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Obeng-Nyarko CN, Ralston PA, Wickrama KKAS, Lemacks JL, Ilich JZ. Health for Hearts United Longitudinal Trial: Improving Perceived Stress and Allostatic Load Outcomes of Mid-Life and Older African American Women. HEALTH EDUCATION & BEHAVIOR 2024:10901981241263027. [PMID: 39051464 DOI: 10.1177/10901981241263027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Cardiovascular disease (CVD) continues to be the leading cause of death in the United States, with African Americans experiencing higher age-adjusted mortality compared to Whites. African American women in particular carry a high CVD burden due to more exposure to adverse personal and socioenvironmental challenges. Church-based interventions can improve health behaviors and health status of African Americans, yet few have addressed stress-related health. The purpose of this study was to determine the effectiveness of the 18-month Health for Hearts United intervention in relation to stress-related outcomes (perceived stress, allostatic load) of mid-life and older African American women (≥45 years of age; n = 152 overall sample, n = 65 clinical subsample). The results of the repeated measures analysis of variance (ANOVA) analyses showed overall significant decreases in perceived stress and allostatic load for both treatment and comparison groups over the measurement occasions (baseline and 18 months) with educational level remaining as a significant correlate over time. There was no significant interaction between treatment and time, yet there were trends in improvements for the treatment group compared to the comparison group. The findings demonstrate the potential of church-based interventions in reducing both self-reported stress and allostatic load in African American women, and highlight the need for further investigation of educational level and other possible factors influencing stress management in these settings.
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Lee M, Nguyen B, Jung J, Razzak E, Oluyemi ET, McDonald ES, Miles RC, Sadigh G, Carlos RC. Assessing the Correlation between Allostatic Load and False-Positive Image-Guided Breast Biopsies. J Womens Health (Larchmt) 2024. [PMID: 38973695 DOI: 10.1089/jwh.2024.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background: Allostatic load (AL) is the accumulation of physiological dysregulation attributed to repeated activation of the stress response over a lifetime. We assessed the utility of AL as a prognostic measure for high-risk benign breast biopsy pathology results. Method: Eligible patients were women 18 years or older, with a false-positive outpatient breast biopsy between January and December 2022 at a tertiary academic health center. AL was calculated using 12 variables representing four physiological systems: cardiovascular (pulse rate, systolic and diastolic blood pressures, total cholesterol, high-density lipoprotein, and low-density lipoprotein); metabolic (body mass index, albumin, and hemoglobin A1C); renal (creatinine and estimated glomerular filtration rate); and immune (white blood cell count). Multivariable logistic regression was used to assess the association between AL before biopsy and breast biopsy outcomes controlling for patients' sociodemographics. Results: In total, 170 women were included (mean age, 54.1 ± 12.9 years): 89.4% had benign and 10.6% had high-risk pathologies (radial scar/complex sclerosing lesion, atypical ductal or lobular hyperplasia, flat epithelial atypia, intraductal papilloma, or lobular carcinoma in-situ). A total of 56.5% were White, 24.7% Asian, and 17.1% other races. A total of 32.5% identified as Hispanic. The mean breast cancer risk score using the Tyrer-Cuzick model was 11.9 ± 7.0. In multivariable analysis, with every one unit increase in AL, the probability of high-risk pathology increased by 37% (odds ratio, 1.37; 95% confidence interval, 1.03, 1.81; p = 0.03). No significant association was seen between high-risk pathology and age, ethnicity, breast cancer risk, or area deprivation index. Conclusion: Our findings support that increased AL, a biological marker of stress, is associated with high-risk pathology among patients with false-positive breast biopsy results.
