Race/ethnic and socioeconomic differences in stress and immune function in The National Longitudinal Study of Adolescent Health

Physiological and genomic signatures of war and displacement: A comprehensive literature review and future directions

There are now 108.4 million forcibly displaced people worldwide, many of whom endure adversities that result in trauma, toxic stress, and potentially, altered epigenetic development. This paper provides a comprehensive review of current literature on the biological signatures of war and forced migration among refugee populations. To consolidate evidence and identify key concerns and avenues for future research, we reviewed 36 publications and one article under review, published since 2000, most of which focused on refugees relocated in Europe and the Middle East. This body of work - including cross-sectional, observational, and experimental studies - reveals heterogenous findings regarding human biological responses to war-related adversities and their associations with health outcomes. We conclude with four main observations, regarding why genomic and physiological biomarkers are valuable, what study designs advance understanding of causality and health-promoting interventions, how to prepare for ethical challenges, and why theoretical frameworks and research procedures need more detailed consideration in scientific publications.

Moving toward affective immunology: Legacy and future directions

The term "affective immunology" has recently been used to denote a field focused on the interplay between affective processes (including mood states, specific emotions, and regulatory processes) and various aspects of immune function. The overarching goals of this commentary are a) to provide historical underpinnings of this field with a focus on the profound impact of the work of Janice Kiecolt-Glaser, who is further honored in this special issue, b) to review important off-shoots of her legacy work in this domain, and c) to highlight important future directions for the field. Kiecolt-Glaser's work laid much of the foundation for affective immunology, with groundbreaking research related to depression, hostility and dyadic interactions, loneliness, and other affective patterns, often in the context of holistic models, novel experimental designs, and interventions. Her former mentees (and many of their mentees) have carried on her legacy in these domains, in ways that continue to advance appreciation of how affective processes relate to immune function. There are numerous remaining questions for the field to pursue, including better understanding of the role of emotion regulation, emotional reactivity and recovery, restorative processes, affective variability, and developmental and dynamic social processes. Such work will require greater use of longitudinal and within-person approaches and/or examination of processes in daily life, as well as models that account for interactive and reciprocal processes and which integrate behavior, social context, sociocultural factors, individual differences, and other aspects of health. As more work in these domains continues, building on Kiecolt-Glaser's rich legacy, we move toward the emergence of affective immunology as an important subfield in the domain of psychoneuroimmunology, one which will offer more nuanced understanding of the role of affective processes in immune health.

Racial and Ethnic Disparities in the Incidence of Anti-NMDA Receptor Encephalitis

OBJECTIVES

To estimate the incidence of anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis.

METHODS

We conducted a retrospective cohort study of >10 million person-years of observation from members of Kaiser Permanente Southern California, 2011-2022. The electronic health record of individuals with text-string mention of NMDA and encephalitis were reviewed to identify persons who met diagnostic criteria for anti-NMDAR encephalitis. Age-standardized and sex-standardized incidences stratified by race and ethnicity were estimated according to the 2020 US Census population.

RESULTS

We identified 70 patients who met diagnostic criteria for anti-NMDAR encephalitis. The median age at onset was 23.7 years (IQR = 14.2-31.0 years), and 45 (64%) were female patients. The age-standardized and sex-standardized incidence of anti-NMDAR encephalitis per 1 million person-years was significantly higher in Black (2.94, 95% CI 1.27-4.61), Hispanic (2.17, 95% CI 1.51-2.83), and Asian/Pacific Island persons (2.02, 95% CI 0.77-3.28) compared with White persons (0.40, 95% CI 0.08-0.72). Ovarian teratomas were found in 58.3% of Black female individuals and 10%-28.6% in other groups.

DISCUSSION

Anti-NMDA receptor encephalitis disproportionately affected Black, Hispanic, or Asian/Pacific Island persons. Ovarian teratomas were a particularly common trigger in Black female individuals. Future research should seek to identify environmental and biological risk factors that disproportionately affect minoritized individuals residing in the United States.

Refugee health and physiological profiles in transitional settlements in Serbia and Kenya: Comparative evidence for effects of gender and social support

When armed conflict compels people to flee from their homelands, they embark on protracted journeys during which they experience wide ranging physical, social, and psychological challenges. Few studies have focused on refugee psychosocial and physiological profiles during the transitional phase of forced migration that often involves temporary sheltering. Transient refugees' experiences can vary substantially based on local socio-ecological conditions in temporary settlements, including the length of stay, living conditions, as well as the availability and accessibility of physical and social resources. In this study, we compared physiological and psychosocial data from refugees (N=365; 406 observations) in Serbia and Kenya, respectively, with divergent temporal (length of stay) and socio-ecological conditions. In Serbia, refugees resided in asylum centers (mean stay: 0.9 y); in Kenya they were living in Kakuma Refugee Camp (mean stay: 8.8 y), one of the world's largest camps at the time. We had limited ability to directly compare psychosocial measures and used meta-analytic techniques to evaluate predictors of refugee mental and physical health at the two sites, including based on perceived social support. Refugees in Serbia had higher fingernail cortisol (p < 0.001) and were less likely to have elevated C-reactive protein (CRP) levels (p < 0.01) than refugees in Kakuma. We found common gender differences in both settings; women had lower cortisol but higher EBV antibody titers and higher likelihood of having elevated CRP compared to men (all p < 0.01). Woman also reported poorer mental and physical health (p < 0.001). These physiological and health differences may reflect variation between men and women in their psychosocial and physical experiences of factors such as stress, violence, and trauma during their journeys and as transitional refugees. Finally, we also found that refugees with lower levels of perceived social support reported poorer physical and mental health (p < 0.001). Although our results are cross-sectional, they suggest that this intermittent phase of the refugee experience is a key window for helping enhance refugee well-being through an emphasis on interpersonal and community support systems.

C-reactive protein and telomerase reverse transcriptase (TERT) associate with chronic disease markers in a sample from low-income neighborhoods in Detroit, Michigan

