A cross-sectional study observing the association of psychosocial stress and dietary intake with gut microbiota genera and alpha diversity among a young adult cohort of black and white women in Birmingham, Alabama.

BACKGROUND: The relationships between psychosocial stress and diet with gut microbiota composition and diversity deserve ongoing investigation. The primary aim of this study was to examine the associations of psychosocial stress measures and dietary variables with gut microbiota genera abundance and alpha diversity among young adult, black and white females. The secondary aim was to explore mediators of psychosocial stress and gut microbiota diversity and abundance. METHODS: Data on 60 females who self-identified as African American (AA; n = 29) or European American (EA; n = 31) aged 21-45 years were included. Cortisol was measured in hair and saliva, and 16S analysis of stool samples were conducted. Discrimination experiences (recent and lifetime), perceived stress, and depression were evaluated based on validated instruments. Spearman correlations were performed to evaluate the influence of psychosocial stressors, cortisol measures, and dietary variables on gut microbiota genus abundance and alpha diversity measured by amplicon sequence variant (ASV) count. Mediation analyses assessed the role of select dietary variables and cortisol measures on the associations between psychosocial stress, Alistipes and Blautia abundance, and ASV count. RESULTS: AA females were found to have significantly lower ASV count and Blautia abundance. Results for the spearman correlations assessing the influence of psychosocial stress and dietary variables on gut microbiota abundance and ASV count were varied. Finally, diet nor cortisol was found to partially or fully mediate the associations between subjective stress measures, ASV count, and Alistipes and Blautia abundance. CONCLUSION: In this cross-sectional study, AA females had lower alpha diversity and Blautia abundance compared to EA females. Some psychosocial stressors and dietary variables were found to be correlated with ASV count and few gut microbiota genera. Larger scale studies are needed to explore the relationships among psychosocial stress, diet and the gut microbiome.

Disability Among Older Immigrants in the United States: Exploring Differences by Region of Origin and Gender.

Rapid aging in American society will be disproportionately concentrated among the foreign-born. Immigrants in the United States (U.S.) are a heterogeneous population, yet little is known regarding their differences in disability later in life by region of origin. We use data from the National Health Interview Survey on respondents ages 60+ (n = 313,072) and employ gender-specific logistic models to predict reports of any activity of daily living (ADL) disability. After accounting for socioeconomic factors, compared to their U.S.-born non-Hispanic (NH) White counterparts, the odds of reporting ADL disability were higher among U.S.-born respondents that are Hispanic, NH Black, and NH Multiracial as well as respondents with Mexican, Puerto Rican, Cuban, Russian/former Soviet, Middle Eastern, East Asian, and South Asian origins. Also, Dominican, African, and Southeast Asian women-and European men-reported high odds of ADL disability. Our results highlight heterogeneity in the disability profiles of foreign-born older adults in the U.S..

Disability and self-rated health: Exploring foreign- and U.S.-born differences across adulthood.

There is limited inquiry regarding how immigrant status intersects with disability to influence health across adulthood. As the U.S. population continues to age, especially immigrants, understanding how disability influences health is imperative. Using 2010-2018 National Health Interview Survey data (n = 461,010) and logistic regression models, we investigate how differences in reporting Activity of Daily Living (ADL) disability influence reports of self-rated health (SRH) between foreign- and U.S.-born respondents (ages 25+) by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian) by age group (25-64 and 65+). Among those ages 25-64, foreign-born respondents generally report lower or similar rates of fair/poor SRH and ADL disability when compared to their U.S.-born peers. Among those ages 65+, we find that foreign-born respondents are at greater risk of fair/poor SRH compared to their U.S.-born peers. Additionally, while having ADL disability greatly increases the likelihood of fair/poor SRH, the impact of this association differs by race/ethnicity/nativity and age. Among those 25-64, having ADL disability appears to be especially, negatively impactful for SRH among foreign-born groups, particularly Hispanics and non-Hispanic Whites. However, among those ages 65+, having ADL disability is less impactful on the SRH of foreign-born respondents, especially non-Hispanic Blacks and Hispanics. Our findings shed new light on marginalization-related diminished returns by showing how ADL disability influences SRH differently between foreign-born groups across adulthood.

Varieties of Financial Stressors and Midlife Health Problems, 1996-2016.

