Jill B. Hamilton

Introduction. Stable religious participation may have beneficial contributions to cognitive and mental health; however, less is known about how changes in religious participation, such as disengagement or increased engagement in church activities, affect these health outcomes and whether there are differences between racial groups. This study aimed to examine the association between changes in church activity and cognitive, functional, and mental health in older adults, and explore differences by race. Methods. Using data from the University of Pennsylvania Alzheimer’s Disease Research Center Aging Brain Cohort in 2021-2022, we examined associations between self-reported change in church activity with cognitive and functional health (Global Clinical Dementia Score (CDR) and total CDR) and neuropsychiatric symptoms (Neuropsychiatric Inventory) in cognitively normal older adults (n=158). We used multivariable regression analysis, controlling for self-reported age, sex, education, and social interaction, to examine differences between individuals who identified as either Black or White. Results. Controlling for covariates, Black participants who reported substantially more or less church activity in the last year had lower cognition and function (Global CDR, β = 0.19, 95%CI [0.04, 0.34], p<0.05) and Total CDR (β = 0.30, 95% CI [0.01, 0.58], p = 0.042), and more neuropsychiatric symptoms (β = 0.63, 95% CI [0.02, 1.24], p<0.045). No significance was found in White older adults. Black older adults reporting major changes in church activity experienced lower cognitive, functional, and mental health. Conclusion. To explore if church activity changes could be an early sign of cognitive, functional, and mental health decline, longitudinal studies are needed.

Background: Communication is an important tool in combatting racial and economic healthcare disparities in cancer care. The ability to communicate treatment-related distress and troubling symptoms can allow proactive symptom mitigation and adherence to a prescribed cancer treatment. Few studies have explored how racial and economic differences in patient–clinician interactions in cancer care influence symptom distress and chemotherapy adherence. Objectives: This study aimed to examine racial differences in interpersonal processes of care and their association with symptom distress and optimal chemotherapy dose among women diagnosed with early-stage breast cancer (ESBC). Methods: Black and White women newly diagnosed with ESBC and prescribed chemotherapy for a diagnosis of invasive breast cancer were recruited. The Interpersonal Processes of Care Survey and Symptom Distress Scale were included in this analysis. Ratios of prescribed chemotherapy to received chemotherapy were recorded as total chemotherapy percentage. Results: Persons who were Black perceived worse scores in communication, including “lack of clarity,” “discrimination due to race/ethnicity,” and “disrespectful office staff.” Participants who lived in areas of greater deprivation perceived worse levels of “discrimination due to race/ethnicity” compared to those living in areas of less deprivation. Participants who perceived higher “discrimination due to race/ethnicity” were less likely to achieve optimal chemotherapy doses. Those who perceived worse scores for “lack of clarity,” “discrimination due to race/ethnicity,” “disrespectful office staff,” and “compassion” had significantly higher levels of symptom distress. Discussion: Symptom distress during ESBC chemotherapy must be communicated via patient–provider interaction. Patients' perceptions of discrimination and bias may inhibit this process. This interaction requires further interrogation to develop an inclusive symptom communication protocol.

Background and Objectives: Racism and religion are recognized as prevailing Social Determinants of Health (SDoH). To explore ways in which racism and religion looms in the daily lives of African Americans, we analyzed the experiences of African Americans born during the Jim Crow years and living in the Southern Appalachian Region of the United States. Research Design and Methods: Twenty-seven African Americans participated in this qualitative descriptive study that utilized criterion sampling, open-ended semistructured interviews, and content analysis to identify a typology of categories related to experienced racism and ways in which religion was used in response to those experiences. Results: Participants were an average age of 82.22 years (SD = 5.07); primarily women (n = 19, 70.4%); married (n = 11, 40.7%); junior high school (n = 6, 22.2%), high school or general educational diploma (n = 7, 25.9%), completed college or professional school (n = 6, 22.2%); were retired (n = 27, 100.0%); and affiliated with Baptist churches (n = 18, 66.7%). Experiences with racism included inequities in healthcare and education, and racially motivated physical violence. Religious practices/beliefs included forgiveness, humility, and humanity. Discussion and Implications: Racism experienced by African American participants was likely countered by religious practices/beliefs inspired through intergenerational teachings with affiliations to the Black Church. These experiences of the oldest old ) African Americans living in communities of the Southern Appalachia, United States, illustrate the pervasive nature of racism. The religious beliefs that are frequently transmitted intergenerationally through the Black Church are relevant to understand present-day encounters with racism among African Americans and possibly other communities of color.

African American women breast cancer survivors are among those with the greater burden of cancer. Breast cancer is the second leading cause of death among black women, and this death rate is 40% higher than that of white women. The COVID-19 pandemic increased the burden of morbidity and mortality among this population of cancer survivors. In this report, we explore the ways in which the COVID-19 pandemic was a source of stress for African American women breast cancer survivors and their subsequent responses to these stressors. This is a qualitative descriptive study with content analysis of data from the narratives of 18 African American breast cancer survivors. Participants were interviewed via phone and video conferencing platform and asked questions related to their experiences with the COVID-19 pandemic. The findings suggest stressors associated with (1) potential COVID-19 spreaders in their immediate environments; (2) closures and restricted access to social- and faith-based activities; (3) televised news broadcasts of COVID-19; and (4) disruptions to planned cancer prevention and control healthcare. Three categories emerged that captured the ways in which these women responded to stressors during the early phase of this pandemic: (1) seeking control in their social environments; (2) following the rules; and (3) seeking support from God, family, and friends. These findings can be used to better support breast cancer patients during the early phases of a pandemic.

Commonly reported in dementia, neuropsychiatric symptoms (NPS), cognitive decline, and sleep disturbances indicate dementia progression. With the growing dementia burden, identifying protective factors that may slow dementia progression is increasingly essential. Religion and spirituality are associated with better mental and physical health, yet few studies have been reported in older adults with dementia. This study examines associations between religious service attendance and symptoms of dementia progression. Using data from the Health and Retirement Study in 2000, 2006, and 2008 and the sub-study, Aging, Demographics, and Memory Study in 2001–2003, 2006–2007, and 2008–2009, we examined the association of religious attendance with neuropsychiatric symptoms, cognitive function, and sleep disturbances among U.S. older adults aged 70 years and older with all-cause dementia (N = 72) using Spearman’s partial Rho correlation controlling for social interaction. Significant associations were identified for religious attendance and NPS (r_s (97) = –0.124, 95% CI [–0.129, –0.119], p < 0.0005); cognitive function, r_s (97) = –0.018, 95% CI [–0.023, –0.013], p < 0.001); and sleep disturbances, r_s (97) = –0.275, 95% CI [–0.280, –0.271], p < 0.0005). Beyond adjusting for social interaction, increased religious attendance was associated with lower NPS, better cognitive function, and fewer sleep disturbances. Clinical trials and longitudinal studies with a larger sample size examining religion and spirituality factors with dementia progression are warranted.