Stephanie Cook

Assistant Professor of Social and Behavioral Sciences

Assistant Professor of Biostatistics

Professional overview

Dr. Stephanie Cook’s overarching research focus is to understand how structural- and individual-level minority stressors contribute to mental health, physical health, and health behaviors across the life span. Further, she seeks to understand how features of close relationships can exacerbate or buffer the negative effects of minority stress on health. Her work primarily focuses on young adults transitioning to adulthood who are at the intersection of racial/ethnic and sexual orientation status. In addition, much of her current work examines the links between minority stress (i.e., daily experiences of discrimination) and biological markers of stress (e.g. cortisol and c-reactive protein).

Dr. Cook’s substantive methodological and statistical focus is in the development and application of longitudinal study designs (i.e., intensive longitudinal designs) for determining the ways in which dynamic changes in features of minority stress (e.g., daily and momentary discrimination events) are associated with changes in risk behaviors and physical health (e.g., sexual risk and substance use, pre-clinical cardiovascular disease, and biological stress) among racial/ethnic and/or sexual minority young adults. 

Dr. Cook is the Director of the Attachment and Health Disparities Research Lab (AHDL) which is currently made up of about 20 undergraduate, graduate, and postdoctoral fellows. She developed an integrated theory of adult attachment (the Integrated Attachment and Sexual Minority Stress Model [IASMS]; i.e., the development, or lack, of strong socio-emotional bonds) and minority stress (i.e., social stress experienced by individuals in minority social groups) as a means to better understand and address the health needs of disadvantaged youth transitioning to adulthood. Dr. Cook and her team’s long-term goal is to continue creating, implementing, and refining sustainable interventions to reduce the influence of stress on health utilizing innovative methodologies.

Current Projects

• GeoSENSE: Geospatial Study on Intersectionality, Discrimination, and Cardiometabolic Health Behaviors Among Young Sexual and Gender Minorities
• Identifying Physiological and Behavioral Mechanisms Linking Discrimination and Subclinical Cardiovascular Disease among Racially Diverse Young Sexual Minority Men
• Minority Stress, Substance Use, and Pre-Clinical Cardiovascular Risk among Sexual Minority Men: Understanding the Protective Features of Social Support
• Optimizing a Daily Mindfulness Intervention to Reduce Stress from Discrimination among Sexual and Gender Minorities of Color
• Race modifies the association between post-traumatic stress disorder and cardiovascular risk in large US population-based study

Teaching

Social and Behavioral Sciences Department

• Global Issues in Social and Behavioral Health
• Research Methods in Public Health

Biostatistics Department

• Longitudinal Analysis of Public Health Data
• Regression I: Regression Analysis and Multivariate Modeling
• Regression II: Categorical Data Analysis

Education

BA, Psychology and Women’s Studies, University of Michigan, Ann Arbor, MI

MPH, Sociomedical Sciences, Columbia University, New York, NY

DrPH, Sociomedical Sciences, Columbia University, New York, NY

Honors and awards

National Institutes of Health (NIH) Summer Institute Fellowship on Randomized Behavioral Clinical Trials Fellowship (2023)

New York University Faculty Fellow in Residence, New York University (2023)

New York University James Weldon Johnson Professor (2023)

NIH Loan Repayment Program Award, National Heart, Lung, and Blood Institute (2023)

Outstanding Research Mentor, The Undergraduate Research Opportunity Program, The University of Michigan (2022)

New York University Dr. Martin Luther King Jr. Faculty Award (2022)

Loan Repayment Program, National Heart, Lung, and Blood Institute (2021)

BioData Catalyst Fellowship, National Heart, Lung, and Blood Institute (NHLBI) (2021)

Diverse Magazine Emerging Scholar: Issues In Higher Education Publication, (2021)

Program to Increase Diversity in Cardiovascular Health Related Research (PRIDE) Fellowship (2020)

American Psychosomatic Society (APS) Diversity Award (2020)

National Institute of Minority Health Disparities Loan Repayment Award (2018)

Inter-university Consortium for Political and Social Research (ICPSR) Summer Program in Quantitative Methods of Social Research Scholarship, The University of Michigan (2018)

Robert Wood Johnson Fellow (RWJF) New Connections Sponsored Scholar (2018)

HIV and Drug Abuse Prevention Research Ethics Training Institute (RETI) Award (2017)

Robert Wood Johnson Fellow (RWJF) New Connections Sponsored Scholar (2017)

Matilda White Riley Distinguished Early Stage Investigator Award, National Institutes of Health (Office of Behavioral and Social Sciences) (2016)

Outstanding Postdoctoral Fellow Award, The University of Michigan (2015)

