Racial Discrimination and Stigma Consciousness Are Associated with Higher Blood Pressure and Hypertension in Minority Men

Investigating the Associations of Sexual Minority Stressors and Incident Hypertension in a Community Sample of Sexual Minority Adults

BACKGROUND

Sexual minority adults are at higher risk of hypertension than their heterosexual counterparts. Sexual minority stressors (i.e., unique stressors attributed to sexual minority identity) are associated with a variety of poor mental and physical health outcomes. Previous research has not tested associations between sexual minority stressors and incident hypertension among sexual minority adults.

PURPOSE

To examine the associations between sexual minority stressors and incident hypertension among sexual minority adults assigned female sex at birth.

METHODS

Using data from a longitudinal study, we examined associations between three sexual minority stressors and self-reported hypertension. We ran multiple logistic regression models to estimate the associations between sexual minority stressors and hypertension. We conducted exploratory analyses to determine whether these associations differed by race/ethnicity and sexual identity (e.g., lesbian/gay vs. bisexual).

RESULTS

The sample included 380 adults, mean age 38.4 (± 12.81) years. Approximately 54.5% were people of color and 93.9% were female-identified. Mean follow-up was 7.0 (± 0.6) years; during which 12.4% were diagnosed with hypertension. We found that a 1-standard deviation increase in internalized homophobia was associated with higher odds of developing hypertension (AOR 1.48, 95% Cl: 1.06-2.07). Stigma consciousness (AOR 0.85, 95% CI: 0.56-1.26) and experiences of discrimination (AOR 1.07, 95% CI: 0.72-1.52) were not associated with hypertension. The associations of sexual minority stressors with hypertension did not differ by race/ethnicity or sexual identity.

CONCLUSIONS

This is the first study to examine the associations between sexual minority stressors and incident hypertension in sexual minority adults. Implications for future studies are highlighted.

"Does Religious Service Attendance Modify the Relationship between Everyday Discrimination and Risk of Obesity? Results from the Study on Stress, Spirituality and Health"

This study examined the association of everyday discrimination with risk of obesity and the potential modifying effect of religious service attendance. Participants included Black, South Asian, and white women in three cohort studies that belong to the Study on Stress, Spirituality and Health. Logistic regression models estimated odds of obesity classification (BMI ≥ 30) relative to experiences of everyday discrimination. In initial pooled analyses, high levels of discrimination were related to increased odds of obesity. Race-specific analyses revealed marginal associations for white and South Asian women. Among Black women, high levels of discrimination and religious service attendance were both associated with higher odds of obesity. However, among women who attended religious services frequently, higher levels of everyday discrimination were associated with slightly lower odds of obesity. These findings underline the complex association between obesity and religion/spirituality, suggesting that higher levels of discrimination may uniquely activate religious resources or coping strategies. Findings highlight the need for additional studies to examine the impact of everyday discrimination on risk of obesity across racial/ethnic communities and how religious practices or coping strategies might affect these dynamics.

Antihypertensive medication adherence and persistence among Black women: A qualitative study

ABSTRACT

The prevalence of hypertension in Black women (57.6%) is among the highest in the world. Many of those who identify as Black do not readily adhere to prescribed antihypertensive medications nor persist with long-term therapy. This qualitative study describes self-reported approaches used by Black women with consistent adherence and persistence to medication-taking for BP control.

Pre-Exposure Prophylaxis Interventions among Black Sexual Minority Men: A Systematic Literature Review

Background: Interventions to promote HIV pre-exposure prophylaxis (PrEP) among Black sexual minority men (BSMM) are especially important, given the disproportionate HIV incidence and relatively low uptake of PrEP among BSMM. Methods: We conducted a systematic literature review to identify the characteristics of interventions between 2016 and 2021 promoting PrEP use among BSMM. We synthesized these studies based on sample size, location, the use of peer-based delivery, and key intervention targets. Results: Of the starting total 198 articles, 10 were included in the final review, with the majority of included studies being randomized controlled trials. We identified providing PrEP access, PrEP counseling, HIV and PrEP education, linkage to general health care, and peer-based support as key successful intervention components. The starkest difference between interventions with and without demonstrated PrEP improvements was the outcome: all interventions focused on PrEP initiation led to large improvements, but those focused on PrEP adherence did not. No other factors demonstrated distinct differences between successful and unsuccessful interventions. Conclusion: We identified notable differences in intervention efficacy between PrEP initiation and PrEP adherence outcomes; PrEP adherence is necessary for optimal HIV prevention. Future interventions promoting and measuring PrEP adherence, with a focus on cultural competence and peer components, are recommended.

