Félice Lê-Scherban

Associations of Parental Depression With Child School Performance at Age 16 Years in Sweden

IMPORTANCE Depression is a common cause of morbidity and disability worldwide. Parental depression is associated with early-life child neurodevelopmental, behavioral, emotional, mental, and social problems. More studies are needed to explore the link between parental depression and long-term child outcomes. OBJECTIVE To examine the associations of parental depression with child school performance at the end of compulsory education (approximately age 16 years). DESIGN, SETTING, AND PARTICIPANTS Parental depression diagnoses (based on the International Classification of Diseases, Eighth Revision [ICD-8], International Classification of Diseases, Ninth Revision [ICD-9], and the International Statistical Classification of Diseases, 10th Revision [ICD-10]) in inpatient records from 1969 onward, outpatient records beginning in 2001, and school grades at the end of compulsory education were collected for all children born from 1984 to 1994 in Sweden. The final analytic sample size was 1,124,162 biological children. We examined the associations of parental depression during different periods (before birth, after birth, and during child ages 1-5, 6-10, and 11-16 years, as well as any time before the childs final year of compulsory schooling) with the final school grades. Linear regression models adjusted for various child and parent characteristics. The dates of the analysis were January to November 2015. MAIN OUTCOME AND MEASURE Decile of school grades at the end of compulsory education (range, 1-10, with 1 being the lowest and 10 being the highest). RESULTS The study cohort comprised 1,124,162 children, of whom 48.9% were female. Maternal depression and paternal depression at any time before the final compulsory school year were associated with worse school performance. After covariate adjustment, these associations decreased to -0.45 (95% CI, -0.48 to -0.42) and -0.40 (-0.43 to -0.37) lower deciles, respectively. These effect sizes are similarly as large as the observed difference in school performance between the lowest and highest quintiles of family income but approximately one-third of the observed difference between maternal education of 9 or less vs more than 12 years. Both maternal depression and paternal depression at different periods (before birth, after birth, and during child ages 1-5, 6-10, and 11-16 years) generally were associated with worse school performance. Child sex modified the associations of maternal depression with school performance such that maternal depression had a larger negative influence on child school performance for girls compared with boys. CONCLUSIONS AND RELEVANCE Diagnoses of parental depression throughout a childs life were associated with worse school performance at age 16 years. Our results suggest that diagnoses of parental depression may have a far-reaching effect on an important aspect of child development, with implications for future life course outcomes.

Neighborhood Ethnic Composition, Spatial Assimilation, and Change in Body Mass Index Over Time Among Hispanic and Chinese Immigrants: Multi-Ethnic Study of Atherosclerosis

OBJECTIVES We investigated relations between changes in neighborhood ethnic composition and changes in body mass index (BMI) and waist circumference among Chinese and Hispanic immigrants in the United States. METHODS We used Multi-Ethnic Study of Atherosclerosis data over a median 9-year follow-up (2000-2002 to 2010-2012) among Chinese (n = 642) and Hispanic (n = 784) immigrants aged 45 to 84 years at baseline. We incorporated information about residential moves and used econometric fixed-effects models to control for confounding by time-invariant characteristics. We characterized neighborhood racial/ethnic composition with census tract-level percentage Asian for Chinese participants and percentage Hispanic for Hispanic participants (neighborhood coethnic concentration). RESULTS In covariate-adjusted longitudinal fixed-effects models, results suggested associations between decreasing neighborhood coethnic concentration and increasing weight, although results were imprecise: within-person BMI increases associated with an interquartile range decrease in coethnic concentration were 0.15 kilograms per meters squared (95% confidence interval [CI] = 0.00, 0.30) among Chinese and 0.17 kilograms per meters squared (95% CI = -0.17, 0.51) among Hispanic participants. Results did not differ between those who did and did not move during follow-up. CONCLUSIONS Residential neighborhoods may help shape chronic disease risk among immigrants.

