1
|
Maier MC, Scharf JY, Gold MA, Ancheta AJ, Bruzzese JM, Garbers S. 'Our mind could be our biggest challenge': A qualitative analysis of urban adolescents' sleep experiences and opportunities for mind-body integrative health approaches to improve sleep. PEC Innov 2023; 2:100130. [PMID: 37214498 PMCID: PMC10194289 DOI: 10.1016/j.pecinn.2023.100130] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 05/24/2023]
Abstract
Objective To inform the development of a combined sleep and mind-body integrative health (MBIH) intervention, we explored urban adolescents' sleep experiences and perceptions of MBIH techniques. Methods We conducted eight focus groups with school-based health center patients in New York City, exploring sleep experiences; mindfulness, body awareness, tapping, acupressure, and self-hypnosis; and intervention delivery preferences. We recorded, transcribed, and analyzed the discussions applying methods from grounded theory. Results Participants (n = 25) were ages 14-17, predominantly female (64%), Latino (60%), and Black (40%). Participants reported social, physical, and internal sleep barriers, but had limited success implementing sleep improvement strategies. Participants viewed MBIH techniques positively, noted audio-guided techniques' accessibility, and were intrigued by less-familiar techniques. Preferences varied around domains of intervention delivery. Conclusion Results underscore the need for adolescent-informed interventions offering sleep improvement strategies. Participants' interest and willingness to engage in MBIH techniques present an opportunity for practitioners to develop and deliver sleep interventions incorporating MBIH components to urban adolescents. Varied intervention preferences highlight the need to be adaptable to adolescents' lived experiences, comfort levels, and learning styles. Innovation This study elucidates the perspectives of underrepresented adolescents whose perspectives on MBIH have rarely been explored, an important first step in developing tailored interventions.
Collapse
Affiliation(s)
- Malia C. Maier
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jodi Y. Scharf
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Melanie A. Gold
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
- School-Based Health Centers, New York-Presbyterian, USA
| | | | | | - Samantha Garbers
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| |
Collapse
|
2
|
Garbers S, Ancheta AJ, Gold MA, Maier M, Bruzzese JM. Sleeping Healthy, Living Healthy: Using Iterative, Participatory Processes to Develop and Adapt an Integrated Sleep Hygiene/Mind-Body Integrative Health Intervention for Urban Adolescents. Health Promot Pract 2023:15248399231184453. [PMID: 37491898 PMCID: PMC10808277 DOI: 10.1177/15248399231184453] [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] [Indexed: 07/27/2023]
Abstract
Racial and ethnic minority adolescents living in urban settings experience sleep disparities. Few interventions have been developed to address these disparities. Guided by principles of participatory design and inclusion, our team developed a novel intervention that combined sleep hygiene education with mind-body integrative health (MBIH) practices to improve sleep quality among adolescents in New York City. The goal of this article is to describe our iterative development and design process, the final product, and future directions. Our participatory approach incorporated information from formative work with adolescents having lived experience, practitioners, and syntheses of published literature. The final intervention-Sleeping Healthy, Living Healthy-consists of six, 40-minute group sessions and one 20-minute individual session designed for high school students. Each session has a set of learning objectives, combining instruction, group activities, and discussions on sleep hygiene and MBIH topics. Our manualized intervention includes handouts created by a graphic design team that served as a review and reminder for home practice. We describe intervention implementation to two unique cohorts and detail our methods used to fine-tune the intervention between cohorts. Our partnership with and insights from both adolescents and practitioners serve as a guide for researchers aiming to use participatory methods to develop interventions to decrease health disparities in specific populations.
