Adult Health Research Articles

What factors attenuate the relationship between childhood neglect and adverse health outcomes? Examining the role of socioeconomic status, health behaviors, and the presence of a protective adult

BackgroundThe detrimental effects of childhood neglect on adult health outcomes are well-recognized; however, less is known about factors that may attenuate this relationship. Objective(1) To examine the associations between childhood neglect and various physical and mental health outcomes in adulthood among those who had not experienced childhood physical or sexual abuse; and (2) To determine whether adjusting for risk and protective factors, including socioeconomic status, health behaviors, and the presence of a trusted adult, attenuates these relationships. Participants and settingData came from the 2021 Behavioral Risk Factor Surveillance System (BRFSS), a representative sample of community-dwelling US adults (n = 41,322). MethodsThe relationships between childhood neglect and health outcomes were investigated using logistic regression analyses. Adjustments were made for demographics, socioeconomic status, health behaviors, and the presence of a protective adult. ResultsChildhood neglect was significantly associated with adverse health outcomes, including health behaviors (e.g., smoking, low physical activity), physical health indicators (e.g., self-reported fair/poor health, stroke, asthma, COPD), disabilities (e.g., hearing impairment, vision impairment, cognitive impairment, difficulty walking or climbing stairs, difficulty bathing), and mental health indicators (e.g., poor mental health/past month, depression) after controlling for demographics. All significant associations indicated small or very small effect sizes. Associations were substantially attenuated when controlling for adult socioeconomic status, and further attenuated when controlling for the presence of a protective adult, with several outcomes becoming non-significant. ConclusionsSocioeconomic status and the presence of a protective adult in childhood considerably diminishes the association between childhood neglect and health outcomes in adulthood.

Did internet usage reduce the impact of COVID-19 on the mental health of middle-aged and older adults? A difference-in-differences study based on CFPS data.

Mental health is the cornerstone of public health, especially where middle-aged and older adults during the COVID-19 pandemic were concerned. The impact of Internet usage on mental health in the time of the crisis still presents a mixed picture. This study employs the PSM-DID method according to longitudinal data (CFPS) to explore whether Internet usage reduced the impact of COVID-19 on the mental health of middle-aged and older adults. The results reveal that Internet use improves the mental health of middle-aged and older adults during the pandemic in China, but that the impact varies between urban and rural residents. Furthermore, the moderator effects model shows that people's perceptions of the Internet have an impact upon the length of time spent online and its consequent effect on mental health. These findings suggested that Internet use had a significant effect on alleviating the levels of depression in middle-aged and older adults. Greater marginal gains may be realized by enhancing the digital capacity of and narrowing the digital divide that exists among rural residents. The enhancement of digital capacity and proper guidance in digital education should be taken into consideration where the mental health of middle-aged and older adults is at issue.

Six Weeks to Wellness: The Role of Breathing Exercises Based on Motor Development Pattern in Improving Fitness and Quality of Life in Overweight Elderly Women.

Background: Being overweight is a major global health epidemic of the 20th and 21st centuries, which can affect the movement system function of older adult women. This study evaluated the effects of a breathing exercise based on motor development patterns on functional fitness and quality of life in overweight older adult women. Methods: A randomized controlled trial was conducted with 40 community-dwelling women aged 65-75. Participants were randomly assigned to an intervention group, which completed a 6-week breathing exercise program (three supervised and three home-based sessions per week), or a control group, which maintained usual routines. Outcome measures included cardiovascular fitness, upper and lower body flexibility, muscle strength, dynamic balance, and quality of life, assessed at baseline and post-intervention. Results: The intervention group showed significant improvements in cardiovascular fitness (p < .001, ES = 0.652), upper body flexibility (p < .001, ES = 0.652), lower body flexibility (p < .001, ES = 0.538), upper body strength (p < .001, ES = 0.538), lower body strength (p < .001, ES = 0.538), and dynamic balance (p < .001, ES = 0.475) compared to the control group. Quality of life also significantly improved in the intervention group (p < .001, ES = 0.475). Conclusion: Breathing exercises based on motor development patterns significantly enhance functional fitness and quality of life in overweight older adult women. Incorporating these exercises into regular physical activity routines may promote health and independence in older adults. Further research should explore long-term benefits and optimal exercise parameters for older adults.

