Ssm-Population Health最新文献

{"title":"Effects of economic empowerment and relationship strengthening intervention on financial behaviors among couples living with HIV: The Mlambe pilot trial in Malawi","authors":"Lakshmi Gopalakrishnan ,&nbsp;Nancy Mulauzi ,&nbsp;James Mkandawire ,&nbsp;Fred M. Ssewamala ,&nbsp;Scott Tebbetts ,&nbsp;Torsten B. Neilands ,&nbsp;Amy A. Conroy","doi":"10.1016/j.ssmph.2025.101768","DOIUrl":"10.1016/j.ssmph.2025.101768","url":null,"abstract":"<div><h3>Introduction</h3><div>Economic insecurity, relationship issues, and gender-based financial disparities pose significant challenges for couples living with HIV in sub-Saharan Africa, potentially undermining treatment adherence and health outcomes. We evaluated <em>Mlambe</em>, an integrated economic empowerment with relationship strengthening intervention for couples living with HIV.</div></div><div><h3>Methods</h3><div>We conducted a pilot randomized controlled trial in Zomba, Malawi with 78 married couples (156 individuals) living with HIV and reporting unhealthy alcohol use based on the AUDIT-C. Couples were recruited from HIV care clinics and randomized to either the <em>Mlambe</em> intervention (n = 39 couples) or enhanced usual care (EUC) control (n = 39 couples). The 10-month <em>Mlambe</em> intervention combined incentivized savings accounts, financial literacy education, relationship education, and couples' counseling. EUC included brief alcohol counseling. We used linear mixed-effects models to evaluate <em>Mlambe's</em> impact on (i) confidence to save, (ii) attitudes towards savings, (iii) equitable financial decision-making.</div></div><div><h3>Results</h3><div>At 10 months follow-up, participants in the <em>Mlambe</em> intervention showed significantly higher confidence to save compared to EUC (coefficient = 0.18, 95% CI: 0.05, 0.32, p &lt; 0.001), with women having greater improvements than men (p &lt; 0.001). However, these effects were not sustained at 15 months. No significant differences were observed between arms in attitudes towards savings. Participants in the intervention showed greater equitable financial decision-making at 10 months (coefficient = 0.13, 95%CI: 0.11, 0.25; p = 0.03) compared to EUC, with effects sustained at 15-months (coefficient = 0.21, 95% CI: 0.11, 0.32, p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Our findings suggest that <em>Mlambe</em> intervention holds promise, underscoring the benefits of an integrated economic and relationship strengthening interventions among HIV-affected couples.</div></div><div><h3>Clinical trial number</h3><div>NCT04906616</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"29 ","pages":"Article 101768"},"PeriodicalIF":3.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccination decisions and social capital in Japan","authors":"Toshihiro Okubo ,&nbsp;Ilan Noy","doi":"10.1016/j.ssmph.2025.101769","DOIUrl":"10.1016/j.ssmph.2025.101769","url":null,"abstract":"<div><div>The COVID-19 vaccines played a pivotal role in safeguarding many people. Yet, vaccine hesitancy remained a significant barrier to increasing coverage rates, as many high-income countries faced prolonged vaccine refusal campaigns. In Japan, vaccine doses were administered under a reservation system accessible via a website and by phone. Achieving a high vaccination coverage for a vaccine that was offered at no financial cost was surprisingly difficult in Japan as well. In many countries, vaccine hesitancy during the pandemic has been closely related to people's trust in their governments given governments' controversial social distancing mandates. In Japan, lockdowns were voluntary, and vaccinations were also not mandated. As there were no significant political conflicts about the government's policies, vaccination acceptance was influenced by more basic tenets, and we focus here on social capital, defined as cohesive links that enable a society to function effectively. Social capital, in this context, refers to community trust, collaboration, and engagement that create social bonds between individuals and society. Using a uniquely large survey, administered repeatedly through the years of the pandemic, we mostly find support, for the hypothesis that social capital matters for the vaccination decision; and that it matters even once we control for institutional trust (especially trust in the medical system). However, this general association between trust in other community members, belief in the willingness of community members to engage in reciprocal assistance, and belief in the more general willingness of the community to support individuals, were all associated differently with the vaccination decision, and with the views expressed about the vaccinations. From a policy perspective, this suggests that intra-community trust (i.e., bonding social capital), is important even in contexts when trust in governmental is not a significant concern.