Association between neighborhood poverty and ovarian reserve: the ovarian aging study

OBJECTIVE

This study aimed to examine the association between neighborhood poverty and ovarian reserve.

METHODS

Among 1,019 healthy premenopausal women in the Ovarian Aging Study, aggregate exposure to neighborhood poverty was examined in relation to biomarkers of ovarian reserve, antimüllerian hormone (AMH) and antral follicle count (AFC). Specifically, the interaction of age-x-neighborhood poverty was assessed cross-sectionally to determine whether AMH and AFC declines across women may be greater in women exposed to more neighborhood poverty. Neighborhood poverty was assessed by geocoding and linking women's residential addresses in adulthood to US Census data.

RESULTS

Independent of covariates, a significant interaction term showed the association between age and AMH varied by degree of exposure to neighborhood poverty in adulthood ( b = -0.001, P < 0.05). AMH declines increased progressively across women exposed to low, medium, and high levels of neighborhood poverty. In addition, main effects showed that higher neighborhood poverty was related to higher AMH in the younger women only ( b = 0.022, P < 0.01). Results related to AFC were all nonsignificant ( P > 0.05).

CONCLUSIONS

Across women, greater aggregate exposure to neighborhood poverty in adulthood was related to lower ovarian reserve, indexed by AMH. In addition, there was a positive association between neighborhood poverty and AMH in younger women that attenuated in the older women. Together, results suggest that neighborhood disadvantage may have detrimental impacts that manifest as initially higher AMH, resulting in greater ovarian follicle loss over time. However, it remains unclear whether these results examining differences across women may replicate when AMH declines by neighborhood poverty are examined longitudinally.

Which aspects of education are health protective? a life course examination of early education and adulthood cardiometabolic health in the 30-year study of early child care and Youth Development (SECCYD)

BACKGROUND

Past research describes robust associations between education and health, yet findings have generally been limited to the examination of education as the number of years of education or educational attainment. Little is known about the specific features or processes underpinning education that are health protective. The objective of the current study was to address this gap by examining specific aspects of early education pertaining to student characteristics and experiences, as well as features of the classroom environment, in predicting cardiometabolic health in adulthood.

METHODS

Subjects were 1364 participants in the NICHD Study of Early Child Care and Youth Development (SECCYD, 1991-2009) and recent SECCYD 30-year follow-up, the Study of Health in Early and Adult Life (SHINE, 2018-2022). Models examined individual education indicators (student social skills, student-teacher relationship quality, and classroom emotional and instructional quality in the period of elementary school and student academic performance between ages 54 months and 15 years) in relation to a composite of cardiometabolic risk in adulthood (ages 26-31), reflecting central adiposity, blood pressure, insulin resistance, inflammation, and dyslipidemia. Models were adjusted for key explanatory factors including socio-demographics, infant characteristics, parental socioeconomic status (SES), and child health status. Follow-up analyses were performed to test potential mediators of early education effects on adult health, including adult SES (educational attainment, household income) and health behaviors (diet quality, activity level, sleep duration, smoking).

RESULTS

In adjusted models, results showed greater student social skills, indexed by a mean of annual teacher ratings between kindergarten and 6th grade, predicted lower cardiometabolic risk in adulthood (β=-0.009, p <.05). In follow-up analyses, results showed the protective effect of student social skills on cardiometabolic risk may be mediated by adult income (β=-0.0014, p <.05) and diet quality (β=-0.0031, p <.05). Effects of the other early education indicators were non-significant (ps > 0.05).

CONCLUSIONS

Findings point to the potential significance of early student social competence as a link to long-term health, possibly via the acquisition of resources needed for the maintenance of health, as well as through engagement in health behaviors supporting healthy eating. However, more research is needed to replicate these findings and to elaborate on the role of early student social competence and the pathways explaining its effects on cardiometabolic health in adulthood.

Thirty-year follow-up of the NICHD Study of Early Child Care and Youth Development (SECCYD): the challenges and triumphs of conducting in-person research at a distance

PURPOSE

The purpose of the current study, The National Institute of Child Health and Human Development (NICHD) Study of Health in Early and Adult Life (SHINE), was to build on the landmark Study of Early Child Care and Youth Development (SECCYD), a longitudinal birth cohort initiated in 1991, by conducting a health-focused follow-up of the now adult participants. This effort has produced an invaluable resource for the pursuit of life course research examining links between early life risk and resilience factors and adulthood health and disease risk.

PARTICIPANTS

Of the 927 NICHD SECCYD participants available for recruitment in the current study, 705 (76.1%) participated in the study. Participants were between 26 and 31 years and living in diverse geographic locations throughout the USA.

FINDINGS TO DATE

In descriptive analyses, the sample exhibited risk on health status indicators, especially related to obesity, hypertension and diabetes. Of particular concern, the prevalence of hypertension (29.4%) and diabetes (25.8%) exceeded national estimates in similar-age individuals. Health behaviour indicators generally tracked with the parameters of poor health status, showing a pattern of poor diet, low activity and disrupted sleep. The juxtaposition of the sample's relatively young age (mean=28.6 years) and high educational status (55.6% college educated or greater) with its poor health status is noteworthy, suggesting a dissociation between health and factors that are typically health protective. This is consistent with observed population health trends, which show a worsening of cardiometabolic health status in younger generations of Americans.

FUTURE PLANS

The current study, SHINE, lays the groundwork for future analyses in which the uniquely robust measures collected as a part of the original NICHD SECCYD will be leveraged to pinpoint specific early life risk and resilience factors as well as the correlates and potential mechanisms accounting for variability in health and disease risk indicators in young adulthood.

Early maternal sensitivity and markers of physical health: Enduring or transient associations from childhood to adulthood?

