Lifetime trauma, personality traits, and health: A pathway to midlife health status.

OBJECTIVE: This study investigated whether lifetime experience of trauma is related to personality through instrumental and reactive trait processes, and whether lifetime trauma is a mechanism underlying the association between childhood conscientiousness and objectively assessed adult physical health. METHOD: Participants (N = 831) were 442 women and 389 men from the Hawaii longitudinal study of personality and health. Teacher assessments of personality were obtained when the participants were in elementary school. Self-reported adult personality assessments, lifetime histories of trauma experience, and objectively assessed physiological dysregulation were obtained between ages 45-55. RESULTS: Women tended to report more high-betrayal trauma than men, whereas men reported more low-betrayal trauma than women. Women who were judged by their teachers to be less agreeable and less conscientious in childhood reported more lifetime trauma, suggesting instrumental trait processes. For both genders, neuroticism and openness/intellect/imagination in adulthood, but not in childhood, were associated with lifetime trauma, suggesting reactive trait processes. For both genders, trauma experience was correlated with dysregulation and with Body Mass Index (BMI). The indirect paths from childhood conscientiousness to adult dysregulation and BMI through total teen and adult trauma were significant for women, but not for men (indirect effect for women's dysregulation = -.025, p = .040, 95% confidence interval [CI] = -.048, -.001; indirect effect for women's BMI = -.037, p = .009, 95% CI = -.067, -.008). CONCLUSION: Teen and adult trauma experience appears to be a hitherto unidentified mechanism in women underlying the association between conscientiousness and health. (PsycINFO Database Record

A Big Five approach to self-regulation: personality traits and health trajectories in the Hawaii longitudinal study of personality and health.

Self-regulatory processes influencing health outcomes may have their origins in childhood personality traits. The Big Five approach to personality was used here to investigate the associations between childhood traits, trait-related regulatory processes and changes in health across middle age. Participants (N = 1176) were members of the Hawaii longitudinal study of personality and health. Teacher assessments of the participants' traits when they were in elementary school were related to trajectories of self-rated health measured on 6 occasions over 14 years in middle age. Five trajectories of self-rated health were identified by latent class growth analysis: Stable Excellent, Stable Very Good, Good, Decreasing and Poor. Childhood Conscientiousness was the only childhood trait to predict membership in the Decreasing class vs. the combined healthy classes (Stable Excellent, Stable Very Good and Good), even after controlling for adult Conscientiousness and the other adult Big Five traits. The Decreasing class had poorer objectively assessed clinical health measured on one occasion in middle age, was less well-educated, and had a history of more lifespan health-damaging behaviors compared to the combined healthy classes. These findings suggest that higher levels of childhood Conscientiousness (i.e. greater self-discipline and goal-directedness) may prevent subsequent health decline decades later through self-regulatory processes involving the acquisition of lifelong healthful behavior patterns and higher educational attainment.

A life-span behavioral mechanism relating childhood conscientiousness to adult clinical health.

OBJECTIVE: To investigate a life-span health-behavior mechanism relating childhood personality to adult clinical health. METHODS: Childhood Big Five personality traits at mean age 10, adult Big Five personality traits, adult clinically assessed dysregulation at mean age 51 (a summary of dysregulated blood glucose, blood pressure, and lipids), and a retrospective, cumulative measure of life-span health-damaging behavior (lifetime smoking, physical inactivity, and body mass index from age 20) were assessed in the Hawaii Personality and Health Cohort (N = 759). Structural equation modeling was used to test the conceptual model with direct and indirect paths from a childhood Conscientiousness factor to an adult Conscientiousness factor, life-span health-damaging behaviors, educational attainment, adult cognitive ability, and adult clinical health. RESULTS: For both men and women, childhood Conscientiousness influenced health-damaging behaviors through educational attainment, and life-span health-damaging behaviors predicted dysregulation. Childhood Conscientiousness predicted adult Conscientiousness, which did not predict any other variables in the model. For men, childhood Conscientiousness predicted dysregulation through educational attainment and health-damaging behaviors. For women, childhood Conscientiousness predicted dysregulation through educational attainment and adult cognitive ability. CONCLUSIONS: Assessing cumulative life-span health behaviors is a novel approach to the study of health-behavior mechanisms. Childhood Conscientiousness appears to influence health assessed more than 40 years later through complex processes involving educational attainment, cognitive ability, and the accumulated effects of health behaviors, but not adult Conscientiousness.

