The psychological burden associated with metabolic syndrome: Evidence from UK and US older adults.

Introduction: We examined the psychological burden associated with metabolic syndrome (MetSyn). Methods: We used comparable longitudinal data of older adults (≥50 years) from the UK (English Longitudinal Study of Aging) and the US (Health and Retirement Study). We defined MetSyn based on biomarker assessments (e.g., blood pressure, impaired glycemic control). Using regression models, we tested a range of individual psychological outcomes (e.g., depressive symptoms) associated with MetSyn. We also examined whether these psychological outcomes may explain or moderate the link between MetSyn and non-communicable diseases (NCDs). Findings: MetSyn was associated cross-sectionally with a range of psychological outcomes, including depression, anxiety, loneliness, hopelessness, cynical hostility, social strain, negative affect and decreased positive affect, social support and purpose in life. There was no convincing evidence that psychological factors interacted with or explained (mediated) the relationship between MetSyn and increased risk of developing NCD over 10-year follow-ups. Conclusions: MetSyn and the psychological burden outcomes examined may have independent effects on NCD risk.

Obesity, psychological well-being related measures, and risk of seven non-communicable diseases: evidence from longitudinal studies of UK and US older adults.

BACKGROUND: We examined the role of psychological well-being related measures in explaining the associations between obesity and increased risk of non-communicable diseases (NCDs: hypertension, heart disease, stroke, diabetes, arthritis, cancer, and memory-related disease) in older adults. METHODS: Data were from the English Longitudinal Study of Ageing (ELSA), UK (baseline: Wave 4-2008/2009; n = 8127) and the Health and Retirement Study (HRS), US (baseline: Waves 9 and 10-2008/2010; n = 12,477). Objective body mass index was used to define obesity. A range of psychological well-being related measures (e.g., depressive symptoms, life satisfaction) was available in ELSA (n = 7) and HRS (n = 15), and an index of overall psychological well-being was developed separately in each study. NCDs were from a self-reported doctor diagnosis and/or other assessments (e.g., biomarker data) in both studies; and in ELSA, NCDs from linked hospital admissions data were examined. Longitudinal associations between obesity status, psychological well-being measures, and NCDs were examined using Cox proportional hazard models (individual NCDs) and Poisson regression (a cumulative number of NCDs). Mediation by psychological well-being related measures was assessed using causal mediation analysis. RESULTS: Obesity was consistently associated with an increased prospective risk of hypertension, heart disease, diabetes, arthritis, and a cumulative number of NCDs in both ELSA and HRS. Worse overall psychological well-being (index measure) and some individual psychological well-being related measures were associated with an increased prospective risk of heart disease, stroke, arthritis, memory-related disease, and a cumulative number of NCDs across studies. Findings from mediation analyses showed that neither the index of overall psychological well-being nor any individual psychological well-being related measures explained (mediated) why obesity increased the risk of developing NCDs in both studies. CONCLUSION: Obesity and psychological well-being may independently and additively increase the risk of developing NCDs.

Changes in the prevalence of perceived discrimination and associations with probable mental health problems in the UK from 2015 to 2020: A repeated cross-sectional analysis of the UK Household Longitudinal Study.

Background: Significant social and political changes occurred in the UK between 2015 and 2020. Few studies have examined population level trends in experiencing discrimination and mental health problems during this period. Aims: To determine prevalence trends in perceived discrimination and probable mental health problems amongst UK adults during 2015-2020. Method: Repeated cross-sectional data from the UK Household Longitudinal Study was used to estimate nationally representative trends in perceived discrimination and probable mental health problems (GHQ-12; 4+ threshold) among adults between 2015/2016-2019/2020 (25,756 observations). Weighted logistic regression models with post-estimation margins commands determined changes between survey waves controlling for sociodemographic characteristics. Mediation models explored whether changes in perceived discrimination prevalence trends explained trends in probable mental health problems. Results: From 2015/2016 to 2019/2020 perceived discrimination and probable mental health problems increased significantly by 6·1% (95% CI: 3·4-8·8, p <·001) and 4·5% (95% CI: 1·3-7·7, p = ·006), respectively. These changes did not tend to reliably differ by sociodemographic grouping. Increased prevalence of probable mental health problems from 2015/2016 to 2019/2020 was partially explained (15·2% of association mediated) by the increase in perceived discrimination observed during the same time period. Conclusions: Amongst UK adults, the prevalence of perceived discrimination and probable mental health problems increased between 2015/2016 to 2019/2020. Increases in perceived discrimination partially explained increases in probable mental health problems. National measures designed to reduce both discrimination and mental health problems have potential to make substantial improvements to public health and should be prioritised in the UK.

