Participant Resource Pool

Research

A key component of MCUAAAR is the support of pilot research by junior investigators that can lead to independent NIH-funded projects. The scientists who are selected each year into the program are given resources to conduct behavioral and social science research that focuses on the health and well-being of older African Americans. The title and abstract for each MCUAAAR Scientist by cohort can be found below.

2020 MCUAAAR Scientists

Christina N. Harrington, PhD

“Designing Health-Related Conversational Assistants for Health-Information Seeking Among Low-Income African- American Older Adults”

Older African Americans experience chronic health conditions and diseases at a disproportionate rate in comparison to the overall population, which may pose additional challenges related to one’s management of health in the home. With costs of medical care steadily increasing and posing a strain on many marginalized Americans, individuals have begun to look to in-home information communication technologies (ICTs) as convenient tools to seek, share, and track personal health information. There has been a recent emphasis in both public health and health information technology research in examining the ways information technologies can support minority populations due to higher rates of disparities and health risks. In-home health-related ICTs have great potential to provide immediate and low-cost access to health information and aid in decision-making and health management, proving to be an equitable solution to those who face additional challenges in this area of their health. Availability of real-time health information may help to address barriers to consistent healthcare access and improve quality of care for marginalized populations. Conversational or voice assistants (i.e. Amazon Echo, Amazon Alexa, Google Home, etc.) have become an increasingly popular approach to searching online information, presenting the possibility of serving health information seeking needs through voice-controlled communication (Bickmore et al., 2018). As the older adult population now makes up 37% of voice assistant owners (Olmstead, Pew Research Center, 2017), these devices are speculated to have great potential to be a welcomed alternative to having to type on small interfaces which may be difficult for individuals with lower dexterity or mobility impairments (Schlogl et al., 2013). As the development of conversational assistant functionality grows more robust, researchers posit that there is a need to better understand relevant scenarios for their use.  However, little is known about the efficiency of these technologies among those who may have lower digital health literacy or technical proficiency. Low health literacy and digital proficiency have been determined to be prevalent barriers to obtaining health knowledge and maintaining self-care among older adults (Kim & Utz; 2018), and thus should be considered in the information exchange through conversational assistants as potential health ICTs.

The research study seeks to understand the ways in which African American older adults in lower-income areas pose health-related questions using online health resources. To best design ICTs that support health information seeking among individuals who may have difficulties in comprehending online health information, it is imperative to understand how this community forms health-related questions and what resources they find useful. This research will advance our understanding of how marginalized groups such as low-income African American older adults frame health-related questions when interacting with conversational assistants and the potential of these devices to support health information seeking. This research has the potential to increase our understanding of voice-controlled conversational devices as health information tools for older adults. This project will also help to provide foundational data for developing and testing culturally informed conversational assistants among African American older adults.

To this end, we will: (Aim 1) Understand what health-related questions low-income, African American older adults ask and in what ways they ask them. We aim to identify common topics, questions, and phrasing among this population to inform a taxonomy aimed to contribute to existing understandings of health information behaviors among marginalized populations.

Capturing health information behaviors in real-time through convenience research methods such as diary studies has been proven effective in previous research efforts (Elsweiler et al. 2010; Church & Smyth, 2012) and thus we have designed this as the foundation of this research agenda. (Aim 2 & 3) Identify the potential for conversational assistants (smart speakers) to support health information seeking among and understand perceptions of trust and credibility related to these devices. Through scenario-based feasibility testing and co-design focus groups, we aim to understand the perceptions and attitudes related to conversational assistants, including perceptions of information credibility and trust of these devices as a health information resource.

Mieka Smart, DrPH, MHS

“Barriers and Facilitators to Genomic Research Participation Reported by Older Adults”

This project is an examination of genomic research participation barriers and facilitators reported by older adults (50+ years) in Flint, Michigan. It is well documented for White populations that aspects of the exposome (e.g. living in poverty, or exposure to lead) are correlated with genomic change (e.g. reduced DNA methylation, or shortened telomere length). By contrast, for Black people, the synergistic effects between aspects of the exposome and their impacts on subsequent genomic changes are understudied, primarily because most genomic study samples do not include sufficient numbers of Black participants. Research has revealed robust associations between demographic characteristics and the likelihood of consenting to provide a sample to genomic research. Simply, Black people are less likely to participate in genomic research, but it remains unclear why. Furthermore, genomic research attitudes among older Black adults are particularly understudied. A deep examination of self-reported genomic research participation barriers and facilitators in a diverse geographic locale is critically important to eliminate disparities in genomic research participation rates.

