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Chen YW, Kim TD, Molina RL, Chang DC, Oseni TO. Minority-Serving Hospitals Are Associated With Low Within-Hospital Disparity. Am Surg 2024; 90:567-574. [PMID: 37723949 DOI: 10.1177/00031348231175117] [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] [Indexed: 09/20/2023]
Abstract
BACKGROUND Disparities in obstetric care have been well documented, but disparities in the within-hospital population have not been as extensively explored. The objective is to assess cesarean delivery rate disparities at the hospital level in a nationally recognized low risk of cesarean delivery group. METHODS An observational study using a national population-based database, Nationwide Inpatient Sample, from 2008 to 2011 was conducted. All patients with nulliparous, term, singleton, vertex pregnancies from Black and White patients were included. The primary outcome was delivery mode (cesarean vs vaginal). The primary independent variable was race (Black vs White). RESULTS A total of 1,064,351 patients were included and the overall nulliparous, term, singleton, and vertex pregnancies cesarean delivery rate was 14.1%. The within-hospital disparities of cesarean delivery rates were lower in minority-serving hospitals (OR: 1.20 95% CI: 1.12-1.28), rural hospitals (OR 1.11 95% CI: 1.02-1.20), and the South (OR 1.24 95% CI 1.19-1.30) compared to their respective counterparts. Non-minority serving hospitals (OR: 1.20 95% CI 0.12-1.25), and urban hospitals (OR1.32 95% CI 1.28-1.37), the Northeast (OR 1.41 95% CI 1.30-1.53) or West (OR 1.52 95% CI 1.38-1.67), had higher within-hospital racial disparities of cesarean delivery rates. The odds ratios reported are comparing within-hospital cesarean delivery rates in Black and White patients. DISCUSSION Significant within-hospital disparities of cesarean delivery rates across hospitals highlight the importance of facility-level factors. Policies aimed at advancing health equity must address hospital-level drivers of disparities in addition to structural racism.
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Affiliation(s)
- Ya-Wen Chen
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
- Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, MA, USA
| | - Tommy D Kim
- Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, MA, USA
- UMass Chan Medical School, Worcester, MA, USA
| | | | - David C Chang
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
- Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital/ Harvard Medical School, Boston, MA, USA
| | - Tawakalitu O Oseni
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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Yang Z, Liao J, Zhang Y, Lin Y, Ge Y, Chen W, Qiu C, Berhane K, Bai Z, Han B, Xu J, Jiang YH, Gilliland F, Yan W, Chen Z, Huang G, Zhang J(J. Critical windows of greenness exposure during preconception and gestational periods in association with birthweight outcomes. Environ Res Health 2024; 2:015001. [PMID: 38022394 PMCID: PMC10647935 DOI: 10.1088/2752-5309/ad0aa6] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/26/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023]
Abstract
Few studies have examined the association between greenness exposure and birth outcomes. This study aims to identify critical exposure time windows during preconception and pregnancy for the association between greenness exposure and birth weight. A cohort of 13 890 pregnant women and newborns in Shanghai, China from 2016-2019 were included in the study. We assessed greenness exposure using Normalized Difference Vegetation Index (NDVI) during the preconception and gestational periods, and evaluated the association with term birthweight, birthweight z-score, small-for-gestational age, and large-for-gestational age using linear and logistic regressions adjusting for key maternal and newborn covariates. Ambient temperature, relative humidity, ambient levels of fine particles (PM2.5) and nitrogen dioxide (NO2) assessed during the same period were adjusted for as sensitivity analyses. Furthermore, we explored the potential different effects by urbanicity and park accessibility through stratified analysis. We found that higher greenness exposure at the second trimester of pregnancy and averaged exposure during the entire pregnancy were associated with higher birthweight and birthweight Z-score. Specifically, a 0.1 unit increase in second trimester averaged NDVI value was associated with an increase in birthweight of 10.2 g (95% CI: 1.8-18.5 g) and in birthweight Z-score of 0.024 (0.003-0.045). A 0.1 unit increase in an averaged NDVI during the entire pregnancy was associated with 10.1 g (95% CI: 1.0-19.2 g) increase in birthweight and 0.025 (0.001-0.048) increase in birthweight Z-score. Moreover, the associations were larger in effect size among urban residents than suburban residents and among residents without park accessibility within 500 m compared to those with park accessibility within 500 m. Our findings suggest that increased greenness exposure, particularly during the second trimester, may be beneficial to birth weight in a metropolitan area.
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Affiliation(s)
- Zhenchun Yang
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Jiawen Liao
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Yi Zhang
- Children’s Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, Shanghai, People’s Republic of China
| | - Yan Lin
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Yihui Ge
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Wu Chen
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Chenyu Qiu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Kiros Berhane
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Zhipeng Bai
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing, People’s Republic of China
| | - Bin Han
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing, People’s Republic of China
| | - Jia Xu
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing, People’s Republic of China
| | - Yong Hui Jiang
- Department of Genetics, Neuroscience, and Pediatrics, Yale University School of Medicine, New Haven, CT, United States of America
| | - Frank Gilliland
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Weili Yan
- Children’s Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, Shanghai, People’s Republic of China
| | - Zhanghua Chen
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Guoying Huang
- Children’s Hospital of Fudan University, Shanghai Key Laboratory of Birth Defect, Shanghai, People’s Republic of China
| | - Junfeng (Jim) Zhang
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Division of Environmental Science and Policy, Nicholas School of the Environment, Duke University, Durham, NC, United States of America
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Ghahyazi K, Familiar-Lopez I, Culbert O, Uruchima J, Van Engen A, Cevallos W, Eisenberg JNS, Levy K, Lee GO. Correlates of maternal depression, anxiety and functioning across an urban-rural gradient in northern Ecuador. Glob Public Health 2024; 19:2291697. [PMID: 38084739 PMCID: PMC10787496 DOI: 10.1080/17441692.2023.2291697] [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] [Received: 06/15/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023]
Abstract
Maternal depression remains under characterised in many low- and middle-income countries, especially in rural settings. We aimed to describe maternal depression and anxiety symptoms in rural and urban communities in northern Ecuador and to identify socioeconomic and demographic factors associated with these symptoms. Data from 508 mothers participating in a longitudinal cohort study were included. Depression and anxiety symptoms were assessed using the Hopkins Symptom Checklist (HSCL-25), and maternal psychological functioning was assessed using a checklist of daily activities. Tobit regression models were used to examine associations with sociodemographic variables and urbanicity. The median HSCL-25 score was 1.2 (IQR: 0.4) and 14% of women scored above the threshold for clinically relevant symptoms. Rural women reported similar food insecurity, less education, younger age of first pregnancy, and lower socio-economic status compared to their urban counterparts. After adjusting for these factors, rural women reported lower HSCL-25 scores compared to women lin urban areas (β = -0.48, 95%CI:0.65, -0.31). Rural residence was also associated with lower depression and anxiety HSCL-25 sub-scale scores, and similar levels of maternal functioning, compared to urban residence. Our results suggest that both household and community-level factors are risk factors for maternal depression and anxiety in this context.
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Affiliation(s)
- Kiana Ghahyazi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | | | - Oriana Culbert
- Rutgers Global Health Institute and Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey, USA
| | - Jessica Uruchima
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Amanda Van Engen
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - William Cevallos
- Instituto de Biomedicina, Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador
| | - Joseph N S Eisenberg
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Karen Levy
- Department of Environmental and Occupational Health Sciences, University of Washington, School of Public Health, Seattle, Washington, USA
| | - Gwenyth O Lee
- Rutgers Global Health Institute and Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey, USA
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Kasai K, Kumagaya SI, Takahashi Y, Sawai Y, Uno A, Kumakura Y, Yamagishi M, Kanehara A, Morita K, Tada M, Satomura Y, Okada N, Koike S, Yagishita S. "World-Informed" Neuroscience for Diversity and Inclusion: An Organizational Change in Cognitive Sciences. Clin EEG Neurosci 2023; 54:560-566. [PMID: 35695218 DOI: 10.1177/15500594221105755] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
By nature, humans are "tojisha (participating subjects/player-witnesses)" who encounter an unpredictable real world. An important characteristic of the relationship between the individual brain and the world is that it creates a loop of interaction and mutual formation. However, cognitive sciences have traditionally been based on a model that treats the world as a given constant. We propose incorporating the interaction loop into this model to create "world-informed neuroscience (WIN)". Based on co-productive research with people with minority characteristics that do not match the world, we hypothesize that the tojisha and the world interact in a two-dimensional way of rule-based and story-based. By defining the cognitive process of becoming tojisha in this way, it is possible to contribute to the various issues of the real world and diversity and inclusion through the integration of the humanities and sciences. The critical role of the brain dopamine system as a basis for brain-world interaction and the importance of research on urbanicity and adolescent development as examples of the application of WIN were discussed. The promotion of these studies will require bidirectional translation between human population science and animal cognitive neuroscience. We propose that the social model of disability should be incorporated into cognitive sciences, and that disability-informed innovation is needed to identify how social factors are involved in mismatches that are difficult to visualize. To promote WIN to ultimately contribute to a diverse and inclusive society, co-production of research from the initial stage of research design should be a baseline requirement.
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Affiliation(s)
- Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- The International Research Center for Neurointelligence (WPI-IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS), The University of Tokyo, Tokyo, Japan
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Tokyo, Japan
- UTokyo Center for Integrative Science of Human Behavior (CiSHuB), Graduate School of Art and Sciences, The University of Tokyo, Tokyo, Japan
- Center for Diversity in Medical Education and Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shin-Ichiro Kumagaya
- Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Yusuke Takahashi
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- St Luke's International Hospital, Tokyo, Japan
| | - Yutaka Sawai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akito Uno
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yousuke Kumakura
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mika Yamagishi
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akiko Kanehara
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kentaro Morita
- Department of Rehabilitation, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mariko Tada
- Center for Research on Counseling and Support Services, The University of Tokyo, Tokyo, Japan
| | - Yoshihiro Satomura
- Center for Diversity in Medical Education and Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naohiro Okada
- The International Research Center for Neurointelligence (WPI-IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS), The University of Tokyo, Tokyo, Japan
| | - Shinsuke Koike
- The International Research Center for Neurointelligence (WPI-IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS), The University of Tokyo, Tokyo, Japan
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Tokyo, Japan
- UTokyo Center for Integrative Science of Human Behavior (CiSHuB), Graduate School of Art and Sciences, The University of Tokyo, Tokyo, Japan
- Center for Evolutionary Cognitive Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Sho Yagishita
- Department of Structural Physiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Miller JS, Bada H, Dunworth C, Charnigo R. Recent and lifetime maternal substance use: Rurality and economic distress. Res Nurs Health 2023; 46:502-514. [PMID: 37515582 PMCID: PMC10528337 DOI: 10.1002/nur.22330] [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] [Received: 11/09/2022] [Revised: 07/10/2023] [Accepted: 07/15/2023] [Indexed: 07/31/2023]
Abstract
Research on opioid use disorder (OUD) in pregnancy has mainly considered women in urban areas receiving treatment, with less known about women in rural areas. We sought to describe demographics and substance use characteristics of pregnant women with OUD and to compare the women based on urbanicity, in a state (Kentucky) with unfavorable economic conditions in many rural counties; we hypothesized that pregnant women in rural areas would have greater adversity, broadly defined, related to substance use. Using data collected from a larger project between 2017 and 2020, we analyzed characteristics of 93 pregnant women (59 rural and 34 urban) with OUD; we examined data in medical, employment, substance use, legal, family history, relationship, and psychiatric health domains, both overall and within rural (population <50,000) and urban (population ≥50,000) strata. Pregnant women with OUD from rural and urban areas were similar on almost all attributes. Among the few significant differences, 30% from urban areas perceived inadequate prenatal care versus 11% from rural areas (p = 0.024); 21% of urban women used amphetamines/methamphetamines in the month before delivery versus 0% of rural women (p < 0.001); and rural women had longer most recent abstinence from substance use than their urban counterparts (medians 7.0 and 2.8 months, p = 0.049). The few significant differences that were discovered favored rural women. These findings, contrary to our hypothesis, suggest that tailoring interventions may require more than focusing on geography. The participants in this study were pregnant women being treated for OUD, and as such there is patient contribution of data.
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Affiliation(s)
- Jennifer Shearer Miller
- College of Medicine, University of Kentucky, Lexington, KY
- College of Nursing, University of Tennessee, Knoxville, TN
| | - Henrietta Bada
- College of Medicine, University of Kentucky, Lexington, KY
| | - Caitlin Dunworth
- KCH Office of Pediatric Research, Kentucky Children’s Hospital, Lexington, KY
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Uruchima J, Renehan C, Castro N, Cevallos W, Levy K, Eisenberg JNS, Lee GO. A Qualitative Study of Food Choice in Urban Coastal Esmeraldas, Ecuador. Curr Dev Nutr 2023; 7:100093. [PMID: 37234101 PMCID: PMC10206432 DOI: 10.1016/j.cdnut.2023.100093] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 01/20/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Background Constraints on food choice increase risk of malnutrition worldwide. Residents of secondary cities within low- and middle-income countries are a population of particular concern because they often face high rates of food insecurity and multiple nutritional burdens. Within this context, effective and equitable interventions to support healthy diets must be based on an understanding of the lived experience of individuals and their interactions with the food environment. Objectives The primary objectives of this study were to describe considerations that drive household decision making around food choice in the city of Esmeraldas, Ecuador; to identify trade-offs between these considerations; and to understand how an evolving urban environment influences these trade-offs. Methods Semistructured interviews were conducted with 20 mothers of young children to explore drivers in food choice throughout the purchase, preparation, and consumption chain. Interviews were transcribed and coded to identify key themes. Results Personal preference, economic access (costs), convenience, and perceptions of food safety were key influencers of decision making related to food. In addition, concerns about personal safety in the urban environment limited physical access to food. This, combined with the need to travel long distances to obtain desirable foods, increased men's participation in food purchasing. Women's increasing engagement in the workforce also increased men's participation in food preparation. Conclusions Policies to promote healthy food behavior in this context should focus on increasing access to health foods, such as affordable fresh produce, in convenient and physically safe locations. CurrDev Nutr 2023;x:xx.