Do trait psychological characteristics moderate sympathetic arousal to racial discrimination exposure in a natural setting?

Personality and psychological traits are known to influence how individuals react to and cope with stress, and thus, have downstream health and aging consequences. However, research considering psychological health traits as individual-level difference factors moderating the links been racism-related stress and health for racial and ethnic minorities in the United States is rare. Using intensive daily diaries and a wearable sensor that continuously recorded sympathetic nervous system arousal in a sample of racial and ethnic minority college students (80% African American, first-generation Black, or African; 20% Latinx), we linked arousal to racism-related experiences dynamically throughout the day as participants naturally went about their lives. Findings suggest that multiple traits are associated with increased arousal in real time when interpersonal discrimination is perceived, but that only anger and anxiety also predicted increased arousal during moments of rumination and reflection on race-related inequities. Vicarious discrimination exposure moments were also linked to suppressed arousal in general, but particularly for more anxious individuals. We use a stress appraisal and coping framework to elucidate the ways in which individual psychological differences may inform physiological responses to race-related stress. The biopsychosocial pathways by which cognitive appraisal and interpersonal race-related stress contribute to racial health disparities are also discussed.

Black Lives Matter in Science Engineering and Medicine : Cato T. Laurencin, M.D., Ph.D.: Winner of the 2020 Herbert W. Nickens Award of the Association of American Medical Colleges, Acceptance Remarks

Addressing racism is key in moving forward as a nation and creating a more equitable environment. Within this paper, Cato T. Laurencin, M.D., Ph.D. describes the critical need to shift from diversity, inclusion, and equity (D.I.E.) to inclusion, diversity, equity, anti-racism, and learning (I.D.E.A.L.)

A Qualitative Study: Hypertension Stigma Among Black Women

BACKGROUND

The prevalence of hypertension (HTN) in Blacks is among the highest in the world. For Black women, 46% experience stage 2 HTN (blood pressure [BP] ≥140/90 mm Hg) as compared with 42% of Black men. Because of higher rates of stage 2 HTN, Black women have greater rates of cardiovascular disease and stroke. For reasons unknown, nonadherence to lifestyle modifications and antihypertensive medications continues. An understudied potential factor associated with poor adherence to the treatment regimen and negative health outcomes is stigma.

OBJECTIVE

The aim of this study was to gain insight and describe the psychological factor of stigma as an influence on poorly controlled HTN in Black women.

METHODS

Hypertensive Black women attending a 6-week self-management program were invited to participate in an open-ended questionnaire. Six groups were held with 62 women aged 24 to 70 years, with group size ranging from 10 to 15. Women anonymously wrote their answer to 2 questions to capture individual responses without group persuasion. Data were analyzed using thematic analysis.

RESULTS

Five themes were generated inductively from the data and included (1) desire to get control, (2) shame and embarrassment, (3) obesity characterizations, (4) stereotype threats, and lastly, (5) disrupted normality. During member checking, younger participants were more vocal about stigma, whereas older participants did not view stigma as problematic.

CONCLUSIONS

Hypertension stigma could potentially deter adherence to high BP treatment. Further research is needed to explore the prevalence of stigma in this population and its impact on behaviors that hinder BP control.

