Salient Risk Research Articles

Testing an integrated dimensional model of adverse childhood experiences: Associations with COVID-19 outcomes

BackgroundAdverse childhood experiences (ACEs) are a salient risk factor for a myriad of negative outcomes. Extant theoretical and empirical models traditionally quantify the impact of ACEs using cumulative representations. Recent conceptualizations challenge this framework and theorize that the types of ACEs children are exposed to differentially impacts their future functioning. ObjectiveThe current study tested an integrated ACEs model using parent-report of child ACEs across four aims: (1) characterize heterogeneity in child ACEs using a latent class analysis (LCA); (2) examine mean level class differences in COVID specific and COVID non-specific environmental factors (i.e., COVID impact, ineffective parenting, effective parenting) and internalizing and externalizing problems during the COVID pandemic; (3) test interactions between COVID impact and ACEs classes in predicting outcomes, and (4) compare a cumulative risk approach to a class membership approach. Participants and settingA nationally representative sample of U.S. parents (N = 796; 51.8 % fathers, M age = 38.87 years, 60.3 % Non-Hispanic White) completed a cross-sectional survey about themselves and one child (5–16 years old) between February–April 2021. MethodMeasures of child's ACEs history, COVID impact, effective and ineffective parenting, and children's internalizing and externalizing problems were completed by parents. ResultsA LCA demonstrated three distinct classes of ACEs reflecting low-risk, trauma-risk, and environmental-risk classes. In general, the trauma-risk class had more negative COVID-19 outcomes than the other classes (small to large effect sizes). ConclusionsThe classes differentially related to outcomes, providing support for dimensions of ACEs and emphasizing the distinct types of ACEs.

A qualitative study of alcohol use disorder psychotherapies for transgender and nonbinary individuals: Opportunities for cultural adaptation

BackgroundTransgender and nonbinary (TGNB) populations experience high rates of hazardous drinking (HD) and alcohol use disorder (AUD) as well as unique treatment barriers. This is due, in-part, to discrimination and stigma within and outside of the healthcare system. Cultural adaptation of clinical interventions can improve outcomes for marginalized populations, but no such adapted interventions exist for AUD among TGNB individuals. This study sought to understand how TGNB individuals perceive currently available AUD psychotherapies and to generate knowledge about potential areas for cultural adaptation. MethodsAs part of a qualitative study of HD among TGNB individuals (N=27), participants were asked to imagine that they were clients in psychotherapy vignettes corresponding to cognitive behavioral therapy, motivational enhancement therapy, and twelve step facilitation. Interviews were audio-recorded and professionally transcribed. A coding team used an iterative codebook to guide coding. Categories emerged from this process that reflected participants’ perceptions and allowed for the identification of potential cultural-adaptation targets. ResultsAcross all three psychotherapies, participants wanted therapists to explicitly discuss gender identity and culturally salient HD risk factors for TGNB individuals (e.g., discrimination, stigma, gender dysphoria). There were also modality-specific recommendations to incorporate principles of trauma-informed care into cognitive behavioral therapy, avoid motivational enhancement therapy exercises that oversimplify decision-making, and recognize that the twelve-step-facilitation concept of “powerlessness” may conflict with how many TGNB people see themselves. ConclusionsThese findings highlight areas for cultural adaptation that can be evaluated in future intervention trials in an effort to improve psychotherapy acceptability and efficacy for TGNB individuals.

Public response to government alerts saves lives during Russian invasion of Ukraine

War is the cause of tremendous human suffering. To reduce such harm, governments have developed tools to alert civilians of imminent threats. Whether these systems are effective remains largely unknown. We study the introduction of an innovative smartphone application that notifies civilians of impending military operations developed in coordination with the Ukrainian government after the Russian invasion. We leverage quasi-experimental variation in the timing of more than 3,000 alerts to study civilian sheltering behavior, using high-frequency geolocation pings tied to 17 million mobile devices, 60% of the connected population in Ukraine. We find that, overall, civilians respond sharply to alerts, quickly seeking shelter. These rapid postalert changes in population movement attenuate over time, however, in a manner that cannot be explained by adaptive sheltering behavior or calibration to the signal quality of alerts. Responsiveness is weakest when civilians have been living under an extended state of emergency, consistent with the presence of an alert fatigue effect. Our results suggest that 35 to 45% of observed civilian casualties were avoided because of public responsiveness to the messaging system. Importantly, an additional 8 to 15% of civilian casualties observed during the later periods of the conflict could have been avoided with sustained public responsiveness to government alerts. We provide evidence that increasing civilians' risk salience through targeted government messaging can increase responsiveness, suggesting a potential policy lever for sustaining public engagement during prolonged episodes of conflict.