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"30 ","pages":"Article 101769"},"PeriodicalIF":3.6,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variance partition that eludes intuition","authors":"Jay S. Kaufman","doi":"10.1016/j.ssmph.2025.101763","DOIUrl":"10.1016/j.ssmph.2025.101763","url":null,"abstract":"","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"29 ","pages":"Article 101763"},"PeriodicalIF":3.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Life course exposure to work strain and cognitive disparities by race and ethnicity","authors":"Mara Getz Sheftel ,&nbsp;Noreen Goldman ,&nbsp;Anne R. Pebley ,&nbsp;Boriana Pratt ,&nbsp;Sung S. Park","doi":"10.1016/j.ssmph.2025.101765","DOIUrl":"10.1016/j.ssmph.2025.101765","url":null,"abstract":"<div><div>There is a well-documented association between exposure to occupational strain and adverse older adult cognition. However, limited research examines differences in this association by race and ethnicity despite considerable disparities in older adult cognition and occupational segregation in the U.S. Using work history data from the U.S. Health and Retirement Study (HRS), we construct comprehensive measures of exposure to occupational strain over working ages and assess differential exposure to cumulative strain, and variation in the association between strain and cognition by race and ethnicity. We find that Black and Latino workers in the U.S. have more exposure to high strain jobs across working ages, and that this type of work history is associated with lower cognitive functioning at older ages. This analysis suggests that occupational segregation and unequal exposure to psychosocial work characteristics are critical social determinants of cognitive health disparities in older adulthood.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"29 ","pages":"Article 101765"},"PeriodicalIF":3.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mediating factors in the association between educational attainment and stroke: A mendelian randomization study","authors":"Nuo Xu ,&nbsp;Yiwen Qiu ,&nbsp;Diliyaer Ainiwan ,&nbsp;Boya Wang ,&nbsp;Xialidan Alifu ,&nbsp;Haibo Zhou ,&nbsp;Haoyue Cheng ,&nbsp;Ye Huang ,&nbsp;Libi Zhang ,&nbsp;Hui Liu ,&nbsp;Lina Yu ,&nbsp;Yunxian Yu","doi":"10.1016/j.ssmph.2025.101766","DOIUrl":"10.1016/j.ssmph.2025.101766","url":null,"abstract":"<div><h3>Background</h3><div>Stroke is a common cardiovascular and cerebrovascular disease with high disability and mortality. Lower educational attainment has been reported to be associated with an increased risk of stroke, but it is unclear which pathways mediate this association.</div></div><div><h3>Methods</h3><div>Using genome-wide association studies (GWAS) based on European ancestry, we performed two-sample Mendelian randomization (MR) analyses to investigate the causal association of genetically estimated educational attainment with stroke and its subtypes. Then, we used mediation analyses to assess the extent to which seven cardiometabolic risk factors alone and in combination explain their effects.</div></div><div><h3>Results</h3><div>Genetically estimated educational attainment was negatively associated with the risk of any stroke (AS), any ischemic stroke (AIS), ischemic stroke subtypes (large artery stroke [LAS], cardioembolic stroke [CES], and small vessel stroke [SVS]), and hemorrhagic stroke subtypes (cerebral hemorrhage [ICH] and subarachnoid hemorrhage [SAH]). For individual mediating effects, type 2 diabetes, hypertension, hyperlipidemia, and smoking mediated the impact of education on AS, AIS, and ischemic stroke subtypes, while obesity, NAFLD, and alcohol consumption played no role. For combined mediation, the proportion of the association that cardiometabolic mediators explained ranged from 4% (95% CI: 2.72%–5.27%) for SVS to 38.73% (95% CI: 37.42%–40.05%) for LAS. Nevertheless, they did not account for any of the estimates for hemorrhagic stroke subtypes.</div></div><div><h3>Conclusion</h3><div>Higher educational attainment would have a protective effect on stroke and its subtypes, and cardiometabolic risk factors mediated part proportion of this association. Hence, patients with low education should pay more attention to managing cardiometabolic diseases to prevent stroke.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"29 ","pages":"Article 101766"},"PeriodicalIF":3.