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OBJECTIVES: To determine if illness representations differ as a function of age and how these representations, in conjunction with age, predict postoperative health behaviors. DESIGN: Prospective study of patients undergoing coronary artery bypass graft (CABG) surgery. SETTING: A large metropolitan hospital providing regional cardiac care for patients in a tri-state area, located in Pittsburgh, Pennsylvania. PARTICIPANTS: All consenting patients (N = 309) from a consecutive series of patients scheduled for CABG surgery between January 1992 and January 1994. To be eligible for participation, patients could not be scheduled for any other coincidental surgery (e.g., valve replacement), and could not be in cardiac intensive care or experiencing angina at the time of the referral. Participants were predominantly male (70%) and married (80%), and averaged 62.8 years of age. MEASUREMENTS: Postoperative self-reported health behaviors. RESULTS: Older participants awaiting CABG surgery were significantly more likely to believe old age to be the cause of their coronary heart disease (CHD) and significantly less likely to believe genetics, health-damaging behaviors, health-protective behaviors, and emotions to be the cause of their CHD than were younger participants awaiting surgery. Furthermore, the older participants were significantly more likely to believe they had no control over the disease and that the disease would be gone after surgery, and reported fewer postoperative health behavior changes than did younger participants. CONCLUSION: These findings demonstrate significant differences in illness representations as a function of age. Furthermore, differences in postoperative health behaviors were consistent with differing illness representations. [ABSTRACT FROM AUTHOR]

Chronic exposure to arsenic causes adverse health effects in children. Aberrant epigenetic modifications including altered DNA methylation pattern are one of the major steps towards malignant transformation of cells. Our group has previously identified significant alteration in DNA methylation mark in arsenic exposed adults, affecting major biological pathways. Till date, no information is available exploring the altered DNA methylation mark in telomere regulation and altered mitochondrial functionality in association with DNA damage in arsenic-exposed children. Our study aims in identifying signature epigenetic pattern associated with telomere lengthening, mitochondrial functionality and DNA damage repair in children with special emphasis on DNA methylation. Biological samples (blood and urine) and drinking water were collected from the children aged between 5 and 16 years of arsenic exposed areas (N = 52) of Murshidabad district and unexposed areas (N = 50) of East Midnapur districts, West Bengal, India. Methylation-specific PCR was performed to analyse subtelomeric methylation status and promoter methylation status of target genes. Results revealed altered DNA methylation profile in the exposed children compared to unexposed. Promoter hypermethylation was observed in MLH1 and MSH2 (p < 0.05 and p < 0.001) indicating inefficiency in DNA damage repair. Hypomethylation in mitochondrial D-loop (p < 0.05) and TFAM promoter region (p < 0.05) along with increased mitochondrial DNA copy number among exposed children was also observed. Significant increase in telomere length and region specific subtelomeric hypermethylation (XpYp, p < 0.05) was found. Analysis of S-Adenosyl Methionine (SAM) and 8-oxoDG level revealed significant depletion of SAM (p < 0.001) and elevated oxidative DNA damage (p < 0.001) respectively in arsenic toxicity. Our study identified key methylation patterns in arsenic-exposed children which may act as an early predictive biomarker in the near future. Further in-depth studies involving large sample size and transcriptomic analysis are required for understanding the mechanistic details., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2023. Published by Elsevier B.V.)

Objective: Per- and polyfluoro-alkyl substances (PFAS) and lead (Pb) are ubiquitous environmental toxicants with apparent impact on cardiovascular disease (CVD) risk. As one possible mechanism for this increased risk, we have previously demonstrated an association between Pb exposure and heightened cardiovascular reactivity to acute psychological stress, a CVD risk factor. The present study expands this approach and considers both PFAS and Pb exposures (and the possible interaction)., Methods: We assessed 14 serum PFAS and whole blood Pb concentrations in a sample of 9-11 year-old children (N = 291; 43.2% White, 56.8% Black; 53.5% female). We measured cardiovascular functioning at rest and during psychological stress as well as multiple indicators of subclinical CVD including resting blood pressure (BP), carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (cIMT), and left ventricular mass (LVM). Data analysis included general linear modeling as well as a non-parametric approach to study metal mixtures, specifically Bayesian Kernel Machine Regression (BKMR)., Results: Significant interactions between different PFAS and with Pb suggest the importance of considering toxicant mixtures when assessing potential disruption of the cardiovascular system. The pattern of findings suggests that greater "vascular reactivity" (elevated BP and vascular resistance during acute psychological stress) was associated with higher concentrations of perfluorononanoic acid (PFNA), perfluorohexane sulfonate (PFHxS), and Pb, but only when perfluorooctanoic acid (PFOA) was concurrently elevated. With respect to subclinical outcomes, increasing perfluorodecanoic acid (PFDA) was associated with greater cIMT (β = 0.21, p = 0.010)., Conclusion: To our knowledge this is the first study to consider how PFAS exposures might affect cardiovascular functioning and subclinical disease. Although a complex pattern of associations emerged, it does appear that PFAS and Pb can be classified as "cardiovascular disruptors" in children. Further research is needed to replicate these novel findings and determine whether these disruptions produce future cardiovascular disease., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interestsBrooks B. Gump reports financial support was provided by National Institute of Health. Patrick Parsons, Kannan Karunthachalam reports financial support was provided by National Institute of Health., (Copyright © 2023. Published by Elsevier Inc.)

