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Dispositional optimism is a potentially modifiable factor and has been associated with multiple physical health outcomes, but its relationship with depression, especially later in life, remains unclear. In the Nurses´ Health Study (n = 33,483), we examined associations between dispositional optimism and depression risk in women aged 57–85 (mean = 69.9, SD = 6.8), with 4,051 cases of incident depression and 10 years of follow-up (2004–2014). We defined depression as either having a physician/clinician-diagnosed depression, or regularly using antidepressants, or the presence of severe depressive symptoms using validated self-reported scales. Age- and multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (95% CIs) across optimism quartiles and for a 1-standard deviation (SD) increment of the optimism score. In sensitivity analyses we explored more restrictive definitions of depression, potential mediators, and moderators. In multivariable-adjusted models, women with greater optimism (top vs. bottom quartile) had a 27% (95%CI = 19–34%) lower risk of depression. Every 1-SD increase in the optimism score was associated with a 15% (95%CI = 12–18%) lower depression risk. When applying a more restrictive definition for clinical depression, the association was considerably attenuated (every 1-SD increase in the optimism score was associated with a 6% (95%CI = 2–10%-) lower depression risk. Stratified analyses by baseline depressive symptoms, age, race, and birth region revealed comparable estimates, while mediators (emotional support, social network size, healthy lifestyle), when combined, explained approximately 10% of the optimism-depression association. As social and behavioral factors only explained a small proportion of the association, future research should investigate other potential pathways, such as coping strategies, that may relate optimism to depression risk.

We prospectively examined the association between leisure activities and changes in instrumental activities of daily living (IADL) among participants of the Japan Gerontological Evaluation Study (JAGES).We analyzed data collected from 49 732 JAGES participants (23 359 men and 26 373 women), aged ≥65 years, from 24 municipalities in Japan.Baseline data were obtained for 25 types of leisure activities in which the cohort members participated. Baseline (2010) and follow-up (2013) data on IADL were collected - the outcome indicated changes in IADL scores from 2010 to 2013. We regressed changes in IADL scores from the 2010 to 2013 to the number of leisure activities.Older adults who engaged in more leisure activities had higher changes in IADL scores than those who engaged in fewer leisure activities: the β values (95% confidence interval [CI]) of the IADL scores were 0.001 [-0.04-0.04], 0.04 [0.01-0.08], 0.09 [0.05-0.13], 0.09 [0.05-0.14], 0.08 [0.02-0.13], and 0.13 [0.07-0.18] for having one, two, three, four, five, and more than six types of leisure activities (P for trend0.001), respectively. Similar associations were found for different types of leisure activities, including predominantly physical and cultural activities. Statistically significant linear trends were obtained among the group, solitary, and other leisure activity subgroups (P for trend0.05).Encouraging engagement in leisure activities may promote maintenance of IADL among older populations. Different types of leisure activities appear to have similar positive impacts on IADL. Geriatr Gerontol Int 2022; 22: 152-159.

Supplemental digital content is available in the text., Purpose Gamification, the use of game design elements in nongame contexts, in combination with insights from behavioral economics, has been applied increasingly to behavior change interventions. However, little is known about the effectiveness or scalability of this approach, especially in the long term. We tested a large-scale smartphone-based intervention to encourage physical activity among Japanese baseball fans using gamification techniques that leveraged fandom and interteam competition inherent in sports. Methods A quasi-experimental study was conducted among fans of the Japanese Pacific League. The app, Pa-League Walk, included gamification elements, such as competition between opposing teams’ fans based on total daily step counts on game days (>60,000 free downloads since March 2016). We analyzed daily steps of 20,052 app users, supplemented by online survey data of 274 users and 613 matched controls. Difference-in-differences estimators evaluated change in daily steps before and after app installation in users versus matched controls. Results Users’ daily steps increased by 574 (95% confidence interval, 83–1064) steps 3 months after installation, compared with controls. The increase was maintained for up to 9 months (559 (99–1018) more steps per day vs baseline), attenuating over a longer follow-up. Positive effect modification was found by high-frequency of the app use (P < 0.001) but not by other covariables (P ≥ 0.14) such as education or income. Days with 10,000-step achievement increased from 24.4% to 27.5% after the additional introduction of incentives (digital player photographs; P < 0.001). Conclusions Using existing fandom and solidarity, the gamification app increased physical activity at scale among baseball fans, including people with lower socioeconomic status underrepresented in traditional health programs.

Background Recent decreases in neonatal mortality have been slower than expected for most countries. This study aims to predict the risk of neonatal mortality using only data routinely available from birth records in the largest city of the Americas. Methods A probabilistic linkage of every birth record occurring in the municipality of São Paulo, Brazil, between 2012 e 2017 was performed with the death records from 2012 to 2018 (1,202,843 births and 447,687 deaths), and a total of 7282 neonatal deaths were identified (a neonatal mortality rate of 6.46 per 1000 live births). Births from 2012 and 2016 (N = 941,308; or 83.44% of the total) were used to train five different machine learning algorithms, while births occurring in 2017 (N = 186,854; or 16.56% of the total) were used to test their predictive performance on new unseen data. Results The best performance was obtained by the extreme gradient boosting trees (XGBoost) algorithm, with a very high AUC of 0.97 and F1-score of 0.55. The 5% births with the highest predicted risk of neonatal death included more than 90% of the actual neonatal deaths. On the other hand, there were no deaths among the 5% births with the lowest predicted risk. There were no significant differences in predictive performance for vulnerable subgroups. The use of a smaller number of variables (WHO’s five minimum perinatal indicators) decreased overall performance but the results still remained high (AUC of 0.91). With the addition of only three more variables, we achieved the same predictive performance (AUC of 0.97) as using all the 23 variables originally available from the Brazilian birth records. Conclusion Machine learning algorithms were able to identify with very high predictive performance the neonatal mortality risk of newborns using only routinely collected data.

Over the past several decades, the incidence of early-onset cancers, often defined as cancers diagnosed in adults50 years of age, in the breast, colorectum, endometrium, oesophagus, extrahepatic bile duct, gallbladder, head and neck, kidney, liver, bone marrow, pancreas, prostate, stomach and thyroid has increased in multiple countries. Increased use of screening programmes has contributed to this phenomenon to a certain extent, although a genuine increase in the incidence of early-onset forms of several cancer types also seems to have emerged. Evidence suggests an aetiological role of risk factor exposures in early life and young adulthood. Since the mid-20th century, substantial multigenerational changes in the exposome have occurred (including changes in diet, lifestyle, obesity, environment and the microbiome, all of which might interact with genomic and/or genetic susceptibilities). However, the effects of individual exposures remain largely unknown. To study early-life exposures and their implications for multiple cancer types will require prospective cohort studies with dedicated biobanking and data collection technologies. Raising awareness among both the public and health-care professionals will also be critical. In this Review, we describe changes in the incidence of early-onset cancers globally and suggest measures that are likely to reduce the burden of cancers and other chronic non-communicable diseases.

