Social Science & Medicine

BackgroundLifespan inequality arises both from heterogeneity (e.g., in sex or race) and from unavoidable individual stochasticity. By treating a heterogeneous population as a mixture we can (and many have) partition variance in lifespan into a between-group component due to heterogeneity and a within-group component due to chance. Until now, such studies have treated factors singly. It is now possible to analyze multiple factors and their contributions to variance. ObjectiveThis paper is the first to exploit the new analysis for multi-factor studies. Multi-factor data are painfully rare, but a remarkable study by Bergeron-Boucher et al. presented U.S. life tables under all 54 combinations of four factors (sex, marital status, education, race). Our objective is to quantify the contributions of these factors and their interactions to lifespan inequality. MethodsThe population is treated as a mixture of 54 groups, with a mixture distribution either flat or proportional to population size of the different factor combinations. Components of the variance in remaining longevity, for starting ages from 30 to 85 years, are calculated using marginal mixture distributions. ResultsEven accounting for four factors and their interactions, between-group heterogeneity accounts for only 7% (population-weighted mixing) to 10% (flat mixing) of lifespan variance. Education and its interactions make the largest contribution. Contributions of two-way, three-way, and four-way interactions are orders of magnitude smaller. This suggests new ways of displaying, summarizing, and interpreting inequality as measured in multi-factor studies. ContributionMulti-factor studies can now be used to identify sources of variance in longevity and other demographic outcomes.

While pregnancy intentions are increasingly recognised as complex and dynamic, unexpected pregnancies are often studied cross-sectionally, and a life course perspective is lacking. This study aimed to explore the salient themes and patterns in 1) the life course trajectories of individuals experiencing an unexpected pregnancy and 2) the transition surrounding an unexpected pregnancy. We conducted semi-structured qualitative interviews with 22 individuals (15 women and 7 men) experiencing unexpected pregnancies. Two interviews were held: during pregnancy and six months after childbirth. The respondents' life course trajectories were mapped using visual timelines and the transition was explored using Schlossberg's transition theory. Interviews were thematically analysed in an iterative process: applying open coding to three interviews followed by thematic coding and comparison of themes within and across life course trajectories. Life course trajectories varied considerably, distinguished by the absence or presence of critical life events, with patterns characterised by clustering life events within the domains of family, mental health or frequent residential mobility. The transition process of unexpected pregnancy was characterised by three patterns of adjustment - shift (instant adjustment), spark (triggered adjustment) and unfolding (ambiguous adjustment) - in which respectively, all life course trajectories, trajectories with clustering of life events and mainly stable trajectories were present. This study contributes to the literature through the unfolding pattern, showing that adjustment to unexpected pregnancy may be an ambiguous process that is not finished when the baby has arrived, especially if individuals have strong aspirations in light of a relatively stable life course.

Female genital cutting (FGC) is identified within global health and human rights discourse as aligned with gender inequality and female disempowerment. The persistence of FGC in high-prevalence societies is assumed to reflect womens limited influence over decisions concerning their daughters. Yet anthropological research has questioned whether this interpretation adequately reflects how FGC is organized within practicing communities. Across two studies with 176,728 participants from 15 African and Asian countries, we examine whether mothers attitudes toward FGC predict daughters circumcision status and whether this relationship varies with regional FGC prevalence. Multilevel logistic regression models show that maternal attitudes strongly predict daughter circumcision status across both datasets. Contrary to expectations derived from disempowerment frameworks, the association between maternal attitudes and daughter outcomes is not weaker in high-prevalence contexts, it is stronger. These findings suggest that interpretations of FGC as reflecting female disempowerment may mischaracterize the social dynamics of societies in which FGC is common. Policy implications of the findings are discussed.

