Publications by authors named "Benjamin A Shaw"

64 Publications

Trends in Opioid Use Disorder Among Older Adults: Analyzing Medicare Data, 2013-2018.

Am J Prev Med 2021 Mar 4. Epub 2021 Mar 4.

Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, Rensselaer, New York.

Introduction: Opioid use disorder has grown rapidly over the years and is a public health crisis in the U.S. Although opioid use disorder is widely studied, relatively little is known about it among older adults. The goal of this study is to gain a better understanding of opioid use disorder among older Medicare beneficiaries over time and across several sociodemographic dimensions.

Methods: Data from the 2013-2018 Centers for Medicare & Medicaid Services Master Beneficiary Summary Files were analyzed in 2020 to examine the trends in opioid use disorder prevalence among Fee-for-Service Medicare beneficiaries aged ≥65 years. Utilizing the overarching opioid use disorder flag, trends in opioid use disorder prevalence were examined for the following sociodemographic dimensions: age, sex, race/ethnicity, and dual eligibility status (i.e., enrolled in both Medicare and Medicaid owing to low income). Chi-square tests were used to compare opioid use disorder prevalence across groups.

Results: Since 2013, estimated rates of opioid use disorder among older adults have increased by >3-fold overall in the U.S. Estimated opioid use disorder is more prevalent among the young-old (i.e., ages 65-69 years) beneficiaries than among other older adults, and dually eligible beneficiaries have consistently shared a heavier burden of opioid use disorder than Medicare-only beneficiaries. Regarding race/ethnicity, Blacks and American Indians/Alaskan Natives are more vulnerable to opioid use disorder than other groups.

Conclusions: The descriptive trends between 2013 and 2018 indicate that estimated opioid use disorder prevalence has increased greatly over the study period in all sociodemographic subgroups of older adults, highlighting an urgent challenge for public health professionals and gerontologists.
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http://dx.doi.org/10.1016/j.amepre.2021.01.010DOI Listing
March 2021

Short-, medium-, and long-term weight changes and all-cause mortality in old age: Findings from the National Survey of the Japanese Elderly.

J Gerontol A Biol Sci Med Sci 2021 Feb 24. Epub 2021 Feb 24.

Tokyo Metropolitan Institute of Gerontology, Sakae-cho, Itabashi-ku, Tokyo, Japan.

Background: Recent studies, predominantly in Western populations, suggest that both weight loss and weight gain are associated with an increased mortality risk in old age. However, evidence of this association in older Asian populations remains sparse. This study aimed to examine the association between weight change and all-cause mortality in a nationally representative sample of community-dwelling older Japanese people.

Methods: Data were obtained from the National Survey of the Japanese Elderly, which included 4,869 adults aged ≥60 years. Participants were followed for up to 30 years. We considered three indicators of weight change according to the follow-up interval: short-term (3 years), medium-term (6-7 years), and long-term (12-13 years). Weight change was classified as loss ≥5%, loss 2.5-4.9%, stable (±2.4%), gain 2.5-4.9%, and gain ≥5%. Cox proportional hazards models were used to calculate the relative mortality risk of each weight change category.

Results: Weight loss ≥5% for all intervals was associated with higher mortality than stable weight and the effects were largely similar across all three intervals (hazard ratio [95% confidence interval]: 1.36 [1.22-1.51] for short-term, 1.36 [1.22-1.51] for medium-term, and 1.31 [1.11-1.54] for long-term). A similar pattern of results was observed among the young-old and old-old, and among men and women. The effect of weight loss on higher mortality was greater among those with a lower body mass index at baseline.

Conclusions: These findings could inform clinical and public health approaches to body-weight management aimed at improving the health and survival of older adults, particularly in Asian populations.
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http://dx.doi.org/10.1093/gerona/glab052DOI Listing
February 2021

Does Serum Vitamin D Level Affect COVID-19 Infection and Its Severity?-A Case-Control Study.

J Am Coll Nutr 2020 Oct 13:1-8. Epub 2020 Oct 13.

Department of Hepatobiliary Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.

Background: As effective medication to treat COVID-19 is currently unavailable, preventive remedies may be particularly important.

Objective: To examine the relationship between serum 25-hydroxy vitamin D (25(OH)D) level and COVID-19 infection, its severity, and its clinical case characteristics.

Methods: This case-control study compared serum 25(OH)D levels and rates of vitamin D deficiency (VDD) between 80 healthy controls and 62 patients diagnosed with COVID-19 and admitted to Guangxi People's Hospital, China, 2/16/2020-3/16/2020. Cases were categorized into asymptomatic, mild/moderate, and severe/critical disease. Logistic regression analysis was conducted to examine the associations between 25(OH)D level, or VDD, and case status/severity of COVID-19 while controlling for demographics and comorbidities. A threshold level of vitamin D for conveying COVID-19 risk was estimated.

Results: Severe/critical COVID-19 cases were significantly older and had higher percentages of comorbidity (renal failure) compared to mild cases. The serum 25(OH)D concentration in COVID-19 patient was much lower than that in healthy control. And 25(OH)D level was the lowest in severe/critical cases, compared with mild cases. In further, significantly higher rates of VDD were found in COVID-19 cases (41.9%) compared to healthy controls (11.1%). And VDD was the greatest in severe/critical cases (80%), compared with mild cases (36%). These statistically significant associations remained even after controlling for demographics and comorbidities. A potential threshold of 25(OH)D (41.19 nmol/L) to protect against COVID-19 was identified.

Conclusion: Elderly and people with comorbidities were susceptible to severe COVID-19 infection. VDD was a risk factor for COVID-19, especially for severe/critical cases. While further confirmation is needed, vitamin D supplementation may have prevention or treatment potential for COVID-19 disease.
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http://dx.doi.org/10.1080/07315724.2020.1826005DOI Listing
October 2020

Older adults' physical activity-related social control and social support in the context of personal norms.

J Health Psychol 2020 Sep 26:1359105320954239. Epub 2020 Sep 26.