In 2017, I designed the Flint Area Study (FASt) to longitudinally monitor genomic and exposome interactions that might impact the health of Flint residents. Despite extensive input from community partners to conceive and promote the FASt, initial recruitment efforts demonstrated that the overwhelming majority of individuals in Flint were disinclined to participate. My current project will explore and seek solutions to minimize that disinclination via the completion of the first stage of a two-stage mixed methods explanatory sequence design. I will utilize a previously piloted brief survey and a series of focus groups to obtain qualitative data regarding genomic research participation barriers and facilitators among older adult respondents. First, I will identify participation factors (barriers and facilitators) to understand which specific aspects of these factors have the most impact on participation in genomics research. Second, I will design a protocol for focus groups to solicit community members’ ideas for solutions for minimizing barriers and activating facilitators. Increased understanding of these factors in Flint could inform the success of genomics studies in other similar communities and will be useful for successfully recruiting diverse longitudinal cohorts nationwide.

Samuele Zilioli, PhD and Jennifer Gomez, PhD

“Cultural Betrayal Trauma as a Novel Social Determinant of Cardiovascular Disease among Urban African American Elders”

Although the prevalence of cardiovascular diseases (CVD) in the U.S. has steadily declined since the 1960s, urban African American (AA) adults continue to bear a disproportionate share of disease burden. Psychosocial stressors—including within-group violence and the emotional reactivity to these stressors—are believed to contribute to the etiology and progression of CVD through their effects on health behaviors and stress-responsive neuroendocrine axes. As proposed by Cultural Betrayal Trauma Theory (CBTT), societal trauma (e.g., institutional racism, perceived discrimination) experienced by racial minorities exacerbates the pernicious effects of within-group violence minority individuals receive from other in-group members. This within-group violence, known as cultural betrayal trauma, may rupture the bond formed by racial minority members in response to societal trauma and be particularly salient for residentially-segregated, urban-dwelling middle-aged and older AAs. Unfortunately, most of the existing literature has focused exclusively on the effects of societal trauma on physical health and neglected the etiological role of within-group violence and dynamics. Further, all previous empirical work on CBTT has focused on psychological well-being among young adults. Therefore, there is a critical need to specify multilevel characterizations of the biobehavioral pathways through which within-group violence and dynamics shape CVD risk among middle-aged and older AA living in urban settings.

Our long-term goal is to establish a model of the most relevant social determinants of CVD risk faced by urban-dwelling middle-aged and older AAs. Our overall objective in this proposal is to clarify the psychological and biological pathways through which cultural betrayal trauma may exacerbate CVD risk among middle-aged and older AAs. To achieve this goal, we will work with a sample of 100 AAs aged 50 and older years living in Detroit. Specifically, this project will leverage psychological, behavioral, and biological data currently being collected as part of the Health among Older adults Living in Detroit (HOLD) study (PI: Zilioli), a Wayne State University-funded project aimed at understanding the links between social stressors, psychological well-being, and physical health among older African American adults living in urban Detroit. Support from the MCUAAAR Grant will allow us to continue data collection of an additional 100 HOLD participants while adding relevant measures of cultural betrayal trauma and within-group dynamics. Our central hypothesis is that cultural betrayal trauma will predict poor psychological well-being (i.e., high daily and global negative affect), high physiological stress (i.e., daily cortisol), and increased CVD risk (i.e., increased smoking behavior, low resting heart rate variability, and high resting blood pressure) above and beyond measures of societal trauma (i.e., lifetime and daily discrimination). Our preliminary studies support the scientific premise and feasibility of the present proposal.

2019 MCUAAAR Scientists

Riana Elyse Anderson, PhD

“Improving Racial Socialization Competency for Black Caregivers through a Culturally-Informed Familial Therapeutic Intervention”

Approximately 90% of Black youth report facing or witnessing racial discrimination in their proximal (e.g. classroom) and virtual (e.g., social network) environments. The association between discrimination and negative mental health outcomes (e.g., more severe and higher rates of depression) has been repeatedly established in the literature. Moreover, discrimination impairs the way youth cope, and it is this compromised coping that is associated with negative psychological4, academic, and health outcomes. Further, adolescent outcomes may lead to marked health complications and widening disparities in adulthood. Within adolescence, families can have a contributing role in the buffering or exacerbation of coping processes and behaviors to discriminatory experiences. The majority of Black families use racial socialization (RS)—or the verbal and nonverbal communication regarding racial matters—to facilitate coping with race. While RS has been shown to disrupt the trajectory from discrimination to negative psychological outcomes in some respects, it has also contributed to increased youth depressive and anxious symptoms given the wide variety of strategies observed in RS communication. Furthermore, less is known about the impact that grandparents have in the socialization process of their adolescent grandchildren, even though Black grandparents are more likely to rear their grandchildren compared to other races and given current trends. To address these gaps, the emergence of a new RS theory and accompanying clinical intervention seeks to investigate and improve upon this potentially protective cultural process by improving RS competency and enhancing coping processes. The Racial Encounter Coping Appraisal and Socialization Theory (RECAST) postulates that caregivers’ explicit and consistent delivery of psychoeducation-informed, skilled, and confident RS practices can reduce caregiver stress and subsequent psychological problems experienced by Black youth via greater coping self-efficacy and coping behaviors. The Engaging, Managing, and Bonding through Race (EMBRace) intervention is the application of RECAST and seeks to improve upon competent RS practices through therapeutic and empirically supported strategies. The use of culturally-relevant theory in clinical treatment is vital to Black youth’s coping with specific (i.e., racial) stressors linked to long-term health and wellness outcomes18. The empirical investigation of RECAST can also clarify whether aging caregivers (e.g., grandparents) develop the same competencies as other primary caregivers for an intergenerational exploration of RS practices.

