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Article Reference Troff document (with manpage macros)Financial strain and ideal cardiovascular health in middle-aged and older women: Data from the Women's health study
Financial strain is a prevalent form of psychosocial stress in the United States; however, information about the relationship between financial strain and cardiovascular health remains sparse, particularly in older women. The cross-sectional association between financial strain and ideal cardiovascular health were examined in the Women's Health Study follow-up cohort (N = 22,048; mean age = 72± 6.0 years).Six self-reported measures of financial strain were summed together to create a financial strain index and categorized into 4 groups: No financial strain, 1 stressor, 2 stressors, and 3+ stressors. Ideal cardiovascular health was based on the American Heart Association strategic 2020 goals metric, including tobacco use, body mass index, physical activity, diet, blood pressure, total cholesterol and diabetes mellitus. Cardiovascular health was examined as continuous and a categorical outcome (ideal, intermediate, and poor). Statistical analyses adjusted for age, race/ethnicity, education and income. At least one indicator of financial strain was reported by 16% of participants. Number of financial stressors was associated with lower ideal cardiovascular health, and this association persisted after adjustment for potential confounders (1 financial stressor (FS): B = −0.10, 95% Confidence Intervals (CI) = −0.13, −0.07; 2 FS: B = −0.20, 95% CI = −0.26, −0.15; 3+ FS: B = −0.44, 95% CI = −0.50, −0.38). Financial strain was associated with lower ideal cardiovascular health in middle aged and older female health professional women. The results of this study have implications for the potential cardiovascular health benefit of financial protections for older individuals.
Located in Retired Persons / Natalie Slopen, Sc.D. / Natalie Slopen Publications
Article Reference Troff document (with manpage macros)Sleep debt: the impact of weekday sleep deprivation on cardiovascular health in older women
STUDY OBJECTIVES:Short sleep duration is associated with increased cardiovascular disease (CVD) risk. However, it is uncertain whether sleep debt, a measure of sleep deficiency during the week compared to the weekend, confers increased cardiovascular risk. Because sleep disturbances increase with age particularly in women, we examined the relationship between sleep debt and ideal cardiovascular health (ICH) in older women. METHODS:Sleep debt is defined as the difference between self-reported total weekday and weekend sleep hours of at least 2 hours among women without apparent CVD and cancer participating in the Women's Health Stress Study follow-up cohort of female health professionals (N = 22 082). The ICH consisted of seven health factors and behaviors as defined by the American Heart Association Strategic 2020 goals including body mass index, smoking, physical activity, diet, blood pressure, total cholesterol, and glucose. RESULTS:Mean age was 72.1 ± 6.0 years. Compared to women with no sleep debt, women with sleep debt were more likely to be obese and have hypertension (pall < .05). Linear regression models adjusted for age and race/ethnicity revealed that sleep debt was significantly associated with poorer ICH (B = -0.13 [95% CI = -0.18 to -0.08]). The relationship was attenuated but remained significant after adjustment for education, income, depression/anxiety, cumulative stress, and snoring. CONCLUSION:Sleep debt was associated with poorer ICH, despite taking into account socioeconomic status and psychosocial factors. These results suggest that weekly sleep duration variation, possibly leading to circadian misalignment, may be associated with cardiovascular risk in older women.