Individual differences in the quality of early experiences with primary caregivers have been reliably implicated in the development of socioemotional adjustment and, more recently, physical health. However, few studies have examined the development of such associations with physical health into the adult years. To that end, the current study used prospective, longitudinal data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (N = 1,306, 52% male, 77% White/non-Hispanic) to investigate whether associations between direct observations of maternal sensitivity in the first 3 years of life and repeated assessments of two commonly used, objective indicators of physical health (i.e., body mass and mean arterial blood pressure) remained stable or diminished in magnitude over time. Associations between early maternal sensitivity and lower body mass remained relatively stable from age 54 months to 26 years and were robust to the modeling of autoregressive and second-order stability processes as well as the inclusion of potential demographic confounders. In contrast, although associations between early caregiving and lower mean arterial pressure remained relatively stable from Grade 4 to age 15 years (the oldest age for which mean arterial pressure was assessed thus far), these associations were not robust to the inclusion of covariates and the modeling of second-order stability processes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Disparities in COVID-19-related stressful life events in the United States: Understanding who is most impacted

Impacts of the COVID-19 pandemic in the United States have been exacerbated by pre-existing inequities in resources and opportunities, leaving the most vulnerable to face a multitude of hardships. The goal of the current study was to characterise COVID-19-related stressful life events in specific life domains and to identify the sociodemographic characteristics of individuals who are more likely to experience such events. Participants (n = 372, 57% female) in a follow-up study of the NICHD Study of Early Child Care and Youth Development completed the Epidemic-Pandemic Impacts Inventory (June-August 2020) to assess COVID-19-related stressors. Sociodemographic factors (gender, race/ethnicity, socioeconomic status and wealth) were examined simultaneously as predictors of the number of stressful life events in separate categories of work/finances, home life, social activity, health and healthcare, adjusted for covariates (household size, community COVID-19 transmission risk). In negative binomial regression analyses, being female (vs. male) predicted a 31%, 64%, 13% and 94% increase in the number of stressful life events in domains of work/finances, home life, social activity and healthcare, respectively, whereas each one standard deviation increase in wealth predicted a 17%, 16% and 21% reduction in the number of stressful life events in domains of work/finances, COVID-19 infection and healthcare, respectively. Findings highlight the pronounced and far-reaching impacts of the COVID-19 pandemic on women as well as the unique role wealth may play in lessening such impacts. This new knowledge may be leveraged to develop intervention and policy-related strategies to remediate impacts of COVID-19-related stressors on those most vulnerable.

The relative contributions of adiposity and activity levels to physical performance in children with excess weight

OBJECTIVE

This study examined predictors of physical performance, a key aspect of quality of life, in children with excess weight.

METHODS

Participants were 269 children aged 6-12 years with a body mass index above the 85th percentile. Children completed a standardized physical performance task capturing lower extremity strength, balance, and gait speed. Height, weight, and waist circumference were objectively measured, and daily moderate-vigorous physical activity (min/day) and sedentary time (% of day) were assessed with a 7-day accelerometer protocol.

RESULTS

Physical performance task completion averaged 15.0 (SD = 2.5) seconds. Children with higher body mass index z-scores and waist circumferences had significantly longer task completion times. The task took 1.8 additional seconds per 1.0 body mass index z-score (p < .001), and 1.2 additional seconds for every 20 cm higher waist circumference (p < .001). Daily moderate-vigorous physical activity and sedentary time were unrelated to physical performance, and did not moderate its associations with the adiposity measures.

CONCLUSION

Among children with excess weight, physical performance declines with increasing levels of total and central adiposity. Daily activity levels do not moderate this association. Interventions that directly target weight reduction would likely yield the greatest improvement in physical performance in children with overweight or obesity.

Effects of Early Life Adversity on Pubertal Timing and Tempo in Black and White Girls: The National Growth and Health Study

OBJECTIVE

Although exposure to abuse in early life predicts earlier pubertal timing, especially for girls, it is unclear if this association generalizes to nonabuse stressors. In addition, the impact of race on the stress-maturation association remains unknown. To address these issues, we examined whether race moderates the effects of early adversity on pubertal timing and tempo using a longitudinal study design.

METHODS

In a cohort of 9- and 10-year-old Black and White girls, pubertal (areolar and pubic hair) maturation was assessed annually for 7 years. In adulthood, 368 participants (186 Black, 182 White) reported on abuse and nonabuse stressors they experienced from ages 0 to 12 years.

RESULTS

Early life abuse was associated with earlier pubertal timing, as indexed by younger age at menarche (b = -0.22, p = .005, 95% confidence interval [CI] = -0.39 to -0.06) and greater pubic hair development (b = 0.11, p = .003, 95% CI = 0.04 to 0.18), in addition to slower pubertal tempo, as indexed by slower rate of pubic hair (b = -0.03, p < .001, 95% CI = -0.05 to -0.01) and areolar (b = -0.02, p = .02, 95% CI = -0.03 to -0.003) development. These associations were not found for nonabuse adversity. Black girls with early life abuse had greater pubic hair development (b = 0.23, p < .001, 95% CI = 0.12 to 0.35) and were slower in pubic hair tempo (b = -0.07, p < .001, 95% CI = -0.09 to -0.04) than their White counterparts.

CONCLUSIONS

Screening for early life abuse may help address health disparities related to earlier pubertal timing.

