Understanding the association between socioeconomic status and physical health: do negative emotions play a role?

The Intrapsychic Psychological Binds of Poverty and Race: The Intersection of Mind and Milieu

Race and poverty are poignant factors in how individuals and communities experience the world. The reality is that more people of color than White people live in poverty (Milner, 2013). How these inequalities intersect with the mind and environment is of compelling importance. The experiences of race and living in poverty are riddled with innumerable stressors and barriers, and as a result are subject to the experience of a range of mental health issues. Those that live the experience of trauma related to race and poverty suffer disproportionately from a host of hardships that contribute to psychological distress that can have a profound effect on mental health and serve as intrapsychic binds. These internalized weights require therapeutic supports to alleviate the internal oppressive circumstances by those that are immersed in the experience on a daily basis. This article explores the intersection of these psychological binds and their effect on human behavior.

Socio-economic trajectories and cardiovascular disease mortality in older people: the English Longitudinal Study of Ageing

Background

Socio-economic status from early life has been linked to cardiovascular disease risk, but the impact of life-course socio-economic trajectories, as well as the mechanisms underlying social inequalities in cardiovascular disease risk, is uncertain.

Objectives

We assessed the role of behavioural, psychosocial and physiological (including inflammatory) factors in the association between life-course socio-economic status and cardiovascular disease mortality in older adults.

Methods

Participants were 7846 individuals (44% women) from the English Longitudinal Study of Ageing, a representative study of individuals aged ≥ 50 years, established in 2002-03. Comprising four indicators of socio-economic status (father's social class, own education, occupational position and wealth), we computed an index of socio-economic trajectory and a lifetime cumulative socio-economic score. Behavioural (smoking, physical activity, alcohol consumption, body mass index) and psychosocial (social relations, loneliness) factors, physiological (blood pressure, total cholesterol, triglycerides) and inflammatory markers (C-reactive protein, fibrinogen), measured repeatedly over time, were potential explanatory variables. Cardiovascular disease mortality was ascertained by linkage of study members to a national mortality register. Mediation was calculated using the traditional 'change-in-estimate method' and alternative approaches such as counterfactual mediation modelling could not be applied in this context.

Results

During the 8.4-year follow-up, 1301 study members died (438 from cardiovascular disease). A stable low-social-class trajectory was associated with around double the risk of cardiovascular disease mortality (hazard ratio; 95% confidence interval: 1.94, 1.37; 2.75) compared with a stable high social class across the life course. Individuals in the lowest relative to the highest life-course cumulative socio-economic status group were also more than twice as likely to die of cardiovascular disease (2.57, 1.81; 3.65). Behavioural factors and inflammatory markers contributed most to explaining this gradient, whereas the role of psychosocial and other physiological risk factors was modest.

Conclusions

In a population-based cohort of older individuals living in England, we provide evidence that disadvantage across the life course is linked to cardiovascular mortality. That behavioural factors and inflammatory markers partially explain this gradient may provide insights into the potential for intervention.

Racial discrimination, educational attainment, and biological dysregulation among midlife African American women

OBJECTIVE

To examine the association between self-reported racial discrimination and allostatic load, and whether the association differs by socioeconomic position.

METHODS

We recruited a purposive cross-section of midlife (ages 30-50) African American women residing in four San Francisco Bay area counties (n = 208). Racial discrimination was measured using the Experience of Discrimination scale. Allostatic load was measured as a composite of 15 biomarkers assessing cardiometabolic, neuroendocrine, and inflammatory activity. We calculated four composite measures of allostatic load and three system-specific measures of biological dysregulation. Multivariable regression was used to examine associations, while adjusting for relevant confounders.

RESULTS

In the high education group, reporting low (b = -1.09, P = .02, 95% CI = -1.99, -0.18) and very high (b = -1.88, P = .003, 95% CI = -3.11, -0.65) discrimination was associated with lower allostatic load (reference=moderate). Among those with lower education, reporting low (b = 2.05, P = .008, 95% CI = 0.55,3.56) discrimination was associated with higher allostatic load. Similar but less consistent associations were found for poverty status. Associations were similar for cardiometabolic functioning, but not for neuroendocrine or inflammatory activity.

CONCLUSIONS

Racial discrimination may be an important predictor of cumulative physiologic dysregulation. Factors associated with educational attainment may mitigate this association for African American women and other groups experiencing chronic social stress.

Resilience attenuates the association between neurocognitive functioning and everyday functioning in individuals aging with HIV in the Deep South

OBJECTIVES

Adults aging with HIV are at risk for poorer neurocognitive and daily functioning. Identifying factors to protect such outcomes is a significant research priority. The aim of this study was to explore the role of resilience in cognitive and everyday functioning in a largely African American and low socioeconomic status sample of adults and older adults with HIV in the Deep South.

METHODS/DESIGN

In this cross-sectional study 100 HIV+ middle-aged and older adults (range 40-73; 61% aged 50+) completed a comprehensive neurocognitive battery along with self-reported measures of resilience and everyday functioning.

RESULTS

Higher resilience was associated with better global neurocognitive functioning (rho = 0.31, P < 0.01), as well as better functioning in all domains (verbal fluency, executive functioning, speed of information processing, learning, working memory) except recall and motor skills. Resilience was also significantly associated with instrumental activities of daily living (IADL) dependence, with lower resilience observed in those with IADL dependence compared with those who were IADL independent (P < 0.01). In a multiple regression adjusting for data-driven covariates (verbal IQ, income, depression), and global neurocognitive impairment, resilience was the only significant (P = 0.02) correlate of IADL dependence. A follow-up mediation showed that the direct relationship between neurocognitive functioning and IADL declines was fully attenuated after accounting for shared variance with resilience.

CONCLUSIONS

Resilience is associated with better cognitive and functional outcomes in people aging with HIV. While further work is needed to understand these associations over time, results suggest interventions to build resilience may promote successful aging in this vulnerable population.

