Issues in exploring variation in childhood socioeconomic gradients by age: a response to Case, Paxson, and Vogl.
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Adolescent↗
Biomedical subjects
Karen A Matthews
Publications and source records attributed to Karen A Matthews.
Heightened functional neural activation to psychological stress covaries with exaggerated blood pressure reactivity.
Individuals who show exaggerated blood pressure reactions to psychological stressors are at increased risk for hypertension, atherosclerosis, and stroke. We tested whether individuals who show exaggerated stressor-induced blood pressure reactivity also show heightened stressor-induced neural activation in brain areas involved in controlling the cardiovascular system. In a functional MRI study, 46 postmenopausal women (mean age: 68.04; SD: 1.35 years) performed a standardized Stroop color-word interference task that served as a stressor to increase blood pressure. Across individuals, a larger task-induced rise in blood pressure covaried with heightened and correlated patterns of activation in brain areas implicated previously in stress-related cardiovascular control: the perigenual and posterior cingulate cortex, bilateral prefrontal cortex, anterior insula, and cerebellum. Entered as a set in hierarchical regression analyses, activation values in these brain areas uniquely predicted the magnitude of task-induced changes in systolic (DeltaR(2)=0.54; P<0.001) and diastolic (DeltaR(2)=0.27; P<0.05) blood pressure after statistical control for task accuracy and subjective reports of task stress. Heightened stressor-induced activation of cingulate, prefrontal, insular, and cerebellar brain areas may represent a functional neural phenotype that characterizes individuals who are prone to show exaggerated cardiovascular reactivity.
Aged↗
Depressive symptoms and production of proinflammatory cytokines by peripheral blood mononuclear cells stimulated in vitro.
One potential pathway by which depression may impact health is through modulation of immune function. Depressed individuals have been shown to display reductions in measures of cellular immune competence as well as elevated markers of systemic inflammation. The current study assessed the in vitro production of proinflammatory cytokines IL-6, IL-1beta, and TNF-alpha by peripheral blood mononuclear cells (PBMCs) in response to mitogen stimulation within a community-based sample of 79 midlife women. Results indicate that midlife women with higher levels of depressive symptoms (as assessed with the Center for Epidemiologic Studies Depression scale) and greater body mass index (BMI) displayed diminished production of IL-6, IL-1beta, and TNF-alpha by stimulated PBMCs, as compared with their less-depressed counterparts. These relationships remained after controlling for such health-related variables as age, recent sleep disruption, physical activity level, and self-reported medical history. In contrast, depressive symptoms were not significantly associated with circulating levels of the same proinflammatory cytokines (IL-6, IL-1beta, and TNF-alpha) obtained from serum samples available for a subset of 62 of the study participants. Moreover, circulating proinflammatory cytokine levels were not significantly associated with the in vitro proinflammatory cytokine production outcomes. Further research is needed to clarify the clinical significance of the current study findings, and the extent to which in vitro tests of stimulated proinflammatory cytokine production are associated with other measures of cellular immune function and/or circulating markers of systemic inflammation obtained across various study populations.
Adult↗
The relation between perceived unfair treatment and blood pressure in a racially/ethnically diverse sample of women.
Elevated blood pressure is an important public health problem in midlife women, especially among minority groups. Few studies have examined the impact of perceived unfair treatment due to different factors such as racism, sexism, or ageism on blood pressure. By use of a racially/ethnically diverse community sample of nearly 3,300 midlife women enrolled in the longitudinal, multisite Study of Women's Health across the Nation between 1995 and 1997, this study examined whether perceived unfair treatment varied by race/ethnicity and whether it was associated with blood pressure levels. Overall, unfair treatment was reported by 65% of African-American women, 60% of Chinese women, 36% of Japanese women, 47% of White women, and 27% of Hispanic women. Although racial/ethnic differences in blood pressure were evident, high levels of perceived unfair treatment were not a correlate of elevated blood pressure.
Adult↗
Individual versus neighborhood socioeconomic status and race as predictors of adolescent ambulatory blood pressure and heart rate.