BackgroundPrevious studies have presented conflicting findings regarding the potential causal relationships between leisure-time physical activity (LTPA) and body mass index (BMI). Here, we use individual-level data and apply a triangulation framework that incorporates three complementary methods to investigate the bidirectional causal associations between LTPA and BMI. MethodsWe used data from a longitudinal Finnish twin cohort with four measurement points spanning 36 years. The data included 22,696 twin individuals aged 18-50 years at baseline (52.4% women); 8,527 had genetic data available. We applied three analytical approaches suggested to strengthen causal inference in observational studies: Random intercept cross-lagged path model (RI-CLPM) for longitudinal data, one-sample Mendelian Randomization (MR) and Direction of Causation (DoC and MR-DoC) twin models for cross-sectional data at each measurement point. ResultsAll three approaches provided evidence for a causal effect of higher BMI on lower LTPA, particularly at the later follow-up stages. Only twin models suggested a negative causal effect of LTPA on BMI. Men and women showed mainly similar effects. ConclusionsEvidence triangulation across the three methodologies provided support for a causal effect of higher BMI on lower LTPA, whereas the evidence for a reverse effect was less convincing. Our results indicate that the role of high BMI in limiting LTPA becomes more important with advancing age, while also highlighting the importance of accounting for timing when studying the causal effects of LTPA on BMI and vice versa.

Introduction: Economic opportunity is a core pillar of the American Dream but is not distributed equally across communities. Substantial evidence has identified economic opportunity as an independent social determinant of health, but relatively little is known about opportunity's relationship with other socioeconomic characteristics such as income. Here we address this gap in the literature to examine how area-level economic opportunity modifies the income-health gradient. Methods: We used multivariable ordinary least squares models to estimate the association between self-reported health and economic opportunity across household income levels for working age adults (ages 25-64). Our measures of income and health come from the 2010-2019 Current Population Survey Annual Social and Economic Supplements. Our measure of economic opportunity was drawn from Opportunity Insights and represents the county-averaged national income percentile rank attained in adulthood for individuals born to parents at the 25th percentile of the income distribution. We adjusted for a wide range of individual- and county-level demographic and socioeconomic characteristics. Results: We find that county-level economic opportunity modified the gradient in self-reported health and household income among working-age adults. Effects were particularly pronounced in the lowest income deciles -- an interdecile increase in economic opportunity was associated with closing almost 33% of the gap in health between the lowest and highest income deciles. The results were robust to sensitivity analyses. Conclusion: We show that local area economic opportunity flattens the relationship between household income and health, with lower-income individuals benefitting the most from living in high opportunity areas.

This study investigated retirement adjustment in retired police officers in the UK (N = 289), examining how time since leaving the service moderates the relationship between perceived organisational support and retirement adjustment while accounting for resilience. Results indicated a developmental trend: organisational support remains stable initially but becomes increasingly influential in later life. Using Johnson-Neyman analysis, a threshold of 32.07 years was identified, after which the association reaches statistical significance. These findings suggest an organisational legacy effect; for the older generation, the retrospective perception of being valued by the service acts as a durable psychological resource. This study offers a novel conceptualisation of long-term organisational influence by identifying a temporally delayed legacy effect that extends beyond existing models of retirement adjustment. The study advocate for lifelong wellbeing strategies that extend, recognising that the organisational relationship continues to shape adjustment outcomes decades after the conclusion of active duty.

