Role Models and the Psychological Characteristics That Buffer Low-Socioeconomic-Status Youth From Cardiovascular Risk

Health Motivation in the Influencer Era: Analyzing Entertainment, Personal, and Social Media Role Models

This research explored how personal and entertainment role models motivate an individual's health goals, and how following a role model on social media affects this process. A survey of 404 adults revealed that identifying a personal role model, such as a family member, friend, or healthcare professional, had a stronger influence on health motivation in comparison to identifying an entertainment role model. Additionally, our findings indicated that following any role model on social media, whether a personal acquaintance or a celebrity, enhanced motivation. Role model attributes that mediated these relationships included perceived similarity, and in some instances, positive and negative norm deviance. This study highlights the importance of leveraging role model relationships in health communication campaigns and developing authentic influencer-driven health initiatives that feature relatable entertainment figures. Additionally, this research supports the need for further examination of how a role model's perceived positive or negative norm deviance influences motivational capability. We discuss implications for the motivational theory of role modeling, health promotion, and entertainment education.

Reflections on resilience

Resilience research has long sought to understand how factors at the child, family, school, community, and societal levels shape adaptation in the face of adversities such as poverty and war. In this article we reflect on three themes that may prove to be useful for future resilience research. First is the idea that mental and physical health can sometimes diverge, even in response to the same social process. A better understanding of explanations for this divergence will have both theoretical and public health implications when it comes to efforts to promote resilience. Second is that more recent models of stress suggest that stress can accelerate aging. Thus, we suggest that research on resilience may need to also consider how resilience strategies may need to be developed in an accelerated fashion to be effective. Third, we suggest that if psychological resilience interventions can be conducted in conjunction with efforts to enact system-level changes targeted at adversities, this may synergize the impact that any single intervention can have, creating a more coordinated and effective set of approaches for promoting resilience in young people who confront adversity in life.

Household Income and Early Adolescents' Executive Function: The Different Roles of Perceived Discrimination and Shift-and-Persist

Household income predicts early adolescents' cognitive development. However, the mechanism underlying this association and protective factors are unclear. This study assessed one-year longitudinal data to examine whether perceived discrimination mediated the association between household income and executive function and the moderating role of shift-and-persist. 344 early adolescents in rural China were included in the study (mean = 10.88 years, SD = 1.32 years, girls: 51.74%). The latent variable model revealed that household income predicted early adolescents' cognitive flexibility and working memory in the subsequent year through perceived discrimination. Shift-and-persist moderated the negative effects of perceived discrimination on cognitive flexibility: perceived discrimination impeded cognitive flexibility only among early adolescents with low shift-and-persist. The findings highlight perceived discrimination in the relation between household income and early adolescents' executive function and underscore the protective role of shift-and-persist.

Cardiovascular risk profiles clusters among children and adolescents with disabilities

BACKGROUND

Cardiovascular diseases (CVD) are a precursor for disabilities and death worldwide. Being overweight or obese in combination with physical inactivity and smoking habits may increase the risk for CVD and other health problems such as lower limb osteoarthritis, diabetes, stroke, and various cancer types among children and adolescents. The literature emphasizes the need to follow such groups and evaluate the risk of individuals developing CVD diseases. Therefore, the current study explores the variety of cardiovascular risks in children and adolescents' profiles clusters with and without disabilities.

METHODS

Data from 42 countries including Israel, was collected with the support of the world health organization (WHO, Europe) through a questionnaire from 11-19 years old school-aged.

RESULTS

The study finding shows that children and adolescents with disabilities demonstrated a higher prevalence of overweight than those who completed the HBSC youth behavior survey. Moreover, the prevalence of tobacco smoking and alcohol use was statisticaly significantly higher among the disabled group than the non-disabled group. In addition, socioeconomic status of responders who presented a very high CVD risk was found as significantly lower than those from the first and second low risk groups.

CONCLUSION

This led to the conclusion that children and adolescents with disability were at a higher risk of developing CVDs than their non-disabled peers. In addition, intervention programs tailored to the needs of adolescents with disability should consider lifestyle habit change and promoting healthy living thus improving their quality of life as well as reducing their risk of being exposed to severe CVD diseases.

Adolescent Psychological Assets and Cardiometabolic Health Maintenance in Adulthood: Implications for Health Equity

Background Positive cardiometabolic health (CMH) is defined as meeting recommended levels of multiple cardiometabolic risk factors in the absence of manifest disease. Prior work finds that few individuals-particularly members of minoritized racial and ethnic groups-meet these criteria. This study investigated whether psychological assets help adolescents sustain CMH in adulthood and explored interactions by race and ethnicity. Methods and Results Participants were 3478 individuals in the National Longitudinal Study of Adolescent Health (49% female; 67% White, 15% Black, 11% Latinx, 6% other [Native American, Asian, or not specified]). In Wave 1 (1994-1995; mean age=16 years), data on 5 psychological assets (optimism, happiness, self-esteem, belongingness, and feeling loved) were used to create a composite asset index (range=0-5). In Waves 4 (2008; mean age=28 years) and 5 (2016-2018; mean age=38 years), CMH was defined using 7 clinically assessed biomarkers. Participants with healthy levels of ≥6 biomarkers at Waves 4 and 5 were classified as maintaining CMH over time. The prevalence of CMH maintenance was 12%. Having more psychological assets was associated with better health in adulthood (odds ratio [OR]_{linear trend}, 1.12 [95% CI, 1.01-1.25]). Subgroup analyses found substantive associations only among Black participants (OR, 1.35 [95% CI, 1.00-1.82]). Additionally, there was some evidence that racial and ethnic disparities in CMH maintenance may be less pronounced among participants with more assets. Conclusions Youth with more psychological assets were more likely to experience favorable CMH patterns 2 decades later. The strongest associations were observed among Black individuals. Fostering psychological assets in adolescence may help prevent cardiovascular disease and play an underappreciated role in shaping health inequities.

First-Generation College Students, Emotional Support, and Systemic Inflammation Following the College Transition

PURPOSE

To examine whether emotional support moderates the association between college generation status and concurrent and prospective levels of systemic inflammation during the college transition among a sample of older U.S. adolescents.

