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Upenieks L, Kent BV, Nagaswami M, Gu Y, Kanaya AM, Shields AE. Do Religion and Spirituality Buffer the Effect of Childhood Trauma on Depressive Symptoms? Examination of a South Asian Cohort from the USA. J Relig Health 2024:10.1007/s10943-024-02040-5. [PMID: 38600425 DOI: 10.1007/s10943-024-02040-5] [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] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/12/2024]
Abstract
Asian Americans have been identified as a racial group that is disproportionately affected by childhood trauma. The goal of this study was to assess if religion/spirituality moderate the effects of childhood trauma on adult depressive symptoms among a sample of South Asians in the USA. Our analysis drew from the study on stress, spirituality, and health (SSSH) questionnaire fielded in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study (n = 990) during 2016-2018. A series of regression models with multiplicative interaction terms were conducted. Emotional neglect, emotional abuse, and physical neglect were associated with higher depressive symptoms. Higher religious attendance and negative religious coping techniques were found to exacerbate this relationship. There were two findings conditional on gender. Among men, gratitude and positive religious coping also exacerbated the relationship between childhood trauma and depressive symptoms. Negative religious coping also exacerbated the association between childhood trauma and depressive symptoms for women. This is the first community-based study of US South Asians to consider the association between various forms of childhood trauma and depressive symptom outcomes. South Asians remain an understudied group in the religion and health literature, and this study sheds light on the important differences in the function and effectiveness of religion/spirituality for those faced with early life trauma.
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Affiliation(s)
- Laura Upenieks
- Department of Sociology, Baylor University, One Bear Place #97326, Waco, TX, 76798, USA.
| | - Blake Victor Kent
- Department of Sociology and Anthropology, Westmont College, Santa Barbara, CA, USA
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital Center On Genomics, Vulnerable Populations, and Health Disparities, Boston, MA, USA
| | - Megha Nagaswami
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Yue Gu
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital Center On Genomics, Vulnerable Populations, and Health Disparities, Boston, MA, USA
| | - Alka M Kanaya
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Alexandra E Shields
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital Center On Genomics, Vulnerable Populations, and Health Disparities, Boston, MA, USA
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Davidson JC, Kent BV, Cozier YC, Kanaya AM, Warner ET, Eliassen AH, Williams DR, Shields AE. "Does Religious Service Attendance Modify the Relationship between Everyday Discrimination and Risk of Obesity? Results from the Study on Stress, Spirituality and Health". J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01765-5. [PMID: 37921946 PMCID: PMC11065965 DOI: 10.1007/s40615-023-01765-5] [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] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 07/18/2023] [Accepted: 08/15/2023] [Indexed: 11/05/2023]
Abstract
This study examined the association of everyday discrimination with risk of obesity and the potential modifying effect of religious service attendance. Participants included Black, South Asian, and white women in three cohort studies that belong to the Study on Stress, Spirituality and Health. Logistic regression models estimated odds of obesity classification (BMI ≥ 30) relative to experiences of everyday discrimination. In initial pooled analyses, high levels of discrimination were related to increased odds of obesity. Race-specific analyses revealed marginal associations for white and South Asian women. Among Black women, high levels of discrimination and religious service attendance were both associated with higher odds of obesity. However, among women who attended religious services frequently, higher levels of everyday discrimination were associated with slightly lower odds of obesity. These findings underline the complex association between obesity and religion/spirituality, suggesting that higher levels of discrimination may uniquely activate religious resources or coping strategies. Findings highlight the need for additional studies to examine the impact of everyday discrimination on risk of obesity across racial/ethnic communities and how religious practices or coping strategies might affect these dynamics.
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Affiliation(s)
- James Clark Davidson
- Massachussetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Westmont College, Santa Barbara, CA, USA.
| | - Blake Victor Kent
- Massachussetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Westmont College, Santa Barbara, CA, USA
| | - Yvette C Cozier
- Slone Epidemiology Center at Boston University, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Alka M Kanaya
- University of California San Francisco, San Francisco, CA, USA
| | - Erica T Warner
- Massachussetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - A Heather Eliassen
- Harvard Medical School, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | | | - Alexandra E Shields
- Massachussetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Stroope S, Kent BV, Schachter AB, Kanaya AM, Shields AE. Why Is Religious Attendance Linked to More Anxiety in U.S. South Asians? The Mediating Role of Congregational Neglect. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01764-6. [PMID: 37721667 DOI: 10.1007/s40615-023-01764-6] [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] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVES Previous research has identified a positive association between religious attendance and anxiety in U.S. South Asians. The current study assesses the mediating role of congregational neglect as a potential mechanism explaining this association. DESIGN Analyses relied on data from the Study on Stress, Spirituality, and Health (SSSH) questionnaire in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study (n = 936), the largest community-based study of health among U.S. South Asians. Analyses were conducted using path analysis and adjusted for a variety of background characteristics. RESULTS Results confirmed that higher levels of religious service attendance were associated with higher levels of anxiety. Congregational neglect was a significant mediator in this relationship, explaining 27% of the association between religious attendance and anxiety. Congregational neglect also had the second largest standardized coefficient in the model. CONCLUSIONS This study provides evidence that congregational neglect plays an important intervening role in the connection between religious service attendance and anxiety among U.S. South Asians. The findings move beyond description, flagging a relevant social process which underlies the relationship. By recognizing the potential adverse effects of religious attendance on anxiety in this population, it may be possible to develop interventions aimed at enhancing social inclusion in South Asian religious communities. In addition to practical implications, this study highlights the need for further research on how communal religious participation shapes mental health in ethnic and racial minority populations in the United States.
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Affiliation(s)
| | - Blake Victor Kent
- Harvard/Massachusetts General Hospital Center on Genomics, Vulnerable Populations, and Health Disparities, Boston, MA, USA
- Westmont College, Santa Barbara, CA, USA
| | - Anna Boonin Schachter
- Harvard/Massachusetts General Hospital Center on Genomics, Vulnerable Populations, and Health Disparities, Boston, MA, USA
| | - Alka M Kanaya
- University of California, San Francisco, San Francisco, CA, USA
| | - Alexandra E Shields
- Harvard/Massachusetts General Hospital Center on Genomics, Vulnerable Populations, and Health Disparities, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Kent BV, Upenieks L, Kanaya AM, Warner ET, Cozier YC, Daviglus ML, Eliassen H, Jang DY, Shields AE. Religion/Spirituality and Prevalent Hypertension among Ethnic Cohorts in the Study on Stress, Spirituality, and Health. Ann Behav Med 2023; 57:649-661. [PMID: 37265144 PMCID: PMC10354840 DOI: 10.1093/abm/kaad007] [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] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Hypertension is a significant public health issue, particularly for Blacks, Hispanics/Latinos, and South Asians who are at greater risk than whites. Religion and spirituality (R/S) have been shown to be protective, but this has been identified primarily in whites with limited R/S measures examined (i.e., religious service attendance). PURPOSE To assess hypertension prevalence (HP) in four racial/ethnic groups while incorporating an array of R/S variables, including individual prayer, group prayer, nontheistic daily spiritual experiences, yoga, gratitude, positive religious coping, and negative religious coping. METHODS Data were drawn from the Study on Stress, Spirituality, and Health, a consortium of ethnically diverse U.S. cohorts. The sample included 994 Black women, 838 Hispanic/Latino men and women, 879 South Asian men and women, and 3681 white women. Using a cross-sectional design, prevalence ratios for R/S and hypertension were reported for each cohort, in addition to pooled analyses. Given differences in R/S among men and women, all models were stratified by gender. RESULTS Different patterns of associations were found between women and men. Among women: 1) religious attendance was associated with lower HP among Black and white women; 2) gratitude was linked to lower HP among Hispanic/Latino, South Asian, and white women; 3) individual prayer was associated with higher HP among Hispanic/Latino and white women; 4) yoga was associated with higher HP among South Asian women, and 5) negative religious coping was linked to higher HP among Black women. Among men: significant results were only found among Hispanic/Latino men. Religious attendance and individual prayer were associated with higher HP, while group prayer and negative religious coping were associated with lower HP. CONCLUSION Religion/spirituality is a multifaceted construct that manifests differently by race/ethnicity and gender. Medical practitioners should avoid a one-size-fits-all approach to this topic when evaluating prevalent hypertension in diverse communities.
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Affiliation(s)
- Blake Victor Kent
- Department of Sociology & Anthropology, Westmont College, Santa Barbara, CA, USA
- Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Laura Upenieks
- Department of Sociology, Baylor University, Waco, TX, USA
| | - Alka M Kanaya
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Erica T Warner
- Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Yvette C Cozier
- Boston University Slone Epidemiology Center, Boston, MA, USA
| | - Martha L Daviglus
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | | | - Daniel Y Jang
- Department of Sociology & Anthropology, Westmont College, Santa Barbara, CA, USA
| | - Alexandra E Shields
- Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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Spence ND, Warner ET, Farvid MS, VanderWeele TJ, Zhang Y, Hu FB, Shields AE. The Association of Religion and Spirituality with Obesity and Weight Change in the USA: A Large-Scale Cohort Study. J Relig Health 2022; 61:4062-4080. [PMID: 34714470 DOI: 10.1007/s10943-021-01368-6] [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] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
The association between religion, spirituality, and body weight is controversial, given the methodological limitations of existing studies. Using the Nurses' Health Study II cohort, follow-up occurred from 2001 to 2015, with up to 35,547 participants assessed for the religious or spiritual coping and religious service attendance analyses. Cox regression and generalized estimating equations evaluated associations with obesity and weight change, respectively. Religious or spiritual coping and religious service attendance had little evidence of an association with obesity. Compared with not using religious or spiritual coping at all, the fully adjusted hazard ratios (HRs) were minimally different across categories: a little bit (HR = 1.05, 95% CI: 0.92-1.18), a medium amount (HR = 1.09, 95% CI: 0.96-1.24), and a lot (HR = 1.10; 95% CI: 0.96-1.25) (Ptrend = 0.17). Compared with participants who never or almost never attend religious meetings or services, there was little evidence of an association between those attending less than once/month (HR = 1.08, 95% CI: 0.97-1.10), 1-3 times/month (HR = 1.01, 95% CI: 0.90-1.13), once/week (HR = 0.92, 95% CI: 0.83-1.02), and more than once/week (HR = 0.94, 95% CI: 0.82-1.07) (Ptrend = 0.06). Findings were similar for weight change. There was no significant association between religious or spiritual coping, religious service attendance, obesity, and weight change. While religion and spirituality are prominent in American society, they are not important psychosocial factors influencing body weight in this sample.
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Affiliation(s)
- Nicholas D Spence
- Department of Sociology, University of Toronto, 725 Spadina Avenue, Office 334, Toronto, ON, M5S 2J4, Canada.
- Department of Health and Society, University of Toronto, Toronto, ON, Canada.
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- National Consortium on Psychosocial Stress, Spirituality, and Health, Massachusetts General Hospital, Boston, MA, USA.
| | - Erica T Warner
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- National Consortium on Psychosocial Stress, Spirituality, and Health, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Maryam S Farvid
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ying Zhang
- Sleep Medicine Epidemiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Frank B Hu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- National Consortium on Psychosocial Stress, Spirituality, and Health, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Isehunwa OO, Warner ET, Spiegelman D, Zhang Y, Palmer JR, Kanaya AM, Cole SA, Tworoger SS, Shields LO, Gu Y, Kent BV, De Vivo I, Shields AE. Depression, religiosity, and telomere length in the Study on Stress, Spirituality, and Health (SSSH). Int J Ment Health Addict 2022; 20:1465-1484. [PMID: 35747346 PMCID: PMC9211376 DOI: 10.1007/s11469-020-00455-1] [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] [Indexed: 10/22/2022] Open
Abstract
Prospective studies on the association between depression and telomere length have produced mixed results and have been largely limited to European ancestry populations. We examined the associations between depression and telomere length, and the modifying influence of religion and spirituality, in four cohorts, each representing a different race/ethnic population. Relative leukocyte telomere length (RTL) was measured by a quantitative polymerase chain reaction. Our result showed that depression was not associated with RTL (percent difference: 3.0 95% CI: -3.9, 10.5; p = 0.41; p-heterogeneity across studies = 0.67) overall or in cohort-specific analyses. However, in cohort-specific analyses, there was some evidence of effect modification by the extent of religiosity or spirituality, religious congregation membership, and group prayer. Further research is needed to investigate prospective associations between depression and telomere length, and the resources of resilience including dimensions of religion and spirituality that may impact such dynamics in diverse racial/ethnic populations.
