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Background: The status of being unmarried is commonly associated with a higher tendency for loneliness and cognitive impairment. However, it has yet to be determined whether there is a link between loneliness and cognitive function among unmarried older people. Therefore, this study used longitudinal data to determine the link between loneliness and cognitive function, and the subjects were unmarried community-dwelling older adults., Methods: The study follows up a sample of 733 unmarried older adults who were either never married, widowed, divorced or separated, from waves one and two of the 'Neuroprotective Model for Healthy Longevity among Malaysian Older Adults' study. The main statistical analysis used to answer the research question was the PROCESS macro (model 1) for SPSS., Results: The study found that increased loneliness was associated with a decline in cognitive function over a 3-year period. Additionally, gender moderated the link between loneliness and cognitive function, with this association being particularly prominent in older men., Conclusions: Loneliness among unmarried older people should be given attention as it could lead to deteriorating cognitive function. Notably, older men experience a more substantial impact of loneliness on cognitive function than women. Therefore, special attention should be focused on this population, and more social services should be developed to reduce the incidence of cognitive impairment, improve their quality of life, and promote successful ageing., (© 2024 Japanese Psychogeriatric Society.)

Objective: The goal of this research was to reveal the association between living alone and depressive symptoms in older adults. It also aims to explore the mediating role of social activity and adult children's relationship satisfaction. Ultimately, the study seeks to add to the body of knowledge for lowering the risk of depression among older people and promoting positive aging., Methods: Based on information from the 2020 China Health and Retirement Longitudinal Study, the ordinary least square (OLS) regression model and propensity score matching (PSM) were used to investigate the association between living alone and depressive symptoms in older adults and to explore possible heterogeneity in different groups. Utilizing the SPSS PROCESS macro application, the mediation model was constructed. The significance of the mediation effect was investigated using the Bootstrap technique., Results: The average level of depressive symptoms of older people living alone (10.55 ± 6.962) was higher than that of older people who do not live alone (8.80 ± 6.363). The baseline regression analysis revealed a significant connection between living alone and the depressive symptoms of older people ( β  = 0.842, p  < 0.001). The association between living alone and the level of depressive symptoms was significantly higher in those aged 60-74 years ( β  = 1.698, p  < 0.001) than in those aged 75 and older ( β  = 0.953, p  < 0.05). The association between living alone and depressive symptoms was significantly higher in rural older adults ( β  = 1.512, p  < 0.001) than in urban older adults ( β  = 1.141, p  < 0.001). Between living alone and the level of depressive symptoms experienced by older people, there was a substantial mediation impact on social engagement and adult children's relationship satisfaction, which contributed to 2.91 and 13.62% of the overall effect., Conclusion: For older age groups, living alone is associated with higher levels of depressive symptoms. This effect is stronger in older adults aged 60-74 or rural areas. In older age groups, the association between living alone and depressive symptoms is mediated by social activity and adult children's relationship satisfaction., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Fang, Duan, Hou, Chang, Hu and Huang.)

Background: Globally, the rise in single-person households poses a potential risk to mental health, with generalized anxiety disorder (GAD) being a prominent concern. The proliferation of single-person households may exacerbate social isolation and foster loneliness and anxiety. Notably, research investigating the association between single-person households and GAD remains limited. Therefore, this study aimed to investigate the association between single-person households and GAD across sexes in Korea., Methods: We utilized data from the Korea National Health and Nutrition Examination Survey conducted in 2021 and 2022, comprising a sample of 9936 participants aged 19 or older. The Generalized Anxiety Disorder Screening Tool (GAD-7) was employed to assess anxiety levels in adults. Multiple logistic regression analysis was conducted to investigate the correlation between single-person households and GAD., Results: The reference variable used in the analysis was multi-person households (consisting of two or more individuals). The association between single-person households and GAD was statistically significant across sexes (male: odds ratio [OR]: 1.92, 95 % CI: 1.15-3.20; female: OR: 1.56, 95 % CI: 1.03-2.36). Participants in single-person households exhibited higher scores on the GAD-7 compared with those in multi-person households. Notably, marital status and education level displayed disparate effects based on sex, whereas physical activity demonstrated consistent effects irrespective of sex., Limitations: Given the use of cross-sectional data, only correlations could be established., Conclusion: The findings indicate an elevated risk of GAD in single-person households compared with multi-person households. Furthermore, promoting physical activity emerged as a potential strategy for mitigating GAD in single-person households., Competing Interests: Declaration of competing interest This manuscript has not been published or presented elsewhere in part or in entirety and is not under consideration by another journal. All study participants provided informed consent. We have read and understood your journal’s policies, and we believe that neither the manuscript nor the study violates any of these., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Abstract: The desires for marriage and fertility among people living with HIV (PLWH) are increasing worldwide because of improved treatment and prognosis; yet they remain understudied in China, which has a family-oriented culture. This study aimed to investigate these desires for marriage and fertility among Chinese PLWH and explore their correlates. A cross-sectional study was conducted among 1,504 Chinese PLWH to assess their desires for marriage, fertility, and other variables through an online questionnaire. Logistic regression models were used to analyze factors associated with desires for marriage and fertility. Among the 1,504 participants, 53.9% aspired to marry at 34.76 ± 5.26 years old, whereas 62.0% desired parenthood at 36.43 ± 5.11 years old. Factors associated with these desires included age, gender, residence, education level, HIV transmission route, CD4 + T-cell count, time since HIV diagnosis, disclosure of HIV status, social support, and mental health indicators., (Copyright © 2024 Association of Nurses in AIDS Care.)

Introduction: Depression is a prevalent and debilitating mental illness affecting young women worldwide. This study aimed to identify psychosocial determinants of major depressive disorder (MDD) among young women in Bihar and Uttar Pradesh, India., Methods: Data from "Understanding the Lives of Adolescents and Young Adults" (UDAYA) study (2018-19) for young women aged 12-23 years, both married and unmarried was used for this paper. MDD was evaluated using the Patient Health Questionnaire PHQ-9 with a cut-off score of ≤10. The determinants of MDD were identified through multilevel binary logistic regression analysis., Results: The prevalence of MDD was 13.6% (95% CL 12.2-15.2) and 5.1% (95% CL 4.2-6.1) for young married women and unmarried girls, respectively. Among the young married women, community-level variables like dowry-related humiliation (1.74, 95% CI 1.15-2.64), and sexual assaults (2.15, 95% CI 1.24-3.73) were significantly associated with MDD. For unmarried girls, reporting of family violence <10% of participants (0.45, 95% CI 0.24-0.85), family violence (≥10% of participants) % (0.35 95% CI 0.19-0.68) and interpartner violence (>25% of participants) (0.42; 95% CI 0.23-0.74) remain significant predictors of MDD. At individual level, for both the groups, age, participation in decision making (on education), social capital (currently attending school/educational course and number of friends), self-efficacy, telephonic harassment, and physical activity were associated with MDD. Wealth index, job seeking, participation in decision making (on health-seeking), parental interactions and physical abuse (for unmarried girls only) and education, reported last sexual intercourse, pressure from the in-laws' to conceive (for young married women only) were associated with MDD., Conclusions: For young married women, community level targeted interventions should focus on the social ecology to foster a sense of safe community environment. For unmarried girls, additionally, interventions should aim to optimize their family environment for effective mental health outcomes., Competing Interests: he authors have declared that no competing interests exist., (Copyright: © 2024 Dhara et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Problem: There has been an increase in the number of single women deciding to have children through the use of medically assisted reproduction (MAR). These women are referred to as 'single mothers by choice' (SMC)., Background: Previous studies have shown how SMC can feel stigmatised., Aim: Explore if single women seeking fertility treatment in Denmark feel stigmatised., Methods: Six single women undergoing MAR at a public fertility clinic in Denmark were interviewed. The interviews were audiotaped, anonymised, and transcribed in full, after provided written consent by the participants to take part in the study. Data were analysed using qualitative content analysis., Findings: The women would have preferred to have a child in a relationship with a partner. Despite their dream of the nuclear family meaning a family group consisting of two parents and their children (one or more), the women choose to become SMC because motherhood was of such importance, and they feared they would otherwise become too old to have children. The participants did not experience stigma or negative responses to their decision, but they all had an awareness of the prejudices other people might have towards SMC., Conclusion: This study contributes to the understanding of the experiences of single women seeking fertility treatment in a welfare state where there are no differences in the possibilities for different social classes to seek MAR., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Premarital screening (PMS) is an essential global measure that seeks to reduce the occurrence of specific genetic disorders and sexually transmitted diseases common in consanguineous marriages. Due to the lack of a nationwide study, this research was designed to comprehend how unmarried individuals perceive the risks and benefits of PMS., Method: A cross-sectional study was conducted using an online questionnaire distributed through different social media platforms, responses from the native adult population (18-49 years) Saudi Arabia was only included in the study. The questionnaire was based on the Health Belief Model (HBM) to assessing seven different constructs including susceptibility, seriousness, benefits-, barriers-, & cues- to action, self-efficacy, and social acceptance. Data frequency was represented by mean and standard deviation; chi-square and t -tests were conducted for the comparison of independent and dependent variables. A multinomial logistic regression was used to predict factors influencing decisions related to PMS., Results: 1,522 participants completed the survey, mostly 18-25 years old and most of them were women. The majority were single with 85 men and 1,370 women. Most participants (59.6%) believed their parents were related, while 40.5% did not. 122 respondents reported they had to marry within their tribe. Findings revealed significant correlations among all HBM themes, with varying strengths. Notably, a moderate positive relationship was found between the perception of benefits and cues to action, suggesting that enhancing the perceived benefits of PMS could facilitate safe marriage practices. Multinomial regression analysis revealed that demographic factors and health beliefs significantly influence individuals' intentions and behaviors toward PMS and safe marriage., Conclusion: The study concludes that by identifying and addressing barriers, and promoting positive social acceptance, PMS can significantly contribute to preventing genetic diseases and promoting safe marriage practices, although the cross-sectional design limits the establishment of causal relationships and further research is needed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Alwhaibi, Almuwais, Alotaibi, AlTaleb, Alsamiri and Khan.)

