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COVID-19 has affected many people across the globe. Though vaccines are available now, early detection of the disease plays a vital role in the better management of COVID-19 patients. An Artificial Neural Network (ANN) powered Computer Aided Diagnosis (CAD) system can automate the detection pipeline accounting for accurate diagnosis, overcoming the limitations of manual methods. This work proposes a CAD system for COVID-19 that detects and classifies abnormalities in lung CT images using Artificial Bee Colony (ABC) optimised ANN (ABCNN). The proposed ABCNN approach works by segmenting the suspicious regions from the CT images of non-COVID and COVID patients using an ABC optimised region growing process and extracting the texture and intensity features from those suspicious regions. Further, an optimised ANN model whose input features, initial weights and hidden nodes are optimised using ABC optimisation classifies those abnormal regions into COVID and non-COVID classes. The proposed ABCNN approach is evaluated using the lung CT images collected from the public datasets. In comparison to other available techniques, the proposed ABCNN approach achieved a high classification accuracy of 92.37% when evaluated using a set of 470 lung CT images.

Several studies have warranted the need to explore the relationship between pedagogical agents in the learning environment and the cognitive load on the learners, specifically, to study the influence on learner populations with different learning and motivation needs. The present work investigates the effects of the presence of a pedagogical agent in the learning environment on intrinsic, extraneous, and germane cognitive load for the dyscalculia and non- learner population. The proposed system intelligently investigates the learner, recommends an exclusive learning dyscalculia path and after tutoring assesses learning gain, and retention. Learner experience and effects of the pedagogical agent on types of cognitive loads are discussed on basis of post tutoring analysis. Samples of 82 learners have been studied, experimental findings based on research questions have been reported and conclusions discussed. Our assumption that ‘a well-articulated and well-designed instructional design exerts a minimal extraneous cognitive load on learners and facilitates learning gain and retention’ is consistent with the obtained results. The result concludes that pedagogical agent does not add to intrinsic and extraneous cognitive load. An improved Germane Cognitive load and a good amount of knowledge retention are noticed post learning.

Considering the computation resources available with sensor devices and the value and validity of Cognitive Wireless Communication Network (CWCN), traditional blockchain is not feasible for CWCN. Further, considering the security and privacy for CWCN that can directly impact human life (as in the case of ambient assisted living applications), blockchain provides a good solution for such applications, however, with some simplicity in the computation of Proof of Work (PoW). Therefore, the fourth objective solution comes up with a simplified energy-efficient blockchain implementation for CWCN that consumes less energy in computation time. The energy-hungry blockchain has been implemented on resource-constrained CWCN for ambient assisted living applications specialized for elderly care. The process includes a collection of physical environmental parameters on a single board computer-based CWCN. The implementation includes possible simplification in the most energy-consuming process, i.e., the mining process, which makes it energy efficient in computation time as energy consumption is a computation time factor.

The recent outbreak of the novel Coronavirus Disease (COVID-19) has given rise to diverse health issues due to its high transmission rate and limited treatment options. Almost the whole world, at some point of time, was placed in lock-down in an attempt to stop the spread of the virus, with resulting psychological and economic sequela. As countries start to ease lock-down measures and reopen industries, ensuring a healthy workplace for employees has become imperative. Thus, this paper presents a mobile app-based intelligent portable healthcare (pHealth) tool, called i WorkSafe, to assist industries in detecting possible suspects for COVID-19 infection among their employees who may need primary care. Developed mainly for low-end Android devices, the i WorkSafe app hosts a fuzzy neural network model that integrates data of employees' health status from the industry's database, proximity and contact tracing data from the mobile devices, and user-reported COVID-19 self-test data. Using the built-in Bluetooth low energy sensing technology and K Nearest Neighbor and K-means techniques, the app is capable of tracking users' proximity and trace contact with other employees. Additionally, it uses a logistic regression model to calculate the COVID-19 self-test score and a Bayesian Decision Tree model for checking real-time health condition from an intelligent e-health platform for further clinical attention of the employees. Rolled out in an apparel factory on 12 employees as a test case, the pHealth tool generates an alert to maintain social distancing among employees inside the industry. In addition, the app helps employees to estimate risk with possible COVID-19 infection based on the collected data and found that the score is effective in estimating personal health condition of the app user.

Industrial Control Systems monitor, automate, and operate complex infrastructure and processes that integrate into critical industrial sectors that affect our daily lives. With the advent of networking and automation, these systems have moved from being dedicated and independent to centralized corporate infrastructure. While this has facilitated the monitoring and overall management using traditional detection methods, Web Application Firewalls or Intrusion Detection Systems has exposed the networks subjecting them to Behavior-based cybersecurity attacks. Such attacks alter the control flow and processes and have the malicious ability to alter the functioning of these systems altogether. This research focuses on the use of process analytics to detect attacks in the industrial control infrastructure systems and compares the effectiveness of signature-based detection methods. The proposed work presents a pattern recognition algorithm aptly named as “Capturing-the-Invisible (CTI)” to find the hidden process in industrial control device logs and detect Behavior-based attacks being performed in real-time.

A novel approach for multichannel epilepsy seizure classification which will help to automatically locate seizure activity present in the focal brain region was proposed. This paper suggested an Internet of Things (IoT) framework based on a smart phone by utilizing a novel feature termed multiresolution critical spectral verge (MCSV), based on frequency-derived information for epileptic seizure classification which was optimized using a flower pollination algorithm (FPA). A wireless sensor technology (WSN) was utilized to record the electroencephalography (EEG) signal of epileptic patients. Next, the EEG signal was pre-processed utilizing a multiresolution-based adaptive filtering (MRAF) method. Then, the maximal frequency point at which the power spectral density (PSD) of each EEG segment was greater than the average spectral power of the corresponding frequency band was computed. This point was further optimized to extract a point termed as critical spectral verge (CSV) to extract the exact high frequency oscillations representing the actual seizure activity present in the EEG signal. Next, a support vector machine (SVM) classifier was used for channel-wise classification of the seizure and non-seizure regions using CSV as a feature. This process of classification using the CSV feature extracted from the MRAF output is referred to as the MCSV approach. As a final step, cloud-based services were employed to analyze the EEG information from the subject’s smart phone. An exhaustive analysis was undertaken to assess the performance of the MCSV approach for two datasets. The presented approach showed an improved performance with a 93.83% average sensitivity, a 97.94% average specificity, a 97.38% average accuracy with the SVM classifier, and a 95.89% average detection rate as compared with other state-of-the-art studies such as deep learning. The methods presented in the literature were unable to precisely localize the origination of the seizure activity in the brain region and reported a low seizure detection rate. This work introduced an optimized CSV feature which was effectively used for multichannel seizure classification and localization of seizure origination. The proposed MCSV approach will help diagnose epileptic behavior from multichannel EEG signals which will be extremely useful for neuro-experts to analyze seizure details from different regions of the brain.

