Independent and Joint Effects of Testosterone Replacement Therapy and Statins use on the Risk of Prostate Cancer Among White, Black, and Hispanic Men

The associations of testosterone therapy (TTh) and statins use with prostate cancer remain conflicted. However, the joint effects of TTh and statins use on the incidence of prostate cancer, stage and grade at diagnosis, and prostate cancer-specific mortality (PCSM) have not been studied.We identified White (N = 74,181), Black (N = 9,157), and Hispanic (N = 3,313) men diagnosed with prostate cancer in SEER-Medicare 2007-2016. Prediagnostic prescription of TTh and statins was ascertained for this analysis. Weighted multivariable-adjusted conditional logistic and Cox proportional hazards models evaluated the association of TTh and statins with prostate cancer, including statistical interactions between TTh and statins.We found that TTh (OR = 0.74; 95% CI, 0.68-0.81) and statins (OR = 0.77; 95% CI, 0.0.75-0.88) were inversely associated with incident prostate cancer. Similar inverse associations were observed with high-grade and advanced prostate cancer in relation to TTh and statins use. TTh plus statins was inversely associated with incident prostate cancer (OR = 0.53; 95% CI, 0.48-0.60), high-grade (OR = 0.43; 95% CI, 0.37-0.49), and advanced prostate cancer (OR = 0.44; 95% CI, 0.35-0.55). Similar associations were present in White and Black men, but among Hispanics statins were associated with PCSM.Prediagnostic use of TTh or statins, independent or combined, was inversely associated with incident and aggressive prostate cancer overall and in NHW and NHB men. Findings for statins and aggressive prostate cancer are consistent with previous studies. Future studies need to confirm the independent inverse association of TTh and the joint inverse association of TTh plus statins on risk of prostate cancer in understudied populations. PREVENTION RELEVANCE: The study investigates a potential interaction between TTh and statin and its effect on incident and aggressive prostate cancer in men of different racial and ethnic backgrounds. These results suggest that among NHW and non-Hispanic Black men TTh plus statins reduced the odds of incident prostate cancer, high-grade and advance stage prostate cancer.

Telomere Length and Neighborhood Circumstances: Evaluating Biological Response to Unfavorable Exposures

Background: Multilevel frameworks suggest neighborhood circumstances influence biology; however, this relationship is not well studied. Telomere length (TL) shortening has been associated with individual-level and neighborhood-level exposures and disease and may provide insights into underlying biologic mechanisms linking neighborhood with biology. To support neighborhood-biology investigations, we sought to determine the independent effect of neighborhood exposures on TL using standard multilevel linear regression models and quantile regression, a nonlinear, social science method applicable for testing the biologic hypothesis that extremes of the TL distribution are related to poor outcomes.Methods: In a multicenter, cross-sectional study, blood TL was measured in 1,488 individuals from 127 census tracts in three U.S. regions using terminal restriction fragment assays. Multilevel linear and quantile regression models were adjusted for individual-level race, education, perceived stress, and depression. Neighborhood exposures included population density, urban/residential crowding, residential stability/mobility, and socioeconomic status.Results: TL was not associated with any neighborhood variable using linear models, but quantile regression revealed inverse associations between population density and urban crowding at the lower tails of the TL distribution [5th (population density P = 0.03; urban crowding P = 0.002), 50th (both P < 0.001), 75th percentiles (both P < 0.001)]. TL was related to residential stability at the upper tail (95th percentile P = 0.006).Conclusions: Findings support the use of nonlinear statistical methods in TL research and suggest that neighborhood exposures can result in biological effects.Impact: TL may serve as an underlying example of a biologic mechanism that can link neighborhood with biology, thus supporting multilevel investigations in future studies. Cancer Epidemiol Biomarkers Prev; 26(4); 553-60. ©2017 AACRSee all the articles in this CEBP Focus section, "Geospatial Approaches to Cancer Control and Population Sciences."

Effects of work-family conflict and job insecurity on psychological distress

Background

Work-family conflict (WFC) and job insecurity are important determinants of workers' mental health.

Aims

To examine the relationship between WFC and psychological distress, and the co-occurring effects of WFC and job insecurity on distress in US working adults.

Methods

This study used cross-sectional data from the 2010 National Health Interview Survey (NHIS) for adults aged 18-64 years. The 2010 NHIS included occupational data from the National Institute for Occupational Safety and Health (NIOSH) sponsored Occupational Health Supplement. Logistic regression models were used to examine the independent and co-occurring effects of WFC and job insecurity on distress.

Results

The study group consisted of 12059 participants. In the model fully adjusted for relevant occupational, behavioural, sociodemographic and health covariates, WFC and job insecurity were independently significantly associated with increased odds of psychological distress. Relative to participants reporting WFC only, participants reporting no WFC and no job insecurity had lower odds of moderate and severe distress. Co-occurring WFC and job insecurity was associated with significantly higher odds of both moderate [odds ratio (OR) = 1.55; 95% confidence interval (CI) 1.25-1.9] and severe (OR = 3.57; 95% CI 2.66-4.79) distress.