Development and validation of a screening questionnaire for early identification of pregnant women at risk for excessive gestational weight gain

BackgroundExcessive weight gain during pregnancy is associated with adverse health outcomes for mother and child. Intervention strategies to prevent excessive gestational weight gain (GWG) should consider women’s individual risk profile, however, no tool exists for identifying women at risk at an early stage. The aim of the present study was to develop and validate a screening questionnaire based on early risk factors for excessive GWG.MethodsThe cohort from the German “Gesund leben in der Schwangerschaft”/ “healthy living in pregnancy” (GeliS) trial was used to derive a risk score predicting excessive GWG. Sociodemographics, anthropometrics, smoking behaviour and mental health status were collected before week 12th of gestation. GWG was calculated using the last and the first weight measured during routine antenatal care. The data were randomly split into development and validation datasets with an 80:20 ratio. Using the development dataset, a multivariate logistic regression model with stepwise backward elimination was performed to identify salient risk factors associated with excessive GWG. The β coefficients of the variables were translated into a score. The risk score was validated by an internal cross-validation and externally with data from the FeLIPO study (GeliS pilot study). The area under the receiver operating characteristic curve (AUC ROC) was used to estimate the predictive power of the score.Results1790 women were included in the analysis, of whom 45.6% showed excessive GWG. High pre-pregnancy body mass index, intermediate educational level, being born in a foreign country, primiparity, smoking, and signs of depressive disorder were associated with the risk of excessive GWG and included in the screening questionnaire. The developed score varied from 0–15 and divided the women´s risk for excessive GWG into low (0–5), moderate (6–10) and high (11–15). The cross-validation and the external validation yielded a moderate predictive power with an AUC of 0.709 and 0.738, respectively.ConclusionsOur screening questionnaire is a simple and valid tool to identify pregnant women at risk for excessive GWG at an early stage. It could be used in routine care to provide targeted primary prevention measures to women at particular risk to gain excessive gestational weight.Trial registrationNCT01958307, ClinicalTrials.gov, retrospectively registered 9 October 2013.

Climate change and commercial real estate: Evidence from Hurricane Sandy

AbstractWe study how professional investors capitalize flood risk in commercial real estate (CRE) markets after hurricane Sandy. We show that New York CRE exposed to flood risk trades at a large, persistent discount. CRE in Boston, which mostly escaped direct hurricane‐related damage, also exhibits persistent price penalties. These price effects are driven by asset‐level capitalization rates, not building occupancy. Results from a placebo test using real estate prices in Chicago show that our inferences are not driven by coincidental, unrelated price trends for waterfront real estate assets. Our results are consistent with professional investors responding to a persistent shift in the salience of flood risk post‐Sandy, even in locations spared by the disaster.

Personal and Professional Mitigation Behavioral Intentions of Agricultural Experts to Address Climate Change

Mitigation activities, whether at the personal level relating to lifestyle or on the professional level, especially in the agriculture sector, are widely encouraged by scientists and policymakers. This research empirically analyses the association between agricultural experts’ perceptions about climate change and their intention to implement climate change mitigation. Based on survey data, individuals’ reported intention to implement personal and professional mitigation behavior is explained using a conceptual model. The structural equation modeling results suggest that the new ecological paradigm (NEP), institutional trust, and risk salience indirectly influence climate change mitigation intentions. The findings indicate that risk perception, personal efficacy, responsibility, belief in climate change occurring, and low psychological distance trigger a significantly greater intention to support personal and professional mitigation behaviors. However, the research framework is much stronger at predicting the intention to mitigate climate change in professional affairs compared to personal activities. The findings suggest that hypothetical distance factors only have a moderating effect on the relationship between higher climate change environmental values, institutional trust, risk salience, and mitigation intention. This paper analytically explores the regulating role of risk perception, hypothetical distance, personal efficacy, and responsibility between institutional trust, risk salience, and the NEP as independent concepts and intention to personal and professional mitigation behaviors as dependent variables. The findings of the study have important implications for encouraging personal and professional mitigation behaviors.

