Health Psychology - SES and Lifespan Stress

Review of Biological Pathways ▪What areas stimulate the SNS?

* the anterior cingulate & amygdala also trigger the SNS * SNS ←→ PNS *

SES & Early Stressor Effects on Health: A model (5)

****************** Psychol Bull. 2011 Nov;137(6):959-97. doi: 10.1037/a0024768. Psychological stress in childhood and susceptibility to the chronic diseases of aging: moving toward a model of behavioral and biological mechanisms. Miller GE1, Chen E, Parker KJ. Among people exposed to major psychological stressors in early life, there are elevated rates of morbidity and mortality from chronic diseases of aging. The most compelling data come from studies of children raised in poverty or maltreated by their parents, who show heightened vulnerability to vascular disease, autoimmune disorders, and premature mortality. These findings raise challenging theoretical questions. How does childhood stress get under the skin, at the molecular level, to affect risk for later diseases? And how does it incubate there, giving rise to diseases several decades later? Here we present a biological embedding model, which attempts to address these questions by synthesizing knowledge across several behavioral and biomedical literatures. This model maintains that childhood stress gets "programmed" into macrophages through epigenetic markings, posttranslational modifications, and tissue remodeling. As a consequence these cells are endowed with proinflammatory tendencies, manifest in exaggerated cytokine responses to challenge and decreased sensitivity to inhibitory hormonal signals. The model goes on to propose that over the life course, these proinflammatory tendencies are exacerbated by behavioral proclivities and hormonal dysregulation, themselves the products of exposure to early stress. Behaviorally, the model posits that childhood stress gives rise to excessive threat vigilance, mistrust of others, poor social relationships, impaired self-regulation, and unhealthy lifestyle choices. Hormonally, early stress confers altered patterns of endocrine and autonomic discharge. This milieu amplifies the proinflammatory environment already instantiated by macrophages. Acting in concert with other exposures and genetic liabilities, the resulting inflammation drives forward pathogenic mechanisms that ultimately foster chronic disease

Review of Biological Pathways ▪What brain areas stimulate the HPA axis ?

**the anterior cingulate & amygdala → hpa axis → adrenal cortex → cortisol

Mastery (3)

*Mastery* = a global sense of control or the belief that one has control over future important life circumstances (close to self-efficacy which is belief that one's actions will obtain a results in a specific domain) - Lower Mastery is associated with higher mortality - Tends to be lower in lower SES

Early life Maltreatment: Lasting Inflammatory Effects (8)

*RESULTS* ▪ No childhood maltreatment = lowest levels of CRP ▪ Probable childhood maltreatment = a bit higher levels of CRP ▪ Definite childhood maltreatment = highest amount of CRP ***************** Danese et al 2007 Childhood maltreatment predicts adult inflammation in a life-course study - PNAS Measure of Childhood Maltreatment. Stress in early life has been associated with insufficient glucocorticoid signaling in adulthood, possibly affecting inflammation processes. Childhood maltreatment has been linked to increased risk of adult disease with potential inflammatory origin. However, the impact of early life stress on adult inflammation is not known in humans. We tested the life-course association between childhood maltreatment and adult inflammation in a birth cohort followed to age 32 years as part of the Dunedin Multidisciplinary Health and Development Study. Regression models were used to estimate the effect of maltreatment on inflammation, adjusting for co-occurring risk factors and potential mediating variables. Maltreated children showed a significant and graded increase in the risk for clinically relevant C-reactive protein levels 20 years later, in adulthood [risk ratio (RR) _ 1.80, 95% confidence interval (CI) _ 1.26-2.58]. The effect of childhood maltreatment on adult inflammation was independent of the influence of co-occurring early life risks (RR _ 1.58, 95% CI _ 1.08-2.31), stress in adulthood (RR _ 1.64, 95% CI _ 1.12-2.39), and adult health and health behavior (RR _ 1.76, 95% CI _ 1.23-2.51). More than 10% of cases of low-grade inflammation in the population, as indexed by high C-reactive protein, may be attributable to childhood maltreatment. The association between maltreatment and adult inflammation also generalizes to fibrinogen and white blood cell count. Childhood maltreatment is a previously undescribed, independent, and preventable risk factor for inflammation in adulthood. Inflammation may be an important developmental mediator linking adverse experiences in early life to poor adult health.