Conclusions

Rates of WFC and job insecurity were influenced by differing factors in working adults; however, both significantly increased risk of adverse mental health outcomes, particularly when experienced jointly. Future studies should explore the temporal association between co-occurring WFC and job insecurity and psychological distress.

Race, Ethnicity, Psychosocial Factors, and Telomere Length in a Multicenter Setting

Background

Leukocyte telomere length(LTL) has been associated with age, self-reported race/ethnicity, gender, education, and psychosocial factors, including perceived stress, and depression. However, inconsistencies in associations of LTL with disease and other phenotypes exist across studies. Population characteristics, including race/ethnicity, laboratory methods, and statistical approaches in LTL have not been comprehensively studied and could explain inconsistent LTL associations.

Methods

LTL was measured using Southern Blot in 1510 participants from a multi-ethnic, multi-center study combining data from 3 centers with different population characteristics and laboratory processing methods. Main associations between LTL and psychosocial factors and LTL and race/ethnicity were evaluated and then compared across generalized estimating equations(GEE) and linear regression models. Statistical models were adjusted for factors typically associated with LTL(age, gender, cancer status) and also accounted for factors related to center differences, including laboratory methods(i.e., DNA extraction). Associations between LTL and psychosocial factors were also evaluated within race/ethnicity subgroups (Non-hispanic Whites, African Americans, and Hispanics).

Results

Beyond adjustment for age, gender, and cancer status, additional adjustments for DNA extraction and clustering by center were needed given their effects on LTL measurements. In adjusted GEE models, longer LTL was associated with African American race (Beta(β)(standard error(SE)) = 0.09(0.04), p-value = 0.04) and Hispanic ethnicity (β(SE) = 0.06(0.01), p-value = 0.02) compared to Non-Hispanic Whites. Longer LTL was also associated with less than a high school education compared to having greater than a high school education (β(SE) = 0.06(0.02), p-value = 0.04). LTL was inversely related to perceived stress (β(SE) = -0.02(0.003), p<0.001). In subgroup analyses, there was a negative association with LTL in African Americans with a high school education versus those with greater than a high school education(β(SE) = -0.11(0.03), p-value<0.001).

Conclusions

Laboratory methods and population characteristics that differ by center can influence telomere length associations in multicenter settings, but these effects could be addressed through statistical adjustments. Proper evaluation of potential sources of bias can allow for combined multicenter analyses and may resolve some inconsistencies in reporting of LTL associations. Further, biologic effects on LTL may differ under certain psychosocial and racial/ethnic circumstances and could impact future health disparity studies.

Environmental hazards and stress: evidence from the Texas City Stress and Health Study

BACKGROUND

Substantial research has suggested that exposure to environmental health hazards, such as polluting industrial activity, has deleterious effects on psychological and physiological well-being. However, one gap in the existing literature is comparative analysis of objective and subjective exposure's relative association with various measurable outcomes of exposure.

METHODS

These relationships were explored within a community sample of 2604 respondents living near a large petrochemical complex in Texas City, Texas, USA. Objective exposure was investigated using distance of residence from a cluster of petrochemical plants and subjective exposure using residents' concern about potential health effects from those plants. Regression models were then used to examine how each type of exposure predicts perceived stress, physiological markers of stress and perceived health.

RESULTS

Results suggest that objective exposure was associated primarily with markers of physiological stress (interleukin-6 and viral reactivation), and subjective exposure (concern about petrochemical health risk) was associated with variables assessing perceived health.

CONCLUSIONS

From the analysis, it can be inferred that, in the context of an environmental hazard of this type, subjective exposure may be at least as important a predictor of poor health outcomes as objective exposure.

Perceived health change in the aftermath of a petrochemical accident: an examination of pre-accident, within-accident, and post-accident variables

BACKGROUND

Little research has been conducted on changes in perceived health after an industrial accident. Using data from an ongoing survey on stress and health in a petrochemical complex in Texas City, Texas, the associations of a petrochemical accident with perceived health changes were examined.

METHODS

The mean changes in perceived mental and physical health across pre-accident, within-accident, and post-accident categories were compared. The association of these categorical variables with the change in perceived mental and physical health using multiple regression was also examined.

RESULTS

Significant declines in both perceived mental and physical health were observed for the sample. Regression analyses showed that middle age, lower education level and reported damage in the neighbourhood were associated with decreases in perceived mental health. Lower education level, explosion impact, and distance from the explosion site were associated with decreases in perceived physical health.

