Psychosocial stress is associated with obesity and diet quality in Hispanic/Latino adults

To examine the association of psychosocial stress with obesity, adiposity, and dietary intake in a diverse sample of Hispanic/Latino adults

Associations of Chronic Stress Burden, Perceived Stress, and Traumatic Stress With Cardiovascular Disease Prevalence and Risk Factors in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study

The current study examined multiple stress indicators (chronic, perceived, traumatic) in relation to prevalent coronary heart disease (CHD), stroke, and major cardiovascular disease (CVD) risk factors (i.e., diabetes, dyslipidemia, hypertension, current smoking) in the multi-site Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study (2010–2011)

CBSM Effects on Sickness Behavior and Pro-Inflammatory Cytokine Mechanisms in Breast Cancer Survivors

The concept of sickness behavior offers a framework to view both the neurovegetative and psychological symptoms that accompany illness as a common entity that results from increased inflammatory activation. Despite the prevalence of sickness behavior in medical populations, to our knowledge this study provides the first attempt to develop a standardized measure to assess sickness behavior using standard self-report questionnaires commonly used with cancer patients. The set of items included in the measure match theoretical conceptualizations of sickness behavior and target symptoms that comprise anhedonia, depressed mood, cognitive dysfunction, social disinterest, fatigue, low libido, poor appetite, somnolence, sensitivity to pain, and malaise. The measure showed high internal consistency, adequate test-retest reliability, and good convergent validity with both psychological and biological correlates. A confirmatory factor analysis also determined that a two-factor, rather than a single-factor measurement model, encompassing a physical and a psychological sickness symptom dimension, accounted for sickness behavior. Future psychometric work is still needed to further validate this new practical assessment tool. Descriptive analyses revealed relatively low levels of sickness behavior symptoms in the sample as a whole with both physical and psychological sickness behavior symptoms exhibiting a significant linear decrease over time. As expected, both physical and psychological sickness behavior symptoms showed associations with two pro-inflammatory cytokine markers, IL6 and TNF-alpha and a neuroendocrine marker, cortisol. Longitudinal associations suggest that higher levels of the pro-inflammatory cytokine TNF-alpha may impact the progressive decline of physical sickness symptoms over time with symptoms taking longer to disappear. Because cortisol was associated with more rather than less physical sickness symptoms, results raise the question of whether the anti-inflammatory neuroendocrine activity may be dysregulated in breast cancer survivors. The mechanistic basis for these associations requires further examination. In this study it was also evaluated whether a cognitive behavioral stress management intervention and relaxation training intervention could reduce sickness symptoms over time. Breast cancer survivors were assessed at baseline and then randomly assigned to a 10-week cognitive behavioral stress management intervention (N = 70) or a 1-day control condition (N = 55). Psychosocial measures, urine, and blood were obtained from participants at 3 months, 6 months, and 12 months post-intervention to assess relevant behavioral, endocrine and immune variables. Relative to the control group, the experimental group showed marginally more prevalence of physical sickness behavior symptoms in the short term (post-intervention, 3-months; p = .08) and a steadier decline of symptoms in the long-term (15-month follow-up period). The adaptive nature of sickness behavior as a motivational strategy that helps restore homeostatic balance in the long run may be one possible interpretation of these results. Whether these intervention effects on sickness behavior were mediated by changes in pro-inflammatory cytokines or cortisol was examined but not supported by these data and needs to be further examined in future studies.</p

Abstract P243: Measurement Properties of the Short Acculturation Scale: Preliminary Findings from the Hispanic Community Health Study/Study of Latinos

