Positive epidemiology, revisited: the case for centering human rights and economic justice.

In recent years, a growing body of research in positive epidemiology has sought to expand the traditional focus of epidemiologic research beyond risk factors for disease and towards a more holistic understanding of health that includes the study of positive assets that shape well-being more broadly. While this paradigm shift holds great promise for transforming people's lives for the better, it is also critiqued for showcasing decontextualized perspectives that could cause great harm to the public's health if translated uncritically into population-based interventions. In this commentary, we argue for orienting positive epidemiology within a human rights and economic justice framework to mitigate this threat, and we discuss two examples of previously proposed health assets (religious involvement and marriage) that demonstrate the urgent need for positive epidemiologic research to center health equity. Finally, to advance the field, we provide recommendations for how future research can address shortcomings of the extant literature by moving from individual-level to societal-level applications. In doing so, we believe that positive epidemiology can be transformed into a powerful force for health equity. This article is part of a Special Collection on Mental Health.

Psychological Well-Being in Childhood and Cardiometabolic Risk in Middle Adulthood: Findings From the 1958 British Birth Cohort.

Childhood adversity is linked to poor cardiometabolic outcomes, but less is known about positive childhood factors. Using data from 4,007 members of the 1958 British Birth Cohort, we investigated whether children with greater psychological well-being had lower adulthood cardiometabolic risk. At age 11, participants wrote essays about their future. Two judges rated each essay for nine psychological well-being items (Finn's r = .82-.91), which were combined into a standardized overall score (Cronbach's α = .91). When participants reached age 45, nurses assessed their blood pressure, heart rate, lipids, glycosylated hemoglobin, fibrinogen, and C-reactive protein, which were standardized and summed for total cardiometabolic risk. Regressions indicated that children with greater psychological well-being had lower cardiometabolic risk (b = -0.14, 95% confidence interval [CI] = [-0.28, -0.006]): specifically, healthier total cholesterol (b = -0.04, 95% CI = [-0.07, -0.003]) and triglycerides (b = -0.06, 95% CI = [-0.09, -0.02]). Childhood psychological well-being may promote adulthood cardiometabolic health.

Optimism and Cardiovascular Health: Longitudinal Findings From the Coronary Artery Risk Development in Young Adults Study.

OBJECTIVE: Favorable cardiovascular health is associated with greater longevity free of cardiovascular disease. Although the prevalence of cardiovascular health decreases with age, less is known about protective factors that promote and preserve it over time. We investigated whether optimism was associated with better cardiovascular health over a 10-year period. METHODS: Participants included 3188 Black and White men and women from the Coronary Artery Risk Development in Young Adults study. Self-reported optimism was assessed in 2000 (this study's baseline) with the revised Life Orientation Test. Favorable cardiovascular health was defined by healthy status on five components of cardiovascular functioning that were repeatedly assessed through 2010 either clinically or via self-report (blood pressure, lipids, body mass index, diabetes, and smoking status). Linear mixed-effects models examined whether optimism predicted cardiovascular health over time, adjusting for covariates such as sociodemographic characteristics, health behaviors, health status, and depression diagnosis. RESULTS: In models adjusting for sociodemographic characteristics, optimism was associated with better cardiovascular health across all time points (ß = 0.08, 95% confidence interval = 0.04-0.11, p ≤ .001) but not with rate of change in cardiovascular health. Findings were similar when adjusting for additional covariates. Optimism did not interact significantly with race (p = .85) but did with sex, such that associations seemed stronger for women than for men (p = .03). CONCLUSIONS: Optimism may contribute to establishing future patterns of cardiovascular health in adulthood, but other factors may be more strongly related to how slowly or quickly cardiovascular health deteriorates over time.

Is Optimism Associated With Healthier Cardiovascular-Related Behavior? Meta-Analyses of 3 Health Behaviors.

