Assessment of a Daily Diary Study Including Biospecimen Collections in a Sample of Sexual and Gender Minority Young Adults: Feasibility and Acceptability Study.

BACKGROUND: Young sexual minority men (YSMM) engage in cardiometabolic risk behaviors (eg, substance use) at higher rates than their heterosexual counterparts. Theory and previous research suggest that these risk behaviors may stem, in part, from exposure to minority stress (ie, discrimination based on sexual identity and other identities such as race). OBJECTIVE: This pilot study examined the feasibility and acceptability of a virtual 2-day daily diary study that examined daily experiences with discrimination, cardiometabolic risk behaviors (ie, sleep, physical activity, and substance use behaviors), and patterns of physiological stress and inflammation among YSMM aged 18 to 35 years. METHODS: Participants (n=20) were recruited from the greater New York metropolitan area and engaged in a 2-day daily diary protocol wherein they provided web-based consent, took a web-based baseline survey, and then, starting the next day, provided 3 saliva samples a day for 2 consecutive days to measure salivary cortisol, engaged in 3 daily diaries per day, and provided 1 blood spot sample via the finger prick method to measure high-sensitivity C-reactive protein. At follow-up, participants were interviewed via videoconferencing to ascertain their experiences and feelings related to the study protocol. Qualitative analyses explored the feasibility and acceptability of the study protocol, and exploratory quantitative analyses explored the descriptive statistics and Pearson correlations among the main study variables of interest. RESULTS: The retention rate was high (19/20, 95%) in our study sample. Qualitative analyses demonstrated that participants were willing to engage in similar, longer-term studies (eg, studies that include both week and weekend days) in the future and suggested the feasibility and acceptability of our study protocol among YSMM. However, participants noted several areas for improvement (eg, redundancy of survey items and difficulty pricking one's finger) that should be considered in future research. Preliminary quantitative analyses revealed a moderate negative correlation between everyday discrimination and mean cortisol levels (r=-0.51; P=.03). Furthermore, descriptive analyses suggest that that daily cortisol curves differ across races or ethnicities among YSMM. White and other-identified YSMM experienced the highest cortisol awakening response (mean 0.39, SD 0.21 µg/dL for White participants; mean 0.34, SD 0.34 µg/dL for others) with the steepest decline around bedtime (mean 0.05, SD 0.04 µg/dL for White participants; mean 0.09, SD 0.13 µg/dL for others) followed by a lower cortisol awakening response (mean 0.31, SD 0.11 µg/dL for Hispanic participants; mean 0.23, SD 0.15 µg/dL for Black participants) and a slower decline around bedtime (mean 0.10, SD 0.09 µg/dL for Hispanic participants; mean 0.03, SD 0.02 µg/dL for Black participants) among Hispanic and Black YSMM. CONCLUSIONS: Overall, the results suggest that similar study protocols are feasible and acceptable among YSMM. Future research should highlight the pathways through which cardiovascular disease risk may arise among YSMM using longer-term study designs and more diverse study samples.

Discrimination, Smoking, and Cardiovascular Disease Risk: A Moderated Mediation Analysis With MESA.

