Associations of street-view greenspace with Parkinson's disease hospitalizations in an open cohort of elderly US Medicare beneficiaries.

INTRODUCTION: Protective associations of greenspace with Parkinson's disease (PD) have been observed in some studies. Visual exposure to greenspace seems to be important for some of the proposed pathways underlying these associations. However, most studies use overhead-view measures (e.g., satellite imagery, land-classification data) that do not capture street-view greenspace and cannot distinguish between specific greenspace types. We aimed to evaluate associations of street-view greenspace measures with hospitalizations with a PD diagnosis code (PD-involved hospitalization). METHODS: We created an open cohort of about 45.6 million Medicare fee-for-service beneficiaries aged 65 + years living in core based statistical areas (i.e. non-rural areas) in the contiguous US (2007-2016). We obtained 350 million Google Street View images across the US and applied deep learning algorithms to identify percentages of specific greenspace features in each image, including trees, grass, and other green features (i.e., plants, flowers, fields). We assessed yearly average street-view greenspace features for each ZIP code. A Cox-equivalent re-parameterized Poisson model adjusted for potential confounders (i.e. age, race/ethnicity, socioeconomic status) was used to evaluate associations with first PD-involved hospitalization. RESULTS: There were 506,899 first PD-involved hospitalizations over 254,917,192 person-years of follow-up. We found a hazard ratio (95% confidence interval) of 0.96 (0.95, 0.96) per interquartile range (IQR) increase for trees and a HR of 0.97 (0.96, 0.97) per IQR increase for other green features. In contrast, we found a HR of 1.06 (1.04, 1.07) per IQR increase for grass. Associations of trees were generally stronger for low-income (i.e. Medicaid eligible) individuals, Black individuals, and in areas with a lower median household income and a higher population density. CONCLUSION: Increasing exposure to trees and other green features may reduce PD-involved hospitalizations, while increasing exposure to grass may increase hospitalizations. The protective associations may be stronger for marginalized individuals and individuals living in densely populated areas.

Shared Genetic Risk in the Association of Screen Time With Psychiatric Problems in Children.

Importance: Children's exposure to screen time has been associated with poor mental health outcomes, yet the role of genetic factors remains largely unknown. Objective: To assess the extent of genetic confounding in the associations between screen time and attention problems or internalizing problems in preadolescent children. Design, Setting, and Participants: This cohort study analyzed data obtained between 2016 and 2019 from the Adolescent Brain Cognitive Development Study at 21 sites in the US. The sample included children aged 9 to 11 years of genetically assigned European ancestry with self-reported screen time. Data were analyzed between November 2021 and September 2023. Exposure: Child-reported daily screen time (in hours) was ascertained from questionnaires completed by the children at baseline. Main Outcomes and Measures: Child psychiatric problems, specifically attention and internalizing problems, were measured with the parent-completed Achenbach Child Behavior Checklist at the 1-year follow-up. Genetic sensitivity analyses model (Gsens) was used, which incorporated polygenic risk scores (PRSs) of both exposure and outcomes as well as either single-nucleotide variant (SNV; formerly single-nucleotide polymorphism)-based heritability or twin-based heritability to estimate genetic confounding. Results: The 4262 children in the sample included 2269 males (53.2%) with a mean (SD) age of 9.9 (0.6) years. Child screen time was associated with attention problems (ß = 0.10 SD; 95% CI, 0.07-0.13 SD) and internalizing problems (ß = 0.03 SD; 95% CI, 0.003-0.06 SD). The television time PRS was associated with child screen time (ß = 0.18 SD; 95% CI, 0.14-0.23 SD), the attention-deficit/hyperactivity disorder PRS was associated with attention problems (ß = 0.13 SD; 95% CI, 0.10-0.16 SD), and the depression PRS was associated with internalizing problems (ß = 0.10 SD; 95% CI, 0.07-0.13 SD). These PRSs were associated with cross-traits, suggesting genetic confounding. Estimates using PRSs and SNV-based heritability showed that genetic confounding accounted for most of the association between child screen time and attention problems and for 42.7% of the association between child screen time and internalizing problems. When PRSs and twin-based heritability estimates were used, genetic confounding fully explained both associations. Conclusions and Relevance: Results of this study suggest that genetic confounding may explain a substantial part of the associations between child screen time and psychiatric problems. Genetic confounding should be considered in sociobehavioral studies of modifiable factors for youth mental health.

Behavioral and neurostructural correlates of childhood physical violence victimization: Interaction with family functioning.

