Psychosocial and socioeconomic factors associated with glycated hemoglobin in nondiabetic middle-aged men and women

Contributions of Eudaimonic Well-Being to Mental Health Practice

Purpose

Synergies between a eudaimonic model of psychological well-being (Ryff, 1989) and mental health practice are examined. The model grew out of clinical, developmental, existential, and humanistic perspectives that emphasized psychological strengths and capacities, in contrast to the focus on emotional distress and dysfunction in clinical psychology.

Design/Approach

Conceptual foundations of the eudaimonic approach are described, along with the six components positive functioning that are used to measure well-being. These qualities may be important in facilitating the recovery experiences, which are of interest in Mental Health and Social Inclusion.

Findings

Four categories of empirical evidence about eudaimonia are reviewed: (1) how it changes with aging, (2) how it matters for health, (3) what are its biological and neurological underpinnings, and (4) whether it can be promoted. Major contemporary forces against eudaimonia are also considered, including ever-widening inequality, the enduring pandemic, and world-wide strife. In contrast, encounters with the arts and nature are put forth as forces for eudaimonia. The relevance of these ideas for mental health research and practice is considered.

Originality

Mental health is often defined as the absence of mental illness. The novelty of the eudaimonic approach is to define mental health as the presence of well-being, assessed with different components of positive functioning.

Practical Implications

Enormous suffering defines our contemporary world. Such realities call for greater attention to factors that undermine as well as nurture the realization of human potential, the core of eudaimonic well-being.

Association between low internal health locus of control, psychological distress and insulin resistance. An exploratory study

AIM

To assess the hypothesis that low internal health locus of control (IHLC) and psychological distress (PD) are associated with insulin resistance.

MATERIALS AND METHODS

In 2002-2005, a random population sample of 2,816 men and women aged 30-74 years participated (76%) in two municipalities in southwestern Sweden. This study included 2,439 participants without previously known diabetes or cardiovascular disease. IHLC was measured by a global scale and PD was measured by the 12-item General Health Questionnaire. Insulin resistance was estimated using HOMA-ir. General linear models were used to estimate differences in HOMA-ir between groups with low IHLC, PD, and both low IHLC and PD, respectively.

RESULTS

Five per cent (n = 138) had both PD and low IHLC, 62 per cent of participants (n = 1509) had neither low IHLC nor PD, 18 per cent (n = 432) had PD, and 15 per cent (n = 360) low IHLC. Participants with both low IHLC and PD had significantly higher HOMA-ir than participants with neither low IHLC nor PD (Δ = 24.8%, 95%CI: 12.0-38.9), also in the fully adjusted model (Δ = 11.8%, 95%CI: 1.5-23.0). Participants with PD had significantly higher HOMA-ir (Δ = 12%, 95%CI: 5.7-18.7), but the significance was lost when BMI was included in the model (Δ = 5.3%, 95%CI:0.0-10.8). Similarly, participants with low IHLC had significantly higher HOMA-ir (Δ = 10.1%, 95%CI: 3.5-17.0) but the significance was lost in the fully adjusted model (Δ = 3.5%, 95%CI: -1.9-9.3).

CONCLUSIONS

Internal health locus of control (IHLC) and psychological distress (PD) were associated with insulin resistance. Especially individuals with both PD and low IHLC may need special attention.

Interplay of occupational stress, sense of humor, and health status among nurses working at hospitals in Ahvaz

Sense of humor constitutes a part of everyday life and work and an indispensable part of healthcare. However, the relationship between sense of humor and nursing occupational health and stress is yet to be studied in Iran. This study aimed to analyze the interplay of demographic factors, occupational stress, sense of humor, and health status of nurses working at the hospitals affiliated with the Ahvaz Jundishapur University of Medical Sciences, Iran. In this descriptive-analytical study, the statistical population consisted of 203 nurses. Occupational stress was assessed using the Iranian version of the Effort-Reward-Imbalance (ERI) Questionnaire. The Sense of Humor Questionnaire (SHQ) and the Iranian version of the 12-item General Health Questionnaire (GHQ-12) were employed to assess the sense of humor and physio-psychological health, respectively. Data collected were analyzed using the Statistical Package for the Social Sciences (SPSS) software. 81% (n=164) of the participants had an “external effort” (E) and “reward” (R) ratio greater than 1, indicating very high occupational stress. 39% (n=79) nurses with high occupational stress displayed their commitment to the workplace. Approximately 42% (n=85) of nurses were suffering from health problems. The mean humor score of participants was 2.90±0.41. Major life events over the past 3 months (p<0.01), weekly working hours (p<0.01), high occupational stress (p<0.01), and sense of humor (p<0.01) were determined to be significant predictors of nurses' health problems. Decision-makers are recommended to reduce nursing working hours through work shift management in order to maintain nurses' health status and reduce their occupational stress. In addition, hospital directors should promote a sense of humor in hospital environments with the help of culture-building practices, comedy books, music CDs, and training courses.

Habitual Coffee and Tea Consumption and Cardiometabolic Biomarkers in the UK Biobank: The Role of Beverage Types and Genetic Variation

BACKGROUND

Mechanisms linking habitual consumption of coffee and tea to the development of type 2 diabetes and cardiovascular diseases remain unclear.

OBJECTIVES

We leveraged dietary, genetic, and biomarker data collected from the UK Biobank to investigate the role of different varieties of coffee and tea in cardiometabolic health.