University of Wisconsin-Milwaukee, Milwaukee, WI, USA.

This study investigated whether perceived physical activity norms moderated the effects of physical activity-related social interactions on intentions to engage in physical activity among community-residing older adults ( = 217). Structural equation modeling tested whether two types of social support and social control interacted with personal norms in predicting intentions to be active. Emotional and informational support were associated with higher intentions, and negative social control was associated with lower intentions to engage in activity. Each of these effects was more prominent in the context of weak personal norms, suggesting future research and interventions should consider joint effects of support and norms.
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http://dx.doi.org/10.1177/1359105320954239DOI Listing
September 2020

Trends in the Mortality Risk of Living Alone during Old Age in Sweden, 1992-2011.

J Aging Health 2020 12 23;32(10):1399-1408. Epub 2020 Jun 23.

Karolinska Institutet and Stockholm University, Stockholm, Sweden.

This study investigates the association between living alone and mortality over a recent 19-year period (1992-2011). Data from a repeated cross-sectional, nationally representative (Sweden) study of adults ages 77 and older are analyzed in relation to 3-year mortality. Findings suggest that the mortality risk associated with living alone during old age increased between 1992 and 2011 ( = .076). A small increase in the mean age of those living alone is partly responsible for the strengthening over time of this association. Throughout this time period, older adults living alone consistently reported poorer mobility and psychological health, less financial security, fewer social contacts, and more loneliness than older adults living with others. Older adults living alone are more vulnerable than those living with others, and their mortality risk has increased. They may have unique service needs that should be considered in policies aiming to support aging in place.
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http://dx.doi.org/10.1177/0898264320930452DOI Listing
December 2020

Changes in perceived knowledge about childbirth among pregnant women participating in the Senses of Birth intervention in Brazil: a cross-sectional study.

BMC Pregnancy Childbirth 2020 May 5;20(1):265. Epub 2020 May 5.

Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY, 12144, USA.

Background: Senses of Birth (SoB) is a health education intervention in Brazil that aims to reduce unnecessary cesareans in the country by providing information on reproductive rights, benefits and risks of childbirth, and use of intrapartum evidence-based practices (EBP) which are recommended by the World Health Organization (WHO) to improve childbirth outcomes and satisfaction. This study evaluates the impact of the SoB on pregnant women's perceived knowledge about normal birth (NB), cesarean, and use of EBP.

Methods: 1287 pregnant women answered a structured survey immediately after their visit to the intervention, between March 2015 and March 2016. To estimate the potential impact of the intervention on women's perceived knowledge, and possible associations between sociodemographic characteristics and perceived knowledge, statistical analyses were performed, including paired T-tests, ANOVA, and logistic and linear regressions.

Results: The mean score (MS) of perceived knowledge after the intervention was higher than the MS before experiencing the intervention for all three knowledge domains: Normal Birth (MS Before = 3.71 x MS After = 4.49), Cesarean (MS Before = 3.54 x MS After = 4.26) and EBPs (MS Before = 3.14 x MS After = 4.14). The results suggest that perceived knowledge increased more for low-income women (B = 0.206; p < 0.001 for EBP), women without private health insurance (OR 2.47, 95% CI: 1.49-4.09 for NB), with private prenatal care (OR 2.42, 95% CI: 1.59-3.66 for NB), experiencing their first pregnancy (OR 1.92, 95% CI: 1.31-2.82 for EBP; OR 1.37, 95% CI: 1.03-1.84 for NB; OR 1.37, 95% CI: 1.03-1.84 for cesarean), and in their first or second trimester (OR 1.64, 95% CI: 1.13-2.39 for EBP; OR 1.48, 95% CI: 1.11-1.97 for NB; OR 1.85, 95% CI: 1.40-2.41 for cesarean).

Conclusion: The study showed that participation in the SoB was associated with an increase in perceived knowledge among Brazilian pregnant women. The intervention gains relevance considering the lack of evidence of the impact of non-clinical interventions to reduce unnecessary cesareans in middle and low-income countries.
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http://dx.doi.org/10.1186/s12884-020-02874-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201865PMC
May 2020

Socioeconomic Differences in Trajectories of Functional Capacity Among Older Japanese: A 25-Year Longitudinal Study.

J Am Med Dir Assoc 2020 06 18;21(6):734-739.e1. Epub 2020 Apr 18.

Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan.

Objectives: There is limited research on long-term changes in functional capacity among older Japanese, who differ significantly from their counterparts in Western, developed nations. This study aimed to identify distinct trajectories of functional capacity over a 25-year period and to explore socioeconomic differences in trajectory-group membership probabilities, using a national sample of older Japanese.

Design: Longitudinal panel study with 8 observation points from 1987 to 2012.

Setting And Participants: The data came from the National Survey of the Japanese Elderly, which consisted of 6193 samples of community-dwelling Japanese aged 60 years and older at baseline.

Methods: Functional capacity measure included basic and instrumental activities of daily living. Group-based mixture models were used for data analysis.

Results: Among participants aged 60 to 74 years at baseline, 4 trajectories were identified: minimal disability (80.3%), late-onset disability (11.6%), early-onset disability (6.2%), and moderate disability (1.9%). Those aged ≥75 years at baseline experienced higher levels of disability but somewhat parallel trajectories, including minimal disability (73.3%), early-onset disability (11.2%), moderate disability (11.3%), and severe and worsening disability (4.2%). Lower socioeconomic status, including education and household income, was associated with a higher risk of experiencing trajectories of poorer functional capacity among those aged 60 to 74 years, but no such association existed among those aged ≥75 years.

Conclusions And Implications: We found that approximately 70% to 80% of older Japanese maintained healthy functional capacity over time. Although we could not follow those who dropped out during the observation period, this study provided useful evidence that socioeconomic disparities in functional health converge with age. Our findings inform the design of health policies and interventions aiming to maintain functional health among older adults with diverse socioeconomic backgrounds. In particular, public policies aiming to reduce socioeconomic disparities should be emphasized to promote healthy aging.
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http://dx.doi.org/10.1016/j.jamda.2020.02.012DOI Listing
June 2020

Impact of Extremely Hot Days on Emergency Department Visits for Cardiovascular Disease among Older Adults in New York State.

