Momentary Partner Involvement in Diabetes Self-Care and Continuously Measured Glucose: A Dynamic Analysis.

OBJECTIVE: This study examined the dynamic, real-time associations between partner involvement in diabetes self-care and continuous glucose monitor (CGM) metrics in adults with type 2 diabetes. METHODS: For 1 week, 63 participants wore Dexcom G4 CGMs and provided momentary reports of partner involvement in diabetes self-care five times per day. Dynamic structural equation models were used to estimate the reciprocal lagged effects of partner involvement on next-hour CGM metrics (and vice versa). RESULTS: Partner involvement predicted improved next-hour glucose control for five of six CGM metrics in analyses adjusted for time-varying covariates. The hour after partner involvement, the model predicted a 26.34 mg/dl decrease in glucose level (standardized ß = -0.19), 30% greater odds of meeting target time in target range ( ß = 0.07), 48% higher odds of target time below target range (TBR; ß = 0.04; the only nonsignificant effect), 47% greater odds of target time above target range (ß = 0.11), a 4.20 unit decrease in glucose standard deviation ( ß = -0.19), and a 0.01 unit decrease in glucose coefficient of variation ( ß = -0.08; all p values < .05). There was less consistent support for the reverse pathway, with only two metrics significantly related to next-hour partner involvement: glucose level ( ß = 0.15) and TBR ( ß = 0.21), such that having higher levels and meeting target TBR were significantly predictive of next-hour partner involvement. CONCLUSIONS: This is the first study showing that partner involvement in daily diabetes management predicts short-term glucose control. More research is needed to understand how partners influence glycemic control and evaluate interventions that promote their involvement in diabetes care.

Poor Sleep Quality Predicts Decline in Physical Health Functioning in Patients with Coronary Heart Disease and Moderating Role of Social Support.

Although sleep problems are common among patients with coronary heart disease (CHD), there is a lack of prospective research examining its influence on health consequences over time. This study investigated whether poor sleep quality predicted patients' decline in physical health functioning over 6 months and whether social support buffered its detrimental effect. Participants were 185 patients with CHD, who completed measures of sleep, psychosocial characteristics, and physical health functioning at baseline and 6 months. Hierarchical regression analyses were conducted to examine whether global sleep index and its subscales, including sleep efficiency, perceived sleep quality, and daily disturbances (sleep disturbances and daytime dysfunction), predicted the decline of physical health functioning at 6 months. Social support was examined for its moderating effect in buffering the negative influence of poor sleep quality on physical health functioning over 6 months. Findings showed that poorer global sleep index, especially subscales of daily disturbances and lower sleep efficiency, significantly predicted greater decline of physical health functioning at 6 months, even after adjusting for covariates, including baseline functioning and depression. Moreover, social support was found to buffer the detrimental impact of poor sleep quality, especially low sleep efficiency, on 6-month physical health functioning. Findings suggest that improving sleep quality for patients with CHD may be promising to facilitate their long-term health maintenance.

Spousal Influence on Diabetes Self-care: Moderating Effects of Distress and Relationship Quality on Glycemic Control.

BACKGROUND: Spouses often attempt to influence patients' diabetes self-care. Spousal influence has been linked to beneficial health outcomes in some studies, but to negative outcomes in others. PURPOSE: We aimed to clarify the conditions under which spousal influence impedes glycemic control in patients with type 2 diabetes. Spousal influence was hypothesized to associate with poorer glycemic control among patients with high diabetes distress and low relationship quality. METHODS: Patients with type 2 diabetes and their spouses (N = 63 couples) completed self-report measures before patients initiated a 7-day period of continuous glucose monitoring. Mean glucose level and coefficient of variation (CV) were regressed on spousal influence, diabetes distress, relationship quality, and their two- and three-way interactions. RESULTS: The three-way interaction significantly predicted glucose variability, but not mean level. Results revealed a cross-over interaction between spousal influence and diabetes distress at high (but not low) levels of relationship quality, such that spousal influence was associated with less variability among patients with low distress, but more among those with high distress. Among patients with high distress and low relationship quality, a 1 SD increase in spousal influence predicted a difference roughly equivalent to the difference between the sample mean CV and a CV in the unstable glycemia range. CONCLUSIONS: This was the first study to examine moderators of the link between spousal influence and glycemic control in diabetes. A large effect was found for glucose variability, but not mean levels. These novel results highlight the importance of intimate relationships in diabetes management.

