Cumulative Stress Across the Life Course and Biological Aging in Adulthood.

OBJECTIVE: Psychosocial stressors have been linked with accelerated biological aging in adults; however, few studies have examined stressors across the life course in relation to biological aging. METHODS: In 359 individuals (57% White, 34% Black) from the Child Health and Development Studies Disparities study, economic (income, education, financial strain), social (parent-child relations, caretaker responsibilities) and traumatic (death of a sibling or child, violence exposure) stressors were assessed at multiple time points (birth and ages 9, 15, and 50 years). Experiences of major discrimination were assessed at age 50. Life period stress scores were then assessed as childhood (birth-age 15 years) and adulthood (age 50 years). At age 50 years, participants provided blood samples, and DNA methylation was assessed with the EPIC BeadChip. Epigenetic age was estimated using six epigenetic clocks (Horvath, Hannum, Skin and Blood age, PhenoAge, GrimAge, Dunedin Pace of Aging). Age acceleration was determined using residuals from regressing chronologic age on each of the epigenetic age metrics. Telomere length was assessed using the quantitative polymerase chain reaction-based methods. RESULTS: In linear regression models adjusted for race and gender, total life stress, and childhood and adult stress independently predicted accelerated aging based on GrimAge and faster pace of aging based on the DunedinPace. Associations were attenuated after adjusting for smoking status. In sex-stratified analyses, greater childhood stress was associated with accelerated epigenetic aging among women but not men. No associations were noted with telomere length. CONCLUSIONS: We found that cumulative stressors across the life course were associated with accelerated epigenetic age, with differences by sex (e.g., accelerated among women). Further research of this association in large and diverse samples is needed.

Disparities in Drinking Water Manganese Concentrations in Domestic Wells and Community Water Systems in the Central Valley, CA, USA.

Over 1.3 million Californians rely on unmonitored domestic wells. Existing probability estimates of groundwater Mn concentrations, population estimates, and sociodemographic data were integrated with spatial data delineating domestic well communities (DWCs) to predict the probability of high Mn concentrations in extracted groundwater within DWCs in California's Central Valley. Additional Mn concentration data of water delivered by community water systems (CWSs) were used to estimate Mn in public water supply. We estimate that 0.4% of the DWC population (2342 users) rely on groundwater with predicted Mn > 300 µg L-1. In CWSs, 2.4% of the population (904 users) served by small CWSs and 0.4% of the population (3072 users) served by medium CWS relied on drinking water with mean point-of-entry Mn concentration >300 µg L-1. Small CWSs were less likely to report Mn concentrations relative to large CWSs, yet a higher percentage of small CWSs exceed regulatory standards relative to larger systems. Modeled calculations do not reveal differences in estimated Mn concentration between groundwater from current regional domestic well depth and 33 m deeper. These analyses demonstrate the need for additional well-monitoring programs that evaluate Mn and increased access to point-of-use treatment for domestic well users disproportionately burdened by associated costs of water treatment.

Police Violence and Public Health.

Despite their enormous potential impact on population health and health inequities, police violence and use of excessive force have only recently been addressed from a public health perspective. Moving to change this state of affairs, this article considers police violence in the USA within a social determinants and health disparities framework, highlighting recent literature linking this exposure to mental health symptoms, physical health conditions, and premature mortality. The review demonstrates that police violence is common in the USA; is disproportionately directed toward Black, Latinx, and other marginalized communities; and exerts a significant and adverse effect on a broad range of health outcomes. The state-sponsored nature of police violence, its embedding within a historical and contemporary context of structural racism, and the unique circumstances of the exposure itself make it an especially salient and impactful form of violence exposure, both overlapping with and distinct from other forms of violence. We conclude by noting potential solutions that clinical psychology and allied fields may offer toalleviate the impact of police violence, while simultaneously recognizing that a true solution to this issue requires a drastic reformation or replacement of the criminal justice system, as well as addressing the broader context of structural and systemic racism in the USA.

A pilot pragmatic trial of a "what matters most"-based intervention targeting intersectional stigma related to being pregnant and living with HIV in Botswana.