Abstract Background Deep-vein thrombosis (DVT) and pulmonary embolism (PE) are frequent and life-threatening complications of ischemic stroke. We evaluated rates of symptomatic DVT/PE, and of in-hospital and post-discharge thromboprophylaxis in patients with acute ischemic stroke (AIS). Methods In a retrospective US database analysis, data were extracted from the Premier Perspective™-i3 Pharma Informatics linked database for patients aged ≥18 years who were hospitalized for ischemic stroke from January 2005 to November 2007, and who had ≥6 months’ continuous plan enrollment prior to index hospitalization. Patients discharged to an acute-care facility or with atrial fibrillation were excluded. Prophylaxis was evaluated during index hospitalization and for 14 days’ post-discharge. DVT/PE rates were calculated during index hospitalization and up to 30 days post-discharge. Results A total of 1524 patients were included; 46.1% received pharmacological and/or mechanical prophylaxis in-hospital (28.3%, 11.4% and 12.3% received unfractionated heparin, enoxaparin and mechanical prophylaxis, respectively). 6.4% of patients received outpatient pharmacological prophylaxis; warfarin was most frequently prescribed (5.9%). Total mean ± standard deviation length of index hospitalization was 3.0 ± 2.5 days. Mean prophylaxis duration in all patients was 0.9 ± 1.5 days in-hospital and 1.7 ± 6.9 days post-discharge. Symptomatic DVT/PE occurred in 25 patients overall (1.64%), with an inpatient rate of 0.98% and an outpatient rate of 0.66%. Conclusions Approximately 1% of patients with AIS experienced symptomatic in-hospital and/or post-discharge DVT/PE. Although 46% received prophylaxis in-hospital, only 6% received prophylaxis in the outpatient setting. This highlights the need for sustained thromboprophylaxis prescribing across the continuum of care.

Abstract Background Although Campylobacter jejuni is consistently ranked as one of the leading causes of bacterial diarrhea worldwide, the mechanisms by which C. jejuni causes disease and how they are regulated have yet to be clearly defined. The global regulator, CsrA, has been well characterized in several bacterial genera and is known to regulate a number of independent pathways via a post transcriptional mechanism, but remains relatively uncharacterized in the genus Campylobacter. Previously, we reported data illustrating the requirement for CsrA in several virulence related phenotypes of C. jejuni strain 81–176, indicating that the Csr pathway is important for Campylobacter pathogenesis. Results We compared the Escherichia coli and C. jejuni orthologs of CsrA and characterized the ability of the C. jejuni CsrA protein to functionally complement an E. coli csrA mutant. Phylogenetic comparison of E. coli CsrA to orthologs from several pathogenic bacteria demonstrated variability in C. jejuni CsrA relative to the known RNA binding domains of E. coli CsrA and in several amino acids reported to be involved in E. coli CsrA-mediated gene regulation. When expressed in an E. coli csrA mutant, C. jejuni CsrA succeeded in recovering defects in motility, biofilm formation, and cellular morphology; however, it failed to return excess glycogen accumulation to wild type levels. Conclusions These findings suggest that C. jejuni CsrA is capable of efficiently binding some E. coli CsrA binding sites, but not others, and provide insight into the biochemistry of C. jejuni CsrA.

Abstract Background Campylobacter jejuni is a gastrointestinal pathogen of humans, but part of the normal flora of poultry, and therefore grows well at the respective body temperatures of 37°C and 42°C. Proteomic studies on temperature regulation in C. jejuni strain 81–176 revealed the upregulation at 37°C of Cj0596, a predicted periplasmic chaperone that is similar to proteins involved in outer membrane protein folding and virulence in other bacteria. Results The cj0596 gene was highly conserved in 24 strains and species of Campylobacter, implying the importance of this gene. To study the role that Cj0596 plays in C. jejuni pathogenesis, a mutant derivative of strain 81–176 was constructed in which the cj0596 gene was precisely deleted. A revertant of this mutant was isolated by restoring the gene to its original chromosomal location using streptomycin counterselection. The cj0596 mutant strain demonstrated a slightly decreased growth rate and lower final growth yield, yet was more motile and more invasive of human intestinal epithelial cells than wild-type. In either single or mixed infections, the mutant was less able to colonize mice than 81–176. The cj0596 mutant also expressed altered levels of several proteins. Conclusion Mutation of cj0596 has an effect on phenotypes related to C. jejuni pathogenesis, probably due to its role in the proper folding of critical outer membrane proteins.

In the United States, it is estimated that 15% of Latinos will experience a depressive or anxiety disorder during their lifetime. Education, prevention programming, and health interventions around topics such as stress, nutrition, mental health, and health maintenance for Latino immigrants are lacking, inadequate, or nonexistent. This type of programming may be protective against depression and anxiety. A total of 19 Latina women completed a five-week, group-based intervention to learn about stress, stress management, nutrition, mental health, and healthy behaviors in a culturally sensitive environment taught by native Spanish speakers. Program evaluation occurred through in-depth interviews and changes in anxiety and depression scores via the Generalized Anxiety Scale and the Patient Health Questionnaire, respectively. The team saw statistically significant decreases in the GAD-7 scores pre- and post-intervention (8.00 versus 5.08, p<0.05), but no differences in the PSS or the PHQ-2 scores. Group-based intervention and education taught by native Spanish speakers may be an acceptable and feasible approach to addressing anxiety in Latina immigrants., Competing Interests: Declarations. Ethical Approval: All study procedures were reviewed and approved by the Institutional Review Board at Montana State University under IRB number 2022-265 Expedited. Consent to Participate: Written informed consent was obtained from all participants. Competing Interests: The authors have no relevant financial or non-financial interests to disclose., (© 2024. The Author(s).)

