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Johnson DA, Lisabeth L, Hickson D, Johnson-Lawrence V, Samdarshi T, Taylor H, Diez Roux AV. The Social Patterning of Sleep in African Americans: Associations of Socioeconomic Position and Neighborhood Characteristics with Sleep in the Jackson Heart Study. Sleep 2016; 39:1749-59. [PMID: 27253767 DOI: 10.5665/sleep.6106] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 04/18/2016] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES We investigated cross-sectional associations of individual-level socioeconomic position (SEP) and neighborhood characteristics (social cohesion, violence, problems, disadvantage) with sleep duration and sleep quality in 5,301 African Americans in the Jackson Heart Study. METHODS All measures were self-reported. Sleep duration was assessed as hours of sleep; sleep quality was reported as poor (1) to excellent (5). SEP was measured by categorized years of education and income. Multinomial logistic and linear regression models were fit to examine the associations of SEP and neighborhood characteristics (modeled dichotomously and tertiles) with sleep duration (short vs. normal, long vs. normal) and continuous sleep duration and quality after adjustment for demographics and risk factors. RESULTS The mean sleep duration was 6.4 ± 1.5 hours, 54% had a short (≤ 6 h) sleep duration, 5% reported long (≥ 9 h) sleep duration, and 24% reported fair to poor sleep quality. Lower education was associated with greater odds of long sleep (odds ratio [OR] = 2.19, 95% confidence interval [CI] = 1.42, 3.38) and poorer sleep quality (β = -0.17, 95% CI = -0.27, -0.07) compared to higher education after adjustment for demographics and risk factors. Findings were similar for income. High neighborhood violence was associated with shorter sleep duration (-9.82 minutes, 95% CI = -16.98, -2.66) and poorer sleep quality (β = -0.11, 95% CI = -0.20, 0.00) after adjustment for demographics and risk factors. Results were similar for neighborhood problems. In secondary analyses adjusted for depressive symptoms in a subset of participants, most associations were attenuated and only associations of low SEP with higher odds of long sleep and higher neighborhood violence with poorer sleep quality remained statistically significant. CONCLUSIONS Social and environmental characteristics are associated with sleep duration and quality in African Americans. Depressive symptoms may explain at least part of this association.
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Affiliation(s)
- Dayna A Johnson
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.,Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston MA
| | - Lynda Lisabeth
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - DeMarc Hickson
- My Brothers Keeper, Inc., Jackson, MS.,University of Mississippi Medical Center, Jackson, MS
| | - Vicki Johnson-Lawrence
- Department of Public Health and Health Sciences, University of Michigan-Flint, Flint, Michigan
| | | | - Herman Taylor
- Morehouse School of Medicine's Cardiovascular Research Institute, Atlanta, GA
| | - Ana V Diez Roux
- Dornsife School of Public Health, Drexel University, Philadelphia, PA
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Johnson DA, Lisabeth L, Lewis TT, Sims M, Hickson DA, Samdarshi T, Taylor H, Diez Roux AV. The Contribution of Psychosocial Stressors to Sleep among African Americans in the Jackson Heart Study. Sleep 2016; 39:1411-9. [PMID: 27166234 DOI: 10.5665/sleep.5974] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/28/2016] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Studies have shown that psychosocial stressors are related to poor sleep. However, studies of African Americans, who may be more vulnerable to the impact of psychosocial stressors, are lacking. Using the Jackson Heart Study (JHS) baseline data, we examined associations of psychosocial stressors with sleep in 4,863 African Americans. METHODS We examined cross-sectional associations between psychosocial stressors and sleep duration and quality in a large population sample of African Americans. Three measures of psychosocial stress were investigated: the Global Perceived Stress Scale (GPSS); Major Life Events (MLE); and the Weekly Stress Inventory (WSI). Sleep was assessed using self-reported hours of sleep and sleep quality rating (1 = poor; 5 = excellent). Multinomial logistic and linear regression models were used to examine the association of each stress measure (in