CHARACTERIZING PATHWAYS

A variety of measurement and data analytic questions need to be resolved before multiple topics discussed in this report can be characterized with precision. Prediseases pathways, life histories of resilience in the face of adversity, and delineation of the biology of flourishing are among phenomena that call for methodological innovation. Priority topics include the need for greater investment in longitudinal designs, the measurement of numerous components of predisease pathways (e.g., childhood and early life influences, work and unemployment, positive health and resilience, collective properties and inequalities), the need to advance understanding of biological mechanisms, and the need for innovative methods of data analysis.

Investment in Longitudinal Studies

Implementation of the integrative perspective requires longitudinal assessment at multiple levels (psychosocial and biological) on the same individuals. This raises the practical question of how comprehensive such measurement can be on single populations and where inferences about pathways must be derived from studies of multiple populations. Concerning psychosocial and biological measures on the same population, several longitudinal studies illustrate needed future directions. The MacArthur Study of Successful Aging (Seeman et al., 1997) has measures of social integration and social support together with assays of glucocorticoids, catecholamines, cholesterol, glycosylated hemoglobin, blood pressure, and measures of adipose tissue deposition (thereby representing the preliminary operationalization of the concept of allostatic load) on the same individuals. A subsample of the Wisconsin Longitudinal Study (WLS) contains extensive psychosocial life history data (over a span of 40 years), community-level information, and multiple neurophysiological assessments (e.g., measures in the current allostatic load inventory, immune system assays of antibody responses to influenza and hepatitis A vaccine, EEG assessments of brain asymmetry, and fMRI assessments; e.g., Singer and Ryff, 1999). The 1999 round of the National Long Term Care Survey contains an extensive array of biomarkers, including assessment of apolipoprotein E (apoE) markers of genetic susceptibility to onset of Alzheimer's. 1 The Whitehall II study of British civil servants (Marmot et al., 1991) and the 1946 (Wadsworth and Kuh, 1997) and 1958 (Power and Matthews, 1998) British birth cohorts each have new biomarker data collections simultaneous

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The data are available electronically: Alzheimer's: http://cds.duke.edu/NLTCS-INTRO.HTML.



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