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Kim ES, Wilkinson R, Okuzono SS, Chen Y, Shiba K, Cowden RG, VanderWeele TJ. Positive affect during adolescence and health and well-being in adulthood: An outcome-wide longitudinal approach. PLoS Med 2024; 21:e1004365. [PMID: 38564500 PMCID: PMC10986977 DOI: 10.1371/journal.pmed.1004365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/22/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Several intergovernmental organizations, including the World Health Organization and United Nations, are urging countries to use well-being indicators for policymaking. This trend, coupled with increasing recognition that positive affect is beneficial for health/well-being, opens new avenues for intervening on positive affect to improve outcomes. However, it remains unclear if positive affect in adolescence shapes health/well-being in adulthood. We examined if increases in positive affect during adolescence were associated with better health/well-being in adulthood across 41 outcomes. METHODS AND FINDINGS We conducted a longitudinal cohort study using data from Add Health-a prospective and nationally representative cohort of community-dwelling U.S. adolescents. Using regression models, we evaluated if increases in positive affect over 1 year (between Wave I; 1994 to 1995 and Wave II; 1995 to 1996) were associated with better health/well-being 11.37 years later (in Wave IV; 2008; N = 11,040) or 20.64 years later (in Wave V; 2016 to 2018; N = 9,003). Participants were aged 15.28 years at study onset, and aged 28.17 or 37.20 years-during the final assessment. Participants with the highest (versus lowest) positive affect had better outcomes on 3 (of 13) physical health outcomes (e.g., higher cognition (β = 0·12, 95% CI = 0·05, 0·19, p = 0.002)), 3 (of 9) health behavior outcomes (e.g., lower physical inactivity (RR = 0·80, CI = 0·66, 0·98, p = 0.029)), 6 (of 7) mental health outcomes (e.g., lower anxiety (RR = 0·81, CI = 0·71, 0·93, p = 0.003)), 2 (of 3) psychological well-being (e.g., higher optimism (β = 0·20, 95% CI = 0·12, 0·28, p < 0.001)), 4 (of 7) social outcomes (e.g., lower loneliness (β = -0·09, 95% CI = -0·16, -0·02, p = 0.015)), and 1 (of 2) civic/prosocial outcomes (e.g., more voting (RR = 1·25, 95% CI = 1·16, 1·36, p < 0.001)). Study limitations include potential unmeasured confounding and reverse causality. CONCLUSIONS Enhanced positive affect during adolescence is linked with a range of improved health/well-being outcomes in adulthood. These findings suggest the promise of testing scalable positive affect interventions and policies to more definitively assess their impact on outcomes.
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Affiliation(s)
- Eric S. Kim
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts, United States of America
- Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Renae Wilkinson
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts, United States of America
| | - Sakurako S. Okuzono
- Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ying Chen
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Koichiro Shiba
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Richard G. Cowden
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts, United States of America
| | - Tyler J. VanderWeele
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Long KNG, Wilkinson R, Cowden RG, Chen Y, VanderWeele TJ. Hope in adolescence and subsequent health and well-being in adulthood: An outcome-wide longitudinal study. Soc Sci Med 2024; 347:116704. [PMID: 38493683 DOI: 10.1016/j.socscimed.2024.116704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND A sense of hopelessness is rising at alarming levels among adolescents in the United States. There is urgent need to understand the potential implications of being hopeful on adolescents' future health and wellbeing. METHODS This study utilized data from the National Longitudinal Study of Adolescent to Adult Health (N = 11,038, mean age at baseline = 15 years) to prospectively examine the relationship between baseline hope and a wide range of outcomes 12 years later. Thirty-eight outcomes were examined in the domains of physical health, health behavior, mental health, psychological well-being, social factors, and civic and prosocial behavior. Regression models were used to regress each outcome on baseline hope separately. Models controlled for a wide range of factors as well as prior values of the exposure (hope) and outcomes. RESULTS Having hope for the future in adolescence was associated with improvements in 11 subsequent outcomes after Bonferonni correction, including higher cognition and self-rated health, less physical inactivity, fewer depressive symptoms, lower perceived stress, and improvement on a number of psychological and social factors including greater happiness, more satisfaction with parenting, and increased voting and volunteering in adulthood. There were also a number of associations that were close to the null, which are equally important to explore and understand. IMPLICATIONS The results of the study may have important implications for hope-based efforts and programs aimed at improving the lives of young people and promoting their current and future well-being.
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Affiliation(s)
- Katelyn N G Long
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Renae Wilkinson
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Richard G Cowden
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Ying Chen
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tyler J VanderWeele
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Espinosa Dice AL, Lawn RB, Ratanatharathorn A, Roberts AL, Denckla CA, Kim AH, de la Rosa PA, Zhu Y, VanderWeele TJ, Koenen KC. Childhood maltreatment and health in the UK Biobank: triangulation of outcome-wide and polygenic risk score analyses. BMC Med 2024; 22:135. [PMID: 38523269 PMCID: PMC10962116 DOI: 10.1186/s12916-024-03360-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Childhood maltreatment is common globally and impacts morbidity, mortality, and well-being. Our understanding of its impact is constrained by key substantive and methodological limitations of extant research, including understudied physical health outcomes and bias due to unmeasured confounding. We address these limitations through a large-scale outcome-wide triangulation study. METHODS We performed two outcome-wide analyses (OWAs) in the UK Biobank. First, we examined the relationship between self-reported maltreatment exposure (number of maltreatment types, via Childhood Trauma Screener) and 414 outcomes in a sub-sample of 157,316 individuals using generalized linear models ("observational OWA"). Outcomes covered a broad range of health themes including health behaviors, cardiovascular disease, digestive health, socioeconomic status, and pain. Second, we examined the relationship between a polygenic risk score for maltreatment and 298 outcomes in a non-overlapping sample of 243,006 individuals ("genetic OWA"). We triangulated results across OWAs based on differing sources of bias. RESULTS Overall, 23.8% of the analytic sample for the observational OWA reported at least one maltreatment type. Of 298 outcomes examined in both OWAs, 25% were significant in both OWAs and concordant in the direction of association. Most of these were considered robust in the observational OWA according to sensitivity analyses and included outcomes such as marital separation (OR from observational OWA, ORo = 1.25 (95% CI: 1.21, 1.29); OR from genetic OWA, ORg = 1.06 (1.03, 1.08)), major diet changes due to illness (ORo = 1.27 (1.24, 1.29); ORg = 1.01 (1.00, 1.03)), certain intestinal diseases (ORo = 1.14 (1.10, 1.18); ORg = 1.03 (1.01, 1.06)), hearing difficulty with background noise (ORo = 1.11 (1.11, 1.12); ORg = 1.01 (1.00, 1.01)), knee arthrosis (ORo = 1.13 (1.09, 1.18); ORg = 1.03 (1.01, 1.05)), frequent sleeplessness (ORo = 1.21 (1.20, 1.23); ORg = 1.02 (1.01, 1.03)), and low household income (ORo = 1.28 (1.26, 1.31); ORg = 1.02 (1.01, 1.03)). Approximately 62% of results were significant in the observational OWA but not the genetic OWA, including numerous cardiovascular outcomes. Only 6 outcomes were significant in the genetic OWA and null in the observational OWA; these included diastolic blood pressure and glaucoma. No outcomes were statistically significant in opposite directions in the two analyses, and 11% were not significant in either OWA. CONCLUSIONS Our findings underscore the far-reaching negative effects of childhood maltreatment in later life and the utility of an outcome-wide triangulation design with sensitivity analyses for improving causal inference.
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Affiliation(s)
- Ana Lucia Espinosa Dice
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
| | - Rebecca B Lawn
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Andrew Ratanatharathorn
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, NY, USA
| | - Andrea L Roberts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christy A Denckla
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ariel H Kim
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, USA
| | - Pedro A de la Rosa
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Yiwen Zhu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Psychiatric Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Hong JH, Nakamura JS, Sahakari SS, Chopik WJ, Shiba K, VanderWeele TJ, Kim ES. The silent epidemic of loneliness: identifying the antecedents of loneliness using a lagged exposure-wide approach. Psychol Med 2024:1-14. [PMID: 38497115 DOI: 10.1017/s0033291723002581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND A large and accumulating body of evidence shows that loneliness is detrimental for various health and well-being outcomes. However, less is known about potentially modifiable factors that lead to decreased loneliness. METHODS We used data from the Health and Retirement Study to prospectively evaluate a wide array of candidate predictors of subsequent loneliness. Importantly, we examined if changes in 69 physical-, behavioral-, and psychosocial-health factors (from t0;2006/2008 to t1;2010/2012) were associated with subsequent loneliness 4 years later (t2;2014/2016). RESULTS Adjusting for a large range of covariates, changes in certain health behaviors (e.g. increased physical activity), physical health factors (e.g. fewer functioning limitations), psychological factors (e.g. increased purpose in life, decreased depression), and social factors (e.g. greater number of close friends) were associated with less subsequent loneliness. CONCLUSIONS Our findings suggest that subjective ratings of physical and psychological health and perceived social environment (e.g. chronic pain, self-rated health, purpose in life, anxiety, neighborhood cohesion) are more strongly associated with subsequent loneliness. Yet, objective ratings (e.g. specific chronic health conditions, living status) show less evidence of associations with subsequent loneliness. The current study identified potentially modifiable predictors of subsequent loneliness that may be important targets for interventions aimed at reducing loneliness.
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Affiliation(s)
- Joanna H Hong
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Julia S Nakamura
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Sakshi S Sahakari
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - William J Chopik
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Koichiro Shiba
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tyler J VanderWeele
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eric S Kim
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
- Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Ortega Bechara A, Chen ZJ, Cowden RG, Worthington EL, Toussaint L, Rodriguez N, Guzman Murillo H, Ho MY, Mathur MB, VanderWeele TJ. Do Forgiveness Campaign Activities Improve Forgiveness, Mental Health, and Flourishing? Int J Public Health 2024; 69:1605341. [PMID: 38524628 PMCID: PMC10957572 DOI: 10.3389/ijph.2024.1605341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/27/2024] [Indexed: 03/26/2024] Open
Abstract
Objectives: To evaluate the effectiveness of a forgiveness public health intervention at promoting forgiveness, mental health, and flourishing. Methods: Colombian students (N = 2,878) at a private, nonreligious university were exposed to a 4-week forgiveness community campaign and were assessed pre- and post-campaign. Results: Forgiveness, mental health, and flourishing outcomes showed improvements after the campaign. On average, participants reported engaging in 7.18 (SD = 3.99) of the 16 types of campaign activities. The number of types of campaign activities that participants engaged in evidenced a positive linear association with forgiveness, although some activities were more popular than others and some activities were more strongly associated with increased forgiveness. For depression, anxiety, and flourishing, engaging in more activities was generally associated with greater improvements, but the patterns were less consistent relative to forgiveness. Conclusion: This forgiveness public health intervention effectively promoted forgiveness, mental health, and flourishing. Effective campaigns in diverse communities involve promoting mental and physical health through forgiveness. However, recent conflict may hinder acceptance, necessitating political capital for leadership advocating forgiveness initiatives.
