Stephanie Cook

Stephanie Cook
Stephanie Cook

Assistant Professor of Biostatistics

Assistant Professor of Social and Behavioral Sciences

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 I 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

  • 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

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
HIV/AIDS
Intersectionality Theory
Longitudinal Methods
Minority Health
Minority Stress
Multiphase Optimization Strategy (MOST)
Physiological Stress
Social Behaviors

Publications

Publications

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
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
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
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
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.

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
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
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
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
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
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
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
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

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

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
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

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.

Publication year

2019

Page(s)

343-359
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
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
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
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
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
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.

Psychometric analysis of the life worries scale for a new generation of sexual minority men: The P18 cohort study

Relationship cognitions and longitudinal trajectories of sexual risk behavior among young gay and bisexual men: The P18 cohort study

Sexual orientation moderates the association between parental overprotection and stress biomarker profiles

Cook, S. H., Pruessner, J. C., Lupien, S. J., & Juster, R. P. (n.d.).

Publication year

2018

Journal title

Psychology and Sexuality

Volume

9

Issue

3

Page(s)

204-220
Abstract
Abstract
Early experiences with parents may be particularly difficult for lesbian, gay and bisexual (LGB) individuals who face stigma that is linked to potentially distinct stress-related biobehavioural profiles. This study examined the association between parental bonding in relation to acute stress (cortisol reactivity) and chronic stress (allostatic load) in LGB and heterosexual individuals. The sample consisted of 87 healthy adults (mean [SD] age = 24.6 [0.6] years; LGB: n = 46, 43% women; and heterosexual n = 41, 49% women). Regressions tested the main effects of retrospectively assessed parental overprotection and care before the age of 16 on stress reactive cortisol (area under the curve) and allostatic load (indexed using 21 neuroendocrine, immune, metabolic and cardiovascular biomarkers), and whether sexual orientation status moderated this association. Results revealed that parental overprotection was associated with increased cortisol reactivity only for LGB participants, but not for heterosexual participants. By contrast, parental overprotection was associated with higher allostatic load only for heterosexual participants, but not for LGB participants. While the functional significance of this requires further study, these preliminary findings suggest that adaptive processes among LGB individuals may mitigate the negative effects of parental overprotection on markers of chronic stress.

Stress levels are associated with poor sleep health among sexual minority men in Paris, France

Mountcastle, H. D., Park, S. H., Al-Ajlouni, Y. A., Goedel, W. C., Cook, S., Lupien, S., Obasi, E. M., Hale, L., Jean-Louis, G., Redline, S., & Duncan, D. T. (n.d.).

Publication year

2018

Journal title

Sleep Health

Volume

4

Issue

5

Page(s)

436-441
Abstract
Abstract
Objective: The objective of this study was to examine the association between perceived stress and sleep health among a sample of sexual minority men (SMM). Design: Cross-sectional survey. Setting: Paris, France. Participants: Gay, bisexual and other SMM users ≥18 years on a geosocial networking application in Paris, France (N = 580). Measurements: Participants were directed to a web-based survey measuring stress, sleep health, and socio-demographics. Multivariate log-binomial regression models were used to estimate the adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) to examine how stress may affect different dimensions of sleep health: 1) poor sleep quality, 2) short sleep duration, 3) problems falling asleep, and 4) problems staying awake in the daytime. Results: Most participants (69.9%) reported at least sometimes feeling stressed (compared to never or rarely). Additionally, results demonstrate that higher perceived stress was associated with poorer sleep health; compared with those who reported feeling stress never or rarely, those who felt stress sometimes, often, or always were more likely to experience poor sleep quality (aRR = 6.67; 95% CI = 3.61–12.3), short sleep duration (aRR = 1.67; 95% CI = 1.17–2.38), problems falling asleep (aRR = 3.20; 95% CI = 2.26–4.52), and problems staying awake during the daytime (aRR = 3.52; 95% CI = 1.64–7.53). Conclusion: Elevated perceived stress can negatively influence sleep health among SMM in Paris, France.

Contact

sc5810@nyu.edu 708 Broadway 7FL New York, NY, 10003