Soohyun Nam - Academia.edu (original) (raw)

Papers by Soohyun Nam

Background: There are many barriers to effective diabetes management for people with type 2 diabe... more Background: There are many barriers to effective diabetes management for people with type 2 diabetes (T2D) and clinicians. Patients' reluctance to start insulin therapy is one of the barriers to effective management that may be influenced by patients' sociodemographic and psychosocial factors. Significant delay in starting insulin may increase complications and impair patients' quality of life. Little is known about insulin reluctance (IR) and its relationship with associated factors. Purpose: 1) Summarize existing knowledge regarding various barriers to diabetes management from the perspectives of both patients and clinicians; 2) investigate the concept of IR, resistance to using insulin therapy, by describing patients' perceived barriers and their relationships with associated factors; and 3) examine the effectiveness of culturally competent diabetes education (CCDE) among ethnic minorities with T2D. Methods: The first paper was a literature review regarding various barriers to diabetes management. The second study was a cross-sectional descriptive study. Data were collected from 178 people with T2D, who were 18 years or older, being treated with diabetic oral agents and able to speak English. The participants from general medicine practice clinics completed validated measures: Diabetes Attitude Scale, Diabetes Knowledge Test, Diabetes Self-efficacy Scale, Interpersonal processes of Care and Barriers to Insulin Treatment. Biomedical data were obtained from medical record vii reviews. The third study was a meta-analysis to evaluate the effectiveness of CCDE for ethnic minorities with T2D. Findings: The first paper revealed that patients' adherence, attitude, knowledge about diabetes, culture, language capability, financial resources, comorbidity and social support may affect diabetes management. Clinician barriers to following treatment guidelines include beliefs, attitudes and knowledge, patient-clinician interaction and communication, and the health care system. The second study demonstrated that people with T2D had moderate IR. Fear of hypoglycemia was the strongest barrier to insulin treatment. Women were more reluctant to use insulin than men. Ethnic minorities had more psychological barriers to insulin treatment than whites. Greater diabetes self-efficacy scores predicted significantly less IR and better perceived interaction with the clinician may reduce IR. The third study showed that CCDE appears to be effective in improving glycemic control for ethnic minorities.

PLOS ONE

Perceived racial discrimination has been associated with the autonomic nervous system (ANS) and h... more Perceived racial discrimination has been associated with the autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis activities—two major stress response systems. To date, most studies have used cross-sectional data that captured retrospective measures of the racial discrimination associated with current physiological stress responses. The purpose of this study was to examine the relationship between racial discrimination measured in real-time and physiological stress responses. Twelve healthy Black adults completed baseline surveys and self-collected saliva samples 4x/day for 4 days to measure cortisol and alpha amylase (AA) as a proxy of HPA and ANS systems, respectively. Real-time racial discrimination was measured using ecological momentary assessments (EMA) sent to participants 5x/day for 7 days. Multilevel models were conducted to examine the relationship between racial discrimination and stress responses. In multilevel models, the previous day’s racial di...

PLOS ONE, 2023

A growing body of research suggests that obesity can be understood as a complex and biobehavioral... more A growing body of research suggests that obesity can be understood as a complex and biobehavioral condition influenced by social relationships ─social networks. Social network analysis allows us to examine how an individual's network characteristics (e.g., popularity) are associated with obesity and obesity-related behaviors. The objectives of the study were to (a) examine whether network members in African American churches are similar in body mass index (BMI) and obesity-related behaviors (physical activity, eating, alcohol consumption) and (b) examine whether an individual's network characteristics, such as popularity (i.e., receiving nominations from peers) and expansiveness (i.e., sending nominations to peers) are associated with BMI and obesity-related behaviors. We used a cross-sectional study design and conducted social network analysis using Exponential random graph models with three African American church-based social networks (network A, B, and C, n = 281). There were no significant network members' similarities on BMI in the three churchbased networks. One out of three networks showed similarities in fruit and vegetable consumption (network B), fast food consumption (network C), physical activity, sedentary behaviors, and alcohol consumption (network A). African Americans with a high BMI were more popular, as were individuals with greater fat intake and alcohol consumption. Our findings support the perspective that we need to improve obesity-related behaviors by targeting influential individuals and existing ties and to develop obesity interventions using social networks. The degree to which our findings varied across churches also suggests that the relationship among an individual's obesity-related behaviors and network characteristics should be understood in the unique social context.