The Impact of acne on the mental health of women and young adults, a case-control multicenter study of 300 patients in Lomé, Togo, West Africa

Background: This study explores the relationship between acne and anxiety, both common health issues among young adults. Acne, a chronic inflammatory skin condition, can significantly impact an individual's self-esteem and quality of life. Anxiety, characterized by feelings of imminent danger and distress, often exacerbates this impact. While the association between acne and anxiety has been well-studied in developed countries, research in Africa, particularly in Togo, is limited. Materials and Methods: A case-control study was conducted over eight months, from July 2017 to February 2018, in three public dermatology clinics in Lomé, Togo. The study included 300 acne patients, matched with 600 controls based on age (±5 years) and gender. Data were collected through structured interviews, clinical examinations, and validated questionnaires like the General Anxiety Disorder-7 (GAD-7) for anxiety assessment. Results: Out of 4,126 dermatology patients, 300 (7.3%) consulted for acne, with young adults representing the majority. The study found a significant correlation between acne and anxiety, with a higher prevalence of anxiety among acne patients compared to the control group. Conclusion: The findings highlight the psychological burden and mental health impact of acne in young adults in general and of women, emphasizing the need for a holistic approach to acne treatment that includes mental health support integrated in dermatologic treatment. Further research is recommended to explore this relationship in different African cultural contexts.

Association between sedentary behavior and bone mass, microstructure and strength in children, adolescents and young adults: a systematic review

Sedentary behavior (SED) research is currently receiving increasing attention in the field of public health. While it has been shown to have negative effects on cardiovascular or metabolic health, there is limited knowledge regarding the relationship between SED and bone health in children, adolescents, and young adults. Thus, the purpose of this review is to investigate the associations between SED and bone health status, specifically bone mass, microstructure, and strength. A comprehensive literature search was conducted across five electronic databases, including EMBASE, PubMed, Medline, Cochrane, Web of Science and CNKI. The inclusion criteria were as follows: healthy participants aged 24 years or younger, with measured SED and measured bone outcomes. The quality of the included articles was assessed using the National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. After excluding, the final sample included 25 cross-sectional, 9 observational and 2 both cross-sectional and longitudinal studies. Among these, seven were rated as ‘high quality’, twenty-three were rated as ‘moderated quality’, and six were rated as ‘low quality’ according to the quality assessment criteria. After summarizing the evidence, we found no strong evidence to support an association between BMC or BMD and SED, even when considering gender or adjusting for moderate-to-vigorous physical activity (MVPA). However, a strong level of evidence was found indicating a negative relationship between objectively measured SED and cortical bone mineral density (Ct.BMD) in the tibia or stiffness index (SI) in the Calcaneus across all age groups. While the association between adverse bone health outcomes and SED still cannot be confirmed due to insufficient evidence, these findings suggest that bone microstructure and strength may be more sensitive to SED than bone mass. Thus, further evidence is needed to fully understand the connection between sedentary behavior and bone health, particularly regarding the relationship between SED and bone strength.

Adult mental health outcomes of adolescent depression and co-occurring alcohol use disorder: a longitudinal cohort study

