Intimate partner violence, depression, and chronic low-grade inflammation among middle-aged women in Cebu, Philippines.

OBJECTIVES: Recent discussions in human biology have highlighted how local ecological contexts shape the relationship between social stressors and health across populations. Chronic low-grade inflammation has been proposed as a pathway linking social stressors to health, with evidence concentrated in high-income Western contexts. However, it remains unclear whether this is an important pathway in populations where prevalence is lower due to lower adiposity and greater infectious exposures. To investigate this further, we tested associations between multiple types of intimate partner violence (IPV), a highly prevalent stressor and health crisis globally, and C-reactive protein (CRP), a commonly used measure of chronic low-grade inflammation, in Cebu, Philippines. For reference, we compared results for CRP to depression, a well-established and consistently observed health outcome of IPV. METHODS: Data came from 1601 currently partnered women (ages 35-69 years) as part of the Cebu Longitudinal Health and Nutrition Survey. IPV exposures included physical, emotional, and controlling behavior. Depression scores were measured using a modified version of the Center for Epidemiologic Studies-Depression Scale for this population, whereas plasma CRP was measured from overnight-fasted morning blood samples. RESULTS: All three types of IPV were associated with a higher depression score. However, none of the IPV measures were associated with CRP. In a post hoc interaction test, emotional IPV became positively associated with CRP as waist circumference increased above the mean. CONCLUSIONS: Our results suggest a complex relationship between social stressors and chronic low-grade inflammation, which is likely dependent on the population-specific context of lifestyle and environmental factors.

Structural racism in school contexts and adolescent depression: Development of new indices for the National Longitudinal Study of Adolescent to Adult Health and beyond.

Racial discrimination is an important predictor of racial inequities in mental and physical health. Scholars have made progress conceptualizing and measuring structural forms of racism, yet, little work has focused on measuring structural racism in social contexts, which are especially relevant for studying the life course consequences of racism for health. Using the National Longitudinal Study of Adolescent to Adult Health, we take a biosocial, life course approach and develop two life stage-specific indices measuring manifestations of structural racism in school contexts in adolescence, a sensitive period of development. The first is a school contextual disadvantage index (CDI), which captures differences in resources and opportunities across schools that have been partly determined by socio-historic structural racism that has sorted Black students into more disadvantaged schools. The second is a school structural racism index (SRI), which measures differences in resources and opportunities between Black and white students within schools. Then, we relate these indices to adolescent depressive symptoms. We find that among both Black and white students of both genders, higher CDI levels are associated with more depressive symptoms. However, Black students are twice as likely to be in schools with a CDI above the median compared to white students. We also find that, controlling for the CDI, the SRI is positively associated with depressive symptoms among Black boys and girls only. Finally, the CDI and the SRI interact to produce a pattern where the likelihood of depressive symptoms increases as the SRI increases, but only among Black boys and girls in low-disadvantage schools. These findings underscore the importance of measuring structural racism in social contexts in multifaceted ways to study life course health inequities.

Using phenome-wide association studies and the SF-12 quality of life metric to identify profound consequences of adverse childhood experiences on adult mental and physical health in a Northern Nevadan population.

In this research, we examine and identify the implications of Adverse Childhood Experiences (ACEs) on a range of health outcomes, with particular focus on a number of mental health disorders. Many previous studies observed that traumatic childhood events are linked to long-term adult diseases using the standard Adverse Childhood Experience Questionnaire. The study cohort was derived from the Healthy Nevada Project, a volunteer-based population health study in which each adult participant is invited to take a retrospective questionnaire that includes the Adverse Childhood Experience Questionnaire, the 12-item Short Form Survey measuring quality of life, and self-reported incidence of nine mental disorders. Using participant's cross-referenced electronic health records, a phenome-wide association analysis of 1,703 phenotypes and the incidence of ACEs examined links between traumatic events in childhood and adult disease. These analyses showed that many mental disorders were significantly associated with ACEs in a dose-response manner. Similarly, a dose response between ACEs and obesity, chronic pain, migraine, and other physical phenotypes was identified. An examination of the prevalence of self-reported mental disorders and incidence of ACEs showed a positive relationship. Furthermore, participants with less adverse childhood events experienced a higher quality of life, both physically and mentally. The whole-phenotype approach confirms that ACEs are linked with many negative adult physical and mental health outcomes. With the nationwide prevalence of ACEs as high as 67%, these findings suggest a need for new public health resources: ACE-specific interventions and early childhood screenings.

