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Falcone M, Salhia B, Halbert CH, Torres ETR, Stewart D, Stern MC, Lerman C. Impact of Structural Racism and Social Determinants of Health on Disparities in Breast Cancer Mortality. Cancer Res 2024; 84:3924-3935. [PMID: 39356624 PMCID: PMC11611670 DOI: 10.1158/0008-5472.can-24-1359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/24/2024] [Accepted: 09/25/2024] [Indexed: 10/04/2024]
Abstract
The striking ethnic and racial disparities in breast cancer mortality are not explained fully by pathologic or clinical features. Structural racism contributes to adverse conditions that promote cancer inequities, but the pathways by which this occurs are not fully understood. Social determinants of health, such as economic status and access to care, account for a portion of this variability, yet interventions designed to mitigate these barriers have not consistently led to improved outcomes. Based on the current evidence from multiple disciplines, we describe a conceptual model in which structural racism and racial discrimination contribute to increased mortality risk in diverse groups of patients by promoting adverse social determinants of health that elevate exposure to environmental hazards and stress; these exposures in turn contribute to epigenetic and immune dysregulation, thereby altering breast cancer outcomes. Based on this model, opportunities and challenges arise for interventions to reduce racial and ethnic disparities in breast cancer mortality.
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Affiliation(s)
- Mary Falcone
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Bodour Salhia
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Chanita Hughes Halbert
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Evanthia T. Roussos Torres
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Medicine, Division of Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Daphne Stewart
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Medicine, Division of Oncology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mariana C. Stern
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Caryn Lerman
- USC Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Galiatsatos P, Garibaldi B, Yao D, Xu Y, Perin J, Shahu A, Jackson JW, Piggott D, Falade-Nwulia O, Shubella J, Michtalik H, Belcher HME, Hansel NN, Golden S. Lack of racial and ethnic disparities in mortality in minority patients hospitalised with COVID-19 in a mid-Atlantic healthcare system. BMJ Open Respir Res 2024; 11:e002310. [PMID: 38692710 PMCID: PMC11086483 DOI: 10.1136/bmjresp-2024-002310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/11/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION In the USA, minoritised communities (racial and ethnic) have suffered disproportionately from COVID-19 compared with non-Hispanic white communities. In a large cohort of patients hospitalised for COVID-19 in a healthcare system spanning five adult hospitals, we analysed outcomes of patients based on race and ethnicity. METHODS This was a retrospective cohort analysis of patients 18 years or older admitted to five hospitals in the mid-Atlantic area between 4 March 2020 and 27 May 2022 with confirmed COVID-19. Participants were divided into four groups based on their race/ethnicity: non-Hispanic black, non-Hispanic white, Latinx and other. Propensity score weighted generalised linear models were used to assess the association between race/ethnicity and the primary outcome of in-hospital mortality. RESULTS Of the 9651 participants in the cohort, more than half were aged 18-64 years old (56%) and 51% of the cohort were females. Non-Hispanic white patients had higher mortality (p<0.001) and longer hospital length-of-stay (p<0.001) than Latinx and non-Hispanic black patients. DISCUSSION In this large multihospital cohort of patients admitted with COVID-19, non-Hispanic black and Hispanic patients did not have worse outcomes than white patients. Such findings likely reflect how the complex range of factors that resulted in a life-threatening and disproportionate impact of incidence on certain vulnerable populations by COVID-19 in the community was offset through admission at well-resourced hospitals and healthcare systems. However, there continues to remain a need for efforts to address the significant pre-existing race and ethnicity inequities highlighted by the COVID-19 pandemic to be better prepared for future public health emergencies.
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Affiliation(s)
| | | | - Dapeng Yao
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Yanxun Xu
- Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Jamie Perin
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andi Shahu
- Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - John W Jackson
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Abreu TC, Mackenbach JD, Heuvelman F, Schoonmade LJ, Beulens JW. Associations between dimensions of the social environment and cardiometabolic risk factors: Systematic review and meta-analysis. SSM Popul Health 2024; 25:101559. [PMID: 38148999 PMCID: PMC10749911 DOI: 10.1016/j.ssmph.2023.101559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/27/2023] [Accepted: 11/11/2023] [Indexed: 12/28/2023] Open
Abstract
Aim The social environment (SE), including social contacts, norms and support, is an understudied element of the living environment which impacts health. We aim to comprehensively summarize the evidence on the association between the SE and risk factors of cardiometabolic disease (CMD). Methods We performed a systematic review and meta-analysis based on studies published in PubMed, Scopus and Web of Science Core Collection from inception to 16 February 2021. Studies that used a risk factor of CMD, e.g., HbA1c or blood pressure, as outcome and social environmental factors such as area-level deprivation or social network size as independent variables were included. Titles and abstracts were screened in duplicate. Study quality was assessed using the Newcastle-Ottawa Scale. Data appraisal and extraction were based on the study protocol published in PROSPERO. Data were synthesized through vote counting and meta-analyses. Results From the 7521 records screened, 168 studies reported 1050 associations were included in this review. Four meta-analyses based on 24 associations suggested that an unfavorable social environment was associated with increased risk of cardiometabolic risk factors, with three of them being statistically significant. For example, individuals that experienced more economic and social disadvantage had a higher "CVD risk scores" (OR = 1.54, 95%CI: 1.35 to 1.84). Of the 458 associations included in the vote counting, 323 (71%) pointed towards unfavorable social environments being associated with higher CMD risk. Conclusion Higher economic and social disadvantage seem to contribute to unfavorable CMD risk factor profiles, while evidence for other dimensions of the social environment is limited.