Background: Non-Hispanic Black Americans have a greater risk for certain subtypes of cardiovascular disease (CVD; e.g., stroke and heart failure) relative to non-Hispanic White Americans. Moreover, Black relative to White adults consistently show elevated cortisol, a CVD risk. The impact of race, environmental stress, and cortisol on subclinical CVD has yet to be fully researched in children., Method: We assessed diurnal salivary cortisol slopes and hair cortisol in a sample of 9- to 11-year-old children ( N = 271; 54% female) with roughly half self-identifying as either Black (57%) or White (43%). Two subclinical CVD indicators were assessed: carotid-femoral pulse wave velocity (cfPWV) and carotid intima-media thickness (cIMT). We assessed numerous environmental stress indicators., Results: After adjusting for covariates, we found that Black children had significantly flatter diurnal cortisol slopes, higher hair cortisol, and thicker IMT than White children. Significant pathways were found: race → salivary cortisol slope → cfPWV (effect = -0.059, 95% CI [-0.116, -0.002]) and race → hair cortisol → cIMT (effect = -0.008, [-0.016, -0.002]). Black children also experienced significantly more environmental stress than White children; however, only income inequality served as a significant indirect pathway from race to salivary cortisol (effect = 0.029, [0.003, 0.060])., Conclusions: Relative to White children, Black children had significantly greater hair cortisol and flatter diurnal slopes which, in turn, were associated with greater subclinical CVD. As suggested by a significant indirect pathway, income inequality might partially explain the race-cortisol association. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Importance: Studies in adults have demonstrated associations between arsenic exposure and clinical and subclinical cardiovascular disease (CVD). No studies to date have considered potential associations in children., Objective: To examine the association between total urinary arsenic levels in children and subclinical indicators of CVD., Design, Setting, and Participants: This cross-sectional study considered 245 children, a subset from the Environmental Exposures and Child Health Outcomes (EECHO) cohort. Children from the Syracuse, New York, metropolitan area were recruited from August 1, 2013, until November 30, 2017, with enrollment throughout the year. Statistical analysis was performed from January 1, 2022, to February 28, 2023., Exposures: Total urinary arsenic was measured using inductively coupled plasma mass spectrometry. Creatinine concentration was used to adjust for urinary dilution. In addition, potential exposure routes (eg, diet) were measured., Main Outcomes and Measures: Three indicators of subclinical CVD were assessed: carotid-femoral pulse wave velocity, carotid intima media thickness, and echocardiographic measures of cardiac remodeling., Results: The study sample included 245 children aged 9 to 11 years (mean [SD] age, 10.52 [0.93] years; 133 [54.3%] female). The geometric mean of the creatinine-adjusted total arsenic level in the population was 7.76 μg/g creatinine. After adjustment for covariates, elevated total arsenic levels were associated with significantly greater carotid intima media thickness (β = 0.21; 95% CI, 0.08-0.33; P = .001). In addition, echocardiography revealed that elevated total arsenic was significantly higher for children with concentric hypertrophy (indicated by greater left ventricular mass and greater relative wall thickness; geometric mean, 16.77 μg/g creatinine; 95% CI, 9.87-28.79 μg/g) relative to the reference group (geometric mean, 7.39 μg/g creatinine; 95% CI, 6.36-8.58 μg/g). With respect to exposure source, significant geographic clustering of total arsenic was found in 1 urban area of Syracuse, New York., Conclusions and Relevance: These findings suggest a significant association between arsenic exposure and subclinical CVD in children. Elevated total arsenic levels were found in an area of Syracuse with known elevations of toxic metals from industrial waste, suggesting historical pollution as a possible source. Given the novelty and potential importance of this association, further research is needed to confirm our findings. Any potential effect of urinary arsenic exposure in childhood on actual clinical CVD outcomes in adulthood remains to be determined.

Background: The use of biomarkers in behavioral HIV research can help to address limitations of self-reported data. The COVID-19 pandemic forced many researchers to transition from standard in-person data collection to remote data collection. We present data on the feasibility of remote self-collection of dried blood spots (DBS), hair, and nails for the objective assessment of alcohol use, antiretroviral therapy adherence, and stress in a sample of people with HIV (PWH) who are hazardous drinkers., Methods: Standardized operating procedures for remote self-collection of DBS, hair, and nails were developed for an ongoing pilot study of a transdiagnostic alcohol intervention for PWH. Prior to each study appointment, participants were mailed a kit containing materials for self-collection, instructions, a video link demonstrating the collection process, and a prepaid envelope for returning samples., Results: A total of 133 remote study visits were completed. For DBS and nail collection at baseline, 87.5% and 83.3% of samples, respectively, were received by the research laboratory, of which 100% of samples were processed. Although hair samples were intended to be analyzed, most of the samples (77.7%) were insufficient or the scalp end of the hair was not marked. We, therefore, decided that hair collection was not feasible in the framework of this study., Conclusion: An increase in remote self-collection of biospecimens may significantly advance the field of HIV-related research, permitting the collection of specimens without resource-intensive laboratory personnel and facilities. Further research is needed on the factors that impeded participants' ability to complete remote biospecimen collection., (© 2023 The Authors. Alcohol: Clinical and Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcohol.)

Air pollution is a serious public health issue with early childhood exposure being of high concern because of the greater risk that children might experience negative health outcomes. Industrial sources in and near communities are one potential path of exposure that children might face with greater levels of air pollution correlating with higher levels of toxicants detected in children. We compare estimated ambient air concentrations of Cadmium (Cd) to a cohort (n = 281) of 9 to 11-year old children during their early childhood years (0-5 years of age) in a mid-size city in Upstate New York. Levels of Cd air pollution are compared to children's urine-Cd levels. Urine has been shown to be a superior biomarker to blood for Cd exposure particularly for longer-term exposures. We find that participants who reside in households that faced greater Cd air pollution during the child's early years have higher urine-Cd levels. This association is stable and stronger than previously presented associations for blood-Cd. Findings support expanded use of air modelling data for risk screening to reduce the potential health burden that industrial pollution can have., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Although hypertension is a risk factor for severe Coronavirus Disease 2019 (COVID-19) illness, little is known about the effects of COVID-19 on blood pressure (BP). Central BP measures taken over a 24-hour period using ambulatory blood pressure monitoring (ABPM) adds prognostic value in assessing cardiovascular disease (CVD) risk compared with brachial BP measures from a single time point. We assessed CVD risk between adults with and without a history of COVID-19 via appraisal of 24-hour brachial and central hemodynamic load from ABPM., Methods: Cross-sectional analysis was performed on 32 adults who tested positive for COVID-19 (29 ± 13 years, 22 females) and 43 controls (28 ± 12 years, 26 females). Measures of 24-hour hemodynamic load included brachial and central systolic and diastolic BP, pulse pressure, augmentation index (AIx), pulse wave velocity (PWV), nocturnal BP dipping, the ambulatory arterial stiffness index (AASI), and the blood pressure variability ratio (BPVR)., Results: Participants who tested positive for COVID-19 experienced 6 ± 4 COVID-19 symptoms, were studied 122 ± 123 days after testing positive, and had mild-to-moderate COVID-19 illness. The results from independent samples t-tests showed no significant differences in 24-hour, daytime, or nighttime measures of central or peripheral hemodynamic load across those with and without a history of COVID-19 (P > 0.05 for all)., Conclusions: No differences in 24-hour brachial or central ABPM measures were detected between adults recovering from mild-to-moderate COVID-19 and controls without a history of COVID-19. Adults recovering from mild-to-moderate COVID-19 do not have increased 24-hour central hemodynamic load., (© The Author(s) 2022. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The cardiovascular disease (CVD) process may begin early in life when accompanied by atherosclerotic risk factors. CVD risk factors in children are associated with stiffening of the large elastic arteries, a reflection of subclinical atherosclerosis. Physical activity is a preventative lifestyle strategy that may benefit arterial stiffness by attenuating the hemodynamic stress on the artery wall. This study examined the relations between physical activity, carotid pulsatile stress, and carotid stiffness in children. One hundred and forty children (9-11 yrs; 50.0% male, 57.9% African-American, 42.10% Caucasian, body mass index (BMI) 20.1 ± 4.7 kg/m 2 ) participated in this study. Physical activity counts were measured using a wrist-worn accelerometer and averaged over 7 days. Carotid artery β-stiffness and pulse pressure (calibrated to brachial mean and diastolic pressure) were assessed as via ultrasound and tonometry, respectively. Pulsatile stress was calculated as the product of carotid pulse pressure and heart rate. Physical activity counts were correlated with pulsatile stress (r = -0.27), and BMI (r = -0.23), but were unrelated to carotid stiffness. In multivariate models, associations between physical activity counts and pulsatile stress remained (B = -1.3 [95%CI, -2.4, -0.2], β = -0.20, p < 0.05) after covariate adjustment for age, race, sex, pubertal stage, and BMI. Carotid pulsatile stress was related to regional carotid stiffness (r = 0.45, p < 0.05). These data suggest that higher levels of physical activity at young age are associated with lower hemodynamic stress in the carotid artery. Findings are discussed in the context of an inverse relationship between hemodynamic pulsatile stress and carotid stiffness in children., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited part of Springer Nature.)

