Adolfo Cuevas

Associate Professor of Social and Behavioral Sciences

Professional overview

Adolfo G. Cuevas, PhD, is an Associate Professor in the Department of Social and Behavioral Sciences at NYU's School of Global Public Health, where he also co-directs the BioSocial Research Initiative (BSRI). His research examines how psychosocial stressors influence health across the lifespan, using epidemiological, psychological, and biological approaches to understand these relationships.

Dr. Cuevas currently leads three NIH-funded projects, totaling nearly $7 million, that investigate the effect of psychosocial stressors on biological dysregulation. These studies investigate how psychosocial stress contributes to biological dysregulation. His first project (R01DK137805; 2024–2029) addresses a key gap in the field by examining how social adversity affects allostatic load across three life course stages and identifying gene expression pathways that link adversity to biological stress. It is also the first study to assess how social relationships—such as kinship and community ties—buffer the impact of social adversity on gene expression and stress physiology. His two additional projects (R01DK137246 and R01MD019251) explore the role of neighborhood and interpersonal stress in obesity across developmental stages, from childhood to older adulthood, with a focus on molecular indicators of stress-related proinflammatory biology that may contribute to adipose tissue formation.

Dr. Cuevas’ work has appeared in leading journals including Annals of Internal Medicine, Proceedings of the National Academy of Sciences, Brain, Behavior, and Immunity, and American Journal of Public Health. It has also been featured by media outlets such as Forbes, USA Today, and NPR’s Code Switch.

In recognition of his contributions to research on stress and health, Dr. Cuevas has received numerous honors, including the Herbert Weiner Early Career Award, the National Minority Quality Forum’s 40 Under 40 Leaders in Minority Health Award, and the Diversity Scholar Award from the Nutrition Obesity Research Center at Harvard University.

Prior to joining NYU, he was the Gerald R. Gill Assistant Professor of Race, Culture, and Society at Tufts University. He earned his PhD and MS in applied psychology from Portland State University and completed postdoctoral training at the Harvard T.H. Chan School of Public Health.

Education

PhD, Applied Psychology, Portland State University

MS, Applied Psychology, Portland State University

BA, Psychology, City College of New York, 2010

Certificate, Applied Biostatistics, Harvard Catalyst

Honors and awards

National Institute of Health Loan Repayment-Renewal (2021)

Diversity Scholar Award, Nutrition Obesity Research Center, Harvard University (2019)

National Institute of Health Loan Repayment (2019)

40 Under 40 Leaders in Health, National Minority Quality Forum (2018)

Neubauer Faculty Fellowship, Tufts University (2017)

Portland African American Leadership Fellowship (2013)

National Cancer Institute R25E Summer Research Experience, The University of Texas MD, Anderson’s Cancer Prevention Research Training Program (2012)

Bernard R. Ackerman Foundation Award for Outstanding Scholarship (2010)

Search for Education, Elevation, and Knowledge Graduate of the Year (2010)

City University of New York Pipeline Fellowship (2009)

City University of New York Search for Education, Elevation, and Knowledge (SEEK) Scholarship (2009)

Psi Chi Honor Society (2009)

Dean’s List Scholar (20082009)

Chi Alpha Epsilon (XAE) Honor Society (2008)

City College of New York’s William Wright Scholarship (2008)

City College of New York Community Service Award (2008)

SEEK Scholarship (2008)

Areas of research and study

Obesity

Psychosocial Stress

Racial/Ethnic Disparities

Publications

Publications

A national study of gender and racial differences in colorectal cancer screening among foreign-born older adults living in the US

Cofie, L. E., Hirth, J. M., Cuevas, A., & Farr, D. (n.d.).

Publication year

2020

Journal title

Journal of Behavioral Medicine

Volume

43

Issue

3

Page(s)

460-467

10.1007/s10865-019-00107-3

Abstract

Abstract

This study examined within group heterogeneity in colorectal cancer screening (CRCS) among foreign-born individuals. Data were from the 2010, 2013 and 2015 National Health Interview Survey data on older adults (N = 5529). In 2018, multivariable logistic regression analysis was conducted to determine whether gender and race/ethnicity were associated with CRCS after controlling for sociodemographic, health access, and acculturation related factors. Overall, Asians were significantly less likely to report CRCS compared with Whites (aOR 0.63, CI 0.52–0.76). Hispanic race/ethnicity was negatively associated with CRCS among men (aOR 0.68, CI 0.50–0.91), but not women compared to white men/women, respectively. Additionally, factors associated with CRCS include having fair/poor health, usual source of care, insurance, ≥ 10 years of US residency and citizenship. Screening disparities experienced by these immigrants may be addressed by improving healthcare access, especially for noncitizens and those with limited healthcare access.

A novel approach to model cumulative stress : Area under the s-factor curve

Mann, F. D., Cuevas, A., Clouston, S. A., Freilich, C. D., Krizan, Z., Zuber, S., Wänström, L., Muniz-Terrera, G., O'Keefe, P., Voll, S., Hofer, S., Rodgers, J. L., & Krueger, R. F. (n.d.).

