Paper Session 11: Stress

Background: Black women frequently encounter complex and cumulative intersectional stressors, including economic strain, caregiver burden, racial stress, and gender discrimination, which serve as upstream determinants of mental health issues, hypertension, and insufficient sleep. In response to these stressors, Black women have developed unique forms of resilience. While portable digital solutions, such as mobile apps, have been developed for mental health, they often do not adequately cater to the specific needs of Black women. To ensure the effectiveness and equity of these interventions, it is crucial to consider the unique experiences of women from diverse racial backgrounds.
Methods: This research involves a series of focus groups composed of 12 perinatal women (from the Nurturing Moms study) and 16 hypertensive women (from the NIH-funded Realist Women Study- 1K01HL175286-01) enrolled in two ongoing clinical trials at the University of Miami Miller School of Medicine. Study 1 assesses the efficacy of Nurture VR™, a VR-based program that integrates mindfulness techniques, relaxation exercises, and guided imagery for pregnancy and postpartum care. Study 2 evaluates the feasibility and acceptability of a VR intervention (First Resort) for stress reduction, resilience enhancement, and blood pressure management among Black women.
Results: Qualitative analysis reveals five primary themes and 19 sub-themes, highlighting the complexities of motherhood while Black in America, attitudes toward VR therapy, and perceptions of resilience. Participants discussed challenges related to household management, caregiving, financial stress, relaxation, sleep, and the importance of social support. Notably, a prominent theme that emerged was the sense of escapism experienced by participants during VR therapy.
Conclusion: Preliminary findings from our studies indicate that the portability and on-demand nature of VR-based interventions present a valuable resource for low-income communities, where transportation challenges, cultural barriers, and the stigma associated with mental health care can significantly impede access to quality services. Culturally tailored and affordable VR-based interventions hold promise in addressing these barriers, thereby contributing to the reduction of social determinants of health stressors among women and mothers of color.

Presenter - Judite Blanc, PhD, PhD,
University of Miami Miller School of Medicine

Author - Azizi Seixas, PhD, PhD,
University of Miami Miller School of Medicine

Co-Author - Mairead Moloney, PhD,
University of Miami Miller School of Medicine

Co-Author - Deborah Jones Weiss, PhD,
University of Miami Miller School of Medicine

Background: Chronic stress in Black individuals is multi-layered amid the context of experiences of racism and discrimination. Cortisol dynamic range (CDR) may be an indicator of chronic stress, but less is known about the association between stress and CDR in Black individuals, which is hypothesized to differ by sex.

Objective: Data from the community-engaged FAITH! Heart Health+ ancillary study was used to explore the feasibility of CDR collection and its association with measures for individual, interpersonal, structural stress and exposure to racism in Black women and men.

Methods: Participants residing in the Minneapolis-St. Paul and Rochester, Minnesota areas provided survey data (everyday discrimination, perceived stress, mood, sleep quality, and high effort coping measures), and saliva samples (morning and afternoon) for cortisol measurement. CDR was calculated as a difference in log cortisol levels (i.e., log of the cortisol diurnal peak-to-nadir ratio). Geospatial area deprivation index and distance lived from George Floyd Square in Minneapolis were calculated. Linear regression examined the association between CDR and outcome variables.

Results: Seventy percent of consented participants (37/53, mean age 57.5 years, 65% women) provided cortisol samples. Lower (less dynamic) CDR in women (n=20) was associated with greater perceived stress (β=-0.07, p=0.01), greater anxiety (β=-0.06, p=0.01), higher Superwoman Schema score (β=-0.02, p=0.04), and greater distance from George Floyd Square (β=-0.02, p=0.01). No associations were observed in men (p>0.05).

Conclusion: The current results suggest that CDR from participant-led saliva collection is feasible and may serve as a biomarker of chronic and physiological stress in Black women.

Presenter - Robin Ortiz, MD, MS,
Departments of Pediatrics and Population Health, NYU Grossman School of Medicine, New York, NY

Co-Author - Joshua Joseph, MD, MPH,
Division of Endocrinology, Diabetes and Metabolism, The Ohio State University College of Medicine, Columbus, OH

Co-Author - Matthew P. Johnson, MS,
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN

Co-Author - Lainey Moen,
Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN

Co-Author - Mathias Lalika, MD, MPH,
Mayo Clinic

Co-Author - Clarence Jones, Med,
Hue-Man Partnership, Minneapolis, MN

Co-Author - Irina Bancos, MD,
Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic College of Medicine, Rochester, MN

Co-Author - Lisa A. Cooper, MD, MPH,
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD

Co-Author - Sharonne N. Hayes, MD,
Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN

Co-Author - Christi A. Patten, PhD,
Mayo Clinic

Co-Author - LaPrincess C. Brewer, MD, MPH,
Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN

Background: Exposure to social stress, such as neighborhood violence, affects the body’s immune responses, contributing to multiple chronic diseases. The long history of racial residential segregation and wealth disparity has resulted in uneven residential contexts, consequently, Black and White Americans are exposed to significantly different neighborhood conditions, which results in racial disparities in cancer health. One mechanism explaining the link between social stress and biological consequences is dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Chronic stress leads to dysregulation of the HPA axis, resulting in persistent elevation of cortisol levels, which may contribute to a tumor microenvironment conducive to cancer development and aggressiveness. Hair cortisol concentration (HCC) is a novel proxy measure of chronic stress response.
Methods: Black men over 45 years old were recruited from 4 barbershops in predominantly Black communities in Chicago. Hair samples were collected by barbers for HCC and a set of survey questions concerning perceived stress, exposure to violence, and fear of crime were administered along with demographic characteristics and residential community. Using residential location, homicide rate and poverty rate were appended.
Results: A total of 127 participants were included in the final analytic sample. The mean HCC was 31.7 pg/mg. HCC was significantly correlated with the homicide rate (r=.252, P=.006) and perceived violence exposure (r=.196, p=.028), but not with perceived stress (r=.060, p=.508) or fear of crime (r=.133, p=.136). The homicide rate was significantly associated with perceived violence exposure (r=.400, p<.001) and perceived stress (r=.318, p<.001), but not with fear of crime (r=.414, p=.124).
Discussion: HCC was significantly correlated with actual neighborhood violence and perceived violence exposure. Neighborhood social determinants affect individual health in multiple ways, including exposure to health risks, access to healthcare and social services, and health behaviors. Given the fact that homicides have been highly clustered in predominantly Black communities, potential health consequences of exposure to neighborhood violence are disproportionately higher for Black Chicagoans than the rest of the city. The impact of neighborhood social stressors, particularly violence, on downstream biophysical immune responses may be a mechanism explaining racial disparities in cancer health.

Author - Sage J. Kim, PhD,
University of Illinois at Chicago

Co-Author - Evgenia Karayeva, MPH,
University of Illinois Chicago, School of Public Health

Co-Author - Miguel Negrete, MPH,
University of Illinois Chicago

Co-Author - Kestutis Bendinskas, PhD,
State University of New York at Oswego, Department of Chemistry

Co-Author - Robert Winn, MD,
VCU Massey Comprehensive Cancer Center

Co-Author - Alicia K. Matthews, PhD,
University of Illinois at Chicago

Background: Despite documented better mental health outcomes, Black women experience earlier onset of chronic diseases of aging compared to White women. Social factors, such as stress and resilience, may explain this paradox and help develop strategies to reduce health disparities. This study aimed to examine racial differences in stress exposure, stress perceptions, and resilience factors from childhood to midlife among Black and White women.

Method: The study utilized data from the National Heart, Lung, and Blood Institute Growth & Health Study, which followed a cohort of Black and White women from childhood into adulthood. Participants were enrolled at ages 9-10 and underwent 10 annual assessments, and a follow-up in midlife at approximately age 39. This analysis included all women with available data for childhood and midlife variables: N = 624; 50.8% Black, 49.2% White; Mage = 39.5, SD = 1.28 [36-43 years].

Data were collected on stress exposures (number of stressful life events), stress perceptions (severity), perceived global stress, and resilience factors (self-worth, family support) during childhood and adulthood. Daily stress appraisals were assessed in midlife using 3-day daily diaries. We conducted a series of Poisson regressions and generalized linear mixed-effects models to test race differences in stress and resilience variables from childhood to midlife, while controlling for the effects of education and household income.

Results: Black women reported greater exposure to stressful life events during childhood and young adulthood, but perceived these events as less severe than White women. They also exhibited lower perceived global stress and higher resilience, including greater self-worth and family support, throughout childhood and adulthood. In midlife, Black women reported more daily joy and a greater sense of control over stress compared to White women.

Conclusions: Despite greater stress exposure, Black women in our study perceived stressful events as less threatening, possibly due to higher resilience factors like strong support systems and self-esteem. This pattern aligns with the Environmental Affordances Model of Health Disparities (Jackson et al., 2010), which suggests that the perception and use of social and internal resources may reduce the impacts of stress on health. Understanding these processes could inform interventions to address health inequities and promote well-being among diverse populations.

Author - Meital Mashash, Ph.D. ,
University of California, San Francisco

Co-Author - John Malamon, Ph.D.,
University of Colorado

Co-Author - Barbara Laraia, Ph.D. ,
University of California, Berkeley

Co-Author - Mahasin Mujahid, Ph.D. ,
University of California, Berkeley

Co-Author - A. Janet Tomiyama, Ph.D.,
University of California, Los Angeles

Co-Author - Elissa Epel, Ph.D.,
University Of California, San Francisco

Co-Author - Stefanie Mayer, Ph.D.,
University of California, San Francisco