Financial-related discrimination and socioeconomic inequalities in psychological well-being related measures: a longitudinal study.

BACKGROUND: This study examined the prospective association between financial-related discrimination and psychological well-being related measures and assessed the role of financial-related discrimination in explaining socioeconomic inequalities in psychological well-being related measures. METHODS: Data of UK older adults (≥ 50 years) from the English Longitudinal Study of Ageing were used (baseline: Wave 5, 2010/2011; n = 8,988). The baseline total non-pension wealth (in tertiles: poorest, middle, richest) was used as a socioeconomic status (SES) measure. Financial-related discrimination at baseline was defined as participants who reported they had been discriminated against due to their financial status. Five psychological well-being related measures (depressive symptoms, enjoyment of life, eudemonic well-being, life satisfaction and loneliness) were examined prospectively across different follow-up periods (Waves 6, 2012/2013, 2-year follow-up; and 7, 2014/2015, 4-year follow-up). Regression models assessed associations between wealth, financial-related discrimination, and follow-up psychological measures, controlling for sociodemographic covariates and baseline psychological measures (for longitudinal associations). Mediation analysis informed how much (%) the association between wealth and psychological well-being related measures was explained by financial-related discrimination. RESULTS: Participants from the poorest, but not middle, (vs. richest) wealth groups were more likely to experience financial-related discrimination (OR = 1.97; 95%CI = 1.49, 2.59). The poorest (vs. richest) wealth was also longitudinally associated with increased depressive symptoms and decreased enjoyment of life, eudemonic well-being and life satisfaction in both 2-year and 4-year follow-ups, and increased loneliness at 4-year follow-up. Experiencing financial-related discrimination was longitudinally associated with greater depressive symptoms and loneliness, and lower enjoyment of life across follow-up periods. Findings from mediation analysis indicated that financial-related discrimination explained 3-8% of the longitudinal associations between wealth (poorest vs. richest) and psychological well-being related measures. CONCLUSIONS: Financial-related discrimination is associated with worse psychological well-being and explains a small proportion of socioeconomic inequalities in psychological well-being.

Neighbourhood characteristics and socioeconomic inequalities in child mental health: Cross-sectional and longitudinal findings from the Growing Up in Ireland study.

This study examined the role of neighbourhood characteristics in explaining socioeconomic inequalities in child mental health (the total difficulties score from the Strengths and Difficulties Questionnaire) using data from Cohort '08 of Growing Up in Ireland Waves 3 (age 5; baseline) and 5 (age 9; follow-up). Twenty neighbourhood items were grouped into neighbourhood safety, built environments, cohesion, interaction, and disorder. Data were analysed using regression, single and multiple mediation, and network psychometric analyses. We found that neighbourhood safety, cohesion, interaction, and disorder were associated with child mental health. These four domains separately (by up to 18 %) or in concert (by up to 23 %) partially explained socioeconomic inequalities in child mental health. Built environments may explain socioeconomic inequalities in mental health in urban children only. Findings from network analysis indicated that specific concerns over "people being drunk or taking drugs in public" and "this is a safe neighbourhood" had the strongest connections with child mental health. Improving neighbourhood characteristics may be important to reduce socioeconomic inequalities in child mental health in Ireland.

The psychological legacy of past obesity and early mortality: evidence from two longitudinal studies.