Racial and ethnic minorities in economically deprived inner cities experience high rates of chronic diseases compared to neighborhoods with higher socioeconomic status (SES). However, these economically deprived populations are understudied in terms of biomarkers associated with chronic disease risk which include C-reactive protein (CRP), telomerase reverse transcriptase (TERT), and glycosylated hemoglobin (A1C). We examined relationships between CRP and TERT and chronic disease indicators (body mass index [BMI] and A1C) in two low-income, predominantly African American (AA) neighborhoods in Detroit, Michigan. Sixty-nine adults (43 females, 26 males, mean age 46 years [y], standard deviation [SD] ​= ​15.9) completed a health survey, anthropometry, and finger stick blood tests. A1C was measured using A1CNow test strips, and CRP and TERT levels were measured using enzyme-linked immunosorbent assay (ELISA) with samples extracted from dried blood spots. We examined CRP (mean ​= ​4.9, SD ​= ​3.1), TERT (mean ​= ​32.5, SD ​= ​15.1), and A1C (mean ​= ​5.4, SD ​= ​1.0) by BMI category. We fitted restricted maximum likelihood regression models to evaluate associations between CRP, TERT, BMI, and A1C, after adjustment for demographics and inclusion of a random effect for the neighborhood. In this predominantly AA sample (91%, 63/69), 68% had levels of CRP (means ​= ​4.8 ​mg/L, SD ​= ​3.0 for AAs; 6.4 ​mg/L, SD ​= ​3.9 for all others) indicative of chronic inflammation (CRP greater than 3 ​mg/L). BMI was significantly associated with CRP (p ​= ​0.004) and TERT (p ​= ​0.026). TERT levels indicate that being overweight is associated with markers of chromosome remodeling, suggestive of chronic disease. CRP followed a similar trend with overweight individuals having higher inflammation and risk of chronic disease. Our findings warrant further exploration of additional factors that may influence CRP and TERT. Furthermore, examining populations in a more ethnically and/or economically diverse, yet still high proportion minority, sample will fill a knowledge gap in this understudied field.

Daily Relations Between Stress and Electroencephalography-Assessed Sleep: A 15-Day Intensive Longitudinal Design With Ecological Momentary Assessments

BACKGROUND

Recent studies have found bi-directional relations between stress and sleep. However, few studies have examined the daily associations between stress and electroencephalography (EEG) measured sleep.

PURPOSE

This study examined the temporal associations between repeated ecological momentary assessments of stress and EEG-estimated sleep.

METHODS

Ninety-eight international or interstate undergraduate students (Mage = 20.54 ± 1.64, 76.5% female, 84.7% Asian) reported their stress levels four times daily at morning awakening, afternoon, evening, and pre-bedtime across 15 consecutive days (>4,000 total observations). Next-day stress was coded as an average of morning, afternoon, and evening stress. Z-Machine Insight+ recorded over 1,000 nights EEG total sleep time (TST), sleep onset latency, wake after sleep onset, sleep efficiency (SE), slow-wave sleep (SWS), and rapid eye movement (REM) sleep duration. Multilevel models, adjusted for covariates (i.e., sociodemographic, health factors, and daily covariates) and lagged outcomes, tested the daily within- and between-level stress-sleep associations.

RESULTS

After adjusting for covariates, within-person shorter TST (b = -0.11 [-0.21, -0.01], p = .04), lower SE (b = -0.02 [-0.03, 0.00], p = .04), less SWS (b = -0.38 [-0.66, -0.10], p = .008), and less REM sleep (b = -0.32 [-0.53, -0.10], p = .004) predicted higher next-day stress. Pre-bedtime stress did not predict same-night sleep. No significant results emerged at the between-person level.

CONCLUSIONS

These findings demonstrate that poor or short sleep, measured by EEG, is predictive of higher next-day stress. Results for sleep architecture support the role of SWS and REM sleep in regulating the perception of stress. Given that only within-person effects were significant, these findings highlight the importance of examining night-to-night fluctuations in sleep affecting next-day stress and its impact on daytime functioning.

The relations between discrimination, stressful life events, and substance use among adults experiencing homelessness

The current study investigated whether stressful life events and everyday discrimination experiences were associated with using one or more substances in the past 30-days and substance use disorder (SUD) among adults experiencing homelessness. We obtained survey data from adults (N = 501) seeking services at a day shelter. Participants self-reported whether they used cigarettes, other tobacco products, cannabis, alcohol, opioids, amphetamine, and cocaine/crack in the past 30-days, and the total number of substances used were also calculated. We measured stressful life events and everyday discrimination using validated scales. We used multivariable logistic and negative binomial regression analyses to evaluate hypothesised associations. Results indicated that reporting a higher number of stressful life events was associated with past 30-days cannabis, tobacco, alcohol, and other substance use, screening positive for a SUD, and using a greater number of substances in the past 30 days. After accounting for stressful life events, everyday discrimination was associated with only past 30-days cannabis use. Overall, we found that reporting stressful life events was related to current substance use and screening positive for a SUD. Findings suggest that life stressors, and discrimination to a lesser extent, were associated with substance use and SUD among adults experiencing homelessness.

Racial differences in psychological stress and insulin sensitivity in non-Hispanic Black and White adolescents with overweight/obesity

INTRODUCTION

Racial differences in type 2 diabetes risk persist among non-Hispanic Black and non-Hispanic White adolescents with overweight/obesity; however, the role of psychological stress in this disparity is less clear.

PURPOSE

To examine racial differences in the association between psychological stress, insulin sensitivity (S_i), acute insulin response to glucose (AIR_g), and disposition index (DI) among non-Hispanic Black and non-Hispanic White adolescents with overweight/obesity.

METHODS

Ninety-six adolescents (60% female; 51% non-Hispanic Black; 16.6 ± 1.8 years of age) with overweight/obesity (BMI percentile ≥ 85th percentile) were included in this analysis. Psychological stress was assessed using the 14-item Perceived Stress Scale. Glucose and insulin data from an intravenous glucose tolerance test was modeled to obtain S_i, AIR_g, and DI. Multivariable linear regression models were used to examine the association between race, psychological stress and metabolic outcomes (S_i, AIR_g, and DI).

RESULTS

Race was a significant predictor of log-AIR_g and log-DI (ps < 0.05) independent of all covariates in the main effect models. Lower S_i (p_interaction = 0.014) and DI (p_interaction = 0.012) was also observed among Black adolescents who reported higher stress levels, whereas higher S_i and DI was observed among non-Hispanic White adolescents reporting higher stress in the race interaction models. Race however, did not moderate the association between psychological stress and AIR_g (p > 0.05), nor was stress associated with S_i, AIR_g, or DI ("p" "s" > 0.05) across all other models.

CONCLUSIONS

Psychological stress may play an important and distinct role in shaping racial differences in type 2 diabetes risk among adolescents with overweight/obesity. Additional research is needed to understand the long-term effects of psychological stress on metabolic health among non-Hispanic Black and non-Hispanic White adolescents with overweight/obesity.

High Parental Education Protects Against Changes in Adolescent Stress and Mood Early in the COVID-19 Pandemic

PURPOSE

The COVID-19 pandemic has brought dramatic changes to the daily lives of U.S. adolescents, including isolation from friends and extended family, transition to remote learning, potential illness and death of loved ones, and economic distress. This study's purpose is to measure changes in adolescents' perceived stress and mood early in the pandemic.

METHODS

The present study drew from a racially and ethnically diverse sample of high school student participants in an ongoing intervention study in the Midwestern U.S., 128 of whom provided reports of their daily stress and mood both before (December 2017 to March 2020) and during (March-July 2020) the COVID-19 pandemic. We expected to see increases in perceived stress, declines in positive mood states, and increases in negative mood states, with larger impacts on individuals from households with lower parental education levels.

