Toward a Life Course Framework for Studying Vulnerability

Experiences and Needs of Caregivers of Community-Dwelling Frail Older Adults: A Mixed Methods Systematic Review

AIM

This study aimed to synthesise current evidence about the experiences and needs of informal caregivers of community-dwelling frail older adults to inform targeted interventions for improving their caregiving situations.

DESIGN

This was a mixed methods systematic review using the convergent integrated analysis framework.

METHODS

We conducted systematic searches across 11 databases, including CINAHL, CNKI, EMBASE, OpenGrey, ProQuest, PsycINFO, PubMed, SinoMed, VIP, WanFang and Web of Science, as well as reference lists, for studies published between January 1, 2000 and March 12, 2025. Quality appraisal was performed using the Mixed Methods Appraisal Tool. Findings were synthesised using a narrative approach.

RESULTS

Of the 5297 citations, 2905 were screened for titles and abstracts, 176 were further screened for full-texts and eight studies were included (n = 6 quantitative, n = 2 qualitative; 1949 caregivers). The themes of caregiving experiences related to (1) influential factors contributing to negative, (2) or positive caregiver outcomes; (3) coping strategies or resources that caregivers employed to address caregiving situations; the outcomes that could be (4) negatively, (5) or positively impacted by caregiving; and (6) difficulties they encountered related to caring for frail older adults. Caregivers expressed needs for psychological support, detailed information on available resources, and family-centred and integrated public services with self-advocacy and coordinators.

CONCLUSIONS

This review highlights broad areas that require more attention for enhancing the well-being of these caregivers. More research is warranted on caregivers' experiences, needs, and interventions, especially their support needs. A theoretical framework, comparative analyses between child caregivers and spousal caregivers, as well as emphasising both mastery and competence, is recommended for future research and practice.

RELEVANCE TO CLINICAL PRACTICE

Our findings hold the potential to guide the development of needs-oriented and evidence-based interventions tailored to the unique challenges faced by caregivers, thereby supporting them in their caregiving roles.

REPORTING METHOD

This review followed the PRISMA 2020 guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution due to design.

Adulthood trajectories of resilience and vulnerability: exploring gender differences in disadvantage after experience of out-of-home care

BACKGROUND

Childhood adversity places individuals in a vulnerable position, resulting in potentially enduring disadvantage across life domains like health and work. Studying the manifestation of this disadvantage is crucial for understanding which resources society can provide to mitigate or prevent it, which makes this subject a fundamental public health concern. This study investigated whether disadvantage patterns after childhood adversity differ by gender and educational level, using out-of-home care as proxy for early adversity.

METHODS

We used register data from a 1953 Swedish birth cohort. Distinct profiles of socioeconomic and health disadvantage in individuals with out-of-home care experience were identified using group-based multi-trajectory modelling. Multinomial logistic regression was then used to determine whether gender and education, individually or in interaction with each other, predict group membership.

RESULTS

In the population without history of out-of-home care, adulthood disadvantage was highly gendered, with women being more likely to experience disadvantage related to unemployment and poor health, while criminality and substance misuse was more common among men. History of out-of-home care was associated with a general increase in adulthood disadvantage, but the gender differences were largely absent. Women in this group were however less likely than men to experience disadvantage across multiple life domains (complex disadvantage OR = 0.56, p = 0.046; unemployment-related disadvantage OR = 0.51, p = 0.005). Higher level of education was associated with reduced likelihood of membership in the group marked by disabling health disadvantage (OR = 0.55, p = 0.002) and complex disadvantage (OR = 0.37, p = 0.001). An interaction term between gender and education was not significant.

CONCLUSIONS

Adulthood disadvantage was more common in the group with history of out-of-home care. The gender differences in disadvantage present in the full cohort were largely attenuated among individuals with out-of-home care history. We showed that using administrative data on outcomes across multiple life domains can provide rich descriptions of adult experiences after childhood adversity. Future research could examine gender differences in mechanisms translating into resilient or vulnerable trajectories, including the protective potential of education in relation to specific disadvantage patterns.

Impacts of Depressive Symptoms on the Effectiveness of a Theory-Driven Exercise Intervention Among Community-Dwelling (Pre)frail Older Adults

OBJECTIVES

To investigate whether baseline depressive symptoms impacted the effectiveness of an exercise intervention among (pre)frail older adults.

METHODS

This is a subanalysis of a stepped-wedge cluster randomized trial implementing an exercise intervention, with an application of the integration of the Health Belief Model, Theory of Planned Behavior, and Health Action Process Approach, among 149 community-dwelling (pre)frail older adults. The intervention effectiveness was examined by baseline depressive symptoms (depressive symptoms (n = 40) and non-depressive symptoms (n = 109).

RESULTS

Intervention effects were observed among (pre)frail older adults regardless of baseline depressive symptoms on frailty, social function, as well as physical and mental quality of life (QoL). (Pre)frail people with depressive symptoms, compared to those without depressive symptoms, were likely to benefit more in muscle mass, muscle strength, lower extremity function, activities of daily living (ADLs), cognitive function, depressive symptoms, and physical QoL, but less in dynamic balance, instrumental ADLs (IADLs), and mental QoL.

CONCLUSIONS

These findings implicate that cognitive and psychological strategies should be integrated into exercise interventions among (pre)frail people with depressive symptoms to improve their functional independence and well-being.

CLINICAL IMPLICATIONS

Interventions that accommodate depressive symptoms may result in improved outcomes for (pre)frail people with depressive symptoms.

Physical fitness levels among children in northeast Italy by sex and age group: a comparison with teachers' assessments and children in other European countries

Introduction

Physical fitness is associated with health-related quality of life, especially among youth. Although schools play an important role in promoting children's physical activity, in Italy the lack of qualified physical education teachers in primary schools may be compromising children's achievement of recommended levels of physical activity.

Methods

To test that possibility, we measured the physical fitness of 170 children (i.e., 79 boys and 91 girls) 6-10 years old in two schools in Cadore, Veneto, in northeast Italy, using the Physical Fitness Test, a tool developed in Norway and previously used among children there and in Lithuania. Teachers in Italy also assessed their students' physical fitness, and their rankings were correlated with the children's test results. The test battery included nine elements: a standing broad jump, hopping 7 m on both feet, hopping 7 m on one foot, throwing a tennis ball, pushing a medicine ball, climbing wall bars, a 10 × 5 m shuttle run, a 20 m run, and a 6 min Cooper test.

Results

Test scores generally increased with age and more steeply among boys than girls, and boys outperformed girls on most items. Children in Italy performed similarly to children in Norway but outperformed ones in Lithuania on nearly every item across sex and age groups. The correlation between teachers' predictions and the actual test results was rather low for boys (.538, p < .001) and even lower for girls (.360, p < .001).

Discussion

Data revealed similar results in physical fitness between the three countries, albeit with some differences for individual items. However, primary school teachers in Italy assessed physical fitness rather poorly, possibly due to their lack of specific academic training in physical education and thus limited perception of physical fitness compared with academically trained physical education teachers. Last, because the procedure for categorizing children by age may significantly affect the results and subsequent between-group comparisons, researchers comparing children in different age groups should report their procedures for categorizing age.