OBJECTIVES: Financial stressors such as wealth loss, indebtedness, and bankruptcy have gained the attention of public health scholars since the Great Recession. In this study, we extend this area of research by comparing the mental and physical impact of multiple financial stressors during midlife, a pivotal period in the life course for wealth accumulation and disease onset. METHODS: With data from the National Longitudinal Survey of Youth 1979 (www.nlsinfo.org), an ongoing survey of adult men and women in the United States, we used logistic regression to estimate the associations between financial stressors and the risk of a psychiatric disorder or high blood pressure diagnosis from ages 31-39 in 1996 to ages 50-59 in 2016 (N = 7,143). Financial stressors include multiple types of wealth loss, debt, and bankruptcy. RESULTS: Even after adjusting for a comprehensive set of confounders, many of the financial stressors we considered had similar positive associations with the risk of a psychiatric disorder, whereas only debt and bankruptcy were associated with the risk of high blood pressure. The best-fitting models for both health outcomes included a simple indicator of indebtedness. Stock losses were not significantly associated with either health outcome. DISCUSSION: Given the recent volatility in the U.S. economy, our results highlight the potential loss of health that may occur if nothing is done to prevent economically vulnerable populations from sliding into financial crisis. Our results also emphasize the need for additional research to develop individual-level interventions to improve health among those already experiencing financial difficulties.

Varieties of Financial Stressors and Midlife Health Problems.

OBJECTIVES: Financial stressors such as wealth loss, indebtedness, and bankruptcy have gained the attention of public health scholars since the Great Recession. In this study, we extend this area of research by comparing the mental and physical impact of multiple financial stressors during midlife, a pivotal period in the life course for wealth accumulation and disease onset. METHODS: With data from the National Longitudinal Survey of Youth 1979 (www.nlsinfo.org), an ongoing survey of adult men and women in the U.S., we used logistic regression to estimate the associations between financial stressors and the risk of a psychiatric disorder or high blood pressure diagnosis from ages 31-39 in 1996 to ages 50-59 in 2016 (N = 7,143). Financial stressors include multiple types of wealth loss, debt, and bankruptcy. RESULTS: Even after adjusting for a comprehensive set of confounders, many of the financial stressors we considered had similar associations with the risk of a psychiatric disorder, whereas only debt and bankruptcy were associated with the risk of high blood pressure. The best fitting models for both health outcomes included a simple indicator of indebtedness. Stock losses were not significantly associated with either health outcome. DISCUSSION: Given the recent volatility in the U.S. economy, our results highlight the potential loss of health that may occur if nothing is done to prevent economically vulnerable populations from sliding into financial crisis. Our results also emphasize the need for additional research to develop individual-level interventions to improve health among those already experiencing financial difficulties.

A quantitative study of race and gender representation within London medical school leadership.

OBJECTIVES: To explore potential disparities in representation of Racially Minoritised (RM) persons and women in leadership roles in London Medical Schools compared to their RM and female student populations. METHODS: General Medical Council's Medical School Annual Return 2017-18 data and official leadership team webpages were used to determine percentages of RM and female students and percentages of RM and women leaders in London medical schools. Student and leadership team percentages were then compared using chi-squared tests to assess statistically significant differences. RESULTS: The percentage of RM persons filling leadership roles in London medical schools combined was statistically significantly less than the percentage of RM persons that compose the combined student body (8.6% (N=81) versus 60.2% (N=8786, χ2(1, N=8,867)=88.83, p<0.001). There was no statistically significant difference between the percentage of women filling leadership roles and the percentage of women in the combined student body (43.4% (N = 83) versus 52.5% (N=9026, χ2(1, N=9,109) =2.85, p=0.0913). CONCLUSIONS: Results mirror the underrepresentation of RM persons in leadership positions throughout the National Health Service (NHS) and in higher education but reflect the improved representation of women in leadership positions seen at the NHS board level. Greater effort is necessary to rectify RM representation within London medical school leadership teams. This is especially imperative given that racially similar role models for RM students are an important predictor in determining academic and future success.

Caste Differences in Hypertension Among Women in India: Diminishing Health Returns to Socioeconomic Status for Lower Caste Groups.

