Health Association Research Articles

Abstract MP44: Non-Genetic Component of Height as a Surrogate Marker for Childhood Socioeconomic Status and Its Association With Cardiovascular and Brain Health: Results From HCHS/SOL

Introduction: Childhood socioeconomic status (SES) has been recognized to have lifelong effects on health, but often studies rely on recollected information subject to bias. Several studies suggest taller adult height is a surrogate for favorable childhood SES, likely due to better nutrition during skeletal development. We aimed to parse out the non-genetic component of height as a refined surrogate marker of childhood SES. Hypothesis: We hypothesized that the higher non-genetic component of height is associated with higher childhood SES, and further, with better cardiovascular and brain health in adulthood. Methods: Self-reported information such as parental education, nativity (born in US 50 states/DC), age at migration, and economic hardship to pay for basic needs and access to household utilities during childhood were collected from US Hispanics/Latinos aged 18-74 years in HCHS/SOL (2008-2011). A non-genetic component of height (height non-pgs ) was estimated by subtracting genetically predicted height from the measured height, where a height genetic prediction model was fitted on sex-standardized height with Hispanic-specific height polygenic score (height pgs ), genetic ancestry components, and sex. The AHA-LE8 cardiovascular health (CVH) clinical score was derived. Neurocognitive function (6-item screener, Spanish English Verbal Learning Test, Word fluency test, Digit symbol substitution test) was assessed among >45 years. We examined the associations of height non-pgs with childhood environment and health outcomes by survey linear regressions. Results: A higher height non-pgs was associated with better childhood environment - younger generation (mean height non-pgs = 0.37 (SE=0.02) for born in 1980-1999 vs -0.45 (0.03) for born in 1930-1949), higher parental education (0.28 (0.02) for college vs -0.11 (0.02) for elementary), US born or migrated at younger age, and availability of plumbing, electricity, and phone during childhood - but not with childhood economic hardship. Further, height non-pgs was positively associated with better cognitive functions in all domains, adjusting for demographics, participants’ SES, and cardiovascular risk factors. These associations with height non-pgs were more pronounced than those with measured height. Height non-pgs showed positive associations with better clinical CVH score among 45+ aged people. Among <45 years, height non-pgs was negatively associated with clinical CVH score. Conclusions: We observed that height non-pgs reflects childhood SES, potentially through better nutrition and greater access to resources that promote growth. Stronger associations of height non-pgs and health, compared to associations with measured height, suggest that height non-pgs is a good proxy for childhood environment. The paradoxical association of height non-pgs with CVH among <45 years old needs further investigation.

Abstract 62: Association of Cardiovascular Health Trajectories Through Young Adulthood With Later-Life Incident Cardiovascular Disease and Mortality: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Introduction: Associations of mid-life cardiovascular health (CVH) and incident cardiovascular disease (CVD) are well-studied. Less is known about patterns of young adulthood (YA) CVH, including its changes, and associations with later-life CVD outcomes. Methods: CVH was defined by Life’s Essential 8 (LE8) score. First, we used latent class modeling (SAS Proc Traj) to determine trajectories of continuous CVH scores (0-100) for CARDIA participants with ≥3 CVH measurements in YA (from year [Y]0, mean age 25, to Y20, mean age 45). Second, we examined direction and magnitude of change in CVH status (low, moderate, or high) between 2 CVH measurements (at Y0 and Y20), comparing participants with increased, decreased, or stable CVH status. Outcomes included incident CVD (MI, heart failure, stroke, CVD death) after Y20. Cox proportional hazards regression was used to estimate HRs for associations of YA CVH patterns with incident CVD. Results: There were 4,257 participants in YA (44% female, 48% Black) included. In the trajectory analysis, we identified four distinct CVH trajectory groups ( Figure 1A ): compared to the Persistently-High CVH group, the Moderate-Low-Declining and Moderate-Declining CVH trajectory groups had substantially higher hazards for incident CVD ( Figure 1B ). In the CVH status change analysis (N=2,884; Figure 1B ), compared to Stable High CVH in YA, Stable Low CVH had a 19-fold higher risk for incident CVD, and both increasing and decreasing CVH status in YA had greater risk for incident CVD as well. Conclusions: Trajectories of declining moderate and low CVH in YA had substantially higher risk for later-life incident CVD events. Those with decreasing CVH and those who started with lower CVH and improved it through YA, were also at higher risk. These data suggest that early life CVH and maintaining high CVH through YA are both important for prevention of later-life CVD.

