Author: nknox

Adverse Childhood Experiences and Sleep Disturbances Among Puerto Rican Young Adults

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Sleep quality is a known marker of overall health and is a chronic health issue in the US.1,2 In addition to the racial and ethnic disparities affecting sleep quality, studies suggest that adverse childhood experiences (ACEs) are associated with sleep disturbances and other chronic diseases among adults.3,4 ACEs are defined as stressful or traumatic life events that occur during the first 18 years of life.5 It is estimated that approximately 58% of youths in the US have experienced at least 1 or more ACE, with a higher prevalence of ACEs among Black and non-White Hispanic children.5–7 Our research group previously found a significant association between childhood adversity and poor sleep outcomes among Puerto Rican children.8 Although ACEs can be assessed both prospectively during childhood and retrospectively in adulthood, no previous study on ACEs and sleep quality has used both forms of reporting, to our knowledge. Despite the utility of retrospective ACEs and patient preference to be screened, both patients and physicians reported that fewer than 10% of adult patients were asked about ACEs.9,10 Furthermore, research has shown low agreement between prospective and retrospective ACEs, suggesting that these 2 forms of reporting may identify distinct groups of people with unique risk factors for various health outcomes.11,12

Compared with previous research on ACEs and sleep, our study introduces a new age group to consider: young adults. Young adults, defined as approximately 18 to 26 years of age, are an underrepresented population in research.13 Young adulthood is a critical period of complex cognitive and emotional maturation, including increased rates of risky behavior and accidental death.13 Despite the high incidence of mental and physical health issues among young adults, this population is less likely to seek health care or undergo routine screening compared with other age groups.14

Considering the disparities in research that exist for Puerto Rican young adults, as well as the promising importance of exploring both retrospective and prospective ACEs, our study examines the association of prospective and retrospective ACEs with sleep quality in a geographically diverse population of Puerto Rican young adults. Understanding this association has the potential to inform interventions to address ACEs, improve sleep quality, and reduce health disparities for Puerto Rican young adults.

Read the full paper: Olsen EL, April-Sanders AK, Bird HR, Canino GJ, Duarte CS, Suglia SF. Adverse Childhood Experiences and Sleep Disturbances Among Puerto Rican Young Adults. JAMA Netw Open. 2024;7(4):e247532.
https://journals.lww.com/psychosomaticmedicine/abstract/2024/04000/cumulative_stress_across_the_life_course_and.3.aspx

Cumulative Stress Across the Life Course and Biological Aging in Adulthood

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Psychosocial stressors have been linked with accelerated biological aging in adults; however, few studies have examined stressors across the life course in relation to biological aging. In 359 individuals (57% White, 34% Black) from the Child Health and Development Studies Disparities study, economic (income, education, financial strain), social (parent-child relations, caretaker responsibilities) and traumatic (death of a sibling or child, violence exposure) stressors were assessed at multiple time points (birth and ages 9, 15, and 50 years). Experiences of major discrimination were assessed at age 50. Life period stress scores were then assessed as childhood (birth–age 15 years) and adulthood (age 50 years). At age 50 years, participants provided blood samples, and DNA methylation was assessed with the EPIC BeadChip. Epigenetic age was estimated using six epigenetic clocks (Horvath, Hannum, Skin and Blood age, PhenoAge, GrimAge, Dunedin Pace of Aging). Age acceleration was determined using residuals from regressing chronologic age on each of the epigenetic age metrics. Telomere length was assessed using the quantitative polymerase chain reaction–based methods. In linear regression models adjusted for race and gender, total life stress, and childhood and adult stress independently predicted accelerated aging based on GrimAge and faster pace of aging based on the DunedinPace. Associations were attenuated after adjusting for smoking status. In sex-stratified analyses, greater childhood stress was associated with accelerated epigenetic aging among women but not men. No associations were noted with telomere length. We found that cumulative stressors across the life course were associated with accelerated epigenetic age, with differences by sex (e.g., accelerated among women). Further research of this association in large and diverse samples is needed.

Read the full paper: Suglia, Shakira F. MS, ScD; Clausing, Elizabeth S. PhD; Shelton, Rachel C. ScD; Conneely, Karen PhD; Prada-Ortega, Diddier MD, PhD; DeVivo, Immaculata PhD; Factor-Litvak, Pam PhD; Cirillo, Piera PhD; Baccarelli, Andrea A. PhD; Cohn, Barbara PhD; Link, Bruce G. PhD. Cumulative Stress Across the Life Course and Biological Aging in Adulthood. Psychosomatic Medicine 86(3):p 137-145, April 2024.
https://link.springer.com/article/10.1007/s40615-021-00978-w

https://pubmed.ncbi.nlm.nih.gov/38345302

Prevalence of cardiometabolic risk and health factors among Puerto Rican young adults

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As part of the Boricua Youth Study – Health Assessment study, which examines the cardiovascular health of Puerto Rican young adults in the San Juan metro area in Puerto Rico and the South Bronx, NY, we recently published on the prevalence of cardiometabolic risk factors and ideal cardiovascular health (CVH) among this population.

The BYS-HA study conducted home visits to collect objective anthropometric, blood pressure and blood samples when participants were on average 23 years of age. Information on diet, physical activity and sleep were collected via surveys. In addition to calculating measures of obesity, diabetes and hypertension we also calculated a measure of ideal cardiovascular Health (CVH). We utilized the American Heart Association, Life’s Essential 8 metric which includes 8 markers of cardiovascular health: adequate sleep, healthy diet, physical activity, no tobacco exposure, blood pressure, weight status, diabetes and lipids. We characterized CVH scores as continuous with higher scores indicating more optimal CVH and categorically (80-100 scores for ideal CVH). We examined different prevalence of cardiometabolic risk factors and CVH by site (NY vs PR) and by sex.

