COVID-19 Vaccine Side Effects and Long-Term Neutralizing Antibody Response : A Prospective Cohort Study.

BACKGROUND: Concern about side effects is a common reason for SARS-CoV-2 vaccine hesitancy. OBJECTIVE: To determine whether short-term side effects of SARS-CoV-2 messenger RNA (mRNA) vaccination are associated with subsequent neutralizing antibody (nAB) response. DESIGN: Prospective cohort study. SETTING: San Francisco Bay Area. PARTICIPANTS: Adults who had not been vaccinated against or exposed to SARS-CoV-2, who then received 2 doses of either BNT162b2 or mRNA-1273. MEASUREMENTS: Serum nAB titer at 1 month and 6 months after the second vaccine dose. Daily symptom surveys and objective biometric measurements at each dose. RESULTS: 363 participants were included in symptom-related analyses (65.6% female; mean age, 52.4 years [SD, 11.9]), and 147 were included in biometric-related analyses (66.0% female; mean age, 58.8 years [SD, 5.3]). Chills, tiredness, feeling unwell, and headache after the second dose were each associated with 1.4 to 1.6 fold higher nAB at 1 and 6 months after vaccination. Symptom count and vaccination-induced change in skin temperature and heart rate were all positively associated with nAB across both follow-up time points. Each 1 °C increase in skin temperature after dose 2 was associated with 1.8 fold higher nAB 1 month later and 3.1 fold higher nAB 6 months later. LIMITATIONS: The study was conducted in 2021 in people receiving the primary vaccine series, making generalizability to people with prior SARS-CoV-2 vaccination or exposure unclear. Whether the observed associations would also apply for neutralizing activity against non-ancestral SARS-CoV-2 strains is also unknown. CONCLUSION: Convergent self-report and objective biometric findings indicate that short-term systemic side effects of SARS-CoV-2 mRNA vaccination are associated with greater long-lasting nAB responses. This may be relevant in addressing negative attitudes toward vaccine side effects, which are a barrier to vaccine uptake. PRIMARY FUNDING SOURCE: National Institute on Aging.

Acute and Chronic Stress Associations With Blood Pressure: An Ecological Momentary Assessment Study on an App-Based Platform.

OBJECTIVE: This study examined the within- and between-person associations of acute and chronic stress with blood pressure (BP) and heart rate (HR) using an app-based research platform. METHODS: We examined data from 31,964 adults (aged 18-90 years) in an app-based ecological momentary assessment study that used a research-validated optic sensor to measure BP. RESULTS: Within-person associations revealed that moments with (versus without) acute stress exposure were associated with higher systolic (SBP; b = 1.54) and diastolic BP (DBP; b = 0.79) and HR ( b = 1.53; p values < .001). During moments with acute stress exposure, higher acute stress severity than usual was associated with higher SBP ( b = 0.26), DBP ( b = 0.09), and HR ( b = 0.40; p values < .05). During moments without acute stress, higher background stress severity than usual was associated with higher BP and HR (SBP: b = 0.87, DBP: b = 0.51, HR: b = 0.69; p values < .001). Between-person associations showed that individuals with more frequent reports of acute stress exposure or higher chronic stress severity had higher SBP, DBP, and HR ( p values < .05). Between-person chronic stress severity moderated within-person physiological responses to stress such that individuals with higher chronic stress severity had higher average BP and HR levels but showed smaller responses to momentary stress. CONCLUSIONS: Technological advancements with optic sensors allow for large-scale physiological data collection, which provides a better understanding of how stressors of different timescales and severity contribute to momentary BP and HR in daily life.

Examining Daily Associations Among Sleep, Stress, and Blood Pressure Across Adulthood.