BACKGROUND: Carotid intima-media thickness (cIMT) and carotid plaque are reliable indicators of cardiovascular disease risk, and research highlights that racial and ethnic minority individuals generally exhibit higher cIMT and carotid plaque than White individuals. At present, the mechanisms driving these disparities among different racial and ethnic and biological sex groups are poorly understood. METHODS AND RESULTS: Data came from the baseline examination of MESA (Multi-Ethnic Study of Atherosclerosis). A total of 6814 participants aged 45 to 84 years free of clinical cardiovascular disease completed assessments on health behavior and perceived discrimination. Four sex-stratified moderated mediation models examined associations between discrimination, cigarette smoking, and mean cIMT and plaque. We hypothesized that cigarette use would mediate the association between discrimination and carotid artery disease features, and that these would differ by race and ethnicity. Indirect effects of discrimination on plaque were observed among Hispanic women such that discrimination was associated with cigarette use and, in turn, higher plaque (ß=0.04 [95% CI, 0.01-0.08]). Indirect effects of discrimination on mean cIMT were found among Hispanic (ß=0.003 [95% CI, 0.0001-0.007]) and White men (ß=0.04 [95% CI, 0.01-0.08]) such that discrimination was associated with cigarette use and, in turn, higher cIMT. Finally, a positive indirect effect of discrimination on plaque was observed among Hispanic men (ß=0.03 [95% CI, 0.004-0.07]). No other racial and ethnic differences were observed. CONCLUSIONS: To understand and address social determinants of cardiovascular disease, researchers must incorporate an intersectional framework that will allow us to understand the complex nature of discrimination and cardiovascular disease risk for individuals of varying intersecting identities and social positions.

Ethnic Disparities in Deep Sedation of Patients with Acute Respiratory Distress Syndrome in the United States: Secondary Analysis of a Multicenter Randomized Trial.

Rationale: Patients identified as Hispanic, the largest minority group in the United States, are more likely to die from acute respiratory distress syndrome (ARDS) than non-Hispanic patients. Mechanisms to explain this disparity remain unidentified. However, Hispanic patients may be at risk of overexposure to deep sedation because of language differences between patients and clinicians, and deep sedation is associated with higher ARDS mortality.Objective: We examined associations between Hispanic ethnicity and exposure to deep sedation among patients with ARDS.Methods: A secondary analysis was conducted of patients enrolled in the control arm of a randomized trial of neuromuscular blockade for ARDS across 48 U.S. hospitals. Exposure to deep sedation was measured over the first 5 days that a patient was alive and received mechanical ventilation. Multilevel mixed-effects models were used to evaluate associations between Hispanic ethnicity and exposure to deep sedation, controlling for patient characteristics.Results: Patients identified as Hispanic had approximately five times the odds of deep sedation (odds ratio, 4.98; 95% confidence interval, 2.02-12.28; P < 0.0001) on a given day, compared with non-Hispanic White patients. Hospitals with at least one enrolled Hispanic patient kept all enrolled patients deeply sedated longer than hospitals without any enrolled Hispanic patients (85.8% of ventilator-days vs. 65.5%; P < 0.001).Conclusions: Hispanic patients are at higher risk of exposure to deep sedation than non-Hispanic White patients. There is an urgent need to understand and address disparities in sedation delivery.

A national examination of discrimination, resilience, and depressive symptoms during the COVID-19 pandemic: the All of Us Research Program.

Objective: To examine the impact of resilience on the association between discrimination and trajectories of depressive symptoms during the COVID-19 pandemic across racial and ethnic groups. Methods: Data were drawn from 5 waves of the All of Us Research Program's survey on the impact of COVID-19 on the lives of American adults. Linear mixed-effects models were fitted to assess the association between discrimination exposure throughout the pandemic and depressive symptoms over time. An interaction term was introduced between resilience and discrimination exposure to assess if resilience buffered the association between discrimination and depressive symptoms over time. Race-stratified linear mixed-effects models examined racial/ethnic differences in the association between resilience, discrimination, and depressive symptoms over time. Results: Fifty-one thousand nine hundred fifty-eight participants completed surveys between May and December of 2020. Results indicated that exposure to more discrimination was associated with increasing trajectories of depressive symptoms over time (b = 0.48, p < 0.001). However, resilience moderated the association between discrimination and well-being over time such that higher resilience mitigated the detrimental effect of experiencing discrimination on depressive symptoms across time (b = -0.02, p < 0.001). Conclusion: Identifying protective features such as resilience can promote the development of culturally tailored interventions to address mental health in the context of discrimination.