Previous studies have found an association between recessions and increased rates of suicide. In the present study we widened the focus to examine the association between economic uncertainty and suicides. We used monthly suicide data from the US at the State level from 2000 to 2017 and combined them with the monthly economic uncertainty index. We followed a panel data econometric approach to study the association between economic uncertainty and suicide, controlling for unemployment and other indicators. Economic uncertainty is positively associated with suicide when controlling for unemployment [coeff: 8.026; 95% CI: 3.692–12.360] or for a wider range of economic and demographic characteristics [coeff: 7.478; 95% CI: 3.333–11.623]. An increase in the uncertainty index by one percent is associated with an additional 11–24.4 additional monthly suicides in the US. Economic uncertainty is likely to act as a trigger, which underlines the impulsive nature of some suicides. This highlights the importance of providing access to suicide prevention interventions (e.g. hotlines) during periods of economic uncertainty. Supplementary Information The online version contains supplementary material available at 10.1007/s10654-021-00770-4.

OBJECTIVE: To examine changes in access to dental care in states using Section 1115 waivers to implement healthy behavior incentive (HBI) programs in their Medicaid expansion under the ACA, compared to traditional expansion states and nonexpansion states. DATA SOURCES: Behavioral Risk Factor Surveillance System from 2008 to 2018. STUDY DESIGN: We used difference‐in‐differences analysis to compare changes in three Medicaid expansion states with HBI (Iowa, Indiana, Michigan) to traditional expansion (Minnesota, North Dakota, Ohio) and nonexpansion states (Nebraska, South Dakota, Wyoming) in the same mid‐Western region of the country. The sample included 32 556 low‐income adults. DATA COLLECTION/EXTRACTION METHODS: NA. PRINCIPAL FINDINGS: We found no significant changes in dental visits associated with HBI or traditional expansion relative to nonexpansion states. HBI expansion was associated with an increase of 2.2 percentage points in reporting a dental visit in the past year for adults in urban areas (P

Background Serious psychological distress (SPD) is common and more prevalent in women, older adults, and individuals with a low-income. Prior studies have highlighted the role of low neighborhood social cohesion (nSC) in potentially contributing to SPD; however, few have investigated this association in a large, nationally representative sample of the United States. Therefore, our objective was to investigate the overall and racial/ethnic-, sex/gender-, self-rated health status-, age-, and household income-specific relationships between nSC and SPD. Methods We used data from survey years 2013 to 2018 of the National Health Interview Survey to investigate nSC and SPD among Asian, Non-Hispanic (NH)-Black, Hispanic/Latinx, and NH-White men as well as women in the United States (N = 168,573) and to determine modification by race/ethnicity, sex/gender, self-rated health status, age, and annual household income. nSC was measured by asking participants four questions related to the trustworthiness and dependability of their neighbors. nSC scores were trichotomized into low ( Results Among 168,573 participants, most were Non-Hispanic (NH)-White (69%), and mean age was 47 ± 0.01 years. After adjustment, low vs. high nSC was associated with a 75% higher prevalence of SPD overall (PR = 1.75 [1.59–1.92]), 4 times the prevalence of SPD among Asian men (PR = 4.06 [1.57–10.50]), 2 times the prevalence of SPD among participants in at least good health (PR = 2.02 [95% CI: 1.74–2.35]), 92% higher prevalence of SPD among participants ≥ 50 years old (PR = 1.92 [1.70–2.18]), and approximately 3 times the prevalence of SPD among Hispanic/Latinx participants with household incomes ≥ $75,000 (PR = 2.97 [1.45–6.08]). Conclusions Low nSC was associated with higher SPD in the overall population and the magnitude of the association was higher in Asian men, participants who reported good health, older participants, and Hispanic/Latinx adults with higher household incomes. Future research should continue to examine how neighborhood contexts can affect health across various sociodemographic groups, especially among groups with multiple marginalized social identities.

Previous studies showed positive associations between specific types of social capital and child nutritional status. Our study examined whether improved food availability mediates the impact of maternal and child social support on child nutritional status in four low- and middle-income countries. We used data from the Young Lives cohort study, comprising 1,000 children aged 8 and 12 in Vietnam and Ethiopia, 1008 in India, and 714 in Peru. The outcome variables were the z-scores for height for age and body mass index (HAZ and BAZ, respectively). The causal mediation analysis framework was used. In Peru, above-median values of maternal social support and receiving child financial support were positively associated with HAZ at age 12. The level of maternal financial support was positively associated with BAZ among 12-year-old children in India. Peru was the only country where a positive association was found between food availability and maternal financial support among children aged 12. However, food availability did not mediate the effect of maternal financial support on HAZ at age 12. Strengthening social support to improve child nutritional status, especially by improving food availability, may not be a sufficient intervention in resource-poor settings because sources of support may lack sufficient food resources to share. However, more comprehensive measurements of social support and food security are necessary to better understand the mechanism of social support and child nutritional status.

Two frequently encountered but underrecognized challenges for causal inference in studying the long-term health effects of disasters among survivors include 1) time-varying effects of disasters on a time-to-event outcome and 2) selection bias due to selective attrition. In this paper, we review approaches for overcoming these challenges and demonstrate application of the approaches to a real-world longitudinal data set of older adults who were directly affected by the 2011 Great East Japan Earthquake and Tsunami (n = 4,857). To illustrate the problem of time-varying effects of disasters, we examined the association between degree of damage due to the tsunami and all-cause mortality. We compared results from Cox regression analysis assuming proportional hazards with those derived using adjusted parametric survival curves allowing for time-varying hazard ratios. To illustrate the problem of selection bias, we examined the association between proximity to the coast (a proxy for housing damage from the tsunami) and depressive symptoms. We corrected for selection bias due to attrition in the 2 postdisaster follow-up surveys (conducted in 2013 and 2016) using multivariable adjustment, inverse probability of censoring weighting, and survivor average causal effect estimation. Our results demonstrate that analytical approaches which ignore time-varying effects on mortality and selection bias due to selective attrition may underestimate the long-term health effects of disasters.

Globally, unintentional injuries are one of the leading causes of infant death. Established risk factors for injuries during infancy include single parent households, socioeconomic disadvantage and maternal postpartum depression. We sought to examine whether maternal working status is associated with unintentional injury among infants in Japan. We used data from an original questionnaire targeting mothers who participated in a 3 or 4-month health check-up program in Aichi prefecture, Japan. Experience of any type of unintentional injury was used as the primary outcome, and we also examined the experience of “falls” and “near-drowning” as secondary outcomes. We conducted multivariable logistic regression analysis, adjusting for covariates. We also performed propensity score matching in order to balance covariates between paid employment and unpaid employment groups. Among 6,465 valid responses (response rate, 67%), 9.8% of infants experienced unintentional injuries. After matching on propensity for maternal employment (based on 26 covariates), we found that infants of mothers in paid employment were 1.35 times (95% CI: 1.04–1.74) more likely to experience injures, including 1.60 times higher likelihood of falls (95% CI: 1.14–2.24). Near-drowning was not significantly associated with maternal employment. We also found that father’s employment status was positively associated with risk of falls. Both multivariable logistic analysis and propensity score matching analysis revealed that maternal paid employment status was associated with unintentional injuries among Japanese infants. To prevent infant injuries, comprehensive support for working families should be considered.

