Yong Yang

We examined longitudinal changes in perceived neighborhood crime and social cohesion from 2020 to 2024 and their associations with depression, anxiety, and loneliness. U.S. adults ( N = 895) recruited in spring 2020 completed at least one annual follow‐up surveys through 2024. Group‐based trajectory modeling identified four perceived‐crime trajectories: low (71.7%), increasing (14.9%), decreasing (8.7%), and high (4.8%), and three stable social‐cohesion trajectories: high (18.2%), middle (63.9%), and low (17.9%). Multivariable logistic regression showed that, compared with the low‐crime trajectory, high and increasing crime were associated with higher odds of depression (OR = 2.61 and 1.82) and anxiety (OR = 3.08 and 1.87), whereas decreasing crime was associated with lower odds of loneliness (OR = 0.55). Compared with high cohesion, low cohesion was associated with higher odds of depression (OR = 6.38), anxiety (OR = 4.81), and loneliness (OR = 4.17). Complementary within‐between mixed‐effects models showed that within‐person increases in perceived crime were associated with higher depression ( β = .12), anxiety ( β = .15), and loneliness ( β = .19), whereas within‐person increases in social cohesion were associated with lower symptoms ( β = −0.02 to −0.04). Findings indicate consistent longitudinal associations between neighborhood perceptions and mental health across person‐centered and variable‐centered approaches.

Objectives: To examine the trajectories of cognitive impairment and transport restriction over time and the interrelation between these trajectories among older adults.Methods: Group‐based trajectory modeling was used on the longitudinal National Health and Aging Trends Study (NHATS) over 11 years from 2011 to 2021, among 5753 participants, stratified by age in 2011 to three groups of 65–74 years, 75–84 years, and 85 years and above.Results: For transport restrictions, these trajectory groups were: (1) a majority with no restrictions, (2) low and increasing or stable, and (3) moderate or high and decreasing. The overall pattern was largely consistent across the three age groups, with the older group showing a higher predicted likelihood of transport restrictions compared to the younger group. For each of the three age groups, there were two cognitive impairment trajectories including (1) low and (2) increasing cognitive impairment. The proportions of increasing cognitive impairment were 12.3% among the 65–74 years old, 27.3% among the 75–84 years old, and 40.4% among the 85 years and above old. Compared with those with no transport restriction, the other two trajectories with either low or moderate transport restrictions were more likely to belong to increasing cognitive impairment. The odds ratio was 3.06 (95% CI 2.0–4.68) for low & increasing transport restrictions versus 1.57 (95% CI 0.96–2.56) for moderate & decreasing transport restrictions among 65–74 years old. The odds ratio was 2.38 (95% CI 1.68–3.38) for low & increasing transport restrictions versus 1.88 (95% CI 1.39–2.55) for moderate & decreasing transport restrictions among 75–84 years old.Conclusions: Cognitive impairment was more likely to co‐occur with those with low and increasing transport restrictions than with those with moderate and decreasing transport restrictions. Addressing transport restriction among older adults holds the potential to ameliorate cognitive outcomes.

Background and Objectives: Older adults are vulnerable to social isolation, making it crucial to understand its impact on dementia risk. Yet, existing evidence lacks consistency, with studies using varied measures of social isolation and overlooking potential confounders. We aim to investigate the associations between social isolation and dementia risk among older adults, hypothesizing that this association may diminish after adjusting for confounding factors. Research Design and Methods: We used 2 977 community-dwelling older adults who had no dementia in 2015 from National Health and Aging Trends. Group-based trajectory modeling was used to analyze the trajectories of social isolation, depression, and anxiety from 2011 to 2015. Cox proportional hazards regression models were then employed to estimate the association between social isolation trajectories and incident dementia from 2015 to 2022, adjusting for demographic variables, depression, anxiety, self-rated health, smoking status, and cardiovascular disease-related variables. Results: Three social isolation trajectories were identified: minimal, moderate, and high levels of social isolation. During a mean follow-up of 3.6 years, 19.0% of participants were diagnosed with dementia. When only demographics were adjusted, individuals in the moderate social isolation group were 22% less likely to develop dementia compared to those with high social isolation. This association between social isolation and incident dementia became nonsignificant after further adjustment for depression, anxiety, and health indicators. Discussion and Implications: The association between social isolation and dementia risk may be mediated by factors such as depression and other health indicators.

Background Land use density and land use mix are the two most studied characteristics of the built environment and generally, it is believed that higher land use density and higher level of land use mix are associated with more walking, especially for utilitarian purposes. However, although a large number of studies including population density and land use mix have been conducted over the last two decades, overall, the result is still not very clear. Methods I developed a simple computer model to simulate the influence of land use density and land use mix on walking. It includes a hypothetical city with a grid space and a number of households and non-residential places located across the city. Eventually, we varied the contexts to explore the corresponding results of the walking trips and walking distance across the population. Results Only at a very low level, increased land use density may increase walking trips. At the same time, increased land use density may decrease the total distance of walking trips. A higher level of land use mix is associated with higher walking trips. However, a higher level of land use mix level may be not associated with a higher total distance of walking trips. The relationship between land use and walking is significantly modified by other factors. Conclusion The relationship between land use and walking is complicated because multiple factors at multiple levels could contribute to this relationship and the conclusions from the most existing practical studies may apply only to a specific population in a specific context. Computer models will be supplemental because they provide a method to disentangle the complex relationship by separating and removing confounding factors and focusing on the interested factors.

