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In response to the COVID-19 pandemic, a variety of social distancing measures to mitigate the virus outbreak have been implemented. These measures may have unintended consequences on individuals’ well-being, such as increased stress, anxiety, and sleep disruptions. We investigated the extent to which individuals’ mental health status is associated with perceived changes in sleep amount and sleep quality among a sample of adult twin pairs (N= 909 pairs; 77% MZ, 23% DZ), less than a month after the outbreak was declared a pandemic by the World Health Organization. About half of participants reported no change in sleep amount (50.1%) or sleep quality (55.6%). Approximately one-third of the participants had increased amount of sleep (29.8%), and 32.9% reported a decrease in sleep quality. We found that stress and anxiety levels were associated with sleep reduction (ORs = 2.36 and 3.12 for stress and anxiety, respectively) and poorer sleep quality (ORs = 2.45 and 3.73 for stress and anxiety, respectively), even after taking into account between-family confounds. A much smaller association was observed between levels of stress and anxiety and increased sleep amount (ORs = 1.42 and 1.60 for stress and anxiety, respectively) and sleep quality (OR = 1.21 and 1.29 for stress and anxiety, respectively), which was no longer significant after controlling for between-family confounds. Our results demonstrate that stress and anxiety associated with the COVID-19 pandemic and social distancing measures may be linked to reduced sleep amount and quality.

BackgroundPhysical distancing and other COVID-19 pandemic mitigation strategies have negatively impacted physical activity (PA) levels and mental health in cross-sectional studies. The purpose of this study was to investigate associations between changes in PA and mental health outcomes during the COVID-19 pandemic, following implementation of mitigation strategies, in a sample of adult twins.MethodsThis was a prospective study of 3,057 adult twins from the Washington State Twin Registry. Study participants completed online surveys in 2020, at baseline (March 26 –April 5), and three follow-up waves (W1: April 20 –May 3; W2: Jul 16 –Aug 2; W3: Sept 16 –Oct 1). Physical activity was operationalized as self-reported moderate-to-vigorous PA (MVPA) and neighborhood walking (minutes/week), and mental health outcomes, operationalized as self-reported anxiety and perceived stress were assessed in the three waves of follow-up. Latent growth curve models (LGCMs) were used to assess changes in PA and mental health outcomes over time. Parallel LGCMs were used to estimate the cross-sectional, parallel, and prospective associations between PA and mental health over time. All models took into within-pair correlations and adjusted for age, sex, and race.ResultsIndividuals’ amount of MVPA and walking decreased over time, whereas levels of anxiety remained stable, and stress increased slightly. Cross-sectional associations observed between both PA predictors and mental health outcomes were weak. After taking into account cross-sectional associations between PA and mental health outcomes, changes in PA over time were not associated with changes in mental health outcomes over time.ConclusionsOver a time period aligned with COVID-19 mitigation strategies and social restrictions, changes in physical activity was not associated with changes in anxiety or stress levels in the current sample. Nonetheless, the average decline in PA over time is worrisome. Public health resources should continue to promote PA as a means to improve physical health during the pandemic.

The novel coronavirus (COVID-19) has impacted the lives of people worldwide since being declared a pandemic on March 11, 2020. Social restrictions aimed at flattening the curve may be associated with an increase in stress and anxiety, which may increase the use of alcohol as a coping mechanism. The objective of this study was to examine if stress and anxiety were associated with changes in alcohol use in a sample of adult twins. Twins allowed us to control for genetic and shared environmental factors that would confound the alcohol - mental health relationship. Twins (N = 3,971; 909 same-sex pairs) from the Washington State Twin Registry (WSTR) completed an online survey examining several health-related behaviors and outcomes and their self-reported changes due to COVID-19. About 14% of the respondents reported an increase in alcohol use. We found an association between both stress and anxiety and increased alcohol use, where twins with higher levels of stress and anxiety were more likely to report an increase in alcohol consumption. The associations were small and confounded by between-family factors and demographic characteristics. However, there was no significant difference in stress or anxiety levels between non-drinkers and those who reported no change in alcohol use. Our findings suggest that individuals’ mental health may be associated with changes in alcohol use during the COVID-19 pandemic.

This study examined how buffer type (shape), size, and the allocation of activity bouts inside buffers that delineate the neighborhood spatially produce different estimates of neighborhood-based physical activity. A sample of 375 adults wore a global positioning system (GPS) data logger and accelerometer over 2 weeks under free-living conditions. Analytically, the amount of neighborhood physical activity measured objectively varies substantially, not only due to buffer shape and size, but by how GPS-based activity bouts are identified with respect to containment within neighborhood buffers. To move the “neighborhood-effects” literature forward, it is critical to delineate the spatial extent of the neighborhood, given how different ways of measuring GPS-based activity containment will result in different levels of physical activity across different buffer types and sizes.