Violence victimization may cause child behavior problems and neurostructural differences associated with them. Healthy family environments may buffer these effects, but neural pathways explaining these associations remain inadequately understood. We used data from 3154 children (x̅age  = 10.1) to test whether healthy family functioning moderated possible associations between violence victimization, behavior problems, and amygdala volume (a threat-responsive brain region). Researchers collected data on childhood violence victimization, family functioning (McMaster Family Assessment Device, range 0-3, higher scores indicate healthier functioning), and behavior problems (Achenbach Child Behavior Checklist [CBCL] total problem score, range 0-117), and they scanned children with magnetic resonance imaging. We standardized amygdala volumes and fit confounder-adjusted models with "victimization × family functioning" interaction terms. Family functioning moderated associations between victimization, behavior problems, and amygdala volume. Among lower functioning families (functioning score = 1.0), victimization was associated with a 26.1 (95% confidence interval [CI]: 9.9, 42.4) unit higher CBCL behavior problem score, yet victimized children from higher functioning families (score = 3.0) exhibited no such association. Unexpectedly, victimization was associated with higher standardized amygdala volume among lower functioning families (y = 0.5; 95% CI: 0.1, 1.0) but lower volume among higher functioning families (y = -0.4; 95% CI: -0.7, -0.2). Thus, healthy family environments may mitigate some neurobehavioral effects of childhood victimization.

Air Pollution and Mortality at the Intersection of Race and Social Class.

BACKGROUND: Black Americans are exposed to higher annual levels of air pollution containing fine particulate matter (particles with an aerodynamic diameter of ≤2.5 µm [PM2.5]) than White Americans and may be more susceptible to its health effects. Low-income Americans may also be more susceptible to PM2.5 pollution than high-income Americans. Because information is lacking on exposure-response curves for PM2.5 exposure and mortality among marginalized subpopulations categorized according to both race and socioeconomic position, the Environmental Protection Agency lacks important evidence to inform its regulatory rulemaking for PM2.5 standards. METHODS: We analyzed 623 million person-years of Medicare data from 73 million persons 65 years of age or older from 2000 through 2016 to estimate associations between annual PM2.5 exposure and mortality in subpopulations defined simultaneously by racial identity (Black vs. White) and income level (Medicaid eligible vs. ineligible). RESULTS: Lower PM2.5 exposure was associated with lower mortality in the full population, but marginalized subpopulations appeared to benefit more as PM2.5 levels decreased. For example, the hazard ratio associated with decreasing PM2.5 from 12 µg per cubic meter to 8 µg per cubic meter for the White higher-income subpopulation was 0.963 (95% confidence interval [CI], 0.955 to 0.970), whereas equivalent hazard ratios for marginalized subpopulations were lower: 0.931 (95% CI, 0.909 to 0.953) for the Black higher-income subpopulation, 0.940 (95% CI, 0.931 to 0.948) for the White low-income subpopulation, and 0.939 (95% CI, 0.921 to 0.957) for the Black low-income subpopulation. CONCLUSIONS: Higher-income Black persons, low-income White persons, and low-income Black persons may benefit more from lower PM2.5 levels than higher-income White persons. These findings underscore the importance of considering racial identity and income together when assessing health inequities. (Funded by the National Institutes of Health and the Alfred P. Sloan Foundation.).

Long-term associations between early-life family functioning and preadolescent white matter microstructure.

BACKGROUND: Causes of childhood behavior problems remain poorly understood. Enriched family environments and corresponding brain development may reduce the risk of their onset, but research investigating white matter neurodevelopmental pathways explaining associations between the family environment and behavior remains limited. We hypothesized that more positive prenatal and mid-childhood family functioning - a measure of a family's problem solving and supportive capacity - would be associated with two markers of preadolescent white matter neurodevelopment related to reduced behavior problems: higher global fractional anisotropy (FA) and lower global mean diffusivity (MD). METHODS: Data are from 2727 families in the Generation R Study, the Netherlands. Mothers reported family functioning (McMaster Family Assessment Device, range 1-4, higher scores indicate healthier functioning) prenatally and in mid-childhood (mean age 6.1 years). In preadolescence (mean age 10.1), the study collected diffusion-weighted scans. We computed standardized global MD and FA values by averaging metrics from 27 white matter tracts, and we fit linear models adjusting for possible confounders to examine global and tract-specific outcomes. RESULTS: Prenatal and mid-childhood family functioning scores were moderately correlated, r = 0.38. However, only prenatal family functioning - and not mid-childhood functioning - was associated with higher global FA and lower global MD in preadolescence in fully adjusted models: ßglobal FA = 0.11 (95% CI 0.00, 0.21) and ßglobal MD = -0.15 (95% CI -0.28, -0.03) per one-unit increase in functioning score. Sensitivity and tract-specific analyses supported these global findings. CONCLUSIONS: These results suggest high-functioning prenatal or perinatal family environments may confer lasting white matter neurodevelopmental benefits into preadolescence.

