Introduction:Adolescence is a period of heightened emotional reactivity and vulnerability to mental health problems, during which well-being plays a central role in psychological adjustment. Beyond reflecting immediate experiences, momentary well-being has been linked to long-term outcomes such as depression and substance use. While social and geographic contexts are recognized determinants of adolescents' mental health, their influence on momentary well-being remains unclear. We aimed to investigate these associations in a sample of French adolescents using real-time assessments. Methods:Participants were adolescents from the EXIST cohort, who agreed to participate in the Geographically-explicit Ecological Momentary Assessment (GEMA) sub-study. Over 10 days, participants received two SMS prompts daily linked to a short questionnaire. Geolocation was recorded at each questionnaire completion. We used mixed-effects linear regression models to assess the associations between momentary contextual factors and well-being. Results:A total of 122 adolescents provided 1236 observations. The median age was 13.4 years (IQR: 13.3-13.6). Being with friends or family was associated with higher momentary well-being compared to being alone (adjusted Beta (95%CI) = 3.5 (1.1-5.9), and 3.0 (1.6-4.5), respectively). There was a trend suggestive of an association between momentary well-being and exposure to green space, as measured by the average NDVI (Normalized Difference Vegetation Index) within a 100m radius. Girls and gender-diverse adolescents reported significantly lower levels of momentary well-being than boys. Conclusion:Immediate social context emerged as one of the strongest correlates of adolescents' momentary well-being. Our findings suggest that supportive social relationships are closely associated with higher momentary well-being among adolescents. They also highlight the potential of GEMA for investigating contextual correlates of well-being and for informing future research on context-sensitive approaches to mental health promotion.
Background:Residential mobility during childhood has been widely discussed as a potential source of psychosocial disruption, yet population-level longitudinal evidence remains limited outside Western contexts. This study examined whether early-life residential mobility is associated with the subsequent risk of mood disorders in South Korea. Methods:We conducted a nationwide retrospective cohort study using the Korean National Health Insurance Service database (N = 6,668,197). Residential mobility was assessed over a six-year period spanning late childhood and early adolescence (ages 10 to 15). Incident clinical diagnoses of mood disorders (ICD-10: F31 to F39) were ascertained between ages 16 and 25. Multivariable Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals, adjusting for key available covariates, including sex and household income. Results:A greater frequency of residential relocation was significantly associated with a higher risk of mood disorders. Relative to non-movers, the adjusted hazard ratios were 1.12 (95% CI: 1.12-1.13) for 1-move, 1.27 (95% CI: 1.25-1.28) for 2-move, and 1.41 (95% CI: 1.38-1.44) for 3+ moves. Associations were stronger among lower-income groups, and similar graded patterns were observed across diagnostic subtypes. Sensitivity analyses excluding early diagnoses yielded comparable results. Early-life residential mobility was associated with an elevated and progressively increasing risk of mood disorders in South Korea. Conclusions:These findings underscore the importance of residential stability during sensitive developmental periods and suggest that residential mobility may represent a potentially modifiable social and environmental risk factor for later mental health. Future research incorporating intergenerational data may help clarify underlying mechanisms.
Informal employment is an important social determinant of health, yet little is known about whether transitions into and out of informal employment are associated with health in similar ways. Using nationally representative panel data from the China Family Panel Studies from 2014 to 2020, this study examines whether transitions from formal to informal employment and from informal to formal employment are differently associated with self-rated health among non-agricultural workers in China. Asymmetric fixed-effects models show that transitioning from formal to informal employment is associated with a 0.078-point decline in self-rated health on a five-point scale, equivalent to approximately 0.07 standard deviations. The corresponding estimate for exit from informal employment is smaller and not statistically significant. Event-study analyses indicate that the entry-related health decline becomes apparent around the observed transition interval and is not preceded by differential health deterioration. The entry-related health decline amounts to approximately 0.16 standard deviations among workers over age 45 and 0.08 standard deviations among workers with a high school education or less, whereas the corresponding entry estimates are not statistically significant among younger and more-educated workers. These findings suggest that the direction of labor-market transition matters for health and highlight the importance of reducing avoidable movement into informal employment and extending social protection across employment forms.