METHODS

At an undergraduate tertiary institution, 41 first-generation college students (first-gens) and 46 continuing-generation college students (continuing-gens) in their first semester of college reported on basic demographic information and perceived emotional support. They also had their blood drawn midway through both the first and second semester to measure C-reactive protein and interleukin-6. An inflammatory composite for each semester was created by averaging the standardized scores for log-transformed C-reactive protein and interleukin-6.

RESULTS

Compared to continuing-gens, first-gens had greater systemic inflammation in the first semester regardless of their level of emotional support (B = 0.515, p = .003). However, emotional support moderated the association between college generation status and prospective systemic inflammation in the second semester (B = -0.525, p = .007) such that first-gens had greater systemic inflammation compared to continuing-gens, but only if they reported lower levels of emotional support (B = 0.826, p = .002). This moderation effect held after further adjusting for systemic inflammation in the first semester (B = -0.374, p = .022). Also discussed are results of secondary analyses examining sources of support.

DISCUSSION

Compared to continuing-gens, first-gens had greater systemic inflammation in the first semester irrespective of emotional support, suggesting all first-gens may stand to benefit from college resources provided early in the college transition. Furthermore, first-gens who reported lower levels of emotional support may benefit from additional college resources provided beyond the first semester.

Hair glucocorticoid concentration, self-perceived stress and their associations with cardiometabolic risk markers in Swedish adolescents

BACKGROUND

While hair cortisol is proposed as a biomarker for chronic stress and a possible mediator linking chronic stress and cardiovascular risk in adults, studies in adolescents are scarce. We explored the associations between self-perceived stress, hair cortisol (HairF) and cortisone (HairE), and cardiometabolic risk markers in adolescents. Further, we examined whether association between self-perceived stress and HairF may depend on the use of the coping strategies "shift-persist".

METHODS

Participants were 7th grade pupils recruited to the STudy of Adolescence Resilience and Stress (STARS) and data from the baseline examinations were used. Adolescents (n = 1553, 26 % boys, Mage=13.6, SD = 0.4) completed questionnaires assessing perceived stress and coping strategies "shift-persist", provided hair sample, and examined for cardiometabolic risk factors including waist circumference (WC), body mass index (BMI) z-score, blood pressure, and white blood cell counts (WBC). HairF and HairE were analysed using liquid chromatography with tandem mass spectrometry. We conducted descriptive analyses (Student's t-test, Wilcoxon Signed Ranks test, Chi-square test) and linear regression analyses.

RESULTS

Perceived stress was not associated with HairF, neither had the use of coping strategies "shift-persist" any influence on this association. Both HairF and HairE were positively associated with BMI z-score (beta coefficients (β): 0.178 (p < 0.001) and 0.119 (p < 0.001) for boys; 0.123 (p < 0.001) and 0.089 (p < 0.01) for girls) and WC (β: 0.089 (p > 0.05) and 0.098 (p < 0.05) for boys; 0.103 (p < 0.01) and 0.076 (p < 0.05) for girls). Perceived stress was also positively associated with BMI z-score and WC. Perceived stress, but not HairF, remained associated with WC in boys (β = 0.200, p < 0.001) in the models with HairF and perceived stress presented simultaneously. Modest association between HairE and WBC was found in boys (β = 0.149, p < 0.01).

CONCLUSIONS

The study supports the association between chronic stress and overweight/obesity in adolescents. Hair cortisol and self-perceived stress capture different aspects of how chronic stress is related to overweight/obesity in adolescents.

Shift and Persist in Mexican American Youth: A Longitudinal Test of Depressive Symptoms

This paper tested whether shift-&-persist coping, or coping involving the combination of cognitive reappraisal, acceptance, and optimism (Chen & Miller, Perspectives on Psychological Science, 2012, 7, 135), attenuates the risks presented by economic hardship and ethnic discrimination for change in depressive symptoms from 9th to 12th grade, in a sample of 674 Mexican American youth (Mage W1 = 10.86; 50% female; 72% US born) and whether this effect depends on ethnic pride. Structural equation modeling indicated that, when accounting for economic hardship, shift-&-persist was associated with fewer concurrent depression symptoms. Youth with lower ethnic pride who endorsed high levels of shift-&-persist were protected against the negative impacts of peer ethnic discrimination on depressive symptoms. Future research on ethnic discrimination should examine patterns of coping and identity that can mitigate risk.

Shifting and Persisting in the Face of Life Stressors: Consequences for Adolescent Health

The current study assessed whether greater use of shift-and persist strategies, which entail the reappraisal of stressors (shifting) and endurance through optimism and meaning-making, buffered the associations between life stressors and adolescents' psychological health (i.e., depressive symptoms, anxiety) and physical health and health behaviors (i.e., self-rated health, sleep quality). Survey data were drawn from a racially/ethnically and socioeconomically diverse sample of 750 9th grade adolescents (53% female). Path analysis revealed racial discrimination, neighborhood risk, and deportation exposure were linked to poorer psychological and physical health, while socioeconomic disadvantage was related to greater anxiety and poorer physical health. Some evidence suggested that shift-and-persist may be protective-reactive, wherein shift-and-persist typically promoted well-being across health domains but more so when the life stressors were at low versus high levels. Shift-and-persist strategies promote both mental and physical health, but the promotive effects appear to be maximized when adolescents' exposure to life stressors is minimal.

Shift-&-Persist and discrimination predicting depression across the life course: An accelerated longitudinal design using MIDUSI-III

Life course theorists posit that sensitive periods exist during life span development where risk and protective factors may be particularly predictive of psychological outcomes relative to other periods in life. While there have been between-cohort studies trying to examine differences in discrimination and depressive symptoms, these studies have not been designed to identify these sensitive periods, which are best modeled by examining intra-individual change across time. To identify sensitive periods where discrimination and shift-&-persist (S&P) - a coping strategy that may protect against the negative impact of discrimination - are most strongly predictive of depressive symptoms, we employed latent growth curve modeling using an accelerated longitudinal design to track intra-individual change in depressive symptoms from ages 20-69. Participants were 3,685 adults measured at three time points ~10 years apart from the Midlife in the United States study (Mage = 37.93, SD = 6.948 at Wave I). Results identified two sensitive periods in development where high levels of S&P interacted with discrimination to protect against depressive symptoms; during the 30s and a lagged effect where 40's S&P protected against depressive symptoms when participants were in their 50s. Implications for the life course study of discrimination, coping, and depression are discussed.

