Stereotype threat, trait perseveration, and vagal activity: evidence for mechanisms underpinning health disparities in Black Americans

Perceptions of HIV-Related Comorbidities and Usability of a Virtual Environment for Cardiovascular Disease Prevention Education in Sexual Minority Men With HIV: Formative Phases of a Pilot Randomized Controlled Trial

BACKGROUND

Sexual minority men with HIV are at an increased risk of cardiovascular disease (CVD) and have been underrepresented in behavioral research and clinical trials.

OBJECTIVE

This study aims to explore perceptions of HIV-related comorbidities and assess the interest in and usability of a virtual environment for CVD prevention education in Black and Latinx sexual minority men with HIV.

METHODS

This is a 3-phase pilot behavioral randomized controlled trial. We report on formative phases 1 and 2 that informed virtual environment content and features using qualitative interviews, usability testing, and beta testing with a total of 25 individuals. In phase 1, a total of 15 participants completed interviews exploring HIV-related illnesses of concern that would be used to tailor the virtual environment. In phase 2, usability testing and beta testing were conducted with 10 participants to assess interest, features, and content.

RESULTS

In phase 1, we found that CVD risk factors included high blood pressure, myocardial infarction, stroke, and diabetes. Cancer (prostate, colon, and others) was a common concern, as were mental health conditions. In phase 2, all participants completed the 12-item usability checklist with favorable feedback within 30 to 60 minutes. Beta-testing interviews suggested (1) mixed perceptions of health and HIV, (2) high risk for comorbid conditions, (3) virtual environment features were promising, and (4) the need for diverse avatar representations.

CONCLUSIONS

We identified several comorbid conditions of concern, and findings carry significant implications for mitigating barriers to preventive health screenings, given the shared risk factors between HIV and related comorbidities. Highly rated aspects of the virtual environment were anonymity; meeting others with HIV who identify as gay or bisexual; validating lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) images and content; and accessibility to CVD prevention education. Critical end-user feedback from beta testing suggested more options for avatar customization in skin, hair, and body representation. Our next phase will test the virtual environment as a new approach to advancing cardiovascular health equity in ethnic and racial sexual minority men with HIV.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04061915; https://clinicaltrials.gov/study/NCT05242952.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/38348.

Multi-ethnic variation in the ties that bind rumination and heart rate variability: Implications for health disparities

Higher self-reported rumination, a common form of trait perseverative cognition, is linked with lower resting heart rate variability (HRV), which indicates poorer cardiac function and greater disease risk. A meta-analysis and systematic review indicated that in samples with fewer European Americans, the association of rumination with both heart rate and blood pressure was stronger. Thus, trait rumination may be more strongly associated with resting HRV among ethnically minoritized populations. The current study investigated whether differences in the association of self-reported rumination with resting HRV varied by ethnicity in a sample (N = 513; Mage = 19.41; 226 Women) of self-identified African Americans (n = 110), Asian Americans (n = 84), and European Americans (n = 319). Participants completed a five-minute baseline period to assess resting HRV, followed by the Ruminative Responses Scale, which contains three facets of rumination including brooding, depressive, and reflective rumination. On average, Asian Americans reported higher levels of rumination relative to European Americans. African Americans had higher resting HRV than Asian Americans. Adjusting for covariates, higher self-reported rumination was significantly associated with lower resting HRV in both African and Asian Americans, but not significantly so in European Americans. This finding was consistent for brooding and reflective, but not depressive rumination. Overall, this study lends insight into a psychological mechanism-rumination-that may impact health disparities among ethnically minoritized individuals, contributing to an understanding of how stress gets under the skin among such minoritized populations.

Everyday perceptions of safety and racial disparities in hair cortisol concentration

OBJECTIVE

Black-White disparities in physiological stress during adolescence are increasingly evident but remain incompletely understood. We examine the role of real-time perceptions of safety in the context of everyday routines to gain insight into the sources of observed adolescent racial differences in chronic stress as measured by hair cortisol concentration (HCC).

METHOD

We combined social survey, ecological momentary assessment (EMA), and hair cortisol data on 690 Black and White youth ages 11-17 from wave 1 of the Adolescent Health and Development in Context (AHDC) study to investigate racial differences in physiological stress. Individual-level, reliability-adjusted measures of perceived unsafety outside the home were drawn from a week-long smartphone-based EMA and tested for association with hair cortisol concentration.