BACKGROUND: We test a novel 'weight scarring' hypothesis which suggests that past obesity is associated with impairments in current psychological well-being and this increases risk of negative physical health outcomes associated with obesity. Across two nationally representative studies, we tested whether past obesity is associated with current psychological outcomes and whether these psychological outcomes explain the association between past obesity and subsequent early mortality. METHODS: Data were from the National Health and Nutrition Examination Survey (NHANES) (n = 29,047) and the Health and Retirement Study (HRS) (n = 11,998). Past obesity was defined based on maximum lifetime weight in NHANES and the highest weight from past study waves in the HRS. Across both studies, current depressive symptoms were analysed. A set of 10 additional well-being measures were combined to produce an 'index of impaired well-being' in HRS. Subsequent all-cause mortality was examined using National Deaths Index records in NHANES and household interviews in HRS. Linear or logistic regression, Cox proportional hazard regression, and causal mediation models were used. RESULTS: We found that past obesity was associated with greater current depressive symptoms after controlling for current weight status and in analyses limited to those who were no longer classified as having obesity in NHANES (ß = 0.17; 95% CI: 0.13, 0.22) and HRS (ß = 0.20; 95% CI: 0.08, 0.31). In HRS, past obesity was also associated with a range of current negative psychological outcomes, including an index of impaired psychological well-being (ß = 0.16; 95% CI: 0.05, 0.27). Past obesity was associated with a higher risk of early mortality in both NHANES and HRS (HR = 1.31; 95% CI: 1.16, 1.48 and HR = 1.34; 95% CI: 1.20, 1.50, respectively). Depressive symptoms explained 6% (95% CI: 0.01, 0.10) and 5% (95% CI: 0.01, 0.09) of the association between past obesity and premature mortality in NHANES and HRS, respectively. Impaired psychological well-being partly mediated the association between past obesity and premature mortality by 10% (95% CI: 0.04, 0.16) in HRS. CONCLUSIONS: Our findings suggest that there may be a psychological legacy of past obesity that is associated with raised mortality risk. Ensuring people with obesity receive psychological support even after experiencing weight loss may be important.

Acceptability and perceived harm of calorie labeling and other obesity policies: A cross-sectional survey study of UK adults with eating disorders and other mental health conditions.

OBJECTIVE: We assessed perceptions of recently proposed UK obesity policies (mandatory calorie labeling, banning of advertisements of unhealthy food and drinks online and before 9 pm on TV, and banning "buy one get one free" deals for unhealthy food and drinks) in people with an eating disorder (ED) and other mental health conditions. METHOD: A total of 1273 participants with a self-reported lifetime mental health condition (N = 583 with an ED) completed an online survey in September-November 2022. Multinomial logistic regression was used to examine support for and potential adverse effects of policies in participants with and without an ED. A qualitative analysis of the potential effects of the policy on current ED symptoms was also conducted to better understand how and why policies may be damaging or beneficial. RESULTS: Participants with an ED had a lower level of support for the implementation of the calorie labeling policy compared to those without an ED (43% vs. 58%). Half of the participants with an ED (55%) reported that labeling may worsen their ED symptoms. Qualitative data indicated perceived potential harm (e.g., a gateway to relapse, negative effects on mood) and perceived benefits (e.g., feeling informed and reassured) of calorie labeling in participants with an ED. No differences in support or perceived harms of the other two policies were observed between participants with versus without an ED. DISCUSSION: Future studies are warranted to explore the potential effects of calorie labeling and how to mitigate negative impacts on people with an ED. PUBLIC SIGNIFICANCE: This research is the first to assess the perceptions of UK obesity-related policies in people with an ED and other mental health conditions. Participants with an ED (vs. without) were more likely to disagree with the government implementing the calorie labeling policy. These findings highlight the potentially harmful effects of calorie labeling in people with an ED and the need for future research to understand how to mitigate negative impacts.

Psychological pathways explaining the prospective association between obesity and physiological dysregulation.