Background: Extensive epidemiologic evidence suggests that greater acculturation levels are associated with higher risk of cardiovascular disease (CVD). However, there is little information on the reliability and validity of instruments to measure acculturation across Hispanic/Latino (H/L) groups who prefer to communicate in English or Spanish. Objective: To evaluate the psychometric properties of the Short Acculturation Scale (SASH) to determine whether it is a reliable measure in a large, diverse sample of H/Ls, and whether there is measurement invariance across language groups. Methods: Cross-sectional data were used from the multi-site HCHS/SOL (Bronx, Chicago, Miami and San Diego) and included Cuban, Dominican, Puerto Rican, Mexican, Central or South American background household resident adults (18 to 74 years old; n = 16,331). Households were selected using a stratified two-stage probability sampling design, and door-to-door recruitment with sampling weights calibrated to the 2010 US Population Census. A 10-item abbreviated version of the SASH was administered in English or Spanish per the participant’s preference. Standardized factor loadings were calculated for all item-level confirmatory factor analysis (CFA) and multi-group confirmatory factor analysis (MCFA) models. Results: The overall scale reliability was acceptable in the full sample (α =.90) and for both language versions (α =.78 for English, and α =.85 for Spanish). The Cronbach’s alphas were similar across H/L ethnic groups (ranging from α =.85 for South Americans to α =.89 for Mexicans). Data from the exploratory factor analysis suggested a 2 factor solution, with dimensions of language use and ethnic social relationships. In addition, CFA showed that the 2 factor solution was invariant across the Spanish and English groups. Conclusion: These preliminary findings suggest that the abbreviated SASH scale is reliable across language versions, and comparable (in terms of reliability and factors structure) across H/L ethnic groups

Loneliness, Cardiovascular Disease, and Diabetes Prevalence in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study

The relationship between loneliness and both cardiovascular disease (CVD) and diabetes mellitus (DM) has been understudied in U.S. Hispanics, a group at high risk for DM. We examined whether loneliness was associated with CVD and DM, and whether age, sex, marital status, and years in U.S moderated these associations. Participants were 5,313 adults (M (SD) age = 42.39 (15.01)) enrolled in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. Loneliness was assessed via the 3-item Revised UCLA Loneliness Scale. Level of reported loneliness was low. Loneliness was significantly associated with CVD: OR 1.10 (CI 1.01-1.20) and DM: OR 1.08 (CI 1.00-1.16) after adjusting for depression, demographics, body mass index, and smoking status. Age, sex, marital status, and years in U.S. did not moderate associations. Given that increased loneliness is associated with higher cardiometabolic disease prevalence beyond depressive symptoms, regardless of age, sex, marital status, or years in the U.S., Hispanic adults experiencing high levels of loneliness may be a subgroup at particularly elevated risk for CVD and DM

Spiritual well-being, religious activity, and the metabolic syndrome: results from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study

Sociocultural risk and protective factors for developing the metabolic syndrome (MetS), a risk factor for cardiovascular disease (CVD), have not been well studied in Hispanics/Latinos residing in the United States (U.S.). Religiosity and/or spirituality (R/S), important aspects of Hispanic/Latino culture, have been inversely associated with CVD and multiple CVD risk factors. Cross-sectional associations between dimensions of R/S and prevalent MetS, and its five individual components were examined using multiple logistic and linear regression, among 3278 U.S., middle-aged and older Hispanic/Latino adults from the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. Dimensions of R/S were not associated with presence of the MetS. Certain dimensions of Spiritual Well-being (Meaning, Peace, Faith), and frequency of non-organizational religious activity were weakly but significantly associated with one or more MetS components including waist circumference, diastolic blood pressure, and systolic blood pressure. R/S variables were not associated with triglycerides, fasting glucose or HDL cholesterol levels. Prospective, longitudinal studies are needed to gain a deeper understanding of the nature of the relationship between R/S and health risk factors in U.S. Hispanics/Latinos

Abstract P295: The Association of Chronic Stress with Obesity among Hispanic/Latino Adults. Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Objectives: Prior studies suggest that high stress levels are associated with obesity. However, few studies distinguish between type, duration or timing of stressful exposures. In this study, we examined the association of chronic and recent stress with excess weight in a diverse sample of Latino adults. Methods: HCHS/SOL is a multicenter cohort study of Latino adults (ages 18-74 years) from 4 US cities (Bronx, Chicago, Miami and San Diego).The Sociocultural Ancillary Study (2009-2011) is a sample of 5,253 participants (61% female) from HCHS/SOL. Overweight was defined as BMI 25-29.9 and Obese as BMI ≥30. Three indicators of stress were studied: chronic stress lasting for at least 6 months (Chronic Burden Scale), lifetime exposure to stressors (Traumatic Stress Schedule), and perceived stress during the last month (past month, Cohen’s Perceived Stress Scale). Odds ratios (OR) were calculated using multinomial regression models to describe the odds of obesity or overweight relative to normal weight; models were adjusted for study sampling design and potential confounders. Results: 37% of participants were overweight and 41% obese. Mean (standard error) scores of chronic stress, traumatic stress and perceived stress were 1.8 (0.04), 2.1 (.04), and 14.9 (0.16), respectively. After adjustment for confounders, the odds of obesity increased with number of chronic stress events. A higher number of traumatic events were associated with overweight but the association was not longer significant after adjustment for confounders (Table). No association between perceived stress with overweight or obesity was observed. Conclusions: Exposure to chronic stressors lasting ≥6 months is more relevant for obesity prevalence than recent exposure (past month) in Hispanics. As high stress and obesity are important problems among Hispanics, stress management techniques may need to be incorporated in obesity prevention and treatment programs for this population

