Promoting Health in a Stressful World

A Congressional Seminar
 

HILL BRIEFING FOCUSES ON STRESS AND HEALTH

         There is increasing evidence that behavioral and social influences can have far-reaching effects on health and disease outcomes.  To explore the latest research in this area, the Coalition for the Advancement of Health Through Behavioral and Social Science Research (CAHT-BSSR) sponsored a briefing on Promoting Health in a Stressful World on February 20.  The briefing was co-sponsored by Rep. Connie Morella (R-MD).  Angela Sharpe, COSSA’s Associate Director for Government Affairs, co-chairs the coalition.

         Stress affects the development and course of heart disease, hypertension, and stroke.  In addition, social relationships – both positive and negative – can have a significant effect on health.  Scientists are just beginning to explore the underlying mechanisms linking biology and the social world.  How we cope with stress also influences our future health.

         The National Institute of Health’s Office of Behavioral and Social Sciences Research (OBSSR) has spearheaded the research on such linkages.  Six reports from the Institute of Medicine and the National Research Council have highlighted the importance addressing these linkages for NIH’s research agenda in the social and behavioral sciences (see Update, January 28, 2002).  The reports aimed at setting priorities for NIH research in the social and behavioral sciences are: 

·         New Horizons in Health: An Integrative Approach (2001)

·         Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences (2001)

·         Promoting Health: Intervention Strategies from Social and Behavioral Research (2000)

·         Cells and Surveys: Should Biological Measures be Included in Social Science Research (2001)

·         From Neurons to Neighborhoods: The Science of Early Childhood Development (2000)

·         Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences (2000)

         The briefing also highlighted NIH’s report on its  June 2000 conference, Toward Higher Levels of Analysis: Progress and Promise in Research on Social and Cultural Dimensions of Health.

         Speaking at the briefing were Neil Schneiderman, Professor of Psychology, Medicine, Psychiatry, and Behavioral Sciences at the University of Miami; Curtis McMillen, Associate Professor in the George Warren Brown School of Social Work at Washington University, St. Louis; and Christine Bachrach of the National Institute of Child Health and Human Development.  Raynard Kington, Director of OBSSR and Acting Director of the National Institute of Alcohol Abuse and Alcoholism, was the moderator.  Due to illness, Linda K. George (pdf file) , Department of Sociology, Center for the Study of Aging and Human Development at Duke University, could not attend, but provided written testimony.

Raynard Kington - NIH/OBSSR

Moderator of the briefing

 

        Schneiderman noted that large-scale epidemiological studies have demonstrated associations between psychosocial factors and diseases.  For example, depression is clearly associated with increases in hypertension and coronary heart disease and also increases the risk of death for men with cancer and women with breast cancer. 

        One pathway between psychosocial factors and adverse health effects, Schneiderman explained, is through behavior.  Smoking, overconsumption of calories, and a sedentary lifestyle can lead to coronary heart disease.  A second pathway that may relate to stress involves low levels of brain serotonin and circulating levels of stress hormones, which can have major impacts upon the immune system and disease progression.  This is evidenced in studies of HIV/AIDS patients.

         Thus, psychosocial interventions may ameliorate disease, Schneiderman declared.  As an example, he cited the Recurrent Coronary Prevention Trial, which found that group therapy reduced hostility and depression in patients after a heart attack and reduced recurrence of a second heart attack by more than 40 percent.  He did admit that not all psychosocial interventions have been successful, since some are carried out on patients whose disease is too advanced.

         Schneiderman’s research on those directly affected by Hurricane Andrew also provided a view of how stress relates to illness and what could be done to reduce people’s vulnerability.  The most important finding of the study was that high levels of resources, together with high levels of social support and low use of denial and alcohol as coping mechanisms, predicted faster recovery for those who suffered from post-traumatic stress syndrome and reduced immune function.

 The Positive Aspects of Adversity

         McMillen addressed the positive by-products of adversity.  Although he has been called upon many times since September 11, he noted that his earlier research focused on disasters such as the Northridge, California earthquake and the Oklahoma City Murrah Building bombing, as well as spinal cord injuries. 