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Affiliation(s)
- Maxwell Lee
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Britney Nguyen
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Jinho Jung
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Eisa Razzak
- Loyola University Stritch School of Medicine, Chicago, Illinois, USA
| | - Eniola T Oluyemi
- Department of Radiology, John Hopkins University, Baltimore, MD, USA
| | | | - Randy C Miles
- Department of Radiology, Denver Health, Denver, CO, USA
| | - Gelareh Sadigh
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Ruth C Carlos
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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Williams E, Harris LK, Zhang S, Cortés YI. Daily spiritual experiences and allostatic load trajectories: a longitudinal study of midlife African American women. Menopause 2024; 31:530-536. [PMID: 38595203 PMCID: PMC11126357 DOI: 10.1097/gme.0000000000002353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE This study aimed to evaluate the association between daily spiritual experiences and allostatic load (AL) trajectories in midlife African American women. METHODS A longitudinal analysis of public-use data from 727 African American women in the Study of Women's Health Across the Nation (SWAN) was performed. We included African American women who completed the Daily Spiritual Experiences Scale at SWAN visit 4 (2000-2001) and had AL data at three or more study visits over 7 years. AL was calculated at each visit using 10 biomarkers: systolic and diastolic blood pressure, body mass index, C-reactive protein, high-density lipoprotein cholesterol, total cholesterol, waist-to-hip ratio, fasting serum glucose, triglycerides, and dehydroepiandrosterone. Group-based trajectory modeling identified women with similar patterns of AL. We used multinomial logistic regression to estimate associations between daily spiritual experiences (some days or less, most days, daily, many times a day) and AL trajectories. FINDINGS Our sample had a mean ± SD age of 49.9 ± 2.66 years, 47% were early perimenopausal, and 17% earned <$19,999 annually. The mean ± SD AL score was 2.52 ± 1.68. Three AL trajectories were identified: low (35.1%), moderate (44.7%), and high (20.2%). In age-adjusted models, women who reported daily comfort in religion and spirituality were less likely to follow a high AL trajectory (odds ratio, 0.41; 95% CI, 0.18-0.93); the association was attenuated when controlling for depressive symptoms (odds ratio, 0.48; 95% CI, 0.19-1.21). CONCLUSIONS Findings from this study do not support an independent association between spirituality in African American women and AL trajectories in midlife. Studies with a larger sample and additional measures of spirituality are warranted in this population.
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Affiliation(s)
- Elizabeth Williams
- From the University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC
| | - Latesha K Harris
- From the University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC
| | - Shuo Zhang
- Duke University School of Medicine, Durham, NC
| | - Yamnia I Cortés
- Division of Community and Primary Health, Duke University School of Medicine, MRI Service Center, University of Iowa College of Nursing, Iowa City, IA
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Hurtado MD, Tama E, Fansa S, Ghusn W, Anazco D, Acosta A, Faubion SS, Shufelt CL. Weight loss response to semaglutide in postmenopausal women with and without hormone therapy use. Menopause 2024; 31:266-274. [PMID: 38446869 PMCID: PMC11209769 DOI: 10.1097/gme.0000000000002310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
OBJECTIVE To compare weight loss response and changes in cardiometabolic risk markers in postmenopausal women using semaglutide with and without menopause hormone therapy (HT) use. METHODS Retrospective cohort study of postmenopausal women treated with semaglutide for overweight or obesity for ≥3 months. Endpoints: total body weight loss percentage (TBWL%) at 3, 6, 9, and 12 months after semaglutide initiation; and percentage of women achieving ≥5% and ≥10% TBWL and changes in cardiometabolic risk markers (glucose, blood pressure, and lipids) at 12 months. RESULTS There were 16 women on HT and 90 on no-HT; mean age 56 ± 8 vs 59 ± 8 yr, P = 0.2 and mean BMI 36 ± 5 vs 39 ± 8 kg/m 2 , P = 0.1; respectively. Among women on no-HT, White race, dyslipidemia, and depression were more prevalent. Women on HT had a higher TBWL% at 3, 6, 9, and 12 months: 7 ± 3% vs 5 ± 4%, P = 0.01; 13 ± 6% vs 9 ± 5%, P = 0.01; 15 ± 6% vs 10 ± 6%, P = 0.02; and 16 ± 6% vs 12 ± 8%, P = 0.04; respectively. After adjusting for potential confounders, this association remained significant across time. At 12 months, a greater percentage of women on HT achieved ≥5% and ≥10% TBWL. Both groups experienced an improvement in cardiometabolic risk markers. CONCLUSION In postmenopausal women with overweight or obesity treated with semaglutide, HT use was associated with an improved weight loss response. This association was maintained when adjusted for confounders. Larger studies should be conducted to confirm these results.
