Superwomen and Sleep: an Assessment of Black College Women Across the African Diaspora.

BACKGROUND: Women and racial/ethnic minority groups in the U.S. report poor sleep health. While stress and alcohol use may contribute to sleep problems, few studies have examined the roles of stress and alcohol use on sleep among Black college women. Gender-racial ideology of Black womanhood may also play a role in sleep. This exploratory study sought to examine the relationships between stress, alcohol, ethnic-gender identity, and sleep. METHOD: Guided by the biopsychosocial model and intersectionality theory, a cross-sectional study design recruited undergraduate women (18-24 years) attending a Historically Black College and University (HBCU) who self-identified as Black (N = 110). Participants completed the Insomnia Severity Index, Pittsburgh Sleep Quality Index, Perceived Stress Scale, Alcohol Use Disorders Test, and Giscombe Superwoman Schema Questionnaire. Univariate and multiple linear regressions were conducted to examine independent and multiple effects of stress, alcohol, and ethnic-gender identity on insomnia and sleep quality. RESULTS: Participants (mean age 19.4 years) represented diverse ethnic groups, 53% American, 25% African, and 20% Caribbean. Nearly 23% reported moderate to severe levels of insomnia. Scores from the Perceived Stress Scale, the Alcohol Use Disorders Test, and the Giscombe Superwoman Schema Questionnaire were independently associated with insomnia and sleep quality. In multivariate analyses, only perceived stress exhibited a significant association with insomnia and sleep quality. CONCLUSION: This exploratory study demonstrated that stress, excessive alcohol use, and ethnic-gender identity have relational impact on sleep health. Yet, stress may have greater importance and further research is needed to explore factors that mediated the relationship between stress and sleep.

Factors Associated with Exercise Motivation among African-American Men.

OBJECTIVE: The primary aims of this study were to: (1) characterize exercise stages of change among a sample of African-American men, (2) determine if exercise motivation was associated with self-reported exercise behavior, and (3) examine if groups of personal (i.e., age, BMI, income, educational attainment, and perceived health), psycho-social (i.e., exercise self-efficacy, personality type, social influence), and environmental factors (i.e., neighborhood safety) predicted stages of change for physical exercise among African-American men. METHODS: One hundred seventy African-American male participants were recruited for this study (age: 47.63(10.23) years). Participants completed a self-report questionnaire assessing study variables. Multinomial logistic regression models were used to examine the association of exercise stages of change with an array of personal, psychosocial, and environmental factors. RESULTS: BMI, exercise self-efficacy, and nighttime neighborhood safety were entered as independent variables in the full model. BMI and exercise self-efficacy continued to be significant predictors of exercise stages of change in the full model. Obese men had a 9.24 greater odds of being in the action stage of change than in the maintenance stage. Also, men reporting greater exercise self-efficacy had lower odds of being in the lower stages of change categories (pre-preparation, preparation, and action) than in the maintenance stage. CONCLUSION: Our results confirmed that using an ecological framework explained more of the variance in exercise stages of change than any of the individual components alone. Information gleaned from this study could inform interventionists of the best ways to create tailored exercise programs for African-American men.

Standardized patient assessment of medical student empathy: ethnicity and gender effects in a multi-institutional study.

PURPOSE: To examine, primarily, the effects of ethnicity and gender, which could introduce bias into scoring, on standardized patient (SP) assessments of medical students and, secondarily, to examine medical students' self-reported empathy for ethnicity and gender effects so as to compare self-perception with the perceptions of SPs. METHOD: Participants were 577 students from four medical schools in 2012: 373 (65%) were white, 79 (14%) black/African American, and 125 (22%) Asian/Pacific Islander. These students were assessed by 84 SPs: 62 (74%) were white and 22 (26%) were black/African American. SPs completed the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) and the Global Ratings of Empathy tool. Students completed the Jefferson Scale of Empathy and two Interpersonal Reactivity Index subscales. The investigators used 2,882 student-SP encounters in their analyses. RESULTS: Analyses of SPs' assessments of students' empathy indicated significant interaction effects of gender and ethnicity. Female students, regardless of ethnicity, obtained significantly higher mean JSPPPE scores than men. Female black/African American, female white, and female Asian/Pacific Islander students scored significantly higher on the JSPPPE than their respective male counterparts. Male black/African American students obtained the lowest SP assessment scores of empathy regardless of SP ethnicity. Black/African American students obtained the highest mean scores on self-reported empathy. CONCLUSIONS: The significant interaction effects of ethnicity and gender in clinical encounters, plus the inconsistencies observed between SPs' assessments of students' empathy and students' self-reported empathy, raise questions about possible ethnicity and gender biases in the SPs' assessments of medical students' clinical skills.

