Publications by authors named "Ichiro Kawachi"

846 Publications

Variability in daily or weekly working hours and self-reported mental health problems in Korea, Korean working condition survey, 2017.

Arch Public Health 2021 Feb 27;79(1):25. Epub 2021 Feb 27.

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Background: Working hour regulation in Korea is being revised to allow increasing variability in number of working hours. We sought to investigate the association between variability in the number of daily or weekly working hours with or without long working hours (> 52 h/w) and mental health among South Korean workers.

Methods: We used data from 28,345 full-time, non-shift employed workers working more than 30 h per week participating in the Korean Working Condition Survey in 2017. We defined six groups according to variability in daily or weekly working hours (same number vs different number) and weekly working hours (31-40, 41-52, > 52 h per week). Odds ratios (ORs) and confidence intervals (CIs) for self-reported depressive symptoms and anxiety were calculated using workers with same number of working hours/31-40 h per week as the reference.

Results: Variability in number of work hours every day or week combined with > 52 working hours per week showed the highest risk of depressive symptoms (OR = 5.13, 95% CI 3.25-8.11) and anxiety (OR = 3.75, 95% CI 2.39-5.88) compared to the reference group, controlling for age, sex, education, occupation, industry, salary, workers' choice of working hours and overtime payment. Workers working ≤52 h/w were adversely impacted by variable working hours as well.

Conclusions: Variable daily or weekly working hours were associated with poorer self-reported depressive and anxiety symptoms in Korea, among full-time and non-shift workers. Reform of the Korean Labor Standards Act warrants consideration.
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http://dx.doi.org/10.1186/s13690-021-00545-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912832PMC
February 2021

Dispositional Optimism and Disaster Resilience: A natural experiment from the 2011 Great East Japan Earthquake and Tsunami.

Soc Sci Med 2021 Feb 13;273:113777. Epub 2021 Feb 13.

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA.

Objective: Dispositional optimism - the general belief that good things will happen - is considered a key asset for the preservation of mental health after a traumatic life event. However, it has been hypothesized that in extreme situations such as major disasters where positive expectations cannot overcome the grim reality on the ground, being optimistic might be a disadvantage. To test this mismatch hypothesis, this study explores whether higher pre-disaster dispositional optimism is associated with higher posttraumatic stress (PTS) and depressive symptoms among individuals who experienced the 2011 Great East Japan Earthquake and Tsunami.

Methods: Information on optimism was collected from community-dwelling residents aged ≥65 years seven months before the 2011 Earthquake/Tsunami in Iwanuma, a Japanese city located 80-km from the epicenter. Data on disaster-related personal experiences (e.g., loss of relatives or friends/housing damage), as well as depressive and PTS symptoms, were collected during a follow-up survey in 2013, 2.5 years after the earthquake and tsunami. Multiple logistic regression models were utilized to evaluate the associations between disaster experiences, optimism, and depressive/PTS symptoms among 962 participants.

Results: Higher pre-disaster dispositional optimism was associated with lower odds of developing depressive symptoms (OR = 0.78, 95% CI: 0.65 to 0.95) and PTS symptoms (OR = 0.83, 95% CI: 0.69 to 0.99) after the earthquake. Contrary to the mismatch hypothesis, high dispositional optimism buffered the adverse impact of housing damage on depressive symptoms (interaction term coefficient = -0.63, p = 0.0431), but not on PTS symptoms.

Conclusions: In contrast to the mismatch hypothesis, the results suggest that dispositional optimism is a resilience resource among survivors of a disaster.
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http://dx.doi.org/10.1016/j.socscimed.2021.113777DOI Listing
February 2021

Prospective Study of Engagement in Leisure Activities and All-Cause Mortality Among Older Japanese Adults.

J Epidemiol 2021 Feb 6. Epub 2021 Feb 6.

Harvard T.H. Chan School of Public Health.

Background: Engagement in leisure activities among older people is associated with a lower risk of mortality. However, no studies have been conducted focusing on the difference of associations with mortality risk among multiple types of leisure activities.

Methods: We examined prospectively the association of engagement in leisure activities with all-cause mortality in a cohort of older Japanese adults. The Japan Gerontological Evaluation Study included 48,216 participants aged 65 years or older. During a mean follow-up period of 5.6 years, we observed 5,575 deaths (11.6%). We investigated the total number of leisure activities, as well as combinations of 25 different leisure activities with Cox proportional hazards models, adjusting for potential confounding factors.

Results: We found a linear relationship between the total number of leisure activities and mortality hazard (adjusted hazard ratio 0.93; 95% CI, 0.92-0.95). Furthermore, engagement in leisure activities involving physical activity, as well as group-based interactions, showed the strongest associations with lowered mortality. By contrast, engagement in cultural leisure activities and solitary leisure activities were not associated with all-cause mortality.

Conclusions: Although we cannot rule out residual confounding, our findings suggest that encouraging engagement in physically-active group-based leisure activities may promote longevity in older adults.
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http://dx.doi.org/10.2188/jea.JE20200427DOI Listing
February 2021

Age differences in secular trends in black-white disparities in mortality from systemic lupus erythematosus among women in the United States from 1988 to 2017.

Lupus 2021 Feb 3:961203321988936. Epub 2021 Feb 3.

Department of Public Health, National Cheng Kung University, Tainan, Taiwan.

Objective: To examine the age differences in secular trends in black-white disparities in mortality from systemic lupus erythematosus (SLE) among women in the United States from 1988 to 2017.

Methods: We used mortality data to calculate age-specific SLE and all-causes (as reference) mortality rates and black/white mortality rates ratios among women from 1988 to 2017. Annual percent change was estimated using joinpoint regression analysis.