RESULTS

Multilevel models revealed increases in perceived stress primarily for adolescents from low/moderate education families during the pandemic. Impacts on mood states also diverged by education: adolescents from low/moderate education households reported feeling more ashamed, caring, and excited than before the pandemic, changes that were not shared by their peers from high education households. Although changes in mood that arose with the onset of the pandemic became less pronounced over time, increased levels of home- and health-related stress stayed high for low/moderate education adolescents.

CONCLUSIONS

During the COVID-19 period, we observed disparate impacts on adolescents according to household education level, with more dramatic and negative changes in the emotional well-being of adolescents from low/moderate education households.

Racial and Economic Adversity Differences in Stress Markers and Immune Function Among Urban Adolescents

BACKGROUND

Exposure to racism and associated adversities, such as poverty, is hypothesized to contribute to racial inequities in health via stress and immune pathways. Furthermore, the effects of adversity may be more salient during sensitive developmental periods. Our study examined racial differences in stress and immune biomarkers during adolescence and the effects of exposure to economic adversity at distinct developmental time periods and cumulatively in accounting for potential racial differences.

METHODS

Secondary analysis of the Adolescent Health and Development in Context study was conducted. Data were derived from self-administered surveys; interviews; smartphone-based, geographic-explicit ecological momentary assessment; stress biomarkers (evening salivary cortisol over six nights and hair cortisol); and immune biomarkers (salivary shedding of Epstein-Barr virus [EBV] DNA among EBV-positive adolescents). Current socioeconomic status measures included annual household income and caregiver education. Caregivers also reported experiences of bankruptcy, difficulty paying bills, receipt of food stamps/Supplemental Nutrition Assistance Program/electronic benefit transfer, and job loss when the child was of ages birth-5 years, 6-10 years, and 11 years or older. An affirmative response to any item was defined as exposure to economic adversity for that developmental time period (yes/no). A cumulative economic adversity measure was calculated as the sum of exposures across developmental periods (0 = never exposed to 3 = exposed across all time periods). Descriptive and multivariable regression analyses were conducted, accounting for covariates.

RESULTS

Black/African American adolescents had higher salivary cortisol concentration, higher hair cortisol concentration, and an increased odd of salivary shedding of EBV DNA compared to White adolescents. Racial differences were not attenuated by the current socioeconomic status or economic adversity (developmental period or cumulatively).

DISCUSSION

Our study provides evidence that stress and immune biomarkers differ by race as early as adolescence and may be one pathway through which racism and associated adversities contribute to racial health inequities. Further research on the contribution of multiple adversities beyond poverty to racial inequities in physiological stress and health is critical for informing effective prevention and intervention efforts.

Personality Traits and Perceptions of Major Life Events

Research examining the associations between major life events and personality trait development is mixed. Work that evaluates perceptions of life events and how those perceptions are themselves associated with personality traits may help clarify the existing literature. We used a large student sample ( N = 1,509) and a demographically diverse sample from a Qualtrics panel ( N = 552) to conduct exploratory analyses examining the associations between the big five personality traits and perceptions of life events. Results suggested that (a) associations between personality and beliefs about event-related personality change differ between students and more representative samples, (b) associations between personality and event perceptions are often nuanced, and (c) event perceptions are not merely proxies for personality traits. These studies highlight the importance of subjective event perceptions in the study of major life events and personality.

Parent-child relationship quality and adolescent health: Testing the differential susceptibility and diathesis-stress hypotheses in African American youths

This study tested two competing models of differential susceptibility and diathesis-stress in a prospective longitudinal study of African American youths (N = 935). It examined whether individual variations in the functioning of the hypothalamic-pituitary-adrenocortical axis at age 11 interact with middle childhood parent-child relationship quality to predict mental and physical health problems in adolescence (ages 11-15 years old). Adolescent boys with lower levels of cortisol reactivity to laboratory challenges had the highest levels of internalizing problems if they experienced a high conflictual relationship with their parents. Equally low-reactive boys, however, reported the lowest number of physical illnesses if their relationship with their parents was characterized by high levels of intimacy and support.

Variations in IgG antibody subclass responses to oral bacteria: Effects of periodontal disease and modifying factors

BACKGROUND AND OBJECTIVE

Local and systemic IgG antibodies or oral bacteria have been described with periodontitis. We extended these observations by assessing the impact of a range of intrinsic factors on serum IgG subclass antibodies to both commensal and pathogenic oral bacteria that would contribute to variations in immune protection or disease susceptibility in periodontitis have not been described.

METHODS

Subjects (n = 278) were classified as healthy, gingivitis, or periodontitis and categorized as mild, moderate, and severe periodontitis. Demographic stratification included sex, age, race/ethnicity, smoking, and obesity. Whole formalin-fixed bacteria were used as antigens to detect serum immunoglobulin (Ig)G subclass antibody levels using an ELISA.

RESULTS

The greatest differences in variations in IgG subclasses occurred in periodontitis versus health or gingivitis to bacteria considered oral pathogens (eg, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Treponema denticola) with IgG1, IgG2, and IgG4 increased by three- to sevenfold with Pg. Differences in subclass levels and distribution were also observed related to disease severity, particularly related to individual subclass responses to Pg. Examination of the overall population showed that females had elevated antibody, reflected by elevated IgG2 amounts/proportions. The older group of subjects demonstrated elevated antibody to multiple oral bacteria, lacking any particular subclass pattern. IgG2 antibody to Aa and Pg was increased in smokers. Multiple IgG subclass antibody levels to oral pathogens were significantly decreased in the obese subset within this population.

CONCLUSION

This investigation identified patterns of IgG subclass antibody responses to oral bacteria and demonstrated substantial effects of disease impacting the level and subclass distribution of antibody to an array of oral bacteria. Altered subclass antibody profiles most often in IgG2 levels and for antibody to P. gingivalis were found related to sex, age, disease severity, race/ethnicity, smoking, and obesity to both pathogens and commensal bacteria.

Maternal Childhood Adversity Associates With Frontoamygdala Connectivity in Neonates

BACKGROUND

It is well established that exposure to adversity, especially during sensitive periods of development such as childhood, has both behavioral (e.g., increasing one's risk for psychiatric illnesses) and neurobiological consequences. But could these effects of early-life exposure to adversity also be transmitted across generations? We directly address this question, investigating the associations between maternal exposure to adversity during her own childhood and neural connectivity in her neonate.

METHODS

Mothers from a sample of Black mother-neonate dyads (n = 48)-a group that is disproportionately affected by early-life adversity-completed questionnaires assessing their current distress (i.e., a composite measure of anxiety, depression, and perceived stress) during the first and third trimesters of pregnancy and retrospectively reported on their own childhood experiences of abuse and neglect. At 1 month postpartum, neonatal offspring of these women underwent a resting-state functional magnetic resonance imaging scan during natural sleep.

