Category: Statistics

JMIR Public Health Surveill. 2025 Jan 13;11:e64564. doi: 10.2196/64564.

ABSTRACT

BACKGROUND: The effects of physical activity (PA) across different domains and intensities on depressive symptoms remain inconclusive. Incorporating the community-built environment (CBE) into longitudinal analyses of PA’s impact on depressive symptoms is crucial.

OBJECTIVE: This study aims to examine the effects of PA at different intensities-low-intensity PA (eg, walking activities) and moderate-to-vigorous-intensity PA (eg, activities requiring substantial effort and causing faster breathing or shortness of breath)-across leisure-time and occupational domains on depressive symptom trajectories among middle-aged and older adults. Additionally, it investigated how CBEs influence depressive symptoms and PA trajectories.

METHODS: This longitudinal study included 6865 middle-aged and older adults from the China Health and Retirement Longitudinal Survey. A CBE variable system was developed using a community questionnaire to assess attributes of the physical built environment. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Latent growth curve modeling was applied to analyze 3 waves of the cohort data (2015, 2018, and 2020) to explore the differential effects of PA on depressive symptoms and the role of the CBE.

RESULTS: In the 2015 and 2018 waves, higher low-intensity leisure-time physical activity (LTPA) was associated with lower depressive symptoms (β=-.025, P=.01 and β=-.027, P=.005, respectively). Across all waves, moderate-to-vigorous-intensity LTPA showed no significant predictive effects (P=.21 in 2015, P=.57 in 2018, and P=.85 in 2020, respectively). However, higher occupational physical activity (OPA), particularly at moderate-to-vigorous intensities, was consistently associated with higher depressive symptoms. Parallel process latent growth curve modeling revealed that the initial level of total LTPA negatively predicted the initial level of depressive symptoms (β=-.076, P=.01). OPA exhibited dual effects, positively predicting the initial level of depressive symptoms (β=.108, P<.001) but negatively predicting their upward trajectory (β=-.136, P=.009). Among CBE variables, better infrastructure conditions (β=-.082, P<.001) and greater accessibility to public facilities (β=-.036, P=.045) negatively predicted the initial level of depressive symptoms. However, greater accessibility to public facilities positively predicted the upward trajectory of depressive symptoms (β=.083, P=.04). Better infrastructure conditions (β=.100, P=.002) and greater accessibility to public transport (β=.060, P=.01) positively predicted the initial level of total LTPA. Meanwhile, better infrastructure conditions (β=-.281, P<.001) and greater accessibility to public facilities (β=-.073, P<.001) negatively predicted the initial level of total OPA. Better infrastructure conditions positively predicted the declining trajectory of total OPA (β=.100, P=.004).

CONCLUSIONS: This study underscores the importance of considering the differential effects of PA across domains and intensities on depressive symptoms in public policies and guidelines. Given the influence of the environment on PA and depressive symptoms, targeted community measures should be implemented.

PMID:39804686 | DOI:10.2196/64564

Games Health J. 2025 Jan 13. doi: 10.1089/g4h.2024.0192. Online ahead of print.

ABSTRACT

Due to the exponential growth in technology, exergames emerged as a potential tool to foster physical activity (PA) levels. This study provides an overall view of the literature on the effects of exergaming on physical fitness components among overweight and obese children and adolescents. A systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed in the PubMed, Web of Science, and Scopus databases. Among the 618 articles identified at the first screening stage, 17 were retained for analysis. The results indicate positive effects of exergaming interventions in body composition outcomes, cardiorespiratory fitness, muscular strength, and skills performance. Results from the randomized studies with the control group revealed significant effects of exergames in decreasing body mass index (mean difference = 0.24; 95% confidence interval [CI]: 0.06 to 0.43, P = 0.01) and increasing cardiorespiratory fitness (Hedges’s g = 0.28; 95% CI: 0.09 to 0.46, P = 0.00). Although not statistically significant, participants submitted to exergames interventions also showed decreased body weight compared to their control peers. The results emphasize the ability of exergames to enhance PA levels and physical fitness components, which might influence the health status of overweight and obese youth. However, due to the limited number of studies included in the meta-analysis (n = 4), future randomized controlled experiments are still needed to improve the understanding of the impact of exergames interventions on physical fitness.

