1
|
Morgan E, Dyar C, Feinstein BA, Rose K. Sexual and Gender Minority Differences in Likelihood of Being a Caregiver and Levels of Caregiver Strain in a Sample of Older Adults. JOURNAL OF HOMOSEXUALITY 2024; 71:2287-2299. [PMID: 37459596 PMCID: PMC10792100 DOI: 10.1080/00918369.2023.2233656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Over the next two decades, the number of caregivers is expected to climb dramatically alongside a rise in older adults, particularly sexual and gender minority (SGM) older adults, yet little research has assessed differences between SGM and non-SGM care partners. Data for these analyses come from the Columbus Healthy Aging Project (N = 79). This study was designed to assess several domains of health among adults aged ≥50 years in Columbus, Ohio, US. Multivariable regression models were used to examine the likelihood of being a care partner, the SGM identity of the primary care recipient, and caregiver strain. In our sample, 227 (28.6%) participants self-identified as care partners for at least one individual. Compared to heterosexuals, gay/lesbian (aOR = 8.38; 95% CI: 5.29, 13.29) participants were more likely to be care partners but did not experience elevated caregiver strain. Bisexual individuals (aIRR = 1.70, 95% CI: 1.11, 2.61) reported greater caregiver strain, while those identifying as a different sexual identity reported lower caregiver strain (aIRR = 0.46, 95% CI: 0.23, 0.96). In turn, caregiver strain was reduced significantly when the care recipient identified as a member of the SGM community (aIRR = 0.67: 95% CI: 0.55, 0.80). These results suggest that SGM care partners may be at risk of unique stressors which may contribute to extant health disparities.
Collapse
Affiliation(s)
- Ethan Morgan
- Colleges of Nursing, The Ohio State University, Columbus, OH
- Infectious Disease Institute and College of Public Health, The Ohio State University, Columbus, OH
| | - Christina Dyar
- Colleges of Nursing, The Ohio State University, Columbus, OH
| | - Brian A. Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Karen Rose
- Colleges of Nursing, The Ohio State University, Columbus, OH
| |
Collapse
|
2
|
Okafor CN, Somasunderam A, Lake JE, Gelfond J, Javanbakht M, Gorbach P, Shoptaw S, Schmitz J. Cannabis Use and Biomarkers of Inflammation, Immune Activation, and Microbial Translocation in Persons with HIV. Cannabis Cannabinoid Res 2024. [PMID: 38335314 DOI: 10.1089/can.2023.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Abstract
Background: The relationship between cannabis and inflammation among persons with HIV (PWH) remains unclear. We examined whether the cannabis metabolite 11-nor-9-carboxy THC (THC-COOH) is associated with lower levels of plasma biomarkers of inflammation, immune activation, and microbial translocation in PWH. We hypothesized that cannabis use would be associated with lower levels of plasma inflammatory biomarkers than noncannabis use. Methods: We quantified THC-COOH in plasma, with THC-COOH levels between 5.1-69.9 μg/L and ≥70 μg/L being classified as moderate and heavy cannabis use, respectively, with noncannabis use defined as undetected THC-COOH. We measured a panel of plasma biomarkers of inflammation (interleukin [IL]-1-β, tumor necrosis factor-alpha, IL-18, IL-6, and C-reactive protein), immune activation (CD14 and CD163), and microbial translocation (iFABP2 and lipopolysaccharide binding protein [LBP]), with all biomarkers collected on the same day. We used a cross-sectional design and linear regression models to test whether cannabis use is associated with lower biomarker levels. Results: Participants were (N=107) sexual minority men with HIV (median age=32 years, IQR=28, 38), of whom 65% were virally suppressed; 36%, 44%, and 20% were classified as nonuse, moderate, and heavy cannabis, respectively. In linear regression models adjusted for viral suppression, stimulant use, and CD4 counts, heavy cannabis use was significantly associated with lower levels of log10 LBP (β=-0.14, 95% confidence interval: -0.24 to -0.04; false discovery rate=0.0029; partial eta squared=0.07) than noncannabis users. No precise associations were observed for other biomarkers (all p>0.05). Conclusions: Our findings suggest that cannabis use may be associated with lower plasma LBP. Further work is needed to clarify the relationship between cannabis use and biomarkers of microbial translocation in PWH.