RESULTS

Greater maternal exposure to emotional neglect during her own childhood correlated with stronger functional connectivity of two different frontoamygdala circuits in these neonates, as early as 1 month after birth. This effect was specific to early experiences of emotional neglect and was not explained by maternal exposure to other forms of childhood maltreatment or by maternal distress during pregnancy.

CONCLUSIONS

These results provide novel evidence that the absence of emotional support early in a mother's life, years before conception, are associated with neural changes-namely, in functional connectivity between the amygdala and medial prefrontal regions-in her offspring shortly after birth.

From social determinants to social epigenetics: Health geographies of chronic disease

Social epigenetics explores relationships between social factors and health inequities embodied at the molecular level. Through modulating gene expression, epigenetic changes resulting from human-environment interactions may play a role in shaping health trajectories. This paper applies a health geography lens to explore the potential and support for conducting social epigenetic studies of chronic diseases with complex and dynamic etiologies. In so doing, we argue that social epigenetics presents a novel space for investigations of health and disease that is transdisciplinary and builds upon new understandings of bodies and place-based experiences. Given gender disparities in chronic diseases, we adopt a feminist perspective that cogitates the transactive relationships between gender and health/ill-health as mediated by biosocial processes at a variety of scales. Looking forward to the practical undertaking of social epigenetic studies, we assess existing theoretical and methodological support as well as insights to be gained. Reflecting upon the central tenets of health geography, we propose a unique positionality for health geographers to drive this field forward.

Stress, Sleep, and Coping Self-Efficacy in Adolescents

Adults are thought to show a sleep-stress spiral in which greater stress worsens sleep quality, which amplifies stress, which leads to worse sleep. This study examined whether adolescents show a similar spiral, and if so, whether coping self-efficacy-believing one can cope with stress-interrupts the spiral. Temporal dynamics of perceived stress, sleep quality, and coping self-efficacy were tracked in 381 9th graders (49% female, mean age 14.43, age range 14-16) using daily surveys across two school weeks (3184 observations). Though expected associations were evident between individuals, only a unidirectional path was found within individuals from sleep quality to perceived stress via coping self-efficacy. This challenges the conventional bidirectional understanding of sleep-stress relations and suggests coping self-efficacy as an intervention target.

Validity of the Trier Social Stress Test in studying discrimination stress

To test the validity of a modified Trier Social Stress Test (TSST) for studying stress reactivity in sexual minority women. Two hundred seventy-four female participants (66.4% Black American), half of whom identified as lesbian/gay or bisexual and half as heterosexual, completed the TSST with instructions to describe an experience of discrimination. Cortisol levels and negative emotion scores increased, and heart rate variability decreased in response to the TSST, and the magnitude of these responses varied as a function of sexual orientation and race. Women who discussed sexual orientation as a source of discrimination had greater increases in cortisol and negative mood following the TSST. The modified instructions did not compromise the validity of the TSST. Prompting participants to discuss specific sources of discrimination may be a useful adaptation of the TSST in studying minority stress reactivity. SUMMARY The goal of the present study was to adapt a widely used measure of stress reactivity to study the impact of experiences with discrimination on biological systems involved in regulating the stress response. The modification included asking women to discuss a time when they had been treated unfairly and to describe how they responded to that experience. The magnitude of response to the task varied as a function of sexual orientation and race, and the topics discussed, demonstrating usefulness of the modification for studying the impact of discrimination stress of physical health.

Do documented records and retrospective reports of childhood maltreatment similarly predict chronic inflammation?

BACKGROUND

Childhood adversities have been associated with chronic inflammation and risk for cardiovascular disease. With some exceptions, existing knowledge of this relationship is based on retrospective self-reports, potentially subject to recall bias or memory problems. We seek to determine whether childhood maltreatment is associated with higher C-reactive protein (CRP) later in life and whether individuals with official and retrospective self-reports of maltreatment and men and women show similar increases in risk.

METHODS

Data are from in-person interviews in 2009-2010 with 443 offspring (mean age = 23.4) of parents in a longitudinal study of the consequences of childhood maltreatment. Official reports of maltreatment were abstracted from 2011-2013 Child Protective Services records. Eleven measures were used to assess self-reported maltreatment retrospectively. Seventeen percent of offspring had official reports, whereas self-reported prevalence rates ranged from 5.4% to 64.8%. CRP was assessed through blood spot samples. Regression models were used to estimate the effect of maltreatment on inflammation, adjusting for age, sex, race, parent occupational status, current depression, smoking, and heavy drinking.

RESULTS

Individuals with official reports of child maltreatment and, specifically, physical abuse, had significantly higher levels of CRP than non-maltreated individuals. Maltreated females showed elevated CRP, independent of control variables, whereas no significant association was observed in males. Retrospective self-report measures of child maltreatment did not predict elevated CRP.

CONCLUSIONS

Individuals with documented histories of childhood maltreatment are at increased risk for chronic inflammation and may benefit from targeted interventions. The results strengthen inferences about the effects of childhood maltreatment on inflammation in females.

Relationship satisfaction determines the association between Epstein-Barr virus latency and somatic symptoms after the loss of a spouse

The loss of a spouse is associated with a host of negative health outcomes. While bereaved individuals commonly report somatic symptoms, no investigations exist of the association between reactivation of latent Epstein-Barr virus (EBV) and somatic symptoms among this population. Further, how an individual perceives the quality of their lost relationship in retrospect may impact loss outcomes. Among 99 bereaved spouses, elevated EBV antibody titers were associated with somatic symptoms for those who retrospectively reported high or mean levels of relationship satisfaction (RS), but not among those less satisfied. Further, higher RS was associated with greater grief symptoms. This study identifies higher retrospective RS as a possible risk factor for negative physical and mental health outcomes during bereavement.

C-reactive protein, Epstein-Barr virus, and cortisol trajectories in refugee and non-refugee youth: Links with stress, mental health, and cognitive function during a randomized controlled trial

Experiencing childhood adversity has been associated with significant changes in inflammation, cell-mediated immunocompetence, and cortisol secretion. Relatively few studies have examined, longitudinally, alterations to inflammatory processes during adolescence, especially outside Western contexts; none have evaluated biomarker trajectories for at-risk youth in response to a structured behavioral intervention. We conducted a randomized controlled trial evaluating the efficacy of a humanitarian intervention targeting stress-alleviation, with 12-18 year-old Syrian refugees (n = 446) and Jordanian non-refugees (n = 371) living side-by-side in war-affected communities in Jordan. We measured C-reactive protein (CRP), Epstein-Barr virus antibodies (EBV), and hair cortisol concentration (HCC) at three timepoints (pre/post intervention and 11 month follow-up), and assessed three main outcomes (psychosocial stress, mental health, and cognitive function). Using growth mixture models, regressions, and growth curve models, we identified three distinct trajectories for CRP, two for EBV, and three for HCC, and examined their associations with age, gender, BMI, poverty, and trauma. We found associations with BMI for CRP, refugee status for EBV, and BMI and gender with HCC trajectory. In terms of health outcomes, we found associations between rising CRP levels and perceived stress (B =  -2.92, p = .007), and between HCC hypersecretion and insecurity (B = 7.21, p = .017). In terms of responses to the intervention, we observed no differential impacts by CRP or EBV trajectories, unlike HCC. These results suggest that commonly-assayed biomarkers do not associate with health outcomes and respond to targeted interventions in straightforward ways. Our study is the first to examine multiple biomarker trajectories in war-affected adolescents, in order to better evaluate the extent, timing, and malleability of the biological signatures of poverty, conflict, and forced displacement.

