Anissa I. Vines

Associations of Abdominal Fat With Perceived Racism and Passive Emotional Responses to Racism in African American Women

OBJECTIVES An excess in abdominal fat may predispose African American women to chronic health conditions such as diabetes and cardiovascular disease. Because stress may increase body fat in the center-body region, we used the waist-to-hip ratio (WHR) to examine associations between excess abdominal fat and perceived racism (a chronic stressor) and daily stress. Passive emotional responses to perceived racism, hypothesized to have particularly adverse effects, were also examined. METHODS We controlled for body mass index in multiple logistic regression models among 447 African American women who completed a telephone interview on perceived racism. RESULTS Passive emotional responses were not related to WHR (odds ratio [OR]=1.4; 95% confidence interval [CI]=0.8, 2.4). High perceived racism was associated with a low WHR in this population (OR=0.4; 95% CI=0.3, 0.8). However, high daily stress was related to a high WHR (OR=2.7; 95% CI=1.1, 6.7). CONCLUSIONS Findings support an association between daily stress and WHR but do not support our hypothesis that passive emotional responses to perceived racism increase abdominal fat. Further study of the stress physiology of perceived racism in African American women is warranted.

The art and science of integrating Undoing Racism with CBPR: challenges of pursuing NIH funding to investigate cancer care and racial equity.

In this nation, the unequal burden of disease among People of Color has been well documented. One starting point to eliminating health disparities is recognizing the existence of inequities in health care delivery and identifying the complexities of how institutional racism may operate within the health care system. In this paper, we explore the integration of community-based participatory research (CBPR) principles with an Undoing Racism process to conceptualize, design, apply for, and secure National Institutes of Health (NIH) funding to investigate the complexities of racial equity in the system of breast cancer care. Additionally, we describe the sequence of activities and “necessary conflicts” managed by our Health Disparities Collaborative to design and submit an application for NIH funding. This process of integrating CBPR principles with anti-racist community organizing presented unique challenges that were negotiated only by creating a strong foundation of trusting relationships that viewed conflict as being necessary. The process of developing a successful NIH grant proposal illustrated a variety of important lessons associated with the concepts of cultural humility and cultural safety. For successfully conducting CBPR, major challenges have included: assembling and mobilizing a partnership; the difficulty of establishing a shared vision and purpose for the group; the problem of maintaining trust; and the willingness to address differences in institutional cultures. Expectation, acceptance and negotiation of conflict were essential in the process of developing, preparing and submitting our NIH application. Central to negotiating these and other challenges has been the utilization of a CBPR approach.

The Association Between Self-Reported Major Life Events and the Presence of Uterine Fibroids

PURPOSE Uterine fibroids are the most common benign tumors in reproductive-age women. Factors associated with this condition such as psychosocial stress are still being elucidated. This paper explores the association between major life events (MLE) stress and fibroids. METHODS Prevalence ratios (PR) and 95% confidence intervals (CI) were used to determine the association between MLE stress (number of events and stress intensity) and fibroids in 556 Black and 373 White women in the Uterine Fibroid Study, 1996-1999. MAIN FINDINGS Fibroids were prevalent in 74% and 50% of the Black and White women, respectively. The mean number of MLE reported by each race group was two. Among White women, the PR for those who reported at least one event compared with those with no events were significant after adjusting for age and study identified fibroid risk factors (PR [1 and 2 events], 1.7; 95% CI, 1.2-2.5), (PR [3 events], 1.9; 95% CI, 1.3-2.7), and (PR [4 events], 1.5; 95% CI, 1.0-2.1), respectively. At all levels of stress compared with no events, significant associations with fibroids were found among White women. For Black women, the PR for fibroids was only significant in the high stress group compared with those without an experienced event, after adjusting for fibroid risk factors (PR, 1.2; 95% CI, 1.1-1.4). CONCLUSION Examining the number and stress intensity of MLE enriched our understanding of this stressor and fibroids. Further research is needed to understand the role of stress on fibroids among women.

A comparison of the occurrence and perceived stress of major life events in black and white women.

Purpose: To describe the occurrence and perceived stress of major life events, and to investigate whether adjusting for socioeconomic status reduced race/ethnicity differences. Methods: Black (n = 639) and white (n = 419) women aged 35–49 years responded to 14 major life event questions within the domains of employment, health, relationship, finance, residential change, and crime. Main Findings: The total number of life events did not differ by race/ethnicity, but black women reported significantly more events in the domains of relationship, financial, and residential change than white women. White women generally reported higher stress for a given event than black women, although for “residential change” black women reported more severe stress than the white women. Conclusions: Inclusion of both the occurrence and perceived stress of major life events can improve our understanding of how this stressor may affect health.

The national cancer institute’s community networks program initiative to reduce cancer health disparities: Outcomes and lessons learned

Background: We describe reach, partnerships, products, benefits, and lessons learned of the 25 Community Network Programs (CNPs) that applied community-based participatory research (CBPR) to reduce cancer health disparities.Methods: Quantitative and qualitative data were abstracted from CNP final reports. Qualitative data were grouped by theme.Results: Together, the 25 CNPs worked with more than 2,000 academic, clinical, community, government, faith-based, and other partners. They completed 211 needs assessments, leveraged funds for 328 research and service projects, trained 719 new investigators, educated almost 55,000 community members, and published 991 articles. Qualitative data illustrated how use of CBPR improved research methods and participation; improved knowledge, interventions, and outcomes; and built community capacity. Lessons learned related to the need for time to nurture partnerships and the need to attend to community demand for sustained improvements in cancer services.Implications: Findings demonstrate the value of government-supported, community–academic, CBPR partnerships in cancer prevention and control research.