Int J Environ Res Public Health 2019 06 14;16(12). Epub 2019 Jun 14.

Department of Environmental Health Sciences, University at Albany School of Public Health, Rensselaer, NY 12144, USA.

Prior studies have reported the impact of ambient heat exposure on heat-related illnesses and mortality in summer, but few have assessed its effect on cardiovascular diseases (CVD) morbidity, and the association difference by demographics and season. This study examined how extremely hot days affected CVD-related emergency department (ED) visits among older adults from 2005-2013 in New York State. A time-stratified case-crossover design was used to assess the heat-CVD association in summer and transitional months (April-May and September-October). Daily mean temperature >95th percentile of regional monthly mean temperature was defined as an extremely hot day. Extremely hot days were found to be significantly associated with increased risk of CVD-related ED visits at lag day 5 (OR: 1.02, 95% CI: 1.01-1.04) and lag day 6 (OR: 1.01, 95% CI: 1.00-1.03) among older adults in summer after controlling for PM concentration, relative humidity, and barometric pressure. Specifically, there was a 7% increased risk of ischemic heart disease on the day of extreme heat, and increased risks of hypertension (4%) and cardiac dysrhythmias (6%) occurred on lag days 5 and 6, respectively. We also observed large geographic variations in the heat-CVD associations.
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http://dx.doi.org/10.3390/ijerph16122119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617208PMC
June 2019

Racial and Ethnic Disparities in the Association Between Adverse Childhood Experience, Perceived Discrimination and Body Mass Index in a National Sample of U.S. Older Adults.

J Nutr Gerontol Geriatr 2019 Jan-Mar;38(1):6-17. Epub 2019 Feb 27.

a School of Public Health , University at Albany, State University of New York , New York , NY , USA.

The current study evaluated whether there were racial/ethnic differences in the association between childhood adverse experience (ACEs), perceived racial discrimination (PRD), and body mass index (BMI) in a sample of middle age and older adults. We used data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (N = 11,404; ≥55 years) that included ACE and past year experiences with PRD. Generalized linear models were stratified by race/ethnicity (non-Hispanic White (NHW; n = 7337), non-Hispanic Black (NHB; n = 1960), and Hispanic (n = 1249)). The prevalence of ACE and PRD was significantly greater in NHB (63.6 and 29.8%, respectively) and Hispanic (61.2 and 15.9%, respectively), relative to NHW (53.1 and 4.6%, respectively). Across race/ethnicity, exposure to ACE's was associated with significantly greater odds of reporting PRD. Surprisingly, among Hispanics, exposure to ACE's was generally associated with lower BMI; however, this association was moderated by PRD in that BMI was highest among those with no ACE's and PRD, and lowest among those without ACE's or PRD. Similar, but not significant, trends were found for NHW's and NHB's. Our findings highlight the importance of screening for psychosocial adversity across the life course as risks factors for high BMI among middle age and older adults, particularly among Hispanics.
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http://dx.doi.org/10.1080/21551197.2019.1572569DOI Listing
May 2020

Age and gender differences in the association between body mass index and all-cause mortality among older Japanese.

Ethn Health 2020 08 4;25(6):874-887. Epub 2018 May 4.

Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.

Increasing evidence suggests a reverse J-shaped association between body mass index (BMI) and all-cause mortality among the older population. However, findings from non-Western societies including Japan are still sparse. Furthermore, little evidence regarding variation by age and gender in the BMI-mortality relationship in old age exists. This study aimed to examine age and gender variations in the relationship between BMI and all-cause mortality among older Japanese. Data came from a national representative sample of community-dwelling Japanese aged 60 years and older at baseline ( = 4,869). Participants were followed for up to 25 years. We categorized BMI into seven categories: < 18.5, 18.5-19.9, 20.0-21.4, 21.5-22.9, 23.0-24.9, 25.0-26.9, and ≥ 27.0. Cox proportional hazards models were used to assess the relative mortality risk associated with BMI categories. Lower BMI (< 18.5 and 18.5-19.9) was associated with higher mortality, compared to the mid-normal weight category (BMI: 21.5-22.9), after adjusting for covariates. In contrast, high-normal weight (BMI: 23.0-24.9) and overweight (BMI: 25.0-26.9 and ≥ 27.0) were not associated with mortality. Relative to old-old (aged ≥ 75 years), the higher mortality risk associated with lower BMI (< 20) appeared to be more prominent among young-old (aged 60-74 years). A moderately increased mortality risk associated with low BMI (18.5-19.9) was identified among men but not among women. Among older Japanese, low BMI (< 20.0) was associated with higher mortality, while high BMI (≥ 27.0) was not. The increased mortality risk associated with low BMI is more apparent among young-old and men. These age and gender differences need to be considered in assessing healthy body weight in old age.
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http://dx.doi.org/10.1080/13557858.2018.1469737DOI Listing
August 2020

Who Lives Alone During Old Age? Trends in the Social and Functional Disadvantages of Sweden's Solitary Living Older Adults.

Res Aging 2018 10 14;40(9):815-838. Epub 2017 Dec 14.

2 Aging Research Center, Karolinska Institutet, Solna, Sweden.

This study identifies specific social and functional disadvantages associated with living alone during old age in Sweden and assesses whether these associations have changed during recent decades. Data came from repeated cross-sectional surveys of Swedish adults aged 77+ during 1992-2014. Findings indicate that several types of disadvantage are consistently associated with the probability of living alone including financial insecurity and having never married for women and having never married and mobility impairment for men. Also for older men, low education has become an increasing strong determinant of living alone. These findings suggest that older adults who live alone are a subgroup that is particularly, and in some cases increasingly, vulnerable with respect to social and functional status. This has important policy implications related to addressing the needs of this growing subgroup as well as methodological implications for studies on the health effects of living alone.
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http://dx.doi.org/10.1177/0164027517747120DOI Listing
October 2018

Does the association between leisure activities and survival in old age differ by living arrangement?