Measurement Structure of the Pittsburgh Sleep Quality Index and Its Association with Health Functioning in Patients with Coronary Heart Disease.

Research on the underlying structure of sleep measures in patients with coronary heart disease (CHD) is lacking. Existing research on sleep and health outcomes primarily focused on only one dimension of sleep (e.g., sleep duration), leaving other aspects unexamined. To address this gap, this study examined the measurement structure of Pittsburgh Sleep Quality Index (PSQI) and its associations with health-related quality of life among CHD patients. Participants were 167 CHD patients from a cardiac wellness program. Confirmatory factor analysis revealed that the two-factor structure with sleep efficiency and perceived sleep quality best fitted the data. Concurrent validity analyses with structural equation modeling showed that, when considered simultaneously, perceived sleep quality, but not sleep efficiency, was significantly associated with emotional, physical, and social quality of life. Findings demonstrated that the PSQI consists of two moderately correlated factors that are differentially associated with separate health domains in cardiac patients.

Depression, Anxiety, Perceived Stress, and Their Changes Predict Greater Decline in Physical Health Functioning over 12 Months Among Patients with Coronary Heart Disease.

BACKGROUND: Although the deleterious impact of psychological distress on patients with coronary heart disease (CHD) is recognized, few studies have examined the influence of change in psychological distress on health outcomes over time. This study investigated whether three common manifestations of distress (depression, anxiety, and perceived stress) and their changes predicted the decline in physical functioning in CHD patients over 12 months. In addition, perceived social support was examined as a buffer of psychological distress or a direct predictor of physical functioning. METHODS: Participants were 255 CHD patients with a mean age of 63 (SD = 8.65) years, including 208 men and 47 women. Psychological distress and physical functioning were assessed at baseline, 6 months and 12 months. Hierarchical regression analyses were conducted to examine the influences of psychological factors on physical functioning over 12 months. All models were adjusted for baseline physical functioning, age, gender, marital status, education, BMI, and length of participation at a wellness center. RESULTS: For each psychological distress variable (depression, anxiety, or perceived stress), both the baseline (ßs = - 0.19 to - 0.32, ps = 0.008 to < 0.001) and its respective change over time (ßs = - 0.17 to - 0.38, ps = 0.020 to < 0.001) independently and significantly predicted greater decline in physical functioning at 6 and 12 months, after adjusting for covariates. Perceived social support predicted greater improvement in physical functioning at 12 months (ß = 0.13, p = 0.050), but it did not buffer impact of psychological distress. CONCLUSIONS: Findings underscore the importance of monitoring various forms of psychological distress continuously over time for CHD patients.

Psychosocial Predictors of Self-reported Medical Adherence in Patients With Heart Failure Over 6 Months: An Examination of the Influences of Depression, Self-efficacy, Social Support, and Their Changes.

Background: Poor adherence to medical regimens is a serious problem that interferes with heart failure (HF) patients' disease management and contributes to poor clinical outcomes. Few prospective studies have examined the psychosocial predictors of adherence over time in HF patients. Purpose: This study examined the influences of depression, self-efficacy, social support, and their changes on self-reported medical adherence over 6 months in HF patients. Methods: Participants were 252 HF outpatients, among whom 168 completed follow-up assessments. Hierarchical multiple regression analyses were conducted to examine whether psychosocial variables and their changes prospectively predicted adherence at 6 months, after adjusting for baseline adherence, age, gender, ethnicity, marital status, education, HF severity, medical comorbidity, and mental health treatment. Results: Baseline self-efficacy (ß = .22, p < .05), increase in self-efficacy (ß = .34, p < .001), and decrease in depression (ß = -.15, p = .05) predicted improved adherence over 6 months, but social support did not. In the combined model that included all significant psychosocial predictors from previous analyses, baseline self-efficacy (ß = .37, p = .001) and its increase (ß = .35, p < .001) emerged as independent predictors of improved adherence at 6 months. Conclusions: Promoting self-efficacy and reducing depressive symptoms may be promising targets of behavioral interventions to facilitate long-term disease management in HF patients.

Influence of Depression and Hostility on Exercise Tolerance and Improvement in Patients with Coronary Heart Disease.

