Emotion Regulation Strategies Relate to Ambulatory Cardiovascular Activity in an American Indian Community.

OBJECTIVE: Poor emotion regulation is associated with risk for cardiovascular disease. However, much of this research is conducted in primarily White samples, thus limiting our understanding of this relationship in other racial/ethnic groups. American Indians (AIs) are uniquely and disproportionately at risk for cardiovascular disease. As such, the present study aimed to examine the relationships between emotion regulation strategies and ambulatory cardiovascular activity in an entirely AI sample. METHODS: The sample consisted of 100 AI adults living on a tribal reservation. Emotion regulation strategies (expressive suppression, cognitive reappraisal) were assessed via the Emotion Regulation Questionnaire. Using ecological momentary assessment, daily measurements of psychological stress and ambulatory cardiovascular activity were taken during a 7-day monitoring period. Statistical analyses included bivariate correlations, hierarchical linear regression models, and mediation models. RESULTS: Expressive suppression was associated with higher systolic and diastolic blood pressure, as well as higher pulse rate. In contrast, cognitive reappraisal was associated with lower systolic and diastolic blood pressure, lower pulse rate, and lower average daily psychological stress. These results remained statistically significant after adjusting for age, sex, body mass index, anxiety, depression, and early life trauma. In addition, psychological stress mediated the associations between blood pressure and cognitive reappraisal, but not expressive suppression. CONCLUSIONS: These results provide preliminary evidence for divergent associations of two emotion regulation strategies with cardiovascular activity and psychological stress in an AI community. Modifying health interventions to include training in effective emotion regulation may be beneficial.

Historical Loss: Implications for Health of American Indians in the Blackfeet Community.

BACKGROUND: Historical loss in American Indians (AIs) is believed to contribute to high incidence of mental health disorders, yet less is known about the associations between historical loss and physical health. PURPOSE: To investigate whether frequency of thought about historical loss predicts risk factors for chronic physical health conditions in an AI community. METHODS: Using Community Based Participatory research (CBPR) and Ecological Momentary Assessment (EMA), we measured frequency of thoughts about historical loss in 100 AI adults residing on the Blackfeet reservation. Participants completed a 1-week monitoring period, during which ambulatory blood pressure and daily levels of psychological stress were measured. At the end of the week, we collected a dried blood spot sample for measurement of C-reactive protein (CRP). RESULTS: In hierarchical linear regression models controlling for demographics and relevant covariates, greater frequency of thoughts about historical loss predicted higher average daily psychological stress (B = .55, t = 6.47, p < .001, ΔR2 = .30) and higher levels of CRP (B = .33, t = 3.93, p < .001, ΔR2 = .10). Using linear mixed modeling with relevant covariates, we found that greater thoughts about historical loss were associated with higher systolic ambulatory blood pressure (B = .32, 95% CI = .22-.42, t = 6.48, p < .001, ΔR2 = .25; Fig. 1c) and greater diastolic ambulatory blood pressure (B = .19, 95% CI = .11-.27, t = 4.73, p < .001, ΔR2 = .19). CONCLUSIONS: The data suggest that frequency of thought about historical loss may contribute to increased subclinical risk for cardiovascular disease in the Blackfeet community.

Historical loss: Implications for physical activity levels in American Indian adults.

PURPOSE: To investigate the relationship between daily thoughts about historical loss and daily levels of moderate to vigorous physical activity (MVPA) in American Indian (AI) adults residing on the Blackfeet reservation in Browning, Montana. METHODS: The study was designed and conducted using a community-based participatory research framework and ecological momentary assessment. Over a period of 1 week, 100 AI adults (mean age = 42.18, SD = 14.92) reported how often they thought about historical loss at the end of each day. During this week-long period, all participants wore a wrist-accelerometer to passively and objectively measure levels of physical activity. FINDINGS: We found that Blackfeet AI adults who reported thinking about historical loss more frequently over the course of the week had lower average levels of MVPA over the course of the week compared to Blackfeet AI adults who reported thinking about historical loss less frequently (B = -10.22, 95% CI = -13.83, -6.60). We also found that on days when Blackfeet AI adults thought more about historical loss compared to their weekly average, they had fewer minutes of MVPA compared to their weekly average of minutes of MVPA (B = -0.87, 95% CI = -1.48, -0.27). CONCLUSIONS: Our data indicate that thoughts about historical loss are linked to lower levels of MVPA. Given high incidence of chronic health conditions linked to physical inactivity in AIs, more work is needed to identify the mechanisms through which thoughts about historical loss may inhibit physical activity in this population.

