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

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

Cook, S. H., Wood, E. P., Risner, E., Weng, C. A., & Xin, Y. (n.d.).

Publication year

2023

Journal title

Frontiers in Psychology

Volume

14

10.3389/fpsyg.2023.1175452

Abstract

Abstract

Objective: To examine the impact of resilience on the association between discrimination and trajectories of depressive symptoms during the COVID-19 pandemic across racial and ethnic groups. Methods: Data were drawn from 5 waves of the All of Us Research Program’s survey on the impact of COVID-19 on the lives of American adults. Linear mixed-effects models were fitted to assess the association between discrimination exposure throughout the pandemic and depressive symptoms over time. An interaction term was introduced between resilience and discrimination exposure to assess if resilience buffered the association between discrimination and depressive symptoms over time. Race-stratified linear mixed-effects models examined racial/ethnic differences in the association between resilience, discrimination, and depressive symptoms over time. Results: Fifty-one thousand nine hundred fifty-eight participants completed surveys between May and December of 2020. Results indicated that exposure to more discrimination was associated with increasing trajectories of depressive symptoms over time (b = 0.48, p < 0.001). However, resilience moderated the association between discrimination and well-being over time such that higher resilience mitigated the detrimental effect of experiencing discrimination on depressive symptoms across time (b = −0.02, p < 0.001). Conclusion: Identifying protective features such as resilience can promote the development of culturally tailored interventions to address mental health in the context of discrimination.

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

Cook, S. H., Wood, E. P., Kapadia, F., & Halkitis, P. (n.d.).

Publication year

2023

Journal title

Journal of Sex Research

10.1080/00224499.2023.2167192

Abstract

Abstract

Internalized homophobia, or the internalization of negative attitudes toward one’s sexual minority identity, is associated with sexual risk behaviors among young sexual minority men (YSMM). However, the formation and maintenance of secure or insecure socio-emotional bonds with friends, family members, and intimate partners (i.e., adult attachment) may mitigate or exacerbate the negative effects of exposure to internalized homophobia. Nevertheless, little is known about how adult attachment influences the association between internalized homophobia and sexual risk behaviors (e.g., condomless anal sex) among YSMM. Thus, this study examined the potential moderating effect of adult attachment on the association between internalized homophobia and condomless anal sex (CAS) behaviors (i.e., insertive CAS and receptive CAS) among a sample of N = 268 YSMM who participated in the study between June 2015-March 2017 using zero-inflated Poisson regression models. We found that adult attachment anxiety, but not adult attachment avoidance, significantly moderated the association between internalized homophobia and receptive CAS behaviors such that those higher on adult attachment anxiety and internalized homophobia had fewer receptive CAS events over the preceding 30 days as compared to those lower on adult attachment anxiety and internalized homophobia. Research efforts should focus on unpacking the complex associations between adult attachment, internalized homophobia, and sexual risk behaviors among YSMM.

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

Riis, J. L., Cook, S. H., Letourneau, N., Campbell, T., Granger, D. A., & Giesbrecht, G. F. (n.d.).

Publication year

2022

Journal title

Frontiers in Endocrinology

Volume

13

10.3389/fendo.2022.813564

Abstract

Abstract

Uric acid levels during pregnancy have been examined as a potential indicator of risk for gestational diabetes mellites, hypertension, and related adverse birth outcomes. However, evidence supporting the utility of serum uric acid levels in predicting poor maternal and fetal health has been mixed. The lack of consistent findings may be due to limitations inherent in serum-based biomeasure evaluations, such as minimal repeated assessments and variability in the timing of these assessments. To address these gaps, we examined repeated measurements of diurnal salivary uric acid (sUA) levels in a sample of 44 healthy women across early-mid and late pregnancy. We assessed potential covariates and confounds of sUA levels and diurnal trajectories, as well as associations between maternal weight gain and blood pressure during pregnancy and sUA concentrations. Using multilevel linear models, we found sUA increased across pregnancy and displayed a robust diurnal pattern with the highest concentrations at waking, a steep decline in the early morning, and decreasing levels across the day. Maternal pre-pregnancy BMI, age, prior-night sleep duration, and fetal sex were associated with sUA levels and/or diurnal slopes. Maternal blood pressure and gestational weight gain also showed significant associations with sUA levels across pregnancy. Our results expand upon those found with serum UA measurements. Further, they demonstrate the feasibility of using at-home, minimally-invasive saliva sampling procedures to track UA levels across pregnancy with potential applications for the long-term monitoring of maternal cardiometabolic risk.