In this sample of 759 participants, 413 of the participants lived in Puerto Rico with 346 in the South Bronx NY. The mean age of participants was 22.6 years and 50% were female. Twenty-seven percent of the sample received public assistance in young adulthood. Overall, there was a high prevalence of obesity and high HBA1C (≥5.7, a measure of diabetes risk) with noted differences across study site. Participants in NY had a higher prevalence of obesity (35% in NY and 19% in PR) and hypertension (8% in NY and 2% in PR). Across both sites, men had a higher prevalence of hypertension, but women had a higher prevalence of obesity and low total cholesterol compared to men. In both NY and PR, women had better blood pressure and lipids but lower physical activity compared to men. In PR, women also had better diet and nicotine exposure scores compared to men.

Mean CVH score among NY participants was lower (61.9) than in PR (68.9). No participant had all ideal health metrics, 36% of participants in PR had 5 or more ideal CVH; while only 16% in NY met this criterion.

Our findings suggest sociocultural factors can influence cardiometabolic health measures. Overall, 4 of the 7 metrics examined were worse in the NY population compared to PR. In PR, measures of diet and PA were worse compared to the NY site. While study participants are ethnically homogenous, Puerto Ricans living in NY are considered and ethnic minority while those living in Puerto Rico are the ethnic majority, experiences of discrimination and racism may differ across groups. Furthermore, BYS participants live in distinct social, political, cultural and built environments. Differences between sites based on access to food, recreational facilities and walkability of neighborhoods could explain noted cardiometabolic differences. Similarly social, political, and cultural factors, including economic and political instability, structural racism, adequate health care access and educational and occupational opportunities differ across sites. Interventions to maintain and improve CVH across the life course, tailored to sociocultural environments, are necessary for the prevention of cardiovascular disease.

https://www.sciencedirect.com/science/article/abs/pii/S1047279723002144

Tips (and a plug) for PhD accountability groups

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Accountability groups and writing groups are fairly common, particularly in academic settings, where students and faculty may have a variety of roles and shifting demands. A quick Google search yields posts from people seeking groups to join, and institution-specific groups for students or faculty to join. A Pub-Med search even identified a study examining differences in “scholarly production” from participants of a faculty research/writing group compared to a matched group of faculty not participating in the group. The results indicated that participation in the group provided junior faculty with the support system needed to feel confident, and that over time, faculty in the group increased their productivity. (https://www-sciencedirect-com.proxy.library.emory.edu/science/article/pii/S1877129716301459)

I joined the SDOH-LIFE research group in the spring of 2019 to begin a project examining cumulative social stress and childhood obesity using data from the Early Childhood Longitudinal Study – Kindergarten Class 2010-11 (ECLS-K:2011). In the fall of 2019, four fellow PhD students and I started an accountability group to motivate ourselves and try to remain productive in the amorphous post-coursework days of our PhD program. We are all completing our PhDs in Epidemiology, though in a variety of different topic areas, and the group has since become integral to our productivity and progress. Our accountability not only serves as a place for goal-setting and planning, but a sounding board for advice, and navigating imposter syndrome and mentor relationships.

Through that first semester we learned what worked and what did not work for our group, and tried to make progress on various projects and dissertations. Probably most importantly, we learned more about each other and how to support each other in the PhD program. Ultimately, the accountability group has seen its members through successful grant submissions, PhD milestones, and of course the pandemic and transition to working from home. During the pandemic we continue to meet via zoom, though those first months were mostly spent figuring out how to make our new reality work for us.

Since its inception, our AG has settled on some best practices and lessons learned for our group that could be adapted for others:

  • Block off the time on your calendar, and treat it like you would any other meeting
  • Have some kind of tracking document for short and long term goal setting
  • Keep track of accomplishments!
  • Check in at regular intervals for wrap-up and next set of long term goals (semesters, quarterly, etc.)
  • Be ready to talk about both what you did and how you did it – we have had a lot of success with helping each other identify processes that work!

Since joining the SDOH-Life Research group, I have also worked on other projects examining bullying and school connectedness in relation to adolescent adiposity in the Fragile Families Child and Wellbeing Study, completed my dissertation proposal and moved into candidacy, submitted pre-doctoral grants, and worked on other projects outside of the research group – and I did most of this while working from home! While it is possible I could have done all these things without an accountability group, the group provided structure and community to help me navigate the challenges of academic life while keeping my sanity intact.

Social stress, epigenetics and cardiometabolic health among Latino Youth

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We are excited to announce we have received a new R01 award (R01MD015204) from NIMHD to examine the association between social stressors, in relation to DNA methylation, mitochondrial DNA (mtDNA) damage and cardiometabolic health, among children participating in the Hispanic Community Health Study /Study of Latinos (HCHS/SOL) Youth Study. The HCHS/SOL Youth study is a study of US Latinos, representing varied countries of origin, conducted in the US. Existing blood samples will be assayed for DNA methylation age, genome-wide methylation and a mtDNA damage marker.  Cardiometabolic health markers (obesity, diabetes, hypertension, inflammation and lipids) have also been assessed. Existing data also includes assessments of current family environment as well as socio-cultural factors among children. Specifically, we will examine 1) whethersocial and economic stressors are associated with DNA methylation age, mtDNA damage and genome-wide methylation; 2) whether DNA methylation age, genome-wide methylation and mtDNA damage is associated with cardiometabolic health among children and 3) whether socio-cultural factors (i.e, ethnic identity, parental closeness, place of birth) modify the association between social and economic stress and DNA methylation and mtDNA damage association. This project is in collaboration with Dr. Carmen Isasi at Albert Einstein College of Medicine and compliments our ongoing Social stress and epigenetics study among HCHS/SOL adult participants (R01MD013320).