Socioeconomic status (SES) disparities are linked to increased cardiovascular disease risk. Although typically considered an individual or family indicator, SES alternatively can be derived from neighborhood characteristics. Previous research has found both family and neighborhood SES predict laboratory blood pressure responses in youth. The question remains as to whether this SES gradient predicts blood pressure during daily living situations. We evaluated individual versus neighborhood SES and race as predictors of ambulatory blood pressure and heart rate. Participants were recruited from two schools in Pittsburgh, diverse in terms of both race and SES. Adolescents' (N=212, 14.5 years, 50% black) cardiovascular responses were measured at school and home. Individual (parent education, household income) and neighborhood SES indices (derived from 78 census tracts: percentage with high school degree or less, percentage below poverty) were assessed. A neighborhood index of race based on the proportion of blacks in the census tract was also derived as a counterpart to individuals' race. Multi-level modeling indicated neighborhood income predicted systolic blood pressure. Individual race predicted diastolic blood pressure. Individual income and education, and neighborhood race each predicted heart rate. These results have important public health implications as they suggest individual and neighborhood SES and race are linked to cardiovascular risk disparities as early as adolescence.
Adolescent↗
Education, 15-year risk factor progression, and coronary artery calcium in young adulthood and early middle age: the Coronary Artery Risk Development in Young Adults study.
CONTEXT: The inverse association between education and cardiovascular disease is well established, but little is known about the relationship between education and subclinical disease, which is free from medical access and treatment-related influences, or about possible mediating pathways for these relationships. OBJECTIVE: To examine the association of education with coronary artery calcium (CAC), an indicator of subclinical atherosclerosis, and cardiovascular risk factors, and their changes as potential mediators. DESIGN, SETTING, AND PARTICIPANTS: A population-based, prospective, observational study (Coronary Artery Risk Development in Young Adults [CARDIA]) of 2913 eligible participants (44.9% black; 53.9% women) recruited from 4 metropolitan areas (Birmingham, Ala; Chicago, Ill; Minneapolis, Minn; and Oakland, Calif) in both the baseline (1985-1986, ages 18-30 years) and year 15 examinations (2000-2001, ages 33-45 years). Education (year 15) was classified into less than high school (n = 128), high school graduate (n = 498), some college (n = 902), college graduate (n = 764), and more than college (n = 621). MAIN OUTCOME MEASURE: Presence of CAC, measured twice by computed tomography (mean total Agatston score >0) at year 15. RESULTS: Overall CAC prevalence in this sample was 9.3%. After adjusting for age, race, and sex, the odds ratios (ORs) for having CAC were 4.14 (95% confidence interval [CI], 2.33-7.35) for less than high school education, 1.89 (95% CI, 1.23-2.91) for high school graduate, 1.47 (95% CI, 0.99-2.19) for some college, and 1.24 (95% CI, 0.84-1.85) for college graduate compared with those participants with more than a college education (P for trend<.001). This was also consistent within each of the 4 race-sex groups. Adjustment for baseline systolic blood pressure, smoking, waist circumference, physical activity, and total cholesterol reduced the ORs to 2.61 (95% CI, 1.40-4.85) for less than high school, 1.38 (95% CI, 0.88-2.17) for high school graduate, 1.17 (95% CI, 0.78-1.77) for some college, and 1.13 (95% CI, 0.76-1.69) for college graduate compared with more than a college education (P for trend = .01), and only slightly attenuated by further adjustment for 15-year changes in risk factors. CONCLUSION: Education was inversely associated with the prevalence of CAC, an association partially explained by baseline risk factors and minimally by 15-year changes in risk factors.
Adult↗
The Life Engagement Test: assessing purpose in life.
This article describes a 6-item scale, the Life Engagement Test, designed to measure purpose in life, defined in terms of the extent to which a person engages in activities that are personally valued. Psychometric data are presented including information about the scale's factor structure, internal consistency, test-retest reliability, convergent validity, discriminant predictive validity, and norms. The data suggest that the Life Engagement Test is psychometrically sound across different gender, age, and ethnic groups and is appropriate for wider use. Discussion centers on the use of the Life Engagement Test in behavioral medicine and health psychology research and recent associations that have begun to emerge between the scale and health-relevant outcomes.
