Diana A. Chirinos

Background: In 2024, the Supreme Court ruled in the City of Grants Pass vs Johnson that local towns and municipalities may ban people from sleeping in public places, overturning a lower-court precedent that previously deemed this cruel and unusual punishment. Purpose: This position paper sought to identify effective interventions for addressing homelessness and emphasize the implications of legislature on sleep and public health outcomes. Methods: As this is a policy position paper, the opinions listed in this report have been informed by existing evidence. We provide policy recommendations for research-supported approaches addressing homelessness. Results: Successful interventions for homelessness included those that focused on providing support and increasing resources, such as the development of Safe Sleeping Zones in California, or providing individuals with housing subsidies, income assistance, or support in finding rentals. Conclusion: We provide the following policy recommendations for legislators: increased federal funding/incentives for unsheltered homelessness programs, a greater allocation of the federal budget attributed to supportive services, and increased legislation for homelessness prevention. We suggest a shift in focus on implementing more empowerment and supportive-based approaches as opposed to punitive approaches. Investing in homelessness prevention efforts has yielded long-term societal-level financial and economic benefits.

Background: This study examined the longitudinal associations of psychosocial stress subgroups with cardiovascular disease (CVD) events and whether social support, neighborhood cohesion, and physical activity modified these associations in MESA (Multi‐Ethnic Study of Atherosclerosis). Methods and Results: Data from 6349 adults (aged: 62.2 ± 10.2 years; 52.9% women) from the MESA study with no prior CVD in 2000 to 2002 (baseline) were used in this analysis. Latent class analysis was used to specify distinct psychosocial stress subgroups based on self‐reported stressors stemming from respondents' neighborhood and social environment. Adjudicated CVD events (fatal and nonfatal events) were ascertained annually through the year 2019. Cox proportional hazards models were used to examine the associations between subgroup membership and CVD events. Five distinct psychosocial stress subgroups were identified via latent class analysis and were labeled “moderate neighborhood noise” (12.1%), “excessive neighborhood noise” (6.4%), “multiple high stressors” (6.3%), “high discrimination” (21.4%), and “optimal” (53.8%). By 2019, 1121 participants had experienced a CVD event. Membership in the high discrimination (hazard ratio [HR], 1.29 [95% CI, 1.10–1.51]) subgroup was associated with higher risk of a CVD event when adjusted for sociodemographic characteristics and cardiovascular health metrics. Neither social support, neighborhood cohesion, nor physical activity modified this association ( P >0.05). Conclusions: Distinct subgroups of individuals with high self‐reported psychological distress—particularly related to discrimination and chronic stress are associated with high incident cardiovascular events.

Growing research shows psychosocial factors are associated with blood pressure (BP) control among individuals with hypertension. To date, little research has examined multiple psychosocial factors simultaneously to identify distinguishing profiles among individuals with hypertension. The association of psychosocial profiles and BP control remains unknown. To characterize the psychosocial profiles of individuals with hypertension and assess whether they are associated with BP control over 14 years. We included 2,665 MESA participants with prevalent hypertension in 2002–2004. Nine psychosocial variables representing individual, interpersonal, and neighborhood factors were included. BP control was achieved if systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 9090 mmHg. Latent profile analysis (LPA) revealed an optimal model of three psychosocial profile groups (AIC 121,229; entropy = .88) “Healthy”, “Psychosocially Distressed” and “Discriminated Against”. Overall, there were no significant differences in systolic and diastolic BP control combined, across the profiles. Participants in the “Discriminated Against” profile group were significantly less likely [OR= 0.60; 95% CI: 0.43, 0.84] to have their DBP < 9090 mmHg as compared to the “Healthy” profile, but this was attenuated with full covariate adjustment. Discrete psychosocial profiles exist among individuals with hypertension but were not associated with BP control after full covariate adjustment.