AbstractDepression and alcohol use disorder (AUD) are frequently co-occurring in adolescence, which often goes undetected in routine care. While this may potentially compromise treatment effectiveness and lead to a less favourable long-term prognosis, few longitudinal studies have followed this group into adulthood. The aim of this study was to explore the risk for adult depression, anxiety disorders, suicidality, and AUD in adolescents with concurrent depression and AUD. The study was based on the Uppsala Longitudinal Adolescent Depression Study (ULADS), a Swedish prospective cohort study. Diagnostic interviews were conducted in adolescence (age 16-17) and adulthood (around age 30). Adolescents with concurrent depression and AUD (n = 38) were compared with peers having only depression (n = 189) or neither of the conditions (n = 144). Logistic regression was used to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Adolescents with concurrent depression and AUD were more likely than their non-affected peers to experience adult depressive episodes (aOR, 5.33; 95% CI, 2.22–12.83), anxiety disorders (4.05; 1.77–9.27), suicidality (5.37; 2.28–12.66), and AUD (7.68; 2.59–22.81). Notably, 34% of adolescents with both depression and AUD subsequently experienced both these conditions as adults, compared to 7% of adolescents with only depression. Adolescents suffering only from depression were less likely than those with both conditions to experience suicidality (0.44; 0.21–0.95) and AUD in adulthood (0.18; 0.07–0.44). These findings underscore the clinical imperative to identify adolescents with this comorbidity. Recognition of the poor long-term prognosis can inform targeted interventions for this vulnerable group, ultimately improving health and well-being throughout the life course.

Prenatal alcohol exposure and health at midlife: Self-reported health outcomes in two cohorts.

The Developmental Origins of Health and Disease Hypothesis (DOHaD) suggests prenatal alcohol exposure (PAE) should have implications for adult physical and mental health. Since the health profile of older adults with PAE and diagnoses of fetal alcohol spectrum disorder (FASD) is unknown, the current study evaluates self-reported health problems of midlife adults with and without a history of PAE to describe these outcomes. Participants (N = 357) recruited from longitudinal cohorts in Atlanta, GA and Seattle, WA completed a health survey assessing a range of physical conditions. Initial analysis compared the frequency of conditions between alcohol-exposed and nonexposed groups. To identify patterns within groups, 10 problem areas were subjected to latent class analysis (LCA). Finally, the direct effect of PAE on health outcomes was evaluated using multilevel modeling, controlling for effects of other factors. Compared with unexposed controls, individuals with PAE reported significantly higher frequencies of problems with hearing, dentition, heart, cancer, gastritis, kidney stones, bladder, diabetes, thyroid, skin, and seizures. LCA found that controls yielded two classes, with 45% reporting sleep and vision problems and 55% reporting sleep, vision, cardiovascular, endocrine, immune, and dental problems. The PAE group yielded three classes, with 13% endorsing few health problems, 43% reporting sleep, vision, immune, and dental problems, and 43% reporting sleep, vision, cardiovascular, urinary, endocrine, skin, immune, dental, and gastrointestinal problems. With multivariate analysis, controlling for other influences, PAE was associated directly with hearing, urinary, dental, and gastrointestinal problems. A similar pattern was found for alcohol-exposed individuals who did and did not meet criteria for fetal alcohol syndrome (FAS). Patients affected by alcohol may report greater frequency and range of health adversity. That PAE was only uniquely associated with a limited set of problems suggests that many health outcomes in midlife result from an initial vulnerability potentiated by postnatal stress resulting from other associated factors.

Early remission of deliberate self-harm predicts emotion regulation capacity in adulthood: 12.4 years follow-up of a randomized controlled trial of adolescents with repeated self-harm and borderline features

