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1.  Living Well With Medical Comorbidities: A Biopsychosocial Perspective 
Objectives.
We take a biopsychosocial perspective on age-related diseases by examining psychological correlates of having multiple chronic conditions and determining whether positive psychological functioning predicts advantageous profiles of biological risk factors.
Method.
Respondents to the national survey of Midlife in the United States who participated in clinical assessments of health and biological processes (n = 998) provided information on chronic medical conditions and multiple domains of psychological functioning. Serum concentrations of interleukin-6 (IL-6) and C-reactive protein (CRP) were determined from fasting blood samples.
Results.
Life satisfaction declined with increasing comorbidity while negative affect increased. In contrast, positive affect, purpose in life, and positive relations with others were unrelated to comorbidity status. Significant interactions showed that although IL-6 and CRP increased with increasing number of chronic conditions, respondents with higher levels of purpose in life, positive relations with others, and (in the case of CRP) positive affect had lower levels of inflammation compared with those with lower well-being scores.
Discussion.
The results suggest that many older adults with medical comorbidities maintain high levels of positive psychological functioning that are in turn linked to better profiles of biological disease risk.
doi:10.1093/geronb/gbr152
PMCID: PMC3441187  PMID: 22377799
Chronic conditions; Inflammation; Successful aging; Well-being; 
2.  Sleep quality, social well-being, gender, and inflammation: an integrative analysis in a national sample 
Social isolation and poor sleep quality are independent predictors of poor health outcomes and increased biological risk for disease. We previously found in a small sample of older women that the presence of social ties compensated for poor sleep in associations with the inflammatory protein interleukin 6 (IL-6). The current study extended those findings to a national sample of middle-aged and older men and women. Using both subjective and objective sleep assessments, we found that in men, but not in women, social engagement moderated the association of subjective sleep complaints with both IL-6 and the soluble adhesion molecule E-selectin. Social engagement also moderated the link between sleep efficiency—assessed by actigraphy—and IL-6 levels in men, but not in women. These results extend our previous work and bolster the suggestion that positive psychological functioning may compensate for other risk factors in predicting advantageous profiles of biological risk in aging adults.
doi:10.1111/j.1749-6632.2011.06040.x
PMCID: PMC3232033  PMID: 21884159
sleep quality; actigraphy; interleukin 6; E-selectin; social well-being
3.  Chronic discrimination predicts higher circulating levels of E-selectin in a national sample: the MIDUS study 
Brain, behavior, and immunity  2009;23(5):684-692.
Chronic discrimination in both minority and non-minority populations is linked to adverse health outcomes, including increased risk of cardiovascular disease and increased mortality, but the biological processes through which discrimination affects health are unclear. The current study tested the hypothesis that discrimination in a sample of Caucasians would predict elevated serum levels of E-selectin, an indication of endothelial dysfunction which itself is associated with atherosclerosis and cardiovascular disease risk. Participants (N = 804) in the biomarker sample from the Survey of Midlife in the United States (MIDUS) provided information about experiences of both major and everyday discrimination at two times separated by a 9–10 year interval. The discrimination measures were designed to assess perceived unfair treatment (e.g. being fired unfairly) independently of the perceived reasons for the unfair treatment (e.g. race, gender). Serum E-selectin was measured at the second wave of data collection. Women reported significantly more instances of major (P<.05) and everyday P<.001) discrimination than men. Analyses of Covariance (ANCOVA) showed that both greater lifetime exposure to major discrimination (P<.05) and chronic exposure to everyday discrimination (P<.05) predicted higher circulating levels of E-selectin, but only in men. These associations remained statistically significant after adjustments for potential confounding variables, including age, race, socioeconomic status, health status, and health behavior. These results highlight a potential biological mechanism by which exposure to unfair treatment may be related to health, particularly cardiovascular function. Moreover, they add to a growing literature suggesting that unfair treatment in general may predict adverse health outcomes.
doi:10.1016/j.bbi.2009.01.002
PMCID: PMC2745951  PMID: 19171188
Discrimination; e-selectin
4.  Variability of Sleep Duration Is Related to Subjective Sleep Quality and Subjective Well-Being: An Actigraphy Study 
PLoS ONE  2013;8(8):e71292.