Thus, the goal of this study is to test the effectiveness of a unique culturally-relevant and family-based intervention developed to enhance RS competencies in Black caregivers and reduce negative psychological outcomes for adolescent children. Building on the preliminary data that I collected during the acceptability pilot testing of the EMBRace intervention in Philadelphia, the proposed study will test the mechanism of caregiver RS competency as a moderator of discrimination, coping self-efficacy, coping, and adolescent psychological outcomes.

Katrina R. Ellis, PhD, MPH, MSW

“Understanding and Supporting the Health of African Americans Cancer Survivors and Their Family Caregivers”

Middle-age and older adults represent the majority of individuals who are newly diagnosed with or living with a history of cancer in the United States (ACS, 2018). In 2018, it was estimated that 87% of patients diagnosed with cancer were ages 50 or older (ACS, 2018). Approximately two-thirds of US cancer survivors – any person with a history of cancer – are ages 60 and older (ACS survivorship 2016), and this proportion of older cancer survivors is expected to grow in the coming years as the population as a whole continues to age (Parry, 2011). The health and well-being of African American (AA) cancer patients and survivors, in particular, are a pressing concern. Despite noted decreases in racial/ethnic disparities in cancer deaths, death rates for all cancers combined remain higher in AAs (ACS, 2016). Consequently, improving cancer outcomes for AAs requires attention to their experiences and needs across the cancer continuum, including cancer treatment and survivorship.

Many AA men and women suffer poor outcomes from chronic diseases (e.g., diabetes, cardiovascular diseases), and high rates of obesity (Gaskin et al, 2014; Mensah, Mokdad, Ford, Greenlund & Croft, 2005; Flegal, Carroll, Ogden & Curtin, 2010). Previous research has noted that cancer affects both the severity of chronic illness and the outcomes of comorbid conditions (Ogle, Swanson, Woods & Azzouz, 2000; Smith et al., 2008), with comorbid health conditions disproportionately prevalent in older patient populations (Bellizzi & Rowland, 2007). While family members are a key source of support after a cancer diagnosis, their own health warrants more attention; many family members performing supportive roles may be managing chronic conditions of their own. Unfortunately, limited research has simultaneously taken into account the cancer and chronic illness experiences of people diagnosed with cancer and their family members (i.e., family caregivers; Rosland & Piette, 2010) and especially as it relates to the needs of AA and other populations of color. Understanding the interdependent relationship between patient and family caregiver health experiences in the cancer context can be useful for designing interventions that are relevant and useful for supporting their collective wellbeing.

Rodlescia S. Sneed, PhD, MPH

“The Health and Well-Being of African-American Older Adults with a History of Incarceration”

The United States has an incarceration rate higher than that of any other Western country, with more than 11 million people admitted to U.S. jails each year [1]. Further, African-Americans are overrepresented in the criminal justice system. While making up only 12% of the U.S. population, they account for 33% of the U.S. sentenced population [2]. Longer prison stays and release programs for older prisoners may result in an increased number of community-dwelling older adults with a history of incarceration. In recent years, there has been a substantial increase in research on the psychosocial and health-related needs of currently incarcerated older adults; however, there has been little inquiry into the needs of formerly incarcerated older adults following community re-entry. These individuals may face re-entry barriers that result in unaddressed psychosocial, economic, and health-related needs. In the current study, we will use a mixed methods approach to examine the psychosocial, economic, and health-related needs of African-American older adults with a history of incarceration. We will conduct secondary analyses of data from the Health and Retirement Study, a large-scale, nationally representative population-based study of U.S. community-dwelling adults aged>50 years. Further, we will utilize key informant interviews in Flint, Michigan, (a majority African-American community with high rates of crime and incarceration) to identify ways in which existing systems support or inhibit the needs of this vulnerable population of African-American older adults.