Publication year

2024

Journal title

Social Science and Medicine

Volume

348

10.1016/j.socscimed.2024.116787

Abstract

Abstract

Objective: Using a large longitudinal sample of adults from the Midlife in the United States (MIDUS) study, the present study extended a recently developed hierarchical model to determine how best to model the accumulation of stressors, and to determine whether the rate of change in stressors or traditional composite scores of stressors are stronger predictors of health outcomes. Method: We used factor analysis to estimate a stress-factor score and then, to operationalize the accumulation of stressors we examined five approaches to aggregating information about repeated exposures to multiple stressors. The predictive validity of these approaches was then assessed in relation to different health outcomes. Results: The prediction of chronic conditions, body mass index, difficulty with activities of daily living, executive function, and episodic memory later in life was strongest when the accumulation of stressors was modeled using total area under the curve (AUC) of estimated factor scores, compared to composite scores that have traditionally been used in studies of cumulative stress, as well as linear rates of change. Conclusions: Like endogenous, biological markers of stress reactivity, AUC for individual trajectories of self-reported stressors shows promise as a data reduction technique to model the accumulation of stressors in longitudinal studies. Overall, our results indicate that considering different quantitative models is critical to understanding the sequelae and predictive power of psychosocial stressors from midlife to late adulthood.

A Novel Approach to Model Cumulative Stress: Area Under the s-factor Curve

Cuevas, A., Mann, F. D., Cuevas, A., Clouston, S., Freilich, C., Krizan, Z., Zuber, S., Linda, W., Muniz-Terrera, G., O???Keefe, P., & Voll, S. (n.d.).

Publication year

2023

Abstract

Abstract

~

Acculturation and Food Insecurity Among Puerto Ricans Living in Boston

Wang, K., Chu, Y., Cuevas, A., Hasson, R. G., Tucker, K. L., & Falcón, L. M. (n.d.).

Publication year

2018

Journal title

Journal of Nutrition Education and Behavior

Volume

50

Issue

8

Page(s)

829-835

10.1016/j.jneb.2018.05.020

Abstract

Abstract

Objective: To examine the associations among acculturation, food environment, and food insecurity among Puerto Ricans in Boston. Methods: The researchers used data from the second wave of the Boston Puerto Rican Health Study. The sample included 719 Puerto Rican adults in Boston. The researchers used logistic regression to examine the associations between psychological and language acculturation and food insecurity. Results: Individuals with medium psychological acculturation were more likely to be food insecure than were those with low or high psychological acculturation (P =.01). The association between language acculturation and food insecurity differed by distance of residence from primary shopping location (P =.02). Conclusions and Implications: This study extends the understanding of acculturation and food insecurity by investigating the impact of psychological and language acculturation. The findings highlight biculturalism, indicated by medium psychological acculturation, as a risk factor for food insecurity. People with low language acculturation who live far from food shopping locations had the highest prevalence of food insecurity.

Advancing cessation research by integrating EMA and geospatial methodologies : Associations between tobacco retail outlets and real-time smoking urges during a quit attempt

Watkins, K. L., Regan, S. D., Nguyen, N., Businelle, M. S., Kendzor, D. E., Lam, C., Balis, D., Cuevas, A., Cao, Y., & Reitzel, L. R. (n.d.).

Publication year

2014

Journal title

Nicotine and Tobacco Research

Volume

16

Issue

SUPPL2

Page(s)

S93-S101

10.1093/ntr/ntt135

Abstract

Abstract

Introduction: Residential tobacco retail outlet (TRO) density and proximity have been associated with smoking behaviors. More research is needed to understand the mechanisms underlying these relations and their potential relevance outside of the residential setting. This study integrates ecological momentary assessment (EMA) and geo-location tracking to explore real-time associations between exposure to TROs and smoking urges among 47 economically disadvantaged smokers in a cessation trial (59.6% female; 36.2% White). Methods: EMA data were collected for 1 week postquit via smartphone, which recorded smoking urge strength =4 random times daily along with real-time participant location data. For each assessment, the participants' proximity to the closest TRO and the density of TROs surrounding the participant were calculated. Linear mixed model regressions examined associations between TRO variables and smoking urges and whether relations varied based on participants' distance from their home. Covariates included sociodemographics, prequit tobacco dependence, treatment group, and daily smoking status. Results: Main effects were nonsignificant; however, the interaction between TRO proximity and distance from home was considered significant (p = .056). Specifically, closer proximity to TROs was associated with stronger smoking urges =1 mile of home (p = .001) but not >1 mile from home (p = .307). Significant associations were attributable to assessments completed at participants' home addresses. All density analyses were nonsignificant. Conclusions: Technological challenges encountered in this study resulted in a significant amount of missing data, highlighting the preliminary nature of these findings and limiting the inferences that can be drawn. However, results suggest that closer residential proximity to tobacco outlets may trigger stronger urges to smoke among economically disadvantaged smokers trying to quit, perhaps due to enhanced cigarette availability and accessibility. Therefore, limiting tobacco sales in close proximity to residential areas may complement existing tobacco control efforts and facilitate cessation.

African American experiences in healthcare : "I always feel like I'm getting skipped over"

Cuevas, A., O'Brien, K., & Saha, S. (n.d.).