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Affiliation(s)
| | - Zhuo Job Chen
- School of Nursing, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Richard G. Cowden
- Human Flourishing Program and T. H. Chan School of Public Health, Harvard University, Cambridge, MA, United States
| | | | | | - Nicole Rodriguez
- Department of Psychology, Universidad del Sinú, Montería, Colombia
| | | | - Man Yee Ho
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Maya B. Mathur
- Quantitative Sciences Unit, Stanford University, Stanford, CA, United States
| | - Tyler J. VanderWeele
- Human Flourishing Program and T. H. Chan School of Public Health, Harvard University, Cambridge, MA, United States
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Padgett RN, Lee MT, Wilkinson R, Tsavaris H, VanderWeele TJ. Reliability and Validity of a Multidimensional Measure of Subjective Community Well-Being. Assessment 2024:10731911241229060. [PMID: 38334097 DOI: 10.1177/10731911241229060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
An individual's flourishing is sustained by and dependent on their community's well-being. We provide one of the first studies of a measure of communal subjective well-being, focusing on individuals' relationships with their community. Using two samples from the Greater Columbus, Ohio region, we provide evidence of the reliability and validity of the Subjective Community Well-being (SCWB) assessment. The five domains of the SCWB are Good Relationships (α = .92), Proficient Leadership (α = .93), Healthy Practices (α = .92), Satisfying Community (α = .88), and Strong Mission (α = .81). A community-based sample (N = 1,435) and an online sample of Columbus residents (N = 692) were scored on the SCWB and compared across domains. We found evidence that the SCWB scores differentiate between active and less active community members. We discuss the appropriate uses of the SCWB as a measure of well-being and provide recommendations for research that could profitably utilize the SCWB measure to examine community well-being.
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Affiliation(s)
- R Noah Padgett
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Human Flourishing Program, Harvard University, Cambridge, MA, USA
| | - Matthew T Lee
- Human Flourishing Program, Harvard University, Cambridge, MA, USA
- Baylor University, Waco, TX, USA
| | - Renae Wilkinson
- Human Flourishing Program, Harvard University, Cambridge, MA, USA
| | | | - Tyler J VanderWeele
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Human Flourishing Program, Harvard University, Cambridge, MA, USA
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VanderWeele TJ. Moral controversies and academic public health: Notes on navigating and surviving academic freedom challenges. Glob Epidemiol 2023; 6:100119. [PMID: 38111523 PMCID: PMC10726229 DOI: 10.1016/j.gloepi.2023.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 12/20/2023] Open
Abstract
Schools of public health often serve both as public health advocacy organizations and as academic units within a university. These two roles, however, can sometimes come into conflict. I experienced this conflict directly at the Harvard T. H. Chan School of Public Health in holding and expressing unpopular minority viewpoints on certain moral controversies. In this essay I describe my experiences and their relation to questions of academic freedom, population health promotion, and efforts at working together across differing moral systems.
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Affiliation(s)
- Tyler J. VanderWeele
- Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
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Chen Y, Mathur MB, Case BW, VanderWeele TJ. Marital transitions during earlier adulthood and subsequent health and well-being in mid- to late-life among female nurses: An outcome-wide analysis. Glob Epidemiol 2023; 5:100099. [PMID: 37638366 PMCID: PMC10445961 DOI: 10.1016/j.gloepi.2023.100099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
Comparing outcomes for individuals remaining married to those for single or divorced individuals might overstate the positive effects of the decision to marry, since marriage carries an inherent risk of divorce and its associated negative outcomes. While a growing literature has examined marital transitions, confounding by past marital history remains a concern and only a limited set of outcomes have been examined. To address these issues, this study examined incident first-time marriage and incident divorce/separation in relation to multiple subsequent physical health, health behavior, psychological distress, and psychosocial well-being outcomes in a large sample of female nurses in the U.S.. Data from the Nurses' Health Study II were studied (1993 to 2015/2017 questionnaire wave, Nmarriage analyses = 11,830, Ndivorce/separation analyses = 73,018, interquartile range of baseline age = 35 to 42 years). A set of regression models were used to regress each outcome on marital transition status, adjusting for a wide range of initial health and wellbeing status in addition to other covariates. Bonferroni correction was performed to account for multiple testing. Among the initially never married, those who became married had lower mortality (RR = 0.65, 95%CI = 0.50, 0.84), lower risks of cardiovascular diseases (e.g., RRstroke = 0.64, 95%CI = 0.50, 0.82), greater psychological wellbeing and less psychological distress (e.g., ßdepressive symptoms = -0.10, 95%CI = -0.15, -0.06). Among the initially married, those who became divorced/separated had lower social integration (β = -0.15, 95%CI = -0.19, -0.11), greater psychosocial distress (e.g., RRdepression = 1.23, 95%CI = 1.10, 1.37), and possibly greater risks of mortality, cardiovascular diseases, and smoking. Future research could study similar questions using data from more recent cohorts, examine potential mechanisms and heterogeneity, and also examine alternative social relationship types.
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Affiliation(s)
- Ying Chen
- Human Flourishing Program, Harvard Institute for Quantitative Social Science, Cambridge, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Maya B. Mathur
- Quantitative Sciences Unit and Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Brendan W. Case
- Human Flourishing Program, Harvard Institute for Quantitative Social Science, Cambridge, MA, USA
| | - Tyler J. VanderWeele
- Human Flourishing Program, Harvard Institute for Quantitative Social Science, Cambridge, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Nakamura JS, Shiba K, Jensen SM, VanderWeele TJ, Kim ES. Who Benefits From Helping? Moderators of the Association Between Informal Helping and Mortality. Ann Behav Med 2023; 57:1058-1068. [PMID: 37540830 DOI: 10.1093/abm/kaad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND While informal helping has been linked to a reduced risk of mortality, it remains unclear if this association persists across different levels of key social structural moderators. PURPOSE To examine whether the longitudinal association between informal helping and all-cause mortality differs by specific social structural moderators (including age, gender, race/ethnicity, wealth, income, and education) in a large, prospective, national, and diverse sample of older U.S. adults. METHODS We analyzed data from the Health and Retirement Study, a national sample of U.S. adults aged >50 (N = 9,662). Using multivariable Poisson regression, we assessed effect modification by six social structural moderators (age, gender, race/ethnicity, wealth, income, and education) for the informal helping (2006/2008) to mortality (2010-2016/2012-2018) association on the additive and multiplicative scales. RESULTS Participants who reported ≥100 hr/year of informal helping (vs. 0 hr/year), had a lower mortality risk. Those who engaged in 1-49 hr/year most consistently displayed lower mortality risk across moderators, while those who engaged in 50-99 and ≥100 hr/year only showed decreased mortality risk across some moderators. When formally testing effect modification, there was evidence that the informal helping-mortality associations were stronger among women and the wealthiest. CONCLUSIONS Informal helping is associated with decreased mortality. Yet, there appear to be key differences in who benefits from higher amounts of informal helping across social structural moderators. Further research is needed to evaluate how the associations between informal helping and health and well-being are patterned across key social structural moderators.
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Affiliation(s)
- Julia S Nakamura
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Koichiro Shiba
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Sofie M Jensen
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Tyler J VanderWeele
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eric S Kim
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
- Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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10
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Hong JH, Nakamura JS, Berkman LF, Chen FS, Shiba K, Chen Y, Kim ES, VanderWeele TJ. Are loneliness and social isolation equal threats to health and well-being? An outcome-wide longitudinal approach. SSM Popul Health 2023; 23:101459. [PMID: 37546381 PMCID: PMC10400921 DOI: 10.1016/j.ssmph.2023.101459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 08/08/2023] Open
Abstract
The detrimental effects of loneliness and social isolation on health and well-being outcomes are well documented. In response, governments, corporations, and community-based organizations have begun leveraging tools to create interventions and policies aimed at reducing loneliness and social isolation at scale. However, these efforts are frequently hampered by a key knowledge gap: when attempting to improve specific health and well-being outcomes, decision-makers are often unsure whether to target loneliness, social isolation, or both. Filling this knowledge gap will inform the development and refinement of effective interventions. Using data from the Health and Retirement Study (13,752 participants (59% women and 41% men, mean [SD] age = 67 [10] years)), we examined how changes in loneliness and social isolation over a 4-year follow-up period (from t0:2008/2010 to t1:2012/2014) were associated with 32 indicators of physical-, behavioral-, and psychosocial-health outcomes 4-years later (t2:2016/2018). We used multiple logistic-, linear-, and generalized-linear regression models, and adjusted for sociodemographic, personality traits, pre-baseline levels of both exposures (loneliness and social isolation), and all outcomes (t0:2008/2010). We incorporated data from all participants into the overall estimate, regardless of whether their levels of loneliness and social isolation changed from the pre-baseline to baseline waves. After adjusting for a wide range of covariates, we observed that both loneliness and social isolation were associated with several physical health outcomes and health behaviors. However, social isolation was more predictive of mortality risk and loneliness was a stronger predictor of psychological outcomes. Loneliness and social isolation have independent effects on various health and well-being outcomes and thus constitute distinct targets for interventions aimed at improving population health and well-being.
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Affiliation(s)
- Joanna H. Hong
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Julia S. Nakamura
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Lisa F. Berkman
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Frances S. Chen
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Koichiro Shiba
- Department of Epidemiology, Boston University, Boston, MA, USA
| | - Ying Chen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Eric S. Kim
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
- Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tyler J. VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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11
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Abstract
Schools of public health are often situated within universities but not infrequently also function as public health advocacy organizations. Viewpoint diversity on many issues is often limited within schools of public health and does not reflect the diversity one finds in society more generally. It is argued that welcoming, and even seeking out, viewpoint diversity within public health would contribute to understanding and knowledge, to the training public health leaders and academics who can serve the whole of society, and to working together across ideological lines to better contribute to population health.
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Affiliation(s)
- Tyler J. VanderWeele
- Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, United States
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12
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Cashin AG, McAuley JH, VanderWeele TJ, Lee H. Understanding how health interventions or exposures produce their effects using mediation analysis. BMJ 2023; 382:e071757. [PMID: 37468141 DOI: 10.1136/bmj-2022-071757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Affiliation(s)
- Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Tyler J VanderWeele
- Departments of Epidemiology and Biostatistics, TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Hopin Lee
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- IQVIA, London, UK
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13
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Shiba K, Cowden RG, Gonzalez N, Ransome Y, Nakagomi A, Chen Y, Lee MT, VanderWeele TJ, Fancourt D. Associations of online religious participation during COVID-19 lockdown with subsequent health and well-being among UK adults. Psychol Med 2023; 53:3887-3896. [PMID: 35189993 PMCID: PMC10317791 DOI: 10.1017/s0033291722000551] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND In-person religious service attendance has been linked to favorable health and well-being outcomes. However, little research has examined whether online religious participation improves these outcomes, especially when in-person attendance is suspended. METHODS Using longitudinal data of 8951 UK adults, this study prospectively examined the association between frequency of online religious participation during the stringent lockdown in the UK (23 March -13 May 2020) and 21 indicators of psychological well-being, social well-being, pro-social/altruistic behaviors, psychological distress, and health behaviors. All analyses adjusted for baseline socio-demographic characteristics, pre-pandemic in-person religious service attendance, and prior values of the outcome variables whenever data were available. Bonferroni correction was used to correct for multiple testing. RESULTS Individuals with online religious participation of ≥1/week (v. those with no participation at all) during the lockdown had a lower prevalence of thoughts of self-harm in week 20 (odds ratio 0.24; 95% CI 0.09-0.62). Online religious participation of <1/week (v. no participation) was associated with higher life satisfaction (standardized β = 0.25; 0.11-0.39) and happiness (standardized β = 0.25; 0.08-0.42). However, there was little evidence for the associations between online religious participation and all other outcomes (e.g. depressive symptoms and anxiety). CONCLUSIONS There was evidence that online religious participation during the lockdown was associated with some subsequent health and well-being outcomes. Future studies should examine mechanisms underlying the inconsistent results for online v. in-person religious service attendance and also use data from non-pandemic situations.
