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• Can Virtual Reality-Based Stress Reduction Interventions Be a Game Changer for Addressing Intersectional Stress Among Minoritized Women?

  

  By Judite Blanc, Ph.D.
  University of Miami Miller School of Medicine
  Posted July 22, 2024

  

  My journey to the field of stress research and disaster mental health began during my postpartum as a first-time mother, after surviving the most devastating Haiti earthquake in 2010, which claimed over 200,000 lives. Worried about our safety and too scared to hide under my bed, halfway through my master’s degree in developmental psychology at the time, I grabbed my baby and hurried into a closet. As the place was shaking and my baby was screaming, I thought we were going to die alone. We were not injured, but with each aftershock, I was terrified that our house would collapse on us.

  After the earthquake, similarly to thousands of displaced survivors, we left Haiti for a month or two and went to Florida for safety, but I knew my place was in Haiti. So, in March 2010, I returned and joined Haiti’s Psycho Trauma Center, which was set up to help heal survivors’ psychological wounds.

  I enjoyed working with the displaced children. Nevertheless, I was also curious about the efficacy and cultural limitations of these Western-centered theoretical frameworks that inspired our interventions. I obtained a scholarship to complete my graduate studies in the field of psychopathology and health psychology in France, where I received extensive training in traumatic stress research. Findings from my dissertation project highlighted the urgent need for trauma-focused and holistic programs for perinatal women, mother-children dyads, and school-aged children who are survivors of traumatic events.

  A few years after the disaster, I moved to the United States. I was confronted with another traumatic reality: Black women and their children, regardless of education levels, suffer significantly from health disparities. For instance, they are the most affected by the maternal mortality crisis in the U.S., which is comparable to that of lower-middle-income countries, making it a national public health emergency. This realization further fueled my passion for addressing these disparities.

  Evaluating the Effect of a Virtual Reality Program on Maternal Stress Among Perinatal Women of Color

  Perinatal mental health issues are the drivers of complications during pregnancy, childbirth, and maternal mortality. Studies indicate that 15% to 20% of pregnant and postpartum individuals in the U.S. suffer from mood or anxiety disorders. However, this mental health crisis does not affect all racial and ethnic groups equally. Women, particularly Black women from marginalized communities, are disproportionately impacted, underscoring the complex interplay of race, ethnicity, gender, and socioeconomic status.

  A mom uses the NurtureVR headset and controller in her hospital room to relax and learn.

  In response to this crisis, in 2022, The Media and Innovation Lab and I implemented the ongoing Nurturing Moms study at the University of Miami Miller School of Medicine. Our study assesses Nurture VR™, a virtual reality (VR)-based, pregnancy-related education program integrating mindfulness techniques, relaxation exercises, and guided imagery for perinatal Black and Latina women. VR uses computer modeling and simulation to allow a person to interact with a simulated 3D visual or sensory environment.

  In our recent qualitative phase of the study, we learned about specific challenges faced by our volunteers, such as time management difficulties, caregiver burden, financial strain, insufficient sleep, societal pressures, lack of social support, traumatic stress, and inadequate health care coverage.

  While conducting the focus groups, I was struck by the contrasting perspectives among participants. Some Latina women emphasized the inherent resilience of motherhood, while Black participants expressed frustration with the societal expectation of the "strong Black woman" archetype.

  "The idea that you just got to keep pushing forward even if the day is tough, like you have to. You’re a mom. You got to like suck it up and do dues because these kids need you, and then at the end of the day, when you want to unwind and go to bed, you end up scrolling through your phone because that’s your only me time."
  – Expectant mother of one, Hispanic

  "Everywhere as a Black woman, you have to be strong, and I just can’t stand to hear that because it’s like, why are we the only race that have to be strong? Why everybody else gets to cry, get to show emotion, get to feel, but we always have to be strong."
  – Expectant mother, Haitian-born

  The women’s responses highlight the nuanced experiences within different cultural contexts. Additionally, there were varied views on the new medicine for postpartum depression, zuranolone. Some participants said they favor complementary medicine, and others showed strong interest in it due to limited access to mental health professionals.

  Many of our study participants provided positive feedback, emphasizing that the immersive quality of VR effectively engaged them and demonstrated its effectiveness in creating a unique experience through guided imagery and relaxation techniques. For example, while wearing the VR headset, pregnant or new moms can select educational modules or guided imagery that allow them to become entranced by the rhythmic waves of a beach or the tranquility of a green space. This experience can elevate their mood and help them focus, learn, and retain positive experiences.

