female gender and the existence of siblings, were stronger moderating factors than were family income and region., Attention-deficit/hyperactivity disorder; Non-parental care; Preschooler; Socioeconomic status.

There is a growing literature demonstrating the health benefits of social capital (defined as the resources accessed through social connections). However, social capital is also acknowledged to be a "double-edged" phenomenon, whose effects on health are not always positive. We sought to systematically review studies that have found a negative (i.e. harmful) association between social capital and health outcomes. Our objective was to classify the different types of negative effects, following a framework originally proposed by Portes (1998). We conducted a literature search in Pubmed, Embase and PsychInfo. We identified 3530 manuscripts. After detailed review, we included 44 articles in our systematic review. There are at least two negative consequences of social capital besides the classification proposed by Portes: behavioral contagion and cross-level interactions between social cohesion and individual characteristics. When leveraging the concept of social capital for health promotion interventions, researchers need to take account of these potential "downsides" for health outcomes.

Background Disparities in cancer care have not been well documented for individuals with disability. Objective To investigate potential disparities in the diagnosis, treatment, and survival of prostate cancer (PC) patients according to disability status. Methods A retrospective cohort study using disability registration data linked to Korean National Health Insurance and national cancer registry data. Totals of 7924 prostate cancer cases among patients with disabilities (diagnosed between 2005 and 2013) and 34,188 PC patients without disability were included. Results While overall PC stage distribution at diagnosis was similar, unknown stage was more common in patients with severe disabilities compared to those without disabilities (18.1% vs. 16.2%, respectively). People with disabilities were less likely to undergo surgery (33.1% vs. 38.6%, respectively; adjusted odds ratio [aOR] 0.79, 95% confidence interval [CI] 0.74–0.84), and more likely to receive androgen deprivation therapy (ADT) (57.9% vs. 55%, respectively; aOR 1.10, 95% CI 1.04–1.16) compared to those without disabilities. This was more evident for people with severe brain/mental impairment (aORs 0.29 for surgery; 1.52 for ADT). Patients with disabilities had higher overall mortality (adjusted hazard ratio [aHR] 1.20; 95% CI, 1.15–1.25), but only slightly higher PC-specific mortality after adjustment for patient factors and treatment (aHR 1.11, 95% CI 1.04–1.18) than people without disability. Conclusions PC patients with disabilities underwent less staging work-up and were more likely to receive ADT than surgical treatment. Overall mortality of PC patients with disabilities was greater than those of PC patients without disability, but PC-specific mortality was only slightly worse.

Background: Machine learning (ML) has spread rapidly from computer science to several disciplines. Given the predictive capacity of ML, it offers new opportunities for health, behavioral, and social scientists. However, it remains unclear how and to what extent ML is being used in studies of social determinants of health (SDH). Methods: Using four search engines, we conducted a scoping review of studies that used ML to study SDH (published before May 1, 2020). Two independent reviewers analyzed the relevant studies. For each study, we identified the research questions, Results, data, and algorithms. We synthesized our findings in a narrative report. Results: Of the initial 8097 hits, we identified 82 relevant studies. The number of publications has risen during the past decade. More than half of the studies (n = 46) used US data. About 80% (n = 66) utilized surveys, and 70% (n = 57) employed ML for common prediction tasks. Although the number of studies in ML and SDH is growing rapidly, only a few studies used ML to improve causal inference, curate data, or identify social bias in predictions (i.e., algorithmic fairness). Conclusions: While ML equips researchers with new ways to measure health outcomes and their determinants from non-conventional sources such as text, audio, and image data, most studies still rely on traditional surveys. Although there are no guarantees that ML will lead to better social epidemiological research, the potential for innovation in SDH research is evident as a result of harnessing the predictive power of ML for causality, data curation, or algorithmic fairness. Funding Agencies| [JP20J01910]