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Affiliation(s)
- Maria D. Hurtado
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Mayo Clinic, Jacksonville, FL
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Elif Tama
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Mayo Clinic, Jacksonville, FL
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Sima Fansa
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Wissam Ghusn
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Diego Anazco
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Andres Acosta
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Stephanie S. Faubion
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Jacksonville, FL
- Women’s Health Research Center, Mayo Clinic, Rochester, MN
| | - Chrisandra L. Shufelt
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Jacksonville, FL
- Women’s Health Research Center, Mayo Clinic, Rochester, MN
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Teresi JA, Ocepek-Welikson K, Eimicke JP, Ramirez M, Liu S, Silver S, Luchsinger JA. Measurement of Allostatic Load in Caregivers of Older Hispanic People With Alzheimer Disease and Related Disorders. Alzheimer Dis Assoc Disord 2024; 38:178-188. [PMID: 38751023 PMCID: PMC11149728 DOI: 10.1097/wad.0000000000000625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 04/07/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Allostatic load (AL) has been studied in the context of biomarkers that may be affected by environmental and contextual stressors, including social determinants of health. The specific stressor studied here is the provision of caregiving to older persons with Alzheimer disease and related disorders. The aims were to examine the factor structure of stress and nonstress biomarkers, different methods for calculating AL, and the relationship of AL with other variables. METHODS Latent variable models were used to examine biomarkers. Regression analyses were performed with the outcomes: AL calculated as percentile-based and clinically-based for both stress and nonstress components. The sample was 187 Hispanic caregivers to individuals with dementia. RESULTS The results of the confirmatory factor analyses (CFAs) suggested defining 2 factors: nonstress and stress-related. Performance was better for the CFA results and the associations with covariates when stress and nonstress components were examined separately. Despite some limitations, this is one of the first studies of biomarkers in Hispanic caregivers to patients with dementia. It was possible to explain almost 30% of the variance in the nonstress AL component. CONCLUSION It may be important to differentiate among biomarkers indicative of cardiovascular, metabolic, and immune response as contrasted with the more stress-related biomarkers.
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Affiliation(s)
- Jeanne A. Teresi
- Columbia University Stroud Center at New York State Psychiatric Institute
- Department of Medicine, Columbia University Irving Medical Center
| | | | | | - Mildred Ramirez
- Department of Medicine, Columbia University Irving Medical Center
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College
| | - Shelley Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai
| | - Stephanie Silver
- Department of Medicine, Columbia University Irving Medical Center
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Neufcourt L, Castagné R, Wilsgaard T, Grimsgaard S, Chadeau-Hyam M, Vuckovic D, Ugarteche-Perez A, Farbu EH, Sandanger TM, Delpierre C, Kelly-Irving M. Educational patterning in biological health seven years apart: Findings from the Tromsø Study. Psychoneuroendocrinology 2024; 160:106670. [PMID: 37992555 DOI: 10.1016/j.psyneuen.2023.106670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Social-to-biological processes is one set of mechanisms underlying the relationship between social position and health. However, very few studies have focused on the relationship between social factors and biology at multiple time points. This work investigates the relationship between education and the dynamic changes in a composite Biological Health Score (BHS) using two time points seven years apart in a Norwegian adult population. METHODS We used data from individuals aged 30 years and above who participated in Tromsø6 (2007-2008) and Tromsø7 (2015-2016) (n = 8117). BHS was defined using ten biomarkers measured from blood samples and representing three physiological systems (cardiovascular, metabolic, inflammatory). The higher the BHS, the poorer the health status. FINDINGS Linear regression models carried out on BHS revealed a strong educational gradient at two distinct time points but also over time. People with lower educational attainment were at higher risk of poor biological health at a given time point (βlow education Tromsø6=0.30 [95 %-CI=0.18-0.43] and βlow education Tromsø7=0.30 [95 %-CI=0.17-0.42]). They also presented higher longitudinal BHS compared to people with higher education (βlow education = 0.89 [95 %-CI=0.56-1.23]). Certain biomarkers related to the cardiovascular system and the metabolic system were strongly socially distributed, even after adjustment for sex, age, health behaviours and body mass index. CONCLUSION This longitudinal analysis highlights that participants with lower education had their biological health deteriorated to a greater extent over time compared to people with higher education. Our findings provide added evidence of the biological embodiment of social position, particularly with respect to dynamic aspects for which little evidence exists.
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Affiliation(s)
- Lola Neufcourt
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France.