A systematic review of the impact of psychosocial factors on immunity: Implications for enhancing BCG response against tuberculosis

BACKGROUND

Tuberculosis (TB) remains an urgent global public health priority, causing 1.5 million deaths worldwide in 2018. There is evidence that psychosocial factors modulate immune function; however, how this may influence TB risk or BCG vaccine response, and whether this pathway can be modified through social protection, has not been investigated. This paper aims to: a) systematically review evidence of how psychosocial factors influence the expression of biomarkers of immunity, and b) apply this general evidence to propose plausible TB-specific pathways for future study.

METHODS

Papers reporting on the impact of psychosocial stressors on immune biomarkers in relation to infectious disease risk were identified through a search of the databases MEDLINE, PsycINFO, Global Health and PsycEXTRA alongside reference list and citation searching of key papers. Data extraction and critical appraisal were carried out using a standardised form. The findings were tabulated and synthesised narratively by infectious disease category, and used to propose plausible mechanisms for how psychosocial exposures might influence immune outcomes relevant to TB and BCG response.

RESULTS

27,026 citations were identified, of which 51 met the inclusion criteria. The literature provides evidence of a relationship between psychosocial factors and immune biomarkers. While the direction and strength of associations is heterogenous, some overarching patterns emerged: adverse psychosocial factors (e.g. stress) were generally associated with compromised vaccine response and higher antibody titres to herpesviruses, and vice versa for positive psychosocial factors (e.g. social support).

CONCLUSIONS

The evidence identifies pathways linking psychosocial factors and immune response: co-viral infection and immune suppression, both of which are potentially relevant to TB and BCG response. However, the heterogeneity in the strength and nature of the impact of psychosocial factors on immune function, and lack of research on the implications of this relationship for TB, underscore the need for TB-specific research.

The reciprocal impacts of adversity and personality traits: A prospective longitudinal study of growth, change, and the power of personality

OBJECTIVE

We integrate the study of post-traumatic growth with personality science by examining the reciprocal effects of adversity and core personality traits. We implemented conceptual (i.e., incorporating personality traits into the study of adversity-related growth, examining trait-specific and configural personality change, and adopting a cumulative approach to adversity) and methodological (i.e., three-wave prospective design, assessing many life events, sampling from populations likely to experience adversity) innovations to advance the study of personality development and of the generality of adversity-related growth.

METHOD

A diverse sample (41% nonwhite, 48% low-income, 68% female, M_age  = 44, 30% diagnosed with Borderline Personality Disorder) participated in a three-wave prospective longitudinal study (N = 258-128 across waves). Participants completed a personality inventory and a battery of life-event surveys (including 105 events) at each wave.

RESULTS

Personality was generally stable from trait-specific and configural perspectives, and all traits were correlated with adversity. All traits, particularly Extraversion and Conscientiousness, predicted adversity. Adversity predicted increases in Emotionality and decreases in Agreeableness.

CONCLUSIONS

Although personality growth is not the typical response to adversity within a 3-year period, findings underscore the real-world impact of personality, and they provide some support for developmental theories emphasizing the effects of life events.

Finding Jobs, Forming Families, and Stressing Out? Work, Family, and Stress among Young Adult Women in the United States

The transition to adulthood is increasingly characterized by complex paths into the world of work and family, especially for young women. Yet how work and family combine to influence stress among young adult women is not well understood. Using data from the National Longitudinal Study of Adolescent to Adult Health, we leverage new extensions to latent class analysis (LCA) to identify common combinations of work and family circumstances among young adult women, their earlier life and contemporaneous correlates, and associations with two stress measures: a multi-item Perceived Stress Scale (PSS) and Epstein–Barr Viral (EBV) antibody titers, a well-validated biomarker of stress-related immunity impairments. We identify seven different common combinations of latent work–family combinations among young adult women ranging from well-compensated professional workers with and without children, mothers without paid employment, and delayed transitions to work and family. Completing a college degree was associated with a higher likelihood of membership in classes marked by professional work irrespective of motherhood, while being raised in a community with greater female labor opportunities was generally associated with membership in child-free classes. Mothers and child-free women in “pink-collar” work with low wages and decision-marking freedom reported higher stress compared to women in “white-collar” work with higher wages and decision-making freedom. These differences are mostly attenuated following adjustments for poverty-related stressors and work–family conflict. While prior work has emphasized the health benefits for women of combining work and family, our research suggests these benefits may be limited to women of higher socioeconomic status with flexible, well-compensated jobs.

Life Expectancy and Mortality Rates in the United States, 1959-2017

Importance

US life expectancy has not kept pace with that of other wealthy countries and is now decreasing.

Objective

To examine vital statistics and review the history of changes in US life expectancy and increasing mortality rates; and to identify potential contributing factors, drawing insights from current literature and an analysis of state-level trends.

Evidence

Life expectancy data for 1959-2016 and cause-specific mortality rates for 1999-2017 were obtained from the US Mortality Database and CDC WONDER, respectively. The analysis focused on midlife deaths (ages 25-64 years), stratified by sex, race/ethnicity, socioeconomic status, and geography (including the 50 states). Published research from January 1990 through August 2019 that examined relevant mortality trends and potential contributory factors was examined.

Findings

Between 1959 and 2016, US life expectancy increased from 69.9 years to 78.9 years but declined for 3 consecutive years after 2014. The recent decrease in US life expectancy culminated a period of increasing cause-specific mortality among adults aged 25 to 64 years that began in the 1990s, ultimately producing an increase in all-cause mortality that began in 2010. During 2010-2017, midlife all-cause mortality rates increased from 328.5 deaths/100 000 to 348.2 deaths/100 000. By 2014, midlife mortality was increasing across all racial groups, caused by drug overdoses, alcohol abuse, suicides, and a diverse list of organ system diseases. The largest relative increases in midlife mortality rates occurred in New England (New Hampshire, 23.3%; Maine, 20.7%; Vermont, 19.9%) and the Ohio Valley (West Virginia, 23.0%; Ohio, 21.6%; Indiana, 14.8%; Kentucky, 14.7%). The increase in midlife mortality during 2010-2017 was associated with an estimated 33 307 excess US deaths, 32.8% of which occurred in 4 Ohio Valley states.

