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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. 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. 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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

25196409 10 Woods-Giscombe CL, Gaylord SA, Li Y. A Mixed-Methods, Randomized clinical trial to examine feasibility of a mindfulness-based stress management and diabetes risk reduction intervention for African Americans with prediabetes. Sixty-eight participants were randomized to the mindfulness-based diabetes risk-reduction education program for prediabetes (MPD; I n i = 38) or the conventional diabetes risk-reduction education program for prediabetes (CPD; I n i = 30). The primary aim of the study was to investigate the feasibility of conducting a randomized trial comparing a novel mindfulness-based stress management program combined with diabetes risk-reduction education versus a conventional diabetes risk-reduction education program among African American adults with prediabetes and self-reported life stress. [Extracted from the article]

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. [ABSTRACT FROM AUTHOR]

African Americans have disproportionately high rates of stress-related conditions, including diabetes and diabetes-related morbidity. Psychological stress may negatively influence engagement in risk-reducing lifestyle changes (physical activity and healthy eating) and stress-related physiology that increase diabetes risk. This study examined the feasibility of conducting a randomized trial comparing a novel mindfulness-based stress management program combined with diabetes risk-reduction education versus a conventional diabetes risk-reduction education program among African American adults with prediabetes and self-reported life stress. Participants were recruited in collaboration with community partners and randomized to the mindfulness-based diabetes risk-reduction education program for prediabetes (MPD; n = 38) or the conventional diabetes risk-reduction education program for prediabetes (CPD; n = 30). The mindfulness components were adapted from the Mindfulness-based Stress Reduction Program. The diabetes risk-reduction components were adapted from the Power to Prevent Program and the Diabetes Prevention Program. Groups met for eight weeks for 2.5 hours, with a half-day retreat and six-monthly boosters. Mixed-methods strategies were used to assess feasibility. Psychological, behavioral, and metabolic data were collected before the intervention and at three and six months postintervention to examine within-group change and feasibility of collecting such data in future clinical efficacy research. Participants reported acceptability, credibility, and cultural relevance of the intervention components. Enrollment of eligible participants (79%), intervention session attendance (76.5%), retention (90%), and postintervention data collection attendance (83%, 82%, and 78%, respectively) demonstrated feasibility, and qualitative data provided information to further enhance feasibility in future studies. Both groups exhibited an A1C reduction. MPD participants had reductions in perceived stress, BMI, calorie, carbohydrate and fat intake, and increases in spiritual well-being. Considering the high prevalence of diabetes and diabetes-related complications in African Americans, these novel findings provide promising guidance to develop a larger trial powered to examine efficacy of a mindfulness-based stress management and diabetes risk-reduction education program for African Americans with prediabetes. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The aim of this clinical training site innovation is to develop accessible pediatric mental health clinical training sites for psychiatric mental health nurse practitioner (PMHNP) students. Mental health services in school settings provide treatment in the child's community and create opportunities for innovation and collaboration with teachers, school counselors, and school psychologists. School settings provide opportunities for early recognition of anxiety symptoms and accessible treatment that can help close the gap in clinical training sites for this population. Mild and moderate symptoms of anxiety often go untreated and may affect academic performance negatively. Cognitive behavioral play therapy is an effective treatment modality provided by PMHNP students and supports the roles of school personnel. [ABSTRACT FROM AUTHOR]

The purpose of this systematic review was to investigate the influence of dosage, type (active, receptive, or combined), and format (individual or group) of music therapy for individuals with schizophrenia. With the terms “music*” and “schizophreni*,” six research databases were searched: CINAHL, EMBASE, Music Index, PsycInfo, Pubmed, and RILM. The search was limited to studies written in English, peer-reviewed, and published between 1991 and 2015. Seventeen articles met the stated criteria. Dosage of music therapy ranged from 20 to 9,720 minutes. Three types of music therapy were delivered: active, receptive, or combined, and therapy was implemented via individual or group format. Depending on the dosage, type, and format, music therapy improved psychotic symptom management, depression and anxiety management, social and cognitive functioning, behavior, and quality of life of the participants. Dosage had a greater impact on the effects of music therapy compared to type and format. Studies that implemented a combination of active and receptive music therapy were more likely to produce significant improvements in outcomes compared to the studies that implemented the other types of music therapy. However, studies using combined type provided higher dosage of the intervention (e.g., more minutes of intervention exposure). This systematic review can be used to guide future research on and clinical applications for music therapy in this population. Future studies might also investigate the interaction of demographic characteristics or severity of illness with dosage and type on effects of music therapy. [ABSTRACT FROM PUBLISHER]