| | - Raphaële Castagné
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Sameline Grimsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Marc Chadeau-Hyam
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Dragana Vuckovic
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Ainhoa Ugarteche-Perez
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Erlend Hoftun Farbu
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Torkjel M Sandanger
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Cyrille Delpierre
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Michelle Kelly-Irving
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
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Guan Y, Shen J, Lu J, Fuemmeler BF, Shock LS, Zhao H. Association between allostatic load and breast cancer risk: a cohort study. Breast Cancer Res 2023; 25:155. [PMID: 38115125 PMCID: PMC10729373 DOI: 10.1186/s13058-023-01754-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Allostatic load (AL) reflects the collective load of chronic stress during lifetime. Previous studies have shown that higher AL is associated with poor clinical outcomes among breast cancer patients. However, the relationship between AL and breast cancer risk is still unclear. METHODS To fill the gap, we analyzed the association between AL and the development of breast cancer in 181,455 women identified from the UK Biobank. RESULTS During the follow-up from 2006 to 2020, 5,701 women were diagnosed with incident breast cancer. Significantly higher AL was observed among incident breast cancer cases than all study participants (mean: 2.77 vs. 2.63, P < 0.01). Univariate Cox regression analysis indicated the risk of breast cancer was increased by 5% per one AL unit increase (hazard ratio (HR) = 1.05, 95% confidence interval (CI) 1.04, 1.07). In multivariate analyses, after adjusting demographics, family history of breast cancer, reproductive factors, socioeconomic status, lifestyle factors, and breast cancer polygenic risk score (PRS), the significant association remained (HR = 1.05, 95%CI 1.03, 1.07). The significant relationship was further confirmed in the categorical analysis. Compared with women in the low AL group (AL: 0 ~ 2), those in the high AL group (AL: 3 ~ 11) had a 1.17-fold increased risk of breast cancer (HR = 1.17, 95%CI 1.11, 1.24). Finally, in the stratified analysis, joint effects on the risk of breast cancer were observed between the AL and selected known breast cancer risk factors, including age, family history of breast cancer, PRS, income, physical activity, and alcohol consumption. CONCLUSION In summary, those findings have demonstrated that higher AL was associated with an increased breast cancer risk in women. This association is likely independent of known breast cancer risk factors. Thus, the AL could be a valuable biomarker to help breast cancer risk prediction and stratification.
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Affiliation(s)
- Yufan Guan
- Departments of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, 23284, USA
| | - Jie Shen
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, 22903, USA
| | - Juan Lu
- Departments of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, 23284, USA
| | - Bernard F Fuemmeler
- Departments of Family Medicine and Population Health, School of Medicine, Virginia Commonwealth University, Richmond, VA, 23284, USA
| | - Lisa S Shock
- Departments of Microbiology and Immunology, School of Medicine, Virginia Commonwealth University, Richmond, VA, 23284, USA
| | - Hua Zhao
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, 22903, USA.
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Valentine C. Architectural Allostatic Overloading: Exploring a Connection between Architectural Form and Allostatic Overloading. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095637. [PMID: 37174157 PMCID: PMC10178048 DOI: 10.3390/ijerph20095637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/06/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023]
Abstract
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.
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Affiliation(s)
- Cleo Valentine
- Department of Architecture, University of Cambridge, Cambridge CB2 1PX, UK
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Measuring allostatic load: Approaches and limitations to algorithm creation. J Psychosom Res 2022; 163:111050. [PMID: 36228435 DOI: 10.1016/j.jpsychores.2022.111050] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/30/2022]
Abstract
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.
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Lueth AJ, Allshouse AA, Blue NM, Grobman WA, Levine LD, Simhan HN, Kim JK, Johnson J, Wilson FA, Murtaugh M, Silver RM. Allostatic Load and Adverse Pregnancy Outcomes. Obstet Gynecol 2022; 140:974-982. [PMID: 36357956 PMCID: PMC9712159 DOI: 10.1097/aog.0000000000004971] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the association between allostatic load, as an estimate of chronic stress, and adverse pregnancy outcomes. METHODS This was a secondary analysis of nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be), a prospective observational cohort study. Our primary exposure was dichotomous high allostatic load in the first trimester, defined as 4 or more of 12 biomarkers in the "worst" quartile. The primary outcome was a composite adverse pregnancy outcome: hypertensive disorders of pregnancy (HDP), preterm birth, small for gestational age (SGA), and stillbirth. Secondary outcomes included components of the composite. Multivariable logistic regression was used to test the association between high allostatic load and adverse pregnancy outcomes, adjusted for potential confounders. Mediation and moderation analyses were conducted to assess the role of allostatic load along the causal pathway between racial disparities and adverse pregnancy outcomes. RESULTS Among 4,266 individuals, 34.7% had a high allostatic load. Composite adverse pregnancy outcome occurred in 1,171 (27.5%): 14.0% HDP, 8.6% preterm birth (48.0% spontaneous and 52.2% indicated), 11.0% SGA, and 0.3% stillbirth. After adjustment for maternal age, gravidity, smoking, bleeding in the first trimester, and health insurance, high allostatic load was significantly associated with a composite adverse pregnancy outcome (adjusted odds ratio [aOR] 1.5, 95% CI 1.3, 1.7) and HDP (aOR 2.5, 95% CI 2.0-2.9), but not preterm birth or SGA. High allostatic load partially mediated the association between self-reported race and adverse pregnancy outcomes. The association between allostatic load and HDP differed by self-reported race, but not for a composite adverse pregnancy outcome, preterm birth, or SGA. CONCLUSION High allostatic load in the first trimester is associated with adverse pregnancy outcomes, particularly HDP. Allostatic load was a partial mediator between race and adverse pregnancy outcomes. The association between allostatic load and HDP differed by self-reported race.
