Integrative Studies

1. CARDIA: Core group members and network collaborators continue to mine the data from this longitudinal study of cardiovascular risk factors among African-Americans and Whites in four U.S. cities (Birmingham, Chicago, Minneapolis and Oakland). The study recruited 5115 men and women in l985 stratified by age (18-24 years and 25-30 years), sex, ethnicity (black and white), and educational level (high school graduate or less and beyond high school). Seven follow-ups have been conducted, and retention has been good. A particular strength of this study is the availability of excellent measures of socioeconomic status, psychosocial factors, and biological indicators in a diverse population, including data from the sociodemographic and psychosocial questionnaires, and the allostatic load battery of biological measures, all of which the network designed for the 15-year (2000-2001) CARDIA exam. With repeated measures of SES, major cardiovascular risk factors, and health outcomes, including hypertension, diabetes, obesity, metabolic syndrome and coronary calcification this data set is a rich resource for testing our pathways model. Analysis centers are established at UCLA, Stony Brook and UCSF.

TABLE 1 – CARDIA analyses involving MacArthur Network Core Group Members and Affiliates
Title of project	Writing Group	Analysis site	Status
Development of psychometrically-sound measures for the CARDIA Year 15 exam.	Seeman, Matthews, McCreath and Network	UCLA	Documentation completed in 2002.
Relation of childhood socioeconomic status and family environment to adult metabolic functioning.	Lehman, Taylor, Kiefe, Seeman	UCLA	Published in 2005.
Does cardiovascular reactivity to mental stress predict coronary calcification?	Matthews, Markovitz	CC	Published in 2005.
Impact of Socio-Economic Status on Longitudinal Accumulation of Cardiovascular Risk in Young Adults: The CARDIA Study.	Karlamangla, Singer, Williams, Schwartz, Matthews, Kiefe, Seeman	UCLA	Published 2005.
Socioeconomic status and health: Is parasympathetic nervous system activity an intervening mechanism?	Sloan, Huang, Sidney, Liu, Williams, Seeman	UCLA	Published in 2005.
Socioeconomic status, race, and diurnal cortisol decline.	Cohen, Schwartz, Epel, Kirschbaum, Sidney, Seeman	Stony Brook	Published in 2006.
Education, 15-year risk factor progression, and coronary artery calcium in young adulthood and early middle age.	Yan, Liu, Daviglus, Colangelo, Kiefe, Sidney, Matthews, Greenland	CC	Published in 2006.
Self-reported health, perceived racial discrimination, and skin color in African Americans	Borrell, Kiefe, Williams, Diez-Roux, Gordon-Larsen	CC	Published in 2006.
Relationship of early life stress and psychological functioning to c-reactive protein.	Taylor, Lehman, Kiefe, Seeman	UCLA	Published in 2006
Diurnal cortisol decline is related to coronary calcification.	Matthews, Schwartz, Cohen, Seeman	Stony Brook	Published in 2006
Socioeconomic trajectories, childhood socioeconomic status, and coronary calcification in adulthood. Includes Year 20 data.	Matthews, Schwartz, Cohen, Yan	Stony Brook	Manuscript in preparation.
Cardiac autonomic control and the effects of age, race, and gender	Sloan, Seeman, Sidney, Liu, Dale Williams	UCLA	Manuscript under review.
Modeling multi-system biological risk in young adults. (Ancillary #1)	Seeman, Gruenewald, Schwartz, Sidney, Liu, McEwen, Karlamangla	UCLA	Being revised for resubmission.
Subjective social status in relationship to blood pressure, coronary calcification, and waist-to-hip ratio: Are there effects above and beyond the standard SES measures and negative emotions?	Adler, Singh-Manoux, Schwartz, Stewart, Matthews, Marmot	Stony Brook	Manuscript under review.
The relationship of early family environment to blood pressure.	Taylor, Lehman, Kiefe, Seeman	UCLA	Final manuscript in progress.
Occupational histories and risk for hypertension.	Burgard, Schwartz, Stewart, Matthews, Seeman	Stony Brook	Manuscript in preparation.
Subjective Social Status Qualitative Study	Connor, Stewart, Sidney, Adler	UCSF	Manuscript proposal to be reviewed by P and P committee 5/07; manuscript nearly completed.