Background We sought to identify depressive symptom subgroups in a community sample of young adults, investigate their stability over time, and determine their association with prevalent and incident cardiovascular disease (CVD) risk factors. Method Participants were 3377 adults from the Coronary Artery Risk Development in Young Adults study. Using latent class and latent transition analysis, we derived subgroups based on items of the 20-item version of the Center for Epidemiologic Studies Depression Scale in 1990, and examined patterns of change over a 10-year period (1990–2000). Cox regression models were used to examine associations between subgroup membership and prevalent (2000) and incident (2000 to 2016) obesity, hypertension, and diabetes. Results Three baseline subgroups were identified and labeled: “No Symptoms” (63.5%), “Lack of Positive Affect” (PA, 25.6%), and “Depressed Mood” (10.9%). At 10-year follow-up, individuals in “No Symptoms” subgroup had the highest probability (0.84) of being classified within the same subgroup. Participants classified as “Lack of PA” were likely (0.46) to remain in the same subgroup or be classified as “No Symptoms.” Participants in the “Depressed Mood” were most likely to transition to the “Lack of PA” subgroup (0.38). Overall, 30.5% of participants transitioned between subgroups, with 11.4% classified as “Worsening” and 19.1% as “Improving.” Relative to the “No Symptoms Stable,” other subgroups (“Depressed Stable,” “Worsening,” and “Improving”) were associated with prevalent obesity and hypertension. Conclusion We identified distinct depressive symptom subgroups that are variably stable over time, and their change patterns were differentially associated with CVD risk factor prevalence.

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in the United States. Despite improvements in the prevention and treatment of CVD over the past 20 years, racial/ethnic minority groups including non-Hispanic Blacks, Hispanic/Latinos, and some Asian subgroups (e.g., Asian Indians, Filipinos) experience higher rates of CVD risk factors and morbidity and mortality from CVD than non-Hispanic Whites. Therefore, addressing cardiovascular health disparities is an immediate priority. Behavioral science can play an important role in reducing disparities by capitalizing on expertise in human behavior change, social determinants of health, and implementation science. In this narrative review, we describe the efforts made within behavioral science to address CVD health disparities. We review current interventions to reduce CVD health disparities and provide practical recommendations that can be used as the field moves forward. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychosocial factors are associated with the achievement of optimal cardiovascular disease risk factor (CVDRF) levels. To date, little research has examined multiple psychosocial factors simultaneously to identify distinguishing psychosocial profiles among individuals with CVDRF. Further, it is unknown whether profiles are associated with achievement of CVDRF levels longitudinally. Therefore, we characterized psychosocial profiles of individuals with CVDRF and assessed whether they are associated with achievement of optimal CVDRF levels over 15 years. We included 1148 CARDIA participants with prevalent hypertension, hypercholesterolemia and/or diabetes mellitus in 2000–2001. Eleven psychosocial variables reflecting psychological health, personality traits, and social factors were included. Optimal levels were deemed achieved if: Hemoglobin A1c (HbA1c) < 7.0%, low-density lipoprotein (LDL) cholesterol < 100 mg/dl, and systolic blood pressure (SBP) < 140 mm Hg. Latent profile analysis revealed three psychosocial profile groups “Healthy”, “Distressed and Disadvantaged” and “Discriminated Against”. There were no significant differences in achievement of CVDRF levels of the 3 targets combined across profiles. Participants in the “Distressed and Disadvantaged” profile were less likely to meet optimal HbA1c levels compared to individuals in the “Healthy” profile after demographic adjustment. Associations were attenuated after full covariate adjustment. Distinct psychosocial profiles exist among individuals with CVDRF, representing meaningful differences. Implications for CVDRF management are discussed.

