Allostatic load in an environmental riskscape: the role of stressors and gender

Associations of Allostatic Load with Level of and Change in Cognitive Function Among Middle-Aged and Older Hispanic/Latino Adults: The Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA)

Background

Higher allostatic load (AL), a multi-system measure of physiological dysregulation considered a proxy for chronic stress exposure, is associated with poorer global cognition (GC) in older non-Hispanic white adults. However, evidence of these associations in middle-aged and older US-based Hispanic/Latino adults is limited.

Objective

To examine associations of AL with level of cognition, performance in cognition 7 years later, and change in cognition over 7 years among middle-aged and older US-based Hispanic/Latino adults.

Methods

We used data (n = 5,799, 45-74 years at baseline) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and SOL-Investigation of Neurocognitive Aging (SOL-INCA). The AL score comprised 16 biomarkers representing cardiometabolic, glucose, cardiopulmonary, parasympathetic, and inflammatory systems (higher scores = greater dysregulation). Cognitive outcomes included GC and individual tests of verbal learning and memory, world fluency (WF), Digit Symbol Substitution (DSS), and Trail Making (Parts A & B). Survey-linear regressions assessed associations of AL with performance in cognition at baseline, 7 years later, and via 7-year cognitive change scores adjusting for sociodemographic characteristics, lifestyle factors, and depressive symptoms.

Results

Higher AL was associated with lower baseline performance in GC and WF; and lower 7-year follow-up performance in these same measures plus DSS and Trail Making Parts A & B. Higher AL was associated with more pronounced 7-year change (reduction) in GC and on WF and DSS tests.

Conclusions

Findings extend previous evidence in predominantly older non-Hispanic white cohorts to show that AL is related to level of and change in GC (as well as WF and DSS) among middle-aged and older US-based Hispanic/Latino adults.

Allostatic load in the US general population: Race and educational intersection

Objectives

Educational attainment is a protective factor against poor health, but high educational attainment has a weaker effect on black people than on white people; this pattern has been called marginalization-related diminished returns (MDRs). Using a national sample of white people and black people 25 years and above, this study estimates the association between high educational attainment and allostatic load between black people and white people, and within each group.

Study design

This cross-sectional study uses data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2016, including 2761 black people and 7058 white people. The outcome variable of interest was the Allostatic Load Scale (AL). We created the allostatic load scale by using 8 biomarkers, then created a binary variable (if ALS≥4 as 1 and ALS<4 as 0) to present elevated AL.

Methods

We used several weighted modified Poisson regression models controlling for educational attainment (a predictor) and race (a moderator variable), age, sex, and marital status. We also controlled the models for smoking and drinking status as health behavior variables. As a sensitivity analysis, we ran several sets of regression analysis using the AL scale as a continuous outcome variable.

Results

We found an inverse association between AL and educational attainment. The interaction between race and education has resulted in an inverse association between AL and educational attainment, with a weaker association in black people than in white people. We found similar findings by running regression models with AL as a continuous variable.

Conclusions

We observed a weaker association between educational attainment and AL in black people than in white people, suggesting that educational attainment has more robust protection against allostatic load for white people than black people.

Prevalence of Contributing Factors Leading to the Development of Insulin Resistance Among Male Medical Students at a Private College in Saudi Arabia

Background Insulin resistance can result from various genetic and lifestyle factors. Initially, symptoms of insulin resistance may not be readily noticeable, but as the condition progresses, individuals may start experiencing symptoms. This study aimed to investigate the factors contributing to the development of insulin resistance among medical students at a private college in Saudi Arabia. Methodology We conducted a cross-sectional study using a convenient non-probability sampling technique, with a sample size of 241 participants. We employed validated questionnaires to gather information on physical activity, sleep, dietary habits, and stress. Specifically, we used the International Physical Activity Questionnaire (IPAQ)-Short Form for assessing physical activity, the Single-Item Sleep Quality Scale (SQS) for evaluating sleep quality, the Healthy Eating Quiz (HEQ) to gauge dietary patterns, and the stress questionnaire designed by the International Stress Management Association (ISMA) to measure stress levels. Additionally, we collected anthropometric measurements, as well as systolic and diastolic blood pressure readings. We calculated prevalence using percentages and employed the chi-square test to analyze variables, with a significance level set at p-values <0.05. Results This study investigated risk factors associated with lifestyle, focusing on waist circumference as an indicator of insulin resistance. Our findings revealed that a majority of individuals with high waist circumference were physically inactive and more susceptible to stress, and this difference was statistically significant when compared to those with normal waist circumference. Additionally, we observed that sleep deprivation and poor nutrition were more prevalent among individuals with high waist circumference, although these differences were not statistically significant. Conclusions This study highlights a high prevalence of elevated waist circumference, indicating insulin resistance, among medical students. Furthermore, it underscores the significant presence of well-known risk factors associated with insulin resistance within this population of medical students.

Examining Racial/Ethnic Disparities in Coping and Stress Within an Environmental Riskscape

Existing research on racial/ethnic differences in stress and coping is limited by small samples, single-item measures, and lack of inclusion of Mexican Americans. We address these gaps by analyzing data from the Texas City Stress and Health Study, a cross-sectional sample of Black (N = 257), White (N = 304), US-born (N = 689), and foreign-born (N = 749) Mexican Americans residing in proximity to a petrochemical complex. We compared active and avoidant coping by race/ethnicity and explored multivariable associations between coping and perceived stress. Black and foreign-born Mexican American respondents had the highest stressor exposure yet displayed different patterns of coping and perceived stress patterns. Active coping may be particularly effective for African Americans but may not offset extreme stress disparities. For Mexican Americans, the lack of association between coping and stress underscores the need for more work focused on the culturally diverse coping experiences.

The allostatic load model: a framework to understand the cumulative multi-system impact of work-related psychosocial stress exposure among firefighters

Firefighting is recognised as a profession where health and well-being can be affected by a variety of occupational factors, such as physical, thermal, and chemical stressors. Along with the risks intuitively associated with the fire service, however, psychosocial stress has begun to attract attention as another variable deserving of consideration. Indeed, long-term exposure to work-related psychosocial stress has been linked with poor health outcomes in many workers; however, despite this association, very little has been done to examine how such stressors become biologically embedded in firefighters. To help facilitate research into how psychosocial stress can affect health-related outcomes in the fire service, we propose a framework centered on the notion of allostatic load. First, we reviewed the occupational characteristics that may generate psychosocial stress within firefighters before introducing allostatic load (that is, dysregulation across various physiological systems caused by the need to manage ongoing stressors). Next, we provided a summary of how allostatic load can be measured and touched on the framework's utility for studying the cumulative effects of work-related stress on firefighter health. After this, factors that may influence the steps leading from stress exposure to health outcomes were discussed; in particular, we commented upon how research in this area should consider specific non-modifiable (age, sex, and ethnicity) and modifiable (psychosocial resources and behavioural habits) factors. Finally, we presented methodological barriers and opportunities that may arise when using the allostatic load framework with this professional group. By introducing the framework, we hope to provide a tool that may be used by those interested in stress-health research in firefighters to build the evidence needed to inform primary prevention measures.

Relationship between Perceived Stress, Obesity, and Hypertension in Korean Adults and Older Adults

BACKGROUND

Perceived stress has a significant effect on metabolic diseases, including obesity and hypertension. However, the association between stress levels, obesity, and hypertension according to age and sex is not fully understood. Therefore, this study investigated the relationship between stress levels and obesity and hypertension in Korean adults and older adults.

METHODS

We analyzed data from the 2015 survey of the Korea National Physical Fitness Project conducted by the Korea Institute of Sports Science and the Korea Ministry of Culture, Sports, and Tourism. Of the 3457 participants, 2829 were adults (20-64 years old) and 628 were older adults (≥65 years old). The correlation between obesity and hypertension according to the degree of perceived stress (low, medium, and high) was analyzed using the chi-square test. Binary logistic regression analysis was used to investigate the influence of perceived stress levels on obesity and hypertension. Age, body mass index (BMI), blood pressure, exercise frequency, smoking, breakfast, and sleeping hours were included as covariates.

