Ssm-Population Health最新文献

英文中文

Residential mobility, neighborhood environment, and diabetes complications among socioeconomically disadvantaged patients in the United States

IF 3.6 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Ssm-Population Health

Pub Date : 2025-03-03 DOI: 10.1016/j.ssmph.2025.101770

Annie Larson , Johanna Georgescu , Treasure Allen , Jun Hwang , Miguel Marino , Michaella Latkovic-Tabor , Nathalie Huguet

Residential mobility can affect health through changes in available resources, social support, or continuity of healthcare. This study sought to understand whether residential mobility and/or change in neighborhood environment among patients with diabetes were associated with diabetes-related complications. This retrospective study used electronic health record data from 19,853 adults aged 18–64 with a diabetes diagnosis seen in 110 safety-net clinics across the United States. Generalized estimating equations logistic regression models estimated whether moving (pre/post) and change in neighborhood environment (improving, worsening, similar) were associated with diagnoses of chronic diabetes-related complications. Post-move versus pre-move was associated with significantly higher probability of diabetes-related chronic complications (predicted probability: 13.16 vs 6.00, respectively), but no association was found by change in neighborhood environment. Those who moved had lower probability of chronic complications than those who did not move which could have been driven by pre-move circumstances among patients who moved. Residential mobility plays an important role in understanding diabetes-related complications while changes in neighborhood environment may be less important among low-income patients served by safety-net clinics. Moving may not be directly responsible for the development of diabetes-related chronic complications, but it may be an indicator for other factors of instability.

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引用次数: 0

Corrigendum to “Associations of social capital and health at a city with high aging rate and low population density” [SSM - Population Health (2021) 100981]

IF 3.6 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Ssm-Population Health

Pub Date : 2025-03-01 DOI: 10.1016/j.ssmph.2024.101737

Jun-ichiro Watanabe , Takashi Kimura , Takahiro Nakamura , Daisuke Suzuki , Takashi Takemoto , Akiko Tamakoshi

引用次数: 0

Changes in family and school environment during the Covid-19 pandemic and their relationship with changes in psychological distress and loneliness among Norwegian adolescents: The HUNT study

IF 3.6 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Ssm-Population Health

Pub Date : 2025-03-01 DOI: 10.1016/j.ssmph.2025.101767

Bodil Elisabeth Valstad Aasan , Monica Lillefjell , Věra Skalická , Steinar Krokstad , Kirsti Kvaløy , Erik R. Sund

In this follow-up study, we investigated how levels of psychological distress, loneliness, family cohesion, teacher support, and peer support changed from before to during the Covid-19 pandemic among Norwegian adolescents (ages 13–19), and whether these changes were predicted by parental education. Additionally, we investigated whether changes in family cohesion, teacher support, and peer support were associated with changes in psychological distress and loneliness, and whether these change-to-change associations were moderated by parental education. Data from the Young-HUNT4 (2017–2019, T1) and Young-HUNT COVID (May–June 2021, T2) surveys were used, in which 1565 adolescents participated in both (response rate = 45%). We specified univariate and multivariate two-wave latent change score models to investigate the aims of this study. Results indicated that levels of psychological distress, loneliness, family cohesion, teacher support, and peer support worsened from T1 to T2. None of these changes were significantly predicted by parental level of education. Deteriorations in family cohesion, teacher support, and peer support were weakly related to increases in psychological distress (β = 0.17, 95% confidence interval (CI) 0.11 to 0.23; β = 0.10, 95% CI 0.04 to 0.16; β = 0.09, 95% CI 0.02 to 0.15), and loneliness (β = 0.10, 95% CI 0.05 to 0.15; β = 0.08, 95% CI 0.02 to 0.13; β = 0.12, 95% CI 0.06 to 0.18). Although largely similar, deteriorations in family cohesion were somewhat more strongly associated with increases in psychological distress among adolescents with parents of lower levels of education.

