Evidence for skin-deep resilience using a co-twin control design: Effects on low-grade inflammation in a longitudinal study of youth

Association between epigenetic age and type 2 diabetes mellitus or glycemic traits: A longitudinal twin study

Epigenetic clocks based on DNA methylation have been known as biomarkers of aging, including principal component (PC) clocks representing the degree of aging and DunedinPACE representing the pace of aging. Prior studies have shown the associations between epigenetic aging and T2DM, but the results vary by epigenetic age metrics and people. This study explored the associations between epigenetic age metrics and T2DM or glycemic traits, based on 1070 twins (535 twin pairs) from the Chinese National Twin Registry. It also explored the temporal relationships of epigenetic age metrics and glycemic traits in 314 twins (157 twin pairs) who participated in baseline and follow-up visits after a mean of 4.6 years. DNA methylation data were used to calculate epigenetic age metrics, including PCGrimAge acceleration (PCGrimAA), PCPhenoAge acceleration (PCPhenoAA), DunedinPACE, and the longitudinal change rate of PCGrimAge/PCPhenoAge. Mixed-effects and cross-lagged modelling assessed the cross-sectional and temporal relationships between epigenetic age metrics and T2DM or glycemic traits, respectively. In the cross-sectional analysis, positive associations were identified between DunedinPACE and glycemic traits, as well as between PCPhenoAA and fasting plasma glucose, which may be not confounded by shared genetic factors. Cross-lagged models revealed that glycemic traits (fasting plasma glucose, HbA1c, and TyG index) preceded DunedinPACE increases, and TyG index preceded PCGrimAA increases. Glycemic traits are positively associated with epigenetic age metrics, especially DunedinPACE. Glycemic traits preceded the increases in DunedinPACE and PCGrimAA. Lowering the levels of glycemic traits may reduce DunedinPACE and PCGrimAA, thereby mitigating age-related comorbidities.

Family Disadvantage, Education, and Health Outcomes Among Black Youths Over a 20-Year Period

Importance

Upward mobility (via educational attainment) is highly valued, but longitudinal associations with mental and physical health among Black youths are less understood.

Objective

To examine associations of childhood family disadvantage and college graduation with adult mental and physical health in Black youths followed up into adulthood.

Design, Setting, and Participants

This longitudinal, prospective cohort study of Black youths from the state of Georgia who were studied for 20 years (ages 11 to 31 years) was conducted between 2001 and 2022. Participants for this study were drawn from the Strong African American Healthy Adults Program. Data analysis was conducted from April 2023 to January 2024.

Exposures

Family economic disadvantage (measured during the adolescent years) and college graduation (indicating upward mobility).

Main Outcomes and Measures

Primary outcomes included mental health, substance use, and physical health. Mental health included a composite of internalizing and disruptive problems (anxiety, depression, anger, aggressive behaviors, and emotional reactivity). Substance use included a composite of smoking, drinking, and drug use. Physical health included metabolic syndrome (MetS) and proinflammatory phenotypes (immune cells mounting exaggerated cytokine responses to bacterial challenge and being insensitive to inhibitory signals from glucocorticoids). Mental and physical health measures were taken at age 31 and during the adolescent years. Linear and logistic regression analyses, as well as mediated moderation analyses, were conducted.

Results

The study population consisted of 329 Black youths (212 women [64%]; 117 men [36%]; mean [SD] age at follow-up, 31 [1] years). Compared with those who did not graduate college, those who graduated from college had 0.14 SD fewer mental health problems (b = -1.377; 95% CI, -2.529 to -0.226; β = -0.137; P = .02) and 0.13 SD lower levels of substance use (b = -0.114; 95% CI, -0.210 to -0.018; β = -0.131; P = .02). Residualized change scores revealed that college graduates showed greater decreases from age 16 to 31 years in mental health problems (b = -1.267; 95% CI, -2.360 to -0.174; β = -0.133; P = .02) and substance use problems (b = -0.116; 95% CI, -0.211 to -0.021; β = -0.136; P = .02). For physical health, significant interactions between childhood family disadvantage and college completion emerged in association with MetS (OR, 1.495; 95% CI, 1.111-2.012; P = .008) and proinflammatory phenotype (b = 0.051; 95% CI, 0.003 to 0.099; β = 0.131; P = .04). Among youths growing up in disadvantaged households, college completion was associated with a 32.6% greater likelihood of MetS (OR, 3.947; 95% CI, 1.003-15.502; P = .049) and 0.59 SD more proinflammatory phenotype (mean difference, 0.249, 95% CI, 0.001 to 0.497; P = .049). Conversely, among those from economically advantaged backgrounds, college completion was correlated with lower MetS and less proinflammatory phenotype. Findings held after controlling for body mass index at age 19 years.

