Modeling relationships among socioeconomic status, hostility, cardiovascular reactivity, and left ventricular mass in African American and White children

Racial Differences in Left Ventricular Mass and Wave Reflection Intensity in Children

The burden of heart failure is disproportionately higher in African Americans, with a higher prevalence seen at an early age. Examination of racial differences in left ventricular mass (LVM) in childhood may offer insight into risk for cardiac target organ damage (cTOD) in adulthood. Central hemodynamic load, a harbinger of cTOD in adults, is higher in African Americans. The purpose of this study was to examine racial differences in central hemodynamic load and LVM in African American and non-Hispanic white (NHW) children. Two hundred sixty-nine children participated in this study (age, 10 ± 1 years; n = 149 female, n = 154 African American). Carotid pulse wave velocity (PWV), forward wave intensity (W1) and reflected wave intensity (negative area, NA) was assessed from simultaneously acquired distension and flow velocity waveforms using wave intensity analysis (WIA). Wave reflection magnitude was calculated as NA/W1. LVM was assessed using standard 2D echocardiography and indexed to height as LVM/[height (2.16) + 0.09]. A cutoff of 45 g/m (2.16) was used to define left ventricular hypertrophy (LVH). LVM was higher in African American vs. NHW children (39.2 ± 8.0 vs. 37.2 ± 6.7 g/m (2.16), adjusted for age, sex, carotid systolic pressure and socioeconomic status; p < 0.05). The proportion of LVH was higher in African American vs. NHW children (25 vs. 12 %, p < 0.05). African American and NHW children did not differ in carotid PWV (3.5 ± 4.9 vs. 3.3 ± 1.3 m/s; p > 0.05). NA/W1 was higher in African American vs. NHW children (8.5 ± 5.3 vs. 6.7 ± 2.9; p < 0.05). Adjusting for NA/W1 attenuated racial differences in LVM (38.8 ± 8.0 vs. 37.6 ± 7.0 g/m (2.16); p = 0.19). In conclusion, racial differences in central hemodynamic load and cTOD are present in childhood. African American children have greater wave intensity from reflected waves and higher LVMI compared to NHW children. WIA offers novel insight into early life origins of racial differences in central hemodynamic load and cTOD.

Threat vigilance and socioeconomic disparities in metabolic health

A quarter of the global population meets diagnostic criteria for metabolic syndrome (MetS). MetS prevalence stratifies by socioeconomic status (SES), such that low SES is associated with higher MetS risk starting in childhood. Despite this trend, some low-SES children maintain good metabolic health across the life span, but the factors responsible for their resilience are not well understood. This study examined the role of threat vigilance as either a moderator or a mediator of the effects of low early life SES on adult metabolic risk. Three hundred twenty-five Canadians aged 15-55 participated (M = 36.4 years, SD = 10.7; 55.4% female). We coded parental occupational status between the ages of 0 and 5 to index early life SES. We used the International Diabetes Federation case definition for MetS based on waist circumference, blood pressure, triglyceride levels, HDL cholesterol, and glycosylated hemoglobin measures. Threat vigilance was assessed using the Weapons Identification Procedure, a visual discrimination paradigm that captures implicit perceptions of threat. Analyses supported the moderator hypothesis: low early life SES was associated with MetS diagnosis exclusively among those with high levels of threat vigilance. This suggests that low early life SES environments that heighten vigilance to threat might be particularly detrimental for metabolic health. Conversely, low threat vigilance may buffer against the metabolic risks associated with socioeconomic disadvantage.

Childhood-Onset Essential Hypertension and the Family Structure

The prevalence and effect of single-parent families in childhood-onset essential hypertension (EH) is unknown. Children with EH and age-, sex-, and ethnicity-matched controls were enrolled. Family structure data were obtained by in-person interview. A total of 148 families (76 hypertension probands, 72 control probands; median 14 years) were prospective-ly enrolled in the study. Single-parent status was seen in 42% of the families--with and without EH (38% vs 46%, P=.41; odds ratio, 0.7; 95% confidence interval, 0.4-1.4). After multivariable analysis, a statistically significant sociofamilial contributor to the development of childhood-onset EH was not identified. A significant number of single-parent families (42%), the majority with single mothers, were found in our pedigree study. Sociofamilial factors are known to contribute to the expression of adult-onset EH, but findings in our study suggest that they appear to contribute less in the expression of childhood-onset EH.