quartiles) with continuous and categorical sleep duration (< 5 ("very short"), 5-6 h ("short") and > 9 h ("long") versus 7 or 8 h ("normal"); and with sleep quality after adjustment for demographics and risk factors (body mass index, hypertension, diabetes, physical activity). RESULTS Mean age of the sample was 54.6 years and 64% were female. Mean sleep duration was 6.4 + 1.5 hours, 54% had a short sleep duration, 5% had a long sleep duration, and 34% reported a "poor" or "fair" sleep quality. Persons in the highest GPSS quartile had higher odds of very short sleep (odds ratio: 2.87, 95% confidence interval [CI]: 2.02, 4.08), higher odds of short sleep (1.72, 95% CI: 1.40, 2.12), shorter average sleep duration (Δ = -33.6 min (95% CI: -41.8, -25.4), and reported poorer sleep quality (Δ = -0.73 (95% CI: -0.83, -0.63) compared to those in the lowest quartile of GPSS after adjustment for covariates. Similar patterns were observed for WSI and MLE. Psychosocial stressors were not associated with long sleep. For WSI, effects of stress on sleep duration were stronger for younger (< 60 y) and college-educated African-Americans. CONCLUSIONS Psychosocial stressors are associated with higher odds of short sleep, lower average sleep duration, and lower sleep quality in African Americans. Psychosocial stressors may be a point of intervention among African Americans for the improvement of sleep and downstream health outcomes.
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Affiliation(s)
- Dayna A Johnson
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.,Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Lynda Lisabeth
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Tené T Lewis
- Department of Epidemiology, Emory University, Atlanta, GA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - DeMarc A Hickson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS.,Center for Research, Evaluation, and Environmental & Policy Change, My Brother's Keeper, Inc, Jackson, MS
| | - Tandaw Samdarshi
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Herman Taylor
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA
| | - Ana V Diez Roux
- Dornsife School of Public Health, Drexel University, Philadelphia, PA
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3
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Waldstein SR, Moody DLB, McNeely JM, Allen AJ, Sprung MR, Shah MT, Al'Najjar E, Evans MK, Zonderman AB. Cross-sectional relations of race and poverty status to cardiovascular risk factors in the Healthy Aging in Neighborhoods of Diversity across the Lifespan (HANDLS) study. BMC Public Health 2016; 16:258. [PMID: 26975845 PMCID: PMC4791792 DOI: 10.1186/s12889-016-2945-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 03/09/2016] [Indexed: 01/30/2023] Open
Abstract
Background Examine interactive relations of race and poverty status with cardiovascular disease (CVD) risk factors in a socioeconomically diverse sample of urban-dwelling African American (AA) and White adults. Methods Participants were 2,270 AAs and Whites (57 % AA; 57 % female; ages 30–64 years) who completed the first wave of the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. CVD risk factors assessed included body mass index (BMI), waist circumference (WC), total cholesterol (TC), high- and low-density lipoprotein cholesterol (HDL-C, LDL-C), triglycerides (TG), glycated hemoglobin (HbA1c), high-sensitivity C-reactive protein (CRP), and systolic, diastolic, and pulse pressure (SBP, DBP, PP). Interactive and independent relations of race, poverty status, and sex were examined for each outcome via ordinary least squares regression adjusted for age, education, literacy, substance use, depressive symptoms, perceived health care barriers, medical co-morbidities, and medications. Results Significant interactions of race and poverty status (p’s < .05) indicated that AAs living in poverty had lower BMI and WC and higher HDL-C than non-poverty AAs, whereas Whites living in poverty had higher BMI and WC and lower HDL-C than non-poverty Whites. Main effects of race revealed that AAs had higher levels of HbA1c, SBP, and PP, and Whites had higher levels of TC, LDL-C and TG (p’s < .05). Conclusion Poverty status moderated race differences for BMI, WC, and HDL-C, conveying increased risk among Whites living in poverty, but reduced risk in their AA counterparts. Race differences for six additional risk factors withstood extensive statistical adjustments including SES indicators.
