Thomas Kamarck

• University of Pittsburgh

Background Cardiovascular responses to psychological stressors have been separately associated with preclinical atherosclerosis and hemodynamic brain activity patterns across different studies and cohorts; however, what has not been established is whether cardiovascular stress responses reliably link indicators of stressor‐evoked brain activity and...

Different tasks of episodic memory (EM) are only moderately correlated with each other. Furthermore, various EM tasks exhibit disproportional relationships with the hippocampus. This study examined the covariance structure of EM tasks and assessed whether this structure relates differently to hippocampal volume (HV) in a sample of 648 cognitively u...

Objectives: Examine the effect of aerobic exercise on structural brain age and explore potential mediators. Methods: In a single-blind, 12-month randomized clinical trial, 130 healthy participants aged 26-58 years were randomized into a moderator-to-vigorous intensity aerobic exercise group or a usual-care control group. The exercise group attended...

Objective: Interpersonal and emotional functioning are closely linked and reciprocally influence one another. Contemporary integrative interpersonal theory (CIIT) offers a useful framework to conceptualize these patterns and guide interventions in cases where these patterns result in dysfunction. Stress processes offer several dynamic frameworks to...

Objetivo: El trauma infantil puede contribuir a la salud durante toda la vida a través de la inflamación sistémica crónica. Sin embargo, las asociaciones entre el trauma infantil y la inflamación son mixtas, lo que indica que distintos tipos de trauma infantil pueden relacionarse con la inflamación de manera diferente. Además, la mayoría de los est...

Objective Evidence suggests a link between positive social relationship perceptions and improved sleep (e.g., quality, efficiency) across the lifespan. Less work has probed the directionality of these relationships. Here, we report findings from the first study to examine bidirectional between- and within- person associations between loneliness and...

Background Cardiovascular responses to psychological stressors have been separately associated with preclinical atherosclerosis and hemodynamic brain activity patterns across different studies and cohorts; however, what has not been established is whether cardiovascular stress responses reliably link indicators of stressor-evoked brain activity and...

Introduction Physical activity (PA) has beneficial effects on brain health and cardiovascular disease (CVD) risk. Yet, we know little about whether PA-induced changes to physiological mediators of CVD risk influence brain health and whether benefits to brain health may also explain PA-induced improvements to CVD risk. This study combines neurobiolo...

Main effect models contend that perceived social support benefits mental health in the presence and the absence of stressful events, whereas stress-buffering models contend that perceived social support benefits mental health especially when individuals are facing stressful events. We tested these models of how perceived social support impacts ment...

Individuals exhibiting exaggerated blood pressure responses to stress are at increased risk for later cardiovascular disease. Engagement in brief bouts of moderate‐to‐vigorous physical activity may reduce instances of these exaggerated blood pressure responses. While observational work has shown that periods of light physical activity may also be a...

Background Dysregulation in physiological responses to stress may provide a mechanism through which low socioeconomic status (SES) in childhood negatively impacts health. Evidence linking early life SES to physiological stress responses is inconsistent. Exposure to childhood trauma may be an important source of heterogeneity accounting for mixed fi...

Objective: To test whether expectations of respect and appreciation from others, assessed in daily life, are associated with preclinical vascular disease. Method: Participants were an urban community sample of 483 employed adults (47% male, 17% Black, mean age = 42.8 years). Carotid intima-media thickness (IMT) was measured using B-mode ultrasou...

Home blood pressure monitoring (HBPM) can improve hypertension management. Digital tools to facilitate routinized HBPM and patient self-care are underutilized and lack evidence of effectiveness. MyBP provides video-based education and automated text messaging to support continuous BP self-monitoring with recurring feedback. In this pragmatic trial,...

Objective: Aging is theoretically accompanied by emotional gains, but physiological self-regulatory losses. Emotional and physiological regulation can be operationalized as the extent of increase in negative affect and blood pressure upon experiencing a stressor (i.e., reactivity). The direction of age-based changes in negative affect reactivity t...