AbstractEmotion regulation capacity, critical for adult functioning and mental health, develops strongly during adolescence in healthy individuals. Deficits in emotion regulation is often referred to as emotion dysregulation [ED] and is associated with various mental health problems, including repeated deliberate self-harm [DSH] which peaks in adolescence. Dialectical Behaviour Therapy for adolescents [DBT-A] systematically targets ED through strategies such as changing coping behaviours and has previously been shown to effectively induce DSH remission in adolescents. However, whether such remission is associated with improved emotion regulation capacity in adulthood, and whether this effect is mediated by changes in use of coping strategies has not been previously studied. Prospective long-term follow-up study of an RCT comparing DBT-A with enhanced usual care [EUC] for adolescents presenting to community child and adolescent psychiatric outpatient clinics with borderline personality features and repeated self-harm. Assessments included both structured interviews and self-report at baseline and 1.6, 3.1 and 12.4 years follow-up. In the final follow-up, adult ED was measured and data were collected for 61 (80%) of the original 77 participants. DSH remission was assessed at 1.6 years follow-up, and use of coping strategies at 3.1 and 12.4 years follow-ups. A mediation analysis was conducted within a causal inference framework. Both treatment groups increased their use of functional coping skills from adolescence to adulthood, while only DBT-A was associated with decreases in dysfunctional coping. There was a direct effect of DSH remission 1 year after treatment on adult ED, particularly for participants who did not receive DBT-A. There was a negative association between reductions in dysfunctional coping and adult ED, however this did not mediate the effect of DSH remission. This is the first study to report that early DSH remission in adolescence predicted lower ED in adulthood. These results highlight the importance of early DSH remission and provides new insight into the long-term relationship between DSH and ED. Clinical trial registration information: “Treatment for Adolescents with Deliberate Self-harm”; http://ClinicalTrials.gov/;NCT00675129

The use of digital technologies to promote sexual health in young adults: a narrative review

Abstract Background New technologies have the potential to play an important role in promoting sexual health, especially among young people, who are the biggest users and those at greatest risk of contracting Sexually Transmitted Infections (STI). The risk behavior assumed by young people today highlights this vulnerability in several contexts, such as individual, social, economic, and family. In this sense, it becomes relevant to approach sex education in schools using digital technologies. Objectives To identify the evidence in the literature on the use of digital technologies to promote the sexual health of young adults. Methods Narrative literature review. Three independent reviewers extracted, analyzed and synthesized the articles and results. Results Through the selection process, four studies were included. The articles show that the use of digital technologies (mobile phones/applications) leads to increased knowledge, improved attitudes and sexual behavior among young adults. The interventions studied in the studies were based on Short Message Service, electronic mail interventions and the MyPEEPS mobile application, with the following main focuses: Increased knowledge, attitudes, and behaviors of young adults. Considering the results of the studies, all interventions proved to be effective as facilitators of sexual health promotion. Conclusions The use of digital technologies allowed an increase in the promotion of the sexual health of the participants, since there was an increase in the level of knowledge with the use of digital technologies such as SMS, emails and mobile applications when comparing the experimental and control groups. The use of these digital technologies also allowed for a change in attitudes and behaviors, such as a significant increase in serological testing for STIs and an increase in health care seeking. Key messages • The use of digital technology promotes the sexual health of young adults, so these strategies should be implemented by health professionals. • The dissemination of these digital strategies will have an impact on Public Health, specifically regarding the sexual health of young adults.

Health and well-being during the pandemic: views and support needs of older adults who lived alone

Abstract Background Physical and social distancing measures during the COVID-19 pandemic had the potential to jeopardize health and well-being of older adults. Especially older adults who lived alone faced challenges due to restrictive COVID-19 measures. In this study, we explored views and support needs to maintain health and well-being of older adults living in a single household during the COVID-19 pandemic. Methods We employed an interpretative phenomenological analysis, including twenty semi-structured interviews with older adults (≥65 years old) living in single households during the pandemic. Interviews were conducted between June and September 2021, audio-recorded and lasted approximately one hour. Data analysis was guided by the heuristic framework of Smith et al. Trustworthiness of the study was enhanced through bracketing and multiple interdisciplinary moments of revision of the data analysis. Results The views and support needs of participants to maintain health and well-being during the pandemic were captured in three overarching themes: ‘A lingering search for connectedness’, ‘Dealing with a discouraging situation to stay well’, and ‘Leaning on lessons learned during life’. Important resources that enabled participants to maintain health and well-being were: experiences of social connectedness, acceptance of the situation, and (re)gaining a sense of control. Participants described how they leaned on lessons learned from life-experiences when facing situations that challenged their health and well-being. Conclusions Our study points out that views and support needs of older adults to maintain health and well-being during the pandemic were diverse and rooted in various coping mechanisms. During future situations similar to the pandemic, public health policies should include strategies to promote social connectedness among older adults who live alone, to prevent adverse health outcomes. Key messages • Experiences of social connectedness, acceptance, and (re)gaining a sense of control were coping mechanisms that enabled older adults to maintain health and well-being during the COVID-19 pandemic. • Public health policies should include strategies to promote social connectedness among older adults who live alone, to prevent adverse health outcomes during future pandemics.

