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Smith SB, Abshire DA, Magwood GS, Herbert LL, Tavakoli AS, Jenerette C. Unlocking Population-Specific Treatments to Render Equitable Approaches and Management in Cardiovascular Disease: Development of a Situation-Specific Theory for African American Emerging Adults. J Cardiovasc Nurs 2024; 39:E103-E114. [PMID: 37052582 PMCID: PMC10564967 DOI: 10.1097/jcn.0000000000000986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Emerging adulthood (18-25 years old) is a distinct developmental period in which multiple life transitions pose barriers to engaging in healthy lifestyle behaviors that reduce cardiovascular disease risk. There is limited theory-based research on African American emerging adults. OBJECTIVE This article introduces a synthesized empirically testable situation-specific theory for cardiovascular disease prevention in African American emerging adults. METHODOLOGY Im and Meleis' integrative approach was used to develop the situation-specific theory. RESULTS Unlocking Population-Specific Treatments to Render Equitable Approach and Management in Cardiovascular Disease is a situation-specific theory developed based on theoretical and empirical evidence and theorists' research and clinical practice experiences. DISCUSSION African American emerging adults have multifaceted factors that influence health behaviors and healthcare needs. Unlocking Population-Specific Treatments to Render Equitable Approaches and Management in Cardiovascular Disease has the potential to inform theory-guided clinical practice and nursing research. Recommendations for integration in nursing practice, research, and policy advocacy are presented. Further critique and testing of the theory are required.
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Educational initiative in an NCATS TL1 training program to address the impact of systemic racism on human health, biomedical research, and the translational scientist. J Clin Transl Sci 2023; 6:e145. [PMID: 36756075 PMCID: PMC9879894 DOI: 10.1017/cts.2022.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction The goal of clinical and translational science (CTS) is to fill gaps in medical knowledge toward improving human health. However, one of our most pressing challenges does not reside within the biological map we navigate to find sustainable cures but rather the moral compass to recognize and overcome racial and ethnic injustices that continue to influence our society and hinder diverse research rigor. The Georgetown-Howard Universities Center for Clinical and Translational Science includes an inter-institutional TL1-funded training program for predoctoral/postdoctoral trainees in Translational Biomedical Science (TBS). Methods In the fall of 2020, the TBS program responded to the national social justice crisis by incorporating a curriculum focused on structural racism in biomedical research. Educational platforms, including movie reviews, Journal Clubs, and other workshops, were threaded throughout the curriculum by ensuring safe spaces to discuss racial and ethnic injustices and providing trainees with practical steps to recognize, approach, and respond to these harmful biases in the CTS. Workshops also focused on why individuals underrepresented in science are vital for addressing and closing gaps in CTS. Results Paring analysis using REDCap software de-identified participants after invitations were sent and collected in the system to maintain anonymity for pre- and post-analysis. The Likert scale evaluated respondents' understanding of diverse scientific circumstances. The pre/Fall and post/Spring surveys suggested this curriculum was successful at raising institutional awareness of racial and ethnic biases. Evaluating the effectiveness of our program with other training Clinical and Translational Science Awards (CTSA) consortiums will strengthen both the academic and professional TBS programs.
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Hobson JM, Moody MD, Sorge RE, Goodin BR. The neurobiology of social stress resulting from Racism: Implications for pain disparities among racialized minorities. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2022; 12:100101. [PMID: 36092741 PMCID: PMC9449662 DOI: 10.1016/j.ynpai.2022.100101] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 11/02/2022]
Abstract
Extant literature posits that humans experience two types of threat: physical threat and social threat. While describing pain as "physical" or "social" can be helpful for understanding pain origins (i.e., broken bone versus lost relationship), this dichotomy is largely artificial and not particularly helpful for understanding how the human brain experiences pain. One real world example of social exclusion and rejection that is threatening and likely to bring about significant stress is racism. Racism is a system of beliefs, practices, and policies that operates to disadvantage racialized minorities while providing advantage to those with historical power, particularly White people in the United States and most other Western nations. The objective of this Mini-Review is to present evidence in support of the argument that racism promotes physical pain in racialized minorities, which in turn promotes chronic pain disparities. First, we provide a theoretical framework describing how racism is a potent stressor that affects the health and well-being of racialized minorities. We will then address the neurobiological underpinnings linking racism to social threat, as well as that linking social threats and physical pain. Finally, we will discuss how the perception of social threat brought about by racism may undermine pain management efforts.