Family history of cancer associated with breast tumor clinicopathological features.

Hereditary breast cancers have unique clinicopathological characteristics. Therefore, the objective of this study was to establish the relationship between self-reported family history of cancer and clinicopathological features in breast cancer patients from Washington, DC. Data on incident breast cancer cases from 2000 to 2010 were obtained from the Washington, DC Cancer Registry. Variables such as estrogen (ER), progesterone (PR), and human epidermal growth factor 2 (HER2) receptor status, as well as stage and grade, were analyzed in those that self-reported with (n = 1,734) and without a family history of cancer (n = 1,712). The breast cancer molecular subtypes were compared when ER, PR, and HER2 statuses were available. Furthermore, tumor characteristics were compared by race/ethnicity. Regression and chi-square analyses were performed. A report of family history was associated with age (OR = 1.27 95 % CI: 1.09-1.48; p < 0.0001), high grade tumors (OR = 1.29 95 % CI: 1.05-1.58; p = 0.02), and having ER and PR negative breast cancer (OR = 1.26 95 % CI: 1.02-1.57; p = 0.029). When tumor characteristics were compared by race/ethnicity, those that self-reported as African American with a family history had a higher frequency of ER negative tumors (OR = 1.51 95 % CI: 1.09-2.08; p = 0.008), PR negative tumors (OR = 1.46 95 % CI: 1.09-1.94; p = 0.028), grade 3 tumors (OR = 1.42 95 % CI: 1.05-1.93; p < 0.0001), and ER/PR negative tumors (OR = 1.5 95 % CI: 1.088-2.064; p = 0.01). These results suggest that a positive family history of cancer in African Americans should increase suspicions of hereditary cancer. Therefore, behavioral risk reduction activities, such as collecting a family history, may reduce late stage diagnosis and cancer mortality.

An exploratory analysis of fear of recurrence among African-American breast cancer survivors.

BACKGROUND: Fear of recurrence (FOR) is a psychological concern that has been studied extensively in cancer survivors but has not been adequately examined in African-American breast cancer survivors. PURPOSE: This exploratory study describes the extent and nature of FOR in African-American breast cancer survivors. FOR is examined in relation to socio-demographic characteristics, treatment-related characteristics, psychological distress, and quality of life (QOL). METHODS: Participants completed questionnaires assessing FOR, psychological distress, QOL, and demographic and treatment characteristics. Pearson r correlations, t tests, and ANOVAs were used to determine the association between FOR and demographic and treatment-related characteristics. Hierarchical multiple regression models were performed to investigate the degree to which FOR dimensions account for the variance in QOL and psychological distress. RESULTS: Fifty-one African-American breast cancer survivors participated in this study. The mean age of participants was 64.24 (SD = 12.3). Overall fears as well as concerns about death and health were rated as low to moderate. Role worries and womanhood worries were very low. Inverse relationships were observed between age and FOR dimensions. FOR was positively correlated with measures of psychological distress and negatively correlated with QOL. FOR significantly accounted for a portion of the variance in QOL and distress after controlling for other variables. CONCLUSIONS: This study suggests that African-American women in this sample demonstrated some degree of FOR. Results indicate that FOR among African-American breast cancer survivors decreases with age and time since diagnosis and co-occurs with psychological distress as well as diminished quality of life.

Priorities of low-income urban residents for interventions to address the socio-economic determinants of health.

OBJECTIVES: To determine the priorities of low-income urban residents for interventions that address the socio-economic determinants of health. METHODS: We selected and estimated the cost of 16 interventions related to education, housing, nutrition, employment, health care, healthy behavior, neighborhood improvement, and transportation. Low-income residents of Washington, D.C. (N=431) participated in decision exercises to prioritize these interventions. RESULTS: Given a budget valued at approximately twice an estimated cost of medical and dental care ($885), the interventions ultimately prioritized by the greatest percentage of individuals were: health insurance (95%), housing vouchers (82%) dental care (82%), job training (72%), adult education (63%), counseling (68%), healthy behavior incentives (68%), and job placement (67%). The percentages of respondents who received support for housing, adult education, and job training and placement were far less than the percentage who prioritized these interventions. CONCLUSIONS: Poor and low-income residents' priorities may usefully inform allocation of social services that affect health.

Impact of perceived racial discrimination on health screening in black women.

