When Is Hope Enough? Hopefulness, Discrimination and Racial/Ethnic Disparities in Allostatic Load

The biology of hope: Inflammatory and neuroendocrine profiles in ovarian cancer patients

INTRODUCTION

Although the concept of hope is highly relevant for cancer patients, little is known about its association with cancer-relevant biomarkers. Here we examined how hope was related to diurnal cortisol and interleukin-6 (IL-6), a pro-inflammatory cytokine previously associated with tumor biology and survival in ovarian cancer. Secondly, we examined whether hope and hopelessness are distinctly associated with these biomarkers.

METHOD

Participants were 292 high-grade ovarian cancer patients who completed surveys and provided saliva samples 4x/daily for 3 days pre-surgery to assess diurnal cortisol. Blood (pre-surgery) and ascites were assessed for IL-6. Hope and hopelessness were assessed using standardized survey items from established scales (Center for Epidemiological Studies Depression Scale; Profile of Mood States, Functional Assessment of Cancer Therapy). Two hopeless items were z-scored and combined into a composite for analysis. Regression models related these variables to nocturnal cortisol, cortisol slope, plasma and ascites IL-6, adjusting for cancer stage, BMI, age, and depression.

RESULTS

Greater hope was significantly related to a steeper cortisol slope, β = -0.193, p = 0.046, and lower night cortisol, β = -0.227, p = 0.018, plasma IL-6, β = -0.142, p = 0.033, and ascites IL-6, β = -0.290, p = 0.002. Secondary analyses including both hope and hopelessness showed similar patterns, with distinct relationships of hope with significantly lower nocturnal cortisol β = -0.233,p = 0.017 and ascites IL-6, β = -0.282,p = 0.003, and between hopelessness and a flatter cortisol slope, β = 0.211, p = 0.031.

CONCLUSIONS

These data suggest a biological signature of hope associated with less inflammation and more normalized diurnal cortisol in ovarian cancer. These findings have potential clinical utility but need replication with more diverse samples and validated assessments of hope.

The Implications of Racialized Economic Segregation and Allostatic Load on Mortality in Patients with Breast Cancer

BACKGROUND

The objective of this study was to examine the association between racialized economic segregation, allostatic load (AL), and all-cause mortality in patients with breast cancer.

PATIENTS AND METHODS

Women aged 18+ years with stage I-III breast cancer diagnosed between 01/01/2012 and 31/12/2020 were identified in the Ohio State University cancer registry. Racialized economic segregation was measured at the census tract level using the index of concentration at the extremes (ICE). AL was calculated with biomarkers from the cardiac, metabolic, immune, and renal systems. High AL was defined as AL greater than the median. Univariable and multivariable regression analyses using restricted cubic splines examined the association between racialized economic segregation, AL, and all-cause mortality.

RESULTS

Among 4296 patients, patients residing in neighborhoods with the highest racialized economic segregation (Q1 versus Q4) were more likely to be Black (25% versus 2.1%, p < 0.001) and have triple-negative breast cancer (18.2% versus 11.6%, p < 0.001). High versus low racialized economic segregation was associated with high AL [adjusted odds ratio (aOR) 1.40, 95% confidence interval (CI) 1.21-1.61] and worse all-cause mortality [adjusted hazard ratio (aHR) 1.41, 95% CI 1.08-1.83]. In dose-response analyses, patients in lower segregated neighborhoods (relative to the 95th percentile) had lower odds of high AL, whereas patients in more segregated neighborhoods had a non-linear increase in the odds of high AL.

DISCUSSION

Racialized economic segregation is associated with high AL and a greater risk of all-cause mortality in patients with breast cancer. Additional studies are needed to elucidate the causal pathways and mechanisms linking AL, neighborhood factors, and patient outcomes.

Promoting hope in minoritized and economically disadvantaged students

Minoritized and economically disadvantaged (MED) students encounter a host of detrimental factors within the academic setting (e.g., racism, classism, low expectations). In order for them to be successful, ways must be found to help them achieve academically despite their disadvantageous academic environments. Recent research indicates that hope theory might provide a pathway for MED students to have a higher chance at success. In this review, how hope has the potential to take on a special significance for MED students as well as how it can be leveraged to increase their odd of academic and life success is discussed. In addition, recent research centered around promoting hope in MED students, both formally and informally, is reviewed. Altogether, this review has implications for cultivating hope in schools.

Hope and physical health

This article provides a brief overview of the recent research focusing on hope and physical health. The reviewed research is limited to research primarily on hope as conceptualized by Snyder and colleagues [33] and to those studies in which the researchers measured hope using scales based on Hope Theory proposed by Snyder and colleagues. Studies on hope and health behaviors, as well as specific health outcomes such as pain, cancer, and chronic illness are included. Overall findings indicate that hope is plays an important role in health.

