1. “Would You Call It Stress or Just Being Scared to Death?” Exploring the Relationship Between Stress Experienced During World War II and Subsequent Ischemic Heart Disease: The Manitoba Follow-Up Study Lisa Dwyer, MA (MSc Candidate) 1,2, Robert B. Tate, PhD 1,2 and T. Edward Cuddy, MD 2 1 Department of Community Health Sciences; 2 Manitoba Follow-up Study Faculty of Medicine, University of Manitoba, Winnipeg, Canada Longest-running prospective longitudinal study of cardiovascular disease in Canada Royal Canadian Air Force (RCAF) male aircrew recruits during World War II Cohort sealed on July 1, 1948 with 3,983 men Routine examinations including blood pressure, body weight and resting electrocardiograms obtained at regular intervals Ischemic Heart Disease (IHD) morbidity and mortality monitored Successful Aging questionnaires in 1996, 2000 and 2002 Website: www.mfus.ca Status of the Study at January 1, 2003: IHD documented in 1,286 (32%) men 2,561 (64%) men have died 1,422 (36%) assumed alive, at a mean age of 82 years Only 2% of cohort lost to follow-up during first 50 years of the study (1948-1998) Cohort members living in every province Few investigations have examined the potential relationship between wartime exposure to stress and outcomes of ischemic heart disease morbidity and / or mortality, especially among World War II veterans. Moreover, no consensus concerning the relationship exists among researchers who have conducted such studies. Hence, further investigation of this relationship is warranted. RATIONALE This research is supported (in part) by a Western Regional Training Centre studentship funded by Canadian Health Services Research Foundation, Alberta Heritage Foundation for Medical Research, and Canadian Institutes of Health Research. Ms. Dwyer will be participating in a field placement with Veterans Affairs Canada during the course of this study. In 1974, 1982, 1984, 1996, 2000, and 2002, questionnaires were administered to participants for the purpose of acquiring information on factors such as lifestyle habits, family history of disease, occupational profiles, smoking history, and physical, mental and social functioning. The 1982/84 questionnaire obtained individual written narratives from study participants concerning perceived stress experienced during the course of World War II while serving in the RCAF. This aspect of that survey was worded as follows: WORK IN PROGRESS The purpose of this “work-in-progress” poster is to present a research design that will be used to examine the relationship between stress experienced during war and development of ischemic heart disease morbidity and / or mortality or death due to other cardiovascular causes in an older adult male World War II veteran population. STRESS The importance of stress as a health factor is being increasingly recognized. Little, however, is known about the long-term effects of acute stress in early adulthood. The MFUS offers a unique opportunity for the scientific study of this question because of the wartime experience of its members. We would be grateful for your answers to the following questions: 1.What was your total wartime flying time, (training plus operational)? (hours) 2.What was your aircrew trade? 3.What commands did you serve in? 4.Give the number of operational tours completed? 5.During this period: 1.Were you married? / /Yes / /No 2.Did you have children? / /Yes / /No 6.What in your opinion were the most stressful experiences of your wartime services? Many of the narratives provided in the survey reveal to a certain extent not only the types of stresses, but also the ways in which the veterans coped with stressful experiences. As a result, the study will incorporate a mixed methods design, i.e. both quantitative and qualitative methods. The potential for multiple experiences, the frequency of occurrence of specific war events, and possible confounding lifestyle factors make the use of a multivariate regression model pertinent in analyzing the stress responses in relation to subsequent disease. The results of this macro-level analysis will in turn inform the types of questions asked in the second stage of the project — the qualitative component. The purpose of conducting the qualitative interviews is to supplement the quantitative analysis by providing a more in-depth, personal view of the experience of stress during war by a small number of veterans. A content analysis will be used to examine the interviews. The proposed temporal sequence of this design is presented above to the right. A mixed method framework has several advantages: the study will explain the relationship between exposure to wartime stress and the development of ischemic heart disease in older male veterans. personal narratives allow individuals to reveal how they understand and cope with memories of wartime stress and / or living with ischemic heart disease. personal narratives also allow individuals to reveal ways in which they integrate personal explanations of stress and health status with epidemiological or biomedical explanations. Adhering to a different ethical standard, written informed consent was not collected from the aircrew members in 1948. The Human Ethics Committee at the University of Manitoba stated that the continual participation of the study members to respond to annual questionnaires is, for all intents and purposes, informed consent. This proposed design requires diverging from practices normally employed in previous research projects conducted at MFUS. A separate ethics approval process will be obtained due to the unique nature of this research. METHODOLOGICAL CONSIDERATIONS 1982/84 STRESS SURVEY OBJECTIVE THE MANITOBA FOLLOW-UP STUDY POLICY IMPLICATIONS ETHICAL CONSIDERATIONS ACKNOWLEDGEMENTS