Minority stressors and tobacco use among a US sample of sexual and gender minority young adults.

INTRODUCTION: Young adults who are sexual and gender minorities (SGM) are at the highest risk for tobacco initiation in young adulthood. Minority stress theory suggests that sexual orientation and gender identity (SOGI)-based discrimination may contribute to nicotine and tobacco use disparities. Our study aimed to quantify the association between SOGI-based distal minority stressors and current tobacco use among SGM young adults living in the United States (US). METHODS: Eligible participants-including young adults (aged 18-35 years old), who identified as SGM, and were currently residing in the US (N=1116) -were recruited via Prolific into an online survey. We applied stepwise binary regressions with backward selection to model the association between average past 30-day distal minority stress and current tobacco use (i.e., combustible cigarettes or e-cigarettes), controlling for perceived stress and sociodemographic covariates. We also tested interactions between minority stress and SGM status. Exploratory analyses assessed associations between minority stress and current tobacco use among YA, stratified by SGM subgroup. RESULTS: A 1-unit increase in experiencing minority stress in the past 30-days was associated with 1.02 greater odds of current tobacco use among SGM young adults. No difference between SGM subgroups in this association was found. Examining stratified SGM subgroups, a 1-unit increase in minority stress was associated with 1.11 greater odds of current tobacco among transgender adults only. CONCLUSION: Distal minority stress is differentially associated with current tobacco use for transgender young adults, which suggests that tobacco prevention and cessation interventions may need tailoring for subgroups. IMPLICATIONS: This study details the influence of minority stress on current tobacco use among sexual and gender minority (SGM) young adults. Findings underscore the need for targeted and tailored approaches to tobacco control, wherein SGM young adults most at-risk are engaged in cessation interventions that address minority stress as a contributing factor to tobacco use and which support their resilience. To promote health equity, tobacco control must address the contexts that engender minority stress. Assessment of policy impacts on SGM tobacco use and the effectiveness of interventions disseminated within SGM-supportive and discriminatory policy environments are important next steps.

Community-Based Cluster-Randomized Trial to Reduce Opioid Overdose Deaths.

BACKGROUND: Evidence-based practices for reducing opioid-related overdose deaths include overdose education and naloxone distribution, the use of medications for the treatment of opioid use disorder, and prescription opioid safety. Data are needed on the effectiveness of a community-engaged intervention to reduce opioid-related overdose deaths through enhanced uptake of these practices. METHODS: In this community-level, cluster-randomized trial, we randomly assigned 67 communities in Kentucky, Massachusetts, New York, and Ohio to receive the intervention (34 communities) or a wait-list control (33 communities), stratified according to state. The trial was conducted within the context of both the coronavirus disease 2019 (Covid-19) pandemic and a national surge in the number of fentanyl-related overdose deaths. The trial groups were balanced within states according to urban or rural classification, previous overdose rate, and community population. The primary outcome was the number of opioid-related overdose deaths among community adults. RESULTS: During the comparison period from July 2021 through June 2022, the population-averaged rates of opioid-related overdose deaths were similar in the intervention group and the control group (47.2 deaths per 100,000 population vs. 51.7 per 100,000 population), for an adjusted rate ratio of 0.91 (95% confidence interval, 0.76 to 1.09; P = 0.30). The effect of the intervention on the rate of opioid-related overdose deaths did not differ appreciably according to state, urban or rural category, age, sex, or race or ethnic group. Intervention communities implemented 615 evidence-based practice strategies from the 806 strategies selected by communities (254 involving overdose education and naloxone distribution, 256 involving the use of medications for opioid use disorder, and 105 involving prescription opioid safety). Of these evidence-based practice strategies, only 235 (38%) had been initiated by the start of the comparison year. CONCLUSIONS: In this 12-month multimodal intervention trial involving community coalitions in the deployment of evidence-based practices to reduce opioid overdose deaths, death rates were similar in the intervention group and the control group in the context of the Covid-19 pandemic and the fentanyl-related overdose epidemic. (Funded by the National Institutes of Health; HCS ClinicalTrials.gov number, NCT04111939.).

