Race Differences in Personality and Affect Between Older White and Black Patients: an Exploratory Study

Genetic Testing and Other Healthcare Use by Black and White Individuals in a Genomic Sequencing Study

INTRODUCTION

Early adopters play a critical role in the diffusion of medical innovations by spreading awareness, increasing acceptability, and driving demand. Understanding the role of race in the context of other characteristics of potential early adopters can shed light on disparities seen in the early implementation of genomic medicine. We aimed to understand the association between self-identified race and individual experience with genetic testing outside of the research context.

METHODS

We assessed factors associated with the odds of having ever received genetic testing prior to enrollment in a genomic sequencing study among 674 self-identified white and 407 self-identified African, African American, or Afro-Caribbean ("Black") individuals.

RESULTS

Controlling for individual determinants of healthcare use (demographics, personality traits, knowledge and attitudes, and health status), identifying as Black was associated with lower odds of prior genetic testing (OR = 0.43, 95% CI [0.27-0.68], p < 0.001). In contrast, self-identified race was not associated with the use of non-genetic clinical screening tests (e.g., echocardiogram, colonoscopy). Black and white individuals were similar on self-reported personality traits tied to early adoption but differed by sociodemographic and resource facilitators of early adoption.

CONCLUSION

Persistent racial disparities among early adopters may represent especially-entrenched disparities in access to and knowledge of genomic technologies in clinical settings.

Racial Disparities in Care Interactions and Clinical Outcomes in Black Versus White Nursing Home Residents With Dementia

BACKGROUND

With the increase in Black nursing home residents, racial and ethnic disparities in quality of care have been raised.

PURPOSE

The purpose of this study was to evaluate racial disparities in care and outcomes over 12 months.

METHODS

This was a secondary data analysis using data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia study. A total of 553 residents, 24% Black residents and 76% White residents, from 55 nursing homes were included.

RESULTS

Differences favoring Black resident were noted in agitation, quality of life, inclusion of person-centered care approaches in care plans, and fewer falls and hospitalizations. Differences in quality-of-care interactions favored White residents. There were no differences in depression, resistiveness to care, function, pain, or transfers to the emergency department.

CONCLUSIONS

Disparities in clinical outcomes were small and generally favored Black versus White residents except for quality-of-care interactions.

Exploring the Association Between Affect and Leisure Activity Engagement in Black Adults

OBJECTIVES

This study examined engagement levels across various domains of leisure activities in community-dwelling Black adults (age range = 50-80 years) and variability in daily leisure activity engagement and positive affect (PA; positive emotions or mood) and negative affect (NA; negative emotions or mood). Additionally, we explored whether PA and NA were associated with leisure activity engagement and whether these associations varied by sociodemographics.

METHODS

Fifty adults (78% women; mean education = 11.62 years, standard deviation = 2.4) reported affect and leisure activity engagement over 8 occasions (2-3 weeks).

RESULTS

Participants averaged 3 leisure activities/day with more engagement in watching television (news), walking, reading, and visiting others. Multilevel models identified significant within-person variation across domains of leisure activity engagement. A significant main effect was observed between daily NA and reduced social activity engagement. A significant interaction between NA and education was further illustrated on those occasions when NA was higher than usual, social and total leisure activity engagement tended to be lower, particularly for adults with ≤10 years of education. A significant interaction between NA and education was observed for entertainment activities. However, results indicated adults with ≥14 years of education, and a mean NA above the sample average, tended to engage in more entertainment activities. Finally, a significant interaction between PA and age was observed indicating adults aged ≥73 had a greater social engagement, particularly when daily PA was heightened.

DISCUSSION

Results demonstrate within-person changes in the types of leisure engagement among Black adults. Potential factors related to these changes may result from interconnections between affect and demographic factors (age and education).

Racial Differences in Associations of Cognitive Health Status With Happiness, Helplessness, and Hopelessness Among Older Adults: An Exploratory Study

Background

The relationship between healthy and positive aging and dementia and cognitive impairment has received limited attention in the field of aging. Affect impacts cognitive changes and processes, and cognitive impairment is associated with affective comorbidities. The purpose of the study was to examine (a) whether happiness, helplessness, and hopelessness are linked to cognitive health status, and (b) whether these associations differ by race.

Methods

Participants were enrollees in the Wisconsin Alzheimer's Disease Research Center's Clinical Core (ADRC). Average age at baseline was 60.85 (SD = 8.65), 73.70 (SD = 8.02), and 73.80 (SD = 9.59) years for cognitively normal individuals, individuals with MCI, and individuals with dementia, respectively.

Results

In the full sample, chi-square test results revealed associations between Cognitive Health Status (CHS) and (a) happiness, χ2(2) = 6.06, p < 0.05, (b) helplessness, χ2(2) = 6.44, p < 0.05, and (c) hopelessness, χ2(2) = 14.11, p < 0.01.