Adult Attachment Anxiety Is Protective Against the Effects of Internalized Homophobia on Condomless Sex Among Young Sexual Minority Men: The P18 Cohort Study.

Internalized homophobia, or the internalization of negative attitudes toward one's sexual minority identity, is associated with sexual risk behaviors among young sexual minority men (YSMM). However, the formation and maintenance of secure or insecure socio-emotional bonds with friends, family members, and intimate partners (i.e., adult attachment) may mitigate or exacerbate the negative effects of exposure to internalized homophobia. Nevertheless, little is known about how adult attachment influences the association between internalized homophobia and sexual risk behaviors (e.g., condomless anal sex) among YSMM. Thus, this study examined the potential moderating effect of adult attachment on the association between internalized homophobia and condomless anal sex (CAS) behaviors (i.e., insertive CAS and receptive CAS) among a sample of N = 268 YSMM who participated in the study between June 2015-March 2017 using zero-inflated Poisson regression models. We found that adult attachment anxiety, but not adult attachment avoidance, significantly moderated the association between internalized homophobia and receptive CAS behaviors such that those higher on adult attachment anxiety and internalized homophobia had fewer receptive CAS events over the preceding 30 days as compared to those lower on adult attachment anxiety and internalized homophobia. Research efforts should focus on unpacking the complex associations between adult attachment, internalized homophobia, and sexual risk behaviors among YSMM.

Structural racism and homophobia evaluated through social media sentiment combined with activity spaces and associations with mental health among young sexual minority men.

BACKGROUND: Research suggests that structural racism and homophobia are associated with mental well-being. However, structural discrimination measures which are relevant to lived experiences and that evade self-report biases are needed. Social media and global-positioning systems (GPS) offer opportunity to measure place-based negative racial sentiment linked to relevant locations via precise geo-coding of activity spaces. This is vital for young sexual minority men (YSMM) of color who may experience both racial and sexual minority discrimination and subsequently poorer mental well-being. METHODS: P18 Neighborhood Study (n = 147) data were used. Measures of place-based negative racial and sexual-orientation sentiment were created using geo-located social media as a proxy for racial climate via socially-meaningfully-defined places. Exposure to place-based negative sentiment was computed as an average of discrimination by places frequented using activity space measures per person. Outcomes were number of days of reported poor mental health in last 30 days. Zero-inflated Poisson regression analyses were used to assess influence of and type of relationship between place-based negative racial or sexual-orientation sentiment exposure and mental well-being, including the moderating effect of race/ethnicity. RESULTS: We found evidence for a non-linear relationship between place-based negative racial sentiment and mental well-being among our racially and ethnically diverse sample of YSMM (p < .05), and significant differences in the relationship for different race/ethnicity groups (p < .05). The most pronounced differences were detected between Black and White non-Hispanic vs. Hispanic sexual minority men. At two standard deviations above the overall mean of negative racial sentiment exposure based on activity spaces, Black and White YSMM reported significantly more poor mental health days in comparison to Hispanic YSMM. CONCLUSIONS: Effects of discrimination can vary by race/ethnicity and discrimination type. Experiencing place-based negative racial sentiment may have implications for mental well-being among YSMM regardless of race/ethnicity, which should be explored in future research including with larger samples sizes.

Race moderates the association between adult attachment avoidance and the cortisol awakening response among young sexual minority men.

Adult attachment, or the ways in which individuals develop and maintain trusting and loving relationships with peers and romantic partners, has been demonstrated to influence hypothalamic-pituitary-adrenal (HPA) axis functioning among young sexual minority men (YSMM). Theory and preliminary evidence suggest that differences in the lived experiences of White and Black sexual minority young adults may influence the way in which adult attachment influences the HPA-axis functioning. We sought to further this field of inquiry by examining if race moderates the association between adult attachment insecurity (i.e., avoidance and anxiety) and HPA-axis functioning among YSMM. Sixty-three YSMM participated in a 5-day daily diary study in which they completed a baseline survey to assess adult attachment orientation and provided saliva samples 4 times per day over a 5-day period in order to measure cortisol across the day. Three-level hierarchical linear modeling was used to examine the association between adult attachment, the cortisol awakening response (CAR), diurnal cortisol, and the moderating effect of race. We found no main effect of attachment anxiety or avoidance on HPA-axis functioning. However, we found that race moderated the association between adult attachment avoidance and the CAR such that Black YSMM with higher attachment avoidance had a lower CAR as compared to White YSMM. Results suggest that there may be key differences between White and Black YSMM men's lived experiences that should be explored in future research.