Study ObjectivesLong and short sleep duration are associated with greater risk of developing post-traumatic stress disorder (PTSD); however, it is unknown how genetic and environmental influences affect this relationship. Thus, we investigated the association between sleep duration and PTSD symptoms using twin models.MethodsData were obtained from 1865 monozygotic and 758 dizygotic twin pairs enrolled in the community-based Washington State Twin Registry. PTSD symptoms were assessed using the Impact of Events Scale (IES). A classical twin model decomposed the variances of sleep duration and IES score into additive genetic, shared environmental, and unique environmental components. We used correlated factor models to examine the moderation of variance components of sleep duration and IES.ResultsShorter and longer sleep duration were associated with higher IES scores with a quadratic association (p < 0.001). The heritability of sleep duration was 36%, and IES 31%. Variance in sleep duration attributable to shared (b1C1 = 2.91, 95% CI = 1.40 to 4.43; p < 0.001) and unique (b1E1 = 0.18, 95% CI = 0.10 to 0.27; p < 0.001) environment was moderated by IES score. Similarly, but to a lesser extent, variance in IES attributable to additive genetics (b1A2 = −0.23, 95% CI = −0.45 to 0.00; p = 0.048) was moderated by sleep duration.ConclusionsGreater PTSD symptom severity was associated with short and long sleep duration. Increasing PTSD symptoms increased variability in sleep duration primarily via shared environmental factors, whereas decreasing sleep duration increased variability in PTSD symptoms primarily via additive genetic factors. This suggests childhood experiences affect variability of sleep duration and genetic factors affect the variability of PTSD symptoms in trauma-exposed individuals.

Approximately 12% of U.S. adults have type 2 diabetes (T2D). Diagnosed T2D is caused by a combination of genetic and environmental factors including age and lifestyle. In adults 45 years and older, the Discordant Twin (DISCOTWIN) consortium of twin registries from Europe and Australia showed a moderate-to-high contribution of genetic factors of T2D with a pooled heritability of 72%. The purpose of this study was to investigate the contributions of genetic and environmental factors of T2D in twins 45 years and older in a U.S. twin cohort (Washington State Twin Registry, WSTR) and compare the estimates to the DISCOTWIN consortium. We also compared these estimates with twins under the age of 45. Data were obtained from 2692 monozygotic (MZ) and same-sex dizygotic (DZ) twin pairs over 45 and 4217 twin pairs under 45 who responded to the question ‘Has a doctor ever diagnosed you with (type 2) diabetes?’ Twin similarity was analyzed using both tetrachoric correlations and structural equation modeling. Overall, 9.4% of MZ and 14.7% of DZ twins over the age of 45 were discordant for T2D in the WSTR, compared to 5.1% of MZ and 8% of DZ twins in the DISCOTWIN consortium. Unlike the DISCOTWIN consortium in which heritability was 72%, heritability was only 52% in the WSTR. In twins under the age of 45, heritability did not contribute to the variance in T2D. In a U.S. sample of adult twins, environmental factors appear to be increasingly important in the development of T2D.

Highlights • Most adults in our sample (>80%) are somewhat concerned about themselves or their household members getting sick from COVID-19. • Individuals with COVID-19 exposure are more concerned about getting sick from COVID-19, and are also more depressed. • Associations between COVID-19 exposure, fear of COVID-19, and depression are confounded by familial influences shared by twins from the same family., Millions of people have been impacted by the novel coronavirus (COVID-19) pandemic worldwide. High infection rates and death tolls, combined with social distancing measures, may have unintended psychological consequences on individuals. The goal of this study was to examine the interrelations between COVID-19 exposure, fear of COVID-19, and depression among a community-based sample of adult twins. We further explored whether fear of COVID-19 mediated the association between COVID-19 exposure and depression. 732 same-sex adult twin pairs (78.1% MZ, 21.9% DZ) completed an online survey examining their feelings in May 2020. About one-fifth of the participants reported having any COVID-19 exposure. Most participants (>80%) were somewhat concerned about themselves or their household members being infected by COVID-19. The average depression level was relatively low (M = 0.9 out of 6). We found that COVID-19 exposure was related to increased fears of COVID-19 and depression, and that depressive feelings increased with fear of COVID-19. The correlation between COVID-19 exposure and depression was partially mediated by fear of COVID-19. However, these associations were confounded by familial influences. As society navigates through the pandemic, it is essential to implement public health strategies to help individuals cope with the concerns and fears about COVID-19.

BackgroundThere is considerable evidence that exposure to fine particulate matter (PM2.5) air pollution is associated with a variety of adverse health outcomes. However, true exposure-outcome associations are hampered by measurement issues, including compliance and exposure misclassification. ObjectiveThis paper describes the use of the design-feedback iterative cycle to improve the design and usability of a new portable PM2.5 monitor for use in an epidemiologic study of personal air pollution measures. MethodsIn total, 10 adults carried on their person a prefabricated PM2.5 monitor for 1 week over 3 waves of the iterative cycle. At the end of each wave, they participated in a 30-minute moderated focus group and completed 2 validated questionnaires on usability and views on research. The topics addressed included positives and negatives of the monitor, charging and battery life, desired features, and changes to the monitor from each previous wave. They also completed a log to record device wear time each day. The log also provided space to record any issues that may have arisen with the device or for general comments during the week of collection. ResultsThe major focus group topics included device size, noise, battery and charge time, and method for carrying the device. These topics formed the basis of iterative design changes; by the final cycle, the device was reasonably smaller, quieter, held a longer charge, and was more convenient to carry. System usability scores improved systematically across each wave (median scores of 50-66 on a 100-point scale), as did median daily wear time (approximately 749-789 minutes). ConclusionsBoth qualitative and quantitative measures showed an improvement in device usability over the 3 waves. This study demonstrates how the design-feedback iterative cycle can be used to improve the usability of devices manufactured for use in large epidemiologic studies on personal air pollution exposures.