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Brown KL, Bettencourt AF, Hines AL, Cooper LA, Gudzune KA. Association Between Maladaptive Eating Behaviors Among Black Women and Vicarious Racial Discrimination Following a High-Profile Event. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01994-2. [PMID: 38578573 DOI: 10.1007/s40615-024-01994-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Evidence suggests that racial discrimination causes stress among non-Hispanic Black women, and some Black women may cope with exposure to vicarious racial discrimination by engaging in maladaptive eating behaviors. METHODS We examined eating behaviors among Black women (N = 254) before and after Freddie Gray's death while in police custody. Maladaptive eating behaviors were assessed using the three-factor eating questionnaire. Our independent variables included the following: (1) time period and (2) geographic proximity to the event. Three two-way analysis of covariance tests were conducted to assess potential effects of geographic proximity (close, distant), time period in relation to unrest (before, after unrest), and their interaction on emotional eating, uncontrolled eating, and cognitive restraint controlling for participant age. RESULTS There was a statistically significant main effect of proximity to the unrest on emotional eating, F (1, 252) = 5.64, p = .018, and partial η2 = .022 such that women living in close geographic proximity to the unrest reported higher mean levels of emotional eating as compared to those living more distant to the unrest. There was also a borderline statistically significant interaction between geographic proximity and time period on cognitive restraint, F (1, 252) = 3.89, p = .050, and partial η2 = .015. CONCLUSION Our study found a relationship between vicarious racial discrimination and maladaptive eating behaviors among Black women. Future work should examine stress related to vicarious racial discrimination and maladaptive eating behaviors longitudinally.
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Affiliation(s)
- Kristal Lyn Brown
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
- Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, 19104, USA.
| | - Amie F Bettencourt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Anika L Hines
- Department of Health Policy, Virginia Commonwealth University School of Population Health, Richmond, VA, USA
| | - Lisa A Cooper
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kimberly A Gudzune
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Hladek MD, Wilson D, Krasnansky K, McDaniel K, Shanbhag M, McAdams-DeMarco M, Crews DC, Brennan DC, Taylor J, Segev D, Walston J, Xue QL, Szanton SL. Using Photovoice to Explore the Lived Environment and Experience of Older Adults with Frailty on their Kidney Transplant Journey. KIDNEY360 2024; 5:589-598. [PMID: 38379153 PMCID: PMC11093540 DOI: 10.34067/kid.0000000000000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/29/2024] [Indexed: 02/22/2024]
Abstract
Key Points Photovoice, a qualitative method, visually depicted the daily lives of participants with frailty, providing insights into independence and symptom management to guide clinicians and researchers. This photovoice study uncovered subthemes of home safety and organization, revealing potential safety hazards like dialysis fluid storage, and suggests its potential use in geriatric nephrology. The findings emphasize the importance of integrating participant values and goals into care decisions and interventional design in the context of kidney transplant journeys for frail adults. Background Older adults with frailty and kidney failure face higher waitlist mortality and are more likely to be listed as inactive on the kidney transplant (KT) waitlist. Photovoice is a qualitative participatory research method where participants use photographs to represent their environment, needs, and experiences. It offers unique insight into the lived environment and experience of patients and may offer direction in how to improve functional independence, symptom burden, and KT outcomes in adults with frailty. Methods This photovoice study was embedded within a larger intervention adaptation project. Participants with prefrailty or frailty awaiting a KT or recently post-transplant took photographs with Polaroid cameras and wrote short descriptions for 11 prompts. Each participant completed a semistructured interview wherein their photographs were discussed. The team coded and discussed photographs and interviews to determine overarching themes and implications. Focus groups were used to triangulate visual data findings. Results Sixteen participants completed both the photovoice and the interview. Participants were a mean age of 60.5 years, 31.2% female, 43.4% self-identifying as Black, and 69% were frail. Outcomes were categorized into seven themes: functional space, home safety, medication management, adaptive coping, life-changing nature of dialysis, support, and communication. Visual data clarified and sometimes changed the interpretations of the text alone. Especially within the themes of home safety and functional space, safety hazards not previously recognized in the literature, like dialysis fluid storage, were identified. Conclusions Photovoice contextualizes the living conditions and experiences of adults with frailty on the KT journey and could be a useful tool in geriatric nephrology and transplant. Addressing issues of home storage, organization, and accessibility should be explored as potential intervention targets. Incorporating participant values and goals into care decisions and interventional design should be further explored.
