Longitudinal associations between mental health and social environment in older adults: a multilevel growth modeling.

OBJECTIVES: This study aimed to assess longitudinal relationships between social environment indicators (social connectedness, social engagement, social contribution) and mental health indicators (depression and anxiety) among community-dwelling adults age 55 years and older. METHODS: Data were drawn from 3-waves of the national longitudinal survey of Midlife Development in the United States (MIDUS) (N = 2,020; age range = 55-94 years). We developed multilevel growth models to ascertain the relationships of interest, controlling for sociodemographic and physical health factors. RESULTS: Over the 20-year period of study, lower levels of emotional social support, social integration and social contribution significantly predicted depression and anxiety, whereas social network and social engagement were not significant predictors of these mental health outcomes in older adults. The models also indicated a moderation effect of the number of chronic conditions on the slopes of depression and anxiety. DISCUSSION: Considering our findings, interventions to enhance social contribution and social connectedness could be effective to help older adults maintain positive mental health, as well as programs that facilitate older adults' connections with their families, communities and health care providers. These interventions must also account for multiple chronic conditions since functional limitations drive declining integration in the community and participation in social activities.

Living with a Smoker and Physical Inactivity across Eight Years in High-Risk Medical Patients.

Recent research has demonstrated a link between living with a smoker and physical inactivity. However, no research has examined this issue in the context of recovery in medical patients. The present study broadens research on living with a smoker by applying it to physical inactivity in a group of high-risk medical patients with histories of cancer or cardiovascular disease compared to a control group without histories of these conditions. In addition, this study extends the time frame of research on living with a smoker in predicting physical inactivity to eight years. Participants were 76,758 women between 49 and 81 years of age from the Women's Health Initiative Observational Study. Data on living with a smoker were collected at baseline; data on physical activity were collected at baseline and annually from 3 to 8 years. Analyses utilized latent growth modeling. Patient status, compared to control status, was associated with more physical inactivity at baseline. Independent of patient status, living with a smoker predicted a significant increase in the odds of no moderate or strenuous exercise and a significant increase in the odds of no walking at baseline. The effect of living with a smoker on physical inactivity was stronger than that of patient status. Moreover, the living with a smoker effect on physical inactivity remained stable across eight years. These findings highlight an overlooked impediment to compliance with recommendations for lifestyle change among high-risk medical patients.

Living with a Smoker and Multiple Health-Risk Behaviors.

BACKGROUND: Behavioral medicine is showing growing theoretical and applied interest in multiple health-risk behaviors. Compared to engaging in a single health-risk behavior, multiple health-risk behaviors are linked to increased morbidity and mortality. A contextual determinant of multiple risk behaviors may be living with a smoker. PURPOSE: This study investigated the role of living with a smoker in predicting multiple health-risk behaviors compared to a single health-risk behavior, as well as whether these multiple risk behaviors occur across both physical activity and dietary domains. Moreover, the study tested these effects across 3 years in longitudinal and prospective (controlling for health-risk behaviors at baseline) analyses. METHODS: Participants were 82,644 women (age M = 63.5, standard deviation = 7.36, age range = 49-81) from the Women's Health Initiative Observational Study. Analyses used multinomial and binary logistic regression. RESULTS: Living with a smoker was more strongly associated with multiple health-risk behaviors than with a single health-risk behavior. These multiple risk behaviors occurred across both physical activity and dietary domains. The effects persisted across 3 years in longitudinal and prospective analyses. Living with a smoker, compared to not living with a smoker, increased the odds of multiple health-risk behaviors 82% cross-sectionally and, across 3 years, 94% longitudinally and 57% prospectively. CONCLUSIONS: These findings integrate research on multiple health-risk behaviors and on living with a smoker and underscore an unrecognized public health risk of tobacco smoking. These results are relevant to household-level interventions integrating smoking-prevention and obesity-prevention efforts.

Spillover Effects of Job Skills Training on Substance Misuse Among Low-Income Youths With Employment Barriers: A Longitudinal Cohort Study.