PMID:39804680 | DOI:10.1089/g4h.2024.0192

Diabetes. 2025 Jan 13:db240841. doi: 10.2337/db24-0841. Online ahead of print.

ABSTRACT

Clonal haematopoiesis of indeterminate potential (CHIP) is associated with macrovascular diseases, including coronary artery disease and stroke. However, the effects of CHIP on microvascular complication have not been evaluated in individuals with type 2 diabetes (T2D). This study included 20,712 T2D participants without prevalent diabetic microvascular complication (DMCs) and hematologic malignancy at baseline. CHIP and related phenotypes were identified using whole exome sequencing derived from peripheral blood samples. The incidence of DMCs defined as a composite of diabetic kidney disease, diabetic retinopathy, or diabetic neuropathy. Associations of any CHIP with incident DMCs and subtypes were assessed using Cox regression. Gene-specific analyses also conducted to determine the effect of mutated driver genes with DMCs. During a median follow-up of 13.0 years, 5,673 participants developed DMCs. Any CHIP was associated with high risk of DMCs (HR, 1.23; 95% CI, 1.10-1.38; P<0.001), specifically, diabetic retinopathy (HR, 1.34; 95% CI, 1.13-1.57; P=0.001) and diabetic kidney disease (HR, 1.26; 95% CI, 1.10-1.45; P=0.001), but not diabetic neuropathy. Gene-specific analyses suggested that DNMT3A, TET2, NF1, and Spliceosome genes were associated with risk of developing DMCs. CHIP increases the risk of developing DMCs in individuals with T2D, independently of other risk factors. These findings offered potential implications for the prevention and management of DMCs.

PMID:39804667 | DOI:10.2337/db24-0841

Transl Vis Sci Technol. 2025 Jan 2;14(1):12. doi: 10.1167/tvst.14.1.12.

ABSTRACT

PURPOSE: To compare a novel high-resolution optical coherence tomography (OCT) with improved axial resolution (High-Res OCT) with conventional spectral-domain OCT (SD-OCT) with regard to their capacity to characterize the disorganization of the retinal inner layers (DRIL) in diabetic maculopathy.

METHODS: Diabetic patients underwent multimodal retinal imaging (SD-OCT, High-Res OCT, and color fundus photography). Best-corrected visual acuity and diabetes characteristics were recorded. DR was graded using the international clinical diabetic retinopathy severity scale (DRSS). In each OCT B-scan, retinal layers were segmented and the loss of discernibility was annotated. DRIL areas were analyzed in en face projection using FIJI plugins. The Wilcoxon test and regression models were used for statistical analysis.

RESULTS: In 93 eyes of 93 patients (mean age, 61.8 ± 12.9 years) DRIL was identified in 48 eyes. DRIL was most frequent in the central subfield (27%). In DRIL eyes, DRSS was significantly higher (4.43 ± 1.01 vs. 2.12 ± 1.66; P < 0.001), BCVA was significantly worse (0.34 ± 0.38 vs. 0.13 ± 0.22; P < 0.001), and the loss of discernibility of the individual inner retinal layers was significantly smaller in High-Res OCT compared with SD-OCT (0.21 ± 0.29 vs. 1.21 ± 1.21 mm2; P < 0.001). The discernibility loss was greatest in the retinal nerve fiber layer and ganglion cell layer.

CONCLUSIONS: DRIL occurs in eyes with advanced diabetic retinopathy, with a characteristic spread: from the inner toward the outer retina. High-Res OCT shows significantly smaller DRIL areas compared with SD-OCT, because of a more precise delineation of the inner retinal layers.

TRANSLATIONAL RELEVANCE: Using OCT with increased axial resolution could enhance our understanding of DRIL development and progression, providing deeper insights into pathophysiological aspects, including malperfusion in the inner capillary plexus.

PMID:39804658 | DOI:10.1167/tvst.14.1.12

JAMA Pediatr. 2025 Jan 13. doi: 10.1001/jamapediatrics.2024.5466. Online ahead of print.