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Affiliation(s)
- Oluwaseyi O. Isehunwa
- MGH/Harvard Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - Erica T. Warner
- MGH/Harvard Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
- Clinical Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Donna Spiegelman
- Department of Biostatistics and Global Health, Yale School of Public Health, New Haven, CT, USA; Center for Methods on Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA; Department of Statistics and Data Science, Yale University, New Haven, CT, USA
| | - Ying Zhang
- MGH/Harvard Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - Julie R. Palmer
- Slone Epidemiology Center, Boston University, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Alka M. Kanaya
- Division of General Internal Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Shelley A. Cole
- Population Health Program, Texas Biomedical Research Institute San Antonio, TX, USA
| | - Shelley S. Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Yue Gu
- MGH/Harvard Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - Blake Victor Kent
- MGH/Harvard Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - Immaculata De Vivo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Program in Genetic Epidemiology and Statistical Genetics, Harvard School of Public Health, Boston, MA, USA
| | - Alexandra E. Shields
- MGH/Harvard Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
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Spence ND, Warner ET, Farvid MS, VanderWeele TJ, Zhang Y, Hu FB, Shields AE. Religious or spiritual coping, religious service attendance, and type 2 diabetes: A prospective study of women in the United States. Ann Epidemiol 2022; 67:1-12. [PMID: 34562589 PMCID: PMC9070558 DOI: 10.1016/j.annepidem.2021.09.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 08/02/2021] [Accepted: 09/16/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate religion and spirituality (R/S) as psychosocial factors in type 2 diabetes risk. METHODS Using the Nurses' Health Study II, we conducted a 14-year prospective analysis of 46,713 women with self-reported use of religion or spiritual beliefs to cope with stressful situations, and 42,825 women with self-reported religious service attendance, with respect to type 2 diabetes. Cox regression was used to assess the associations. RESULTS Compared with not using religious or spiritual coping at all, the fully-adjusted hazard ratios (HR) were minimally different across all categories: a little bit (HR=1.01; 95% CI:0.85, 1.19), a medium amount (HR=0.96; 95% CI:0.80, 1.14), a lot (HR=0.93; 95% CI: 0.77, 1.11) (Ptrend=0.24). Similarly, compared with participants who never or almost never attend religious meetings or services, there were minimal differences with participants attending less than once/month (HR=1.06; 95% CI:0.92, 1.22), 1-3 times/month (HR=1.00; 95% CI:0.85, 1.17), once/week (HR=0.98; 95% CI:0.85, 1.14), more than once/week (HR=1.20; 95% CI:1.01, 1.43) (Ptrend=0.29). Perceived stress did not modify these associations. Our hypothesis of mediated effects through lifestyle factors and social integration was not supported. CONCLUSIONS R/S was not significantly associated with type 2 diabetes, but its role in other chronic conditions may be important.
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Affiliation(s)
- Nicholas D. Spence
- Department of Sociology, University of Toronto, Toronto, Ontario, Canada,Department of Health and Society, University of Toronto, Toronto, Ontario, Canada,Harvard/MGH Center on Genomics, Vulnerable Populations and Health Disparities, Massachusetts General Hospital and Harvard Medical School, Boston, MA,National Consortium on Psychosocial Stress, Spirituality, and Health, Massachusetts General Hospital, Boston, MA, USA,Correspondence: Nicholas D. Spence, 725 Spadina Avenue, Office 334, Toronto, Ontario, Canada M5S2J4,
| | - Erica T. Warner
- Harvard/MGH Center on Genomics, Vulnerable Populations and Health Disparities, Massachusetts General Hospital and Harvard Medical School, Boston, MA,National Consortium on Psychosocial Stress, Spirituality, and Health, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA
| | - Maryam S. Farvid
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tyler J. VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ying Zhang
- Division of Sleep Medicine, Sleep Medicine Epidemiology, Harvard Medical School & Brigham and Women’s Hospital, Boston, MA
| | - Frank B. Hu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alexandra E. Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations and Health Disparities, Massachusetts General Hospital and Harvard Medical School, Boston, MA,National Consortium on Psychosocial Stress, Spirituality, and Health, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA
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Stroope S, Kent BV, Zhang Y, Spiegelman D, Kandula NR, Schachter AB, Kanaya A, Shields AE. 'Mental health and self-rated health among U.S. South Asians: the role of religious group involvement'. Ethn Health 2022; 27:388-406. [PMID: 31466458 PMCID: PMC7048668 DOI: 10.1080/13557858.2019.1661358] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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] [Received: 02/28/2019] [Accepted: 08/26/2019] [Indexed: 05/21/2023]
Abstract
Objectives: Only one community-based study has assessed religious group involvement and health outcomes among South Asians in the U.S., with mixed results. Here, using a large, South Asian community-based sample, the effects of six religious group involvement predictors - religious tradition, attendance, group prayer, giving/receiving congregational emotional support, congregational neglect, and congregational criticism - were examined in relation to four health outcomes: self-rated health, positive mental health functioning, trait anxiety, and trait anger.Design: The study used a new religion/spirituality questionnaire in the Mediators of Atherosclerosis Among South Asians Living in America (MASALA), the largest study of mental and physical well-being among U.S. South Asians. Associations were assessed cross-sectionally using OLS regression in both the full sample (N = 928) and a subsample of congregation members (N = 312).Results: Jains reported better self-rated health compared to Hindus and Muslims. Group prayer involvement, when measured ordinally, was positively associated with self-rated health and mental health functioning. In reference group comparisons, individuals who participated in group prayer once/day or more had lower levels of anxiety and anger compared to several comparison groups in which individuals prayed less than once a day. Religious service attendance was associated with higher levels of anxiety. Giving/receiving congregational emotional support was positively associated with self-rated health and mental health functioning, and inversely associated with anxiety. Congregational criticism was associated with higher levels of anger and anxiety.Conclusions: This study provided a new assessment of religious group involvement and health in the U.S. South Asian population. Religious group participation was associated with mental and self-rated health in well-controlled models, indicating this is a fruitful area for further research. Group religious involvement may be a health-promoting resource for U.S. South Asians who are religiously active, but it is not an unalloyed boon.
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Affiliation(s)
- Samuel Stroope
- Louisiana State University Department of Sociology, Baton Rouge, LA
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
| | - Blake Victor Kent
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Boston, MA
- Harvard Medical School, Boston, MA
| | - Ying Zhang
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Boston, MA
| | - Donna Spiegelman
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Yale School of Public Health, New Haven, CT
| | - Namratha R. Kandula
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Anna B. Schachter
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Boston, MA
| | - Alka Kanaya
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- University of California, San Francisco, San Francisco, CA
| | - Alexandra E. Shields
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Boston, MA
- Harvard Medical School, Boston, MA
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Daubman BR, Stoltenberg M, Spence D, Krakauer EL, Farrell S, Traeger L, Thomas R, Bromfield B, Sharpe N, Toppin PJ, Paul T, Schachter AB, Shields AE. Implementing Palliative Care Training in the Caribbean: Development and Assessment of a Basic Palliative Care Training Course in Jamaica. J Pain Symptom Manage 2021; 62:1145-1153. [PMID: 34146660 DOI: 10.1016/j.jpainsymman.2021.06.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/14/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
CONTEXT The majority of people in need of palliative care (PC) in low- and middle-income countries lack access to it and suffer unnecessarily as a consequence. This unmet need is due, in part, to the lack of trained PC providers. OBJECTIVES This study aims to assess the effects of regional training in PC for doctors, nurses, and pharmacists in the Caribbean through assessment of participant satisfaction, anticipated course impact on participants' clinical practice, barriers to changing practice, and perceived course impact on achievement of key PC milestones. METHODS We created and taught a course in basic PC for clinicians from the Caribbean region and collected and analyzed postcourse quantitative and qualitative data on satisfaction and expected impact. RESULTS Eighty-three clinicians from five Caribbean countries participated in this workshop. Thirty participants completed the post-course survey. One hundred percent of these participants ranked the quality of the course as "very high quality" or "high quality." The majority of participants anticipated changing their practice as a result of this course. Several barriers were reported, including lack of formal PC training in participants' home countries. Results of participants' retrospective pre- and postcourse self-assessment for achievement of key PC milestones showed a statistically significant mean increase of at least one point on the seven-point Likert scale for each milestone. CONCLUSION Overall satisfaction with the course was high, and self-assessed competency in PC improved. These data suggest that an intensive training over several days is an effective format for increasing providers' perceived efficacy in delivering PC.
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Affiliation(s)
- Bethany-Rose Daubman
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Jamaica Cancer Care and Research Institute, Kingston, Jamaica.
| | - Mark Stoltenberg
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Jamaica Cancer Care and Research Institute, Kingston, Jamaica
| | - Dingle Spence
- Jamaica Cancer Care and Research Institute, Kingston, Jamaica; Hope Institute Hospital, Kingston, Jamaica
| | - Eric L Krakauer
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Jamaica Cancer Care and Research Institute, Kingston, Jamaica
| | - Susan Farrell
- Harvard Medical School, Boston, MA, USA; Office of Continuing and Professional Development, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Lara Traeger
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston MA, USA
| | - Robert Thomas
- Jamaica Cancer Care and Research Institute, Kingston, Jamaica; Harvard/Massachusetts General Hospital Center on Genomics, Vulnerable Populations and Health Disparities, Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Brittany Bromfield
- Jamaica Cancer Care and Research Institute, Kingston, Jamaica; Harvard/Massachusetts General Hospital Center on Genomics, Vulnerable Populations and Health Disparities, Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - Patrick Jason Toppin
- University of the West Indies, Mona, Section of Anaesthesia and Intensive Care, Mona, Jamaica
| | - Tomlin Paul
- Jamaica Cancer Care and Research Institute, Kingston, Jamaica; The Faculty of Medical Sciences, The University of the West Indies (Mona), Kingston, Jamaica
| | - Anna Boonin Schachter
- Jamaica Cancer Care and Research Institute, Kingston, Jamaica; Harvard/Massachusetts General Hospital Center on Genomics, Vulnerable Populations and Health Disparities, Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Alexandra E Shields
- Harvard Medical School, Boston, MA, USA; Jamaica Cancer Care and Research Institute, Kingston, Jamaica; Harvard/Massachusetts General Hospital Center on Genomics, Vulnerable Populations and Health Disparities, Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA; The Faculty of Medical Sciences, The University of the West Indies (Mona), Kingston, Jamaica
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10
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Shields AE, Zhang Y, Argentieri MA, Warner ET, Cozier YC, Liu C, Dye CK, Kent BV, Baccarelli AA, Palmer JR. Stress and spirituality in relation to HPA axis gene methylation among US Black women: results from the Black Women's Health Study and the Study on Stress, Spirituality and Health. Epigenomics 2021; 13:1711-1734. [PMID: 34726080 PMCID: PMC8579940 DOI: 10.2217/epi-2021-0275] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/28/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Few epigenetics studies have been conducted within the Black community to examine the impact of diverse psychosocial stressors and resources for resiliency on the stress pathway (hypothalamus-pituitary-adrenal axis). Methods: Among 1000 participants from the Black Women's Health Study, associations between ten psychosocial stressors and DNA methylation (DNAm) of four stress-related genes (NR3C1, HSDB1, HSD11B2 and FKBP5) were tested. Whether religiosity or spirituality (R/S) significantly modified these stress-DNAm associations was also assessed. Results: Associations were found for several stressors with DNAm of individual CpG loci and average DNAm levels across each gene, but no associations remained significant after false discovery rate (FDR) correction. Several R/S variables appeared to modify the relationship between two stressors and DNAm, but no identified interaction remained significant after FDR correction. Conclusion: There is limited evidence for a strong signal between stress and DNAm of hypothalamus-pituitary-adrenal axis genes in this general population cohort of US Black women.