Results: We identified 10,793 and 4,165,613 black women and 19,455 and 31,129,528 white women who died between 1988 and 2017 from SLE and all-causes, respectively. The black/white SLE mortality rate ratio according joinpoint regression model was 6.6, 7.2, 4.4, and 1.4 for decedents aged 0-24, 25-44, 45-64, and 65+ years in 1988 and was 7.2, 5.9, 4.1, and 1.9, respectively in 2017. No significant decline trend was noted and the annual percent change was 0.3%, -0.7%, -0.2%, and 1.0%, respectively. On the contrast, the black/white all-causes mortality rate ratio was 2.0, 2.5, 1.8, and 1.0, respectively in 1988 and was 1.7, 1.3, 1.5, and 0.9, respectively in 2017, a significant decline trend was noted in each age group.

Conclusions: Black adults, youths and adolescents had four to seven times higher SLE mortality rates than their white counterparts and the black-white disparities persisted during the past three decades. On the contrast, black women had less than two times higher all-causes mortality rates than their white counterparts and black-white disparities significantly diminish during the past three decades.
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http://dx.doi.org/10.1177/0961203321988936DOI Listing
February 2021

The relative contributions of behavioral, biological, and psychological risk factors in the association between psychosocial stress and all-cause mortality among middle- and older-aged adults in the USA.

Geroscience 2021 Jan 28. Epub 2021 Jan 28.

Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA, 02138, USA.

Evidence of an association between psychosocial stress and mortality continues to accumulate. However, despite repeated calls in the literature for further examination into the physiological and behavioral pathways though which stress affects health and mortality, research on this topic remains limited. This study addresses this gap by employing a counterfactual-based mediation analysis of eight behavioral, biological, and psychological pathways often hypothesized to play a role in the association between stress and health. First, we calculated the survival rate of all-cause mortality associated with cumulative psychosocial stress (high vs. low/moderate) using random effects accelerated failure time models among a sample of 7108 adults from the Midlife in the United States panel study. Then, we conducted a multiple mediator mediation analysis utilizing a counterfactual regression framework to determine the relative contributions of each mediator and all mediators combined in the association between stress and mortality. Exposure to high psychosocial stress was associated with a 0.76 times reduced survival rate over the follow-up period 1995-2015, while adjusting for age, sex, race, income, education, baseline health, and study design effects. The mediators accounted for 49% of this association. In particular, smoking, sedentary behavior, obesity/BMI, and cardiovascular disease displayed significant indirect effects and accounted for the largest reductions in the total effect of stress on mortality, with natural indirect effects of 14%, 12%, 11%, and 4%, respectively. In conclusion, traditional behavioral and biological risk factors play a significant role in the association between psychosocial stress and mortality among middle and older adults in the US context. While eliminating stress and the socioeconomic disparities that so often deliver people into high-stress scenarios should be the ultimate goal, public health interventions addressing smoking cessation, physical activity promotion, and cardiovascular disease treatment may pay dividends for preventing premature mortality in the near-term.
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http://dx.doi.org/10.1007/s11357-020-00319-5DOI Listing
January 2021

The Direct and Indirect Relationships of Environmental, Interpersonal and Personal Factors with High School Students Physical Activity: An Ecological Approach.

Int J Environ Res Public Health 2021 Jan 20;18(3). Epub 2021 Jan 20.

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA.

Background: Across countries, young people are not sufficiently physically active. The evidence confirms that beyond demographic and individual agents, individuals participate within their social and physical environment. The ecological model enables a search for the modifiable factors in specific populations, as it allows consideration of factors affecting individuals' lives on different levels, as well as considering the interplay of those factors. The aim of this study was to examine the complex interconnections among environmental, social capital and motivational factors at different levels, within an ecological model for high school students' moderate-to-vigorous physical activity during their leisure time.

Methods: This cross-sectional population-based study included 1285 students from 14 to 18 years old, with a mean age of 16.14 ± 1.22. Physical activity, neighborhood physical activity recourses, neighborhood safety, social capital, physical activity motivation and sociodemographic factors were evaluated. Logistic regression, mediation and moderation analyses were performed predicting moderate-to-vigorous physical activity during leisure time.

Results: In the final multivariate logistic regression model, greater social participation (OR 1.03 [1.01-1.05]), higher relative autonomy index (OR 1.11 [1.06-1.15]) and male gender (OR 1.71 [1.13-2.57]) directly predicted meeting MVPA recommendations. Any significant moderation effects ( > 0.05) of environmental characteristics were not found for the relationship between social capital, motivational factors and moderate-to-vigorous physical activity. The evidence of positive indirect mediation effects was found in all five models for social capital components as all CIs for its βs do not contain 0, though standardized effect sizes were between 0.02 and 0.07, indicating small effect sizes.

Conclusion: These findings provide support for the presence of some direct and indirect pathways from social capital to moderate-to-vigorous physical activity. Future intervention strategies should focus on strengthening physical activity motivation by encouraging the development of social network and social participation as well as family, neighborhood and school social capital within the framework of the ecological model.
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http://dx.doi.org/10.3390/ijerph18030874DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908480PMC
January 2021

Multilevel Social Mechanisms of Post-Disaster Depression.

Int J Environ Res Public Health 2021 Jan 6;18(2). Epub 2021 Jan 6.

HealthNet TPO, Department of Research and Development, 1074 VJ Amsterdam, The Netherlands.