Timing, duration, and differential susceptibility to early life adversities and cardiovascular disease risk across the lifespan: Implications for future research

Early life adversities (ELA), include experiences such as child maltreatment, household dysfunction, bullying, exposure to crime, discrimination, bias, and victimization, and are recognized as social determinants of cardiovascular disease (CVD). Strong evidence shows exposure to ELA directly impacts cardiometabolic risk in adulthood and emerging evidence suggests there may be continuity in ELA's prediction of cardiometabolic risk over the life course. Extant research has primarily relied on a cumulative risk framework to evaluate the relationship between ELA and CVD. In this framework, risk is considered a function of the number of risk factors or adversities that an individual was exposed to across developmental periods. The cumulative risk exposure approach treats developmental periods and types of risk as equivalent and interchangeable. Moreover, cumulative risk models do not lend themselves to investigating the chronicity of adverse exposures or consider individual variation in susceptibility, differential contexts, or adaptive resilience processes, which may modify the impact of ELA on CVD risk. To date, however, alternative models have received comparatively little consideration. Overall, this paper will highlight existing gaps and offer recommendations to address these gaps that would extend our knowledge of the relationship between ELA and CVD development. We focus specifically on the roles of: 1) susceptibility and resilience, 2) timing and developmental context; and 3) variation in risk exposure. We propose to expand current conceptual models to incorporate these factors to better guide research that examines ELA and CVD risk across the life course.

Patterns of Early Life Weight Gain and Female Onset of Puberty

Context

Prepubertal obesity is a well-established predictor of earlier pubertal onset, which is itself a risk factor for poor health and well-being. Identifying specific patterns of weight gain in early life may help explain differential risk for earlier pubertal onset.

Objective

The objective of the study was to examine patterns of weight gain across infancy and early childhood in relation to pubertal onset outcomes.

Design, Setting, and Participants

Participants were 426 girls in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, a longitudinal birth cohort of children and their families followed between birth and adolescence.

Main Outcome Measures

Three pubertal onset outcomes were examined, including age at menarche and ages at Tanner stage II for dimensions of breast and pubic hair development.

Results

In infancy (birth to 15 months), greater percent weight gain and higher birthweight predicted earlier pubertal onset for all outcomes (Ps < 0.05). In early childhood (24 months to grade 1), body mass index (BMI) trajectories reflecting BMI values that were persistently high or changed from low to high over time (vs BMI values that were stable at median or low levels), predicted younger ages at menarche and the onset of breast (Ps < 0.05), but not pubic hair (Ps > 0.05), development. All associations were independent of breastfeeding, maternal menarcheal age, and race/ethnicity.

Conclusions

Distinct patterns of early life weight gain predict differential risk for earlier onset puberty. Focusing on these patterns for earlier and more targeted intervention may help lessen life course linkages between prepubertal obesity, accelerated pubertal development, and negative postpubertal outcomes.

Does secure base script knowledge mediate associations between observed parental caregiving during childhood and adult romantic relationship quality and health?

Increasingly, attachment representations are being assessed via secure base script knowledge - the degree to which individuals show awareness of the temporal-causal schema that summarizes the basic features of seeking and receiving effective support from caregivers during times of need. Limited research has assessed the links between secure base script knowledge and aspects of adult functioning and the role that secure base script knowledge may play in accounting for associations between early caregiving quality and adulthood functioning. We used follow-up assessments of the NICHD Study of Early Child Care and Youth Development cohort (N = 585) to examine whether secure base script knowledge at age 18 years: (a) is associated with later romantic relationship quality, depressive symptoms, and body mass index (BMI) at age 26 years, and (b) mediates expected associations between the quality of maternal and paternal sensitivity across the first 15 years of life and age-26 outcomes. More access to, and elaborated knowledge of the secure base script predicted less extreme hostility with romantic partners, and better emotional and physical health. Moreover, secure base script knowledge mediated the links between early maternal and paternal sensitivity and both later romantic partner hostility and depressive symptoms, but not BMI.

Randomized trial of promoting first relationships for new mothers who received community mental health services in pregnancy

The effectiveness of Promoting First Relationships (PFR), a 10-week home visiting program with video feedback, was tested in a randomized controlled trial involving 252 mothers and their 8- to 12-week-old infants. Mothers were eligible if they initiated treatment after mental health screening (depression, anxiety, posttraumatic stress disorder [PTSD]) at a community or public health primary care center in pregnancy. At baseline, 51% had mild to severe depression symptoms, 54% had mild to severe anxiety, and 35% had PTSD. Their ages ranged from 18 to 42 years. Mothers were 66% White, 18% Black, and 16% other races. Forty-seven percent identified as Hispanic, and 33% preferred to read and speak in Spanish. The median family annual income was less than $20,000. The PFR program or receipt of a resource packet (control condition) followed the baseline assessment and randomization; we assessed outcomes when infants were age 6 and 12 months. Compared to mothers in the control condition, mothers in the PFR condition had significantly (ps < .05) higher observed sensitivity scores at both follow-up time points (d = .25, d = .26), had improved understanding of infant-toddler social-emotional needs at both time points (d = .21, d = .45), and reported less infant externalizing behavior at age 12 months (d = .28). This study is the fourth completed randomized controlled trial of the PFR program, all involving populations experiencing adversity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Targeting Parenting Quality to Reduce Early Life Adversity Impacts on Lifespan Cardiometabolic Risk

Mounting evidence that early life adversity (ELA) exposures confer risk for cardiometabolic disease over the lifespan motivated this narrative review to examine parenting quality as a potential intervention target to reduce ELA exposures or mitigate their impact as a way of reducing or preventing cardiometabolic disease. We describe findings from the limited number of family-based intervention studies in ELA-exposed children that have tested parenting impacts on cardiometabolic health outcomes. We then describe the implications of this work and make recommendations for future research that will move this field forward.

Early life predictors of positive change during the coronavirus disease pandemic

BACKGROUND

The COVID-19 pandemic is a crisis unprecedented in its size and scope. Yet studies of resilience suggest most individuals will successfully negotiate this challenge and some may even experience growth and positive change. Some evidence suggests that the capacity to enact positive change in the face of adversity may be shaped by early life experiences.