SES and Health - Longitudinal Study of English Civil Servant and Coronary Heart Disease

*WHITEHALL STUDIES show that low-ranked british civil servants (offive messengers and other support staff) are almost twice as likely to die from heart disease as administrators of the same age. Differences in risk factors - for example, higher smoking rates among the supporting staff - account for less than half of the gap in mortality rates ▪ there's something going on that's not soley access to resources ▪ is it health behaviors? ▪ yes, to some extent if you look at things like smoking ▪ those with lower SES are going to be more likely to smoke? ▪even when you're controlling for health behaviors, those who are more affluent are less likely to get diseases ▪ This is a linear correlation -->the middle class people aren't stressed, or worrying about when the next paycheck is coming but they're still not living as long as those who are more affluent than them

High HRV (heart rate variability) associated with ...

*high HRV = high PNS & low SNS

Low HRV (heart rate variability) associated with ...

*low HRV = low PNS

Parental/Nepotistic Effort:

- Bioenergetic and material resources devoted to enhancing survival of any offspring produced by self or kin

Subjective Socioeconomic Status Cont. (7) *Ladder Study*

- It's not so much being poor as *feeling poor* - In addition to income and education captures: - Contentment with standard of living - Concern about future standing **This is also in the reading -->if you're ranked highest SES, you have better health -->as you go down the ladder, reportings of your health go down -->if you're at the bottom to the middle , you can see that there is some steepness (there is a big difference between being all the way at the bottom and being in the middle/bottom)

SES and Amygdala Reactivity (3) - Emotional Face MRI Study

- MRI study of 12 and 13 year olds looking at emotional faces - Lower socioeconomic status is associated with greater amygdala reactivity, suggesting greater sympathetic nervous system activity ▪maybe lower SES has higher amygdala activity because you might be more exposed to threats (if you live in a bad neighborhood) *************** Muscatell et al 2012 Social status modulates neural activity in the mentalizing network - Neuroimage The current research explored the neural mechanisms linking social status to perceptions of the social world. Two fMRI studies provide converging evidence that individuals lower in social status are more likely to engage neural circuitry often involved in 'mentalizing' or thinking about others' thoughts and feelings. Study 1 found that college students' perception of their social status in the university community was related to neural activity in the mentalizing network (e.g., DMPFC, MPFC, precuneus/PCC) while encoding social information, with lower social status predicting greater neural activity in this network. Study 2 demonstrated that socioeconomic status, an objective indicator of global standing, predicted adolescents' neural activity during the processing of threatening faces, with individuals lower in social status displaying greater activity in the DMPFC, previously associated with mentalizing, and the amygdala, previously associated with emotion/salience processing. These studies demonstrate that social status is fundamentally and neurocognitively linked to how people process and navigate their social worlds.

Somatic Effort (upkeep)

Bioenergetic and material resources devoted to continued survival of individual organism

Mating Effort:

Bioenergetic and material resources devoted to obtaining and retaining sexual partners

Reproductive Effort (propagation)

Bioenergetic and material resources devoted to production of new organisms as vehicles for survival of individual's genes

Subjective Socioeconomic Status: "Cold Unit"

Cohen, S., et al. "Objective and subjective socioeconomic status and susceptibility to the common cold." Health Psychology, v. 27 issue 2, 2008, p. 268-74. *Objective:* We ask whether subjective socioeconomic status (SES) predicts who develops a common cold when exposed to a cold virus. *Design:* 193 healthy men and women ages 21-55 years were assessed for subjective (perceived rank) and objective SES, cognitive, affective and social dispositions, and health practices. Subsequently, they were exposed by nasal drops to a rhinovirus or influenza virus and monitored in quarantine for objective signs of illness and self-reported symptoms. *Main Outcome Measures:* Infection, signs and symptoms of the common cold, and clinical illness (infection and significant objective signs of illness). *Results:* *Increased subjective SES was associated with decreased risk for developing a cold for both viruses*. This association was independent of objective SES and of cognitive, affective and social disposition that might provide alternative spurious (third factor) explanations for the association. *Poorer sleep among those with lesser subjective SES may partly mediate the association between subjective SES and colds.* *Conclusions: Increased Subjective SES is associated with less susceptibility to upper respiratory infection, and this association is independent of objective SES, suggesting the importance of perceived relative rank to health*