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Affiliation(s)
- Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations & Health Disparities, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02114, USA
| | - Yuankai Zhang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - M Austin Argentieri
- Harvard/MGH Center on Genomics, Vulnerable Populations & Health Disparities, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
- School of Anthropology & Museum Ethnography, University of Oxford, Oxford, OX2 6PE, UK
| | - Erica T Warner
- Harvard/MGH Center on Genomics, Vulnerable Populations & Health Disparities, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
- Clinical Translational Epidemiology Unit, Mongan Institute, Department of Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
| | - Yvette C Cozier
- Boston University School of Public Health, Boston, MA 02118, USA
- Slone Epidemiology Center, Boston University, Boston, MA 02118, USA
| | - Chunyu Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Christian K Dye
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Blake Victor Kent
- Department of Sociology, Westmont College, Santa Barbara, CA 93108, USA
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Julie R Palmer
- Boston University School of Public Health, Boston, MA 02118, USA
- Slone Epidemiology Center, Boston University, Boston, MA 02118, USA
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11
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Schachter AB, Argentieri MA, Seddighzadeh B, Isehunwa OO, Kent BV, Trevvett P, McDuffie M, Mandel L, Pargament KI, Underwood LG, McCray AT, Shields AE. R|S Atlas: Identifying existing cohort study data resources to accelerate epidemiological research on the influence of religion and spirituality on human health. BMJ Open 2021; 11:e043830. [PMID: 34697108 PMCID: PMC8547361 DOI: 10.1136/bmjopen-2020-043830] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Many studies have documented significant associations between religion and spirituality (R/S) and health, but relatively few prospective analyses exist that can support causal inferences. To date, there has been no systematic analysis of R/S survey items collected in US cohort studies. We conducted a systematic content analysis of all surveys ever fielded in 20 diverse US cohort studies funded by the National Institutes of Health (NIH) to identify all R/S-related items collected from each cohort's baseline survey through 2014. DESIGN An R|S Ontology was developed from our systematic content analysis to categorise all R/S survey items identified into key conceptual categories. A systematic literature review was completed for each R/S item to identify any cohort publications involving these items through 2018. RESULTS Our content analysis identified 319 R/S survey items, reflecting 213 unique R/S constructs and 50 R|S Ontology categories. 193 of the 319 extant R/S survey items had been analysed in at least one published paper. Using these data, we created the R|S Atlas (https://atlas.mgh.harvard.edu/), a publicly available, online relational database that allows investigators to identify R/S survey items that have been collected by US cohorts, and to further refine searches by other key data available in cohorts that may be necessary for a given study (eg, race/ethnicity, availability of DNA or geocoded data). CONCLUSIONS R|S Atlas not only allows researchers to identify available sources of R/S data in cohort studies but will also assist in identifying novel research questions that have yet to be explored within the context of US cohort studies.
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Affiliation(s)
- Anna Boonin Schachter
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - M Austin Argentieri
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, Massachusetts, USA
- School of Anthropology and Museum Ethnography, Oxford University, Oxford, UK
| | - Bobak Seddighzadeh
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, Massachusetts, USA
- School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Oluwaseyi O Isehunwa
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Blake Victor Kent
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Westmont College, Santa Barbara, CA, USA
| | | | - Michael McDuffie
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Laura Mandel
- Chesapeake Regional Information Systems for our Patients, Columbia, MD, USA
| | - Kenneth I Pargament
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Lynn G Underwood
- Inamori International Center for Ethics, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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12
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Argentieri MA, Baccarelli AA, Shields AE. Special Focus Issue - Epigenomics and health disparities. Epigenomics 2021; 13:1673-1676. [PMID: 34636256 DOI: 10.2217/epi-2021-0359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- M Austin Argentieri
- Harvard/MGH Center on Genomics, Vulnerable Populations, & Health Disparities, Massachusetts General Hospital, Boston, MA 02114, USA.,School of Anthropology & Museum Ethnography, University of Oxford, Oxford, OX2 6PE, UK
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, & Health Disparities, Massachusetts General Hospital, Boston, MA 02114, USA.,Harvard Medical School, Boston, MA 02114, USA
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13
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Isehunwa OO, Warner ET, Spiegelman D, Huang T, Tworoger SS, Kent BV, Shields AE. Religion, spirituality and diurnal rhythms of salivary cortisol and dehydroepiandrosterone in postmenopausal women. Compr Psychoneuroendocrinol 2021; 7. [PMID: 34308392 PMCID: PMC8297624 DOI: 10.1016/j.cpnec.2021.100064] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Religion and spirituality (R/S) are important resources for coping with stress and are hypothesized to influence health outcomes via modulation of the hypothalamic-pituitary-adrenal (HPA) axis, though this has not been evaluated extensively. In this study, we examined associations between several measures of religiosity or spirituality (R/S) and three HPA axis biomarkers: cortisol, dehydroepiandrosterone (DHEA), and cortisol:DHEA ratio. Methods Sample included 216 female postmenopausal Nurses’ Health Study II participants who provided up to five timed saliva samples: immediately upon awakening, 45 min, 4 h, and 10 h after waking, and prior to going to sleep during a single day in 2013. Multivariable-adjusted linear mixed models with piecewise cubic spline functions and adjustment for potential covariates were used to estimate the cross-sectional associations of eight R/S measures with diurnal rhythms of cortisol, DHEA, and the cortisol/DHEA ratio. Results There was little evidence of association between the eight R/S measures analyzed and diurnal rhythms of cortisol, DHEA, and the cortisol/DHEA ratio. Women who reported that R/S was very involved in understanding or dealing with stressful situations had slower night rise in cortisol than those who did not. Greater levels of religious struggles were associated with higher cortisol levels throughout the day. Higher non-theistic daily spiritual experiences scores were associated with slower DHEA night rise, and a higher cortisol/DHEA ratio upon waking and at night. However, these associations were significantly attenuated when we excluded women reporting bedtimes at least 30 min later than usual. Conclusion Observed associations were driven by those with late sleep schedules, and given the number of comparisons made, could be due to chance. Future research using larger, more diverse samples of individuals is needed to better understand the relationship between R/S and HPA axis biomarkers. We examined the influence of religion and spirituality on HPA-axis diurnal rhythms of cortisol, DHEA, and their ratio. Religious coping, religious struggles, and non-theistic DSES were associated with modest alterations in HPA axis rhythms. Observed associations were driven by those with late sleep schedules.
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Affiliation(s)
- Oluwaseyi O. Isehunwa
- MGH/Harvard Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Corresponding author. 50 Staniford St., Suite 802, Boston, MA, 02114, USA.
| | - Erica T. Warner
- MGH/Harvard Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Clinical Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Donna Spiegelman
- Department of Biostatistics and Global Health, Yale School of Public Health, New Haven, CT, USA
- Center for Methods on Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
- Department of Statistics and Data Science, Yale University, New Haven, CT, USA
| | - Tianyi Huang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shelley S. Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Blake Victor Kent
- MGH/Harvard Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Sociology, Westmont College, Santa Barbara, CA, USA
| | - Alexandra E. Shields
- MGH/Harvard Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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14
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Stoltenberg M, Spence D, Daubman BR, Greaves N, Edwards R, Bromfield B, Perez-Cruz PE, Krakauer EL, Argentieri MA, Shields AE. The central role of provider training in implementing resource-stratified guidelines for palliative care in low-income and middle-income countries: Lessons from the Jamaica Cancer Care and Research Institute in the Caribbean and Universidad Católica in Latin America. Cancer 2021; 126 Suppl 10:2448-2457. [PMID: 32348569 DOI: 10.1002/cncr.32857] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 01/24/2020] [Revised: 02/16/2020] [Accepted: 02/25/2020] [Indexed: 11/11/2022]
Abstract
Individuals in low-income and middle-income countries (LMICs) account for approximately two-thirds of cancer deaths worldwide, and the vast majority of these deaths occur without access to essential palliative care (PC). Although resource-stratified guidelines are being developed that take into account the actual resources available within a given country, and several components of PC are available within health care systems, PC will never improve without a trained workforce. The design and implementation of PC provider training programs is the lynchpin for ensuring that all seriously ill patients have access to quality PC services. Building on the Breast Health Global Initiative's resource-stratified recommendations for provider education in PC, the authors report on efforts by the Jamaica Cancer Care and Research Institute in the Caribbean and the Universidad Católica in successfully developing and implementing PC training programs in the Caribbean and Latin America, respectively. Key aspects of this approach include: 1) fostering strategic academic partnerships to bring additional expertise and support to the effort; 2) careful adaptation of the curriculum to the local context and culture; 3) early identification of feasible metrics to facilitate program evaluation and future outcomes research; and 4) designing PC training programs to meet local health system needs.
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Affiliation(s)
- Mark Stoltenberg
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, Massachusetts.,Jamaica Cancer Care and Research Institute, University of the West Indies, Mona Campus, Mona, Jamaica.,Harvard Medical School, Boston, Massachusetts
| | - Dingle Spence
- Jamaica Cancer Care and Research Institute, University of the West Indies, Mona Campus, Mona, Jamaica.,Hope Institute Hospital, Kingston, Jamaica.,Department of Medicine, University of the West Indies, Mona Campus, Mona, Jamaica
| | - Bethany-Rose Daubman
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, Massachusetts.,Jamaica Cancer Care and Research Institute, University of the West Indies, Mona Campus, Mona, Jamaica.,Harvard Medical School, Boston, Massachusetts
| | - Natalie Greaves
- Department of Medical Sciences, University of the West Indies, Cave Hill Campus, Cave Hill, Barbados
| | - Rebecca Edwards
- University of Alabama at Birmingham School of Nursing, Birmingham, Alabama
| | - Brittany Bromfield
- Jamaica Cancer Care and Research Institute, University of the West Indies, Mona Campus, Mona, Jamaica
| | - Pedro E Perez-Cruz
- Palliative Medicine and Continuing Care Program, Faculty of Medicine, Pontifical Universidad Católica of Chile, Santiago, Chile.,Departament of Internal Medicine, Faculty of Medicine, Pontifical Universidad Católica of Chile, Santiago, Chile
| | - Eric L Krakauer
- Division of Palliative Care and Geriatrics, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - M Austin Argentieri
- Jamaica Cancer Care and Research Institute, University of the West Indies, Mona Campus, Mona, Jamaica.,Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,School of Anthropology and Museum Ethnography, University of Oxford, Oxford, United Kingdom
| | - Alexandra E Shields
- Jamaica Cancer Care and Research Institute, University of the West Indies, Mona Campus, Mona, Jamaica.,Harvard Medical School, Boston, Massachusetts.,Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
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15
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Lock M, Argentieri MA, Shields AE. The contribution of ethnography to epigenomics research: toward a new bio-ethnography for addressing health disparities. Epigenomics 2021; 13:1771-1786. [PMID: 33653089 DOI: 10.2217/epi-2020-0009] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This article describes ethnography as a research method and outlines how it excels in capturing the salient experiences of individuals among diverse communities in their own words. We argue that the integration of ethnographic findings into epigenomics will significantly improve disparities-focused study designs within environmental epigenomics by identifying and contextualizing the most salient dimensions of the 'environment' that are affecting local communities. Reciprocally, epigenetic findings can enhance anthropological understanding of human biological variation and embodiment. We introduce the term bio-ethnography to refer to research designs that integrate both of these methodologies into a single research project. Emphasis is given in this article, through the use of case studies, to socially disadvantaged communities that are often underrepresented in scientific literature. The paper concludes with preliminary recommendations for how ethnographic methods can be integrated into epigenomics research designs in order to elucidate the manner in which disadvantage translates into disparities in the burden of illness.
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Affiliation(s)
- Margaret Lock
- Department of Social Studies of Medicine, McGill University, Montreal H3A 1X1, Canada
| | - M Austin Argentieri
- School of Anthropology & Museum Ethnography, University of Oxford, Oxford OX2 6PE, UK.,Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA.,Harvard Medical School, Boston, MA 02114, USA
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16
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Kent BV, Davidson JC, Zhang Y, Pargament KI, VanderWeele TJ, Koenig H, Underwood LG, Krause N, Kanaya AM, Tworoger SS, Schachter AB, Cole S, O’Leary M, Cozier Y, Daviglus M, Giachello AL, Zacher T, Palmer JR, Shields AE. Religion and Spirituality among American Indian, South Asian, Black, Hispanic/Latina, and White Women in the Study on Stress, Spirituality, and Health. J Sci Study Relig 2021; 60:198-215. [PMID: 34012171 PMCID: PMC8127946 DOI: 10.1111/jssr.12695] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Social scientists have increasingly recognized the lack of diversity in survey research on American religion, resulting in a dearth of data on religion and spirituality (R/S) in understudied racial and ethnic groups. At the same time, epidemiological studies have increasingly diversified their racial and ethnic representation, but have collected few R/S measures to date. With a particular focus on American Indian and South Asian women (in addition to Blacks, Hispanic/Latinas, and white women), this study introduces a new effort among religion and epidemiology researchers, the Study on Stress, Spirituality, and Health (SSSH). This multi-cohort study provides some of the first estimates of R/S beliefs and practices among American Indians and U.S. South Asians, and offers new insight into salient beliefs and practices of diverse racial/ethnic and religious communities.