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Affiliation(s)
- Taymara C. Abreu
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
- Upstream Team, the Netherlands
| | - Joreintje D. Mackenbach
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
- Upstream Team, the Netherlands
| | - Fleur Heuvelman
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
| | - Linda J. Schoonmade
- University Library, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, the Netherlands
| | - Joline W.J. Beulens
- Department of Epidemiology & Data Science, Amsterdam UMC - location VUmc, Amsterdam, Noord-Holland, the Netherlands
- Upstream Team, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Utrecht, the Netherlands
- Amsterdam Public Health, Amsterdam Cardiovascular Sciences, Amsterdam, Noord-Holland, the Netherlands
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Socioeconomic Status and Inflammation in Women with Early-stage Breast Cancer: Mediation by Body Mass Index. Brain Behav Immun 2022; 99:307-316. [PMID: 34673177 PMCID: PMC9802182 DOI: 10.1016/j.bbi.2021.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Breast cancer is the most common cancer among women in the US, and women of low socioeconomic status (SES) show markedly poorer outcomes than those of high SES. SES may influence health through inflammation, although links between SES and inflammatory biomarkers have not been investigated in women with breast cancer. This study tested the hypothesis that breast cancer patients of lower SES would show higher levels of inflammation than those of higher SES. BMI was examined as a mediator of this association. METHODS Women recently diagnosed with early-stage breast cancer (N = 194) were recruited before neoadjuvant or adjuvant therapy. Participants completed questionnaires and provided blood samples for immune assessment. SES was indexed by participants' self-reported education and annual household income, BMI was determined by height and weight measurements, and blood was assayed for inflammatory biomarkers linked with cancer outcomes: IL-6, CRP, TNF-α, and sTNF-RII. General linear models tested associations between SES and inflammation, and mediation models examined indirect effects through BMI. RESULTS Consistent with hypotheses, education status was associated with CRP, (F(2,185) = 4.72, p = 0.001), and sTNF-RII, (F(2,185) = 4.19, p = 0.02), such that lower education was associated with higher levels of both biomarkers. Further, BMI mediated the associations between education and CRP, (95% CIs [-0.62, -0.11; -0.76, -0.21]), sTNF-RII, (95% CIs [-0.09, -0.01; -0.10, -0.02]), and IL-6, (95% CIs [-0.32, -0.05; -0.38, -0.09]). Annual household income was not significantly associated with inflammation (ps > 0.25), and indirect effects on inflammation through BMI were not significant. CONCLUSIONS Lower education was associated with higher levels of inflammation in this sample, which may presage poor breast cancer-related and clinical outcomes. SES should inform the development of interventions targeting BMI and inflammation in breast cancer.
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The Association between Neighborhood Disorder and Health: Exploring the Moderating Role of Genotype and Marriage. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030898. [PMID: 33494231 PMCID: PMC7908190 DOI: 10.3390/ijerph18030898] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 01/19/2023]
Abstract
The present study extends prior research on the link between neighborhood disorder and health by testing an integrated model that combines various social and biological factors. Hypotheses were tested using a sample of 325 African American women from the Family and Community Health Study (FACHS). As expected, inflammatory burden was the biophysiological mechanism that mediated much of the association between neighborhood physical disorder and perceived physical health. This finding provided additional support for the view that global self-ratings of health are powerful predictors of morbidity because, in large measure, they are indicators of chronic, systemic inflammation. Further, both genetic variation and marital status served to moderate the association between neighborhood disorder and health. Finally, being married largely eliminated the probability that neighborhood disorder would combine with genetic vulnerability to increase inflammatory burden and perceived illness. Overall, the findings demonstrate the value of constructing integrated models that specify various biophysiological mechanisms that link social conditions to physical health.
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Cortés YI, Berry DC, Perreira KM, Stuebe A, Stoner L, Giscombé CW, Crandell J, Santíago L, Harris LK, Duran M. A multi-component, community-engaged intervention to reduce cardiovascular disease risk in perimenopausal Latinas: pilot study protocol. Pilot Feasibility Stud 2021; 7:10. [PMID: 33407947 PMCID: PMC7786946 DOI: 10.1186/s40814-020-00756-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/16/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) risk increases substantially during perimenopause. Latinas have a significantly worse CVD risk factor profile than non-Hispanic White women, potentially due to multiple sociocultural and environmental factors. To date, interdisciplinary interventions have not focused on improving nutrition, physical activity, stress management, and biologic CVD risk in perimenopausal Latinas. The purpose of this study is to examine the feasibility and initial efficacy of a multi-component intervention to reduce CVD risk in perimenopausal Latinas. METHODS This is a two-group, repeated measures experimental study. Eighty perimenopausal Latinas (age 40-55 years) from two community groups will be randomized: one group will complete the intervention; the other will be a wait-list control. The intervention consists of 12-weekly sessions (education, physical activity, stress management, coping skills training), followed by 3 months of continued support, and 6 months of skill maintenance on their own. The primary outcomes include arterial stiffness, blood pressure, lipids, and blood glucose. Secondary outcomes are health behaviors (nutrition, physical activity, sleep, coping strategies), self-efficacy, and other biological factors related to CVD risk (adiposity, C-reactive protein, hair cortisol, vasomotor symptoms). We will assess changes in outcomes from Time 1 (baseline) to Time 2 (6 months) and Time 3 (12 months) using general linear mixed models to test the hypotheses. We will also evaluate the feasibility of the intervention by assessing enrollment and retention rates, barriers, and facilitators to enrollment, intervention fidelity, the suitability of study procedures, and participant satisfaction with the intervention and study protocol. We hypothesize the intervention group will decrease biologic CVD risk and improve health behaviors and self-efficacy significantly more than the wait-list control. DISCUSSION Results from this study will contribute to knowledge on the feasibility of behavioral interventions, including stress management and coping skills training, which could reduce CVD burden among perimenopausal Latinas. Because Hispanic/Latinos are the largest ethnic minority in the United States (US), progress regarding CVD risk among perimenopausal Latinas may lead to significant improvement in the overall CVD burden in the US. TRIAL REGISTRATION Prospectively registered, NCT04313751 (03/19/2020), Protocol version 1.0.
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Affiliation(s)
- Yamnia I. Cortés
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
| | - Diane C. Berry
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
| | - Krista M. Perreira
- Department of Social Medicine, The University of North Carolina at Chapel Hill, 333 South Columbia Street, MacNider Hall, Campus Box 7240, Chapel Hill, NC 27599-7240 USA
| | - Alison Stuebe
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, The University of North Carolina at Chapel Hill, 3010 Old Clinic Building, Campus Box 7516, Chapel Hill, NC 27599-7516 USA
| | - Lee Stoner
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, 306 Woollen Gym, Campus Box 8605, Chapel Hill, NC 27599-8605 USA
| | - Cheryl Woods Giscombé
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
| | - Jamie Crandell
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
| | - Lymarí Santíago
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
| | - Latesha K. Harris
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
| | - Mayra Duran
- School of Nursing, The University of North Carolina at Chapel Hill, Campus Box 7460, Chapel Hill, NC 27599-7460 USA
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Cortés YI, Marginean V, Berry D. Physiologic and psychosocial changes of the menopause transition in US Latinas: a narrative review. Climacteric 2020; 24:214-228. [PMID: 33174466 DOI: 10.1080/13697137.2020.1834529] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Latinos comprise the fastest-growing minority group in the USA, with Hispanic women (Latinas) constituting 17% of women aged 45-54 years. The menopause transition (MT) is associated with many physiological, behavioral, and psychosocial changes that can affect disease risk in women. While several epidemiologic investigations have enhanced our understanding of the MT, to date, menopause research has mostly focused on non-Latina White women. As a consequence, there is a dearth of information on strategies for managing menopause-related issues in Latinas and important factors to consider to provide culturally appropriate care and promote lifestyles that may reduce adverse health outcomes. This narrative review summarizes existing evidence of the MT in Latinas, with a focus on hormonal alterations, menopausal symptoms, mental health, cognition, and cardiometabolic health. The clinical and research implications of the current literature will also be discussed.