METHODS

We included data from ≤447,794 participants aged 37-73 y in 2006-2010 who provided a blood sample and completed questionnaires regarding sociodemographic factors, medical history, diet, and lifestyle. Multivariable linear regression was used to examine the association between coffee or tea consumption and blood concentrations of glycated hemoglobin, fasting glucose, total cholesterol, HDL cholesterol, LDL cholesterol, fasting triglycerides (TGs), apoA-1, apoB, lipoprotein-a, and C-reactive protein (CRP). Lifestyle and genetic factors affecting caffeine metabolism, responses, or intake were tested for interactions with beverage intake in relation to biomarker concentrations.

RESULTS

Compared with coffee nonconsumers, each additional cup of coffee was significantly associated with higher total cholesterol, HDL-cholesterol, and LDL-cholesterol concentrations and lower TG and CRP concentrations in both men and women (P-trend < 0.002). Higher consumption of espresso coffee (≥2 compared with 0 cups/d) was associated with higher LDL cholesterol in men (β: 0.110 mmol/L; 95% CI: 0.058, 0.163 mmol/L) and women (β: 0.161 mmol/L; 95% CI: 0.088, 0.234 mmol/L), whereas no substantial association was observed for instant coffee. Compared with tea nonconsumers, higher tea consumption was associated with lower total and LDL cholesterol and apoB and higher HDL cholesterol (P-trend < 0.002); these associations were similar for black and green tea. Associations were not modified by genetics.

CONCLUSIONS

In the UK Biobank, consumption of certain coffee brews such as espresso had unfavorable associations with blood lipids, whereas consumption of tea had favorable associations. Findings were not modified by genetic variants affecting caffeine metabolism, suggesting a role of noncaffeine constituents of these beverages in cardiometabolic health.

Socioeconomic Status and Biological Risks for Health and Illness Across the Life Course

OBJECTIVES

We assess the temporal properties and biosocial mechanisms underlying the associations between early-life socioeconomic status (SES) and later health. Using a life-course design spanning adolescence to older adulthood, we assess how early life and various dimensions of adult SES are associated with immune and metabolic function in different life stages and examine possible bio-behavioral and psychosocial mechanisms underlying these associations.

METHOD

Data for this study come from 3 national studies that collectively cover multiple stages of the life course (Add Health, MIDUS, and HRS). We estimated generalized linear models to examine the prospective associations between early-life SES, adult SES, and biomarkers of chronic inflammation and metabolic disorder assessed at follow-up. We further conducted formal tests of mediation to assess the role of adult SES in linking early SES to biological functions.

RESULTS

We found that early-life SES exerted consistent protective effects for metabolic disorder across the life span, but waned with time for CRP. The protective effect of respondent education remained persistent for CRP but declined with age for metabolic disorder. Adult income and assets primarily protected respondents against physiological dysregulation in middle and old ages, but not in early adulthood.

DISCUSSION

These findings are the first to elucidate the life-course patterns of SES that matter for underlying physiological functioning during the aging process to produce social gradients in health.

SMART: Study protocol for a sequential multiple assignment randomized controlled trial to optimize weight loss management

BACKGROUND

Stepped care is a rational resource allocation approach to reduce population obesity. Evidence is lacking to guide decisions on use of low cost treatment components such as mobile health (mHealth) tools without compromising weight loss of those needing more expensive traditional treatment components (e.g., coaching, meal replacement). A sequential multiple assignment randomization trial (SMART) will be conducted to inform the development of an empirically based stepped care intervention that incorporates mHealth and traditional treatment components.

OBJECTIVE

The primary aim tests the non-inferiority of app alone, compared to app plus coaching, as first line obesity treatment, measured by weight change from baseline to 6 months. Secondary aims are to identify the best tactic to address early treatment non-response and the optimal treatment sequence for resource efficient weight loss.

STUDY DESIGN

Four hundred participants, 18-60 years old with Body Mass Index between 27 and 45 kg/m2 will be randomized to receive a weight loss smartphone app (APP) or the app plus weekly coaching (APP + C) for a 12 week period. Those achieving <0.5 lb. weight loss on average per week, assessed by wireless scale at 2, 4, and 8 weeks, will be classified as non-responders and re-randomized once to step-up modestly (adding another mHealth component) or vigorously (adding mHealth and traditional treatment components) for the remaining treatment period. Weight will be assessed in person at baseline, 3, 6, and 12 months.

SIGNIFICANCE

Results will inform construction of an obesity treatment algorithm that balances weight loss outcomes with resource consumption.

Predicting the Happiness of Adolescents Based on Coping Styles and Religious Attitudes

The study aimed to predict the happiness of adolescents based on coping styles and religious attitudes. To this end, the correlational research methodology was used. In total, 381 subjects were selected from adolescents of Semnan (Eastern province of Iran), using multistage clustering sampling method. Research tools were Ways of Coping Questionnaire by Lazarus, Golriz and Barahani's Religious Attitude Questionnaire, and Oxford Happiness Questionnaire. Data analysis was performed in SPSS using Pearson's correlation coefficient and multiple regression analysis. Results of Pearson's correlation demonstrated a significant positive relationship between happiness of adolescents and variables of problem-focused coping styles (r = 0.31, P < 0.01) and religious attitudes (r = 0.129, P < 0.05). Meanwhile, a negative significant association was observed between emotion-focused coping styles and happiness (r = -0.184, P < 0.01). Moreover, results of multiple regression analysis indicated that the listed variables explained 17% of the variance of happiness in totality. According to the results, it is recommended that use of problem-focused styles be emphasized in addition to strengthening of religious attitudes to increase the happiness of adolescents.

