Which aspects of education are health protective? a life course examination of early education and adulthood cardiometabolic health in the 30-year study of early child care and Youth Development (SECCYD).

BACKGROUND: Past research describes robust associations between education and health, yet findings have generally been limited to the examination of education as the number of years of education or educational attainment. Little is known about the specific features or processes underpinning education that are health protective. The objective of the current study was to address this gap by examining specific aspects of early education pertaining to student characteristics and experiences, as well as features of the classroom environment, in predicting cardiometabolic health in adulthood. METHODS: Subjects were 1364 participants in the NICHD Study of Early Child Care and Youth Development (SECCYD, 1991-2009) and recent SECCYD 30-year follow-up, the Study of Health in Early and Adult Life (SHINE, 2018-2022). Models examined individual education indicators (student social skills, student-teacher relationship quality, and classroom emotional and instructional quality in the period of elementary school and student academic performance between ages 54 months and 15 years) in relation to a composite of cardiometabolic risk in adulthood (ages 26-31), reflecting central adiposity, blood pressure, insulin resistance, inflammation, and dyslipidemia. Models were adjusted for key explanatory factors including socio-demographics, infant characteristics, parental socioeconomic status (SES), and child health status. Follow-up analyses were performed to test potential mediators of early education effects on adult health, including adult SES (educational attainment, household income) and health behaviors (diet quality, activity level, sleep duration, smoking). RESULTS: In adjusted models, results showed greater student social skills, indexed by a mean of annual teacher ratings between kindergarten and 6th grade, predicted lower cardiometabolic risk in adulthood (ß=-0.009, p <.05). In follow-up analyses, results showed the protective effect of student social skills on cardiometabolic risk may be mediated by adult income (ß=-0.0014, p <.05) and diet quality (ß=-0.0031, p <.05). Effects of the other early education indicators were non-significant (ps > 0.05). CONCLUSIONS: Findings point to the potential significance of early student social competence as a link to long-term health, possibly via the acquisition of resources needed for the maintenance of health, as well as through engagement in health behaviors supporting healthy eating. However, more research is needed to replicate these findings and to elaborate on the role of early student social competence and the pathways explaining its effects on cardiometabolic health in adulthood.

Psychopathology in adolescents presenting for laparoscopic banding.

This study documents psychological problems in obese adolescents seeking bariatric surgery with laparoscopic adjustable gastric band. Depression, self-harm, suicidal ideation, anxiety, and bullying were reported frequently. Professionals will need to carefully assess adolescents for high-risk behaviors and provide appropriate follow-up care if these individuals undergo laparoscopic banding.

Trait negative affect: toward an integrated model of understanding psychological risk for impairment in cardiac autonomic function.

OBJECTIVE: To assess depression, anxiety, and anger as well as the variance that these emotions share (conceptualized as negative affect) in relationship to high-frequency heart rate variability (HF-HRV), a specific indicator of parasympathetic cardiac autonomic function related to premature cardiovascular morbidity and mortality. Although individual trait negative emotions have been studied in relation to risk for coronary heart disease (CHD) as well as biological mechanisms leading to CHD end points (e.g., autonomic nervous system [ANS] dysfunction), the degree to which a general tendency to experience negative emotions may account for these relations is not known. METHODS: The sample included 653 community volunteers (51.0% female; 15.8% Black) aged 30 to 54 years (mean +/- standard deviation = 43.8 +/- 7.1 years). Latent constructs of depression, anxiety, and anger were each measured by three scales from well-validated self-report questionnaires. Resting HF-HRV was derived from 5-minute segments of continuous electrocadiographs recorded during both unpaced and paced respiration conditions. RESULTS: Structural equation models (SEM) of the individual trait emotions showed depression and anxiety related inversely to HF-HRV and anger unrelated to HF-HRV. SEM also showed negative affect related inversely to HF-HRV. All associations were present after covariate adjustment for traditional cardiovascular risk factors, including age, sex, race, education, body mass index, smoking status, and blood pressure. CONCLUSIONS: Negative affect as a common pathway between depression, anxiety, and anger and impairments in cardiac autonomic function was supported, suggesting negative affect may be the unifying and potentially toxic element linking individual trait negative emotions to ANS dysregulation.