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Affiliation(s)
- Koichiro Shiba
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Richard G. Cowden
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | | | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Atsushi Nakagomi
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Ying Chen
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Matthew T. Lee
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Tyler J. VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
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14
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Nakamura JS, Lee MT, VanderWeele TJ, Kim ES. Informal Helping and Subsequent Health and Well-Being in Older U.S. Adults. Int J Behav Med 2023:10.1007/s12529-023-10187-w. [PMID: 37233899 DOI: 10.1007/s12529-023-10187-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Growing evidence suggests that informal helping (unpaid volunteering not coordinated by an organization or institution) is associated with improved health and well-being outcomes. However, studies have not investigated whether changes in informal helping are associated with subsequent health and well-being. METHODS This study evaluated if changes in informal helping (between t0;2006/2008 and t1;2010/2012) were associated with 35 indicators of physical, behavioral, and psychosocial health and well-being (at t2;2014/2016) using data from 12,998 participants in the Health and Retirement study - a national cohort of US adults aged > 50. RESULTS Over the four-year follow-up period, informal helping ≥ 100 (versus 0) hours/year was associated with a 32% lower mortality risk (95% CI [0.54, 0.86]), and improved physical health (e.g., 20% reduced risk of stroke (95% CI [0.65, 0.98])), health behaviors (e.g., 11% increased likelihood of frequent physical activity (95% CI [1.04, 1.20])), and psychosocial outcomes (e.g., higher purpose in life (β = 0.15, 95% CI [0.07, 0.22])). However, there was little evidence of associations with various other outcomes. In secondary analyses, this study adjusted for formal volunteering and a variety of social factors (e.g., social network factors, receiving social support, and social participation) and results were largely unchanged. CONCLUSIONS Encouraging informal helping may improve various aspects of individuals' health and well-being and also promote societal well-being.
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Affiliation(s)
- Julia S Nakamura
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada.
| | - Matthew T Lee
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, USA
- Institute for Studies of Religion, Baylor University, Waco, USA
| | - Tyler J VanderWeele
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Eric S Kim
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, USA
- Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, USA
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15
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Bialowolski P, Lee MT, Weziak-Bialowolska D, Chen Y, Cowden RG, McNeely E, VanderWeele TJ. Differences in Multi-Dimensional Well-Being Among Factory Workers: Evidence from Six Countries. Appl Res Qual Life 2023:1-22. [PMID: 37359225 PMCID: PMC10209924 DOI: 10.1007/s11482-023-10181-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/14/2023] [Indexed: 06/28/2023]
Abstract
This paper presents cross-cultural comparisons of well-being among factory workers, as measured by the six well-being domains of happiness and life satisfaction, physical and mental health, meaning and purpose, character and virtue, close social relationships, and financial and material stability. Relative ranks of well-being domains across examined groups of workers are also compared. Results are based on survey data from factory workers in Cambodia, China, Mexico, Poland, Sri Lanka, and the United States. Average well-being scores are higher among factory workers in Mexico, China, and Cambodia than in the U.S., Poland, and Sri Lanka across all domains except financial and material stability. Close social relationships were the highest ranked domain in Cambodia and China but ranked much lower (5th) in the U.S. Meaning and purpose, as well as character and virtue were highly ranked across the board. Strong social relationships seem to thrive in contexts where financial insecurity is high.
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Affiliation(s)
- Piotr Bialowolski
- Department of Economics, Kozminski University, Warsaw, Poland
- SHINE, Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, US
| | - Matthew T. Lee
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, US
- Institute for Studies of Religion, Baylor University, Waco, US
| | - Dorota Weziak-Bialowolska
- Center for Evaluation and Analysis of Public Policies, Faculty of Philosophy, Jagiellonian University, Kraków, Poland
- SHINE, Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, US
| | - Ying Chen
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, US
| | - Richard G. Cowden
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, US
| | - Eileen McNeely
- SHINE, Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, US
| | - Tyler J. VanderWeele
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, US
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16
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Wilkinson R, Cowden RG, Chen Y, VanderWeele TJ. Exposure to negative life events, change in their perceived impact, and subsequent well-being among U.S. adults: A longitudinal outcome-wide analysis. Soc Sci Med 2023; 324:115861. [PMID: 36989835 DOI: 10.1016/j.socscimed.2023.115861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/06/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Negative life events have the potential to undermine an individual's ability to function and thrive, but less is known about the implications of changes in subjective appraisals of those events for long-term well-being. This research examines how exposure to negative life events and subsequent changes in the perceived impact of those events are related to longer-term well-being in adulthood. METHOD Drawing on three waves of data from the Midlife in the United States study (M1: 1995-1996, M2: 2004-2006, M3: 2013-2014), we applied the analytic template for outcome-wide longitudinal designs to investigate associations of (a) negative life event exposure between M1 and M2 and (b) change in the perceived impact of negative life event exposure assessed at M2 with 25 outcomes across several domains of well-being assessed approximately 9 years later at M3: psychological distress, psychological well-being, social well-being, prosociality, physical health, and health behavior. RESULTS Whereas negative life event exposure was associated with worse subsequent well-being on selected outcomes (5/25 in total) in some domains, positive change in the perceived impact of negative life event exposure was associated with better well-being on one or more outcomes in most domains (11/25 in total). Effect sizes in both sets of analyses were generally small, with more consistent associations found for psychological and social outcomes. CONCLUSION Subjective appraisals of negative life events (particularly positive changes in those appraisals over time) may be more closely related to individual well-being in the long run than mere exposure to negative life events themselves. The findings bring attention to the possibility that positive changes in a person's subjective appraisal of negative life events could have beneficial consequences for long-term well-being.
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17
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Weziak-Bialowolska D, Lee MT, Cowden RG, Bialowolski P, Chen Y, VanderWeele TJ, McNeely E. Psychological caring climate at work, mental health, well-being, and work-related outcomes: Evidence from a longitudinal study and health insurance data. Soc Sci Med 2023; 323:115841. [PMID: 36958241 DOI: 10.1016/j.socscimed.2023.115841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/06/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023]
Abstract
Psychological climate for caring (PCC) is a psychosocial factor associated with individual work outcomes and employee well-being. Evidence on the impacts of various psychological climates at work is based mostly on self-reported health measures and cross-sectional data. We provide longitudinal evidence on the associations of PCC with subsequent diagnosed depression and anxiety, subjective well-being, and self-reported work outcomes. Employees of a US organization with a worker well-being program provided data for the analysis. Longitudinal survey data merged with data from personnel files and health insurance claims records comprising medical information on diagnosis of depression and anxiety were used to regress each outcome on PCC at baseline, adjusting for prior values of all outcomes and other covariates. PCC was found to be associated with lower odds of subsequent diagnosed depression, an increase in overall well-being, mental health, physical health, social connectedness, and financial security, as well as a decrease in distraction at work, an increase in productivity/engagement and possibly in job satisfaction. There was little evidence of associations between PCC and subsequent diagnosed anxiety, character strengths, and work-family conflict. Work policies focused on improving PCC may create a promising pathway to promoting employee health and well-being as well as improving work-related outcomes.
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Affiliation(s)
- Dorota Weziak-Bialowolska
- Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA; Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, 12 Arrow St, Cambridge, 02138, MA, USA; Centre for Evaluation and Analysis of Public Policies, Faculty of Philosophy, Jagiellonian University, Ul. Ingardena 3, 30-060, Cracow, Poland.
| | - Matthew T Lee
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, 12 Arrow St, Cambridge, 02138, MA, USA; Institute for Studies of Religion, Baylor University, One Bear Place #97236, Waco, 76798, TX, USA.
| | - Richard G Cowden
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, 12 Arrow St, Cambridge, 02138, MA, USA.
| | - Piotr Bialowolski
- Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA; Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, 12 Arrow St, Cambridge, 02138, MA, USA; Department of Economics, Kozminski University, Ul. Jagiellońska 57, 03-301, Warsaw, Poland.
| | - Ying Chen
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, 12 Arrow St, Cambridge, 02138, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA.
| | - Tyler J VanderWeele
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, 12 Arrow St, Cambridge, 02138, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA.
| | - Eileen McNeely
- Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
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18
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Lomas T, VanderWeele TJ. The Mental Illness-Health Matrix and the Mental State Space Matrix: Complementary meta-conceptual frameworks for evaluating psychological states. J Clin Psychol 2023. [PMID: 36916858 DOI: 10.1002/jclp.23512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/27/2023] [Accepted: 03/04/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE It is increasingly appreciated that mental health may not just involve a relative absence of mental illness, but the active presence of positive psychological desiderata. However, research attention on mental illness and health has tended to remain siloed and disconnected-proceeding along parallel tracks-with their potential relationship underexplored and undertheorized. As such, we sought to develop theoretical models to help us better understand the interaction of these two domains of experience. METHODS Through extensive engagement with relevant literature, we created two complementary meta-conceptual frameworks to represent and evaluate states of mental illness and health. RESULTS The Mental Illness-Health Matrix allows different forms of mental illness and health to be situated and assessed within a common framework. The Mental State Space Matrix further enables these various forms to be conceptualized and appraised in terms of numerous common parameters (e.g., valence and arousal). CONCLUSION It is hoped that these frameworks will stimulate and support further research on the inter-relational dynamics of illness and health. Indeed, the matrices themselves are provisional works-in-progress, with their articulation here intended as a foundation for their further development as understanding of these topics evolves and improves.
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Affiliation(s)
- Tim Lomas
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Human Flourishing Program, Harvard University, Cambridge, MA, USA
| | - Tyler J VanderWeele
- Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Human Flourishing Program, Harvard University, Cambridge, MA, USA
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19
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Cowden RG, Nakamura JS, de la Rosa Fernández Pacheco PA, Chen Y, Fulks J, Plake JF, VanderWeele TJ. The road to postpandemic recovery in the USA: a repeated cross-sectional survey of multidimensional well-being over two years. Public Health 2023; 217:212-217. [PMID: 36924673 PMCID: PMC10010931 DOI: 10.1016/j.puhe.2023.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/02/2022] [Accepted: 02/02/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES Examine differences in multidimensional well-being from before (January 2020) to three timepoints during the COVID-19 pandemic (June 2020, January 2021, January 2022). STUDY DESIGN Repeated cross-sectional design. METHODS Nationally representative cross-sectional cohorts of US adults completed the Secure Flourish Index before (January 2020 cohort: N = 1010) and during the COVID-19 pandemic (June 2020 cohort: N = 3020; January 2021 cohort: N = 3366; January 2022 cohort: N = 2598). We estimated differences in indicators, domains, and composite well-being between the January 2020 cohort and each of the subsequent cohorts. We also explored whether changes in well-being between January 2020 and January 2022 varied based on age, gender, and race/ethnicity. RESULTS Initial declines in well-being observed by June 2020 were largely followed by a return to prepandemic levels in January 2022, with some exceptions. Notably, general declines in mental health have persisted through to January 2022. On the other hand, there was evidence of general improvements in character & virtue that exceeded prepandemic levels in January 2022. Young adults and racial/ethnic minorities reported lower financial & material stability in January 2022 compared to before the COVID-19 pandemic. CONCLUSIONS Although there are promising signs that the well-being of US adults has mostly recovered to prepandemic levels, a coordinated response is urgently needed to support population mental health and the financial security of vulnerable groups. As society continues the journey toward postpandemic recovery, continued tracking of multidimensional well-being will be important for making informed decisions about public health priorities.