Background: In 2009, the South Korean government expanded universal health insurance to include oral health services. In the present study, we sought to examine whether improved access resulted in a reduction in income-based self-reported oral health inequalities. Methods: We analyzed repeated cross-sectional data from the Korea National Health and Nutrition Examination Survey (KNHANES) waves IV through VI (2007–2015). We analyzed self-reported oral health status among 68,431 subjects. Changes in oral health inequalities across four income levels (low, middle-low, middle-high, and high) were assessed with the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). Results: The average oral health status of children and adolescents improved the most over the observation period. The absolute magnitude of oral health inequalities (measured by the SII) improved for most groups, with the notable exception of young male adults. By contrast, the ratio of poor oral health between high- and low-income groups (measured by the RII) changed little over time, indicating that relative inequalities remained resistant to change. Conclusions: The expansion of dental health insurance may not be sufficient to move the needle on self-reported oral health inequalities among adults.

Background Socioeconomic mobility affects health throughout the life course. However, it is not known whether there are gender differences in the association between life-course subjective socioeconomic status (SSS) mobility and mortality at older ages. Methods Participants were 16,690 community-dwelling adults aged 65-100 years in the Japan Gerontological Evaluation Study (JAGES). Baseline information including demographic characteristics, depression, and lifestyle factors were collected in 2010. Participants' vital status was confirmed in 2013 via linkage to death records. We categorized life-course socioeconomic mobility into the following categories: 'persistently high', 'downward mobility', 'upward mobility', and 'persistently low'. Cox proportional hazard modeling was used to estimate hazard ratios (HR) for all-cause mortality. Results Mortality HRs for the 'downward' group were 1.37 (95% confidence interval [CI], 1.08-1.74) among men and 1.27 (95% CI, 0.94-1.71) among women in comparison with the 'persistently high' group. Compared to the 'persistently low' group, the HRs for the 'upward' group were 0.54 (95% CI, 0.35-0.83) among women and 0.91 (95% CI, 0.73-1.24) among men. Associations were not changed after adjusting for objective socioeconomic status but were attenuated by depression. Conclusions 'Downward' mobility was associated with mortality among men, but not among women. Depression appeared to mediate the association. A protective effect of upward mobility was observed among women but not among men.

Introduction Not much is known regarding the disparities in cancer care between women with and without disabilities. Objectives The aim of this study was to investigate the potential disparities in the diagnosis, treatment, and survival of women with cervical cancer with and without disabilities. Methods We performed a retrospective cohort study and linked the National Disability Database, Korean Central Cancer Registry, and Korean National Health Insurance claims database. Charlson comorbidity index was used for adjusting the comorbidity. The study population comprised 3 185 women with disabilities (physical/brain, communication, mental, cardiopulmonary, and other impairment) who were diagnosed with cervical cancer and 13 582 age- and sex-matched women without disability who were diagnosed with cervical cancer for comparison. Results Distant metastatic stage (7.7% vs 3.7%) and unknown stage (16.1% vs 7.0%) were more common in cervical cancer women with grade 1 disabilities, compared with women without disabilities. Women with cervical cancer with disabilities were less likely to undergo surgery (adjusted odds ratio (aOR) 0.81, 95% confidence interval (CI) 0.73–0.90) or chemotherapy (aOR 0.86, 95% CI 0.77–0.97). Lower rate of surgery was more evident in patients with physical/brain impairment (aOR 0.46, 95% CI 0.37–0.58) and severe mental impairment (aOR 0.57, 95% CI 0.41–0.81). The overall mortality risk was also higher in patients with disabilities (adjusted hazard ratio (aHR) 1.36, 95% CI 1.25–1.48). Conclusion Women with cervical cancer with disabilities, especially with severe disabilities, were diagnosed at later stages, received less treatment, and had higher mortality rates, compared with patients who lacked disabilities. Social support and policies, along with education for women with disabilities, their families, and healthcare professionals, are needed to improve these disparities.

We analyzed the patterns of diagnosis, treatment, and prognoses of acute myeloid leukemia (AML) patients with and without disabilities. The data were collected from the National Disability Database, the Korean Central Cancer Registry, and the Korean National Health Insurance claim database. We built a cohort of 2 776 450 people with disabilities and a nondisabled cohort of 8 329 350 people who were selected at a ratio of 1:3 by matching age and sex. From this population, adult patients who were diagnosed with AML were analyzed. The number of patients with AML were 26.74 per 100 000 in people without disabilities and 20.39 per 100 000 in those with disabilities (P, We report herein that individuals with disabilities have a relatively low diagnosis rate of acute myeloid leukemia (AML), undergo less active treatment, and have significantly lower survival rates than those without a disability.

The Korean National Health Insurance expanded the dental insurance in 2012 to cover denture services for older adults. We analyzed whether the new policy improved of chewing ability in the eligible population. We used regression discontinuity (RD), a quasi-experimental design, to analyze the effects of the expanded dental insurance. We analyzed data from the Korea National Health and Nutrition Examination Survey conducted in 2010 and 2015. The study population consisted of two groups: the treatment group, aged 65 and above who were eligible; and the control group, under 65 years of age who were not eligible for the dental insurance benefit. The main outcome evaluated was self-reported chewing difficulty. The RD analysis showed that in 2015, the chewing difficulty in aged above 65 was 2.2% lower than in those aged under 65. However, the difference was not statistically significant (P = 0.76). The results from the falsification testing of predetermined covariates, placebo cut-offs, and bandwidths validated our main conclusion. The expansion of dental insurance benefits to include dentures for the older adults did not improve the chewing ability in the eligible population. Future studies should evaluate long-term outcomes of oral health as well as the social impacts on the elderly.

The strength of social connections in the community (“social capital”) is hypothesized to be a crucial ingredient in disaster resilience. We examined whether community-level social capital is correlated with the ability to maintain functional capacity among older residents who experienced the 2011 Great East Japan Earthquake and Tsunami. The baseline of our cohort (mean age, 74 years) was established in 2010, 7 months before the disaster in Iwanuma, a Japanese city located 80 km from the epicenter. Disaster-related personal experiences (e.g., housing damage or relocation) were assessed through a follow-up survey (n = 3,594; follow-up rate, 82.1%) conducted in 2013, 2.5 years after the earthquake. Multiple membership multilevel models were used to evaluate the associations between functional capacity, measured by the Instrumental Activities of Daily Living scale, and 3 subscales of community-level social capital: social cohesion, social participation, and reciprocity. Community-level social participation was associated with a lower risk of functional decline after disaster exposure. The average level of social participation in the community also mitigated the adverse impact of housing damage on functional status, suggesting a buffering mechanism.

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.