Fetal Origins of Adult Disease - Dutch Hunger Winter Study (4)

Dutch Hunger Winter, Nazi induced starvation for several months, particularly adverse effects on pregnant mothers Offspring showed: - Later life obesity and insulin resistance (think cardiovascular disease and Type II diabetes) - Increased Depression

Early Life Adversity's Lasting Effects - Male Health Insurance Worker Study

Felitti et al (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults- The Adverse Childhood Experiences (ACE) Study Background: The relationship of health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse, and household dysfunction during childhood has not previously been described. Methods: A questionnaire about adverse childhood experiences was mailed to 13,494 adults who had completed a standardized medical evaluation at a large HMO; 9,508 (70.5%) responded. Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. Logistic regression was used to adjust for effects of demographic factors on the association between the cumulative number of categories of childhood exposures (range: 0-7) and risk factors for the leading causes of death in adult life. Results: More than half of respondents reported at least one, and one-fourth reported $2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P , .001). Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, $50 sexual intercourse partners, and sexually transmitted disease; and a 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life. Conclusions: We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.

Model of Early Life Adversity's Lasting Effects

Felitti et al (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults- The Adverse Childhood Experiences (ACE) Study Background: The relationship of health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse, and household dysfunction during childhood has not previously been described. Methods: A questionnaire about adverse childhood experiences was mailed to 13,494 adults who had completed a standardized medical evaluation at a large HMO; 9,508 (70.5%) responded. Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. Logistic regression was used to adjust for effects of demographic factors on the association between the cumulative number of categories of childhood exposures (range: 0-7) and risk factors for the leading causes of death in adult life. Results: More than half of respondents reported at least one, and one-fourth reported $2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P , .001). Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, $50 sexual intercourse partners, and sexually transmitted disease; and a 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life. Conclusions: We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.

Urban Vs. Rural Living (4)

Individuals in urban areas have: • 21% increased risk anxiety disorders • 39% increased risk of Major Depression • 200% increase of Schizophrenia - What could explain these effects?

SES and Health: Why?

Is it access to health care? 1. SES gradient exists across nations (differences in steepness, though) 2. It is linear 3. Exists for diseases where preventative... ____ 4. health behaviors ************************ Pincus et al., 1998 Social Conditions and Self-Management Are More Powerful Determinants of Health Than Access to Care - Annals Int Med Professional organizations advocate universal access to medical care as a primary approach to improving health in the population. Access to medical services is critical to outcomes of acute processes managed in an inpatient hospital, the setting of most medical education, research, and training, but seems to be limited in its capacity to affect outcomes of outpatient care, the setting of most medical activities. Persistent and widening disparities in health according to socioeconomic status provide evidence of limitations of access to care. First, job classification, a measure of socioeconomic status, was a better predictor of cardiovascular death than cholesterol level, blood pressure, and smoking combined in employed London civil servants with universal access to the National Health Service. Second, disparities in health according to socioeconomic status widened between 1970 and 1980 in the United Kingdom despite universal access (similar trends were seen in the United States). Third, in the United States, noncompletion of high school is a greater risk factor than biological factors for development of many diseases, an association that is explained only in part by age, ethnicity, sex, or smoking status. Fourth, level of formal education predicted cardiovascular mortality better than random assignment to active drug or placebo over 3 years in a clinical trial that provides optimal access to care. Increased recognition of limitations of universal access by physicians and their professional societies may enhance efforts to improve the health of the population.