Background Aerobic exercise remains one of the most promising approaches for enhancing cognitive function in late adulthood, yet its potential positive effects on episodic memory remain poorly understood and a matter of intense debate. Prior meta-analyses have reported minimal improvements in episodic memory following aerobic exercise but have been...

Objective: Socially integrated individuals are at lower risk of cardiovascular disease morbidity and mortality compared to their more isolated counterparts. This association may be due, in part, to the effect of social integration on nocturnal blood pressure (BP) decline or "dipping," a physiological process associated with decreased disease risk....

Objective: Two decades of research has examined within-persons associations between negative emotion states and ambulatory blood pressure (ABP) using ecological momentary assessment (EMA), but no meta-analysis has been conducted. We conducted this systematic review and meta-analysis to quantify the magnitude of this association and identify modera...

Compared to others, individuals living in communities of socioeconomic disadvantage experience more atherosclerotic cardiovascular disease (CVD) and a greater extent of preclinical atherosclerosis. Although the mechanisms underlying these associations remain unclear, it is widely hypothesized that alterations in normative cortisol release from the...

Background High trait conscientiousness is associated with lower cardiometabolic risk, and health behaviors are a putative but relatively untested pathway that may explain this association. Purpose To explore the role of key health behaviors (diet, physical activity, substance use, and sleep) as links between conscientiousness and cardiometabolic...

Background The processes through which social support exerts its influence in daily life are not well understood. Arguably, its salutary effects as an environmental variable might be construed as shared effects of personality. Method To test this possibility, we investigated the unique and shared effects of personality and social support on daily...

Despite the high co‐occurrence of sleep and mood disturbances, day‐to‐day associations between sleep characteristics (sleep duration, continuity, and timing) and dimensions of mood (positive affect and negative affect) remain unclear. The present study aimed to test whether there is a daily, bidirectional association between these sleep characteris...

Stress exposure is linked to elevated blood pressure, which increases risk for cardiovascular disease (Spruill, 2010; WHO, 2013). Stress exposure may be especially harmful when concentrated in one particular domain (i.e., low stressor diversity) (Koffer, et al., 2016). Using a diversity index, we test whether high stressor exposure and low stressor...

Introduction: Hypertension is uncontrolled in 50% of diagnosed adults in the US, and especially in older adults. Home blood pressure monitoring (HBPM) can improve hypertension management by providing clinicians with up-to-date information on BP control and by improving patients’ adherence to prescribed medications and other healthy behaviors. MyBP...

Introduction Despite the high co-occurrence of sleep and mood disturbances, day-to-day associations between sleep characteristics (sleep duration, continuity, timing) and dimensions of mood (positive affect, PA, and negative affect, NA) remain unclear. Few field studies have tested whether sleep changes may affect mood by altering people’s emotiona...

Objective: A growing number of studies have associated various measures of social integration, the diversity of social roles in which one participates, with alterations in hypothalamic-pituitary-adrenocortical (HPA) functioning. The pathways through which social integration may be linked to HPA functioning, however, are as yet unknown. The present...

Objective: Racial discrimination is a common experience for African Americans, but no research has examined how discrimination reported in daily-life moments influences concurrent negative emotions and psychosocial resources. Method: Emerging adult African Americans (N = 54) reported hourly on momentary racial discrimination, negative emotions, and...

Objective Evidence links trait hostility with components of the metabolic syndrome (MetS), a clustering of cardiometabolic risk factors, but which hostility dimensions (e.g., expressive or cognitive hostility) relate to MetS are not well known. Further, there may be age and sex differences in the extent to which hostility dimensions relate to MetS....

The specific processes through which social support exerts its influence in daily life are not well understood. Its salutary effects as an environmental variable might be construed as effects of individual differences and related, contextualized personality processes. We investigated the unique effects of personality and social support on daily str...

Both affective and blood pressure (BP) reactivity are associated with long term risk of chronic disease and mortality. Thus, understanding age-related changes in negative affect and BP responses to everyday demands is vital for promoting healthy aging. However, few studies have examined both psychological and BP reactivity simultaneously, which wou...