Socioeconomic disadvantage, chronic stress, and proinflammatory phenotype: an integrative data analysis across the lifecourse

Socioeconomic disadvantage confers risk for many chronic illnesses, and theories have highlighted chronic psychological stress and alterations to inflammatory processes as key pathways. Specifically, disadvantage can heighten chronic stress, which may promote a proinflammatory phenotype characterized by immune cells mounting exaggerated cytokine responses to challenge and being less sensitive to inhibitory signals. Importantly, lifecourse perspectives emphasize that such immune alterations should be more potent earlier in life during a sensitive period when bodily tissues are highly plastic to environmental inputs. However, examining these propositions is resource intensive, as they require cell-culturing approaches to model functional inflammatory activities, a wide age range, and longitudinal data. Here, we integrated data from five independent studies to create a diverse sample of 1,607 individuals (960 with longitudinal data; 8 to 64 years old; 359 Asian, 205 Black, and 151 Latino/a). Leveraging the resulting lifecourse data, rich interview assessments of disadvantage and stress, and ex vivo assessments of inflammation, we examined two questions: (1) Does chronic stress account for the link between disadvantage and proinflammatory phenotype? (2) Is there a developmental period during which inflammatory responses are more sensitive to disadvantage and chronic stress? Disadvantage was associated with higher chronic stress, which was linked with a proinflammatory phenotype cross-sectionally, longitudinally, and in terms of prospective change across 1.5 to 2 years. Consistent with the sensitive period hypothesis, the magnitude of these indirect associations was strongest in earlier decades and declined across the lifecourse. These findings highlight the importance of taking a lifecourse perspective in examining health disparities.

Culturally informed shift-&-persist: A higher-order factor model and prospective associations with discrimination and depressive symptoms

OBJECTIVES

Based on the conceptual overlap between shift-&-persist (S&P) and culturally based strategies (critical civic engagement [CCE] and spiritually based coping), this study tests whether associations between these three previously disparate strategies are attributable to the existence of a higher-order coping construct: culturally informed S&P.

METHODS

Among 364 diverse minoritized youth (Mage = 18.79, 85.2% female), we tested for the existence of this higher-order factor through confirmatory factor analysis.

RESULTS

We found theoretical and empirical support for the existence of a higher-order factor structure and for our higher-order factor-culturally informed S&P. Culturally informed S&P promotes fewer depressive symptoms as a main effect in addition to completely protecting against the negative impact of discrimination on depressive symptoms when culturally informed S&P is high.

CONCLUSIONS

The current study illustrates relations between three previously distinct coping strategies through their association with culturally informed S&P. Results highlight culturally informed S&P's promotive and protective effects in the face of ethnic-racial discrimination. Implications for subsequent study of culturally based coping are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The use of coping strategies "shift-persist" mediates associations between physical activity and mental health problems in adolescents: a cross-sectional study

Background

Self-perceived mental health problems among adolescents has had an upward trend. Concurrently, adolescents’ physical activity (PA) has been falling whilst sedentary time (SED) has increased. There is a lack of research using accelerometer measured PA and SED to study their relationships to perceived stress and psychosomatic symptoms, both frequently observed mental health problems among adolescents. Whether coping strategies is one of the mechanisms underlying such relationship is less clear.

Methods

A total of 2283 13-year olds were enrolled in the baseline examination of the STARS (STudy of Adolescence Resilience and Stress) study in Western Sweden. Light-, moderate-, vigorous-intensity PA (LPA, MPA and VPA) and SED were measured using hip-worn ActiGraph GT3X+ accelerometer. A total of 1284 adolescents provided valid accelerometer data (at least 4 days with ≥10 h per day). PA and SED during school-time and leisure-time were analysed separately. Surveys were utilized to monitor perceived stress, psychosomatic symptoms and the use of coping strategies “shift-persist”. Logistic regression and mediation analyses were performed adjusting for gender, ethnicity, socioeconomic status and puberty development.

Results

We observed that more time spent in PA was associated with less stress in adolescents. The associations were observed for LPA (Odds ratio for LPA per 60 min: 0.557 (95% CI 0.399–0.776), VPA (Odds ratio for VPA per 15 min: 0.688 (95% CI 0.588–0.806) and MVPA (Odds ratio for MVPA per 15 min: 0.795 (95%CI 0.718–0.879) during leisure time, but not during school time. Similar associations were observed between leisure time PA and psychosomatic symptoms. The associations remained statistically significant even after adjusting for the confounders. Further, our data showed that adolescents who engaged more time in PA during leisure time were more likely to adopt the coping strategies of “shift-persist”. Mediation analysis showed that the use of “shift-persist” mediated the associations between leisure time PA and stress/psychosomatic symptoms.

Conclusions

Leisure time physical activity, irrespective of intensity, may facilitate successful coping with stress and stress-related mental health problems in adolescents.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11158-0.

Challenges in researching the immune pathways between early life adversity and psychopathology

Exposure to childhood adversity is a critical risk factor for the development of psychopathology. A growing field of research examines how exposure to childhood adversity is translated into biological risk for psychopathology through alterations in immune system functioning, most notably heightened levels of inflammation biomarkers. Though our knowledge about how childhood adversity can instantiate biological risk for psychopathology is growing, there remain many challenges and gaps in the field to understand how inflammation from childhood adversity contributes to psychopathology. This paper reviews research on the inflammatory outcomes arising from childhood adversity and presents four major challenges that future research must address: (a) the measurement of childhood adversity, (b) the measurement of inflammation, (c) the identification of mediators between childhood adversity and inflammation, and (d) the identification of moderators of inflammatory outcomes following childhood adversity. We discuss synergies and inconsistencies in the literature to summarize the current understanding of the association between childhood adversity, a proinflammatory phenotype, and the biological risk for psychopathology. We discuss the clinical implications of the inflammatory links between childhood adversity and psychopathology, including possibilities for intervention. Finally, this review conclude by delineates future directions for research, including issues of how best to detect, prevent, and understand these “hidden wounds” of childhood adversity.

