Polypharmacy and Psychological Distress May Be Associated in African American Adults

Background: Compared to Whites, African Americans are at a higher risk of multiple chronic conditions, which places them at a higher risk of polypharmacy. Few national studies, however, have tested whether polypharmacy is associated with psychological distress—the net of socioeconomic status, health status, and stress—in African Americans. Aims: In a national sample of African Americans in the US, this study investigated the association between polypharmacy and psychological distress. Methods: The National Survey of American Life (NSAL, 2003) included 3570 African American adults who were 18 years or over. This number was composed of 2299 women and 1271 men. Polypharmacy (using ≥ 5 medications) and hyper-polypharmacy (using ≥ 10 medications) were the independent variables. Psychological distress was the dependent variable. Age, gender, socioeconomic status (education attainment, income, employment, and marital status), health care access (insurance status and usual place of care), and health status (multimorbidity and psychiatric disorders) were the covariates. Linear multivariable regression was applied to perform the data analysis. Results: Both polypharmacy and hyper-polypharmacy were associated with psychological distress. This association was significant after controlling for all the covariates. Conclusions: African Americans with polypharmacy, particularly those with hyper-polypharmacy, are experiencing higher levels of psychological distress, which itself is a known risk factor for poor adherence to medications. There is a need for a comprehensive evaluation of medications as well as screening for psychopathology in African Americans with multiple medical conditions.

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Polypharmacy in African American Adults: A National Epidemiological Study

Pharmacy ◽

10.3390/pharmacy7020033 ◽

2019 ◽

Vol 7 (2) ◽

pp. 33 ◽

Cited By ~ 6

Author(s):

Shervin Assari ◽

Hamid Helmi ◽

Mohsen Bazargan

Keyword(s):

African American ◽

African Americans ◽

Psychiatric Disorders ◽

National Sample ◽

Health Determinants ◽

Multiple Chronic Conditions ◽

Poverty Index ◽

African American Adults ◽

Medical Disease ◽

Nationally Representative

Background: Despite the association between polypharmacy and undesired health outcomes being well established, very little is known about epidemiology of polypharmacy in the African American community. We are not aware of any nationally representative studies that have described the socioeconomic, behavioral, and health determinants of polypharmacy among African Americans. Aims: We aimed to investigate the socioeconomic and health correlates of polypharmacy in a national sample of African American adults in the US. Methods: The National Survey of American Life (NSAL, 2003–2004) included 3,570 African American adults. Gender, age, socioeconomic status (SES; education attainment, poverty index, and marital status), access to the healthcare system (health insurance and having a usual source of care), and health (self-rated health [SRH], chronic medical disease, and psychiatric disorders) in addition to polypharmacy (5 + medications) as well as hyper-polypharmacy (10 + medications) were measured. Logistic regressions were applied for statistical analysis. Results: that About 9% and 1% of all African American adults had polypharmacy and hyper-polypharmacy, respectively. Overall, higher age, higher SES (education and poverty index), and worse health (poor SRH, more chronic medical disease, and psychiatric disorders) were associated with polypharmacy and hyper-polypharmacy. Individuals with insurance and those with a routine place for healthcare also had higher odds of polypharmacy and hyper-polypharmacy. Conclusions: Given the health risks associated with polypharmacy, there is a need for systemic evaluation of medication use in older African Americans with multiple chronic conditions. Such policies may prevent medication errors and harmful drug interactions, however, they require effective strategies that are tailored to African Americans.

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Educational Attainment Better Protects African American Women than African American Men Against Depressive Symptoms and Psychological Distress

Brain Sciences ◽

10.3390/brainsci8100182 ◽

2018 ◽

Vol 8 (10) ◽

pp. 182 ◽

Cited By ~ 18

Author(s):

Shervin Assari

Keyword(s):