Predicting breast cancer risk in a racially diverse, community-based sample of potentially high-risk women.

BACKGROUND: Identifying women with high risk of breast cancer is necessary to study high-risk experiences and deliver risk-management care. Risk prediction models estimate individuals' lifetime risk but have rarely been applied in community-based settings among women not yet receiving specialized care. Therefore, we aimed: (1) to apply three breast cancer risk prediction models (i.e., Gail, Claus, and IBIS) to a racially diverse, community-based sample of women, and (2) to assess risk prediction estimates using survey data. METHODS: An online survey was administered to women who were determined by a screening instrument to have potentially high risk for breast cancer. Risk prediction models were applied using their self-reported family and medical history information. Inclusion in the high-risk subsample required ≥20% lifetime risk per ≥1 model. Descriptive statistics were used to compare the proportions of women identified as high risk by each model. RESULTS: N = 1053 women were initially eligible and completed the survey. All women, except one, self-reported the information necessary to run at least one model; 90% had sufficient information for >1 model. The high-risk subsample included 717 women, of which 75% were identified by one model only; 96% were identified by IBIS, 3% by Claus, <1% by Gail. In the high-risk subsample, 20% were identified by two models and 3% by all three models. CONCLUSIONS: Assessing breast cancer risk using self-reported data in a community-based sample was feasible. Different models identify substantially different groups of women who may be at high risk for breast cancer; use of multiple models may be beneficial for research and clinical care.

Daily stressors and diurnal cortisol among sexual and gender minority young adults.

OBJECTIVE: Minority stress may contribute to poor health by dysregulating stress response systems, including diurnal cortisol rhythms. However, few studies have examined the association between sexual and gender minority stress and diurnal cortisol in lesbian, gay, bisexual, and transgender (LGBT) individuals. The current investigation tested whether the daily experience of minority stressors is uniquely related to diurnal cortisol above and beyond general stressors. METHOD: One hundred and 21 sexual and gender minority young adults (aged 18-35, 54.5% female) completed initial and daily evening questionnaires for 7 consecutive days to document daily general stressors and LGBT stressors. A randomly selected subset (n = 58) also provided salivary cortisol samples at wake, 45-min postwake, 12-hr postwake, and bedtime. RESULTS: Controlling for covariates (sex assigned at birth, wake time, bedtime, and day of the week) and general stressors, individuals who reported more LGBT stressors across the week displayed elevated cortisol levels at wake, t(491) = 9.68, p = .002 and 45-min postwake, t(492) = 6.41, p = .011, relative to individuals who reported fewer LGBT stressors. In contrast, after controlling for covariates, the frequency of general stressors only predicted cortisol 12 hr postwake, t(785) = 2.02, p = .043. Diurnal cortisol was unrelated to within-person fluctuations in LGBT and general stressors. CONCLUSIONS: Results imply that the experience of everyday minority stressors is uniquely related to diurnal cortisol and may have implications for the mental and physical health of LGBT adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cognitive behavioral therapy, mindfulness, and cortisol habituation: A randomized controlled trial.