Optimistic people have reduced risk for cardiovascular disease and cardiovascular-related mortality compared with their less optimistic peers. One explanation for this is that optimistic people may be more likely to engage in healthy behavior like exercising frequently, eating fruits and vegetables, and avoiding cigarette smoking. However, researchers have not formally determined the extent or direction of optimism's association with health behaviors. Moreover, it is unclear whether optimism temporally precedes health behaviors or whether the relationship is because of shared common causes. We conducted random effects meta-analyses examining optimism's association with 3 health behaviors relevant for the prevention of cardiovascular disease. PubMed and PsycINFO databases were searched for studies published through November 2017 reporting on optimism's relationship with physical activity, diet, and cigarette smoking. We identified 34 effect sizes for physical activity (n=90 845), 15 effect sizes for diet (n=47 931), and 15 effect sizes for cigarette smoking (n=15 052). Findings suggested that more optimistic individuals tended to engage in healthier behaviors compared with less optimistic individuals, but effect sizes were modest (ractivity=0.07, P<0.0001; rdiet=0.12, P<0.0001; and rsmoking=0.07, P=0.001). Most evidence was cross-sectional (≥53% of effect sizes) and did not consider sociodemographic characteristics (<53% of effect sizes) or psychological distress (<27% of effect sizes) as potential confounders. Optimism is associated with healthier behaviors that protect against cardiovascular disease, although most evidence was relatively low quality. Additional longitudinal and experimental research is required to determine whether optimism causally contributes to healthy behaviors and whether optimism could be an effective target for preventing cardiovascular disease.

Sense of purpose in life and five health behaviors in older adults.

Accumulating evidence shows that a higher sense of purpose in life is associated with lower risk of chronic conditions and premature mortality. Health behaviors might partially explain these findings, however, the prospective association between sense of purpose and health behaviors is understudied. We tested whether a higher sense of purpose at baseline was associated with lower likelihood of developing unhealthy behaviors over time. Prospective data were from the Health and Retirement Study, a national sample of U.S. older adults. Our sample included 13,770 adults assessed up to five times across eight years. Among people who met recommended guidelines for a given health behavior outcome at baseline, those in the top versus lowest quartile of purpose in life had 24% lower likelihood of becoming physically inactive (95% CI: 0.68-0.85), 33% lower likelihood of developing sleep problems (95% CI: 0.58-0.79), and 22% lower likelihood of developing unhealthy body mass index (BMI) (95% CI: 0.69-0.87) in sociodemographic-adjusted models. Further there was a marginal reduction in smoking relapse (HR = 0.65, 95% CI: 0.41-1.03) and no association with heavy alcohol use (HR = 1.02, 95% CI: 0.81-1.29). Findings for physical inactivity, sleep problems, and unhealthy BMI remained evident after further adjusting for baseline health status and depression. Our results, suggest that a sense of purpose in life might emerge (with further research) as a valuable target to consider for interventions aimed at helping older adults maintain some health behaviors.

Positive emotions and favorable cardiovascular health: A 20-year longitudinal study.

No studies have examined whether positive emotions lead to favorable cardiovascular health (CVH) early in the lifespan, before cardiovascular disease is diagnosed. Moreover, the direction of the association has not been thoroughly investigated. Among younger adults, we investigated whether baseline positive emotions were associated with better CVH over 20 years. We also considered whether baseline CVH was associated with subsequent positive emotions during the same period. Participants included 4196 Black and White men and women from the Coronary Artery Risk Development in Young Adults Study. Positive emotions and cardiovascular-related parameters were each assessed in 1990 (this study's baseline), with repeated assessment through 2010. CVH was defined by blood pressure, lipids, body mass index, diabetes, and smoking status. Primary analyses used linear mixed effects models adjusting for potential confounders; secondary analyses stratified by race and sex. Controlling for sociodemographic factors, greater baseline positive emotions were associated with better CVH across time (ß = 0.03, 95% confidence interval = 0.007-0.06). However, positive emotions were unrelated to rate of change in CVH across time. Baseline CVH was also associated with greater average positive emotions across time (ß = 0.09, 95% confidence interval = 0.02-0.15), but not rate of change. Positive emotions' association with CVH was stronger for women than men, but race did not modify associations. Positive emotions in early to middle adulthood were associated with better CVH across several decades. Baseline CVH was also associated with greater positive emotions during follow-up. Future research may be able to disentangle these relationships by assessing positive emotions and CVH earlier in life.

