The Social Determinants of Ideal Cardiovascular Health: A Global Systematic Review

This systematic review synthesizes research published from January 2010-July 2022 on the social determinants of ideal cardiovascular health (CVH) carried out around the world and compares trends in high-income countries (HICs) to those in low- and middle-income countries (LMICs). 41 studies met inclusion criteria (n = 28 HICs, n = 13 LMICs). Most were from the United States (n = 22) and cross-sectional (n = 33), and nearly all evaluated associations among adults. Among studies conducted in LMICs, nearly all were from middle-income countries and only one was carried out in low-income country. Education (n = 24) and income/wealth (n = 17) were the most frequently examined social determinants in both HICs and LMICs. Although most studies assessed ideal CVH using reliable and valid methods (n = 24), only 7 used criteria pre-defined by the American Heart Association to characterize ideal levels of each CVH metric. Despite heterogeneity in how outcome measures were derived and analyzed, consistent associations were evident between multiple markers of higher social status (i.e. greater education, income/wealth, socioeconomic status, racial/ethnic majority status) and greater levels of ideal CVH across both country contexts. Gaps in the literature include evidence from LMICs and HICs other than the United States, longitudinal research, and investigations of a wider array of social determinants beyond education and income/wealth

Positive affect during adolescence and health and well-being in adulthood: An outcome-wide longitudinal approach.

BackgroundSeveral intergovernmental organizations, including the World Health Organization and United Nations, are urging countries to use well-being indicators for policymaking. This trend, coupled with increasing recognition that positive affect is beneficial for health/well-being, opens new avenues for intervening on positive affect to improve outcomes. However, it remains unclear if positive affect in adolescence shapes health/well-being in adulthood. We examined if increases in positive affect during adolescence were associated with better health/well-being in adulthood across 41 outcomes.Methods and findingsWe conducted a longitudinal cohort study using data from Add Health-a prospective and nationally representative cohort of community-dwelling U.S. adolescents. Using regression models, we evaluated if increases in positive affect over 1 year (between Wave I; 1994 to 1995 and Wave II; 1995 to 1996) were associated with better health/well-being 11.37 years later (in Wave IV; 2008; N = 11,040) or 20.64 years later (in Wave V; 2016 to 2018; N = 9,003). Participants were aged 15.28 years at study onset, and aged 28.17 or 37.20 years-during the final assessment. Participants with the highest (versus lowest) positive affect had better outcomes on 3 (of 13) physical health outcomes (e.g., higher cognition (β = 0·12, 95% CI = 0·05, 0·19, p = 0.002)), 3 (of 9) health behavior outcomes (e.g., lower physical inactivity (RR = 0·80, CI = 0·66, 0·98, p = 0.029)), 6 (of 7) mental health outcomes (e.g., lower anxiety (RR = 0·81, CI = 0·71, 0·93, p = 0.003)), 2 (of 3) psychological well-being (e.g., higher optimism (β = 0·20, 95% CI = 0·12, 0·28, p ConclusionsEnhanced positive affect during adolescence is linked with a range of improved health/well-being outcomes in adulthood. These findings suggest the promise of testing scalable positive affect interventions and policies to more definitively assess their impact on outcomes

Characteristics of participants at pre-baseline by tertiles of baseline positive affect (National Longitudinal Study of Adolescent to Adult Health [Add Health]).

Characteristics of participants at pre-baseline by tertiles of baseline positive affect (National Longitudinal Study of Adolescent to Adult Health [Add Health]).</p

Associations of positive affect in adolescence with subsequent health and well-being in adulthood (National Longitudinal Study of Adolescent to Adult Health [Add Health]).

Associations of positive affect in adolescence with subsequent health and well-being in adulthood (National Longitudinal Study of Adolescent to Adult Health [Add Health]).</p

Robustness to unmeasured confounding (E-values) for the association between positive affect (3rd tertile vs. 1st tertile) in adolescence and subsequent health and well-being in adulthood (National Longitudinal Study of Adolescent to Adult Health [Add Health]).