While there is a large body of evidence that poor subjective sleep quality is related to lower subjective well-being, studies on the relation of objective sleep measures and subjective well-being are fewer in number and less consistent in their findings. Using data of the Survey of Mid-Life in the United States (MIDUS), we investigated whether duration and quality of sleep, assessed by actigraphy, were related to subjective well-being and whether this relationship was mediated by subjective sleep quality. Three hundred and thirteen mainly white American individuals from the general population and 128 urban-dwelling African American individuals between 35 and 85 years of age were studied cross-sectionally. Sleep duration, variability of sleep duration, sleep onset latency, and time awake after sleep onset were assessed by actigraphy over a period of 7 days. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index, positive psychological well-being and symptoms of psychological distress were assessed with the Satisfaction with Life Scale and the Mood and Anxiety Symptom Questionnaire. In both white and African Americans high day-to-day variability in sleep duration was related to lower levels of subjective well-being controlling age, gender, educational and marital status, and BMI. By contrast, sleep duration, sleep onset latency, and time awake after sleep onset were not related to subjective well-being controlling covariates and other sleep variables. Moreover, the relationship between variability in sleep duration and well-being was partially mediated by subjective sleep quality. The findings show that great day-to-day variability in sleep duration – more than average sleep duration – is related to poor subjective sleep quality and poor subjective well-being.
doi:10.1371/journal.pone.0071292
PMCID: PMC3743871  PMID: 23967186
5.  Income, Education, and Inflammation: Differential Associations in a National Probability Sample (The MIDUS Study) 
Psychosomatic medicine  2010;72(3):290-300.
Objective
To examine the associations between income and education and three markers of inflammation: interleukin-6 (IL-6), C-reactive protein (CRP), and fibrinogen. Socioeconomic status is inversely linked with health outcomes, but the biological processes by which social position “gets under the skin” to affect health are poorly understood.
Method
Cross-sectional analyses involved participants (n = 704) from the second wave of the national population-based Survey of Midlife Development in the United States (MIDUS). Data on pretax household-adjusted income and educational attainment were collected by questionnaire and telephone interview, respectively. Detailed medical history interviews, inventories of medication, and fasting blood samples for assessment of inflammatory proteins were obtained during an overnight clinic stay.
Results
All three inflammatory proteins were inversely associated with both income and education in bivariate analyses. However, multivariate regression models, adjusting for potential confounds, showed that only low income predicted higher levels of inflammatory proteins. Moreover, inclusion of IL-6 in the regression models for CRP and fibrinogen eliminated the associations with income.
Conclusion
These results suggest that income explains the association between education and peripheral inflammation. In short, the reason that higher education is linked to reduced peripheral inflammation is because it reduces the risk for low income status, which is what is directly associated with reduced peripheral inflammation. The findings also suggest that the links between income and both CRP and fibrinogen are mediated by IL-6. These observations help to sharpen our understanding of the relationship between social position and biological markers of illness in the United States.
doi:10.1097/PSY.0b013e3181cfe4c2
PMCID: PMC2855758  PMID: 20100883
inflammation; income; education
6.  Socioeconomic and Psychosocial Predictors of Interleukin-6 in the MIDUS National Sample 
Objective
To investigate whether psychosocial factors (i.e., depression, anxiety, and well-being) moderate educational gradients in interleukin-6 (IL-6) levels using data from the Survey of Mid-life Development in the U.S. (MIDUS). The influences of educational attainment and psychosocial factors on IL-6 in middle aged and older adults were also examined.
Design
Telephone interviews and mail surveys were utilized to collect educational attainment and psychosocial information from participants (N = 1028). Respondents also participated in an overnight clinic visit, during which health information and a fasting blood sample was obtained.
Main Outcome Measures
Serum levels of IL-6.