ABSTRACT

IMPORTANCE: Multisystem inflammatory syndrome in children (MIS-C) is a life-threatening complication of COVID-19 infection. Data on midterm outcomes are limited.

OBJECTIVE: To characterize the frequency and time course of cardiac dysfunction (left ventricular ejection fraction [LVEF] <55%), coronary artery aneurysms (z score ≥2.5), and noncardiac involvement through 6 months after MIS-C.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study enrolled participants between March 2020 and January 2022 with a follow-up period of 2 years. Participants were recruited from 32 North American pediatric hospitals, and all participants met the 2020 Centers for Disease Control and Prevention case definition of MIS-C.

EXPOSURE: MIS-C after COVID-19 infection.

MAIN OUTCOMES AND MEASURES: Outcomes included echocardiography core laboratory (ECL) assessments of LVEF and maximum coronary artery z scores (zMax); data collection on cardiac and noncardiac sequelae during hospitalization and at 2 weeks, 6 weeks, and 6 months after discharge; and age-appropriate Patient-Reported Outcomes Measurement Information Systems (PROMIS) Global Health Instruments at follow-up. Descriptive statistics, linear regression models, and Kaplan-Meier analysis were used.

RESULTS: Of 1204 participants (median [IQR] age, 9.1 [5.6-12.7] years; 724 male [60.1%]), 325 self-identified with non-Hispanic Black race (27.0%) and 324 with Hispanic ethnicity (26.9%). A total of 548 of 1195 participants (45.9%) required vasoactive support, 17 of 1195 (1.4%) required extracorporeal membrane oxygenation, and 3 (0.3%) died during hospitalization. Of participants with echocardiograms reviewed by the ECL (n = 349 due to budget constraints), 131 of 322 (42.3%) had LVEF less than 55% during hospitalization; of those with follow-up, all but 1 normalized by 6 months. Black race (vs other/unknown race), higher C-reactive protein level, and abnormal troponin level were associated with lowest LVEF (estimate [SE], -3.09 [0.98]; R2 = 0.14; P =.002). Fifteen participants had coronary artery z scores of 2.5 or greater at any time point; 1 participant had a large/giant aneurysm. Of the 13 participants with z scores of 2.5 or greater during hospitalization, 12 (92.3%) had normalized by 6 months. Return to greater than 90% of pre-MIS-C health status (energy, sleep, appetite, cognition, and mood) was reported by 711 of 824 participants (86.3%) at 2 weeks, increasing to 548 of 576 (95.1%) at 6 months. Fatigue was the most common symptom reported at 2 weeks (141 of 889 [15.9%]), falling to 3.4% (22 of 638) by 6 months. PROMIS Global Health parent/guardian proxy median T scores for fatigue, global health, and pain interference improved significantly from 2 weeks to 6 months (fatigue, 56.1 vs 48.9; global health, 48.8 vs 51.3; pain interference, 53.0 vs 43.3; P < .001) and by the 6-week visit were at least equivalent to prepandemic population norms.

CONCLUSIONS AND RELEVANCE: Results of this cohort study suggest that although children and young adults with MIS-C can have severe disease during the acute phase, most recovered quickly and had a reassuring midterm prognosis.

PMID:39804656 | DOI:10.1001/jamapediatrics.2024.5466

JAMA Netw Open. 2025 Jan 2;8(1):e2453987. doi: 10.1001/jamanetworkopen.2024.53987.

ABSTRACT

IMPORTANCE: Cardiovascular health outcomes associated with noncigarette tobacco products (cigar, pipe, and smokeless tobacco) remain unclear, yet such data are required for evidence-based regulation.

OBJECTIVE: To investigate the association of noncigarette tobacco products with cardiovascular health outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted within the Cross Cohort Collaboration Tobacco Working Group by harmonizing tobacco-related data and conducting a pooled analysis from 15 US-based prospective cohorts with data on the use of at least 1 noncigarette tobacco product ranging between 1948 and 2015. The analysis for this study was conducted between September 2023 and February 2024. The median (IQR) follow-up time for the all-cause mortality outcome was 13.8 (10.2-19.2) years.

