Goals of CCBAR: Foster interdisciplinary research community Establish means of exchanging rapidly evolving ideas related to biomarker collection in population-based health research Translation to clinical, remote, understudied areas

Population surveys Provide more detailed information on specific topics compared to censuses Cover relatively small proportion of population (usually several thousand) Population-based survey – random sample of the total population; represents existing groups of population

New trends in health surveys Harmonization of surveys at world scale Biomarker collection

Large-scale study of health and retirement of older americans Survey of more that americans older than 55 years every 2 years. Started in 1992

HRS-harmonizing studies UK English Longitudinal Study of Ageing (ELSA) Study on Health, Ageing and Retirement in Europe (SHARE) WHO Study on global AGEing and adult health (SAGE) including Russia Отдельные исследования в Мексике, Китае, Индии, Японии, Корее, Ирландии

Introduction to:

Public Dataset

NSHAP Collaborators Co-Investigators Linda Waite, PI Ed Laumann Wendy Levinson Martha McClintock Stacy Tessler Lindau Colm O’Muircheartaigh Phil Schumm NORC Team Stephen Smith and many others Collaborators David Friedman Thomas Hummel Jeanne Jordan Johan Lundstrom Thomas McDade Ethics Consultant John Lantos Outstanding Research Associates and Staff

Affiliated Investigators and Labs LABSPECIMENS ASHATest results Lundstrom, SwedenOlfaction Hummel, GermanyGustation Magee Women’s Hospital, Jeanne Jordon Vaginal Swabs, Orasure TM McClintock Lab, Univ. Chicago Vaginal Cytology McDade Lab, Northwestern Univ. Blood Spots SalimetricsSaliva USDTL*Urine

Corporate Contributions and Grants ItemCompany/Contact Information Smell pens Martha McClintock, Institute for Mind and Biology at the University of Chicago OraSure  collection device Orasure Technologies Digital scalesSunbeam Corporation Blood pressure monitorsA & D Lifesource Vision charts David Freidman, Wilmer Eye Institute at the Johns Hopkins Bloomberg School of Public Health Filter paper for blood spot collection Schleicher & Schuell Bioscience Blood pressure cuff (large size) A & D Lifesource OraSure  Western Blot Kit Biomerieux Company HPV kitsDigene Laboratory Boxes of swabsDigene Laboratory 2-point discriminatorsRichard Williams

Study Timeline Funding: NIH / October, 2003 Pretest: September – December, 2004 Wave I Field Period: June 2005 – March 2006 Wave I Analysis: Began October, 2006

He, W., Sengupta, M., Velkoff, V. A., DeBarros, K. A. (2005). 65+ In the United States: Current Population Reports: Special Studies, U. S. Census Bureau.

Interview 3,005 community-residing adults ages Population-based sample, minority over-sampling 75.5% weighted response rate 120-minute in-home interview Questionnaire Biomarker collection Leave-behind questionnaire NSHAP Design Overview

MenWomen (n=1455)(n=1550) AGE RACE/ETHNICITY White African-American Latino Other RELATIONSHIP STATUS Married Other intimate relationship No relationship SELF-RATED HEALTH Poor/Fair Good Very good/Excellent Est. Pop. Distributions (%)

Medical Physical Health Medications, vitamins, nutritional supplements Mental Health Caregiving HIV Women’s Health Ob/gyn history, care Hysterectomy, oophorectomy Vaginitis, STDs Incontinence Demographics Basic Background Information Marriage Employment and Finances Religion Social Networks Social Support Activities, Engagement Intimate relationships, sexual partnerships Physical Contact Domains of Inquiry

Demographic Variables: Age Race/Ethnicity Education Insurance Status Self-Report Measures

Social/Sexuality Variables: Spousal/other intimate partner status Cohabitation Lifetime sex partners Sex partners in last 12 months Frequency of sex in last 12 months Frequency of vaginal intercourse Condom use Self-Report Measures

Health Measures: Obstetric/Gynecologic history Number of pregnancies Duration since last menstrual period Hysterectomy Physical health Overall health Co-morbidities Health behaviors Tobacco use Pap smear, pelvic exam history Cancer Self-Report Measures

