The Association of Context with Reported Self-Efficacy for Cancer-Preventive Behaviors and Perceived Cancer Risk in U.S. Adults from the Midlife in the United States (MIDUS) Study.

Background: Cancer is one of the leading causes of death in the United States. It is critical to understand the associations among multilevel determinants of cancer prevention and control behaviors. This study examined associations of neighborhood factors with perceived risk of cancer and self-efficacy for reducing cancer risk. Methods: Cross-sectional analyses included 2324 U.S. adults from the Midlife in the U.S. Wave 3. Participants completed surveys of neighborhood environment (perceived neighborhood trust and safety, built environment conditions, social integration), perceived cancer risk and cancer prevention efficacy. Multivariate linear regressions examined associations of neighborhood context with risk perceptions and self-efficacy. Results: In the model that adjusted for sociodemographic characteristics, better perceived neighborhood trust and safety were associated with lower perceived cancer risk. In fully adjusted models for sociodemographic characteristics and contextual factors, higher perceptions of neighborhood trust and safety were associated with higher cancer prevention self-efficacy. Perceptions of better built neighborhood conditions and higher social integration were significantly associated with lower perceived cancer risk and higher perceived cancer prevention efficacy. Conclusions: Perceptions of neighborhood context may play a role in shaping psychosocial factors such as perceived cancer risk and self-efficacy, even after controlling for robust predictors of these perceptions.

Goldilocks at work: Just the right amount of job demands may be needed for your sleep health.

OBJECTIVES: It has been reported that job demands affect sleep, but how different levels of job demands affect sleep remains unclear. We examined whether curvilinear relationships exist between job demands and multiple sleep health outcomes. DESIGN: Cross-sectional analyses with linear and quadratic effects, using self-administered survey data. SETTING: A national sample of US adults. PARTICIPANTS: Workers from Midlife in the United States Study (MIDUS2; n = 2927). MEASUREMENTS: The Job Content Questionnaire assessed overall and 5 specific aspects of job demands (intensity, role conflict, work overload, time pressure, and interruptions). Habitual sleep health patterns across 5 dimensions (regularity, satisfaction/quality, daytime alertness, efficiency, and duration) were assessed. Age, sex, race/ethnicity, marital/partnered status, education, job tenure, work hours, body mass index, smoking status, and study sample were covariates. RESULTS: There were significant linear and quadratic relationships between job demands and sleep outcomes. Specifically, the linear effects indicated that participants with higher job demands had worse sleep health, such as shorter duration, greater irregularity, greater inefficiency, and more sleep dissatisfaction. The quadratic effects, however, indicated that sleep regularity and efficiency outcomes were the best when participants' job demands were moderate rather than too low or too high. These effects were found for overall job demands as well as for specific aspects of job demands. Stratified analyses further revealed that these curvilinear associations were mainly driven by participants with low job control. CONCLUSIONS: Moderate levels of job demands, especially if combined with adequate job control, are related to optimal sleep health.

Understanding the relationship between perceived discrimination and mortality in United States adults.

OBJECTIVE: To understand the relationship between mortality and three types of perceived discrimination (lifetime, daily, chronic job) using a nationally representative sample of U.S. adults. METHODS: Data from 4562 adults in the Midlife in the United States (MIDUS) between 2004 and 2006 (MIDUS II and MIDUS African American sample) were analyzed. Unadjusted associations between primary independent discrimination variables (lifetime, chronic job, daily) and mortality were analyzed using univariate Cox's proportional hazards regression models. Covariates were added to the models by group: predisposing (sex, age, race/ethnicity, education, marital status); enabling (household income, employment status, insurance status); and need factors (body mass index, diabetes, hypertension, stroke, cancer) to estimate hazard ratios. RESULTS: After adjusting for all covariates, hazard ratios for lifetime discrimination (HR: 1.09, p = 0.034) and daily discrimination (HR: 1.03, p = 0.030) were statistically significant. There was no relationship between mortality and chronic job discrimination (HR:1.03, p = 0.15). CONCLUSIONS: Adults experiencing lifetime and daily discrimination had significantly increased risk of mortality after adjusting for predisposing, enabling, and need factors. The findings highlight the importance of screening patients during clinical encounters for experiences of discrimination and providing appropriate resources to mitigate the negative impact of discriminatory events on mortality. Future research should work to fully understand the mechanism by which discrimination increases risk of mortality. These future findings should be used to develop targets for interventions designed to decrease mortality among adults who have experienced discrimination.

Inflammation and emotion regulation: Findings from the MIDUS II study.