PURPOSE: Although hostility and depression have been linked to higher cardiac risk and poor prognosis of patients with coronary heart disease (CHD), there is a lack of research that studies how they may influence the short-term outcomes among patients participating in cardiac rehabilitation (CR). This study aimed to investigate the influence of hostility and depression on patients' exercise tolerance and improvement trajectory in a CR program over 6 weeks. METHOD: Participants were 142 patients with CHD, with a mean age of 62 years. Latent growth curve modeling was conducted to determine whether hostility and depression predicted patients' baseline exercise tolerance and rates of improvement on treadmill, while controlling for age and severity of illness. In addition, analysis was conducted to examine whether depression mediated the influence of hostility on exercise outcomes. RESULTS: Patients with CHD with higher hostility scores had a lower baseline exercise tolerance and slower rates of improvement over 6 weeks. Depressive symptom severity mediated the influence of hostility on exercise baseline and improvement. Patients with higher hostility were more likely to have more severe depressive symptoms, which in turn were associated with lower baseline exercise tolerance and slower improvement. CONCLUSION: While both hostility and depression predicted the exercise outcomes in CR, depression explained the influence of hostility. The findings underscore the importance of addressing psychosocial issues in treatment of CHD patients and provide support for psychosocial interventions in CR to facilitate patients' recovery.

Psychosocial and Physiological Predictors of Mortality in Patients of Heart Failure: Independent Effects of Marital Status and C-Reactive Protein.

PURPOSE: Few studies have examined the interplay between psychosocial and physiological variables in prediction of mortality in heart failure (HF) patients. This study investigated the prospective influence of marital status, social support, depression, and C-reactive protein (CRP) on the mortality of patients with chronic HF. In addition, it examined whether there was a mediating relationship between social support and marital status and whether depression and inflammation influenced one another to predict mortality of HF patients. METHODS: The participants were 220 HF patients, among whom 48 were deceased over an average of 4.60 years. A number of psychosocial and biomedical variables were examined for their associations with mortality and their relationships between each other in hierarchical logistic regression analyses. RESULTS: After adjusting for New York Heart Association (NYHA) class, age, and gender, being unmarried predicted mortality (OR = 2.80, p = 0.004), whereas perceived social support did not. Higher CRP was not associated with depression, and it independently predicted mortality (OR = 1.92, p = 0.030). Depression predicted mortality only in the univariate analysis (OR = 1.02, p = 0.030), but the association was no longer significant either after removing somatic items or after adjusting for covariates. In the combined multivariate model, marital status (OR = 2.20, p = 0.047), CRP (OR = 1.91, p = 0.035), and NYHA class (OR = 2.41, p = 0.001) independently predicted mortality. CONCLUSIONS: Monitoring chronic HF patients who are unmarried, with elevated inflammation, or in higher NYHA class may help identify those at greater mortality risk to implement targeted intervention.

Increased association between endometriosis and endometrial cancer: a nationwide population-based retrospective cohort study.

OBJECTIVE: Association between endometriosis and ovarian cancer has been well established. Nonetheless, endometriosis may also be associated with endometrial cancer because of shared etiological mechanisms of both estrogen stimulation and chronic inflammation; however, the association between these 2 disorders has rarely been investigated. METHODS: The National Health Insurance Research Databases in Taiwan were retrieved and analyzed. The case cohort consisted of patients with a diagnosis of endometriosis between January 1997 and December 2000 (N = 15,488). For the construction of control cohort, 8 age- and sex-matched control patients for every patient in the case cohort were selected using a random sampling method (n = 123,904). All subjects were tracked for 10 years from the date of entry to identify whether they had developed endometrial cancer. The Cox proportional hazards regression model was used to evaluate 10-year event occurrence of endometrial cancer. RESULTS: During the 10-year follow-up period, 392 participants developed endometrial cancer, with 104 (0.7%) distributed in the case cohort and 288 (0.2%) in the control cohort. Multivariable Cox regression modeling demonstrates a higher risk for developing endometrial cancer in the case cohort than in the control cohort (adjusted hazard ratio [aHR], 2.83; 95% confidence interval [CI], 1.495.35; P < 0.01). Age at diagnosis of endometriosis shows a moderator effect: when 40 years or younger, the risk for developing endometrial cancer was comparable between the case cohort and the control cohort (aHR, 1.42; 95% CI, 0.55-3.70; P = 0.226), whereas when older than 40 years, the risk for developing endometrial cancer was higher in the former group than in the latter group (aHR, 7.08; 95% CI, 2.33-21.55; P = 0.007). CONCLUSIONS: Patients diagnosed with endometriosis may harbor an increased risk for developing endometrial cancer in their later life. Closer monitoring is advised for this patient population.

Loneliness, perceived social support, and their changes predict medical adherence over 12 months among patients with coronary heart disease.

