1. Paper Symposium: Social Support and Social Trauma Predict Long-Term Physical Health Outcomes: Exploring Mechanisms and Sensitive Periods

2. Mid-Adolescent Peer Relationship Qualities as Predictors of Physical Health Outcomes at Ages 25-27 Joe Allen Emily Loeb Rachel Narr University of Virginia We gratefully acknowledge grant support from NIMH & NICHD (#’s 2R01HD058305 & R01-MH58066). Copies of related papers are available at: www.Teenresearch.org Collaborators: Maryfrances Porter, Ph.D. Kathleen McElhaney, Ph.D. Joseph Tan Sarah Coe-Odess Lauren Elreda, Ph.D. Farah Williams, Ph.D. Chris Hafen, Ph.D. Megan Schad Lauren Everhart Elie Hessel Christy McFarland, Ph.D. Emily Marston, Ph.D. Erin Miga, Ph.D. Amanda Hare, Ph.D. Jessica Kansky

3. Social Relationships and Physical Health Surprisingly Powerful Links Social isolation linked to: Numerous Health Problems Including Early Mortality Effects Comparable to Physical Risk Factors (e.g., cigarette smoking)

4. Social Relationships and Physical Health Hypothesized Mechanisms Health Behavior Poor Physical Health as Creating Social Isolation Stress/Allostatic Load

5. Social Relationships and Physical Health Hypothesized Mechanisms Humans as Pack Animals Needing Social Contact to Thrive

6. Overarching Question Can we identify Social relationship qualities that predict Long-term health outcomes?

7. Sample 184 Adolescents (followed from age 13 to 29), their Parents, Best Friends, Other Friends, Romantic Partners (Blood samples from 108 thus far). 184 Adolescents (followed from age 13 to 29), their Parents, Best Friends, Other Friends, Romantic Partners (Blood samples from 108 thus far). Intensive Interviews and Observations with all parties (Total N over first 15 years ~ 3400). Intensive Interviews and Observations with all parties (Total N over first 15 years ~ 3400). Equal numbers of Males and Females Equal numbers of Males and Females Socio-economically Diverse (Median Family Income= $40- $60K) Socio-economically Diverse (Median Family Income= $40- $60K) 31% African American; 69% European American 31% African American; 69% European American Very Low Attrition (98% participation rate in current phase) Very Low Attrition (98% participation rate in current phase)

8. Can We Prospectively Identify Adolescent Relationship Qualities That Will Predict Their Health as Adults? Prior Findings: Predictors of Early Adult Reported Physical Health (SRA, 2014; Allen, Uchino, & Hafen, 2015 Psychological Science)

9. Assessing Global Adult Health at 25 5-item Self-Report Scale 5-item Self-Report Scale (Medical Outcomes Study Short-form Health Survey, DeSalvo, 2006) Cronbach’s =.83 Cronbach’s α =.83

10. Assessing Global Adult Health Links from Prior Literature Global Health Assessment Objective Markers of Illness Early Mortality Future Illness

11. Close Friendship Quality Age 14 Combination of Two Peer-report Measures: Close Friend Attachment to Target Teen: Close Friend Attachment to Target Teen: Inventory of Parent and Peer Attachment (Armsden & Greenberg, 1987) Inventory of Parent and Peer Attachment (Armsden & Greenberg, 1987) Overall Friendship Quality with Target Teen: Overall Friendship Quality with Target Teen: Friendship Quality Questionnaire (Parker & Asher, 1993) Friendship Quality Questionnaire (Parker & Asher, 1993)

12. Composite Measure of Allocentrism (Ages 14 -17) Communal Focus – Emphasis on Group Harmony Combination of Three Peer-report Measures: Teen as Follower (age 14) Teen as Follower (age 14) Teen Influenced by Peers (Age 16) Teen Influenced by Peers (Age 16) Teen Assertiveness (Age 17; reverse-scored) Teen Assertiveness (Age 17; reverse-scored) Standardized and summed together. Standardized and summed together. Conceptually Allocentrism is the opposite of “Rugged Individualism” Conceptually Allocentrism is the opposite of “Rugged Individualism”

13. Physical Health Quality Age 14-17Age 25-27 History of Serious Illness Prior to Age 18 Allocentrism vis-a-vis Peers Body Mass Index Internalizing Symptoms Close Friendship Quality Age 13 Family Income Gender -.32** -.19** -.17* -.19**.19**.21** Direct Pathway to Health Quality -.16* Depressive Symptoms.19** -.20**.15* Potential Mediated Pathway to Health Quality Friendship and Communal Focus Directly and Indirectly Predict Adult Reported Health Quality

14. Turning from Friendship and Communal Focus Predicting Self-reported Current Health Quality Current Study: To Now Assess: Measures of Conflict Management Predicting Physiological Factors Linked to Long-term Physical Health Outcomes