Integrating Biomarkers in Social Stratification and Health Research

This article provides an overview of the integration of biomarkers and biological mechanisms in social science models of stratification and health. The goal in reviewing this literature is to highlight research that identifies the social forces that drive inequalities over the life course and across generations. The article is structured in the following way. First, descriptive background information on biomarkers is presented, followed secondly by a review of the general theoretical paradigms that lend themselves to an integrative approach. Third, the biomarkers used to capture several biological systems that are most responsive to social conditions are described. Fourth, research that explicates how social exposures "get under the skin" to affect physiological functioning and downstream health is discussed, using socioeconomic disadvantage as an illustrative social exposure. The review ends with emerging directions in the use of biomarkers in social science research. This article endeavors to encourage sociologists to embrace biosocial approaches in order to elevate the importance of social factors in biomedical processes and to intervene on the social conditions that create inequities.

Psychological resources and glucoregulation in Japanese adults: Findings from MIDJA

OBJECTIVE

To examine associations between glucoregulation and 3 categories of psychological resources: hedonic well-being (i.e., life satisfaction, positive affect), eudaimonic well-being (i.e., personal growth, purpose in life, ikigai), and interdependent well-being (i.e., gratitude, peaceful disengagement, adjustment) among Japanese adults. The question is important given increases in rates of type 2 diabetes in Japan in recent years, combined with the fact that most prior studies linking psychological resources to better physical health have utilized Western samples.

METHOD

Data came from the Midlife in Japan Study involving randomly selected participants from the Tokyo metropolitan area, a subsample of whom completed biological data collection (N = 382; 56.0% female; M(SD)age = 55.5(14.0) years). Glycosylated hemoglobin (HbA1c) was the outcome. Models adjusted for age, gender, educational attainment, smoking, alcohol, chronic conditions, body mass index (BMI), use of antidiabetic medication, and negative affect.

RESULTS

Purpose in life (β = -.104, p = .021) was associated with lower HbA1c, and peaceful disengagement (β = .129, p = .003) was associated with higher HbA1c in fully adjusted models. Comparable to the effects of BMI, a 1 standard deviation change in well-being was associated with a .1% change in HbA1c.

CONCLUSIONS

Associations among psychological resources and glucoregulation were mixed. Healthy glucoregulation was evident among Japanese adults with higher levels of purpose in life and lower levels of peaceful disengagement, thereby extending prior research from the United States. The results emphasize the need for considering sociocultural contexts in which psychological resources are experienced in order to understand linkages to physical health. (PsycINFO Database Record

Neighborhood Socioeconomic Status in Relation to Serum Biomarkers in the Black Women's Health Study

Lower neighborhood socioeconomic status (SES) is associated with higher cardiovascular disease (CVD) risk. Black women have a higher CVD risk and are more likely to live in poor neighborhoods than white women. We examined the association of neighborhood SES with several CVD biomarkers using data from the Black Women's Health Study (BWHS), a follow-up study of US black women reporting high levels of education and income. Blood specimens of 418 BWHS participants were assayed for C-reactive protein (CRP), hemoglobin A1C (hgA1C), and high-density lipoprotein (HDL) cholesterol. US Census block group data were linked to the women's addresses to reflect neighborhood SES. Multivariable-adjusted mixed linear regression models that adjusted for person-level SES and for cardiovascular risk factors were used to assess CRP, hgA1C, and HDL levels in relation to quintiles of neighborhood SES. Women living in the poorest neighborhoods had the least favorable biomarker levels. As neighborhood SES increased, CRP decreased (P for trend = 0.01), hgA1C decreased (P for trend = 0.07), and HDL increased (P for trend = 0.19). These associations were present within strata of individual educational level. The present findings suggest that neighborhood environments may affect physiological processes within residents independently of individual SES.

Financial strain, inflammatory factors, and haemoglobin A1c levels in African American women

OBJECTIVE

Type 2 diabetes disproportionately affects African American women, a population exposed to high levels of stress, including financial strain (Centers for Disease Control & Prevention, 2011, http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf). We tested a mediational model in which chronic financial strain among African American women contributes to elevated serum inflammation markers, which, in turn, lead to increased haemoglobin A1C (HbA1c) levels and risk for type 2 diabetes.

METHODS

We assessed level of financial strain four times over a 10-year period and tested its effect on two serum inflammation markers, C-reactive protein (CRP) and soluble interleukin-6 receptor (sIL-6R) in year 11 of the study. We tested the inflammation markers as mediators in the association between chronic financial strain and HbA1c, an index of average blood glucose level over several months.

DESIGN

Data were from 312 non-diabetic African American women from the Family and Community Health Study (FACHS; Cutrona et al., 2000, J. Pers. Soc. Psychol., 79, 1088).

RESULTS

Chronic financial strain predicted circulating sIL-6R after controlling for age, BMI, health behaviours, and physical health measures. In turn, sIL-6R significantly predicted HbA1c levels. The path between chronic financial strain and HbA1c was significantly mediated by sIL-6R. Contrary to prediction, CRP was not predicted by chronic financial strain.

CONCLUSIONS

Results support the role of inflammatory factors in mediating the effects of psychosocial stressors on risk for type 2 diabetes. Findings have implications for interventions that boost economic security and foster effective coping as well as medical interventions that reduce serum inflammation to prevent the onset of type 2 diabetes.

