Feasibility of oropharyngeal and respiratory muscle training in individuals with OSA and spinal cord injury or disease: A pilot study.

OBJECTIVES: To examine the feasibility of individuals with spinal cord injury or disease (SCI/D) to perform combined oropharyngeal and respiratory muscle training (RMT) and determine its impact on their respiratory function. METHODS: A prospective study at a single Veterans Affairs (VA) Medical Center. Inclusion criteria included: 1) Veterans with chronic SCI/D (>6 months postinjury and American Spinal Injury Association (ASIA) classification A-D) and 2) evidence of OSA by apnea-hypopnea index (AHI ≥5 events/h). Eligible participants were randomly assigned to either an experimental (exercise) group that involved performing daily inspiratory, expiratory (using POWERbreathe and Expiratory Muscle Strength Trainer 150 devices, respectively), and tongue strengthening exercises or a control (sham) group that involved using a sham device, for a 3-month period. Spirometry, maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP), polysomnography, and sleep questionnaires were assessed at baseline and at 3 months. RESULTS: Twenty-four individuals were randomized (12 participants in each arm). A total of eight (67%) participants completed the exercise arm, and ten (83%) participants completed the sham arm. MIP was significantly increased (p < 0.05) in the exercise group compared with the baseline. CONCLUSIONS: Combined oropharyngeal and RMT are feasible for individuals with SCI/D. Future studies are needed to determine the clinical efficacy of these respiratory muscle exercises.

Effectiveness of an Algorithmic Approach to Ventilator Withdrawal at the End of Life: A Stepped Wedge Cluster Randomized Trial.

Background: The transition to spontaneous breathing puts patients who are undergoing ventilator withdrawal at high risk for developing respiratory distress. A patient-centered algorithmic approach could standardize this process and meet unique patient needs because a single approach (weaning vs. one-step extubation) does not capture the needs of a heterogenous population undergoing this palliative procedure. Objectives: (1) Demonstrate that the algorithmic approach can be effective to ensure greater patient respiratory comfort compared to usual care; (2) determine differences in opioid or benzodiazepine use; (3) predict factors associated with duration of survival. Design/Settings/Measures: A stepped-wedge cluster randomized design at five sites was used. Sites crossed over to the algorithm in random order after usual care data were obtained. Patient comfort was measured with the Respiratory Distress Observation Scale© (RDOS) at baseline, at ventilator off, and every 15-minutes for an hour. Parenteral morphine and lorazepam equivalents from the onset of the process until patient death were calculated. Results: Usual care data n = 120, algorithm data n = 48. Gender and race were evenly distributed. All patients in the usual care arm underwent a one-step ventilator cessation; 58% of patients in the algorithm arm were weaned over an average of 18 ± 27 minutes as prescribed in the algorithm. Patients had significantly less respiratory distress in the intervention arm (F = 10.41, p = 0.0013, effective size [es] = 0.49). More opioids (t = -2.30, p = 0.023) and benzodiazepines (t = -2.08, p = 0.040) were given in the control arm. Conclusions: The algorithm was effective in ensuring patient respiratory comfort. Surprisingly, more medication was given in the usual care arm; however, less may be needed when distress is objectively measured (RDOS), and treatment is initiated as soon as distress develops as in the algorithm. Clinical Trial Registration number: NCT03121391.

Development of an HIV/STI and partner violence health promotion intervention for abused US Virgin Islands women.

Women in the US Virgin Islands (USVI) experience intimate partner violence (IPV) and human immunodeficiency virus (HIV) at disproportionate rates compared to women on the US mainland. Women in violent relationships report experiencing controlling behaviours that decrease their ability to negotiate for sex using condoms or to prevent unwanted pregnancies. Though several evidence-based interventions exist to prevent either IPV or HIV, few address them through an integrated health promotion approach or attend to particular USVI cultural mores. This article describes the systematic development of a theory based, culturally tailored, integrated health promotion intervention that addresses IPV and HIV among USVI women experiencing abuse. The process included: (i) identifying and integrating evidence-based health promotion interventions, (ii) conducting formative research using focus groups, (iii) synthesizing focus group data to inform intervention development and (iv) developing a culturally and linguistically appropriate intervention specific to the needs and concerns of USVI women. The Empowered Sisters Project: Making Choices Reducing Risks (ESP) was developed through this research. ESP is a three-session health promotion curriculum focussed on enhancing sexual health and safety among women experiencing abuse. The ESP intervention components included promoting condom use, increasing IPV and HIV knowledge and developing a personalized safety plan. Health professionals facilitated individual intervention sessions using culturally tailored visual media and scripts. This program focussed on experiences of women living in the USVI and has implications for utility across the Caribbean diaspora.