Racial Inequities in Birth Weight by Maternal Age Among College-Educated Mothers: The Role of Early Disadvantage.

INTRODUCTION: Non-Hispanic Black infants experience disproportionately high risks of low birth weight compared with non-Hispanic White infants, particularly among mothers with high educational attainment and greater socioeconomic advantage. This study investigates how maternal early-life disadvantage contributes to ongoing racial birth weight inequities among U.S. college‒educated mothers, specifically declining birth weights with age among non-Hispanic Black mothers. METHODS: Study analyses used cohort data from the National Longitudinal Study of Adolescent to Adult Health. Racial inequities in birth weight by maternal age and early-life disadvantage were assessed using completed reproductive histories among college-educated mothers at ages 33-44 years collected in 2016‒2018 and regression-based marginal standardization techniques. Early-life disadvantage was measured using a study-based composite measure of early-life concentrated poverty and social disadvantage in homes, neighborhoods, and schools, collected in previous waves. Primary analyses were completed in 2020‒2021. RESULTS: Among non-Hispanic Black mothers who experienced high early-life disadvantage, a 1-year increase in maternal age at delivery was associated with lower birth weight by 26.07 g (95% CI= -48.74, -3.40). Similar declines were not found among non-Hispanic Black mothers with low early-life disadvantage. Non-Hispanic White mothers experienced increased birth weight with maternal age, 6.85 g (95% CI= -1.12, 14.82) per year, which did not significantly vary by early-life disadvantage. CONCLUSIONS: Early-life disadvantage modifies whether and how college-educated mothers experience birth weight decline with older age. The effects of early-life contexts and embedded racial inequities on maternal health inequities and differential weathering warrant further public health attention.

Legal status as a life course determinant of health: parent status, adjudication stages, and HIV knowledge among highlanders in Thailand.

BACKGROUND: Rising nativism and political volatility worldwide threaten to undermine hard-won achievements in human rights and public health. Risks are particularly acute for hundreds of millions of migrants, minorities, and Indigenous peoples, who face disproportionately high health burdens, including HIV/AIDS, and precarious legal status (LS). While LS is receiving increasing attention as a social determinant of health and HIV, understandings are still limited to select immigrant communities. Its effects on health among stateless communities, particularly in the Global South, remain largely unknown. Moreover, widespread limitations in census measures of LS reduce its complexity to a simplistic citizen/non-citizen binary or insufficient proxies. Thailand's ethnolinguistically diverse highlander population experiences disproportionately high HIV prevalence and comprises one of the world's largest and most protracted cases of statelessness, an acute condition of precarious LS. As such, analysis of LS and health outcomes among highlanders is both critically warranted, and useful as a case study outside of the migration paradigm. METHODS: Drawing on the UNESCO Highland Peoples Survey II (2010), an unprecedented and unique cross-sectional census of highlanders in Thailand, we mobilize complex measures of LS in adjusted ordinal logistic regression models to assess how parent citizenship and LS adjudication over the early life course condition adult HIV knowledge-a key protective factor against transmission (n = 8079). RESULTS: Adjusted ordinal logistic regression on knowledge scores reveal that parent citizenship predicts odds of greater knowledge by 1.4- to 2.2-fold, depending on ethnic group. This is partially explained by divergent stages of LS adjudication between birth and adulthood, including successful birth registration and adult citizenship acquisition, along with secondary school completion. Precisely how these factors contribute to HIV knowledge varies by ethnic group. CONCLUSIONS: This study advances knowledge of LS outside of the migration paradigm, reveals heretofore unexamined connections between LS and access to public health information, and elucidates how instabilities in LS adjudication stages underlie health inequalities over the life course. Findings indicate that securing success in public health and human rights agendas requires attention to how states adjudicate and deploy LS in multiple stages across the life course to structure access and exclusion among migrant and non-migrant communities alike.

Body mass and the epidemic of chronic inflammation in early mid-adulthood.