American Psychological Association Smoking Dissemination Award (2015)

Poster Award, Excellence in Innovation and Advanced Research in the Field of Sexual Health, American Public Health Association (2014)

Excellence in Abstract Submission, American Public Health Association (2011)

Areas of research and study

Biostatistics

Cardiovascular Disease

Intersectionality Theory

Longitudinal Methods

Minority Health

Minority Stress

Multiphase Optimization Strategy (MOST)

Physiological Stress

Social Behaviors

Publications

Publications

Personal Justice Beliefs, Everyday Discrimination, and Carotid Intima Media Thickness in Sexual Minority Men

A national examination of discrimination, resilience, and depressive symptoms during the COVID-19 pandemic: the All of Us Research Program

Adult Attachment Anxiety Is Protective Against the Effects of Internalized Homophobia on Condomless Sex Among Young Sexual Minority Men: The P18 Cohort Study

Structural racism and homophobia evaluated through social media sentiment combined with activity spaces and associations with mental health among young sexual minority men

Duncan, D. T., Cook, S. H., Wood, E. P., Regan, S. D., Chaix, B., Tian, Y., & Chunara, R. (n.d.).

Publication year

2023

Journal title

Social Science and Medicine

Volume

320

10.1016/j.socscimed.2023.115755

Abstract

Abstract

Background: Research suggests that structural racism and homophobia are associated with mental well-being. However, structural discrimination measures which are relevant to lived experiences and that evade self-report biases are needed. Social media and global-positioning systems (GPS) offer opportunity to measure place-based negative racial sentiment linked to relevant locations via precise geo-coding of activity spaces. This is vital for young sexual minority men (YSMM) of color who may experience both racial and sexual minority discrimination and subsequently poorer mental well-being. Methods: P18 Neighborhood Study (n = 147) data were used. Measures of place-based negative racial and sexual-orientation sentiment were created using geo-located social media as a proxy for racial climate via socially-meaningfully-defined places. Exposure to place-based negative sentiment was computed as an average of discrimination by places frequented using activity space measures per person. Outcomes were number of days of reported poor mental health in last 30 days. Zero-inflated Poisson regression analyses were used to assess influence of and type of relationship between place-based negative racial or sexual-orientation sentiment exposure and mental well-being, including the moderating effect of race/ethnicity. Results: We found evidence for a non-linear relationship between place-based negative racial sentiment and mental well-being among our racially and ethnically diverse sample of YSMM (p <.05), and significant differences in the relationship for different race/ethnicity groups (p <.05). The most pronounced differences were detected between Black and White non-Hispanic vs. Hispanic sexual minority men. At two standard deviations above the overall mean of negative racial sentiment exposure based on activity spaces, Black and White YSMM reported significantly more poor mental health days in comparison to Hispanic YSMM. Conclusions: Effects of discrimination can vary by race/ethnicity and discrimination type. Experiencing place-based negative racial sentiment may have implications for mental well-being among YSMM regardless of race/ethnicity, which should be explored in future research including with larger samples sizes.

A Mindfulness-Based Intervention to Alleviate Stress from Discrimination among Young Sexual and Gender Minorities of Color: Protocol for a Pilot Optimization Trial

Cook, S. H., Wood, E. P., Mirin, N., Bandel, M., Delorme, M., Gad, L., Jayakar, O., Mustafa, Z., Tatar, R., Javdani, S., & Godfrey, E. (n.d.).