Background: Physical activity is associated with improved health and function in older adults, yet most older adults are sedentary. Loneliness is associated with decreased physical activity at the cross-section, but longitudinal studies are scarce. We examined longitudinal associations between loneliness and physical activity-and whether they were modified by marital status and network size (the number of children, relatives, and friends a person interacts with at least once a month)., Methods: We analyzed data from 1,931 older adults without dementia at baseline from the Rush Memory and Aging Project with a mean follow-up of 4.8 years (mean age 79.6 ± 7.7, 74.9% women). Loneliness was assessed using the de Jong Gierveld Loneliness Scale. Physical activity was assessed as the frequency with which participants engaged in five categories of activities (e.g., walking, gardening, calisthenics, bicycling, and swimming). Linear mixed effects models examined associations between baseline loneliness and change in physical activity over time after adjusting for demographics, depressive symptoms, global cognition, disability, network size, marital status, social support, and social and cognitive activities. We assessed for effect modification by marital status and network size., Results: Associations between loneliness and physical activity differed by marital status. In widowed individuals, baseline loneliness was associated with a 0.06 h/week greater decrease in physical activity per year compared to those who were not lonely ( p  = 0.005, CI -0.1, 0.02)-which equaled a 150% decrease in physical activity per year. Loneliness did not predict a statistically significant decrease in physical activity in married or unmarried individuals., Discussion: Loneliness is associated with decreased physical activity in widowed older adults and should be considered in the design of interventions to prevent or slow the decline in physical activity and promote healthy aging., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Pollak, Verghese and Blumen.)

Background: A large proportion of adults in Japan remain unmarried even though they intend to marry during their lifetime. To provide data for policy makers and those searching for partners in the Japanese marriage market, we estimated the number and characteristics of unmarried women and men with marriage intention and assessed their partner preferences. Based on the findings, we hypothesized regarding potential mismatches between the individuals available in the marriage market and the type of partners they are looking for., Methods: We used data from the National Fertility Survey (2015), a nationally representative survey in Japan, and included 20,344 participants aged 18-49 years, of which 6,568 were unmarried with marriage intention. We estimated the total number of unmarried women and men who intend to marry, extrapolated their characteristics to the Japanese population, and assessed their partner preferences, as well as their ideal age of marriage and the ideal age of their partner., Results: In 2015, there were 8.48 million unmarried women and 9.83 million unmarried men aged 18-49 years with marriage intention in Japan. Surpluses of around 600,000 men were observed in non-densely inhabited areas (men-to-women ratio: 1.31) and in the Kanto region (1.23). Most of the women and men in the marriage market had annual incomes lower than 3,000,000 JPY (28,000 USD) and only 263,000 women (3%) and 883,000 men (9%) had an income of 5,000,000 JPY (47,000 USD) or more; 167,000 men (2%) had an income of 7,000,000 JPY (66,000 USD) or more, with roughly three-quarters of them having a university degree. When asked about eight items that one may consider in a potential partner, the proportion of women listing an item as "important" tended to be larger than those of men across all items (education, occupation, finances, personality, mutual hobbies, cooperation/understanding regarding one's work, and attitude towards/skills in housework and childrearing) except appearance. The largest differences were observed for finances (proportion of women vs. men listing the item as "important" or "would consider:" 94.0% vs. 40.5%, p<0.001), occupation (84.9% vs. 43.9%, p<0.001), and education (53.9% vs. 28.7%, p<0.001). While women, on average, preferred men who were around 1-3 years older than themselves, men preferred women around their own age until the age of 26 years, at which point men preferred women who were younger than themselves, with the preferred age difference increasing substantially with age. As such, the number of men preferring a younger partner was larger than the number of women who preferred an older partner., Conclusions: By providing data on the number, characteristics and partner preferences of individuals in the marriage market, our study could inform decisions for those searching for marriage partners in Japan. Moreover, we hypothesize that mismatches in geographical location, the supply-demand disparity for partners with higher income, and age preferences could partly explain the large number of Japanese women and men who remain unmarried despite intending to get married. Further studies are needed to assess if, and to what extent, the identified mismatches may affect marriage rates., Competing Interests: The authors have declared that no competing interests exist.

Background: The improvement of maternal and child health (MCH) outcomes is an important part of the sustainable development goals (SDGs). MCH remains an important issue globally as the SDGs have not yet been achieved in most countries. Young women in universities are likely to experience unintended pregnancy due to risky sexual behaviors in tertiary institutions which is characterized by lack of condom and/or contraceptive use and coercion. Pregnant young women in an academic environment are susceptible to stressors associated with unintended pregnancy and academic demands of universities. However, very little is known about the stress and coping among young people in tertiary institutions who get pregnant during the course of their studies and choose to keep the pregnancy., Methods: Participants were purposively selected among pregnant students and those in the puerperal period at the time of the study. Semi-structured qualitative interviews were undertaken to explore the experiences of pregnancy and early motherhood, with particular focus on the various stressors experienced and possible coping strategies employed by students. The data were audio-recorded and transcribed verbatim, then analysed using thematic analysis., Results: The findings show that pregnancy and early motherhood was an experience that came with a lot of stress emanating from fear of parents' reactions, academic pressure, financial constraints, relationship problems with male partners and experiences of social stigma. Participants used emotion-focused and problem-focused coping strategies to deal with the stressors confronting them during and after their pregnancy., Conclusion: The experiences of pregnant students are multifaceted and generally characterised by financial crisis, academic challenges, shame, strenuous relationships and transitioning into a new identity. A multipronged approach to healthcare for pregnant students that focus on comprehensive antenatal services, health education, health promotion, psychosocial interventions including academic counselling will have positive outcomes for young mothers and their children., (© 2021. The Author(s).)