The Effect of Economic Reliance, Stress, and Women's Employment Status on Intimate Partner Violence Risk Among Partnered Women in Burkina Faso and Kenya

Economic factors, such as economic reliance on male partners, and economic stressors such as household income or employment loss, play an important role in the risk of intimate partner violence (IPV) within romantic partnerships. To investigate these relationships, we used survey data from IPUMS Performance Monitoring for Action that were collected in 2020 and 2021. We assessed the relationship between several economic factors-(1) women's economic reliance on their partners, (2) household income loss, and (3) respondent's employment status over the past year-and experience of IPV in the past year in Burkina Faso (N = 2,646) and Kenya (N = 3,416). Women who reported being economically reliant on their partners were less likely to experience physical or psychological violence in Burkina Faso (Prevalence ratio [PR]: 0.41, 95% confidence interval [CI]: 0.26-0.64 and PR: 0.75, 95% CI: 0.59-0.94, respectively), and physical violence in Kenya (PR: 0.69, 95% CI: 0.52-0.90) compared to women who reported not being economically reliant. In Kenya, women in households that experienced a complete loss of income were more likely to experience IPV compared to households that did not experience income loss-1.9 times more likely to experience psychological violence, and three times more likely to experience sexual violence. In Burkina Faso, no significant relationship was found between household income loss and IPV. Our findings indicate that both relative economic empowerment and overall economic stress may act as important risk factors for IPV, particularly where patriarchal and gender inequitable norms are relevant. These findings reinforce the need for a nuanced and intersectional understanding of IPV risk and intervention development, with the relationships between economic dynamics and IPV varying across countries and contexts.

Predicting population-level vulnerability among pregnant women using routinely collected data and the added relevance of self-reported data

Recognizing and addressing vulnerability during the first thousand days of life can prevent health inequities. It is necessary to determine the best data for predicting multidimensional vulnerability (i.e. risk factors to vulnerability across different domains and a lack of protective factors) at population level to understand national prevalence and trends. This study aimed to (1) assess the feasibility of predicting multidimensional vulnerability during pregnancy using routinely collected data, (2) explore potential improvement of these predictions by adding self-reported data on health, well-being, and lifestyle, and (3) identify the most relevant predictors. The study was conducted using Dutch nationwide routinely collected data and self-reported Public Health Monitor data. First, to predict multidimensional vulnerability using routinely collected data, we used random forest (RF) and considered the area under the curve (AUC) and F1 measure to assess RF model performance. To validate results, sensitivity analyses (XGBoost and Lasso) were done. Second, we gradually added self-reported data to predictions. Third, we explored the RF model's variable importance. The initial RF model could distinguish between those with and without multidimensional vulnerability (AUC = 0.98). The model was able to correctly predict multidimensional vulnerability in most cases, but there was also misclassification (F1 measure = 0.70). Adding self-reported data improved RF model performance (e.g. F1 measure = 0.80 after adding perceived health). The strongest predictors concerned self-reported health, socioeconomic characteristics, and healthcare expenditures and utilization. It seems possible to predict multidimensional vulnerability using routinely collected data that is readily available. However, adding self-reported data can improve predictions.

Development and vulnerability across the lifecourse

What is it that develops in adult life? Development through work and family life have been documented and theorised in detail, but much less is known about what is learned beyond these domains, through people's engagements in hobbies or when out of work (e.g., unemployed, retired). We argue that adult development can be addressed in general terms, beyond domain specificity; drawing on our sociocultural psychology framework, and assuming an open-system perspective, we highlight the two processes of progressive differentiation and psychological distancing in diverse domains of activity. To address development over time, we explore 20 years of people's lives through the longitudinal analysis of online diaries. A combination of quantitative and qualitative analysis enables us to identify people's experiences of rupture and transitions, the diversity of their domains of interests, and how these change over time. Based on a case-study, we show that, if the general direction of development does entail progressive differentiation and distanciation, these processes can also be hindered by the cumulation of vulnerabilising events. Finally, we show that some domains, such as the long-standing activity of diary writing, can itself be used as resource for adult development.

Effects of (pre)frailty and cognitive reserve on mild cognitive impairment among community-dwelling older adults

OBJECTIVE

We aimed to identify the effect of lifespan cognitive reserve and (pre)frailty on mild cognitive impairment (MCI) among older adults.

MATERIALS AND METHODS

A total of 4420 older adults aged above 60 with intact cognition recruited in 2011/2012 were followed up in 2015 from the China Health and Retirement Longitudinal Study (CHARLS). The assessment of MCI was based on executive function, episodic memory, and visual-spatial ability. (Pre)frailty was assessed by the validated version of the Fried physical frailty phenotype scale. The lifespan cognitive reserve consisted of the highest educational level, occupational complexity, and participation in leisure activities. Modified Poisson regression models were used to identify the risk of MCI in relation to (pre)frailty and lifespan cognitive reserve index. We examined the interactions of (pre)frailty and lifespan cognitive reserve index on both additive and multiplicative scales.

RESULTS

Baseline (pre)frailty significantly increased the risk of MCI after 3-4 years of follow-up, and high cognitive reserve protected individuals from the risk of MCI. There was an additive interaction between (pre)frailty and the low lifespan cognitive reserve (the relative excess interaction risk=1.08, 95 % CI= 0.25-1,91), but no multiplicative interaction (RR=0.95, 95 % CI= 0.67-1.37). The risk of MCI was larger among older adults with comorbid (pre)frailty and low cognitive reserve than those with each condition alone.

CONCLUSION

Cognitive reserve attenuates the risk of MCI associated with (pre)frailty. This finding implicates the urgency for identifying and managing MCI among frail older adults who accumulate low cognitive reserve in the life course.

Young Adults with a History of Residential Youth Care: A Cohort Profile of a Hard-to-Reach Population

Adults with a history of living in residential youth care (RYC) face elevated risks across various life domains. In this cohort profile paper, we outline the design of a comprehensive follow-up study-the VINGO study-targeting young adults (22-30 years) with a history of living in RYC (T2). We describe the recruitment strategy and present sample characteristics. Data were collected in the baseline study (T1) from 2011 to 2014. At T1, the 400 adolescent participants showed a high prevalence of mental disorders, maltreatment experiences, substance use, and self-reported suicide attempts. Data collection at T2 10 years later (2021-2023) included self-reported sociodemographic information, physical health, childhood maltreatment, dissociation, quality of life, social support, and self-esteem using standardized and validated instruments. A diagnostic psychiatric assessment and subjective evaluation of service utilization were conducted by telephone interviews. Additionally, a qualitative sub-study involved in-depth interviews of fourteen participants. We reached a 52% response rate at T2. Comparing participants (n = 157, 107 females) to non-participants (n = 243, 123 females) based on T1 data revealed that T2 participants had a higher prevalence of depression, anxiety, and conduct disorder and a lower prevalence of ADHD at T1. Furthermore, T2 participants reported more suicide attempts, experiences of maltreatment, and problematic substance use at T1. Our results show that we reached a burdened population, positioning the VINGO study as a unique opportunity to examine a vulnerable population of emerging adults.

Impacts of subjective cognitive decline and mild cognitive impairment on the effectiveness of an exercise intervention among community-dwelling (Pre)frail older adults

BACKGROUND

Subjective cognitive decline (SCD) is prevalent in community-dwelling (pre)frail older adults. This study aimed to investigate whether baseline subjective cognitive decline (SCD) and mild cognitive impairment (MCI) impacted the effectiveness of an exercise intervention among (pre)frail older adults.

METHODS

This is a post hoc analysis of a stepped-wedge cluster randomized trial among (pre)frail older adults across six communities. The intervention effectiveness was examined among (pre)frail older people among subgroups with normal cognition (n = 44), SCD (n = 58), or MCI (n = 30).