Background: Cancer caregivers are at increased risk for cardiovascular disease (CVD) and mortality. The aims of this study were to examine psychosocial and behavioral predictors of metabolic syndrome. Methods: Cancer caregivers were administered a battery of questionnaires assessing sociodemographic characteristics, depressive symptoms, perceive...

Objective: Hypertension is largely asymptomatic and, as a result, patients often fail to sufficiently engage in medication adherence and other health behaviors to control their blood pressure (BP). This study explores the mechanisms by which MyBP, an automated SMS-facilitated home blood pressure monitoring (HBPM) program, helps facilitate healthy...

Objective To examine the associations among socioeconomic factors, depressive symptoms, and cytokines in patients diagnosed with hepatocellular carcinoma (HCC). Methods A total of 266 HCC patients were administered a battery of questionnaires including a sociodemographic questionnaire and the Center for Epidemiologic Studies Depression (CES‐D) sca...

Objective: Previous literature has shown an inconsistent relationship between physical activity and stressor-evoked blood pressure reactivity. Use of ecological momentary assessment (EMA) may facilitate detecting such a relationship. In this study, the moderating effects of regular physical activity on the magnitude of ambulatory blood pressure (A...

Uncontrolled hypertension constitutes a major challenge for healthcare systems. Home blood pressure monitoring (HBPM) is widely recommended and may lower BP when combined with other supports. However, scalable and systematic HBPM interventions are lacking and the behavioral mechanism(s) through which BP is lowered remain poorly understood. Our team...

Objective: We examined whether associations between daily psychosocial stressor exposures and carotid artery intima medial thickness (IMT) may be stronger among those showing larger stress-related cardiovascular reactivity (CVR) during the course of daily living. Methods: 474 healthy working adults (ages 30-54) collected ambulatory blood pressur...

Background: Uncontrolled hypertension constitutes a significant challenge throughout the world. Blood pressure measurement by patients is informative for both patients and providers, but is rarely performed systematically, thereby reducing its utility. Mobile phones can be used to efficiently prompt individuals to measure blood pressure and automa...

Background: Physical and psychological symptoms are common during chemotherapy in cancer patients, and real-time monitoring of these symptoms can improve patient outcomes. Sensors embedded in mobile phones and wearable activity trackers could be potentially useful in monitoring symptoms passively, with minimal patient burden. Objective: The aim...

Objectives: To compare estimates of sleep duration defined by polysomnography (PSG), actigraphy, daily diary, and retrospective questionnaire and to identify characteristics associated with differences between measures. Design: Cross-sectional. Setting: Community sample. Participants: The sample consisted of 223 Black, White, and Asian middl...

Objective: Emerging research demonstrates race differences in diurnal cortisol slope, an indicator of hypothalamic-pituitary-adrenocortical (HPA)-axis functioning associated with morbidity and mortality, with African Americans showing flatter diurnal slopes than their White counterparts. Sleep characteristics are associated with both race and with...

Objective: In clinical trials, omega-3 fatty acid supplementation improves symptoms in psychiatric disorders involving dysregulated mood and impulse control, yet it is unclear whether in healthy adults omega-3 fatty acid supplementation affects mood, impulse control and the brain systems supporting these processes. Accordingly, this study tested t...

Objective Sleep problems have been linked to increased risk of mortality in the general population. Limited evidence suggests similar relationships among people diagnosed with cancer. The aims of the present study were to investigate the type and rates of sleep problems in advanced cancer patients and examine whether sleep problems are associated w...

Objectives: The objectives of this study were to determine whether job strain is more strongly associated with higher ambulatory blood pressure (ABP) among blue-collar workers compared with white-collar workers, to examine whether this pattern generalizes across working and nonworking days and across sex, and to examine whether this pattern is acc...

Background Socioeconomic position is a well-established risk factor for poor physical health. Purpose This study examines whether the effects of lower social rank on physical health may be accounted for by differences in daily social experience. Methods In a large community sample (N = 475), we examined whether subjective social rank is associated...