U.S. Military veterans and the opioid overdose crisis: a review of risk factors and prevention efforts.

U.S. military veterans have been heavily impacted by the opioid overdose crisis, with drug overdose mortality rates increasing by 53% from 2010-2019. Risk for overdose among veterans is complex and influenced by ongoing interaction among physiological/biological, psychological, and socio-structural factors. A thorough understanding of opioid-related overdose among veterans, one that goes beyond simple pharmacological determinism, must examine the interplay of pain, pain treatment, and stress, as well as psychological and social experiences-before, during, and after military service. Comprehensive efforts to tackle the overdose crisis among veterans require interventions that address each of these dimensions. Promising interventions include widespread naloxone distribution and increased provision of low-threshold wrap-around services, including medications for opioid use disorder (MOUD) and holistic/complementary approaches. Interventions that are delivered by peers - individuals who share key experiential or sociodemographic characteristics with the population being served - may be ideally suited to address many of the barriers to opioid-related risk mitigation common among veterans. Community care models could be beneficial for the large proportion of veterans who are not connected to the Veterans Health Administration and for veterans who, for various reasons including mental health problems and the avoidance of stigma, are socially isolated or reluctant to use traditional substance use services. Interventions need to be tailored in such a way that they reach those more socially isolated veterans who may not have access to naloxone or the social support to help them in overdose situations. It is important to incorporate the perspectives and voices of veterans with lived experience of substance use into the design and implementation of new overdose prevention resources and strategies to meet the needs of this population. Key messagesU.S. military veterans have been heavily impacted by the opioid overdose crisis, with drug overdose mortality rates increasing by 53% from 2010-2019.The risks for overdose that veterans face need to be understood as resulting from an ongoing interaction among biological/physiological, psychological, and social/structural factors.Addressing drug overdose in the veteran population requires accessible and non-judgemental, low threshold, wraparound, and holistic solutions that recognise the complex aetiology of overdose risk for veterans.

Young men of color lower on adult attachment anxiety have higher carotid-intima media thickness compared to white young men: The exploration of an unexpected finding.

Cardiovascular disease (CVD) remains the number one cause of death among men in the United States. Emerging research demonstrates that socioemotional mechanisms such as adult attachment, or the ways in which individuals are able to form and maintain socioemotional bonds, may impact physical health via alterations in physiological stress functioning. However, there may be key differences in the relation between attachment and physical health by race and sexual orientation. Thus, this study sought to examine the potential moderating effect of race and sexual orientation on the association between adult attachment and carotid-intima media thickness (cIMT), a measure of subclinical cardiovascular disease, among young men. The sample consisted of 72 young men (mean [SD] age = 22.92 [3.23]: 30.6 % identified as White, 30.6 % as Black, and 38.8 % as Other), each of which were surveyed and underwent an ultrasound to measure cIMT. Ordinary Least Squares (OLS) regression was used in order to examine our study hypotheses. We first ran a main effects model to examine adult attachment's (i.e., anxiety and avoidance) association with mean cIMT. We then ran two interaction models with an interaction between race/ethnicity and adult-related attachment and sexual orientation and adult attachment. We found that race significantly moderated the association between attachment-related anxiety and mean cIMT in our study sample. However, we did not find evidence to suggest that race moderated the association between attachment-related avoidance and mean cIMT in our study sample. In comparison to White individuals, Black individuals and those who identified as "Other" race with lower scores on attachment-related anxiety had higher mean cIMT. Additionally, higher scores on attachment-related anxiety were associated with lower mean cIMT among Black and "Other" respondents, but not among White respondents. We did not find evidence to suggest that sexual orientation moderated the association between adult attachment and mean cIMT in our study sample. Our findings suggest that adult attachment anxiety may be protective for young men of color but not for White young men. Future research should utilize longitudinal study designs in order to better understand how adult attachment influences CVD risk among racially/ethnically diverse young men.

