PROJECT SUMMARY
This randomized controlled trial will evaluate the impact of a novel race-based stress reduction program on
well-being, inflammatory burden, and DNA methylation (DNAm) in older African American (AA) women at risk
for cardiometabolic disease (CMD). Although the number of deaths related to CMD continues to decline, that
decline has slowed recently with AAs bearing a disproportionate burden. Furthermore, women face more sex-
specific risk factors for increased adiposity and AA women have the highest prevalence of obesity,
hypertension, and prediabetes compared to all other racial and ethnic groups. Chronic stress is associated with
low-grade inflammation and increased CMD risk. Growing evidence demonstrates that stressors such as
racism and discrimination are significant contributing factors to psychological distress, low-grade chronic
inflammation, and CMD health disparities among minorities, particularly among older AA women who endure
the intersection of both racism and sexism across their lifespan. Resilience, Stress, and Ethnicity (RiSE) is a
group-based, 8-week intervention that integrates cognitive-behavioral strategies focused on the
biopsychosocial impact of racism, racial identity development, and empowerment. Based on our preliminary
work, we anticipate that participation in RiSE will reduce psychological distress and inflammation. Further, our
previous work demonstrated that women with high levels of perceived discrimination have a greater
proinflammatory cytokine response to acute stress and decreased DNAm of genes related to inflammation and
hypertension. DNAm is one type of epigenetic process that modulates gene expression by adding or removing
methyl groups to DNA in response to the environment. Studies demonstrate that hyper or hypo methylation of
genes due chronic stressors, including racism and discrimination are significantly associated with CMD risk.
Emerging evidence demonstrates that psychobehavioral interventions may modify methylation of stress
response-related genes potentially buffering the impact of psychological stress at the molecular level.
However, few studies have examined the impact of a psychobehavioral intervention on changes in DNAm and
none have addressed chronic stress in older AA women.Therefore, the specific aims are: (1) Determine the
extent to which participation in RiSE decreases stress-related symptoms and inflammatory burden in older AA
women at risk for CMD; (2) Evaluate the extent to which RiSE increases the use of adaptive coping versus
maladaptive coping strategies in older AA women at risk for CMD; and (3) Determine the extent to which
participation in RiSE modifies DNAm of stress response- related candidate genes in older AA women at risk for
CMD from baseline to post RiSE intervention. AA women 50 to 70 years of age who are at risk for CMD will be
randomized into either an 8-week RiSE program or a health education program. RiSE is an innovative
intervention that addresses perceived racism and discrimination at the individual level. Further, RiSE has the
potential to improve the health of minority women impacted by racism and discrimination.