Experts Discuss ‘Alarming’ Disparities in AUD Treatment Access

Back to table of contents Previous article Next article APA & MeetingsFull AccessExperts Discuss ‘Alarming’ Disparities in AUD Treatment AccessKatie O'ConnorKatie O'ConnorSearch for more papers by this authorPublished Online:28 Mar 2023https://doi.org/10.1176/appi.pn.2023.04.3.17AbstractWomen are less likely than men to obtain treatment for alcohol use disorder, and this disparity is further exacerbated by race and ethnicity. Experts will discuss the latest research around this problem and highlight treatment programs that show promise in meeting the needs of women from diverse communities.Compared with men, women are less likely to obtain treatment for alcohol use disorder (AUD), more likely to present with comorbid conditions, and more likely to remain in treatment for shorter durations. These disparities are even starker for Black, American Indian/Alaska Native, and Latina American women.There is sometimes a sense of shame among women from racial and ethnic minoritized backgrounds with alcohol use disorder, as they want to be viewed as strong and that they don’t need help, said Ayana Jordan, M.D., Ph.D.“[B]y some estimates, both Black and Latina women have approximately one-quarter the odds of obtaining alcohol [treatment] services as White women, yet population-level efforts to address these disparities are lacking,” said Deidra Roach, M.D., medical project officer for the National Institute on Alcohol Abuse and Alcoholism. Roach manages research portfolios addressing the treatment of HIV/AIDS and harmful drinking, AUD and co-occurring mental and other medical disorders, harmful drinking among women, and fetal alcohol spectrum disorders.Roach will chair a session at APA’s 2023 Annual Meeting titled “Overcoming Disparities in Alcohol Treatment Among BIPOC Women.” She and her fellow speakers will address the challenges in accessing treatment, as well as opportunities to expand treatment access for Black, Hispanic American, and American Indian/Alaska Native women.“Historically, the substance use literature has primarily focused on treatment trends and outcomes among men, with little attention to gender differences, and even less attention to women with SUD from racial and ethnic minoritized backgrounds,” explained Ayana Jordan, M.D., Ph.D., one of the session presenters. Jordan is the Barbara Wilson Associate Professor of Psychiatry in the Department of Psychiatry and an associate professor in the Department of Population Health at the NYU Grossman School of Medicine.“Research has also found that women progress more rapidly in their severity and quantity of use and are less likely to enter treatment over their lifetimes compared with men,” Jordan said. “When women do decide to enter treatment, it is likely to be for a mental health difficulty and not substance use.”The speakers will review findings from the latest research on the prevalence of and trends in problem drinking among American Indian/Alaska Native, Black, and Latina American women. They will also discuss some of the most salient risk factors for problem drinking among these groups. Further, the speakers will highlight promising treatment options.“Stigma poses a very serious barrier to treatment for alcohol use disorder in BIPOC women, who regularly contend with discrimination in health care and other sectors of society based on intersecting identities of gender, race, and socioeconomic status,” Roach said. “Women often avoid reporting their problems with substance use to health care providers because they fear being labeled and poorly treated by providers and/or reported to legal authorities with the ability to remove their children from the home or to otherwise punish them and their families.” ■ ISSUES NewArchived

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The co-occurrence of potentially traumatic events (PTEs) and their associations with posttraumatic stress disorder (PTSD) in Indian and Malaysian adolescents