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Affiliation(s)
- Amir J. Lueth
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Amanda A. Allshouse
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Nathan M. Blue
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - William A. Grobman
- Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio
| | - Lisa D. Levine
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hyagriv N. Simhan
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jin Kyung Kim
- Department of Obstetrics and Gynecology, University of California Irvine, Irvine, California
| | - Jasmine Johnson
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University
| | - Fernando A. Wilson
- Department of Population Health Sciences, University of Utah Health, Salt Lake City, Utah
| | - Maureen Murtaugh
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
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11
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Woods NF, Coslov N, Richardson MK. Perimenopause meets life: observations from the Women Living Better Survey. Menopause 2022; 29:1388-1398. [PMID: 36194844 DOI: 10.1097/gme.0000000000002072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of these analyses was to test a predictive quantitative model relating personal characteristics, reproductive aging stages, health behaviors, roles, stressors, and satisfaction with life roles to bothersome symptoms experienced during the late reproductive stage and the menopausal transition (MT). METHODS Participants (N = 2,406) aged 35 to 55 years completed the Women Living Better Survey online between March to August 2020, and 1,529 met the inclusion criteria and provided menstrual cycle data for staging reproductive aging. They were recruited from the Women Living Better newsletter and from other online groups of midlife women. Hierarchical regression analysis using a two-stage model tested the effect of several factors on each of five bothersome symptom groups: brain fog, volatile mood, fatigue/pain, vasomotor/sleep disruption, and anxiety/vigilance symptoms. In stage I, personal characteristics, reproductive aging stage, and health behaviors were examined, and in stage II roles (ie, caregiver, partner, employment-related), satisfaction with life roles and stressors associated with roles were added. RESULTS More bothersome brain fog symptoms were associated with less education, MT (vs late reproductive stage), low satisfaction with life roles, and greater health-related and overcommitment stress (all P < 0.005). More bothersome volatile mood symptoms were associated with health-related, partner relationship, and other relationship stress. More bothersome fatigue/pain symptoms were associated with less education and greater difficulty paying for basics and health-related and other relationship stress. Vasomotor/sleep-onset symptoms were associated with less education, MT, and health-related and work stress. More bothersome anxiety/vigilance symptoms were associated with less education, more difficulty paying for basics, and health and work stress. CONCLUSIONS Recognizing that midlife stress comes from many role- and relationship-related sources and that several of these stressors are associated with greater symptom bother supports the importance of proactive identification and management of sources of stress.
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Affiliation(s)
- Nancy Fugate Woods
- From the Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA
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Association of Allostatic Load and All Cancer Risk in the SWAN Cohort. Cancers (Basel) 2022; 14:cancers14133044. [PMID: 35804816 PMCID: PMC9264860 DOI: 10.3390/cancers14133044] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/23/2022] Open
Abstract
Elevated chronic stress is thought to increase cancer risk, though the results so far have been inconsistent. In this study, we assessed the relationship between allostatic load (AL), a biological indicator of chronic stress, and overall cancer risk in 3015 women who participated in the Study of Women’s Health Across the Nation (SWAN). Based on the distribution of AL, the study population was categorized into four groups, from the lowest (1st category) to the highest AL group (4th category). At baseline, African American and Hispanic women were more likely to be in the higher AL categories than White women (p < 0.001). In addition, women who smoked regularly, drank alcohol regularly, had no leisure physical activity, and had restless sleep were also more likely to be in the higher AL categories than their relative counterparts (p < 0.001). We also observed that women in the lower-income category with no health insurance were more likely to be in the higher AL category (p < 0.001). The study then found that women in the 4th category of AL (the highest AL group) had a 1.64-fold increased risk of overall cancer (Hazard ratio (HR): 1.64, 95% confidence interval (CI): 1.04, 2.59). The risk association was further strengthened after adjusting demographics, healthy behaviors, and socioeconomic factors with an HR of 2.08. In further analysis of individual biomarkers of AL score, we found that higher levels of triglyceride and CRP were associated with increased risk of cancer, highlighting the role of metabolic dysfunction and inflammation in the etiology of cancer development. In summary, we report that higher AL is associated with increased cancer risk.