Collapse
Affiliation(s)
- Chukwuemeka N Okafor
- Division of Infectious Diseases, Department of Medicine, Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Anoma Somasunderam
- Division of Infectious Disease, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jordan E Lake
- Division of Infectious Disease, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jonathan Gelfond
- Department of Population Health Sciences, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Pamina Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Steven Shoptaw
- Department of Family Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Joy Schmitz
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| |
Collapse
|
3
|
Morgan E, Dyar C, Feinstein B, Hudson H, D’Aquila R, McDade TW, Mustanski B. Inflammation Assessed by Latent Profiling is Associated with Stress and Suicidality but not Depression: Findings from the RADAR Cohort Study. ANNALS OF LGBTQ PUBLIC AND POPULATION HEALTH 2023; 4:1-13. [PMID: 37599862 PMCID: PMC10437120 DOI: 10.1891/lgbtq-2021-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Past research has suggested that sexual and gender minorities experience elevated levels of systemic inflammation which in turn has been linked to worse mental health outcomes. Therefore, the goals of this work are to develop a better understanding of the relationship between mental health variables and inflammation among this high-risk population. Data were collected among a sample of young men who have sex with men and transgender women (YMSM/TGW, N=685) aged 16-20 at the time of enrollment. Multiplex plasma cytokine and inflammatory biomarkers were quantified. Mental health variables were self-reported and included perceived stress, depression, and suicidal ideation. Latent profile analyses (i.e., latent class analyses intended for continuous variables) were utilized to identify four unique profiles of individuals with similar inflammatory markers followed by adjusted multinomial logistic regression to estimate the association between inflammatory profiles and mental health variables. Participants experienced moderate levels of perceived stress, normal levels of depression and ten percent reported suicidal ideation in the past six months. Multinomial regression models indicated that being in the highest inflammation profile, compared to the lowest inflammation profile, was significantly associated only with increased perceived stress and suicidal ideation. In sum, we observed significant relationships between inflammation and both perceived stress and suicidal ideation, but not between inflammation and depression. Future research should continue to assess these relationships using longitudinal data as they are intricate and likely bidirectional and may be key to reducing health disparities among this population.
Collapse
Affiliation(s)
- Ethan Morgan
- College of Nursing, Infectious Disease Institute, The Ohio State University, Columbus, OH
| | - Christina Dyar
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Brian Feinstein
- Department of Psychology, Rosalind Franklin University, North Chicago, IL
| | - Hannah Hudson
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Richard D’Aquila
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Thomas W. McDade
- Department of Anthropology and Institute for Policy Research, Northwestern University, Evanston, IL
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| |
Collapse
|
4
|
Discrimination is associated with C-reactive protein among young sexual minority men. J Behav Med 2022; 45:649-657. [PMID: 35394239 DOI: 10.1007/s10865-022-00307-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/07/2022] [Indexed: 12/25/2022]
Abstract
This report examines associations between everyday discrimination, microaggressions, and CRP to gain insight on potential mechanisms that may underlie increased CVD risk among sexual minority male young adults. The sample consisted of 60 participants taken from the P18 cohort between the ages of 24 and 28 years. Multinomial logistic regression models were used to examine the association between perceived everyday discrimination and LGBQ microaggressions with C-reactive protein cardiovascular risk categories of low-, average-, and high-risk, as defined by the American Heart Association and Centers for Disease Control. Adjustments were made for BMI. Individuals who experienced more everyday discrimination had a higher risk of being classified in the high-risk CRP group compared to the low-risk CRP group (RRR = 3.35, p = 0.02). Interpersonal LGBQ microaggressions were not associated with CRP risk category. Everyday discrimination, but not specific microaggressions based on sexual orientation, were associated with elevated levels of CRP among young sexual minority men (YSMM). Thus, to implement culturally and age-appropriate interventions, further researcher is needed to critically examine the specific types of discrimination and the resultant impact on YSMM's health.
