The impact of social constraints on insomnia among African-American breast cancer survivors: The mediating role of fear of recurrence.

OBJECTIVE: Insomnia is a significant concern among African-American breast cancer survivors (BCS). Social constraints (SC)-receiving unsupportive or critical responses when expressing trauma-related emotions-and fear of recurrence (FOR) have been associated with insomnia. We examined FOR as a mediator in the relationship between SC and insomnia in African-American BCS. We hypothesized a direct effect of SC on insomnia, and an indirect effect of SC on insomnia through FOR. METHODS: Sixty-four African-American BCS completed a questionnaire assessing demographics, clinical characteristics, SC, FOR, and insomnia. Participants were an average of M = 8.41 (SD = 5.8) year survivors. The mediation was tested using PROCESS for SPSS. RESULTS: The direct effect of SC on insomnia was significant (direct effect = .17, SE = .08, P = .04). Moreover, the indirect effect of SC on insomnia through FOR was significant (indirect effect = .19, SE = .10, 95% CI = .05, .41). CONCLUSIONS: Experiencing SC from family and friends could produce cognitions that impact sleep for BCS, and FOR could be one of those cognitions. Family-based models of care that emphasize the emotional needs of survivors and families could be a relevant strategy to address the SC that impacts sleep.

Releasing the Net to Promote Minority Faculty Success in Academic Medicine.

Underrepresented minority faculty in academic medicine continue to be underrepresented in academic health centers across the country. Their underrepresentation impacts advancements in clinical care, education, and discovery and slows our forward progress in the field. Underrepresented in medicine faculty includes people who are black or African American, Hispanic or Latinx, or Native American. Barriers to underrepresented faculty recruitment, retention, and advancement include minority and gratitude taxes, imposter syndrome, and a lack of an appreciation of power distance and distance traveled. This article reviews five barriers to progress in achieving appropriate diversity among faculty and leadership of academic health centers, focusing on the multiplying effects of these barriers and potential steps forward.