Introduction: Levels of plant-based aeroallergens are rising as growing seasons lengthen and intensify with anthropogenic climate change. Increased exposure to pollens could increase risk for mortality from respiratory causes, particularly among older adults. We determined short-term, lag associations of four species classes of pollen (ragweed, deciduous trees, grass pollen and evergreen trees) with respiratory mortality (all cause, chronic and infectious related) in Michigan, USA., Methods: We obtained records for all Michigan deaths from 2006-2017 from the Michigan Department of Health and Human Services (MDHHS). Deaths from infectious and chronic respiratory-related causes were selected using International Classification of Diseases (ICD-10) codes. Pollen data were obtained from a prognostic model of daily pollen concentrations at 25 km resolution. Case-crossover models with distributed lag non-linear crossbases for pollen were used to estimate associations between lags of daily pollen concentrations with mortality and to explore effect modification by sex and racial groups., Results: 127,163 deaths were included in the study. Cumulative daily high concentrations (90th percentile) of deciduous broadleaf, grass and ragweed were associated with all-cause respiratory mortality at early lags with e.g., a 1.81 times higher risk of all respiratory deaths at cumulative 7 day lag exposure to deciduous broadleaf pollen at the 90th percentile (95% confidence interval: 1.04, 3.15). Exposure to high concentrations of grass and ragweed pollens was associated with increased risk for death from chronic respiratory causes. No association was found for any pollen species with death from infectious respiratory causes though there was a positive but non-significant association of exposure to deciduous broadleaf and ragweed pollens. We found no evidence to suggest effect modification by race or sex., Conclusions: Modelled exposures to high concentrations of pollen taxa were associated with increased all-cause and chronic respiratory mortality among older adults. Results suggest that pollen exposure may become more important to respiratory mortality as the temperatures increase and pollen seasons lengthen., Competing Interests: Declarations. Ethics approval and consent to participate: Approval for data use was obtained from the Michigan Department of Health and Human Services. The Institutional Review Board of the University of Michigan ruled this research exempt (HUM00166964). Informed consent for this study was waived by the Michigan Department of Health and Human Services as we used datasets of public death record. This research is in accordance with all the standards of the Helsinki Declaration. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Anhedonia and suicidal ideation are symptoms of major depressive disorder (MDD) that are not regularly captured in structured scales but may be captured in unstructured clinical notes. Natural language processing (NLP) techniques may be used to extract longitudinal data on suicidal behaviors and anhedonia within unstructured clinical notes. This study assessed the accuracy of using NLP techniques on electronic health records (EHRs) to identify these symptoms among patients with MDD., Methods: EHR-derived, de-identified data were used from the NeuroBlu Database (version 23R1), a longitudinal behavioral health real-world database. Mental health clinicians annotated instances of anhedonia and suicidal symptoms in clinical notes creating a ground truth. Interrater reliability (IRR) was calculated using Krippendorff's alpha. A novel transformer architecture-based NLP model was trained on clinical notes to recognize linguistic patterns and contextual cues. Each sentence was categorized into one of four labels: (1) anhedonia; (2) suicidal ideation without intent or plan; (3) suicidal ideation with intent or plan; (4) absence of suicidal ideation or anhedonia. The model was assessed using positive predictive values (PPV), negative predictive values, sensitivity, specificity, F1-score, and AUROC., Results: The model was trained, tested, and validated on 2,198, 1,247, and 1,016 distinct clinical notes, respectively. IRR was 0.80. For anhedonia, suicidal ideation with intent or plan, and suicidal ideation without intent or plan the model achieved a PPV of 0.98, 0.93, and 0.87, an F1-score of 0.98, 0.91, and 0.89 during training and a PPV of 0.99, 0.95, and 0.87 and F1-score of 0.99, 0.95, and 0.89 during validation., Conclusions: NLP techniques can leverage contextual information in EHRs to identify anhedonia and suicidal symptoms in patients with MDD. Integrating structured and unstructured data offers a comprehensive view of MDD's trajectory, helping healthcare providers deliver timely, effective interventions. Addressing current limitations will further enhance NLP models, enabling more accurate extraction of critical clinical features and supporting personalized, proactive mental health care., Competing Interests: Declarations. Ethics approval and consent to participate: Institutional review board approval of the study protocol, including a waiver of Health Insurance Portability and Accountability Act authorization, was obtained from WCG IRB (reference # 1-1470336-1) prior to study conduct, and covers data originating from all sites represented. WCG IRB reviewed the protocol against the Common Rule and determined that it was exempt from ongoing IRB oversight and review and from obtaining informed consent as per exemptions outlined in 45 CFR § 46.104(d)(4). Consent for publication: Not applicable. Competing interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: AV, EOCP, LW, DK and AGirdhari report current employment with and equity ownership in Holmusk Technologies, Inc. AGhosh, MU, KMYC and JS report previous employment with and equity ownership in Holmusk Technologies, Inc., (© 2025. The Author(s).)

Background: The current study used U.S. young adult data to examine overall and age group-specific historical trends in (a) mean perceived risk and disapproval of cannabis use, and (b) risk/use and disapproval/use associations., Methods: Data were collected from 2011 to 2022 from 16,492 respondents aged 19-30 in the national Monitoring the Future panel study. Trends in mean risk and disapproval overall and by age group (19-22, 23-26, 27-30) were modeled. Models regressing any past 30-day cannabis use on risk and disapproval controlled for sex, race/ethnicity, college education, population density, state cannabis policy, region, and year. Age group differences and historical trends in regression estimates from year-specific models were examined., Results: From 2011 to 2022, overall mean perceived risk decreased from 3.08 (just over moderate) to 2.50 (between slight and moderate); mean disapproval decreased from 2.21 (between disapprove and strongly disapprove) to 1.66 (between don't disapprove and disapprove). Higher risk and disapproval were independently associated with lower odds of past 30-day cannabis use overall (AORs 0.86 and 0.76, respectively); controlling for sociodemographics and state policy had virtually no impact on association strength. There were no significant age-related association differences. The risk/use association weakened from AOR 0.84 in 2011 to AOR 0.91 in 2022; the disapproval/use association remained stable (AORs 0.753 and 0.749)., Conclusions: Young adults now perceive cannabis as less risky and are less disapproving of using than they were a decade ago. Perceived risk has weakened as a cannabis use risk factor over time; disapproval has remained a stable risk factor., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: While PTSD is commonly associated with multiple comorbidities, studies have yet to quantify the impact of these comorbidities on key clinical outcomes and HCRU. This study explored risks of emergency room (ER) visits, inpatient admissions (IA), suicidal ideation (SI), and treatment follow-up duration (FU), amongst PTSD patients with comorbid MDD and/or SUD., Methods: Using real-world data (RWD) generated by electronic health records accessed from the NeuroBlu database, a cohort of adolescent patients (12-17 yrs) was examined over a one-year study period following PTSD diagnosis., Results: 5794 patients were included in the cohort. Compared to patients with only PTSD (n = 3061), those with comorbid MDD (n = 1820) had greater odds of ER (4.5 times), IA (1.6 times), and FU (4.3 times). Those with comorbid SUD (n = 653) had greater odds of IA (4.5 times), shorter FU (34 days), and lower odds of ER (0.5 times). Both comorbidities (n = 260) had greater odds of ER (3.8 times), IA (2.6 times), SI (3.6 times), and shorter FU (12 days)., Limitations: These RWD had a high proportion of missingness. Health records of patients who changed service providers could not be accounted for in this study., Conclusions: Both MDD and SUD substantially elevated the risk of HCRU and suicidal ideation for PTSD patients., Competing Interests: Declaration of competing interest A. John Rush has received consulting fees from Compass Inc., Curbstone Consultant LLC, Emmes Corp., Evecxia Therapeutics, Inc., Holmusk Technologies, Inc., ICON, PLC, Johnson and Johnson (Janssen), Liva-Nova, MindStreet, Inc., Neurocrine Biosciences Inc., Otsuka-US;speaking fees from Liva-Nova, Johnson and Johnson (Janssen); and royalties from Wolters Kluwer Health, Guilford Press and the University of Texas Southwestern Medical Center, Dallas, TX (for the Inventory of Depressive Symptoms and its derivatives). He is also named co- inventor on two patents: U.S. Patent No. 7,795,033: Methods to Predict the Outcome of Treatment with Antidepressant Medication, Inventors: McMahon FJ, Laje G, Manji H, Rush AJ, Paddock S, Wilson AS; and U.S. Patent No. 7,906,283: Methods to Identify Patients at Risk of Developing Adverse Events During Treatment with Antidepressant Medication, Inventors:McMahon FJ, Laje G, Manji H, Rush AJ, Paddock S. Kelly Chan, Li Tong Low, Joshua Wong, and Sherwin Kuah are employees of Holmusk Technologies, Inc. when the research was undertaken., (Copyright © 2024. Published by Elsevier B.V.)