Psychosocial Correlates of Frailty Among HIV-Infected and HIV-Uninfected Adults

Frailty is a geriatric condition characterized by increased vulnerability to physical impairments and limitations that may lead to disabilities and mortality. Although studies in the general population suggest that psychosocial factors affect frailty, less is known about whether similar associations exist among people living with HIV (PLWH). The purpose of this study was to examine psychosocial correlates of frailty among PLWH and HIV-uninfected adults. Our sample included 127 adults (51% PLWH) participating in the Multi-Dimensional Successful Aging among HIV-Infected Adults study at the University of California San Diego (average age 51 years, 80% male, 53% White). Frailty was assessed via the Fried Frailty Index. Psychosocial variables significant in bivariate models were included in principal component analysis to generate factor variables summarizing psychosocial correlates. Multivariate logistic regression models were fit to examine the independent effects of factor variables and their interaction terms with HIV status. In bivariate models, frailty was associated with multiple psychosocial variables, for example, grit, optimism, personal mastery, social support, emotional support. Factor analysis revealed that psychosocial variables loaded on two factors-Positive Resources/Outlook and Support by Others. The multivariate model showed significant main effects of Support by Others and HIV status, and interactive effects HIV X Positive Resources/Outlook, such that Positive Resources/Outlook was negatively associated with frailty for PLWH but not for HIV-uninfected individuals. These analyses indicate that psychosocial factors may be associated with frailty among PLWH. Positive resources and outlook may play a role in frailty prevention. Future longitudinal studies are needed to establish causal links.

Sedentary behaviour and risk of anxiety: A systematic review and meta-analysis

OBJECTIVE

This research synthesis sought to determine the magnitude of the association between sedentary behaviour (sitting time) and anxiety.

EVIDENCE ACQUISITION

A comprehensive literature search of eight electronic databases (and a manual search) identified 13 observational studies that met inclusion criteria (22 effect sizes; total n = 70,425). Pooled mean effects were computed using inverse-variance weighted random effects meta-analysis and moderation by study and population characteristics were tested using random effects meta-regression.

EVIDENCE SYNTHESIS

Sedentary behaviour was associated with an increased risk of anxiety for non-adjusted effect sizes (k = 7, OR = 1.33 [95% CI: 1.14, 1.55]) and effect sizes adjusted for sociodemographic and health-related factors (k = 11, OR = 1.48 [95% CI: 1.25, 1.75]). There was no evidence of publication bias in the results. The regression models showed that effect sizes were not moderated by age or gender. However, there was some evidence of moderation by study quality and measurement of sedentary behaviour and anxiety. Measures of sitting time showed larger associations than measures of screen time, and measures of anxiety symptoms showed larger associations than measures of anxiety disorders.

CONCLUSION

The research synthesis provides evidence that sedentary behaviour has a small positive association with anxiety, after controlling for sociodemographic and other health-related factors. Study limitations include low statistical power in meta-regression models and heterogeneity in measures of anxiety and sedentary behaviour. Findings might be of interest to health care professionals developing health care initiatives to reduce risk of anxiety.

Examining the Relationship Between Undergraduate Student Parent Social Support-Seeking Factors, Stress, and Somatic Symptoms: A Two-Model Comparison of Direct and Indirect Effects

Approximately 4.8 million undergraduate students are also raising at least one child but only 26% of these student parents will graduate within six years. This study aimed to examine how academic and parenting stress influence the relationship between support-seeking factors (i.e., the costs of seeking support and communicated support availability) and somatic health symptoms such as headaches, sleep disruption, and exercise. Two parallel mediation models (n = 185 undergraduate student parents) are compared and revealed strong patterns of indirect effects. Intrapersonal and interpersonal costs indirectly influenced somatic symptoms through academic and parenting stress. Stress also mediated the relationship between support seeking factors and somatic symptoms. Theoretical implications and practical applications are discussed.

Race, Education Attainment, and Happiness in the United States

BACKGROUND AND OBJECTIVES

As suggests by the Minorities' Diminished Returns (MDR) theory, education attainment and other socioeconomic status (SES) indicators have a smaller impact on the health and well-being of non-White than White Americans. To test whether MDR also applies to happiness, in the present study, Blacks and Whites were compared in terms of the effect of education attainment on the level of happiness among American adults.

METHODS

General Social Survey (1972-2016) is a series of national surveys that are performed in the United States. The current analysis included 54,785 adults (46,724 Whites and 8,061 Blacks). The years of schooling (i.e., education attainment) and happiness were the main independent variable and the main dependent variable of interest, respectively. In addition, other parameters such as gender, age, employment status, marital status, and the year of the survey were the covariates and race was the focal effect modifier. Finally, the logistic regression model was used to analyze the data.

RESULTS

Based on the results, high education attainment was associated with higher odds of happiness in the pooled sample. Further, a significant interaction was found between race and education attainment on the odds of happiness, showing a larger gain for Whites compared to Blacks. Race-specific models also confirmed this finding (i.e., a larger magnitude of the effect of education for Whites compared to Blacks).

CONCLUSION

Overall, the MDR theory also applies to the effect of education attainment on happiness. Blacks' disadvantage in comparison to the Whites in gaining happiness from their education may be due to the structural, institutional, and interpersonal racism and discrimination in the US. Therefore, there is a need for economic and public policies that can minimize the Blacks' diminished returns of education attainment and other SES resources.

Objective and subjective financial status and mortality among older adults in China

The association between financial status and mortality in older adults is well documented. However, it is unclear whether the association may vary by objective and subjective indicators of financial status. To examine this issue, we used the latest four waves (2005, 2008/2009, 2011/2012, and 2014) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) of community-residing adults aged 65 and older (n = 25,954). Financial status was assessed using eight objective, subjective, and culturally-oriented measures to capture various dimensions of financial resources at older ages. Multivariate hazard models were used to examine how different indicators of financial status were associated with subsequent mortality in all older adults and by age, gender, and urban-rural residence. Results showed that higher financial status-either objective or subjective-was associated with lower risks of mortality. Subjective assessments of financial status had stronger associations with mortality than objective assessments. The patterns were generally similar between young-old (aged 65-79) and the oldest-old (aged 80+), between women and men, and between rural and urban areas. Together, the findings offer new evidence to help improve the socioeconomic gradient in mortality among older adults in China.