BACKGROUND: Sleep can have consequential effects on people's health and well-being, and these effects may vary among younger and older adults. PURPOSE: The goal of the present study was to investigate how sleep relates to physiologic and stress responses in daily life across adulthood. METHODS: We used an Ecological Momentary Assessment method in a large sample of participants (N = 4,359; Mage = 46.75, SD = 12.39; 69.30% male, 29.85% female) who completed morning sleep diaries, reported subjective stress, and recorded their heart rate and blood pressure for 21 days. Sleep was assessed with self-reports of duration, efficiency, and quality. RESULTS: Using multilevel modeling, between-person analyses showed that sleep duration, efficiency, and quality were negatively related to morning heart rate and stress, such that people who slept longer, more efficiently, or better experienced lower heart rate and stress compared to those who slept shorter, less efficiently, or worse. Within-person analyses showed that sleep duration, efficiency, and quality predicted morning heart rate, blood pressure (though less consistently), and stress. That is, people experienced lower heart, blood pressure, and stress following nights when they slept longer, more efficiently, or better than they typically did. These within-person relationships were moderated by age, such that the effects of better and longer sleep on lower morning heart rate, blood pressure, and stress were stronger among younger than older adults. CONCLUSION: These findings suggest that daily variations in sleep show immediate associations with stress and physiologic responses, but these daily variations have a stronger relationship among younger compared to older adults.

We examined how sleep influences people's blood pressure and well-being among younger and older adults. Participants (N = 4,359) completed questionnaires in the morning over the course of 21 days and reported how well and how long they slept that night and how stressed they felt. They also recorded their heart rate and blood pressure using an optic sensor on their phones. Our analyses showed that people who slept longer, more efficiently, or better experienced lower levels of heart rate and stress on average compared to those who slept shorter, less efficiently, or worse. In addition, we examined how changes in sleep influenced stress, heart rate, and blood pressure for a given individual. These analyses showed that people experienced lower heart rate, lower blood pressure, and less stress following nights when they slept longer, more efficiently, or better than they typically did. These relationships varied by age such that the beneficial effects of sleep were more pronounced among younger than older adults. That is, receiving a particularly good night of sleep tends to be beneficial for younger adults, whereas older adults may not be influenced as strongly by the quality and duration of their sleep.

Estimating the effect of timing of earned income tax credit refunds on perinatal outcomes: a quasi-experimental study of California births.

BACKGROUND: The largest poverty alleviation program in the US is the earned income tax credit (EITC), providing $60 billion to over 25 million families annually. While research has shown positive impacts of EITC receipt in pregnancy, there is little evidence on whether the timing of receipt may lead to differences in pregnancy outcomes. We used a quasi-experimental difference-in-differences design, taking advantage of EITC tax disbursement each spring to examine whether trimester of receipt was associated with perinatal outcomes. METHODS: We conducted a difference-in-differences analysis of California linked birth certificate and hospital discharge records. The sample was drawn from the linked CA birth certificate and discharge records from 2007-2012 (N = 2,740,707). To predict eligibility, we created a probabilistic algorithm in the Panel Study of Income Dynamics and applied it to the CA data. Primary outcome measures included preterm birth, small-for-gestational age (SGA), gestational diabetes, and gestational hypertension/preeclampsia. RESULTS: Eligibility for EITC receipt during the third trimester was associated with a lower risk of preterm birth compared with preconception. Eligibility for receipt in the preconception period resulted in improved gestational hypertension and SGA. CONCLUSION: This analysis offers a novel method to impute EITC eligibility using a probabilistic algorithm in a data set with richer sociodemographic information relative to the clinical and administrative data sets from which outcomes are drawn. These results could be used to determine the optimal intervention time point for future income supplementation policies. Future work should examine frequent income supplementation such as the minimum wage or basic income programs.

Psychological Resources and Biomarkers of Health in the Context of Chronic Parenting Stress.

BACKGROUND: Epidemiological studies link psychological resources to better physical health. One reason may be that psychological resources are protective in stressful contexts. This study tested whether indeed psychological resources are protective against biological degradation for healthy mid-life women under the chronic stress of caring for a child with an autism spectrum disorder diagnosis ("caregivers"). METHODS: We tested whether five types of psychosocial resources (i.e., eudaimonic well-being, autonomy, purpose in life, self-acceptance, and mastery) were associated with biological indices of aging in a sample of mid-life women stratified by chronic stress; half were caregivers (n = 92) and half were mothers of neurotypical children (n = 91; controls). Selected stress and age related biological outcomes were insulin resistance (HOMA-IR), systemic inflammation (IL-6, CRP), and cellular aging (leukocyte telomere length). We tested whether each resource was associated with these biomarkers, and whether caregiving status and high parenting stress moderated that relationship. RESULTS: All the psychological resources except mastery were significantly negatively associated with insulin resistance, while none were related to systemic inflammation or telomere length. The relationships between eudaimonic well-being and HOMA-IR, and self-acceptance and HOMA-IR, were moderated by parental stress; lower resources were associated with higher insulin resistance, but only for women reporting high parental stress. The well-known predictors of age and BMI accounted for 46% of variance in insulin resistance, and psychological resources accounted for an additional 13% of variance.  CONCLUSION: These findings suggest that higher eudaimonic well-being and greater self-acceptance may be protective for the metabolic health of mid-life women, and particularly in the context of high parenting stress. This has important implications given the rising rates of both parental stress and metabolic disease, and because psychological interventions can increase eudaimonic well-being and self-acceptance.

