Racial/ethnic disparities in hypertension prevalence: reconsidering the role of chronic stress

Interpersonal discrimination and depressive symptoms among older Black and African American adults

To examine the association between recent experiences of discrimination and depressive symptom presentation and severity among a U.S. sample of older Black and African American adults. A cross-sectional survey of 124 Black and African American adults aged 50 and older in the United States was conducted assessing interpersonal discrimination and depressive symptoms. The Perceived Ethnic Discrimination Questionnaire assessed four forms of interpersonal discrimination. A measure of heightened vigilance to bias assessed anticipatory coping with discrimination experiences. Past-month affective and somatic symptoms of depression were assessed using the Depressive and Somatic Symptoms Scale. All forms of interpersonal racial discrimination were positively associated with greater affective symptom severity. Being avoided, devalued, and threatened or actively physically harmed were associated with greater somatic symptom severity. Vigilant coping was positively associated with affective symptom severity but not somatic symptom severity. Racial discrimination is linked to depression severity among older Black and African American and varies by symptom. This study helps inform work on processes linking discrimination with poorer psychological outcomes and will allow for more effective interventions and prevention efforts that are tailored to older minority populations.

Nonlinear associations between the ratio of family income to poverty and all-cause mortality among adults in NHANES study

Socioeconomic status (SES) has been linked to mortality rates, with family income being a quantifiable marker of SES. However, the precise association between the family income-to-poverty ratio (PIR) and all-cause mortality in adults aged 40 and older remains unclear. A cross-sectional study was conducted using data from NHANES III, including 20,497 individuals. The PIR was used to assess financial status, and various demographic, lifestyle, and clinical factors were considered. Mortality data were collected from the NHANES III linked mortality file. The study revealed a non-linear association between PIR and all-cause mortality. The piecewise Cox proportional hazards regression model showed an inflection point at PIR 3.5. Below this threshold, the hazard ratio (HR) for all-cause mortality was 0.85 (95% CI 0.79-0.91), while above 3.5, the HR decreased to 0.66 (95% CI 0.57-0.76). Participants with lower income had a higher probability of all-cause mortality, with middle-income and high-income groups showing lower multivariate-adjusted HRs compared to the low-income group. This study provides evidence of a non-linear association between PIR and all-cause mortality in adults aged 40 and older, with an inflection point at PIR 3.5. These findings emphasize the importance of considering the non-linear relationship between family income and mortality when addressing socioeconomic health disparities.

A daily diary study of discrimination and distress in Mexican-origin adolescents: Testing mediating mechanisms

The present 21-day daily diary study (conducted 2021-2022) tested anger and racism-related vigilance as potential transdiagnostic mediators linking exposure to racial and ethnic discrimination (RED) to distress (negative affect and stress, respectively). The data analytic sample included N = 317 Mexican-origin adolescents (Mage = 13.5 years; 50.8% male, 46.7% female; 2.5% non-binary) from the Midwestern United States. Results from longitudinal mediation models revealed significant mediation effects through anger and racism-related vigilance, respectively, in the association between daily RED and daily distress, both within and across adolescents. Implications for theory, research, and practice are discussed so that future work can leverage these novel findings toward promoting the well-being of Mexican-origin adolescents, especially those who live in contexts of ethnoracial adversity.

"Hypertension is such a difficult disease to manage": federally qualified health center staff- and leadership-perceived readiness to implement a technology-facilitated team-based hypertension model

BACKGROUND

Despite decades of evidence demonstrating the efficacy of hypertension care delivery in reducing morbidity and mortality, a majority of hypertension cases remain uncontrolled. There is an urgent need to elucidate and address multilevel facilitators and barriers clinical staff face in delivering evidence-based hypertension care, patients face in accessing it, and clinical systems face in sustaining it. Through a rigorous pre-implementation evaluation, we aimed to identify facilitators and barriers bearing the potential to affect the planned implementation of a multilevel technology-facilitated hypertension management trial across six primary care sites in a large federally qualified health center (FQHC) in New York City.

METHODS

During a dedicated pre-implementation period (3-9 months/site, 2021-2022), a capacity assessment was conducted by trained practice facilitators, including (1) online anonymous surveys (n = 124; 70.5% of eligible), (2) hypertension training analytics (n = 69; 94.5% of assigned), and (3) audio-recorded semi-structured interviews (n = 67; 48.6% of eligible) with FQHC leadership and staff. Surveys measured staff sociodemographic characteristics, adaptive reserve, evidence-based practice attitudes, and implementation leadership scores via validated scales. Training analytics, derived from end-of-course quizzes, included mean score and number attempts needed to pass. Interviews assessed staff-reported facilitators and barriers to current hypertension care delivery and uptake; following audio transcription, trained qualitative researchers employed a deductive coding approach, informed by the Consolidated Framework for Implementation Research (CFIR).

RESULTS

Most survey respondents reported moderate adaptive reserve (mean = 0.7, range = 0-1), evidence-based practice attitudes (mean = 2.7, range = 0-4), and implementation leadership (mean = 2.5, range = 0-4). Most staff passed training courses on first attempt and demonstrated high scores (means > 80%). Findings from interviews identified potential facilitators and barriers to implementation; specifically, staff reported that complex barriers to hypertension care, control, and clinical communication exist; there is a recognized need to improve hypertension care; in-clinic challenges with digital tool access imposes workflow delays; and despite high patient loads, staff are motivated to provide high-quality cares.

CONCLUSIONS

This study serves as one of the first to apply the CFIR to a rigorous pre-implementation evaluation within the understudied context of a FQHC and can serve as a model for similar trials seeking to identify and address contextual factors known to impact implementation success.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03713515 , date of registration: October 19, 2018.

Relationships among race, ethnicity, and gender and whole health among U.S. veterans

Racial, ethnic, and gender health care disparities in the United States are well-documented and stretch across the lifespan. Even in large integrated health care systems such as Veteran Health Administration, which are designed to provide equality in care, social and economic disparities persist, and limit patients' achievement of health goals across multiple domains. We explore Veterans' Whole Health priorities among Veteran demographic groups. Participants who were enrolling in Veteran Health Administration provided demographics and Whole Health priorities using eScreening, a web-based self-assessment tool. Veterans had similar health care goals regardless of demographic characteristics but differences were noted in current health appraisals. Non-White and women Veterans reported worse health-relevant functioning. Black Veterans were more likely to endorse a low rating for their personal development/relationships. Multiracial Veterans were more likely to endorse a low rating of their surroundings. Asian Veterans were less likely to provide a high rating of their surroundings. Women Veterans reported lower appraisals for body and personal development but higher appraisals of professional care. Results indicated that demographic factors such as race and gender, and to a lesser extent ethnicity, were associated with health disparities. The Whole Health model provides a holistic framework for addressing these disparities. These findings may inform more culturally sensitive care and enhance Veteran Health Administration equal access initiatives. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Low income and education are associated with greater ASCVD risk scores among adults in the US

Introduction

Social determinants of health (SDOH) are fundamental causes of poor cardiovascular health, yet cardiovascular disease (CVD) risk assessment tools exclude SDOH. Our objective was to determine whether SDOH are independently associated with CVD risk in US adults.

Methods

Utilizing the National Health and Nutrition Examination Survey (NHANES), we combined years 1999-2018 and included participants aged 40-79 without history of CVD and with information to calculate CVD risk (n = 21,694). Ten-year risk of atherosclerotic CVD (ASCVD) was calculated using the American Heart Association/American College of Cardiology (AHA/ACC) pooled cohort equations. We used linear regression models to estimate the association between SDOH and ASCVD risk, after adjusting for demographic factors. All analyses accounted for the complex survey design.