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

Cook, S. H., Slopen, N., Scarimbolo, L., Mirin, N., Wood, E. P., Rosendale, N., Chunara, R., Burke, C. W., & Halkitis, P. N. (n.d.).

Publication year

2022

Journal title

Journal of Behavioral Medicine

Volume

45

Issue

4

Page(s)

649-657

10.1007/s10865-022-00307-4

Abstract

Abstract

This report examines associations between everyday discrimination, microaggressions, and CRP to gain insight on potential mechanisms that may underlie increased CVD risk among sexual minority male young adults. The sample consisted of 60 participants taken from the P18 cohort between the ages of 24 and 28 years. Multinomial logistic regression models were used to examine the association between perceived everyday discrimination and LGBQ microaggressions with C-reactive protein cardiovascular risk categories of low-, average-, and high-risk, as defined by the American Heart Association and Centers for Disease Control. Adjustments were made for BMI. Individuals who experienced more everyday discrimination had a higher risk of being classified in the high-risk CRP group compared to the low-risk CRP group (RRR = 3.35, p = 0.02). Interpersonal LGBQ microaggressions were not associated with CRP risk category. Everyday discrimination, but not specific microaggressions based on sexual orientation, were associated with elevated levels of CRP among young sexual minority men (YSMM). Thus, to implement culturally and age-appropriate interventions, further researcher is needed to critically examine the specific types of discrimination and the resultant impact on YSMM’s health.

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

Cook, S. H., Wood, E. P., Chan, A., Rambarran, S., & Aguilera, L. (n.d.).

Publication year

2022

Journal title

Psychoneuroendocrinology

Volume

145

10.1016/j.psyneuen.2022.105899

Abstract

Abstract

Adult attachment, or the ways in which individuals develop and maintain trusting and loving relationships with peers and romantic partners, has been demonstrated to influence hypothalamic-pituitary-adrenal (HPA) axis functioning among young sexual minority men (YSMM). Theory and preliminary evidence suggest that differences in the lived experiences of White and Black sexual minority young adults may influence the way in which adult attachment influences the HPA-axis functioning. We sought to further this field of inquiry by examining if race moderates the association between adult attachment insecurity (i.e., avoidance and anxiety) and HPA-axis functioning among YSMM. Sixty-three YSMM participated in a 5-day daily diary study in which they completed a baseline survey to assess adult attachment orientation and provided saliva samples 4 times per day over a 5-day period in order to measure cortisol across the day. Three-level hierarchical linear modeling was used to examine the association between adult attachment, the cortisol awakening response (CAR), diurnal cortisol, and the moderating effect of race. We found no main effect of attachment anxiety or avoidance on HPA-axis functioning. However, we found that race moderated the association between adult attachment avoidance and the CAR such that Black YSMM with higher attachment avoidance had a lower CAR as compared to White YSMM. Results suggest that there may be key differences between White and Black YSMM men's lived experiences that should be explored in future research.

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

Cook, S. H., Wood, E. P., Jaiswal, J., Castro, R., Calderon, L., Qi, Y., & Llaneza, A. (n.d.).

Publication year

2021

Journal title

Archives of Sexual Behavior

Volume

50

Issue

7

Page(s)

3313-3321

10.1007/s10508-021-01964-3

Abstract

Abstract

The use of broad consent to store human biospecimens to be used in future research studies has increased over the years. However, it is currently unknown how young sexual minority men (YSMM) perceive broad consent in these specific types of studies. Therefore, in this study we aimed to determine the extent to which YSMM are comfortable with providing broad consent concerning their identifiable biological specimens to a variety of entities, including external researchers and pharmaceutical companies and to examine the relationship between mistrust based on racial/ethnic identity or sexual orientation and attitudes toward broad consent. YSMM (N = 239) ages 24–27 years were recruited from a prospective cohort study in New York City in 2018 to complete a survey assessing attitudes about the use of broad consent concerning biospecimens for secondary research. We found that YSMM were most willing to provide broad consent to the researcher from the study they were enrolled in (85.3%), other researchers within the same university (82.4%), and researchers at other universities (74.5%). Participants were least willing to provide broad consent to government organizations (64.4%) and pharmaceutical companies (53.8%). Further, we found that medical mistrust based on racial/ethnic identity or sexual orientation was associated with attitudes toward the use of broad consent. Research institutions should consider modifying consent procedures around the use of broad consent in order to maximize recruitment and retention, especially among minority populations.

