The Canadian COVID-19 Experiences Survey: Study Protocol

Introduction: Vaccine hesitancy remains a significant challenge even through the second year of the COVID-19 pandemic, even in the most well-supplied countries. In Canada, despite high vaccine uptake of the first wave of vaccinations, there are signs of declining uptake of vaccine boosters. Likewise, recommended COVID-19 mitigation behaviors such as mask wearing, distancing, and hand hygiene have been challenging to sustain over the pandemic. The aim of the Canadian COVID-19 Experiences Survey (CCES) is to use a variety of social-cognitive and neurocognitive variables to predict the uptake and sustaining of vaccinations, boosters, and COVID-19 mitigation behaviors across the Canadian population through the second and third years of the pandemic. Methods and analyses: Vaccine hesitant and fully vaccinated adults (N=1,958) were recruited to the 35-minute CCES web survey, using quota sampling, with sampling weights being applied to ensure representativeness of the Canadian population. In Wave 1, conducted between 28 September and 21 October, 2021, 43.3% (n=848) reported not having received any vaccinations, 50.2% (n=983) reported being fully vaccinated, and 6.5% (n=127) reported having had one vaccination with no intention of having a second dose. Social cognitive variables being measured include intentions, beliefs, reasons, and attitudes. Neurocognitive variables being measured include executive dysfunction, delay discounting, and temporal orientation. Other key variables being measured include trust in science, political orientation, mood, and long-COVID symptoms. Ethics and dissemination: The CCES has received ethical review and approval by the University of Waterloo Office of Research Ethics. Findings will be disseminated through peer-reviewed publications and presentations at scientific meetings.

Underweight, Overweight and Obesity among Reproductive Bangladeshi Women: A Nationwide Survey

The double burden of malnutrition is becoming more prevalent among Bangladeshi women. Underweight, overweight, and obesity were examined among women aged 15–49 years using the 2017–2018 Bangladesh Demographic and Health Survey (BDHS). A dataset of 20,127 women aged 15–49 years with complete Body Mass Index (BMI) measurements were extracted and categorized as underweight, normal weight, overweight, and obesity. A multiple logistic regression that adjusts for clustering and sampling weights was used to examine underweight, overweight, and obesity among reproductive age Bangladeshi women. Our analyses revealed that the odds of being overweight and obese were higher among women who completed primary and secondary or more levels of education, rich households, breastfeeding women, and women exposed to media (newspapers and television (TV). Women from the poorest households were significantly more likely to be underweight (AOR = 3.86, 95%CI: 2.94–5.07) than women from richer households. The likelihood of being underweight was higher among women with no schooling, adolescent women, and women not using contraceptives. Conclusions: Overweight and obesity was higher among educated and affluent women while underweight was higher among women from low socioeconomic status, indicating that tailored messages to combat overweight and obesity should target educated and affluent Bangladeshi women while improving nutrition among women from low socioeconomic status.

Machine learning models of tobacco susceptibility and current use among adolescents from 97 countries in the Global Youth Tobacco Survey, 2013-2017

Adolescents are particularly vulnerable to tobacco initiation and escalation. Identifying factors associated with adolescent tobacco susceptibility and use can guide tobacco prevention efforts. Novel machine learning (ML) approaches efficiently identify interactive relations among factors of tobacco risks and identify high-risk subpopulations that may benefit from targeted prevention interventions. Nationally representative cross-sectional 2013–2017 Global Youth Tobacco Survey (GYTS) data from 97 countries (28 high-income and 69 low-and middle-income countries) from 342,481 adolescents aged 13–15 years (weighted N = 52,817,455) were analyzed using ML regression tree models, accounting for sampling weights. Predictors included demographics (sex, age), geography (region, country-income), and self-reported exposure to tobacco marketing, secondhand smoke, and tobacco control policies. 11.9% (95% CI 11.1%-12.6%) of tobacco-naïve adolescents were susceptible to tobacco use and 11.7% (11.0%-12.5%) of adolescents reported using any tobacco product (cigarettes, other smoked tobacco, smokeless tobacco) in the past 30 days. Regression tree models found that exposure or receptivity to tobacco industry promotions and secondhand smoke exposure predicted increased risks of susceptibility and use, while support for smoke-free air policies predicted decreased risks of tobacco susceptibility and use. Anti-tobacco school education and health warning messages on product packs predicted susceptibility or use, but their protective effects were not evident across all adolescent subgroups. Sex, region, and country-income moderated the effects of tobacco promotion and control factors on susceptibility or use, showing higher rates of susceptibility and use in males and high-income countries, Africa and the Americas (susceptibility), and Europe and Southeast Asia (use). Tobacco policy-related factors robustly predicted both tobacco susceptibility and use in global adolescents, and interacted with adolescent characteristics and other environments in complex ways that stratified adolescents based on their tobacco risk. These findings emphasize the importance of efficient ML modeling of interactions in tobacco risk prediction and suggest a role for targeted prevention strategies for high-risk adolescents.