Mukbang (eating-broadcast) and Cookbang (cooking-broadcast) content, a globally distributed digital food exposure originating in South Korea, reaches adolescents through algorithmically curated platforms, yet its population-level implications for oral health remain uncharacterised. Pooled cross-sectional data from 106,005 Korean adolescents (2022 and 2025 Korea Youth Risk Behavior Web-based Surveys) were analysed using design-based methods. Viewing frequency was classified as not watching (32.2%), ≤3 times/month (30.3%), 1-4 times/week (26.4%), and ≥5 times/week (11.1%); two-thirds (67.8%) had viewed such content in the preceding 12 months. Design-based logistic regression estimated adjusted odds ratios (aORs) for two patient-reported oral symptoms, toothache and gingival pain/bleeding; natural direct and indirect effects through sugary beverage intake, late-night snacking, and fast-food intake were estimated by g-computation. Viewing frequency was associated with both symptoms in a dose-response pattern. Comparing ≥5 times/week with not watching, aORs were 1.21 (95% CI, 1.14-1.28) for toothache and 1.22 (1.15-1.30) for gingival pain/bleeding (P for trend < .001). Sugary beverage intake and late-night snacking, but not fast-food intake, carried significant indirect effects, accounting for 29.6% (22.2-42.7) and 18.0% (13.2-25.5) of the respective total effects; these proportions are a design-based decomposition of cross-sectional associations and require longitudinal confirmation. The toothache association was stronger in females and middle-school students. Given that most adolescents are exposed and one in nine views this content near-daily, even modest individual-level associations imply an appreciable population burden. Korean food-advertising law already covers this age group and these food categories, but not the platforms that carry the content.
While physical activity has been associated with lower healthcare expenditures, existing studies relying on self-reports and linear models have struggled to characterize the non-linear shape of this association. Using a linked dataset of mHealth step counts and administrative claims data from 20,950 residents aged ≥40 years, this study employed Generalized Additive Models to elucidate the non-linear association between daily steps and future healthcare expenditures. The outcome was defined as the total healthcare expenditures accrued during the 6 months following each observation month; this 6-month window was chosen a priori for stability and interpretability, not because health effects of walking are assumed to emerge within exactly 6 months. Predicted 6-month healthcare expenditures decreased steeply as daily steps increased from low activity levels and then leveled off at approximately 10,000-12,000 steps/day, indicating a non-linear association between daily steps and subsequent expenditures. This low-expenditure plateau (point-estimate: ∼11,000 steps/day) was associated with a predicted geometric mean expenditure of 17,170 [16,174-18,229] JPY, though confidence intervals widened at higher step counts. Stratified analyses showed similar local nadirs in the data-dense range across age groups despite large differences in absolute magnitudes: the local nadir was 10,612 steps/day (48,407 [45,568-51,423] JPY) for older adults (≥65 years) versus 11,317 steps/day (1514 [1360-1685] JPY) for middle-aged adults, suggesting ∼11,000 steps/day as a common associational benchmark. These associations are observational and cannot establish that increasing walking causally lowers expenditures; rather, the non-linear shape suggests that strategies shifting population activity distributions toward this lower-expenditure range merit further evaluation.
Individuals with higher levels of educational attainment experience lower levels of disability than their lower educated counterparts, but it remains unclear how this educational gradient manifests at the end of life. We propose two competing perspectives that offer contrasting expectations. The cumulative dis/advantage hypothesis suggests that educational differences in disability continue to widen at the end of life, whereas the terminal convergence hypothesis postulates diminishing differences as proximity to death overrides prior social advantages through universal mortality related decline. We test these hypotheses using harmonized end-of-life interviews from 6957 deceased participants in the Survey of Health, Ageing and Retirement in Europe. Additionally, we examine whether educational inequalities vary across welfare regimes. Multilevel beta-binomial models are used to capture individual- and country-level variation in limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL). During the final year of life, medium-educated and high-educated decedents were predicted to have 0.22-0.37 (8-10%) fewer ADL limitations and 0.50-0.63 (17-18%) fewer IADL limitations than low-educated decedents. Conditioning on the disability status at the last observation alive attenuated inequalities, though it did not eliminate them. This suggests that educational inequalities in disability continue to widen in the final phase of life. Welfare regimes moderated these inequalities, with strong evidence for ADL disability and limited evidence for IADL disability. Within-regime differences showed significant educational inequalities in Bismarckian and Eastern European regimes, but not in Southern European or Nordic regimes. Overall, the findings support the cumulative dis/advantage hypothesis and highlight the role of institutional context in shaping inequalities in end-of-life disability.