Results

Mean age was 54.7 years, with 52.7 % female, 73.8 % non-Hispanic White, 9.4 % non-Hispanic Black, and 10.7 % Hispanic. From adjusted models, compared with an income of ≥ $75 K, ASCVD risk was greater by 3.06 (95 % CI: 2.65, 3.47) among those with income < $25 K, by 1.55 (95 % CI: 1.21, 1.89) among those with income $25 K-<$55 K, and by 1.20 (95 % CI: 0.84, 1.56) among those with income $55 K-<$75 K. Compared to college graduates, ASCVD risk was greater by 3.09 (95 % CI: 2.56, 3.62) among those with less than a high school education, by 1.65 (95 % CI: 1.31, 200) among those who were high school graduates, and by 1.41 (95 % CI: 1.11, 1.72) among those with some college education.

Conclusion

We found strong graded associations between lower income and lower educational attainment with greater CVD risk.

The influence of Life's Essential 8 on the link between socioeconomic status and depression in adults: a mediation analysis

BACKGROUND

Individuals with low socioeconomic status (SES) are at a higher risk of developing depression. However, evidence on the role of cardiovascular health (CVH) in this chain is sparse and limited. The purpose of this research was to assess the mediating role of Life's Essential 8 (LE8), a recently updated measurement of CVH, in the association between SES and depression according to a nationally representative sample of adults.

METHODS

Data was drawn from the National Health and Nutrition Examination Survey (NHANES) in 2013-2018. Multivariate logistic regression analysis was applied to analyze the association of SES (measured via the ratio of family income to poverty (FIPR), occupation, educational level, and health insurance) and LE8 with clinically relevant depression (CRD) (evaluated using the Patient Health Questionnaire (PHQ-9)). Multiple linear regression analysis was performed to analyze the correlation between SES and LE8. Mediation analysis was carried out to explore the mediating effect of LE8 on the association between SES and CRD. Moreover, these associations were still analyzed by sex, age, and race.

RESULTS

A total of 4745 participants with complete PHQ-9 surveys and values to calculated LE8 and SES were included. In the fully adjusted model, individuals with high SES had a significantly higher risk of CRD (odds ratio = 0.21; 95% confidence interval: 0.136 to 0.325, P < 0.01) compared with those with low SES. Moreover, LE8 was estimated to mediate 22.13% of the total association between SES and CRD, and the mediating effect of LE8 varied in different sex and age groups. However, the mediating effect of LE8 in this chain was significant in different sex, age, and racial subgroups except for Mexican American (MA) individuals.

CONCLUSION

The results of our study suggest that LE8 could mediate the association between SES and CRD. Additionally, the mediating effect of LE8 in this chain could be influenced by the race of participants.

Heart 2 Heart: Pilot Study of a Church-Based Community Health Worker Intervention for African Americans with Hypertension

African Americans (AAs) have higher prevalence of uncontrolled hypertension than Whites, which leads to reduced life expectancy. Barriers to achieving blood pressure control in AAs include mistrust of healthcare and poor adherence to medication and dietary recommendations. We conducted a pilot study of a church-based community health worker (CHW) intervention to reduce blood pressure among AAs by providing support and strategies to improve diet and medication adherence. To increase trust and cultural concordance, we hired and trained church members to serve as CHWs. AA adults (n = 79) with poorly controlled blood pressure were recruited from churches in a low-income, segregated neighborhood of Chicago. Participants had an average of 7.5 visits with CHWs over 6 months. Mean change in systolic blood pressure across participants was - 5 mm/Hg (p = 0.029). Change was greater among participants (n = 45) with higher baseline blood pressure (- 9.2, p = 0.009). Medication adherence increased at follow-up, largely due to improved timeliness of medication refills, but adherence to the DASH diet decreased slightly. Intervention fidelity was poor. Recordings of CHW visits revealed that CHWs did not adhere closely to the intervention protocol, especially with regard to assisting participants with action plans for behavior change. Participants gave the intervention high ratings for acceptability and appropriateness, and slightly lower ratings for feasibility of achieving intervention behavioral targets. Participants valued having the intervention delivered at their church and preferred a church-based intervention to an intervention conducted in a clinical setting. A church-based CHW intervention may be effective at reducing blood pressure in AAs.

Fear of a Black Neighborhood: Anti-Black Racism and the Health of White Americans

Does anti-Black racism harm White Americans? We advance hypotheses that address this question within the neighborhood context. Hypotheses are tested with neighborhood and survey data from a probability sample of White residents of Nashville, Tennessee. We find that regardless of neighborhood crime rates or socioeconomic compositions, Whites report heightened perceptions of crime and danger in their neighborhoods as the proportion of Black residents increases. Perceived neighborhood danger, in turn, predicts increased symptoms of psychophysiological distress. When stratified by socioeconomic status (SES), however, low-SES Whites also report perceptions of higher status when living near more Black neighbors, which entirely offsets their distress. We conclude that although anti-Black racism can ironically harm the health of White Americans, compensatory racist ideologies can also offset these harms, particularly for lower-status Whites. We situate our findings within broader discussions of anti-Black racism, residential segregation, and psychiatric disorders commonly observed among White Americans.

The effect of Medicaid expansion on the take-up of disability benefits by race and ethnicity

Public disability programs provide financial support to 12 million working-age individuals per year, though not all eligible individuals take up these programs. Mixed evidence exists regarding the impact of Medicaid eligibility expansion on program take-up, and even less is known about the relationship between Medicaid expansion and racial and ethnic disparities in take-up. Using 2009-2020 Current Population Survey data, we compare changes in Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) take-up among respondents with disabilities living in Medicaid expansion states to respondents with disabilities living in non-expansion states, before and after Medicaid expansion. We further explore heterogeneity by race/ethnicity. We find that Medicaid expansion reduced SSI take-up by 10% overall, particularly among White and Hispanic respondents (10% and 21%, respectively). Medicaid expansion increased SSDI take-up by 8% overall, particularly among White and Black respondents (9% and 11%, respectively). Moreover, we find that Medicaid expansion reduced the probability that respondents with disabilities had employer-sponsored health insurance by approximately 8%, suggesting that expansion may have reduced job-lock among the SSDI-eligible, contributing to the observed increase in SSDI take-up.

Black Pastors' Experiences of Occupational and Life Stress During COVID-19 in the USA

This study sought to identify the occupational stressors Black pastors experience, who serve in Black Church denominations and Black nondenominational churches. A total of 218 pastors completed the survey out of 2786 for a response rate of 10.1%. Black pastors identified their most challenging stressors as member dynamics, financial stress, leading a church to fulfill its mission, and pastor's workload. Black women pastors faced the additional stressor of having their pastoral leadership challenged by male congregants. Black pastors faced more stressors during the COVID-19 pandemic including church closures, transitioning to virtual services, unexpected deaths, and an increased workload with 72.5% of pastors reporting moderate to extreme stress levels. Approximately 77% of pastors acknowledged experiencing from moderate to extreme stress levels during social protests for the deaths of Black people by law enforcement. Black pastors further acknowledged experiencing an additional three to six life stressors outside of their pastoral roles.

Religious Involvement and Allostatic Resilience: Findings from a Community Study of Black and White Americans

Wide inequities in stress and health have been documented between Black and White women and men in the United States. This study asks: How does religion factor into these inequities? We approach this open question from a biopsychosocial perspective, developing three hypotheses for the stress-coping effects of religiosity between groups. We then test our hypotheses with survey and biomarker data from the Nashville Stress and Health Study (2011-2014), a probability sample of Black and White women and men from Davidson County, Tennessee. We find that Black women score the highest on all indicators of religiosity, followed by Black men, White women, and White men. We also find that increased divine control and religious coping predict higher levels of resiliency biomarkers for Black women only and lower levels for White respondents, especially White men. We discuss how our findings inform broader population health inequities and outline several avenues for future research.