J Epidemiol Community Health 2018 Jan 27;72(1):1-6. Epub 2017 Oct 27.

Center for Social and Demographic Analysis, School of Public Health, University at Albany, State University of New York, Albany, New York, USA.

Background: Government policies to promote ageing in place have led to a growing frail population living at home in advanced old age, many of whom live alone. Living alone in old age is associated with adverse health outcomes, but we know little about whether it moderates the health impact of other risk and protective factors. Engagement in leisure activities is considered critical to successful ageing. We investigated whether the association between different types of leisure activities and survival in non-institutionalised older adults (aged 76 and above) differs by living arrangement and gender.

Methods: We used the Swedish Panel Study of Living Conditions of the Oldest Old study from 2011 and the Swedish Cause of Death Register (until 30 June 2014) to conduct Cox regression analyses (n=669). Incident mortality was 30.2% during the follow-up period.

Results: Overall level of leisure activity was not significantly associated with survival in either living arrangement, but some specific leisure activities, and associations, were different across gender and living arrangement. More specifically, certain social activities (participation in organisations and having relatives visit) were associated with longer survival, but only in men living alone. In women, most results were statistically non-significant, with the exception of solving crosswords being associated with longer survival in women living with someone.

Conclusion: In order to facilitate engagement with life, interventions focusing on leisure activities in the oldest age groups should take gender and living arrangement into consideration when determining the type of activity most needed.
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http://dx.doi.org/10.1136/jech-2017-209614DOI Listing
January 2018

Heterogeneity in Trajectories of Body Mass Index and Their Associations with Mortality in Old Age: A Literature Review.

J Obes Metab Syndr 2017 Sep 30;26(3):181-187. Epub 2017 Sep 30.

Department of Health Policy, Management and Behavior, School of Public Health, State University of New York at Albany, NY, USA.

This article reviewed studies to investigate the association between trajectories of body mass index (BMI) and mortality among older adults. Investigators conducted a systematic search of published peer-reviewed literature in the PubMed database, and three articles that satisfied the inclusion criteria for the review were identified. All of these studies used group-based trajectory models to identify distinct BMI trajectories. Two studies were derived from the U.S. and used data from the Health and Retirement Study, with up to nine repeated observations. Most of the BMI trajectories in older Americans were increasing and fell primarily within the overweight and obese ranges. The other study was from Japan and used nationwide data, with up to seven repeated observations. BMI trajectories identified in the older Japanese were mostly decreasing and fell primarily within the normal weight range. Although the distribution of BMI trajectories was different between the two nations, the findings from these three studies consistently demonstrated that people with stable overweight trajectories had the lowest all-cause mortality rates in both countries. Beyond this, however, these studies suggested that priorities for weight control in old age should likely differ between Western and non-Western countries. Research regarding BMI trajectories and mortality in old age is very limited at present. Evidence from countries other than the U.S. and Japan is warranted in order to validate current findings and guide the development of local clinical and public health strategies for body weight management aimed at improving the health and survival of older adults.
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http://dx.doi.org/10.7570/jomes.2017.26.3.181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484918PMC
September 2017

Changes in health behaviors and the trajectory of body mass index among older Japanese: A 19-year longitudinal study.

Geriatr Gerontol Int 2017 Nov 9;17(11):2008-2016. Epub 2017 Mar 9.

Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.

Aim: Although the modification of lifestyle factors might facilitate weight control, the effects of health behaviors on the trajectory of bodyweight among older adults have been understudied. We examined the effect of changes in smoking, alcohol use and physical activity on the long-term trajectory of body mass index (BMI) among older Japanese adults.

Methods: Data came from a national sample of 4869 Japanese adults aged 60 years and older at baseline, with up to seven repeated observations over a period of 19 years (1987-2006). Hierarchical linear modeling was used to analyze the intrapersonal and interpersonal differences in BMI trajectory.

Results: The average BMI among older Japanese adults was 22.3 at baseline, and decreased with an accelerating rate over time. Smoking was significantly associated with lower BMI over time, whereas smoking cessation was associated with higher BMI. Drinking and physical activity were not associated with BMI. We found significant interactions between age and smoking status, and between sex and physical activity, on BMI trajectory: the association between smoking and lower BMI was stronger in younger participants compared with older participants. The association between physical activity and higher BMI was more pronounced among men compared with women.

Conclusion: The present findings yield important new information regarding the complex dynamics underlying the linkage between lifestyles factors and BMI trajectory among older Japanese, and suggest that there might be cross-cultural differences in these linkages. Geriatr Gerontol Int 2017; 17: 2008-2016.
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http://dx.doi.org/10.1111/ggi.13008DOI Listing
November 2017

Ethnic differences in all-cause and cardiovascular mortality by physical activity levels among older adults in the US.

Ethn Health 2018 01 9;23(1):72-80. Epub 2016 Nov 9.

h Department of Health Policy, Management and Behavior, School of Public Health and Center for Social and Demographic Analysis , University at Albany (SUNY) , Albany , NY , USA.

Aims: This study sought to determine whether the association between varying levels of physical activity (PA) and all-cause and cardiovascular mortality differ by race/ethnicity in older adults.

Methods: The sample comprised 2520 women and 2398 men drawn from National Health and Nutrition Examination Survey III (1988-1994) aged ≥ 60 years. We used the metabolic equivalent (MET) of self-reported PA levels to define activity groups (inactive: those who did not report any PA; active: those who reported 3-6 METs for ≥5 times/week or >6 METs, ≥3 times/week; insufficiently active: those meeting neither criteria). Racial/Ethnic differences were modeled using proportional hazard regression (HR) adjusting for age, education, smoking, diabetes, and hypertension.