We examine the associations between characteristics of young adults' communities and their cardiovascular health. Young adult cardiovascular health (CVH) is assessed by a set of eight factors encompassing both health-related behaviors and clinical metrics. We analyze a recent data collection effort fielded during 2021-2023: The Future of Families - Cardiovascular Health Among Young Adults (FF-CHAYA) study, designed to examine the social determinants of cardiovascular health and subclinical cardiovascular disease among young adults. Participants were subsampled from a longitudinal survey of about 5000 births in large cities in the US that has conducted seven waves of interviews since 1998-2000. A total of 1421 young adults, average age 23, participated in 33 "pop-up" clinics across the US. We use latent transition analysis based on a rich set of contextual variables at the census tract or county level to uncover three profiles of geographic areas of childhood residence around the time of birth and at age nine years. We find significant relationships between young adult CVH and their level of schooling, their racial/ethnic identity, and their neighborhood environments. Associations between spending childhood years in disadvantaged neighborhood archetypes and CVH scores were largely but not entirely attenuated by individual-level characteristics. At this early stage of adulthood, these associations are driven largely by health-related behaviors, particularly physical activity, but linkages with clinical metrics of cardiovascular risk are likely to appear in the coming years and decades.
Purpose Higher SES is associated with lower mortality among colorectal cancer (CRC) survivors. We performed a mediation analysis to identify factors that mediate the association between household income and CRC mortality. Methods Data arise from 1038 participants of the prospective Southern Community Cohort Study (SCCS) who developed incident CRC after enrollment (2002-2009); 73% self-identify as Black. Fifty-nine percent self-reported household income <$15,000/year. Mortality outcomes were determined via the National Death Index. Proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for mortality by income level. Mediation analysis was used to estimate indirect effects of stage, healthcare-access and use, comorbidities and health behaviors on mortality. Results Higher income was associated with lower risk for all-cause mortality (≥$15,000 vs. <$15,000/year: HR = 0.70, 95%CI:0.58-0.84) and CRC-specific mortality (HR = 0.75, 95%CI:0.59-0.94). Differences in stage and surgical resection together explained 33% of the association with CRC-specific mortality and 16% for all-cause mortality. Smoking history explained 11% of the association with all-cause mortality and 9% for CRC-specific mortality. Diet explained 9% of the association with each outcome. Adjustment for all potential mediators explained 26% and 44% of the associations with all-cause and CRC-specific mortality, respectively. Associations between income and mortality were similar for participants with local/regional tumors only. Conclusions Differences in early detection and surgical resection are the strongest mediators of the association between income and mortality. SES-targeted health policies and patient navigation will improve CRC outcomes. Additionally, health policies to address smoking cessation and food availability will create opportunities for interventions to promote health equity.
Background:Amid rising global life expectancy, the debate over whether population aging entails a "compression" or an "expansion" of morbidity remains unresolved. Previous evidence, drawn largely from Western nations and often reliant on cross-sectional data or single health indicators, has produced mixed findings. This study addresses this gap by investigating the health trajectory of older adults in China, examining whether it reflects morbidity compression or expansion across multiple health domains. Methods:We analyzed 20 years of longitudinal data (1998-2018) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), comprising 93,581 observations of birth cohorts from 1895 to 1949. To overcome the limitations of prevalence-based measures, we employed continuous-time multi-state Markov models for interval-censored data. This approach enabled us to estimate cohort-specific transition probabilities (i.e., onset, recovery, and mortality) and compute Healthy Life Expectancy (HLE) across three distinct domains: cognitive function, physical independence (ADL), and major chronic diseases. Results:After controlling for age and sex, we observed divergent health trajectories across successive birth cohorts. In the cognitive domain, a relative compression of morbidity emerged, characterized by a delayed onset of impairment and a reduced proportion of total life expectancy (TLE) spent with cognitive deficits. The functional (ADL) domain, however, exhibited a pattern of dynamic equilibrium, with the proportion of TLE lived with disability remaining highly stable or showing only a marginal, subtle decline across cohorts. Conversely, the chronic disease domain revealed a pronounced morbidity expansion. While the incidence of major chronic diseases declined only marginally across cohorts, the associated mortality risk decreased substantially. Consequently, later-born cohorts are living more absolute years, and a greater proportion of their TLE, with chronic conditions. Conclusions:The health transition among older adults in China is highly domain-specific, characterized by a compression of cognitive morbidity, a dynamic equilibrium in physical functioning, and an expansion of chronic disease morbidity. More recent cohorts are maintaining their cognitive clarity and physical autonomy (proportionately) for longer, yet this is increasingly occurring alongside prolonged periods of chronic illness. These findings challenge the conventional compression-versus-expansion dichotomy and highlight the need for public health systems in rapidly aging societies to shift focus from acute treatment toward proactive chronic disease management and integrated long-term care.
