Has the UK Campaign to End Loneliness Reduced Loneliness and Improved Mental Health in Older Age? A Difference-in-Differences Design.

OBJECTIVE: To estimate the impact of the UK nationwide campaign to End loneliness on loneliness and mental health outcomes among older people in England. DESIGN: Quasi-experimental design, namely, a difference-in-differences approach. SETTING: Local authorities across England. PARTICIPANTS: Older adults aged 65 and over participating in waves 4-8 (2008-2017) of the English Longitudinal Study of Aging (ELSA) and waves 1-9 (2009-2019) of the UK Household Longitudinal Study (UKHLS). MAIN OUTCOME MEASURES: Loneliness was measured through the UCLA Loneliness scale. A social isolation scale with components of household composition, social contact and participation was constructed. Mental health was measured by The Centre for Epidemiological Studies of Depression (CES-D) score, the General Health Questionnaire (GHQ-12) score, and the Short-Form-12 Mental Component Summary (SF-12 MCS) score. RESULTS: There was no evidence of change in loneliness scores over the study period. Difference-in-differences estimates suggest that explicitly developed and implemented antiloneliness strategies led to no change in loneliness scores (estimate = 0.044, SE = 0.085), social isolation caseness (estimate = 0.038, SE = 0.020) or levels of depressive symptoms (estimate = 0.130, SE = 0.165). Heterogeneity analyses indicate that antiloneliness strategies produced little impact on loneliness or mental health overall, despite small reductions in loneliness and increases in social engagement among well-educated and higher-income older adults. The results were robust to various sensitivity and robustness analyses. CONCLUSIONS: Antiloneliness strategies implemented by local authorities have not generated a significant change in loneliness or mental health in older adults in England. Generating changes in loneliness in the older population might require longer periods of exposure, larger scope of intervention or more targeted strategies.

Aircraft noise control policy and mental health: a natural experiment based on the Longitudinal Aging Study Amsterdam (LASA).

BACKGROUND: This study examines the impact of environmental noise policy on depressive symptoms by exploiting the national experiment afforded by the New Deal aircraft noise control policy introduced in Schiphol (Amsterdam) in 2008. METHODS: Data came from older adults (ages 57-102) participating in three waves (2005/2006, 2008/2009 and 2011/2012) of the Longitudinal Aging Study Amsterdam (LASA) (N=1746). Aircraft noise data from the Netherlands Environmental Assessment Agency were linked to LASA cohort addresses using the GeoDMS software. The Centre for Epidemiologic Studies-Depression (CES-D) scale was used to measure depressive symptoms. Using a difference-in-dfferences (DiD) approach, we compared changes in CES-D levels of depressive symptoms before and after the policy between people living close (≤15 km) and those living far away (>15 km) from Schiphol airport. RESULTS: There were few changes in noise levels after the introduction of the policy. Estimates suggested that the policy did not lead to a reduction in noise levels in the treatment areas relative to the control areas (DiD estimate=0.916 dB(A), SE=0.345), and it had no significant impact on levels of depressive symptoms (DiD estimate=0.044, SE=0.704). Results were robust to applying different distance thresholds. CONCLUSION: The New Deal aircraft noise control policy introduced in Amsterdam was not effective in reducing aircraft noise levels and had no impact on depressive symptoms in older people. Our results raise questions about the effectiveness of the current noise control policy to improve the well-being of residents living near the airport.

Regeneration of deprived neighbourhoods and indicators of functioning in older adults: A quasi-experimental evaluation of the Dutch District Approach.

This study examines the impact of the Dutch District Approach, a major urban regeneration programme that was started in 2008 in the Netherlands, on social, physical and mental functioning of older adults. Data from 1092 participants (58-93 years at baseline) across two waves (2005/06 and 2011/12) of the Longitudinal Aging Study Amsterdam were linked to detailed data on exposure to the programme. Using a difference-in-difference approach, we assessed differences from pre-intervention to the intervention period between the target and control districts in loneliness, social engagement, social isolation, physical activity, and anxiety and depressive symptoms. Regardless of programme intensity, the results indicate that the Dutch District Approach did not benefit or harm these aspects of functioning in older adults.