Adult↗
Understanding health disparities: the role of race and socioeconomic status in children's health.
OBJECTIVES: We sought to determine whether childhood health disparities are best understood as effects of race, socioeconomic status (SES), or synergistic effects of the two. METHODS: Data from the National Health Interview Survey 1994 of US children aged 0 to 18 years (n=33911) were used. SES was measured as parental education. Child health measures included overall health, limitations, and chronic and acute childhood conditions. RESULTS: For overall health, activity and school limitations, and chronic circulatory conditions, the likelihood of poor outcomes increased as parental education decreased. These relationships were stronger among White and Black children, and weaker or nonexistent among Hispanic and Asian children. However, Hispanic and Asian children exhibited an opposite relationship for acute respiratory illness, whereby children with more educated parents had higher rates of illness. CONCLUSIONS: The traditional finding of fewer years of parent education being associated with poorer health in offspring is most prominent among White and Black children and least evident among Hispanic and Asian children. These findings suggest that lifestyle characteristics (e.g., cultural norms for health behaviors) of low-SES Hispanic and Asian children may buffer them from health problems. Future interventions that seek to bolster these characteristics among other low-SES children may be important for reducing childhood health disparities.
Adolescent↗
Relation of cardiovascular risk factors in women approaching menopause to menstrual cycle characteristics and reproductive hormones in the follicular and luteal phases.
CONTEXT: Menstrual cycle characteristics may be associated with cardiovascular disease (CVD) risk. OBJECTIVE: The objective of this study was to describe the relationships between menstrual cycle characteristics and daily reproductive hormone measures with CVD risk factors in middle-aged women. DESIGN AND SETTING: Cross-sectional associations were examined between CVD risk factors and urinary LH, FSH, estrone conjugates, and pregnanediol glucuronide (Pdg) measured across one menstrual cycle or 50 d. PARTICIPANTS: Menstruating women (n = 500) who were free from diabetes or past stroke or heart attack enrolled in the Daily Hormone Study-Study of Women's Health across the Nation were studied. MAIN OUTCOME MEASURES: Body mass index (BMI), blood pressure, hemostatic, and metabolic factors were measured. RESULTS: Few differences existed in risk factors between women with evidence of luteal activity and those with no evidence of luteal activity. Associations between elevated CVD risk factors and long cycle length were reduced substantially by age and BMI adjustments. Those with lower estrone conjugate and PdG averaged across the follicular phase had higher waist circumference, triglycerides, insulin, plasminogen activator inhibitor type-1, tissue type plasminogen activator-antigen, and factor VIIc levels in age- and BMI-adjusted analyses (P < 0.05). CONCLUSIONS: In midlife menstruating women, a longer cycle length was related to CVD risk factors, in large part through their common association with BMI. More favorable levels of metabolic and hemostatic factors were associated with higher levels of follicular-phase estrogen, a pattern consistent with a more competent ovary, and higher levels of follicular-phase PdG, perhaps of adrenal origin. Metabolic and hemostatic factors may be sensitive to hormonal variation during the early perimenopausal transition.
Adult↗
Blood pressure reactivity to psychological stress and coronary calcification in the Coronary Artery Risk Development in Young Adults Study.