Circulation, Nov 20, 2012

BACKGROUND: Sleep disturbances have adverse cardiovascular consequences and are linked to glucose... more BACKGROUND: Sleep disturbances have adverse cardiovascular consequences and are linked to glucose intolerance and obesity. Weight loss and exercise are primary treatments for obese patients with glucose intolerance yet few lifestyle intervention trials have evaluated changes in sleep quality in relation to changes in body composition and fitness. METHODS: We randomized persons aged 35-65 years with type 2 diabetes or pre-diabetes to 6-months of weight loss diet (D); or D combined with supervised moderate-intensity exercise training (D+E). Sleep quality was determined with a 50 item self-report questionnaire that identifies symptoms of apnea, daytime fatigue, hypersomnolence, circadian rhythm sleep disorder, insomnia, restless sleep, parasomnia, and dream disorders. Sleep quality is a composite score of all these items. Other measurements included weight; body mass index (BMI); total, abdominal subcutaneous and visceral fat by magnetic resonance imaging; and aerobic fitness expressed as VO 2 peak during treadmill testing. RESULTS: Of 77 subjects randomized, 55 participants (54.8 ± 7.8 years; n=24 of 38 D, n=31 of 39 D+E) completed the study. At 6 months, both groups improved from baseline (p 2 ; D+E:-104.16 ± 72.37 cm 2 , p= 0.92), VO 2 peak (D: 2.26 ± 3.92 ml/kg/min ; D+E:3.71 ±2.65 ml/kg/min, p=0.11), and sleep quality (D: -3.53 ± 7.69; D+E:-0.37 ±7.23, p=0.16). In bivariate analysis, improvement in sleep quality was associated with a reduction in BMI (r=0.47, p CONCLUSION: The novel finding herein is that a reduction in abdominal subcutaneous fat, with either diet alone or diet plus exercise, was associated with improved sleep quality. These data suggest that interventions that target central obesity may prove to be an effective strategy for reducing the incidence and severity of sleep disorders.

AIDS and Behavior

The original version of this article unfortunately contained an error, and it has been corrected ... more The original version of this article unfortunately contained an error, and it has been corrected with this erratum. The co-author name of "Robert Garofalo" is misspelled as ""Robert Garafalo" and there appears to be a formatting irregularity on page 4 under "case 2" these corrections are updated. The original article has been corrected.

AIDS and Behavior

Adolescents and sexual minority men (SMM) are high priority groups in the United Nations’ 2021 − ... more Adolescents and sexual minority men (SMM) are high priority groups in the United Nations’ 2021 − 2016 goals for HIV prevention and viral load suppression. Interventions aimed at optimizing HIV prevention, testing and viral load suppression for adolescents must also attend to the intersectional realities influencing key sub-populations of SMM. Consequently, there is not a robust evidence-base to guide researchers and program partners on optimal approaches to implementing interventions with adolescent SMM. Using a multiple case study design, we integrated the Implementation Research Logic Model with components of the Consolidated Framework for Implementation Research and applied it as a framework for a comparative description of ten HIV related interventions implemented across five countries (Ghana, Kenya, Nigeria, Tanzania and United States). Using self-reported qualitative survey data of project principal investigators, we identified 17 of the most influential implementation determi...

Research in Nursing & Health, 2020

Perceived racial discrimination is linked to unhealthy behaviors and stress‐related morbidities. ... more Perceived racial discrimination is linked to unhealthy behaviors and stress‐related morbidities. A compelling body of research indicates that perceived racial discrimination may contribute to health disparities among African Americans (AAs). The purposes of this study were to describe the study protocol including data collection procedures and study measures and to evaluate the feasibility and acceptability of intensive biobehavioral data collection using ecological momentary assessment (EMA), salivary biomarkers, and accelerometers over 7 days among middle‐aged AAs with a goal of understanding the relationships between perceived racial discrimination and biobehavioral responses to stress. Twelve AA men and women participated in the feasibility/acceptability study. They completed surveys, anthropometrics, and received in‐person training in EMA and saliva sample collection at baseline. Participants were asked to respond to the random prompt text message‐based EMA five times a day, we...

