Resources and resilience in Older Women: Implications for health outcomes and culturally tailored interventions.

Dr. Springfield\u27s Bio: As a nutritionist, Springfield’s research interests focus on the social, behavioral, and structural determinants of dietary behaviors in African American women and developing community-based interventions to promote health equity. Her most recent work examines relationships between psychological resilience, diet quality, and cardiovascular disease-related outcomes. Abstract:  Introduction  Resilience – which we define as the “ability to bounce back from stress” – can foster successful aging among older, ethnically diverse women. This study investigated the association between psychological resilience in the Women’s Health Initiative Extension Study (WHI-ES) and three constructs defined by Staudinger’s 2015 model of resilience and aging: (1) perceived stress, (2) non-psychological resources, and (3) psychological resources. We further examined whether the relationship between resilience and key resources differed by race/ethnicity. Methods  We conducted a secondary analysis on 77,395 women aged 62+ (4,475 African American; 69,448 non-Hispanic White; 1,891 Hispanic/Latina; and 1,581 Asian or Pacific Islanders) who enrolled in the WHI-ES. Participants completed a short version of the Brief Resilience Scale. Guided by Staudinger’s model, we used linear regression analysis to examine the relationships between resilience and resources, adjusting for age, race/ethnicity, and stressful life events. To identify the most significant associations, we applied elastic net regularization to our linear regression models.  Findings On average, women who reported higher resilience were younger, had fewer stressful life events, and reported access to more resources. African American women reported the highest resilience, followed by Latinas, White, and Asian women. The most important resilience-related resources were psychological, including control beliefs, energy, personal growth, mild-to-no forgetfulness, and experiencing a sense of purpose. Race/ethnicity significantly modified the relationship between resilience and energy (overall interaction p=0.0017). Conclusion  Increasing resilience among older women may require culturally tailored stress reduction techniques and resource-building strategies, including empowerment to control the important things in life and energy

Adherence to the American Heart Association\u27s Life\u27s Essential 8 in Young African American Women

African American women have the highest burden of cardiovascular disease compared to women of other racial and ethnic groups. The American Heart Association (AHA) developed the Life’s Essential 8 (LE8) to promote ideal cardiovascular health. No known studies have examined adherence to the AHA’s Life’s Essential 8 in young African American women. Based on AHA’s definitions of ideal cardiovascular health, we operationalized the LE8 strategies into a quantitative score and assessed young African American women\u27s adherence

Efficacy of a Weight Loss Intervention for African American Breast Cancer Survivors

African American women with breast cancer have higher cancer-specific and overall mortality rates. Obesity is common among African American women and contributes to breast cancer progression and numerous chronic conditions. Weight loss interventions among breast cancer survivors positively affect weight, behavior, biomarkers, and psychosocial outcomes, yet few target African Americans. This article examines the effects of Moving Forward, a weight loss intervention for African American breast cancer survivors (AABCS) on weight, body composition, and behavior

Evaluating Diet Quality in African American Breast Cancer Survivors

This study involved a cross-sectional analysis of baseline dietary intake data from African American breast cancer survivors (AABCS) enrolled in “Moving Forward,” a randomized controlled weight management intervention study. Analyses examined: 1) habitual dietary intake; 2) adherence to the general United States (US) population 2010 Dietary Guidelines for Americans (2010 DGAs); and 3) adherence to the American Cancer Society/American Institute of Cancer Research (ACS/AICR) dietary recommendations. We used the Healthy Eating Index-2010 (HEI 2010) to assess adherence to the 2010 DGAs and a 24-point dietary quality scoring system adapted from Berdan et al. 2014 and Hastert et al. 2013 to assess adherence to the combined ACS/AICR dietary recommendations. We also examined predictors of dietary quality including demographics, self-efficacy, social support, and perceived barriers to healthy foods. In this cohort of AABCS, dietary quality was sub-optimal. However, the dietary quality scores were higher than reported for AA women in the general population and some studies targeting white breast cancer survivors. Dietary components with optimal and poor adherence should be acknowledged when developing interventions, as well as the relationship between education, self-efficacy, and lifestyle factors on dietary adherence. Self-efficacy and perceived barriers to healthy foods play a significant role in dietary adherence. This relationship seems to be modified by lifestyle factors. Greater attention is needed to understand how social, cultural, and environmental factors may work together and be leveraged to strengthen intervention and improve dietary outcomes in AABCS

