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 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. CLINICALTRIAL INTERNATIONAL REGISTERED REPORT DERR1-10.2196/69753

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. CLINICALTRIAL ClinicalTrials.gov NCT05902741; https://www.clinicaltrials.gov/study/NCT05902741