OBJECTIVE: Obesity is associated with a range of negative psychological conditions that may also affect physiological health. Across two studies, we tested whether a range of psychological measures explain why obesity is prospectively associated with physiological dysregulation, measured via clinical indicators of cardiovascular, immune system, and metabolic function. METHOD: We used comparable 4-year follow-up representative longitudinal data of U.K. and U.S. older adults (≥50 years) from the English Longitudinal Study of Ageing (2008/2009-2012/2013; Study 1; n = 6,250) and the Health and Retirement Study (2008/2010-2012/2014; Study 2; n = 9,664). A diverse range of psychological measures (e.g., depressive symptoms, life satisfaction, weight stigma, positive affect) were tested as candidate mediators in Studies 1 (n = 14) and 2 (n = 21). RESULTS: Obesity predicted physiological dysregulation at follow-up across both studies. In Study 1, only weight stigma (measured between baseline and follow-up) explained 37% of the association between obesity and physiological dysregulation. In Study 2, only changes in weight stigma from baseline to follow-up (not baseline weight stigma) explained 13% of the effect of obesity on future physiological dysregulation. Mediation by weight stigma in both studies was partially attenuated when changes in body mass index from baseline to follow-up were controlled for. No other psychological measures explained the association between obesity and physiological dysregulation in either study. CONCLUSIONS: The prospective association between obesity and physiological dysregulation was largely not explained by psychological factors. However, experiencing weight stigma is associated with increased weight gain and this process may explain obesity-related declines in physiological health. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Prevalence of perceived discrimination and associations with mental health inequalities in the UK during 2019-2020: A cross-sectional study.

Experiencing discrimination is associated with poorer mental health and the demographic patterning of discrimination may explain social inequalities in mental health. The present research examined prevalence of perceived discrimination in the UK and associations with social inequalities in mental health. Data were taken from the UK Household Longitudinal Study (n = 32,003). Population subgroups (sex, age, ethnicity, health, religiousness, income, education, and occupation), perceived personal discrimination (personal experience) and perceived belonging to a discriminated group (identified as belonging to a group discriminated against in this country), and probable mental health problems (GHQ-12 assessed, cut off 4+) were reported on in 2019/2020. Nineteen percent of participants perceived personal discrimination in the last year, 9% perceived belonging to a discriminated group, and 22% had probable mental health problems. There were significant inequalities in both perceived discrimination and mental health. Being a younger adult, of mixed ethnicity, having health problems, having a university degree, and being unemployed increased risk of mental health problems and these associations were partially explained by perceived discrimination being more common among these groups. Perceived discrimination is common among UK adults, but prevalence differs by population subgroup. Perceived discrimination may contribute to social inequalities in mental health.

Gender differences in social environmental factors of psychological distress among Indonesian adolescents: Findings from the 2015 Global School-based Student Health Survey.

BACKGROUND: This study aimed to investigate gender differences in social environmental factors of psychological distress among Indonesian adolescents. METHODS: This was a cross-sectional study using the data from the 2015 Indonesia Global School-based Student Health Survey. Binary logistic regression was used to assess the influences of main independent variables - social environmental factors (i.e., peer support, having close friends, bullying victimisation, physical fight, physical attack, parental supervision, connectedness, bonding), demographic characteristics, and health-related behaviours on the measures of psychological distress (loneliness, anxiety-induced sleep disturbance, and a combination of both measures as psychological distress). RESULTS: The prevalence of psychological distress measured as loneliness, anxiety-induced sleep disturbance, and combined psychological distress was 6.12%, 4.52%, and 8.04%, respectively. Findings from multivariate analyses indicated that bullying victimisation, physical attack, experience of hunger (a proxy of socioeconomic status), and sedentary behaviour were associated with all measures of psychological distress. Meanwhile, age, gender, drug use, parental connectedness and bonding, and having no close friends were correlates of one or two measures of psychological distress. Based on gender-stratified analyses, experience of hunger, sedentary behaviour, bullying victimisation, and having no close friends were consistently associated with measures of psychological distress among both girls and boys. In addition, the influence of some social environmental factors, such as parental connectedness, peer support, and physical attack, were more salient among girls. CONCLUSIONS: The findings suggest that social environmental factors, demographic characteristics, and health-related behaviours were associated with psychological distress, and the associations appeared to differ by gender. Interventions that include improving positive social environmental factors (e.g., reducing interpersonal violence, encouraging positive relationships with parents and peers) and promoting healthy behaviours (e.g., less sedentary behaviour, preventing substance use) might help reduce the risk of psychological distress among Indonesian adolescents.