RESULTS

In adult males, perceived stress levels, age, and diastolic blood pressure were found to have a significant impact on obesity rates, whereas age and breakfast had a significant effect on hypertension rates. In adult females, age and systolic blood pressure were found to significantly influence obesity rates, whereas age, BMI, and exercise frequency had a significant impact on hypertension rates. In older adult females, perceived stress levels and systolic blood pressure were found to significantly impact obesity rates, and sleep duration influenced the rates of hypertension. The effect of perceived stress level on obesity and hypertension rates was less pronounced in the elderly population than in the adult population.

CONCLUSIONS

This study revealed age and sex differences in the relationship between perceived stress, obesity, and hypertension among Koreans. These findings contribute to a better understanding of the complex relationship between perceived stress and metabolic disorders and emphasize the need for a deeper understanding of the specific factors involved in the prevention and management of metabolic diseases.

Architectural Allostatic Overloading: Exploring a Connection between Architectural Form and Allostatic Overloading

This paper examines, conceptually, the relationship between stress-inducing architectural features and allostatic overload by drawing on literature from neuroimmunology and neuroarchitecture. The studies reviewed from the field of neuroimmunology indicate that chronic or repeated exposure to stress-inducing events may overwhelm the body's regulatory system, resulting in a process termed allostatic overload. While there is evidence from the field of neuroarchitecture that short-term exposure to particular architectural features produce acute stress responses, there is yet to be a study on the relationship between stress-inducing architectural features and allostatic load. This paper considers how to design such a study by reviewing the two primary methods used to measure allostatic overload: biomarkers and clinimetrics. Of particular interest is the observation that the clinical biomarkers used to measure stress in neuroarchitectural studies differ substantially from those used to measure allostatic load. Therefore, the paper concludes that while the observed stress responses to particular architectural forms may indicate allostatic activity, further research is needed to determine whether these stress responses are leading to allostatic overload. Consequently, a discrete longitudinal public health study is advised, one which engages the clinical biomarkers indicative of allostatic activity and incorporates contextual data using a clinimetric approach.

Longitudinal associations between allostatic load, pet ownership, and socioeconomic position among U.S. adults aged 50

It is hypothesized that pets provide benefits to human health by buffering the deleterious effects of stress, but varying exposure to chronic stress via social position is rarely considered in these conceptual and empirical models. Allostatic load is an index of biological and physical measures that represents cumulative wear and tear on the body via chronic stress exposure. In this study, we use the 2006-2016 waves of the Health and Retirement Study, a nationally representative, longitudinal panel survey of adults aged 50+ in the United States, to test whether and to what extent pet ownership has an impact on allostatic load, and whether pet ownership moderates the effects of socioeconomic position on allostatic load. Linear mixed effects regression models revealed that pet owners had significantly lower allostatic load scores than those who do not own pets; however, after adjusting for socioeconomic position (i.e., wealth, education, race, ethnicity, gender, marital status), the effect of pet ownership was no longer significant. We estimated a series of models stratified by sociodemographic groups to test moderation effects. Among those who had a high school education, pet owners had lower allostatic load scores, whereas among those who had attended some college, pet owners had higher scores. Among those who were aged 80+, pet owners had higher scores than those who did not own pets. These findings suggest that the magnitude of the effect of pet ownership on allostatic load may not be sufficient to counteract experiences of high chronic stress as experienced by lower-status groups. Supporting the human-animal bond may contribute to improving older adult population health if paired with efforts to address the underlying causes of population health disparities.

Allostatic Load Measurement: A Systematic Review of Reviews, Database Inventory, and Considerations for Neighborhood Research

BACKGROUND

Neighborhoods are critical to understanding how environments influence health outcomes. Prolonged environmental stressors, such as a lack of green spaces and neighborhood socioeconomic disadvantage, have been associated with higher allostatic load levels. Since allostatic load levels experienced earlier in life have stronger associations with mortality risk, neighborhoods may be uniquely suited to monitor and mitigate the impacts of environmental stressors. Researchers often study allostatic load in neighborhoods by utilizing administrative boundaries within publicly accessible databases as proxies for neighborhoods.

METHODS

This systematic review of reviews aims to identify commonly used biomarkers in the measurement of allostatic load, compare measurement approaches, inventory databases to study allostatic load, and spotlight considerations referenced in the literature where allostatic load is studied in neighborhoods. The review was conducted using the search term "allostatic load" in the MEDLINE, CINAHL, and PsychINFO databases. The search results were filtered to include reviews.

RESULTS

The search returned 499 articles after deduplication. Overall, 18 synthesis reviews met the inclusion criteria and were retained for extraction. The synthesis reviews analyzed represented 238 studies published from 1995 to 2020. The original ten biomarkers were most often used to measure allostatic load. More recently, body mass index and C-reactive protein have additionally been frequently used to measure allostatic load burden.

CONCLUSIONS

The scientific contributions of this study are that we have identified a clear gap in geographic considerations when studying allostatic load. The implication of this study is that we have highlighted geographic concepts when conducting neighborhood-level research using administrative databases as a neighborhood proxy and outlined emerging future trends that can enable future study of allostatic load in the neighborhood context.

Measuring allostatic load: Approaches and limitations to algorithm creation

OBJECTIVE

Allostatic load literature has proliferated over the past three decades, and a growing body of research demonstrates that higher levels of allostatic load are associated with a wide range of negative physical and mental health outcomes. However, there remain significant challenges with operationalization of the concept. A scoping review of the methods employed to create an allostatic load algorithm was conducted and recommendations for future research with an orientation towards advancing clinical application of the theory are discussed.

METHODS

A search of seven electronic databases (PubMed, PsycINFO, Social Work Abstracts, Social Service Abstracts, Social Sciences Citation Index (Web of Science), Sociological Abstracts, Scopus) was completed with the search term "allostatic load." Studies were reviewed, and if they met the inclusion criteria, data was extracted, complied, and presented in the narrative, table, and figures.

RESULTS

The initial searches yielded 5280 results with the final sample of 395 non-duplicate articles that met the inclusion criteria. More than half (52.5%) of all included publications employed biomarker cutoffs based on the high-risk quartiles of the sample distribution, 11.1% employed the sum of at-risk clinical scores, and the remainder of studies utilized a range of different algorithms.

CONCLUSION

Allostatic load literature has grown at an exponential rate in recent years, but researchers continue to operationalize the concept via algorithms that may have limited utility moving forward. More nuanced statistical approaches are emerging and should be considered, as should a shift towards an approach that can provide additional clinical utility.

Comparing different operationalizations of allostatic load measured in mid-life and their patterning by race and cumulative life course socioeconomic status

Since its conceptualization, there has been a lack of consensus on the best way to operationalize allostatic load (AL). As a marker of the cumulative, physiological wear and tear on the body resulting from chronic exposure to stressors, it follows that AL should be higher among people who have faced more stressful life experiences. Thus, the purpose of this study was to construct AL scores using different operationalizations and, as a measure of construct validity, compare whether each construction produced expected disparities in AL by race and a composite socioeconomic status (SES) variable which accounts for measures over the life course; we also explored differences by sex. We conducted the study in a sample of 45-52-year-old offspring from the Child Health and Development Studies, a longitudinal birth cohort established in the early 1960s. AL scores were constructed in 6 different ways and included 10 biomarkers from inflammatory, neuroendocrine, cardiovascular, and metabolic systems. Our main approach to constructing AL was to sum across high-risk biomarker quartiles, correct for medication use, and use sex-specific high-risk quartiles for specific biomarkers. Alternative constructions did not use sex-specific quartiles and/or weighted biomarkers within subsystems and/or did not correct for medication use. We estimated differences in AL scores by race, SES, sex and their pairwise interactions. All constructions of AL, including the main approach, produced expected disparities by race (higher scores for Black vs. non-Black participants) and life course SES (higher scores for low vs. high SES participants). However, disparities by sex only emerged when the AL score was constructed via approaches that did not use sex-specific high-risk quartiles; for these alternative constructions, overall, female participants had higher AL scores than male participants and Black female participants had the highest AL scores in the sample. For most constructions, the pairwise interaction between sex and SES, showed a stronger disparity in AL scores between low and high-SES female compared with low- and high-SES male participants; this suggests that, in terms of lowering AL, high life course SES may be more important for female than male participants. In conclusion, our results suggest that the basic AL concept is consistently expressed in different operationalizations, making it an especially useful and robust tool for understanding disparities by race and SES.