Objectives. To examine spillover effects of job skills training (vs basic services only [e.g., adult basic education, job readiness training]) on substance misuse among low-income youths with employment barriers.Methods. Data came from the National Longitudinal Survey of Youth 1997, a longitudinal cohort study of youths born between 1980 and 1984 in the United States. Based on respondents' reports of substance misuse (past-month binge drinking and past-year marijuana and other illicit drug use) from 2000 to 2016, we estimated substance misuse trajectories of job skills training (n = 317) and basic services (n = 264) groups. We accounted for potential selection bias by using inverse probability of treatment weighting.Results. Compared with the basic services group, the job skills training group showed notable long-term reductions in its illicit drug misuse trajectory, translating to a 56.9% decrease in prevalence rates from 6.5% in year 0 to 2.8% in year 16.Conclusions. Job skills training can be an important service component for reducing substance misuse and improving employment outcomes among youths with economic disadvantages and employment barriers.

Living with a smoker, health risk behaviors, and adiposity: an analysis with middle-aged and older women.

This study investigated: (a) the association between living with a smoker and weight-related health risk behaviors, and (b) the role of these behaviors in indirectly linking living with a smoker to general and central adiposity. Participants were 83,492 women (age M = 63.5, SD = 7.36) from the Women's Health Initiative Observational Study. In logistic regression analyses at baseline, living with a smoker was associated with increased odds of no exercise (29%), no walking (33%), high dietary fat (62%), and low fruit and vegetable consumption (43%). Using structural equation modeling, bootstrap confidence intervals confirmed a significant indirect effect from living with a smoker to adiposity through health risk behaviors at baseline and prospectively across 3 and 8 years. Health risk behaviors fully explained the living with a smoker-adiposity relationship. These findings integrate clustering and contagion theoretical perspectives on health behaviors and contribute to understanding a novel pathway to adiposity.

Bridging the Gap Between Common Mental Disorders and Service Use: The Role of Self-Rated Mental Health Among African Americans.

OBJECTIVE: The unmet need for mental health care in racial/ethnic minorities has been a major public health concern. Using a sample of African Americans, this study questioned whether self-rated mental health (SRMH), an individual's subjective assessment of personal mental and emotional status, modifies the link between mental disorders and service use. DESIGN: Cross-sectional analyses of the Milwaukee African American oversample of the Midlife Development in the United States (MIDUS II) study, 2005-2006. SETTING: In-home personal interviews. PARTICIPANTS: Self-identified African American/black participants aged 40 to 85 years (N = 460). MEASUREMENTS: Participants were assessed if they met the diagnostic criteria for three common mental disorders (major depression, generalized anxiety disorder, and panic disorder) in the prior 12 months, using the Composite International Diagnostic Interview (CIDI). Response to a single-item SRMH was dichotomized (excellent/very good/good or fair/poor). Service use was indicated by the use of any services in the past year (mental health specialist, general doctor, and clergy). RESULTS: Multivariate analyses identified a significant interaction between mental disorder and SRMH in predicting service use. The likelihood of service use increased substantially when individuals with a disorder reported their mental health to be fair/poor. CONCLUSIONS: Reflecting its subjective nature, SRMH enhances our understanding of individual variations in self-recognition and help-seeking behaviors. Findings suggest that interventions that enhance an individual's self-awareness of mental health problems may help bridge the gap between mental health care needs and service use in African Americans.

Obesity and US mortality risk over the adult life course.

In this study, we analyzed age variation in the association between obesity status and US adult mortality risk. Previous studies have found that the association between obesity and mortality risk weakens with age. We argue that existing results were derived from biased estimates of the obesity-mortality relationship because models failed to account for confounding influences from respondents' ages at survey and/or cohort membership. We employed a series of Cox regression models in data from 19 cross-sectional, nationally representative waves of the US National Health Interview Survey (1986-2004), linked to the National Death Index through 2006, to examine age patterns in the obesity-mortality association between ages 25 and 100 years. Findings suggest that survey-based estimates of age patterns in the obesity-mortality relationship are significantly confounded by disparate cohort mortality and age-related survey selection bias. When these factors are accounted for in Cox survival models, the obesity-mortality relationship is estimated to grow stronger with age.

The impact of obesity on US mortality levels: the importance of age and cohort factors in population estimates.

OBJECTIVES: To estimate the percentage of excess death for US Black and White men and women associated with high body mass, we examined the combined effects of age variation in the obesity-mortality relationship and cohort variation in age-specific obesity prevalence. METHODS: We examined 19 National Health Interview Survey waves linked to individual National Death Index mortality records, 1986-2006, for age and cohort patterns in the population-level association between obesity and US adult mortality. RESULTS: The estimated percentage of adult deaths between 1986 and 2006 associated with overweight and obesity was 5.0% and 15.6% for Black and White men, and 26.8% and 21.7% for Black and White women, respectively. We found a substantially stronger association than previous research between obesity and mortality risk at older ages, and an increasing percentage of mortality attributable to obesity across birth cohorts. CONCLUSIONS: Previous research has likely underestimated obesity's impact on US mortality. Methods attentive to cohort variation in obesity prevalence and age variation in obesity's effect on mortality risk suggest that obesity significantly shapes US mortality levels, placing it at the forefront of concern for public health action.