METHODS

In a subset of 374 participants (57% female, mean age = 29 years) in the Study of Early Child Care and Youth Development (SECCYD), a longitudinal, birth cohort, prospective models were tested to determine whether early life adversities in family and neighborhood contexts predict positive change events in response to the COVID-19 pandemic. Childhood family and neighborhood contexts were assessed using a combination of self-report questionnaires and US Census data. Adulthood positive change events (e.g., becoming more appreciative of things usually taken for granted) were assessed using the Epidemic-Pandemic Impacts Inventory (EPII).

RESULTS

In regression analyses, neighborhood disadvantage in childhood, measured both by objective and subjective assessments, predicted a higher number of positive change events in response to the COVID-19 pandemic (β = .18, p = .004 and β = .15, p = .006, respectively). Examination of the positive change event subscales showed neighborhood disadvantage in childhood predicted increases in events related to 'perspective taking and charitable giving' (β = .20, p = .022 and β = .17, p = .002, respectively) and improved 'social relationships' (β = .18, p = .004 and β = .13, p = .020, respectively), but not to positive 'health behaviors' (ps > .05). All associations were independent of sociodemographic factors and childhood family dysfunction.

CONCLUSIONS

Findings suggest that neighborhood disadvantage in childhood may shape prosocial responses to stress in adulthood, potentially through early life adaptions to stress that are protective when facing adversity. There are several notable implications of the study findings. Although adversity in early life has clear negative impacts, it is possible that adversity experiences may also provide opportunities to develop adaptive strategies that foster resilience and growth when facing stress. Intervention efforts should consider leveraging such stress-adapted strengths to reduce the many negative impacts of early life adversity.

Preexisting Executive Function Deficits and Change in Health Behaviors During the COVID-19 Pandemic

BACKGROUND

Executive functions (EF) support engagement in goal-directed behaviors, including several health behaviors. Stressful and cognitively demanding events can disrupt EFs and interfere with health behavior, possibly to a greater extent in those with preexisting EF deficits. This study examined the association between preexisting EF deficits and subsequent negative changes in eating patterns, physical activity, sedentariness, and alcohol/substance use during the COVID-19 pandemic.

METHOD

Participants were 374 young adults in a follow-up study of the longitudinal, multisite Study of Early Child Care and Youth Development (SECCYD). Preexisting EF deficits were assessed with the Barkley Deficits in Executive Function Scales-Short Form, and personally impactful negative changes in four health behaviors (physical activity, unhealthy eating, sedentary time, alcohol/substance use) during the COVID-19 pandemic were subsequently assessed with the Epidemic-Pandemic Impacts Inventory.

RESULTS

In ordered logistic regression models, higher preexisting total EF deficits were associated with greater negative impactful changes in physical activity and unhealthy eating, independent of sociodemographic variables, obesity, and (as relevant) accelerometer-based physical activity and pre-COVID-19 diet quality. Socioeconomic status moderated the association between total EF deficits and impactful change in alcohol/substance use, with EF deficits linked to greater impactful change in alcohol/substance use only in higher socioeconomic strata.

CONCLUSION

Individuals with preexisting EF deficits appear more vulnerable to the negative impact of the COVID-19 pandemic on several key health behaviors. As the pandemic unfolds, strategies may be needed to identify those with EF deficits (e.g., screening tools) and provide them with tailored support for chronic disease risk reduction.

Early Life Adversity and Pubertal Timing: Implications for Cardiometabolic Health

OBJECTIVE

To identify early life adversity (ELA) risk factors for earlier pubertal timing, itself a risk factor for poor cardiometabolic health, and to determine whether such ELA-related risk may be mediated by pre-pubertal body mass index (BMI).

METHODS

Subjects included 426 female participants in a prospective birth cohort study, the NICHD Study of Early Child Care and Youth Development. Survival analysis models were fit to examine ELA exposures, representing childhood socioeconomic status (SES), maternal sensitivity, mother-child attachment, and negative life events, along with child health indicators and covariates, in relation to pubertal timing outcomes, including age at menarche and ages at Tanner stage II for breast and pubic hair development.

RESULTS

Higher childhood SES emerged as an independent predictor of older age at menarche, showing each one standard deviation increase in childhood SES corresponded to a 1.3% increase in age at menarche (factor change = 1.013; 1.003-1.022; p < .01), but did not predict breast or pubic hair development (ps > .05). In mediation analyses, indirect (mediated) effects of mother-child attachment on the pubertal timing outcomes, via pre-pubertal BMI, were all statistically significant (ps < .05).

CONCLUSIONS

Higher childhood SES predicted directly, and secure (vs. insecure) mother-child attachment predicted indirectly (via pre-pubertal BMI), later pubertal timing, suggesting these factors may protect girls from earlier pubertal development. By extension, clinical implications are that intervention strategies designed to lessen ELA- and pre-pubertal obesity-related risk may be effective in remediating life course pathways linking ELA, accelerated pubertal development, and cardiometabolic risk.

Is in utero exposure to maternal socioeconomic disadvantage related to offspring ovarian reserve in adulthood?

BACKGROUND

Because the ovarian follicle pool is established in utero, adverse exposures during this period may be especially impactful on the size and health of the initial follicle endowment, potentially shaping trajectories of ovarian follicle loss and the eventual onset of menopause. Building on a robust literature linking socioeconomic status (SES) and menopausal timing, the current study examined adverse prenatal exposures related to maternal SES, hypothesizing that greater maternal socioeconomic disadvantage would be associated with lower ovarian reserve in the adult offspring.

METHODS

In a healthy, community-based sub-sample (n = 350) of reproductive age participants in the OVA Study (2006-2011), prenatal maternal SES was examined in relation to two biomarkers of ovarian reserve, antimullerian hormone (AMH) and antral follicle count (AFC). Prenatal maternal SES was assessed indirectly using maternal addresses abstracted from participant birth certificates, geocoded, and linked to US Census-derived variables, including neighborhood-level characteristics: education (% of individuals with a HS diploma); poverty (% of families below the poverty line); unemployment (% of individuals > 16 years who are unemployed); and income (median family income).