How does the social world shape health across the lifespan? Insights and new directions

Decades of research highlight the connections between stressful life experiences-particularly those experienced in childhood-and physical health across the lifespan. In recent years, studies at the intersection of social and biomedical science have provided intriguing insights into the biological mechanisms that might explain how chronic and acute stressors give rise to health problems, sometimes decades later in life. To date, efforts to understand these connections have relied on a handful of study designs, and these studies have revealed important observations about how stressful experiences are thought to shape health. At the same time, these study designs have some drawbacks that limit the conclusions that can be drawn about the role of the social world for health. This article provides an overview of research on social determinants of health and includes a discussion of conceptual and methodological directions for the field to consider. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Race, socioeconomic status, and low-grade inflammatory biomarkers across the lifecourse: A pooled analysis of seven studies

Cardiovascular diseases are patterned by race and socioeconomic status, and chronic low-grade inflammation is proposed as a key underlying mechanism. Theories for how racial and socioeconomic disadvantages foster inflammation emphasize a lifecourse approach: social disadvantages enable chronic or repeated exposure to stressors, unhealthy behaviors, and environmental risks that accumulate across the lifecourse to increase low-grade inflammation. However, single samples rarely include multiple racial and socioeconomic groups that each span a wide age range, precluding examination of this proposition. To address this issue, the current study combined seven studies that measured C-reactive protein and interleukin-6, producing a pooled sample of 1650 individuals aged 11-60 years. We examined (a) whether race and socioeconomic disparities in inflammatory biomarkers vary across the lifecourse, (b) whether adiposity operates as a pathway leading to these disparities, and (c) whether any indirect pathways through adiposity also vary across the lifecourse. Relative to White individuals, Black individuals exhibited higher, whereas Asian individuals exhibited lower, levels of inflammatory biomarkers, and adiposity accounted for these racial differences. Similarly, lower socioeconomic status was associated with higher inflammatory biomarkers via elevated adiposity. Importantly, both racial and socioeconomic disparities, as well as their pathways via adiposity, widened across the lifecourse. This pattern suggests that the impact of social disadvantages compound with age, leading to progressively larger disparities in low-grade inflammation. More broadly, these findings highlight the importance of considering age when examining health disparities and formulating conceptual models that specify how and why disparities may vary across the lifecourse.

Family socio-economic status and children's academic achievement: The different roles of parental academic involvement and subjective social mobility

BACKGROUND

Low family socio-economic status (SES) is usually associated with children's poor academic achievement, but the mechanisms underlying this relationship are less understood.

AIMS

The present study examined the mediating role of parental academic involvement and the moderating role of parental subjective social mobility in this relationship with cross-sectional data.

SAMPLE AND METHODS

A total of 815 fourth- to sixth-grade children were recruited from five elementary schools in China. Family SES (measured by parents' education, parents' occupation and family income) and parental subjective social mobility were obtained directly from parents, parental academic involvement was reported by children, and information on children's academic achievement was collected from their teachers.

RESULTS

The results showed that (1) both family SES and parental academic involvement were positively correlated with children's Chinese and math achievement, (2) parental academic involvement mediated the relationships between family SES and children's Chinese and math achievement, and (3) parental subjective social mobility moderated the path from family SES to parental academic involvement. The models of children's Chinese and math achievement showed that the association between family SES and parental academic involvement was weak among children's parents who reported high levels of subjective social mobility.

CONCLUSIONS

These findings suggest that there is a pathway from family SES to children's academic achievement through parental academic involvement and that this pathway is dependent on the level of parental subjective social mobility.

Optimism and Social Support Predict Healthier Adult Behaviors Despite Socially Disadvantaged Childhoods

BACKGROUND

Studies have shown adverse effects of a disadvantaged childhood on adult health-promoting behaviors and related outcomes. Optimism and social support have been linked to greater likelihood of engaging in healthy behavior, but it is unclear whether these positive psychosocial factors may buffer harmful effects of early adversity. This study aims to determine if optimism and social support in adulthood can modify effects of childhood disadvantage on health behavior-related outcomes.

METHODS

Longitudinal data were analyzed from a subset of participants in a US birth cohort established in 1959-1966 (ns of 681-840, per outcome). An index of childhood social disadvantage was derived from adverse socioeconomic and family stability factors reported by mothers at child's birth and age 7 years. Health behavior-related outcomes were self-reported when participants were of mean age 47 years. Multivariable adjusted robust Poisson regressions were performed.

RESULTS

Regardless of level of childhood social disadvantage, we found higher levels of optimism and social support were both associated with higher probabilities of being a non-smoker (relative risk [RR]_optimism = 1.17, 95% confidence interval [CI] = 1.09-1.26; RR_{social support} = 1.24, 95%CI = 1.11-1.39), having a healthy diet (RR_optimism = 1.25, 95%CI = 1.10-1.43; RR_{social support} = 1.27, 95%CI = 1.04-1.56), and a healthy body mass index (RR_optimism = 1.18, 95%CI = 1.00-1.40; RR_{social support} = 1.29, 95%CI = 1.00-1.66). Interactions link higher optimism or social support with lower risk of smoking among those with moderate childhood disadvantage.

CONCLUSIONS

Overall, these findings are consistent with the possibility that positive psychosocial resources contribute to maintaining a healthy lifestyle in mid-adulthood and may buffer effects of childhood social disadvantage.

Early life adversity exposure and circulating markers of inflammation in children and adolescents: A systematic review and meta-analysis

This study provides a comprehensive review of the published research on the association between early life adversity and markers of inflammation in children and adolescents. We conducted a systematic review of the published literature on the association between early life adversity and markers of inflammation in pediatric populations. To date, 27 studies have been published in this area representing a wide range of global populations and diverse methods of which nearly half were prospective, longitudinal studies. Of these 27, only 12 studies shared an inflammatory outcome with 4 or more other studies; 9 for CRP, and 6 for IL-6. The association between early life adversity and both CRP, z = .07 [.04, .10], and IL-6, z = .17 [-.07, .42], were small and only significant for CRP although comparable in magnitude to the effects observed in adult samples. Descriptively, the association between early life adversity and CRP appeared to be stronger in studies conducted in infants and adolescents compared with middle childhood. There was minimal evidence of publication bias for studies measuring CRP, but evidence of publication bias for studies using IL-6. Eight studies have looked at the association between early life adversity and stimulated inflammatory cytokines in vitro, and both the methods and results of these studies were mixed; the majority observed exaggerated production of inflammatory cytokines despite mixed methodological approaches that make comparisons across studies difficult. In summary, the evidence supporting an association between early life adversity and inflammation in pediatric samples is limited so far by the number of studies and their heterogeneous methodological approaches. More research that is grounded in a developmental framework and informed by the complexity of the innate immune system is needed in this area.