Social oral epidemi(olog)(2) y where next: one small step or one giant leap?

Since the early 1990s, there has been heated debate critically reflecting on social epidemiology. Yet, very little of this debate has reached oral epidemiology. This is no more noticeable than in the field of oral health inequalities. One of the significant achievements of social oral epidemiology has been the persistent documentation of social patterning of oral disease. Nevertheless, where social oral epidemiology has fallen down is going beyond description to explaining these patterns. Thinking how and in what way things happen, not just in relation to oral health inequalities but also more broadly, requires a more creative approach which links to scholarship outside of dentistry, including the work from critical epidemiologists to that within the social sciences. The aim of this review study is to provide a critical commentary on key aspects of more general epidemiological debates in order to inform and develop social oral epidemiology theory and methodology. In the first section, 'Where are we now?', six key debates are reflected upon: (i) analysis of variance versus analysis of causes, (ii) the fallacy of independent effects, (iii) black box thinking, (iv) theory and the understanding of mechanisms, (v) individualization of risk and (vi) the meaning of 'social'. In the second section, 'Where to next?' we draw on a number of fundamental issues from within the social science literature in order to highlight possible channels of future inquiry. Our overriding goal throughout is to facilitate a critical engagement in order to improve understanding and generate knowledge in relation to population oral health.

Childhood physical abuse predicts stressor-evoked activity within central visceral control regions

Early life experience differentially shapes later stress reactivity, as evidenced by both animal and human studies. However, early experience-related changes in the function of central visceral neural circuits that control stress responses have not been well characterized, particularly in humans. The paraventricular nucleus of the hypothalamus (PVN), bed nucleus of the stria terminalis (BNST), amygdala (Amyg) and subgenual anterior cingulate cortex (sgACC) form a core visceral stress-responsive circuit. The goal of this study is to examine how childhood emotional and physical abuse relates to adulthood stressor-evoked activity within these visceral brain regions. To evoke acute states of mental stress, participants (n = 155) performed functional magnetic resonance imaging (fMRI)-adapted versions of the multi-source interference task (MSIT) and the Stroop task with simultaneous monitoring of mean arterial pressure (MAP) and heart rate. Regression analyses revealed that childhood physical abuse correlated positively with stressor-evoked changes in MAP, and negatively with unbiased, a priori extractions of fMRI blood-oxygen level-dependent signal change values within the sgACC, BNST, PVN and Amyg (n = 138). Abuse-related changes in the function of visceral neural circuits may reflect neurobiological vulnerability to adverse health outcomes conferred by early adversity.

Psychosocial predictors of nicotine dependence among women during their mid-sixties

Although there is considerable research demonstrating the prospective association between earlier maladaptive personal attributes and later nicotine dependence, there is less work on the psychosocial mediators of this relationship. Maladaptive personal attributes appear in the form of depression, anxiety, and interpersonal sensitivity. This study was designed to assess the prospective relationship between earlier maladaptive personal attributes (mean age = 40) and later nicotine dependence ( age = 65.2) within an understudied female community sample. The participants were given self-administered questionnaires. The results supported a model by which earlier maladaptive personal attributes predicted later nicotine dependence through several indirect pathways. In addition to cigarette smoking, several domains mediated the relation of earlier maladaptive personal attributes and later nicotine dependence. These domains included internal factors (ie, later maladaptive personal attributes), interpersonal factors (ie, marital/partner conflict), later contextual factors (ie, family financial difficulty). Our multidimensional longitudinal findings have important implications for the prevention and treatment of nicotine dependence. The results identify earlier and later significant psychosocial risk factors to be targeted, and suggest the timing of interventions to reduce or eliminate nicotine dependence.