Abstract P292: Severe Obesity is Associated with Dramatic Increase in Cardiovascular Disease Risk Factor Prevalence: Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Introduction: Prevalence of severe obesity is increasing, especially among the young Hispanic population. Methods: In the HCHS/SOL cohort of 18-74 year old US Hispanics, we examined gradients across BMI and age in CVD risk factors. Results: Approximately one in five males (total N = 6,547) and one in ten females (total N=9,797) met criteria for class II obesity (BMI 35 - 40 kg/m 2 ) or class III obesity (BMI ≥ 40 kg/m 2 ). The prevalence of hypertension, diabetes, and elevated C-reactive protein rose with each successive class of overweight/obesity. In contrast, the prevalence of elevated levels of total cholesterol, LDL-c and triglycerides increased across normal weight, overweight (BMI 25 - 30 kg/m 2 ), and class I obese (BMI 30 - 35 kg/m 2 ) groups, but did not increase in frequency across class I, class II, and class III obesity groups. The Figure depicts isolines that identify age- specific subgroups of the normal-weight and class II - III obese groups that had the same estimated prevalence of CVD risk factors, with 95 percent confidence intervals. Among young adults with class II or III obesity, the prevalence of hypertension, diabetes, and the combination of three or more CVD risk factors was similar to that among normal-weight individuals (BMI 18.5 - 25 kg/m 2 ) who were 15 to 30 years older. Among young obese individuals, the prevalence of low HDL-c levels and high C-reactive protein levels exceeded that among the oldest adults in the cohort. CVD risk factors had stronger, more consistent gradients across the BMI categories among men than among women. Conclusion: Class II and III obesity, defined as BMI ≥ 35 kg/m 2 , are common in the Hispanic/Latino population. Young adults with these severe forms of obesity have dramatically increased frequency of cardiometabolic risk factors. The age-related accumulation of multiple CVD risk factors, such as is typically seen in normal-weight individuals, is accelerated by 1-2 decades in severly overweight women and by 2-3 decades in severely overweight men

Abstract P340: Structural Social Support and Cardiovascular Disease Risk Factors in Hispanic/Latino Adults With Diabetes: Results From the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Introduction: There is mounting evidence linking social support to restorative health processes and favorable cardiovascular risk profiles. However, observational studies have yielded inconsistent findings on the associations of social support networks with cardiovascular health in Hispanic/Latino adults with diabetes. We examined the cross-sectional associations of structural social support and traditional cardiovascular disease ( CVD ) risk factors in a diverse sample of Hispanic/Latino adults with diabetes. Hypothesis: Persons with lower indices of social support will have higher odds of adverse CVD risk factors. Methods: This analysis included 2,994 adult participants ages 18-74 with diabetes from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL—2008-2011). Select items from the Social Network Inventory were used to assess indices of structural social support, i.e., network size (number of children, parents, and in-laws) and frequency of familial contact. Standardized methods were used to measure diabetes and other CVD risk factors -- abdominal obesity, body mass index, hypertension, hypercholesterolemia, and smoking status. Multivariate regression was used to examine associations of structural support with individual CVD risk factors with demographics, acculturation, physical health, and psychological distress included as covariates. Results: There were no significant cross-sectional associations of structural support indices with abdominal obesity, hypertension, hypercholesterolemia, or smoking status. There was a marginally significant (OR: 1.05; 95% CI 1.00-1.12) trend toward higher odds of obesity in participants reporting a larger family unit (including children, parents, and in-laws) ( Table 1 ). Conclusions: Structural social support was marginally associated with higher odds of obesity in Hispanic/Latino adults with diabetes. Alternate forms of social support should be further explored as potential markers of cardiac risk in Hispanics/Latinos with diabetes