Abstract from: Brain, Behavior, and Immunity (in press)
Resilience and immunity
Dantzer, Cohen, Russo, & Dinan
Resilience is the process that allows individuals to adapt to adverse conditions and recover from them. This process is favored by individual qualities that have been amply studied in the field of stress such as personal control, positive affect, optimism, and social support. Biopsychosocial studies on the individual qualities that promote resilience show that these factors help protect against the deleterious influences of stressors on physiology in general and immunity in particular. The reverse is also true as there is evidence that immune processes influence resilience. Most of the data supporting this relationship comes from animal studies on individual differences in the ability to resist situations of chronic stress. These data build on the knowledge that has accumulated on the influence of immune factors on brain and behavior in both animal and human studies. In general, resilient individuals have a different immunophenotype from that of stress susceptible individuals. It is possible to render susceptible individuals resilient and vice versa by changing their inflammatory phenotype. The adaptive immune phenotype also influences the ability to recover from inflammation-induced symptoms. The modulation of these bidirectional relationships between resilience and immunity by the gut microbiota opens the possibility to influence them by probiotics and prebiotics. However, more focused studies on the reciprocal relationship between resilience and immunity will be necessary before this can be put into practice.
Abstract from: Annual Review of Psychology
Cohen, Murphy, & Prather
After over 70 years of research on the association between stressful life events and health, it is generally accepted that we have a good understanding of the role of stressors in disease risk. In this review, we highlight that knowledge but also emphasize misunderstandings and weaknesses in this literature with the hope of triggering further theoretical and empirical development. We organize this review in a somewhat provocative manner, with each section focusing on an important issue in the literature where we feel that there has been some misunderstanding of the evidence and its implications. Issues that we address include the definition of a stressful event, characteristics of diseases that are impacted by events, differences in the effects of chronic and acute events, the cumulative effects of events, differences in events across the life course, differences in events for men and women, resilience to events, and methodological challenges in the literature.
Abstract from: Developmental Psychobiology (2018)
Low childhood subjective social status and telomere length in adulthood: The role of attachment orientations
Murdock, Seiler, Chirinos, Garcini, Acebo, Cohen, & Fagundes
Low subjective social status (SSS) in childhood places one at greater risk of a number of health problems in adulthood. Theoretical and empirical evidence indicates that exposure to supportive parenting may buffer the negative effects of low childhood SSS on adult health. Given the importance of supportive caregivers and close others for the development of attachment orientations throughout the lifespan, attachment theory may be important for understanding why some individuals are resilient to the negative effects of low childhood SSS on adult health while others are not. We examined if attachment anxiety and attachment avoidance altered the association between childhood subjective social status (SSS) and length of telomeres in white blood cells in adulthood. Shorter telomere length is associated with increased risk of age-related diseases including cancer, type 2 diabetes, and cardiovascular disease. Participants (N = 128) completed self-report measures of childhood SSS and attachment orientations, as well as a blood draw. We found that among those with low childhood SSS, low attachment anxiety was associated with longer telomere length in white blood cells in comparison to high attachment anxiety controlling for participant age, sex, race, body mass index, and adult SSS. Among those with high childhood SSS, low attachment anxiety was associated with a slight decrease in telomere length. Attachment avoidance was unrelated to length of telomeres. Such findings provide further evidence for the role that close relationships may have on buffering SSS related health disparities.
Abstract from: Health Psychology (2018)
Crittenden, Murphy, & Cohen
OBJECTIVES: We tested the hypothesis that social integration, measured as number of social roles, is associated with less age-related loss of lung function, an important marker of health and longevity. We also investigated possible psychological factors through which social integration might influence lung health. METHODS: Data were analyzed from the Health and Retirement Study (ages 52-94, n = 4,224). RESULTS AND CONCLUSIONS: Each additional social role reported at baseline was associated with less of a decline in lung function between baseline and the follow-up assessment four years later. The association withstood controls for demographics, weight, and height and was mediated by more positive and less negative affect and lower rates of cigarette smoking and more physical activity. Roles were mostly substitutable, with both high (spouse, parent, friends, relatives) and low (employee, religious service attendee, volunteer, members of other groups) intimacy roles independently contributing to less age-related decline in lung function.
Abstract from: Psychoneuroendocrinology (2018)
Age moderates the association between social integration and diurnal cortisol measures
Chin, Murphy, & Cohen
Social integration is defined as the degree to which an individual participates in a broad range of social relationships. Although measures of social integration vary across studies, it is often assessed as the number of social roles (e.g., parent, friend, student, volunteer) that an individual reports actively participating in. More socially integrated individuals tend to be healthier than those less socially integrated, but the biological mechanisms through which this occurs remain unclear. One possibility is that social integration might alter the function of the hypothalamic-pituitary-adrenal axis, of which cortisol is a key product, and in turn influence a broad range of health outcomes. This study examined the association between social integration and two indices of cortisol in a community sample of 680 healthy men and women aged 18-55. Because the social roles held by younger individuals may be more numerous yet superficial than those held by older individuals, this study also tested the hypothesis that these associations could be moderated by age such that lower levels of integration would be associated with cortisol dysregulation for older but not younger individuals in our sample. Participants provided salivary cortisol samples during waking hours on three days that were used to calculate diurnal cortisol levels and slopes. Increased social integration was associated with lower cortisol AUC among older (ages 35-55) but not younger (ages 18-34) individuals in our sample. Moreover, while increased social integration was associated with steeper diurnal cortisol slopes regardless of age, this association was strongest among older individuals. Differences in health behaviors, affect, and psychological stress did not mediate these associations. The results of this study support cortisol as a candidate biological mechanism through which increased social integration is associated with better physical health among older individuals.
Abstract from: Annals of Allergy, Asthma, and Immunology (2017)
Rosa, Just, Kloog, Pantic, Schnaas, Lee, Bose, Chiu, Hsu, Coull, Schwartz, Cohen, Tellez Rojo, Wright, & Wright
BACKGROUND: Air pollution exposure in childhood is associated with greater incidence and exacerbation of asthma, particularly in children whose parents report high levels of psychological stress. However, this interaction has not been completely elucidated in pregnancy. OBJECTIVE: To examine whether the association between prenatal exposure to particulate matter no larger than 2.5 μm in diameter (PM2.5) and wheeze in children is modified by prenatal stress. METHODS: Mexican women were recruited during pregnancy (N = 552). Residential prenatal daily exposure to PM2.5 was estimated using a satellite-based spatiotemporally resolved prediction model and averaged over trimesters. Maternal stress was indexed by maternal negative life events (NLE) score (range 0-11) ascertained during mid to late pregnancy. NLE scores were dichotomized at the median as low (NLE score ≤ 3) and high (NLE score > 3) stress. Reports of ever wheeze and wheeze in the past 12 months (current wheeze) for children were obtained using the International Study of Asthma and Allergies in Childhood survey at 48 months. The association between prenatal PM2.5 and wheeze was analyzed using a modified Poisson regression and stratified by low vs high stress. RESULTS: Greater PM2.5 exposure during the first trimester was associated with increased risk of current wheeze among children with mothers reporting high prenatal stress (relative risk 1.35, 95% confidence interval 1.00-1.83, per interquartile range increase 3.8 μg/m3) but not among those reporting low stress (relative risk 0.84, 95% confidence interval 0.61-1.16, per interquartile range increase 3.8 μg/m3; P for interaction = .04). CONCLUSION: Increased prenatal stress enhanced the association between PM2.5 exposure in early pregnancy, and child wheeze at 48 months of age. It is important to consider chemical and nonchemical stressors together to more comprehensively characterize children's environmental risk.
Abstract from: Annals of Behavioral Medicine (2017)
Prather, Janicki-Deverts, Adler, Hall, & Cohen
BACKGROUND: Sleep is a predictor of infectious illness that may depend on one's socioeconomic status (SES). PURPOSE: This study aimed to investigate the moderating effects of objective and subjective SES on sleep-clinical cold risk link and test whether nasal inflammation serves as a plausible biological pathway. METHODS: This study combined data (n = 732) from three viral challenge studies. Measures of self-reported sleep and objective and subjective measures of SES were obtained. Participants were quarantined and administrated rhinovirus (RV) or influenza virus and monitored over 5 (RV) or 6 (influenza) days for the development of a cold. Symptom severity, including mucus production and nasal clearance time, and levels of nasal cytokines (interleukin (IL)-6 and IL-1β) were measured prior to administration and each day during the quarantined period. RESULTS: Subjective SES, but not objective SES, moderated associations between shorter sleep duration and increased likelihood of a clinical cold. Compared to ≥8-hour sleepers, ≤6-hour sleepers with low subjective SES were at increased risk for developing a cold (OR = 2.57, 95% CI 1.10-6.02). There was no association between sleep duration and colds in high subjective SES participants. Among infected individuals who reported low subjective SES, shorter sleep duration was associated with greater mucus production. There was no evidence that markers of nasal inflammation mediated the link between sleep duration and cold susceptibility among those reporting low subjective SES. CONCLUSION: Subjective SES may reflect an important social factor for understanding vulnerability to and protection against infectious illness among short sleepers.
Abstract from: Proceedings of the National Academy of Sciences of the United States of America (2017)
Murphy, Cohen, Janicki-Deverts, & Doyle
Exposure to parental separation or divorce during childhood has been associated with an increased risk for physical morbidity during adulthood. Here we tested the hypothesis that this association is primarily attributable to separated parents who do not communicate with each other. We also examined whether early exposure to separated parents in conflict is associated with greater viral-induced inflammatory response in adulthood and in turn with increased susceptibility to viral-induced upper respiratory disease. After assessment of their parents’ relationship during their childhood, 201 healthy volunteers, age 18–55 y, were quarantined, experimentally exposed to a virus that causes a common cold, and monitored for 5 d for the development of a respiratory illness. Monitoring included daily assessments of viral-specific infection, objective markers of illness, and local production of proinflammatory cytokines. Adults whose parents lived apart and never spoke during their childhood were more than three times as likely to develop a cold when exposed to the upper respiratory virus than adults from intact families. Conversely, individuals whose parents were separated but communicated with each other showed no increase in risk compared with those from intact families. These differences persisted in analyses adjusted for potentially confounding variables (demographics, current socioeconomic status, body mass index, season, baseline immunity to the challenge virus, affectivity, and childhood socioeconomic status). Mediation analyses were consistent with the hypothesis that greater susceptibility to respiratory infectious illness among the offspring of noncommunicating parents was attributable to a greater local proinflammatory response to infection.
Abstract from: Journal of Allergy and Clinical Immunology (2017)
Lee, Leon Hsu, Mathilda Chiu, Bose, Rosa, Kloog, Wilson, Schwartz, Cohen, Coull, Wright, & Wright
Background: The impact of prenatal ambient air pollution on child asthma may be modified by maternal stress, child sex, and exposure dose and timing. Objective: We prospectively examined associations between coexposure to prenatal particulate matter with an aerodynamic diameter of less than 2.5 microns (PM2.5) and maternal stress and childhood asthma (n = 736). Methods: Daily PM2.5 exposure during pregnancy was estimated using a validated satellite-based spatiotemporally resolved prediction model. Prenatal maternal negative life events (NLEs) were dichotomized around the median (high: NLE ≥ 3; low: NLE < 3). We used Bayesian distributed lag interaction models to identify sensitive windows for prenatal PM2.5 exposure on children's asthma by age 6 years, and determine effect modification by maternal stress and child sex. Results: Bayesian distributed lag interaction models identified a critical window of exposure (19-23 weeks' gestation, cumulative odds ratio, 1.15; 95% CI, 1.03-1.26; per interquartile range [1.7 μg/m3] increase in prenatal PM2.5 level) during which children concomitantly exposed to prenatal PM2.5 and maternal stress had increased risk of asthma. No significant association was seen in children born to women reporting low prenatal stress. When examining modifying effects of prenatal stress and fetal sex, we found that boys born to mothers with higher prenatal stress were most vulnerable (19-21 weeks' gestation; cumulative odds ratio, 1.28; 95% CI, 1.15-1.41; per interquartile range increase in PM2.5). Conclusions: Prenatal PM2.5 exposure during sensitive windows is associated with increased risk of child asthma, especially in boys concurrently exposed to elevated maternal stress.
Abstract from: Annals of Allergy and Asthma Immunology (2017)
Lee, Chiu, Rosa, Cohen, Coull, Wright, Morgan, & Wright
Background: No prior study has examined associations between prenatal and early-life stress on childhood lung function or identified critical windows of exposure. Objective: To prospectively examine associations between prenatal and early-life stress and childhood lung function. Methods: Stress was indexed by a maternal negative life events (NLEs) score ascertained during pregnancy and between 1 and 2 years post partum. Spirometry was performed when children were a mean (SD) of 6.99 (0.89) years old. Associations of prenatal and early postnatal stress with spirometry z scores were examined in 199 children using linear regression. Effect modification by child sex was explored. Results: Most mothers were minorities (65% Hispanic, 21% African American), had 12 years or less of education (67%), and did not smoke prenatally (78%). The highest level of prenatal stress (≥5 NLEs) was associated with lower levels of forced expiratory volume in 1 second (FEV1) (z score = −0.53, P = .03), forced vital capacity (FVC) (z score = −0.49, P = .04), and forced expiratory flow between 25% and 75% (FEF25%–75%) (z score = −0.68, P = .01) after covariate adjustment; effects were similar for postnatal stress considered separately. In sex-stratified analyses, high postnatal stress (≥5 NLEs) was associated with lower FEV1 (z score = −0.76, P = .01), FVC (z score = −0.77, P = .01), and FEF25%–75% (z score = −0.67, P = .02) in boys but not girls, although the interaction term was not significant (P for interaction >.10). Conclusion: These are the first prospective data that link perinatal stress with reduced child lung function. High levels of stress in the prenatal and postnatal periods were associated with symmetric reductions in FEV1 and FVC consistent with impaired lung growth. Given that lung function growth patterns are established by 7 years of age, these findings have lifelong implications.
Abstract from: Journal of Personality (2017)
Janicki-Deverts, Cohen, & Doyle
Objective: The aim was to examine whether trait positive and negative affect (PA, NA) moderate the stress-buffering effect of perceived social support on risk for developing a cold subsequent to being exposed to a virus that causes mild upper respiratory illness. Method: Analyses were based on archival data from 694 healthy adults (Mage = 31.0 years, SD = 10.7 years; 49.0% female; 64.6% Caucasian). Perceived social support and perceived stress were assessed by self-report questionnaire and trait affect by aggregating responses to daily mood items administered by telephone interview across several days. Subsequently, participants were exposed to a virus that causes the common cold and monitored for 5 days for clinical illness (infection + objective signs of illness). Results: Two 3-way interactions emerged—Support x Stress x PA and Support x Stress x NA. The nature of these effects was such that among persons with high trait PA or low trait NA, greater social support attenuated the risk of developing a cold when under high but not low perceived stress; this stress-buffering effect did not emerge among persons with low trait PA or high trait NA. Conclusions: Dispositional affect might be used to identify individuals who may be most responsive to social support and support-based interventions.
Abstract from: Psychoneuroendocrinology (2017)
Chin, Murphy, Janicki-Deverts, & Cohen
Married people tend to be healthier than both the previously (bereaved, divorced, and separated) and never married, but the mechanisms through which this occurs remain unclear. To this end, research has increasingly focused on how psychological stress experienced by unmarried versus married individuals may differentially impact physiological systems related to health. One key system that is modulated by stress is the hypothalamic-pituitary-adrenal (HPA) axis, of which cortisol is a key hormonal product. Increased cortisol production and disruption of cortisol's daily rhythm have been linked to poorer health outcomes. This study examined the association between current marital status and these two indices of cortisol in a community sample of 572 healthy men and women aged 21-55. It also tested whether marriage buffers against the effect of stress (perceived stress by marital status interaction) on cortisol production. Participants provided salivary cortisol samples during waking hours on three nonconsecutive separate days to calculate diurnal cortisol levels and slopes. Married individuals had lower cortisol levels than either their never married or previously married counterparts. Differences in cortisol levels were due at least in part to currently married individuals having a more rapid decline in cortisol through the afternoon hours compared to individuals who were never married (but not those who were previously married). Furthermore, there was an interaction between perceived stress and marital status in predicting cortisol levels. Specifically, higher stress was associated with higher cortisol levels for previously married individuals but not for the married or never married. The results of this study support cortisol as one candidate mechanism accounting for the association of marital status and health.
Abstract from: Health Psychology (2016)
Miller, Cohen, Janicki-Deverts, Brody, & Chen
Objective: Studies have revealed a phenomenon called skin-deep resilience, which develops in upwardly mobile African American youth. They perform well in school, maintain good mental health, and avoid legal problems. Despite outward indications of success, they also show evidence of worse health in biomarker studies. Here we extend this research, asking whether it manifests in differential susceptibility to upper respiratory infection, and if it emerges in European Americans as well. Methods: The sample included 514 adults in good health, as judged by physician examination and laboratory testing. Participants completed questionnaires about lifecourse socioeconomic conditions, conscientiousness, psychosocial adjustment, and lifestyle factors. They were subsequently inoculated with a rhinovirus that causes upper respiratory infection, and monitored in quarantine for 5 days the development of illness. Results: Consistent with past work, African Americans from disadvantaged backgrounds displayed indications of skin-deep resilience. To the extent these participants were high in conscientiousness, they fared better across multiple domains of psychosocial functioning, as reflected in educational attainment, symptoms of depression, and close relationship quality (p values = .01–.04). But analyses of these participants’ susceptibility to infection revealed the opposite pattern; higher conscientiousness was associated with a greater likelihood of becoming ill following inoculation (p value = .03). In European Americans, there was no evidence of skin-deep resilience; conscientiousness was associated with better psychosocial outcomes, but not infection risk. Conclusions: These observations suggest that resilience may be a double-edged sword for African Americans from disadvantaged backgrounds. The same characteristics associated with academic success and psychological adjustment forecast increased vulnerability to health problems.