Conclusion

This study provides support for the association of both positive and negative affect with cognitive health status in middle- to older-aged adults.

Trait neuroticism does not relate to cardiovascular reactivity or habituation to repeated acute psychosocial stress

Neuroticism has been associated with adverse cardiovascular health. Adverse cardiovascular health outcomes have also been linked to cardiovascular reactivity and cardiovascular reactivity habituation to acute psychosocial stress. As such, cardiovascular stress reactivity and habituation may be a factor in the association between neuroticism and disease risk. However, studies of the relationship between neuroticism and cardiovascular reactivity have produced mixed results. Moreover, the relationships between neuroticism, cardiovascular reactivity habituation, and general affect across a repeated stress paradigm have not been examined. The present study aimed to assess the relationships between neuroticism, positive and negative affect, and cardiovascular reactivity and habituation to acute psychosocial stress in a large, demographically diverse sample. Participants (N = 426) completed two 4-min mental arithmetic stressors, each with a separate baseline, in a single laboratory session while having discrete blood pressure and heart rate measurements taken. State positive and negative affect were measured immediately following informed consent, after receiving task instructions, and after each stress task. Trait neuroticism was measured using the Big Five Inventory. Each stress task elicited significant cardiovascular changes. Trait neuroticism was not significantly associated with cardiovascular reactivity or cardiovascular reactivity habituation, within or across stress tasks (all p's > 0.12). Across the entire study protocol, neuroticism was significantly related to lower positive affect and higher negative affect (both p's < 0.001). Trait neuroticism did not relate to stress-related cardiovascular adjustments but might confer a predisposition toward high negative affect.

Race/Ethnicity Moderates the Association Between Psychosocial Resilience and Movement-Evoked Pain in Knee Osteoarthritis

Objective

Racial/ethnic disparities in pain are well‐recognized, with non‐Hispanic blacks (NHBs) experiencing greater pain severity and pain‐related disability than non‐Hispanic whites (NHWs). Although numerous risk factors are posited as contributors to these disparities, there is limited research addressing how resilience differentially influences pain and functioning across race/ethnicity. Therefore, this study examined associations between measures of psychosocial resilience, clinical pain, and functional performance among adults with knee osteoarthritis (OA), and assessed the moderating role of race/ethnicity on these relationships.

Methods

In a secondary analysis of the Understanding Pain and Limitations in Osteoarthritic Disease (UPLOAD‐2) study, 201 individuals with knee OA (NHB = 105, NHW = 96) completed measures of resilience (ie, trait resilience, optimism, positive well‐being, social support, positive affect) and clinical pain, as well as a performance‐based measure assessing lower‐extremity function and movement‐evoked pain.

Results

Bivariate analyses showed that higher levels of psychosocial resilience were associated with lower clinical pain and disability and more optimal physical functioning. NHBs reported greater pain and disability, poorer lower‐extremity function, and higher movement‐evoked pain compared with NHWs; however, measures of psychosocial resilience were similar across race/ethnicity. In moderation analyses, higher optimism and positive well‐being were protective against movement‐evoked pain in NHBs, whereas higher levels of positive affect were associated with greater movement‐evoked pain in NHWs.

Conclusion

Our findings underscore the importance of psychosocial resilience on OA‐related pain and function and highlight the influence of race/ethnicity on the resilience‐pain relationship. Treatments aimed at targeting resilience may help mitigate racial/ethnic disparities in pain.

Depressive Symptoms Increase the Risk of Mortality for White but Not Black Older Adults

Introduction. Long-term studies have shown that depressive symptoms predict the risk of mortality. However, it is unknown if this effect is present in shorter time intervals. In addition, recent research suggests that the salience of the negative affect on the risk of mortality is not similar across racial groups. The current study uses data from a national study of Black and White older adults to examine racial differences in the effect of baseline depressive symptoms on mortality risk over three years in the United States. Methods. This study used a longitudinal prospective design and followed 1493 older adults who were either White (n = 759) or Black (n = 734) for three years from 2001 to 2004. Depressive symptoms measured at baseline was the independent variable. Demographic factors, socio-economic characteristics (education, income, marital status), health behaviors (smoking and drinking), and health (self-rated health) measured at baseline in 2001 were covariates. The dependent variable was all-cause mortality between 2001 and 2004. Race was the moderator. Logistic regressions were used for data analysis. Results. In the pooled sample, high depressive symptoms at baseline were not associated with the three-year risk of mortality. In the pooled sample, we found a significant interaction between race and depressive symptoms on mortality, suggesting a stronger effect for Whites in comparison to Blacks. In race stratified models, depressive symptoms at baseline were predictive of mortality risk for Whites, but not Blacks. Conclusions. In the United States, Black-White differences exist in the effects of depressive symptoms on mortality risk in older adults. White older adults may be more vulnerable to the effects of depressive symptoms on mortality risk.