This exploratory study empirically shows how community social capital is related to post-disaster depression, whereas most disaster mental health research has focused on posttraumatic stress disorder. We tested the validity of earlier found multilevel social and individual mechanisms of posttraumatic stress for symptoms of post-disaster depression. We used data (n = 231) from a community study after a flood in Morpeth (2008), a rural town in northern England. At the salutary community level, our multilevel analyses showed that, in communities with high social capital, individuals employ less individual social support and coping effort, which protects individuals from developing symptoms of depression. Yet, on the 'dark' individual level of our model, we found that perceiving the disaster as less traumatic after a year was related to more feelings of depression in contrast to previous findings for posttraumatic stress. Our explanation of this finding is that, when the appraisal of the disaster as threatening fades into the background, individuals may perceive the full scope of the disaster aftermath and start to feel depressed. We also found that more social support is related to more depression. Although depressed people may attract or receive more social support, this social support can paradoxically become disabling by reinforcing a sense of dependence, thereby undermining self-esteem and leading to feelings of helplessness. Our results imply that to curb post-disaster depression, boosting community level social capital may be an important starting point for building resilience. At the same time, interventionists need to identify risk groups for whom the stressful experience becomes less intrusive and who experience the burden of dependency on an unequal relationship with ones' social inner circle.
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http://dx.doi.org/10.3390/ijerph18020391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825536PMC
January 2021

Association Between Maternal Working Status and Unintentional Injuries Among 3 to 4-Month-Old Infants in Japan.

Matern Child Health J 2021 Jan 7. Epub 2021 Jan 7.

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Objectives: Globally, unintentional injuries are one of the leading causes of infant death. Established risk factors for injuries during infancy include single parent households, socioeconomic disadvantage and maternal postpartum depression. We sought to examine whether maternal working status is associated with unintentional injury among infants in Japan.

Methods: We used data from an original questionnaire targeting mothers who participated in a 3 or 4-month health check-up program in Aichi prefecture, Japan. Experience of any type of unintentional injury was used as the primary outcome, and we also examined the experience of "falls" and "near-drowning" as secondary outcomes. We conducted multivariable logistic regression analysis, adjusting for covariates. We also performed propensity score matching in order to balance covariates between paid employment and unpaid employment groups.

Results: Among 6,465 valid responses (response rate, 67%), 9.8% of infants experienced unintentional injuries. After matching on propensity for maternal employment (based on 26 covariates), we found that infants of mothers in paid employment were 1.35 times (95% CI: 1.04-1.74) more likely to experience injures, including 1.60 times higher likelihood of falls (95% CI: 1.14-2.24). Near-drowning was not significantly associated with maternal employment. We also found that father's employment status was positively associated with risk of falls.

Conclusion: Both multivariable logistic analysis and propensity score matching analysis revealed that maternal paid employment status was associated with unintentional injuries among Japanese infants. To prevent infant injuries, comprehensive support for working families should be considered.
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http://dx.doi.org/10.1007/s10995-020-03083-2DOI Listing
January 2021

Social inequality and the syndemic of chronic disease and COVID-19: county-level analysis in the USA.

J Epidemiol Community Health 2021 Jan 5. Epub 2021 Jan 5.

UCL Institute of Health Equity, University College London, London, UK.

Background: Given the effect of chronic diseases on risk of severe COVID-19 infection, the present pandemic may have a particularly profound impact on socially disadvantaged counties.

Methods: Counties in the USA were categorised into five groups by level of social vulnerability, using the Social Vulnerability Index (a widely used measure of social disadvantage) developed by the US Centers for Disease Control and Prevention. The incidence and mortality from COVID-19, and the prevalence of major chronic conditions were calculated relative to the least vulnerable quintile using Poisson regression models.

Results: Among 3141 counties, there were 5 010 496 cases and 161 058 deaths from COVID-19 by 10 August 2020. Relative to the least vulnerable quintile, counties in the most vulnerable quintile had twice the rates of COVID-19 cases and deaths (rate ratios 2.11 (95% CI 1.97 to 2.26) and 2.42 (95% CI 2.22 to 2.64), respectively). Similarly, the prevalence of major chronic conditions was 24%-41% higher in the most vulnerable counties. Geographical clustering of counties with high COVID-19 mortality, high chronic disease prevalence and high social vulnerability was found, especially in southern USA.

Conclusion: Some counties are experiencing a confluence of epidemics from COVID-19 and chronic diseases in the context of social disadvantage. Such counties are likely to require enhanced public health and social support.
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http://dx.doi.org/10.1136/jech-2020-215626DOI Listing
January 2021

Six-year follow-up study of residential displacement and health outcomes following the 2011 Japan Earthquake and Tsunami.

Proc Natl Acad Sci U S A 2021 Jan;118(2)

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115.

Studies examining the long-term health consequences of residential displacement following large-scale disasters remain sparse. Following the 2011 Japan Earthquake and Tsunami, victims who lost their homes were resettled by two primary means: 1) group relocation to public housing or 2) individual relocation, in which victims moved into public housing by lottery or arranged for their own accommodation. Little is known about how the specific method of residential relocation affects survivors' health. We examined the association between residential relocation and long-term changes in mental and physical well-being. Our baseline assessment predated the disaster by 7 mo. Two follow-up surveys were conducted ∼2.5 y and 5.5 y after the disaster to ascertain the long-term association between housing arrangement and health status. Group relocation was associated with increased body mass index and depressive symptoms at 2.5-y follow-up but was no longer significantly associated with these outcomes at 5.5-y follow-up. Individual relocation at each follow-up survey was associated with lower instrumental activities of daily living as well as higher risk of cognitive impairment. Our findings underscore the potential complexity of long-term outcomes associated with residential displacement, indicating both positive and negative impacts on mental versus physical dimensions of health.
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http://dx.doi.org/10.1073/pnas.2014226118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812822PMC
January 2021

Delay discounting in children exposed to disaster.

PLoS One 2020 30;15(12):e0243994. Epub 2020 Dec 30.

Department of Social and Behaviroral Science, Harvard School of Public Health, Boston, Massachusetts.