Hostile behavior links negative childhood family relationships to heart rate reactivity and recovery in young adulthood

Prior research has demonstrated that vulnerability to stress is influenced by early life experiences. This study evaluates the impact of negative childhood family relationships on cardiovascular stress reactivity in young adulthood. Participants (age 18-22) from families characterized by negative (n=39) or positive relationships (n=36) engaged in a role-play conflict task. Hostile/aggressive verbal behaviors during the task were observed, and blood pressure (BP) and heart rate (HR) responses were measured before, during, and after the task. Participants from negative families engaged in more hostile/aggressive verbal behavior during the task and showed attenuated HR reactivity. Hostile/aggressive verbal behavior predicted attenuated HR reactivity and recovery. Path analyses linked negative family relationships to more hostile verbal behavior during the task, and attenuated HR reactivity and recovery. These results support the development of hostile/aggressive behavior in social situations as a pathway linking childhood adversity to stress vulnerability across the lifespan.

Mediators of the relationship between socioeconomic status and allostatic load in the Chicago Health, Aging, and Social Relations Study (CHASRS)

Low socioeconomic status (SES) has been associated with higher levels of allostatic load (AL). Posited mechanisms for this association include stress, personality, psychosocial variables, coping, social networks, and health behaviors. This study examines whether these variables explain the SES-AL relationship in a population-based sample of 208 51- to 69-year-old White, Black, and Hispanic adults in the Chicago Health, Aging, and Social Relations Study. AL was based on nine markers of physiological dysregulation. SES was inversely associated with a composite measure of AL; hostility and poor sleep quality helped to explain the association between AL and SES. Factor analyses revealed four AL components corresponding to the bodily systems of interest. SES was significantly associated with two AL components, suggesting that the effects of SES on physiological dysregulation are specific to certain systems in a middle to early old-age population.

Association between social isolation and left ventricular mass

BACKGROUND

Social isolation is associated with progression of cardiovascular disease, with the most socially isolated patients being at increased risk. Increased left ventricular mass is a predictor of cardiovascular morbidity and mortality. It is not yet clear whether social isolation is a determinant of increased left ventricular mass.

METHODS

We performed a cross-sectional study of Northern Manhattan Study participants who were free of clinical cardiovascular disease and had obtained transthoracic echocardiograms (n=2021) and a baseline questionnaire on social habits. Social isolation was defined as the lack of friendship networks (knowing fewer than 3 people well enough to visit within their homes). Echocardiographic left ventricular mass was indexed to height(2.7), analyzed as a continuous variable and compared between exposure groups.

RESULTS

The prevalence of social isolation was 13.5%. The average left ventricular mass was significantly higher (50.2 gm/m(2.7)) in those who were, as compared with those who were not (47.6 gm/m(2.7)), socially isolated (P<.05). Higher prevalence of social isolation was found among those less educated, uninsured, or unemployed. There were no significant race-ethnic differences in the prevalence of social isolation. In multivariate analysis, there was a trend toward an association between social isolation and increased left ventricular mass in the total cohort (P=.09). Among Hispanics, social isolation was significantly associated with greater left ventricular mass. Hispanics who were socially isolated averaged 3.9 gm/ht(2.7) higher left ventricular mass compared with those not socially isolated (P=.002). This relationship was not present among non-Hispanic blacks or whites.

CONCLUSION

In this urban tri-ethnic cohort, social isolation was prevalent and associated with indices of low socioeconomic status. Hispanics who were socially isolated had a greater risk for increased left ventricular mass.

The association of optimism and perceived discrimination with health care utilization in adults with sickle cell disease

OBJECTIVE

We evaluated the effect of perceived discrimination, optimism, and their interaction on health care utilization among African American adults with sickle cell disease (SCD).

METHODS

Measures of optimism and perceived discrimination were obtained in 49 African American SCD patients. Multiple regression analyses controlling for sex and age tested effects of optimism and perceived discrimination on the number of emergency department visits (ED) and number and duration of hospitalizations over the past year.