Conclusions and Relevance

US life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (eg, drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, with an onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England. The implications for public health and the economy are substantial, making it vital to understand the underlying causes.

Socioenvironmental adversity and risk of prostate cancer in non-Hispanic black and white men

Non-Hispanic black (NHB) men experience higher risk of prostate cancer than other racial/ethnic groups, and it is possible that socioenvironmental (SE) adversity and resulting stress may contribute to this disparity. Data from the Southern Community Cohort Study were used to evaluate associations between SE adversity and perceived stress in relation to prostate cancer risk, overall and by race/ethnicity and grade. Between 2002 and 2009, 26,741 men completed a questionnaire, from which an 8-item SE adversity composite was created (covering socioeconomic status, residential environment, and social support/buffers). Two items from the Perceived Stress Scale were assessed. With follow-up through 2011, 527 prostate cancer cases were diagnosed. In multivariable models, each one-unit increase in the SE adversity composite was associated with increased prostate cancer risk among non-Hispanic white (NHW) men (HR 1.23; 95% CI 1.02-1.48) and reduced risk among NHB men (HR 0.89; 95% CI 0.82-0.95) (p interaction: 0.001). This pattern held for low grade, but not high grade, cancers although power was limited for the latter. Perceived stress variables were associated with increased risk of prostate cancer among NHW men, but not among NHB men. Results do not support the hypothesis that SE adversity my underlay the racial disparity in prostate cancer, over and above that of covariates, including healthcare utilization.

Early childhood family instability and immune system dysregulation in adolescence

Exposure to stress is one way in which social disadvantages during childhood may alter biological and psychological systems with long-term consequences. Family social and economic conditions are critical for early childhood development and exposure to difficult family conditions may have lasting physiological effects. However, there is little research linking early childhood conditions with physiological indicators of stress and system dysregulation in adolescence. In this study, we assess how family social and economic instability that occurred in early childhood (birth to age 5) is associated with immune system dysregulation in adolescence, as indicated by DNA shedding of the Epstein-Barr virus (EBV). We utilize a biomarker of EBV obtained through saliva, a non-invasive method of collecting immune-system biomarkers, in 674 adolescents 11-17 years old. Multivariable regression results indicated that experiences of moving into a new parent/caregiver household or moving in with a grandparent during early childhood was associated with an estimated 100% increase in EBV DNA shedding among prior EBV-infected adolescents. Other measures of early childhood family instability, total number of family structure changes and economic insecurity, were marginally significant. Contemporaneous family conditions were not associated with adolescents' EBV DNA shedding.

The impact of intimate partner violence, depressive symptoms, alcohol dependence, and perceived stress on 30-year cardiovascular disease risk among young adult women: A multiple mediation analysis

Intimate partner violence (IPV), the physical, sexual, psychological abuse or control by a former or current intimate partner, affects almost one-third of women in the United States. IPV exposure can result in many negative outcomes including physical injury, increased stress, and depression. Currently, there is a small, but, growing body of literature examining the link between IPV victimization and increased cardiovascular disease (CVD) risk among young adult women. To better prevent this negative outcome, it is imperative to understand what factors associated with IPV victimization may be increasing this risk. A secondary analysis of Wave IV of the Add Health study was conducted to examine possible factors mediating past year IPV exposure and 30-year CVD risk score including perceived stress, depressive symptoms, and alcohol dependence among a representative sample of young adult women in the United States. Multiple mediation analyses were run to examine the possible mediating factors in the relationship between IPV and CVD risk. In a multiple mediation model, the indirect effect of perceived stress became insignificant when depressive symptoms were introduced. The findings of this study reveal that 30-year CVD risk in the context of IPV victimization should continue to be examined among this population. The mediation models suggested the importance of stress and depression in the context of IPV and heart health. Screening for depression among women exposed to IPV should be considered as an important intervention point, not only to mitigate mental health issues, but to also help prevent the development of cardiovascular disease.

Racial/Ethnic Differences in Incidence and Persistence of Childhood Atopic Dermatitis

Although previous studies have explored racial/ethnic differences in incident atopic dermatitis (AD) in childhood, few studies have examined risk factors associated with AD persistence. As such, we sought to examine differences in incidence and persistence of childhood AD by race/ethnicity accounting for sociodemographic characteristics and perinatal vitamin D levels. Using data from Project Viva, a prospective prebirth cohort in eastern Massachusetts, we studied 1,437 mother-child pairs with known AD status to examine the associations of race/ethnicity with maternally reported child AD. We used multivariable logistic regression, adjusting for sociodemographic factors and maternal plasma vitamin D, to estimate adjusted odds ratios (aORs) of AD incidence at early childhood and persistence at mid-childhood. Compared to non-Hispanic whites, non-Hispanic blacks (aOR = 2.71, 95% confidence interval = 1.75-4.19) and other non-Hispanics (aOR = 1.80, 95% confidence interval = 1.16-2.80) were more likely to have incident AD. Non-Hispanic blacks (aOR = 6.26, 95% confidence interval = 2.32-16.88) and Hispanics (aOR = 6.42, 95% CI = 1.93-21.41) with early childhood AD were more likely to have persistent AD. In conclusion, compared with non-Hispanic whites, AD incidence and persistence are higher among certain nonwhite racial/ethnic subgroups. Further research is warranted to identify environmental, socioeconomic, and genetic factors that may be responsible for the observed differences.

Long-term effects of disaster on depressive symptoms: Type of exposure matters

RATIONALE

Natural disasters have the potential to change the lives of older people, yet most studies rely on small convenience samples, few include assessments of people prior to the disaster, and only a handful examine the effects of different types of exposure.

OBJECTIVE

Our analyses add new knowledge to the literature by examining the ways in which four types of exposure (i.e., geographic, peri-traumatic stress, personal and property loss, and post-storm hardship) affect depressive symptoms experienced by older people over a five-year period.

METHOD

We analyzed four waves of data from the ORANJ BOWL panel using multilevel mixed effects models.

RESULTS

We found that although each type of exposure had an independent effect on depressive symptoms, the effects of peri-traumatic stress were dominant.

CONCLUSIONS

As nearly 20% of people in the United States will experience a natural disaster during the course of their lives, it is critical to understand how disaster exposure can influence mental health because each type of exposure demands a different response. Finding that an individual's emotional response during the disaster plays an important role in the development of depressive symptoms suggests that reduction of exposure to traumatic stress during a storm (i.e., evacuation from a storm area) is important for older people. Likewise, immediate interventions following a disaster that target people experiencing high levels of peri-traumatic distress may be particularly effective and that failing to attend to these people may miss a critical opportunity and result in years of suffering.