15. Interleukin-6 Cytokine (small protein involved in cell signalling). Cytokine (small protein involved in cell signalling). Regulates the maturation, growth, and responsiveness of particular cell populations Regulates the maturation, growth, and responsiveness of particular cell populations Linked to aging; levels increase with age Linked to aging; levels increase with age Measured via blood samples Measured via blood samples High levels in blood stream predict: High levels in blood stream predict: Tumor progression in cancer Tumor progression in cancer Arthritis Arthritis Osteoporosis Osteoporosis Cardiovascular disease Cardiovascular disease Mortality risk Mortality risk

16. Why Conflict Might Predict Levels of Interleukin-6 Links to Social Stress Links to Social Stress Associations with high stress roles in Adulthood Associations with high stress roles in Adulthood Caring for a parent with Alzheimer’s Disease Caring for a parent with Alzheimer’s Disease Likely Mechanism: Chronic Stress Reactions Likely Mechanism: Chronic Stress Reactions Release of Cortisol  Immune System Effects Release of Cortisol  Immune System Effects Conflictual Relationships as a Potentially Potent Social Stressor Conflictual Relationships as a Potentially Potent Social Stressor

17. Primary Question: Do Adolescent Conflict Management Patterns Predict Adult Levels of Interleukin-6?

18. Interleukin-6 (covariates) Associated with Body Mass Index Associated with Body Mass Index Focusing today only on predictors after accounting for BMI Focusing today only on predictors after accounting for BMI BMI was assessed directly in adulthood BMI was assessed directly in adulthood BMI was assessed via a proxy measure in early adolescence (observer-rated physical attractiveness, which is highly correlated with BMI, r =.68) BMI was assessed via a proxy measure in early adolescence (observer-rated physical attractiveness, which is highly correlated with BMI, r =.68) Linked to Income/Poverty Linked to Income/Poverty Poverty as a stressor Poverty as a stressor

19. Observed Autonomy with Close Peer (Age 13) 7-minute Revealed Differences task 7-minute Revealed Differences task Observing Handling of Disagreements over Hypothetical Task Observing Handling of Disagreements over Hypothetical Task Coded with Autonomy & Relatedness Coding System for Peer Interactions (Allen et al., 2001) Coded with Autonomy & Relatedness Coding System for Peer Interactions (Allen et al., 2001) Behaviors that Facilitate Friendly Resolution of the Disagreement: Behaviors that Facilitate Friendly Resolution of the Disagreement: Autonomous Behaviors: Autonomous Behaviors: Focus on reasoning and persuasion Dyadic Assessment: Summing codes for both parties’ behaviors Dyadic Assessment: Summing codes for both parties’ behaviors

20. Interleukin-6 Predicting Adult Levels of Interleukin-6 Age 13 Adolescent-era Family Income and Current Body Mass Index are both Predictive Family Income Body Mass Index.60*** Age 26 _ -.23** R 2 =.41***

21. Interleukin-6 Adolescent Conflict Management Predicts Adult Levels of Interleukin-6 Age 13 Peer Interactions Characterized by Mutual Autonomous Discussion Predict LOWER levels of Adult IL-6 Family Income Body Mass Index.58*** Age 26 _ Autonomy w/ Peer* -.15* -.20** *Coded from Observed Interactions R 2 =.46*** R 2 change =.03* -.24**

22. Conflict Resolution with Close Peer (Age 16) From Friendship Quality Questionnaire (Parker & Asher, 1993) From Friendship Quality Questionnaire (Parker & Asher, 1993) Close-friend’s report about our participant Close-friend’s report about our participant 3 items tapping ability to get over being mad, resolving arguments quickly and making up easily after a fight. 3 items tapping ability to get over being mad, resolving arguments quickly and making up easily after a fight. Cronbach’s =.75 Cronbach’s α =.75

23. Interleukin-6 Adolescent Conflict Management Predicts Adult Levels of Interleukin-6 Age 13 More Successful Conflict Resolution with Peers Predicts LOWER levels of Adult IL-6 Family Income Body Mass Index.63*** Age 26 _ Age 16 Conflict Resolution w/ Peer -.22** R 2 =.46*** R 2 change =.05**

24. Autonomy-Relatedness Struggles with Romantic Partner (Age 21) 8-minute Revealed Differences task 8-minute Revealed Differences task Observing Handling of Actual Disagreements in Romantic Relationship Observing Handling of Actual Disagreements in Romantic Relationship Coded with Autonomy & Relatedness Coding System for Romantic Partners (Allen et al., 2007) Coded with Autonomy & Relatedness Coding System for Romantic Partners (Allen et al., 2007) Behaviors that make it difficult to resolve a disagreement in a mutually agreeable manner: Behaviors that make it difficult to resolve a disagreement in a mutually agreeable manner: Behaviors Undermining Autonomy Enmeshing, overpersonalizing, pressuring behavior Behaviors Undermining Relatedness Behaviors Undermining Relatedness Rudeness and hostility

