Shivika Udaipuria

Objective: African American women experience disproportionate cardiovascular disease risk, and altered central hemodynamics signal early vascular aging. For African American mothers, concern about their children’s exposure to racism represents a salient psychosocial stressor, but its vascular consequences are unclear. We examined whether greater racism‑related Concern for Children (CFC) was associated with adverse longitudinal changes in central hemodynamics. Methods: African American mothers aged 30-46 years ( n =236) underwent assessments of central systolic blood pressure (cSBP), augmentation index (AIx), pulse pressure amplification (PPA), and pulse wave velocity (PWV; n =205) at baseline and 4±1 years later. CFC was measured continuously (range 0-24) and categorically (high vs. low). Multivariable linear regression models examined associations between CFC and changes in central hemodynamics, adjusting for baseline values and sociodemographic, clinical, and psychosocial covariates. Logistic regression evaluated CFC and odds of newly developed high‑risk PPA (PPAP =0.002). At follow‑up, women with high CFC had AIx values 3.9 percentage points higher than those with low CFC ( P =0.005). CFC was also associated with declining PPA (b=‑0.003, 95% CI [‑0.005, ‑0.001]; P =0.024) and greater odds of newly developed high‑risk PPA (OR=1.08, 95% CI [1.01, 1.15]; P =0.033). No associations were observed for cSBP or PWV. Conclusions: Greater racism‑related concern for children is associated with signs of early vascular aging in African American mothers, highlighting the cardiovascular consequences of racism‑related maternal stress.

Objective: Anti-black police violence and harassment have been identified as public health issues. However, studies have primarily focused on direct and/or vicarious police encounters. A dearth of studies has also examined vigilance related to future police encounters, and to our knowledge, no studies have examined all 3 kinds of police-related stress among African American women. Methods: We employed a latent class analysis (LCA) approach to identify classes of African American women ( N = 422), aged 30 to 46, based on the patterning of various forms of self-reported police-related stress: direct, vicarious, police-related vigilance for self, and police-related vigilance for children. We then examined associations between latent class membership and carotid intima media thickness (IMT), a marker of cardiovascular risk. Results: We identified 3 latent classes of police-related stress: (1) high child vigilance-high personal exposure, (2) no child vigilance-high personal exposure, and (3) moderate child vigilance-low self vigilance-low personal exposure class. Findings from the fully adjusted model reveal that the no child vigilance-high personal exposure class had lower common carotid artery (CCA) IMT than the high child vigilance-high personal exposure and moderate child vigilance-low self vigilance-low personal exposure classes. Conclusions: Vigilance for children’s future police encounters may be associated with increased cardiovascular risk in African American women. Agency, system, and policy-level solutions may be needed to reduce anti-black police violence and improve the cardiovascular health of this high-risk population.

Background: Emerging evidence suggests that the Superwoman Schema (SWS)—the sociocultural representation of Black women as naturally strong, independent, and nurturing—may play an important role in Black women’s cardiovascular health; but findings have been relatively mixed. One interesting possibility is that environmental mastery, a sense of control over one’s environment, may mitigate negative aspects of SWS. Purpose: We investigated whether mastery moderated the association between SWS and pulse wave velocity (PWV), the gold standard measure of arterial stiffness linked to cardiovascular morbidity and mortality. Methods: Participants were N = 368 early middle-aged (30-45 years old) Black women from the southeastern USA who completed the 35-item Giscombé Superwoman Schema Questionnaire and Ryff’s 14-item environmental mastery scale. Carotid-femoral PWV was assessed using the SphygmoCor device. Linear regression models examined the main and interactive associations of SWS and mastery on PWV, adjusting for age, education, income, body mass index, smoking status, blood pressure, and antihypertensive medication use. Results: Analyses revealed a significant overall SWS endorsement by mastery interaction [β = −.11, P = .02], such that SWS was positively associated with higher PWV only when mastery was low. Three SWS dimensions drove this association: SWS strength, SWS suppress emotions, and SWS resistance to vulnerability (all P-values < .05) showing similar patterns to the overall SWS interaction with mastery. Conclusions: In Black women, high endorsement of SWS is associated with greater arterial stiffness when environmental mastery is low. Thus, SWS may be more physiologically taxing when one senses less control over their environment.

Differences of sex development (DSD) can affect the physical health, appearance, and psychosocial functioning of affected individuals, but little is known about how subjective appearance perceptions (body image) impact psychosocial outcomes. This study evaluated body image and its associations with psychosocial outcomes including quality of life, resilience, and psychosocial adjustment. This cross-sectional, multi-method study assessed body image and psychosocial outcomes including quality of life, adjustment, and resilience in 97 youth and young adults with DSD (mean age = 17 ± 3.7 years; 56% assigned female in infancy) using psychometrically sound instruments. A subsample (n = 40) completed qualitative interviews. Quantitative results indicated that overall, participants were satisfied with their physical appearance, although less so with their primary sex characteristics. Body image dissatisfaction was associated with poorer psychosocial adjustment, quality of life, and resilience. Qualitatively, youth and young adults reported a variety of perceptions, both positive and negative, related to their body image and the impact of living with a DSD condition. Themes identified included appearance management; effects of DSD on body image; diagnostic factors and features; attitudes about diagnosis; and treatment. Body image is significantly associated with psychosocial outcomes in youth and young adults with DSD, with qualitative findings highlighting both positive and negative body image experiences. Results have implications for clinical care including screening for appearance concerns, normalization of appearance variations, and intervention development to better support healthy body image and psychosocial functioning in youth and young adults with DSD.

As congenital heart disease (CHD) survivors age, they are confronted with elevated risk of cardiovascular morbidity and increasingly complex disease self-management demands. Given that stress is associated with poor physical and psychosocial outcomes, it is crucial to examine how disease-related stress changes over time in this population. However, this outcome has received little research attention to date. This study aimed to identify demographic and clinical predictors of change in disease-related stress over six years among CHD survivors. CHD survivors (N = 252, M_age = 25.6 ± 7.1, 52.9% female) completed the first 13 items of the Responses to Stress Questionnaire, adapted for use among CHD survivors, to assess disease-related stressors at study entry (T1) and six-year follow-up (T2). Age, gender, estimated family income, and New York Heart Association (NYHA) functional class at T1 were entered into mixed linear models to determine their impact on change in disease-related stress. Older age (p < .001), lower income (p < .001), and presence of functional limitations (NYHA ≥ II) (p < .001) predicted greater increases in disease-related stress. When controlling for NYHA, functional class, and income, a significant time by age interaction was identified such that disease-related stress increased over time among those who were adolescents at T1 (b = 4.20, p = .010, 95% CI [1.01, 7.40]), but remained stable among young adults. The transition from adolescence to adulthood may be a period of increasing disease-related stress. Healthcare providers should consider screening adolescents for elevated disease-related stress during transition education and provide resources to bolster resilience.