Smoking status, physical health-related quality of life, and mortality in middle-aged and older women.

INTRODUCTION: Women who smoke, particularly older women, have been relatively neglected in smoking research. There is a lack of knowledge concerning the relation of level of smoking to quality of life and mortality among middle-aged and older women smokers. METHODS: This study examined the relation of smoking status to physical health-related quality of life (PHRQL) and total mortality in women in the Women's Health Initiative (WHI) Observational Study. Participants were 90,849 postmenopausal women, who were an average age of 63.6 years at baseline. Analyses used multiple linear and Cox proportional hazards regression and controlled for age, educational level, and ethnicity. Never-smokers were the reference group. RESULTS: We found that smoking status was significantly related to PHRQL cross-sectionally at baseline and prospectively at a 3-year follow-up, with those who smoked having lower PHRQL. Heavier smokers showed large, clinically meaningful associations with PHRQL and light smokers showed small associations. In addition, we found that the smoking status at baseline was significantly related to 10-year total mortality. Both light and heavier smoking at baseline significantly correlated with higher mortality risk; however, the relationship of smoking to mortality was dose dependent. Among former smokers, those who had smoked longer showed significantly lower PHRQL and significantly increased mortality risk. CONCLUSIONS: Findings suggest that the risks of smoking may not be evident to light smokers and that educational interventions targeted to middle-aged and older women stressing the consequences of light smoking may be particularly beneficial.

Educational Differences in U.S. Adult Mortality: A Cohort Perspective.

We use hierarchical cross-classified random-effects models to simultaneously measure age, period, and cohort patterns of mortality risk between 1986 and 2006 for non-Hispanic white and non-Hispanic black men and women with less than a high school education, a high school education, and more than a high school education. We examine all-cause mortality risk and mortality risk from heart disease, lung cancer, and unpreventable cancers. Findings reveal that temporal reductions in black and white men's and women's mortality rates were driven entirely by cohort changes in mortality. Findings also demonstrate that disparate cohort effects between education groups widened the education gap in all-cause mortality risk and mortality risk from heart disease and lung cancer across this time period. Educational disparities in mortality risk from unpreventable cancers, however, did not change. This research uncovers widening educational differences in adult mortality and demonstrates that a cohort perspective provides valuable insights for understanding recent temporal changes in U.S. mortality risk.

Performance of an Abbreviated Lubben Social Network Scale (LSNS-6) in Three Ethnic Groups of Older Asian Americans.

BACKGROUND AND OBJECTIVES: The present study examined the measurement quality and performance of an abbreviated Lubben Social Network Scale (LSNS-6) in three ethnic groups (Chinese, Koreans, and Vietnamese) of older Asian Americans, addressing both within- and cross-group validations. RESEARCH DESIGN AND METHODS: We selected 605 participants aged 50 or older (242 Chinese, 150 Koreans, and 213 Vietnamese) from the 2015 Asian American Quality of Life survey, conducted with self-identified Asian Americans aged 18 or above living in central Texas. We analyzed LSNS-6 data on measurement qualities (internal consistency and corrected item-total correlation), dimensionality (exploratory and confirmatory factor analyses), and correlations with other indicators. RESULTS: LSNS-6 showed very good internal consistency in each ethnic group, and the two-factor structure of family and friends were invariant across the groups. The items on friends demonstrated greater homogeneity than those on family and emerged as a first factor. Both subscale and total scores of LSNS-6 were associated in expected directions with the social and health indicators considered. DISCUSSION AND IMPLICATIONS: The findings confirm the measurement qualities of LSNS-6 within each group and provide support for measurement invariance across the groups. While the observed difference in family and friend networks warrants further investigation, LSNS-6 serves as a viable option for the assessment of social networks. When using LSNS-6 with older Asian Americans, it is highly recommended to use the family/friend subscales in consideration of cultural and immigration contexts.

Depressive symptoms and smoking in middle-aged and older women.