Editorial: Are Neural Biomarkers Valid for All Children?

Poverty-like all life experiences-can change the developing brain. Psychopathology can, too. But how? And when? And why? And what happens to brain development when children face both poverty and pathology at the same time? With 1 in 5 children growing up poor in the United States today-each at higher risk for developing depression-answering these questions remains among public mental health's most important imperatives. Yet doing so is wickedly challenging: investigators must decipher a wide array of interacting social and biological processes.

Pursuing Pharmacoequity: Determinants, Drivers, and Pathways to Progress.

The United States pays more for medical care than any other nation in the world, including for prescription drugs. These costs are inequitably distributed, as individuals from underrepresented racial and ethnic groups in the United States experience the highest costs of care and unequal access to high-quality, evidence-based medication therapy. Pharmacoequity refers to equity in access to pharmacotherapies or ensuring that all patients, regardless of race and ethnicity, socioeconomic status, or availability of resources, have access to the highest quality of pharmacotherapy required to manage their health conditions. Herein the authors describe the urgent need to prioritize pharmacoequity. This goal will require a bold and innovative examination of social policy, research infrastructure, patient and prescriber characteristics, as well as health policy determinants of inequitable medication access. In this article, the authors describe these determinants, identify drivers of ongoing inequities in prescription drug access, and provide a framework for the path toward achieving pharmacoequity.

Differences in cortical morphology and child internalizing or externalizing problems: Accounting for the co-occurrence.

Background: Childhood internalizing and externalizing problems frequently co-occur. Many studies report neural correlates of either internalizing or externalizing problems, but few account for their co-occurrence. We aimed to assess specific cortical substrates of these psychiatric problems. Methods: We used data from 9635 children aged 9-11 years in the baseline Adolescent Brain Cognitive Development Study. Internalizing and externalizing problem composite scales scores were derived from the Child Behavior Checklist. We standardized FreeSurfer-derived volumes of 68 cortical regions. We examined internalizing and externalizing problems separately and jointly (covariate-adjustment) in relation to cortical volumes, with and without adjusting for total brain volume (TBV) in multivariate linear regressions adjusted for demographics and multiple comparisons. We fit bifactor models to confirm the consistency of patterns exploring specific internalizing and specific externalizing problems. Sensitivity analyses included a vertex-wide analysis and a replication in another large population-based study. Results: In separate TBV-unadjusted analyses, externalizing and internalizing problems were associated with smaller cortical volumes. If adjusted for externalizing behavior, however, larger cortical volumes were associated with internalizing problems, while smaller cortical volumes remained associated with externalizing problems after adjustment for internalizing problems. The bifactor model produced similar results, which were consistently replicated in another pre-adolescent neuroimaging sample. These associations likely represent global effects: adjusting for TBV rendered most associations non-significant. Vertex-wise analyses confirmed global patterns. Conclusion: Our results suggest that internalizing and externalizing problems have globally opposing, and non-specific associations with cortical morphology in childhood, which are only apparent if analyses account for their co-occurrence.

Are all domains of life satisfaction equal? Differential associations with health and well-being in older adults.

PURPOSE: Growing evidence documents strong associations between overall life satisfaction and favorable health and well-being outcomes. However, because most previous studies have assessed satisfaction with one's life as a whole, we know little about whether specific domains of life satisfaction (e.g., satisfaction with family life, income) might be responsible for longitudinally driving better health and well-being. METHODS: Data were from 13,752 participants in the Health and Retirement Study-a prospective and nationally representative cohort of US adults aged > 50. We evaluated if positive changes in seven individual domains of life satisfaction (between t0; 2008/2010 and t1; 2012/2014) were associated with 35 indicators of physical, behavioral, and psychosocial health and well-being (at t2; 2016/2018). RESULTS: Most domains of life satisfaction were associated with psychological outcomes: satisfaction with family and non-work activities showed the largest associations (sometimes double in magnitude) with subsequent psychological factors, followed by satisfaction with financial situation and income. Further, some domains showed associations with specific physical health outcomes (e.g., mortality, number of chronic conditions, physical functioning limitations), health behaviors (e.g., sleep problems), and social factors (e.g., loneliness). CONCLUSIONS: As countries seek innovative and cost-effective methods of enhancing the health and well-being of our rapidly aging populations, findings from our study suggest that some domains of life satisfaction have a substantially larger influence on health and well-being outcomes than others. Individual domains of life satisfaction might be novel targets for interventions and policies seeking to enhance specific facets of health and well-being.

