Toward a Model for Measuring Social and Structural Determinants of Alzheimer’s Disease and Related Dementias

Social and structural determinants of health (SSDoH) are conditions in the environments in which individuals are born, live, learn, work, play, worship, and age that affect health, functioning, and quality-of-life outcomes across the life course. Growing evidence suggests that SSDoH can help to explain heterogeneity in cognitive, functional, and interventional outcomes in Alzheimer’s disease and related disorders research and clinical practice. The National Institute on Aging (NIA) has prioritized collecting SSDoH data in order to elucidate disease mechanisms and aid discovery of a disease modifying treatments. However, a major nexus of ADRD research, the national network of Alzheimer’s Disease Research Centers (ADRCs), does not routinely collect SSDoH data. We describe a model for feasibly gathering and analyzing SSDoH data across Alzheimer’s Disease Research Centers (ADRCs). We lay out theoretical underpinnings of key constructs and their measure, empirical evidence for their importance, and their potential for elucidating disease and prevention mechanisms. Toward a goal of translation, we describe a general approach to measuring SSDoH along with core set of measures. We also describe empirical support and rationales for assessing SSDoH in standing geographically and culturally diverse research cohorts, and guiding considerations in selecting modules to serve unique communities. We specifically address SSDoH in Black, Hispanic/Latin, and refugee populations with an eye toward conveying how geographic proximity, socioeconomic status, ethnoracial factors, and sex\gender\sexual orientation affect populations in ways directly relevant to Alzheimer’s disease (AD) and Alzheimer’s disease related dementias (ADRD).

Working conditions and mental health functioning among young public sector employees

Background: The associations between adverse working conditions and mental disorders are well established. However, associations between adverse working conditions and poor mental health functioning is a less explored area. This study examines these associations among younger public sector employees of the City of Helsinki, Finland. Methods: We use data from the Young Helsinki Health Study with a representative sample of the employees of the City of Helsinki, aged 19–39 years ( n=4 217). Mental health functioning was measured with mental composite summary of the Short Form 36. Working conditions included factors related to both the psychosocial (job control and job demands) and the physical work environment (physical workload). To examine the associations, we used logistic regression models with adjustments for socio-demographics, other working conditions and health-related covariates. Results: After adjustment for sociodemographic characteristics, poor health, health behaviours and other occupational exposures, high job demands (OR=1.69; 95% CI=1.45–1.97) and low job control (OR=1.65; 95% CI=1.40–1.94) were associated with poor mental health functioning. High physical workload was not associated with the outcome (OR=0.87; 95% CI=0.72–1.05) after the adjustments. Conclusions: Adverse psychosocial working conditions were associated with mental health functioning, whereas physical working conditions were not. As impaired functioning is likely to cause health-related lost productivity and can lead to work disability, further research and interventions with a balanced approach focusing on both psychosocial working conditions and mental health functioning are recommended.

Associations between community cultural engagement and life satisfaction, mental distress and mental health functioning using data from the UK Household Longitudinal Study (UKHLS): are associations moderated by area deprivation?

ObjectivesThe association between community cultural engagement and mental health and well-being is well established. However, little is known about whether such associations are influenced by area characteristics. This study therefore examined whether the association between engagement in community cultural assets (attendance at cultural events, visiting museums and heritage sites) and subsequent well-being (life satisfaction, mental distress and mental health functioning) is moderated by neighbourhood deprivation.DesignData were drawn from Understanding Society: The UK Household Longitudinal Study waves 2 and 5. Participating households’ addresses were geocoded into statistical neighbourhood zones categorised according to their level of area deprivation.SettingGeneral population.ParticipantsUK general adult population, with a total sample of 14 783.Main outcome measuresLife satisfaction was measured with a seven-point scale (1: completely unsatisfied to 7: completely satisfied). Mental distress was measured using the General Health Questionnaire 12. Mental health functioning was measured using 12-item Short Form Health Survey (SF-12).ResultsUsing Ordinary Least Squares (OLS) regression, we found that engagement in cultural assets was consistently and positively associated with subsequent life satisfaction and mental health functioning and negatively associated with mental distress. Importantly, such associations were independent of individuals’ demographic background, socioeconomic characteristics and regional location. The results also show that relationships between engagement in community cultural assets and well-being were stronger in more deprived areas.ConclusionsThis study shows that engagement in community cultural assets is associated with better well-being, with some evidence that individuals in areas of high deprivation potentially may benefit more from these engagements. Given that causal mechanisms were not tested, causal claims cannot be generated from the results. However, the results suggest that place-based funding schemes that involve investment in areas of higher deprivation to improve engagement rates should be explored further to see if they can help promote better well-being among residents.

