Rumination mediates associations between microaggressions and sleep quality in Black Americans: the toll of racial microstressors.

Disparities in health outcomes between Black and White Americans are well-documented, including sleep quality, and disparities in sleep may lead to disparities in health over the life course. A meta-model indicates that cognitive processes may underly the connection between race and poor sleep quality, and ultimately, health disparities. That is, there are race-specific stressors that disproportionately affect Black Americans, which are associated with poor health through biological, cognitive, and behavioral mechanisms (e.g., sleep). Among these race-specific stressors is discrimination, which has been linked to poor sleep quality, and there is a body of literature connecting perseverative cognition (e.g., rumination and worry or vigilance) to poor sleep. Microaggressions, a more subtle but pervasive form of discrimination, are another race-specific stressor. Although less research has considered the connection of microaggressions to perseverative cognition, there are some studies linking microaggressions to health outcomes and sleep. Therefore, using a cross-sectional survey, we tested the following hypotheses: racism-related vigilance and rumination would mediate the relationship between discrimination and poor sleep as well as between microaggressions and poor sleep among Black Americans (N = 223; mean age = 35.77 years, 53.8% men, 86% employed, 66.8% with college degree or higher education). Results of seven parallel mediation models showed that neither rumination nor racism-related vigilance mediated a relationship between discrimination and poor sleep quality. However, rumination partially mediated relationships between the six microaggression sub-scales and poor sleep quality: there were significant indirect effects for Foreigner/Not Belonging (ß = .13, SE = 0.03, 95% CI 0.08, 0.20), Criminality (ß = .11, SE = 0.03, 95% CI 0.05, 0.17), Sexualization (ß = .10, SE = 0.03, 95% CI 0.05, 0.17), Low-Achieving/Undesirable (ß = .10, SE = 0.03, 95% CI 0.05, 0.15), Invisibility (ß = .15, SE = 0.04, 95% CI 0.08, 0.23), and Environmental Invalidations (ß = .15, SE = 0.04, 95% CI 0.08, 0.23). Overall, these findings indicate support for the meta-model, demonstrating a specific pathway from racial microstressors to poor sleep quality. Furthermore, these results suggest the importance of developing clinical and community approaches to address the impact of microaggressions on Black Americans' sleep quality.

Evaluating skills for psychological recovery with gunshot injury survivors in a hospital-based early intervention program.

Gun violence is a serious public health problem that places surviving victims at increased risk for a variety of mental health problems, including posttraumatic stress disorder (PTSD) and depression. Recognizing that many gunshot injury survivors lack access to mental health care in the early aftermath of a shooting, there has been growing interest in the use of early, preventive mental health interventions to help prevent long-term mental health complications like PTSD as part of routine care for survivors in acute medical settings, where initial outreach to survivors may be more successful. This study evaluates clinical outcomes associated with one such early intervention-Skills for Psychological Recovery (SPR)-provided to gunshot injury survivors as part of a hospital-based early intervention program embedded in a Level 1 trauma center in the Midwestern United States. Clinic data from 100 survivors (74.0% male, 78.0% Black/African American) who received SPR were included in the present study. Results suggest that receiving SPR in the early aftermath of a shooting is associated with statistically significant reductions in both PTSD, F(1, 26.77) = 22.49, p < .001, and depression, F(1, 29.99) = 6.49, p = .016, symptoms. Outcomes did not vary as a function of either PTSD risk status or intervention delivery method (i.e., in-person, telehealth). These findings support the effectiveness and acceptability of SPR as an early intervention for gunshot injury survivors when delivered as part of a hospital-based early intervention program. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Finding benefits in a cardiac event: Direct links with positive affect and healthy dietary behaviors during cardiac rehabilitation.

Benefit finding (BF) may be a coping strategy that positively influences outcomes after a stressful event, but previous studies provide an inconsistent pattern of results across several different patient populations. This study aimed to reconcile these inconsistencies by testing whether positive affect related to a cardiac event (PA) mediates the relationship between BF and healthy dietary behaviors, and whether this mediating relationship is stronger for participants high in disease severity. Participants were patients with cardiovascular disease in a cardiac rehabilitation program. Results supported partial mediation, but the interaction was not as predicted: participants low in disease severity showed a stronger relationship between BF and PA than their counterparts high in disease severity. Additionally, the PA/healthy dietary behaviors relationship was negative. Health providers may encourage patients in CR to engage in BF, but also to make thoughtful food decisions when in a positive mood, especially for patients low in disease severity.