Objective To examine the association between occupational class and high-sensitivity C-reactive protein (hsCRP) in Korean workers. Methods We used a nationally representative sample of Koreans (n = 2591) aged 19 to 65 years from the 2015 Korea National Health and Nutrition Examination Survey. The concentration of hsCRP (mg/L) was assessed by a high sensitivity immunoturbidimetric assay. Current occupation was categorized as: white-collar (managers/professionals), pink-collar (clerks/service/sales), blue-collar (craft/equipment/machine-assembling, agricultural/forestry/fishery, and elementary-level labor), or unemployed. Cross-sectional linear regression models adjusted for sociodemographic/work-related/health conditions and behaviors. Results Compared with blue-collar workers, white-collar workers showed significantly higher levels of hsCRP (β = 0.16, 95% CI: 0.02, 0.30) after adjusting for all covariates, whereby the pattern was more pronounced among professionals. However, the association was not significant for unemployed and pink-collar workers. Conclusions Findings suggest that Korean white-collar workers, particularly professionals, have elevated levels of inflammation.

Background Accumulating evidence has shown that high-quality early childhood education and care may be an effective way of promoting children's optimal health and development, especially for the most disadvantaged. However, socially disadvantaged families are less likely to enroll children in center-based childcare. In this study, we explored characteristics associated with use of center-based childcare among Japanese families. Methods We used data from two Japanese birth cohorts in 2001 (n = 17,019) and 2010 (n = 24,333). Enrollment in center-based childcare was assessed at the ages of three and four years in the 2001 cohort and at the age of three in the 2010 cohort. Logistic regression analyses were conducted. Results Children in the lowest quintile of household income were 1.54 (95% confidence interval, 1.20-1.98) times more likely to not receive center-based childcare than those in the highest-income quartile at the age of four in the 2001 cohort. Other socio-economic disadvantage (mother's low education, non-Japanese parent, and higher number of siblings) and child's health and developmental problems (preterm birth, congenital diseases, and developmental delay) were also associated with the non-use of center-based childcare at the age of three in the 2001 and 2010 cohorts. Conclusions An inverse care law operates in the use of early childhood education (ie, children with the least need enjoy the highest access). Children with socio-economic, health, and developmental disadvantages are at a greater risk of not receiving early childhood education and care. Social policies to promote equal access to early childhood education are needed to reduce future socio-economic inequalities.

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.

OBJECTIVES: The deleterious health effects of long working hours have been previously investigated, but there is a dearth of studies on mortality resulting from accidents or suicide. This prospective study aims to examine the association between working hours and external-cause mortality (accidents and suicide) in Korea, a country with some of the longest working hours in the world. METHODS: Employed workers (N=14 484) participating in the Korean National Health and Nutrition Examination Survey (KNHANES) were matched with the Korea National Statistical Office’s death registry from 2007–2016 (person-years = 81 927.5 years, mean weighted follow-up duration = 5.7 years). Hazard ratios (HR) for accident (N=25) and suicide (N=27) mortality were estimated according to weekly working hours, with 35–44 hours per week as the reference. RESULTS: Individuals working 45–52 hours per week had higher risk of total external cause mortality compared to those working 35–44 hours per week [HR 2.79, 95% confidence interval (CI) 1.22–6.40], adjusting for sex, age, household income, education, occupation, and depressive symptoms. Among the external causes of death, suicide risk was higher (HR 3.89, 95% CI 1.06–14.29) for working 45–52 hours per week compared to working 35–44 hours per week. Working >52 hours per week also showed increased risk for suicide (HR 3.74, 95% CI 1.03–13.64). No statistically significant associations were found for accident mortality. CONCLUSIONS: Long working hours are associated with higher suicide mortality rates in Korea.

Background The association of sensory loss with mortality remains unclear. We aimed to explore the associations of hearing loss (HL), visual loss (VL), and dual sensory loss (DSL) with survival. Methods Data came from the Komo-Ise study cohort in Gunma Prefecture, Japan, where the community-dwelling residents aged 40-69 years were followed up from 1993 to 2010. We analyzed 9,522 individuals who answered the follow-up questionnaires in 2000 (average age 64 [range, 47 to 77] years in 2000). The primary exposures were "HL only," "VL only," or "DSL", with "no HL/VL" as the reference. These sensory loss statuses were assessed by asking the difficulty in hearing conversation or reading newspaper even with aids in the follow-up questionnaires in 2000. All-cause and cause-specific mortality were ascertained from linkage to death certificate data. Cox proportional hazards models adjusting for confounders, including demographic factors, socioeconomic status, and health status, were used. Potential mediators (depression, walking disability, and social participation) were additionally adjusted for. Results There were 1,105 deaths over the 10-year follow-up. After adjustment for the potential confounders, HL and DSL were associated with increased all-cause mortality (hazard ratios of 1.74 [95% CI, 1.18-2.57] and 1.63 [95% CI, 1.09-2.42], respectively). Potential mediators explained a modest portion of the association. As for cause-specific mortality, HL was associated with increased cancer mortality, while VL and DSL were associated with increased cardiovascular disease mortality. Conclusions Self-reported HL and DSL may be risk factors of mortality among middle-aged or elderly Japanese populations.

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.

Objectives To estimate the effect of Medicaid expansion under the Affordable Care Act (ACA) on the frequency and payment source for Emergency Department (ED) visits for dental care. Study design Retrospective, quasi-experimental study. Data sources/study setting We used the State Emergency Department Database to compare changes in ED visit rates and payment source for dental conditions among patients from 33 states. These states represent four distinct policy environments, based on whether they expanded Medicaid and whether their Medicaid programs provide dental benefits. We first assessed the number of ED dental visits before (2012) and after (2014) the ACA. Then, we used differences-in-differences regression to estimate changes in insurance for dental visits by nonelderly adults. Principal findings Our sample contained 375 944 dental ED visits. In states that expanded Medicaid and offered dental coverage, dental ED visits decreased by 14.1 percent (from 19 443 to 16 709, for a net difference of 2734). By contrast, in the remaining three state groups, dental ED visits rose. Meanwhile, the expansion significantly increased Medicaid coverage and decreased the rate of self-pay for ED dental visits. Conclusions Medicaid expansion, combined with adult dental coverage in Medicaid, was associated with a reduction in ED utilization for dental visits.

Background Little is known about occupational disparities in bladder cancer survival. Methods Using data from a population‐based cancer registry (1970‐2016), we identified 3593 patients with incident bladder cancer diagnosed during 1970‐2011 who completed occupational information. The patients were followed for 5 years (median follow‐up time 5.0 years). Their longest‐held occupations at incident bladder cancer diagnosis were classified according to a national standardized classification. Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall death were estimated by Cox proportional hazard model, adjusted for age, sex, and year of diagnosis. Clerical workers served as the reference group. Results Overall prognosis was fair in this population (5‐year overall survival, 61.9%). Compared with patients in clerical jobs, survival was poorer for those in professional and managerial jobs (mortality HR 1.36; 95% CI 1.09‐1.69), sales and service jobs (HR 1.25, 95% CI 1.01‐1.56), construction jobs (HR 1.83, 95% CI 1.40‐2.38), and manufacturing jobs (HR 1.32, 95% CI 1.05‐1.66), as well as those not actively employed (HR 1.27, 95% CI 1.02‐1.58). A similar pattern was observed in the subgroup analyses restricted to male patients as well as additional analyses adjusted for potential prognostic variables (eg, stage) with multiple imputation. Conclusion We documented occupational disparities in bladder cancer survival in Japan. However, the pattern of disparity did not favor highest occupational groups., We documented occupational disparities in bladder cancer survival in Japan. However, the pattern of disparity did not favor highest occupational groups.