Feasibility, Acceptability, and Preliminary Efficacy of an App-Based Meditation Intervention to Decrease Firefighter Psychological Distress and Burnout: A One-Group Pilot Study.

BACKGROUND: Firefighters are often exposed to occupational stressors that can result in psychological distress (ie, anxiety and depression) and burnout. These occupational stressors have only intensified with the onset of the COVID-19 pandemic and will likely persist in the postpandemic world. OBJECTIVE: To address occupational stressors confronting firefighters, we pilot tested a novel, cost-effective, smartphone app-based meditation intervention created by Healthy Minds Innovations that focused on mindfulness (awareness) training along with practices designed to cultivate positive relationships (connection), insight into the nature of the self (insight), and a sense of purpose in the context of challenge (purpose) with a sample of professional firefighters from a large metropolitan area in southwestern United States. METHODS: A total of 35 participants were recruited from a closed online group listserv and completed the self-guided 10-unit meditation app over the course of 10 days, at 1 unit per day. We assessed anxiety symptoms, depression symptoms, burnout, and negative affect as well as saliva diurnal cortisol rhythm, an objective indicator of stress-related biology, before and after use of the meditation app. RESULTS: This study demonstrated the meditation app was both feasible and acceptable for use by the majority of firefighters. We also found significant reductions in firefighters' anxiety (P=.01), burnout (P=.05), and negative affect (P=.04), as well as changes in cortisol diurnal rhythm, such as waking cortisol (P=.02), from before to after use of the meditation app. CONCLUSIONS: Our study findings call for future research to demonstrate the efficacy of this meditation app to reduce psychological distress and burnout in firefighters.

Discrimination is associated with C-reactive protein among young sexual minority men.

This report examines associations between everyday discrimination, microaggressions, and CRP to gain insight on potential mechanisms that may underlie increased CVD risk among sexual minority male young adults. The sample consisted of 60 participants taken from the P18 cohort between the ages of 24 and 28 years. Multinomial logistic regression models were used to examine the association between perceived everyday discrimination and LGBQ microaggressions with C-reactive protein cardiovascular risk categories of low-, average-, and high-risk, as defined by the American Heart Association and Centers for Disease Control. Adjustments were made for BMI. Individuals who experienced more everyday discrimination had a higher risk of being classified in the high-risk CRP group compared to the low-risk CRP group (RRR = 3.35, p = 0.02). Interpersonal LGBQ microaggressions were not associated with CRP risk category. Everyday discrimination, but not specific microaggressions based on sexual orientation, were associated with elevated levels of CRP among young sexual minority men (YSMM). Thus, to implement culturally and age-appropriate interventions, further researcher is needed to critically examine the specific types of discrimination and the resultant impact on YSMM's health.

Characterizing and Evaluating Diurnal Salivary Uric Acid Across Pregnancy Among Healthy Women.

