Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review.

BACKGROUND: Health literacy (HL) is the ability to make informed decisions using health information. As health data and information availability increase due to online clinic notes and patient portals, it is important to understand how HL relates to social determinants of health (SDoH) and the place of informatics in mitigating disparities. OBJECTIVE: This systematic literature review aims to examine the role of HL in interactions with SDoH and to identify feasible HL-based interventions that address low patient understanding of health information to improve clinic note-sharing efficacy. METHODS: The review examined 2 databases, Scopus and PubMed, for English-language articles relating to HL and SDoH. We conducted a quantitative analysis of study characteristics and qualitative synthesis to determine the roles of HL and interventions. RESULTS: The results (n=43) were analyzed quantitatively and qualitatively for study characteristics, the role of HL, and interventions. Most articles (n=23) noted that HL was a result of SDoH, but other articles noted that it could also be a mediator for SdoH (n=6) or a modifiable SdoH (n=14) itself. CONCLUSIONS: The multivariable nature of HL indicates that it could form the basis for many interventions to combat low patient understandability, including 4 interventions using informatics-based solutions. HL is a crucial, multidimensional skill in supporting patient understanding of health materials. Designing interventions aimed at improving HL or addressing poor HL in patients can help increase comprehension of health information, including the information contained in clinic notes shared with patients.

Educational Mobility, Pace of Aging, and Lifespan Among Participants in the Framingham Heart Study.

Importance: People who complete more education live longer lives with better health. New evidence suggests that these benefits operate through a slowed pace of biological aging. If so, measurements of the pace of biological aging could offer intermediate end points for studies of how interventions to promote education will affect healthy longevity. Objective: To test the hypothesis that upward educational mobility is associated with a slower pace of biological aging and increased longevity. Design, Setting, and Participants: This prospective cohort study analyzed data from 3 generations of participants in the Framingham Heart Study: (1) the original cohort, enrolled beginning in 1948; (2) the Offspring cohort, enrolled beginning in 1971; and (3) the Gen3 cohort, enrolled beginning in 2002. A 3-generation database was constructed to quantify intergenerational educational mobility. Mobility data were linked with blood DNA-methylation data collected from the Offspring cohort in 2005 to 2008 (n = 1652) and the Gen3 cohort in 2009 to 2011 (n = 1449). Follow-up is ongoing. Data analysis was conducted from June 2022 to November 2023 using data obtained from the National Institutes of Health database of Genotypes and Phenotypes (dbGaP). Exposure: Educational mobility was measured by comparing participants' educational outcomes with those of their parents. Main Outcomes and Measures: The pace of biological aging was measured from whole-blood DNA-methylation data using the DunedinPACE epigenetic clock. For comparison purposes, the analysis was repeated using 4 other epigenetic clocks. Survival follow-up was conducted through 2019. Results: This study analyzed data from 3101 participants from the Framingham Heart Study; 1652 were in the Offspring cohort (mean [SD] age, 65.57 [9.22] years; 764 [46.2%] male) and 1449 were in the Gen3 cohort (mean [SD] age, 45.38 [7.83] years; 691 [47.7%] male). Participants who were upwardly mobile in educational terms tended to have slower pace of aging in later life (r = -0.18 [95% CI, -0.23 to -0.13]; P < .001). This pattern of association was similar across generations and held in within-family sibling comparisons. There were 402 Offspring cohort participants who died over the follow-up period. Upward educational mobility was associated with lower mortality risk (hazard ratio, 0.89 [95% CI, 0.81 to 0.98]; P = .01). Slower pace of aging accounted for approximately half of this association. Conclusions and Relevance: This cohort study's findings support the hypothesis that interventions to promote educational attainment may slow the pace of biological aging and promote longevity. Epigenetic clocks have potential as near-term outcome measures of intervention effects on healthy aging. Experimental evidence is needed to confirm findings.

Is reproductive development adaptively calibrated to early experience? Evidence from a national sample of females.