Examining Lifestyle Risk Factor Clusters and Mental Health in Adults

Abstract Background Lifestyle risk factors often cluster, impacting both physical and mental health. Studies reveal bidirectional relationships between lifestyle factors and health. The aim of this study is to examine the relationship between mental health problems, self-reported depression, and lifestyle risk factors in a sample of the adult population in Turkey. Methods 2022 Turkey Health Survey (THS) data were used. The sample group was made using cross-sectional data of approximately 22742 individuals in the adult population over 15 years of age. Two-stage clustering method was used to determine vital risk factor clusters. Regression analysis was used to determine the relationship between vital risk factor clusters and self-reported depression and mental health problems. Results Lifestyle risk factors were grouped into 4 clusters. It was observed that unhealthy diet, inadequate physical activity, and smoking, which are modifiable lifestyle risk factors, were together in the clusters. It was also observed that self-reported depression and mental problems were more associated with clusters with more than one lifestyle risk factor. In addition, women, married individuals, and individuals over 65 years of age were more associated with mental problems. Conclusions As a result of the findings, there was an association between people with mental problems and lifestyle risk factors such as smoking, unhealthy diet, and insufficient physical activity. These findings may help to plan and implement more effective health policies and individual interventions targeting groups with multiple lifestyle risk factors in the future. Key messages • The target group was determined to improve community mental health and to make necessary interventions. • Since inadequate physical activity, which is one of the vital risk factors, and unhealthy nutrition and smoking tend to cluster together, it was determined that these problems should be prioritised

Childhood socioeconomic status and depression in adulthood: systematic review

Abstract Background Low socioeconomic status (SES) is generally associated with poorer mental health, particularly depression. We carried out a systematic review to address the question of whether childhood SES is associated with depression in adulthood and the potential pathways which may explain this association. Methods We followed a systematic search strategy in PubMed and Scopus with specific inclusion and exclusion criteria. After removing duplicates, studies were screened for eligibility and quality was assessed independently by two assessors using the Newcastle-Ottawa scale. Results After the selection process, 20 observational studies (7 cohort and 13 cross-sectional) that examine the association between SES during childhood and depression in adulthood were included in the systematic review. The most common measures of childhood SES were parental education, occupation or family income, estimated subjectively and/or objectively. In 17 of the studies an inverse relationship between childhood SES and depression was shown. In 17 studies, models were employed to demonstrate the possible pathways which explain the relationship between childhood SES and depressive symptoms. The most important mediators were adult SES, psychosocial factors, childhood trauma and physical health. Conclusions Our findings reveal the long-term association between childhood socioeconomic conditions and depression later in life. Suboptimal childhood SES seems to be an important risk factor for depression in adulthood. Improving childhood socioeconomic conditions can potentially have lasting effects well beyond childhood. Key messages • Protecting children against the effects of socioeconomic adversity could reduce depression in adult life. • Policy makers should direct resources towards alleviating childhood disadvantage for promoting health in adulthood.

