Dynamic residential movement and depression among the World Trade Center Health Registry enrollees

Purpose Residential instability is associated with poor mental health, but its causal inference is challenging due to time-varying exposure and confounding, and the role of changing social environments. We tested the association between frequent residential moving and depression risk among adults exposed to the 9/11 disaster. Methods We used four waves of survey data from the World Trade Center Health Registry. We measured residential movement and depression using geocoded annual address records and the Personal Health Questionnaire Depression Scale, respectively, for a prospective cohort of 38,495 adults. We used the longitudinal Targeted Maximum Likelihood Method to estimate depression risk by frequent residential moving and conducted causal mediation analysis to evaluate a mediating role of social environments. Results Most enrollees (68%) did not move in 2007–2014, and 6% moved at least once every 4 years. The remaining 26% moved less frequently (e.g., only moving in 2007–2010). Frequent moving versus no moving was associated with risk of depression in 2015–16 (RR = 1.20, 95% CI = 1.06, 1.37). Frequent residential moving—depression pathway was mediated by high social integration (OR = 0.93, 95% CI = 0.90, 0.97). Conclusion These findings demonstrate the importance of social networks in understanding increased risk of depression associated with housing instability.

Chronic Stress and Unhealthy Dietary Behaviors among Low-Income African-American Female Caregivers

ABSTRACT Background Chronic stress increases the risk of excess intake of calorie-dense foods. Low-income minority caregivers in the United States are cumulatively exposed to stressors and unhealthy foods, but evidence of this association is limited in this population group. The objective of the current study was to assess the association between chronic stress and unhealthy dietary behaviors among low-income African-American caregivers in Detroit, Michigan. Methods Data came from Detroit Dental Health Project, a longitudinal study of pairs of African-American caregivers and children during 2002–2007. A sample of 912 female caregivers were included and their baseline (2002–2003) survey responses were analyzed to identify those with chronic stress and patterns of dietary behaviors. The likelihood of having unhealthy dietary behaviors was compared between chronically stressed caregivers and others, and the mediator role of depressive symptoms or current smoking was tested. Results Approximately 10% of caregivers experienced chronic stress as they all reported discrimination, residential movement, and lack of social support. Twenty-five percent of the caregivers were found to have an unhealthy dietary pattern characterized by excess intake of high fatty foods and soda. Chronically stressed caregivers were more likely to exhibit unhealthy dietary behaviors (prevalence ratio: 1.39; 95% CI: 1.05, 1.84), and this relation was significantly mediated by depressive symptoms, not current smoking. Conclusions These findings suggest that chronic stress played a role in negatively influencing dietary behaviors. As this association might be mediated by depressive symptoms, an intervention to reduce depressive symptoms can be considered as an effective strategy to promote healthy dietary behaviors among chronically stressed minority caregivers.

Neighbourhood tobacco supply and individual maternal smoking during pregnancy: a fixed-effects longitudinal analysis using routine data

BackgroundTobacco policy is increasingly focusing on the ‘tobacco endgame’ which commits to eradicating tobacco use (prevalence below 5%) within the next two decades. Strategies for achieving the endgame are likely to include addressing the supply of tobacco products, yet current evidence to support this approach is primarily cross-sectional.MethodsWe use longitudinal smoking information from routine maternity records of all women who gave birth in Scotland between 2000 and 2015. We linked this data to the residential density of retailers selling tobacco products and the neighbourhood prevalence of smoking during pregnancy. In the analysis, individual mothers act as their own controls because we compare changes in their smoking behaviour between pregnancies to changes in exposure to tobacco retailing that arises from residential movement between pregnancies.ResultsAdjusted ORs showed an increased risk of being a smoker associated with increases in exposure to retailer density (OR 1.67, 95% CI 1.27 to 2.20).ConclusionsThe results provide the strongest evidence to date of an association between the neighbourhood availability of tobacco and smoking, and the first to do so among pregnant women. These findings provide supportive evidence for interventions targeting the supply of tobacco products in achieving the endgame.