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Affiliation(s)
- Shari R Waldstein
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, 21250, USA.
| | - Danielle L Beatty Moody
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, 21250, USA
| | - Jessica M McNeely
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, 21250, USA.,Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA
| | - Allyssa J Allen
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, 21250, USA
| | - Mollie R Sprung
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, 21250, USA
| | - Mauli T Shah
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, 21250, USA.,Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA
| | - Elias Al'Najjar
- Department of Mathematics and Statistics, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA
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Non AL, Gravlee CC, Mulligan CJ. Education, genetic ancestry, and blood pressure in African Americans and Whites. Am J Public Health 2012; 102:1559-65. [PMID: 22698014 DOI: 10.2105/ajph.2011.300448] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES We assessed the relative roles of education and genetic ancestry in predicting blood pressure (BP) within African Americans and explored the association between education and BP across racial groups. METHODS We used t tests and linear regressions to examine the associations of genetic ancestry, estimated from a genomewide set of autosomal markers, and education with BP variation among African Americans in the Family Blood Pressure Program. We also performed linear regressions in self-identified African Americans and Whites to explore the association of education with BP across racial groups. RESULTS Education, but not genetic ancestry, significantly predicted BP variation in the African American subsample (b=-0.51 mm Hg per year additional education; P=.001). Although education was inversely associated with BP in the total population, within-group analyses showed that education remained a significant predictor of BP only among the African Americans. We found a significant interaction (b=3.20; P=.006) between education and self-identified race in predicting BP. CONCLUSIONS Racial disparities in BP may be better explained by differences in education than by genetic ancestry. Future studies of ancestry and disease should include measures of the social environment.
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Affiliation(s)
- Amy L Non
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA 02138, USA.
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5
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Igna CV, Julkunen J, Vanhanen H. Vital exhaustion, depressive symptoms and serum triglyceride levels in high-risk middle-aged men. Psychiatry Res 2011; 187:363-9. [PMID: 21095621 DOI: 10.1016/j.psychres.2010.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Revised: 10/15/2010] [Accepted: 10/19/2010] [Indexed: 11/25/2022]
Abstract
The role of elevated serum triglyceride level as a risk factor of coronary artery disease is well established. Previous results have also indicated that depression or depressive symptoms and vital exhaustion correlate with triglyceride levels. The aim of this study was to investigate the associations of depressive symptoms, vital exhaustion, and health behavior with serum triglyceride levels. The study sample comprised 444 high-risk middle-aged men. Participants completed self-report questionnaires before laboratory tests. Triglyceride concentrations were measured by the enzymatic method. Vital exhaustion and depression were associated with unhealthy lifestyles and triglycerides. Vital exhaustion and depression were closely correlated constructs with comparable relations with known coronary artery disease risk factors. When comparing vital exhaustion (VE) to Beck Depression Inventory (BDI), however, the first one had a stronger correlation with triglycerides (TG), and also, path analyses showed a direct link from vital exhaustion to body mass index but not from depression. Both vital exhaustion and depression are related to triglyceride levels. The relations are partly mediated by unfavorable lifestyles. Although vital exhaustion is not so commonly assessed as depression, results of this study support the importance of vital exhaustion as a health-related psychological risk factor.