Conclusions and Relevance

In this longitudinal cohort study of Black youths, graduating from college was associated with an adult profile of better mental health but poorer physical health among those from economic disadvantage. These findings suggest that developing interventions that foster healthy outcomes across multiple life domains may be important for ensuring that striving for upward mobility is not accompanied by unintended cardiometabolic risk.

Socioeconomic disadvantage and high-effort coping in childhood: evidence of skin-deep resilience

BACKGROUND

Low socioeconomic status (SES) is a risk factor for poor outcomes across development. Recent evidence suggests that, although psychosocial resilience among youth living in low-SES households is common, such expressions of resilience may not extend to physical health. Questions remain about when these diverging mental and physical health trajectories emerge. The current study hypothesized that skin-deep resilience - a pattern wherein socioeconomic disadvantage is linked to better mental health but worse physical health for individuals with John Henryism high-effort coping - is already present in childhood.

METHODS

Analyses focus on 165 Black and Latinx children (Mage  = 11.5) who were free of chronic disease and able to complete study procedures. Guardians provided information about their SES. Children reported on their John Henryism high-effort coping behaviors. They also provided reports of their depressed and anxious mood, which were combined into a composite of internalizing symptoms. Children's cardiometabolic risk was captured as a composite reflecting high levels of systolic or diastolic blood pressure, waist circumference, HbA1c, triglycerides, and low high-density lipoprotein cholesterol.

RESULTS

Among youth who reported using John Henryism high-effort coping, SES risk was unrelated to internalizing symptoms and was positively associated with cardiometabolic risk. In contrast, for youth who did not engage in high-effort coping, SES risk was positively associated with internalizing symptoms and was unrelated to cardiometabolic risk.

CONCLUSIONS

For youth with high-effort coping tendencies, socioeconomic disadvantage is linked to cardiometabolic risk. Public health efforts to support at-risk youth must consider both mental and physical health consequences associated with striving in challenging contexts.

Reflections on resilience

Resilience research has long sought to understand how factors at the child, family, school, community, and societal levels shape adaptation in the face of adversities such as poverty and war. In this article we reflect on three themes that may prove to be useful for future resilience research. First is the idea that mental and physical health can sometimes diverge, even in response to the same social process. A better understanding of explanations for this divergence will have both theoretical and public health implications when it comes to efforts to promote resilience. Second is that more recent models of stress suggest that stress can accelerate aging. Thus, we suggest that research on resilience may need to also consider how resilience strategies may need to be developed in an accelerated fashion to be effective. Third, we suggest that if psychological resilience interventions can be conducted in conjunction with efforts to enact system-level changes targeted at adversities, this may synergize the impact that any single intervention can have, creating a more coordinated and effective set of approaches for promoting resilience in young people who confront adversity in life.

Skin-deep Resilience and Early Adolescence: Neighborhood Disadvantage, Executive Functioning, and Pubertal Development in Minority Youth

Skin-deep resilience, in which youth overcome adversity and achieve success in psychological and academic domains but at a cost to their physiological well-being, has been documented in late adolescence and adulthood. However, its potential to emerge at earlier developmental stages is unknown. To address this gap, secondary data analyses were executed using waves 1 and 2 of the Adolescent Brain Cognitive Development study (n = 7712; ages 9-10 years at baseline [mean: 9.92; SD = 0.63]; 47.1% female; 66.1% White, 13.4% Black, and 20.6% Hispanic). The results indicated high levels of executive functioning were associated with improved psychological and behavioral outcomes at one-year follow-up. However, for racial and ethnic minority (i.e., Black or Hispanic) youth from disadvantaged neighborhoods, high levels of executive functioning were also associated with accelerated pubertal development. No significant interaction was observed among White youth. The findings suggest the skin-deep resilience pattern may be evident in early adolescence.