OBJECTIVES: Chronic inflammation is a potentially important mechanism through which social inequalities may contribute to health inequalities over the life course. Excess body fat contributes to chronic inflammation, and younger adults in the US have come of age during a pronounced secular increase in body mass index (BMI). We aim to document levels of chronic inflammation in a nationally representative sample of 33-to-44 year-old adults in the US, and to describe associations with BMI, race/ethnicity, and education. METHODS: High sensitivity C-reactive protein (CRP) was measured in Wave V (2016-18) of the National Longitudinal Study of Adolescent to Adult Health, with complete data available for 4349 participants. Sex-stratified weighted regression models were implemented to investigate CRP in association with education, race/ethnicity, and BMI. RESULTS: Geometric mean CRP was 1.9 mg/L, and 35.4% of the sample had CRP >3 mg/L. Females had significantly higher CRP than males. Body mass index was a strong positive predictor of CRP, and education level was negatively associated with CRP. Associations between education and CRP were substantially attenuated after adjusting for BMI. High risk CRP increased linearly with BMI even among the obese: 87.0 percent of females and 74.1 percent of males with class 3 obesity (BMI ≥40) were predicted to have high risk CRP > 3 mg/L. CONCLUSIONS: The obesity epidemic is producing an epidemic of chronic inflammation in early mid-adulthood in the US. Strong associations between BMI and chronic inflammation portend high risk for future disease-and inequitable distribution of disease-as the cohort ages.

Reproductive health at conflict borders: a cross-sectional survey of human rights violations and perinatal outcomes at the Thai-Myanmar border.

BACKGROUND: Human rights violations (HRVs) are common in conflict and displacement contexts. Women are especially vulnerable to HRVs in these contexts, and perinatal health is acutely sensitive to related stressors and health care barriers. However, how HRVs affect immediate and long-term perinatal health in chronic displacement settings has not been closely investigated. Furthermore, it remains unclear whether and how HRVs in these contexts are tied directly to displacement circumstances or other marginalizing factors affecting local migrant and minority populations generally. METHODS: We investigated these questions using novel survey data from 577 women at the northern Thai-Myanmar border, where thousands of people have fled conflict in Shan State, Myanmar, for refuge in a range of precarious settings in Thailand, including unofficial refugee camps, villages, and worksites. We compared HRV exposures by ethnicity, country of birth, legal documentation, and residential setting. We then analyzed perinatal outcomes associated with HRV frequency, timing, and type. RESULTS: Birth in Myanmar, and ethnic minority and precarious legal status more broadly, predicted higher HRV prevalence. HRV frequency significantly predicted unmet antenatal care and lower birth weight, along with HRVs related to labor exploitation and violence or conflict. HRVs timed closer to pregnancies were more adversely associated with perinatal outcomes. Resource/property deprivation was the strongest predictor of pregnancy complications. CONCLUSIONS: Human rights must be urgently attended to, through expanded HRV screenings and responsive care, and policy changes to further protect migrant workers, displaced persons, and others in precarious legal status situations.

Early origins of socioeconomic inequalities in chronic inflammation: Evaluating the contributions of low birth weight and short breastfeeding.

The United States is characterized by persistent and widening social inequities in a wide range of adult health outcomes. A life course approach challenges us to consider if, and how, these inequities trace back to early life conditions, and chronic inflammation represents a potentially important mechanism through which early environments may have lasting effects on health in adulthood. Low birth weight (LBW) and shorter durations of breastfeeding both predict increased inflammation in adulthood, which is associated with increased risk for cardiovascular disease, metabolic syndrome, and all-cause mortality. Using data from a large representative sample of young adults in the US (National Longitudinal Study of Adolescent to Adult Health (Add Health)), we document the socioeconomic status (SES) gradient in chronic inflammation, as indicated by concentrations of C-reactive protein (CRP). Using a nested set of structural equation models and marginal standardization techniques, we investigate the extent to which this gradient is explained by patterns of LBW and breastfeeding in infancy. Findings reveal a particularly important role for breastfeeding duration: Based on model predictive margins, increasing breastfeeding duration to three or more months corresponds to a flattening of the SES gradient by 80%, and 83% when LBW is eliminated. This study expands current understandings of the consequential role of developmental environments for population health and for addressing health inequities in future generations.

