George Kaplan, Ph.D. - US grants

DESCRIPTION: (Adapted from Investigator's Abstract) Increases in longevity are leading to a substantial growth in the elderly population, and this trend is expected to continue. Opposing opinions hold that this will result in an enormous growth of hale and hearty elderly or a pandemic of dependency, disability, and dementia. This debate has focused attention on issues related to quality of life. We know little about the factors that are associated with development of functional limitations and decreased quality of life, or factors that modify the impact of disease on functional limitations. The proposed study uses data collected in a population-based, prospective study with one of the broadest collections of behavioral, social, psychological, socio-environmental, biological, and physiological risk factors of any study. Data from extensive laboratory tests, medical history, ultrasonographic examination of the carotid arteries, maximal exercise testing, and extensive spirometry are also available. Substantial information is available on physical, social, and psychological functioning. In a sample of 1,036, there was a four-year re-examination. Computerized linkage will allow determination of sickness absence, disability, and early retirement. These data will allow the investigators to examine if incidence, and changes in physical, social, and psychological functioning, and sickness absence, disability, and early retirement, are associated with the following: 1) behavioral factors (e.g., smoking, physical activity, alcohol consumption, body mass index); 2) social factors (e.g., social network participation, social support); 3) psychological factors (e.g., depression, hopelessness, hostility); 4) job characteristics (e.g., psychological job strain, physical strain); 5) diagnosed conditions (e.g., cardiovascular disease, claudication), subclinical pathology (e.g., carotid atherosclerosis) and physiological impairments (e.g., reduced lung function, poor fitness); 6) if diagnosed conditions, subclinical pathology, and physiological impairments confound these associations; and 7) if behavioral, social, psychological, and work-related factors modify the associations between diagnosed conditions, subclinical pathology, and physiological impairments and these outcomes.

DESCRIPTION: (Adapted from Investigator's Abstract) Considerable epidemiologic evidence suggests that a variety of behavioral, psychosocial, and socioeconomic factors are associated with ischemic heart disease. However, little is available concerning the pathophysiologic pathways that link these factors with clinically important events, on the impact of changes in these factors on morbidity or mortality, or subclinical manifestations of atherosclerotic disease. Little is also known about the contributions which these factors make to explaining cardiovascular disease in women or sex differences in CVD in later life. The Kuopio Ischemic Heart Disease Risk Factor Study (KIHD) is the most comprehensive, population-based study to prospectively assess the association between behavioral, psychosocial, and socioeconomic factors and the extent and progression of atherosclerosis, and the incidence of ischemic heart disease. Data from a baseline examination, a 4-year re-examination, and a proposed 1-year re-examination of ultrasonographically assessed carotid and femoral atherosclerosis, and surveillance for myocardial infarctions and other outcomes, will be used to examine the progression or incidence of these outcomes in relation to changes in behavioral, psychosocial and socioeconomic factors. It will also be possible to see to what extent the input of these behavioral, psychosocial and socioeconomic factors on CVD in men and women is mediated by lipid peroxidation, hemostatic factors, and cardiovascular reactivity. Finally, the investigators state that this will be the first population-based epidemiologic study to examine the association between a carefully developed set of measures of cardiovascular reactivity to stress and the progression of carotid atherosclerosis, risk of myocardial infarction and death, and development of hypertension.