Purpose Previous studies have suggested that individuals affected by natural disasters experience changes in their cortisol levels. However, the associations have not been consistent, with results indicating either elevated cortisol levels or reduced levels. We examined serum cortisol levels among survivors who experienced housing damage in the 2011 Great East Japan Earthquake. Methods A cross-sectional sample was drawn from a cohort of 9,148 survivors living in three affected municipalities in Iwate prefecture, Japan (mean age, 61.0 years; men, 38.9%). Serum cortisol levels were measured between 5 to 9 months after the 2011 disaster. Housing damage was categorized into three groups: no damage, major damage, and undamaged but inundated. The association between serum cortisol and housing damage was examined using generalized linear regression. Results Cortisol levels were significantly lower in individuals who experienced major damage or inundation compared the group with no damage (coefficient [95% confidence interval (CI)]: major damage group, -0.47 ug/dL [-0.64 to -0.30], P Conclusions Severe housing damage was related to lower cortisol levels in tsunami affected survivors.

Background Few studies have examined associations between neighborhood social cohesion and sexual risk behaviors among gay, bisexual, and other sexual minority men (SMM), and none have among Black SMM in the southern U.S. The purpose of the current study is to examine associations between neighborhood social cohesion and sexual risk behaviors among Black SMM in the southern U.S., a population heavily impacted by HIV. We also examined whether these relationships are modified by religious participation for Black SMM in the southern U.S. Methods Data was obtained from the MARI Study, a sample of Black SMM ages 18–66 years, recruited from the Jackson, MS and Atlanta, GA metropolitan areas (n = 354). Neighborhood social cohesion was assessed with a validated 5-item scale. We conducted multivariable regression analyses to examine the association between neighborhood social cohesion with each of the sexual risk behaviors (e.g., condomless sex and drug use before or during sex), controlling for key confounders. We then performed moderation analysis by religious participation (religious attendance and private religiosity). Results Compared to Black SMM with higher perceived neighborhood social cohesion, Black SMM with lower neighborhood social cohesion had increased odds of alcohol use before or during sex (aPR = 1.56; 95% CI = 1.16–2.11) and condomless anal sex with casual partners (aPR = 1.55; 1.03–2.32). However, the magnitude of these associations varied by religious attendance and private religiosity. Black SMM with low religious service attendance had higher risk of alcohol use in the context of sex when perceived neighborhood social cohesion was low; those with high private religiosity had elevated alcohol use in the context of sex when perceived neighborhood social cohesion was low. Discussion Interventions that target connectedness among neighborhood members through community education or mobilization efforts, including the involvement of religious organizations, should be considered for HIV prevention focused on alcohol and condomless sex among Black SMM.

Introduction Income is hypothesized to affect health not just through material pathways (i.e., the ability to purchase health-enhancing goods) but also through psychosocial pathways (e.g., social comparisons with others). Two concepts relevant to the psychosocial effects of income are: relative deprivation (for example expressed by the Yitzhaki Index, measuring the magnitude of difference in income among individuals) and Income Rank. This study examined whether higher relative deprivation and lower income rank are associated with depressive symptoms in an older population independently of absolute income. Method Using cross-sectional data of 83,100 participants (40,038 men and 43,062 women) in the Japan Gerontological Evaluation Study (JAGES), this study applied multiple logistic regression models to calculate the odds ratios ( OR ) of depression associated with relative deprivation/Income Rank. The Japanese Geriatric Depression Scale (GDS-15) was used to assess depressive symptoms, and subjects with a score of ≥5 were categorized as depressed. Reference groups for calculating the Yitzhaki Index and income rank were constructed based on same gender, age-group, and municipality of residence. Results The findings indicated that after controlling for demographic factors, each 100,000 yen increase in relative deprivation and 0.1 unit decrease in relative rank was associated with a 1.07 (95% CI = 1.07, 1.08) and a 1.15 (95% CI = 1.14, 1.16) times higher odds of depression, respectively, in men. The corresponding OR s in women were 1.05 (95% CI = 1.05, 1.06) and 1.12 (95% CI = 1.11, 1.13), respectively. After adjustment for other covariates and stratification by income quartiles, the results remained statistically significant. Women in the highest income quartile appeared to be more susceptible to the adverse mental health effects of low income rank, while among men the associations were reversed. Low income rank appeared to be more toxic for the poor. Conclusion Concepts of relative income appear to be relevant for mental health over and above the effects of absolute income.