Relative contributions of naturalistic and constructed support: two studies of women with type 2 diabetes

Do distinct sources of social support have differential effects on health? Although previous research has contrasted family and friend support (naturalistic support), research on the relative effects of naturalistic support and constructed support (e.g., support groups) is extremely rare. Two studies of women with type 2 diabetes were conducted that assessed the independent effects of naturalistic and constructed support on physical activity and glycosylated hemoglobin (HbA1c). Participants were women diagnosed with type 2 diabetes from the intervention arms of two randomized controlled trials: primarily European American women (Study 1; N = 163) and exclusively Hispanic women (Study 2; N = 142). Measures assessed physical activity, HbA1c, and friend and family support at baseline and at 6 months, as well as group support after 6 months of intervention. In Study 1, only group support was related to increases in physical activity (ΔR(2) = .036). In Study 2, group support and family support showed independent effects on increases in physical activity (ΔR(2) = .047 and .060, respectively). Also, group support was related to decreases in HbA1c in Study 1 (ΔR(2) = .031) and Study 2 (ΔR(2) = .065). Overall, constructed (group) support was related to outcomes most consistently, but naturalistic (family) support showed some independent relation to physical activity improvement.

Work stress is associated with diabetes and prediabetes: cross-sectional results from the MIPH Industrial Cohort Studies

BACKGROUND

Diabetes is rapidly rising globally, and the relation of psychosocial stress in workplace to diabetes and prediabetes is not well investigated.

PURPOSE

The aim of the study was to examine the association of work stress with diabetes and prediabetes in a sample of German industrial workers.

METHOD

In this cross-sectional survey of an occupational cohort (n = 2,674, 77 % male), work stress was measured by the Effort-Reward Imbalance (ERI) Questionnaire. Diabetic status, i.e., diabetes and prediabetes, were diagnosed by glycated hemoglobin A1c criterion or fasting plasma glucose criterion supplemented by self-reports.

RESULTS

The overall prevalence rates of diabetes and prediabetes were 3.5 and 42.2 %, respectively. Using ordinal logistic regression with adjustment for potential confounding factors, high ERI at work was associated with diabetes-related ordinal variable (odds ratio [OR], 1.27; 95 % confidence interval [95 % CI], 1.02-1.58) and prediabetes-related ordinal variable (OR, 1.26; 95 % CI, 1.01-1.58) in men, whereas the associations in women were somewhat less pronounced and did not reach statistical significance.

CONCLUSION

The findings indicate that work stress in terms of ERI is associated with diabetes and prediabetes in German industrial male workers. If supported by prospective evidence, results point to a new approach towards primary prevention of diabetes.

Association between socio-economic status and hemoglobin A1c levels in a Canadian primary care adult population without diabetes

BACKGROUND

Hgb A1c levels may be higher in persons without diabetes of lower socio-economic status (SES) but evidence about this association is limited; there is therefore uncertainty about the inclusion of SES in clinical decision support tools informing the provision and frequency of Hgb A1c tests to screen for diabetes. We studied the association between neighborhood-level SES and Hgb A1c in a primary care population without diabetes.

METHODS

This is a retrospective study using data routinely collected in the electronic medical records (EMRs) of forty six community-based family physicians in Toronto, Ontario. We analysed records from 4,870 patients without diabetes, age 45 and over, with at least one clinical encounter between January 1st 2009 and December 31st 2011 and one or more Hgb A1c report present in their chart during that time interval. Residential postal codes were used to assign neighborhood deprivation indices and income levels by quintiles. Covariates included elements known to be associated with an increase in the risk of incident diabetes: age, gender, family history of diabetes, body mass index, blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, and fasting blood glucose.

RESULTS

The difference in mean Hgb A1c between highest and lowest income quintiles was -0.04% (p = 0.005, 95% CI -0.07% to -0.01%), and between least deprived and most deprived was -0.05% (p = 0.003, 95% CI -0.09% to -0.02%) for material deprivation and 0.02% (p = 0.2, 95% CI -0.06% to 0.01%) for social deprivation. After adjustment for covariates, a marginally statistically significant difference in Hgb A1c between highest and lowest SES quintile (p = 0.04) remained in the material deprivation model, but not in the other models.

CONCLUSIONS

We found a small inverse relationship between Hgb A1c and the material aspects of SES; this was largely attenuated once we adjusted for diabetes risk factors, indicating that an independent contribution of SES to increasing Hgb A1c may be limited. This study does not support the inclusion of SES in clinical decision support tools that inform the use of Hgb A1c for diabetes screening.

Locus of control and obesity

In the developed world, the hazards associated with obesity have largely outstripped the risk of starvation. Obesity remains a difficult public health issue to address, due in large part to the many disciplines involved. A full understanding requires knowledge in the fields of genetics, endocrinology, psychology, sociology, economics, and public policy - among others. In this short review, which serves as an introduction to the Frontiers in Endocrinology research topic, we address one cross-disciplinary relationship: the interaction between the hunger/satiation neural circuitry, an individual's perceived locus of control, and the risk for obesity. Mammals have evolved a complex system for modulating energy intake. Overlaid on this, in humans, there exists a wide variation in "perceived locus of control" - that is, the extent to which an individual believes to be in charge of the events that affect them. Whether one has primarily an internal or external locus of control itself affects, and is affected by, external and physiological factors and has been correlated with the risk for obesity. Thus, the path from hunger and satiation to an individual's actual behavior may often be moderated by psychological factors, included among which is locus of control.

Elevated HbA1c levels in individuals not diagnosed with type 2 diabetes in Qatar: a pilot study

BACKGROUND

The prevalence of type 2 diabetes (T2D) in Qatar and the Middle East is one of the highest in the world. It is estimated that about one quarter of the individuals with tbl2D are undiagnosed. Elevated HbA1c levels are an indicator of tbl2D or a pre-diabetic state. In this study we set out to examine which factors, such as anthropometric and socio-demographic risk factors, are associated with elevated HbA1c levels in a population without tbl2D.