The Mediating Role of Sleep Disturbance on the Association Between Stress and Self-Rated Health Among Chinese and Korean Immigrant Americans

INTRODUCTION

Disturbed sleep may be a factor that links stress with poor health, especially among groups experiencing high levels of stress caused by racial and ethnic minority and nativity status. The objective of this study was to describe the potential mediating role of sleep disturbance in the associations between various types of stress and self-rated health among Chinese and Korean Americans.

METHODS

Our cross-sectional study consisted of 400 Chinese and Korean immigrants aged 50 to 75 years recruited from August 2018 through June 2020 from physicians' clinics in the Baltimore-Washington, DC, metropolitan area. We used the Patient Reported Outcomes Measurement Information System (PROMIS) short-form questionnaire to measure sleep disturbance. Linear regression analyses examined associations between 3 types of stress (acculturative stress, perceived stress, and distress) and self-rated health, accounting for demographic, socioeconomic, and health insurance factors. The Karlson-Holm-Breen method was used to estimate the total and direct effects of stresses on self-rated health and the indirect effects of stresses on health through sleep disturbance.

RESULTS

Greater acculturative stress (β = 0.08; 95% CI, 0.01-0.14), perceived stress (β = 0.05; 95% CI, 0.03-0.08), and distress (β = 0.09; 95% CI, 0.05-0.13) were all associated with poorer self-rated health. Sleep disturbance was a partial mediator, with sleep disturbance accounting for 21.7%, 14.9%, and 18.7% of the associations between acculturative stress, perceived stress, and distress and self-rated health, respectively.

CONCLUSION

Because sleep disturbance partially mediates the associations between stress and poor self-rated health, future interventions and research may consider mitigating sleep disturbances and stress among racial and ethnic minority populations to address health disparities.

Education in the Jim Crow South and Black-White inequities in allostatic load among older adults

In the U.S., Black adults consistently have higher allostatic load – an indicator of physiological dysregulation – than White adults. Education is considered a likely mechanism given racial differences in attainment, but evidence is mixed. This may be due, in part, to data limitations that have made it difficult for scholars to account for the structurally rooted systemic racism that shaped the U.S. education system and led to large racial inequities in school term length and school attendance among older adults who grew up in the Jim Crow South. Our study addresses this limitation by linking historical data on Black and White segregated school systems in the U.S. South from 1919 to 1954 to the Health and Retirement Study (HRS) to determine if a new measure of educational attainment that accounts for structural racism that led to differences in the number of school days attended by Black and White students across years and states better explains Black-White inequities in allostatic load among older adults who attended school during Jim Crow. We restrict our sample to HRS respondents racialized as White or Black, who resided in the South when they were school-aged, completed primary/secondary school between 1919 and 1954, and provided a measure of allostatic load (n = 1932). We find that our new measure of schooling – duration in school – reduced the Black-White inequity in allostatic load more so than self-reported years of schooling whether we measured allostatic load continuously (34% vs 16%) or categorically (45% vs 20%). Our findings highlight the importance of identifying and using historically informed measures of schooling that account for structurally rooted systemic racism when trying to understand how education shapes the health of individuals racialized as Black in the United States.

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U.S. Black adults show greater physiological dysregulation than White adults.

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Mixed evidence as to whether education explains this inequity.

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May be due to unmeasured structurally rooted systematic racism in early schooling.

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Our education measure accounts for race inequity in term length and days attended.

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This measure explains Black-White inequity in allostatic load.

Positive affect decreases the negative association between social mobility belief and physical health among Chinese rural-to-urban migrant adolescents

OBJECTIVE

The belief in upward social mobility promotes the mental health and social adaptation of disadvantaged adolescents. However, efforts for upward mobility may facilitate psychosocial adaptation while undermining physical health for minority youth from disadvantaged backgrounds. Therefore, we aimed to examine how social mobility belief is associated with mental and physical health among Chinese rural-to-urban migrant adolescents and explore whether positive affect acts as a protective factor moderating these relationships.

METHOD

A total of 158 rural-to-urban migrant adolescents aged 10-14 completed a self-report questionnaire and underwent medical examination.

RESULTS

Social mobility belief and positive affect were positively related to mental health (general self-efficacy). Positive affect interacted with social mobility belief in predicting physical health (self-rated health and allostatic load). For migrant adolescents with low levels of positive affect, strong belief in social mobility was associated with poor self-rated health and high allostatic load. For migrant adolescents with high levels of positive affect, their physical health was better and not associated with social mobility belief.

