Rumination mediates associations between microaggressions and sleep quality in Black Americans: the toll of racial microstressors.

Disparities in health outcomes between Black and White Americans are well-documented, including sleep quality, and disparities in sleep may lead to disparities in health over the life course. A meta-model indicates that cognitive processes may underly the connection between race and poor sleep quality, and ultimately, health disparities. That is, there are race-specific stressors that disproportionately affect Black Americans, which are associated with poor health through biological, cognitive, and behavioral mechanisms (e.g., sleep). Among these race-specific stressors is discrimination, which has been linked to poor sleep quality, and there is a body of literature connecting perseverative cognition (e.g., rumination and worry or vigilance) to poor sleep. Microaggressions, a more subtle but pervasive form of discrimination, are another race-specific stressor. Although less research has considered the connection of microaggressions to perseverative cognition, there are some studies linking microaggressions to health outcomes and sleep. Therefore, using a cross-sectional survey, we tested the following hypotheses: racism-related vigilance and rumination would mediate the relationship between discrimination and poor sleep as well as between microaggressions and poor sleep among Black Americans (N = 223; mean age = 35.77 years, 53.8% men, 86% employed, 66.8% with college degree or higher education). Results of seven parallel mediation models showed that neither rumination nor racism-related vigilance mediated a relationship between discrimination and poor sleep quality. However, rumination partially mediated relationships between the six microaggression sub-scales and poor sleep quality: there were significant indirect effects for Foreigner/Not Belonging (ß = .13, SE = 0.03, 95% CI 0.08, 0.20), Criminality (ß = .11, SE = 0.03, 95% CI 0.05, 0.17), Sexualization (ß = .10, SE = 0.03, 95% CI 0.05, 0.17), Low-Achieving/Undesirable (ß = .10, SE = 0.03, 95% CI 0.05, 0.15), Invisibility (ß = .15, SE = 0.04, 95% CI 0.08, 0.23), and Environmental Invalidations (ß = .15, SE = 0.04, 95% CI 0.08, 0.23). Overall, these findings indicate support for the meta-model, demonstrating a specific pathway from racial microstressors to poor sleep quality. Furthermore, these results suggest the importance of developing clinical and community approaches to address the impact of microaggressions on Black Americans' sleep quality.

Finding benefits in a cardiac event: Direct links with positive affect and healthy dietary behaviors during cardiac rehabilitation.

Benefit finding (BF) may be a coping strategy that positively influences outcomes after a stressful event, but previous studies provide an inconsistent pattern of results across several different patient populations. This study aimed to reconcile these inconsistencies by testing whether positive affect related to a cardiac event (PA) mediates the relationship between BF and healthy dietary behaviors, and whether this mediating relationship is stronger for participants high in disease severity. Participants were patients with cardiovascular disease in a cardiac rehabilitation program. Results supported partial mediation, but the interaction was not as predicted: participants low in disease severity showed a stronger relationship between BF and PA than their counterparts high in disease severity. Additionally, the PA/healthy dietary behaviors relationship was negative. Health providers may encourage patients in CR to engage in BF, but also to make thoughtful food decisions when in a positive mood, especially for patients low in disease severity.

Development and Psychometric Properties of the Self-Blame Attributions for Cancer Scale.

OBJECTIVES: To adapt the Cardiac Self-Blame Attributions Scale into the Self-Blame Attributions for Cancer Scale (SBAC) for use in patients with cancer and analyze its psychometric properties. SAMPLE & SETTING: 113 patients receiving radiation therapy at the University of Kansas Cancer Center. METHODS & VARIABLES: The SBAC and other self-report measures were administered during outpatient oncology appointments for radiation therapy to establish the psychometric properties of the SBAC. RESULTS: A two-factor structure represented behavioral and characterological self-blame attributions. Reliability estimates for each factor were excellent and evidence of convergent and discriminant validity was found, indicating support for the SBAC as a valid and reliable measure of self-blame attributions in patients with cancer. IMPLICATIONS FOR NURSING: The SBAC may help healthcare providers, including nursing staff, to identify the self-blame patterns exhibited by patients with cancer. Future research can assess the reliability and validity of SBAC across stages of treatment and establish the predictive validity of the scale in individuals with cancer.