RESULTS

The normal cognition group had both immediate and persistent treatment responses to most outcomes. The SCD group showed positive responses to frailty (0-, 12-, 24 week), ambulation and dynamic balance (0-week), and depressive symptoms (12-week). The MCI group exhibited immediate improvement in frailty, cognition, depressive symptoms, social support and QoL, which persisted only in frailty status, social support and mental QoL at follow-ups. The MCI group showed superior immediate responses to cognitive function and depressive symptoms compared to another two subgroups. No differences were found between the normal cognition and SCD groups except for cognitive status (12-week).

CONCLUSIONS

(Pre)frail people with SCD or MCI had fewer improved outcomes compared to those with normal cognition regardless of immediate or persistent improvements. The incorporation of cognitive strategies with exercise interventions are recommended among (pre)frail older adults with SCD or MCI.

Older adults' experiences of wellbeing during the COVID-19 pandemic: a comparative qualitative study in Italy and Switzerland

Background

Particularly at the beginning of the pandemic, adults aged 65 and older were portrayed as a homogeneously vulnerable population due to the elevated health risks associated with contracting the COVID-19 disease. This portrayal, combined with travel restrictions, closures of economic sectors, country-wide lockdowns, and suggestions by governmental authorities to limit social contact, had important implications for the wellbeing of older individuals. However, older adults are a heterogeneous population who relies on different resources to cope with stressful periods, like the COVID-19 pandemic. Simultaneously, countries also employed different measures to contain the virus. Research thus far has focused on the short-term consequences of the pandemic, but studies have yet to address its long-term consequences.

Objectives

We explore older adults' lived experiences nearly 2 years after the pandemic onset. Moreover, we focus on the bordering countries of Switzerland and Italy, who employed contrasting containment measures. This paper analyzes (1) How the COVID-19 pandemic impacted the experiences of wellbeing of older adults in these regions and (2) How older adults coped with the stressors brought about by the pandemic, in particular social distancing.

Methods

The paper draws on 31 semi-structured interviews with 11 Swiss natives residing in Switzerland, 10 Italian migrants residing in Switzerland, and 10 Italian natives residing in Italy. Interviews were conducted from December 2021 to March 2022.

Results

Coping mechanisms of the three groups related to acceptance, hobbies, cognitive reframing, telephone use, vaccine use and social distancing. However, results show heterogeneous experiences of wellbeing, with Swiss natives sharing more positive narratives than the other two groups. Moreover, Italian migrants and Italian natives expressed the long-term negative consequences of the pandemic on their experienced wellbeing.

Western life courses challenged in life stories collected in contemporary China

Introduction

The life course describes the progression of life as a social role, from birth to death. Traditional Western life-history studies of the life course usually describe a continuous lifeline with occasional interruptions in between. The extraordinary temporal events of the Anti-Japanese War (AJW), Civil War (CW), Great Famine (GF), Cultural Revolution (CR), and the Reform and Opening-up of China in just few decades mean that the life history of contemporary Chinese older adults may be quite different from those of their western peers.

Methods

The study used qualitative research methods to conduct in-depth interviews with 16 older adults and collect their life stories through a standardized list of questions. Grounded theory was employed to condense, compare, conceptualize, and synthesize patterns within the collected data, approaching the investigation with a "naturalistic" perspective.

Results

Based on a generalized analysis of the Interview transcripts, we can find that Chinese old adults' life stories were shaped by recurring exceptional and rapidly changing environmental conditions. The themes and sub-themes of Chinese old adults' life stories were focus on (1) violence, loss of family member, escape and unstable life in their early life which are related to AJW and CW; (2) poverty and starvation in daily life when they were adolescents and young adults which are related to GF; (3) discontinuity, timed opportunities, categorizations in order to split the social relationships and networks in CR. The data also suggest that education is an important part of the life story and that its value changes over time.

Discussion

The discontinuity and instability of the life stories of the Chinese old adults are unexpected according to the dominant Western-influenced life course theories, which enriches life course theory and provides a new perspective for studying the individual life course in a society of constant and rapid change.

Earlier-life individual and spatial socioeconomic conditions and later-life physical activity

This study investigated the association between earlier-life (before age 16) individual and spatial socioeconomic conditions and later-life (mean age 61) physical activity (PA), and the role of later-life characteristics. Contemporary and historical Census data as well as three bi-annual waves of nationally representative panel data from the Understanding America Study (N = 1,981) were used. Multilevel growth curve models were estimated to address the research questions. Father's education in respondents' earlier life was positively associated with light and moderate PA in respondents' later life. Growing up in a higher-poverty area was negatively associated with moderate and vigorous later-life PA. Findings underscore the long-term ramifications of earlier-life circumstances for later-life PA. Consideration should be given to socioeconomic conditions at both individual and spatial levels over the life course to promote PA at older ages.

Racial, ethnic and neighborhood socioeconomic differences in incidence of dementia: A regional retrospective cohort study

BACKGROUND

Evidence on the effects of neighborhood socioeconomic disadvantage on dementia risk in racially and ethically diverse populations is limited. Our objective was to evaluate the relative extent to which neighborhood disadvantage accounts for racial/ethnic variation in dementia incidence rates. Secondarily, we evaluated the spatial relationship between neighborhood disadvantage and dementia risk.

METHODS

In this retrospective study using electronic health records (EHR) at two regional health systems in Northeast Ohio, participants included 253,421 patients aged >60 years who had an outpatient primary care visit between January 1, 2005 and December 31, 2015. The date of the first qualifying visit served as the study baseline. Cumulative incidence of composite dementia outcome, defined as EHR-documented dementia diagnosis or dementia-related death, stratified by neighborhood socioeconomic deprivation (as measured by Area Deprivation Index) was determined by competing-risk regression analysis, with non-dementia-related death as the competing risk. Fine-Gray sub-distribution hazard ratios were determined for neighborhood socioeconomic deprivation, race/ethnicity, and clinical risk factors. The degree to which neighborhood socioeconomic position accounted for racial/ethnic disparities in the incidence of composite dementia outcome was evaluated via mediation analysis with Poisson rate models.

RESULTS

Increasing neighborhood disadvantage was associated with increased risk of EHR-documented dementia diagnosis or dementia-related death (most vs. least disadvantaged ADI quintile HR = 1.76, 95% confidence interval = 1.69-1.84) after adjusting for age and sex. The effect of neighborhood disadvantage on this composite dementia outcome remained after accounting for known medical risk factors of dementia. Mediation analysis indicated that neighborhood disadvantage accounted for 34% and 29% of the elevated risk for composite dementia outcome in Hispanic and Black patients compared to White patients, respectively.

CONCLUSION

Neighborhood disadvantage is related to the risk of EHR-documented dementia diagnosis or dementia-related death and accounts for a portion of racial/ethnic differences in dementia burden, even after adjustment for clinically important confounders.

Diaries as Technologies for Sense-making and Self-transformation in Times of Vulnerability

Diaries have been generally understood as "windows" on sense-making processes when studying life ruptures. In this article, we draw on Michel Foucault's conceptualization of self-writing as a "technology of the self" and on sociocultural psychology to propose that diaries are not "windows" but technologies that aid in the sense-making. Concretely, we analyzed three non-exhaustive and non-exclusive uses of diary writing in times of vulnerability: (1) imagination of the future and preparation to encounter difficulties; (2) distancing from one's own experience; and (3) creating personal commitments. Our longitudinal data comprised three public online diaries written over more than twenty years, belonging to three anonymous individuals selected from a database of more than 400 diaries. We analyzed these three diaries by iterating between qualitative and quantitative analysis. We conclude that: (1) beyond their expressive dimension, diaries are technologies that support the sense-making process, but not without difficulties; (2) diaries form a self-generated space for dialogue with oneself in which the diarist also becomes aware of the social nature of her life story; (3) diaries are not only technologies for the Socratic "know thyself" but also technologies to work on oneself, especially in terms of the personal perspective on the past or the future; and (4) the practice of diary writing goes beyond sense-making towards personal development and the desire to transform one's life trajectory.

A dual-path psychosocial model of social determinants of health in the community: Results from the Cause Commune program

We tested a dual-path psychosocial framework of social vulnerability that considers the impact of socioeconomic resources and cognitive social capital on health, and whether they were mediated by an enabling psychosocial path (collective efficacy) and a disabling path (loneliness). A total of 1401 people (53.6% female, M_age  = 48.7, SD = 18.1) from a community in Switzerland participated in the study. Structural equation models showed that psychosocial factors were related to both social determinants and health outcomes and partially mediated their interrelation. Our model showed an adequate fit to the data (χ²  = 1,377.56, df = 341, p = 0.000, comparative fit index = 0.93, root mean square error of approximation = 0.05, standardized root mean-squared residual = 0.05). The findings highlight the role of psychosocial-relational factors in the processes of social vulnerability and would be of interest to researchers working on social vulnerability in the community.

Defining vulnerability subgroups among pregnant women using pre-pregnancy information: a latent class analysis

BACKGROUND

Early detection of vulnerability during or before pregnancy can contribute to optimizing the first 1000 days, a crucial period for children's development and health. We aimed to identify classes of vulnerability among pregnant women in the Netherlands using pre-pregnancy data on a wide range of social risk and protective factors, and validate these classes against the risk of adverse outcomes.

METHODS

We conducted a latent class analysis based on 42 variables derived from nationwide observational data sources and self-reported data. Variables included individual, socioeconomic, lifestyle, psychosocial and household characteristics, self-reported health, healthcare utilization, life-events and living conditions. We compared classes in relation to adverse outcomes using logistic regression analyses.

RESULTS

In the study population of 4172 women, we identified five latent classes. The largest 'healthy and socioeconomically stable'-class [n = 2040 (48.9%)] mostly shared protective factors, such as paid work and positively perceived health. The classes 'high care utilization' [n = 485 (11.6%)], 'socioeconomic vulnerability' [n = 395 (9.5%)] and 'psychosocial vulnerability' [n = 1005 (24.0%)] were characterized by risk factors limited to one specific domain and protective factors in others. Women classified into the 'multidimensional vulnerability'-class [n = 250 (6.0%)] shared multiple risk factors in different domains (psychosocial, medical and socioeconomic risk factors). Multidimensional vulnerability was associated with adverse outcomes, such as premature birth and caesarean section.

CONCLUSIONS

Co-existence of multiple risk factors in various domains is associated with adverse outcomes for mother and child. Early detection of vulnerability and strategies to improve parental health and well-being might benefit from focussing on different domains and combining medical and social care and support.

Toward a conceptual framework of health and its operational definition: an application in the 1958 British birth cohort

BACKGROUND

Defining and measuring Health presents a challenge, partly due to its conceptual pluralism. To measure Health as an ability to adapt and self-manage, we developed an approach within the theoretical framework of resources and reserves over the life course, recently proposed in the literature. We aimed to (i) use the conceptual framework developed to identify indicators of deteriorating health reserves, (ii) construct an overall health measure from these indicators, (iii) evaluate the association between the overall health measure and subsequent health outcomes and (iv) assess the robustness of our method.

METHODS

We used data from 7,043 individuals born in 1958 in Great Britain included in the National Child Development Study. An overall health measure was constructed via the sum of three selected indicators of deteriorating health reserves in mid-life: chronic widespread pain (CWP), Clinical Interview Schedule - revised (CIS-r), and allostatic load (AL). A three-category variable was defined: impaired/medium/optimal overall health. We explored criterion validity by modelling the relationships between the overall health measure, or each reserve taken separately at 44-45 years, and self-rated health at 46 years and mortality up to 58 years, corresponding to 14 years of follow up, using Cox and logistic regressions respectively. We performed comparative analyses to assess the robustness of the method.

RESULTS

Having an impaired overall health measure was significantly associated with all-cause premature mortality (HR_impaired = 2.74 [1.86; 4.05]) and an increased risk of later fair/poor/very poor self-rated health (OR_impaired = 7.50 [6.29; 8.95]). The overall health measure had a greater effect on the self-rated health estimates than each indicator of deteriorating health reserves considered separately (OR_{AL medium} = 1.82 [1.59; 2.09]; OR_{AL high} = 2.74 [2.37; 3.16]; OR_CIS-r = 5.20 [4.45; 6.08]; OR_CWP = 2.85 [2.53; 3.21]). CIS-r and allostatic load were also associated with premature mortality contrary to chronic widespread pain (HR_{AL medium}1.82 [1.27; 2.61]; HR_{AL high} = 3.10 [2.19; 4.40]; HR_CIS-r = 1.77 [1.22; 2.56]; HR_CWP = 1.32 [0.98; 1.76]). The multiple comparative analyses conducted allowed us to assess the robustness of our method within this cohort.

CONCLUSIONS

We proposed a method for measuring Health in mid-life in line with the concept of Health as the ability to adapt and self-manage and the concept of health reserves. This method may be applied and further developed within the field of social and positive epidemiology.

The mediating role of self-continuity on the link between childhood adversity and loneliness in later life

Many factors may influence adaptation to critical life events such as divorce and bereavement in the second half of life, including having faced childhood adversity. However, pathways to reduced adaptation success are poorly understood. Self-continuity, an identity mechanism that incorporates life changes into a coherent life story, may contribute to better adaptation to adult critical life events, such as feeling less socially and emotionally lonely. We investigated the mediating role of self-continuity channeling the effects of childhood adversity on later life adaptation outcomes among individuals who had experienced divorce or bereavement. Data were derived from the longitudinal LIVES Intimate Partner Loss Study conducted in Switzerland from 2012 to 2016. The sample consisted of individuals who had experienced divorce (n = 416, Mage = 57.35) or bereavement (n = 339, Mage = 71.36) in later life, and a continuously married control group (n = 925, Mage = 67.04). Multilevel moderated mediations were used. Self-continuity mediated the effect of childhood adversity on emotional loneliness for all marital groups, but to a greater extent among divorcees. Self-continuity also mediated the effect of childhood adversity on social loneliness; however, this effect did not differ by marital group. In conclusion, childhood adversity was associated to greater loneliness in later life through self-continuity. Divorcees were the most impacted group regarding emotional loneliness, as they experienced lower levels of self-continuity. Interventions that aim to reinforce self-continuity may help overcome social and emotional loneliness, especially for individuals who have experienced the loss of their partner through divorce.

Does social participation decrease the risk of frailty? Impacts of diversity in frequency and types of social participation on frailty in middle-aged and older populations

BACKGROUND

Social participation (SP) may be an effective measure for decreasing frailty risks. This study investigated whether frequency and type of SP is associated with decreased frailty risk among Chinese middle-aged and older populations.

METHODS

Data were derived from the China Health and Retirement Longitudinal Study (CHARLS). Frailty was assessed using the Rockwood's Cumulative Deficit Frailty Index. SP was measured according to frequency (none, occasional, weekly and daily) and type (interacting with friends [IWF]; playing mah-jong, chess, and cards or visiting community clubs [MCCC], going to community-organized dancing, fitness, qigong and so on [DFQ]; participating in community-related organizations [CRO]; voluntary or charitable work [VOC]; using the Internet [INT]). Smooth curves were used to describe the trend for frailty scores across survey waves. The fixed-effect model (N = 9,422) was applied to explore the association between the frequency/type of SP and frailty level. For baseline non-frail respondents (N = 6,073), the time-varying Cox regression model was used to calculate relative risk of frailty in different SP groups.