Abstract from: Brain, Behavior, and Immunity (2016)
Lockwood, Marsland, Cohen, & Gianaros
Individuals differ consistently in the magnitude of their inflammatory responses to acute stressors, with females often showing larger responses than males. While the clinical significance of these individual differences remains unclear, it may be that greater inflammatory responses relate to increased systemic inflammation and thereby risk for chronic inflammatory disease. Here, we examined whether acute stressor-evoked interleukin (IL)-6 responses associate with resting levels of C-reactive protein (CRP), a marker of systemic inflammation, and whether this association differs by sex. Subjects were 57 healthy midlife adults (30-51years; 33% female; 68% white). Blood was drawn before and 30-min after two mental stress tasks: a multisource interference task and a Stroop color word task. Hierarchical regressions controlling for age, sex, race, and BMI tested whether stressor-evoked IL-6 responses were associated with resting CRP and whether this association differed by sex. Results indicated that sex and stressor-evoked IL-6 responses interacted to predict CRP (change in R^2=0.08, B=-1.33, beta=-0.39, p=0.02). In males, larger stressor-evoked IL-6 responses associated with higher CRP, whereas in females, stressor-evoked IL-6 responses showed a non-significant negative association with CRP. These findings indicate that inflammatory responses to acute stressors associate with resting levels of CRP; however, this association differs by sex. Previous literature suggests that there are sex differences in stressor-evoked IL-6 responses, but this is the first study to show sex differences in the relationship between acute inflammatory responses and systemic inflammation. The contribution of these sex differences to inflammatory disease risk warrants further investigation.
Abstract from: Brain, Behavior, and Immunity (2016)
Janicki-Deverts, Cohen, Turner, & Doyle
The immunosuppressive effects of glucocorticoids (GCs) are well-established. However, whether the net effect of GC-elicited alterations in immune function is sufficient to influence a clinically relevant outcome in healthy adults has yet to be shown. The aim of the present study was to investigate whether inter-individual differences in basal salivary cortisol production are associated with increased risk and severity of infection and subsequent illness following experimental exposure to a virus that causes the common cold. The present analyses combine archival data from three viral-challenge studies. Participants were 608 healthy adults, aged 18 to 55 years (49.2% female; 65.8% white), who each completed a three-day saliva collection protocol; was subsequently exposed to a virus that causes the common cold; and monitored for 5 days for objective signs of infection (presence of challenge virus in nasal secretions) and clinical illness (mucus weight, mucociliary clearance time). Basal cortisol production (operationalized as the calculated area-under-the-curve averaged across the 3 days) showed a graded association with infection risk, with those producing higher levels of cortisol being at greater risk. Cortisol also showed a continuous association with duration of viral shedding, an indicator of viral replication and continuing infection, such that higher cortisol concentrations predicted more days of shedding. Cortisol was not, however, related to severity of objective illness. These findings are the first to demonstrate in healthy adults an association between basal cortisol production and an objectively measured and clinically relevant infectious disease outcome.
Abstract from: Perspectives in Psychological Science (2016)
Cohen, Gianaros, & Manuck
In this article, we argued that the term stress has served as a valuable heuristic, helping researchers to integrate traditions that illuminate different stages of the process linking stressful life events to disease. We provided a short history of three traditions in the study of stress: the epidemiological, psychological, and biological. The epidemiological tradition focuses on defining which circumstances and experiences are deemed stressful on the basis of consensual agreement that they constitute threats to social or physical well-being. The psychological tradition focuses on individuals’ perceptions of the stress presented by life events on the basis of their appraisals of the threats posed and the availability of effective coping resources. The biological tradition focuses on brain-based perturbations of physiological systems that are otherwise essential for normal homeostatic regulation and metabolic control. The foci of these three traditions have informed elements of a stage model of disease, wherein events appraised as stressful are viewed as triggering affective states that in turn engender behavioral and biological responses having possible downstream implications for disease.
Abstract from: Sleep (2015)
Prather, Janicki-Deverts, Hall, & Cohen
Study Objectives: Short sleep duration and poor sleep continuity have been implicated in the susceptibility to infectious illness. However, prior research has relied on subjective measures of sleep, which are subject to recall bias. The aim of this study was to determine whether sleep, measured behaviorally using wrist actigraphy, predicted cold incidence following experimental viral exposure. Design, Measurements, and Results: A total of 164 healthy men and women (age range, 18 to 55 y) volunteered for this study. Wrist actigraphy and sleep diaries assessed sleep duration and sleep continuity over 7 consecutive days. Participants were then quarantined and administered nasal drops containing the rhinovirus, and monitored over 5 days for the development of a clinical cold (defined by infection in the presence of objective signs of illness). Logistic regression analysis revealed that actigraphy- assessed shorter sleep duration was associated with an increased likelihood of development of a clinical cold. Specifically, those sleeping < 5 h (odds ratio [OR] = 4.50, 95% confidence interval [CI], 1.08-18.69) or sleeping between 5 to 6 h (OR = 4.24, 95% CI, 1.08-16.71) were at greater risk of developing the cold compared to those sleeping > 7 h per night; those sleeping 6.01 to 7 h were at no greater risk (OR = 1.66; 95% CI 0.40-6.95). This association was independent of prechallenge antibody levels, demographics, season of the year, body mass index, psychological variables, and health practices. Sleep fragmentation was unrelated to cold susceptibility. Other sleep variables obtained using diary and actigraphy were not strong predictors of cold susceptibility. Conclusions: Shorter sleep duration, measured behaviorally using actigraphy prior to viral exposure, was associated with increased susceptibility to the common cold.
Abstract from: Psychosomatic Medicine (2015)
Cohen, Janicki-Deverts, & Doyle
Objectives: To explore the association of self-rated health (SRH) with host resistance to illness after exposure to a common cold virus and identify mechanisms linking SRH to future health status. Methods: We analyzed archival data from 360 healthy adults (mean [standard deviation] age = 33.07 [10.69] years, 45.6% women). Each person completed validated questionnaires that assessed SRH (excellent, very good, good, fair, poor), socioemotional factors, and health practices and was subsequently exposed to a common cold virus and monitored for 5 days for clinical illness (infection and objective signs of illness). Results: Poorer SRH was associated in a graded fashion with greater susceptibility to developing clinical illness (good/fair versus excellent: odds ratio = 3.21, 95% confidence interval = 1.47-6.99; very good versus excellent: odds ratio = 2.60, 95% confidence interval = 1.27-5.32), independent of age, sex, race, prechallenge immunity (specific antibody), body mass, season, education, and income. Greater illness risk was not attributable to infection, but to increased likelihood of developing objective signs of illness once infected. Poorer SRH also correlated with poorer health practices, increased stress, lower positive emotions, and other socioemotional factors. However, none of these (alone or together) accounted for the association between SRH and host resistance. Additional data (separate study) indicated that history of having colds was unrelated to susceptibility and hence also did not account for the SRH link with immunocompetence. Conclusions: Poorer SRH is associated with poorer immunocompetence, possibly reflecting sensitivity to sensations associated with premorbid immune dysfunction. In turn, poorer immune function may be a major contributing mechanism linking SRH to future health.
Abstract from: Psychological Science (2015)
Cohen, Janicki-Deverts, Turner, & Doyle
Perceived social support has been hypothesized to protect against the pathogenic effects of stress. How such protection might be conferred, however, is not well understood. In 406 healthy adults, we examined the roles of perceived social support and received hugs in buffering against interpersonal stress-induced susceptibility to infectious disease. Perceived support was assessed by questionnaire, and daily interpersonal conflict and receipt of hugs by telephone interviews on 14 consecutive evenings. Subsequently, participants were exposed to a virus that causes a common cold, and monitored in quarantine to assess infection and illness signs. Perceived support protected against the rise in infection risk associated with increasing frequency of conflict. A similar stress-buffering effect emerged for hugging, which explained 32% of the attenuating effect of support. Among infected participants, greater perceived support and more frequent hugs each predicted less severe illness signs. These data suggest that hugging may act as an effective means of conveying support.
Abstract from: Brain, Behavior, and Immunity (2014)
Janicki-Deverts, Cohen, Doyle, Marsland, & Bosch
Childhood adversity, defined in terms of material hardship or physical or emotional maltreatment has been associated with risk for infection with cytomegalovirus (CMV) among children and adolescents, and with CMV reactivation in children and adults. The present study examined whether different dimensions of childhood experience-those pertaining to socioeconomic status (SES), physical environment, or family relationships, relate differentially to CMV serostatus and reactivation during adulthood. Participants were 140 healthy adults, aged 18-55 years (41% female; 64% white). Childhood environments were assessed retrospectively and included family SES (parental housing tenure); childhood neighborhood environment (urban residence; physical conditions; safety; and social atmosphere); residential exposures (parental smoking and physical condition of home); family relationships (parental divorce; warmth; harmony; dysfunction; parental bonding); and overall perceived stress during childhood. Approximately 39% (n = 53) of participants were CMV+. In individual analyses controlling for age, sex, race, body mass, current adult SES and smoking status, fewer years of parental home ownership, having a parent who smoked, and living in a poorly maintained or unsafe neighborhood each were associated with greater odds of infection with CMV. By comparison, in individual analyses limited to CMV+ participants, less family warmth, less harmony, greater dysfunction, and suboptimal parental bonding each were related to higher antibody levels, independent of the aforementioned covariates. Findings were not attributable to current adult perceptions of psychological stress or relative levels of emotional stability. These results suggest that different types of childhood adversity may be associated with differential effects on CMV infection and latency.
Abstract from: Health Psychology (2014)
Sneed & Cohen
Objective: To determine if negative social interactions are prospectively associated with hypertension among older adults. Methods: This is a secondary analysis of data from the 2006 and 2010 waves of the Health and Retirement Study, a survey of community-dwelling older adults (age >50). Total average negative social interactions were assessed at baseline by averaging the frequency of negative interactions across four domains (partner, children, other family, friends). Blood pressure was measured at both waves. Individuals were considered to have hypertension if they reported use of antihypertensive medications, had measured average resting systolic blood pressure ≥ 140 mmHg, or measured average resting diastolic blood pressure ≥90 mmHg. Analyses excluded those hypertensive at baseline and controlled for demographics, personality, positive social interactions, and baseline health. Results: Twenty-nine percent of participants developed hypertension over the four-year follow-up. Each one-unit increase in the total average negative social interaction score was associated with a 38% increased odds of developing hypertension. Sex moderated the association between total average negative social interactions and hypertension, with effects observed among women but not men. The association of total average negative interactions and hypertension in women was attributable primarily to interactions with friends, but also to negative interactions with family and partners. Age also moderated the association between total average negative social interactions and hypertension, with effects observed among those ages 51-64, but not those ages ≥65. Conclusion: In this sample of older adults, negative social interactions were associated with increased hypertension risk in women and the youngest older adults.
Abstract from: Psychoneuroendocrinology (2014)
Seeman, Gruenewald, Cohen, Williams, & Matthews
Objective: Analyses test the hypothesis that aspects of social relationships (quantity of ties, social support and social strain) are associated with differences in levels of biological risk across multiple major physiological regulatory systems and consequently overall multi-systems risk (i.e., allostatic load [AL]). Methods: Data are from the Coronary Artery Risk Development in Young Adults (CARDIA) study - a bi-ethnic, prospective, multi-center epidemiological study, initiated in 1985-86 to track the development of cardiovascular risk in young adulthood(N=5,115). At the year 15 follow-up when participants were between 32-45 years of age, additional social and biological data were collected; biological data used to assess AL were collected at the Oakland, CA and Chicago, IL sites (N=844). Results: Social strains were most strongly and positively related to overall AL (Cohen's d=.79 for highest vs. lowest quartile), and to each of its component biological subsystems, independent of social ties and support as well as sociodemographics and health behaviors. Social ties and emotional support were also negatively related to AL (Cohen's d=.33 and d=.44 for lowest vs. highest quartiles of ties and support, respectively) though controls for social strains reduced these associations to nonsignificance. Social support and social strain were more strongly related to overall AL than to any of its component subscales while social ties were less strongly related to AL and to its component subscales. There was no evidence that effects differed by sex, age or ethnicity. Conclusions: Findings focus attention on the particularly strong relationship between social strains and profiles of biological risk and support the cumulative impact of social factors on biological risks, showing larger effects for cumulative AL than for any of the individual biological systems.
Abstract from: Health Psychology (2014)
Crittenden, Pressman, Cohen, Janicki-Deverts, Smith, & Seeman
Objective: This study sought to determine whether social integration, defined as number of social roles, is associated with better pulmonary function in the elderly and which roles are associated with greatest benefit. It also examined pathways that connect social integration to better lung health. Methods: High functioning men (N = 518) and women (N = 629) ages 70-79 were recruited as part of the MacArthur Study of Successful Aging and data were collected on social roles as well as pulmonary function as assessed by peak expiratory flow rate (PEFR). Multiple regressions predicting PEFR from the number of social roles controlled for age, sex, race, education, weight and height. Physiological, behavioral, social and psychological factors were tested as mediators of the association between the number of social roles and PEFR. Results: More social roles were associated with better PEFR. Analysis of specific roles indicated that marriage was the strongest positive correlate of PEFR. However, greater numbers of roles were also associated with better PEFR independent of marriage. Being a relative or friend were each also individually associated with better PEFR. Even so, greater numbers of social roles were associated with better PEFR independent of relative and friend. The data were consistent with greater happiness, not smoking, and more physical activity acting as pathways linking the number of roles to PEFR. Conclusions: Number of social roles is an important correlate of healthy lung function in the elderly. This association may be driven by healthier behaviors and greater feelings of well-being.
Abstract from: Journal of Allergy and Clinical Immunology (2014)
Chiu, Coull, Sternthal, Kloog, Schwartz, Cohen, & Wright
BACKGROUND: Prenatal exposures to stress and physical toxins influence children's respiratory health, although few studies consider these factors together. OBJECTIVES: We sought to concurrently examine the effects of prenatal community-level psychosocial (exposure to community violence [ECV]) and physical (air pollution) stressors on repeated wheeze in 708 urban children followed to age 2 years. METHODS: Multi-item ECV reported by mothers in pregnancy was summarized into a continuous score by using Rasch modeling. Prenatal black carbon exposure was estimated by using land-use regression (LUR) modeling; particulate matter with a diameter of less than 2.5 μm (PM2.5) was estimated by using LUR modeling incorporating satellite data. Mothers reported child's wheeze every 3 months. The effects of ECV and air pollutants on repeated wheeze (≥2 episodes) were examined by using logistic regression. Interactions between ECV and pollutants were examined. RESULTS: Mothers were primarily black (29%) and Hispanic (55%), with lower education (62% with ≤12 years); 87 (12%) children wheezed repeatedly. In models examining concurrent exposures, ECV (odds ratio [OR], 1.95; 95% CI, 1.13-3.36; highest vs lowest tertile) and black carbon (OR, 1.84; 95% CI, 1.08-3.12; median or greater vs less than median) were independently associated with wheeze adjusting for sex, birth season, maternal atopy, education, race, and cockroach antigen. Associations were similar for PM2.5 (adjusted OR, 2.02; 95% CI, 1.20-3.40). An interaction between ECV with air pollution levels was suggested. CONCLUSIONS: These findings suggest that both prenatal community violence and air pollution can contribute to respiratory health in these urban children. Moreover, place-based psychosocial stressors might affect host resistance such that physical pollutants can have adverse effects, even at relatively lower levels.
Abstract from: American Journal of Respiratory and Critical Care Medicine (2013)
Wright, Fisher, Chiu, Wright, Fein, Cohen, & Coull
RATIONALE: Exploring prenatal factors influencing childhood wheeze may inform programming mechanisms. OBJECTIVES: We examined associations among prenatal maternal cortisol profiles, maternal obesity, and repeated wheeze up to age 2 years (n = 261). METHODS: Salivary cortisol was collected five times per day over 3 days at 29.0 ± 4.9 weeks gestation. Mothers were categorized as obese (body mass index ≥ 30 kg/m(2)) versus nonobese (body mass index < 30 kg/m(2)). Using logistic regression, we examined the influence of log-transformed cortisol metrics (level at each time point, morning rise, diurnal and afternoon slopes) and obesity on wheeze adjusting for covariates. Linear mixed models were implemented to examine associations between cortisol trajectories and wheezing. Interactions between maternal cortisol and obesity were considered. MEASUREMENTS AND MAIN RESULTS: Mothers were primarily minority (56.5% Hispanic, 24.1% African American), 61% had less than or equal to 12 years of education, 34% were obese, and 8.4% of children had repeated wheeze. An interquartile range increase in mean log cortisol at bedtime (odds ratio, 2.2; 95% confidence interval, 1.09-4.09) and maternal obesity (odds ratio, 3.43; 95% confidence interval, 1.26-9.35) were independently associated with wheeze. Linear mixed models revealed an association between a flatter afternoon slope (slower decline in log cortisol per hour) and repeated wheeze in children of obese mothers (children with [-0.017 change] and without [-0.061 change] wheeze [P = 0.009 for time × wheeze interaction]), but not in children of nonobese mothers (with [-0.050 change] and without [-0.061 change] wheeze [P = 0.51]). CONCLUSIONS: Maternal prenatal cortisol disruption and obesity were independently associated with children's wheeze. Obese women with adverse cortisol profiles were most likely to have children with repeated wheeze.