Collapse
Affiliation(s)
- Samantha Garbers
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - April J. Ancheta
- University of Pennsylvania, Philadelphia, PA, USA
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Melanie A. Gold
- Columbia University Mailman School of Public Health, New York, NY, USA
- NewYork-Presbyterian, New York, NY USA
| | - Malia Maier
- Columbia University Mailman School of Public Health, New York, NY, USA
| | | |
Collapse
|
3
|
Ancheta AJ, Hughes TL, Liu J, Russell ST, Bruzzese JM. Interpersonal- and Community-Level Risk Factors for Adolescent Obesity: An Examination of Sexual Identity, School Violence, and School Climate in a Large Sample of Urban Adolescents. J Youth Adolesc 2023:10.1007/s10964-023-01774-x. [PMID: 37067642 DOI: 10.1007/s10964-023-01774-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/26/2023] [Indexed: 04/18/2023]
Abstract
Sexual minority adolescents are more likely to have obesity compared to their heterosexual peers, but little is known about potential contributors to this disparity that lie outside of individual-level health behaviors, such as diet and exercise. One possible contributor is school violence victimization, a factor associated with overweight/obesity in adolescence. Another possible contributor is school climate, which is associated with feelings of safety and connectedness that can lower the likelihood of school violence victimization. Moreover, even less is known about relationships among all these factors among sexual minority adolescents. This gap in the literature was addressed by analyzing CDC's district-level data from the Youth Risk Behavior Survey and School Health Profiles (N = 60,625; 50.9% female, Mage = 16 years, 84.7% heterosexual, 15.3% sexual minority). Using multilevel mixed effects logistic regression models and controlling for covariates, it was found that among females and males, those with 2+ counts of last 12-month school violence victimization had higher odds of obesity than those with no school violence victimization (AOR = 1.33; AOR = 1.24). Furthermore, females and males in more positive LGBTQ school climates had lower odds of obesity than those in less positive school climates (AOR = 0.84; AOR = 0.85). There were no sexual identity differences in these models. Findings support the careful consideration of school violence victimization and LGBTQ school climate in future obesity prevention initiatives.
Collapse
Affiliation(s)
- April J Ancheta
- Perelman School of Medicine, University of Pennsylvania, 13th Floor, 423 Guardian Dr, Philadelphia, PA, 19146, USA.
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, 19146, USA.
| | - Tonda L Hughes
- Columbia University School of Nursing, New York, NY, 10032, USA
| | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, 10032, USA
| | - Stephen T Russell
- Department of Human Development and Family Studies, University of Texas, 108 Dean Keeton St, Austin, TX, 78712, USA
| | | |
Collapse
|
4
|
Ancheta AJ, Cunningham PB, Liu J, Powell JS, Halliday CA, Bruzzese JM. Asthma is associated with bullying victimization in rural adolescents. J Asthma 2023; 60:1409-1417. [PMID: 36413706 DOI: 10.1080/02770903.2022.2151466] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We characterized bullying among rural adolescents and examined the association between asthma and bullying victimization. METHODS Participants (N = 1905; 44.5% Black) were students attending rural high schools who were screened for a randomized trial to address uncontrolled asthma. Screening questions asked students about asthma diagnosis and symptoms, bullying victimization, and demographic characteristics. Logistic regression analyses with school as a fixed effect were employed to examine the extent to which demographic factors, asthma diagnosis, asthma status (i.e. current asthma, no asthma, possible undiagnosed asthma), and among those with current asthma, asthma severity, were associated with bullying victimization. Sensitivity analyses using bullying frequency as the outcome were also conducted. RESULTS 26.0% reported being bullied. Younger age and self-identifying as White were associated with increased risk of bullying victimization. Compared to those with no asthma, those with current asthma or possible undiagnosed asthma were at increased risk for bullying victimization (adjusted odds ratio [AOR] = 2.46; 95% confidence interval (CI) = 1.76-3.46 and AOR = 2.42; 95% CI = 1.87-3.14, respectively). Among those with current asthma, persistent symptoms increased the risk for bullying victimization (AOR = 2.59; 95% CI = 1.45-4.71). Similar results were obtained with sensitivity analyses. CONCLUSIONS In a large rural community cohort, asthma was associated with bullying victimization. Findings suggest that rural students with asthma, with or without diagnosis, could benefit from schools creating inclusive environments that reduce victimization based on this medical condition. School administrators should foster environments that are accepting of all students' abilities and statuses, and healthcare providers can provide proper asthma management education to these adolescents.