Suicidal ideation and suicide attempts: associations with sleep duration, insomnia, and inflammation.

BACKGROUND: Sleep disturbance has been consistently identified as an independent contributor to suicide risk. Inflammation has emerged as a potential mechanism linked to both sleep disturbance and suicide risk. This study tested associations between sleep duration, insomnia, and inflammation on suicidal ideation (SI) and history of a suicide attempt (SA). METHODS: Participants included 2329 adults with current or remitted depression and/or anxiety enrolled in the Netherlands Study of Depression and Anxiety. Sleep duration, insomnia, past week SI, and SA were assessed with self-report measures. Plasma levels of C-reactive protein, interleukin-6, and tumor necrosis factor-α were obtained. RESULTS: Short sleep duration (⩽6 h) compared to normal sleep duration (7-9 h) was associated with reporting a prior SA, adjusting for covariates [adjusted odds ratio (AOR) 1.68, 95% CI 1.13-2.51]. A higher likelihood of SI during the past week was observed for participants with long sleep duration (⩾10 h) compared to normal sleep duration (AOR 2.22, 95% CI 1.02-4.82), more insomnia symptoms (AOR 1.44, 95% CI 1.14-1.83), and higher IL-6 (AOR 1.31, 95% CI 1.02-1.68). Mediation analyses indicated that the association between long sleep duration and SI was partially explained by IL-6 (AOR 1.02, 95% CI 1.00-1.05). CONCLUSIONS: These findings from a large sample of adults with depression and/or anxiety provide evidence that both short and long sleep duration, insomnia symptoms, and IL-6 are associated with the indicators of suicide risk. Furthermore, the association between long sleep duration and SI may operate through IL-6.

The long shadow of childhood trauma for depression in midlife: examining daily psychological stress processes as a persistent risk pathway.

BACKGROUND: Childhood trauma (CT) increases the risk of adult depression. Buffering effects require an understanding of the underlying persistent risk pathways. This study examined whether daily psychological stress processes - how an individual interprets and affectively responds to minor everyday events - mediate the effect of CT on adult depressive symptoms. METHODS: Middle-aged women (N = 183) reported CT at baseline and completed daily diaries of threat appraisals and negative evening affect for 7 days at baseline, 9, and 18 months. Depressive symptoms were measured across the 1.5-year period. Mediation was examined using multilevel structural equation modeling. RESULTS: Reported CT predicted greater depressive symptoms over the 1.5-year time period (estimate = 0.27, s.e. = 0.07, 95% CI 0.15-0.38, p < 0.001). Daily threat appraisals and negative affect mediated the effect of reported CT on depressive symptoms (estimate = 0.34, s.e. = 0.08, 95% CI 0.22-0.46, p < 0.001). Daily threat appraisals explained more than half of this effect (estimate = 0.19, s.e. = 0.07, 95% CI 0.08-0.30, p = 0.004). Post hoc analyses in individuals who reported at least moderate severity of CT showed that lower threat appraisals buffered depressive symptoms. A similar pattern was found in individuals who reported no/low severity of CT. CONCLUSIONS: A reported history of CT acts as a latent vulnerability, exaggerating threat appraisals of everyday events, which trigger greater negative evening affect - processes that have important mental health consequences and may provide malleable intervention targets.

HPA axis regulation and epigenetic programming of immune-related genes in chronically stressed and non-stressed mid-life women.