Importance: Parent/caregiver-infant early relational health (ERH) is known to play a critical role in the promotion of socio-emotional functioning and wellbeing across the life course. The negative impact of the COVID-19 pandemic on maternal mental health and secondarily on ERH and child socio-emotional functioning is clear. However, the direct impact of maternal viral exposure during pregnancy on ERH has not been investigated. Objective: The goal of this study was to determine the impact of prenatal SARS-CoV-2 exposure on ERH and infant socio-emotional functioning in the first 6 months of life. Design: Mothers with and without SARS-CoV-2 exposure during pregnancy who gave birth from 02/2020 to 09/2021 were enrolled from 05/2020 to 09/2021 in one of two parallel prospective studies (the COVID-19 Mother Baby Outcomes [COMBO] Initiative or the Respiratory Syndrome Coronavirus 2 in Pregnancy and Infancy [ESPI] COMBO sub-study). Mothers reported on their health and the socio-emotional functioning of their infant via online surveys (REDCap) at enrollment, 1, 2, 4, and 6 months. At 4 to 6 months, dyads were invited to participate in a video-based, remote assessment of ERH. Participants: 884 mother-infant dyads from three U.S. States (Alabama, New York, and Utah). Exposure: Prenatal SARS-CoV-2. Main Outcomes and Measures: Maternal-reported ERH (parental stress, parenting confidence and bonding) and observer-based ERH (video-coded quality of maternal caregiving behaviors and mother-infant emotional connection). Infant socio-emotional development assessed using the 6-month Ages and Stages Questionnaire: Socio-Emotional 2nd Edition (ASQ:SE-2). Results: 316 (36%) mothers had a positive prenatal SARS-CoV-2 exposure. Prenatal SARS-CoV-2 exposure was associated with an adjusted estimate of ~5% reduction (incidence rate ratio=0.95, 95% confidence interval [0.90, 1.00], p=0.03) in observed maternal caregiving quality, after accounting for postnatal maternal mental health and sociodemographic factors. We found no evidence of effect on other ERH constructs or infant socio-emotional functioning. Conclusions and Relevance: In this large prospective cohort study, prenatal SARS-CoV-2 was associated with a small decrement in caregiving quality, but not other ERH constructs or infant socio-emotional functioning. These findings should be interpreted as hypothesis generating and will require replication in independent studies.

Large-scale epidemics are consistently associated with increased psychological distress and substantial changes in human mobility, yet the relationship between mental health responses and effective population mobility remains overlooked. During the COVID-19 pandemic, non-pharmaceutical interventions (NPIs) such as lockdowns and travel restrictions altered daily movement patterns while simultaneously affecting psychological well-being. Importantly, formal policy stringency alone does not fully capture realized mobility behavior, which also reflects spontaneous adaptation and adherence fatigue over time. In this study, we examine the association between self-reported mental distress and mobility recovery across the United States during the first wave of the COVID-19 pandemic. We combine state-level human mobility data derived from anonymized mobile phone records with large-scale survey data on self-reported anxiety and depression. Our analysis focuses on the U.S. states and territories from April 1 to September 1, 2020. Using fixed-effects regression models, we assess how variations in mental distress relate to deviations from pre-pandemic mobility levels, while controlling for reported COVID-19 mortality and the stringency of NPIs. We find a negative and statistically significant association between mental distress and mobility recovery: higher levels of self-reported anxiety and depression are associated with lower recovery of pre-pandemic mobility. These results indicate that psychological distress is associated with population mobility beyond what is explained by formal restrictions alone. Our findings highlight the relevance of mental health as a factor linked to behavioral responses during public health crises. Incorporating psychological well-being into the evaluation of mobility dynamics may inform more balanced public health strategies in future emergencies. Author summaryDuring the COVID-19 pandemic, governments introduced restrictions on movement, such as stay-at-home orders and travel limits, to slow the spread of the virus. At the same time, many people experienced increased anxiety and depression. In this study, we ask whether changes in mental well-being were linked to how quickly people returned to their usual patterns of movement. Here, we focus on the first wave of the pandemic in the United States and combine mobility data and large-scale digital survey data to study the association between self-reported mental health indicators and effective mobility at the population level. By comparing states over time, we explore whether changes in mental distress were associated with changes in mobility, beyond what can be explained by public restrictions or reported deaths alone. We find that states with higher levels of reported anxiety and depression tended to show slower recovery toward normal mobility levels. This suggests that psychological well-being played an important role in shaping individual and collective responses to the pandemic, with implications for the design of future public health interventions.

