Reducing race-based stress improves well-being

RACISM and discrimination can seep into every aspect of a Black woman’s life: from the stress of being a minority in a workplace that might be tinged with microaggressions or overt racism to living in a neighborhood that’s not welcoming or still marked by historic redlining to worrying about the safety of loved ones every time they leave the house.

Karen Saban, PhD, APRN, CNRN, FAHA, FAAN, a professor and associate dean of research and scholarly innovation at Loyola Nursing, has studied health disparities in cardiovascular disease for years. “Even if you control for things like weight, smoking, and diet, disparities still exist, especially for women of color,” she notes. “We know that stress, particularly social stressors like discrimination, can increase inflammation and risk of cardiovascular disease.” Saban designed the Resilience, Stress, and Ethnicity (RiSE) program to reduce race-based stress in Black women at risk for cardiovascular disease.

After connecting with two local psychologists who were implementing a race-based stress-reduction program for veterans of color in the Chicago area, Saban collaborated with them to tailor the program for Black women. During the eight-week pilot, 40 women attended in-person small-group sessions facilitated by the psychologists. Participants shared how racism and discrimination affect their daily lives and discussed how their emotions affect their body. The psychologists—Darnell Motley, PhD, University of Chicago faculty, and Lamise Shawahin, PhD, Governors State University faculty, introduced the women to stress-reducing strategies, including listening to music, coloring, meditation, journaling, and setting boundaries. “We give them a toolbox so they can choose the best tools to address their specific needs,” Saban says.

The pilot study was promising, with early data showing a positive impact. Participants gave the program rave reviews; they reported that it increased their awareness of race-based stress, provided coping tools, and enhanced their feeling of empowerment.

Regina Conway-Phillips, PhD, RN, associate professor and department chair of Health Systems and Adult Health Nursing at Loyola Nursing led the qualitative analysis of feedback from participants. “Black women are exposed to stress almost from day one,” says Conway-Phillips. “We might not even realize it’s stress. But if your body is on alert at all times, it adds up. When does your body relax? Living under constant tension isn’t healthy for anyone.”

“Participants said the program provided them with the tools to negotiate life as Black women who are at risk of cardiac issues, hypertension, and other diseases that increase with stress,” says Conway-Phillips. “It helped them deal with the daily pressures of being Black women in America.” In particular, participants appreciated opportunities to discuss painful issues in a safe space. “When they were subjected to a racist comment, a racial injustice, or someone disrespecting them in another way, the program allowed them to express themselves,” Conway-Phillips notes. “A lot of that gets bottled up because the comment might come from a manager, and because the woman needs the job she takes it, and takes it, and takes it. After a while, she can’t even validate her feelings. Allowing the women to express their hurt helped validate their feelings.”

Saban notes that while the RiSE intervention can help Black women better cope with stress associated with racism and discrimination, it is imperative to continue working to eradicate discrimination and racism throughout society. “RiSE may help individuals cope with racism, but eliminating structural racism on a systems level is so needed,” she says.

She plans to continue examining the effectiveness of RiSE in a larger, randomized controlled trial and says that the program also may benefit Black men, students of color, LGBTQ individuals, and anyone experiencing stress associated with racism and discrimination. “I’m excited about it because it can be replicated in other populations,” she says. “RiSE is a low-cost, low-risk intervention that may be effective in helping reduce chronic stress in a variety of populations experiencing discrimination.”

Understanding disparities in breast cancer screenings

CHRONIC STRESS IS JUST ONE FACTOR affecting the healthof Black women. They are also less likely to get potentiallylife-saving early cancer screenings because of distrust of thehealth care system, lack of access, and other barriers. Theproblem is especially acute in Chicago, which has one of thenation’s highest disparity rates in breast cancer mortality.

To better understand the thought processes of Black womenconsidering a mammogram screening, Associate ProfessorRegina Conway-Phillips, PhD, RN, led a qualitative study ofrarely or never screened Black women. She learned that somebarriers were logistical, such as lack of insurance and access tohealth care. Other barriers were deeply rooted in cultural beliefsand fear: some women did not trust the health care systembecause of past and present systemic racism; others werefearful of pain; and some believed a myth that mammogramscause breast cancer. Yet others believed it wasn’t their place tointerfere with God’s plan or worried that thinking about cancerwould make it more likely to occur.

Many women admitted they would not feel comfortable sharingtheir beliefs and fears with their health care providers. “Thewomen were open to exposing their true concerns because I’ma Black researcher. They could be honest and open in a safespace about what they really believed and how they really felt,”Conway-Phillips says. “They are reluctant to tell doctors theirreal reasons.”

Diversifying the health care field is one way to bridge the gapand more effectively address health disparities, Conway-Phillips notes. “We need to get more Black nurses into theprofession,” she says. “It’s so important. People will tend to goto, listen to, and trust people who look like them and who comefrom the same culture or ethnic background. They know that ifthey say something that sounds different to a white health careprovider or white nurse who doesn’t understand their culture,they run the risk of being criticized. People feel safer sharing acultural belief with someone who shares that culture.”

In her study, Conway-Phillips discovered that female relativesand close family friends were the most powerful influencers ofa woman’s decision to have a mammogram, and she plans touse that insight to develop an intervention. “I’d like to explorethe intergenerational aspects of breast cancer education andawareness,” she says. “It’s not necessarily to make women havemammograms. Rather, it is to give someone the facts aboutcancer screenings so they can make an informed decision.”