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Affiliation(s)
| | - Deborah Wilson
- Johns Hopkins School of Nursing, Baltimore, Maryland
- Auckland University of Technology School of Clinical Sciences, Auckland, New Zealand
| | | | | | - Meera Shanbhag
- University of Central Florida College of Medicine, Orlando, Florida
| | - Mara McAdams-DeMarco
- New York University Grossman School of Medicine Lagoune Health, New York, New York
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deidra C. Crews
- Johns Hopkins School of Nursing, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Dorry Segev
- New York University Grossman School of Medicine Lagoune Health, New York, New York
| | - Jeremy Walston
- Johns Hopkins School of Nursing, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Geriatric Medicine and Gerontology, Baltimore, Maryland
| | - Qian-Li Xue
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah L. Szanton
- Johns Hopkins School of Nursing, Baltimore, Maryland
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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Farmer N, Tuason R, Middleton KR, Ude A, Tataw-Ayuketah G, Flynn S, Kazmi N, Baginski A, Mitchell V, Powell-Wiley TM, Wallen GR. Assessing Acceptability: The Role of Understanding Participant, Neighborhood, and Community Contextual Factors in Designing a Community-Tailored Cooking Intervention. Nutrients 2024; 16:463. [PMID: 38337747 PMCID: PMC10857272 DOI: 10.3390/nu16030463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Cooking is an identified dietary strategy that is positively associated with optimal diet quality. Prior to initiating cooking interventions, evaluating the prospective acceptability of the intervention among community members living within low food access areas and understanding geospatial food shopping locations may aid in designing community-tailored interventions. METHODS A sequential mixed methods study was conducted to determine the prospective acceptability of a planned community-located cooking intervention among African American adults living in a low food access area and with at least one cardiovascular disease risk factor. A semi-structured guide was used to conduct five virtual focus groups. Qualitative data were analyzed using thematic analysis and validated through participant check-in interviews. Survey responses were analyzed based on descriptive data. Geospatial analysis of participant locations that were reported for food shopping was conducted to show food environment utilization. RESULTS Focus groups with study participants (n = 20, all female, mean age 60.3, SD 9.3, mean cooking frequency per week 4.0, food insecure n = 7) were conducted between March and April, 2021. Thematic analysis of the focus group transcripts identified five main themes as follows: (A) Barriers to Cooking (family and caregiving, transportation, COVID-19 pandemic, time availability, household composition); (B) Motivators for Cooking (family, caregiving, health, enjoyment, COVID-19 pandemic); (C) Strategies (food shopping, social support, social media, meal planning); (D) Neighborhood (gentrification, perceived safety, stigmatization, disparities in grocery stores); (E) and Acceptability of the Intervention (reasons to participate, barriers, recruitment, intervention delivery). Participant validation interviews confirmed the themes and subthemes as well as the illustrative quotes. Geospatial analysis showed a majority of locations were outside of the participants' residential areas. CONCLUSIONS Prospective acceptability of a community-tailored cooking intervention found that the planned intervention could be modified to address individual level factors, such as caregiving and health, community contextual factors, such as perceived safety, and the general health needs of the community.
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Affiliation(s)
- Nicole Farmer
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Ralph Tuason
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Kimberly R. Middleton
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Assumpta Ude
- Clinical Center Nursing Department, The National Institutes of Health, Bethesda, MD 20892, USA; (A.U.); (G.T.-A.); (S.F.)
| | - Gladys Tataw-Ayuketah
- Clinical Center Nursing Department, The National Institutes of Health, Bethesda, MD 20892, USA; (A.U.); (G.T.-A.); (S.F.)
| | - Sharon Flynn
- Clinical Center Nursing Department, The National Institutes of Health, Bethesda, MD 20892, USA; (A.U.); (G.T.-A.); (S.F.)
| | - Narjis Kazmi
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Alyssa Baginski
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
| | - Valerie Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD 20892, USA; (V.M.); (T.M.P.-W.)
| | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, Bethesda, MD 20892, USA; (V.M.); (T.M.P.-W.)
- Intramural Research Program, National Institute on Minority Health and Health Disparities, Bethesda, MD 20892, USA
| | - Gwenyth R. Wallen
- Translational Biobehavioral and Health Disparities Branch, The National Institutes of Health, Clinical Center, Bethesda, MD 20892, USA; (R.T.); (K.R.M.); (N.K.); (A.B.); (G.R.W.)
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Breathett K, Manning KD. Catalyzing Restructure of a Broken Health Care System. Circ Cardiovasc Qual Outcomes 2024; 17:e010009. [PMID: 38377225 PMCID: PMC10949780 DOI: 10.1161/circoutcomes.123.010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Khadijah Breathett
- Division of Cardiovascular Medicine, Department of Medicine, Indiana University, Indianapolis (K.B.)
| | - Kimberly D Manning
- Division of General Medicine, Department of Medicine, Emory University, Atlanta, GA (K.D.M.)