EXPOSURE: Current, sole, and exclusive use of noncigarette tobacco products. Sole use refers to using a noncigarette tobacco product without currently smoking cigarettes. Exclusive use means using only the noncigarette tobacco product and never having smoked cigarettes.

MAIN OUTCOMES AND MEASURES: Myocardial infarction, stroke, heart failure, atrial fibrillation, total coronary heart disease, total cardiovascular disease (CVD), coronary heart disease mortality, CVD mortality, and all-cause mortality.

RESULTS: Of 103 642 participants (mean [SD] age, 55.7 [13.2] years; 49 550 female [47.8%] and 54 092 male [52.2%]), current use rates were 26 962 participants (26.3%) for cigarettes, 1147 participants (2.1%) for cigars, 530 participants (1.2%) for pipes, and 1410 participants (2.1%) for smokeless tobacco. Current cigar use was associated with stroke (hazard ratio [HR], 1.25; 95% CI, 1.01-1.55), atrial fibrillation (HR, 1.32; 95% CI, 1.13-1.53), and heart failure (HR, 1.29; 95% CI, 1.10-1.51) compared with never using cigars in the model adjusted for demographic and socioeconomic factors, cardiovascular risk factors, and cohort. Sole (HR, 1.34; 95% CI, 1.12-1.62) and exclusive (HR, 1.53; 95% CI, 1.20-1.96) cigar use was associated with stroke compared with never using cigars or cigarettes. Current pipe use was associated with heart failure (HR, 1.23; 95% CI, 1.01-1.49) compared with never using pipes, and sole pipe use was associated with myocardial infarction (HR, 1.43; 95% CI, 1.17-1.74) compared with never using pipes or cigarettes. Current use of smokeless tobacco was associated with coronary heart disease mortality (HR, 1.31; 95% CI, 1.08-1.59) and myocardial infarction (HR, 1.20; 95% CI, 1.03-1.39) compared with never using smokeless tobacco. Sole and exclusive smokeless tobacco use demonstrated associations with total CVD (HR, 1.34; 95% CI, 1.19-1.50 and HR, 1.34; 955 CI, 1.13-1.59, respectively), total coronary heart disease (HR, 1.41; 95% CI, 1.21-1.64 and HR, 1.36; 95% CI, 1.08-1.70, respectively), heart failure (HR, 1.41; 95% CI, 1.22-1.64 and HR, 1.70; 95% CI, 1.40-2.06, respectively), and cardiovascular (HR, 1.41; 95% CI, 1.20-1.65 and HR, 1.54; 95% CI, 1.24-1.91, respectively) and all-cause (HR, 1.46; 95% CI, 1.34-1.60 and HR, 1.39; 95% CI, 1.22-1.58, respectively) mortality compared with never using smokeless tobacco or cigarettes.

CONCLUSIONS AND RELEVANCE: In this study, there were distinct risk patterns associated with the use of noncigarette tobacco products. These findings may carry implications for public health and regulation of noncigarette tobacco products.

PMID:39804647 | DOI:10.1001/jamanetworkopen.2024.53987

JAMA Netw Open. 2025 Jan 2;8(1):e2454253. doi: 10.1001/jamanetworkopen.2024.54253.

ABSTRACT

IMPORTANCE: The open-label randomized phase 2 LACOG0415 trial evaluated 3 treatment strategies for patients with advanced castration-sensitive prostate cancer (CSPC): androgen deprivation therapy (ADT) plus abiraterone acetate and prednisone (AAP), apalutamide (APA) alone, or APA plus AAP.

OBJECTIVE: To investigate the association of ADT plus AAP, APA alone, or APA plus AAP with health-related quality of life (HRQOL) in patients with advanced CSPC in the LACOG0415 trial.

DESIGN, SETTING, AND PARTICIPANTS: The LACOG0415 randomized clinical trial comprised 128 patients with advanced CSPC who were randomized (1:1:1) to 1 of 3 treatment arms from October 16, 2017, to April 23, 2019. Statistical analysis was conducted from March to September 2022.

INTERVENTIONS: Patients were randomized (1:1:1) to 1 of 3 treatment arms: ADT plus AAP, APA alone, or APA plus AAP.