25. Interleukin-6 Adolescent Conflict Management Predicts Adult Levels of Interleukin-6 Age 13 Observed Struggles Handling Conflict in Romantic Relationships Predict HIGHER levels of Adult IL-6 Family Income Body Mass Index.59*** Age 26 _ Age 21 Rom. Auton. Struggles*.29*** -.17* *Coded from Observed Interactions R 2 =.48*** R 2 change =.07***

26. Romantic Relationship Stress (Age 26) Romantic Life Satisfaction Measure Romantic Life Satisfaction Measure 3 items capturing stress, worry and feeling a need to make changes in current romantic life 3 items capturing stress, worry and feeling a need to make changes in current romantic life Cronbach’s Cronbach’s α =.81

27. Interleukin-6 Adolescent Conflict Management Predicts Adult Levels of Interleukin-6 Age 13 Greater Perceived Concurrent Romantic Relationship Stress in Adulthood is Associated with HIGHER levels of IL-6 Family Income Body Mass Index.62*** Age 26 _ Romantic Rel. Stress.19** -.24*** R 2 =.45*** R 2 change =.04**

28. Conflict Management Across Adolescence Repeatedly Appears as a Predictor of Adult Interleukin-6 Levels

29. The Question of Potential Residual/Lingering Effects: Does Early Conflict Management Contribute to Predicting Adult Interleukin-6 Levels AFTER Accounting for Later Conflict Management?

30. Interleukin-6 Adolescent Conflict Management Predicts Adult Levels of Interleukin-6 Age 13 Peer Interactions Characterized by Mutual Autonomous Discussion Predict LOWER levels of Adult IL-6 Family Income Body Mass Index.58*** Age 26 _ Autonomy w/ Peer* -.15* -.20** *Coded from Observed Interactions R 2 =.46*** R 2 change =.03* -.24**

31. Interleukin-6 Adolescent Conflict Management Predicts Adult Levels of Interleukin-6 Age 13 Prior Conflict Management Processes Remain as Predictors Even After Considering Later Conflict Management at Age 16 Family Income Body Mass Index.61*** Age 26 _ Age 16 Conflict Resolution w/ Peer -.22** Autonomy w/ Peer*.-.17* -.20** *Coded from Observed Interactions R 2 =.48*** R 2 change =.07** -.24**

32. Interleukin-6 Adolescent Conflict Management Predicts Adult Levels of Interleukin-6 Age 13 Family Income Body Mass Index.61*** Age 26 _ Age 21 Rom. Auton. Struggles*.24** Age 16 Conflict Resolution w/ Peer.-.20** Autonomy w/ Peer* -.11 -.15* *Coded from Observed Interactions R 2 =.52*** R 2 change =.11*** -.24** Age 16 Conflict Management Processes Remain as Predictors Even After Considering Later Conflict Management at Age 21

33. Interleukin-6 Adolescent Conflict Management Predicts Adult Levels of Interleukin-6 Age 13 Family Income Body Mass Index.62*** Age 26 _ Romantic Rel. Stress.15* Age 21 Rom. Auton. Struggles*.19* Age 16 Conflict Resolution w/ Peer -.19** Autonomy w/ Peer* -.14* -.17* *Coded from Observed Interactions R 2 =.54*** R 2 change =.13*** -.24** Prior Conflict Management Processes Remain as Predictors Even After Considering Later Conflict Management at Ages 16-26

34. Conclusions Problematic Conflict Management in Adolescence Consistently Predicts Adult IL-6 Levels Problematic Conflict Management in Adolescence Consistently Predicts Adult IL-6 Levels Significant long-term health/aging implications Significant long-term health/aging implications Effects Appear Cumulative (vs. Mediated) Effects Appear Cumulative (vs. Mediated) Future Repair/Improvement in Conflict Management does NOT eliminate prediction from earlier conflict management Future Repair/Improvement in Conflict Management does NOT eliminate prediction from earlier conflict management Adolescent Social Relationships and Future Physical Health Adolescent Social Relationships and Future Physical Health Copies of related papers are available at: www.TeenResearch.org

35. Limitations Correlational not Causal Correlational not Causal Did not have baseline IL-6 assessments Did not have baseline IL-6 assessments Still Need to Understand Possible Mediating and Moderating Mechanisms! Still Need to Understand Possible Mediating and Moderating Mechanisms! Stress response patterns Stress response patterns Other physical health indices Other physical health indices Cardiovascular reactivity/ C-Reactive Protein, etc. Cardiovascular reactivity/ C-Reactive Protein, etc. Copies of related papers are available at: www.TeenResearch.org

36. Implications Peer Relationships and peer pressure really may be ‘life and death’ issues for teens. Peer Relationships and peer pressure really may be ‘life and death’ issues for teens. Targets of Well-child Visits Targets of Well-child Visits Need for interventions to enhance peer relationships Need for interventions to enhance peer relationships Copies of related papers are available at: www.TeenResearch.org