Many developmental theories have not been sufficiently evaluated using designs that control for unobserved familial confounds. Our long-term goal is to determine the causal structure underlying associations between early environmental conditions and later psychosocial and health outcomes. Our overall objective in this study was to further evaluate predictions derived from applications of life history theory to female reproductive development, key among them that reproductive milestones translate early environmental risk into fertility, health, and behavioral outcomes. To this end, we used female data from the National Longitudinal Survey of Youth 1979 and structural equation modeling to conduct increasingly severe tests, beginning with covariate control and then progressing to sibling control and behavioral genetic designs. After adjusting for confounds varying between sets of siblings, we did not find evidence that age at menarche reflected components of early environment or that any focal outcomes reflected early fragmented family structure (birth to age nine). Although we detected no links between measured environment and individual differences in age at sexual debut, we did find that it reflected both shared and nonshared influences in our behavior genetic models. Interestingly, delayed sexual debut (into young adulthood) reflected identification of parents as the greatest influences and forecasted an array of fertility-related outcomes. Taken together, these findings challenge theories suggesting menarche timing is adaptively calibrated to early environment. They also highlight the need for more research using sibling control and related designs to examine the roles of environments in development. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Assessing the Readability of Online Patient Education Materials in Obstetrics and Gynecology Using Traditional Measures: Comparative Analysis and Limitations.

BACKGROUND: Patient education materials (PEMs) can be vital sources of information for the general population. However, despite American Medical Association (AMA) and National Institutes of Health (NIH) recommendations to make PEMs easier to read for patients with low health literacy, they often do not adhere to these recommendations. The readability of online PEMs in the obstetrics and gynecology (OB/GYN) field, in particular, has not been thoroughly investigated. OBJECTIVE: The study sampled online OB/GYN PEMs and aimed to examine (1) agreeability across traditional readability measures (TRMs), (2) adherence of online PEMs to AMA and NIH recommendations, and (3) whether the readability level of online PEMs varied by web-based source and medical topic. This study is not a scoping review, rather, it focused on scoring the readability of OB/GYN PEMs using the traditional measures to add empirical evidence to the literature. METHODS: A total of 1576 online OB/GYN PEMs were collected via 3 major search engines. In total 93 were excluded due to shorter content (less than 100 words), yielding 1483 PEMs for analysis. Each PEM was scored by 4 TRMs, including Flesch-Kincaid grade level, Gunning fog index, Simple Measure of Gobbledygook, and the Dale-Chall. The PEMs were categorized based on publication source and medical topic by 2 research team members. The readability scores of the categories were compared statistically. RESULTS: Results indicated that the 4 TRMs did not agree with each other, leading to the use of an averaged readability (composite) score for comparison. The composite scores across all online PEMs were not normally distributed and had a median at the 11th grade. Governmental PEMs were the easiest to read amongst source categorizations and PEMs about menstruation were the most difficult to read. However, the differences in the readability scores among the sources and the topics were small. CONCLUSIONS: This study found that online OB/GYN PEMs did not meet the AMA and NIH readability recommendations and would be difficult to read and comprehend for patients with low health literacy. Both findings connected well to the literature. This study highlights the need to improve the readability of OB/GYN PEMs to help patients make informed decisions. Research has been done to create more sophisticated readability measures for medical and health documents. Once validated, these tools need to be used by web-based content creators of health education materials.

Genetic associations with parental investment from conception to wealth inheritance in six cohorts.

Genetic inheritance is not the only way parents' genes may affect children. It is also possible that parents' genes are associated with investments into children's development. We examined evidence for links between parental genetics and parental investments, from the prenatal period through to adulthood, using data from six population-based cohorts in the UK, US and New Zealand, together totalling 36,566 parents. Our findings revealed associations between parental genetics-summarized in a genome-wide polygenic score-and parental behaviour across development, from smoking in pregnancy, breastfeeding in infancy, parenting in childhood and adolescence, to leaving a wealth inheritance to adult children. Effect sizes tended to be small at any given time point, ranging from RR = 1.12 (95% confidence interval (95%CI) 1.09, 1.15) to RR = 0.76 (95%CI 0.72, 0.80) during the prenatal period and infancy; ß = 0.07 (95%CI 0.04, 0.11) to ß = 0.29 (95%CI 0.27, 0.32) in childhood and adolescence, and RR = 1.04 (95%CI 1.01, 1.06) to RR = 1.11 (95%CI 1.07, 1.15) in adulthood. There was evidence for accumulating effects across development, ranging from ß = 0.15 (95%CI 0.11, 0.18) to ß = 0.23 (95%CI 0.16, 0.29) depending on cohort. Our findings are consistent with the interpretation that parents pass on advantages to offspring not only via direct genetic transmission or purely environmental paths, but also via genetic associations with parental investment from conception to wealth inheritance.