INTRODUCTION: Smoking research and intervention efforts have neglected older women. Depressive symptoms, which are common in middle-aged and older women, are related to the maintenance of adult smoking. METHODS: This study investigated the relation of a composite measure of current depressive symptoms, derived from a short form of the Center for Epidemiological Studies Depression Scale, and history of depressive symptoms, derived from two items from the Diagnostic Interview Schedule, to smoking outcomes in the Women's Health Initiative Observational Study (N = 90,627). Participants were postmenopausal with an average age of 63.6 years at baseline. Participants were recruited from urban, suburban, and rural areas surrounding 40 clinical centers in the United States. Analyses controlled for age, educational level, and ethnicity. RESULTS: In multinomial logistic regression analyses, depressive symptoms were related cross-sectionally to current light (odds ratio [OR] = 1.19, 95% CI = 1.14-1.23) and heavier (OR = 1.28, 95% CI = 1.23-1.32) smoking at baseline compared with nonsmokers. In prospective multiple logistic regression analyses, baseline depressive symptoms were negatively predictive of smoking cessation at a 1-year follow-up (OR = .85, 95% CI = 0.77-0.93) and at participants' final assessments in the study (OR = .92, 95% CI = 0.85-0.98). Light smokers had more than 2 times higher odds of smoking cessation than did heavier smokers. CONCLUSIONS: The present findings demonstrate a consistent link between depressive symptoms and negative smoking-related behaviors among middle-aged and older women at both light and heavier smoking levels.

Impact of contraceptive counseling on Texans who can and cannot receive no-cost post-abortion contraception.

OBJECTIVE: To assess optimal timing, patient satisfaction, and 1-year contraceptive continuation associated with contraceptive counseling among Texans who could and could not receive no-cost long-acting reversible contraception (LARC) via a specialized funding program. STUDY DESIGN: In this prospective study conducted between October 2014 and March 2016, we evaluated participants' desire for contraceptive counseling during abortion visits, impact of counseling on change in contraceptive preference, satisfaction with counseling, and 1-year postabortion contraceptive continuation. We stratified participants into 3 groups by income, insurance status, and eligibility for no-cost LARC: (1) low-income eligible, (2) low-income ineligible, and (3) higher-income and/or insured ineligible. We examined the association between contraceptive counseling rating and 1-year method continuation by program eligibility and post-abortion contraceptive type. RESULTS: Among 428 abortion patients, 68% wanted to receive contraceptive counseling at their first abortion visit. Counseling led to a contraceptive preference change for 34%. Of these, 21% low-income eligible participants received a more effective method than initially desired, 10% received a less effective method, and 69% received the method they initially desired. No low-income ineligible participants received a more effective method than they initially desired, 55% received a less effective method, and 45% received the method they initially desired. Five percent of higher-income eligible participants received a more effective method than they initially desired, 48% received a less effective method, and 47% received the method they initially desired. Highest counseling rating was reported by 51%. Compared to those providing a lower rating in each group, highest counseling rating was significantly associated with lower 1-year contraceptive discontinuation for low-income eligible participants (aHR 0.34, 95% CI 0.14, 0.81), but not for low-income ineligible (aHR 1.56, 95% CI 0.83, 2.91) and higher-income (aHR 0.73, 95% CI 0.47,1.13) participants. Additionally, 1-year contraceptive continuation was associated with highest counseling rating (OR 1.72, 95% CI 1.09, 2.72) and post-abortion LARC use (OR 11.70, 95% CI 6.37, 21.48) in unadjusted models, but only postabortion LARC in adjusted models (aOR 1.55, 95% CI 0.90, 2.66 for highest counseling rating vs. aOR 11.83, 95% CI 6.29, 22.25 for postabortion LARC use). CONCLUSIONS: In Texas, where access to affordable postabortion contraception is limited, high quality contraceptive counseling is associated with 1-year contraceptive continuation only among those eligible for no-cost methods. IMPLICATIONS: State policies which restrict access to affordable post-abortion contraception limit the beneficial impact of patient-centered counseling and impede patients' ability to obtain their preferred method.

A longitudinal evaluation of government-sponsored job skills training and basic employment services among U.S. baby boomers with economic disadvantages.