Abstract MP42: Insomnia Symptoms Are Associated With Poor Cardiometabolic Health Among Bhutanese Refugees in the United States

Introduction: The prevalence of insomnia symptoms is higher among refugees globally compared to the general population, and poor sleep is a risk factor for poor cardiometabolic health. The resettled Bhutanese refugee community is the third-largest refugee group in the United States (US) and appears to be-based on a few existing studies-particularly susceptible to sleep disturbances such as insomnia symptoms as well as cardiometabolic conditions such as hypertension, and type 2 diabetes. No prior studies have investigated associations between insomnia symptoms and cardiometabolic conditions in this community. Hypothesis: We hypothesized that participants reporting insomnia symptoms will have a higher prevalence of cardiometabolic conditions. Methods: We used data from the 2021-2022 Bhutanese Community of Central Ohio Health Study (N=495) to examine associations between insomnia symptoms and cardiometabolic health. Insomnia symptoms, measured by self-reports of difficulty falling/staying asleep, were categorized as “not at all,” “sometimes,” and “often/all the time.” A cardiometabolic condition was based on self-reported medical diagnosis/treatment of one or more of the following conditions: hypertension, dyslipidemia, and type 2 diabetes. Poisson regression with robust variance was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) of cardiometabolic conditions among participants with insomnia symptoms compared to participants without insomnia symptoms while adjusting for sociodemographic characteristics and body mass index (using criteria for Asians). Results: The sample was mainly aged between 18-44 years (69.8%), 51% were male, and most lived in the US for ≥11 years (60.2%). Insomnia symptoms prevalence was 56.4% for “not at all”, 30.7% for “sometimes,” and 12.9% for “often/all the time.” Overall, 12.9% of participants had at least 1 cardiometabolic condition, 10.8% had at least 2 conditions, and 6.3% had all 3 conditions. Compared to not having insomnia symptoms, having insomnia symptoms sometimes was associated with a higher prevalence of type 2 diabetes [PR=2.15, 95%CI: 1.19-3.87], hypertension [PR=1.86, 95%CI: 1.24-2.79], dyslipidemia [PR=1.73, 95%CI: 1.01-2.96], and 1 or more cardiometabolic conditions [PR=1.67, 95%CI: 1.20-2.32]. Similarly, compared to not having insomnia symptoms, having insomnia symptoms often/all the time was associated with a higher prevalence of type 2 diabetes [PR=2.18, 95%CI: 1.04-4.54], hypertension [PR=1.71, 95%CI: 1.06-2.74], dyslipidemia [PR=3.03, 95%CI: 1.67-5.47], and 1 or more cardiometabolic conditions [PR=1.68, 95%CI: 1.15-2.47]. Conclusions: In conclusion, the burden of both insomnia symptoms and cardiometabolic health conditions were prevalent among the US Bhutanese refugee population, and the insomnia-cardiometabolic health associations were strong.

Abstract MP64: Cardiovascular Responses to Occupational Physical Activity Are Exaggerated by Work-Related Stress and Low Fitness

Introduction: Proposed mechanisms explaining the link between high occupational physical activity (OPA) and cardiovascular disease hypothesize that high work-related stress and low worker fitness may exacerbate cardiovascular responses to OPA. Hypothesis: Direct associations between OPA and acute cardiovascular responses will be stronger under high work-related stress and in workers with lower fitness. Methods: 19 male workers (age=46.6±7.9, 68.4% White) with high OPA jobs were observed for seven days. Steps, light (LPA), and moderate-to-vigorous physical activity (MVPA) during work were measured using a thigh-worn activPAL3 micro, hip-worn Actigraph GT3X-BT, and time-use diary. Heart rate (HR) was measured continuously with a Polar chest strap. 24-hour blood pressure (BP) was measured using an ambulatory BP monitor on one workday. Rate-pressure product (RPP), an indirect measure of cardiac workload, was calculated as systolic BP x HR. Daily work-related stress was measured with the Stress in General Scale (scores=-3-21 where higher scores indicate more stress). Worker fitness was estimated as VO 2 max (ml·kg -1 ·min -1 ) using a submaximal treadmill test. Effect modification by stress and fitness on the associations between OPA and RPP was examined using mixed effects models with interaction terms. Results: Work-related stress was directly associated with 24-hour RPP (β=94.10 mmHg*bpm/stress point, p=0.024) while worker fitness was not (β=-33.0 mmHg*bpm/VO 2 max, p=0.561). Direct association between RPP and occupational MVPA were stronger with higher work-related stress and lower fitness (Table 1, p-for-interaction<0.05 for all). Lower intensity OPA (steps and LPA) were also associated with exacerbated RPP responses outside of work with higher work-related stress (Table 1, p-for-interaction<0.001 for all). Conclusions: OPA performed under high stress or by workers with low fitness may exaggerate cardiovascular responses and contribute to OPA's paradoxical cardiovascular health associations.