Testing Environmental Effects on Age at Menarche and Sexual Debut within a Genetically Informative Twin Design.

Life-history-derived models of female sexual development propose menarche timing as a key regulatory mechanism driving subsequent sexual behavior. The current research utilized a twin subsample of the National Longitudinal Study of Adolescent to Adult Health (Add Health; n = 514) to evaluate environmental effects on timings of menarche and sexual debut, as well as address potential confounding of these effects within a genetically informative design. Results show mixed support for each life history model and provide little evidence rearing environment is important in the etiology of individual differences in age at menarche. This research calls into question the underlying assumptions of life-history-derived models of sexual development and highlights the need for more behavior genetic research in this area.

Socioeconomic factors in the age-graded effect of incarceration on depressive symptoms in early adulthood.

Based on insights from the stress process and life-course paradigms, this study investigates the effect of incarceration on depressive symptoms during early adulthood (ages 18-40). We employed fixed-effects dynamic panel models that adjust for confounding effects due to unobserved time-invariant variables and reverse causality using data from the National Longitudinal Study of Adolescent to Adult Health (N = 11, 811). Our analysis shows that the effect of incarceration on depressive symptoms is greater when incarceration occurs after individuals have established a stable adult status (ages 32-40) as compared to incarceration that occurs at earlier stages of adulthood (ages 18-24 and ages 25-31). The age-graded effect of incarceration on depressive symptoms is partially attributable to time-varying effects of incarceration on socioeconomic factors, such as employment status and income. All these findings contribute to our understanding of the mental health consequences of incarceration.

Genetically Adjusted Propensity Score Matching: A Comparison to Discordant MZ Twin Models.

Discordant monozygotic (MZ) twin methodologies are considered one of the foremost statistical approaches for estimating the influence of environmental factors on phenotypic variance. Limitations associated with the discordant MZ twin approach generates an inability to estimate particular relationships and adjust estimates for the confounding influence of gene-nonshared environment interactions. Recent advancements in molecular genetics, however, can provide the opportunity to address these limitations. The current study reviews an alternative technique, genetically adjusted propensity scores (GAPS) matching, that integrates observed genetic and environmental information to adjust for the confounding of these factors in nonkin individuals. Simulations and a real data example were used to compare the GAPS matching approach to the discordant MZ twin method. Although the results of the simulated comparisons demonstrated that the discordant MZ twin approach remains the more robust statistical technique to adjust for shared environmental and genetic factors, GAPS matching - under certain conditions - could represent a viable alternative when MZ twin samples are unavailable. Overall, the findings suggest that GAPS matching can potentially provide an alternative to the discordant MZ twin approach when limited variation exists between identical twin pairs. Moreover, the ability to adjust for gene-nonshared environment interactions represents a potential advancement associated with the GAPS approach. The limitations of the approach, as well as polygenic risk scores, are also discussed.

Incarceration, polygenic risk, and depressive symptoms among males in late adulthood.

This study demonstrates how social and genetic factors jointly influence depression in late adulthood. We focus on the effect of incarceration, a major life event consistently found to be associated with mental health problems. Drawing on data from males in the Wisconsin Longitudinal Study and the Health and Retirement Study, we conduct a polygenic score analysis based on a genome-wide association study on depressive symptoms. Our analysis produces two important findings. First, incarceration experience mediates the association between the depression polygenic score and depressive symptoms in late adulthood (i.e., greater polygenic scores are associated with elevated incarceration risk, which increases depressive symptoms in late adulthood). Second, about one-fifth of the association between incarceration experience and late-adulthood depressive symptoms is accounted for by the depression polygenic score and childhood depression. These findings reveal complex biological and social mechanisms in the development of depression and, more broadly, provide important insights for causal inference in social science research.

Why are Women More Religious than Men? Do Risk Preferences and Genetic Risk Predispositions Explain the Gender Gap?

