Improving Cardiovascular Health Through the Consideration of Social Factors in Genetics and Genomics Research: A Scientific Statement From the American Heart Association

Posted on September 9, 2025 by nknox

Cardiovascular health (CVH) is affected by genetic, social, and genomic factors across the life course, yet little research has focused on the interrelationships among them. An extensive body of work has documented the impact of social determinants of health at both the structural and individual levels on CVH, highlighting pathways in which racism, housing, violence, and neighborhood environments adversely affect CVH and contribute to disparities in cardiovascular disease. Genetic factors have also been identified as contributors to risk for cardiovascular disease. Emerging evidence suggests that social factors can interact with genetic susceptibility to affect disease risk. Increasingly, social factors have been shown to affect epigenetic markers such as DNA methylation, which can regulate gene and protein expression. This is a potential biological mechanism through which exposure to poor social determinants of health becomes physically embodied at the molecular level, potentially contributing to the development of suboptimal CVH and chronic disease, thus reinforcing and propagating health disparities. The objective of this statement is to highlight and summarize key literature that has examined the joint associations between social, genetic, and genomic factors and CVH and cardiovascular disease.

Read the full publication: Suglia SF, Hidalgo B, Baccarelli AA, et al. Improving Cardiovascular Health Through the Consideration of Social Factors in Genetics and Genomics Research: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes. 2025;18(5):e000138. doi:10.1161/HCQ.0000000000000138
https://www.ahajournals.org/doi/10.1161/HCQ.0000000000000138?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

Adverse Childhood Experiences and Sleep Disturbances Among Puerto Rican Young Adults

Posted on May 31, 2024 by nknox

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

Posted on May 31, 2024 by nknox

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

Posted on December 20, 2023 by nknox

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

Racial Disparities in Avoidant Coping and Hypertension Among Midlife Adults

Posted on February 3, 2022 by bbataye

In the United States (U.S.), roughly one in three adults has hypertension, and the burden of hypertension is particularly high among African American populations (African American: 40.3%; White: 27.8%). Existing literature has demonstrated that experiencing stress is positively associated with hypertension. Coping strategies, or how individuals respond to stress, have been hypothesized to explain disparate associations between stress and hypertension.

Whether directly stated or implied, public health has historically tended to focus on behavioral and individual- level explanations for understanding patterns in racial/ethnic or class health inequities. Past research has demonstrated that attributing health disparities to poorer health behaviors (e.g., not following recommended guidelines) and individual-level factors without accounting for the broader social context in which they arise is insufficient and inaccurate in seeking to understand and address disparities.

This research examined the association between avoidant coping (often perceived to be maladaptive, individual-level behavior) and hypertension while assessing potential differences by race. Additionally, we assessed this relationship both with regard to coping responses to discrimination and stress more generally.

We found that avoidant coping in response to the general stress and discrimination was associated with increased hypertension among White respondents and no associations among African American respondents. This research suggests that racial disparities in hypertension may not be attributable to individual-level coping behaviors.

As this paper examined coping in relation to hypertension, we are not suggesting that general stress and discrimination do not impact the cardiovascular health of African Americans. The impacts of stress and discrimination on cardiovascular health are well supported by the literature, which we suggest be a continued area of research.

We recommend further research build on examinations of stress and social context as determinants of hypertension. Our findings call for a nuanced analytic approach that situates findings within broader social contexts that shape both stressors and coping responses when studying relationships between coping and health. To mitigate the impacts of stress on hypertension, we recommend health interventions not only address individual-level behavior change but also address policies that reinforce health disparities at the structural level.

Read the full paper: Batayeh, B., Shelton, R., Factor-Litvak, P. et al. Racial Disparities in Avoidant Coping and Hypertension Among Midlife Adults. J. Racial and Ethnic Health Disparities (2022). https://doi.org/10.1007/s40615-022-01232-7
https://link.springer.com/article/10.1007%2Fs40615-022-01232-7

Tips (and a plug) for PhD accountability groups

Posted on June 16, 2021 by nknox

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.