Eating behaviors and their associated cognitions exist along a biopsychosocial continuum, yet their structural organization remains largely unmapped in non-Western contexts. Adopting a dimensional network perspective, this study characterizes the architecture of non-clinical eating behaviors in India--a region defined by a unique interplay of cultural, structural, and psychological influences. We utilized Mixed Graphical Models (MGMs) to estimate a weighted network of 35 variables from a geographically diverse Indian cohort (N=1,508). Our analysis reveals that the Indian eating behavior landscape is a highly optimized, small-world system (S=54.64) defined by a dual-layered hierarchy of influence. We found that structural and cultural variables--notably HomeTypes and Religion--serve as the primary local anchors (highest Expected Influence), driving the state of their immediate modules. Conversely, systemic integration across the entire network is maintained by a "socio-economic and regulatory bridge" comprising Employment, Education, and Self-Esteem. These nodes exhibited the highest betweenness centrality, functioning as the critical "highways" that link disparate socio-economic, psychological, and behavioral modules. Notably, while Shape and Weight Concern were highly predictable, they functioned as local cluster nodes rather than global integrators--directly challenging the body-image-centric models dominant in Western literature. These results demonstrate that in the Global South, structural social determinants form the primary scaffold of the biopsychosocial system. Our findings provide a data-driven blueprint for systemic, culturally attuned public health interventions that prioritize structural stability alongside individual regulatory resilience. Significance StatementWhile eating behaviors are traditionally conceptualized as individual psychological phenomena, this study reveals that in the Global South, they are fundamentally anchored by systemic social determinants. Using network science to map the biopsychosocial landscape of a large Indian cohort, we demonstrate a specific hierarchy of influence: while cultural and living conditions (e.g., religion and home type) act as local anchors for behavior, socio-economic factors (employment and education) and core psychological traits (self-esteem) function as the primary structural bridges that integrate the entire system. This architecture provides an empirical corrective to Western-centric models that prioritize body image as the central driver of eating pathology. Our findings suggest that in developing economies, public health strategies may be most effective when they target these "upstream" structural integrators, reframing eating behavior as a systemic expression of social, economic, and cultural stability.

HighlightsO_LIHealth inequalities have widened over 15 years, favouring high-income groups C_LIO_LIInequality in physical activity & mental health widened the most pre-intervention C_LIO_LIPost-intervention, inequalities persisted but stayed relatively unchanged. C_LIO_LILong-term illness and unemployment were key drivers of inequality C_LIO_LIThe greenway may have slowed down the inequality widening but the impact is limited C_LI BackgroundEvidence concerning health inequalities following urban green and blue space UGBS) interventions is limited. This study examined the changes in health inequalities after a major urban regeneration project, the Connswater Community Greenway (CCG), in Belfast, UK. MethodCross-sectional household surveys were conducted in 2010/11 (baseline), 2017/18 (immediately after completion), and 2023/24 (long-term follow-up) with a sample of approximately 1,000 adults each wave. Using concentration indices (CI), income-related health inequalities for three outcomes (physical activity, mental wellbeing and quality of life) were measured. A regression-based decomposition of concentration index examined the contribution of sociodemographic factors to the observed inequalities underpinning each outcome over time. ResultsAcross three waves, there was widening of inequalities over the 15-year period across all three health outcomes, with those from high-income groups reported higher levels of physical activity (CI=0.33, SE=0.026), better mental wellbeing (CI=0.03, SE=0.003), and better quality of life (CI=0.09, SE=0.008). The widening inequalities mainly occurred during the construction phase of CCG (2010-2017) and remained stable post-intervention (2017-2023). Decomposition analysis revealed that the pro-poor concentration of long-term illness and unemployment was the key driver that together explained approximately 51%-76% of the inequalities. ConclusionThe CCG was limited in reducing health inequalities which were mainly driven by long-term illness and unemployment - factors beyond the direct scope of the UGBS intervention - resulting in low-income groups likely to fall further behind the wealthier groups. The widening of inequality is consistent with findings from other public interventions that did not have a primary equity focus.