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Affiliation(s)
- Cornel Victor Igna
- Department of Behavioural Sciences, University of Helsinki, Helsinki, Finland
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6
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Dedert EA, Calhoun PS, Watkins LL, Sherwood A, Beckham JC. Posttraumatic stress disorder, cardiovascular, and metabolic disease: a review of the evidence. Ann Behav Med 2010; 39:61-78. [PMID: 20174903 DOI: 10.1007/s12160-010-9165-9] [Citation(s) in RCA: 179] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a significant risk factor for cardiovascular and metabolic disease. PURPOSE The purpose of the current review is to evaluate the evidence suggesting that PTSD increases cardiovascular and metabolic risk factors, and to identify possible biomarkers and psychosocial characteristics and behavioral variables that are associated with these outcomes. METHODS A systematic literature search in the period of 2002-2009 for PTSD, cardiovascular disease, and metabolic disease was conducted. RESULTS The literature search yielded 78 studies on PTSD and cardiovascular/metabolic disease and biomarkers. CONCLUSIONS Although the available literature suggests an association of PTSD with cardiovascular disease and biomarkers, further research must consider potential confounds, incorporate longitudinal designs, and conduct careful PTSD assessments in diverse samples to address gaps in the research literature. Research on metabolic disease and biomarkers suggests an association with PTSD, but has not progressed as far as the cardiovascular research.
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Affiliation(s)
- Eric A Dedert
- VA Research Service, Department of Psychiatry and Behavioral Sciences, Durham Veterans Affairs and Duke University Medical Centers, Durham, NC, USA.
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7
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Williams DR, Mohammed SA, Leavell J, Collins C. Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities. Ann N Y Acad Sci 2010; 1186:69-101. [PMID: 20201869 DOI: 10.1111/j.1749-6632.2009.05339.x] [Citation(s) in RCA: 849] [Impact Index Per Article: 60.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This paper provides an overview of racial variations in health and shows that differences in socioeconomic status (SES) across racial groups are a major contributor to racial disparities in health. However, race reflects multiple dimensions of social inequality and individual and household indicators of SES capture relevant but limited aspects of this phenomenon. Research is needed that will comprehensively characterize the critical pathogenic features of social environments and identify how they combine with each other to affect health over the life course. Migration history and status are also important predictors of health and research is needed that will enhance understanding of the complex ways in which race, SES, and immigrant status combine to affect health. Fully capturing the role of race in health also requires rigorous examination of the conditions under which medical care and genetic factors can contribute to racial and SES differences in health. The paper identifies research priorities in all of these areas.
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Affiliation(s)
- David R Williams
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA 02115, USA.
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8
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Abstract
OBJECTIVE To determine if nocturnal blood pressure (BP) dipping among non-Hispanic blacks is influenced by social support. Non-Hispanic blacks have higher rates of cardiovascular morbidity and mortality from hypertension and are more likely to have ambulatory blood pressure (ABP) that remains high at night (nondipping). METHODS A total of 68 non-Hispanic black normotensive and 13 untreated hypertensive participants (age 72 +/- 10 years, 48% female) free of clinical cardiovascular disease completed 24-hour ABP monitoring and a questionnaire that included a modified version of the CARDIA Study Social Support Scale (CSSS). Nondipping was defined as a decrease of <10% in the ratio between average awake and average asleep systolic BP. Analyses were adjusted for age, gender, and systolic BP. RESULTS The prevalence of nondipping was 26.8% in subjects in the highest CSSS tertile versus 41.1% in the lowest CSSS tertile (p = .009). On adjusted analysis, CSSS was analyzed as a continuous variable and remained independently and inversely associated with nondipping (odds ratio 0.27, 95% Confidence Interval 0.08-0.94, p = .04). CONCLUSIONS Social support may be an important predictor of BP dipping at night. These findings suggest that social support may have positive health affects through physiologic (autonomic) pathways.
