Individual-level Outcomes Research Articles

Cost-effectiveness analysis of atraumatic restorative treatment to manage early childhood caries: microsimulation modelling.

This study assessed the cost-effectiveness of atraumatic restorative treatment and the Hall Technique approach (ART/HT) in managing dental caries in young children under the health provider perspective in order to explore a best-buy alternative to dental general anaesthesia (DGA). Sixty-five observations from a randomized controlled trial were used to construct 20000 microsimulations representing individual-level clinical outcome and costs of the DGA and ART/HT. Outcome was percentage of successfully managed cases. Costs were reported in 2020 price. Three different scenarios with different assumptions of clinical success of the DGA and the ART/HT were analysed. Probabilistic sensitivity analysis was carried out. The ART/HT successfully managed more cases at lower cost ($557) than the DGA when the system failure of the DGA was considered. Under per protocol analysis, participants in both arms were successfully managed, but the ART/HT costed $580 less than the DGA. Probabilistic sensitivity analysis confirmed the ART/HT was a dominant intervention. The ART/HT approach was non-inferior in managing dental caries in young children but at lower costs than the DGA. The ART/HT could be a viable option in the provision of comprehensive dental care in locations with limited access to DGA and reduce hospital admission.

Development and validation of a machine learning model predicting illness trajectory and hospital utilization of COVID-19 patients: A nationwide study.

ObjectiveThe spread of coronavirus disease 2019 (COVID-19) has led to severe strain on hospital capacity in many countries. We aim to develop a model helping planners assess expected COVID-19 hospital resource utilization based on individual patient characteristics.Materials and MethodsWe develop a model of patient clinical course based on an advanced multistate survival model. The model predicts the patient's disease course in terms of clinical states—critical, severe, or moderate. The model also predicts hospital utilization on the level of entire hospitals or healthcare systems. We cross-validated the model using a nationwide registry following the day-by-day clinical status of all hospitalized COVID-19 patients in Israel from March 1 to May 2, 2020 (n = 2703).ResultsPer-day mean absolute errors for predicted total and critical care hospital bed utilization were 4.72 ± 1.07 and 1.68 ± 0.40, respectively, over cohorts of 330 hospitalized patients; areas under the curve for prediction of critical illness and in-hospital mortality were 0.88 ± 0.04 and 0.96 ± 0.04, respectively. We further present the impact of patient influx scenarios on day-by-day healthcare system utilization. We provide an accompanying R software package.DiscussionThe proposed model accurately predicts total and critical care hospital utilization. The model enables evaluating impacts of patient influx scenarios on utilization, accounting for the state of currently hospitalized patients and characteristics of incoming patients. We show that accurate hospital load predictions were possible using only a patient’s age, sex, and day-by-day clinical state (critical, severe, or moderate).ConclusionsThe multistate model we develop is a powerful tool for predicting individual-level patient outcomes and hospital-level utilization.

Environmental-specific servant leadership as a strategic tool to accomplish environmental performance: a case of China

PurposeThe Chinese firms are keenly focused on reducing their environmental footprints as part of the competitive strategy. Within the context of sustainable organizations in China, we test a multilevel framework that examined the impact of environmental-specific servant leadership on the green individual (pro-environmental behavior) and team (project green performance) outcomes within projects. Using social identity theory, we theorize and test the mediating role of green self-identity (individual level) and team green identification (team level) in the relationships between environmental-specific servant leadership, pro-environmental behavior and project green performance.Design/methodology/approachWe used survey questionnaires to collect multi-level and multi-wave data from 42 ongoing project-based sustainable organisations in China. The multilevel team to individual-level hypothesis were analyzed using multilevel-modeling via Mplus, while team level hypotheses were tested using ordinary least squares regression.FindingsThe multilevel regression analysis showed that environmental-specific servant leadership has a trickle-down effect of green self-identity, which subsequently predicts pro-environmental behavior. The ordinary least squares regression results demonstrated that environmental-specific servant leadership predicts project green performance via team green identification. Also, environmental-specific servant leadership has a positive and direct impact on pro-environmental behavior and project green performance.Research limitations/implicationsWe offer community and service dimension of leadership as a determinant of environmental performance at multiple levels. We provide managerial and policy implications to Chinese organizations striving to reposition themselves as eco-friendly organizations both nationally and globally.Originality/valueThe study is among the first to understand the role of environmental-specific servant leadership in predicting individual-level and team-level environment-related mediator and outcomes simultaneously.