Perceived discrimination has been shown to be related to health screening behavior. The present study examines the effect of discrimination on cancer screening among women in the Black Women's Health Study. Five self-report items measured discrimination in everyday life and three items measured experiences of major discrimination. Logistic regression was used to test associations of discrimination with Pap smear, mammography, or colonoscopy utilization. At the start of follow-up, 88.8% had a Pap smear in the previous year, 52.7% had a mammogram, and 20.0% had received a colonoscopy. Both everyday and major discrimination were associated with not having received a Pap smear, even after adjusting for other variables. Discrimination was not associated with mammography or colonoscopy utilization. In conclusion, perceived everyday and major discrimination is associated with poorer utilization of Pap smears for cervical cancer screening among Black women.

Validation of physical activity instruments: Black Women's Health Study.

PURPOSE: Few studies have reported on the validity of physical activity measures in African Americans. The present study was designed to determine the validity of a self-administered physical activity questionnaire (PAQ) that was used in a large prospective study of African American women in the United States against an accelerometer (actigraph), an objective assessment of movement, and a seven-day activity diary. METHODS: The study was conducted among 101 women enrolled in the Black Women's Health Study (BWHS) cohort who resided in the Washington, DC, metropolitan area, representing 11.2% (101/900) of this sample. Physical activity levels were obtained from the parent BWHS PAQ (eg, 1997 and 1999) and repeated in the present study. This information entailed hours per week of participation in walking for exercise, hours per week of moderate activity (eg, housework, gardening, and bowling), and hours per week of strenuous activity (eg, basketball, swimming, running, and aerobics) during the previous year. The participants were required to wear actigraphs for seven days and then record their physical activities in their diaries (seven-day physical activity diary) during this time. The diaries were used to record the amount and pattern of daily energy expenditure. RESULTS: Significant positive correlations were seen between the BWHS PAQ and the actigraph for total activity, r=.28; walking, r=.26; and vigorous activity, r=.40, P<.001. For the seven-day physical activity diary, the BWHS PAQ also demonstrated significant correlations for total (r=0.42, P<.01); moderate (r=.26, P<.05); and vigorous activities (r=.41, P<.01). CONCLUSIONS: The BWHS PAQ is a useful measure of physical activity in the BWHS cohort and thus has utility in prospective epidemiologic research.

gamma-Radiation-induced chromosomal mutagen sensitivity is associated with breast cancer risk in African-American women: caffeine modulates the outcome of mutagen sensitivity assay.

Several different cancer studies have indicated that lymphocyte mutagen sensitivity is a marker of DNA repair deficiency and increased cancer risk. We have used a mutagen sensitivity assay (MSA) measuring gamma-radiation-induced chromosomal aberrations in freshly cultured lymphocytes and assessed breast cancer risk in African-American women. Concurrently, we conducted duplicate cultures in the presence of caffeine, which overrides G(2) arrest in cultured cells, decreases time to DNA repair, and hence increases the aberration rate. In comparison with the non-caffeine-treated cells, we are conceptually segregating the contribution of DNA repair and time for DNA repair as individual susceptibility phenotypes. Blood samples were obtained from 61 cases and 86 controls at Howard University Hospital. Two sets of whole-blood cultures were established and gamma-irradiated (1 Gy) at 67 hours, one of which was treated with caffeine (1 mg/mL). Thereafter, cultures were processed for obtaining metaphase spreads. Fifty metaphases were screened for chromatid breaks. The mean breaks per cell (MBPC) for cases (0.34 +/- 0.15) was significantly greater than for controls (0.24 +/- 0.12; P < 0.0001). Using the 75th percentile value of controls as a cutoff to define mutagen sensitivity, the sensitive individuals had an odds ratio of 4.5 (95% confidence intervals, 2.2-9.1) for breast cancer compared with individuals that were not sensitive. The adjusted odds ratio was 3.3 (95% confidence intervals, 0.147-73.917), which was statistically significant but was limited by the small number of subjects. The results for caffeine co-culture were not predictive of breast cancer (MBPC: cases, 1.6 +/- 0.9 versus controls, 1.5 +/- 0.8; P = 0.8663). Comparing the MBPC for caffeine and non-caffeine cultures, there was a correlation in controls (n = 79; Spearman r = 0.4286; P < 0.0001), but not in cases (n = 58; Spearman r = 0.06609; P = 0.6221). This study indicates that the MSA phenotype is a risk factor for breast cancer in African-American women, with a significant effect observable even in small studies. The use of caffeine did not enhance the predictivity of MSA, but the correlation with non-caffeine cultures in controls indicates that the MSA phenotype is due to both DNA repair and G(2) arrest capacity.