INTRODUCTION: The caste system is a relatively rigid system of social hierarchy in India. The caste membership defines one's access to resources and life opportunities. A growing body of research suggests that lower caste groups have an excess burden of morbidity and mortality in India. However, it is not clear as to what extent caste differences in health are conditioned by socioeconomic status (SES) indicators. PURPOSE: This study examined the caste differences in hypertension and tested whether caste differences in hypertension are conditioned by education and household wealth in a representative sample of women in India. METHODS: This study used data from the National Family Health Survey (NFHS) 2015-2016, India. The analysis is based on a nationally representative sample of 648,064 adult women aged 15-49 years. We used logistic regression to examine whether the association between caste and hypertension varied by education and wealth index using interactions and controlling for potential confounders. RESULTS: The regression models suggest that scheduled tribes and non-caste members have the highest odds of hypertension compared with privileged upper caste members. Interaction models indicate complex intersections of caste, education, and wealth index. The predicted probabilities derived from these interaction models suggest that while SES indicators are inversely associated with the odds of hypertension, the inverse patterning was significantly weaker in other backward classes and more protective in non-caste members compared with upper caste. Additionally, caste difference in predictive risk of hypertension tends to diverge at the lower levels of SES and become narrower at the higher levels of SES. CONCLUSIONS: These findings provide evidence of differential returns to SES and have implications for understanding the causes of SES patterning in health among disadvantaged caste groups in India.

Wealth and Obesity Among US Adults Entering Midlife.

OBJECTIVE: This study examines the relationship between wealth and obesity among adults entering midlife and whether this relationship varies by sex, race, and measure of wealth. METHODS: The data were obtained from the National Longitudinal Survey of Youth 1979 (NLSY-79). Population-averaged models were used to examine the associations between multiple measures of wealth and obesity among 6,979 respondents while controlling for education, occupation, income, and relevant sociodemographic variables. RESULTS: The analysis found a robust association between wealth and midlife obesity as well as heterogeneity in the wealth-obesity association across sex, race, and measure of wealth. With the exception of black men, net worth generally had a significant and inverse relationship with obesity. The net worth-obesity association was largest among women and was driven primarily by home value, in addition to savings and debt for black women. Although home value was significant for white men, the components of wealth were generally unrelated to obesity among men. CONCLUSIONS: The association between wealth and obesity was generally robust but also complex, depending on sex, race, and measure of wealth. Research that does not consider multiple components of wealth may overlook the importance of economic resources in shaping obesity rates in the US population.

Health literacy and quality of life in patients with treatment-resistant epilepsy.

This exploratory study examined the impact of health literacy on quality of life (QoL) in patients with treatment-resistant epilepsy (TRE). Health literacy is a discrete form of literacy in which an individual can readily interpret prose and apply that skill to understand medical, pharmaceutical, and self-management information. From the perspectives of cultural health capital (CHC) and social disability theory, we hypothesized that greater levels of health literacy would be associated with a higher QoL score. The sample (n = 79) included adult patients with TRE enrolled in the University of Alabama at Birmingham Cannabidiol Program. The data were analyzed by using nested linear regression. Respondents aged 19-63 years (mean, standard deviation [SD] = 32.9 [13.65]) and were 92% white; 44% of patients were in Special Education until age 21 years, and 29% reported a total annual family income of less than $25,000. Significant bivariate relationships were found between health literacy and QoL (p = .004), age (p = .0001), and income (p = .036). There was a significant difference in health literacy scores for patients who completed high school or less (mean [SD] = 0.68 [0.86]) and those with any postsecondary education (mean [SD] = 1.59 [1.0]). The regression results showed health literacy to be positively associated with QoL where a 1% increase in health literacy was associated with a 6.61-point increase in QoL (p = .004), and this pattern persisted through each addition of other independent factors and control variables. This is one of the first studies investigating the role of health literacy in QoL among patients with TRE. The results suggest that health literacy is important and may function as a tool through which healthcare participation is expanded. Further research is needed with larger, more diverse, and longitudinal samples to accurately model the development of health literacy and its impact on QoL in this population.

Do income inequalities in higher weight status depend on social integration?

Those with higher incomes tend to have better health outcomes, including healthy weight status. We use data from the 2003-2008 National Health and Nutrition Examination Survey (NHANES) to examine whether the association between higher weight status and social integration varies by income. We examine gender differences in weight status, measured by BMI and obesity, by social integration and income, and find evidence that high social integration is a risk factor for higher weight status among low-income men. The association between income and higher weight status operates differently for women and men and is dependent, in part, on their level of social integration. Income is negatively associated with weight status for men who are highly integrated, but is positively associated with weight status among men who have low integration. We conclude that higher numbers of close friends and family places low-income men at greater risk of higher weight status.