Purpose: To evaluate the size and characteristics of the demand for a newly established, publicly sponsored, program of assisted reproduction for single women (SW) and women with a female partner (FP) in a European country., Materials and Methods: We analysed the application forms received during the first two years and structured interviews with 300 successive non selected applicants., Results: The mean sustained size of the demand was of 52.6 applications per month (sd 14) and corresponded to 0.06 % of the target population. Data from 237 applicants was evaluable. 119 (50.2 %) were SW and 118 (49.8 %) were FP. The median age was 36 years, 36.5 years for SW and 34 years for FP ( p  < 0.001, Mann-Whitney). Clinically 18.6 % of women presented irregular cycles, and 17.8 % of women had undergone hysterosalpingography (HSG), with a 14.3% prevalence of tubal dysfunction., Conclusions: A publicly sponsored program for Assisted Reproduction for SWFP should establish clear inclusion criteria, especially as regards to age, ovarian reserve, techniques offered, and the number of cycles to obtain the maximal efficiency. Further research specific for this group is required to ensure that they receive adequate care and ultimately to fulfil their reproductive rights.

Introduction: The societal norm in India is such that adolescents are expected to respect and follow traditional values and view early sexual debut as undesirable and deviant from the social mores. However, a dramatic shift in attitudes towards sex before marriage has been observed in India. We in this study, aim to study the factors associated with early sexual debut among unmarried adolescents., Materials and Methods: The study used data from the Understanding the lives of adolescents and young adults (UDAYA) survey conducted in 2016 with 15,388 adolescents aged 10-19 years from two Indian states. Bivariate and logistic regression analyses were performed to determine the associated factors., Results: Adolescent boys (9%) were more prone to early sexual debut compared to girls (4%). Both boys (17.2%) and girls (6%) who were school dropouts had significantly higher chances of early sexual debut. Boys who had rare [OR: 2.28; CI: 1.12-4.64] or frequent media exposure [OR: 2.70; CI: 1.36-5.32] were significantly more likely to report early sexual debut than those who had no media exposure. Further, the likelihood of early sexual debut was significantly higher among boys [OR: 3.01; CI: 2.34-3.87] and girls [OR: 1.87; CI: 1.12-3.12] who had exposure to pornography compared to their counterparts. The odds of early sexual debut were higher among boys [OR: 1.89; CI: 1.19-3.01] and girls [OR: 1.77; CI: 1.30-2.41] who had moderately-severe/severe depressive symptoms compared to their counterparts., Conclusions: The results highlight that Indian unmarried adolescents demand the appropriate knowledge to promote safer sexual behavior and lead a responsible and healthy lifestyle. The preventive efforts must be multifaceted with involvement at the individual and parental levels. Especially, interventions appear advantageous to be parents-focused emphasizing family life education that can prevent risky sexual behaviors among adolescent boys and girls. And the public programs should focus on sexual health promotion considering the physical and psychosocial changes during early ages of sex life., Competing Interests: The authors have declared that no competing interests exist.

Objective: Developing countries have seen an increase in the use of hormonal contraception due to its high efficacy in preventing pregnancy. Our study assessed risk compensation among single women of reproductive age using hormonal contraception., Methods: The study used data from a nationally representative, cross-sectional sample of the 2018 Zambia Demographic and Health Survey (DHS). Study participants ( N  = 2151) were single, sexually active women aged 15-49 years, of whom 595 were using hormonal contraception., Results: Hormonal contraception was used by 26% of participants, 81% of whom reported they had not used a condom every time they had sexual intercourse ( p  < .001). Sexually transmitted infections (STIs) were reported in 4% of hormonal contraceptive users, compared with 2% of non-hormonal contraceptive users ( p  = .036). The odds of condom use at each occurrence of sexual intercourse were lower for: hormonal contraceptive users (adjusted odds ratio [OR] 0.62; 95% confidence interval [CI] 0.48, 0.80); women aged 15-19 years (adjusted OR 0.62; 95% CI 0.36, 1.08) and 20-24 years (adjusted OR 0.56; 95% CI 0.33, 0.95); women with no education (adjusted OR 0.33; 95% CI 0.16, 0.69) and primary education (adjusted OR 0.62; 95% CI 0.42, 0.94); women in the low wealth quintile (adjusted OR 0.46; 95% CI 0.36, 0.61); and women who had one or more children (adjusted OR 0.59; 95% CI 0.45, 0.77)., Conclusion: Lack of knowledge about hormonal contraception predisposes women to sexual risk behaviour. As hormonal contraception is very effective in preventing unwanted pregnancy, and condoms are effective in reducing the risk of STI transmission, the use of both (dual protection) should be encouraged.

Access to sexual and reproductive health in conservative communities and in the MENA region are particularly limited and, as such, increase women's vulnerability to unwanted pregnancies, unsafe abortions, and sexually transmitted infections (STIs). The aim was to assess the prevalence of STIs, sexual practices, recreational drug-use and their possible associations among cisgender unmarried women residing in Lebanon. Data on demographics, sexual practices and substance-use were collected from 2083 unmarried cisgender women who voluntarily attended a sexual health clinic in Lebanon between 2015 and 2019. They tested for HIV, Hepatitis B, Hepatitis C and Syphilis through rapid testing. Other infections (genital warts, Neisseria gonorrhea/Chlamydia trachomatis) were screened for. Regression models were computed between variables. There were two cases of HIV, one of Hepatitis B and syphilis, and no cases of Hepatitis C. Genital warts were present in 15% and symptoms indicative of Neisseria gonorrhea/Chlamydia trachomatis in 14%. Inconsistent condom-use (81%) was significantly associated with number of partners (adj. OR: 0.4). Inconsistent condom-use discussion with partners (33%) was significantly associated with unemployment (adj OR: 1.7), recreational drug-use (adj. OR: 1.4), and number of partners (adj. ORs 3.7-4.4). Unwanted pregnancies (11%) were significantly associated with age (adj. ORs 0.1-0.37), recreational drug-use (adj. OR: 2), using intrauterine device (adj. OR:2.9) and natural birth control methods (adj. OR: 2.4). Recreational drug-use (33%) was significantly associated with age (adj ORs 1.9-2.2), and smoking status (adj. OR: 0.6). The results indicate an urgent need for: (1) Accessible, non-stigmatizing, and inclusive sexual health services dedicated to women's sexual health; (2) Comprehensive and non-stigmatizing sexual health education for all, but especially women, in order to promote safer sexual practices and effective decision making with regards to contraception and condom-use.

It is essential to equip adolescents with the right information and appropriate skills for a quality transition to their adulthood. This study examines the individual agency of unmarried adolescent girls and young women (AGYW) who were organized into self-help groups (SHG) as compared to those who were not in groups. The paper uses data from a cross-sectional survey conducted with 872 unmarried AGYW aged 15-21 years from 80 villages across two districts of Uttar Pradesh, India. The dependent variables were AGYW's financial independence, collective action, decisionmaking, mobility, self-expression, generalized perceived self-efficacy, gender norms attitudes, and attitudes toward violence. The primary independent variables were group membership and the duration of the membership. Bivariate and multiple logistic regression analyses were conducted to examine the relationship between group membership and various components of individual agency. More than half of the respondents, with an average age of 18 years were enrolled in school or college and one-third had 12 or more years of education. The group members, compared to non-members, were significantly more likely to be financially independent (odds ratio [OR] = 2.29, p<0.01), to take collective action for entitlements (OR = 3.80, p<0.01), and to have progressive attitudes toward gender roles and norms (OR = 1.43, p<0.05). A longer duration of group membership increases the likelihood of financial independence, collective action, and decisionmaking ability. The study highlights the need for further investment in adolescent girls' programming and highlights the potential of organizing AGYW into SHG and using the 'platform' to bring change in their lives and consequential individual agency., Competing Interests: The authors declare no individual or organizational competing interest exist. Commercial affiliation of one author (AS) does not alter our adherence to PLOS ONE policies on sharing data and materials.

The aim of this study was to understand how sexual minority women of the baby boom cohort viewed their social connections and planned for their later years. Framed by feminist and life course perspectives, this study used semi-structured interviews and constructivist grounded theory. Thirteen single sexual minority baby boom women from across the U.S. were interviewed. The women were active in their communities and viewed their social connections with local community, family of origin and of choice. The women had formal and informal plans for their future, anticipating the possibilities of aging-related issues, related to housing and support.