Abstract from: Psychology and Aging (2013)
Sneed & Cohen
The purpose of the current study was to determine whether volunteerism is prospectively associated with hypertension risk among older adults. Participants provided data during the 2006 and 2010 waves of the Health and Retirement Study, a longitudinal panel survey using a nationally representative sample of community-dwelling older adults (age > 50 years). Volunteerism and blood pressure were measured at baseline and again 4 years later. Analyses excluded individuals hypertensive at baseline and controlled for age, race, sex, education, baseline systolic/diastolic blood pressure, and major chronic illnesses. Those who had volunteered at least 200 hr in the 12 months prior to baseline were less likely to develop hypertension (OR = 0.60; 95% CI [0.40, 0.90]) than nonvolunteers. There was no association between volunteerism and hypertension risk at lower levels of volunteer participation. Volunteering at least 200 hr was also associated with greater increases in psychological well-being (B = 0.99, β = .05, p = .006) and physical activity (B = 0.21, β = .05, p = .04) compared with nonvolunteers; however, these factors did not explain the association of volunteerism with hypertension risk.
Abstract from: Brain, Behavior, and Immunity (2013)
Cohen, Janicki-Deverts, Turner, Marsland, Casselbrant, Li-Korotky, Epel, & Doyle
Low socioeconomic status (SES) during childhood and adolescence has been found to predict greater susceptibility to common cold viruses in adults. Here, we test whether low childhood SES is associated with shorter leukocyte telomere length in adulthood, and whether telomere length mediates the association between childhood SES and susceptibility to acute upper respiratory disease in adulthood. At baseline, 196 healthy volunteers reported whether they currently owned their home and, for each year of their childhood, whether their parents owned the family home. Volunteers also had blood drawn for assessment of specific antibody to the challenge virus, and for CD8(+)CD28(-) T-lymphocyte telomere length (in a subset, n=135). They were subsequently quarantined in a hotel, exposed to a virus (rhinovirus [RV] 39) that causes a common cold and followed for infection and illness (clinical cold) over five post-exposure days. Lower childhood SES as measured by fewer years of parental home ownership was associated with shorter adult CD8(+)CD28(-) telomere length and with an increased probability of developing infection and clinical illness when exposed to a common cold virus in adulthood. These associations were independent of adult SES, age, sex, race, body mass, neuroticism, and childhood family characteristics. Associations with infections and colds were also independent of pre-challenge viral-specific antibody and season. Further analyses do not support mediating roles for smoking, alcohol consumption or physical activity but suggest that CD8(+)CD28(-) cell telomere length may act as a partial mediator of the associations between childhood SES and infection and childhood SES and colds.
Abstract from: Journal of the American Medical Association (2013)
Cohen, Janicki-Deverts, Turner, Casselbrant, Li-Korotky, Epel, & Doyle
Importance. Although leukocyte telomere length is associated with mortality and many chronic diseases thought to be manifestations of age-related functional decline, it is not known whether it relates to acute disease in younger healthy populations. Objective. To determine whether shorter telomeres in leukocytes, especially CD8CD28- T cells, are associated with decreased resistance to upper respiratory infection and clinical illness in young to midlife adults. Design, Setting, and Participants. Between 2008 and 2011, telomere length was assessed in peripheral blood mononuclear cells (PBMCs) and T-cell subsets (CD4, CD8CD28+, CD8CD28-) from 152 healthy 18- to 55-year-old residents of Pittsburgh, Pennsylvania. Participants were subsequently quarantined (single rooms), administered nasal drops containing a common cold virus (rhinovirus 39), and monitored for 5 days for development of infection and clinical illness. Main Outcome Measures. Infection (virus shedding or 4-fold increase in virus-specific antibody titer) and clinical illness (verified infection plus objective signs of illness). Results. Rates of infections and clinical illness were 69% (n=105) and 22% (n=33), respectively. Shorter telomeres were associated with greater odds of infection, independent of prechallenge virus-specific antibody, demographics, contraceptive use, season, and body mass index (PBMC: odds ratio [OR] per 1-SD decrease in telomere length, 1.71 [95% CI, 1.08-2.72]; n=128 [shortest tertile 77% infected; middle, 66%; longest, 57%]; CD4: OR, 1.76 [95% CI, 1.15-2.70]; n=146 [shortest tertile 80% infected; middle, 71%; longest, 54%]; CD8CD28+: OR, 1.93 [95% CI, 1.21-3.09], n=132 [shortest tertile 84% infected; middle, 64%; longest, 58%]; CD8CD28-: OR, 2.02 [95% CI, 1.29-3.16]; n=144 [shortest tertile 77% infected; middle, 75%; longest, 50%]). CD8CD28- was the only cell population in which shorter telomeres were associated with greater risk of clinical illness (OR, 1.69 [95% CI, 1.01-2.84]; n=144 [shortest tertile, 26%; middle, 22%; longest, 13%]). The association between CD8CD28- telomere length and infection increased with age (CD8CD28- telomere length x age interaction, b=0.09 [95% CI, 0.02-0.16], P=.01, n=144). Conclusion and Relevance. In this preliminary study among a cohort of healthy 18- to 55-year-olds, shorter CD8CD28- T-cell telomere length was associated with increased risk for experimentally induced acute upper respiratory infection and clinical illness.
Abstract from: American Journal of Respiratory and Critical Care Medicine (2012)
Prenatal and Postnatal Maternal Stress and Wheeze in Urban Children: Effect of Maternal Sensitization
Chiu, Coull, Cohen, Wooley, & Wright
Rationale: Critical periods for programming early wheeze risk may include pregnancy and infancy. Effects of timing remain poorly understood. Objectives: Associations among prenatal and postnatal maternal stress and children's wheeze were prospectively examined in 653 families. Effect modification by maternal sensitization was also examined. Methods: Stress was indexed by a maternal negative life events (NLEs) score (range, 0–9) ascertained during pregnancy and between 1 and 2 years postpartum. Mothers reported child wheeze every 3 months up to age 2 years. Relationships of prenatal and postnatal maternal NLEs with repeated wheeze (≥2 episodes) were examined using logistic regression adjusting for covariates. Penalized splines were implemented to explore possible nonlinear associations. We also examined the interaction between prenatal stress and maternal sensitization indexed by allergen-specific IgE from maternal prenatal serum. Measurements and Main Results: Adjusted models considering prenatal or postnatal NLEs alone both showed an exposure-response relationship between higher stress and child wheeze.When considering prenatal and postnatal stress concurrently, only children of mothers with high stress in both periods were significantly more likely to wheeze (adjusted odds ratio, 3.04; 95% confidence interval, 1.67–5.53) than children of mothers reporting low stress in both periods. Associations between high prenatal stress and wheeze were significant in children born to nonsensitized mothers (any IgE ‹ 0.35 kU/L) but not in the sensitized group (P for interaction = 0.03). Conclusions: Although children have heightened sensitivity to maternal stress in utero and in early childhood, those with higher stress in both periods were particularly at risk for wheeze. The prenatal maternal immune milieu modified effects.
Abstract from: Sleep (2012)
Sleep and Antibody Response to Hepatitis B Vaccination
Prather, Hall, Fury, Ross, Muldoon, Cohen, & Marsland
Study Objectives: Experimental evidence links poor sleep with susceptibility to infectious illness; however, it remains to be determined if naturally occurring sleep is associated with immune responses known to play a role in protection against infection. The aim of this study was to determine whether sleep duration, sleep efficiency, and sleep quality, assessed in the natural environment, predict magnitude of antibody responses to a novel antigen among community volunteers in midlife. Design: Observational. Measurements and Results: Healthy midlife adults (n = 125; 70 female; age 40-60 yr) received the standard 3-dose hepatitis B vaccination series. Actigraphy and electronic sleep diaries were used to assess sleep duration, sleep efficiency, and subjective sleep quality. Viral-specific antibody titers were obtained prior to the 2nd and 3rd vaccination to assess primary and secondary antibody responses. Clinical protection status (anti-hepatitis B surface antigen immunoglobulin G ≥ 10 mIU/ml) was assessed 6 m after the final immunization. Regression analyses revealed that shorter actigraphy-based sleep duration was associated with a lower secondary antibody response independent of age, sex, body mass index, and response to the initial immunization. Shorter sleep duration, measured by actigraphy and sleep diary, also predicted a decreased likelihood of being clinically protected from hepatitis B at the conclusion of the vaccination series. Neither sleep efficiency nor subjective sleep quality were significant predictors of antibody response. Conclusions: Short sleep duration in the natural environment may negatively affect in vivo antibody responses to novel antigens, providing a possible explanation for observed associations of poor sleep with increased susceptibility to infectious disease.
Abstract from: Psychosomatic Medicine (2012)
Sex Differences in the Association of Childhood Socioeconomic Status with Adult Blood Pressure Change: The CARDIA Study
Janicki-Deverts, Cohen, Matthews, & Jacobs Jr.
Objective: To examine sex differences in the relation of childhood socioeconomic status (CSES) to systolic (SBP) and diastolic blood pressure (DBP) trajectories during 15 years, spanning young (mean [M] [standard deviation {SD}] = 30 [3] years) and middle (M [SD] = 45 [3] years) adulthood, independent of adult SES. Methods: A total of 4077 adult participants reported father's and mother's educational attainments at study enrollment (Year 0) and own educational attainment at enrollment and at all follow-up examinations.Resting BP also was measured at all examinations. Data from examination Years 5 (when participantM[SD] age = 30 [3] years), 7, 10, 15, and 20 are examined here. Associations of own adult (Year 5), mother's, and father's educations with 15-year BP trajectories were examined in separate multilevel models. Fully controlled models included time-invariant covariates (age, sex, race, recruitment center) and time-varying covariates that were measured at each examination (marital status, body mass, cholesterol, oral contraceptives/ hormones, and antihypertensive drugs). Analyses of parental education controlled for own education. Results: When examined without covariates, higher education -- own (SBP y = -0.03, DBP y = -0.03), mother's (SBP y = -0.02, DBP y = -0.02), and father's (SBP y= -0.02, DBP y = -0.01) -- were associated with attenuated 15-year increases in BP (p ‹ .001). Associations of own (but not either parent's) education with BP trajectories remained independent of standard controls. Sex moderated the apparent null effects of parental education, such that higher parental education -- especially mother's, predicted attenuated BP trajectories independent of standard covariates among women (SBP y = -0.02, p = .02; DBP y = -0.01, p = .04) but not men (SBP y = 0.02, p = .06; DBP y = 0.005, p = .47; p interaction SBP ‹ .001, p interaction DBP = .01). Conclusions: Childhood socioeconomic status may influence women's health independent of their own adult status.
Abstract from: Brain, Behavior, and Immunity (2012)
Janicki-Deverts, Cohen, Kalra, & Matthews
Better health is a well-documented benefit of having a higher socioeconomic status (SES). Inflammation may be one pathway through which SES influences health. Using 2658 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study, we examine whether two measures of SES assessed at baseline (mean age, 32 ± 4 years)—years of education and household income—predict change in C-reactive protein (CRP) concentrations over the course of 13 years. We also examine whether four health-related behaviors—smoking, fruit and vegetable consumption, physical activity, and alcohol consumption—mediate the prospective association of SES with CRP. Both higher education and household income predicted smaller increases in CRP over the 13 years of follow-up independent of age, sex, race, CARDIA center, body mass, medical diagnoses, medications, and hormone use (among women). Associations did not differ by race or sex. When examined in separate analyses, smoking and fruit and vegetable intake each accounted for a significant proportion of the respective effects of education and household income on CRP change, and physical activity a significant proportion of the effect of household income. These findings suggest that poor health behaviors among persons of lower socioeconomic status can have long-term effects on inflammation.
Abstract from: Psychosomatic Medicine (2012)
Parenthood and Host Resistance to the Common Cold
Sneed, Cohen, Turner, & Doyle
Objective: To determine whether parenthood predicts host resistance to the common cold among healthy volunteers experimentally exposed to a common cold virus. Methods: Participants were 795 healthy volunteers (age range = 18Y55 years) enrolled in one of three viral-challenge studies conducted from 1993 to 2004. After reporting parenthood status, participants were quarantined, administered nasal drops containing one of four common cold viruses, and monitored for the development of a clinical cold (infection in the presence of objective signs of illness) on the day before and for 5 to 6 days after exposure. All analyses included controls for immunity to the experimental virus (prechallenge specific antibody titers), viral strain, season, age, sex, race/ethnicity, marital status, body mass, study, employment status, and education. Results: Parents were less likely to develop colds than nonparents were (odds ratio [OR] = 0.48, 95% confidence interval [CI] = 0.31-0.73). This was true for both parents with one to two children (OR = 0.52, 95% CI = 0.33-0.83) and three or more children (OR = 0.39, 95% CI = 0.22-0.70). Parenthood was associated with a decreased risk of colds for both those with at least one child living at home (OR = 0.46, 95% CI = 0.24-0.87) and those whose children all lived away from home (OR = 0.27, 95% CI = 0.12-0.60). The relationship between parenthood and colds was not observed in parents aged 18 to 24 years but was pronounced among older parents. Conclusions: Parenthood was associated with greater host resistance to common cold viruses.
Abstract from: Health Psychology (2012)
Positive Emotion Word Use and Longevity in Famous Deceased Psychologists
Pressman & Cohen
Objective: This study examined whether specific types of positive and negative emotional words used in the autobiographies of well-known deceased psychologists were associated with longevity. Methods: For each of the 88 psychologists, the percent of emotional words used in writing was calculated and categorized by valence (positive or negative) and arousal (activated [e.g., lively, anxious] or not activated [e.g., calm, drowsy]) based on existing emotion scales and models of emotion categorization. Results: After controlling for sex, year of publication, health (based on disclosed illness in autobiography), native language, and year of birth, the use of more activated positive emotional words (e.g., lively, vigorous, attentive, humorous) was associated with increased longevity. Negative terms (e.g., angry, afraid, drowsy, sluggish) and unactivated positive terms (e.g., peaceful, calm) were not related to longevity. The association of activated positive emotions with longevity was also independent of words ind cative of social integration, optimism, and the other affect/activation categories. Conclusions: Results indicate that in writing, not every type of emotion correlates with longevity and that there may be value to considering different categories beyond emotional valence in health relevant outcomes.
Abstract from: Allergy (2012)
Prenatal Negative Life Events Increases Cord Blood IgE: Interactions with Dust Mite Allergen and Maternal Atopy
Peters, Cohen, Staudenmayer, Hosen, Platts-Mills, & Wright
Background: Prenatal exposure to both stress and aeroallergens (dust mite) may modulate the fetal immune system. These exposures may interact to affect the newborn immune response. We examined associations between prenatal maternal stress and cord blood total IgE in 403 predominately low-income minority infants enrolled in the Asthma Coalition on Community, Environment, and Social Stress (ACCESS) project. We also examined potential modifying effects of maternal atopy and maternal dust mite exposure. Methods: The Crisis in Family Systems survey was administered to mothers prenatally, and a negative life event domain score was derived to characterize stress. Dust mite allergen was quantified in dust from pregnant mothers' bedrooms. Cord blood was analyzed for total IgE. Using linear regression, we modeled the relationship of stress with cord blood IgE and interactions of stress with dust mite and/or maternal atopy, adjusting for potential confounders. Results: Higher prenatal maternal stress (ß = 0.09; P = 0.01) was associated with increased cord blood IgE. The interactive effects between stress and dust mite groups (high vs low) were significantly different for children of atopic vs nonatopic mothers (P for three-way interaction = 0.005). Among children of atopic mothers, the positive association between stress and IgE was stronger in the high dust mite group. In children of mothers without a history of atopy, the positive association between stress and IgE was most evident in the low allergen group. Conclusions: Prenatal stress was independently associated with elevated cord blood IgE. Mechanisms underlying stress effects on fetal immunomodulation may differ based on maternal atopic status.
Abstract from: Proceedings of the National Academy of Sciences of the United States of America (2012)
Chronic Stress, Glucocorticoid Receptor Resistance, Inflammation, and Disease Risk
Cohen, Janicki-Deverts, Doyle, Miller, Frank, Rabin, & Turner
We propose a model wherein chronic stress results in glucocorticoid receptor resistance (GCR) that, in turn, results in failure to downregulate inflammatory response. Here we test the model in two viral-challenge studies. In study 1, we assessed stressful life events, GCR, and control variables including baseline antibody to the challenge virus, age, body mass index (BMI), season, race, sex, education, and virus type in 276 healthy adult volunteers. The volunteers were subsequently quarantined, exposed to one of two rhinoviruses, and followed for 5 d with nasal washes for viral isolation and assessment of signs/symptoms of a common cold. In study 2, we assessed the same control variables and GCR in 79 subjects who were subsequently exposed to a rhinovirus and monitored at baseline and for 5 d after viral challenge for the production of local (in nasal secretions) proinflammatory cytokines (IL-1beta, TNF-alpha, and IL-6). Study 1: After covarying the control variables, those with recent exposure to a long-term threatening stressful experience demonstrated GCR; and those with GCR were at higher risk of subsequently developing a cold. Study 2: With the same controls used in Study 1, greater GCR predicted the production of more local proinflammatory cytokines among infected subjects. These data provide support for a model suggesting that prolonged stressors result in GCR, which, in turn, interferes with appropriate regulation of inflammation. Because inflammation plays an important role in the onset and progression of a wide range of diseases, this model may have broad implications for understanding the role of stress in health.
Abstract from: Journal of Applied Social Psychology (2012)
Who's Stressed? Distributions of Psychological Stress in the United States in Probability Samples from 1983, 2006, and 2009
Cohen & Janicki-Deverts
Psychological stress was assessed in 3 national surveys administered in 1983, 2006, and 2009. In all 3 surveys, stress was higher among women than men; and increased with decreasing age, education and income. Unemployed persons reported high levels of stress, while the retired reported low levels. All associations were independent of one another and of race/ethnicity. Although minorities generally reported more stress than whites, these differences lost significance when adjusted for the other demographics. Stress increased little in response to the 2008-2009 economic downturn, except among middle-aged, college-educated white men with full-time employment. These data suggest greater stress-related health risks among women, younger adults, those of lower socioeconomic status, and men potentially subject to substantial losses of income and wealth.