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Affiliation(s)
- Y I Cortés
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - V Marginean
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - D Berry
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Socioeconomic status and inflammation: a meta-analysis. Mol Psychiatry 2020; 25:2189-2199. [PMID: 31628416 PMCID: PMC6814496 DOI: 10.1038/s41380-018-0259-2] [Citation(s) in RCA: 156] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/06/2018] [Accepted: 09/06/2018] [Indexed: 12/17/2022]
Abstract
Socioeconomic status (SES), often conceptualized as income, education, or occupation, is associated with risk for disease morbidity and psychopathology. Recent research has focused on the potential biological mechanisms linking lower SES and poor outcomes; much of this work has examined the relationship between SES and markers of systemic inflammation. The strength of the estimated association between SES and inflammatory markers varies widely across individual studies. Thus, we used meta-analytic techniques to quantify the magnitude of this relationship. To accomplish this, PubMed and PsycINFO were searched for papers that reported on SES and two commonly measured systemic inflammatory markers, C-reactive protein (CRP) and interleukin-6 (IL-6). Peer-reviewed, empirical papers conducted in non-patient populations were included. Data from 43 papers (N = 111,156) reporting a total of 63 relevant effect sizes were included in analyses. SES, broadly defined, was significantly associated with both levels of CRP (Z = 0.12; 95% CI, 0.09-0.16) and IL-6 (Z = 0.15; 95% CI, 0.12-0.18); individuals with lower SES showed higher levels of systemic inflammation. Subanalyses demonstrated that studies operationalizing SES as either levels of income or educational attainment also found significant associations with both CRP and IL-6. Moderator analyses revealed that effect sizes varied based on sample characteristics and analysis approaches. Lower SES is associated with significantly elevated levels of inflammatory markers of disease risk. Thus, pro-inflammatory pathways are likely an important mechanism translating socioeconomic inequalities into mental and physical health disparities.
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Jankowska MM, Sears DD, Natarajan L, Martinez E, Anderson CAM, Sallis JF, Matthews SA, Crist K, Dillon L, Johnson E, Barrera-Ng A, Full K, Godbole S, Kerr J. Protocol for a cross sectional study of cancer risk, environmental exposures and lifestyle behaviors in a diverse community sample: the Community of Mine study. BMC Public Health 2019; 19:186. [PMID: 30760246 PMCID: PMC6375220 DOI: 10.1186/s12889-019-6501-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 01/31/2019] [Indexed: 01/08/2023] Open
Abstract
Background Physical inactivity and unhealthy diet are modifiable behaviors that lead to several cancers. Biologically, these behaviors are linked to cancer through obesity-related insulin resistance, inflammation, and oxidative stress. Individual strategies to change physical activity and diet are often short lived with limited effects. Interventions are expected to be more successful when guided by multi-level frameworks that include environmental components for supporting lifestyle changes. Understanding the role of environment in the pathways between behavior and cancer can help identify what environmental conditions are needed for individual behavioral change approaches to be successful, and better recognize how environments may be fueling underlying racial and ethnic cancer disparities. Methods This cross-sectional study was designed to select participants (n = 602 adults, 40% Hispanic, in San Diego County) from a range of neighborhoods ensuring environmental variability in walkability and food access. Biomarkers measuring cancer risk were measured with fasting blood draw including insulin resistance (fasting plasma insulin and glucose levels), systemic inflammation (levels of CRP), and oxidative stress measured from urine samples. Objective physical activity, sedentary behavior, and sleep were measured by participants wearing a GT3X+ ActiGraph on the hip and wrist. Objective measures of locations were obtained through participants wearing a Qstarz Global Positioning System (GPS) device on the waist. Dietary measures were based on a 24-h food recall collected on two days (weekday and weekend). Environmental exposure will be calculated using static measures around the home and work, and dynamic measures of mobility derived from GPS traces. Associations of environment with physical activity, obesity, diet, and biomarkers will be measured using generalized estimating equation models. Discussion Our study is the largest study of objectively measured physical activity, dietary behaviors, environmental context/exposure, and cancer-related biomarkers in a Hispanic population. It is the first to perform high quality measures of physical activity, sedentary behavior, sleep, diet and locations in which these behaviors occur in relation to cancer-associated biomarkers including insulin resistance, inflammation, impaired lipid metabolism, and oxidative stress. Results will add to the evidence-base of how behaviors and the built environment interact to influence biomarkers that increase cancer risk. Trial registration ClinicalTrials.gov NCT02094170, 03/21/2014.
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Affiliation(s)
- Marta M Jankowska
- Calit2/Qualcomm Institute, UCSD, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
| | - Dorothy D Sears
- Nutrition, College of Health Solutions, Arizona State University, 445 N 5th Street, Phoenix, AZ, 85004, USA
| | - Loki Natarajan
- Department of Family Medicine and Public Health, UCSD, 9500 Gilman Dr, La Jolla, CA, 92093, USA.,UCSD Moores Cancer Center, 3855 Health Sciences Dr, La Jolla, CA, 92093, USA
| | - Elena Martinez
- UCSD Moores Cancer Center, 3855 Health Sciences Dr, La Jolla, CA, 92093, USA
| | - Cheryl A M Anderson
- Department of Family Medicine and Public Health, UCSD, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - James F Sallis
- Department of Family Medicine and Public Health, UCSD, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Stephen A Matthews
- Department of Sociology & Criminology, Department of Anthropology, Population Research Institute, Old Main, State College, PA, 16801, USA
| | - Katie Crist
- Department of Family Medicine and Public Health, UCSD, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Lindsay Dillon
- Department of Family Medicine and Public Health, UCSD, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Eileen Johnson
- Department of Family Medicine and Public Health, UCSD, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Angelica Barrera-Ng
- Department of Family Medicine and Public Health, UCSD, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Kelsey Full
- Department of Family Medicine and Public Health, UCSD, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Suneeta Godbole
- Department of Family Medicine and Public Health, UCSD, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Jacqueline Kerr
- Department of Family Medicine and Public Health, UCSD, 9500 Gilman Dr, La Jolla, CA, 92093, USA.,UCSD Moores Cancer Center, 3855 Health Sciences Dr, La Jolla, CA, 92093, USA
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Sleep duration and risk of cancer in the Mexican American Mano-a-Mano Cohort. Sleep Health 2019; 5:78-83. [DOI: 10.1016/j.sleh.2018.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/02/2018] [Accepted: 09/11/2018] [Indexed: 02/06/2023]
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Stinson EJ, Votruba SB, Venti C, Perez M, Krakoff J, Gluck ME. Food Insecurity is Associated with Maladaptive Eating Behaviors and Objectively Measured Overeating. Obesity (Silver Spring) 2018; 26:1841-1848. [PMID: 30426695 PMCID: PMC6249092 DOI: 10.1002/oby.22305] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/28/2018] [Accepted: 06/15/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The association between food insecurity and obesity may be partially explained by overeating in response to unpredictable food availability cycles. The aim of this study was to measure objective food intake in food-insecure individuals. METHODS Eighty-two volunteers (53 m; BMI 29 ± 7; 38 ± 12 years) were admitted to our inpatient Clinical Research Unit and completed the Food Security Short Form, Three-Factor Eating Questionnaire, Gormally Binge Eating Scale, and body composition assessment (dual-energy x-ray absorptiometry). After 5 days of a weight-maintaining diet, participants self-selected food from an ad libitum vending machine paradigm for 3 days. Mean daily intake (kilocalories), macronutrient intake, and percentage of weight-maintaining energy needs (%WMEN) were calculated. RESULTS Based on Food Security Short Form cutoffs, food-insecure participants (n = 46; 56%) had higher body weight (P = 0.04), fat-free mass (P = 0.05), disinhibition (P = 0.008), hunger (P = 0.02), and binge-eating scores (P = 0.02) but not cognitive restraint (P = 0.37) compared with food-secure individuals. They overate more kilocalories (P = 0.001), %WMEN (P = 0.003), fat (P = 0.003), and carbohydrates (P = 0.004) during the vending machine paradigm, continued to increase their hourly rate of kilocalories (group × time; β = 37.7 cumulative kcal/h; P < 0.0001), and ate more total kilocalories across the 72 hours (β = 47.09 kcal/h; P = 0.003). CONCLUSIONS Food insecurity may amplify susceptibility to weight gain via overeating during times of unlimited food access.