OVERALL DESCRIPTION: The Michigan Interdisciplinary Center on Social Inequalities, Mind and Body will foster an interdisciplinary training program seeking to understand the interactions of psychological states, their determinants, stress and pathophysiologic markers of stress in the development of physical and mental disorders in child development and in aging. The center will focus on socioeconomic and racial inequalities in health, and on lifecourse and community determinants in population-based samples of children and adults, men and women, whites and minorities. The proposed projects will focus on: (1) the extent to which children's emotional, physical and cognitive status reflect the influence of parental socioeconomic status, income trajectories, economic stress and community characteristics, (2) the role of glucocorticoid and seratonergic mechanisms in the association between psychosocial states, SES and risk for CVD, (3) the interrelations between a broad array of psychological attributes and related biological markers of stress within a multilevel representative community sample, (4) a study of the contributions of socioeconomic, biological and psychosocial factors at different stages of the lifecourse to a broad range of indicators of psychological wellbeing, cardiovascular risk factor status and (5) the impact of chronic economic stress on health and function in a randomly selected cohort of poor women. The Center will also emphasize the development of new methodological and biostatistical tools, novel approaches to career development and will emphasize the dissemination of research findings to policy audiences. The Center will involve the collaboration of 22 senior researchers from nine disciplines.

DESCRIPTION (adapted from investigator's abstract): The Michigan Interdisciplinary Center on Social Inequalities, Mind, and Body (MICSIMB), will foster an interdisciplinary research program seeking to understand the interactions of psychosocial states (beliefs, attitudes, affective states, values, and social relationships), their determinants, stress, and pathophysiologic marker of stress, in the development of physical and mental disorders, in child development, and in aging. The investigators include a focus on socioeconomic and racial inequalities in health, and on lifecourse and community determinants in community-based samples of children and adults, men and women, and minorities. The projects represent novel, cost-effective, and interrelated investigations of: (1) the extent to which children's physical, emotional, and cognitive status reflect the influence of parental socioeconomic status, income trajectories economic stress, and community characteristics; (2) the role of glucocorticoid and serotonergic mechanisms in the associations between psychosocial states, SES, and excess risk for CVD; (3) the interrelations between a broad array of psychological attributes, their antecedents and health sequelae, and related biological markers of stress, within a multilevel representative community sample, utilizing state of the art assessment of community factors; (4) contributions of socioeconomic, biological, and psychosocial factors at different stages of the life course to a broad range of indicators of psychosocial well-being, cardiovascular risk factors, subclinical and diagnosed CVD in adulthood, using data reflecting over 50 years of assessments; and, (5) the impact of chronic economic stress, in situ, on health and function in a randomly selected cohort of poor women with young children who, as part of welfare reform, were moved from the AFDC roles in Michigan into a new "workfare" program. The development and utilization of new methodological and biostatistical tools, career development, and dissemination activities coupled with the above research program will help to further establish the MICSIMB as a major international center for the study of mind/body interactions and physical health and mental health, cardiovascular disease, aging, and child development. This will be accomplished by a team of 21 experienced researchers from nine disciplines who will come together in a symbiotic way on five research projects and efforts to expand the methodological and biostatistical tools available for such analyses.

DESCRIPTION (adapted from investigator's abstract): The proposed study brings together an interdisciplinary team of epidemiologists, psychologists, sociologists, economists, and statisticians focused on assessing the extent to which children's physical, emotional, and cognitive status reflect the influence of parental socioeconomic status, income trajectories, economic stress, and community characteristics. Analysis of these issues will be conducted using the Panel Study of Income Dynamics (PSID), which has been the premier U.S. source of data on the economic status of U.S. families since 1968, and has resulted in over 600 journal articles, 250 books and book chapters, and 350 government reports, working papers, and dissertations. In 1997, the PSID fielded a Child Supplement (PSID-CDS) that interviewed all PSID participants who were the parents of children under 13 as well as one to two of their children. The PSID-CDS-collected information on the physical and mental health of the children, child behavior problems, psychosocial states of parent and child (self-efficacy, self-esteem, social support, etc.), cognitive abilities of the child, attitudinal data from parents, and community and school characteristics. It represents a depth and breadth of data collection never before found in a nationally representative sample By linking data collected in the CDS with data collected in the PSID, representing decades of data on the children's families (and grandparents, in some cases), it will be possible to address a series of focused questions regarding the determinants of health and psychosocial states in children. (1) How are parental socioeconomic status (SES), SES trajectories over decades, and parental economic strain associated with children's physical and mental health, psychosocial states, and cognitive development? (2) What is the impact of the community environment on the children's physical and mental health, psychosocial states, and cognitive development? 3) What is the association between race/ethnicity and immigrant status and child physical and mental health, psychosocial states, and cognitive development? Do individual measures of SES and/or measures of the community environment account for or modify race/ethnicity and immigrant status effects on children's physical and mental health, psychosocial states, and cognitive development? (4) Do parenting behavior and attitudes, home environment, and family structure mediate the association between SES and race/ethnicity effects and children's physical and mental health, psychosocial states and cognitive development? (5) What is the association between community characteristics and parenting behavior and attitudes, home environment, and family structure?