Characterization of a Regional Childhood Obesity Prevention and Treatment System.

This project characterized the system of childhood obesity-related programs and functions based on a socioecological framework within the Kansas City region to determine strengths, weaknesses, and leverage points for informing collective impact. A mixed-method approach was employed to identify and collect data ∼260 childhood obesity-related programs provided by 89 organizations. Findings indicated no major gaps in population or location served although few programs specifically focused on service to minority groups or neighborhoods. The region has many programs working within the system, yet the distribution of programs does not occur as expected throughout the dimensions of a standard socioecological model or community health system. In addition, several organizations perform certain leadership functions such as coordination, resource allocation, or monitoring, but none perform all, indicating the lack of a traditional "backbone" organization. These findings demonstrate how a region's childhood obesity prevention and treatment programs can be evaluated using a socioecological framework.

Development and Psychometric Properties of the Self-Blame Attributions for Cancer Scale.

OBJECTIVES: To adapt the Cardiac Self-Blame Attributions Scale into the Self-Blame Attributions for Cancer Scale (SBAC) for use in patients with cancer and analyze its psychometric properties. SAMPLE & SETTING: 113 patients receiving radiation therapy at the University of Kansas Cancer Center. METHODS & VARIABLES: The SBAC and other self-report measures were administered during outpatient oncology appointments for radiation therapy to establish the psychometric properties of the SBAC. RESULTS: A two-factor structure represented behavioral and characterological self-blame attributions. Reliability estimates for each factor were excellent and evidence of convergent and discriminant validity was found, indicating support for the SBAC as a valid and reliable measure of self-blame attributions in patients with cancer. IMPLICATIONS FOR NURSING: The SBAC may help healthcare providers, including nursing staff, to identify the self-blame patterns exhibited by patients with cancer. Future research can assess the reliability and validity of SBAC across stages of treatment and establish the predictive validity of the scale in individuals with cancer.

Stability in Cardiac Attributions Before and After Cardiac Rehabilitation.

PURPOSE: This study examined temporal patterns in causal attributions generated by patients with cardiovascular disease before and after cardiac rehabilitation (CR). DESIGN: Qualitative, descriptive survey. METHODS: Eighty-six participants were asked what they believed was the primary cause of their cardiac events. Cardiac attributions were collected at the beginning of CR, at the end of CR, and 15 months after baseline. FINDINGS: Content analyses showed that heredity and behavior were the most commonly generated causes. Most participants showed stability in attributions over time, although we found a trend for more participants endorsing behavioral attributions at the end of the study. CONCLUSIONS: Cardiac attributions remain relatively stable across time. CLINICAL RELEVANCE: Cardiac rehabilitation staff should approach patients differently, depending on their causal narratives. Some patients enter CR understanding that behavior played a causal role, whereas some do not. Encouraging appreciation of the importance of behavior in cardiovascular disease onset and recurrence is vital.

Multilevel Factors Predicting Cardiac Rehabilitation Attendance and Adherence in Underserved Patients at a Safety-Net Hospital.

PURPOSE: This study examined multilevel factors as predictors of cardiac rehabilitation (CR) attendance and adherence among underserved patients at a safety-net hospital (SNH). METHODS: Participants were recruited during hospitalization for a cardiac procedure or event. Participants responded to a questionnaire, and outcome data (including CR attendance and adherence) were extracted from medical records at baseline and 6 mo post-discharge. RESULTS: Data were collected from 171 participants, 92 (53.8%) of whom attended CR. On average, participants completed 24 CR sessions (66.7% adherence) and 40 (43.5%) participants fully adhered to the 36 prescribed sessions. Bivariate comparisons showed that participants who attended CR were more likely to have insurance (P = .002), perceive CR as important (P = .008), believe they needed CR (P = .005), and endorsed fewer barriers to CR (P = .005) than their nonattending counterparts. After controlling for insurance status, a regression analysis to predict attendance revealed only 1 predictor; perceived lack of time (P = .04). Bivariate analyses showed that only 1 clinical factor, treatment during hospitalization, was significantly related to adherence (P = .03). Patients with medical management alone (no revascularization) showed less adherence than their counterparts with revascularization. CONCLUSIONS: Although access to insurance is a significant predictor of attendance, psychological barriers that are amenable to being addressed by CR staff are also important. Findings suggest that perceived lack of time is important in SNH patient decision making to attend CR. This psychological barrier is a subject on which CR staff can intervene to educate patients about the life expectancy increases and decreased personal health care expenditures because of attendance.