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Affiliation(s)
- Emma J Stinson
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, USA
| | - Susanne B Votruba
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, USA
| | - Colleen Venti
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, USA
| | - Marisol Perez
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Jonathan Krakoff
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, USA
| | - Marci E Gluck
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona, USA
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Gerber LM, Sievert LL. Neighborhood disorder, exposure to violence, and perceived discrimination in relation to symptoms in midlife women. Womens Midlife Health 2018; 4:14. [PMID: 30766724 PMCID: PMC6297945 DOI: 10.1186/s40695-018-0043-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 09/21/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Some symptoms at midlife are associated with stress, such as hot flashes, trouble sleeping, headaches, or depressed mood. Hot flashes have been studied in relation to laboratory stressors, physiological biomarkers, and self-reported stress, but less is known about hot flashes in relation to the larger context of women's lives. This study examined the risk of symptoms in relation to neighborhood disorder, exposure to neighborhood violence, social cohesion and perceived discrimination. We hypothesized that women exposed to more negative neighborhood characteristics and discrimination would be more likely to report hot flashes and other midlife symptoms. METHODS Participants were black and white women, aged 40 to 60, drawn from a cross-sectional investigation of race/ethnicity, socioeconomic status, and blood pressure in New York City (n = 139). Demographic information, medical history, menopausal status, and symptoms were measured by questionnaire. Likert scales were used to measure neighborhood characteristics, specifically, the Neighborhood Disorder Scale, the Exposure to Violence Scale, the Perceived Violence Subscale, the Neighborhood Social Cohesion and Trust Scale, and the Everyday Discrimination Scale. Ten symptoms were included in analyses: lack of energy, feeling blue/depressed, backaches, headaches, aches/stiffness in joints, shortness of breath, hot flashes, trouble sleeping, nervous tension, and pins/needles in hands/feet. Each scale with each symptom outcome was examined using logistic regression analyses adjusting for significant covariates. RESULTS Black women reported higher scores on all negative neighborhood characteristics and discrimination, and a lower score on the positive Neighborhood Social Cohesion and Trust. Neighborhood Disorder was associated with feeling blue/depressed, aches/stiffness in joints, and hot flashes, and Perceived Violence was associated with aches/stiffness in joints, after controlling for model-specific covariates. There was a lower risk of backaches with increasing Neighborhood Social Cohesion and Trust score. The Everyday Discrimination Scale was associated with lack of energy. Lack of energy, feeling blue/depressed, aches/stiffness in joints, and hot flashes appeared to be most vulnerable to negative neighborhood context and discrimination. CONCLUSIONS This study adds to the literature linking neighborhood environments to health outcomes. The associations between negative neighborhood contexts and discrimination with diverse symptoms, and the association between social cohesion and back pain, point to the need to expand analyses of stress to multiple physiological systems.
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Affiliation(s)
- Linda M Gerber
- Department of Healthcare Policy & Research, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, 402 E. 67th St., LA-231, New York, NY 10065 USA
- Department of Medicine, Division of Nephrology and Hypertension, Weill Cornell Medical College, New York City, NY USA
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McCurley JL, Penedo F, Roesch SC, Isasi CR, Carnethon M, Sotres-Alvarez D, Schneiderman N, Gonzalez P, Chirinos DA, Camacho A, Teng Y, Gallo LC. Psychosocial Factors in the Relationship between Socioeconomic Status and Cardiometabolic Risk: the HCHS/SOL Sociocultural Ancillary Study. Ann Behav Med 2018; 51:477-488. [PMID: 28130624 DOI: 10.1007/s12160-016-9871-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND U.S. Hispanics/Latinos display a high prevalence of metabolic syndrome (MetSyn), a group of co-occurring cardiometabolic risk factors (abdominal obesity, impaired fasting glucose, dyslipidemia, elevated blood pressure) associated with higher cardiovascular disease and mortality risk. Low socioeconomic status (SES) is associated with higher risk for MetSyn in Hispanics/Latinos, and psychosocial factors may play a role in this relationship. PURPOSE This cross-sectional study examined psychosocial factors in the association of SES and MetSyn components in 4,996 Hispanic/Latino adults from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. METHODS MetSyn components were measured at the baseline examination. Participants completed interviews to determine psychosocial risks (e.g., depression) and resources (e.g., social support) within 9 months of baseline (< 4 months in 72.6% of participants). Confirmatory factor analysis (CFA) and structural equation modeling (SEM) were used to identify latent constructs and examine associations. RESULTS Participant mean age was 41.7 years (SE = 0.4) and 62.7% were female. CFA identified single latent factors for SES and psychosocial indicators, and three factors for MetSyn [blood pressure, lipids, metabolic factors]. SEMs showed that lower SES was related to MetSyn factors indirectly through higher psychosocial risk/lower resources (Y-Bχ2 (df = 420) = 4412.90, p < .05, RMSEA = .042, SRMR = .051). A statistically significant effect consistent with mediation was found from lower SES to higher metabolic risk (glucose/waist circumference) via psychosocial risk/resource variables (Mackinnon's 95% asymmetric CI = -0.13 to -0.02). CONCLUSIONS SES is related to metabolic variables indirectly through psychosocial factors in U.S. Hispanics/Latinos of diverse ancestries.