IntroductionThis article summarises lessons learnt from the Health Outcomes for young People throughout Education (HOPE) Study and serves as a real world, transferable application for addressing causal questions using administrative data. The HOPE study applied causal methods to analyses of administrative data in Education and Child Health Insights from Linked Data (ECHILD) aimed at studying the effectiveness of provision for special educational needs and disability (SEND) on health and education outcomes. MethodsDefining causal questions regarding the impact of SEND provision required judicious mapping of the question onto the data, leading to the selection of appropriate measures of effect, transparent handling of the data and control of confounding factors to estimate effects. We adopted the target trial emulation framework to guide these steps. Having encountered specific computational challenges in estimating the effects of interest, we simulated data that resembled the HOPE study and used them to practice the implementation of alternative estimation methods and to study impact of some of their assumptions. ResultsThe creation and analysis of the simulated data provided valuable insights. First, we learned the importance of aligning the target of estimation with the causal question at hand. Second, we observed how deviations from assumptions specific to each estimation method can affect results. Third, we highlighted the benefits of employing alternative estimation methods as sensitivity tools that can aid the interpretation of the resulting estimates. Finally, we offer user-friendly code in two programming languages (R and Stata) and accompanying simulated data to facilitate the implementation of these methods for similar causal questions. ConclusionWe recommend users of administrative data to fully specify -and possibly revise- the causal questions they wish to address and to carefully examine and compare assumptions, implementation and results obtained using alternative estimation methods.

Loneliness--the perceived discrepancy between desired and actual social connection--is a common and aversive psychological state associated with a range of adverse health outcomes. Several theoretical models suggest that these associations may operate partly through health behaviors. In this preregistered study, we used data from the All of Us Research Program to evaluate associations of loneliness and functional rurality (FR), a study-specific contextual index of reduced neighborhood accessibility, with Fitbit-derived physical activity and sleep outcomes. Final samples included 16,912 participants for physical activity analyses and 13,937 for sleep analyses. In adjusted models, higher FR was associated with greater loneliness ({beta} = 0.061, 95% CI [0.045, 0.077], p = 9.63 x 10-14). FR and loneliness were independently associated with fewer daily steps and lower moderate-to-vigorous physical activity. Loneliness was also associated with shorter sleep duration, greater sleep duration variability, higher odds of short sleep, and higher odds of low sleep efficiency. FR was not associated with sleep duration or sleep duration variability but showed a small positive association with mean sleep efficiency and lower odds of low sleep efficiency. Interaction analyses provided little evidence that FR modified the associations of loneliness with most outcomes, although the FR x loneliness interaction was significant for sleep duration variability, indicating that loneliness was more strongly associated with irregular sleep duration in higher-FR contexts. Sensitivity analyses using stricter valid-day thresholds, winsorization, quartile-based exposure coding, and a backward 30-day window yielded directionally similar findings. These results suggest that FR and loneliness are independently associated with lower physical activity, whereas loneliness shows a more consistent relationship with adverse sleep patterns.

Although the built environment has been identified as a risk factor for depressive symptoms, it is unclear whether these associations are driven by specific environmental features and whether they remain stable over time. In 10,310 ALSPAC women living in Bristol city, we conducted preregistered network analyses to investigate cross-sectional and longitudinal associations between built environment features (e.g., population density, green space and walkability) and depressive symptoms (at ages 28, 32 and 48 years). Contrary to our hypotheses, associations between individual built environment variables and depressive symptoms were consistently weak. Exploratory factor analyses indicated a built environment factor associated with depressive symptoms at baseline ({beta} = 0.148, p < .001) and 4-year follow-up ({beta} = 0.114, p = .011), but not at 18-year follow-up ({beta} = -0.005, p = .950). These findings suggest the combined influence of built environment features may explain depressive outcomes better than individual built environment measures alone.