Scale development and psychometric properties of the Cardiac Self-Blame Attributions scale in patients with cardiovascular disease.

Patients with cardiovascular disease may attribute their cardiovascular disease to their behaviors (behavioral self-blame) or to their dispositions (characterological self-blame). However, findings are mixed on the effects of behavioral self-blame and characterological self-blame on health outcomes, possibly because there are no validated, multiple-item measures. This study developed and tested an 11-item Cardiac Self-Blame Attributions scale via questionnaire data from 121 patients with cardiovascular disease. Results yielded a two-factor structure that explained 65 percent of the variance, with good reliability and discriminant validity. Findings suggest that the scale is reliable and valid and can be used to understand the cardiac attributions patients create.

Marginal Emissions Factors for Electricity Generation in the Midcontinent ISO.

Environmental consequences of electricity generation are often determined using average emission factors. However, as different interventions are incrementally pursued in electricity systems, the resulting marginal change in emissions may differ from what one would predict based on system-average conditions. Here, we estimate average emission factors and marginal emission factors for CO2, SO2, and NOx from fossil and nonfossil generators in the Midcontinent Independent System Operator (MISO) region during years 2007-2016. We analyze multiple spatial scales (all MISO; each of the 11 MISO states; each utility; each generator) and use MISO data to characterize differences between the two emission factors (average; marginal). We also explore temporal trends in emissions factors by hour, day, month, and year, as well as the differences that arise from including only fossil generators versus total generation. We find, for example, that marginal emission factors are generally higher during late-night and early morning compared to afternoons. Overall, in MISO, average emission factors are generally higher than marginal estimates (typical difference: ∼20%). This means that the true environmental benefit of an energy efficiency program may be ∼20% smaller than anticipated if one were to use average emissions factors. Our analysis can usefully be extended to other regions to support effective near-term technical, policy and investment decisions based on marginal rather than only average emission factors.

Marginal Emission Factors Considering Renewables: A Case Study of the U.S. Midcontinent Independent System Operator (MISO) System.

Estimates of marginal emission factors (MEFs) for the electricity sector have focused on emitting sources only, assuming nonemitting renewables rarely contribute to marginal generation. However, with increased penetration and improved dispatch of renewables, this assumption may be outdated. Here, we improve the methodology to incorporate renewables in MEF estimates and demonstrate a case study for the Midcontinent Independent System Operator (MISO) system where wind has been commonly dispatched on the margin. We also illustrate spatiotemporal variations of MEFs and explore implications for energy storage technologies. Results show that because the share of renewables in MISO is still relatively low (6.34%), conventional MEFs focused on emitting sources can provide a good estimate in MISO overall, as well as in the Central and South subregions. However, in the MISO North subregion where wind provides 22.5% of grid generation, neglecting nonemitting sources can overestimate MEFs for CO2, SO2, and NOx by about 30%. The application of expanded MEFs in this case also reveals heightened emission increases associated with load shifting of storage technologies. Our study highlights the importance of expanded MEFs in regions with high and growing renewables penetration, particularly as renewable energy policy seeks to incorporate demand-side technologies.

The Leakage Risk Monetization Model for Geologic CO2 Storage.

We developed the Leakage Risk Monetization Model (LRiMM) which integrates simulation of CO2 leakage from geologic CO2 storage reservoirs with estimation of monetized leakage risk (MLR). Using geospatial data, LRiMM quantifies financial responsibility if leaked CO2 or brine interferes with subsurface resources, and estimates the MLR reduction achievable by remediating leaks. We demonstrate LRiMM with simulations of 30 years of injection into the Mt. Simon sandstone at two locations that differ primarily in their proximity to existing wells that could be leakage pathways. The peak MLR for the site nearest the leakage pathways ($7.5/tCO2) was 190x larger than for the farther injection site, illustrating how careful siting would minimize MLR in heavily used sedimentary basins. Our MLR projections are at least an order of magnitude below overall CO2 storage costs at well-sited locations, but some stakeholders may incur substantial costs. Reliable methods to detect and remediate leaks could further minimize MLR. For both sites, the risk of CO2 migrating to potable aquifers or reaching the atmosphere was negligible due to secondary trapping, whereby multiple impervious sedimentary layers trap CO2 that has leaked through the primary seal of the storage formation.