Located in Retired Persons / Natalie Slopen, Sc.D. / Natalie Slopen Publications
Article Reference Troff document (with manpage macros)Externalizing trajectories predict elevated inflammation among adolescents exposed to early institutional rearing: A randomized clinical trial
  BACKGROUND: There has been mounting interest in the pathophysiological relation between inflammation and psychopathology. In this paper, we examined associations between internalizing and externalizing psychopathology and inflammation in adolescents with a history of severe psychosocial deprivation and children reared in typical family contexts. METHOD: The Bucharest Early Intervention Project is a longitudinal randomized trial of high-quality foster care as an alternative to institutional care. This report is based on 56 institutionalized children randomized to care as usual, 59 institutionalized children randomized to foster care, and 101 never institutionalized children who were recruited as an in-country comparison sample. Externalizing and internalizing behaviors were reported by parents and teachers at ages 8, 12, and 16. At age 16, C-reactive protein (CRP) was derived from blood spots in a subset of participants (n = 127). Multiple-group latent growth curve models were used to examine externalizing and internalizing trajectories and their associations with CRP. RESULTS: Among children assigned to care as usual, higher levels of externalizing behaviors at age 8, as well as smaller decreases in these behaviors from 8 to 16 years predicted higher levels of CRP at age 16. In the same group of children, higher internalizing behaviors at age 8, but not the rate of change in these behaviors, also predicted higher levels of CRP. In contrast, these relations were not observed in the children assigned to foster care and never institutionalized controls. CONCLUSIONS: Early institutional rearing is associated with a coupling of psychopathology and inflammation, whereas early placement into foster care buffers against these risks. These findings have implications for promoting healthy mental and physical development amongst institutionalized children.
Located in Retired Persons / Natalie Slopen, Sc.D. / Natalie Slopen Publications
Article Reference Troff document (with manpage macros)Effect of Change in Cumulative Psychosocial Stressors on Change in Body Mass Index Over Time
Introduction:  Increased psychosocial stress and obesity are both associated with elevated risk of cardiovascular disease (CVD). However, the effect of change in cumulative psychosocial stressors (stressors) on change in body mass index (BMI) over time is unknown, particularly among older women, a population in whom weight change characterization is complex. Methods and Results:  We examined change in stressors in relation to change in BMI among 20,750 women without CVD or cancer at baseline (2012-13) participating in the Women’s Health Study (WHS) follow-up cohort. Stressors and BMI were collected at two time points 2012-13 (Baseline: T1; mean age=71.8 ± 5.8 years) and 2014-15 (Follow-up: T2; mean age=73.8 ± 5.8 years). Our measures of stressors were comprised of a composite of 8 domains, including acute (e.g. negative life events) and chronic (e.g., financial) stressors. We defined stressors over 3 years of follow-up into four categories: chronically low, delayed, acutely high, and chronically high; and BMI change was grouped into three categories (BMI: loss >3%, gain >3%, and maintenance ± 3%). Women with chronically high stress and delayed stress were younger, current smokers and reported more anxiety/depressive symptoms compared to other women. Women with chronically high stress were more likely to have diabetes, hypertension and hypercholesterolemia than their counterparts. Compared to women who maintained both their BMI and had low stress over time, women with delayed stress or chronically high stress had higher odds of decreased BMI [Delayed: Odds Ratio (OR)  1.16,  95% Confidence Interval (CI):  1.03-1.30 ; Chronically High:  OR=1.12, 95% CI 1.01-1.24 ] ( Table 1 ). Conclusion:  Chronically high and delayed cumulative stress were associated with higher odds of weight loss in older women over 3 years. Future studies are needed to test associations between stressors and metabolic, hormonal and autonomic factors resulting in adiposity or musculoskeletal changes.
Located in Retired Persons / Natalie Slopen, Sc.D. / Natalie Slopen Publications
Article Reference Troff document (with manpage macros)Inequalities in the distribution of childhood adversity from birth to 11 years
Objective Exposure to early adversity carries long term harmful consequences for children's health and development. This study aims to 1) estimate the prevalence of childhood adversity for Australian children from infancy to 10-11 years, and 2) document inequalities in the distribution of adversity according to socioeconomic position (SEP), Indigenous status, and ethnicity. Methods Adversity was assessed every two years from 0-1 to 10-11 years in the nationally representative birth cohort of the Longitudinal Study of Australian Children (N=5,107). Adversity included legal problems; family violence; household mental illness; household substance abuse; harsh parenting; parental separation/divorce; unsafe neighborhood; family member death; and bullying (from 4-5 years). Adversities were examined individually and summed for a measure of multiple adversity (2+ adverse experiences). Results By 10-11 years, 52.8% (95% CI 51.0-54.7) of children had been exposed to two or more adversities. When combined with low SEP, children from ethnic minority and from Indigenous backgrounds had four to eight times the odds of exposure to two or more adversities than children from higher SEP Anglo-Euro backgrounds, respectively (OR 4.3, 95% CI 2.8-6.6 and OR 8.1, 95% CI 4.4-14.8). Ethnic minority and Indigenous children from higher SEP backgrounds had increased odds of exposure to multiple adversity than similarly advantaged Anglo-Euro children (OR 1.8, 95% CI 1.4-2.3 and OR 2.3, 95% CI 1.3-4.3, respectively). Conclusions Addressing early adversity is a significant opportunity to promote health over the life course, and reduce health inequalities experienced by marginalized groups of children.