Background Upper-tract urothelial cancer (UTUC), which includes renal pelvic cancer and ureter cancer, is a rare cancer and its prognosis is poor. Smoking and high-risk occupations (e.g., printing and dyestuff working which involves exposure to aniline dyes) are well-known risk factors for UTUC. However, the risk of alcohol consumption in UTUC remains unclear. This study aimed to determine whether alcohol consumption is an independent risk factor for UTUC. Methods The study was a case–control study which used the nationwide clinical inpatient database of the Rosai Hospital group in Japan. We identified 1569 cases and 506,797 controls between 1984 and 2014. We estimated the odds ratio (OR) and 95% confidence interval (95%CI) of alcohol consumption for UTUC – never, up to 15g/day, >15–30g/day, or >30g/day – using unconditional logistic regression. We adjusted for the following covariates: age, sex, study period, hospital, history of smoking, and high-risk occupation. Results The risk of UTUC was significantly higher in ever-drinkers compared with never-drinkers (OR=1.23, 95%CI, 1.08–1.40; P =0.001). Compared with never-drinkers, the risk threshold for UTUC was >15g of alcohol consumption per day (equivalent to 6 ounces of Japanese sake containing 23g of alcohol). A dose-response was observed ( P Conclusion Alcohol consumption may be an independent risk factor for UTUC, with a low-risk threshold of 15g of alcohol per day.

Purpose Underestimating one's weight is often seen as a barrier to weight loss. However, recent research has shown that weight underperception may be beneficial, with lower future weight gain and fewer depressive symptoms. Here, we examine the relationship between adolescent weight underperception and future blood pressure. Methods Using data from the National Longitudinal Study of Adolescent to Adult Health, we obtained a nationally representative sample of 2,463 adolescents with overweight and obesity (students in grades 8–12 in 1996). We used multivariable linear regression to prospectively examine the relationship between weight self-perception in adolescence and blood pressure in adulthood (year 2008; follow-up rate 80.3%), controlling for age, gender, race/ethnicity, smoking, alcohol consumption, education level, household income, and body mass index. Additional analyses were stratified by gender and race/ethnicity. Results Youth with overweight/obesity who underperceived their weight had lower blood pressure in adulthood than those who perceived themselves to be overweight. The decrease in systolic blood pressure was −2.5 mm Hg (95% confidence interval: −4.3, −0.7; p = .006). Although the interaction by gender was statistically insignificant ( p = .289), important differences appeared upon stratification by gender. Young men showed no significant difference in adult blood pressure related to weight self-perception. Conversely, in young women, weight underperception was associated with an average decrease in systolic blood pressure of −4.3 mm Hg (95% confidence interval: −7.0, −1.7; p = .002). Conclusions Contrary to conventional wisdom, weight underperception is associated with improved health markers in young women. The observed differences in blood pressure are clinically relevant in magnitude, and interventions to correct weight underperception should be re-examined for unintended consequences.