Age differences in allostatic load among veterans: The importance of combat exposure

The current study examinedage differences in allostatic load among nonveterans, noncombat veterans, and combat veterans. Participants included 280 individuals from the Midlife Development in the United States (MIDUS) survey, including 164 veterans (n = 48 combat veterans; n = 116 noncombat veterans) and 116 nonveterans. Age differences in allostatic load were similar among nonveterans and noncombat veterans, B = 0.002, SE = .011, p = .878, with older adults showing higher levels of allostatic load than their comparatively younger counterparts. Among combat veterans, however, a different pattern emerged. In this group, levels of allostatic load were similar across age, seemingly due to higher levels of allostatic load among younger combat veterans, B = -0.029, SE = .014, p = .031, ƞ_p ²  =  .022. Results reveal the importance of considering combat exposure when examining health outcomes of military veterans, particularly in the context of age.

Association of Socioeconomic Status With Ideal Cardiovascular Health in Black Men

Background

Black men are burdened by high cardiovascular risk and the highest all‐cause mortality rate in the United States. Socioeconomic status (SES) is associated with improved cardiovascular risk factors in majority populations, but there is a paucity of data in Black men.

Methods and Results

We examined the association of SES measures including educational attainment, annual income, employment status, and health insurance status with an ideal cardiovascular health (ICH) score, which included blood pressure, glucose, cholesterol, body mass index, physical activity, and smoking in African American Male Wellness Walks. Six metrics of ICH were categorized into a 3‐tiered ICH score 0 to 2, 3 to 4, and 5 to 6. Multinomial logistic regression modeling was performed to examine the association of SES measures with ICH scores adjusted for age. Among 1444 men, 7% attained 5 to 6 ICH metrics. Annual income <$20 000 was associated with a 56% lower odds of attaining 3 to 4 versus 0 to 2 ICH components compared with ≥$75 000 (P=0.016). Medicare and no insurance were associated with a 39% and 35% lower odds of 3 to 4 versus 0 to 2 ICH components, respectively, compared with private insurance (all P<0.05). Education and employment status were not associated with higher attainment of ICH in Black men.

Conclusions

Among community‐dwelling Black men, higher attainment of measures of SES showed mixed associations with greater attainment of ICH. The lack of association of higher levels of educational attainment and employment status with ICH suggests that in order to address the long–standing health inequities that affect Black men, strategies to increase attainment of cardiovascular health may need to address additional components beyond SES.

Does allostatic load predict incidental coronary events differently among sexes?

Background

One measure to quantify the degree of dysregulation is allostatic load (AL). Typically, AL incorporates information on diverse biomarkers and is associated with health outcomes such as cardiovascular diseases or the incidence of coronary events (C-E).

Aims

This study investigates the predictive performance of different AL scoring methods on the incidence of coronary events (C-E). This study also elaborates sex differences in the baseline risks of C-E and the AL associated risks of C-E.

Design

Longitudinal data analysis of the Heinz Nixdorf Recall Study (Risk Factors, Evaluation of Coronary Calcification, and Lifestyle) of 4327 participants free of C-E at study baseline aged 45–75. The data contains over 13 biomarkers measuring AL.

Methods

After conducting multiple imputations on missing values on AL for 826 participants, the analysis sample consisted of N = 4327 participants. We applied the two most commonly used methods of AL scoring AL (count-based and Z-score) and a recently developed logistic regression weighting method (LRM) approach. Cox regression was used to predict the incidence of C-E for each AL score. Results were estimated without (M0) and with (M1) covariate adjustment, and in a final model (M2), with an interaction between AL and sex.

Results

We found no violation of the proportional hazard assumption and significant differences in the survival curves between the sexes for C-E (Log-rank test: prob. > Chi² = 0.000). In M0, all AL-scoring methods predicted C-E significantly, with the LRM based AL-score having the best performance (hazard ratio = 3.133; CI: [2.630, 3.732]; Somer's D = 0.717). After covariate inclusion, differences between the scoring methods levelled, though the count-based method and LRM performed better than the Z-scoring method. The interaction analysis in M2 showed a significant multiplicative interaction for the count-based method (1.254; [1.066, 1.475]) and for the LRM (1.746; [1.132, 2.692]). The additive relative excess risk due to interaction (RERI) measure was negative for the count-based method (RERI = −1.967; [-3.778; −0.156]) and the LRM (RERI = −1.909 [-3.910; 0.091]), indicating subadditivity.

Conclusion

AL scores are suitable for predicting C-E. Differences between the AL-scoring algorithms were only present after including interactions. We value the count-based method as suitable for clinical practice since its calculation is relatively simple, and performance was among the best. Interaction analysis revealed that despite strong sex differences in baseline C-E, the effect of AL is more pronounced for females at high levels of AL; thus, females could benefit more from a potential intervention on AL. We suggest further investigation of sex differences concerning the mediation by physiological and psychological intermediates.

Allostatic Load and Its Impact on Health: A Systematic Review

INTRODUCTION

Allostatic load refers to the cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity. When environmental challenges exceed the individual ability to cope, then allostatic overload ensues. Allostatic load is identified by the use of biomarkers and clinical criteria.

OBJECTIVE

To summarize the current knowledge on allostatic load and overload and its clinical implications based on a systematic review of the literature.

METHODS

PubMed, PsycINFO, Web of Science, and the Cochrane Library were searched from inception to December 2019. A manual search of the literature was also performed, and reference lists of the retrieved articles were examined.We considered only studies in which allostatic load or overload were adequately described and assessed in either clinical or non-clinical adult populations.

RESULTS

A total of 267 original investigations were included. They encompassed general population studies, as well as clinical studies on consequences of allostatic load/overload on both physical and mental health across a variety of settings.

CONCLUSIONS

The findings indicate that allostatic load and overload are associated with poorer health outcomes. Assessment of allostatic load provides support to the understanding of psychosocial determinants of health and lifestyle medicine. An integrated approach that includes both biological markers and clinimetric criteria is recommended.

Psychosocial stressors predict lower cardiovascular disease risk among Mexican-American adults living in a high-risk community: Findings from the Texas City Stress and Health Study

The objective of this study was to examine the link between systemic and general psychosocial stress and cardiovascular disease (CVD) risk in a group of U.S. Latinos as a function of acculturation and education within the blended guiding conceptual framework of the biopsychosocial model of the stress process plus the reserve capacity model. We analyzed data from self-identifying Mexican-origin adults (n = 396, 56.9% female, Mage = 58.2 years, 55.5% < 12 years of education, 79% U.S.-born) from the Texas City Stress and Health Study. We used established measures of perceived stress (general stress), neighborhood stress and discrimination (systemic stress) to capture psychosocial stress, our primary predictor. We used the atherosclerotic CVD calculator to assess 10-year CVD risk, our primary outcome. This calculator uses demographics, cholesterol, blood pressure, and history of hypertension, smoking, and diabetes to compute CVD risk in the next 10 years. We also created an acculturation index using English-language use, childhood interaction, and preservation of cultural values. Participants reported years of education. Contrary to expectations, findings showed that higher levels of all three forms of psychosocial stress, perceived stress, neighborhood stress, and perceived discrimination, predicted lower 10-year CVD risk. Acculturation and education did not moderate the effects of psychosocial stress on 10-year CVD risk. Contextualized within the biopsychosocial and reserve capacity framework, we interpret our findings such that participants who accurately reported their stressors may have turned to their social networks to handle the stress, thereby reducing their risk for CVD. We highlight the importance of examining strengths within the sociocultural environment when considering cardiovascular inequities among Latinos.