Are high performance work systems compatible with the extending working life agenda?

PurposeThe paper examines the compatibility of two UK policy priorities – extending working life (EWL) and the promotion of national economic performance through high performance work practices (HPWP).Design/methodology/approachEmpirical analysis has been conducted using data from WERS2011 to test hypotheses on whether age moderates the link between HPWP and employee well-being outcomes.FindingsDevelopment-oriented human resource strategies are found to compromise the wellbeing of older workers relative to younger ones, while some dimensions of HPWP lead to more favourable wellbeing outcomes for older workers relative to their younger counterparts (flexible working, performance-related pay and appraisal systems).Research limitations/implicationsAt older ages those still in the workforce may be over-represented by happier and psychologically more robust individuals who have settled into jobs they find fulfilling, matching their personal characteristics and abilities. If so, the adverse well-being influence of development-oriented strategies may be understated, while favourable well-being outcomes for older workers may be overstated.Practical implicationsHRM strategies may need to be more age sensitive to support the EWL agenda better.Originality/valueWhile many studies have examined the link between HPWP and a range of individual-level outcomes, less widely researched is whether responses vary by age, which the paper addresses.

Changes in the Activity Measure for Post-Acute Care Domains in Persons With Stroke During the First Year After Discharge From Inpatient Rehabilitation

ObjectiveTo describe functional changes after inpatient stroke rehabilitation using the Activity Measure for Post-Acute Care (AM-PAC), an assessment measure sensitive to change and with a low risk of ceiling effect. DesignRetrospective, longitudinal cohort study. SettingInpatient rehabilitation unit of an urban academic medical center. ParticipantsAmong 433 patients with stroke admitted from 2012-2016, a total of 269 (62%) were included in our database and 89 of 269 patients (33.1%) discharged from inpatient stroke rehabilitation had complete data. Patients with and without complete data were very similar. The group had a mean age of 68.0±14.2 years, National Institutes of Health Stroke Score of 8.0±8.0, and rehabilitation length of stay of 14.7±7.4 days, with 84% having an ischemic stroke and 22.5% having a recurrent stroke. InterventionNone. Main Outcome MeasuresChanges in function across the first year after discharge (DC) were measured in a variety of ways. Continuous mean scores for the basic mobility (BM), daily activity (DA), and applied cognitive domains of the AM-PAC were calculated at and compared between inpatient DC and 6 (6M) and 12 months (12M) post DC. Categorical changes among individuals were classified as “improved,” “unchanged,” or “declined” between the 3 time points based on the minimal detectable change, (estimated) minimal clinically important difference, and a change ≥1 AM-PAC functional stage (FS). ResultsFor the continuous analyses, the Friedman test was significant for all domains (P≤.002), with Wilcoxon signed-rank test significant for all domains from DC to 6M (all P<.001) but with no change in BM and DA between 6M and 12M (P>.60) and a decline in applied cognition (P=.002). Despite group improvements from DC to 6M, for categorical changes at an individual level 10%-20% declined and 50%-70% were unchanged. Despite insignificant group differences from 6M-12M, 15%-25% improved and 20%-30% declined in the BM and DA domains. ConclusionsDespite group gains from DC to 6M and an apparent “plateau” after 6M post stroke, there was substantial heterogeneity at an individual level. Our results underscore the need to consider individual-level outcomes when evaluating progress or outcomes in stroke rehabilitation.