Interplay between family History and polygenic risk for coronary heart disease: a cohort study among over 60 thousand individuals

Abstract Background The degree to which background genetic risk adds to self-report of family history of coronary heart disease (CHD) remains an important question. Methods We utilized data from the multiethnic Genetic Epidemiology Resource in Adult Health and Aging (GERA) cohort of 60,070 Kaiser Permanente of Northern California (KPNC) members (mean ± SD age=59 ± 9 years; 67% female; 18% non-white). We characterized the cohort at baseline in 2003-2007. Excluding those with missing self-report of family history of CHD (n=1,718) resulted in a final sample of 61,352. We stratified the cohort into not having (n=42,866; 70%) and having (n=18,486; 30%) self-reported family history of CHD and then (within stratum of family history of CHD) by three groups of CHD polygenic risk (low: quintile 1; intermediate: quintiles 2, 3 and 4 combined; and high: quintile 5) using a validated 12-SNP polygenic risk score (PRS) for CHD (CARDIO inCode-Score®). Incident CHD was based on ICD-9/10 codes for angina pectoris, myocardial infarction, revascularization procedures or CHD death (n=3,040) through 12/31/2022; mean follow-up was 14.5 years. Results Age-adjusted CHD incidence rates per 10,000 person years were estimated using Poisson regression (accounting for death and health plan disenrollment) by absence/presence of family history of CHD and polygenic risk groups. As shown in the Figure, polygenic risk provided additional risk stratification within categories of family history. The hazard ratio of high PRS (vs low PRS) adjusted for age, sex, 10 principal components of ancestry, smoking, body mass index, diabetes, hypertension, total cholesterol/HDL ratio and cholesterol lowering therapy was 1.62 (95% CI, 1.39-1.87; p&amp;lt;0.001) in those with no family history of CHD, and 1.66 (95% CI, 1.37-2.00; p&amp;lt;0.001) in those with family history of CHD (p-interaction PRS continuous*family history of CHD=0.93). Conclusions Our results show that polygenic risk predicts future CHD regardless of the presence of family history of CHD. Thus, it is not enough to rely of family history to fully characterize potential genetic burden. These data are therefore important for the future of precision medicine.

I Have Decided to Read Out Loud for the Rest of My Life! Cognitive Health and the StrongerMemory Program

The StrongerMemory program aims to improve cognitive health in older adults through three daily brain exercises stimulating the prefrontal cortex: reading aloud, writing, and math activities. The brain’s prefrontal cortex governs memory retrieval, decision-making, concentration, planning, insight, and judgment. This paper reports on focus groups conducted to understand participants’ perspectives of the StrongerMemory program and their continuation of the exercises post-study. Thirty older adults, mostly female, white, married, and holding advanced degrees, participated. Rigorous data analysis involving coding, memoing, and constant comparative analysis generated 132 codes leading to the emergence of five themes: motivating, appreciating, taxing, committing, and enhancing. Social work practitioners can gain valuable insights from this study to enhance the creation and implementation of accessible and meaningful brain health interventions for older adults.

Impact of an Active Nutrition Program on Weight Loss and Metabolic Health in Overweight and Obese Adults: A Randomized Controlled Trial

Impact of an Active Nutrition Program on Weight Loss and Metabolic Health in Overweight and Obese Adults: A Randomized Controlled Trial

Limited critical and communicative health literacy is related to poorer health among older adults

Abstract Background Health literacy-related challenges are expected to increase with age due to a discrepancy between individual capacity and health care demands. Knowledge about associations between health literacy and age-related health outcomes among older adults is scarce. This is important to address and promote optimal health in older adults. The study aims to investigate the association between health literacy and health status among older adults and explore differences between the younger old and the oldest old adults. Methods Cross-sectional study using SWEOLD population-based data from 2022, a national representative sample of people 77+ years in Sweden. Univariate and multivariate logistic regression analysis assessed associations between communicative- and critical health literacy and health outcomes. Models were adjusted for age, sex, and socioeconomic status, and stratified by age. Results Significant adjusted associations were found between inadequate and problematic health literacy and less than good self-rated health (OR 2.64, 95%CI: 1.61-4.33; 2.11, 95%CI: 1.40.3.17), and requiring assistance with medicine management (OR 5.26, 95%CI: 2.67-10.38, 2.14, 95%CI 1.08-4.22). Among the younger old (77-84 years) inadequate and problematic HL was associated with having lifestyle-related conditions (OR 1.77, 95%CI: 1.07-2.93, 2.75, 95%CI: 1.33-2.71). Among the oldest old (85+), inadequate health literacy was associated with higher likelihood of poor activities of daily living (ADL) (OR 4.48, 95%CI: 1.99-10.07) and frailty (OR 3.51, 95%CI: 1.43-8.47). Level of frailty increases earlier in age for individuals with limited HL than among those with sufficient HL. Conclusions Limited health literacy is a prevalent issue in the older population and is associated with negative health-related outcomes. To mitigate development of poor health and frailty and to promote healthy ageing, care organisations need to meet the needs of this population in a health literacy friendly way. Key messages • Limited health literacy among the older population is associated with several negative health-related outcomes. • Care organisations need to work actively to mitigate the development of poor health while promoting healthy aging among the older population in a health literacy-friendly and age sensitive manner.