Aedes aegypti, the mosquito that transmits arboviral diseases such as dengue (DENV), chikungunya (CHIKV), and Zika viruses (ZIKV), is present in tropical and subtropical regions of the world. Individuals at risk of mosquito-borne disease (MBD) in the urban tropics face daily challenges linked to their socio-environment conditions, such as poor infrastructure, poverty, crowding, and limited access to adequate healthcare. These daily demands induce chronic stress events and dysregulated immune responses. We sought to investigate the role of socio-ecologic risk factors in distress symptoms and their impact on biological responses to MBD in Machala, Ecuador. Between 2017 and 2019, individuals (≥ 18 years) with suspected arbovirus illness (DENV, ZIKV, and CHIKV) from sentinel clinics were enrolled (index cases, N = 28). Cluster investigations of the index case households and people from four houses within a 200-m radius of index home (associate cases, N = 144) were conducted (total N = 172). Hair samples were collected to measure hair cortisol concentration (HCC) as a stress biomarker. Blood samples were collected to measure serum cytokines concentrations of IL-10, IL-8, TNF-α, and TGF-β. Univariate analyses were used to determine the association of socio-health metrics related to perceived stress scores (PSS), HCC, and immune responses. We found that housing conditions influence PSS and HCC levels in individuals at risk of MBD. Inflammatory cytokine distribution was associated with the restorative phase of immune responses in individuals with low-moderate HCC. These data suggest that cortisol may dampen pro-inflammatory responses and influence activation of the restorative phase of immune responses to arboviral infections.

Background: Vacationing provides potential recovery from work stress and is associated with cardiovascular disease morbidity and mortality. This study considered psychological variables that might change as a vacation is approaching (fade-in) or after a vacation ends (fade-out) and how these associations might vary as a function of ongoing work stress. Methods: Sixty workers eligible for paid time off were recruited from the community. Multiple assessments occurred during an 8- to 10-week period spanning the period before and after a vacation. A piecewise random coefficient model compared changes over time (slopes) for pre- and post-vacation periods. Outcomes included affect, aggression, social support, and work stress. Results: Hostile affect, negative affect, stress, and physical aggression all declined significantly during the post-vacation period (relative to no change during the pre-vacation period). In addition, these changes in pre- versus post-vacation periods differed as a function of work stress, with some vacation benefits observed specifically among workers with low work stress. Conclusions: Findings indicate that vacations produced psychological benefits that persist beyond the vacation period. Vacation-associated benefits may serve as mechanisms underlying associations between vacations and slow developing disease. However, work stress appears to spillover and can thereby undermine a vacation's fade-in and fade-out benefits.

Objective: Research has consistently found associations between sleep characteristics and cardiovascular disease risk in children, adolescents, and adults. Although primarily investigated in clinical samples (e.g., in those with sleep disorders), greater left ventricular mass is associated with poor sleep quality in nonclinical adult populations as well; however, this has not been evaluated in children or adolescents. Our study aim was to consider the relationship between objectively measured sleep characteristics and left ventricular mass in children., Methods: We assessed sleep and cardiac structure in a biracial sample of 9- to 11-year-old children (n = 176; 41% White, 59% Black; 50% female). Sleep was assessed with actigraphy for five nights. Cardiac dimensions were assessed using echocardiography., Results: After adjusting for covariates, we found that poor sleep quality was associated with significantly greater left ventricular mass (β = 0.13, t(167) = 2.14, p = .034, Cohen d = 0.16, for activity during sleep; β = 0.15, t(167) = 2.43, p = .016, Cohen d = 0.18, for sleep fragmentation). Other cardiac dimensions (namely, relative wall thickness and right ventricular dimension) were also significantly associated with sleep characteristics. Notably, associations did not differ as a function of sex or race., Conclusions: The present findings are novel and unique because no prior reports have systematically documented the association between poor sleep quality with potentially detrimental cardiac remodeling in a nonclinical sample of children. However, the novelty and importance of these findings require additional research for confirmation., (Copyright © 2021 by the American Psychosomatic Society.)

Background: Exposure to air pollution has been linked to individual health effects in occupational environments and communities proximate to air pollution sources. Use of estimated chemical concentrations from the Risk Screening Environmental Indicators (RSEI) model, derived from the Toxics Release Inventory, can help approximate some contributions to individual lifetime exposure to risk from air pollution and holds potential for linkages with specific health outcome data., Objectives: Our objectives were: (1) use regression modeling to test for associations between observed blood metal concentrations in children and RSEI total air concentrations of the same metals released from proximate manufacturing facilities; (2) determine the relative contribution of RSEI air pollution to blood metal concentrations; and (3) examine associations between chronic metal exposure and cardiovascular functioning and structure in study participants., Methods: Using data synthesis methods and regression modeling we linked individual blood-based levels of lead, mercury, and cadmium(Pb, Hg, Cd) and cardiovascular functioning and structure to proximate industrial releases of the same metals captured by the Environmental Protection Agency's (EPA) RSEI geographic microdata., Results: We found that RSEI-derived ground-level ambient air concentrations of Hg and Cd were a significant predictor of blood metal levels, when controlling for covariates and other exposure variables. In addition to associations with blood metal findings, RSEI concentrations also predicted cardiovascular dysfunction and risk including changes in left-ventricular mass, blood pressure, and heart rate., Discussion: Right-to-know data, such as EPA's RSEI, can be linked to objective health outcomes, rather than simply serving as a non-specific risk estimate. These data can serve as a proxy for hazard exposure and should be used more widely to understand the dynamics of environmental exposure. Furthermore, since these data are both a product of and contribute to regulatory decision making, they could serve as an important link between disease risk and translation-orientated national environmental health policy., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Hepatitis E virus (HEV) is a major cause of viral hepatitis around the world, especially in developing countries. Recently, HEV has also been recognized as important cause of hepatitis in Europe and Japan, however, there is a paucity of clinical data from the United States. The overall seroprevalence of HEV antibodies is around 10% in the United States, but considerable variation is seen based on geographic location, year, and assay used. In this study, 63 adults and 417 children from New York State were tested for anti-HEV IgG antibodies using the commercially available Wantai IgG assay. The overall seroprevalence of HEV antibodies among adult participants was 9.52% (95% CI: 3.58-19.59%). Positive adults tended to be older than HEV negative adults, all positive adults were female. Only 3 (0.7%, 95% CI:: 0.15-2.09%) of the children were positive, all positive children were male. These results are consistent with global and United States trends in HEV seroprevalence., Competing Interests: The authors have declared that no competing interests exist.

