Risky families: family social environments and the mental and physical health of offspring

Evaluating the evidence for models of life course socioeconomic factors and cardiovascular outcomes: a systematic review

Background

A relatively consistent body of research supports an inverse graded relationship between socioeconomic status (SES) and cardiovascular disease (CVD). More recently, researchers have proposed various life course SES hypotheses, which posit that the combination, accumulation, and/or interactions of different environments and experiences throughout life can affect adult risk of CVD. Different life course designs have been utilized to examine the impact of SES throughout the life course. This systematic review describes the four most common life course hypotheses, categorizes the studies that have examined the associations between life course SES and CVD according to their life course design, discusses the strengths and weaknesses of the different designs, and summarizes the studies' findings.

Methods

This research reviewed 49 observational studies in the biomedical literature that included socioeconomic measures at a time other than adulthood as independent variables, and assessed subclinical CHD, incident CVD morbidity and/or mortality, and/or the prevalence of traditional CVD risk factors as their outcomes. Studies were categorized into four groups based upon life course design and analytic approach. The study authors' conclusions and statistical tests were considered in summarizing study results.

Results

Study results suggest that low SES throughout the life course modestly impacts CVD risk factors and CVD risk. Specifically, studies reviewed provided moderate support for the role of low early-life SES and elevated levels of CVD risk factors and CVD morbidity and mortality, little support for a unique influence of social mobility on CVD, and consistent support for the detrimental impact of the accumulation of negative SES experiences/conditions across the life course on CVD risk.

Conclusions

While the basic life course SES study designs have various methodologic and conceptual limitations, they provide an important approach from which to examine the influence of social factors on CVD development. Some limitations may be addressed through the analysis of study cohorts followed from childhood, the evaluation of CVD risk factors in early and middle adulthood, and the use of multiple SES measures and multiple life course analysis approaches in each life course study.

Improving family functioning and child outcome in methadone maintained families: the Parents Under Pressure programme

Twelve families responded to posters displayed in a methadone clinic for inclusion in a pilot study assessing the viability and potential utility of an intensive, multi-component family-focused intervention, the Parents Under Pressure programme. The programme was designed to improve child behaviour, decrease parental stress and improve family functioning in methadone-maintained families by targeting affect regulation, mood, views of self as a parent, drug use and parenting skills. Nine of the families completed the programme delivered in their homes; eight were recontacted at 3 months. Each family reported significant improvements in three domains: parental functioning, parent-child relationship and parental substance use and risk behaviour. In addition to the changes in family functioning, the majority of families reported a decrease in concurrent alcohol use, HIV risk-taking behaviour and maintenance dose of methadone. The families reported high levels of satisfaction with the programme. It is recommended that future studies include independent measures (e.g. behavioural observations) of child outcome and parental functioning. The results were optimistic and provided the impetus to evaluate the treatment programme using a randomized controlled trial.

Codevelopment of externalizing and internalizing problems in early childhood

Using cross-domain latent growth modeling, we examined trajectories of externalizing and internalizing problems in disadvantaged boys followed from ages 2 to 6 years (N = 303). On average, externalizing problems gradually decreased and internalizing problems gradually increased. However, we found significant variability in individual-level trajectories. Higher levels of externalizing problems were associated with higher levels of internalizing problems; rates of change were also positively correlated across domains. In addition, high levels of externalizing problems predicted rapid increases in internalizing problems. In follow-up analyses involving child and parenting factors, the combination of high negative emotionality, low fearfulness, and high negative maternal control preceded high, nondecreasing externalizing trajectories. The combination of high negative emotionality, high fearfulness, and high negative maternal control preceded high, increasing internalizing trajectories. Taken together, the results indicate both general and specific processes in the development of early externalizing and internalizing problems.

The programming of individual differences in defensive responses and reproductive strategies in the rat through variations in maternal care

There are profound maternal effects on individual differences in defensive responses and reproductive strategies in species ranging literally from plants to insects to birds. Maternal effects commonly reflect the quality of the environment and are most likely mediated by the quality of the maternal provision (egg, propagule, etc.), which in turn determines growth rates and adult phenotype. In this paper, we review data from the rat that suggest comparable forms of maternal effects on both defensive responses to threat and reproductive behavior and which are mediated by variations in maternal behavior. Ultimately, we will need to contend with the reality that neural development, function and health are defined by social and economic influences.