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Affiliation(s)
- Blake Victor Kent
- Westmont College, Department of Sociology, Santa Barbara, CA
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Harvard Medical School/Massachusetts General Hospital Center on Genomics, Vulnerable Populations, and Health Disparities, Boston, MA
| | - James C. Davidson
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Harvard Medical School/Massachusetts General Hospital Center on Genomics, Vulnerable Populations, and Health Disparities, Boston, MA
- California State University – Northridge, Department of Sociology, Northridge, CA
| | - Ying Zhang
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Brigham and Women’s Hospital, Boston, MA
| | - Kenneth I. Pargament
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Bowling Green State University, Department of Psychology, Bowling Green, OH
| | - Tyler J. VanderWeele
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Harvard School of Public Health, Department of Epidemiology, Boston, MA
- Harvard School of Public Health, Department of Biostatistics, Boston, MA
| | - Harold Koenig
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Duke University Medical Center, Durham, NC
| | - Lynn G. Underwood
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Case Western Reserve University Inamori International Center for Ethics and Excellence, Cleveland, OH
| | - Neal Krause
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- University of Michigan School of Public Health, Ann Arbor, MI
| | - Alka M. Kanaya
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- University of California, San Francisco School of Medicine, San Francisco, CA
| | - Shelley S. Tworoger
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Harvard School of Public Health, Department of Epidemiology, Boston, MA
- Moffitt Cancer Center Department of Cancer Epidemiology, Tampa, FL
| | - Anna B. Schachter
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Harvard Medical School/Massachusetts General Hospital Center on Genomics, Vulnerable Populations, and Health Disparities, Boston, MA
| | - Shelley Cole
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Texas Biomedical Research Institute, San Antonio, TX
| | - Marcia O’Leary
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD
| | - Yvette Cozier
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Boston University School of Public Health, Slone Epidemiology Center, Boston, MA
| | - Martha Daviglus
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- University of Illinois at Chicago College of Medicine, Chicago, IL
| | - Aida L. Giachello
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Northewestern University Feinberg School of Medicine, Department of Preventive Medicine, Chicago, IL
| | - Tracy Zacher
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
| | - Julie R. Palmer
- Boston University School of Public Health, Slone Epidemiology Center, Boston, MA
| | - Alexandra E. Shields
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA
- Harvard Medical School/Massachusetts General Hospital Center on Genomics, Vulnerable Populations, and Health Disparities, Boston, MA
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17
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Abstract
Potential antecedents to having a sense of purpose in life remain understudied. As researchers begin contemplating purpose as a promising target of public health intervention, it is critical to identify its antecedents. Using prospective data from the Nurses' Health Study II (2009-2016; N ranged from 3,905 to 4,189), this study evaluated a wide range of potential antecedents of purpose, including: psychosocial well-being, psychological distress, employment characteristics, lifestyle, and physical health factors. In separate regression models we regressed purpose in life on each candidate antecedent. In each model, we adjusted for the prior value of purpose, prior values of all exposure variables, and various other covariates simultaneously. Bonferroni correction was used to correct for multiple testing. The results suggested that positive affect and the number of close relatives were each associated with higher purpose (e.g., β=0.14, 95% CI: 0.11, 0.17 for positive affect). Several psychological distress indicators were inversely associated with purpose, including depressive symptoms, anxiety symptoms, loneliness, and hopelessness (e.g., β=-0.16, 95% CI: -0.19, -0.13 for depressive symptoms). There was also some evidence suggesting that fewer close friends, living alone, and unemployment/retirement were associated with lower purpose. There was, however, little evidence that health behaviors or physical health were associated with subsequent purpose. This study extends the literature by providing longitudinal evidence with rigorous analytic methodologies, and by considering a wide range of potential antecedents of purpose including some that have seldom been examined previously.
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Affiliation(s)
- Ying Chen
- Human Flourishing Program, Harvard Institute for Quantitative Social Science, Cambridge, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eric S Kim
- Human Flourishing Program, Harvard Institute for Quantitative Social Science, Cambridge, MA, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alexandra E Shields
- Department of Medicine, Harvard Medical School, Boston, MA; Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Tyler J VanderWeele
- Human Flourishing Program, Harvard Institute for Quantitative Social Science, Cambridge, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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18
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Shields AE, Balboni TA. Building towards common psychosocial measures in U.S. cohort studies: principal investigators' views regarding the role of religiosity and spirituality in human health. BMC Public Health 2020; 20:973. [PMID: 32571256 PMCID: PMC7310072 DOI: 10.1186/s12889-020-08854-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/11/2019] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goal of this study was to understand prospective cohort study Principal Investigators' (PIs') attitudes regarding the importance of religion and spirituality (R/S) on disease etiology in order to identify barriers and opportunities for greater inclusion of these domains in high-quality epidemiological research. METHODS One-hour, semi-structured qualitative interviews were conducted with 20 PIs, who represent 24 different National Institutes of Health (NIH)-funded prospective cohort studies in the U.S. Collectively, these PIs collect detailed health data on approximately 1.25 of every 100 adult Americans. Sample size was calculated to achieve thematic saturation. RESULTS The majority of PIs we interviewed viewed R/S as potentially important factors influencing disease etiology, particularly among minority communities that report higher levels of religiosity. Yet nearly all PIs interviewed felt there was not yet a compelling body of evidence elucidating R/S influences on health, and the potential mechanisms through which R/S may be operating to affect health outcomes. PIs identified 5 key areas that would need to be addressed before they would be persuaded to collect more R/S measures in their cohorts: (1) high-quality, prospective studies that include all appropriate covariates for the outcome under study; (2) studies that posit a plausible biological mechanism of effect; (3) well-validated R/S measures, collected in common across multiple cohorts; (4) the need to address bias against R/S research among investigators; and (5) NIH funding for R/S research. CONCLUSIONS Results of this study provide a roadmap for future R/S research investigating the impact of R/S influences on disease etiology within the context of U.S. prospective cohort studies. Identifying significant R/S influences on health could inform novel interventions to improve population health. Given the higher levels of religiosity/spirituality among minority communities, R/S research may also provide new leverage points for reducing health disparities.
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Affiliation(s)
- Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital, 50 Staniford St, Suite 802, Boston, MA, 02114, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Tracy A Balboni
- Harvard Medical School, Boston, MA, USA.,Department of Radiation Oncology and Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
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Spence ND, Farvid MS, Warner ET, VanderWeele TJ, Tworoger SS, Argentieri MA, Shields AE. Religious Service Attendance, Religious Coping, and Risk of Hypertension in Women Participating in the Nurses' Health Study II. Am J Epidemiol 2020; 189:193-203. [PMID: 31595952 DOI: 10.1093/aje/kwz222] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 01/20/2019] [Revised: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 12/30/2022] Open
Abstract
The association between religious service attendance, religious coping, and hypertension is unclear. Prospective research and assessment of potential mediators is needed to understand this relationship. From 2001-2013, we prospectively followed 44,281 nonhypertensive women who provided information on religious service attendance and religious coping in the Nurses' Health Study II. Cox regression and mediation analyses were conducted to assess associations between religion and hypertension. There were 453,706 person-years of follow-up and 11,773 incident hypertension cases. Women who attended religious services were less likely to develop hypertension. In the fully adjusting model, compared with women who never or almost never attend religious meetings or services, women attending less than once per month (hazard ratio (HR) = 0.97, 95% confidence interval (CI): 0.91, 1.03), 1-3 times per month (HR = 0.94, 95% CI: 0.88, 1.00), once per week (HR = 0.93, 95% CI: 0.88, 0.98), or more than once per week (HR = 0.91, 95% CI: 0.86, 0.97) showed a decreased risk of hypertension (P for trend = 0.001). Body mass index was an important mediator (11.5%; P < 0.001). Religious coping had a marginal association with hypertension. In conclusion, religious service attendance was modestly associated with hypertension in an inverse dose-response manner and partially mediated through body mass index. Future research is needed on biological or social reasons for the lower risk of hypertension.
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Affiliation(s)
- Nicholas D Spence
- Department of Sociology, University of Toronto, Toronto, Ontario
- Interdisciplinary Center for Health and Society, University of Toronto, Toronto, Ontario
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, Massachusetts
| | - Maryam S Farvid
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Erica T Warner
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shelley S Tworoger
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - M Austin Argentieri
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, Massachusetts
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, United Kingdom
| | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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20
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Thornton PL, Kumanyika SK, Gregg EW, Araneta MR, Baskin ML, Chin MH, Crespo CJ, de Groot M, Garcia DO, Haire-Joshu D, Heisler M, Hill-Briggs F, Ladapo JA, Lindberg NM, Manson SM, Marrero DG, Peek ME, Shields AE, Tate DF, Mangione CM. New research directions on disparities in obesity and type 2 diabetes. Ann N Y Acad Sci 2019; 1461:5-24. [PMID: 31793006 DOI: 10.1111/nyas.14270] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 09/03/2019] [Accepted: 10/18/2019] [Indexed: 12/12/2022]
Abstract
Obesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities and low-income populations. Improvements in implementing efficacious interventions to reduce the incidence of type 2 diabetes are underway (i.e., the National Diabetes Prevention Program), but challenges in effectively scaling-up successful interventions and reaching at-risk populations remain. In October 2017, the National Institutes of Health convened a workshop to understand how to (1) address socioeconomic and other environmental conditions that perpetuate disparities in the burden of obesity and type 2 diabetes; (2) design effective prevention and treatment strategies that are accessible, feasible, culturally relevant, and acceptable to diverse population groups; and (3) achieve sustainable health improvement approaches in communities with the greatest burden of these diseases. Common features of guiding frameworks to understand and address disparities and promote health equity were described. Promising research directions were identified in numerous areas, including study design, methodology, and core metrics; program implementation and scalability; the integration of medical care and social services; strategies to enhance patient empowerment; and understanding and addressing the impact of psychosocial stress on disease onset and progression in addition to factors that support resiliency and health.
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Affiliation(s)
- Pamela L Thornton
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, Maryland
| | - Shiriki K Kumanyika
- Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Edward W Gregg
- Epidemiology and Statistics Branch, Division of Diabetes Translation, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Maria R Araneta
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Monica L Baskin
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Carlos J Crespo
- Oregon Health and Science University and Portland State University Joint School of Public Health, Portland, Oregon
| | - Mary de Groot
- Indiana University School of Medicine, Indianapolis, Indiana
| | - David O Garcia
- Department of Health Promotion Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona
| | - Debra Haire-Joshu
- Washington University in St. Louis, School of Medicine and the Brown School, St. Louis, Missouri
| | | | - Felicia Hill-Briggs
- Johns Hopkins School of Medicine and Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, Maryland
| | - Joseph A Ladapo
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | | | | | | | | | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Deborah F Tate
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Carol M Mangione
- David Geffen School of Medicine at the University of California, and UCLA Fielding School of Public Health, Los Angeles, Los Angeles, California
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21
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Kent BV, Stroope S, Kanaya AM, Zhang Y, Kandula NR, Shields AE. Private religion/spirituality, self-rated health, and mental health among US South Asians. Qual Life Res 2019; 29:495-504. [PMID: 31650305 DOI: 10.1007/s11136-019-02321-7] [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] [Accepted: 09/27/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Connections between private religion/spirituality and health have not been assessed among US South Asians. The aim of this study was to examine the relationship between private religion/spirituality and self-rated and mental health in a community-based sample of US South Asians. METHODS Data from the Mediators of atherosclerosis in South Asians living in America (MASALA) study (collected 2010-2013 and 2015-2018) and the attendant study on stress, spirituality, and health (n = 881) were analyzed using OLS regression. Self-rated health measured overall self-assessed health. Emotional functioning was measured using the mental health inventory-3 index (MHI-3) and Spielberger scales assessed trait anxiety and trait anger. Private religion/spirituality variables included prayer, yoga, belief in God, gratitude, theistic and non-theistic spiritual experiences, closeness to God, positive and negative religious coping, divine hope, and religious/spiritual struggles. RESULTS Yoga, gratitude, non-theistic spiritual experiences, closeness to God, and positive coping were positively associated with self-rated health. Gratitude, non-theistic and theistic spiritual experiences, closeness to God, and positive coping were associated with better emotional functioning; negative coping was associated with poor emotional functioning. Gratitude and non-theistic spiritual experiences were associated with less anxiety; negative coping and religious/spiritual struggles were associated with greater anxiety. Non-theistic spiritual experiences and gratitude were associated with less anger; negative coping and religious/spiritual struggles were associated with greater anger. CONCLUSION Private religion/spirituality is associated with self-rated and mental health. Opportunities may exist for public health and religious care professionals to leverage existing religion/spirituality for well-being among US South Asians.