A pilot study of an Internet walking program and pedometer in COPD.

BACKGROUND: Higher levels of physical activity are associated with better functional status, fewer hospital admissions, and lower mortality. In this pilot study, we examined the feasibility and safety of a novel program that combines a pedometer with a website to increase walking. METHODS: 27 persons with stable COPD wore the Omron HJ-720ITC pedometer and used the website for 90 days. They uploaded step-count data to the study server using their home computer and received an email each week with their individualized step-count goal. The website provided step-count feedback, education, and motivational content. Subjects participated in a monthly semi-structured interview by telephone. Subjects reported changes in medical condition by telephone or on the website. Paired T-tests assessed change in daily step counts. RESULTS: Subjects were males, mean age 72 ± 8 years, with moderate COPD, FEV(1) 1.57 ± 0.48 L (55 ± 16% predicted). 87% and 65% reported no problems using the pedometer and website, respectively. At month 3, 96% reported it was true that they knew their step count goal every day, and 52% reported that they were able to reach their goal. 95% of participants said they would recommend the walking program to another person with COPD. Eight subjects experienced breathing problems unrelated to the intervention. In 24 subjects with step counts at baseline and month 3, there was a significant increase of 1263 steps per day (approximately 1.0 km), p = 0.0054. CONCLUSIONS: The use of a website and pedometer was feasible and safe, and persons increased their daily walking.

Vehicle emissions during children's school commuting: impacts of education policy.

We explore how school policies influence the environmental impacts of school commutes. Our research is motivated by increased interest in school choice policies (in part because of the U.S. "No Child Left Behind" Act) and in reducing bus service to address recent budget shortfalls. Our analysis employs two samples of elementary-age children, age 5-12: a travel survey (n = 1246 respondents) and a school enrollment data set (n = 19,655 students). Multinomial logistic regression modeled the determinants of travel mode (automobile, school bus, and walking; n = 803 students meeting selection criteria). Travel distance has the single greatest effect on travel mode, though school choice, trip direction (to- or from-school), and grade play a role. Several policies were investigated quantitatively to predict the impact on school travel, vehicle emissions, and costs. We find that eliminating district-wide school choice (i.e., returning to a system with neighborhood schools only) would have significant impacts on transport modes and emissions, whereas in many cases proposed shifts in school choice and bus-provision policies would have only modest impacts. Policies such as school choice and school siting may conflict with the goal of increasing rates of active (i.e., nonmotorized) school commuting. Policies that curtail bus usage may reduce bus emissions but yield even larger increases in private-vehicle emissions. Our findings underscore the need to critically evaluate transportation-related environmental and health impacts of currently proposed changes in school policy.

Wind deployment in the United States: states, resources, policy, and discourse.

A transformation in the way the United States produces and uses energy is needed to achieve greenhouse gas reduction targets for climate change mitigation. Wind power is an important low-carbon technology and the most rapidly growing renewable energy technology in the U.S. Despite recent advances in wind deployment, significant state-by-state variation in wind power distribution cannot be explained solely by wind resource patterns nor by state policy. Other factors embedded within the state-level socio-political context also contribute to wind deployment patterns. We explore this socio-political context in four U.S. states by integrating multiple research methods. Through comparative state-level analysis of the energy system, energy policy, and public discourse as represented in the media, we examine variation in the context for wind deployment in Massachusetts, Minnesota, Montana, and Texas. Our results demonstrate that these states have different patterns of wind deployment, are engaged in different debates about wind power, and appear to frame the risks and benefits of wind power in different ways. This comparative assessment highlights the complex variation of the state-level socio-political context and contributes depth to our understanding of energy technology deployment processes, decision-making, and outcomes.

Reducing motor vehicle greenhouse gas emissions in a non-California state: a case study of Minnesota.