RESULTS

A perceived discrimination-optimism interaction was associated with number of emergency departments visits (b = .29, p = .052), number of hospitalizations (b = .36, p = .019), and duration of hospitalizations (b = .30, p = .045) such that those with high perceived discrimination/high optimism had the greatest health care utilization.

CONCLUSIONS

African American SCD patients with high perceived discrimination/high optimism had greater health care utilization than patients who reported either low perceived discrimination or low optimism. This study suggests that patient personality and coping styles should be considered when evaluating the effects of stress on SCD-related outcomes.

Socioeconomic Status and Coronary Heart Disease Risk: The Role of Social Cognitive Factors

The aim of this study is to examine existing research on social cognitive factors that may, in part, mediate the relationship between socioeconomic status (SES) and coronary heart disease (CHD). We focus on how social status is 'carried' in the mental systems of individuals, and how these systems differentially affect CHD risk and associated behaviors. To this end, literatures documenting the association of various social cognitive factors (e.g., social comparison, perceived discrimination, and self-efficacy) with cardiovascular disease are reviewed as are literatures regarding the relationship of these factors to SES. Possible mechanisms through which social cognitions may affect health are addressed. In addition, directions for future research are discussed, and a model identifying the possible associations between social cognitive factors, SES, and coronary disease is provided.

Blood lead (Pb) levels: further evidence for an environmental mechanism explaining the association between socioeconomic status and psychophysiological dysregulation in children

OBJECTIVE

The authors recently reported that blood lead (Pb) was a significant mediator for the positive association between socioeconomic status (SES) and peripheral vascular responses to acute stress in children (B. B. Gump et al., 2007). The present study considers the possibility that Pb may also mediate an association between SES and cortisol responses to acute stress.

DESIGN

Early childhood Pb exposure was tested as a mediator for cross-sectional associations between SES and cortisol responses.

MAIN OUTCOME MEASURES

The primary outcome was cortisol responses to acute stress in 9.5-year-old children (N = 108).

RESULTS

Lower family income was associated with significantly greater cortisol levels following an acute stress task. A mediational analysis confirmed that Pb was a significant mediator for this association.

CONCLUSION

These results reaffirm the importance of considering the chemical environment as well as social and psychological environment when evaluating psychophysiological effects of low SES.

Trajectories of maternal depressive symptoms over her child's life span: relation to adrenocortical, cardiovascular, and emotional functioning in children

Maternal depression has a number of adverse effects on children. In the present study, maternal depressive symptoms were assessed (using the Center for Epidemiological Studies Depression Scale) when their child was 3 months, 6 months, 1 year, 2 years, 4.25 years, 6 years, 7 years, 8 years, and 10 years of age. At 9.5 years of age, children's (94 females, 82 males) depressive symptoms as well as cardiovascular and cortisol levels during baseline and two psychologically stressful tasks were measured. Using multilevel modeling, maternal depressive symptom trajectories were considered in relation to their child's adrenocortical and cardiovascular responses to acute stress. Our goal was to determine maternal depressive symptom trajectories for children with elevated cardiovascular and cortisol reactivity to acute stress and elevated depressive symptoms. In general, those mothers with chronically elevated depressive symptoms over their child's life span had children with lower initial cortisol, higher cardiac output and stroke volume in response to acute stress, lower vascular resistance during acute stress tasks, and significantly more depressive symptoms at 9.5 years of age. These results are discussed in the context of established associations among hypothalamic-pituitary-adrenal axis dysregulation, depression, and cardiovascular disease.

Mastery, perceived stress and health-related behaviour in northeast Arnhem Land: a cross-sectional study

BACKGROUND

Indigenous peoples in Australia are disadvantaged on all markers of health and social status across the life course. Psychosocial factors are implicated in the aetiology of chronic diseases and in pathways underpinning social health disparities. Minimal research has investigated psychosocial factors and health in Indigenous peoples. This study evaluated associations between mastery, perceived stress, and health-related behaviour for a remote Indigenous population in Australia.

METHODS

Complete data on mastery (the degree to which individuals feel in control of their lives), perceived stress, physical activity, and fruit and vegetable consumption were obtained for 177 participants in a community-based chronic disease risk factor survey. Psychosocial questionnaires were completed as an option during community screening (response rate = 61.9%). Extensive consultation facilitated the cross-cultural adaptation of measures.