Environmental justice, cumulative environmental risk, and health among low- and middle-income children in upstate New York

OBJECTIVES

We documented inequitable, cumulative environmental risk exposure and health between predominantly White low-income and middle-income children residing in rural areas in upstate New York.

METHODS

Cross-sectional data for 216 third- through fifth-grade children included overnight urinary neuroendocrine levels, noise levels, residential crowding (people/room), and housing quality.

RESULTS

After control for income, maternal education, family structure, age, and gender, cumulative environmental risk exposure (0-3) (risk >1 SD above the mean for each singular risk factor [0, 1]) was substantially greater for low-income children. Cumulative environmental risk was positively correlated with elevated overnight epinephrine, norepinephrine, and cortisol in the low-income sample but not in the middle-income sample.

CONCLUSIONS

Cumulative environmental risk exposure among low-income families may contribute to bad health, beginning in early childhood.

Maternal Programming of Individual Differences in Defensive Responses in the Rat

This paper describes the results of a series of studies showing that variations in mother-pup interactions program the development of individual differences in behavioral and endocrine stress responses in the rat. These effects are associated with altered expression of genes in brain regions, such as the amygdala, hippocampus, and hypothalamus, that regulate the expression of stress responses. Studies from evolutionary biology suggest that such "maternal effects" are common and often associated with variations in the quality of the maternal environment. Together these findings suggest an epigenetic process whereby the experience of the mother alters the nature of the parent-offspring interactions and thus the phenotype of the offspring.

Family-based therapies for adolescent alcohol and drug use: research contributions and future research needs

OBJECTIVE

To characterize the developmental status of the family-based adolescent alcohol and drug treatment specialty by identifying and discussing research and clinical advances.

METHOD

Selective and interpretative literature review and analysis.

STUDY SELECTION

Controlled trials and mechanisms of change studies of family-based treatments for adolescent alcohol and drug misuse.

RESULTS

Clinical innovations of family-based treatments include development of detailed therapy, training/supervision, and adherence manuals. Different family-based treatments have been tested with success in controlled trials and process studies. Different versions of the same approach might vary on parameters such as treatment dose, setting, and client characteristics. Research advances include findings that engagement and retention rates for family-based treatments are superior to standard treatment engagement/retention methods. Also, in clinical trials in which they are compared with alternative interventions, in the majority of studies, family-based treatments produce superior and stable outcomes with significant decreases on target symptoms of alcohol and drug use, and related problems such as delinquency, school and family problems, and affiliation with substance abusing peers. Mechanisms of change studies support the theory basis of family-based treatments. For instance, improvements in family interaction patterns coincide with decreases in core target alcohol and drug misuse symptoms.

CONCLUSIONS

Once in the shadows of the adult substance abuse field, the adolescent substance abuse specialty has become a unique, clinically creative, and empirically-based area. Research and clinical advances of family-based treatments have implications for non-family-based interventions in the adolescent substance misuse treatment specialty.

The role of family-of-origin violence in men's marital violence perpetration

This paper presents overall transmission rates between family-of-origin violence and marital violence, as well as theoretical and empirical work on possible mechanisms of transmission. In identified samples, approximately 60% of the maritally violent men report family-of-origin violence, whereas slightly over 20% of the comparison group of maritally nonviolent men report family-of-origin violence. Modest associations between experiencing violence in the family of origin and marital violence are found in community samples and in studies with prospective and longitudinal designs. Variables that intervene in the association between family-of-origin violence and marital violence are reviewed, with a focus on personal characteristics such as antisocial personality, psychological distress, and attitudes condoning violence, as well as on contextual factors, such as marital problems and conflict resolution style. Variables associated with nonviolence in men who grew up in violent families also are identified, including strong interpersonal connections and the ability to create psychological distance from the family-of-origin violence. Continued empirical investigation of variables that potentiate or mitigate the association between family-of-origin violence and marital violence at different developmental stages is needed to identify explanatory mechanisms and, ultimately, to interrupt the intergenerational transmission of marital violence.

Psychological factors in chronic pain: a worthwhile undertaking for nursing?

Chronic pain is one of the clearest examples of the complex relationship between the mind, body, spirit, and environment. After decades of research, a growing body of evidence supports the importance of certain psychological factors in the chronic pain experience. This article reviews research related to evaluating the role of depression, personality factors, pain-related beliefs, trauma, and coping style in the chronic pain experience. Understanding and using the findings of this research can improve nursing care of persons with chronic pain.