Stigma as a Barrier to Substance Abuse Treatment Among Those With Unmet Need: An Analysis of Parenthood and Marital Status.

Substance use (SU) stigma is one factor contributing to unmet need for SU treatment. Additionally, theory suggests that women and single parents who use substances experience enhanced stigma because they do not adhere to normative social expectations. This study examines differences in perceived stigma by gender and parenthood among those with unmet need for SU treatment using the 2003-2010 National Survey of Drug Use and Health (N = 1,474). Results indicate that women are more likely to report stigma as a barrier to treatment compared with men, though the interaction between gender and parenthood is not significant. We find that married parents report the highest level of stigma. We situate our findings in past health-related stigma research. We suggest that these results shed a light on stigma, particularly as it relates to family status, as a contributing factor to differences regarding SU treatment utilization. Finally, we raise a provocative question concerning social status and anticipated stigma.

Athletic Participation and Intimate Partner Violence Victimization: Investigating Sport Involvement, Self-Esteem, and Abuse Patterns for Women and Men.

This study used representative, quantitative data from The National Longitudinal Study of Adolescent Health (Add Health) and explored the relationship between young adults' sport participation and experiences of intimate partner violence victimization (IPVV) for both women and men. Past research has suggested that sports participation, especially among women, results in increased self-esteem, a prominent protective factor against experiencing IPVV. We found that sports participation was associated with a lower prevalence of experiencing IPVV, but only for women. In addition, this pattern held after controls for race, mother's education, age, number of relationships, and the hypothesized pathways of self-esteem and alcohol consumption. However, controls for the young adult's own education completely mediated the association between sports participation and IPVV. Additional analyses indicated that higher education reduced the risk of experiencing IPVV and increased the likelihood of sports participation. Nonetheless, even among women with the highest educational attainment, sports participation was associated with lower prevalence of experiencing IPVV.

The Role of Perceived Discrimination in Obesity Among African Americans.

INTRODUCTION: African Americans, especially those in the South, suffer a disproportionate burden of obesity and are at high risk for perceived discrimination (PD). This study investigates the association between PD and weight status among African Americans and clarifies the role of perceived stress and health behaviors in this relationship. METHODS: Data came from the Jackson Heart Study, Examination 1 (2000-2004; analyses conducted in 2016 using Stata, version 14). African Americans from Jackson, Mississippi, aged 21-95 years were recruited (N=5,301). Weight status was measured using anthropometric data with BMI; waist circumference (in centimeters); and obesity class (I, II, III). Survey instruments were used to measure PD, perceived global stress, and health behaviors. Multivariate regression was used to model weight status outcomes as a function of PD, perceived stress, and health behaviors. RESULTS: After controlling for sociodemographic factors and health status, perceived everyday discrimination was associated with higher BMI (b=0.33, p<0.01); higher waist circumference (b=0.70, p<0.01); and higher relative risk of Class III obesity versus non-obesity (relative risk ratio, 1.18; p<0.001). Global perceived stress was linked to higher BMI (b=0.42, p<0.05) and higher waist circumference (b=1.18; p<0.01) and partially mediated the relationships between PD and these weight status outcomes. Health behaviors led to suppression rather than mediation between PD and weight status and between stress and weight status. CONCLUSIONS: PD and perceived stress are potential risk factors for higher weight status. They should be considered as a part of a comprehensive approach to reduce obesity among African Americans.

The role of sex, gender, and education on depressive symptoms among young adults in the United States.

BACKGROUND: Men are less likely to experience depression and both women and men who self-assess as high in traits associated with masculinity are less likely to experience depression. Recent theoretical developments stress that the context of gender construction varies by other aspects of social status such as education. METHODS: Data come from the National Longitudinal Study of Adolescent Health Wave III, romantic relationship sub-sample, a nationally representative sample of middle and high school students in the U.S. in 1997. Wave III data were collected in 2001-2002 when they are ages 18-26. A subsample of individuals who were or currently are in a romantic relationship (N=4302) were administered the Bem Sex Role Inventory (BSRI). RESULTS: We find that femininity, not masculinity, results in less depressive symptoms among women regardless of education. Femininity is associated with less depressive symptoms among college educated men, but masculinity is associated with less depressive symptoms among non-college educated men. Sex differences in the association between gender traits and depression symptoms are smaller among those who have attended college. CONCLUSIONS: Results stress the importance of context for understanding the relationship between sex, gender, and depression. Individuals benefit more from both masculinity and femininity with increased education. Conversely, those with less education may be penalized for sex-gender incongruent traits in terms of mental health. LIMITATIONS: These analyses are cross-sectional, making causal inference impossible. This sample is limited to young adults who were or had been in a romantic relationship at the time of the survey.