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Affiliation(s)
- Joanna M. Hobson
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Myles D. Moody
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
| | - Robert E. Sorge
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
- Center for Addiction & Pain Prevention & Intervention (CAPPI), University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
- Center for Addiction & Pain Prevention & Intervention (CAPPI), University of Alabama at Birmingham, Birmingham, AL, U.S.A
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Confronting Racism in All Forms of Pain Research: Reframing Study Designs. THE JOURNAL OF PAIN 2022; 23:893-912. [PMID: 35296390 PMCID: PMC9472383 DOI: 10.1016/j.jpain.2022.01.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 12/27/2022]
Abstract
This second paper in a 3-part series on antiracism in pain research across the translational spectrum focuses on study design factors. Although objectivity is a cornerstone value of science, subjectivity is embedded in every step of the research process as investigators make choices about who they collaborate with, which research questions they ask, how they recruit participants, which research tools they use, and how they analyze and interpret data. We present theory and evidence from disciplines such as sociology, medical anthropology, statistics, and public health to discuss 4 common study design factors, including 1) the dominant biomedical narrative of pain that restricts funding and exploration of social indicators of pain, 2) low diversity and inclusion in pain research enrollment that restricts generalizability to racialized groups, 3) the use of "race" or "ethnicity" as a statistical variable and proxy for lived experiences (eg, racism, resilience), and 4) limited modeling in preclinical research for the impact of social factors on pain physiology. The information presented in this article is intended to start conversations across stakeholders in the pain field to explore how we can come together to adopt antiracism practices in our work at large to achieve equity for racialized groups. PERSPECTIVE: This is the second paper in a 3-part series on antiracism in pain research. This part identifies common study design factors that risk hindering progress toward pain care equity. We suggest reframes using an antiracism framework for these factors to encourage all pain investigators to collectively make strides toward equity.
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Hargons C, Malone NJ, Montique CS, Dogan J, Stuck J, Meiller C, Sullivan QA, Sanchez A, Bohmer C, Curvey RMG, Tyler KM, Stevens-Watkins D. Race-Based Stress Reactions and Recovery: Pilot Testing a Racial Trauma Meditation. JOURNAL OF BLACK PSYCHOLOGY 2021. [DOI: 10.1177/00957984211034281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Twenty-six Black collegians were exposed to a vicarious racial harassment stimulus (VRHS) then randomized into a Black Lives Matter Meditation for Healing Racial Trauma condition or a silence control condition. Heart rate (HR) was recorded throughout the experiment. Semi-structured interviews were then conducted to elicit participants’ appraisal of the VRHS and meditation. Using a Qual:Quan mixed methods experimental design, this pilot study qualitatively categorized how participants (1) described their reactions to the VRHS and (2) appraised the meditation. Participants described three types of race-based stress reactions and reported mostly positive appraisal of the meditation, although some indicated that it would not be a preferred coping strategy. To triangulate the quantitative findings, we found a significant increase in HR during VRHS. The meditation group displayed statistically significant reductions in HR from stimulus to the end of meditation; however, there were no statistically significant differences between the control and meditation groups. Results have implications for understanding and facilitating race-based stress recovery.
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Affiliation(s)
- Candice Hargons
- Educational, School, and Counseling Psychology, University of Kentucky, Lexington, KY, USA
| | - Natalie J. Malone
- Educational, School, and Counseling Psychology, University of Kentucky, Lexington, KY, USA
| | - Chesmore S. Montique
- Educational, School, and Counseling Psychology, University of Kentucky, Lexington, KY, USA
| | - Jardin Dogan
- Educational, School, and Counseling Psychology, University of Kentucky, Lexington, KY, USA
| | - Jennifer Stuck
- Educational, School, and Counseling Psychology, University of Kentucky, Lexington, KY, USA
| | - Carolyn Meiller
- Educational, School, and Counseling Psychology, University of Kentucky, Lexington, KY, USA
| | - Queen-Ayanna Sullivan
- Educational, School, and Counseling Psychology, University of Kentucky, Lexington, KY, USA
| | - Anyoliny Sanchez
- Educational, School, and Counseling Psychology, University of Kentucky, Lexington, KY, USA
| | - Carrie Bohmer
- Educational, School, and Counseling Psychology, University of Kentucky, Lexington, KY, USA
| | - Rena M. G. Curvey
- Educational, School, and Counseling Psychology, University of Kentucky, Lexington, KY, USA
| | - Kenneth M. Tyler
- Educational, School, and Counseling Psychology, University of Kentucky, Lexington, KY, USA