High-intensity drinking (HID; 10+ drinks/occasion) is associated with acute and long-term risks, including use of other substances. Earlier HID initiation is associated with high-risk alcohol use in young adulthood. Less is known about when HID initiation occurs relative to other substances and how it is associated with subsequent substance use. This study examined survey data from 468 respondents (35.5% female, 65.5% non-Hispanic white) who reported initiating HID by age 20. Weighted descriptive statistics of year of initiation for HID, marijuana, and nicotine were obtained. Weighted linear and logistic regressions examined associations between year and order of HID initiation and age 20 substance use (i.e., nicotine vaping, cigarette use, other tobacco use, marijuana use, marijuana vaping, simultaneous alcohol and marijuana use, and other illicit drug use) and alcohol use disorder (AUD) symptoms. Over half of participants initiated HID after marijuana (54.6%) and nicotine (54.4%). Later HID initiation was associated with fewer AUD symptoms and lower odds of all outcomes except marijuana and other illicit drug use. Initiating HID before marijuana was associated with lower odds of marijuana use outcomes and other illicit drug use at age 20. Initiating HID before nicotine was associated with lower odds of all substance use outcomes at age 20. Earlier HID initiation was associated with risk for subsequent substance use, but initiating HID earlier than other substances was not. Given its association with both alcohol-related outcomes and other substance use in young adulthood, earlier HID initiation is an important target for screening and intervention., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Data collection and manuscript preparation were supported by research grants from the National Institute on Alcohol Abuse and Alcoholism (R01AA023504) and the National Institute on Drug Abuse (R01DA001411 and R01DA016575). The study sponsors had no role in the study design, collection, analysis or interpretation of the data, writing of the manuscript, or the decision to submit the paper for publication. The content is soley the responsibility of the authors and does not necessarily represent the official views of the study sponsor., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This study investigates the relationship between home mortgages and neighborhood mental health across the 18 largest metropolitan statistical areas (MSAs) in the United States. Home mortgages, a primary avenue to homeownership, contribute to housing security and stability. Moreover, their issuance reflects local investment and potential improvements in the built environment, hypothesized to positively influence community mental well-being. Using census tract-level data from multiple sources, we employed a spatial econometric approach, specifically spatial error modeling, to account for spatial dependency and estimate the association between home mortgage lending (2011 to 2020) and the prevalence of self-reported poor mental health in 2020. Our findings indicate a statistically significant negative association between mortgage issuance and self-reported poor mental health across all 18 MSAs, suggesting that increased mortgage lending is associated with improved neighborhood mental health. Comparisons between standard linear models and spatial error models highlight the influence of unmeasured, spatially correlated factors on neighborhood mental health outcomes. This study underscores mortgage lending as a crucial factor in community well-being and emphasizes the necessity of addressing spatial dependency in neighborhood health studies for accurate estimations. The findings offer valuable insights for researchers and policymakers aiming to enhance community mental health and address health disparities through informed housing policies., (© 2024. The New York Academy of Medicine.)

Natural-experiment designs that compare survivors of in-utero famine exposure to unaffected controls suggest that in-utero undernutrition predisposes to development of obesity. However, birth rates drop dramatically during famines. Selection bias could arise if factors that contribute to obesity also protect fertility and/or fetal survival under famine conditions. We investigated this hypothesis using genetic analysis of a famine-exposed birth cohort. We genotyped participants in the Dutch Hunger Winter Families Study (DHWFS, N=950; 45% male), of whom 51% were exposed to the 1944-1945 Dutch Famine during gestation and 49% were their unexposed same-sex siblings or "time controls" born before or after the famine in the same hospitals. We computed body-mass index (BMI) polygenic indices (PGIs) in DHWFS participants and compared BMI PGIs between famine-exposed and control groups. Participants with higher polygenic risk had higher BMIs (Pearson r=0.42, p<0.001). However, differences between BMI PGIs of famine-exposed participants and controls were small and not statistically different from zero across specifications (Cohen's d=0.10, p>0.092). Our findings did not indicate selection bias, supporting the validity of the natural-experiment design within DHWFS. In summary, our study outlines a novel approach to explore the presence of selection bias in famine and other natural experiment studies., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Allergic rhino-conjunctivitis (AR) is a globally relevant health disorder characterized by sneezing, rhinorrhea and sleep disturbance. Ragweed (Ambrosia artemisiifolia) is a plant common to North America and an important allergen. Coarse methods of measuring airborne pollen counts are used to predict seasonal allergy symptoms. This research used a longitudinal study design with a novel, model-based raster of predicted pollen counts to test associations with self-reported symptoms of AR collected from patients receiving immunotherapy for pollen allergies at an allergy clinic. Researchers visited a clinic six times over three weeks. Immunotherapy patients were asked to fill out a brief intake survey on allergic and symptomatic profiles, daytime sleepiness, housing quality, and demographics. Participants responded to a daily, emailed survey on sleepiness and asthma symptoms for 21 days. Using the date and location of responses, ragweed pollen counts were extracted from a prognostic, model based raster (25km pixels). Lag associations of pollen counts with sleepiness were tested using a logistic regression model , adjusted for housing and demographic characteristics, in a distributed lag non-linear model (DLNM) framework. 49 people participated in the study. 26 (52%) were female. The mean age was 37.9 years. Asthma/allergy symptoms were not associated with ragweed pollen but sleepiness was highest two days after exposure (Estimate: 0.33 [0.04,0.62]). Subjects traveled widely during the study period. Intense exposures to ragweed pollen may be associated with daytime sleepiness within small exposure windows. Model-based predicted pollen counts could be used to study health impacts of pollen in people with disease severe enough to receive immunotherapy. Daytime sleepiness can affect productivity and injury risk, and pollen season length and allergenicity may be increasing with climate change. Thus our results may have important implications for population health., (© 2024. The Author(s) under exclusive licence to International Society of Biometeorology.)

Few studies have assessed the association of educational attainment on dementia and cognitive impairment through DNA methylation age acceleration, while accommodating exposure-mediator interaction effects. We evaluated the mediation role of six epigenetic clocks with dementia, cognitive impairment non-dementia, and normal cognition, while accommodating exposure-mediator interaction effects. To understand the joint association of low education (≤12 years) and DNA methylation age acceleration (yes/no) in relation to cognitive impairment, we used weighted logistic regression, adjusting for chronological age, sex, race/ethnicity, and cell type composition. We performed four-way mediation and interaction decomposition analysis. Analyses were conducted on 2016 venous blood study participants from the Health and Retirement Study (N = 3724). Both GrimAge acceleration (OR = 1.6 95%CI 1.3-2.1) and low educational attainment (OR = 2.4 95%CI 1.9-3.0) were associated with higher odds of cognitive impairment in a mutually adjusted logistic model. We found additive interaction associations between low education and GrimAge acceleration on dementia. We observed that 6-8% of the association of education on dementia was mediated through GrimAge acceleration. While mediation effects were small, the portion of the association of education on dementia due to additive interaction with GrimAge acceleration was between 23.6 and 29.2%. These results support the interplay of social disadvantage and biological aging processes on impaired cognition., (© 2024. The Author(s).)

Background: The objectives of this study were to examine the association of psychiatric comorbidities and patient characteristics with treatment change and response as well as to assess the association between treatment change and healthcare resource utilization (HCRU) among adult patients with attention-deficit/hyperactivity disorder (ADHD) and psychiatric comorbidities., Methods: De-identified electronic health records from the NeuroBlu Database (2002-2021) were used to select patients ≥ 18 years with ADHD who were prescribed ADHD-specific medication. The index date was set as the first prescription of ADHD medication. The outcomes were treatment change (discontinuation, switch, add-on, or drop) and HCRU (inpatient, outpatient, composite) within 12 months of follow-up. Cox proportional-hazard model was used to assess the association between clinical and demographic patient characteristics and treatment change, while generalized linear model with negative binomial distribution and log link function was used to assess the association between key risk factors linked to treatment change and HCRU rates., Results: A total of 3,387 patients with ADHD were included (ADHD only: 1,261; ADHD + major depressive disorder (MDD): 755; ADHD + anxiety disorder: 467; ADHD + mood disorder: 164). Nearly half (44.8%) of the study cohort experienced a treatment change within the 12-month follow-up period. Treatment switch and add-on were more common in patients with ADHD and comorbid MDD and anxiety disorder (switch: 18.9%; add-on: 20.5%) compared to other cohorts (range for switch: 8.5-13.6%; range for add-on: 8.9-12.1%) Survival analysis demonstrated that the probability of treatment change within 12 months from treatment initiation in the study cohort was estimated to be 42.4%. Outpatient visit rates statistically significantly increased from baseline (mean [SD] 1.03 [1.84] visits/month) to 3 months post-index (mean [SD] 1.62 [1.91] visits/month; p < 0.001), followed by a gradual decline up to 12 months post-index. Being prescribed both a stimulant and a non-stimulant at index date was statistically significantly associated with increased risk of treatment change (adjusted hazard ratio: 1.64; 95% CI: 1.13, 2.38; p = 0.01)., Conclusions: This real-world study found that treatment change was common among patients with ADHD and psychiatric comorbidities. These findings support the need for future studies to examine the unmet medical and treatment needs of this complex patient population., (© 2024. The Author(s).)