Objective: Systemic inflammation is thought to be a biological mediator between social relationship quality and premature mortality. Empirical work has yielded mixed support for an association of social relationship variables with systemic inflammation, perhaps due to methodological limitations. To date, research in this literature has focused on...

There is a lack of comprehensive research on Ecological Momentary Assessment (EMA) feasibility to study occupational stress, especially its long-term sustainability. EMA application in education contexts has also been sparse. This study investigated the feasibility of using EMA to study teacher stress over 2 years using both objective compliance da...

Context: Shift work, which imposes a habitual disruption in the circadian system, has been linked to increased incidence of cardiometabolic diseases, and acute circadian misalignment alters various metabolic processes. However, it remains unclear whether day-to-day circadian dysregulation contributes to these risks beyond poor sleep and other beha...

Recent advances in mobile health have produced several new models for inferring stress from wearable sensors. But, the lack of a gold standard is a major hurdle in making clinical use of continuous stress measurements derived from wearable sensors. In this paper, we present a stress model (called cStress) that has been carefully developed with atte...

Objectives: Evidence supports an inverse association of childhood socioeconomic status (SES) with systemic inflammation in adulthood. However, it remains to be determined whether this association is dependent on exposure to stressful life experiences. Methods: We predicted that the combination of a high number of recent negative life events and...

Evening chronotype, a correlate of delayed circadian rhythms, is associated with depression. Altered positive affect (PA) rhythms may mediate the association between evening chronotype and depression severity. Consequently, a better understanding of the relationship between chronotype and PA may aid in understanding the etiology of depression. Rece...

Objective: To examine the association between marital interaction quality during daily life and subclinical cardiovascular disease (CVD). Studies have shown that marital status and quality of marriage are associated with cardiovascular health. However, little is known about the role of marital interaction quality during daily life in contributing...

Objective: To examine longitudinal bidirectional associations between two depressive symptom clusters-the cognitive-affective and somatic-vegetative clusters--and insulin resistance, a marker of prediabetes. Methods: Participants were 269 adults aged 50 to 70 years without diabetes enrolled in the Pittsburgh Healthy Heart Project, a prospective...

Short sleep has been related to incident cardiovascular disease, but physiological mechanisms accounting for this relationship are largely unknown. This study examines sleep duration and cardiovascular stress responses in 79 healthy, young men. Sleep duration was assessed by wrist actigraphy for seven nights. Participants then completed a series of...

Background Hostility is a multidimensional construct related to cardiovascular (CV) disease risk. Daily hostile mood and social interactions may precipitate stress-related CV responses in hostile individuals. Purpose Determine whether trait cognitive hostility best predicts daily hostile mood and social interactions relative to other trait hostilit...

We examine associations between the perception of ongoing psychological demands by ecological momentary assessment (EMA) and 6-year changes in carotid artery atherosclerosis by ultrasonography. A total of 270 initially healthy participants collected ambulatory blood pressure (ABP) and recorded their daily experiences, using electronic diaries, duri...

Objective: Unrealistic optimism-typically conceptualized as underestimation of comparative risk-has been previously associated with poorer health behaviors and outcomes, but no research to date has examined the association between unrealistic optimism and subclinical or clinical disease endpoints. Here, cross-sectional data from one time point in...

Vasomotor symptoms (VMS) are common during the menopausal transition. Negative affect is consistently associated with self-reported VMS, but the interpretation of this relationship is limited by the infrequent measurement and retrospective recall of VMS. Using prospective data from daily diaries, we examined the daily association between negative a...

Objective: To determine whether lower childhood socioeconomic status (SES) was associated with fewer psychosocial resources independent of adult SES, and whether these associations differed by race/ethnicity. Method: Cross-sectional study of 342 middle-aged (M = 60.5 ± 4.7) African American (n = 49) and Caucasian (n = 293) adults. Childhood SES and...

Short and less efficient sleep may be risk factors for atherosclerosis. Few studies have investigated the associations between sleep characteristics and early cardiovascular disease (CVD) risk. Evaluate the associations between coronary artery calcification (CAC) and Framingham risk score profile with sleep characteristics in middle-aged men and wo...