Results: Among those classified as inactive, Non-Hispanic Blacks (NHB) (HR: 0.72, 95% CI: 0.58-0.90) and Mexican Americans (HR: 0.59, 95%CI: 0.45-0.78) had a lower risk of all-cause mortality when compared to non-Hispanic Whites (NHW). Among those classified as insufficiently active, Mexican Americans (HR: 0.63, 95% CI: 0.51-0.77), but not NHB (HR: 0.81, (95% CI: 0.64-1.02) had a lower risk of all-cause mortality when compared to NHWs Similar results were observed for cardiovascular mortality.

Conclusion: Overall, PA in the elderly (either insufficient or active) is associated with a lower all-cause mortality across all race/ethnic groups as compared to NHW. Further investigation, including studies with larger sample, is needed to address the health consequences of varying degrees of PA in ethnically diverse populations.
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http://dx.doi.org/10.1080/13557858.2016.1253830DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852666PMC
January 2018

Physical activity-related social control and social support in older adults: Cognitive and emotional pathways to physical activity.

J Health Psychol 2018 09 28;23(11):1389-1404. Epub 2016 Jul 28.

4 University of Wisconsin-Milwaukee, USA.

A survey of 217 older adults assessed physical activity-related positive and negative social control and emotional and informational support, using structural equation modeling to investigate mediational effects of emotional responses and behavioral intentions on physical activity. There were significant indirect effects of social control and social support on intentions as mediated by positive, but not negative, emotional responses, and significant indirect effects of emotional responses on physical activity as mediated by intentions. These findings help to identify the cognitive and emotional pathways by which social control and social support may promote or detract from physical activity in later life.
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http://dx.doi.org/10.1177/1359105316656768DOI Listing
September 2018

Smoking and Physical Inactivity as Predictors of Mobility Impairment During Late Life: Exploring Differential Vulnerability Across Education Level in Sweden.

J Gerontol B Psychol Sci Soc Sci 2018 04;73(4):675-683

Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, Rensselaer, New York.

Objectives: To test whether older adults from high and low educational groups are differentially vulnerable to the impact of smoking and physical inactivity on the progression of mobility impairment during old age.

Methods: A nationally representative sample of older Swedish adults (n = 1,311), aged 57-76 years at baseline (1991), were followed for up to 23 years (2014). Multilevel regression was used to estimate individual trajectories of mobility impairment over the study period and to test for differences in the progression of mobility impairment on the basis of smoking status, physical activity status, and level of education.

Results: Compared to nonsmokers, heavy smokers had higher levels and steeper increases in mobility impairment with advancing age. However, there were only small and statistically nonsignificant differences in the impact of heavy smoking on mobility impairment in high versus low education groups. A similar pattern of results was found for physical inactivity.

Discussion: Differential vulnerability to unhealthy behaviors may vary across populations, age, time-periods, and health outcomes. In this study of older adults in Sweden, low and high education groups did not differ significantly in their associations between heavy smoking or physical inactivity, and the progression of mobility impairment.
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http://dx.doi.org/10.1093/geronb/gbw090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018878PMC
April 2018

Racial/Ethnic Differences in Trajectories of Cognitive Function in Older Adults.

J Aging Health 2016 12 8;28(8):1382-1402. Epub 2016 Jul 8.

1 University at Albany, School of Public Health, Rensselaer, NY, USA.

Objective: The objective of this study is to (a) examine racial/ethnic differences in trajectories of cognitive function and (b) evaluate the role of education and health behaviors (physical activity [PA] and smoking) as mediators of racial/ethnic differences in the rate of decline in cognitive function in older adults.

Method: Data for this study came from the Health and Retirement Study ( n = 3,424). Hierarchical linear models were used to define the trajectory of cognitive function between 2002 and 2008. Participants were classified based on PA as non-vigorously active, intermittent vigorously active, and consistently vigorously active.

Results: After adding education, the Hispanic's and Black's disparities in cognitive performance were slightly attenuated (Hispanics, β = -1.049, p < .001; Blacks, β = -3.397, p < .001) but were still different from Whites. Smoking was not associated with the cognition intercept or rate of decline.

Discussion: We found education had a partial mediating effect on racial differences in levels of cognition but not on the rate of change over time.
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http://dx.doi.org/10.1177/0898264315620589DOI Listing
December 2016

A lifetime history of alcohol use disorder increases risk for chronic medical conditions after stable remission.

Drug Alcohol Depend 2015 Dec 13;157:68-74. Epub 2015 Oct 13.

School of Public Health, University at Albany, State University of New York, NY, United States.

Background: The long-term impact of a past alcohol use disorder (AUD) among those who are currently in stable remission has not been well-explored. This study examined whether a past history of AUD was associated with increased risk for chronic medical conditions in a large U.S. nationally representative sample of adults ≥30 years old.

Methods: Using 25,840 participants from Wave 1 and Wave 2 surveys of the National Epidemiologic Survey on Alcohol and Related Condition (NESARC), multiple logistic regression analysis was conducted to compare the risk for reporting metabolic, cardiovascular, liver, gastrointestinal, and inflammatory conditions between those in full-remission from AUD for longer than 5 years and those without a history of AUD diagnosis.

Results: Compared with a model adjusting only for age, a model adjusting for other potential psychosocial confounders revealed fewer significant associations between AUD history and chronic medical conditions, particularly for the middle-aged population and for men. For the elderly, AUD history was associated with more chronic medical conditions in fully adjusted models. AUD history was associated with severe medical conditions such as liver diseases and myocardial infarction in women. In general, longer AUD exposure and shorter remission were also associated with the risk for chronic medical conditions.

Conclusions: Our findings suggest associations between past AUD diagnosis and chronic medical conditions, particularly for the elderly individuals. Screening for past alcohol use problems and associated health risks are important for the promotion of aging and prevention of chronic medical conditions even when an individual presents no current symptoms of AUD.
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http://dx.doi.org/10.1016/j.drugalcdep.2015.10.008DOI Listing
December 2015

Trajectories of Body Mass Index and Their Associations With Mortality Among Older Japanese: Do They Differ From Those of Western Populations?