Profiles of grief, post-traumatic stress, and post-traumatic growth among people bereaved due to COVID-19

ABSTRACT Background: COVID-19 deaths elevate the prevalence of prolonged grief and post-traumatic stress symptoms among the bereaved, yet few studies have examined potential positive outcomes. Moreover, how COVID-19 bereavement affects individual-level mental health outcomes is under-researched. Objective: This is the first study to use latent profile analysis (LPA) to identify heterogeneous profiles of prolonged grief, post-traumatic stress and post-traumatic growth among people bereaved due to COVID-19 and to identify predictors of latent class membership. Methods: Four hundred and twenty-two Chinese participants who were bereaved due to COVID-19 completed an online survey between September and October 2020. The survey included the International (ICD-11) Prolonged Grief Disorder Scale (IPGDS), the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5) and the Post-traumatic Growth Inventory (PTGI). LPA was run in Mplus, and the 3-step auxiliary approach was used to test the predicting effects of potential predictors of latent class membership identified with chi-square tests and ANOVAs. Results: Four latent profiles were identified: resilience (10.7%), growth (20.1%), moderate-combined (42.2%) and high-combined (27.0%). The bereaved who shared a close relationship with the deceased and identified COVID-19 as the fundamental cause of death were more likely to be in the high-combined group. A conflictful bereaved-deceased relationship reduces the chance of being in the growth group. Moreover, the death of a younger person and loss of a partner attributed to maladaptive outcomes. Conclusions: Serious attention needs to be paid to the mental health issues of people bereaved due to COVID-19 because nearly 70% of this group would have a moderate-combined or high-combined symptom profile. Special care should be given to those who lost someone younger, lost a partner or shared a close relationship with the deceased. Grief therapies that work on the conflicts between the deceased and the bereaved and unfinished business can be applied to facilitate growth.

Constructing internally consistent BMI Z-scores for adults and children to examine intra-household outcomes

The ultimate goal of development is to improve health and well-being at the individual level. Yet, survey data are routinely collected at the household level. To bridge this gap the existing literature has used various, not fully satisfactory direct and indirect methods to impute individual level outcomes from household data. This paper proposes a new direct statistical method that constructs BMI Z-scores for all ages. It develops age-gender specific Body Mass Index (BMI) growth curve distributions using generalized LMS estimations in a GAMLSS framework which allows flexible modelling of all parameters. These growth curve distributions are then used to construct BMI Z-scores that are consistent for children and adults and that can thus be used to examine individual-level well-being and intra-household allocation patterns. Compared to existing methods that estimate intra-household allocations, BMI Z-scores present several advantages. One, the BMI measures health outcomes rather than caloric or monetary health inputs. Two, it is easier to collect and is measured with less error. Three, the BMI Z-score methodology also enables a range of previously unmeasurable within-household comparisons and it opens up the use of existing sources of survey data to answer new research questions in health and development economics. An empirical example for Tanzania provides one simple application of the BMI Z-score method, showing how household-level measures significantly overestimate individual measures of well-being and health.

National Early Warning Scores And COVID-19 Deaths In Care Homes: An Ecological Time Series Study

Tracking COVID-19 infections in the care home population has been challenging, because of the limited availability of testing and varied disease presentation. We consider whether National Early Warning Scores (NEWS/NEWS2) could contribute to COVID-19 surveillance in care homes. We analysed NEWS measurements from care homes in England (December 2019 to May 2020). We estimated pre-COVID (baseline) levels for NEWS and NEWS components using 80th and 20th centile scores for measurements before March 2020. We used time-series to compare the proportion of above-baseline NEWS to area-matched reports of registered deaths in care home residents from the Office for National Statistics We analysed 29,656 anonymised NEWS from 6,464 people in 480 care home units across 46 local authority areas. From March 23rd to May 20th, there were 5,753 deaths (1,532 involving COVID-19, 4,221 other causes) in corresponding geographical areas. A rise in the proportion of above-baseline NEWS was observed from March 16th 2020. The proportion of above-baseline oxygen saturation, respiratory rate and temperature measurements also increased approximately two weeks before peaks in deaths. We conclude that NEWS could contribute to disease surveillance in care homes during the COVID-19 pandemic. Oxygen saturation, respiratory rate and temperature could be prioritised as they appear to signal rise in mortality almost as well as total NEWS. This study reinforces the need to collate data from care homes, to monitor and protect residents’ health. Further work using individual level outcome data is needed to evaluate the role of NEWS in the early detection of resident illness.