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Guidi J, Lucente M, Sonino N, Fava GA. Allostatic Load and Its Impact on Health: A Systematic Review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:11-27. [PMID: 32799204 DOI: 10.1159/000510696] [Citation(s) in RCA: 397] [Impact Index Per Article: 132.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/06/2020] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy,
| | | | - Nicoletta Sonino
- Department of Statistical Sciences, University of Padova, Padova, Italy.,Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York, USA
| | - Giovanni A Fava
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York, USA
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Richardson LJ, Goodwin AN, Hummer RA. Social status differences in allostatic load among young adults in the United States. SSM Popul Health 2021; 15:100771. [PMID: 34584929 PMCID: PMC8455854 DOI: 10.1016/j.ssmph.2021.100771] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 11/22/2022] Open
Abstract
Allostatic load refers to wear and tear on the body due to repeated activation of the stress response and, thus, may be an early subclinical indicator of future disease and mortality risk. To date, few studies of allostatic load have focused on young adults, racial/ethnic comparisons that include Mexican Americans, or the interplay between race/ethnicity, gender, and educational attainment. To fill these gaps, we used data on non-Hispanic Black, non-Hispanic White, and Mexican-origin respondents from Waves I (1994-1995) and IV (2007-2008) of the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 11,807). We calculated allostatic load scores based on respondents' values for 10 metabolic, cardiovascular, and inflammatory biomarkers measured at Wave IV, when respondents were 24-34 years old. We then used negative binomial regression models to assess the combined effects of race/ethnicity, gender, and educational attainment on allostatic load, while controlling for key covariates. We found that Black women had significantly higher allostatic load scores than White women and Black men, net of educational attainment and other covariates. Yet, education modified the relationship between race/ethnicity, gender, and allostatic load. Obtaining a college education was protective for White males and females but no more or less protective for other women and deleterious for Black males. In other words, by the time they reach young adulthood, the cumulative physiological burden of stress on Black women and college-educated Black men is already greater than it is among their similarly or less educated White counterparts. These findings provide important information about the intermediate physiological dysregulation that underlies social inequalities in stress-related health outcomes, especially those that occur at the intersections of race/ethnicity, gender, and educational attainment. They also suggest that research on its antecedents should focus on earlier life periods.
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Affiliation(s)
- Liana J. Richardson
- Department of Sociology, University of North Carolina at Chapel Hill, 155 Hamilton Hall, CB #3210, Chapel Hill, NC, 27599-3210, USA
- Carolina Population Center, 123 W. Franklin Street, CB #8120, Chapel Hill, NC, 27516-2524, USA
| | - Andrea N. Goodwin
- Department of Sociology, University of North Carolina at Chapel Hill, 155 Hamilton Hall, CB #3210, Chapel Hill, NC, 27599-3210, USA
- Carolina Population Center, 123 W. Franklin Street, CB #8120, Chapel Hill, NC, 27516-2524, USA
| | - Robert A. Hummer
- Department of Sociology, University of North Carolina at Chapel Hill, 155 Hamilton Hall, CB #3210, Chapel Hill, NC, 27599-3210, USA
- Carolina Population Center, 123 W. Franklin Street, CB #8120, Chapel Hill, NC, 27516-2524, USA
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15
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Alebna P, Maleki N. Allostatic Load in Perimenopausal Women With Migraine. Front Neurol 2021; 12:649423. [PMID: 33967942 PMCID: PMC8100599 DOI: 10.3389/fneur.2021.649423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/23/2021] [Indexed: 01/03/2023] Open
Abstract
Objective: There is very limited data on women with migraine disease as they age and transition to menopause. Despite evidence for the increased burden of the disease during this transition, there is no data on the association between migraine and allostatic load as a marker of cumulative biological risk. We aimed to determine whether women with migraine suffer from higher levels of allostatic load during perimenopausal transition. Methods: A total of 2,105 perimenopausal women from the first wave of the Study of Women's Health Across the Nation (SWAN) were included in this study. Allostatic Load (AL) score was estimated for each participant from the measurements of: systolic and diastolic blood pressure, C-reactive protein level, high-density lipoprotein cholesterol level, total cholesterol level, waist-to-hip ratio, fasting serum glucose, triglycerides, and dehydroepiandrosterone levels. Results: Of the 2,105 participants included in the study, there were 369 migraineurs and 1,730 controls. Migraineurs had 63% higher odds of increased load score (odds ratio 1.63; 95% confidence interval, 1.17-2.29). Compared to controls, migraineurs were more likely to experience sleep problems in the univariate analysis, however despite the high burden of sleep problems, there were no significant associations between allostatic load and sleep disturbances in perimenopausal women with migraine after controlling for other factors. Conclusion: This is the first study to systematically and quantitatively examine allostatic load in migraine patients. The findings establish that migraineurs are more likely to experience higher allostatic load than their non-migraine counterparts during perimenopausal transition. The findings encourage new lines of investigation for lowering the burden of the disease through interventions that modify the levels of allostatic load biomarkers examined in this study.