Allostatic Load and Exposure Histories of Disadvantage

The stress pathway posits that those in disadvantaged circumstances are exposed to a higher degree of stressful experiences over time resulting in an accumulated biological burden which subsequently relates to poorer health. Trajectories of disadvantage, in the form of neighbourhood deprivation and structural social capital, are evaluated in their relation to allostatic load representing the cumulative “wear and tear” of chronic stress. This paper uses data from the British Household Panel Survey and Understanding Society in a latent class growth analysis. We identify groups of exposure trajectories over time using these classes to predict allostatic load at the final wave. The results show that persistent exposure to higher deprivation is related to worse allostatic load. High structural social capital over time relates to lower allostatic load, in line with a stress buffering effect, though this relationship is not robust to controlling for individual sociodemographic characteristics. By demonstrating a gradient in allostatic load by histories of deprivation, this analysis supports a biological embedding of disadvantage through chronic exposure to stressful environments as an explanation for social health inequalities.

The relationship between traffic-related air pollution exposures and allostatic load score among youth with type 1 diabetes in the SEARCH cohort

OBJECTIVE

We investigated the effects of chronic exposures to particulate and traffic-related air pollution on allostatic load (AL) score, a marker of cumulative biological risk, among youth with type 1 diabetes.

RESEARCH DESIGN AND METHODS

Participants were drawn from five clinical sites of the SEARCH for Diabetes in Youth (SEARCH) study (n = 2338). Baseline questionnaires, anthropometric measures, and a fasting blood test were taken at a clinic visit between 2001 and 2005. AL was operationalized using 10 biomarkers reflecting cardiovascular, metabolic, and inflammatory risk. Annual residential exposures to PM2.5 and proximity to heavily-trafficked major roadways were estimated for each participant. Poisson regression models adjusted for sociodemographic and lifestyle factors were conducted for each exposure.

RESULTS

No significant associations were observed between exposures to PM2.5 or proximity to traffic and AL score, however analyses were suggestive of effect modification by race for residential distance to heavily-trafficked major roadways (p = 0.02). In stratified analyses, residing <100, 100-<200 and 200-<400 m compared to 400 m or more from heavily-trafficked major roadways was associated with 11%, 26% and 14% increases in AL score, respectively (95% CIs: -4, 29; 9, 45; -1, 30) for non-white participants compared to 6%, -2%, and -2% changes (95% CIs: -2, 15; -10, 7; -8, 6) for white participants.

CONCLUSIONS

Among this population of youth with type 1 diabetes, we did not observe consistent relationships between chronic exposures to particulate and traffic-related air pollution and changes in AL score, however associations for traffic-related pollution exposures may differ by race/ethnicity and warrant further examination.

Chronic environmental contamination: A narrative review of psychosocial health consequences, risk factors, and pathways to community resilience

A body of psychological and social scientific evidence suggests that the experience of technological disaster or long-term exposure to environmental contamination can be psychologically stressful. Addressing the psychosocial impact in communities living with chronic contamination is therefore a vital part of improving their resilience. Guided by a synthetic theoretical model of the unique psychosocial impact of chronic environmental contamination (in contrast to natural and technological disasters, and background pollution), we undertook a narrative review to assess the current research on this important social problem. Relevant qualitative peer-reviewed studies and grey literature were examined to derive a model identifying likely factors increasing risk for distress in chronic contamination experience and actions that may be taken by public health professionals and local leaders to enhance community resilience and take health-protective actions. Based on our initial theoretical model and the literature reviewed, we emphasize the importance of considering both the material and social dimensions of chronic environmental contamination experience. For instance, our review of the qualitative literature suggests that individuals who attribute material health impacts to contamination, and who have the social experience of their concerns being delegitimized by responsible institutions, are most at risk for psychological stress. Psychological stress in the context of chronic contamination is an important potential public health burden and a key area for additional research.

Serum osteocalcin is associated with subjective stress in people with depression and type 2 diabetes

BACKGROUND

Low serum osteocalcin is a risk factor for type 2 diabetes mellitus (T2DM), and osteocalcin release from bone is associated with an acute stress response in mice. Both diabetes and stress are associated with depression. Here, we assess relationships between serum osteocalcin, depression and subjective stress in people with T2DM.

METHODS

Participants with T2DM (HbA1c above 6.4 %, impaired fasting glucose or impaired glucose tolerance) were assessed for a major depressive episode using the research version of the Structured Clinical Interview for DSM-5 depression criteria (SCID-5RV). Subjective stress over the past month was assessed using the Perceived Stress Scale (PSS). Serum carboxylated (cOCN) and fully decarboxylated (dcOCN) osteocalcin were assayed from fasting morning blood by commercial enzyme-linked immunosorbent assay.

RESULTS

Among 95 participants (mean age 62.4 ± 9.9, 51 % women), 22 % were experiencing a depressive episode (9 men, 12 women). The presence of a depressive episode was not associated with dcOCN or cOCN concentrations; however, higher concentrations of cOCN were associated with higher PSS scores in participants with depression (r = 0.585, p = 0.005). In an analysis of covariance model controlling for age, sex, body mass index, glycemic control (glycosylated hemoglobin), insulin resistance (homeostatic model), depression, and antidepressant use, cOCN was associated with PSS scores (F=10.302, p = 0.002), and this relationship was stronger in those with depression (depression × cOCN interaction F=4.978, p = 0.028). Although associations between dcOCN concentrations and PSS scores did not reach significance, the same trend seen with cOCN concentrations was observed in participants with depression for dcOCN (r=0.365, p=0.10), and for a depression × dcOCN interaction associated with PSS scores in the whole group (F=2.165, p = 0.15).

CONCLUSIONS

Osteocalcin is a neuroendocrine marker associated with perceived chronic stress among people with T2DM experiencing a depressive episode.

Weathering in Detroit: Place, Race, Ethnicity, and Poverty as Conceptually Fluctuating Social Constructs Shaping Variation in Allostatic Load

Policy Points Despite 30 years of attention to eliminating population health inequity, it remains entrenched, calling for new approaches. Targeted universalism, wellness-based local development, and Jedi Public Health approaches that are community informed, evidence based, and focused on improving everyday settings and diverse lived experiences are important policy directions. State and federal revenue transfers are necessary to mitigate the harms of austerity and assure greater equity in fiscal and population health in places like Detroit, Michigan.

CONTEXT

US population health inequity remains entrenched, despite mandates to eliminate it. To promote a public health approach of consequence in this domain, stakeholders call for moving from risk-factor epidemiology toward consideration of dynamic local variations in the physiological impacts of structured lived experience.

METHODS

Using a community-based, participatory research approach, we collected and analyzed a unique data set of 239 black, white, and Mexican adults from a stratified, multistage probability sample of three Detroit, Michigan, neighborhoods. We drew venous blood, collected saliva, took anthropometric measurements, and assayed specimens to measure allostatic load (AL), an indicator of stress-mediated biological dysregulation, linking participants' AL scores and survey responses. In a series of nested Poisson models, we regressed AL on socioeconomic, psychosocial, neighborhood, and behavioral stressors to test the hypothesis that race/ethnicity and poverty-to-income ratio (PIR) are conceptually fluctuating variables whose impacts on AL are sensitive to structured lived experience.

FINDINGS

White and Mexican Detroit participants with PIR < 1 have higher AL than counterparts nationally; black participants in Detroit and nationwide had comparable AL. Within Detroit, disparities by PIR were higher in whites than blacks, with no significant difference by PIR in Mexicans. The size of estimated effects of having PIR < 1 for whites is 58 percentage points greater than that of Mexicans and twice that of blacks.

CONCLUSIONS

Structurally rooted unobserved heterogeneity bias threatens the validity of independent main effects interpretations of associations between race/ethnicity, socioeconomic characteristics, or place and health. One-size-fits-all analytic or policy models developed from the perspective of the dominant social group insufficiently address the experiences of diverse populations in specific settings and historical moments; nor do they recognize culturally mediated protective resources residents may have developed against material and psychosocial hardship.