The Association of Optimism with Sleep Duration and Quality: Findings from the Coronary Artery Risk and Development in Young Adults (CARDIA) Study.

Optimism is associated with better health outcomes with hypothesized effects due in part to optimism's association with restorative health processes. Limited work has examined whether optimism is associated with better quality sleep, a major restorative process. We test the hypothesis that greater optimism is associated with more favorable sleep quality and duration. Main analyses included adults aged 32-51 who participated in the Coronary Artery Risk Development in Young Adults (CARDIA) study (n = 3,548) during the fifth (Year 15: 2000-2001) and sixth (Year 20: 2005-2006) follow-up visits. Optimism was assessed using the revised Life-Orientation Test. Self-report measures of sleep quality and duration were obtained twice 5 years apart. A subset of CARDIA participants (2003-2005) additionally provided actigraphic data and completed the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Multivariate regression analyses were used to examine associations of optimism and sleep indicators. In cross-sectional analyses of 3548 participants, each standard deviation (SD) higher optimism score resulted in 78% higher odds of self-reporting very good sleep quality. Prospectively, a 1-SD higher optimism score was related to higher odds of reporting persistently good sleep quality across 5-years relative to those with persistently poor sleep [OR = 1.31; 95%CI:1.10,1.56]. In participant with supplementary data, each SD higher optimism score was marginally associated with 22% greater odds of favorable sleep quality [OR = 1.22; 95%CI:1.00,1.49] as measured by the PSQI, with possible mediation by depressive symptoms. Optimism was unrelated to objective actigraphic sleep data. Findings support a positive cross-sectional and prospective association between optimism and self-reported sleep behavior.

Maintaining Healthy Behavior: a Prospective Study of Psychological Well-Being and Physical Activity.

BACKGROUND: Although higher psychological well-being has been linked with a range of positive biological processes and health outcomes, the prospective association between psychological well-being and physical activity among older adults has been understudied. PURPOSE: We tested whether higher baseline psychological well-being predicted higher levels of physical activity over time. METHODS: Prospective data were from the English Longitudinal Study of Aging, a nationally representative sample of English adults over the age of 50. Our sample included 9986 adults who were assessed up to six times across an average of 11 years. RESULTS: After adjusting for sociodemographic factors, each standard deviation increase in baseline psychological well-being was associated with higher median physical activity in linear regression models that examined physical activity across all six waves (ß = 0.20; 95% confidence interval [CI] 0.18-0.21) and in linear mixed effect models that examined repeated measures of physical activity over the entire follow-up period (ß = 0.20; 95% CI 0.19-0.21). Further, higher baseline psychological well-being was associated with a slower rate of decline in physical activity among people who were active at baseline (hazard ratio [HR] = 0.79, 95% CI 0.76-0.82) and increasing physical activity among people who were inactive at baseline (HR = 1.28, 95% CI 1.22-1.35). Findings were maintained after adjusting for baseline health status and depression. CONCLUSIONS: Psychological well-being was independently associated with attaining and maintaining higher physical activity levels over 11 years, suggesting that it may be a valuable target for interventions aimed at helping older adults acquire more physical activity.

A Positive Psychology Intervention for Patients with an Acute Coronary Syndrome: Treatment Development and Proof-of-Concept Trial.