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Affiliation(s)
- Jessica Uruchima
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Cala Renehan
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Nancy Castro
- Carrera de Nutrición y Dietética, Universidad de San Francisco de Quito, Quito, Ecuador
| | - William Cevallos
- Centro de Biomedicina, Carrera de Medicina, Universidad Central, Quito, Ecuador
| | - Karen Levy
- Department of Environmental and Occupational Health, University of Washington, Seattle, WA, United States
| | - Joseph NS. Eisenberg
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Gwenyth O. Lee
- Rutgers Global Health Institute, Rutgers University, New Brunswick, NJ, United States
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Matsuzaki M, Sanchez‐Vaznaugh EV, Alexovitz K, Acosta ME, Sánchez BN. Trends in school-neighbourhood inequalities and youth obesity: Repeated cross-sectional analyses of the public schools in the state of California. Pediatr Obes 2023; 18:e12991. [PMID: 36517944 PMCID: PMC10078445 DOI: 10.1111/ijpo.12991] [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: 08/08/2022] [Accepted: 10/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND It is currently unknown whether the relationship between affluence of school neighbourhoods and prevalence of youth overweight/obesity is uniform across demographic subgroups and areal context in the United States. METHODS We examined association between school-neighbourhood income tertiles and school-level overweight/obesity (OVOB) prevalence, using data on body mass index of fifth, seventh, and nineth graders who attended public schools in California in 2001 and 2010 (n = 1 584 768), using multiple logistic regression models. RESULTS Overall, OVOB prevalence was higher in lower-income school neighbourhoods, with a steeper income-OVOB gradient for girls. Among boys, the gradient became steeper in 2010 than 2000. Among Asian and White girls, the negative gradients were steepest in rural areas. For African-American students in all areas and Latino boys in rural areas, there was less clear evidence of inverse income-OVOB gradients. Addition of fast-food restaurant availability to the models did not change the observed inverse school-neighbourhood income-obesity gradients. CONCLUSIONS The findings suggest the needs to investigate reasons for this variability with consideration to combinations of sociodemographic, economic, and environmental risk factors that may contribute to disparities in childhood obesity.
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Affiliation(s)
- Mika Matsuzaki
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Center for Human NutritionJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Emma V. Sanchez‐Vaznaugh
- Department of Public HealthSan Francisco State UniversitySan FranciscoCaliforniaUSA
- Health Equity InstituteSan Francisco State UniversitySan FranciscoCaliforniaUSA
- Center for Health EquityUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Kelsey Alexovitz
- Department of Epidemiology and BiostatisticsDrexel Dornsife School of Public HealthPhiladelphiaPennsylvaniaUSA
| | - Maria E. Acosta
- Department of Public HealthSan Francisco State UniversitySan FranciscoCaliforniaUSA
| | - Brisa N. Sánchez
- Department of Epidemiology and BiostatisticsDrexel Dornsife School of Public HealthPhiladelphiaPennsylvaniaUSA
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Roberts T, Susser E, Lee Pow J, Donald C, John S, Raghavan V, Ayinde O, Olley B, Miguel Esponda G, Lam J, Murray RM, Cohen A, Weiss HA, Hutchinson G, Thara R, Gureje O, Burns J, Morgan C. Urbanicity and rates of untreated psychotic disorders in three diverse settings in the Global South. Psychol Med 2023; 53:1-9. [PMID: 36645027 PMCID: PMC10600928 DOI: 10.1017/s0033291722003749] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/28/2022] [Accepted: 11/23/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Extensive evidence indicates that rates of psychotic disorder are elevated in more urban compared with less urban areas, but this evidence largely originates from Northern Europe. It is unclear whether the same association holds globally. This study examined the association between urban residence and rates of psychotic disorder in catchment areas in India (Kancheepuram, Tamil Nadu), Nigeria (Ibadan, Oyo), and Northern Trinidad. METHODS Comprehensive case detection systems were developed based on extensive pilot work to identify individuals aged 18-64 with previously untreated psychotic disorders residing in each catchment area (May 2018-April/May/July 2020). Area of residence and basic demographic details were collected for eligible cases. We compared rates of psychotic disorder in the more v. less urban administrative areas within each catchment area, based on all cases detected, and repeated these analyses while restricting to recent onset cases (<2 years/<5 years). RESULTS We found evidence of higher overall rates of psychosis in more urban areas within the Trinidadian catchment area (IRR: 3.24, 95% CI 2.68-3.91), an inverse association in the Nigerian catchment area (IRR: 0.68, 95% CI 0.51-0.91) and no association in the Indian catchment area (IRR: 1.18, 95% CI 0.93-1.52). When restricting to recent onset cases, we found a modest positive association in the Indian catchment area. CONCLUSIONS This study suggests that urbanicity is associated with higher rates of psychotic disorder in some but not all contexts outside of Northern Europe. Future studies should test candidate mechanisms that may underlie the associations observed, such as exposure to violence.
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Affiliation(s)
- Tessa Roberts
- ESRC Centre for Society & Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ezra Susser
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
- New York State Psychiatric Institute, New York, USA
| | - Joni Lee Pow
- Department of Psychiatry, University of the West Indies, St Augustine Campus, Trinidad & Tobago
| | - Casswina Donald
- Department of Psychiatry, University of the West Indies, St Augustine Campus, Trinidad & Tobago
| | - Sujit John
- Schizophrenia Research Foundation, Chennai, India
| | | | - Olatunde Ayinde
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bola Olley
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Georgina Miguel Esponda
- ESRC Centre for Society & Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joseph Lam
- Department of Population, Practice and Policy, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Robin M. Murray
- Division of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alex Cohen
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen A. Weiss
- MRC International Statistics & Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Gerard Hutchinson
- Department of Psychiatry, University of the West Indies, St Augustine Campus, Trinidad & Tobago
| | | | - Oye Gureje
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Jonathan Burns
- Mental Health Research Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Craig Morgan
- ESRC Centre for Society & Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research, Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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Kim K, Tsai AC, Lowe S, Stewart R, Jung SJ. Urbanicity, posttraumatic stress disorder, and effect modification by socioeconomic position: A nested case-control study of the Korean National Health Insurance Database. Acta Psychiatr Scand 2023; 147:54-64. [PMID: 36086797 DOI: 10.1111/acps.13499] [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] [Received: 02/15/2022] [Revised: 08/28/2022] [Accepted: 09/03/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to estimate the association between urbanicity and the onset of posttraumatic stress disorder (PTSD) and to investigate heterogeneity therein according to age and socioeconomic position (SEP). METHODS We analyzed administrative data from the Korean National Health Insurance Database for patients with PTSD from 2004 to 2018 (N = 109,230) and for a 1:4 sample of age-, sex-, and enrollment year-matched controls. Information on eligibility, SEP (proxied by insurance premium), place of residence, diagnosis, and medical claims was obtained. Urbanicity of administrative districts was assessed using data from the Korean Statistical Information Service, 2005-2018. We estimated hazard ratios (HRs) from baseline and time-dependent models. Subgroup analyses and polynomial splines were used to investigate heterogeneity by age and SEP. RESULTS Urbanicity was associated with an increased risk of PTSD (per 10%p increase, HR = 1.056, 95% CI 1.050-1.061). A positive association was estimated among patients aged 0-29 years (HR = 1.115, CI 1.106-1.124), while negative associations were estimated among patients aged 30-64 years (HR = 0.990, CI 0.987-0.994) and 65 years or older (HR = 0.992, CI 0.979-1.014). The estimated associations with urbanicity were more prominent at the extremes of SEP, but only among younger participants. CONCLUSION Urban residence was associated with an increased risk of PTSD diagnosis. The estimated association was larger among younger individuals (but not among middle-aged and older individuals). Among younger individuals, the estimated association was larger at both extremes of SEP.
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Affiliation(s)
- Kwanghyun Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, USA.,Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Sarah Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, Connecticut, USA
| | - Robert Stewart
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Sun Jae Jung
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea.,Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, USA.,Harvard Center for Population and Development Studies, Harvard Medical School, Boston, USA
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10
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Goldbach JT, Parra LA, O’Brien RP, Rhoades H, Schrager SM. Explaining behavioral health differences in urban and rural sexual minority adolescents: A longitudinal investigation of minority stress in a diverse national sample of sexual minority adolescents: A longitudinal investigation of minority stress in a diverse national sample of sexual minority adolescents. J Rural Health 2023; 39:262-271. [PMID: 35977886 PMCID: PMC9771913 DOI: 10.1111/jrh.12706] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/01/2023]
Abstract
PURPOSE Experiences of sexuality-based discrimination (ie, minority stressors) against youth who identify as nonheterosexual (ie, sexual minority) have been associated with increased symptoms of anxiety, depression, and post-traumatic stress disorder (PTSD) for sexual minority adolescents (SMA; ages 14-17). However, little is known about the experiences of SMA living in rural communities across the United States. Thus, the present study sought to examine differences in mental health patterns between urban and rural dwelling SMA, and to see whether these differences are, at least in part, explained by experiences of lifetime minority stress. METHODS A nationwide sample of SMA residing in the United States (N = 2,558; aged 14-17, M = 15.90 years, SD = 0.98) was recruited through purposive social media and respondent-driven sampling methods to complete a cross-sectional survey online. Measures included those of minority stress, urbanicity, and symptoms of anxiety, depression, and PTSD. Parallel multiple mediation (PMM) analysis was employed to test whether urbanicity was associated with anxiety, depressive, and PTSD symptoms through reported lifetime minority stress. FINDINGS On average, SMA living in rural areas significantly reported more lifetime minority stress, depressive, and PTSD symptoms than SMA living in urban settings. Results from our PMM analysis indicated that heightened experiences of lifetime minority stress indirectly linked the effects of living in rural areas on anxiety (b = -0.288, 95% CI = [-0.491, -0.085]), depressive (b = -0.158, 95% CI = [-0.270, -0.047), and PTSD symptoms PTSD (b = -0.349, 95% CI = [-0.596, -0.105]). The model accounted for 16.8%, 18%, and 24.1% of the variability in anxiety symptoms, depressive symptoms, and PTSD symptoms, respectively. CONCLUSIONS SMA in our study who reside in rural areas reported elevated minority stress, depressive, and PTSD symptoms as compared to their urban dwelling peers. Our study found that lifetime experiences of minority stress fully mediated the relationship between urbanicity and both depressive and PTSD symptoms, and partially mediated the relationship between urbanicity and anxiety. These findings highlight the need to increase support for rural youth who are growing into adulthood and may find continuing challenges in their family, peer, and community relationships.
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Affiliation(s)
- Jeremy T. Goldbach
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Luis A. Parra
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Rory P. O’Brien
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Harmony Rhoades
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
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11
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Jones J, Pampati S, Emrick K, Siegler AJ. Demographic and behavioral characteristics of urban and non-urban PrEP-using MSM in the South. AIDS Care 2022; 34:1461-1464. [PMID: 35676749 DOI: 10.1080/09540121.2022.2085864] [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: 10/18/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention intervention; however, most studies of PrEP adherence and persistence among men who have sex with men (MSM) have been conducted with MSM who live in urban areas. The experiences of PrEP-using MSM in non-urban areas might differ due to increased barriers to culturally competent care. We examined similarities and differences among urban and non-urban PrEP-using MSM in the southern United States, the region with the highest number of annual HIV diagnoses. We surveyed a total of 78 (n = 25 non-urban, n = 53 urban) PrEP-using MSM. Self-reported adherence was high across all participants. No differences were observed with respect to PrEP persistence, source of PrEP, or reasons for PrEP initiation. Fewer non-urban than urban men reported STI testing in the past 12 months. Overall, we observed few differences comparing urban and non-urban PrEP-using MSM. Additional studies are needed to describe differences in PrEP initiation comparing urban and non-urban MSM.
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Affiliation(s)
- Jeb Jones
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Sanjana Pampati
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Kayla Emrick
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Aaron J Siegler
- Department of Epidemiology, Emory University, Atlanta, GA, USA
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12
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Meeker MA, Schwartz BS, Bandeen‐Roche K, Hirsch AG, De Silva SSA, McAlexander TP, Black NC, McClure LA. Assessing Measurement Invariance of a Land Use Environment Construct Across Levels of Urbanicity. Geohealth 2022; 6:e2022GH000667. [PMID: 36262526 PMCID: PMC9576186 DOI: 10.1029/2022gh000667] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
Variation in the land use environment (LUE) impacts the continuum of walkability to car dependency, which has been shown to have effects on health outcomes. Existing objective measures of the LUE do not consider whether the measurement of the construct varies across different types of communities along the rural/urban spectrum. To help meet the goals of the Diabetes Location, Environmental Attributes, and Disparities (LEAD) Network, we developed a national, census tract-level LUE measure which evaluates the road network and land development. We tested for measurement invariance by LEAD community type (higher density urban, lower density urban, suburban/small town, and rural) using multiple group confirmatory factor analysis. We determined that metric invariance does not exist; thus, measurement of the LUE does vary across community type with average block length, average block size, and percent developed land driving most shared variability in rural tracts and with intersection density, street connectivity, household density, and commercial establishment density driving most shared variability in higher density urban tracts. As a result, epidemiologic studies need to consider community type when assessing the LUE to minimize place-based confounding.