Susceptibility Variations in Air Pollution Health Effects: Incorporating Neuroendocrine Activation

Diverse host factors/phenotypes may exacerbate or diminish biological responses induced by air pollutant exposure. We lack an understanding of biological indicators of environmental exposures that culminate in a physiological response versus those that lead to adversity. Variations in response phenotype might arise centrally and/or at the local tissue level. In addition to genetic differences, the current evidence supports the roles of preexisting cardiopulmonary diseases, diabetes, diet, adverse prenatal environments, neurobehavioral disorders, childhood infections, microbiome, sex, and psychosocial stressors in modifying the susceptibility to air pollutant exposures. Animal models of human diseases, obesity, nutritional inadequacies, and neurobehavioral conditions have been compared with healthy controls to understand the causes of variations in susceptibility. Although psychosocial stressors have been associated with increased susceptibility to air pollutant effects, the contribution of neuroendocrine stress pathways in mediating these effects is just emerging. The new findings of neuroendocrine activation leading to systemic metabolic and immunological effects of air pollutants, and the potential contribution to allostatic load, emphasize the consideration of these mechanisms into susceptibility. Variations in susceptibility to air pollution health effects are likely to underlie host genetic and physiological conditions in concert with disrupted neuroendocrine circuitry that alters physiological stability under the influence of stressors.

Objective and subjective stress, personality, and allostatic load

INTRODUCTION

Despite the understanding of allostatic load (AL) as a consequence of ongoing adaptation to stress, studies of the stress-AL association generally focus on a narrow conceptualization of stress and have thus far overlooked potential confounding by personality. The present study examined the cross-sectional association of objective and subjective stress with AL, controlling for Big Five personality traits.

METHODS

Participants comprised 5,512 members of the Copenhagen Aging and Midlife Biobank aged 49-63 years (69% men). AL was measured as a summary index of 14 biomarkers of the inflammatory, cardiovascular, and metabolic system. Objective stress was assessed as self-reported major life events in adult life. Subjective stress was assessed as perceived stress within the past four weeks.

RESULTS

Both stress measures were positively associated with AL, with a slightly stronger association for objective stress. Adjusting for personality traits did not significantly change these associations.

CONCLUSIONS

The results suggest measures of objective and subjective stress to have independent predictive validity in the context of personality. Further, it is discussed how different operationalizations of stress and AL may account for some of the differences in observed stress-AL associations.

Understanding Embodiment in Place-Health Research: Approaches, Limitations, and Opportunities

Research on how place affects health continues to grow. Within the place-health research field, there is increasing focus on how place becomes embodied-i.e., how place-based social and environmental experiences and exposures "get under our skin" to affect physiological functioning and health. While much has been learned, currently favored place-embodiment research approaches present limitations that inhibit continued gains in understanding. This article presents a brief summary of place-health literature related to place-embodiment, highlighting common approaches. Core limitations are then discussed with an eye towards improving research going forward, highlighting mixed-method, spatially dynamic, and participatory intergenerational approaches as promising considerations.

Allostatic Load: Importance, Markers, and Score Determination in Minority and Disparity Populations

Allostatic load is a physiological measure of the cumulative burden of stress on the body assessed by markers of physiological dysregulation. It is a multisystem construct that quantifies biological risk which leads to poor health and maladaptive trajectories. In this overview, which is based on a presentation made at the Flip the Script: Understanding African American Women's Resilience in the Face of Allostatic Load meeting at Ohio State University in August 2018, we build upon previous reviews by discussing four key aspects of allostatic load, specifically its: (1) importance, (2) operationalization, (3) use in minority health and health disparities research, and (4) value in such research. Operationalized in various ways, allostatic load is composed of 10 original markers and additional markers deriving from research among minority and disparity populations. The markers represent four biological systems: (1) cardiovascular, (2) metabolic, (3) inflammatory, and (4) neuroendocrine. System-specific racial/ethnic and sex-based differences have been observed. An overall score can be determined using sample-generated or empirically derived clinically relevant cut points. In summary, allostatic load provides an overall and a body system-specific mechanistic link between exposures to stressors and health outcomes that may help explain health disparities among minority populations.

Neighbourhood characteristics and cumulative biological risk: evidence from the Jamaica Health and Lifestyle Survey 2008: a cross-sectional study

OBJECTIVE

To examine whether neighbourhood characteristics are associated with cumulative biological risk (CBR) and sex differences in CBR in a nationally representative sample in Jamaica, a small island developing country with increasing prevalence of non-communicable diseases (NCDs).

DESIGN

Cross-sectional study SETTING: A population-based cross-sectional survey, the Jamaica Health and Lifestyle Survey 2008 (JHLS II) recruited persons at their homes over a 4 month period from all 14 parishes and 113 neighbourhoods defined as enumeration districts (EDs).

PARTICIPANTS

2544 persons aged 15-74 years old from the 2008 Jamaica Health and Lifestyle Survey (JHLS II), who completed interviewer-administered questionnaires and had biomarkers assessed, and whose home addresses could be reliably geocoded.

PRIMARY OUTCOME

A summary measure CBR was created using seven markers-systolic and diastolic blood pressure readings, waist circumference, body mass index, total cholesterol, fasting blood glucose levels and self-reported asthma. Weighted multilevel models examined clustering, using the intraclass correlation coefficient (ICC), of CBR across neighbourhoods and the impact of neighbourhood characteristics (recreational space availability and neighbourhood disorder) on CBR.

RESULTS

Women had significantly higher mean CBR scores than men across all age groups. There was significant clustering of CBR by ED, and among women versus men (ICC: F=6.9%, M=0.7%). Women living in more disordered neighbourhoods were 26% more likely to have high CBR as those in less disordered ones (aOR=1.26, 95% CI=1.08 to 1.47; p<0.05). Individuals living in EDs with greater recreational space availability were 25% less likely to have a high CBR (aOR=0.75, 95% CI=0.64 to 0.90; p<0.05).

CONCLUSIONS

Policy-makers in Jamaica should pay greater attention to neighbourhood factors such as recreational space availability and neighbourhood disorder that may contribute to CBR in any effort to curtail the epidemic of NCDs.

End-of-day reports of daily hassles and stress in men and women with opioid-use disorder: Relationship to momentary reports of opioid and cocaine use and stress

BACKGROUND AND AIMS

Stress can be validly assessed "live" or by a summary evaluation of the very recent past. Using smartphone-based ecological momentary assessment (EMA) combined with end-of-day (EOD) entries, we assessed the association between daily hassles, stressful events and use of opioids and cocaine, in opioid- and cocaine-using men and women.

METHODS

For up to 16 weeks, 161 outpatients in opioid-agonist treatment who reported cigarette smoking carried smartphones on which they reported stressful events (SEs) and drug use (DU) and completed an EOD questionnaire to report hassles encountered throughout the day, current perceived stress, cigarettes/day, and current mood. We compared EOD responses on days with and without SE and DU reports and on days when thrice-weekly urine drug screens indicated opioid or cocaine use or abstinence.

RESULTS

Participants (N = 161) made 11,544 EOD entries; EMA SEs were reported on 861 (7.5%) days, and DUs on 1685 (14.6%) days. The most frequently reported hassles in EOD entries were "not enough money" (31.4% of daily reports) and maintaining abstinence (18.7%). Total EOD hassles showed small but statistically significant associations [odds ratios (95% CIs)] with EMA SEs [1.09 (1.06-1.13)], DUs [1.08 (1.06-1.10)], and urine-positive opioid [1.06 (1.04-1.09)] and cocaine [1.03 (1.00-1.06)] results. Men and women had similar rates (mean/day (SD)) of hassles: men 2.25 (3.55); women 2.55 (3.76) (F_1,159 = 0.53, p = 0.47).

CONCLUSIONS

Daily hassles, reported at the end of the day, are associated with both same-day stressful events and drug use. Monitoring hassles and devising specific coping strategies might be useful therapeutic targets.