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引用次数: 0

Examining variation within Hispanic ethnicity: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) of birthweight inequities in New York City, 2012–2019

IF 3.6 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Ssm-Population Health

Pub Date : 2025-03-01 DOI: 10.1016/j.ssmph.2025.101759

Luisa N. Borrell , Christina I. Nieves , Clare R. Evans

Birthweight inequities in the United States have been persistent with variations observed across maternal age, race/ethnicity, education, and nativity status. However, the Hispanic/Latino population is often treated as a monolithic category, ignoring within-group diversity and heterogeneity of health outcomes. This study employed an intersectional MAIHDA (multilevel analysis of individual heterogeneity and discriminatory accuracy) to examine birthweight inequities among singleton births in New York City from 2012 to 2019 (n = 819,920 records of singleton births) by maternal age, race/ethnicity, education, and nativity status, with particular attention to within-group heterogeneity among Hispanic/Latino mothers. Birthweight was measured in grams and was considered continuous for analytical purposes. The analysis was conducted using both the aggregate "Hispanic" category and disaggregated into Hispanic subgroups, based on the country/region of birth as part of the racial/ethnic categories. We found that 2.7%–3.2% of the variation in birthweight means among NYC women lies between intersectional strata, suggesting both meaningful between-stratum birthweight inequities and a high-degree of between-person birthweight variation. The finding of between-stratum inequities is consistent with a difference of 384.7g. between strata with the highest and lowest predicted birthweight means. We found consistent additive inequity patterns in birthweight by maternal age, race/ethnicity, educational attainment, and nativity status. The latter explained 81.2% of the variation in birthweight inequities. While attention to subgroup differences is often limited by sample size, intersectional MAIHDA allows for the identification of between- and within-strata variations regardless of whether Hispanic ethnicity was treated as an aggregate or subgroup based on country/region of origin.

{"title":"Examining variation within Hispanic ethnicity: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) of birthweight inequities in New York City, 2012–2019","authors":"Luisa N. Borrell , Christina I. Nieves , Clare R. Evans","doi":"10.1016/j.ssmph.2025.101759","DOIUrl":"10.1016/j.ssmph.2025.101759","url":null,"abstract":"<div><div>Birthweight inequities in the United States have been persistent with variations observed across maternal age, race/ethnicity, education, and nativity status. However, the Hispanic/Latino population is often treated as a monolithic category, ignoring within-group diversity and heterogeneity of health outcomes. This study employed an intersectional MAIHDA (multilevel analysis of individual heterogeneity and discriminatory accuracy) to examine birthweight inequities among singleton births in New York City from 2012 to 2019 (n = 819,920 records of singleton births) by maternal age, race/ethnicity, education, and nativity status, with particular attention to within-group heterogeneity among Hispanic/Latino mothers. Birthweight was measured in grams and was considered continuous for analytical purposes. The analysis was conducted using both the aggregate \"Hispanic\" category and disaggregated into Hispanic subgroups, based on the country/region of birth as part of the racial/ethnic categories. We found that 2.7%–3.2% of the variation in birthweight means among NYC women lies between intersectional strata, suggesting both meaningful between-stratum birthweight inequities and a high-degree of between-person birthweight variation. The finding of between-stratum inequities is consistent with a difference of 384.7g. between strata with the highest and lowest predicted birthweight means. We found consistent additive inequity patterns in birthweight by maternal age, race/ethnicity, educational attainment, and nativity status. The latter explained 81.2% of the variation in birthweight inequities. While attention to subgroup differences is often limited by sample size, intersectional MAIHDA allows for the identification of between- and within-strata variations regardless of whether Hispanic ethnicity was treated as an aggregate or subgroup based on country/region of origin.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"29 ","pages":"Article 101759"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effects of economic empowerment and relationship strengthening intervention on financial behaviors among couples living with HIV: The Mlambe pilot trial in Malawi

IF 3.6 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Ssm-Population Health

Pub Date : 2025-03-01 DOI: 10.1016/j.ssmph.2025.101768

Lakshmi Gopalakrishnan , Nancy Mulauzi , James Mkandawire , Fred M. Ssewamala , Scott Tebbetts , Torsten B. Neilands , Amy A. Conroy

Introduction

Economic insecurity, relationship issues, and gender-based financial disparities pose significant challenges for couples living with HIV in sub-Saharan Africa, potentially undermining treatment adherence and health outcomes. We evaluated Mlambe, an integrated economic empowerment with relationship strengthening intervention for couples living with HIV.