OBJECTIVES: This study investigated whether changes in loneliness and perceived social support predicted medical adherence in patients with coronary heart disease (CHD) over 12 months. Moreover, short-term and long-term buffering effects of social support on the association between loneliness and medical adherence were systematically examined. DESIGN: A three-wave longitudinal study. METHODS: Participants were 255 CHD patients with a mean age of 63 years. Medical adherence, loneliness, and perceived social support were assessed at baseline, 3 months, and 12 months. Hierarchical regression analyses were conducted to examine the influences of loneliness and social support as well as their changes on medical adherence over 12 months. Moderation analyses were performed to test buffering effects of baseline social support and its changes against loneliness and its changes, respectively. RESULTS: Changes in loneliness significantly predicted medical adherence at 12 months (ß = -.23, p = .001) but not at 3 months (ß = -.10, p = .142). Changes in social support predicted medical adherence at both 3 (ß = .23, p = .002) and 12 months (ß = .26, p = .001). Social support concurrently buffered the adverse impact of loneliness on medical adherence (B = .29, SE = .12, p = .020) at baseline but did not at 3 or 12 months (Bs = -.21 to .40, SEs = .12 to .30, ps = .177 to .847). CONCLUSIONS: Findings highlight the importance of monitoring loneliness and perceived social support continuously over time for CHD patients to promote medical adherence.

Self-efficacy mediates the associations of social support and depression with treatment adherence in heart failure patients.

BACKGROUND: Nonadherence to treatment recommendations is a leading preventable cause of rehospitalization and premature mortality in chronic heart failure (HF) patients. PURPOSE: This study examined whether self-efficacy mediates the contributions of social support and depression to treatment adherence. METHODS: A sample of 252 HF outpatients with a mean age of 54 years completed self-report questionnaires assessing depression, perceived social support, self-efficacy, and treatment adherence. RESULTS: Self-efficacy mediated the associations of social support and depression with treatment adherence after adjusting for demographic (age, gender, marital status, education, and ethnicity) and medical (New York Heart Association Classification and comorbidity) covariates. CONCLUSION: Self-efficacy explains the influence of social support and depression on treatment adherence and may be a key target for interventions to improve disease management and self-care behaviors in HF patients.

Loneliness predicts physical and mental health-related quality of life over 9 months among patients with coronary heart disease.

This study investigated whether loneliness would predict physical and mental health-related quality of life (HRQoL) over 9 months and examined whether medical adherence would mediate their associations in patients with coronary heart disease (CHD). The overall design is a three-wave longitudinal study. A sample of 255 outpatients with CHD was recruited from a community-based cardiac rehabilitation programme. Participants, with a mean age of 63 years, completed measures assessing loneliness, depression and physical and mental HRQoL at baseline. Medical adherence was assessed at 3 months, and physical and mental HRQoL were reassessed at 9 months. A total of 88% of participants reported moderate or high loneliness. Baseline loneliness predicted physical and mental HRQoL at 9 months after adjusting for baseline physical and mental HRQoL, respectively. The effects remained significant when depression was also adjusted. Medical adherence at 3 months partially mediated the associations of baseline loneliness with 9-month physical and mental HRQoL. Findings underline the necessity of assessing loneliness for CHD patients to promote long-term medical adherence and further improve physical and mental HRQoL.

Avoidant coping moderates the association between anxiety and patient-rated physical functioning in heart failure patients.

Previous research has indicated that anxiety may be associated with adverse health outcomes in heart failure patients. Little research, however, has explored whether anxiety interacts with patients' coping strategies in their associations with physical functioning. The present study examined whether coping strategies moderated the association between anxiety and self-rated physical functioning in 273 heart failure patients. Hierarchical multiple regression analysis, adjusting for demographic and medical covariates, indicated that both anxiety (b=1.15, ß=0.46, P<0.001) and avoidant coping (b=0.43, ß=0.16, P<0.01) were significantly associated with poorer physical functioning in separate models. Results also demonstrated a significant interaction between avoidant coping and anxiety (b=0.56, ß=0.14, P<0.01), such that the association between anxiety and poorer physical functioning was stronger for patients who frequently used avoidant coping strategies than for those who avoided less frequently. Approach coping, however, was not directly associated with physical functioning, nor did it moderate the association between anxiety and physical functioning. The findings suggest that anxious heart failure patients who engage in avoidant coping may be at particular risk for physical dysfunction.