We conducted a pilot trial of an intervention targeting intersectional stigma related to being pregnant and living with HIV while promoting capabilities for achieving 'respected motherhood' ('what matters most') in Botswana. A pragmatic design allocated participants to the intervention (N = 44) group and the treatment-as-usual (N = 15) group. An intent-to-treat, difference-in-difference analysis found the intervention group had significant decreases in HIV stigma (d = - 1.20; 95% CI - 1.99, - 0.39) and depressive symptoms (d = - 1.96; 95% CI - 2.89, - 1.02) from baseline to 4-months postpartum. Some, albeit less pronounced, changes in intersectional stigma were observed, suggesting the importance of structural-level intervention components to reduce intersectional stigma.

Arrest history, stigma, and self-esteem: a modified labeling theory approach to understanding how arrests impact lives.

PURPOSE: Modified labeling theory theorizes that when people acquire a label, personally held views about that label gain relevance and exert negative effects. We assessed whether being arrested reduces self-esteem to different extents based on the degree to which individuals hold stigmatizing beliefs about people with arrest records. METHODS: Adults living in the South Bronx, New York City (N = 532, 56% of whom had ever been arrested) indicated their level of agreement with statements about people with arrest records. We used exploratory factor analysis to identify categories of stigmatizing views, and calculated scores for the two following categories: "stereotype awareness" and "stereotype agreement." Self-esteem was assessed with the Rosenberg self-esteem scale. Using fitted linear regression models, we assessed interaction between arrest history and each stigma score, and calculated mean differences representing the association between arrest history and self-esteem score, for those with stigma scores one standard deviation (SD) below and above the mean. RESULTS: For each type of stigma, participants with stigma scores one SD below the mean had similar self-esteem scores, regardless of arrest history. However, among participants with stigma scores one SD above the mean, those who had experienced an arrest had lower self-esteem scores than those who had not (mean difference = - 2.07, 95% CI - 3.16, - 0.99 for "stereotype awareness"; mean difference = - 2.92, 95% CI - 4.05, - 1.79 for "stereotype agreement"). CONCLUSION: Being arrested affects self-esteem to a greater degree among persons who hold stigmatizing views about people with arrest records. These findings support a modified labeling theory of arrest-related stigma.

Stigma and discrimination associated with mental illness and other stigmatizing conditions in China using two cultural-sensitive measures of stigma: interpersonal distance and occupational restrictiveness.

BACKGROUND: Reducing stigma is a perennial target of mental health advocates, but effectively addressing stigma relies on the ability to correctly understand and accurately measure culture-specific and location-specific components of stigma and discrimination. METHODS: We developed two culture-sensitive measures that assess the core components of stigma. The 40-item Interpersonal Distance Scale (IDS) asks respondents about their willingness to establish four different types of relationships with individuals with 10 target conditions, including five mental health-related conditions and five comparison conditions. The 40-item Occupational Restrictiveness Scale (ORS) asks respondents how suitable it is for individuals with the 10 conditions to assume four different types of occupations. The scales - which take 15 min to complete - were administered as part of a 2013 survey in Ningxia Province, China to a representative sample of 2425 adult community members. RESULTS: IDS and ORS differentiated the level of stigma between the 10 conditions. Of the total, 81% of respondents were unwilling to have interpersonal relationships with individuals with mental health-related conditions and 91% considered them unsuitable for various occupations. Substantial differences in attitudes about the five mental health-related conditions suggest that there is no community consensus about what constitutes a 'mental illness'. CONCLUSIONS: Selection of comparison conditions, types of social relationships, and types of occupations considered by the IDS and ORS make it possible to develop culture-sensitive and cohort-specific measures of interpersonal distance and occupational restrictiveness that can be used to compare the level and type of stigma associated with different conditions and to monitor changes in stigma over time.

Stigma, Structural Vulnerability, and "What Matters Most" Among Women Living With HIV in Botswana, 2017.

