Does physician communication style affect patient health outcomes?
Poor medication adherence in black patients with Type 2 diabetes is particularly prevalent. One important factor contributing to patients’ medication adherence is patient reports of patient-physician communication quality. However, we know little about which specific physician communication behaviors during clinical encounters are perceived positively or negatively by black patients.
Nao Hagiwara, Ph.D., assistant professor of health psychology, and her research team—which includes Scott Vrana, Ph.D., professor of clinical psychology as co-investigator—will study these phenomena with the help of a four-year, $1.7 million grant from the National Institutes of Health (National Institute of Diabetes and Digestive Kidney Disease). The overall goal of this research is to find out which specific physician communication behaviors during medical interactions are associated with health outcomes among black patients with Type 2 diabetes, such as satisfaction with care, trust in physicians, medication adherence and diabetes management. The project also aims to identify what physician factors (e.g., demographic characteristics, professional backgrounds, experiences, social bias, personality, etc.) meaningfully predict those physician communication behaviors.
CCEP engages Richmond in HIV and substance abuse education and awareness
The College of Humanities and Sciences recently profiled the Center for Cultural Experiences in Prevention, the research and training center in the Department of Psychology devoted to conducting research and providing innovative, evidenced-based programs and interventions to reduce health disparities and promote healthy youth, families and communities. Under the leadership of Faye Z. Belgrave, Ph.D., the Center develops and evaluates programs that are sensitive to cultural and community needs.
"African American men and women across the United States are disproportionately impacted by the ongoing HIV health crisis in America. Although African Americans make up only 13% of the overall population, they represent 40% of all people living with HIV according to the Centers for Disease Control and Prevention. Black adolescents and young adults between the ages of 13 and 24 are particularly at-risk for contracting HIV, and represent over half of new infections. The high prevalence of HIV among African Americans is due to several intersecting factors including socioeconomic factors, cultural stigmatization and high rates of sexually transmitted infections, according to the CDC."
'We know that these disparities are happening because of a lot of sociocultural factors. In most cases it’s not increased risky or irresponsible behavior on the part of individuals, it’s often linked to socio-environmental determinants of behavior,' said Belgrave."
On well-being: Better to be older or younger?
Janna Lynn Imel is a doctoral student of counseling psychology and student representative for the Older Adult Special Interest Group (OASIG) in the American Psychological Association's Division 17 (Society of Counseling Psychology). She recently composed a blog post for the OASIG in which she shared her reflections on successful aging interspersed with insights from socioemotional selectivity theory.
"In thinking about successful aging, including anecdotal stories from older adults in my family and my research on emotional well-being in older adults, I realized I may be the only 24-year-old who is excited to enter older adulthood decades from now, as it is associated with perks younger adults do not report. The term 'older adult' encompasses a vast array of people with unique experiences, personalities, and stories all over the age of 65. More often than not, society associates older adulthood with decline. It is true that older age can bring forth declines in health, the loss of close friends and family, and difficult transitions. However, one consistent research finding is that older age is linked to increased well-being and more positive affect in comparison to individuals in younger and middle adulthood (Gooding, Hurst, Johnson, & Tarrier, 2012). This blog is intended to counteract the deficit model of aging and focus on some positive aspects of growing older."
Can Apps Increase Rural Women’s Access to HIV Prevention Services?
With funding from the National Institute on Drug Abuse, Kristina Hood, Ph.D., assistant professor of health psychology, is assessing if using social media and mobile compatible web-based tools can improve recruitment, enrollment and retention of young substance-using African American women residing in rural communities in an evidence-based HIV prevention program.Preliminary findings from a pilot project including 75 African American women from rural Mississippi suggested that web-based technology could be used to implement evidence-based HIV interventions with positive short-term results (increased condom use, intentions to use condoms and attitudes toward using condoms at a one-month follow-up). Younger women with lower incomes, those with more education, those without consistent transportation and those with children reported a preference for online intervention over the traditional face-to face model. However, women often discussed challenges negotiating condoms and using condoms consistently while under the influence of alcohol and marijuana. Women felt like more discussion was needed around the intersection of substance use, condom use and safer sex practices. Therefore, Hood is adapting an evidence-based single-session HIV intervention to include discussions about the intersection of safer sex practices and occasional alcohol or drug use to be delivered in a mobile web-based format. This project could demonstrate the use of mobile web-based tools as a wide-reaching, cost-effective method to recruit and implement evidence-based, group-level HIV interventions for individuals using substances and for those with limited access to prevention services.
Can Adolescents’ Online Experiences Affect their Social Functioning?
Approximately 92% of adolescents report going online daily, mostly to connect with others via social networking sites like Facebook, Twitter, and Instagram. However, for African American youth in particular, online social communication can lead to both positive (e.g., connecting with same race peers in online spaces) and negative (e.g., online racial discrimination) race-related experiences. Can these types of experiences impact the way that adolescents interact with others?
Dr. Fantasy Lozada and her collaborator Dr. Brendesha Tynes with the Digital Learning and Development Lab (DLDL) at the University of Southern California have been studying adolescents’ Internet experiences and how online experiences may impact youths’ academic, social, and emotional functioning at school. One longitudinal study of 337 African American adolescents found that when these adolescents connected with others of the same race online, they reported engaging in more empathy-related social behaviors (e.g., listening to others when they have a problem, trying to understand others’ feelings, standing up for others) with their peers at school, one year later. However, if these adolescents had experienced high amounts of online racial discrimination (e.g., being called a racial slur, being threatened because of their race) during the previous year, they reported engaging in less empathy-related social behaviors with their peers in school, one year later. In fact, even when African American adolescents had engaged with others of the same race online, the positive benefits of engaging in more empathy-related social behaviors over time was erased if the adolescent had also experienced high amounts of online racial discrimination. This suggests that the impact of online racial discrimination extends beyond the bounds of the Internet to impact adolescents’ daily social functioning.