Publication year

2022

Journal title

JMIR Research Protocols

Volume

11

Issue

1

10.2196/35593

Abstract

Abstract

Background: Young sexual and gender minorities (SGMs) of color may face unique experiences of discrimination based on their intersectional positions (eg, discrimination based on both racial or ethnic identity and sexual identity). Emerging evidence suggests that mindfulness practices may reduce stress from discrimination and improve overall well-being among young SGM. Moreover, the omnipresence of smartphone access among racial or ethnic and sexual minority communities provides a method through which to administer mindfulness-based interventions among young SGMs of color. Objective: This paper outlines the protocol of the Optimizing a Daily Mindfulness Intervention to Reduce Stress from Discrimination among Young Sexual and Gender Minorities of Color (REDUCE) study, a pilot optimization trial of a smartphone-based mindfulness intervention that was developed in conjunction with the Healthy Minds Program (HMP) with the aim of reducing stress from discrimination among young SGMs. Methods: In total, 80 young (ages 18-29 years) SGMs of color will be enrolled in the study. The HMP is a self-guided meditation practice, and participants will be randomized to either a control condition or an intervention that uses a neuroscience-based approach to mindfulness. We will use the multiphase optimization strategy to assess which combination of mindfulness interventions is the most effective at reducing stress from discrimination among young SGMs of color. A combination of mindfulness-based meditation intervention components will be examined, comprising mindfulness-based practices of awareness, connection, and purpose. Awareness refers to the practice of self-Awareness, which reduces the mind s ability to be distracted and instead be present in the moment. Connection refers to the practice of connection with oneself and others and emphasizes on empathy and compassion with oneself and others. Purpose encourages goal-making in accordance with one s values and management of behavior in accordance with these goals. In addition, we will assess the feasibility and acceptability of the HMP application among young SGMs of color. Results: The REDUCE study was approved by the Institutional Review Board of New York University, and recruitment and enrollment began in the winter of 2021. We expect to complete enrollment by the summer of 2022. The results will be disseminated via social media, journal articles, abstracts, or presentations, as well as to participants, who will be given the opportunity to provide feedback to the researchers. Conclusions: This optimization trial is designed to test the efficacy, feasibility, and acceptability of implementing an application-based, mindfulness-based intervention to reduce stress from discrimination and improve well-being among young SGMs of color. Evidence from this study will assist in the creation of a sustainable, culturally relevant mobile app based mindfulness intervention to reduce stress from discrimination among young SGMs of color.

Characterizing and Evaluating Diurnal Salivary Uric Acid Across Pregnancy Among Healthy Women

Discrimination is associated with C-reactive protein among young sexual minority men

Feasibility, Acceptability, and Preliminary Efficacy of an App-Based Meditation Intervention to Decrease Firefighter Psychological Distress and Burnout: A One-Group Pilot Study

Pace, T. W., Zeiders, K. H., Cook, S. H., Sarsar, E. D., Hoyt, L. T., Mirin, N. L., Wood, E. P., Tatar, R., & Davidson, R. J. (n.d.).

Publication year

2022

Journal title

JMIR Formative Research

Volume

6

Issue

6

10.2196/34951

Abstract

Abstract

Background: Firefighters are often exposed to occupational stressors that can result in psychological distress (ie, anxiety and depression) and burnout. These occupational stressors have only intensified with the onset of the COVID-19 pandemic and will likely persist in the postpandemic world. Objective: To address occupational stressors confronting firefighters, we pilot tested a novel, cost-effective, smartphone app–based meditation intervention created by Healthy Minds Innovations that focused on mindfulness (awareness) training along with practices designed to cultivate positive relationships (connection), insight into the nature of the self (insight), and a sense of purpose in the context of challenge (purpose) with a sample of professional firefighters from a large metropolitan area in southwestern United States. Methods: A total of 35 participants were recruited from a closed online group listserv and completed the self-guided 10-unit meditation app over the course of 10 days, at 1 unit per day. We assessed anxiety symptoms, depression symptoms, burnout, and negative affect as well as saliva diurnal cortisol rhythm, an objective indicator of stress-related biology, before and after use of the meditation app. Results: This study demonstrated the meditation app was both feasible and acceptable for use by the majority of firefighters. We also found significant reductions in firefighters’ anxiety (P=.01), burnout (P=.05), and negative affect (P=.04), as well as changes in cortisol diurnal rhythm, such as waking cortisol (P=.02), from before to after use of the meditation app. Conclusions: Our study findings call for future research to demonstrate the efficacy of this meditation app to reduce psychological distress and burnout in firefighters.

Race moderates the association between adult attachment avoidance and the cortisol awakening response among young sexual minority men

U.S. Military veterans and the opioid overdose crisis: a review of risk factors and prevention efforts

Bennett, A. S., Guarino, H., Britton, P. C., O’Brien-Mazza, D., Cook, S. H., Taveras, F., Cortez, J., & Elliott, L. (n.d.).

Publication year

2022

Journal title

Annals of Medicine

Volume

54

Issue

1

Page(s)