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Affiliation(s)
- Melissa A. Meeker
- Department of Epidemiology and BiostatisticsDrexel University Dornsife School of Public HealthPhiladelphiaPAUSA
| | - Brian S. Schwartz
- Department of Population Health SciencesGeisingerDanvillePAUSA
- Department of Environmental Health and EngineeringJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Karen Bandeen‐Roche
- Department of BiostatisticsJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - S. Shanika A. De Silva
- Department of Epidemiology and BiostatisticsDrexel University Dornsife School of Public HealthPhiladelphiaPAUSA
| | - Tara P. McAlexander
- Department of Epidemiology and BiostatisticsDrexel University Dornsife School of Public HealthPhiladelphiaPAUSA
| | | | - Leslie A. McClure
- Department of Epidemiology and BiostatisticsDrexel University Dornsife School of Public HealthPhiladelphiaPAUSA
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13
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Ngwenya TZ, Huang N, Wang IA, Chen CY. Urban-Rural Differences in Depression Literacy Among High School Teachers in the Kingdom of Eswatini. J Sch Health 2022; 92:561-569. [PMID: 35318668 DOI: 10.1111/josh.13173] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Concerns have been raised over teachers' mental health literacy in low-income countries and lower- and middle-income countries wherein pediatric mental health resources are limited. This study aims to investigate adolescent depression literacy among teachers in Eswatini and to explore the role of urbanicity. METHODS We conducted a cross-sectional survey in 59 public high schools in Eswatini in 2019-2020. Data were collected by a paper-and-pencil questionnaire; depression literacy was assessed by the 17-item Adolescent Depression Knowledge Questionnaire. RESULTS Teachers' adolescent depression literacy item-level correct rates fell between 27 and 80%. Although the multivariate response models indicated that teaching in urban areas was slightly associated with having higher depression literacy in general (adjusted odds ratio [aOR] = 1.46; 95% confidence interval = 1.00-2.12), such urban-rural differences did not manifest homogeneously across all items: urban teaching was significantly linked with reduced correct responses toward certain items concerning depression etiology and treatment, including "depression runs in some families," "major stress as a necessary cause," and "a curable illness" (aOR = 0.57 ∼ 0.68). CONCLUSION Urban-rural differences in teachers' depression literacy were manifested at both scale- and item-levels. A critical need exists for urban/rural areas-tailored intervention on teachers' literacy toward mental disorders in the resource-limited regions to better improve health and developmental outcomes of students.
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Affiliation(s)
- Thabo Zwelethu Ngwenya
- His Majesty's Correctional Services, Health Care Services, Box 166, Mbabane, Eswatini; International Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Nicole Huang
- International Health Program; Institute of Hospital and Health Care Administration; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - I-An Wang
- Center for Neuropsychiatric Research, National Health Research Institute, Zhunan, Taiwan
| | - Chuan-Yu Chen
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
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14
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Newbury JB, Arseneault L, Caspi A, Moffitt TE, Odgers CL, Belsky DW, Sugden K, Williams B, Ambler AP, Matthews T, Fisher HL. Association between genetic and socioenvironmental risk for schizophrenia during upbringing in a UK longitudinal cohort. Psychol Med 2022; 52:1527-1537. [PMID: 32972469 PMCID: PMC9226384 DOI: 10.1017/s0033291720003347] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/12/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Associations of socioenvironmental features like urbanicity and neighborhood deprivation with psychosis are well-established. An enduring question, however, is whether these associations are causal. Genetic confounding could occur due to downward mobility of individuals at high genetic risk for psychiatric problems into disadvantaged environments. METHODS We examined correlations of five indices of genetic risk [polygenic risk scores (PRS) for schizophrenia and depression, maternal psychotic symptoms, family psychiatric history, and zygosity-based latent genetic risk] with multiple area-, neighborhood-, and family-level risks during upbringing. Data were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally-representative cohort of 2232 British twins born in 1994-1995 and followed to age 18 (93% retention). Socioenvironmental risks included urbanicity, air pollution, neighborhood deprivation, neighborhood crime, neighborhood disorder, social cohesion, residential mobility, family poverty, and a cumulative environmental risk scale. At age 18, participants were privately interviewed about psychotic experiences. RESULTS Higher genetic risk on all indices was associated with riskier environments during upbringing. For example, participants with higher schizophrenia PRS (OR = 1.19, 95% CI = 1.06-1.33), depression PRS (OR = 1.20, 95% CI = 1.08-1.34), family history (OR = 1.25, 95% CI = 1.11-1.40), and latent genetic risk (OR = 1.21, 95% CI = 1.07-1.38) had accumulated more socioenvironmental risks for schizophrenia by age 18. However, associations between socioenvironmental risks and psychotic experiences mostly remained significant after covariate adjustment for genetic risk. CONCLUSION Genetic risk is correlated with socioenvironmental risk for schizophrenia during upbringing, but the associations between socioenvironmental risk and adolescent psychotic experiences appear, at present, to exist above and beyond this gene-environment correlation.
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Affiliation(s)
- J. B. Newbury
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - L. Arseneault
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - A. Caspi
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, and Centre for Genomic and Computational Biology, Duke University, Durham, NC, USA
| | - T. E. Moffitt
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, and Centre for Genomic and Computational Biology, Duke University, Durham, NC, USA
| | - C. L. Odgers
- Social Science Research Institute, Duke University, Durham, NC, USA
- Department of Psychological Science, School of Social Ecology, University of California, Irvine, CA, USA
| | - D. W. Belsky
- Department of Epidemiology and Robert N Butler Aging Center, Columbia University, Mailman School of Public Health, NY, USA
| | - K. Sugden
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - B. Williams
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - A. P. Ambler
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - T. Matthews
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - H. L. Fisher
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
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15
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Rossen LM, Ahrens KA, Womack LS, Uddin SFG, Branum AM. Rural-Urban Differences in Maternal Mortality Trends in the United States, 1999-2017: Accounting for the Impact of the Pregnancy Status Checkbox. Am J Epidemiol 2022; 191:1030-1039. [PMID: 35020799 DOI: 10.1093/aje/kwab300] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 12/20/2021] [Accepted: 12/30/2021] [Indexed: 11/13/2022] Open
Abstract
It has been difficult to measure rural-urban differences in maternal mortality ratios (MMRs) in the United States in recent years because of the incremental adoption of a pregnancy status checkbox on the standard US death certificate. Using 1999-2017 mortality and birth data, we examined the impact of the pregnancy checkbox on MMRs according to urbanicity of residence (large urban area, medium/small urban area, or rural area), using log-binomial regression models to predict trends that would have been observed if all states had adopted the checkbox as of 1999. Implementation of the checkbox resulted in an average estimated increase of 7.5 maternal deaths per 100,000 live births (95% confidence interval (CI): 6.3, 8.8) in large urban areas (a 76% increase), 11.6 (95% CI: 9.6, 13.6) in medium/small urban areas (a 113% increase), and 16.6 (95% CI: 12.9, 20.3) in rural areas (a 107% increase), compared with MMRs prior to the checkbox. Assuming that all states had the checkbox as of 1999, demographic-factor-adjusted predicted MMRs increased in rural areas, declined in large urban areas, and did not change in medium/small urban areas. However, trends and urban-rural differences were substantially attenuated when analyses were limited to direct/specific causes of maternal death, which are probably subject to less misclassification. Accurate ascertainment of maternal deaths, particularly in rural areas, is important for reducing disparities in maternal mortality.
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16
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Janda KM, Ranjit N, Salvo D, Hoelscher DM, Nielsen A, Casnovsky J, van den Berg A. Examining Geographic Food Access, Food Insecurity, and Urbanicity among Diverse, Low-Income Participants in Austin, Texas. Int J Environ Res Public Health 2022; 19:ijerph19095108. [PMID: 35564504 PMCID: PMC9104388 DOI: 10.3390/ijerph19095108] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 12/10/2022]
Abstract
The purpose of this study was to explore the association between geographic food access and food insecurity and the potential role of race/ethnicity, income, and urbanicity among a low-income, diverse sample in Central Texas. Utilizing a cross-sectional study design, secondary data analysis of an existing cohort was used to examine the association between food insecurity; geographic food access; and sociodemographic factors of race/ethnicity, income, urbanicity, and additional covariates using binomial logistic regression models. The existing cohort was recruited from lower-income communities in Travis County, Texas. The sample (N = 393) was predominantly Hispanic, lived in urban areas, and nearly 40% were food insecure. Geographic food access was not found to be significantly associated with food insecurity. However, rural residents had greater odds of being food insecure than urban residents. Also, participants who earned USD 45,000-64,999 and over USD 65,000 had lower odds of being food insecure than participants who earned under USD 25,000. These findings add to the inconsistent literature about the association between geographic food access and food insecurity and contribute to urbanicity and income disparities in food-insecurity literature. Future work should consider urbanicity, income, and utilize community-specific data to gain greater understanding of the association between geographic food access and food insecurity.
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Affiliation(s)
- Kathryn M. Janda
- UTHealth School of Public Health, Austin, TX 78701, USA; (N.R.); (D.M.H.); (A.N.); (A.v.d.B.)
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
- Correspondence:
| | - Nalini Ranjit
- UTHealth School of Public Health, Austin, TX 78701, USA; (N.R.); (D.M.H.); (A.N.); (A.v.d.B.)
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
| | - Deborah Salvo
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA;
| | - Deanna M. Hoelscher
- UTHealth School of Public Health, Austin, TX 78701, USA; (N.R.); (D.M.H.); (A.N.); (A.v.d.B.)
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
| | - Aida Nielsen
- UTHealth School of Public Health, Austin, TX 78701, USA; (N.R.); (D.M.H.); (A.N.); (A.v.d.B.)
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
| | | | - Alexandra van den Berg
- UTHealth School of Public Health, Austin, TX 78701, USA; (N.R.); (D.M.H.); (A.N.); (A.v.d.B.)
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
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17
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Saxena A, Dodell-Feder D. Explaining the Association Between Urbanicity and Psychotic-Like Experiences in Pre-Adolescence: The Indirect Effect of Urban Exposures. Front Psychiatry 2022; 13:831089. [PMID: 35360125 PMCID: PMC8962621 DOI: 10.3389/fpsyt.2022.831089] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/27/2022] [Indexed: 11/30/2022] Open
Abstract
Urban living is a growing worldwide phenomenon with more than two-thirds of people expected to live in cities by 2050. Although there are many benefits to living in an urban environment, urbanicity has also been associated with deleterious health outcomes, including increased risk for psychotic outcomes particularly when the urban exposure occurs in pre-adolescence. However, the mechanisms underlying this association is unclear. Here, we utilize one-year follow-up data from a large (N=7,979), nationwide study of pre-adolescence in the United States to clarify why urbanicity (i.e., census-tract population density) might impact psychotic-like experiences (PLE) by looking at the indirect effect of eight candidate urbanicity-related physical (e.g., pollution) and social (e.g., poverty) exposures. Consistent with other work, we found that of the evaluated exposures related to urbanicity, several were also related to increased number of PLE: PM2.5, proximity to roads, census-level homes at-risk for exposure to lead paint, census-level poverty, and census-level income-disparity. These same urban-related exposures were also related to the persistence of PLE after 1 year, but not new onset of PLE. Mediation analysis revealed that a substantial proportion the urbanicity-PLE association (number and persistence) could be explained by PM2.5 (23-44%), families in poverty (68-93%), and income disparity (67-80%). Together, these findings suggest that specific urban-related exposures contribute to the existence and maintenance, but not onset of PLE, which might help to explain why those in urban environments are disproportionately at-risk for psychosis and point toward areas for public health intervention.
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Affiliation(s)
- Abhishek Saxena
- Department of Psychology, University of Rochester, Rochester, NY, United States
| | - David Dodell-Feder
- Department of Psychology, University of Rochester, Rochester, NY, United States
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, United States
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Casant J, Helbich M. Inequalities of Suicide Mortality across Urban and Rural Areas: A Literature Review. Int J Environ Res Public Health 2022; 19:2669. [PMID: 35270369 DOI: 10.3390/ijerph19052669] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 02/01/2023]
Abstract
Suicide mortality is a major contributor to premature death, with geographic variation in suicide rates. Why suicide rates differ across urban and rural areas has not yet been fully established. We conducted a literature review describing the urban–rural disparities in suicide mortality. Articles were searched in five databases (EMBASE, PubMed, PsychINFO, Scopus, and Web of Science) from inception till 26 May 2021. Eligible studies were narratively analyzed in terms of the urban–rural disparities in suicides, different suicide methods, and suicide trends over time. In total, 24 articles were included in our review. Most studies were ecological and cross-sectional evidence tentatively suggests higher suicide rates in rural than in urban areas. Men were more at risk by rurality than women, but suicide is in general more prevalent among men. No obvious urban–rural pattern emerged regarding suicide means or urban–rural changes over time. Potential suicidogenic explanations include social isolation, easier access to lethal means, stigmatization toward people with mental health problems, and reduced supply of mental health services. For research progress, we urge, first, individual-level cohort and case-control studies in different sociocultural settings. Second, both rurality and urbanicity are multifaceted concepts that are inadequately captured by oversimplified typologies and require detailed assessments of the sociophysical residential environment.