Am J Epidemiol 2015 Oct 12;182(7):597-605. Epub 2015 Sep 12.

Few studies have focused on the relationship between the trajectories of long-term changes in body mass index (BMI; weight (kg)/height (m)(2)) and all-cause mortality in old age, particularly in non-Western populations. We evaluated this association by applying group-based mixture models to data derived from the National Survey of the Japanese Elderly, which included 4,869 adults aged 60 or more years, with up to 7 repeated observations between 1987 and 2006. Four distinct BMI trajectories were identified: "low-normal weight, decreasing" (baseline BMI = 18.7; 23.8% of sample); "mid-normal weight, decreasing" (baseline BMI = 21.9; 44.6% of sample); "high-normal weight, decreasing" (baseline BMI = 24.8; 26.5% of sample); and "overweight, stable" (baseline BMI = 28.7; 5.2% of sample). Survival analysis with an average follow-up of 13.8 years showed that trajectories of higher BMI were associated with lower mortality. In particular, relative to those with a mid-normal weight, decreasing BMI trajectory, those with an overweight, stable BMI trajectory had the lowest mortality, and those with a low-normal, decreasing BMI trajectory had the highest mortality. In sharp contrast with prior observations from Western populations, BMI changes lie primarily within the normal-weight range, and virtually no older Japanese are obese. The association between BMI trajectories and mortality varies according to the distribution of BMI within the population.
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http://dx.doi.org/10.1093/aje/kwv107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4692978PMC
October 2015

The Role of Stress in Understanding Differences in Sedentary Behavior in Hispanic/Latino Adults: Results From the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study.

J Phys Act Health 2016 Mar 14;13(3):310-7. Epub 2015 Jul 14.

Dept of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, NY.

Background: Chronic stress and/or lifetime traumatic stress can create a self-reinforcing cycle of unhealthy behaviors, such as overeating and sedentary behavior, that can lead to further increases in stress. This study examined the relationship between stress and sedentary behavior in a sample of Hispanic/Latino adults (N = 4244) from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study.

Methods: Stress was measured as the number of ongoing difficulties lasting 6 months or more and as lifetime exposure to traumatic events. Sedentary behavior was measured by self-report and with accelerometer. Multivariable regression models examined associations of stress measures with time spent in sedentary behaviors adjusting by potential confounders.

Results: Those who reported more than one chronic stressor spent, on average, 8 to 10 additional minutes per day in objectively measured sedentary activities (P < .05), whereas those with more than one lifetime traumatic stressor spent (after we adjusted for confounders) 10 to 14 additional minutes in sedentary activities (P < .01) compared with those who did not report any stressors. Statistical interactions between the 2 stress measures and age or sex were not significant.

Conclusion: Interventions aimed at reducing sedentary behaviors might consider incorporating stress reduction into their approaches.
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http://dx.doi.org/10.1123/jpah.2014-0608DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985239PMC
March 2016

Racial Differences in Heart Failure Outcomes: Evidence From the Tele-HF Trial (Telemonitoring to Improve Heart Failure Outcomes).

JACC Heart Fail 2015 Jul;3(7):531-538

Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut.

Objectives: The purpose of this study was to determine whether there are racial differences in patient-reported health status as well as mortality and rehospitalization after hospitalization for heart failure (HF).

Background: Little is known about whether racial differences exist in patient-reported outcomes after HF hospitalization.

Methods: We analyzed data from 1,427 patients (636 non-Hispanic African Americans [45%]; 791 non-Hispanic whites [55%]) enrolled in the Tele-HF (Telemonitoring to Improve Heart Failure Outcomes) trial. Health status was measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ) at baseline and then at 3 and 6 months. Generalized linear mixed models and propensity score methods were used to adjust for clustering within sites and differences between races.

Results: Although black patients reported better adjusted health status at baseline (black vs. white difference in KCCQ summary scores was 6.22; 95% confidence interval [CI]: 2.98 to 9.46; p < 0.001), after adjusting for patient demographics, comorbidities, clinical laboratory values, and baseline KCCQ score, we detected no significant racial differences in patient-reported health status at 3 months (black vs. white difference in KCCQ score: 2.28; 95% CI: -0.84 to 5.41; p = 0.15) or 6 months (black vs. white difference in KCCQ score: 1.91; 95% CI: -1.31 to 5.13; p = 0.24).

Conclusions: Compared with white patients, black patients with HF had better patient-reported health status shortly after HF admission but not at 3 or 6 months. Our study failed to show that black patients were disadvantaged with regard to health status after HF hospitalization. (Tele-HF: Yale Heart Failure Telemonitoring Study; NCT00303212).
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http://dx.doi.org/10.1016/j.jchf.2015.03.005DOI Listing
July 2015

Characteristics, quality of care, and in-hospital outcomes of Asian-American heart failure patients: Findings from the American Heart Association Get With The Guidelines-Heart Failure Program.

Int J Cardiol 2015 9;189:141-7. Epub 2015 Apr 9.

VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, United States.

Background: Because little was previously known about Asian-American patients with heart failure (HF), we compared clinical profiles, quality of care, and outcomes between Asian-American and non-Hispanic white HF patients using data from the American Heart Association Get With The Guidelines-Heart Failure (GWTG-HF) program.

Methods: We analyzed 153,023 HF patients (149,249 whites, 97.5%; 3774 Asian-Americans, 2.5%) from 356 U.S. centers participating in the GWTG-HF program (2005-2012). Baseline characteristics, quality of care metrics, in-hospital mortality, discharge to home, and length of stay were examined.