MAIN OUTCOMES AND MEASURES: Health-related quality of life was evaluated using the Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire, including its subscales, completed at baseline and every 4 weeks until week 25. FACT-P scores range from 0 to 156, and higher scores indicate better HRQOL. Mean changes in score from baseline to week 25 were adjusted by baseline score and were calculated to evaluate whether there was a difference according to the treatment arm using a mixed-effect model for repeated measures. Time to deterioration was estimated by Kaplan-Meier curves and compared by stratified log-rank test. Analysis was performed on an intention-to-treat basis.

RESULTS: A total of 128 patients with advanced CSPC were randomized to receive ADT plus AAP (n = 42; median age, 69.8 years [IQR, 58.9-71.6 years]), APA alone (n = 42; median age, 69.5 years [IQR, 59.8-72.6 years]), or APA plus AAP (n = 44; median age, 71.0 years [IQR, 63.0-72.3 years]). Metastatic disease was present in 95 patients (74.2%), high-risk biochemical recurrence disease in 22 (17.2%), and locally advanced disease in 11 (8.6%). There was no significant difference in baseline mean (SD) FACT-P total scores and subscales among the 3 treatment arms (FACT-P total score: ADT plus AAP arm, 118.5 [24.3]; APA alone arm, 116.1 [23.9]; AAP plus APA arm, 114.9 [18.1]; P = .69). Health-related quality of life was maintained during treatment period, and there were no statistically significant differences at 25 weeks in mean (SD) FACT-P total scores or subscales between treatment arms (FACT-P total score: ADT plus AAP arm, 122.3 [20.4]; APA alone arm, 119.5 [16.4]; AAP plus APA arm, 119.9 [20.3]). The APA alone and AAP plus APA arms were not associated with meaningful improvements in HRQOL compared with the ADT plus AAP arm, except in time to deterioration of the emotional well-being score, which was more favorable in the APA alone arm (reference arm: ADT plus AAP arm; APA alone arm: hazard ratio, 0.37 [0.15-0.85]; P = .02; ADT plus AAP arm: hazard ratio, 0.56 [0.26-1.19]; P = .13). Limitations include short follow-up period and the absence of other questionnaires to capture differences between therapies.

CONCLUSIONS AND RELEVANCE: In this prespecified secondary analysis of a randomized clinical trial of ADT plus AAP, APA alone, or APA plus AAP for patients with advanced CSPC, HRQOL was not statistically different between treatments with APA alone or APA plus AAP as compared with ADT plus AAP. Larger studies with longer follow-up and more specific questionnaires are needed to further evaluate HRQOL with these treatment strategies.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02867020.

PMID:39804646 | DOI:10.1001/jamanetworkopen.2024.54253

JAMA Netw Open. 2025 Jan 2;8(1):e2454447. doi: 10.1001/jamanetworkopen.2024.54447.

ABSTRACT

IMPORTANCE: Enhanced breast cancer screening with magnetic resonance imaging (MRI) is recommended to women with elevated risk of breast cancer, yet uptake of screening remains unclear after genetic testing.

OBJECTIVE: To evaluate uptake of MRI after genetic results disclosure and counseling.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study was conducted at the University of Southern California Norris Cancer Hospital, the Los Angeles General Medical Center, and the Stanford University Cancer Institute. Patients were recruited from July 1, 2014, through November 30, 2016. Following multiplex gene panel testing and genetic counseling, patients responded to surveys about breast MRI screening at 3, 6, 12, and 24 months and to a final survey between 3 and 4 years after counseling. Participants met standard clinical criteria for genetic testing or had a 2.5% or greater probability of inherited cancer susceptibility. Patients were categorized based on breast cancer risk from genetic testing results and Tyrer-Cuzick model-calculated risk as having (1) a BRCA or other high-risk pathogenic variant (PV), (2) a moderate-risk PV, (3) a higher lifetime breast cancer risk (≥20%), or (4) a lower lifetime breast cancer risk (<20%). Analysis was conducted from September 28 to November 9, 2023.

INTERVENTIONS: Genetic testing with a 25- or 28-gene panel, and pretest and posttest genetic counseling by a genetic counselor or an advanced practice genetics nurse practitioner, which included cancer-specific screening recommendations.