RESULTS

Mastery was inversely correlated with perceived stress measures (p < 0.009): recent stress, r = -0.47; chronic stress, r = -0.41; and youth stress, r = -0.30. Relationships between mastery and behaviour varied according to age group (<25 or > or =25 years) for physical activity (p = 0.001) and vegetable consumption (p = 0.005). Individuals aged > or =25 years engaging in < or =2 bouts of physical activity/week had lower mastery than individuals engaging in > or =3 bouts/week, with means (95% CI) of 14.8 (13.7-15.8) and 17.1 (15.3-19.0), respectively (p = 0.026). Individuals aged > or =25 years eating vegetables < or =3 times/week had lower mastery than those eating vegetables > or =4 times/week (p = 0.009) [means 14.7 (13.8-15.5) and 17.3 (15.5-19.1), respectively]. Individuals <25 years engaging in < or =2 bouts of physical activity/week had greater mastery than individuals engaging in > or =3 bouts/week (p = 0.022) [means 17.2 (15.2-19.2) and 13.8 (11.9-15.7), respectively]. For men > or =25 years and women > or =15 years, mastery was inversely related to age (p < 0.002). Men <25 years had less mastery than women of equivalent age (p = 0.001) [means 13.4 (12.1-14.7) and 17.5 (15.3-19.8), respectively].

CONCLUSION

Consistent with previous research, this study provides additional support for a link between mastery and health-related behaviour, and extends evidence of this association to a remote Indigenous population. Mastery's association with perceived stress, its age-specific association with health behaviour, and findings of low mastery amongst young men, highlights a need for life course research accounting for contextual factors affecting Indigenous peoples.

Socioeconomic status and health in adolescents: the role of stress interpretations

The role of psychological interpretations in the relationship between low socioeconomic status (SES) and physiological responses was tested. One hundred high school students (ages 15-19) watched videos of ambiguous and negative life situations, and were interviewed about their interpretations. Lower SES was associated with greater threat interpretations during ambiguous (but not negative) situations and with greater diastolic blood pressure and heart rate reactivity. Threat interpretations partially mediated relationships between SES and reactivity. General life events (e.g., lack of positive life events), rather than specific life events (e.g., exposure to violence), partially explained the relationship between low SES and threat interpretations. Results suggest that the larger social environment helps explain how adolescents approach new social situations, which in turn has implications for adolescent physical health.

Relation between socioeconomic status, race-ethnicity, and left ventricular mass: the Northern Manhattan study

Increased left ventricular mass (LVM) and lower socioeconomic status (SES) are predictors of cardiovascular morbidity and mortality. Blacks and Hispanics are more likely to have higher LVM and lower SES. The relation between SES, race-ethnicity, and LVM has not been fully explored. Data were used from the NOMAS population-based sample of 1916 subjects living in Northern Manhattan. SES was characterized on the basis of educational attainment and divided into 4 categories. Echocardiography-defined LVM was indexed according to height at the allometric power of 2.7 and analyzed as a continuous variable. LVM varied by race in our cohort (blacks 48.9 g/m2.7, Hispanics 48.4 g/m2.7, whites 45.6 g/m2.7; P=0.004). Using ANCOVA, there was a significant inverse and graded association between mean LVM and SES for the total cohort. Mean LVM was 48.4 g/m2.7, 48.6 g/m2.7, 47.1 g/m2.7, and 45.3 g/m2.7 for the lowest to the highest educational level category (P trend=0.0004). This relationship remained among normotensives (P trend=0.0005) and was present for blacks (P trend=0.009), but not for whites (P trend=0.86) or Hispanics (P trend=0.47). The difference in mean LVM between the highest and lowest categories of education was 5.3 g/m2.7 for blacks, 0.0 g/m2.7 for whites, and 1.0 g/m2.7 for Hispanics. Lower SES is an independent predictor of increased LVM among hypertensive and normotensive blacks.