Assessing hostility in patients with chronic obstructive pulmonary disease (COPD)

COPD is a disease that can adversely affect patients' psychology. The purpose of this study is to investigate whether COPD patients feel increased hostility, and if hostility is associated with socio-economic factors. A cross-sectional study was conducted in 203 COPD patients in primary health care services in Greece, using the hostility and direction of hostility questionnaire HDHQ. Patient demographics, smoking habits, body mass index (BMI) and disease grade were also recorded. The results showed significant differences between males and females, with women exhibiting higher hostility (p = 0.004). Age correlates negatively with hostility, with younger patients showing higher values. Patients who continue to smoke (p = 0.005), and those in a very poor financial situation, have a much higher level of hostility. Regarding family status, married patients show the least hostility. In patients with very severe COPD and those with low education (p = 0.035) there is a high level of self-criticism. In conclusion, patients with COPD, still smokers, single, low-income and low-educated, especially female patients, have a higher risk of developing hostility. These findings suggest a need for further research in order to clarify the complexity of the different risk factors.

The impact of personal relative deprivation on aggression over time

Being at a disadvantage and perceiving this predicament to be unfair are at the core of the experience of personal relative deprivation. Previous research has shown that personal relative deprivation is associated with interpersonal aggression. The present longitudinal study extended these investigations by examining the impact of personal relative deprivation on aggression over time. In fact, personal relative deprivation at Time 1 was associated with reported aggression at Time 2 even when controlling for the impact of aggression at Time 1. As a secondary goal, we aimed to show that the effect of personal relative deprivation (i.e., increased aggression) may spread through the participant's social network. Egocentric networking data showed that individuals who perceive their friends as being personally deprived are more aggressive and that this relationship statistically holds when taking the individual's level of personal relative deprivation into account. Limitations of this approach are discussed.

Reprint of: Positive Psychological Well-Being and Cardiovascular Disease: JACC Health Promotion Series

Facets of positive psychological well-being, such as optimism, have been identified as positive health assets because they are prospectively associated with the 7 metrics of cardiovascular health (CVH) and improved outcomes related to cardiovascular disease. Connections between psychological well-being and cardiovascular conditions may be mediated through biological, behavioral, and psychosocial pathways. Individual-level interventions, such as mindfulness-based programs and positive psychological interventions, have shown promise for modifying psychological well-being. Further, workplaces are using well-being-focused interventions to promote employee CVH, and these interventions represent a potential model for expanding psychological well-being programs to communities and societies. Given the relevance of psychological well-being to promoting CVH, this review outlines clinical recommendations to assess and promote well-being in encounters with patients. Finally, a research agenda is proposed. Additional prospective observational studies are needed to understand mechanisms underlying the connection between psychological well-being and cardiovascular outcomes. Moreover, rigorous intervention trials are needed to assess whether psychological well-being-promoting programs can improve cardiovascular outcomes.

Social Stratification and Risk for Cardiovascular Disease: Examination of Emotional Suppression as a Pathway to Risk

This article examines whether emotional suppression is associated with socioeconomic position (SEP) in a community sample of Black and White men, and whether emotional suppression may help explain the aggregation of multiple biopsychosocial risk factors for cardiovascular disease at lower SEP (social support, depression, cardiovascular stress reactivity). Aim 1 tests whether multiple indicators of SEP show a consistent graded association with self-reported trait suppression, and whether suppression mediates associations between SEP and perceived social support and depressive affect. Aim 2 tests whether suppression during a laboratory anger recall task mediates associations between SEP and cardiovascular reactivity to the task. All measures of higher SEP were associated with lower suppression. Findings in this racially diverse sample of adult men suggest that socioeconomic disparities in emotional suppression may be more likely to confer cardiovascular risk through disruption of affect and social relationships, than through direct and immediate physiological pathways.

Pathways linking childhood abuse history and current socioeconomic status to inflammation during pregnancy

Women who have experienced significant adversities during childhood and adulthood are at risk for excessive inflammation during pregnancy, but the mechanisms are unclear. Using structural equation modeling, we examined pathways from childhood abuse history and current socioeconomic status (SES) to inflammatory markers through indicators of health risk, recent stressors, and psychological distress in 214 women assessed at mid-pregnancy (5-31 weeks gestation). Self-reported data on socioeconomic indicators, childhood trauma history, pre-pregnancy body mass index (BMI), smoking, sleep quality, interpersonal conflict, recent life events, perceived stress, and depressive symptoms were collected, and serum levels of C-reactive protein (CRP) and interleukin (IL)-6 were determined. In separate models, pre-pregnancy BMI, sleep quality, and interpersonal conflict statistically explained the relationship between adversity and inflammation. These three intermediate variables were then entered into a multiple mediation analysis to examine unique effects. Childhood abuse history and current SES both demonstrated significant indirect effects on CRP through pre-pregnancy BMI, and current SES showed a significant indirect effect on IL-6 through all intermediate variables. When examining each indirect pathway individually, pre-pregnancy BMI and interpersonal conflict emerged as parallel pathways by which low current SES leads to elevated IL-6; the indirect pathway through sleep quality was no longer significant. Pre-pregnancy BMI and interpersonal conflict are two independent mechanisms by which adversity is associated with increased inflammation during pregnancy. Women who have been exposed to significant adversity may be at particular risk for obesity, sleep disruption, and interpersonal conflict, with implications for immune dysregulation during pregnancy.

Do process simulations during episodic future thinking enhance the reduction of delay discounting for middle income participants and those living in poverty?

Two studies examined whether episodic future thinking (EFT; pre-experiencing future events) reduces discounting of future rewards (DD). No studies have investigated whether process simulations (i.e., simulating the process of executing a future event) amplify EFT's reduction of DD. Study 1 examined the effect of incorporating process simulations into EFT (N = 42, M _age = 43.27; 91% female, family income = $75,976) using a 2 × 2 factorial design with type of episodic thinking (process, nonprocess/general) and temporal perspective (EFT, episodic recent thinking) as between-subjects factors. Study 2 replicated Study 1 in a sample of adults living in poverty (N = 36; M _age = 38.44, 88% female; family income = $25,625). The results of both studies showed EFT reduced DD, but process-oriented EFT did not amplify the effect of EFT. Our findings suggest the key ingredient in EFT's effect on DD is self-projection into the future. This was also the first study to show EFT improves DD in a sample living in poverty.