Allostatic load and risk of invasive breast cancer among postmenopausal women in the U.S

OBJECTIVE

Allostatic load can reflect the body's response to chronic stress. However, little is known about the association between allostatic load and risk of breast cancer in postmenopausal women. This study used a large prospective cohort in the United States to examine the relationship between allostatic load and invasive breast cancer risk, and to evaluate the relationship by racial and ethnic identity and breast cancer subtypes.

METHODS

Among 161,808 postmenopausal participants in Women's Health Initiative, eligible were a subsample of 27,393 postmenopausal women aged 50-79 years old, who enrolled from 1993 to 1998, had serum test biomarkers, and were followed for breast cancer incidence through February 2022. Allostatic load at enrollment was computed based on eight biomarkers from lab serum tests and a questionnaire about participants' prescription drug use. The associations between allostatic scores and risk of breast cancer (overall and by subtypes) were assessed using Cox proportional hazards models. The race and ethnic differences were examined.

RESULTS

Over a median follow-up time of 17.24 years, 1722 invasive breast cancer cases were identified. High allostatic load was associated with an increased risk of breast cancer (HR = 1.36, 95%CI: 1.20, 1.54 for third tertile vs first tertile, Ptrend < 0.0001). Similar trends were found in White women and non-Hispanic women. Higher allostatic load was associated with hormone receptor-positive and HER2/Neu-negative breast cancer (HR = 1.54, 95%CI: 1.30, 1.80 for third tertile vs first tertile, Ptrend < 0.0001).

CONCLUSION

In this study, we found that higher allostatic load was significantly associated with an increased risk of breast cancer in postmenopausal women.

Race Disparities in Hypertension Prevalence Among Older Men

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.

Lifetimes of Vulnerability: Childhood Adversity, Poor Adult Health, and the Criminal Legal System

On average, incarcerated people have higher rates of poor health, mental illness, and histories of adverse childhood experiences (ACEs) than the general population. This mixed-methods analysis examines the relationship between ACEs and poor adult health among a sample of formerly incarcerated people. The quantitative analysis (N = 122) shows childhood adversity is associated with various health conditions in adulthood, although the strength of this relationship varies by the kinds of ACEs respondents encountered. The qualitative analysis of life history timelines (N = 42) reveals two pathways relating ACEs to poor health and legal system involvement: (1) violence and victimization and (2) drug use as a coping mechanism. Unaddressed mental health challenges in the aftermath of adversity emerged as an important precursor to both pathways. Prisons lack a meaningful consideration of these early life events and the social structures that result in the high rates of vulnerable people in its care.

Black Mothers' Concern for Their Children as a Measure of Vicarious Racism-Related Vigilance and Allostatic Load

This study investigates the relationship between allostatic load and a novel form of altruistic racism-related fear, or concern for how racism might harm another, which we term vicarious racism-related vigilance. Using a subsample of Black mothers from the African American Women's Heart & Health Study (N = 140), which includes detailed health and survey data on a community sample of Black women in the San Francisco Bay Area, this study investigates the relationship between Black mothers' experiences with racism-related vigilance as it relates to their children and allostatic load-a multisystem metric of underlying health across multiple biological systems. Findings indicate that vicarious racism-related vigilance was positively associated with allostatic load (i.e., worse health). Findings highlight the salience of vicarious racism-related vigilance for the health of Black mothers, underscoring how intersections between race, gender, and parenthood result in susceptibility to unique forms of health-harming stress.

Racial and Ethnic Residential Segregation and Monocyte DNA Methylation Age Acceleration

Importance

Neighborhood segregation and poverty may be important drivers of health inequities. Epigenomic factors, including DNA methylation clocks that may mark underlying biological aging, have been implicated in the link between social factors and health.

Objective

To examine the associations of neighborhood segregation and poverty with 4 DNA methylation clocks trained to capture either chronological age or physiological dysregulation.

Design, Setting, and Participants

This cohort study uses data from the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal study that started in 2000 to 2002, with follow-up in 2002 to 2004, 2004 to 2005, 2005 to 2007, and 2010 to 2012. In 2000 to 2002, adults who identified as White or Black race or Hispanic or Chinese ethnicity in 6 US sites (Baltimore, Maryland; Chicago, Illinois; Forsyth County, North Carolina; Los Angeles County, California; Northern Manhattan, New York; and St. Paul, Minnesota) were sampled for recruitment. A random subsample of 4 sites (Maryland, North Carolina, New York, and Minnesota) were selected for inclusion in the MESA epigenomics ancillary study at examination 5 (2010-2012). Participants who identified as White or Black race or Hispanic ethnicity, were aged 45 to 84 years, and did not have clinical cardiovascular disease were included in this analysis. Data were analyzed from May 2021 to October 2023.

Exposure

Information on 2000 census tract poverty and Getis-Ord G statistic segregation of Hispanic residents, non-Hispanic Black residents, or non-Hispanic White residents were linked to participant addresses at examination 1 (2000-2002).

Main Outcomes and Measures

At examination 5, DNA methylation was measured in purified monocytes. DNA methylation age acceleration was calculated using 4 clocks trained on either chronological age or physiological dysregulation. Linear regressions were used to test associations.

Results

A total of 1102 participants (mean [SD] age, 69.7 [9.4] years; 562 [51%] women) were included, with 348 Hispanic participants, 222 non-Hispanic Black participants, and 533 non-Hispanic White participants. For non-Hispanic Black participants, living in tracts with greater segregation of Black residents was associated with GrimAge DNA methylation age acceleration, a clock designed to capture physiological dysregulation. A 1-SD increase in segregation was associated with 0.42 (95% CI, 0.20-0.64) years age acceleration (P < .001); this association was not observed with other clocks. This association was particularly pronounced for participants living in high poverty tracts (interaction term, 0.24; 95% CI, 0.07-0.42; P = .006). In the overall sample, census tract poverty level was associated with GrimAge DNA methylation age acceleration (β = 0.45; 95% CI, 0.20-0.71; adjusted P = .005).

Conclusions and Relevance

These findings suggest that epigenomic mechanisms may play a role in the associations of segregated and poor neighborhoods with chronic conditions.

Inequities in Anticipatory Stress of Police Brutality and Depressed Mood Among Women

BACKGROUND

Police brutality towards racially minoritized populations is structural racism. Even though most of the research on the health impacts of police brutality centers the experiences of men, women are also harmed by this structural violence.

OBJECTIVES

We identify factors associated with the anticipatory stress of police brutality among women and examine its relationship with depressed mood across ethno-racial categories.

METHODS

Data came from the cross-sectional Survey of the Health of Urban Residents in the United States (N = 2796). Logistic regressions were used to identify factors associated with odds of always worrying about the possibility of becoming a victim of police brutality and to examine its association with depression among Latinas, Black, and White women.

RESULTS

Odds of always worrying about police brutality were greater among Black women and Latinas compared to White women. Household history of incarceration was associated with anticipation of police brutality among Black women and Latinas but not among White women. Black women and Latinas with constant anticipation of police brutality and history of incarceration of a household member during their childhood had elevated odds of depressed mood.

CONCLUSION

Although police brutality harms all women, the stressful anticipation of police brutality does not burden all women equally. Structural racism in communities of color continues to be associated with the anticipatory stress of police brutality and it harms the mental health of women of color. Developing policies to eliminate structural racism and for the allocation of resources to persons who are strongly impacted by these injustices is important.

Association between Racial Residential Segregation and COVID-19 Mortality

This study investigates the impact of racial residential segregation on COVID-19 mortality during the first year of the US epidemic. Data comes from the Center for Disease Control and Prevention (CDC), and the Robert Wood Johnson Foundation's and the University of Wisconsin's joint county health rankings project. The observation includes a record of 8,670,781 individuals in 1488 counties. We regressed COVID-19 deaths, using hierarchical logistic regression models, on individual and county-level predictors. We found that as racial residential segregation increased, mortality rates increased. Controlling for segregation, Blacks and Asians had a greater risk of mortality, while Hispanics and other racial groups had a lower risk of mortality, compared to Whites. The impact of racial residential segregation on COVID-19 mortality did not vary by racial group.

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

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.

Inflation hardship, gender, and mental health

Inflation hit a 40 year high in the United States in 2022, yet the impact of inflation related hardships on distress is poorly understood, particularly the impact on women, whose income is already more limited. Using data from the US Household Pulse Survey (September-November 2022), we test whether exposure to inflation hardships is associated with greater distress and whether this association is moderated by gender (n = 119,531). We draw on a list of eighteen inflation related hardships (e.g., purchasing less food, working additional jobs, delaying medical treatment) to construct an ordinal measure of exposure to inflation hardship ranging from "no inflation hardship" to "five or more inflation hardships." We observe that an increasing number of inflation hardships is associated with higher levels of distress. We find no evidence of gender differences in the magnitude of that association at lower levels of inflation hardship (four inflation hardships or less). However, our findings suggest that exposure to five or more inflation hardships is more strongly associated with distress among men compared to women. The current study provides new insights into the cumulative burden of inflation hardships on mental health and the role that gender plays in this association.

Racial/Ethnic Disparities in Vicarious and Direct COVID-19-Related Discrimination and Vigilance

INTRODUCTION

The high visibility of COVID-19-related discrimination underscores the importance of understanding the psychological harms associated with vicariously and directly experiencing such incidents. In this observational study, both vicariously and directly experienced COVID-19-related discrimination and their association with heightened concerns about discrimination and vigilance were examined in U.S. adults who use commercial tobacco.

METHODS

Data were from a nationally representative sample of adults who currently or formerly used commercial tobacco products (N=1,700; mean age=43 years) from an online survey panel administered in January-February 2021 (analyzed in 2021-2022). Participants reported vicariously and directly experienced COVID-19-related discrimination, concern about experiencing such discrimination, and heightened vigilance. Weighted multivariable linear and logistic regression models were used to examine the associations among these variables.

RESULTS

Overall, 69% of individuals reported exposure to vicarious COVID-19-related discrimination, and 22% reported directly experiencing COVID-19-related discrimination. Asian, Hispanic, and Black individuals reported higher levels of concern and vigilance than White individuals (p<0.05). Vicariously and directly experienced COVID-19-related discrimination was independently associated with concern about experiencing COVID-19-related discrimination in the entire sample and within each racial and ethnic group (p<0.05). This concern was associated with increased vigilance (p<0.05) and was stronger in those exposed to vicarious COVID-19-related discrimination than in those who were not (p<0.05).

CONCLUSIONS

COVID-19-related discrimination may undermine the psychological well-being of those who are exposed to it vicariously as well as those who experience it directly and may also make individuals feel vulnerable and unsafe. Interventions to prevent and reduce the impact of COVID-19-related discrimination may have wide-reaching societal benefits.

Assessing Factors Influencing Commitment to a Disparities Reduction Intervention: Social Justice Attitudes and Organizational Mission

ABSTRACT

This mixed-methods study aims to understand what the perceptions of leaders and healthcare professionals are regarding causes of disparities, cultural competence, and motivation before launching a disparity reduction project in hypertension care, contrasting perceptions in Federally Qualified Health Centers (FQHCs), and in a non-FQHC system. We interviewed leaders of six participating primary care systems and surveyed providers and staff. FQHC respondents reported more positive cultural competence attitudes and behavior, higher motivation to implement the project, and less concern about barriers to caring for disadvantaged patients than those in the non-FQHC practices; however, egalitarian beliefs were similar among all. Qualitative analysis suggested that the organizational missions of the FQHCs reflect their critical role in serving vulnerable populations. All system leaders were aware of the challenges of provider care to underserved groups, but comprehensive initiatives to address social determinants of health and improve cultural competence were still needed in both system types. The study provides insights into the perceptions and motivations of primary care organizational leaders and providers who are interested in improving chronic care. It also offers an example for care disparity programs to understand commitment and values of the participants for tailoring interventions and setting baseline for progress.

Indirect Effects of Racial Discrimination on Health Outcomes Through Prefrontal Cortical White Matter Integrity

BACKGROUND

Racial discrimination is consistently associated with adverse health outcomes and has been linked to structural decrements in brain white matter. However, it is unclear whether discrimination-related neuroplastic changes could indirectly affect health outcomes. Our goal was to evaluate indirect associations of racial discrimination on health outcomes through white matter microstructure in a sample of trauma-exposed Black women.

METHODS

A trauma study in an urban hospital setting recruited 79 Black women who received a history and physical examination to assess medical disorders (compiled into a summed total of disorder types). Participants reported on experiences of racial discrimination and underwent diffusion tensor imaging; fractional anisotropy values were extracted from white matter pathways previously linked to racial discrimination (corpus callosum, including the body and genu; anterior cingulum bundle; and superior longitudinal fasciculus) and entered into mediational models.

RESULTS

Indirect effects of racial discrimination on medical disorders through left anterior cingulum bundle fractional anisotropy were significant (β = 0.07, SE = 0.04, 95% CI [0.003, 0.14]) after accounting for trauma and economic disadvantage. Indirect effects of racial discrimination on medical disorders through corpus callosum genu fractional anisotropy were also significant (β = 0.08, SE = 0.04, 95% CI [0.01, 0.16]).

CONCLUSIONS

Racial discrimination may increase risk for medical disorders via neuroplastic effects on microstructural integrity of stress-sensitive prefrontal white matter tracts. Racial discrimination-related changes in these tracts may affect health behaviors, which, in turn, influence vulnerability for medical disorders. These data highlight the connections between racial discrimination, prefrontal white matter connections, and incidence of medical disorders in Black Americans.

Food Insecurity and Blood Pressure in a Multiethnic Population

Food insecurity is a social determinant of health and is increasingly recognized as a risk factor for hypertension. Native Hawaiians bear a disproportionate burden of hypertension and known risk factors. Despite this, the relative effects of food insecurity and financial instability on blood pressure have yet to be investigated in this population. This study examines the relative effects of food insecurity and financial instability on blood pressure, controlling for potential confounders in a multiethnic sample. Participants (n = 124) were recruited from a U.S. Department of Agriculture-funded study called the Children's Healthy Living Center of Excellence. Biometrics (i.e., blood pressure, weight, and height) were measured. Demographics, physical activity, diet, psychosocial variables, food insecurity, and financial instability were assessed via self-report questionnaires. Hierarchical linear regression models were conducted. Model 1, which included sociodemographic variables and known biological risk factors, explained a small but significant amount of variance in systolic blood pressure. Model 2 added physical activity and daily intake of fruit, fiber, and whole grains, significantly improving the model. Model 3 added financial instability and food insecurity, further improving the model (R2 = 0.37, F = 2.67, p = 0.031). Food insecurity, female sex, and BMI were significantly and independently associated with increased systolic blood pressure. These results suggest a direct relationship between food insecurity and systolic blood pressure, which persisted after controlling for physical activity, consumption of fruits, fiber, and whole grains, and BMI. Efforts to reduce food insecurity, particularly among Native Hawaiians, may help reduce hypertension in this high-risk population.

Implications of Cumulative Life Event Stress for Daily Stress Exposure and Cardiovascular Reactivity Among Black and White Americans

OBJECTIVES

Daily stress and cardiovascular reactivity may be important mechanisms linking cumulative life event stress with cardiovascular health and may help to explain racial health disparities. However, studies have yet to examine links between exposure to life event stress, daily stress exposure, and cardiovascular reactivity. This study assessed links between trajectories of life event stress exposure, daily stressors, and cardiovascular reactivity among Black and White individuals.

METHODS

Participants are from the Stress and Well-being in Everyday Life Study in which 238 individuals (109 Black 129 White; ages 33-93), drawn from the longitudinal Social Relations Study, reported life event stress in 1992, 2005, 2015, and 2018. Of those individuals, 169 completed an ecological momentary assessment study in which they reported stress exposure every 3 hr, and 164 wore a heart rate monitor for up to 5 days.

RESULTS

Latent class growth curve models revealed 2 longitudinal trajectories of life event stress: moderate-increasing and low-decreasing. Individuals in the moderate-increasing stress trajectory reported greater daily stress exposure and links did not vary by race. Black individuals in the low-decreasing trajectory and White individuals in the moderate-increasing trajectory showed positive associations between daily stress and heart rate (i.e., were reactive to daily stress exposure). The link between daily stress and heart rate was not significant among Black individuals in the moderate-increasing trajectory and White individuals in the low-decreasing trajectory.

DISCUSSION

Individuals who experience more life events across the adult life course report greater daily stress exposure which has important implications for daily cardiovascular health. Black individuals with moderate-increasing life event stress show evidence of blunted daily stress reactivity (nonsignificant association between daily stress and heart rate) whereas Black individuals with low-decreasing life event stress show evidence of stress reactivity (positive association between daily stress and heart rate). White individuals showed the opposite pattern (albeit marginally). These findings expand the weathering hypothesis and indicate that chronic life event stress may be associated with blunted stress reactivity among Black individuals.

The COVID-19, racism, and violence syndemic: Evidence from a qualitative study with Black residents of Chicago

The COVID-19 pandemic emerged in the United States in the shadows of a vast history of structural racism and community and police violence that disproportionately affect Black communities. Collectively, they have created a syndemic, wherein COVID-19, racism, and violence are mutually reinforcing to produce adverse health outcomes. The purpose of this study was to understand the COVID-19, racism, and violence syndemic and examine how structural racism and violence contributed to the disproportionate impact of COVID-19 on Black communities. In early 2021, we conducted phenomenological qualitative interviews with 50 Black residents of Chicago. Interview transcripts were coded and analyzed using thematic analysis. We identified four primary themes in our analyses: 1) the intersection of racism and violence in Chicago; 2) longstanding inequities were laid bare by COVID-19; 3) the pervasiveness of racism and violence contributes to poor mental health; 4) and COVID-19, racism and violence emerged as a syndemic. Our findings underscore the importance of addressing social and structural factors in remediating the health and social consequences brought about by COVID-19.

Racialized Health Inequities: Quantifying Socioeconomic and Stress Pathways Using Moderated Mediation

Racism drives population health inequities by shaping the unequal distribution of key social determinants of health, such as socioeconomic resources and exposure to stressors. Research on interrelationships among race, socioeconomic resources, stressors, and health has proceeded along two lines that have largely remained separate: one examining differential effects of socioeconomic resources and stressors on health across racialized groups (moderation processes), and the other examining the role of socioeconomic resources and stressors in contributing to racial inequities in health (mediation processes). We conceptually and analytically integrate these areas using race theory and a novel moderated mediation approach to path analysis to formally quantify the extent to which an array of socioeconomic resources and stressors-collectively and individually-mediate racialized health inequities among a sample of older adults from the Health and Retirement Study. Our results yield theoretical contributions by showing how the socioeconomic status-health gradient and stress processes are racialized (24% of associations examined varied by race), substantive contributions by quantifying the extent of moderated mediation of racial inequities (approximately 70%) and the relative importance of various social factors, and methodological contributions by showing how commonly used simple mediation approaches that ignore racialized moderation processes overestimate-by between 5% and 30%-the collective roles of socioeconomic status and stressors in accounting for racial inequities in health.

The differential impact of COVID-19 across health service psychology students of color: An embedded mixed-methods study

OBJECTIVES

Communities of color in the United States systematically experience inequities in physical and mental health care compared to individuals who identify as non-Hispanic White. The coronavirus disease 2019 (COVID-19) pandemic exacerbated these structural drivers of inequity to disproportionate and devastating effects for persons of color. In addition to managing the direct effects of COVID-19 risk, persons of color were also navigating increased racial prejudice and discrimination. For mental health professionals and trainees of color, the effects of COVID-19 racial health disparities and the increase in acts of racism may have been compounded by their work responsibilities. The current study used an embedded mixed-methods approach to examine the differential impact of COVID-19 on health service psychology (HSP) students of color as compared to their non-Hispanic White peers.

METHOD

Using quantitative and qualitative data from the Epidemic-Pandemic Impacts Inventory, measures of perceived support and of discrimination, and open-ended questions about students' experiences with racism and microaggressions, we examined the extent to which different racial/ethnic HSP student groups experienced COVID-19-related discrimination, the impacts of COVID-19 felt by students of color, and how these experiences differed from those of their non-Hispanic White peers.

RESULTS

HSP students of color endorsed greater impacts of the pandemic on both self and others in the home, perceived themselves as less supported by others, and reported more experiences of racial discrimination than non-Hispanic White HSP students.

CONCLUSION

Throughout the graduate experience, HSP students of color and their experiences of discrimination need to be addressed. We provided recommendations to HSP training program directors and students both during and after the COVID-19 pandemic.

Gender, race/skin colour and incidence of hypertension in ELSA-Brasil: an intersectional approach

OBJECTIVE

Race and gender inequities in the incidence of hypertension (HTN) are well documented; however, few empirical investigations looked into these associations, considering the synergies and heterogeneous experiences of intersectional gender and race/skin colour groups. This study investigated the association of intersectional identities defined by gender and race/skin colour with HTN incidence, and verified whether they are affected by educational level in adulthood.

DESIGN

We used the Longitudinal Study of Adult Health (ELSA-Brasil) data to estimate the incidence of HTN between visits 1 (2008-2010) and 2 (2012-2014), in 8528 participants without hypertension at visit 1. HTN was defined as systolic blood pressure ≥140 mmHg, or diastolic blood pressure ≥90 mmHg, or use of antihypertensive drugs. Generalized linear models with Poisson distribution and log link function were used to assess the associations.

RESULTS

The incidence of HTN was 43.4/1000 person-years, ranging from 30.5/1000 in White women to 59.4/1000 in Black men. After adjusting by age and family history of HTN, the incidence rate ratio (IRR) was higher in Black men (2.25; 95%CI: 1.65-3.08), Brown (Pardo) men (1.89; 95%CI: 1.59-2.25), Black women (1.85; 95%CI: 1.50-2.30), Brown (Parda) women (1.47; 95%CI: 1.31-1.67) and White men (1.76; 95%CI: 1.49-2.08), compared to White women. These associations were maintained even after considering socioeconomic, behavioural and health mediators in the model. No interaction was found between education level and intersectional identities in the IRRs observed.

CONCLUSION

By using an intersectional approach, we showed the complex relations between race/skin colour and gender inequities in the incidence of HTN, pointing not only that Black men have the highest risk of developing HTN, but also that the risk of HTN is greater in Black women than in White men, when compared to White women.