BACKGROUND: Hypothalamic-pituitary-adrenocortical (HPA) axis dysregulation is associated with disease and may be indexed by poor cortisol habituation (i.e., a failure to show decreased responding with repeated stressor exposure). Thus, stress management training that can enhance HPA axis habituation may benefit health. To date, the effects of Mindfulness Based Stress Reduction (MBSR) and Cognitive Behavioral Therapy (CBT) interventions on HPA axis habituation remain untested. To test the effects of MBSR and CBT on HPA axis habituation, the present study used a parallel arm randomized controlled trial. METHODS: Healthy adults reporting moderate-to-high stress (n = 138) were randomly assigned to a 6-week MBSR intervention, a 6-week CBT intervention, or Waitlist control group. Post-intervention, participants completed a social-evaluative performance stressor during each of two laboratory visits scheduled 48-h apart. Salivary cortisol was collected pre-stressor, and 25, 35, and 60 min post-stressor onset during each visit. Final analyses included 86 participants who completed procedures up to the first laboratory visit. RESULTS: Relative to the control condition, both MBSR and CBT groups showed greater cortisol habituation. The MBSR group exhibited marginally greater habituation than the Waitlist group in cortisol samples corresponding to the recovery time points (35 and 60 min post-stressor onset). In contrast, the CBT group showed greater habituation than the Waitlist across all sampling timepoints collected (pre-stressor, 25, 35, and 60 min post-stressor onset). Yet, the CBT group also demonstrated elevated pre-stressor cortisol during the first visit. CONCLUSIONS: Results suggest that MBSR and CBT interventions promote greater HPA axis habituation relative to no training, but do not reduce overall cortisol output (i.e., across both visits). Observed differences between CBT and MBSR training in relation to cortisol habituation are discussed.

An Examination of Demographic and Psychosocial Factors, Barriers to Healthy Eating, and Diet Quality Among African American Adults.

A healthy diet is associated with lower risk of chronic disease. African Americans generally have poor diet quality and experience a higher burden of many chronic diseases. We examined the associations of demographic and psychosocial factors and barriers to diet quality among African American adults. This cross-sectional study included 100 African American adults in a southeastern metropolitan area. Psychosocial factors (social support, self-efficacy), and barriers to healthy eating were assessed with validated measures. Diet quality was assessed using the Healthy Eating Index (HEI-2010). Nested linear regressions were used to examine the association between the variables of interest and HEI scores. Participants reported having social support (M (mean) = 2.0, SD (standard deviation) = 0.6, range 0⁻3), high levels of self-efficacy (M = 3.1, SD = 0.7, range 1⁻4), and low barriers (M = 1.4, SD = 0.6, range 0⁻4) to engage in healthy eating but total mean HEI scores needed improvement (M = 54.8, SD = 10.9, range 27.1⁻70.0). Participants consumed significantly higher empty calories and lower whole fruits, dairy, and total protein foods than the national average. Barriers to healthy eating (b = -12.13, p = 0.01) and the interaction between age and barriers (b = 0.25, p = 0.02) were most strongly associated with lower HEI scores. Younger African Americans with the highest barriers to healthy eating had the lowest HEI scores. Culturally appropriate interventions targeting empty calories, barriers to healthy eating, and knowledge of the Dietary Guidelines for Americans are needed for African Americans.

Physical Activity Among Native Hawaiians and Pacific Islanders: A Systematic Review and Meta-Analysis.

OBJECTIVE: To examine the proportion of Native Hawaiian and Pacific Islander (NHPI) meeting recommended physical activity guidelines for Americans (PAG) and determine differences in physical activity (PA) by sex and between NHPI and Asians when data are disaggregated. DESIGN: Systematic review and meta-analysis. SETTING: Articles identified in CINAHL, The Cochrane Library, Embase, PsychINFO, PubMed, Scopus, SocINDEX, SPORTDiscus, and Web of Science. PARTICIPANTS: NHPI children and adults, and Asian adults. INTERVENTIONS: Proportion of NHPI meeting PAG and differences in PA involvement by sex and by ethnicity. METHODS: Summary reporting for articles, and meta-analysis using random-effects and inverse-various weighted models. CONCLUSIONS AND IMPLICATIONS: Just over one-third of NHPI children met the PAG (mean = 38.6%, 95% CI [32.43-45.08]), with more males (42.8%) than females (34.7%) meeting the guidelines (t = 6.74, df = 1, P = .02). Less than half met the PAG for combination (mean = 48.7%, 95% CI [34.69-62.97]), moderate (mean = 47.1%, 95% CI [33.62-61.07]), and about one-third met the PAG for vigorous PA (mean = 33.4%, 95% CI [24.55-43.62]). There were no significant differences between Asians and NHPI in PA. Policy, systems, and environmental changes as well as culturally appropriate interventions are needed to increase physical activity among NHPI.

