Cellular response to chronic psychosocial stress: Ten-year longitudinal changes in telomere length in the Multi-Ethnic Study of Atherosclerosis

Meier, Helen C.S.; Hussein, Mustafa; Needham, Belinda L.; Barber, Sharrelle; Lin, Jue; Seeman, Teresa E.; Roux, Ana Diez

doi:10.1016/j.psyneuen.2019.04.018

Cited by 24 publications

(21 citation statements)

References 74 publications

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“…This difference may be due to differences in measurements (using the 4-item Perceived Stress Scale as opposed to the 10-item), definition of what constitutes high stress, or because the Perceived Stress Scale may not accurately assess common stressors experienced specifically by EMS personnel. Conversely, only about 4-5% of participants in the Multi-Ethnic Study of Atherosclerosis reported high chronic stress compared to almost one-third of EMS personnel (47). Therefore, it is unclear from our results if EMS personnel suffer from higher stress levels than would be expected in the general population.…”

Section: Discussioncontrasting

confidence: 64%

Comparing the Prevalence of Poor Sleep and Stress Metrics in Basic versus Advanced Life Support Emergency Medical Services Personnel

Cash

Anderson

Lancaster

et al. 2020

Prehospital Emergency Care

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Background: Emergency medical services (EMS) personnel frequently encounter occupational factors that increase the risk of poor sleep and stress. The national prevalence of poor sleep and stress in EMS personnel is unclear, especially differences between personnel at the basic (BLS) versus advanced (ALS) life support levels. The objectives of this study were to: (1) estimate the prevalence of sleep and stress metrics in EMS personnel; and (2) compare these metrics between BLS and ALS-certified personnel. Methods: This study was a survey of recertifying nationally-certified EMS personnel working in civilian settings. Respondents completed an electronic questionnaire assessing their sleep quality; workday, non-workday, and average sleep duration; sleep debt; perceived stress; and chronic stress. Survey-weighted Poisson regression models were used to estimate adjusted prevalence ratios (PR) comparing BLS (emergency medical technician) to ALS (advanced emergency medical technician and paramedic) for each metric. Models were adjusted for age, sex, minority status, education level, EMS agency type, service type, EMS role, and significant interactions. Results: A total of 17,913 (response rate ¼ 19%) responses were received with 17,522 included in the analysis. Adjusted PRs were significantly higher for ALS-certified personnel compared to BLS-certified for poor sleep quality (PR: 1.23, 95% CI: 1.20-1.27) and short (<7 hours) or long (!9 hours) workday sleep duration (PR: 1.17, 95% CI: 1.15-1.19). Significant interactions were found between certification level and sex (average sleep duration) or age category (sleep debt, perceived stress, and chronic stress). The highest prevalence of short or long average sleep duration was among ALS men. Sleep debt, perceived stress, and chronic stress differed by age group between certification levels with higher PRs for ALS regardless of age group. Conclusions: There is a high prevalence of poor sleep and stress in EMS personnel, with evidence of the highest prevalence among ALS-certified personnel. Evidence of effect modification by age category and among BLS and ALS personnel suggests that interventions could target certain subgroups, such as older ALS personnel, to be most effective. Continued focus on sleep health and stress reduction is needed to improve the health and well-being of the EMS workforce.

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Section: Discussioncontrasting

confidence: 64%

Comparing the Prevalence of Poor Sleep and Stress Metrics in Basic versus Advanced Life Support Emergency Medical Services Personnel

Cash

Anderson

Lancaster

et al. 2020

Prehospital Emergency Care

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“…Poor neighborhood perception represents one such chronic stressor and therefore may mediate the relationship between neighborhood environment and LTL (Ross & Mirowsky, 2009). This is supported by recent work demonstrating an association between chronic stress and telomere attrition over a 10-year period (Meier et al, 2019).…”

Section: Discussionsupporting

confidence: 78%

“…This may indicate a stress-resilience mechanism among women living in extreme socioeconomic disadvantage. Recent exploratory findings from a longitudinal study of chronic stress suggest that individual-level stressors may be more significant to telomere shortening among women, whereas neighborhood-level stressors may have a greater impact on telomere dynamics among men (Meier et al, 2019). The neuro-endocrine pathways that comprise the stress response are complex (Charney, 2004), but there is evidence for gender-specific stress responses (Bekhbat & Neigh, 2018), possibly due to a combination of the effects of estrogen (Bale & Epperson, 2015; Charney, 2004), differential recruitment of neural networks (Goldfarb, Seo, & Sinha, 2019), and social support (Ozbay et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