COVID-19 and food insecurity in the Blackfeet Tribal Community.

To examine the impact of the COVID-19 pandemic on food insecurity in the Blackfeet American Indian Tribal Community. American Indian adults residing on the Blackfeet reservation in Northwest Montana (n = 167) participated in a longitudinal survey across 4 months during the COVID-19 pandemic (August 24, 2020- November 30, 2020). Participants reported on demographics and food insecurity. We examined trajectories of food insecurity alongside COVID-19 incidence. While food insecurity was high in the Blackfeet community preceding the pandemic, 79% of our sample reported significantly greater food insecurity at the end of the study. Blackfeet women were more likely to report higher levels of food insecurity and having more people in the household predicted higher food insecurity. Longitudinal data indicate that the COVID-19 pandemic exacerbated already high levels of food insecurity in the Blackfeet community. Existing programs and policies are inadequate to address this public health concern in AI tribal communities.

Covid-19 and changes in sleep health in the Blackfeet Community.

We examined changes in psychological outcomes related to the COVID-19 pandemic (ie psychological stress, perceived control, and perceived ability to cope) and changes in sleep health in the American Indian Blackfeet community over 4 months (August 24, 2020-November 30, 2020). American Indian adults residing on the Blackfeet reservation (n = 167) completed measures of perceived control over contracting COVID-19, perceived ability to cope with pandemic stressors, psychological stress linked to the pandemic, and a measure of sleep health each month. Linear-effects mixed models were used to examine changes in our outcomes. Community members who reported more control over contracting the virus had better sleep health relative to those who reported less control (B = 0.72, SE = 0.29, p = 0.015). Further, during months when individuals felt they had more control over contracting the virus compared to their average perceived control levels, they had better sleep health relative to their own average (B = 1.06, SE = 0.13, p < 0.001). Average sleep health was the lowest in October, 2020, the month during which COVID-19 incidence was at its highest on the reservation. Declines in sleep health linked to low levels of control over contracting COVID-19 may exacerbate high incidence of chronic mental and physical health conditions in tribal communities. Interventions which highlight strategies known to reduce risk of contracting the virus, may increase perceived control and sleep health, and thus may improve downstream health outcomes for this at-risk population.

Loneliness and sleep in the American Indian Blackfeet community.

BACKGROUND: Sleep is largely understudied in American Indians (AIs), even though sleep is implicated in the chronic diseases which disproportionately affect AI communities. OBJECTIVE: To investigate relationships between daily self-reported loneliness and sleep as measured with actigraphy. METHODS: In a sample of 98 Blackfeet adults living on the Blackfeet reservation in Montana, we used Ecological Momentary Assessment and actigraphy over a week-long period to investigate relationships between loneliness and sleep. Loneliness was measured daily using the Short Loneliness Scale and actigraphy was used to measure total sleep time, sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE). RESULTS: Using a series of generalized linear mixed-effects models controlling for demographic characteristics, anxiety and depressive symptoms, and adverse childhood experiences, we found that those who were lonelier had higher WASO and SOL, and lower SE relative to those who were less lonely. Within-subject effects indicate that participants who were lonelier for a given day relative to their own weekly average had higher WASO that night relative to their own weekly average. CONCLUSIONS: Our findings provide initial preliminary evidence suggesting that loneliness may be a psychosocial factor which contributes to poor sleep in AI communities.