Circulation, 2016

Introduction: Due to genetic predisposition and acculturation experiences, Korean immigrants (KIs... more Introduction: Due to genetic predisposition and acculturation experiences, Korean immigrants (KIs) are vulnerable to developing obesity and cardiovascular complications. However, few studies have e...

Circulation, 2012

BACKGROUND: Sleep disturbances have adverse cardiovascular consequences and are linked to glucose... more BACKGROUND: Sleep disturbances have adverse cardiovascular consequences and are linked to glucose intolerance and obesity. Weight loss and exercise are primary treatments for obese patients with glucose intolerance yet few lifestyle intervention trials have evaluated changes in sleep quality in relation to changes in body composition and fitness. METHODS: We randomized persons aged 35-65 years with type 2 diabetes or pre-diabetes to 6-months of weight loss diet (D); or D combined with supervised moderate-intensity exercise training (D+E). Sleep quality was determined with a 50 item self-report questionnaire that identifies symptoms of apnea, daytime fatigue, hypersomnolence, circadian rhythm sleep disorder, insomnia, restless sleep, parasomnia, and dream disorders. Sleep quality is a composite score of all these items. Other measurements included weight; body mass index (BMI); total, abdominal subcutaneous and visceral fat by magnetic resonance imaging; and aerobic fitness expressed...

Journal of the International Association of Providers of AIDS Care (JIAPAC), 2021

In Ghana, the HIV prevalence among MSM is more than 10 times greater than the general population ... more In Ghana, the HIV prevalence among MSM is more than 10 times greater than the general population of adults, and rates of engagement in HIV medical care are low among MSM diagnosed with HIV. Using structured surveys, we investigated the impact of HIV-related stigma, same-sex behavior stigma, and gender nonconformity stigma on linkage to HIV care (LTC) in MSM ( N = 225) living with HIV in Ghana. Autonomy-supportive healthcare climate ( OR = 1.63, p < .01), vicarious HIV stigma ( OR = 2.73, p < .01), and age ( OR = 1.06, p < .004) predicted LTC. Conversely, felt normative HIV stigma negatively predicted LTC ( OR = 0.65, p < .05). Finally, we identified regional disparities, with MSM from Takoradi being 4 times and 5 times more likely to be LTC compared to Kumasi and Accra, respectively. Our findings highlight the nuanced roles of stigmas in shaping the HIV care continuum among MSM living with HIV, while revealing potential gaps in current measures of HIV-related stigma.

Circulation, 2021

Introduction: Perceived racial discrimination has been associated with dysregulation of sympathet... more Introduction: Perceived racial discrimination has been associated with dysregulation of sympathetic-adrenal-medullary (SAM) and hypothalamic-pituitary-adrenal (HPA) axis, two major physiological stress response systems linked to cardiovascular disease outcomes. Most studies, to date, used cross-sectional data that captured retrospective measures of lifetime racial discrimination associated with current physiological stress responses. Relative to overt racial discrimination, a subtle form of racial discrimination, known as microaggression is more prevalent, yet most commonly measured retrospectively, and understudied. The purpose of this pilot study was to examine the relationship between microaggression measured in real-time and physiological stress responses. Methods: Twelve healthy Black adults (mean age=43.4 years) completed baseline surveys, and self-collected saliva 4x a day for 4 days to measure cortisol and alpha amylase (AA) as a proxy of HPA and SAM systems, respectively. R...

Circulation, 2015

Background: Though a high amount of visceral fat is associated with insulin resistance, which can... more Background: Though a high amount of visceral fat is associated with insulin resistance, which can lead to type 2 diabetes (T2D) and cardiovascular diseases (CVDs), less is known about whether lifestyle modification (weight loss diet and exercise) induced changes in visceral fat are associated with improvements in glycemia. Methods: We randomized 77 individuals aged 35-65 years with T2D or pre-diabetes to 6-months of weight loss diet (D); or D combined with supervised moderate-intensity exercise training (D+E). Study measures were total abdominal, visceral and subcutaneous fat volumes by magnetic resonance imaging, aerobic fitness expressed as VO 2 peak during treadmill testing, body mass index (BMI), and HbA1c levels from blood samples. Results: Of 77 subjects (mean age, 54.8±7.8 years; mean BMI, 34.5 ± 4.7 kg/m 2 , women, 77.9%; Whites-65%, Blacks-34%, Asians-1%), n=37 had T2D and n=40 had pre-diabetes. At 6 months, both D and D+E groups improved from baseline (p<0.05 for all) b...