Using the national disability registration linked to the cancer screening database in Korea, we examined (1) trends in the gastric cancer screening rate among people with disabilities over time, and (2) whether gastric cancer screening participation and modalities differed according to presence, severity, and type of disability. We examined gastric cancer screening participation rates among individuals with registered disability, from 2006 to 2015. The age- and sex-adjusted rate for gastric cancer screening in people with disabilities increased from 25.9% in 2006 to 51.9% in 2015 (change: + 26.0%). During the same period, screening rates among people without disability improved from 24.7 to 56.5% (change: + 31.8%). Disability was associated with a screening rate [adjusted odds ratio (aOR) 0.89, 95% confidence interval (CI), 0.88–0.89]. Screening rates were markedly lower among people with severe disabilities (aOR 0.58, 95% CI 0.57–0.58) and people with autism (aOR 0.36, 95% CI 0.25–0.52), renal failure (aOR 0.39, 95% CI 0.38–0.39), brain injury (aOR 0.41, 95% CI 0.40–0.41), ostomy problems (aOR 0.53, 95% CI 0.51–0.55), intellectual disabilities (aOR 0.54, 95% CI 0.53–0.54), or mental disorders (aOR 0.55, 95% CI 0.54–0.56). The use of gastroscopy as the initial screening modality in people with disabilities was lower than in people without a disability. In spite of the availability of national gastric cancer screening program, we found significant disparities in gastric cancer screening participation, especially among people with severe disabilities and those with renal failure or brain-related/mental disabilities.

Objective Azathioprine (AZA) and mycophenolate mofetil (MMF) are immunosuppressants frequently used in the treatment of moderate-to-severe systemic lupus erythematosus (SLE). We studied longitudinal patterns and predictors of adherence to AZA and MMF in a nationwide US SLE cohort. Methods In the Medicaid Analytic eXtract (2000-2010) database, we identified patients with SLE who initiated AZA or MMF (no use in the prior 6 months) with ≥12 months of continuous follow-up. We dichotomized adherence at 80%, with ≥24 of 30 days per month considered adherent. We used group-based trajectory models to estimate monthly adherence patterns and multivariable multinomial logistic regression to determine the association between demographic, SLE and utilization-related predictors, and the odds ratios (OR) of belonging to a nonadherent versus the adherent trajectory, separately for AZA and MMF. Results We identified 2,309 AZA initiators and 2,070 MMF initiators with SLE. Four-group trajectory models classified 17% of AZA and 21% of MMF initiators as adherent. AZA and MMF nonadherers followed similar trajectory patterns. African American race (OR 1.67 [95% confidence interval (95% CI) 1.20-2.31]) and Hispanic ethnicity (OR 1.58 [95% CI 1.06-2.35]) increased odds of AZA nonadherence; there were no significant associations between race/ethnicity and MMF nonadherence. Male sex and polypharmacy were associated with lower odds of nonadherence to both medications; lupus nephritis was associated with lower odds of nonadherence to MMF (OR 0.74 [95% CI 0.55-0.99]). Conclusion Adherence to AZA or MMF over the first year of use was rare. Race, sex, and lupus nephritis were modestly associated with adherence, but the magnitude, direction, and significance of predictors differed by medication, suggesting the complexity of predicting adherence behavior.

Importance The provision of end-of-life care is an important policy issue associated with population aging around the world. Yet it is unclear whether the provision of in-home care services can allow patients the option of in-home death at end of life. Objective To assess whether the frequent use of in-home care services can assist recipients to stay at home at the end of life. Design, Setting, and Participants This cohort study of older adults in Japan’s long-term care insurance system used national claims data. Participants were long-term care insurance beneficiaries aged 65 years or over who died in 2015, excluding those who died due to external causes such as accidents. Data analyses were conducted from October to December 2020. Exposures Mean days of in-home care service used per week from the first day of the month before the month of death to the date of death. Main Outcomes and Measures Primary outcome was whether the older person died at home (or not). To address lack of information on individual preference for place of death, we used an instrumental variable estimation with the full-time equivalent number of care workers providing in-home care services per older population at the municipality level in 2014. Results Of the 572 059 decedents included in the study, 314 743 (55.0%) were women (median [IQR] age, 87 [81-91] years). The proportion of in-home deaths was 10.5% (60 175 decedents), and 81 675 decedents (14.3%) used in-home care services at least once prior to their death. Ordinary least squares and 2-stage least squares analyses both indicated that more frequent use of in-home care was associated with a higher probability of in-home deaths (ordinary least squares estimate, 5.0 percentage points; 95% CI, 4.9-5.1 points vs 2-stage least squares estimate, 3.6 percentage points; 95% CI, 2.3-4.9 points). Conclusions and Relevance This retrospective cohort study using an instrumental variable approach demonstrated that more frequent use of in-home care services at the end of life was associated with a higher probability of in-home death. One policy implication of these results is that in order to meet the end-of-life preferences of patients, it is not only necessary to promote the provision of medical services at home but also to ensure an adequate supply of care workers.

Objective To estimate the changes in life expectancy and years of life lost in 2020 associated with the covid-19 pandemic. Design Time series analysis. Setting 37 upper-middle and high income countries or regions with reliable and complete mortality data. Participants Annual all cause mortality data from the Human Mortality Database for 2005-20, harmonised and disaggregated by age and sex. Main outcome measures Reduction in life expectancy was estimated as the difference between observed and expected life expectancy in 2020 using the Lee-Carter model. Excess years of life lost were estimated as the difference between the observed and expected years of life lost in 2020 using the World Health Organization standard life table. Results Reduction in life expectancy in men and women was observed in all the countries studied except New Zealand, Taiwan, and Norway, where there was a gain in life expectancy in 2020. No evidence was found of a change in life expectancy in Denmark, Iceland, and South Korea. The highest reduction in life expectancy was observed in Russia (men: −2.33, 95% confidence interval −2.50 to −2.17; women: −2.14, −2.25 to −2.03), the United States (men: −2.27, −2.39 to −2.15; women: −1.61, −1.70 to −1.51), Bulgaria (men: −1.96, −2.11 to −1.81; women: −1.37, −1.74 to −1.01), Lithuania (men: −1.83, −2.07 to −1.59; women: −1.21, −1.36 to −1.05), Chile (men: −1.64, −1.97 to −1.32; women: −0.88, −1.28 to −0.50), and Spain (men: −1.35, −1.53 to −1.18; women: −1.13, −1.37 to −0.90). Years of life lost in 2020 were higher than expected in all countries except Taiwan, New Zealand, Norway, Iceland, Denmark, and South Korea. In the remaining 31 countries, more than 222 million years of life were lost in 2020, which is 28.1 million (95% confidence interval 26.8m to 29.5m) years of life lost more than expected (17.3 million (16.8m to 17.8m) in men and 10.8 million (10.4m to 11.3m) in women). The highest excess years of life lost per 100 000 population were observed in Bulgaria (men: 7260, 95% confidence interval 6820 to 7710; women: 3730, 2740 to 4730), Russia (men: 7020, 6550 to 7480; women: 4760, 4530 to 4990), Lithuania (men: 5430, 4750 to 6070; women: 2640, 2310 to 2980), the US (men: 4350, 4170 to 4530; women: 2430, 2320 to 2550), Poland (men: 3830, 3540 to 4120; women: 1830, 1630 to 2040), and Hungary (men: 2770, 2490 to 3040; women: 1920, 1590 to 2240). The excess years of life lost were relatively low in people younger than 65 years, except in Russia, Bulgaria, Lithuania, and the US where the excess years of life lost was >2000 per 100 000. Conclusion More than 28 million excess years of life were lost in 2020 in 31 countries, with a higher rate in men than women. Excess years of life lost associated with the covid-19 pandemic in 2020 were more than five times higher than those associated with the seasonal influenza epidemic in 2015.