The effect of anti-poverty tax credit interventions on tobacco consumption is unclear. Previous studies have estimated short-term effects, did not isolate the effects of cumulative dose of tax credits, produced conflicting results, and used methods with limited control for some time-varying confounders (e.g., those affected by prior treatment) and treatment regimen (i.e., study participants' tax credit receipt pattern over time). We estimated the longer-term, cumulative effect of New Zealand's Family Tax Credit (FTC) on tobacco consumption, using a natural experiment (administrative errors leading to exogenous variation in FTC receipt) and methods specifically for controlling confounding, reverse causation, and treatment regimen. We extracted seven waves (2002-2009) of the nationally representative Survey of Family, Income and Employment including 4404 working-age (18-65 years) parents in families. The exposure was the total numbers of years of receiving FTC. The outcomes were regular smoking and the average daily number of cigarettes usually smoked at wave 7. We estimated average treatment effects using inverse probability of treatment weighting and marginal structural modelling. Each additional year of receiving FTC affected neither the odds of regular tobacco smoking among all parents (odds ratio 1.02, 95% confidence interval 0.94-1.11), nor the number of cigarettes smoked among parents who smoked regularly (rate ratio 1.01, 95% confidence interval 0.99-1.03). We found no evidence for an association between the cumulative number of years of receiving an anti-poverty tax credit and tobacco smoking or consumption among parents. The assumptions of marginal structural modelling are quite demanding, and we therefore cannot rule out residual confounding. Nonetheless, our results suggest that tax credit programme participation will not increase tobacco consumption among poor parents, at least in this high-income country.

Bridging social capital is defined as the connections between individuals who are dissimilar with respect to socioeconomic and other characteristics. There is an important gap in the literature related to its measurement. We describe the development and validation of a questionnaire to measure bridging social capital. We focused the development of the questionnaire to be suitable for use in Latino immigrant populations in the U.S. The structure of the questionnaire comprised the following: Socialization in the job place (5 items); Membership in community activities (16 items); Participation in community activities (5 items); Contact with similar/different people (7 items); Assistance (17 items); Trust of institutions, corporations and other people(14 items); and Trust of intimate people (3 items). First, we used focus groups (N=17 participants) to establish content validity with an inductive thematic analysis to identify themes and subthemes. Changes were made to the questionnaire based on difficulty, redundancy, length and semantic equivalence. Second, we analyzed the questionnaire's psychometric properties (N=138). We tested internal consistency with Cronbach alpha and construct validity with a Confirmatory Factor Analysis (CFA) for each sub-scale to test theoretical unity; discriminant validity to observe differences between participants from high and low SES backgrounds and different language; and content validity with an independent expert panel. Cronbach alphas ranged from 0.80 (Assistance) to 0.92 (Trust). CFA results indicated that CFI and TLI were higher than 0.90 in almost all the scales, with high factor loadings. The Wilcoxon tests indicated that there were statistically significant mean differences between SES and language groups (p, Highlights • Bridging social capital evaluates connections between dissimilar individuals. • The measurement of bridging social capital is crucial in underserved populations. • There is an important gap in the literature related to its measurement. • We present a validated questionnaire to test bridging social capital.

Rationale Few studies have examined whether changes in participation in civic associations can mitigate depressive symptoms among older disaster survivors. Objectives We examined prospectively the association between changes in participation in civic associations and changes in depressive symptoms among older survivors of the 2011 Great Eastern Japan Earthquake. Methods We analyzed questionnaire-based survey data on pre- and post-disaster participation in civic associations and depressive symptoms compiled for 3567 respondents aged 65 years and above. Changes in these symptoms were assessed using a 15-item Geriatric Depression Scale (GDS) as a continuous variable for 2010 and 2013. We investigated four types of civic associations: sports, hobby, voluntary groups, and senior citizens’ clubs. Changes in participation were calculated by subtracting the participation frequency measured in 2010 from that measured in 2013. Applying 95% confidence intervals, we used linear regression models with imputation to estimate the age- and sex-adjusted and multivariate-adjusted standardized coefficients. Results The survivors' GDS scores increased by 0.13 points on average between the pre-disaster and post-disaster periods. Average changes in the participation frequencies of respondents in each group were respectively +0.36 days/year, −5.63 days/year, +0.51 days/year, and −1.45 days/year. Increased frequencies of participation in the sports and hobby groups were inversely associated with changes in GDS scores (B = −0.003, Cohen's f2 = 0.10, P = 0.01 and B = −0.002, Cohen's f2 = 0.08, P = 0.04, respectively). The associations did not differ depending on the experience of housing damage caused by the disaster. In addition, we did not observe a significant association between changes in participation frequencies for voluntary groups or senior citizens' clubs and changes in GDS scores after multivariable adjustment. Conclusions Depressive symptoms of older adults post-disaster may be mitigated through increased frequency of participation in sports and hobby groups; yet, civic participation did not mitigate the adverse impact of disaster experiences on mental health.