Hypothalamic-pituitary-adrenal (HPA) axis dysregulation has been associated with altered immune function, but the underlying molecular mechanisms are unclear. Epigenetic processes, including DNA methylation, respond to the glucocorticoid end-products of the HPA axis (cortisol in humans) and could be involved in this neuroendocrine-immune crosstalk. Here we examined the extent to which variations in HPA axis regulation are associated with peripheral blood DNA (CpG) methylation changes in 57 chronically stressed caregivers and 67 control women. DNA methylation was determined with the Illumina 450k array for a panel of genes involved in HPA axis and immune function. HPA axis feedback was assessed with the low-dose dexamethasone suppression test (DST), measuring the extent to which cortisol secretion is suppressed by the synthetic glucocorticoid dexamethasone. After multiple testing correction in the entire cohort, higher post-DST cortisol, reflecting blunted HPA axis negative feedback, but not baseline waking cortisol, was associated with lower DNA methylation at eight TNF and two FKBP5 CpG sites. Caregiver group status was associated with lower methylation at two IL6 CpG sites. Since associations were most robust with TNF methylation (32% of the 450k-covered sites), we further examined functionality of this epigenetic signature in cultured peripheral blood mononuclear cells in 33 participants; intriguingly, lower TNF methylation resulted in higher ex vivo TNF mRNA following immune stimulation. Taken together, our findings link chronic stress and HPA axis regulation with epigenetic signatures at immune-related genes, thereby providing novel insights into how aberrant HPA axis function may contribute to heightened inflammation and disease risk.

Chronic psychosocial and financial burden accelerates 5-year telomere shortening: findings from the Coronary Artery Risk Development in Young Adults Study.

Leukocyte telomere length, a marker of immune system function, is sensitive to exposures such as psychosocial stressors and health-maintaining behaviors. Past research has determined that stress experienced in adulthood is associated with shorter telomere length, but is limited to mostly cross-sectional reports. We test whether repeated reports of chronic psychosocial and financial burden is associated with telomere length change over a 5-year period (years 15 and 20) from 969 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study, a longitudinal, population-based cohort, ages 18-30 at time of recruitment in 1985. We further examine whether multisystem resiliency, comprised of social connections, health-maintaining behaviors, and psychological resources, mitigates the effects of repeated burden on telomere attrition over 5 years. Our results indicate that adults with high chronic burden do not show decreased telomere length over the 5-year period. However, these effects do vary by level of resiliency, as regression results revealed a significant interaction between chronic burden and multisystem resiliency. For individuals with high repeated chronic burden and low multisystem resiliency (1 SD below the mean), there was a significant 5-year shortening in telomere length, whereas no significant relationships between chronic burden and attrition were evident for those at moderate and higher levels of resiliency. These effects apply similarly across the three components of resiliency. Results imply that interventions should focus on establishing strong social connections, psychological resources, and health-maintaining behaviors when attempting to ameliorate stress-related decline in telomere length among at-risk individuals.

Telomere length analysis from minimally-invasively collected samples: Methods development and meta-analysis of the validity of different sampling techniques: American Journal of Human Biology.

OBJECTIVES: Telomeres are the protective caps of chromosomes. They shorten with cell replication, age, and possibly environmental stimuli (eg, infection and stress). Short telomere length (TL) predicts subsequent worse health. Although venous whole blood (VWB) is most commonly used for TL measurement, other, more minimally invasive, sampling techniques are becoming increasingly common due to their field-friendliness, allowing for feasible measurement in low-resource contexts. We conducted statistical validation work for measuring TL in dried blood spots (DBS) and incorporated our results into a meta-analysis evaluating minimally invasive sampling techniques to measure TL. METHODS: We isolated DNA extracts from DBS using a modified extraction protocol and tested how they endured different shipping conditions and long-term cryostorage. We then included our in-house DBS TL validation statistics (correlation values with VWB TL and age) in a series of meta-analyses of results from 24 other studies that published similar associations for values between TL measured in DBS, saliva, and buccal cells. RESULTS: Our modified DBS extraction technique produced DNA yields that were roughly twice as large as previously recorded. Partially extracted DBS DNA was stable for 7 days at room temperature, and still provided reliable TL measurements, as determined by external validation statistics. In our meta-analysis, DBS TL had the highest external validity, followed by saliva, and then buccal cells-possibly reflecting similarities/differences in cellular composition vs VWB. CONCLUSIONS: DBS DNA is the best proxy for VWB from the three minimally-invasively specimen types evaluated and can be used to expand TL research to diverse settings and populations.

Temporal Links Between Self-Reported Sleep and Antibody Responses to the Influenza Vaccine.