Positive psychological constructs are associated with superior outcomes in cardiac patients, but there has been minimal study of positive psychology (PP) interventions in this population. Our objective was to describe the intervention development and pilot testing of an 8-week phone-based PP intervention for patients following an acute coronary syndrome (ACS). Initial intervention development and single-arm proof-of-concept trial, plus comparison of the PP intervention to a subsequently-recruited treatment as usual (TAU) cohort. PP development utilized existing literature, expert input, and qualitative interview data in ACS patients. In the proof-of-concept trial, the primary outcomes were feasibility and acceptability, measured by rates of exercise completion and participant ratings of exercise ease/utility. Secondary outcomes were pre-post changes in psychological outcomes and TAU comparisons, measured using effect sizes (Cohen's d). The PP intervention and treatment manual were successfully created. In the proof-of-concept trial, 17/23 PP participants (74 %) completed at least 5 of 8 exercises. Participants rated the ease (M = 7.4/10; SD = 2.1) and utility (M = 8.1/10, SD = 1.6) of PP exercises highly. There were moderate pre-post improvements (ds = .46-.69) in positive affect, anxiety, and depression, but minimal effects on dispositional optimism (d = .08). Compared to TAU participants (n = 22), PP participants demonstrated greater improvements in positive affect, anxiety, and depression (ds = . 47-.71), but not optimism. A PP intervention was feasible, well-accepted, and associated with improvements in most psychological measures among cardiac patients. These results provide support for a larger trial focusing on behavioral outcomes.

Variability Modifies Life Satisfaction's Association With Mortality Risk in Older Adults.

Greater life satisfaction is associated with greater longevity, but its variability across time has not been examined relative to longevity. We investigated whether mean life satisfaction across time, variability in life satisfaction across time, and their interaction were associated with mortality over 9 years of follow-up. Participants were 4,458 Australians initially at least 50 years old. During the follow-up, 546 people died. After we adjusted for age, greater mean life satisfaction was associated with a reduction in mortality risk, and greater variability in life satisfaction was associated with an increase in mortality risk. These findings were qualified by a significant interaction such that individuals with low mean satisfaction and high variability in satisfaction had the greatest risk of mortality over the follow-up period. In combination with mean life satisfaction, variability in life satisfaction is relevant for mortality risk among older adults. Considering intraindividual variability provides additional insight into associations between psychological characteristics and health.

In the Words of Early Adolescents: A Novel Assessment of Positive Psychological Well-Being Predicts Young Adult Depressive Symptoms.

PURPOSE: Given the burden of depression in young adulthood, identifying protective early life factors is important. Protective factors like positive psychological well-being may be challenging to assess via conventional methods if early adolescents lack personal insight or informants disagree. We investigated whether essays written by 11-year-olds could indicate the presence of positive psychological well-being and predict depressive symptom levels in young adulthood, beyond informant reports of problematic behaviors. METHODS: Data were from 4,599 individuals in the 1958 National Child Development Study who wrote an essay at age 11 about how they imagined their life at age 25. Coders rated essays for seven facets of positive psychological well-being, which were averaged together (α = 0.92). Participants self-reported depressive symptoms (yes/no) at age 23 on the 24-item Malaise Inventory. Depressive symptoms were modeled as a sum, both continuously (range = 0-24) and dichotomously (depressed: total scores ≥8). Linear and logistic regressions adjusted for relevant age 11 covariates including teacher-reported internalizing and externalizing behaviors. RESULTS: Unadjusted logistic regression showed a 1-SD higher positive psychological well-being score in early adolescence was associated with reduced odds of being depressed 12 years later (odds ratio = 0.83, 95% confidence interval [0.75, 0.93], p = .001). Associations remained when adjusting for all covariates (odds ratio = 0.87, 95% confidence interval [0.78, 0.98], p = .02); patterns were similar with continuous depressive symptoms. DISCUSSION: A well-being measure derived from the words of 11-year-olds was associated with young adult depressive symptoms independent of teacher-reported internalizing and externalizing behaviors. Incorporating early adolescents' perspectives on positive functioning provides valuable information about current and future health beyond problem behaviors.

Mean Affect Moderates the Association between Affect Variability and Mental Health.