A longstanding hypothesis is that individuals who exhibit large increases in blood pressure during psychological stress are at risk for atherosclerosis. We tested whether blood pressure changes during psychological stress predict subsequent coronary calcification (CaC) in young healthy adults. We evaluated 2816 healthy black and white women, 20 to 35 years of age, from the Coronary Artery Risk Development in Young Adults Study, who were not using medication for hypertension or diabetes in 1987-1988. Participants completed video game and star tracing tasks while their blood pressure was recorded. Thirteen years later (2000-2001), they completed computed tomography measures of CaC. Overall 9.3% (261 of 2816) had CaC present at follow-up. Each 10 mm Hg change in systolic blood pressure during the video game was associated with a 24% increased odds of having CaC at follow-up (unadjusted odds ratio, 1.24; 95% CI, 1.06 to 1.46; P=0.008). This association persisted after adjustment for age, race, sex, education, smoking, alcohol, family history of myocardial infarction, smoking, daily alcohol consumption, body mass index, and resting or baseline blood pressure (odds ratio, 1.31; 95% CI, 1.08 to 1.58; P=0.006). Blood pressure changes during the star tracing task were not associated with subsequent CaC. Blood pressure changes during a video game predicted the presence of CaC 13 years later. To our knowledge, this is the first study that reports blood pressure reactivity to a stressor being related to calcification in the coronary arteries. Blood pressure reactivity may provide useful prognostic information about future risk beyond standard risk factors.
Adult↗
Effects of media violence on health-related outcomes among young men.
OBJECTIVE: To test the effects of media violence exposure on blood pressure, negative affect, hostile social information processing, uncooperative behavior, and attitudes toward health risk behaviors among young men varying in lifetime violence exposure within the home and community. DESIGN: Experimental laboratory study. SETTING: University campus situated within an urban environment. PARTICIPANTS: One hundred male undergraduates aged 18 to 21 years. INTERVENTION: Men who had previously reported differing amounts of lifetime home and community violence were randomly assigned to play The Simpsons: Hit and Run (low-violence condition) or Grand Theft Auto III (high-violence condition). MAIN OUTCOME MEASURES: Systolic and diastolic blood pressure; negative affect; hostile social information processing; uncooperative behavior; and permissive attitudes toward violence, alcohol use, marijuana use, and sexual activity without condom use. RESULTS: Men randomly assigned to play Grand Theft Auto III exhibited greater increases in diastolic blood pressure from a baseline rest period to game play, greater negative affect, more permissive attitudes toward using alcohol and marijuana, and more uncooperative behavior in comparison with men randomly assigned to play The Simpsons. Only among participants with greater exposure to home and community violence, play of Grand Theft Auto III led to elevated systolic blood pressure in comparison with play of The Simpsons (mean, 13 vs 5 mm Hg). CONCLUSIONS: Media violence exposure may play a role in the development of negative attitudes and behaviors related to health. Although youth growing up in violent homes and communities may become more physiologically aroused by media violence exposure, all youth appear to be at risk for potentially negative outcomes.
Adolescent↗
Depression symptom severity and reported treatment history in the prediction of cardiac risk in women with suspected myocardial ischemia: The NHLBI-sponsored WISE study.
BACKGROUND: Depression is associated with clinical events and premature mortality among patients with established coronary artery disease (CAD). Typically, however, studies in this area focus only on baseline symptom severity and lack any data concerning symptom duration or symptom history. OBJECTIVES: To describe and compare the relationships between 2 measures of depression-assessed in the form of depression symptom severity and reported treatment history-with atherosclerosis risk factors and major clinical events in a sample of women with suspected myocardial ischemia. DESIGN: Follow-up study of women who completed a diagnostic CAD protocol, including cardiac symptoms, coronary angiography, ischemic testing, and assessments of depression symptom severity and reported treatment history. SETTING: The Women's Ischemia Syndrome Evaluation (WISE), a National Heart, Lung, and Blood Institute (NHLBI)-sponsored multicenter study assessing cardiovascular function using state-of-the-art techniques in women referred for coronary angiography to evaluate chest pain or suspected myocardial ischemia. PARTICIPANTS: Five hundred five women (mean age, 53.4 years) enrolled in WISE and followed up for a mean of 4.9 years. MAIN OUTCOME MEASURES: Incidence of cardiac events, including myocardial infarction, stroke, and heart failure, and total mortality. RESULTS: Relative to those with no or less stable depression symptoms, women with elevated depression symptoms and a reported treatment history showed higher rates of smoking, hypertension, and poorer education and an increased incidence of death and cardiac events (multivariate-adjusted risk ratio, 3.1; 95% confidence interval, 1.5-6.3; P = .001). CONCLUSIONS: Among women with suspected myocardial ischemia, a combination of depressive symptom severity and treatment history was a strong predictor of an elevated CAD risk profile and increased risk of cardiac events compared with those without depression or with only 1 of the 2 measured depression markers. These findings reinforce the importance of assessing mental health factors in women at elevated CAD risk. Focusing only on baseline depression symptom severity may provide an incomplete picture of CAD risk.