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

Hoyt, L. T., Zeiders, K. H., Chaku, N., Niu, L., & Cook, S. H. (n.d.).

Publication year

2021

Journal title

Psychoneuroendocrinology

Volume

128

10.1016/j.psyneuen.2021.105204

Abstract

Abstract

Previous research has used cortisol, the major hormonal byproduct of the hypothalamic pituitary adrenal (HPA) axis system, to explore how environmental stressors influence daily physiological functioning. Most of the research focused on diurnal cortisol has examined specific cortisol markers, with little consideration of how different components of the diurnal pattern may co-occur. Morning level, cortisol awakening response (CAR), bedtime level, as well as the diurnal slope and total cortisol exposure throughout the day (area under the curve; AUC), are five common parameters of diurnal HPA axis functioning that have been individually linked to physical and mental health outcomes, with mixed results. The current study introduces a novel approach to capture heterogeneity in HPA axis activity by using latent profile analysis to generate empirically-derived, theoretically supported diurnal cortisol profiles based on all five indicators. We analyzed salivary cortisol data from 278 young adults during a time of heightened sociopolitical stress – the 2016 U.S. presidential election – and examined whether profiles differentially predicted mental health trajectories across six months. Findings suggest that a specific combination of cortisol parameters (i.e., flat slope, high AUC, and high CAR) may predict worse mental health risk over time. Overall, this work suggests that diurnal cortisol profiles likely reflect distinct physiological underpinnings with unique health consequences that may not be observed by studying individual cortisol parameters.

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

Kim, S., Capasso, A., Cook, S. H., Ali, S. H., Jones, A. M., Foreman, J., DiClemente, R. J., & Tozan, Y. (n.d.).

Publication year

2021

Journal title

PloS one

Volume

16

Issue

11

10.1371/journal.pone.0260643

Abstract

Abstract

This study assessed the modifying role of primary source of COVID-19 information in the association between knowledge and protective behaviors related to COVID-19 among adults living in the United States (US). Data was collected from 6,518 US adults through an online cross-sectional self-administered survey via social media platforms in April 2020. Linear regression was performed on COVID-19 knowledge and behavior scores, adjusted for sociodemographic factors. An interaction term between knowledge score and primary information source was included to observe effect modification by primary information source. Higher levels of knowledge were associated with increased self-reported engagement with protective behaviors against COVID-19. The primary information source significantly moderated the association between knowledge and behavior, and analyses of simple slopes revealed significant differences by primary information source. This study shows the important role of COVID-19 information sources in affecting people's engagement in recommended protective behaviors. Governments and health agencies should monitor the use of various information sources to effectively engage the public and translate knowledge into behavior change during an evolving public health crisis like COVID-19.

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

Zhao, Y., Wood, E. P., Mirin, N., Cook, S. H., & Chunara, R. (n.d.).

Publication year

2021

Journal title

American journal of preventive medicine

Volume

61

Issue

4

Page(s)

596-605

10.1016/j.amepre.2021.04.016

Abstract

Abstract

Introduction: Cardiovascular disease is the leading cause of death worldwide, and cardiovascular disease burden is increasing in low-resource settings and for lower socioeconomic groups. Machine learning algorithms are being developed rapidly and incorporated into clinical practice for cardiovascular disease prediction and treatment decisions. Significant opportunities for reducing death and disability from cardiovascular disease worldwide lie with accounting for the social determinants of cardiovascular outcomes. This study reviews how social determinants of health are being included in machine learning algorithms to inform best practices for the development of algorithms that account for social determinants. Methods: A systematic review using 5 databases was conducted in 2020. English language articles from any location published from inception to April 10, 2020, which reported on the use of machine learning for cardiovascular disease prediction that incorporated social determinants of health, were included. Results: Most studies that compared machine learning algorithms and regression showed increased performance of machine learning, and most studies that compared performance with or without social determinants of health showed increased performance with them. The most frequently included social determinants of health variables were gender, race/ethnicity, marital status, occupation, and income. Studies were largely from North America, Europe, and China, limiting the diversity of the included populations and variance in social determinants of health. Discussion: Given their flexibility, machine learning approaches may provide an opportunity to incorporate the complex nature of social determinants of health. The limited variety of sources and data in the reviewed studies emphasize that there is an opportunity to include more social determinants of health variables, especially environmental ones, that are known to impact cardiovascular disease risk and that recording such data in electronic databases will enable their use.

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

Cook, S. H., Wood, E. P., Scott, M., Pierce, K. A., Kapadia, F., & Halkitis, P. N. (n.d.).