Diurnal Cortisol in a Sample of Socioeconomically Disadvantaged Chinese Children: Evidence for the Shift-and-Persist Hypothesis

OBJECTIVE

Low socioeconomic status (SES) is one of the most well-established social determinants of health. However, little is known about what can protect the health of individuals (especially children) living in low-SES circumstances. This study explored whether the psychological strategy of "shift-and-persist" protects low-SES children from stress-related physiological risks, as measured through blunted (unhealthy) diurnal cortisol profiles.

METHODS

A sample of 645 children (aged 8-15 years) from low-SES backgrounds and having at least one HIV-positive parent completed a battery of psychological scales. Diurnal cortisol assessments included collection of saliva samples four times a day for 3 days, from which three cortisol parameters (cortisol at awakening, cortisol awakening response, and cortisol slope) were derived.

RESULTS

Higher levels of shift-and-persist, considered as a single variable, were associated with higher cortisol at awakening (B = 0.0119, SE = 0.0034, p < .001) and a steeper cortisol slope (B = -0.0007, SE = 0.0003, p = .023). These associations remained significant after adjusting for covariates and did not vary by age. In supplementary analyses, where shifting and persisting were treated as separate variables, the interaction between these two coping strategies significantly predicted cortisol at awakening (B = 0.0250, SE = 0.0107, p = .020) and the cortisol slope (B = -0.0022, SE = 0.0011, p = .040), suggesting that the combination of shift-and-persist is important for predicting diurnal cortisol profiles.

CONCLUSIONS

Our findings demonstrate that shift-and-persist is associated with healthier diurnal cortisol profiles among socioeconomically disadvantaged children and introduce the possibility that this coping strategy is protective against other stressors, such as those uniquely faced by children in our study (i.e., being affected by parental HIV).

"You Can Sit in the Middle or Be One of the Outliers": Older Male Athletes and the Complexities of Social Comparison

Sporting events for older adults are proliferating in both popularity and participation numbers, mirroring the growth that is occurring globally with an aging population. Preliminary evidence indicates that older athletes have a tendency to compare themselves (in terms of their performance, participation, and aging) to inactive older adults deemed “worse-off.” Our aim was to examine the stories and experiences of older, male Masters athletes, not only in terms of their own lives and in relation to others but also in the broader context of current (neoliberal) policies that promote sport across the lifespan. We use social comparison theory to interpret our findings and highlight the strengths and limitations of social comparison as a psychological strategy. For this study, 17 male competitive athletes (age range from 70 to 90 years) who participated in either the 2013 or 2017 World Masters Games were interviewed as part of a larger project on the meaning of sport in their lives. Seven different sports were represented, and participants hailed from multiple countries. Within the interpretive paradigm, we used qualitative methods to interview each participant, analyze individual transcripts, and develop common themes across the data set to address the aforementioned aims. Our two major themes were, Sport as social comparison:“It’s the competitive nature” and Downward comparisons. A number of participants commented on the nature of sport, and competitive sport in particular, as being important to their motivation to train and prepare. Within the theme of Downward comparisons, we established two categories: Resisting loss and Assigning blame. While downward comparisons were used by our participants to separate themselves from other seniors of the same age, thereby bolstering their sense of self, participants also tied those comparisons to neoliberal notions of individual and moral responsibility for health. Participants believed that compromised health was due to individual negligence and bad decisions, with little reference to uncontrollable factors, such as non-modifiable risk factors for disease, disability, and/or socioeconomic status, which could be affecting people’s lives or decisions. Ultimately, our findings show that the useful psychological strategy of social comparison for maintaining a positive sense of self and performance may also have some negative individual and societal consequences.

Childhood socioeconomic status and inflammation: A systematic review and meta-analysis

Recent research suggests that risk for chronic diseases of aging including cardiovascular disease, diabetes, and even cancer can be programmed early in the lifespan as a result of exposure to chronic stressors like low socioeconomic status (SES) that are hypothesized to promote a pro-inflammatory response in immune cells that results in chronic, systemic inflammation. The present paper conducted a meta-analysis to establish whether exposure to low (versus higher) SES in childhood and adolescence is associated with higher levels of inflammation (as measured by C-reactive protein, IL-6, and fibrinogen) concurrently and in adulthood. We conducted meta-analyses with both unadjusted bivariate associations between SES and inflammation and with adjusted associations that controlled for a range of covariates including demographic factors, body mass index, smoking, physical activity and current SES. A systematic review of Pubmed and PsycINFO identified a total 35 studies (26 with unadjusted and 31 adjusted effect sizes) to be included in the meta-analysis. Random-effects meta-analysis showed that individuals who were exposed to low SES in childhood and adolescence had significantly higher levels of inflammatory markers (r = -0.07, p < .001, 95% CI = -0.09, -0.05). This association remained significant in adjusted analyses (r = -0.06, p < .001, 95% CI = -0.09, -0.03). However, the relationship between childhood SES and inflammation was non-significant in a meta-analysis with longitudinal studies that all controlled for adulthood SES (r = -0.03, p = .356, 95% CI = -0.08, 0.03). Future longitudinal research should utilize measurement of inflammatory markers at multiple time points to further examine the complex relationships between SES and health both in childhood and adulthood.

