Characterizing daily physical activity patterns with unsupervised learning via functional mixture models.

Physical inactivity is a significant public health concern. Consideration of inter-individual variations in physical activity (PA) trends can provide additional information about the groups under study to aid intervention design. This study aims to identify latent profiles ("phenotypes") based on daily PA trends among adults living in. This was a secondary analysis of 724 person-level days of accelerometry data from 133 urban-dwelling adults (89% Latinx, age = 19-77 years). We used Actigraph accelerometers and the Actilife software to collect and process 24-hour PA data. We implemented a probabilistic clustering technique based on functional mixture models. Multiple days of data per person were averaged for entry into the models. We evaluated step counts, moderate-intensity PA (MOD), total activity and sedentary minutes as potential model variables. Bayesian Information Criterion (BIC) index was used to select the model that provided the best fit for the data. A 4-cluster resolution provided the best fit for the data (i.e., BIC=-3257, improvements of Δ = 13 and Δ = 7 from 3- and 5-cluster models, respectively). MOD provided the greatest between-cluster discrimination. Phenotype 1 (N = 61) was characterized by a morning peak in PA that declined until bedtime. Later bedtimes and the highest daily PA volume were distinct for phenotype 2 (N = 18), along with a similar peak pattern. Phenotype 3 (N = 29) membership was associated with the lowest PA levels throughout the day. Phenotype 4 was characterized by a more evenly distributed PA during the day, and later waking/bedtimes. Our findings point to distinct, interpretable PA phenotypes based on temporal patterns. Functional clustering of PA data could provide additional actionable points for tailoring behavioral interventions.

Differences in Cardiovascular Health at the Intersection of Race, Ethnicity, and Sexual Identity.

Importance: An understanding of the intersectional effect of sexual identity, race, and ethnicity on disparities in cardiovascular health (CVH) has been limited. Objective: To evaluate differences in CVH at the intersection of race, ethnicity, and sexual identity using the American Heart Association's Life's Essential 8 measure. Design, Setting, and Participants: This cross-sectional study was conducted from July 27 to September 6, 2023, using National Health and Nutrition Examination Survey data from 2007 to 2016. Participants were noninstitutionalized, nonpregnant adults (aged 18-59 years) without cardiovascular disease or stroke. Exposures: Self-reported sexual identity, categorized as heterosexual or sexual minority (SM; lesbian, gay, bisexual, or "something else"), and self-reported race and ethnicity, categorized as non-Hispanic Black (hereafter, Black), Hispanic, non-Hispanic White (hereafter, White), and other (Asian, multiracial, or any other race and ethnicity). Main Outcome and Measures: The primary outcome was overall CVH score, which is the unweighted mean of 8 CVH metrics, assessed from questionnaire, dietary, and physical examination data. Regression models stratified by sex, race, and ethnicity were developed for the overall CVH score and individual CVH metrics, adjusting for age, survey year, and socioeconomic status (SES) factors. Results: The sample included 12 180 adults (mean [SD] age, 39.6 [11.7] years; 6147 [50.5%] male, 2464 [20.2%] Black, 3288 [27.0%] Hispanic, 5122 [42.1%] White, and 1306 [10.7%] other race and ethnicity). After adjusting for age, survey year, and SES, Black (ß, -3.2; 95% CI, -5.8 to -0.6), Hispanic (ß, -5.9; 95% CI, -10.3 to -1.5), and White (ß, -3.3; 95% CI, -6.2 to -0.4) SM female adults had lower overall CVH scores compared with their heterosexual counterparts. There were no statistically significant differences for female adults of other race and ethnicity (ß, -2.8; 95% CI, -9.3 to 3.7) and for SM male adults of any race and ethnicity compared with their heterosexual counterparts (Black: ß, 2.2 [95% CI, -1.2 to 5.7]; Hispanic: ß, -0.9 [95% CI, -6.3 to 4.6]; White: ß, 1.5 [95% CI, -2.2 to 5.2]; other race and ethnicity: ß, -2.2 [95% CI, -8.2 to 3.8]). Conclusions and Relevance: In this cross-sectional study, CVH differed across race and ethnicity categories in SM females, suggesting that different communities within the larger SM population require tailored interventions to improve CVH. Longitudinal studies are needed to identify the causes of CVH disparities, particularly in Black and Hispanic SM females and inclusive of other racial and ethnic identities.