Publication year

2016

Journal title

Health Psychology

Volume

35

Issue

9

Page(s)

987-995

10.1037/hea0000368

Abstract

Abstract

Objective: Although African Americans perceive discrimination in health care settings, experience higher levels of medical mistrust compared with European Americans, and experience poorer communication with health care providers, little is known as to how these barriers to quality patient-provider relationships arise and manifest themselves. This study examined experiences of African American community members regarding these barriers and additionally explored participants' perspectives on race in the patient-provider relationship. Methods: Focus groups were conducted as part of a study exploring participants' experiences and relationships in health care settings. Sixty African American adults were recruited through community settings and activities to participate in 1 of 9 focus groups segmented by gender. Transcripts were reviewed for content related to perceived discrimination, mistrust, poor communication, and race discordance. Themes providing insight into participants' subjective experience of these potential relationship barriers were derived through qualitative coding (using NVivo 10) and iterative discussion. Results: Perceived discrimination arose when African American patients, particularly women, felt their symptoms or problems were discredited. Medical mistrust occurred when clinicians did not convey respect to patients, leaving patients to wonder whether their clinician's treatment was discriminatory or not. Poor communication arose when clinicians did not acknowledge patients' perspectives during interactions. Patients often viewed these actions as discriminatory. Conclusions: African Americans experience poor communication with their health care providers, medical mistrust, and perceived discrimination when accessing health care in numerous and sometimes interrelated ways. The investigators recommend ways to reduce the experience of such barriers and to improve patient-provider relationships for African Americans in health care.

Assessing racial differences in lifetime and current smoking status & menthol consumption among Latinos in a nationally representative sample

Cuevas, A., Ortiz, K., Lopez, N., & Williams, D. R. (n.d.).

Publication year

2020

Journal title

Ethnicity and Health

Volume

25

Issue

5

Page(s)

759-775

10.1080/13557858.2018.1447651

Abstract

Abstract

Objective: To examine the relationship between race and smoking behaviors among Latinos/Hispanics. Design: Using data from the National Adult Tobacco Survey (NATS), we implemented Log-Poisson regression models for each dependent variable (smoking pattern and menthol cigarette use). Each analysis adjusted for age, gender, marital status, employment status, and socioeconomic status (SES). Final pooled cross-sectional sample included 505 Black-Latinos and 9078 White-Latinos. Results: While no racial differences were found in lifetime smoking status among Latinos, Black-Latinos had a 16.6% (95% CI: 0.274, 0.057) increased risk of menthol smoking compared to White-Latinos. Conclusions: The results indicate that menthol consumption is influenced by race among Hispanics/Latinos. To comprehensively address racial disparities among Latinos/Hispanics, further attention needs to be given to racial differences in smoking-related risks among Latinos/Hispanics.

Assessing the Role of Health Behaviors, Socioeconomic Status, and Cumulative Stress for Racial/Ethnic Disparities in Obesity

Cuevas, A., Chen, R., Slopen, N., Thurber, K. A., Wilson, N., Economos, C., & Williams, D. R. (n.d.).

Publication year

2020

Journal title

Obesity

Volume

28

Issue

1

Page(s)

161-170

10.1002/oby.22648

Abstract

Abstract

Objective: This study aimed to examine the explanatory role of health behaviors, socioeconomic position (SEP), and psychosocial stressors on racial/ethnic obesity disparities in a multiethnic and multiracial sample of adults. Methods: Using data from the Chicago Community Adult Health Study (2001-2003), Oaxaca-Blinder decomposition analysis was conducted to quantify the extent to which health behaviors (fruit and vegetable consumption and physical activity), SEP, and cumulative stressors (e.g., perceived discrimination, financial strain) each explained differences in obesity prevalence in Black, US-born Hispanic, and non-US-born Hispanic compared with non-Hispanic White participants. Results: SEP and health behaviors did not explain obesity differences between racial/ethnic minorities and White individuals. Having high levels of stress in four or more domains explained 4.46% of the differences between Black and White individuals, whereas having high levels of stress in three domains significantly explained 14.13% of differences between US-born Hispanic and White. Together, the predictors explained less than 20% of differences between any racial/ethnic minority group and White individuals. Conclusions: Exposure to stressors may play a role in obesity disparities, particularly among Black and US-born Hispanic individuals. Other obesity-related risk factors need to be examined to understand the underlying mechanisms explaining obesity disparities.

Assessing the role of socioeconomic status and discrimination exposure for racial disparities in inflammation

Cuevas, A., Goler, E., Guetta, C. J., & Krueger, R. F. (n.d.).

Publication year

2022

Journal title

Brain, Behavior, and Immunity

Volume

102

Page(s)

333-337

10.1016/j.bbi.2022.03.005

Abstract

Abstract

Socioeconomic status (SES) and discrimination have been implicated as social determinants of health and health disparities. Yet, very little research has been done to assess their contributing role in Black-White disparities in inflammation. Using data from the Midlife in the United States (2004–2006), we conducted Oaxaca-Blinder decomposition analysis to quantify the extent to which three indicators of SES (i.e., education, household income, and employment status) and three forms of discrimination exposures (i.e., everyday, lifetime, and workplace discrimination) explained Black-White differences in inflammation. Education, particularly having a college degree or more, explained 16.88% of the differences between Blacks and Whites. There was no evidence that household income and employment status explained Black-White inflammation differences. Lifetime discrimination significantly explained 18.18% of Black-White difference in inflammation burden. There was no evidence that everyday and workplace discrimination explained Black-White difference in inflammation burden. Together, the predictors explained 44.16% of inflammation differences between Black and White participants. Education and lifetime exposure to discrimination may play a role in inflammation disparities. Further research is needed to examine other dimensions of SES (e.g., wealth) and discrimination (e.g., racial segregation) that are associated with health to better understand the contributions of these key social determinants of Black-White inflammation disparities.