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Affiliation(s)
- R G Cowden
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA.
| | - J S Nakamura
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | | | - Y Chen
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - J Fulks
- American Bible Society, Philadelphia, PA, USA; Evangel University, Springfield, MO, USA
| | - J F Plake
- American Bible Society, Philadelphia, PA, USA
| | - T J VanderWeele
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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20
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Lomas T, VanderWeele TJ. Toward an Expanded Taxonomy of Happiness: A Conceptual Analysis of 16 Distinct Forms of Mental Wellbeing. Journal of Humanistic Psychology 2023. [DOI: 10.1177/00221678231155512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Recent decades have seen a surge of scientific interest in happiness. However, its theoretical conceptualization is a work in progress. Much of the literature focuses on two main forms: hedonic (encompassing life satisfaction and positive affect) and eudaimonic (encompassing phenomena such as character development and meaning in life). However, this binary has been critiqued as being incomplete, in part because it reflects a Western-centric perspective that overlooks forms emphasized in non-Western cultures. As a result, scholars have begun to highlight other forms besides hedonia and eudaimonia. This article surveys the literature to identify 16 potential forms in total, classified according to whether they primarily pertain to feelings (hedonic, contented, mature, chaironic, and vital), thought (evaluative, meaningful, intellective, aesthetic, and absorbed) or action (eudaimonic, masterful, accomplished, harmonic, nirvanic, and relational). This article thus offers a more expansive, albeit still just provisional, taxonomy of this vital and still-evolving topic.
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Affiliation(s)
- Tim Lomas
- Harvard University, Cambridge, MA, USA
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21
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Kubzansky LD, Kim ES, Boehm JK, Davidson RJ, Huffman JC, Loucks EB, Lyubomirsky S, Picard RW, Schueller SM, Trudel-Fitzgerald C, VanderWeele TJ, Warran K, Yeager DS, Yeh CS, Moskowitz JT. Interventions to Modify Psychological Well-Being: Progress, Promises, and an Agenda for Future Research. Affect Sci 2023; 4:174-184. [PMID: 37064816 PMCID: PMC9982781 DOI: 10.1007/s42761-022-00167-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/16/2022] [Indexed: 03/06/2023]
Abstract
Psychological well-being, characterized by feelings, cognitions, and strategies that are associated with positive functioning (including hedonic and eudaimonic well-being), has been linked with better physical health and greater longevity. Importantly, psychological well-being can be strengthened with interventions, providing a strategy for improving population health. But are the effects of well-being interventions meaningful, durable, and scalable enough to improve health at a population-level? To assess this possibility, a cross-disciplinary group of scholars convened to review current knowledge and develop a research agenda. Here we summarize and build on the key insights from this convening, which were: (1) existing interventions should continue to be adapted to achieve a large-enough effect to result in downstream improvements in psychological functioning and health, (2) research should determine the durability of interventions needed to drive population-level and lasting changes, (3) a shift from individual-level care and treatment to a public-health model of population-level prevention is needed and will require new infrastructure that can deliver interventions at scale, (4) interventions should be accessible and effective in racially, ethnically, and geographically diverse samples. A discussion examining the key future research questions follows.
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Affiliation(s)
- Laura D. Kubzansky
- Department of Social & Behavioral Sciences, Lee Kum Sheung Center for Health and Happiness, Harvard T. H. Chan School of Public Health, Boston, MA USA
| | - Eric S. Kim
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Julia K. Boehm
- Department of Psychology, Chapman University, One University Drive, Orange, CA USA
| | | | - Jeffrey C. Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Eric B. Loucks
- Department of Epidemiology, Mindfulness Center, Brown University School of Public Health, Providence, RI USA
| | - Sonja Lyubomirsky
- Department of Psychology, University of California, Riverside, Riverside, CA USA
| | | | - Stephen M. Schueller
- Department of Psychological Science, University of California, Irvine, Irvine, CA USA
| | - Claudia Trudel-Fitzgerald
- Department of Psychology, Université du Québec À Trois-Rivières, Trois-Rivières, Canada
- Research Center, Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Tyler J. VanderWeele
- Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA USA
- Human Flourishing Program, Harvard University, Cambridge, MA USA
| | - Katey Warran
- Research Department of Behavioural Science and Health, WHO Collaborating Centre for Arts & Health, University College London, London, UK
| | - David S. Yeager
- Department of Psychology, University of Texas at Austin, Austin, TX USA
| | | | - Judith T. Moskowitz
- Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
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22
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Ahrenfeldt LJ, Möller S, Hvidt NC, VanderWeele TJ, Stripp TA. Effect of religious service attendance on mortality and hospitalisations among Danish men and women: longitudinal findings from REGLINK-SHAREDK. Eur J Epidemiol 2023; 38:281-289. [PMID: 36646924 DOI: 10.1007/s10654-023-00964-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023]
Abstract
Research suggests a protective effect of religious service attendance on various health outcomes. However, most research has been done in religious societies, raising the question of whether these associations are also prominent in secular cultures. Here we examine mortality and hospitalisations by religious service attendance among men and women in a secular society. We performed a cohort study including 2987 Danes aged 40+ interviewed in SHARE from 2004 to 2007 and followed up in the Danish registries until 2018. We used Cox regressions and negative binomial regressions to examine associations, including interactions with sex and adjusting for age, wave, socioeconomic factors, lifestyle factors, body mass index, and history of diseases. Overall, 5.0% of men and 6.6% of women reported that they had taken part in a religious organisation within the last month. Among 848 deaths, we found lower mortality for people who attended religious services (hazard ratio (HR) 0.70; 95% CI 0.50-0.99). There was evidence for an association among women (HR 0.56; 95% CI 0.35-0.89), but not among men (HR 0.95; 95% CI 0.59-1.53). In contrast, regarding hospital admissions (n = 12,010), we found lower hospitalisation rates among men who attended religious services (incidence rate ratio (IRR) 0.67; 95% CI 0.45-0.98), whereas no association was found among women (IRR 0.95; 95% CI 0.70-1.29). Sensitivity analyses with E-values were moderately robust. Our results contribute to the limited literature on possible health benefits of religious service attendance in secular societies, demonstrating lower mortality among women and fewer hospitalisations among men.
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Affiliation(s)
- Linda Juel Ahrenfeldt
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense, Denmark.
| | - Sören Möller
- Open Patient Data Explorative Network, Odense University Hospital, 5000, Odense, Denmark
- Research unit OPEN, Department of Clinical Research, University of Southern Denmark, 5000, Odense, Denmark
| | - Niels Christian Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, 5000, Odense, Denmark
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Tobias Anker Stripp
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
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Abstract
In this commentary, we offer some remarks concerning distinctions that might be drawn between psychological well-being, emotional well-being, well-being more generally, and flourishing. We put forward a flexible map of flourishing to help understand the relative place of these and other terms, and their respective nestings. We discuss some of the challenges concerning terminology related to the use of ordinary language, as well as practices of branding ordinary language expressions that potentially threaten understanding, and we offer some suggestions as to how to navigate some of these terminological challenges in the well-being literature.
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Affiliation(s)
- Tyler J. VanderWeele
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Human Flourishing Program, Harvard University, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Tim Lomas
- Human Flourishing Program, Harvard University, Cambridge, MA USA
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Chen Y, Weziak-Bialowolska D, Lee MT, Bialowolski P, Cowden RG, McNeely E, VanderWeele TJ. Working from home and subsequent work outcomes: Pre-pandemic evidence. PLoS One 2023; 18:e0283788. [PMID: 37014892 PMCID: PMC10072379 DOI: 10.1371/journal.pone.0283788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
Frequent working from home (WFH) may stay as a new work norm after the COVID-19 pandemic. Prior observational studies on WFH and work outcomes under non-pandemic circumstances are mostly cross-sectional and often studied employees who worked from home in limited capacity. To provide additional insights that might inform post-pandemic work policies, using longitudinal data collected before the COVID-19 pandemic (June 2018 to July 2019), this study aims to examine the associations between WFH and multiple subsequent work-related outcomes, as well as potential modifiers of these associations, in a sample of employees among whom frequent or even full-time WFH was common (N = 1,123, Meanage = 43.37 years). In linear regression models, each subsequent work outcome (standardized score was used) was regressed on frequencies of WFH, adjusting for baseline values of the outcome variables and other covariates. The results suggested that WFH for 5 days/week versus never WFH was associated with subsequently less work distraction (ß = -0.24, 95% CI = -0.38, -0.11), greater perceived productivity/engagement (ß = 0.23, 95% CI = 0.11, 0.36), and greater job satisfaction (ß = 0.15, 95% CI = 0.02, 0.27), and was associated with subsequent work-family conflicts to a lesser extent (ß = -0.13, 95% CI = -0.26, 0.004). There was also evidence suggesting that long work hours, caregiving responsibilities, and a greater sense of meaningful work can all potentially attenuate the benefits of WFH. As we move towards the post-pandemic era, further research will be needed to understand the impacts of WFH and resources for supporting employees who work from home.