Stability in Cardiac Attributions Before and After Cardiac Rehabilitation.

PURPOSE: This study examined temporal patterns in causal attributions generated by patients with cardiovascular disease before and after cardiac rehabilitation (CR). DESIGN: Qualitative, descriptive survey. METHODS: Eighty-six participants were asked what they believed was the primary cause of their cardiac events. Cardiac attributions were collected at the beginning of CR, at the end of CR, and 15 months after baseline. FINDINGS: Content analyses showed that heredity and behavior were the most commonly generated causes. Most participants showed stability in attributions over time, although we found a trend for more participants endorsing behavioral attributions at the end of the study. CONCLUSIONS: Cardiac attributions remain relatively stable across time. CLINICAL RELEVANCE: Cardiac rehabilitation staff should approach patients differently, depending on their causal narratives. Some patients enter CR understanding that behavior played a causal role, whereas some do not. Encouraging appreciation of the importance of behavior in cardiovascular disease onset and recurrence is vital.

Multilevel Factors Predicting Cardiac Rehabilitation Attendance and Adherence in Underserved Patients at a Safety-Net Hospital.

PURPOSE: This study examined multilevel factors as predictors of cardiac rehabilitation (CR) attendance and adherence among underserved patients at a safety-net hospital (SNH). METHODS: Participants were recruited during hospitalization for a cardiac procedure or event. Participants responded to a questionnaire, and outcome data (including CR attendance and adherence) were extracted from medical records at baseline and 6 mo post-discharge. RESULTS: Data were collected from 171 participants, 92 (53.8%) of whom attended CR. On average, participants completed 24 CR sessions (66.7% adherence) and 40 (43.5%) participants fully adhered to the 36 prescribed sessions. Bivariate comparisons showed that participants who attended CR were more likely to have insurance (P = .002), perceive CR as important (P = .008), believe they needed CR (P = .005), and endorsed fewer barriers to CR (P = .005) than their nonattending counterparts. After controlling for insurance status, a regression analysis to predict attendance revealed only 1 predictor; perceived lack of time (P = .04). Bivariate analyses showed that only 1 clinical factor, treatment during hospitalization, was significantly related to adherence (P = .03). Patients with medical management alone (no revascularization) showed less adherence than their counterparts with revascularization. CONCLUSIONS: Although access to insurance is a significant predictor of attendance, psychological barriers that are amenable to being addressed by CR staff are also important. Findings suggest that perceived lack of time is important in SNH patient decision making to attend CR. This psychological barrier is a subject on which CR staff can intervene to educate patients about the life expectancy increases and decreased personal health care expenditures because of attendance.

Scale development and psychometric properties of the Cardiac Self-Blame Attributions scale in patients with cardiovascular disease.

Patients with cardiovascular disease may attribute their cardiovascular disease to their behaviors (behavioral self-blame) or to their dispositions (characterological self-blame). However, findings are mixed on the effects of behavioral self-blame and characterological self-blame on health outcomes, possibly because there are no validated, multiple-item measures. This study developed and tested an 11-item Cardiac Self-Blame Attributions scale via questionnaire data from 121 patients with cardiovascular disease. Results yielded a two-factor structure that explained 65 percent of the variance, with good reliability and discriminant validity. Findings suggest that the scale is reliable and valid and can be used to understand the cardiac attributions patients create.

Comparison of factor structure models for the Beck Anxiety Inventory among cardiac rehabilitation patients.