Sexual Health in Emerging Adulthood

Sexual health in emerging adulthood encompasses a wide spectrum of medical and mental health functioning and associated behaviors. This chapter addresses aspects of physical sexual health that are of concern to emerging adults, including prevalence rates, determinants, and consequences of sexually transmitted infections, including HIV, and unintended pregnancy among emerging adults. The chapter also discusses sexual dysfunction and its treatment. Whenever possible, the chapter highlights differences in prevalence, risk, and protective factors related to aspects of human diversity, guided by an intersectional approach based on the ADDRESSING framework. Both protective and risky sexual health behaviors and decision making about sexual behavior are discussed, with a focus on the role of substance use in sexual risk taking. The chapter concludes with implications for future research, particularly in the area of prevention.

Financial inclusion and physical health functioning among aging adults in the sub-Saharan African context: Exploring social networks and gender roles

Background It remains poorly understood how financial inclusion influences physical health functioning in later life in sub-Saharan African context and whether the association differs by gender and social relationships. We aim 1) to examine the associations of financial inclusion with functional impairment during older age in Ghana; and 2) to evaluate whether gender and social networks modify this association. Methods The cross-sectional analyses are based on a sample (N = 1,201) of study participants aged 50 years and over (M = 66.5 years, SD = 11.9, 63.3% female) deriving from the 2016–2017 AgeHeaPsyWel-HeaSeeB Study. Ordinary least squares (OLS) regression analyses with interactions were performed to estimate the link between financial inclusion and functional health and how the association is modified by gender and older age social networks. Results The mean financial inclusion score was 1.66 (SD = 1.74) in women and 2.33 (SD = 1.82) in men whilst mean activities of daily living (ADL) score was 13.03 (SD = 4.99) and 14.85 (SD = 5.06) in women and men respectively. We found that financial inclusion was associated with decreases in ADL (total sample: β = -.548, p < .001; women: β = -.582, p < .001; men: β = -1.082 p < .001) and instrumental ADL (IADL) (total sample: β = -.359, p = .034; women: β = -.445, p = .026 but not in men). Social networks significantly moderated the association of financial inclusion with ADL such that the financially included who were embedded in a stronger constellation of social networks were 6% less likely to report ADL impairment compared to those with weaker social networks (β = -.062, p = .025). Conclusions The study provides empirical evidence for a better understanding of the association between financial inclusion and physical health functioning in the context of later life social networks. Interventions for functional health through financial inclusion in sub-Saharan Africa should include improving interpersonal and social networks for older adult and also through gender lenses.

Towards an ICF-based self-report questionnaire for people with skeletal dysplasia to study health, functioning, disability and accessibility

Background Little is known about the spectrum of everyday challenges that people with skeletal dysplasia face because of their health and functioning. We aimed to identify factors related to health, functioning and disability in people with skeletal dysplasia, and their challenges with accessibility in order to form a self-reported questionnaire for national data collection. The comprehensive musculoskeletal post-acute core set of the International Classification of Functioning, Disability and Health (ICF) was used as a framework. Methods An iterative, participatory and qualitative process was used to formulate a questionnaire. Items were searched from Patient-Reported Outcomes Measurement Information System and from other self-report instruments, additional items were formulated using ICF linking rules. Expert panels from the target population assessed the face and content validity in thematic interviews. Results The questionnaire demonstrated its relevance, comprehensiveness and feasibility for people with skeletal dysplasia. The ICF linkages showed the contents’ correspondence to the construct. Expert panels added 15 categories and one on chapter level to the core set and confirmed content validity. The final survey covers 86 ICF categories and 173 ICF-linked items that were grouped to 33 questions. Conclusions The content of the questionnaire proved to be sufficiently valid for people with skeletal dysplasia. It can be used to explore their health, functioning, disability and accessibility to develop care and rehabilitation policies, to plan services and to provide information to various parties involved.

Introduction to the Special Issue on Early Child Development: From Measurement to Optimal Functioning and Evidence-Based Policy

Early child development and overall children’s developmental trajectories have long-term implications for health, functioning, and earning potential as these children become adults [...]