RESULTS

We observed a statistically significant interaction (p < .05) between race and perceptions of unsafety. For Black youth, perceived unsafety was associated with higher HCC (p < .05). We observed no evidence of an association between perceptions of safety and expected HCC for White youth. For youth who perceive their out-of-home activity locations to be consistently safe, the racial difference in expected HCC was not statistically significant. At the high end of perceived unsafety, however, Black-White differences in HCC were pronounced (0.75 standard deviations at the 95th percentile on perceived unsafety; p < .001).

DISCUSSION

These findings call attention to the role of everyday perceptions of safety across non-home routine activity contexts in explaining race differences in chronic stress as assessed by hair cortisol concentrations. Future research may benefit from data on in situ experiences to capture disparities in psychological and physiological stress.

Impact of stereotype threat on brain activity during memory tasks in older adults

We report the first neuroimaging experiment to investigate the impact of explicitly activating aging stereotypes (i.e., stereotype threat) on brain activity during cognitive tasks. Cognitively normal older adults read about aging stereotypes or a control passage prior to taking episodic memory, working memory, and a non-demanding control task during fMRI. At the group level, stereotype activation did not impact cognitive performance or measures sensitive to stress and anxiety (physiological or self-report), but like prior work, highly educated and retired adults exhibited greater stereotype effects on episodic memory. At the neural level, stereotype activation did not impact brain activity in executive control or emotional regulation regions previously linked to stereotype threat effects in younger adults, suggesting that stereotype threat operates differently in older adults. Instead, on each task, the stereotype group showed more brain activity than the control group in parietal midline regions (e.g., precuneus, posterior cingulate). Although activity in these regions can arise from many processes, they have previously been associated with self-referential thinking and error-prevention focus, and in our study, brain activity in these regions was associated with slower responses and lower false alarm errors on the episodic memory task. Collectively, these findings are more consistent with the regulatory fit hypothesis than an executive control interference hypothesis of stereotype threat effects in older adults, whereby older adults adopt an error-prevention mindset in response to explicit stereotype threat.

Ethnicity, nativity, and the effects of stereotypes on cardiovascular health among people of African ancestry in the United States: internal versus external sources of racism

OBJECTIVE

The present study tests the hypothesis that ethnicity and nativity moderate the association of negative racial stereotypes versus perceived discrimination to cardiovascular health among Black respondents to the National Survey of American Life (NSAL). It is also hypothesized that the relationship is strongest in African Americans and weakest in foreign-born Caribbean Blacks with U.S.-born Caribbean Blacks falling in the middle. The same pattern of results is expected to occur for the correlation between perceived discrimination and cardiovascular health.

METHOD

A representative sample of 3570 (100%) African American and 1419 (87.4%) of 1623 Caribbean Black respondents to the NSAL had complete data for use in this study. The Caribbean subsample was divided by nativity into 373 (26.3%) U.S.-born and 1044 (73.7%) foreign-born participants. Structural equation modeling (SEM) tested the measurement model for effects of internalized racism and perceived racism on cardiovascular health mediated by perceived mastery and performance apprehension.

RESULTS

SEM analyses revealed that perceived discrimination had a much stronger effect on cardiovascular health than internalized racism for African Americans and foreign-born Caribbean Blacks, but the diametrically opposite pattern was the case for U.S.-born Caribbean Blacks who reported greater effects for internalized racism than perceived discrimination.

CONCLUSION

Interventions and policies to eliminate disparities in cardiovascular health for the U.S. Black population must address internal and external sources of racism by ethnicity and nativity.

Chronic stress, autonomic dysregulation and prospective drug use among African American emerging adults

OBJECTIVE

Chronic stress is associated with increased vulnerability to drug use and may contribute to drug-related health disparities in the African American community. The underlying physiological mechanisms by which chronic stress confers this increased risk remain unclear. The present study aimed to characterize the impact of chronic and race-related stress exposure on regulatory mechanisms of the autonomic nervous system (ANS) in response to acute stress, to examine John Henryism as potential moderator of this relationship, and to investigate the association between ANS reactivity and subsequent drug use among a sample of African American emerging adults (18-25 years old) in the Southern United States (U.S.).

METHOD

Participants (N = 276) completed self-report measures of chronic and race-related stress and John Henryism and underwent a laboratory-based stressor. ANS reactivity was assessed via heart rate variability (HRV) and skin conductance levels (SCL). At 90-day follow-up, retrospective reports of drug use were provided.