Delay discounting is an important predictor of future health and academic success in children but can change in environmental uncertainty situations. Here we show that the experience of loss of housing in the Great East Japan Earthquake 2011-but not other psychological trauma such as loss of loved ones-was correlated delay discounting of children. In 2014, we assessed delay discounting in children (N = 167; mean age = 8.3 years-old), who were preschool age at the time of the earthquake (mean age at the time of disaster = 4.8 years-old) in a time-investment exercise where children allocated five tokens between rewards "now" (one candy per token on the same day) versus "one month later" (two candies per token one month later). The number of tokens allocated for "now" was higher by 0.535 (95% confidence interval: -0.012, 1.081) in children who had their housing destroyed or flooded than those with no housing damage. Other types of traumatic experiences were not associated with delay discounting.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243994PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773199PMC
February 2021

Can Online Communication Prevent Depression Among Older People? A Longitudinal Analysis.

J Appl Gerontol 2020 Dec 24:733464820982147. Epub 2020 Dec 24.

Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Evidence on the association between internet usage and incidence of depression remains mixed. We examined the associations between different categories of internet usage and developing clinical depression. We used data from the 2013 and 2016 waves of the Japan Gerontological Evaluation Study (JAGES) comprising 12,333 physically and cognitively independent adults aged ≥65 years. Participants were engaged in seven categories of internet usage: communication with friends/family, social media, information collection about health/medicine, searching for medical facilities, purchase of drugs and vitamins, shopping, and banking. We found that internet use for communication had a protective influence on the probability of developing clinical depression defined as the Geriatric Depression Scale scores ≥5 or self-reported diagnosed depression. Our findings support the role of online communication with friends/family in preventing clinical depression among older people. Online communication could be particularly useful in the COVID-19 crisis because many families are geographically dispersed and/or socially distanced.
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http://dx.doi.org/10.1177/0733464820982147DOI Listing
December 2020

Neighborhood Social Cohesion and Sleep Health by Age, Sex/Gender, and Race/Ethnicity in the United States.

Int J Environ Res Public Health 2020 12 17;17(24). Epub 2020 Dec 17.

Epidemiology Branch, National Institute of Environmental Health Sciences, National Institute of Health, Department of Health and Human Services, Research Triangle Park, Durham, NC 27709, USA.

Although low neighborhood social cohesion (nSC) has been linked with poor sleep, studies of racially/ethnically diverse participants using multiple sleep dimensions remain sparse. Using National Health Interview Survey data, we examined overall, age, sex/gender, and racial/ethnic-specific associations between nSC and sleep health among 167,153 adults. Self-reported nSC was categorized into low, medium, and high. Very short sleep duration was defined as <6 hours; short as <7 h, recommended as 7-9 h, and long as ≥9 h. Sleep disturbances were assessed based on trouble falling and staying asleep, waking up feeling unrested, and using sleep medication (all ≥3 days/times in the previous week). Adjusting for sociodemographics and other confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for sleep dimensions by low and medium vs. high nSC. The mean age of the sample was 47 ± 0.1 years, 52% of those included were women, and 69% were Non-Hispanic (NH)-White. Low vs. high nSC was associated with a higher prevalence of very short sleep (PR = 1.29; (95% CI = 1.23-1.36)). After adjustment, low vs. high nSC was associated with very short sleep duration among NH-White (PR = 1.34 (95% CI = 1.26-1.43)) and NH-Black (PR = 1.14 (95% CI = 1.02-1.28)) adults. Low nSC was associated with shorter sleep duration and sleep disturbances.
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http://dx.doi.org/10.3390/ijerph17249475DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767208PMC
December 2020

Did Expanded Dental Insurance Improve Chewing Ability in the Older Korean Population? Results of an Interrupted Time-Series Analysis.

J Epidemiol 2020 Dec 19. Epub 2020 Dec 19.

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health.

Background: In 2012, the Korean National Health Insurance extended its coverage to include denture services for older adults. We examined whether the new policy resulted in improved chewing ability in the eligible population.

Method: We used interrupted time-series (ITS) analysis, a quasi-experimental design, to analyze the effect of the policy. We used data from the Korea National Health and Nutrition Examination Survey conducted from 2007 to 2016-2018. The study population consisted of two groups: the treatment group, aged 65 years or older and eligible for the dental insurance benefit; and the control group, those younger than 65 years and ineligible. The main evaluated outcome was self-reported chewing difficulty.

Results: The ITS analysis showed that chewing difficulty decreased annually by 0.93% (95% CI -1.30 to -0.55) and 0.38% (95% CI -0.59 to -0.16) after the policy extension in the older than 65 and younger than 65 groups, respectively. However, we could not conclude that the insurance extension affected chewing difficulty because there was a decrease in the control group as well.

Conclusions: Chewing ability improved in both older and younger adults regardless of dental insurance coverage for older adults. Other exogenous factors probably led to the improvements in chewing ability as well as dental insurance benefits.
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http://dx.doi.org/10.2188/jea.JE20200417DOI Listing
December 2020

Impact of Decreased Night Work on Workers' Musculoskeletal Symptoms: A Quasi-Experimental Intervention Study.

Int J Environ Res Public Health 2020 12 5;17(23). Epub 2020 Dec 5.

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.

A possible association between night shift work and musculoskeletal disorder has been suggested. This study aimed to evaluate the impact of decreased night work on musculoskeletal pain. Difference-in-difference estimation was used to compare changes in musculoskeletal pain between shift workers ( = 122) and non-shift workers ( = 170) in a manufacturing company before and after the introduction of a new shift system eliminating overnight work. Musculoskeletal pain was measured by a questionnaire asking if workers had symptoms in specific body parts, including the neck, shoulder, arm/elbow, wrist/hand, back, and leg/foot, over the past year. Generalized estimating equation models were used to estimate changes in pre- versus post-intervention musculoskeletal pain rates between the treated and control group. In the difference-in-difference (DID) models, prevalence of musculoskeletal pain for shoulder (-10.3%), arm (-12.9%), all sites combined (-9.2%), and upper extremity combined (-14.8%) showed significant decreases from pre- to post-intervention among the treated group (shift workers) compared to the control group (non-shift workers) after controlling for age and weekly working hours. Decreasing night work was related to improvement in musculoskeletal pain in shift workers.
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http://dx.doi.org/10.3390/ijerph17239092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730522PMC
December 2020

Depression, smoking, and lung cancer risk over 24 years among women.