Objective Dispositional optimism – the general belief that good things will happen – is considered a key asset for the preservation of mental health after a traumatic life event. However, it has been hypothesized that in extreme situations such as major disasters where positive expectations cannot overcome the grim reality on the ground, being optimistic might be a disadvantage. To test this mismatch hypothesis, this study explores whether higher pre-disaster dispositional optimism is associated with higher posttraumatic stress (PTS) and depressive symptoms among individuals who experienced the 2011 Great East Japan Earthquake and Tsunami. Methods Information on optimism was collected from community-dwelling residents aged ≥65 years seven months before the 2011 Earthquake/Tsunami in Iwanuma, a Japanese city located 80-km from the epicenter. Data on disaster-related personal experiences (e.g., loss of relatives or friends/housing damage), as well as depressive and PTS symptoms, were collected during a follow-up survey in 2013, 2.5 years after the earthquake and tsunami. Multiple logistic regression models were utilized to evaluate the associations between disaster experiences, optimism, and depressive/PTS symptoms among 962 participants. Results Higher pre-disaster dispositional optimism was associated with lower odds of developing depressive symptoms (OR = 0.78, 95% CI: 0.65 to 0.95) and PTS symptoms (OR = 0.83, 95% CI: 0.69 to 0.99) after the earthquake. Contrary to the mismatch hypothesis, high dispositional optimism buffered the adverse impact of housing damage on depressive symptoms (interaction term coefficient = −0.63, p = 0.0431), but not on PTS symptoms. Conclusions In contrast to the mismatch hypothesis, the results suggest that dispositional optimism is a resilience resource among survivors of a disaster.

Summary Background Inequality of opportunity, defined as differences in the prospects for upward social mobility, might have important consequences for health. Diminished opportunity can lower the motivation to invest in future health by reducing economic returns to health investments and undermining hope. We estimated the association between county-level economic opportunity and individual-level health in young adults in the general US population. Methods In this population-based cross-sectional study, we used individual-level data from the 2009–12 United States Behavioral Risk Factor Surveillance Surveys. Our primary outcomes were current self-reported overall health and the number of days of poor physical and mental health in the last month. Economic opportunity was measured by the county-averaged national income rank attained by individuals born to families in the lowest income quartile. We restricted our sample to adults aged 25–35 years old to match the data used to assign exposure. Multivariable ordinary least squares and probit models were used to estimate the association between the outcomes and economic opportunity. We adjusted for a range of demographic and socioeconomic characteristics, including age, sex, race, education, income, access to health care, area income inequality, segregation, and social capital. Findings We assessed nearly 147 000 individuals between the ages of 25 years and 35 years surveyed from 2009 to 2012. In models adjusting for individual-level demographics and county-level socioeconomic characteristics, increases in county-level economic opportunity were associated with greater self-reported overall health. An interdecile increase in economic opportunity was associated with 0·76 fewer days of poor mental health (95% CI −1·26 to −0·25) and 0·53 fewer days of poor physical health (−0·96 to −0·09) in the last month. The results were robust to sensitivity analyses. Interpretation Economic opportunity is independently associated with self-reported health and health behaviours. Policies seeking to expand economic opportunities might have important spillover effects on health. Funding Robert Wood Johnson Foundation Health and Society Scholars Program.