Skin tone, life satisfaction, and psychological distress among African Americans: The mediating effect of stigma consciousness

This study examined the indirect effect of skin tone on psychological distress via (1) stigma consciousness and (2) life satisfaction among African American adults (N = 780; %Female = 57.65%; M_age = 37.68). Results show indirect effects of (1) skin tone on life satisfaction and (2) skin tone on psychological distress, each via stigma consciousness. Specifically, those with darker (vs. lighter) skin tones reported increased stigma consciousness, which then predicted (1) lower life satisfaction and (2) lower levels of psychological distress. Life satisfaction did not predict psychological distress. Implications for African American mental health are discussed.

The seemingly 'protective' effect of internalised racism on overall health among 780 Black/African Americans: the serial mediation of stigma consciousness and locus of control

OBJECTIVE

Internalised racism (IR) is associated with better and worse health outcomes among racial/ethnic minorities. However, the underlying mechanisms associating IR with either positive or negative health outcomes are not well understood.Design & main outcomes measures: To address this gap, this study investigated two pathways that associate increased IR with better self-reported overall health (OH; i.e. dental, mental, physical and vision health) among 780 Black/African American adults (mean age 37.68 years, 57.6% female): (1) via stigma consciousness and (2) via stigma consciousness and locus of control beliefs.

RESULTS

Consistent with predictions, stigma consciousness mediated the indirect effect of IR on OH, such that higher IR was associated with lower stigma consciousness, which was associated with better self-reported OH. Confirming predictions, this indirect effect was also carried through locus of control beliefs, such that higher IR was associated with lower stigma consciousness; lower stigma consciousness was also associated with internal locus of control beliefs, which were associated with better self-reported OH.

CONCLUSIONS

Although seemingly protective, this adaptive, strategic and short-term response to race-based threat in which group stereotypes are internalised can lead to negative health outcomes over time. These findings have implications for understanding IR and associated health disparities.

Weight discrimination, anticipated weight stigma, and disordered eating

Weight discrimination is a well-established risk factor for disordered eating cognitions and behaviors. However, little is known about what may account for this association. Recent research suggests that anticipated weight stigma may explain the relationship between weight discrimination and non-eating disorder related health outcomes; the present study seeks to replicate this premise and extend it to the disordered eating realm. In a non-clinical sample of adults in the United States (N = 297) we test the hypothesis that weight discrimination has an indirect association with eating disorder symptomatology through anticipated stigma. At a single timepoint, participants recruited from the online data collection platform SocialSci completed self-report, online surveys of weight discrimination in day-to-day life, anticipated weight stigma, eating disorder symptoms, and demographic information. As hypothesized, weight discrimination was indirectly associated with greater disordered eating symptoms via its association with anticipated weight stigma. This pattern of results held when controlling for gender, body mass index, and self-perceived weight status. These findings suggest that anticipated stigma is relevant in the association between weight discrimination and greater disordered eating. This premise deserves additional attention using methodological approaches that can facilitate stronger causal claims. We discuss the potential for this line of research to inform clinical interventions.

Black-White Marriages: The Moderating Role of Openness on Experience of Couple Discrimination and Marital Satisfaction

This study examined how open communication between spouses may buffer against discrimination experienced by Black-White couples. Results from 178 couples analyzed using a combination of common-fate and actor-partner interdependence models, indicated that for Black partners, marital satisfaction was not contingent on the level of openness when experiences of couple discrimination were low. When experiences of couple discrimination were high, levels of marital satisfaction were maintained among partners who reported high openness and reduced among partners who reported low openness. Moderation effects were not found for White partners. The results suggest that because Black partners are more aware of and sensitized to discrimination, White partners' abilities to attune to their partners' needs for support could help enhance their relationships.

Links between discrimination and cardiovascular health among socially stigmatized groups: A systematic review

BACKGROUND

There is a high prevalence of cardiovascular disease across diverse groups in the U.S. population, and increasing research has identified stigma as a potential barrier to cardiovascular disease prevention and treatment. This systematic review examines evidence linking discrimination and cardiovascular health among socially stigmatized groups.

STUDY DESIGN

Six databases were systematically reviewed from inception through February 2018 for studies with adult subjects, focusing on cardiovascular health indicators among social groups stigmatized because of their gender, race/ethnicity, age, body weight/obesity, or sexual orientation. The Newcastle-Ottawa Scale was used to evaluate the methodological quality and risk of bias for nonrandomized studies, and the Cochrane Collaboration 7-item domain for randomized controlled and experimental trials.