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Affiliation(s)
- Blake Victor Kent
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA, USA.,Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Samuel Stroope
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA, USA. .,Department of Sociology, Louisiana State University, Baton Rouge, LA, USA.
| | - Alka M Kanaya
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA, USA.,University of California San Francisco, San Francisco, CA, USA
| | - Ying Zhang
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA, USA.,Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Boston, MA, USA
| | - Namratha R Kandula
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA, USA.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alexandra E Shields
- National Consortium on Psychosocial Stress, Spirituality, and Health, Boston, MA, USA.,Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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22
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Spence D, Argentieri MA, Andall-Brereton G, Anderson BO, Duggan C, Bodkyn C, Bray F, Gibson T, Garcia WG, Greaves N, Gupta S, Hobday V, McLean F, Mery L, Nimrod M, Ocho O, Quee-Brown CS, Tortolero-Luna G, Shields AE. Advancing cancer care and prevention in the Caribbean: a survey of strategies for the region. Lancet Oncol 2019; 20:e522-e534. [PMID: 31395471 DOI: 10.1016/s1470-2045(19)30516-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 11/20/2022]
Abstract
Cancer is now the second leading cause of death in the Caribbean. Despite this growing burden, many Caribbean small island nations have health systems that struggle to provide optimal cancer care for their populations. In this Series paper, we identify several promising strategies to improve cancer prevention and treatment that have emerged across small island nations that are part of the Caribbean Community. These strategies include the establishment of a Caribbean cancer registry hub, the development of resource-appropriate clinical guidelines, innovations in delivering specialty oncology services (eg, paediatric oncology and palliative care), improving access to opioids, and developing regional training capacity in palliative medicine. These developments emphasise the crucial role of public-private partnerships in improving health care for the region and show how fostering strategic collaborations with colleagues and centres in more developed countries, who can contribute specialised expertise and improve regional collaboration, can improve care across the cancer control continuum.
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Affiliation(s)
- Dingle Spence
- Hope Institute Hospital, Kingston, Jamaica; Faculty of Medicine, University of the West Indies, Kingston, Jamaica; Jamaica Cancer Care and Research Institute, University of the West Indies, Kingston, Jamaica.
| | - M Austin Argentieri
- Jamaica Cancer Care and Research Institute, University of the West Indies, Kingston, Jamaica; Harvard/ MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK
| | | | - Benjamin O Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Institute, Seattle, WA, USA
| | - Catherine Duggan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Institute, Seattle, WA, USA
| | - Curt Bodkyn
- Faculty of Medical Sciences, The University of the West Indies, Saint Augustine, Trinidad and Tobago
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Tracey Gibson
- Department of Pathology, University of the West Indies, Kingston, Jamaica
| | - Wendy Gomez Garcia
- Oncology Unit, Dr Robert Reid Cabral Children's Hospital, Santo Domingo, Dominican Republic
| | - Natalie Greaves
- Faculty of Medical Sciences, University of the West Indies, Wanstead, Barbados
| | - Sumit Gupta
- Division of Haematology/ Oncology, Hospital for Sick Children, Faculty of Medicine and IHPME, University of Toronto, Toronto, ON, Canada
| | | | | | - Les Mery
- Global Initiative for Cancer Registry Development, International Agency for Research on Cancer, Lyon, France
| | - Marisa Nimrod
- The Caribbean Association for Oncology and Hematology, Port of Spain, Trinidad and Tobago
| | - Oscar Ocho
- University of West Indies School of Nursing, Saint Augustine, Trinidad and Tobago
| | | | - Guillermo Tortolero-Luna
- Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Centre, San Juan, Puerto Rico
| | - Alexandra E Shields
- Jamaica Cancer Care and Research Institute, University of the West Indies, Kingston, Jamaica; Harvard/ MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
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23
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Lu D, Palmer JR, Rosenberg L, Shields AE, Orr EH, DeVivo I, Cozier YC. Perceived racism in relation to telomere length among African American women in the Black Women's Health Study. Ann Epidemiol 2019; 36:33-39. [PMID: 31387775 DOI: 10.1016/j.annepidem.2019.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 02/11/2019] [Revised: 06/08/2019] [Accepted: 06/12/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Telomere length is considered a biomarker of human aging and premature morbidity and mortality which has been associated with chronic stress. METHODS We assessed the relation between perceived racism and telomere length in the Black Women's Health Study, a follow-up study of U.S. black women begun in 1995. Participants were asked about frequency of "everyday racism" (e.g., "people act as if they think you are not intelligent") and "institutional racism" (e.g., "ever treated unfairly due to race by police"). Using quantitative real-time polymerase chain reaction assay, relative telomere lengths (RTL) were measured as the copy number ratio of telomere repeat to a single control gene in 997 participants. Associations of racism variables with log-RTL were estimated by multivariable linear regression, with adjustment for age at blood draw and potential confounders. RESULTS Participants were aged 40-70 years (mean = 55.6 years), and mean telomere length was 0.77 (range 0.21-1.38). In stratified analyses, there was an inverse association between everyday racism and log-RTL among women who did not discuss their experiences of racism with others (β = -0.1104; 95% CI = -0.2140 to -0.0067; P = .045). CONCLUSIONS Everyday racism was associated with shorter telomere length among women who reported not discussing those experiences with others.
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Affiliation(s)
- Darlene Lu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA; Slone Epidemiology Center at Boston University, Boston, MA
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Alexandra E Shields
- Department of Medicine, Harvard Medical School, Boston, MA; Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, MA
| | - Esther H Orr
- Brigham and Women's Hospital, Boston, MA; Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Immaculata DeVivo
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Yvette C Cozier
- Slone Epidemiology Center at Boston University, Boston, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA.
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24
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Cozier YC, Yu J, Wise LA, VanderWeele TJ, Balboni TA, Argentieri MA, Rosenberg L, Palmer JR, Shields AE. Religious and Spiritual Coping and Risk of Incident Hypertension in the Black Women's Health Study. Ann Behav Med 2018; 52:989-998. [PMID: 30418522 PMCID: PMC6230974 DOI: 10.1093/abm/kay001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 01/16/2023] Open
Abstract
Background The few studies of the relationship between religion and/or spirituality (R/S) and hypertension are conflicting. We hypothesized that R/S may reduce the risk of hypertension by buffering adverse physiological effects of stress. Methods We prospectively assessed the association of R/S with hypertension within the Black Women's Health Study (BWHS), a cohort study initiated in 1995 that follows participants through biennial questionnaires. The 2005 questionnaire included four R/S questions: (i) extent to which one's R/S is involved in coping with stressful situations, (ii) self-identification as a religious/spiritual person, (iii) frequency of attending religious services, and (iv) frequency of prayer. Incidence rate ratios (IRRs) and 95% confidence intervals were calculated for each R/S variable in relation to incident hypertension using Cox proportional hazards regression models, controlling for demographics, known hypertension risk factors, psychosocial factors, and other R/S variables. Results During 2005-2013, 5,194 incident cases of hypertension were identified. High involvement of R/S in coping with stressful events compared with no involvement was associated with reduced risk of hypertension (IRR: 0.87; 95% CI: 0.75, 1.00). The association was strongest among women reporting greater levels of perceived stress (IRR: 0.77; 95% CI: 0.61, 0.98; p interaction = .01). More frequent prayer was associated with increased risk of hypertension (IRR: 1.12; 95% CI: 0.99, 1.27). No association was observed for the other R/S measures. Conclusion R/S coping was associated with decreased risk of hypertension in African American women, especially among those reporting higher levels of stress. Further research is needed to understand the mechanistic pathways through which R/S coping may affect health.
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Affiliation(s)
- Yvette C Cozier
- Slone Epidemiology Center, Boston University, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jeffrey Yu
- Slone Epidemiology Center, Boston University, Boston, MA, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Tyler J VanderWeele
- Department of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tracy A Balboni
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston MA, USA
- Department of Radiation Oncology, Harvard Medical School, Boston, MA, USA
| | - M Austin Argentieri
- National Consortium on Psychosocial Stress, Spirituality, and Health, Massachusetts General Hospital, Department of Medicine, Boston, MA, USA
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, MA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center, Boston University, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Julie R Palmer
- Slone Epidemiology Center, Boston University, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Boston University Cancer Center, Boston University, Boston, MA, USA
| | - Alexandra E Shields
- National Consortium on Psychosocial Stress, Spirituality, and Health, Massachusetts General Hospital, Department of Medicine, Boston, MA, USA
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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25
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Zaimi I, Pei D, Koestler DC, Marsit CJ, De Vivo I, Tworoger SS, Shields AE, Kelsey KT, Michaud DS. Variation in DNA methylation of human blood over a 1-year period using the Illumina MethylationEPIC array. Epigenetics 2018; 13:1056-1071. [PMID: 30270718 PMCID: PMC6342169 DOI: 10.1080/15592294.2018.1530008] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 04/13/2018] [Revised: 08/02/2018] [Accepted: 09/22/2018] [Indexed: 12/29/2022] Open
Abstract
Assessing DNA methylation profiles in human blood has become a major focus of epidemiologic inquiry. Understanding variability in CpG-specific DNA methylation over moderate periods of time is a critical first step in identifying CpG sites that are candidates for DNA methylation-based etiologic, diagnostic and prognostic predictors of pathogenesis. Using the Illumina MethylationEPIC [850K] BeadArray, DNA methylation was profiled in paired whole blood samples collected approximately 1 year apart from 35 healthy women enrolled in the Nurses Study II cohort. The median intraclass correlation coefficient (ICC) across all CpG loci was 0.19 [Interquartile Range (IQR) 0.00-0.50]; 74.8% of ICCs were in the low range (0-0.5), 16.9% in the mid-range of ICCs (0.5-0.8), and 8.3% in the high-range of ICCs (0.8-1). ICCs were similar for CpG probes on the 450K Illumina array (median 0.17) and the new probes added to the 850K array (median 0.21). ICCs for CpG loci on the sex chromosomes and known metastable epialleles were high (median 0.71, 0.97, respectively), and ICCs among methylation quantitative trait loci (mQTL) CpGs were significantly higher as compared to non-mQTL CpGs (median 0.73, 0.16, respectively, P < 2 × 10-16). We observed wide variation in DNA methylation stability over a 1-year period. Probes considered non-stable, due to substantial variation over a moderate period of time and with minimal variability across individuals could be removed in large epidemiological studies. Moreover, adjusting for technical variation that arises from using high-dimensional arrays is critical.