Expanding developmental and behavioral services for newborns in primary care: implications of the findings

BACKGROUND

In two other papers in this issue, the rationale, development, implementation, experimental design, approach to evaluation, and early results of a program to deliver developmental and behavioral services to all infants in primary care practice were described. Positive effects were seen for parental satisfaction, including decreased disenrollment, provider satisfaction, parenting practices, and health outcomes.

METHODS

In the present article, the results are reviewed and implications of our findings for the delivery of care, families, healthcare systems, and further research are discussed.

RESULTS

Findings that have broad implications are as follows: (1) developmental and behavioral services can be delivered successfully in practice using dedicated professionals to deliver and integrate services; (2) the "planned care model" was useful in program implementation for making "the right thing to do, the easy thing to do"; (3) the added focus on satisfaction and cost helps to develop the "business case" for broad scale implementation; (4) bonding of parents to organizations has marketing implications; (5) the program provides positive effects for all parents, not just high-risk parents; and (6) several research questions emerge, including persistence of effects on health outcomes, costs, and utilization.

CONCLUSIONS

The authors conclude that study results have implications for preventive services, families, child healthcare in office practice, healthcare systems, and healthcare policy. In this ongoing study, examination of intervention effects at 30 months of age shoud be informative. Further research is warranted as it remains to be seen whether or not these interventions can become viable ongoing programs.

Spanking in early childhood and later behavior problems: a prospective study of infants and young toddlers

OBJECTIVE

To explore the relationship of spanking frequency before age 2 with behavior problems near time of entry into school.

METHODS

Children who were younger than 2 years were followed up approximately 4 years later, after they had entered school. The likelihood of significant behavior problems at follow-up was estimated in multivariate analyses that controlled for baseline spanking frequency and other characteristics. Participants were mothers from a large-scale national study and their children. Statistical analysis included an ethnically diverse sample of 1966 children aged 0 to 23 months at baseline. Two dichotomous indicators of behavior problems were used. The first indicated that maternal rating of child behavior problems exceeded a threshold. The second indicated that a mother met with a school administrator to discuss her child's behavior problems.

RESULTS

White non-Hispanic children who were spanked more frequently before age 2 were substantially more likely to have behavior problems after entry into school, controlling for other factors. For Hispanic and black children, associations between spanking frequency and behavior problems were not statistically significant and were not consistent across outcome measures.

CONCLUSION

Among white non-Hispanic children but not among black and Hispanic children, spanking frequency before age 2 is significantly and positively associated with child behavior problems at school age. These findings are consistent with those reported in studies of children older than 2 years but extend these findings to children who are spanked beginning at a relatively early age.

Contribution of adolescent and early adult personality to the inverse association between education and cardiovascular risk behaviours: prospective population-based cohort study

BACKGROUND

The role of early personality in socioeconomic inequalities in health is not well understood. We investigated the extent to which type A components in adolescence and early adulthood contributed to the inverse association between education and behavioural cardiovascular disease risk factors in adulthood.

METHODS

Prospective cohort study with a population-based random sample of 477 men and 648 women, aged 12-21 years at baseline. Baseline data included information on pathogenic and protective components of type A behaviours (impatience, aggression, hard-driving, and engagement-involvement) and parental education. The 9-year follow-up data included information on the participant's educational level and health behaviours (smoking, alcohol consumption, physical inactivity, butter use).

RESULTS

After adjustment for parental education, high levels of impatience and low levels of hard-driving in adolescence and early adulthood predicted low educational level in adulthood (Ps < 0.01 for men, Ps < 0.001 for women). Adulthood education was inversely associated with smoking in women and men (odds ratios [OR] = 8.5 and 7.9, 95% CI: 3.4-18.4 and 3.1-23.9, respectively), and with physical inactivity in women (OR = 5.4, 95% CI: 2.6-11.4). In men, components of type A behaviour explained 28.5% of the inverse association between education and smoking, even after controlling for parental education. In women, the corresponding proportions were 20.5% and 17.7% for smoking and physical inactivity, respectively.

CONCLUSIONS

The inverse associations of adulthood education with smoking in men and women and physical inactivity in women may be partly rooted in personality-related factors present earlier in life. Our evidence suggests that personality should be studied as a potential contributor to socioeconomic differences in health behaviours.

Childhood abuse and neglect histories in low-income women: prevalence in a menopausal population

OBJECTIVES

To examine the prevalence of self-reported childhood abuse and neglect in a primary care population of menopausal women.

DESIGN

A cross-sectional questionnaire-based study.