Increasing evidence suggests that within-person variation in affect is a dimension distinct from mean levels along which individuals can be characterized. This study investigated affect variability's association with concurrent and longitudinal mental health and how mean affect levels moderate these associations. The mental health outcomes of depression, panic disorder, self-rated mental health, and mental health professional visits from the second and third waves of the Midlife in the United States Study were used for cross-sectional (n = 1,676) and longitudinal outcomes (n = 1,271), respectively. These participants took part in the National Study of Daily Experiences (NSDE II), where they self-reported their affect once a day for 8 days, and this was used to compute affect mean and variability. Greater positive affect variability cross-sectionally predicted a higher likelihood of depression, panic disorder, mental health professional use, and poorer self-rated mental health. Greater negative affect variability predicted higher panic disorder probability. Longitudinally, elevated positive and negative affect variability predicted higher depression likelihood and worse self-rated mental health over time, while greater positive affect variability also predicted increased panic disorder probability. Additionally, mean affect moderated associations between variability and health such that variability-mental health associations primarily took place when mean positive affect was high (for concurrent mental health professional use and longitudinal depression) and when mean negative affect was low (for concurrent depression, panic disorder, self-rated mental health, and longitudinal self-rated mental health). Taken together, affect variability may have implications for both short- and long-term health and mean levels should be considered. Supplementary Information: The online version contains supplementary material available at 10.1007/s42761-024-00238-0.

Who Benefits and How: Five Dimensions of Adolescent Psychological Well-Being and Their Relative Impact on Cardiometabolic Health in Adulthood.

PURPOSE: Positive dimensions of psychological well-being in adolescence may help youth preserve cardiometabolic health (CMH) as they age, but little is known about which aspects of well-being matter most and for whom. This study examines the differential impact of five dimensions of adolescent psychological well-being on CMH maintenance in adulthood and considers social patterning in both their distribution and respective health benefits. METHODS: Data were from the National Longitudinal Study of Adolescent Health (N = 3,464), five dimensions of psychological well-being were identified at baseline (1994-1995; mean age = 15 years): happiness, optimism, self-esteem, belonging, and feeling loved. CMH was measured using seven biomarkers related to chronic disease risk in 2008 (mean age = 28 years) and 2016-2018 (mean age = 38 years): high-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure, hemoglobin A1c, C-reactive protein, and body mass index. CMH maintenance in adulthood was characterized as having healthy levels of ≥6 biomarkers at each follow-up. RESULTS: Youth who reported higher levels of belonging in the teen years were more likely to maintain CMH across young adulthood than those who reported lower levels, regardless of one's social standing (ORper 1-standard deviation = 1.23, 95% CI = 1.03-1.46). Associations with other dimensions of well-being were heterogeneous by sex and race and ethnicity, while differences by socioeconomic factors were less apparent. DISCUSSION: Fostering belonging through supportive social environments may help set youth on positive health trajectories and prevent chronic disease across the lifespan.

Associations between positive affect and physical activity from young adulthood to midlife: A 25-year prospective study.

OBJECTIVE: Positive affect may influence health by promoting physical activity, but evidence evaluating this association is mostly cross-sectional and cannot discern directionality. This study used a counterfactual-based framework to estimate the causal effect of positive affect on physical activity patterns over 25 years, accounting for potential reverse associations. METHOD: Data were from 3,352 participants in the Coronary Artery Risk Development in Young Adults study. Repeated assessments of positive affect and physical activity were collected from 1990 to 2016. Longitudinal associations were evaluated in two ways: (a) using baseline positive affect in traditional linear mixed models that accounted for reverse causal associations by adjusting for baseline physical activity, and (b) using marginal structural models that treated positive affect as a time-varying exposure, thus accounting for dynamic reverse causal associations due to bidirectional relationships. RESULTS: Fully adjusted traditional models found no association with physical activity at the first follow-up assessment, but positive affect was related to a slower decline in physical activity over time. Marginal structural models similarly found that positive affect was unrelated to physical activity at the first follow-up assessment but robustly associated with a slower decline in activity levels (5-year change: ß = -3.33, 95% confidence interval [CI] = -5.80, -0.86; difference in 5-year change per 1 - SD positive affect: ß = 4.99, 95% CI = 2.52, 7.46). CONCLUSIONS: Positive affect may play a causal role in slowing the decline in physical activity adults generally experience during through midlife. Efforts to enhance positive affect at the population level may be a promising new approach to help individuals stay active as they age. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Association between optimism and serum antioxidants in the midlife in the United States study.