Day-to-day associations of intersectional minority stressors with sleep health in sexual and gender minority people of color.

OBJECTIVE: To determine the day-to-day associations between minority stressors (i.e., anticipated and experienced discrimination) and sleep health outcomes (i.e., total sleep time (TST), sleep disturbances, and sleep-related impairment) among sexual and gender minority (SGM) people of color. METHOD: An online sample of SGM people of color living in the United States participated in a 30-day daily diary study. Daily anticipated and experienced discrimination as well as subjective sleep outcomes were assessed via electronic diaries using validated measures. Wrist-worn actigraphy was used to objectively assess TST. Multilevel linear models (MLMs) were used to estimate the independent associations of daily intersectional minority stressors with subsequent sleep outcomes, adjusted for demographic factors and lifetime discrimination. RESULTS: The sample included 43 SGM people of color with a mean age of 27.0 years (± 7.7) of which 84% were Latinx, 47% were multiracial, and 37% were bisexual. Results of MLMs indicated that greater report of daily experienced discrimination was positively associated with same-night sleep disturbances, B (SE) = 0.45 (0.10), p < .001. Daily anticipated discrimination was positively associated with sleep-related impairment on the following day, B (SE) = 0.77 (0.17), p < .001. However, daily anticipated and experienced discrimination were not associated with same-night TST. CONCLUSIONS: Findings highlight the importance of considering the differential effects of daily intersectional minority stressors on the sleep health of SGM people of color. Further research is needed to identify factors driving the link between daily minority stressors and sleep outcomes to inform sleep health interventions tailored to this population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Caring for Sexual and Gender Minority Adults with Cardiovascular Disease.

This article summarizes existing evidence on cardiovascular disease (CVD) risk and CVD diagnoses among sexual and gender minority adults and provides recommendations for providing nursing care to sexual and gender minority adults with CVD. More research is needed to develop evidence-based strategies to care for sexual and gender minority adults with CVD.

Investigating the Associations of Sexual Minority Stressors and Incident Hypertension in a Community Sample of Sexual Minority Adults.

BACKGROUND: Sexual minority adults are at higher risk of hypertension than their heterosexual counterparts. Sexual minority stressors (i.e., unique stressors attributed to sexual minority identity) are associated with a variety of poor mental and physical health outcomes. Previous research has not tested associations between sexual minority stressors and incident hypertension among sexual minority adults. PURPOSE: To examine the associations between sexual minority stressors and incident hypertension among sexual minority adults assigned female sex at birth. METHODS: Using data from a longitudinal study, we examined associations between three sexual minority stressors and self-reported hypertension. We ran multiple logistic regression models to estimate the associations between sexual minority stressors and hypertension. We conducted exploratory analyses to determine whether these associations differed by race/ethnicity and sexual identity (e.g., lesbian/gay vs. bisexual). RESULTS: The sample included 380 adults, mean age 38.4 (± 12.81) years. Approximately 54.5% were people of color and 93.9% were female-identified. Mean follow-up was 7.0 (± 0.6) years; during which 12.4% were diagnosed with hypertension. We found that a 1-standard deviation increase in internalized homophobia was associated with higher odds of developing hypertension (AOR 1.48, 95% Cl: 1.06-2.07). Stigma consciousness (AOR 0.85, 95% CI: 0.56-1.26) and experiences of discrimination (AOR 1.07, 95% CI: 0.72-1.52) were not associated with hypertension. The associations of sexual minority stressors with hypertension did not differ by race/ethnicity or sexual identity. CONCLUSIONS: This is the first study to examine the associations between sexual minority stressors and incident hypertension in sexual minority adults. Implications for future studies are highlighted.