RESULTS

Three of four women (119/160, 74%) reported histories of childhood abuse and neglect. The prevalence of emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect were 43%, 35%, 33%, 49%, and 44%, respectively. Eleven percent of the sample reported maltreatment in all five categories of trauma. Fifteen percent of women studied met criteria for severe-extreme levels of maltreatment, usually in more than one category.

CONCLUSIONS

A high prevalence of self-reported childhood trauma was detected in our low-income population of menopausal women attending primary care clinics. Because of the potential impact of childhood trauma on physical and mental health, clinicians need to inquire about childhood maltreatment in women of menopausal age and appropriately refer women to mental health intervention and treatment.

Early life influences on life-long patterns of behavior and health

The stability of a child's early life has profound effects on physical and mental health, and unstable parent-child relationships, as well as abuse, can lead to behavioral disorders and increased mortality and morbidity from a wide variety of common diseases later in life. One common consequence, namely, depressive illness, is associated with chemical imbalances in the brain and hormonal dysregulation, constituting a form of allostatic load that alters interpretations of stimuli and influences, behavioral, and hormonal responses to potentially stressful situations. The brain not only encodes information and controls the behavioral responses but it is also changed structurally by those experiences. Structural changes in the hippocampus and amygdala, which are important brain structures for cognition and emotion, are representative of what may be occurring throughout the brain as a result of allostatic load resulting from the chronic stress of a disorder such as depression. Such structural changes include dendritic debranching and hypertrophy, cell proliferation, and synaptic remodeling; they are produced by the combined overactivity of stress hormones and endogenous neurotransmitters. These mediators are normally involved in adaptation, but can also promote damage when they are dysregulated and over-active. They are very likely to be strongly biased by early life experiences. The findings from animal models thus provide a basis for understanding potential mechanisms of environmental and developmental determinants of individual differences in human stress reactivity, as well as anxiety, depression, and a host of related systemic disorders. There is an increasing amount of translational research that is beginning to tie the basic research to clinical outcomes of individuals exposed to abusive or inconsistent care-giving in early life. A major goal of studies on this important topic is to define times in development and strategies for intervening to prevent or reverse the effects of adverse early life experiences. Although prevention is clearly the preferable route, some degree of reversal of psychopathology and pathophysiology caused by early life adversity appears to be an achievable goal.

Adolescent Preventive Health and Teams-Games-Tournaments

The problematic behaviors of teenagers and the subsequent negative consequences are extensive and well documented: unwanted pregnancy, substance abuse, violent behavior, depression, and social and psychological consequences of unemployment. In this article the authors review an approach that uses a cooperative learning, empirically-based intervention that employs peers as teachers. This intervention of choice is Teams-Games-Tournaments (TGT), a paradigm backed by four decades of empirical support. The application of TGT in preventive health programs incorporates elements in common with other prevention programs that are based on a public health orientation and comprise the essential components of health education, that is skills training and practice in applying skills. The Teams-Games-Tournaments intervention supports the idea that children and adolescents from various socioeconomic classes, between the ages of 8 to 18, in classrooms or groups ranging in size from 4 to 17 members, can work together effectively in cooperative instructional situations where group members serve as teachers for one another. Teams-Games-Tournaments has been applied successfully in such diverse areas as adolescent development, sexuality education, psychoactive substance use, anger control, coping with depression and suicide, nutrition, comprehensive employment preparation, and family intervention. This article reviews the extensive research on TGT using examples of successful projects in substance abuse and nutrition. Issues are raised that relate to the implementation of preventive health strategies for adolescents, including cognitive aspects, social and family networks, and intervention components.

Prophecies of childhood: how children's social environments and biological propensities affect the health of populations

During the past decade, important steps have been taken globally to improve the status of children. Concurrently, significant advances have been made toward understanding how child development is shaped by transactions between biological and environmental influences. Despite such advances, ongoing adversities in the lives of children worldwide undermine the development of individuals and thus the health of nations. The primary tenets of this paper are that: children continue to suffer a disproportionate share of the world's adversities; exposure to early adversities is not only associated with increased morbidity during childhood, but also across the lifespan; and recent advances in understanding the operation and ontogeny of stress-response systems can help explain how adversity is translated into lifelong effects on health. Acknowledging the long-lasting sequelae of childhood adversity has important implications for public health and society.