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19
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Stieglitz LM, Bärnighausen T, Leyna GH, Kazonda P, Killewo J, Rohr JK, Kohler S. Patterns of comorbidity and multimorbidity among middle-aged and elderly women in peri-urban Tanzania. J Multimorb Comorb 2022; 12:26335565221076254. [PMID: 35586032 PMCID: PMC9106316 DOI: 10.1177/26335565221076254] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/04/2021] [Indexed: 12/11/2022]
Abstract
Background Multimorbidity poses an increasing challenge to health care systems in Sub-Saharan Africa. We studied the extent of multimorbidity and patterns of comorbidity among women aged 40 years or older in a peri-urban area of Dar es Salaam, Tanzania. Methods We assessed 15 chronic conditions in 1528 women who participated in a cross-sectional survey that was conducted within the Dar es Salaam Urban Cohort Study (DUCS) from June 2017 to July 2018. Diagnoses of chronic conditions were based on body measurements, weight, blood testing, screening instruments, and self-report. Results The five most prevalent chronic conditions and most common comorbidities were hypertension (49.8%, 95% CI 47.2 to 52.3), obesity (39.9%, 95% CI 37.3 to 42.4), anemia (36.9%, 95% CI 33.3 to 40.5), signs of depression (32.5%, 95% CI 30.2 to 34.9), and diabetes (30.9%, 95% CI 27.6 to 34.2). The estimated prevalence of multimorbidity (2+ chronic conditions) was 73.8% (95% CI 71.2 to 76.3). Women aged 70 years or older were 4.1 (95% CI 1.5 to 10.9) times mores likely to be affected by multimorbidity and had 0.7 (95% CI 0.3 to 1.2) more chronic conditions than women aged 40 to 44 years. Worse childhood health, being widowed, not working, and higher food insecurity in the household were also associated with a higher multimorbidity risk and level. Conclusion A high prevalence of multimorbidity in the general population of middle-aged and elderly women suggests substantial need for multimorbidity care in Tanzania. Comorbidity patterns can guide multimorbidity screening and help identify health care and prevention needs.
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Affiliation(s)
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Germana H. Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Julia K. Rohr
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - Stefan Kohler
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
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20
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Richey BF, Obrock RS, Gee ZM, Lu DY, Jacobsen G, Richards SC. SMOKING, RURAL RESIDENCE AND DIABETES AS RISK FACTORS FOR PRESUMED OCULAR HISTOPLASMOSIS SYNDROME. Retina 2022; 42:369-374. [PMID: 34690340 PMCID: PMC8765210 DOI: 10.1097/iae.0000000000003322] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the relationship of smoking, urbanicity, and diabetes to presumed ocular histoplasmosis syndrome (POHS) and associated choroidal neovascularization (CNV). METHODS Medical records of 751 adult patients with POHS were reviewed, including 603 patients without CNV and 148 patients with CNV. Age-matched and gender-matched controls were randomly selected from the same practice for comparison. Statistical comparisons of smoking history, urbanicity, and diabetic history were performed using chi-square and conditional logistic regression analyses. RESULTS Increased rates of current or former smoking, rural residence, and diabetes were found in patients with POHS compared with controls. POHS patients with CNV had increased rates of current or former smoking and rural residence as compared with controls. CONCLUSION A history of current or past smoking is associated with an increased risk of developing both POHS alone and POHS with CNV. We did not find a significant additional risk of smoking on the development of CNV in patients with POHS. Patients living in rural locations are more likely than those in urban locations to develop both POHS and POHS with CNV. Diabetics may be more likely to develop POHS than nondiabetics.
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Affiliation(s)
| | | | - Zachary M. Gee
- College of Osteopathic Medicine, Des Moines University, Des Moines, Iowa
| | - David Y. Lu
- Department of Ophthalmology, Henry Ford Hospital, Detroit, Michigan; and
| | - Gordon Jacobsen
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
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21
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McAlexander TP, Algur Y, Schwartz BS, Rummo PE, Lee DC, Siegel KR, Ryan V, Lee NL, Malla G, McClure LA. Categorizing community type for epidemiologic evaluation of community factors and chronic disease across the United States. Soc Sci Humanit Open 2022; 5:100250. [PMID: 35369036 PMCID: PMC8974313 DOI: 10.1016/j.ssaho.2022.100250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Existing classifications of community type do not differentiate urban cores from surrounding non-rural areas, an important distinction for analyses of community features and their impact on health. Inappropriately classified community types can introduce serious methodologic flaws in epidemiologic studies and invalid inferences from findings. To address this, we evaluate a modification of the United States Department of Agriculture's Rural Urban Commuting Area codes at the census tract, propose a four-level categorization of community type, and compare this with existing classifications for epidemiologic analyses. Compared to existing classifications, our method resulted in clearer geographic delineations of community types within urban areas.
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Affiliation(s)
- Tara P. McAlexander
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, United States
| | - Yasemin Algur
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, United States
| | - Brian S. Schwartz
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Pasquale E. Rummo
- Department of Population Health, NYU School of Medicine, New York, New York, United States
| | - David C. Lee
- Department of Population Health, NYU School of Medicine, New York, New York, United States
- Department of Emergency Medicine, NYU School of Medicine, New York, New York, United States
| | - Karen R. Siegel
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Victoria Ryan
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, United States
| | - Nora L. Lee
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, United States
| | - Gargya Malla
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Leslie A. McClure
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, United States
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22
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Abrams LR, Myrskylä M, Mehta NK. The growing rural-urban divide in US life expectancy: contribution of cardiovascular disease and other major causes of death. Int J Epidemiol 2022; 50:1970-1978. [PMID: 34999859 PMCID: PMC8743112 DOI: 10.1093/ije/dyab158] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 07/15/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The US rural disadvantage in life expectancy (LE) relative to urban areas has grown over time. We measured the contribution of cardiovascular disease (CVD), drug-overdose deaths (DODs) and other major causes of death to LE trends in rural and urban counties and the rural-urban LE gap. METHODS Counterfactual life tables and cause-of-death decompositions were constructed using data on all US deaths in 1999-2019 (N = 51 998 560) from the Centers for Disease Control and Prevention. RESULTS During 1999-2009, rural and urban counties experienced robust LE gains, but urban LE increased by 1.19 years more in women and 0.86 years more in men compared with rural LE. During 2010-2019, rural counties experienced absolute declines in LE (women -0.20, men -0.30 years), whereas urban counties experienced modest increases (women 0.55, men 0.29 years). Counterfactual analysis showed that slowed CVD-mortality declines, particularly in ages 65+ years, were the main reason why rural LE stopped increasing after 2010. However, slow progress in CVD-mortality influenced LE trends more in urban areas. If CVD-mortality had continued to decline at its pre-2010 pace, the rural-urban LE gap would have grown even more post 2010. DODs and other causes of death also contributed to the LE trends and differences in each period, but their impact in comparison to that of CVD was relatively small. CONCLUSIONS Rural disadvantage in LE continues to grow, but at a slower pace than pre 2010. This slowdown is more attributable to adverse trends in CVD and DOD mortality in urban areas than improvements in rural areas.
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Affiliation(s)
- Leah R Abrams
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
| | - Mikko Myrskylä
- Max Planck Institute for Demographic Research, Rostock, Germany
- Center for Social Data Science, University of Helsinki, Finland
| | - Neil K Mehta
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
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23
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Plana-Ripoll O, Di Prinzio P, McGrath JJ, Mortensen PB, Morgan VA. Factors that contribute to urban-rural gradients in risk of schizophrenia: Comparing Danish and Western Australian registers. Aust N Z J Psychiatry 2021; 55:1157-1165. [PMID: 33985345 DOI: 10.1177/00048674211009615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/29/2022]
Abstract
INTRODUCTION An association between schizophrenia and urbanicity has long been observed, with studies in many countries, including several from Denmark, reporting that individuals born/raised in densely populated urban settings have an increased risk of developing schizophrenia compared to those born/raised in rural settings. However, these findings have not been replicated in all studies. In particular, a Western Australian study showed a gradient in the opposite direction which disappeared after adjustment for covariates. Given the different findings for Denmark and Western Australia, our aim was to investigate the relationship between schizophrenia and urbanicity in these two regions to determine which factors may be influencing the relationship. METHODS We used population-based cohorts of children born alive between 1980 and 2001 in Western Australia (N = 428,784) and Denmark (N = 1,357,874). Children were categorised according to the level of urbanicity of their mother's residence at time of birth and followed-up through to 30 June 2015. Linkage to State-based registers provided information on schizophrenia diagnosis and a range of covariates. Rates of being diagnosed with schizophrenia for each category of urbanicity were estimated using Cox proportional hazards models adjusted for covariates. RESULTS During follow-up, 1618 (0.4%) children in Western Australia and 11,875 (0.9%) children in Denmark were diagnosed with schizophrenia. In Western Australia, those born in the most remote areas did not experience lower rates of schizophrenia than those born in the most urban areas (hazard ratio = 1.02 [95% confidence interval: 0.81, 1.29]), unlike their Danish counterparts (hazard ratio = 0.62 [95% confidence interval: 0.58, 0.66]). However, when the Western Australian cohort was restricted to children of non-Aboriginal Indigenous status, results were consistent with Danish findings (hazard ratio = 0.46 [95% confidence interval: 0.29, 0.72]). DISCUSSION Our study highlights the potential for disadvantaged subgroups to mask the contribution of urban-related risk factors to risk of schizophrenia and the importance of stratified analysis in such cases.
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Affiliation(s)
| | - Patsy Di Prinzio
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - John J McGrath
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia
| | - Preben B Mortensen
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,Centre for Clinical Research in Neuropsychiatry, The University of Western Australia, Perth, WA, Australia
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24
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Shing JZ, Beeghly-Fadiel A, Griffin MR, Chang RS, Sudenga SL, Slaughter JC, Pemmaraju M, Mitchel EF, Hull PC. The Impact of the Human Papillomavirus Vaccine on High-Grade Cervical Lesions in Urban and Rural Areas: An Age-Period-Cohort Analysis. Cancers (Basel) 2021; 13:4215. [PMID: 34439369 DOI: 10.3390/cancers13164215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Human papillomavirus (HPV) vaccination disparities between urban and rural regions may moderate the vaccine’s impact on reducing cervical precancer (CIN2+) and cancer incidence. We assessed population-level trends in CIN2+ incidence (2008–2018) in urban and rural areas among Medicaid-enrolled women aged 18–39 years in Tennessee, United States. A sub-group analysis among women screened for cervical cancer was conducted to control for changing screening trends. CIN2+ incidence among young women aged 18–20 and 21–24 years, who most likely benefited from the HPV vaccine, declined similarly between urban and rural areas, although significant declines began earlier in urban versus rural areas. Our results suggest evidence of HPV vaccine impact regardless of urbanicity but demonstrate lagged impact in rural areas. These findings emphasize the importance of reducing barriers to HPV vaccination, particularly in rural areas, to improve the reduction of cervical precancer and cancer incidence, toward the World Health Organization’s goals of eliminating cervical cancer. Abstract Disparities in human papillomavirus (HPV) vaccination exist between urban (metropolitan statistical areas (MSAs)) and rural (non-MSAs) regions. To address whether the HPV vaccine’s impact differs by urbanicity, we examined trends in cervical intraepithelial neoplasia grades 2 or 3 and adenocarcinoma in situ (collectively, CIN2+) incidence in MSAs and non-MSAs among Tennessee Medicaid (TennCare)-enrolled women aged 18–39 years and among the subset screened for cervical cancer in Tennessee, United States. Using TennCare claims data, we identified annual age-group-specific (18–20, 21–24, 25–29, 30–34, and 35–39 years) CIN2+ incidence (2008–2018). Joinpoint regression was used to identify trends over time. Age–period–cohort Poisson regression models were used to evaluate age, period, and cohort effects. All analyses were stratified by urbanicity (MSA versus non-MSA). From 2008–2018, 11,243 incident CIN2+ events (7956 in MSAs; 3287 in non-MSAs) were identified among TennCare-enrolled women aged 18–39 years. CIN2+ incident trends (2008–2018) were similar between women in MSAs and non-MSAs, with largest declines among ages 18–20 (MSA average annual percent change (AAPC): −30.4, 95% confidence interval (95%CI): −35.4, −25.0; non-MSA AAPC: −30.9, 95%CI: −36.8, −24.5) and 21–24 years (MSA AAPC: −14.8, 95%CI: −18.1, −11.3; non-MSA AAPC: −15.1, 95%CI: −17.9, −12.2). Significant declines for ages 18–20 years began in 2008 in MSAs compared to 2010 in non-MSAs. Trends were largely driven by age and cohort effects. These patterns were consistent among screened women. Despite evidence of HPV vaccine impact on reducing CIN2+ incidence regardless of urbanicity, significant declines in CIN2+ incidence were delayed in non-MSAs versus MSAs.
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25
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Cheng W, Luo N, Zhang Y, Zhang X, Tan H, Zhang D, Sui J, Yue W, Yan H. DNA Methylation and Resting Brain Function Mediate the Association between Childhood Urbanicity and Better Speed of Processing. Cereb Cortex 2021; 31:4709-4718. [PMID: 33987663 PMCID: PMC8408435 DOI: 10.1093/cercor/bhab117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/07/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 01/10/2023] Open
Abstract
Urbanicity has been suggested to affect cognition, but the underlying mechanism remains unknown. We examined whether epigenetic modification (DNA methylation, DNAm), and brain white matter fiber integrity (fractional anisotropy, FA) or local spontaneous brain function activity (regional homogeneity, ReHo) play roles in the association between childhood urbanicity and cognition based on 497 healthy Chinese adults. We found significant correlation between childhood urbanicity and better cognitive performance. Multiset canonical correlation analysis (mCCA) identified an intercorrelated DNAm-FA-ReHo triplet, which showed significant pairwise correlations (DNAm-FA: Bonferroni-adjusted P, Pbon = 4.99E−03, rho = 0.216; DNAm-ReHo: Pbon = 4.08E−03, rho = 0.239; ReHo-FA: Pbon = 1.68E−06, rho = 0.328). Causal mediation analysis revealed that 1) ReHo mediated 10.86% childhood urbanicity effects on the speed of processing and 2) childhood urbanicity alters ReHo through DNA methylation in the cadherin and Wnt signaling pathways (mediated effect: 48.55%). The mediation effect of increased ReHo in the superior temporal gyrus underlying urbanicity impact on a better speed of processing was further validated in an independent cohort. Our work suggests a mediation role for ReHo, particularly increased brain activity in the superior temporal gyrus, in the urbanicity-associated speed of processing.