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Affiliation(s)
- Ying Chen
- Harvard Institute for Quantitative Social Science, Human Flourishing Program, Cambridge, MA, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Dorota Weziak-Bialowolska
- Harvard Institute for Quantitative Social Science, Human Flourishing Program, Cambridge, MA, United States of America
- Department of Environmental Health, Sustainability and Health Initiative (SHINE), Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Faculty of Philosophy, Centre for Evaluation and Analysis of Public Policies, Jagiellonian University, Cracow, Poland
| | - Matthew T Lee
- Harvard Institute for Quantitative Social Science, Human Flourishing Program, Cambridge, MA, United States of America
| | - Piotr Bialowolski
- Harvard Institute for Quantitative Social Science, Human Flourishing Program, Cambridge, MA, United States of America
- Department of Environmental Health, Sustainability and Health Initiative (SHINE), Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Department of Economics, Kozminski University, Warsaw, Poland
| | - Richard G Cowden
- Harvard Institute for Quantitative Social Science, Human Flourishing Program, Cambridge, MA, United States of America
| | - Eileen McNeely
- Department of Environmental Health, Sustainability and Health Initiative (SHINE), Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Tyler J VanderWeele
- Harvard Institute for Quantitative Social Science, Human Flourishing Program, Cambridge, MA, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Weziak-Bialowolska D, Lee MT, Bialowolski P, Chen Y, VanderWeele TJ, McNeely E. Prospective associations between strengths of moral character and health: longitudinal evidence from survey and insurance claims data. Soc Psychiatry Psychiatr Epidemiol 2023; 58:163-176. [PMID: 35916915 PMCID: PMC9344441 DOI: 10.1007/s00127-022-02344-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/19/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE Excellent character, reflected in adherence to high standards of moral behavior, has been argued to contribute to well-being. The study goes beyond this claim and provides insights into the role of strengths of moral character (SMC) for physical and mental health. METHODS This study used longitudinal observational data merged with medical insurance claims data collected from 1209 working adults of a large services organization in the US. Self-reported physical and mental health as well as diagnostic information on depression, anxiety, and cardiovascular disease were used as outcomes. The prospective associations between SMC (7 indicators and a composite measure) and physical and mental health outcomes were examined using lagged linear and logistic regression models. A series of sensitivity analyses provided evidence for the robustness of results. RESULTS The results suggest that persons who live their life according to high moral standards have substantially lower odds of depression (by 21-51%). The results were also indicative of positive associations between SMC and self-reports of mental health (β = 0.048-0.118) and physical health (β = 0.048-0.096). Weaker indications were found for a protective role of SMC in mitigating anxiety (OR = 0.797 for the indicator of delayed gratification) and cardiovascular disease (OR = 0.389 for the indicator of use of SMC for helping others). CONCLUSIONS SMC may be considered relevant for population mental health and physical health. Public health policies promoting SMC are likely to receive positive reception from the general public because character is both malleable and aligned with the nearly universal human desire to become a better person.
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Affiliation(s)
- Dorota Weziak-Bialowolska
- Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA. .,Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA. .,Centre for Evaluation and Analysis of Public Policies, Faculty of Philosophy, Jagiellonian University, Cracow, Poland.
| | - Matthew T. Lee
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA USA , Institute for Studies of Religion, Baylor University, Waco, TX, USA
| | - Piotr Bialowolski
- Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA USA ,Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA USA ,Department of Economics, Kozminski University, Warsaw, Poland
| | - Ying Chen
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA USA ,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA USA
| | - Tyler J. VanderWeele
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA USA ,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA USA
| | - Eileen McNeely
- Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA USA
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Cowden RG, Nakamura JS, Chen ZJ, Case B, Kim ES, VanderWeele TJ. Identifying pathways to religious service attendance among older adults: A lagged exposure-wide analysis. PLoS One 2022; 17:e0278178. [PMID: 36445902 PMCID: PMC9707744 DOI: 10.1371/journal.pone.0278178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/12/2022] [Indexed: 12/02/2022] Open
Abstract
We used prospective data (spanning 8 years) from a national sample of older U.S. adults aged > 50 years (the Health and Retirement Study, N = 13,771) to evaluate potential factors that lead to subsequent religious service attendance. We applied a lagged exposure-wide epidemiologic design and evaluated 60 candidate predictors of regular subsequent religious service attendance. Candidate predictors were drawn from the following domains: health behaviors, physical health, psychological well-being, psychological distress, social factors, and work. After rigorous adjustment for a rich set of potential confounders, we observed modest evidence that changes in some indices of physical health, psychological well-being, psychological distress, and social functioning predicted regular religious service attendance four years later. Our findings suggest that there may be opportunities to support more regular religious service attendance among older adults who positively self-identify with a religious/spiritual tradition (e.g., aid services for those with functional limitations, psychological interventions to increase hope), which could have downstream benefits for various dimensions of well-being in the later years of life.
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Affiliation(s)
- Richard G. Cowden
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts, United States of America
- * E-mail:
| | - Julia S. Nakamura
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Zhuo Job Chen
- School of Nursing, University of North Carolina at Charlotte, Charlotte, NC, United States of America
| | - Brendan Case
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts, United States of America
| | - Eric S. Kim
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts, United States of America
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
- Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Tyler J. VanderWeele
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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Cowden RG, Seidman AJ, Duffee C, Węziak-Białowolska D, McNeely E, VanderWeele TJ. Associations of suffering with facets of health and well-being among working adults: longitudinal evidence from two samples. Sci Rep 2022; 12:20141. [PMID: 36418921 PMCID: PMC9684157 DOI: 10.1038/s41598-022-24497-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/16/2022] [Indexed: 11/24/2022] Open
Abstract
Suffering is an experiential state that every person encounters at one time or another, yet little is known about suffering and its consequences for the health and well-being of nonclinical adult populations. In a pair of longitudinal studies, we used two waves of data from garment factory workers (Study 1 [T1: 2017, T2: 2019]: n = 344) and flight attendants (Study 2 [T1: 2017/2018, T2: 2020]: n = 1402) to examine the prospective associations of suffering with 16 outcomes across different domains of health and well-being: physical health, health behavior, mental health, psychological well-being, character strengths, and social well-being. The primary analysis involved a series of regression analyses in which each T2 outcome was regressed on overall suffering assessed at T1, adjusting for relevant sociodemographic characteristics and the baseline value (or close proxy) of the outcome assessed at T1. In Study 1, associations of overall suffering with worse subsequent health and well-being were limited to a single outcome on each of the domains of physical health and mental health. Overall suffering was more consistently related to worse subsequent health and well-being in Study 2, with associations emerging for all but two outcomes. The pattern of findings for each study was largely similar when aspects of suffering were modeled individually, although associations for some aspects of suffering differed from those that emerged for overall suffering. Our findings suggest that suffering may have important implications for the health and well-being of worker populations.
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Affiliation(s)
- Richard G. Cowden
- grid.38142.3c000000041936754XHuman Flourishing Program, Harvard University, Cambridge, MA USA
| | - Andrew J. Seidman
- grid.21925.3d0000 0004 1936 9000Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA
| | - Charlotte Duffee
- grid.38142.3c000000041936754XHuman Flourishing Program, Harvard University, Cambridge, MA USA
| | - Dorota Węziak-Białowolska
- grid.38142.3c000000041936754XHuman Flourishing Program, Harvard University, Cambridge, MA USA ,grid.38142.3c000000041936754XSustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA USA ,grid.5522.00000 0001 2162 9631Centre for Evaluation and Analysis of Public Policies, Faculty of Philosophy, Jagiellonian University, Kraków, Poland
| | - Eileen McNeely
- grid.38142.3c000000041936754XSustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA USA
| | - Tyler J. VanderWeele
- grid.38142.3c000000041936754XHuman Flourishing Program, Harvard University, Cambridge, MA USA ,grid.38142.3c000000041936754XDepartment of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA USA
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Lomas T, Diego-Rosell P, Shiba K, Standridge P, Lee MT, Case B, Lai AY, VanderWeele TJ. Complexifying Individualism Versus Collectivism and West Versus East: Exploring Global Diversity in Perspectives on Self and Other in the Gallup World Poll. Journal of Cross-Cultural Psychology 2022. [DOI: 10.1177/00220221221130978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A wealth of research has suggested the West tends toward individualism and the East toward collectivism. We explored this topic on an unprecedented scale through two new items in the 2020 Gallup World Poll, involving 121,207 participants in 116 countries. The first tapped into orientations toward self-care versus other-care (“Do you think people should focus more on taking care of themselves or on taking care of others?”). The second enquired into self-orientation versus other-orientation (“Which of the following is closest to your main purpose in life? Being good at what you do in your daily life, Caring for family and close friends, or Helping other people who need help?”). We anticipated that self-care and self-orientation would index individualism (hence be higher in the West), while other-care and other-orientation would index collectivism (hence be higher in the East). However, contrary to expectation, there was greater self-care in the East (45.82%) than in the West (41.58%). As predicted though, there was greater self-orientation in the West (30.20%) than in the East (23.08.%). Greater self-care in the East invites one of two interpretations. Either these items: (a) index individualism and collectivism as anticipated, so in some ways the East is more individualistic and the West less individualistic than assumed; or (b) do not index individualism and collectivism as anticipated, so the concepts are more complex than often realized (e.g., collectivism may involve prioritizing self-care over other-care). Either way, the findings help complexify these concepts, challenging common cross-cultural generalizations in this area.
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Affiliation(s)
- Tim Lomas
- Harvard University, Cambridge, MA, USA
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Lomas T, VanderWeele TJ. The Garden and the Orchestra: Generative Metaphors for Conceptualizing the Complexities of Well-Being. Int J Environ Res Public Health 2022; 19:14544. [PMID: 36361423 PMCID: PMC9657769 DOI: 10.3390/ijerph192114544] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 05/09/2023]
Abstract
Our understanding of well-being, and related concepts such as health and flourishing, is shaped by the metaphors through which we think about such ideas. Current dominant metaphors-including a pyramid, ladder, and continuum-all have various issues. As such, this paper offers two other metaphors which can better do justice to the nuanced complexities of these notions, namely, a garden and an orchestra. Through these metaphors, this paper articulates a comprehensive framework for conceptualizing and appreciating the nature of well-being (and associated concepts), which it is hoped will generate further insights and research into these valued and sought-after phenomena.
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Affiliation(s)
- Tim Lomas
- Harvard T.H. Chan School of Public Health, Human Flourishing Program, Harvard University, Boston, MA 02115, USA
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VanderWeele TJ, Case BW, Chen Y, Cowden RG, Johnson B, Lee MT, Lomas T, Long KG. Flourishing in critical dialogue. SSM - Mental Health 2022. [DOI: 10.1016/j.ssmmh.2022.100172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Mathur MB, VanderWeele TJ. The Authors Respond. Epidemiology 2022; 33:e22-e23. [PMID: 36220586 PMCID: PMC9756971 DOI: 10.1097/ede.0000000000001533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Maya B Mathur
- Quantitative Sciences Unit and Department of Pediatrics, Stanford University, Palo Alto, CA
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA,
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Shiba K, Kubzansky LD, Williams DR, VanderWeele TJ, Kim ES. Purpose in life and 8-year mortality by gender and race/ethnicity among older adults in the U.S. Prev Med 2022; 164:107310. [PMID: 36283485 DOI: 10.1016/j.ypmed.2022.107310] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/12/2022] [Accepted: 10/15/2022] [Indexed: 10/31/2022]
Abstract
We examined the associations between a sense of purpose and all-cause mortality by gender and race/ethnicity groups. Data were from the Health and Retirement Study, a nationally representative cohort study of U.S. adults aged >50 (n = 13,159). Sense of purpose was self-reported at baseline (2006/2008), and risk of all-cause mortality was assessed over an 8-year follow-up period. We also formally tested for potential effect modification by gender and race/ethnicity. We observed the associations between higher purpose and lower all-cause mortality risk across all gender and race/ethnicity groups. There was modest evidence that the highest level of purpose (versus lowest quartile) was associated with even lower risk of all-cause mortality among women (risk ratio = 0.66, 95% confidence interval: 0.56, 0.77) compared to men (risk ratio = 0.80, 95% confidence interval: 0.69, 0.93; p-value for multiplicative effect modification =0.07). However, we observed no evidence of effect modification by race/ethnicity. Having a higher sense of purpose appears protective against all-cause mortality regardless of gender and race/ethnicity. Purpose, a potentially modifiable factor, might be a health asset across diverse populations.
