JULY 2013 NEWSLETTER BLAC K WOMEN'S HEALTH STUDY IN SIDE: Working together • The BWHS Examines Stress and Illness to improve the health of • Health Recommendations black women • New BWHS Cancer Research www.bu.edu/bwhs STUDYING STRESS IN THE BWHS I HIS NEWSLETTER focuses on BWHS studies of "stressors"-experiences that may evoke a stress response in the body. This "fight or flight response" has probably been Tpresent for thousands of years; for early humans, it was critical to survival. In the face of danger, the body produces chemicals that increase heart beat and blood flow, preparing the person to fight or to run away. This kind of response to short-term stress makes sense, even now. When we shout, "Don't touch!" to a toddler who is near a hot stove, the child may become stressed for a few moments, but learns not to touch the stove. However, stresses that are present IN EMERGENCY BREAK GLASS all or most of the time-chronic stresses-can have undesirable effects on physical and mental health. The I FIGHT I IFLIGHT I BWHS is making important contributions by studying stressors in relation to a range of diseases that affect black women. This research will help explain how and why illness occurs and, we hope, provide strong evi­ ct~ dence for public policies, programs, and laws that can help reduce stress in people's lives. THE 2013 HEALTH INFORMATION UPDATE Once again, it's time to update your health information with the BWHS. You may have received an email inviting you to fill out the 2013 health survey online, or a paper survey in the mail. Just think-your 20 minutes or so every two years has made more than 120 scientific papers possible from the BWHS, the most recent of which include results on breast cancer, sarcoidosis, weight change, and uterine fibroids (check them out at www.bu.edu/bwhs). Your he lp is crucial and very much appreciated by the National Institutes of Health (which funds the study); by the doctors and health practitioners who learn from the results; by the BWHS investigators and staff; and by future genera­ tions of black women who will benefit from the findings. CONTACT INFORMATION _ _ _ __ _ _ _J Telephone: '-800-786-0814 or 617-734-6006 Email: [email protected] Fax : 617-738-5119 Website: www.bu.edu/ bwhs Address: Black Women's Health Study Boston University Slone Epide miology Center Boston University Medical Cent er 1010 Commonwealth Avenue Slone Epidemiology Center Boston, MA 02215-1204 2 BLACK WOMEN'S HEALTH STUDY July 2013 newsletter WHAT ARE COMMON STRESSORS? • Many African Americans experience racism in their daily lives, in housing, on the job, and in other areas. • Millions of Americans are in demand­ ing caregiving roles. Caregiving can be rewarding but can also be stressful if the caregiver does not receive support or relief. Family caregiving is more common among black women. • Major depression is widespread and a leading cause of disability worldwide. • African Americans are more likely BWHS INFORMATION ON STRESSORS than whites to live in stressful circum­ AND POSSIBLE PROTECTIVE FACTORS: stances, such as in neighborhoods • In 1997 and 2009, the BWHS survey with high crime rates. asked about experiences of racism in • On various health surveys, up to one­ daily life, on the job, in housing, and fourth of American women report by the police. some form of physical or sexual abuse • The 1999 and 2009 surveys asked about during childhood. Large numbers of feelings of depression or happiness. teenagers and adults are also affected. • The 2001 survey asked you to list up WHAT CAN PROTECT to five important things that you do AGAINST STRESS? for your health. • The harmful effects of stress can be reduced by family and social support. • The 2005 survey asked about stress and coping, attending church, prayer, • Coping skills can lessen the harmful spirituality, and experiences of abuse. effects of stress (for example, getting help or emotional support, or working • The 2011 survey asked about support to change the situation). from friends, family, and others. It also included questions on caregiving • Religion, spirituality, and meditation and how you rated your physical and may also reduce the harmful effects mental health. of stress. • Almost every survey asked about • Exercise often reduces the stress exercise. response. 