100 Years of the American Public Health Association's Public Health Education and Health Promotion Section: Celebrating the Past, Forging the Future.

The American Public Health Association's Public Health Education and Health Promotion (APHA PHEHP) Section celebrates its 100th anniversary by reflecting on its humble beginnings and early contributions to the field of health education. This article highlights the often-unsung history of our field and its fledgling beginnings, which is important to scholars and students alike. First codified as the Health Education and Publicity Section in the early 1920s, we trace the history and challenges of using new modes of publicity such as motion pictures and innovative exhibits to help curb the spread of infectious diseases (e.g., tuberculosis, venereal disease). Evart G. Routzahn, credited as the Section's father, worked tirelessly to increase the Section's visibility (renamed the Health Education Section in 1927 and the Public Health Education and Health Promotion Section in 1990) and in advancing the professionalization of health education during a time when there were no formal professional preparation programs in health education. Over the years, the Section has played significant roles in strengthening the practice of health education and communication; advancing APHA's overall leadership, infrastructure, and governance; and contributing to the unified voice and advocacy for the health education profession and health equity. We conclude by describing contemporary initiatives that reflect the continued spirit and vibrancy of the Section in setting the stage for the next 100 years.

Physico-Chemical Quality Assessment of Ground Water in Kathmandu Valley and Siraha District

A key element in maintaining human health is the quality of drinking water which is a vital component of natural resources. This study was conducted to assess the ground water quality in the Kathmandu Valley and Siraha district from October 2022 to March 2023 in the Water Engineering and Training Centre, Ratopul, Kathmandu. A total of 123 water samples were collected from various wells and borings around the Kathmandu Valley and Siraha district and were subjected to physicochemical investigation following the standard techniques for water sample collection and analyzed by methods as described in the American Public Health Association (1998). The pH, conductivity, turbidity, ammonia concentration, and iron content were found to exceed National Drinking Water Quality Standard guidelines value in 21.95%, 3.25 %, 53.65 %, 47.15 %, and 18.7 % of total water samples respectively. All water samples had total hardness and chloride levels within the acceptable range. The arsenic content of all samples except one well water sample from Siraha was found within a permissible level. The findings suggest that water quality is not satisfactory, which could lead to various water-borne illnesses. Therefore, proper water purification techniques should be used before consumption.

Use of Digital COVID-19 Exposure Notifications at a Large Gathering: Survey Analysis of Public Health Conference Attendees.

