Stephanie Cook

Associate Professor of Social and Behavioral Sciences

Associate Professor of Biostatistics

Professional overview

Dr. Stephanie Cook's research focuses on understanding the complex relationship between stress, health, and social determinants of health across the lifespan. Her work examines how both structural and individual-level stressors contribute to mental and physical health outcomes, particularly in vulnerable populations. Dr. Cook is particularly interested in how features of close relationships—such as attachment patterns—can either exacerbate or buffer the negative effects of stress on overall well-being.

Her current research explores how daily and momentary experiences of stress are linked to physical health markers (e.g., cortisol, C-reactive protein) and health behaviors (e.g., substance use, sexual risk behaviors). She focuses on how these stressors impact health trajectories over time, particularly among young adults navigating significant life transitions.

Dr. Cook employs advanced longitudinal study designs, including intensive longitudinal methods, to track how changes in stress exposure affect changes in risk behaviors and physical health outcomes.

As the Director of the Attachment and Health Disparities Research Lab (AHDL), Dr. Cook leads a team of undergraduates, graduate students, and postdoctoral fellows in exploring innovative ways to mitigate the impact of stress on health. She has developed an integrated model combining adult attachment theory and stress research to better understand how relational factors influence health outcomes for individuals facing social disadvantage. Her long-term goal is to develop and implement sustainable interventions aimed at reducing the harmful effects of stress on health, with a focus on improving health equity.

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 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.

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

Cook, S. H., 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

Page(s)

1175452

Abstract

Abstract

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.

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

Publication year

2023

Journal title

Journal of sex research

Page(s)

1-8

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 = 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.

Adult attachment as a moderator of the association between childhood traumatic experiences and depression symptoms among young black gay and bisexual men

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

Publication year

2017

Journal title

Cultural Diversity and Ethnic Minority Psychology

Volume

23

Issue

3

Page(s)

388-397

10.1037/cdp0000119

Abstract

Abstract

The present study examined the moderating effect of adult attachment on the association between childhood traumatic experiences, (i.e., physical abuse, emotional abuse, emotional neglect, and being bullied), age of childhood traumatic experience, and young adult depression symptoms among young Black gay and bisexual men (YBGBM). Method: Self-report measures of attachment, childhood traumatic experiences, and depression symptoms were collected from a community-based sample of YBGBM living in New York City (n = 228). Regression analyses were conducted to address the study goals. Results: Findings indicated that YBGBM who were more anxious in their adult attachment style and experienced being bullied or physically abused by a non-family member during childhood experienced greater depression in young adulthood than YBGBM who were less anxious in their adult attachment style. In addition, we found that being bullied later in childhood was associated with greater depression symptoms than being bullied earlier. Lastly, we found that YBGBM who were more avoidant and bullied later in adolescence reported more depression symptoms in young adulthood than YBGBM who were less avoidant in their attachment style. Discussion: The findings suggest that it may be important to utilize an attachment perspective that is sensitive to age of traumatic experience when creating mental health and trauma interventions for YBGBM.

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.

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.

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.

Assessment of a Daily Diary Study Including Biospecimen Collections in a Sample of Sexual and Gender Minority Young Adults : Feasibility and Acceptability Study

Cook, S. H., Wood, E. P., Rodrigues, M., Caldas, J. J., & Delorme, M. (n.d.).