Competing Interests: Disclosures: All relevant financial relationships have been mitigated. Disclosure forms are available with this article online.

Background: Dementia susceptibility likely begins years before symptoms. Early life has not been comprehensively tested for dementia associations., Method: In the US Health and Retirement Study (normal baseline cognition; n=16,509; 2008-2018 waves), 31 exposures before age 16 were retrospectively assessed with ten-year incident cognitive status (dementia, impaired, normal). Using parallel logistic models, each exposure was tested with incident cognition, adjusting for sex, baseline age, follow-up, race/ethnicity, personal/parental education., Result: 14.5% had incident impairment and 5.3% had dementia. Depression was associated with 1.71 (95%CI:1.28,2.26) times higher odds of incident impairment, relative to normal cognition. Headaches/migraines were associated with 1.63 (95%CI:1.18,2.22) times higher odds of incident impairment. Learning problems were associated with 1.75 (95%CI:1.05,2.79) times higher odds of incident impairment. Childhood self-rated health of fair (1.86, 95%CI:1.27,2.64) and poor (3.39, 95%CI:1.91,5.82) were associated with higher incident dementia odds, relative to excellent., Conclusion: Early life factors may be important for impairment or dementia, extending the relevant risk window.

Objective: Functional limitations are prevalent among aging demographics, especially women. Structural and health factors, which vary worldwide, influence rates of functional limitations. Yet, gender disparities in functional limitation remain unclear in a global context., Methods: We use 2018 data from the Health and Retirement Study (HRS) international family of studies with respondents ages 50-64 and (n = 87,479) and 65-89 (n = 92,145) to investigate gender disparities in large muscle functional limitation (LMFL) across 10 countries/regions using mixed effects logistic regression, with special attention to structural indicators of inequality and health., Results: Among both women and men, LMFL was generally higher in China, India, Mexico, United States, and Baltic States than in England, Scandinavia, Southern Europe, Eastern Europe, and Western Europe. The gender disparity in LMFL gradually declined at older ages in India, China, Mexico, and United States, while this disparity gradually increased at older ages throughout Europe. Among middle age respondents, the greater risk of LMFL for women in countries/regions with a high GII was no longer observed after accounting for comorbidities. Among older respondents, a lower risk of LMFL for women in countries/regions with a high GII was not observed until accounting for comorbidities., Discussion: Our findings suggest that rates of LMFL are higher in middle-income countries than high-income countries, especially among women, and in countries with a higher GII. In addition, consideration of comorbidities was integral to these relationships. Thus, national/regional contexts inform differential rates of functional limitation, particularly as it relates to gender., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Exposure to systemic racism is linked to increased dementia burden. To assess systemic inflammation as a potential pathway linking exposure to racism and dementia disparities, we investigated the mediating role of C-reactive protein (CRP), a systemic inflammation marker, and the moderating role of the racialization process in incident dementia., Methods: In the US Health and Retirement Study (n = 6,908), serum CRP was measured at baseline (2006, 2008 waves). Incident dementia was classified by cognitive tests over a six-year follow-up. Self-reported racialized categories were a proxy for exposure to the racialization process. We decomposed racialized disparities in dementia incidence (non-Hispanic Black and/or Hispanic vs. non-Hispanic white) into 1) the mediated effect of CRP, 2) the moderated portion attributable to the interaction between racialized group membership and CRP, and 3) the controlled direct effect (other pathways through which racism operates)., Results: The 6-year cumulative incidence of dementia is 12%. Among minoritized participants (i.e., non-Hispanic Black and/or Hispanic), high CRP levels ( ≥ 75 th percentile or 4.73μg/mL) are associated with 1.26 (95%CI: 0.98, 1.62) times greater risk of incident dementia than low CRP ( < 4.73μg/mL). Decomposition analysis comparing minoritized versus non-Hispanic white participants shows that the mediating effect of CRP accounts for 3% (95% CI: 0%, 6%) of the racial disparity, while the interaction effect between minoritized group status and high CRP accounts for 14% (95% CI: 1%, 27%) of the disparity. Findings are robust to potential violations of causal mediation assumptions., Conclusions: Minoritized group membership modifies the relationship between systemic inflammation and incident dementia., (© 2024. The Author(s).)

Background: About 16% of worldwide dementia cases are in India. Evaluating the prospects for dementia prevention in India requires knowledge of context-specific risk factors, as relationships between risk factors and dementia observed in high-income countries (HICs) may not apply., Methods: We computed population attributable fractions (PAFs) for dementia in India by estimating associations between risk factors and dementia, their prevalence and communality, within the same nationally representative sample of 4,096 Indians aged 60 and older, surveyed through the Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD)., Results: The risk factor with the largest PAF (>20%) was no education, followed by vision impairment (14%), physical inactivity (12%), and social isolation (8%). According to our estimates, eliminating exposure to risk factors significantly associated with dementia would potentially prevent up to 70% of dementia cases in India., Discussion: Previous estimates, based on samples limited to specific geographic areas and using risk factors' definitions and relative risks from HICs, may not correctly estimate the real opportunities for preventing dementia in India or identify the most critical areas for intervention., Competing Interests: Conflicts of Interest: All authors have no conflicts of interest.

There is growing recognition of the importance of immune health for understanding the origins of ageing-related disease and decline. Numerous studies have demonstrated consistent associations between the social determinants of health and immunosenescence (i.e. ageing of the immune system). Yet few studies have interrogated the relationship between neighborhood socioeconomic status (nSES) and biologically specific measures of immunosenescence. We used data from the US Health and Retirement Study to measure immunosenescence linked with neighborhood socioeconomic data from the National Neighborhood Data Archive to examine associations between indicators of nSES and immunosenescence. We found associations between both the ratio of terminally differentiated effector memory to naïve (EMRA:Naïve) CD4+ T cells and cytomegalovirus (CMV) immunoglobulin G (IgG) levels and nSES. For the CD4+ EMRA:Naïve ratio, each 1% increase in the neighborhood disadvantage index was associated with a 0.005 standard deviation higher value of the EMRA:Naïve ratio (95% CI: 0.0003, 0.01) indicating that living in a neighborhood that is 10% higher in disadvantage is associated with a 0.05 higher standardized value of the CD4+ EMRA:Naïve ratio. The results were fully attenuated when adjusting for both individual-level SES and race/ethnicity. For CMV IgG antibodies, a 1% increase in neighborhood disadvantage was associated a 0.03 standard deviation higher value of CMV IgG antibodies ( β = 0.03; 95% CI: 0.002, 0.03) indicating that living in a neighborhood that is 10% higher in disadvantage is associated with a 0.3 higher standardized value of CMV. This association was attenuated though still statistically significant when controlling for individual-level SES and race/ethnicity. The findings from this study provide compelling initial evidence that large, nonspecific social exposures, such as neighborhood socioeconomic conditions, can become embodied in cellular processes of immune ageing., (© The Author(s) 2024. Published by Oxford University Press on behalf of National Academy of Sciences.)