Epidemiological Paradox or Immigrant Vulnerability? Obesity Among Young Children of Immigrants.

According to the "immigrant epidemiological paradox," immigrants and their children enjoy health advantages over their U.S.-born peers--advantages that diminish with greater acculturation. We investigated child obesity as a potentially significant deviation from this paradox for second-generation immigrant children. We evaluated two alternate measures of mother's acculturation: age at arrival in the United States and English language proficiency. To obtain sufficient numbers of second-generation immigrant children, we pooled samples across two related, nationally representative surveys. Each included measured (not parent-reported) height and weight of kindergartners. We also estimated models that alternately included and excluded mother's pre-pregnancy weight status as a predictor. Our findings are opposite to those predicted by the immigrant epidemiological paradox: children of U.S.-born mothers were less likely to be obese than otherwise similar children of foreign-born mothers; and the children of the least-acculturated immigrant mothers, as measured by low English language proficiency, were the most likely to be obese. Foreign-born mothers had lower (healthier) pre-pregnancy weight than U.S.-born mothers, and this was protective against their second-generation children's obesity. This protection, however, was not sufficiently strong to outweigh factors associated or correlated with the mothers' linguistic isolation and marginal status as immigrants.

Maternal ratings of child health and child obesity, variations by mother's race/ethnicity and nativity.

We examined whether indicators of child health, focusing on obesity, are associated with maternal ratings of child health (MRCH) and its variation by mother's ethnicity/nativity, focusing on Hispanics. The early childhood longitudinal study, kindergarten cohort kindergarten-eighth grade waves (n = 48,814) and nested general linear mixed modeling are used to examine excellent MRCH. The only indicator of child health that varies by mother's ethnicity/nativity for MRCH is child obesity. Child obesity did not influence MRCH for foreign-born Hispanic mothers, especially among less acculturated mothers, though significant differences among immigrants by acculturation were not found. However, among native-born white, black, and Hispanic mothers child obesity was associated with a lower likelihood of excellent MRCH even after controls for socioeconomic characteristics, family characteristics, and other indicators of child health are included. MRCH reflect not only child's actual health, but also the mother's perception of what contributes to poor child health. Our findings suggest that less acculturated foreign-born Hispanic mothers are less likely to associate child obesity with poor child health. Cultural orientations that prefer heavier children or are unlikely to associate child obesity with poor child health may contribute to the higher levels of obesity found among their children.

Multiple Imputation For Combined-Survey Estimation With Incomplete Regressors In One But Not Both Surveys.

Within-survey multiple imputation (MI) methods are adapted to pooled-survey regression estimation where one survey has more regressors, but typically fewer observations, than the other. This adaptation is achieved through: (1) larger numbers of imputations to compensate for the higher fraction of missing values; (2) model-fit statistics to check the assumption that the two surveys sample from a common universe; and (3) specificying the analysis model completely from variables present in the survey with the larger set of regressors, thereby excluding variables never jointly observed. In contrast to the typical within-survey MI context, cross-survey missingness is monotonic and easily satisfies the Missing At Random (MAR) assumption needed for unbiased MI. Large efficiency gains and substantial reduction in omitted variable bias are demonstrated in an application to sociodemographic differences in the risk of child obesity estimated from two nationally-representative cohort surveys.

Differences in tobacco use between Canada and the United States.

OBJECTIVES: This study explores differences in who smokes (smoker type) and exposure to smoking (pack-years) between Canada and the US. Both countries have policies to limit the number of smokers and smoking-related deaths. METHODS: This research uses The Joint Canada/United States Survey of Health (JCUSH) and employs multinomial logistic regression and ordinary least squares regression. RESULTS: In Canada, native-born, young, White males without a degree, with poor health and who had been previously married predominate in smoking. This profile is the same for the US. However, different characteristics predict exposure to smoking for the two countries. Native-born males without a degree, with poor health and who had been previously married smoked more cigarettes per day in Canada. For the US, younger individuals smoked more cigarettes per day. CONCLUSIONS: If countries want to focus on limiting the number of new cases of smokers, the target population is different from the target population that should be used if countries are interested in converting smokers into non-smokers, based on the demographic analyses presented.