RESULTS

Weekly (β =  - 0.006; 95%CI: [- 0.009, - 0.003]) and daily (β =  - 0.009; 95% CI: [- 0.012, - 0.007]) SP is associated with lower frailty scores using the fixed-effect models. Time-varying Cox regressions present lower risks of frailty in daily SP group (HR = 0.76; 95% CI: [0.69, 0.84]). SP types that can significantly decrease frailty risk include IWF, MCCC and DFQ. Daily IWF and daily DFQ decreases frailty risk in those aged < 65 years, female and urban respondents, but not in those aged ≥ 65 years, male and rural respondents. The impact of daily MCCC is significant in all subgroups, whereas that of lower-frequent MCCC is not significant in those aged ≥ 65 years, male and rural respondents.

CONCLUSION

This study demonstrated that enhancing participation in social activities could decrease frailty risk among middle-aged and older populations, especially communicative activities, intellectually demanding/engaging activities and community-organized physical activities. The results suggested very accurate, operable, and valuable intervening measures for promoting healthy ageing.

Social determinants of vulnerability in the population of reproductive age: a systematic review

Background

The health of an (unborn) child is largely determined by the health and social determinants of its parents. The extent to which social determinants of parents or prospective parents affect their own health depends partly on their coping or resilience abilities. Inadequate abilities allow negative effects of unfavourable social determinants to prevail, rendering them vulnerable to adverse health outcomes. Addressing these determinants in the reproductive-aged population is therefore a key approach in improving the health of the future generation. This systematic review aims to synthesise evidence on social determinants of vulnerability, i.e., inadequate coping or low resilience, in the general population of reproductive age.

Methods

The databases EMBASE, Medline, PsycINFO, CINAHL, Google Scholar, Web of Science, and Cochrane Library, were systematically searched from database inception to December 2th 2021.

Observational studies examining social determinants and demographics in relation to vulnerability among the general population of reproductive age (men and women aged 18-40 years), conducted in a high-income country in Europe or North America, Australia or New Zealand were eligible for inclusion. Relevant data was extracted from each included article and findings were presented in a narrative and tabulated manner.

Results

We identified 40,028 unique articles, of which 78 were full text reviewed. Twenty-five studies were included, of which 21 had a cross-sectional study design (84%). Coping was the most frequently assessed outcome measure (n = 17, 68%). Thirty social determinants were identified. Overall, a younger age, lower socioeconomic attainment, lack of connection with the social environment, and adverse life events were associated with inadequate coping or low resilience.

Conclusions

This review shows that certain social determinants are associated with vulnerability in reproductive-aged individuals. Knowing which factors make people more or less vulnerable carries health-related implications. More high-quality research is needed to obtain substantial evidence on the strength of the effect of these social conditions in this stage of life.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13651-6.

Relationship between the COVID-19 Pandemic and the Well-Being of Adolescents and Their Parents in Switzerland

This study is based on two waves of data collected by the Swiss Household panel, the first one in 2019, before the beginning of the COVID-19 pandemic, and the second one in May-June 2020, just after the end of the partial lockdown that was decided by the Swiss government. We considered "couples" of adolescents (age 14-24, mean = 18.82, 51.96% female) and their parents living together (n = 431). Our main goal was to determine whether the evolution of the well-being among adolescents was similar to the evolution of the well-being among parents. Ten indicators of well-being were measured identically in both waves and for both adolescents and their parents. Results indicate that while almost all indicators of well-being decreased during partial lockdown for both adolescents and their parents, adolescents were more strongly impacted than their parents. Furthermore, the change observed in adolescents was virtually unaffected by the change observed in their parents, and vice versa. This research is a reminder that while different population groups may be affected differently by a sudden and extreme event, it is not only older people who will be most affected. Here, adolescents appear to have been more adversely affected than adults.

Work-to-family conflict, family satisfaction and engagement nexus: insights from millennial managers

Purpose

Millennials’ perception of work, personal and family life is different from other generations. Building on studies on workforce generations, this paper aims to uncover not only the effect of work-to-family conflict (WFC) and family satisfaction (FS) on millennial managers engagement but also the moderating effect of (gender and marital status) in predicting engagement.

Design/methodology/approach

This paper used a survey to collect data from managers of selected companies in Nigeria. In total, 127 questionnaires were analysed using the partial least square structural equation modelling method.

Findings

Results reveal that the relationship between WFC, FS and millennial managers’ engagement is direct and significant. Besides, the effect of WFC on engagement is stronger in men and for married. The effect of FS on engagement is greater for women than men and for married.

Practical implications

This study informs the research community as well as practitioners and affirms the importance of supportive work-to-family life and FS in fostering millennial managers’ engagement with their organisations.

Originality/value

This study is among the initial attempts to evaluate the impact of WFC and FS on engagement among millennial managers, especially in Africa, Nigeria in particular. The results identify millennial managers’ unique perspectives towards engagement and how gender and marital status may enhance engagement. With millennials fast attaining leadership roles, such knowledge is important.

General and Vulnerable Population’s Satisfaction With the Healthcare System in Urban and Rural Areas: Findings From the European Social Survey

Introduction: Access to the healthcare system when patients are vulnerable and living outside metropolitan areas can be challenging. Our objective was to explore healthcare system satisfaction of urban and rural inhabitants depending on financial and health vulnerabilities.

Methods: Repeated cross-sectional data from 353,523 European citizens (2002–2016). Multivariable associations between rural areas, vulnerability factors and satisfaction with the healthcare system were assessed with linear mixed regressions and adjusted with sociodemographic and control factors.

Results: In unadjusted analysis, the people who lived in houses in the countryside and those who lived in the suburbs were the most satisfied with the healthcare system. In the adjusted model, residents living in big cities had the highest satisfaction. Financial and health vulnerabilities were associated with less satisfaction with the healthcare system, with a different effect according to the area of residence: the presence of health vulnerability was more negatively correlated with the healthcare system satisfaction of big city inhabitants, whereas financial vulnerability was more negatively correlated with the satisfaction of those living in countryside homes.

Conclusion: Vulnerable residents, depending on their area of residence, may require special attention to increase their satisfaction with the healthcare system.

Financial scarcity undermines health across the globe and the life course

The gradient between income and health is well established: the lower the income, the poorer the health. However, low income (having few economic resources) may not be enough to characterize economic vulnerability, and financial scarcity (perceiving having insufficient economic resources) may further reduce health. First, analysis of cross-national data (275,000+ participants from 200+ country-years) revealed that financial scarcity was associated with twice the odds of suffering from reduced self-rated health and feelings of unhappiness; this association was observed in ≈90% of the country-years and explained variance over and above income. Second, analysis of national longitudinal data (20,000+ participants over 20 years of assessment) revealed that facing financial scarcity in the course of one's life decreased self-rated and objective health and increased feelings of depression; again, these effects explained variance over and above income. Two subsidiary findings were obtained: (i) three adverse life events (illness, separation, family conflicts) predicted financial scarcity over the life course, and (ii) self-mastery (a component of sense of control) accounted for the detrimental longitudinal effects of financial scarcity on health. This research suggests that to understand socioeconomic inequality in health, one should consider not only an individual's quantity of monetary resources but also the perceived sufficiency of these resources.