Diabetes Research and Clinical Practice, 2011

Diabetes Care, 2010

OBJECTIVE To describe the predictive relationships of selected sociodemographic, biomedical, and ... more OBJECTIVE To describe the predictive relationships of selected sociodemographic, biomedical, and psychosocial variables to reluctance to use insulin among patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 178 patients with type 2 diabetes participated in this cross-sectional, observational study. Data were obtained by patient interview using validated measures of diabetes attitude, knowledge, self-efficacy, care communication, and perceived barriers to treatment, as well as sociodemographic and biomedical data. RESULTS Women and ethnic minorities with type 2 diabetes have more psychological barriers to insulin treatment (P < 0.05). The final regression model showed that individuals who believed in the value of tight glucose control, had strong self-efficacy, and had better interpersonal processes with their healthcare providers were less reluctant to use insulin treatment (R2 = 0.403; P < 0.0001). CONCLUSIONS Diabetes self-efficacy and better interaction wi...

JMIR Formative Research, 2021

Background A growing number of studies indicate that exposure to social stress, such as perceived... more Background A growing number of studies indicate that exposure to social stress, such as perceived racial discrimination, may contribute to poor health, health behaviors, and health disparities. Increased physical activity (PA) may buffer the impact of social stress resulting from racial discrimination. However, to date, data on the relationship between racial discrimination and PA have been mixed. Part of the reason is that the effect of perceived racial discrimination on PA has primarily been examined in cross-sectional studies that captured retrospective measures of perceived racial discrimination associated with individuals’ current PA outcomes. The association between real-time perceived racial discrimination and PA among African Americans remains unclear. Objective The purpose of this study is to examine the relationship among demographic, anthropometric and clinical, and psychological factors with lifetime racial discrimination and examine the within- and between-person associ...

Research in Nursing & Health

Archives of Environmental & Occupational Health

Background: There are many barriers to effective diabetes management for people with type 2 diabe... more Background: There are many barriers to effective diabetes management for people with type 2 diabetes (T2D) and clinicians. Patients' reluctance to start insulin therapy is one of the barriers to effective management that may be influenced by patients' sociodemographic and psychosocial factors. Significant delay in starting insulin may increase complications and impair patients' quality of life. Little is known about insulin reluctance (IR) and its relationship with associated factors. Purpose: 1) Summarize existing knowledge regarding various barriers to diabetes management from the perspectives of both patients and clinicians; 2) investigate the concept of IR, resistance to using insulin therapy, by describing patients' perceived barriers and their relationships with associated factors; and 3) examine the effectiveness of culturally competent diabetes education (CCDE) among ethnic minorities with T2D. Methods: The first paper was a literature review regarding various barriers to diabetes management. The second study was a cross-sectional descriptive study. Data were collected from 178 people with T2D, who were 18 years or older, being treated with diabetic oral agents and able to speak English. The participants from general medicine practice clinics completed validated measures: Diabetes Attitude Scale, Diabetes Knowledge Test, Diabetes Self-efficacy Scale, Interpersonal processes of Care and Barriers to Insulin Treatment. Biomedical data were obtained from medical record vii reviews. The third study was a meta-analysis to evaluate the effectiveness of CCDE for ethnic minorities with T2D. Findings: The first paper revealed that patients' adherence, attitude, knowledge about diabetes, culture, language capability, financial resources, comorbidity and social support may affect diabetes management. Clinician barriers to following treatment guidelines include beliefs, attitudes and knowledge, patient-clinician interaction and communication, and the health care system. The second study demonstrated that people with T2D had moderate IR. Fear of hypoglycemia was the strongest barrier to insulin treatment. Women were more reluctant to use insulin than men. Ethnic minorities had more psychological barriers to insulin treatment than whites. Greater diabetes self-efficacy scores predicted significantly less IR and better perceived interaction with the clinician may reduce IR. The third study showed that CCDE appears to be effective in improving glycemic control for ethnic minorities.