Depression and anxiety predict decline in physical health functioning in patients with heart failure.

BACKGROUND: Few studies have examined the prospective influences of depression and anxiety on physical health functioning in heart failure (HF) patients. Prior studies were also limited by employing psychological measures containing somatic items confounded with HF symptoms. PURPOSE: This study examined whether depression, anxiety, social support, and their changes predicted the decline of physical functioning in HF patients over 6 months. METHODS: Participants were 238 HF patients among whom 164 provided follow-up data. The depression and anxiety measures did not contain somatic items. RESULTS: After controlling for baseline physical functioning and demographic and medical covariates, baseline depression and its increase, as well as baseline anxiety and its increase, independently predicted greater decline in physical functioning at 6 months. Social support and its change were not associated with either concurrent or follow-up physical functioning. CONCLUSIONS: Depression, anxiety, and their changes independently predicted the decline of physical health functioning over 6 months.

Utility of the Millon Behavioral Medicine Diagnostic to predict medication adherence in patients diagnosed with heart failure.

Medication non-adherence is common and a primary reason for poor medical outcomes among individuals with heart failure (HF). This study's aims were to determine whether depression, hostility, and the personality-based Millon Behavioral Medicine Diagnostic (MBMD) Medication Abuse scale were associated with medication adherence (e.g., beta-blockers, ACE inhibitors, diuretics, statins) beyond contributions of demographic, medical, and psychosocial variables in an ethnically-diverse sample of 105 men and women diagnosed with HF. In hierarchical regression, greater MBMD Medication Abuse scale scores were associated with poorer adherence above and beyond both depression (ß = .236, t[102] = 2.113, p = .037) and hostility (ß = .244, t[102] = 2.506, p = .014). The Medication Abuse scale also completely mediated the relationship between adherence and depression. These findings suggest that personality measures such as the MBMD and hostility scales might be utilized in future studies investigating predictors of adherence and also used clinically to predict medication adherence among HF patients.

Depression, anxiety, perceived stress, and their changes predicted medical adherence over 9 months among patients with coronary heart disease.

OBJECTIVES: Although effective medical treatments have proved to successfully improve prognoses and outcomes of patients with coronary heart disease (CHD), low adherence to treatments is still common among patients. Deleterious impact of psychological distress on medical adherence has been recognized; however, few studies examined the influence of change in psychological distress on attenuation in adherence. This study investigated whether three common manifestations of distress (depression, anxiety, and perceived stress) and their changes predicted decline in medical adherence among CHD patient over 9 months. DESIGN: A three-wave longitudinal study. METHODS: Participants were 255 CHD patients with a mean age of 63 years. Psychological distress, medication adherence, and specific treatment adherence were assessed at baseline, 3 months, and 9 months. Hierarchical regression analyses were conducted to examine the influences of psychological distress on medical adherence over 9 months. All models were adjusted for baseline medication or specific adherence, demographic, and medical covariates. RESULTS: Baseline depression and its changes over time significantly predicted greater decline in both medication adherence (ßs = .15-.20, ps < .05) and specific adherence (ßs = -.21 to -.15, ps < .05). Anxiety showed a similar trend. For perceived stress, baseline and its change significantly predicted specific adherence over 9 months (ßs = -.30 to -.23, ps < .01), but did not predict medication adherence at 3 and 9 months. CONCLUSIONS: Findings underline the necessity of tracking various forms of psychological distress over time for CHD patients to promote medical adherence and further improve the disease prognosis.

Persistent sexual dysfunction impairs quality of life after cardiac transplantation.

INTRODUCTION: The impact of sexual dysfunction (SD) on mental and physical health after heart transplantation (HTx) has not been established. AIM: We investigated the relationship of SD on quality of life (QoL), physical and mental health, and depressive symptoms after HTx. MAIN OUTCOME MEASURES: We evaluated SD according to the International Index of Erectile Dysfunction and the Female Sexual Function Index. QoL, physical and mental health were assessed using: 1) Short Form 12 Health Survey Questionnaire, 2) Quality of Life Enjoyment and Satisfaction Questionnaire--Short Form, and two depressive symptoms questionnaires: 1) Beck Depression Inventory-II and 2) Quick Inventory Depressive Symptomatology-Self Report. METHODS: We enrolled patients who were greater than 6 months post HTx. Patients unable to read English, had pelvic surgery or trauma, urogenital abnormalities, or sexually inactive were excluded. RESULTS: Out of 79 subjects that were screened, 33 men and 6 women participated (mean age 61.4 + 1.4). Response rates were at least 82% for all questionnaires. Overall prevalence of SD was 61%, with 78% of men being affected and 50% of women. There was no significant difference in measures between genders. HTx recipients with SD reported significantly worse QoL on measures of physical health when compared to those without SD. After HTx, patients suffering from SD had significantly worse general health (P = 0.02) and physical health (P = 0.02), including physical functioning (P = 0.01) and physical role limitation (P = 0.01). In contrast, mental health and depressive symptoms after HTx were not significantly different between those with and without SD. CONCLUSIONS: After HTx a high prevalence of SD remains among both men and women. Patients with SD had worse general and physical health but not depressive symptoms when compared to those without SD. The contributing factors may be more related to physical rather than psychological causes.