ImportanceFunding of womens health research has been low, with a narrow focus on what is considered womens health. Understanding which lifespan stages and areas of womens health are funded is essential to determine the breadth of womens health research and identify where gaps in research are concentrated. ObjectiveTo examine which lifespan stages and areas of womens health were more likely to be funded in open Canadian grant competitions. Evidence ReviewPublicly available funded Canadian Institutes of Health Research (CIHR) Project Grant abstracts from 2009 and 2023 were coded for mention of a hormonal transition period (puberty, menstrual cycle, pregnancy/postpartum, perimenopause/menopause), exogenous hormone use (hormonal contraception, fertility treatments, menopause hormone therapy), and/or a female-specific health condition. Abstracts were also coded for Indigenous health and Two Spirit, Lesbian, Gay, Bisexual, Trans, Transgender or Trans Identified, Queer, Intersex, Asexual, Plus (S2/LGBTQIA+) populations. Remaining grant abstracts were grouped by common theme.Abstracts were analyzed for changes in research representation and funding over time and whether funding was lower than expected based on population prevalence or proportion of the lifespan spent in that stage. FindingsNearly 50% of female-specific research focused on cancers (breast, gynecologic) or pregnancy and did not significantly increase in funding or representation over time. Of the funded grant abstracts that focused on pregnancy, ~22% examined outcomes pertaining only to the fetus/offspring, not the birthing parent. Over 15 years, 2.37% of all CIHR abstracts over 15 years were devoted to pregnancy, whereas only 0.24% was devoted to other hormonal life stages (menstrual cycles, menopause). For all hormonal transition stages except pregnancy, the proportion of grants and funding devoted to that stage was lower than expected based on the proportion of the lifespan spent in that stage. Conclusions and RelevanceThese findings reflect the narrow breadth of womens health, which largely focused on cancers (breast, gynecologic) or pregnancy, rather than being distributed across key life course stages that shape womens health. To advance science for all, the heterogeneity and complexity in womens health across the lifespan must be embraced and barriers for womens health research must be removed. Key PointsO_ST_ABSQuestionC_ST_ABSWhich areas and life stages of womens health are most likely to be funded in Canadian open grant competitions, and where are funding gaps concentrated? FindingsNearly half of female-specific grants focused on cancer or pregnancy, with little change over time. Pregnancy dominated hormonal-stage research, often excluding maternal outcomes, while menstrual and menopausal stages were rarely funded. For most life stages, funding was lower than expected based on lifespan representation. MeaningWomens health research funding remains narrowly focused. Broader, life-course-inclusive investment is needed to address critical gaps and advance equitable health science.

Objectives. To test whether the association between household income and tooth retention differs by race/ethnicity and whether this interaction varies by reason for the most recent dental visit among US adults. Methods. We analyzed 13,190 adults in the National Health and Nutrition Examination Survey (2009 to 2018). Survey weighted linear regression estimated interactions between household income and race/ethnicity in models of tooth retention, stratified by reason for last dental visit. Results. Higher income was associated with greater tooth retention across groups, but income related gains were larger for Non-Hispanic White adults than for Non Hispanic Black and Mexican American adults, particularly in problem-focused care settings. In problem focused visits, each higher income category was associated with 0.5 additional teeth among White adults (95% CI 0.4, 0.6) versus 0.2 (95% CI 0.0, 0.4) among Black adults and 0.1 (95% CI 0.1, 0.3) among Mexican American adults. Racial differences were attenuated in routine check-up contexts. Conclusions. Income related gains in tooth retention differed by race/ethnicity and dental care context. Public Health Implications. Expanding access alone may be insufficient to reduce racial inequities in oral health.