Collapse
Affiliation(s)
- April J Ancheta
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Phillippe B Cunningham
- Division of Global and Community Health, Medical University of South Carolina, Charleston, SC, USA
| | - Jianfang Liu
- Office of Scholarship and Research, Columbia University School of Nursing, New York, NY, USA
| | - Jennifer S Powell
- Division of Global and Community Health, Medical University of South Carolina, Charleston, SC, USA
| | - Colleen A Halliday
- Division of Global and Community Health, Medical University of South Carolina, Charleston, SC, USA
| | - Jean-Marie Bruzzese
- Office of Scholarship and Research, Columbia University School of Nursing, New York, NY, USA
| |
Collapse
|
5
|
Caceres BA, Ancheta AJ, Dorsen C, Newlin-Lew K, Edmondson D, Hughes TL. A population-based study of the intersection of sexual identity and race/ethnicity on physiological risk factors for CVD among U.S. adults (ages 18-59). Ethn Health 2022; 27:617-638. [PMID: 32159375 PMCID: PMC7483257 DOI: 10.1080/13557858.2020.1740174] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 06/16/2019] [Accepted: 03/03/2020] [Indexed: 05/24/2023]
Abstract
Objectives: Sexual minorities face significant psychosocial stressors (such as discrimination and violence) that impact their health. Several studies indicate that sexual minority women (SMW) and bisexual men may be at highest risk for cardiovascular disease (CVD), but limited research has examined physiological CVD risk or racial/ethnic differences. This study sought to examine racial/ethnic differences in physiological risk factors for CVD among sexual minority and heterosexual adults.Design: We analyzed data from the National Health and Nutrition Examination Survey (2001-2016) using sex-stratified multiple linear regression models to estimate differences in physiological CVD risk. We compared sexual minorities (gay/lesbian, bisexual, 'not sure') to heterosexual participants first without regard to race/ethnicity. Then we compared sexual minorities by race/ethnicity to White heterosexual participants.Results: The sample included 22,305 participants (ages 18-59). Lesbian women had higher body mass index (BMI) but lower total cholesterol than heterosexual women. Bisexual women had higher systolic blood pressure (SBP). Gay men had lower BMI and glycosylated hemoglobin (HbA1c) relative to heterosexual men. White and Black lesbian women and bisexual women of all races/ethnicities had higher BMI than White heterosexual women; Black bisexual women had higher SBP and HbA1c. Black sexual minority men had higher HbA1c relative to White heterosexual men. Latino 'not sure' men also had higher SBP, HbA1c, and total cholesterol than White heterosexual men.Conclusions: Given evidence of higher CVD risk in sexual minority people of color relative to White heterosexuals, there is a need for health promotion initiatives to address these disparities. Additional research that incorporates longitudinal designs and examines the influence of psychosocial stressors on CVD risk in sexual minorities is recommended. Findings have implications for clinical and policy efforts to promote the cardiovascular health of sexual minorities.
Collapse
Affiliation(s)
- Billy A. Caceres
- Program for the Study of LGBT Health, Columbia University School of Nursing, 560 W 168th St, New York, NY 10032
| | - April J. Ancheta
- Program for the Study of LGBT Health, Columbia University School of Nursing, 560 W 168th St, New York, NY 10032
| | - Caroline Dorsen
- New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010
| | - Kelley Newlin-Lew
- University of Connecticut School of Nursing, Storrs Hall, Room 214, 231 Glenbrook Rd. U-4026, Storrs, CT 06269
| | - Donald Edmondson
- Columbia University Irving Medical Center, 622 W 168th St, New York, NY 10032
| | - Tonda L. Hughes
- Program for the Study of LGBT Health, Columbia University School of Nursing, 560 W 168th St, New York, NY 10032
| |
Collapse
|
6
|
Ancheta AJ, Caceres BA, Zollweg SS, Heron KE, Veldhuis CB, VanKim NA, Hughes TL. Examining the associations of sexual minority stressors and past-year depression with overeating and binge eating in a diverse community sample of sexual minority women. Eat Behav 2021; 43:101547. [PMID: 34412003 PMCID: PMC8629849 DOI: 10.1016/j.eatbeh.2021.101547] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 07/16/2021] [Accepted: 07/31/2021] [Indexed: 02/01/2023]
Abstract
Sexual minority stressors (e.g., stigma consciousness, internalized homophobia, discrimination) are posited to contribute to higher prevalence of overeating and binge eating among sexual minority women (SMW) relative to heterosexual women. Few studies have examined psychosocial mediators of the associations of minority stressors with overeating and binge eating in SMW. Using data from a diverse, community-based sample of SMW, we examined these associations, including the potential mediating effects of past-year depression. We also conducted exploratory analyses to determine if the associations of sexual minority stressors with overeating and binge eating differed by sexual identity or by race and ethnicity. The sample included 607 SMW (38.2% White, 37.1% African American, 24.7% Latina) with a mean age of 39.7 years. Approximately 17% and 9% of SMW reported overeating and binge eating, respectively, in the past 3 months. Greater stigma consciousness was associated with higher odds of overeating (AOR 1.31, 95% CI = 1.03-1.66). We found no significant associations between minority stressors and binge eating. Past-year depression did not mediate associations between minority stressors and overeating or binge eating. Although we found no sexual identity differences, stigma consciousness among Latina SMW was associated with higher odds of overeating relative to White SMW (AOR 1.95, 95% CI = 1.21-3.12) and African American SMW (AOR 1.99, 95% CI = 1.19-3.31). Findings highlight the importance of screening SMW for stigma consciousness as a correlate of overeating and considering racial and ethnic differences in overeating and binge eating in this population.
