Kathy Wright

Hair Cortisol Analysis: A Promising Biomarker of HPA Activation in Older Adults

Prolonged stress is a potentially harmful and often undetected risk factor for chronic illness in older adults. Cortisol, one indicator of the bodys hormonal responses to stress, is regulated by the hypothalamic-pituitary-adrenal (HPA) axis and is commonly measured in saliva, urine, or blood samples. Cortisol possesses a diurnal pattern and thus collection timing is critical. Hair cortisol is a proxy measure to the total retrospective activity of the HPA axis over the preceding months, much like hemoglobin A1c is a proxy measure of glucose control over the past 3 months. The aim of this review is to examine a novel biomarker, hair cortisol, as a practical measure of long-term retrospective cortisol activity associated with chronic stress in older adults. Hair cortisol analysis advances the science of aging by better characterizing chronic stress as a risk factor for chronic illness progression and as a biomarker of the effectiveness of stress reduction interventions.

Collecting Hair Samples for Hair Cortisol Analysis in African Americans

The hormone cortisol is typically assessed in saliva, serum, or urine samples. More recently, cortisol has been successfully extracted from hair, including humans. The advantage of hair cortisol concentration is that it reflects a retrospective representation of hypothalamic-pituitary-adrenal (HPA) axis function over time, much like hemoglobin A1C represents glycemic control. However, obtaining hair samples can be challenging, due to the cultural beliefs and hair care practices of minority participants. For example, African Americans may be reluctant to provide samples. Additionally, few researchers are trained to collect hair samples from African Americans. The purpose of this paper is to present a culturally informed protocol to help researchers obtain hair samples from African Americans. To illustrate the representative results of this protocol implementation, de-identified data from African Americans that participated in a community-based study on chronic stress are provided. Hair practice preferences are assessed. The participants are made comfortable by showing pictures of hair samples prior to cutting their hair. The single strain twist and gently pull method is used to collect approximately 30 - 50 strands of hair from the posterior vertex region of the scalp. This protocol will significantly improve collection of hair samples from African Americans.

Take an opportunity whenever you get it: Information sharing among African-American women with hypertension

Nearly half of African‐American women have hypertension, which increases their risk for cardiovascular disease and stroke. A plethora of consumer health information products and services exist to inform people with hypertension and to promote self‐management among them. Promotion of information sharing by African‐American women represents a promising, culturally applicable strategy for consumer health information services focused on hypertension self‐management. Yet how African‐American women share hypertension information with others is unclear. The purpose of this qualitative, descriptive study was to examine practices of information sharing in African‐American women with hypertension. Thirteen women (mean age = 73, SD = 9.87) participated in one of 2 focus groups held at an urban community health center. Thematic analysis revealed that the women shared information about how they self‐managed their blood pressure i) with female family members and friends, ii) about ways in which they adapted self‐management strategies to work for them, iii) mostly in group settings, and iv) because they wanted to prevent others from suffering and reinforce their own knowledge about hypertension self‐management. New findings emerged regarding assessing “readiness” for information. Study findings will be used to inform the design of an information‐sharing intervention to support self‐management of hypertension in African‐American women.

Opportunities for the Advanced Practice Nurse to Enhance Hypertension Knowledge and Self-management Among African American Women

Purpose: Despite increased awareness and the advent of methods to manage the disease, hypertension is poorly controlled among African American women. This study explored hypertension knowledge and blood pressure in a sample of African American women. Design: A descriptive, cross-sectional design was used to collect survey data on hypertension knowledge. Methods: African American women attending a church conference were invited to complete a questionnaire, which included the Check Your High Blood Pressure Prevention IQ survey, and had their blood pressures measured. Results: Of the 151 women who participated, 62% were diagnosed with hypertension. Many of the women, even those not diagnosed with hypertension, had elevated blood pressures. Although the average scores showed that the women scored well on the survey, there were 4 items on the survey that a percentage of the women had difficulty with: questions about (1) stress as a cause of hypertension, (2) symptoms associated with high blood pressure, (3) whether hypertension could be cured, and (4) the amount of exercise needed to help reduce blood pressure. Conclusion: Despite efforts to increase awareness and control of hypertension, considerable misconceptions about the disease were found in this sample of African American women. To improve self-management of hypertension among this group, advanced practice nurses need to directly address these misconceptions.