Introduction Beginning in 2019, several U.S. states implemented temporary or permanent bans on the sale of flavored e-cigarettes. This study examined the impact of flavor bans on adult e-cigarette use in Washington, New Jersey, and New York. Methods Adults who used e-cigarettes at least once a week before the flavor bans were recruited online. Respondents reported their e-cigarette use, primarily used flavor, and ways of obtaining ecigarettes before and after the bans. Descriptive statistics and multinomial logistic regression models were applied. Results After the ban, 8.1% of respondents (N=1624) quit using e-cigarettes, those primarily used banned menthol or other flavors declined from 74.4% to 50.8, those using tobacco-flavored declined from 20.1% to 15.6%, and those using non-flavored increased from 5.4% to 25.4%. More frequent e-cigarette use and smoking cigarettes were associated with being less likely to quit e-cigarettes and more likely to use banned flavors. Of those primarily using banned flavors, 45.1% obtained e-cigarettes from in-state stores, 31.2% from out-of-state stores, 32% from friends, family, or others, 25.5% from Internet/mail sellers, 5.2% from illegal sellers, 4.2% mixed flavored e-liquids themselves, and 6.9% stocked up on e-cigarettes before the ban. Conclusions Most respondents continued to use e-cigarettes with banned flavors post-ban. Compliance of local retailers with the ban was not high, and many respondents obtained banned-flavor e-cigarettes through legal channels. However, the significant increase in the use of non-flavored e-cigarettes post-ban suggests that these may serve as a viable alternative among those who used previously used banned or tobacco flavors. Implications This study examined the impact on adult e-cigarette users from the recent e-cigarette-only flavor bans in Washington State, New Jersey, and New York. We found that most respondents continued to use e-cigarettes with banned flavors post-ban and obtain banned-flavor e-cigarettes through legal channels. Our findings indicate that non-flavored e-cigarettes may serve as an acceptable alternative to both non-tobacco and tobacco-flavored e-cigarettes and state e-cigarette flavor bans are unlikely to prompt a significant number of adult e-cigarette users to replace their e-cigarette use with new or increased smoking. Enforcing compliance of retailers to the policy is crucial to control e-cigarette use.

Background Vaccination for seasonal influenzas is particularly important during the COVID-19 pandemic, but the influenza vaccination coverage in the U.S. was far lower than the targeted rate. Objective To examine how people’s actual uptake of the influenza vaccine and the disparity of the vaccination changed during the pandemic. Methods A survey was conducted online in November 2022. Respondents were asked for influenza vaccination during each of the three latest seasons, prior influenza vaccination history, and COVID-19 vaccination. A linear regression model was used to estimate how the respondents’ change in influenza vaccination was associated with their demographics, COVID-19 vaccination status, and other related variables. Results Nearly 70% of US adults had influenza vaccine each season during past the three seasons of the COVID-19 pandemic. The prevalence of influenza vaccination varied markedly across demographics. Non-Hispanic Black, Hispanic, and people with low educational attainment were more likely to see relatively negative changes in their level of influenza vaccination. Respondents who uptook their COVID-19 vaccine in 2022 increased their level of influenza vaccine more than those who uptook the vaccine in 2021. Conclusions Our study indicated that influenza vaccination increased during the pandemic compared with before the pandemic. The disparity of influenza vaccination by race/ethnicity and socioeconomic status may enlarge during the pandemic. Tailored interventions were needed to target some groups to promote their vaccination uptake.

Recently President Joe Biden announced the end to the COVID-19 pandemic in the US but some scientists expressed different opinions. This study aimed to examine the view of the end of the COVID-19 pandemic among the public. Data were collected in September 2022 from an online crowdsourcing platform, and respondents answered if they believed that the pandemic has ended in the United States or not. Logistic regressions were used to estimate the likelihood of agreeing on the end of the pandemic, adjusted by demographics and several related variables. Among 2983 respondents, 78.1% believed that the COVID-19 pandemic had ended, and the percentage decreased to 66.5% after adding weights. Males, younger adults, Hispanics, those with higher levels of educational attainment, those with middle levels of household income, those living in suburban or rural areas, and those living in states that voted for the Republican party in the 2020 Presidential Election were more likely to believe that the pandemic had ended, compared with their counterparts. With about one-third of Americans did not agree that the pandemic had ended and marked demographical and geographical differences, the timing and the way of the pandemic end announcement should be deliberately cautious.

Banning flavors in e-cigarettes and other tobacco products may decrease their use. To examine how current users of flavored e-cigarettes might react to a ban on flavored e-cigarettes when: (i) menthol flavor is banned together with other flavors, or (ii) this ban on e-cigarettes is combined with a ban on menthol cigarettes and flavored cigars. A national cross-sectional survey of 2,347 current users of flavored e-cigarettes was conducted in May 2022. For each hypothetical ban scenario, respondents reported if they would quit all tobacco product use, continue to use e-cigarettes with no flavor or flavors that were not banned, or switch to alternative tobacco products. Multinomial logistic regressions were used to estimate the associations between responses and ban scenarios, adjusting for tobacco use and demographic variables. If e-cigarettes with any flavors except menthol and tobacco were banned, the majority of current e-cigarette users would keep using e-cigarettes with no flavor or tobacco and menthol flavor. When menthol flavor was added to a ban, a greater proportion of respondents would quit all tobacco use; however, more would also switch to cigarettes or cigars. When menthol cigarettes and flavored cigars were added to a ban, those who used menthol flavor only would be less likely to switch to cigarettes and cigars. Among current e-cigarette users, the harm reduction (i.e., from quitting all use) from a ban on flavored e-cigarettes, particularly if menthol is also banned, may be outweighed by the harm increases (i.e., switching to cigarettes or cigars, or other products that are more harmful than using e-cigarettes). A concurrent ban on menthol cigarettes and flavored cigars would secure more certain net reductions to public health harms from e-cigarette use and smoking.