Life History Strategies: English Neighborhoods - part 2

Nettle, D. (2010). Dying young and living fast- Variation in life history across English neighborhoods. Behavioral Ecology Where the expected reproductive life span is short, theory predicts that individuals should follow a ''fast'' life-history strategy of early reproduction, reduced investment in each offspring, and high reproductive rate. I apply this prediction to different neighborhood environments in contemporary England. There are substantial differences in the expectation of healthy life between the most deprived and most affluent neighborhoods. Using data from the Millennium Cohort Study (n . 8660 families), I show that in deprived neighborhoods compared with affluent ones, age at first birth is younger, birthweights are lower, and breastfeeding duration is shorter. There is also indirect evidence that reproductive rates are higher. Coresidence of a father figure is less common, and contact with maternal grandmothers is less frequent, though grandmaternal contact shows a curvilinear relationship with neighborhood quality. Children from deprived neighborhoods perform less well on a verbal cognitive assessment at age 5 years, and this deficit is partly mediated by parental age and investment variables. I suggest that fast life history is a comprehensible response, produced through phenotypic plasticity, to the ecological context of poverty, but one that entails specific costs to children.

what hormones have to do with inflammation?

adrenaline/epinephrine & noradrenaline/norepinephrine → inflammation

Subjective Socioeconomic Status

this simple checking off of where you are on the ladder seems to predict health - Subjective Community status measure: substitute "relative to other people in the United States" with "your immediate community"

Birthplace & the Stress Response - MRI Study (3)

• In two separate studies, participants living in different regions did mental arithmetic under time pressure while in the MRI scanner • Urban dwellers showed: greater amygdala reactivity (graphed to the left) - greater cortisol response • Effect seems to be particularly driven by where grew up more than where currently live ****************** Lederbogen et al Preussner, Meyer-Lindenberg 2011 City living and urban upbringing affect neural social stress processing in humans - Nature More than half of the world's population now lives in cities, making the creation of a healthy urban environment a major policy priority1. Cities have both health risks and benefits1, but mental health is negatively affected: mood and anxiety disorders are more prevalent in city dwellers2 and the incidence of schizophrenia is strongly increased in people born and raised in cities3-6. Although these findings have been widely attributed to the urban social environment2,3,7,8, the neural processes that could mediate such associations are unknown. Here we show, using functional magnetic resonance imaging in three independent experiments, that urban upbringing and city living have dissociable impacts on social evaluative stress processing in humans. Current city living was associated with increased amygdala activity, whereas urban upbringing affected the perigenual anterior cingulate cortex, a key region for regulation of amygdala activity, negative affect9 and stress10. These findings were regionally and behaviourally specific, as no other brain structures were affected and no urbanicity effect was seen during control experiments invoking cognitive processing without stress. Our results identify distinct neural mechanisms for an established environmental risk factor, link the urban environment for the first time to social stress processing, suggest that brain regions differ in vulnerability to this risk factor across the lifespan, and indicate that experimental interrogation of epidemiological associations is a promising strategy in social neuroscience.

SES: Biological Contributors - Hotel Study (5)

▪ *Results*: Those who had a lower SES, had higher levels of cortisol throughout the day, middle SES - mid level, high SES had lower levels of cortisol even though all three SES groups were in a hotel for 2/3 of the days ******************************************** Cohen et al 2006 Socioeconomic Status Is Associated With Stress Hormones - PM *Objective:* We assess whether socioeconomic status (SES) is associated with basal levels of cortisol and catecholamines and determine if any association between SES and these hormones can be explained (is mediated) by behavioral, social, and emotional differences across the SES gradient. *Methods:* One hundred ninety-three adult subjects, including men and women and whites and African-Americans, provided 24-hour urine catecholamine samples on each of 2 days and seven saliva cortisol samples on each of 3 days beginning 1 hour after wakeup and ending 14 to 16 hours later. Values for both hormones were averaged across days to obtain basal levels. *Results:* Lower SES (income and education) was associated with higher levels of cortisol and epinephrine and marginally higher levels of norepinephrine. These associations were independent of race, age, gender, and body mass. Low SES was also associated with a greater likelihood of smoking, of not eating breakfast, and with less diverse social networks. Further analyses provided evidence consistent with the hypothesis that these behavioral and social variables mediate the link between SES and the three stress hormones. *Conclusions:* Lower SES was associated in a graded fashion with higher basal levels of cortisol and catecholamines. These associations occurred independent of race, and the data were consistent with mediation by health practices and social factors. *Key words:* cortisol, education, epinephrine, income, norepinephrine, socioeconomic status.