The relationship between neighborhood socioeconomic deprivation and telomere length: The 1999–2002 National Health and Nutrition Examination Survey

Powell‐Wiley

Gebreab

Claudel

et al. 2020

SSM - Population Health

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Socioeconomically disadvantaged neighborhoods have been associated with poor health outcomes. Little is known about the biological mechanism by which deprived neighborhood conditions exert negative influences on health. Data from the 1999–2002 National Health and Nutrition Examination Surveys (NHANES) were used to assess the relationship between neighborhood deprivation index (NDI) and log-transformed leukocyte telomere length (LTL) via multilevel modeling to control for census tract level clustering. Models were constructed using tertiles of NDI (ref = low NDI). NDI was calculated using census tract level socioeconomic indicators from the 2000 U.S. Census. The sample (n = 5,106 adults) was 49.8% female and consisted of 82.9% non-Hispanic whites, 9.4% non-Hispanic blacks, and 7.6% Mexican Americans. Mean age was 45.8 years. Residents of neighborhoods with high NDI were younger, non-white, had lower educational attainment, and had a lower poverty to income ratio (all p < 0.0001). Neighborhood deprivation was inversely associated with LTL among individuals living in neighborhoods with medium NDI (β = −0.043, SE = 0.012, p = 0.0005) and high NDI (β = −0.039, SE = 0.013, p = 0.003). Among men, both medium (β = −0.042, SE = 0.015, p = 0.006) and high (β = −0.047, SE = 0.015, p = 0.001) NDI were associated with shorter LTL. Among women, only medium NDI (β = −0.020, SE = 0.016, p = 0.009) was associated with shorter LTL. After controlling for individual characteristics, including individual-level socioeconomic status, increasing neighborhood socioeconomic deprivation is associated with shorter LTL among a nationally representative sample of US adults. This suggests that telomere shortening may be a mechanism through which neighborhood deprivation results in poor health outcomes.

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“…EMS personnel in this sample had worse sleep quality, short and long sleep durations, and high chronic stress compared to the general population. 41 , 50 , 51 , 52 , 53 The high‐stress nature of EMS work, as well as reliance on shift work and long shift durations, may help explain some of these differences. This sample had higher prevalence of poor sleep and stress compared to prior descriptions of EMS personnel.…”

Section: Discussionmentioning

confidence: 99%

Associations between sleep, stress, and cardiovascular health in emergency medical services personnel

et al. 2021

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Objective Our objective was to quantify the associations between sleep duration and perceived and chronic stress with ideal cardiovascular health (CVH) among emergency medical services (EMS) personnel from county‐based EMS agencies. Methods We conducted a cross‐sectional survey of cardiovascular disease (CVD)‐free EMS personnel from 4 US EMS agencies. The questionnaire consisted of the Pittsburgh Sleep Quality Index (PSQI), Perceived Stress Scale (PSS), Chronic Burden Scale, and the CVH components (smoking, body mass index, physical activity, diet, blood glucose, blood pressure, cholesterol, each scored 0–2 points). The components were summed and ideal CVH considered 11–14 points. Mixed effects logistic regression models with a random intercept for agency were used to estimate the odds of ideal CVH for good sleep quality (PSQI < 5 points), recommended sleep duration (7 to < 9h), low perceived stress (PSS < 26 points), and low chronic stress (0 recent stressful events). Results We received 379 responses (response rate = 32%). There was low prevalence of good sleep quality (23%) and recommended sleep duration (25%), but 95% reported low perceived stress, and 33% had low chronic stress. Ideal CVH was reported by 30%. No significant associations between ideal CVH and sleep quality, perceived stress, or chronic stress were found. There was a nearly 2‐fold increase in the odds of ideal CVH with recommended sleep duration (odds ratio: 1.83, 95% confidence interval: 1.08–3.10). Conclusion In this sample of EMS personnel, only recommended sleep duration was associated with ideal CVH. Future longitudinal studies are needed to understand the relationship between sleep, stress, and CVD in this understudied occupational group.

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Cellular response to chronic psychosocial stress: Ten-year longitudinal changes in telomere length in the Multi-Ethnic Study of Atherosclerosis

Cited by 24 publications

References 74 publications

Comparing the Prevalence of Poor Sleep and Stress Metrics in Basic versus Advanced Life Support Emergency Medical Services Personnel

Comparing the Prevalence of Poor Sleep and Stress Metrics in Basic versus Advanced Life Support Emergency Medical Services Personnel

The relationship between neighborhood socioeconomic deprivation and telomere length: The 1999–2002 National Health and Nutrition Examination Survey

Associations between sleep, stress, and cardiovascular health in emergency medical services personnel

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