Background This study explores how depressive symptoms change across a gradual spectrum of housing cost burdens rather than at a single affordability benchmark. Methods Drawing on twelve waves of the Korean Welfare Panel Study (2012-2023), we created a series of housing cost cut-offs and estimated their associations with household heads’ depressive symptom scores using a panel hybrid model. Results Findings show that depressive symptoms begin to rise once housing payments claim a modest share of income, well below the long-standing 30% guideline, and then intensify in a steady, gradual pattern as the burden grows. The association between housing cost burden and depressive symptoms becomes statistically significant at an 11% threshold and remains significant up to the conventional 30% benchmark. The most pronounced effect is observed near the 27% burden cut-off. Tenure-specific analyses further indicated that this graded association was concentrated primarily among renters. Conclusions Our results indicate that mental health risks emerge at moderate cost levels and build progressively, suggesting that policies attuned to the early stages of housing cost strain may help prevent psychological distress from becoming entrenched.
This study explores the impact of digital financial inclusion (DFI) on older adults' health outcomes and the underlying mechanisms. Using data from the China Health and Retirement Longitudinal Study (CHARLS), we employ a two-way fixed effects model and an instrumental variable approach. The results indicate that advancing DFI significantly improves self-rated health and reduces functional impairment and depression in older adults. DFI primarily improves health outcomes by increasing the ability and willingness to pay for health investments. The positive effect of DFI on health is more pronounced among older adults in Midwestern provinces, with digital access, under 75 years old, and living with their children. These findings highlight the potential of DFI to promote healthy aging, and suggest that policy efforts should prioritize digital financial product innovation, strengthen payment capacity, and integrate health platforms to foster proactive health management. Targeted initiatives to improve digital access and literacy are also essential to ensure that vulnerable groups equitably share in the health benefits of the digital economy.
Background Rising health-related economic inactivity (IN-HLT) is a growing concern in the United Kingdom, yet little is known about whether its relationship with chronic health conditions has changed across generations. Methods Using data from two large birth cohort studies representative of people born in Britain in 1958 (n = 9761) and 1970 (n = 7336), we quantified associations between physical and mental ill-health at age 42 with IN-HLT at age 50-54 using multinomial logistic regression models, adjusting for previous economic activity and a rich set of lifecourse sociodemographic characteristics, and estimated average marginal effects (AME). Results Ill-health, particularly longstanding illness and mental ill-health, were associated with a higher risk of IN-HLT in both cohorts. Having a longstanding illness at age 42 was associated with 5 to 6 percentage-point higher risk of IN-HLT (AME1958 = 5.1 [95% Confidence Interval (CI) 2.1, 8.1], AME1970 = 6.5 [95%CI 3.4, 9.6]), and psychological distress with a 4 percentage-point higher risk (AME1958 = 3.8 [95%CI 0.4, 7.1], AME1970 = 4.5 [95%CI 1.1, 7.8]). Except for high blood pressure, which was associated with IN-HLT in the 1958 cohort only, the magnitude of associations between chronic conditions and IN-HLT was similar across generations despite them experiencing different economic and policy contexts. Implications Given increases in obesity and mental ill-health prevalence across successive British birth cohorts, our findings suggest that both primary prevention and policies to better support individuals with chronic health conditions to remain and return to economic activity are needed to sustain later-life labour force participation.
Prestige bias and social norms messaging are among the most widely recommended vaccination communication strategies, yet they have been validated almost exclusively in high-trust, Western settings. Whether these strategies transfer to contexts where institutional trust is structurally low remains largely untested. We address this gap using a factorial survey experiment (n = 1420 parents) in Kazakhstan-a post-Soviet setting where institutional trust is characterized by Soviet legacies and post-pandemic coercion-that varied messenger endorsement (Grand Mufti, President, Chief Sanitary Doctor, control) and social norm framing (Muslim, national, local, control), supplemented by qualitative analysis of 829 open-ended responses. All three endorsements reduced vaccination intent by 6-7 percentage points relative to the 76% control baseline, while norm messaging showed null effects overall. Non-Muslims drove the backfire (11-12 percentage point decline); Muslims were insulated. Urban residents responded positively to norms; rural residents did not. Qualitative analysis traced hesitancy to pragmatic safety and efficacy concerns-only two respondents cited religion-indicating the endorsement strategy targeted barriers that did not drive hesitancy in this population. These findings identify trust-dependent boundary conditions for prestige bias theory in health communication: when institutional trust is low and recent coercion has primed reactance, endorsements from prestigious figures trigger resistance rather than deference. The contrast with positive endorsement effects during the pandemic in the same country suggests that effectiveness depends on timing and whether attitudes are still forming. Where institutions have lost credibility, leveraging institutional authority is not just ineffective but counterproductive.