Public transit and depression among older adults: using agent-based models to examine plausible impacts of a free bus policy.

BACKGROUND: Daily transport is associated with mental health. A free bus policy (FBP) may be effective in promoting the use of public transit in older adults and be associated with reductions in depressive symptoms. METHODS: We developed an agent-based model and grounded it using empirical data from England to examine the impact of an FBP on public transit use and depression among older adults. We also used the model to explore whether the impact of the FBP bus use and depression is modified by the type of income segregation or by simultaneous efforts to improve attitudes towards the bus, to reduce waiting times or to increase the cost of driving via parking fees or fuel price. RESULTS: Our model suggests that improving attitudes towards the bus (eg, campaigns that promote bus use) could enhance the effect of the FBP, especially for those in proximity to public transit. Reducing wait times could also significantly magnify FPB impacts, especially in those who live in proximity to public transit. Contrary to expectation, neither fuel costs nor parking fees significantly enhanced the impact of the FBP. The impact of improving attitudes towards the bus and increasing bus frequency was more pronounced in the lower-income groups in an income segregation scenario in which destination and public transit are denser in the city centre. CONCLUSION: Our results suggest that the beneficial mental health effects of an FBP for older adults can be magnified when combined with initiatives that reduce bus waiting times and increased spatial access to transit.

Public Transportation Use and Cognitive Function in Older Age: A Quasiexperimental Evaluation of the Free Bus Pass Policy in the United Kingdom.

In this quasiexperimental study, we examined whether the introduction of an age-friendly transportation policy-free bus passes for older adults-increased public transport use and in turn affected cognitive function among older people in England. Data came from 7 waves (2002-2014) of the English Longitudinal Study of Ageing (n = 17,953), which measured total cognitive function, memory, executive function, and processing speed before and after the bus pass was introduced in 2006. The analytical strategy was an instrumental-variable approach with fixed effects, which made use of the age-eligibility criteria for free bus passes and addressed bias due to reverse causality, measurement error, and time-invariant confounding. Eligibility for the bus pass was associated with a 7% increase in public transport use. The increase in public transportation use was associated with a 0.346 (95% confidence interval: 0.017, 0.674) increase in the total cognitive function z score and with a 0.546 (95% confidence interval: 0.111, 0.982) increase in memory z score. Free bus passes were associated with an increase in public transport use and, in turn, benefits to cognitive function in older age. Public transport use might promote cognitive health through encouraging intellectually, socially, and physically active lifestyles. Transport policies could serve as public health tools to promote cognitive health in aging populations.

MINDMAP: establishing an integrated database infrastructure for research in ageing, mental well-being, and the urban environment.

BACKGROUND: Urbanization and ageing have important implications for public mental health and well-being. Cities pose major challenges for older citizens, but also offer opportunities to develop, test, and implement policies, services, infrastructure, and interventions that promote mental well-being. The MINDMAP project aims to identify the opportunities and challenges posed by urban environmental characteristics for the promotion and management of mental well-being and cognitive function of older individuals. METHODS: MINDMAP aims to achieve its research objectives by bringing together longitudinal studies from 11 countries covering over 35 cities linked to databases of area-level environmental exposures and social and urban policy indicators. The infrastructure supporting integration of this data will allow multiple MINDMAP investigators to safely and remotely co-analyse individual-level and area-level data. Individual-level data is derived from baseline and follow-up measurements of ten participating cohort studies and provides information on mental well-being outcomes, sociodemographic variables, health behaviour characteristics, social factors, measures of frailty, physical function indicators, and chronic conditions, as well as blood derived clinical biochemistry-based biomarkers and genetic biomarkers. Area-level information on physical environment characteristics (e.g. green spaces, transportation), socioeconomic and sociodemographic characteristics (e.g. neighbourhood income, residential segregation, residential density), and social environment characteristics (e.g. social cohesion, criminality) and national and urban social policies is derived from publically available sources such as geoportals and administrative databases. The linkage, harmonization, and analysis of data from different sources are being carried out using piloted tools to optimize the validity of the research results and transparency of the methodology. DISCUSSION: MINDMAP is a novel research collaboration that is combining population-based cohort data with publicly available datasets not typically used for ageing and mental well-being research. Integration of various data sources and observational units into a single platform will help to explain the differences in ageing-related mental and cognitive disorders both within as well as between cities in Europe, the US, Canada, and Russia and to assess the causal pathways and interactions between the urban environment and the individual determinants of mental well-being and cognitive ageing in older adults.