PLOS ONE

Perceived racial discrimination has been associated with the autonomic nervous system (ANS) and h... more Perceived racial discrimination has been associated with the autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis activities—two major stress response systems. To date, most studies have used cross-sectional data that captured retrospective measures of the racial discrimination associated with current physiological stress responses. The purpose of this study was to examine the relationship between racial discrimination measured in real-time and physiological stress responses. Twelve healthy Black adults completed baseline surveys and self-collected saliva samples 4x/day for 4 days to measure cortisol and alpha amylase (AA) as a proxy of HPA and ANS systems, respectively. Real-time racial discrimination was measured using ecological momentary assessments (EMA) sent to participants 5x/day for 7 days. Multilevel models were conducted to examine the relationship between racial discrimination and stress responses. In multilevel models, the previous day’s racial di...

PLOS ONE, 2023

A growing body of research suggests that obesity can be understood as a complex and biobehavioral... more A growing body of research suggests that obesity can be understood as a complex and biobehavioral condition influenced by social relationships ─social networks. Social network analysis allows us to examine how an individual's network characteristics (e.g., popularity) are associated with obesity and obesity-related behaviors. The objectives of the study were to (a) examine whether network members in African American churches are similar in body mass index (BMI) and obesity-related behaviors (physical activity, eating, alcohol consumption) and (b) examine whether an individual's network characteristics, such as popularity (i.e., receiving nominations from peers) and expansiveness (i.e., sending nominations to peers) are associated with BMI and obesity-related behaviors. We used a cross-sectional study design and conducted social network analysis using Exponential random graph models with three African American church-based social networks (network A, B, and C, n = 281). There were no significant network members' similarities on BMI in the three churchbased networks. One out of three networks showed similarities in fruit and vegetable consumption (network B), fast food consumption (network C), physical activity, sedentary behaviors, and alcohol consumption (network A). African Americans with a high BMI were more popular, as were individuals with greater fat intake and alcohol consumption. Our findings support the perspective that we need to improve obesity-related behaviors by targeting influential individuals and existing ties and to develop obesity interventions using social networks. The degree to which our findings varied across churches also suggests that the relationship among an individual's obesity-related behaviors and network characteristics should be understood in the unique social context.

Circulation, Nov 20, 2012

BACKGROUND: Sleep disturbances have adverse cardiovascular consequences and are linked to glucose... more BACKGROUND: Sleep disturbances have adverse cardiovascular consequences and are linked to glucose intolerance and obesity. Weight loss and exercise are primary treatments for obese patients with glucose intolerance yet few lifestyle intervention trials have evaluated changes in sleep quality in relation to changes in body composition and fitness. METHODS: We randomized persons aged 35-65 years with type 2 diabetes or pre-diabetes to 6-months of weight loss diet (D); or D combined with supervised moderate-intensity exercise training (D+E). Sleep quality was determined with a 50 item self-report questionnaire that identifies symptoms of apnea, daytime fatigue, hypersomnolence, circadian rhythm sleep disorder, insomnia, restless sleep, parasomnia, and dream disorders. Sleep quality is a composite score of all these items. Other measurements included weight; body mass index (BMI); total, abdominal subcutaneous and visceral fat by magnetic resonance imaging; and aerobic fitness expressed as VO 2 peak during treadmill testing. RESULTS: Of 77 subjects randomized, 55 participants (54.8 ± 7.8 years; n=24 of 38 D, n=31 of 39 D+E) completed the study. At 6 months, both groups improved from baseline (p 2 ; D+E:-104.16 ± 72.37 cm 2 , p= 0.92), VO 2 peak (D: 2.26 ± 3.92 ml/kg/min ; D+E:3.71 ±2.65 ml/kg/min, p=0.11), and sleep quality (D: -3.53 ± 7.69; D+E:-0.37 ±7.23, p=0.16). In bivariate analysis, improvement in sleep quality was associated with a reduction in BMI (r=0.47, p CONCLUSION: The novel finding herein is that a reduction in abdominal subcutaneous fat, with either diet alone or diet plus exercise, was associated with improved sleep quality. These data suggest that interventions that target central obesity may prove to be an effective strategy for reducing the incidence and severity of sleep disorders.