Publication year

2020

Journal title

TPM - Testing, Psychometrics, Methodology in Applied Psychology

Volume

27

Issue

3

Page(s)

291-311

10.4473/TPM27.3.1

Abstract

Abstract

The application of group-based trajectory analysis with a zero-inflation specification to understand adaptations in alcohol and marijuana use among sexual minorities during the emerging adulthood period is underutilized. We propose a series of four steps in the application of group-based trajectory analysis for outcomes that follow a zero-inflated distribution. In addition, using a longitudinal cohort study of emerging adult sexual minority men (n = 597) we provide an example of how to obtain group-based trajectory profiles of alcohol and marijuana use among emerging adult sexual minority men with a zeroinflated specification. In addition, we examined racial/ethnic differences in trajectory profiles. Findings suggest that there were five distinct alcohol and marijuana use trajectories that were reliably predicted by racial/ethnic identity for alcohol but not marijuana utilizing the zero-inflated specification. A summary of findings and concluding remarks related to the utility of this modeling technique are presented.

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

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

Publication year

2019

Journal title

Psychoneuroendocrinology

Volume

110

10.1016/j.psyneuen.2019.06.019

Abstract

Abstract

Background: Exposure to sexual orientation-related discrimination among sexual minorities may lead to elevated levels of C-reactive protein (CRP) as compared to their heterosexual counterparts. However, little is known about factors that may buffer the association between discrimination and CRP among sexual minorities versus heterosexuals. The current study examined if the association between discrimination, sexual orientation, and CRP differed across levels of social support from one's father/father-figure or mother/mother-figure between sexual minorities and heterosexuals. Methods: Data came from Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health). The sample sizes for father support and mother support was 3167 and 3575, respectively. Participants ranged in age from 24 to 33 years. Stratified linear regression models examined if father and mother support moderated the association between discrimination and CRP among sexual minorities and heterosexuals. Results: Father support significantly moderated the association between discrimination and CRP among sexual minorities but not heterosexuals. Sexual minorities with higher father support and who experienced discrimination had lower CRP as compared to those with lower father support and who experienced discrimination. Mother support did not moderate the association between discrimination and CRP among either sexual minorities or heterosexuals. Conclusion: Father support may mitigate the negative effects of stress from discrimination on CRP among sexual minorities. Future research should further examine the potential differential role that father support may play in reducing cardiovascular risk among sexual minorities versus heterosexuals who experience discrimination.

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

Cook, S. H., Wood, E. P., Harris, J., D’Avanzo, P., & Halkitis, P. (n.d.). In Men’s Health Equity: Theoretical Approaches and Policy Implications (1–).

Publication year

2019

Page(s)

343-359

10.4324/9781315167428-22

Abstract

Abstract

This chapter presents theories and conceptual models that describe the ways in which behavioral, psychological and social aspects of gay and bisexual men (GBM) lived experiences influence health outcomes among the population. It describes key developmental theories that identify the ways in which social structures have framed the ways in which GBM develop their identities over time. The chapter explores key aspects of how social stigma and discrimination influence the mental and physical health of GBM. It discusses how multiple co-occurring epidemics influence the health of GBM across the life course and explains the ways in which state- and federal-level policies influence the health and well-being of GBM. The chapter provides a general, but critical, overview of current theories and controversies concerning the health of GBM. It analyses further expansion of the Sexual Minority Stress model to better incorporate multiple levels of risk and protective mechanisms associated with the health outcomes of GBM.

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

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

Publication year

2019

Journal title

Journal of Sex Research

Volume

56

Issue

4

Page(s)

604-619

10.1080/00224499.2018.1440280

Abstract

Abstract

We conducted a mixed-methods study to identify factors that influence transitions in attachment style between childhood and adulthood among 28 young Black gay and bisexual men (YBGBM) in the United States. We used a phenomenological approach to data integration, with the major component to the results being garnered from the qualitative interviews. We organized our results by four attachment transition groups: stable secure (secure attachment in childhood and young adulthood), stable insecure (insecure attachment in childhood and young adulthood), secure to insecure (secure in childhood and insecure in adulthood) and insecure to secure (insecure in childhood and secure in adulthood). Within each of the typologies, two major themes emerged: social support and religion. Generally, transitions from secure to insecure attachment were related to experiences of perceived rejection by a parental figure during adolescence that corresponded with sexual orientation disclosure. Transitions from insecure to secure attachment appeared to be related to the absence of an attachment figure early in life, but with the acquisition of an attachment figure during early to late adolescence. The findings from our study suggest a need for attachment-based approaches to social support interventions, as well as for an increased understanding of social and cultural factors that impact attachment changes among practitioners who use attachment-based therapy models for YBGBM.

