花里 真道

Abstract Well-being (WB) extends beyond physical health, as defined by the World Health Organization and encompasses two aspects: (1) long-term WB (LWB), such as overall life satisfaction; and (2) momentary WB (MWB), such as immediate mood. While research has demonstrated a positive association between one’s environment and LWB, limited studies have explored the association between environmental characteristics and MWB. We applied the experience sampling method (ESM) to collect data on location, perceived environmental characteristics, MWB, and LWB of adult participants living in Kashiwa-no-ha area, Kashiwa City, Japan. Structural equation modeling was used to calculate the correlation coefficients between different environments and both MWB and LWB. LWB was positively associated with MWB (standardized coefficient=0.24) and urban elements—cafés/restaurants/bars (0.11), cultural/sports/education facilities (0.04), and public spaces (0.11). Meanwhile, relaxing/clean (0.56) and natural environments (0.14) were associated with higher MWB. Conversely, vibrant environments (−0.14) and being on the move (−0.11) were linked to lower MWB. LWB was positively associated with being at cultural/sports/educational facilities (0.06), and vibrant (0.15) and communicative (0.13) urban settings. MWB was associated with various built environments, emphasizing the need for places like parks and cafés that promote a positive mood, and well-designed transportation and roads. These elements are important for developing urban areas that meet the physical requirements of residents while supporting their emotional and psychological well-being.

Importance It is widely known that individuals with adverse childhood experiences (ACEs) have an increased risk of abusing their own children, thereby perpetuating the cycle of violence. However, the association between ACEs and elder abuse perpetration has not been fully examined. Objective To examine the association between ACEs and elder abuse and the mediating factors. Design, Setting, and Participants This cross-sectional study used data collected via the self-administered Japan COVID-19 and Society Internet Survey from September 12 to October 19, 2022. Men and women aged 20 to 64 years who responded to related questions were included. Data were analyzed from July 2023 to April 2024. Exposures ACEs, defined as the experience of any of 7 items—interpersonal loss (parental loss and parental divorce), family psychopathology (parental mental disease and violence in family), abuse (physical and psychological abuse), and neglect—before the age of 18 years. Main Outcomes and Measures The primary outcome was the perpetration of physical and/or psychological abuse against an older person (aged ≥65 years) self-reported via questionnaire. The direct and indirect effect estimates were determined using logistic regression analyses. Results Of a total of 13 318 participants (mean [SD] age, 41.1 [12.1] years; 6634 female [49.8%]), 1133 (8.5%) reported perpetrating violence against older adults. Compared with individuals without ACEs, the odds ratios (ORs) for perpetrating violence were 3.22 (95% CI, 2.74-3.79) for those with 1 ACE and 7.65 (95% CI, 6.41-9.13) for those with 2 or more ACEs. In the mediation analysis, factors with large indirect effect estimates included depression (OR, 1.13; 95% CI, 1.11-1.14; proportion mediated [PM], 18.6%), mental illness other than depression (OR, 1.12; 95% CI, 1.10-1.14; PM, 17.3%), and self-rated health (OR, 1.04; 95% CI, 1.03-1.05; PM, 6.0%). Conclusions and Relevance These findings suggest that intergenerational cycles of violence may extend to any vulnerable group, not only children but also older adults. Further research into the prevention of ACEs and breaking these cycles of violence is warranted.

IMPORTANCE: There are limited data on whether the vulnerabilities and impacts of social isolation vary across populations. OBJECTIVE: To explore the association between social isolation and mortality due to all causes, cardiovascular diseases (CVD), and malignant neoplasms focusing on heterogeneity by sociodemographic factors. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a moderator-wide approach to examine the heterogeneity in the association of social isolation with all-cause, CVD, and malignant neoplasm mortality using baseline data from the Japan Gerontological Evaluation Study in 2010 and 2011. Eligible participants were adults aged 65 years or older without heart disease, stroke, cancer, or impaired activity of daily living across 12 Japanese municipalities. Follow-up continued until December 31, 2017, identifying 6-year all-cause, cardiovascular disease (CVD), and malignant neoplasm mortality. Logistic regression assessed effect modification by age, gender, education, income, population density, marital status, and employment on mortality associations. Data analysis was performed from September 13, 2023, to March 17, 2024. EXPOSURE: Social isolation, determined by a 3-item scale (scores of 2 or 3 indicating isolation) was the primary exposure variable. MAIN OUTCOMES AND MEASURES: Six-year all-cause, CVD, and malignant neoplasms mortality. RESULTS: This study included 37 604 older adults, with a mean (SD) age of 73.5 (5.9) years (21 073 women [56.0%]). A total of 10 094 participants (26.8%) were classified as experiencing social isolation. Social isolation was associated with increased all-cause (odds ratio [OR], 1.20 [95% CI, 1.09-1.32]), CVD (OR, 1.22 [95% CI, 0.98-1.52]), and malignant neoplasm mortality (OR, 1.14 [95% CI, 1.01-1.28]). Stratified analysis showed associations of social isolation with all-cause and malignant neoplasm mortality among people with high income (highest tertile all cause: OR, 1.27 [95% CI, 1.06-1.53]; malignant neoplasm: OR, 1.27 [95% CI, 1.02-1.60]), living in areas with high population density (highest tertile all cause: OR, 1.47 [95% CI, 1.26-1.72]; malignant neoplasm: OR, 1.38 [95% CI, 1.11-1.70]), not married (all cause: OR, 1.33 [95% CI, 1.15-1.53]; malignant neoplasm: OR, 1.25 [95% CI, 1.02-1.52]), and retirees (all cause: OR, 1.27 [95% CI, 1.14-1.43]; malignant neoplasm: OR, 1.27 [95% CI, 1.10-1.48]). Formal testing for effect modification indicated modification by population density and employment for all-cause mortality and by household income and employment for neoplasm mortality. CONCLUSIONS AND RELEVANCE: Social isolation was associated with increased risks of all-cause, CVD, and malignant neoplasm mortality, with associations varying across populations. This study fills an important gap in research on social isolation, emphasizing its varied associations across demographic and socioeconomic groups.