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Affiliation(s)
- Ina Zaimi
- a Department of Public Health & Community Medicine, Tufts University School of Medicine , Tufts University , Boston , USA
| | - Dong Pei
- b Department of Biostatistics , University of Kansas Medical Center , Kansas City , USA
- c University of Kansas Cancer Center , The University of Kansas Medical Center , Kansas City , USA
| | - Devin C Koestler
- b Department of Biostatistics , University of Kansas Medical Center , Kansas City , USA
- c University of Kansas Cancer Center , The University of Kansas Medical Center , Kansas City , USA
| | - Carmen J Marsit
- d Department of Environmental Health and Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , USA
| | - Immaculata De Vivo
- e Channing Division of Network Medicine, Department of Medicine , Brigham and Women's Hospital and Harvard Medical School , Boston , USA
| | - Shelley S Tworoger
- f Department of Cancer Epidemiology , Moffitt Cancer Center , Tampa , USA
- g Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , USA
| | - Alexandra E Shields
- h Department of Medicine , Harvard Medical School , Boston , MA , USA
- k Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities , Massachusetts General Hospital , Boston , MA , USA
| | - Karl T Kelsey
- i Department of Epidemiology , Brown University , Providence , USA
- j Department of Pathology and Laboratory Medicine , Brown University , Providence , USA
| | - Dominique S Michaud
- a Department of Public Health & Community Medicine, Tufts University School of Medicine , Tufts University , Boston , USA
- i Department of Epidemiology , Brown University , Providence , USA
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26
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Spence D, Austin Argentieri M, Greaves N, Cox K, Chin SN, Munroe M, Watson G, Harewood H, Shields AE. Palliative Care in the Caribbean Through the Lens of Women with Breast Cancer: Challenges and Opportunities. Curr Breast Cancer Rep 2018. [DOI: 10.1007/s12609-018-0280-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Argentieri MA, Nagarajan S, Seddighzadeh B, Baccarelli AA, Shields AE. Epigenetic Pathways in Human Disease: The Impact of DNA Methylation on Stress-Related Pathogenesis and Current Challenges in Biomarker Development. EBioMedicine 2017; 18:327-350. [PMID: 28434943 PMCID: PMC5405197 DOI: 10.1016/j.ebiom.2017.03.044] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [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: 10/25/2016] [Revised: 03/06/2017] [Accepted: 03/28/2017] [Indexed: 01/30/2023] Open
Abstract
HPA axis genes implicated in glucocorticoid regulation play an important role in regulating the physiological impact of social and environmental stress, and have become a focal point for investigating the role of glucocorticoid regulation in the etiology of disease. We conducted a systematic review to critically assess the full range of clinical associations that have been reported in relation to DNA methylation of CRH, CRH-R1/2, CRH-BP, AVP, POMC, ACTH, ACTH-R, NR3C1, FKBP5, and HSD11β1/2 genes in adults. A total of 32 studies were identified. There is prospective evidence for an association between HSD11β2 methylation and hypertension, and functional evidence of an association between NR3C1 methylation and both small cell lung cancer (SCLC) and breast cancer. Strong associations have been reported between FKBP5 and NR3C1 methylation and PTSD, and biologically-plausible associations have been reported between FKBP5 methylation and Alzheimer's Disease. Mixed associations between NR3C1 methylation and mental health outcomes have been reported according to different social and environmental exposures, and according to varying gene regions investigated. We conclude by highlighting key challenges and future research directions that will need to be addressed in order to develop both clinically meaningful prognostic biomarkers and an evidence base that can inform public policy practice.
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Affiliation(s)
- M Austin Argentieri
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Suite 901, Boston, MA 02114, USA
| | - Sairaman Nagarajan
- Department of Pediatrics, State University of New York Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11218, USA
| | - Bobak Seddighzadeh
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Suite 901, Boston, MA 02114, USA
| | - Andrea A Baccarelli
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Suite 901, Boston, MA 02114, USA; Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W. 168th St., 11th Floor, New York, NY 10032, USA
| | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Suite 901, Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
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VanderWeele TJ, Palmer JR, Shields AE. VanderWeele et al. Respond to "Church Attendance and Mortality". Am J Epidemiol 2017; 185:526-528. [PMID: 28338843 DOI: 10.1093/aje/kww181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 10/21/2016] [Indexed: 11/14/2022] Open
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VanderWeele TJ, Yu J, Cozier YC, Wise L, Argentieri MA, Rosenberg L, Palmer JR, Shields AE. Attendance at Religious Services, Prayer, Religious Coping, and Religious/Spiritual Identity as Predictors of All-Cause Mortality in the Black Women's Health Study. Am J Epidemiol 2017; 185:515-522. [PMID: 28338863 DOI: 10.1093/aje/kww179] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/20/2016] [Indexed: 11/15/2022] Open
Abstract
Previous longitudinal studies have consistently shown an association between attendance at religious services and lower all-cause mortality, but the literature on associations between other measures of religion and spirituality (R/S) and mortality is limited. We followed 36,613 respondents from the Black Women's Health Study from 2005 through December 31, 2013 to assess the associations between R/S and incident all-cause mortality using proportional hazards models. After control for numerous demographic and health covariates, together with other R/S variables, attending religious services several times per week was associated with a substantially lower mortality rate ratio (mortality rate ratio = 0.64, 95% confidence interval: 0.51, 0.80) relative to never attending services. Engaging in prayer several times per day was not associated with mortality after control for demographic and health covariates, but the association trended towards a higher mortality rate ratio when control was made for other R/S variables (for >2 times/day vs. weekly or less, mortality rate ratio = 1.28, 95% confidence interval: 0.99, 1.67; P-trend < 0.01). Religious coping and self-identification as a very religious/spiritual person were associated with lower mortality when adjustment was made only for age, but the association was attenuated when control was made for demographic and health covariates and was almost entirely eliminated when control was made for other R/S variables. The results indicate that service attendance was the strongest R/S predictor of mortality in this cohort.
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Affiliation(s)
- Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations & Health Disparities, Department of Medicine, Massachusetts General Hospital, 50 Staniford St, Suite 901, Boston, MA 02114, USA
- Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- National Consortium on Psychosocial Stress, Spirituality & Health, Massachusetts General Hospital, 50 Staniford St, Suite 901, Boston, MA 02114, USA
- Broad Institute of MIT & Harvard, 415 Main Street, Cambridge, MA 02142, USA
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Shields AE, Wise LA, Ruiz-Narvaez EA, Seddighzadeh B, Byun HM, Cozier YC, Rosenberg L, Palmer JR, Baccarelli AA. Childhood abuse, promoter methylation of leukocyte NR3C1 and the potential modifying effect of emotional support. Epigenomics 2016; 8:1507-1517. [PMID: 27620456 DOI: 10.2217/epi-2016-0074] [Citation(s) in RCA: 34] [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: 12/31/2022] Open
Abstract
AIM To investigate childhood abuse victimization in relation to adult DNA methylation levels in a novel region of NR3C1, with emotional support as a possible modifier. MATERIALS & METHODS 295 participants from the Black Women's Health Study. Multivariable linear regression models were used to compute differences in mean percent methylation levels. RESULTS Women reporting childhood abuse victimization exhibited higher mean NR3C1 methylation levels than nonabused women, with a clear dose-response relationship. Childhood emotional support appeared to attenuate associations only among women with the highest levels of physical and sexual abuse. CONCLUSION NR3C1 mean methylation was higher among women who reported childhood abuse. Further research is warranted to clarify whether or the extent to which childhood emotional support buffers the association.
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Affiliation(s)
- Alexandra E Shields
- Harvard Medical School, 25 Shattuck St, Boston, MA 02114, USA.,Harvard/MGH Center on Genomics, Vulnerable Populations & Health Disparities, Massachusetts General Hospital, 50 Staniford St, Suite 901, Boston, MA 02114, USA
| | - Lauren A Wise
- Boston University School of Public Health, Talbot Building, 715 Albany St, Boston, MA 02118, USA.,Slone Epidemiology Center, Boston University, 1010 Commonwealth Ave, Boston, MA 02215, USA
| | - Edward A Ruiz-Narvaez
- Boston University School of Public Health, Talbot Building, 715 Albany St, Boston, MA 02118, USA.,Slone Epidemiology Center, Boston University, 1010 Commonwealth Ave, Boston, MA 02215, USA
| | - Bobak Seddighzadeh
- Harvard/MGH Center on Genomics, Vulnerable Populations & Health Disparities, Massachusetts General Hospital, 50 Staniford St, Suite 901, Boston, MA 02114, USA
| | - Hyang-Min Byun
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Yvette C Cozier
- Boston University School of Public Health, Talbot Building, 715 Albany St, Boston, MA 02118, USA.,Slone Epidemiology Center, Boston University, 1010 Commonwealth Ave, Boston, MA 02215, USA
| | - Lynn Rosenberg
- Boston University School of Public Health, Talbot Building, 715 Albany St, Boston, MA 02118, USA.,Slone Epidemiology Center, Boston University, 1010 Commonwealth Ave, Boston, MA 02215, USA
| | - Julie R Palmer
- Boston University School of Public Health, Talbot Building, 715 Albany St, Boston, MA 02118, USA.,Slone Epidemiology Center, Boston University, 1010 Commonwealth Ave, Boston, MA 02215, USA
| | - Andrea A Baccarelli
- Harvard/MGH Center on Genomics, Vulnerable Populations & Health Disparities, Massachusetts General Hospital, 50 Staniford St, Suite 901, Boston, MA 02114, USA.,Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY 10032, USA
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Williams DR, Mohammed SA, Shields AE. Understanding and effectively addressing breast cancer in African American women: Unpacking the social context. Cancer 2016; 122:2138-49. [PMID: 26930024 PMCID: PMC5588632 DOI: 10.1002/cncr.29935] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [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: 09/15/2015] [Revised: 01/20/2016] [Accepted: 01/25/2016] [Indexed: 12/12/2022]
Abstract
Black women have a higher incidence of breast cancer before the age of 40 years, more severe disease at all ages, and an elevated mortality risk in comparison with white women. There is limited understanding of the contribution of social factors to these patterns. Elucidating the role of the social determinants of health in breast cancer disparities requires greater attention to how risk factors for breast cancer unfold over the lifecourse and to the complex ways in which socioeconomic status and racism shape exposure to psychosocial, physical, chemical, and other individual and community-level assaults that increase the risk of breast cancer. Research that takes seriously the social context in which black women live is also needed to maximize the opportunities to prevent breast cancer in this underserved group. Cancer 2016;122:2138-49. © 2016 American Cancer Society.
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Affiliation(s)
- David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health
- Department of African and African American Studies, Harvard University
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Selina A. Mohammed
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA
| | - Alexandra E. Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital
- Department of Medicine, Harvard Medical School
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Nagarajan S, Seddighzadeh B, Baccarelli A, Wise LA, Williams M, Shields AE. Adverse maternal exposures, methylation of glucocorticoid-related genes and perinatal outcomes: a systematic review. Epigenomics 2016; 8:925-44. [DOI: 10.2217/epi.16.9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim: Maternal environmental exposures affect perinatal outcomes through epigenetic placental changes. We examine the literature addressing associations between adverse maternal exposures, perinatal outcomes and methylation of key genes regulating placental cortisol metabolism. Methods: We searched three databases for studies that examined NR3C1 and HSD11β1/HSD11 β 2 methylation with maternal exposures or perinatal outcomes. Nineteen studies remained after screening. We followed Cochrane's PRISMA reporting guidelines (2009). Results: NR3C1 and HSD11 β methylation were associated with adverse infant neurobehavior, stress response, blood pressure and physical development. In utero exposure to maternal stress, nutrition, preeclampsia, smoking and diabetes were associated with altered NR3C1 and HSD11 β methylation. Conclusion: NR3C1 and HSD11 β methylation are useful biomarkers of specific environmental stressors associated with important perinatal outcomes that determine pediatric and adult disease risk.