Effect of Zolpidem on nocturnal arousals and susceptibility to central sleep apnea.

PURPOSE: Arousals may contribute to the pathogenesis of sleep-disordered breathing (SDB) and central sleep apnea (CSA). We aimed to determine the effect of the nonbenzodiazepine hypnotic zolpidem on the frequency of respiratory-related arousals and central apnea in patients with moderate-to-severe SDB. We hypothesized that zolpidem decreases the severity of SDB by decreasing the frequency of respiratory-related arousals. METHODS: Patients with apnea-hypopnea index ≥ 15 events/hour and central apnea-hypopnea index ≥ 5 events/hour underwent a sleep study on zolpidem 5 mg and a sleep study with no medication in a randomized order. The respiratory arousal index was compared between the two studies using a randomized crossover design. Sleep, respiratory, and physiologic parameters, including the CO2 reserve and the respiratory arousal threshold, were also compared. RESULTS: Eleven participants completed the study. Compared to no treatment, zolpidem reduced the respiratory arousal index (39.7 ± 7.7 vs. 23.3 ± 4.4 events/h, P = 0.031). Zolpidem also lowered the total apnea-hypopnea index (55.6 ± 8.5 vs. 41.3 ± 7.5 events/hour, P = 0.033) but did not affect other clinical and physiologic parameters. Compared to control, zolpidem did not widen CO2 reserve (- 0.44 ± 1.47 vs. - 0.63 ± 0.86 mmHg, P = 0.81). The respiratory arousal threshold did not show a significant change on zolpidem compared to control (- 8.72 ± 2.1 vs. - 8.25 ± 2.81 cmH2O, P = 0.41). CONCLUSION: Nocturnal arousals and overall SDB severity were reduced with a single dose of zolpidem in patients with moderate-to-severe sleep-disordered breathing with increased susceptibility for central apnea. Zolpidem did not widen the CO2 reserve or increase the arousal threshold. TRIAL REGISTRATION: Clinicaltrials.gov. Sleep and Breathing in the General Population - Chemical Stimuli (NCT04720547).

Tetraplegia is associated with increased hypoxic ventilatory response during nonrapid eye movement sleep.

People with cervical spinal cord injury (SCI) are likely to experience chronic intermittent hypoxia while sleeping. The physiological effects of intermittent hypoxia on the respiratory system during spontaneous sleep in individuals with chronic cervical SCI are unknown. We hypothesized that individuals with cervical SCI would demonstrate higher short- and long-term ventilatory responses to acute intermittent hypoxia (AIH) exposure than individuals with thoracic SCI during sleep. Twenty participants (10 with cervical SCI [9 male] and 10 with thoracic SCI [6 male]) underwent an AIH and sham protocol during sleep. During the AIH protocol, each participant experienced 15 episodes of isocapnic hypoxia using mixed gases of 100% nitrogen (N2 ) and 40% carbon dioxide (CO2 ) to achieve an oxygen saturation of less than 90%. This was followed by two breaths of 100% oxygen (O2 ). Measurements were collected before, during, and 40 min after the AIH protocol to obtain ventilatory data. During the sham protocol, participants breathed room air for the same amount of time that elapsed during the AIH protocol and at approximately the same time of night. Hypoxic ventilatory response (HVR) during the AIH protocol was significantly higher in participants with cervical SCI than those with thoracic SCI. There was no significant difference in minute ventilation (V.E. ), tidal volume (V.T. ), or respiratory frequency (f) during the recovery period after AIH in cervical SCI compared to thoracic SCI groups. Individuals with cervical SCI demonstrated a significant short-term increase in HVR compared to thoracic SCI. However, there was no evidence of ventilatory long-term facilitation following AIH in either group.

Tragedy in Haiti: Suicidality, PTSD, and Depression Associated with Intimate Partner Violence Among Haitian Women After the 2010 Earthquake.