Collapse
|
5
|
Schrock JM, McDade TW, D'Aquila RT, Mustanski B. Does body mass index explain the apparent anti-inflammatory effects of cannabis use? Results From a cohort study of sexual and gender minority youth. Drug Alcohol Depend 2022; 233:109344. [PMID: 35182843 PMCID: PMC8988174 DOI: 10.1016/j.drugalcdep.2022.109344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cannabis use has been linked to lower systemic inflammation, but the pathways connecting cannabis use and systemic inflammation are unclear. Here we investigate whether body mass index (BMI) accounts for the association between cannabis use and systemic inflammation in a cohort of sexual and gender minority youth assigned male at birth (n = 712). METHODS Substance use was assessed across six biannual visits. Cannabis use was measured using the Cannabis Use Disorders Identification Test-Revised (CUDIT-R) and urine screening for tetrahydrocannabinol (THC). At the final visit, BMI was measured, and a plasma sample was collected to measure biomarkers of systemic inflammation: C-reactive protein (CRP), interleukin-6, interleukin-1β, and tumor necrosis factor-α. Inflammatory markers were log2-transformed. Age, gender, race/ethnicity, education, HIV status, cigarette use, alcohol use, and polydrug use were included as covariates. RESULTS In models including all covariates except BMI, greater cumulative CUDIT-R score was associated with lower CRP (β = -0.14; 95% CI: -0.22,-0.05) and lower interleukin-6 (β = -0.12; 95% CI: -0.21,-0.04). These associations were attenuated when BMI was added to the model. Mediation analyses revealed an indirect effect of cumulative CUDIT-R score on CRP (β = -0.08; 95% CI: -0.12,-0.05) and interleukin-6 (β = -0.08; 95% CI: -0.12,-0.05), mediated by BMI. Models using urine THC or self-reported frequency to operationalize cannabis use produced similar results. We found no clear evidence that HIV status moderates these associations. CONCLUSIONS These results suggest that BMI may partially account for the apparent anti-inflammatory effects of cannabis use. Research on the mechanisms linking cannabis use, adiposity, and inflammation may uncover promising intervention targets.
Collapse
Affiliation(s)
- Joshua M Schrock
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Suite 14, Chicago, IL 60611, USA; Department of Anthropology, Northwestern University, 1810 Hinman Avenue, Evanston, IL 60208, USA.
| | - Thomas W McDade
- Department of Anthropology, Northwestern University, 1810 Hinman Avenue, Evanston, IL 60208, USA; Institute for Policy Research, Northwestern University, 2040 Sheridan Road, Evanston, IL 60208, USA.
| | - Richard T D'Aquila
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Arkes Suite 2330, Chicago, IL 60611, USA.
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Suite 14, Chicago, IL 60611, USA; Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, 21st Floor, Chicago, IL 60611, USA.
| |
Collapse
|
6
|
Sexual minorities are at elevated risk of cardiovascular disease from a younger age than heterosexuals. J Behav Med 2022; 45:571-579. [PMID: 35034218 PMCID: PMC9287494 DOI: 10.1007/s10865-021-00269-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/29/2021] [Indexed: 12/22/2022]
Abstract
Cardiovascular disease is the leading cause of death worldwide. In this study, we assessed factors related to cardiovascular disease risk and outcomes among sexual minorities (SM). Data from multiple waves of the PATH study were used in this analysis. Multivariable regression models were used to assess the association between sexual identity and: tobacco or e-cigarette use, adverse cardiovascular events, and age at first diagnosis of adverse cardiovascular disease events. In our sample (N = 23,205), 1,660 (7.15%) participants identified as SM. SM men, relative to heterosexual men, are more likely to be diagnosed with high blood pressure (aRR = 1.27; 95% CI 1.10, 1.47), high cholesterol (aRR = 1.32; 95% CI: 1.12, 1.55), congestive heart failure (aRR = 2.29; 95% CI 1.13, 4.65), stroke (aRR = 2.39; 95% CI: 1.14, 5.04), heart attack (aRR = 2.40; 95% CI 1.42, 4.04), and other heart conditions (aRR = 1.52; 95% CI: 1.06, 2.18). Although no simple differences were observed among SM women compared to heterosexual women, SM women were more likely to be diagnosed at a younger age for high blood pressure (aRR = -0.69; 95% CI - 1.08, - 0.29), high cholesterol (aRR = -0.77; 95% CI - 1.15, - 0.38), stroke (aRR = - 1.04; 95% CI - 1.94, - 0.13), and heart attack (aRR = - 1.26; 95% CI - 2.42, - 0.10). SM men were only diagnosed at a younger age for stroke (aRR = - 1.18; 95% CI - 2.06, - 0.30). Compared to heterosexuals, sexual minorities are at higher risk for cardiovascular disease, more likely to develop cardiovascular disease at an earlier age, and more likely to use tobacco products. Future research should focus on decreasing cardiovascular risk among sexual minorities including reducing tobacco use and stress. Screening recommendations for sexual minority populations should also be reviewed in light of a growing body of literature suggesting elevated risk from a young age.