Background Gun violence is a traumatic and pervasive neighborhood stressor with far-reaching consequences for population health. However, less is known about how gun violence exposure becomes biologically embedded during adolescence, a sensitive period for shaping aging trajectories. We examined whether residential exposure to deadly gun violence is associated with accelerated biological aging in a diverse sample of U.S. adolescents. Methods The sample included 1,781 15-year-olds in the Future of Families and Child Well-being Study (2014-2017). Neighborhood-level gun violence was defined as the count of fatal shootings within 1600 m (∼1 mile) of respondents’ homes in the prior year. Accelerated biological aging was measured using a composite of three epigenetic clocks (GrimAge, PhenoAge, DunedinPACE). Propensity score matching balanced exposed and unexposed adolescents on race/ethnicity, socioeconomic characteristics, and area-level crime; weighted linear regression models targeting the average treatment effect on the treated then estimated associations between exposure counts and biological aging in the matched sample (n = 499). Results Approximately half of adolescents (51.3%) lived near at least one deadly shooting in the prior year. Among exposed adolescents in the matched sample (n = 265), the mean exposure count was 3.24 (SD = 3.50). Greater exposure to deadly gun violence was associated with accelerated biological aging (β = 0.033; 95% CI, 0.003 to 0.064). Conclusions Adolescent exposure to deadly gun violence may be linked to epigenetic markers of aging-related health risk, suggesting that chronic early-life exposure may have lasting implications for long-term health and aging.
Background:The rise of artificial intelligence (AI) is transforming work tasks and social relations within organizations. Work exhaustion is increasing, and AI may heighten employees' sense of adaptability and social comparison. This three-wave longitudinal study examines employees' work exhaustion as an outcome of AI use at work, perceived AI readiness, and social comparison tendencies. Methods:Data were drawn from a national survey of employed adults aged 18-65 years in Finland. Baseline data were collected in fall 2024 (N = 2109; 50% men; mean age 42·6 years), with biannual follow-ups. Work exhaustion (Maslach Burnout Inventory), social comparison orientation (INCOM), perceived AI readiness, and AI use at work were assessed. Within-between and multilevel mixed effects regression models were used to estimate within- and between-person associations over time. Findings:Frequent AI use at work was not associated with work exhaustion, whereas social comparison tendency showed robust associations with greater exhaustion at both the within- (β = 0·02, [95% CI 0·01 to 0·04], P = 0·001) and between-person (B = 0·20, [95% CI 0·15 to 0·25], P < 0·001) levels. Workers with higher perceived AI readiness reported lower exhaustion between individuals in the first model (B = -1·41, [95% CI -2·17 to -0·64], P <0·001) and within individuals (B = -0·02, [95% CI -0·04 to -0·01], P = 0·002) and between individuals in the second model (B = -0·16, [95% CI -0·21 to -0·11], P <0.001). No interaction effects were observed between AI use at work and AI readiness or social comparison in the primary models. However, exploratory analyses suggested that among employees with high social comparison tendencies, frequent AI use at work was associated with elevated exhaustion (B = 0·05, [95% CI 0·00 to 0·09], P = 0·035). Interpretation:Findings suggest that individual psychosocial dispositions may play an important role in experiences of exhaustion in AI-augmented workplaces. At the same time, perceived AI readiness may function as a personal resource associated with lower exhaustion.
Introduction:Social relationships are crucial for healthy ageing, but the role of social network size in older adults' mental health remains underexplored in nationwide studies. We examined associations between social network size and mental health in a national sample of older Japanese adults. Methods:We analysed cross-sectional data from the 2024 Japan COVID-19 and Society Internet Survey (JACSIS), a nationwide internet survey, including 6786 respondents aged 65-84 years. Mental health outcomes were poor mental health days in the past 30 days (any vs none; ≥7 vs < 7 days) and psychological distress (moderate: K6 ≥5; severe: K6 ≥13). Social network size was measured using the Lubben Social Network Scale (LSNS-6: family/friends; LSNS-8: including professional contacts) and categorized into tertiles. Logistic regression estimated odds ratios (ORs) adjusted for demographic, socioeconomic, health, lifestyle, and work-related factors. Results:Overall, 11.8% reported any poor mental health day, 16.3% had moderate distress, and 1.9% had severe distress. In fully adjusted models, smaller social network size was consistently associated with poorer mental health in graded patterns. Compared with the highest LSNS-6 tertile, the lowest tertile had lower odds of no poor mental health days (OR = 0.80, 95% CI: 0.70-0.92) and higher odds of moderate (OR = 2.74, 95% CI: 2.28-3.29) and severe distress (OR = 6.54, 95% CI: 3.42-12.51). Similar patterns were observed for LSNS-8. Conclusions:Larger social networks were associated with fewer poor mental health days and lower psychological distress among older Japanese adults.