Fundamental Motor Skill Delays in Preschool Children With Disabilities: 2012 National Youth Fitness Survey

Delays in fundamental motor skill (FMS) competency have been observed in a variety of children with disabilities. However, evidence of FMS delays is largely limited to small, geographically specific, limitedly diverse, and non-representative samples. The purpose of this study was to examine the association between FMS competency and reported disability status among pre-school children, ages 3–5 years, using the 2012 National Youth Fitness Survey (NYFS). In total, 329 preschool children (49% female; 4.00 ± 0.04 years of age) from the 2012 NYFS completed the Test of Gross Motor Development−2, including 43 preschoolers identified with a disability based on parental report (44% female; 4.20 ± 0.16 years). Associations were examined with logistic regression using sampling weights. Poor FMS competency, defined as gross motor quotient scores ≤ 79, was observed in significantly more children with disabilities (29%) than children without disabilities (10%, OR = 3.5, p = 0.04). While not statistically significant, there was a growing disparity in FMS competency at age 5 (41 vs. 11%) compared to age 3 (15 vs. 9%, OR = 1.80, p = 0.30). The results provide additional evidence for poor FMS competency among pre-school children with disabilities. FMS should be an early part of comprehensive assessments for all children suspected of disability or development delay as it is critical to identify and intervene upon FMS delays before discrepancies can widen.

A Weighted Residual Bootstrap Method for Multilevel Modeling with Sampling Weights

Multilevel modeling is often used to analyze survey data collected with a multistage sampling design. When the selection is informative, sampling weights need to be incorporated in the estimation. We propose a weighted residual bootstrap method as an alternative to the multilevel pseudo-maximum likelihood (MPML) estimators. In a Monte Carlo simulation using two-level linear mixed effects models, the bootstrap method showed advantages over MPML for the estimates and the statistical inferences of the intercept, the slope of the level-2 predictor, and the variance components at level-2. The impact of sample size, selection mechanism, intraclass correlation (ICC), and distributional assumptions on the performance of the methods were examined. The performance of MPML was suboptimal when sample size and ICC were small and when the normality assumption was violated. The bootstrap estimates performed generally well across all the simulation conditions, but had notably suboptimal performance in estimating the covariance component in a random slopes model when sample size and ICCs were large. As an illustration, the bootstrap method is applied to the American data of the OECD’s Program for International Students Assessment (PISA) survey on math achievement using the R package bootmlm.

Factors Associated With Deficient Housing Among Community-Living Older Adults in the United States

Housing quality is a recognized social determinant of health. Qualitative evidence suggests the ability of older adults to maintain their homes is affected by the domains of financial resources, social environment, and functional abilities, but this conceptualization has not been tested quantitatively. This cross-sectional study examined associations between financial resources (indicated by socioeconomic characteristics: education, racial-status, annual income, financial hardship, Medicaid eligibility), social environment (living arrangement, social integration), and functional abilities (lower extremity performance, self-care disability, independent-living disability, homebound-status, dementia, depression) with deficient housing among 6,489 community-living adults ≥ 65 years participating in the nationally representative 2015 National Health and Aging Trends Study. Sampling weights accounted for study design and non-response. An estimated 9.2% (3.2 million) older Americans lived in housing with ≥1 deficiency (any peeling paint, evidence of pests, flooring in disrepair, broken windows, crumbling foundation, missing siding, or roof problems). In bivariate logistic regressions, factors from all three domains were associated with deficient housing. In a multivariable model that included all variables above and adjusted for age and sex, indicators of financial resources and social environment remained associated with deficient housing (including financial hardship, adjusted odds ratio (aOR)=1.48, 95% confidence interval (CI): 1.10,1.98; and living with non-spousal others versus alone, aOR=1.48; 95% CI:1.09, 2.03), whereas indicators of functional abilities did not. To ensure quality housing for all community-dwelling older adults, efforts that increase financial resources and further examine the role of social environment in deficient housing are needed.

