Youth who Feel Loved, Optimistic, and Happy More Likely to Maintain Good Cardiometabolic Health into Adulthood

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Adolescents who reported feeling optimism, happiness, self-esteem, belongingness, and loved were more likely to experience favorable cardiometabolic health (CMH) patterns 2 decades later, according to new data published in the Journal of the American Heart Association. Further, according to the study authors, the effect was most pronounced among Black youth.

“Observational and intervention research suggests that facets of psychological well-being (eg, optimism, happiness) may be important modifiable assets that promote healthy cardiovascular functioning over time. However, most of this work was conducted among older adults, despite evidence suggesting that health promoting processes triggered by psychological assets may manifest before adulthood,” wrote researchers led by Farah Qureshi, ScD, MHS, assistant professor in the department of population, family, and reproductive health at the Johns Hopkins Bloomberg School of Public Health.

“Another gap in the existing literature,” continued the team, “relates to studies conducted among racially and ethnically diverse samples.” They point out that Black and Latinx adolescents are the least likely to have optimal CMH and sustain it over time compared with adolescents of other races and ethnicities, underscoring the crucial role psychological assets may have for these groups. “To our knowledge, no studies have examined group differences in the relationship between assets and positive CVH early in life.”

To fill these gaps, Qureshi and colleagues examined whether psychological assets help adolescents sustain positive CMH in adulthood and explored interactions by race and ethnicity.

Participants of the current study were 3478 individuals in the National Longitudinal Study of Adolescent Health, a school-based survey of adolescents in the US that followed them into adulthood. Within the cohort, 49% were girls, 67% were White, 15% were Black, and 11% were Hispanic.

In wave 1 of the study (1994-1995; mean age, 16 years), researchers used data on 5 psychological assets (optimism, happiness, self-esteem, belongingness, and feeling loved) to create a composite asset index ranging from 0 to 5. For wave 4 (2008; mean age, 28 years) and wave 5 (2016-2018; mean age, 38 years), investigators defined CMH using 7 clinically assessed biomarkers: high-density lipoprotein cholesterol (HDL-C), non-HDL-C, systolic blood pressure (SBP), diastolic BP (DBP), HbA1c, C-reactive protein, and body mass index.

“We did not examine low‐density lipoprotein cholesterol because most participants did not fast before their blood draw, and low‐density lipoprotein cholesterol was ascertained using the Friedewald equation, which may provide invalid estimates in nonfasting samples,” wrote researchers.

Participants with healthy levels of ≥6 biomarkers at waves 4 and 5 were classified as maintaining CMH over time.

Key Findings

Overall, 55% of adolescents had 0-1 asset, 29% had 2-3 assets, and 16% had 4-5 assets, according to the study results. While 21% of the total cohort reached mid-young adulthood in optimal CMH, only 12% maintained it into late young adulthood. Each additional asset was related to a 12% greater likelihood of CMH maintenance (odds ratio [OR] _{linear trend,} 1.12; 95% CI, 1.01-1.25).

In subgroup analyses, investigators observed substantive associations only among Black participants (OR, 1.35; 95% CI, 1.00-1.82). Also, there was some evidence that, “racial and ethnic disparities in CMH maintenance may be less pronounced among participants with more assets.”

“Because racial and ethnic disparities in health are a manifestation of inequitable social structures, these findings provide preliminary evidence that psychological assets may be an underappreciated source of resilience for youth from minoritized racial and ethnic groups,” concluded Qureshi et al. “Future work should evaluate whether population‐based efforts to build psychological assets early in life may bolster the impact of broader structural interventions aimed at eliminating racial and ethnic health inequities.”

Reference: Qureshi F, Guimond AJ, Tsao E, et al. Adolescent psychological assets and cardiometabolic health maintenance in adulthood: Implications for health equity. J Am Heart Assoc. 2023;0:e026173.