Located in Retired Persons / Natalie Slopen, Sc.D. / Natalie Slopen Publications
Article ReferenceAssessing the Role of Health Behaviors, Socioeconomic Status, and Cumulative Stress for Racial/Ethnic Disparities in Obesity
Objective: This study aimed to examine the explanatory role of health behaviors, socioeconomic position (SEP), and psychosocial stressors on racial/ethnic obesity disparities in a multiethnic and multiracial sample of adults. Methods: Using data from the Chicago Community Adult Health Study (2001-2003), Oaxaca-Blinder decomposition analysis was conducted to quantify the extent to which health behaviors (fruit and vegetable consumption and physical activity), SEP, and cumulative stressors (e.g., perceived discrimination, financial strain) each explained differences in obesity prevalence in Black, US-born Hispanic, and non-US-born Hispanic compared with non-Hispanic White participants. Results: SEP and health behaviors did not explain obesity differences between racial/ethnic minorities and White individuals. Having high levels of stress in four or more domains explained 4.46% of the differences between Black and White individuals, whereas having high levels of stress in three domains significantly explained 14.13% of differences between US-born Hispanic and White. Together, the predictors explained less than 20% of differences between any racial/ethnic minority group and White individuals. Conclusions: Exposure to stressors may play a role in obesity disparities, particularly among Black and US-born Hispanic individuals. Other obesity-related risk factors need to be examined to understand the underlying mechanisms explaining obesity disparities.
Located in Retired Persons / Natalie Slopen, Sc.D. / Natalie Slopen Publications
Article Reference Troff document (with manpage macros)Racial discrimination and telomere shortening among African Americans: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
OBJECTIVE: Telomeres are protective sequences of DNA capping the ends of chromosomes that shorten over time. Leukocyte telomere length (LTL) is posited to reflect the replicative history of cells and general systemic aging of the organism. Chronic stress exposure leads to accelerated LTL shortening, which has been linked to increased susceptibility to and faster progression of aging-related diseases. This study examined longitudinal associations between LTL and experiences of racial discrimination, a qualitatively unique source of minority psychosocial stress, among African Americans. METHOD: Data are from 391 African Americans in the Coronary Artery Risk Development in Young Adults (CARDIA) Telomere Ancillary Study. We examined the number of domains in which racial discrimination was experienced in relation to LTL collected in Years 15 and 25 (Y15: 2000/2001; Y25: 2010/2011). Multivariable linear regression examined if racial discrimination was associated with LTL. Latent change score analysis (LCS) examined changes in racial discrimination and LTL in relation to one another. RESULTS: Controlling for racial discrimination at Y15, multivariable linear regression analyses indicated that racial discrimination at Y25 was significantly associated with LTL at Y25. This relationship remained robust after adjusting for LTL at Y15 (b = -.019, p = .015). Consistent with this finding, LCS revealed that increases in experiences of racial discrimination were associated with faster 10-year LTL shortening (b = -.019, p = .015). CONCLUSIONS: This study adds to evidence that racial discrimination contributes to accelerated physiologic weathering and health declines among African Americans through its impact on biological systems, including via its effects on telomere attrition. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Located in Retired Persons / Natalie Slopen, Sc.D. / Natalie Slopen Publications
Article Reference Troff document (with manpage macros)Testing a Syndemic Index of Psychosocial and Structural Factors associated with HIV Testing among Black Men
Black populations in the United States are disproportionately affected by HIV. This disparity may be affected by social and structural barriers to HIV testing, leading to undiagnosed infection and prolonged HIV transmissibility. Using data from a nationally representative sample of 1,727 Black men in the 2015 Behavioral Risk Factor Surveillance System we tested for differences in poverty, depression, and health care barriers between Black men who had been HIV tested in the past year and those who had not. We also tested a syndemic index of these factors. Number of syndemic factors was linearly associated with less HIV testing (aPR=0.79, 95% CI 0.66-0.95). Assumptions of unidimensionality were met. The use of a syndemic index was a superior approach to analyzing these factors individually, both in terms of model fit and associations detected. The accumulation of poverty, depression, and health care barriers has an adverse impact on HIV testing among Black men.