The misuse of prescription painkillers is a major contributor to the ongoing drug overdose epidemic. This study investigated variability in non-medical use of prescription painkillers (NMUPP) by race and early-life socioeconomic status (SES) in a sample now at increased risk for opioid overdose. Data from two waves of the National Longitudinal Study of Adolescent to Adult Health (n = 11,602) were used to calculate prevalence of reported NMUPP by Wave 4 (2008; mean age 28), and to assess variation by race and by equivalized household family income at Wave 1 (1994/5). Predicted values for prevalence of NMUPP were modelled, adjusting for age, sex, parental education, and region. Race and SES in adolescence were associated with later reported NMUPP. A gradient was seen in prevalence by SES (adjusted: family income quartile 1 = 13.3%; quartile 2 = 13.8%; quartile 3 = 14.8%; quartile 4 = 16.0%; trend p-value = 0.007). Prevalence was higher among males. Racial/ethnic differences in prevalence were seen (non-Hispanic white (NHW) = 18.5%; non-Hispanic black (NHB) = 5.8%; Hispanic = 10.5%; Other = 10.0%). SES differences were less pronounced upon stratification, with trend tests significant only among females (p = 0.004), and marginally significant among Hispanic males (p = 0.06). Early-life SES was associated with reported lifetime NMUPP: the higher the family income in adolescence, the greater the likelihood of NMUPP by young adulthood. Variations in NMUPP by income paled in comparison with racial/ethnic differences. Results point to a possible long-enduring association between SES and NMUPP, and a need to examine underlying mechanisms.

Objectives Hypertension has reached epidemic levels in rural China, where loneliness has been a major problem among community dwellers as a consequence of rural-to-urban migration among younger generations. The objective of the study is to investigate the association between loneliness and hypertension, and whether social support can buffer the association (i.e., stress buffering theory), using cross-sectional data from 765 adults (mean age: 59.1 years) in rural Fujian, China. Methods Social support was measured as the reciprocal instrumental social support from/to neighbors and the reciprocal emotional support (i.e., the number of close friends that the respondent could turn to for help immediately when they are in trouble). A mixed-effect Poisson regression model with a robust variance estimator was used to investigate the association between loneliness, social support, and hypertension. Results Analysis revealed that those who were lonely had a higher prevalence ratio for hypertension (prevalence ratio = 1.12, 95% confidence interval 0.99–1.26) compared to those who reported not being lonely. There was an interaction between social support and loneliness in relation to hypertension. Specifically, contrary to the stress buffering theory, the positive association between loneliness and hypertension was more pronounced among those who reported higher social support compared to those who reported lower support (p for interaction Conclusion The results suggest that being lonely despite high levels of social support poses the greatest risk for hypertension. This study did not confirm a buffering effect of social support on the association between loneliness and hypertension.

Little is known about occupational disparities in survival for common cancer sites in Japan.Using data from a population-based cancer registry, we identified 32,870 cancer patients diagnosed during 1992-2011. We followed the patients for 5 years (median follow-up time 5.0 years). For each individual, we classified their longest-held occupation into 5 classes (upper non-manual, lower non-manual, manual, farmer, and others) following the Erikson-Goldthorpe-Portocarero scheme. Poisson regression models were used to estimate overall and site-specific mortality rate ratios (MRRs) and 95% confidence intervals (CI) for each occupational class, adjusted for sex, age, and diagnosis year. Upper non-manual workers served as the reference group. Additionally, using a binary categorization of occupations (manual workers versus non-manual workers), a causal mediation analysis with 4-way decomposition was performed to investigate the potential mediation of the association between occupation and overall mortality by cancer stage.Overall prognosis was good in this population (5-year overall survival was 81.7%). Compared with upper non-manual workers, both overall and cancer-specific mortality was higher in lower non-manual workers (MRR=1.14, 95% CI 1.05-1.24) and manual workers (MRR=1.40, 95% CI 1.29-1.53). After adjusting for the mediating influence of prognostic factors (stage and treatment), the observed occupational differences were attenuated but remained significant in manual workers: MRR = 1.23 (95% CI 1.08-1.39). Observed occupational disparities tended to be attributable to common cancers, i.e., stomach and lung among men and female breast cancer. Additionally, manual workers had 1.25 times higher odds for advanced stage. In the mediation analysis, the overall proportion explained by mediating effect of cancer stage was 29% (4% due to mediated interaction and 25% due to pure indirect effect).We documented occupational disparities in survival from commonly-occurring cancers in Japan. Occupational differences in cancer stage may explain one-third of the survival disparities.

This study investigated the 10-year trends of weight and prevalence of underweight, overweight and obesity according to disability grade and types compared with those without disabilities.This serial cross-sectional analysis was conducted using national disability registration data with national general health checkup data from 2008 to 2017. Age-standardized prevalence of underweight and obesity were analyzed for each year, according to the presence, type, and severity of disabilities. Odds of underweight, overweight, obesity, and severe obesity were examined by multinomial logistic regression after adjusting for socio-demographic and clinical variables using data in 2017.Over 10 million subjects in each year were included in the analysis. In 2017, 14,246,785 people with age between 19 and 110 years were included and 53.1% was men. For 10 years, age-standardized prevalence of obesity and severe obesity showed significant increases regardless of sex and presence of disability. However, age-standardized underweight prevalence in people without disability tended to decrease whereas it was an increase in 2012 and the prevalence has remained steady since in people with disability. People with disabilities had higher odds of underweight compared to those without disability (OR 1.41, 95% CI 1.38-1.44 in male and OR 1.31, 95% CI 1.28-1.34 in female), 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). 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). Participants with mental disorder showed the highest prevalence of obesity, followed by epilepsy and developmental disability.Having a disability was associated with higher odds/probability of both obesity and underweight. The intersection of female, severe disability, and mental/developmental disabilities was associated with probability of severe obesity. Simultaneous efforts are needed to develop health policy to reduce both the prevalence of obesity and underweight.