Results: Relative to white patients, Asian-American HF patients were younger, more likely to be male, uninsured or covered by Medicaid, and recruited in the western region. They had higher prevalence of diabetes, hypertension, and renal insufficiency, but similar ejection fraction. Overall, Asian-American HF patients had comparable quality of care except that they were less likely to receive aldosterone antagonists at discharge (relative risk , 0.88; 95% confidence interval , 0.78-0.99), and anticoagulation for atrial fibrillation (RR, 0.91; 95% CI, 0.85-0.97) even after risk adjustment. Compared with white patients, Asian-American patients had comparable risk adjusted in-hospital mortality (RR, 1.11; 95% CI, 0.91-1.35), length of stay>4 days (RR, 1.01; 95% CI, 0.95-1.08), and were more likely to be discharged to home (RR, 1.08; 95% CI, 1.06-1.11).

Conclusions: Despite some differences in clinical profiles, Asian-American patients hospitalized with HF receive very similar quality of care and have comparable health outcomes to their white counterparts.
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http://dx.doi.org/10.1016/j.ijcard.2015.03.400DOI Listing
April 2016

Screening, brief intervention, and referral to treatment for adolescents: Attitudes, perceptions, and practice of New York school-based health center providers.

Subst Abus 2016 16;37(1):161-7. Epub 2015 Mar 16.

b School of Social Welfare , State University of New York at Albany , Albany , New York , USA.

Background: Screening, brief intervention, and referral to treatment (SBIRT) has been endorsed by the American Academy of Pediatrics as an evidence-based strategy to address risky substance use among adolescents in primary care. However, less than half of pediatricians even screen adolescents for substance use. The purpose of this study was to identify variation in SBIRT practice and explore how program directors' and clinicians' attitudes and perceptions of effectiveness, role responsibility, and self-efficacy impact SBIRT adoption, implementation, and practice in school-based health centers (SBHCs).

Methods: All 162 New York State SBHC program directors and clinicians serving middle and high school students were surveyed between May and June of 2013 (40% response rate).

Results: Only 22% of participants reported practicing the SBIRT model. Of the individual SBIRT model components, using a standardized tool to screen students for risky substance use, referring students with substance use problems to specialty treatment, and assessing students' readiness to change were practiced least frequently. Less than 30% of participants felt they could be effective at helping students reduce substance use, 63% did not believe it was their role to use a standardized screening tool, and 20-30% did not feel confident performing specific aspects of intervention and management. Each of these factors was correlated with SBIRT practice frequency (P < .05).

Conclusions: Findings from this study identify an important gap between an evidence-based SBIRT model and its adoption into practice within SBHCs, indicating a need for dissemination strategies targeting role responsibility, self-efficacy, and clinicians' perceptions of SBIRT effectiveness.
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http://dx.doi.org/10.1080/08897077.2015.1015703DOI Listing
January 2017

Socioeconomic Status and the Trajectory of Body Mass Index Among Older Japanese: A Nationwide Cohort Study of 1987-2006.

J Gerontol B Psychol Sci Soc Sci 2016 Mar 10;71(2):378-88. Epub 2015 Jan 10.

Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan.

Objectives: This research analyzed the body mass index (BMI) level and rate of change, and their association with socioeconomic status among older Japanese adults.

Methods: Data came from a national sample of over 4,800 Japanese adults aged 60 and older at baseline, with up to 7 repeated observations over a period of 19 years (1987-2006). Hierarchical linear modeling was used to analyze the intrapersonal and interpersonal differences in BMI.

Results: Average BMI among older Japanese was 22.26 at baseline and decreased with an accelerating rate over time. Relative to those with less education, BMI among older Japanese with more education was lower and it declined linearly at a faster rate over time. In contrast, higher household income at baseline was associated with a higher level of BMI but similar rates of decline over time. Furthermore, we found no evidence for age variations in the SES-BMI linkage as predicted by prior investigators.

Discussion: These findings provide new insights into the complex relationship between socioeconomic factors and BMI, and help to inform the design of health policies and interventions related to weight control among older adults with diverse socioeconomic backgrounds.
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http://dx.doi.org/10.1093/geronb/gbu183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5926508PMC
March 2016

Lifecourse Socioeconomic Position and Racial Disparities in BMI Trajectories among Black and White Women: Exploring Cohort Effects in the Americans Changing Lives' Study.

J Racial Ethn Health Disparities 2014 Dec;1(4):309-318

School of Public Health, University at Albany, SUNY, Rensselaer, NY ; Bassett Research Institute, Cooperstown, NY.

Introduction: Few studies have analyzed the cohort effects of lifecourse socioeconomic position (SEP) on racial disparities in body mass index (BMI) trajectories. We assessed the contribution of lifecourse SEP on racial differences in BMI trajectories among two different age cohorts of women.

Methods: Four waves of the Americans' Changing Lives' study (1986-2002) were used to compute BMI trajectories for 2194 Black and White women. Multivariable associations of lifecourse SEP variables (father's education, perceived childhood family status, education, income, wealth and financial security) with Wave 1(W1) BMI and BMI change were assessed using mixed models.

Results: Black women had higher W1 BMI than White women in both cohorts (women <40 years in 1986 (+2.6 kg/m (95%CI: +1.71, +3.53)) and women>=40 in 1986 (+2.68 kg/m (95%CI:+2.12,3.24))); Black women in the younger cohort had a higher change in BMI (+0.73 kg/m/year (95%CI:+0.17,+1.29)). High education was associated with lower W1 BMI in both cohorts (-1.34 (95%CI:-2.53,-0.15) and -1.08 kg/m (95%CI:-0.50,-1.65), respectively). Among the younger cohort, high income was associated with lower W1 BMI (-0.78kg/m/unit log income (95%CI:-1.32,-0.25)) while among the older cohort, high father's education (-0.78 kg/m (95%CI:-0.06,-1.50)) and higher wealth (-0.26 kg/m(95%CI:-0.43,-0.08))were associated with low W1 BMI. Racial disparities in W1 BMI were attenuated by 20-25% while those for BMI change remained unexplained on adjustment for lifecourse SEP.

Conclusion: In this large population-based dataset, results suggest that the contribution of lifecourse SEP to racial disparities in BMI may be established early in adulthood.
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http://dx.doi.org/10.1007/s40615-014-0038-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4262791PMC
December 2014

Smoking and physical inactivity patterns during midlife as predictors of all-cause mortality and disability: A 39-year prospective study.