PTSD and the influence of context: The self as a social mirror

The principal accepted models of posttraumatic stress disorder (PTSD) are based on both memory processing and biological/brain changes occurring when one's life or well-being is threatened. It is our thesis that these models would be greatly informed by community studies indicating that PTSD is predicted to a greater extent by earlier life experience and experiences that occur distant from the threatening event. These findings suggest posttraumatic responding is best conceptualized through the lens of the self-in-context, as opposed to imprinting that results from a given event at a given time. Moreover, studies of non-Western populations often do not express trauma as PTSD, or at least not primarily as PTSD, which argues against specific neural or memory encoding processes, but rather for a more plastic neural process that is shaped by experience and how the self develops in its cultural context, as a product of a broad array of experiences. We posit that fear and emotional conditioning as well as the ways traumas are encoded in memory are only partial explanatory mechanisms for trauma responding, and that issues of safety and harm, which are long term and developmental, are the common and principal underpinnings of the occurrence of posttraumatic distress, including PTSD.

The experience of deprivation: Does relative more than absolute status predict hostility?

The present research examined the causal effects of absolute and relative status on experienced deprivation and hostility. On the basis of the theory of relative deprivation, we reasoned that the subjective experience of being worse off than others is a better predictor for hostility than is the absolute level of how well‐off people are. Indeed, three experiments showed that relative more than absolute status has an impact on aggressive affect. That is, even when objective resources were high, people were more hostile when their resources compared negatively to others’ resources. Although no consistent direct effects were found for a measure of aggressive behaviour, mediation analyses suggest that relative but not absolute deprivation ultimately impacts aggressive behaviour via increased feelings of disadvantage and aggressive affect. The results emphasize the drastic consequences of the rising income inequality, irrespective of a nation's absolute wealth.

Taking rejection to heart: Associations between blood pressure and sensitivity to social pain

A reliable finding from the physical pain literature is that individuals with higher resting (i.e., tonic) blood pressure experience relatively less pain in response to nociceptive stimuli. Converging lines of evidence suggest that biological factors that influence the experience of physical pain may also relate to social pain. An open question, however, is whether higher blood pressure per se is a biological factor associated with lower sensitivity to social pain. This possible association was tested in three studies. Consistent with prior findings on physical pain, higher resting blood pressure was associated with lower self-reported sensitivity to social pain across individuals (Study 1 r = -.303, Study 2 r = -.262, -.246), even after adjusting for confounding factors related to blood pressure (Study 3 r = -.222). Findings suggest a previously unknown biological correlate of sensitivity to social pain, providing further evidence for possible shared substrates for physical and social pain.

Grit and Ambition are Associated with Better Neurocognitive and Everyday Functioning Among Adults Living with HIV

Grit and ambition are psychological factors that may protect neurocognitive function among persons living with HIV (PLWH). We examined associations between grit, ambition, premorbid verbal intellectual function, and current neurocognitive and everyday functioning among PLWH and persons without HIV (HIV-). 120 PLWH and 94 HIV- adults completed the Grit Scale (includes total score and consistency of interests and perseverance of effort subscales), ambition scale, and a comprehensive neurobehavioral battery. PLWH had lower grit scores than HIV- adults. The two groups did not differ on ambition. No relationship was observed between grit and cognition among HIV- adults. Among PLWH, however, higher perseverance of effort and more ambition was related to better global neurocognitive functioning, and higher grit, but not ambition, was related to independence in daily functioning. Longitudinal studies are needed to elucidate these relationships over time and examine whether grit or ambition have protective effects on cognitive outcomes among PLWH.

Public Housing on the Periphery: Vulnerable Residents and Depleted Resilience Reserves post-Hurricane Sandy

Hurricane Sandy was the greatest natural disaster to ever impact public housing residents in New York City. It affected approximately 80,000 residents in 400 buildings in 33 developments throughout the city. The storm left residents without power, heat, or running water, yet many chose not to evacuate. This qualitative study was conducted to understand the impact of Sandy among this socially, physically, and geographically vulnerable population. It is the first known study to examine the impact of disasters in high-rise, high-density public housing as a unique risk environment. Findings demonstrate (1) broad impacts to homes, health and access to resources, (2) complex evacuation decision-making, (3) varied sources of support in the response and recovery phases, and (4) lessons learned in preparedness. Results are contextualized within an original conceptual framework-"resilience reserve"-that explains the phenomenon of delayed recovery stemming from enactments of resilience to manage chronic hardship leaving vulnerable populations without the requisite capacity to take protective action when facing acute adversity. We discuss recommendations to establish and replenish the resilience reserve that include personal, institutional, and structural facets.

Emotion Classification Using a Tensorflow Generative Adversarial Network Implementation

The detection of human emotions has applicability in various domains such as assisted living, health monitoring, domestic appliance control, crowd behavior tracking real time, and emotional security. The paper proposes a new system for emotion classification based on a generative adversarial network (GAN) classifier. The generative adversarial networks have been widely used for generating realistic images, but the classification capabilities have been vaguely exploited. One of the main advantages is that by using the generator, we can extend our testing dataset and add more variety to each of the seven emotion classes we try to identify. Thus, the novelty of our study consists in increasing the number of classes from N to 2N (in the learning phase) by considering real and fake emotions. Facial key points are obtained from real and generated facial images, and vectors connecting them with the facial center of gravity are used by the discriminator to classify the image as one of the 14 classes of interest (real and fake for seven emotions). As another contribution, real images from different emotional classes are used in the generation process unlike the classical GAN approach which generates images from simple noise arrays. By using the proposed method, our system can classify emotions in facial images regardless of gender, race, ethnicity, age and face rotation. An accuracy of 75.2% was obtained on 7000 real images (14,000, also considering the generated images) from multiple combined facial datasets.

Positive Psychological Well-Being and Cardiovascular Disease: JACC Health Promotion Series

Facets of positive psychological well-being, such as optimism, have been identified as positive health assets because they are prospectively associated with the 7 metrics of cardiovascular health (CVH) and improved outcomes related to cardiovascular disease. Connections between psychological well-being and cardiovascular conditions may be mediated through biological, behavioral, and psychosocial pathways. Individual-level interventions, such as mindfulness-based programs and positive psychological interventions, have shown promise for modifying psychological well-being. Further, workplaces are using well-being-focused interventions to promote employee CVH, and these interventions represent a potential model for expanding psychological well-being programs to communities and societies. Given the relevance of psychological well-being to promoting CVH, this review outlines clinical recommendations to assess and promote well-being in encounters with patients. Finally, a research agenda is proposed. Additional prospective observational studies are needed to understand mechanisms underlying the connection between psychological well-being and cardiovascular outcomes. Moreover, rigorous intervention trials are needed to assess whether psychological well-being-promoting programs can improve cardiovascular outcomes.

