RiSE study aims to evaluate a race-based stress-reduction intervention as an effective strategy to improve coping and decrease stress-related symptoms, inflammatory burden, and modify DNA methylation of stress response-related genes in older AA women. This article will describe genomic analytic methods to be utilized in this longitudinal, randomized clinical trial of older adult AA women in Chicago and NYC that examines the effect of the RiSE intervention on DNAm pre- and post-intervention, and its overall influence on inflammatory burden. Salivary DNAm will be measured at baseline and 6 months following the intervention, using the Oragene-DNA kit. Measures of perceived stress, depressive symptoms, fatigue, sleep, inflammatory burden, and coping strategies will be assessed at 4 time points including at baseline, 4 weeks, 8 weeks, and 6 months. Genomic data analysis will include the use of pre-processed and quality-controlled methylation data expressed as beta (β) values. Association analyses will be performed to detect differentially methylated sites on the targeted candidate genes between the intervention and non-intervention groups using the Δβ(changes in methylation) with adjustment for age, health behaviors, early life adversity, hybridization batch, and top principal components of the probes as covariates. To account for multiple testing, we will use FDR adjustment with a corrected p-value of <0.05 regarded as statistically significant. To assess the relationship between inflammatory burden and Δβamong the study samples, we will repeat association analyses with the inclusion of individual inflammation protein measures. ANCOVA will be used because it is more statistically powerful to detect differences.

(1) The prevalence of depression is two times higher in women than men. Black women have an increased risk of depression due to stressors such as low socioeconomic status and perceived discrimination. Depression is likely influenced by both genetic and environmental factors. Psychosocial stressors can influence DNA methylation (DNAm), leading to changes in gene expression and ultimately, depression. The objective of this study was to examine associations between DNAm and depressive symptoms in Black women. (2) This study was a secondary analysis of data from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure (InterGEN) Study. Perceived discrimination was assessed using Krieger’s Experiences of Discrimination and Waelde’s Race-Related Events Scale, and participants were screened for depressive symptoms with the Beck Depression Inventory. Raw data from saliva samples were analyzed using the Illumina Infinium Epic (850 K) BeadChip and then preprocessed in RStudio. (3) Differential methylation analysis identified DNAm sites and regions associated with depressive symptoms. Six DNAm sites had a q-value less than 0.05. Additionally, of the 25 regions identified, 12 were associated with neurological diseases or disorders. (4) These findings suggest that there is a neurological component to depression, which should be considered during treatment.

Background: Racial discrimination experiences are associated with the activation of stress biology pathways and signs of accelerated biological aging, including alterations in DNA methylation (DNAm). Coping strategies may mitigate stress from racial discrimination and protect against long-term adverse health outcomes. Methods: We conducted a secondary analysis of data from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure cohort, an all-African-American sample, to test the hypothesis that social support can protect against accelerated biological aging associated with experiences of racial discrimination. We measured biological aging from saliva DNAm using six epigenetic clocks. Clock values were residualized on participant age and the estimated proportion of epithelial cells contributing to the DNA sample and standardized to M = 0, SD = 1 within the analysis sample. The primary analysis was focused on the second-generation PhenoAge and GrimAge clocks and the third-generation DunedinPACE “speedometer,” which previous studies have linked with racial discrimination. Results: In our sample (n = 234; mean age = 31.9 years; SD = 5.80), we found evidence consistent with our hypothesis in the case of the PhenoAge clock, but not the other clocks. Among mothers who did not seek social support, experiences of racial discrimination were associated with an older PhenoAge (b = 0.26, 95% CI = 0.02–0.50, p = 0.03). However, social-support seeking mitigated this risk; at the highest levels of social support, no adverse consequences of discrimination were observed (interaction b = −0.01, 95% CI = −0.02–−0.00, p = 0.03). Conclusions: The replication of results is needed. Future research should also investigate additional adaptive and maladaptive coping strategies utilized by African American women and mothers to identify protective measures that influence health outcomes.