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An overview of modern machine learning methods for effect measure modification analyses in high-dimensional settings","authors":"Michael Cheung,&nbsp;Anna Dimitrova,&nbsp;Tarik Benmarhnia","doi":"10.1016/j.ssmph.2025.101764","DOIUrl":"10.1016/j.ssmph.2025.101764","url":null,"abstract":"<div><div>A primary concern of public health researchers involves identifying and quantifying heterogeneous exposure effects across population subgroups. Understanding the magnitude and direction of these effects on a given scale provides researchers the ability to recommend policy prescriptions and assess the external validity of findings. Traditional methods for effect measure modification analyses require manual model specification that is often impractical or not feasible to conduct in high-dimensional settings. Recent developments in machine learning aim to solve this issue by utilizing data-driven approaches to estimate heterogeneous exposure effects. However, these methods do not directly identify effect modifiers and estimate corresponding subgroup effects. Consequently, additional analysis techniques are required to use these methods in the context of effect measure modification analyses. While no data-driven method or technique can identify effect modifiers and domain expertise is still required, they may serve an important role in the discovery of vulnerable subgroups when prior knowledge is not available. We summarize and provide the intuition behind these machine learning methods and discuss how they may be employed for effect measure modification analyses to serve as a reference for public health researchers. We discuss their implementation in R with annotated syntax and demonstrate their application by assessing the heterogeneous effects of drought on stunting among children in the Demographic and Health survey data set as a case study.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"29 ","pages":"Article 101764"},"PeriodicalIF":3.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public libraries and functional disability: A cohort study of Japanese older adults","authors":"Saeko Otani ,&nbsp;Koryu Sato ,&nbsp;Naoki Kondo","doi":"10.1016/j.ssmph.2025.101762","DOIUrl":"10.1016/j.ssmph.2025.101762","url":null,"abstract":"<div><div>This study examined the association between the presence of public libraries and functional disability risk among community-dwelling older adults. We studied 73,138 participants aged 65 years or older in 19 Japanese municipalities using data from the Japan Gerontological Evaluation Study. They were physically and cognitively independent at baseline and followed up between 2013 and 2021 (mean follow-up: 7.3 years). The onset of functional disability was ascertained by linking participants to the public registries of long-term care insurance. The exposures were the number of library books and that of libraries per population in each municipality. During the study period, we observed 16,336 cases (22.3%) of functional disability onset. Our Cox proportional hazards model revealed that the number of library books (hazard ratio [HR] = 0.96, 95% confidence interval [CI]: 0.95–0.97) and that of libraries (HR = 0.52, 95% CI: 0.28–1.00) were associated with the onset of functional disability. The association was consistent even after adjusting for individuals' reading habits and other potential confounders, which suggested the contextual effect of public libraries on older adults’ functional ability. Additionally, the magnitude of association was larger for the younger, women, and people with reading habits than their counterparts. Building new libraries and increasing the number of library books in a community may contribute to lowering the functional disability risk among older adults.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"29 ","pages":"Article 101762"},"PeriodicalIF":3.6,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143242112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender disparities in job flexibility, job security, psychological distress, work absenteeism, and work presenteeism among U.S. adults","authors":"Monica L. Wang ,&nbsp;Marie-Rachelle Narcisse ,&nbsp;Kate Rodriguez ,&nbsp;Pearl A. McElfish","doi":"10.1016/j.ssmph.2025.101761","DOIUrl":"10.1016/j.ssmph.2025.101761","url":null,"abstract":"<div><h3>Background</h3><div>While international research has examined the relationship between job characteristics and mental health, including gender differences, few studies have assessed these associations at the national level in the U.S., which has unique labor markets, health care systems, and societal structures that may exacerbate gender disparities. This study investigates gender differences in the associations between job flexibility, job security, mental health outcomes, work absenteeism, work presenteeism, and mental health care utilization among a representative sample of working U.S. adults.</div></div><div><h3>Methods</h3><div>We analyzed cross-sectional population-based survey data from employed adults in the 2021 National Health Interview Survey. Job characteristics included perceived job flexibility and security. Outcomes included serious psychological distress, frequency of anxiety, work absenteeism, work presenteeism, and mental health care utilization. Multivariable logistic and binomial regression analyses examined associations of interest, with statistical interaction tests conducted to assess gender differences.