Xinyu Zheng

Background: Few studies have simultaneously considered the impacts of parental labour migration and childhood maltreatment on psychosocial health.Objective: To estimate the complex associations of parental labour migration and childhood maltreatment with psychosocial health among adolescents and young adults in China.Method: This cross-sectional study was conducted among undergraduates aged 17 to 24 years from sixty colleges and universities across 10 provinces of China. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire-Short Form, and psychosocial health was measured using the Strengths and Difficulties Questionnaire (SDQ). Weighted linear mixed regression models, multiplicative interactions, and joint and mediation analyses were performed.Results: Of the 28,810 participants included (mean [SD] age, 19.87 [1.62] years), 12035 (41.8%) were male. In the fully adjusted model, participants who experienced parental migration were more likely to report higher levels of SDQ total difficulties (e.g. β = 0.16 [95% CI, 0.05 to 0.28]) compared with those with non-migrant parents. A positive association was found between the cumulative number of childhood maltreatment and SDQ total difficulties (β = 0.54 [95% CI, 0.49 to 0.60]), with a dose-response relationship observed for the levels of childhood maltreatment and SDQ total difficulties. Compared with individuals without exposure to both parental migration and childhood maltreatment, those exposed to both parental migration and at least 2 numbers of childhood maltreatment had the highest magnitude of psychosocial health difficulties (β = 1.12 [95% CI, 0.91 to 1.33]). Moreover, childhood maltreatment may partially mediate the association between parental migration and psychosocial health, with the mediation proportion being 58.8%.Conclusion: Exposure to parental labour migration or childhood maltreatment was positively associated with psychosocial health among adolescents and young adults. Parental migration and childhood maltreatment may jointly aggravate psychosocial health problems. These findings indicate the necessity of comprehensive interventions targeting adversity stressors to improve psychosocial health, especially for left-behind children experiencing maltreatment.

Background and aims: Gender nonconformity (GNC), which refers to an individual's expression of gender that does not align with the socially prescribed norms for their biological sex, may be associated with adverse behavioral problems, such as problematic smartphone use (PSU) and problematic internet use (PIU). This study examined the associations between GNC and PSU and GNC and PIU among Chinese adolescents.Methods: This cross-sectional study utilized data from the 2021 School-based Chinese Adolescents Health Survey, recruiting 23,054 eligible adolescents aged 11 to 21, with an average age of 14.9 (SD: 1.7) years from 504 classes in 84 public high schools across 7 cities in China. Gender nonconformity, PSU/PIU, and demographics were measured. Mixed-effect linear regression models were performed.Results: Among the participants (51.0% male), 5.3% reported high GNC and 26.9% reported moderate GNC. After adjusting for covariates, high GNC was significantly and positively associated with PSU (Β = 1.11, 95% CI = 0.49–1.72) and PIU severity (Β = 2.16, 95% CI = 1.40–2.93). Stratified analyses indicated that the associations between GNC and PSU differed between males and females, with a significant association observed only among male students (Β = 1.91, 95% CI = 0.97–2.86).Discussion and conclusions: GNC is positively associated with the severity of PSU and PIU among Chinese adolescents, with male gender-nonconforming adolescents being more vulnerable to PSU. These results highlight the importance of implementing education on gender expression diversity in schools to create an inclusive school environment, which may potentially help prevent PSU and PIU among gender-nonconforming adolescents.