Purpose: Research shows that subjective social status (SSS) is a salient determinant of health. However, there is little research on SSS-related group differences on psychosocial outcomes among children. The purpose of the current study was to determine if associations between psychosocial functioning and SSS in children varied as a function of racial groups., Methods: We used a series of regression models to examine associations between SSS and measures of hostility and depressive symptom severity in groups of Black and White children. All analyses controlled for objective markers of family- and neighborhood-level socioeconomic status. Participants included 291 school-age children in Syracuse, NY., Results: Among Black children, SSS was negatively associated with hostility scores, R 2  = 0.10, F(6, 160) = 3.34, p = 0.006, but not depressive symptom severity. Conversely, among White children, SSS was negatively associated with depressive symptom severity, R 2  = 0.18, F(6, 117) = 4.37, p = 0.001, but not hostility., Conclusion: These racial differences in SSS-associated psychosocial functioning could be explained by race-based differences in attributions of social mobility and socioeconomic inequalities. Findings provide support for investigating possible tailoring of behavioral interventions to assist children in developing high SSS or coping with low SSS.

Objective: To examine how the association between psychological stress and ambulatory heart rate varies in the weeks before and after a planned vacation. We hypothesized that the impact of stress on heart rate would weaken in the weeks leading up to the vacation and return to normal levels in the weeks following the vacation. Method: Fifty-four workers eligible for paid vacation time were recruited; stress ratings obtained via weekly surveys and ambulatory heart rate readings obtained via a wrist-worn consumer device were collected before and after the vacation. Results: A statistically significant interaction was observed between weekly stress and the time period leading up to the vacation on ambulatory heart rate ( b = -0.51, SE  = 0.21, 95% CI = -0.91, -0.10, p  = 0.01). A plot of predicted values demonstrated that the relationship between weekly stress and heart rate was stronger when the vacation was further away in the future and imparted less of an effect as the vacation approached. Conclusions: Vacations may have physical health benefits that extend beyond the vacation experience by reducing the association between stress and ambulatory heart rate in the weeks leading up to a planned vacation.

Background: A variety of wearable monitors are available for objectively assessing physical activity but there is a lack of established values for the activity intensity of MotionWatch8 (MW8) and a similar lack of studies on comparability across devices. Our study aimed to establish activity intensity cutpoints for the MW8 accelerometer in children, which are necessary to determine whether they are meeting physical activity guidelines., Methods: Children (n = 39, ages 9-13 years) were asked to wear two different accelerometers (MW8 and ActiGraph) simultaneously on the same dominant wrist as they performed different activities designed to mimic activities of variable intensity that a child might perform in a free-living environment. Linear regression and receiver operating characteristic (ROC) curves were performed to assess sensitivity and specificity of the identified MW8 intensity cutpoints compared to established ActiGraph cutpoints., Results: Mean values for each activity were positively correlated using the MW8 and ActiGraph monitors (r = 0.85, p<0.001). The optimal cutpoints for differentiating sedentary from light physical activity, light from moderate, and moderate from vigorous activity were ≤32 counts, ≥ 371.5 counts, and ≥ 859.5 counts per 30 seconds, respectively., Conclusions: Our study demonstrated the ability of MW8 to discriminate different intensity activities and provided the first cutoff values for researchers using the MW8 to measure physical activity patterns among children., Competing Interests: The authors have declared that no competing interests exist.

Background: Initial interest in the adverse consequences of exposure to lead (Pb), mercury (Hg), and cadmium (Cd) focused on relatively high exposures through environmental or occupational sources; however, recent evidence suggests even low-level background exposure to non-essential metals might be detrimental, particularly for children's health and development. One potentially important source of increased background levels of non-essential toxic metals is diet., Objectives: We considered whether differences in diet are associated with levels of non-essential metals in blood and whether racial differences in metals are mediated by dietary differences., Methods: We assessed blood levels of Pb, Hg, and Cd in a sample of 9-11 year-old children (N = 295) comprised of 42% European Americans (EAs), 58% African American (AAs), and 47% female. Diet was assessed using 24-h dietary recalls during phone interviews administered to parents on two consecutive days (Friday and Saturday). The Healthy Eating Index-2105 (HEI-2015) was calculated to assess diet quality., Results: The current study identified significant dietary sources of non-essential metal exposure - namely total fruit for Pb, total protein for Hg, and greens and beans for Cd. Moreover, AAs were found to have significantly higher blood levels of Pb and Hg than EAs and these racial differences were significantly mediated by these dietary differences., Discussion: This study is one of very few to consider total diet in children and exposure to the non-essential metals Pb, Hg, and Cd, and the first to demonstrate that racial differences in increased background blood levels of non-essential toxic metals can be accounted for by racial differences in diet. Given regional differences in food consumption patterns and specific farm and store sources for the foods, the generalizability of the current findings has yet to be determined; however, commonly consumed foods appear to be a significant source of low-level non-essential metals., Competing Interests: Declaration of competing interest The other authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The burden of heart failure is disproportionately higher in African Americans, with a higher prevalence seen at an early age. Examination of racial differences in left ventricular mass (LVM) in childhood may offer insight into risk for cardiac target organ damage (cTOD) in adulthood. Central hemodynamic load, a harbinger of cTOD in adults, is higher in African Americans. The purpose of this study was to examine racial differences in central hemodynamic load and LVM in African American and non-Hispanic white (NHW) children. Two hundred sixty-nine children participated in this study (age, 10 ± 1 years; n = 149 female, n = 154 African American). Carotid pulse wave velocity (PWV), forward wave intensity (W1) and reflected wave intensity (negative area, NA) was assessed from simultaneously acquired distension and flow velocity waveforms using wave intensity analysis (WIA). Wave reflection magnitude was calculated as NA/W1. LVM was assessed using standard 2D echocardiography and indexed to height as LVM/[height (2.16) + 0.09]. A cutoff of 45 g/m (2.16) was used to define left ventricular hypertrophy (LVH). LVM was higher in African American vs. NHW children (39.2 ± 8.0 vs. 37.2 ± 6.7 g/m (2.16), adjusted for age, sex, carotid systolic pressure and socioeconomic status; p < 0.05). The proportion of LVH was higher in African American vs. NHW children (25 vs. 12 %, p < 0.05). African American and NHW children did not differ in carotid PWV (3.5 ± 4.9 vs. 3.3 ± 1.3 m/s; p > 0.05). NA/W1 was higher in African American vs. NHW children (8.5 ± 5.3 vs. 6.7 ± 2.9; p < 0.05). Adjusting for NA/W1 attenuated racial differences in LVM (38.8 ± 8.0 vs. 37.6 ± 7.0 g/m (2.16); p = 0.19). In conclusion, racial differences in central hemodynamic load and cTOD are present in childhood. African American children have greater wave intensity from reflected waves and higher LVMI compared to NHW children. WIA offers novel insight into early life origins of racial differences in central hemodynamic load and cTOD., (Copyright © 2020 Heffernan, Lefferts, Atallah-Yunes, Glasgow and Gump.)