Psychol Med 2020 Dec 3:1-10. Epub 2020 Dec 3.

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA.

Background: Studies evaluating depression's role in lung cancer risk revealed contradictory findings, partly because of the small number of cases, short follow-up periods, and failure to account for key covariates including smoking exposure. We investigated the association of depressive symptoms with lung cancer risk in a large prospective cohort over 24 years while considering the role of smoking.

Methods: Women from the Nurses' Health Study completed measures of depressive symptoms, sociodemographics, and other factors including smoking in 1992 (N = 42 913). Depressive symptoms were also queried in 1996 and 2000, whereas regular antidepressant use and physician-diagnosed depression were collected starting in 1996. Multivariable Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of lung cancer risk until 2016.

Results: We identified 1009 cases of lung cancer. Women with the highest v. lowest level of depressive symptoms had an increased lung cancer risk (HRsociodemographics-adjusted = 1.62, 95% CI 1.34-1.95; HRfully-adjusted = 1.25, 95% CI 1.04-1.51). In a test of mediation, lifetime pack-years of smoking accounted for 38% of the overall association between depressive symptoms and disease risk. When stratifying by smoking status, the elevated risk was evident among former smokers but not current or never smokers; however, the interaction term suggested no meaningful differences across groups (p = 0.29). Results were similar or stronger when considering time-updated depression status (using depressive symptoms, physician diagnosis, and regular antidepressant use) and chronicity of depressive symptoms.

Conclusions: These findings suggest that greater depressive symptoms may contribute to lung cancer incidence, directly and indirectly via smoking habits, which accounted for over a third of the association.
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http://dx.doi.org/10.1017/S0033291720004390DOI Listing
December 2020

The Consumption of Sweets and Academic Performance among Mongolian Children.

Int J Environ Res Public Health 2020 11 30;17(23). Epub 2020 Nov 30.

Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.

The regular consumption of sweets has been shown to have an adverse association with the academic performance of children in developed countries; however, the situation in developing countries is less clear. Therefore, we examined the association between the consumption of sweets and academic performance among Mongolian children via a cross-sectional study employing data from 787 children aged 8-16 from two public schools in Ulaanbaatar, the capital of Mongolia. The frequency of the consumption of sweets by the children was captured using a questionnaire and then linked to their academic scores; the association between the consumption of sweets and scores in mathematics and the Mongolian language was evaluated using multiple linear regression adjusted for other covariates. It was found that out of 787 students, 58.6% ate sweets every day. After adjusting for covariates, no significant association was observed between the consumption of sweets and mathematics scores (coefficient: 0.15; 95% confidence interval (CI): -0.02-0.32), while a higher consumption of sweets was significantly associated with higher scores in the Mongolian language (coefficient: 0.25; 95% CI: 0.09-0.41). The associations established in this study are inconsistent with the reports of other studies.
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http://dx.doi.org/10.3390/ijerph17238912DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7729965PMC
November 2020

The role of cortisol in ischemic heart disease, ischemic stroke, type 2 diabetes, and cardiovascular disease risk factors: a bi-directional Mendelian randomization study.

BMC Med 2020 11 27;18(1):363. Epub 2020 Nov 27.

School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Hong Kong Special Administrative Region, China.

Background: Cortisol, a steroid hormone frequently used as a biomarker of stress, is associated with cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). To clarify whether cortisol causes these outcomes, we assessed the role of cortisol in ischemic heart disease (IHD), ischemic stroke, T2DM, and CVD risk factors using a bi-directional Mendelian randomization (MR) study.

Methods: Single nucleotide polymorphisms (SNPs) strongly (P < 5 × 10) and independently (r < 0.001) predicting cortisol were obtained from the CORtisol NETwork (CORNET) consortium (n = 12,597) and two metabolomics genome-wide association studies (GWAS) (n = 7824 and n = 2049). They were applied to GWAS of the primary outcomes (IHD, ischemic stroke and T2DM) and secondary outcomes (adiposity, glycemic traits, blood pressure and lipids) to obtain estimates using inverse variance weighting, with weighted median, MR-Egger, and MR-PRESSO as sensitivity analyses. Conversely, SNPs predicting IHD, ischemic stroke, and T2DM were applied to the cortisol GWAS.

Results: Genetically predicted cortisol (based on 6 SNPs from CORNET; F-statistic = 28.3) was not associated with IHD (odds ratio (OR) 0.98 per 1 unit increase in log-transformed cortisol, 95% confidence interval (CI) 0.93-1.03), ischemic stroke (0.99, 95% CI 0.91-1.08), T2DM (1.00, 95% CI 0.96-1.04), or CVD risk factors. Genetically predicted IHD, ischemic stroke, and T2DM were not associated with cortisol.

Conclusions: Contrary to observational studies, genetically predicted cortisol was unrelated to IHD, ischemic stroke, T2DM, or CVD risk factors, or vice versa. Our MR results find no evidence that cortisol plays a role in cardiovascular risk, casting doubts on the cortisol-related pathway, although replication is warranted.
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http://dx.doi.org/10.1186/s12916-020-01831-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694946PMC
November 2020

Association of community level social trust and reciprocity with mortality: a retrospective cohort study.

BMC Public Health 2020 Nov 25;20(1):1793. Epub 2020 Nov 25.

Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea.

Background: Whether community level social capital is associated with mortality within an Asian population is yet unclear.

Methods: The study population was derived from the Korean National Health Insurance Service-National Sample Cohort. A total of 636,055 participants were followed-up during 2012-2013 for deaths from all causes, cardiovascular disease (CVD), cancer, and other causes. Community level social trust and reciprocity at the administrative district level were derived from the Korean Community Health Survey. Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for mortality according to levels of community level social trust and reciprocity.