High blood pressure (HBP) is a major public health concern in the USA. Sexual minority adults (such as gay/lesbian or bisexual) are at greater risk of HBP than heterosexual adults. However, the reasons for this difference have not been studied. Sexual minority stressors are unique stressors specific to sexual minority individuals. Multiple studies have shown that sexual minority stressors, such as internalized homophobia (defined as someone's internalization of negative societal values towards sexual minority individuals), stigma consciousness (defined as the extent that someone expects to be stereotyped), and experiences of discrimination due to sexual identity, are associated with poor health outcomes. Yet, the relationship between these stressors and HBP has not been studied in this population. In our study, we examined the associations between sexual minority stressors and newly diagnosed HBP among sexual minority adults. Those who reported more internalized homophobia had a higher likelihood of developing HBP within 7 years. There were no significant associations between other sexual minority stressors and HBP. We also found no differences in the associations of sexual minority stressors and HBP by race/ethnicity or sexual identity. Findings highlight the importance of educating healthcare professionals about risk factors for hypertension in sexual minority adults.

Differences in Ideal Cardiovascular Health Between Sexual Minority and Heterosexual Adults.

Importance: Research on the cardiovascular health (CVH) of sexual minority adults has primarily examined differences in the prevalence of individual CVH metrics rather than comprehensive measures, which has limited development of behavioral interventions. Objective: To investigate sexual identity differences in CVH, measured using the American Heart Association's revised measure of ideal CVH, among adults in the US. Design, Setting, and Participants: This cross-sectional study analyzed population-based data from the National Health and Nutrition Examination Survey (NHANES; 2007-2016) in June 2022. Participants included noninstitutional adults aged 18 to 59 years. We excluded individuals who were pregnant at the time of their interview and those with a history of atherosclerotic cardiovascular disease or heart failure. Exposures: Self-identified sexual identity categorized as heterosexual, gay/lesbian, bisexual, or something else. Main Outcomes and Measures: The main outcome was ideal CVH (assessed using questionnaire, dietary, and physical examination data). Participants received a score from 0 to 100 for each CVH metric, with higher scores indicating a more favorable CVH profile. An unweighted average was calculated to determine cumulative CVH (range, 0-100), which was recoded as low, moderate, or high. Sex-stratified regression models were performed to examine sexual identity differences in CVH metrics, disease awareness, and medication use. Results: The sample included 12 180 participants (mean [SD] age, 39.6 [11.7] years; 6147 male individuals [50.5%]). Lesbian (B = -17.21; 95% CI, -31.98 to -2.44) and bisexual (B = -13.76; 95% CI, -20.54 to -6.99) female individuals had less favorable nicotine scores than heterosexual female individuals. Bisexual female individuals had less favorable body mass index scores (B = -7.47; 95% CI, -12.89 to -1.97) and lower cumulative ideal CVH scores (B = -2.59; 95% CI, -4.84 to -0.33) than heterosexual female individuals. Compared with heterosexual male individuals, gay male individuals had less favorable nicotine scores (B = -11.43; 95% CI, -21.87 to -0.99) but more favorable diet (B = 9.65; 95% CI, 2.38-16.92), body mass index (B = 9.75; 95% CI, 1.25-18.25), and glycemic status scores (B = 5.28; 95% CI, 0.59-9.97). Bisexual male individuals were twice as likely as heterosexual male individuals to report a diagnosis of hypertension (adjusted odds ratio [aOR], 1.98; 95% CI, 1.10-3.56) and use of antihypertensive medication (aOR, 2.20; 95% CI, 1.12-4.32). No differences in CVH were found between participants who reported their sexual identity as something else and heterosexual participants. Conclusion and Relevance: Results of this cross-sectional study suggest that bisexual female individuals had worse cumulative CVH scores than heterosexual female individuals, whereas gay male individuals generally had better CVH than heterosexual male individuals. There is a need for tailored interventions to improve the CVH of sexual minority adults, particularly bisexual female individuals. Future longitudinal research is needed to examine factors that might contribute to CVH disparities among bisexual female individuals.

Associations between Paternal Co-residence and Child Health among African American Children.