We studied the association between living alone and the risk of incident type 2 diabetes in middle-aged individuals using nationwide cohort data from the Korean population. 11,686, 677 middle-aged individuals aged 40-64 years who underwent health examinations by the Korean National Health Insurance System between 2009 and 2012 were followed up until December 31, 2015. The hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox proportional hazards regression analysis. During the median follow-up duration of 5.6 years, 393,438 individuals developed type 2 diabetes. Living alone was significantly associated with incident type 2 diabetes in all adjusted models (HR 1.08; 95% CI 1.07-1.09 in model 4). Individuals who lived alone for < 1 year and 1-7 years were associated with increased HRs of 1.07 (1.04-1.09) and 1.08 (1.07-1.09). Living alone was associated with incident type 2 diabetes in all subgroups. The association was stronger in men than in women and younger individuals than in older individuals. Living alone, even for a short duration, may be an important factor in type 2 diabetes development. Better household conditions and appropriate support to one-person households may be needed to prevent type 2 diabetes.

In recent years, dating apps have changed the way people meet and communicate with potential romantic and/or sexual partners. There exists a stereotype considering that these apps are used only for casual sex, so those apps would not be an adequate resource to find a long-term relationship. The objective of this study was to analyze possible individual differences in the mating orientations (short-term vs. long-term) between users and non-users of dating apps. Participants were 902 single students from a mid-size Spanish university, of both sexes (63% female, and 37% male), aged between 18 and 26 years (M = 20.34, SD = 2.05), who completed a battery of online questionnaires. It was found that, whereas dating apps users had a higher short-term mating orientation than non-users (more frequent behavior, higher desire, and more positive attitude), there were no differences in the long-term orientation as a function of use/non-use. Considering this, dating apps are a resource with a strong presence of people interested on hooking-up while, simultaneously, not a bad (nor good) option for finding long-term love., Competing Interests: The authors declared that no competing interests exist.

Context: Nigeria is a high-burden country in terms of young people's health. Understanding changes in young people's sexual and reproductive health (SRH) behaviours and the associated factors is important for framing appropriate interventions., Objective: This study assessed changes in SRH behaviours of unmarried young people aged 15-24 and associated factors over a ten-year period in Nigeria., Data and Method: We analysed datasets from Nigeria Demographic and Health Surveys of 2008, 2013 and 2018 to assess changes in inconsistent condom use, non-use of modern contraceptives; multiple sexual partnership; and early sexual debut. Using binary logistic regression, we assessed the association of selected variables with the SRH behaviours., Results: Over four-fifths of unmarried young people (15-24) in Nigeria engaged in at least one risky sexual behaviour in each survey year. The pattern of changes in the four risky SRH behaviours was consistent over the 10-year period, with the highest rates of each behaviour occurring in 2018 while the lowest rates were in 2013, thus indicating an increase in the proportion of respondents engaging in risky sexual behaviours over the study period. Comprehensive HIV/AIDS knowledge, male gender, older age category (20-24), residence in south-west Nigeria, urban residence, higher socio-economic status, secondary/higher education were mostly protective against the four SRH variables analysed across the different data waves., Conclusion: Addressing the high and increasing level of risky SRH behaviours among young people in Nigeria is imperative to improve overall national health status and to ensure progress towards achieving SDG target 3.7 focusing on SRH., Competing Interests: The authors have declared that no competing interests exist.

We examined sex differences in preferences for sexual variety and novelty to determine whether the Coolidge effect plays a role in human sexuality. In two experimental studies that employed different manipulations, we found converging evidence that men showed a greater preference for variety in potential short-term mates than did women. In the first study, men (n = 281) were more likely than women (n = 353) to select a variety of mates when given the opportunity to distribute chances to have sex with different individuals in hypothetical situations. This sex difference was evident regardless of the targets' attractiveness and age. Further, men found it more appealing if their committed romantic/sexual partners frequently changed their physical appearance, while women reported that they modified their physical appearance more frequently than did men, potentially appealing to male desires for novelty. In the second study, when participants were given a hypothetical dating task using photographs of potential short-term mates, men (n = 40) were more likely than women (n = 56) to select a novel person to date. Collectively, these findings lend support to the idea that sex differences in preferences for sexual variety and novelty are a salient sex-specific evolved component of the repertoire of human mating strategies.

Introduction: Inadequate efforts towards meeting the sexual and reproductive health needs of adolescents and young people, who disproportionately share the burden of unwanted pregnancies, poor maternal and child health outcomes, risks of RTI/STI and HIV/AIDS, increase the risk of losing much of the progress made towards the Millennium Development Goals over the last decade, particularly in the context of low-and-middle-income countries like India., Data and Methods: Using the nationally representative data on 160551 unmarried young women aged 15-24 years from the District Level Reproductive and Child Health Survey (DLHS: 2007-2008) in India, this research evaluated the demographic and socioeconomic differentials in the access to family life/sex education (FLE) among youth in India. Using the adjusted multiple logistic regression models, the association between access to family life/sex education and attitudes towards a range of sexual and reproductive health matters among young unmarried Indian women were investigated., Results: Less than half of the unmarried young women had received some form of FLE (48 percent) in India. However, there were substantial demographic and socioeconomic variations in their access to FLE, as relatively less educated women from the poorest wealth quintiles, religious and social minorities (Muslims, Scheduled Castes/Scheduled Tribes) were significantly less likely to receive FLE as compared to other women. Importantly, the likelihood of holding favourable/positive attitudes towards reproductive processes, knowledge and discussion of contraceptive methods, precise awareness about the transmission pathways of RTIs/STIs and HIV/AIDS was significantly higher among those women in India who had access to FLE., Conclusion: The present research underscores the protective role of family life education towards improving the sexual and reproductive life experiences of young people. It further underscores the vital need to implement a comprehensive and culturally appropriate programme of family life education in order to meet the sexual and reproductive health demands of the adolescents and young people in India., Competing Interests: The authors have declared that no competing interests exist.

Purpose: Adolescents 360 (A360) is an initiative being rolled out across Nigeria with the aim of increasing voluntary modern contraception use among women aged 15 to 19 years. Using evaluation study baseline data, we identified sexuality, fertility and contraceptive use characteristics of young unmarried girls in South Western Nigeria., Methods: A cross-sectional baseline survey of unmarried girls aged 15 to 19 years was conducted in Ogun state, Nigeria in August 2017. A clustered sampling design was used. We identified determinants of modern contraceptive use in this subpopulation using logistic regression., Results: Of 12,024 women interviewed, 15.3% reported sexual intercourse in the past year. The majority of respondents (79.6%, 9525/11,967) had heard of contraception. 45.3% of sexually active respondents were using a modern contraceptive method. Of those using any method of contraception, male condoms (50.3%) were the most widely used modern method followed by the emergency contraceptive pill (16.7%). Following adjustment for socio-demographic characteristics, there was evidence that the use of modern contraception was positively associated with having never given birth, living in an urban area, current enrolment in education, high level of education, high socioeconomic status, exposure to information about contraception, perceived social support for contraception, and self-efficacy for contraception., Conclusions: In South Western Nigeria, unmarried sexually active adolescent girls have relatively low levels of modern contraceptive use. Programmes should aim to increase access to modern contraception and to increase social support and acceptability of contraceptive use.

Objectives: The coronavirus disease (COVID-19) pandemic has forced many employees to alter both their work style and lifestyle. This study aimed to examine how the combination of changes in overtime working hours and social interaction affects the full-time employees' mental well-being, focusing on the difference in household composition., Methods: In November 2020, we conducted a cross-sectional Internet survey that included 4388 Japanese men and women aged 25-64 years, who continued the same full-time job during the pandemic. We performed a logistic regression analysis using a combination of the changes in overtime working hours and social interaction as an independent variable, and the presence/absence of deterioration of mental well-being as the dependent variable., Results: Overall, 44% of participants reported the deterioration of mental well-being compared to before the outbreak. The multivariate analysis revealed that the participants coded as "increased overtime/decreased interaction" were significantly associated with the deterioration of mental well-being compared to those with "unchanged overtime/unchanged interaction" (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.59-2.89). Moreover, this association was relatively stronger among single-person households (OR 2.66, 95% CI 1.50-4.69)., Conclusions: The negative combination of increasing overtime working hours and decreasing social interaction may have an impact on the deterioration of mental well-being during the COVID-19 pandemic, and this association was comparably strong among single-person households. In the pandemic, it is necessary to pay close attention to both overtime working hours and the presence of social interaction to address the mental well-being among employees., (© 2021 The Authors. Journal of Occupational Health published by John Wiley & Sons Australia, Ltd on behalf of The Japan Society for Occupational Health.)