Cause of Death↗
Cynical hostility and carotid atherosclerosis in African American and white women: the Study of Women's Health Across the Nation (SWAN) Heart Study.
BACKGROUND: Hostility is associated with increased cardiovascular disease mortality and morbidity and may be related to subclinical atherosclerosis; less is known about this association among women and minority groups. METHODS: We examined the association between hostility and intimal-medial thickening (IMT) as well as presence/absence of plaque in the carotid arteries in middle-aged white and African American women. Hostility was measured by a 13-item questionnaire and IMT and plaque were assessed by B-mode ultrasonography in 589 participants from the Chicago and Pittsburgh sites of the SWAN. RESULTS: In age- and site-adjusted models, each 1-point increment in hostility score predicted a significant 0.0057-mm higher mean IMT (P < .0001) and 0.0081-mm higher maximum IMT (P < .0001)--effects that were identical in magnitude to each 1-year increment in age. Adjustments for race, education, body mass index, resting systolic blood pressure, and smoking diminished these associations, but they remained significant (P < or = .01). With hostility scores modeled in approximate tertiles, high scorers (> or = 6) had greater mean (P = .0005) and maximum (P = .0004) IMT than low scorers (0 or 1); moderate and low scorers did not differ (age-adjusted mean values for low, moderate, and high scorers were 0.657, 0.662, and 0.694 mm, respectively, for mean IMT; those for low, moderate, and high scorers were 0.855, 0.860, and 0.906 mm, respectively, for maximum IMT). Hostility was unrelated to presence of plaque and did not interact with race, education, smoking, and body mass index. CONCLUSIONS: Hostility is related to small but significantly greater subclinical atherosclerosis in middle-aged women; this association is not explained by traditional risk factors.
Black or African American↗
Does who you marry matter for your health? Influence of patients' and spouses' personality on their partners' psychological well-being following coronary artery bypass surgery.
Research suggests that presurgical personality attributes influence postsurgical well-being in both patients and their spouses in the context of coronary artery bypass grafting (CABG) surgery. The authors hypothesized that a spouse's characteristics would influence a partner's psychological well-being, regardless of whether he or she was the patient or the caregiver. In this study, 111 male patients and their caregiver spouses completed measures of neuroticism, optimism, perceived marital satisfaction, and depression prior to elective CABG. Follow-up was conducted at 18 months. As expected, higher caregiver presurgical neuroticism predicted higher patient depressive symptoms at follow-up, with caregiver's concurrent 18-month affect controlled for. Likewise, higher patient presurgical neuroticism predicted higher caregiver depressive symptoms at follow-up. Additionally, higher patient presurgical depressive symptoms and lower presurgical optimism contributed to greater caregiving burden. Relationship satisfaction moderated these effects. These results suggest that partners' personality traits are important determinants of both patients' and their caregiving spouses' well-being.
Adult↗
Anger, hostility, and cardiac symptoms in women with suspected coronary artery disease: the Women's Ischemia Syndrome Evaluation (WISE) Study.