Waist circumference moderates the association between marital stress and C-reactive protein in middle-aged healthy women.

The relationships among stress, obesity, and inflammation in women remain unclear. This study examined the relationships among marital stress, waist circumference, and C-reactive protein (CRP) in 201 healthy women from the Stockholm Female Coronary Risk Study. We tested whether marital stress was associated with CRP and whether this association was moderated by waist circumference. Hierarchical multiple regression revealed that after adjusting for age, occupation status, fasting glucose, apolipoprotein A1, apolipoprotein B, blood pressure, smoking, and menopausal status, marital stress was not directly associated with CRP. However, waist circumference significantly moderated the association between marital stress and CRP (p = 0.012) such that marital stress was significantly associated with higher CRP among women with larger waist circumferences but not in those with smaller waists. More obese women may be particularly vulnerable to the effects of marital stress by manifesting higher inflammation.

Promoting recovery of sexual functioning after radical prostatectomy with group-based stress management: the role of interpersonal sensitivity.

OBJECTIVE: Treatment for localized prostate carcinoma (PCa) is frequently associated with decrements in sexual functioning and satisfaction. Given the highly interpersonal nature of these decrements, interpersonal problems (such as interpersonal sensitivity) may affect recovery of sexual functioning after PCa treatment through interference with physician and partner communication and through distorted cognitions surrounding sexual dysfunction. The objective of the present study was to determine the effect of interpersonal sensitivity on several treatment indicators, including response to a group-based psychosocial intervention. METHODS: Participants were 101 older men recovering from radical prostatectomy who were enrolled in a randomized controlled trial of a 10-week group-based cognitive-behavioral stress management (CBSM) intervention. Measures included the Inventory of Interpersonal Problems and the sexual functioning subscale of the University of California-Los Angeles quality-of-life measure. RESULTS: At baseline, interpersonal sensitivity was related to a belief linking sexual dysfunction to core male identity (r=.29, P<.05). Using hierarchical regression, we found that (a) the CBSM intervention was effective in promoting sexual recovery in all participants, and (b) this effect was moderated by interpersonal sensitivity, such that individuals with higher levels of interpersonal sensitivity made larger improvements in sexual functioning in response to CBSM. CONCLUSIONS: CBSM was effective in improving sexual function after radical prostatectomy. Individuals with higher levels of interpersonal sensitivity were more likely to perceive sexual dysfunction as a threat to masculine identity and made larger gains in the CBSM intervention. Results and relevance to the older male cancer patients are discussed from the perspective of interpersonal theory.

Is the factor structure of the metabolic syndrome comparable between men and women and across three ethnic groups: the Miami Community Health Study.

PURPOSE: The metabolic syndrome (MS) is conceived as a cluster of disorders that increase risk for coronary heart disease and type 2 diabetes. Studies examining its structure primarily have used an exploratory factor analytic technique, but yielded discrepant results. There also is a lack of research that investigates whether the clustering pattern is similar across sex and ethnic groups. This study uses confirmatory factor analysis to evaluate the factor structure of the MS and examines its similarity between men and women and across three ethnic groups (Caucasian, African, and Cuban Americans). METHOD: A hierarchical four-factor model with an overarching MS factor uniting insulin resistance, obesity, lipid, and blood pressure factors was tested with 517 individuals from the Miami Community Health Study. RESULTS: Findings show that the proposed structure was well supported (comparative fit index=0.97) and similar between men and women and across ethnic groups. The MS was represented strongly by insulin resistance, followed by obesity, lipid factors, and, to a lesser extent, a blood pressure factor. CONCLUSIONS: This study provides empirical support for identifying and diagnosing the MS by its component factors in a diverse population.