METHODS

We examined 191 subjects with no record of tbl2D. Anthropometrics and HbA1c were measured. Socio-demographic (age, gender, ethnicity and educational level) and health information were assessed through questionnaires. Elevated HbA1c levels were defined as >6.0% (>42 mmol/mol). Individual risk factors were examined in relationship to having elevated HbA1c levels using logistic regression.

RESULTS

Thirty-eight (20%) study participants had elevated HbA1c levels. Participants from South Asian and Filipino descent were more likely to present with elevated HbA1c levels than Arab participants (adjusted odds ratios (OR): 13.30 (95% confidence interval (CI): 4.24, 41.79), p < 0.001 for South Asian and 4.54 (95% CI: 1.04, 19.83), p = 0.04 for Filipinos). A body mass index of above 30 kg/m(2) was associated with elevated HbA1c levels (adjusted OR: 2.90 (95% CI: 1.29, 6.51), p = 0.01). Neither gender nor educational level was associated with elevated HbA1c levels.

CONCLUSIONS

Elevated HbA1c levels in individuals not diagnosed with diabetes were most frequently found in the South Asian and Filipino immigrant population. Special attention should therefore be given to the early identification of tbl2D in these subjects.

Association of coping style and psychological well-being in hospital nurses

INTRODUCTION

Nursing jobs are among the occupations experiencing high levels of stress. Level of psychological well-being and coping style with stressful situations among nurses has large impact on their job performance. Limited information exists about the relationship between coping styles and psychological well-being among nurses, so the present study examined the way of coping and the level of psychological well-being as well as their relationships among nurses.

METHODS

In this correlational study, 100 nurses from Shahid Sadoughi University of Medical Sciences were selected by multi-stage random sampling in 2012. Lazarus and Folkman's coping styles and Ryff's psychological well-being Questionnaires were completed by self-report method. Collected data were entered software SPSS ver. 13 and then analyzed using Pearson correlation test.

RESULTS

The results showed EFCSwere more used  but PFCSstyle was less used with a little difference by mean (SD) of  87.91 (10.76) vs. 73.12 (12.15). Between EFCSand some psychological well-being dimensions such as purpose in life (P=0.01, r= -0.28) and personal development (P=0.03, r=-0.024), a significant negative association and between PFCSstyle and purpose in life, a significant positive relationship was found (P=0.006, r=0.31).

CONCLUSION

Considering that PFCSstyle is more effective in solving problems and job stress, as well as, the increased use of EFCSis associated with adverse health consequences, improvement of nurses' coping strategies to cope better with stressful events by skill training and promotion of nurses' psychological well-being level is recommended.

Gender differences in material, psychological, and social domains of the income gradient in mortality: implications for policy

We set out to examine the material, psychological, and sociological pathways mediating the income gradient in health and mortality. We used the 2008 General Social Survey-National Death Index dataset (N = 26,870), which contains three decades of social survey data in the US linked to thirty years of mortality follow-up. We grouped a large number of variables into 3 domains: material, psychological, and sociological using factor analysis. We then employed discrete-time hazard models to examine the extent to which these three domains mediated the income-mortality association among men and women. Overall, the gradient was weaker for females than for males. While psychological and material factors explained mortality hazards among females, hazards among males were explained only by social capital. Poor health significantly predicted both income and mortality, particularly among females, suggesting a strong role for reverse causation. We also find that many traditional associations between income and mortality are absent in this dataset, such as perceived social status.

Hemoglobin A1c as a diagnostic tool: public health implications from an actor-network perspective

Public health arguments for collecting hemoglobin A1c (HbA1c) data, particularly in clinical settings, should be reframed to place more emphasis on nonmedical determinants of population health. We compare individual- with population-level interpretations of HbA1c titers. This comparison reveals that public health researchers need to pay close attention to diagnostic tests and their uses, including rhetorical uses. We also synthesize historical and current evidence to map out 2 possible scenarios for the future. In the first scenario, prevention efforts emphasize primary care and focus almost entirely downstream. The second scenario anticipates downstream interventions but also upstream interventions targeting environments. Our analysis adapts actor-network theory to strategic planning and forecasting in public health.

Psychosocial determinants of socioeconomic inequalities in cancer screening participation: a conceptual framework

Cancer screening participation shows a strong, graded association with socioeconomic status (SES) not only in countries such as the United States, where insurance status can be a barrier for lower income groups, but also in the United Kingdom, where the National Health Service provides all health care to residents, including screening, for free. Traditionally, the literature on socioeconomic inequalities has focused on upstream factors, but more proximal (downstream) influences on screening participation also need to be examined, particularly those that address the graded nature of the association rather than focusing specifically on underserved groups. This review offers a framework that links some of the components and corollaries of SES (life stress, educational opportunities, illness experience) to known psychosocial determinants of screening uptake (beliefs about the value of early detection, fatalistic beliefs about cancer, self-efficacy). The aim is to explain why individuals from lower SES backgrounds perceive cancer screening tests as more threatening, more difficult to accomplish, and less beneficial. A better understanding of the mechanisms through which lower SES causes negative attitudes toward screening could facilitate the development of intervention strategies to reduce screening inequalities.