A person-centered approach to resilience and vulnerability in emerging adulthood: Predictions from parenting and personality in adolescence

In this person-centered study, we identified different profiles of resilience and vulnerability in emerging adulthood in response to previously experienced stressful life events. Additionally, we examined whether mothers' and fathers' parenting and participants' personality traits in adolescence predicted these profiles. Data from the Flemish Study on Parenting, Personality, and Development (N = 346 families) were used. At T1 (2004; Mage = 11 years), T2 (2007), and T3 (2009), mothers and fathers reported on their parenting and their child's personality. At T4 (2018; Mage = 25 years), emerging adults retrospectively self-reported the occurrence and impact of 22 stressful life events and rated current behavior problems and subjective well-being. Latent profile analysis revealed three profiles: Competent (71%; low stress, low behavior problems, high subjective well-being), Vulnerable (21%; average stress, high behavior problems, low subjective well-being), and Resilient (9%; high stress, average behavior problems, average subjective well-being). Emerging adults in the Resilient profile had experienced higher levels of maternal positive parenting and were less emotionally stable and conscientious than those in the Competent profile. Furthermore, emerging adults in the Vulnerable profile were less emotionally stable than their peers in the Competent profile. These findings reveal new insights into the heterogeneous patterns of emerging adults' adaptation following stressful life events.

Trauma History Predicts Decoupling of C-Reactive Protein and Somatic Symptoms: Results From a Cohort Study of Sexual and Gender Minority Youth

OBJECTIVE

Systemic inflammation can induce somatic symptoms (e.g., pain, nausea, fatigue) through neuroimmune signaling pathways. Previous research suggests that early-life adversity amplifies signaling between peripheral inflammation and the brain. We therefore hypothesized that greater lifetime trauma exposure at baseline would predict stronger associations between systemic inflammation and somatic symptoms at 2.5-year follow-up in a cohort study of sexual and gender minority youth assigned male at birth ( n = 694).

METHODS

We measured prior trauma exposure (lifetime count of traumatic event types reported at baseline), somatic symptoms (Brief Symptom Inventory somatization score), and systemic inflammation (C-reactive protein, interleukin 6, interleukin 1β, and tumor necrosis factor α). All models included age, gender, education, recent trauma exposure, substance use, body mass index, and HIV status as covariates.

RESULTS

Higher C-reactive protein concentrations were associated with greater somatic symptoms in the main effects model ( β = 0.019, 95% confidence interval [CI] = 0.006 to 0.031). Contrary to our hypothesis, we observed a negative interaction between prior trauma exposure and C-reactive protein levels in predicting somatic symptoms ( β = -0.017, 95% CI = -0.030 to -0.004). Higher C-reactive protein was associated with greater somatic symptoms only in participants without prior trauma exposure at baseline ( β = 0.044, 95% CI = 0.026 to 0.062). Specificity analyses revealed similar patterns when nonsomatic depressive symptoms were used as the outcome variable.

CONCLUSIONS

These results suggest that sexual and gender minority youth assigned male at birth who have a history of prior trauma exposure may experience decoupling of systemic inflammation and somatic symptoms. The absence of inflammation-related symptoms may prevent individuals from seeking necessary medical care by reducing interoceptive awareness of pathological states.

Explaining Physical Health Disparities and Inequalities Over the First Half of the Life Course: An Integrative Review of Add Health Studies

This integrative review of research utilizing the National Longitudinal Study of Adolescent to Adult Health draws on previous research detailing pathways linking early socioeconomic adversity in childhood and adolescence (Wave 1 in 1995 and prior) to physical health outcomes in young adulthood (Wave 5 in 2015). Health outcomes considered included specific diseases, disease risk, and morbidity as prospectively measured by parent-reported and self-reported health outcomes as well as clinical biomarkers. A heuristic research framework was developed from the comprehensive review focused on 4 study designs and identifying total associations, physiological pathways, stress pathways, and resources pathways linking early socioeconomic adversity to physical health outcomes for young adults, as well as potential modifiers of these pathways. The appropriateness of different analytical strategies used in these research studies including approaches for analysis of change in health are discussed. Taken together, review findings suggest the merit of an integrated perspective taking a long view over early life course to explain cumulative physical health risk over the first half of the life course by assessing multiple pathways simultaneously. Looking forward, the review findings also emphasize the need for the investigation of the continuity and change in these pathways over the second half of the life course.