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Affiliation(s)
- Sairaman Nagarajan
- Harvard/MGH Center on Genomics, Vulnerable Populations & Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Bobak Seddighzadeh
- Harvard/MGH Center on Genomics, Vulnerable Populations & Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Andrea Baccarelli
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Lauren A Wise
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Michelle Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations & Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
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Affiliation(s)
- Tyler J VanderWeele
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Program on Integrative Knowledge and Human Flourishing, Harvard University, National Consortium on Psychosocial Stress, Spirituality, and Health, United States.
| | - Alexandra E Shields
- Harvard Medical School, Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, National Consortium on Psychosocial Stress, Spirituality, and Health, United States
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LeBaron VT, Smith PT, Quiñones R, Nibecker C, Sanders JJ, Timms R, Shields AE, Balboni TA, Balboni MJ. How Community Clergy Provide Spiritual Care: Toward a Conceptual Framework for Clergy End-of-Life Education. J Pain Symptom Manage 2016; 51:673-681. [PMID: 26706624 PMCID: PMC5987222 DOI: 10.1016/j.jpainsymman.2015.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/18/2015] [Accepted: 11/21/2015] [Indexed: 11/22/2022]
Abstract
CONTEXT Community-based clergy are highly engaged in helping terminally ill patients address spiritual concerns at the end of life (EOL). Despite playing a central role in EOL care, clergy report feeling ill-equipped to spiritually support patients in this context. Significant gaps exist in understanding how clergy beliefs and practices influence EOL care. OBJECTIVES The objective of this study was to propose a conceptual framework to guide EOL educational programming for community-based clergy. METHODS This was a qualitative, descriptive study. Clergy from varying spiritual backgrounds, geographical locations in the U.S., and race/ethnicities were recruited and asked about optimal spiritual care provided to patients at the EOL. Interviews were audio taped, transcribed, and analyzed following principles of grounded theory. A final set of themes and subthemes were identified through an iterative process of constant comparison. Participants also completed a survey regarding experiences ministering to the terminally ill. RESULTS A total of 35 clergy participated in 14 individual interviews and two focus groups. Primary themes included Patient Struggles at EOL and Clergy Professional Identity in Ministering to the Terminally Ill. Patient Struggles at EOL focused on existential questions, practical concerns, and difficult emotions. Clergy Professional Identity in Ministering to the Terminally Ill was characterized by descriptions of Who Clergy Are ("Being"), What Clergy Do ("Doing"), and What Clergy Believe ("Believing"). "Being" was reflected primarily by manifestations of presence; "Doing" by subthemes of religious activities, spiritual support, meeting practical needs, and mistakes to avoid; "Believing" by subthemes of having a relationship with God, nurturing virtues, and eternal life. Survey results were congruent with interview and focus group findings. CONCLUSION A conceptual framework informed by clergy perspectives of optimal spiritual care can guide EOL educational programming for clergy.
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Affiliation(s)
- Virginia T LeBaron
- University of Virginia School of Nursing, Charlottesville, Virginia, USA.
| | - Patrick T Smith
- Harvard Medical School Center for Bioethics, Boston, Massachusetts, USA; Gordon-Conwell Theological Seminary, Boston, Massachusetts, USA
| | | | | | | | | | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations and Health Disparities, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tracy A Balboni
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Initiative on Health, Religion, and Spirituality, Harvard University, Cambridge, Massachusetts, USA
| | - Michael J Balboni
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Initiative on Health, Religion, and Spirituality, Harvard University, Cambridge, Massachusetts, USA
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Wosu AC, Gelaye B, Valdimarsdóttir U, Kirschbaum C, Stalder T, Shields AE, Williams MA. Hair cortisol in relation to sociodemographic and lifestyle characteristics in a multiethnic US sample. Ann Epidemiol 2014; 25:90-5, 95.e1-2. [PMID: 25534254 DOI: 10.1016/j.annepidem.2014.11.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [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: 05/01/2014] [Revised: 11/18/2014] [Accepted: 11/23/2014] [Indexed: 02/01/2023]
Abstract
PURPOSE We investigated the feasibility of obtaining hair samples from men and women at community-based barbershops and hair salons for analysis of cortisol and assessed sociodemographic and lifestyle correlates of hair cortisol concentrations (HCCs). A total of 102 participants completed the study. METHODS Research staff interviewed participants using a structured questionnaire, and samples of hair were collected. HCCs were determined using liquid chromatography-tandem mass spectrometry. Age- and sex-adjusted linear regression models were used to evaluate the association of HCC with covariates. RESULTS Analyses by race/ethnicity showed highest median HCC in blacks (12.5 [6.9-29.3]) pg/mg) followed by Hispanics (10.7 [5.8-14.9] pg/mg), whites (5.0 [3.8-10.8] pg/mg), and other participants (4.2 [3.3-15.7] pg/mg), P < .01. Current smokers had significantly higher median HCC (11.7 [8.8-18.9] pg/mg) compared with former smokers (4.6 [3.5-14.6] pg/mg) and those who had never smoked (6.9 [4.7-12.8] pg/mg), P = .04. After adjustment for age and sex, geometric mean HCC was 0.72 pg/mg lower in dyed hair compared with hair that was not dyed (β = -0.72, standard error = 0.30, 95% confidence interval, -1.29 to -0.15, P = .02). CONCLUSIONS HCC can be assessed in community-based studies. Future HCC studies should consider cosmetic hair treatment, cigarette smoking, and the potential role of psychosocial stressors in the association between race/ethnicity and HCC.
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Affiliation(s)
- Adaeze C Wosu
- Department of Epidemiology, Harvard School of Public Health, Boston, MA.
| | - Bizu Gelaye
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Unnur Valdimarsdóttir
- Department of Epidemiology, Harvard School of Public Health, Boston, MA; Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Clemens Kirschbaum
- Department of Psychology, Technical University of Dresden, Dresden, Germany
| | - Tobias Stalder
- Department of Psychology, Technical University of Dresden, Dresden, Germany
| | - Alexandra E Shields
- Department of Medicine, Harvard Medical School, Harvard/Massachusetts General Hospital Center for Genomics, Vulnerable Populations and Health Disparities, Mongan Institute for Health Policy, Boston, MA
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Wosu AC, Valdimarsdóttir U, Shields AE, Williams DR, Williams MA. Correlates of cortisol in human hair: implications for epidemiologic studies on health effects of chronic stress. Ann Epidemiol 2013; 23:797-811.e2. [PMID: 24184029 PMCID: PMC3963409 DOI: 10.1016/j.annepidem.2013.09.006] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [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: 04/02/2013] [Revised: 09/03/2013] [Accepted: 09/30/2013] [Indexed: 01/05/2023]
Abstract
Assessment of cortisol concentrations in hair is one of the latest innovations for measuring long-term cortisol exposure. We performed a systematic review of correlates of cortisol in human hair to inform the design, analysis, and interpretation of future epidemiologic studies. Relevant publications were identified through electronic searches on PubMed, WorldCat, and Web of Science using keywords, "cortisol," "hair," "confounders," "chronic," "stress," and "correlates." Thirty-nine studies were included in this review. Notwithstanding scarce data and some inconsistencies, investigators have found hair cortisol concentrations to be associated with stress-related psychiatric symptoms and disorders (e.g., post-traumatic stress disorder), medical conditions indicating chronic activation of the hypothalamic-pituitary-adrenal axis (e.g., Cushing's syndrome), and other life situations associated with elevated risk of chronic stress (e.g., shiftwork). Results from some studies suggest that physical activity, adiposity, and substance abuse may be correlates of hair cortisol concentrations. In contrast to measures of short-term cortisol release (saliva, blood, and urine), cigarette smoking and use of oral contraceptives appear not to be associated with hair cortisol concentrations. Studies of pregnant women indicate increased hair cortisol concentrations across successive trimesters. The study of hair cortisol presents a unique opportunity to assess chronic alterations in cortisol concentrations in epidemiologic studies.
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Affiliation(s)
- Adaeze C Wosu
- Multidisciplinary International Research Training Program, Harvard School of Public Health, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA.
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Abstract
OBJECTIVE To extend recent conceptual and methodological advances in disparities research to include the incorporation of genomic information in analyses of racial/ethnic disparities in health care and health outcomes. DATA SOURCES Published literature on human genetic variation, the role of genetics in disease and response to treatment, and methodological developments in disparities research. STUDY DESIGN We present a conceptual framework for incorporating genomic information into the Institute of Medicine definition of racial/ethnic disparities in health care, identify key concepts used in disparities research that can be informed by genomics research, and illustrate the incorporation of genomic information into current methods using the example of HER-2 mutations guiding care for breast cancer. PRINCIPAL FINDINGS Genomic information has not yet been incorporated into disparities research, though it has direct relevance to concepts of race/ethnicity, health status, appropriate care, and socioeconomic status. The HER-2 example demonstrates how available genetic information can be incorporated into current disparities methods to reduce selection bias and measurement error. Advances in health information infrastructure may soon make standardized genetic information more available to health services researchers. CONCLUSION Genomic information can refine measurement of racial/ethnic disparities in health care and health outcomes and should be included wherever possible in disparities research.
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Affiliation(s)
- Alexandra E Shields
- Harvard/MGH Center for Genomics, Vulnerable Populations and Health Disparities, and Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA.
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Olden K, Freudenberg N, Dowd J, Shields AE. Discovering how environmental exposures alter genes could lead to new treatments for chronic illnesses. Health Aff (Millwood) 2011; 30:833-41. [PMID: 21555469 DOI: 10.1377/hlthaff.2011.0078] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Emerging research demonstrates that diet, pollution, and other environmental triggers can alter both the function and expression of human genes and lead to a heightened disease risk. These environment-gene interactions can cause so-called epigenetic changes in gene expression-patterns of which genes are switched "on" or "off"-that may account for the rising mortality from chronic diseases in industrialized nations. In this paper, we call for a new transdisciplinary approach to public health that would examine how environmental exposures, both physical and social, influence gene expression and a person's susceptibility to chronic disease. This initiative could lead to new ways to prevent and treat such illnesses.
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Affiliation(s)
- Kenneth Olden
- City University of New York School of Public Health at Hunter College, in New York City, USA.
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Shields AE. Ethical concerns related to developing pharmacogenomic treatment strategies for addiction. Addict Sci Clin Pract 2011; 6:32-43. [PMID: 22003420 PMCID: PMC3188829] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pharmacogenomics (PGx) research is poised to enable physicians to identify optimally effective treatments for individual substance abusers based on their genetic profiles. This paper addresses ethical issues related to PGx treatment strategies for addiction, focusing especially on the use of race variables in genomics research and ensuring equitable access to novel PGx treatments. Unless the field addresses the ethical challenges posed by these issues, PGx treatment innovations for addiction threaten to exacerbate already dramatic disparities in the burden of drug dependence for minority and other underserved populations.
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Affiliation(s)
- Alexandra E Shields
- Harvard/MGH Center for Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy Massachusetts General Hospital, Boston, Massachusetts, USA.
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Park ER, Kleimann S, Youatt EJ, Lockhart A, Campbell EG, Levy DE, Halbert CH, Schmieder E, Krishna R, Shields AE. Black and White adults' perspectives on the genetics of nicotine addiction susceptibility. Addict Behav 2011; 36:769-72. [PMID: 21406316 DOI: 10.1016/j.addbeh.2011.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 01/18/2011] [Accepted: 02/18/2011] [Indexed: 10/18/2022]
Abstract
AIMS Emerging research may soon lead to improved quit rates via genetically-tailored smoking cessation treatment. The purpose of this study was to explore individuals' beliefs and attitudes about genetic testing in this context, and how these may differ across racial groups. DESIGN Two site qualitative study. METHODS Eleven focus groups were conducted in 2007 with 51 Black and 55 White adult participants in Montgomery, AL and Baltimore, MD. MEASUREMENTS Questions were asked about smoking as an addiction, the role of genetics in nicotine addiction susceptibility, and undergoing genetic testing to receive tailored smoking cessation treatment. Data were analyzed using content analysis. FINDINGS Most participants believed that smoking was an addiction yet were unwilling to endorse the notion that genetics played a role in nicotine addiction susceptibility. However, 91% of White participants and 62% of Black participants indicated that they would likely take a genetic test that would match them to their optimal smoking cessation treatment. The primary potential benefit was a vague sense that additional knowledge about oneself would be of value. Primary barriers included disinterest and skepticism about the test, unwillingness to believe that genetics played a role in nicotine addiction or treatment response, and concerns about psychological consequences. CONCLUSIONS The majority of participants, particularly Black participants, did not believe that genetics played a significant role in nicotine addiction susceptibility but were willing to undergo genetic testing. Participants identified some benefit to tailoring smoking treatment by genotype. However, participants also expressed skepticism about the test and concerns about its consequences; these issues would need to be addressed in the clinical encounter.
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Schnoll RA, Shields AE. Physician barriers to incorporating pharmacogenetic treatment strategies for nicotine dependence into clinical practice. Clin Pharmacol Ther 2011; 89:345-7. [PMID: 21326262 DOI: 10.1038/clpt.2010.267] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Advances in genomics research may improve health outcomes by tailoring treatment according to patients' genetic profiles. The treatment of nicotine dependence, in particular, may soon encompass pharmacogenetic treatment models. Realizing the benefits of such treatment strategies may depend on physicians' preparedness to incorporate genetic testing into clinical practice. This article describes barriers to clinical integration of pharmacogenetic treatments that will need to be addressed to realize the benefits of individualized smoking-cessation treatment.