Public transport policy, social engagement and mental health in older age: a quasi-experimental evaluation of free bus passes in England.

BACKGROUND: Social engagement and social isolation are key determinants of mental health in older age, yet there is limited evidence on how public policies may contribute to reducing isolation, promoting social engagement and improving mental health among older people. This study examines the impact of the introduction of an age-friendly transportation policy, free bus passes, on the mental health of older people in England. METHODS: We use an instrumental variable (IV) approach that exploits eligibility criteria for free bus passes to estimate the impact of increased public transportation use on depressive symptoms, loneliness, social isolation and social engagement. RESULTS: Eligibility for the free bus travel pass was associated with an 8% (95% CI 6.4% to 9.6%) increase in the use of public transportation among older people. The IV model suggests that using public transport reduces depressive symptoms by 0.952 points (95% CI -1.712 to -0.192) on the Center for Epidemiologic Studies Depression Scale. IV models also suggest that using public transport reduces feelings of loneliness (ß -0.794, 95% CI -1.528 to -0.061), increases volunteering at least monthly (ß 0.237, 95% CI 0.059 to 0.414) and increases having regular contact with children (ß 0.480, 95% CI 0.208 to 0.752) and friends (ß 0.311, 95% CI 0.109 to 0.513). CONCLUSION: Free bus travel is associated with reductions in depressive symptoms and feelings of loneliness among older people. Transportation policies may increase older people's social engagement and consequently deliver significant benefits to mental health.

The Great Recession and the Health of Young Children: A Fixed-Effects Analysis in Ireland.

Economic recessions have been linked to adult health, but few studies have examined how recessions influence the health of young children. This study examined the impact of life transitions linked to the recent financial crisis on the health of young children in Ireland. Data came from the Growing Up in Ireland Infant Cohort Study (n = 11,134), which assessed children before (2008), during (2011), and after (2013) the Great Recession that followed the financial crisis of 2008 and incorporated questions on the impacts of the financial crisis on families. Using fixed-effects models to control for confounding, we found that a reduction in welfare benefits during the recession was associated with a significant increase in the risks of asthma (ß = 0.014, 95% confidence interval (95% CI): 0.004, 0.023) and atopy (ß = 0.014, 95% CI: 0.001, 0.027). While parental job loss was not associated with child health, a reduction in working hours was associated with increased reports of child health problems (ß = 0.024, 95% CI: 0.004, 0.043), as were difficulties affording basic necessities (ß = 0.019, 95% CI: 0.001, 0.038). Results suggest that failing to protect vulnerable families and children during economic recessions may have long-lasting implications for child health.

Structural Interventions for HIV Prevention Among Women Who Use Drugs: A Global Perspective.

We briefly review extant literature on the contextual sources of HIV risk among drug users­the drug user risk environment­and on structural interventions to address drug user vulnerability to HIV. We argue that issues of gender inequality and gendered power relations are largely absent from this literature. We then identify 5 contextual factors that are critical for understanding women's HIV-related vulnerability and whose impacts are exacerbated among women who use drugs, including a division of reproductive labor in which women bear primary responsibility for family caretaking, women's lack of full access to or control of productive resources and decision making, women's vulnerability to sexual and physical violence, and especially, intimate partner violence, women's (particularly heterosexual women's) relationship dependency and limited power in sexual interactions, and harmful gender norms that reinforce these other factors. We discuss a range of structural interventions and structural intervention approaches with the potential to address these contextual factors and call for more research, both to better understand the risk environment of women who use drugs and the impacts of structural interventions on it. We argue that our understanding of and ability to impact on the HIV-related risk environment of drug users is incomplete if we do not fully incorporate the analysis of gender inequality and gendered power relations.