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9
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Bunde J, Suls J. A quantitative analysis of the relationship between the Cook-Medley Hostility Scale and traditional coronary artery disease risk factors. Health Psychol 2006; 25:493-500. [PMID: 16846324 DOI: 10.1037/0278-6133.25.4.493] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
One possible explanation for the association between Cook-Medley Hostility Scale (Ho Scale; W. W. Cook & D. M. Medley, 1954) scores and premature coronary artery disease (CAD) morbidity and mortality is that hostile persons also have elevations on CAD risk factors. Meta-analyses with fixed and random-effects models were used to evaluate the relationship between Ho Scale scores and CAD risk factors in the empirical literature. Ho Scale scores were significantly related to body mass index, waist-to-hip ratio, insulin resistance, lipid ratio, triglycerides, glucose, socioeconomic status (SES), alcohol consumption, and smoking. Although there was also heterogeneity among study outcomes, the results of conservative random effects models provide confidence in the obtained relationships. On the basis of available evidence, researchers might give attention to obesity, insulin resistance, damaging health behaviors, and SES as potential contributing factors in understanding the association between Ho Scale scores and CAD.
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Affiliation(s)
- James Bunde
- Department of Psychology, University of Iowa, Spence Labs, Iowa City, Iowa 52242-1407, USA
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10
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Zhang J, McKeown RE, Hussey JR, Thompson SJ, Woods JR, Ainsworth BE. Low HDL cholesterol is associated with suicide attempt among young healthy women: the Third National Health and Nutrition Examination Survey. J Affect Disord 2005; 89:25-33. [PMID: 16263178 DOI: 10.1016/j.jad.2005.05.021] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2004] [Accepted: 05/11/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Serum cholesterol is reported to be associated with suicidality, but studies conducted among general healthy population are rare. We examined the association between serum cholesterol and suicidality in a national sample of the general population of US. METHODS We used the data of 3237 adults aged 17 to 39 years, who completed a mental disorder diagnostic interview and had blood specimens collected after a 12-h fast, as a part of the Third National Health and Nutrition Examination Survey, 1988-1994. The serum concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were dichotomized according to the recommended levels of the National Cholesterol Education Program. A polytomous logistic regression was employed to control for covariates. RESULTS Independent of socio-demographic variables, health risks and nutrition status, and a history of medical and psychiatric illness (including depression), a significant association between low HDL-C (< or = 40 mg/dl) and increased prevalence of suicide attempts was observed in women (OR=2.93, 95% CI=1.07-8.00). No significant evidence was found to support an association between cholesterol and suicide ideation in women. Serum cholesterol was unrelated with either suicide ideation or attempts in men. LIMITATION The inherent limitation of cross-sectional design prevented the authors from investigating causality. CONCLUSIONS Low HDL-C is significantly associated with suicide attempts in women. Further studies are necessary to explore the clinical application of serum cholesterol as an indicator for suicide attempts among high risk population.
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Affiliation(s)
- Jian Zhang
- Division of Health and Family Studies, Institute for Families in Society, University of South Carolina, United States.
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11
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Karlamangla AS, Singer BH, Williams DR, Schwartz JE, Matthews KA, Kiefe CI, Seeman TE. Impact of socioeconomic status on longitudinal accumulation of cardiovascular risk in young adults: the CARDIA Study (USA). Soc Sci Med 2005; 60:999-1015. [PMID: 15589670 DOI: 10.1016/j.socscimed.2004.06.056] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Our objectives were to describe the trajectories of biological risk factors of cardiovascular disease in young adults, and to study the association of socioeconomic status (SES) with aggregate risk scores that summarize longitudinal risk accumulation from multiple risk factors. We used data from a prospective, bi-racial, cohort study of 18-30-year-old adults in the USA, initiated in 1985, with 10-year follow-up. SES was measured by parental education level, financial hardship during the study, and the participant's education level by the end of the study. We studied growth patterns of seven biological risk factors for cardiovascular disease using a semi-parametric, class-mixture model to identify clusters of individuals with distinct growth trajectories. Risk scores that summarize risk from all seven risk factors were created to reflect risk at baseline, longitudinal risk change over 10 years, and total accumulated risk. Multivariable regression was used to study their associations with SES within each race/gender group. We found tracking of all seven risk factors: in each case, the cluster with the highest baseline value maintained its position as the highest-risk cluster over the next 10 years. After adjustment for age, lifestyle, and healthcare access, SES was associated inversely with baseline risk score in women (black and white), with risk change score in all four race/gender groups, and with accumulated risk score in women (black and white) and in white men. Our findings suggest that individuals with high overall cardiovascular risk in midlife can be identified by their relatively higher values of risk factors in younger ages and that socioeconomic differences in cardiovascular risk start accumulating early in life.
