Protocol of the HARMONY study: A culturally relevant, randomized-controlled, stress management intervention to reduce cardiometabolic risk in African American women.

BACKGROUND: African American Women (AAW) are at high risk for stress-related cardiometabolic (CM) conditions including obesity, heart disease, and diabetes. Prior interventions lack attention to culturally-nuanced stress phenomena (Superwoman Schema [SWS], contextualized stress, and network stress), which are positively and significantly associated with unhealthy eating and sedentary behavior. PURPOSE: The HARMONY Study is designed to test a culturally tailored mindfulness-based stress management intervention to address SWS, contextualized stress, and network stress as potential barriers to adherence to healthy exercise and eating goals. The study will help AAW build on their strengths to promote cardiometabolic health by enhancing positive reappraisal, self-regulation, and self-efficacy as protective factors against chronic stress-inducing biobehavioral morbidity and mortality risk. METHODS: This two-arm, randomized-controlled trial will test the effects of two group-based, online interventions. HARMONY 1 includes culturally-tailored exercise and nutrition education. HARMONY 2 includes mindfulness-based stress reduction, exercise, and nutrition education. We aim to recruit 200 AAW ≥ 18 years old with CM risk. RESULTS: Primary outcomes (actigraphy and carotenoid levels) and secondary outcomes (body composition, inflammatory markers, glucose metabolism, and stress) are being collected at baseline and 4-, 8-, and 12-months post-intervention. Intent-to-treat, data analytic approaches will be used to test group differences for the primary outcomes. DISCUSSION: This study is the first to address culturally-nuanced stress phenomena in AAW (SWS, network stress, and contextualized stress) using culturally-tailored stress management, exercise, and nutrition educational approaches to reduce biobehavioral CM risk among AAW. Quantitative and qualitative results will inform the development of scalable and sustainable CM risk-reduction programming for AAW. TRIAL REGISTRATION: The Multiple PIs registered the clinical trial (Identifier: NCT04705779) and reporting of summary results in ClinicalTrials.gov in accordance with the NIH Policy on the Dissemination of NIH-Funded Clinical Trial Information, within the required timelines.

Use of Food to Cope With Culturally Relevant Stressful Life Events Is Associated With Body Mass Index in African American Women.

BACKGROUND: Although stress is an established contributor to obesity (in general population studies), mechanisms to explain this association in African American women that incorporate culturally relevant frameworks have received little attention. OBJECTIVE: To investigate how stress is associated with body mass index (BMI) in this population, we examined multivariate models of BMI predicted by race-related, gender-related, and generic stressful life events and by use of food to cope with stress. We hypothesized that the three types of stressful life events would be indirectly associated with BMI through using food to cope with stress. METHODS: Psychometrically robust measures were included in surveys administered to a socioeconomically diverse sample of 189 African American women aged 21-78 years. Hypotheses were tested using structural equation modeling. We examined race-related, gender-related, and generic stressful life events as latent constructs indicated by exposure to and appraisal of potential stressors predicting a mediator, using food to cope, which predicted BMI; this model also included direct paths from the three latent stressful life event constructs to BMI. RESULTS: Almost every participant reported using food in some way to cope with stress; 33% and 42% met established criteria for overweight and obesity, respectively. The race-related stressful life event construct was the only latent construct predicting using food to cope with stress, and using food to cope with stress predicted BMI. A significance test of indirect effects demonstrated that the race-related stressful life event construct was indirectly associated with BMI through the mediator, using food to cope. DISCUSSION: Culturally relevant stress exposures and stress-related eating are important areas of foci for tackling overweight, obesity, and related health inequities in African American women. Findings highlight the importance of developing more complex models to understand the stress-related factors that elevate risk for overweight and obesity in this population.

Student perspectives on recruiting underrepresented ethnic minority students to nursing: Enhancing outreach, engaging family, and correcting misconceptions.

BACKGROUND: Increasing the diversity of the nursing workforce is a high priority for addressing the nursing shortage and for developing a workforce capable of meeting the cultural needs of an increasingly diverse population. The purpose of this study was to identify student perspectives on the (1) influence of family, friends and others on nursing as a career choice and (2) optimal recruitment strategies to enhance diversity in schools of nursing. METHOD: Twenty-two diverse, underrepresented baccalaureate nursing students (including underrepresented ethnic minorities, economically disadvantaged students, and men) participated in two focus groups. Applied thematic analysis was used to organize the data and identify major themes. RESULTS: Participants perceptions involved two major thematic areas: (a) misconceptions of nursing, and (b) closing the gap, which had two sub-themes: facilitating support and encouragement and marketing nursing to younger groups. Recommendations for recruitment strategies included: providing applicants information to overcome myths and stereotypes about nursing, incorporating family members and friends into the recruitment process, highlighting nursing as a STEM field grounded in science and evidence-based practice, and engaging in outreach to educate elementary, middle, and high school students about the nursing profession. CONCLUSION: Findings provide direction for developing programming and collaborations to enhance recruitment of underrepresented students to nursing.

The Giscombe Superwoman Schema Questionnaire: Psychometric Properties and Associations with Mental Health and Health Behaviors in African American Women.

The purpose of this research was to examine the psychometric properties of the Giscombe Superwoman Schema Questionnaire. Three separate studies conducted with 739 African American women provided preliminary evidence that the Questionnaire's factor structure aligns with the Superwoman Schema Conceptual Framework and has good reliability. In addition, it is positively associated with perceived stress, depressive symptoms, using food to cope with stress, poor sleep quality, and physical inactivity. This study provides preliminary evidence to suggest that the Giscombe Superwoman Schema Questionnaire is psychometrically sound; Superwoman Schema is associated with health behaviors and psychological states that may increase risk for illness.