Study Objectives This study aims to examine associations between acculturative stress—defined as the psychological impact, or stress reaction, of adapting to a new cultural context—and self-reported sleep outcomes among Chinese and Korean immigrants in the United States. Methods In this cross-sectional study, acculturative stress was assessed using a 9-item scale, and sleep disturbance was measured using the 8-item scale. Sleep duration was self-reported. Poisson and linear regression analyses were conducted to examine the associations between acculturative stress, sleep disturbance, and sleep duration. Results Our sample consists of 400 participants (females: 52%, Chinese: 50%, Koreans: 50%, the mean of age = 58.4). 81.8% of them were classified as having no sleep disturbance, whereas 18.2% were classified as having sleep disturbance. Poisson models revealed that greater acculturative stress was associated with a higher prevalence of sleep disturbance (Prevalence Ratio (PR): 1.18, 95% confidence interval (CI): 1.06% to 1.31%). In linear models, a one-unit increase in acculturative stress was associated with 0.08 hr less sleep (p < .05). Interaction tests indicated effect modification for sleep disturbance by sex and ethnic identity: only women had a significant association between acculturative stress and sleep disturbance (PR: 1.30; 95% CI: 1.13 to 1.49), while the association was significant for individuals identifying as “very Asian” (PR: 1.21; 95% CI: 1.08 to 1.35), but not for those identifying as “mostly Asian” or “bicultural/western”. Conclusions If findings are replicated, we suggest developing intervention programs for Asian immigrants to minimize acculturative stress and bolster protective factors that decrease the risk for poor sleep outcomes. Information on Clinical Trial: Name: Screening To Prevent ColoRectal Cancer (STOP CRC) among At-Risk Asian American Primary Care Patients NCT Number: NCT03481296 URL: https://clinicaltrials.gov/ct2/show/NCT03481296?term=Sunmin+Lee&draw=2&rank=1

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.

Background A growing body of evidence has demonstrated the associations between social capital and health. In residential or geographical areas, social capital has attracted attention for its protective effects against suicide. However, to this date, the relationship between social capital and suicidal ideation is not fully elaborated in the occupational setting. Therefore, the aim of the present study was to examine the association between workplace social capital and suicidal ideation in the past year among employees in Japan. Methods A cross-sectional, web-based survey was conducted in February/March 2017 via an anonymous self-administered questionnaire distributed to workers in Tsukuba Science City, Japan. Binomial logistic regressions were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for suicidal ideation in the past year, controlling for age group, marital status, educational attainment, and annual household income. The results were shown stratified by sex and occupation. Results In total, 7255 of 19,481 workers responded, out of which we could analyze 6325 responses (4030 men, 2295 women). The prevalence of suicidal ideation in the past year was 5.9% for men and 7.8% for women. Low workplace social capital was statistically significantly associated with suicidal ideation both for men (OR = 2.57, 95% CI = 1.72–3.83) and for women (OR = 1.75, 95% CI = 1.15–2.66), compared with high workplace social capital after controlling for socioeconomic factors. Conclusion Higher workplace social capital was associated with a reduced risk of suicidal ideation in the past year. Promoting workplace social capital could contribute to preventing suicide among employees in Japan.

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.

Health information mavens are those who provide and share health information with others via interpersonal communication. We investigated the characteristics of health information mavens among Japanese elderly and whether those who share health information with others via interpersonal communication behave more healthily or report better health status compared to their peers. Data come from a cross-sectional analysis of 27,414 participants in the Japanese Gerontological Evaluation Study (JAGES) (mean age = 74 years). Mavenism is associated with being female, younger age, higher educational status, and perceived financial condition, as well as larger social networks, higher social support, and media exposure. A higher mavenism score was associated with healthier dietary, and exercise behaviors, but not associated with smoking or alcohol consumption. Mavens were more likely to have a disease and/or report disease symptoms. Health information mavens have the potential to facilitate word-of-mouth communication among older adults, who tend to be more disadvantaged in terms of health information access compared to younger populations.

Studies have found that sibling loss is associated with an increased risk of death from external causes (i.e. suicides, accidents and homicides). Increased psychiatric health problems following bereavement could underlie such an association. We studied the influence of sibling loss during childhood on psychiatric care in young adulthood, adjusting for psychosocial covariates shared by siblings in childhood. A national cohort born in Sweden in 1973–1982 (N = 701,270) was followed prospectively until 2013. Cox proportional hazards models were used to analyse the association between sibling loss during childhood and psychiatric inpatient and outpatient care identified by the Hospital Discharge Register. After adjustment for confounders, the HRs of psychiatric care in men who experienced sibling loss were 1.17 (95% CI 1.07–1.27) while the associations turned non-significant in women after adjustment for family-related psychosocial covariates, HR 1.07 (95% CI 0.99–1.16). An increased risk was found in men bereaved in early childhood (1.22 95% CI 1.07–1.38) and adolescence (1.27 95% CI 1.08–1.48). Among women, loss of a sibling during adolescence was significantly associated with psychiatric care (1.19 95% CI 1.03–1.36). Increased psychiatric health problems following bereavement could underlie the previously found association between sibling loss and mortality from external causes. Family-related psychosocial conditions shared by siblings in childhood may account for the association between sibling death and psychiatric care in adulthood. Electronic supplementary material The online version of this article (10.1007/s00787-019-01324-6) contains supplementary material, which is available to authorized users.

We investigated the association between disaster experience and the cardiometabolic risk of survivors 2.5 years after disaster onset, adjusting for health information predating the disaster, using natural experiment data stemming from the 2011 Great East Japan Earthquake and Tsunami. We used data from a cohort of adults aged 65 years or older in Iwanuma City, Japan, located 80 km (128 miles) west of the earthquake epicenter. The baseline survey was completed 7 months before the disaster, and the follow-up survey was performed among survivors approximately 2.5 years after the disaster. The survey data were linked to medical records with information on objectively measured cardiometabolic risk factors (n = 1,195). The exposure of interest was traumatic disaster experiences (i.e., housing damage and loss of loved ones). Fixed-effects regression showed that complete housing destruction was significantly associated with a 0.81-unit greater change in body mass index (weight (kg)/height (m)2; 95% confidence interval (CI): 0.24, 1.38), a 4.26-cm greater change in waist circumference (95% CI: 1.12, 7.41), and a 4.77-mg/dL lower change in high-density lipoprotein cholesterol level (95% CI: −7.96, −1.58) as compared with no housing damage. We also observed a significant association between major housing damage and decreased systolic blood pressure. Continued health checkups and supports for victims who lost homes should be considered to maintain their cardiometabolic health.