 

Curtis McMillen - Washington University, St. Louis

Assistant Professor of Social Work

 

         In what may be a surprise, 88 percent of respondents directly affected said that something good came out of the Oklahoma City bombing.  These included increased compassion, increased family closeness, increased self-efficacy, and increased spirituality.  In addition, unique adversities also yield unique positive by-products, McMillen explained.  These are:  increased ability to help other people, increased faith in people, increased knowledge about a kind of event, increased self-knowledge, decreased naďveté, and sometimes, financial gain.

         McMillen said that the research is still unclear about the correlates of these by-products.  He noted that personality theorists believe it all depends on the personality of the people experiencing the event.  The relationship of optimism, extraversion, and other such traits needs further exploration.  Other possible variables that affect these positive outcomes are social support, gender, and religious coping activities.

         Further research in this area, McMillen suggested, could focus on the durability of these positive by-products.  What elements of the process are most potent in promoting growth and recovery?  How can others assist in this process?

         Finally, Bachrach focused on the results of the NIH Conference, Toward Higher Levels of Analysis: Progress and Promise in Research on Social and Cultural Dimensions of Health, held in June 2000.  The conference was designed to:  1) highlight the contributions of social and cultural factors to health and illness to achieve a better understanding of the interdependence of social, behavioral, and biological levels of analysis in health research; 2) examine the state of science in the area of sociocultural constructs like race, ethnicity, socioeconomic status, and gender; 3) examine the influences of social and cultural factors as well as interpersonal, neighbor-hood, and community influences on prevention, treatment, and use of health services; 4) examine the current status of issues related to health justice and ethics and perspectives for global health; and 5) provide recommendations for future research directions.

         A summary of the conference can be viewed on the web at http://obssr.od.nih.gov/Conf_Wkshp/higherlevel/conference.html  .               

         OBSSR and 15 Institutes and Centers of NIH are currently soliciting applications for research examining the social and cultural dimensions of health (PA-02-043).  The program announcement is based on the recommendations submitted to NIH (see Update, July 10, 2000).  For more information see http://grants.nih.gov/grants/guide/pafiles/PA-02-043.html .  Direct general inquiries regarding the scope and content of the PA to Ronald P. Abeles (301/496-7859 or abeles@nih.gov ).

 

APA CO-HOSTS CONGRESSIONAL BRIEFING ON STRESS AND HEALTH (http://www.apa.org/ppo/issues/spinmarch.html#stress)

 

APA cosponsored a congressional briefing on February 20, 2002, entitled “Promoting Health in a Stressful World.” Speakers included Raynard Kington, MD, PhD, of the NIH Office of Behavioral and Social Sciences Research, University of Miami Professor Neil Schneiderman, Christine Bachrach of the National Institute of Child Health and Human Development, and Curtis McMillen, Assistant Professor of Social Work at Washington University, St. Louis.

 

 

Neil Schneiderman - University of Florida

Recent chair of APA’s Board of Scientific Affairs and a longtime NIH grantee

 

Neil Schneiderman, who is a recent chair of APA’s Board of Scientific Affairs and a longtime NIH grantee, explained what scientists have learned through behavioral research about the effects of stress on health and illness.  Christine Bachrach spoke about the types of research that may be spurred by an NIH conference she co-chaired, “Toward Higher Levels of Analysis: Progress and Promise in Research on Social and Cultural Dimensions of Health.”   Curtis McMillen spoke about his research on unanticipated positive by-products of tragedies such as the Oklahoma City bombing and traumatic accidents.  Raynard Kington served as moderator. Congressional staff members as well as representatives of federal science funding agencies attended.

 

The briefing was sponsored by the Coalition for the Advancement of Health through Behavioral and Social Sciences Research, whose members include representatives of the American Psychological Association, the Consortium of Social Science Associations, the American Sociological Association, and other behavioral and social science-focused organizations.  Representative Connie Morella (R-MD) agreed to serve as the congressional sponsor for the briefing.  Congressional briefings are one means of sharing exciting scientific findings with policymakers.  APA will bring scientists to Capitol Hill throughout the year to explain the importance of behavioral research in venues ranging from briefings, to congressional testimony, to one-on-one meetings with policymakers.    