WA Notify was Washington State's smartphone-based COVID-19 digital exposure notification (EN) tool, which was used to help limit the spread of COVID-19 between November 30, 2020, and May 11, 2023. Following the 2022 Washington State Public Health Association Annual Conference, attendees who had WA Notify activated began receiving ENs alerting them to a possible COVID-19 exposure during the conference. A survey was emailed to all conference attendees to measure WA Notify adoption, mechanisms through which attendees received ENs, and self-reported engagement in protective behaviors postexposure. This study aimed to learn more about the experiences of WA Notify adopters and nonadopters who may have been exposed to COVID-19 at a large group gathering. A web-based survey administered through REDCap (Research Electronic Data Capture; Vanderbilt University) was sent to all attendees of the Washington State Public Health Association conference. Self-reported demographic information and characteristics of respondents were summarized. Regression models were used to estimate relative risks to compare WA Notify adoption and testing behaviors between groups. Of the 464 total registered attendees who were sent the survey, 205 (44%) responses were received; 201 eligible attendees were included in this analysis. Of those, 149 (74%) respondents reported having WA Notify activated on their phones at the time of the conference. Among respondents with WA Notify activated, 54% (n=77) reported learning of their potential exposure from a WA Notify EN. Respondents who reported that they did not have WA Notify activated and learned of their potential exposure via the event-wide email from conference organizers were 39% less likely to test for COVID-19 compared to respondents with WA Notify activated who learned of their potential exposure from the email (relative risk 0.61, 95% CI 0.40-0.93; P=.02), and this gap was even larger when compared to respondents who learned of their exposure from a WA Notify EN. The most commonly cited reason for not having WA Notify activated was privacy concerns (n=17, 35%), followed by not wanting to receive ENs (n=6, 12%) and being unaware of WA Notify (n=5, 10%). Digital EN systems are an important tool to directly and anonymously notify close contacts of potential exposures and provide guidance on the next steps in a timely manner. Given the privacy concerns, there is still a need for increasing transparency surrounding EN technology to increase uptake by the public if this technology were to be used in the future to slow the spread of communicable diseases.

Public-Private engagement and health systems resilience in times of health worker strikes: a Ghanaian case study.

In low and middle-income countries like Ghana, private providers, particularly the grouping of faith-based non-profit health providers networked by the Christian Health Association of Ghana (CHAG), play a crucial role in maintaining service continuity during health worker strikes. Poor engagement with the private sector during such strikes could compromise care quality and impose financial hardships on populations, especially the impoverished. This study delves into the engagement between CHAG and the Government of Ghana (GoG) during health worker strikes from 2010 to 2016, employing a qualitative descriptive and exploratory case study approach. By analysing evidence from peer-reviewed literature, media archives, grey literature and interview transcripts from a related study using a qualitative thematic analysis approach, this study identifies health worker strikes as a persistent chronic stressor in Ghana. Findings highlight some system-level interactions between CHAG and GoG, fostering adaptive and absorptive resilience strategies, influenced by CHAG's non-striking ethos, unique secondment policy between the two actors and the presence of a National Health Insurance System. However, limited support from the government to CHAG member facilities during strikes and systemic challenges with the National Health Insurance System pose threats to CHAG's ability to provide quality, affordable care. This study underscores private providers' pivotal role in enhancing health system resilience during strikes in Ghana, advocating for proactive governmental partnerships with private providers and joint efforts to address human-resource-related challenges ahead of strikes. It also recommends further research to devise and evaluate effective strategies for nations to respond to strikes, ensuring preparedness and sustained quality healthcare delivery during such crises.

Association of cardiovascular health with subclinical coronary atherosclerosis progression among five racial and ethnic groups: The MASALA and MESA studies

Background and aimsSouth Asian adults (SA) are at higher risk for atherosclerotic cardiovascular disease (ASCVD) compared with other racial/ethnic groups. Life's Simple 7 (LS7) is a guideline-recommended, cardiovascular health (CVH) construct to guide optimization of cardiovascular risk factors. We sought to assess if the LS7 metrics predict coronary artery calcium (CAC) incidence and progression in asymptomatic SA compared with four other racial/ethnic groups. MethodsWe assessed the distribution of CVH metrics (inadequate: score 0–8, average: 9–10, optimal: 11–14, and per 1-unit higher score) and its association with incidence and progression of CAC among South Asians in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study compared with other race/ethnic groups from the Multiethnic Study of Atherosclerosis (MESA). ResultsWe included 810 SA, 2622 Non-Hispanic White (NHW), and 4192 Other adults (collectively 1893 Black, 1496 Hispanic and 803 Chinese American participants, respectively). SA and White participants compared to Other race/ethnicity groups were more likely to have optimal CVH metrics (26% SA vs 28% White participants vs 21% Other, respectively, p < 0.001). Similar to NHW and the Other race/ethnic group, SA participants with optimal baseline CVH were less likely to develop incident CAC on follow-up evaluation compared to participants with inadequate CVH metrics, optimal CVH/CAC = 0: 24% SA, 28% NHW, and 15% Other (p < 0.01). In multivariable linear and logistic regression models, there was no difference in annualized CAC incidence or progression between each race/ethnic group (pinteraction = 0.85 and pinteraction = 0.17, respectively). Optimal blood pressure control was associated with lower CAC incidence among SA participants [OR (95% CI): 0.30 (0.14–0.63), p < 0.01] and Other race and ethnicity participants [0.32 (0.19–0.53), p < 0.01]. ConclusionsOptimal CVH metrics are associated with lower incident CAC and CAC progression among South Asians, similar to other racial groups/ethnicities. These findings underscore the importance of optimizing and maintaining CVH to mitigate the future risk of subclinical atherosclerosis in this higher risk population.

Practicing weight-inclusive healthcare in a weight-centric field: An examination of the barriers faced by weight-inclusive healthcare practitioners in the U.S.

ABSTRACT The provision of stigmatizing, weight-centric healthcare negatively affects health in many ways, including the stress generated during discriminatory and microaggressive provider-patient interactions, the barriers to healthcare access it creates, and the way it encourages healthcare avoidance, facilitating the reproduction of widespread health disparities. As the harms of weight-centric healthcare have been increasingly exposed across both scholarly publications and lay media in recent years, a greater number of healthcare practitioners have begun adopting a weight-inclusive practice paradigm in their work with patients and clients. Yet, given the constraining nature of social structures, healthcare practitioners committed to providing weight-inclusive care likely face barriers they must contend with as they transition toward and carry out weight-inclusive care in their work. Currently, little is known about the experiences of weight-inclusive healthcare practitioners, the barriers they face in adopting or enacting a weight-inclusive care, and the ways they navigate those barriers. The present study explores these questions via a thematic analysis of 53 semi-structured, in-depth interviews with self-identified weight-inclusive healthcare practitioners (36 dietitians/nutritionists, 13 mental health therapists, 2 physical therapists, 1 fitness coach, and 1 physician’s assistant) recruited through the Association for Size Diversity and Health’s Health at Every Size professional listing and snowball sampling. The results of this study indicate several barriers to adopting and enacting weight-inclusive healthcare in the U.S., including weight-centric healthcare training, weight-centric workplaces, and weight-centric insurance systems, which require time, money, and energy to navigate. Suggestions for how these barriers can be mitigated are discussed.

Coming Up…

The New Jersey Association of Mental Health and Addiction Agencies is holding its annual spring conference, “Advancing Opportunities, Improving Lives,” April 9–10 in Somerset, New Jersey. Visit https://web.cvent.com/event/174eb79e‐c916‐4279‐bf59‐7a5f64186863/regProcessStep1:fa8700dc‐6be3‐470c‐a096‐4a77cbb0f1ef for more information.

Sex and Racial/Ethnic Patterns of Tobacco Product Use Among Students at a U.S. University in 2021–2023

Background : Although the prevalence of conventional tobacco product use among U.S. college students has declined, an increasing number of students use various novel tobacco products. Objectives : This study aims to examine up-to-date sex and racial/ethnic patterns of tobacco use among students at a U.S. university in 2021–2023. Methods : Data of 2,732 students at an urban university in the Southeast of the U.S. were collected in 2021–2023 as part of the National College Health Assessment of the American College Health Association. Self-reported past 3-month use of five tobacco products (cigarette, electronic vapor products, water pipe/hookah, smokeless tobacco, and cigars) was dichotomized. We conducted multinomial logistic regression analysis to examine sex (male or female) and racial/ethnic (non-Hispanic White, non-Hispanic Black, Hispanic, or non-Hispanic Other) differences in single and dual/poly (con-current use of two or more tobacco products) tobacco use compared to nonuse, adjusting for age, student status, parent education level, obese status, psychological distress level, and survey year. Results : Male students had higher odds of being dual/poly tobacco user than female students, adjusting for covariates (adjusted odds ratio [AOR] = 2.00, 95% confidence interval [CI] = 1.42, 2.82). Non-Hispanic Black students had lower odds of being single (AOR = 0.43, 95% CI = 0.26, 0.69) and dual/poly (AOR = 0.09, 95% CI = 0.02, 0.37) tobacco user compared to non-Hispanic White students, adjusting for covariates. Conclusions : Considering higher health risk of con-current use of multiple tobacco products, dual/poly tobacco use prevention strategies targeting male and non-Hispanic White students may be considered.