A growing body of literature supports the association between adverse stress experiences and health inequities, including obesity, among African American/Black women. Adverse stress experiences can contribute to poor appetite regulation, increased food intake, emotional eating, binge eating, and sedentary behavior, all of which can contribute to weight gain and obesity. Most research studies concerning the effect of psychological stress on eating behaviors have not examined the unique stress experience, body composition, and eating behaviors of African American/Black women. Even fewer studies have examined these constructs among Black female college students, who have an increased prevalence of overweight and obesity compared to their counterparts. Therefore, the aim of the current study is to examine the associations among emotional eating, perceived stress, contextualized stress, and BMI in African American female college students. All participants identified as African American or Black (N=99). The mean age of the sample was 19.4 years (SD=1.80). A statistically significant eating behavior patterns×perceived stress interaction was evident for body mass index (BMI) (β=0.036, S.E.=.0118, p<.01). In addition, a statistically significant eating behavior patterns×contextualized stress interaction was observed for BMI (β=0.007, S.E.=.0027, p=.015). Findings from this study demonstrate that the stress experience interacts with emotional eating to influence BMI. Based on these findings, culturally relevant interventions that target the unique stress experience and eating behavior patterns of young African American women are warranted. [ABSTRACT FROM AUTHOR]

Mental health providers in the USA encounter the challenge and opportunity to engage the rapidly growing population of Hispanic older adults in evidence-based mental health treatments. This population underutilizes mental health services, despite comparable or slightly higher rates of mental illness compared with non-Hispanic White older adults. This review identified barriers and facilitators of mental health service use by Hispanic older adults in the USA to identify practice, policy, and research implications. Hispanic older adults face multiple compounding barriers to mental health service use. Issues related to identification of needs, availability of services, accessibility of services, and acceptability of mental healthcare treatment are discussed. [ABSTRACT FROM AUTHOR]

Careers Beyond the Bedside (CaBB) aimed to increase diversity in the BSN program and encourage the pursuit of graduate education. The program included recruitment activities, academic and professional support for nursing students, and activities to stimulate interest in graduate school. CaBB targeted disadvantaged and underrepresented ethnic minority (UREM) students. Seminars, the cornerstone of CaBB, provided career information and a structured support group. Modest scholarships provided financial assistance. Twenty-nine of 35 scholarship students graduated by the end of the three-year grant and three were enrolled in graduate programs, demonstrating the effectiveness of CaBB to recruit and graduate UREM and disadvantaged students. [ABSTRACT FROM AUTHOR]

Mental health concerns among doctorate (PhD) nursing students may impact program retention, especially among underrepresented racial-/ethnic-minoritized (UREM) students. Understanding mental health concerns among UREM PhD students is necessary to develop retention strategies. We conducted a qualitative secondary data analysis of a descriptive study with focus groups and individual semi-structured interviews. Participants identified as actively enrolled UREM in PhD nursing programs. Conventional content analysis was utilized. Mental health informed retention through the following themes: PhD program pressure and expectations, help-seeking barriers, personal motivations to succeed, and it takes a village: fostering peer support. Implications for nursing faculty are discussed. [ABSTRACT FROM AUTHOR]

Objective: Indigenous people's ceremonies using rhythm and dance have been used for countless generations throughout the world for healing, conflict resolution, social bonding, and spiritual experience. A previous study reported that a ceremony based on the Central African ngoma tradition was favorably received by a group of Americans. The present trial compared the effects of the modified ngoma ceremony (Ngoma) with those of mindfulness-based stress reduction (MBSR) in a randomized pilot study. Methods: Twenty-one women were randomized to either Ngoma or MBSR. Both groups had sessions on a weekly basis for 8 weeks and completed questionnaires at baseline, week 8, and 1 month after the intervention. Participants completed questionnaires, which included self-report of depressive and anxiety symptoms, health status (e.g., quality of life and functioning), social bonding, and perception of the credibility of the two interventions. Results: Both groups showed improvements in depression, anxiety, emotional well being, and social functioning as measured by respective scales. Social bonding also increased in both groups during the study and may be a mechanism for both interventions. Participants found both interventions credible. Conclusions: In this pilot study, Ngoma showed significant and durable beneficial effects comparable to MBSR. The effects of Ngoma and other indigenous rhythm-dance ceremonies on distress and health status in western culture should be investigated in larger clinical studies. [ABSTRACT FROM AUTHOR]