Collapse
Affiliation(s)
- April J Ancheta
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
| | - Billy A Caceres
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
| | - Sarah S Zollweg
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
| | - Kristin E Heron
- Department of Psychology, Old Dominion University, Virginia Consortium Program in Clinical Psychology, 250 Mills Godwin Building, Norfolk, VA 23529, United States of America.
| | - Cindy B Veldhuis
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
| | - Nicole A VanKim
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences University of Massachusetts Amherst, 406 Arnold House, Amherst, MA 01003, United States of America.
| | - Tonda L Hughes
- Columbia University School of Nursing, 560 W 168th St, New York, NY 10032, United States of America.
| |
Collapse
|
7
|
Ancheta AJ, Caceres BA, Jackman KB, Kreuze E, Hughes TL. Sexual Identity Differences in Health Behaviors and Weight Status among Urban High School Students. Behav Med 2021; 47:259-271. [PMID: 34719340 PMCID: PMC8560978 DOI: 10.1080/08964289.2020.1763903] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 04/16/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
Although racial/ethnic disparities in childhood obesity are well documented in the United States (U.S.), fewer studies have investigated elevated body mass index (BMI) and related health behaviors among sexual minority youth (SMY; gay/lesbian, bisexual, not sure). We examined pooled data from the 2009-2017 Youth Risk Behavior Surveys, which included high school students from 12 urban U.S. school districts. We used sex-stratified logistic regression models to estimate the association of sexual identity with health behaviors and elevated BMI (reference = heterosexual participants). A total of 133,615 participants were included. Sexual minority boys were more likely to report physical inactivity than heterosexual boys. Gay and not sure boys were also less likely to consume the recommended daily intake of fruit. Bisexual girls were more likely than heterosexual girls to report watching television ≥ 3 hours on a school day and to consume sugar-sweetened beverages (AOR 1.30, 95% CI= 1.18-1.43). All SMY reported higher rates of current tobacco use than their heterosexual peers. Sexual minority girls and bisexual boys had significantly higher rates of obesity than their heterosexual counterparts. These findings can inform tailored health promotion initiatives to reduce obesity risk in SMY.
Collapse
Affiliation(s)
- April J Ancheta
- Columbia University School of Nursing, New York, New York, USA
| | - Billy A Caceres
- Columbia University School of Nursing, New York, New York, USA
| | - Kasey B Jackman
- Columbia University School of Nursing, New York, New York, USA
| | | | - Tonda L Hughes
- Henrik H. Bendixen Professor of International Nursing (in Psychiatry), Columbia University School of Nursing, New York, New York, USA
| |
Collapse
|
8
|
Abstract
Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) adolescents are more likely to report suicidality and worse mental health than their heterosexual peers. We conducted a systematic review to examine the relationship between positive school climate and suicidality and mental health among LGBTQ adolescents. We searched the literature using PubMed, PsycINFO, and CINAHL. Six studies met inclusion criteria, and all had low to moderate risks of bias. Results indicate that LGBTQ students in schools with more positive school climates were at lower risk of suicidality and reported fewer depressive symptoms compared to students in less positive school climates. Being at the forefront of health in schools, school nurses have the opportunity to advocate for changes in school environments that promote positive mental health for all youth, including LGBTQ adolescents.
Collapse
Affiliation(s)
- April J. Ancheta
- Program for the Study of LGBT Health, Columbia University School of Nursing, New York, NY, USA
| | | | - Tonda L. Hughes
- Program for the Study of LGBT Health, Columbia University School of Nursing, New York, NY, USA
| |
Collapse
|