MAIN OUTCOMES AND MEASURES: MRI screening adherence over time across risk groups was estimated using Cox proportional hazards regression modeling. Likelihood of screening adherence (odds ratios [ORs] with 95% CIs), controlling for potential confounders, was estimated using logistic regression.

RESULTS: This study included 638 patients, with a mean (SD) age of 50.7 (13.3) years at testing. There were 43 patients (6.7%) with a BRCA or other high-risk PV, 16 (2.5%) with a moderate-risk PV, 146 (22.9%) with higher lifetime breast cancer risk, and 433 (67.9%) with lower lifetime breast cancer risk. A total of 52 patients (8.2%) identified as Asian, 21 (3.3%) as Black, 271 (42.5%) as Hispanic, and 255 (40.0) as White. Compared with patients with lower lifetime breast cancer risk, patients with a BRCA or other high-risk PV and those with a moderate-risk PV were approximately 10 times (OR, 9.81 [95% CI, 4.05-23.86]; P < .001) and 4 times (OR, 4.12 [95% CI, 1.10-14.35]; P = .03) as likely to undergo MRI, respectively. Patients with a BRCA or other high-risk PV were nearly 16 times (OR, 15.81 [95% CI, 5.17-48.31]) as likely to report consistent yearly MRI screening compared with patients with lower lifetime risk.

CONCLUSIONS AND RELEVANCE: In this study, women with inherited PVs conferring increased breast cancer risk had higher and more consistent MRI uptake than women with lower estimated risk. These findings emphasize the importance of genetic cancer risk assessment for effective enhanced breast cancer screening.

PMID:39804645 | DOI:10.1001/jamanetworkopen.2024.54447

JAMA Netw Open. 2025 Jan 2;8(1):e2454455. doi: 10.1001/jamanetworkopen.2024.54455.

ABSTRACT

IMPORTANCE: Women who use heroin in sub-Saharan Africa face elevated HIV risk linked to structural vulnerability including frequent incarceration. However, little is known about the association between incarceration and drug use and HIV outcomes among women who use heroin in Africa.

OBJECTIVE: To estimate associations between incarceration and adverse HIV-related and drug use-related outcomes among women who used heroin.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included participants from Dar es Salaam, Tanzania, who were recruited using respondent-driven sampling. Eligible participants were women who used heroin who were aged 18 years or older and reported past-month heroin use. Data were collected from November 2018 to February 2019 and analyzed from September 2023 to May 2024.

EXPOSURE: The exposure was recent incarceration, defined as self-report of being held in prison or jail in the past 6 months.

MAIN OUTCOMES AND MEASURES: Main outcomes were self-reported HIV testing in the past 6 months, self-reported HIV status, and lifetime nonfatal overdose. Associations between recent incarceration and outcomes were examined using modified Poisson regression with robust variance estimation.

RESULTS: This study included 195 women who used heroin (median [IQR] age, 33 [27-39] years); 119 women (61%) reported incarceration in the past 6 months. In bivariate analyses, incarceration was associated with transactional sex (111 of 119 [93.3%]), symptoms of anxiety (104 of 119 [87.4%]), physical violence victimization (83 of 118 [70.3%]), and stigma from family (eg, 99 of 119 women [83.2%] reported being treated differently) and health care clinicians (eg, 46 of 119 women [38.7%] reported receiving poor health care). In adjusted analyses, incarceration was associated with higher prevalence of sexual concurrency (101 of 119 [84.9%] vs 41 of 76 [54.0%]; aPR, 1.43; 95% CI, 1.16-1.78), stimulant use (26 of 119 [21.9%] vs 3 of 76 [4.0%]; aPR, 5.60; 95% CI, 1.63-19.28), and lifetime nonfatal overdose (51 of 119 [42.9%] vs 17 of 76 [22.4%]; aPR, 1.62; 95% CI, 1.01-2.61). Among women who used heroin living with HIV, incarceration was associated with stopping HIV care (9 of 27 [33.3%] vs 1 of 24 [4.2%]; aPR, 9.74; 95% CI, 1.22-77.22).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of HIV-related outcomes among recently incarcerated women who used heroin in sub-Saharan Africa, behavioral and structural vulnerabilities associated with incarceration were identified, which may exacerbate HIV disparities. Elevated stimulant use among recently incarcerated women who used heroin is of particular concern, given associations with adverse HIV outcomes. In the context of highly criminalized drug use, interventions targeting policing practices may be effective at reducing incarceration-associated risks. Findings could inform development and evaluation of multilevel interventions to reduce service interruptions and ensure linkage to HIV and substance use services during incarceration and reentry.