Cost of resilience: Childhood poverty, mental health, and chronic physiological stress

Childhood poverty is associated with elevated internalizing symptoms. Nevertheless, some children exposed to poverty evince remarkable resilience, demonstrating lower than expected levels of psychological distress. However, recent work suggests that coping with adversity can lead to undesirable physical health consequences. Specifically, successful adaptation in the context of early adversity, including socioeconomic disadvantage, appears to be associated with elevated chronic physiological stress and ill health. The current study adds to this emerging literature by examining in a longitudinal context whether low levels of internalizing symptoms in the face of childhood poverty is accompanied by elevated chronic physiological stress (allostatic load) during childhood, as well as over time from childhood to adulthood. Results (n = 341; M=9.2 years, 49 % female; 94 % Caucasian) show that childhood poverty was prospectively associated with higher allostatic load during adolescence, controlling for baseline allostatic load. Furthermore, greater duration of childhood poverty led to steeper, more elevated allostatic load trajectories from childhood to adulthood, for youth with lower levels of internalizing symptoms. Efforts to manage adverse sequelae of early adversity likely yield a complex array of benefits and costs.

Planful Self-Control, Metabolic Risk, and Psychosocial Outcomes Among Young, Black Men: A Test of Skin-Deep Resilience Theory

Research on skin-deep resilience suggests that for youth and young adults from disadvantaged backgrounds, high levels of planful self-control may promote positive psychosocial outcomes while simultaneously conferring vulnerabilities to chronic diseases related to aging. In this study, we investigated the divergent effects of planful self-control on young Black American men’s psychosocial well-being and their metabolic risk. We expected that high levels of planful self-control in emerging adulthood would predict positive outcomes in young adulthood (educational attainment, low depressive symptoms, job satisfaction); however, the combination of high levels of planful self-control and the experience of contextual adversity either in emerging adulthood or in childhood would forecast poor metabolic health. Hypotheses were tested with prospective data from 504 Black American men followed from age 20 to age 26. Planful self-control in emerging adulthood directly forecasted low levels of depressive symptoms, one’s likelihood of obtaining a bachelor’s degree, increased job satisfaction, and increases in metabolic risk. Exposure to childhood deprivation moderated the influence of planful self-control on metabolic risk. Men with high levels of deprivation and high levels of planful self-control exhibited the worst metabolic profiles in the sample. In contrast, men with high levels of childhood deprivation and low levels of planful self-control exhibited the best metabolic profiles. Documenting the health consequences associated with planful self-control provides a foundation from which to identify modifiable psychosocial factors that affect the course of psychosocial problems and health.

What Are the Health Consequences of Upward Mobility?

Health disparities by socioeconomic status (SES) have been extensively documented, but less is known about the physical health implications of achieving upward mobility. This article critically reviews the evolving literature in this area, concluding that upward mobility is associated with a trade-off, whereby economic success and positive mental health in adulthood can come at the expense of physical health, a pattern termed skin-deep resilience. We consider explanations for this phenomenon, including prolonged high striving, competing demands between the environments upwardly mobile individuals seek to enter and their environments of origin, cultural mismatches between adaptive strategies from their childhood environments and those that are valued in higher-SES environments, and the sense of alienation, lack of belonging, and discrimination that upwardly mobile individuals face as they move into spaces set up by and for high-SES groups. These stressors are hypothesized to lead to unhealthy behaviors and a dysregulation of biological systems, with implications for cardiometabolic health.