Income as a moderator of psychological stress and nicotine dependence among adult smokers

BACKGROUND

Perceived stress and psychological distress are associated with more cigarette craving and withdrawal, higher nicotine dependence, and less success during quit attempts. Low income smokers have disproportionately higher rates of smoking and may be particularly vulnerable to the effects of stress on smoking dependence. The aim of the current study was to assess if lower income smokers have a stronger association between stress and nicotine dependence than higher income smokers.

METHODS

Data were obtained from the Pennsylvania Adult Smoking Study, which included 351 daily smokers. Subjects completed PhenX Toolkit and other self-report measures of socioeconomic factors, the 10-item Perceived Stress Scale, Kessler Psychological Distress Scale (K6), Fagerstrom Test for Nicotine Dependence (FTND), and the Hooked on Nicotine Checklist (HONC). Moderation analyses using linear regression examined income-related differences in the association between stress and nicotine dependence.

RESULTS

Income groups were categorized by an annual household income of $50,000 based on visual-inspection of scatter plots of income by nicotine dependence. Compared to higher income smokers, lower income smokers had significantly higher mean levels of nicotine dependence on the FTND [3.74 vs. 4.79, p < 0.001], perceived stress [15.63 vs. 17.95, p = 0.004], and psychological distress [5.30 vs. 6.86, p = 0.001], respectively. There were interaction effects, such that lower income smokers had a strong, positive associations between FTND and perceived stress (B = -0.11, CI = -0.17 to -0.04, p = 0.002) and psychological distress (B = -0.13, CI = -0.25 to -0.02, p = 0.022) whereas no association was found in higher income smokers. No significant moderation effects were found for the HONC or when income groups were categorized by U.S. federal poverty level.

CONCLUSIONS

The results highlight that the relationship between increasing stress and FTND was found in lower but not higher income groups. Future research should examine socioeconomic, environmental and psychosocial factors that may facilitate increased smoking during stress-induced craving.

Perceived discrimination and cardiovascular health disparities: a multisystem review and health neuroscience perspective

There are distinct racial disparities in cardiovascular disease (CVD) risk, with Black individuals at much greater risk than White individuals. Although many factors contribute to these disparities, recent attention has focused on the role of discrimination as a stress-related factor that contributes to racial disparities in CVD. As such, it is important to understand the mechanisms by which discrimination might affect CVD. Recent studies have examined these mechanisms by focusing on neurobiological mediators of CVD risk. Given this increase in studies, a systematic review of perceived discrimination and neurobiological mediators of CVD risk is warranted. Our review uses a multisystem approach to review studies on the relationship between perceived discrimination and (1) cardiovascular responses to stress, (2) hypothalamic-pituitary-adrenocortical axis function, and (3) the immune system, as well as (4) the brain systems thought to regulate these parameters of peripheral physiology. In addition to summarizing existing evidence, our review integrates these findings into a conceptual model describing multidirectional pathways linking perceived discrimination with a CVD risk.

Pathways between food insecurity and glycaemic control in individuals with type 2 diabetes

OBJECTIVE

Food insecurity is reported in approximately 28 % of individuals with diabetes in the USA and is associated with poor glycaemic and lipid control. The present study aimed to understand the direct and indirect pathways through which food insecurity impacts glycaemic control in individuals with diabetes.Design/Setting/SubjectsAdults (n 615) with type 2 diabetes completed validated questionnaires after recruitment from two primary care clinics. Structural equation modelling was used to investigate mechanisms through which food insecurity influences diabetes self-care behaviours and glycaemic control, including investigation into possible direct and indirect effects of perceived stress and social support.

RESULTS

The final model showed that higher food insecurity was directly significantly related to increased stress (r=0·14, P<0·001) and increased glycosylated Hb (r=0·66, P=0·03). Higher stress was significantly related to poorer self-care (r=-0·54, P<0·001) and lower social support (r=-0·41, P<0·001). There was no significant direct association between food insecurity and self-care, or between perceived stress and glycaemic control.

CONCLUSIONS

Food insecurity had both a direct effect on glycaemic control and an indirect effect on self-care through stress. The indirect pathway suggests that efforts to address stress may influence the ability of individuals to perform diabetes self-care behaviours. The direct effect on glycaemic control suggests that pathways independent of self-care behaviours may also be necessary to improve diabetes outcomes. Results from the study suggest a multipronged approach is necessary to address food insecurity in individuals with diabetes.

Promoting health equity to prevent crime

Traditionally, research activities aimed at diminishing health inequalities and preventing crime have been conducted in isolation, with relatively little cross-fertilization. We argue that moving forward, transdisciplinary collaborations that employ a life-course perspective constitute a productive approach to minimizing both health disparities and early delinquent involvement. Specifically, we propose a multidimensional framework that integrates findings on health disparities and crime across the early life-course and emphasizes the role of racial and socioeconomic disparities in health. Developing the empirical nexus between health disparities research and criminological research through this multidimensional framework could fruitfully direct and organize research that contributes to reductions in health inequalities and the prevention of crime during the early life course. We also propose that this unified approach can ultimately enhance public safety policies and attenuate the collateral consequences of incarceration.

Psychosocial Factors in the Relationship between Socioeconomic Status and Cardiometabolic Risk: the HCHS/SOL Sociocultural Ancillary Study

BACKGROUND

U.S. Hispanics/Latinos display a high prevalence of metabolic syndrome (MetSyn), a group of co-occurring cardiometabolic risk factors (abdominal obesity, impaired fasting glucose, dyslipidemia, elevated blood pressure) associated with higher cardiovascular disease and mortality risk. Low socioeconomic status (SES) is associated with higher risk for MetSyn in Hispanics/Latinos, and psychosocial factors may play a role in this relationship.

PURPOSE

This cross-sectional study examined psychosocial factors in the association of SES and MetSyn components in 4,996 Hispanic/Latino adults from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study.