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Affiliation(s)
- Jessica L McCurley
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Frank Penedo
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Scott C Roesch
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Carmen R Isasi
- Deptartment of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mercedes Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniela Sotres-Alvarez
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Neil Schneiderman
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Patricia Gonzalez
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Diana A Chirinos
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Alvaro Camacho
- Departments of Psychiatry and Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
| | - Yanping Teng
- Department of Biostatistics, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA. .,South Bay Latino Research Center, 450 4th Ave, Suite 304, Chula Vista, CA, 91910, USA.
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Pedersen JM, Budtz-Jørgensen E, De Roos A, Garcia L, Lund R, Rod NH, Kroenke C, Chan KHK, Liu S, Michael Y. Understanding the relation between socioeconomic position and inflammation in post-menopausal women: education, income and occupational prestige. Eur J Public Health 2018; 27:1074-1079. [PMID: 29186460 DOI: 10.1093/eurpub/ckx070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background The role of occupational prestige, a direct measure of the perceived status of job and job holder, in inflammation is unknown. To contribute to understanding the pathways by which socioeconomic position (SEP) is associated with inflammation, we aimed to estimate the direct effects of education, income and occupational prestige on C-reactive protein (CRP) and to describe the relationship between these markers and CRP. Methods The study was based on 2026 post-menopausal women enrolled in the Women's Health Initiative-Observational Study. Occupational prestige was determined by linking a text description of longest held occupation with a social status item from the Occupational Information Network. Path analysis was employed to estimate direct and mediated effects. Results The study suggests that higher levels of education, income, and occupational prestige are associated with 8% (95% CI as percentage change -12, -4), 5% [95% CI (-8, -2) and 4% (95% CI - 7, -1)] lower levels of CRP, respectively. The inverse association between education and CRP was explained by the effect of education on income and occupational prestige. The effect of occupational prestige on CRP was independent of mediators in the model. Conclusions The findings indicate that education may work to influence CRP primarily through increasing income and occupational prestige and provides evidence that occupational prestige captures a unique aspect of SEP.
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Affiliation(s)
- Jolene Masters Pedersen
- Department of Public Health Science, University of Copenhagen, Copenhagen, Denmark.,The Center for Healthy Ageing, University of Copenhagen, Copenhagen, Denmark
| | | | - Anneclaire De Roos
- Department of Environmental and Occupational Health, Drexel University, Philadelphia, PA, USA
| | - Lorena Garcia
- Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Rikke Lund
- Department of Public Health Science, University of Copenhagen, Copenhagen, Denmark.,The Center for Healthy Ageing, University of Copenhagen, Copenhagen, Denmark
| | - Naja Hulvej Rod
- Department of Public Health Science, University of Copenhagen, Copenhagen, Denmark
| | | | - Kei Hang Katie Chan
- School of Public Health and Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Simin Liu
- School of Public Health and Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Yvonne Michael
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA, USA
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Associations of blood mitochondrial DNA copy number with social-demographics and cancer risk: results from the Mano-A-Mano Mexican American Cohort. Oncotarget 2018; 9:25491-25502. [PMID: 29876003 PMCID: PMC5986640 DOI: 10.18632/oncotarget.25321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/16/2018] [Indexed: 11/25/2022] Open
Abstract
The relationship between blood mitochondrial DNA (mtDNA) copy number and subsequent cancer risk has been investigated previously. However, such association has never been examined in Mexican Americans. In the current study, we examined association between social-demographic factors and blood mtDNA copy number, as well as longitudinal relationship between cancer and mtDNA copy number, among 10,802 Mexican Americans in the Mano-A-Mano Mexican American Cohort. Overall, mtDNA copy number was statistically significantly higher among participants who developed cancer during the study period than among cancer-free controls (0.17 vs 0.13, P = 0.007). Among cancer-free control participants, mtDNA copy number significantly differed by social-demographic characteristics. However, there was a large degree of heterogeneity in these effects across the mtDNA copy number distribution. In the longitudinal analysis, we observed that higher mtDNA copy number was positively associated with increased risk of all cancer types (adjusted hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.09–1.17). Participants with mtDNA copy number in the fourth (highest) quartile had a higher risk of all cancer (adjusted HR, 2.12; 95% CI, 1.65–2.73) than did participants in the first (lowest) quartile. In summary, our results in Mexican Americans support an association between increased mtDNA copy number and cancer risk. Our results also suggest that mtDNA copy number may be influenced by social and demographic factors.
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16
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Menezes AMB, Oliveira PD, Wehrmeister FC, Gonçalves H, Assunção MCF, Tovo-Rodrigues L, Ferreira GD, Oliveira IO. Association between interleukin-6, C-reactive protein and adiponectin with adiposity: Findings from the 1993 pelotas (Brazil) birth cohort at 18 and 22 years. Cytokine 2018; 110:44-51. [PMID: 29704817 PMCID: PMC6109205 DOI: 10.1016/j.cyto.2018.04.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 11/29/2022]
Abstract
There is a positive association between IL and 6 and CRP with body adiposity. The analysis between adiponectin and adiposity shows an inverse association. These associations are both cross-sectional and prospective and cumulative. Women show higher mean IL-6, CRP and adiponectin when compared with men. The associations were found in a cohort at 18 and 22 years of age and in both sexes.
Background Most of the literature has shown a direct association between adiposity, interleukin-6 (IL-6) and C-reactive protein (CRP), and an inverse association with adiponectin. The aim of this paper was to assess the association of obesity measurements and IL-6, CRP and adiponectin. Methods We performed cross-sectional/longitudinal analysis in the 1993 Birth Cohort in Brazil. Associations between IL-6 (pg/mL), CRP (mg/L) and adiponectin (µg/Ml) with body mass index (BMI), waist circumference (WC), percentage total fat mass (FM) (BODPOD) and trunk FM (DXA) were verified. Four trajectory variables were generated: (a) highest tertile/obesity according to BMI in both follow-ups; (b) highest tertile/obesity only at 18 years; (c) highest tertile/obesity only at 22 years; (d) not in the highest tertile/not obese at both ages. Results We found a direct association for IL-6 and CRP and an inverse association for adiponectin with measures of adiposity. For instance, for females, the highest mean IL-6 and CRP, respectively, was for those who had been in the obese category at 18–22 years (2.49; 3.75), in the highest tertile of WC (2.11; 3.08), in the highest % of FM (1.56; 3.30 l), and in the highest tertile of trunk FM (2.07; 3.26) (p < 0.001 for all these results in the adjusted analysis). Adiponectin showed an inverse association for the above variables, with lower mean values for males than females. Conclusion There was a longitudinal and direct association between adiposity and IL-6 and CRP, and an inverse association with adiponectin at 22 years.