African Americans’ Perceptions of Prostate-Specific Antigen Prostate Cancer Screening

Background. In 2012, the U.S. Preventive Services Task Force released a hotly debated recommendation against prostate-specific antigen testing for all men. The present research examines African Americans’ beliefs about their susceptibility to prostate cancer (PCa) and the effectiveness of prostate-specific antigen testing in the context of the controversy surrounding this recommendation. Method. This study used a qualitative design to examine perceptions regarding susceptibility and screening. Data were collected at a community health center and three predominantly African American churches in North Carolina. Study participants were 46 African American men and women who attended one of four “listening sessions” for pretesting PCa educational materials (average age = 55 years). Listening sessions of 1.5-hour duration were conducted to pretest materials; while presenting the materials, researchers probed beliefs and knowledge about PCa screening. The sessions were recorded and transcribed, and the transcripts were qualitatively analyzed using grounded theory. Results. The four emergent themes indicated that participants (1) cited behavioral, psychosocial, and biological reasons why African American men have higher PCa risk compared with others; (2) knew about the controversy and had varying responses and intentions; (3) believed screening could save lives, so it should be used regardless of the 2012 recommendation; and (4) felt that women can help men go to the doctor and make screening decisions. Conclusion. Health education efforts to help community members understand health controversies, screening options, and how to make informed screening decisions are critical.

A community-academic partnership to plan and implement an evidence-based lay health advisor program for promoting breast cancer screening.

Despite a growing body of evidence concerning effective approaches to increasing breast cancer screening, the gap between research and practice continues. The North Carolina Breast Cancer Screening Program (NC-BCSP) is an example of an evidence-based intervention that uses trained lay health advisors (LHA) to promote breast cancer screening. Partnerships that link academic researchers knowledgeable about specific evidence-based programs with community-based practitioners offer a model for increasing their use. This article describes a partnership between CrossWorks, Inc., a community-based organization, and the UNC-CH Lineberger Comprehensive Cancer Center in planning and implementing an evidence-based program for promoting breast cancer screening among older African American women in rural eastern North Carolina communities. We used in-depth interviews to explore the relationship of the partnership to the activities that were undertaken to launch the evidence-based program.

Connecting Community With Campus to Address Cancer Health Disparities: A Community Grants Program Model

Background: With growing interest in the CBPR approach to cancer health disparities research, mechanisms are needed to support adherence to its principles. The Carolina Community Network (CCN), 1 of 25 Community Network Programs funded by the National Cancer Institute (NCI), developed a model for providing funds to community-based organizations. Objectives: This paper presents the rationale and structure of a Community Grants Program (CGP) model, describes the steps taken to implement the program, and discusses the lessons learned and recommendations for using the grants model for CBPR. Methods: Three types of projects—cancer education, implementation of an evidence-based intervention, and the development of community–academic research partnerships—could be supported by a community grant. The CGP consists of four phases: Pre-award, peer-review process, post-award, and project implementation. Results: The CGP serves as a catalyst for developing and maintaining community–academic partnerships through its incorporation of CBPR principles. Conclusions: Providing small grants to community-based organizations can identify organizations to serve as community research partners, fostering the CBPR approach in the development of community–academic partnerships by sharing resources and building capacity.

Perceived Racial/Ethnic Discrimination and Mental Health: a Review and Future Directions for Social Epidemiology

Purpose of ReviewRecent literature on racial or ethnic discrimination and mental health was reviewed to assess the current science and identify key areas of emphasis for social epidemiology. Objectives of this review were to (1) determine whether there have been advancements in the measurement and analysis of perceived discrimination, (2) identify the use of theories and/or frameworks in perceived discrimination and mental health research, and (3) assess the extent to which stress buffers are being considered and evaluated in the existing literature.Recent FindingsMetrics and analytic approaches used to assess discrimination remain largely unchanged. Theory and/or frameworks such as the stress and coping framework continue to be underused in majority of the studies. Adolescents and young adults experiencing racial/ethnic discrimination were at greater risk of adverse mental health outcomes, and the accumulation of stressors over the life course may have an aggregate impact on mental health. Some growth seems evident in studies examining the mediation and moderation of stress buffers and other key factors with the findings suggesting a reduction in the effects of discrimination on mental health.SummaryDiscrimination scales should consider the multiple social identities of a person, the context where the exposure occurs, how the stressor manifests specifically in adolescents, the historical traumas, and cumulative exposure. Life course theory and intersectionality may help guide future work. Despite existing research, gaps remain in elucidating the effects of racial and ethnic discrimination on mental health, signaling an opportunity and a call to social epidemiologists to engage in interdisciplinary research to speed research progress.

Building Capacity in a Rural North Carolina Community to Address Prostate Health Using a Lay Health Advisor Model

Background. Prostate cancer is a critical concern for African Americans in North Carolina (NC), and innovative strategies are needed to help rural African American men maximize their prostate health. Engaging the community in research affords opportunities to build capacity for teaching and raising awareness. Approach and Strategies. A community steering committee of academicians, community partners, religious leaders, and other stakeholders modified a curriculum on prostate health and screening to include interactive knowledge- and skill-building activities. This curriculum was then used to train 15 African American lay health advisors, dubbed Prostate Cancer Ambassadors, in a rural NC community. Over the 2-day training, Ambassadors achieved statistically significant improvements in knowledge of prostate health and maintained confidence in teaching. The Ambassadors, in turn, used their personal networks to share their knowledge with over 1,000 individuals in their community. Finally, the Ambassadors became researchers, implementing a prostate health survey in local churches. Discussion and Conclusions. It is feasible to use community engagement models for raising awareness of prostate health in NC African American communities. Mobilizing community coalitions to develop curricula ensures that the curricula meet the communities’ needs, and training lay health advisors to deliver curricula helps secure community buy-in for the information.