Publication year

2024

Journal title

JMIR Formative Research

Volume

8

10.2196/52195

Abstract

Abstract

Background: Young sexual minority men (YSMM) engage in cardiometabolic risk behaviors (eg, substance use) at higher rates than their heterosexual counterparts. Theory and previous research suggest that these risk behaviors may stem, in part, from exposure to minority stress (ie, discrimination based on sexual identity and other identities such as race). Objective: This pilot study examined the feasibility and acceptability of a virtual 2-day daily diary study that examined daily experiences with discrimination, cardiometabolic risk behaviors (ie, sleep, physical activity, and substance use behaviors), and patterns of physiological stress and inflammation among YSMM aged 18 to 35 years. Methods: Participants (n=20) were recruited from the greater New York metropolitan area and engaged in a 2-day daily diary protocol wherein they provided web-based consent, took a web-based baseline survey, and then, starting the next day, provided 3 saliva samples a day for 2 consecutive days to measure salivary cortisol, engaged in 3 daily diaries per day, and provided 1 blood spot sample via the finger prick method to measure high-sensitivity C-reactive protein. At follow-up, participants were interviewed via videoconferencing to ascertain their experiences and feelings related to the study protocol. Qualitative analyses explored the feasibility and acceptability of the study protocol, and exploratory quantitative analyses explored the descriptive statistics and Pearson correlations among the main study variables of interest. Results: The retention rate was high (19/20, 95%) in our study sample. Qualitative analyses demonstrated that participants were willing to engage in similar, longer-term studies (eg, studies that include both week and weekend days) in the future and suggested the feasibility and acceptability of our study protocol among YSMM. However, participants noted several areas for improvement (eg, redundancy of survey items and difficulty pricking one's finger) that should be considered in future research. Preliminary quantitative analyses revealed a moderate negative correlation between everyday discrimination and mean cortisol levels (r=-0.51; P=.03). Furthermore, descriptive analyses suggest that that daily cortisol curves differ across races or ethnicities among YSMM. White and other-identified YSMM experienced the highest cortisol awakening response (mean 0.39, SD 0.21 μg/dL for White participants; mean 0.34, SD 0.34 μg/dL for others) with the steepest decline around bedtime (mean 0.05, SD 0.04 μg/dL for White participants; mean 0.09, SD 0.13 μg/dL for others) followed by a lower cortisol awakening response (mean 0.31, SD 0.11 μg/dL for Hispanic participants; mean 0.23, SD 0.15 μg/dL for Black participants) and a slower decline around bedtime (mean 0.10, SD 0.09 μg/dL for Hispanic participants; mean 0.03, SD 0.02 μg/dL for Black participants) among Hispanic and Black YSMM. Conclusions: Overall, the results suggest that similar study protocols are feasible and acceptable among YSMM. Future research should highlight the pathways through which cardiovascular disease risk may arise among YSMM using longer-term study designs and more diverse study samples.

Associations Among Patient Race, Sedation Practices, and Mortality in a Large Multi-Center Registry of COVID-19 Patients

Cook, S. H., Valley, T. S., Iwashyna, T. J., Cook, S., Hough, C. L., & Armstrong-Hough, M. (n.d.).

Publication year

2021

Journal title

American Journal of Respiratory and Critical Care Medicine

Volume

203

Issue

9

Abstract

Abstract

~

Attachment orientation and sexual risk behaviour among young Black gay and bisexual men

Cook, S. H., Watkins, D. C., Calebs, B. J., & Wilson, P. A. (n.d.).

Publication year

2016

Journal title

Psychology and Sexuality

Volume

7

Issue

3

Page(s)

177-196

10.1080/19419899.2016.1168312

Abstract

Abstract

This mixed methods study used an explanatory sequential design to examine the relationship between attachment and sexual behaviour among young Black gay and bisexual men (YBGBM). Cross sectional online surveys and sex diaries were completed by a sample of YBGBM in New York City (n = 153) to assess the association between adult attachment insecurity and sexual risk behaviour. The Experiences in Close Relationships Scale-Revised (ECR-R) was used to assess three types of adult attachment (i.e., secure, anxious and avoidant). Participants reported condomless sex encounters, as well as serodiscordant condomless anal sex encounters, as measures of sexual risk. Quantitative findings suggested that there were few associations between attachment type and sexual risk behaviour; only men with attachment avoidance were likely to engage in condomless sex. However, qualitative findings illuminated some of the social complexities of the association between attachment in childhood, attachment in young adulthood and intimate partnerships, which could be linked to young adult sexual risk behaviour. The study findings highlight the need for researchers to further examine the process by which individual differences in attachment orientation are related to YBGBM’s sexual behaviour.

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.

Conducting Health Disparities Research with Criminal Justice Populations : Examining Research, Ethics, and Participation

Valera, P., Cook, S. H., Macklin, R., & Chang, Y. (n.d.).

Publication year

2014

Journal title

Ethics and Behavior

Volume

24

Issue

2

Page(s)

164-174

10.1080/10508422.2013.826581

Abstract

Abstract

This study explored the challenges of informed consent and understanding of the research process among Black and Latino men under community supervision (e.g., parole and/or probation). Between February and October 2012, we conducted cognitive face-to-face interviews using open-ended questions on the significant areas of research participation (i.e., the informed consent process, confidentiality, compensation, what is meant by human subject and clinical trials) among 259 men aged 35 to 67 under community supervision in Bronx, New York. Content analysis of the open-ended questions revealed limited knowledge concerning the understanding of research participation. The study participants appeared to generally understand concepts such as compensation after research participation and confidentiality. Participants demonstrated a lack of understanding of certain aspects of the research process-informed consent, human subject, Institutional Review Board, and clinical trials. These findings are informative to researchers conducting studies with criminal justice populations and Institutional Review Boards reviewing research studies.