Background: Dyslipidemia, which is characterized by an unfavorable lipid profile, is a key risk factor for cardiovascular disease (CVD). Understanding the relationships between epigenetic aging and lipid levels may help guide early prevention and treatment efforts for dyslipidemia., Methods: We used weighted linear regression to cross-sectionally investigate the associations between five measures of epigenetic age acceleration estimated from whole blood DNA methylation (HorvathAge Acceleration, HannumAge Acceleration, PhenoAge Acceleration, GrimAge Acceleration, and DunedinPACE) and four blood lipid measures (total cholesterol (TC), LDL-C, HDL-C, and triglycerides (TG)) in 3,813 participants (mean age = 70 years) from the Health and Retirement Study (HRS). As a sensitivity analysis, we examined the same associations in participants who fasted prior to the blood draw (n = 2,531) and in participants who did not take lipid-lowering medication (n = 1,869). Using interaction models, we also examined whether demographic factors including age, sex, and educational attainment modified the relationships between epigenetic age acceleration and blood lipids., Results: After adjusting for age, race/ethnicity, sex, fasting status, and lipid-lowering medication use, greater epigenetic age acceleration was associated with lower TC, HDL-C, and LDL-C, and higher TG (p < 0.05), although the effect sizes were relatively small (e.g., < 7 mg/dL of TC per standard deviation in epigenetic age acceleration). GrimAge acceleration and DunedinPACE associations with all lipids remained significant after further adjustment for body mass index, smoking status, and educational attainment. These associations were stronger in participants who fasted and who did not use lipid-lowering medication, particularly for LDL-C. We observed the largest number of interactions between DunedinPACE and demographic factors, where the associations with lipids were stronger in younger participants, females, and those with higher educational attainment., Conclusion: Multiple measures of epigenetic age acceleration are associated with blood lipid levels in older adults. A greater understanding of how these associations differ across demographic groups can help shed light on the relationships between aging and downstream cardiovascular diseases. The inverse associations between epigenetic age and TC and LDL-C could be due to sample limitations or non-linear relationships between age and these lipids, as both TC and LDL-C decrease faster at older ages., (© 2024. The Author(s).)

Emerging evidence suggests that psychosocial stress ages the immune system. Accordingly, immune aging may be an important potential mechanism linking psychosocial stress to aging-related decline and disease. Incarceration and housing insecurity represent severe and complex experiences of a multitude of psychosocial stressors, including discrimination, violence, and poverty. In this study, we investigated the association between incarceration and/or housing insecurity and advanced immune age in adults aged 55 and older. Our sample was derived from the Health and Retirement Survey (HRS), with n = 7003 individuals with valid housing insecurity data and n = 7523 with valid incarceration data. From 2016 Venous Blood Study data, we assessed immune aging using a comprehensive set of immune markers including inflammatory markers (IL-6, CRP, s-TNFR1), markers of viral control (CMV IgG antibodies), and ratios of T cell phenotypes (CD8 + :CD4 + , CD +  Memory: Naïve, CD4 + Memory: Naïve, CD8 + Memory: Naïve ratios). We found that both incarceration and housing insecurity were strongly associated with more advanced immune aging as indicated by increased inflammation, reduced viral control, and reduction in naïve T cells relative to memory T cells. Given that those who experienced incarceration, housing insecurity, and/or are racialized minorities were less likely to be included in this study, our results likely underestimated these associations. Despite these limitations, our study provided strong evidence that experiencing incarceration and/or housing insecurity may accelerate the aging of the immune system., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

There is a growing number of immigrants arriving in the USA, with the majority being of Latinx descent. Coupled with this increase, there has also been growing anti-immigration legislation which impacts the experiences this group faces and creates additional concerns for those who are residing in this country without documentation. Experiences of overt and covert discrimination and marginalization have been shown to relate to poorer mental and physical health outcomes. Drawing from Menjivar and Abrego's Legal Violence Framework, this paper explores the impact of perceived discrimination and social support on the mental and physical health of Latinx adults. We further observe whether these relationships differ based on participants' concerns about their documentation status. This data comes from a community-based participatory study conducted in a Midwestern County. Our analytic sample was comprised of 487 Latinx adults. We found social support to be related to fewer self-reported days of mental health symptoms for all participants regardless of documentation status concern. Perceived discrimination was found to be related to worse physical health for participants with concerns about their status. These findings point to the pernicious role of discrimination for Latinx's physical health and the importance of social support as an asset beneficial for their mental health., (© 2023. W. Montague Cobb-NMA Health Institute.)

Although decades of research documents powerful associations between parents' characteristics and their children's marital behaviors, the role of parental mental health has largely been ignored, despite the high prevalence of mental disorders and their strong potential to shape multiple dimensions of family life. Many studies examine other consequences of mothers' mental disorders, particularly for young children, but rarely do studies investigate the consequences of fathers' mental disorders, especially the potential for long-term consequences. We construct a theoretical framework for the study of intergenerational influences on family formation behaviors, integrating parental mental health, and emphasizing the potential for father's disorders to shape their children's lives. To investigate these associations, we use new intergenerational panel data featuring clinically validated diagnostic measures of parental mental health for both mothers and fathers, assessed independently. Results demonstrate that fathers' major depressive disorder is associated with significantly earlier marriage timing among sons. These important new findings provide insights into key priorities for social research on family formation processes and intergenerational influences across many domains., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Emerging research suggests morning cannabis use may be associated with using more cannabis and experiencing more cannabis-related consequences. This paper examined whether months when young adults reported morning cannabis use (use between 6:00AM and 12:00PM) were associated with cannabis use frequency, negative cannabis-related consequences, and changes in cannabis use disorder (CUD) symptoms., Methods: Participants were 778 young adults (M age =21.11 years, 58.5% female) enrolled in a longitudinal study on substance use and social role transitions. Eligible participants were 18-23 years old at screening and reported past-year alcohol use. Participants completed a baseline survey, 24 consecutive monthly surveys, and a follow-up survey 30 months after baseline. Aims were tested using multilevel models and multiple regression., Results: Analyses were limited to cannabis use months (N=4719; 28.9% of sampled months) and participants who reported cannabis use at least once (N=542; 69.7% of all participants). Morning use was reported in 12.3% of cannabis use months and at least once by 23.6% of participants who reported using cannabis. Relative to non-morning use months, morning use months were associated with greater cannabis use frequency and more negative consequences. However, the association between morning use and negative consequences was not statistically significant after controlling for cannabis use frequency. The percentage of cannabis use months with morning use was positively associated with increased CUD symptoms at the 30-month follow-up, relative to baseline., Conclusions: Morning cannabis use may be a useful marker of high-risk cannabis use and may contribute to the maintenance and worsening of CUD over time., Competing Interests: Declaration of Competing Interest All authors declare that they have no conflicts of interest., (Copyright © 2024. Published by Elsevier B.V.)

