Polygenic and socioeconomic contributions to nicotine use and cardiometabolic health in early mid-life.

INTRODUCTION: Early mid-life is marked by accumulating risks for cardiometabolic illness linked to health-risk behaviors like nicotine use. Identifying polygenic indices (PGI) has enriched scientific understanding of the cumulative genetic contributions to behavioral and cardiometabolic health, though few studies have assessed these associations alongside socioeconomic (SES) and lifestyle factors. METHODS: Drawing on data from 2,337 individuals from the United States participating in the National Longitudinal Study of Adolescent to Adult Health, the current study assesses the fraction of variance in five related outcomes - use of conventional and electronic cigarettes, body mass index (BMI), waist circumference, and glycosylated hemoglobin (A1c) - explained by PGI, SES, and lifestyle. RESULTS: Regression models on African ancestry (AA) and European ancestry (EA) subsamples reveal that the fraction of variance explained by PGI ranges across outcomes. While adjusting for sex and age, PGI explained 3.5%, 2.2%, and 0% in the AA subsample of variability in BMI, waist circumference, and A1c, respectively (in the EA subsample these figures were 7.7%, 9.4%, and 1.3%). The proportion of variance explained by PGI in nicotine-use outcomes is also variable. Results further indicate that PGI and SES are generally complementary, accounting for more variance in the outcomes when modeled together versus separately. CONCLUSIONS: PGI are gaining attention in population health surveillance, but polygenic variability might not align clearly with health differences in populations or surpass SES as a fundamental cause of health disparities. We discuss future steps in integrating PGI and SES to refine population health prediction rules. IMPLICATIONS: Study findings point to the complementary relationship of polygenic indices (PGI) and socioeconomic indicators in explaining population variance in nicotine outcomes and cardiometabolic wellness. Population health surveillance and prediction rules would benefit from the combination of information from both polygenic and socioeconomic risks. Additionally, the risk for electronic cigarette use among users of conventional cigarettes may have a genetic component tied to the cumulative genetic propensity for heavy smoking. Further research on PGI for vaping is needed.

The Relative Contributions of Socioeconomic and Genetic Factors to Variations in Body Mass Index Among Young Adults.

In light of recent findings on the small proportion of variance in body mass index (BMI) explained by shared environment, and growing interests in the role of genetic susceptibility, we assessed the relative contribution of socioeconomic status (SES) and genome-wide polygenic score for BMI to explaining variation in BMI. Our final analytic sample included 4,918 White and 1,546 Black individuals from the US National Longitudinal Study of Adolescent to Adult Health Wave IV (2007-2008) who had complete measures on BMI, demographics, SES, genetic data, and health behaviors. We used ordinary least-squares regression to assess variation in log(BMI) as a function of the aforementioned predictors, independently and mutually adjusted. All analyses were stratified by race/ethnicity in the main analysis, and further by sex. The age-adjusted variation in log(BMI) was 0.055 among Whites and 0.066 among Blacks. The contribution of SES and polygenic score ranged from less than1% to 6% and from 2% to 8%, respectively, and majority of the variation (87%-96%) in log(BMI) remained unexplained. Differential distribution of socioeconomic resources, stressors, and buffers may interact to produce systematically larger variation in vulnerable populations. More understanding of the contribution of biological, genetic, and environmental factors, as well as stochastic elements, in diverse phenotypic variance is needed in population health sciences.

Parent-child relationships in Latinx families: The role of immigrant concentration, residential stability, and generational status.

Prior research links neighborhood immigrant concentration and residential stability to individual health outcomes. It remains unclear how neighborhood social organization extend to family functioning among immigrant families. Expanding the scope of research on neighborhoods and family relationships, this study draws on data from 1417 Latinx families (Myouth age = 10.19 years, SDyouth age = 3.34) to: (1) examine associations between neighborhood immigrant concentration, residential stability, and parent-child warmth and conflict in Latinx families, and (2) test whether associations vary by family generational status. Multilevel mod3els revealed that associations between immigrant concentration and parent-child relationships were contingent on residential stability, and that the association differed according to generational status. In general, stable neighborhoods with larger immigrant populations were associated with more warmth and less conflict for first- and second-generation families relative to foreign-born families. Discussion centers on the conditional role of neighborhood structural characteristics for family relationships among Latinx families and advances directions for future research on neighborhoods and families.

Schools Influence Adolescent E-Cigarette use, but when? Examining the Interdependent Association between School Context and Teen Vaping over time.