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Affiliation(s)
- Pamela Alebna
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Nasim Maleki
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Behavioral and psychological health inequities in income disparate perimenopausal women: a brief report. ACTA ACUST UNITED AC 2020; 28:86-92. [PMID: 32898022 DOI: 10.1097/gme.0000000000001650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess differences in behavioral and psychological health characteristics in perimenopausal women delineated by income disparity. METHODS A hypothesis generating secondary data analysis was conducted in 33 women, using public health insurance enrollment as a proxy for income. Sociodemographic characteristics were assessed. Study outcomes included behavioral health characteristics: current cigarette smoking, substance abuse history, current exercise, obesity (BMI ≥30); psychological health characteristics, and sleep: depressed mood (Center for Epidemiologic Studies Depression Scale [CES-D]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and sleep (Insomnia Severity Index [ISI]). Group comparisons were assessed via the Student t test, Wilcoxon Rank-Sum test or Chi-square test, and multivariable models. RESULTS Forty-two percent (n = 14) were designated as income disparate, and sociodemographic characteristics were similar between groups; nearly half were Black/African American. More income disparate women reported current cigarette smoking [71% (10) vs 21%(4), P = 0.004] and substance abuse history [79%(11) vs 5%(1), P < 0.0001]. Fewer income disparate women reported current exercise [57%(8) vs 89%(17), P = 0.03] and more were obese [BMI ≥30; 50%(7) vs 11%(2), P = 0.01]. Income disparate women experienced significantly higher CES-D scores [13.5 (11.75, 23.75) vs 6 (0, 9), P < 0.0001], GAD-7 scores [5.5 (2, 8.75) vs 2 (0, 4), P = 0.04], and ISI scores [11 (5.55) vs 5 (4.36), P = 0.004]. CONCLUSIONS Findings from this preliminary analysis evidence inequities in behavioral, psychological, and sleep characteristics in perimenopausal women. Awareness of how the social determinants of health impact outcomes among vulnerable perimenopausal women is critical to developing equitable aging opportunities, including customized preventive health screenings and interventions that engage income disparate perimenopausal women.
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Carbone JT. The mediating effect of allostatic load on the relationship between neighborhood perceptions and depression. SSM Popul Health 2020; 11:100638. [PMID: 32817880 PMCID: PMC7426578 DOI: 10.1016/j.ssmph.2020.100638] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/08/2020] [Accepted: 08/03/2020] [Indexed: 01/04/2023] Open
Abstract
Neighborhood perceptions is an important predictor of both allostatic load in the form of biological dysregulation and major depressive disorder. Furthermore, biological dysregulation is predictive of major depressive disorder. Yet to date, the use of biological dysregulation as one potential causal pathway linking neighborhood perceptions to depression has not been explored. This study examined the relationship between neighborhood perception, biological dysregulation in the form of allostatic load, and depression among individuals who participated in the three waves of the Midlife Development in the United States study (1996-2014). Two-to-one propensity score matching was employed prior the use of causal mediation analyses. Lower neighborhood perceptions at wave one were associated with increased allostatic load at wave two. Allostatic load at wave two is associated with depression at wave three. The mediation analysis shows that 6.0% of the relationship between neighborhood perception and depression is mediated by biological dysregulation. These results can inform future prevention and treatment methods by supporting efforts to integrate individuals and community-level interventions to aid in addressing both the environmental conditions and biological factors associated with depression.
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Affiliation(s)
- Jason T Carbone
- School of Social Work, Wayne State University, Integrative Biosciences (IBio) Center, Rm 1119, 6135 Woodward Avenue, Detroit, MI, 48202, USA
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18
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Acheampong T, Jiang L, Ziogas A, Odegaard AO. Multi-Systemic Biological Risk and Cancer Mortality: The NHANES III Study. Sci Rep 2020; 10:5047. [PMID: 32193496 PMCID: PMC7081240 DOI: 10.1038/s41598-020-61945-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 03/02/2020] [Indexed: 01/16/2023] Open
Abstract
Multi-systemic biological risk (MSBR), a proxy for allostatic load, is a composite index of biomarkers representing dysregulation due to responses to chronic stress. This study examined the association of an MSBR index with cancer mortality. The sample included n = 13,628 adults aged 20–90 from the NHANES III Linked Mortality File (1988–1994). The MSBR index included autonomic (pulse rate, blood pressure), metabolic (HOMAir, triglycerides, waist circumference), and immune (white blood cell count, C-reactive protein) markers. We fit Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CI) of overall cancer mortality risk, according to quartiles (q) of the index. In multivariable models, compared to those in q1, q4 had a 64% increased risk for cancer mortality (HR = 1.64, 95% CI:1.13–2.40). The immune domain drove the association (HR per unit = 1.19, 95% CI:1.07–1.32). In stratified analyses, the HR for those with a BMI ≥ 25 was 1.12 per unit (95% CI:1.05–1.19) and those with a BMI < 25 was 1.04 per unit (95% CI:0.92–1.18). MSBR is positively associated with risk for cancer mortality in a US sample, particularly among those who are overweight or obese. The utilization of standard clinical measures comprising this index may inform population cancer prevention strategies.