Methods

We conducted a pilot randomized controlled trial in Zomba, Malawi with 78 married couples (156 individuals) living with HIV and reporting unhealthy alcohol use based on the AUDIT-C. Couples were recruited from HIV care clinics and randomized to either the Mlambe intervention (n = 39 couples) or enhanced usual care (EUC) control (n = 39 couples). The 10-month Mlambe intervention combined incentivized savings accounts, financial literacy education, relationship education, and couples' counseling. EUC included brief alcohol counseling. We used linear mixed-effects models to evaluate Mlambe's impact on (i) confidence to save, (ii) attitudes towards savings, (iii) equitable financial decision-making.

Results

At 10 months follow-up, participants in the Mlambe intervention showed significantly higher confidence to save compared to EUC (coefficient = 0.18, 95% CI: 0.05, 0.32, p < 0.001), with women having greater improvements than men (p < 0.001). However, these effects were not sustained at 15 months. No significant differences were observed between arms in attitudes towards savings. Participants in the intervention showed greater equitable financial decision-making at 10 months (coefficient = 0.13, 95%CI: 0.11, 0.25; p = 0.03) compared to EUC, with effects sustained at 15-months (coefficient = 0.21, 95% CI: 0.11, 0.32, p < 0.001).

Conclusion

Our findings suggest that Mlambe intervention holds promise, underscoring the benefits of an integrated economic and relationship strengthening interventions among HIV-affected couples.

Clinical trial number

NCT04906616

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引用次数: 0

Vaccination decisions and social capital in Japan

IF 3.6 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Ssm-Population Health

Pub Date : 2025-02-26 DOI: 10.1016/j.ssmph.2025.101769

Toshihiro Okubo , Ilan Noy

The COVID-19 vaccines played a pivotal role in safeguarding many people. Yet, vaccine hesitancy remained a significant barrier to increasing coverage rates, as many high-income countries faced prolonged vaccine refusal campaigns. In Japan, vaccine doses were administered under a reservation system accessible via a website and by phone. Achieving a high vaccination coverage for a vaccine that was offered at no financial cost was surprisingly difficult in Japan as well. In many countries, vaccine hesitancy during the pandemic has been closely related to people's trust in their governments given governments' controversial social distancing mandates. In Japan, lockdowns were voluntary, and vaccinations were also not mandated. As there were no significant political conflicts about the government's policies, vaccination acceptance was influenced by more basic tenets, and we focus here on social capital, defined as cohesive links that enable a society to function effectively. Social capital, in this context, refers to community trust, collaboration, and engagement that create social bonds between individuals and society. Using a uniquely large survey, administered repeatedly through the years of the pandemic, we mostly find support, for the hypothesis that social capital matters for the vaccination decision; and that it matters even once we control for institutional trust (especially trust in the medical system). However, this general association between trust in other community members, belief in the willingness of community members to engage in reciprocal assistance, and belief in the more general willingness of the community to support individuals, were all associated differently with the vaccination decision, and with the views expressed about the vaccinations. From a policy perspective, this suggests that intra-community trust (i.e., bonding social capital), is important even in contexts when trust in governmental is not a significant concern.