OBJECTIVE: To determine the relationship of anger and hostility to angiographic coronary artery disease (CAD), symptoms, and functional status among women with suspected CAD. METHODS: Data were collected from 636 women with suspected CAD referred for diagnostic angiography in the Women's Ischemia Syndrome Evaluation (WISE) Study. CAD was assessed as angiographic presence/absence of disease (> or =50% stenosis in any epicardial coronary artery). Hostility/anger, angina, symptoms, and functional status were assessed by the Cook-Medley Hostility Inventory, Spielberger Anger Expression Scale, cardiovascular symptom history, and the Duke Activity Status Index. RESULTS: Logistic regression revealed that anger-out (i.e., aggressive behavior in response to angry feelings) was independently associated with the presence/absence of angiographic CAD (OR = 1.09, CI 1.01-1.17). Anger and hostility were higher among women reporting increased cardiovascular symptoms. In women without angiographic CAD, those with nonanginal cardiac symptoms had the highest anger-out, anger expression, hostile affect, and aggressive responding scores, and those with typical angina reported the lowest functional status. Among women with CAD, functional status was lowest in women with atypical angina. CONCLUSIONS: Among women with suspected CAD, anger-out scores were associated with the presence of angiographic CAD. Anger/hostility traits were associated with increased symptoms, particularly with nonanginal chest pain in women without angiographic CAD. Relationships among psychosocial factors, cardiac symptoms, and angiographic CAD are potentially important in the management of women with suspected CAD.
Aged↗
Socioeconomic status in childhood and adulthood: associations with dispositional optimism and pessimism over a 21-year follow-up.
We examined whether dispositional optimism and pessimism (overall LOT-R and optimism and pessimism component scores) of 694 adults aged 24 and 27 were associated with socioeconomic status (SES) measured concurrently and in childhood at ages 3 and 6. SES measures included education, occupational status and unemployment, and income. Concurrent adulthood SES was associated with the overall LOT-R and optimism and the pessimism component scores. Childhood family SES predicted overall LOT-R and pessimism component scores, even after controlling statistically for the adulthood SES. Social mobility between SES of family of origin and current SES also influenced the scores. The current findings suggest that the foundation of dispositional optimism and pessimism is related to early SES of the family.
Adult↗
Chronic stress influences ambulatory blood pressure in adolescents.
BACKGROUND: High ambulatory blood pressure (ABP) predicts cardiovascular events, even after controlling for clinic BP and other established risk factors. PURPOSE: This study examined whether chronic or discrete stress in the past year was associated with greater ABP in adolescents. METHOD: Participants were 217 male and female Black and White adolescents who wore ABP monitors on 2 consecutive school days and completed a survey of life events. RESULTS: Report of discrete, negative events was not associated with ABP. Adolescents experiencing greater numbers of chronic, negative life events exhibited greater systolic blood pressure (SBP), independent of ethnicity; sex; body mass index; and location, position, physical activity, and consumption of food/caffeine/nicotine at time of measurement. Greater numbers of chronic, negative events were associated with greater diastolic blood pressure (DBP) among boys. When resting clinic BP was introduced into the model, the main effect of chronic, negative life events on ambulatory SBP became nonsignificant, whereas the effect of chronic, negative life events on male adolescents' DBP persisted. CONCLUSIONS: Chronic stress is associated with greater ambulatory SBP among male and female adolescents and with greater ambulatory DBP among male adolescents. The latter association persisted after controlling for clinic BP, suggesting that males may be more vulnerable to chronic stress as a determinant of BP regulation than females early in life.
Adolescent↗
History of depression, race, and cardiovascular risk in CARDIA.
Though previous data indicate a positive association between depression and coronary heart disease, the mechanisms mediating these associations remain unclear. These prospective analyses assessed the association between history of Center for Epidemiologic Studies Depression Scale depression and possible mediators of cardiovascular risk at Year 15 of follow-up in African Americans (AA) and Caucasians (C) in the Coronary Artery Risk Development in Young Adults Study. Physiological assessments included plasma levels of low-density-lipoprotein cholestrol (LDL), high-density-lipoprotein cholestrol (HDL), total cholesterol, triglycerides and fasting glucose, diabetes and blood pressure. Behavioral risk factors included alcohol consumption, smoking, physical activity, and body mass index (BMI). AA's showed significant associations between history of depression and diabetes that did not exist in Cs and AA women had significantly more episodes of depression than any other group. However, associations of depression with smoking, BMI, and physical activity were consistent across groups in the expected direction. HDL-cholesterol was positively and LDL-cholesterol inversely associated with depression in Cs, which was unexpected. These data indicate that in this still healthy cohort, there are already associations between depression and factors that predispose to cardiovascular risk.
Adult↗