Objective: To test the association between self-reported unfair treatment and objective and self-reported sleep characteristics in African American and Caucasian adults. Design: Cross-sectional study of 97 African American and 113 Caucasian middle-aged adults. Main Outcome Measures: Participants completed: (a) two-night in-home, polysomnography (PS...

Hostility is associated with a number of metabolic risk factors for cardiovascular disease, including waist-hip ratio, glucose, and triglycerides. Along with hostility, many of these measures have also been shown to be associated with reduced central serotonergic function. We have previously reported that a citalopram intervention was successful in...

Repeated exposures to psychological stress can lead to or worsen diseases of slow accumulation such as heart diseases and cancer. The main challenge in addressing the growing epidemic of stress is a lack of robust methods to measure a person's exposure to stress in the natural environment. Periodic self-reports collect only subjective aspects, ofte...

To evaluate the relations between sleep characteristics and cardiovascular risk factors and napping behavior, and to assess whether daytime napping leads to subsequent better or worse sleep. The sample consisted of 224 (African American, Caucasian, and Asian) middle-aged men and women. Sleep measures included nine nights of actigraphy and sleep dia...

Ecological Momentary Assessment (EMA) is a technique used to collect real-time self-assessment data, often via interactive questionnaires. Frequently, EMA devices are implemented using PDAs. The PDA pen-based interaction is unsuitable for responding in certain situations that may be of interest, e.g. driving and walking, and is unsuitable for parti...

Given that emotional risk factors for coronary artery disease (CAD) tend to cluster within individuals, surprisingly little is known about how these negative emotions might influence one another over time. We examined the longitudinal associations among measures of depressive symptoms and hostility/anger in a cohort of 296 healthy, older adults. Pa...

An attenuation of the nighttime decline in blood pressure (BP) predicts cardiovascular disease and cardiovascular-related mortality, beyond daytime BP levels. We investigated whether positive and negative psychological attributes were associated with sleep-wake BP ratios and examined sleep parameters as potential mediators of these relationships. T...

Both the size and diversity of an individual's social network are strongly and prospectively linked with cardiovascular morbidity and mortality. Social relationships may influence cardiovascular outcomes, at least in part, via their impact on physiologic pathways influenced by stress, such as daytime blood pressure (BP) levels. However, scant resea...

This paper describes a study on continuous, non-intrusive stress detection from physiological measurements, involving data collection, feature extraction, and model con-struction. We built a personalized stress detection model based on Support Vector Machines, and evaluated it on the collected data. Experimental results show that our model can dete...

High-trait hostility is associated with persistent cigarette smoking. To better understand mechanisms that may account for this association, we examined the effects of acute smoking abstinence and delayed versus immediate smoking reinstatement on responses to a social stressor among 48 low hostile (LH) and 48 high hostile (HH) smokers. Participants...

Cross-sectional studies have found that individuals with depressive disorders or symptoms have elevated levels of inflammatory markers predictive of coronary artery disease, including interleukin-6 (IL-6) and C-reactive protein (CRP). Due to the paucity of prospective studies, however, the directionality of the depression–inflammation relationship...

Despite growing evidence that there is substantial nightly, intra-individual variability in sleep duration and fragmentation, few studies have investigated the correlates of such variability. The current study examined whether intra-individual variability in sleep parameters was associated with psychosocial and physiological indices of stress, espe...

To examine the association of positive and negative aspects of friendship to psychological well-being, self-care behavior, and blood glucose control and to determine whether these relations were moderated by gender. Adolescents with Type 1 diabetes (n = 76) completed baseline measures of friendship quality, depressive symptoms, and self-care. A mea...

Trait negative affect has been implicated as a risk marker for cardiovascular disease, but the mechanisms underlying this association are uncertain. Our aim was to examine associations between trait measures of anger, hostility, depression, and anxiety with endothelial dysfunction via brachial artery flow-mediated dilation (FMD), an early indicator...