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Affiliation(s)
- Ana Maria Baptista Menezes
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
| | - Paula Duarte Oliveira
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
| | - Fernando César Wehrmeister
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
| | - Helen Gonçalves
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
| | - Maria Cecilia F Assunção
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
| | - Luciana Tovo-Rodrigues
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
| | - Gustavo Dias Ferreira
- Federal University of Pelotas, Department of Physiology and Pharmacology Campus Capão do Leão, s/n. Pelotas, RS. Zip code: 96010-900, Brazil.
| | - Isabel O Oliveira
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
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Zhao H, Han L, Chang D, Ye Y, Shen J, Daniel CR, Gu J, Chow WH, Wu X. Social-demographics, health behaviors, and telomere length in the Mexican American Mano a Mano Cohort. Oncotarget 2017; 8:96553-96567. [PMID: 29228552 PMCID: PMC5722504 DOI: 10.18632/oncotarget.19903] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/26/2017] [Indexed: 12/12/2022] Open
Abstract
In the current study, we examined cross-sectional associations among social-demographics, lifestyle behaviors, and relative telomere length (RTL) in peripheral blood leukocytes, as well as longitudinal relationships among major chronic diseases, weight gain, and RTL, among 12,792 Mexican Americans aged 20 to 85 years in the Mano-A-Mano, the Mexican American Cohort. As expected, RTL was inversely correlated with age (ρ=-0.15, ρ<0.001). In the multivariate analysis, we found that RTL was positively correlated with levels of education (ρ=0.021), self-insurance (ρ=0.041), body mass index (BMI) (ρ<0.001), and sleeping time per day (ρ for trend<0.001), and RTL was inversely correlated with sitting time per day (ρ for trend =0.001). In longitudinal analysis, we found that longer RTL was modestly but positively associated with increased risks of overall cancer (adjusted hazard ratio (adj.HR)=1.05, 95% conference interval (95%CI)=1.02-1.09). In quartile analysis, 4th quartile (longest RTL) was associated with 1.53-fold increased risk of overall cancer (adj.HR=1.53, 95%CI=1.11-2.10), compared to 1st quartile (shortest RTL). RTL was reversely associated with the risk of type-2 diabetes (adj.HR=0.89, 95%CI=0.82-0.94). In quartile analysis, 4th quartile (longest RTL) was associated with 48% decreased risk of typle-2 diabetes (adj.HR=0.52, 95%CI=0.32-0.70), compared to 1st quartile (shortest RTL). In addition, longer RTL was a positive predictor of at least 10% weight gain (adj.HR=1.03, 95%CI=1.00-1.05). In summary, our results in Mexican Americans support the notion that telomere length is a biological mechanism by which social demographics and health behaviors “get under the skin” to affect health.
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Affiliation(s)
- Hua Zhao
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lixia Han
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Chang
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yuanqing Ye
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jie Shen
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carrie R Daniel
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jian Gu
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wong-Ho Chow
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xifeng Wu
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Luecken LJ, Jewell SL, MacKinnon DP. Prediction of Postpartum Weight in Low-Income Mexican-Origin Women From Childhood Experiences of Abuse and Family Conflict. Psychosom Med 2017; 78:1104-1113. [PMID: 27583713 PMCID: PMC5096993 DOI: 10.1097/psy.0000000000000391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The postpartum period represents a crucial transition period in which weight gain or loss can affect lifetime obesity risk. This study examined the prevalence of obesity and the influence of childhood abuse and family conflict on postpartum weight among low-income Mexican-origin women. Depressive symptoms and partner support were evaluated as mediators. METHODS At a prenatal assessment, low-income Mexican-origin women (N = 322; mean [SD] age, 27.8 [6.5]) reported on childhood abuse and family conflict. Weight was measured 7 times between 6 weeks and 2 years postpartum and calculated as body mass index. Regression and growth models were used to estimate the impact of childhood abuse, childhood family conflict, partner support, and depressive symptoms on weight and weight change. RESULTS Higher family conflict predicted higher weight across the first (β = .12; p = .037) and second (β = .16; p = .012) postpartum years. Family conflict (β = .17; p = .018) and low partner support (β = -.16; p = .028) also predicted increasing weight in the first year. Partner support partially mediated the effect of childhood abuse on weight change in the first year (p = .031). Depressive symptomatology mediated the effects of childhood abuse and family conflict on weight status in the second year (abuse: p = .005; conflict: p = .023). CONCLUSIONS For low-income Mexican-origin women with a history of childhood abuse or high family conflict, depression and low partner support may be important targets for obesity prevention efforts in the postpartum period.
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Affiliation(s)
- Linda J Luecken
- From the Department of Psychology, Arizona State University, Tempe, Arizona
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Dinwiddie GY, Zambrana RE, Doamekpor LA, Lopez L. The Impact of Educational Attainment on Observed Race/Ethnic Disparities in Inflammatory Risk in the 2001-2008 National Health and Nutrition Examination Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010042. [PMID: 26703686 PMCID: PMC4730433 DOI: 10.3390/ijerph13010042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 10/08/2015] [Accepted: 10/26/2015] [Indexed: 12/21/2022]
Abstract
Inflammation has shown to be an independent predictor of cardiovascular disease (CVD) and growing evidence suggests Non-Hispanic Blacks (NHBs) and certain Hispanic subgroups have higher inflammation burden compared to Non-Hispanic Whites (NHWs). Socioeconomic status (SES) is a hypothesized pathway that may account for the higher inflammation burden for race/ethnic groups yet little is known about the biological processes by which SES “gets under the skin” to affect health and whether income and education have similar or distinct influences on elevated inflammation levels. The current study examines SES (income and education) associations with multiple levels of C-Reactive Protein (CRP), an important biomarker of inflammation, in a sample of 13,362 NHWs, 7696 NHBs and 4545 Mexican Americans (MAs) in the United States from the 2001 to 2008 National Health and Nutrition Examination Survey. After adjusting for age, sex, and statin use, NHBs and MAs had higher intermediate and high CRP levels compared to NHWs. Income lessened the magnitude of the association for both race/ethnic groups. The greater intermediate and high CRP burden for NHBs and MAs was strongly explained by educational attainment. MAs were more vulnerable to high CRP levels for the lowest (i.e., less than nine years) and post high school (i.e., associates degree) educational levels. After additional adjustment for smoking, heavy drinking, high waist circumference, high blood pressure, diabetes and statin use, the strength of the association between race/ethnicity and inflammation was reduced for NHBs with elevated intermediate (RR = 1.31; p ≤ 0.001) and high CRP levels (RR = 1.14; p ≤ 0.001) compared to NHWs but the effect attenuated for MAs for both intermediate (RR = 0.74; p ≤ 0.001) and high CRP levels (RR = 0.38; p ≤ 0.001). These findings suggest educational attainment is a powerful predictor of elevated CRP levels in race/ethnic populations and challenges studies to move beyond examining income as a better predictor in the SES-inflammation pathway.
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Affiliation(s)
- Gniesha Y Dinwiddie
- African American Studies Department, University of Maryland, College Park, MD 20742, USA.