Stress, Psychological Resources, and HPA and Inflammatory Reactivity During Late Adolescence

Psychosocial stress during childhood and adolescence is associated with alterations in the hypothalamic-pituitary-adrenal (HPA) axis and with heightened inflammation, both of which are implicated in poor health; however, factors that may protect against these effects relatively early in life are not well understood. Thus, we examined whether psychosocial resources protect against stress-related alterations in the HPA axis and heightened inflammation in a sample of 91 late adolescents. Participants completed measures of various stressors (major life events, daily interpersonal stress, early adversity), and psychosocial resources (mastery, optimism, self-esteem, and positive reappraisal). They also completed the Trier Social Stress Test and provided saliva and blood samples for the assessment of cortisol and interleukin-6 reactivity. Each of the stressors was associated with lower cortisol reactivity. Additionally, associations with major life events and daily stress were moderated by psychological resources, such that more life events and daily stress were associated with decreased HPA reactivity among adolescents with lower levels of psychological resources, but not among those with higher levels of psychological resources. This pattern of findings was observed only for cortisol reactivity and not for interleukin-6 reactivity. Findings suggest that psychological resources may counteract the effects of certain adversity-related decreases in cortisol reactivity.

One size does not fit all: Links between shift-and-persist and asthma in youth are moderated by perceived social status and experience of unfair treatment

The links between low socioeconomic status and poor health are well established, yet despite adversity, some individuals with low socioeconomic status appear to avoid these negative consequences through adaptive coping. Previous research found a set of strategies, called shift-and-persist (shifting the self to stressors while persisting by finding meaning), to be particularly adaptive for individuals with low socioeconomic status, who typically face more uncontrollable stressors. This study tested (a) whether perceived social status, similar to objective socioeconomic status, would moderate the link between shift-and-persist and health, and (b) whether a specific uncontrollable stressor, unfair treatment, would similarly moderate the health correlates of shift-and-persist. A sample of 308 youth (Meanage = 13.0, range 8-17), physician diagnosed with asthma, completed measures of shift-and-persist, unfair treatment, asthma control, and quality of life in the lab, and 2 weeks of daily diaries about their asthma symptoms. Parents reported on perceived family social status. Results indicated that shift-and-persist was associated with better asthma profiles, only among youth from families with lower (vs. higher) parent-reported perceived social status. Shift-and-persist was also associated with better asthma profiles, only among youth who experienced more (vs. less) unfair treatment. These findings suggest that the adaptive values of coping strategies for youth with asthma depend on the family's perceived social status and on the stressor experienced.

Chronic Stress in Children and Adolescents: A Review of Biomarkers for Use in Pediatric Research

PROBLEM

Incorporating biomarkers of chronic stress into pediatric research studies may help to explicate the links between exposure to adversity and lifelong health, but there are currently very few parameters to guide nurse researchers in choosing appropriate biomarkers of chronic stress for use in research with children and adolescents.

METHODS

Biomarkers of chronic stress are described, including primary mediators (glucocorticoids, catecholamines, and cytokines) and secondary outcomes (neurologic, immune, metabolic, cardiovascular, respiratory, and anthropometric) of the chronic stress response.

RESULTS

Evidence of the use of each biomarker in pediatric research studies is reviewed. Recommendations for pediatric researchers, including selection of appropriate biomarkers, measurement considerations, potential moderators, and future directions for research, are presented.

DISCUSSION

A wide range of biomarkers is available for use in research studies with children. While primary mediators of chronic stress have been frequently measured in studies of children, measurement of secondary outcomes, particularly immune and metabolic biomarkers, has been limited. With thoughtful and theoretically based approaches to selection and measurement, these biomarkers present an important opportunity to further explore the physiologic pathways linking exposure to chronic stress with later health and disease.

CONCLUSION

The incorporation of chronic stress biomarkers into pediatric research studies may provide valuable insight into the mechanisms through which stressful environments "get under the skin" and ultimately inform efforts to promote health and reduce inequities among children exposed to adversity.

Sharing the Burden of the Transition to Adulthood: African American Young Adults' Transition Challenges and Their Mothers' Health Risk

For many African American youth, the joint influences of economic and racial marginalization render the transition to stable adult roles challenging. We have gained much insight into how these challenges affect future life chances, yet we lack an understanding of what these challenges mean in the context of linked lives. Drawing on a life course framework, this study examines how young African Americans' experiences across a variety of salient domains during the transition to adulthood affect their mothers' health. Results suggest that stressors experienced by African Americans during the transition to adulthood (e.g., unemployment, troubled romantic relationships, arrest) heighten their mothers' cumulative biological risk for chronic diseases, or allostatic load, and reduce subjective health. These results suggest that the toll of an increasingly tenuous and uncertain transition to adulthood extends beyond young people to their parents. Hence, increased public investments during this transition may not only reduce inequality and improve life chances for young people themselves, but may also enhance healthy aging by relieving the heavy burden on parents to help their children navigate this transition.

Socioeconomic Status and Parental Perceived Social Support in Relation to Health-Related Quality of Life in Youth with Spina Bifida

Spina bifida (SB) is a congenital birth defect causing a wide variance of physical and intellectual disabilities. The first objective of this study was to examine SES and parental perceived support as predictors of HRQoL among youth with SB. It was hypothesized that lower SES would predict lower youth HRQoL, and higher parental perceived support would predict higher youth HRQOL. The second objective of this study was to examine parental perceived support as a moderator of the association between SES and youth HRQoL. Parental perceived support was hypothesized to serve as a buffer of the negative impact that low SES has on HRQoL. Results indicated significant effects of SES on school, physical, and total HRQoL subscales when covariates were not included. In addition, parental perceptions of social support from family members were significantly associated with Emotional HRQoL in youth with SB. There was a significant interaction between SES and parental perceived support from friends predicting youth Social HRQoL. However, post-hoc simple slope analyses were not significant. This study works to expand the understanding of the roles of SES and parental perceived social support on the HRQoL in children with SB, a population susceptible to poor quality of life due to the physical and cognitive challenges commonly associated with this condition.

Psychological buffers against poor health: the role of the socioeconomic environment

Beliefs, emotions, and other psychological resources can protect physical health. Notably, however, the particular ways of thinking, feeling, and acting that are associated with better health can vary with one's socioeconomic status (SES). Those that are most protective reflect what is afforded in and valued by the context. Specifically, in higher SES environments, where people often have the resources to be independent and influence their own destinies, beliefs that reflect independence and a focus on the individual predict better health. In contrast, in lower SES environments, where people often encounter more constraints, beliefs and coping strategies that reflect connection to others, and adjustment to the environment predict better health. Understanding these differences will help to address health disparities.