Abstract from: Journal of Allergy and Clinical Immunology (2011)
Associations Among Maternal Childhood Socioeconomic Status, Cord Blood IgE Levels, and Repeated Wheeze in Urban Children
Sternthal, Coull, Chiu, Cohen, & Wright
BACKGROUND: Independent of current socioeconomic status (SES), past maternal SES might influence asthma outcomes in children. OBJECTIVE: We examined associations among the mother’s SES in the first 10 years of her life (maternal childhood SES), increased cord blood IgE levels (upper 20% [1.37 IU/mL]), and repeated wheeze (>/=2 episodes by age 2 years) in an urban pregnancy cohort (n = 5,510). METHODS: Data on sociodemographics, discrimination, financial strain, community violence, interpersonal trauma, and other negative events were obtained prenatally. Prenatal household dust was assayed for cockroach and murine allergens, and traffic-related air pollution was estimated by using spatiotemporal land-use regression. Maternal childhood SES was defined by parental home ownership (birth to 10 years). Maternally reported child wheeze was ascertained at 3-month intervals from birth. Using structural equation models, we examined whether outcomes were dependent on maternal childhood SES directly versus indirect relationships operating through (1) cumulative SES-related adversities, (2) the mother’s socioeconomic trajectory (adult SES), and (3) current prenatal environmental exposures. RESULTS: Mothers were largely Hispanic (60%) or black (28%), 37% had not completed high school, and 56% reported parental home ownership. When associations between low maternal childhood SES and repeated wheeze were examined, there were significant indirect effects operating through adult SES and prenatal cumulative stress (b = 0.28, P = .003) and pollution (b = 0.24, P = .004; P value for total indirect effects </= .04 for both pathways). Low maternal childhood SES was directly related to increased cord blood IgE levels (b = 0.21, P = .003). Maternal cumulative adversity (interpersonal trauma) was also associated with increased cord blood IgE levels (b = 0.19, P =.01), although this did not explain maternal childhood SES effects. CONCLUSION: Lower maternal childhood SES was associated with increased cord blood IgE levels and repeated wheeze through both direct and indirect effects, providing new insights into the role of social inequalities as determinants of childhood
respiratory risk.
Abstract from: Social Science & Medicine (2011)
Matthews, Schwartz, & Cohen
Few studies have investigated the association of socioeconomic status (SES) and coronary artery calcification (CAC) and only one study has examined African Americans separately from Caucasians, despite
empirical evidence suggesting that blacks have equivalent or lower CAC, relative to whites.We tested the hypotheses that lower childhood SES and lower average education, occupation, and income and change in SES (slope) in adulthood are related to risk of CAC in blacks and whites in the US CARDIA study. Parental education and occupation were measured at study entry (Year 0 in 1985-1986) and participant education, occupation, and household income were evaluated multiple times throughout a 20 year follow-up period at four sites in the United States. CAC was measured at Year 20 in 3,138 (45% black) participants in CARDIA; 19% had CAC. Latent growth models and multivariate logistic regression analyses adjusted for the major risk factors for CAC. Multivariate models showed that lower paternal education in blacks and lower maternal occupational status in the full sample and in whites were related to higher risk of any CAC, independent of adult SES. Lower average adult education, occupation, and income were related to higher risk of any CAC, with the effects primarily in blacks. Our results are the first to show that SES, measured retrospectively and prospectively in multiple ways, is related to CAC, and the first to document the effects primarily in blacks.
Abstract from: Health Psychology (2011)
Positive Emotion Word Use and Longevity in Famous Deceased Psychologists
Pressman & Cohen
OBJECTIVE: This study examined whether specific types of positive and negative emotional words used in the autobiographies of well-known deceased psychologists were associated with longevity. METHODS: For each of the 88 psychologists, the percent of emotional words used in writing was calculated and categorized by valence (positive or negative) and arousal (activated [e.g., lively, anxious] or not activated [e.g., calm, drowsy]) based on existing emotion scales and models of emotion categorization. RESULTS: After controlling for sex, year of publication, health (based on disclosed illness in autobiography), native language, and year of birth, the use of more activated positive emotional words (e.g., lively, vigorous, attentive, humorous) was associated with increased longevity. Negative terms (e.g., angry, afraid, drowsy, sluggish) and unactivated positive terms (e.g., peaceful, calm) were not related to longevity. The association of activated positive emotions with longevity was also independent of words indicative of social integration, optimism, and the other affect/activation categories. CONCLUSIONS: Results indicate that in writing, not every type of emotion correlates with longevity and that there may be value to considering different categories beyond emotional valence in health relevant outcomes.
Abstract from: Journal of Asthma (2011)
Preliminary Evidence for the Feasibility of a Stress Management Intervention for 7- to 12-Year-Olds with Asthma
Long, Ewing, Cohen, Skoner, Gentile, Koehrsen, Howe, Thompson, Rosen, Ganley, & Marsland
OBJECTIVE: Evidence supports a bidirectional relationship between stress and asthma exacerbations in children, suggesting that interventions to reduce stress may improve both psychosocial quality of life and disease course. Here, we examine the feasibility of a stress management intervention for 7- to 12-year-olds with asthma. METHODS: Two trials were conducted. Cohort 1 (n = 11) was recruited from the community and attended intervention sessions at an urban university. Cohort 2 (n = 7) was school based and recruited from an African American charter school. Six individual intervention sessions focused on psychoeducation about asthma, stress, and emotions; problem-solving and coping skills training; and relaxation training paired with physiological feedback. Pre- and post-intervention stress, mood, and lung function data were collected. Satisfaction surveys were administered after intervention completion. RESULTS: The intervention was rated as highly acceptable by participating families. Feasibility was much stronger for the school-based than the university-based recruitment mechanism. Initial efficacy data suggest that both cohorts showed pre- to post-intervention improvements in lung function, perceived stress, and depressed mood. CONCLUSION: Findings provide evidence for the feasibility of offering asthma-related stress management training in a school setting. Initial findings offer support for future, large-scale efficacy studies.
Abstract from: Psychosomatic Medicine (2011)
Occupational Mobility and Carotid Artery Intima-Media Thickness: Findings From the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Janicki-Deverts, Cohen, Matthews, Jacobs, & Adler
OBJECTIVE: To examine whether a 10-year change in occupational standing is related to carotid artery intima-media thickness (IMT) 5 years later. METHODS: Data were obtained from 2,350 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Occupational standing was measured at the Year 5 and 15 CARDIA follow-up examinations when participants were 30.2 (standard deviation = 3.6) and 40.2 (standard deviation = 3.6) years of age, respectively. IMT (common carotid artery [CCA], internal carotid artery [ICA], and bulb) was measured at Year 20. Occupational mobility was defined as the change in occupational standing between Years 5 and 15 using two semicontinuous variables. Analyses controlled for demographics, CARDIA center, employment status, parents’ medical history, own medical history, Year 5 Framingham Risk Score, physiological risk factors and health behaviors averaged across the follow-up, and sonography reader. RESULTS: Occupational mobility was unrelated to IMT save for an unexpected association of downward mobility with less CCA-IMT (b = -0.04, p = .04). However, associations differed depending on initial standing (Year 5) and sex. For those with lower initial standings, upward mobility was associated with less CCA-IMT (b = -0.07, p = .003), and downward mobility was associated with greater CCA-IMT and bulb-ICA-IMT (b = 0.14, p = .01 and b = 0.14, p = .03, respectively); for those with higher standings, upward mobility was associated with greater CCA-IMT (b = 0.15, p = .008), but downward mobility was unrelated to either IMT measure (p values greater than .20). Sex-specific analyses revealed associations of upward mobility with less CCA-IMT and bulb-ICA-IMT among men only ( p values less than .02). CONCLUSIONS: Occupational mobility may have implications for future cardiovascular health. Effects may differ depending on initial occupational standing and sex.
Abstract from: Brain, Behavior, and Immunity (2011)
Carroll, Low, Prather, Cohen, Fury, Ross, & Marsland
Laboratory studies show that individuals differ appreciably in the magnitude of their inflammatory responses to acute psychological stress. These individual differences are poorly understood, yet may contribute to variation in stress-associated disease vulnerability. The present study examined the possibility that affective responses to acute stress contribute to these differences. For this purpose, 102 relativelyhealthy community volunteers (mean age 50 years; 60% female; 91.2% white) performed an acute stress protocol and measures of affective state and serum levels of the proinflammatory cytokine, interleukin (IL)-6 were collected at the end of a 30-min resting baseline, a 5-min evaluative public speaking task, and a 30-min recovery period. Results of regression analyses, controlling for age, race, gender, menopausal status, and body mass index, revealed a positive association of task-related increases in anger and anxiety with increases in IL-6 (R2 change = .08, p = .004; R2 change = .08, p = .005, respectively). Further examination showed that these affective responses to the task were independent predictors of change in IL-6. Cardiovascular reactivity to the task did not explain the association. These results suggest that individuals who exhibit angry or anxious responses to acute challenge are more vulnerable to stressrelated increases in markers of systemic inflammation, possibly rendering them more susceptible to inflammatory disease.
Abstract from: Brain, Behavior, and Immunity (2011)
Carroll, Cohen, & Marsland
It is proposed that socioeconomic conditions in early childhood effect immune programming, with poorer conditions resulting in adult phenotypes that are prone to inflammation. Recent evidence supports this possibility, showing an inverse association of childhood SES with adult markers of systemic inflammation. In this study, we further investigate this association, extending prior studies to include an examination of multiple indices of SES across distinct periods of childhood. Subjects were 112 men and women, 40–60 years of age (88.6% Caucasian). Childhood SES was indexed by a composite of three indicators of parental wealth (parental home and vehicle ownership, and number of bedrooms per child in the family home) averaged across 2 year periods of childhood between 1 and 18 years old. Higher adult serum concentrations of interleukin (IL)-6 were associated with lower SES in early childhood (years 1–2) (b = .05, p < .05), associations that were independent of adult age, personal income, educational attainment, gender, race, body mass index, and physical activity. These associations support recent suggestions that the early environment may program immune phenotypes that contribute to disease risk.
Abstract from: Psychological Trauma: Theory, Research, Practice, and Policy (2010)
Suglia, Staudenmayer, Cohen, Enlow, Rich-Edwards, & Wright
While adult hypothalamic-pituitary-adrenocortical (HPA) axis functioning is thought to be altered by traumatic experiences, little data exist on the effects of cumulative stress on HPA functioning among pregnant women or among specific racial/ethnic groups. The goal of this study was to explore the effects of multiple social stressors on HPA axis functioning in a sample of urban Black (n = 68) and Hispanic (n = 132) pregnant women enrolled in the Asthma Coalition on Community, Environment, and Social Stress (ACCESS). Women were administered the Revised Conflict Tactics Scale (R-CTS) survey, the Experiences of Discrimination (EOD) survey, the Crisis in Family Systems-Revised (CRISYS-R) negative life events survey, and the My Exposure to Violence (ETV) survey, which ascertains community violence exposure. A cumulative stress measure was derived from these instruments. Salivary cortisol samples were collected five times per day over three days in order to characterize diurnal salivary cortisol patterns. Repeated measures mixed models, stratified by race/ethnicity, were performed adjusting for education level, age, smoking status, body mass index and weeks pregnant at time of cortisol sampling. The majority of Hispanic participants (57%) had low cumulative stress, while Black participants had intermediate (35%) or high (41%) cumulative stress. Among Black but not Hispanic women, cumulative stress was associated with lower morning cortisol levels, including a flatter waking to bedtime rhythm. These analyses suggest that the combined effects of cumulative stressful experiences are associated with disrupted HPA functioning among pregnant women. The etiology of racial/ethnic differences in stress-induced HPA alterations warrants further research.
Abstract from: Psychosomatic Medicine (2010)
Janicki-Deverts, Cohen, DiLillo, Lewis, Kiefe, Whooley, & Matthews
OBJECTIVE: To examine the prospective association of depressive symptoms with circulating C-reactive protein (CRP) and to determine the direction of that association. METHODS: Using data from 2,544 healthy participants in the Coronary Artery Risk Development in Young Adults study (ages, 33–45 years; 55% female; 42% black), we examined the prospective association of depressive symptoms, as measured by the Centers for Epidemiologic Studies Depression Scale, with circulating CRP 5 years later. RESULTS: Depressive symptoms in the Coronary Artery Risk Development in Young Adults study Year 15 predicted CRP at Year 20, independent of demographic characteristics, biological and medical risk factors, health behaviors, and Year 15 CRP. This association, however, was conditional on race such that the increase in CRP with increasing depressive symptoms was present in blacks but not whites. In neither blacks nor whites did Year 15 CRP predict Year 20 depressive symptoms. Among black participants, when examined in separate analyses, higher scores on the depressed affect and somatic symptoms subscales of the Centers for Epidemiologic Studies Depression Scale and lower scores on the positive affect subscale were associated with greater Year 20 CRP. The interpersonal problems subscale was unrelated to CRP. When all four subscale scores were entered simultaneously in the same model, black participants’ scores on the positive affect and somatic symptoms subscales emerged as independent predictors of Year 20 CRP, whereas the depressed affect and interpersonal problems subscales did not. CONCLUSIONS: Depressive symptoms may be linked more closely to inflammation in blacks than in whites.
Abstract from: International Journal of Behavioral Medicine (2010)
Suglia, Staudenmayer, Cohen, & Wright
BACKGROUND: While community violence has been linked to psychological morbidity in urban youth, data on the physiological correlates of violence and associated post-traumatic stress symptoms are sparse. We examined the influence of child posttraumatic stress symptoms reported in relationship to community violence exposure on diurnal salivary cortisol response in a population based sample of 28 girls and 15 boys ages 7–13, 54% self-identified as white and 46% as Hispanic. METHODS: Mothers reported on the child’s exposure to community violence using the Survey of Children’s Exposure to Community Violence and completed the Checklist of Children’s Distress Symptoms (CCDS) which captures factors related to posttraumatic stress; children who were eight years of age or greater reported on their own community violence exposure. Saliva samples were obtained from the children four times a day (after awakening, lunch, dinner and bedtime) over three days. Mixed models were used to assess the influence of posttraumatic stress symptoms on cortisol expression, examined as diurnal slope and area under the curve (AUC), calculated across the day, adjusting for socio-demographics. RESULTS: In adjusted analyses, higher scores on total traumatic stress symptoms (CCDS) were associated with both greater cortisol AUC and with a flatter cortisol waking to bedtime rhythm. The associations were primarily attributable to differences on the intrusion, arousal and avoidance CCDS subscales. CONCLUSION: Posttraumatic stress symptomatology reported in response to community violence exposure was associated with diurnal cortisol disruption in these community-dwelling urban children.
Abstract from: The Journal of Infectious Diseases (2010)
Doyle, Casselbrant, Li-Korotky, Doyle, Lo, Turner, & Cohen
BACKGROUND: In adults and children with respiratory syncytial virus (RSV) infection, a polymorphism in the interleukin 6 (IL-6) promoter at position 174 predicts illness magnitude. In addition, polymorphisms in the interleukin 10 (IL-10), tumor necrosis factor a (TNF-a), and interferon g (IFN-g) genes are associated with immune responsiveness and the frequency of complications. Here, the effect of these polymorphisms on illness and seroconversion during infection with rhinovirus type 39 (RV39) was evaluated. METHODS: Seventy-two adults were genotyped for the selected polymorphisms, experimentally exposed to RV39, and followed to track infection, seroconversion, and symptoms and signs of illness. Regression analysis was used to determine whether these polymorphisms predicted seroconversion and illness magnitude in 57 infected subjects. RESULTS: The low-production IL-6 174 phenotype (C/C genotype) was associated with greater symptom magnitudes, and the IFN-g phenotype +874 predicted the frequency of seroconversion. No relationship between the IL-10 or TNF-a polymorphisms and any measured outcome was documented. The concentration of IL-6 protein, as measured in nasal wash fluids from subjects, was positively correlated with symptom magnitude, but it was independent of the IL-6 174 genotypes representing the high- and low-production phenotypes. CONCLUSIONS: These results document statistically significant associations between the IL-6 174 and IFN-g +874 polymorphisms and specific responses to experimental RV39 infection. For the IL-6 174 polymorphism, the results replicate those for experimental RSV infection.
Abstract from: Brain, Behavior, and Immunity (2010)
Janicki-Deverts, Cohen, & Doyle
Hostility has been associated with heightened proinflammatory activity. However, it is not known whether greater hostility contributes to greater inflammation by promoting higher Th1 activity, lower Th2 activity, or both. The present study examines the relation of hostility to mitogen-stimulated Th1 and Th2 cytokine production in vitro. Participants were 193 healthy men and women (mean age 37.3; 44% non-white). Hostility was assessed with a 20-item version of the Cook-Medley Hostility Scale (CMHS). PHA-stimulated interleukin (IL)-2, tumor necrosis factor (TNF)-alpha, and interferon (IFN)-gamma were used to measure Th1 activity; PHA-stimulated IL-4, IL-5, and IL-10 were used to measure Th2 activity. Greater hostility was related to greater production of two of the three Th1 cytokines, TNF-alpha and IFN-gamma. Hostility was not associated with any measure of Th2 cytokine production. Associations with Th1 cytokines were independent of age, sex, race, socioeconomic status, body mass index, depressive symptoms, and health-related behaviors, and were consistent across men and women. Associations were not explained by social network characteristics, social support, or personality traits closely associated with social behavior. Exploratory analyses substituting the CMHS cognitive, affective, and behavioral subscales for total hostility revealed that associations between hostility and Th1 cytokine production were primarily driven by the cognitive component of hostility (i.e., cynicism). Results suggest that a unique dimension of hostility, particularly the cynicism subcomponent, that is unrelated to social factors, may influence inflammation by promoting greater Th1 cytokine production. This effect on stimulated cytokine activity may have implications for a role of hostility in exacerbating immune-related disease.