The grant provides funding to open a Research Data Center (RDC) within the Survey Research Center of the Institute for Social Research at the University of Michigan. The RDC would provide researchers access to source data collected by the Census Bureau and other agencies. These confidential data are placed within a secure facility at the Survey Research Center. To gain access to these data, researchers with approved projects would obtain special sworn status within the Census Bureau. Researchers can publish results of analysis carried out within the RDC subject to a rigorous protocol for protecting the confidentiality of the underlying data.

The purpose of this access would be to conduct academic research using data on individuals and firms. The ability to analyze the source data has enormous scientific benefits. These include the ability to make full use of the information collected by government agencies; to analyze the behavior of individuals and firms taking into account the heterogeneity of behavior and characteristics; and to combine sources of data at the individual level to study relationships obscured by more aggregate data. This RDC promotes productive interaction between the data collection agencies and the research community. Typically, researchers using government statistics are passive consumers of the data, which is usually collected for a purpose other than academic research. By providing a vehicle for working with the source data in collaboration with the Census Bureau, the RDC allows the research community to participate effectively in improving Census data.

A Research Data Center would build on the University of Michigan's long-standing strength in social science research and in the processing and analysis of large-scale databases. The Institute of Social Research and its Survey Center and Population Studies Center house substantial expertise in the management of such databases and for maintaining the confidentiality of information on individuals. The University, the Institute, and the Centers have an established record in providing wide access to data and in improving quality data.

We propose to continue and expand a successful series of interdisciplinary collaborations currently funded as the P-50 Michigan Interdisciplinary Center on Social Inequalities, Mind, and Body. Consistent with the change from a P50 to an R24 Center, the MICSIMB will emphasize support cores for funded research projects, research enhancements to these projects, and exploratory/pilot studies. The R-24 MICSIMB will support the expansion of an innovative interdisciplinary research program seeking to understand the relationships of psychosocial factors related to health (beliefs, attitudes, affective states, values, stress and social relationships), their broader social, community, and psychological antecedents, and the pathophysiologic pathways through which psychosocial factors and their antecedents contribute to the development of physical and mental disorders. The research will encompass human development over the full life course from infancy and childhood through adulthood and older age, consider a broad range of physical and mental health outcomes, with some emphasis on aging, human development, and cardiovascular disease, and have important foci on health disparities, life course approaches, spatial analysis/neighborhood effects, gene-environment interaction, and methodological innovation. The research enhancements will make use of a large set of ongoing activities and archived data available at the University of Michigan, representing information on diverse, representative study populations of over 200,000 people. The activities cover a range of topics from analysis of the role of neighborhood and community factors and psychosocial factors in health, to interactions between genes and the socioeconomic and psychosocial environment in hypertension and dementia. Such an approach will build on the previous efforts of a large number of studies and represents a very cost-effective approach to addressing critical issues in the expanded program of mind-body research that we have been carrying on so successfully. Participating will be a very accomplished interdisciplinary group of 22 core investigators, spanning 16 units across the University who have published over 1,000 scientific papers that have been cited more than 22,000 times with at least 85% of these papers relevant to the proposed Center expansion.