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Affiliation(s)
- Koichiro Shiba
- Department of Epidemiology, Boston University School of Public Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Human Flourishing Program, University of British Columbia, Vancouver, Canada.
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Lee Kum Sheung Center for Health and Happiness, University of British Columbia, Vancouver, Canada
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Sociology, University of British Columbia, Vancouver, Canada
| | - Tyler J VanderWeele
- Harvard University, Cambridge, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Human Flourishing Program, University of British Columbia, Vancouver, Canada
| | - Eric S Kim
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Lee Kum Sheung Center for Health and Happiness, Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA; Department of Psychology, University of British Columbia, Vancouver, Canada
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Abstract
Vitality has been underappreciated and underexplored by academia at large. This oversight is potentially explained by the Western-centric nature of most fields, with vitality having been comparatively neglected in the West relative to elsewhere. One explanation for this lacuna is that vitality is not easily pigeonholed within the ontological categories dominant in the West, such as mind and body. This paper therefore aims to learn from cultures that have cultivated a greater understanding of vitality, doing so by engaging with relevant ‘untranslatable’ words (i.e., those without exact equivalent in English), thus enriching our conceptual map of this topic. Over 200 relevant terms were located and analyzed using an adapted form of grounded theory. Three themes were identified, each with four subthemes: spirit (life force, channels, soul, and transcendence); energy (fortitude, channeling, willpower, and recharging); and heart (desire, passion, affection, and satisfaction). The paper thus refines our understanding of this important topic and provides a foundation for future research.
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VanderWeele TJ, Vansteelandt S. A statistical test to reject the structural interpretation of a latent factor model. J R Stat Soc Series B Stat Methodol 2022; 84:2032-2054. [PMID: 36818188 PMCID: PMC9937555 DOI: 10.1111/rssb.12555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Factor analysis is often used to assess whether a single univariate latent variable is sufficient to explain most of the covariance among a set of indicators for some underlying construct. When evidence suggests that a single factor is adequate, research often proceeds by using a univariate summary of the indicators in subsequent research. Implicit in such practices is the assumption that it is the underlying latent, rather than the indicators, that is causally efficacious. The assumption that the indicators do not have effects on anything subsequent, and that they are themselves only affected by antecedents through the underlying latent is a strong assumption, effectively imposing a structural interpretation on the latent factor model. In this paper, we show that this structural assumption has empirically testable implications, even though the latent variable itself is unobserved. We develop a statistical test to potentially reject the structural interpretation of a latent factor model. We apply this test to data concerning associations between the Satisfaction-with-Life-Scale and subsequent all-cause mortality, which provides strong evidence against a structural interpretation for a univariate latent underlying the scale. Discussion is given to the implications of this result for the development, evaluation, and use of measures, and for the use of factor analysis itself.
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Liu C, Murchland AR, VanderWeele TJ, Blacker D. Eliminating racial disparities in dementia risk by equalizing education quality: A sensitivity analysis. Soc Sci Med 2022; 312:115347. [PMID: 36162365 PMCID: PMC9990698 DOI: 10.1016/j.socscimed.2022.115347] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/06/2022] [Accepted: 09/01/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Higher risk of dementia among racial/ethnic minorities compared to White populations in the U.S. has been attributed to life-course exposures to adverse conditions such as lower educational attainment, but most studies have not considered additional disparities in education quality. We sought to determine the extent to which disparities in dementia would be reduced had different racial groups received the same quality of education, with no change to present disparities in educational attainment. METHODS We conducted a literature review to assess whether and how measures of educational attainment and quality are utilized in the development of norms for standard cognitive screening measures. In a separate search of the literature, we identified estimates of relationships between race, education quality and dementia; and calculated the adjusted association between race and dementia had education quality been equalized between Black and White participants. RESULTS Most norms for cognitive measures included educational attainment, but few addressed quality. Our search identified relevant parameter estimates: 44.3% of Black participants and 10.5% of White participants had "limited literacy" (<9th grade reading level, a potential marker of poor education quality), which was associated with a 53% greater hazard of dementia compared with "adequate literacy" (≥ 9th grade reading level) after adjusting for educational attainment. Applying these parameters to a hazard ratio of 1.37 (95%CI: 1.12,1.67) for the risk of dementia comparing Black to White participants, we obtained an adjusted hazard ratio of 1.17 (0.96,1.43), a 54% reduction. DISCUSSION Present studies are limited in their consideration of education quality. Our work using available measures from the literature suggests that if education quality were equalized across groups by race, without changing disparities in attainment, racial disparities in dementia would be reduced by about half. Future work should seek to consistently incorporate education quality in order to better understand the sources of disparities.
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Affiliation(s)
- Chelsea Liu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Audrey R Murchland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Deborah Blacker
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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Smith LH, Dollinger CY, VanderWeele TJ, Wyszynski DF, Hernández-Díaz S. Timing and severity of COVID-19 during pregnancy and risk of preterm birth in the International Registry of Coronavirus Exposure in Pregnancy. BMC Pregnancy Childbirth 2022; 22:775. [PMID: 36258186 PMCID: PMC9578260 DOI: 10.1186/s12884-022-05101-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022] Open
Abstract
Background Studies of preterm delivery after COVID-19 are often subject to selection bias and do not distinguish between early vs. late infection in pregnancy, nor between spontaneous vs. medically indicated preterm delivery. This study aimed to estimate the risk of preterm birth (overall, spontaneous, and indicated) after COVID-19 during pregnancy, while considering different levels of disease severity and timing. Methods Pregnant and recently pregnant people who were tested for or clinically diagnosed with COVID-19 during pregnancy enrolled in an international internet-based cohort study between June 2020 and July 2021. We used several analytic approaches to minimize confounding and immortal time bias, including multivariable regression, time-to-delivery models, and a case-time-control design. Results Among 14,264 eligible participants from 70 countries who did not report a pregnancy loss before 20 gestational weeks, 5893 had completed their pregnancies and reported delivery information; others were censored at time of their last follow-up. Participants with symptomatic COVID-19 before 20 weeks’ gestation had no increased risk of preterm delivery compared to those testing negative, with adjusted risks of 10.0% (95% CI 7.8, 12.0) vs. 9.8% (9.1, 10.5). Mild COVID-19 later in pregnancy was not clearly associated with preterm delivery. In contrast, severe COVID-19 after 20 weeks’ gestation led to an increase in preterm delivery compared to milder disease. For example, the risk ratio for preterm delivery comparing severe to mild/moderate COVID-19 at 35 weeks was 2.8 (2.0, 4.0); corresponding risk ratios for indicated and spontaneous preterm delivery were 3.7 (2.0, 7.0) and 2.3 (1.2, 3.9), respectively. Conclusions Severe COVID-19 late in pregnancy sharply increased the risk of preterm delivery compared to no COVID-19. This elevated risk was primarily due to an increase in medically indicated preterm deliveries, included preterm cesarean sections, although an increase in spontaneous preterm delivery was also observed. In contrast, mild or moderate COVID-19 conferred minimal risk, as did severe disease early in pregnancy. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05101-3.
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Affiliation(s)
- Louisa H Smith
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, ME, 02115, USA. .,Roux Institute at Northeastern University, 100 Fore St, Portland, ME, 04101, USA.
| | - Camille Y Dollinger
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, ME, 02115, USA
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, ME, 02115, USA
| | | | - Sonia Hernández-Díaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, ME, 02115, USA
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Abstract
This survey study assesses well-being among US adults by age group.
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Affiliation(s)
- Ying Chen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts,Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts
| | - Richard G. Cowden
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts
| | - Jeffery Fulks
- American Bible Society, Philadelphia, Pennsylvania,Evangel University, Springfield, Missouri
| | | | - Tyler J. VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts,Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts
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Spence ND, Warner ET, Farvid MS, VanderWeele TJ, Zhang Y, Hu FB, Shields AE. The Association of Religion and Spirituality with Obesity and Weight Change in the USA: A Large-Scale Cohort Study. J Relig Health 2022; 61:4062-4080. [PMID: 34714470 DOI: 10.1007/s10943-021-01368-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
The association between religion, spirituality, and body weight is controversial, given the methodological limitations of existing studies. Using the Nurses' Health Study II cohort, follow-up occurred from 2001 to 2015, with up to 35,547 participants assessed for the religious or spiritual coping and religious service attendance analyses. Cox regression and generalized estimating equations evaluated associations with obesity and weight change, respectively. Religious or spiritual coping and religious service attendance had little evidence of an association with obesity. Compared with not using religious or spiritual coping at all, the fully adjusted hazard ratios (HRs) were minimally different across categories: a little bit (HR = 1.05, 95% CI: 0.92-1.18), a medium amount (HR = 1.09, 95% CI: 0.96-1.24), and a lot (HR = 1.10; 95% CI: 0.96-1.25) (Ptrend = 0.17). Compared with participants who never or almost never attend religious meetings or services, there was little evidence of an association between those attending less than once/month (HR = 1.08, 95% CI: 0.97-1.10), 1-3 times/month (HR = 1.01, 95% CI: 0.90-1.13), once/week (HR = 0.92, 95% CI: 0.83-1.02), and more than once/week (HR = 0.94, 95% CI: 0.82-1.07) (Ptrend = 0.06). Findings were similar for weight change. There was no significant association between religious or spiritual coping, religious service attendance, obesity, and weight change. While religion and spirituality are prominent in American society, they are not important psychosocial factors influencing body weight in this sample.
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Affiliation(s)
- Nicholas D Spence
- Department of Sociology, University of Toronto, 725 Spadina Avenue, Office 334, Toronto, ON, M5S 2J4, Canada.
- Department of Health and Society, University of Toronto, Toronto, ON, Canada.
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- National Consortium on Psychosocial Stress, Spirituality, and Health, Massachusetts General Hospital, Boston, MA, USA.
| | - Erica T Warner
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- National Consortium on Psychosocial Stress, Spirituality, and Health, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Maryam S Farvid
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ying Zhang
- Sleep Medicine Epidemiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Frank B Hu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- National Consortium on Psychosocial Stress, Spirituality, and Health, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Lee MT, McNeely E, Weziak-Bialowolska D, Ryan KA, Mooney KD, Cowden RG, VanderWeele TJ. Demographic Predictors of Complete Well-Being. BMC Public Health 2022; 22:1687. [PMID: 36068553 PMCID: PMC9446856 DOI: 10.1186/s12889-022-13769-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
This paper examines demographic differences in flourishing, defined as "complete well-being" and consisting of six domains: emotional health, physical health, purpose, character strengths, social connectedness, and financial security. Results are based on a random, cross-sectional sample of 2363 survey respondents drawn from employees of a large, national, self-insured employer based in the United States. We found that well-being across domains tends to increase with age, although there are some variations. Results are similar across most domains for men and women, although women score higher on character strengths, while men had higher scores on financial security. Racial and ethnic differences were striking. Black employees score higher than the reference group (White employees) on the emotional, purpose, and character strengths domains, but considerably lower on financial security. Hispanics also score lower on financial security (though not as low as Blacks), but higher than Whites on purpose, character strengths, and social connectedness. Asians reported higher well-being than Whites across all domains except purpose.