Abstract from: Psychological Science (2010)
How Low Socioeconomic Status Affects 2-Year Hormonal Trajectories in Children
Chen, Cohen, & Miller
Disparities by socioeconomic status (SES) are seen for numerous mental and physical illnesses, and yet understanding of the pathways to health disparities is limited. We tested whether SES alters longitudinal trajectories of cortisol output and what types of psychosocial factors could account for these links. Fifty healthy children collected saliva samples (four times per day for 2 days) at 6-month intervals for 2 years. At baseline, families were interviewed about SES and psychosocial factors. Lower-SES children displayed greater 2-year increases in daily cortisol output compared with higher-SES children. These effects were partially mediated by children's perceptions of threat and by family chaos. These findings may help explain, and provide some first steps toward ameliorating, low-SES children's vulnerability to health problems later in life by identifying the tendency to perceive threat in ambiguous situations and experiences of chaos as factors that link low SES to 2-year hormonal trajectories.
Abstract from: Journal of Allergy & Clinical Immunology (2009)
Maternal Interpersonal Trauma and Cord Blood IgE Levels in an Inner-City Cohort: A Life-Course Perspective
Sternthal, Enlow, Cohen, Canner, Staudenmayer, Tsang, & Wright
BACKGROUND: Prenatal stress affects immunocompetence in offspring, although the underlying mechanisms are not well understood. OBJECTIVE: We sought to examine associations between maternal
lifetime interpersonal trauma (IPT) and cord blood total IgE levels in a sample of urban newborns (n = 478). METHODS: Maternal IPT during childhood and adolescence (birth to 17 years), adulthood (18 years to index pregnancy), and the index pregnancy were ascertained by using the Revised Conflict Tactics Scale at 28.4 +/- 7.9 weeks’ gestation. Cord blood IgE levels were derived by using a fluoroenzyme immunoassay. We examined effects of maternal IPT on increased cord blood IgE levels (upper quartile, 1.08 IU/mL) by using logistic regression, adjusting for confounders and mediating variables. RESULTS: Maternal trauma was categorized as unexposed (n = 285 [60%]), early (childhood and/or teenage years only, n = 107 [22%]), late (adulthood and/or index pregnancy only, n = 29 [6%]), and chronic (early and late, n = 57 [12%]) exposure. Relative to no IPT, early (odds ratio [OR], 1.78; 95% CI, 1.05-3.00) and chronic maternal IPT (OR, 2.25; 95% CI, 1.19-4.24) were independently associated with increased IgE levels in unadjusted analyses. When adjusting for standard controls, including maternal age and race, season of birth, child’s sex, and childhood and current socioeconomic status, early effects became nonsignificant (OR, 1.48; 95% CI, 0.85-2.58). Chronic exposure remained significant in fully adjusted models, including standard controls, current negative life events, allergen exposure, and potential pathway variables (maternal atopy, prenatal smoking, and birth weight; OR, 2.18; 95% CI, 1.06-4.50). CONCLUSION: These data link chronic trauma over the mother’s life course with increased IgE levels in infants at birth. Research examining associations between maternal trauma and indicators of offspring’s atopic risk might be particularly relevant in innercity high-risk populations.
Abstract from: Psychosomatic Medicine (2009)
Pressman, Matthews, Cohen, Martire, Scheier, Baum, & Schulz
OBJECTIVE: To examine whether engaging in multiple enjoyable activities was associated with better psychological and physiological functioning. Few studies have examined the health benefits of the enjoyable activities that individuals participate in voluntarily in their free time. METHOD: Participants from four different studies (n = 1,399 total, 74% female, age = 19–89 years) completed a self-report measure (Pittsburgh Enjoyable Activities Test [PEAT]) assessing their participation in ten different types of leisure activities as well as measures assessing positive and negative psychosocial states. Resting blood pressure, cortisol (over 2 days), body mass index, waist circumference, and perceived physiological functioning were assessed. RESULTS: Higher PEAT scores were associated with lower blood pressure, total cortisol, waist circumference, and body mass index, and perceptions of better physical function. These associations withstood controlling for demographic measures. The PEAT was correlated with higher levels of positive psychosocial states and lower levels of depression and negative affect. CONCLUSION: Enjoyable leisure activities, taken in the aggregate, are associated with psychosocial and physical measures relevant for health and well-being. Future studies should determine the extent that these behaviors in the aggregate are useful predictors of disease and other health outcomes.
Abstract from: Brain, Behavior, and Immunity (2009)
Phillips, Marsland, Flory, Muldoon, Cohen, & Manuck
Growing evidence suggests that socioeconomic attributes of both childhood and adulthood confer risk for cardiovascular morbidity and mortality. In this study, we examine the association of both parental and individual educational attainment with C-reactive protein (CRP), an inflammatory mediator relevant to cardiovascular pathophysiology, in a mid-life community sample. Subjects were 811 men and women (394 men / 417 women; 87% European-American / 13% African-American), 30-54 years of age. Plasma concentrations of CRP were determined from blood samples obtained at a single session following an overnight fast. Regression analyses adjusting for age and race showed both parental education and individual education to be associated inversely with CRP in women, but not men. The relationship of parental education with CRP in women persisted on multivariable adjustment for both lifestyle risk factors (smoking, alcohol consumption, sleep, exercise, body mass index) and individual SES. Independent of reported personal educational attainment, mid-life adult women whose parents achieved fewer years of educational attainment exhibit higher levels of circulating CRP than women with higher parental education. This association may help explain the increased risk of atherosclerotic cardiovascular morbidity and mortality conferred by low childhood socioeconomic status.
Abstract from: Psychosomatic Medicine (2009)
Janicki-Deverts, Cohen, Matthews, Gross, & Jacobs Jr.
OBJECTIVE: To examine whether socioeconomic status (SES) (education, occupation, income), is associated both cross sectionally and prospectively with circulating concentrations of a) two correlates of oxidative damage, F2-isoprostanes (F2-IsoPs) and gamma-glutamyltransferase (GGT); and b) antioxidant nutrients (ascorbic acid and carotenoids). We also examine whether the proposed associations are mediated by smoking, alcohol consumption, and depression. Risk for chronic disease increases with decreasing SES. One pathway by which low SES might influence disease risk is by promoting oxidative stress. METHODS: Data from 1,278 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study were used to examine the association of SES with oxidation correlates and antioxidant nutrients. Education, occupation, health behaviors, and body mass index (BMI) were assessed during Years 0, 10, and 15 of the study; income and depression were evaluated at Years 10 and 15. F2-isoprostanes were measured at Year 15, gamma-glutamyltransferase (GGT) at Years 0 and 10, carotenoids at Years 0 and 15, and ascorbic acid at Years 10 and 15. RESULTS: Cross sectionally, oxidation correlates decreased and antioxidant nutrients increased with increasing SES, estimated in several ways, independent of age, sex, race, and BMI. Prospectively, lower Year 0 education and occupation predicted greater increases in GGT and greater decreases in carotenoids over 10 to 15 years. Prospective associations of Year 0 SES with Year 15 carotenoids were independent of Year 15 SES. Smoking, drinking, and depression symptoms partially mediated these effects. CONCLUSIONS: Circulating oxidation correlates increase and antioxidant nutrients decrease with decreasing SES, both cross sectionally and prospectively.
Abstract from: Social Science & Medicine (2009)
Gruenewald, Cohen, Matthews, Tracy, & Seeman
Inflammatory processes are implicated in a number of diseases for which there are known socioeconomic status (SES) disparities, including heart disease and diabetes. Growing evidence also suggests SES
gradients in levels of peripheral blood markers of inflammation. However, we know little about potential gender and racial/ethnic differences in associations between SES and inflammation, despite the fact that
the burden of inflammation-related diseases varies by gender and race. The present study examines SES (education and income) gradients in levels of two inflammatory biomarkers, C-reactive protein (CRP) and interleukin-6 (IL-6), in a biethnic (White and Black) sample of men and women (n = 3,549, aged 37–55 years) in the USA from the CARDIA Study. Health status, behavioral and psychosocial variables that may underlie SES differences in inflammatory biomarker levels were also examined. Age-adjusted CRP and IL-6 levels were inversely associated with education level in each race/gender group except Black males. Income gradients were also observed in each race/gender group for IL-6 and in White females and males for CRP. In general, differences in CRP and IL-6 levels between low and high SES groups were reduced in magnitude and significance with the addition of health status, behavioral, and psychosocial variables, although the impact of the addition of model covariates varied across race/gender groups and different SES-inflammation models. Overall, findings indicate SES gradients in levels of inflammation burden in middle-aged White and Black males and females.
Abstract from: Perspectives on Psychological Science (2009)
Cohen & Janicki-Deverts
Persons with more types of social relationships live longer and have less cognitive decline with aging, greater resistance to infectious disease, and better prognoses when facing chronic life-threatening illnesses. We have known about the importance of social integration (engaging in diverse types of relationships) for health and longevity for 30 years. Yet, we still do not know why having a more diverse social network would have a positive influence on our health, and we have yet to design effective interventions that influence key components of the network and in turn physical health. Better understanding of the role of social integration in health will require research on how integrated social networks influence health relevant behaviors, regulate emotions and biological responses, and contribute to our expectations and worldviews.
Abstract from: Archives of Internal Medicine (2009)
Cohen, Doyle, Alper, Janicki-Deverts, & Turner
BACKGROUND: Sleep quality is thought to be an important predictor of immunity and in turn susceptibility to the common cold. This article examines whether sleep duration and efficiency in the weeks preceding viral exposure are associated with cold susceptibility. METHODS: Participants were 153 healthy men and women volunteers, ages 21-55. For 14 consecutive days, they reported their sleep duration and sleep efficiency (percent of time in bed actually asleep) for the previous night, and whether they felt rested. Average scores for each sleep variable were calculated over the 14-day baseline. Subsequently, participants were administered nasal drops containing a rhinovirus, quarantined and monitored on the day before and for five days following exposure for development of a clinical cold (infection in the presence of objective signs of illness). RESULTS: There was a graded association with average sleep duration, with those with <7 hours sleep 2.94 times (CI[95%]=1.18-7.30) more likely to develop a cold than those with >8 hours. The association with sleep efficiency was also graded with those with < 92% efficiency 5.50 times (CI[95%]=2.08-14.48) more likely to develop a cold than those with efficiencies >98%. These relations could not be explained by differences in pre-challenge virus-specific antibody, demographics, season of the year, body mass, socioeconomic status, psychological variables or health practices. Percent of days feeling rested was not associated with colds. CONCLUSIONS: Poorer sleep efficiency and shorter sleep duration in the weeks preceding an exposure to a rhinovirus were associated with lower resistance to illness.
Abstract from: Annals of Behavioral Medicine (2008)
History of Unemployment Predicts Future Elevations in C-Reactive Protein among Male Participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Janicki-Deverts, Cohen, Matthews, & Cullen
BACKGROUND: Unemployment is associated with risk of future morbidity and premature mortality. PURPOSE: To examine whether unemployment history predicts future C-reactive protein (CRP) levels in male participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. METHODS: Unemployment, body mass index (BMI), and health behaviors were measured at 7, 10, and 15 years post-recruitment. CRP was measured at Years 7 and 15. RESULTS: Having a history of unemployment at Year 10 was associated with higher CRP at Year 15, independent of age, race, BMI, Year 7 CRP, Year 15 unemployment, and average income across Years 10-15. Poor health practices and depressive symptoms explained 22% of the association, but Year 10 unemployment history remained a significant predictor. Findings did not differ across age, race, education, or income. CONCLUSIONS: Discrete episodes of unemployment may have long-term implications for future CRP levels.
Abstract from: Brain, Behavior, and Immunity (2008)
Marsland, Prather, Petersen, Cohen, & Manuck
Recent evidence suggests that individuals with certain personality traits are at elevated risk for chronic systemic inflammation. To date, this literature has focused on the related traits of hostility and negative affect (NA). In this study, we examine the covariation of trait measures of hostility and NA with the inflammatory mediators interleukin-6 and C-reactive protein. We also explore whether observed associations reflect independent contributions of cognitive, affective and behavioral components of hostile dispositions or shared trait variance with global negative affectivity. Subjects were a diverse sample of 855 relatively healthy middle-aged community volunteers (50% male) from the Adult Health and Behavior Project. The Buss and Perry Aggression Questionnaire (BPAQ) and an Abbreviated Cook-Medley Hostility Scale (ACM) were used to measure dimensions of hostility, and the Multidimensional Personality Questionnaire was used to measure trait NA. Regression analyses accounting for demographic characteristics and medical covariates showed a positive relationship of all components of hostility and trait NA with both IL-6 and CRP. After controlling for trait NA, only the behavioral component of hostility was independently associated with the inflammatory markers. The relationships of cognitive and affective components of hostility with inflammatory markers were largely explained by lifestyle factors, particularly body mass index and smoking. In contrast, lifestyle factors did not explain the covariation of hostile behavioral tendencies and inflammation. These findings suggest that unique attributes of aggresive behavioral tendencies account for much of the variability in inflammation associated with hostility and negative emotions, raising the possibility that individuals high in aggression are at increased risk of inflammatory disease.
Abstract from: Social Cognitive and Affective Neuroscience (2008)
Gianaros, Horenstein, Hariri, Sheu, Manuck, Matthews, & Cohen
Socioeconomic disadvantage during childhood and adolescence predicts poor mental and physical health and premature death by major medical diseases in adulthood. However, the neural pathways through which socioeconomic factors may exert a developmental influence on health and longevity remain largely unknown. This fMRI study provides novel evidence of a unique relationship between the perception that one's parents had a relatively low social standing-a putative indicator of early socioeconomic disadvantage-and greater amygdala reactivity to threatening facial expressions. This relationship was not explained by several possible confounders, including sex, ethnicity, dispositional emotionality, symptoms of depression and anxiety, parental education and participants' perceptions of their own social standing. The amygdala expresses marked developmental plasticity and plays instrumental roles in processing emotional information, regulating emotion-related behaviors and orchestrating biobehavioral stress responses throughout life. Thus, these findings may provide insight into the neurodevelopmental pathways impacting socioeconomic disparities in health.
Abstract from: Health Psychology (2008)
Objective and Subjective Socioeconomic Status and Susceptibility to the Common Cold
Cohen, Alper, Doyle, Adler, Treanor, & Turner
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.
Abstract adapted from: Journal of the American Medical Association (2007)
Cohen, Janicki-Deverts, & Miller
Despite widespread public belief that psychological stress leads to disease, the biomedical community remains skeptical of this conclusion. In this commentary, we discuss the plausibility of the belief that stress contributes to a variety of disease processes and summarize the role of stress in 4 major diseases: clinical depression, cardiovascular disease (CVD), human immunodeficiency virus (HIV)/AIDS, and cancer. This commentary addresses several questions. (1) What is psychological stress? (2) What are the pathways linking psychological stress to disease? (3) Does stress cause disease?
Abstract from: Social Cognitive and Affective Neuroscience (2007)
Gianaros, Horenstein, Cohen, Matthews, Brown, Flory, Critchley, Manuck, & Hariri
Low socioeconomic status (SES) increases the risk for developing psychiatric and chronic medical disorders. A stress-related pathway by which low SES may affect mental and physical health is through the perception of holding a low social standing, termed low subjective social status. This proposal implicates overlapping brain regions mediating stress reactivity and socioemotional behaviors as neuroanatomical substrates that could plausibly link subjective social status to health-related outcomes. In a test of this proposal, we used a computational structural neuroimaging method (voxel-based morphometry) in a healthy community sample to examine the relationships between reports of subjective social status and regional gray matter volume. Results showed that after accounting for potential demographic confounds, subclinical depressive symptoms, dispositional forms of negative emotionality and conventional indicators of SES, self-reports of low subjective social status uniquely covaried with reduced gray matter volume in the perigenual area of the anterior cingulate cortex (pACC)-a brain region involved in experiencing emotions and regulating behavioral and physiological reactivity to psychosocial stress. The pACC may represent a neuroanatomical substrate by which perceived social standing relates to mental and physical health.
Abstract from: Psychosomatic Medicine (2007)
Pressman & Cohen
OBJECTIVE: To analyze the relationship between social word use in autobiographies and longevity. Although there is substantial evidence that our social relationships are associated with mortality, interpretation of this work is weakened by the limitations of assessing the social environment with structured questionnaires and interviews. By analyzing the word content of autobiographies, we could assess spontaneous indicators of important social relationships and relate them to longevity. This technique is less subject to social desirability reporting biases and more sensitive to aspects of the social environment that are central to how one experiences his or her social world. METHODS: The autobiographies of 96 psychologists and 220 literary writers were digitized and scanned for social relationship word frequency via a computerized word counting program. Archival data were collected on birth and death dates, year of publication, place of birth, age when the autobiography was written, and sex. RESULTS: After controlling for sex, year of birth, and age at the time of writing, we found that higher use of words indicating social roles/integration (e.g., father, sister, neighbor, co-worker) was associated with an increased lifespan in both samples. Specific social categories assessing the use of family role terms (e.g., aunt, family, brother) and references to other individuals (e.g., they, we, us, everyone) also predicted longer life, but only in the sample of psychologists. CONCLUSIONS: Assessing social word use in autobiographies provided an indirect measure of social relationships that predicted longevity. This technique of analyzing writing samples may be useful in future archival research as well as in studies where it is desirable to study social relationships in an indirect fashion.