We investigated the associations between paternal co-residence and asthma, obesity, and blood pressure among children aged 3-5 years. Mother/child dyads (N = 250) self-identified as African American or Black. Mothers reported on father's co-residence and child's asthma diagnosis. Height, weight, and blood pressure were measured. Regression models were used to examine paternal co-residence with child health outcomes (i.e., asthma, obesity, and blood pressure). Confounders included maternal and child age, child sex, maternal smoking, and insurance status. Children who lived with their fathers were less likely to have asthma (OR = 0.39, 95% CI 0.18-0.79), though this association was not significant after adjustment for confounders (aOR = 0.47, 95% CI 0.22-1.01). Paternal co-residence was not significantly associated with child obesity (aOR = 0.78, 95% CI 0.35-1.73), systolic (ß = 0.57, SE = 1.2, p = .64), or diastolic (ß = 1.91, SE = 1.0, p = .07) blood pressure. More research is necessary to understand the diversity of family living situations and how they affect child health.

The Interaction of Trauma Exposure and DNA Methylation on Blood Pressure Among Black Women in the InterGEN Study.

Objective: Despite evidence that trauma exposure is linked to higher risk of hypertension, epigenetic mechanisms (such as DNA methylation) by which trauma potentially influences hypertension risk among Black adults remain understudied. Methods: Data from a longitudinal study of Black mothers were used to test the hypothesis that direct childhood trauma (ie, personal exposure) and vicarious trauma (ie, childhood trauma experienced by their children) would interact with DNA methylation to increase blood pressure (BP). Separate linear mixed effects models were fitted at each CpG site with the DNA methylation beta-value and direct and vicarious trauma as predictors and systolic and diastolic BP modeled as dependent variables adjusted for age, cigarette smoking, and body mass index. Interaction terms between DNA methylation beta-values with direct and vicarious trauma were added. Results: The sample included 244 Black mothers with a mean age of 31.2 years (SD = ±5.8). Approximately 45% of participants reported at least one form of direct childhood trauma and 49% reported at least one form of vicarious trauma. Epigenome-wide interaction analyses found that no CpG sites passed the epigenome-wide significance level indicating the interaction between direct or vicarious trauma with DNAm did not influence systolic or diastolic BP. Conclusions: This is one of the first studies to simultaneously examine whether direct or vicarious exposure to trauma interact with DNAm to influence BP. Although findings were null, this study highlights directions for future research that investigates epigenetic mechanisms that may link trauma exposure with hypertension risk in Black women.

Examination of Sexual Identity Differences in the Prevalence of Hypertension and Antihypertensive Medication Use Among US Adults: Findings From the Behavioral Risk Factor Surveillance System.

BACKGROUND: Recent evidence suggests that sexual minority (eg, gay/lesbian, bisexual) adults might be at increased risk of hypertension compared with heterosexual adults. However, disparities by sexual identity in antihypertensive medication use among adults with hypertension have not been comprehensively examined. METHODS: We analyzed data from the Behavioral Risk Factor Surveillance System (2015-2019), to examine sexual identity differences in the prevalence of hypertension and antihypertensive medication use among adults. We ran sex-stratified logistic regression models to estimate the odds ratios of diagnosis of hypertension and antihypertensive medication use among sexual minority (ie, gay/lesbian, bisexual, and other) and heterosexual adults (reference group). RESULTS: The sample included 420 340 participants with a mean age of 49.7 (±17.0) years, of which 66.7% were Non-Hispanic White. Compared with heterosexual participants of the same sex, bisexual women (adjusted odds ratio, 1.19 [95% CI, 1.03-1.37]) and gay men (adjusted odds ratio, 1.18 [95% CI, 1.03-1.35]) were more likely to report having been diagnosed with hypertension. Among women with diagnosed hypertension, bisexual women had lower odds of current antihypertensive medication use (adjusted odds ratio, 0.71 [95% CI, 0.56-0.90]). Among men with diagnosed hypertension, gay men were more likely than heterosexual men to report current antihypertensive medication use (adjusted odds ratio, 1.39 [95% CI, 1.10-1.78]). Compared with heterosexual participants of the same sex, there were no differences in hypertension or antihypertensive medication use among lesbian women, bisexual men, and participants who reported their sexual identity as other. CONCLUSIONS: Clinical and public health interventions are needed to reduce the risk of hypertension among bisexual women and gay men. Bisexual women were at higher risk of untreated hypertension, which may be attributed to lower health care utilization due to fear of discrimination from health care providers and socioeconomic disadvantage. Future research is needed to better understand factors that may contribute to untreated hypertension among bisexual women with hypertension.