METHODS

MetSyn components were measured at the baseline examination. Participants completed interviews to determine psychosocial risks (e.g., depression) and resources (e.g., social support) within 9 months of baseline (< 4 months in 72.6% of participants). Confirmatory factor analysis (CFA) and structural equation modeling (SEM) were used to identify latent constructs and examine associations.

RESULTS

Participant mean age was 41.7 years (SE = 0.4) and 62.7% were female. CFA identified single latent factors for SES and psychosocial indicators, and three factors for MetSyn [blood pressure, lipids, metabolic factors]. SEMs showed that lower SES was related to MetSyn factors indirectly through higher psychosocial risk/lower resources (Y-Bχ² (df = 420) = 4412.90, p < .05, RMSEA = .042, SRMR = .051). A statistically significant effect consistent with mediation was found from lower SES to higher metabolic risk (glucose/waist circumference) via psychosocial risk/resource variables (Mackinnon's 95% asymmetric CI = -0.13 to -0.02).

CONCLUSIONS

SES is related to metabolic variables indirectly through psychosocial factors in U.S. Hispanics/Latinos of diverse ancestries.

Emotional reserve and prolonged post-concussive symptoms and disability: a Swedish prospective 1-year mild traumatic brain injury cohort study

OBJECTIVE

Prolonged post-concussive symptoms (PCS) affect a significant minority of patients withmild traumatic brain injury (mTBI). The aetiology is multifactorial depending on preinjury as well as peri-injury and postinjury factors. In this study, we examine outcome from an emotional reserve perspective.

DESIGN

Prospective cohort study.

SETTING

Patients were recruited from three emergency departments in major university hospitals in Stockholm, Sweden. Follow-up data were collected in an outpatient setting at one of the recruiting hospitals.

PARTICIPANTS

122 patients with a history of blunt head trauma (aged 15-65 years; admitted for mTBI within 24 hours after trauma (Glasgow Coma Scale score of 14-15, loss of consciousness <30 min and/or post-traumatic amnesia <24 hours). Exclusion criteria were other significant physical injury and other major neurological disorder, including previous significant head injury.

PROCEDURE

Recruitment in three emergency departments. Initial assessments were made within 1 week after the injury. Patients were mailed the follow-up questionnaires 1 year postinjury.

OUTCOME MEASURES

A psychiatric assessment was performed at 1 week post injury. The participants also completed a personality inventory, measures of psychological resilience, depression, anxiety and post-traumatic symptoms. One-year outcome was measured by the Rivermead Post Concussion Symptoms and the Rivermead Head Injury Follow-Up questionnaires.

RESULTS

The psychiatric assessment revealed more symptoms of anxiety, depression and post-traumatic symptoms in the acute stage for patients who later developed PCS.After 1 year, 94 participants were still in the programme (male/female 57/37) and 12% matched the extended criteria for PCS (≥3 symptoms and ≥2 disabilities). PCS patients reported more preinjury and concurrent psychiatric problems, lower level of functioning before the injury and experienced more stress. They showed higher somatic trait anxiety, embitterment, mistrust and lower level of psychological resilience than recovered participants.

CONCLUSION

Intrapersonal emotional reserve shape the emergence and persistence of PCS after mTBI.

When anger expression might be beneficial for African Americans: The moderating role of chronic discrimination

OBJECTIVES

Anger expression is assumed to have mostly negative health effects. Yet, evidence is mixed on how anger expression influences African Americans' cardiovascular health. The present research aimed to clarify this link by examining moderating effects of chronic discrimination on the relationship between anger expression and cardiovascular risk among African Americans in experimental (Study 1) and epidemiological (Study 2) studies.

METHOD

Study 1 examined how African Americans' trait anger expression was linked to (a) physiologic reactivity to acute social rejection during an interracial encounter (Session 1); and (b) total/HDL cholesterol assessed two months later (Session 2). Study 2 examined the relationship between anger expression and total/HDL cholesterol with a larger sample of African Americans from the Midlife in the United States (MIDUS) survey. Both studies examined perceptions of chronic discrimination as a moderator of the relationships between anger expression and biological responses.

RESULTS

In Study 1 higher anger expression was associated with quicker cortisol recovery and greater testosterone reactivity following outgroup social rejection in Session 1 and lower total/HDL cholesterol in Session 2. Study 2 replicated the relationship between anger expression and lower total/HDL cholesterol and further showed that this relationship was unique to the expressive aspect of anger. Importantly, in both studies, these potentially beneficial effects of anger expression were only evident among individuals with lower perceptions of chronic discrimination.

CONCLUSIONS

These findings suggest that anger expression, when coupled with low levels of chronic discrimination, is associated with adaptive patterns of physiologic responses among African Americans. (PsycINFO Database Record

Education and Income Predict Future Emotional Well-Being of Whites but Not Blacks: A Ten-Year Cohort

BACKGROUND

The Minorities’ Diminished Return (MDR) theory is defined as systematically smaller effects of socioeconomic status (SES) on the health and well-being of minority groups when compared to Whites. To extend the existing literature on the MDR theory as applied to the change of mental well-being over time, we investigated Black-White differences in the effects of baseline education and income on subsequent changes in positive and negative affect over a ten-year period.

METHODS

The Midlife in the United States (MIDUS) is a 10-year longitudinal study of American adults. This analysis followed 3731 adults who were either Whites (n = 3596) or Blacks (n = 135) for 10 years. Education and income, as measured at baseline and 10 years later, were the independent variables. Negative and positive affect, measured at baseline and over ten years of follow up, were the dependent variables. Covariates were age, gender, and physical health (body mass index, self-rated health, and chronic medical conditions), measured at baseline. Race was the focal moderator. We ran multi-group structural equation modeling in the overall sample, with race defining the groups.

RESULTS

High education at baseline was associated with an increase in income over the 10-year follow up period for Whites but not Blacks. An increase in income during the follow up period was associated with an increase in the positive affect over time for Whites but not Blacks.

CONCLUSION

The MDR theory is also relevant to the effects of baseline education attainment on subsequent changes in income and then in turn on positive affect over time. The relative disadvantage of Blacks in comparison to Whites in receiving mental health gains from SES may reflect structural racism and discrimination in the United States. There is a need for additional research on specific societal barriers that minimize Blacks’ mental health gains from their SES resources, such as education and income. There is also a need for policies and programs that help Blacks to leverage their SES resources.