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Affiliation(s)
- Weiqiu Cheng
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China.,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Na Luo
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yuyanan Zhang
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China.,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Xiao Zhang
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China.,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Haoyang Tan
- Lieber Institute for Brain Development, Baltimore, MD 21205, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Dai Zhang
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China.,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China.,Tsinghua University-Peking University Joint Center for Life Sciences, Beijing 100871, China.,PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100871, China
| | - Jing Sui
- University of Chinese Academy of Sciences, Beijing 100049, China.,State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
| | - Weihua Yue
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China.,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China.,PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing 100871, China
| | - Hao Yan
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China.,NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
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26
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Karcher NR, Schiffman J, Barch DM. Environmental Risk Factors and Psychotic-like Experiences in Children Aged 9-10. J Am Acad Child Adolesc Psychiatry 2021; 60:490-500. [PMID: 32682894 PMCID: PMC7895444 DOI: 10.1016/j.jaac.2020.07.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 01/17/2020] [Revised: 04/30/2020] [Accepted: 07/09/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Research implicates environmental risk factors, including correlates of urbanicity, deprivation, and environmental toxins, in psychotic-like experiences (PLEs). The current study examined associations between several types of environmental risk factors and PLEs in school-age children, whether these associations were specific to PLEs or generalized to other psychopathology, and examined possible neural mechanisms for significant associations. METHOD The current study used cross-sectional data from 10,328 children 9-10 years old from the Adolescent Brain Cognitive Development (ABCD) Study. Hierarchical linear models examined associations between PLEs and geocoded environmental risk factors and whether associations generalized to internalizing/externalizing symptoms. Mediation models examined evidence of structural magnetic resonance imaging abnormalities (eg, intracranial volume) potentially mediating associations between PLEs and environmental risk factors. RESULTS Specific types of environmental risk factors, namely, measures of urbanicity (eg, drug offense exposure, less perception of neighborhood safety), deprivation (eg, overall deprivation, poverty rate), and lead exposure risk, were associated with PLEs. These associations showed evidence of stronger associations with PLEs than internalizing/externalizing symptoms (especially overall deprivation, poverty, drug offense exposure, and lead exposure risk). There was evidence that brain volume mediated between 11% and 25% of associations of poverty, perception of neighborhood safety, and lead exposure risk with PLEs. CONCLUSION Although in the context of cross-sectional analyses, this evidence is consistent with neural measures partially mediating the association between PLEs and environmental exposures. This study also replicated and extended recent findings of associations between PLEs and environmental exposures, finding evidence for specific associations with correlates of urbanicity, deprivation, and lead exposure risk.
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Affiliation(s)
| | - Jason Schiffman
- University of Maryland, Baltimore County; University of California, Irvine
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27
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Luo Y, Pang L, Guo C, Zhang L, Zheng X. Association of Urbanicity with Schizophrenia and Related Mortality in China: Association de l'urbanicité avec la schizophrénie et la mortalité qui y est reliée en Chine. Can J Psychiatry 2021; 66:385-394. [PMID: 32878467 PMCID: PMC8172350 DOI: 10.1177/0706743720954059] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Although higher prevalence of schizophrenia in Chinese urban areas was observed, studies focused on the association between schizophrenia and urbanicity were less in China. Using a national representative population-based data set, this study aimed to investigate the relationship between urbanicity and schizophrenia and its related mortality among adults aged 18 years old and above in China. METHODS Data were obtained from the Second China National Sample Survey on Disability in 2006 and follow-up studies from 2007 to 2010 each year. We restricted our analysis to 1,909,205 participants aged 18 years or older and the 2,071 schizophrenia patients with information of survival and all-caused mortality of the follow-up surveys from 2007 to 2010.Schizophrenia was ascertained according to the International Statistical Classification of Diseases, 10th Revision. The degree of urbanicity and the region of residence were used to be the proxies of urbanicity. Of these, the degree of urbanicity measured by the ratio of nonagricultural population to total population and the region of residence measured by six categorical variables (first-tier cities, first-tier city suburbs, second-tier cities, second-tier city suburbs, other city areas, and rural areas). Logistics regression models and restricted polynomial splines were used to examine the linear/nonlinear relationship between urbanicity and the risk of schizophrenia. Cox proportional hazards regression models were used to test the role of urbanicity on mortality risk of schizophrenia patients. RESULTS 10% increase in the degree of urbanicity was associated with increased risk of schizophrenia (OR = 1.44; 95% CI, 1.32 to 1.57). The nonlinear model further confirmed the association between the degree of urbanicity and the risk of schizophrenia. This association existed sex difference, as the level of urbanicity increased, schizophrenia risk of males grew faster than the risk of females. The hazard ratio (HR) of mortality in schizophrenia patients decreased with the elevated of urbanicity level, with a HR of 0.42 (95% CI, 0.21 to 0.84). CONCLUSIONS This research suggested that incremental changes in the degree of urbanicity linked to higher risk of schizophrenia, and as the degree of urbanicity elevated, the risk of schizophrenia increased more for men than for women. Additionally, we found that schizophrenia patients in higher degree of urbanicity areas had lower risk of mortality. These findings contributed to the literature on schizophrenia in developing nations under a non-Western context and indicates that strategies to improve mental health conditions are needed in the progress of urbanicity.
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Affiliation(s)
- Yanan Luo
- Institute of Population Research, 12465Peking University, Beijing, People Republic of China.,APEC Health Science Academy, 12465Peking University, Beijing, People Republic of China
| | - Lihua Pang
- Institute of Population Research, 12465Peking University, Beijing, People Republic of China.,APEC Health Science Academy, 12465Peking University, Beijing, People Republic of China
| | - Chao Guo
- Institute of Population Research, 12465Peking University, Beijing, People Republic of China.,APEC Health Science Academy, 12465Peking University, Beijing, People Republic of China
| | - Lei Zhang
- Institute of Population Research, 12465Peking University, Beijing, People Republic of China.,APEC Health Science Academy, 12465Peking University, Beijing, People Republic of China
| | - Xiaoying Zheng
- Institute of Population Research, 12465Peking University, Beijing, People Republic of China.,APEC Health Science Academy, 12465Peking University, Beijing, People Republic of China
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28
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Luke AA, Huang K, Lindley KJ, Carter EB, Joynt Maddox KE. Severe Maternal Morbidity, Race, and Rurality: Trends Using the National Inpatient Sample, 2012-2017. J Womens Health (Larchmt) 2020; 30:837-847. [PMID: 33216678 DOI: 10.1089/jwh.2020.8606] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 12/25/2022] Open
Abstract
Background: Severe maternal morbidity is related to maternal mortality and an important measure of maternal health outcomes. Our objective was to evaluate differences in rates of severe maternal morbidity and mortality (SMM&M) by rurality and race, and examine these trends over time. Materials and Methods: It involves the retrospective cohort study of delivery hospitalizations from January 1, 2012 to December 31, 2017 from the National Inpatient Sample. We identified delivery hospitalizations using International Classification of Diseases, Ninth Revision, Clinical Modification and International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis and procedure codes and diagnosis-related groups. We used hierarchical regression models controlling for insurance status, income, age, comorbidities, and hospital characteristics to model odds of SMM&M. Results: The eligible cohort contained 4,494,089 delivery hospitalizations. Compared with women from small cities, women in the most urban and most rural areas had higher odds of SMM&M (urban adjusted odds ratio [aOR] 1.09, 95% confidence interval [1.04-1.14]; noncore rural aOR 1.24 [1.18-1.31]). Among White women, the highest odds of SMM&M were in noncore rural counties (aOR 1.20 [1.12-1.27]), while among Black women the highest odds were in urban (aOR 1.21 [1.11-1.31]) and micropolitan areas (aOR 1.36 [1.19-1.57]). Findings were similar for Hispanic, Native American, and other race women. Rates of SMM&M increased from 2012 to 2017, especially among urban patients. Conclusions: Women in the most urban and most rural counties experienced higher odds of SMM&M, and these relationships differed by race. These findings suggest particular areas for clinical leaders and policymakers to target to reduce geographic and racial disparities in maternal outcomes.
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Affiliation(s)
- Alina A Luke
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kristine Huang
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kathryn J Lindley
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ebony B Carter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Karen E Joynt Maddox
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.,Center for Health Economics and Policy, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri, USA
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29
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Assaf S, Juan C. Stunting and Anemia in Children from Urban Poor Environments in 28 Low and Middle-income Countries: A Meta-analysis of Demographic and Health Survey Data. Nutrients 2020; 12:E3539. [PMID: 33217992 DOI: 10.3390/nu12113539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/11/2020] [Accepted: 11/14/2020] [Indexed: 12/29/2022] Open
Abstract
Child malnutrition remains a global concern with implications not only for children’s health and cognitive function, but also for countries’ economic growth. Recent reports suggest that global nutrition targets will not be met by 2025. Large gaps are evident between and within countries. One of the largest disparities in child malnutrition within counties is between urban and rural children. Large disparities also exist in urban areas that have higher rates of child malnutrition in the urban poor areas or slums. This paper examines stunting and anemia related to an urban poverty measure in children under age 5 in 28 low and middle-income countries with Demographic and Health Survey data. We used the United Nations Human Settlements Programme (UN-HABITAT) definition to define urban poor areas as a proxy for slums. The results show that in several countries, children had a higher risk of stunting and anemia in urban poor areas compared to children in urban non-poor areas. In some countries, this risk was similar to the risk between the rural and urban non-poor. Tests of heterogeneity showed that these results were not homogeneous across countries. These results help to identify areas of greater disadvantage and the required interventions for stunting and anemia.
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30
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He S, Song D, Jian WY. The Association between Urbanization and Depression among the Middle-Aged and Elderly: A Longitudinal Study in China. Inquiry 2020; 57:46958020965470. [PMID: 33095089 PMCID: PMC7585885 DOI: 10.1177/0046958020965470] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Urbanization has been and will continue to be the mainstream trend of global population movement, including China. Depression is the most common mental disorders and the leading factor of disabilities. However, the impacts of urbanization on the depression occurrence are still unclear. This paper analyzed the data from 3 waves of the China Health and Retirement Longitudinal Study (CHARLS) with sample size as 8510 adults representing the middle aged and elderly group in China. Depression was identified and measured by the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Urbanization level was measured by population density, GDP per capita and secondary/tertiary industry as percentage to GDP in the China City Statistical Yearbook. The fixed effect regression model was used to explore the association between the changes of urbanization and depression. As result, depression is closely related to the urbanization, protective effects are found for 3 indicators above: The depression prevalence decreases while urbanization level increases (from lowest urbanization level to the highest: P < 0.01). Among the 10 depression symptoms, "Bothered", "Reduced energy leading to diminished activity" and "Hopelessness" are the most significantly improved with urbanization. The impact of urbanization on residents' mental health is a long-term, multi-factor interaction. Therefore we need to fully consider all possible influencing factors, and longer follow-up study to verify.
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Affiliation(s)
- Shan He
- Peking University Health Science Center, Beijing, P.R. China
| | - Duo Song
- Peking University Health Science Center, Beijing, P.R. China
| | - Wei-Yan Jian
- Peking University Health Science Center, Beijing, P.R. China
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Abstract
Chronotype refers to individual differences in sleep timing ("owls" and "larks") and "eveningness" has been associated with nightmares. However, it has not been tested as to whether neuroticism mediates this relationship. Urbanicity refers to being raised in an urban region and/or currently living in an urban region and is associated with heightened risk for developing mental disorders, and thus might be related to nightmare frequency and nightmare distress. Overall, 2492 persons (1437 women, 1055 men) completed an online survey between 23 March 2015 and 8 April 2015. The mean age of the sample was 47.75 ± 14.41 years. The findings indicate that the previously reported relationship between chronotype and nightmare frequency was mediated by neuroticism and "morningness" was related to higher dream recall compared to persons with a late bedtime preference. Urbanicity was not related to nightmare frequency but to lower nightmare distress, raising the interesting question as to whether beliefs about nightmares might be an important variable that contributes to nightmare distress. Based on the few studies so far, there are still many unresolved questions about the interaction between nightmares, chronotype, and urbanicity.
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Affiliation(s)
- Michael Schredl
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, 68159 Mannheim, Germany
| | - Anja S. Göritz
- Psychology Department, University of Freiburg, 79085 Freiburg, Germany;
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Abrahamyan Empson L, Baumann PS, Söderström O, Codeluppi Z, Söderström D, Conus P. Urbanicity: The need for new avenues to explore the link between urban living and psychosis. Early Interv Psychiatry 2020; 14:398-409. [PMID: 31389169 DOI: 10.1111/eip.12861] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Received: 04/04/2018] [Revised: 11/25/2018] [Accepted: 07/14/2019] [Indexed: 12/26/2022]
Abstract
AIM A growing body of evidence suggests that urban living contributes to the development of psychosis. However, the mechanisms underlying this phenomenon remain unclear. This paper aims to explore the best available knowledge on the matter, identify research gaps and outline future prospects for research strategies. METHOD A comprehensive literature survey on the main computerized medical research databases, with a time limit up to August 2017 on the issue of urbanicity and psychosis has been conducted. RESULTS The impact of urbanicity may result from a wide range of factors (from urban material features to stressful impact of social life) leading to "urban stress." The latter may link urban upbringing to the development of psychosis through overlapping neuro- and socio-developmental pathways, possibly unified by dopaminergic hyperactivity in mesocorticolimbic system. However, "urban stress" is poorly defined and research based on patients' experience of the urban environment is scarce. CONCLUSIONS Despite accumulated data, the majority of studies conducted so far failed to explain how specific factors of urban environment combine in patients' daily life to create protective or disruptive milieus. This undermines the translation of a vast epidemiological knowledge into effective therapeutic and urbanistic developments. New studies on urbanicity should therefore be more interdisciplinary, bridging knowledge from different disciplines (psychiatry, epidemiology, human geography, urbanism, etc.) in order to enrich research methods, ensure the development of effective treatment and preventive strategies as well as create urban environments that will contribute to mental well-being.