Factors Associated with Caregiver Burden in Caregivers of Older Patients with Dementia in Indonesia.

This cross-sectional study aimed to identify caregiver burden and its determinants in the informal caregivers of older patients with dementia (PWDs) aged ≥ 60 years in Java, Indonesia. Data were collected from 207 caregivers of older PWDs using self-administered questionnaires. The dependent variable was caregiver subjective burden, assessed using the Zarit Burden Interview (ZBI). The independent variables included the socio-demographic characteristics of PWDs and caregivers, the caregiver's perceived social support, and the behavioural and psychological symptoms of dementia (BPSD). Linear regression with a stepwise elimination method was used to identify the factors associated with caregiver burden. This study found that four factors were associated with the caregiver burden, such as the gender of PWDs, the educational level of caregivers, social support, and BPSD (R-squared = 27.78%). Higher burden was reported among the caregivers of female PWDs (ß = 5.58; 95%CI = 2.16; 8.99) and PWDs with higher scores of BPSD (ß = 0.34; 95%CI = 0.25; 0.43). Meanwhile, the caregivers with higher perceived social support (ß = -0.26; 95%CI = -0.42; -0.10) and who completed high school education and above (ß = -6.41; 95%CI = -10.07; -2.74) tended to have lower scores of subjective burden. These findings suggest that BPSD management and maintaining the resources of support may provide an opportunity to minimise caregiver burden and improve the quality of life of caregivers and PWDs.

Green space and loneliness: A systematic review with theoretical and methodological guidance for future research.

Persistent loneliness troubles people across the life span, with prevalence as high as 61 % in some groups. Urban greening may help to reduce the population health impacts of loneliness and its concomitants, such as hopelessness and despair. However, the literature lacks both a critical appraisal of extant evidence and a conceptual model to explain how green space would work as a structural intervention. Both are needed to guide decision making and further research. We conducted a systematic review of quantitative studies testing associations between green space and loneliness, searching seven databases. Twenty two studies were identified by 25/01/2022. Most of the studies were conducted in high-income countries and fifteen (68 %) had cross-sectional designs. Green space was measured inconsistently using either objective or subjective indicators. Few studies examined specific green space types or qualities. The majority of studies measured general loneliness (e.g. using the UCLA loneliness scale). Different types of loneliness (social, emotional, existential) were not analysed. Of 132 associations, 88 (66.6 %) indicated potential protection from green space against loneliness, with 44 (33.3 %) reaching statistical significance (p < 0.05). We integrated these findings with evidence from qualitative studies to elaborate and extend the existing pathway domain model linking green space and health. These elaborations and extensions acknowledge the following: (a) different types of green space have implications for different types of loneliness; (b) multilevel circumstances influence the likelihood a person will benefit or suffer harm from green space; (c) personal, relational, and collective processes operate within different domains of pathways linking green space with loneliness and its concomitants; (d) loneliness and its concomitants are explicitly positioned as mediators within the broader causal system that links green space with health and wellbeing. This review and model provide guidance for decision making and further epidemiological research on green space and loneliness.

Association between built environments and weight status: evidence from longitudinal data of 9589 Australian children.