Schools are important contexts for adolescent health and health-risk behaviors, but how stable is this relationship? We develop a conceptual model based on Ecological Systems Theory describing the changing role of schools for adolescent health outcomes-in this case, teen e-cigarette use. To examine this change, we fit Bayesian multilevel regression models to two-year intervals of pooled cross-sectional data from the 2011-2017 U.S. National Youth Tobacco Survey, a school-based study of the nicotine use behaviors of roughly 65,000 middle and high school students (49.5% female; 41.1% nonwhite; x̄ age of 14.6 ranging from 9 to 18) from over 700 schools. We hypothesized that school-level associations with student e-cigarette use diminished over time as the broader popularity of e-cigarettes increased. Year-specific variance partitioning coefficients (VPC) derived from the multilevel models indicated a general decrease in the extent to which e-cigarette use clusters within specific schools, suggesting that students across schools became more uniform in their propensity to vape over the study period. This is above and beyond adjustments for personal characteristics and vicarious exposure to smoking via friends and family. Across all years, model coefficients indicate a positive association between attending schools where vaping is more versus less common and student-level odds of using e-cigarettes, suggesting that school contexts are still consequential to student vaping, but less so than when e-cigarettes were first introduced to the US market. These findings highlight how the health implications of multiply-embedded ecological systems like schools shift over time with concomitant changes in other ecological features including those related to policy, culture, and broader health practices within society. Though not uniformly reported in multilevel studies, variance partitioning coefficients could be used more thoughtfully to empirically illustrate how the influence of multiple developmentally-relevant contexts shift in their influence on teen health over time.

Association Between School-Level Prevalence of Electronic Cigarette Use and Student-Level Use Behaviors, Pre-Use Intentions, and Risk Perceptions: Evidence From the 2014 US National Youth Tobacco Survey.

Background: Adolescent electronic cigarette ("e-cigarette") use tripled in recent years, yet little is known about the school-level correlates of teenage e-cigarette use, harm and risk perceptions, or pre-use intentions to use. Methods: Multilevel regression and 2014 National Youth Tobacco Survey data were used to assess school-level e-cigarette prevalence and person-level e-cigarette use as well as age at initiation and frequency of use (among initiates), expectations for future use (among abstainers), and perceived e-cigarette addictivity and harm. Results: Lifetime use was higher among students in medium- (odds ratio [OR] = 2.30, 95% confidence interval [CI] = 1.82, 2.89) and high- (OR = 4.66, 95% CI = 3.67, 5.90) versus low-use schools. Past 30-day use followed a similar pattern. Multilevel ordinal logistic models revealed that initiates from high-use schools reported more days of use in the past month (OR = 2.25, 95% CI = 1.52, 3.33) and higher age-at-first-use (OR = 1.45, 95% CI = 1.08, 2.00) than students at low-use schools. Expectations for future use were higher among abstainers from medium- and high- versus low-use schools, and among all students, perceived addictivity and harm caused by e-cigarettes were lower in medium- and high- versus low-use schools. Conclusion: School context is associated with multiple dimensions of e-cigarette use, pre-use intentions, and perceptions of e-cigarette health risks. Implications: The current study demonstrates a link between school prevalence of e-cigarette use and student-level use, as well as perceived risks of e-cigarette use, age of initiation and frequency of use among users, and intentions to use among abstainers. Health communication and prevention initiatives should target school social environments to promote nicotine abstinence and a culture of health.

Associations of Continuity and Change in Early Neighborhood Poverty With Adult Cardiometabolic Biomarkers in the United States: Results From the National Longitudinal Study of Adolescent to Adult Health, 1995-2008.

Limitations of extant research on neighborhood disadvantage and health include general reliance on point-in-time neighborhood measures and sensitivity to residential self-selection. Using data from the US Census and the 1995-2008 National Longitudinal Study of Adolescent to Adult Health, we applied conventional methods and coarsened exact matching to assess how cardiometabolic health varies among those entering, exiting, or remaining in poor and nonpoor neighborhoods. Within the full sample (n = 11,767), we found significantly higher systolic and diastolic blood pressures among those who entered or consistently lived in poor neighborhoods relative to those who never lived in poor neighborhoods. Obesity was similarly more common among those who originated from poor neighborhoods than among those who originated from nonpoor neighborhoods. Having exited poor neighborhoods was associated with lower systolic blood pressure than was consistent residence in low-income communities. Among the matched sample (n = 9,727), results adjusted for confounders and residential self-selection revealed fewer significant contrasts. Compared with peers who had no neighborhood poverty exposure, those who consistently lived in poor neighborhoods had 46% and 52% higher odds of being obese or hypertensive, respectively. Those who exited neighborhood poverty had significantly higher diastolic blood pressures than those who had never lived in poor neighborhoods. These findings underscore the importance of past as well as current residential circumstances for cardiometabolic health.

Weight change and depression among US young women during the transition to adulthood.