SES and Changes in Blood Pressure (2)

▪ 1000 civil servants underwent a mental stress test (solving difficult problems while loud noises were being presented through headphones) ▪ Results: the lower ranked civil servants had higher SBP (systolic blood pressure) levels than those civil servants who were higher ranked ******************************************************************** Carroll et al Marmot 1997 The Relationship Between Socioeconomic Status, Hostility, and Blood Pressure Reactions to Mental Stress in Men- Data From the Whitehall II Study - HP This study investigated the relationship among blood pressure reactions to mental stress, cynical hostility, and socioeconomic status (SES) in 1,091 male public servants. Occupational grade served to index SES and cynical hostility was assessed using the Cook-Medley scale. (Cook & Medley, 1954). The magnitude of systolic, but not diastolic, blood pressure change scores to stress was positively associated with occupational grade: the higher the grade, the greater the reactions. Mental stress task performance also varied with occupational grade but was unrelated to reactivity. Ratings of task difficulty did not vary with occupational grade. Cynical hostility was negatively related to occupational grade, and, contrary to previous findings, negatively related to systolic blood pressure reactivity. Cynical hostility was also negatively related to mental stress task performance but unrelated to ratings of task difficulty

Early Life Socioeconomic Status: Lasting Effects

▪ 1131 Graduates of Johns Hopkins Medical School from 1948 to 1964 followed longitudinally ▪ Low SES: Father was a farmer, laborer, machine operator, craftsman...etc ▪ High SES: Father was a manager, physician, accountant, engineer, lawyer...etc --> Even with this crude measure of SES and high adulthood SES, childhood SES still matters ▪ Those who were *raised* in lower SES had a lower risk of CVD even if you look at their *current* SES which is high, the ones who grew up with lower SES still had higher cumulative rate of morbidity (CHD) ************************* Kittleson et al (2007) Association of childhood socioeconomic status with subsequent coronary heart disease in physicians Background: Adult socioeconomic status (SES) is an independent risk factor for the development of coronary heart disease (CHD), but whether low childhood SES has an effect in adults who have achieved high SES is unknown. Methods: We examined the risk of CHD and mortality associated with low childhood SES in 1131 male medical students from The Johns Hopkins Precursors Study, a prospective cohort of graduates of The Johns Hopkins University School of Medicine from 1948 to 1964 with a median follow-up of 40 years. Results: Of 1131 subjects, 216 (19.1%) were from low- SES families. Medical students from low-SES families were slightly older at graduation (26.8 vs 26.2 years; P=.004) and gained more weight over time (P=.01). Low childhood SES conferred a 2.40-fold increased hazard of developing CHD on or before age 50 years (95% confidence interval, 1.21-4.74) but not at older ages. The impact of low SES on early CHD was not reduced by adjusting for other CHD risk factors, including body mass index, cholesterol level, amount of exercise, depression, coffee drinking, smoking, hypertension, diabetes mellitus, and parental CHD history. Low childhood SES did not confer an increased risk of all-cause mortality. Conclusions: Low childhood SES is associated with an increased incidence of CHD before age 50 years among men with high adulthood SES. This risk is not mediated by traditional risk factors for CHD. These findings highlight the importance of childhood events on the development of CHD early in adulthood and the persistent effects of low SES.

Age and Markers of Inflammation

▪ Emerging Risk Factors Collaboration 2010 C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality- an individual participant meta-analysis - Lancet

Life History Strategies: English Neighborhoods - Continued

▪ Millenium Cohort Study: longitudinal examination of children born in 2000 and 2001. ▪ England divided into 32,000 neighborhoods (~1500 people per) ****************** Paternal involvement with the child was assessed using the same 7 questions about activities with the child in the partner interview of 2006-2007. Note that these items reflect investment by the mother's current partner, which is most often the biological father of the child but in some cases is the stepfather. From web found this: E.parenting Activities (pa) CPREOFA0 S3 PART: How often reads to CM C1 CPSITSA0 S3 PART: How often tells stories to CM C1 CPPLMUA0 S3 PART: How often does musical activities with CM C1 CPPAMAA0 S3 PART: How often draws/paints with CM C1 CPACTIA0 S3 PART: How often plays physically active games with CM C1 CPGAMEA0 S3 PART: How often plays games/toys indoors with CM C1 CPWALKA0 S3 PART: How often takes CM to park/playground C1 CPBEDRA0 S3 PART: How often puts CM to bed (partner) C1 CPLOOKA0 S3 PART: How often looks after CM on own (partner) C1