Association of Racial Discrimination With Adiposity in Children and Adolescents

Cuevas, A., Krobath, D. M., Rhodes-Bratton, B., Xu, S., Omolade, J. J., Perry, A. R., & Slopen, N. (n.d.).

Publication year

2023

Journal title

JAMA network open

Volume

6

Issue

7

Page(s)

e2322839

10.1001/jamanetworkopen.2023.22839

Abstract

Abstract

Importance: Childhood obesity is a major public health issue and is disproportionately prevalent among children from minority racial and ethnic groups. Personally mediated racism (commonly referred to as racial discrimination) is a known stressor that has been linked to higher body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) in adults, but little is known about the association of racial discrimination and childhood and adolescent adiposity. Objective: To assess the prospective association between self-reported experiences of racial discrimination and adiposity (BMI and waist circumference) in a large sample of children and adolescents in the Adolescent Brain Cognitive Development (ABCD) study. Design, Setting, and Participants: This cohort study used complete data from the ABCD study (2017 to 2019), involving a total of 6463 participants. The ABCD study recruited a diverse sample of youths from across the US, with rural, urban, and mountain regions. Data were analyzed from January 12 to May 17, 2023. Exposure: The child-reported Perceived Discrimination Scale was used to quantify racial discrimination, reflecting participants' perceptions of being treated unfairly by others or unaccepted by society based on their race or ethnicity. Main Outcomes and Measures: Weight, height, and waist circumference were measured by trained research assistants. BMI z scores were computed by applying the US Centers for Disease Control and Prevention's age and sex-specific reference standards for children and adolescents. Waist circumference (inches) was quantified as the mean of 3 consecutive measures. Measurements were taken from time 1 (ie, 2017 to 2019) and time 2 (ie, 2018 to 2020). Results: Of the 6463 respondents with complete data, 3090 (47.8%) were female, and the mean (SD) age was 9.95 (0.62) years. Greater racial discrimination exposure at time 1 was associated with higher BMI z score in both unadjusted (β, 0.05; 95% CI, 0.02-0.08) and adjusted regression models (β, 0.04; 95% CI, 0.01-0.08). Discrimination at time 1 was associated with higher waist circumference in unadjusted (β, 0.35; 95% CI, 0.15-0.54) and adjusted (β, 0.24; 95% CI, 0.04-0.44) models. Conclusions and Relevance: In this cohort study of children and adolescents, racial discrimination was positively associated with adiposity, quantified by BMI z score and waist circumference. Interventions to reduce exposure to racial discrimination in early life may help reduce the risk of excess weight gain across throughout life.

Breaking Academic Silos : Pedagogical Recommendations for Equitable Obesity Prevention Training and Research During an Age of Nutrition Polarization

Taylor, S. F., Krobath, D. M., Cuevas, A., Hennessy, E., & Roberts, S. B. (n.d.).

Publication year

2024

Journal title

AJPM Focus

Volume

3

Issue

3

10.1016/j.focus.2024.100217

Abstract

Abstract

Introduction: Obesity is a preventable chronic condition and a risk factor for poor health and early mortality. Weight stigma and weight-neutral medicine are popular topics in social media that are often at odds with current medical guidelines on obesity treatment and prevention. This conflict may erode the public's trust in science, impede research progress on preventing obesity in marginalized groups, and uphold the ongoing and historical lack of diversity among nutrition trainees. Methods: The authors conducted a series of student-led dialogue sessions with nutrition graduate students in Boston, Massachusetts, from March to May 2023 to understand perceptions of obesity research, health equity, and racism and discrimination. This article summarizes the lessons learned and provides pedagogical recommendations for jointly addressing obesity at the population level and the recruitment, training, and retention of diverse scholars, clinicians, and public health practitioners. Results: Dialogue sessions revealed that students perceive a disproportionate focus on the harms of obesity as a chronic disease, highlighting that inadequate attention is given to weight stigma and discrimination. Some participants believed that weight-based discrimination is equally detrimental to individual health and wellbeing as having obesity. Discussions also emphasized the need to pinpoint the multidimensional and cultural manifestations of weight stigma, which necessitates collaboration across social sectors and academic disciplines. Students recognized the urgent need to apply an equity lens to obesity research and teaching but felt limited in their access to experts within nutrition science who specialize in racism, discrimination, eating disorders, and weight stigma. Conclusions: This study identified concrete opportunities for urgently needed new training and research in population-level obesity prevention, emphasizing antiracism, harm reduction, and elimination of stigma and bias across multiple levels of science and society. Overall, the decision to use the BMI within pedagogy and training must be explicitly stated—research, population surveillance, decision-making, or treatment pedagogy and training—while acknowledging its strengths and limitations across diverse settings. Finally, the social determinants of obesity should incorporate not only weight stigma but also racism and multiple forms of discrimination.

Can patient-centered communication reduce the effects of medical mistrust on patients' decision making?

Cuevas, A., O'Brien, K., & Saha, S. (n.d.).