Results: Compared to participants who reside in areas within the lower half of community level social trust, those who reside in areas within the upper half had lower risk of death from all causes (aHR 0.84, 95% CI 0.78-0.89), CVD (aHR 0.82, 95% CI 0.67-0.99), and cancer (aHR 0.85, 95% CI 0.73-0.98). Similarly, residing in areas in the upper half of community level social reciprocity was associated with reduced risk for all-cause mortality (aHR 0.80, 95% CI 0.75-0.86). The protective association of high community level social trust and reciprocity on mortality remained after additional adjustments for smoking, alcohol intake, and physical activity.

Conclusions: Residing in areas with high community level social trust and reciprocity may be associated with better population health status.
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http://dx.doi.org/10.1186/s12889-020-09944-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690021PMC
November 2020

Insurance coverage expansion and inequalities in unmet oral healthcare needs in Korea: Repeated cross-sectional analysis, 2007-2015.

Community Dent Oral Epidemiol 2020 Nov 11. Epub 2020 Nov 11.

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Objectives: This study aimed to evaluate whether Korea's 2012 health insurance expansion of adult dental care coverage reduced income-based oral health inequalities.

Methods: This study analysed nationally representative repeated cross-sectional data from waves IV to VI (2007-2015) of the Korean National Health and Nutrition Examination Survey. The main outcome variable is unmet dental needs due to cost, and the independent variable is household income. Further, the slope index of inequality (SII) and the relative index of inequality (RII) were calculated. Calculations were adjusted for income and stratified by age group, gender and survey period. Data from the three waves were pooled to estimate the SII and RII trend coefficients between survey years. These were tested using two-way interaction terms for each age group and gender.

Results: Some changes in income-based inequality trends were identified. Relative and absolute inequalities in unmet needs (indicated by the RII and SII) decreased over time for most age groups. However, this trend was not observed for older women.

Conclusions: Income-based inequalities in unmet dental needs persisted among older women in Korea despite the insurance expansion. By contrast, after the 2012 insurance expansion, the absolute and relative inequality in unmet dental needs decreased for young and middle-aged as well as older adults.
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http://dx.doi.org/10.1111/cdoe.12594DOI Listing
November 2020

Evaluation of Trust Within a Community After Survivor Relocation Following the Great East Japan Earthquake and Tsunami.

JAMA Netw Open 2020 11 2;3(11):e2021166. Epub 2020 Nov 2.

Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.

Importance: Trust is a core component of social cohesion, facilitating cooperation and collective action in the face of adversity and enabling survivors to remain resilient. Residential stability is an important prerequisite of developing trusting relations among community members. However, little is known about whether the movement of internally displaced persons (IDPs) after a disaster might change community relations.

Objective: We explored perceived changes in trust within 1 community directly impacted by the 2011 Great East Japan Earthquake and Tsunami.

Design, Setting, And Participants: This prospective cohort study examined survey data from 3594 residents of Iwanuma City, Japan, aged 65 years or older. Data were obtained from the Iwanuma Study-part of the Japan Gerontological Evaluation Study, a nationwide cohort study established in 2010-approximately 7 months before the disaster. All Iwanuma City residents age 65 years or older (8576 residents) were eligible to participate in 2010. The response rate was 59.0% (5058 residents). A follow-up survey was conducted in 2013, approximately 2.5 years after the disaster. Of the 4380 remaining participants who answered the baseline survey, 3594 were recontacted (follow-up rate, 82.1%). Data analysis was performed from July 1, 2019, to January 9, 2020.

Exposures: The number of temporarily relocated Iwanuma City survivors within 100 m and 250 m of a nonrelocated resident's home address.

Main Outcomes And Measures: Perceived changes in particularized trust (ie, trusting people from the same community) and generalized trust (trusting people from other communities) measured on a 5-point Likert scale.

Results: Among 3250 nonrelocated residents (1808 [55.6%] women; mean [SD] age, 76.5 [6.2] years) of Iwanuma City included in the analytic sample, multivariable-adjusted multinomial logistic regression analyses found that each standard deviation increase in the influx of internally displaced persons (1 SD = 11 IDPs) within 250 m of a resident's home address was associated with higher odds of a decrease in the resident's particularized and generalized trust (odds ratio, 1.17; 95% CI, 1.04-1.32).

Conclusions And Relevance: The influx of IDPs in the host community appeared to be associated with an erosion of trust among locals. To avoid the erosion of social cohesion after a disaster, it may be crucial to provide opportunities for social interaction between old and new residents of communities.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.21166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7645695PMC
November 2020

Changes In Coverage And Access To Dental Care Five Years After ACA Medicaid Expansion.

Health Aff (Millwood) 2020 Nov;39(11):1900-1908

Ichiro Kawachi is the John L. Loeb and Frances Lehman Professor of Social Epidemiology in the Department of Social and Behavioral Sciences at the Harvard T. H. Chan School of Public Health.

With the implementation of the Affordable Care Act (ACA), millions of low-income adults gained health coverage. We examined how the ACA's expansion of Medicaid eligibility affected dental coverage and the use of oral health services among low-income adults, using data from the National Health Interview Survey from the period 2010-18. We found that the ACA increased rates of dental coverage by 18.9 percentage points in states that provide dental benefits through Medicaid. In terms of utilization, expansion states that provide dental benefits saw the greatest increase in people having a dental visit in the past year (7.2 percentage points). However, there was no significant change in the overall share of people who had a dental visit in the past year, although the expansion was associated with a significant increase in this metric among White adults. The expansion was also associated with a 1.4-percentage-point increase in complete teeth loss, which may be a marker of both poor oral health and the potential gaining of access to dental services (with subsequent tooth extractions). Our findings suggest that in addition to expanded coverage, policies need to tackle other barriers to accessing dental care to improve population oral health.
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http://dx.doi.org/10.1377/hlthaff.2020.00386DOI Listing
November 2020

Disparities in the Diagnosis and Treatment of Gastric Cancer in Relation to Disabilities.