Objectives. To explore whether beneficial health care policies, when implemented in the context of gender inequality, yield unintended structural consequences that stigmatize and ostracize women with HIV from "what matters most" in local culture. Methods. We conducted 46 in-depth interviews and 5 focus groups (38 individuals) with men and women living with and without HIV in Gaborone, Botswana, in 2017. Results. Cultural imperatives to bear children bring pregnant women into contact with free antenatal services including routine HIV testing, where their HIV status is discovered before their male partners'. National HIV policies have therefore unintentionally reinforced disadvantage among women with HIV, whereby men delay or avoid testing by using their partner's status as a proxy for their own, thus facilitating blame toward women diagnosed with HIV. Gossip then defines these women as "promiscuous" and as violating the essence of womanhood. We identified cultural and structural ways to resist stigma for these women. Conclusions. Necessary HIV testing during antenatal care has inadvertently perpetuated a structural vulnerability that propagates stigma toward women. Individual- and structural-level interventions can address stigma unintentionally reinforced by health care policies.

Racial differences in alcohol and tobacco use in adolescence and mid-adulthood in a community-based sample.

PURPOSE: Smoking and alcohol use have been posited as possible contributors to racial health disparities, despite higher smoking and alcohol use among non-Hispanic White youth and young adults compared to Blacks. To further investigate this claim, we aim to assess variation in alcohol and cigarette use across two distinct points of the life course. METHOD: Data are from a subset of 559 (279 male, 280 female) self-identified Black and White participants of the Child Health and Development study. Self-report alcohol and cigarette use were collected between age 15-17 and at mean age 50. Logistic regressions were estimated; supplementary analyses adjusted for maternal age, prenatal smoking, household income, childhood SES, and education. RESULTS: White participants were more likely to drink regularly (Odds ratio (OR) 2.2; 95%CI 1.2, 4.0) and be intoxicated (OR 2.0; 95%CI 1.2, 3.2) in adolescence compared with Blacks. In mid-adulthood, Whites remained more likely to currently drink (OR 2.3; 95%CI 1.6, 3.4) but among drinkers, less likely to binge drink (OR 0.4; 95%CI 0.2, 0.8). White participants were less likely to smoke in mid-adulthood (OR 0.4; 95%CI 0.3, 0.6), but among smokers, were more likely to smoke ≥ ½ a pack per day (OR 3.4; 95%CI 1.5, 7.8). CONCLUSIONS: Blacks were less likely to engage in drinking across the life course, but, among drinkers, more likely to binge drink in mid-adulthood. Blacks were more likely to smoke in mid-adulthood, but smoked infrequently compared with Whites. These patterns suggest that a reframing of disparities mechanisms to focus on broader structural and social factors may benefit progress in understanding and ameliorating inequities.

Media language preferences and mental illness stigma among Latinx adolescents.

PURPOSE: Media-a powerful influence on mental illness stigma-varies by language and culture. Nevertheless, recent meta-analyses have demonstrated scant attention to Spanish language media as well as historically low Latinx participation in mental illness anti-stigma intervention. To better inform how to improve equity in mental health service utilization, this study assessed how language preferences in mass media influence stigma among Latinx adolescents, compared to family language and social preferences. METHODS: Sixth-graders self-identifying as Latinx self-completed assessments of mental illness knowledge/positive attitudes and desired separation from peers and adolescent vignette characters experiencing mental illness (N = 179; Texas, U.S., 2011-2012). Participants also responded to measures of language preferences (any Spanish versus only English) for consuming media (film/television, music/radio) and speaking with family (parents/grandparents), and social preferences for parties or social gatherings (Latinx versus Anglo persons). Linear regression models adjusting for student and household factors examined the associations between media and family language and social preferences on mental illness stigma. RESULTS: Latinx adolescents preferring any Spanish versus English-only media reported less mental illness knowledge/positive attitudes and greater social separation from peers and vignette characters with a mental illness, net of all covariates. Family language and social preferences were not associated with any mental illness stigma outcomes. CONCLUSIONS: Spanish media preference is associated with greater stigma suggesting more stigmatization may exist in Spanish- versus English-media. Ensuring anti-stigma messaging in Spanish media may reduce disparities in mental illness stigma among Latinx adolescents. These findings have implications for populations with other non-English media preferences.

The Human Cost of Politicizing Immigration: Migration Stigma, US Politics, and Health.

This Viewpoint discusses stigma and health consequences associated with migration in the context of the US election and identifies ways to develop structural competencies for physicians and future research.