Cortisol profiles differ by race/ethnicity among young sexual minority men

Cook, S. H., Juster, R. P., Calebs, B. J., Heinze, J., & Miller, A. L. (n.d.).

Publication year

2017

Journal title

Psychoneuroendocrinology

Volume

75

Page(s)

1-4

10.1016/j.psyneuen.2016.10.006

Abstract

Abstract

Much of the extant scientific research examining hypothalamic-pituitary-adrenal (HPA)-axis functioning is conducted among White heterosexuals. Very little research examines HPA-axis functioning between different minority groups. Individuals who identify as both sexual and racial minorities may experience increased stigma and discrimination that can affect HPA-axis functioning. In the current study, we examined diurnal cortisol rhythm in young White gay men (WGM) compared to young Black gay men (BGM). The sample consisted of 70 healthy gay men (mean [SD] age = 22.9 [3.2]: 68% White and 38% Black) who collected four saliva samples daily for five days. Repeated measures analysis of covariance and post-hoc tests revealed that BGM had higher cortisol levels than WGM in the evening. Secondary analyses revealed no significant group differences for the cortisol awakening response or systemic output throughout the day. However, BGM compared to WGM had a lower drop from peak (morning) to lowest (evening) cortisol concentrations. Taken together, these findings reveal a flatter diurnal cortisol rhythm among BGM compared to WGB. The functional significance of these preliminary findings must be explored further with assessment of psychosocial factors among sexual minorities at the intersection of multiple identities. In summary, we expand health disparities research aimed at delineating sexual minority and race/ethnic variation in stress physiology.

Deficits in dopamine D 2 receptors and presynaptic dopamine in heroin dependence : Commonalities and differences with other types of addiction

Martinez, D., Saccone, P. A., Liu, F., Slifstein, M., Orlowska, D., Grassetti, A., Cook, S. H., Broft, A., Van Heertum, R., & Comer, S. D. (n.d.).

Publication year

2012

Journal title

Biological Psychiatry

Volume

71

Issue

3

Page(s)

192-198

10.1016/j.biopsych.2011.08.024

Abstract

Abstract

Positron emission tomography (PET) imaging studies have shown that addiction to a number of substances of abuse is associated with a decrease in dopamine D 2/3 receptor binding and decreased presynaptic dopamine release in the striatum. Some studies have also shown that these reductions are associated with the severity of addiction. For example, in cocaine dependence, low dopamine release is associated with the choice to self-administer cocaine. The goal of the present study was to investigate these parameters of striatal dopamine transmission in heroin dependence and their association with drug seeking behavior. Heroin-dependent and healthy control subjects were scanned with [ 11C]raclopride before and after stimulant administration (methylphenidate) to measure striatal D 2/3 receptor binding and presynaptic dopamine release. After the PET scans, the heroin-dependent subjects performed heroin self-administration sessions. Both striatal D 2/3 receptor binding and dopamine release were reduced in the heroin-dependent subjects compared with healthy control subjects. However, neither PET measure of dopamine transmission predicted the choice to self-administer heroin. These findings show that heroin addiction, like addiction to other drugs of abuse, is associated with low D 2/3 receptor binding and low presynaptic dopamine. However, neither of these outcome measures was associated with the choice to self-administer heroin.

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., 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.

Discrimination, Smoking, and Cardiovascular Disease Risk : A Moderated Mediation Analysis With MESA

Cook, S. H., Wood, E. P., Stein, J. H., & McClelland, R. L. (n.d.).