Allostatic load and its relationship to socioeconomic status and social support	Seeman, McEwen, Singer,Kiefe, Williams	UCLA	Manuscript in preparation.
Are psychological factors related to abnormal diurnal ambulatory blood pressure patterns in young adults?	Shimbo, Davidson, Haas, Lewis, Pickering, Schwartz	CC/Stony Brook	Manuscript in preparation. Findings negative, unlikely to complete manuscript.
Do depressive symptoms moderate the link between low socioeconomic status and diabetes incidence?	Davidson, Jonas, Shimbo, Schwartz, Matthews, Kiefe	CC/ESC	Manuscript in preparation.
Perceptions of discrimination and hypertension.	Williams, Pletcher, Kiefe, Matthews, Sidney	CC/ESC	Analyses in progress.
Perceived discrimination and coronary calcification.	Williams, Kiefe, Matthews, Sidney	CC/ESC	Analyses in progress.
Discrimination and metabolic syndrome.	Ahmed, Sidney, Matthews, Williams, Seeman	Oakland/UCLA	Analyses in progress
Anabolic (IGF-1) and catabolic (urinary cortisol and catecholamine) hormones in relationship to depression, chronic stress, and disease risk (coronary calcification, insulin resistance and visceral fat).	Epel, Sidney	UCSF	Analyses in progress.
Hostility and pulmonary function in CARDIA: A 10-year prospective study.	Jackson, Jacobs, Kubzansky, Cohen, Wright	Stony Brook	Analyses in progress.
Allostatic load as a mediator of SES differences in coronary calcification (Ancillary #2)	Seeman, Singer, McEwen, Karlamangla Matthews, Sidney	UCLA	*Whitehall IMT data Analyses in progress.
A Multilevel Analysis of Neighborhood SES and Social Cohesion As Predictors of Allostatic Load and Coronary Calcification	Kim, Diez-Roux, Kiefe, Williams, Kawachi, Liu, Seeman	Harvard/ UCLA	Descriptive analyses have been conducted, and multilevel analyses are currently in progress. It is anticipated that all of the project analyses and the two resulting manuscripts will be completed by the summer of 2007.
Neighborhood socioeconomic status, social cohesion, and coronary calcification in young adults.	Kim, Diez Roux, Kiefe, Kawachi, Liu	By Diez-Roux	Analyses in progress.
Experience of discrimination in CARDIA: Ethnicity, gender, and socioeconomic position. (Patterns of experience of perception and change over time.)	Williams, Kiefe, Matthews, Sidney	CC	Analyses in progress.
Socioeconomic status and inflammation.	Gruenewald, Seeman, Cohen, Tracy, Matthews, Britt, Liu	UCLA	Manuscript completed—to be submitted for CARDIA review soon.
Heart rate variability and heart rate recovery.	Sloan, Liu, Sidney, Seeman	UCLA	*already done in Whitehall Analyses in progress.
RR interval variability and inflammation.	Sloan, Sidney, Liu	UCLA	Manuscript under review.
Adrenocortical and autonomic activity in relation to obesity: cross-sectional study	Brunner, Liu, Huang, Adler, Sidney, Seeman	UCLA	No longer active.
Affect, Stress, SES, and Salivary Cortisol	Epel, Schwartz, Matthews, Adler, Seeman, Haritatos	Stony Brook	Analyses in progress.
Heart rate variability and coronary calcification	Sloan, Matthews, Seeman	UCLA	Analyses in progress.
Visceral Fat, psychosocial distress and HPA axis function	Epel, Stewart, Adler, Sidney, Seeman	UCSF	Analyses in progress.
Race, Stress and Health: A lifecourse perspective	Nuru-Jeter, Diez-Roux, Williams, Adler, Sidney, Seeman	UCSF	Analyses in progress.
Cellular aging, psychosocial factors, and risk of cardiovascular disease	Epel, Adler, Seeman, Pletcher, Hulley, Cawthon Blackburn, Lin	UCSF	Analyses in progress.
Socioeconomic status is related to urinary catecholamines in CARDIA.	Janicki-Deverts, Cohen, Adler, Schwartz, Matthews, Seeman	Stony Brook	Manuscript under editorial review.
Social relationships and inflammation	Janicki-Deverts, Cohen, Gruenewald, Seeman	CMU	Analyses in progress.