When Family Matters Most: A Test of the Association Between Sexual Minority Identity Disclosure Context and Diurnal Cortisol in Sexual Minority Young Adults.

OBJECTIVE: Revealing one's sexual identity to others is a complex process marked by a shift in the types of stressors faced by sexual minority young adults. Such stressors influence the secretion of health-relevant hormones, including cortisol, yet how dimensions of disclosure (i.e., the degree and context) influence neuroendocrine functioning remains poorly understood. The current study examined the association between disclosure context (disclosure to family members, friends/co-workers/acquaintances, and members of religious groups) and diurnal cortisol while allowing disclosure to vary in degree (i.e., how much is disclosed). METHODS: One hundred twenty-one sexual minority young adults (aged 18-35 years, 54.5% female, free of major psychiatric/endocrine disorders) completed an initial survey that assessed the degree and context of sexual minority identity disclosure. A randomly selected subset (n = 58) also provided salivary cortisol samples at wake, 45 minutes after wake, 12 hours after wake, and at bedtime for 1 week. RESULTS: Greater total disclosure and greater disclosure to family members were associated with reduced cortisol output, defined as Area Under the Curve relative to ground (AUCg; F(1,230) = 5.95, p = .015, and F(1,231) = 10.90, p = .001, respectively). Disclosure to co-workers, friends, acquaintances, or religious groups was unrelated to cortisol AUCg. All disclosure contexts tested were unrelated to the shape of diurnal cortisol slopes (including the cortisol awakening response). CONCLUSIONS: Disclosure to family members uniquely predicted cortisol AUCg. Therefore, these results suggest that effects of disclosure on diurnal cortisol and its associated health outcomes may occur in the context of familial relationships.

Trait Rumination Predicts Elevated Evening Cortisol in Sexual and Gender Minority Young Adults.

Stress may contribute to illness through the impaired recovery or sustained activity of stress-responsive biological systems. Rumination, or mental rehearsal of past stressors, may alter the body's stress-responsive systems by amplifying and prolonging exposure to physiological mediators, such as cortisol. The primary aim of the current investigation was to test the extent to which the tendency to ruminate on stress predicts diminished diurnal cortisol recovery (i.e., elevated evening cortisol) in a sample of sexual and gender minority young adults. Participants included 58 lesbian, gay, bisexual, and transgender young adults (Mage = 25.0, SD = 4.1) who completed an initial online survey that assessed trait rumination and current depressed mood. Participants completed daily evening questionnaires and provided salivary cortisol samples at wake, 45 min post-wake, 12 h post-wake, and at bedtime over seven consecutive days. Trait rumination predicted significantly higher cortisol concentrations at bedtime, but was unrelated to other cortisol indices (e.g., morning cortisol, diurnal slope, total output). The association with trait rumination was not accounted for by daily negative affect, and was largely independent of depressed mood. These results have implications for identifying and treating those who may be at risk for impaired diurnal cortisol recovery and associated negative health outcomes.

Buccal telomere length and its associations with cortisol, heart rate variability, heart rate, and blood pressure responses to an acute social evaluative stressor in college students.

OBJECTIVE: Understanding the relationship between stress and telomere length (a marker of cellular aging) is of great interest for reducing aging-related disease and death. One important aspect of acute stress exposure that may underlie detrimental effects on health is physiological reactivity to the stressor. METHODS: This study tested the relationship between buccal telomere length and physiological reactivity (salivary cortisol reactivity and total output, heart rate (HR) variability, blood pressure, and HR) to an acute psychosocial stressor in a sample of 77 (53% male) healthy young adults. RESULTS: Consistent with predictions, greater reductions in HR variability (HRV) in response to a stressor and greater cortisol output during the study session were associated with shorter relative buccal telomere length (i.e. greater cellular aging). However, the relationship between cortisol output and buccal telomere length became non-significant when adjusting for medication use. Contrary to past findings and study hypotheses, associations between cortisol, blood pressure, and HR reactivity and relative buccal telomere length were not significant. Overall, these findings may indicate there are limited and mixed associations between stress reactivity and telomere length across physiological systems.