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Affiliation(s)
- Matthew T Lee
- Human Flourishing Program, Harvard University, 12 Arrow St., Ste 100, Cambridge, MA, 02138, USA. .,Institute for Studies of Religion, Baylor University, Waco, TX, 76798, USA.
| | - Eileen McNeely
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA
| | | | - Karen A Ryan
- AVANGRID, 180 Marsh Hill Road, Orange, CT, 06577, USA
| | | | - Richard G Cowden
- Human Flourishing Program, Harvard University, 12 Arrow St., Ste 100, Cambridge, MA, 02138, USA
| | - Tyler J VanderWeele
- Human Flourishing Program, Harvard University, 12 Arrow St., Ste 100, Cambridge, MA, 02138, USA.,Departments of Epidemiology and Biostatistics, T.H. Chan School of Public Health, Harvard University, Cambridge, MB, USA
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Cowden RG, Wȩziak-Białowolska D, McNeely E, VanderWeele TJ. Are depression and suffering distinct? An empirical analysis. Front Psychol 2022; 13:970466. [PMID: 36186371 PMCID: PMC9518749 DOI: 10.3389/fpsyg.2022.970466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Depression and the subjective experience of suffering are distinct forms of distress, but they are sometimes commingled with one another. Using a cross-sectional sample of flight attendants (n = 4,652), we tested for further empirical evidence distinguishing depression and suffering. Correlations with 15 indices covering several dimensions of well-being (i.e., physical health, emotional well-being, psychological well-being, character strengths, social well-being, financial/material well-being) indicated that associations with worse well-being were mostly stronger for depression than suffering. There was a large positive correlation between depression and suffering, but we also found evidence of notable non-concurrent depression and suffering in the sample. After dividing participants into four groups that varied based on severity of depression and suffering, regression analyses showed higher levels of well-being among those with both none-mild depression and none-mild suffering compared to those with moderate-severe depression, moderate-severe suffering, or both. All indices of well-being were lowest among the group of participants with moderate-severe depression and moderate-severe suffering. In addition to providing further evidence supporting a distinction between depression and suffering, our findings suggest that concurrent depression and suffering may be more disruptive to well-being than when either is present alone.
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Affiliation(s)
- Richard G. Cowden
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, United States
- *Correspondence: Richard G. Cowden,
| | - Dorota Wȩziak-Białowolska
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, United States
- Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, United States
- Centre for Evaluation and Analysis of Public Policies, Faculty of Philosophy, Jagiellonian University, Cracow, Poland
| | - Eileen McNeely
- Sustainability and Health Initiative (SHINE), Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Tyler J. VanderWeele
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, United States
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Nakamura JS, Chen Y, VanderWeele TJ, Kim ES. What makes life purposeful? Identifying the antecedents of a sense of purpose in life using a lagged exposure-wide approach. SSM Popul Health 2022; 19:101235. [PMID: 36203472 PMCID: PMC9529595 DOI: 10.1016/j.ssmph.2022.101235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/23/2022] [Accepted: 09/19/2022] [Indexed: 11/18/2022] Open
Abstract
Aims Prior research documents strong associations between an increased sense of purpose in life and improved health and well-being outcomes. However, less is known about candidate antecedents that lead to more purpose among older adults. Methods We used data from 13,771 participants in the Health and Retirement Study (HRS) — a diverse, national panel study of adults aged >50 in the United States, to evaluate a large number of candidate predictors of purpose. Specifically, using linear regression with a lagged exposure-wide approach, we evaluated if changes in 61 predictors spanning physical health, health behaviors, and psychosocial well-being (between t0;2006/2008 and t1;2010/2012) were associated with purpose four years later (t2;2014/2016) after adjustment for a rich set of baseline covariates. Results Some health behaviors (e.g., physical activity ≥1x/week [β = 0.14, 95% CI: 0.09, 0.19]), physical health conditions (e.g., stroke [β = −0.25, 95% CI: −0.40, −0.10]), and psychosocial factors (e.g., depression [β = −0.21, 95% CI: −0.27, −0.15]) were associated with subsequent purpose four years later. However, there was little evidence that other health behaviors, physical health conditions, and psychosocial factors such as smoking, drinking, or financial strain, were associated with subsequent purpose. Conclusions Several of our candidate predictors such as volunteering, time with friends, and physical activity may be important targets for interventions and policies aiming to increase purpose among older adults. However, some effect sizes were modest and contrast with prior work on younger populations, suggesting purpose may be more easily formed earlier in life. Factors that lead to increased purpose in life in older adults remain unclear. We leveraged a large and prospective cohort of US adults aged >50. We evaluated associations between 61 predictors and subsequent purpose in life. Some health/well-being factors were associated with purpose in life 4 years later, but not others.
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Affiliation(s)
- Julia S. Nakamura
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
- Corresponding author. Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada.
| | - Ying Chen
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tyler J. VanderWeele
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eric S. Kim
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
- Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Maier M, VanderWeele TJ, Mathur MB. Using selection models to assess sensitivity to publication bias: A tutorial and call for more routine use. Campbell Syst Rev 2022; 18:e1256. [PMID: 36909879 PMCID: PMC9247867 DOI: 10.1002/cl2.1256] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In meta-analyses, it is critical to assess the extent to which publication bias might have compromised the results. Classical methods based on the funnel plot, including Egger's test and Trim-and-Fill, have become the de facto default methods to do so, with a large majority of recent meta-analyses in top medical journals (85%) assessing for publication bias exclusively using these methods. However, these classical funnel plot methods have important limitations when used as the sole means of assessing publication bias: they essentially assume that the publication process favors large point estimates for small studies and does not affect the largest studies, and they can perform poorly when effects are heterogeneous. In light of these limitations, we recommend that meta-analyses routinely apply other publication bias methods in addition to or instead of classical funnel plot methods. To this end, we describe how to use and interpret selection models. These methods make the often more realistic assumption that publication bias favors "statistically significant" results, and the methods also directly accommodate effect heterogeneity. Selection models have been established for decades in the statistics literature and are supported by user-friendly software, yet remain rarely reported in many disciplines. We use a previously published meta-analysis to demonstrate that selection models can yield insights that extend beyond those provided by funnel plot methods, suggesting the importance of establishing more comprehensive reporting practices for publication bias assessment.
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Affiliation(s)
- Maximilian Maier
- Department of Experimental PsychologyUniversity College LondonLondonUK
- Department of PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
| | | | - Maya B. Mathur
- Quantitative Sciences Unit, Department of PediatricsStanford UniversityStanfordCaliforniaUSA
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Nakamura JS, Lee MT, Chen FS, Archer Lee Y, Fried LP, VanderWeele TJ, Kim ES. Identifying pathways to increased volunteering in older US adults. Sci Rep 2022; 12:12825. [PMID: 35896597 PMCID: PMC9328015 DOI: 10.1038/s41598-022-16912-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 07/18/2022] [Indexed: 11/29/2022] Open
Abstract
While growing evidence documents strong associations between volunteering and improved health and well-being outcomes, less is known about the health and well-being factors that lead to increased volunteering. Using data from 13,771 participants in the Health and Retirement Study (HRS)—a diverse, longitudinal, and national sample of older adults in the United States—we evaluated a large range of candidate predictors of volunteering. Specifically, using generalized linear regression models with a lagged exposure-wide approach, we evaluated if changes in 61 predictors spanning physical health, health behaviors, and psychosocial well-being (over a 4-year follow-up between t0; 2006/2008 and t1; 2010/2012) were associated with volunteer activity four years later (t2; 2014/2016). After adjusting for a rich set of covariates, certain changes in some health behaviors (e.g., physical activity ≥ 1x/week), physical health conditions (e.g., physical functioning limitations, cognitive impairment), and psychosocial factors (e.g., purpose in life, constraints, contact with friends, etc.) were associated with increased volunteering four years later. However, there was little evidence that other factors were associated with subsequent volunteering. Changes in several indicators of physical health, health behaviors, and psychosocial well-being may predict increased volunteering, and these factors may be novel targets for interventions and policies aiming to increase volunteering in older adults.
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Affiliation(s)
- Julia S Nakamura
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada.
| | - Matthew T Lee
- Institute for Studies of Religion, Baylor University, Waco, TX, USA.,Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Frances S Chen
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Yeeun Archer Lee
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Linda P Fried
- Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Tyler J VanderWeele
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eric S Kim
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada.,Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA.,Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Abstract
Happiness is an increasingly prominent topic of interest across academia. However, relatively little attention has been paid to how it is created, especially not in a multidimensional sense. By ‘created’ we do not mean its influencing factors, for which there is extensive research, but how it actually forms in the person. The work that has been done in this arena tends to focus on physiological dynamics, which are certainly part of the puzzle. But they are not the whole picture, with psychological, phenomenological, and socio cultural processes also playing their part. As a result, this paper offers a multidimensional overview of scholarship on the ‘architecture’ of happiness, providing a stimulus for further work into this important topic.
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Balboni TA, VanderWeele TJ, Doan-Soares SD, Long KNG, Ferrell BR, Fitchett G, Koenig HG, Bain PA, Puchalski C, Steinhauser KE, Sulmasy DP, Koh HK. Spirituality in Serious Illness and Health. JAMA 2022; 328:184-197. [PMID: 35819420 DOI: 10.1001/jama.2022.11086] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Despite growing evidence, the role of spirituality in serious illness and health has not been systematically assessed. OBJECTIVE To review evidence concerning spirituality in serious illness and health and to identify implications for patient care and health outcomes. EVIDENCE REVIEW Searches of PubMed, PsycINFO, and Web of Science identified articles with evidence addressing spirituality in serious illness or health, published January 2000 to April 2022. Independent reviewers screened, summarized, and graded articles that met eligibility criteria. Eligible serious illness studies included 100 or more participants; were prospective cohort studies, cross-sectional descriptive studies, meta-analyses, or randomized clinical trials; and included validated spirituality measures. Eligible health outcome studies prospectively examined associations with spirituality as cohort studies, case-control studies, or meta-analyses with samples of at least 1000 or were randomized trials with samples of at least 100 and used validated spirituality measures. Applying Cochrane criteria, studies were graded as having low, moderate, serious, or critical risk of bias, and studies with serious and critical risk of bias were excluded. Multidisciplinary Delphi panels consisting of clinicians, public health personnel, researchers, health systems leaders, and medical ethicists qualitatively synthesized and assessed the evidence and offered implications for health care. Evidence-synthesis statements and implications were derived from panelists' qualitative input; panelists rated the former on a 9-point scale (from "inconclusive" to "strongest evidence") and ranked the latter by order of priority. FINDINGS Of 8946 articles identified, 371 articles met inclusion criteria for serious illness; of these, 76.9% had low to moderate risk of bias. The Delphi panel review yielded 8 evidence statements supported by evidence categorized as strong and proposed 3 top-ranked implications of this evidence for serious illness: (1) incorporate spiritual care into care for patients with serious illness; (2) incorporate spiritual care education into training of interdisciplinary teams caring for persons with serious illness; and (3) include specialty practitioners of spiritual care in care of patients with serious illness. Of 6485 health outcomes articles, 215 met inclusion criteria; of these, 66.0% had low to moderate risk of bias. The Delphi panel review yielded 8 evidence statements supported by evidence categorized as strong and proposed 3 top-ranked implications of this evidence for health outcomes: (1) incorporate patient-centered and evidence-based approaches regarding associations of spiritual community with improved patient and population health outcomes; (2) increase awareness among health professionals of evidence for protective health associations of spiritual community; and (3) recognize spirituality as a social factor associated with health in research, community assessments, and program implementation. CONCLUSIONS AND RELEVANCE This systematic review, analysis, and process, based on highest-quality evidence available and expert consensus, provided suggested implications for addressing spirituality in serious illness and health outcomes as part of person-centered, value-sensitive care.