Sexual minority health and allostatic load in the National Health and Nutrition Examination Survey: A systematic scoping review with intersectional implications.

Understood largely from a minority stress framework, sexual minorities (SM) are hypothesized to suffer more physical and mental health burdens compared to their heterosexual counterparts. Several studies have used data from the National Health and Nutrition Examination Survey (NHANES) in the United States to assess SM health disparities and the 'wear and tear' of allostatic load. Because findings are generally mixed and sometimes contradictory with sexual minority stress theory, we endeavoured to explore existing NHANES studies of SM health. Our scoping review yielded a comprehensive analysis of all existing published articles (N = 43) that have used the NHANES to assess any outcome regarding SM health and well-being. Our synthesis confirms that SM sub-groups are significantly different from one another and from their heterosexual peers on several key health variables. Surprisingly, gay men appear to have the lowest allostatic load and no differences have yet been identified among women as a function of sexual identity/behavior. The existing literature suggests a need to use the NHANES more broadly and to include more psychosocial variables to better delineate sexual minority stress. This is especially important to consider at a physiological level in allostatic load research that should better include health behaviors available in NHANES and from other available datasets as moderators linking psychosocial exposures (e.g., minority stress) and health outcomes. Suggested future directions are proposed in an intersectional perspective that incorporates interactions among sex, gender, sexual identity/behaviors, race, ethnicity, age cohorts, socioeconomic status, and lived experiences.

Experiences of Trauma and DNA Methylation Profiles among African American Mothers and Children.

Potentially traumatic experiences have been associated with chronic diseases. Epigenetic mechanisms, including DNA methylation (DNAm), have been proposed as an explanation for this association. We examined the association of experiences of trauma with epigenome-wide DNAm among African American mothers (n = 236) and their children aged 3-5 years (n = 232; N = 500), using the Life Events Checklist-5 (LEC) and Traumatic Events Screening Inventory-Parent Report Revised (TESI-PRR). We identified no DNAm sites significantly associated with potentially traumatic experience scores in mothers. One CpG site on the ENOX1 gene was methylome-wide-significant in children (FDR-corrected q-value = 0.05) from the TESI-PRR. This protein-coding gene is associated with mental illness, including unipolar depression, bipolar, and schizophrenia. Future research should further examine the associations between childhood trauma, DNAm, and health outcomes among this understudied and high-risk group. Findings from such longitudinal research may inform clinical and translational approaches to prevent adverse health outcomes associated with epigenetic changes.

Functional Limitations and Access to Long-Term Services and Supports Among Sexual Minority Older Adults.

Objective: Little is known about sexual minority (SM) older adults' activities of daily living (ADL) and instrumental activities of daily living (IADL) limitations and their subsequent access to long-term services and supports (LTSS). Methods: We analyzed cross-sectional data from the 2016 Health and Retirement Study limited to individuals ≥50 years old. Bivariate analyses were performed to examine 1) sexual identity differences in the prevalence of ADL/IADL limitations and 2) associations of sexual identity with having ADL/IADL limitations and having access to help with ADL/IADL limitations. Results: Our sample consisted of 3833 older adults, 6% (n = 213) were SM. Compared to heterosexual participants, bisexual older adults had greater reports of ADL/IADL limitations (20.9% vs. 35.9%, p = 0.013). Among those who reported having ADL/IADL limitations (n = 803), there were no sexual identity differences in accessing help for ADL/IADL limitations (p = .901). Discussion: Our findings contribute to the limited research on LTSS access among SM older adults.

Diet, Food Insecurity, and CVD Risk in Sexual and Gender Minority Adults.

PURPOSE OF REVIEW: Sexual and gender minority (SGM) adults experience significant cardiovascular health disparities, yet little is known about diet and food insecurity in this population. This review summarizes recent literature on diet and food insecurity in SGM adults and their contribution to cardiovascular disease (CVD) risk in this population. RECENT FINDINGS: Existing evidence on diet and food insecurity disparities among SGM adults is inconclusive and research examining their link with CVD risk in SGM adults is limited. The majority of existing studies lack standardized and validated assessments of diet and food insecurity. Correlates of unhealthy diet and food insecurity among SGM adults are poorly understood. Research examining the associations between diet and food insecurity with CVD risk in SGM adults is limited. Longitudinal studies are needed to investigate whether diet and food insecurity contribute to the cardiovascular health disparities observed in SGM adults.