Clin Transl Gastroenterol 2020 Oct;11(10):e00242

1Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University, Cheongju, Korea; 2Supportive Care Center/Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; 3Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea; 4College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea; 5Department of Public Health and Preventive Medicine, Chungbuk National University Hospital, Cheongju, Korea; 6Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts, USA; 7Big Data Steering Department, National Health Insurance Service, Wonju, Korea.

Introduction: We investigated potential disparities in the diagnosis, treatment, and survival of gastric cancer (GC) patients with and without disabilities.

Methods: We linked Korean National Disability Registry data with the Korean National Health Insurance database and Korean Central Cancer Registry data. This study included a total of 16,849 people with disabilities and 58,872 age- and sex-matched control subjects in whom GC had been diagnosed.

Results: When compared to GC patients without disabilities, patients with disabilities tended to be diagnosed at a later stage (localized stage 53.7% vs 59.0% or stage unknown 10.7% vs 6.9%), especially those with severe disabilities (P < 0.001). This was more evident in patients with mental impairment (localized stage 41.7% and stage unknown 15.2%). In addition, not receiving treatment was more common in patients with disabilities than those without disabilities (29.3% vs 27.2%, P < 0.001), and this disparity was more evident in those with severe disabilities (35.4%) and in those with communication (36.9%) and mental (32.3%) impairment. Patients with disabilities were at slightly higher risk of overall mortality as well as GC-specific mortality compared to people without disabilities (adjusted hazard ratio [aHR] = 1.18, 95% confidence interval: 1.14-1.21 and aHR = 1.12, 95% confidence interval: 1.09-1.16, respectively), and these disparities were more pronounced in those with severe disabilities (aHR = 1.62 and 1.51, respectively).

Discussion: Patients with disabilities, especially severe disabilities, were diagnosed with GC at a later stage, received less staging evaluation and treatment, and their overall survival rate was slightly worse compared to those without disabilities.
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http://dx.doi.org/10.14309/ctg.0000000000000242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7544185PMC
October 2020

The link between unemployment and opioid prescribing. An instrumental variable approach using evidence from England.

J Epidemiol Community Health 2020 Oct 22. Epub 2020 Oct 22.

Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.

Background: Unemployment has been associated with chronic pain, which is often treated with prescription opioids. Opioid mortality has been included in the so-called category of 'deaths of despair' due to the role of lack of opportunity. While previous studies have found an association between unemployment and opioids, the relationship is endogenous and examining any effect is challenging.

Objective: The objective of this paper is to study the association between unemployment and opioid prescribing in England.

Data And Methods: We used data from the GP prescribing database in England for the period 2011-2017 and followed ordinary least squares (OLS) and Instrumental Variable econometric approaches, controlling for other confounders. We used the number of foreign direct investment projects and the number of registered companies as instruments for unemployment, taking population size into account.

Results: The OLS model suggests that an increase in the unemployment rate by 1 percentage point is associated with 0.017 additional opioid defined daily doses per capita-a 0.9% increase compared with the mean of 1.745. According to the instrumental variable model, an increase in unemployment by 1 percentage point leads to an increase in the number of opioid doses prescribed per capita by between 0.315 and 0.437, which constitutes a 18-25% increase compared with the mean of 1.745.

Conclusions: Unemployment appears to have an impact on opioid prescribing volume in England. This reveals yet another negative effect of unemployment on health. Relevant labour market policies may play a protective role with regards to opioid use.
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http://dx.doi.org/10.1136/jech-2020-213897DOI Listing
October 2020

Causal effect of deteriorating socioeconomic circumstances on new-onset arthritis and the moderating role of access to medical care: A natural experiment from the 2011 great east Japan earthquake and tsunami.

Soc Sci Med 2020 11 25;264:113385. Epub 2020 Sep 25.

Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Miyagi, Japan.

Socioeconomic disadvantage is a risk factor for arthritis, but its causal relationship remains unclear. This study examined the causal relationship between socioeconomic circumstances and new-onset arthritis by taking advantage of the "natural experiment" that resulted from the Great East Japan Earthquake and Tsunami. The baseline survey was conducted in August 2010, 7 months before the disaster. Self-reported questionnaires were mailed to all eligible residents of Iwanuma City in Miyagi Prefecture. The earthquake and tsunami occurred on March 11, 2011. The follow-up survey was conducted in October 2013, as well as the gathering of information about disaster damage (housing damage and subjective deterioration of economic circumstances) and health-related information. We used a two-stage least squares instrumental variable model to analyze 2360 survivors who did not have arthrosis at baseline, of whom 95 (4.0%) developed arthritis over the 2.5-year follow-up period. We used the linear probability model for the estimations. Our results revealed that both the subjective deterioration of economic circumstances and housing damage were associated with the development of arthritis (95% confidence interval [CI], 0.08 [0.03-0.12] and 0.02 [0.01-0.04], respectively). In addition, we also found that the disruption of access to orthopedics was associated with the development of arthritis. Our findings added robust evidence of the causal relationship between worsening economic circumstances and the development of arthritis. Our study emphasized the importance of recovery as well as the establishment of the post-disaster orthopedic medical system in the aftermath of a disaster.
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http://dx.doi.org/10.1016/j.socscimed.2020.113385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577562PMC
November 2020

Mediation of the relationship between home loss and worsened cardiometabolic profiles of older disaster survivors by post-disaster relocation: A natural experiment from the Great East Japan earthquake and tsunami.

Health Place 2020 Nov 1;66:102456. Epub 2020 Oct 1.