Abstract from: Brain, Behavior, and Immunity (2007)
Janicki-Deverts, Cohen, Doyle, Turner, & Treanor
Infection commonly triggers nonspecific psychological and behavioral changes including fatigue and malaise, anhedonia, inability to concentrate, and disturbed sleep that collectively are termed "sickness behaviors". Converging evidence from several lines of research implicate the activities of proinflammatory cytokines as a cause of sickness behaviors. Here we elaborate upon the findings of previous research by examining whether infection-associated elevations in local proinflammatory cytokines are associated with increased negative mood and decreased positive mood. One hundred and eighty-nine healthy adults were experimentally exposed to rhinovirus or influenza virus during a 6-day period of quarantine. Infection, objective signs of illness, nasal IL-1B, IL-6, and TNF-alpha, and self-reported affect were assessed at baseline and on each of the five post-challenge quarantine days. In the 153 persons who became infected following exposure to the challenge virus, daily production of IL-6, but not IL-1B or TNF-alpha, was associated with reduced concurrent daily positive affect. One-day lagged analyses showed that daily production of all three cytokines was related to lower positive affect on the next day. All lagged associations were independent of previous-day positive affect and objective signs of illness (mucus production, mucociliary clearance function). There were no associations between cytokines and negative affect. Findings support a causal association between pathogen-induced local cytokine production and changes in positive affect over a 24-h timeline.
Abstract from: Psychosomatic Medicine (2007)
Janicki-Deverts, Cohen, Adler, Schwartz, Matthews, & Seeman
OBJECTIVE: To determine whether socioeconomic status (SES) is associated with catecholamine levels (epinephrine [E] and norepinephrine [NE]-indicators of sympathetic nervous system [SNS] activity) in a community-based sample of men and women, Blacks and Whites, with a broad range of income; and to test whether such a relationship is mediated by psychosocial factors and/or health behaviors. METHODS: A total of 672 participants from the Coronary Artery Risk Development in Young Adults study (CARDIA) provided 12-hour, overnight urine samples, and completed sociodemographic, health behavior, and psychosocial questionnaires. RESULTS: Regardless of whether measured in terms of income, education, or occupation, higher SES was associated with lower urinary catecholamine levels, independent of age, race, and gender. These relationships were stronger in men than in women but were similar across Blacks and Whites. Smoking and greater levels of depressive symptoms accounted for some of the association of SES with E, and, to a lesser extent, with NE. CONCLUSIONS: These data provide support for the hypothesis that lower SES is accompanied by increased physiologic distress, indicated by elevated SNS activity. Further, they suggest that the association of SES with catecholamines, like the associations of SES with morbidity and mortality, is apparent at all levels of the socioeconomic hierarchy.
Abstract from: Health Psychology (2007)
Jackson, Kubzansky, Cohen, Jacobs Jr., & Wright
OBJECTIVE: To examine the cross-sectional association between hostility and pulmonary function (PF) and its consistency across race/ethnicity-gender groups. DESIGN: Data were from the Coronary Artery Risk Development in (Young) Adults (CARDIA) cohort study (N=4,629). Participants were recruited from 4 metropolitan areas in the United States, ages 18-30 years at baseline in 1985-1986, approximately balanced across race/ethnicity (Black, White) and gender. MAIN OUTCOME MEASURES: Main outcome measures were percent predicted values for forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). RESULTS: In full-sample multiple linear regression analyses, each 1 standard deviation (SD) increase in hostility was associated with a 0.66% decrease in FEV1 (p=.0002) and a 0.60% decrease in FVC (p=.0006). This inverse association of hostility with PF remained after controlling for age, height, current socioeconomic status (SES), participant smoking status, and asthma and is more consistent than that of smoking and PF. In stratified analyses, each 1 SD increase in hostility predicted statistically significant reductions in PF for Black women, White women, and Black men. For White men, hostility showed no statistically significant relation with PF, although the pattern relating hostility to PF was similar to the pattern in the other three groups. Further, both of the post hoc three-way interaction terms for hostility, race/ethnicity, and gender predicting FEV1 and FVC were nonsignificant. CONCLUSION: PF was inversely associated with hostility across race/ethnicity and gender, independent of age, height, current SES, smoking, and asthma. On the basis of these cross-sectional findings, the authors hypothesize that higher hostility will predict a more rapid decline in PF.
Abstract from: Health Psychology (2007)
Why Would Social Networks be Linked to Affect and Health Practices?
Cohen & Lemay
OBJECTIVE: To examine the relation among social integration (SI), affect, and smoking and alcohol consumption. DESIGN: The authors administered social network and psychological questionnaires to 193 adults and then interviewed them on 14 consecutive evenings about their daily social interactions, affect, and smoking and alcohol consumption. MAIN OUTCOME MEASURES: The main outcome measures were positive and negative affect, smoking, and alcohol consumption. RESULTS: Between-subjects analyses found that those with more diverse social networks (high in SI) interacted with more people and smoked and drank less. SI was not, however, associated with affect. In contrast, within-subject analyses found that the more people participants interacted with during a day, the greater their positive affect, drinking, and smoking on that day. However, this occurred primarily for persons low in SI. High-SI persons reported high positive affect irrespective of the number of people with whom they interacted, and their smoking and drinking behaviors were less influenced by number of interactants. CONCLUSION: SI may alter health because it affects responsiveness to the social influences of others.
Abstract from: Journal of Applied Biobehavioral Research (2006)
Can a 15-hour (Overnight) Urinary Catecholamine Measure Substitute for a 24-hour Measure?
Janicki-Deverts, Zilles, Cohen, & Baum
This study examined whether 15-hr and 24-hr urinary catecholamine measures show comparable associations with other physiological measures that are expected to correlate with sympathetic nervous system activity. Participants (193 healthy adults) provided 24-hr urine samples that were collected in a controlled environment (hotel), and divided into 9-hr daytime and 15-hr overnight collections. On the same day, resting blood pressure (BP) was measured, and 8 samples of salivary cortisol were collected. Catecholamine (15-hr and 24-hr) measures were correlated substantially in the entire sample, and when examined separately by sex and by race. Both 15-hr and 24-hr epinephrine (E) correlated significantly with systolic BP and cortisol; 15-hr and 24-hr norepinephrine (NE) correlated significantly with cortisol. Correlation coefficients for 15-hr measures were similar, but not equivalent to those for 24-hr measures. Urinary catecholamines obtained via 15-hr overnight collection approximated but were not equivalent to catecholamines obtained via 24-hr collection. Overnight collection was associated with reduced power to detect significant associations of catecholamines with criterion variables, such that use of 15-hr rather than 24-hr sampling required a relative increase in sample size of 1.32 times for E and 1.18 times for NE to detect similar effects. Researchers should weigh the costs of additional subjects to the benefit of decreased burden when choosing between the two sampling methods.
Abstract from: Psychosomatic Medicine (2006)
Positive Emotional Style Predicts Resistance to Illness After Experimental Exposure to Rhinovirus or Influenza A Virus
Cohen, Alper, Doyle, Treanor, & Turner
OBJECTIVE: In an earlier study, positive emotional style (PES) was associated with resistance to the common cold and a bias to underreport (relative to objective disease markers) symptom severity. This work did not control for social and cognitive factors closely associated with PES. We replicate the original study using a different virus and controls for these alternative explanations. METHODS: 193 healthy volunteers ages 21 to 55 years were assessed for a PES characterized by being happy, lively, and calm; a negative emotional style (NES) characterized by being anxious, hostile, and depressed; other cognitive and social dispositions; and self-reported health. 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. RESULTS: For both viruses, increased PES was associated with lower risk of developing an upper respiratory illness as defined by objective criteria (adjusted odds ratio comparing lowest with highest tertile = 2.9) and with reporting fewer symptoms than expected from concurrent objective markers of illness. These associations were independent of prechallenge virus-specific antibody, virus type, age, sex, education, race, body mass, season, and NES. They were also independent of optimism, extraversion, mastery, self-esteem, purpose, and self-reported health. CONCLUSIONS: We replicated the prospective association of PES and colds and PES and biased symptom reporting, extended those results to infection with an influenza virus, and "ruled out" alternative hypotheses. These results indicate that PES may play a more important role in health than previously thought.
Abstract from: Psychosomatic Medicine (2006)
Matthews, Schwartz, Cohen, & Seeman
OBJECTIVE: Chronic stress may be a risk factor for coronary heart disease and is associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. We tested the hypotheses that two markers of HPA axis dysregulation, elevated average level (area under the curve, adjusted for time awake) and diurnal decline of salivary cortisol, were associated with presence of coronary calcification (CaC). METHOD: Seven hundred eighteen black and white middle-aged adults enrolled in an ancillary study of Coronary Artery Risk Development in Young Adults provided six salivary cortisol samples throughout one full day and had measurements of CaC. RESULTS: The prevalence of any calcification was low, 8.1% in the participants of the ancillary study, with white men having the highest proportion. Average cortisol did not differentiate groups, means = 2.15 and 2.08. Those with any CaC declined approximately 6% per hour in cortisol over the course of the day, whereas those with no CaC declined more than 8% per hour (p<.003). Those persons with slope scores in the flattest quartile had a greater likelihood of any CaC than did those in the remaining quartiles adjusted for sex-race group, age, smoking, treatment for diabetes, systolic blood pressure, logged triglycerides, average cortisol, and educational attainment (odds ratio = 2.58; 95% confidence interval = 1.26-5.30). CONCLUSIONS: Our results are consistent with the hypothesis that HPA axis dysregulation may affect risk for atherosclerosis.
Abstract from: Thorax (2006)
Kubzansky, Sparrow, Jackson, Cohen, Weiss, & Wright
BACKGROUND: Hostility and anger are risk factors for, or co-occur with, many health problems of older adults such as cardiovascular diseases, all-cause mortality, and asthma. Evidence that negative emotions are associated with chronic airways obstruction suggests a possible role for hostility in the maintenance and decline of pulmonary function. This study tests the hypothesis that hostility contributes to a faster rate of decline in lung function in older adults. METHODS: A prospective examination was undertaken of the effect of hostility on change in lung function over time. Data are from the VA Normative Aging Study, an ongoing cohort of older men. Hostility was measured in 1986 in 670 men who also had an average of three pulmonary function examinations obtained over an average of 8.2 years of follow up. Hostility was ascertained using the 50-item MMPI based Cook-Medley Hostility Scale. Pulmonary function was assessed using spirometric tests to obtain measures of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). RESULTS: Baseline pulmonary function differed between high and medium/low hostility groups (mean [SE] percent predicted FEV1 88.9 [18.5] v 95.3 [16.9] and FVC 92.5 [16.5] v 98.9 [15.9], respectively; p<0.01 for both). This overall association between higher hostility and reduced lung function remained significant after adjusting for smoking and education, although the effect size was attenuated for both FEV1 and FVC. Higher hostility was associated with a more rapid decline in lung function, and this effect was unchanged and remained significant for FEV1 in multivariate models but was attenuated for FVC. Each standard deviation increase in hostility was associated with a loss in FEV1 of approximately 9 ml/year. CONCLUSIONS: This study is one of the first to show prospectively that hostility is associated with poorer pulmonary function and more rapid rates of decline among older men.
Abstract from: Journal of Behavioral Medicine (2006)
The Life Engagement Test: Assessing Purpose in Life
Scheier, Wrosch, Baum, Cohen, Martire, Matthews, Schulz, & Zdaniuk
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.
Abstract from: Current Directions in Psychological Science (2006)
Positive Affect and Health
Cohen & Pressman
Negative affective styles such as anxiety, depression, and hostility have long been accepted as predictors of increased risk for illness and mortality. In contrast, positive affective styles have been relatively ignored in the health literature. Here we highlight consistent patterns of research associating trait positive affect (PA) and physical health. The evidence we review suggests an association of trait PA and lower morbidity and decreased symptoms and pain. PA is also associated with increased longevity among community-dwelling elderly. The association of PA and survival among those with serious illness is less clear and suggests the possibility that PA may be harmful in some situations. We conclude by raising conceptual and methodological reservations about this literature and suggesting directions for future research.
Abstract from: Psychosomatic Medicine (2006)
Cohen, Doyle, & Baum
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.
Abstract from: Brain, Behavior, and Immunity (2006)
Marsland, Cohen, Rabin, & Manuck
Recent evidence suggests that dispositional positive affect may be associated with decreased vulnerability to upper respiratory infections. To explore a potential pathway of this relationship, we examined whether trait positive affect is related to an in vivo immune response relevant for host resistance to infection. Eighty-four healthy graduate students who tested negative for prior exposure to the hepatitis B virus were administered the standard hepatitis B vaccination series. Five months after the first dose, a blood sample was collected for the measurement of specific antibody response to the vaccine and subjects completed a battery of psychosocial questionnaires. Higher scores on a measure of dispositional positive affect were associated with a greater antibody response to hepatitis B vaccination. This relationship occurred after controlling for demographics and body mass and was largely independent of concomitant levels of dispositional negative affect, optimism, and extraversion. In the presence of dispositional positive affect, there was no independent effect of trait negative affect on antibody response. Physical activity played a protective role for individuals low in positive affect, being related to higher antibody responses. These data provide initial evidence that individual differences in dispositional positive affect may be of health significance, being related to an in vivo immune response relevant for protection against infection.
Abstract from: Brain, Behavior, and Immunity (2006)
Doyle, Gentile, & Cohen
Psychosocial factors moderate the expression of illness during upper respiratory virus infections but past attempts to define mediational pathways were not successful. Here, we used a model of experimental rhinovirus infection in humans to evaluate three proinflammatory cytokines for their potential role in mediating the previously documented association between positive emotional style and illness. After assessing emotional style in 327 healthy adults, each was exposed to one of two strains of rhinovirus and followed for 5 days in quarantine. Symptoms/signs, nasal lavage IL-1B, IL-6, and IL-8 protein, and viral shedding were assessed at baseline and on each of the 5 days after exposure. Virus-specific antibody was assessed at baseline and 28 days after challenge. An analysis of the data for 234 subjects with documented infection showed that nasal IL-1B, IL-6, and IL-8 protein levels were all associated with greater illness expression but IL-6 was by far the best predictor of nasal signs and symptoms. Lower positive emotional style was associated with greater objective and subjective markers of illness and these associations were decreased substantially by controlling for IL-6 but not for IL-1B or IL-8. These results are consistent with the hypothesis that IL-6 acts as a biological mediator in linking positive emotional style to illness expression during rhinovirus infection.
Abstract from: Psychosomatic Medicine (2006)
Cohen, Schwartz, Epel, Kirschbaum, Sidney, & Seeman
Objective. The objectives of this study were to assess whether socioeconomic status (SES) is associated with dysregulation of the cortisol diurnal rhythm and whether this association is independent of race and occurs equally in whites and blacks; and to determine if an association between SES and cortisol can be explained (is mediated) by behavioral, social, and emotional differences across the SES gradient. Methods. 781 subjects from a multi-site sample representing both whites and blacks provided 6 saliva cortisol samples over the course of the day: at awakening, 45 min, 2.5 hrs, 8 hrs, and 12 hrs after awakening, and at bedtime. Results. Both lower SES (education and income) and being black were associated with higher evening levels of cortisol. These relationships were independent of one another and SES associations with cortisol were similar across racial categories. The evidence was consistent with poorer health practices (primarily smoking), higher levels of depressive symptoms, poorer social networks and supports, and feelings of helplessness (low mastery) mediating the link between SES and cortisol. However, we found no evidence for psychosocial or behavioral mediation of the association between race and cortisol response. Conclusions. Lower SES was associated in a graded fashion with flatter diurnal rhythms as a result of less of a decline during the evening. This association occurred independent of race and the data were consistent with mediation by health practices, emotional and social factors. Blacks also showed a flatter rhythm at the end of the day. This association was independent of SES and could not be explained by behavioral, social, or emotional mediators.
Abstract from: Psychological Bulletin (2005)
Pressman & Cohen
This review highlights consistent patterns in the literature associating positive affect (PA) and physical health. However, it also raises serious conceptual and methodological reservations. Evidence suggests an association of trait PA and lower morbidity and of state and trait PA and decreased symptoms and pain. Trait PA is also associated with increased longevity among older community-dwelling individuals. The literature on PA and surviving serious illness is inconsistent. Experimentally inducing intense bouts of activated state PA triggers short-term rises in physiological arousal and associated (potentially harmful) effects on immune, cardiovascular, and pulmonary function. However, arousing effects of state PA are not generally found in naturalistic ambulatory studies in which bouts of PA are typically less intense and often associated with health protective responses. A theoretical framework to guide further study is proposed.
Abstract from: International Journal of Behavioral Medicine (2005)
The Pittsburgh Common Cold Studies: Psychosocial Predictors of Susceptibility to Respiratory Infectious Illness
Cohen
This article provides a selected overview of 20 years of research on the role of psychosocial factors in susceptibility to upper respiratory infections. We present evidence from our laboratory that psychological stress is associated with increased risk for developing respiratory illness for persons intentionally exposed to a common cold virus, that the longer the duration of the stressor the greater the risk, and that stress association with susceptibility may be mediated by stress-induced disruption of the regulation of proinflammatory cytokines. We further provide evidence that social relationships (social integration and social support) are also associated with risk for respiratory illness: Social integration is associated with reduced risk irrespective of stress level and social support protects persons from the pathogenic influences of stress. Finally, we report recent evidence that lower levels of early childhood socioeconomic status (SES) are associated with greater risk of viral-induced illness during adulthood, independent of adult SES.