Systematic reviews and meta-analyses have found inconsistent associations between working hours and depressive symptoms. The purpose of this study was to investigate the possible moderators of this association, using data from a large-scale cross-sectional survey. A total of 16,136 Japanese employees (men 83.5%; women 16.5%) responded to a self-administered questionnaire inquiring about overtime working hours during the previous month and depressive symptoms (Center for Epidemiologic Studies Depression scale), as well as moderating factors including gender, age, marital status, socioeconomic status, commuting time, sleeping hours per day, job control and worksite social support (Job Content Questionnaire), neuroticism (Eysenck’s Personality Questionnaire Revised), and social desirability (Social Desirability Scale) (response rate, 85%). We conducted sequential regression analyses to investigate the main effects and interaction effects of all moderating variables. The association between overtime working hours and depressive symptoms was significantly moderated by gender (interaction effect: β = 0.03), age (β = − 0.02), manager (β = 0.03), sleeping hours (β = − 0.02), job control (β = − 0.03), and neuroticism (β = 0.02). Among workers engaged in 80 + hours of overtime, higher depressive symptoms were reported by women, younger employees, non-managers, employees with low job control, low worksite social support, and high neuroticism. A significant main effect of long overtime working hours on depressive symptoms was also observed even after controlling for all independent variables (β = 0.02). Long overtime working hours is associated with depressive symptoms. We also found significant heterogeneity in the association according to employee characteristics, which may explain the inconsistent findings in previous literature.

Background: Previous studies have identified poor dietary intake as a health risk affecting survivors of the 2011 Great East Japan Earthquake and Tsunami. We examined the association between different social factors (eg, living conditions and perceptions of community social capital) and dietary intakes among disaster-affected survivors. Methods: We studied 6,724 survivors in four municipalities of Iwate Prefecture 3 years after the disaster. Social capital was assessed via four items inquiring about respondents’ perceptions of social cohesion in their communities. Good dietary intake was defined according to the following criteria: intake of staple food ≥three times a day; intake of meat, fish and shellfish eggs, or soybean products ≥twice a day; vegetable intake ≥twice a day; and intake of fruit or dairy products ≥once a day. An individual who did not meet any of these criteria was defined as having poor dietary intake. We adjusted for covariates, including socioeconomic status, marital status, and residential area. Results: Poor dietary intake was reported by 31.6% of respondents. Poisson regression analyses revealed that the following factors were related to poor dietary intake: age

Objectives Socioeconomically disadvantaged children have worse adult health; we test if this ‘long arm’ of childhood disadvantage can be overcome through upward socioeconomic mobility in adulthood. Methods Four SES trajectories (stable low, upwardly mobile, downwardly mobile and stable high) were created from median dichotomized childhood socioeconomic status (SES; childhood human and financial capital) and adult SES (wealth at age 67) from Health and Retirement Study respondents (N = 6669). Healthy ageing markers, in tertiles, were walking speed, peak expiratory flow (PEF), and grip strength measured in 2008 and 2010. Multinomial logistic regression models, weighted to be nationally representative, controlled for age, gender, race, birthplace, outcome year and childhood health and social capital. Results Upwardly mobile individuals were as likely as the stable high SES group to be in the best health tertile for walking speed (OR = 0.81; 95% CI: 0.63, 1.05; P = 0.114), PEF (OR = 0.97; 95% CI: 0.78, 1.21; P = 0.810) and grip strength (OR = 0.97; 95%CI: 0.74, 1.27; P = 0.980). Discussion Findings suggest the ‘long arm’ of childhood socioeconomic disadvantage can be overcome for these markers of healthy ageing through upward socioeconomic mobility.

One possible predictive factor that affects both pro-environmental behavior and health behavior is health consciousness (a psychological state where an individual is aware of and involved in his/her health condition). We examined the relationship between health consciousness and two pro-environmental behaviors (recycling and green purchasing) within health professionals in a Japanese large hospital. Multivariate linear regression analysis revealed a significant association between health consciousness and recycling behavior, while there was no association between health consciousness and green purchasing behavior. We assume that health consciousness can certainly be a factor promoting pro-environmental behavior, but that it may have been insufficient to cause green purchasing, because of the organizational norm of recycling in the Japanese context. Given that there is previous evidence about the relationship between health consciousness and health behavior, health consciousness might be a predictive factor that encourages both health behavior and pro-environmental behavior simultaneously.

ObjectivesWe examined exposure to different types of organisational changes at work as risk factors for subsequent prescription for psychotropic medication among employees.MethodsThe study population included 15 038 public healthcare employees nested within 1284 work units in the Capital Region of Denmark. Multilevel mixed-effects parametric survival models were developed to examine time to prescription for psychotropic medications (anxiolytics/hypnotics/sedatives/antidepressants) during the 12-month interval following exposure to organisational changes relative to no change from January to December 2013. Data on work-unit level organisational changes (including mergers, split-ups, relocation, change in management, employee lay-offs and budget cuts) were collected from work-unit managers (59% response).ResultsAny organisational change versus no change was associated with a higher risk of psychotropic prescription (HR: 1.14, 95% CI: 1.02 to 1.26), especially change in management (HR: 1.23, 95% CI: 1.07 to 1.41). Splitting the 12-month follow-up period into two halves yielded particularly high rates of psychotropic prescription in the latter half of the follow-up, for example, any change (HR: 1.25, 95% CI: 1.11 to 1.41), change in management (HR: 1.42, 95% CI: 1.22 to 1.65), mergers (HR: 1.26, 95% CI: 1.06 to 1.50), employee lay-off (HR: 1.23, 95% CI: 1.03 to 1.46) and budget cuts (HR: 1.13, 95% CI: 1.00 to 1.41). The associations did not vary by sex.ConclusionsOrganisational changes in the workplace, especially change in management, may be associated with increased risk of psychotropic prescription among employees regardless of sex.

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 Alcohol consumption in pregnancy has been associated with serious fetal health risks and maternal complications. While previous systematic reviews of digital interventions during pregnancy have targeted smoking cessation and flu vaccine uptake, few studies have sought to evaluate their effectiveness in preventing alcohol consumption during pregnancy. Objective This systematic review aims to assess (1) whether digital interventions are effective in preventing alcohol consumption during the pregnancy/pregnancy-planning period, and (2) the differential effectiveness of alternative digital intervention platforms (ie, computers, mobiles, and text messaging services). Methods PubMed, Embase, CINAHL, and Web of Science were searched for studies with digital interventions aiming to prevent alcohol consumption among pregnant women or women planning to become pregnant. A random effects primary meta-analysis was conducted to estimate the combined effect size and extent to which different digital platforms were successful in preventing alcohol consumption in pregnancy. Results Six studies were identified and included in the final review. The primary meta-analysis produced a sample-weighted odds ratio (OR) of 0.62 (95% CI 0.42-0.91; P=.02) in favor of digital interventions decreasing the risk of alcohol consumption during pregnancy when compared to controls. Computer/internet-based interventions (OR 0.59, 95% CI 0.38-0.93) were an effective platform for preventing alcohol consumption. Too few studies of text messaging (OR 0.29, 95% CI 0.29-2.52) were available to draw a conclusion. Conclusions Overall, our review highlights the potential for digital interventions to prevent alcohol consumption among pregnant women and women planning to become pregnant. Considering the advantages of digital interventions in promoting healthy behavioral changes, future research is necessary to understand how certain platforms may increase user engagement and intervention effectiveness to prevent women from consuming alcohol during their pregnancies.