- Maryland Population Research Center, University of Maryland, College Park, MD 20742, USA.
| | - Ruth E Zambrana
- Women's Studies Department, University of Maryland, College Park, MD 20742, USA.
- Consortium on Race, Gender and Ethnicity, University of Maryland, College Park, MD 20742, USA.
| | | | - Lenny Lopez
- Department of Medicine, University of California, San Francisco, CA 94121, USA.
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Elder JP, Ayala GX, McKenzie TL, Litrownik AJ, Gallo LC, Arredondo EM, Talavera GA, Kaplan RM. A three-decade evolution to transdisciplinary research: community health research in California-Mexico border communities. Prog Community Health Partnersh 2015; 8:397-404. [PMID: 25435566 DOI: 10.1353/cpr.2014.0039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Institute for Behavioral and Community Health (IBACH) is a transdisciplinary organization with a team-oriented approach to the translation of research to practice and policy within the context of behavioral medicine. OBJECTIVES This paper tracks the growth of IBACH in the context of evolving, multi-university transdisciplinary research efforts from a behavioral medicine research focus to community approaches to disease prevention and control, ultimately specializing in Latino health research and practice. We describe how this growth was informed by our partnerships with community members and organizations, and training a diverse array of students and young professionals. METHODS Since 1982, IBACH's research has evolved to address a greater breadth of factors associated with health and well-being. This was driven by our strong community focus and emphasis on collaborations, the diversity of our investigative teams, and our emphasis on training. Although behavioral science still forms the core of IBACH's scientific orientation, research efforts extend beyond those traditionally examined. CONCLUSIONS IBACH's "team science" successes have been fueled by a specific population emphasis, making IBACH one of the nation's leaders in Latino health behavior research.
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Hemmingsson E. A new model of the role of psychological and emotional distress in promoting obesity: conceptual review with implications for treatment and prevention. Obes Rev 2014; 15:769-79. [PMID: 24931366 DOI: 10.1111/obr.12197] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/12/2014] [Accepted: 05/12/2014] [Indexed: 11/29/2022]
Abstract
The lack of significant treatment and prevention progress highlights the need for a more expanded strategy. Given the robust association between socioeconomic factors and obesity, combined with new insights into how socioeconomic disadvantage affects both behaviour and biology, a new causal model is proposed. The model posits that psychological and emotional distress is a fundamental link between socioeconomic disadvantage and weight gain. At particular risk are children growing up in a disharmonious family environment, mainly caused by parental socioeconomic disadvantage, where they are exposed to parental frustrations, relationship discord, a lack of support and cohesion, negative belief systems, unmet emotional needs and general insecurity. Without adequate resilience, such experiences increase the risk of psychological and emotional distress, including low self-esteem and self-worth, negative emotions, negative self-belief, powerlessness, depression, anxiety, insecurity and a heightened sensitivity to stress. These inner disturbances eventually cause a psycho-emotional overload, triggering a cascade of weight gain-inducing effects including maladaptive coping strategies such as eating to suppress negative emotions, chronic stress, appetite up-regulation, low-grade inflammation and possibly reduced basal metabolism. Over time, this causes obesity, circular causality and further weight gain. Tackling these proposed root causes of weight gain could potentially improve both treatment and prevention outcomes.
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Affiliation(s)
- E Hemmingsson
- Obesity Center, Karolinska University Hospital, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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Fedewa MV, Das BM, Forehand RL, Evans EM. Area-level socioeconomic status, adiposity, physical activity, and inflammation in young adults, 2013. Prev Chronic Dis 2014; 11:E130. [PMID: 25078567 PMCID: PMC4124040 DOI: 10.5888/pcd11.140090] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION We assessed the independent effects of socioeconomic status, sex, adiposity, and physical activity on C-reactive protein in young adults. METHODS During the fall semester of their first year, college students (n = 177; mean age, 18.1 y; 66.7% female; 65.5% white) were assessed for adiposity via dual x-ray absorptiometry, physical activity via accelerometer, and serum C-reactive protein. Area-level socioeconomic status was based on self-reported home zip code. Hierarchical linear modeling was used to assess the relationship of sex, adiposity, and physical activity on the dependent variable of C-reactive protein, with participants nested within geographic regions of similar socioeconomic characteristics. RESULTS C-reactive protein was positively associated with adiposity and inversely associated with socioeconomic status (both P < .05). Area-level socioeconomic status explained 28.2% of the variance in C-reactive protein. Adiposity was significantly associated with C-reactive protein in the full model (P = .006); physical activity was not associated with C-reactive protein (P = .48), and area-level socioeconomic status approached significance (P = .05) within the age range of our analysis after accounting for the variance explained by adiposity. CONCLUSION The significant positive association between adiposity and C-reactive protein suggests that young adults with higher adiposity have higher C-reactive protein levels after accounting for area-level socioeconomic status, sex, and physical activity.
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Affiliation(s)
- Michael V Fedewa
- Department of Kinesiology, Office 101B, 330 River Rd, Ramsey Center, University of Georgia, Athens, GA 30602-6554. E-mail:
| | - Bhibha M Das
- East Carolina University, Greenville, North Carolina
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Thompson AL, Houck KM, Adair L, Gordon-Larsen P, Popkin B. Multilevel examination of the association of urbanization with inflammation in Chinese adults. Health Place 2014; 28:177-86. [PMID: 24908386 DOI: 10.1016/j.healthplace.2014.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 05/05/2014] [Accepted: 05/06/2014] [Indexed: 12/13/2022]
Abstract
We examine the associations between overall urbanicity and specific physical and social components of community-level urbanization with C-reactive protein (CRP) in adults participating in the China Health and Nutrition Study. Higher overall urbanicity and environment-related urbanicity component scores, including education, housing quality, and access to markets, were associated with elevated CRP in multilevel models controlling for clustering by community. These associations differed by age and gender and persisted after controlling for individual-level anthropometric, diet, and pathogenic risk factors. These results highlight the importance of place in relation to inflammation across the spectrum of rural and urban environments.