Marginal Effects of Multiple Years of Volunteering on Objective and Subjective Measures of Cognition

Volunteering is conducive to older Americans’ physical and mental health; however, the effect of volunteering on cognitive health is less studied. Using four waves (2010-2016) of the Health and Retirement Study, this study examined the incremental effect of volunteering engagement on older adults’ cognitive health. We included10,718 cognitively unimpaired, community-dwelling individuals aged 51+ in 2010 and were alive through 2016. Volunteering engagement was measured by the number of times respondents participated in volunteering throughout the four waves. Objective cognition was assessed using the Telephone Interview for Cognitive Status (TICS), a standardized test of cognitive functioning. The TICS score was further categorized into three statuses: “No impairment,” “Cognitive impairment no dementia (CIND),” and “Dementia.” Subjective cognition referred to self-rated memory on a 5-point Likert scale. With sampling weights, ordered logit regression was performed controlling for health-related variables (e.g., health conditions, depression), SES (e.g., income, assets), contextual features (e.g., neighborhood safety, urbanicity), and sociodemographics. The average marginal effects (AMEs) were produced. Results show that more volunteering engagement significantly reduced the likelihood of CIND or dementia (OR=0.88, p<0.001). Specifically, every one-time increase in volunteering increased the probability of remaining cognitively normal by 0.01 (p<0.001), whereas it decreased the probability of CIND by 0.008 (p<0.001) and dementia by 0.001 (p<0.001). For subjective cognition, there was no significant relationship with volunteering. Our findings address gaps in literature by adding evidence of the incremental health benefits of volunteering on cognitive functioning. Differences in the findings for subjective and objective cognition warrant further investigation.

Hypertension incidence among middle-aged and older adults: findings from a 5-year prospective study in rural South Africa, 2010–2015

ObjectivesThere is a scarcity of longitudinal cohort studies in sub-Saharan Africa to understand the epidemiology of cardiovascular disease as a basis for intervention. We estimated incident hypertension and associated sociodemographic, health and behavioural risk factors in a population aged 40 years and older over a 5-year period.DesignWe assessed the association between incident hypertension and sociodemographic, health and behavioural factors using Poisson regression. We adjusted for non-response in 2015 using inverse probability sampling weights from a logistic regression including sex and age at baseline.SettingRural South Africa.ParticipantsWe used a population-based cohort of normotensive adults in 2010 who were aged 40 years and older at retest in 2015.ResultsOf 676 individuals completing baseline and 5-year follow-up, there were 193 incident cases of hypertension. The overall hypertension incidence rate was 8.374/100 person-years. In multivariable analyses, those who became hypertensive were more likely to be older, have a high waist circumference (incidence rate ratio (IRR): 1.557, 95% CI: 1.074 to 2.259) and be employed (IRR: 1.579, 95% CI: 1.071 to 2.329) at baseline. Being HIV positive and not on antiretroviral therapy at baseline was associated with lower risk of incident hypertension.ConclusionsOver a 5-year period, 29% of respondents developed hypertension. Given the high burden of hypertension in South Africa, continued longitudinal follow-up is needed to understand the complex interplay of non-communicable and infectious diseases and their underlying and modifiable risk factors to inform public health prevention strategies and programmes.

Hopefulness During COVID-19: Associations With Function, Sleep, and Loneliness in the NHATS

The associations between hopefulness and function, loneliness, and sleep have not been explored in a nationally representative sample of older adults. Additionally, COVID19 dramatically increased stress burden, potentially influencing these relationships. This study used National Health and Aging Trends COVID19 Supplement data (N=2,894 adults aged ≥ 65 years) to evaluate cross-sectional associations between hopefulness about the future during COVID19 with limitations in activities of daily living (ADLs) using a negative binomial model and one-item sleep and loneliness measures using ordered logistic models. Adjusting for age, race/ethnicity, and education and applying sampling weights, increased hopefulness was associated with better ADLs (b= -0.11, p-value=0.021), less loneliness (b=-0.32, p-value=<0.001), and better sleep (b= -0.27, p-value= <0.001). In the midst of a world-wide stressor, hopefulness was associated with better function and symptoms. This relationship is likely bidirectional and further longitudinal research is needed.

COVID-19 and Psychosocial Changes: Results From the National Health and Aging Trends Study (NHATS)

The COVID-19 pandemic likely altered many aspects of daily life for older adults, including social connectedness, technology use, financial resources and hopefulness. This symposium examines these exposures and changes during the COVID-19 pandemic and tests their associations with health and related factors. Analyses are all conducted among a nationally representative sample of U.S. adults aged ≥65 years who participated in the NHATS COVID-19 supplement, which was a mail-in survey with participant and proxy respondents conducted between June and October of 2020. Additional NHATS participant data collected between 2011 and 2019 was used to account for individual characteristics before COVID-19, including demographic, socioeconomic and relevant health characteristics. Sampling weights were applied to analyses to account for study design and non-response so that inferences can be drawn to the US population of adults aged ≥65 years. This symposium will present results from five COVID-19 pandemic focused studies that examine the associations between 1) financial changes and health, 2) loneliness and behavioral changes, 3) hopefulness with function, sleep and loneliness, 4) technology use and mental health, and 5) predictors of technology use. These results offer insights into the mechanisms that influence health during the COVID-19 pandemic. Results have clinical, policy and public health implications because they can inform the development of interventions, programs and policies with potential to improve health and health care and advance health equity for older adults.