RESULTS

The search identified 84 eligible studies published between 1984 and 2017. Studies retrieved were categorized according to demonstrated links between stigma and cardiovascular disease risk factors including blood pressure (n = 45), heart rate variability (n = 6), blood/saliva cardiovascular biomarkers (n = 18), as well as other indicators of cardiovascular health (n = 15). Based on the findings from included studies, 86% concluded that there was a significant relationship among stigma or discrimination and cardiovascular health indicators among socially stigmatized groups. However, there were varying degrees of evidence supporting these relationships, depending on the type of discrimination and cardiovascular health indicator. The current evidence implies an association between perceived discrimination and cardiovascular health. However, a majority of these studies are cross-sectional (73%) and focus on racial discrimination (79%), while using a wide variety of measurements to assess social discrimination and cardiovascular health.

CONCLUSIONS

Future research should include longitudinal and randomized controlled trial designs, with larger and more diverse samples of individuals with stigmatized identities, using consistent measurement approaches to assess social discrimination and its relationship with cardiovascular health.

A Framework for Using eHealth Interventions to Overcome Medical Mistrust Among Sexual Minority Men of Color Living with Chronic Conditions

The purpose of this paper is to present a stepwise, multi-construct, innovative framework that supports the use of eHealth technology to reach sexual minority populations of color to establish trustworthiness and build trust. The salience of eHealth interventions can be leveraged to minimize the existing paradigm of medical mistrust among sexual minority populations of color living with chronic illnesses. These interventions include virtual environments and avatar-led eHealth videos, which address psychosocial and structural-level challenges related to mistrust. Our proposed framework addresses how eHealth interventions enable technology adoption and usage, anonymity, co-presence, self-disclosure, and social support and establish trustworthiness and build trust.

Perceived Racial Discrimination and DNA Methylation Among African American Women in the InterGEN Study

INTRODUCTION

Experiences of racial discrimination have been associated with poor health outcomes. Little is known, however, about how perceived racial discrimination influences DNA methylation (DNAm) among African Americans (AAs). We examined the association of experiences of discrimination with DNAm among AA women in the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure (InterGEN) study.

METHODS

The InterGEN study examines the effects of genetic and psychological factors on blood pressure among AA women and their children. Measures include the Major Life Discrimination (MLD) and the Race-Related Events (RES) scales. In the present analysis, we examined discrimination and DNAm at baseline in the InterGEN study. The 850K EPIC Illumina BeadChip was used for evaluating DNAm in this epigenome-wide association study (EWAS).

RESULTS

One hundred and fifty-two women contributed data for the RES-EWAS analysis and 147 for the MLD-EWAS analysis. Most were 30-39 years old, nonsmokers, had some college education, and had incomes

CONCLUSION

We observed significant epigenetic associations between disease-associated genes (e.g., schizophrenia, bipolar disorder, and asthma) and perceived discrimination as measured by the MLD Scale. Future health disparities research should include epigenetics in high-risk populations to elucidate functional consequences induced by the psychosocial environment.

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Key Words

• African Americans
• DNA methylation
• epigenomics
• racism
• women

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MESH Headings

• Adult
• Black or African American/genetics
• Asthma/genetics
• Blood Pressure/genetics
• Child
• DNA/analysis
• DNA Methylation/genetics
• Epigenesis, Genetic
• Epigenomics
• Female
• Humans
• Male
• Racism
• Risk Factors
• United States

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Grants

• R01 NR013520 NINR NIH HHS
• UL1 TR001863 NCATS NIH HHS
• National Institute of Nursing Research

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Affiliation(s)

Veronica Barcelona de Mendoza 1 Yale School of Nursing, Orange, CT, USA
Yunfeng Huang 2 Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
Cindy A Crusto 3 Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
Yan V Sun 2 Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
Jacquelyn Y Taylor 1 Yale School of Nursing, Orange, CT, USA

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