Immigrant-Related Policies and the Health of Youth in Immigrant Families in the U.S.

Posted on March 25, 2021 by daniellecrookes

There are more than 44 million immigrants in the U.S. who make up approximately 14 percent of the U.S. population. For these immigrants, a complex system of federal, state, and local policies determines their rights and their eligibility for resources and services based on their immigration status and length of residence in the U.S. In doing so, these policies influence immigrants’ ability to incorporate socially and economically into U.S. society and can have implications for their health and for the health of their families. For example, in the U.S., having health insurance is associated with better health care usage, better quality of care, and better health outcomes. Current federal policies restrict unlawfully present immigrants (undocumented immigrants) from receiving Medicaid and from purchasing insurance coverage through the Health Insurance Marketplace®, even though many undocumented immigrants pay taxes and provide economic and social contributions to U.S. society, including working as frontline essential workers. Restrictions are sometimes not limited to undocumented immigrants. Some lawfully present immigrants face a five-year waiting period before they are eligible for Medicaid, a practice which began in 1996 under the Personal Responsibility and Work Opportunity Act. Using state-level funds, some states opted to offer coverage to pregnant women and/or children up who had not met the five-year eligibility and in 2009, the Children’s Health Insurance Program Reauthorization Act (CHIPRA) allowed states to opt to use federal funding to provide coverage for these special groups. In January 2020, 11 states still do not provide this coverage.

Non-healthcare policies also affect health through access to employment, driver’s licenses and other resources, and increased policing. For example, states that restrict undocumented immigrants from obtaining state driver’s licenses, limit the mobility of these immigrants, which can limit access to employment opportunities and threaten their family’s financial wellbeing, can limit access to clinics and force a delay care seeking when needed, and can increase experiences of policing, identification and apprehension through strategically placed police license, insurance, and registration checkpoints. When policies limit the health care access, employment opportunities, and mobility of caregivers, the policies limit the family resources needed for children to thrive.

Understanding that policies that affect adult immigrants may also affect the children in their families, we conducted a systematic review of quantitative studies published between 1986 and 2020 that examined the relationship between immigrant-related policies in the U.S. and the mental and physical health of infants, children, and adolescents living in immigrant families. After screening more than 7,000 studies, we identified only 17 studies that specifically examined the effect of a policy on the health of these youth. Among the 12 policies examined in these studies were the Personal Responsibility and Work Opportunity Act, Arizona Senate Bill 1070 (the infamous “Show me your papers” omnibus law), and the Deferred Action for Childhood Arrivals (DACA) program. Most studies (58%) examined birth outcomes and the remaining studies examined additional outcomes in childhood and adolescence such as self-rated health, food insecurity, and school days missed. While there were studies that did not observe an association between policies and the health of these youth, especially for birth outcomes, among those studies that did find an association, restrictive policies were generally associated with worse health outcomes and inclusive policies were associated with better health outcomes.

Our review highlights that immigrant-related policies can be structural drivers of health not just for adults targeted by these laws, but also for the children living in immigrant families. These findings support a rich body of qualitative research that has found that immigrant-related policies affect the health and wellbeing of immigrant families, especially undocumented and mixed status families. Our review also highlights that even though our search spanned a 30-year period during which several immigrant-related policies were passed at all levels of government, there are very few quantitative studies that have examined the effects of these policies on the health of youth living in immigrant families. Further, while we made no restrictions on the race/ethnicity of the study populations, nearly all of the studies focused on or included immigrants from Latin America, highlighting the burden that these laws place on Latinx immigrants and their families. With growing support for the study of structural drivers of health, it is time to push forward the study of immigrant-related policies, which are forms of structural racism and xenophobia.