Collapse
|
7
|
Tomer S, Mu W, Suryawanshi G, Ng H, Wang L, Wennerberg W, Rezek V, Martin H, Chen I, Kitchen S, Zhen A. Cannabidiol modulates expression of type I IFN response genes and HIV infection in macrophages. Front Immunol 2022; 13:926696. [PMID: 36248834 PMCID: PMC9560767 DOI: 10.3389/fimmu.2022.926696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/15/2022] [Indexed: 01/27/2023] Open
Abstract
Cannabis (Cannabis sativa) is a widely used drug in the United States and the frequency of cannabis use is particularly high among people living with HIV (PLWH). One key component of cannabis, the non-psychotropic (-)-cannabidiol (CBD) exerts a wide variety of biological actions, including anticonvulsive, analgesic, and anti-inflammatory effects. However, the exact mechanism of action through which CBD affects the immune cell signaling remains poorly understood. Here we report that CBD modulates type I interferon responses in human macrophages. Transcriptomics analysis shows that CBD treatment significantly attenuates cGAS-STING-mediated activation of type I Interferon response genes (ISGs) in monocytic THP-1 cells. We further showed that CBD treatment effectively attenuates 2'3-cGAMP stimulation of ISGs in both THP-1 cells and primary human macrophages. Interestingly, CBD significantly upregulates expression of autophagy receptor p62/SQSTM1. p62 is critical for autophagy-mediated degradation of stimulated STING. We observed that CBD treated THP-1 cells have elevated autophagy activity. Upon 2'3'-cGAMP stimulation, CBD treated cells have rapid downregulation of phosphorylated-STING, leading to attenuated expression of ISGs. The CBD attenuation of ISGs is reduced in autophagy deficient THP-1 cells, suggesting that the effects of CBD on ISGs is partially mediated by autophagy induction. Lastly, CBD decreases ISGs expression upon HIV infection in THP-1 cells and human primary macrophages, leading to increased HIV RNA expression 24 hours after infection. However, long term culture with CBD in infected primary macrophages reduced HIV viral spread, suggesting potential dichotomous roles of CBD in HIV replication. Our study highlights the immune modulatory effects of CBD and the needs for additional studies on its effect on viral infection and inflammation.
Collapse
Affiliation(s)
- Shallu Tomer
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
- UCLA AIDS Institute and the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Wenli Mu
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
- UCLA AIDS Institute and the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Gajendra Suryawanshi
- UCLA AIDS Institute and the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
- Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Hwee Ng
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
- UCLA AIDS Institute and the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Li Wang
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
- UCLA AIDS Institute and the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Wally Wennerberg
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
- UCLA AIDS Institute and the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Valerie Rezek
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
- UCLA AIDS Institute and the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Heather Martin
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
- UCLA AIDS Institute and the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Irvin Chen
- UCLA AIDS Institute and the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
- Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Scott Kitchen
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
- UCLA AIDS Institute and the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Anjie Zhen
- Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
- UCLA AIDS Institute and the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
- *Correspondence: Anjie Zhen,
| |
Collapse
|