Who Is Your Successful Aging Role Model?

Objectives

Having a role model of successful aging may contribute to views on aging. This article investigated the nature and correlates of young, middle-aged, and older adults' successful aging role models.

Method

One hundred and fifty-one individuals aged 18-99 were asked whether they had a role model of successful aging and if so, the reasons for their choice. Open-ended answers were coded for recurring themes. Views on aging and attitudes toward own aging were assessed with questionnaires.

Results

Eighty-five percent of participants indicated at least one role model. Most mentioned role models from their family, including parents and grandparents. Role models were gender matched. Most frequent reasons for model choices were health, activities, and social resources. Participants with family role models had less negative views on aging. Mediation analyses confirmed that family role models were associated with more reasons for role model choice, which in turn was associated with less negative views on aging. Furthermore, the effect of reasons on attitudes toward own aging was mediated by negative views on aging.

Discussion

Young, middle-aged, and older adults have role models for successful aging. Links between role model features and views on aging suggest that role models may be useful in promoting successful aging.

Resilience to adversity and the early origins of disease

For the past quarter century, scientists at the Center for Family Research at the University of Georgia have conducted research designed to promote understanding of normative developmental trajectories among low socioeconomic status African American children, youths, and young adults. In this paper, we describe a recent expansion of this research program using longitudinal, epidemiological studies and randomized prevention trials to test hypotheses about the origins of disease among rural African American youths. The contributions of economic hardship, downward mobility, neighborhood poverty, and racial discrimination to allostatic load and epigenetic aging are illustrated. The health benefits of supportive family relationships in protecting youths from these challenges are also illustrated. A cautionary set of studies is presented showing that some psychosocially resilient youths demonstrate high allostatic loads and accelerated epigenetic aging, suggesting that, for some, "resilience is just skin deep." Finally, we end on an optimistic note by demonstrating that family-centered prevention programs can have health benefits by reducing inflammation, helping to preserve telomere length, and inhibiting epigenetic aging.

Change the things you can: Emotion regulation is more beneficial for people from lower than from higher socioeconomic status

Emotion regulation is central to psychological health, and several emotion-regulation strategies have been identified as beneficial. However, new theorizing suggests the benefits of emotion regulation should depend on its context. One important contextual moderator might be socioeconomic status (SES), because SES powerfully shapes people's ecology: lower SES affords less control over one's environment and thus, the ability to self-regulate should be particularly important. Accordingly, effectively regulating one's emotions (e.g., using cognitive reappraisal) could be more beneficial in lower (vs. higher) SES contexts. Three studies (N = 429) tested whether SES moderates the link between cognitive reappraisal ability (CRA; measured with surveys and in the laboratory) and depression. Each study and a meta-analysis of the 3 studies revealed that CRA was associated with less depression for lower SES but not higher SES individuals. Thus, CRA may be uniquely beneficial in lower SES contexts. More broadly, the effects of emotion regulation depend upon the ecology within which it is used. (PsycINFO Database Record

Relationships between Psychosocial Resilience and Physical Health Status of Western Australian Urban Aboriginal Youth

BACKGROUND

Psychosocial processes are implicated as mediators of racial/ethnic health disparities via dysregulation of physiological responses to stress. Our aim was to investigate the extent to which factors previously documented as buffering the impact of high-risk family environments on Aboriginal youths' psychosocial functioning were similarly beneficial for their physical health status.

METHOD AND RESULTS

We examined the relationship between psychosocial resilience and physical health of urban Aboriginal youth (12-17 years, n = 677) drawn from a representative survey of Western Australian Aboriginal children and their families. A composite variable of psychosocial resilient status, derived by cross-classifying youth by high/low family risk exposure and normal/abnormal psychosocial functioning, resulted in four groups- Resilient, Less Resilient, Expected Good and Vulnerable. Separate logistic regression modeling for high and low risk exposed youth revealed that Resilient youth were significantly more likely to have lower self-reported asthma symptoms (OR 3.48, p<.001) and carer reported lifetime health problems (OR 1.76, p<.04) than Less Resilient youth.

CONCLUSION

The findings are consistent with biopsychosocial models and provide a more nuanced understanding of the patterns of risks, resources and adaptation that impact on the physical health of Aboriginal youth. The results support the posited biological pathways between chronic stress and physical health, and identify the protective role of social connections impacting not only psychosocial function but also physical health. Using a resilience framework may identify potent protective factors otherwise undetected in aggregated analyses, offering important insights to augment general public health prevention strategies.

Recent Developments in the Study of Social Relationships, Stress Responses, and Physical Health

This selective review aims to highlight some of the most recent empirical or theoretical advancements in the study of social relationships as buffers against stress and as protective factors against risk for disease, focusing on articles published between 2013 and 2015. The review summarizes novel findings showing that social relationships can protect individuals against negative health outcomes associated with chronic adversity and can be associated with reduced cumulative physiological damage (allostatic load). There is also evidence that some relationships can be a source of stress. Additionally, recent findings concerning the psychological and neurobiological mechanisms of action for social support, the developmental patterning of social stress-buffering and recent experimental studies attempting to change relationships to affect health are also reviewed.

Talking About Type 2 Diabetes: Family Communication From the Perspective of At-Risk Relatives

PURPOSE

The purpose of this study was to describe type 2 diabetes (T2DM) communication and risk reduction recommendations from the perspective of family members at risk for T2DM based on family history.

METHODS

Semistructured qualitative interviews were conducted with 33 individuals with a first-degree relative with T2DM. Participants were recruited from the community and a previous pharmacogenetics study. Deductive and inductive codes were applied to the transcripts.

RESULTS

Conversations with family members with and without T2DM focused on symptoms and disease management of the family member with T2DM. With at-risk relatives, conversations also focused on prevention. Lack of perceived relevance to family members without T2DM was a barrier to communication. Recommendations to facilitate communication included education of an at-risk family member to increase awareness of risk, followed by sharing of learned information with others.