An alternative conceptualisation of coach expertise

ABSTRACT The coaching industry has grown to become a multi-billion dollar business, yet there remain few barriers to entry and an absence of national governing bodies. Wide variation in quality of practice undermines the credibility of a field that has been found to be effective (Grover, S., & Furnham, A. (2016). Coaching as a developmental intervention in organisations: A systematic review of its effectiveness and the mechanisms underlying it. PLoS One, 11(7), e0159137. https://doi.org/10.1371/journal.pone.0159137; Theeboom, T., Beersma, B., & van Vianen, A. E. (2014). Does coaching work? A meta-analysis on the effects of coaching on individual level outcomes in an organizational context. The Journal of Positive Psychology, 9(1), 1–18. https://doi.org/10.1080/17439760.2013.837499). Coaching stakeholders should therefore be motivated to understand what ‘good coaching’ looks like. However, it remains unclear what it means to be an outstanding, or expert, practitioner, or even whether the construct of expertise applies to the field of coaching. Within this paper, I critique literature that discusses coach expertise, and suggest the philosophical constraints embedded within current thinking imply the need for an alternative conceptualisation of expertise; adaptive expertise. Adaptive expertise is compatible with the complexity that characterises coaching, and prioritises coach decision-making (judgment and reasoning) over coaching outcomes. Many coaching texts largely ignore the construct of decision-making, with the exception of intuitive decision-making. Further research that seeks to understand coach judgment and decision-making will help coaches’ develop their practice, and may be a key to demystifying the central role of intuition in coaching.

Modeling the Joint Effect of Leader and Follower Authenticity on Work and Non-Work Outcomes

Recent theoretical and empirical work has developed the concept of authenticity, both as it relates to leader authenticity and as it relates to authenticity in followers. The present study examines perceptions of employee authenticity and perceived leader authenticity and highlights the utility of jointly examining the congruence between the two to predict individual-level outcomes. The present study utilized Qualtrics Panels to recruit three waves of survey participants. A total of 420 participants responded to all three time points. Polynomial regression, response surface modeling, and a block variable approach with indirect effects were used to test our hypotheses. Results supported the effect of authenticity congruence on individual-level work-related outcomes. Leader–member exchange was found to be a mediating variable between leader–follower authenticity congruence and outcomes in the work and non-work domains.

Employment Trends in Rhode Island From 2011 to 2017 for Adults With Intellectual Disability and Developmental Disabilities.

This study reports on state-level data in Rhode Island on employment and non-work activities of adults with intellectual and developmental disabilities receiving services between 2011 and 2017. The goal was to examine the complex patterns of change over time in individual-level employment outcomes and the potential short-term impacts of a consent decree entered into by the state of Rhode Island to address integrated employment outcomes. Findings suggest that policy initiatives such as the consent decree can lead to reductions in reliance on facility-based work, but also highlight the importance of planning for the transition to competitive, integrated employment and not simply a shift toward non-work activities. Further, the data support the notion that the best predictor of integrated employment over time is previous experiences in integrated employment (not facility-based or other work or non-work activities), suggesting the role of ongoing supported employment and transition services that create and support the maintenance of integrated employment.

Putting the Patient Back in Clinical Significance: Moderated Nonlinear Factor Analysis for Estimating Clinically Significant Change in Treatment for Posttraumatic Stress Disorder.