We propose to continue and expand a successful series of interdisciplinary collaborations currently funded as the P-50 Michigan Interdisciplinary Center on Social Inequalities, Mind, and Body. Consistent with the change from a P50 to an R24 Center, the MICSIMB will emphasize support cores for funded research projects, research enhancements to these projects, and exploratory/pilot studies. The R-24 MICSIMB will support the expansion of an innovative interdisciplinary research program seeking to understand the relationships of psychosocial factors related to health (beliefs, attitudes, affective states, values, stress and social relationships), their broader social, community, and psychological antecedents, and the pathophysiologic pathways through which psychosocial factors and their antecedents contribute to the development of physical and mental disorders. The research will encompass human development over the full life course from infancy and childhood through adulthood and older age, consider a broad range of physical and mental health outcomes, with some emphasis on aging, human development, and cardiovascular disease, and have important foci on health disparities, life course approaches, spatial analysis/neighborhood effects, gene-environment interaction, and methodological innovation. The research enhancements will make use of a large set of ongoing activities and archived data available at the University of Michigan, representing information on diverse, representative study populations of over 200,000 people. The activities cover a range of topics from analysis of the role of neighborhood and community factors and psychosocial factors in health, to interactions between genes and the socioeconomic and psychosocial environment in hypertension and dementia. Such an approach will build on the previous efforts of a large number of studies and represents a very cost-effective approach to addressing critical issues in the expanded program of mind-body research that we have been carrying on so successfully. Participating will be a very accomplished interdisciplinary group of 22 core investigators, spanning 16 units across the University who have published over 1,000 scientific papers that have been cited more than 22,000 times with at least 85% of these papers relevant to the proposed Center expansion.

[unreadable] DESCRIPTION (provided by applicant): Over the last two decades there has been an exponential increase in the number of publications that have examined the association between socioeconomic position (SEP) and a wide variety of health outcomes examined the association between socioeconomic position (SEP) and a wide variety of health outcomes. For example, according to a MEDLINE search, well over 700 articles on the association between income and mortality have appeared since 1990, not including analyses that only included income as an adjustment variable. For most outcomes, a graded inverse association has been found, with higher SEP associated with lower risk of these outcomes. While some recent attention has turned to estimating the contribution of reverse selection (poor health leading to low income) to these observed associations, there are additional critical issues that are necessary to resolve, the answers to which will also have some bearing upon the argument over the causal effect of income on health. We propose to examine whether or not the benefits of increasing income on risk of death are primarily felt at lower incomes, if the protective effects of income decrease with increasing income- whether there are important non-linearities in this "gradient," and calculate the relative concentration of deaths in different parts of the income distribution. In addition we will add to the literature by considering the differential contribution of taxes and transfers to the association between income and mortality and their impact on the concentration of mortality, analyses not previously done. Using three large longitudinal studies, representative of the US population, the proposed study will estimate the shape of the association between income and risk of death from all causes and common causes, where the greatest burden of mortality falls in the income distribution, and analyze the extent to which tax and transfer programs alter the shape of this association. In addition, it will coordinate efforts of an experienced set of researchers conducting identical analyses in Canada, Denmark, Finland, Norway, and Sweden in order to examine in a broader context the nature of the association between income and mortality risk, and to explore the role of tax and transfer policies in the income-mortality association. By bringing together investigators conducting identical analyses in countries that differ with regard to their commitment to social welfare policies we hope to inform the discussion of the health benefits of such policies. PUBLIC HEALTH RELEVANCE: The proposed exploratory study contributes to our understanding of socioeconomic inequalities in mortality by carefully estimating the exact shape of this relationship between income and mortality, where the burden of income-related mortality falls in the population, and whether or not tax and transfer programs have an impact on mortality in the population. In addition, by coordinating a set of identical analyses in five other countries (Canada, Denmark, Finland, Norway, Sweden) we hope to gain some insight into the possible impact of more redistributive tax and transfer policies on the distribution of the mortality burden in the population. [unreadable] [unreadable] [unreadable] [unreadable] [unreadable]