Publication year

2024

Journal title

Journal of the American Heart Association

Volume

13

Issue

5

10.1161/JAHA.123.032659

Abstract

Abstract

BACKGROUND: Carotid intima-media thickness (cIMT) and carotid plaque are reliable indicators of cardiovascular disease risk, and research highlights that racial and ethnic minority individuals generally exhibit higher cIMT and carotid plaque than White individuals. At present, the mechanisms driving these disparities among different racial and ethnic and biological sex groups are poorly understood. METHODS AND RESULTS: Data came from the baseline examination of MESA (Multi-Ethnic Study of Atherosclerosis). A total of 6814 participants aged 45 to 84 years free of clinical cardiovascular disease completed assessments on health behavior and perceived discrimination. Four sex-stratified moderated mediation models examined associations between discrimination, cigarette smoking, and mean cIMT and plaque. We hypothesized that cigarette use would mediate the association between discrimination and carotid artery disease features, and that these would differ by race and ethnicity. Indirect effects of discrimination on plaque were observed among Hispanic women such that discrimination was associated with cigarette use and, in turn, higher plaque (β=0.04 [95% CI, 0.01–0.08]). Indirect effects of discrimination on mean cIMT were found among Hispanic (β=0.003 [95% CI, 0.0001–0.007]) and White men (β=0.04 [95% CI, 0.01–0.08]) such that discrimination was associated with cigarette use and, in turn, higher cIMT. Finally, a positive indirect effect of discrimination on plaque was observed among Hispanic men (β=0.03 [95% CI, 0.004–0.07]). No other racial and ethnic differences were observed. CONCLUSIONS: To understand and address social determinants of cardiovascular disease, researchers must incorporate an intersectional framework that will allow us to understand the complex nature of discrimination and cardiovascular disease risk for individuals of varying intersecting identities and social positions.

Empowering the biomedical research community : Innovative SAS deployment on the All of Us Researcher Workbench

Humes, I., Shyr, C., Dillon, M., Liu, Z., Peterson, J., Jeor, C. S., Malkes, J., Master, H., Mapes, B., Azuine, R., Mack, N., Abdelbary, B., Gamble-George, J., Goldmann, E., Cook, S. H., Choupani, F., Baskir, R., McMaster, S., Lunt, C., … Harris, P. A. (n.d.).

Publication year

2024

Journal title

Journal of the American Medical Informatics Association : JAMIA

Volume

31

Issue

12

Page(s)

2994-3000

10.1093/jamia/ocae216

Abstract

Abstract

OBJECTIVES: The All of Us Research Program is a precision medicine initiative aimed at establishing a vast, diverse biomedical database accessible through a cloud-based data analysis platform, the Researcher Workbench (RW). Our goal was to empower the research community by co-designing the implementation of SAS in the RW alongside researchers to enable broader use of All of Us data. MATERIALS AND METHODS: Researchers from various fields and with different SAS experience levels participated in co-designing the SAS implementation through user experience interviews. RESULTS: Feedback and lessons learned from user testing informed the final design of the SAS application. DISCUSSION: The co-design approach is critical for reducing technical barriers, broadening All of Us data use, and enhancing the user experience for data analysis on the RW. CONCLUSION: Our co-design approach successfully tailored the implementation of the SAS application to researchers' needs. This approach may inform future software implementations on the RW.

Exploring the relationship between gender nonconformity and mental health among black South African gay and bisexual men

Cook, S. H., Sandfort, T. G., Nel, J. A., & Rich, E. P. (n.d.).

Publication year

2013

Journal title

Archives of Sexual Behavior

Volume

42

Issue

3

Page(s)

327-330

10.1007/s10508-013-0087-z

Abstract

Abstract

~

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.

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.

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.

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.

HIV status disclosure, depressive symptoms, and sexual risk behavior among HIV-positive young men who have sex with men

Cook, S. H., Valera, P., & Wilson, P. A. (n.d.).

Publication year

2015

Journal title

Journal of Behavioral Medicine

Volume

38

Issue

3

Page(s)

507-517

10.1007/s10865-015-9624-7

Abstract

Abstract

The rate of HIV infection among young men who have sex with men (YMSM) is increasing in the United States, and targeted research is needed to inform interventions aimed at reducing HIV transmission in this population. This study aims to understand the association between HIV status disclosure and sexual risk behavior among HIV-positive YMSM. A particular focus is given to depressive symptoms and their potential role in explaining the association between HIV disclosure and sexual risk behavior. In a sample of 991 YMSM receiving care at 20 clinics across the United States, Univariate and multivariate analyses were conducted to explore these associations. Approximately one-half (52.4 %) of participants reported disclosing to their current sexual/romantic partner. Disclosure to family members was negatively associated with sexual risk behavior. Also, depressive symptoms were positively associated with sexual risk behavior. We discuss the implications of our findings for future research and intervention.

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.