Displacement contexts and violent landscapes: How conflict and displacement structure women's lives and ongoing threats at the Thai-Myanmar border.

Chronic conflict and displacement carry consequences for personal and social violence. How is violence embedded in displacement-related histories and ongoing circumstances? How might it underlie social and health inequities in host countries? For addressing these questions, I offer a new approach to conceptualizing and measuring displacement contexts and the structural violence embedded therein. I present the empirical case of the Thai-Myanmar border. Myanmar's civil conflict has fueled one of the largest and most chronically displaced populations globally. Thailand's border population has consequently grown with people displaced from the varied conflict-related circumstances within Myanmar. I administered a novel survey in two sub-districts along Thailand's northern border with Myanmar in 2016-17. With data from 520 respondents, I used clustering of life events and circumstances to uncover displacement-related contexts and violence. I uncovered livelihood- and security-based threat contexts, which disproportionately affected ethnic minority women. Among women from Myanmar, past military occupation and acute violence co-occurred with unexpectedly low perceived past oppression-indicative of covert everyday violence. In contrast, women who fled home destruction or deprivation, but often less overt military violence, were more likely to perceive oppression. Women born in Myanmar also experienced acute potential violence at the border, including severe livelihood and security threats. These threats were most prevalent among women that experienced the most forceful and abrupt displacement. This study uses a person-centered perspective to characterize and measure violence embedded in displacement, including the structural violence against women that is perpetuated across displacement contexts and embodied over time.

Stressor landscapes, birth weight, and prematurity at the intersection of race and income: Elucidating birth contexts through patterned life events.

Women of color and women in poverty experience disproportionately high rates of adverse birth outcomes in the United States (US). We use an intersectionality-based approach to examine how maternal life events (LE's) preceding childbirth are patterned and shape birth outcomes at the intersection of race and income. Using population data from the Pregnancy Risk Assessment Monitoring System we uncover common maternal LE clusters preceding births in 2011-2015, offering a description and measurement of what we call "stressor landscapes" that go beyond standard measures by frequency or type alone. Three landscapes emerge: (1) Protected, characterized by very few LE's; (2) Illness/Isolated, with very few LE's and most commonly involving an illness or death of someone close; and (3) Toxic/Cumulative, comprising more frequent and acute LE's. Mothers in the toxic landscape experience on average 107-g lighter birth weights and a 27%, 49%, and 57% greater risk of PTB, LBW, and VLBW, respectively, compared to in the protected landscape. Low-income and non-Hispanic black (NHB), Hispanic, American Indian (AI), and Alaska Native (AN) mothers are among the groups disproportionately exposed to toxic stressor landscapes. The association between landscape and birth outcomes additionally varies by race and income. Among non-Hispanic white mothers, toxic landscapes are linked to poor birth outcomes at lower incomes. Among NHB mothers, illness-related stressors are additionally linked to worse outcomes and stressor landscapes disproportionately harm middle-income mothers. Toxic stressors may contribute to worse outcomes among middle- and high-income Hispanic and AI/AN mothers, but these patterns are less clear. Our study offers a new approach to measuring LE's that match common conceptions of exposure clustering and applies it to US population data to reveal LE patterns underlying persistent social disparities in maternal and child health.

Moving Beyond Salmon Bias: Mexican Return Migration and Health Selection.

Despite having lower levels of education and limited access to health care services, Mexican immigrants report better health outcomes than U.S.-born individuals. Research suggests that the Mexican health advantage may be partially attributable to selective return migration among less healthy migrants-often referred to as "salmon bias." Our study takes advantage of a rare opportunity to observe the health status of Mexican-origin males as they cross the Mexican border. To assess whether unhealthy migrants are disproportionately represented among those who return, we use data from two California-based studies: the California Health Interview Survey; and the Migrante Study, a survey that samples Mexican migrants entering and leaving the United States through Tijuana. We pool these data sources to look for evidence of health-related return migration. Results provide mixed support for salmon bias. Although migrants who report health limitations and frequent stress are more likely to return, we find little evidence that chronic conditions and self-reported health are associated with higher probabilities of return. Results also provide some indication that limited health care access increases the likelihood of return among the least healthy. This study provides new theoretical considerations of return migration and further elucidates the relationship between health and migration decisions.