A systematic review of health outcomes of public transport use by older adults

Abstract Background and Aim Public transport use has been linked to several health benefits in the general population, and is crucial for older adults’ mobility, due to an age-related decline in mobility, and particularly the ability to use other transport modes. The objective of this systematic review is to determine what is known about the physical and mental health outcomes of public transport use by older adults and to identify remaining gaps in the literature. Methods Five electronic databases were searched in April 2023, with an update in January 2024: Pubmed, Scopus, Web of Science, Ageline and Transport Research International Documentation (TRID). Included were studies that were in English, contained a measure of public transport use as exposure, and any health outcome, including mental or physical health, physical or cognitive function, morbidity, or mortality, among people aged ≥ 60 years. Results Of a total of 2247 unique records that were screened, the full text of 20 was assessed for eligibility and 11 were identified as eligible. Citation search identified two additional studies, amounting to a total of 13 included studies. Significant health outcomes described in assessed studies were decreased obesity and depressive symptoms, and to a lesser extent increased gait speed and cognitive function. Conclusions Initial evidence suggests a positive impact of public transport use on obesity, depressive symptoms, gait and cognitive function, although available research was limited in context and methodology. Further research should focus on determining causality between public transport use and health, and be conducted in more diverse contexts. Transport and urban planners, as well as policymakers, should consider the implications of public transport on the health and independence of older adults. Key messages • Public transport use is linked to reduced obesity and depression among older adults. Links with other health outcomes were reported in several studies, but evidence is scarce. • Current research is limited in terms of quantity, scope, and design. Future research should be conducted in wider contexts, encompass a broader range of health outcomes, and address reverse causality.

A lifestyle program for socially vulnerable community-dwelling elderly

Abstract Problem Socially vulnerable older adults often face lower health literacy and limited access to health care. Description of the problem Current lifestyle programs are often insufficiently adapted to this socially vulnerable target group. As a result, these older adults are underrepresented in lifestyle programs. From a public health perspective, lifestyle programs that improve the poorer physical and mental health of these older adults, should be made more accessible by involving the expertise, participation and needs of this group. The aim of this study was to develop and implement a lifestyle program adapted to the expectations and needs of socially vulnerable older adults. Results Both the target group and the local community (health) centers were involved during the co-creative phase of development. A neighborhood analysis was used to identify and reach out to the target group. Motivators and barriers for a healthy lifestyle were identified through focus groups. The developed program consisted of 10 weekly group sessions. Various health aspects were integrated, including exercise, nutrition, stress, sleep, positive psychology, meaningful living, and motivation. Nine centers for community dwelling older adults in Flanders and Brussels were included. In total, 93 older adults were recruited out of which 76 completed the full program. In the final phase, the program was evaluated by means of objective and subjective measuring methods. Finally, the local community (health) centers are currently involved in the program’s sustainability through a trainers’ program. Lessons The belongingness, the catering, the empowering attitude of the trainer and the ‘fun’ factor turned out to be success factors for the adherence to the program. The participating centres experienced an increase in numbers of older adults that were attracted to their activities that are focused on healthy lifestyle behaviors. The continuity of the program is currently being examined. Key messages • A neighbourhood analysis in collaboration with local partners helped to reach the target group. • The program was made attractive by the involvement of the older adults, the fun-factor and the small groups.