Beyond abuse: the association among parenting style, abdominal pain, and somatization in IBS patients

This study assessed the relative strength of the association between abuse, negative parenting style, and somatization in irritable bowel syndrome (IBS) patients. Drawing from preclinical stress physiology and abuse research identifying the family social climate as a frequently stronger and independent determinant of long-term health effects than abuse-specific variables, we predicted that negative parenting behaviors would more strongly correlate with somatization than abuse. Subjects were 81 consecutively evaluated patients, who at baseline underwent psychological testing, measuring perceived parental style, abuse history, somatization, and pain. Although abuse correlated with maternal and paternal rejection, abuse was not associated with somatization. Higher levels of rejection and/or hostility among fathers (not mothers) were more strongly correlated with somatization than was abuse. Further, paternal parenting behaviors were more predictive of somatization than abuse, age, and gender. The lack of an association between abuse and somatization is discussed in light of limitations of biopsychosocial IBS models, whose strong focus on "pathological stressors" (e.g., abuse, trauma) as risk factors may overlook the importance of "less extreme" parenting variables in influencing somatic complaints. The relationship between parenting and somatization is discussed in the context of broader behavioral science research linking disruptions in the quality of parenting to dramatic and long-term changes in patterns of stress reactivity and brain abnormalities seen in IBS patients.

Evolutionary perspectives on pregnancy: maternal age at menarche and infant birth weight

We present a novel evolutionary analysis of low birth weight (LBW). LBW is a well-known risk factor for increased infant morbidity and mortality. Its causes, however, remain obscure and there is a vital need for new approaches. Life history theory, the most dynamic branch of evolutionary ecology, provides important insights into the potential role of LBW in human reproductive strategies. Life history theory's primary rationale for LBW is the trade-off between current and future reproduction. This trade-off underlies the prediction that under conditions of environmental risk and uncertainty (experienced subjectively as psychosocial stress) it can be evolutionarily adaptive to reproduce at a young age. One component of early reproduction is early menarche. Early reproduction tends to maximise offspring quantity, but parental investment theory's assumption of a quantity-quality trade-off holds that maximizing offspring quantity reduces quality, of which LBW may be the major component. We therefore predict that women who experienced early psychosocial stress and had early menarche are more likely to produce LBW babies. Furthermore, the extension of parent-offspring conflict theory in utero suggests that the fetus will attempt to resist its mother's efforts to reduce its resources, allocating more of what it does receive to the placenta in order to extract more maternal resources to increase its own quality. We propose that LBW babies born to mothers who experience early psychosocial stress and have early menarche are more likely to have a higher placental/fetal weight ratio. We review evidence in support of these hypotheses and discuss the implications for public health.

A multimethodological analysis of cumulative risk and allostatic load among rural children

This study merged two theoretical constructs: cumulative risk and allostatic load. Physical (crowding, noise, housing quality) and psychosocial (child separation, turmoil, violence) aspects of the home environment and personal characteristics (poverty, single parenthood, maternal highschool dropout status) were modeled in a cumulative risk heuristic. Elevated cumulative risk was associated with heightened cardiovascular and neuroendocrine parameters, increased deposition of body fat, and a higher summary index of total allostatic load. Previous findings that children who face more cumulative risk have greater psychological distress were replicated among a sample of rural children and shown to generalize to lower perceptions of self-worth. Prior cumulative risk research was further extended through demonstration of self-regulatory behavior problems and elevated learned helplessness.

Male-perpetrated violence among Vietnam veteran couples: relationships with veteran's early life characteristics, trauma history, and PTSD symptomatology

Using structural equation modeling, we examined the impact of early-life stressors, war-zone stressors, and PTSD symptom severity on partner's reports of recent male-perpetrated intimate partner violence (IPV) among 376 Vietnam veteran couples. Results indicated that several variables demonstrated direct relationships with IPV, including relationship quality with mother, war-zone stressor variables, and PTSD symptom severity. Importantly, retrospective reports of a stressful early family life, childhood antisocial behavior, and war-zone stressors were indirectly associated with IPV via PTSD. One of our 2 war-zone stressor variables, perceived threat, had both direct and indirect (through PTSD) relationships with IPV. Experiencing PTSD symptoms as a result of previous trauma appears to increase an individual's risk for perpetrating IPV. Implications for research and treatment are discussed.