The present study introduced a modernized approach to Jacobson and Truax's (1991) methods of estimating treatment effects on individual-level (a) movement from the clinical to the normative range and (b) reliable change on posttraumatic stress disorder (PTSD) severity. Participants were 450 trauma-exposed women (M age = 39.2 years, SD = 8.9, range: 18-65 years) who presented to seven geographically diverse community mental health and substance use treatment centers. Data from 53 of these women, none of whom met the criteria for full or subthreshold PTSD, were used to establish the normative range. Using moderated nonlinear factor analysis (MNLFA) scale scoring, which weights symptoms by their clinical relevance, a significantly larger proportion of participants moved into the normative range for PTSD severity scores and/or exhibited reliable changes after treatment compared to the same individuals' movement when using symptom counts. Further, approximately 24% of the participants showed discrepant judgments on reliable change indices (RCI) between MNLFA scores and symptom counts, likely due to the false assumption that the standard error of measurement is equal for all levels of underlying PTSD severity when estimating RCIs with symptom counts. An MNLFA approach to estimating underlying PTSD severity can provide clinically meaningful information about individual-level change without the de facto assumption that PTSD symptoms have equivalent weight. Study implications are discussed with regard to a joint emphasis on (a) measurement models that highlight differential symptom weighting and (b) treatment-arm differences in individual-level outcomes rather than the current overemphasis of treatment-arm differences on group-averaged trajectories.

Seasonal Variation in Demand for Smoking Cessation Treatment and Clinical Outcomes.

Smoking behaviour shows seasonal variation, with cigarette consumption and youth smoking onset highest in summer and smoking-related web searches and sales of nicotine replacement products highest in winter. Variation in demand for clinical care and in outcomes has not been explored. We measure seasonal variation in enrolments, total clinical visits, visits per enrolment, and treatment outcome (7-day abstinence at 6-month follow-up) from 2015 to 2018 in a large (n = 85 869) clinical cohort from 454 clinics across Ontario, Canada. We model seasonality using harmonic logistic and negative binomial regression. For individual-level outcomes, we adjust for variables, selected a priori, known to be associated with treatment use or outcomes. Data are nearly complete for 3 outcomes, but 6m abstinence is missing for 45% of participants. We use multiple imputation to adjust for missing data. All four outcomes showed significant seasonal variation (all p <.001). Total enrolments and visits were 20%-25% higher in January-April than in June-September. Visits per enrolment varied slightly, with lowest levels from May-July. Abstinence at 6 months was lowest among individuals enrolled from February-May and highest for those enrolled from July-November, with an absolute peak-trough difference of 4.3% (95% CI = 3.2% to 5.5%). There is meaningful seasonal variation in demand for, and outcomes of, smoking cessation treatment. Climate and weather may be indirectly responsible. Seasonal differences underscore the general importance of contextual factors in smoking cessation, may be useful in program promotion, and may explain some variability in outcomes in evaluation and research. Demand for tobacco cessation treatment and clinical outcomes vary seasonally. This underscores the importance of context in substance-related problems, and implies that some variability in research and evaluation results may be due to the time of year data were collected. Promotion efforts might usefully consider seasonal effects to smooth out demand and possibly improve outcomes.

Medical Marijuana Laws, Marijuana Use, and Opioid-Related Outcomes among Women in the United States.

In the context of the opioid epidemic, a limited but growing body of literature has found state medical marijuana laws (MMLs) to be associated with lower levels of opioid prescribing. However, robust evidence linking state MMLs with individual-level opioid-related outcomes is lacking, particularly among women. This finding is especially true for pregnant and parenting women, who have been disproportionately affected by the opioid crisis. Using data drawn from the 2002-2014 National Survey on Drug Use and Heath, the study uses a difference-in-differences estimation strategy to compare opioid-related outcomes (opioid misuse initiation, opioid misuse in the past month and past year, and opioid use disorder) among all women, pregnant women, and parenting women in states with and without MMLs (before and after implementation). The study also investigates the impact of MMLs on marijuana use and marijuana use disorder. The findings indicate that MMLs were not associated with opioid misuse, opioid misuse initiation, or opioid use disorder among all women, pregnant women, and parenting women. These laws were, however, positively correlated with marijuana use and marijuana use disorder among all women and women with children. In addition, MMLs were associated with an increase in the frequency of opioid misuse for pregnant women and a decrease in the frequency of opioid misuse for parenting women. This finding suggests that, although medical marijuana may be viewed by some as a substitute for opioid analgesics, MMLs may not be an effective policy tool to tackle the opioid epidemic among women, especially pregnant and parenting women.