A scoping review of alcohol, tobacco, and other drug use treatment interventions for sexual and gender minority populations.

BACKGROUND: Alcohol, tobacco, and other drug use are among the most prevalent and important health disparities affecting sexual and gender minority (SGM; e.g., lesbian, gay, bisexual, transgender) populations. Although numerous government agencies and health experts have called for substance use intervention studies to address these disparities, such studies continue to be relatively rare. METHOD: We conducted a scoping review of prevention and drug treatment intervention studies for alcohol, tobacco, and other drug use that were conducted with SGM adults. We searched three databases to identify pertinent English-language, peer-reviewed articles published between 1985 and 2019. RESULTS: Our search yielded 71 articles. The majority focused on sexual minority men and studied individual or group psychotherapies for alcohol, tobacco, or methamphetamine use. CONCLUSION: Our findings highlight the need for intervention research focused on sexual minority women and gender minority individuals and on cannabis and opioid use. There is also a need for more research that evaluates dyadic, population-level, and medication interventions.

A population-based study of the intersection of sexual identity and race/ethnicity on physiological risk factors for CVD among U.S. adults (ages 18-59).

Objectives: Sexual minorities face significant psychosocial stressors (such as discrimination and violence) that impact their health. Several studies indicate that sexual minority women (SMW) and bisexual men may be at highest risk for cardiovascular disease (CVD), but limited research has examined physiological CVD risk or racial/ethnic differences. This study sought to examine racial/ethnic differences in physiological risk factors for CVD among sexual minority and heterosexual adults.Design: We analyzed data from the National Health and Nutrition Examination Survey (2001-2016) using sex-stratified multiple linear regression models to estimate differences in physiological CVD risk. We compared sexual minorities (gay/lesbian, bisexual, 'not sure') to heterosexual participants first without regard to race/ethnicity. Then we compared sexual minorities by race/ethnicity to White heterosexual participants.Results: The sample included 22,305 participants (ages 18-59). Lesbian women had higher body mass index (BMI) but lower total cholesterol than heterosexual women. Bisexual women had higher systolic blood pressure (SBP). Gay men had lower BMI and glycosylated hemoglobin (HbA1c) relative to heterosexual men. White and Black lesbian women and bisexual women of all races/ethnicities had higher BMI than White heterosexual women; Black bisexual women had higher SBP and HbA1c. Black sexual minority men had higher HbA1c relative to White heterosexual men. Latino 'not sure' men also had higher SBP, HbA1c, and total cholesterol than White heterosexual men.Conclusions: Given evidence of higher CVD risk in sexual minority people of color relative to White heterosexuals, there is a need for health promotion initiatives to address these disparities. Additional research that incorporates longitudinal designs and examines the influence of psychosocial stressors on CVD risk in sexual minorities is recommended. Findings have implications for clinical and policy efforts to promote the cardiovascular health of sexual minorities.

Lifetime Trauma and Cardiovascular Health in Latinas.

BACKGROUND: Potentially traumatic experiences throughout the life course are associated with poor cardiovascular health among women. However, research on the associations of trauma with cardiovascular health among Latino populations is limited. Understanding the impact of trauma on cardiovascular health within marginalized populations may provide guidance on developing interventions with a particular focus on preventative care. OBJECTIVE: The purpose of this descriptive cross-sectional study was to examine the associations of lifetime trauma with cardiovascular health among middle-aged and older Latina women. METHODS: Participants were recruited from an existing study in New York City. All participants completed a structured questionnaire to assess lifetime trauma, demographic characteristics (such as age and education), financial resource strain, and emotional support. The Trauma History Questionnaire was used to assess lifetime exposure to potentially traumatic experiences (range 0-24). Cardiovascular health was measured with a validated measure of cardiovascular health from the American Heart Association (Life's Simple 7). We used self-reported and objective data to calculate cardiovascular health scores (range 0-14). Multiple linear regression was used to examine the associations of lifetime trauma with cardiovascular health, adjusted for age, education, financial resource strain, and emotional support. RESULTS: The sample included 50 Latina women with a mean age of 63.1 years, 88% were Dominican, and only 6% had completed a college degree. Women reported an average of 4.8 traumatic experiences. Mean cardiovascular health score was 6.5 (SD = 1.6, range 3-10). Linear regression models found that, after adjusting for age, education, financial resource strain, and emotional support, a higher count of lifetime trauma was associated with worse cardiovascular health. However, this association did not reach statistical significance. DISCUSSION: Women with a higher count of lifetime trauma had worse cardiovascular health scores; this association was not statistically significant. Future studies should investigate associations of lifetime trauma and cardiovascular health in larger and more diverse samples of Latinas. Nurses and other clinicians should incorporate trauma-informed approaches to cardiovascular disease risk reduction to improve the cardiovascular health of Latina women who are survivors of trauma.

