Exposure to Armed Conflict and HIV Risk Among Rwandan Women.

This article focuses on the link between past exposure to violence and a critical public health issue in sub-Saharan Africa: HIV-positive status in women of reproductive age. Specifically, we use biosocial data from the Rwandan Demographic and Health Survey (2005‒2014) to assess how the timing and intensity of women's exposure to the war and genocide in Rwanda (1990‒1994) may be associated with their HIV status. We find significant differences in risk across age cohorts, with the late adolescence cohort (women born in 1970‒1974, who were aged 16‒20 at the start of the conflict) having the highest risk of being HIV positive 10‒20 years after the violence, even after controlling for current socioeconomic and demographic characteristics. Women who reported two or more sibling deaths, excluding those related to maternal mortality, during the conflict years also had higher odds of being HIV positive, net of cohort and control variables. Age at first sexual intercourse and number of lifetime sexual partners partially-but not fully-explain the associations between cohort and sibling deaths and HIV. These findings advance research related to armed conflict and population health and indicate that experiencing conflict during key stages of the life course and at higher intensity may affect women's long-term sexual health.

Divergent Trends in the Effects of Early-Life Factors on Adult Health.

Life course theories have shaped social and health scientists' understanding of the origins and pathways of health, aging, and mortality. However, few studies have examined how these origins might have changed across cohorts. This study investigates the impact of birth, childhood, and adolescence factors on adult health across birth cohorts born in the second half of the 20th century in the United States. Data come from the Panel Study of Income Dynamics Family and Individual Files 1968-2013 and the Childbirth and Adoption History File 1985-2013. Multilevel growth models are used to capture the growth trajectories of two adult health outcomes: self-rated health and health summary index. We find the association between three pre-adulthood factors (birth weight, mother's education, childhood family income-to-needs ratio) and health outcomes weakens in more recent cohorts, while the association strengthens for the other two early life factors (early-life disease index and parental smoking status before age 17). These findings demonstrate the complexity of the social-to-biological embodiment across the life course, and suggest that the effects of early-life factors on adult health can increase or decrease across cohorts due to macro social, economic, policy, technological, and medical changes. They also illuminate the long-term debate on the period and cohort effects in shaping the health trend, and suggest that the cohort effect is multidimensional and is weaker or stronger depending on the dimension of early life examined.

Are Recent Cohorts Getting Worse? Trends in US Adult Physiological Status, Mental Health, and Health Behaviors Across a Century of Birth Cohorts.

Morbidity and mortality have been increasing among middle-aged and young-old Americans since the turn of the century. We investigated whether these unfavorable trends extend to younger cohorts and their underlying physiological, psychological, and behavioral mechanisms. Applying generalized linear mixed-effects models to data from 62,833 adults from the National Health and Nutrition Examination Surveys (1988-2016) and 625,221 adults from the National Health Interview Surveys (1997-2018), we found that for all sex and racial groups, physiological dysregulation has increased continuously from Baby Boomers through late-Generation X and Generation Y. The magnitude of the increase was higher for White men than for other groups, while Black men had a steepest increase in low urinary albumin (a marker of chronic inflammation). In addition, Whites underwent distinctive increases in anxiety, depression, and heavy drinking, and they had a higher level than Blacks and Hispanics of smoking and drug use in recent cohorts. Smoking is not responsible for the increasing physiological dysregulation across cohorts. The obesity epidemic contributes to the increase in metabolic syndrome but not in low urinary albumin. The worsening physiological and mental health profiles among younger generations imply a challenging morbidity and mortality prospect for the United States, one that might be particularly inauspicious for Whites.

Life-long body mass index trajectories and mortality in two generations.

PURPOSE: To identify life-long body mass index (BMI) trajectories across two related generations and estimate their associated mortality risks and population attributable deaths. METHODS: We use prospective cohort data from the Framingham Heart Study (1948-2011) original (4576 individuals, 3913 deaths) and offspring (3753 individuals, 967 deaths) cohorts and latent trajectory models to model BMI trajectories from age 31 to 80 years. Survival models are used to estimate trajectory-specific mortality risk. RESULTS: We define seven BMI trajectories among original cohort and six among offspring cohort. Among original cohort, people who are normal weight at age 31 years and gradually move to overweight status in middle or later adulthood have the lowest mortality risk even compared to those who maintain normal weight throughout adulthood, followed by overweight stable, lower level of normal weight, overweight downward, class I obese upward, and class II/III upward trajectories. Mortality risks associated with obesity trajectories have declined across cohorts, while the prevalence of high-risk trajectories has increased. CONCLUSIONS: The mortality impact of weight gain depends on an individual's BMI trajectory. Population attributable deaths associated with unhealthy weight trajectories have grown over generations because the prevalence has increased, offsetting the decline in trajectory-specific mortality risks.

Obesity-mortality link over the life course: the contribution of population compositional changes.

A key uncertainty in the obesity-mortality association continues to be how this association changes over the life course. Prior studies tend to rely on cross-sectional design with static weight status taken at the time of the survey. This study tracks a cohort of individuals and employs lifelong body mass index information from the Framingham Heart Study original cohort (1948-2010). We focus on respondents who were younger than age 45 at time of their first survey (n = 2,176) and evaluate how the mortality risk associated with obesity changes over three age groups (below 45, 45-59, and 60 and above) and how population compositions may contribute to this pattern. We find the hazard ratio associated with obesity compared to normal weight decreases over three age groups, but this pattern is influenced by different ages of onset of obesity, inconsistency in the reference group (normal weight) over ages, and mortality selection effects. These factors explain away the decreasing effect of obesity (with onset before age 45) on mortality up to age 60; after age 60, the detrimental effect still declines, but to a much less degree. Later onset of obesity, however, is not significantly associated with excess mortality risks after age 60.