Short-term lending: Payday loans as risk factors for anxiety, inflammation and poor health

While research now consistently links consumer financial debt with adverse emotional health outcomes, specific forms of debt and their impact on measures of physical health are underexplored. This gap in knowledge is significant because different forms of loans and debt may have different experiential qualities. In this paper, we focus on a type of unsecured debt - short-term/payday loan borrowing – that has risen dramatically in recent decades in the United States and is characterized by predatory, discriminatory, and poorly regulated lending practices. Using data from a study of debt and health among adults in Boston, MA (n=286), we test whether short-term borrowing is associated with a range of emotional and physical health indicators. We find that short-term loans are associated with higher body mass index, waist circumference, C-reactive protein levels, and self-reported symptoms of physical health, sexual health, and anxiety, after controlling for several socio-demographic covariates. We discuss these findings within the contexts of regulatory shortcomings, psychosocial stress, and racial and economic credit disparities. We suggest that within the broader context of financial debt and health, short-term loans should be considered a specific risk to population health.

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Short-term loans (STL) are associated with multiple indicators of poor health

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Prior research has explored general debt as a health determinant

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Specific types of debt, like STL, are understudied

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STL’s predatory lending practices raise concerns for population health

Depressive symptoms are associated with salivary shedding of Epstein-Barr virus in female adolescents: The role of sex differences

BACKGROUND

Adolescent females have a higher prevalence of depression in comparison to their male peers - a disparity that has been increasing over the past decade. Depression is of concern as it is associated with chronic disease and to immune dysregulation, which may be one mechanism linking depression to future pathology. This study examined the extent to which sex moderated the association between depressive symptoms and immune dysregulation during adolescence using Epstein-Barr virus (EBV) reactivation, a biomarker of cellular immune response, as a model.

METHODS

A representative community sample of 259 female and 279 male adolescents aged 11-17 years who were EBV IgG positive were examined. Trained interviewers collected the data during two home visits, one week apart. Depressive symptoms were measured at the first visit using the 9 item short-form of the Center for Epidemiologic Studies-Depression scale. EBV biomarkers were collected via saliva at the second visit and included a qualitative measure of EBV viral capsid antigen immunoglobulin G to assess prior EBV infection and a quantitative measure of EBV DNA to assess the number of viral copies shed in the saliva.

RESULTS

In multivariable logistic regression analyses, increasing depressive symptoms were significantly associated with salivary shedding of EBV DNA for adolescent females only (logit=0.66, se=0.30, p<0.05), and the interaction between sex and depressive symptoms on salivary shedding of EBV DNA was statistically significant (logit=-1.19, se=0.42, p<0.01). Sensitivity analyses were conducted in which sex was examined as a moderator in the relationship between depressive symptoms and salivary EBV DNA quantitative copies via Tobit regression; results were consistent with the presented findings.

CONCLUSIONS

Depressive symptoms are associated with EBV reactivation among EBV positive female adolescents, but not males. Future research is needed to examine EBV reactivation in female adolescents as a mechanism linking depression to future chronic disease and the role of sex hormones in explaining sex differences in the relationship between depressive symptoms and EBV reactivation.

Childhood Socioeconomic Status and Stress in Late Adulthood: A Longitudinal Approach to Measuring Allostatic Load

Objectives: This study examines how the effects of childhood socioeconomic status (SES) may carry on into late adulthood. Methods: We examine how childhood SES affects both perceived stress and allostatic load, which is a cumulative measure of the body’s biologic response to chronic stress. We use the National Social Life, Health, and Aging Project, Waves 1 and 2, and suggest a novel method of incorporating a longitudinal allostatic load measure. Results: Individuals who grew up in low SES households have higher allostatic load scores in late adulthood, and this association is mediated mostly by educational attainment. Discussion: The longitudinal allostatic load measure shows similar results to the singular measures and allows us to include 2 time points into one outcome measure. Incorporating 2 separate time points into one measure is important because allostatic load is a measure of cumulative physiological dysregulation, and longitudinal data provide a more comprehensive measure.

Epstein-Barr virus, cytomegalovirus, and multiple sclerosis susceptibility: A multiethnic study

OBJECTIVE

To determine whether Epstein-Barr virus (EBV) or cytomegalovirus (CMV) seropositivity is associated with multiple sclerosis (MS) in blacks and Hispanics and to what extent measures of the hygiene hypothesis or breastfeeding could explain these findings. EBV and CMV have been associated with MS risk in whites, and the timing and frequency of both viruses vary by factors implicated in the hygiene hypothesis.

METHODS

Incident cases of MS or its precursor, clinically isolated syndrome (CIS), and matched controls (blacks, 111 cases/128 controls; Hispanics, 173/187; whites, 235/256) were recruited from the membership of Kaiser Permanente Southern California. Logistic regression models accounted for HLA-DRB1*1501 status, smoking, socioeconomic status, age, sex, genetic ancestry, and country of birth.

RESULTS

Epstein-Barr nuclear antigen-1 (EBNA-1) seropositivity was independently associated with an increased odds of MS/CIS in all 3 racial/ethnic groups (p < 0.001 for blacks and whites, p = 0.02 for Hispanics). In contrast, CMV seropositivity was associated with a lower risk of MS/CIS in Hispanics (p = 0.004) but not in blacks (p = 0.95) or whites (p = 0.96). Being born in a low/middle-income country was associated with a lower risk of MS in Hispanics (p = 0.02) but not after accounting for EBNA-1 seropositivity. Accounting for breastfeeding did not diminish the association between CMV and MS in Hispanics.

CONCLUSIONS

The consistency of EBNA-1 seropositivity with MS across racial/ethnic groups and between studies points to a strong biological link between EBV infection and MS risk. The association between past CMV infection and MS risk supports the broader hygiene hypothesis, but the inconsistency of this association across racial/ethnic groups implies noncausal associations.

The role of race and ethnicity in sleep, circadian rhythms and cardiovascular health

In recent years, strong evidence has emerged suggesting that insufficient duration, quality, and/or timing of sleep are associated with cardiovascular disease (CVD), and various mechanisms for this association have been proposed. Such associations may be related to endophenotypic features of the sleep homeostat and the circadian oscillator, or may be state-like effects of the environment. Here, we review recent literature on sleep, circadian rhythms and CVD with a specific emphasis on differences between racial/ethnic groups. We discuss the reported differences, mainly between individuals of European and African descent, in parameters related to sleep (architecture, duration, quality) and circadian rhythms (period length and phase shifting). We further review racial/ethnic differences in cardiovascular disease and its risk factors, and develop the hypothesis that racial/ethnic health disparities may, to a greater or smaller degree, relate to differences in parameters related to sleep and circadian rhythms. When humans left Africa some 100,000 years ago, some genetic differences between different races/ethnicities were acquired. These genetic differences have been proposed as a possible predictor of CVD disparities, but concomitant differences in culture and lifestyle between different groups may equally explain CVD disparities. We discuss the evidence for genetic and environmental causes of these differences in sleep and circadian rhythms, and their usefulness as health intervention targets.