Uric acid levels during pregnancy have been examined as a potential indicator of risk for gestational diabetes mellites, hypertension, and related adverse birth outcomes. However, evidence supporting the utility of serum uric acid levels in predicting poor maternal and fetal health has been mixed. The lack of consistent findings may be due to limitations inherent in serum-based biomeasure evaluations, such as minimal repeated assessments and variability in the timing of these assessments. To address these gaps, we examined repeated measurements of diurnal salivary uric acid (sUA) levels in a sample of 44 healthy women across early-mid and late pregnancy. We assessed potential covariates and confounds of sUA levels and diurnal trajectories, as well as associations between maternal weight gain and blood pressure during pregnancy and sUA concentrations. Using multilevel linear models, we found sUA increased across pregnancy and displayed a robust diurnal pattern with the highest concentrations at waking, a steep decline in the early morning, and decreasing levels across the day. Maternal pre-pregnancy BMI, age, prior-night sleep duration, and fetal sex were associated with sUA levels and/or diurnal slopes. Maternal blood pressure and gestational weight gain also showed significant associations with sUA levels across pregnancy. Our results expand upon those found with serum UA measurements. Further, they demonstrate the feasibility of using at-home, minimally-invasive saliva sampling procedures to track UA levels across pregnancy with potential applications for the long-term monitoring of maternal cardiometabolic risk.

A Mindfulness-Based Intervention to Alleviate Stress From Discrimination Among Young Sexual and Gender Minorities of Color: Protocol for a Pilot Optimization Trial.

BACKGROUND: Young sexual and gender minorities (SGMs) of color may face unique experiences of discrimination based on their intersectional positions (eg, discrimination based on both racial or ethnic identity and sexual identity). Emerging evidence suggests that mindfulness practices may reduce stress from discrimination and improve overall well-being among young SGM. Moreover, the omnipresence of smartphone access among racial or ethnic and sexual minority communities provides a method through which to administer mindfulness-based interventions among young SGMs of color. OBJECTIVE: This paper outlines the protocol of the Optimizing a Daily Mindfulness Intervention to Reduce Stress from Discrimination among Young Sexual and Gender Minorities of Color (REDUCE) study, a pilot optimization trial of a smartphone-based mindfulness intervention that was developed in conjunction with the Healthy Minds Program (HMP) with the aim of reducing stress from discrimination among young SGMs. METHODS: In total, 80 young (ages 18-29 years) SGMs of color will be enrolled in the study. The HMP is a self-guided meditation practice, and participants will be randomized to either a control condition or an intervention that uses a neuroscience-based approach to mindfulness. We will use the multiphase optimization strategy to assess which combination of mindfulness interventions is the most effective at reducing stress from discrimination among young SGMs of color. A combination of mindfulness-based meditation intervention components will be examined, comprising mindfulness-based practices of awareness, connection, and purpose. Awareness refers to the practice of self-awareness, which reduces the mind's ability to be distracted and instead be present in the moment. Connection refers to the practice of connection with oneself and others and emphasizes on empathy and compassion with oneself and others. Purpose encourages goal-making in accordance with one's values and management of behavior in accordance with these goals. In addition, we will assess the feasibility and acceptability of the HMP application among young SGMs of color. RESULTS: The REDUCE study was approved by the Institutional Review Board of New York University, and recruitment and enrollment began in the winter of 2021. We expect to complete enrollment by the summer of 2022. The results will be disseminated via social media, journal articles, abstracts, or presentations, as well as to participants, who will be given the opportunity to provide feedback to the researchers. CONCLUSIONS: This optimization trial is designed to test the efficacy, feasibility, and acceptability of implementing an application-based, mindfulness-based intervention to reduce stress from discrimination and improve well-being among young SGMs of color. Evidence from this study will assist in the creation of a sustainable, culturally relevant mobile app-based mindfulness intervention to reduce stress from discrimination among young SGMs of color. TRIAL REGISTRATION: Clinicaltrials.gov NCT05131360; https://clinicaltrials.gov/ct2/show/NCT05131360. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/35593.

Impact of COVID-19-related knowledge on protective behaviors: The moderating role of primary sources of information.