Background: Psoriasis is a systemic inflammatory disease capable of creating stigmatization in the form of social exclusion and decrement of psychological conditions., Aim: The aim of the study was to determine the level of stigmatization in patients with plaque psoriasis., Methods: The study included 166 patients with plaque psoriasis (55.6% women and 44.3% men) with Psoriasis Area and Severity Index scores ≤10. The age of the study patients ranged between 18 and 72 years (arithmetic mean = 37.4; median = 38; standard deviation [SD] = 11.0). The mean age at the diagnosis of psoriasis was 21.5 years (median = 20; SD = 9.1) and disease duration varied from 2 to 59 years (arithmetic mean = 15.8; median = 15; SD = 11.3). The study patients completed the Polish version of the 6-item Stigmatization Scale and the 33-item Feelings of Stigmatization Questionnaire and a survey developed by the authors of this study, containing questions about the participants' sociodemographic characteristics (sex, age, place of residence, marital status, education, employment status) and information about their disease (location of psoriatic lesions, time elapsed since the diagnosis of psoriasis)., Results: The mean score for the 6-item Stigmatization Scale for the whole study group was 7.6 out of 18 points (median = 7; SD = 3.8; minimum = 0; maximum = 17). The average score for the 33-item Stigma Feelings Questionnaire in our series was 84.5 out of 165 points (median = 88; SD = 20.9; minimum = 30; maximum = 136). A statistically significant sex-related difference was observed in the 6-item Stigmatization Scale scores, with higher stigmatization levels found in men than in women (p = 0.0082). Moreover, significantly higher levels of stigmatization were observed in countryside dwellers (p = 0.0311) and unmarried persons (p = 0.0321). Patients with a longer history of the disease (≥15 years) scored significantly higher on the 6-item Stigmatization Scale (p = 0.0217) than those in whom psoriasis lasted less long, and presented with higher, at the threshold of statistical significance, scores for the 33-item Feelings of Stigmatization Questionnaire., Conclusions: Stigmatization awareness should be promoted among physicians and psoriatic patients to improve psoriasis management., (The Author(s). Published by S. Karger AG, Basel.)

Objectives: Partnership status is a central predictor of loneliness. The strength of this predictive relationship, however, may decrease in the course of aging and over historical time. Moreover, there may be aging-related and historical changes in the satisfaction with partnership and singlehood., Method: Longitudinal data from the German Ageing Survey (DEAS) assessed in 2008 and 2014 (N = 6,188, age range: 40-85 years) was analyzed with multigroup structural equation models to disentangle aging-related and historical changes in the relationship of partnership status and loneliness and in the average level of satisfaction with partnership and singlehood., Results: With advancing age, partnership status became less predictive of loneliness and the satisfaction with being single increased. Among later-born cohorts, the association between partnership status and loneliness was less strong than among earlier-born cohorts. Later-born single people were more satisfied with being single than their earlier-born counterparts. There was no indication for an aging-related or historical decrease in partnership satisfaction., Discussion: The relevance of partnership status as a predictor of social well-being is neither universal nor stable but appears to change in the course of aging and across historical time., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: Drawing on activity theory of aging, we examined whether solitary activities may be associated with negative well-being, as they may reflect social isolation. Using American Time Use Surveys, with information on "with whom" individuals engaged in activities over a 24 hr period, we created measures capturing solitary days and solitary activities to understand their prevalence and associations with well-being., Methods: At the daily level, we examined associations between solitary days and proportion of the day in solitary activities with life satisfaction. At the activity level, we examined associations between engaging in an activity alone versus with others and emotional state during the activity., Results: Solitary days and higher proportion of the day spent in solitary activities were associated with lower life satisfaction. These associations were attenuated controlling for individual covariates. Engagement in activities alone was associated with lower levels of happiness and higher levels of sadness and pain during the activity, and association with happiness remained even adjusting for covariates., Discussion: A sizable proportion of older adults reported solitary days, and proportion of the day spent in solitary activities increases by age. Examining lived experiences of older adults and presence of others during activities could contribute to research on social isolation., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Father involvement contributes uniquely to children's developmental outcomes. The antecedents of father involvement among unmarried, African American fathers from rural areas, however, have been largely overlooked. The present study tested a conceptual model linking retrospective reports of childhood trauma and early adulthood social instability to father involvement among unmarried, African American men living in resource-poor, rural communities in the southeastern United States. We hypothesized these factors would influence father involvement indirectly, via DNA methylation of the oxytocin receptor gene (OXTR). A sample of 192 fathers participated in 3 waves of data collection in early adulthood. Fathers reported on social instability at Wave 1; OXTR methylation was assessed via saliva samples at Wave 2; and measures of father involvement, retrospective childhood trauma, and quality of the fathers' relationships with their children's mothers were collected at Wave 3. Structural equation modeling indicated that childhood trauma was related directly to reduced levels of father involvement and to increased social instability. Social instability was associated with elevated levels of OXTR methylation, which in turn predicted decreased father involvement. The indirect effect from social instability to father involvement via OXTR methylation was significant. These associations did not operate through fathers' relationship with the child's mother and remained significant even accounting for associations between interparental relationship quality and father involvement. Findings suggest that OXTR methylation might be a biological mechanism linking social instability to father involvement among unmarried, African American fathers in vulnerable contexts and underscore the detrimental influence of childhood trauma on father involvement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

In China, suicide accounts for twenty-six percent of all suicides worldwide; however, researches on the suicidal ideation among older people living alone in the rural region are few. We performed a cross-sectional study to explore the prevalence and influence factors of suicidal ideation, and provide a theoretical basis for suicide prevention among older people living alone in rural region.695 older people living alone in rural region were selected by using stratified cluster sampling. Chi-square for categorical variables, T-test for continuous variables, and path analysis were conducted to statistical analysis.The prevalence of suicidal ideation among the elderly living alone in rural China was 23.6%. Path analyses showed that depression had the most substantial influence on suicidal ideation among the elderly living alone, it was also as a mediator between physical, economic status, social support, anxiety, and suicidal ideation; anxiety and social support had both direct and indirect influence on suicidal ideation; physical status and economic status had indirection impact.The incidence of suicidal ideation among the elderly living alone was high in Dangtu county. Psychological disorders (anxiety and depression) had the strongest impact on suicidal ideation. Strategies and measures targeting these relevant factors (economic status, physical status, and social support) should be taken to reduce the burdens of suicidal ideation among the elderly living alone in China.

Background: Many unmarried young people in low- and middle-income countries (LMIC) want to avoid pregnancy but do not use modern methods of contraception-as a result, half of teen births in these countries are unintended. Researchers have identified numerous barriers that prevent youth from using contraception. However, much of the research in West Africa is narrowly focused on married women, and relatively little research has been done to understand the needs, preferences, barriers, and solution set for sexually active unmarried young people who would like to avoid pregnancy. The purpose of this study was to gain insight into the behavioral barriers that prevent unmarried young people in eastern Senegal from using modern methods of contraception., Methods: This qualitative study conducted in 2017 in the Tambacounda and Kedougou regions in Senegal explores attitudes and beliefs relating to sex and contraception among unmarried young women and men through 48 in-depth individual interviews with young people aged 15-24 and parents of youth and 5 sex-segregated focus groups with 6-9 young people per group. The research team conducted a thematic content analysis and synthesized the findings by major theme following the behavioral diagnosis methodology., Results: Drawing insights from behavioral science, the analysis yields five key findings: (1) unmarried young people avoid making a decision about contraception because thinking about contraceptive use provokes uncomfortable associations with a negative identity (i.e., being sexually active before marriage); (2) unmarried young people see modern methods as inappropriate for people like them; (3) unmarried young people are overconfident in their ability to prevent pregnancy through traditional and folk methods; (4) unmarried young people overestimate the social and health risks of modern contraceptive methods; and (5) unmarried young people fail to plan ahead and are not prepared to use modern contraceptive methods before every sexual encounter., Conclusions: Interventions aimed at increasing uptake of contraceptives among unmarried young people in eastern Senegal must address several significant behavioral barriers in addition to structural, informational, and socio-cultural barriers in order to be successful.