CONCLUSIONS

These results indicate that both pre-accident and within-accident variables, such as education level and explosion impact, are associated with decreases in perceived physical and mental health. Even a modest event within the range of accidents and disasters was shown to be associated with negative health outcomes for a population-based sample.

Depression and mental health among older Mexican American spouses

Although the association between marriage and well-being is well established, few studies have focused on learning more about the context of marriage and mental health. Recent research studying the mechanisms of marriage and health has focused on contagion of well-being among spouses. This study examined the association of depression with self-esteem, social support, life satisfaction, concern for independence, and cognitive function using baseline data for 553 older, Mexican American couples. Overall, we found evidence to suggest an interdependent relationship between husbands' and wives' emotional states, but the association was not equal for couples. Husbands' depression was significantly associated with the well-being of their wife, but the wife's depression was rarely associated with the husband's well-being. The findings from this study add to the increasing literature on spousal contagion by focusing on an under studied minority group, examining how depression affects well-being, and highlighting unequal effects of marriage on spousal well-being.

Acculturation and self-esteem among older Mexican Americans

Several researchers have examined how acculturation shapes the self-esteem of adolescents, but few studies have looked at the influence of acculturation for older Mexican Americans. The aim of this study was to examine how language acculturation shaped the self-esteem of older Mexican Americans. The data come from the baseline wave (N=3050) of the ongoing Hispanic Established Populations for the Epidemiologic Studies of the Elderly (H-EPESE), a multistage area probability sample conducted in 1993 and 1994. Research revealed that language acculturation is positively associated with self-esteem. However, depressive symptoms mediate and moderate the association of acculturation on self-esteem. Language acculturation among older Mexican Americans is positively associated with self-esteem, even when individuals experience depressive symptoms. Findings suggest that acculturation influences multiple dimensions of mental health.

Networks in later life: an examination of race differences in social support networks

Although there has been considerable interest in the effects of social support networks on various health outcomes for older adults, there has been little research directed toward the predictors of networks. In this study, we examine race differences in the determinants of social support network characteristics (size, frequency of interaction with network members, proportion of kin, and amount of support received and given to network members) using data from an older community sample drawn from the North Carolina site of the Established Populations for Epidemiologic Studies of the Elderly (EPESE) focusing on adults sixty-five and older (n = 4124). This research focuses on the extent to which race differences in network dimensions are present and whether these variations can be attributed to varying social structural positions held by African Americans and Whites. The results indicate that several race differences persist even when controlling for social structural variables. The structural argument and future implications are discussed.

Race differences in cognitive functioning among older adults

OBJECTIVES

Explaining race differences in cognitive functioning in later life continues to challenge researchers. This study was an attempt to incorporate the clinical literature, emphasizing biological correlates of cognitive functioning, and the social research literature, emphasizing social inequalities and consequent health outcomes, in the examination of sources of race differences in cognitive functioning in older adults.

METHODS

With data from Wave 1 of the Assets and Health Dynamics of the Oldest Old survey, the authors used structural equation models (LISREL 8.30) to estimate the direct effects of race on cognitive functioning and indirect effects through social and biological risk factors for the total sample (N = 5,955).

RESULTS

Race had a direct association with cognitive functioning. Race also had indirect effects on cognitive functioning through social risk factors-education and health insurance. There did not appear to be indirect effects of race through biological risk factors.

DISCUSSION

The direct and indirect effects of race through social risk factors attest to the importance of examining different ways through which race can influence cognitive functioning of older adults. This research also emphasizes the need for researchers to investigate more closely race differences in dimensions of cognitive functioning and cognitive functioning over time.

The association between emotional well-being and the incidence of stroke in older adults

OBJECTIVE

Individuals with high levels of depressive symptoms have an increased risk of many illnesses, including stroke. Measures of depressive symptoms include questions about the presence of negative affect, such as sadness, as well as the absence of positive affect, such as happiness and optimism. We assessed whether positive or negative affect, or both, predicted risk of stroke.

METHODS

Data were from a 6-year prospective cohort study of a population-based sample of 2478 older whites and blacks from five counties in North Carolina who reported no history of stroke at the baseline interview. Baseline, in-person interviews were conducted to gather information on sociodemographic, psychosocial, and health-related characteristics of subjects. Thereafter interviews were conducted annually for 6 years.

RESULTS

Increasing scores on the modified version of the Center for Epidemiological Studies Depression Scale (CES-D) were significantly associated with stroke incidence for the overall sample (relative risk [RR] = 1.04 for each one-point increase, 95% confidence interval [CI] = 1.01-1.09) over the 6-year follow-up period after adjusting for sociodemographic characteristics, blood pressure, body mass index, smoking status, and selected chronic diseases. Positive affect score demonstrated a strong inverse association with stroke incidence (RR = 0.74, 95% CI = 0.62-0.88).