OBJECTIVE: Psychological and physical health are often conceptualized as the absence of disease; there is less research that addresses positive psychological and physical functioning. For example, optimism has been linked with reduced disease risk and biological dysfunction, but very little research has evaluated associations with markers of healthy biological functioning. Thus, we investigated the association between two indicators of positive health: optimism and serum antioxidants. METHODS: The cross-sectional association between optimism and antioxidant concentrations was evaluated in 982 men and women from the Midlife in the United States study. Primary measures included self-reported optimism (assessed with the revised Life Orientation Test) and serum concentrations of nine different antioxidants (carotenoids and vitamin E). Regression analyses evaluated the relationship between optimism and antioxidant concentrations in models adjusted for demographics, health status, and health behaviors. RESULTS: For every standard deviation increase in optimism, carotenoid concentrations increased by 3% to 13% in age-adjusted models. Controlling for demographic characteristics and health status attenuated this association. Fruit and vegetable consumption and smoking status were identified as potential pathways underlying the association between optimism and serum carotenoids. Optimism was not significantly associated with vitamin E. CONCLUSIONS: Optimism was associated with greater carotenoid concentrations, and this association was partially explained by diet and smoking status. The direction of effects cannot be conclusively determined. Effects may be bidirectional given that optimists are likely to engage in health behaviors associated with more serum antioxidants, and more serum antioxidants are likely associated with better physical health that enhances optimism.

Child psychological well-being and adult health behavior and body mass index.

OBJECTIVE: Psychological well-being (PWB) is linked with health behaviors among adults, but it is unclear if childhood PWB prospectively predicts healthy adulthood biobehavioral profiles. Such evidence may identify developmental windows for establishing positive health trajectories across the lifespan. Using data spanning 30 years, we investigated whether PWB at age 11 was associated with health behaviors and body mass index (BMI) at ages 33 and 42. We hypothesized children with higher versus lower PWB would engage in healthier behaviors, have lower BMI in adulthood, and be more likely to maintain optimal levels over time. METHOD: Data were from 4,728 participants of the 1958 National Child Development Study. At age 11, participants wrote an essay about how they imagined their lives at age 25. Two judges rated each essay for multiple facets of PWB, which were combined into a summary score (Cronbach's α = .91). At ages 33 and 42, participants reported on cigarette smoking, physical activity, and diet; BMI was also assessed. Regression models evaluated PWB's association with adult outcomes at each follow-up, and with patterns over time. RESULTS: Child PWB was unassociated with smoking in adulthood. However, greater child PWB was associated with healthier adult physical activity, diet, and BMI when adjusting for sex. Child PWB was associated with the likelihood of maintaining optimal BMI in adulthood, but not with maintaining healthy behaviors. Some associations were not independent of other childhood covariates. CONCLUSIONS: Early life lays the foundation for lifelong health. Childhood PWB may contribute to healthier behaviors and BMI in adulthood. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Resilience factors during the Coronavirus pandemic: Testing the main effect and stress buffering models of optimism and positive affect with mental and physical health.

This study investigates associations between resilience factors (optimism and positive affect) and self-rated health during the COVID-19 pandemic. Longitudinal data were collected (N = 292) across five assessments. Multilevel modeling tested main effects of the resilience factors and how they interacted with stress to predict health. Greater optimism and positive affect were prospectively associated with fewer depressive symptoms (ps < 0.01) and a lower burden of physical health symptoms (ps <0.01). Positive affect interacted with stress to predict depressive symptoms (p < 0.05), suggesting a stress buffering effect. These findings suggest that resilience factors may improve health during COVID-19.