Across the world, suicidal behaviors are responsible for more than one million deaths each year. In Haiti, suicidal behaviors were found to be related to intimate partner violence (IPV) against women. This study was conducted after the 2010 earthquake in Haiti and women were asked about IPV before and after that event. A sample of women between 18 and 44 years of age responded to a questionnaire about physical, psychological, or sexual abuse by an intimate or non-intimate partner. The women were divided into two groups: (a) women who were abused by partners (n = 133) and (b) women who were not abused (n = 75). Those who were abused had 2.2 times higher odds for suicidal thoughts and 1.9 times higher odds for suicidal attempts and were significantly more likely to suffer from depression and PTSD. For each 1-unit increase in a measured PTSD score, the odds of being abused increased by 105.7%. For each 1-unit increase in the measured depression score, the odds of being abused increased by 14.9%.

Testing a Middle -Range Theory of Heart Failure Self-Care.

A middle-range theory of heart failure self-care, derived from the self-care deficit theory of nursing, was tested among 175 Arab American older adults with heart failure. The middle-range theory achieved good statistical fit, but not all hypothesized relationships were supported. Specifically, conceptualizing basic conditioning factors as a single latent variable was not supported. However, individual factors of depression, social support, and time living with heart failure had a direct effect on both self-care agency and quality of life. Understanding predictors and outcomes of self-care within a theoretical framework is essential in caring for patients with heart failure.

Developing a Middle-Range Theory of Heart Failure Self-Care.

Middle-range nursing theories provide a bridge between the more abstract grand nursing theories, research, and clinical practice. As such, middle-range nursing theories derived from extant nursing theories are critical for developing and advancing both nursing science and practice. This paper describes the strategy used in developing a middle-range theory of heart failure self-care. After integrating theoretical and empirical literature, a hypothetico-deductive approach was used to develop the middle-range theory of heart failure self-care from Orem's theory of self-care. Theoretical substruction was used to provide a graphic representation of the conceptual-theoretical-empirical structure demonstrating the congruence between the theoretical and operational systems.

Preexisting respiratory diseases and clinical outcomes in COVID-19: a multihospital cohort study on predominantly African American population.

BACKGROUND: Comorbidities play a key role in severe disease outcomes in COVID-19 patients. However, the literature on preexisting respiratory diseases and COVID-19, accounting for other possible confounders, is limited. The primary objective of this study was to determine the association between preexisting respiratory diseases and severe disease outcomes among COVID-19 patients. Secondary aim was to investigate any correlation between smoking and clinical outcomes in COVID-19 patients. METHODS:  This is a multihospital retrospective cohort study on 1871 adult patients between March 10, 2020, and June 30, 2020, with laboratory confirmed COVID-19 diagnosis. The main outcomes of the study were severe disease outcomes i.e. mortality, need for mechanical ventilation, and intensive care unit (ICU) admission. During statistical analysis, possible confounders such as age, sex, race, BMI, and comorbidities including, hypertension, coronary artery disease, congestive heart failure, diabetes, any history of cancer and prior liver disease, chronic kidney disease, end-stage renal disease on dialysis, hyperlipidemia and history of prior stroke, were accounted for. RESULTS:  A total of 1871 patients (mean (SD) age, 64.11 (16) years; 965(51.6%) males; 1494 (79.9%) African Americans; 809 (43.2%) with ≥ 3 comorbidities) were included in the study. During their stay at the hospital, 613 patients (32.8%) died, 489 (26.1%) needed mechanical ventilation, and 592 (31.6%) required ICU admission. In fully adjusted models, patients with preexisting respiratory diseases had significantly higher mortality (adjusted Odds ratio (aOR), 1.36; 95% CI, 1.08-1.72; p = 0.01), higher rate of ICU admission (aOR, 1.34; 95% CI, 1.07-1.68; p = 0.009) and increased need for mechanical ventilation (aOR, 1.36; 95% CI, 1.07-1.72; p = 0.01). Additionally, patients with a history of smoking had significantly higher need for ICU admission (aOR, 1.25; 95% CI, 1.01-1.55; p = 0.03) in fully adjusted models. CONCLUSION:  Preexisting respiratory diseases are an important predictor for mortality and severe disease outcomes, in COVID-19 patients. These results can help facilitate efficient resource allocation for critical care services.

Medical Mistrust Among Black Women in America.

This qualitative research study highlights medical mistrust as a significant barrier to quality health care for Black women. Unraveling mistrust is essential for reducing health disparities and improving well-being for women and their families. Three research sites were included: Florida, Ohio, and the U.S. Virgin Islands. Three 90-minute focus groups were convened with 10 women in each of them. The discussions were recorded. Five themes will be discussed through the voices of women from each of the sites. Mistrust of healthcare professionals was associated with fears about being rejected, embarrassed, and misunderstood during the clinical encounter. Others reported that providers who were reluctant to make physical contact with them during the clinical visits provoked feelings that the color of their skin might seem "dirty." Finally, this research will help to inform discussions about COVID-19 vaccine hesitancy, which remains a critical health concern among Black women and healthcare providers.