OBJECTIVE: Individuals with cardiovascular disease (CVD) experience greater rates of distress symptoms, such as anxiety and depressive symptoms, than the general population. These psychological outcomes have been linked to greater risk for negative outcomes following a cardiac event; however, research examining the relationship between specific components of anxiety and outcomes in CVD is limited. Further, prior research has not investigated the structure of anxiety symptoms in CVD. This study sought to compare previously established one, two, and four-factor models of the Beck Anxiety Inventory (BAI) in individuals enrolled in cardiac rehabilitation (CR). METHODS: Our sample included 208 individuals with CVD recruited during enrollment in a phase II CR program. Participants completed the BAI at enrollment in CR (Time 1) and again 12weeks later at CR completion (Time 2, n=151). RESULTS: Consistent with prior literature, 41% of our sample reported at least mild symptoms of anxiety (BAI>8), and the BAI proved to be a reliable measure within this sample (α=0.89). Confirmatory factor analysis (CFA) results indicated that a second-order model with four first order factors, consisting of cognitive, autonomic, neuromotor, and panic components, fit our data well. A multi-group CFA approach supported measurement invariance across time. CONCLUSION: These results suggest that anxiety following CVD can be evaluated based on cognitive, autonomic, neuromotor, and panic components as well as the encompassing anxiety construct.

Causal attributions following a cardiac event: Short- and long-term differences in health appraisals and outcomes.

This study examined attributions generated by cardiac rehabilitation patients shortly after experiencing a cardiovascular event, exploring whether attribution type was associated with health appraisals and outcomes concurrently and 21 months later. Attributions fell into three categories: controllable behavioral ones, uncontrollable biological ones, and stress-related causes. Linking attribution type to appraisals and outcomes showed that creating a behavioral attribution was beneficial in the short-term for control appraisals, but was associated with increased anxiety symptoms 21 months later. Thus, cardiac rehabilitation providers should encourage patients to maintain a future-focus that promotes perceived control over health promotion behaviors that reduce risk for recurrence.

Socioeconomic status, cognitive-emotional factors, and health status following myocardial infarction: testing the Reserve Capacity Model.

Health disparities by socioeconomic status (SES) exist for many outcomes, including patients' subjective health status after myocardial infarction (MI). The Reserve Capacity Model (RCM), a theoretical means to understand such disparities, was tested to examine the possible mediating effects of cognitive-emotional factors on the association between SES and health status. Data from 2,348 post-MI patients in PREMIER were used. Indicators of SES were collected during hospitalization via personal interviews, while participants completed measures of stress and reserves at 1 month, depressive symptoms at 6 months, and health status at 1 year through telephone interviews. Structural equation model results provide partial support for the RCM, as cognitive-emotional factors partially mediated the association between SES and mental health status. For physical health status, results supported direct rather than indirect effects of SES. Findings suggest psychosocial interventions with patients of low SES will have their greatest effects on appraisals of psychological health status.

Exercise self-efficacy and symptoms of depression after cardiac rehabilitation: predicting changes over time using a piecewise growth curve analysis.

BACKGROUND: Cardiac rehabilitation is often recommended after experiencing a cardiac event and has been shown to significantly improve health outcomes among patients. Several psychosocial variables have been linked with cardiac rehabilitation program success, including exercise self-efficacy. However, little is known about temporal patterns in patients' exercise self-efficacy after program completion. OBJECTIVE: This study examined changes in exercise self-efficacy among 133 cardiac rehabilitation patients and whether symptoms of depression impacted the rate of change in exercise self-efficacy. METHOD: Participants completed questionnaires at the beginning and end of cardiac rehabilitation and at 6-month intervals for 2 years. RESULTS: Growth curve analyses showed that exercise self-efficacy levels were highest at the beginning of cardiac rehabilitation, significantly declined 6 months after cardiac rehabilitation, and leveled off over the next 18 months. Results also showed that baseline depressive symptoms interacted with time: Compared with participants with fewer symptoms, participants high in depressive symptoms began cardiac rehabilitation with lower levels of exercise self-efficacy and evidenced significant declines 6 months after cardiac rehabilitation. At no time were they equal to their counterparts in exercise self-efficacy, and their means were lower 2 years after cardiac rehabilitation than before cardiac rehabilitation. CONCLUSIONS: Our findings imply that patients show unrealistic optimism surrounding the ease of initiating and maintaining an exercise program and that integrating efficacy-building activities into cardiac rehabilitation, especially for patients who show signs of distress, is advisable.