Harsh Parenting and Child Brain Morphology: A Population-Based Study.

Evidence suggests that maltreatment shapes the child's brain. Little is known, however, about how normal variation in parenting influences the child neurodevelopment. We examined whether harsh parenting is associated with the brain morphology in 2,410 children from a population-based cohort. Mothers and fathers independently reported harsh parenting at child age 3 years. Structural and diffusion-weighted brain morphological measures were acquired with MRI scans at age 10 years. We explored whether associations between parenting and brain morphology were explained by co-occurring adversities, and whether there was a joint effect of both parents' harsh parenting. Maternal harsh parenting was associated with smaller total gray (ß = -0.05 (95%CI = -0.08; -0.01)), cerebral white matter and amygdala volumes (ß = -0.04 (95%CI = -0.07; 0)). These associations were also observed with the combined harsh parenting measure and were robust to the adjustment for multiple confounding factors. Similar associations, although non-significant, were found between paternal parenting and these brain outcomes. Maternal and paternal harsh parenting were not associated with the hippocampus or the white matter microstructural metrics. We found a long-term association between harsh parenting and the global brain and amygdala volumes in preadolescents, suggesting that adverse rearing environments common in the general population are related to child brain morphology.

Are all threats equal? Associations of childhood exposure to physical attack versus threatened violence with preadolescent brain structure.

BACKGROUND: Neurodevelopmental studies of childhood adversity often define threatening experiences as those involving harm or the threat of harm. Whether effects differ between experiences involving harm ("physical attack") versus the threat of harm alone ("threatened violence") remains underexplored. We hypothesized that while both types of experiences would be associated with smaller preadolescent global and corticolimbic brain volumes, associations with physical attack would be greater. METHODS: Generation R Study researchers (the Netherlands) acquired T1-weighted scans from 2905 preadolescent children, computed brain volumes using FreeSurfer, and asked mothers whether their children ever experienced physical attack (n = 202) or threatened violence (n = 335). Using standardized global (cortical, subcortical, white matter) and corticolimbic (amygdala, hippocampus, anterior cingulate cortex, orbitofrontal cortex) volumes, we fit confounder-adjusted models. RESULTS: Physical attack was associated with smaller global volumes (ßcortical=-0.14; 95% CI: -0.26, -0.02); ßwhite matter= -0.16; 95% CI: - 0.28, - 0.03) and possibly some corticolimbic volumes, e.g., ßamygdala/ICV-adjusted= -0.10 (95% CI: -0.21, 0.01). We found no evidence of associations between threatened violence and smaller volumes in any outcome; instead, such estimates were small, highly uncertain, and positive in direction. CONCLUSIONS: Experiences of physical attack and threatened violence may have quantitively different neurodevelopmental effects. Thus, differences between types of threatening experiences may be neurodevelopmentally salient.

Life Satisfaction and Subsequent Physical, Behavioral, and Psychosocial Health in Older Adults.

Policy Points Several intergovernmental organizations (Organisation for Economic Co-operation and Development, World Health Organization, United Nations) are urging countries to use well-being indicators (e.g., life satisfaction) in addition to traditional economic indicators when making important policy decisions. As the number of governments implementing this new approach grows, so does the need to continue evaluating the health and well-being outcomes we might observe from policies aimed at improving life satisfaction. The results of this study suggest that life satisfaction is a valuable target for policies aiming to enhance several indicators of psychosocial well-being, health behaviors, and physical health outcomes. CONTEXT: Several intergovernmental organizations (Organisation for Economic Co-operation and Development, World Health Organization, United Nations) are urging countries to use well-being indicators (e.g., life satisfaction) in addition to traditional economic indicators when making important policy decisions. As the number of governments implementing this new approach grows, so does the need to continue evaluating the health and well-being outcomes we might observe from policies aimed at improving life satisfaction. METHODS: We evaluated whether positive change in life satisfaction (between t0 ;2006/2008 and t1 ;2010/2012) was associated with better outcomes on 35 indicators of physical, behavioral, and psychosocial health and well-being (in t2 ;2014/2016). Data were from 12,998 participants in the University of Michigan's Health and Retirement Study-a prospective and nationally representative cohort of US adults over age 50. FINDINGS: Participants with the highest (versus lowest) life satisfaction had better subsequent outcomes on some physical health indicators (lower risk of pain, physical functioning limitations, and mortality; lower number of chronic conditions; and higher self-rated health) and health behaviors (lower risk of sleep problems and more frequent physical activity), and nearly all psychosocial indicators (higher positive affect, optimism, purpose in life, mastery, health mastery, financial mastery, and likelihood of living with spouse/partner; and lower depression, depressive symptoms, hopelessness, negative affect, perceived constraints, and loneliness) over the 4-year follow-up period. However, life satisfaction was not subsequently associated with many specific health conditions (i.e., diabetes, hypertension, stroke, cancer, heart disease, lung disease, arthritis, overweight/obesity, or cognitive impairment), other health behaviors (i.e., binge drinking or smoking), or frequency of contact with children, family, or friends. CONCLUSIONS: These results suggest that life satisfaction is a valuable target for policies aiming to enhance several indicators of psychosocial well-being, health behaviors, and physical health outcomes.