Approaches for reducing greenhouse gas (GHG) emissions from motor vehicles include more-efficient vehicles, lower-carbon fuels, and reducing vehicle-kilometers traveled (VKT). Many U.S. states are considering steps to reduce emissions through actions in one or more of these areas. We model several technology and policy options for reducing GHGs from motor vehicles in Minnesota. Considerable analysis of transportation GHGs has been done for California, which has a large population and vehicle fleet and can enact unique emissions regulations; Minnesota represents a more typical state with respect to many demographic and transportation parameters. We conclude that Minnesota has a viable approach to meeting its stated GHG reduction targets (15% by 2015 and 30% by 2025, relative to year 2005) only if advancements are made in all three areas-vehicle efficiency, carbon content of fuels, and VKT. If policies focus on only one or two areas, potential improvements may be negated by backsliding in another area (e.g., increasing VKT offsetting improvements in vehicle efficiency).

Regulating geologic sequestration in the United States: early rules take divergent approaches.

Regulations for geological sequestration (GS) of carbon dioxide (CO2) have been adopted in the state of Washington and proposed by the state of Kansas and the U.S. Environmental Protection Agency (EPA) Underground Injection Control (UIC) Program. These three sets of rules take significantly different approaches to regulating GS of CO2. This paper compares these rules, focusing on elements where their differences highlight the choices that must be made to create a regulatory framework for GS in the United States. Consensus is emerging in some areas, but there is still substantial disagreement regarding the allowable composition of the CO2 stream, the size of the area of review, reservoir performance goals, and management of risks other than those to groundwater. Gaps include issues related to ownership of subsurface pore space, greenhouse gas accounting, and long-term stewardship. The divergent approaches of these rules raise two overarching questions: (1) Should policy makers create GS regulations by modifying and supplementing UIC rules or through new enabling legislation? (2) What should be the relative roles of state and federal governments in GS regulation? We outline trade-offs between the consistency and coordination that federal involvement could offer and the reality that states need to be heavily involved with implementation of GS regulations. We conclude that federal involvement above and beyond the proposed EPA Class VI rules is needed to create effective GS regulation in the United States.

Reducing greenhouse gas emissions for climate stabilization: framing regional options.

The Intergovernmental Panel on Climate Change (IPCC) has stated that stabilizing atmospheric CO2 concentrations will require reduction of global greenhouse gas (GHG) emissions by as much as 80% by 2050. Subnational efforts to cut emissions will inform policy development nationally and globally. We projected GHG mitigation strategies for Minnesota, which has adopted a strategic goal of 80% emissions reduction by 2050. A portfolio of conservation strategies, including electricity conservation, increased vehicle fleet fuel efficiency, and reduced vehicle miles traveled, is likely the most cost-effective option for Minnesota and could reduce emissions by 18% below 2005 levels. An 80% GHG reduction would require complete decarbonization of the electricity and transportation sectors, combined with carbon capture and sequestration at power plants, or deep cuts in other relatively more intransigent GHG-emitting sectors. In order to achieve ambitious GHG reduction goals, policymakers should promote aggressive conservation efforts, which would probably have negative net costs, while phasing in alternative fuels to replace coal and motor gasoline over the long-term.

Environmental bonds and the challenge of long-term carbon sequestration.

The potential to capture carbon from industrial sources and dispose of it for the long-term, known as carbon capture and sequestration (CCS), is widely recognized as an important option to reduce atmospheric carbon dioxide emissions. Specifically, CCS has the potential to provide emissions cuts sufficient to stabilize greenhouse gas levels, while still allowing for the continued use of fossil fuels. In addition, CCS is both technologically-feasible and commercially viable compared with alternatives with the same emissions profile. Although the concept appears to be solid from a technical perspective, initial public perceptions of the technology are uncertain. Moreover, little attention has been paid to developing an understanding of the social and political institutional infrastructure necessary to implement CCS projects. In this paper we explore a particularly dicey issue--how to ensure adequate long-term monitoring and maintenance of the carbon sequestration sites. Bonding mechanisms have been suggested as a potential mechanism to reduce these problems (where bonding refers to financial instruments used to ensure regulatory or contractual commitments). Such mechanisms have been successfully applied in a number of settings (e.g., to ensure court appearances, completion of construction projects, and payment of taxes). The paper examines the use of bonding to address environmental problems and looks at its possible application to nascent CCS projects. We also present evidence on the use of bonding for other projects involving deep underground injection of materials for the purpose of long-term storage or disposal.