Chronic Stress and Depressive Symptoms in Midlife African-American Women.

Chronic stress and depressive symptoms in midlife southern rural African-American women were examined because little is known about the intersections among them in this population. The research used Vitaliano's model of chronic stress to guide a secondary analysis of a convenience sample 206 (N = 206) midlife (40-65 years) African-American women from a southern rural community in Florida. Data were obtained from a larger study that focused on menopausal health and well-being among women. It also included brief comments from the women during focus group meetings, indicating that they experienced stress and were feeling "down." Statistical data showed that although the women reported relatively low levels of chronic stress and depressive symptoms, associations with certain personal vulnerabilities and social resources emerged as significant. The results from this secondary analysis will help to inform healthcare professionals about the role of personal vulnerability and social resources.

Buspirone decreases susceptibility to hypocapnic central sleep apnea in chronic SCI patients.

Spinal cord injury (SCI) is a risk factor for central sleep apnea (CSA). Previous studies in animal models with SCI have demonstrated a promising recovery in respiratory and phrenic nerve activity post-injury induced by the systemic and local administration of serotonin receptor agonists such as Buspirone and Trazodone. Human trials must be performed to determine whether individuals with SCI respond similarly. We hypothesized that Buspirone and Trazodone would decrease the propensity to hypocapnic CSA during sleep. We studied eight males with chronic SCI and sleep-disordered breathing (SDB) [age: 48.8 ± 14.2 yr; apnea-hypopnea index (AHI): 44.9 ± 23.1] in a single-blind crossover design. For 13 days, participants were randomly assigned either Buspirone (7.5-15 mg twice daily), Trazodone (100 mg), or a placebo followed by a 14-day washout period before crossing over to the other interventions. Study nights included polysomnography and induction of CSA using a noninvasive ventilation protocol. We assessed indexes of SDB, CO2 reserve, apneic threshold (AT), controller gain (CG), plant gain (PG), and ventilatory parameters. CO2 reserve was significantly widened on Buspirone (-3.6 ± 0.9 mmHg) compared with both Trazodone (-2.5 ± 1.0 mmHg, P = 0.009) and placebo (-1.8 ± 1.5 mmHg, P < 0.001) but not on Trazodone vs. placebo (P = 0.061). CG was significantly decreased on Buspirone compared with placebo (1.8 ± 0.4 vs. 4.0 ± 2.0 L/(mmHg·min), P = 0.025) but not on Trazodone compared with placebo (2.5 ± 1.1 vs. 4.0 ± 2.0 L/(mmHg·min); P = 0.065). There were no significant differences for PG, AT, or any SDB indexes (AHI, obstructive apnea index, central apnea index, oxygen desaturation index). The administration of Buspirone decreased the susceptibility to induced hypocapnic central apnea by reducing chemosensitivity and increasing CO2 reserve in chronic SCI patients.NEW & NOTEWORTHY This research study is novel as it is the first study in a humans that we are aware of that demonstrates the ability of Buspirone to increase CO2 reserve and hence decrease susceptibility to hypocapnic central apnea in patients with spinal cord injury.

Multiple Dimensions and Correlates of Fatigue in Individuals on Hemodialysis.

This study examined the severity, pattern, and correlates of fatigue among adults undergoing hemodialysis. Measures included the Piper Fatigue Scale (PFS-12), Patient-Reported Outcomes Measurement Information System (PROMIS) - Fatigue, Charlson Comorbidity Index, and Six-Minute Walk Test (6MWT). Patients were excluded if mobility or cardiovascular issues prevented conducting the 6MWT. Participants were 86 cognitively intact adults (M = 61.7 years, SD = 13.81), predominantly male (58.1%), and African American (48.8%), with 80% reporting fatigue in the week prior to hemodialysis. Significant increases were noted in sensory and cognitive fatigue from pre- to post-dialysis, while the 6MWT distance decreased significantly pre- to post-dialysis. Factors significantly associated with pre-dialysis fatigue included low hemoglobin, younger age, and living with someone else, while comorbidities and dialysis inadequacy were trending to significant associations with fatigue.

Association of Psychosocial Symptoms, Blood Pressure, and Menopausal Status in African-American Women.