  A prominent theme that emerged was the participants’ sense of escapism. The portability and on-demand nature of VR-based interventions make them a valuable asset for low-income communities. In these communities, transportation challenges, cultural barriers, and the stigma surrounding mental health can significantly hinder access to quality mental health services among marginalized populations.

  Culturally tailored and affordable VR-based interventions have the potential to mitigate these barriers, thereby contributing to the reduction of social determinants of health stressors among women and mothers of color.

  Judite Blanc, Ph.D., is a 2023 NIMHD HDRI Scholar and a multilingual assistant professor of psychiatry and behavioral sciences at the University of Miami Miller School of Medicine. Dr. Blanc leverages innovative ethnographical and integrative medicine tools to investigate and confront cumulative intersectional stressors. Her work evaluates the stress responses among marginalized families, women, and children to provide solutions for transforming the lives of families, women, and children through science, education/training, community services, and advocacy in the United States and globally. She was recently awarded a K01 from NHLBI to evaluate a Virtual Reality Intervention for Stress, Resilience, and Blood Pressure Management in Black Women (1K01HL175286-01).

• Confronting the Legacy of Medical Misinformation - Let's Start With Race-Based Medicine

  

  By Keisha Bentley-Edwards, Ph.D., Olanrewaju Adisa, Kennedy Ruff, and Catherine Kiplagat
  Samuel DuBois Cook Center Health Equity Working Group
  Posted May 30, 2024

  
  

  

  Throughout the COVID-19 pandemic, the health community was alerted to the proliferation of medical misinformation, particularly messages related to vaccines and treatment. For me, Dr. Bentley-Edwards, I became alerted to the dangers of medical misinformation in the early 1990’s from my father’s annual physical. My father’s new primary care provider (PCP) asked him what medication he was taking to control his hypertension. My father was confused. He wasn’t taking antihypertensive medication because his blood pressure was normal. However, his medical records revealed his blood pressure was well above the hypertension level cut-offs for several years. In past years, my father’s prior doctors had been telling him that his blood pressure was “high-normal” or that his levels were “normal for a Black man.” This misinformation allowed his blood pressure to be uncontrolled for an unnecessarily long time, heightening his risk for cardiovascular disease, stroke, and kidney disease. Upon learning all of this, my father’s new PCP, a young Black doctor, immediately prescribed him the appropriate medication, and he has taken care of his health since then.

  
  

  Loud and Wrong

  Hypertension is often called the “silent killer,” but in this case, my father’s physicians’ reliance on race-based medicine to guide diagnosis and care rang loud and wrong. Race-based medicine relies upon biological distinctions between racial groups that are integrated into practice, training, and health algorithms and represents a systemic form of medical misinformation. As such, medical misinformation cannot be reduced to error-filled social media campaigns. As researchers, providers, and other members of the health community, we must reflect on how we generate, share, and sustain medical misinformation so that we can bring it to an end. To be clear, race-based medicine is not to be confused with personalized care or precision medicine.

  In the past, providers were taught to provide Black patients with a specific class of antihypertensive medication, narrowing their medication options early in their treatment course from those that may be more effective and reduce the risk for progression to chronic kidney disease.  These race-based assumptions do not exist in a vacuum. They inform the development of critical assessments and risk predictors. This history calls into question the goal of algorithms to save time, money, or lives. If the goal of an algorithm is to save lives and reduce health disparities, an over-reliance on race-based medicine can get in the way of its success.

  Important Steps

  Prior to 2021, kidney function was determined by a calculation that considered multiple biological indicators and included a coefficient accounting for patient race. The use of this formula systematically overestimated kidney function for Black patients, reduced the chances of patients meeting the threshold for end-stage kidney disease, and increased the wait times for Black patients to get on the transplant list or receive other appropriate care such as dialysis. However, the National Kidney Foundation and the American Society of Nephrology revised the eGFR recommendations to exclude Black race as a biological factor. In 2023, researchers  estimated that roughly 70,000 Black adults could move higher up in the matching system and decrease their wait time for a kidney transplant as a result of the improved algorithm. As evidenced by the pre-2021 eGFR recommendations and the lack of evidence supporting race-based antihypertensive treatment, race-based medicine is not the solution. The Organ Procurement and Transplantation Network took an important step to push policy that has helped nearly 2,500 Black patients receive a kidney who would not have if the old algorithm were still in use. More needs to be done to improve the health of Black Americans.