Risk preference theory argues that the gender gap in religiosity is caused by greater female risk aversion. Although widely debated, risk preference theory has been inadequately tested. Our study tests the theory directly with phenotypic and genetic risk preferences in three dimensions-general, impulsive, and sensation-seeking risk. Moreover, we examine whether the effect of different dimension of risk preference on the gender gap varies across different dimensions of religiosity. We find that general and impulsive risk preferences do not explain gender differences in religiosity, whereas sensation-seeking risk preference makes the gender gap in self-assessed religiousness and church attendance insignificant, but not belief in God, prayer, or importance of religion. Genetic risk preferences do not remove any of the gender gaps in religiosity, suggesting that the causal order is not from risk preference to religiosity. Evidence suggests that risk preferences are not a strong predictor for gender differences in religiosity.

The longitudinal associations between motivation, self-regulatory capacities, and future-oriented cognition and behavior among serious young offenders.

OBJECTIVES: The present study examined how changes in a set of motivational/self-regulatory factors were associated with subsequent change in future-oriented cognition and behavior. HYPOTHESES: We hypothesized that within-individual changes in aspirations, expectations, emotion regulation, resistance to peer influence, and impulse control would be positively associated with later change in future-oriented cognition and behavior. We also predicted that between-individual effects would be larger in magnitude than within-individual effects. METHOD: Serious young offenders (N = 1,318; M age = 16.04; 86% male) were followed over a 7-year period from adolescence to young adulthood during the Pathways to Desistance study. The analytical strategy incorporated both fixed and hybrid effects regression models to assess the time-ordered correlates of future-oriented cognition and behavior. RESULTS: Net of controls, within-individual changes in aspirations and expectations about the future, emotion regulation, and impulse control had statistically significant, positive associations with subsequent change in future-oriented cognition and behavior; however, between-person effects were much larger in magnitude than within-individual effects. CONCLUSIONS: Motivation and aspects of self-regulation are potentially important targets for correctional treatment and prevention efforts. Future orientation is an intermediate treatment mechanism worthy of further study. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Genetic architecture of socioeconomic outcomes: Educational attainment, occupational status, and wealth.

This study takes a socio-genomic approach to examine the complex relationships among three important socioeconomic outcomes: educational attainment, occupational status, and wealth. Using more than 8,000 genetic samples from the Health and Retirement study, it first estimates the collective influence of genetic variants across the whole human genome to each of the three socioeconomic outcomes. It then tests genetic correlations among three socioeconomic outcomes, and examines the extent to which genetic influences on occupational status and wealth are mediated by educational attainment. Analyses using the genomic-relatedness-matrix restricted maximum likelihood method show significant genetic correlations among the three outcomes, and provide evidence for both mediated and independent genetic influences. A polygenic score analysis demonstrates the utility of findings in socio-genomic studies to address genetic confounding in causal relationships among the three socioeconomic outcomes.

Every contact leaves a trace: contact with the criminal justice system, life outcomes, and the intersection with genetics.

Contact with the criminal justice (CJ) system is a relatively common occurrence in the United States. Criminologists and sociologists have long considered the impact of contact with the CJ system on later-in-life outcomes. This body of work has revealed a great deal of heterogeneity in life outcomes, suggesting individual differences are important to consider. At the same time, recent advances in the genomic sciences have allowed researchers to gather information from across the entire genome and to summarize that information into polygenic scores. In the present review, we consider how polygenic scores might be used to advance research into the impact of CJ system contact on life outcomes. In particular, we emphasize the importance of gene-environment interaction (G × E). We suggest that contact with the CJ system might represent a substantively important environmental moderator of polygenic risks. But we caution that studying the moderating role of contact with the CJ system will have its own complications-points that scholars must begin to consider and discuss now that the genomic era has reached the social sciences.

The Genome-Wide Study of Human Social Behavior and Its Application in Sociology.