Molecular genetic contributions to self-rated health

Background: Poorer self-rated health (SRH) predicts worse health outcomes, even when adjusted for objective measures of disease at time of rating. Twin studies indicate SRH has a heritability of up to 60% and that its genetic architecture may overlap with that of personality and cognition.

Methods: We carried out a genome-wide association study (GWAS) of SRH on 111 749 members of the UK Biobank sample. Univariate genome-wide complex trait analysis (GCTA)-GREML analyses were used to estimate the proportion of variance explained by all common autosomal single nucleotide polymorphisms (SNPs) for SRH. Linkage disequilibrium (LD) score regression and polygenic risk scoring, two complementary methods, were used to investigate pleiotropy between SRH in the UK Biobank and up to 21 health-related and personality and cognitive traits from published GWAS consortia.

Results: The GWAS identified 13 independent signals associated with SRH, including several in regions previously associated with diseases or disease-related traits. The strongest signal was on chromosome 2 (rs2360675, P = 1.77 x 10^-10) close to KLF7. A second strong peak was identified on chromosome 6 in the major histocompatibility region (rs76380179, P = 6.15 x 10^-10). The proportion of variance in SRH that was explained by all common genetic variants was 13%. Polygenic scores for the following traits and disorders were associated with SRH: cognitive ability, education, neuroticism, body mass index (BMI), longevity, attention-deficit hyperactivity disorder (ADHD), major depressive disorder, schizophrenia, lung function, blood pressure, coronary artery disease, large vessel disease stroke and type 2 diabetes.

Conclusions: Individual differences in how people respond to a single item on SRH are partly explained by their genetic propensity to many common psychiatric and physical disorders and psychological traits.

Developmental patterns of change in mother and child emotional availability from infancy to the end of the preschool years: A four-wave longitudinal study

In this four-wave longitudinal study, we examined intraindividual developmental patterns of change in mother-child emotional availability (EA) during infancy and the preschool years, the factors that promote or hinder it, and the longitudinal within-dyad association between maternal and child EA. Mother-infant dyads (N = 56) were observed at home when children were 6,12, 18 and 55-months-old. Multilevel growth modeling revealed that mother and child EA follow distinct trajectories across time. While maternal EA was found to be stable, a significant increase in child EA was found across the infancy years and into preschool. The results from the study also provide evidence for a sustained within-dyad relation between mother and child EA across time and suggest that mother, child, and contextual factors can create variations in the trajectories of maternal EA over time. The findings lead to a deeper understanding of the intraindividual changes that occur in mother and child EA across the infancy years and into preschool and the factors that can promote or hinder it.

Optimism, pessimism, cynical hostility, and biomarkers of metabolic function in the Women's Health Initiative

BACKGROUND

Psychological attitudes reflecting expectations about the future (optimism, pessimism) and people (cynical hostility) independently predict incident cardiovascular disease and possibly diabetes, but underlying biologic pathways are incompletely understood. Herein we examined the cross-sectional relationship between optimism, pessimism, and cynicism and biomarkers of metabolic function in the Women's Health Initiative.

METHODS

Among 3443 postmenopausal women, biomarkers of metabolic function (fasting insulin [FINS] and glucose) were measured at baseline and used to calculate insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR]) and pancreatic β-cell activity (homeostasis model assessment of β-cell function [HOMA-B]). Psychological attitudes were assessed by the Life Orientation Test, Revised (full scale, and optimism and pessimism subscales) and the Cook-Medley cynicism subscale. Multivariable linear regression modeled the association of psychological attitudes with biomarker levels, adjusting for sociodemographics, health conditions, and health behaviors. Because obesity promotes insulin resistance and obese individuals tend to report higher levels of pessimism and cynical hostility, an interaction with body mass index (BMI) was explored.

RESULTS

In fully adjusted models, only pessimism remained independently associated with higher FINS and insulin resistance (HOMA-IR). Scoring 1 point higher on the pessimism subscale was associated with a 1.2% higher FINS, whereas scoring 1 SD higher was associated with a 2.7% higher FINS (P = 0.03); results were similar for HOMA-IR. An interaction term with BMI was not significant.

CONCLUSIONS

In multivariable models, higher dispositional pessimism was associated with worse metabolic function; these findings were not modified by obesity status. Results extend prior work by linking pessimism to an objective biomarker of insulin resistance in elderly women.

Socioeconomic Disparities in Smoking Among U.S. Adults With Depression, 2005-2014

INTRODUCTION

The purpose of this study is to estimate changes in the cigarette smoking prevalence among U.S. adults with and without depression from 2005 to 2014 by income and education level and overall.

METHODS

This study examined data from adult respondents (aged ≥18 years) in the National Survey on Drug Use and Health, an annual cross-sectional study of U.S. individuals. Data from the years 2005 to 2014 were analyzed for a total analytic sample of n=378,733. The prevalence of past-month cigarette smoking was examined annually from 2005 to 2014 among adults with and without past-year major depression, overall and by income/education, using linear trend analyses. Data analysis occurred in 2017.

RESULTS

The prevalence of smoking declined significantly from 2005 to 2014 among those with depression (37.62% to 34.01%; p<0.001) and without depression (23.99% to 19.87%; p<0.001). Yet, smoking remained nearly twice as common among those with depression during this period. Among adults with depression in the lowest income and education groups, the prevalence of smoking was more than double the prevalence of smoking among adults with depression in the highest income and education groups.

CONCLUSIONS

Disparities in smoking prevalence are pronounced when depression and SES are considered simultaneously. Targeted public health and clinical efforts to reduce smoking among adult smokers of lower SES with depression are needed.

Early Childhood Obesity Risk Factors: Socioeconomic Adversity, Family Dysfunction, Offspring Distress, and Junk Food Self-Medication

PURPOSE OF REVIEW

To explore the sequence and interaction of infancy and early childhood risk factors, particularly relating to disturbances in the social environment, and how the consequences of such exposures can promote weight gain and obesity.

RECENT FINDINGS

This review will argue that socioeconomic adversity is a key upstream catalyst that sets the stage for critical midstream risk factors such as family strain and dysfunction, offspring insecurity, stress, emotional turmoil, low self-esteem, and poor mental health. These midstream risk factors, particularly stress and emotional turmoil, create a more or less perfect foil for calorie-dense junk food self-medication and subtle addiction, to alleviate uncomfortable psychological and emotional states. Disturbances in the social environment during infancy and early childhood appear to play a critical role in weight gain and obesity, through such mechanisms as insecurity, stress, and emotional turmoil, eventually leading to junk food self-medication and subtle addiction.