Adverse Childhood Experiences and Diet Quality in young African American women: A descriptive analysis of a community-based survey

Background: High exposure to ACEs (4+) is associated with an increased risk of CVD and poorer health behaviors in adulthood. However, evidence is limited in young adults2-4. Aims. To describe diet quality and exposure to ACEs in AA women aged 18-35 years old. Methods: Descriptive analysis of survey data collected in self-identified AA women aged 18-35 (N=512). Assessments included self-reported ACE exposure (4+ indicates high risk) and WELL Diet score (range 0-120; higher score = better diet quality). Results: XX% of our sample reported high ACEs exposure. Mean Well Diet score was xx (sd:) out of 120. Further research is warranted. 2Su, S., Jimenez, M. P., Roberts, C. T., & Loucks, E. B. (2015). The role of adverse childhood experiences in cardiovascular disease risk: a review with emphasis on plausible mechanisms. Current cardiology reports, 17(10), 88. https://doi.org/10.1007/s11886-015-0645-1 3Nikulina, V., & Widom, C. S. (2014). Do race, neglect, and childhood poverty predict physical health in adulthood? A multilevel prospective analysis. Child abuse & neglect, 38(3), 414–424. https://doi.org/10.1016/j.chiabu.2013.09.007 4Sonu, S., Post, S., & Feinglass, J. (2019). Adverse childhood experiences and the onset of chronic disease in young adulthood. Preventive medicine, 123, 163–170. https://doi.org/10.1016/j.ypmed.2019.03.03

Love and Power: A Community Power Building Case

Dr. Hatchett\u27s bio: Dr. Lena Hatchett is a Senior Fellow with We in the World, a diverse team of change agents who are passionate about igniting transformation for well-being and equity in the world. She brings the voice of people with lived experience of inequity to the design process of the Racial Justice Community 2021. Dr. Springfield’s bio: As a nutritionist, Springfield’s research interests focus on the social, behavioral, and structural determinants of dietary behaviors in African American women and developing community-based interventions to promote health equity. Her most recent work examines relationships between psychological resilience, diet quality, and cardiovascular disease-related outcomes. Abstract: Proviso Partners for Health (PP4H) is a community-led coalition to advance action of racial and economic equity in the food system. Over the last six years, PP4H received funding from multi-sector organizations, including Trinity Health System and Robert Wood Johnson, to implement policy, systems, and environmental (PSE) change initiatives. The long-term sustainability of these efforts beyond the funding period is vital and requires an in-depth inquiry into the effectiveness of community power building strategies. Pastor, Ito, and Wander, 2020, define community power building as the ability of communities most impacted by structural inequity to develop, sustain and grow an organized base of people who act together through democratic structures to set agendas, shift public discourse, influence decision-makers, and cultivate ongoing relationships of mutual accountability with them to change systems and advance health equity. Multi-sector partners collaboratively designed and conducted a practice-based, action-driven evaluation to answer two questions: 1) What factors facilitate the sustainability of a food justice movement? 2) How can community residents sustain efforts? We used a case study approach that included semi-structured interviews, documentary data and field notes, observations, and quantitative data. Results found five community power building strategies to catalyzing PSE change in the food system 1) transparency and accountability, 2) shared leadership and power, 3) community voice, 4) leveraged assets, and 5) community love. Conclusion revealed that power-building with people with lived experience of inequity to leverage their individual and collective assets advanced action in the food system. In doing so, PP4H has aligned its work with a more health-equity-oriented vision

The WELL diet score correlates with the alternative healthy eating index-2010

The quality of one's overall diet has proven to be of great importance to health and well-being. Unfortunately, diet quality is time-consuming to assess. The Stanford Wellness Living Laboratory (WELL) administered an online survey that included the WELL Diet Score (a novel diet quality assessment calculated from 12 diet-related items). Subsequently, WELL participants were asked to complete the 127-item Block Food Frequency Questionnaire (FFQ) online. The present study's primary objective was to compare the WELL Diet Score with the established FFQ-based Alternative Healthy Eating Index-2010 (AHEI-2010), in a subset of WELL participants (n = 248) who completed both dietary measures through WELL’s online platform. The two scores were significantly correlated (r = .69; p < .0001). Regression analyses demonstrated that the WELL Diet Score was positively significantly associated with sociodemographic determinants of diet quality and protective health factors, including older age, higher education, lower BMI, and higher physical activity. In summary, the WELL Diet Score, derived from 12 small diet-related items that can be completed in 5 min, was significantly positively correlated with the AHEI-2010 derived from the lengthy 127-item FFQ, suggesting the potential utility of the WELL Diet Score in future large-scale studies, including future WELL studies