SES over the lifecourse and oxidative stress	Cohen, Janicki-Deverts, Jacobs, Gross, Matthews, Schwartz	Stony Brook	Analyses in progress.
SES trajectories and changes in health practices	Janicki-Deverts, Cohen, Matthews, Schwartz, Kiefe, Daviglus	Stony Brook	Analyses in progress.
SES trajectories and inflammation	Cohen, Janicki-Deverts, Matthews, Schwartz	Stony Brook	Analyses in progress.
Risk factor profiles linked to self-rated health.	Nayak, Hubbard, Kiefe, Sidney, Adler, Syme	UCSF	Analyses in progress.
The psychosocial context and consequences of race: extent of black-white differences in the broad range of psychosocial factors assessed and the extent to which they contribute (independent of and in combination with SES) to racial differences in coronary calcification, diabetes, and hypertension.	Williams and Network Psychosocial Group	CC	Wait till larger discussion of psychosocial variables. Look at: 1) extent W/B differences in psychosocial, what extent independent and interactions, 2) Differences in psychosocial and how contribute to health outcomes.
Race, age, and allostatic load: Is there an age patterning to the racial differences in allostatic load? That is, are markers of allostatic load evident at earlier ages for African Americans than for whites?	Willia Williams and Seeman	UCLA	On hold.
SES, allostatic load and mental health: The mediating role of cumulative risk.	Evans, Seeman, Gruenewald, Matthews, Epel, Williams	UCLA	Data received; operationalizing variables and developing in depth analysis plan.
Delineating subtypes of early family environments that confer physical and psychological risk.	Saxby, Taylor, Seeman, Gruenewald, Kiefe	UCLA	Data received, analyses initiated 3/07.
Biological correlates of social integration, social support and social conflict.	Seeman, Gruenewald, Cohen	UCLA	Analyses underway.
Unemployment and inflammation.	Janicki-Deverts, Cohen, Matthews and Cullen	CMU	Manuscript in preparation.
Influence of Race, Gender, and Marital Status on the Development of the Metabolic Syndrome	Kiefer, Adler, Matthews	UCSF	Analyses in progress.
Racial differences in blood pressure trajectory in a biracial cohort: The CARDIA study.	Schwartz, Ogedegbe, Williams, Cohen, Matthews	Stony Brook	Manuscript proposal to be reviewed by P and P committee 5/07.

2. Whitehall II: This longitudinal study of 10,308 British civil servants, initiated in 1985, has been central to our ongoing integrative studies. It offers a unique opportunity for studying the relationship between SES and health in an occupationally based population. Respondents span the range of employment grades from office support to permanent secretary, with a 20-fold salary range. They have been well-characterized in terms of social position: economic/material (personal income, household income, wealth), occupational (employment grade), educational (years of education; qualification obtained), and parental social class. Measures of health, lifestyle, work characteristics, social support and life events have been repeatedly obtained over 22 years. With an increasingly large population of older citizens in the UK the Whitehall team seeks: (1) to determine the degree to which occurrence of cardiovascular disease and social inequalities at older age are produced by contemporaneous circumstances and by prior cumulative exposures to risk factors during working life, (2) to test the hypothesis that the functional consequences of living with increased cardiovascular risk in later life are modifiable, and (3) to understand social differences in the progression of cardiovascular risk based on longitudinal analysis of repeated measures.