</div></div><div><h3>Findings</h3><div>The study sample included 18,112 respondents weighted to represent a population of 168,068,586 civilian, non-institutionalized working U.S. adults (47.7% female). Females with low job security had a decreased probability of serious psychological distress than males with low job security (F_(3,589) = 2.79; <em>p</em> = 0.040). Females with the lowest job flexibility reported more days worked while ill than males over the past 3 months, while males with higher job flexibility reported more days worked while ill than females (F_(3,589) = 4.1; <em>p</em> = 0.007). The average number of work days missed over 12 months was lower among females than males when job security was perceived as fairly low and higher among females than males as job security increased (F_(3,589) = 4.3; <em>p</em> = 0.005).</div></div><div><h3>Interpretation</h3><div>Findings highlight the need for policies and practices that recognize and address gender-specific workforce experiences and needs. Tailored interventions that enhance job flexibility and security, support caregiving responsibilities, and provide comprehensive mental health services can address such challenges.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"29 ","pages":"Article 101761"},"PeriodicalIF":3.6,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-intervention gendered impacts and moderating factors of a government cash plus intervention for adolescents in Tanzania","authors":"Jennifer Waidler ,&nbsp;Leah Prencipe ,&nbsp;Nyasha Tirivayi ,&nbsp;Tumpe Mnyawami Lukongo ,&nbsp;Paul Luchemba ,&nbsp;Frank Eeataama ,&nbsp;Jennifer Matafu ,&nbsp;Tia Palermo ,&nbsp;Tanzania Adolescent Cash Plus Evaluation Team","doi":"10.1016/j.ssmph.2025.101760","DOIUrl":"10.1016/j.ssmph.2025.101760","url":null,"abstract":"<div><h3>Introduction</h3><div>Reducing poverty (including multidimensional poverty) and gender inequality can improve social development outcomes. Studies have sought to understand how poverty reduction and intersectoral programming targeted to adolescents can facilitate safe transitions to adulthood among adolescents. However, most intersectoral interventions for adolescents to date have been implemented by non-governmental actors with limited generalizability and potential for scale-up. In the current study, we examine 22-month post intervention impacts of the “plus components” of a cash plus intervention, Ujana Salama (Swahili for “Safe Youth”) targeted to adolescents ages 14–19 years (males and females) in households participating in a government social protection program in Tanzania. The government-implemented cash plus intervention, comprised of livelihoods and life skills training, a productive grant, mentoring, and linkages to adolescent-friendly health services, was implemented over 18 months in 2018 and 2019.</div></div><div><h3>Methods</h3><div>Using a cluster randomized controlled trial, we estimated post-intervention impacts in 2021 on the following domains: relationships, modern contraception, health seeking and HIV knowledge and risk, psychosocial outcomes and attitude, and violence. We further examined whether contextual factors, including gender norms and quality of health services, moderated these post-intervention impacts.</div></div><div><h3>Results</h3><div>Few impacts found at earlier rounds were still evident post-intervention. Exceptions include protective impacts on lifetime sexual violence risk among females and increases in sexual and reproductive health services utilization among males. Moreover, newly detected adverse impacts on mental health contrasted with earlier protective impacts.</div></div><div><h3>Conclusion</h3><div>While external factors such as lengthy delays of cash transfer payments to adolescents' households and the COVID-19 pandemic may have mitigated the potential for sustained impacts of this intervention, findings suggest that future programs may need to provide different combinations of programming, provide support longer-term, or intervene at more levels of the social ecological model to influence many of the outcomes examined and to effect more lasting change.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"29 ","pages":"Article 101760"},"PeriodicalIF":3.6,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parent discrimination clusters and pediatric health in a national survey: The modifying effect of parenting","authors":"Violeta J. Rodriguez ,&nbsp;Dominique L. La Barrie","doi":"10.1016/j.ssmph.2025.101757","DOIUrl":"10.1016/j.ssmph.2025.101757","url":null,"abstract":"","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"29 ","pages":"Article 101757"},"PeriodicalIF":3.6,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143421873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}