Pharmacological treatment of hyperinsulineamia in rats depends on coping style

Passive and proactive coping styles are associated with marked differences in behavioral and neuroendocrine responses. Previous studies revealed that the passive individuals are more prone to hyperinsulinemia. Likewise, we hypothesize that different coping styles may require different drugs to treat this. We tested this by treating passive and proactive rats (Roman Low Avoidance and Roman High Avoidance rats respectively) with either Rosiglitazone or with RU486. After eight days of treatment we performed and intravenous glucose tolerance test (IVGTT) and we compared the insulin and glucose levels with those measured during the IVGTT at baseline. Rosiglitazone improved insulin levels during an IVGTT in both passive and proactive coping styles. RU486, however, lowered insulin levels only in rats with a passive coping style. This study suggests that insight in the neuroendocrine differences between passive and proactive coping styles may provide an extra impulse to improve treatment of insulin resistance, since it allows the application of drugs targeted at the individual.

Purpose in life is associated with a reduced risk of incident disability among community-dwelling older persons

BACKGROUND

Purpose in life is thought to be associated with positive health outcomes in old age, but its association with disability is unknown.

OBJECTIVE

Test the hypothesis that greater purpose in life is associated with a reduced risk of incident disability, including impairment in basic and instrumental activities of daily living and mobility disability, among community-based older persons free of dementia.

DESIGN

Participants were from the Rush Memory and Aging Project, a large longitudinal clinical-pathologic study of aging.

SETTING

Retirement communities, senior housing facilities, and homes across the greater Chicago metropolitan area.

MEASUREMENTS

All participants underwent baseline assessment of purpose in life and detailed annual clinical evaluations to document incident disability.

RESULTS

The mean score on the purpose in life measure at baseline was 3.6 (standard deviation = 0.5, range: 2-5). In a series of proportional hazards models adjusted for age, sex, and education, greater purpose in life was associated with a reduced risk of disability in basic activities of daily living (hazard ratio [HR] = 0.60, 95% confidence interval [C1] = 0.45-0.81), instrumental activities of daily living (HR = 0.56, 95% CI = 0.40-0.78), and mobility disability (HR = 0.61, 95% CI = 0.44-0.84). These associations did not vary along demographic lines and persisted after the addition of terms to control for global cognition, depressive symptoms, social networks, neuroticism, income, physical frailty, vascular risk factors, and vascular diseases.

CONCLUSIONS

Among community-based older persons without dementia, greater purpose in life is associated with maintenance of functional status, including a reduced risk of developing impairment in basic and instrumental activities of daily living and mobility disability.

Coping style predicts the (in)sensitivity for developing hyperinsulinemia on a high fat diet in rats

The aim of this study was to explore interactions between coping style and diet as risk factors for developing insulin resistance in rats. We hypothesized that rats characterized by a passive coping strategy are more susceptible for developing insulin resistance and visceral obesity than proactively coping rats, particularly on a high (45%) fat diet. This hypothesis was tested by comparing 1) insulin and glucose responses to an intravenous glucose tolerance test (IVGTT), and 2) body fat distribution, in two rat models for passive and proactive coping styles. We found that the most extremely passive rats are characterized by elevated insulin levels during a IVGTT, even on chow. Moderately passive rats display normal insulin responses under chow conditions, but develop insulin resistance on a high fat diet. Proactive rats are remarkably resistant to insulin resistance and visceral obesity, even when overfeeding on a high fat diet. Carcass analysis revealed that passive rats are characterized by increased epididymal fat deposition, which is in line with the observed differences in insulin resistance. We conclude that a passive personality is prone to develop insulin resistance and visceral obesity on a palatable fat diet and a proactive personality might be protected against the development of diet-induced insulin resistance.

Does low socioeconomic status affect use of nutritional services by pre-diabetes patients?

PURPOSE

This paper's aim is to identify whether community-level socioeconomic status (SES) predicts: screening test for pre-diabetes; actual diagnosis of pre-diabetes; or nutritional counseling.

DESIGN/METHODOLOGY/APPROACH

This is an analysis of 1,348,124 insured adults receiving medical care from Maccabi Healthcare Services (MHS) in 107 MHS clinics throughout Israel. The research population comprised 79 percent of the MHS members over 18 years of age in 2004-2006. Area level socioeconomic data were drawn from the Israel Central Bureau of Statistics SES index for every geographical area and each MHS clinic in the study was coded from: - 1.03 to 2.73 (- 1.03 indicating low SES and 2.73 + high SES) according to the SES index for the location. The fasting glucose laboratory test was used for analysis. Pre-diabetes diagnosis was based on a fasting glucose above 100 mg/dl. Nutritional counseling was defined by dietitian visits in the claims database.

FINDINGS

The percentage of insured individuals who underwent blood glucose testing during the study increased with age from 67 percent at ages 18-45 to92 percent for age 65 and over. The percentage of individuals diagnosed with pre-diabetes also increased with age, rising from 4 percent in the younger group to 14 percent in those aged 46-65 and to 14-16 percent of 65 and older. The percentage of individuals with pre-diabetes who visited a dietitian was 16-27 percent for those under 65 and 14-17 percent for those over 65 (males and females, respectively). Individuals living in lower socioeconomic areas were less likely to have blood tests. Among tested patients, the prevalence of pre-diabetes was higher in areas of lower SES and their dietitian visits were less frequent.

PRACTICAL IMPLICATIONS

In lower SES index areas, there is a need for better identification and treatment of patients.

ORIGINALITY/VALUE

The paper shows that a proactive approach is needed both to detect pre-diabetes and to encourage patients to receive nutritional treatment.

Purpose in life is associated with mortality among community-dwelling older persons

OBJECTIVE

To assess the association between purpose in life and all-cause mortality in community-dwelling elderly persons.