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Affiliation(s)
- Lilith Abrahamyan Empson
- Treatment and early Intervention in Psychosis Program, Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Philipp S Baumann
- Treatment and early Intervention in Psychosis Program, Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland.,Center for Psychiatric Neurosciences, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Ola Söderström
- Institute of Geography, University of Neuchâtel, Neuchâtel, Switzerland
| | - Zoé Codeluppi
- Institute of Geography, University of Neuchâtel, Neuchâtel, Switzerland
| | | | - Philippe Conus
- Treatment and early Intervention in Psychosis Program, Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland
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van der Leeuw C, de Witte LD, Stellinga A, van der Ley C, Bruggeman R, Kahn RS, van Os J, Marcelis M. Vitamin D concentration and psychotic disorder: associations with disease status, clinical variables and urbanicity. Psychol Med 2020; 50:1680-1686. [PMID: 31327333 DOI: 10.1017/s0033291719001739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The association between schizophrenia and decreased vitamin D levels is well documented. Low maternal and postnatal vitamin D levels suggest a possible etiological mechanism. Alternatively, vitamin D deficiency in patients with schizophrenia is presumably (also) the result of disease-related factors or demographic risk factors such as urbanicity. METHODS In a study population of 347 patients with psychotic disorder and 282 controls, group differences in vitamin D concentration were examined. Within the patient group, associations between vitamin D, symptom levels and clinical variables were analyzed. Group × urbanicity interactions in the model of vitamin D concentration were examined. Both current urbanicity and urbanicity at birth were assessed. RESULTS Vitamin D concentrations were significantly lower in patients (B = -8.05; 95% confidence interval (CI) -13.68 to -2.42; p = 0.005). In patients, higher vitamin D concentration was associated with lower positive (B = -0.02; 95% CI -0.04 to 0.00; p = 0.049) and negative symptom levels (B = -0.03; 95% CI -0.05 to -0.01; p = 0.008). Group differences were moderated by urbanicity at birth (χ2 = 6.76 and p = 0.001), but not by current urbanicity (χ2 = 1.50 and p = 0.224). Urbanicity at birth was negatively associated with vitamin D concentration in patients (B = -5.11; 95% CI -9.41 to -0.81; p = 0.020), but not in controls (B = 0.72; 95% CI -4.02 to 5.46; p = 0.765). CONCLUSIONS Lower vitamin D levels in patients with psychotic disorder may in part reflect the effect of psychosis risk mediated by early environmental adversity. The data also suggest that lower vitamin D and psychopathology may be related through direct or indirect mechanisms.
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Affiliation(s)
- C van der Leeuw
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Mondriaan, Maastricht, the Netherlands
| | - L D de Witte
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, NY, USA
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - A Stellinga
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- University Center for Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - C van der Ley
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - R Bruggeman
- University Center for Psychiatry, Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - R S Kahn
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, NY, USA
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - J van Os
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - M Marcelis
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, the Netherlands
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Su C, Song X, Hu H, Du W, Wang H, Zhang B. Longitudinal Association between Urbanicity and Total Dietary Fat Intake in Adults in Urbanizing China from 1991 to 2015: Findings from the CHNS. Nutrients 2020; 12:E1597. [PMID: 32485826 DOI: 10.3390/nu12061597] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 01/21/2023] Open
Abstract
Few studies have examined the longitudinal association between urbanicity and dietary fat intake in Chinese adults. A population-based longitudinal observational study was carried out in Chinese adults aged 18–65 from the China Health and Nutrition Survey. Three consecutive 24 h dietary recalls were used to assess dietary fat intake. Multilevel models were used to explore the relationship between urbanicity and dietary fat intake. People in the highest urbanicity quartile had the increments of 7.48 g/d (95% CI:5.42–9.58) and 8.92 g/d (95% CI: 7.03–10.80) in dietary fat intake, 2.86 (95% CI: 2.29–3.44) and 2.69 (95% CI: 2.13–3.25) in proportion of energy from total fat, and odds ratios (ORs) for the risk of excess dietary fat intake of 1.84 (95% CI: 1.65–2.05) and 2.01 (95% CI: 1.78–2.26) for men and women, respectively, compared to the lowest quartile after controlling for potential confounders. These results indicate that urbanicity was an important factor influencing dietary fat intake among Chinese adults. Aggressive nutritional education action coupled with governmental guidelines and programs tailored for the Chinese population are required to promote less dietary fat intake, especially in those adults living in less urbanized areas and whose dietary fat intake is ≥ 30% of their total energy intake per day.
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Lemmers-Jansen IL, Fett AKJ, van Os J, Veltman DJ, Krabbendam L. Trust and the city: Linking urban upbringing to neural mechanisms of trust in psychosis. Aust N Z J Psychiatry 2020; 54:138-149. [PMID: 31409094 DOI: 10.1177/0004867419865939] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 01/02/2023]
Abstract
OBJECTIVE Elevated prevalence of non-affective psychotic disorders is often found in densely populated areas. This functional magnetic resonance imaging study investigates if reduced trust, a component of impaired social functioning in patients with psychotic disorder, is associated with urban upbringing. METHODS In total, 39 patients (22 first episode and 17 clinical high risk) and 30 healthy controls, aged 16-29, performed two multi-round trust games, with a cooperative and unfair partner during functional magnetic resonance imaging scanning. Baseline trust was operationalized as the first investment made, and changes of trust as changes in investments made over the 20 trials during the games. Urban exposure during upbringing (0-15 years) was defined as higher urban (≥2500 inhabitants/km2) or lower urban (<2500 inhabitants/km2). RESULTS Patients displayed lower baseline trust (first investment) than controls, regardless of urbanicity exposure. During cooperative interactions, lower-urban patients showed increasing investments. In addition, during cooperative interactions, group-by-developmental urbanicity interactions were found in the right and left amygdalae, although for the latter only at trend level. Higher urbanicity was associated with decreased activation of the left amygdala in patients and controls during investments and with increased activation of the right and left amygdalae in patients only, during repayments. During unfair interactions, no associations of urbanicity with behavior or brain activation were found. CONCLUSION Urban upbringing was unrelated to baseline trust. Associations with urbanicity were stronger for patients compared to controls, suggesting greater susceptibility to urbanicity effects during the developmental period. Higher-urban patients failed to compensate for the initial distrust specifically during repeated cooperative interactions. This finding highlights potential implications for social functioning. Urban upbringing was linked to differential amygdala activation, suggesting altered mechanisms of feedback learning, but this was not associated with trust game behavior.
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Affiliation(s)
- Imke Lj Lemmers-Jansen
- Department of Clinical, Neuro & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,The Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anne-Kathrin J Fett
- Department of Clinical, Neuro & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,The Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Psychology, City, University of London, London, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychiatry, Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands.,Department of Psychiatry and Psychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, VU Medical Center, Amsterdam, The Netherlands
| | - Lydia Krabbendam
- Department of Clinical, Neuro & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,The Institute for Brain and Behavior Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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36
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Cioffi G, Cote DJ, Ostrom QT, Kruchko C, Barnholtz-Sloan JS. Association between urbanicity and surgical treatment among patients with primary glioblastoma in the United States. Neurooncol Pract 2020; 7:299-305. [PMID: 32537179 DOI: 10.1093/nop/npaa001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/12/2022] Open
Abstract
Background Glioblastoma (GB) is the most common and most lethal primary malignant brain tumor. Extent of surgical resection is one of the most important prognostic factors associated with improved survival. Historically, patients living in nonmetropolitan counties in the United States have limited access to optimal treatment and health care services. The aim of this study is to determine whether there is an association between urbanicity and surgical treatment patterns among US patients with primary GB. Methods Cases with histologically confirmed, primary GB diagnosed between 2005 and 2015 were obtained from the Central Brain Tumor Registry of the United States (CBTRUS) in collaboration with the Centers for Disease Control and Prevention, and the National Cancer Institute. Multivariable logistic regression models were constructed to assess the association between urbanicity and receipt of surgical treatment (gross total resection [GTR]/subtotal resection [STR] vs biopsy only/none) and extent of resection (GTR vs STR), adjusted for age at diagnosis, sex, race, US regional division, and primary tumor site. Results Patients residing in nonmetropolitan counties were 7% less likely to receive surgical treatment (odds ratio [OR] = 0.93, 95% CI: 0.89-0.96, P < .0001). Among those who received surgical treatment, metropolitan status was not significantly associated with receiving GTR vs STR (OR = 0.99, 95% CI: 0.94-1.04, P = .620). Conclusions Among US patients with GB, urbanicity is associated with receipt of surgical treatment, but among patients who receive surgery, urbanicity is not associated with extent of resection. These results point to potential differences in access to health care for those in nonmetropolitan areas that warrant further exploration.
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Affiliation(s)
- Gino Cioffi
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH.,Central Brain Tumor Registry of the United States, Hinsdale, IL
| | - David J Cote
- Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA.,Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, IL.,Section of Epidemiology and Population Sciences, Department of Medicine, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, IL
| | - Jill S Barnholtz-Sloan
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH.,Central Brain Tumor Registry of the United States, Hinsdale, IL
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Wu J, Chen J, Li Z, Jiao B, Muennig P. Spatiotemporal Variation of the Association between Urbanicity and Incident Hypertension among Chinese Adults. Int J Environ Res Public Health 2020; 17:E304. [PMID: 31906366 DOI: 10.3390/ijerph17010304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 12/27/2019] [Accepted: 12/27/2019] [Indexed: 12/20/2022]
Abstract
Urbanization is believed to result in a transition towards energy-dense diets, sedentary lifestyles, and a subsequent increase in the burden of hypertension (HTN) and other cardiovascular diseases (CVDs) in developing countries. However, the extent to which this occurs is likely dependent on social contexts. We performed multilevel logistic regression models to examine whether the association between incident HTN and the degree to which a community exhibits urban features varied by region (the Northeast, East Coast, Central, and West) within China and period. We used longitudinal data from the China Health and Nutrition Survey (1991–2015) and stratified analyses by sex. Among women, the positive association between medium-to-high urbanicity and HTN onset generally shifted to negative between 1991 and 2015. The high urbanicity was associated with lower odds of developing HTN in the East Coast from the early 1990s. The negative association between high urbanicity and HTN occurrence became statistically significant during 1991–2015 in the Northeastern and Central Regions, while the association remained positive and non-significant in the West. Among men, the relationship between urbanicity and incident HTN was generally non-significant, except for the East Coast in which the negative association between high urbanicity and HTN occurrence became statistically-significant in more recent years. Our findings suggest that, when a subnational region or the society as a whole has become more economically developed, higher urbanicity might turn out to be a protective factor of cardiovascular health. Moreover, improvements made to communities’ urban features might be more effective in preventing HTN for women than for men.
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Li Y, Akkus C, Yu X, Joyner A, Kmet J, Sweat D, Jia C. Heatwave Events and Mortality Outcomes in Memphis, Tennessee: Testing Effect Modification by Socioeconomic Status and Urbanicity. Int J Environ Res Public Health 2019; 16:E4568. [PMID: 31752218 DOI: 10.3390/ijerph16224568] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/05/2019] [Accepted: 11/13/2019] [Indexed: 11/17/2022]
Abstract
Heatwave studies typically estimate heat-related mortality and morbidity risks at the city level; few have addressed the heterogeneous risks by socioeconomic status (SES) and location within a city. This study aimed to examine the impacts of heatwaves on mortality outcomes in Memphis, Tennessee, a Mid-South metropolitan area top-ranked in morbidity and poverty rates, and to investigate the effects of SES and urbanicity. Mortality data were retrieved from the death records in 2008-2017, and temperature data from the Applied Climate Information System. Heatwave days were defined based on four temperature metrics. Heatwave effects on daily total-cause, cardiovascular, and respiratory mortality were evaluated using Poisson regression, accounting for temporal trends, sociodemographic factors, urbanicity, and air pollution. We found higher cardiovascular mortality risk (cumulative RR (relative risk) = 1.25, 95% CI (confidence interval): 1.01-1.55) in heatwave days defined as those with maximum daily temperature >95th percentile for more than two consecutive days. The effects of heatwaves on mortality did not differ by SES, race, or urbanicity. The findings of this study provided evidence to support future heatwave planning and studies of heatwave and health impacts at a coarser geographic resolution.