RESULTS

In separate covariate-adjusted linear regression models (following the backward elimination of main effects with P > .10), greater maternal neighborhood education was related to higher ovarian reserve as marked by higher levels of offspring AMH (beta = .142, P < .001) and AFC (beta = .092, P < .10) with models accounting for 19.6% and 21.5% of the variance in AMH and AFC, respectively. In addition, greater maternal neighborhood poverty was related to lower ovarian reserve as marked by lower offspring AMH (beta = -.144, P < .01), with the model accounting for 19.5% of the variance in AMH.

CONCLUSIONS

Maternal socioeconomic disadvantage measured indirectly at the neighborhood level was associated with lower ovarian reserve among the adult offspring, independently of offspring SES and other potential confounding factors. This suggests SES-related adversity exposures may have a detrimental impact on the size or health of the initial follicle endowment, leading to accelerated follicle loss over time.

Race disparities in pubertal timing: Implications for cardiovascular disease risk among African American women

Compared to white girls, sexual maturation is accelerated in African American girls as measured by indicators of pubertal development, including age at first menses. Increasing epidemiological evidence suggests that the timing of pubertal development may have strong implications for cardio-metabolic health in adolescence and adulthood. In fact, younger menarcheal age has been related prospectively to poorer cardiovascular risk factor profiles, a worsening of these profiles over time, and an increase in risk for cardiovascular events, including non-fatal incident cardiovascular disease and cardiovascular-specific and all-cause mortality. Yet, because this literature has been limited almost exclusively to white girls/women, whether this same association is present among African American girls/women has not been clarified. In the current narrative review, the well-established vulnerability of African American girls to experience earlier pubertal onset is discussed as are findings from literatures examining the health outcomes of earlier pubertal timing and its antecedents, including early life adversity exposures often experienced disproportionately in African American girls. Gaps in these literatures are highlighted especially with respect to the paucity of research among minority girls/women, and a conceptual framework is posited suggesting disparities in pubertal timing between African American and white girls may partially contribute to well-established disparities in adulthood risk for cardio-metabolic disease between African American and white women. Future research in these areas may point to novel areas for intervention in preventing or lessening the heightened cardio-metabolic risk among African American women, an important public health objective.

Addressing the needs of fertility treatment patients and their partners: are they informed of and do they receive mental health services?

OBJECTIVE

To determine the extent to which fertility patients and partners received mental health services (MHS) and were provided with information about MHS by their fertility clinics, and whether the use of MHS, or the provision of information about MHS by fertility clinics, was targeted to the most distressed individuals.

DESIGN

Prospective longitudinal cohort study.

SETTING

Five fertility practices.

PATIENT(S)

A total of 352 women and 274 men seeking treatment for infertility.

INTERVENTION(S)

No interventions administered.

MAIN OUTCOME MEASURE(S)

Depression, anxiety, and MHS information provision and use.

RESULT(S)

We found that 56.5% of women and 32.1% of men scored in the clinical range for depressive symptomatology at one or more assessments and that 75.9% of women and 60.6% of men scored in the clinical range for anxiety symptomatology at one or more assessments. Depression and anxiety were higher for women and men who remained infertile compared with those who were successful. Overall, 21% of women and 11.3% of men reported that they had received MHS, and 26.7% of women and 24.1% of men reported that a fertility clinic made information available to them about MHS. Women and men who reported significant depressive or anxiety symptoms, even those with prolonged symptoms, were no more likely than other patients to have received information about MHS.

CONCLUSION(S)

Psychological distress is common during fertility treatment, but most patients and partners do not receive and are not referred for MHS. Furthermore, MHS use and referral is not targeted to those at high risk for serious psychological distress. More attention needs to be given to the mental health needs of our patients and their partners.

Prevalence and predictors of major depressive disorder for fertility treatment patients and their partners

OBJECTIVE

To examine the prevalence and predictors of major depressive disorder (MDD) for women and their partners during the course of fertility treatment.

DESIGN

Prospective cohort study during an 18-month period. Participants completed interviews and questionnaires at baseline and at 4, 10, and 18 months of follow-up.

SETTING

Five community and academic fertility practices.

PATIENT(S)

A total of 174 women and 144 of their male partners who did not have a successful child-related outcome during the time frame of the study.

INTERVENTION(S)

No interventions administered.

MAIN OUTCOME MEASURE(S)

The MDD was assessed using the Composite International Diagnostic Interview Major Depression module, a structured diagnostic interview. Additional variables were assessed with self-report questionnaire measures.

RESULT(S)

Of the women 39.1% and of the men 15.3% met the criteria for MDD during the 18-month course of the study. A binary logistic covariate-adjusted model showed that, for both women and men, past MDD was a significant predictor of MDD during treatment. Past MDD further predicted significant risk for MDD during treatment after controlling for other well-established risk factors (i.e., baseline levels of depression, anxiety, and partner support).

CONCLUSION(S)

The MDD was highly prevalent for fertility treatment patients and their partners. Past MDD predicted risk for MDD during treatment, and it contributed to MDD risk more than other commonly assessed risk factors. This suggests that patients and their partners would benefit from being routinely assessed for a history of MDD before the start of treatment to best direct psychosocial support and interventions to those most in need.

Race/ethnic disparities in reproductive age: an examination of ovarian reserve estimates across four race/ethnic groups of healthy, regularly cycling women

OBJECTIVE

To determine whether reproductive age, as indexed by a validated marker of ovarian reserve (antimüllerian hormone [AMH]), varies among women of different race/ethnic backgrounds.

DESIGN

Cross-sectional study.

SETTING

Community-based sample.