A Case Study of the Philadelphia Sugar-Sweetened Beverage Tax Policymaking Process: Implications for Policy Development and Advocacy

Context: Policymakers are increasingly proposing sugar-sweetened beverage (SSB) taxes as an evidence-based strategy to reduce chronic disease risk; and local health departments (LHDs) are well-positioned to play a role in SSB policy development and advocacy. However, most SSB tax proposals fail to become law and limited empiric guidance exists to inform advocacy efforts. In June 2016, Philadelphia, Pennsylvania, passed an SSB tax. Objective: To identify features of the Philadelphia SSB tax policymaking process that contributed to the proposals passage. Design: Qualitative case study. Semistructured interviews were conducted with key informants closely involved with the policymaking process. Interviews were audio-recorded and transcribed. Local news media about the SSB tax proposal were analyzed to triangulate interview findings. Analysis was conducted in NVivo 10 using inductive qualitative content analysis. Setting: Philadelphia, Pennsylvania, during the SSB tax policymaking in process. Participants: Nine key informants (2 city councilpersons, 4 city agency officials, 1 community-based advocate, 1 news reporter, and 1 researcher). Results: The Philadelphia SSB tax proposal was introduced with the explicit goal of financing universal prekindergarten and deliberately not framed as a health intervention. This framing shifted contentious debates about government involvement in individual behavior toward discussions about how to finance universal prekindergarten, a goal for which broad support existed. The LHD played an important role in communicating research evidence about potential health benefits of the SSB tax proposal at the end of the policymaking process. Conclusions: During local SSB tax policy development processes, LHD officials and other advocates should encourage policymakers to design SSB tax policies so that revenue is directed toward community investments for which broad public support exists. When communicating with policymakers and the public, LHDs should consider emphasizing how SSB tax revenue will be used in addition to presenting evidence about the potential health benefits of the SSB tax at the local level.

Childhood family wealth and mental health in a national cohort of young adults

Purpose Mental health is critical to young adult health, as the onset of 75% of psychiatric disorders occurs by age 24 and psychiatric disorders early in life predict later behavioral health problems. Wealth may serve as a buffer against economic stressors. Family wealth may be particularly relevant for young adults by providing them with economic resources as they make educational decisions and move towards financial and social independence. Methods We used prospectively collected data from 2060 young adults aged 18–27 in 2005–2011 from the Panel Study of Income Dynamics, a national cohort of US families. We examined associations between nonspecific psychological distress (measured with the K-6 scale) and childhood average household wealth during ages 0–18 years (net worth in 2010 dollars). Results In demographics-adjusted generalized estimating equation models, higher childhood wealth percentile was related to a lower prevalence of serious psychological distress: compared to lowest-quartile wealth, prevalence ratio (PR)=0.52 (0.32–0.85) for 3rd quartile and PR=0.41 (0.24–0.68) for 4th quartile. The associations were attenuated slightly by adjustment for parent education and more so by adjustment for childhood household income percentile. Conclusions Understanding the lifelong processes through which distinct aspects of socioeconomic status affect mental health can help us identify high-risk populations and take steps to minimize future disparities in mental illness.

Child and Adult Socioeconomic Status and the Cortisol Response to Acute Stress: Evidence from the Multi-Ethnic Study of Atherosclerosis

Objective A long-hypothesized pathway through which low socioeconomic status (SES) harms health is through dysregulation of the physiologic stress response systems. No previous studies have tested this hypothesis by investigating cortisol reactivity and recovery to acute stress in relation to SES at different times in the life course in adults. Alteration of the cortisol response to an acute stressor could signal dysregulation of the hypothalamic-pituitary-adrenal axis and has been associated with chronic illness. Methods We used data on 997 adults 54 years or older from a multiethnic, multisite United States study to examine associations between life course SES and cortisol response to a laboratory stress challenge. Informed by life course theory, we hypothesized that lower child and adult SES would be associated with lower reactivity (i.e., smaller increase in cortisol) and a slower recovery rate (i.e., slower rate of decline in cortisol after the challenge). Results In demographics-adjusted multilevel piecewise linear regression models, low child and adult SES were associated with a 19% (95% CI = 4%–50%) and 27% (7%–55%) slower recovery rate compared with high child and adult SES, respectively. Compared with participants with stable high SES, those with stable low SES had a 48% (16%–70%) slower recovery rate. Differences in reactivity by SES were small. Conclusions Our results support the hypothesis that low SES throughout life affects the hypothalamic-pituitary-adrenal axis and in turn the ability to recover from exposure to acute stressors. This mechanism can help explain how socioeconomic disparities contribute to disparities in chronic disease.