PMID:39804644 | DOI:10.1001/jamanetworkopen.2024.54455

JAMA Netw Open. 2025 Jan 2;8(1):e2454516. doi: 10.1001/jamanetworkopen.2024.54516.

ABSTRACT

IMPORTANCE: Literature suggests that well-being and health status differ by generational status among Asian American individuals.

OBJECTIVE: To compare young children’s well-being and health behaviors and their parents’ parenting practices among families of second-generation Asian American, third- or later-generation Asian American, and third- or later-generation non-Hispanic White children in the US.

DESIGN, SETTING, AND PARTICIPANTS: For this survey study, secondary data analysis was conducted from September 2, 2023, to June 19, 2024, using data from the 2018 to 2022 National Survey of Children’s Health participants aged 6 months to 5 years. Parents completed a survey about their positive parenting practices and their child’s psychological well-being and health behaviors via mail or online. Multivariable logistic and linear regression analyses were conducted to compare psychological well-being and health behaviors by study groups and positive parenting practices, adjusting for sociodemographic variables.

MAIN OUTCOMES AND MEASURES: Positive parenting practices (ie, reading, storytelling or singing, and family meals), psychological well-being (ie, flourishing, social-emotional development, and self-regulation), and health behaviors.

RESULTS: The analysis included 42 846 participants (5456 in 2018, 5140 in 2019, 7494 in 2020, 12 817 in 2021, and 11 939 in 2022; 46.6% female and 53.4% male). Participants were categorized into 3 groups: 2881 (6.7%) were second-generation Asian American children aged 0 to 5 years, 570 (1.3%) third- or later-generation Asian American children aged 0 to 5 years, and 39 395 (92.0%) third- or later-generation non-Hispanic White children aged 0 to 5 years. Compared with White children, Asian American children were less likely to flourish (odds ratio [OR], 0.57 [95% CI, 0.52-0.63] for second-generation Asian American; OR, 0.82 [95% CI, 0.65-1.03] for third- or later-generation Asian American), have regular bedtimes (OR, 0.80 [95% CI, 0.69-0.92] for second-generation Asian American; OR, 0.66 [95% CI, 0.49-0.88] for third- or later-generation Asian American), and have moderate screen time (OR, 0.92 [95% CI, 0.84-1.00] for second-generation Asian American; OR, 0.82 [95% CI, 0.69-0.97] for third- or later-generation Asian American). Results for regular reading and storytelling or singing were the lowest among second-generation Asian American children (1430 [49.6%] for reading and 1629 [56.5%] for storytelling or singing), followed by the third- or later-generation Asian American children (376 [66.0%] for reading and 412 [72.3%] for storytelling or singing) and than White children (28 628 [72.7%] for reading and 30 375 [77.1%] for storytelling or singing) (P < .001). Results for family meals were similar between second-generation (2356 [81.8%]) and third- or later-generation (467 [81.9%]) Asian American children; however, both were significantly lower than for White children (33 928 [86.1%]) (P < .001). All 3 positive parenting practices were positively associated with children’s psychological well-being and health behaviors.

CONCLUSIONS AND RELEVANCE: This survey study of young children found lower likelihoods of flourishing, regular bedtimes, and moderate screen time among Asian American children compared with non-Hispanic White children in the US. Reading and storytelling or singing parenting practices, which were associated with children’s well-being and health behaviors, were particularly less frequent among parents of second-generation Asian American children than those of third- or later-generation Asian American children. Promotion of these practices among Asian immigrant parents may help improve the psychological well-being and health behaviors of their young Asian American children.

PMID:39804643 | DOI:10.1001/jamanetworkopen.2024.54516