Stress-Induced Parasympathetic Control and Its Association With Inflammatory Reactivity.

OBJECTIVE: It has been proposed that the inflammatory cytokine system is regulated through the vagus nerve, where vagal activation inhibits release of inflammatory cytokines and, therefore, inflammation. Thus, loss of vagal activation (i.e., reduced high-frequency heart rate variability [HF-HRV]) should result in greater inflammation. Evidence to date for this relationship has relied on animal models and resting states in humans. The present study used a psychosocial stressor to test whether stress-induced decreases in HF-HRV predict increases in circulating inflammatory markers. METHODS: Thirty healthy young women completed a speech stressor. HF-HRV was assessed before and during the stressor while circulating plasma interleukin 6, tumor necrosis factor α, and C-reactive protein were assessed before and 1 hour after the stressor. RESULTS: Consistent with the neural reflex for immunity, greater reductions in HF-HRV during the stressor were associated with greater increases in tumor necrosis factor α (ß = -0.29 to -0.47) and interleukin 6 (ß = -0.40 to -0.68) but not C-reactive protein (ß = 0.10 to 0.29) 1 hour after the stressor. CONCLUSIONS: These findings expand on the current literature by showing that changes in HF-HRV predict and precede changes in circulating inflammatory cytokines in humans and may have implications for treatment of inflammatory diseases.

Communication and Stress: Effects of Hope Evocation and Rumination Messages on Heart Rate, Anxiety, and Emotions After a Stressor.

How we cope with the many stressors that we encounter throughout our lives has implications for our well-being. By affecting how individuals appraise stressful events, communication can prolong or ameliorate physiological and emotional responses to stress. This study investigated the short-term effects of hope-inducing and rumination-inducing messages on heart rate, state anxiety, and emotions after a standardized, social-evaluative stressor. Continuous heart rate was monitored for 127 college students (64 female, 63 male) throughout an experiment that included a performance stressor and messages designed to (a) cause feelings of hope, (b) evoke rumination, or (c) be a distraction (control). Heart rate varied by message, such that heart rate was lowest in the hope evocation condition. State anxiety was lower in the hope evocation and distraction control conditions than in the rumination condition. The rumination condition led to greater anger, greater guilt, and less happiness than did the other conditions. This study advances our knowledge about potential ways that communication messages can counter the psychological and biological effects of stressful life events. Overall, the study provides preliminary evidence that hope evocation messages may be a form of supportive communication and can ameliorate stress.

Trait reflection predicts interleukin-6 response to a social-evaluative stressor.

Past work has linked negative repetitive thought (worry, rumination) about stressors to sustained stress responses. Less is known about the effects of neutral types of repetitive thought (e.g., reflection) on physiological stress responses. The present study examined whether greater trait reflection was associated with a lower inflammatory response to an acute psychosocial stressor. Thirty-four healthy undergraduate women completed a speech stressor, and plasma interleukin-6 (IL-6), C-reactive protein, and tumor necrosis factor-α levels were assessed before and after the stressor. Higher levels of reflection predicted lower IL-6 responses 1h after the stressor. Stressor appraisal was not a significant mediator. These preliminary findings stand in contrast to existing evidence that other forms of repetitive thought like worry and rumination may exacerbate or prolong the inflammatory stress response and indicate that reflection is a notable factor worth considering when examining the relationship between stress, inflammation, and health.

Sources of Discrimination and Their Associations With Health in Sexual Minority Adults.

Health disparities exist between sexual minorities and heterosexuals. These health disparities may be due to stressful social situations and environments that are created by discrimination. The current study recruited 277 sexual minorities to complete an online survey to examine the effects of discrimination on health. Discrimination from family and friends, compared to non-family and friends, was found to be more strongly associated with poorer health. This effect was partially statistically mediated by perceived stress reactivity. Findings from this study highlight the importance of distinguishing between different sources of discrimination when examining the effect of discrimination on health in sexual minority adults.