Hostility is associated with an increased risk for cardiovascular disease (CVD). Because central serotonin may modulate aggression, we might expect selective serotonin reuptake inhibitors (SSRIs) to be effective in reducing hostility. Such effects have never been examined in individuals scoring high on hostility who are otherwise free from major Ax...

1) To characterize PSQI and ESS scores, and their relationship to each other, in an adult community sample; 2) To determine whether PSQI and ESS scores, in combination with each other, were associated with distinct demographic, clinical, and sleep characteristics. The PSQI, ESS, clinical rating scales, sleep diaries, actigraphy, and home polysomnog...

Elevated night time/daytime blood pressure (BP) ratios are associated with cardiovascular morbidity and mortality. We evaluated the associations between sleep/awake BP ratios and sleep disturbances. Sleep disturbances were assessed by in-home actigraphy and diary measures for nine nights, and polysomnography (PSG) for two nights; ambulatory BP was...

To examine the independent and interactive effects of race and socioeconomic status (SES) on objective indices and self-reports of sleep. The sleep of 187 adults (41% black; mean age = 59.5 +/- 7.2 years) was examined. Nine nights of actigraphy and two nights of inhome polysomnography (PSG) were used to assess average sleep duration, continuity, an...

This study sought to determine the role of hostility in moderating the effects of positive social interactions on ambulatory blood pressure (ABP). Participants (341 adults) completed the Cook-Medley Hostility Scale and underwent ABP monitoring, assessed every 45 min during waking hours across 6 days. An electronic diary measuring mood and social in...

Recent evidence suggests that depressive symptoms and hostility may act together, as interacting factors, to have an effect on the circulating levels of inflammatory markers relevant to coronary artery disease. Further research, however, is needed to clarify the nature of this interaction and to determine whether previous findings extend to older a...

The authors previously reported that individuals who rate their daily life as more demanding or less controllable by momentary electronic diary (ED) reports showed greater intima-medial thickness (IMT) by carotid ultrasonography. They now present prospective findings on this relation. Three hundred thirty-five healthy individuals (ages 50-70 at stu...

The set of techniques known collectively as real-time data capture (RTDC) is becoming increasingly important in medical research. Based on the collection of data in people's typical environments, RTDC is primarily used with self-reported data, such as medical symptoms and psychological states. Now, its guiding principles and supporting technologies...

We investigated the relationship between heart rate variability and preclinical carotid intima-media thickening, a putative index of atherosclerosis. A sample of 350 men and women (mean age 56.8 years) selected for the presence or absence of untreated hypertension was assessed for heart rate variability at rest and separately for carotid intima-med...

Although depression, anxiety, and hostility/anger have each been associated with an increased risk of coronary artery disease, these overlapping negative emotions have not been simultaneously examined as predictors of the progression of subclinical atherosclerosis. To evaluate the relative importance of depressive symptoms, anxiety symptoms, and ho...

The authors examined the utility of ecological momentary assessment for assessing spousal interactions in the natural environment among 245 healthy, married, older adults. Convergent validity for this method was demonstrated by (a) a positive association between marital adjustment (MA) and average diary ratings of agreeableness during spousal inter...

The authors examined whether cardiovascular reactivity to and recovery from psychological challenge predict 3-year change in blood pressure (BP) among 216 initially normotensive, community-dwelling adults. Clinic BP assessments were conducted at baseline and follow-up. BP and heart rate (HR) readings were obtained before, during, and after 5 psycho...

We describe an ecological momentary assessment (EMA) protocol designed to measure daily life experiences along several psychosocial dimensions (Social Conflict, Task Demand, Decisional Control, Negative Affect, and Arousal) hypothesized to be relevant for cardiovascular disease risk. In a large community sample, these assessments have been administ...

We employed Ecological Momentary Assessment (EMA) real-time recording in the natural setting to determine whether spousal interaction frequency predicts 3-year progression of carotid artery intima medial thickening (IMT). Participants were 250 healthy, older adults (M age = 61, 48% female) who, at baseline, underwent 6 days of ambulatory monitoring...