OBJECTIVE Various organizations have highlighted the need to examine whether abdominal obesity cut points are appropriate for identification of cardiovascular risk among ethnic minority adults, particularly Hispanic/Latino adults living in Western societies. This study aimed 1) to establish optimal definitions for abdominal obesity among Hispanics/Latinos and 2) to determine the level of agreement between the presence of metabolic syndrome diagnosed by the current Joint Interim Statement (JIS) definition and an updated definition with optimal abdominal obesity cut points. RESEARCH DESIGN AND METHODS The sample included 16,289 adults who self-identified as Hispanic/Latino ages 18–74 years enrolled in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Receiver operating characteristic curves were used to derive sensitivity and specificity values. The largest sum of sensitivity plus specificity was used to determine appropriate cut points. RESULTS Among U.S. Hispanic/Latino adults, waist circumference cut points of >102 cm in men (in line with current JIS criteria) and >97 cm (9 points higher than JIS criteria) in women provide optimal discrimination for cardiovascular risk as judged by the presence of coronary heart disease. When using these cut points to create an updated metabolic syndrome definition among women, we found disagreement between our updated definition and the current JIS criteria. The prevalence of the metabolic syndrome was overestimated by ∼5 percentage points among women based on JIS criteria in comparison with our definition. CONCLUSIONS Our results suggest that the current recommendations for waist circumference cut points may not be appropriate for U.S. Hispanic/Latino women.

Spousal bereavement is linked to increased mortality and morbidity from inflammatory conditions. It also has a significant impact on sleep disturbances. Evidence from experimental studies indicates that chronic stress may prime individuals to have an exaggerated inflammatory response to acute stress. In this study, we examined the association between self-reported sleep disturbances and inflammation after adjusting for depressive symptoms, and determined whether this association varies by bereavement status (bereaved individuals vs. controls). Participants included 54 bereaved individuals and 47 controls with a mean age of 67.12 (SD=12.11). Inflammation was measured using C-reactive protein (CRP). Self-reported sleep disturbances were measured using the Pittsburgh Sleep Quality Index (PSQI). Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Sleep disturbances were not associated with elevated levels of CRP in the overall group (B=0.030, standardized β=0.122, 95% Confidence Intervals [CI]=-0.027 – 0.087, p=0.299) after adjusting for depressive symptoms. Results indicated, however, that bereavement moderated the association between inflammation and sleep disturbances (B=0.104, β=0.517, 95% CI=0.009 – 0.198, p=0.032). Stratified analyses demonstrated that these associations differed across groups. Associations were significant among bereaved individuals (B=0.104, β=0.406, 95% CI=0.013 – 0.196, p=0.026) and not controls (B=-0.016, β=-0.066, 95% CI=-0.096 – 0.065, p=0.690). These findings provide preliminary evidence that bereavement moderates the association between self-reported sleep disturbances and inflammation. Future studies should examine the course of sleep disturbances following bereavement and establish whether objective sleep has differential associations with inflammation among bereaved adults.

Perceived neighborhood characteristics are linked to obesity, however, the mechanisms linking these two factors remain unknown. This study aimed to examine associations between perceived neighborhood characteristics and body mass index (BMI), establish whether indirect pathways through psychological distress and inflammation are important, and determine whether these associations vary by race/ethnicity. Participants were 1,112 adults enrolled in the Texas City Stress and Health Study. Perceived neighborhood characteristics were measured using the Perceived Neighborhood Scale. Psychological distress was measured with the Center for Epidemiological Studies Depression Scale, Perceived Stress Scale and mental health subscale of the Short Form Health Survey-36. Markers of inflammation included C-reactive protein, interleukin-6, and tumor necrosis factor receptor-1. Associations were examined with Structural Equation Modeling. A model linking neighborhood characteristics with BMI through direct and indirect (i.e., psychological distress and inflammation) paths demonstrated good fit with the data. Less favorable perceived neighborhood characteristics were associated with greater psychological distress (B = −0.87, β = −0.31, p < .001) and inflammation (B = −0.02, β = −0.10, p = .035). Psychological distress and inflammation were also significantly associated with BMI (B_distress = 0.06, β = 0.08, p = .006; B_inflammation = 4.65, β = 0.41, p < .001). Indirect paths from neighborhood characteristics to BMI via psychological distress (B = −0.05, β = −0.03, p = .004) and inflammation (B = −0.08, β = −0.04, p = .045) were significant. In multiple group analysis, a model with parameters constrained equal across race/ethnicity showed adequate fit suggesting associations were comparable across groups. Our study extends the literature by demonstrating the importance of neighborhood perceptions as correlates of BMI across race/ethnicity, and highlights the role of psychological and physiological pathways.