Police violence among women in four U.S. cities.

Police violence has been identified as a public health concern in the U.S., yet few studies have assessed the prevalence and nature of police violence among women. Furthermore, increasing evidence suggests that women reporting intimate partner violence (IPV) and sexual violence (SV) to police are often met with harmful or neglectful police responses and thus, women's exposures to police violence may be associated with experiences of IPV and SV; however, this has not yet been empirically tested. This study assesses lifetime prevalence and sociodemographic correlates of police violence among women and investigates potential associations between IPV, SV, and police violence. A cross-sectional survey was administered in four Eastern U.S. cities in March and April 2016 (N=932). Physical, sexual, and psychological police victimization and neglect by police were assessed. Logistic regression was used to examine the relationship between IPV, SV, and police violence, adjusting for sociodemographics. Lifetime prevalence of physical (4%), sexual (3.3%), and psychological (14.4%) police violence and neglect (17.2%), show that a notable proportion of women experience police victimization, with significantly higher rates among racial and ethnic minority women. Women with IPV and SV histories had increased odds of experiencing most forms of police violence compared to women without IPV and SV histories. Findings suggest the need for gender-inclusive community-centered policing initiatives and other preventive efforts aimed at eliminating police violence. Police violence and victimization among women should also be considered in IPV and SV intervention and treatment responses.

Measuring Recurring Stigma in the Lives of Individuals with Mental Illness.

We present an exploratory factor analysis of the 8-item Daily Indignities of Mental Illness (DIMI) scale, created to measure the detection and perceptions of recurring stigma among individuals with recent psychiatric hospitalizations. Structured in-person interviews were conducted with individuals with recent psychiatric hospitalizations in metropolitan New York. The 8-item DIMI scale's internal consistency for the sample (n = 65), measured by Cronbach's alpha, was 0.869. Statistically significantly higher DIMI scale scores were observed among individuals with more than 2 psychotic episodes and those reporting seeing relatives less often after hospitalization. The DIMI scale possesses good internal consistency for research contextualizing perceptions around the occurrence or recurrence of mental illness-related stigma among individuals with recent psychiatric hospitalizations.

Elevated Prevalence of Suicide Attempts among Victims of Police Violence in the USA.

Recent evidence suggests that police victimization is widespread in the USA and psychologically impactful. We hypothesized that civilian-reported police victimization, particularly assaultive victimization (i.e., physical/sexual), would be associated with a greater prevalence of suicide attempts and suicidal ideation. Data were drawn from the Survey of Police-Public Encounters, a population-based survey of adults (N = 1615) residing in four US cities. Surveys assessed lifetime exposure to police victimization based on the World Health Organization domains of violence (i.e., physical, sexual, psychological, and neglect), using the Police Practices Inventory. Logistic regression models tested for associations between police victimization and (1) past 12-month suicide attempts and (2) past 12-month suicidal ideation, adjusted for demographic factors (i.e., gender, sexual orientation, race/ethnicity, income), crime involvement, past intimate partner and sexual victimization exposure, and lifetime mental illness. Police victimization was associated with suicide attempts but not suicidal ideation in adjusted analyses. Specifically, odds of attempts were greatly increased for respondents reporting assaultive forms of victimization, including physical victimization (odds ratio = 4.5), physical victimization with a weapon (odds ratio = 10.7), and sexual victimization (odds ratio = 10.2). Assessing for police victimization and other violence exposures may be a useful component of suicide risk screening in urban US settings. Further, community-based efforts should be made to reduce the prevalence of exposure to police victimization.

Age at cancer diagnosis, amenability to medical interventions, and racial/ethnic disparities in cancer mortality.