BackgroundLiterature on sexual assault prevalence among homeless women is limited, with few studies disaggregating risk by geography, resource access, mental health, LGBTQ status, or disability. ObjectiveThis study provides two distinct meta-analyses to ascertain the aggregated overall prevalence (k=20 studies) and the aggregated 12-month prevalence (k=14 studies) of sexual assault among homeless women. By examining each recall period independently, we elucidate cumulative burden throughout the life cycle and annual risk, offering unique insights for public health interventions. By synthesizing global data, we aimed to clarify risks for women with disabilities, mental illness, or Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Plus (LGBTQ+) identities to inform crisis care interventions. MethodsFollowing PRISMA 2020 guidelines, six databases were searched for studies published after 2010 reporting sexual assault prevalence in homeless women. Twenty studies met the inclusion criteria. Random-effects meta-analyses were performed using a logit transformation. Heterogeneity was assessed with I{superscript 2} and Cochrans Q; publication bias with funnel plots and Eggers test. ResultsThe pooled lifetime prevalence of sexual assault was 39.2 % (95 % CI 25-56 %), and 12-month prevalence was 22 % (95 % CI 16-30 %). Heterogeneity was extreme (I{superscript 2} = 97 %). Subgroup analyses showed the highest prevalence among women with disabilities (92 %, single study), followed by LGBTQ+ (33 %) and women with mental illness (34 %). HIV-positive women had the lowest prevalence (2.6 %). Eggers test indicated no publication bias (p = 0.64). ConclusionHomeless women face disproportionately high rates of sexual assault, far exceeding the general female population, with particularly elevated estimates among women with disabilities, LGBTQ+ women, and those with mental illness. These preliminary findings highlight the need for improved screening practices and tailored public health interventions to address sexual assault in doubly vulnerable populations. Standardizing definitions of sexual assault and investigating risk factors could lead to more tailored public health interventions. HighlightsO_LIMarked Epidemiologic Burden: Nearly 40% of homeless women report lifetime sexual assault. C_LIO_LIPersistent risk: One in five homeless women assaulted within the past 12 months. C_LIO_LIMarginalized Impact: Rates highest among disabled, LGBTQ+, and HIV+ women. C_LIO_LIHigh Variability: Extreme heterogeneity (I{superscript 2} {approx} 97%) shows research inconsistency. C_LIO_LIResearch Priority: Standardize methods and definitions to improve accuracy. C_LI

Many Asian American (AA) subgroups experience disproportionate rates of cardiometabolic (CMB) conditions, yet the contextual drivers of these disparities remain unclear. Little is known about the role of Asian residential segregation, often conceptualized as Asian enclaves, with limited prior work largely ignoring region of origin and nativity. Using six years of population-based survey data from New York City (N>6,000 AAs) linked with multiple sources of community data, we examine how residence in ethnicity-specific enclaves relates to CMB risks (obesity, hypertension, and diabetes), whether these associations differ by nativity, and the extent to which neighborhood socioeconomic conditions, the built environment, social cohesion, and institutional support account for observed associations. Our combined concentration-based and spatial clustering analysis identified five East Asian enclaves and six South Asian enclaves, with no geographic overlap between the two. Logistic regression analyses show that residence in an East Asian enclave was associated with lower odds of obesity (OR=0.63), while residence in a South Asian enclave was linked to higher odds of diabetes (OR=1.42) and hypertension (OR=1.46). These associations were present only among foreign-born individuals. After adjusting for neighborhood characteristics, the lower obesity risk in East Asian enclaves persisted, while elevated risks in South Asian enclaves were partly reduced. Both suggest a role for unmeasured enclave factors, including cultural and food environments. Our findings challenge the view that Asian enclaves are monolithically health-promoting and redirects scholarly attention toward disaggregated approaches to investigating AA health disparities.