AIDS and Behavior

The original version of this article unfortunately contained an error, and it has been corrected ... more The original version of this article unfortunately contained an error, and it has been corrected with this erratum. The co-author name of "Robert Garofalo" is misspelled as ""Robert Garafalo" and there appears to be a formatting irregularity on page 4 under "case 2" these corrections are updated. The original article has been corrected.

AIDS and Behavior

Adolescents and sexual minority men (SMM) are high priority groups in the United Nations’ 2021 − ... more Adolescents and sexual minority men (SMM) are high priority groups in the United Nations’ 2021 − 2016 goals for HIV prevention and viral load suppression. Interventions aimed at optimizing HIV prevention, testing and viral load suppression for adolescents must also attend to the intersectional realities influencing key sub-populations of SMM. Consequently, there is not a robust evidence-base to guide researchers and program partners on optimal approaches to implementing interventions with adolescent SMM. Using a multiple case study design, we integrated the Implementation Research Logic Model with components of the Consolidated Framework for Implementation Research and applied it as a framework for a comparative description of ten HIV related interventions implemented across five countries (Ghana, Kenya, Nigeria, Tanzania and United States). Using self-reported qualitative survey data of project principal investigators, we identified 17 of the most influential implementation determi...

Research in Nursing & Health, 2020

Perceived racial discrimination is linked to unhealthy behaviors and stress‐related morbidities. ... more Perceived racial discrimination is linked to unhealthy behaviors and stress‐related morbidities. A compelling body of research indicates that perceived racial discrimination may contribute to health disparities among African Americans (AAs). The purposes of this study were to describe the study protocol including data collection procedures and study measures and to evaluate the feasibility and acceptability of intensive biobehavioral data collection using ecological momentary assessment (EMA), salivary biomarkers, and accelerometers over 7 days among middle‐aged AAs with a goal of understanding the relationships between perceived racial discrimination and biobehavioral responses to stress. Twelve AA men and women participated in the feasibility/acceptability study. They completed surveys, anthropometrics, and received in‐person training in EMA and saliva sample collection at baseline. Participants were asked to respond to the random prompt text message‐based EMA five times a day, we...

Circulation, 2016

Introduction: Due to genetic predisposition and acculturation experiences, Korean immigrants (KIs... more Introduction: Due to genetic predisposition and acculturation experiences, Korean immigrants (KIs) are vulnerable to developing obesity and cardiovascular complications. However, few studies have e...

Circulation, 2012

BACKGROUND: Sleep disturbances have adverse cardiovascular consequences and are linked to glucose... more BACKGROUND: Sleep disturbances have adverse cardiovascular consequences and are linked to glucose intolerance and obesity. Weight loss and exercise are primary treatments for obese patients with glucose intolerance yet few lifestyle intervention trials have evaluated changes in sleep quality in relation to changes in body composition and fitness. METHODS: We randomized persons aged 35-65 years with type 2 diabetes or pre-diabetes to 6-months of weight loss diet (D); or D combined with supervised moderate-intensity exercise training (D+E). Sleep quality was determined with a 50 item self-report questionnaire that identifies symptoms of apnea, daytime fatigue, hypersomnolence, circadian rhythm sleep disorder, insomnia, restless sleep, parasomnia, and dream disorders. Sleep quality is a composite score of all these items. Other measurements included weight; body mass index (BMI); total, abdominal subcutaneous and visceral fat by magnetic resonance imaging; and aerobic fitness expressed...

Journal of the International Association of Providers of AIDS Care (JIAPAC), 2021

In Ghana, the HIV prevalence among MSM is more than 10 times greater than the general population ... more In Ghana, the HIV prevalence among MSM is more than 10 times greater than the general population of adults, and rates of engagement in HIV medical care are low among MSM diagnosed with HIV. Using structured surveys, we investigated the impact of HIV-related stigma, same-sex behavior stigma, and gender nonconformity stigma on linkage to HIV care (LTC) in MSM ( N = 225) living with HIV in Ghana. Autonomy-supportive healthcare climate ( OR = 1.63, p < .01), vicarious HIV stigma ( OR = 2.73, p < .01), and age ( OR = 1.06, p < .004) predicted LTC. Conversely, felt normative HIV stigma negatively predicted LTC ( OR = 0.65, p < .05). Finally, we identified regional disparities, with MSM from Takoradi being 4 times and 5 times more likely to be LTC compared to Kumasi and Accra, respectively. Our findings highlight the nuanced roles of stigmas in shaping the HIV care continuum among MSM living with HIV, while revealing potential gaps in current measures of HIV-related stigma.

