Compliance with ambulatory saliva sampling in the Chicago health, aging, and social relations study and associations with social support

Background: Noncompliance with instructed saliva sampling times in ambulatory settings can compromise resulting cortisol findings. Purpose and Methods: Here, the impact of noncompliance on the cortisol awakening response (CAR), an established marker for hypothalamic-pituitary-adrenalaxis activity, was examined over 3 sampling days in middle- and older-age participants in the Chicago Health, Aging, and Social Relations Study. Results: Noncompliant participants had a significantly lower cortisol rise after awakening (assessed by an awakening sample and a 30-min after awakening sample) on 2 of the 3 sampling days (Day 1, ns; Days 2 & 3, ps < .02). Furthermore, social support measured by the Interpersonal Support Evaluation List correlated negatively with the number of "noncompliant" samples (r = -.19, p < .05), indicating that participants reporting more social support had more "compliant" samples. Conclusion: The results confirm that nonadherence to saliva sampling in ambulatory settings can exert a significant impact on the resulting CAR. Furthermore, the data raise the idea that the extent of nonadherence might be systematically associated with psychosocial factors like social support. For future studies on the relationship between CAR and psychological factors, we therefore recommend controlling for saliva sampling adherence because noncompliance might be systematically associated with the phenomenon being investigated.