Browsing by Author "Garcia, Lorena"

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    Correction: Taking action to advance the study of race and ethnicity: the Women’s Health Initiative (WHI)
    (Springer Nature, 2022-11-25) Garcia, Lorena; Follis, Shawna; Thomson, Cynthia A.; Breathett, Khadijah; Wiley Cené, Crystal; Jimenez, Monik; Kooperberg, Charles; Masaki, Kamal; Paskett, Electra D.; Pettinger, Mary; Aragaki, Aaron; Dilworth‑Anderson, Peggye; Stefanick, Marcia L.; Medicine, School of Medicine
    Correction: Women’s Midlife Health 8, 1 (2021) https://doi.org/10.1186/s40695-021-00071-6
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    Taking action to advance the study of race and ethnicity: the Women’s Health Initiative (WHI)
    (Springer Nature, 2022) Garcia, Lorena; Follis, Shawna; Thomson, Cynthia A.; Breathett, Khadijah; Wiley Cené, Crystal; Jimenez, Monik; Kooperberg, Charles; Masaki, Kamal; Paskett, Electra D.; Pettinger, Mary; Aragaki, Aaron; Dilworth‑Anderson, Peggye; Stefanick, Marcia L.; Medicine, School of Medicine
    “Race” and “ethnicity” are socially constructed terms, not based on biology - in contrast to biologic ancestry and genetic admixture - and are flexible, contested, and unstable concepts, often driven by power. Although individuals may self-identify with a given race and ethnic group, as multidimensional beings exposed to differential life influencing factors that contribute to disease risk, additional social determinants of health (SDOH) should be explored to understand the relationship of race or ethnicity to health. Potential health effects of structural racism, defined as “the structures, policies, practices, and norms resulting in differential access to goods, services, and opportunities of society by “race,” have been largely ignored in medical research. The Women’s Health Initiative (WHI) was expected to enroll a racially and ethnically diverse cohort of older women at 40 U.S. clinical centers between 1993 and 1998; yet, key information on the racial and ethnic make-up of the WHI cohort of 161,808 women was limited until a 2020–2021 Task Force was charged by the WHI Steering Committee to better characterize the WHI cohort and develop recommendations for WHI investigators who want to include “race” and/or “ethnicity” in papers and presentations. As the lessons learned are of relevance to most cohorts, the essence of the WHI Race and Ethnicity Language and Data Interpretation Guide is presented in this paper. Recommendations from the WHI Race and Ethnicity Language and Data Interpretation Guide include: Studies should be designed to include all populations and researchers should actively, purposefully and with cultural-relevance, commit to recruiting a diverse sample; Researchers should collect robust data on race, ethnicity and SDOH variables that may intersect with participant identities, such as immigration status, country of origin, acculturation, current residence and neighborhood, religion; Authors should use appropriate terminology, based on a participant’s self-identified “race” and “ethnicity”, and provide clear rationale, including a conceptual framework, for including race and ethnicity in the analytic plan; Researchers should employ appropriate analytical methods, including mixed-methods, to study the relationship of these sociocultural variables to health; Authors should address how representative study participants are of the population to which results might apply, such as by age, race and ethnicity.
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    When the At-Risk Do Not Develop Heart Failure: Understanding Positive Deviance Among Postmenopausal African-American and Hispanic Women
    (Elsevier, 2021) Breathett, Khadijah; Kohler, Lindsay N.; Eaton, Charles B.; Franceschini, Nora; Garcia, Lorena; Klein, Liviu; Martin, Lisa W.; Ochs-Balcom, Heather M.; Shadyab, Aladdin H.; Cené, Crystal W.; Medicine, School of Medicine
    Background: African American and Hispanic postmenopausal women have the highest risk for heart failure compared with other races, but heart failure prevalence is lower than expected in some national cohorts. It is unknown whether psychosocial factors are associated with lower risk of incident heart failure hospitalization among high-risk postmenopausal minority women. Methods and results: Using the Women's Health Initiative Study, African American and US Hispanic women were classified as high-risk for incident heart failure hospitalization with 1 or more traditional heart failure risk factors and the highest tertile heart failure genetic risk scores. Positive psychosocial factors (optimism, social support, religion) and negative psychosocial factors (living alone, social strain, depressive symptoms) were measured using validated survey instruments at baseline. Adjusted subdistribution hazard ratios of developing heart failure hospitalization were determined with death as a competing risk. Positive deviance indicated not developing incident heart failure hospitalization with 1 or more risk factors and the highest tertile for genetic risk. Among 7986 African American women (mean follow-up of 16 years), 27.0% demonstrated positive deviance. Among high-risk African American women, optimism was associated with modestly reduced risk of heart failure hospitalization (subdistribution hazard ratio 0.94, 95% confidence interval 0.91-0.99), and social strain was associated with modestly increased risk of heart failure hospitalization (subdistribution hazard ratio 1.07, 95% confidence interval 1.02-1.12) in the initial models; however, no psychosocial factors were associated with heart failure hospitalization in fully adjusted analyses. Among 3341 Hispanic women, 25.1% demonstrated positive deviance. Among high-risk Hispanic women, living alone was associated with increased risk of heart failure hospitalization (subdistribution hazard ratio 1.97, 95% confidence interval 1.06-3.63) in unadjusted analyses; however, no psychosocial factors were associated with heart failure hospitalization in fully adjusted analyses. Conclusions: Among postmenopausal African American and Hispanic women, a significant proportion remained free from heart failure hospitalization despite having the highest genetic risk profile and 1 or more traditional risk factors. No observed psychosocial factors were associated with incident heart failure hospitalization in high-risk African Americans and Hispanics. Additional investigation is needed to understand protective factors among high-risk African American and Hispanic women.