PATIENT(S)

Multiethnic sample of 947 (277 white, 237 African American, 220 Latina, and 213 Chinese) healthy and regularly cycling premenopausal women, ages 25-45.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

AMH level.

RESULT(S)

A multivariate model was fit examining race/ethnicity, covariates, nonlinear terms for age (age(2), age(3)), and body mass index (BMI(2), BMI(3)), and two-way interactions between race/ethnicity and each of the other predictor variables in relation to AMH. After backward elimination, significant effects included race/ethnicity (F = 8.45), age (F = 349.94), race/ethnicity-by-linear age interaction (F = 4.67), age(2) (F = 31.61), and BMI (F = 10.69). Inspection of the significant race/ethnicity-by-linear age interaction showed AMH levels were consistently lower among Latina women compared with white women across all ages, whereas AMH levels were lower among African American and Chinese women compared with the white women at younger and middle ages, respectively. The AMH levels were higher among African American compared with Latina and Chinese women at older ages.

CONCLUSION(S)

Although the results must be considered preliminary, the findings are twofold: African American women may have lower AMH levels at younger ages but experience less of a reduction in AMH with advancing age, and Latina and Chinese women compared with white women may have lower AMH levels, marking a lower ovarian reserve and a possibly increased risk for earlier menopause.

Beverages contribute extra calories to meals and daily energy intake in overweight and obese women

Caloric beverages may promote obesity by yielding energy without producing satiety, but prior laboratory and intervention studies are inconclusive. This study examined whether the diets of free-living overweight and obese women show evidence that calories from beverages are offset by reductions in solid food within individual eating occasions and across entire days. Eighty-two women weighed and recorded all consumed foods and beverages for seven days. Beverages were coded as high-calorie (≥ 0.165 kcal/g) or low-calorie (<0.165 kcal/g), and total energy intake and energy intake from solid food were calculated for each eating occasion and day. In covariate-adjusted models, energy intake from solid food did not differ between eating occasions that included high-calorie or low-calorie beverages and those with no reported beverage. Energy intake from solid food was also unrelated to the number of high-calorie or low-calorie beverages consumed per day. On average, eating occasions that included a high-calorie beverage were 169 kcal higher in total energy than those with no reported beverage, and 195 kcal higher in total energy than those that included a low-calorie beverage. Each high-calorie beverage consumed per day contributed an additional 147 kcal to women's daily energy intake, whereas low-calorie beverage intake was unrelated to daily energy intake. Beverages contributed to total energy intake in a near-additive fashion among free-living overweight and obese women, suggesting a need to develop more effective interventions to reduce caloric beverage intake in the context of weight management, and to potentially reexamine dietary guidelines.

Childhood adversity and pubertal timing: understanding the origins of adulthood cardiovascular risk

OBJECTIVE

To determine whether greater childhood adversity relates to younger menarcheal age; whether younger menarcheal age relates to increased CVD risk; and whether greater childhood adversity relates to increased CVD risk, directly or indirectly (mediated by menarcheal age).

METHODS

Among 650 pre-menopausal women (ages 25-45; M=34.9[5.6]), SEM was performed to estimate relations between childhood adversity, menarcheal age, and CVD risk.

RESULTS

Results supported a covariate-adjusted model (RMSEA=0.035; CFI=0.983) in which greater childhood adversity was related to younger menarcheal age (β=-.13, p<.01) and younger menarcheal age was related to greater CVD risk (β=-.18, p<.05). Direct and indirect effects of childhood adversity on CVD risk were non-significant. Re-evaluation of the same model with additional covariate-adjustment for adulthood body composition showed the relation between menarcheal age and CVD risk attenuated (β=-.03, p=.376).

CONCLUSIONS

Cross-sectional evidence suggests family-related adversity experiences in childhood confer risk for earlier menarche which, in turn, relates to increased CVD risk in adulthood, possibly via post-pubertal body size.

Pubertal timing, androgens, and obesity phenotypes in women at midlife

CONTEXT

Individuals with metabolically healthy or benign obesity vs. unhealthy or at risk obesity have been distinguished; however, the predisposing factors for developing these phenotypes are poorly understood.

OBJECTIVE

Our objective was to examine pubertal timing marked by menarcheal age in relation to at-risk obese, benign obese, and healthy normal-weight phenotypes at midlife and to characterize the potential role of androgens, marked by the free androgen index (FAI), in accounting for any associations between menarcheal age and obesity phenotype.

DESIGN

The study was cross-sectional.

SETTING AND PARTICIPANTS

Participants included a multiethnic community sample of 989 premenopausal women ages 25-45 yr (mean=35.2 yr; sd=5.5 yr).

MAIN OUTCOME MEASURE

Membership in at-risk obese, benign obese, and healthy normal-weight groups was defined by body mass index and number of metabolic syndrome components.

RESULTS

With each 1-yr increase in menarcheal age, the probability of having the at-risk obese compared with the healthy normal-weight phenotype decreased by 22%. This association attenuated when FAI was covaried, suggesting androgen levels may account for this association. In addition, higher FAI was independently related to having the at-risk obese compared with the healthy normal-weight phenotype as well as having the at-risk compared with the benign obese phenotype (all P<0.05).

CONCLUSIONS

Younger menarcheal age is associated with having the metabolically unhealthy obesity phenotype compared with the healthy normal-weight phenotype at midlife. This relation may be driven by levels of bioavailable androgens, which were especially elevated among women with the at-risk obesity phenotype.

Psychological stress and reproductive aging among pre-menopausal women

BACKGROUND

Life history models suggest that biological preparation for current versus longer term reproduction is favored in environments of adversity. In this context, we present a model of reproductive aging in which environmental adversity is proposed to increase the number of growing follicles at the cost of hastening the depletion of the ovarian reserve over time. We evaluated this model by examining psychological stress in relation to reproductive aging indexed by antral follicle count (AFC), a marker of total ovarian reserve. We hypothesized that stress would be related to (i) higher AFC in younger women, reflecting greater reproductive readiness as well as (ii) greater AFC loss across women, reflecting more accelerated reproductive aging.