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

Córdova, D., Heinze, J. E., Hsieh, H. F., Mistry, R., Salas-Wright, C. P., Cook, S. H., & Zimmerman, M. A. (n.d.).

Publication year

2018

Journal title

AIDS

Volume

32

Issue

4

Page(s)

495-503

10.1097/QAD.0000000000001717

Abstract

Abstract

Objectives: To examine trajectories of adolescent psychosocial risk-drug use, depressive and anxiety symptoms, and violence victimization and observation-and the longitudinal relationship between psychosocial risk trajectories during adolescence and HIV risk behaviors in adulthood. Methods: The 18-year longitudinal study was conducted from September 1994 through May 2013, in Michigan. Eight hundred and fifty predominantly (80%) African-American adolescents completed demographics and measures of drug use, depressive and anxiety symptoms, violence victimization and observation at Times 1-4, sexual risk behaviors at Times 5 and 6, and social conditions (i.e. family, peer, and community-level factors) between 14.9 and 32.0 years of age. Results: Growth mixture modeling revealed two trajectories of psychosocial risk factors which can be characterized as a syndemic index: high-frequency and low-frequency. The high-frequency class was more likely to report HIV risk behaviors, including condomless sex at last sexual intercourse with their primary and secondary partner, sexual intercourse with someone they just met, at least four sexual partners, and licit and illicit drug use prior to sexual intercourse at Time 5 (mean age 23.1). At Time 6 (mean age 32.0), the high-frequency class was more likely to report sexual intercourse with someone they just met and at least four sexual partners, relative to the low-frequency class. In addition, the high-frequency class was linked to peer and family-level indicators of social conditions. Conclusion: A syndemic index comprised of co-occurring psychosocial risk factors in adolescence seem to have lasting effects on the vulnerability to engage in HIV risk behaviors in emerging adulthood, some of which extend into young adulthood.

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

Doom, J. R., Cook, S. H., Sturza, J., Kaciroti, N., Gearhardt, A. N., Vazquez, D. M., Lumeng, J. C., & Miller, A. L. (n.d.).

Publication year

2018

Journal title

Developmental Psychobiology

Volume

60

Issue

4

Page(s)

364-379

10.1002/dev.21602

Abstract

Abstract

Childhood poverty is hypothesized to increase risk for mental and physical health problems at least in part through dysregulation of the hypothalamic-pituitary-adrenal axis. However, less is known about the specific psychosocial stressors associated with cortisol reactivity and regulation for children living in poverty. The current study investigates negative life events, household chaos, and family conflict in preschool and middle childhood as potential predictors of cortisol regulation in low-income 7–10 year olds (N = 242; M age = 7.9 years). Participants were assessed in preschool and participated in a follow-up assessment in middle childhood, during which diurnal free cortisol and free cortisol reactivity to the Trier Social Stress Test for Children (TSST-C) were assessed. Household chaos during preschool predicted a more blunted diurnal cortisol slope in middle childhood. Greater negative life events during preschool and greater concurrent family conflict were associated with increased free cortisol reactivity in middle childhood.

Friendship Attachment Style Moderates the Effect of Adolescent Exposure to Violence on Emerging Adult Depression and Anxiety Trajectories

Heinze, J. E., Cook, S. H., Wood, E. P., Dumadag, A. C., & Zimmerman, M. A. (n.d.).

Publication year

2018

Journal title

Journal of Youth and Adolescence

Volume

47

Issue

1

Page(s)

177-193

10.1007/s10964-017-0729-x

Abstract

Abstract

Exposure to violence during adolescence is associated with increased risk behaviors and mental health problems in adulthood. Friendship attachment during adolescence may, however, mitigate the negative effects of exposure to violence on trajectories of depression and anxiety in young adulthood. In this study, we used growth curve modeling to examine associations between exposure to violence and mental health outcomes, followed by multi-group analyses with friendship attachment as the moderator. The sample was drawn from a longitudinal study (12 waves; 1994–2012) of 676 (54% female) urban high school students. We found strong positive associations between exposure to violence during adolescence and later self-reported depressive and anxiety symptoms. Notably, securely attached adolescents reported faster decreases in mental health symptoms as a function of violence relative to their insecurely attached peers as they transitioned into adulthood.