In China, the serious involuntary bachelorhood due to sex ratio imbalance in decades is expected to dramatically increase the spread of HIV through heterosexual contact. However, the higher HIV transmission risk and its correlates among never married men in rural China are not well understood. This study explored whether and how bachelorhood and migration increased the HIV transmission risk through commercial sex. By combining two cross-sectional survey data from never married men in rural areas and male migrants (including both married and unmarried men) in urban areas, a total of 1030 participants who were never married and age 28 and above or married male migrants were included in this study. The results show that both bachelorhood and migration put the never married male migrants at particularly higher HIV transmission risk by increasing both the possibility of engaging in commercial sex, and the frequency and inconsistency of condom use in commercial sex. Selection bias into marriage and neighborhood characteristics associated with exposure to commercial sexual risk may partly explain why male migrants that never married had a higher commercial sex related risk than that of married male migrants and never married non-migrant males.

Background and Purpose: Post-stroke anxiety (PSA) is common and disabling. PSA should be considered as an important outcome in stroke. However, there is a lack of understanding of factors that may be linked to PSA. The purpose of this study was to determine the frequency of PSA and sociodemographic and clinical factors associated with PSA in a cohort of racially and ethnically diverse stroke patients., Methods: We conducted a retrospective study of ischemic and hemorrhagic stroke patients seen in a stroke outpatient clinic from August 1, 2017 to June 30, 2018. Patients were eligible if a Generalized Anxiety Disorder 7-Item (GAD-7) instrument was available. GAD-7 scores greater than or equal to 10 indicated the presence of moderate to severe PSA. Multivariable logistic regression was used to identify independent sociodemographic and clinical factors associated with PSA., Results: Records from 289 stroke patients with a GAD-7 instrument were analyzed. PSA was common (21%; GAD-7 ≥ 10). Fifty-seven percent of females had a GAD-7 greater than or equal to 10 compared to 41% of females who had a GAD-7 less than 10 (P = .03). Multivariable analysis found that self-reported nonmarried status (odds ratio, 3.27; 95% confidence interval, 1.44-7.44), excessive fatigue (odds ratio, 4.46; 95% confidence interval, 1.87-10.63), and depression (odds ratio, 1.24; 95% confidence interval, 1.16-1.33) were independently associated with PSA., Conclusions: PSA may occur more frequently in those who report non-married, excessive fatigue, or depression. Trials of PSA interventions should consider the potential impact of social support, depression, and comorbid conditions contributing to post-stroke fatigue, including sleep apnea., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Single prostate cancer (PCa) patients may face difficulties in starting a new relationship for various reasons. Here, we studied barriers and enablers to starting a relationship for PCa patients and characteristics of patients who were and were not in a relationship. PCa organizations distributed for us a 20-minute online survey, consisting of validated questionnaires (on treatment side effects, loneliness, social provision, and shyness) and questions on factors identified by patients as barriers and enablers to forming a new relationship. Participants were either single [ n  = 20] or had started a new relationship post-diagnosis [non-single, n  = 15]. Three factors-confidence, sexual function, finding the right person-were perceived of as factors that can affect starting a relationship. Fourteen of twenty single patients were confident that they could find a partner and sixteen were comfortable in disclosing their cancer diagnosis to a potential partner. Non-single patients met their partners through various ways, including online dating and social events. They all revealed their cancer status prior to starting the relationship, and most partners reacted well to this disclosure. Single patients were lacking emotional support, more shy, and lonelier than non-single patients. Clinicians need to consider biopsychosocial factors when advising single patients who wish to start a new relationship.

Objectives: We explore and compare older adults' lived experiences and coping strategies in two postcommunist countries-Albania and Bulgaria. Wholesale youth outmigration and economic and institutional regional decline have led to decaying rural areas where older adults become "abandoned." Aging alone, as couples or widowed, they are socially marginalized and in constant search for coping mechanisms which enable them to survive., Methods: We adopt a social-psychology theoretical framework which distinguishes between problem-focused and emotion-focused coping. Data include 28 in-depth interviews with older residents and participant observation in selected rural areas of the two countries., Results: In both countries, rural social isolation is expressed as a lack of close family ties-mainly due to the removal through outmigration of children and grandchildren-and detachment from society at large. The most prevalent coping mechanism consists of practical and emotional support from non-kin ties, especially neighbors. Remittances help to resolve material needs, especially in Albania, where most rural young people migrate abroad. In both settings, a range of emotion-focused coping strategies were identified, including perceptions of decreased needs, lowered expectations about relationships, and satisfaction at the achievements of the younger generations., Discussion: Similarities between research findings in Albania and Bulgaria reflect their shared political and institutional history. Although few, differences relate to a combination of contrasting migration and cultural patterns. In both settings problem- and emotion-focused adaptive strategies are overlapping, and successful aging efforts seem to be of a communal rather than an individualistic nature., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: Previous studies have shown that unmarried older adults are generally at disadvantage in personal networks and social well-being compared with the married. It can be questioned whether their situation has improved in contemporary society, as among others the stigma of divorce and being never-married has declined. We hypothesize differential developments in networks and well-being according to marital status (married, widowed, divorced, and never-married) across birth cohorts., Method: Data are from the 1993 and 2013 observations of the Longitudinal Aging Study Amsterdam on Dutch people aged 55-69 (N = 2,894) and 70-84 years (N = 2,317). We employ general linear modeling of network size and diversity, received emotional and instrumental support, emotional and social loneliness, and depressive symptoms., Results: The widowed are better off socially in 2013 than in 1993. Similar to the divorced they have a larger network, and similar to the never-married they receive more emotional support and are less emotional lonely. We find some gender differences in these developments., Discussion: Societal change has not radically altered networks and well-being of unmarried older people. The widowed seem to benefit most, possibly because they are better able to retain relationships after widowhood., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: While older adults living alone face challenges to maintaining social ties, elders in urban areas also have unique opportunities for daily socializing that can buffer against loneliness., Method: Drawing on 5 years of ethnographic fieldwork among elders in New York City, this study presents empirical insights into the development of supplementary neighborhood-based networks of support for older people living alone and vulnerable to isolation., Results: This study finds that elders who lived alone, without close kin, engaged in daily gossip about other older people they encountered as regulars in local eateries. Despite its negative reputation, gossip helped them connect and access less conventional social support close to home. The majority resisted formal organizations, such as churches or senior centers, and thus their interactions in public venues served as an important source of social involvement. In line with Gluckman's argument (1963), gossip betrayed emotional intimacy and caretaking that connected people who could have fallen off the social radar., Discussion: Higher rates of divorce and lifelong singlehood, coupled with increased longevity, will compel greater numbers of older adults to construct alternative support networks. My findings suggest that more will draw these connections from unconventional venues such as neighborhood public places., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: China's recent demographic and social changes might undermine the sustainability of its family-oriented system for elder care. We investigate kin availability among adults aged 45+ in contemporary China, with an emphasis on child gender., Method: Using nationally representative survey data from the China Health and Retirement Longitudinal Study (2011), we examine the prevalence and correlates of lacking different kin types and combinations, and we test associations between kin availability and received economic support., Results: Kinlessness is low in China (less than 2% lack a spouse/partner and children), but kin availability is patterned by gender, age group, and sociodemographic characteristics. More than twice as many older adults have no spouse/partner and no daughter (3.2%) as those who have no spouse/partner and no son (1.4%). Adults without close kin are disadvantaged across health, wealth, and economic support. In contrast to traditional expectations, we find that those with only daughters are more similar to those with mixed sex children, whereas those with only sons are more similar to those without children in receipt of economic support., Discussion: Access to kin forms the basis of an emergent system of stratification in China, which will be amplified as cohorts with only one child age into older adulthood., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: When identifying older adults who may be at risk of being without necessary supports, policy makers and scholars tend to focus on those living alone, neglecting differences within that group. We examine how their social networks contribute to subjective well-being, why some of them fare better and compare their well-being to older adults coresiding with others., Method: Data are from the fourth wave of the Survey of Health and Retirement in Europe (N = 53,383). A network typology for older people living alone (N = 10,047) is constructed using a latent class analysis. Using ordinary least squares (OLS) regressions, we examined differences in subjective well-being (life satisfaction, satisfaction with social network, depression) by network type, adding adults coresiding with others (N = 43,336) as comparison group., Results: We find four social network types among older adults living alone. The likelihood of having "restricted" and "child-based" networks is greater in Eastern and Southern European countries, whereas the likelihood of having "friend-oriented" networks is greater in Western and Northern European countries. Across countries, only those with "restricted" networks tend to have the poorest well-being. Those with "diverse" networks have even better well-being than coresiding older adults., Discussion: Our study shows the importance of drawing distinctions within the group of older adults living alone. Most (two thirds) are not vulnerable and at risk, but fare just as well or even better than peers who coreside with others. Country-level factors shape the opportunities to build satisfactory networks, but subjective well-being depends more strongly on individual resources, including social networks, than country-level factors., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Guided by family systems theory and using 2-wave data from 4,843 low-income, unmarried couples in the Building Strong Families study, we examined paths from paternal and maternal pregnancy intentions to family functioning in personal, relationship, and coparenting domains. Using 3-step Latent Class Analysis, we first identified 3 subgroups of couples based on both parents' pregnancy intentions: Both Wanted/Both On-time (33.8%), Both Wanted/Both Mistimed (56.1%), and Women Wanted/Both Mistimed (10.1%). We then examined how family functioning varied across these 3 classes. We found that fathers and mothers in the Women Wanted/Both Mistimed class experienced the lowest levels of family functioning. Mothers in the Both Wanted/Both On-time class reported higher family functioning than mothers in the Both Wanted/Both Mistimed class, whereas few differences were identified between fathers in the Both Wanted/Both On-time class and the Both Wanted/Both Mistimed class. We discussed implications for families transitioning to parenthood of this nuanced understanding of associations between pregnancy intentions and family functioning. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Infidelity is often conceptualized as a traumatic event; however, little research has explored this topic empirically, particularly in unmarried adults. We determined the prevalence of infidelity-related post-traumatic stress disorder (PTSD) symptoms among unmarried adults who experienced a partner's infidelity and whether probable infidelity-related PTSD was associated with additional psychological health outcomes (i.e., depressive symptoms, perceived stress, and anxiety symptoms). We also investigated whether negative post-traumatic cognitions mediated the associations between infidelity-related PTSD symptoms and psychological health. This study included 73 adults (M age = 19.42, SE = 0.19 years) who experienced infidelity within a committed nonmarital relationship within the last 5 years. Controlling for gender, race, and exposure to Diagnostic and Statistical Manual of Psychiatric Disorders Criterion A traumas, 45.2% of our sample reported symptoms suggesting probable infidelity-related PTSD. Whether used as continuous or categorical predictor, infidelity-related PTSD symptoms were significantly associated with depressive symptoms, although results for perceived stress and anxiety symptoms were mixed. Post-traumatic cognitions acted as a partial mediator for depressive symptoms and full mediator for perceived stress and anxiety symptoms. This empirical evidence suggests that infidelity may produce PTSD symptoms at a relatively high rate, even in unmarried young adults, and may put individuals at risk for poorer psychological health, partially through post-traumatic cognitions., (© 2019 John Wiley & Sons, Ltd.)