METHODS

In a multi-ethnic, community sample of 979 participants [ages 25-45 (mean (standard deviation) = 35.2 (5.5)); 27.5% Caucasian] in the Ovarian Aging study, an investigation of the correlates of reproductive aging, the interaction of age-x-stress was assessed in relation to AFC to determine whether AFC and AFC loss varied across women experiencing differing levels of stress. Stress was assessed by the perceived stress scale and AFC was assessed by summing the total number of antral follicles visible by transvaginal ultrasound.

RESULTS

In linear regression examining AFC as the dependent variable, covariates (race/ethnicity, socio-economic status, menarcheal age, hormone-containing medication for birth control, parity, cigarette smoking, bodymass index, waist-to-hip ratio) and age were entered on step 1, stress on step 2 and the interaction term (age-x-stress) on step 3. On step 3, significant main effects showed that older age was related to lower AFC (b = -0.882, P = 0.000) and greater stress was related to higher AFC (b = 0.545, P = 0.005). Follow-up analyses showed that the main effect of stress on AFC was present in the younger women only. A significant interaction term (b = -0.036, P = 0.031) showed the relationship between age and AFC varied as function of stress. When the sample was divided into tertiles of stress, the average follicle loss was -0.781, -0.842 and -0.994 follicles/year in the low-, mid- and high-stress groups, respectively.

CONCLUSIONS

Psychological stress was related to higher AFC among younger women and greater AFC decline across women, suggesting that greater stress may enhance reproductive readiness in the short term at the cost of accelerating reproductive aging in the long term. Findings are preliminary, however, due to the cross-sectional nature of the current study.

Adverse childhood experiences and repeat induced abortion

OBJECTIVE

The objective of the study was to characterize the backgrounds of women who have repeat abortions.

STUDY DESIGN

In a cross-sectional study of 259 women (mean age, 35.2 ± 5.6 years), the relation between adverse experiences in childhood and risk of having 2 or more abortions vs 0 or 1 abortion was examined. Self-reported adverse events occurring between the ages of 0 and 12 years were summed.

RESULTS

Independent of confounding factors, women who experienced more abuse, personal safety, and total adverse events in childhood were more likely to have 2 or more abortions vs 0 abortions (odds ratio [OR], 2.56; 95% confidence interval [CI], 1.15-5.71; OR, 2.74; 95% CI, 1.29-5.82; and OR, 1.59; 95% CI, 1.21-2.09, respectively) and vs 1 abortion (OR, 5.83; 95% CI, 1.71-19.89; OR, 2.23; 95% CI, 1.03-4.81; and OR, 1.37; 95% CI, 1.04-1.81, respectively). Women who experienced more family disruption events in childhood were more likely to have 2 or more abortions vs 0 abortions (OR, 1.75; 95% CI, 1.14-2.69) but not vs 1 abortion (OR, 1.16; 95% CI, 0.79-1.70).

CONCLUSION

Women who have repeat abortions are more likely to have experienced childhood adversity than those having 0 or 1 abortion.

Psychopathology in adolescents presenting for laparoscopic banding

This study documents psychological problems in obese adolescents seeking bariatric surgery with laparoscopic adjustable gastric band. Depression, self-harm, suicidal ideation, anxiety, and bullying were reported frequently. Professionals will need to carefully assess adolescents for high-risk behaviors and provide appropriate follow-up care if these individuals undergo laparoscopic banding.

Apolipoprotein E polymorphism and preclinical carotid artery disease in untreated hypertensive men

METHODS

The apolipoprotein E (apoE) polymorphism was evaluated alone, and in interaction with smoking status, in predicting carotid intima-medial thickness and plaque among 182 untreated, hypertensive, white men (mean age 56+/-8.9 years).

RESULTS

After covariate adjustment (age, education, smoking, body mass index, systolic and diastolic blood pressure, glucose, total : high-density lipoprotein), apoE genotype (no [epsilon]4 versus any [epsilon]4) predicted mean ([beta]=-0.139, P=0.023) and maximum ([beta]=-0.138, P=0.028) intima-medial thickness, as well as plaque ([beta]=-0.744; P=0.072). Tests of a genotype-x-smoking interaction were non-significant.

CONCLUSIONS

Mean intima-medial thickness was greater in men with the 3/3 than [epsilon]4 genotypes (2/4 3/4 4/4), suggesting genetic risk for carotid atherosclerosis may be conferred by the [epsilon]3, rather than the [epsilon]4, allele.

Community socioeconomic status is associated with carotid artery atherosclerosis in untreated, hypertensive men

BACKGROUND

Individuals of low socioeconomic status (SES) are at increased risk for cardiovascular disease relative to persons of more advantaged social position. Recent evidence suggests that community SES (variation in the material and social resources of communities) also predicts incident cardiovascular disease, and may do so independently of individual level SES. In this study we examined whether community SES is similarly associated with preclinical vascular disease, as measured by carotid artery ultrasonography.

METHODS

Subjects were 230 untreated hypertensive men without history of coronary heart disease, residing in and around Pittsburgh, PA (80% white, 20% African-American; mean age, 56 years). Community SES was defined by levels of income, economic disadvantage (eg, poverty, unemployment), housing costs, and educational attainment in the US Census tract of residence for each subject. A composite community SES score was calculated for each subject as the average of all extracted census measures. Individual SES was estimated from subjects' years of education and current annual income.

RESULTS

Regression analyses accounting for traditional risk factors showed community disadvantage to be associated with greater intima-medial thickness (b = 0.02, P < .05) and plaque occurrence (odds ratio [OR] = 1.51, P < .01). The latter association persisted on multivariable adjustment for both risk factors and individual markers of social position (SES) (OR = 1.68, P < .01).