Household Diversity and the Impacts of COVID-19 on Families in Portugal

Throughout the world, the COVID-19 pandemic disrupted family routines, relationships, projects and sociability, threatening the health, income, social cohesion, and well-being of individuals and their families. Lockdown restrictions imposed during the first wave of the pandemic challenged the theories, concepts, and methods used by family sociologists and the intersecting fields of gender and social inequality. By restricting physical interactions to co-resident family members, the household regained a privileged role as a crucial social laboratory for studying the impact of COVID-19 on family life. The difficulties encountered by individuals in maintaining and dealing with close relationships across households and geographical borders, in a context in which relational proximity was discouraged by the public authorities, exposed the linked nature of family and personal relationships beyond the limits of co-residence. The main aim of this article is to investigate the social impacts of the pandemic on different types of households during the first lockdown at an early stage of the pandemic in Portugal. Drawing on an online survey applied to a non-probabilistic sample of 11,508 households between 25 and 29 March 2020, the authors combined quantitative and qualitative methods, including bi-variate inferential statistics, cluster analysis and in-depth case studies. The article distinguishes between different household types: solo, couple with and without children, extended, friendship, lone-parent families, and intermittent arrangements, such as shared custody. A cross-tabulation of the quantitative data with open-ended responses was carried out to provide a refined analysis of the household reconfigurations brought about during lockdown. The analysis showed how pre-existing unequal structural living conditions shaped the pathways leading to household reconfiguration as families sought to cope with restrictions on mobility, social distancing norms, and other lockdown measures. The findings stress that, in dealing with a crisis, multilevel welfare interventions need to be considered if governments are to cater to the differentiated social needs and vulnerabilities faced by individuals and families.

Housing Instability and Depression among US Mothers Following a Nonmarital Birth

Mothers who had a nonmarital birth experience multiple risk factors for depression, including housing instability. Yet, important questions remain about the extent of long-term housing instability and its association with future depression among at-risk mothers. Using the Fragile Families and Child Wellbeing Study data, we examine cumulative housing instability over a 15-year period following nonmarital birth and its association with maternal depression. Based on a sample of 2279 mothers who had a nonmarital birth in 20 major US cities between 1998–2000, we examined their 15-year residential moves and housing arrangements. Then, we tested the associations between the cumulative residential moves and major depressive episodes (MDE) in Year 15 using logistic regression analysis. One in every four mothers had six or more residential moves in 15 years following a nonmarital birth. For each additional move, mothers reported up to 27.9% higher odds of having a past-year MDE in Year 15, translating into the prevalence increases from 6.0% (zero move) to 20.6% (10 moves). Our findings suggest that greater attention should be paid to housing needs among mothers following a nonmarital birth, including temporary housing assistance and more fundamental programs to reduce housing instability as preventive mental health services.

Taking Up and Terminating Leisure-Time Physical Activity over the Life Course: The Role of Life Events in the Familial and Occupational Life Domains

Leisure-time physical activity (LTPA) is associated with various health-promoting effects. However, little is known about the relationship between life events and changes in LTPA over the life course, especially when multiple life events occur simultaneously. Therefore, this study examines taking up and terminating LTPA associated with life events in the familial and occupational life domains over 16 years of 16-76-year-old Swiss inhabitants (n = 1857) in a retrospective longitudinal cohort design, using a validated telephone survey and multilevel discrete-time event-history analyses. The results show that taking up LTPA was more likely when ending a relationship and retiring and less likely when becoming a parent; terminating LTPA was more likely when ending a job, starting vocational training after 30 years, a relationship ended for men, and becoming a mother with increasing age. If experiencing multiple life events simultaneously, the greater the number of life events, the more likely persons aged 45-70 years were to take up LTPA and, conversely, the more likely persons aged 15-44 years to terminate LTPA. The relationship between life events and changes in LTPA over the life course was often age dependent, especially when experiencing multiple life events simultaneously. The findings should be considered when promoting LTPA.

Male childlessness across the adult life course: A case study addressing a potentially 'vulnerable' population

BACKGROUND

Like other Latin American countries, over the past half-century, Colombia has experienced rapid urbanization, dramatic fertility decline, and massive educational expansion. These socio-demographic changes have transformed gender roles and, with them, the landscape surrounding reproductive decisions, family life, and opportunities in other life 'domains.' I draw on the 'life course cube' (LCC) approach, which frames individual actions within a multidimensional behavioral process shaped by interdependencies between time, life domains, and levels to explore Colombian male childlessness.

OBJECTIVE

I seek to answer two questions: How does Colombian non-fatherhood vary across the life course (with respect to overall prevalence and associated factors)? and How do men frame their non-fatherhood, and, especially, how do they envision a future without children?

METHODOLOGY

To address the first question, I used the 2015 Colombian Demographic and Health Survey's men's dataset (N > 30,000) to explore the overall level of male childlessness across age/generational groups and separate voluntary/involuntary childlessness. Then, using generalized linear models, I analyzed the relationships between different life domains (e.g. education, employment) and non-fatherhood at time points representing early-, mid-, and later-life childlessness (among men in their thirties, forties, and fifties). To address the second question, I used qualitative data from in-depth life history interviews I conducted with male (N = 7) and female (N = 28) parents/non-parents in Bogotá, analyzing connections between different 'levels' of men's experiences: their inner feelings, past and (envisioned) future actions, and societal factors framing childlessness.

RESULTS AND DISCUSSION

The quantitative findings indicate that male childlessness across the adult life course is strongly associated with later start of first union/never entering a union, and with small ideal family size. Later-life, definitive childlessness is also strongly associated with relative economic disadvantage and lower-prestige occupations, though early-life fatherhood postponement is not. Qualitatively, interviewed men expressed more worry and less preparation for the future than childless women. Understanding 'vulnerability' as 'the dynamics of stress and resources across the life course', I discuss these findings, paying attention to older non-fathers' potential psycho-social, relational, and socioeconomic vulnerability. Therefore, this work seeks to contribute to the literature on the determinants and experiences of male childlessness, focusing on a Latin American perspective.

"Juntos pero no revueltos": Family residential dependence and care vulnerabilities along the life course

In the study of family residential dependence, Latin American literature has focused on coresidence and explained its relationship with care vulnerability trajectories in terms of the survival strategies of the poor. This approach implies the hypothesis of a substitution mechanism between family and paid care. However, this represents an incomplete picture of residential dependence in this context. Based on the contributions of three theoretical approaches-residential proximity, family configurations, and life course-and data from an ethnographic study carried out in Santiago, Chile, between 2006 and 2015, we analyze the relationship between family residential dependence configurations and care among individuals belonging to professional middle- and upper-class kinship groups. First, we show that residential dependence may occur between non-coresident individuals, mainly through quasi-coresidence and recohabitation practices. This allows individuals to remain rooted in a multigenerational network of interdependence throughout the life course at all socioeconomic levels, what the interviewees in the study called the "together but not mixed" ideal. Second, although a significant part of the residential interdependence is articulated around daily intergenerational care practices, we propose an alternative explanatory model based on the redundancy hypothesis, where the family solution to care vulnerabilities is generally preferred even when non-family care alternatives are available. The relationship between family members' care needs and residential dependence mechanisms cannot be reduced to economic deficits or strategic responses. Such needs participate in a structure of care preferences linked to culturally defined kinship styles, where frequent co-presence solidarity predominates.

Gender and race differences in pathways out of in-work poverty in the US

Research on in-work poverty has focused on the probability of being employed while living in an impoverished household, but no studies have investigated pathways of labor market attachment and economic vulnerability following in-work poverty. We use the Panel Study of Income Dynamics (PSID) to establish a typology of employment pathways out of in-work poverty and to estimate differences by gender and race. By using the Sequence Analysis Multistate Model procedure, we identify five distinct pathways characterized by varying degrees of labor market attachment, economic vulnerability, and volatility. White men are most likely exit in-work poverty into stable employment outside of poverty, while Black men and women often experience recurrent spells of in-work poverty. Gender and race differences persist even after controlling for labor market and family demographic characteristics. Our results indicate that work-related anti-poverty strategies must be coupled with adequately high wages and employment protection legislation to effectively raise working households out of poverty.

