Cheryl A. Armstead

TOWARD UNDERSTANDING THE ASSOCIATION OF SOCIOECONOMIC STATUS AND HEALTH : A NEW CHALLENGE FOR THE BIOPSYCHOSOCIAL APPROACH

The association of socioeconomic status (SES) with morbidity and mortality is a ubiquitous finding in the health literature. One of the principal challenges for biobehavioral researchers is understanding the mechanisms that link SES with health outcomes. This article highlights possible pathways by which SES may influence health. It also provides a discussion of sociodemographic and geographical modifiers of the SES-health relationship and offers several potentially fruitful directions for future research.

Interdisciplinary, Translational, and Community-Based Participatory Research: Finding a Common Language to Improve Cancer Research

Preventing cancer, downstaging disease at diagnosis, and reducing mortality require that relevant research findings be translated across scientific disciplines and into clinical and public health practice. Interdisciplinary research focuses on using the languages of different scientific disciplines to share techniques and philosophical perspectives to enhance discovery and development of innovations; (i.e., from the “left end” of the research continuum). Community-based participatory research (CBPR), whose relevance often is relegated to the “right end” (i.e., delivery and dissemination) of the research continuum, represents an important means for understanding how many cancers are caused as well as for ensuring that basic science research findings affect cancer outcomes in materially important ways. Effective interdisciplinary research and CBPR both require an ability to communicate effectively across groups that often start out neither understanding each others worldviews nor even speaking the same language. Both demand an ability and willingness to treat individuals from other communities with respect and understanding. We describe the similarities between CBPR and both translational and interdisciplinary research, and then illustrate our points using squamous cell carcinoma of the esophagus as an example of how to deepen understanding and increase relevance by applying techniques of CBPR and interdisciplinary engagement. (Cancer Epidemiol Biomarkers Prev 2009;18(4):1213–7)

Gender and cardiovascular responses: What is the role of hostility?

Two experiments are reported investigating hostility group by gender effects on heart rate and blood pressure. In experiment 1, 58 males and 59 females were tested with a protocol that included baseline, reaction time with and without harassment, and recovery. In experiment 2, 55 males and 50 females participated in a procedure of baseline, Stroop color--word conflict, anger recall interview, and recovery. Based on Buss-Durkee subscales, genders were divided into high and low neurotic hostility and expressed hostility groups. High expressed hostility was associated with greater diastolic reactivity to all tasks in males, but not in females. Low expressed hostility was associated with greater heart rate and systolic reactivity, specifically during the anger recall interview. High neurotic hostility in males and females was associated with greater diastolic reactivity to the anger task only, while low Neurotic hostility males had higher resting systolic pressures. These results suggest that outward expression of hostility in men may increase their coronary heart disease risk; however, results for both men and women support an association between cardiovascular reactivity and a lack of match between self-reported anger management style and task demands.

Circadian Disruption, Per3, and Human Cytokine Secretion

Circadian disruption has been linked with inflammation, an established cancer risk factor. Per3 clock gene polymorphisms have also been associated with circadian disruption and with increased cancer risk. Patients completed a questionnaire and provided a blood sample prior to undergoing a colonoscopy (n = 70). Adjusted mean serum cytokine concentrations (IL-6, TNF-alpha, gamma-INF, IL-1ra, IL-1-beta, VEGF) were compared among patients with high and low scores for fatigue (Multidimensional Fatigue Inventory), depressive symptoms (Beck Depression Inventory II), or sleep disruption (Pittsburgh Sleep Quality Index), or among patients with different Per3 clock gene variants. Poor sleep was associated with elevated VEGF, and fatigue-related reduced activity was associated with elevated TNF-alpha concentrations. Participants with the 4/5 or 5/5 Per3 variable tandem repeat sequence had elevated IL-6 concentrations compared to those with the 4/4 genotype. Biological processes linking circadian disruption with cancer remain to be elucidated. Increased inflammatory cytokine secretion may play a role.

Family history of hypertension, gender, and cardiovascular responsivity during stress

The relationships of family history of hypertension and gender to cardiovascular responses to stress were investigated in this research. One hundred twenty-three subjects were monitored while they rested and performed two tasks, reaction time and Ravens progressive matrices. Positive-family history males exhibited higher levels of systolic blood pressure than the negative male group and higher levels of rate pressure product than the positive-family history female group. Positive-family history males also had heart rate levels as high as the females. Female subjects did not differ from each other based on family history. In addition, subjects were grouped by gender and by high- or low-heart rate reactivity. The results suggest that heart rate reactivity has equally broad effects on cardiovascular function for males and females; for males, this reactivity during rests and tasks also tends to be associated with family history of hypertension.

Preliminary study examining relationship between family environment and resting mean arterial pressure in African-American youth

This investigation examined the relationship between family environment and mean arterial pressure in a sample of African-American youth. Completed data were collected from 46 adolescents attending an inner-city junior high school. Blood pressure measurements were assessed in a seated position with a Dinamap 1846 Vital Signs Monitor. To assess the additive effects associated with the family environment, a composite risk score (cohesion, conflict, control, and organization subscales of the Family Environment Scale) was computed. Regression analyses indicated that the cumulative risk associated with the family environment was predictive of resting mean arterial pressure.