Background: Although the association between social isolation and the risk of subsequent cardiovascular disease (CVD) is well documented, most studies have only assessed social isolation at a single time point, and few studies have considered the association using repeatedly measured social isolation. Objective: This study aimed to examine the association between social isolation trajectories and incident CVD in a large cohort of middle-aged and older adults. Methods: This study used data from 4 waves (wave 1, wave 2, wave 3, and wave 4) of the China Health and Retirement Longitudinal Study. We defined the exposure period as from June 2011 to September 2015 (from wave 1 to wave 3) and the follow-up period as from September 2015 to March 2019 (wave 4). On the basis of the inclusion and exclusion criteria, our final analytic sample included 8422 individuals who had no CVD in the China Health and Retirement Longitudinal Study in waves 1 to 3 and were fully followed up in wave 4. Social isolation was ascertained using an extensively used questionnaire at 3 consecutive, biennial time points from waves 1 to 3, and individuals were assigned to 3 predefined social isolation trajectories based on their scores at each wave (consistently low, fluctuating, and consistently high). Incident CVD included self-reported physician-diagnosed heart disease and stroke combined. Cox proportional hazard models estimated the associations of social isolation trajectories with risks of incident CVD, adjusting for demographics, health behaviors, and health conditions. Results: Of the 8422 participants (mean age 59.76, SD 10.33 years at baseline), 4219 (50.09%) were male. Most of the participants (5267/8422, 62.54%) had consistently low social isolation over time and 16.62% (1400/8422) of the participants had consistently high social isolation over the exposure period. During the 4-year follow-up, 746 incident CVDs occurred (heart disease: 450 cases and stroke: 336 cases). Compared with individuals with consistently low social isolation, those with fluctuating social isolation (adjusted hazard ratio 1.27, 95% CI 1.01-1.59) and consistently high social isolation (adjusted hazard ratio 1.45, 95% CI 1.13-1.85) had higher risks for incident CVD after adjusting for demographics (ie, age, sex, residence, and educational level), health behaviors (ie, smoking status and drinking status), and health conditions (ie, BMI; history of diabetes, hypertension, dyslipidemia, chronic kidney disease; use of diabetes medications, hypertension medications, and lipid-lowering therapy; and depressive symptoms scores). Conclusions: In this cohort study, middle-aged and older adults with fluctuating and consistently high social isolation exposure had higher risks of the onset of CVD than those without the exposure. The findings suggest that routine social isolation screenings and efforts to improve social connectedness merit increased attention for preventing CVD among middle-aged and older adults.

BACKGROUND Although the association between social isolation and the risk of subsequent cardiovascular disease (CVD) is well documented, most studies have only assessed social isolation at a single time point, and few studies have considered the association using repeatedly measured social isolation. OBJECTIVE This study aimed to examine the association between social isolation trajectories and incident CVD in a large cohort of middle-aged and older adults. METHODS This study used data from 4 waves (wave 1, wave 2, wave 3, and wave 4) of the China Health and Retirement Longitudinal Study. We defined the exposure period as from June 2011 to September 2015 (from wave 1 to wave 3) and the follow-up period as from September 2015 to March 2019 (wave 4). On the basis of the inclusion and exclusion criteria, our final analytic sample included 8422 individuals who had no CVD in the China Health and Retirement Longitudinal Study in waves 1 to 3 and were fully followed up in wave 4. Social isolation was ascertained using an extensively used questionnaire at 3 consecutive, biennial time points from waves 1 to 3, and individuals were assigned to 3 predefined social isolation trajectories based on their scores at each wave (consistently low, fluctuating, and consistently high). Incident CVD included self-reported physician-diagnosed heart disease and stroke combined. Cox proportional hazard models estimated the associations of social isolation trajectories with risks of incident CVD, adjusting for demographics, health behaviors, and health conditions. RESULTS Of the 8422 participants (mean age 59.76, SD 10.33 years at baseline), 4219 (50.09%) were male. Most of the participants (5267/8422, 62.54%) had consistently low social isolation over time and 16.62% (1400/8422) of the participants had consistently high social isolation over the exposure period. During the 4-year follow-up, 746 incident CVDs occurred (heart disease: 450 cases and stroke: 336 cases). Compared with individuals with consistently low social isolation, those with fluctuating social isolation (adjusted hazard ratio 1.27, 95% CI 1.01-1.59) and consistently high social isolation (adjusted hazard ratio 1.45, 95% CI 1.13-1.85) had higher risks for incident CVD after adjusting for demographics (ie, age, sex, residence, and educational level), health behaviors (ie, smoking status and drinking status), and health conditions (ie, BMI; history of diabetes, hypertension, dyslipidemia, chronic kidney disease; use of diabetes medications, hypertension medications, and lipid-lowering therapy; and depressive symptoms scores). CONCLUSIONS In this cohort study, middle-aged and older adults with fluctuating and consistently high social isolation exposure had higher risks of the onset of CVD than those without the exposure. The findings suggest that routine social isolation screenings and efforts to improve social connectedness merit increased attention for preventing CVD among middle-aged and older adults.