Objective Communication inequality has been offered as one potential mechanism through which social determinants influence multiple health behaviors. The purpose of this study was to examine the underlying mechanisms between communication inequality and health behaviors. Methods Data from a nationally representative cross-sectional survey of 18,426 people aged 18 years and above in the United States were used for secondary analysis. Measures included socio-demographic characteristics, social participation (structural social capital), health media use (TV, print, and the Internet), and five health behaviors (physical activity, cigarette smoking, alcohol use, and intake of fruit and vegetable). Path analysis was performed to examine the linkages between social determinants, health media use, social participation, and social gradients in health behaviors. Results Path analysis revealed that socioeconomic gradients in health behaviors is mediated by: 1) inequalities in health media use; 2) disparities in social participation, which leads to differential media use; and 3) disparities in social participation that are not mediated by media use. Conclusions Consistent with the theory of communication inequality, socioeconomic disparities in media use partially mediate disparities in multiple health behaviors. Practice implications To address health inequalities, it is important to utilize health media to target populations with low socioeconomic statuses.

Objective To assess racial variation in depression risk factors and symptom trajectories among older women. Methods Using Nurses' Health Study data, participants (29,483 non-Hispanic white and 288 black women) aged 60 years or older, free of depression in 2000, were followed until 2012. Data on race and risk factors, selected a priori, were obtained from biennial questionnaires. Incident depression was defined as depression diagnosis, antidepressant use, or presence of severe depressive symptoms. Group-based trajectories of depressive symptoms were determined using latent variable modeling approaches. Results Black participants had lower risk (hazard ratio: 0.76; 95% confidence interval: 0.57–0.99) of incident late-life depression compared with whites. Although blacks had higher prevalence than whites of some risk factors at study baseline, distributions of major contributors to late-life depression risk (low exercise, sleep difficulty, physical/functional limitation, pain) were comparable. There was evidence of effect modification by race for relations of region of birth (Southern birthplace), smoking, and medical comorbidity to depression risk; however, wide confidence intervals occurred among blacks because of smaller sample size. Four trajectories were identified: minimal symptoms-stable (58.3%), mild symptoms-worsening (31.4%), subthreshold symptoms-worsening (4.8%), and subthreshold symptoms-improving (5.5%). Probabilities of trajectory types were similar for blacks and whites. Conclusion Although overall trajectories of late-life depressive symptoms were comparable by race, there was racial variation in depression risk estimates associated with less-studied factors, such as U.S. region of birth. Future work may address unmeasured health and resilience determinants that may underlie observed findings and that could inform clinical assessment of late-life depression risk factors.

Objective The relationship between social capital and mortality is not clear-cut. There have been few longitudinal studies investigating this association so far. The objective was to assess the effect of different dimensions of social capital on mortality among adults of a Brazilian city. Study design This is a prospective multilevel study. Baseline data were obtained from a population-based random sample of 846 adults (aged 18 years or more) residing in 38 neighbourhoods (census blocks). Methods Participants were interviewed in 2006–7 and their vital status investigated in 2013. Social capital was assessed by five scales (social cohesion, informal social control, neighbours' support, social action and political efficacy). The outcome was all-cause mortality. Data analysis used multilevel logistic regression models. Results At the individual level social cohesion was positively related to mortality in the unadjusted model but this association lost significance after adjustment for other variables in multivariable models. At the neighbourhood level, high mortality rates were associated with low social action independently of demographic, socio-economic, behavioural and health-related variables. Conclusion We found more evidence for a contextual than individual level effect of social capital on mortality.