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Affiliation(s)
- Arun S Karlamangla
- Division of Geriatrics, UCLA School of Medicine, 10945 Le Conte #2339, Los Angeles, CA 90095-1687, USA.
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12
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Cooper DC, Waldstein SR. Hostility differentially predicts cardiovascular risk factors in African American and White young adults. J Psychosom Res 2004; 57:491-9. [PMID: 15581654 DOI: 10.1016/j.jpsychores.2004.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2003] [Accepted: 02/17/2004] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Hostility may influence racial disparities in cardiovascular disease through differential associations with cardiovascular risk factors. This study explored racial variations in relations between hostility and selected cardiovascular risk factors. METHODS Cook-Medley Hostility (Ho) scores and 11 risk factors were examined among 66 healthy, White and African American young adults. RESULTS Controlling for age, gender, and body mass index, the interaction of hostility and race yielded significant (or marginal) associations with resting systolic and diastolic blood pressure (SBP, DBP), cardiac index (CI; i.e. cardiac output adjusted for body size), total peripheral resistance (TPR), insulin (INS), triglycerides (TG) and percent body fat (PBF). Contributing substantial variance, hostility was positively associated with SBP, DBP, TPR, TG and INS, and negatively associated with CI among African Americans. Conversely, hostility was negatively associated with TPR and PBF among Whites. CONCLUSION Hostility may confer greater cardiovascular risk among young African Americans than Whites.
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Affiliation(s)
- Denise C Cooper
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
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13
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Beckham JC, Calhoun PS, Glenn DM, Barefoot JC. Posttraumatic stress disorder, hostility, and health in women: a review of current research. Ann Behav Med 2003; 24:219-28. [PMID: 12173679 DOI: 10.1207/s15324796abm2403_07] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
A large body of evidence indicates that hostility is related to increased morbidity and mortality and evidence is growing that posttraumatic stress disorder (PTSD) is associated with poorer health outcomes. The majority of this research, however, has been conducted in male samples. As a result, the connections between PTSD and hostility and the ramifications of these variables on health in women are less clear. We review the current literature examining PTSD, hostility, and health in women and discuss possible mechanisms underlying the relationship between PTSD and hostility on health outcomes in the context of a proposed theoretical model. Although the current literature suggests that hostility and PTSD are related to health in women, more rigorous, focused research is lacking. A number of suggestions for future research are provided.
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Affiliation(s)
- Jean C Beckham
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA.
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14
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Allen J, Markovitz J, Jacobs DR, Knox SS. Social support and health behavior in hostile black and white men and women in CARDIA. Coronary Artery Risk Development in Young Adults. Psychosom Med 2001; 63:609-18. [PMID: 11485115 DOI: 10.1097/00006842-200107000-00014] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE These cross-sectional analyses of the Coronary Artery Risk Development in Young Adults (CARDIA) data were stimulated by previous CARDIA analyses that showed an adverse association between hostility and several health behaviors: physical activity, cigarette smoking, alcohol consumption, and caloric intake, in both black and white men and women, such that the higher the hostility, the worse the health behavior profile. The current study investigated whether high social support was associated with better health behavior than low social support in individuals with high hostility scores. METHODS The subjects were 5115 healthy black and white men and women ranging in age from 18 to 30 years. The hypothesis was that the association between hostility and certain adverse health behaviors would be diminished in the presence of high social support. Race-gender specific median cutpoints of the Cook-Medley Hostility scale and an index of social support defined levels of high and low hostility and social support. RESULTS After controlling for age and body mass index (BMI), support was positively associated with more exercise in all groups except black women, but when coupled with high hostility, this positive association between support and exercise remained only in men. White women with high support were less often smokers but this association did not hold when examined only in the high-hostile group. Black men and white women with high support in the presence of high hostility consumed more alcohol, but the amount was moderate. CONCLUSIONS We conclude that social support in the presence of high hostility only sometimes reduces the association of hostility to adverse health behaviors and that these effects are complex. Additional research investigating types of social support on health behavior in different race-gender groups is advocated.