Body mass index change and risk of poor oral health in Norwegian adults: the HUNT longitudinal study

Abstract Background Oral diseases and obesity share common risk factors and are highly prevalent. However, the relationships between body mass index (BMI), BMI change and oral health conditions in adults are less studied. In this study, we investigate the associations of long-term obesity and BMI change with risk of poor self-rated oral health among adults. Methods This study include individuals aged 29-90 years (57.8 % women, mean age at baseline, HUNT3, was 54.9 years) who participated in the first (HUNT1, 1984-86), second (HUNT2, 1995-97), third (HUNT3, 2006-08) and fourth (HUNT4, 2017-19) survey of the Trondelag Health Study (HUNT). Weight and height were measured at each survey. We estimated average BMI values and BMI change over a 10-year (HUNT2- HUNT3, N = 19,729) and 20-year (HUNT1- HUNT3, N = 14,276) period and linked to their information on oral health status at HUNT4. We employed logistic regression models with adjustment for confounders and computed odds ratio (OR) with 95 % Confidence Interval (CI). Results At HUNT4, 1812 (9.2 %) participants rated their oral health as poor or very poor. The multivariable-adjusted ORs for average BMI over 30 kg/m2 were 1.3 (95 % CI: 1.1-1.5) and 1.2 (95 % CI: 1.0-1.5) over a 10-year and 20-year period, respectively, when compared to normal weight. After adjustment for most recent BMI (HUNT4), the associations of long-term obesity with poor self-rated oral health weakened. Compared with stable BMI, both loss and gain in BMI over a 10-year period were associated with increased risk of poor oral health. In the adjusted analysis, we found that a BMI loss of more than 2.5 kg/m2 and a BMI gain of more than 5 kg/m2 was associated with 1.5 times (OR = 1.5, 95 % CI: 1.1-1.9) and 1.3 times (OR = 1.3, 95 % CI: 1.1-1.6) greater risk of poor oral health. Conclusions Our findings suggest that individuals with long-term obesity and BMI change have a markedly higher risk of poor self-rated oral health. Key messages • Long-term obesity was associated with increased risk of poor self-rated oral health. • Compared with stable body mass index (BMI), loss- and gain in BMI were associated with increased risk of poor self-rated oral health.

Do discrepancies between subjective and objective health shift over time in later life? A markov transition model

Subjective health (SH) deteriorates less rapidly than objective health (OH) in older adults. However, scant evidence exists regarding if discrepancies between SH and OH shift in the same individuals over time. We explore whether such discrepancies change over time in a sample of older adults living in England, through a prospective, observational cohort study design. Using data from the English Longitudinal Study of Ageing, we followed a sample of 6803 older adults, aged 60+ years at baseline, over three waves of data collection (2002–2007), yielding two wave transitions. A ‘health asymmetry’ metric classified older adults into four categories at each wave, based on the level of agreement between their SH and OH scores (‘health pessimist’, ‘health optimist’, ‘good health realist’ and ‘poor health realist’). First-order Markov transition and generalised logit models yielded estimated transition probabilities and odds ratios for health asymmetry transitions over time. At baseline, 36.84% of the sample were ‘good health realists’, 33% were ‘poor health realists’, 14.54% were ‘health optimists’, and 15.62% were ‘health pessimists’. Good and poor health realists were likely to remain health realistic over time. Good health realists who did transition however, were likely to become health optimists. Subsequently, the proportion of health optimists in the sample increased over time. Health pessimists had a high probability of being lost to study attrition. In conclusion, health optimism (i.e. where SH is rated better than OH) becomes more prevalent over time, in later life. Future research should investigate if promoting positive SH appraisals among health pessimists and poor health realists can optimise health and survival outcomes.