CONCLUSIONS

Irrespective of one's own income or educational attainment, untreated hypertensive men living in poorer communities are more likely to exhibit preclinical atherosclerosis than residents of more affluent areas.

The socio-economic status of communities predicts variation in brain serotonergic responsivity

BACKGROUND

We reported previously that the socio-economic status (SES) of individuals predicts variation in brain serotonergic responsivity, as assessed by neuropharmacological challenge in an adult community sample, and that this association is qualified by allelic variation in the serotonin transporter gene-linked polymorphic region (5-HTTLPR). Here we examine whether serotonergic responsivity covaries similarly with the SES of communities, as indexed by US Census data in the same study sample.

METHOD

Community SES was defined by levels of income, economic disadvantage, housing costs, and educational attainment of census tracts in which 249 locally recruited study participants (54% male) resided. Serotonergic responsivity was assessed as the baseline-adjusted, peak plasma prolactin (Prl) concentration following acute administration of the serotonin-releasing agent, fenfluramine; tissue for DNA extraction and 5-HTTLPR genotyping was available on 131 participants.

RESULTS

Subjects residing in census tracts of lower SES showed a blunted Prl response to fenfluramine (diminished serotonergic responsivity) relative to individuals living in more affluent neighborhoods. When adjusted for personal income and education, SES at the community level continued to predict fenfluramine-stimulated Prl responses and did so independently of 5-HTTLPR genotype.

CONCLUSIONS

Area-level indices of relative social and economic disadvantage covary with individual differences in brain serotonergic responsivity, and this association is, in part, independent of individually defined SES. These findings may be relevant to reported effects of low community SES on the prevalence of psychiatric disorders or behaviors associated with dysregulation of central serotonergic function, such as depression, impulsive aggression, and suicide.

Anger-related personality traits and carotid artery atherosclerosis in untreated hypertensive men

OBJECTIVE

To determine whether anger-related personality traits are associated with carotid artery atherosclerosis in untreated hypertensive patients.

METHODS

Study participants were 237 men with elevated blood pressure (systolic 140-180 mm Hg and/or diastolic 90-110 mm Hg) but untreated for hypertension. Average age was 56 years; 80% of subjects were white. Eighty-six percent had no history of antihypertensive treatment, and the remainder reported median lifetime treatment exposure of 4 months. Subjects were administered the Spielberger State-Trait Anger Expression Inventory, which measures tendencies to experience anger (Trait Anger) and modes of anger expression (Anger-In, Anger-Out, Anger-Control). Mean and maximum intima-medial thickness (IMT) and plaque occurrence in the extracranial carotid arteries were measured by B-mode ultrasonography.

RESULTS

Trait Anger was marginally (p =.065) related to mean and significantly (p <.05) related to maximum IMT, independent of standard risk factors (age, race, body mass index, education, smoking, fasting glucose, total:high-density lipoprotein cholesterol ratio). A component of Trait Anger, Angry Temperament, similarly predicted mean (p =.062) and maximum IMT (p <.05) and plaque occurrence (p <.05). Anger-Out predicted both mean and maximum IMT (p values <.01).

CONCLUSIONS

An antagonistic disposition (Trait Anger), particularly a tendency to experience anger on minimal provocation (Angry Temperament) and a propensity to express anger outwardly (Anger-Out), are associated with heightened carotid atherosclerosis. These findings suggest that recently reported prospective associations between these anger dimensions and incident cerebrovascular disease may be mediated, in part, by increased atherosclerotic disease.

Is cardiovascular reactivity associated with atherosclerosis among hypertensives?

Exaggerated cardiovascular reactivity to behavioral challenges among otherwise healthy individuals has been associated with carotid atherosclerosis. We evaluated whether a similar relationship exists among hypertensives, who are at a heightened atherosclerotic risk. Untreated, hypertensive men (n=251; age range, 40 to 70 years; 197 white, 54 black) completed a standardized battery of behavioral challenges while their blood pressure responses to the battery were measured. Mean and maximum carotid intima-media thickness and the occurrence of carotid plaques were subsequently determined using B-mode ultrasonography. Although greater systolic and diastolic responses to the battery were associated with greater mean and maximum intima-media thickness in univariate analyses (P<0.01), only diastolic reactivity showed a unique association with mean and maximum carotid intima-media thickness after multivariate adjustment for age, race, socioeconomic status, smoking and alcohol use, body mass index, lipid profile, glucose and insulin concentrations, and resting blood pressure (P<0.05). Carotid plaque occurrence was associated with greater systolic reactivity (P=0.05) and was marginally associated with greater diastolic reactivity (P=0.07) in univariate analyses, but neither systolic nor diastolic reactivity was uniquely associated with the presence of carotid plaques after multivariate risk-factor adjustment. Among hypertensives, exaggerated behaviorally evoked cardiovascular reactivity appears to be uniquely associated with greater carotid intima-media thickness but not with carotid plaque occurrence.

The influence of parent-child relatedness on depressive symptoms in children with asthma: tests of moderator and mediator models

OBJECTIVE

To examine the influence of parent-child relationship quality on the association between illness-related functional status and depressive symptoms in children with asthma.

METHODS

Questionnaire data were collected from the child, caregiver, and physician. Fifty-five children with asthma (8-17 years of age), their caregivers, and physicians participated.

RESULTS

Regression analyses suggest that patterns of mother-child relatedness (secure vs. insecure) mediate the relationship between functional status and depressive symptoms.

CONCLUSIONS

The parent-child relationship may be an important pathway by which illness influences symptoms of depression in children with asthma. This study suggests that impaired functional status does not directly contribute to symptoms of depression, but rather influences the parent-child relationship in ways that may promote the development of depressive symptoms in the child.