Childhood conscientiousness relates to objectively measured adult physical health four decades later.

OBJECTIVE: Many life span personality-and-health models assume that childhood personality traits result in life-course pathways leading through morbidity to mortality. Although childhood conscientiousness in particular predicts mortality, there are few prospective studies that have investigated the associations between childhood personality and objective health status in adulthood. The present study tested this crucial assumption of life span models of personality and health using a comprehensive assessment of the Big Five traits in childhood (M age = 10 years) and biomarkers of health over 40 years later (M age = 51 years). METHODS: Members of the Hawaii Personality and Health Cohort (N = 753; 368 men, 385 women) underwent a medical examination at mean age 51. Their global health status was evaluated by well-established clinical indicators that were objectively measured using standard protocols, including blood pressure, lipid profile, fasting blood glucose, and body mass index. These indicators were combined to evaluate overall physiological dysregulation and grouped into five more homogeneous subcomponents (glucose intolerance, blood pressure, lipids, obesity, and medications). RESULTS: Lower levels of childhood conscientiousness predicted more physiological dysregulation (ß = -.11, p < .05), greater obesity (ß = -.10, p < .05), and worse lipid profiles (ß = -.10, p < .05), after controlling for the other Big Five childhood personality traits, gender, ethnicity, parental home ownership, and adult conscientiousness. CONCLUSIONS: These findings are consistent with a key assumption in life span models that childhood conscientiousness is associated with objective health status in older adults. They open the way for testing mechanisms by which childhood personality may influence mortality through morbidity; mechanisms that could then be targeted for intervention.

Trauma, socioeconomic resources, and self-rated health in an ethnically diverse adult cohort.

OBJECTIVES: To evaluate ethnic group differences in the association between trauma exposure and health status among an ethnically diverse sample originating in Hawai'i. DESIGN: Across a 10-year period (1998-2008), participants (N=833) completed five waves of questionnaire assessments. Trauma exposure was measured retrospectively at the most recent assessment (wave 5), socioeconomic resources (educational attainment and employment status) were measured at wave 1, and self-rated health was measured at each of the five waves. RESULTS: Results indicated that greater exposure to trauma was associated with poorer self-rated health, as were lower educational attainment and lower work status. In addition, there was ethnic group variation in health ratings, as well as in how strongly trauma exposure predicted health status. Specifically, within Filipino American and Native Hawaiian ethnic groups, there was a stronger negative association between trauma exposure and self-rated health. CONCLUSION: These results suggest complex interrelations among trauma, ethnicity, socioeconomic status, and physical health. Further understanding these relations may have implications for medical and behavioral interventions in vulnerable populations.

Use of health information technology to improve medication adherence.

OBJECTIVES: To evaluate the effectiveness of an intervention based on health information technology (HIT) that used speech recognition software to promote adherence to inhaled corticosteroids (ICS) among individuals with asthma who were members of a large health maintenance organization. STUDY DESIGN: Pragmatic randomized clinical trial. METHODS: Adults with asthma enrolled in a large managed care organization (N = 8517) were randomized to receive either usual care or an interactive voice recognition (IVR) intervention designed to prompt medication refills and improve ICS adherence. The primary outcome was ICS adherence as measured by modified medication possession ratio calculated from the electronic medical record (EMR). Secondary measures included survey- and EMR-based measures of asthma morbidity. RESULTS: Our primary analyses found that ICS adherence increased modestly but significantly for participants in the intervention group relative to those in the usual care group ( Δ= 0.02, 95% confidence interval 0.01-0.03), with a baseline adherence of 0.42 in both groups. No difference was observed in asthma morbidity measures. In post hoc analyses of participants receiving 2 or more direct IVR contacts or detailed messages, the intervention effect was more marked. The overall effect was triple that observed in the primary analyses (0.06 vs 0.02), and significant differences were observed between groups in asthma control. CONCLUSIONS: An HIT-based adherence intervention shows potential for supporting medication adherence in patients with chronic diseases such as asthma. However, additional research is needed to determine how best to enhance the reach and effectiveness of such interventions.