How do extremely high temperatures affect labor market performance? Evidence from rural China

To improve understanding of the labor market implications of climate change, this paper investigates how heat extremes affect individual-level labor market outcomes in rural China. By exploiting daily weather and household survey data during the period 1989–2011, we find that extremely high temperatures significantly reduce rural laborers’ working hours and wages but have no statistically significant effect on their employment status. In addition, the adverse effects of extremely high temperatures on the service sector and on female workers could be long-lasting. To attenuate the detrimental effects of temperature shocks, rural laborers may perform adjustment behaviors to reduce direct exposure to high-temperature working environments, including leaving agricultural primary occupations and engaging in non-agricultural secondary occupations.

A REVIEW OF PERSON-ORGANIZATIONAL CONGRUENCE AND OUTCOME VARIABLES

The accessible writing is occupied with affirmation proposing the necessity for picking and utilizing proper individuals for the organization's, likewise as reporting the significance of congruence among people at workplaces with the organization and making this relationship among the duo stronger for the general accomplishment of the great number of objectives of the organization and all the stakeholders associated directly or indirectly with the organizations. Likewise, researchers, experts and practitioners in the field of organizational behaviour and its allied fields across the globe have demonstrated and proved a lot of enthusiasm in examining the domain of person-organizational congruence in relation to several individual level organizational level outcomes like, organizational commitment, work satisfaction, organizational citizenship behaviour, work performance, turnover intention and intention to stay. Research’s that have been carried out as of now on person-organizational congruence and its relationship with several individual level and organizational level outcomes were limited in context to the Indian settings and growing number of studies advised a need to further investigate person-organizational congruence and its relationship with individual and organizational level outcomes. In light of this developing essentialness associated to the phenomenon of person-organizational congruence domain the present examination is as such a modest undertaking toward this way. KEY WORDS: person-organizational congruence, organizational outcome variables, individual outcome variables

The roles of gender affirmation and discrimination in the resilience of transgender individuals

Abstract Background Transgender individuals face severe stigma-driven health inequities structurally, institutionally and interpersonally, yielding poor individual-level outcomes. Gender affirmation, or being recognized based on one's gender identity, expression and/or role, may be considered a manifestation of resilience. Methods To provide intervention and policy guidelines, we examined latent constructs representative of gender affirmation (legal documentation changes, transition-related medical procedures, familial support) and discrimination (unequal treatment, harassment, and attacks), and tested their impact on mental, physical, and behavioral health outcomes among 17,188 binary-identified transgender participants in the 2015 US Transgender Survey. Results Confirmatory factor analyses revealed high standardized factor loadings for both latent variables, on which we regressed outcomes using structural equation modeling. Fit indices suggested good model fit. Affirmation was associated with lower odds of suicidal ideation (p &amp;lt; .001) and psychological distress (p &amp;lt; .001), and higher odds of substance use (p &amp;lt; .001), and past-year healthcare use and HIV-testing (p &amp;lt; .001). Discrimination was associated with higher odds of suicidal ideation (p &amp;lt; .001), psychological distress (p &amp;lt; .001), substance use (p &amp;lt; .001), and past-year HIV-testing (p &amp;lt; .001). Affirmation and discrimination interaction analyses showed lower odds of past-year suicidal ideation (p &amp;lt; .01), with affirmation having a significant moderating protective effect against discrimination. Conclusions Gender affirmation is paramount in upholding transgender health, and these findings carry global significance, beyond the US. Clarification of affirmation procedures, and increases in its accessibility, equitably across racial/ethnic groups, should become a priority, from policy to the family unit. The impact of discrimination demands continued advocacy via education and policy.

Negative outcomes of ICT use at work: meta-analytic evidence and the role of job autonomy