Robustness to unmeasured confounding (E-values) for the association between positive affect (3rd tertile vs. 1st tertile) in adolescence and subsequent health and well-being in adulthood (National Longitudinal Study of Adolescent to Adult Health [Add Health]).</p

S1 Appendix -

Text A. Assessment of Outcomes. Text B. Proof Illustrating How Controlling for Prior Levels of Positive Affect Can Help Us Evaluate How “Change” in Positive Affect is Associated with Subsequent Health and Well-Being Outcomes Over Time. Table A. Missing Data on Study Variables (National Longitudinal Study of Adolescent to Adult Health [Add Health]). Table B. Change in Positive Affect from the Pre-Baseline Wave (Wave I; t0) to the Baseline Wave (Wave II; t1). Table C. Associations of Positive Affect in Adolescence with Subsequent Health and Well-Being in Adulthood (Complete-Case Analyses; National Longitudinal Study of Adolescent to Adult Health [Add Health]). Table D. Associations of Positive Affect in Adolescence with Subsequent Health and Well-Being in Adulthood (Unadjusted or Fully Adjusted for Covariates; National Longitudinal Study of Adolescent to Adult Health [Add Health]). Table E. Associations of Positive Affect in Adolescence with Subsequent Health and Well-Being in Adulthood (Adjusting for Conventional Covariates or All Covariates; National Longitudinal Study of Adolescent to Adult Health [Add Health]). Table F. Associations of Positive Affect in Adolescence with Subsequent Health and Well-Being in Adulthood (Actual Amounts and/or Absolute Risks of Binary Outcomes; National Longitudinal Study of Adolescent to Adult Health [Add Health]). Fig A. Sample Inclusion Criteria for Positive Affect Analyses (Wave IV Outcomes). Fig B. Sample Inclusion Criteria for Positive Affect Analyses (Wave V Outcomes). Checklist A. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist. (DOCX)</p

Long-Term Associations between Disaster-Related Home Loss and Health and Well-Being of Older Survivors : Nine Years after the 2011 Great East Japan Earthquake and Tsunami

BACKGROUND: Little research has examined associations between disaster-related home loss and multiple domains of health and well-being, with extended long-term follow-up and comprehensive adjustment for pre-disaster characteristics of survivors. OBJECTIVES: We examined the longitudinal associations between disaster-induced home loss and 34 indicators of health and well-being, assessed similar to 9 y post-disaster. METHODS: We used data from a preexisting cohort study of Japanese older adults in an area directly impacted by the 2011 Japan Earthquake (n = 3,350 and n = 2,028, depending on the outcomes). The study was initiated in 2010, and disaster-related home loss status was measured in 2013 retrospectively. The 34 outcomes were assessed in 2020 and covered dimensions of physical health, mental health, health behaviors/sleep, social well-being, cognitive social capital, subjective well-being, and prosocial/altruistic behaviors. We estimated the associations between disaster-related home loss and the outcomes, using targeted maximum likelihood estimation and SuperLearner. We adjusted for pre-disaster characteristics from the wave conducted 7 months before the disaster (i.e., 2010), including prior outcome values that were available. RESULTS: After Bonferroni correction for multiple testing, we found that home loss (vs. no home loss) was associated with increased posttraumatic stress symptoms (standardized difference = 0.50; 95% CI: 0.35, 0.65), increased daily sleepiness (0.38; 95% CI: 0.21, 0.54), lower trust in the community (-0.36; 95% CI: -0.53, -0.18), lower community attachment (-0.60; 95% CI: -0.75, -0.45), and lower prosociality (-0.39; 95% CI: -0.55, -0.24). We found modest evidence for the associations with increased depressive symptoms, increased hopelessness, more chronic conditions, higher body mass index, lower perceived mutual help in the community, and decreased happiness. There was little evidence for associations with the remaining 23 outcomes. DISCUSSION: Home loss due to a disaster may have long-lasting adverse impacts on the cognitive social capital, mental health, and prosociality of older adult survivors.Funding Agencies|National Institutes of Health; Japan Society for the Promotion of Science [R01 AG042463]; Health Labour Sciences Research Grant from the Japanese Ministry of Health, Labour, and Welfare [KAKENHI 23243070, KAKENHI 22390400, KAKENHI 20H00557, KAKENHI 24390469]; Strategic Research Foundation Grant-Aided Project for Private Universities from the Japanese Ministry of Education, Culture, Sports, Science, and Technology [H24-Choju-Wakate-009]; Japan Agency for Medical Research and Development [S0991035]; Well-being for Planet Earth Foundation [JP17dk0110017, JP18dk0110027, JP18ls0110002, JP18le0110009, JP19dk0110034, JP19dk0110037, JP20dk0110034]; Japan Society for the Promotion of Science Research Fellowship for Young Scientists; Swedish Research Council [KAKENHI 21J01171]; Royal Swedish Academy of Letters, History, and Antiquities, Stockholm, Sweden</p