Mental Health ◽

Socioeconomic Status ◽

African American ◽

Psychological Distress ◽

Depressive Symptoms ◽

High Education ◽

African Americans ◽

African American Men ◽

Education Attainment ◽

African American Adults

Background: Recent research has shown smaller health effects of socioeconomic status (SES) indicators such as education attainment for African Americans as compared to whites. However, less is known about diminished returns based on gender within African Americans. Aim: To test whether among African American men are at a relative disadvantage compared to women in terms of having improved mental health as a result of their education attainment. This study thus explored gender differences in the association between education attainment and mental health, using a representative sample of American adults. Methods: The National Survey of American Life (NSAL; 2003) recruited 3570 African American adults (2299 females and 1271 males). The dependent variables were depressive symptoms and psychological distress. The independent variable was education attainment. Race was the focal moderator. Age, employment status, and marital status were covariates. Linear regressions were used for data analysis. Results: In the pooled sample that included both male and female African American adults, high education attainment was associated with lower depressive symptoms and psychological distress, net of covariates. Significant interactions were found between gender and education attainment with effects on depressive symptoms and psychological distress, suggesting stronger protective effects of high education attainment against depressive symptoms and psychological distress for female as compared to male African Americans. Conclusion: A smaller gain in mental health with respect to educational attainment for male African American males as compared to African American females is in line with studies showing high risk of depression in African American men of high-socioeconomic status. High-SES African American men need screening for depression and psychological distress.

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Workplace Racial Composition Explains High Perceived Discrimination of High Socioeconomic Status African American Men

Brain Sciences ◽

10.3390/brainsci8080139 ◽

2018 ◽

Vol 8 (8) ◽

pp. 139 ◽

Cited By ~ 31

Author(s):

Shervin Assari ◽

Maryam Moghani Lankarani

Keyword(s):

Socioeconomic Status ◽

African American ◽

African Americans ◽

Predominantly White ◽

Household Income ◽

Perceived Discrimination ◽

Equation Modeling ◽

Racial Composition ◽

Male And Female ◽

African American Adults

Background: Sociological and epidemiological literature have both shown that socioeconomic status (SES) protects populations and individuals against health problems. Recent research, however, has shown that African Americans gain less from their SES and African Americans of high SES, particularly males, may be vulnerable to perceived discrimination, as explained by the Minorities’ Diminished Returns theory. One potential mechanism for this phenomenon is that high SES African Americans have a higher tendency to work in predominantly White workplaces, which increases their perceived discrimination. It is, however, unknown if the links between SES, working in predominantly White work groups and perceived discrimination differ for male and female African Americans. Aim: To test the associations between SES, workplace racial composition and perceived discrimination in a nationally representative sample of male and female African American adults. Methods. This study included a total number of 1775 employed African American adults who were either male (n = 676) or female (n = 1099), all enrolled from the National Survey of American Life (NSAL). The study measured gender, age, SES (educational attainment and household income), workplace racial composition and perceived discrimination. Structural Equation Modeling (SEM) was applied in the overall sample and also by gender. Results: In the pooled sample that included both genders, high education and household income were associated with working in a predominantly White work group, which was in turn associated with more perceived discrimination. We did not find gender differences in the associations between SES, workplace racial composition and perceived discrimination. Conclusion: Although racial composition of workplace may be a mechanism by which high SES increases discriminatory experiences for African Americans, males and females may not differ in this regard. Policies are needed to reduce discrimination in racially diverse workplaces. This is particularly the case for African Americans who work in predominantly White work environments.

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Socioeconomic Status, Ecologically Assessed Social Activities, and Daily Cortisol Among Older Urban African Americans

Journal of Aging and Health ◽

10.1177/0898264319856481 ◽

2019 ◽

Vol 32 (7-8) ◽

pp. 830-840

Author(s):

Samuele Zilioli ◽

Heather Fritz ◽

Wassim Tarraf ◽

Susan A. Lawrence ◽

Malcolm P. Cutchin

Keyword(s):

Older Adults ◽

Socioeconomic Status ◽

African American ◽

Health Disparities ◽

African Americans ◽

Relative Frequency ◽

Community Dwelling ◽

Endocrine Function ◽

Social Activities ◽

African American Adults

Objectives: Higher socioeconomic status (SES) individuals report more social activities than their lower SES counterparts. Yet, SES and racial health disparities are often confounded. Here, we tested whether the frequency of engagement in social activities contributed to the association between SES and daily cortisol secretion among urban African American older adults. Methods: Ninety-two community-dwelling African Americans aged 55 years and older reported what they were doing at regular intervals across the day on an Android smartphone for seven consecutive days. They also provided four saliva samples at four time points a day during the same period. Results: Higher SES older adults engaged in proportionally more social activities than their lower SES counterparts. A greater relative frequency of weekly social activities was associated with a steeper diurnal cortisol decline. Higher SES was indirectly linked to a steeper cortisol decline via increased relative frequency of weekly social activities. Discussion: Our findings suggest that engagement in weekly social activities represents a behavioral intermediary for SES health disparities in endocrine function among older urban African American adults.