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Affiliation(s)
- J Allen
- Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892-7936, USA
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15
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Rutledge T, Reis SE, Olson M, Owens J, Kelsey SF, Pepine CJ, Reichek N, Rogers WJ, Merz CN, Sopko G, Cornell CE, Matthews KA. Psychosocial variables are associated with atherosclerosis risk factors among women with chest pain: the WISE study. Psychosom Med 2001; 63:282-8. [PMID: 11292277 DOI: 10.1097/00006842-200103000-00014] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We investigated associations between atherosclerosis risk factors (smoking behavior, serum cholesterol, hypertension, body mass index, and functional capacity) and psychological characteristics with suspected linkages to coronary disease (depression, hostility, and anger expression) in an exclusively female cohort. METHODS Six hundred eighty-eight middle-aged women with chest pain warranting clinical investigation completed a comprehensive diagnostic protocol that included quantitative coronary angiography to assess coronary artery disease (CAD). Primary analyses controlled for menopausal status, age, and socioeconomic status variables (income and education). RESULTS High depression scores were associated with a nearly three-fold risk of smoking (odds ratio (OR) = 2.8, 95% confidence interval (CI) = 1.4-5.7) after covariate adjustment, and women reporting higher depression symptoms were approximately four times more likely to describe themselves in the lowest category of functional capacity (OR = 3.7, 95% CI = 1.7-7.8). High anger-out scores were associated with a four-fold or greater risk of low high-density lipoprotein cholesterol concentration (<50 mg/dl; OR = 4.0, 95% CI = 1.4-11.1) and high low-density lipoprotein cholesterol concentration (>160 mg/dl; OR = 4.8, 95% CI = 1.5-15.7) and a larger body mass index (OR = 3.5, 95% CI = 1.1-10.8) after covariate adjustment. CONCLUSIONS These results demonstrate consistent and clinically relevant relationships between psychosocial factors and atherosclerosis risk factors among women and may aid our understanding of the increased mortality risk among women reporting high levels of psychological distress.
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Affiliation(s)
- T Rutledge
- University of Pittsburgh, Pennsylvania, USA.
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Knox SS, Adelman A, Ellison RC, Arnett DK, Siegmund K, Weidner G, Province MA. Hostility, social support, and carotid artery atherosclerosis in the National Heart, Lung, and Blood Institute Family Heart Study. Am J Cardiol 2000; 86:1086-9. [PMID: 11074204 DOI: 10.1016/s0002-9149(00)01164-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This cross-sectional study investigates the association of hostility and social support (measured by standardized instruments) to carotid artery atherosclerosis in men and women with a high familial risk for coronary heart disease (CHD) and those with low to medium risk. The hypothesis was that high hostility and low social support would have a stronger association in subjects with a familial predisposition to CHD. There were 535 low- to medium-risk women, 491 low- to medium-risk men, 1,950 high-risk women, and 1,667 high-risk men in the study. The extent of carotid artery atherosclerosis was assessed by B-mode ultrasound imaging. A lesion was defined as an intimal-medial far wall thickness of 1 mm in the common, internal, or carotid bifurcation, or identification of plaque at any site. Odds ratios and their 95% confidence intervals were calculated using generalized estimating equations (GEE) for logistic regression. Family was specified as the clustering variable, and robust SEEs were obtained that account for dependence of the data within families. After controlling for age, education, body mass index, ever having smoked, ever drinking > 5 drinks a day, and metabolic index, hostility was significantly associated with increased odds of carotid lesions in only high-risk women. High-risk women showed a significantly reduced odds of carotid lesions with high social support, but the extent of this protection was reduced when age and education were included in the equation. A combination of high hostility and low social support was associated with higher odds than hostility alone in both high-risk men and women. These results suggest that women with a high familial predisposition for CHD may be more vulnerable to cardiovascular influences from hostility and social support than high-risk men or men and women with low to medium risk.