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Radhakrishnan R, Guloksuz S, Ten Have M, de Graaf R, van Dorsselaer S, Gunther N, Rauschenberg C, Reininghaus U, Pries LK, Bak M, van Os J. Interaction between environmental and familial affective risk impacts psychosis admixture in states of affective dysregulation. Psychol Med 2019; 49:1879-1889. [PMID: 30284529 DOI: 10.1017/s0033291718002635] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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] [Indexed: 12/22/2022]
Abstract
BACKGROUND Evidence suggests that cannabis use, childhood adversity, and urbanicity, in interaction with proxy measures of genetic risk, may facilitate onset of psychosis in the sense of early affective dysregulation becoming 'complicated' by, first, attenuated psychosis and, eventually, full-blown psychotic symptoms. METHODS Data were derived from three waves of the second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2). The impact of environmental risk factors (cannabis use, childhood adversity, and urbanicity) was analyzed across severity levels of psychopathology defined by the degree to which affective dysregulation was 'complicated' by low-grade psychotic experiences ('attenuated psychosis' - moderately severe) and, overt psychotic symptoms leading to help-seeking ('clinical psychosis' - most severe). Familial and non-familial strata were defined based on family history of (mostly) affective disorder and used as a proxy for genetic risk in models of family history × environmental risk interaction. RESULTS In proxy gene-environment interaction analysis, childhood adversity and cannabis use, and to a lesser extent urbanicity, displayed greater-than-additive risk if there was also evidence of familial affective liability. In addition, the interaction contrast ratio grew progressively greater across severity levels of psychosis admixture (none, attenuated psychosis, clinical psychosis) complicating affective dysregulation. CONCLUSION Known environmental risks interact with familial evidence of affective liability in driving the level of psychosis admixture in states of early affective dysregulation in the general population, constituting an affective pathway to psychosis. There is interest in decomposing family history of affective liability into the environmental and genetic components that underlie the interactions as shown here.
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Affiliation(s)
- Rajiv Radhakrishnan
- Department of Psychiatry,Yale University School of Medicine,New Haven, CT,USA
| | - Sinan Guloksuz
- Department of Psychiatry,Yale University School of Medicine,New Haven, CT,USA
| | - Margreet Ten Have
- Department of Epidemiology,Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands
| | - Ron de Graaf
- Department of Epidemiology,Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands
| | - Saskia van Dorsselaer
- Department of Epidemiology,Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands
| | - Nicole Gunther
- Department of Psychiatry and Neuropsychology,School for Mental Health and Neuroscience, Maastricht University Medical Centre,Maastricht,the Netherlands
| | - Christian Rauschenberg
- Department of Psychiatry and Neuropsychology,School for Mental Health and Neuroscience, Maastricht University Medical Centre,Maastricht,the Netherlands
| | - Ulrich Reininghaus
- Department of Psychiatry and Neuropsychology,School for Mental Health and Neuroscience, Maastricht University Medical Centre,Maastricht,the Netherlands
| | - Lotta-Katrin Pries
- Department of Psychiatry and Neuropsychology,School for Mental Health and Neuroscience, Maastricht University Medical Centre,Maastricht,the Netherlands
| | - Maarten Bak
- Department of Psychiatry and Neuropsychology,School for Mental Health and Neuroscience, Maastricht University Medical Centre,Maastricht,the Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology,School for Mental Health and Neuroscience, Maastricht University Medical Centre,Maastricht,the Netherlands
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Abstract
PURPOSE OF REVIEW Epidemiological studies associate city living with an elevated psychosis risk. Urban (social/economic) stress and exposure to environmental toxins, pollution or disease agents have been proposed to underlie this association. This review provides an update on the recent evidence (May 2017 - November 2018). RECENT FINDINGS Of 647 screened studies, 17 on: urbanicity-psychosis associations in worldwide high, middle and low-income countries; explanatory mechanisms, including nature exposure, social and economic stressors and genetic risk; urbanicity effects on the brain and coping; and urbanicity and resources, were included. The reviewed evidence revealed complex patterns of urbanicity-psychosis associations with considerable international variation within Europe and between low, middle and high-income countries worldwide. Social and economic stressors (e.g. migration, ethnic density and economic deprivation), nature exposure and access to resources could only explain part of the urbanicity effects. Risk factors differed between countries and between affective and non-affective psychosis. SUMMARY Urbanicity-psychosis associations are heterogeneous and driven by multiple risk and protective factors that seem to act differently in different ethnic groups and countries. Interdisciplinary research combining approaches, for example from experimental neuroscience and epidemiology, are needed to unravel specific urban mechanisms that increase or decrease psychosis risk.
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Piccirillo ML, Levinson CA, Rodebaugh TL. The effect of urbanicity on internalizing disorders. J Clin Psychol 2019; 75:1129-1139. [PMID: 30817000 DOI: 10.1002/jclp.22766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/08/2018] [Revised: 12/29/2018] [Accepted: 02/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Urbanicity is a known risk factor for psychopathology, yet the term urbanicity has been used to describe multiple constructs, resulting in mixed findings across the social sciences literature. METHODS We used the National Survey of American Life (N = 6,082) to construct a structural equation model of urbanicity and internalizing disorders. Urbanicity was measured using both neighborhood characteristics, as well as population-based measures. We hypothesized that urbanicity would predict higher rates of internalizing disorders. RESULTS Neighborhood quality (b* = 0.18, p < 0.001) was the strongest predictor of psychopathology in the final model. Population-based indicators were not significant predictors of internalizing disorders. CONCLUSIONS Results suggest that neighborhood characteristics, rather than population-based indicators, may be better predictors of psychopathology. Future research should continue to develop and examine structural interventions. Integration of allied mental health professionals may help to alleviate negative health outcomes associated with poor neighborhood quality.
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Affiliation(s)
- Marilyn L Piccirillo
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Thomas L Rodebaugh
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
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Miller P, Votruba-Drzal E, Coley RL. Poverty and Academic Achievement Across the Urban to Rural Landscape: Associations with Community Resources and Stressors. RSF 2019; 5:106-122. [PMID: 31168472 PMCID: PMC6545987 DOI: 10.7758/rsf.2019.5.2.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Poor children begin school with fewer academic skills than their nonpoor peers, and these disparities translate into lower achievement, educational attainment, and economic stability in adulthood. Child poverty research traditionally focuses on urban or rural poor, but a shifting spatial orientation of poverty necessitates a richer examination of how urbanicity intersects with economic disadvantage. Combining geospatial administrative data with longitudinal survey data on poor children from kindergarten through second grade (N ≈ 2,950), this project explored how differences in community-level resources and stressors across urbanicity explain variation in achievement. Resources and stressors increased in more urbanized communities and were associated with academic achievement. Both mediated differences in poor children's achievement. Mediation was both direct and indirect, operating through cognitive stimulation and parental warmth.
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Affiliation(s)
- Portia Miller
- Research scientist in the Learning Research and Development Center at the University of Pittsburgh
| | - Elizabeth Votruba-Drzal
- Professor of psychology at the University of Pittsburgh and a research scientist in the Learning Research and Development Center at the University of Pittsburgh
| | - Rebekah Levine Coley
- Department chair and professor in the Counseling, Developmental, and Educational Psychology Department at Boston College
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Conus P, Abrahamyan Empson L, Codeluppi Z, Baumann PS, Söderström O, Söderström D, Golay P. City Avoidance in the Early Phase of Psychosis: A Neglected Domain of Assessment and a Potential Target for Recovery Strategies. Front Psychiatry 2019; 10:342. [PMID: 31214055 PMCID: PMC6557174 DOI: 10.3389/fpsyt.2019.00342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/30/2019] [Indexed: 01/13/2023] Open
Abstract
Background: A considerable amount of research has explored the link between living in an urban environment during childhood and the increased risk to develop psychosis. However, the urban milieu is more than a risk factor as it is also a place for socialization and enrichment. The aims of the current study were to explore, in a large sample of early psychosis (EP) patients, their pattern of use of the city, their perception when exposed to various critical stressors, and their sensitivity to diverse forms of stimuli. Methods: We sent a questionnaire (based on previous work conducted in a group of patients, including video-recorded walk-along in the city and a literature review) to 305 EP patients and to 220 medical students. Results: Response rate in patients was low (38%). City avoidance and negative perceptions towards the urban environment increased in patients after onset of psychosis. Patients' tendency to avoid city center correlates with both problematic social interactions and stimuli perceived as unpleasant. Patients seemed less likely to enjoy urban spaces considered as relaxing, suggesting a lower capacity to benefit from positive aspects of this environment. Conclusions: The development of psychosis influences the way EP patients perceive the city and their capacity to feel at ease in the urban environment, leading to a high rate of city avoidance. Considering the possible influence of city avoidance on social relations and the recovery process, the development of strategies to help patients in this regard may have a significant effect on their recovery process.
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Affiliation(s)
- Philippe Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Clinique de Cery, Prilly, Switzerland
| | - Lilith Abrahamyan Empson
- Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Clinique de Cery, Prilly, Switzerland
| | - Zoé Codeluppi
- Institute of Geography, University of Neuchâtel, Neuchâtel, Switzerland
| | - Philipp Sebastien Baumann
- Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Clinique de Cery, Prilly, Switzerland
| | - Ola Söderström
- Institute of Geography, University of Neuchâtel, Neuchâtel, Switzerland
| | | | - Philippe Golay
- Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Clinique de Cery, Prilly, Switzerland
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Taylor LG, Clark AF, Wilk P, Button BL, Gilliland JA. Exploring the Effect of Perceptions on Children's Physical Activity in Varying Geographic Contexts: Using a Structural Equation Modelling Approach to Examine a Cross-Sectional Dataset. Children (Basel) 2018; 5:children5120159. [PMID: 30486424 PMCID: PMC6306871 DOI: 10.3390/children5120159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 12/04/2022]
Abstract
Most Canadian children are not meeting the recommended 60 min of moderate-to-vigorous physical activity per day. Research suggests that children’s perceptions of their environment have an influence on their physical activity behaviours, but there is a lack of generalizability among previous work. The purpose of this study was to assess the mediating effect of children’s perceptions of barriers to physical activity on the relationship between their environments and their level of moderate-to-vigorous physical activity (measured with accelerometers). Structural equation modelling stratified by gender was used to assess the research objective in a sample of 546 participants aged 8–14 years old from Northwestern and Southwestern Ontario, Canada. In both models stratified by gender, perceptions of barriers did not significantly mediate the relationship between urbanicity and physical activity. Independent of all other factors, there was no significant relationship between urbanicity and physical activity in girls, but there was in boys. These results offer insight into potential processes by which perceptions impact physical activity and provide initial information to further our understanding of the behavioural aspects of physical activity through multiple levels of analysis. Researchers must continue to improve efforts for quantifying the experience of children’s daily activity contexts.
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Affiliation(s)
- Leah G Taylor
- Human Environments Analysis Laboratory, Western University, London, ON N6A 3K7, Canada.
- Department of Geography, Western University, London, ON N6A 3K7, Canada.
- Children's Health Research Institute, London, ON N6C 2V5, Canada.
| | - Andrew F Clark
- Human Environments Analysis Laboratory, Western University, London, ON N6A 3K7, Canada.
- Department of Geography, Western University, London, ON N6A 3K7, Canada.
- Children's Health Research Institute, London, ON N6C 2V5, Canada.
| | - Piotr Wilk
- Human Environments Analysis Laboratory, Western University, London, ON N6A 3K7, Canada.
- Children's Health Research Institute, London, ON N6C 2V5, Canada.
- Department of Epidemiology & Biostatistics, Western University, London, ON N6A 3K7, Canada.
- Department of Paediatrics, Western University, London, ON N6A 3K7, Canada.
| | - Brenton L Button
- Human Environments Analysis Laboratory, Western University, London, ON N6A 3K7, Canada.
- Department of Geography, Western University, London, ON N6A 3K7, Canada.
- Children's Health Research Institute, London, ON N6C 2V5, Canada.
| | - Jason A Gilliland
- Human Environments Analysis Laboratory, Western University, London, ON N6A 3K7, Canada.
- Department of Geography, Western University, London, ON N6A 3K7, Canada.
- Children's Health Research Institute, London, ON N6C 2V5, Canada.
- Department of Epidemiology & Biostatistics, Western University, London, ON N6A 3K7, Canada.
- Department of Paediatrics, Western University, London, ON N6A 3K7, Canada.
- School of Health Sciences, Western University, London, ON N6A 3K7, Canada.
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Abstract
BACKGROUND AND OBJECTIVES To examine temporal trends in dietary energy, fat, carbohydrate, protein, sodium and potassium intake of Chinese adolescents aged 12 - 17 years by sex and urbanicity, using data from the China Health and Nutrition Survey. METHODS AND STUDY DESIGN Individual level, consecutive 3 - day 24-hour recalls were analyzed from survey years 1991 (n=504), 2000 (n=665), and 2011 (n=267) from nine provinces representing a range of geography, economic development, and health indicators in China. Linear multivariable regression models were conducted to predict mean intakes of energy, macronutrients, sodium, and potassium. Models were adjusted for age, per capita income, parental education, region, and family size. RESULTS From 1991 to 2011, total energy consumption decreased among both sexes and all urbanicity groups (p<0.05). Sodium intake decreased in all sex and urbanicity groups except the high urbanicity group, which was the only group to show significant change in potassium intake (p<0.05). Sodium-potassium ratios decreased overall and across both sexes (p<0.05). However, the major observed shift was a structural change from carbohydrates to fat and protein. Both sexes showed decrease in carbohydrate-derived energy (p<0.05). Proportion of fat-derived energy increased in female adolescents. Proportion of protein-derived energy increased in male adolescents, as well as in the low and high urbanicity groups (p<0.01). CONCLUSIONS This suggests Chinese adolescents are transitioning to a low carbohydrate diet. Urbanicity appears to play a role in sodium, potassium and protein intake. Improvements of sodiumpotassium ratios are primarily due to decreased sodium intake and require further reduction efforts.
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Affiliation(s)
- Alice Yunzi L Yu
- Department of Nutrition, University of North Carolina at Chapel Hill, USA
| | - Nancy López-Olmedo
- Department of Nutrition, University of North Carolina at Chapel Hill, USA
| | - Barry M Popkin
- Department of Nutrition, University of North Carolina at Chapel Hill, USA.