Emotion regulation (ER) strategies are thought to contribute to mental as well as physical health outcomes. Two common ER strategies include expressive suppression, or inhibition of emotional expression, and cognitive reappraisal, which involves changing how to think about an emotion-eliciting event in order to change its emotional impact. Recent reports have hypothesized that one potential way in which ER may be linked to health outcomes is via the immune system. However, information on this putative link is scarce. The present study aims to explore whether peripheral inflammatory biomarkers are associated with individual differences in ER-strategy use. Participants (n = 117) from the Midlife in the United States II (MIDUS II) study completed the Emotion Regulation Questionnaire (ERQ), and provided a blood sample for immune biomarker extraction including interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), E-selectin, Intercellular Adhesion Molecule-1 (ICAM-1), and fibrinogen. Results showed higher levels of expressive suppression were associated with decreased IL-10, TNF-α, and ICAM-1 levels (controlling for age, sex, BMI, total prescribed medications, and depressive symptoms). Consistent with these findings, hierarchical regression results identified TNF-α as a significant predictor of expressive suppression use. In contrast, no inflammatory markers were associated with predicted use of cognitive reappraisal. Our findings suggest a link between inflammation and specific ER-strategy use. Future research should consider the effects of pro-vs. anti-inflammatory cytokines on adaptive ER and subsequent mental and physical health.

Repetitive thought, cognition, and systemic inflammation in the midlife in the United States study.

OBJECTIVE: Poor cognition increases risk for negative health outcomes, and this may be explained by associations with systemic inflammation. Previously, amount of repetitive thought (Total RT) interacted with IQ to predict interleukin-6 (IL-6) in older adults. This study continued the investigation of repetitive thought (RT) as an element involved in the effect of cognition on inflammation. DESIGN: Participants (N = 164) came from the Midlife in the United States Refresher project (Mage = 45.33, SD = 11.51, ranges = 25-74; 48.2% female; 85% Caucasian). Cognition was assessed via telephone, inflammatory biomarkers (IL-6, C-reactive protein (CRP), and tumour-necrosis factor-alpha (TNF- α)) analysed after blood draw, and RT derived from daily diary data. RESULTS: Cognition significantly interacted with RT valence (p = .009) to explain CRP after covariate adjustment. Better cognition and more negative RT valence was associated with lower CRP (ß = -0.190 [-.387, .008]). Worse cognition and more negative RT valence was associated with higher CRP (ß = 0.133 [-.031, .297]). No significant effects were found for IL-6 or TNF-α. CONCLUSION: RT may interact with cognition to affect different inflammatory biomarkers. Those with worse cognition may benefit more from skills related to regulating thought than those with better cognition.

Socioeconomic disparities in U.S. mortality: The role of smoking and alcohol/drug abuse.

Prior studies have identified smoking as a key driver of socioeconomic disparities in U.S. mortality, but the growing drug epidemic leads us to question whether drug abuse is exacerbating those disparities, particularly for mortality from external causes. We use data from a national survey of midlife Americans to evaluate socioeconomic disparities in all-cause and cause-specific mortality over an 18-year period (1995-2013). Then, we use marginal structural modeling to quantify the indirect effects of smoking and alcohol/drug abuse in mediating those disparities. Our results demonstrate that alcohol/drug abuse makes little contribution to socioeconomic disparities in all-cause mortality, probably because the prevalence of substance abuse is low and socioeconomic differences in abuse are small, especially at older ages when most Americans die. Smoking prevalence is much higher than drug/alcohol abuse and socioeconomic differentials in smoking are large and have widened among younger cohorts. Not surprisingly, smoking accounts for the majority (62%) of the socioeconomic disparity in mortality from smoking-related diseases, but smoking also makes a substantial contribution to cardiovascular (38%) and all-cause mortality (34%). Based on the observed cohort patterns of smoking, we predict that smoking will further widen SES disparities in all-cause mortality until at least 2045 for men and even later for women. Although we cannot yet determine the mortality consequences of recent widening of the socioeconomic disparities in drug abuse, social inequalities in mortality are likely to grow even wider over the coming decades as the legacy of smoking and the recent drug epidemic take their toll.

Diagnoses associated with dietary supplement use in a national dataset.

