title: Hostility and adiposity mediate disparities in insulin resistance among adolescents and young adults.
abstract: OBJECTIVE
  This study explores whether the relationship between lower socioeconomic status and insulin resistance in adolescents is mediated by both physiological and psychological factors associated with increased cardiometabolic risk.
  
  
  METHODS
  School-based longitudinal cohort study of 1222 healthy, non-Hispanic black and white teens. Parent education (PE), youth-specific Cook-Medley hostility scale, waist circumference, height, weight, pubertal status, and fasting plasma insulin (FPI) were measured and FPI reassessed 1 year later. Regression analyses utilizing bootstrapping (n=2000) were used to estimate the direct and indirect effects of PE on FPI and assess the role of hostility and adiposity while adjusting for covariates.
  
  
  RESULTS
  Lower PE predicted higher FPI (B=-1.52, P=.003), as did hostility (B=.19, P=.002) and adiposity (waist circumference B=.44, P<.001, BMI B=.98, P<.001). The effect of PE on FPI was mediated by both hostility and adiposity. When adiposity and hostility were accounted for, the effect of PE on FPI decreased by 32% (B=-1.04, P=.04); the total indirect estimate was -.485 (95% CI, -.652, -.041). Hostility accounted for 36% of the meditational effect.
  
  
  CONCLUSIONS
  Lower PE influences insulin resistance through adiposity and hostility. Thus, interventions to reduce health disparities associated with insulin resistance should consider both physiological and psychological approaches.
authors.affiliation: Floating Hospital for Children at Tufts Medical Center, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02114, USA. egoodman3@partners.org
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Goodman
authors.forename: Aviva
authors.initials: A
authors.lastname: Must
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Daniels
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Dolan
mesh_terms: D050154:Adiposity / Q000208:ethnology; D000293:Adolescent; D044383:Black People / Q000706:statistics & numerical data*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000208:ethnology*; D015331:Cohort Studies; D005260:Female; D006791:Hostility; D006801:Humans; D007333:Insulin Resistance / Q000208:ethnology*; D008297:Male; D009765:Obesity / Q000208:ethnology*; D011446:Prospective Studies; D012572:School Health Services; D012959:Socioeconomic Factors; D055105:Waist Circumference; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult