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Nguyen AW, Hope MO, Qin W, Cobb N, Ding K, Taylor HO, Mitchell UA. "So, Do Not Fear": Religion and the prevalence, persistence, and severity of anxiety disorders among Black Americans. J Affect Disord 2024; 350:247-254. [PMID: 38232778 DOI: 10.1016/j.jad.2024.01.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND There is a dearth of scholarship that explicates the effects of religious participation on anxiety disorders among Black Americans. A better understanding of the links between religious participation, a coping resource, and anxiety disorders among Black Americans remains essential, given Black Americans are less likely than their white counterparts to seek professional treatment for mental health problems, leading to greater unmet mental health needs. The aim of this study was to investigate whether religious participation is associated with the prevalence, persistence, and severity of anxiety disorders among Black adults. METHODS We used a national sample of Black adults (N = 4999) from the National Survey of American Life, a cross-sectional study conducted from 2001 to 2003. Five anxiety disorders were assessed: posttraumatic stress disorder, generalized anxiety disorder, panic disorder, social anxiety disorder, and agoraphobia. Three dimensions of religious participation were assessed: organizational, non-organizational, and subjective religious participation. Weighted logistic and linear regressions were estimated to examine the associations between religious participation and anxiety disorders. RESULTS Findings indicate that organizational religious participation and subjective religiosity were associated with lower odds of anxiety disorders and decreased severity. Findings for non-organizational religious participation in relation to the prevalence, persistence, and severity of anxiety disorders were mixed. LIMITATIONS The study limitations include the utilization of self-reported measures, cross-sectional study design, and age of the data set. CONCLUSIONS Different dimensions of religious participation have differing effects on anxiety disorders. Religious participation may be an important resource for Black Americans in coping and preventing anxiety disorders.
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Affiliation(s)
- Ann W Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, United States of America.
| | | | - Weidi Qin
- Sandra Rosenbaum School of Social Work, University of Wisconsin, Madison, United States of America
| | - Nichole Cobb
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, United States of America
| | - Kedong Ding
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, United States of America
| | - Harry O Taylor
- Factor Inwentash Faculty of Social Work, University of Toronto, Canada
| | - Uchechi A Mitchell
- School of Public Health, University of Illinois at Chicago, United States of America
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Al-Amin NS, McBryde-Redzovic A, Gutierrez-Kapheim M, Mitchell UA. COVID-Related Stressors and Psychological Distress Among Chicago Residents: the Moderating Role of Race. J Racial Ethn Health Disparities 2024; 11:598-610. [PMID: 36877378 PMCID: PMC9987389 DOI: 10.1007/s40615-023-01544-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/31/2023] [Accepted: 02/16/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Racial and ethnic minorities have been disproportionately affected by the COVID-19 pandemic and have experienced greater financial loss, housing instability, and food insecurity due to COVID-related restrictions. As a result, Black and Hispanic communities may be at greater risk of experiencing psychological distress (PD). METHODS Using data collected between October 2020 and January 2021from 906 Black (39%), White (50%), and Hispanic (11%) adults, we assessed racial/ethnic differences in the effect of three COVID-related stressors-employment stress, housing instability, and food insecurity-on PD using ordinary least square regression. RESULTS Black adults reported lower PD levels compared to White adults (β = - 0.23, P < 0.001), but Hispanic adults did not differ significantly from White adults. COVID-related housing instability (β = 0.46, P < 0.001), food insecurity (β = 0.27, P < 0.001), and employment stress (β = 0.29, P < 0.001) were associated with higher PD. Employment stress was the only stressor to differentially affect PD by race/ethnicity. Among those that reported employment stress, Black adults had lower levels of distress compared to Whites (β = - 0.54, P < 0.001) and Hispanics (β = - 0.04, P = 0.85). CONCLUSION Despite relatively high exposure to COVID-related stressors, Black respondents had lower levels of PD compared to Whites and Hispanics which may reflect differences in race-specific coping mechanisms. Future research is needed to elucidate the nuances of these relationships and identify policies and interventions that prevent and minimize the impact of employment, food, and housing-related stressors and support coping mechanisms that promote mental health among minority populations, such as policies that support easier access to mental health and financial and housing assistance.
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Affiliation(s)
- Nadia S Al-Amin
- School of Public Health, Community Health Sciences Division, University of Illinois at Chicago, Chicago, IL, USA.
| | - Aminah McBryde-Redzovic
- School of Public Health, Community Health Sciences Division, University of Illinois at Chicago, Chicago, IL, USA
| | - Melissa Gutierrez-Kapheim
- School of Public Health, Community Health Sciences Division, University of Illinois at Chicago, Chicago, IL, USA
| | - Uchechi A Mitchell
- School of Public Health, Community Health Sciences Division, University of Illinois at Chicago, Chicago, IL, USA
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Nguyen AW, Taylor HO, Keith VM, Qin W, Mitchell UA. Discrimination and social isolation among African Americans: The moderating role of skin tone. Cultur Divers Ethnic Minor Psychol 2024; 30:374-384. [PMID: 36441993 PMCID: PMC10225012 DOI: 10.1037/cdp0000569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Discrimination is an urgent public health problem. A number of major cities and counties across the United States has declared racism a public health crisis. While there is a growing body of research on the discrimination-health connection, less is known regarding the social relational consequences of discrimination. The present study addresses this knowledge gap by investigating the relationship between discrimination, skin tone, and objective and subjective social isolation using a nationally representative sample of African Americans. METHOD This analysis was based upon the African American subsample (N = 3,570) of the National Survey of American Life. Discrimination was assessed with the Everyday Discrimination Scale. Objective and subjective isolation differentiated between respondents who were (a) socially isolated from both family and friends, (b) socially isolated from friends only, (c) socially isolated from family only, and (d) not socially isolated. Skin tone was self-reported. Multinomial logistic regression analyses were used to test the study hypotheses. RESULTS The analyses indicated that more frequent discriminatory experiences were associated with increased risk for subjective and objective social isolation. Skin tone moderated the association between discrimination and subjective isolation; the discrimination-isolation relationship was stronger among participants with darker skin tones. CONCLUSIONS These findings shed light on African Americans' nuanced experiences with discrimination and colorism. Further, the data demonstrate heterogeneity in the vulnerability to the adverse effects of discrimination within the African American population; the relationship between discrimination and subjective isolation was stratified by skin tone. This underscores the well-documented and persistent racialized social stratification system in the United States (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Ann W. Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University
| | | | - Verna M. Keith
- Department of Sociology, University of Alabama at Birmingham
| | - Weidi Qin
- Populations Studies Center, University of Michigan
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Yang TC, Kim S, Choi SWE, Halloway S, Mitchell UA, Shaw BA. Neighborhood Features and Cognitive Function: Moderating Roles of Individual Socioeconomic Status. Am J Prev Med 2024; 66:454-462. [PMID: 37871754 DOI: 10.1016/j.amepre.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION There is an interest in exploring the associations between neighborhood characteristics and individual cognitive function; however, little is known about whether these relationships can be modified by individual socioeconomic status, such as educational attainment and income. METHODS Drawing from the 2010-2018 Health and Retirement Study, this study analyzed 10,621 older respondents (aged 65+) with a total of 33,931 person-waves. These respondents did not have dementia in 2010 and stayed in the same neighborhood throughout the study period. Cognitive function was measured with a 27-point indicator biennially, and neighborhood characteristics (i.e., walkability, concentrated disadvantage, and social isolation) were assessed in 2010. All analyses were performed in 2023. RESULTS Cognitive function is positively associated with neighborhood walkability and negatively related to concentrated disadvantage, suggesting that exposures to these neighborhood characteristics have long-lasting impacts on cognitive function. Furthermore, individual socioeconomic status modifies the relationship between neighborhood characteristics and cognitive function. Compared with those graduating from college, respondents without a bachelor's degree consistently have lower cognitive function but the educational gap in cognitive function narrows with increases in walkability (b= -0.152, SE=0.092), and widens when neighborhood concentrated disadvantage (b=0.212, SE=0.070) or social isolation (b=0.315, SE=0.125) rises. The income gap in cognitive function shrinks with increases in walkability (b= -0.063, SE=0.027). CONCLUSIONS The moderating role of socioeconomic status indicates that low-socioeconomic status older adults who also live in disadvantaged neighborhoods face a higher risk of poor cognitive function. Low-education and low-income aging adults may have the most to gain from investments to improve neighborhood characteristics.
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Affiliation(s)
- Tse-Chuan Yang
- Department of Sociology, University at Albany, State University of New York, Albany, New York.
| | - Seulki Kim
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Seung-Won Emily Choi
- Department of Sociology, Anthropology, and Social Work, Texas Tech University, Lubbock, Texas
| | - Shannon Halloway
- Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois
| | - Uchechi A Mitchell
- Division of Community Health Sciences, University of Illinois Chicago, Chicago, Illinois
| | - Benjamin A Shaw
- Division of Community Health Sciences, University of Illinois Chicago, Chicago, Illinois
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Torres JM, Flores Romero KR, Kotwal AA, Chen R, Hill‐Jarrett T, Mitchell UA, Glymour MM. Spouses of individuals living with mild cognitive impairment or dementia in the United States: A descriptive, population-based study. Alzheimers Dement 2024; 20:1562-1572. [PMID: 38041823 PMCID: PMC10984471 DOI: 10.1002/alz.13555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Little is known about the population of individuals who live with a spouse with cognitive impairment (CI) or dementia. METHODS Using the US Health and Retirement Study, 2000 to 2018, we estimated the population of adults ≥ 50 years old co-residing with a spouse with probable CI/dementia. We described their socio-demographic and health characteristics and quantified socio-demographic inequities. RESULTS Among community-dwelling adults ≥ 50 years old, 6% of women and 4% of men co-resided with a spouse with probable CI/dementia. Among those who were married/partnered, the prevalence of spousal dementia was greater for Black and Hispanic adults compared to their White counterparts, and for those with lower versus higher educational attainment. Among spouses, activities of daily living disability, depression, and past 2-year hospitalization was common. DISCUSSION Millions of older adults, disproportionately Black and Hispanic people and people with lower levels of educational attainment, live with a spouse with CI while also facing their own major health challenges.
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Affiliation(s)
- Jacqueline M. Torres
- Department of Epidemiology & BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Karla Renata Flores Romero
- Department of Epidemiology & BiostatisticsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Ashwin A. Kotwal
- Division of GeriatricsDepartment of MedicineUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Geriatrics, Palliative, and Extended Care Service LineSan Francisco Veterans Affairs Medical CenterSan FranciscoCaliforniaUSA
| | - Ruijia Chen
- Department of EpidemiologySchool of Public HealthBoston UniversityBostonMassachusettsUSA
| | - Tanisha Hill‐Jarrett
- Memory and Aging CenterDepartment of NeurologyUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Uchechi A. Mitchell
- Division of Community Health SciencesSchool of Public HealthUniversity of IllinoisChicagoIllinoisUSA
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Mitchell UA, Shaw BA, Torres JM, Brown LL, Barnes LL. The Effects of Midlife Acute and Chronic Stressors on Black-White Differences in Cognitive Decline. J Gerontol B Psychol Sci Soc Sci 2023; 78:2147-2155. [PMID: 37788484 PMCID: PMC10699748 DOI: 10.1093/geronb/gbad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVES Midlife stressors may be particularly consequential for cognitive performance and disparities in cognitive decline. This study examined Black-White differences in trajectories of cognition among middle-aged adults and the effects of acute and chronic stressors on these trajectories. METHODS Data come from 4,011 cognitively healthy individuals aged 51-64 (620 Black and 3,391 White) who participated in the 2006-2018 waves of the Health and Retirement Study. Stressors included a count of recent life events and measures of financial strain and everyday discrimination. Global cognition was assessed using a modified version of the Telephone Interview for Cognitive Status. Linear mixed models with random slopes and intercepts assessed change in cognition over time. Race-by-time, race-by-stressor, time-by-stressor, and race-by-stressor-by-time interactions were assessed as were quadratic terms for time and each stressor. RESULTS After adjusting for sociodemographic, health behaviors, and health-related factors, Black respondents had lower initial cognitive performance scores (b = -1.75, p < .001) but experienced earlier but slower decline in cognitive performance over time (Black × Time2 interaction: b = 0.02, p < .01). Financial strain, discrimination, and recent life events each had distinct associations with cognitive performance but did not influence racial differences in levels of or change in cognition over time. DISCUSSION Middle-aged Black adults have lower initial cognition levels and experience earlier but less accelerated cognitive decline compared to White middle-aged adults. Midlife acute and chronic stressors influence baseline cognition but do so in different ways. Future research should examine the influence of other stressors on racial differences in cognitive decline at other points in the life course.
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Affiliation(s)
- Uchechi A Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Benjamin A Shaw
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Jacqueline M Torres
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Lauren L Brown
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Lisa L Barnes
- Department of Neurological Sciences and Rush Alzheimer’s Disease Center at Rush Medical College, Chicago, Illinois, USA
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Nguyen AW, Qin W, Wei W, Keith VM, Mitchell UA. Racial discrimination and 12-month and lifetime anxiety disorders among African American men and women: Findings from the National Survey of American Life. J Affect Disord 2023; 330:180-187. [PMID: 36907462 PMCID: PMC10065954 DOI: 10.1016/j.jad.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND The purpose of this study was to assess the associations between racial discrimination and 12-month and lifetime DSM-IV anxiety disorders among African American men and women. METHODS Data was drawn from the African American sample of the National Survey of American Life (N = 3570). Racial discrimination was assessed with the Everyday Discrimination Scale. 12-month and lifetime DSM-IV outcomes were any anxiety disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and agoraphobia (AG). Logistic regressions were utilized to assess the relationships between discrimination and anxiety disorders. RESULTS The data indicated that racial discrimination was associated with increased odds for 12-month and lifetime anxiety disorders, AG, and PD and lifetime SAD among men. Regarding 12-month disorders among women, racial discrimination was associated with increased odds for any anxiety disorder, PTSD, SAD, and PD. With respect to lifetime disorders among women, racial discrimination was associated with increased odds for any anxiety disorder, PTSD, GAD, SAD, and PD. LIMITATIONS The limitations of this study include the utilization of cross-sectional data, self-reported measures, and the exclusion of non-community dwelling individuals. CONCLUSIONS The current investigation showed that African American men and women are not impacted by racial discrimination in the same ways. These findings suggest that the mechanisms through which discrimination operates among men and women to influence anxiety disorders is potentially a relevant target for interventions to address gender disparities in anxiety disorders.
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Affiliation(s)
- Ann W Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, United States of America.
| | - Weidi Qin
- Population Studies Center, University of Michigan, United States of America
| | - Wenxing Wei
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, United States of America
| | - Verna M Keith
- Department of Sociology, University of Alabama at Birmingham, United States of America
| | - Uchechi A Mitchell
- School of Public Health, University of Illinois Chicago, United States of America
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Chebli P, McBryde-Redzovic A, Al-Amin N, Gutierrez-Kapheim M, Molina Y, Mitchell UA. Understanding COVID-19 Risk Perceptions and Precautionary Behaviors in Black Chicagoans: A Grounded Theory Approach. Health Educ Behav 2023; 50:7-17. [PMID: 36510857 PMCID: PMC9749057 DOI: 10.1177/10901981221139168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To determine whether actual community-level risk for COVID-19 in the Black community influenced individual perceptions of community-level and personal risk and how self-assessment of personal risk was reflected in the adoption of COVID-19 precautionary behaviors. METHODS Semistructured interviews were conducted with 20 Black Chicago adults from February to July 2021. A grounded theory approach was used for the qualitative analysis and initial, focused, and theoretical coding were performed. RESULTS We developed a grounded model consisting of four major themes: (a) Pre-Existing Health Conditions; (b) Presence of COVID-19 Infection in Participant Social Network; (c) COVID-19-Related Information, Participant Trust, and Perceived Personal Risk; and (d) Perceived Higher Burden of COVID-19 in the Black Community. CONCLUSIONS Higher perceptions of personal risk were shaped by pre-existing health conditions and experiences with COVID-19 in one's social network but were not influenced by perceived higher burden of COVID-19 in the Black community. POLICY IMPLICATIONS Black adults' perceptions of their individual risk and precautionary behaviors were not congruent with public health data and recommendations. Therefore, COVID-19 messaging and mitigation should be informed by local community engagement and transparent communication.
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Affiliation(s)
- Perla Chebli
- New York University Grossman School of
Medicine, New York, NY, USA,Perla Chebli, Section for Health Equity,
Department of Population Health, New York University Grossman School of
Medicine, 180 Madison Ave., 8th Fl, New York, NY 10016, USA.
| | | | | | | | - Yamilé Molina
- University of Illinois Chicago,
Chicago, IL, USA,University of Illinois Cancer Center,
Chicago, IL, USA
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Mitchell UA, Nguyen AW, Brown LL. Hope, Purpose, and Religiosity: The Impact of Psychosocial Resources on Trajectories of Depressive Symptoms Among Middle-Aged and Older Blacks. J Aging Health 2022; 34:363-377. [PMID: 35414282 PMCID: PMC9580265 DOI: 10.1177/08982643221085820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: We assessed the effects of hope, purpose in life, and religiosity on trajectories of depressive symptoms among middle-aged and older Blacks, with a focus on age differences in these associations. Methods: Data come from 1906 respondents from the 2006-2016 Health and Retirement Study. Linear mixed models were estimated and included interactions between age and time and between age and each psychosocial resource. Results: Depressive symptoms decreased for Blacks ages 51-64, did not change for those 65-74, and increased among Blacks age 75+. Hope and purpose in life were inversely associated with symptom levels but were not associated with change over time in symptomology. Associations were stronger among the youngest age group and weakest among the oldest. Religiosity was unrelated to depressive symptoms. Discussion: Psychosocial resources protect against depressive symptoms in age-dependent ways among middle-aged and older Blacks. Differences in these effects may be related to aging, cohort, and selection effects.
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Brown LL, García C, Reeves AN, Pamplin JR, Mitchell UA. Stress is a Latent Construct: Exploring the Differential Experience of Stress and Discrimination on Depressive Symptoms Among Black Older Adults. J Aging Health 2022; 34:334-346. [PMID: 35418259 PMCID: PMC9379938 DOI: 10.1177/08982643221086333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objectives: While evidence highlights the detrimental mental health consequences of chronic stress exposure, the impact of this stress exposure on older Black Americans' mental health varies by exposure to other types of stressors like discrimination as well as subjective evaluations of stress like chronic stress appraisal. Methods: Using data from the 2010/2012 Health and Retirement Study, we use latent profile analysis (LPA) to describe 2,415 Black older adults experience with chronic stress exposure, appraisal, and discrimination and examine which stress contexts are associated with depressive symptomology. Results: Analyses revealed five stress clusters-demonstrating the diversity in the stress experience for older Black adults. Black older adults with stress profiles that include lower stress appraisal report fewer depressive symptoms regardless of number of stress exposures. Discussion: LPA is as an alternative approach to examining the stress-mental health link that can define stress profiles by both exposure and appraisal-based measures.
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Affiliation(s)
- Lauren L. Brown
- School of Public Health Management and Policy, San Diego State University, San Diego, CA, USA
| | - Catherine García
- Human Development and Family Science, Aging Studies Institute, Center for Aging and Policy Studies, Lerner Center for Public Health Promotion, Syracuse University, Syracuse, NY, USA
| | - Alexis N. Reeves
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - John R. Pamplin
- Center for Urban Science and Progress, New York University, New York, NY, USA
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Uchechi A. Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL, USA
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Abstract
Objective: This study sought to determine whether religious involvement is associated with sleep quality in a nationally representative sample of older African Americans. Methods: The analytic sample included African American respondents aged 55+ from the National Survey of American Life-Reinterview (N = 459). Religious involvement variables included service attendance, reading religious texts, watching religious television programs, listening to religious radio programs, prayer, and subjective religiosity. Sleep outcomes were restless sleep and sleep satisfaction. Multiple linear regression analysis was used. Results: Watching religious television programs was associated with more restless sleep. Respondents who attended religious services less than once a year, at least once a week, or nearly every day reported greater sleep satisfaction than respondents who never attended religious services. Subjective religiosity was associated with lower sleep satisfaction. Discussion: The findings demonstrate the importance of examining a variety of religious involvement domains, which could point to different explanatory pathways between religious involvement and sleep.
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Affiliation(s)
- Ann W Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, 114588Case Western Reserve University, Cleveland, OH, USA
| | - Harry Owen Taylor
- Factor-Inwentash Faculty of Social Work, 7938University of Toronto, Toronto, ON, Canada
| | - Karen D Lincoln
- Suzanne Dworak-Peck School of Social Work, 5116University of Southern California, Los Angeles, CA, USA
| | - Fei Wang
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, 114588Case Western Reserve University, Cleveland, OH, USA
| | - Tyrone Hamler
- Graduate School of Social Work, University of Denver, Denver, CO, USA
| | - Uchechi A Mitchell
- School of Public Health, 14681University of Illinois Chicago, Chicago, USA
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Nguyen AW, Miller D, Bubu OM, Taylor HO, Cobb R, Trammell AR, Mitchell UA. Discrimination and Hypertension Among Older African Americans and Caribbean Blacks: The Moderating Effects of John Henryism. J Gerontol B Psychol Sci Soc Sci 2021; 77:2049-2059. [PMID: 34978323 PMCID: PMC9683497 DOI: 10.1093/geronb/gbab215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Discrimination is a major contributor to health disparities between Black and White older adults. Although the health effects of discrimination are well established, less is known about factors that may intervene in the discrimination-health connection, such as coping strategies. The study aim was to determine whether John Henryism (JH; high-effort coping) moderates the association between racial discrimination and hypertension in nationally representative samples of older African Americans and Caribbean Blacks. METHODS The analytic sample was drawn from the National Survey of American Life-Reinterview, which was conducted 2001-2003, and included African Americans (N = 546) and Caribbean Blacks (N = 141) aged 55 and older. Study variables included racial discrimination, JH, and hypertension. Logistic regressions, which controlled key sociodemographic differences, were used to test the study aim. RESULTS Among both Black ethnic groups, discrimination and JH were not associated with hypertension. For African Americans low and moderate in JH, discrimination was unrelated to hypertension; discrimination was positively associated with hypertension for African Americans high in JH. For Caribbean Blacks, discrimination was positively associated with hypertension among respondents low in JH. Among Caribbean Blacks moderate and high in JH, discrimination was not associated with hypertension. DISCUSSION The findings indicate that JH, in the face of discrimination, is associated with hypertension of older African Americans but may be an effective coping strategy for older Caribbean Blacks due to cultural and sociodemographic differences between the 2 ethnic groups. Future research should investigate the differing mechanisms by which JH influences health in heterogeneous older Black populations.
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Affiliation(s)
- Ann W Nguyen
- Address correspondence to: Ann W. Nguyen, PhD, Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA. E-mail:
| | - David Miller
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Omonigho M Bubu
- Department of Psychiatry and Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Harry O Taylor
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Ryon Cobb
- Department of Sociology, University of Georgia, Athens, Georgia, USA
| | | | - Uchechi A Mitchell
- School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
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Huang YK, Mitchell UA, Conroy LM, Jones RM. Community daytime noise pollution and socioeconomic differences in Chicago, IL. PLoS One 2021; 16:e0254762. [PMID: 34347815 PMCID: PMC8336802 DOI: 10.1371/journal.pone.0254762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 07/03/2021] [Indexed: 11/18/2022] Open
Abstract
Environmental noise may affect hearing and a variety of non-auditory disease processes. There is some evidence that, like other environmental hazards, noise may be differentially distributed across communities based on socioeconomic status. We aimed to a) predict daytime noise pollution levels and b) assess disparities in daytime noise exposure in Chicago, Illinois. We measured 5-minute daytime noise levels (Leq, 5-min) at 75 randomly selected sites in Chicago in March, 2019. Geographically-based variables thought to be associated with noise were obtained, and used to fit a noise land-use regression model to estimate the daytime environmental noise level at the centroid of the census blocks. Demographic and socioeconomic data were obtained from the City of Chicago for the 77 community areas, and associations with daytime noise levels were assessed using spatial autoregressive models. Mean sampled noise level (Leq, 5-min) was 60.6 dBA. The adjusted R2 and root mean square error of the noise land use regression model and the validation model were 0.60 and 4.67 dBA and 0.51 and 5.90 dBA, respectively. Nearly 75% of city blocks and 85% of city communities have predicted daytime noise level higher than 55 dBA. Of the socioeconomic variables explored, only community per capita income was associated with mean community predicted noise levels, and was highest for communities with incomes in the 2nd quartile. Both the noise measurements and land-use regression modeling demonstrate that Chicago has levels of environmental noise likely contributing to the total burden of environmental stressors. Noise is not uniformly distributed across Chicago; it is associated with proximity to roads and public transportation, and is higher among communities with mid-to-low incomes per capita, which highlights how socially and economically disadvantaged communities may be disproportionately impacted by this environmental exposure.
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Affiliation(s)
- Yu-Kai Huang
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Uchechi A. Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Lorraine M. Conroy
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Rachael M. Jones
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, United States of America
- * E-mail:
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Mitchell UA, Nishida A, Fletcher FE, Molina Y. The Long Arm of Oppression: How Structural Stigma Against Marginalized Communities Perpetuates Within-Group Health Disparities. Health Educ Behav 2021; 48:342-351. [PMID: 34080480 DOI: 10.1177/10901981211011927] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Understanding and addressing health inequities calls for enhanced theoretical and empirical attention to multiple forms of stigma and its influence on health behaviors and health outcomes within marginalized communities. While recent scholarship highlights the role of structural stigma on between-group health disparities, the extant literature has yet to elucidate the mechanisms through which structural stigma gives rise to within-group health disparities. In this article, we review and use relevant literature to inform the development of a conceptual model outlining how structural stigma contributes to within-group health disparities by creating division and tension within communities marginalized due to their social statuses and identities. We specifically focus on disparities among (1) communities of color due to White supremacy, (2) gender and sexual minority communities due to patriarchy and heterosexism, and (3) the disability community due to ableism. We argue that the nature and extent of the stigma members of stigmatized communities face are intricately tied to how visible the stigmatized characteristic is to others. By visibility, we refer to characteristics that are more easily perceived by others, and reveal a person's social identity (e.g., race/ethnicity, nativity, relationship status, gender expression, and disability status). This paper advances the literature by discussing the implications of the model for future research, practice, and policy, including the importance of acknowledging the ways in which structural stigma intentionally disrupts the collective identity and solidarity of communities and consequently threatens health equity.
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Torres JM, Mitchell UA, Sofrygin O, Rudolph KE, López-Ortega M, Sharif MZ, Wong R, Glymour MM. Associations between spousal caregiving and health among older adults in Mexico: A targeted estimation approach. Int J Geriatr Psychiatry 2021; 36:775-783. [PMID: 33258494 PMCID: PMC8407372 DOI: 10.1002/gps.5477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 11/01/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate associations between spousal caregiving and mental and physical health among older adults in Mexico. METHODS Data come from the Mexican Health & Aging Study, a national population-based study of adults ≥50 years and their spouses (2001-2015). We compared outcomes for spousal caregivers to outcomes for those whose spouses had difficulty with at least one basic or instrumental activity of daily living (I/ADL) but were not providing care; the control group conventionally includes all married respondents regardless of spouse's need for care. We used targeted maximum likelihood estimation to evaluate the associations with past-week depressive symptoms, lower-body functional limitations, and chronic health conditions. RESULTS At baseline, 846 women and 629 men had a spouse with ≥1 I/ADL. Of these, 60.9% of women and 52.6% of men were spousal caregivers. Spousal caregiving was associated with more past-week depressive symptoms for men (Marginal Risk Difference (RD): 0.27, 95% confidence internal [CI]: 0.03, 0.51) and women (RD: 0.15, 95% CI: 0.07, 0.23). We could not draw conclusions about associations with lower-body functional limitations and chronic health conditions. On average, all respondents whose spouses had caregiving needs had poorer health than the overall sample. CONCLUSION We found evidence of an association between spousal caregiving and mental health among older Mexican adults with spouses who had need for care. However, our findings suggest that older adults who are both currently providing or at risk of providing spousal care may need targeted programs and policies to support health and long-term care needs.
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Affiliation(s)
| | | | - Oleg Sofrygin
- Division of Research, Oakland, CA, Kaiser Permanente
| | | | | | | | - Rebeca Wong
- Sealy Center on Aging, University of Texas – Medical Branch
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Nguyen AW, Taylor HO, Lincoln KD, Qin W, Hamler T, Wang F, Mitchell UA. Neighborhood Characteristics and Inflammation among Older Black Americans: The Moderating Effects of Hopelessness and Pessimism. J Gerontol A Biol Sci Med Sci 2021; 77:315-322. [PMID: 33929517 DOI: 10.1093/gerona/glab121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Research documents the adverse health effects of systemic inflammation. Overall, older Black Americans tend to have higher inflammation than older non-Hispanic white adults. Given that inflammation is related to a range of chronic health problems that disproportionately affect Blacks compared to whites, this racial disparity in inflammation may contribute to racial disparities in particular chronic health problems. Thus, a better understanding of its determinants in the older Black population is of critical importance. This analysis examined the association between neighborhood characteristics and inflammation in a national sample of older non-Hispanic Black Americans. An additional aim of this study was to determine whether hopelessness and pessimism moderates the association between neighborhood characteristics and inflammation. METHODS A sample of older non-Hispanic Black Americans aged 60+ were drawn from the Health and Retirement Study (N=1,004). Neighborhood characteristics included neighborhood physical disadvantage and neighborhood social cohesion. Inflammation was assessed by C-reactive protein (CRP). RESULTS The analyses indicated that neighborhood physical disadvantage and social cohesion were not associated with CRP. Hopelessness and pessimism moderated the association between neighborhood physical disadvantage and CRP. CONCLUSIONS Knowledge regarding the role of hopelessness and pessimism as moderator in the neighborhood-inflammation association can inform cognitive-behavioral interventions targeted at changes in cognition patterns.
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Nwanaji-Enwerem JC, Jackson CL, Ottinger MA, Cardenas A, James KA, Malecki KM, Chen JC, Geller AM, Mitchell UA. Adopting a "Compound" Exposome Approach in Environmental Aging Biomarker Research: A Call to Action for Advancing Racial Health Equity. Environ Health Perspect 2021; 129:45001. [PMID: 33822649 PMCID: PMC8043128 DOI: 10.1289/ehp8392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/24/2021] [Accepted: 03/15/2021] [Indexed: 05/02/2023]
Abstract
BACKGROUND In June 2020, the National Academies of Sciences, Engineering, and Medicine hosted a virtual workshop focused on integrating the science of aging and environmental health research. The concurrent COVID-19 pandemic and national attention on racism exposed shortcomings in the environmental research field's conceptualization and methodological use of race, which have subsequently hindered the ability of research to address racial health disparities. By the workshop's conclusion, the authors deduced that the utility of environmental aging biomarkers-aging biomarkers shown to be specifically influenced by environmental exposures-would be greatly diminished if these biomarkers are developed absent of considerations of broader societal factors-like structural racism-that impinge on racial health equity. OBJECTIVES The authors reached a post-workshop consensus recommendation: To advance racial health equity, a "compound" exposome approach should be widely adopted in environmental aging biomarker research. We present this recommendation here. DISCUSSION The authors believe that without explicit considerations of racial health equity, people in most need of the benefits afforded by a better understanding of the relationships between exposures and aging will be the least likely to receive them because biomarkers may not encompass cumulative impacts from their unique social and environmental stressors. Employing an exposome approach that allows for more comprehensive exposure-disease pathway characterization across broad domains, including the social exposome and neighborhood factors, is the first step. Exposome-centered study designs must then be supported with efforts aimed at increasing the recruitment and retention of racially diverse study populations and researchers and further "compounded" with strategies directed at improving the use and interpretation of race throughout the publication and dissemination process. This compound exposome approach maximizes the ability of our science to identify environmental aging biomarkers that explicate racial disparities in health and best positions the environmental research community to contribute to the elimination of racial health disparities. https://doi.org/10.1289/EHP8392.
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Affiliation(s)
- Jamaji C. Nwanaji-Enwerem
- Department of Environmental Health, Harvard T.H. Chan School of Public Health and MD/PhD Program, Harvard Medical School, Boston, Massachusetts, USA
- Division of Environmental Health Sciences, School of Public Health and Center for Computational Biology, University of California, Berkeley, Berkeley, California, USA
| | - Chandra L. Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health (NIH), U.S. Department of Health and Human Services (U.S. HHS), Research Triangle Park, North Carolina, USA
- Intramural Program, National Institute on Minority Health and Health Disparities, NIH, U.S. HHS, Bethesda, Maryland, USA
| | - Mary Ann Ottinger
- Department of Biology and Biochemistry, University of Houston, Houston, Texas USA
| | - Andres Cardenas
- Division of Environmental Health Sciences, School of Public Health and Center for Computational Biology, University of California, Berkeley, Berkeley, California, USA
| | - Katherine A. James
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kristen M.C. Malecki
- Department of Population Health Sciences, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jiu-Chiuan Chen
- Departments of Preventive Medicine and Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Andrew M. Geller
- Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Uchechi A. Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
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Mitchell UA, Nguyen AW, McBryde-Redzovic A, Brown LL. "What Doesn't Kill You, Makes You Stronger": Psychosocial Resources and the Mental Health of Black Older Adults. Annu Rev Gerontol Geriatr 2021; 41:269-302. [PMID: 36311274 PMCID: PMC9614571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A robust body of research has shown that Black Americans are less likely than Whites to have psychiatric disorders despite the social and economic disadvantage and systemic racism that they face. This mental health paradox has been demonstrated across all ages of the life course, including older adulthood. One of the prevailing explanations for the lower prevalence of psychiatric disorders among Blacks pertains to the influence of psychosocial resources on mental health. Psychosocial resources can directly or indirectly support mental health through physiological and psychological pathways. They can also mitigate the adverse effects of social stressors of discrimination and other stressors on psychological distress and mental illness. Black older adults may particularly benefit from psychosocial resources because they have had a lifetime of experiencing and overcoming adversity. Although this cycle of stress adaptation can wear away at the physical body, it may facilitate mental health resilience. In this chapter, we review research on the relationship between psychosocial resources and mental health. The chapter begins with a brief review of the Black-White mental health paradox and the mechanisms through which psychosocial resources operate to influence mental health. We then review research on intrapersonal, interpersonal, and community-level psychosocial resources that are particularly salient for Black Americans. Throughout the chapter we highlight research specifically focused on Black older adults and discuss the cultural relevance of each resource to their mental health and psychological functioning.
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Affiliation(s)
| | - Ann W Nguyen
- Case Western Reserve University, Jack, Joseph, and Morton Mandel School of Applied Social Sciences
| | | | - Lauren L Brown
- San Diego State University, College of Health and Human Services, School of Public Health
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Mitchell UA, Gutierrez-Kapheim M, Nguyen AW, Al-Amin N. Hopelessness Among Middle-Aged and Older Blacks: The Negative Impact of Discrimination and Protecting Power of Social and Religious Resources. Innov Aging 2020; 4:igaa044. [PMID: 33241123 PMCID: PMC7679998 DOI: 10.1093/geroni/igaa044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Indexed: 02/04/2023] Open
Abstract
Background and Objectives Hopelessness—a state of despair characterized by a negative outlook towards the future and a belief in insurmountable challenges—is a risk factor for major depression, cardiovascular disease, and all-cause mortality among older adults. It is also an understudied consequence of discrimination. Older blacks disproportionately report experiencing discrimination and, as a result, may be at greater risk of feeling hopeless. However, social and religious resources may protect against the adverse effects of discrimination. The current study examines whether social support, social engagement, religious attendance, and religiosity buffer the effects of self-reported everyday discrimination on hopelessness among a nationally representative sample of blacks. Research Design and Methods Using data from the 2010/2012 psychosocial assessment of the Health and Retirement Study, we regressed hopelessness on everyday discrimination, stratifying by 2 age groups, ages 51–64, representing middle-age (n = 1,302), and age 65 and older, representing old age (n = 887). Interaction terms tested whether each resource moderated the discrimination–hopelessness relationship controlling for depressive symptoms, socioeconomic status, and demographic characteristics. Results Greater reports of everyday discrimination were associated with higher levels of hopelessness for middle-aged and older blacks. For middle-aged blacks, the resources did not moderate the discrimination–hopelessness relationship; rather, higher levels of support (b = −0.294, p < .01), religiosity (b = −0.297, p < .001), religious attendance (b = −0.218, p < .05) were independently and inversely associated with hopelessness. For older blacks, higher levels of religiosity moderated the discrimination–hopelessness relationship (b = −0.208, p < .05) and higher levels of support (b = −0.304, p < .05) and social engagement (b = −0.236, p < .05) were independently and inversely associated with hopelessness. Discussion and Implications Findings suggest that self-reported everyday discrimination increases hopelessness among middle-aged and older blacks but social and religious resources may counterbalance its effects, in age-specific ways, to protect against hopelessness. Religiosity may be especially important for older blacks as a buffer against the negative consequences of discrimination on hopelessness.
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Affiliation(s)
- Uchechi A Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | | | - Ann W Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Nadia Al-Amin
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
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Brown LL, Abrams LR, Mitchell UA, Ailshire JA. Measuring More Than Exposure: Does Stress Appraisal Matter for Black-White Differences in Anxiety and Depressive Symptoms Among Older Adults? Innov Aging 2020; 4:igaa040. [PMID: 33123630 PMCID: PMC7580160 DOI: 10.1093/geroni/igaa040] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Prior research and theory suggest that exposure to objectively stressful events contributes to mental health disparities. Yet, blacks report higher cumulative stress exposure than whites but lower levels of common psychiatric disorders. In order to understand why blacks bear disproportionate stress exposure but similar or better mental health relative to whites, we need to consider race differences in not only stress exposure, but also stress appraisal-how upsetting stress exposures are perceived to be. RESEARCH DESIGN AND METHODS We examine whether race differences in the number of reported chronic stressors across 5 domains (health, financial, residential, relationship, and caregiving) and their appraised stressfulness explain black-white differences in anxiety and depressive symptoms. Data come from 6019 adults aged older than 52 from the 2006 Health and Retirement Study. RESULTS Older blacks in this sample experience greater exposure to chronic stressors but appraise stressors as less upsetting relative to whites. In fully adjusted models, stress exposure is related to higher levels of anxiety and depressive symptoms, and perceiving stress as upsetting is associated with higher symptomology for whites and blacks. We also find that blacks report greater anxiety symptoms but fewer depressive symptoms with more stress exposure relative to whites. Stress appraisal partially explains race differences in the association between stress exposure and anxiety symptoms and fully explains race differences in the association between exposure and depressive symptoms. DISCUSSION AND IMPLICATIONS The relationship between race, chronic stress exposure, and mental health is mediated by stress appraisal. Stress appraisal provides insight on important pathways contributing to black-white mental health disparities in older adulthood.
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Affiliation(s)
- Lauren L Brown
- Division of Health Management and Policy, San Diego State University School of Public Health, California
| | - Leah R Abrams
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts
| | - Uchechi A Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois Chicago
| | - Jennifer A Ailshire
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles
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Brown LL, Mitchell UA, Ailshire JA. Disentangling the Stress Process: Race/Ethnic Differences in the Exposure and Appraisal of Chronic Stressors Among Older Adults. J Gerontol B Psychol Sci Soc Sci 2020; 75:650-660. [PMID: 29878196 PMCID: PMC7328036 DOI: 10.1093/geronb/gby072] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Exposure to stressors is differentially distributed by race/ethnicity with minority groups reporting a higher stress burden than their white counterparts. However, to really understand the extent to which some groups bear a disproportionate stress burden, we need to consider race/ethnic differences in stress appraisal, specifically how upsetting stressors may be, in addition to stress exposure. We examine racial/ethnic differences in both the number of reported chronic stressors across five domains (health, financial, residential, relationship, and caregiving) and their appraised stressfulness among a diverse sample of older adults. METHOD Data come from 6,567 adults ages 52+ from the 2006 Health and Retirement Study. RESULTS Results show older blacks, U.S. and foreign-born Hispanics report more chronic stress exposure than whites and are two to three times as likely to experience financial strain and housing-related stress. Socioeconomic factors fully explain the Hispanic-white difference in stress exposure, but black-white differences remain. Despite experiencing a greater number of stressors, blacks and U.S.-born Hispanics are less likely to be upset by exposure to stressors than whites. U.S.-born Hispanics are less upset by relationship-based stressors specifically, while blacks are less upset across all stress domains in fully-adjusted models. Foreign-born Hispanics are only less upset by caregiving strain. DISCUSSION The distinction between exposure and appraisal-based measures of stress may shed light on important pathways that differentially contribute to race/ethnic physical and mental health disparities.
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Affiliation(s)
- Lauren L Brown
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles
| | - Uchechi A Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Jennifer A Ailshire
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles
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Abstract
Hopefulness is associated with better health and may be integral for stress adaptation and resilience. Limited research has prospectively examined whether hopefulness protects against physiological dysregulation or does so similarly for U.S. whites, blacks and Hispanics. We examined the association between baseline hopefulness and future allostatic load using data from the Health and Retirement Study (n = 8,486) and assessed differences in this association by race/ethnicity and experiences of discrimination. Four items measured hopefulness and allostatic load was a count of seven biomarkers for which a respondent's measured value was considered high-risk for disease. A dichotomous variable assessed whether respondents experienced at least one major act of discrimination in their lifetime. We used Poisson regression to examine the association between hopefulness and allostatic load and included a multiplicative interaction term to test racial/ethnic differences in this association. Subsequent analyses were stratified by race/ethnicity and tested the interaction between hopefulness and discrimination within each racial/ethnic group. Hopefulness was associated with lower allostatic load scores, but its effects varied significantly by race/ethnicity. Race-stratified analyses suggested that hopefulness was protective among whites and not associated with allostatic load among Hispanics irrespective of experiencing discrimination. Hopefulness was associated with lower allostatic load among blacks reporting discrimination but associated with higher allostatic load among those who did not. Findings suggest that hopefulness plays differing roles for older whites, blacks and Hispanics and, for blacks, its protective effects on physiological dysregulation are intricately tied to their experiences of discrimination.
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Affiliation(s)
- Uchechi A. Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | | | - Mienah Z. Sharif
- Center for Racism, Social Justice and Health, University of California Los Angeles
| | - Lauren L. Brown
- Population Studies Center, Institute for Social Research, University of Michigan
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Ann Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University
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Mitchell UA, Ailshire JA, Kim JK, Crimmins EM. Black-White Differences in 20-year Trends in Cardiovascular Risk in the United States, 1990-2010. Ethn Dis 2019; 29:587-598. [PMID: 31641326 DOI: 10.18865/ed.29.4.587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective Improvements in the Black-White difference in life expectancy have been attributed to improved diagnosis and treatment of cardiovascular diseases and declines in cardiovascular disease mortality. However, it is unclear whether race differences in total cardiovascular risk and the prevalence of cardiovascular risk factors have improved in the United States since the 1990s. Design Serial cross-sectional design. Setting Data from the 1988-1994, 1999-2002, and 2009-2012 National Health and Nutrition Examination Survey (NHANES). Methods We estimated total cardiovascular risk levels, the prevalence of high-risk cardiovascular risk factors and the use of antihypertensive and lipid-lowering drugs among US Black and White men and women to determine whether differential changes occurred from 1990-2010. Results Total cardiovascular risk declined for all races from 1990-2010. The Black-White difference was only significant in 2000 and sex-specific analyses showed that trends seen in the total population were driven by changes among women. Black and White men did not differ in risk at any time during this period. Conversely, Black women had significantly higher risk than White women in 1990 and 2000; this difference was eliminated by 2010. Improved diagnosis and treatment of high blood pressure and high cholesterol reduced risk in the total population; improved blood pressure and lipid profiles among Black women and increasing obesity prevalence among White women specifically contributed to the narrowing of the Black-White difference in risk among women. Conclusion Cardiovascular risk and racial disparities in risk declined among US Whites and Blacks due to greater use and effectiveness of lipid-lowering and antihypertensive medications.
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Affiliation(s)
- Uchechi A Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Jennifer A Ailshire
- Andrus Gerontology Center, University of Southern California, Los Angeles, CA
| | - Jung Ki Kim
- Andrus Gerontology Center, University of Southern California, Los Angeles, CA
| | - Eileen M Crimmins
- Andrus Gerontology Center, University of Southern California, Los Angeles, CA
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Mitchell UA, Ailshire JA, Brown LL, Levine ME, Crimmins EM. Education and Psychosocial Functioning Among Older Adults: 4-Year Change in Sense of Control and Hopelessness. J Gerontol B Psychol Sci Soc Sci 2019; 73:849-859. [PMID: 27013537 DOI: 10.1093/geronb/gbw031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 02/23/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives This study investigates education differences in levels and change in sense of control and hopelessness among older adults. Method We used data from the Health and Retirement Study, an ongoing biennial survey of a nationally representative sample of older Americans, to examine education differences in sense of control (e.g., mastery and perceived constraints) and hopelessness. Our sample included 8,495 adults aged 52 and older who were interviewed in 2006/2008 and 2010/2012. We assessed separate models for change in sense of control and hopelessness, accounting for recent changes in social circumstances and health status. Results Low mastery, perceived constraints, and hopelessness were highest among individuals with less than a high school education. Over a 4-year period, this group experienced the greatest declines in psychosocial functioning, as indicated by greater increases in low mastery, perceived constraints, and hopelessness. Education differences existed net of recent negative experiences, specifically the loss of intimate social relationships and social support and increases in disease and disability. Discussion These findings highlight the importance of education for sense of control and hopelessness in older adulthood and demonstrate the cumulative advantage of higher levels of education for psychosocial functioning.
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Affiliation(s)
- Uchechi A Mitchell
- USC Leonard Davis School of Gerontology, USC/UCLA Center on Biodemography and Population Health, University of Southern California, Los Angeles
| | - Jennifer A Ailshire
- USC Leonard Davis School of Gerontology, USC/UCLA Center on Biodemography and Population Health, University of Southern California, Los Angeles
| | - Lauren L Brown
- USC Leonard Davis School of Gerontology, USC/UCLA Center on Biodemography and Population Health, University of Southern California, Los Angeles
| | - Morgan E Levine
- UCLA Department of Human Genetics, University of California, Los Angeles
| | - Eileen M Crimmins
- USC Leonard Davis School of Gerontology, USC/UCLA Center on Biodemography and Population Health, University of Southern California, Los Angeles
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Mitchell UA, Chebli PG, Ruggiero L, Muramatsu N. The Digital Divide in Health-Related Technology Use: The Significance of Race/Ethnicity. Gerontologist 2019; 59:6-14. [PMID: 30452660 DOI: 10.1093/geront/gny138] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Indexed: 01/31/2023] Open
Abstract
Background and Objectives Technology can enhance the health and quality of life of diverse populations and may play an important role in reducing health disparities. Although a "digital divide" between the young and the old has been noted, it is unclear whether the use of technology for managing health differs by race/ethnicity among older adults. This study uses nationally representative data from community-dwelling older Americans to characterize racial/ethnic differences in health-related technology use. Design and Methods Data came from 1,336 white, black, and Hispanic adults aged 54 and older who completed the 2014 technology module of the Health and Retirement Study. Racial/ethnic differences in overall health-related technology use were assessed using Poisson regression. Then, F-tests were used to assess differences in the use of phone calls, text messages, E-mails, social media, health management sites, health-related mobile applications, web searches, and brain games for health purposes. Results Compared to whites, older blacks and Hispanics were less likely to use technology for health-related purposes after accounting for demographic characteristics, education, and health conditions. They were also less likely to make or receive phone calls, use health management sites, search the web for health information, and use brain games for their health. Discussion and Implications Older racial and ethnic minorities are less likely than whites to use certain technologies when managing their health. These findings highlight the importance of understanding the patterns of health-related technology use across racially and ethnically diverse populations to appropriately tailor interventions aimed at improving minority health and eliminating health disparities.
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Affiliation(s)
- Uchechi A Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Perla G Chebli
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Laurie Ruggiero
- Behavioral Health and Nutrition Department, College of Health Sciences, University of Delaware, Newark
| | - Naoko Muramatsu
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
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Mitchell UA, Ailshire JA, Crimmins EM. Change in Cardiometabolic Risk Among Blacks, Whites, and Hispanics: Findings From the Health and Retirement Study. J Gerontol A Biol Sci Med Sci 2019; 74:240-246. [PMID: 29452335 PMCID: PMC6333938 DOI: 10.1093/gerona/gly026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 02/13/2018] [Indexed: 01/13/2023] Open
Abstract
Background Blacks experience greater multisystem physiological dysregulation, or cumulative biological risk, which is associated with poor cardiometabolic health and mortality. In this study, we assess race differences in change in risk over 4 years among older whites, blacks, and Hispanics. Method We examined race differences in 4-year change in individual biomarkers and a cumulative measure of risk-cardiometabolic risk (CMR)-using data for each respondent from two waves of the Health and Retirement Study's biomarker assessment (n = 5,512). CMR is a count of high-risk cardiovascular and metabolic biomarkers. We estimated mean CMR at baseline and follow-up by race/ethnicity, and used logistic regression to determine whether race differences exist in 4-year transitions between high- and low-risk states for individual biomarkers. Results Blacks had higher baseline CMR than whites and Hispanics and experienced an increase in risk over 4 years; conversely, CMR decreased among whites and Hispanics. Blacks were more likely to develop high-risk pulse pressure and high-risk hemoglobin A1c, which contributed to increases in CMR. Whites and Hispanics were more likely to become low-risk on C-reactive protein and high-density lipoprotein cholesterol which contributed to declines in CMR. Race differences in transitions between risk states remained after controlling for social, behavioral, and health care-related factors. However, the racial patterning of these differences was influenced by disease diagnosis and medication use. Conclusions We show that the cardiometabolic health of older blacks worsens as they age both absolutely and relative to that of whites and Hispanics because of poor blood pressure control and diabetes prevention.
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Affiliation(s)
- Uchechi A Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Jennifer A Ailshire
- USC/UCLA Center on Biodemography and Population Health, Davis School of Gerontology, University of Southern California (USC)
| | - Eileen M Crimmins
- USC/UCLA Center on Biodemography and Population Health, Davis School of Gerontology, University of Southern California (USC)
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Abstract
OBJECTIVE Systemic inflammation is an important risk factor for cardiovascular diseases and inequalities by race/ethnicity, gender, and education have been documented. However, there is incomplete knowledge as to how these disparities present across age, especially in late life. This study assesses whether differences in C-reactive protein (CRP), a marker of inflammation, are contingent on age among older persons. METHOD Data are from the 2006/2008 Health and Retirement Study ( n = 10,974) biomarker assessment. CRP was regressed on interactions between age and other status characteristics. RESULTS Racial/ethnic differences in inflammation do not vary significantly by age. However, gender and education differences are greatest at younger ages and then narrow steadily with increasing age. DISCUSSION There is considerable heterogeneity in how disparities in inflammation present across age and characteristics such as race/ethnicity, gender, and education. Understanding status differences in the influence of age on factors affecting late-life health is useful for health disparities research.
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Nguyen AW, Taylor RJ, Chatters LM, Taylor HO, Lincoln KD, Mitchell UA. Extended family and friendship support and suicidality among African Americans. Soc Psychiatry Psychiatr Epidemiol 2017; 52:299-309. [PMID: 27838732 PMCID: PMC5346057 DOI: 10.1007/s00127-016-1309-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 10/30/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE This study examined the relationship between informal social support from extended family and friends and suicidality among African Americans. METHODS Logistic regression analysis was based on a nationally representative sample of African Americans from the National Survey of American Life (N = 3263). Subjective closeness and frequency of contact with extended family and friends and negative family interaction were examined in relation to lifetime suicide ideation and attempts. RESULTS Subjective closeness to family and frequency of contact with friends were negatively associated with suicide ideation and attempts. Subjective closeness to friends and negative family interaction were positively associated with suicide ideation and attempts. Significant interactions between social support and negative interaction showed that social support buffers against the harmful effects of negative interaction on suicidality. CONCLUSIONS Findings are discussed in relation to the functions of positive and negative social ties in suicidality.
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Affiliation(s)
- Ann W. Nguyen
- Edward R. Roybal Institute On Aging, Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 South Olive Street, Los Angeles, CA 90015, USA
| | | | | | - Harry Owen Taylor
- George Warren Brown School of Social Work, Washington University, St. Louis, MO, USA
| | - Karen D. Lincoln
- Edward R. Roybal Institute On Aging, Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 South Olive Street, Los Angeles, CA 90015, USA
| | - Uchechi A. Mitchell
- Division of Community Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
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