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Affiliation(s)
- R A Schnoll
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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DesRoches CM, Campbell EG, Vogeli C, Zheng J, Rao SR, Shields AE, Donelan K, Rosenbaum S, Bristol SJ, Jha AK. Electronic Health Records’ Limited Successes Suggest More Targeted Uses. Health Aff (Millwood) 2010; 29:639-46. [PMID: 20368593 DOI: 10.1377/hlthaff.2009.1086] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Catherine M. DesRoches
- Catherine M. DesRoches ( ) is an assistant professor at the Institute for Health Policy, Massachusetts General Hospital (MGH), in Boston
| | - Eric G. Campbell
- Eric G. Campbell is an associate professor at the Institute for Health Policy, MGH
| | - Christine Vogeli
- Christine Vogeli is a senior scientist at the Institute for Health Policy, MGH
| | - Jie Zheng
- Jie Zheng is a senior statistician at the Harvard School of Public Health in Boston, Massachusetts
| | - Sowmya R. Rao
- Sowmya R. Rao is a statistician at the Biostatistics Center, MGH
| | - Alexandra E. Shields
- Alexandra E. Shields is director of the Harvard/MGH Center for Genomics, Vulnerable Populations, and Health Disparities
| | - Karen Donelan
- Karen Donelan is a senior scientist at the Institute for Health Policy, MGH
| | - Sara Rosenbaum
- Sara Rosenbaum is the Harold and Jane Hirsh Professor and founding chair of the Department of Health Policy, School of Public Health and Health Services, George Washington University, in Washington, D.C
| | - Steffanie J. Bristol
- Steffanie J. Bristol is a project manager at the Department of Health Policy and Management, Harvard School of Public Health
| | - Ashish K. Jha
- Ashish K. Jha is an associate professor at the Harvard School of Public Health
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Schnoll RA, Patterson F, Wileyto EP, Heitjan DF, Shields AE, Asch DA, Lerman C. Effectiveness of extended-duration transdermal nicotine therapy: a randomized trial. Ann Intern Med 2010; 152:144-51. [PMID: 20124230 PMCID: PMC3782858 DOI: 10.7326/0003-4819-152-3-201002020-00005] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Tobacco dependence is a chronic, relapsing condition that may require extended treatment. OBJECTIVE To assess whether extended-duration transdermal nicotine therapy increases abstinence from tobacco more than standard-duration therapy in adult smokers. DESIGN Parallel randomized, placebo-controlled trial from September 2004 to February 2008. Participants and all research personnel except the database manager were blinded to randomization. (ClinicalTrials.gov registration number: NCT00364156) SETTING Academic center. PARTICIPANTS 568 adult smokers. INTERVENTION In an unstratified small block-randomization scheme, participants were randomly assigned to standard therapy (Nicoderm CQ [GlaxoSmithKline, Research Triangle Park, North Carolina], 21 mg, for 8 weeks and placebo for 16 weeks) or extended therapy (Nicoderm CQ, 21 mg, for 24 weeks). MEASUREMENTS The primary outcome was biochemically confirmed point-prevalence abstinence at weeks 24 and 52. Secondary outcomes were continuous and prolonged abstinence, lapse and recovery events, cost per additional quitter, and side effects and adherence. RESULTS At week 24, extended therapy produced higher rates of point-prevalence abstinence (31.6% vs. 20.3%; odds ratio, 1.81 [95% CI, 1.23 to 2.66]; P = 0.002), prolonged abstinence (41.5% vs. 26.9%; odds ratio, 1.97 [CI, 1.38 to 2.82]; P = 0.001), and continuous abstinence (19.2% vs. 12.6%; odds ratio, 1.64 [CI, 1.04 to 2.60]; P = 0.032) versus standard therapy. Extended therapy reduced the risk for lapse (hazard ratio, 0.77 [CI, 0.63 to 0.95]; P = 0.013) and increased the chances of recovery from lapses (hazard ratio, 1.47 [CI, 1.17 to 1.84]; P = 0.001). Time to relapse was slower with extended versus standard therapy (hazard ratio, 0.50 [CI, 0.35 to 0.73]; P < 0.001). At week 52, extended therapy produced higher quit rates for prolonged abstinence only (P = 0.027). No differences in side effects and adverse events between groups were found at the extended-treatment assessment. LIMITATION The generalizability of the findings may be limited because participants were smokers without medical comorbid conditions who were seeking treatment, and differences in adherence across treatment groups were detected. CONCLUSION Transdermal nicotine for 24 weeks increased biochemically confirmed point-prevalence abstinence and continuous abstinence at week 24, reduced the risk for smoking lapses, and increased the likelihood of recovery to abstinence after a lapse compared with 8 weeks of transdermal nicotine therapy. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Robert A Schnoll
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA 19104, USA
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Gibson TB, Lee TA, Vogeli CS, Hidalgo J, Carls GS, Sredl K, DesHarnais S, Marder WD, Weiss KB, Williams TV, Shields AE. A four-system comparison of patients with chronic illness: the Military Health System, Veterans Health Administration, Medicaid, and commercial plans. Mil Med 2009; 174:936-43. [PMID: 19780368 DOI: 10.7205/milmed-d-03-7808] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We compared chronic care utilization in four major health systems in the U.S.: the military health system (TRICARE), the Department of Veterans Affairs (VA), Medicaid, and employer-sponsored commercial plans. Prevalence rates and key performance indicators were constructed from administrative data in federal fiscal year 2003 for eight chronic conditions: hypertension, major depression, diabetes, tobacco dependence, ischemic heart disease, severe mental illness, persistent asthma, and stroke. Continuously enrolled beneficiaries under 65 years old were studied: TRICARE (N = 2,963,987), VA (N = 2,114,739), Medicaid enrollees in five states (N = 5,554,974), and commercial insurance (N = 5,212,833). Condition-specific adjusted prevalence rates and measures were compared using the standardized rate ratio. For the majority of the conditions, the estimated prevalence rates were highest in the VA and Medicaid populations. Prevalence rates were generally lower in TRICARE and commercial plans. Medicaid beneficiaries had the highest hospitalization rates in four of the six conditions where hospitalization rates were measured. These results provide empirical evidence of differences in chronically ill patient populations in several of the major U.S. health insurance systems.
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Affiliation(s)
- Teresa B Gibson
- Thomson Reuters, 777 E. Eisenhower Parkway, Ann Arbor, MI 48108, USA
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Jha AK, DesRoches CM, Shields AE, Miralles PD, Zheng J, Rosenbaum S, Campbell EG. Evidence of an emerging digital divide among hospitals that care for the poor. Health Aff (Millwood) 2009; 28:w1160-70. [PMID: 19858142 DOI: 10.1377/hlthaff.28.6.w1160] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Some hospitals that disproportionately care for poor patients are falling behind in adopting electronic health records (EHRs). Data from a national survey indicate early evidence of an emerging digital divide: U.S. hospitals that provide care to large numbers of poor patients also had minimal use of EHRs. These same hospitals lagged others in quality performance as well, but those with EHR systems seemed to have eliminated the quality gap. These findings suggest that adopting EHRs should be a major policy goal of health reform measures targeting hospitals that serve large populations of poor patients.
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Affiliation(s)
- Ashish K Jha
- Harvard School of Public Health in Boston, Massachusetts, USA.
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Shields AE, Levy DE, Blumenthal D, Currivan D, McGinn-Shapiro M, Weiss KB, Yucel R, Lerman C. Primary care physicians' willingness to offer a new genetic test to tailor smoking treatment, according to test characteristics. Nicotine Tob Res 2008; 10:1037-45. [PMID: 18584467 DOI: 10.1080/14622200802087580] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Emerging pharmacogenetics research may improve clinical outcomes for common complex conditions typically treated in primary care settings. Physicians' willingness to offer genetically-tailored treatments to their patients will be critical to realizing this potential. According to recent research, it is likely that genotypes used to tailor smoking will have pleiotropic associations with other addictions and diseases, and may have different frequencies across populations. These additional features may pose an additional barrier to adoption. To assess physicians' willingness to offer a new test to individually tailor smoking treatment according to specific test characteristics, we conducted a national mailed survey of 2,000 U.S. primary care physicians (response rate: 62.3%). Physicians responded to a baseline scenario describing a new test to tailor smoking treatment, and three additional scenarios describing specific test characteristics based on published research; there was random assignment to one of two survey conditions in which the test was described as a genetic or non-genetic test. Our findings indicate physicians' self-reported likelihood (0-100 scale) that they would offer a new test to tailor smoking cessation treatment ranged from 69%-78% across all scenarios. Relative to baseline scenario responses, physicians were significantly less likely to offer the test when informed that the same genotypes assessed for treatment tailoring: (1) may also identify individuals predisposed to become addicted to nicotine (p<.001), (2) differ in frequency by race (p<.004), and (3) may have associations with other conditions (e.g., alcohol and cocaine addiction, attention deficit hyperactivity disorder ADHD and Tourette Syndrome) (p<.01). Describing a new test to individually tailor smoking treatment as a "genetic" versus non-genetic test significantly reduced physicians' likelihood of offering the test across all scenarios, regardless of specific test characteristics (p<.0007). Effective education of primary care physicians will be critical to successful integration of promising new pharmacogenetic treatment strategies for smoking.
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Affiliation(s)
- Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations and Health Disparities, Institute for Health Policy, Boston, MA 02111, USA.
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Phillips JM, Siegel SJ, Shields AE, Patterson F, Gould TJ, Strasser AA, Ray R, Pinto A, Audrain-McGovern J, Rukstalis M, Perkins KA, Blendy JA, Lerman C. Translating basic science to improve pharmacotherapy for nicotine dependence. Nicotine Tob Res 2008; 9 Suppl 4:S583-98. [PMID: 18067034 DOI: 10.1080/14622200701691755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Nicotine dependence has a complex multifactorial etiology, underscoring the value of applying a transdisciplinary research model. The important goal of treating nicotine dependence can be realized by transdisciplinary research that translates discoveries in basic neuroscience, pharmacology, genetics, and behavioral science to develop new treatment models that can be translated readily into the clinic and community. As part of this special issue highlighting work at the Transdisciplinary Tobacco Use Research Centers (TTURCs), we describe transdisciplinary research at the University of Pennsylvania TTURC aimed at elucidating the neurobiological and genetic basis of nicotine dependence, the development of novel medications, and the translation of this research to practice.
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Shields AE, McGinn-Shapiro M, Fronstin P. Trends in Private Insurance, Medicaid/State Children's Health Insurance Program, and the Healthcare Safety Net. Ann N Y Acad Sci 2008; 1136:137-48. [DOI: 10.1196/annals.1425.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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DesRoches CM, Campbell EG, Rao SR, Donelan K, Ferris TG, Jha A, Kaushal R, Levy DE, Rosenbaum S, Shields AE, Blumenthal D. Electronic health records in ambulatory care--a national survey of physicians. N Engl J Med 2008; 359:50-60. [PMID: 18565855 DOI: 10.1056/nejmsa0802005] [Citation(s) in RCA: 579] [Impact Index Per Article: 36.2] [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] [Indexed: 11/19/2022]
Abstract
BACKGROUND Electronic health records have the potential to improve the delivery of health care services. However, in the United States, physicians have been slow to adopt such systems. This study assessed physicians' adoption of outpatient electronic health records, their satisfaction with such systems, the perceived effect of the systems on the quality of care, and the perceived barriers to adoption. METHODS In late 2007 and early 2008, we conducted a national survey of 2758 physicians, which represented a response rate of 62%. Using a definition for electronic health records that was based on expert consensus, we determined the proportion of physicians who were using such records in an office setting and the relationship between adoption and the characteristics of individual physicians and their practices. RESULTS Four percent of physicians reported having an extensive, fully functional electronic-records system, and 13% reported having a basic system. In multivariate analyses, primary care physicians and those practicing in large groups, in hospitals or medical centers, and in the western region of the United States were more likely to use electronic health records. Physicians reported positive effects of these systems on several dimensions of quality of care and high levels of satisfaction. Financial barriers were viewed as having the greatest effect on decisions about the adoption of electronic health records. CONCLUSIONS Physicians who use electronic health records believe such systems improve the quality of care and are generally satisfied with the systems. However, as of early 2008, electronic systems had been adopted by only a small minority of U.S. physicians, who may differ from later adopters of these systems.
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