Abstract from: Current Opinion in Allergy & Clinical Immunology (2005)
The Impact of Stress on the Development and Expression of Atopy
Wright, Cohen, & Cohen
PURPOSE OF REVIEW. Biological hypersensitivity to environmental stimuli is a fundamental feature of atopy predisposing to a number of clinically expressed disorders including allergic rhinitis, atopic dermatitis or eczema, and allergic asthma. There is provocative evidence that psychological stress constitutes an increased risk for atopy. This risk is thought to be mediated by the effects of stress on immunoregulation which in turn modulates the hypersensitivity response. The primary objective is to review recent evidence updating our understanding of the role for psychological stress in atopy. RECENT FINDINGS. The Th1-Th2 paradigm has been central to interpreting quantitative differences in cytokine expression in response to environmental stimuli like stress. Here we argue that examination of other mechanisms (e.g. oxidative stress pathways, glucocorticoid resistance, nerve-mast cell interactions, intestinal dysbiosis) and a broader range of cytokines and neuropeptides produced by cells both within and outside the immune system may better delineate the true complexity of the underlying mechanisms linking stress to allergic sensitization and asthma. The role of genetics and gene by environment interactions - based on evolving knowledge of candidate genes that may be relevant to both the stress response in general and pathways linked specifically to atopy - is also discussed. SUMMARY. Psychological stress may be conceptualized as a social pollutant that, when 'breathed' into the body, may disrupt biological mechanisms related to inflammation through mechanisms potentially overlapping with those altered by physical pollutants and toxicants.
Abstract from: Health Psychology (2005)
Loneliness, Social Network Size, and Immune Response to Influenza Vaccination in College Freshmen
Pressman, Cohen, Miller, Barkin, Rabin, & Treanor
Antibody response to the influenza immunization was investigated in 83 1st-semester healthy university freshmen. Elevated
levels of loneliness throughout the semester and small social networks were independently associated with poorer antibody response to 1 component of the vaccine. Those with both high levels of loneliness and a small social network had the lowest antibody response. Loneliness was also associated with greater psychological stress and negative affect, less positive affect, poorer sleep efficiency and quality, and elevations in circulating levels of cortisol. However, only the stress data were consistent with mediation of the loneliness-antibody response relation. None of these variables were associated with social network size, and hence none were potential mediators of the relation between network size and immunization response.
Abstract from: Psychoneuroendocrinology (2005)
State and Trait Affect as Predictors of Salivary Cortisol in Healthy Adults
Polk, Cohen, Doyle, Skoner, & Kirschbaum
We measured affect in 334 healthy adults on each of 7 days over a 3-week period. On the last day, salivary cortisol was assessed 14 times yielding scores for total concentration, morning rise amplitude, and slope of the time function. Trait negative affect (NA) was associated with higher total cortisol concentrations and greater morning rise in men. Cortisol levels for men low in trait positive affect (PA) did not decrease in the afternoon, resulting in a relatively high, flat rhythm. In contrast, women high in trait PA had low morning cortisol resulting in a low flat rhythm. State (person-centered) NA was not associated with same-day cortisol measures. State PA was associated with decreased total cortisol concentration in women. These are the first results showing associations between cortisol and trait PA. Differences in rhythmicity found here are noteworthy given the possible role of cortisol dysregulation in disease incidence, morbidity, mortality, and severity.
Abstract from: American Psychologist (2004)
Social Relationships and Health
Cohen
The author discusses three variables that assess different aspects of social relationships--social support, social integration, and negative interaction. The author argues that all 3 are associated with health outcomes, that these variables each influence health through different mechanisms, and that associations between these variables and health are not spurious findings attributable to our personalities. This argument suggests a broader view of how to intervene in social networks to improve health. This includes facilitating both social integration and social support by creating and nurturing both close (strong) and peripheral (weak) ties within natural social networks and reducing opportunities for negative social interaction. Finally, the author emphasizes the necessity to understand more about who benefits most and least from social-connectedness interventions.
Abstract from: Psychosomatic Medicine (2004)
Childhood Socioeconomic Status and Host Resistance to Infectious Illness in Adulthood
Cohen, Doyle, Turner, Alper, & Skoner
Objective: Low childhood socioeconomic status (SES) is a risk factor for adult morbidity and mortality primarily attributable to cardiovascular disease. Here, we examine whether childhood SES is associated with adult host resistance to infectious illness, and whether the effect is limited to a critical period of low SES exposure, can be undone by changes in childhood SES, and is explained by adult SES. Methods: Three hundred thirty-four healthy volunteers reported their own and their parents' level of education and the ages during their childhood when their parents owned their homes. Volunteers' current home ownership was recorded from real estate records. Subsequently, they were given nasal drops containing 1 of 2 rhinoviruses and were monitored in quarantine for infection and signs/symptoms of a common cold. Results: For both viruses, susceptibility to colds decreased with the number of childhood years during which their parents owned their home (odds ratios by tertiles adjusted for demographics, body mass, season, and prechallenge viral-specific immunity were 3.7 for fewest years, 2.6 and 1). This decreased risk was attributable to both lower risk of infection and lower risk of illness in infected subjects. Moreover, those whose parents did not own their home during their early life but did during adolescence were at the same increased risk as those whose parents never owned their home. These associations were independent of parent education level, adult education and home ownership, and personality characteristics. Conclusions: A marker of low income and wealth during early childhood is associated with decreased resistance to upper respiratory infections in adulthood. Higher risk is not ameliorated by higher SES during adolescence and is independent of adult SES.
Abstract from: American Journal of Public Health (2004)
Wright, Visness, Cohen, Stout, Evans, & Gold
Objectives: We examined the association between exposure to violence and asthma among urban children. Methods: We obtained reports from caretakers (n=851) of violence, negative life events, unwanted memories (rumination), caretaker-perceived stress, and caretaker behaviors (keeping children indoors, smoking, and medication adherence). Outcomes included caretaker-reported wheezing, sleep disruption, interference with play because of asthma, and effects on the caretaker (nights caretaker lost sleep because of child's asthma). Results: Increasing exposure to violence predicted higher number of symptom days (p=.0008) and more nights that caretakers lost sleep (p=.02) in a graded fashion after control for socioeconomic status, housing deterioration, and negative life events. Control for stress and behaviors partially attenuated this gradient, although these variables had little effect on the association between the highest level of exposure to morbidity, which suggests there are other mechanisms. Conclusions: Mechanisms linking violence and asthma morbidity need to be further explored.
Abstract from: Psychosomatic Medicine (2004)
Miller, Cohen, Pressman, Rabin, Barkin, & Treanor
Objectives: This study attempted to determine whether stress of moderate intensity could modulate the antibody response to an influenza vaccination in healthy young adults, identify critical periods during which stress could influence antibody response, and delineate behavioral and biological pathways that might explain relations between stress and antibody. Methods: A cohort of 83 healthy young adults underwent 13 days of ambulatory monitoring before, during, and after vaccination. Four times daily, subjects reported the extent to which they felt stressed and overwhelmed and collected a saliva sample that was later used to measure cortisol. A battery of health practices (cigarette smoking, alcohol use, physical activity, sleep hygiene) was assessed daily. Antibody titers to the vaccine components were measured at baseline and at 1-month and 4-month follow-up assessments. Results and Conclusions: To the extent that they reported higher levels of stress across the monitoring period, subjects exhibited poorer antibody responses to the New Caledonia strain of the vaccine. Stress ratings on the 2 days before the vaccine and the day it was given were not associated with antibody response. However, the 10 days afterward appeared to be a window of opportunity during which stress could shape the long-term antibody response to varying degrees. With respect to potential mediating pathways, little evidence emerged in favor of cortisol secretion, alcohol consumption, physical activity, or cigarette smoking. However, analyses were consistent with a pattern in which feelings of stress and loss of sleep become locked into a feed-forward circuit that ultimately diminishes the humoral immune response. These findings may shed light on the mechanisms through which stress increases vulnerability to infectious disease.
Abstract from: Psychology and Health (2004)
Psychological Stress, Appraisal, Emotion and Cardiovascular Response in a Public Speaking Task
Feldman, Cohen, Hamrick, & Lepore
Forty-three undergraduates (30 males, 13 females) prepared and performed a speech task (stressor) or a reading task (no-stressor control). Preparing to speak led to greater threat appraisal, negative emotion, and cardiovascular (CV) response than preparing to read aloud, particularly in speech anxious individuals. Delivering the speech, however, did not result in an increment in CV response over and above preparation. Although threat appraisals could not explain the effect of stress on CV response during task preparation, negative emotion accounted for over half of the effect. These data support the hypothesis that CV response in these studies is at least partially accounted for by psychological processes (stressor-specific anxiety and negative emotional response) and suggests that these processes may be best studied during a period of stressor anticipation.
Abstract from: International Journal of Epidemiology (2003)
Jackson, Kubzansky, Cohen, Weiss, & Wright
Background: Socioeconomic status (SES) may contribute to the trajectory of pulmonary function over the life course. Studies suggest that people with lower (versus higher) SES during childhood subsequently have lower levels of adult pulmonary function. But prospective studies are sparse across young adulthood, an important phase in pulmonary development. Methods: Participants were from the Coronary Artery (Disease) Risk Development in (Young) Adults (CARDIA) Study: 5113 young adults ages 18-30 at baseline, approximately balanced within centres across gender, self-identified race/ethnicity (Black, White), and current SES. Childhood SES was ascertained from baseline self reports of parents' highest completed education. Pulmonary function in young adulthood was measured using FEV1 (forced expiratory volume in one second) and FVC (forced vital capacity), assessed on three occasions over a period of 5 years. Results: Longitudinal analyses suggested that rates of change in FEV1 and FVC both differed in a gradient fashion by childhood SES. As shown by significant childhood SES by time interaction terms, these associations with FEV1 were robust for both men (b = 1.59E-3, SE = 5.21E-4, P < 0.001) and women b = 1.93E-3, SE = 4.80E-4, P < 0.001), and adjusted for multiple potential confounders including smoking. Results were similar for FVC. Subsequent examination of the interaction terms showed that FEV1 and FVC declined for participants in the lowest childhood SES group, showed continued growth for those in the highest group, and were intermediate for the middle group. Conclusions: Childhood SES may influence men's and women's young adult pulmonary function in two ways. First, individuals with lower childhood SES may not attain as high levels of pulmonary function in early adulthood relative to individuals with higher childhood SES. Second, pulmonary function may decline earlier and faster for individuals with lower childhood SES.
Abstract from: Brain, Behavior, and Immunity (2003)
Cohen & Hamrick
Stress reactivity refers to a stable individual difference in response to stressors. This article addresses three questions about reactivity: (1) Are cardiovascular, endocrine, and immune responses to acute laboratory stressors stable over time and across stressor tasks? (2) Are cardiovascular, endocrine, and immune reactors the same people? and (3) Are reactive people more vulnerable to stressor-induced effects on susceptibility to infectious disease? We conclude that for many individual indicators of physiological responsiveness to stressors there is moderate stability over time and across stressor tasks indicating the possible existence of underlying dispositional characteristics; the commonality of immune and cardiovascular and hormonal responses to stress depend on the nature of regulation of the immune response being assessed; reactivity appears to have implications for vulnerability to stressor-associated disease risk (stress-by-reactivity interaction) in the natural environment, but the exact nature of this vulnerability is not as yet entirely clear.
Abstract from: Psychosomatic Medicine (2003)
Cohen, Doyle, Turner, Alper, & Skoner
It has been hypothesized that persons who usually express negative emotions are at greater risk for disease and those who usually express positive emotions are at less risk. We tested these hypotheses for host resistance to the common cold. 334 healthy volunteers 18-54 years were assessed for their tendency to express positive emotions such as happy, pleased and relaxed; and for negative emotions such as anxious, hostile and depressed. Subsequently, they were given nasal drops containing 1 of 2 rhinoviruses and monitored in quarantine for the development of a common cold (illness in the presence of verified infection). For both viruses, increased positive emotional style (PES) was associated (in a dose-response manner) with lower risk of developing a cold. This relationship was maintained after controlling for pre-challenge virus-specific antibody, virus-type, age, sex, education, race, body mass, and season (adjusted relative risk comparing lowest-to-highest tertile=2.9). Negative emotional style (NES) was not associated with colds and the association of positive style and colds was independent of negative style. Although PES was associated with lower levels of endocrine hormones and better health practices, these differences could not account for different risks for illness. In separate analyses, NES was associated with reporting more unfounded (independent of objective markers of disease) symptoms, and PES with reporting fewer. The tendency to express positive emotions was associated with greater resistance to objectively verifiable colds. PES was also associated with reporting fewer unfounded symptoms and NES with reporting more.
Abstract from: Psychological Science (2003)
Sociability and Susceptibility to the Common Cold
Cohen, Doyle, Turner, Alper, & Skoner
There is considerable evidence that social relationships can influence our health, but only limited evidence on the health effects of the personality characteristics that are thought to mold our social lives. We asked whether sociability predicted resistance to infectious disease and whether this relationship was attributable to the quality and quantity of social interactions and relationships. 334 volunteers completed questionnaires assessing their sociability, social networks, and supports, and six evening interviews assessing daily interactions. They were subsequently exposed to a virus that causes a common cold and monitored to see who developed verifiable illness. Increased sociability was associated in a linear fashion with a decreased probability of developing a cold. Although sociability was associated with more and higher quality social interactions, it predicted disease susceptibility independent of these variables. The association between sociability and disease was also independent of baseline immunity (virus-specific antibody), demographics, emotional styles, stress-hormones, and health practices.
Abstract from: Physiology & Behavior (2002)
Stress, Immune Reactivity and Susceptibility to Infectious Disease
Marsland, Bachen, Cohen, Rabin, & Manuck
Psychological stress is known to affect immune function and to predict infectious disease susceptibility, but not all individuals who are stressed develop disease. We report on a series of studies from our laboratory describing interindividual variability of immune responses to psychological stress. In our initial series of experiments, we demonstrated that acute laboratory stress alters both quantitative and functional components of cellular immunity. An examination of response variability revealed that individuals differ substantially in the magnitude of these immune responses. These differences were found to parallel (and be predicted by) interindividual variability in stress-induced sympathetic nervous system activation. Further investigation revealed that individuals vary consistently in the magnitude of their immune responses to stress, making it conceivable that individual differences in immune reactivity provide a vulnerability factor mediating relationships between stress and disease. We have recently reported that individual differences in the magnitude of stress-induced reduction of immune function may be of clinical significance, being related to an immune response relevant for protection against infection, antibody response to hepatitis B vaccination.
Abstract from: Annals of Behavioral Medicine (2002)
Breathing Easy: A Prospective Study of Optimism and Pulmonary Function in the Normative Aging Study
Kubzansky, Wright, Cohen, Weiss, Rosner, & Sparrow
Although there is good evidence that emotions are associated with chronic airways obstruction, evidence for the influence of psychological factors on the level and decline of pulmonary function is sparse. Optimism has been linked to enhanced well-being, whereas pessimism has been identified as a risk factor for poor physical health. This investigation examines prospectively the effects of optimism versus pessimism on pulmonary function. Data are from the Veterans Administration Normative Aging Study, an ongoing cohort of older men. In 1986, 670 men completed the revised Minnesota Multiphasic Personality Inventory from which we derived the bipolar Revised Optimism-Pessimism Scale. During an average of 8 years of follow-up, an average of 3 pulmonary function exams were obtained. Men with a more optimistic explanatory style had significantly higher levels of forced expiratory volume in 1 sec (FEV1) and forced vital capacity (both p < .01). Interactions between time and optimism suggested that rate of decline in FEV1 over time was slower in men with a more optimistic explanatory style relative to men who were more pessimistic. These data are the first to link optimism with higher levels of pulmonary function and slower rate of pulmonary function decline in older men, a protective effect that is independent of smoking.
Abstract from: Health Psychology (2002)
Chronic Psychological Stress and the Regulation of Pro-Inflammatory Cytokines: A Glucocorticoid Resistance Model
Miller, Cohen, & Ritchey
The study examined whether chronic stress impairs the immune system's capacity to respond to hormonal signals that terminate inflammation. Fifty healthy adults were studied. Half of them were parents of cancer patients; the remaining half were parents of healthy children. Parents of cancer patients reported more psychological distress than parents of healthy children. They also had flatter diurnal slopes of cortisol secretion, primarily due to reduction in output during the morning hours. There was also evidence that chronic stress impaired the immune system's response to anti-inflammatory signals: The capacity of a synthetic glucocorticoid hormone to suppress in vitro production of the pro-inflammatory cytokine interleukin-6 was diminished among parents of cancer patients. These findings suggest a novel pathway by which chronic stress might alter the course of inflammatory disease.
Abstract from: Personality and Social Psychology Bulletin (2002)
The Contribution of Individual Differences in Hostility to the Association Between Daily Interpersonal Conflict, Affect and Sleep
Brissette & Cohen
Adults of both sexes completed evening phone interviews assessing interpersonal conflict, state negative and positive affect (NA and PA), and sleep from the previous night on 7 consecutive days. Greater interpersonal conflict was associated with increased NA and decreased PA that day, and increased sleep disturbance that night (measured on the next day). Mediational analyses were consistent with NA on the conflict day (but not PA) being a partial mediator of the relation between greater conflict and greater sleep disturbance. Participants reported greater NA on days they reported getting less sleep and experiencing greater sleep disturbance the previous night, but conflict was not associated with NA or PA on the following day. The associations between conflict and greater NA and sleep disturbance were exacerbated among individuals higher in cynical hostility. This exacerbation was not due to individuals higher in hostility reporting a greater number conflicts or more severe conflicts.