Primary care professionals' perspectives on tailoring buprenorphine training for rural practice.

Buprenorphine is a highly effective medication for opioid use disorder (OUD) that remains substantially underutilized by primary care professionals (PCPs). This is particularly true in rural communities, which have fewer prescribers and significant access disparities. The Drug Enforcement Administration removed the X-waiver requirement in December 2022, yet many rural clinicians still report barriers to prescribing buprenorphine. In this study, we examined rural PCPs' experiences with buprenorphine to identify tailored training strategies for rural practice. Physicians, nurse practitioners, and physician associates practicing in rural Ohio counties were recruited through contacts at statewide health associations and health professions training programs. Twenty-three PCPs were interviewed about their perspectives on prescribing buprenorphine, including their training history. PCPs self-reported being motivated to respond to OUD. However, they also reported that current training efforts failed to equip them with the knowledge and resources needed to prescribe effectively, and that urban-focused training often alienated rural clinicians. Participants suggested tailoring training content to rural settings, using rural trainers, and bolstering confidence in navigating rural-specific barriers, such as resource deficits and acute opioid fatigue. Our study found that current training on buprenorphine prescribing is inadequate for meeting the needs of rural PCPs. Tailored buprenorphine training is needed to improve accessibility and acceptability, and to better support the clinical workforce in communities disproportionately impacted by the opioid epidemic.

Deep learning of movement behavior profiles and their association with markers of cardiometabolic health

BackgroundTraditionally, existing studies assessing the health associations of accelerometer-measured movement behaviors have been performed with few averaged values, mainly representing the duration of physical activities and sedentary behaviors. Such averaged values cannot naturally capture the complex interplay between the duration, timing, and patterns of accumulation of movement behaviors, that altogether may be codependently related to health outcomes in adults. In this study, we introduce a novel approach to visually represent recorded movement behaviors as images using original accelerometer outputs. Subsequently, we utilize these images for cluster analysis employing deep convolutional autoencoders.MethodsOur method involves converting minute-by-minute accelerometer outputs (activity counts) into a 2D image format, capturing the entire spectrum of movement behaviors performed by each participant. By utilizing convolutional autoencoders, we enable the learning of these image-based representations. Subsequently, we apply the K-means algorithm to cluster these learned representations. We used data from 1812 adult (20–65 years) participants in the National Health and Nutrition Examination Survey (NHANES, 2003–2006 cycles) study who worn a hip-worn accelerometer for 7 seven consecutive days and provided valid accelerometer data.ResultsDeep convolutional autoencoders were able to learn the image representation, encompassing the entire spectrum of movement behaviors. The images were encoded into 32 latent variables, and cluster analysis based on these learned representations for the movement behavior images resulted in the identification of four distinct movement behavior profiles characterized by varying levels, timing, and patterns of accumulation of movement behaviors. After adjusting for potential covariates, the movement behavior profile characterized as “Early-morning movers” and the profile characterized as “Highest activity” both had lower levels of insulin (P < 0.01 for both), triglycerides (P < 0.05 and P < 0.01, respectively), HOMA-IR (P < 0.01 for both), and plasma glucose (P < 0.05 and P < 0.1, respectively) compared to the “Lowest activity” profile. No significant differences were observed for the “Least sedentary movers” profile compared to the “Lowest activity” profile.ConclusionsDeep learning of movement behavior profiles revealed that, in addition to duration and patterns of movement behaviors, the timing of physical activity may also be crucial for gaining additional health benefits.

Increasing mental health issues in college students from 2016-2019: Assessing the intersections of race/ethnicity, gender, and sexual orientation