BackgroundAlthough it is well-established that people can experience multiple traumatic events, there are few studies examining the co-occurrence of such experiences in non-Western nations. The current study sought to examine the occurrence of multiple potentially traumatic experiences (PTEs) and their associations with posttraumatic stress disorder (PTSD) among adolescents from two Asian nations. MethodsLatent class analysis (LCA) was employed to model the co-occurrence of PTEs in two school samples of adolescents from India (n = 411) and Malaysia (n = 469). Demographic correlates (i.e., sex, age, household composition, parent education) of the latent classes and the association between latent class membership and probable diagnosis of posttraumatic stress disorder (PTSD) were examined. ResultsThe LCA identified three latent classes for the Indian sample: ‘Low Risk – moderate sexual trauma’, ‘Moderate Risk’, and ‘High Risk’. Similarly, three classes were also identified for the Malaysian sample: ‘Low Risk’, ‘Moderate Risk’, and ‘High Risk’. Membership of ‘Moderate Risk’ was associated with male sex in both samples, and with older age and lower levels of parental education attainment in the Malaysian sample. No correlates of ‘High Risk’ class were identified in either sample. Membership of the ‘High Risk’ class was significantly associated with probable PTSD diagnosis in both samples, while membership of the ‘Moderate Risk’ class was associated with probable PTSD diagnosis in the Malaysian sample. ConclusionFindings from this study correspond with Western studies indicating co-occurrence of PTEs to be common and to represent a salient risk factor for the development of PTSD.

Adolescents’ coping and internalizing symptoms: Role of maternal socialization of coping and depression symptoms

Parental emotion socialization, including processes of the socialization of coping and emotion regulation, is a key factor in shaping children's adjustment in response to acute and chronic stress. Given well-established links between parental depression and youth psychopathology, levels of parental depression symptoms are an important factor for understanding emotion socialization and regulation processes. The present study examined associations among maternal coping and depression symptoms with their adolescents’ coping and internalizing problems. A sample of 120 adolescents (45% female, M = 12.27, SD = 1.90) and their mothers participated in a cross-sectional, multi-informant study. Mothers’ depression symptoms and adolescents’ coping were significantly related to adolescents’ internalizing problems. Adolescents’ coping moderated the association between maternal depression symptoms and adolescents’ internalizing problems, where at low and moderate levels of primary control coping, maternal depression predicted greater internalizing symptoms in adolescents. Further, this study expanded on prior work, demonstrating that the relationship between adolescents’ coping and internalizing symptoms was associated with the degree to which mothers model coping. Taken together, results suggest that maternal coping and adolescent coping serve as salient risk and protective factors in the context of family stress. Findings emphasize a need for researchers to further clarify the role of emotion socialization processes in adolescents’ development of coping in the context of family stress.

Life Expectancy and Built Environments in the U.S.: A Multilevel Analysis

The purpose of this study is to examine the associations between built environments and life expectancy across a gradient of urbanicity in the U.S. Census tract‒level estimates of life expectancy between 2010 and 2015, except for Maine and Wisconsin, from the U.S. Small-Area Life Expectancy Estimates Project were analyzed in 2022. Tract-level measures of the built environment included: food, alcohol, and tobacco outlets; walkability; park and green space; housing characteristics; and air pollution. Multilevel linear models for each of the 4 urbanicity types were fitted to evaluate the associations, adjusting for population and social characteristics. Old housing (built before 1979) and air pollution were important built environment predictors of life expectancy disparities across all gradients of urbanicity. Convenience stores were negatively associated with life expectancy in all urbanicity types. Healthy food options were a positive predictor of life expectancy only in high-density urban areas. Park accessibility was associated with increased life expectancy in all areas, except rural areas. Green space in neighborhoods was positively associated with life expectancy in urban areas but showed an opposite association in rural areas. After adjusting for key social characteristics, several built environment characteristics were salient risk factors for decreased life expectancy in the U.S., with some measures showing differential effects by urbanicity. Planning and policy efforts should be tailored to local contexts.

Exposure to Doxorubicin Modulates the Cardiac Response to Isoproterenol in Male and Female Mice.

Sex is a salient risk factor in the development of doxorubicin-induced cardiotoxicity. Sex differences in the heart's ability to respond to hypertrophic stimuli in doxorubicin-exposed animals have not been reported. We identified the sexual dimorphic effects of isoproterenol in mice pre-exposed to doxorubicin. Male and female intact or gonadectomized C57BL/6N mice underwent five weekly intraperitoneal injections of 4 mg/kg doxorubicin followed by a five-week recovery period. Fourteen days of subcutaneous isoproterenol injections (10 mg/kg/day) were administered after the recovery period. Echocardiography was used to assess heart function one and five weeks after the last doxorubicin injection and on the fourteenth day of isoproterenol treatment. Thereafter, mice were euthanized, and the hearts were weighed and processed for histopathology and gene expression analysis. Doxorubicin did not produce overt cardiac dysfunction in male or female mice before starting isoproterenol treatment. The chronotropic response to a single isoproterenol injection was blunted by doxorubicin, but the inotropic response was maintained in both males and females. Pre-exposure to doxorubicin caused cardiac atrophy in both control and isoproterenol-treated male mice but not in female mice. Counterintuitively, pre-exposure to doxorubicin abrogated isoproterenol-induced cardiac fibrosis. However, there were no sex differences in the expression of markers of pathological hypertrophy, fibrosis, or inflammation. Gonadectomy did not reverse the sexually dimorphic effects of doxorubicin. Additionally, pre-exposure to doxorubicin abrogated the hypertrophic response to isoproterenol in castrated male mice but not in ovariectomized female mice. Therefore, pre-exposure to doxorubicin caused male-specific cardiac atrophy that persisted after isoproterenol treatment, which could not be prevented by gonadectomy.