Neighborhood, Socioeconomic, and Racial Influence on Chronic Pain

The purpose of this review is to highlight the neighborhood, socioeconomic, and racial influences on chronic pain. Negative influences on the experience of chronic pain are explored and defined as any adverse stressor common in low socioeconomic, urban neighborhoods that potentially contributes to health disparity in African Americans experiencing chronic pain. The multifactorial influences on chronic pain disparity in African Americans are explored and expounded upon in this review of existing evidence. Databases used for the search included CINAHL, PubMed, and PsycArticles. The experience of chronic pain is multifaceted, existing with multiple comorbidities and lasting consequences. To improve the burden of chronic pain requires a multifactorial assessment that considers neighborhood risk factors, emphasis on environmental stressors, limitations to support networks, barriers to physical activity, and access to primary care providers with whom communication is open and without bias. A comprehensive assessment of barriers will aid in the development of interventions that reach beyond the physical factors of chronic pain, also considering the psychosocial barriers to improving the burden of chronic pain in African Americans living in impoverished urban neighborhoods.

Neighborhood cohesion, neighborhood disorder, and cardiometabolic risk

Perceptions of neighborhood disorder (trash, vandalism) and cohesion (neighbors trust one another) are related to residents' health. Affective and behavioral factors have been identified, but often in studies using geographically select samples. We use a nationally representative sample (n = 9032) of United States older adults from the Health and Retirement Study to examine cardiometabolic risk in relation to perceptions of neighborhood cohesion and disorder. Lower cohesion is significantly related to greater cardiometabolic risk in 2006/2008 and predicts greater risk four years later (2010/2012). The longitudinal relation is partially accounted for by anxiety and physical activity.

Changes in Allostatic Load during workplace reorganization

OBJECTIVE

Allostatic Load (AL) represents the strain on the body produced by repeated physiologic or allostatic responses activated during stressful situations. Several cross-sectional studies have found empirical substantiation for the relationship between impaired psychosocial work environment and high AL. The aim of this longitudinal study is to investigate changes in AL during workplace reorganization that has been shown to cause impaired psychosocial work environment. Moreover, we aim to investigate the association between changes in AL and changes in psychosocial work environment (job strain, effort-reward imbalance) and psychological distress (stress symptoms and perceived stress).

METHODS

A major reorganization of non-state public offices was effectuated in Denmark on 1 January 2007. In 2006 and 2008, we collected clinical and questionnaire data from 359 participants, 265 women and 94 men, employed in seven municipality or county administrations. Four municipalities and one county merged with others, while one municipality and one county remained unmerged. We calculated the AL score based on 13 physiological markers reflecting stress responses of the cardiovascular, metabolic, neuroendocrine and immune systems. We analysed changes in AL from 2006 to 2008.

RESULTS

AL increased significantly during workplace reorganization in the whole study group but we observed only a tendency of significant increase in AL in the merger group compared with the control group. Moreover, we observed no association between the changes in AL and changes in psychosocial work environment and psychological distress.

CONCLUSIONS

This result leaves the conclusion unclear but contributes to the limited research in this area with a longitudinal design and focus on low-risk levels and small changes in AL in healthy people as predictor of future disease.

Navigating 'riskscapes': The experiences of international health care workers responding to the Ebola outbreak in West Africa

This paper draws on interview data to examine how international health care workers navigated risk during the unprecedented Ebola outbreak in West Africa. It identifies the importance of place in risk perception, including how different spatial localities give rise to different feelings of threat or safety, some from the construction of physical boundaries, and others mediated through aspects of social relations, such as trust, communication and team dynamics. Referring to these spatial localities as 'riskscapes', the paper calls for greater recognition of the role of place in understanding risk perception, and how people navigate risk.

Cortisol dysregulation: the bidirectional link between stress, depression, and type 2 diabetes mellitus

Controversy exists over the role of stress and depression in the pathophysiology of type 2 diabetes mellitus. Depression has been shown to increase the risk for progressive insulin resistance and incident type 2 diabetes mellitus in multiple studies, whereas the association of stress with diabetes is less clear, owing to differences in study designs and in forms and ascertainment of stress. The biological systems involved in adaptation that mediate the link between stress and physiological functions include the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous and immune systems. The HPA axis is a tightly regulated system that represents one of the body's mechanisms for responding to acute and chronic stress. Depression is associated with cross-sectional and longitudinal alterations in the diurnal cortisol curve, including a blunted cortisol awakening response and flattening of the diurnal cortisol curve. Flattening of the diurnal cortisol curve is also associated with insulin resistance and type 2 diabetes mellitus. In this article, we review and summarize the evidence supporting HPA axis dysregulation as an important biological link between stress, depression, and type 2 diabetes mellitus.

Policy, Research and Residents' Perspectives on Built Environments Implicated in Heart Disease: A Concept Mapping Approach

An underrepresentation of stakeholder perspectives within urban health research arguably limits our understanding of what is a multi-dimensional and complex relationship between the built environment and health. By engaging a wide range of stakeholders using a participatory concept mapping approach, this study aimed to achieve a more holistic and nuanced understanding of the built environments shaping disease risk, specifically cardiometabolic risk (CMR). Moreover, this study aimed to ascertain the importance and changeability of identified environments through government action. Through the concept mapping process, community members, researchers, government and non-government stakeholders collectively identified eleven clusters encompassing 102 built environmental domains related to CMR, a number of which are underrepresented within the literature. Among the identified built environments, open space, public transportation and pedestrian environments were highlighted as key targets for policy intervention. Whilst there was substantive convergence in stakeholder groups' perspectives concerning the built environment and CMR, there were disparities in the level of importance government stakeholders and community members respectively assigned to pedestrian environments and street connectivity. These findings support the role of participatory methods in strengthening how urban health issues are understood and in affording novel insights into points of action for public health and policy intervention.

Nativity differences in allostatic load by age, sex, and Hispanic background from the Hispanic Community Health Study/Study of Latinos

Allostatic load (AL), an index of biological "wear and tear" on the body from cumulative exposure to stress, has been little studied in US Hispanics/Latinos. We investigated AL accumulation patterns by age, sex, and nativity in the Hispanic Community Health Study/Study of Latinos. We studied 15,830 Hispanic/Latinos of Mexican, Cuban, Dominican, Puerto Rican, Central and South American descent aged 18-74 years, 77% of whom were foreign-born. Consistent with the conceptualization of AL, we developed an index based upon 16 physiological markers that spanned the cardiometabolic, parasympathetic, and inflammatory systems. We computed mean adjusted AL scores using log-linear models across age-groups (18-44, 45-54, 55-74 years), by sex and nativity status. Among foreign-born individuals, differences in AL by duration of residence in the US (<10, ≥10 years) and age at migration (<24, ≥24 years) were also examined. In persons younger than 55 years old, after controlling for socioeconomic and behavioral factors, AL was highest among US-born individuals, intermediate in foreign-born Hispanics/Latinos with longer duration in the US (≥10 years), and lowest among those with shorter duration in the US (<10 years) (P <0.0001 for increasing trend). Similarly, AL increased among the foreign-born with earlier age at immigration. These trends were less pronounced among individuals ≥55 years of age. Similar patterns were observed across all Hispanic/Latino heritage groups (P for interaction=0.5). Our findings support both a "healthy immigrant" pattern and a loss of health advantage over time among US Hispanics/Latinos of diverse heritages.