Circulation, 2021

Introduction: Perceived racial discrimination has been associated with dysregulation of sympathet... more Introduction: Perceived racial discrimination has been associated with dysregulation of sympathetic-adrenal-medullary (SAM) and hypothalamic-pituitary-adrenal (HPA) axis, two major physiological stress response systems linked to cardiovascular disease outcomes. Most studies, to date, used cross-sectional data that captured retrospective measures of lifetime racial discrimination associated with current physiological stress responses. Relative to overt racial discrimination, a subtle form of racial discrimination, known as microaggression is more prevalent, yet most commonly measured retrospectively, and understudied. The purpose of this pilot study was to examine the relationship between microaggression measured in real-time and physiological stress responses. Methods: Twelve healthy Black adults (mean age=43.4 years) completed baseline surveys, and self-collected saliva 4x a day for 4 days to measure cortisol and alpha amylase (AA) as a proxy of HPA and SAM systems, respectively. R...

Circulation, 2015

Background: Though a high amount of visceral fat is associated with insulin resistance, which can... more Background: Though a high amount of visceral fat is associated with insulin resistance, which can lead to type 2 diabetes (T2D) and cardiovascular diseases (CVDs), less is known about whether lifestyle modification (weight loss diet and exercise) induced changes in visceral fat are associated with improvements in glycemia. Methods: We randomized 77 individuals aged 35-65 years with T2D or pre-diabetes to 6-months of weight loss diet (D); or D combined with supervised moderate-intensity exercise training (D+E). Study measures were total abdominal, visceral and subcutaneous fat volumes by magnetic resonance imaging, aerobic fitness expressed as VO 2 peak during treadmill testing, body mass index (BMI), and HbA1c levels from blood samples. Results: Of 77 subjects (mean age, 54.8±7.8 years; mean BMI, 34.5 ± 4.7 kg/m 2 , women, 77.9%; Whites-65%, Blacks-34%, Asians-1%), n=37 had T2D and n=40 had pre-diabetes. At 6 months, both D and D+E groups improved from baseline (p<0.05 for all) b...

Diabetes Research and Clinical Practice, 2011

Diabetes Care, 2010

OBJECTIVE To describe the predictive relationships of selected sociodemographic, biomedical, and ... more OBJECTIVE To describe the predictive relationships of selected sociodemographic, biomedical, and psychosocial variables to reluctance to use insulin among patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 178 patients with type 2 diabetes participated in this cross-sectional, observational study. Data were obtained by patient interview using validated measures of diabetes attitude, knowledge, self-efficacy, care communication, and perceived barriers to treatment, as well as sociodemographic and biomedical data. RESULTS Women and ethnic minorities with type 2 diabetes have more psychological barriers to insulin treatment (P < 0.05). The final regression model showed that individuals who believed in the value of tight glucose control, had strong self-efficacy, and had better interpersonal processes with their healthcare providers were less reluctant to use insulin treatment (R2 = 0.403; P < 0.0001). CONCLUSIONS Diabetes self-efficacy and better interaction wi...

JMIR Formative Research, 2021

Background A growing number of studies indicate that exposure to social stress, such as perceived... more Background A growing number of studies indicate that exposure to social stress, such as perceived racial discrimination, may contribute to poor health, health behaviors, and health disparities. Increased physical activity (PA) may buffer the impact of social stress resulting from racial discrimination. However, to date, data on the relationship between racial discrimination and PA have been mixed. Part of the reason is that the effect of perceived racial discrimination on PA has primarily been examined in cross-sectional studies that captured retrospective measures of perceived racial discrimination associated with individuals’ current PA outcomes. The association between real-time perceived racial discrimination and PA among African Americans remains unclear. Objective The purpose of this study is to examine the relationship among demographic, anthropometric and clinical, and psychological factors with lifetime racial discrimination and examine the within- and between-person associ...

Research in Nursing & Health

Archives of Environmental & Occupational Health