Inequality of educational opportunity at time of schooling predicts cognitive functioning in later adulthood

Objectives

Our understanding of how societal conditions and educational policies influence cognitive development across the life course is improving. We tested the extent to which inequality of educational opportunity (IEO), the country- and cohort-specific correlation of parents' and their offspring's length of schooling, offers systematically different opportunities to contribute to cognitive development, which in turn influences cognitive abilities up to older ages.

Methods

A total of 46,972 individuals of three cohorts born 1940-63 from 16 European countries and Israel provided up to six cognitive assessments and information on covariates in the SHARE survey 2004-2017. Individual-level data were linked to indicators of IEO at time of schooling, and economic, health, and human development, provided by World Bank, WHO, and the UN.

Results

In multilevel (mixed-effects) models with random individual and country-cohort effects and adjusted for a large set of confounders, higher IEO was associated with lower levels of cognitive functioning in men and women. Interaction analyses suggested lower cognitive levels particularly of women who were schooled in higher IEO contexts and had lower educational attainment. Associations with rate of change in cognitive functioning were present only in women, however there was little clinically relevant cognitive decline across the window of observation. Result patterns were mostly consistent after including additional contextual indicators, and in a subsample with childhood information.

Discussion

Findings suggest that IEO is able to substantially influence cognitive development with long-lasting impacts. Lower-educated women of the cohorts under investigation may have been particularly vulnerable to high-inequality educational contexts.

Rewealthization in twenty-first century Western countries: the defining trend of the socioeconomic squeeze of the middle class

The wealth-to-income ratio (WIR) in many Western countries, particularly in Europe and North America, increased by a factor of two in the last three decades. This represents a defining empirical trend: a rewealthization (from the French repatrimonialisation)-or the comeback of (inherited) wealth primacy since the mid-1990s. For the sociology of social stratification, "occupational classes" based on jobs worked must now be understood within a context of wealth-based domination. This paper first illustrates important empirical features of an era of rising WIR. We then outline the theory of rewealthization as a major factor of class transformations in relation to regimes stabilized in the post-WWII industrial area. Compared to the period where wealth became secondary to education and earnings for middle-class lifestyles, rewealthization steepens society's vertical structure; the "olive-shaped" Western society is replaced by a new one where wealth "abundance" at the top masks social reproduction and frustrations below.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40711-020-00135-6.

Field-Based Health-Related Physical Fitness Tests in Children and Adolescents: A Systematic Review

Physical fitness (PF) is a multi-component construct and a biomarker of health. Worse PF is related to vulnerability and predicts worse academic achievements. Thus, assessing PF is important to monitor health in youth. This systematic review aimed to identify and inform physical education, health professionals and entities about existing PF batteries and field-tests that can be used in school settings. A comprehensive literature search was carried out in five electronic databases (Academic Search Complete, Education Resources Information Center, PubMed, Scopus, and Web of Science) to identify PF battery protocols that can be carried out in the school setting. Overall, 24 PF batteries were identified. Regarding the PF components assessed, only cardiorespiratory fitness and upper body strength were contemplated in all batteries. Middle-body strength and lower body strength were presented in most batteries (21 and 19 of 24, respectively). Agility (16 of 24) and body composition (16 of 24) were also considered in several batteries, although to a lesser extent. Flexibility (14 of 24) and speed (12 of 24) were the PF components less represented in the batteries. Among the 24 identified PF batteries, 81 PF tests assessing the different PF components were encountered. The advances in the PF field-based assessment in school settings and health in youth resulted in the amplification of the number of existing batteries. Considering the connection between PF and health and the opportunity that the school setting provides to assess fitness in children and adolescents, there is a need for standardization and a consensus of PF assessments in this specific setting.

Cognitive Reserve Mitigates Decline in Executive Functioning Following Hepatobiliary Diseases

Abstract. The cognitive reserve hypothesis postulates that lifelong cognitive stimulation establishes a buffer that is instrumental in maintaining cognitive health. To examine this conceptual proposition in detail, we applied a novel, more general conceptual view that included recent models of vulnerability and examined whether the longitudinal association between hepatobiliary diseases and later decline in executive functioning across 6 years varied by cognitive reserve. For this purpose, we investigated longitudinal data from 897 older individuals ( M = 74.33 years) tested using the Trail Making Test (TMT) in two waves 6 years apart. Individuals reported information on key commonly used indicators of lifelong cognitive reserve build-up (i.e., education, work, and participation in leisure activity) and hepatobiliary diseases. The results revealed a significant interaction of hepatobiliary diseases with participation in leisure activity on latent change in executive functioning. Specifically, only in individuals with little (but not greater) participation in leisure activity did hepatobiliary diseases significantly predict a steeper decline in executive functioning over 6 years (i.e., increases in TMT finishing time). In conclusion, the unfavorable aftereffects of hepatobiliary diseases on a later decline in executive functioning seem to be mitigated in individuals who have built up greater cognitive reserve via participation in leisure activity during their life.

Toward a dynamic model of Gelotophobia: Social support, workplace bullying and stress are connected with diverging trajectories of life and job satisfaction among Gelotophobes

Recent theoretical advances have grounded gelotophobia (Greek: gelos = laughter, phobos = fear) in a dynamic framework of causes, moderating factors, and consequences of the fear of being laughed at. This understanding corresponds to that of vulnerability and translates gelotophobia into a distinguishable pattern of lacking resources (i.e., misinterpretation of joy and laughter) that can result in negative consequences (e.g., reduced well-being and performance) if individuals have no access to further resources (e.g., social support) or are exposed to severe stressors (e.g., workplace bullying). Based on the panel data provided by the Swiss National Centre of Competence in Research LIVES (N = 2469 across six measurement intervals), this study takes the first step toward empirically testing this model's assumptions: First, we computed exemplary zero-order correlations and showed that gelotophobia was negatively connected with social support (resource) and life and job satisfaction (consequences) and positively connected with perceived stress, work stress, and workplace bullying (stressors). Second, we used longitudinal cluster analyses (KmL; k-means-longitudinal) and showed that the panel data can be clustered into three stable patterns of life and job satisfaction and that gelotophobia is primarily related to the two clusters marked by lower levels of satisfaction. Third, we computed partial correlations and showed that social support, perceived stress, and work stress (but not workplace bullying) can weaken or completely resolve gelotophobia's relationships with such diverging trajectories of life and job satisfaction. We concluded that seeing gelotophobia through the lens of vulnerability is useful and that such research warrants further attention using more dedicated, theoretically grounded projects.

Spillover Effects of Job Skills Training on Substance Misuse Among Low-Income Youths With Employment Barriers: A Longitudinal Cohort Study

Objectives. To examine spillover effects of job skills training (vs basic services only [e.g., adult basic education, job readiness training]) on substance misuse among low-income youths with employment barriers.Methods. Data came from the National Longitudinal Survey of Youth 1997, a longitudinal cohort study of youths born between 1980 and 1984 in the United States. Based on respondents' reports of substance misuse (past-month binge drinking and past-year marijuana and other illicit drug use) from 2000 to 2016, we estimated substance misuse trajectories of job skills training (n = 317) and basic services (n = 264) groups. We accounted for potential selection bias by using inverse probability of treatment weighting.Results. Compared with the basic services group, the job skills training group showed notable long-term reductions in its illicit drug misuse trajectory, translating to a 56.9% decrease in prevalence rates from 6.5% in year 0 to 2.8% in year 16.Conclusions. Job skills training can be an important service component for reducing substance misuse and improving employment outcomes among youths with economic disadvantages and employment barriers.