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Affiliation(s)
- Tracy A Balboni
- Departments of Radiation Oncology and Psychosocial Oncology and Palliative Care, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Tyler J VanderWeele
- Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts
| | - Stephanie D Doan-Soares
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Katelyn N G Long
- Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts
| | - Betty R Ferrell
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, California
| | - George Fitchett
- Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois
| | - Harold G Koenig
- Departments of Psychiatry and Behavioral Sciences and Medicine, Duke University Medical Center, Duke University, Durham, North Carolina
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Paul A Bain
- Harvard Medical School, Boston, Massachusetts
| | - Christina Puchalski
- The George Washington Institute for Spirituality and Health, Departments of Medicine and Health Care Sciences, George Washington University, Washington, DC
| | - Karen E Steinhauser
- Division of Palliative Medicine, Department of Medicine, Duke University Medical Center, Duke University, Durham, North Carolina
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
| | - Daniel P Sulmasy
- Kennedy Institute of Ethics, Departments of Medicine and Philosophy and the Pellegrino Center for Clinical Bioethics, Georgetown University, Washington, DC
| | - Howard K Koh
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- John F. Kennedy School of Government, Harvard University, Boston, Massachusetts
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Shiba K, Hikichi H, Okuzono SS, VanderWeele TJ, Arcaya M, Daoud A, Cowden RG, Yazawa A, Zhu DT, Aida J, Kondo K, Kawachi I. Long-Term Associations between Disaster-Related Home Loss and Health and Well-Being of Older Survivors: Nine Years after the 2011 Great East Japan Earthquake and Tsunami. Environ Health Perspect 2022; 130:77001. [PMID: 35776697 PMCID: PMC9249145 DOI: 10.1289/ehp10903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/26/2022] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Little research has examined associations between disaster-related home loss and multiple domains of health and well-being, with extended long-term follow-up and comprehensive adjustment for pre-disaster characteristics of survivors. OBJECTIVES We examined the longitudinal associations between disaster-induced home loss and 34 indicators of health and well-being, assessed ∼9y post-disaster. METHODS We used data from a preexisting cohort study of Japanese older adults in an area directly impacted by the 2011 Japan Earthquake (n=3,350 and n=2,028, depending on the outcomes). The study was initiated in 2010, and disaster-related home loss status was measured in 2013 retrospectively. The 34 outcomes were assessed in 2020 and covered dimensions of physical health, mental health, health behaviors/sleep, social well-being, cognitive social capital, subjective well-being, and prosocial/altruistic behaviors. We estimated the associations between disaster-related home loss and the outcomes, using targeted maximum likelihood estimation and SuperLearner. We adjusted for pre-disaster characteristics from the wave conducted 7 months before the disaster (i.e., 2010), including prior outcome values that were available. RESULTS After Bonferroni correction for multiple testing, we found that home loss (vs. no home loss) was associated with increased posttraumatic stress symptoms (standardized difference=0.50; 95% CI: 0.35, 0.65), increased daily sleepiness (0.38; 95% CI: 0.21, 0.54), lower trust in the community (-0.36; 95% CI: -0.53, -0.18), lower community attachment (-0.60; 95% CI: -0.75, -0.45), and lower prosociality (-0.39; 95% CI: -0.55, -0.24). We found modest evidence for the associations with increased depressive symptoms, increased hopelessness, more chronic conditions, higher body mass index, lower perceived mutual help in the community, and decreased happiness. There was little evidence for associations with the remaining 23 outcomes. DISCUSSION Home loss due to a disaster may have long-lasting adverse impacts on the cognitive social capital, mental health, and prosociality of older adult survivors. https://doi.org/10.1289/EHP10903.
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Affiliation(s)
- Koichiro Shiba
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts, USA
| | - Hiroyuki Hikichi
- Division of Public Health, Kitasato University School of Medicine, Kanagawa, Japan
| | - Sakurako S. Okuzono
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Tyler J. VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Mariana Arcaya
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Adel Daoud
- Institute for Analytical Sociology, Linköping University, Linköping, Sweden
- Division of Data Science and Artificial Intelligence, Department of Computer Science and Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Richard G. Cowden
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, Massachusetts, USA
| | - Aki Yazawa
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - David T. Zhu
- Faculty of Science, Western University, London, Ontario, Canada
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Katsunori Kondo
- Department of Gerontological Evaluation, National Center for Geriatrics and Gerontology, Aichi, Japan
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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48
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Weziak-Bialowolska D, Bialowolski P, Lee MT, Chen Y, VanderWeele TJ, McNeely E. Prospective Associations Between Social Connectedness and Mental Health. Evidence From a Longitudinal Survey and Health Insurance Claims Data. Int J Public Health 2022; 67:1604710. [PMID: 35755953 PMCID: PMC9218058 DOI: 10.3389/ijph.2022.1604710] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/16/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives: Evidence on social stimuli associated with mental health is based mostly on self-reported health measures. We aimed to examine prospective associations between social connectedness and clinical diagnosis of depression and of anxiety. Methods: Longitudinal observational data merged with health insurance data comprising medical information on diagnosis of depression and anxiety were used. 1,209 randomly sampled employees of a US employer provided data for the analysis. Robust Poisson regression models were used. Multiple imputation was conducted to handle missing data on covariates. Results: Better social connectedness was associated with lower risks of subsequently diagnosed depression and anxiety, over a one-year follow-up period. Reports of feeling lonely were associated with increased risks of depression and anxiety. Association between community-related social connectedness and subsequent diagnosis of depression, but not of anxiety, was found. The associations were independent of demographics, socioeconomic status, lifestyle, and work characteristics. They were also robust to unmeasured confounding, missing data patterns, and prior health conditions. Conclusion: Social connectedness may be an important factor for reducing risks of depression and anxiety. Loneliness should be perceived as a risk factor for depression and anxiety.
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Affiliation(s)
- Dorota Weziak-Bialowolska
- Department of Environmental Health, School of Public Health, Harvard University, Boston, MA, United States.,Institute for Quantitative Social Science, Harvard University, Cambridge, MA, United States.,Center for Evaluation and Analysis of Public Policies, Faculty of Philosophy, Jagiellonian University, Kraków, Poland
| | - Piotr Bialowolski
- Department of Environmental Health, School of Public Health, Harvard University, Boston, MA, United States.,Institute for Quantitative Social Science, Harvard University, Cambridge, MA, United States.,Department of Economics, Kozminski University, Warsaw, Poland
| | - Matthew T Lee
- Institute for Quantitative Social Science, Harvard University, Cambridge, MA, United States
| | - Ying Chen
- Institute for Quantitative Social Science, Harvard University, Cambridge, MA, United States.,Department of Epidemiology, School of Public Health, Harvard University, Boston, MA, United States
| | - Tyler J VanderWeele
- Institute for Quantitative Social Science, Harvard University, Cambridge, MA, United States.,Department of Epidemiology, School of Public Health, Harvard University, Boston, MA, United States
| | - Eileen McNeely
- Department of Environmental Health, School of Public Health, Harvard University, Boston, MA, United States
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49
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Mathur MB, Smith LH, Yoshida K, Ding P, VanderWeele TJ. E-values for effect heterogeneity and approximations for causal interaction. Int J Epidemiol 2022; 51:1268-1275. [PMID: 35460421 PMCID: PMC9365630 DOI: 10.1093/ije/dyac073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 04/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background Estimates of effect heterogeneity (i.e. the extent to which the causal effect of one exposure varies across strata of a second exposure) can be biased if the exposure–outcome relationship is subject to uncontrolled confounding whose severity differs across strata of the second exposure. Methods We propose methods, analogous to the E-value for total effects, that help to assess the sensitivity of effect heterogeneity estimates to possible uncontrolled confounding. These E-value analogues characterize the severity of uncontrolled confounding strengths that would be required, hypothetically, to ‘explain away’ an estimate of multiplicative or additive effect heterogeneity in the sense that appropriately controlling for those confounder(s) would have shifted the effect heterogeneity estimate to the null, or alternatively would have shifted its confidence interval to include the null. One can also consider shifting the estimate or confidence interval to an arbitrary non-null value. All of these E-values can be obtained using the R package EValue. Results We illustrate applying the proposed E-value analogues to studies on: (i) effect heterogeneity by sex of the effect of educational attainment on dementia incidence and (ii) effect heterogeneity by age on the effect of obesity on all-cause mortality. Conclusion Reporting these proposed E-values could help characterize the robustness of effect heterogeneity estimates to potential uncontrolled confounding.
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Affiliation(s)
- Maya B Mathur
- Quantitative Sciences Unit and Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Louisa H Smith
- Roux Institute, Northeastern University, Portland, ME, USA
| | - Kazuki Yoshida
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Peng Ding
- Department of Statistics, University of California at Berkeley, Berkeley, CA, USA
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50
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Shiba K, Cowden RG, Counted V, VanderWeele TJ, Fancourt D. Associations of home confinement during COVID-19 lockdown with subsequent health and well-being among UK adults. Curr Psychol 2022:1-10. [PMID: 35309290 PMCID: PMC8922081 DOI: 10.1007/s12144-022-03001-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
During the COVID-19 pandemic, the United Kingdom (UK) government introduced public health safety measures to mitigate the spikes in infection rates. This included stay-at-home orders that prevented people from leaving their homes for work or study, except for urgent medical care or buying essential items. This practice could have both short and long-term implications for health and wellbeing of people in the UK. Using longitudinal data of 10,630 UK adults, this study prospectively examined the association between home confinement status during the stringent lockdown in the UK (March 23-May 13, 2020) and 20 indicators of subjective well-being, social well-being, pro-social/altruistic behaviors, psychological distress, and health behaviors assessed approximately one month after the stringent lockdown ended. All analyses adjusted for socio-demographic characteristics and social isolation status in the beginning of the pandemic. Home confinement during the lockdown was associated with greater subsequent compliance with COVID-19 rules, more perceived major stressors, and a lower prevalence of physical activity. There was modest evidence of associations with lower life satisfaction, greater loneliness, greater depressive symptoms, greater anxiety symptoms, and more perceived minor stressors post-lockdown. However, there was little evidence that home confinement was associated with other indices of subsequent health and well-being. While our study shows that home confinement impacts some indices of subsequent health and wellbeing outcomes even after lockdown, the degree of the psychological adaptation to the difficult confinement behavior remains unclear and should be further studied. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-022-03001-5.
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Affiliation(s)
- Koichiro Shiba
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA USA
| | - Richard G. Cowden
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA USA
| | - Victor Counted
- School of Psychology and Counselling, College of Health and Behavioral Sciences, Regent University, Virginia Beach, VA USA
| | - Tyler J. VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
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