Affect variability and physical health: The moderating role of mean affect.

Research has only begun to explore how affect variability relates to physical health and has typically not assessed long-term associations nor considered the moderating role of mean affect. Therefore, we used data from the Midlife in the United States Study waves 2 (N = 1512) and 3 (N = 1499) to test how affect variability predicted concurrent and long-term physical health while also testing the moderating role of mean affect. Results indicated that greater negative affect variability was associated concurrently with a greater number of chronic conditions (p = .03) and longitudinally with worse self-rated physical health (p < .01). Greater positive affect variability was associated concurrently with more chronic conditions (p < .01) and medications (p < .01) and longitudinally with worse self-rated physical health (p = .04). Further, mean negative affect played a moderating role such that at lower levels of mean negative affect, as affect variability increased, so did the number of concurrent chronic conditions (p < .01) and medications (p = .03) and the likelihood of reporting worse long-term self-rated physical health (p < .01). Thus, the role of mean affect should be considered when testing short- and long-term associations between affect variability and physical health.

Adolescent Psychological Assets and Cardiometabolic Health Maintenance in Adulthood: Implications for Health Equity.

Background Positive cardiometabolic health (CMH) is defined as meeting recommended levels of multiple cardiometabolic risk factors in the absence of manifest disease. Prior work finds that few individuals-particularly members of minoritized racial and ethnic groups-meet these criteria. This study investigated whether psychological assets help adolescents sustain CMH in adulthood and explored interactions by race and ethnicity. Methods and Results Participants were 3478 individuals in the National Longitudinal Study of Adolescent Health (49% female; 67% White, 15% Black, 11% Latinx, 6% other [Native American, Asian, or not specified]). In Wave 1 (1994-1995; mean age=16 years), data on 5 psychological assets (optimism, happiness, self-esteem, belongingness, and feeling loved) were used to create a composite asset index (range=0-5). In Waves 4 (2008; mean age=28 years) and 5 (2016-2018; mean age=38 years), CMH was defined using 7 clinically assessed biomarkers. Participants with healthy levels of ≥6 biomarkers at Waves 4 and 5 were classified as maintaining CMH over time. The prevalence of CMH maintenance was 12%. Having more psychological assets was associated with better health in adulthood (odds ratio [OR]linear trend, 1.12 [95% CI, 1.01-1.25]). Subgroup analyses found substantive associations only among Black participants (OR, 1.35 [95% CI, 1.00-1.82]). Additionally, there was some evidence that racial and ethnic disparities in CMH maintenance may be less pronounced among participants with more assets. Conclusions Youth with more psychological assets were more likely to experience favorable CMH patterns 2 decades later. The strongest associations were observed among Black individuals. Fostering psychological assets in adolescence may help prevent cardiovascular disease and play an underappreciated role in shaping health inequities.

Interventions to Modify Psychological Well-Being: Progress, Promises, and an Agenda for Future Research.

Psychological well-being, characterized by feelings, cognitions, and strategies that are associated with positive functioning (including hedonic and eudaimonic well-being), has been linked with better physical health and greater longevity. Importantly, psychological well-being can be strengthened with interventions, providing a strategy for improving population health. But are the effects of well-being interventions meaningful, durable, and scalable enough to improve health at a population-level? To assess this possibility, a cross-disciplinary group of scholars convened to review current knowledge and develop a research agenda. Here we summarize and build on the key insights from this convening, which were: (1) existing interventions should continue to be adapted to achieve a large-enough effect to result in downstream improvements in psychological functioning and health, (2) research should determine the durability of interventions needed to drive population-level and lasting changes, (3) a shift from individual-level care and treatment to a public-health model of population-level prevention is needed and will require new infrastructure that can deliver interventions at scale, (4) interventions should be accessible and effective in racially, ethnically, and geographically diverse samples. A discussion examining the key future research questions follows.