  Race vs. Genetic Ancestry

  Eliminating confusion by understanding race versus genetic ancestry is fundamental to addressing and redressing health inequities. Although structural racism is the most undeniable factor of disparate outcomes for Black patients with hypertension and kidney disease, ancestral genetic variation can partially explain differential experiences with kidney disease.  APOL1 is a genetic marker present in all people; however, certain Black Americans (up to 10-15%) inherited a genetic high-risk allele combination (G1 and G2) that has evolved over 10,000 years beyond the original function in protection against African sleeping sickness (trypanosomiasis). This combination correlates with an increased risk of kidney diseases like kidney failure. Similar to sickle cell disease, there is an increased incidence of these alleles where the disease is prevalent (e.g., West Africa).  APOL1-mediated kidney disease (AMKD) may accelerate the progression to kidney failure, but it is not the single cause of progression. Even with the help of ancestry studies, physicians must resist jumping to conclusions about how to use these findings to serve their patients.

  Thoughtful Engagement

  Studies about AMKD hold promise for personalized and genetically informed care for millions of Americans in the wake of precision medicine. Up against an extensive history of medical untrustworthiness by the U.S. health care and research systems, my team and I have argued that we must thoughtfully engage and include communities impacted by health disparities throughout the research enterprise.

  Discussions of structural racism and medical misinformation do not diminish the relevance of personal agency and health behaviors. Yet, our personal agency is informed by the options that are available to us. When our choices are clouded by misinformation, so is our personal agency. Although I can’t decisively say that my father’s eventual progression to chronic kidney disease was the result of medical racism and structural racism, I can confidently say that it was contributing factor.

  In the Health Equity Working Group for the Samuel DuBois Cook Center on Social Equity at Duke University, we study the causes and consequences of racism and sociocultural indicators on health outcomes. Does race matter in understanding health disparities? Yes, but we argue that when you recognize race as a social construct, you realize that social conditions should be an integral area of study for resolving racial health disparities. In our NIMHD-funded project, we examined Black people’s religiosity for its effect on cardiovascular disease risk factors, including hypertension. Our findings showed that Black religious and cultural experiences in America are diverse and important in understanding cardiovascular disease risks. Additionally, we are members of the recently formed ERASE-KD consortium (Eliminating Racism And Structural inEquities in Kidney Disease) dedicated to mitigating structural racism’s impact on kidney disease.

  We, as members of the health community, must have the humility to recognize that we are not immune to the allure of medical misinformation, even when it is rooted in systemic racism. How this form of racism is reproduced and disseminated as medical misinformation is neither isolated nor benign.

  Keisha Bentley-Edwards, Ph.D., is an associate professor of medicine, Co-Director of the Center for Equity in Research, and associate director of research for the Samuel DuBois Cook Center (Cook Center) on Social Equity at Duke University.

  Olanrewaju Adisa is a medical student at Duke University.

  Kennedy Ruff is an associate in research at the Cook Center and graduate student at North Carolina State University’s Clinical Mental Health Counseling Program.

  Catherine Kiplagat is a 2nd year undergraduate student at Duke University.

  Dr. Bentley-Edwards leads the Cook Center’s Health Equity Working Group, and Adisa, Ruff, and Kiplagat are all members.

• Love, Health, and the Hood: Neighborhood Effects on Black Couples’ Functioning

  

  By August "A.J." Jenkins, Ph.D.
  University of Illinois at Urbana-Champaign
  Posted Feb. 16, 2024

  When I think about the resources that may be important to Black Americans' psychological health and their intimate relationships, I often think about my grandparents' neighborhood on the westside of Detroit (my hometown). Growing up, my sister and I regularly went to their house. I was fascinated by their community—because it was exactly that: a community. All the neighbors knew each other's families, looked out for each other, shared resources, and had get-togethers and barbeques.

  To me, my grandparents' community defied the things people typically associated with living in the city. Detroit neighborhoods are often thought of as dangerous and disadvantaged, but for me, our neighborhoods can also provide a sense of belonging, safety, and protection.

  I understand that neighborhoods are not only a context for living but also a resource for flourishing, and this has shaped my perspective and how I approach work. I investigate how racism impacts Black Americans' mental health and intimate relationships, along with how they are connected over time. Experiences have taught me that resilience can always be found in adverse circumstances, so I also study how Black Americans leverage available sociocultural and ecological capital and coping resources to maintain and enhance their well-being.