The role of discrimination and adverse childhood experiences in disordered eating

BackgroundIn clinical research, there has been a call to move beyond individual psychosocial factors towards identifying cultural and social factors that inform mental health. Similar calls have been made in the eating disorders (ED) field underscoring the need to understand larger sociocultural influences on EDs. Discrimination is a social stressor that may influence mental health in similar ways to traumatic or adverse childhood experiences (ACEs). Given the high rates of EDs and discrimination among marginalized groups, it is vital to understand the role of discrimination and ACEs as predictors of ED symptoms in these populations. The aim of this study is to examine how perceived discrimination predicts ED pathology when statistically adjusting for gender, race, and ACEs.MethodsThe diverse study sample consisted of 331 undergraduate students from a longitudinal cohort study (ages 18–24; 66% female; 35% White/non-Hispanic). Participants completed measures of everyday discrimination, ACEs, and ED pathology.ResultsFollowing adjustment for multiple statistical comparisons, the frequency of daily discrimination predicted all ED symptoms above and beyond history of ACEs. In follow-up analyses, number of reasons for discrimination predicted cognitive restraint and purging. Differences in ED symptomatology were found based on the reason for discrimination, gender, and race. Specifically, those who experienced weight discrimination endorsed higher scores on all ED symptoms, and those experiencing gender discrimination endorsed higher body dissatisfaction, cognitive restraint, and restriction. People of color endorsed higher restriction, while female participants endorsed higher scores on all ED symptom with the exception of cognitive restraint.ConclusionDiscrimination is a salient risk factor for ED symptoms even when accounting for individuals’ history of ACEs. Future research should utilize an intersectional approach to examine how perceived discrimination affects ED pathology over time. (Word count: 234).

An exploratory study of salient family risk factors in relation to preschoolers’ unintentional injury in northwest China

Unintentional injury among Chinese preschoolers is an under-researched area. This study examined four salient risk factors underlying unintentional injury; these risk factors have been studied in samples of older children, but not preschoolers, in China. In light of an ecological systems theory, these factors can be conceptualized as three microsystem characteristics (only child status, main caregivers, and family mobility) and one mesosystem characteristic (residential area). We tested the hypotheses that only child status, having caregivers other than two parents, family mobility, and rural residential area would be associated with increased risk for unintentional injury in preschoolers. Caregivers of 217 preschoolers in northwest China completed a questionnaire on their family characteristics and their children’s injury status over the last year. Age, gender, and family SES were controlled for in the analyses. Logistic regression showed that urban children and those in high mobility families were more than twice as likely to have unintentional injuries than rural children and those in low mobility families. Tests of moderation showed that being in a high mobility family, and being cared for by other than two parents, each increased the injury risk for rural preschoolers. The results are discussed in terms of the importance of studying the micro- and mesosystems of preschoolers in the context of China’s rapid economic growth, as well as the importance of designing research-based prevention programs to reduce preschoolers’ risk of unintentional injury.

Practical Considerations for Using the Eating Disorder Examination Interview with Adolescents.