This study assessed the modifying role of primary source of COVID-19 information in the association between knowledge and protective behaviors related to COVID-19 among adults living in the United States (US). Data was collected from 6,518 US adults through an online cross-sectional self-administered survey via social media platforms in April 2020. Linear regression was performed on COVID-19 knowledge and behavior scores, adjusted for sociodemographic factors. An interaction term between knowledge score and primary information source was included to observe effect modification by primary information source. Higher levels of knowledge were associated with increased self-reported engagement with protective behaviors against COVID-19. The primary information source significantly moderated the association between knowledge and behavior, and analyses of simple slopes revealed significant differences by primary information source. This study shows the important role of COVID-19 information sources in affecting people's engagement in recommended protective behaviors. Governments and health agencies should monitor the use of various information sources to effectively engage the public and translate knowledge into behavior change during an evolving public health crisis like COVID-19.

Assessing Perceptions of Broad Consent Concerning Biological Specimen Collection in a Cohort of Young Sexual Minority Men.

The use of broad consent to store human biospecimens to be used in future research studies has increased over the years. However, it is currently unknown how young sexual minority men (YSMM) perceive broad consent in these specific types of studies. Therefore, in this study we aimed to determine the extent to which YSMM are comfortable with providing broad consent concerning their identifiable biological specimens to a variety of entities, including external researchers and pharmaceutical companies and to examine the relationship between mistrust based on racial/ethnic identity or sexual orientation and attitudes toward broad consent. YSMM (N = 239) ages 24-27 years were recruited from a prospective cohort study in New York City in 2018 to complete a survey assessing attitudes about the use of broad consent concerning biospecimens for secondary research. We found that YSMM were most willing to provide broad consent to the researcher from the study they were enrolled in (85.3%), other researchers within the same university (82.4%), and researchers at other universities (74.5%). Participants were least willing to provide broad consent to government organizations (64.4%) and pharmaceutical companies (53.8%). Further, we found that medical mistrust based on racial/ethnic identity or sexual orientation was associated with attitudes toward the use of broad consent. Research institutions should consider modifying consent procedures around the use of broad consent in order to maximize recruitment and retention, especially among minority populations.

Social Determinants in Machine Learning Cardiovascular Disease Prediction Models: A Systematic Review.

INTRODUCTION: Cardiovascular disease is the leading cause of death worldwide, and cardiovascular disease burden is increasing in low-resource settings and for lower socioeconomic groups. Machine learning algorithms are being developed rapidly and incorporated into clinical practice for cardiovascular disease prediction and treatment decisions. Significant opportunities for reducing death and disability from cardiovascular disease worldwide lie with accounting for the social determinants of cardiovascular outcomes. This study reviews how social determinants of health are being included in machine learning algorithms to inform best practices for the development of algorithms that account for social determinants. METHODS: A systematic review using 5 databases was conducted in 2020. English language articles from any location published from inception to April 10, 2020, which reported on the use of machine learning for cardiovascular disease prediction that incorporated social determinants of health, were included. RESULTS: Most studies that compared machine learning algorithms and regression showed increased performance of machine learning, and most studies that compared performance with or without social determinants of health showed increased performance with them. The most frequently included social determinants of health variables were gender, race/ethnicity, marital status, occupation, and income. Studies were largely from North America, Europe, and China, limiting the diversity of the included populations and variance in social determinants of health. DISCUSSION: Given their flexibility, machine learning approaches may provide an opportunity to incorporate the complex nature of social determinants of health. The limited variety of sources and data in the reviewed studies emphasize that there is an opportunity to include more social determinants of health variables, especially environmental ones, that are known to impact cardiovascular disease risk and that recording such data in electronic databases will enable their use.

An Emerging Syndemic of Smoking and Cardiopulmonary Diseases in People Living with HIV in Africa.