Association of Poor Family Functioning From Pregnancy Onward With Preadolescent Behavior and Subcortical Brain Development.

Importance: The association of poor family functioning, a potent stressor, with child behavior is potentially long term and relevant for a person's well-being later in life. Whether changes in brain development underlie the associations with preadolescent behavior and help identify periods of vulnerability is unclear. Objective: To assess the associations of poor family functioning from pregnancy onward with cortical, white matter, and subcortical volumes, and to examine the extent to which, in particular, hippocampal volume mediates the association of prenatal parental environmental exposures with child problem behavior in preadolescence. Design, Setting, and Participants: This population-based cohort study, conducted from April 2002 to January 2006, was embedded in Generation R, a multiethnic population-based cohort from fetal life onward. All pregnant women living in Rotterdam, the Netherlands, with an expected delivery date between April 2002 and January 2006 were invited to participate. Of the 8879 pregnant women enrolled during pregnancy, 1266 mothers with no partner data and 490 with missing family functioning data were excluded, as well as 1 sibling of 32 twin pairs. After excluding an additional 657 children with poor imaging data quality or incidental findings, the final sample consisted of 2583 mother-child pairs. Data analysis was performed from March 1, 2019, to June 28, 2019. Exposures: Mother- and father-rated poor family functioning was repeatedly measured by the General Functioning subscale of the Family Assessment Device. Main Outcomes and Measures: Our primary hypothesis, formulated after data collection but before analysis, was that poor prenatal family functioning would be associated with smaller hippocampal and amygdala volumes in late childhood. High-resolution structural neuroimaging data of children aged 10 years were collected with a single 3-T magnetic resonance imaging system. Child emotional and behavioral problems were assessed with the Child Behavior Checklist. Results: Data were available for 2583 children (mean [SD] age, 10.1 [0.6] years; 1315 girls [50.9%]). Data for parents included 2583 mothers (mean [SD] age, 31.1 [4.7] years; 1617 Dutch race/ethnicity [62.6%]) and 1788 fathers (mean [SD] age, 33.5 [5.3] years; 1239 Dutch race/ethnicity [69.3%]). Children exposed to prenatal maternal-reported poor family functioning had smaller hippocampal (B = -0.08; 95% CI, -0.13 to -0.02) and occipital lobe (B = -0.70; 95% CI, -1.19 to -0.21) volumes in preadolescence. There was no evidence for an association of exposure to poor family functioning at mid- or late childhood with brain morphology. Hippocampal volumes partially mediated the association of prenatal maternal-reported poor family functioning with preadolescent problem behavior (B = 0.08; 95% CI, 0.03-0.13), even after adjusting for prior child problems at age 1.5 years. Analyses of combined maternal and paternal family functioning ratings showed similar results, but associations were largely driven by maternal family functioning reports. Conclusions and Relevance: In this population-based cohort study, prenatal maternal-reported poor family functioning was associated with a smaller hippocampus in preadolescents. This difference in brain structure may underlie behavioral problems and is a possible neurodevelopmental manifestation of the long-term consequences of poor family functioning for the child.

Sense of Purpose in Life and Cardiovascular Disease: Underlying Mechanisms and Future Directions.

PURPOSE OF REVIEW: In this review, we synthesize recent research that has reported associations of a higher sense of purpose in life with reduced risk of developing cardiovascular disease (CVD), and then explore mechanisms that might underlie these associations. RECENT FINDINGS: Accumulating observational and experimental evidence suggests that having a higher sense of purpose might influence CVD risk through three pathways: (1) enhancement of other psychological and social resources that buffer against the cardiotoxic effects of overwhelming stress; (2) indirect effects through health behaviors; and (3) direct effects on biological pathways. A sense of purpose in life is emerging as an independent risk factor for incident CVD. A key remaining question is whether purpose causally effects CVD risk; in the "Future Research Directions" section, we focus on work needed to establish causality and provide suggestions for next steps.