Approximately 35 years after its initial publication, the Eating Disorder Examination (EDE) remains one of the most widely used semi-structured interviews for assessing eating disorder diagnoses and symptomatology. Although the interview provides certain advantages over other common measurement approaches (ie, questionnaires), there are particular considerations regarding the EDE that warrant attention, including in its use with adolescents. The aims of this paper are therefore to: 1) provide a brief overview of the interview itself, as well as a description of its origin and underlying conceptual framework; 2) describe relevant factors for administering the interview with adolescents; 3) review potential limitations regarding use of the EDE with adolescents; 4) address considerations for using the EDE with pertinent subpopulations of adolescents who may experience distinct eating disorder symptoms and/or risk factors; and 5) discuss the integration of self-report questionnaires with the EDE. Advantages of using the EDE include the ability for interviewers to clarify complex concepts and mitigate inattentive responding, enhanced orientation to the interview timeframe to improve recall, increased diagnostic accuracy compared to questionnaires, and accounting for potentially salient external factors (eg, food/eating rules imposed by a parent/guardian). Limitations include more extensive training requirements, greater assessment burden, variable psychometric performance across subgroups, lack of items evaluating muscularity-oriented symptoms and avoidant/restrictive food intake disorder diagnostic criteria, and lack of explicit consideration for salient risk factors other than weight and shape concerns (eg, food insecurity).

Depression and Suicidal Behavior Comorbidity in Patients Admitted to Substance-Use Residential Treatment in Aguascalientes, Mexico

ABSTRACT Purpose Epidemiological studies show that depressive and substance use disorders are salient risk factors for suicidal behavior. In residential centers in Mexico City, 75.72% of the patients are diagnosed with comorbidity of substance use and psychiatric disorders; however, the specific prevalence of depression and suicidal behavior in this population has not been reported. This study aims to inform the comorbidity of depression and suicidal behavior in crystal users in residential centers in the state of Aguascalientes, Mexico. Method A brief survey was applied to measure substance use patterns, suicidal behavior, and depression symptoms using the Depression Scale of the Center of Epidemiological Studies (CES-D-R). The sample included 343 participants. Results The results show that of the 23.3% of participants who reported depressive symptoms, 65% showed suicidal ideation, 46% suicide planning, and 43% suicidal attempt. Discussions These results show the importance of implementing components that address depression and suicidal behavior in interventions for substance use. Conclusions Currently, no specialized interventions are developed to treat substance use disorders with crystal methamphetamine and, at the same time, treat others mental problems like depression and suicidal behavior. We conclude that the development of this intervention is necessary and urgent.

Do non-damaging earthquakes shake mortgage lenders' risk perception?

This study examines how banks respond to earthquakes that convey seismic risk salience but do not cause damage, i.e., noticeable non-damaging earthquakes (NNDEs). Using evidence from California, we find loans more likely to be denied or sold after increased NNDEs. Banks with fewer assets, more diversified branching markets, or stronger sales capability relied more on securitization to transfer the perceived seismic risk. We show evidence that banks likely learned about the NNDEs through personal experience and local news. The effects of NNDEs persisted up to three years. Meanwhile, the NNDEs only caused moderate and temporary collateral devaluation but did not increase the observable default risk. Thus, banks' responses most likely resulted from the increased risk salience of future damaging earthquakes during the mortgage term. Our findings call for reevaluations of the heuristics in banks' risk-perception updating and have implications for designing more efficient disaster risk-sharing mechanisms in the financial market.

PREDICTORS OF DEPRESSION AMONG MIDDLE-AGED AND OLDER MEN AND WOMEN IN EUROPE: A MACHINE LEARNING APPROACH

Abstract The high prevalence of depression in a growing aging population represents a critical public health issue. It is unclear how social, health, cognitive, and functional variables rank as risk/protective factors for depression among older adults and whether there are conspicuous differences among men and women. We utilized random forest analysis (RFA), a machine learning method, to compare 56 risk/protective factors for depression in a large representative sample of European older adults (N = 67,603; ages 45-105y; 56.1% women; 18 countries represented) from the Survey of Health, Ageing and Retirement in Europe (SHARE Wave 6). Self-rated social isolation and self-rated poor health were the most salient risk factors, jointly accounting for 22.0% (in men) and 22.3% (in women) of variability in depression. Difficulties in mobility (in both sexes), difficulties in instrumental activities of daily living (in men), and higher self-rated family burden (in women) accounted for an additional but small percentage of variance in depression risk (2.2% in men, 1.5% in women). To our knowledge, this is the first large, multi-country study to use machine learning to compare a broad range of social, health, functional, and cognitive variables as concurrent risk/protective factors for depression in middle-aged and older adults—and with analyses conducted independently for women and men. The results point to the importance of screening for depression risk within this age demographic during routine medical visits (i.e., when assessing general health status) and further indicate that such screening may be improved by inclusion of measures of perceived social isolation.