1826-1838

10.1080/07853890.2022.2092896

Abstract

Abstract

U.S. military veterans have been heavily impacted by the opioid overdose crisis, with drug overdose mortality rates increasing by 53% from 2010–2019. Risk for overdose among veterans is complex and influenced by ongoing interaction among physiological/biological, psychological, and socio-structural factors. A thorough understanding of opioid-related overdose among veterans, one that goes beyond simple pharmacological determinism, must examine the interplay of pain, pain treatment, and stress, as well as psychological and social experiences—before, during, and after military service. Comprehensive efforts to tackle the overdose crisis among veterans require interventions that address each of these dimensions. Promising interventions include widespread naloxone distribution and increased provision of low-threshold wrap-around services, including medications for opioid use disorder (MOUD) and holistic/complementary approaches. Interventions that are delivered by peers–individuals who share key experiential or sociodemographic characteristics with the population being served–may be ideally suited to address many of the barriers to opioid-related risk mitigation common among veterans. Community care models could be beneficial for the large proportion of veterans who are not connected to the Veterans Health Administration and for veterans who, for various reasons including mental health problems and the avoidance of stigma, are socially isolated or reluctant to use traditional substance use services. Interventions need to be tailored in such a way that they reach those more socially isolated veterans who may not have access to naloxone or the social support to help them in overdose situations. It is important to incorporate the perspectives and voices of veterans with lived experience of substance use into the design and implementation of new overdose prevention resources and strategies to meet the needs of this population. Key messages U.S. military veterans have been heavily impacted by the opioid overdose crisis, with drug overdose mortality rates increasing by 53% from 2010–2019. The risks for overdose that veterans face need to be understood as resulting from an ongoing interaction among biological/physiological, psychological, and social/structural factors. Addressing drug overdose in the veteran population requires accessible and non-judgemental, low threshold, wraparound, and holistic solutions that recognise the complex aetiology of overdose risk for veterans.

Young men of color lower on adult attachment anxiety have higher carotid-intima media thickness compared to white young men: The exploration of an unexpected finding

Cook, S. H., Wood, E. P., Martinez, V., Alvarez, G. M., & Lazar, J. (n.d.).

Publication year

2022

Journal title

Psychoneuroendocrinology

Volume

143

10.1016/j.psyneuen.2022.105825

Abstract

Abstract

Cardiovascular disease (CVD) remains the number one cause of death among men in the United States. Emerging research demonstrates that socioemotional mechanisms such as adult attachment, or the ways in which individuals are able to form and maintain socioemotional bonds, may impact physical health via alterations in physiological stress functioning. However, there may be key differences in the relation between attachment and physical health by race and sexual orientation. Thus, this study sought to examine the potential moderating effect of race and sexual orientation on the association between adult attachment and carotid-intima media thickness (cIMT), a measure of subclinical cardiovascular disease, among young men. The sample consisted of 72 young men (mean [SD] age = 22.92 [3.23]: 30.6 % identified as White, 30.6 % as Black, and 38.8 % as Other), each of which were surveyed and underwent an ultrasound to measure cIMT. Ordinary Least Squares (OLS) regression was used in order to examine our study hypotheses. We first ran a main effects model to examine adult attachment's (i.e., anxiety and avoidance) association with mean cIMT. We then ran two interaction models with an interaction between race/ethnicity and adult-related attachment and sexual orientation and adult attachment. We found that race significantly moderated the association between attachment-related anxiety and mean cIMT in our study sample. However, we did not find evidence to suggest that race moderated the association between attachment-related avoidance and mean cIMT in our study sample. In comparison to White individuals, Black individuals and those who identified as “Other” race with lower scores on attachment-related anxiety had higher mean cIMT. Additionally, higher scores on attachment-related anxiety were associated with lower mean cIMT among Black and “Other” respondents, but not among White respondents. We did not find evidence to suggest that sexual orientation moderated the association between adult attachment and mean cIMT in our study sample. Our findings suggest that adult attachment anxiety may be protective for young men of color but not for White young men. Future research should utilize longitudinal study designs in order to better understand how adult attachment influences CVD risk among racially/ethnically diverse young men.

An emerging syndemic of smoking and cardiopulmonary diseases in people living with HIV in Africa

Peprah, E., Armstrong-Hough, M., Cook, S. H., Mukasa, B., Taylor, J. Y., Xu, H., Chang, L., Gyamfi, J., Ryan, N., Ojo, T., Snyder, A., Iwelunmor, J., Ezechi, O., Iyegbe, C., O’reilly, P., & Kengne, A. P. (n.d.).

Publication year

2021

Journal title

International journal of environmental research and public health

Volume

18

Issue

6

Page(s)