In a related study, adolescents’ online racial discrimination experiences were examined in more depth through open-ended questions. Responses from African American adolescents revealed that most of them encountered online racial discrimination when engaging with racist social media posts (e.g., posts that included hate speech toward African Americans or included violent, racist imagery) and when playing videogames online. Over half of the participants who described being a victim of online racial discrimination shared that they were emotionally hurt and/or bothered by the experience. Many of the adolescents in the study reported keeping these experiences to themselves and not reporting them to a parent, teacher, or other adult.
Together, the results of these studies call for further investigation into the nature of ethnic minorities’ race-related Internet experiences and to clearly map out how Internet experiences impact the way adolescents engage with others face to face. Additionally, these studies point to the importance of developing effective technological tools and curriculum that will teach ethnic minority youth how to understand and cope with a variety of race-related experiences in the digital age.
Is Revenge Truly Sweet?
Despite the clear costs of doing so, people often hurt each other. More often than not, such aggression is retaliatory, in that it is in response to a perceived provocation. Because of this, it is important to understand why people seek revenge in the form of aggressive behavior. Social psychology faculty member David Chester and his colleagues used functional MRI scans in two studies to investigate whether retaliatory aggression is motivated by its associated “sweetness” or pleasure. Specifically, these studies tested whether retaliatory aggression was associated with activity in the brain’s pleasure circuit.
In one study, 68 undergraduate students were placed in an MRI scanner while they repeatedly chose the extent to which they physically hurt someone who had either provoked them or not. While they made these decisions about how aggressive to be, the MRI scanner measured how active different parts of the brain were. Participants showed greater aggression towards the person who insulted them, as compared to when they were not provoked. The more aggressive participants were in retaliation to provocation was associated with greater activity in the brain’s pleasure circuit. Further, the likelihood that participants had been in a physical fight at some point in their lives was associated with greater activity in the brain’s pleasure circuit during their acts of aggression in the laboratory.
There are many complicated reasons why people hurt each other. This research suggests that one reason is that, during the act itself, revenge is truly sweet. Attempts at reducing human violence might benefit from reducing the pleasure of revenge.
How Does Being Hospitalized Impact Sleep?
When an older adult goes to the hospital they expect to leave in better condition than when they arrived. However, mounting evidence suggests this is not always the case. Often times the act of being hospitalized can lead to a downward progression of mental and physical health. For example, researchers have shown that being hospitalized carries the unwanted side effect of hastened cognitive decline. Understanding how the act of being hospitalized might impact important aspects of an older adult’s life, like sleep, is imperative, as sleep is essential to mental and physical functioning.
In collaboration with investigators from the University of California, Los Angeles (UCLA) and the VA Greater Los Angeles Healthcare System, Dr. Joseph Dzierzewski investigated the sleeping patterns of older adults before, during, and following a hospital stay. Older patients were asked about their sleep habits prior to hospital admission, during their hospital stay, at hospital discharge, and up to 12-months following discharge.
Overall, they found that there were several patterns of sleep that occurred in response to hospitalization: (1) good sleep throughout the hospitalization process, (2) poor sleep throughout the hospitalization process, (3) a pattern of worsening sleep as a result of hospitalization, and (4) a pattern of improving sleep as a result of hospitalization. Not surprisingly, only a very small percentage of older adults displayed improvements in sleep. These results add evidence to the growing literature that hospitalization in late-life is often accompanied by many unwanted, negative consequences. There are several highly effective interventions to improve the sleep of older adults. Perhaps improving the sleep of older adults who are in the hospital might negate some of the negative consequences of hospital stays. Additionally, improving sleep may boost the positive effects of hospitalization, leading to better recovery of function and health. These possibilities still need to be addressed.
Are Experiences of Discrimination Associated with Worse Sleep at Night?
Using the Midlife in the United States (MIDUS-II) dataset, researchers from VCU (Drs. Dautovich and Kliewer) and the University of Alabama (Drs. Kim, Lichstein, Parmelee, Shoji and Caitie Tighe), examined perceptions of discrimination, global sleep quality, and depressive symptoms in a national sample of adults. The researchers were interested in: 1) whether sleep served as a pathway from perceptions of discrimination to depressive symptoms, and 2) whether these associations differed depending on if the discriminatory experiences were isolated and idiosyncratic versus pervasive. Daily and lifetime experiences of discrimination that were based on multiple aspects of identity including race, ethnicity, sex, age, religion, physical appearance, sexual orientation, or other characteristics were examined in relation to well-being.
Participants who reported major experiences of discrimination across their lifetime and participants who reported daily instances of discrimination endorsed more depressive symptoms. The association of discrimination with sleep quality was less uniform. Consistent with sleep being a daily process, more daily experiences of perceived discrimination predicted poorer sleep, while lifetime experiences did not. Sleep quality was identified as a mechanism linking daily experiences of discrimination and depressive symptoms, even after controlling for known covariates (age, sex, race, education, income, neighborhood quality, baseline depressive symptoms). Sleep quality, however, did not mediate the association between lifetime perceptions of discrimination and depressive symptoms.
Experiences of discrimination repeatedly occur and are linked to numerous negative mental and physical health outcomes. Sleep shows potential as a target for reducing the impact of daily perceptions of discrimination on depressive symptoms. Future research is warranted to investigate the role of sleep interventions such as cognitive-behavioral interventions for insomnia (CBTi) that focus on targeting cognitive and physiological arousal in response to perceptions of discrimination.