Purpose: To determine the research output of Caribbean nurses and midwives. Methods: We searched the Scopus database to identify publications by Caribbean nurses and midwives during the period 2000–2020. Publications were included in the analysis if they had at least one author who was either a nurse or midwife and affiliated with a Caribbean geographic location. All publication types and languages were included in the analysis. Organization analysis and collaboration networks were created using the VOS Viewer application. Findings: The number of Scopus publications by Caribbean nurses and midwives progressively grew from 22 in 2000 to 584 in 2020. Cuba recorded the highest number of nursing research publications (319) followed by Jamaica (92), and Puerto Rico (59). Most publishing institutions were universities. The University of the West Indies (Jamaica) ranked highest with 15.2% of publications, followed by Universidad de Ciencias Médicas de La Habana with 14.4% of publications, Universidad de Puerto Rico ranked third with 9.8% of publications. The majority of publications (83.6%) were peer reviewed research articles, while review articles accounted for 9.8% of publications. Six out of the ten journals that published most research done by Caribbean nurse researchers were Cuban journals which published a total of n = 250 (75.8%) articles. All six journals had no impact factor and had low cite scores. Conclusions: Our analysis of bibliometric indicators suggest that recent and steady growth in nursing and midwifery research in the Caribbean has had low visibility. Equipping nurses and midwives with the necessary knowledge and skills to lead, teach, and conduct high quality research through doctorate level education is an imperative for increasing research productivity among Caribbean nurses and midwives. Clinical relevance: Nursing and midwifery research is critical for evidence‐based nursing and midwifery practice. High quality and context specific research evidence will enable Caribbean nurses and midwives to provide quality and culturally sensitive nursing and midwifery care and contribute to evidence informed policy decisions. [ABSTRACT FROM AUTHOR]

The objective of this study is to evaluate the life course effects of racism on depressive symptoms in young Black women and to identify particularly sensitive periods. Guided by life-course theory and using logistic regression, we analyzed baseline data on racism frequency and stress from racism at two time periods (before age 20 and during the 20s) and follow-up data (at approximate 20-month intervals) on depressive symptoms (using a modified 11-item Center for Epidemiologic Studies Depression Scale, CES-D) among 1612 Black women participants aged 23–34 years living in Detroit, MI. Of the 1612 women, 65% reported experiencing some racism at baseline, and 36.5% had high depressive symptoms at follow-up. Those who experienced high frequency of racism before age 20 had an increased risk for high depressive symptoms (RR = 1.26, 95% CI: 1.07, 1.46) compared to participants in the low racism frequency group. We observed similar associations for high vs. low stress from racism (RR = 1.30, 95% CI : 1.06, 1.54) and high vs. low combination of racism frequency and stress (RR = 1.38, 95% CI: 1.13, 1.64). These findings did not hold or were weaker when assessing racism during the 20s. Among women who experienced high racism across the two time periods, the risk of high depressive symptoms was higher than those who experienced low racism during both periods (RR = 1.49, 95% CI: 1.14, 1.86). The slightly stronger associations between racism and depressive symptoms in childhood and adolescence than in young adulthood suggest that early life might be a sensitive period for experiencing racism. [ABSTRACT FROM AUTHOR]

