Sakurako S. Okuzono’s research while affiliated with Massachusetts Department of Public Health and other places

Objectives We examined long-term trajectories of depressive symptoms among older adults following exposure to the 2011 Great East Japan Earthquake and Tsunami. We further characterized the pre- and post-disaster social relationship factors that predicted membership in each trajectory group. Method Data from four time points (including pre-disaster data) were used to analyze the depression trajectories of 2,033 survivors through a group-based trajectory model. Multinomial logistic analysis was used to investigate the social relationship factors (i.e., social interactions with neighbors, social support, social participation, and social cohesion) that predicted membership to each trajectory group. Results Five distinct trajectories of depressive symptoms were identified; stably not depressed (12.4%), increased after the disaster (14.2%), decreased after the disaster (8.8%), persistent mild depressive symptoms (28.1%) and persistent severe depressive symptoms (36.5%). Compared to those who were stably not depressed, those who experienced an increase in symptoms were more likely to experience housing damage and not to participate in social activities. Compared to those who were stably mildly depressed, those who experienced a decrease in symptoms had higher pre-disaster social interactions with neighbors as well as higher post-disaster social support. Adults with persistent severe symptoms were physically, psychologically, and socially vulnerable preceding the disaster. Discussion The study revealed the heterogeneity of older adults experiencing depressive symptoms in the wake of major disaster. Those who experienced increased symptoms after the disaster showed a chronic rather than temporary rise, while those with pre-disaster depressive symptoms showed sustained symptoms regardless of disaster-related trauma.

Does higher perceived neighborhood social cohesion in adolescence lead to better health and well‐being 10–12 years later? We evaluated this question using data from a large, prospective, and nationally representative sample of US adolescents (Add Health; N = 10,963), and an outcome‐wide approach. Across 38 outcomes, perceived neighborhood social cohesion was associated with some: mental health outcomes (i.e., depressive symptoms, suicidal ideation, perceived stress), psychological well‐being outcomes (i.e., happiness, optimism), social outcomes (i.e., loneliness, romantic relationship quality, satisfaction with parenting), and civic/prosocial outcomes (i.e., volunteering). However, it was not associated with health behaviors nor physical health outcomes. These results were maintained after robust control for a wide range of potential confounders.

Background Several 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 findings We 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 < 0.001)), 4 (of 7) social outcomes (e.g., lower loneliness (β = −0·09, 95% CI = −0·16, −0·02, p = 0.015)), and 1 (of 2) civic/prosocial outcomes (e.g., more voting (RR = 1·25, 95% CI = 1·16, 1·36, p < 0.001)). Study limitations include potential unmeasured confounding and reverse causality. Conclusions Enhanced 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.

Purpose There is widespread recognition of the importance and complexity of measuring neighborhood contexts within research on child psychopathology. In this study, we assessed the cross-sectional associations between two measures of neighborhood quality and internalizing and externalizing behaviors in preadolescence. Methods Drawing on baseline data from the Adolescent Brain Cognitive Development Study (n = 10,577 preadolescents), we examined two multi-component assessments of neighborhood quality in relation to children’s internalizing and externalizing symptoms: the Area Deprivation Index (ADI), which measures socioeconomic adversity, and the Child Opportunity Index 2.0 (COI), which measures economic, educational, and environmental opportunity. Both measures were categorized into quintiles. We then used mixed-effects linear regression models to examine bivariate and adjusted associations. Results The bivariate associations displayed strong inverse associations between the COI and ADI and externalizing symptoms, with a graded pattern of fewer externalizing behaviors with increasing neighborhood quality. Only the ADI was associated with externalizing behaviors in models adjusted for child and family characteristics. We did not observe a clear association between either measure of neighborhood quality and internalizing behaviors in bivariate or adjusted models. Conclusions Neighborhood quality, as measured by the COI and ADI, was associated with externalizing behaviors in preadolescent children. The association using the ADI persisted after adjustment for family-level characteristics, including financial strain. Our results indicate that different assessments of neighborhood quality display distinct associations with preadolescent behavioral health. Future research is needed to assess the association between neighborhood quality and behavior trajectories and to identify place-based intervention strategies.

Traumatic experiences from disasters have enduring effects on health, both directly and indirectly by influencing health behaviors. Among potential pathways, the impact of disaster-related trauma on dietary patterns has been understudied. This study investigated the relationship between disaster-related trauma and dietary inflammatory index (DII ® ), and how these relationships differed by gender and whether they prepare meal by themselves or not among older survivors of the 2011 Great East Japan Earthquake and Tsunami (n = 1,375). Dietary data was collected in 2020 using a brief-type self-administered diet history questionnaire (BDHQ), from which we derived a dietary inflammatory index (DII ® ) based on 26 food/nutrient items, where higher scores indicate pro-inflammatory (i.e., unhealthy) diet. We found that the experience of housing damage due to the earthquake and tsunami was associated with slightly higher DII scores (coef. = 0.38, 95% CI -0.05, 0.81). Specifically, women who cooked by themselves tended to have higher DII when they experienced housing damage (coef. = 1.33, 95%CI -0.63, 3.28). On the other hand, loss of friends was associated with a lower DII score (coef. = -0.28, 95% CI -0.54, -0.01). These findings highlight the importance of providing support to groups who are at increased risk of deterioration in dietary quality in the aftermath of disasters.