Life History Strategies: English Neighborhoods

▪ Millenium Cohort Study: longitudinal examination of children born in 2000 and 2001. (n = ~8500) ▪ England divided into 32,000 neighborhoods (~1500 people per) --> the bottom line represents a measure akin to self-reported health ******************** Nettle, D. (2010). Dying young and living fast- Variation in life history across English neighborhoods. Behavioral Ecology *Where the expected reproductive life span is short, theory predicts that individuals should follow a ''fast'' life-history strategy of early reproduction, reduced investment in each offspring, and high reproductive rate. I apply this prediction to different neighborhood environments in contemporary England*. There are substantial differences in the expectation of healthy life between the most deprived and most affluent neighborhoods. Using data from the Millennium Cohort Study (n . 8660 families), I show that *in deprived neighborhoods compared with affluent ones, age at first birth is younger, birthweights are lower, and breastfeeding duration is shorter. There is also indirect evidence that reproductive rates are higher*. Coresidence of a father figure is less common, and contact with maternal grandmothers is less frequent, though grandmaternal contact shows a curvilinear relationship with neighborhood quality. Children from deprived neighborhoods perform less well on a verbal cognitive assessment at age 5 years, and this deficit is partly mediated by parental age and investment variables. I suggest that fast life history is a comprehensible response, produced through phenotypic plasticity, to the ecological context of poverty, but one that entails specific costs to children.

Life History Strategies: English Neighborhoods - Conclusions (3)

▪ More offspring per family in more stressful neighborhoods ▪ Maternal Age, birthweight, Breastfeeding duration, paternal involvement, maternal grandmother involvement all explain neighborhood effects on cognitive skills (at age 5). ▪ these effects are highly adaptive in the context of stress, may not be adaptive for contemporary societal goals *********************** Nettle's Conclusion: It is not my intention to add to such stigmatization. On the contrary, the central premise of the behavioral ecological perspective taken in this study is that behavior is best seen as an adaptive response, produced through phenotypic plasticity, to the environment, which the individual faces. Much as Geronimus et al. (1999) argued for parts of the urban United States, it is completely comprehensible—predictable, even —that people in the poorest areas of England will follow a somewhat accelerated life history strategy, given the increased risks of premature mortality and morbidity that they face. These behaviors are not mistakes or negligence, so much as coherent strategic responses to the context in which people have to live. However, as with any life history decision, there are costs as well as benefits, and those costs fall on the development of each individual child.

Low Birthweight & Adult Disease Study (3)

▪ Trier Social Stress Test in 106 males (Age 19) ▪ Participants provided birth records --> Lower birthweight, greater cortisol response ************************* Wust et al 2005 Birth weight is associated with salivary cortisol responses to psychosocial stress in adult life - PNE Fetal programming of the hypothalamus-pituitary-adrenal (HPA) axis was proposed as one mechanism underlying the link between prenatal stress, adverse birth outcomes (particularly low birth weight) and an enhanced vulnerability for several diseases later in life. In recent studies, birth weight was significantly related to basal cortisol levels as well as to cortisol responses to pharmacological stimulation. In order to investigate the association between cortisol responses to psychological challenge, birth weight and length of gestation, 106 young healthy males were exposed to the 'Trier Social Stress Test'. Salivary cortisol responses to the stress exposure were significantly and inversely related to the subjects' birth weight, while the analysis of the impact of gestational age yielded inconsistent results. This finding is consistent with the concept of fetal programming of the HPA axis and provides the first preliminary evidence for an association between birth weight and adrenocortical responses to psychosocial stress. As the investigated subjects were twins, possible implications of this sample characteristic for the present findings are discussed.