Intergenerational Associations of Parent Adverse Childhood Experiences and Child Health Outcomes

Using cross-sectional survey data, we examine associations of parent-reported current child health with parent ACE exposure. BACKGROUND: Adverse childhood experiences (ACEs) robustly predict future morbidity and mortality. Researchers are just beginning to investigate intergenerational effects. We hypothesize there are intergenerational associations between parent ACE exposure and worse child health, health behaviors, and health care access and use. METHODS: We linked data from 2 population-based cross-sectional telephone surveys in Philadelphia, Pennsylvania, that were used to ask parents about their past exposure to ACEs and their child’s health, respectively. Participants were 350 parent-child dyads. Logistic regression models adjusted for parent and child characteristics. Parent ACE score was used to summarize indicators of parents’ childhood adversity. Child health outcomes were poor overall health status, asthma diagnosis, obesity, low fruit and vegetable consumption, any soda consumption, inadequate physical activity, excessive television watching, no health insurance, no usual source of health care, and no dental examination in past 12 months. RESULTS: Of adult participants, 80% were female participants and 45% were non-Latino African American. Eighty-five percent of parents had experienced ≥1 ACE and 18% had experienced ≥6 ACEs. In adjusted models, each additional parent ACE was associated with higher odds of poor child overall health status (odds ratio [OR] = 1.19; 95% confidence interval [CI]: 1.07–1.32), asthma (OR = 1.17; 95% CI: 1.05–1.30), and excessive television watching (OR = 1.16; 95% CI: 1.05–1.28). CONCLUSIONS: The full scope of the health effects of ACEs may not be limited to the exposed individual, highlighting the need for a 2-generation approach to addressing the social determinants of child health.

Association of plasma phospholipid polyunsaturated and trans fatty acids with body mass index: Results from the multi-ethnic study of atherosclerosis

Background/Objective:Previous research has focused on associations between dietary fat and body mass index (BMI), but the contributions of different types of fat to BMI remain unclear. The purpose of this study is to estimate whether plasma phospholipid omega-3 (n−3), omega-6 (n−6) or trans fatty acids are associated with BMI at baseline and with subsequent BMI changes over time; and whether total phospholipid n−6 or trans fatty acids modify any association between phospholipid n−3 and BMI.Methods:Cross-sectional and longitudinal linear mixed models include 6243 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. Participants were 45−84 years old, had no history of cardiovascular disease at baseline (2000−2002) and were followed for up to 10 years. Plasma phospholipid fatty acids were measured using fasting plasma samples at baseline. Fully adjusted models include demographics, health behaviors and other fatty acids (n−3, n−6 and trans) as appropriate.Results:In fully adjusted models, phospholipid n−3 fatty acid levels were inversely associated with baseline BMI (Ptrend <0.001). Baseline BMI was 1.14 (95% confidence interval (CI): 0.71, 1.57) kg m–2 lower among participants with total n−3 values in the highest vs the lowest quartiles, but was not associated with changes in BMI. Total phospholipid n−6 was positively associated with baseline BMI in partially adjusted but not fully adjusted models. No overall association was observed between fatty acid levels and changes in BMI. No clear association was observed between trans fatty acids and baseline BMI or BMI change. No effect modification in the association between phospholipid n−3 and baseline BMI or BMI change was observed by either phospholipid n−6 or trans fatty acids.Conclusions:Phospholipid total and specific n−3 fatty acid levels were inversely associated with BMI at baseline, whereas associations tended to be positive for total n−6 fatty acids. Significant associations between fatty acid levels and BMI changes were not observed.

An audience research study to disseminate evidence about comprehensive state mental health parity legislation to US State policymakers: Protocol