Publication year

2019

Journal title

Health Psychology

Volume

38

Issue

4

Page(s)

325-333

10.1037/hea0000721

Abstract

Abstract

Objective: Mistrust in medical institutions has been implicated as a barrier that disproportionately affects the quality of health care received by patients. Although patient-centered communication has been shown to improve patient-provider relationships, little is known as to whether it may reduce the effects of medical mistrust on patients' decision-making and trust in physicians (physician mistrust). Method: In a laboratory study, 231 primary care patients (101 African American and 130 White participants) were randomly assigned to one of two conditions in which they viewed video recorded, standardized vignettes depicting a cardiologist recommending coronary bypass surgery to a patient diagnosed with angina and 3-vessel coronary artery disease. In each vignette, the cardiologist-actor demonstrated either low or high patient-centered communication behavior. Participants were asked to assume the role of the patient interacting with the video-recorded physician. Results: Hypotheses were partially supported. High levels of medical mistrust were associated with greater physician mistrust and lesser endorsement of the hypothetical bypass surgery. Among patients exposed to high patient-centered communication, the relationships between medical mistrust and both physician mistrust and surgery endorsement were weaker than among patients exposed to low patient-centered communication. Although African American patients reported greater medical mistrust compared with White patients, respondents' race did not moderate the relationships. Conclusions: Results suggest that mistrust toward health care may unfavorably affect interactions and patients' health-related outcomes. Physicians may buffer the effects of mistrust by using patient-centered communication skills such as soliciting the patient's concerns and priorities and being responsive to the health care needs which patients identify.

Contested racial identity and the health of women and their infants

Abuelezam, N. N., Cuevas, A., Galea, S., & Hawkins, S. S. (n.d.).

Publication year

2022

Journal title

Preventive Medicine

Volume

155

10.1016/j.ypmed.2022.106965

Abstract

Abstract

Contested racial identity— self-identified race not matching socially-assigned race—may be an indication of experiences with racism. We aimed to understand the relationship between contested racial identity and women's health behaviors, health outcomes, and infant health outcomes. We used 2012–2015 Massachusetts Pregnancy Risk Assessment Monitoring System data on 5735 women linked with infants' birth certificates. We conducted regression analyses to examine associations between contested racial identity with pregnancy and infant health outcomes and further sub-analyses among women who had experienced a contested racial identity. A total of 901 (15.7%) women reported a contested racial identity. When compared to those who did not, women who had a contested racial identity had lower odds of initiating prenatal care in the first trimester (AOR: 0.76, 95% CI: 0.62, 0.95) and higher odds of smoking (AOR: 1.70, 95% CI: 1.32, 2.19). Among women who had experienced a contested racial identity, those who were socially-assigned as White had decreased odds of having a low birth weight baby (AOR: 0.52, 95% CI: 0.28, 0.99) when compared to those socially-assigned as non-White. Contested racial identity is common; it affects the behaviors that women engage in and the outcomes they experience postpartum. Further, we found that there is a potential benefit to a White social ascription. This work adds to growing evidence of the impact of racism on maternal and infant health in the United States.

Cumulative stress : A general “s” factor in the structure of stress

Mann, F. D., Cuevas, A., & Krueger, R. F. (n.d.).

Publication year

2021

Journal title

Social Science and Medicine

Volume

289

10.1016/j.socscimed.2021.114405

Abstract

Abstract

Objective: The present study tested a hierarchical model of cumulative stress in a large probability sample of adults from the United States. Methods: Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) models were used to develop and test a hierarchical model of cumulative stress. Structural equation models were used to estimate concurrent associations with demographic factors, polygenic risk scores, and physical health outcomes, as well as prospective associations with physical health outcomes. Results: A hierarchical model of cumulative stress was the best-fitting model, with a general “s-factor” capturing the tendency for subordinate dimensions of stress to correlate. Associations with demographic factors and polygenic risk scores for physical and psychological phenotypes provide evidence for the convergent validity of a general s-factor of cumulative stress. The general s-factor and subordinate factors of cumulative stress were also associated with physical health outcomes, concurrently and prospectively, including number of chronic conditions, body mass index, and difficulty with activities of daily living. Conclusions: Like other human individual differences, the co-occurrence of social stressors can be understood using a hierarchical model.

Developmental timing of initial racial discrimination exposure is associated with cardiovascular health conditions in adulthood

Cuevas, A., Ho, T., Rodgers, J., DeNufrio, D., Alley, L., Allen, J., & Williams, D. R. (n.d.).

Publication year

2021

Journal title

Ethnicity and Health

Volume

26

Issue

7

Page(s)

949-962

10.1080/13557858.2019.1613517

Abstract

Abstract

Objective: To examine the association between developmental timing of initial exposure to racial discrimination and cardiovascular health conditions. Design: Using data from the 1995 Detroit Area Study, logistic and negative binomial regression models were used to assess the association between timing of initial exposure to racial/ethnic discrimination, classified as early childhood (0-7), childhood (8-12), adolescence (13-19), and adulthood (>19), on physician-diagnosed cardiovascular health conditions during adulthood. Each analysis adjusted for age, gender, race/ethnicity, income, education, marital status, health-related behaviors, and pre-existing health conditions. Results: Of the 1,106 participants in the final sample, 520 identified as White and 586 identified as Black. Over half (64%) of the sample experienced at least one major cardiovascular health event at the time of the study, with 39% reporting two or more events. Results from logistic regression models showed that initial exposure to racial discrimination during early childhood was associated with a 2.96 (95%CI:1.15, 7.83) times greater odds of having any cardiovascular-related health condition later in life compared to individuals who reported no discrimination. Results from negative binomial regression models demonstrated that individuals who reported initial exposure to racial discrimination during early childhood and adolescence had a CVD incidence rate that was 1.63 (95%CI:1.11, 2.38) and 1.37 (95%CI:1.10, 1.69) times higher than individuals who reported no discrimination. Conclusion: Initial exposure to racial discrimination in early childhood and adolescence may increase the risk of cardiovascular conditions later in life. Clinicians and researchers should consider racial discrimination during childhood as a possible risk factor for illness and disease.

