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Cumulative stress burden and cognitive function in African American adults living in low-income neighborhoods

Fan, Erica (2021) Cumulative stress burden and cognitive function in African American adults living in low-income neighborhoods. Master Essay, University of Pittsburgh.

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Dementia disproportionately affects African Americans. Differences in prevalence may be related to stress: African Americans are more likely to be exposed to stressors as a result of racial discrimination and living in segregated and disadvantaged neighborhoods. Despite this, few studies have considered the role of cumulative stress in cognitive decline across cognitive domains in a longitudinal aging cohort.

We hypothesize that individuals with higher cumulative stress, as quantified by a cumulative stress burden (CSB) index, will have poorer cognition across all domains.

Stressors and cognition by domain (executive, attention, memory, visuospatial, and language) were measured in a cohort of 253 participants 50 years and older, recruited from two urban, primarily African American neighborhoods in Pittsburgh, PA. Domains were assessed by z-scores adjusted for age, sex, and educational attainment calculated through combining relevant cognitive tests. Stressors include perceived stress, psychological distress, unfair treatment, post-traumatic stress disorder, neighborhood satisfaction, safety, and walkability. Factor analysis and assessment of stress variability over time was performed. Three indices were formed by dichotomizing stressor scores and summing: individual-level, neighborhood-level, and a sum of both. Generalized linear models adjusted for covariates were used to assess the relationship between these indices and cognition, as well as the relationship between individual stressors and cognition.

The individual CSB index was associated with language (= -0.11, p= 0.03) and executive function (= -0.087, p=0.04) in unadjusted and adjusted models. The neighborhood-level CSB index was not significantly associated with cognition. The combined index was significantly associated with language in both unadjusted and adjusted models (= -0.10, p= 0.01). When all four components of the individual CSB index were assessed, there were no significant associations between any particular stressor and cognition.

These results show that increased cumulative stress is associated with poorer cognitive function in older African Americans. This indicates that a more holistic and comprehensive assessment of cumulative stress is vital in understanding the dimensionality of racialized stress for older adults potentially experiencing cognitive decline. Additionally, this analysis provides evidence for the public health relevance of interventions in African American neighborhoods aimed at decreasing experiences of stress.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Fan, Ericaekf13@pitt.eduekf13
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairRosso, Andreaalr143@pitt.edualr143UNSPECIFIED
Committee MemberWeinstein, Andreaweinsteinam2@upmc.eduUNSPECIFIEDUNSPECIFIED
Committee MemberDubowitz, Tamaradubowtz@rand.orgUNSPECIFIEDUNSPECIFIED
Date: 10 February 2021
Date Type: Completion
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 48
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 10 Feb 2021 16:06
Last Modified: 10 Feb 2021 16:06


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