  Racism impacts multiple levels (e.g., interpersonal, cultural levels), with scholars noting the incredibly devastating consequences of structural racism for Black Americans' health and health inequities. For Black Americans, the residential context is one of the most striking examples of structural racism. There is a long history and enduring practice of segregation; no other racial group has experienced the same degree of residential segregation as Black Americans.

  Consequently, Black Americans are also more likely to live in disadvantaged environments and be exposed to community stressors like poverty, crime, physical, and/or social disrepair that are associated with poorer mental-emotional health outcomes for Black Americans. Nonetheless, neighborhoods can also provide residents a sense of community, cohesion, and safety and offer resources that benefit mental health.

  Notably, neighborhood environments not only affect individual functioning but also intimate relationships. Research shows the significance of the neighborhood context for Black romantic relationships, as disadvantaged areas can influence relationship behaviors and quality. Black adults living in urban neighborhoods have discussed how neighborhood violence and distress can contribute to their reluctance to be emotionally vulnerable/available with romantic partners and reinforce feelings of worry and anxiety.

  Still, positive neighborhood characteristics can benefit romantic relationship quality, providing couples with healthy relationship role models and providing opportunities for support (e.g., childcare support from neighbors) and access to helpful resources (e.g., community centers, religious organizations).

  In a study funded by my NIMHD F31 fellowship, my colleagues and I investigated the ways that neighborhood quality and romantic relationship functioning combine to impact Black Americans' mental health over time. Utilizing an intersectional frame, we also looked at how these variables were related to mental health in unique ways for Black men and women.

  Research highlights that Black men can be particularly sensitive to neighborhood factors—possibly because they contend with societal pressure to appear fearless and tough and counter stereotypes around criminality even when exposed to gangs, negative police interactions/profiling, and other racialized community stressors. Black men's perceptions of community strife have also been linked to hostile behaviors within their marriage, which are connected to poorer mental health for both men and their partners/wives.

  A key takeaway from my F31 fellowship is that better neighborhood quality is related to better mental health for both men and women. Study participants living in higher-quality neighborhoods showed lower levels of negative mood and higher levels of positive mood 10 years later, even after accounting for their initial levels of emotional functioning and socioeconomic status.

  Additionally, neighborhood quality and relationship functioning combined to uniquely affect Black men's (but not women's) psychological health. Men who reported better relationship functioning, but poorer neighborhood quality showed more emotional distress ten years later. Perhaps Black men in positive relationships want to provide the best for their partners, but ambient neighborhood stress is detracting, signaling that they are not living up to their desires to provide for and protect their family or interfering with their attempts to do so, resulting in more distress. However, men in better-quality neighborhoods might not experience this level of external stress, allowing them to capitalize on the positive effects of both their romantic relationships and neighborhoods, showing less emotional distress over time.

  Together, these results underscore the powerful, long-lasting psychological effects of people's ideas about the support (or stress) that is present in their communities. Further, the results highlight the specific ways neighborhood context and romantic relationship functioning intersect to impact psychological health, suggesting that interventions at the neighborhood level could have valuable mental health impacts for Black Americans and their ability to take advantage of the positive psychological consequences of relationship functioning.

  Ultimately, in my work, I aim to illuminate complex issues related to health, relationships, and social inequity for Black Americans and uncover opportunities to redress disparities in these areas. I intend to continue interrogating the connections between community contexts and other manifestations of racism to Black mental health and relationships by unpacking these links at multiple intersections (e.g., gender, social class) and examining their contribution to long-term psychological and relational health outcomes. This work helps highlight points for change/intervention in policy, clinical, and community realms. Through this work, I hope that eventually, we all can experience a sense of community just like my grandparents in their neighborhood.

  Citations
  Bryant, C. M., & Wickrama, K. A. S. (2005). Marital relationships of African Americans: A contextual approach. In V. McLoyd, N. Hill, & K. A. Dodge (Eds.), African American family life: Ecological and cultural diversity (pp. 111–134). Guilford Press.

  August "A.J." Jenkins, Ph.D., is a 2023 - 2024 Vice Chancellor's Distinguished Postdoctoral Fellow and Visiting Scholar in the Department of Human Development and Family Studies at the University of Illinois at Urbana-Champaign. Dr. Jenkins investigates how racism impacts Black Americans' mental health and intimate relationships, along with how they are connected over time. She also studies how Black Americans leverage available sociocultural and ecological capital and coping resources to maintain and enhance their well-being.