BACKGROUND: Growing evidence suggests that sleep plays an important role in immunological memory, including antibody responses to vaccination. However, much of the prior research has been carried out in the laboratory limiting the generalizability of the findings. Furthermore, no study has sought to identify sensitive periods prior to or after vaccination where sleep may have a stronger influence on antibody responses. METHODS: Eighty-three healthy young adults completed 13 days of sleep diaries and received the trivalent influenza vaccine on day 3 of the study. Measures of self-reported sleep duration, sleep efficiency, and subjective sleep quality were assessed on each day. Antibody levels to the influenza viral strains were quantified at baseline and 1 and 4 months following influenza vaccination. RESULTS: Shorter sleep duration, averaged over the collection period, was associated with fewer antibodies to the A/New Caledonia viral strain 1 and 4 months later, independent of baseline antibodies, age, sex, and cohort year. Analyses focused on nightly sleep on the days preceding and after the vaccination revealed that shorter sleep duration on the two nights before the vaccination predicted fewer antibodies 1 and 4 months later. Measures of self-reported sleep efficiency and subjective quality were unrelated to antibody responses to the influenza vaccination. CONCLUSION: These findings provide further support for an association between sleep duration and antibody responses to the influenza vaccine and suggest that perhaps sleep on nights prior to vaccination are critical. If replicated, these findings may support sleep as a target for enhancing vaccination efficacy.

Early life adversity, pubertal timing, and epigenetic age acceleration in adulthood.

BACKGROUND: Given associations linking early life adversity, pubertal timing, and biological aging, we examined the direct and indirect effects of early life trauma on adult biological aging (via age of menarche). METHODS: Participants were premenopausal women (N = 183). Path models evaluated whether early life trauma predicted early pubertal timing and thereby, adult epigenetic age acceleration (indexed via four epigenetic clocks: Horvath DNAm Age, Hannum DNAm Age, DNAm PhenoAge, and DNAm GrimAge). Secondary analyses explored the effects of type of trauma (abuse and neglect) and adult chronic stress status (caregiver of child with autism and non-caregiver). RESULTS: Early life trauma and earlier age at menarche independently predicted accelerated aging based on one of the four epigenetic clocks, DNAm GrimAge, though early life trauma was not associated with age of menarche. Childhood abuse, but not neglect, predicted faster epigenetic aging; results did not differ by chronic stress status. CONCLUSIONS: Early trauma and early menarche appear to exert independent effects on DNAm GrimAge, which has been shown to be the strongest epigenetic predictor of mortality risk. This study identifies a potential correlate or determinant of accelerated epigenetic aging-menarcheal age. Future research should address the limitations of this study by using racially diverse samples.

The Pain of Sleep Loss: A Brain Characterization in Humans.

Sleep loss increases the experience of pain. However, the brain mechanisms underlying altered pain processing following sleep deprivation are unknown. Moreover, it remains unclear whether ecologically modest night-to-night changes in sleep, within an individual, confer consequential day-to-day changes in experienced pain. Here, we demonstrate that acute sleep deprivation amplifies pain reactivity within human (male and female) primary somatosensory cortex yet blunts pain reactivity in higher-order valuation and decision-making regions of the striatum and insula cortex. Consistent with this altered neural signature, we further show that sleep deprivation expands the temperature range for classifying a stimulus as painful, specifically through a lowering of pain thresholds. Moreover, the degree of amplified reactivity within somatosensory cortex following sleep deprivation significantly predicts this expansion of experienced pain across individuals. Finally, outside of the laboratory setting, we similarly show that even modest nightly changes in sleep quality (increases and decreases) within an individual determine consequential day-to-day changes in experienced pain (decreases and increases, respectively). Together, these data provide a novel framework underlying the impact of sleep loss on pain and, furthermore, establish that the association between sleep and pain is expressed in a night-to-day, bidirectional relationship within a sample of the general population. More broadly, our findings highlight sleep as a novel therapeutic target for pain management within and outside the clinic, including circumstances where sleep is frequently short yet pain is abundant (e.g., the hospital setting).SIGNIFICANCE STATEMENT Are you experiencing pain? Did you have a bad night of sleep? This study provides underlying brain and behavioral mechanisms explaining this common co-occurrence. We show that sleep deprivation enhances pain responsivity within the primary sensing regions of the brain's cortex yet blunts activity in other regions that modulate pain processing, the striatum and insula. We further establish that even subtle night-to-night changes in sleep in a sample of the general population predict consequential day-to-day changes in pain (bidirectionally). Considering the societal rise in chronic pain conditions in lock-step with the decline in sleep time through the industrial world, our data support the hypothesis that these two trends may not simply be co-occurring but are significantly interrelated.