BackgroundDepression is estimated to be the leading cause of disability in South Africa, yet data on depression prevalence and antidepressant use are inconsistent and fragmentary. We present a system dynamics modelling approach to integrate these data and assess trends and inequalities in depression prevalence and treatment access. MethodsWe developed a deterministic model of the South African population aged 15 and older, stratified by age, sex, HIV status/stage and susceptibility to depression. Individual transitions between depressed/healthy and treated/untreated states were simulated over time, from 1985. The model was calibrated to depression prevalence data from nine nationally representative household surveys (2002-2024) and ten smaller studies reporting prevalence of antidepressant use, using a Bayesian approach. ResultsThe model estimated a slight decline in depression point prevalence over time, from 5.1% (95% CI: 4.5-5.6%) in 2002 to 4.5% (95% CI: 4.0-5.0%) in 2024, although with a transient rise in depression prevalence during the COVID-19 period. In 2024, depression prevalence was higher in women (5.3%, 95% CI: 4.7-5.9%) than men (3.6%, 95% CI: 3.2-4.0%), and highest at ages 60 and older. The lifetime prevalence of depression was 70.6% (95% CI: 67.8-73.6); alternative model settings with a more concentrated distribution of depression risk were inconsistent with longitudinal data. The proportion of adults using antidepressants increased from 1.0% (95% CI: 0.8-1.2%) in 2008 to 2.8% (95% CI: 2.2-3.4%) in 2024. In 2024, antidepressant use was 11.0% (95% CI: 8.8-13.5%) in the private sector, compared to only 0.9% (95% CI: 0.7-1.1%) in the rest of the population, and the ratio of new antidepressant initiations to new cases of depression was 0.12 nationally. ConclusionThe prevalence of depression in South Africa has been relatively stable over the last two decades. Although antidepressant use has increased, overall use remains low, and substantial inequality remains in access to treatment in the public and private health sectors.

BackgroundMental well-being encompasses positive psychological functioning, life satisfaction, and engagement with daily activities. It is influenced by multiple interrelated factors, including symptoms of stress, anxiety, depression, and psychological inflexibility. Network analysis provides a data-driven framework for examining the complex interconnections between these components and for identifying elements that may play a central role in the mental well-being system. The present study aimed to identify key elements related to stress, anxiety, depression, and psychological inflexibility associated with mental well-being in individuals seeking online psychological support. MethodsThis cross-sectional study analyzed data drawn from the Online Well-being intervention. A total of 967 Mexican participants were included. A psychological network comprising seventy-four items was estimated, and centrality indices (strength, closeness, and betweenness) were computed to determine the relative importance of individual elements within the network. Network comparisons by gender were conducted to evaluate global and local differences. ResultsThe network revealed multiple inter-domain associations, particularly negative relationships between mental well-being and symptoms of depression, anxiety, negative stress, and psychological inflexibility. Items reflecting self-evaluation and emotional well-being consistently emerged as the most central elements in the network across centrality metrics. Gender-based comparisons indicated overall structural similarity between networks, although differences were observed in the strength of specific connections. ConclusionsNetwork analysis identified central elements linking mental well-being with psychological distress and inflexibility in a population seeking online psychological support. These findings contribute to a systems-level understanding of mental well-being and highlight potential targets for psychological interventions to enhance well-being and reduce distress.

BackgroundThe present study examines the link between DNA methylation at the nerve growth factor-induced protein A (NGFI-A) binding domain of the NR3C1 1F promoter and later cognitive functions in children from families living in disadvantaged psychosocial conditions. MethodsParticipants were 132 children who took part in a Swiss Parents as Teachers (PAT) randomized controlled trial (72 in the intervention group, 60 in the control group). DNA methylation was quantified from saliva samples collected at age three using sodium bisulfite next-generation sequencing (NGS). Cognitive functions were assessed at age five using the SON-R 2.5-7 Intelligence Test. Results(a) DNA methylation at age three predicted lower IQ at age five through increased concentration problems; (b) participation in the three-year PAT program predicted lower methylation levels at the end of the intervention; and (c) early life stressors predicted lower IQ through increased methylation and concentration problems with descriptively stronger effects in the control group. ConclusionsThese findings demonstrate a link between early DNA methylation at the NGFI-A binding site of the NR3C1 1F promoter and later cognitive functions in children and highlight the role of early life stressors and the PAT intervention in shaping these associations.