Socioeconomic Stress

▪ almost all species (not sure of any that don't) form dominance hierarchies

Socioeconomic Status and IL 6 - Representative Sample of Americans in Midlife

▪ lower SES associated w/ increased IL 6 cytokine ▪ higher SES associated w/ decreased IL 6 cytokine ▪ this is just correlational (weak evidence) ******************************************************************** ▪where does this evidence fall about whether SES is related to these health markers? ▪this is all correlational data , which means this is weak evidence ▪it would be hard to do a RCT becuase you couldn't just take people and put them into different SES ▪not ethical (ex: can't take a rich person and put them in a low SES neighborhood) ******************** Friedman & Herd 2010 Income, education, and inflammation: differential associations in a national probability sample (The MIDUS study) - PM *OBJECTIVE:* To examine the associations between income and education and three markers of inflammation: interleukin-6 (IL-6), C-reactive protein (CRP), and fibrinogen. Socioeconomic status is inversely linked with health outcomes, but the biological processes by which social position "gets under the skin" to affect health are poorly understood. *METHOD:* Cross-sectional analyses involved participants (n = 704) from the second wave of the national population-based Survey of Midlife Development in the United States (MIDUS). Data on pretax household-adjusted income and educational attainment were collected by questionnaire and telephone interview, respectively. Detailed medical history interviews, inventories of medication, and fasting blood samples for assessment of inflammatory proteins were obtained during an overnight clinic stay. *RESULTS:* All three inflammatory proteins were inversely associated with both income and education in bivariate analyses. However, multivariate regression models, adjusting for potential confounds, showed that only low income predicted higher levels of inflammatory proteins. Moreover, inclusion of IL-6 in the regression models for CRP and fibrinogen eliminated the associations with income. *CONCLUSION:* These results suggest that income explains the association between education and peripheral inflammation. In short, the reason that higher education is linked to reduced peripheral inflammation is because it reduces the risk for low income status, which is what is directly associated with reduced peripheral inflammation. The findings also suggest that the links between income and both CRP and fibrinogen are mediated by IL-6. These observations help to sharpen our understanding of the relationship between social position and biological markers of illness in the United States.

Results of the Questionnaire (3)

▪ the more of the negative events you had, the more likely you are to be a smoker ▪ it seems that early life seems to drive certain health behaviors ▪ if you've been exposed to early adversity , you risk for suicide will be increased by 9X ********************* Felitti et al (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults- The Adverse Childhood Experiences (ACE) Study Background: The relationship of health risk behavior and disease in adulthood to the breadth of exposure to childhood emotional, physical, or sexual abuse, and household dysfunction during childhood has not previously been described. Methods: A questionnaire about adverse childhood experiences was mailed to 13,494 adults who had completed a standardized medical evaluation at a large HMO; 9,508 (70.5%) responded. Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of these adverse childhood experiences was then compared to measures of adult risk behavior, health status, and disease. Logistic regression was used to adjust for effects of demographic factors on the association between the cumulative number of categories of childhood exposures (range: 0-7) and risk factors for the leading causes of death in adult life. Results: More than half of respondents reported at least one, and one-fourth reported $2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P , .001). Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, $50 sexual intercourse partners, and sexually transmitted disease; and a 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life. Conclusions: We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.

Experimental Study of SES Effects (3)

▪ they tried to do a RCT ▪ the people who used the vouchers to move away ended up having better health ▪ this was short term ***************** Ludwig et al 2012 Neighborhood Effects on the Long-Term Well-Being of Low-Income Adults - Science.pdf Nearly 9 million Americans live in extreme-poverty neighborhoods, places that also tend to be racially segregated and dangerous. Yet, the effects on the well-being of residents of moving out of such communities into less distressed areas remain uncertain. Using data from Moving to Opportunity, a unique randomized housing mobility experiment, we found that moving from a high-poverty to lower-poverty neighborhood leads to long-term (10- to 15-year) improvements in adult physical and mental health and subjective well-being, despite not affecting economic self-sufficiency. A 1-standard deviation decline in neighborhood poverty (13 percentage points) increases subjective well-being by an amount equal to the gap in subjective well-being between people whose annual incomes differ by $13,000—a large amount given that the average control group income is $20,000. Subjective well-being is more strongly affected by changes in neighborhood economic disadvantage than racial segregation, which is important because racial segregation has been declining since 1970, but income segregation has been increasing.

Questionnaire

▪ this is the actual questionnaire ▪ they tallied up the negative events