Longitudinal Associations of US Acculturation With Cognitive Performance, Cognitive Impairment, and Dementia.

US Latinos, a growing, aging population, are disproportionately burdened by cognitive decline and dementia. Identification of modifiable risk factors is needed for interventions aimed at reducing risk. Broad sociocultural context may illuminate complex etiology among culturally diverse Latinos. Among 1,418 older (≥60 years), low-socioeconomic position (SEP) Latinos (predominantly of Mexican descent) in Sacramento, California, we examined whether US acculturation was associated with cognitive performance, cognitive decline, and dementia/ cognitive impairment without dementia over a 10-year period and whether education modified the associations (Sacramento Area Latino Study on Aging, 1998-2008). Analyses used linear mixed models, competing-risk regression, and inverse probability of censoring weights for attrition. Participants with high US acculturation had better cognitive performance (0.21 fewer cognitive errors at grand-mean-centered age 70 years) than those with low acculturation after adjustment for sociodemographic factors, practice effects, and survey language. Results may have been driven by cultural language use rather than identity factors (e.g., ethnic identity, interactions). Rate of cognitive decline and risk of dementia/cognitive impairment without dementia did not differ by acculturation, regardless of education (ß = 0.00 (standard error, 0.00) and hazard ratio = 0.81 (95% confidence interval: 0.49, 1.35), respectively). High US acculturation was associated with better cognitive performance among these older, low-SEP Latinos. Acculturation may benefit cognition when SEP is low. Future studies should incorporate extended longitudinal assessments among more diverse groups.

Ten Surprising Facts About Stressful Life Events and Disease Risk.

After over 70 years of research on the association between stressful life events and health, it is generally accepted that we have a good understanding of the role of stressors in disease risk. In this review, we highlight that knowledge but also emphasize misunderstandings and weaknesses in this literature with the hope of triggering further theoretical and empirical development. We organize this review in a somewhat provocative manner, with each section focusing on an important issue in the literature where we feel that there has been some misunderstanding of the evidence and its implications. Issues that we address include the definition of a stressful event, characteristics of diseases that are impacted by events, differences in the effects of chronic and acute events, the cumulative effects of events, differences in events across the life course, differences in events for men and women, resilience to events, and methodological challenges in the literature.

Is cellular energy monitoring more responsive to hypoxia than pulse oximetry?

PURPOSE: Pulse oximetry is the current standard for detecting drops in arterial blood oxygen saturation (SpO2) associated with obstructive sleep apnea and hypopnea events in polysomnographic (PSG) testing. However, cellular energy monitoring (CE monitoring), a measure related to cellular hypoxia in the skin, is likely to be more responsive to inadequate breathing during sleep because during hypoxic challenge, such as occurs during apneic events, regulatory mechanisms restrict blood flow to the skin to preferentially maintain SpO2 for more vital organs. We carried out initial proof of concept testing to determine if CE monitoring has promise for being more responsive to hypoxic challenge occurring during sleep-disordered breathing (SDB) than pulse oximetry. METHODS: We assessed both CE monitoring and pulse oximetry in a series of conditions which affect oxygen supply: (1) breathing nitrogen or 100% oxygen, (2) physical exertion, and (3) studying a night of sleep in an individual known to be a loud snorer. We also present the results of a preliminary study comparing CE monitoring to pulse oximetry in eight individuals undergoing standard clinical overnight polysomnography for suspected SDB. RESULTS: CE monitoring is responsive to changes in cellular oxygen supply to the skin and detects hypoxia during SDB events that is not detected by pulse oximetry. CONCLUSION: CE monitoring is a promising tool for identifying pathology at the mild end of the SDB spectrum.

Pregnant Patient Perceptions of Provider Detection and Treatment of Insomnia.