BACKGROUND: No studies appear to examine potential associations between changes in built environments across childhood and the developmental trajectories of child weight status. OBJECTIVE: Examine the developmental trajectories of child weight status with respect to changes in childhood exposure to the built environments. METHODS: This study used data of 9589 children with biennial follow-up (2004-2016), retrieved from the Longitudinal Study of Australian Children. Changes in objectively-measured child weight status (i.e., body mass index-BMI, waist circumference) were investigated in relation to changes in seven built environments (i.e., neighbourhood safety; green space quality; footpaths and street conditions; public transport; shopping facilities; basic services; and local traffic) subjectively reported by caregivers. Group-based discrete trajectory mixture models were used to classify children according to their developmental trajectories of built environments and weight status. Multilevel multinomial logistic regression was employed to examine associations between built environments and child weight status adjusted for confounding. RESULTS: Two, four, and six trajectory groups were developed for built environment variables. Three groups namely "moderate", "high", and "extreme increase" were generated for each BMI and waist circumference. Findings from multilevel analyses indicated that growing up in neighbourhoods that are considered highly safe, with better quality of green space nearby, and in areas with low local traffic over time are protective against unhealthy weight increase in childhood. Meanwhile, living with better access to shopping facilities and basic services was associated with an unhealthy increase in BMI and/or waist circumference. No clear associations appeared between the quality of footpath and street conditions, access to public transport, and child weight status. CONCLUSIONS: Built environments might act either as a risk or protective factor of an unhealthy increase in child weight status. Enabling health-promoting neighbourhoods (i.e., highly safe, quality green space nearby, low local traffic) is important to support a healthy weight trajectory across childhood.

Perceived green space quality, child biomarkers and health-related outcomes: A longitudinal study.

Accumulating exposure to quality green space over time is posited to influence child health, yet longitudinal studies are scarce. This study aimed to examine the associations between trajectories of perceived green space quality and child health-related outcomes. We used data from 1874 childrenin the B-cohort of the Longitudinal Study of Australian Children who participated in the Child Health Checkpoint module at 11-12 years. Data on caregiver perceived green space quality measured biennially was assessed using discrete trajectory mixture models to group children by contrasting distributions in green space quality over time. Examination of associations between trajectory groups of perceived green space quality and child biomarkers (i.e., albumin-to-creatinine ratio, total, cholesterol, total triglycerides, and glucose), physical health and behavioural assessments (i.e., anthropometric measurements, blood pressure, sedentary behaviour, physical activity, sleep, aerobic work capacity, and general wellbeing), and health care use were assessed using multilevel models, adjusted for sociodemographic variables. Four perceived green space quality trajectories were identified: "decreasing quality from high to moderate"; "increasing quality from low to high"; "consistently high quality"; "consistently low quality". Compared with consistently low levels of quality green space, adjusted models indicated consistently high-quality green space was associated with lower total triglycerides (ß -0.13; 95%CI -0.25, -0.01). Lower odds of hospital admission was observed among children who accumulated quality green space over time (OR 0.45; 95%CI 0.23, 0.87). These associations were observed in boys only in sex-stratified analyses. Moreover, boys accumulating quality green space through time tended to have lower diastolic blood pressure (ß -2.76; 95%CI -5.17, -0.35) and girls who experienced loss in quality green space tended to have a higher percentage of body fat (ß 2.81; 95%CI 0.43, 5.20). Accumulating quality green space over time is important for various aspects of child health, with contrasting benefits by sex.

Caregiver perceptions of neighbourhood green space quality, heavy traffic conditions, and asthma symptoms: Group-based trajectory modelling and multilevel longitudinal analysis of 9,589 Australian children.