Background: Despite the fact that solitary drinking is becoming more common in Korea, few studies have investigated the association between drinking alone and mental health. This study aimed to investigate the relationship between solitary drinking, depressive symptoms, and suicidal ideation in Korean college students., Method: Primary data on a nationally representative sample of college students were used. Data were collected by Yonsei University and the Korean Center for Disease Control in 2017 to investigate alcohol-related behaviors and health consequences in students. The association between solitary drinking, depressive symptoms, and suicidal ideation were measured using multivariate logistic regression analysis., Results: A total of 3,935 students were analyzed, in which 11.5% had depressive symptoms and 2.8% suicidal ideation. Compared to non-solitary drinkers, solitary drinkers were more likely to have depressive symptoms [Odds Ratio (OR) 2.28, 95% Confidence Interval (95% CI) 1.72-3.02] and suicidal ideation (OR 2.24, 95% CI 1.32-3.81). Moreover, larger differences were found in individuals with higher alcohol use disorders identification test (AUDIT) scores and with more frequent underage drinking experience., Limitations: As this study was cross-sectional in design, causal inferences cannot be made on the association between solitary drinking, depressive symptoms, and suicidal ideation., Conclusion: Solitary drinking is associated with higher likelihoods of depressive symptoms and suicidal ideation in college students. The results suggest the importance of monitoring solitary drinkers as they may be more vulnerable to the negative mental health effects of alcohol., (Copyright © 2019. Published by Elsevier B.V.)

Background: The last 10 years have seen an increase in the number of suicides in the US Armed Forces. Accordingly, the topic of suicides in the German military has received a lot of attention in media and science alike., Methods: This study retrospectively examined all suicides (N = 107) committed by active, nonretired German military personnel from 2010 to the end of 2014, analyzing archived medical records. In a second step, these data were compared to a representative German Armed Forces survey conducted in 2012 (N = 1,549)., Results: The following risk groups for suicide were identified: male (OR = 9.6), single (OR = 7.8), aged over 45 years (OR = 4.0), short period of service (<2 years; OR = 2.7), and low level of education (OR = 2.2). Surprisingly, military personnel with little experience in deployments abroad (<2 missions) showed double the risk (OR = 2.0) compared to those who had been deployed more than once., Discussion: Multiple robustness checks show that being single, aged over 45 years, and having obtained a low level of education exhibit the most robust effects on suicide risk., Conclusion: Efforts should be made to develop and evaluate risk group-focused prevention programs. We conclude, that further studies should be initiated to show differences of risk groups between lethal and nonlethal suicidal behavior., (© 2018 The American Association of Suicidology.)

Background : In South Asian countries like India, family system lays a strong foundation in societies and therefore, the context and consequences of single parent family structures are markedly different from that of the West. In these societies single parenthood is mainly an outcome of untimely death of any one of the parents. Aims : This study tried to examine the influence of parents' survival status on the mental health of youth in India. Methods : "Youth in India: situation and Needs (2006-2007)" survey data was used in the present study. We compared two groups of unmarried young population aged 15-24 y ( n  = 28 637): one having both parents alive and another having only one parent alive. Bivariate and multivariate techniques were applied to analyze the data. Results : Results revealed that around 11% of the unmarried youth belonged to single parent families. Findings underscored a significant association between parent's survival and mental health of youth; respondents from single parent families were more likely to report metal health problems Moreover, effects of parents' survival were significant on females' mental health rather than males'. Conclusion : Policies must focus on reducing stress of young people growing up in single parent families through enhanced educational and employment opportunities.