African-American women have disproportionate rates of hypertension that can be further complicated as they transition through menopause. Stress, coupled with depression and hypertension in perimenopausal African-American women has not been fully explored. This study examines the associations of stress, depression, and social support on systolic blood pressure (SBP) among a sample of 184 perimenopausal African-American women. We used descriptive statistics, Pearson's correlation, and logistic regression to analyze data stratified by menopausal status (perimenopausal or menopausal) and SBP status (<130 mmHg vs. >130 mmHg). Women classified as menopausal reported higher levels of stress and depressive symptoms, and lower levels of social support. Age, body mass index (BMI), health insurance, and perceived health status were significant predictors of SBP in menopausal women. Stress, depression, and social support did not play a role in SBP. It is necessary that future research focus on reducing cardiovascular risk include addressing menopausal health.

Effect of acetazolamide on susceptibility to central sleep apnea in chronic spinal cord injury.

Spinal cord injury (SCI) is an established risk factor for central sleep apnea. Acetazolamide (ACZ), a carbonic anhydrase inhibitor, has been shown to decrease the frequency of central apnea by inducing mild metabolic acidosis. We hypothesized that ACZ would decrease the propensity to develop hypocapnic central apnea and decrease the apneic threshold. We randomized 16 participants with sleep-disordered breathing (8 SCI and 8 able-bodied controls) to receive ACZ (500 mg twice a day for 3 days) or placebo with a 1-wk washout before crossing over to the other drug arm. Study nights included polysomnography and determination of the hypocapnic apneic threshold and CO2 reserve using noninvasive ventilation. For participants with spontaneous central apnea, CO2 was administered until central apnea was abolished, and CO2 reserve was measured as the difference in end-tidal Pco2 (PETCO2) before and after. Steady-state plant gain, the response of end-tidal Pco2 to changes in ventilation, was calculated from PETCO2 and V̇e ratio during stable sleep. Controller gain, the response of ventilatory drive to changes in end-tidal Pco2, was defined as the ratio of change in V̇e between control and hypopnea to the ΔCO2 during stable non-rapid eye movement sleep. Treatment with ACZ for three days resulted in widening of the CO2 reserve (-4.0 ± 1.2 vs. -3.0 ± 0.7 mmHg for able-bodied, -3.4 ± 1.9 vs. -2.2 ± 2.2 mmHg for SCI, P < 0.0001), and a corresponding decrease in the hypocapnic apnea threshold (28.3 ± 5.2 vs. 37.1 ± 5.6 mmHg for able-bodied, 29.9 ± 5.4 vs. 34.8 ± 6.9 mmHg for SCI, P < 0.0001), respectively. ACZ significantly reduced plant gain when compared with placebo (4.1 ± 1.7 vs. 5.4 ± 1.8 mmHg/L min for able-bodied, 4.1 ± 2.0 vs. 5.1 ± 1.7 mmHg·L-1·min for SCI, P < 0.01). Acetazolamide decreased apnea-hypopnea index (28.8 ± 22.9 vs. 39.3 ± 24.1 events/h; P = 0.05), central apnea index (0.6 ± 1.5 vs. 6.3 ± 13.1 events/h; P = 0.05), and oxyhemoglobin desaturation index (7.5 ± 8.3 vs. 19.2 ± 15.2 events/h; P = 0.01) compared with placebo. Our results suggest that treatment with ACZ decreases susceptibility to hypocapnic central apnea due to decreased plant gain. Acetazolamide may attenuate central sleep apnea and improve nocturnal oxygen saturation, but its clinical utility requires further investigation in a larger sample of patients.NEW & NOTEWORTHY Tetraplegia is a risk factor for central sleep-disordered breathing (SDB) and is associated with narrow CO2 reserve (a marker of susceptibility to central apnea). Treatment with high-dose acetazolamide for 3 days decreased susceptibility to hypocapnic central apnea and reduced the frequency of central respiratory events during sleep. Acetazolamide may play a therapeutic role in alleviating central SDB in patients with cervical spinal cord injury, but larger clinical trials are needed.

A Power Conundrum: Black Women and Their Sexual Partners in the Midwest.