The relation of low cognitive abilities to low well-being in old age is attenuated in individuals with greater cognitive reserve and greater social capital accumulated over the life course

Objectives: The present study sets out to investigate the relation of cognitive abilities to well-being and its interplay with key life course proxies of cognitive reserve and social capital in a large sample of older adults.Method: Three thousand eighty older adults served as sample for the present study. Physical well-being (EuroQoL-5D questionnaire) and psychological well-being (Satisfaction with Life Scale) as well as cognitive performance in terms of verbal abilities (Mill Hill vocabulary scale), processing speed (Trail Making Test part A), and cognitive flexibility (Trail Making Test part B) were assessed. Participants reported information on education, occupation, cognitively stimulating leisure activities, the different languages regularly spoken as well as family and close friends.Results: Moderation analyses showed that the relation of cognitive performance to physical and psychological well-being was significantly attenuated in individuals with a higher cognitive level of the first job after education, a larger number of midlife and current cognitively stimulating leisure activities, a larger number of languages regularly spoken, a larger number of significant family members and friends, and more frequent contact with and more confidence in significant family members.Conclusion: Present data suggest that the relation of low cognitive abilities to low well-being in old age is attenuated in individuals with greater cognitive reserve and greater social capital accumulated over the life course.

Building an interdisciplinary framework to advance conceptual and technical aspects of population-environment research focused on women's and children's health

Great gains have been made in providing researchers geo-spatial data that can be combined with population health data. This development is crucial given concerns over the human health outcomes associated with a changing climate. Merging population and environmental data remains both conceptually and technically challenging because of a large range of temporal and spatial scales. Here we propose a framework that addresses and advances both conceptual and technical aspects of population-environment research. This framework can be useful for considering how any time or space-based environmental occurrence influences population health outcomes and can be used to guide different data aggregation strategies. The primary consideration discussed here is how to properly model the space and time effects of environmental context on individual-level health outcomes, specifically maternal, child and reproductive health outcomes. The influx of geospatial health data and highly detailed environmental data, often at daily scales, provide an opportunity for population-environment researchers to move towards a more theoretically and analytically sound approach for studying environment and health linkages.

Crisis, recession and social resilience: A biographical life course analysis

This article examines social resilience to the economic crisis and recession across three 'generational cohorts' of Irish people, using a mixed biographical life course approach. Drawing on narrative interviews and individual lifelines conducted as part of a cross-national European study, we describe and explain how age-differentiated lives and times intersected with ill-timed transitions and patterns of inter-generational relations, leading to variations in resilient future orientations. Our analysis yields three key findings. First, failed expectations for intra-generational social mobility, combined with inter-generational obligations, gave rise to negative future orientations amongst those in mid-life. Second, the crisis created multiple negative life changes that compounded the accumulated costs of poorly timed transitions and adverse experiences within biographies. The effect of this varied by generational cohort, life course stage (with its implications for inter-generational obligations), gender and social class. Third, both life course stage and biographical experience affected peoples' orientations towards the future, with implications for their resilience.

Work Burnout and Engagement Profiles Among Teachers

The focus of the current study was to examine teachers' well-being in terms of work engagement and burnout by using a person-oriented approach. The participants (n = 149, 70.5% female) were subject-matter teachers from 22 schools from metropolitan Helsinki area in Finland. The first aim was to examine the kinds of profiles we can identify based on work burnout and engagement among teachers. The second aim was to study how the identified profiles differed in job-related demands and resources and personal resources in terms of resilience. Based on the demands-resources model, we expected to find profiles that differ in terms of key resources and demands. The sample was acquired as a convenience sample and the data was collected using online self-report questionnaires. The measures were work engagement, work burnout, work demands/resources (workload and control) and resilience as the personal resource. In addition, changes and effects of the economic circumstances were accounted for with two binary variables assessing the effect on class sizes and material resources. We identified two profiles among teachers: engaged (30%) and engaged-burnout (70%) profiles. We found that those in the engaged profile group had more job and personal resources, such as control and resilience, whereas those in the engaged-burnout profile group experienced more work demands, such as workload.

How plans change: Anticipation, interferences and unpredictabilities

The purpose of this article is to examine the way in which individuals consider their futures, what happens to these anticipations over time and where the unpredictabilities that disrupt the realization of these expectations are located. These reflections are based on a qualitative longitudinal survey conducted over 20 years (1995-2015) with six waves, among a panel of young people entering adult life in Normandy (France). I propose to explore empirically why their anticipations frequently remain unrealized and what factors intervened in a predictable or unpredictable way and diverted the life course from what had been anticipated. We will then see that these changes are due mainly to the interdependencies between the different levels and domains of life and to the effects of time which produces synchronizations, shifts and coincidences between these levels and domains. The interdependencies apply not only to lives following their course, but also to the turning points that brought them to change direction. It becomes crucial to take into consideration theoretically and empirically the disruptions that occur over the life course rather than considering individuals' lives as following simple linear trajectories. The analysis of turning points highlights the relevant elements of the life course, the decisive factors and the changes in priority, which are made more conscious and explicit by the respondents than in more stable sequences. A lifecourse theory must integrate these unpredictabilities, interferences and reorientations which are part of the complex processes at stake.

The life course cube: A tool for studying lives

This paper proposes a conceptualization of the life course as a set of behavioral processes characterized by interdependencies that cross time, life domains, and levels of analysis. We first discuss the need for a systematized approach to life course theory that integrates parallel and partially redundant concepts developed in a variety of disciplines. We then introduce the 'life course cube,' which graphically defines and illustrates time-domain-level interdependencies and their multiple interactions that are central to understanding life courses. Finally, in an appendix, we offer a formal account of these interactions in a language that can be readily adopted across disciplines. Our aim is to provide a consistent and parsimonious foundation to further develop life course theories and methods and integrate life course scholarship across disciplines.

The Longitudinal Relationship of Perceived Stress Predicting Subsequent Decline in Executive Functioning in Old Age Is Attenuated in Individuals with Greater Cognitive Reserve

BACKGROUND

Cognitively stimulating activities contribute to the accumulation of cognitive reserve that is proposed to be instrumental for maintaining cognitive functioning in aging. Adopting a novel, more general conceptual perspective including models of vulnerability, we argue that cognitive reserve may modify the longitudinal association between perceived stress and the rate of subsequent decline in executive functioning.

OBJECTIVE

The present study set out to investigate the longitudinal relationship between perceived stress and subsequent decline in executive functioning over 6 years as measured through performance changes in the Trail Making Test (TMT) and whether this longitudinal relationship differed by key markers of cognitive reserve (education, occupation, and leisure activities), taking into account age, sex, and chronic diseases as covariates.

METHODS

We used latent change score modeling based on longitudinal data from 897 older adults tested on TMT parts A and B in two waves 6 years apart. Mean age in the first wave was 74.33 years. Participants reported information on perceived stress, education, occupation, leisure activities, and chronic diseases.

RESULTS

The longitudinal relationship between greater perceived stress in the first wave of data collection and steeper subsequent decline in executive functioning over 6 years was significantly reduced in individuals who had pursued a higher frequency of leisure activities in the first wave.

CONCLUSION

The longitudinal relationship between perceived stress and subsequent decline in executive functioning may be attenuated in individuals who have accumulated greater cognitive reserve through an engaged lifestyle. Implications for current cognitive reserve and gerontological research are discussed.