Aims: To find factors that are associated with a general practitioner's (GP's) subjective impression of a patient being 'difficult' within a sample of patients with type 2 diabetes mellitus (T2DM)., Methods: Secondary cross-sectional analysis of a cohort of GP patients with T2DM. GP questionnaire on clinical data and GPs' subjective ratings of patient attributes (including 'patient difficulty'). Patient questionnaire on sociodemographics and illness perceptions. Bivariate and multivariate analyses, adjusted for cluster-effect of GP practice., Results: Data from 314 patients from 49 GPs could be analysed. Independent associations with higher GP-rated difficulty were found for (odds ratio; 95% confidence interval): male patients from male GPs (1.27; 1.06-1.53), unmarried men (1.25; 1.04-1.51), men with non-German nationality (1.80; 1.24-2.61), patients perceiving more problems with diabetes (1.17; 1.04-1.30), patients with higher BMI (1.01; 1.00-1.02) and HbA1c values (1.06; 1.02-1.10), patients being perceived by the GP as less adherent (1.34; 1.22-1.46) and less health-literate (1.19; 1.04-1.35)., Conclusions: The impact of patients' gender and illness perception yield new insights into GP-perceived complexity of care. Culturally and gender-sensitive communication techniques for adapting health care goals to patients' problems (rather than norm values) may alleviate GPs' work., (Copyright © 2019 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Background: Marital status is known to influence quality of life, survival, and treatment decision-making after breast cancer diagnosis. We aimed to determine whether relationship status impacts contemporary patterns of immediate breast reconstruction., Methods: Surveillance, Epidemiology, and End Results (SEER)-18 was used to identify females undergoing mastectomy for stage 0-III breast cancer from 1998 to 2014. Multivariate logistic regression was used to estimate the association of relationship status with the likelihood of postmastectomy reconstruction. Patients were grouped by diagnosis year to assess change in the reconstructed population with time. Among younger patients ≤45 years, a generalized logistic model was used to predict reconstruction subtype., Results: Among 346,418 patients, reconstruction after mastectomy was more likely to occur in women with relationship support in the form of a marriage or partner [odds ratio (OR) 1.31; 95% confidence interval (CI), 1.28-1.34; p<0.001]. Women who were separated (OR 0.76), single (OR 0.73), or widowed (OR 0.56) were significantly less likely than married women to undergo reconstruction (all p<0.001). During the 17-year study period, change in reconstruction rates with time varied by relationship status (interaction p=0.02), with reconstruction rates among divorced patients increasing more slowly than those among married and partnered women. Among younger women, subtype patterns varied by relationship status (p=0.004), with divorced women less likely to receive autologous over implant reconstruction (OR 0.87; p = 0.03)., Conclusion: Relationship status may influence decision-making regarding pursuit and type of postmastectomy reconstruction. Consideration of support networks of patients with breast cancer could facilitate tailored preoperative counseling by reconstructive surgeons., (Copyright © 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Early pregnancy among unmarried youth is a serious public health challenge. Male youth's knowledge, attitude and practice (KAP) of sexual and reproductive health (SRH) and its association with the risk of their sexual partners' pregnancy in China remains unexplored. This study investigates the KAP among Chinese unmarried male youth aged 15-24 years and identifies its association with partner pregnancy using nationally representative data from Survey of Youth Access to Reproductive Health in China (YARHC) in 2009., Methods: Chi-square tests were applied to explore the prevalence of partner pregnancy by male youth's KAP of SRH and logistic regression were applied to identify the associations of partner pregnancy with knowledge, attitudes and practice among male youth., Results: Among 2853 sexually experienced male youth, totally 597 unmarried male youth caused 852 partner pregnancies and the prevalence rate was 20.93%. Lacking the knowledge of contraception access (OR: 0.66, 95% CI: 0.44-0.99) was significantly associated with lower risk of causing partner pregnancy. Contraception discussion before (1.49, 1.04-2.11) or after first sexual intercourse (1.46, 1.11-1.93), not using valid contraception (1.29, 1.03-1.64) and male contraception decision-maker (1.79, 1.41-2.28) were significantly associated with higher risk of causing partner pregnancy., Conclusion: Our results indicated that male youth's knowledge and behaviors of sexual and reproductive health were significantly associated with the risk of causing partner pregnancy, and highlighted the importance and need of sexual and reproductive programs targeting male for the prevention of unintended partner pregnancy in China., Competing Interests: The authors have declared that no competing interests exist.

Background: In China, unmarried female migrants are vulnerable to sexual and reproductive health risks. One effective protection strategy is promoting consistent condom use (CCU)., Methods: We conducted a cross-sectional study to apply the information-motivation-behavioral skills (IMB) model and modified it by addition of psychological and personal factors to examine the related factors of CCU and provide suggestions for intervention among unmarried female migrants., Results: Of all 903 eligible participants, only 13.8% of participants reported CCU in the past six months. Both the IMB model and the modified IMB model provided acceptable fit to the data. In both models, information had no direct or indirect influence on CCU (p > 0.05). However, behavioral skills had a positive effect on CCU (β = 0.344, p < 0.001 and β = 0.330, p < 0.001). Moreover, motivation contributed to CCU indirectly by affecting behavioral skills (β = 0.800, p < 0.001) and had no direct influence (p > 0.05). In the modified model, psychological and personality factors influenced CCU directly (β = - 0.100, p = 0.005)., Conclusions: Our results highlight the importance of conducting CCU promotion among unmarried female migrants. Future intervention strategies should focus on both the traditional IMB model constructs and the added psychological and personality factors.

Rates of singlehood are increasing rapidly in the Western World. In the current paper, we discuss the phenomenon of long-term singlehood from an attachment perspective, outline three distinct sub-groups of singles (anxious, avoidant, and secure), and demonstrate the utility of these groups by highlighting their unique characteristics and possible life outcomes, including factors that may moderate these outcomes. Finally, we offer suggestions for future research to enhance our understanding of this vastly under-researched population., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the efficacy of electroacupuncture (EA) for the treatment of anxiety and depression in unmarried patients with polycystic ovarian syndrome (PCOS) by secondary analysis of a randomised controlled trial., Methods: A prospective pilot randomised controlled trial of unmarried women with PCOS was conducted from November 2012 to March 2016. Participants were assigned to the acupuncture group (receiving EA for 16 weeks) or the control group (receiving sham acupuncture for 16 weeks), with 27 patients in each group. The pre-specified primary outcomes and all secondary outcomes, with the exception of serum levels of neurotransmitters including norepinephrine (NE), epinephrine (AD), serotonin (5-HT) and γ-aminobutyric acid (GABA), will be reported separately. Additional outcome measures selected for this secondary analysis included anxiety and depression scale scores (Zung-SAS and Zung-SDS), 36-Item Short Form (SF-36) scale scores, PCOS Quality of Life (PCOSQOL) scale scores and Chinese Quality of Life (CHQOL) scale scores., Results: After the16-week intervention, an increase in serum NE and reduction in 5-HT were observed in the acupuncture group (P=0.028 and P=0.023, respectively). The serum level of GABA decreased in both groups after the interventions (both P<0.001). However, there were no significant differences between the two groups in the levels of any neurotransmitters (p>0.05). After EA treatment, SAS and SDS scores were decreased in the acupuncture group (P=0.007 and P=0.027, respectively) and were lower than those of the control group (P=0.003 and P=0.004, respectively). The SF-36 domain scores for mental health, vitality, social functioning, general health and health transition, the total CHQOL scores, and the infertility problems and body hair domains of the PCOSQOL improved significantly after EA (P<0.05)., Conclusion: EA appears to improve symptoms of anxiety/depression and quality of life in PCOS patients and may influence serum levels of NE and 5-HT. These findings should be interpreted with caution, given the secondary nature of the outcome measures reported herein., Trial Registration Number: NCT01812161; ChiCTR-TRC-12002529.

Objectives: To investigate associations between number of children and partnership with depressive symptoms among older Europeans and assess whether associations are greater in Eastern than Western countries. We further analyze whether associations are mediated by provision and receipt of emotional and financial support., Methods: Using cross-sectional data for five Eastern (Bulgaria, Czech Republic, Georgia, Romania, and Russia) and four Western European countries (Belgium, France, Norway, and Sweden) (n = 15,352), we investigated variation in depressive symptoms using linear regression. We fitted conditional change score models for depressive symptoms using longitudinal data for four countries (Bulgaria, Czech Republic, Georgia, and France) (n = 3,978)., Results: Unpartnered women and men had more depressive symptoms than the partnered. In Eastern, but not Western, European countries childlessness and having one compared with two children were associated with more depressive symptoms. Formal tests indicated that partnership and number of children were more strongly associated with depressive symptoms in Eastern than Western Europe., Discussion: Availability of close family is more strongly associated with older people's depressive symptoms in Eastern than Western Europe. The collapse of previous state supports and greater economic stress in Eastern Europe may mean that having a partner and children has a greater psychological impact than in Western countries.