Eur J Ageing 2014 Sep;11(3):195-204

Aging Research Center, Karolinska Institutet/Stockholm University, Gävlegatan 16, 113 30 Stockholm, Sweden,

This study estimated the long-term mortality hazards and disability risks associated with various combinations of smoking and physical inactivity measured over time in a sample of middle-aged adults. Data came from a national sample of Swedish adults, originally interviewed in 1968 and followed until 2007 (N=1,682). Smoking and physical activity status were measured at baseline and 13 years later (1981). Different patterns of change and stability in smoking and physical inactivity over this 13 year period were used as predictors of mortality through 2007. Also, associations between different patterns of these health behaviors and the odds of disability (measured in 2004) were estimated among survivors (n=925). Results suggest that mortality rates were elevated among persistent (HR=1.7; 95% CI=1.5, 2.0) and new smokers (HR=2.5; 95% CI=1.6, 4.1), but not among discontinued smokers. However, mortality rates remained elevated among discontinued smokers who were also persistently inactive (HR=1.9; 95% CI=1.3, 2.6). Additional findings suggest that persistent physical inactivity during midlife was associated with increased odds of late-life disability (OR=1.8; 95% CI=1.1, 2.7), but that smoking had no clear additive or multiplicative effects on disability. As such, these findings indicate that while persistent smoking during midlife primarily impacts subsequent mortality, persistent physical inactivity during midlife appears to counteract the survival benefits of smoking cessation, while also imposing a long-term risk on late life disability among those who do survive to old age.
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http://dx.doi.org/10.1007/s10433-013-0298-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4191664PMC
September 2014

Lifecourse socioeconomic position and 16 year body mass index trajectories: differences by race and sex.

Prev Med 2014 Oct 24;67:17-23. Epub 2014 Jun 24.

University at Albany, State University of New York, Albany, NY, United States; Bassett Research Institute, Cooperstown, NY, United States.

Objective: The aim of this study is to evaluate the association between lifecourse socioeconomic position (SEP) and changes in body mass index (BMI), and assess disparities in these associations across racial/ethnic groups.

Methods: With longitudinal data from 4 waves of the Americans' Changing Lives Study (1986-2002), we employed mixed-effects modeling to estimate BMI trajectories for 1174 Blacks and 2323 White adults. We also estimated associations between these trajectories and lifecourse SEP variables, including father's education, perceived childhood SEP, own education, income, wealth, and financial security.

Results: Blacks had higher baseline BMIs, and steeper increases in BMI, compared to Whites. Childhood SEP, as measured by high father's education, was associated with lower baseline BMI among Whites. High education was associated with a lower baseline BMI within both race and sex categories. Income had contrasting effects among men and women. Higher income was associated with higher BMI only among males. Associations between indicators of SEP and BMI trajectories were only found for Whites.

Conclusions: Our study demonstrates that lifecourse SEP may influence adult BMI differently within different racial and sex groups.
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http://dx.doi.org/10.1016/j.ypmed.2014.06.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167219PMC
October 2014

Impact of obesity and physical activity on functional outcomes in the elderly: data from NHANES 2005-2010.

J Aging Health 2014 Sep 9;26(6):1032-46. Epub 2014 Jun 9.

University at Albany, School of Public Health, State University of New York, Albany, NY, USA.

Objective: The objective of this study was to (a) to examine whether the association between obesity and physical functioning among older adults is moderated by physical activity (PA) and (b) to test whether this moderating effect varies by gender.

Method: Data from adults (aged >60 years) who participated in the National Health and Nutrition Examination Surveys (2005-2010) were analyzed. Using multivariate logistic regression, we estimated the prevalence ratio (PR) of functional limitations and impairment in activities of daily living and instrumental activities of daily living, by body mass index and PA, while adjusting for age, educational level, and a comorbidity index.

Results: The sample included 5,304 subjects (mean age = 70.4 years), and 50.5% were female. Overweight and obesity were associated with higher levels of functional limitations when compared with normal weight individuals regardless of the PA status (PR = 1.47, 95% confidence interval [CI] [1.17, 1.85], and PR = 2.71, 95% CI [2.00, 3.67], respectively) even after adjustment for confounders.

Discussion: Overweight and obesity are associated with impairment in functional outcomes irrespective of PA.
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http://dx.doi.org/10.1177/0898264314535635DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4429890PMC
September 2014

Social and economic conditions in childhood and the progression of functional health problems from midlife into old age.

J Epidemiol Community Health 2014 Aug 23;68(8):734-40. Epub 2014 Apr 23.

Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden.

Background: Childhood living conditions have been found to predict health and mortality in midlife and in old age. This study examines the associations between social and economic childhood conditions and the onset and progression of functional health problems from midlife into old age, and the extent to which potential associations are mediated by educational attainment and smoking.

Methods: Data from the Level of Living Survey and the Swedish Panel Study of Living Conditions of the Oldest Old were merged to create a longitudinal data set with five repeated measures from 1968 to 2004 (n=1765, aged 30-50 years and free from functional health problems at baseline). Multilevel regression models were used to analyse retrospective reports of social and economic conditions in childhood (eg, conflicts or economic problems in the family) in relation to the progression of functional health problems over the 36-year period.

Results: Results showed that social and economic disadvantages in childhood were associated with an earlier onset and a faster progression of functional health problems from midlife into old age. Subsequent models showed that differences in educational attainment, but not smoking, explained much of the association between childhood disadvantages and trajectories of functional health problems.

Conclusions: According to these results, adverse social and economic conditions in childhood affect the development of functional health problems from midlife into old age indirectly through less favourable life careers, including lower education. Creating equal opportunities for educational attainment may help reduce the long-term effects of disadvantaged childhood conditions and postpone functional health problems.
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http://dx.doi.org/10.1136/jech-2013-203698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112427PMC
August 2014