Objective: To examine the extent to which vacationing behavior is associated with metabolic outcomes. Specifically, we consider how total vacation episodes and total vacation days from the past 12 months relate to metabolic syndrome and metabolic symptoms. Design: Sixty-three workers eligible for paid vacation attended a lab visit during which their blood was drawn and they completed an interview assessing vacationing behavior in the past 12 months. Main outcome measures: Metabolic syndrome and metabolic symptoms are the main outcome measures. Results: Over the past 12 months, participants took approximately five vacations ( M =  5.44, SD  = 3.16) and used about 2 weeks of their paid vacation days ( M  = 13.80, SD  = 7.25). Participants rated vacations positively, expressing low levels of travel-, childcare- and financial burden-related stress. As vacation episodes increased, metabolic syndrome incidence ( OR  = 0.76, p  = 0.051) and number of metabolic symptoms met (IRR = 0.92, p  = 0.035) decreased. Notably, risk for metabolic syndrome decreased by nearly a quarter with each additional vacation taken by participants. Conclusions: Overall, vacations are experienced as positive events. This positive subjective experience may translate into physical health benefits given that vacation frequency may protect against metabolic syndrome and symptoms.

Background: Heightened blood lead levels (BLL) are associated with cognitive deficiencies and adverse behavioral outcomes. Lead-contaminated house dust is the primary source of exposure in U.S. children, and evidence suggests that even background (low-level) exposure has negative consequences. Identifying sources of background exposure is of great public health significance because of the larger number of children that can be affected., Methods: Blood lead was assessed in a bi-racial sample of children from Syracuse, NY, aged 9-11, using established biomonitoring methods. The spatial density of vacant properties was modelled from publicly available georeferenced datasets. Further, regression models were used to measure the impact of this spatial density variable on children's BLL., Results: In a sample of 221 children, with a mean BLL of 1.06 µg/dL (SD = 0.68), results showed increases in spatial density of vacant properties predict increases in median blood-PB levels, b = 0.14 (0.06-0.21), p < .001. This association held true even after accounting for demographic covariates, and age of individual housing. Further analysis showed spatial autocorrelation of the residuals changed from a clustered pattern to a random pattern once the spatial density variable was introduced to the model., Discussion: This study is the first to identify a background-lead exposure source using spatial density modelling. As vacant properties deteriorate, lead-contaminated dust likely disperses into the surrounding environment. High-density areas have an accumulation of lead hazards in environmental media, namely soil and dust, putting more children at risk of exposure., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Perceived discrimination can affect psychological and physical health, starting in childhood. Yet, the measures that exist for measuring perceived discrimination among children have methodological limitations and structural/theoretical inconsistencies. The Child Perceived Discrimination Questionnaire (CPDQ) fills the gaps of the current measures by assessing two dimensions of everyday discrimination from both child and adult sources. To assess the reliability and validity of the CPDQ, we examined data from 163 participants, aged 9-11, 52.15% female, 57.67% Black. Results indicated that the CPDQ has good to excellent internal consistency and provided preliminary support for an a priori hypothesized factor structure. The CPDQ also discriminated between different race groups and demonstrated construct validity. Future research should seek additional evidence of reliability and validity for the CPDQ, though this preliminary evidence suggests that the CPDQ is appropriate for assessing perceived discrimination in children.