Objective: To survey pregnant patients about whether their health care providers assessed insomnia, the types of treatment recommendations providers made, and the types of treatments patients utilized. Participants: Participants were 423 English-speaking pregnant women. Methods: In this cross-sectional study, participants self-reported insomnia symptoms on the Insomnia Severity Index and indicated whether they discussed their sleep with a health care provider, whether they received any recommendations to improve their sleep, and whether they utilized any interventions or aids to improve their sleep during their current pregnancy. Results: Approximately one-third (39%) of participants reported that they discussed their sleep with a health care provider at some point during their pregnancy. Among participants who reported moderate to severe insomnia symptoms (Insomnia Severity Index>14), 57% reported that they had discussed their sleep with a health care provider, and 28% reported receiving an insomnia diagnosis. Over-the-counter medication was the most commonly recommended (53%) and utilized (39%) sleep intervention among women with moderate to severe insomnia symptoms. Conclusions: According to patient report, insomnia may be under-detected during pregnancy. When insomnia is recognized, treatment recommendations do not match clinical practice guidelines or women's preferences for receiving cognitive behavior therapy for insomnia. Taken together with previous research on the prevalence and consequences of prenatal insomnia, these findings suggest the need for an increased focus on the importance of sleep during pregnancy.

More than a feeling: A unified view of stress measurement for population science.

Stress can influence health throughout the lifespan, yet there is little agreement about what types and aspects of stress matter most for human health and disease. This is in part because "stress" is not a monolithic concept but rather, an emergent process that involves interactions between individual and environmental factors, historical and current events, allostatic states, and psychological and physiological reactivity. Many of these processes alone have been labeled as "stress." Stress science would be further advanced if researchers adopted a common conceptual model that incorporates epidemiological, affective, and psychophysiological perspectives, with more precise language for describing stress measures. We articulate an integrative working model, highlighting how stressor exposures across the life course influence habitual responding and stress reactivity, and how health behaviors interact with stress. We offer a Stress Typology articulating timescales for stress measurement - acute, event-based, daily, and chronic - and more precise language for dimensions of stress measurement.

Bidirectional Links Between Social Rejection and Sleep.

OBJECTIVE: This set of studies examines the bidirectional links between social rejection and poor sleep, a ubiquitous and increasingly problematic health behavior. METHODS: In study 1, a multiday field experiment, 43 participants completed a neutral task just before sleep on night 1 and a social rejection task on night 2. Objective and subjective sleep, postrejection affect, and physiological responses were measured. In study 2, 338 participants reported typical sleep quality before coming to the laboratory where they received social rejection or social acceptance feedback from a stranger. Physiological and affective responses were measured throughout the session. RESULTS: In study 1, after social rejection, participants took longer going to bed (M [SD] = 38.06 [48.56] versus 11.18 [15.52], t(42) = 3.86, p < .001) and had shorter sleep durations (6:46 [1:27] versus 7:19 [1:38], t(41) = 2.92, p = .006) compared with the baseline night. Trait rumination moderated these effects, with high ruminators taking the longest to go to bed postrejection (t(38) = 2.90, p = .006). In both studies, there was (inconsistent) evidence that sleep influences reactions to rejection: some sleep measures predicted physiological reactivity during the rejection task in study 1 and greater negative affect after social rejection in study 2. CONCLUSIONS: These studies provide evidence that social rejection may affect sleep outcomes, particularly for trait ruminators, and poor sleep in turn may exacerbate affective responses to social rejection. Given the mixed findings, small sample size, and no active control condition, more work is needed to confirm and build on these findings.

Links Between Stress, Sleep, and Inflammation: Are there Sex Differences?

PURPOSE OF REVIEW: Inflammation has emerged as an important biological process in the development of many age-related diseases that occur at different frequencies in men and women. The aim of this review was to examine the current evidence linking stress and sleep with inflammation with a focus on sex differences. RECENT FINDINGS: Psychosocial stress that occurs either acutely or chronically is associated with elevated levels of systemic inflammation. While not as robust, insufficient sleep, particularly sleep disturbances, appears to be associated with higher levels of inflammatory activity as well. In several contexts, associations of stress and insufficient sleep with inflammation appear stronger in women than in men. However, this should be interpreted with caution as few studies test for sex differences. Stress and poor sleep often predict elevations in systemic inflammation. While there is some evidence that these associations are stronger in women, findings are largely mixed and more systematic investigations of sex differences in future studies are warranted.