1-800 -786-0814 o r www . bu .e du/bwhs 3 BWHS RESULTS ON STRESS REPRODUCTIVE OUTCOMES • Mothers with a high level of depres­ • The first BWHS paper on the health sion before pregnancy had a higher effects of a stressor assessed racism risk of their babies being born pre­ and premature birth (Rosenberg maturely (Phillips et aI., 2010); other et aI., 2002). A higher risk of studies have found similar results premature birth was associ­ for depression during pregnancy. ated with unfair treatment • BWHS participants who reported on the job and with people having been sexually abused as chil­ acting afraid of the partici­ dren got their periods at an earlier age pant. These results have been than women who had not been abused confirmed in later studies. (Wise et al., 2009). The same rela­ • BWHS participants with more tionship has been found among white frequent experiences of racial discrimi­women. nation had a higher risk of developing • BWHS participants who reported uterine fibroids than women with fewer abuse during childhood were more such experiences (Wise et al., 2007). Ilikely to develop uterine fibroids The increase was smaller or nonexistent (Wise et aI., 2012); the increase in among women who were better able risk was less among women with to cope - for example, those who often good coping skills. Similar results received support from a friend or who were found in a study of white nurses. usually took action to improve situations. CANCER AND CANCER SCREENING • Being physically abused as an adult was • The BWHS published the very first associated with a higher risk of breast results on racism and the occurrence cancer (Wise et al., 2011). This is the of breast cancer (Taylor et aI., 2007). first report of such a link and needs Among participants under age 50, confirmation. women who reported frequent experi­ • BWHS participants with more ences of racism in daily life or in hous­ frequent experiences of racism in ing, on the job, and by police were more daily life were slightly less likely to likely to develop breast cancer. No I go for Pap smears, but just as likely other study has reported on this issue. as others to have a mammogram or Stressors may contribute to inflamma­ colonoscopy (Mouton et aI., 2010). tion, which in turn may increase the risk of some types of cancer. 4 BL ACK WOMEN'S HEALTH STUDY July 2013 newsletter OBESITY AND METABOLIC (Cozier et aI., 2009). Experimental DISORDERS evidence has shown that stress can • There was no link between ex peri­ lead to weight gain. ences of racism and high blood pres­ • High levels of physical and sexual abuse sure except possibly among women during childhood were associated with born outside of the United States higher risks of obesity (Boynton -Jarrett (Cozier et aI., 2006). et al., 2012). The association was • The incidence of high blood pressure partly explained by health behaviors among BWHS participants who lived in adulthood, which might have been in poorer neighborhoods was greater influenced by early abuse. than that among women in wealthier • Women who lived in poorer neigh­ areas (Cozier et al., 2007). This adds borhoods more often developed to evidence that health is affected by diabetes than women who lived in living conditions as well as by personal wealthier areas (Krishnan et aI., factors. 2010). Efforts to reduce diabetes • Weight gain was greater incidence need to consider healthy among BWHS partici­ and unhealthy aspects of neighbor­ pants who most often hoods. experienced racism OTHER RESULTS linked with an increased risk of asthma • Experiences of racism were unrelated in children. These associations may to death from all causes or from heart result from an effect of stress disease or cancer (Albert et aI., 2010). on the immune system. • Childhood abuse was associated with • Participants who a higher risk of developing asthma as exercised the most were an adult (Coogan et al. , 2012). This least likely to be depressed is believable because abuse has been (Wise et aI. , 2006). SUMMARY (see www.bu.edu/ bwhs/research/ publications for more detail s) BW HS re search indicates that stressors such as racism and childhood abuse are associated wit h negative health effects. In some ca ses, good coping skills are effective in lowering the risk. Future analyses wil l assess other conditions, other stressors, and protective factors. 1·800·786· 08 14 o r www. bu .edu/ bwhs 5 • Limit high-calorie foods li ke sweets. • Avoid drinks with added sugar. RECOMMENDATIONS FOR PHYSICAL ACTIVITY Many health organizations and experts have issued recommendations for physi­ cal activity; while their proposals vary, HEALTHY EATING GUIDELINES they all agree that exercise is essential to Today more than 12 million Americans a healthy life. The u.s. Centers for Dis­ are cancer survivors-about one of ease Control and Prevention (CDC) rec­ every 25 people. In 2012, the American ommends that adults, including seniors, Cancer Society issued new guidelines spend two and a half hours a week (150 for healthy living, which are available at minutes) doing moderate and vigorous their website, www.cancer.org. A great activity and muscle strengthening (www. deal of research shows that stickin g CDC.gov). How can most people fit exer­ to these guidelines lowers the risk of cise into their schedules? According to developing cancer, heart disease, dia­ the CDC, even if you do 10 minutes at a betes, and many other illnesses.