Health-related economic inactivity is a growing concern in the United Kingdom but little is known about how the relationship between health and work participation has changed across cohorts. We used data from two British birth cohorts born in 1958 (National Child Development Study, n = 9,761) and 1970 (British Cohort Study, n = 7,336). We examined how self-reported chronic health conditions at age 42 (longstanding illness, obesity, diabetes, high blood pressure, back pain, and mental ill-health) were associated with economic activity at ages 50–54, focusing on health-related inactivity. Multinomial logistic regression models, adjusted for previous economic activity and sociodemographic characteristics, were used to estimate average marginal effects (AME). Poor health was more prevalent in the 1970c, including among those still working at age 50-54. Longstanding illness and mental ill-health were associated with a higher risk of health-related inactivity in both cohorts. A longstanding illness at age 42 was associated with a 6 percentage-point increase in health-related inactivity risk a decade later (AME 1958 = 5.9 [95% Confidence Interval (CI) 2.7, 9.1], AME 1970 = 6.5 [95%CI 3.4, 9.6]), and mental ill-health with a 4.5 percentage-point higher risk (AME 1958 = 4.4 [95%CI 0.9, 7.9], AME 1970 = 4.5 [95%CI 1.1, 7.8]). The magnitude of associations was similar across cohorts except for high blood pressure. Chronic health conditions in early midlife were strongly associated with a health-related inactivity, despite contextual change. Preventing ill-health and supporting employment for those with chronic conditions is key to face the challenges of population ageing.
Health is widely recognized as shaped by social and structural conditions, yet time remains largely absent from dominant public health frameworks. This paper brings together sociological and epidemiological perspectives to argue that time is a fundamental dimension of health that has been insufficiently articulated. Rather than proposing a new determinant, it reframes time as an essential condition through which social inequalities are produced and experienced. In public health research, time is most often treated as a technical parameter, such as duration or life course stage, obscuring how it is socially organised and unequally distributed. Drawing on interdisciplinary scholarship, the present paper highlights two interrelated dimensions of time - availability and intensity - and shows how temporal scarcity, acceleration, and uncertainty are patterned by social position, gender, and economic insecurity. It examines how constrained time shapes everyday possibilities for care, rest, and participation, while ill health and caregiving further restrict control over time, reinforcing cycles of disadvantage. The paper also reflects on how healthcare systems are shaped by standardised clock time, often misaligning with the lived realities of chronic illness and long-term care. By synthesising existing scholarship and making time visible as a condition shaping agency, dignity, and health, this paper seeks to strengthen critical public health debates and encourage greater attention to temporal inequalities in research, policy, and practice.
Objectives: This study aimed to examine the association between types of intergenerational family interactions and frailty index (FI) among older adults across countries with different cultural backgrounds, and to explore variations in these associations among older individuals. Methods: We conducted a comprehensive longitudinal, cross-cultural analysis, involving adults aged 60 years and older from four countries, each participating in a nationally representative longitudinal cohort study: the China Health and Retirement Longitudinal Study (CHARLS; Wave 1-Wave 4), the Korean Longitudinal Study of Aging (KLoSA; Wave 4-Wave 7), the Health and Retirement Study (HRS; Wave 11-Wave 14), and the English Longitudinal Study of Ageing (ELSA; Wave 7-Wave 9). Results: Associations varied across countries. In the U.S., greater time spent on grandchild care was significantly associated with a lower FI, whereas more frequent intergenerational contact was marginally associated with a lower FI only in China. Downward economic support was associated with a higher FI in China (amount) and in the U.S. and the U.K. (any transfer), while upward economic support was marginally associated with a higher FI in Korea (amount) and significantly associated with a higher FI in the U.S. (any transfer) but was not statistically significant in China. Discussion: These findings suggest that certain forms of intergenerational family interactions may be associated with lower frailty among older adults, warranting further investigation.