Recent years have seen a push for the integration of modern genomic methodologies with sociological inquiry. The inclusion of genomic approaches promises to help address long-standing issues in sociology (e.g., selection effects), as well as open up new avenues for future research. This article reviews the substantive findings of behavior genetic/genomic research, both from the recent past (e.g., twin/adoption studies, candidate gene studies) and from contemporary genomic analyses. The article primarily focuses on modern genomic methods available to sociologists (e.g., polygenic score analysis) and their various applications for answering sociological questions. The article concludes by considering a number of areas to which genomic researchers and sociologists should pay close attention if a consilience between genomic methods and sociological research is to be fully realized.

Functional connectomics from neural dynamics: probabilistic graphical models for neuronal network of Caenorhabditis elegans.

We propose an approach to represent neuronal network dynamics as a probabilistic graphical model (PGM). To construct the PGM, we collect time series of neuronal responses produced by the neuronal network and use singular value decomposition to obtain a low-dimensional projection of the time-series data. We then extract dominant patterns from the projections to get pairwise dependency information and create a graphical model for the full network. The outcome model is a functional connectome that captures how stimuli propagate through the network and thus represents causal dependencies between neurons and stimuli. We apply our methodology to a model of the Caenorhabditis elegans somatic nervous system to validate and show an example of our approach. The structure and dynamics of the C. elegans nervous system are well studied and a model that generates neuronal responses is available. The resulting PGM enables us to obtain and verify underlying neuronal pathways for known behavioural scenarios and detect possible pathways for novel scenarios.This article is part of a discussion meeting issue 'Connectome to behaviour: modelling C. elegans at cellular resolution'.

Genetic Heterogeneity in Depressive Symptoms Following the Death of a Spouse: Polygenic Score Analysis of the U.S. Health and Retirement Study.

OBJECTIVE: Experience of stressful life events is associated with risk of depression. Yet many exposed individuals do not become depressed. A controversial hypothesis is that genetic factors influence vulnerability to depression following stress. This hypothesis is often tested with a "diathesis-stress" model, in which genes confer excess vulnerability. The authors tested an alternative formulation of this model: genes may buffer against depressogenic effects of life stress. METHOD: The hypothesized genetic buffer was measured using a polygenic score derived from a published genome-wide association study of subjective well-being. The authors tested whether married older adults who had higher polygenic scores were less vulnerable to depressive symptoms following the death of their spouse compared with age-matched peers who had also lost their spouse and who had lower polygenic scores. Data were analyzed from 8,588 non-Hispanic white adults in the Health and Retirement Study (HRS), a population-representative longitudinal study of older adults in the United States. RESULTS: HRS adults with higher well-being polygenic scores experienced fewer depressive symptoms during follow-up. Those who survived the death of their spouses (N=1,647) experienced a sharp increase in depressive symptoms following the death and returned toward baseline over the following 2 years. Having a higher well-being polygenic score buffered against increased depressive symptoms following a spouse's death. CONCLUSIONS: The effects were small, and the clinical relevance is uncertain, although polygenic score analyses may provide clues to behavioral pathways that can serve as therapeutic targets. Future studies of gene-environment interplay in depression may benefit from focus on genetics discovered for putative protective factors.

Opportunities and challenges of big data for the social sciences: The case of genomic data.

In this paper, we draw attention to one unique and valuable source of big data, genomic data, by demonstrating the opportunities they provide to social scientists. We discuss different types of large-scale genomic data and recent advances in statistical methods and computational infrastructure used to address challenges in managing and analyzing such data. We highlight how these data and methods can be used to benefit social science research.

Does Marriage Moderate Genetic Effects on Delinquency and Violence?

Using data from the National Longitudinal Study of Adolescent to Adult Health (N = 1,254), the authors investigated whether marriage can foster desistance from delinquency and violence by moderating genetic effects. In contrast to existing gene-environment research that typically focuses on one or a few genetic polymorphisms, they extended a recently developed mixed linear model to consider the collective influence of 580 single nucleotide polymorphisms in 64 genes related to aggression and risky behavior. The mixed linear model estimates the proportion of variance in the phenotype that is explained by the single nucleotide polymorphisms. The authors found that the proportion of variance in delinquency/violence explained was smaller among married individuals than unmarried individuals. Because selection, confounding, and heterogeneity may bias the estimate of the Gene × Marriage interaction, they conducted a series of analyses to address these issues. The findings suggest that the Gene × Marriage interaction results were not seriously affected by these issues.