{"title":"Vaccination decisions and social capital in Japan","authors":"Toshihiro Okubo , Ilan Noy","doi":"10.1016/j.ssmph.2025.101769","DOIUrl":"10.1016/j.ssmph.2025.101769","url":null,"abstract":"<div><div>The COVID-19 vaccines played a pivotal role in safeguarding many people. Yet, vaccine hesitancy remained a significant barrier to increasing coverage rates, as many high-income countries faced prolonged vaccine refusal campaigns. In Japan, vaccine doses were administered under a reservation system accessible via a website and by phone. Achieving a high vaccination coverage for a vaccine that was offered at no financial cost was surprisingly difficult in Japan as well. In many countries, vaccine hesitancy during the pandemic has been closely related to people's trust in their governments given governments' controversial social distancing mandates. In Japan, lockdowns were voluntary, and vaccinations were also not mandated. As there were no significant political conflicts about the government's policies, vaccination acceptance was influenced by more basic tenets, and we focus here on social capital, defined as cohesive links that enable a society to function effectively. Social capital, in this context, refers to community trust, collaboration, and engagement that create social bonds between individuals and society. Using a uniquely large survey, administered repeatedly through the years of the pandemic, we mostly find support, for the hypothesis that social capital matters for the vaccination decision; and that it matters even once we control for institutional trust (especially trust in the medical system). However, this general association between trust in other community members, belief in the willingness of community members to engage in reciprocal assistance, and belief in the more general willingness of the community to support individuals, were all associated differently with the vaccination decision, and with the views expressed about the vaccinations. From a policy perspective, this suggests that intra-community trust (i.e., bonding social capital), is important even in contexts when trust in governmental is not a significant concern.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"30 ","pages":"Article 101769"},"PeriodicalIF":3.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Variance partition that eludes intuition

IF 3.6 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Ssm-Population Health

Pub Date : 2025-02-17 DOI: 10.1016/j.ssmph.2025.101763

Jay S. Kaufman

引用次数: 0

Life course exposure to work strain and cognitive disparities by race and ethnicity

IF 3.6 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Ssm-Population Health

Pub Date : 2025-02-17 DOI: 10.1016/j.ssmph.2025.101765

Mara Getz Sheftel , Noreen Goldman , Anne R. Pebley , Boriana Pratt , Sung S. Park

There is a well-documented association between exposure to occupational strain and adverse older adult cognition. However, limited research examines differences in this association by race and ethnicity despite considerable disparities in older adult cognition and occupational segregation in the U.S. Using work history data from the U.S. Health and Retirement Study (HRS), we construct comprehensive measures of exposure to occupational strain over working ages and assess differential exposure to cumulative strain, and variation in the association between strain and cognition by race and ethnicity. We find that Black and Latino workers in the U.S. have more exposure to high strain jobs across working ages, and that this type of work history is associated with lower cognitive functioning at older ages. This analysis suggests that occupational segregation and unequal exposure to psychosocial work characteristics are critical social determinants of cognitive health disparities in older adulthood.

引用次数: 0

Mediating factors in the association between educational attainment and stroke: A mendelian randomization study 教育程度与中风之间关系的中介因素：亡羊补牢式随机研究

IF 3.6 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Ssm-Population Health

Pub Date : 2025-02-15 DOI: 10.1016/j.ssmph.2025.101766

Nuo Xu , Yiwen Qiu , Diliyaer Ainiwan , Boya Wang , Xialidan Alifu , Haibo Zhou , Haoyue Cheng , Ye Huang , Libi Zhang , Hui Liu , Lina Yu , Yunxian Yu

Background

Stroke is a common cardiovascular and cerebrovascular disease with high disability and mortality. Lower educational attainment has been reported to be associated with an increased risk of stroke, but it is unclear which pathways mediate this association.

Methods

Using genome-wide association studies (GWAS) based on European ancestry, we performed two-sample Mendelian randomization (MR) analyses to investigate the causal association of genetically estimated educational attainment with stroke and its subtypes. Then, we used mediation analyses to assess the extent to which seven cardiometabolic risk factors alone and in combination explain their effects.

Results

Genetically estimated educational attainment was negatively associated with the risk of any stroke (AS), any ischemic stroke (AIS), ischemic stroke subtypes (large artery stroke [LAS], cardioembolic stroke [CES], and small vessel stroke [SVS]), and hemorrhagic stroke subtypes (cerebral hemorrhage [ICH] and subarachnoid hemorrhage [SAH]). For individual mediating effects, type 2 diabetes, hypertension, hyperlipidemia, and smoking mediated the impact of education on AS, AIS, and ischemic stroke subtypes, while obesity, NAFLD, and alcohol consumption played no role. For combined mediation, the proportion of the association that cardiometabolic mediators explained ranged from 4% (95% CI: 2.72%–5.27%) for SVS to 38.73% (95% CI: 37.42%–40.05%) for LAS. Nevertheless, they did not account for any of the estimates for hemorrhagic stroke subtypes.