Apolipoprotein E polymorphism and preclinical carotid artery disease in untreated hypertensive men.

METHODS: The apolipoprotein E (apoE) polymorphism was evaluated alone, and in interaction with smoking status, in predicting carotid intima-medial thickness and plaque among 182 untreated, hypertensive, white men (mean age 56+/-8.9 years). RESULTS: After covariate adjustment (age, education, smoking, body mass index, systolic and diastolic blood pressure, glucose, total : high-density lipoprotein), apoE genotype (no [epsilon]4 versus any [epsilon]4) predicted mean ([beta]=-0.139, P=0.023) and maximum ([beta]=-0.138, P=0.028) intima-medial thickness, as well as plaque ([beta]=-0.744; P=0.072). Tests of a genotype-x-smoking interaction were non-significant. CONCLUSIONS: Mean intima-medial thickness was greater in men with the 3/3 than [epsilon]4 genotypes (2/4 3/4 4/4), suggesting genetic risk for carotid atherosclerosis may be conferred by the [epsilon]3, rather than the [epsilon]4, allele.

Anger-related personality traits and carotid artery atherosclerosis in untreated hypertensive men.

OBJECTIVE: To determine whether anger-related personality traits are associated with carotid artery atherosclerosis in untreated hypertensive patients. METHODS: Study participants were 237 men with elevated blood pressure (systolic 140-180 mm Hg and/or diastolic 90-110 mm Hg) but untreated for hypertension. Average age was 56 years; 80% of subjects were white. Eighty-six percent had no history of antihypertensive treatment, and the remainder reported median lifetime treatment exposure of 4 months. Subjects were administered the Spielberger State-Trait Anger Expression Inventory, which measures tendencies to experience anger (Trait Anger) and modes of anger expression (Anger-In, Anger-Out, Anger-Control). Mean and maximum intima-medial thickness (IMT) and plaque occurrence in the extracranial carotid arteries were measured by B-mode ultrasonography. RESULTS: Trait Anger was marginally (p =.065) related to mean and significantly (p <.05) related to maximum IMT, independent of standard risk factors (age, race, body mass index, education, smoking, fasting glucose, total:high-density lipoprotein cholesterol ratio). A component of Trait Anger, Angry Temperament, similarly predicted mean (p =.062) and maximum IMT (p <.05) and plaque occurrence (p <.05). Anger-Out predicted both mean and maximum IMT (p values <.01). CONCLUSIONS: An antagonistic disposition (Trait Anger), particularly a tendency to experience anger on minimal provocation (Angry Temperament) and a propensity to express anger outwardly (Anger-Out), are associated with heightened carotid atherosclerosis. These findings suggest that recently reported prospective associations between these anger dimensions and incident cerebrovascular disease may be mediated, in part, by increased atherosclerotic disease.

Is cardiovascular reactivity associated with atherosclerosis among hypertensives?

Exaggerated cardiovascular reactivity to behavioral challenges among otherwise healthy individuals has been associated with carotid atherosclerosis. We evaluated whether a similar relationship exists among hypertensives, who are at a heightened atherosclerotic risk. Untreated, hypertensive men (n=251; age range, 40 to 70 years; 197 white, 54 black) completed a standardized battery of behavioral challenges while their blood pressure responses to the battery were measured. Mean and maximum carotid intima-media thickness and the occurrence of carotid plaques were subsequently determined using B-mode ultrasonography. Although greater systolic and diastolic responses to the battery were associated with greater mean and maximum intima-media thickness in univariate analyses (P<0.01), only diastolic reactivity showed a unique association with mean and maximum carotid intima-media thickness after multivariate adjustment for age, race, socioeconomic status, smoking and alcohol use, body mass index, lipid profile, glucose and insulin concentrations, and resting blood pressure (P<0.05). Carotid plaque occurrence was associated with greater systolic reactivity (P=0.05) and was marginally associated with greater diastolic reactivity (P=0.07) in univariate analyses, but neither systolic nor diastolic reactivity was uniquely associated with the presence of carotid plaques after multivariate risk-factor adjustment. Among hypertensives, exaggerated behaviorally evoked cardiovascular reactivity appears to be uniquely associated with greater carotid intima-media thickness but not with carotid plaque occurrence.