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Guloksuz S, Rutten BPF, Pries LK, ten Have M, de Graaf R, van Dorsselaer S, Klingenberg B, van Os J, Ioannidis JPA. The Complexities of Evaluating the Exposome in Psychiatry: A Data-Driven Illustration of Challenges and Some Propositions for Amendments. Schizophr Bull 2018; 44:1175-1179. [PMID: 30169883 PMCID: PMC6192470 DOI: 10.1093/schbul/sby118] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 12/21/2022]
Abstract
Identifying modifiable factors through environmental research may improve mental health outcomes. However, several challenges need to be addressed to optimize the chances of success. By analyzing the Netherlands Mental Health Survey and Incidence Study-2 data, we provide a data-driven illustration of how closely connected the exposures and the mental health outcomes are and how model and variable specifications produce "vibration of effects" (variation of results under multiple different model specifications). Interdependence of exposures is the rule rather than the exception. Therefore, exposure-wide systematic approaches are needed to separate genuine strong signals from selective reporting and dissect sources of heterogeneity. Pre-registration of protocols and analytical plans is still uncommon in environmental research. Different studies often present very different models, including different variables, despite examining the same outcome, even if consistent sets of variables and definitions are available. For datasets that are already collected (and often already analyzed), the exploratory nature of the work should be disclosed. Exploratory analysis should be separated from prospective confirmatory research with truly pre-specified analysis plans. In the era of big-data, where very low P values for trivial effects are detected, several safeguards may be considered to improve inferences, eg, lowering P-value thresholds, prioritizing effect sizes over significance, analyzing pre-specified falsification endpoints, and embracing alternative approaches like false discovery rates and Bayesian methods. Any claims for causality should be cautious and preferably avoided, until intervention effects have been validated. We hope the propositions for amendments presented here may help with meeting these pressing challenges.
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Affiliation(s)
- Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands,Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Lotta-Katrin Pries
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Margreet ten Have
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction; Utrecht, the Netherlands
| | - Ron de Graaf
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction; Utrecht, the Netherlands
| | - Saskia van Dorsselaer
- Department of Epidemiology, Netherlands Institute of Mental Health and Addiction; Utrecht, the Netherlands
| | - Boris Klingenberg
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands,Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands,Department of Psychosis Studies, King’s College London, King’s Health Partners, Institute of Psychiatry, London, UK
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, Department of Health Research and Policy and Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA,Department of Statistics, Stanford University School of Humanities and Science, Stanford, CA,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA,To whom correspondence should be addressed; Stanford Prevention Research Center, Stanford University, Medical School Office Bldg, 1265 Welch Rd, Stanford, CA 94305, US; tel: (650) 725-5465, fax: (650) 725-6247, e-mail:
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Castillejos MC, Martín-Pérez C, Moreno-Küstner B. A systematic review and meta-analysis of the incidence of psychotic disorders: the distribution of rates and the influence of gender, urbanicity, immigration and socio-economic level. Psychol Med 2018; 48:2101-2115. [PMID: 29467052 DOI: 10.1017/s0033291718000235] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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: 12/20/2022]
Abstract
BACKGROUND Considering existing knowledge on the relationship between certain environmental factors and incidence rates of psychosis, we carried out a systematic review to provide a broad and updated picture of the incidences of different psychotic disorder subgroups worldwide and how some environmental factors influence these rates. METHODS Studies with original data related to the incidence of psychosis (published between 2000 and 2015) were identified via searching electronic databases (CINAHL, MEDLINE, PSYCINFO, PUBMED, and SCOPUS). Data on the following risk factors were extracted: gender, urbanicity, immigration and socio-economic level. Descriptive appraisals of variation in incidence rates (IR) and incidence rate ratios (IRR), with a 95% confidence interval were calculated. In addition, a meta-analysis was performed to calculate IR pooled by diagnosis group and IRR pooled by diagnosis and gender, urbanity, immigration and socio-economic level, using a random effects model. RESULTS We identified 33 reports to analyse. Overall IR per 100 000 persons for non-affective psychoses (IR pooled = 22.53 (16.51-28.54)) were higher than affective psychoses (IR pooled = 7.12 (5.03-9.22)). There was an increase in rates of psychosis in men v. women (IRR pooled = 1.54 (1.37-1.72)), in urban v. rural areas (IRR pooled = 1.64 (1.38-1.95)), in immigrants v. natives (IRR pooled = 3.09 (2.74-3.49)), and in lower socio-economic level areas (IRR pooled = 1.78 (1.43-2.22)). CONCLUSIONS IR among different psychotic disorders was found to vary depending on gender, urbanicity, and immigration (as most of the previous literature focuses on non-affective psychosis or schizophrenia).
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Affiliation(s)
- M C Castillejos
- Departament of Personality, Assessment and Psychological Treatment, University of Málaga, Campus Teatinos, Málaga, Spain
- Andalusian Group of Psychosocial Research (GAP), Research group of the Ministry of Innovation, Science and Business of the Junta de Andalucía, code CTS-945. Andalucía, Spain
| | - C Martín-Pérez
- Andalusian Health Service, North East Granada Sanitary District, Clinical Management Unit at Marquesado, Alquife, Granada, Spain
| | - B Moreno-Küstner
- Departament of Personality, Assessment and Psychological Treatment, University of Málaga, Campus Teatinos, Málaga, Spain
- Andalusian Group of Psychosocial Research (GAP), Research group of the Ministry of Innovation, Science and Business of the Junta de Andalucía, code CTS-945. Andalucía, Spain
- Biomedical Research Institute of Malaga (IBIMA)
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48
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Bringolf-Isler B, de Hoogh K, Schindler C, Kayser B, Suggs LS, Dössegger A, Probst-Hensch N. Sedentary Behaviour in Swiss Children and Adolescents: Disentangling Associations with the Perceived and Objectively Measured Environment. Int J Environ Res Public Health 2018; 15:E918. [PMID: 29734712 PMCID: PMC5981957 DOI: 10.3390/ijerph15050918] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 04/27/2018] [Accepted: 05/03/2018] [Indexed: 11/16/2022]
Abstract
Identifying correlates of sedentary behaviour across all levels of the ecological model and understanding their interrelations is a promising method to plan effective interventions. The present study examined whether the objectively assessed and the perceived neighbourhood are associated with children’s sedentary behaviour time (SBT). A comprehensive set of factors at different levels of influence across the ecological model were taken into account and analysed for mediating and modifying effects. Analyses were based on 1306 children and adolescents (6⁻16 years) participating in the population-based SOPHYA-study. Accelerometers were used to assess SBT, the perceived environment was examined by a validated parental questionnaire, and objective environmental data were allocated using GIS (ArcMap 10.2, Esri, Redlands, CA, USA) for each family’s residential address. A high perceived safety was associated with less SBT. Boys, those whose residential neighbourhood was characterized by dead ends in urban areas, a low main street density in the neighbourhood of children and greenness were less likely to exhibit SBT. The association of the objective environment with the respective parental perceptions was low and no significant mediating effect was found for the perceived environment. We conclude for land-use planning to reduce sedentary behaviour objective environments should be complemented with efforts to increase parental sense of security.
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Affiliation(s)
- Bettina Bringolf-Isler
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland.
- University of Basel, Petersplatz 1, 4051 Basel, Switzerland.
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland.
- University of Basel, Petersplatz 1, 4051 Basel, Switzerland.
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland.
- University of Basel, Petersplatz 1, 4051 Basel, Switzerland.
| | - Bengt Kayser
- Institute of Sport Sciences, University of Lausanne, 1015 Lausanne, Switzerland.
| | - L Suzanne Suggs
- Institute of Public Communication, University della Svizzera italiana, Via G. Buffi 13, 6900 Lugano, Switzerland.
| | - Alain Dössegger
- Swiss Federal Institute of Sport Magglingen SFISM, 2532 Magglingen, Switzerland.
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland.
- University of Basel, Petersplatz 1, 4051 Basel, Switzerland.
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Newbury J, Arseneault L, Caspi A, Moffitt TE, Odgers CL, Fisher HL. Cumulative Effects of Neighborhood Social Adversity and Personal Crime Victimization on Adolescent Psychotic Experiences. Schizophr Bull 2018; 44:348-358. [PMID: 28535284 PMCID: PMC5815129 DOI: 10.1093/schbul/sbx060] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Little is known about the impact of urbanicity, adverse neighborhood conditions and violent crime victimization on the emergence of adolescent psychotic experiences. METHODS Participants were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally-representative cohort of 2232 British twins who were interviewed about adolescent psychotic experiences at age 18. Urbanicity, neighborhood characteristics, and personal victimization by violent crime were measured during childhood and adolescence via geocoded census data, surveys of over 5000 immediate neighbors of the E-Risk participants, and interviews with participants themselves. RESULTS Adolescents raised in urban vs rural neighborhoods were significantly more likely to have psychotic experiences (OR = 1.67, 95% CI = 1.21-2.30, P = .002). This association remained significant after considering potential confounders including family socioeconomic status, family psychiatric history, and adolescent substance problems (OR = 1.43, 95% CI = 1.01-2.03, P = .042), but became nonsignificant after considering adverse social conditions in urban neighborhoods such as low social cohesion and high neighborhood disorder (OR = 1.35, 95% CI = 0.94-1.92, P = .102). The combined association of adverse neighborhood social conditions and personal crime victimization with adolescent psychotic experiences (adjusted OR = 4.86, 95% CI = 3.28-7.20, P < .001) was substantially greater than for either exposure alone, highlighting a potential interaction between neighborhood conditions and crime victimization (interaction contrast ratio = 1.81, 95% CI = -0.03 to 3.65) that was significant at the P = .054 level. CONCLUSIONS Cumulative effects of adverse neighborhood social conditions and personal victimization by violent crime during upbringing partly explain why adolescents in urban settings are more likely to report psychotic experiences. Early intervention efforts for psychosis could be targeted towards victimized youth living in urban and socially adverse neighborhoods.
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Affiliation(s)
- Joanne Newbury
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Louise Arseneault
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Avshalom Caspi
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Departments of Psychology and Neuroscience, Psychiatry and Behavioral Sciences, and Centre for Genomic and Computational Biology, Duke University, Durham, NC
| | - Terrie E Moffitt
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Departments of Psychology and Neuroscience, Psychiatry and Behavioral Sciences, and Centre for Genomic and Computational Biology, Duke University, Durham, NC
| | - Candice L Odgers
- Center for Child and Family Policy and the Sanford School of Public Policy, Duke University, Durham, NC
| | - Helen L Fisher
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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Radua J, Ramella-Cravaro V, Ioannidis JPA, Reichenberg A, Phiphopthatsanee N, Amir T, Yenn Thoo H, Oliver D, Davies C, Morgan C, McGuire P, Murray RM, Fusar-Poli P. What causes psychosis? An umbrella review of risk and protective factors. World Psychiatry 2018; 17:49-66. [PMID: 29352556 PMCID: PMC5775150 DOI: 10.1002/wps.20490] [Citation(s) in RCA: 320] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Psychosis is a heterogeneous psychiatric condition for which a multitude of risk and protective factors have been suggested. This umbrella review aimed to classify the strength of evidence for the associations between each factor and psychotic disorders whilst controlling for several biases. The Web of Knowledge database was searched to identify systematic reviews and meta-analyses of observational studies which examined associations between socio-demographic, parental, perinatal, later factors or antecedents and psychotic disorders, and which included a comparison group of healthy controls, published from 1965 to January 31, 2017. The literature search and data extraction followed PRISMA and MOOSE guidelines. The association between each factor and ICD or DSM diagnoses of non-organic psychotic disorders was graded into convincing, highly suggestive, suggestive, weak, or non-significant according to a standardized classification based on: number of psychotic cases, random-effects p value, largest study 95% confidence interval, heterogeneity between studies, 95% prediction interval, small study effect, and excess significance bias. In order to assess evidence for temporality of association, we also conducted sensitivity analyses restricted to data from prospective studies. Fifty-five meta-analyses or systematic reviews were included in the umbrella review, corresponding to 683 individual studies and 170 putative risk or protective factors for psychotic disorders. Only the ultra-high-risk state for psychosis (odds ratio, OR=9.32, 95% CI: 4.91-17.72) and Black-Caribbean ethnicity in England (OR=4.87, 95% CI: 3.96-6.00) showed convincing evidence of association. Six factors were highly suggestive (ethnic minority in low ethnic density area, second generation immigrants, trait anhedonia, premorbid IQ, minor physical anomalies, and olfactory identification ability), and nine were suggestive (urbanicity, ethnic minority in high ethnic density area, first generation immigrants, North-African immigrants in Europe, winter/spring season of birth in Northern hemisphere, childhood social withdrawal, childhood trauma, Toxoplasma gondii IgG, and non-right handedness). When only prospective studies were considered, the evidence was convincing for ultra-high-risk state and suggestive for urbanicity only. In summary, this umbrella review found several factors to be associated with psychotic disorders with different levels of evidence. These risk or protective factors represent a starting point for further etiopathological research and for the improvement of the prediction of psychosis.
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Affiliation(s)
- Joaquim Radua
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- FIDMAG Germanes Hospitalàries, CIBERSAM, Sant Boi de Llobregat, Spain
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Valentina Ramella-Cravaro
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - John P A Ioannidis
- Department of Medicine, Stanford Prevention Research Center, Stanford, CA, USA
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
- Meta-Research Innovation Center at Stanford, Stanford University, Stanford, CA, USA
- Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA
| | - Abraham Reichenberg
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Frieman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nacharin Phiphopthatsanee
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Taha Amir
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hyi Yenn Thoo
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Dominic Oliver
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Cathy Davies
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Craig Morgan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Center, London, UK
| | - Philip McGuire
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Center, London, UK
| | - Robin M Murray
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Center, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Center, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
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