METHODS

We used data from 1238 older persons without dementia from two longitudinal cohort studies (Rush Memory and Aging Project and Minority Aging Research Study) with baseline evaluations of purpose in life and up to 5 years of follow-up to test the hypothesis that greater purpose in life is associated with a reduced risk of mortality among community-dwelling older persons.

RESULTS

The mean +/- standard deviation score on the purpose in life measure at baseline was 3.7 +/- 0.5 (range = 2-5), with higher scores indicating greater purpose in life. During the 5-year follow-up (mean = 2.7 years), 151 of 1238 persons (12.2%) died. In a proportional hazards model adjusted for age, sex, education, and race, a higher level of purpose in life was associated with a substantially reduced risk of mortality (hazard ratio = 0.60, 95% Confidence Interval = 0.42, 0.87). Thus, the hazard rate for a person with a high score on the purpose in life measure (score = 4.2, 90th percentile) was about 57% of the hazard rate of a person with a low score (score = 3.1, 10th percentile). The association of purpose in life with mortality did not differ among men and women or whites and blacks. Further, the finding persisted after the addition of terms for several potential confounders, including depressive symptoms, disability, neuroticism, the number of chronic medical conditions, and income.

CONCLUSION

Greater purpose in life is associated with a reduced risk of all-cause mortality among community-dwelling older persons.

Psychosocial correlates of cardiorespiratory fitness and muscle strength in overweight and obese post-menopausal women: a MONET study

The purpose of this study was to examine the psychosocial correlates of cardiorespiratory fitness (VO2peak) and muscle strength in overweight and obese sedentary post-menopausal women. The study population consisted of 137 non-diabetic, sedentary overweight and obese post-menopausal women (mean age 57.7 years, s = 4.8; body mass index 32.4 kg.m(-2), s = 4.6). At baseline we measured: (1) body composition using dual-energy X-ray absorptiometry; (2) visceral fat using computed tomography; (3) insulin sensitivity using the hyperinsulinaemic-euglycaemic clamp; (4) cardiorespiratory fitness; (5) muscle strength using the leg press exercise; and (6) psychosocial profile (quality of life, perceived stress, self-esteem, body-esteem, and perceived risk for developing chronic diseases) using validated questionnaires. Both VO2peak and muscle strength were significantly correlated with quality of life (r = 0.29, P < 0.01 and r = 0.30, P < 0.01, respectively), and quality of life subscales for: physical functioning (r = 0.28, P < 0.01 and r = 0.22, P < 0.05, respectively), pain (r = 0.18, P < 0.05 and r = 0.23, P < 0.05, respectively), role functioning (r = 0.20, P < 0.05 and r = 0.24, P < 0.05, respectively), and perceived risks (r = -0.24, P < 0.01 and r = -0.30, P < 0.01, respectively). In addition, VO2peak was significantly associated with positive health perceptions, greater body esteem, and less time watching television/video. Stepwise regression analysis showed that quality of life for health perceptions and for role functioning were independent predictors of VO2peak and muscle strength, respectively. In conclusion, higher VO2peak and muscle strength are associated with a favourable psychosocial profile, and the psychosocial correlates of VO2peak were different from those of muscle strength. Furthermore, psychosocial factors could be predictors of VO2peak and muscle strength in our cohort of overweight and obese sedentary post-menopausal women.

Socioeconomic status and psychological well-being predict cross-time change in glycosylated hemoglobin in older women without diabetes

OBJECTIVE

To investigate whether socioeconomic status and psychological well-being (eudaimonic and hedonic aspects) predicted nondiabetic levels of glycosylated hemoglobin (HbA1c) over time, after adjusting for covariates and baseline level of HbA1c.

METHODS

These questions were investigated with a longitudinal sample (n = 97; age = 61-91 years) of older women without diabetes. Socioeconomic status, well-being, and health behaviors were assessed using self-administered questionnaires. Fasting blood samples for assays of HbA1c were obtained before 7 AM during the respondents' overnight stay at the General Clinical Research Center at the University of Wisconsin-Madison. All measurements were obtained at baseline and 2-year follow-up.

RESULTS

Regression analyses showed that higher income and positive affect predicted lower levels of HbA1c, after controlling for baseline HbA1c and health factors. Additionally, three well-being measures (purpose in life, personal growth, and positive affect) moderated the relationship between income and HbA1c.

CONCLUSION

These results suggest that psychological well-being and socioeconomic status interact in important ways in influencing nondiabetic glucose metabolism.

Psychological underpinnings of metabolic syndrome

Metabolic syndrome (MS) is more common among socio-economically disadvantaged individuals and is associated with certain risky lifestyle practices. MS also appears to be triggered by adverse social circumstances and chronic stress. The present paper reviews accumulating evidence to imply that individuals who have certain personality and behaviour traits are particularly predisposed to develop MS, and brings together theories that relate to possible psychological mechanisms underlying MS. It considers how such factors might interact causally to encourage the development of MS. As part of the EU-funded LIPGENE Integrated Project, multi-level modelling will be undertaken to explore potential pathways to MS, taking into consideration the interplay between a range of psycho-social, demographic, cultural and lifestyle factors thought to contribute to the development of MS. Data will be gathered for this purpose from a representative sample of >50-year-olds living in Britain (n 1000) and Portugal (n 500). It is anticipated that this information will assist in the development and targetting of future intervention to prevent and treat MS in the normal population.

The Chinese version of the multidimensional health locus of control scale form C in pregnancy

OBJECTIVE

The concept of locus of control (LOC) is an important psychological dimension within health research. The current study sought to establish the psychometric properties of the Chinese version of the Multidimensional Health Locus of Control Scale Form C (C-MHLC-C) on the third trimester of pregnancy to assess the potential usefulness of this measure within this clinical population.