This study examined central artery stiffness and hemodynamic pulsatility during cognitive engagement in younger and older adults., Methods: Vascular-hemodynamic measures were completed in 19 younger (age 35±1yrs) and 20 older (age 69±2yrs) adults at rest and during a Stroop task. Aortic stiffness (carotid-femoral pulse wave velocity, PWV) and carotid pulse pressure (PP) were assessed using applanation tonometry. Carotid stiffness was assessed as a single-point PWV using Doppler Ultrasound. Middle cerebral artery (MCA) mean flow and flow pulsatility index (PI) were assessed using transcranial Doppler. Cognitive function was assessed as accuracy and reaction time from the Stroop task., Results: Older adults had lower accuracy scores and longer reaction times on the Stroop task compared to younger adults (p<0.05). Both age groups had similar increases in MCA mean flow during Stroop (p<0.05). There were significant increases in aortic PWV, carotid PWV, carotid PP and MCA PI during Stroop in older but not younger adults (p<0.05). Carotid PP and MCA PI assessed during Stroop were statistical mediators of the association between age group and Stroop performance metrics (accuracy and reaction time, p<0.05), while aortic and carotid PWV were indirect statistical mediators of MCA PI through carotid PP (p<0.05)., Conclusions: Older adults experience increases in large artery stiffness during cognitive engagement possibly preventing effective buffering of pulsatile hemodynamic energy entry into the cerebrovasculature. This is important as pulsatile flow during cognitive engagement, and not mean flow per se, was related to overall cognitive performance., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: The potential harm from exposure to nonessential metals, particularly mercury (Hg) and lead (Pb), has been the focus of research for years. Initial interest focused on relatively high exposures; however, recent evidence suggests that even background exposures might have adverse consequences for child development. Identifying the extent of these consequences is now a priority., Methods: We assessed blood Pb and Hg levels in a biracial sample of 9-11 year-old children (N = 203). Neurodevelopment and psychological functioning assessments included hostility, disruptive behaviors, emotion regulation, and autism spectrum disorder behaviors. Parasympathetic (vagal) responses to acute stress were indexed by heart rate variability (HRV) at rest and during stress., Results: With increasing Pb levels, children exhibit higher levels of hostile distrust and oppositional defiant behaviors, were more dissatisfied and uncertain about their emotions, and had difficulties with communication. These significant associations were found within a range of blood Pb levels from 0.19 to 3.25μg/dL, well below the "reference value" for children of >5μg/dL. Vagal reactivity interacted with Hg such that increasing Hg was associated with increasing autism spectrum behaviors for those children with sustained vagal tone during acute stress., Conclusions: This study is the first to demonstrate an association between very low-level Pb exposure and fundamental psychological mechanisms that might explain prior associations with more complex outcomes such as delinquency. Analyses of vagal reactivity yielded entirely novel associations suggesting that Hg may increase autism spectrum behaviors in children with sustained vagal tone during acute stress. The novelty of these later findings requires additional research for confirmation and the cross-sectional nature of the data caution against assumptions of causality without further research., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To investigate racial differences in central blood pressure and vascular structure/function as subclinical markers of atherosclerotic cardiovascular disease in children., Study Design: This cross-sectional study recruited 54 African American children (18 female, 36 male; age 10.5 ± 0.9 years) and 54 white children (27 female, 26 male; age 10.8 ± 0.9 years) from the Syracuse City community as part of the Environmental Exposures and Child Health Outcomes study. Participants underwent blood lipid and vascular testing on 2 separate days. Carotid artery intima-media thickness and aortic stiffness were measured by ultrasonography and carotid-femoral pulse wave velocity, respectively. Blood pressure was assessed at the brachial artery and estimated in the carotid artery using applanation tonometry., Results: African American children had significantly higher pulse wave velocity (4.8 ± 0.8 m/s) compared with white children (4.2 ± 0.7 m/s; P < .05), which remained significant after adjustment for confounding variables including socioeconomic status. African American children had significantly higher intima-media thickness (African American 0.41 ± 0.06, white 0.39 ± 0.05 mm), and carotid systolic blood pressure (African American 106 ± 11, white 102 ± 8 mm Hg; P < .05) compared with white children, although these racial differences were no longer present after covariate adjustments for height., Conclusions: Racial differences in aortic stiffness are present in childhood. Our findings suggest that racial differences in subclinical cardiovascular disease occur earlier than previously recognized., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objectives: Cardiovascular reactivity has been associated with future hypertension and cardiovascular mortality. Higher physical activity (PA) has been associated with lower cardiovascular reactivity in adults, but little data is available in children. The purpose of this study was to examine the relationship between PA and cardiovascular reactivity to mental stress in children., Design: Cross-sectional study., Methods: This study sample included children from the Oswego Lead Study (n=79, 46% female, 9-11 years old). Impedance cardiography was performed while children participated in a stress response protocol. Children were also asked to wear Actigraph accelerometers on their wrists for 3 days to measure intensity and duration of PA and sedentary time., Results: In multivariable models, moderate to vigorous (MV) PA was associated with lower body mass index (BMI) percentile and lower total peripheral resistance (TPR) response to stress (beta=-0.025, p=0.02; beta=-0.009, p=0.05). After additional adjustment for BMI, MVPA was also associated with lower diastolic blood pressure response to stress (beta=-0.01, p=0.03). Total PA and sedentary time were not associated with BMI or cardiovascular responses to stress., Conclusions: A modest, inverse relation of PA to vascular reactivity to mental stress was observed in children. These data provide confirmatory evidence that the promotion of PA recommendations for children are important for cardiovascular health., (Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Background: The matching of vascular supply to neuronal metabolic demand during cognitive engagement is known as neurovascular coupling (NVC). Arterial stiffness is a prominent determinant of pulsatility in the systemic circulation and may thus indirectly impact NVC. In this pilot investigation, we explored changes in carotid artery stiffness and cerebrovascular hemodynamic pulsatiltiy during cognitive engagement in healthy adults., Methods: Twenty-seven adults (age 39 ± 3 years, BMI 24 ± 1 kg/m(2)) underwent Doppler ultrasonography of the common carotid artery (CCA) combined with applanation tonometry to derive (i) CCA elastic modulus (Ep) and β-stiffness index; (ii) CCA flow pulsatility index (PI); (iii) CCA pulse pressure, (iv) CCA augmentation index (AIx). Cerebral PI was assessed using transcranial Doppler at the middle cerebral artery (MCA). All measures were made at rest and during an incongruent Stroop task., Results: CCA PI was reduced (1.75 ± 0.06 to 1.57 ± 0.06, P < 0.05) while MCA PI was unchanged (0.75 ± 0.02 to 0.75 ± 0.02, P > 0.05) during Stroop. Brachial pulse pressure increased during Stroop (43 ± 1 to 46 ± 1 mm Hg, P < 0.05) while CCA pulse pressure was unchanged (36 ± 1 to 35 ± 1 mm Hg, P > 0.05). Similarly, CCA Ep (54.5 ± 5.5 to 53.8 ± 4.9 kPa, P > 0.05) and β-stiffness index (4.4 ± 0.4 to 4.2 ± 0.3 aU, P > 0.05) were unchanged. CCA AIx increased (1 ± 4 to 13 ± 4%, P < 0.05)., Conclusion: Carotid pressure pulsatility is unaltered while carotid flow pulsatility is reduced during cognitive engagement. Carotid artery stiffness does not change suggesting that factors other than the dynamic elastic properties of the CCA buffer cerebrovascular hemodynamic pulsatility during cognitive engagement., (© American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Background: Brachial blood pressure (BP) reactivity to stress predicts large artery damage and future cardiovascular (CV) events. Central BP is an emerging risk factor associated with target organ damage (TOD). Currently, little is known about the central BP response to mental stress and its association to TOD., Methods and Results: Twenty-five healthy, non-obese adults completed a computerized mental stress test. Brachial and carotid systolic (S)BP reactivity to stress were calculated as SBP during stress minus resting SBP. Resting carotid intima-media thickness (IMT) was also measured. Carotid SBP reactivity to stress was significantly associated with carotid IMT, independent of age, sex, body mass index, non-high density lipoprotein cholesterol and brachial SBP reactivity to stress (r = 0.386, p < 0.05)., Conclusion: The relationship between carotid SBP reactivity and carotid IMT suggests that the central BP response to stress may prove to be an early risk marker for potential subclinical TOD., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

There is a sizeable literature suggesting that mercury (Hg) exposure affects cytokine levels in humans. In addition to their signaling role in the immune system, some cytokines are also integrally associated with sleep behavior. In this cross-sectional study of 9-11 year old children (N=100), we measured total blood Hg in whole blood, serum levels of tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6), and objectively measured sleep and activity using actigraphy. Increasing blood Hg was associated with significantly shorter sleep duration and lower levels of TNF-α. IL-6 was not associated with sleep or blood Hg. This study is the first to document an association between total blood Hg and sleep (albeit a small effect), and the first to consider the associations of total blood Hg with cytokines TNF-α and IL-6 in a pediatric sample. Further research using alternative designs (e.g., time-series) is necessary to determine if there is a causal pathway linking low-level Hg exposure to sleep restriction and reduced cytokines., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Polybrominated diphenyl ethers (PBDE) have been used widely in consumer products and are currently found at detectable levels in the blood of humans and animals across the globe. In stark contrast to this widespread exposure to PBDEs, there is relatively little research on potential adverse health effects of exposure of children to these chemicals., Objectives: We performed this cross-sectional study to determine if blood PBDE levels (for 4 congeners) are associated with cardiovascular stress responses and psychological states in children., Methods: Levels of 4 PBDE congeners (BDE-28, -47, -99, and -100) in whole blood were measured in children (N=43). These levels were analyzed in relation to cardiovascular disease risk factors, including cardiovascular responses to acute stress and relevant psychological variables, namely, hostility and depression., Results: Higher levels of blood PBDEs were associated with significantly greater sympathetic activation during acute psychological stress and greater anger, as evidenced by significant associations with 3 different measures of this psychological variable., Conclusions: This study suggests an association between PBDE exposure and children's cardiovascular responses to stress as well as parental and self-reported anger in the child. These variables are particularly important as they may be of potential relevance to the future development of cardiovascular disease (CVD). Although intriguing, there is a need for further investigation and replication with a larger sample of children., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Metal-binding proteins have a pivotal role in normal and diseased states. We used metal affinity chromatography to enrich a fraction of human serum proteins on immobilized columns loaded with cadmium, nickel, zinc, copper, or lead in bis-Tris saline and these proteins were identified using LC-MS/MS. Tens of enriched proteins were identified and we here present the 20 most abundant for binding each metal. The binding of various proteins (complement C3, alpha-2-macroglobulin, serum albumin, apolipoprotein B-100, complement component 4B preproprotein, apolipoprotein A-I, serotransferrin, alpha-1-antitrypsin, ceruloplasmin, 47kDa protein, uncharacterized protein DKFZp686P15220, transthyretin, hemopexin, inter-alpha-trypsin inhibitor heavy chain H2, and histidine-rich glycoprotein) to different metals using immobilized metal affinity chromatography was compared to the literature. Although many metal-binding properties of these proteins have been confirmed, new metal-binding proteins have also been identified. The metal array use in the proteomic biomarker search technologies gives this data particular importance., (Copyright © 2013 Elsevier B.V. All rights reserved.)