Diminished Health Returns of Educational Attainment Among Immigrant Adults in the United States

Assari, S., Cobb, S., Cuevas, A., & Bazargan, M. (n.d.).

Publication year

2020

Journal title

Frontiers in Psychiatry

Volume

11

10.3389/fpsyt.2020.535624

Abstract

Abstract

Objectives: Marginalization-related diminished returns (MDRs) refer to weaker health effects of educational attainment for socially marginalized groups compared to the socially privileged groups. Most of the existing literature on MDRs, however, has focused on marginalization due to race, ethnicity, and sexual orientation. Thus, very limited information exists on MDRs of educational attainment among immigrant populations in the United States. Aims: Building on the MDRs framework and using a nationally representative sample of US adults, we compared immigrant and native-born adults for the effects of educational attainment on psychological distress, self-rated health (SRH), and chronic diseases (CDs). Methods: The 2015 National Health Interview Survey (NHIS) has enrolled 33,672 individuals who were either immigrant (n = 6,225; 18.5%) or native born (n = 27,429; 81.5%). The independent variable (IV) was educational attainment, which was treated as a categorical variable. The dependent variables included psychological distress, SRH, and CDs, all of which were dichotomous variables. Age, gender, race, ethnicity, and region were confounders. Immigration (nativity status) was the moderator. Results: Higher educational attainment was associated with lower odds of psychological distress, poor SRH, and CDs. However, immigration showed a significant statistical interaction with college graduation on all outcomes, which were suggestive of smaller protective effects of college graduation on psychological distress, poor SRH, and CDs for immigrant than native-born adults. Conclusions: In the US, the associations between educational attainment and psychological distress, SRH, and CDs are all weaker for immigrant than native-born adults. To prevent health disparities, it is essential to decompose health inequalities that are due to low educational attainment from those that are due to diminished returns of educational attainment (i.e., MDRs). There is a need to help highly educated immigrant adults secure positive health outcomes, similar to their native-born counterparts. Such changes may require bold and innovative economic, public, and social policies that help immigrant adults to more effectively mobilize their educational attainment to secure tangible outcomes. Elimination of health disparities in the US requires efforts that go beyond equalizing access to education.

Discrimination and anxiety : Using multiple polygenic scores to control for genetic liability

Cuevas, A., Mann, F. D., Williams, D. R., & Krueger, R. F. (n.d.).

Publication year

2021

Journal title

Proceedings of the National Academy of Sciences of the United States of America

Volume

118

Issue

1

10.1073/PNAS.2017224118

Abstract

Abstract

An established body of research indicates that discrimination is associated with increased symptoms of anxiety and negative affect. However, the association cannot be interpreted unambiguously as an exposure effect because a common set of genetic factors can simultaneously contribute to increased liability for symptoms of anxiety, negative affect, and the perception of discrimination. The present study elucidates the association between discrimination and anxiety/negative affect by implementing strict genetic controls in a large sample of adults. We used data from the biomarker project of the Study of Midlife Development in the United States (MIDUS), a national probability sample of noninstitutionalized, English-speaking respondents aged 25 to 74 y. Participants who consented to provide genetic data were biologically unrelated and of European ancestry as determined by genotype principal components analysis (n = 1,146). A single structural regression model was fit to the data with three measures of discrimination specified to load onto a latent factor and six measures of anxiety and negative affect specified to load onto a second latent factor. After accounting for potential genetic confounds—polygenic scores for anxiety, depression, and neuroticism and the first five genetic principal components—greater discrimination was associated with greater anxiety/negative affect (β = 0.53, SE = 0.04, P < 0.001). Findings suggest that measures of perceived discrimination should be considered environmental risk factors for anxiety/negative affect rather than indices of genetic liability for anxiety, depression, or neuroticism. Clinical interventions and prevention measures should focus on ways to mitigate the impact of discrimination to improve mental health at the population level.

Discrimination and systemic inflammation : A critical review and synthesis

Cuevas, A., Ong, A. D., Carvalho, K., Ho, T., Chan, S. W., Allen, J. D., Chen, R., Rodgers, J., Biba, U., & Williams, D. R. (n.d.).

Publication year

2020

Journal title

Brain, Behavior, and Immunity

Volume

89

Page(s)

465-479

10.1016/j.bbi.2020.07.017

Abstract

Abstract

Exposure to discrimination or unfair treatment has emerged as an important risk factor for illness and disease that disproportionately affects racial and ethnic minorities. Discriminatory experiences may operate like other stressors in that they activate physiological responses that adversely affect the maintenance of homeostasis. Research suggests that inflammation plays a critical role in the pathophysiology of stress-related diseases. Recent findings on discrimination and inflammation are discussed. We highlight limitations in the current evidence and provide recommendations for future studies that seek to examine the association between discrimination and inflammation.