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Abstract P149: Retention of Participants in Longitudinal Research: The Multi-Ethnic Study of Atherosclerosis

Circulation ◽

10.1161/circ.137.suppl_1.p149 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Sandi Shrager

Keyword(s):

Cardiovascular Disease ◽

Socioeconomic Status ◽

African American ◽

Health Insurance ◽

Health Status ◽

Marital Status ◽

Ethnic Minority ◽

Ethnic Groups ◽

Longitudinal Research ◽

Minority Participants

Background: Retention of participants is a critical component of ensuring the scientific goals of longitudinal research studies. Differential rates of attrition for ethnic minority participants can be particularly problematic in the fields of health and cardiovascular research, where ethnic minorities are shown to have disproportionately higher rates of both cardiovascular disease and risk factors for heart disease such as diabetes, hypertension, and obesity. The ability to explore the underlying causes of these differences is adversely affected when attrition in a study occurs at a higher rate among the ethnic minority subject participants. Understanding and preventing the causes of subject drop-out to improve retention among all ethnic groups is therefore a vital endeavor of any longitudinal research or cohort study. Methods: We analyzed data on ten-year retention rates of Caucasian, Chinese, Hispanic, and African-American participants in the Multi-Ethnic Study of Atherosclerosis (MESA). 6814 participants were recruited into the study in 2000, and 5,865 participants were still alive for the fifth in-person examination ten years later. Of these, 4651 participants returned for this examination. Logistic regression was used to examine the association between retention in the study, race/ethnicity and various baseline demographic characteristics, including age, gender, marital status, income, employment, education, language, place of birth, health insurance status and overall health status as measured by a 10-year predicted cardiovascular disease rate. Results: Racial differences in retention were observed, with Chinese, African-American, and Hispanic participants having 30-40% lower odds of being retained than Caucasian participants. However, after adjusting for demographic variables, these differences were primarily explained by indicators of socioeconomic status. Higher income, higher education, employment status, availability of health insurance and health status were significantly associated with ten-year retention in the study across all racial/ethnic groups. Marital status, gender, age, and birthplace (US vs non-US) were not associated with retention. Conclusions: Although minority participants were retained at lower rates in MESA, this can be primarily explained by differences in socioeconomic status and health status. Individuals with higher SES indicators may have life circumstances making participation in an examination taking much of a full day more plausible. Future studies should consider how these findings may inform developing support services or incentives which make follow-up participation in clinical research more persuasive for these individuals.

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An Examination of Demographic and Psychosocial Factors, Barriers to Healthy Eating, and Diet Quality Among African American Adults

Nutrients ◽

10.3390/nu11030519 ◽

2019 ◽

Vol 11 (3) ◽

pp. 519 ◽

Cited By ~ 3

Author(s):

Ingrid Richards Adams ◽

Wilson Figueroa ◽

Irene Hatsu ◽

James Odei ◽

Mercedes Sotos-Prieto ◽

...

Keyword(s):

Social Support ◽

African American ◽

African Americans ◽

Psychosocial Factors ◽

Healthy Eating ◽

Diet Quality ◽

Self Efficacy ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

African American Adults

A healthy diet is associated with lower risk of chronic disease. African Americans generally have poor diet quality and experience a higher burden of many chronic diseases. We examined the associations of demographic and psychosocial factors and barriers to diet quality among African American adults. This cross-sectional study included 100 African American adults in a southeastern metropolitan area. Psychosocial factors (social support, self-efficacy), and barriers to healthy eating were assessed with validated measures. Diet quality was assessed using the Healthy Eating Index (HEI-2010). Nested linear regressions were used to examine the association between the variables of interest and HEI scores. Participants reported having social support (M (mean) = 2.0, SD (standard deviation) = 0.6, range 0–3), high levels of self-efficacy (M = 3.1, SD = 0.7, range 1–4), and low barriers (M = 1.4, SD = 0.6, range 0–4) to engage in healthy eating but total mean HEI scores needed improvement (M = 54.8, SD = 10.9, range 27.1–70.0). Participants consumed significantly higher empty calories and lower whole fruits, dairy, and total protein foods than the national average. Barriers to healthy eating (b = −12.13, p = 0.01) and the interaction between age and barriers (b = 0.25, p = 0.02) were most strongly associated with lower HEI scores. Younger African Americans with the highest barriers to healthy eating had the lowest HEI scores. Culturally appropriate interventions targeting empty calories, barriers to healthy eating, and knowledge of the Dietary Guidelines for Americans are needed for African Americans.

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