5 results
1 Associations between social determinants of health and 10-year change in everyday functioning within Black and White older adults from the ACTIVE study
- Alexandra L. Clark, Alexandra J. Weigand, Olivio J. Clay, Michael Marsiske, Joshua Owens, Jacob Fiala, Michael Crowe, Kelsey R. Thomas
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 783-784
-
- Article
-
- You have access Access
- Export citation
-
Objective:
Social determinants of health (SDoH) are structural elements of our living and working environments that fundamentally shape health risks and outcomes. The Healthy People 2030 campaign delineated SDoH into five distinct categories that include: economic stability, education access/quality, healthcare access, neighborhood and built environment, and social and community contexts. Recent research has demonstrated that minoritized individuals have greater disadvantage across SDoH domains, which has been linked to poorer cognitive performance in older adulthood. However, the independent effects of SDoH on everyday functioning across and within racial groups remains less clear. The current project explored the association between SDoH factors and 10-year change in everyday functioning in a large sample of community-dwelling Black and White older adults.
Participants and Methods:Data from 2,505 participants without dementia enrolled in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study (age M=73.5; 76% women; 28% Black/African American). Sociodemographic, census, and industry classification data were reduced into five SDoH factors: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community contexts. The Observed Tasks of Daily Living, a performance-based measure of everyday functioning with tasks involving medication management, finances, and telephone use, was administered at baseline, 1-, 2-, 3-, 5, and 10-year follow up visits. Mixed-effects models with age as the timescale tested (1) racial group differences in OTDL trajectories, (2) race x SDOH interactions on OTDL trajectories, and (3) associations between SDoH and OTDL trajectories stratified within Black and White older adults. Covariates included sex/gender, vocabulary score, Mini-Mental Status Examination, depressive symptoms, visual acuity, general health, training group status, booster status, testing site, and recruitment wave.
Results:Black older adults had a steeper decline of OTDL performance compared to Whites (linear: b = -.25, quadratic b=-.009, ps < .001). There was a significant race x social and community context interaction on linear OTDL trajectories (b =.06, p=.01), but no other significant race x SDoH interactions were observed (bs =-.007-.05, ps=.73-.11). Stratified analyses revealed lower levels of social and community context were associated with steeper age-related linear declines in OTDL performance in Black (b = .08, p=.001), but not White older adults (b =.004, p=.64). Additionally, lower levels of economic stability were associated with steeper age-related linear declines in OTDL performance in Black (b =.07, p=.04), but not White older adults (b =.01, p=.35). Finally, no significant associations between other SDoH and OTDL trajectories were observed in Black (bs = -.04-.01, ps =.09-.80) or White (bs = -.02-.003, ps=.07-.96) older adults.
Conclusions:SDoH, which measure aspects of structural racism, play an important role in accelerating age-related declines in everyday functioning. Lower levels of economic and community-level social resources are two distinct SDoH domains associated with declines in daily functioning that negatively impact Black, but not White, older adults. It is imperative that future efforts focus on both identifying and acting upon upstream drivers of SDoH-related inequities. Within the United States, this will require addressing more than a century of antiBlack sentiment, White supremacy, and unjust systems of power and policies designed to intentionally disadvantage minoritized groups.
54 Individuals Employing Extreme Coping Behaviors Correlated with Increased Severity of Symptoms Following mTBI
- Jessica Bove, Jacob A Fiala, oJrdan Milano, Adriana Sandino, Breton M Asken, Russell M Bauer
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 159-160
-
- Article
-
- You have access Access
- Export citation
-
Objective:
Approximately 10-15% of patients with mild traumatic brain injury (mTBI) report persistent, chronic symptoms more than one month later. Coping behaviors after mTBI can range from fear avoidance (FA), or a reluctance to return to activity because of the fear of symptom exaggeration, to endurance (END), or an overly aggressive return to activity. We evaluated how coping strategy relates to self-reported symptoms in patients with prolonged recovery from mTBI.