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

The underlying mechanism for deterioration in cardiometabolic health after major natural disasters is unknown. We leveraged natural experiment data stemming from the 2011 Great East Japan Earthquake and Tsunami (n = 1165) to examine whether specific types of post-disaster accommodations explain the association between disaster-related property damage and objectively measured cardiometabolic profiles of older disaster survivors. Causal mediation analysis showed that relocation to trailer-style temporary shelters largely mediated the associations between home loss and unhealthy changes in anthropometric measures (72.6% of 0.65 kg/m for body mass index and 62.3% of 3.89 cm for waist circumference), but it did not mediate the associations with serum lipid measures. This study demonstrates that there are outcome-specific pathways linking disaster damage and health of survivors.
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http://dx.doi.org/10.1016/j.healthplace.2020.102456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686264PMC
November 2020

Cardiometabolic Profiles and Change in Neighborhood Food and Built Environment Among Older Adults: A Natural Experiment.

Epidemiology 2020 11;31(6):758-767

From the Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.

Background: The association between neighborhood environment and health may be biased due to confounding by residential self-selection. The displacement of disaster victims can act as a natural experiment that exposes residents to neighborhood environments they did not select, allowing for the study of neighborhood effects on health.

Methods: We leveraged data from a cohort of older adults 65 years of age or older living in Iwanuma, Japan, located 80 km west of the 2011 Great East Japan Earthquake and Tsunami. Surveys were conducted 7 months before the disaster, as well as 2.5 and 5.5 years afterward, and linked with medical records. We classified each individual's type of exposure to neighborhood environment based on proximity to local food and recreation destinations and walkability.

Results: Fixed-effect models indicated that change in the exposure type from low to high urban density was associated with increased body mass index (0.46 kg/m; 95% confidence interval [CI] = 0.20, 0.73), waist circumference (1.8 cm; 95% CI = 0.56, 3.0), low-density lipoprotein cholesterol (11 mg/dl; 95% CI = 5.0, 17), and decreased high-density lipoprotein cholesterol (-3.1 mg/dl; 95% CI = -5.0, -1.3). We observed similar trends when we analyzed only the individuals who experienced postdisaster relocation to temporary homes.

Conclusions: Increased proximity to food outlets was simultaneously correlated with greater walkability and accessibility to recreational destinations; however, any protective association of physical activity-promoting built environment appeared to be offset by proximity to unhealthy food outlets, especially fast-food restaurants and bars.
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http://dx.doi.org/10.1097/EDE.0000000000001243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534567PMC
November 2020

Experiences of discrimination and self-reported health in Chinese migrants: a structural equation model.

BMC Public Health 2020 Sep 29;20(1):1477. Epub 2020 Sep 29.

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA.

Background: Many migrants suffer from discrimination and poor health in China. We sought to examine the associations between experiences of discrimination and self-reported health among internal migrants in China, as well as the mediators of social integration and perceived stress.

Methods: The data was obtained from a specific survey of migrants, as a part of the National Health and Family Planning Dynamic Monitoring for Migrants conducted in 2014. A total of 15,999 migrants aged 15 to 59 years were recruited by a stratified, multistage clustered sampling procedure in eight Chinese cities. Structural Equation Modeling (SEM) was conducted.

Results: The results indicated that experiences of discrimination were associated with worse self-reported health (β = - 0.32, P < 0.001), less social integration (β = - 0.25, P < 0.001), as well as higher perceived stress (β = 0.21, P < 0.01). Both objectively measured socioeconomic status (β = 0.21, P < 0.001) and subjective social status (β = 0.21, P < 0.01) had significantly positive correlations with self-reported health.

Conclusions: The discrimination, social exclusion and perceived stress experienced by migrants have significant implications on their health.
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http://dx.doi.org/10.1186/s12889-020-09588-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7526124PMC
September 2020

COVID-19 and the 'rediscovery' of health inequities.

Authors:
Ichiro Kawachi

Int J Epidemiol 2020 10;49(5):1415-1418

Harvard T.H. Chan School of Public Health, Boston, MA, USA.

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http://dx.doi.org/10.1093/ije/dyaa159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543525PMC
October 2020

Cultural engagement and incidence of cognitive impairment: A six-year longitudinal follow-up of the Japan Gerontological Evaluation Study (JAGES).

J Epidemiol 2020 Sep 19. Epub 2020 Sep 19.

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health.

Background: Active engagement in intellectually enriching activities reportedly lowers the risk of cognitive decline; however, few studies have examined this association, including engagement in traditional cultural activities. This study aimed to elucidate the types of cultural engagement associated with lower risk of cognitive impairment.

Methods: We examined the association between cultural engagement and cognitive impairment using Cox proportional hazards models in a cohort of 44,985 participants (20,772 males and 24,213 females) aged 65 years or older of the Japan Gerontological Evaluation Study from 2010 to 2016. Intellectual activities (e.g., reading books, magazines, and/or newspapers), creative activities (e.g., crafts and painting), and traditional cultural activities (e.g., poetry composition [haiku], calligraphy, and tea ceremony/flower arrangement) were included among cultural engagement activities.

Results: Over a follow-up period of six years, incident cognitive disability was observed in 4,198 respondents (9.3%). After adjusting for potential confounders such as depression and social support, intellectual activities were protectively associated with the risk of cognitive impairment (hazard ratio, HR for those who read and stated that reading was their hobby: 0.75 [95% confidence interval, CI 0.66-0.85] and those who read but did not consider reading a hobby: 0.72 [95% CI, 0.65-0.80]). Engagement in creative activities was also significantly correlated with lower risk of cognitive impairment (crafts: 0.71 [95% CI, 0.62-0.81] and painting: 0.80 [95% CI, 0.66-0.96]). The association between traditional cultural activities and the risk of cognitive impairment was not statistically significant.

Conclusions: Engagement in intellectual and creative activities may be associated with reduced risk of dementia.
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http://dx.doi.org/10.2188/jea.JE20190337DOI Listing
September 2020