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Affiliation(s)
- Teofilia Acheampong
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th street, New York, NY, 10032, United States
| | - Luohua Jiang
- Department of Epidemiology, University of California-Irvine, Anteater Instruction & Research Building (AIRB), 653 E. Peltason Drive, Suite 3060 E, Irvine, CA, 92697, United States
| | - Argyrios Ziogas
- Department of Epidemiology, University of California-Irvine, Anteater Instruction & Research Building (AIRB), 653 E. Peltason Drive, Suite 3060 E, Irvine, CA, 92697, United States
| | - Andrew O Odegaard
- Department of Epidemiology, University of California-Irvine, Anteater Instruction & Research Building (AIRB), 653 E. Peltason Drive, Suite 3060 E, Irvine, CA, 92697, United States.
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Gillespie SL, Anderson CM, Zhao S, Tan Y, Kline D, Brock G, Odei J, O'Brien E, Sims M, Lazarus SA, Hood DB, Williams KP, Joseph JJ. Allostatic load in the association of depressive symptoms with incident coronary heart disease: The Jackson Heart Study. Psychoneuroendocrinology 2019; 109:104369. [PMID: 31307010 PMCID: PMC7232849 DOI: 10.1016/j.psyneuen.2019.06.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/24/2019] [Accepted: 06/28/2019] [Indexed: 12/16/2022]
Abstract
African Americans are at heightened risk for coronary heart disease (CHD), with biologic pathways poorly understood. We examined the role of allostatic load (AL) in the association of depressive symptoms with incident CHD among 2,670 African American men and women in the prospective Jackson Heart Study. Depressive symptoms were quantified using the Center for Epidemiologic Studies Depression Scale (CES-D). Incident CHD was ascertained by self-report, death certificate survey, and adjudicated medical record surveillance. Baseline AL was quantified using biologic parameters of metabolic, cardiovascular, immune, and neuroendocrine subsystems and as a combined meta-factor. Sequential models adjusted for demographic, socioeconomic, and behavioral covariates, stratified to examine differences by sex. Greater depressive symptomatology was associated with greater metabolic, cardiovascular, and immune AL (p-values≤0.036) and AL meta-factor z-scores (p = 0.007), with findings driven by observations among females. Each 1-point increase in baseline depressive symptomatology, and 1-SD increase in metabolic AL, neuroendocrine AL, and AL meta-factor z-scores was associated with 3.3%, 88%, 39%, and 130% increases in CHD risk, respectively (p-values <0.001). Neuroendocrine AL and AL meta-factor scores predicted incident CHD among males but not females in stratified analyses. Metabolic AL partially mediated the association of depressive symptoms with incident CHD (5.79% mediation, p = 0.044), a finding present among females (p = 0.016) but not males (p = 0.840). Among African American adults, we present novel findings of an association between depressive symptomatology and incident CHD, partially mediated by metabolic AL. These findings appear to be unique to females, an important consideration in the design of targeted interventions for CHD prevention.
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Affiliation(s)
- Shannon L Gillespie
- Martha S. Pitzer Center for Women, Children, & Youth, College of Nursing, The Ohio State University, Columbus, OH, United States.
| | - Cindy M Anderson
- Martha S. Pitzer Center for Women, Children, & Youth, College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Songzhu Zhao
- Department of Bioinformatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Yubo Tan
- Department of Bioinformatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - David Kline
- Department of Bioinformatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Guy Brock
- Department of Bioinformatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - James Odei
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Emily O'Brien
- Duke Clinical Research Institute and Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Sophie A Lazarus
- Department of Psychology, The Ohio State University, United States
| | - Darryl B Hood
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Karen Patricia Williams
- Martha S. Pitzer Center for Women, Children, & Youth, College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Joshua J Joseph
- Division of Endocrinology, Diabetes & Metabolism, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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