The Affordable Care Act Appears to Have Narrowed Racial and Ethnic Disparities in Insurance Coverage and Access to Care Among Young Adults

Prior to the Affordable Care Act, one in three young adults aged 19 to 25 years were uninsured, with substantial racial/ethnic disparities in coverage. We analyzed the separate and cumulative changes in racial/ethnic disparities in coverage and access to care among young adults after implementation of the Affordable Care Act’s 2010 dependent coverage provision and 2014 Medicaid and Marketplace expansions. We find that the dependent coverage provision was associated with similar gains across racial/ethnic groups, but the 2014 expansion was associated with larger gains in coverage among Hispanics and Blacks relative to Whites. After the 2014 expansion, coverage increased by 11.0 and 10.1 percentage points among Hispanics and Blacks, respectively, compared with a 5.6 percentage point increase among Whites. The percentage with a usual source of care and a recent doctor’s visit also increased more for Blacks relative to Whites. Increases in coverage were larger in Medicaid expansion compared with nonexpansion states for most racial/ethnic groups.

Poverty and perceived stress: Evidence from two unconditional cash transfer programs in Zambia

INTRODUCTION

Poverty is a chronic stressor that can lead to poor physical and mental health. This study examines whether two similar government poverty alleviation programs reduced the levels of perceived stress and poverty among poor households in Zambia.

METHOD

Secondary data from two cluster randomized controlled trials were used to evaluate the impacts of two unconditional cash transfer programs in Zambia. Participants were interviewed at baseline and followed over 36 months. Perceived stress among female caregivers was assessed using the Cohen Perceived Stress Scale (PSS). Poverty indicators assessed included per capita expenditure, household food security, and (nonproductive) asset ownership. Fixed effects and ordinary least squares regressions were run, controlling for age, education, marital status, household demographics, location, and poverty status at baseline.

RESULTS

Cash transfers did not reduce perceived stress but improved economic security (per capita consumption expenditure, food insecurity, and asset ownership). Among these poverty indicators, only food insecurity was associated with perceived stress. Age and education showed no consistent association with stress, whereas death of a household member was associated with higher stress levels.

CONCLUSION

In this setting, perceived stress was not reduced by a positive income shock but was correlated with food insecurity and household deaths, suggesting that food security is an important stressor in this context. Although the program did reduce food insecurity, the size of the reduction was not enough to generate a statistically significant change in stress levels. The measure used in this study appears not to be correlated with characteristics to which it has been linked in other settings, and thus, further research is needed to examine whether this widely used perceived stress measure appropriately captures the concept of perceived stress in this population.

Cultures of engagement: The organizational foundations of advancing health in immigrant and low-income communities of color

A rich civic infrastructure of community-based organizations (CBOs) can help generate, diffuse and maintain a culture of engagement and health that benefits marginalized populations most at risk for illness, disability, and poor health. Attention to CBOs advances "meso-level" frameworks for understanding health cultures and outcomes by going beyond attention to social networks and social identities. We focus on three mechanisms: CBOs can (1) empower individuals by developing civic capacity and personal efficacy; (2) foster solidarity by building networks, social identities and a shared commitment to collective well-being; and (3) mobilize people to have a voice in health-related policies and programming, thereby affecting community well-being. We draw on theory and research in sociology, political science and psychology, and we illustrate the utility of a CBO approach by examining survey and semi-structured interview data from participants in youth civic groups in 13 low-income, predominantly immigrant communities in California. Interview data illustrate the ways in which CBOs enhance members' civic capacities, provide a sense of empowerment and efficacy to engage in healthy behaviors, develop solidarity among diverse participants, and elaborate networks among those committed to community well-being. We also discuss CBO-led campaigns in which youth mobilized for change in policies and practices of local institutions to illustrate possible community-wide health consequences of CBO engagement. CBOs can thus generate individual-level well-being effects, and reduce structural barriers to good health through changes in the broader environment.

Health Care Resources and Mental Health Service Use Among Suicidal Adolescents

Developing policies and interventions that increase rates of mental health service use for suicidal adolescents is crucial for suicide prevention. Data from a sample of suicidal youth (n = 1356) from the National Longitudinal Study of Adolescent Health (Add Health) were analyzed to examine whether type of insurance, receipt of routine medical care, and access to school-based mental health treatment predicted mental health service use cross-sectionally and longitudinally. Rates of mental health service use were low in cross-sectional analyses at all three waves (∼11%-30%), despite the fact that respondents were at high risk for suicide attempts and depression. With demographic factors and symptom severity controlled, only receipt of a routine physical predicted an increased likelihood of mental health service use at wave I and in longitudinal analyses. Implications discussed include the utility of universal suicide screenings and integrated behavioral health care as potential intervention strategies for this population.

Neighborhood deprivation, race/ethnicity, and urinary metal concentrations among young girls in California

BACKGROUND

Although metals can adversely impact children's health, the distribution of exposures to many metals, particularly among vulnerable subpopulations, is not well characterized.

OBJECTIVES

We sought to determine whether neighborhood deprivation was associated with urinary concentrations of thirteen metals and whether observed relationships varied by race/ethnicity.

METHODS

We obtained neighborhood characteristics from the 2005-2009 American Community Survey. Demographic information and urine samples from 400 healthy young girls in Northern California were obtained during a clinical visit. Urine samples were analyzed for metals using inductively-coupled plasma-mass spectrometry and levels were corrected for creatinine. We ran analysis of variance and generalized linear regression models to estimate associations of urinary metal concentrations with neighborhood deprivation and race/ethnicity and stratified multivariable models to evaluate possible interactions among predictors on metals concentrations.

RESULTS

Urinary concentrations of three metals (barium, lead, antimony) varied significantly across neighborhood deprivation quartiles, and four (barium, lead, antimony, tin) varied across race/ethnicity groups. In models adjusted for family income and cotinine, both race/ethnicity (F3,224=4.34, p=0.01) and neighborhood deprivation (F3,224=4.32, p=0.01) were associated with antimony concentrations, but neither were associated with lead, barium, or tin, concentrations. Examining neighborhood deprivation within race/ethnicity groups, barium levels (pinteraction<0.01) decreased with neighborhood deprivation among Hispanic girls (ptrend<0.001) and lead levels (pinteraction=0.06) increased with neighborhood deprivation among Asian girls (ptrend=0.04).

CONCLUSIONS

Our results indicate that children's vulnerability to some metals varies by neighborhood deprivation quartile and race/ethnicity. These differential distributions of exposures may contribute to environmental health disparities later in life.