METHODS

Internal consistency and confirmatory factor analyses were conducted on C-MHLC-C data from 292 women on the third trimester of pregnancy. Case detection for significant psychological disturbance was assessed using the 12-item General Health Questionnaire.

RESULTS

The best fit to the data was offered by a modified four-factor model comprising correlated dimensions of "internal," "chance," "doctors," and "powerful others" LOC. However, even this best-fit model offered a poor fit to the data. The subscales of the C-MHLC-C all demonstrated poor internal consistency.

CONCLUSION

The C-MHLC-C cannot be recommended as a valid and reliable measure of LOC until a full translation and validation study has been conducted.

Psychological factors as mechanisms for socioeconomic disparities in health: a critical appraisal of four common factors

Social epidemiology has increasingly looked to psychological factors as both risk factors for physical health and mechanisms behind disparities. Yet, there has been little resolution to the question of whether psychological factors explain disparities, and skepticism has begun to mount about whether psychological factors are causally linked to health. Furthermore, some have questioned the nature of the relationship: most research suggests that psychological factors mediate the relationship between socioeconomic status and health, but recent research suggests that they moderate the relationship. The present paper attempts to provide a more comprehensive appraisal of the current debate. It uses four popular psychological factors (i.e., self-esteem, mastery, neuroticism, and depressive symptoms), three health outcomes, and a nationally representative, three-panel longitudinal survey. The results illustrate the promise and limitations of psychological mechanisms. In the cross-section, the results provide evidence for substantial moderating effects, but these effects disappear entirely when estimated prospectively. The results also provide some evidence for mediating effects, but these effects are very weak and the prospective effects of psychological factors diminish over time and with controls for baseline health. Implications for theories of socioeconomic status and health are discussed and a more social psychologically sophisticated approach is encouraged.

Relation of childhood socioeconomic status and family environment to adult metabolic functioning in the CARDIA study

OBJECTIVE

Low SES and a conflict-ridden, neglectful, or harsh family environment in childhood have been linked to a high rate of physical health disorders in adulthood. The objective of the present investigation was to evaluate a model of the pathways that may help to explain these links and to relate them to metabolic functioning (MF) in the Coronary Artery Risk Development In Young Adults (CARDIA) dataset.

METHODS

Participants (n = 3225) in the year 15 assessment of CARDIA, age 33 to 45 years, completed measures of childhood socioeconomic status (SES), risky early family environment (RF), adult psychosocial functioning (PsyF, a latent factor measured by depression, hostility, positive and negative social contacts), and adult SES. Indicators of the latent factor MF were assessed, specifically, cholesterol, insulin, glucose, triglycerides, and waist circumference.

RESULTS

The overall prevalence of metabolic syndrome was 9.7%. Structural equation modeling indicated that childhood SES and RF are associated with MF via their association with PsyF (standardized path coefficients: childhood SES to RF -0.13, RF to PsyF 0.44, PsyF to MF 0.09, all p < .05), but also directly (coefficient from childhood SES to MF -0.12, p < .05), with good overall model fit. When this model was tested separately for race-sex subgroups, it fit best for white women, fit well for African-American women and white men, but did not fit well for African-American men.

CONCLUSIONS

These results indicate that childhood SES and early family environment contribute to metabolic functioning through pathways of depression, hostility, and poor quality of social contacts.

The impact of time of waking and concurrent subjective stress on the cortisol response to awakening

Both time of awakening and stress are thought to influence the magnitude of the cortisol awakening response (CAR), but the relative importance of these factors is unclear. This study assessed these influences in a combined within- and between-subject design. Data were collected from 32 men and women working as station staff in the London underground railway system in three conditions: early-shift days, day-shift days, and control days. Saliva samples were obtained on waking, 30 and 60 min later, together with measures of concurrent subjective stress, sleep quality the night before, and accumulated stress at the end of the day. Participants woke up more than 3.5h earlier on average on early-shift than day-shift or control days, and cortisol levels on waking were lower in the early-shift condition. The CAR (assessed both with increases from waking to 30 min and with area under the curve measures) was greater on early-shift days. However, respondents were more stressed over the hour after waking and reported more sleep disturbance on early-shift days; when these factors were taken into account, the difference in CAR related to experimental condition was no longer significant. Comparisons were also made between individuals who started their day-shifts in the morning and afternoon. The morning shift group woke an average of 2h earlier than did the afternoon shift group, but did not differ on stress, sleep quality, or CAR. Stress assessed retrospectively at the end of the day was not associated with the CAR. We conclude that early waking, stress early in the day, and sleep disturbance often coincide, but need to be distinguished in order accurately to interpret differences in CAR magnitude.

Positive health: connecting well-being with biology

Two key types of well-being, eudaimonic and hedonic, are reviewed. The first addresses ideas of self-development, personal growth and purposeful engagement, while the second is concerned with positive feelings such as happiness and contentment. How well-being varies by age and socio-economic standing is briefly summarized, followed by examination of its biological correlates (neuroendocrine, immune, cardiovascular, rapid eye movement (REM) sleep). Preliminary findings on a sample of ageing women showed that those with higher levels of eudaimonic well-being had lower levels of daily salivary cortisol, pro-inflammatory cytokines, cardiovascular risk, and longer duration REM sleep compared with those showing lower levels of eudaimonic well-being. Hedonic well-being, however, showed minimal linkage to biomarker assessments. Future research directions building on these initial findings are discussed.