Allostatic Load as a Complex Clinical Construct: A Case-Based Computational Modeling Approach

Allostatic load (AL) is a complex clinical construct, providing a unique window into the cumulative impact of stress. However, due to its inherent complexity, AL presents two major measurement challenges to conventional statistical modeling (the field's dominant methodology): it is comprised of a complex causal network of bioallostatic systems, represented by an even larger set of dynamic biomarkers; and, it is situated within a web of antecedent socioecological systems, linking AL to differences in health outcomes and disparities. To address these challenges, we employed case-based computational modeling (CBM), which allowed us to make four advances: (1) we developed a multisystem, 7-factor (20 biomarker) model of AL's network of allostatic systems; (2) used it to create a catalog of nine different clinical AL profiles (causal pathways); (3) linked each clinical profile to a typology of 23 health outcomes; and (4) explored our results (post hoc) as a function of gender, a key socioecological factor. In terms of highlights, (a) the Healthy clinical profile had few health risks; (b) the pro-inflammatory profile linked to high blood pressure and diabetes; (c) Low Stress Hormones linked to heart disease, TIA/Stroke, diabetes, and circulation problems; and (d) high stress hormones linked to heart disease and high blood pressure. Post hoc analyses also found that males were overrepresented on the High Blood Pressure (61.2%), Metabolic Syndrome (63.2%), High Stress Hormones (66.4%), and High Blood Sugar (57.1%); while females were overrepresented on the Healthy (81.9%), Low Stress Hormones (66.3%), and Low Stress Antagonists (stress buffers) (95.4%) profiles.

Neighborhood features and physiological risk: An examination of allostatic load

Poor neighborhoods may represent a situation of chronic stress, and may therefore be associated with health-related correlates of stress. We examined whether lower neighborhood income would relate to higher allostatic load, or physiological well-being, through psychological, affective, and behavioral pathways. Using data from the Biomarker Project of the Midlife in the United States (MIDUS) study and the 2000 Census, we demonstrated that people living in lower income neighborhoods have higher allostatic load net of individual income. Moreover, findings indicate that this relation is partially accounted for by anxious arousal symptoms, fast food consumption, smoking, and exercise habits.

Biological costs of economic transition: Stress levels during the transition from communism to capitalism in Poland

At the end of the 1980s, Poland began the transformation from an essentially one-party communist system to a politically pluralistic democratic system. These political and economic changes had major social consequences, among others unemployment and a sharp decrease in real personal income. The aim of the study was to investigate the possible relationship between stress in adult men, measured by the Allostatic Load, and the socio-economic deterioration during the first part of the economic transition. The Allostatic Load included eleven markers assessing adverse nutritional intake, cardiovascular activity, inflammatory processes, and lung, hepatic and renal functions. The results indicate a significantly higher risk of metabolic dysregulation in men examined after 1990, compared to men from previous years. After adjustment for socioeconomic variables and lifestyle variables, men examined in 1991 had a 31% greater risk of higher Allostatic Load compared with men examined in 1985 (OR=1.31; p=0.0541), in 1992, this risk was 50% greater (OR=1.50; p<0.01), and in 1993, the risk was 66% greater (OR=1.66; p<0.05). The conclusion is drawn that significantly more stressogenic factors for men were those directly connected with the financial situation of their families, than a sudden but short increase of prices for goods and services.

The importance of age, sex and place in understanding socioeconomic inequalities in allostatic load: Evidence from the Scottish Health Survey (2008-2011)

BACKGROUND

Given the broad spectrum of health and wellbeing outcomes that are patterned by socioeconomic position (SEP), it has been suggested that there may be common biological pathways linking SEP and health. Allostatic load is one such pathway, which aims to measure cumulative burden/dysregulation across multiple physiological systems. This study aimed to determine the contextual and demographic factors (age, sex and place) that may be important in better understanding the links between lower SEP and higher allostatic load.

METHODS

Data were from a nationally representative sample of adults (18+): the Scottish Health Survey (2008-2011). Higher SEP ('1') was defined as having 'Higher'-level, secondary school qualifications versus having lower level or no qualifications ('0'). For allostatic load, a range of 10 biomarkers across the cardiovascular, metabolic and immune systems were used. Respondents were scored "1" for each biomarker that fell into the highest quartile of risk. Linear regressions were run in STATA, including SEP, age (continuous and as a 7-category variable), sex (male/female), urbanity (a 5-category variable ranging from primary cities to remote rural areas) and geographical location (based on 10 area-level healthboards). Interactions between SEP and each predictor, as well as stratified analyses, were tested.

RESULTS

Lower SEP was associated with higher allostatic load even after adjusting for age, sex and place (b = -0.631, 95 % CI -0.795, -0.389, p < 0.001). There was no significant effect moderation between SEP and age, sex or place. Stratified analysis did show that the inequality identified in the baseline models widened with age, becoming significant at ages 35-44, before narrowing at older ages (75+). There was no difference by sex, but more mixed findings with regards place (urbanity or geographical location), with a mix of significant and non-significant results by SEP that did not appear to follow any pattern.

CONCLUSIONS

Inequalities in allostatic load by educational attainment, as a measure of SEP, are consistent with age, sex and place. However, these stratified analyses showed that these inequalities did widen with age, before narrowing in later life, matching the patterns seen with other objective and subjective health measures. However, effect moderation analysis did not support evidence of a statistically significant interaction between age and SEP. Context remains an important feature in understanding and potentially addressing inequalities, although may be less of an issue in terms of physiological burden.

Family Environment and the Metabolic Syndrome: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study (SCAS)

BACKGROUND

Metabolic syndrome (MetS) is a risk factor for cardiovascular disease. Very limited work has evaluated associations of sociocultural processes with prevalence of the MetS.

PURPOSE

The purpose of the present study was to evaluate associations between family environment (cohesion/conflict) and the MetS, in a multi-site sample of US Hispanics/Latinos.

METHODS

A total of 3278 participants from the Hispanic Community Health Study/Study of Latinos underwent a clinical exam and completed psychosocial measures including family environment (cohesion and conflict) as part of the Sociocultural Ancillary Study.

RESULTS

The association between family environment and the MetS was moderated by sex. Among all women, higher family conflict was associated with MetS prevalence. Results by ancestry group showed that only among Cuban women, higher conflict was associated with the MetS, whereas only among Dominican men, greater cohesion was associated with the MetS.

CONCLUSIONS

The family context may be a sociocultural protective or risk factor among Hispanics/Latinos in terms of MetS risk, but these associations may vary by sex and Hispanic background.

Dysbiotic drift: mental health, environmental grey space, and microbiota

Advances in research concerning the mental health implications of dietary patterns and select nutrients have been remarkable. At the same time, there have been rapid increases in the understanding of the ways in which non-pathogenic microbes can potentially influence many aspects of human health, including those in the mental realm. Discussions of nutrition and microbiota are often overlapping. A separate, yet equally connected, avenue of research is that related to natural (for example, green space) and built environments, and in particular, how they are connected to human cognition and behaviors. It is argued here that in Western industrial nations a ‘disparity of microbiota’ might be expected among the socioeconomically disadvantaged, those whom face more profound environmental forces. Many of the environmental forces pushing against the vulnerable are at the neighborhood level. Matching the developing microbiome research with existing environmental justice research suggests that grey space may promote dysbiosis by default. In addition, the influence of Westernized lifestyle patterns, and the marketing forces that drive unhealthy behaviors in deprived communities, might allow dysbiosis to be the norm rather than the exception in those already at high risk of depression, subthreshold (subsyndromal) conditions, and subpar mental health. If microbiota are indeed at the intersection of nutrition, environmental health, and lifestyle medicine (as these avenues pertain to mental health), then perhaps the rapidly evolving gut-brain-microbiota conversation needs to operate through a wider lens. In contrast to the more narrowly defined psychobiotic, the term eco-psychotropic is introduced.

Allostatic load model associated with indoor environmental quality and sick building syndrome among office workers

This study investigates whether indoor environmental quality (IEQ) influences allostatic load (AL) and whether AL can be a predictor for sick building syndrome (SBS). We also assessed and compared the associations between AL and SBS versus 8-hydroxydeoxyguanosine (8-OHdG) and SBS. A total of 115 office workers from 21 offices completed self-reported SBS questionnaires, and provided 11 biomarkers for their AL. Multiple linear regressions and logistic regression analysis were applied to examine the correlations between IEQ and AL or 8-OHdG and between AL or 8-OHdG and SBS, respectively. Our data revealed that the neuroendocrine system was correlated with CO₂, the difference between indoor and outdoor CO₂ levels (dCO₂), and the indoor-outdoor ratio of CO₂ (CO₂ I/O). Metabolic system effects were associated with illumination. The relationships between illumination, CO₂, dCO₂, CO₂ I/O and 8-OHdG were consistent with those and AL in specific systems. Furthermore, we found that risks for SBS syndromes were related with neuroendocrine and metabolic system of the AL. 8-OHdG was associated with eye dryness or irritation, eye tiredness and vomiting. We conclude that IEQ significantly influences AL and that AL can be a predictor for reporting SBS with information on system-specific effects.