Read the full paper: Crookes, D. M., Stanhope, K. K., Kim, Y. J., Lummus, E., & Suglia, S. F. (2021). Federal, State, and Local Immigrant-Related Policies and Child Health Outcomes: a Systematic Review. Journal of racial and ethnic health disparities, 1-11. https://link.springer.com/article/10.1007/s40615-021-00978-w

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870024

Childhood Adversity: Sex Differences in Puberty Effects for Puerto Rican Youth

Posted on August 13, 2020 by Elizabeth Lummus

Childhood adversity, including experiences of abuse and neglect, bear a strong link to both early and delayed puberty—and both of these outcomes are tied to higher risk for serious mental and physical health problems. The evidence, though, comes mostly from white girls.

Now unique research considering two largely under-studied groups on this issue—boys and Puerto Rican children—reveals some striking gender differences, along with new facts on how abuse and neglect may affect the tempo of puberty, how long it takes for kids to go through adolescence. The study is published in the June issue of Psychosomatic Medicine, journal of the American Psychosomatic Society.

As part of a long-term study on Puerto Rican youth in the South Bronx and San Juan area of Puerto Rico, 1,949 children five to 13 years old at the start were followed over three years. About half lived in the Bronx, half in the San Juan area of Puerto Rico, and at least one of their parents or caretakers was Puerto Rican.

The children completed standard written questionnaires all three years about whether they had experienced parental loss, violence exposure, neglect or physical, sexual or emotional abuse. In addition, parents filled out questionnaires about their own emotional health and any substance abuse problems, aggression or impulsive behavior, and violence in the home. Finally, the kids completed detailed puberty development scales all three years, indicating where they fell on the spectrum of going through adolescence. There were significant gender differences, says senior author Shakira Suglia, ScD, MS, Associate Professor of Epidemiology at the Emory University Rollins School of Public Health:

++ Girls exposed to two or more types of adversities were at a more advanced puberty stage at the start of the three-year study than girls not exposed to any of the adversities.

++ Boys exposed to just one adverse behavior had a lower pubertal stage at the outset than boys with no reported adversity.

++ Girls exposed to emotional abuse had smaller increases in pubertal development over time, while for boys, exposure to violence was tied to a slower tempo of their adolescent development.

What could be the reason for these sex differences, and why does it matter if kids reach puberty earlier or later? Some evidence shows that abuse of girls alters their normal stress hormone pattern, and that in turn increases body mass, which spurs puberty. “Stress hormone changes might have a different impact on boys, we just don’t know,” says Suglia. Also, since boys overall start puberty later than girls, “we might have to look later than we’ve been looking,” she adds. This gender difference “underscores the need for more research on boys.”

Puerto Ricans are under-studied compared to other Latino groups, yet their health risks are worse than those of other Latinos; for example, Puerto Rican women have the highest prevalence of obesity, diabetes and elevated cholesterol of any Latina women, notes Suglia. The majority of Puerto Rican youngsters of both sexes start puberty earlier than the typical age of 10 for white girls and 11 for white boys, she says. Both early and late timing are linked to later teen mental health problems and serious adult health problems such as heart attack, stroke and cancer. Much remains unknown about why these associations exist, Suglia says. But the new study suggests a specific way that childhood adversity makes an impact that can affect the health and well-being of Puerto-Ricans,

Study Link: https://journals.lww.com/psychosomaticmedicine/Abstract/2020/06000/Childhood_Adversity_and_Pubertal_Development_Among.5.aspx?context=FeaturedArticles&collectionId=1

Faculty Link: https://sph.emory.edu/faculty/profile/index.php?FID=shakira%20-suglia-8895

The American Psychosomatic Society (APS) (http://www.psychosomatic.org), founded in 1942, is an international multidisciplinary academic society that conducts an annual scientific meeting and educational programs. Psychosomatic Medicine is its scientific journal. The membership of over 700 is composed of academic scientists and clinicians in medicine, psychiatry, epidemiology, health psychology and allied health services. The mission of the APS is “to advance and integrate the scientific study of biological, psychological, behavioral and social factors in health and disease.”