Conclusion

Higher educational attainment would have a protective effect on stroke and its subtypes, and cardiometabolic risk factors mediated part proportion of this association. Hence, patients with low education should pay more attention to managing cardiometabolic diseases to prevent stroke.

{"title":"Mediating factors in the association between educational attainment and stroke: A mendelian randomization study","authors":"Nuo Xu , Yiwen Qiu , Diliyaer Ainiwan , Boya Wang , Xialidan Alifu , Haibo Zhou , Haoyue Cheng , Ye Huang , Libi Zhang , Hui Liu , Lina Yu , Yunxian Yu","doi":"10.1016/j.ssmph.2025.101766","DOIUrl":"10.1016/j.ssmph.2025.101766","url":null,"abstract":"<div><h3>Background</h3><div>Stroke is a common cardiovascular and cerebrovascular disease with high disability and mortality. Lower educational attainment has been reported to be associated with an increased risk of stroke, but it is unclear which pathways mediate this association.</div></div><div><h3>Methods</h3><div>Using genome-wide association studies (GWAS) based on European ancestry, we performed two-sample Mendelian randomization (MR) analyses to investigate the causal association of genetically estimated educational attainment with stroke and its subtypes. Then, we used mediation analyses to assess the extent to which seven cardiometabolic risk factors alone and in combination explain their effects.</div></div><div><h3>Results</h3><div>Genetically estimated educational attainment was negatively associated with the risk of any stroke (AS), any ischemic stroke (AIS), ischemic stroke subtypes (large artery stroke [LAS], cardioembolic stroke [CES], and small vessel stroke [SVS]), and hemorrhagic stroke subtypes (cerebral hemorrhage [ICH] and subarachnoid hemorrhage [SAH]). For individual mediating effects, type 2 diabetes, hypertension, hyperlipidemia, and smoking mediated the impact of education on AS, AIS, and ischemic stroke subtypes, while obesity, NAFLD, and alcohol consumption played no role. For combined mediation, the proportion of the association that cardiometabolic mediators explained ranged from 4% (95% CI: 2.72%–5.27%) for SVS to 38.73% (95% CI: 37.42%–40.05%) for LAS. Nevertheless, they did not account for any of the estimates for hemorrhagic stroke subtypes.</div></div><div><h3>Conclusion</h3><div>Higher educational attainment would have a protective effect on stroke and its subtypes, and cardiometabolic risk factors mediated part proportion of this association. Hence, patients with low education should pay more attention to managing cardiometabolic diseases to prevent stroke.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"29 ","pages":"Article 101766"},"PeriodicalIF":3.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

An overview of modern machine learning methods for effect measure modification analyses in high-dimensional settings

IF 3.6 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Ssm-Population Health

Pub Date : 2025-02-13 DOI: 10.1016/j.ssmph.2025.101764

Michael Cheung, Anna Dimitrova, Tarik Benmarhnia

A primary concern of public health researchers involves identifying and quantifying heterogeneous exposure effects across population subgroups. Understanding the magnitude and direction of these effects on a given scale provides researchers the ability to recommend policy prescriptions and assess the external validity of findings. Traditional methods for effect measure modification analyses require manual model specification that is often impractical or not feasible to conduct in high-dimensional settings. Recent developments in machine learning aim to solve this issue by utilizing data-driven approaches to estimate heterogeneous exposure effects. However, these methods do not directly identify effect modifiers and estimate corresponding subgroup effects. Consequently, additional analysis techniques are required to use these methods in the context of effect measure modification analyses. While no data-driven method or technique can identify effect modifiers and domain expertise is still required, they may serve an important role in the discovery of vulnerable subgroups when prior knowledge is not available. We summarize and provide the intuition behind these machine learning methods and discuss how they may be employed for effect measure modification analyses to serve as a reference for public health researchers. We discuss their implementation in R with annotated syntax and demonstrate their application by assessing the heterogeneous effects of drought on stunting among children in the Demographic and Health survey data set as a case study.

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