CONCLUSIONS

Social mobility belief showed a double-edged sword effect; it was positively associated with mental adaptation while negatively associated with physical health among Chinese rural-to-urban migrant adolescents. Positive affect acted as a protective factor for decreasing the negative association between social mobility belief and physical health.

Hope, Purpose, and Religiosity: The Impact of Psychosocial Resources on Trajectories of Depressive Symptoms Among Middle-Aged and Older Blacks

Objective: We assessed the effects of hope, purpose in life, and religiosity on trajectories of depressive symptoms among middle-aged and older Blacks, with a focus on age differences in these associations. Methods: Data come from 1906 respondents from the 2006-2016 Health and Retirement Study. Linear mixed models were estimated and included interactions between age and time and between age and each psychosocial resource. Results: Depressive symptoms decreased for Blacks ages 51-64, did not change for those 65-74, and increased among Blacks age 75+. Hope and purpose in life were inversely associated with symptom levels but were not associated with change over time in symptomology. Associations were stronger among the youngest age group and weakest among the oldest. Religiosity was unrelated to depressive symptoms. Discussion: Psychosocial resources protect against depressive symptoms in age-dependent ways among middle-aged and older Blacks. Differences in these effects may be related to aging, cohort, and selection effects.

Disparities in allostatic load, telomere length and chronic stress burden among African American adults: A systematic review

BACKGROUND

The chronic disease burden among African Americans has continued to rise. Although racial disparities in chronic disease risk are well documented, the role of chronic stress in risk disparities among racial and ethnic minorities is not well understood. This systematic review of studies reporting on the relationship between chronic stress, education, and/or income, and biomarkers of chronic stress (allostatic load and telomere length) longitudinally among African Americans, seeks to contribute to this knowledge gap.

OBJECTIVE

To use the existing literature to both examine the strength of two objective biomarkers--telomere length and allostatic load--as measures of the overactivation of physiological stress processes in African American adults; and determine if existing studies used these two biomarkers to assess the relationship between chronic stress, income and level of educational attainment among African Americans longitudinally.

METHODS

In order to identify English-language articles published prior to October 11, 2021, a comprehensive search strategy was developed using five databases: PubMed/Medline, EMBASE, Web of Science Plus, Global Health (Ovid), and PsycINFO. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used to record progress on the comprehensive search for studies reporting on allostatic load and/or telomere length biomarkers longitudinally within all bodily fluids and chronic stress among African American adults.

RESULTS

In total, 7 studies met the search criteria; 902 were excluded. Thus, less than 1% of all studies reporting on biomarkers of chronic stress longitudinally included African Americans. Each of the 7 studies described the relationship between telomere length and/or allostatic load among African Americans and chronic stress, education, and/or income. Higher chronic stress levels and experiences of racial discrimination were associated with telomere shortening while lower income and higher chronic stress levels were associated with an increase in allostatic load among African Americans.

DISCUSSION

Given the limited number of studies reporting on the association between allostatic load, telomere length, and/or the relationship between both in assessing chronic stress severity longitudinally among African American populations, it is impossible to determine whether one biomarker has greater predictive value than the other. However, based on the literature included in this review, higher chronic stress levels and experiences of racial discrimination were associated with shorter telomere length, while lower income and higher chronic stress levels are associated with an increase in allostatic load among African Americans.

CONCLUSION

These data illustrate a gap in the literature on the relationship between the biomarkers of telomere length and allostatic load combined as a potential measure for chronic stress among African Americans. To our knowledge, none the current literature describes the relationship between telomere length and allostatic load longitudinally among African American adults. As the field strives to develop a "gold standard" for measuring chronic stress, the combination of these biomarkers needs to be the subject of scientific inquiry and thus, fully examined. Future longitudinal studies among African Americans are needed to better understand which biomarker, or combination of biomarkers will provide the most accurate measure of physiological stress processes.

“We Were Loving Warriors!”: A Content Analysis of Black Women’s Resistance Within Psychological Science

Though findings are mixed, collective action engagement has been shown to be positively associated with greater academic success, social support, political efficacy, and well-being with racially marginalized individuals. Despite these findings, however, investigations of collective action engagement with Black American adult women within psychological science are scarce. Consistent with Black feminist thought, the construct of resistance may provide a necessary expansion to include all the ways that Black women actively work to transform their communities toward justice, beyond collective action. To ascertain the breadth and scope of psychological research related to Black women’s resistance (i.e., collective action engagement) to interpersonal discrimination and structural oppression, in this systematic review and content analysis we sought to identify participants’ and scholars’ definitions of resistance, as well as thematic dimensions and specific strategies of resistance. Additionally, we sought to determine the outcomes of resistance that have been assessed and the degree to which psychological health and well-being have been examined as an outcome of resistance within the literature. Findings from the analysis suggest the need for future examinations of the specific influence of Black American women’s collective action engagement and resistance to oppression on their well-being. Additionally, the findings of this review may have important implications for Black women’s well-being and as such, we discuss resistance work as a therapeutic intervention that can be encouraged by therapists, healers, community leaders, and educators.