NSHAP Biomeasures Blood: hgb, HgbA1c, CRP, EBV Saliva: estradiol, testosterone, progesterone, DHEA, cotinine Vaginal Swabs: BV, yeast, HPV, cytology Anthropometrics: ht, wt, waist Physiological: BP, HR and regularity Sensory: olfaction, taste, vision, touch Physical: gait, balance

NSHAP Biomeasures Cooperation

Principles of Minimal Invasiveness Compelling rationale: high value to individual health, population health or scientific discovery In-home collection is feasible Cognitively simple Can be self-administered or implemented by single data collector during a single visit Affordable Low risk to participant and data collector Low physical and psychological burden Minimal interference with participant’s daily routine Logistically simple process for transport from home to laboratory Validity with acceptable reliability, precision and accuracy Lindau ST and McDade TW Minimally-Invasive and Innovative Methods for Biomeasure Collection in Population-Based Research. National Academies and Committee on Population Workshop. Under Review.

McClintock Laboratory (Cytology) Jordan Clinical Lab Magee Women’s Hospital (Bacterial, HPV Analysis) McDade Lab Northwestern (Blood Spot Analysis) Salimetrics (Saliva Analysis) “Laboratory Without Walls” UC Cytopathology (Cytology) NSHAP Biomeasures

Sex hormone assays Salivary Biomeasures Estradiol Progesterone DHEA Testosterone Cotinine

Salivary Sex Hormones (preliminary analysis) log(progesterone) Frequency log(estradiol) Frequency log(testosterone) Frequency Units: pg/ml

Nicotine metabolite Objective marker of tobacco exposure, including second-hand Non-invasive collection method (vs. serum cotinine) Salivary Cotinine

10 ng15 ng34 ng 10% M 103 ng 30% M 344 ng M Nonsmoker Passive Occasional Regular Fraction log(Cotinine) M = mean cotinine among female who report current smoking Bar on left corresponds to cotinine below level of detection Cut-points based on distribution among smokers Classification of Smoking Status by Cotinine Level in Females Distribution of Salivary Cotinine

C-Reactive Protein (CRP) Epstein-Barr Virus (EBV) Antibody Titers Dried Blood Spots Thanks, Thom and McDade Lab Staff!

Challenges for Predicting Mortality

Accuracy Measurement errors (e.g., sex hormones) Individual variability (e.g., CRP)

Different risk factors at different ages Examples: Cholesterol Blood pressure

Blood Pressure, Lipids and Mortality Risk among older Costa Ricans Source: Rosero-Bixby, Dow, Pop. Health Metrics, 2012

More Information on Biomarkers is Available at the CCBAR website

Is sex an “integral part” of health at older ages? What is health? Subjective measures Functional measures Biomeasures What aspects of health are most highly associated with sexual function at older ages? SEX HEALTH

National survey conducted in 1994/95 7,189 Americans aged core national sample (N=3,485) city oversamples (N=957) Strata: age, self-reported health status Control variables : partner status, partner health, race, education

Domains of Inquiry Childhood family background Psychological turning Community involvement Neighborhood Life overall Social Networks Physical Health Sexuality Personal beliefs Work and Finances Children Marriage Religion

MIDUS study

SEXUALITY AND HEALTH Self-rated physical health is higher among sexually active women Women with very good and excellent health are more sexually active at all ages Satisfaction with sexual aspect of life is higher among women with very good and excellent health compared to women with poor health

How to Compare Sexual Activity Across Populations? We suggest to use a new measure – Sexually Active Life Expectancy (SALE) Calculated using the Sullivan method Based on self-reported prevalence of having sex over the last 6 months (MIDUS and NSHAP studies) Life tables for the U.S. population in 1995 and 2003 (from Human Mortality Database)

Prevalence of Sexual Activity by Age and Gender (MIDUS 1)

Prevalence of Sexual Activity by Age and Gender (MIDUS 1) Men and women having intimate partner

Publication on sexuality Lindau, Gavrilova, British Medical Journal, 2010, 340, c810

Life expectancy and sexually active life expectancy (SALE) Based on the MIDUS study

Sexually active life expectancy and self-rated health Based on the MIDUS study