BACKGROUND: This study assessed the associations between changes in exposure to green space quality, heavy traffic conditions, and asthma symptoms among children. METHODS: 10-year cohort data of 9589 children, retrieved from the Longitudinal Study of Australian Children, were analysed. Caregiver-reported neighbourhood green space quality, heavy traffic conditions, and asthma symptoms were measured biennially. Group-based trajectory mixture models were used to develop trajectory groups, denoting different patterns of, or changes in, exposure to green space quality, heavy traffic conditions, and asthma symptoms across childhood. Multilevel multinomial logistic regression was used to identify factors associated with trajectory group membership and examine the confounders-adjusted associations between trajectory groups of green space quality, heavy traffic conditions, and asthma symptoms. RESULTS: Four trajectory groups for each green space quality and heavy traffic conditions, and five trajectory groups for asthma symptoms were developed. Children in less disadvantaged areas were more likely to be in trajectory groups with exposure to quality green space, but less likely to be exposed to heavy neighbourhood traffic. Living in more remote areas was associated with the decreased likelihood to be in groups with exposure to both quality green space and heavy traffic conditions over time. Accumulation of exposure to quality green space across childhood was not found to be protective against asthma symptoms. However, children whose caregiver perceptions of heavy traffic conditions trended from low to moderate levels; or were consistently in high levels across childhood had a higher likelihood to be in trajectory groups with a higher risk of asthma symptoms. CONCLUSION: Exposure to quality green space was not associated with the reduced risk of asthma symptoms. The accumulation of exposure to heavy traffic conditions increased the likelihood of asthma symptoms among children. Reducing the presence of heavy traffic in neighbourhoods might reduce the risk of childhood asthma.

Is prosocial behaviour a missing link between green space quality and child health-related outcomes?

BACKGROUND: This study aimed to investigate prosocial behaviour-those behaviours that benefit others or enhance relationships with others-as a mediator of the associations between green space quality and child health-related outcomes (physical activity, mental health, and health-related quality of life (HRQOL)). METHODS: This study involved data from 4983 children with 10-year follow-up (2004-2014) retrieved from the Longitudinal Study of Australian Children. Green space quality (the exposure), prosocial behaviour (the candidate mediator), and child health-related outcomes were assessed biennially based on caregiver reports. Causal mediation analysis was used, with four mediation models developed for each outcome. RESULTS: Mediation by prosocial behaviour appeared in the late childhood mediation model with higher mediation proportions reported compared to models of earlier and middle childhood. Prosocial behaviour had moderate mediation consistency for the association between green space quality and physical activity enjoyment, but no mediation was evident for other physical activity variables. Prosocial behaviour had low mediation consistency for child mental health (internalising and externalising subscales). Similarly, low mediation consistency of prosocial behaviour was also evident for all HRQOL variables, such as physical, emotional, social, school functioning, psychosocial health, and total quality of life (QOL). CONCLUSION: Prosocial behaviour partially mediated the association between green space quality and child health-related outcomes (physical activity enjoyment, mental health, and HRQOL). Improving the quality of neighbourhood green space that supports the development of prosocial behaviour may result in better child health-related outcomes. Other physical activity variables might not specifically relate to social interactions, and therefore, no mediation by prosocial behaviour was apparent.

Association between green space quality and prosocial behaviour: A 10-year multilevel longitudinal analysis of Australian children.

BACKGROUND: Current evidence from studies on green space and child prosocial behaviour suggests a paucity of studies investigating the plausible role of green space quality in shaping the development of prosocial behaviour. This study aimed to examine longitudinal association between green space quality and prosocial behaviour among children. METHODS: We analysed 10-year longitudinal data (2004-2014) from the Longitudinal Study of Australian Children (LSAC), a nationally representative cohort study. Prosocial behaviour that covers positive behaviours (e.g. sharing, helping) was measured using a prosocial scale from Goodman's Strengths and Difficulties Questionnaire (SDQ). Parents' perceptions on the availability of "good" parks, playgrounds, and play space in the neighbourhood assessed green space quality. Multilevel linear regression models were used to examine potential changes in prosocial behaviour across childhood in relation to green space quality. A two-way interaction term between green space and age was fitted to assess potential differences in the effect of green space quality by age. Sensitivity analyses by child's sex and history of residential movement were also performed. RESULTS: From the analysis of 24,418 observations nested in 4969 children, prosocial behaviour was relatively high (mean = 8.13 out of 10; SD = 1.79) and about balanced proportions between girls (48.74%) and boys (51.26%) were included. Prosocial behaviour was higher among children whose parents agreed (ß = 0.10; 95%CI = 0.04, 0.16) and strongly agreed (ß = 0.20; 95%CI = 0.13, 0.27) to having quality green space in their neighbourhood. The benefit of exposure to favourable green space on prosocial behaviour was similar among both children who changed and did not change neighbourhood, but reported higher among boys than girls. Younger compared with older children or adolescents tended to benefit more by the presence of quality green space. CONCLUSION: Green space quality was positively associated with child prosocial behaviour. Boys and younger children tended to benefit more from quality green space. Future research might seek to identify preferred characteristics of quality green spaces, and to understand how these preferences vary by gender and age, to best support the development of prosocial behaviour across childhood and adolescence.

The roles of women empowerment on attitude for safer sex negotiation among Indonesian married women.

The situation of low women empowerment in household settings might influence women's attitude and ability to negotiate for protected sex in their marital relationship. This study aimed to investigate the association between women empowerment factors and the attitude for safer sex negotiation among Indonesian married women. The secondary data of 28,934 individual records of married women retrieved from the 2017 Indonesia Demographic and Health Survey (IDHS) was used. The dependent variable was the attitude for safer sex negotiation measured by women's acceptance toward a justification to ask her husband to use a condom if her husband has a sexually transmitted disease. Multivariate logistic regression analysis accounting for the complex survey design was performed. The results showed that women empowerment factors, that include higher level of education and participation in household decision-making had a positive effect on women's attitude for protected sex. Those women with higher levels of HIV knowledge and whoever talked about HIV with their husbands were also more likely to justify for protected sex. Therefore, women empowerment through education, improving socioeconomic conditions, and increasing HIV-related knowledge can help develop a positive attitude and enable women to negotiate for safer sex with their partners.

The Relationship Between Green Space and Prosocial Behaviour Among Children and Adolescents: A Systematic Review.

The plausible role of nearby green space in influencing prosocial behaviour among children and adolescents has been studied recently. However, no review has been conducted of the evidence testing the association between green space and prosocial behaviour. This systematic review addresses this gap among children and adolescents. Within this review, we propose a conceptual framework describing potential pathways linking green space to prosocial behaviour, discuss the direction, magnitude, moderators, and mediators of the association, and develop a narrative synthesis of future study directions. Out of 63 extracted associations from 15 studies, 44 were in the positive or expected direction, of which 18 were reported to be statistically significant (p < 0.05). Overall, the current evidence shows that exposure to green space may potentially increase prosocial behaviour among children and adolescents, with some contingencies (e.g., child's sex and ethnic background). However, the volume and quality of this evidence is not yet sufficient to draw conclusions on causality. Further, heterogeneity in the indicators of green space exposure could lead to mixed findings. In addition, none of the included studies investigated potential mediators. Nevertheless, this review provides preliminary evidence and a basis for further investigation with rigorous study methodology capable of drawing causal inferences and testing potential effect modifiers, linking pathways, and relevant green space measures.

Psychological factors associated with protected sex among indirect female sex workers in Denpasar, Bali, Indonesia.

A cross-sectional study was conducted among indirect FSWs (a type of FSWs who provide sex services under the cover of entertainment or recreational enterprises) in Denpasar, Bali from August to October 2017 to investigate factors associated with protected sex with clients using the Health Belief Model (HBM) framework. The protected sex as a dependent variable was identified through self-reported consistency in using condoms with clients in the last month. Independent variables consisted of six HBM constructs and three main groups of modifying factors (personal, sex work, and interventional factors). Binary logistic regression was employed to identify the determinants. The prevalence of protected sex with clients in last month was 50.17% (95%CI = 41.50-80.83). Indirect FSWs were more likely to use condoms consistently if they completed senior high school or higher. Meanwhile, those working in a karaoke lounge, bar, or café were less likely to have protected sex than those in a massage parlour, spa, or beauty salon. Based on HBM, an increase of one-score of these following constructs increased likelihood of protected sex: perceived susceptibility, self-efficacy, and cues to action. Low protected sex among indirect FSWs indicates the need for public health interventions at individual, interpersonal, and institutional level.