RESULTS

Race-related stress was associated with greater SCL reactivity. John Henryism moderated the relationship between chronic stress exposure and HRV reactivity. SCL reactivity was associated with higher rates of alcohol and marijuana use at 90-day follow-up. HRV reactivity was associated with tobacco use at 90-day follow-up.

CONCLUSIONS

Chronic stress exposure and active coping may interact to affect regulatory mechanisms of the ANS. ANS (dys)regulation may be an important endophenotype for increasing drug use vulnerability among African American emerging adults. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Accelerating Our Science: Finding Innovative Solutions to Tomorrow's Health Challenges

This introduction to the special issue outlines key ways that behavioral medicine researchers can accelerate their science. The authors highlight the 2020 Society of Behavioral Medicine's annual meeting plenary sessions, that fit this theme.

Sex Differences in the Impact of Racial Discrimination on Mental Health Among Black Americans

PURPOSE OF REVIEW

Greater racial discrimination is associated with poorer mental health among Black Americans; yet, there remains an incomplete understanding of sex differences in exposure to racial discrimination, and further, of how sex differences in coping with racial discrimination may heighten or diminish risk for poorer mental health.

RECENT FINDINGS

Black men may experience greater exposure to both structural and communal forms of racial discrimination, whereas Black women may face both a wider range of potential sources, as well as encounter greater variability in the subjective experience of racial discrimination. For both Black women and men, racial discrimination may be similarly associated with maladaptive coping strategies (i.e., emotional eating, rumination) that also are linked to poorer mental health; however, emerging findings suggest that mindfulness may partially buffer these deleterious effects. Overall, the recent literature reveals mixed findings with respect to sex differences in the experience and negative mental health impact of racial discrimination. Despite this heterogeneity, evidence documents sex differences in the settings, type, and qualitative experience of racial discrimination among Black Americans. Additionally, growing evidence indicating that racial discrimination is associated with physiological markers of stress reactivity and psychopathology risk further bolsters its characterization as a unique form of chronic stress among Black Americans and other minority groups in the USA.

Agents of empathy: How medical interpreters bridge sociocultural gaps in genomic sequencing disclosures with Spanish-speaking families

OBJECTIVES

To describe how linguistic tools used by interpreters during return of genomic sequencing results may have impacted communication with Spanish-speaking families, and to discuss the implications for the role of medical interpreters.

METHODS

Using discourse analysis, we identified and categorized the various ways hospital-based interpreters adapted clinicians' language in 37 audio-recorded sessions in which Spanish-speaking parents participating in a clinical trial received their child's genomic sequencing results from English-speaking clinicians.

RESULTS

We found that interpreters adapted clinicians' statements using five empathic linguistic tools: contextualization, encouragement, checking comprehension, endearment, and softening. Interpreters used an average of four linguistic tools per session, with contextualization and encouragement being the most frequently used.

CONCLUSIONS

Interpreters used empathic linguistic tools to alter clinicians' statements when communicating genomic information to Spanish-speaking families. Our findings demonstrate the critical role of interpreters as cultural mediators and facilitators of understanding for Spanish-speaking families.

PRACTICE IMPLICATIONS

This study expands upon the definition of clinical empathy in interpreter-mediated sessions. Our findings suggest that revisions of standards of medical interpretation practice may be warranted regarding interpreters' ability to adapt clinicians' language in a culturally sensitive manner during interpretation.

The Autonomic Nervous System and Hypertension: Ethnic Differences and Psychosocial Factors

PURPOSE OF THE REVIEW

In the present paper, we overview emerging research examining the autonomic nervous system (ANS), especially the parasympathetic nervous system as indexed by heart rate variability (HRV), and the impact of psychosocial factors on hypertension-related disease in African Americans.

RECENT FINDINGS

A growing corpus of studies has shown that (1) usual patterns of compensatory sympathetic-parasympathetic regulation differ between African Americans and European Americans; (2) despite their enhanced cardiovascular disease risk profile, African Americans tend to exhibit higher HRV relative to European Americans; and (3) racial discrimination and other forms of psychosocial stress are associated with diminished HRV among African Americans. Significant disparities in hypertension-related disease exist such that African Americans have greater risk. The underlying factors associated with this increased risk are, to date, not fully understood. The present review provides evidence for a unique pattern of ANS regulation in African Americans and shows that psychosocial factors such as racial discrimination may contribute to this paradoxical situation.