Introduction: Drinking intensity among young adults is associated with greater negative alcohol-related consequences, but often studied using categorical drinking thresholds. This study examined how alcohol-related consequences varied as a continuous function of number of drinks consumed, without imposing thresholds, to identify drink ranges for which risk is greatest., Methods: Analyses included daily surveys from the Young Adult Daily Life study (2019-22) in which individuals reported drinking 1 or more alcoholic drinks (n=5219 days; 832 individuals). Time-varying effect models estimated total number of negative alcohol-related consequences and five individual consequences (hangover, drank more than planned, nausea/vomiting, did something embarrassing, blacked out) as a function of the number of drinks consumed among young adult males and females., Results: Often, increases in the number and prevalence of negative consequences were a nonlinear function of the number of drinks consumed. Females reported few negative consequences on 1-to-3-drink occasions but steep increases in consequences on 4-to-9-drink occasions. Among females, the prevalence of blacking out increased six-fold from 4-drink (3.4%; 95% CI=2.6,4.7) to 9-drink occasions (20.6%; 95% CI=16.1,26.1). Among males, the prevalence of some consequences, while not linear, increased across the full drink range. Blacking out among males increased from 9.6% (95% CI=6.2,14.7) on 10-drink occasions to 23.9% (95% CI=15.0,35.8) on 15-drink occasions., Conclusions: Substantial heterogeneity is missed when typical drinking categories are used. In particular, variability in consequences across levels of the traditional binge drinking category suggests that important differences in risk may be missed when assessed as a uniform category., Competing Interests: Declaration of Competing Interest none., (Copyright © 2024. Published by Elsevier B.V.)

Morning cannabis use is associated with heavier, frequent cannabis use and more cannabis-related negative consequences, yet little empirical research has examined its predictors. Using 24 months of longitudinal data, the present study tested demographic, psychosocial, and behavioral predictors of morning cannabis use among young adults at the monthly- and person-levels. Young adults (N = 778) were part of a larger study on substance use and social role transitions; participants completed a baseline survey and up to 24 consecutive monthly surveys. Hypotheses were tested using logistic multilevel models to estimate odds ratios for any vs. no morning use in a given month. At the monthly level, social anxiety motives and cannabis use frequency on a given month were positively associated with morning cannabis use. At the person level, typical coping motives, average cannabis use frequency, and male sex were positively associated with morning cannabis use. Findings advance our understanding of individual and psychosocial predictors of morning cannabis use among young adults. Notably, social anxiety motives may represent a malleable target for intervention efforts that could reduce risky use patterns associated with morning use. Such efforts may be especially prudent for young men, as our findings indicated morning cannabis use probabilities were much higher for men than women., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Transgender and gender diverse (TGD) people who use drugs report barriers to accessing substance use treatment, including provider mistreatment. Little research has explored the multilevel factors that shape the capacity of substance use treatment professionals to provide gender-affirmative care (i.e., care that respects and affirms one's gender) to TGD people., Methods: From October 2021 to March 2022, substance use treatment and harm reduction professionals in Rhode Island were surveyed (N = 101) and qualitatively interviewed (N = 19) about the provision of substance use treatment-related services to TGD people. Quantitative data were analyzed descriptively; differences were examined using Fisher exact tests (p < 0.05). Qualitative interviews were coded and analyzed using thematic analysis., Results: Participants reported limited exposure to TGD people and lacked training on TGD health, which resulted in limited cultural and clinical competency and low self-efficacy in their ability to care for TGD people. Participants also highlighted structural factors (e.g., non-inclusive intake forms, limited availability of gender-inclusive ancillary community services) that restricted their ability to provide effective and affirming care to TGD people. Some participants also reported a "gender blind" ethos at their institutions- described by some as ignoring the potential impact of TGD peoples' unique experiences on their substance use and ability to benefit from treatment. While some perceived gender blindness as problematic, others believed this approach enabled substance use treatment professionals to consider all the identities and needs that patients/clients may have. Despite differences in treatment approaches, most participants agreed that their workplaces could benefit from efforts to create a safe and affirming space for people who use drugs, particularly TGD patients/clients., Conclusion: Results underscore how structural, interpersonal, and individual factors contributed to barriers in the provision of gender-affirmative substance use-related care for TGD people. Findings can inform efforts to increase the capacity of providers to deliver gender-affirmative substance use-related services, which is essential to supporting the recovery goals of TGD people., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Forced intercourse is a high prevalence experience among US women, with high potential to produce subsequent major depressive episodes (MDE). However, the extent to which prior risk factors are associated with the timing of both sexual assault experiences and subsequent MDE onset is not known. The aim of this study was to document the associations between childhood depression, subsequent forced intercourse, and later MDE. We used retrospective information on childhood depression, forced intercourse, and MDE after forced intercourse from female respondents in the nationally representative 2017 US Panel Study of Income Dynamics-Transition to Adulthood Supplement (PSID-TAS, N = 1298, response rate: 87%). Multivariable logistic regression estimated these associations, controlling for age, race, poverty, religiosity, family history of depression, and adverse childhood experiences (such as parental physical abuse or parental violence). Women who experienced childhood depression (prevalence: 15%) had 2.57 times the odds of experiencing forced intercourse after depression onset, even after adjusting for these other risk factors. However, even though childhood depression is a powerful risk factor for later MDE, independent of that women who experienced forced intercourse had 2.28 times the odds of experiencing MDE after the occurrence of forced intercourse, adjusting for childhood depression and other risk factors. This study provided the first clear evidence for time-ordered associations between forced intercourse and subsequent MDE among women in the general population., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: This study examines historical trends in coping reasons for marijuana use among adolescents (1976-2022) and explores sociodemographic variations in recent years (2016-2022)., Method: Data from U.S. national samples of 12th grade adolescents in the Monitoring the Future (MTF) study were used to examine long-term trends (1976-2022, N = 43,237) and recent differences by sociodemographic characteristics (2016-2022, N = 3,816). Measures included marijuana use, coping reasons for use, and sociodemographic characteristics., Results: The most prevalent coping reason across time was "relax," endorsed by 52.9% of past 12-month users. Coping reasons mostly exhibited significant increases over time. Sociodemographic factors were associated with coping reasons. Females had higher odds of using marijuana to escape problems and get through the day (vs. males). Black respondents were more likely to use marijuana to get through the day, and Hispanic respondents were more likely to use to relax (vs. White respondents). Those with lower (vs. higher) parental education were more likely to use due to anger/frustration and to escape problems. Adolescents who used marijuana frequently (vs. less often) had higher odds of endorsing all coping reasons. There was no robust evidence of interactions between sociodemographic characteristics and year., Conclusions: Results indicate a consistent increase in coping reasons for adolescent marijuana use over time, with variations based on sociodemographic characteristics. The findings highlight the importance of understanding subpopulations of adolescents who have higher risk of coping-related marijuana use., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

This randomized experiment tested whether the inclusion of a "something else" response option for a question about sexual identity in a national health survey would significantly moderate estimated differences between sexual identity subgroups in terms of various health outcomes, including substance use and reproductive health. We conducted secondary analyses of data from five consecutive years of the National Survey of Family Growth (NSFG; 2015-2019), where two large national half-samples were randomly assigned to receive one of two different versions of a question about sexual identity (a four-category version that included a "something else" response option or a three-category version omitting this option). We focused on national estimates of differences between subgroups defined by sexual identity. Multivariable models indicated that the estimated subgroup differences changed in a statistically significant fashion when using the four-category version of the sexual identity question for several measures, including 16% of male measures (household size, past-year cigarette use, and past-year illicit drug use) and 15% of female measures (wanting a/another child, ever had a sexually transmitted disease, and past-year marijuana use). The absence of a "something else" response option for questions about sexual identity in national health surveys may cause respondents to select options that do not accurately describe their identities, and this can have a significant effect on national estimates of differences between sexual identity subgroups in terms of selected health outcomes., (© 2023. The Author(s).)