The purpose of this research was to determine the extent to which women of African ancestry manifested power in their relationships regarding sexual activities and to examine the influence that specific variables had on their sexual partnerships. A sample (N = 200) of midlife women aged 40-65, who lived in the Midwest participated in this research. The Sexual Relationship Power Scale was used to examine these relationships. Face-to-face interviews occurred in community settings. Multiple regression equations were used to examine the potential impact of specific variables on sexual functioning. Results of the analysis revealed that variables such as mental quality of life, decision-making, and health promotion were positively associated with sexual relationships. Conversely, depression and life stress scores were negatively linked to sexual relationships. Knowledge gained from this research could be used to explore the phenomena of power as expressed in the daily lives of women of African descent. The research can also be discussed from the perspective of a "Black tax," that has burdened Black women for centuries and is manifested through years of discrimination, bias, and the lack of equity in most domains of American institutions.

Comparison of EMLA and Diclofenac on Reduction of Pain and Phlebitis Caused by Peripheral IV Catheter: A Randomized-Controlled Trial Study.

Peripheral venous catheters (PVC) are often used to provide hydration, medications, and blood products when the length of therapy is expected to be less than 1 week. Pain and phlebitis are frequent complications of PVC. Diclofenac and EMLA have been used to minimize these adverse effects; however, conflicting results have been reported regarding which has better outcomes. This double-blind, randomized controlled trial was conducted to compare the efficacy of EMLA and Diclofenac (TDP) in attenuating PVC pain and phlebitis. The inpatient setting was chosen because of the higher frequency of PVC insertions, allowing for a sufficient sample size. One hundred fifty-four subjects were randomly assigned to three groups: EMLA patch (n = 61), a TDP patch (n = 50), or a patch with lubricant gel (n = 46) as a placebo. The pain was measured by Visual Analogue Scale (VAS). Phlebitis was examined based on Boxter criteria in intervals of 6, 12, 18, 24, and 48 hours after PVC insertion. The mean score of VAS was 41.86 ± 22.49 for the control, 39.40 ± 21.60 for TDP, and 38.77 ± 23.28 for the EMLA group, with no significant differences in pain severity between the three groups. The rate of phlebitis in the group with EMLA was significantly higher than the other two groups at 6, 12, and 18 hours (p = 0.02, p = 0.003 and p = 0.04, respectively). In all interval times, the rate of phlebitis in the TDP group was significantly lower than the other groups. Compared with men, women experienced higher rate of phlebitis and intensity of PVC pain. EMLA and TDP had similar analgesic effects, but phlebitis was less frequently observed with TDP, suggesting TDP as a potential medication for reducing pain and phlebitis before PVC insertion.

The Impact of Cyberbullying on Physical and Psychological Health of Arab American Adolescents.

Utilizing a community-based, cross-sectional design, the present study explored Arab American adolescents' experiences in cyberbullying and its effect on their health. A convenience sample of 150 Arab American adolescents, ages 12-16, were recruited from two community centers located at Southeast Michigan. The survey focused on cyberbullying victimization and perpetration in the past year including frequencies and types of technology used. Thirty-four percent of adolescents reported cyberbullying victimization and 26.7% reported cyberbullying perpetration at least once in the past year. Males were significantly more involved in both victimization and perpetration. Text messaging, Instagram and Facebook were most commonly used. Perpetration predicted physical complaints (p = .001), whereas, victimization predicted psychological distress (p = .014) after controlling for all demographic variables. Arab American adolescents reported significant cyberbullying perpetration and victimization. Perpetrators experienced more physical symptoms while victims experienced more psychological distress. Implications for future research are discussed.

Acculturation and Postpartum Depression Among Immigrant Women of Arabic Descent.

Acculturation has been related to risk of postpartum depression (PPD) among immigrant women globally. The purpose of this study was to examine the relationship between acculturation and PPD symptoms among U.S. immigrant women of Arabic descent. A cross-sectional study was conducted with 115 postpartum immigrant women of Arabic descent. Women completed questionnaires including measures of acculturation [attraction to Arabic culture (AArC), attraction to American culture (AAmC), marginalization] and PPD symptoms (Edinburgh Postnatal Depression Scale-EPDS) between 1 and 12 months postpartum. Twenty-five percent of women (n = 29) had EPDS scores ≥ 10 that represent PPD symptoms. Women with higher marginalization reported more PPD symptoms (r = .25, p = .008). None of the acculturation factors correlated with PPD symptoms after adjustment for maternal sociodemographic and health characteristics. Higher education (p = .001), lower gestational age at birth (p < .05), and antenatal anxiety (p < .05) were correlated with PPD symptoms in multivariate analyses. Health care providers should identify and assess immigrant women of Arabic descent for antenatal anxiety as this may identify women at risk for development of PPD symptoms. Future studies need to examine acculturation in relation to mental health among immigrant women of Arabic descent.