Discrimination Exposure and Polygenic Risk for Obesity in Adulthood : Testing Gene-Environment Correlations and Interactions

Cuevas, A., Mann, F. D., & Krueger, R. F. (n.d.).

Publication year

2023

Journal title

Lifestyle Genomics

Volume

16

Issue

1

Page(s)

90-97

10.1159/000529527

Abstract

Abstract

Introduction: Exposure to discrimination has emerged as a risk factor for obesity. It remains unclear, however, whether the genotype of the individual can modulate the sensitivity or response to discrimination exposure (gene × environment interaction) or increase the likelihood of experiencing discrimination (gene-environment correlation). Methods: This was an observational study of 4,102 white/European Americans in the Health and Retirement Study with self-reported, biological assessments, and genotyped data from 2006 to 2014. Discrimination was operationalized using the average of nine Everyday Discrimination Scale items. Polygenic risk scores (PRSs) for body mass index (BMI) and waist circumference (WC) were calculated using the weighted sum of risk alleles based on studies conducted by the Genetic Investigation of Anthropometric Traits (GIANT) consortium. Results: We found that greater PRS-BMI was significantly associated with more reports of discrimination (β = 0.04 ± 0.02; p = 0.037). Further analysis showed that measured BMI partially mediated the association between PRS-BMI and discrimination. There was no evidence that the association between discrimination and BMI, or the association between discrimination and WC, differed by PRS-BMI or PRS-WC, respectively. Conclusion: Our findings suggest that individuals with genetic liability for obesity may experience greater discrimination in their lifetime, consistent with a gene-environment correlation hypothesis. There was no evidence of a gene-environment interaction. More genome-wide association studies in diverse populations are needed to improve generalizability of study findings. In the meantime, prevention and clinical intervention efforts that seek to reduce exposure to all forms of discrimination may help reduce obesity at the population level.

Discrimination Exposure and Polygenic Risk for Obesity in Adulthood: Testing Gene-Environment Correlations and Interactions

Cuevas, A., Cuevas, A. G., Mann, F. D., & Krueger, R. F. (n.d.).

Publication year

2023

Journal title

Lifestyle Genomics

Volume

16

Issue

1

Page(s)

90

Abstract

Abstract

~

Discrimination in Medical Settings across Populations : Evidence From the All of Us Research Program

Wang, V. H., Cuevas, A., Osokpo, O. H., Chang, J. E., Zhang, D., Hu, A., Yun, J., Lee, A., Du, S., Williams, D. R., & Pagán, J. A. (n.d.).

Publication year

2024

Journal title

American journal of preventive medicine

10.1016/j.amepre.2024.05.018

Abstract

Abstract

Introduction: Discrimination in medical settings (DMS) contributes to healthcare disparities in the United States, but few studies have determined the extent of DMS in a large national sample and across different populations. This study estimated the national prevalence of DMS and described demographic and health-related characteristics associated with experiencing DMS in seven different situations. Methods: Survey data from 41,875 adults participating in the All of Us Research Program collected in 2021–2022 and logistic regression were used to examine the association between sociodemographic and health-related characteristics and self-reported DMS among adults engaged with a healthcare provider within the past 12 months. Statistical analysis was performed in 2023–2024. Results: About 36.89% of adults reported having experienced at least one DMS situation. Adults with relative social and medical disadvantages had higher prevalence of experiencing DMS. Compared to their counterparts, respondents with higher odds of experiencing DMS in at least one situation identified as female, non-Hispanic Black, having at least some college, living in the South, renter, having other living arrangement, being publicly insured, not having a usual source of care, having multiple chronic conditions, having any disability, and reporting fair or poor health, p

Discrimination, affect, and cancer risk factors among African Americans

Cuevas, A., Reitzel, L. R., Adams, C. E., Cao, Y., Nguyen, N., Wetter, D. W., Watkins, K. L., Regan, S. D., & McNeill, L. H. (n.d.).

Publication year

2014

Journal title

American Journal of Health Behavior

Volume

38

Issue

1

Page(s)

31-41

10.5993/AJHB.38.1.4

Abstract

Abstract

Objectives: To examine whether stress or depressive symptoms mediated associations between perceived discrimination and multiple modifiable behavioral risk factors for cancer among 1363 African American adults. Methods: Nonparametric bootstrapping procedures, adjusted for sociodemographics, were used to assess mediation. Results: Stress and depressive symptoms each mediated associations between discrimination and current smoking, and discrimination and the total number of behavioral risk factors for cancer. Depressive symptoms also mediated the association between discrimination and overweight/obesity (p values < .05). Conclusions: Discrimination may influence certain behavioral risk factors for cancer through heightened levels of stress and depressive symptoms. Interventions to reduce cancer risk may need to address experiences of discrimination, as well as the stress and depression they engender. Copyright (c) PNG Publications. All rights reserved.

Education, Income, Wealth, and Discrimination in Black-White Allostatic Load Disparities

Cuevas, A., McSorley, A. M., Lyngdoh, A., Kaba-Diakité, F., Harris, A., Rhodes-Bratton, B., & Rouhani, S. (n.d.).