When seeking to release public use files for confidential data, statistical agencies can generate fully synthetic data. We propose an approach for making fully synthetic data from surveys collected with complex sampling designs. Our approach adheres to the general strategy proposed by Rubin (1993). Specifically, we generate pseudo-populations by applying the weighted finite population Bayesian bootstrap to account for survey weights, take simple random samples from those pseudo-populations, estimate synthesis models using these simple random samples, and release simulated data drawn from the models as public use files. To facilitate variance estimation, we use the framework of multiple imputation with two data generation strategies. In the first, we generate multiple data sets from each simple random sample. In the second, we generate a single synthetic data set from each simple random sample. We present multiple imputation combining rules for each setting. We illustrate the repeated sampling properties of the combining rules via simulation studies, including comparisons with synthetic data generation based on pseudo-likelihood methods. We apply the proposed methods to a subset of data from the American Community Survey.

Background: Positive childhood experiences ( PCEs) are supportive relationships and environments associated with improved health when aggregated into composite scores. Adverse childhood experiences (ACEs), a reciprocal measure to PCEs, are associated with worse health in aggregate scores and when disaggregated into measures of specific ACE types (hereafter domains). Understanding the associations between specific PCE domains and health, while accounting for ACEs, may direct investigations and intervention planning to foster PCE exposure., Methods: We analyzed data from the nationally representative United States longitudinal Panel Study of Income Dynamics. Five PCE domains were examined: (i) peer support and healthy school climate, (ii) neighborhood safety, (iii) neighborhood support, and nurturing relationships with (iv) maternal and (v) paternal figures. Survey weighted logistic regression models tested associations between each PCE domain measure and adult general health rating, controlling for demographic covariates and nine ACE exposures: physical, emotional, or sexual abuse/assault; emotional neglect; witnessing intimate partner violence or household substance use; having a parent with mental illness; any parental separation or divorce; and/or having a deceased or estranged parent. Secondary outcomes included adult functional status and mental and physical health diagnoses. We also tested for statistical interactions between PCE domain and ACE score measures., Results: The sample included 7105 adults. Higher scores for the "peer support and healthy school climate" and "neighborhood safety" domain measures showed the most protective relationships with the adverse health conditions tested, most notably for mental illness. The relationship between PCE domain measures and health outcomes was attenuated, but not statistically moderated by ACE exposure., Conclusion: Experiencing childhood peer support, a healthy school climate, and neighborhood safety were especially protective against multiple adult health conditions, including for ACE exposed individuals. Interventions that promote PCEs may yield population health gains., Competing Interests: Declarations of interest: none., (© 2023 The Authors.)

Adaptive survey designs are increasingly used by survey practitioners to counteract ongoing declines in household survey response rates and manage rising fieldwork costs. This paper reports findings from an evaluation of an early-bird incentive (EBI) experiment targeting high-effort respondents who participate in the 2019 wave of the US Panel Study of Income Dynamics. We identified a subgroup of high-effort respondents at risk of nonresponse based on their prior wave fieldwork effort and randomized them to a treatment offering an extra time-delimited monetary incentive for completing their interview within the first month of data collection (treatment group; N = 800) or the standard study incentive (control group; N = 400). In recent waves, we have found that the costs of the protracted fieldwork needed to complete interviews with high-effort cases in the form of interviewer contact attempts plus an increased incentive near the close of data collection are extremely high. By incentivizing early participation and reducing the number of interviewer contact attempts and fieldwork days to complete the interview, our goal was to manage both nonresponse and survey costs. We found that the EBI treatment increased response rates and reduced fieldwork effort and costs compared to a control group. We review several key findings and limitations, discuss their implications, and identify the next steps for future research.

Competing Interests: Conflict of interest: None declared.

Phenomenon : Faculty career success in academic medicine is complex. Dynamic interactions among faculty and between faculty and their socio-cultural working environments contribute to the mystique of academic advancement. There are few empirical studies that analyze the social practice of faculty career advancement in academic medicine, especially those that focus on relations between individual and environmental contexts. This study aimed to investigate various faculty members' experiences around career advancement in a medical school. Through the analytical lens of Bourdieu's theory of practice, we focused on the relationship among individuals, positions, and environmental contexts. Approach : Following a general process of interpretive grounded theory, we collected faculty members' perceptions and experiences related to their career development and advancement via in-depth semi structured-interviews of 23 faculty at a medical school in the United States. We analyzed the interview transcripts using thematic and constant-comparison analyses, informed by Bourdieu's theory of practice emphasizing the concepts of habitus, field, doxa, illusio, and capital. Findings : While there was a general perception of collaborative success in the school, access to resources seemed to be unequally distributed and linked to faculty positions. Career opportunities, such as leadership and promotion, were mostly granted by leaders based on interpersonal relationships (social capital). Clinical faculty's limited access to professional development activities (cultural capital), including research, limited their likelihood for promotion (symbolic capital) at the school. An institutional emphasis on clinical productivity reinforced clinical faculty's constraints on academic scholarship, which led to perceived inequities by clinical faculty. Participants also perceived subtle gender bias and an unequal distribution of power among the specialties, which contradicted a culture of collaboration and support in the school. Insights : Complex power structures influence faculty career success. Unequal access and differential power among faculty positions resulted in disparities in career advancement. Greater transparency, equity, and inclusivity are obvious suggestions for change to allow all faculty to benefit from essential resources and career building opportunities. Furthermore, building high-quality relationships between leaders and faculty and mutual respect between specialties are essential to sustaining an organizational culture conducive to career success for all faculty. Faculty will benefit from a greater awareness of the structural and normative aspects of a medical school that are less obvious and more difficult to change. This is the value of applying Bourdieu's theory of practice to the socio-cultural dynamics of the medical school.

Survey design decisions are-by their very nature-tradeoffs between costs and errors. However, measuring costs is often difficult. Furthermore, surveys are growing more complex. Many surveys require that cost information be available to make decisions during data collection. These complexities create new challenges for monitoring and understanding survey costs. Often, survey cost information lags behind reporting of paradata. Furthermore, in some situations, the measurement of costs at the case level is difficult. Given the time lag in reporting cost information and the difficulty of assigning costs directly to cases, survey designers and managers have frequently turned to proxy indicators for cost. These proxy measures are often based upon level-of-effort paradata. An example of such a proxy cost indicator is the number of attempts per interview. Unfortunately, little is known about how accurately these proxy indicators actually mirror the true costs of the survey. In this article, we examine a set of these proxy indicators across several surveys with different designs, including different modes of interview. We examine the strength of correlation between these indicators and two different measures of costs-the total project cost and total interviewer hours. This article provides some initial evidence about the quality of these proxies as surrogates for the true costs using data from several different surveys with interviewer-administered modes (telephone, face to face) across three organizations (University of Michigan's Survey Research Center, Westat, US Census Bureau). We find that some indicators (total attempts, total contacts, total completes, sample size) are correlated (average correlation ∼0.60) with total costs across several surveys. These same indicators are strongly correlated (average correlation ∼0.82) with total interviewer hours. For survey components, three indicators (total attempts, sample size, and total miles) are strongly correlated with both total costs (average correlation ∼0.77) and with total interviewer hours (average correlation ∼0.86)., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Association for Public Opinion Research. All rights reserved. For permissions, please email: journals.permissions@oup.com.)