Abstract from: American Journal of Respiratory and Critical Care Medicine (2002)
Wright, Cohen, Carey, Weiss, & Gold
The role of stress in the pathogenesis of childhood wheeze remains controversial. Caretaker stress might influence wheeze through stress-induced behavioral changes in caregivers (e.g., smoking, breast-feeding) or biologic processes impacting infant development (e.g., immune response, susceptibility to lower respiratory infections). The influence of caregiver stress on wheeze in infancy was studied in a genetically predisposed prospective birth-cohort (n=496). Caregiver-perceived stress and wheeze in the children were ascertained bimonthly from the first 2 to 3 months of life. Greater levels of caregiver-perceived stress at 2 to 3 months was associated with increased risk of subsequent repeated wheeze among the children during the first 14 months of life (RR, 1.6; 95% CI, 1.3 to 1.9). Caregiver-perceived stress remained significant (RR, 1.4, 95% CI, 1.1 to 1.9) when controlling for factors potentially associated with both stress and wheeze (parental asthma, socioeconomic status, birth weight, and race/ethnicity) as well as mediators through which stress might influence wheeze (maternal smoking, breast-feeding, indoor allergen exposures, and lower respiratory infections). Furthermore, caregiver stress prospectively predicted wheeze in the infants, whereas wheeze in the children did not predict subsequent caregiver stress. The effect of caregiver stress on early childhood wheeze was independent of caregiver smoking and breast-feeding behaviors, as well as allergen exposure, birth weight, and lower respiratory infections. These findings suggest a more direct mechanism may be operating between stress and wheeze in early childhood. Stress may contribute significantly to the population burden of preventable childhood respiratory illness.
Abstract from: Health Psychology (2002)
Being Popular Can Be Healthy or Unhealthy: Stress, Social Network Diversity and Incidence of Upper Respiratory Infection
Hamrick, Cohen, & Rodriguez
Diverse social contacts are generally associated with better health. However, diverse contacts can increase exposure to infectious agents. This should increase risk for disease, particularly among those whose host resistance is otherwise (e.g., stressed individuals) compromised. In this prospective study, 114 healthy college students who completed questionnaires assessing social network diversity (married, friends, social groups, religious groups, etc.) and stressful life events were subsequently interviewed weekly for 12 weeks to track incidence of upper respiratory infections (URI). URI episodes were defined by a symptom criterion and by self-reported illness verified by a nurse practitioner. Stress and diversity of social contacts interacted--diversity was associated with more illnesses among those with high numbers of stressful life events and slightly fewer illnesses among those with lower numbers of stressful events. These associations remained after controlling for neuroticism.
Abstract from: Psychosomatic Medicine (2002)
Cohen, Hamrick, Rodriguez, Feldman, Rabin, & Manuck
Objective: We tested the hypothesis that the greater a person’s laboratory stress-elicited elevation in cortisol, the greater the life stress-related risk for upper respiratory infection (URI). We also tested the prediction that the greater the laboratory stress-elicited rise in natural killer cell (NK) cytotoxicity, the smaller the life stress-related URI risk. Finally, we explored whether sympathetic nervous system (SNS) and enumerative immune reactivities to laboratory stress moderate the relation between life stress and URI. Method: At baseline, 115 healthy subjects were administered a negative stressful life events checklist and were tested to assess their SNS (blood pressure, heart rate & catecholamines), HPA (cortisol), and immune (NK cell cytotoxicity & lymphocyte subsets) reactivities to laboratory speech tasks administered two weeks apart. Responses were averaged across the two laboratory assessments to create reactivity scores. After these assessments were completed, participants were followed weekly for 12 consecutive weeks. At each follow-up they completed a measure of perceived stress experienced over the last week. They were also instructed to contact the study coordinator if they had a cold or flu at any time during follow-up. A health care worker verified reported illnesses. Results: In a traditional prospective analysis, high cortisol reactors with high levels of life events had a greater incidence of verified URI than high reactors with low levels of life events and low reactors irrespective of their life event scores. Using hierarchical linear modeling, CD8+ number, Natural Killer (NK) cell number, and NK cell cytotoxicity each interacted with weekly-perceived stress levels in predicting concurrent occurrences of self-reported URIs. For these outcomes, it was low immune reactors who were more likely to experience an URI during high stress than low stress weeks. High immune reactors did not exhibit differences in weekly URIs as a function of weekly stress level. The SNS reactivity markers did not moderate the association of stress and URI incidence in either analysis. Conclusions: Acute HPA and immune responses to laboratory stressors are markers of how vulnerable people are to the increased risk for URI associated with stressors in the natural environment.
Abstract from: Health Psychology (2001)
Long-Term Effects of Educational and Peer Discussion Group Interventions on Adjustment to Breast Cancer
Helgeson, Cohen, Schulz, & Yasko
The authors report a 3-year follow-up of the effects of 8-week support group interventions on the quality of life of women with early stage breast cancer. Shortly after diagnosis, women were randomly assigned to 1 of 4 conditions: control, education, peer discussion, and education plus peer discussion. The education group intervention focused on providing information to enhance control over the illness experience, whereas the peer discussion group intervention focused on providing emotional support through the expression of feelings. Consistent with the results that emerged 6 months after the interventions (V. S. Helgeson, S. Cohen, R. Schulz, & J. Yasko, 1999), the authors found that the benefits of the education intervention were maintained over a 3-year period (N=252), although effects dissipated with time. The authors continued to find no benefits of the peer discussion intervention, either alone or in combination with education.
Abstract from: Health Psychology (2001)
Associations Between Stress, Trait Negative Affect, Acute Immune Reactivity, and Antibody Response to Hepatitis B Injection in Healthy Young Adults
Marsland, Cohen, Rabin, & Manuck
Eighty-four healthy graduate participants were administered the standard course of 3 hepatitis B vaccinations. Five months after the first dose (shortly after the second injection), each participant completed psychosocial measures, and a blood sample was drawn for determination of hepatitis B surface antibody titer. After completion of the vaccination series, participants performed an acute stress protocol, consisting of a 30-min adaptation period and a 5-min evaluative speech task. Blood was drawn at the end of the resting and task periods for assessment of cellular immune measures. Lower antibody response, as assessed after the second hepatitis B injection, was predicted independently by (a) high trait negative affect and (b) diminished T-cell proliferation in response to PHA. These data provide evidence that trait negative affect and the magnitude of stress-induced suppression of immune function may have clinical significance.
Abstract from: Psychoneuroendocrinology (2001)
Individual Differences in the Diurnal Cycle of Salivary Free Cortisol: A Replication of Flattened Cycles for Some Individuals
Stone, Schwartz, Smyth, Kirschbaum, Cohen, Hellhammer, & Grossman
Free cortisol measured in saliva has been shown to have the same diurnal rhythm as serum cortisol, one that typically declines rapidly throughout the waking day. A recent study showed that over 15% of a sample of community individuals who were monitored over two days did not show the typical diurnal rhythm. The present study specifically tested the hypothesis that there is significant between-subject variation (individual differences) in diurnal rhythms using multi-level, random regression models. Analyses of participants from four studies were conducted; studies varied in terms of the number of saliva samples taken per day, the number of days studied, and participants' demographic and health status. Significant individual differences of diurnal cycle in each of the four samples were found. In at least 10% of each sample no significant diurnal cycles was detected; however, the overall mean level of cortisol of those with flat cycles differed among the samples. These results suggest that some people do not have the expected diurnal rhythm of cortiosol secretion. It is not clear what the determinants of this finding are or if there are any health consequences of having a flat cycle.
Abstract from: Psychosomatic Medicine (2001)
Cohen, Miller, & Rabin
Objective: To evaluate the evidence for the hypothesis that psychological stress influences antibody response to immunization in humans. Methods: Critical review of the literature. Results: The evidence supports an association between psychological stress and suppression of humoral immune (antibody) response to immunization. This association is convincing in the case of secondary immune response but weak for primary response. The lack of consistent evidence for a relation with primary response may be attributable to a failure to consider the critical point(s) when stress needs to be elevated in the course of the production of antibody. Lower secondary antibody responses were found among patients with chronically high levels of stress (severe enduring problems or high levels of trait negative affect). These responses were found most consistently among older adults. Lower secondary responses were also found for those reporting acute stress or negative affect, but only in studies of S-IgA antibody where psychological and antibody measures were linked very closely in time. Health practices did not mediate relations between stress and antibody responses, however, there were indications that elevated cortisol levels among stressed patients could play a role. Evidence also suggests the possible influences of dispositional stress-reactivity and low positive affect in the inhibition of antibody production. Conclusions: The literature supports a relationship between psychological stress and antibody responses to immunizations. The data are convincing in the case of secondary response but weak for primary response. More attention to the kinetics of stress and antibody response and their interrelations is needed in future research.
Abstract from: Health Psychology (2001)
Psychological Interventions and the Immune System: A Meta-Analytic Review and Critique
Miller & Cohen
This article reviews evidence for the hypothesis that psychological interventions can modulate the immune response in humans, and presents a series of models depicting the psychobiological pathways through which this might occur. Although more than eighty-five trials have been conducted, meta-analyses reveal only modest evidence that interventions can reliably alter immune parameters. The most consistent evidence emerges from hypnosis and conditioning trials. Disclosure and stress-management show scattered evidence of success. Relaxation demonstrates little capacity to elicit immune change. While these data provide only modest evidence of successful immune modulation, it would be premature to conclude that the immune system is unresponsive to psychological interventions. This literature has important conceptual and methodological issues that need to be resolved before any definitive conclusions can be reached.
Abstract from: Journal of Social Structure (2000)
Cohen, Brissette, Skoner, & Doyle
In this article, we discuss the concept of social integration and its implications for health. We provide both an overview of the social epidemiology and a review of theories of how participation in a diverse social network might influence health. We also present evidence from a prospective study of social network diversity (number of social roles) and susceptibility to the common cold in people experimentally exposed to a cold virus. We found that the greater the social diversity, the lesser the susceptibility to infectious illness. However, our attempts to isolate the pathways through which social diversity was associated with susceptibility (health practices, hormones, immune function) were unsuccessful. The relation was independent of the number of people in the social network, and of personality characteristics thought to influence social participation.
Abstract from: Annals of Behavioral Medicine (2000)
Cohen, Hamrick, Rodriguez, Feldman, Rabin, & Manuck
One hundred fifteen college students were exposed to an evaluative speech task twice, separated by two weeks. At both sessions, we assessed cardiovascular, endocrine, immune, and psychological response at baseline and during the task. We found stability across sessions for stress-induced increases in anxiety and task engagement, heart rate, blood pressure, norepinephrine (but not epinephrine), cortisol, natural killer cell cytotoxicity, and numbers of circulating CD3+, CD8+, and CD56+ (but not CD4+ or CD19+) lymphocytes. The stable cardiovascular, immune, and endocrine reactivities were intercollated, providing evidence of a unified physiological stress response across these outcomes. Although stable stress-induced increases in task engagement were associated with the physiological stress responses, stress-induced anxiety was not.
Abstract from: Journal of Personality and Social Psychology (1999)
The Impact of Personality on the Reporting of Unfounded Symptoms and Illness
Feldman, Cohen, Doyle, Skoner, & Gwaltney
We examined the role of personality in the reporting of symptoms and illness not supported by underlying pathology. After assessment of the "Big Five" personality factors, 276 healthy volunteers were inoculated with a common cold virus. On each of the following five days, we assessed objective indicators of pathology, self-reported symptoms, and self-reported illness onset. Neuroticism was directly associated with reports of unfounded (without a physiological basis) symptoms in individuals at baseline and post-inoculation in those with and without colds. Neuroticism was also indirectly associated with reports of unfounded illness through greater symptom reporting. Openness was associated with reporting unfounded symptoms in those with verifiable colds, while conscientiousness was associated with reporting unfounded illness in those who were not ill.
Abstract from: Annals of Behavioral Medicine (1999)
Negative Emotions and Acute Physiological Responses to Stress
Feldman, Cohen, Lepore, Matthews, Kamarck, & Marsland
One pathway through which stressors are thought to influence physiology is through their effects on emotion. We used meta-analytic statistical techniques with data from nine studies to test the effects of acute laboratory stressors (speech, star mirror-image tracing, handgrip) on emotional (undifferentiated negative emotion, anger, anxiety) and cardiovascular (CV) response. In all of the studies, participants responded to stressors with both increased CV response and increased negative emotion. Increases in negative emotion were associated with increases in CV response across tasks, however, these associations were small. The range of variance accounted for was between 2% and 12%. Thus, the contribution of negative emotion, as assessed in these studies, to physiological responses to acute laboratory stressors was limited. Although these results raise questions about the role of emotion in mediating stress-elicited physiological responses, the nature of the acute laboratory stress paradigm may contribute to the lack of a strong association.
Abstract from: New York Academy of Sciences (1999)
Social Status and Susceptibility to Respiratory Infections
Cohen
Adults and children of lower socioeconomic status (SES) are at higher risk for a wide range of communicable infectious diseases, especially respiratory infections. Greater risk for infectious illness among people with lower SES is thought to be attributable to increased exposure to infectious agents and decreased host resistance to infection. We summarize three studies that examine the prospective association of several markers of social status (unemployment, perceived and observed social status) with host resistance to upper respiratory infections. Unemployment was associated with increased susceptibility to infection in adult humans. Lower social status in male monkeys was also associated with increased susceptibility, as was lower perceived social status in humans. The association of social status and susceptibility was accounted for primarily by increased risk in the lowest social status groups. However, further increases in social status were associated with further decreases in susceptibility in both monkeys and humans.
Abstract from: Psychosomatic Medicine (1999)
Cohen, Doyle, & Skoner
Objective: To assess the role of psychological stress in the expression of illness among infected subjects and test the plausibility of local pro-inflammatory cytokine production as a pathway linking stress to illness. Methods: After completing a measure of psychological stress, 55 subjects were experimentally infected with an influenza A virus. Subjects were monitored in quarantine daily for upper respiratory symptoms, mucus production, and nasal lavage levels of interleukin (IL) 6. Results: Higher psychological stress assessed prior to the viral challenge was associated with greater symptom scores, greater mucus weights, and higher IL-6 lavage concentrations in response to infection. The IL-6 response was temporally related to the two markers of illness severity, and mediation analyses indicated that these data were consistent with IL-6 acting as a major pathway through which stress was associated with increased symptoms of illness. However, this pattern of data is also consistent with rises in IL-6 occurring in response to tissue damage associated with illness symptoms. Conclusions: Psychological stress predicts a greater expression of illness and an increased production of IL-6 in response to an upper respiratory infection.
Abstract from: Psychosomatic Medicine (1999)
Miller, Cohen, & Herbert
Objective: The goals of this study were to investigate whether depression is associated with cellular immunity in ambulatory patients and to identify neuroendocrine and behavioral pathways that might account for this relationship. Method: We studied 32 women who met DSM-IV criteria for Major Depressive Disorder and 32 healthy female control subjects. The groups were matched on age and ethnicity. All were unmedicated and free of disease involving the immune system. Results: Depressed subjects had reduced proliferative responses to the mitogens ConA and PHA compared to controls. Natural killer cell activity was reduced among older depressed subjects but enhanced among younger depressed subjects. Although depression was associated with elevated circulating levels of norepinephrine and estradiol, these hormones could not account for the immunologic differences between depressed and control subjects. Depression was also associated with greater tobacco and caffeine consumption, less physical activity, and poorer sleep quality. Mediational analyses were consistent with physical activity acting as a pathway through which depression was associated with reduced lymphocyte proliferation. Conclusions: Ambulatory patients with mild to moderately severe depression exhibit reduced mitogen-stimulated lymphocyte proliferative responses and altered natural killer cell cytotoxicity. The relationship between depression and proliferative responses may be mediated by physical activity.
Abstract from: Journal of the American Medical Association (1997)
Social Ties and Susceptibility to the Common Cold
Cohen, Doyle, Skoner, Rabin, & Gwaltney
Objective: To examine the hypothesis that diverse ties to friends, family, work, and community are associated with increased host resistance to infection. Design: After reporting the extent of participation in 12 types of social ties (e.g., spouse, parent, friend, workmate, member of social group), subjects were given nasal drops containing one of two rhinoviruses, and monitored for the development of a common cold. Setting: Quarantine. Participants: 276 healthy volunteers, ages 18-55, neither HIV positive nor pregnant. Outcome Measures: Colds (illness in the presence of a verified infection), mucus production, mucociliary clearance function, and amount of viral replication. Results: In response to both viruses, those with more types of social ties were less susceptible to common colds, shed less virus, produced less mucus, and were more effective in ciliary clearance of their nasal passages. These relations were unaltered by statistical controls for pre-challenge virus-specific antibody, virus-type, age, gender, season, body mass, education, and race. Susceptibility to colds decreased in a dose-response manner with increased diversity of the social network. There was an adjusted relative risk of 4.2 comparing persons with fewest (1-3) to those with most (6 or more) types of social ties. Although smoking, poor sleep quality, alcohol abstinence, low dietary intake of vitamin C, elevated catecholamine levels, and being introverted were all associated with greater susceptibility to colds, they could only partially account for the relation between social network diversity and incidence of colds. Conclusions: More diverse social networks were associated with greater resistance to upper respiratory illness.
Abstract from: Health Psychology (1998)
Types of Stressors That Increase Susceptibility to the Common Cold in Healthy Adults
Cohen, Frank, Doyle, Skoner, Rabin, & Gwaltney
Two-hundred seventy-six volunteers completed a life stressor interview and psychological questionnaires and provided blood and urine samples. They were then inoculated with common cold viruses and monitored for the onset of disease. Although severe acute stressful life events (less than 1 month long) were not associated with developing colds, severe severe chronic stressors (1 month or longer) were associated with a substantial increase in risk of disease. This relation was attributable primarily to under- or unemployment and to enduring interpersonal difficulties with family or friends. The association between chronic stressors and susceptibility to colds could not be fully explained by differences among stressed and nonstressed persons in social network characteristics, personality, health practices, or prechallenge endocrine or immune measures.
For earlier publications, please see Dr. Cohen's .
Updated May 22, 2018