Using physiological dysregulation to assess global health status: associations with self-rated health and health behaviors.

Six measures of physiological dysregulation were derived from 11 clinically assessed biomarkers, and related to health outcomes and health behaviors for the Hawaii Personality and Health cohort (N = 470). Measures summing extreme scores at one tail of the biomarker distributions performed better than ones summing both tails, and continuous measures performed better than count scores. Health behaviors predicted men's dysregulation but not women's. Dysregulation and health behaviors predicted self-rated health for both men and women, and depressive symptoms predicted self-rated health only for women. These findings provide preliminary guidelines for constructing valid summary measures of global health status for use in health psychology.

Effects of ethnicity and socioeconomic status on body composition in an admixed, multiethnic population in Hawaii.

This study determined ethnic differences in anthropometric measures of a sample of adults in Hawaii, examining the effects of differing degrees of ethnic admixing and socioeconomic status (SES) on the measures. Adults who had attended elementary school in Hawaii underwent anthropometric measurements and answered questionnaires about their educational attainment, income, age, cultural identity, ethnic ancestry, and health. Individuals reporting Asian American cultural identity had significantly lower mean body mass index (BMI) and waist circumference (WC) than others, whereas those with Hawaiian/Pacific Islander cultural identity had significantly higher BMI and WC. Educational attainment, but not reported family income and age, was significantly related to BMI and WC, and differences in educational attainment accounted for the increased mean BMI and WC in Hawaiian/Pacific Islanders, but did not account for the lower mean BMI and WC among Asian Americans. Higher percentage of Asian ancestry was significantly correlated with lower BMI and WC, whereas higher percentage of Hawaiian/Pacific Islander ancestry was significantly correlated with increased BMI and WC. Differences in education accounted for the significantly increased BMI in participants with a higher percentage of Hawaiian/Pacific Islander ancestry, but did not entirely account for the lower BMI in individuals with a higher percentage of Asian American ancestry. These results suggest that the high rate of obesity and its sequelae seen in Pacific Islanders may be more a result of socioeconomic status and lifestyle than of genetic propensity, whereas the lower rates of obesity observed in Asian American populations are less directly influenced by socioeconomic factors.

Mechanisms by which childhood personality traits influence adult health status: educational attainment and healthy behaviors.

OBJECTIVE: The purpose of this study was to test a life span health behavior model in which educational attainment and health behaviors (eating habits, smoking, and physical activity) were hypothesized as mechanisms to account for relations between teacher ratings of childhood personality traits and self-reported health status at midlife. DESIGN: The model was tested on 1,054 members of the Hawaii Personality and Health cohort, which is a population-based cohort participating in a longitudinal study of personality and health spanning 40 years from childhood to midlife. OUTCOME: Childhood Agreeableness, Conscientiousness, and Intellect-Imagination influenced adult health status indirectly through educational attainment, healthy eating habits, and smoking. Several direct effects of childhood traits on health behaviors and health status were also observed. CONCLUSION: The model extends past associations found between personality traits and health behaviors or health status by identifying a life-course pathway based on the health behavior model through which early childhood traits influence adult health status. The additional direct effects of personality traits indicate that health behavior mechanisms may not provide a complete account of relations between personality and health.

Forty years on: teachers' assessments of children's personality traits predict self-reported health behaviors and outcomes at midlife.

A life span health-behavior model was investigated in this longitudinal study of personality influences on health. Teachers assessed 963 elementary schoolchildren on traits that formed scales assessing the dimensions of the five-factor (Big Five) model of personality. Smoking, alcohol use, body mass index (BMI), and self-rated health were assessed 40 years later in midlife. Childhood personality traits were significantly associated with all 4 outcomes, and the effects were consistently larger for women than men. For men and women, childhood Conscientiousness was associated with less adult smoking and better adult self-rated health and, for women only, with lower adult BMI. Mediation analyses suggested that the effects of Conscientiousness on self-rated health were partially mediated by smoking and BMI. These findings add to the growing evidence that childhood personality traits predict adult health outcomes and are discussed in terms of future testing of the life span health-behavior model.