A Question of Color The Influence of Skin Color and Stress on Resting Blood Pressure and Body Mass Among African American Women

This study describes the relative influence of facial skin color, lifetime exposure to racial discrimination, chronic stress, and traditional prehypertension risk factors (family history of hypertension and age) on resting blood pressure and body mass index (BMI) among 196 southern African American (AA) female undergraduate students. Stepwise regression analyses indicated that skin color was the strongest predictor of systolic blood pressure (SBP), diastolic blood pressure (DBP), and BMI. Skin color, chronic stress, and family history of hypertension predicted 53% of the SBP variance. Skin color, chronic stress, and family history of hypertension predicted 30.2% of the DBP variance. Racism and age were not significant predictors of SBP or DBP. Of the variance in BMI, 33% was predicted by skin color, chronic stress, and racism. Age and family history of hypertension were not predictors of BMI. The current study provides evidence of the relationship of skin color and chronic stress to blood pressure among young southern AA women. The study identifies an important relationship between increased racial stress exposure and heavier BMIs, a predictor of prehypertensive risk.

Fulfilling Ethical Responsibility: Moving Beyond the Minimal Standards of Protecting Human Subjects from Research Harm.

Problem: Rules for protecting human subjects, in place federally since 1974, have focused primarily on guarding against placing research subjects at social, physical, or psychological risk or violating their privacy and confidentiality. Nevertheless, high-risk communities are routinely subjected to “sins of omission,” which limit access to potentially significant research opportunities and result in the absence of studies that could confer high degree of community beneficence.Purpose of Article: To describe “sins of omission” and provide examples from the Community Networks Program Centers (CNPC) to illustrate how community-based participatory research (CBPR) can prevent them.Key Points: CBPR is an effective antidote to sins of omission. Activities undertaken by the CNPCs illustrate how adherence to CBPR principles can improve research access and outcomes.Conclusions: By working with community members as partners, we expand the concept of beneficence to include “community beneficence,” thus reducing the probability of “sins of omission.”

Considering the Role of Stress in Populations of High-Risk, Underserved Community Networks Program Centers

Background: Cancer disparities are associated with a broad range of sociocultural determinants of health that operate in community contexts. High-risk populations may be more vulnerable to social and environmental factors that lead to chronic stress. Theoretical and empirical research indicates that exposure to contextual and sociocultural stress alters biological systems, thereby influencing cancer risk, progression, and, ultimately, mortality.Objective: We sought to describe contextual pathways through which stress likely increases cancer risk in high-risk, underserved populations.Methods: This review presents a description of the link between contextual stressors and disease risk disparities within underserved communities, with a focus on 1) stress as a proximal link between biological processes, such as cytokine responses, inflammation, and cancer and 2) stress as a distal link to cancer through biobehavioral risk factors such as poor diet, physical inactivity, circadian rhythm or sleep disruption, and substance abuse. These concepts are illustrated through application to populations served by three National Cancer Institute-funded Community Networks Program Centers (CNPCs): African Americans in the Deep South (the South Carolina Cancer Disparities Community Network [SCCDCN]), Native Hawaiians (’Imi Hale—Native Hawaiian Cancer Network), and Latinos in the Lower Yakima Valley of Washington State (The Center for Hispanic Health Promotion: Reducing Cancer Disparities).Conclusions: Stress experienced by the underserved communities represented in the CNPCs is marked by social, biological, and behavioral pathways that increase cancer risk. A case is presented to increase research on sociocultural determinants of health, stress, and cancer risk among racial/ethnic minorities in underserved communities.

Mentoring and Training of Cancer-Related Health Disparities Researchers Committed to Community-Based Participatory Research.

Background and Objective: The National Cancer Institute’s (NCI) Community Networks Program Centers (CNPCs) provide community-based participatory research (CBPR)-oriented mentoring and training to prepare early-stage/midcareer investigators and student trainees (trainees) in disparities reduction. This paper describes the academic, mentoring, training, and work–life balance experiences of CNPC-affiliated trainees.Methods: We used a collaborative and iterative process to develop a 57-item, web-based questionnaire completed by trainees from the 23 CNPCs between August 2012 and February 2013. Their CNPC mentors completed a 47-item questionnaire. Descriptive statistics were calculated.Results: The final analytic sample included 189 of 269 individuals (70%) identified as active participants in CNPC research or training/mentoring. Mentors (n = 45) were mostly non-Hispanic White (77.8%) and 48.9% were male. Mentors published a median of 6 (interquartile range [IQR], 3–12) first-authored and 15 (IQR, 6–25) senior authored manuscripts, and secured 15 (IQR, 11–29) grants from the National Institutes of Health (NIH) and other sources in the previous 5 years. Most trainees (n = 144) were female (79.2%), 43.7% were underrepresented racial/ethnic minorities, and 36.8% were first-generation college graduates. Over the previous 5 years, trainees reported a median of 4 (IQR, 1–6) publications as first author and 4 (IQR, 2–8) as co-author; 27.1% reported having one or more NIH R01s. Trainees reported satisfaction with their CNPC mentor (79.1%) and confidence in demonstrating most CBPR competencies.Conclusion: The CNPC training program consists of a scientifically productive pool of mentors and trainees. Trainees reported rates of scholarly productivity comparable to other national training programs and provided insights into relationships with mentors, academic pressures, and professional–personal life balance.