BACKGROUND: African countries have the highest number of people living with HIV (PWH). The continent is home to 12% of the global population, but accounts for 71% of PWH globally. Antiretroviral therapy has played an important role in the reduction of the morbidity and mortality rates for HIV, which necessitates increased surveillance of the threats from pernicious risks to which PWH who live longer remain exposed. This includes cardiopulmonary comorbidities, which pose significant public health and economic challenges. A significant contributor to the cardiopulmonary comorbidities is tobacco smoking. Indeed, globally, PWH have a 2-4-fold higher utilization of tobacco compared to the general population, leading to endothelial dysfunction and atherogenesis that result in cardiopulmonary diseases, such as chronic obstructive pulmonary disease and coronary artery disease. In the context of PWH, we discuss (1) the current trends in cigarette smoking and (2) the lack of geographically relevant data on the cardiopulmonary conditions associated with smoking; we then review (3) the current evidence on chronic inflammation induced by smoking and the potential pathways for cardiopulmonary disease and (4) the multifactorial nature of the syndemic of smoking, HIV, and cardiopulmonary diseases. This commentary calls for a major, multi-setting cohort study using a syndemics framework to assess cardiopulmonary disease outcomes among PWH who smoke. CONCLUSION: We call for a parallel program of implementation research to promote the adoption of evidence-based interventions, which could improve health outcomes for PWH with cardiopulmonary diseases and address the health inequities experienced by PWH in African countries.

Identifying diurnal cortisol profiles among young adults: Physiological signatures of mental health trajectories.

Previous research has used cortisol, the major hormonal byproduct of the hypothalamic pituitary adrenal (HPA) axis system, to explore how environmental stressors influence daily physiological functioning. Most of the research focused on diurnal cortisol has examined specific cortisol markers, with little consideration of how different components of the diurnal pattern may co-occur. Morning level, cortisol awakening response (CAR), bedtime level, as well as the diurnal slope and total cortisol exposure throughout the day (area under the curve; AUC), are five common parameters of diurnal HPA axis functioning that have been individually linked to physical and mental health outcomes, with mixed results. The current study introduces a novel approach to capture heterogeneity in HPA axis activity by using latent profile analysis to generate empirically-derived, theoretically supported diurnal cortisol profiles based on all five indicators. We analyzed salivary cortisol data from 278 young adults during a time of heightened sociopolitical stress - the 2016 U.S. presidential election - and examined whether profiles differentially predicted mental health trajectories across six months. Findings suggest that a specific combination of cortisol parameters (i.e., flat slope, high AUC, and high CAR) may predict worse mental health risk over time. Overall, this work suggests that diurnal cortisol profiles likely reflect distinct physiological underpinnings with unique health consequences that may not be observed by studying individual cortisol parameters.

Father support is protective against the negative effects of perceived discrimination on CRP among sexual minorities but not heterosexuals.

BACKGROUND: Exposure to sexual orientation-related discrimination among sexual minorities may lead to elevated levels of C-reactive protein (CRP) as compared to their heterosexual counterparts. However, little is known about factors that may buffer the association between discrimination and CRP among sexual minorities versus heterosexuals. The current study examined if the association between discrimination, sexual orientation, and CRP differed across levels of social support from one's father/father-figure or mother/mother-figure between sexual minorities and heterosexuals. METHODS: Data came from Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health). The sample sizes for father support and mother support was 3167 and 3575, respectively. Participants ranged in age from 24 to 33 years. Stratified linear regression models examined if father and mother support moderated the association between discrimination and CRP among sexual minorities and heterosexuals. RESULTS: Father support significantly moderated the association between discrimination and CRP among sexual minorities but not heterosexuals. Sexual minorities with higher father support and who experienced discrimination had lower CRP as compared to those with lower father support and who experienced discrimination. Mother support did not moderate the association between discrimination and CRP among either sexual minorities or heterosexuals. CONCLUSION: Father support may mitigate the negative effects of stress from discrimination on CRP among sexual minorities. Future research should further examine the potential differential role that father support may play in reducing cardiovascular risk among sexual minorities versus heterosexuals who experience discrimination.