Participants and Methods:Participants were 72 individuals (age 37.8 + 18.4, 65% female) who sustained a mTBI at least one month prior to assessment (median (IQR) = 5.5 (2.0-11.3) months). Participants completed the Brain Injury Recovery Disposition Scale (BIRDS) to assess FA and END behaviors, and Sport Concussion Assessment Tool (SCAT5) Symptom Inventory. A BIRDS spectrum score was calculated as the difference between FA and END scores to determine individual coping behavior on a spectrum from extreme FA (more negative) to extreme END (more positive). SCAT5 symptoms were separated into four domain scores: somatic, cognitive, sleep, and emotion. Regressions were performed for each outcome examining their potential linear and quadratic associations to coping behavior (i.e., BIRDS spectrum score). Follow-up regressions were performed covarying for age and sex to explore the potential influence of these variables on each outcome.
Results:The linear and quadratic components of the BIRDS spectrum score were not significantly related to total number of persisting concussive symptoms. For overall total symptom severity, the quadratic component of the relationship was significant (B = .24, p = 0.04). Visualization of the overall trend line suggested that symptom severity was highest on the extreme FA side of the BIRDS spectrum (highly negative BIRDS spectrum score), decreased as coping behavior become more balanced (BIRDS spectrum score surrounding “0"), plateaued, then increased abruptly on the extreme END side (highly positive BIRDS spectrum score). For cognitive symptoms, the linear component of the BIRDS spectrum score was significant (B = -.28, p = 0.02) and the quadratic component was marginally significant (B = .22, p = 0.06). The quadratic (but not linear) component was significantly related to both the severity of sleep (B = .31, p = 0.01) and emotion symptoms (B = .25, p = 0.03). Finally, neither the linear nor quadratic components were significantly related to the somatic symptom severity. After covarying for age and sex, the quadratic component remained significant for total symptom severity (p = 0.05) as well as the linear component for cognitive severity (p = 0.02).
Conclusions:Both extreme “fear avoidance” and “endurance” coping styles may be related to more severe chronic mTBI symptoms, especially in domains of sleep and emotion symptoms. Patients with balance of both fear avoidance and endurance behaviors may be more likely to experience less severe symptoms even among mTBI patients with persistent complaints. Identifying coping behavior styles early after mTBI could improve prognostication and help with developing personalized treatment plans to improve patient recovery. Future research with larger sample sizes should further examine the influence of age and sex on the relationship between coping behavior and symptom severity.
1 Quantifying the Role of Social Determinants of Health in Racial Disparities
- Joshua H Owens, Lindsay Rotblatt, Jacob Fiala, Michael Marsiske
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 869-870
-
- Article
-
- You have access Access
- Export citation
-
Objective:
In the United States, Black individuals have suffered from 300 years of racism, bias, segregation and have been systematically and intentionally denied opportunities to accrue wealth. These disadvantages have resulted in disparities in health outcomes. Over the last decade there has been a growing interest in examining social determinants of health as upstream factors that lead to downstream health disparities. It is of vital importance to quantify the contribution of SDH factors to racial disparities in order to inform policy and social justice initiatives. This demonstration project uses years of education and white matter hyperintensities (WMH) to illustrate two methods of quantifying the role of a SDH in producing health disparities.
Participants and Methods:The current study is a secondary data analysis of baseline data from a subset of the National Alzheimer's Coordinating Center database with neuroimaging data collected from 2002-2019. Participants were 997 cognitively diverse, Black and White (10.4% Black) individuals, aged 60-94 (mean=73.86, 56.5% female), mean education of 15.18 years (range= 0-23, SD=3.55). First, mediation, was conducted in the SEM framework using the R package lavaan. Black/White race was the independent variable, education was the mediator, WMH volume was the dependent variable, and age/sex were the covariates. Bootstrapped standard errors were calculated using 1000 iterations. The indirect effect was then divided by the total effect to determine the proportion of the total effect attributable to education. Second, a population attributable fraction (PAF) or the expected reduction in WMH if we eliminated low education and structural racism for which Black serves as a proxy was calculated. Two logistic regressions with dichotomous (median split) WMH as the dependent variable, first with low (less than high school) versus high education, and second with Black/White race added as predictors. Age/sex were covariates. PAF of education, and then of Black/White race controlling for education were obtained. Subsequently, a combined PAF was calculated.
Results:In the lavaan model, the total effect of Black/White race on WMH was not significant (B=.040, se=.113, p=.246); however, Black/White race significantly predicted education (B= -.108, se=.390, p=.001) and education significantly predicted WMH burden (B=-.084, se=.008, p=.002). This resulted in a significant indirect effect (effect=.009, se=.014, p=.032). 22.6 % of the relationship between Black/White race and WMH was mediated by education. In the logistic models, the PAF of education was 5.3% and the additional PAF of Black/White race was 2.7%. The combined PAF of Black race and low education was 7.8%.