BackgroundA large proportion of the US population has limited access to mental health treatments because insurance providers limit the utilization of mental health services in ways that are more restrictive than for physical health services. Comprehensive state mental health parity legislation (C-SMHPL) is an evidence-based policy intervention that enhances mental health insurance coverage and improves access to care. Implementation of C-SMHPL, however, is limited. State policymakers have the exclusive authority to implement C-SMHPL, but sparse guidance exists to inform the design of strategies to disseminate evidence about C-SMHPL, and more broadly, evidence-based treatments and mental illness, to this audience. The aims of this exploratory audience research study are to (1) characterize US State policymakers’ knowledge and attitudes about C-SMHPL and identify individual- and state-level attributes associated with support for C-SMHPL; and (2) integrate quantitative and qualitative data to develop a conceptual framework to disseminate evidence about C-SMHPL, evidence-based treatments, and mental illness to US State policymakers.MethodsThe study uses a multi-level (policymaker, state), mixed method (QUAN→qual) approach and is guided by Kingdon’s Multiple Streams Framework, adapted to incorporate constructs from Aarons’ Model of Evidence-Based Implementation in Public Sectors. A multi-modal survey (telephone, post-mail, e-mail) of 600 US State policymakers (500 legislative, 100 administrative) will be conducted and responses will be linked to state-level variables. The survey will span domains such as support for C-SMHPL, knowledge and attitudes about C-SMHPL and evidence-based treatments, mental illness stigma, and research dissemination preferences. State-level variables will measure factors associated with C-SMHPL implementation, such as economic climate and political environment. Multi-level regression will determine the relative strength of individual- and state-level variables on policymaker support for C-SMHPL. Informed by survey results, semi-structured interviews will be conducted with approximately 50 US State policymakers to elaborate upon quantitative findings. Then, using a systematic process, quantitative and qualitative data will be integrated and a US State policymaker-focused C-SMHPL dissemination framework will be developed.DiscussionStudy results will provide the foundation for hypothesis-driven, experimental studies testing the effects of different dissemination strategies on state policymakers’ support for, and implementation of, evidence-based mental health policy interventions.

Invited Commentary: Multigenerational Social Determinants of Health—Opportunities and Challenges

An emerging area of social epidemiology examines the relationship between grandparental education and grandchild health. In an accompanying article, Huang et al. (Am J Epidemiol. 2015;182(7):568-578) join the small but growing body of research on this topic. It is useful to contextualize Huang et al.s work within the much larger body of research examining relationships between education and health within a single generation or across 2 generations. These investigators have generally concluded that higher educational attainment is robustly associated with better health. There are many potential mechanisms through which education and other social exposures may affect health outcomes in a single generation or across generations, and estimating direct and indirect effects can be helpful for assessing specific mechanisms. Researchers conducting multigenerational analyses are faced with several challenges, including limited availability of data for some measures (e.g., educational attainment, and sometimes for 1 grandparent only), limited age ranges of participants, disparate social and political contexts in which study participants of different generations have lived, and patterns of social class reproduction. We encourage future researchers to weave together the careful analytical considerations illustrated by Huang et al. with a rich understanding of the social context for each of the generations studied to help overcome these challenges and advance our understanding of multigenerational social determinants of health.

Audience segmentation to disseminate behavioral health evidence to legislators: an empirical clustering analysis

BackgroundElected officials (e.g., legislators) are an important but understudied population in dissemination research. Audience segmentation is essential in developing dissemination strategies that are tailored for legislators with different characteristics, but sophisticated audience segmentation analyses have not been conducted with this population. An empirical clustering audience segmentation study was conducted to (1) identify behavioral health (i.e., mental health and substance abuse) audience segments among US state legislators, (2) identify legislator characteristics that are predictive of segment membership, and (3) determine whether segment membership is predictive of support for state behavioral health parity laws.MethodsLatent class analysis (LCA) was used. Data were from a multi-modal (post-mail, e-mail, telephone) survey of state legislators fielded in 2017 (N = 475). Nine variables were included in the LCA (e.g., perceptions of behavioral health treatment effectiveness, mental illness stigma). Binary logistic regression tested associations between legislator characteristics (e.g., political party, gender, ideology) and segment membership. Multi-level logistic regression assessed the predictive validity of segment membership on support for parity laws. A name was developed for each segment that captured its most salient features.ResultsThree audience segments were identified. Budget-oriented skeptics with stigma (47% of legislators) had the least faith in behavioral health treatment effectiveness, had the most mental illness stigma, and were most influenced by budget impact. This segment was predominantly male, Republican, and ideologically conservative. Action-oriented supporters (24%) were most likely to have introduced a behavioral health bill, most likely to identify behavioral health issues as policy priorities, and most influenced by research evidence. This was the most politically and ideologically diverse segment. Passive supporters (29%) had the greatest faith in treatment effectiveness and the least stigma, but were also least likely to have introduced a behavioral health bill. Segment membership was a stronger predictor of support for parity laws than almost all other legislator characteristics.ConclusionsState legislators are a heterogeneous audience when it comes to behavioral health. There is a need to develop and test behavioral health evidence dissemination strategies that are tailored for legislators in different audience segments. Empirical clustering approaches to audience segmentation are a potentially valuable tool for dissemination science.