Type 2 diabetes and cardiovascular disease: what next?

PURPOSE OF REVIEW

Cardiovascular disease (CVD) is the leading cause of mortality in type 2 diabetes mellitus (T2DM), and modifying cardiovascular risk through lifestyle intervention and pharmacologic therapy is paramount. This review focuses on recent advances in treatment of classical (traditional) cardiovascular risk factors and highlights the impact of novel risk factors, including sleep disorders, socioeconomic status and chronic psychological stress on CVD in T2DM.

RECENT FINDINGS

Obesity is a substantial cardiovascular risk factor, and recently, large trials of lifestyle and surgical (e.g. gastric bypass) interventions impact on CVD in overweight and obese patients have been reported. Lifestyle intervention including low calorie diet and exercise reduced individual cardiovascular risk factors but did not decrease the rate of long-term cardiovascular events. Bariatric surgery was beneficial in reducing cardiovascular risk factors and long-term cardiovascular events. Sleep insufficiency, poor sleep quality and obstructive sleep apnoea lead to higher CVD and further research is needed to characterize the benefit of treating sleep disorders on long-term cardiovascular events in T2DM. Lastly, socioeconomic status and chronic psychological stress independently have a major impact on increasing CVD in T2DM, and public health policies to reduce this burden will be important to address over the coming decade.

SUMMARY

CVD in T2DM is multifactorial and requires a multifaceted approach in reducing known cardiovascular risks at the individual patient level through lifestyle, pharmacotherapy and surgical interventions and at the societal level through public health policies that support reduction in classical and novel cardiovascular risk factors.

The relationship between daily hassles and sexual function in men and women

Psychological stressors can interfere with sexual function through psychological and physiological mechanisms. Chronic stress, in particular, seems to have a negative effect on sexual functioning for men and women. The present study was designed to identify categories of stressors that contribute to sexual difficulties as well as assess the role of anxiety and depression in the relationship between stress and sexual function. Participants were recruited for an online survey in which they completed questionnaires on daily stressors, anxiety, depression, and sexual function. Results indicated that daily stressors predicted lower scores on sexual satisfaction for men and women and sexual activity for women. These effects were mediated by scores on the depression scale. Daily stressors, depression, and anxiety were highly correlated. A factor analysis of stressors resulted in 5 distinct categories of stressors. Of these, financial stressors and stressors related to low socioeconomic status were related to lower scores on all aspects of sexual functioning for women but not for men. Women's sexual functioning scores were more strongly related to stress and depression than men's scores. Results suggest that contextual factors (e.g., daily stressors, depression) are important considerations when assessing problems with sexual functioning.

Life-course accumulation of neighborhood disadvantage and allostatic load: empirical integration of three social determinants of health frameworks

OBJECTIVES

We examined if the accumulation of neighborhood disadvantages from adolescence to mid-adulthood were related to allostatic load, a measure of cumulative biological risk, in mid-adulthood, and explored whether this association was similar in women and men.

METHODS

Data were from the participants in the Northern Swedish Cohort (analytical n = 818) at ages 16, 21, 30, and 43 years in 1981, 1986, 1995, and 2008. Personal living conditions were self-reported at each wave. At age 43 years, 12 biological markers were measured to operationalize allostatic load. Registered data for all residents in the cohort participants' neighborhoods at each wave were used to construct a cumulative measure of neighborhood disadvantage. Associations were examined in ordinary least-squares regression models.

RESULTS

We found that cumulative neighborhood disadvantage between ages 16 and 43 years was related to higher allostatic load at age 43 years after adjusting for personal living conditions in the total sample (B = 0.11; P = .004) and in men (B = 0.16; P = .004), but not in women (B = 0.07; P = .248).

CONCLUSIONS

Our findings suggested that neighborhood disadvantage acted cumulatively over the life course on biological wear and tear, and exemplified the gains of integrating social determinants of health frameworks.

Does exposure to stressors predict changes in physiological dysregulation?

BACKGROUND

The allostatic load framework implies that cumulative exposure to stressors results in multi-system physiological dysregulation.

PURPOSE

The purpose of this study was to investigate the effect of stress burden on subsequent changes (2000-2006) in physiological dysregulation.

METHODS

Data came from a population-based cohort study in Taiwan (n = 521, aged 54+ in 2000, re-examined in 2006). Measures of stressful events and chronic strain were based on questions asked in 1996, 1999, and 2000. A measure of trauma was based on exposure to the 1999 earthquake. Dysregulation was based on 17 biomarkers (e.g., metabolic, inflammatory, neuroendocrine).

RESULTS

There were some small effects among men: chronic strain was associated with subsequent increases in dysregulation (standardized β = 0.08, 95 % CI = 0.01 to 0.20), particularly inflammation; life events were also associated with increased inflammation (β = 0.10, CI = 0.01 to 0.26). There were no significant effects in women.

CONCLUSIONS

We found weak evidence that stress burden is associated with changes in dysregulation.

Chronic stress and sexual function in women

INTRODUCTION

Chronic stress is known to have negative effects on reproduction, but little is known about how it affects the sexual response cycle. The present study examined the relationship between chronic stress and sexual arousal and the mechanisms that mediate this relationship.

AIM

The aim of this study is to test the relationship between chronic stress and sexual arousal and identify mechanisms that may explain this relationship. We predicted that women experiencing high levels of chronic stress would show lower levels of genital arousal and dehydroepiandrosterone (DHEAS) and higher levels of cortisol and cognitive distraction compared with women with average levels of stress.

METHODS

Women who were categorized as high in chronic stress (high stress group; n=15) or average in chronic stress (average stress group; n=15) provided saliva samples and watched an erotic film while having their genital and psychological arousal measured.

MAIN OUTCOME MEASURES

Main outcome measures were vaginal pulse amplitude, psychological arousal, salivary cortisol, salivary DHEAS, and heart rate and compared them between women with high and average levels of chronic stress.

RESULTS

Women in the high stress group had lower levels of genital, but not psychological arousal, had higher levels of cortisol, and reported more distraction during the erotic film than women in the average stress group. The main predictor of decreased genital sexual arousal was participants' distraction scores.

CONCLUSIONS

High levels of chronic stress were related to lower levels of genital sexual arousal. Both psychological (distraction) and hormonal (increased cortisol) factors were related to the lower levels of sexual arousal seen in women high in chronic stress, but distraction was the only significant predictor when controlling for other variables.

ALLOSTATIC LOAD AND SOCIOECONOMIC STATUS IN POLISH ADULT MEN

This study considers the relationship between a cumulative index of biological dysregulation (allostatic load) and several dimensions of socioeconomic status (SES) and lifestyle in adult Polish males. The extent to which lifestyle variables can explain SES variation in allostatic load was also evaluated. Participants were 3887 occupationally active men aged 25–60 years living in cities and villages in the Silesia region of Poland. The allostatic load indicator included eleven markers: % fat (adverse nutritional intake), systolic and diastolic blood pressures (cardiovascular activity), FEV1 (lung function), erythrocyte sedimentation rate (inflammatory processes), glucose and total cholesterol (cardiovascular disease risk), total plasma protein (stress-haemoconcentration), bilirubin, creatinine clearance and alkaline phosphatase activity (hepatic and renal functions). A higher level of completed education, being married and residing in an urban area were associated with lower physiological dysregulation. The association between indicators of SES and allostatic load was not eliminated or attenuated when unhealthy lifestyle variables were included in the model. Smoking status and alcohol consumption played minimal roles in explaining the association between SES and allostatic load; physical activity, however, had a generally protective effect on allostatic load.