Objectives Few studies have examined the joint impact of neighborhood disadvantage and low social cohesion on health. Moreover, no study has considered the joint impact of these factors on a cumulative disease risk profile among a large sample of African American adults. Using data from the Jackson Heart Study, we examined the extent to which social cohesion modifies the relationship between neighborhood disadvantage and cumulative biological risk (CBR)—a measure of accumulated risk across multiple physiological systems. Methods Our analysis included 4408 African American women and men ages 21–85 residing in the Jackson, MS Metropolitan Area. We measured neighborhood disadvantage using a composite score of socioeconomic indicators from the 2000 US Census and social cohesion was assessed using a 5-item validated scale. Standardized z-scores of biomarkers representing cardiovascular, metabolic, inflammatory, and neuroendocrine systems were combined to create a CBR score. We used two-level linear regression models with random intercepts adjusting for socio-demographic and behavioral covariates in the analysis. A three-way interaction term was included to examine whether the relationship between neighborhood disadvantage and CBR differed by levels of social cohesion and gender. Results The interaction between neighborhood disadvantage, social cohesion and gender was statistically significant (p = 0.05) such that the association between living in a disadvantaged neighborhood and CBR was strongest for men living in neighborhoods with low levels of social cohesion (B = 0.63, SE: 0.32). In gender-specific models, we found a statistically significant interaction between neighborhood disadvantage and social cohesion for men (p = 0.05) but not for women (p = 0.50). Conclusion Neighborhoods characterized by high levels of economic disadvantage and low levels of social cohesion contribute to higher cumulative risk of disease among African American men. This suggests that they may face a unique set of challenges that put them at greater risk in these settings.

Background The United States has the unenviable distinction of having both the highest obesity rate among Organisation for Economic Co-operation and Development (OECD) member countries and the highest incarceration rate in the world. Further, both are socially patterned by race/ethnicity and socioeconomic position. Incarceration involves various health behaviors that could influence adult weight trajectory. Methods We evaluated the associations between history and duration of adult incarceration and weight gain using the National Survey of American Life (N = 6082 adults residing in the 48 contiguous states between February 2001 and March 2003). We propensity score-matched individuals to control for the probability of having a history of incarceration. To examine the relation between prior incarceration and adult weight gain, we fit gender-stratified generalized estimating equations controlling for propensity of incarceration history, age, education, income, race/ethnicity, and marital status. Results For males (N = 563), incarceration was associated with about a 1.77 kg/m 2 lower gain in body mass index (BMI) during adulthood, after adjusting for age, education, income, race/ethnicity, and marital status in addition to the propensity of having a history of incarceration (95% CI: − 2.63, − 0.92). For females (N = 286), no significant overall relationship was found between a history of incarceration and adult weight gain. In subgroup analyses among those with an incarceration history, we found no overall association between duration of incarceration and adult weight gain in men or women. In sensitivity analyses, neither tobacco smoking nor parity changed the results. Conclusions The results of this study indicate that incarceration is associated with a lower transition of weight gain in males, but not in females..

Background Growing research documents associations between neighborhood social cohesion with better health and well-being. However, other work has identified social cohesion's “dark side” and its ability to promote negative outcomes. It remains unclear if such diverging findings are attributable to differences in study design, or other reasons. To better capture its potential heterogeneous effects, we took an outcome-wide analytic approach to examine perceived neighborhood social cohesion in relation to a range of health and well-being outcomes. Methods Data were from 12,998 participants in the Health and Retirement Study—a large, diverse, prospective, and nationally representative cohort of U.S. adults age >50. Multiple regression models evaluated if social cohesion was associated with physical health, health behavior, psychological well-being, psychological distress, and social well-being outcomes. All models adjusted for sociodemographics, personality, and numerous baseline health and well-being characteristics. To evaluate the effects of change in cohesion, we adjusted for prior social cohesion. Bonferroni correction was used to account for multiple testing. Results Perceived neighborhood social cohesion was not associated with most physical health outcomes (except for reduced risk of physical functioning limitations and better self-rated health) nor health behavior outcomes (except for more binge drinking). However, it was associated with numerous subsequent psychosocial well-being (i.e., higher: positive affect, life satisfaction, optimism, purpose in life, mastery, health mastery, financial mastery; reduced likelihood of infrequent contact with friends) and psychological distress outcomes (i.e., lower depression, hopelessness, negative affect, loneliness) over the 4-year follow-up period. Conclusions With further research, these results suggest that perceived neighborhood social cohesion might be a valuable target for innovative policies aimed at improving well-being.