Publication year

2024

Journal title

American journal of preventive medicine

10.1016/j.amepre.2024.02.021

Abstract

Abstract

Introduction: Allostatic load (AL) is a significant marker of aging, associated with disease and mortality. Research has elucidated the impact of education and income on AL. However, the roles of wealth and discrimination in contributing to AL and shaping AL disparities remain underexplored. This study aimed to investigate the association between wealth and AL, while also examining the independent contributions of education, income, wealth, and everyday discrimination in shaping AL disparities. Methods: Using 2016 data from the nationally representative Health and Retirement Study (N=3,866), this study employed multilinear regression analysis to quantify the association between education and income, wealth (calculated as assets minus debts), and everyday discrimination with AL. Oaxaca-Blinder decomposition analysis was conducted to determine the proportion of AL disparities between Black and White participants attributed to education and income, wealth, and everyday discrimination. Analyses were performed in 2023. Results: Having a college degree or more (b = −0.32; 95% CI: −0.46, −0.17), higher income (b = −0.06; 95% CI: −0.11, −0.01), and greater wealth (b = −0.11; 95% CI: −0.16, −0.07) were linked to reduced AL. Conversely, increased experiences of everyday discrimination were associated with heightened AL (b = 0.07; 95% CI: 0.01, 0.16). Collectively, differences in possessing a college degree or more, wealth, and exposure to discrimination accounted for about 18% of the observed Black-White AL disparities. Conclusions: Education, income, wealth, and experiences of discrimination may independently contribute to AL and partially explain Black-White disparities in AL. There is a need to elucidate the underlying mechanisms governing these relationships, particularly wealth, and extend the research to additional social determinants of racial health disparities.

Educational mobility and telomere length in middle-aged and older adults : testing three alternative hypotheses

Cuevas, A., Greatorex-Voith, S., Abuelezam, N., Eckert, N., & Assari, S. (n.d.).

Publication year

2020

Journal title

Biodemography and Social Biology

Volume

66

Issue

3-4

Page(s)

220-235

10.1080/19485565.2021.1983760

Abstract

Abstract

Critical period, social mobility, and social accumulation are three hypotheses that may explain how educational mobility impacts health. Thus far, there is little evidence on how these processes are associated with biological aging as measured by telomere length. Using cross-sectional data from the 2008 Health and Retirement Study, we examined the association between educational mobility (parental education and contemporaneous education) and telomere length. The final model is adjusted for sociodemographic factors and socioeconomic status, childhood adversity, and health behaviors/risk factors, as well as depressive symptoms. A total of 1,894 participants were included in the main analyses. High parental education was associated with longer telomere length in a fully adjusted model (B = 0.03, CI [0.002,0.07]). Downwardly mobile individuals (high parental education and low contemporaneous education) had longer telomere length compared to stably low individuals in a fully adjusted model (B = 0.05, CI [0.004,0.09]). There was support for the critical period hypothesis and partial support for the change hypothesis. There was no evidence to support the social accumulation hypothesis. Prospective studies are needed to understand the mechanism that can help further explain the association between educational mobility and telomere length.

Examining the external validity of the CRUZA study, a randomized trial to promote implementation of evidence-based cancer control programs by faith-based organizations

Allen, J. D., Shelton, R. C., Kephart, L., Tom, L. S., Leyva, B., Ospino, H., & Cuevas, A. (n.d.).

Publication year

2018

Journal title

Translational Behavioral Medicine

Volume

10

Issue

1

Page(s)

213-222

10.1093/tbm/iby099

Abstract

Abstract

The CRUZA trial tested the efficacy of an organizational-level intervention to increase capacity among Catholic parishes to implement evidence-based interventions (EBIs) for cancer control. This paper examines the external generalizability of the CRUZA study findings by comparing characteristics of parishes that agreed to participate in the intervention trial versus those that declined participation. Sixty-five Roman Catholic parishes that offered Spanish-language mass in Massachusetts were invited to complete a four-part survey assessing organization-level characteristics that, based on the Consolidated Framework for Implementation Research (CFIR), may be associated with EBI implementation. Forty-nine parishes (75%) completed the survey and were invited to participate in the CRUZA trial, which randomized parishes to either a "capacity enhancement intervention" or a "standard dissemination" group. Of these 49 parishes, 31 (63%) agreed to participate in the trial, whereas 18 parishes (37%) declined participation. Parishes that participated in the CRUZA intervention trial were similar to those that did not participate with respect to "inner organizational setting" characteristics of the CFIR, including innovation and values fit, implementation climate, and organizational culture. Change commitment, a submeasure of organizational readiness that reflects the shared resolve of organizational members to implement an innovation, was significantly higher among the participating parishes (mean = 3.93, SD = 1.08) as compared to nonparticipating parishes (mean = 3.27, SD = 1.08) (Z = -2.16, p =. 03). Parishes that agreed to participate in the CRUZA intervention trial were similar to those that declined participation with regard to organizational characteristics that may predict implementation of EBIs. Pragmatic tools to assess external generalizability in community-based implementation trials and to promote readiness among faith-based organizations to implement EBIs are needed to enhance the reach and impact of public health research. Clinical Trial information: The CRUZA trial identifier number with clinicaltrials.gov is NCT01740219.