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Toth S, Jenkins I, Highfill C. Investigating Exercise Readiness and Life Stress among Undergraduate Students at an Historically Black University. AMERICAN JOURNAL OF HEALTH EDUCATION 2021. [DOI: 10.1080/19325037.2021.1955227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sgambat K, Roem J, Brady TM, Flynn JT, Mitsnefes M, Samuels JA, Warady BA, Furth SL, Moudgil A. Social Determinants of Cardiovascular Health in African American Children With CKD: An Analysis of the Chronic Kidney Disease in Children (CKiD) Study. Am J Kidney Dis 2021; 78:66-74. [PMID: 33418013 DOI: 10.1053/j.ajkd.2020.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 11/03/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE To identify differences in socioeconomic factors (SES) and subclinical cardiovascular disease (CVD) markers by race among Chronic Kidney Disease in Children (CKiD) participants and determine whether differences in CVD markers persist after adjusting for SES. STUDY DESIGN Analysis of 3,103 visits with repeated measures from 628 children (497 White participants; 131 African American participants) enrolled in the CKiD study. SETTING & PARTICIPANTS Children with mild-moderate CKD with at least 1 cardiovascular (CV) parameter (ambulatory blood pressure, left ventricular mass index [LVMI], or lipid profile) measured. EXPOSURE African American race. OUTCOMES Ambulatory hypertension, LVMI, triglycerides, high-density lipoprotein cholesterol. ANALYTICAL APPROACH Due to increased CV risks of glomerular disease, the analysis was stratified by CKD cause. Inverse probability weighting was used to adjust for SES (health insurance, household income, maternal education, food insecurity, abnormal birth history). Linear and logistic regression were used to evaluate association of race with CV markers. RESULTS African American children were disproportionately affected by adverse SES. African Americans with nonglomerular CKD had more instances of ambulatory hypertension and higher LVMI but more favorable lipid profiles. After adjustment for SES, age, and sex, the magnitude of differences in these CV markers was attenuated but remained statistically significant. Only LVMI differed by race in the glomerular CKD group, despite adjustment for SES. LIMITATIONS Study design limits causal inference. CONCLUSION African American children with CKD are disproportionately affected by socioeconomic disadvantages compared with White children. The degree to which CV markers differ by race is influenced by disease etiology. African Americans with nonglomerular CKD have increased LVMI, more ambulatory hypertension, and favorable lipid profile, but attenuation in magnitude after adjustment for SES was observed. African Americans with glomerular CKD had increased LVMI, which persisted after SES adjustment. As many social determinants of health were not captured, future research should examine effects of systemic racism on CV health in this population.
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Affiliation(s)
- Kristen Sgambat
- Division of Nephrology, Childrens' National Hospital, Washington DC.
| | - Jennifer Roem
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tammy M Brady
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joseph T Flynn
- Department of Pediatrics, Division of Nephrology, Children's Hospital, University of Washington, Seattle, WA
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Joshua A Samuels
- Division of Pediatric Nephrology and Hypertension, McGovern Medical School at University of Texas Health, Houston, TX
| | - Bradley A Warady
- Division of Nephrology, Children's Mercy Kansas City, Kansas City, MO
| | - Susan L Furth
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Asha Moudgil
- Division of Nephrology, Childrens' National Hospital, Washington DC
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Gaston SA, Feinstein L, Slopen N, Sandler DP, Williams DR, Jackson CL. Everyday and major experiences of racial/ethnic discrimination and sleep health in a multiethnic population of U.S. women: findings from the Sister Study. Sleep Med 2020; 71:97-105. [PMID: 32505024 DOI: 10.1016/j.sleep.2020.03.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/12/2020] [Accepted: 03/10/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Perceived racial/ethnic discrimination and poor sleep occur across all races/ethnicities in the U.S., although both are most common among racial/ethnic minorities. Few studies have investigated associations between perceived racial/ethnic discrimination and various sleep dimensions in a multiethnic population. METHODS We analyzed cross-sectional associations among 40,038 eligible Sister Study participants (enrollment: 2003-2009) who reported ever/never experiencing specific types of everyday (eg, treated unfairly at a store or restaurant) or major (eg, unfairly stopped, threatened, or searched by police) discrimination attributed to their race/ethnicity during a follow-up survey in 2008-2012. Participants also reported short sleep duration (<7 h), sleep debt (≥2-h difference between longest and shortest sleep duration), frequent napping (≥3 times/week), and insomnia. Poisson regression with robust variance estimation, adjusted for sociodemographic and health characteristics, estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) for the association between each type of racial/ethnic discrimination and each sleep dimension, overall and by race/ethnicity. RESULTS Mean age was 55 ± 8.9 years, 89% were Non-Hispanic (NH)-white, 8% NH-black, and 3% Hispanic/Latina. NH-black participants were the most likely to report everyday (76% vs. 4% [NH-whites] and 36% [Hispanics/Latinas]) and major racial/ethnic discrimination (52% vs. 2% [NH-whites] and 18% [Hispanics/Latinas]). Participants who experienced both types versus neither were more likely to report short sleep duration (PR = 1.17 [95% CI: 1.09-1.25]) and insomnia symptoms (PR = 1.10 [1.01-1.20]) but not other poor sleep dimensions. CONCLUSIONS Racial/ethnic minority women were most likely to experience racial/ethnic discrimination, which was associated with certain poor sleep dimensions among women of all races/ethnicities.
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Affiliation(s)
- Symielle A Gaston
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institute of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
| | - Lydia Feinstein
- Social & Scientific Systems, Inc., Durham, NC, USA; Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Natalie Slopen
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institute of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of African and African American Studies, Harvard University, Cambridge, MA, USA
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institute of Health, Department of Health and Human Services, Research Triangle Park, NC, USA; Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
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