OBJECTIVES: The purpose of this study was to determine if participant diagnosis, as determined by a health care provider, is associated with dietary supplement (DS) use. DESIGN/SETTING: Surveys from 1255 study participants aged 34-84, part of the Midlife in the US Study (MIDUS 2 Survey) Biomarker Project, were reviewed. Participant data included pharmaceutical use (prescription and over-the-counter medications (OTC)), clinical symptoms and diagnosis, and laboratory results. Associations were calculated between the above participant characteristics and DS use. MAIN OUTCOME MEASURES: Frequency of DS use for physician-reported diagnoses. RESULTS: Overall prevalence of DS use was 32.4%. Participants taking DS were more often female (p = .048), white (p < 0.001), and older (mean age 57 years, p < 0.001). Participants taking DS reported taking more OTC (p < .001) and prescription medications (p = .024), and had an increased number of chronic conditions (p = .004). Participants reporting physician-diagnosed diabetes were significantly less likely to be taking DS (p = .0066), while participants with eye disease (p = .001), high cholesterol (p = 0.041), cancer (p = 0.042), and arthritis (p = 0.044) were more likely to be taking DS than those without those conditions. No difference in DS use was found between patients with and without other identified medical conditions. After adjusting for age, race/ethnicity, and gender, only diabetes remained a significant predictor of decreased DS use (OR 0.588, CI 0.388-0.873, p = .01). CONCLUSIONS: Some physician-reported participant diagnoses were associated, positively or negatively, with DS use.

Elevated inflammation in association with alcohol abuse among Blacks but not Whites: results from the MIDUS biomarker study.

Some studies document racial disparities in self-reported health associated with alcohol use and abuse. However, few studies examined biomarkers that underlie the onset of alcohol-related chronic diseases. We investigated whether the association between alcohol abuse and five biomarkers of inflammation (CRP, IL-6, fibrinogen, E-selectin, sICAM-1) vary between Black and White Americans aged 35 to 84 (n = 1173) from the Midlife in the United States Biomarker Study. Multivariable Ordinary Least Squares regressions were used to assess Black-White differences in the association between alcohol abuse and the biomarkers. Race moderated the association between alcohol abuse and CRP (b = 0.56, SE = 0.28, p = 0.048), IL-6 (b = 0.65, SE = 0.22, p = 0.004), and a composite inflammation score (b = 0.014, SE = 0.07, p = 0.041). These findings potentially shed light for why alcohol has a stronger negative association with poorer health for Blacks compared to Whites. Analysis should be replicated in larger prospective cohorts.

The association between alcohol abuse and neuroendocrine system dysregulation: Race differences in a National sample.

OBJECTIVES: Health outcomes, including chronic disease and mortality, attributed to or associated with alcohol abuse are discrepant between African Americans and Whites. To date, the topic is not fully understood and few studies conducted have used biomarker indicators of health. We investigated whether the association between alcohol abuse and biomarkers of the neuroendocrine system vary between black or African American and White respondents aged 34-84 from the Midlife in the United States Study (MIDUS) II (2004-2006) (n=1129). Alcohol abuse was assessed with a modified version of the Michigan Alcohol Screening Test. Ordinary least squared (OLS) regression was used to evaluate whether race moderated the associations between alcohol abuse and four biomarkers-urinary cortisol and serum dehydroepiandrosterone sulfate (DHEA-S), epinephrine and norepinephrine-and two composite summary scores, each consisting of two components that characterize the hypothalamic pituitary adrenal (HPA)-axis and sympathetic nervous systems (SNS), respectively. Covariates included age, sex, education, income, current drinking, smoking, exercise, fast food consumption, heart disease, blood pressure, diabetes, body mass index, medication use, anxiety/depression, sleep duration, and cholesterol markers. Race significantly moderated the associations between alcohol abuse and norepinephrine concentration (χ2 [1]=4.48, p=0.034) and the SNS composite score (χ2 [1]=5.83, p=0.016). Alcohol abuse was associated with higher mean norepinephrine levels (b=0.26, standard error (SE)=0.12, p=0.034) and SNS composite score (b=0.23, SE=0.11, p=0.016) for African Americans compared to Whites. Interestingly, for Whites a paradoxical association between alcohol abuse, norepinephrine and SNS levels was observed; those who abused alcohol had lower mean norepinephrine levels than non-abusers. Race differences in neuroendocrine response could be biological pathways that contribute the excess risk of chronic disease and mortality attributed to alcohol abuse among African Americans compared to Whites. Replication of these analyses in larger cohorts are warranted in addition to further studies of underlying mechanisms among Blacks and Whites separately.

Self-Reported Sleep Problems Prospectively Increase Risk of Disability: Findings from the Survey of Midlife Development in the United States.