Job skills training is a cost-effective strategy for improving employment among individuals who have low income and employment barriers, but few U.S. government-sponsored employment program participants have received such training. To better understand long-term gains from job skills training, this study compared employment and earnings trajectories between program participants who received job skills training and those who received basic services only. Using data from the National Longitudinal Survey of Youth 1979, we estimated 33-year employment and earnings trajectories among U.S. baby-boomer cohorts while accounting for baseline group heterogeneity using inverse propensity score weighting. We found increases in employment rates over the life course, especially among Black women. Job skills training also increased earnings by up to 69.6 % compared to basic services only. Despite the long-term gains in employment and earnings, job skills training participation is not sufficient to address gender as well as racial and ethnic gaps in full-time employment. Findings reinforce the importance of incorporating job skills training as an essential service element of government-sponsored employment programs to improve long-term labor market outcomes among Americans with economic disadvantages.

Differences in abortion rates by race-ethnicity after implementation of a restrictive Texas law.

OBJECTIVE: To evaluate the association between a restrictive Texas law, House Bill 2 (HB2), and receipt of in-clinic abortion by patient's race-ethnicity. STUDY DESIGN: In this retrospective cohort study, we collected Texas state statistics on number of abortions, abortions per county, and abortions per county by race-ethnicity for 2012, before HB2 was enacted, and 2015, after HB2 was in effect. Using female reproductive-aged population estimates, we calculated the abortion rate and percent change in the abortion rate between the two time periods by county, patient residence in a county with an open clinic or HB2-related clinic closure, and change in distance to an open clinic for each race-ethnicity. We also used geospatial analyses to depict the greatest decrease in abortion rate by race-ethnicity and county. RESULTS: In Texas, there were 64,716 reported abortions in 2012 and 54,253 in 2015. Statewide, there was a 20% decrease in the abortion rate affecting all racial-ethnic groups, yet the reduction was greater among Hispanic women compared to White women (-25% vs. -16%, respectively). The abortion rate also decreased more among those living in a county with an HB2-related clinic closure, especially for Hispanic women (-41% Hispanic vs. -29% White vs. -30% Black vs. -3% Other). Hispanic women whose travel distance increased 100+ miles had the greatest reduction in the abortion rate (-43%). Geospatial mapping confirmed our quantitative findings. CONCLUSION: HB2 led to a disproportionate reduction in the abortion rate among Hispanic women in Texas, including those living in counties with a closed clinic or traveling long distances to obtain in-clinic abortion care. IMPLICATIONS: Restrictive abortion policies in Texas may disproportionately burden Hispanic women and those affected by clinic closures.

The Effects of Family Transitions on Depressive Symptoms: Differences among Young Adults with and without Childhood Symptoms of Attention-Deficit/ Hyperactivity Disorder.

Attention-deficit/hyperactivity disorder (ADHD) is tied to higher levels of depression, but the social factors that shape these associations are not well understood. This study considers whether family transitions affect depressive symptoms differently for young adults with and without childhood symptoms of ADHD at subthreshold or diagnostic levels. Between-within regression analysis of nationally representative longitudinal survey data shows that transitions into cohabitation and parenthood affect depressive symptoms differently for young adults with and without childhood symptoms of ADHD. Specifically, within-person effects indicate that transitions into cohabitation and parenthood are tied to decreases in depressive symptoms, but only for young adults without childhood symptoms of ADHD. In contrast, transitions into marriage are tied to decreases in depressive symptoms, and transitions out of coresidential unions are tied to increases in depressive symptoms, regardless of childhood symptoms of ADHD. The results suggest that some family transitions may work to widen ADHD disparities in depression, under-scoring the importance of family contexts for shaping mental health throughout the life course.

Race/ethnicity, maternal educational attainment, and infant mortality in the United States.

This study examines patterns of and explanations for racial/ethnic-education disparities in infant mortality in the United States. Using linked birth and death data (2007-2010), we find that while education-specific infant mortality rates are similar for Mexican Americans and Whites, infants of college-educated African American women experience 3.1 more deaths per 1,000 live births (Rate Ratio = 1.46) than infants of White women with a high school degree or less. The high mortality rates among infants born to African American women of all educational attainment levels are fully accounted for by shorter gestational lengths. Supplementary analyses of data from the National Longitudinal Study of Adolescent to Adult Health show that college-educated African American women exhibit similar socioeconomic, contextual, psychosocial, and health disadvantages as White women with a high school degree or less. Together, these results demonstrate African American-White infant mortality and socioeconomic, health, and contextual disparities within education levels, suggesting the role of life course socioeconomic disadvantage and stress processes in the poorer infant health outcomes of African Americans relative to Whites.