CONCLUSION

Efforts are needed to increase awareness and improve communication about T2DM risk factors, familial risk, and risk reduction behaviors within families with a family history of T2DM. Family members with and without T2DM should be encouraged to communicate with their relatives about T2DM and the risk to family members. Identification of family members who can facilitate communication, education, and modeling of healthy behaviors may increase awareness and motivate at-risk individuals to engage in risk-reducing behaviors.

Shift-and-Persist Strategies: Associations With Socioeconomic Status and the Regulation of Inflammation Among Adolescents and Their Parents

OBJECTIVE

Shift-and-persist is a resilience construct hypothesized to be beneficial to physical health among individuals with low socioeconomic status (SES). This shift-and-persist construct entails a combination of reframing stressors more positively while also enduring adversity through finding purpose in life. In this study, we investigated how shift-and-persist relates to key inflammatory processes that are implicated in cardiovascular and other diseases. We also obtained validation information on a new shift-and-persist measure.

METHOD

A sample of 122 adolescents and 122 parents from a diverse range of SES backgrounds completed our shift-and-persist measure, a battery of other psychosocial questionnaires and interviews, and provided blood samples. Parents also provided SES information.

RESULTS

Reliability and validity of the shift-and-persist measure were demonstrated across both adolescents and adults. Shift-and-persist moderated the association between SES and indicators of inflammatory regulation. Specifically, as SES declined, shift-and-persist was associated with greater sensitivity to glucocorticoids' anti-inflammatory properties (interaction in adolescents: [beta] = .21, p = .033; interaction in adults: [beta] = .25, p = .011), and also with less low-grade, chronic inflammation (interaction in adolescents: [beta] = .18, p = .044). Conversely, as SES increased, the opposite pattern was evident.

CONCLUSIONS

These findings suggest that adaptive psychosocial characteristics have the potential to regulate inflammatory processes in ways that may mitigate risk for a number of chronic diseases, particularly among disadvantaged groups.

Optimism and depression: a new look at social support as a mediator among women at risk for breast cancer

OBJECTIVE

Breast cancer risk is a chronic stressor associated with depression. Optimism is associated with lower levels of depression among breast cancer survivors. However, to our knowledge, no studies have explored the relationship between optimism and depression among women at risk for breast cancer. We hypothesized that women at risk for breast cancer who have higher levels of optimism would report lower levels of depression and that social support would mediate this relationship.

METHOD

Participants (N = 199) with elevated distress were recruited from the community and completed self-report measures of depression, optimism, and social support. Participants were grouped based on their family history of breast cancer. Path analysis was used to examine the cross-sectional relationship between optimism, social support, and depressive symptoms in each group.

RESULTS

Results indicated that the variance in depressive symptoms was partially explained through direct paths from optimism and social support among women with a family history of breast cancer. The indirect path from optimism to depressive symptoms via social support was significant (β = -.053; 90% CI = -.099 to -.011, p = .037) in this group. However, among individuals without a family history of breast cancer, the indirect path from optimism to depressive symptoms via social support was not significant.

CONCLUSIONS

These results suggest that social support partially mediates the relationship between optimism and depression among women at risk for breast cancer. Social support may be an important intervention target to reduce depression among women at risk for breast cancer.

Health-related hindrance of personal goals of adolescents with cancer: The role of the interaction of race/ethnicity and income

This study examined the interaction of race/ethnicity and income to health-related hindrance (HRH) of personal goals of adolescents with cancer. Adolescents (N = 94) receiving treatment for cancer completed a measure of HRH, (including identification of personal goals, rating the impact of health on goal pursuit, and ratings of goal appraisals). The interaction of race/ethnicity and income on HRH was examined. Goal content and appraisal were compared by race/ethnic groups. The interaction between race/ethnicity and income was significant in predicting HRH, with HRH increasing for minority adolescents as income increases and HRH decreasing for white adolescents as income increases. Higher income minority adolescents reported the most goals. Low income minorities reported the least difficult goals. Goal content did not differ between groups. Sociodemographic factors contribute to HRH in adolescents with cancer. Structural and psychosocial support during treatment to maintain goal pursuit may improve psychosocial outcomes.

Neighborhood Poverty, College Attendance, and Diverging Profiles of Substance Use and Allostatic Load in Rural African American Youth

A subset of African American youth who live in impoverished neighborhoods display resilient profiles academically and behaviorally. We hypothesized that this resilience might be "skin-deep," in that the ongoing efforts needed to achieve success might take a physiological toll on these youth. At age 19, 452 rural African American youth were assessed on broader contextual risk (neighborhood poverty) and external indicators of success (college attendance). One year later, participants were assessed on substance use and cumulative physiological risk (allostatic load). African American youth from more disadvantaged neighborhoods who attended college had lower levels of substance use, but higher levels of allostatic load compared to those from less disadvantaged neighborhoods who attended college, or to those who did not attend college. These findings indicate that a subset of African American youth from poor neighborhoods exhibits a profile of "skin-deep resilience," characterized by external successes combined with heightened internal physiological risk.

A family-oriented psychosocial intervention reduces inflammation in low-SES African American youth

Children of low socioeconomic status (SES) are at elevated risk for health problems across the lifespan. Observational studies suggest that nurturant parenting might offset some of these health risks, but their design precludes inferences about causal direction and clinical utility. Here we ask whether a psychosocial intervention, focused improving parenting, strengthening family relationships, and building youth competencies, can reduce inflammation in low-SES, African Americans from the rural South. The trial involved 272 mothers and their 11-y-old children from rural Georgia, half of whose annual household incomes were below the federal poverty line. Families were randomly assigned to a 7-wk psychosocial intervention or to a control condition. When youth reached age 19, peripheral blood was collected to quantify six cytokines that orchestrate inflammation, the dysregulation of which contributes to many of the health problems known to pattern by SES. Youth who participated in the intervention had significantly less inflammation on all six indicators relative to controls (all P values < 0.001; effect sizes in Cohen's d units ranged from -0.69 to -0.91). Mediation analyses suggested that improved parenting was partially responsible for the intervention's benefits. Inflammation was lowest among youth who received more nurturant-involved parenting, and less harsh-inconsistent parenting, as a consequence of the intervention. These findings have theoretical implications for research on resilience to adversity and the early origins of disease. If substantiated, they may also highlight a strategy for practitioners and policymakers to use in ameliorating social and racial health disparities.