PURPOSE: Racial disparities in cancer mortality may be greater for cancers that are amenable to available early detection and treatment (amenability level). We investigated whether these patterns vary by age at cancer diagnosis. METHODS: Using 5-year relative survival rates (5Y-RSR), we classified 51 cancer sites into least amenable, partly amenable, and mostly amenable cancers (<40%, 40-69%, ≥70% 5-YRS, respectively). We examined whether racial disparities in mortality rates (African-Americans, Asian/Pacific Islanders, Hispanics, whites), as estimated through Cox regression models, were modified by age at diagnosis and amenability level in 516,939 cancer cases diagnosed in 1995-1999. RESULTS: As compared with whites, all racial minority groups experienced higher cancer mortality rates in the youngest age group of 20-34 years. African-Americans and Hispanics diagnosed with partly and mostly amenable cancers had higher mortality rates relative to whites with cancers of the same amenability levels; further, these differences decreased in magnitude or reversed in direction with increasing age. In contrast, the racial differences in mortality were smaller and remained fairly constant across age groups for least amenable cancers. For example, in the youngest (20-34) and oldest (80-99) age groups, the adjusted hazard ratios (HRs) for African-Americans versus whites with least amenable cancers were, respectively, 1.26 (95% CI 1.02, 1.55) and 0.90 (95% CI 0.85, 0.96), while the HRs for African-Americans versus whites with mostly amenable cancers were 2.77 (95% CI 2.38, 3.22) and 1.07 (95% CI 0.98, 1.17). CONCLUSIONS: Cancer survival disadvantage for racial minorities is larger in younger age groups for cancers that are more amenable to medical interventions.

Sexual Orientation Disparities in Preventable Disease: A Fundamental Cause Perspective.

OBJECTIVES: To determine whether fundamental cause theory (which posits that, in societal conditions of unequal power and resources, members of higher-status groups experience better health than members of lower-status groups because of their disproportionate access to health-protective factors) might be relevant in explaining health disparities related to sexual orientation. METHODS: We used 2001 to 2011 morbidity data from the Stockholm Public Health Cohort, a representative general population-based study in Sweden. A total of 66 604 (92.0%) individuals identified as heterosexual, 848 (1.2%) as homosexual, and 806 (1.1%) as bisexual. To test fundamental cause theory, we classified diseases in terms of preventability potential (low vs high). RESULTS: There were no sexual orientation differences in morbidity from low-preventable diseases. By contrast, gay or bisexual men (adjusted odds ratio [OR] = 1.48; 95% confidence interval [CI] = 1.13, 1.93) and lesbian or bisexual women (adjusted OR = 1.64; 95% CI = 1.28, 2.10) had a greater risk of high-preventable morbidity than heterosexual men and women, respectively. These differences were sustained in analyses adjusted for covariates. CONCLUSIONS: Our findings support fundamental cause theory and suggest that unequal distribution of health-protective resources, including knowledge, prestige, power, and supportive social connections, might explain sexual orientation health disparities.

Why the Neighborhood Social Environment Is Critical in Obesity Prevention.

The continuing obesity epidemic in the USA calls for the examination of antecedents to the well-known risk factors of physical activity and diet. The neighborhood built environment has been extensively studied in relation to obesity noting an increased risk of development and prevalence of obesity in relation to numerous built environment characteristics (lack of green spaces, higher number of fast food restaurants, low walkability indices). The neighborhood social environment, however, has been less extensively studied but is perhaps an equally important component of the neighborhood environment. The neighborhood social environment, particularly constructs of social capital, collective efficacy, and crime, is associated with obesity among both adults and children. Several studies have identified physical activity as a potential pathway of the neighborhood social environment and obesity association. Further work on social networks and norms and residential segregation, as well as the examination of dietary behaviors and mental health as potential mediating pathways, is necessary. Given the existing evidence, intervening on the neighborhood social environment may prove to be an effective target for the prevention on obesity. Intervention studies that promote healthy behaviors and prevent obesity while addressing aspects of the neighborhood social environment are necessary to better identify targets for obesity prevention.

A Social History of Disease: Contextualizing the Rise and Fall of Social Inequalities in Cause-Specific Mortality.

Fundamental cause theory posits that social inequalities in health arise because of unequal access to flexible resources, including knowledge, money, power, prestige, and beneficial social connections, which allow people to avoid risk factors and adopt protective factors relevant in a particular place. In this study, we posit that diseases should also be put into temporal context. We characterize diseases as transitioning through four stages at a given time: (1) natural mortality, characterized by no knowledge about risk factors, preventions, or treatments for a disease in a population; (2) producing inequalities, characterized by unequal diffusion of innovations; (3) reducing inequalities, characterized by increased access to health knowledge; and (4) reduced mortality/disease elimination, characterized by widely available prevention and effective treatment. For illustration, we pair an ideal-types analysis with mortality data to explore hypothesized incidence rates of diseases. Although social inequalities exist in incidence rates of many diseases, the cause, extent, and direction of inequalities change systematically in relation to human intervention. This article highlights opportunities for further development, specifically highlighting the role of stage duration in maintaining social inequalities in cause-specific mortality.