Located in Retired Persons / Natalie Slopen, Sc.D. / Natalie Slopen Publications
Article Reference Troff document (with manpage macros)Social Determinants of Cardiovascular Health: Early Life Adversity as a Contributor to Disparities in Cardiovascular Diseases
Social determinants of health (SDoH), factors related to the conditions in which people are born, live, work, play, age, and the systems that shape the conditions of daily life, have emerged as key drivers of health and health disparities. 1 , 2  A strong body of research supports that SDoH are associated with cardiovascular risk factors and outcomes, independently or in conjunction with more traditionally recognized risk factors. As a result, efforts to improve cardiovascular health are predicated on improved understanding of the impact of SDoH on cardiovascular disease (CVD) over the life course.
Located in Retired Persons / Natalie Slopen, Sc.D. / Natalie Slopen Publications
Article Reference Troff document (with manpage macros)Association of Childhood Asthma With Federal Rental Assistance
Importance   Millions of low-income children in the United States reside in substandard or unaffordable housing. Relieving these burdens may be associated with changes in asthma outcomes. Objectives   To examine whether participation in the US Department of Housing and Urban Development’s (HUD) rental assistance programs is associated with childhood asthma outcomes and to examine whether associations varied by program type (public housing, multifamily housing, or housing choice vouchers). Design, Setting, and Participants   This survey study used data from the nationally representative National Health Interview Survey linked to administrative housing assistance records from January 1, 1999, to December 31, 2014. A total of 2992 children aged 0 to 17 years who were currently receiving rental assistance or would enter a rental assistance program within 2 years of survey interview were included. Data analysis was performed from January 15, 2018, to August 31, 2019. Exposures   Participation in rental assistance provided by HUD. Main Outcomes and Measures   Ever been diagnosed with asthma, 12-month history of asthma attack, and 12-month history of visiting an emergency department for the treatment of asthma among program participants vs those waiting to enter a program. Overall participation was examined, and participation in public or multifamily housing was compared with participation in housing choice vouchers. Results   This study included 2992 children who were currently participating in a HUD program or would enter a program within 2 years. Among children with an asthma attack in the past year, participation in a rental assistance program was associated with a reduced use of emergency departments for asthma of 18.2 percentage points (95% CI, −29.7 to −6.6 percentage points). Associations were only found after entrance into a program, suggesting that they were not confounded by time-varying factors. Statistically significant results were found for participation in public or multifamily housing (percentage point change, −36.6; 95% CI, −54.8 to −18.4) but not housing choice vouchers (percentage point change, −7.2; 95% CI, −24.6 to 10.3). No statistically significant evidence of changes in asthma attacks was found (percentage point change, −2.7; 95% CI, −12.3 to 7.0 percentage points). Results for asthma diagnosis were smaller and only significant at the 10% level (−4.3; 95% CI, −8.8 to 0.2 percentage points). Conclusions and Relevance   Among children with a recent asthma attack, rental assistance was associated with less emergency department use. These results may have important implications for the well-being of low-income families and health care system costs.
Located in Retired Persons / Natalie Slopen, Sc.D. / Natalie Slopen Publications