• Within-group studies examined primarily female and Hispanic/Latinx adolescents. • Studies examined general and mental healthcare services exclusively. • Crisis-oriented, intensive services were the most accessed. • Utilization of preventive services was rarely reported. • Externalizing behavior problems were associated with utilization of services. Adolescents from racial and ethnic minority groups (herein ethnoracially minoritized) in the US contemplate and/or attempt suicide at higher rates than other youths. To address suicide risk, access to and utilization of mental health services is necessary. However, service utilization characteristics for these adolescents at elevated risk for suicide are not well understood. To systematically synthesize service utilization characteristics and identify factors associated with utilization among ethnoracially minoritized adolescents reporting elevated suicide risk (i.e., suicidal ideation, attempts, non-suicidal self-injury). This review follows established scoping review guidelines and Andersen's Behavioral Model of Health Service Use to guide data synthesis. We systematically searched five scientific databases with no restriction to dates of publication. A total of 15 records (12 unique studies) were reviewed. Studies primarily focused on female adolescents (n = 12), suicide attempts (n = 6), and predominantly Hispanic/Latinx samples (n = 4). Crisis oriented services after a suicide attempt were the most reported service utilization outcomes (n = 7). Factors that informed service utilization include the adolescent's psychiatric symptom presentation and family characteristics. Studies suggest limited access to preventative services for ethnoracially minoritized adolescents at risk for suicide. Future studies must examine service utilization more broadly to include non-healthcare service utilization and structural and socio-cultural factors associated with utilization. Limitations of this review and implications for future research are discussed. [ABSTRACT FROM AUTHOR]

Racial discrimination has been linked to allostatic load (i.e., cumulative biological stress) among African American women. However, limited attention has been given to psychosocial processes involved in the stress response—critical for understanding biological pathways to health—in studies examining racial discrimination as a social determinant of health. We examined whether the superwoman schema (SWS), a multidimensional culture‐specific framework characterizing psychosocial responses to stress among African American women, modifies the association between racial discrimination and allostatic load. We used purposive sampling to recruit a community sample of African American women ages 30–50 from five San Francisco Bay Area counties (n = 208). Path analysis was used to test for interactions while accounting for the covariance among SWS subscales using both linear and quadratic models. Significant interactions were observed between racial discrimination and four of the five SWS subscales. Feeling obligated to present an image of strength and an obligation to suppress emotions were each protective whereas feeling an intense motivation to succeed and feeling an obligation to help others exacerbated the independent health risk associated with experiencing racial discrimination. Our findings affirm the need to consider individual variability in coping and potentially other psychosocial processes involved in the stress response process, and offer several insights that may help elucidate the mechanisms by which racial discrimination gets "under the skin." [ABSTRACT FROM AUTHOR]

John Henryism and Superwoman Schema (SWS) are dispositional characteristics adopted to overcome the challenges of chronic psychosocial stress, and have particular salience for African American women. Both show protective and harmful effects on health and share conceptual similarities and distinctions, yet there is no empirical evidence of the potential overlap resulting in uncertainty about the unique roles they may each play concerning the health of African American women. We examined: 1) whether and to what extent John Henryism and SWS represent similar or distinct constructs relevant to the unique sociohistorical and sociopolitical position of African American women, and 2) whether the two differentially predict health outcomes. Data are from a purposive and socioeconomically diverse sample of 208 African American women in the San Francisco Bay Area. First, we conducted a progressive series of tests to systematically examine the conceptual and empirical overlap between John Henryism and SWS: correlation analysis, exploratory factor analysis (EFA), principal component analysis and k-modes cluster analysis. Next, we used multivariable regression to examine associations with psychological distress and hypertension. John Henryism and SWS were moderately correlated with one another (r s = 0.30–0.48). In both EFA and cluster analyses, John Henryism items were distinct from SWS subscale items. For SWS, feeling an obligation to present an image of strength and an obligation to help others predicted higher odds of hypertension (p < 0.05); having an intense motivation to succeed predicted lower odds (p = 0.048). John Henryism did not predict hypertension. Feeling an obligation to help others and an obligation to suppress emotions predicted lower levels of psychological distress (p < 0.05) whereas John Henryism predicted higher distress (p = 0.002). We discuss the implications of these findings for the measurement of culturally specific phenomena and their role in contributing to the unequal burden of ill health among African American women. • John Henryism and Superwoman Schema are statistically distinct constructs. • The two constructs represent unique forms of coping in African American women. • The two measures differentially predict psychological distress and pre/hypertension. • Understanding culturally-specific coping may inform how racism gets under the skin. • The findings have implications for understanding intersectional stress-coping dynamics. [ABSTRACT FROM AUTHOR]