Neighborhood social organization exposures and racial/ethnic disparities in hypertension risk in Los Angeles

Despite a growing evidence base documenting associations between neighborhood characteristics and the risk of developing high blood pressure, little work has established the role played by neighborhood social organization exposures in racial/ethnic disparities in hypertension risk. There is also ambiguity around prior estimates of neighborhood effects on hypertension prevalence, given the lack of attention paid to individuals' exposures to both residential and nonresidential spaces. This study contributes to the neighborhoods and hypertension literature by using novel longitudinal data from the Los Angeles Family and Neighborhood Survey to construct exposure-weighted measures of neighborhood social organization characteristics-organizational participation and collective efficacy-and examine their associations with hypertension risk, as well as their relative contributions to racial/ethnic differences in hypertension. We also assess whether the hypertension effects of neighborhood social organization vary across our sample of Black, Latino, and White adults. Results from random effects logistic regression models indicate that adults living in neighborhoods where people are highly active in informal and formal organizations have a lower probability of being hypertensive. This protective effect of exposure to neighborhood organizational participation is also significantly stronger for Black adults than Latino and White adults, such that, at high levels of neighborhood organizational participation, the observed Black-White and Black-Latino hypertension differences are substantially reduced to nonsignificance. Nonlinear decomposition results also indicate that almost one-fifth of the Black-White hypertension gap can be explained by differential exposures to neighborhood social organization.

Racial discrimination and its impact on mental health

There is evidence that racial discrimination at different levels has a major impact on mental health over the whole life span. It is related generally to poor health, with the relationship being particularly strong for mental health. All forms of structural, institutionalised, interpersonal and internalised racism as well as the cumulative impact of intersectional discrimination appear to be linked to mental health and well-being. Studies also show links between effects of racial discrimination and neurophysiology especially on the brain volume. All forms of racism need to be addressed in inter- and transdisciplinary ways in order to dismantle racial discrimination. This review provides an overview of these interconnections.

Stress Reduction to Decrease Hypertension for Black Women: A Scoping Review of Trials and Interventions

INTRODUCTION

Chronic stress is a potential root cause of racial/ethnic disparities in cardiovascular disease. This review assesses literature surrounding effective stressreduction interventions to reduce hypertension (HTN)-a cardiovascular disease (CVD) risk factor-among an understudied population, non-Hispanic black (NHB) women.

METHODS

We conducted an electronic search of PubMed and PsycINFO literature published between January 1, 2000 and February 1, 2020, employing the keywords: "blood pressure", "hypertension", and "women", "black", "African-American", "stress", "meditation", "stress-coping", "stress-management", and "faith-based". We manually searched the bibliographies for additional articles. Studies were excluded if they: were published before 2000; were not intervention-based; did not study Black women in the US; did not target stress reduction; or did not measure blood pressure as an outcome. Independent reviewers screened the articles, which were selected based on consensus. Effect sizes and statistical p values were reported as provided in the included articles.

RESULTS

We identified 109 articles in total. Of those, six articles met inclusion criteria. Stronger evidence presented by a randomized control trial supported the efficacy of transcendental meditation with reductions in systolic and diastolic blood pressure up to 7 mmHg. Relaxation exercises, support groups, and therapeutic massage emerged as potentially beneficial in non-randomized pilot trials with reductions in systolic BP up to 9 mmHg and diastolic BP up to 5 mmHg varying by type and duration of the intervention.

CONCLUSIONS

This scoping review found that faith-based strategies and meditation can be effective stress reduction techniques to reduce BP among NHB women. However, much remains to be known about how these strategies may be leveraged to reduce blood pressure within this highly vulnerable population.

Responding to Microaggressions: Social Cost of Bystander Intervention Strategies

This two-part study examined the effects of intervener’s race (White vs. Asian) and intervention format (high-threat—emphasizing the act of racism, low-threat—emphasizing the norm of justice, support-based—emphasizing a nonjudgmental attitude) on perceptions of microaggression interventions for White observers and Asian American targets. In separate 2 x 3 experimental designs, Asian Americans participants ( N = 187) and White American participants ( N = 185) were recruited through Qualtrics panels and randomly assigned to one of six conditions (three formats of intervention and two intervener groups). Participants read a vignette, imagined themselves as targets of the microaggression (Asian sample) or witnesses of the interaction (White sample), and completed a set of questionnaires assessing positive and negative perceptions of the intervener and aggressor. Asian American targets and White witnesses had more negative perceptions of interveners in the high threat condition. Covariates were relevant in interpreting reactions to intervention.

Association between socioeconomic status and arteriosclerotic cardiovascular disease risk and cause-specific and all-cause mortality: Data from the 2005-2018 National Health and Nutrition Examination Survey

Background

Morbidity and mortality of arteriosclerotic cardiovascular disease (ASCVD) varied according to socioeconomic status (SES), and evidence on the association between SES and ASCVD risk, and cause-specific and all-cause mortality was nevertheless lacking in large-scale or population-based studies.

Methods

A multicycle cross-sectional design and mortality linkage study was conducted using data from Continuous National Health and Nutrition Examination Survey (NHANES) in the United States, including public use linked mortality follow-up files through December 31, 2019. Poverty income ratio (PIR) served as a SES index. A series of weighted Logistic regressions and Cox proportional hazards regressions were used to investigate the association between the SES and the risk of ASCVD and mortality, respectively.

Results

The study sample was comprised of 30,040 participants aged 20-85 years old during the 2005-2018 period. Weighted Logistic regression models consistently indicated significant relationship between people experiencing poverty and increased risk of ASCVD, and linear trend tests were all statistically significant (all P for trend < 0.001). Additionally, weighted Cox regression analysis consistently demonstrated that the hazards of cause-specific and all-cause mortality increased, with the decrease of each additional income level, and trend analyses indicated similar results (all P for trend < 0.001).

Conclusions

Our study confirmed that the SES was strongly linked to living with ASCVD, and cause-specific and all-cause mortality, even after adjusting for other factors that could impact risk, such as the American Heart Association (AHA)'s Life's Simple 7 cardiovascular health score and variables of age, sex, marital status, education, and depression severity.

Adjusting for Patient Economic/Access Issues in a Hypertension Quality Measure

INTRODUCTION

The American Heart Association and American College of Cardiology have proposed adjusting hypertension-related care quality measures by excluding patients with economic/access issues from the denominator of rate calculations. No research to date has explored the methods to operationalize this recommendation or how to measure economic/access issues. This study applied and compared different approaches to populating these denominator exceptions.

METHODS

Electronic health record data from 2019 were used in 2021 to calculate hypertension control rates in 84 community health centers. A total of 10 different indicators of patient economic/access barriers to care were used as denominator exclusions to calculate and then compare adjusted quality measure performance. Data came from a nonprofit health center‒controlled network that hosts a shared electronic health record for community health centers located in 22 states.

RESULTS

A total of 5 of 10 measures yielded an increase in adjusted hypertension control rates in ≥50% of clinics (average rate increases of 0.7-3.71 percentage points). A total of 3 of 10 measures yielded a decrease in adjusted hypertension control rates in >50% of clinics (average rate decreases of 1.33-13.82 percentage points). A total of 5 measures resulted in excluding >50% of the clinic's patient population from quality measure assessments.

CONCLUSIONS

Changes in clinic-level hypertension control rates after adjustment differed depending on the measure of economic/access issue. Regardless of the exclusion method, changes between baseline and adjusted rates were small. Removing community health center patients experiencing economic/access barriers from a hypertension control quality measure resulted in excluding a large proportion of patients, raising concerns about whether this calculation can be a meaningful measure of clinical performance.