Trait rumination moderates the effect of mentation type on heart rate responses to stressor recall.

Ruminative thought about stressors has been linked to extended post-stressor cardiovascular activation, which in turn predicts negative long-term health outcomes. Past work indicates that the nature of thought (mental imagery or verbal thought) may shape cardiovascular responses. Some evidence suggests that individuals with rumination tendencies may be especially vulnerable to stress-related cardiovascular activation, although it is unclear to what extent type of thought (imagery or verbal thought) influences this relationship. This study included a laboratory stressor followed by a stressor recall task in which mentation type was manipulated. Healthy undergraduate students (N = 138; 47% female) underwent a speech stressor and then were randomly assigned to complete a stressor recall task using either mental imagery or verbal-linguistic mentation. Heart rate (HR) and blood pressure (BP) were measured throughout. Self-report trait rumination was measured at baseline. Results indicated that trait rumination and mentation type interacted to predict HR. Individuals with high trait rumination scores had significantly greater increases in HR during the verbal-linguistic conditions compared to the mental imagery conditions. There were no mentation type differences in the low trait ruminators, no differences in BP and no main effects of trait rumination. Results suggest that mentation type may be a key in understanding the relationship between rumination and cardiovascular activation, especially for trait ruminators.

Cardiovascular and affective consequences of ruminating on a performance stressor depend on mode of thought.

Psychological detachment from work is important for facilitating recovery. This can be threatened by rumination, or thinking about the day's stressors. Rumination may lead to distress, fatigue and extended activation of stress-related systems, but findings are not unequivocal. Level of construal (abstract or concrete) and type of mentation (imagery or verbal thought) used during stressor-focused rumination may shape physiological and affective responses and impact recovery. This study tested whether blood pressure (BP) and anxiety responses to stressor-focused rumination differ by mentation type and construal level. Healthy undergraduates (n = 136) performed a speech stressor and then completed a rumination task in one of four randomly assigned conditions: concrete imagery, abstract imagery, concrete verbal thought or abstract verbal thought. Anxiety and continuous BP were assessed. Concrete rumination led to greater BP, whereas rumination with abstract construals led to lower BP. Furthermore, participants in the abstract conditions had greater increases in anxiety following stressor-focused rumination than in the concrete conditions. Results suggest that the immediate physiological and psychological consequences of stressor-focused rumination depend upon mode of thought.

Differential effects of poststressor rumination and distraction on cortisol and C-reactive protein.

OBJECTIVE: Stress-related physiological activation may last longer for those who ruminate, or dwell, on past stressors. Correlational and quasi-experimental research has linked rumination to immune activity and elevated cortisol. This study's aim was to experimentally test whether rumination (relative to distraction) can sustain stress-induced increases in inflammation and cortisol. Concentrations of poststressor cortisol and inflammatory markers were hypothesized to be greater for those who ruminated compared with those who were distracted. METHOD: Thirty-four healthy young women completed a laboratory speech stressor and were then randomly assigned to either ruminate on the stressor or engage in distraction for 5 minutes. Salivary cortisol and circulating plasma concentrations of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) were assessed throughout the 2-hr visit. RESULTS: As predicted, CRP and cortisol responses differed for the rumination and distraction groups. In the distraction group, participants' CRP concentrations increased poststressor and then returned to prestressor levels by the end of the visit. In contrast, participants in the rumination condition demonstrated increases in CRP that did not return to prestressor levels by the end of the visit. Similarly, poststressor cortisol was higher for those who ruminated compared with those who were distracted. Plasma IL-6 and TNF-α concentrations increased over the visit, but did not differ by experimental group. CONCLUSIONS: RESULTS suggest that ruminating on stressors may sustain CRP and cortisol responses, whereas distraction may diminish them. Findings have implications for understanding potential risk and protective factors for stress-related activation.