By using data from wave 2 (in 1996) and wave 3 (in 2000-2001) of the US-based National Longitudinal Study of Adolescent Health, we investigated the association between young women's body weight and depression during the transition to adulthood. Respondents (n = 5,243) were 13-18 years of age during wave 2 and 19-25 years of age during wave 3. We used Center for Epidemiologic Studies Depression Scale scores to classify young women as never depressed, consistently depressed, experiencing depression onset, or experiencing depression recovery from wave 2 to wave 3. Results from adjusted multinomial logistic regression models indicated that respondents who experienced significant weight gain were at risk of depression onset. Normal weight (adjusted odds ratio = 2.10, 95% confidence interval: 1.14, 3.84) and overweight (adjusted odds ratio = 1.86, 95% confidence interval: 1.15, 2.99) adolescent girls who were obese by young adulthood, as well as young women who were consistently obese during adolescence and young adulthood (adjusted odds ratio = 1.97, 95% confidence interval: 1.19, 3.26), had roughly twice the odds of depression onset as did young women who were never overweight. We concluded that weight gain and obesity are risk factors for depression onset during the transition to adulthood. Policies prioritizing healthy weight maintenance may help improve young women's mental health as they begin their adult lives.

System Failure: The Geographic Distribution of Sepsis-Associated Death in the USA and Factors Contributing to the Mortality Burden of Black Communities.

Sepsis is deadly and costly to health care systems, but these costs are disproportionately born by Black patients. Little empirical work has established the geographic patterning of sepsis or its area-level correlates. This study illustrates the geography of sepsis-associated death and racial composition of US counties with area socioeconomic indicators, health care access, and population health. Cartographic and spatially explicit analyses utilize mortality data from the National Cancer Institute and county data from the American Community Survey, Area Health Resource File, and County Health Rankings. Death rates are highest in the South, Southeast, and Appalachia. Counties disproportionately populated by Black people have higher death rates and associated risk indicators including poor air quality and vaccination coverage, socioeconomic distress, and impaired access to high-quality health care. Spatial Durbin error models suggest that conditions in nearby counties may also influence death rates within focal counties. Racial disparities in sepsis-associated death can be narrowed with improved health care equity-including immunization coverage-and by reducing socioeconomic distress in Black communities. Policy options for achieving these ends are discussed.

Student Debt and Cardiovascular Disease Risk Among U.S. Adults in Early Mid-Life.

INTRODUCTION: Student loan debt has become common for young adults in the U.S. and is correlated with poor physical and mental health. It is unclear how the accumulation or repayment of student debt is associated with longer-term cardiovascular risks and chronic inflammation. METHODS: Nationally representative data collected between 1994 and 2018 from >4,000 participants of a U.S. cohort study were analyzed in 2021 to assess the associations among change in student debt between young adulthood and early mid-life, 30-year Framingham cardiovascular disease risk scores, and C-reactive protein levels. RESULTS: Ordinary least squares regression revealed higher cardiovascular disease and C-reactive protein risks among those in households who became indebted or were consistently in debt between young adulthood and early mid-life than among those in households who were either never in debt or repaid their loans. This pattern persisted after adjustments for degree completion, socioeconomic measures, and other sources of debt. CONCLUSIONS: These findings provide a benchmark for widening health inequalities among a cohort bearing more student debt than any other in U.S. HISTORY: As student debt accumulates, within-cohort disparities in cardiovascular disease and related morbidities may undermine the health benefits of postsecondary education.

Estimating the influence of adolescent delinquent behavior on adult health using sibling fixed effects.

Despite the well-established link between juvenile delinquency and socioeconomic attainment in adulthood, less is known about whether engagement in delinquent behavior during adolescence shapes adult health outcomes. This study examines the association between juvenile delinquency and adult physical and mental health, and whether this association is confounded by unobserved family heterogeneity. Moreover, this study explores the potential underlying mechanisms through which juvenile delinquency shapes adult physical and mental health. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) 1994-1995 (Wave 1) and 2007-2008 (Wave 4), we adopted a sibling fixed effect approach to account for genetic factors, family environment, and childhood social contexts such as school and neighborhood effects. The conventional OLS results show that engagement in delinquent behavior during adolescence strongly predicts higher levels of Framingham cardiovascular disease (CVD) risk score and depressive symptoms in adulthood. Once we account for family-specific heterogeneity, however, the point estimates of the associations of delinquency with CVD risk score and depressive symptoms are attenuated by 33% and 45%, respectively. Despite this attenuation, the association of juvenile delinquency with adult health is robust: a one standard-deviation increase in juvenile delinquency is associated with approximately 8 and 6 percent of one standard-deviation increases in CVD risk and depressive symptoms, respectively. Our mediation analyses suggest that a combination of several mediating pathways jointly explain the association between juvenile delinquency with adult health. The most consistent and significant mediating pathways connecting juvenile delinquency to both physical and mental health included disruption in student-teacher relationship, smoking, criminal justice contact, and educational attainment. Moreover, while binge drinking explained part of the association between delinquency and CVD risk score, student-friend relationship partially mediated the association with depression.