Social modulation of stress responses

Social interactions can profoundly affect the hypothalamic-pituitary-adrenal (HPA) axis. Although most research on social modulation of glucocorticoid concentrations has focused on the consequences of exposure to stressful social stimuli, there is a growing body of literature which suggests that social support in humans and affiliative behaviors in some animals can provide a buffer against stress and have a positive impact on measures of health and well-being. This review will compare HPA axis activity among individuals for whom social relationships are maintained through aggressive displays, such as dominance hierarchies, vs. individuals engaging in high levels of prosocial behavior. We also will examine oxytocin, a neuropeptide that is well known for promoting social behavior, as the physiological link between positive social interactions and suppression of the HPA axis. Despite many examples of social interaction modulating the HPA axis and improving health outcomes, there is relatively little known regarding the underlying mechanisms through which social behavior can provide a buffer against stress-related disease.

Evaluation of what parents know about their children's drug use and how they perceive the most common family risk factors

Research on family risk factors for addictive behaviors in young people has not paid a great deal of attention to parents' knowledge of their children's addictive behaviors and of the family risk factors that affect such behaviors. The aim of this work is to compare knowledge about these two aspects in two groups of parents that differ regarding their children's declared drug use. The research was carried out with a sample of 309 schoolchildren and their families, divided into two groups: one of 154 families with children defined as non-Drug Users and another of 155 families with children defined as Drug Users. The results show that parents with children who consume drugs tend to strongly underestimate their children's use. Moreover, they overestimate the control they exercise over them and appear to be more familiarized with the use of drugs, if we compare them with parents of non-Drug Users. It is suggested that these results may be relevant for the planning of strategies that increase motivation in families with drug-risk children to participate in prevention programs.

Child-rearing attitudes and cardiovascular risk among children: moderating influence of parental socioeconomic status

BACKGROUND

We examined associations of parental socioeconomic status (SES) and hostile maternal child-rearing attitudes with the insulin resistance syndrome (IRS) precursors in children.

METHODS

The participants were 210 randomly selected healthy boys and girls who participated in the epidemiological Cardiovascular Risk in Young Finns study and who were 3, 6, and 9 years of age at the three study phases. Hostile maternal child-rearing attitudes were self-rated by the mothers. SES consisted of the years of education of the parents and family income. The IRS comprised serum insulin, high-density lipoprotein cholesterol, triglycerides, systolic blood pressure, and body mass index.

RESULTS

Among boys, low parental SES and strict maternal discipline were associated with heightened somatic risk. Among girls, parental SES moderated the association between maternal child-rearing attitudes and somatic risk so that belonging to a high-SES family seemed to protect the girls against the adverse health effects of hostile mothering.

CONCLUSIONS

The findings indicate that the psychosocial environment is differentially related to girls' and boys' somatic risk. It is concluded that belonging to high social class may buffer against childhood stress, while belonging to low social class may enhance vulnerability to stressors in childhood.

Life course health development: an integrated framework for developing health, policy, and research

The life course health development (LCHD) framework organizes research from several fields into a conceptual approach explaining how individual and population health develops and how developmental trajectories are determined by interactions between biological and environmental factors during the lifetime. This approach thus provides a construct for interpreting how people's experiences in the early years of life influence later health conditions and functional status. By focusing on the relationship between experiences and the biology of development, the LCHD framework offers a better understanding of how diseases occur. By suggesting new strategies for health measurement, service delivery, and research, as well as for improving health outcomes, this framework also supports health care-purchasing strategies to develop health throughout life and to build human health capital.

Social relationships, gender, and allostatic load across two age cohorts

OBJECTIVE

This article addresses the question of biological pathways through which social integration and support may affect morbidity and mortality risks. A new concept of cumulative biological risk, allostatic load, is used to test the hypothesis that social experiences affect a range of biological systems. Data from two community-based cohorts are examined to evaluate the consistency of findings across two different age groups.

METHODS

One cohort included older adults aged 70 to 79 years (N = 765); the other cohort included persons aged 58 to 59 years (N = 106). Allostatic load was assessed using identical protocols in the two cohorts. Measures of social experience were similar but not identical, reflecting levels of social integration and support for the older cohort vs. childhood and adult experiences of loving/caring relationships with parents and spouse for the younger cohort. Gender-specific analyses were examined to evaluate possible gender differences in patterns of association.

RESULTS

In the younger cohort, positive cumulative relationship experiences were associated with lower allostatic load for men and women. In the older cohort, men who were more socially integrated and those reporting more frequent emotional support from others had lower allostatic load scores; similar but nonsignificant associations were seen for women.

CONCLUSIONS

Evidence from two cohorts provides support for the hypothesis that positive social experiences are associated with lower allostatic load. These findings are consistent with the hypothesis that social experiences affect a range of biological systems, resulting in cumulative differences in risks that in turn may affect a range of health outcomes.