Discrimination and Depression among Urban Hispanics with Poorly Controlled Diabetes.

OBJECTIVES: We had three objectives for our study: 1) to describe the prevalence and burden of experiences of discrimination among Hispanics with poorly controlled diabetes; 2) to evaluate associations among discrimination experiences and their burden with comorbid depression among Hispanics with poorly controlled diabetes; and 3) to evaluate whether discrimination encountered in the health care context itself was associated with comorbid depression for Hispanic adults with diabetes. DESIGN: We conducted a cross-sectional analysis of baseline data of a randomized controlled trial (RCT). SETTING: We collected data in the context of an RCT in a clinical setting in New York City. PARTICIPANTS: Our sample comprised 221 urban-dwelling Hispanics, largely of Caribbean origin. MAIN OUTCOME MEASURES: The main outcome measure was major depression, measured by the Euro-D (score > 3). RESULTS: Of 221 participants, 58.8% reported at least one experience of everyday discrimination, and 42.5% reported at least one major experience of discrimination. Depression was associated significantly with counts of experiences of major discrimination (OR = 1.46, 95% CI = 1.09 - 1.94, P = .01), aggregate counts of everyday and major discrimination (OR = 1.13, 95% CI = 1.02 - 1.26, P = .02), and the experience of discrimination in getting care for physical health (OR = 6.30, 95% CI= 1.10-36.03). CONCLUSIONS: Discrimination may pose a barrier to getting health care and may be associated with depression among Hispanics with diabetes. Clinicians treating Caribbean-born Hispanics should be aware that disadvantage and discrimination likely complicate a presentation of diabetes.

Criminogenic factors, psychotic symptoms, and incident arrests among people with serious mental illnesses under intensive outpatient treatment.

Although research robustly indicates that general or "criminogenic" factors predict various measures of recidivism, there is controversy about the extent to which these factors, versus untreated symptoms, lead to justice involvement for people with mental illnesses. Based on a sample of 183 people in intensive outpatient treatment followed for an average period of 34.5 months, the present study tested whether criminogenic factors (i.e., factor-analytically derived proxies of some of the "Central Eight"; Andrews & Bonta, 2010) and psychotic symptoms were independently associated with arrest. The study also compared the predictive utility of these domains. In the fully adjusted model, the antisocial subscale and male sex were associated with increased arrest rates, whereas psychosis and age were associated with decreased arrest rates. Criminogenic factors and psychotic symptoms had comparable predictive utility. We conclude that criminogenic factors-chiefly arrest history-and psychotic symptoms predict arrest rates. Both sets of variables appear useful for assessing risk of arrest among people with mental illnesses who are not under current correctional supervision.

Cumulative Effects of Stressful Childhood Experiences on Delusions and Hallucinations.

The association between stressful childhood experiences (SCE) and psychotic symptoms is still not clearly understood, and different causal pathways have been proposed. Generalized estimating equation modeling was used to test the dose-response relationship between SCE and delusions and hallucinations at baseline and follow-up periods and the possible confounding effects of dissociation on this relationship. The prevalence of SCE in individuals with psychotic disorders was high, with more co-occurring SCE categories being positively associated with more types of delusions and hallucinations. Each additional SCE was associated with a 1.20 increase in the incidence rate ratio (95% confidence interval [CI; 1.09, 1.32]) for hallucinations and a 1.19 increase (CI [1.09, 1.29]) for delusions, supporting a dose-response association. After we controlled for the mediating effects of dissociative symptoms at follow-up, SCE remained independently associated with delusions. We propose that cumulative SCE can result in complex trauma reactions that present with a broad range of symptomatology, including dissociative, posttraumatic stress disorder, and psychotic symptoms.