Comparative Effectiveness of Behavioral Interventions for Cardiovascular Risk Reduction in Latinos: A Systematic Review.

BACKGROUND: Latinos, the fastest growing ethnic minority group in the United States, are at a high risk for cardiovascular disease (CVD). However, little is known about effective strategies to reduce CVD risk in this population. OBJECTIVE: The aim of this study was to systematically review and synthesize evidence from randomized controlled trials that examined the effectiveness of behavioral interventions to reduce CVD risk in Latinos living in the United States. METHODS: Four electronic databases were searched for relevant peer-reviewed English- and Spanish-language articles published between January 1, 2000, and December 31, 2019. Four reviewers independently completed article screening, data abstraction, and quality appraisal. At least 2 reviewers completed data abstraction and quality appraisal for each article, and a third reviewer was assigned to settle disagreements. Data on study characteristics and outcomes were abstracted. RESULTS: We retrieved 1939 articles. After applying inclusion/exclusion criteria, 17 articles were included. Most interventions were led by community health workers (n = 10); 2 family-based interventions were identified. None of the included studies was nurse led. Behavioral factors were assessed across all included studies, whereas only 4 studies reported on psychosocial outcomes. Improvements were observed in dietary habits and psychosocial outcomes. Findings for physical activity and biological outcomes were mixed. We identified no differences in outcomes based on intervention modalities used or the role of those who led the interventions. CONCLUSION: Existing evidence is mixed. Future research should assess the effectiveness of understudied treatment modalities (including nurse-led, mobile health, and family-based interventions) in reducing CVD risk in Latinos.

Examining the associations of gender minority stressors with sleep health in gender minority individuals.

OBJECTIVES: Investigate the associations of gender minority stressors (including stigma consciousness [SC] and gender-related discrimination [GRD]) with sleep health in gender minority individuals. DESIGN: Cohort. PARTICIPANTS: 279 gender minority individuals. MEASUREMENTS: SC and GRD were measured using the Stigma Consciousness and Everyday Discrimination scales, respectively. Sleep disturbance was assessed using the PROMIS Sleep Disturbance measure. Subjective short sleep duration (<7 hours) was assessed. We used k-means longitudinal clustering to identify minority stress clusters (including SC and GRD scores). Linear and logistic regression models were used to examine the associations of these clusters with sleep disturbance and sleep duration, respectively, adjusted for demographic characteristics. RESULTS: Mean age was 36.9 ± 13.6 years; most were non-White (54.5%), 52.5% were transmasculine, and 22.6% were heterosexual. Mean sleep disturbance score was 17.2 ± 6.1 (range 6-30) and 52% reported short sleep duration. We identified 3 minority stress clusters. Compared to participants with low SC/low GRD, those with high SC/low GRD (B 3.33, 95% confidence interval [CI] = 1.64, 5.01) and high SC/high GRD (B 4.51, 95% CI = 2.63, 6.39) had worse sleep disturbance scores. Participants in the high SC/high GRD cluster were more likely to report short sleep duration relative to the low SC/low GRD cluster (adjusted odds ratios 2.17; 95% CI = 1.11-4.26). CONCLUSIONS: Participants with both high SC and high GRD had worse sleep health. Future longitudinal studies should examine factors that drive the link between gender minority stress and sleep health in gender minority individuals to inform sleep health interventions tailored for this population.