There is considerable evidence that consuming fish has numerous health benefits, including a reduced risk of cardiovascular disease. However, fish is also the primary source of human exposure to mercury (Hg). In a cross-sectional study of 9-11 year old children (N=100), we measured fish consumption, blood lipids, total blood Hg, diurnal salivary cortisol (4 samples collected throughout the day), and performed a proteomic analysis of serum proteins using spectral count shotgun proteomics. Children who consumed fish had a significantly more atheroprotective lipid profile but higher levels of blood Hg relative to children that did not consume fish. Although the levels of blood Hg were very low in these children (M=0.77 μg/L; all but 1 participant had levels below 3.27 μg/L), increasing blood Hg was significantly associated with blunted diurnal cortisol levels. Blood Hg was also significantly associated with acute-phase proteins suggesting systemic inflammation, and several of these proteins were found to significantly reduce the association between Hg and diminished cortisol when included in the model. This study of a pediatric population is the first to document an association between blood Hg, systemic inflammation, and endocrine disruption in humans. Without a better understanding of the long-term consequences of an atheroprotective lipid profile relative to blunted diurnal cortisol and systemic inflammation, a determination of the risk-benefit ratio for fish consumption by children is not possible., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Perfluorinated chemicals (PFCs) have been used widely in consumer products since the 1950s and are currently found at detectable levels in the blood of humans and animals across the globe. In stark contrast to this widespread exposure to PFCs, there is relatively little research on potential adverse health effects of exposure to these chemicals., Objectives: We performed this cross-sectional study to determine if specific blood PFC levels are associated with impaired response inhibition in children., Methods: Blood levels of 11 PFCs were measured in children (N = 83) and 6 PFCs: perfluorooctane sulfonate (PFOS), perfluorohexane sulfate (PFHxS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorooctanesulfonamide (PFOSA), and perfluorodecanoic acid (PFDA) - were found at detectable levels in most children (87.5% or greater had detectable levels). These levels were analyzed in relation to the differential reinforcement of low rates of responding (DRL) task. This task rewards delays between responses (i.e., longer inter-response times; IRTs) and therefore constitutes a measure of response inhibition., Results: Higher levels of blood PFOS, PFNA, PFDA, PFHxS, and PFOSA were associated with significantly shorter IRTs during the DRL task. The magnitude of these associations was such that IRTs during the task decreased by 29-34% for every 1 SD increase in the corresponding blood PFC., Conclusions: This study suggests an association between PFC exposure and children's impulsivity. Although intriguing, there is a need for further investigation and replication with a larger sample of children.

Objective: A number of studies suggest that Pb exposure increases cardiovascular disease risk in humans. As a potential mechanism for this effect, we recently reported a significant association between early childhood Pb levels and cardiovascular response to acute stress. The current study considers the association between current Pb levels and the autonomic nervous system activation pattern underlying the cardiovascular response to stress in a new cohort of children., Methods: We assessed blood Pb levels as well as cardiovascular responses to acute stress in 9-11 year old children (N=140). Sympathetic activation (measured with pre-ejection period) and parasympathetic activation (measured with high frequency heart rate variability) were also assessed., Results: In a sample with very low levels of blood Pb (M=1.0 μg/dL), we found that increasing blood Pb was associated with coinhibition of sympathetic and parasympathetic activation in response to acute stress. In addition, increasing Pb levels were associated with the hemodynamic stress response pattern typical of coinhibition--significantly greater vascular resistance and reduced stroke volume and cardiac output., Conclusions: Blood Pb levels were associated with significant autonomic and cardiovascular dysregulation in response to acute psychological stress in children. Moreover, these effects were significant at Pb levels considered to be very low and notably well below the 10 μg/dL, the Centers for Disease Control and Prevention definition of an elevated blood Pb level. The potential for autonomic dysregulation at levels of Pb typical for many US children would suggest potentially broad public health ramifications., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Heavy metal exposure in children has been associated with a variety of physiological and neurological problems. The goal of this study was to utilize proteomics to enhance the understanding of biochemical interactions responsible for the health problems related to lead and mercury exposure at concentrations well below CDC guidelines. Blood plasma and serum samples from 34 children were depleted of their most abundant proteins using antibody-based affinity columns and analyzed using two different methods, LC-MS/MS and 2-D electrophoresis coupled with MALDI-TOF/MS and tandem mass spectrometry. Apolipoprotein E demonstrated an inverse significant association with lead concentrations (average being one microgram/deciliter) as deduced from LC-MS/MS and 2-D electrophoresis and confirmed by Western blot analysis. This coincides with prior findings that Apolipoprotein E genotype moderates neurobehavioral effects in individuals exposed to lead. Fifteen other proteins were identified by LC-MS/MS as proteins of interest exhibiting expressional differences in the presence of environmental lead and mercury.

Plasma prekallikrein (PK) has been shown to be associated with cardiovascular disease (CVD) and its risk factors, but these associations have not been investigated in children. The present study examined PK activity in relation to well-established cardiovascular risk factors in a cohort of children aged 9-11 years (N=97). We found a significant and positive association between PK and fasting levels of total cholesterol (p<0.01), non-high-density lipoprotein cholesterol (p<0.01), and triglycerides (p<0.001). In addition, there was a significant association between PK activity and the metabolic syndrome, a clustering of risk factors considered to have an impact on atherosclerosis and CVD mortality. Finally, we found that children with a family history of CVD had significantly elevated PK activity. These novel findings warrant further investigations into the relationship between circulating PK levels and CVD risk factors because PK may be involved in the progression of the disease state.

Maternal depression has a number of adverse effects on children. In the present study, maternal depressive symptoms were assessed (using the Center for Epidemiological Studies Depression Scale) when their child was 3 months, 6 months, 1 year, 2 years, 4.25 years, 6 years, 7 years, 8 years, and 10 years of age. At 9.5 years of age, children's (94 females, 82 males) depressive symptoms as well as cardiovascular and cortisol levels during baseline and two psychologically stressful tasks were measured. Using multilevel modeling, maternal depressive symptom trajectories were considered in relation to their child's adrenocortical and cardiovascular responses to acute stress. Our goal was to determine maternal depressive symptom trajectories for children with elevated cardiovascular and cortisol reactivity to acute stress and elevated depressive symptoms. In general, those mothers with chronically elevated depressive symptoms over their child's life span had children with lower initial cortisol, higher cardiac output and stroke volume in response to acute stress, lower vascular resistance during acute stress tasks, and significantly more depressive symptoms at 9.5 years of age. These results are discussed in the context of established associations among hypothalamic-pituitary-adrenal axis dysregulation, depression, and cardiovascular disease.