OBJECTIVES: To determine whether subjective poor sleep prospectively increases functional limitations and incident disability in a national sample of adults living in the United States. DESIGN: Prospective cohort. SETTING: Longitudinal Survey of Midlife Development in the United States (MIDUS). PARTICIPANTS: Young, middle-aged, and older men and women (aged 24-75) surveyed in 1995/96 (MIDUS 1) and followed up in 2004-06 (MIDUS 2). Complete data were available for 3,620 respondents. MEASUREMENTS: Data were from telephone interviews and self-administered questionnaires. Participant reported chronic sleep problems within the prior month; functional limitations were assessed using the Functional Status Questionnaire. Demographic (age, sex, race), socioeconomic (educational attainment), health (chronic conditions, depression), and health behavior (obesity, smoking) covariates were assessed to reduce potential confounding. RESULTS: Approximately 11% of the sample reported chronic sleep problems at both MIDUS waves. Average number of activity of daily living (ADL) and instrumental activity of daily living (IADL) limitations increased significantly between MIDUS 1 (ADL limitations: 0.06; IADL limitations: 0.95) and MIDUS 2 (ADL limitations: 0.15; IADL limitations: 1.6; P < .001). Adjusted regression models estimating change in ADL scores showed that chronic sleep problems at MIDUS 1 predicted significantly greater increases in ADL (incident rate ratio (IRR) = 1.55, P < .001) and IADL (IRR = 1.28, P < .001) limitations. In those with no functional limitations at baseline, logistic regression models showed that chronic sleep problems significantly increased the odds of incident ADL (odds ratio (OR) = 2.33, 95% confidence interval (CI) = 1.68-3.24, P < .001) and IADL (OR = 1.70, 95% CI = 1.21-2.42, P = .002) disability. CONCLUSION: Reports of chronic sleep problems predicted greater risk of onset of and increases in functional limitations 9 to 10 years later. Poor sleep may be a robust and independent risk factor for disability in adults of all ages.

Integrating nap and night-time sleep into sleep patterns reveals differential links to health-relevant outcomes.

Both night-time sleep and nap behaviour have been linked consistently to health outcomes. Although reasons for napping are usually tied to night-time sleep, the majority of studies assess their effects independently. The current study thus aimed to examine the health relevance of patterns of sleep behaviour that take into account both night-time and daytime sleep habits. Night-time sleep, recorded during 7 days via actigraphy from 313 participants (aged 34-82 years) of the Midlife in the United States II Biomarker study, was assessed. Blood and urine specimens were assayed for noradrenaline, interleukin-6 and C-reactive protein. Participants self-reported nap behaviour, depressive symptoms, perceived chronic stress and the presence of medical symptoms and conditions. Overall, nappers (n = 208) showed elevated waist-hip ratios, C-reactive protein and interleukin-6 levels compared to non-nappers and reported more physiological symptoms and conditions (all P ≤ 0.019). Within nappers, cluster analysis revealed three patterns of sleep behaviour-infrequent nappers with good night-time sleep, frequent nappers with good night-time sleep and nappers with poor night-time sleep. Nappers with poor night-time sleep thereby exhibited elevated noradrenaline levels, depressive symptoms and perceived stress scores compared to other groups (all P ≤ 0.041). These findings support the idea that nap-health relationships are complex, in that frequency of napping and accumulation of nap sleep is not related linearly to health consequences. Assessing nap behaviour in conjunction with night-time sleep behaviour appeared crucial to elucidate further the health relevance of napping, particularly in terms of psychological health outcomes, including chronic stress and depressive symptoms.

Inflammation Partially Mediates the Association of Multimorbidity and Functional Limitations in a National Sample of Middle-Aged and Older Adults: The MIDUS Study.

OBJECTIVE: Older adults are increasingly likely to have two or more chronic medical conditions (multimorbidity) and are consequently at greater risk of disability. Here we examine the role of inflammation in mediating the relationship between multimorbidity and disability. METHOD: Data are from the Survey of Mid-Life in the United States (MIDUS), a national sample of middle-aged and older adults. Structural equation models were used to assess direct relationships between multimorbidity and activities of daily living as well as indirect associations with a latent variable for inflammation (indicated by circulating levels of interleukin-6, C-reactive protein, and fibrinogen) as a mediator. RESULTS: After adjustment for potential confounds, multimorbidity was positively associated with inflammation (p < .001) and functional limitations (p < .001), and inflammation partially mediated the link between multimorbidity and functional limitations (p < .01). DISCUSSION: Inflammation may be an important biological mechanism through which chronic medical conditions are linked to disability in later life.