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Affiliation(s)
- S S Knox
- National Heart, Lung, and Blood Institute, Bethesda, Maryland 20892-7936, USA
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Twisk JW, Snel J, Kemper HC. Positive and negative life events: the relationship with coronary heart disease risk factors in young adults. J Psychosom Res 2000; 49:35-42. [PMID: 11053602 DOI: 10.1016/s0022-3999(00)00082-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE to investigate the influence of positive and negative life events (including daily uplifts and daily hassles) on several biological and lifestyle coronary heart disease (CHD) risk factors. METHODS from the Amsterdam Growth and Health Longitudinal Study (AGHLS), a cross-section sample of 207 males and 231 females aged 32/33 years was used. RESULTS hardly any associations were found between both positive and negative life events and biological CHD risk factors. On the other hand, daily uplifts and positive life events were positively related to lifestyle. For both positive and negative life events coping behaviour played a role in these relationships. Furthermore, it was shown that the associations of health-related variables with daily uplifts and hassles were comparable to those found for major positive and negative life events. CONCLUSION This study could not fully determine whether or not different mechanisms play a role in the health benefits of positive life events compared to the health burdens of negative life events.
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Affiliation(s)
- J W Twisk
- Faculty of Medicine, Institute for Research in Extramural Medicine, Vrije Universiteit, vd Boechorststraat 7-9, 1081 BT, Amsterdam, Netherlands.
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Twisk JW, Snel J, Kemper HC, van Mechelen W. Relation between the longitudinal development of personality characteristics and biological and lifestyle risk factors for coronary heart disease. Psychosom Med 1998; 60:372-7. [PMID: 9625228 DOI: 10.1097/00006842-199805000-00027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study was undertaken to assess the stability of personality characteristics (ie, inadequacy, rigidity, dominance, self-sufficiency, and social inadequacy) over a 15-year period covering adolescence and young adulthood and to analyze the longitudinal relationships between personality characteristics and both biological (ie, lipoproteins, blood pressure, and body fatness) and lifestyle (ie, physical activity, dietary intake, smoking, and alcohol consumption) risk factors for coronary heart disease (CHD). METHODS The data were derived from the Amsterdam Growth and Health Study, an observational longitudinal study in which, over a period from 13 to 27 years of age, six repeated measurements were performed on 181 subjects. Both the stability analysis and the analysis of the longitudinal relationships were performed by generalized estimating equations (GEE). This method is suitable for both continuous and dichotomous outcome variables, by using all available longitudinal data. RESULTS Stability coefficients for the personality characteristics varied between 0.39 for self-sufficiency and dominance and 0.53 for social inadequacy. Self-sufficiency was inversely related to total serum cholesterol (only male subjects) and body fatness; inadequacy was inversely related to systolic blood pressure. Dominance (female subjects) was positively related to body fatness and social inadequacy (male subjects) was positively related to total serum cholesterol. Furthermore, inadequacy was positively related to smoking behavior. Social inadequacy and rigidity were inversely related to smoking behavior. Self-sufficiency was inversely related to alcohol consumption. CONCLUSIONS Over a period of 15 years, personality characteristics showed marginal stability. Weak relationships were found between personality characteristics and both biological and lifestyle CHD risk factors.
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Affiliation(s)
- J W Twisk
- EMGO Institute, Faculty of Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
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