Conclusions:From our mediation we can conclude that 22.6% of the relationship between Black/White race and WMH volume is explained by education. Our PAF analysis suggests that we could reduce 7.8% of the cases with high WMH burden if we eliminated low education and the structural racism for which Black serves as a proxy. This is an under estimation of the role that education and structural racism play in WMH burden due to our positively selected sample and crude measure of education. However, these methods can help researchers quantify the contribution of SDH to disparities in older adulthood and provide targets for policy change.
24 Demographic Adjustment Is Not Demographic Correction: A Simulation Study
- Jacob A Fiala
-
- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 706-707
-
- Article
-
- You have access Access
- Export citation
-
Objective:
Prior studies have presented demographic adjustment as beneficial because it helps equalize, across demographic groups, the percentage of participants (recruited from the general population without prior diagnosis) who fell beneath the test impairment cutoff (e.g., Smith, et al., 2008). This methodology ignores the possibility that group differences in those falling beneath an impairment cutoff could reflect cognitive impairment prevalence differences between demographic groups in the undiagnosed general population. Demographic group differences in cognitive test scores reflect a mixture of two categories of influences: measurement bias (item/test/examiner bias, language/cultural bias, stereotype threat, etc.) and factors which differentially increase the number of low scores in one group by increasing relative risk (RR) for cognitive impairment (biological aging processes, cognitive reserve, social determinants of health [SDoH], etc.). The current simulation study examined how the effect of demographic adjustment on the diagnostic accuracy of a hypothetical test (operationalized as the area under the curve [AUC] in an ROC analysis) varied as the mixture of influences which caused demographic differences in scores were varied.
Participants and Methods:215,040 samples were randomly generated. Each sample consisted of two demographic groups, with Group 0 always representing the lower scoring group. Across samples, Group 1's baseline risk of impairment and Group 0's relative risk were varied, and these determined the prevalence of cognitive impairment in the groups. Three facets of measurement bias were varied in the simulation: how much lower Group 0's average score was than Group 1's, the degree of non-homogeneity of variance between groups, and how much less reliable the measure was for Group 0. Additional parameters were included and varied to ensure the robustness of findings across a variety of situations. Samples reflected all possible combinations of all varied parameters. For each sample, a baseline AUC was calculated when impairment was regressed on the unadjusted test score. Then, test scores were adjusted for demographic group and difference in adjusted and unadjusted AUC was calculated. This adjusted/unadjusted AUC difference was then regressed on the simulation parameters to quantify their relative influence.
Results:The more Group 0's average score was reduced by measurement bias, the more improvement in AUC was seen after adjustment (ß = 1.76). Trivial but significant main effects of variance non-homogeneity (ß = .09), increased relative risk (ß = -.08), and reduced reliability (ß = .02) were also found, but more importantly, each of these predictors significantly interacted with Group 0 mean score reduction, such that higher relative risks (ß = -1.22), lower reliability (ß = .36), and higher variance (ß = -.15) in Group 0 compared to Group 1 each reduced the association between Group 0 mean score reduction and improvement in AUC.
Conclusions:Demographic adjustment only improves AUC when the mean reduction in scores due to measurement bias is sufficiently high while risk for impairment, test reliability and test score variances are sufficiently equivalent among the demographic groups. When this is not the case, demographic adjustment can be counter-productive, reducing the AUC of the test. We conclude by proposing a novel method for adjusting test scores.
Genetic predilections and predispositions for the development of shamanism
- Jacob A. Fiala, Frederick L. Coolidge
-
- Journal:
- Behavioral and Brain Sciences / Volume 41 / 2018
- Published online by Cambridge University Press:
- 06 April 2018, e73
-
- Article
- Export citation
-
Singh's cultural evolutionary theory of shamanism provides a valuable framework for understanding shamanism. We argue, however, that a full understanding of shamanism should incorporate the psychological predilections and genetic predispositions commonly found in individual shamans. In other words, only a small subset of individuals in a culture is prone or attracted to shamanistic practices, regardless of the evolutionary value of those practices.