Resilience and CVD-protective Health Behaviors in Older Women: Examining Racial and Ethnic Differences in a Cross-Sectional Analysis of the Women\u27s Health Initiative

Little is known about the relationship between self-reported psychological resilience (resilience) and health behaviors shown to reduce the risk of cardiovascular disease (CVD). This study examines the associations between resilience and CVD-related risk factors, such as diet, smoking, physical activity, sleep, and alcohol consumption among older American women from diverse backgrounds. METHODS: A cross-sectional secondary analysis was conducted on 77,395 women (mean age 77 years, Black (N = 4475, 5.8%), non-Hispanic white (N = 69,448, 89.7%), Latina (N = 1891, 2.4%), and Asian or Pacific Islander (N = 1581, 2.0%)) enrolled in the Women\u27s Health Initiative Extension Study II. Resilience was measured using an abbreviated version of the brief resilience scale. Multivariable logistic regression models were used to evaluate the association between resilience and health behaviors associated with risk for CVD, while adjusting for stressful life events and sociodemographic information. To test whether these associations varied among racial/ethnic groups, an interaction term was added to the fully adjusted models between resilience and race/ethnicity. RESULTS: High levels of resilience were associated with better diet quality (top 2 quintiles of the Healthy Eating Index 2015) (OR = 1.22 (95% Confidence Interval (1.15-1.30)), adhering to recommended physical activity ( \u3e /= 150 min per week) (1.56 (1.47, 1.66)), sleeping the recommended hours per night (7-9) (1.36 (1.28-1.44)), and moderate alcohol intake (consuming alcoholic drink(s) 1-7 days per week) (1.28 (1.20-1.37)). The observed association between resilience and sleep is modified by race/ethnicity (p = 0.03). CONCLUSION: Irrespective of race/ethnicity, high resilience was associated with CVD-protective health behaviors. This warrants further investigation into whether interventions aimed at improving resilience could increase the effectiveness of lifestyle interventions

Correlation of the WELL Diet Score and NutritionQuest Fruit, Vegetable, and Fiber Screener

Our study aims to identify a brief DQI that evaluates the diet quality of young African American women (ages 18-35) by examining the association between the WELL Diet Score and the FVF Screener with young, female African American participants. There is currently no gold standard for a DQI to solidify the validity of the WELL Diet Score (Springfield et al., 2020). Nonetheless, the FVF is well substantiated in effectively measuring the dietary components that have been identified as disease causing agents (Block et al., 2000; Dahl et al., 2012). A strong association via correlational statistics between the WELL Diet Score and the established FVF in our target population would provide evidence to support the validation of the WELL Diet Score in accurately assessing the diet quality of young African American women. We hypothesize a strong and significant association between the WELL Diet Score and the FVF Screener, which would support the validation of the WELL Diet Score in young African American women

Diet Quality and Resilience through Adulthood: A Cross-Sectional Analysis of the WELL for Life Study

Despite evidence suggesting the importance of psychological resilience for successful aging, little is known about the relationship between diet quality and resilience at different ages. Our study aims to examine the association between diet quality and resilience across the stages of adulthood. Using Stanfords’ WELL for Life (WELL) survey data, we conducted a cross-sectional study of diet quality, resilience, sociodemographic, perceived stress, lifestyle, and mental health factors among 6171 Bay Area adults. Diet quality was measured by the WELL Diet Score, which ranges from 0–120. A higher score indicates a better diet quality. Linear regression analysis was used to evaluate the association between the WELL Diet Score and overall resilience and within the following age groups: early young (18–24), late young (25–34), middle (35–49), and late adulthood (≥50). To test whether these associations varied by age groups, an age group by resilience interaction term was also examined. In the fully adjusted model, the WELL Diet Score was positively and significantly associated with overall resilience (all ages (β = 1.2 ± sd: 0.2, p p p p p < 0.001)). Young adults demonstrated the strongest associations between diet quality and resilience. However, there were no significant age-by-resilience interactions. Diet quality may be positively associated with resilience at all stages of adulthood. Further research is needed to determine whether assessing and addressing resilience could inform the development of more effective dietary interventions, particularly in young adults