Perceived discrimination and health-related quality of life: testing the Reserve Capacity Model in Hispanic Americans.

This study tested aspects of the Reserve Capacity Model (Gallo & Matthews, 2003; Gallo, Penedo Espinosa de los Monteros, & Arguelles, 2009) as a means of understanding disparities in health-related quality of life appraisals among Hispanic Americans. Questionnaire data were collected from 236 Hispanic participants, including measures of perceived discrimination, optimism, social support, symptoms of trait anxiety, and physical and mental health-related quality of life. Path analysis indicated direct, negative associations between perceived discrimination and both forms of health-related quality of life. Results also showed that these relationships were partially mediated by the reserve capacity variable of optimism and by symptoms of anxiety, though evidence for mediation by anxiety was stronger than for optimism. Findings suggest that perceived discrimination depletes intrapersonal reserves in Hispanic Americans, which, in turn, induces negative emotions. Implications for community-level interventions are discussed.

Self-blame attributions, control appraisals and distress among cardiac rehabilitation patients.

This study examined associations between self-blame attributions, control appraisals and distress among cardiovascular disease patients participating in a cardiac rehabilitation (CR) programme. Questionnaire data were collected from 129 patients at the beginning and end of CR. We found little evidence that characterological self-blame (CSB) affects distress symptoms, but behavioural self-blame at the beginning of CR was positively associated with distress symptoms concurrently, and 12 weeks later. Furthermore, diet- and exercise-focused self-blame was only modestly, positively related to control appraisals concurrently, while CSB was negatively associated with control. Prospectively, we found few significant associations between self-blame and control. Results imply that making any type of self-blame attribution during CR does not aid in adjustment or enhanced control appraisals. Our findings suggest that CR staff should encourage patients to recognise their control over reducing risk for recurrence, but should discourage patients from looking backward and ruminating about factors that may have contributed to disease onset.

Social-cognitive predictors of intention to vaccinate against the human papillomavirus in college-age women.

This study examined social-cognitive predictors of college-age women's intentions to obtain the human papillomavirus (HPV) vaccine using the Health Belief Model (HBM) and Theory of Planned Behavior (TBP) as theoretical guides. Questionnaire data were collected from 143 women at a Midwestern university. Among the HBM variables, perceived susceptibility to HPV, perceived benefits of the vaccine, and self-efficacy to obtain the vaccine were significant predictors. Among the TPB variables, positive attitudes toward the vaccine and beliefs that important others would support vaccination predicted intentions. A model with all HBM and TPB variables explained nearly 60% of the variance in intentions. Comparison of the theories suggests that the TPB is a better predictor of intentions than the HBM. Results suggest that targeting personal beliefs about the vaccine, and increasing acceptance for the vaccine among social network members, may increase vaccination intentions among college-age women.

Self-blame and distress among women with newly diagnosed breast cancer.

This study examined relations between behavioral and characterological self-blame attributions for breast cancer and psychological distress in the year following a diagnosis. One hundred fifteen women with newly diagnosed breast cancer participated. First, we predicted that both forms of self-blame would be associated with distress shortly after diagnosis (i.e., at 4 months). Second, we predicted that only characterological self-blame would be related to distress at 7 and 12 months post-diagnosis because behavioral self-blame would enhance perceptions of control, thereby protecting against distress. Results supported the first hypothesis; both forms of self-blame were related to symptoms of anxiety and depression at 4 months post-diagnosis. Findings did not support the second hypothesis because both forms of self-blame continued to be related to distress at 7 and 12 months post-diagnosis. Furthermore, perceptions of control did not mediate the self-blame/distress relation. Implications for social cognitive processes in adaptation to breast cancer are discussed.