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Affiliation(s)
- Amanda L Thompson
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Carolina Population Center, University of North Carolina at Chapel Hill, 123 W Franklin St, Chapel Hill, NC 27516, USA.
| | - Kelly M Houck
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Carolina Population Center, University of North Carolina at Chapel Hill, 123 W Franklin St, Chapel Hill, NC 27516, USA.
| | - Linda Adair
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W Franklin St, Chapel Hill, NC 27516, USA; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Penny Gordon-Larsen
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W Franklin St, Chapel Hill, NC 27516, USA; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Barry Popkin
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W Franklin St, Chapel Hill, NC 27516, USA; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Egger G, Dixon J. Beyond obesity and lifestyle: a review of 21st century chronic disease determinants. BIOMED RESEARCH INTERNATIONAL 2014; 2014:731685. [PMID: 24804239 PMCID: PMC3997940 DOI: 10.1155/2014/731685] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/10/2014] [Indexed: 01/08/2023]
Abstract
The obesity epidemic and associated chronic diseases are often attributed to modern lifestyles. The term "lifestyle" however, ignores broader social, economic, and environmental determinants while inadvertently "blaming the victim." Seen more eclectically, lifestyle encompasses distal, medial, and proximal determinants. Hence any analysis of causality should include all these levels. The term "anthropogens," or "…man-made environments, their by-products and/or lifestyles encouraged by these, some of which may be detrimental to human health" provides a monocausal focus for chronic diseases similar to that which the germ theory afforded infectious diseases. Anthropogens have in common an ability to induce a form of chronic, low-level systemic inflammation ("metaflammation"). A review of anthropogens, based on inducers with a metaflammatory association, is conducted here, together with the evidence for each in connection with a number of chronic diseases. This suggests a broader view of lifestyle and a focus on determinants, rather than obesity and lifestyle per se as the specific causes of modern chronic disease. Under such an analysis, obesity is seen more as "a canary in a mineshaft" signaling problems in the broader environment, suggesting that population obesity management should be focused more upstream if chronic diseases are to be better managed.
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Affiliation(s)
- Garry Egger
- School of Health and Human Sciences, Southern Cross University, P.O. Box 313, Balgowlah, Lismore, NSW 2093, Australia
| | - John Dixon
- Clinical Obesity Research, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
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King K. Neighborhood walkable urban form and C-reactive protein. Prev Med 2013; 57:850-4. [PMID: 24096140 PMCID: PMC3898708 DOI: 10.1016/j.ypmed.2013.09.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 09/26/2013] [Accepted: 09/26/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND Walkable urban form predicts physical activity and lower body mass index, which lower C-reactive protein (CRP). However, urban form is also related to pollution, noise, social and health behavior, crowding, and other stressors, which may complement or contravene walkability effects. PURPOSE This paper assesses within-neighborhood correlation of CRP, and whether three features of walkable urban form (residential density, street connectivity, and land use mix) are associated with CRP levels. METHODS CRP measures (n=610) and sociodemographic data come from the 2001-3 Chicago Community Adult Health Study, linked with objective built environment data. RESULTS Within-neighborhood correlations of CRP are greater than those of related health measures. A one standard deviation increase in residential density predicts significantly higher log CRP (e.g. β=0.11, p<.01) in Chicago, while a one standard deviation increase in land use mix predicts significantly lower CRP (e.g. β=-0. 19, p<0.01). Street connectivity is unrelated to CRP in this highly walkable city. DISCUSSION Results suggest that residential density may be a risk factor for inflammation, while greater walkability of mixed land use areas may be protective. It may be that negative aspects of density overcome the inflammatory benefits of walking.
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Affiliation(s)
- Katherine King
- Environmental Protection Agency, 104 Mason Farm Road, Chapel Hill, NC 27514, USA; Duke University Sociology Department, P.O. Box 90088, Durham, NC 27707, USA
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Abstract
Socioeconomic disadvantage confers risk for ill health. Historically, the pathways by which socioeconomic disadvantage may affect health have been viewed from epidemiological perspectives emphasizing environmental, behavioral, and biopsychosocial risk factors. Such perspectives, however, have yet to integrate findings from emerging neuroscience studies demonstrating that indicators of socioeconomic disadvantage relate to patterns of brain morphology and functionality that have been associated with aspects of mental, physical, and cognitive health over the lifecourse. This commentary considers findings from one such study appearing in the current issue of Psychosomatic Medicine. It reports that an area-level indicator of socioeconomic disadvantage relates to cortical morphology in brain regions important for language, executive control, and other cognitive and behavioral functions-possibly via a systemic inflammatory pathway. These findings are put into context by discussing broader questions and challenges that need to be addressed in order for neuroscience approaches to a) become better integrated with existing epidemiological perspectives and b) more fully advance our understanding of the pathways by which socioeconomic disadvantage becomes embodied by the brain in relation to health.
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O'Bryant SE, Johnson L, Edwards M, Soares H, Devous MD, Ross S, Rohlfing G, Hall J. The link between C-reactive protein and Alzheimer's disease among Mexican Americans. J Alzheimers Dis 2013; 34:701-6. [PMID: 23254637 PMCID: PMC3608400 DOI: 10.3233/jad-122071] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The aim of this study is to evaluate the link between C-reactive protein (CRP) and Alzheimer's disease (AD) and mild cognitive impairment (MCI) among Mexican Americans. METHODS Non-fasting serum CRP levels, Mini-Mental State Examination scores, and Clinical Dementia Rating scale (CDR) scores were analyzed from 1,066 participants (Mexican American n = 471; non-Hispanic n = 595) of the Texas Alzheimer's Research & Care Consortium. RESULTS Among the total cohort, CRP levels among AD cases were significantly decreased as compared to normal controls (p < 0.001) and MCI cases (p = 0.002). CRP levels among MCI cases were decreased relative to controls (p = 0.03). Among Mexican American and non-Hispanic AD cases, CRP levels were significantly decreased among AD cases as compared to controls. CRP levels were only associated with disease severity (CDR scores) among non-Hispanics (p = 0.03) AD cases. CONCLUSIONS These results show that while CRP levels are decreased among Mexican American AD cases, CRP does not appear to be related to clinical variables as it is among non-Hispanic whites.
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Affiliation(s)
- Sid E O'Bryant
- University of North Texas Health Sciences Center, Department of Internal Medicine, Fort Worth, TX 76107, USA. sid.o’
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Socioeconomic status and stress in Mexican-American women: a multi-method perspective. J Behav Med 2012; 36:379-88. [PMID: 22644814 DOI: 10.1007/s10865-012-9432-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 05/02/2012] [Indexed: 12/15/2022]
Abstract
Stress is a hypothesized pathway in socioeconomic status (SES)-physical health associations, but the available empirical data are inconsistent. In part, this may reflect discrepancies in the approach to measuring stress across studies, and differences in the nature of SES-stress associations across demographic groups. We examined associations of SES (education, income) with general and domain-specific chronic stressors, stressful life events, perceived stress, and stressful daily experiences in 318 Mexican-American women (40-65 years old). Women with higher SES reported lower perceived stress and fewer low-control experiences in everyday life (ps < .05), but greater chronic stress (education only, p < .05). Domain-specific analyses showed negative associations of income with chronic housing and financial stress (ps < .05), but positive associations of SES with chronic work and caregiving stress (all ps < .05 except for income and caregiving stress, p < .10). Sensitivity analyses showed that most SES-stress associations were consistent across acculturation levels. Future research should adopt a multi-dimensional assessment approach to better understand links among SES, stress, and physical health, and should consider the sociodemographic context in conceptualizing the role of stress in SES-related health inequalities.
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