BackgroundThis study aimed to evaluate how trends in mental health (e.g., diagnosis/treatment of depression, anxiety, suicidal ideation) varied across intersections of gender, race/ethnicity, and sexual orientation in a large, national sample of undergraduate students. MethodsData from the American College Health Association, and National College Health Assessment II: 2016–2019 were analyzed (N = 228,640 undergraduate students from 442 campuses, ages 18–24; 67.8 % female, 40.4 % BIPOC, 3.0 % non-binary (trans/non-conforming), 19.4 % LGBQ+). We used logistic regression to predict each mental health indicator; covariates included year, gender, BIPOC, LGBQ+ status, and their interactions, as well as other covariate controls (e.g., region, year in school). ResultsThere were significant and steady increases in the odds of each mental health indicator by year (ORs = 1.12–1.13), which were significantly greater in magnitude for LGBQ+ students (ORs = 1.20–1.23). Increases did not vary by gender, race/ethnicity, or intersections between these groups and LGBQ+ status. There were significant interactions between identity groups that aligned with intersectional and minority stress theories (which did not vary by year). Non-Hispanic White students had significantly greater odds of past-year treatment/diagnosis of depression and anxiety compared to BIPOC students; however, BIPOC students had significantly greater odds of past-year suicidal ideation and this was pronounced for BIPOC women. Being non-binary x LGBQ+ was associated with significantly greater odds of each indicator. DiscussionResults affirm the importance of promoting mental health among college students, with a particular focus on how to better serve and support BIPOC, non-binary, and LGBQ+ students.

The association of resilience and positive mental health in systemic sclerosis: A Scleroderma Patient-centered Intervention Network (SPIN) cohort cross-sectional study

ObjectiveA previous study using Scleroderma Patient-centered Intervention Network (SPIN) Cohort data identified five classes of people with systemic sclerosis (also known as scleroderma) based on patient-reported somatic (fatigue, pain, sleep) and mental health (anxiety, depression) symptoms and compared indicators of disease severity between classes. Across four classes (“low”, “normal”, “high”, “very high”), there were progressively worse somatic and mental health outcomes and greater disease severity. The fifth (“high/low”) class, however, was characterized by high disease severity, fatigue, pain, and sleep but low mental health symptoms. We evaluated resilience across classes and compared resilience between classes. MethodsCross-sectional study. SPIN Cohort participants completed the 10-item Connor-Davidson-Resilience Scale (CD-RISC) and PROMIS v2.0 domains between August 2022 and January 2023. We used latent profile modeling to identify five classes as in the previous study and multiple linear regression to compare resilience levels across classes, controlling for sociodemographic and disease variables. ResultsMean CD-RISC score (N = 1054 participants) was 27.7 (standard deviation = 7.3). Resilience decreased progressively across “low” to “normal” to “high” to “very high” classes (mean 4.7 points per step). Based on multiple regression, the “high/low” class exhibited higher resilience scores than the “high” class (6.0 points, 95% confidence interval [CI] 4.9 to 7.1 points; standardized mean difference = 0.83, 95% CI 0.67 to 0.98). ConclusionsPeople with worse disease severity and patient-reported outcomes reported substantially lower resilience, except a class of people with high disease severity, fatigue, pain, and sleep disturbance but positive mental health and high resilience.

British association for sexual health and HIV national guideline for the management of anogenital warts in adults (2024).

This guideline offers recommendations on the diagnosis, treatment and health promotion principles needed for the effective management of human papillomavirus (HPV)-related warts at anogenital sites including the external genitals, vagina, cervix, urethra, perianus and anal canal. The guideline is aimed primarily at patients aged 16years or older presenting to healthcare professionals working in level 3 sexual health services in the United Kingdom. However, the principles of the recommendations may be applied in other care settings, including in primary care, using locally adapted care pathways where appropriate. The management of HPV-related anogenital dysplasia or warts at other extragenital sites is outside the scope of this guideline.

Incidence of Health Facility Switching and Associations With HIV Viral Rebound Among Persons on Antiretroviral Therapy in Uganda: A Population-based Study.