 

ASA Co-Sponsors Health Briefing on Capitol Hill  (http://www.asanet.org/footnotes/)

Evidence continues to accumulate that social influences can have a profound effect on health. Numerous recent reports of the National Academy of Sciences (NAS) (see table) and one from the Office of Behavioral and Social Sciences Research of the National Institutes of Health (NIH) were aimed at explicating these pathways and in setting a course for behavioral and social sciences research at the NIH.

This message was too important to be locked away in scholarly reports and discussed exclusively in academic circles, and, as a result, the American Sociological Association (ASA), as part of the Coalition for the Advancement of Health through Behavioral and Social Science Research, organized a Congressional briefing for policymakers, their staffs, and federal agency representatives. The briefing, entitled “Promoting Health in a Stressful World,” was sponsored by Congresswoman Connie Morella in whose district the NIH sits.

Three speakers from psychology, sociology, and social work addressed themes found in the seven NAS and NIH reports. The speakers described the mechanisms by which stress affects health, the impact of social connections in reducing stress, and coping and resiliency following traumatic life events. Sociology was prominently represented by speaker Christine Bachrach, Immediate Past-Chair of ASA's Section on Sociology of Population, and a paper from Linda George, Chair of ASA's Section on Aging and Life Course.

Moderator Raynard Kington, Director of the Office of Behavioral and Social Sciences Research and Acting Director of the National Institute of Alcohol Abuse and Alcoholism, set the stage by providing an overview of major themes. Kington noted that the goal of the briefing was to show that a multi-level framework that fully accounts for social-level influences on biology-research that necessarily includes basic research on social constructs and processes-will provide a more complete picture of how to prevent and treat disease.

The first panelist, Neil Schneiderman, Professor of Psychology, Medicine, Psychiatry and Behavioral Sciences at the University of Miami, described “when and how stress leads to disease.” Schneiderman described research findings linking psychosocial factors to coronary heart disease, HIV/AIDS, and cancer. According to Schneiderman, one pathway from social factors to health outcomes is through behaviors such as smoking, sedentary lifestyle, and overconsumption of calories. Another pathway, noted Schneiderman, involves triggering stress hormones which can have enormous effects on the immune system and the progression of disease.

Following Schneiderman, Sociologist Christine Bachrach, Chief of the Demographic and Behavioral Sciences Branch at the National Institute of Child Health and Human Development, described the NIH's new roadmap for research on social and cultural influences on health, and highlighted research examples showing the effect of social-level factors on health. Bachrach noted that asthma, for example, is known to be affected not only by one's physical environment, but also one's social environment, especially where stress is involved.

Chris Bachrach - NICHD

Bachrach also said that planning was underway for a new and comprehensive interagency study, the National Children's Study, that will track children pre-birth to 21 years of age (see page 3 for an article on the study). “Everywhere you look, people are recognizing the absolute necessity of examining social factors as contributors to health outcomes. We see it in the NAS reports, the NIH conference, and here again in the planning for this new federal study,” said Bachrach.

Supplementing the materials on social factors, ASA provided a paper by Linda George on “the health-promoting effects of social bonds” written especially for the occasion. The paper highlighted the point that social bonds (through social support and community engagement) promote physical health, mental health, and longevity, even after accounting for every other predictor of health and longevity that is known. George wrote, “in addition to directly affecting health, social support substantially reduces the detrimental effects of both acute and chronic stress on health.” George noted, however, that the above positive effects of social bonds hold true only for people in high-quality relationships. Low-quality relationships, on the other hand, can actually harm physical and mental health.

Rounding out the day, Curtis McMillen, Associate Professor at the Washington University George Warren Brown School of Social Work, described how people who have faced severe adversity often report that there have been positive by-products despite the difficult experience. These positive by-products often include a sense of increased compassion, increased family closeness, increased spirituality, and changed life priorities.

As Kington emphasized during the briefing, “The scientific community stands at extraordinary crossroads.” The hope is that the new enthusiasm regarding the importance of social-level factors in health will translate into funding to build and expand scientific knowledge in these areas.