Narrowing Racial Differences in Trust: How Discrimination Shapes Trust in a Racialized Society

In the United States, survey research and qualitative studies consistently find that people of color-and Blacks in particular-report substantially lower levels of trust than do whites. These racial differences in trust pervade a range of social contexts, from interpersonal relationships with friends, family, and neighbors to interactions with the health care and criminal justice systems. Scholars often attribute racial differences in trust to historical and contemporary forms of discrimination, yet few studies have assessed the relationship among race, discrimination, and trust in the context of the United States. Using the Chicago Community Adult Health Study, I examine how the experience of discrimination relates to generalized trust, trust in neighbors, and trust in community police. Findings reveal that personal experience with discrimination contributes modestly to racial differences in trust. In fact, the negative association between discrimination and generalized trust appears strongest for whites. These findings suggest that understanding distrust requires a richer conceptual framework that moves beyond personal experience with discrimination. I argue that the theory of systemic racism provides a framework for understanding distrust as a consequence of countervailing efforts to uphold and contest the racial hierarchy.

The impact of COVID-19 and housing insecurity on lower-income Black women

During the COVID-19 pandemic, multiple groups faced increased risks for negative health and mortality. Using an intersectional framework, the current study explores how the global pandemic impacted lower-income women living in the United States through access to housing. Findings indicate several challenges  remaining stably housed during the pandemic. Major themes included: (1) High-Risk Survival Economies, (2) Landlord Stress, Deception, and Exclusion, (3) Landlord Harassment, (4) Low Levels of Formal and Informal Support, (5) Housing as a Health Risk Factor, and (6) Resilience. These themes are explored through four in-depth narrative accounts. Implications for health and policy are discussed. Future research that examines and engages with both direct (e.g., material scarcity) and indirect (e.g., discrimination) pathways that connect housing to health are strongly encouraged.

Skin Tone and the Health Returns to Higher Status

This study addresses two questions. First, why do Black Americans exhibit worse health outcomes than White Americans even at higher levels of socioeconomic status (SES)? Second, are diminished health returns to higher status concentrated among Black Americans with darker skin color? Novel hypotheses are tested with biosocial panel data from Add Health, a nationally representative cohort of Black and White adolescents who have transitioned to adulthood. We find that White and light-skin Black respondents report improved health after achieving higher SES, on average, while their darker-skin Black peers report declining health. These patterns persist regardless of controls for adolescent health status and unmeasured between-person heterogeneity. Moreover, increased inflammation tied to unfair treatment and perceptions of lower status helps to account for patterns of diminished health returns for dark-skin Black groups. Our study is the first to document skin tone heterogeneity in diminished health returns and one of few studies to identify life course stress processes underlying such disparities. We consider additional processes that could be examined in future studies, as well as the broader health and policy implications of our findings.

How Racism "Gets Under the Skin": An Examination of the Physical- and Mental-Health Costs of Culturally Compelled Coping

Historically and contemporarily, Black Americans have been compelled to use effortful coping styles characterized by high behavioral and emotional restraint in the face of systematic racism. Lynch and colleagues have previously conceptualized a class of regulatory strategies-overcontrolled coping-characterized by emotional suppression, hypervigilance for threat, and high distress tolerance, which bear close analogy to coping styles frequently used among individuals facing chronic racial stress. However, given the inherent culture of racism in the United States, engaging in highly controlled coping strategies is often necessitated and adaptive, at least in the short term. Thus, for Black Americans this class of coping strategies is conceptualized as culturally compelled coping rather than overcontrolled coping. In the current article, I offer a critical examination of the literature and introduce a novel theoretical model-culturally compelled coping-that culturally translates selected components of Lynch's model. Cultural translation refers to considering how the meaning, function, and consequences of using overcontrolled coping strategies changes when considering how Black Americans exist and cope within a culture of systematic racism. Importantly, this model may offer broad implications for future research and treatment by contextualizing emotion regulation as a central mechanism, partially answering how racism "gets under the skin" and affects the health of Black Americans.

Self-employment, educational attainment, and hypertension among Black women and men

Background

Self-employment is generally associated with better health outcomes and educational attainment can shape self-employment. Yet, Black Americans are less likely to be self-employed and analyses of self-employment and health among Black Americans are few. The aim of this study was to determine how educational attainment moderates the associations between self-employment and hypertension among Black adults.

Methods

Using data from the 2007-2018 National Health and Nutrition Examination Survey, participants who self-identified as non-Hispanic Black (n = 2,855) were categorized as (1) employees with no self-employment income, (2) employees with self-employment income, or (3) having full-time self-employment. Modified Poisson regressions and multiplicative interaction terms were used to determine whether educational attainment moderated the associations between self-employment and measured hypertension (i.e., 140/90 mm Hg or anti-hypertensive medication).

Results

Most participants were employees with no self-employment income (81.9%), but 11.8% were employees reporting some self-employment income and 6.3% were self-employed full-time. About two in five (40.9%) had hypertension. Having full-time self-employment was associated with lower risk of hypertension compared to those who were employees (risk ratio = 0.82, 95% confidence interval = 0.67-0.98), and educational attainment moderated the associations among Black men such that part-time self-employment was associated with high rates of hypertension among Black men who had not completed high school.

Conclusions

These results suggest that full-time self-employment is associated with lower risk of hypertension among Black adults, but that being an employee with some self-employment income may elevate rates of hypertension among Black men depending on educational attainment. Future studies should assess pathways between self-employment and hypertension by educational attainment among Black women and men.

Experiences of stress among West Africa-born immigrant women with hypertension in Washington DC area

OBJECTIVE

To report a study that explored hypertension (HTN) stress and coping experiences of West-Africa-born immigrant (WABI) women in Washington DC Metropolitan area of the United States.

DESIGN AND SAMPLE

This qualitative study conducted from December 2017 to May 2018 involved WABI women (n = 15) in Washington Metropolitan area that self-reported diagnosis of HTN. The transactional model of stress and coping (TMSC) provided the conceptual framework. Data collection was through semi-structured one-on-one interviews.  Data analysis was done through manual open-hand coding of themes.

RESULTS

Three themes emerged from the analysis: Perceived Stressors, Sources of Stress, and Coping Measures. Participants perceived that their HTN diagnosis contributed to their stress; reported other financial, school, work, trauma, household and marriage-related stressors, and coping measures that include faith-based and other recreational leisure activities.

CONCLUSION

Participants mentioned stressors related to lack of support with domestic house chores and described various religious practices as coping strategies. These findings provide additional insights relevant to several ongoing public health nursing conversations on acute and chronic stress management in different parts of the globe. Public health nurses need to utilize these findings when assessing stressors and considering safe coping measures that appeal to WABI women experiencing HTN or chronic illness.

The effects of racism and resilience on Black stroke- survivor quality of life: Study protocol and rationale for a mixed-methods approach

Introduction

Stroke, a life-threatening stressor, often negatively impacts stroke-survivor (SS) quality of life (QoL). Annual age-adjusted incidence and death rates for stroke are significantly higher among Black Americans than among White Americans. Racism, a significant stressor, occurs at structural, cultural, and interpersonal levels and contributes to health disparities for Black SS. Resilience, a dynamic process of positive adaptation to significant stress, is impacted by factors or resources both internal and external to the individual. This study aims to examine the effects of experiences of racism and resilience on Black SS QoL during early stroke recovery. This article presents the study protocol.