PurposeIndividuals can improve their task performance by using information and communications technology (ICT). However, individuals who use ICT may also suffer from negative outcomes, such as burnout and anxiety, which lead to poorer performance and well-being. While researchers have studied the positive outcomes of ICT use in the aggregate, the same has not been done for negative outcomes.Design/methodology/approachThis study uses a meta-analysis of 52 studies to examine the relationship between ICT use and negative outcomes, and the influence of job autonomy on ICT use and the negative outcomes of ICT use. Job autonomy is relevant because a higher level of job autonomy allows individuals to decide how, how often and when they will use ICT that is causing negative outcomes for their work.FindingsThe results of the meta-analysis revealed that ICT use increased negative job outcomes and that, unexpectedly, autonomy exacerbated this effect.Research limitations/implicationsThe results of this study point to the prevalence of negative outcomes from ICT use among individuals. Researchers should study how users may potentially restrict the value that organizations may be able to obtain from the implementation of new systems, especially whether individual-level negative outcomes could coalesce into a collective resistance. There also needs to be further research into the motivating and inhibiting roles of autonomy in enhancing ICT use, while mitigating its negative impacts simultaneously.Originality/valueThe study provides an aggregate analysis of the negative impacts of ICT use among individuals and the role of autonomy in the relationship.

Twitter-Derived Social Neighborhood Characteristics and Individual-Level Cardiometabolic Outcomes: Cross-Sectional Study in a Nationally Representative Sample.

BackgroundSocial media platforms such as Twitter can serve as a potential data source for public health research to characterize the social neighborhood environment. Few studies have linked Twitter-derived characteristics to individual-level health outcomes.ObjectiveThis study aims to assess the association between Twitter-derived social neighborhood characteristics, including happiness, food, and physical activity mentions, with individual cardiometabolic outcomes using a nationally representative sample.MethodsWe collected a random 1% of the geotagged tweets from April 2015 to March 2016 using Twitter’s Streaming Application Interface (API). Twitter-derived zip code characteristics on happiness, food, and physical activity were merged to individual outcomes from restricted-use National Health and Nutrition Examination Survey (NHANES) with residential zip codes. Separate regression analyses were performed for each of the neighborhood characteristics using NHANES 2011-2016 and 2007-2016.ResultsIndividuals living in the zip codes with the two highest tertiles of happy tweets reported BMI of 0.65 (95% CI –1.10 to –0.20) and 0.85 kg/m2 (95% CI –1.48 to –0.21) lower than those living in zip codes with the lowest frequency of happy tweets. Happy tweets were also associated with a 6%-8% lower prevalence of hypertension. A higher prevalence of healthy food tweets was linked with an 11% (95% CI 2% to 21%) lower prevalence of obesity. Those living in areas with the highest and medium tertiles of physical activity tweets were associated with a lower prevalence of hypertension by 10% (95% CI 4% to 15%) and 8% (95% CI 2% to 14%), respectively.ConclusionsTwitter-derived social neighborhood characteristics were associated with individual-level obesity and hypertension in a nationally representative sample of US adults. Twitter data could be used for capturing neighborhood sociocultural influences on chronic conditions and may be used as a platform for chronic outcomes prevention.

The Roles of Gender Affirmation and Discrimination in the Resilience of Transgender Individuals in the US

Transgender individuals face severe stigma-driven health inequities structurally, institutionally, and interpersonally, yielding poor individual-level outcomes. Gender affirmation, or being recognized based on one’s gender identity, expression, and/or role, may be considered a manifestation of resilience. To provide intervention and policy guidelines, we examined latent constructs representative of gender affirmation (legal documentation changes, transition-related medical procedures, familial support) and discrimination (unequal treatment, harassment, and attacks), and tested their impact on mental, physical, and behavioral health outcomes among 17,188 binary-identified transgender participants in the 2015 US Transgender Survey. Confirmatory factor analyses revealed high standardized factor loadings for both latent variables, on which we regressed outcomes using structural equation modeling. Fit indices suggested good model fit. Affirmation was associated with lower odds of suicidal ideation and psychological distress, and higher odds of substance use, and past-year healthcare use and HIV-testing. Discrimination was associated with higher odds of suicidal ideation, psychological distress, substance use, and past-year HIV-testing. Affirmation and discrimination interaction analyses showed lower odds of past-year suicidal ideation, with affirmation having a significant moderating protective effect against discrimination. Gender affirmation is paramount in upholding transgender health. Clarification of affirmation procedures, and increases in its accessibility, equitably across racial/ethnic groups, should become a priority, from policy to the family unit. The impact of discrimination demands continued advocacy via education and policy.