Objective: The authors recently reported that blood lead (Pb) was a significant mediator for the positive association between socioeconomic status (SES) and peripheral vascular responses to acute stress in children (B. B. Gump et al., 2007). The present study considers the possibility that Pb may also mediate an association between SES and cortisol responses to acute stress., Design: Early childhood Pb exposure was tested as a mediator for cross-sectional associations between SES and cortisol responses., Main Outcome Measures: The primary outcome was cortisol responses to acute stress in 9.5-year-old children (N = 108)., Results: Lower family income was associated with significantly greater cortisol levels following an acute stress task. A mediational analysis confirmed that Pb was a significant mediator for this association., Conclusion: These results reaffirm the importance of considering the chemical environment as well as social and psychological environment when evaluating psychophysiological effects of low SES., (Copyright 2009 APA, all rights reserved.)

Background: Several epidemiologic studies have demonstrated relationships between prenatal exposure to polychlorinated biphenyls (PCBs) and modest cognitive impairments in infancy and early childhood. However, few studies have followed cohorts of exposed children long enough to examine the possible impact of prenatal PCB exposure on psychometric intelligence in later childhood. Of the few studies that have done so, one in the Great Lakes region of the United States reported impaired IQ in children prenatally exposed to PCBs, whereas another found no association., Objectives: This study was designed to determine whether environmental exposure to PCBs predicts lower IQ in school-age children in the Great Lakes region of the northeastern United States., Methods: We measured prenatal exposure to PCBs and IQ at 9 years of age in 156 subjects from Oswego, New York. We also measured > 50 potential predictors of intelligence in children, including repeated measures of the home environment [Home Observation for Measurement of the Environment (HOME)], socioeconomic status (SES), parental IQ, alcohol/cigarette use, neonatal risk factors, and nutrition., Results: For each 1-ng/g (wet weight) increase in PCBs in placental tissue, Full Scale IQ dropped by three points (p = 0.02), and Verbal IQ dropped by four points (p = 0.003). The median PCB level was 1.50 ng/g, with a lower quartile of 1.00 ng/g and an upper quartile of 2.06 ng/g. Moreover, this association was significant after controlling for many potential confounders, including prenatal exposure to methylmercury, dichlorodiphenyldichloroethylene, hexachlorobenzene, and lead., Conclusions: These results, in combination with similar results obtained from a similar study in the Great Lakes conducted 10 years earlier, indicate that prenatal PCB exposure in the Great Lakes region is associated with lower IQ in children.

Background: A few recent studies have demonstrated heightened hypothalamic-pituitary-adrenal (HPA) axis reactivity to acute stress in animals exposed to heavy metal contaminants, particularly lead. However, Pb-induced dysregulation of the HPA axis has not yet been studied in humans., Objective: In this study, we examined children's cortisol response to acute stress (the glucocorticoid product of HPA activation) in relation to low-level prenatal and postnatal Pb exposure., Methods: Children's prenatal blood Pb levels were determined from cord blood specimens, and postnatal lead levels were abstracted from pediatrician and state records. Children's adrenocortical responses to an acute stressor were measured using assays of salivary cortisol before and after administration of a standard cold pressor task., Results: Pb exposure was not associated with initial salivary cortisol levels. After an acute stressor, however, increasing prenatal and postnatal blood Pb levels were independently associated with significantly heightened salivary cortisol responses., Conclusions: Our results suggest that relatively low prenatal and postnatal blood lead levels--notably those below the 10 microg/dL blood lead level identified by the Centers for Disease Control and Prevention for public health purposes--can alter children's adrenocortical responses to acute stress. The behavioral and health consequences of this Pb-induced HPA dysregulation in children have yet to be determined.

Objective: A number of studies have shown an association between socioeconomic status (SES) and cardiovascular reactivity to acute stress. In addition, the authors recently reported that higher early childhood blood lead (Pb) levels are associated with significantly greater total peripheral (vascular) resistance (TPR) responses to acute stress. It is not known whether the SES-TPR association is mediated by underlying differences in blood lead levels., Design: Participants were 9.5-year-old children (N=122) with established early childhood blood lead levels., Main Outcome Measures: Family SES was measured using the Hollingshead Index, blood lead levels were abstracted from pediatrician and state records, and children's cardiovascular responses to acute stressors were measured in the laboratory with impedance cardiography and an automated blood pressure monitor., Results: Lower family SES was shown to be associated with significantly higher blood lead levels as well as significantly heightened systolic blood pressure, diastolic blood pressure, and TPR responses to acute stress tasks. A mediational analysis confirmed that Pb was a significant mediator of the SES-TPR reactivity association; some evidence also suggested moderation., Conclusion: These results suggest the importance of considering the chemical environment as well as social and psychological environment when evaluating cardiovascular effects of low SES., (Copyright (c) 2007 APA, all rights reserved.)

Background: Animal studies have shown that exposure to common, low-level environmental contaminants [e.g., polychlorinated biphenyls (PCBs), lead] causes excessive and inappropriate responding on intermittent reinforcement schedules. The Differential Reinforcement of Low Rates task (DRL) has been shown to be especially sensitive to low-level PCB exposure in monkeys., Objectives: We investigated the relationships between prenatal PCB and postnatal Pb exposure performance on a DRL schedule in children. We predicted that a) prenatal PCB exposure would reduce interresponse times (IRTs) and reinforcements earned, and b) postnatal Pb exposure would reduce IRTs and reinforcements earned., Methods: We tested 167 children on a DRL20 (20 sec) reinforcement schedule, and recorded IRTs and the number of reinforced responses across the session. We measured prenatal PCB exposure (cord blood), methylmercury (MeHg) (maternal hair), and postnatal Pb exposure (venous blood), and > 50 potentially confounding variables., Results: Results indicated impaired performance in children exposed to PCBs, MeHg, and Pb. Children prenatally exposed to PCBs responded excessively, with significantly lower IRTs and fewer reinforcers earned across the session. In addition, exposure to either MeHg or Pb predicted statistically significant impairments of a similar magnitude to those for PCBs, and the associated impairments of all three contaminants (PCB, MeHg, and Pb) were statistically independent of one another., Conclusions: These results, taken with animal literature, argue the high sensitivity of DRL performance to low-level PCB, MeHg, and Pb exposure. Future research should employ behavioral tasks in children, such as DRL, that have been demonstrably sensitive to low-level PCB, MeHg, and Pb exposure in animals.

A number of studies have considered whether background stress affects cardiovascular responses to acute stress tasks. The present study considers the effect of a potent background stressor with a clear onset, namely the terrorist attacks on September 11, 2001. Specifically, the authors investigated differences among 9.5-year-old children tested before (N = 30) and then following (N = 20) the 9/11 attacks. In addition, a majority of these children (N = 37) were retested approximately 1 year later (i.e., before and after 9/11/2002). Children tested directly following 9/11/2001 exhibited significantly greater stroke volume and cardiac output responses to acute stress tasks compared with their responses 1 year later, and this change in reactivity differed significantly from the change in reactivity exhibited by children tested before 9/11/2001 and again 1 year later. These results suggest that a potent background stressor can temporarily heighten some children's cardiovascular responses to subsequent acute stressors.