Sleep: important considerations for the prevention of cardiovascular disease

PURPOSE OF REVIEW

Sleep plays many roles in maintenance of cardiovascular health. This review summarizes the literature across several areas of sleep and sleep disorders in relation to cardiometabolic disease risk factors.

RECENT FINDINGS

Insufficient sleep duration is prevalent in the population and is associated with weight gain and obesity, inflammation, cardiovascular disease, diabetes, and mortality. Insomnia is also highly present and represents an important risk factor for cardiovascular disease, especially when accompanied by short sleep duration. Sleep apnea is a well-characterized risk factor for cardiometabolic disease and cardiovascular mortality. Other issues are relevant as well. For example, sleep disorders in pediatric populations may convey cardiovascular risks. Also, sleep may play an important role in cardiovascular health disparities.

SUMMARY

Sleep and sleep disorders are implicated in cardiometabolic disease risk. This review addresses these and other issues, concluding with recommendations for research and clinical practice.

Screening and support for emotional burdens of youth with type 1 diabetes: Strategies for diabetes care providers

Multiple sources of burden for youth with type 1 diabetes (T1D) impact key outcomes including quality of life, self-management, and glycemic control. Professional diabetes organizations recommend diabetes care providers screen for psychosocial and behavioral challenges and implement strategies to support youth with T1D. The purpose of this article is to review the literature and recommend practical strategies medical providers can use for screening and behavioral support for youth with diabetes and their families. As part of their routine medical care, diabetes care providers are well-positioned to identify and intervene to address emotional distress related to the burdens of living with diabetes. In collaboration with multidisciplinary team members, including psychologists and mental health professionals, medical providers may be able to successfully implement brief behavioral strategies for screening and providing emotional support.

Socioeconomic status, family negative emotional climate, and anti-inflammatory gene expression among youth with asthma

The glucocorticoid receptor gene NR3C1 is an important down-regulator of inflammation and is typically under-expressed in individuals with low socioeconomic status (SES). Negative emotionality has been suggested as a potential mediator of SES disparities in health outcomes. In this study, we expand this literature by naturalistically assessing negative emotionality in a key emotional environment: the family. In a sample of 104 youth with asthma (10-17 years) and their primary caregiver, we assessed SES via caregiver report, emotional expression by youth and parents in the home over four days using the electronically activated recorder (EAR), and NR3C1 expression via blood collected from youth. Although there was not a direct effect of SES on NR3C1 expression, bootstrapping mediation analyses showed a significant indirect path such that lower SES was associated with a more negative family emotional climate, which in turn predicted reduced NR3C1 expression. No mediation effects were found for family positive emotional climate. This research demonstrates the importance of examining the effects of SES on emotion expression in the family context and suggests a critical biopsychosocial pathway underlying SES-based health disparities that may extend beyond youth.

Economic strain and support in couple: The mediating role of positive emotions

This study examined positive emotions as mediating mechanisms in the association between economic strain and spouses' supportive behaviour. Data were collected from 295 married couples living in Romania. Results from the Actor-Partner Mediator Model indicated that economic strain had a negative indirect effect on spouses' supportive dyadic coping due to its negative association with partners' positive emotions (joy, contentment, and pride). For both partners, positive emotions decreased when they experienced economic strain, which in turn reduced supportive dyadic coping in couples. These findings have theoretical implications in explaining the association of economic strain with partners' positive emotions and behaviours and also clinical implications for practitioners working with couples experiencing economic strain.

Emotional intelligence, anxiety, and emotional eating: A deeper insight into a recently reported association?

Recent studies reported a negative association between emotional intelligence (EI: defined here as individual predispositions associated with effective identification and regulation of emotions) and emotional eating. Although theory provides some insights into how the concept represents mechanisms that may serve as protective factors, empirical evidence of the mechanism behind the association has yet to be presented. This study tested a proposed model in which anxiety levels mediate the association between emotional intelligence and emotional-eating patterns in a normative sample of women in Israel. A cross-sectional/correlational design was used to gather data from 208 generally healthy female participants who completed measures of trait emotional intelligence, anxiety, and tendency toward emotional eating, as well as demographics. Anxiety levels mediated the negative association between emotional intelligence and emotional eating. Background variables had only marginal involvement in this model. The results shed light on the mechanisms underlying the association between emotional intelligence and emotional eating. Should future studies corroborate the findings, they may serve as a basis for future screening protocols, prevention and interventions with individuals and groups at risk of EE and eating disorders.

Socioeconomic Status and Cardiovascular Responses to Standardized Stressors: A Systematic Review and Meta-Analysis

OBJECTIVE

Disparities in cardiovascular health by socioeconomic status (SES) are a pressing public health concern. Hypothesized mechanisms linking low SES to poor health are large cardiovascular responses to and delayed recovery from psychological stress. The current study presents a meta-analysis of the literature on the association of SES with blood pressure and heart rate reactivity to and recovery from acute stress tasks.

METHODS

The PubMed database was searched, and 26 unique studies with relevant data were identified (k = 25 reactivity [n = 14,617], k = 6 recovery [n = 1,324]).

RESULTS

Using random-effects models, no significant association between SES and cardiovascular reactivity to stress emerged (r = .008, 95% confidence interval = -.02 to .04), although higher SES was associated with better recovery from stress (r = -.14, 95% confidence interval -.23 to -.05). Stressor type moderated the reactivity effect, wherein higher SES was associated with greater reactivity to cognitive stressors (r = .036, p = .024), not with reactivity to interpersonal stressors (r = -.02, p = .62), but was associated with lower reactivity to tasks with combinations of cognitive, interpersonal, and physical challenges (r = -.12, p = .029). Accounting for publication bias revealed a significant association between SES and reactivity in the opposite direction of hypotheses.

CONCLUSIONS

Cardiovascular recovery from acute stress, but not reactivity to stress, may be a key pathway between low SES and risk for cardiovascular diseases. Heterogeneity in effect size and direction, challenges related to working across temporal dynamics, and recommendations for future research are discussed.