A substantial proportion of persons on antiretroviral therapy (ART) considered lost to follow-up have actually transferred their human immunodeficiency virus (HIV) care to other facilities. However, the relationship between facility switching and virologic outcomes, including viral rebound, is poorly understood. We used data from 40 communities (2015-2020) in the Rakai Community Cohort Study to estimate incidence of facility switching and viral rebound. Persons aged 15-49 years with serologically confirmed HIV who self-reported ART use and contributed ≥1 follow-up visit were included. Facility switching and virologic outcomes were assessed between 2 consecutive study visits (ie, index and follow-up visits, interval of approximately 18 months). Those who reported different HIV treatment facilities between index and follow-up study visits were classified as having switched facilities. Virologic outcomes included viral rebound among individuals initially suppressed (<200 copies/mL). Multivariable Poisson regression was used to estimate associations between facility switching and viral rebound. Overall, 2257 persons who self-reported ART use (median age, 35 years; 65% female, 92% initially suppressed) contributed 3335 visit-pairs and 5959 person-years to the analysis. Facility switching was common (4.8 per 100 person-years; 95% confidence interval [CI], 4.2-5.5) and most pronounced in persons aged <30 years and fishing community residents. Among persons suppressed at their index visit (n = 2076), incidence of viral rebound was more than twice as high in persons who switched facilities (adjusted incidence rate ratio = 2.27; 95% CI, 1.16-4.45). Facility switching was common and associated with viral rebound among persons initially suppressed. Investments in more agile, person-centered models for mobile clients are needed to address system inefficiencies and bottlenecks that can disrupt HIV care continuity.

Association of perceived childhood socio-economic status and health with depressive symptoms among middle-aged and older adults in India: using data from LASI Wave I, 2017–2018

BackgroundChildhood adverse experience has been linked with poor health outcomes across the life course. Nevertheless, whether such an association or direction could be projected to older people’s life remains still unclear and needs to generate more evidence, particularly in India. Therefore, this study was conducted to examine the association of childhood socio-economic status and health with depressive symptoms amongst middle- aged and older adults in India.MethodsThe data for the study was drawn from national representative survey “Longitudinal Ageing Study in India (LASI)” Wave I, 2017–2018 in order to conduct cross-sectional study. Multivariable regression analysis was used to examine the association of childhood socioeconomic status and health with depressive symptoms in the older population.ResultsPoor childhood health was significantly and positively associated with depressive symptoms (AoR: 1.56, CI: 1.19, 2.04). Likewise, respondents who were bedridden for a month during their childhood had high odds of developing depressive symptoms (AoR: 1.16 CI: 1.01, 1.34). In addition to this, the odds of having depressive symptoms increased significantly among the average (AoR: 1.28 CI: 1.08, 1.51) and poor childhood socioeconomic status group (AoR: 1.31 CI: 1.11, 1.55) as compared to the higher socioeconomic category.ConclusionsChildhood socioeconomic status and health have a significant role in determining mental health in later life. Results suggest that considering childhood socioeconomic status and health is important while diagnosing depression in older population in order to identify the significant associated factors in early childhood and thus help in preventing depressive symptoms in later life.

Association of pre-migration socioeconomic status and post-migration mental health in Syrian refugees in Lebanon: a descriptive sex-stratified cross-sectional analysis

BackgroundRefugee populations present with high levels of psychological distress, which may vary among sociodemographic characteristics. Understanding the distribution across these characteristics is crucial to subsequently provide more tailored support to the most affected according to their specific healthcare needs. This study therefore seeks to investigate the association between pre-migration socioeconomic status (SES) and post-migration mental health separately for male and female Syrian refugees in Lebanon.MethodsIn a cross-sectional study, a cluster randomized sample of 599 refugees from Syria were recruited between 2016 and 2019 within 12 months after they fled to Lebanon. Logistic regression was used to determine the association between self-reported pre-migration SES and levels of anxiety and depressive symptoms assessed on the Hopkins Symptoms Checklist-25 (HSCL-25) scale, both for the entire sample and stratified by sex. To assess the informative value of self-reported SES, its correlation with education variables was tested. All analyses were conducted in R version 4.3.ResultsUsing complete cases, 457 participants (322 female, 135 male) were included in the analyses. Females showed on average more symptoms of anxiety (Median: 2.5) and depression (Median: 2.4) than males (Median: 2.10 and 2.07, respectively). Below average SES was associated with significantly higher odds for mental illness compared to average SES (anxiety: OR 4.28, 95% CI [2.16, 9.49]; depression: OR 1.85, 95% CI [1.06, 3.36]). For anxiety, differences between SES strata were larger for males than females. The self-reported SES measure showed only a weak positive correlation with education.ConclusionsThis study adds additional descriptive data highlighting mental health differences in Syrian refugees in Lebanon, whereby below average SES is associated with worse mental health outcomes compared to average SES. These findings demand further research into the underlying mechanisms. Improving our understanding of the observed differences will provide valuable insights that can contribute to the future development of targeted measures.