1-12

10.3390/ijerph18063111

Abstract

Abstract

Background: African countries have the highest number of people living with HIV (PWH). The continent is home to 12% of the global population, but accounts for 71% of PWH globally. Antiretroviral therapy has played an important role in the reduction of the morbidity and mortality rates for HIV, which necessitates increased surveillance of the threats from pernicious risks to which PWH who live longer remain exposed. This includes cardiopulmonary comorbidities, which pose significant public health and economic challenges. A significant contributor to the cardiopulmonary comorbidities is tobacco smoking. Indeed, globally, PWH have a 2–4-fold higher utilization of tobacco compared to the general population, leading to endothelial dysfunction and atherogenesis that result in cardiopulmonary diseases, such as chronic obstructive pulmonary disease and coronary artery disease. In the context of PWH, we discuss (1) the current trends in cigarette smoking and (2) the lack of geographically relevant data on the cardiopulmonary conditions associated with smoking; we then review (3) the current evidence on chronic inflammation induced by smoking and the potential pathways for cardiopulmonary disease and (4) the multifactorial nature of the syndemic of smoking, HIV, and cardiopulmonary diseases. This commentary calls for a major, multi-setting cohort study using a syndemics framework to assess cardiopulmonary disease outcomes among PWH who smoke. Conclusion: We call for a parallel program of implementation research to promote the adoption of evidence-based interventions, which could improve health outcomes for PWH with cardiopulmonary diseases and address the health inequities experienced by PWH in African countries.

Assessing Perceptions of Broad Consent Concerning Biological Specimen Collection in a Cohort of Young Sexual Minority Men

Identifying diurnal cortisol profiles among young adults: Physiological signatures of mental health trajectories

Impact of COVID-19-related knowledge on protective behaviors: The moderating role of primary sources of information

Social Determinants in Machine Learning Cardiovascular Disease Prediction Models: A Systematic Review

Predicting trajectories of substance use during emerging adulthood: Exploring the benefits of group-based trajectory modeling for zero-inflated outcomes

Using Digital Data to Protect and Promote the Most Vulnerable in the Fight Against COVID-19

Chunara, R., & Cook, S. H. (n.d.).

Publication year

2020

Journal title

Frontiers in Public Health

Volume

8

10.3389/fpubh.2020.00296

Father support is protective against the negative effects of perceived discrimination on CRP among sexual minorities but not heterosexuals

Positive Development and Changes in Self-Rated Health Among Young Sexual Minority Males: The P18 Cohort Study

Kapadia, F., D’Avanzo, P. A., Cook, S. H., Barton, S., Halkitis, S. N., & Halkitis, P. (n.d.).

Publication year

2019

Journal title

Behavioral Medicine

Volume

45

Issue

4

Page(s)

304-313

10.1080/08964289.2018.1536644

Abstract

Abstract

We seek to move beyond a deficits-based approach, which has dominated our understanding of health and wellbeing in in young sexual minority males (YSMM), by examining how indicators of positive development are associated with development of positive self-rated health in YSMM. Using data from a prospective cohort study of YSMM (n = 514; 18–22 years old; 36.9% Hispanic/Latino, 15.6% non-Hispanic Black, 30.2% White, 16.9% other/multi-racial), we examined how three measures of positive development–the Life Orientation Test, the Satisfaction with Life Scale (SWLS) and the Social Responsibility Scale (SRS) were associated with self-rated health (SRH), a valid and reliable measure of self-assessed general health status. Findings suggest that YSMM who self-identified as homosexual reported higher SRH while those who reported higher levels of substance use and mental health burdens reported lower SRH. Second, in linear growth models controlling for mental health burdens and substance use, higher scores on all measures of positive development were associated with higher ratings of SRH over time. In conclusion, the presence of positive development characteristics, specifically generalized optimism, life satisfaction and social responsibility, may buffer against negative SRH assessments. Health promotion programs focusing on positive development may more effectively promote health and well-being among YSMM.

THE HEALTH OF GAY AND BISEXUAL MEN

The Mediating Role of Emotion Dysregulation in the Relation Between Adult Attachment Insecurity and Depression Among Young Gay and Bisexual Men

Wood, E. P., Cook, S. H., & Calebs, B. J. (n.d.).

Publication year

2019

Journal title

International Journal of Sexual Health

Volume

31

Issue

2

Page(s)

186-195

10.1080/19317611.2019.1611689

Abstract

Abstract

Objectives: Attachment insecurity may be more pronounced among young gay and bisexual men (YGBM). Further, attachment insecurity is associated with dysregulated patterns of emotion regulation, which can lead to depression. However, pathways linking attachment insecurity to depression are underexplored among YGBM. Methods: This study used pilot data from N = 67 YGBM to examine if emotion dysregulation mediated the association between attachment insecurity and depression. Results: Results supported the study hypotheses. Attachment insecurity was associated with emotion dysregulation, which was associated with depression. Conclusion: Findings provide preliminary evidence that emotion regulation training may be a useful approach for addressing depression among YGBM.

Understanding Attachment Transitions Through the Lived Experiences of Young Black Gay and Bisexual Men

Are trajectories of a syndemic index in adolescence linked to HIV vulnerability in emerging and young adulthood?

Family conflict, chaos, and negative life events predict cortisol activity in low-income children