Methods and analyses

This will be a prospective observational mixed-methods study. Black community-dwelling adults who are within 4 weeks of a stroke will be eligible for inclusion. Baseline measures will include the exposure variables of experiences of racism and resilience. Covariates measured at baseline include sociodemographic variables (age, sex, marital status, education, income, health insurance, employment status, number of people in household, residential address), clinical variables (date and type of stroke, inferred Modified Rankin Scale, anxiety and depression screening), and psychosocial variables (COVID-19 stress, perceived stress, mindfulness). The outcome variable (QoL) will be assessed 6-months post-stroke. Multiple-level linear regression models will be used to test the direct effects of experiences of racism, and the direct and indirect effects of resilience, on QoL. Qualitative data will be collected via focus groups and analyzed for themes of racism, resilience, and QoL.

Discussion

Racism can compound the stress exerted by stroke on Black SS. This study will occur during the COVID-19 pandemic and in the aftermath of calls for social justice for Black Americans. Experiences of racism will be measured with instruments for both “everyday” discrimination and vigilance. Sociodemographic variables will be operationalized to assess specific social determinants of health that intersect with structural racism. Because of the long-standing history of racism in the United States of America (USA), cultural influences and access to resources are central to the consideration of individual-level resilience in Black SS. Study results may inform the development of interventions to support Black SS QoL through enhanced resilience.

The neurobiology of social stress resulting from Racism: Implications for pain disparities among racialized minorities

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.

Lethal Police Encounters and Cardiovascular Health among Black Americans

This study uses insights from social stress theory to examine associations between exposure to police killings of Black Americans and cardiovascular health among Black women and men. Data on lethal police encounters come from the Mapping Police Violence (MPV) database, which allows for examination of total exposures to police killings of Black people and exposures to events when decedents were unarmed. MPV data are merged with the Behavioral Risk Factor Surveillance System (n = 26,086) and state-level information from multiple federal databases. Four cardiovascular health outcomes are examined-hypertension, diabetes, heart attack, and stroke. After adjusting for important risk factors, results from gender-stratified multilevel logistic regressions reveal a positive association between exposures to police killings of unarmed Black people and odds of hypertension among Black women and stroke among Black men. Total exposures to police killings of Black people are also associated with greater likelihood of stroke for Black men. Findings from this study demonstrate that stress exposures generated by the quantity and injustice of police killings have important implications for cardiovascular health among Black Americans. Furthermore, adverse cardiovascular health associated with exposure to police violence tends to manifest differently for Black men and women.

"Well in in this neighborhood I have walked, not at all": Stroke survivors lived experience in the outdoor environment

Stroke survivors face unique challenges in the outdoor environment when returning to their home community following a stroke. Challenges include navigating uneven terrain, social stigma, and adapting to changes in functioning. Outdoor environments may serve as potential points of intervention to promote independence and participation post stroke. This study aimed to understand lived post-stroke experience in the outdoor environment as it pertains to independent mobility.

METHODS

Qualitative semi-structured interviews were conducted with 20 stroke survivors (8 males, 12 females; mean age 64.2 years: range 45 years-90 years). Participants were eligible if they were over the age of 45, could communicate in English, lived outside a nursing home, able to walk safely outdoors, were a minimum of six-months post stroke, and had no severe cognitive impairment. Interviews with participants were tape recorded, audio files were transcribed verbatim, codes were created and applied to transcripts, and themes were generated using interpretative phenomenological analysis.

RESULTS

Post-stroke experiences in the outdoor environment were multidimensional. Three themes emerged from the stroke survivors' description of personal experiences in the outdoor environment. These themes included feelings of vigilance, employing adaptation strategies, and management of dynamic relations between the self and context.

DISCUSSION

The findings highlight the post-stroke experience traversing the outdoor environment. Investing in the public outdoor environment to remove barriers and install facilitators could reduce feelings of apprehension and hypervigilance while walking in the outdoor environment. Future research is needed to evaluate the role of environmental interventions on hypervigilance in the outdoor environment post stroke.

Ethnicity, nativity, and the effects of stereotypes on cardiovascular health among people of African ancestry in the United States: internal versus external sources of racism

OBJECTIVE

The present study tests the hypothesis that ethnicity and nativity moderate the association of negative racial stereotypes versus perceived discrimination to cardiovascular health among Black respondents to the National Survey of American Life (NSAL). It is also hypothesized that the relationship is strongest in African Americans and weakest in foreign-born Caribbean Blacks with U.S.-born Caribbean Blacks falling in the middle. The same pattern of results is expected to occur for the correlation between perceived discrimination and cardiovascular health.

METHOD

A representative sample of 3570 (100%) African American and 1419 (87.4%) of 1623 Caribbean Black respondents to the NSAL had complete data for use in this study. The Caribbean subsample was divided by nativity into 373 (26.3%) U.S.-born and 1044 (73.7%) foreign-born participants. Structural equation modeling (SEM) tested the measurement model for effects of internalized racism and perceived racism on cardiovascular health mediated by perceived mastery and performance apprehension.

RESULTS

SEM analyses revealed that perceived discrimination had a much stronger effect on cardiovascular health than internalized racism for African Americans and foreign-born Caribbean Blacks, but the diametrically opposite pattern was the case for U.S.-born Caribbean Blacks who reported greater effects for internalized racism than perceived discrimination.

CONCLUSION

Interventions and policies to eliminate disparities in cardiovascular health for the U.S. Black population must address internal and external sources of racism by ethnicity and nativity.

Association between race/color and incidence of hypertension in the ELSA-Brasil population: investigating the mediation of racial discrimination and socioeconomic position

OBJECTIVE

To investigate the mediation effect of socioeconomic position and racial discrimination in the association between race/color and incidence of hypertension in 4-years follow up.

METHODS

We included 8,370 participants of the Longitudinal Study of Adult Health (ELSA-Brasil). A latent variable was constructed to represent socioeconomic position (SEP). The perception of discrimination was measured through an adaptation of the Lifetime Major Events Scale; and hypertension was defined using standard criteria. We investigated Body Mass Index (BMI) due to its role in proximal risk for hypertension. To investigate the mediating role of SEP and racial discrimination, we used structural equation modeling.

RESULTS

SEP had a direct and negative effect on HT incidence (HT incidence increased in worse SEP categories), while the effect of BMI on HT was direct and positive. We did not find significant direct effects of race/color and racial discrimination on HT. As for indirect effects, we observed associations between race/color and HT only through SEP mediation.

CONCLUSION

According to our results, race/color is indirectly related to HT incidence, mediated by SEP. Racial discrimination was not a mediator in the relationship between race/color and HT in the follow-up period.

Unique Cardiovascular Disease Risk Factors in Hispanic Individuals

Purpose of Review

This review summarizes contemporary data on unique cardiovascular disease (CVD) risk factors in Hispanic individuals in the USA, and how addressing these factors is important in addressing health equity.

Recent Findings

Recent studies have shown high rates of traditional CVD risk factors in Hispanic individuals such as obesity, hypertension, diabetes, hyperlipidemia, and emerging CVD risk factors like hypertensive disorders of pregnancy, psychological stress, and occupational exposures. However, most studies fail to consider the significant heterogeneity in risk factor burden and outcomes in atherosclerotic CVD by Hispanic subgroup. Heart failure and rhythm disorders are less well studied in Hispanic adults, making risk assessment for these conditions difficult. High levels of CVD risk factors in Hispanic youth given an aging Hispanic population overall highlight the importance of risk mitigation among these individuals.

Summary

In brief, these data highlight the significant, unique burden of CVD risk among Hispanic individuals in the USA and predict a rising burden of disease among this growing and aging population. Future CVD research should focus on including robust, diverse Hispanic cohorts as well as specifically delineating results for disaggregated Hispanic groups across CVDs. This will allow for better risk assessment, prevention, and treatment decisions to promote health equity for Hispanic patients.