Psychometric Characteristics of a Questionnaire Measuring Hopefulness: An Exploratory and Confirmatory Factor Analysis Approach

Background: In the third millennium, which is called the information era, despite the technological growth and industrialization, lack of hopefulness is seen in the general population, especially among the youth. Therefore, hope is one of the critical issues that should be promoted among the youth. Objectives: This study was aimed at evaluating a hopefulness questionnaire among the youth. Methods: This cross-sectional study with an exploratory approach was carried out among the Iranian youth population in 2020. All students of Shahed University in Tehran (estimated as 5000 people) were considered the study population, 600 of whom were selected as the study sample by the simple random sampling method. For data collection, a researcher-made questionnaire was utilized. Data analysis was performed by SPSS v. 21 and LISREL v. 8.80. Alpha Cronbach coefficient was used to investigate the reliability of the questionnaire. Results: The results showed the adequate reliability of the hopefulness questionnaire. Also, the findings showed that three latent variables in the questionnaire had significantly larger values than the other factors. Therefore, with three latent factors, the hopefulness questionnaire was significantly saturated. Cronbach’s alpha coefficient for the 33 items of the questionnaire was 0.80. Conclusions: It was found that the questionnaire constructs are useful in predicting hopefulness intention. The scale consisted of three factors that did not completely replicate the factors found in previous studies. The use of this tool is recommended for all age groups.

Neighborhood Characteristics and Inflammation among Older Black Americans: The Moderating Effects of Hopelessness and Pessimism

BACKGROUND

Research documents the adverse health effects of systemic inflammation. Overall, older Black Americans tend to have higher inflammation than older non-Hispanic white adults. Given that inflammation is related to a range of chronic health problems that disproportionately affect Blacks compared to whites, this racial disparity in inflammation may contribute to racial disparities in particular chronic health problems. Thus, a better understanding of its determinants in the older Black population is of critical importance. This analysis examined the association between neighborhood characteristics and inflammation in a national sample of older non-Hispanic Black Americans. An additional aim of this study was to determine whether hopelessness and pessimism moderates the association between neighborhood characteristics and inflammation.

METHODS

A sample of older non-Hispanic Black Americans aged 60+ were drawn from the Health and Retirement Study (N=1,004). Neighborhood characteristics included neighborhood physical disadvantage and neighborhood social cohesion. Inflammation was assessed by C-reactive protein (CRP).

RESULTS

The analyses indicated that neighborhood physical disadvantage and social cohesion were not associated with CRP. Hopelessness and pessimism moderated the association between neighborhood physical disadvantage and CRP.

CONCLUSIONS

Knowledge regarding the role of hopelessness and pessimism as moderator in the neighborhood-inflammation association can inform cognitive-behavioral interventions targeted at changes in cognition patterns.

"What Doesn't Kill You, Makes You Stronger": Psychosocial Resources and the Mental Health of Black Older Adults

A robust body of research has shown that Black Americans are less likely than Whites to have psychiatric disorders despite the social and economic disadvantage and systemic racism that they face. This mental health paradox has been demonstrated across all ages of the life course, including older adulthood. One of the prevailing explanations for the lower prevalence of psychiatric disorders among Blacks pertains to the influence of psychosocial resources on mental health. Psychosocial resources can directly or indirectly support mental health through physiological and psychological pathways. They can also mitigate the adverse effects of social stressors of discrimination and other stressors on psychological distress and mental illness. Black older adults may particularly benefit from psychosocial resources because they have had a lifetime of experiencing and overcoming adversity. Although this cycle of stress adaptation can wear away at the physical body, it may facilitate mental health resilience. In this chapter, we review research on the relationship between psychosocial resources and mental health. The chapter begins with a brief review of the Black-White mental health paradox and the mechanisms through which psychosocial resources operate to influence mental health. We then review research on intrapersonal, interpersonal, and community-level psychosocial resources that are particularly salient for Black Americans. Throughout the chapter we highlight research specifically focused on Black older adults and discuss the cultural relevance of each resource to their mental health and psychological functioning.