Trajectories of adolescent stressful life events and young adults' socioeconomic and relational outcomes: Weight and depressive symptoms as mediators

Little is known about how biological and psychological consequences of adolescent stressful life events (SLEs) are jointly associated with socioeconomic and relational outcomes in adulthood. To address this gap, the present study involved testing a model based on the life course perspective that posits adolescent SLE trajectories produce parallel trajectories of depressive symptoms and weight status, which are jointly associated with socioeconomic status and intimate relationship quality in adulthood. Prospective data over 13 years from a nationally representative sample of 11,677 US adolescents was utilized. The results demonstrated that trajectories of BMI and depressive symptoms, which showed contemporaneous and longitudinal comorbidities over the early life course, were influenced by adolescent SLEs. Both BMI and depressive symptoms trajectories are additively and jointly associated with socioeconomic status and intimate relationship quality in adulthood. Additionally, adolescent SLE trajectories are directly associated with these adult outcomes. These observed associations persisted even after controlling for early family socioeconomic adversity and race/ethnicity. The theoretical and practical implications of these findings are discussed.

Effects of social support in an academic context on low-grade inflammation in high school students

Bolstering academic motivation is a high priority in school settings, but some evidence suggests this could take a toll on students' physical health. To address this, this study compared the effects of an experimental manipulation of academic motivation alone (AM) to academic motivation enhanced with social support (SS + AM) on markers of inflammation in a sample of 80 high school 9th graders. Outcomes included low-grade inflammation: C-reactive protein (CRP) and interleukin-6 (IL-6); a motivation measure; and grade point average (GPA), taken at baseline and follow-up (beginning and end of school year, respectively). Students in the SS + AM condition had lower levels of inflammation at follow-up (covarying baseline levels) compared to those in the AM condition. The two groups were equivalent on motivation and GPA at follow-up. This preliminary study suggests that incorporating social support into academic motivation programs has the potential to benefit inflammatory markers in young people while allowing them to maintain positive academic outcomes.

Socioeconomic position, social mobility, and health selection effects on allostatic load in the United States

The contemporaneous association between higher socioeconomic position and better health is well established. Life course research has also demonstrated a lasting effect of childhood socioeconomic conditions on adult health and well-being. Yet, little is known about the separate health effects of intergenerational mobility-moving into a different socioeconomic position than one's parents-among early adults in the United States. Most studies on the health implications of mobility rely on cross-sectional datasets, which makes it impossible to differentiate between health selection and social causation effects. In addition, understanding the effects of social mobility on health at a relatively young age has been hampered by the paucity of health measures that reliably predict disease onset. Analysing 4,713 respondents aged 25 to 32 from the National Longitudinal Study of Adolescent Health's Waves I and IV, we use diagonal reference models to separately identify the effects of socioeconomic origin and destination, as well as social mobility on allostatic load among individuals in the United States. Using a combined measure of educational and occupational attainment, and accounting for individuals' initial health, we demonstrate that in addition to health gradient among the socially immobile, individuals' socioeconomic origin and destination are equally important for multi-system physiological dysregulation. Short-range upward mobility also has a positive and significant association with health. After mitigating health selection concerns in our observational data, this effect is observed only among those reporting poor health before experiencing social mobility. Our findings move towards the reconciliation of two theoretical perspectives, confirming the positive effect of upward mobility as predicted by the "rags to riches" perspective, while not contradicting potential costs associated with more extensive upward mobility experiences as predicted by the dissociative thesis.

Introducing two types of psychological resilience with partly unique genetic and environmental sources

Psychological resilience is indicated when individuals demonstrate good mental health despite exposure to significant stress or adversity. Good mental health may involve low levels of illbeing and/or high levels of wellbeing. There is still very limited knowledge about the potential differences between these outcomes in relation to stressors. We propose a distinction between type 1 and type 2 resilience, examine their underlying genetic and environmental architecture, and identify modifiable resilience factors. The data come from a population-based twin sample (N = 1987, mean age = 63) in the Norwegian Twin Registry. Type 1 and type 2 resilience are operationalised as the residual of anxiety/depression symptoms and life satisfaction, respectively, after lifetime cumulative adversity has been regressed out. We used biometric modelling and cotwin-control linear mixed models to estimate underlying factors and identify predictors while controlling for genetic confounding. The results support the notion of two separate, but partly overlapping types of resilience. We find heritabilities of 0.30 (type 1) and 0.24 (type 2) and a genetic correlation of 0.43. Potentially causal resilience factors include, but are not limited to, meaning in life, physical activity, positive affect and relationship satisfaction. Whereas some factors are associated with both resilience types, other factors are unique to each type.