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Baxter SLK, Zare H, Thorpe RJ. Race Disparities in Hypertension Prevalence Among Older Men. Int J Aging Hum Dev 2024; 98:10-26. [PMID: 37150878 DOI: 10.1177/00914150231172119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This study aimed to examine whether hypertension prevalence varies by race/ethnicity and within age groups in a nationally representative sample of men in the United States. Hypertension was defined as blood pressure (BP) readings of 140 mm Hg and higher for systolic BP, 90 mm Hg and higher for diastolic BP, or self-reports of taking medication for hypertension. Modified Poisson models estimated prevalence ratios (PRs) and 95% confidence intervals (CI) for race and age group associations with hypertension. The prevalence of hypertension was 38% overall and 46% of the men were aged 50 and older. Analyses that focused on older men (50 years of age or older) found that non-Hispanic Black men had a higher prevalence of hypertension (PR = 1.28, 95% CI: 1.19 - 1.37) compared to non-Hispanic White men. We suggest future research utilize life course perspectives to better identify which cumulative experiences impact hypertension disparities.
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Affiliation(s)
- Samuel L K Baxter
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- School of Business, University of Maryland Global Campus (UMGC), Baltimore, MD, USA
| | - Roland J Thorpe
- Program for Research on Men's Health, Johns Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, Baltimore, MD, USA
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Hines AL, Albert MA, Blair JP, Crews DC, Cooper LA, Long DL, Carson AP. Neighborhood Factors, Individual Stressors, and Cardiovascular Health Among Black and White Adults in the US: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. JAMA Netw Open 2023; 6:e2336207. [PMID: 37773494 PMCID: PMC10543067 DOI: 10.1001/jamanetworkopen.2023.36207] [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] [Received: 03/30/2023] [Accepted: 08/23/2023] [Indexed: 10/01/2023] Open
Abstract
Importance Chronic stress has been posited to contribute to racial disparities in cardiovascular health. Investigation of whether neighborhood- and individual-level stressors mediate this disparity is needed. Objective To examine whether racial differences in ideal cardiovascular health (ICH) are attenuated by experiences with neighborhood- and individual-level stressors within a racially and geographically diverse population sample. Design, Setting, and Participants This cross-sectional study examined data from 7720 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study who completed the second in-home visit (2013-2016). The REGARDS study is a population-based, longitudinal study of 30 239 non-Hispanic Black and non-Hispanic White adults aged 45 years or older at baseline (2003-2007). Data for the present study were analyzed from June to July 2021 and in March 2022. Exposures Neighborhood physical environment (eg, excessive noise, violence; scored from 7-28, with higher scores indicating more problems), neighborhood safety (scored as very safe, safe, or not safe), neighborhood social cohesion (eg, shared values; scored from 5-25, with higher scores indicating higher cohesion), perceived stress (eg, coping; scored from 0-16, with higher scores indicating greater perceived stress), and the experience of discrimination (yes or no). Main Outcomes and Measures Ideal cardiovascular health (ICH), measured as a composite of 4 health behaviors (cigarette smoking, diet, physical activity, body mass index) and 3 health factors (blood pressure, cholesterol, and glucose levels). Results The sample included 7720 participants (mean [SD] age, 71.9 [8.3] years; 4390 women [56.9%]; 2074 Black participants [26.9%]; and 5646 White participants [73.1%]). Black participants compared with White participants reported higher perceived stress (mean [SD] score, 3.2 [2.8] vs 2.8 [2.7]) and more often reported discrimination (77.0% vs 24.0%). Black participants also reported poorer neighborhood physical environment (mean [SD] score, 11.2 [3.8] vs 9.8 [2.9]) and social cohesion (mean [SD] score, 15.5 [2.0] vs 15.7 [1.9]) and more often reported their neighborhoods were unsafe (54.7% vs 24.3%). The odds of having a high total ICH score (ie, closer to ideal) were lower for Black adults compared with White adults, both overall (adjusted odds ratio [AOR], 0.53; 95% CI, 0.45-0.61) and by gender (men: AOR, 0.73 [95% CI, 0.57-0.93]; women: AOR, 0.45 [95% CI, 0.37-0.54]). In mediation analyses, the racial disparity in total ICH score was attenuated by neighborhood physical environment (5.14%), neighborhood safety (6.27%), neighborhood social cohesion (1.41%), and discrimination (11.01%). In stratified analyses, the factors that most attenuated the racial disparity in total ICH scores were neighborhood safety among men (12.32%) and discrimination among women (14.37%). Perceived stress did not attenuate the racial disparity in total ICH scores. Conclusions and Relevance In this cross-sectional study of Black and White US adults aged 45 years and older, neighborhood-level factors, including safety and physical and social environments, and individual-level factors, including discrimination, attenuated racial disparities in cardiovascular health. Interventional approaches to improve ICH that separately target neighborhood context and discrimination by gender and race are warranted.
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Affiliation(s)
- Anika L. Hines
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Michelle A. Albert
- Department of Medicine, University of California, San Francisco, San Francisco
| | - Jessica P. Blair
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham
| | - Deidra C. Crews
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lisa A. Cooper
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - D. Leann Long
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham
| | - April P. Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson
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