Results
. Greater educational attainment predicted lower levels of IL-6 independent of age and gender, although this effect was attenuated after taking health behaviors, body mass index, waist-to-hip ratio, and chronic illnesses into account. Psychological well-being interacted with education to predict IL-6, such that for those with less education, higher well-being was associated with lower levels of IL-6.
Conclusion
The findings indicate a strong association between education and inflammation, which can be further moderated by psychosocial factors. The health benefits associated with psychological well-being were particularly evident for individuals with low educational attainment.
doi:10.1037/a0021360
PMCID: PMC2991411  PMID: 20954777
education; well-being; affect; inflammation
7.  The Survey of the Health of Wisconsin (SHOW), a novel infrastructure for population health research: rationale and methods 
BMC Public Health  2010;10:785.
Background
Evidence-based public health requires the existence of reliable information systems for priority setting and evaluation of interventions. Existing data systems in the United States are either too crude (e.g., vital statistics), rely on administrative data (e.g., Medicare) or, because of their national scope (e.g., NHANES), lack the discriminatory power to assess specific needs and to evaluate community health activities at the state and local level. This manuscript describes the rationale and methods of the Survey of the Health of Wisconsin (SHOW), a novel infrastructure for population health research.
Methods/Design
The program consists of a series of independent annual surveys gathering health-related data on representative samples of state residents and communities. Two-stage cluster sampling is used to select households and recruit approximately 800-1,000 adult participants (21-74 years old) each year. Recruitment and initial interviews are done at the household; additional interviews and physical exams are conducted at permanent or mobile examination centers. Individual survey data include physical, mental, and oral health history, health literacy, demographics, behavioral, lifestyle, occupational, and household characteristics as well as health care access and utilization. The physical exam includes blood pressure, anthropometry, bioimpedance, spirometry, urine collection and blood draws. Serum, plasma, and buffy coats (for DNA extraction) are stored in a biorepository for future studies. Every household is geocoded for linkage with existing contextual data including community level measures of the social and physical environment; local neighborhood characteristics are also recorded using an audit tool. Participants are re-contacted bi-annually by phone for health history updates.
Discussion
SHOW generates data to assess health disparities across state communities as well as trends on prevalence of health outcomes and determinants. SHOW also serves as a platform for ancillary epidemiologic studies and for studies to evaluate the effect of community-specific interventions. It addresses key gaps in our current data resources and increases capacity for etiologic, applied and translational population health research. It is hoped that this program will serve as a model to better support evidence-based public health, facilitate intervention evaluation research, and ultimately help improve health throughout the state and nation.
doi:10.1186/1471-2458-10-785
PMCID: PMC3022857  PMID: 21182792
8.  Sleep Duration in the United States: A Cross-sectional Population-based Study 
American Journal of Epidemiology  2009;169(9):1052-1063.
Sleep duration is associated with cardiovascular disease and diabetes risk factors, depression, automobile and workplace accidents, and prospective mortality. Little is known, however, about sleep patterns in the US population. The 2004–2007 National Health Interview Survey-Sample Adult Files provide nationally representative data for 110,441 noninstitutionalized US adults aged 18 years or older, and multinomial logistic regression examines whether variables in 5 domains—demographic, family structure, socioeconomic, health behavior, and health status—are associated with long or short sleep duration. Being older, non-Hispanic black, or a current or former smoker; having low levels of education, income, or few income sources; consuming few or numerous drinks in a week; or reporting cardiovascular disease, diabetes, depression, underweight, or activity limitations is associated with increased odds of both long and short sleep duration. Other variables are associated with shorter (e.g., living with young children, being unmarried, working long hours, more frequent binge drinking) or longer (e.g., being younger, Mexican American, pregnant, or having low levels of physical activity) sleep hours. The authors identify numerous risk factors for long and short sleep; many of those variables are potential confounders of the relation between sleep hours and other health outcomes.
doi:10.1093/aje/kwp023
PMCID: PMC2727237  PMID: 19299406
family; health behavior; health status disparities; life style; sleep; social class

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