Background: In recent years, the prevalence of cardiometabolic disease (CMD) in African American women has risen; the risk also increases with age, in comparison to men. Evidence demonstrates that stressful life events, including experiences of racism and perceived discrimination, contribute substantially to inflammatory diseases, such as CMD. Despite this evidence, few evidence-based interventions are available to assist individuals from minoritized communities in coping with the chronic stress related to their racial or ethnic identity. Objective: Our proposed randomized controlled trial will test a novel, race-based intervention tailored to African American women, called Resilience, Stress, and Ethnicity (RiSE). Methods: In this randomized controlled trial, we will randomize participants 1:1 to the 8-week, group-based RiSE program (intervention) or a health education program (active control group). Both programs will consist of synchronous classes on Zoom and will be led by experts. The primary end point will be stress at 6 months after the intervention, and the efficacy of RiSE will be evaluated for improving stress-related symptoms (current perceived stress, depressive symptoms, fatigue, and sleep disturbance), improving coping strategies, and reducing inflammatory burden in African American women at risk for CMD. Validated survey measures and inflammatory biomarkers will be assessed at baseline, midintervention, intervention completion, and 6 months after the intervention, and differences over time by intervention will be evaluated using mixed effects models. Results: This study was funded by the National Institute on Aging on March 30, 2023, with recruitment and enrollment beginning in October 2023. The study is underway, with 120 participants enrolled as of March 2025. Conclusions: This study will be one of the first to examine a race-based stress reduction intervention in African American women and has the potential to improve the health of minoritized groups faced with chronic stress associated with experiencing racism and discrimination. We anticipate that RiSE will reduce stress-related symptoms, enhance adaptive coping, and reduce inflammation. Trial Registration: ClinicalTrials.gov NCT05902741; https://www.clinicaltrials.gov/study/NCT05902741

Background: Stigmatizing language is common in clinical notes and can adversely affect the quality of patient care. Natural language processing (NLP) is a promising technology for identifying such language across large volumes of clinical notes in electronic health records. Objective: This study proposes an NLP-driven reduce stigmatizing language (ENGAGE) system to automatically identify and replace stigmatizing language. Methods: Using a mixed methods study, we will extract electronic health record data for patients admitted to 2 large, diverse home health care (HHC) organizations between January 2019 and December 2021. We propose the following 4 aims: aim 1 is to refine the ontology of stigmatizing language in HHC by (1) interviewing a diverse sample of HHC nurses and patients to identify terms to avoid and (2) analyzing clinical notes from various regions in the United States to categorize stigmatizing language. Aim 2 is to determine the best NLP approach for accurately identifying stigmatizing language by training algorithms and comparing their performance to human annotations. Aim 3 is to analyze the prevalence of stigmatizing language based on patients’ race and ethnicity using adjusted statistical analyses of a sample of approximately half a million HHC patients (34% racial and ethnic minority groups). Aim 4 is to develop the NLP-driven ENGAGE system by (1) testing NLP methods (rule based; “delete, retrieve, and generate”; and transformers) for suggesting alternative wording and (2) designing and refining the user interface for clinical trial preparation. Results: We received funding from the National Institute on Minority Health and Health Disparities in September 2023. Recruitment began in May 2024, and as of March 2025, interviews have been completed for 9 enrolled participants. We anticipate completing all study aims by April 2027. Conclusions: This study will leverage extensive data sources to examine stigmatizing language in HHC settings and contribute to the development of systems aimed at effectively reducing the use of such language among HHC nurses. International Registered Report Identifier (IRRID): DERR1-10.2196/69753

Background: African American (AA) women are disproportionately affected by hypertension. Discrimination, which can be traumatic, and depressive symptoms are independently associated with blood pressure (BP). Objective: We assessed whether the combined influence of discrimination and race-related trauma and depressive symptoms influenced BP over time. Methods: We conducted a secondary data analysis of data from a longitudinal cohort study examining factors associated with BP in 250 AA/Black mother-child dyads. Eligible participants were AA/Black mothers, 21 years and older, with a biological child aged 3–5 years. Clinical (BP, body mass index) and psychosocial measures (racial discrimination, major discrimination, race-related stress, depressive symptoms) were examined. Principal component analysis and linear regression were completed to assess the associations of discrimination, race-related trauma, and depressive symptoms with maternal BP. Results: Data from 183 participants were analyzed. Principal component analysis identified 2 key components: overall discrimination and race-related trauma (principal component 1) and depressive symptoms (principal component 2), which explained 83% of data variation. Linear regression analyses revealed principal component 1 was associated with changes in systolic BP (b = 0.92; P = .04), whereas principal component 2 was not (b = 0.31; P = .71). Conclusions: Our findings highlight the need to further explore experiences of discrimination and race-related trauma as a contributing factor for hypertension. In addition, building on existing efforts, future studies should further analyze the presentation of depressive symptoms among AA women to inform the development and validation of culturally sensitive screening tools that effectively capture these symptoms and enhance access to care.