During the course of our collaboration with the Whitehall team we have intellectually and financially supported a number of young researchers, including Meena Kumari, Tarani Chandola, Archana Singh-Manoux, and Mai Stafford. Meena Kumari and her colleague, Ellena Badrick, are continuing their work examining associations with cortisol secretion. They have recently published a paper (Badrick et al. The Relationship between Smoking Status and Cortisol Secretion. J Clin Endocrinol Metab. 2007 Mar;92(3):819-24) and are planning to submit a manuscript describing the relationship between alcohol consumption and cortisol secretion. Meena and Tarani Chandola are working on a manuscript describing patterns of cortisol release in a 'healthy' cohort. A paper comparing the association between subjective socioeconomic status and health between different ethnic groups in Whitehall II and CARDIA has been submitted (Adler NE, Singh-Manoux A, Schwartz J, Stewart J, Matthews K, Marmot, MG. Social status and health: A comparison of British civil servants with European- and African- Americans). It replicates analyses published in 2003 (Singh-Manoux A, Adler NE, Marmot M. Subjective social status: its determinants and its association with measures of ill-health in the Whitehall II study. Soc Sci Med 2003; 56:1321-33). Tarani Chandola continues to collaborate with researchers in Japan applying models of the social determinants of health in non-Western societies. Discovering common patterns in the social determinants of health in different societies makes the evidence base regarding social inequalities in health stronger. A series of papers examining models developed from the Whitehall II data and testing their application in a Japanese context have been produced to date. These include: Sekine,M., Chandola,T., Martikainen,P., Marmot,M., Kagamimori,S. (2006). Psychosocial Work and Family Environment as Determinants of Gender and Socioeconomic Inequalities in Sleep: the Japanese Civil Servants Study. Sleep 29(2), 206-216. Sekine, M., Chandola, T., Martikainen, P., Marmot, M., Kagamimori, S. (2006). Socioeconomic Inequalities in Physical and Mental Functioning of Japanese Civil Servants: Explanations from Work and Family Characteristics. Social Science and Medicine 63(2), 430-445. Sekine, M., Chandola,T., Martikainen,P., McGeoghegan, D., Marmot, M., Kagamimori, S. (2006). Explaining social inequalities in health by sleep: the Japanese civil servants study. Journal of Public Health 28, 63-70. Archana Singh-Manoux continues to build a research team to support her research program comparing ageing in French (GAZEL) and British (WHITEHALL II) cohorts. This work is funded by her EURYI - European Young Investigator award, 2005-2010 (€1,168,139). One publication from this period is: Singh-Manoux A., Martikainen P., Ferrie J.E., Zins M., Marmot M, Goldberg M. What does self-rated-health measure? – Results from the British Whitehall II and French Gazel cohort studies. J Epidemiol Community Health 2006; 60: 364-72. She is part of the collaborative research network called the Sickness Absence Research Collaboration (SARC) involving investigators and data from four countries, Finland, France, Sweden and the UK which aims to investigate the neglected area of causes and consequences of sickness absence, and the effect of different national policies on sickness absence rates or associations with health..

3. Large industrial company: The Industry Study was initiated with Network support in 1998 by Mark Cullen. This study includes 25,000 employees of a large industrial company at 15 industrial plants scattered around the US; over 20% are non-white and over 25% are women. This rich data set includes complete demographics, work histories and work performance measures for all workers since 1985, continuous and complete health insurance and various physical status measures since 1996, and key information about physical and social characteristics of each job and each work location. Network support has allowed these data bases to be linked, making possible analyses of health effects of job categories and work conditions. Work proceeds looking at the role of physical and psychosocial characteristics of jobs and work locations as they predict physical injury, chronic disease, mental health outcomes, and disability. There is also an increased focus on utilization of care and quality as it may impact the relationship between SES and health.

In 2006 the study received funding from NIA for a five year project totaling 5.5 million dollars (“Disease, disability and death in an aging workforce”) which will ensure the continued work on these issues. This is a good example of how an investment of network funds resulted in far greater support for a major research initiative. In addition, the richly linked database whose assemblage was funded by the network has allowed members of the team to obtain a number of smaller grants and awards, and has resulted in seven dissertations. There is an active line-up of manuscripts in various stages of completion, including: “Use of Health Claims Data Files for Occupational Health Research”, “Effects of a Cost-sharing Exemption on Use of Preventive Services at One Large Employer”, “Does obesity increase workplace injuries: A literature review”, “Relationship of job demands to mental health in a large manufacturing workforce”, “The contribution of psychosocial stress to risk of acute injury in hourly manufacturing workers”. Four collaborations with other network members are of particular note: with core group member Ichiro Kawachi and post-doctoral fellow Jane Clougherty, a major multilevel analysis of the causes of chronic disease; with Sheldon Cohen and his colleagues, an analysis of the impact of job stress on risk for lung function lost longitudinally; with Joe Schwartz, an assessment of the predictive value of the externally rated job demand survey versus the Karasek quality of employment survey on injury risk; and with Michael Marmot, a comparison of the externally rated job demand survey in Whitehall and this company’s populations.