Objectives: Associations of stress-related coping strategies with lifespan among the general population are understudied. Coping strategies are characterized as being either adaptive or maladaptive, but it is unknown the degree to which variability in tailoring their implementation to different contexts may influence lifespan. Method: Women (N = 54,353; Mage = 47) completed a validated coping inventory and reported covariate information in 2001. Eight individual coping strategies (e.g., Acceptance, Denial) were considered separately. Using a standard deviation-based algorithm, participants were also classified as having lower, moderate, or greater variability in their use of these strategies. Deaths were ascertained until 2019. Accelerated failure time models estimated percent changes and 95% confidence intervals (CI) in predicted lifespan associated with coping predictors. Results: In multivariable models, most adaptive and maladaptive strategies were associated with longer and shorter lifespans, respectively (e.g., per 1-SD increase: Active Coping = 4.09%, 95%CI = 1.83%, 6.41%; Behavioral Disengagement = -6.56%, 95%CI = -8.37%, -4.72%). Moderate and greater (versus lower) variability levels were similarly and significantly related to 8-10% longer lifespans. Associations were similar across age, racial/ethnic, residential income, and marital status subgroups. Conclusions: Findings confirm the adaptive and maladaptive nature of specific coping strategies, and further suggest benefits from both moderate and greater variability in their use for lifespan among women.

BACKGROUND Epidemiological studies demonstrate higher loneliness is associated with increased risk of developing cardiovascular disease (CVD). However, most studies are conducted with populations in Western developed countries, whose cultures generally emphasize independence. Less clear is whether these associations are also evident in more interdependent cultures, such as those in East Asian countries. We hypothesized feeling lonely could be more stressful and exhibit stronger associations with CVD risk in a highly interdependent versus independent culture. METHODS We examined associations of loneliness with fatal and non-fatal CVD incidence in older adults from the Health and Retirement Study (HRS; n =13,073) conducted in the U.S. and from the Korean Longitudinal Study of Aging (KLoSA; n=8,311) conducted in South Korea. In both cohorts, baseline loneliness was assessed using one item from the Center for Epidemiologic Studies Depression Scale. Incident CVD was defined as reporting new-onset CVD on the biennial questionnaire or CVD death reported by proxies. Within each cohort, we estimated adjusted hazard ratios (aHR) of incident CVD according to loneliness (yes/no) over 12-14 years of follow-up, adjusting for relevant baseline covariates, including social isolation, sociodemographic factors, health conditions, and health behaviors. We further examined health behaviors as a potential pathway underlying these associations using counterfactual mediation analyses. RESULTS Controlling for all covariates, feeling lonely was associated with an increased likelihood of developing CVD in the U.S. (aHR:1.15, 95%CI: 1.04,1.27) and in South Korea (aHR: 1.16, 95%CI: 1.00, 1.34). The pooled analysis showed no heterogeneity (Q=0.009, p=0.92), and the HR for loneliness was 1.14 (95% CI: 1.05-1.23). Regarding potential mediators, several behaviors accounted for a proportion of the association: physical activity, in both countries (14.6%, p=0.03 in HRS; 1.3%, p = 0.04 in KLoSA), alcohol consumption only in KLoSA (1.1%, p < 0.001), smoking only in HRS (4.7%, p < 0.001). CONCLUSIONS AND RELEVANCE Contrary to our hypothesis, the magnitude of the loneliness-CVD relationship was similar in both countries, with 14% higher odds of developing CVD, while behavioral pathways appeared different. Loneliness may be a risk factor for CVD regardless of culture; however, different prevention strategies in clinical settings may be required. Clinical Perspective What is New? Even after controlling for social isolation, health behaviors/conditions, and sociodemographic factors, feeling lonely was associated with an increased likelihood of developing CVD among older adults in both the U.S. (15% increase) and South Korea (16% increase). The impact of loneliness on CVD risk did not appear to differ substantially by culture, comparing individuals from a more independent versus interdependent culture. The behaviors linking loneliness and CVD differed somewhat between the U.S. and South Korea, suggesting cultural factors may contribute to shaping distinct behavioral pathways through which loneliness impacts health. What are the clinical implications? A consistent association between loneliness and CVD risk was evident in two very different cultures, suggesting loneliness may be a relevant target for CVD prevention strategies in diverse populations. While the associations are modest, the public health implications of loneliness-related CVD could be significant if a substantial portion of the population experiences loneliness, particularly in the aftermath of the COVID-19 pandemic. Assessing loneliness levels may provide healthcare professionals with greater insight into patients’ CVD risk.