Youth academic achievement, social context, and body mass index

This study assesses the relationship between academic achievement and body mass index for age (BMI) trajectories across childhood and adolescence, and investigates how this relationship is moderated by social context. Specifically, we test the hypothesis that academic achievement is not associated with improved BMI among youth from disadvantaged social contexts. We test for differences by race/ethnicity, and examine the role of county-level economic mobility in shaping these patterns. We use data from the longitudinal Fragile Families and Child Wellbeing Study (FFCWS), an ongoing birth cohort study representative of children born in large US cities in 2000, and measure BMI, academic achievement, and social context at Years 5, 9, and 15. Estimating multilevel random effects linear regression models of BMI from childhood to adolescence, we find that youth who were exposed to social advantage displayed a negative association between academic achievement and BMI. In contrast, youth exposed to social disadvantage displayed no association between academic achievement and BMI. This difference was observed regardless of race/ethnicity. County-level economic mobility modified the observed relationship, such that youth living in places with low levels of mobility displayed higher BMI associated with high academic performance. The results suggest that the health costs of academic achievement among disadvantaged youth are concentrated in areas with low institutional support for upward mobility. The findings demonstrate that the unequal benefits of educational attainment begin early in life, while living in places that promote upward mobility can help individuals realize the health benefits of their own educational attainment.

Characterizing competence among a high-risk sample of emerging adults: Prospective predictions and biological considerations

Few conditions epitomize severe and chronic stress to a greater extent than child maltreatment, which can derail development across multiple domains of functioning and throughout the life course. Furthermore, child maltreatment tends to co-occur with other adversities, such as poverty. Many individuals grow up under the stressful conditions of these adversities and exhibit developmental competence. The current study prospectively charted the developmental progression of economically disadvantaged maltreated and nonmaltreated children from childhood to emerging adulthood, and examined patterns of competence across multiple developmental domains of functioning central to the period of emerging adulthood. The study investigated childhood precursors to these patterns of adaptation and maladaptation, as well as the physiological cost of these patterns of adaptation (i.e., C-reactive protein; CRP). Latent class analysis revealed four distinct classes of functioning: multifaceted competence across domains (Multifaceted Competence); (multifaceted maladaptation across domains (Multi-Problem); (c) and two classes with mixed patterns of competence and maladaptation (Externalizing Problems and Work/School Impairment). Maltreated individuals were less likely than nonmaltreated individuals to demonstrate patterns of multifaceted competence and more likely to demonstrate aggregate maladaptation across domains. Additionally, Black men who demonstrated a pattern of multifaceted psychosocial competence also evidenced higher levels of low-grade inflammation (indexed by CRP), suggesting physiological distress was associated with adaptation in the context of stress among these individuals. Findings demonstrate the heterogenous patterns of functioning and diverse developmental outcomes that follow early adversity.

Adolescent college expectation and nutritional health in adulthood: The hidden power of social position

Few studies investigated whether expected college attendance in adolescence may generate comparable health benefits in early adulthood for the disadvantaged and the privileged. Using data from the National Longitudinal Study of Adolescent to Adult Health, this study examined the contingent associations of college attendance expectation with weekly fast food consumption (FFC), sugar-sweetened beverage consumption (SBC), physical activity (PA), and obesity in early adulthood based on four social position indicators: family poverty, neighborhood poverty, parental education, and race. Results suggested that family poverty, neighborhood poverty, and low parental education significantly compromised college expectation's associations with all outcomes except for PA. Further, college expectation's negative associations with FFC and SBC were lower for Blacks than for Whites; and college expectation's negative association with SBC and positive association with PA were lower for Hispanics than for Whites. These findings imply that the "ambition inflation" among American youth, often celebrated by the American culture for its acclaimed life changing power, may be not equally benefiting the disadvantaged and the privileged. Future behavioral interventions focusing on fostering a positive outlook in youth should consider possible effect heterogeneity based on social background.