Factors Associated With Neuromusculoskeletal Injury and Disability in Navy and Marine Corps Personnel.

Neuromusculoskeletal injuries (NMSKI) are very common in the military, which contribute to short- and long-term disability. Population-level NMSKI, limited duty (LIMDU), and long-term disability episode counts in the U.S. Navy (USN) and U.S. Marine Corps (USMC) from December 2016 to August 2021 were extracted from the Musculoskeletal Naval Epidemiological Surveillance Tool. The incidence of NMSKI, LIMDU, and long-term disability was calculated. A hurdle negative binomial regression evaluated the association of body region, sex, age, rank, age by rank, and service branch on NMSKI, LIMDU, and long-term disability incidence. From December 2016 to August 2021, there were 2,004,196 NMSKI episodes (USN: 3,285/1,000 Sailors; USMC: 4,418/1,000 Marines), 16,791 LIMDU episodes (USN: 32/1,000 Sailors; USMC: 29/1,000 Marines), and 2,783 long-term disability episodes (USN: 5/1,000 Sailors; USMC: 5/1,000 Marines). There was a large-magnitude protective effect on NMSKI during the pandemic (relative risk, USN: 0.70; USMC: 0.75). Low back and ankle-foot were the most common, primarily affecting female personnel, aged 25-44 years, senior enlisted, in the USMC. Shoulder, arm, pelvis-hip, and knee conditions had the greatest rates of disability, with female sex, enlisted ranks, aged 18-24 years, and service in the USMC having the most salient risk factors. Body region, sex, age, rank, and branch were the salient factors for NMSKI. The significant protective effect during the pandemic was likely a function of reduced physical exposure and limited access to nonurgent care. Geographically accessible specialized care, aligned with communities with the greatest risk, is needed for timely NMSKI prevention, assessment, and treatment.

Cumulative loneliness and subsequent memory function and rate of decline among adults aged ≥50 in the United States, 1996‐2016

AbstractBackgroundTo investigate the association between the cumulative duration of loneliness and subsequent memory function and rate of decline over a 20‐year period in middle aged and older adults.MethodData were from biennial interviews with 9,032 adults aged ≥50 in the population‐based US Health and Retirement Study from 1996‐2016. Loneliness status (yes vs. no) was assessed biennially from 1996‐2004 and its duration over this period was categorized as never, 1 time point, 2 time points, and ≥3 time points. Episodic memory was assessed biennially from 2004‐2016 as a composite of immediate and delayed recall trials combined with proxy‐reported memory. We used multivariable‐adjusted mixed effects regression to estimate the association between loneliness duration and subsequent memory function and decline. Three‐way interaction terms were included to test effect modification by sex and age.ResultMean (SD) age at baseline was 64 (9) years, 63% of the sample was female (5,646/9,032), and the median follow‐up time was 10 years, contributing 46,890 observations from 2004‐2016. A total of 1,624 adults (18%) experienced loneliness at one time point, 825 (9%) experienced loneliness at two time points, and 1,069 (12%) experienced loneliness at ≥3 time points. Annual memory decline among non‐lonely adults was 0.08 standard deviation (SD) units (95% CI: ‐0.08, ‐0.07) per year. A longer duration of loneliness was associated with a faster rate of memory decline (1 time point: 0.01 SD additional annual decline, 95% CI: ‐0.01, ‐0.01; 2 time points: 0.02 SD additional annual decline, 95% CI: ‐0.02, ‐0.01; ≥3 time points: 0.03 SD additional annual decline, 95% CI: ‐0.03, ‐0.02; P trend <0.001). The association was stronger among women than men (three‐way interaction P trend <0.001) and adults aged ≥65 years than those aged <65 years (three‐way interaction P trend = 0.01).ConclusionLong‐term loneliness may be a salient risk factor for accelerated memory aging, especially among women aged 65 and over. Our findings could help rule out reverse causation between loneliness and memory outcomes, suggesting that loneliness could be part of a preclinical syndrome of Alzheimer’s disease and related dementias.