CONCLUSIONS

Increasing scores on the modified CES-D are related to an increased risk of stroke, whereas high levels of positive affect seem to protect against stroke in older adults.

Race and ethnic variation in the disablement process

OBJECTIVES

This analysis examines ethnoracial group differences in the transition from health to disability.

METHODS

Using data from the AHEAD study, the authors examine the relative influence of each stage in the disablement process in the evolution of ethnoracial group differences in basic and instrumental disability.

RESULTS

Predisposing factors account for disability differences between Whites and other Latinos, whereas excess disability among African Americans stems from their higher level of cognitive limitation. The excess disability of Mexican Americans arises from their higher level of physical limitations. The data also reveal a larger impact of medical conditions and physical limitations on acquisition of disability among African Americans and Mexican Americans. This article demonstrates the importance of cognitive status in the disablement process, especially in ethnoracial group differences.

DISCUSSION

The authors discuss the practical implications for health care delivery to non-White elders and the theoretical implications for understanding the complexities of disablement.

Structural equation modeling and rehabilitation research

Structural equation modeling (SEM) has been used extensively in the social sciences in the recent past to model human behavior. SEM has been less used by other disciplines, including rehabilitation medicine. This article begins by providing an introduction to structural equation modeling through the discussion of the definition and basic concepts behind SEM using a conceptual model relevant to rehabilitation medicine that describes the pathway from health to disability (the Enabling-Disabling model). The next focus is on several potential pitfalls of which the researcher needs to be aware when using SEM. After this discussion, a hypothetical example is presented using structural equation modeling to evaluate the Enabling-Disabling model. The article concludes with a review of the advantages and disadvantages of using SEM for clinical and social science research. Throughout the article, references are provided for a more detailed examination of SEM.

Age differences in the effects of network composition on psychological distress

The main goal of this research is to better understand age differences in the effects of social networks on mental health. Using a social network approach to revise the convoy of social support model (Kahn and Antonucci, 1980), we examine specifically how two aspects of social support networks (kin composition and convoy dimensions) influence psychological distress for older and younger samples (18-59 and 60+). We hypothesize that kin composition will influence distress in general but especially for the younger sample, while two competing hypotheses for the convoy of social support model are tested. Using data from a three-wave panel health study, structural equation models (LISREL 8.20) indicate that a greater proportion of kin in the perceived support network and the presence of family members in the inner circle of the convoy significantly reduce distress, primarily for the younger sample. Implications for the convoy model are discussed.

Gender differences in the risk of developing disability among older adults with arthritis

OBJECTIVES

Although older women are disabled from arthritis at higher rates than men, there is an inadequate understanding of the factors that place women at higher risks. The purpose of this research is to improve understanding of gender differences in the process of becoming disabled among older adults with arthritis.

METHODS

Gender differences in risk factors associated with developing a disability during a 30-month period are examined among a sample of noninstitutionalized elders with arthritis (N = 749).

RESULTS

Results from discrete time-hazard models indicate that sociodemographic factors account for gender differences in disability with activities of daily living (ADLs). However, for difficulties performing instrumental activities of daily living (IADLs), gender differences remain unexplained by variations in demographic and health factors.

DISCUSSION

More descriptive and explanatory work needs to focus on gender differences in IADL disability; however, these findings suggest that the gendered nature of the IADL tasks influences gender differences in IADL disability.

Are expectations for care related to the receipt of care? An analysis of parent care among disabled elders

This investigation explores the relationship between the degree to which older parents expect assistance from their children and the actual amount of care they receive from their children. Combining the theories of reasoned action and intergenerational solidarity, we hypothesize that global expectations (social norms about receiving care) influence specific expectations (behavioral intentions to seek care), but that it is specific expectations that influence the amount of care received from children. Data were collected at three points over a 12-month period among a sample of impaired older parents (65+) who lived independently in community settings (n = 334). Using structural equation models, the results were consistent with the hypothesis. We conclude that the theory of reasoned action is a useful adjunct to the theory of intergenerational solidarity by proposing that parents adjust their global expectations to reflect the specific realities of the lives of their children.

Stress in the life course: a life history approach

This article examines the relationship between stress and distress in the life course, emphasizing the time elapsed between the event and measurement of psychological distress. Stressors are conceptualized as either distal or proximal based on how recently they occurred. Distal stressors are further classified as status changes or undesirable life changes. Using a life history calendar approach, we examine stressors occurring over a 15-year-period. We explore whether distal stressors affect current depressive symptomatology above and beyond the effect of more recent stressors and how these stressors vary in frequency and affect over 3 empirically defined age groups. While some events decrease in frequency over age, others occur consistently across age groups. Most important, distal stressors significantly impact current depressive symptomatology, independent of proximal stressors. Types of distal stressors affecting depression vary over age, indicating that the stage of life at which a stressor occurs is a significant determinant of the stressor's effect on depression.