Clinical Interactions Unit

Physical and
Mental Health

Perceived physical health and psychological distress will be assessed using the SF-12 Health Survey. The physical scale includes role limitations due to physical health problems, bodily pain, and general health. The mental scale reflects vitality, social functioning, role limitations due to emotional problems, and mental health (psychological distress and psychological well-being). The reliability and validity of the SF-12 is well established. It has been used extensively in studies of quality of life. A recent study by Munoz examined the relationship between adherence to the Mediterranean diet and self-perceived health based on the SF-12.

Depression

Depression will be measured using the Beck Depression Inventory-2nd Edition, an instrument recommended by the NHLBI-commissioned panel of experts for assessment of depression in patients with cardiovascular disease. The BDI-II has high reliability (alpha =.80) and factorial validity. Kendrick used the BDI-II to examine management of depression in the general practice setting , while Meldolesi examined quality of life and depression among a sample of patients with epilepsy.

Perceived Stress

The Perceived Stress Scale (PSS) will be used to measure self reported stress. The PSS captures the degree to which a person believes life to be unpredictable, uncontrollable, and overloaded. For each item, participants indicate whether they felt or thought a certain way within the past month. A single score is calculated by summing items, and higher scores indicate greater perceived stress. The measure has been used widely in health research. It demonstrates acceptable validity and reliability, and a brief 4-item version is both efficient and psychometrically consistent with lengthier versions. It has been used recently by Mikolasjczyk, El Ansari, and Maxwell to examine the relationship between food consumption frequency, perceived stress, and depressive symptoms.

Big Five Personality Traits

Big Five personality traits will be measured using the ten-item Brief Big Five measure. This measure was developed specifically for use in research endeavors where circumstances may permit only a brief assessment of personality. It assesses Neuroticism, Extraversion, Openness, Conscientiousness, and Agreeableness and contains ten questions. This measure has shown strong test-retest reliability and also strong convergent validity with lengthier measures of Big Five personality.

Trait Anger
and Hostility

The Spielberger State-Trait Anger Expression Inventory (STXI) will be used to assess trait anger. The trait component of this 10-item measure assesses the frequency with which anger is generally experienced. This measure has demonstrated desirable psychometric characteristics such as strong internal consistency and a replicable factor structure. We will measure trait hostility with the Symptom Checklist-90-R Hostility Scale a measure that has shown strong internal consistency, test-retest reliability, and validity. Caska used the inventory to examine the relationship between anger expression and poor sleep quality among patients with coronary heart disease.

Daytime sleepiness will be measured by the reliable and valid Epworth Sleepiness Scale (ESS). The level of sleepiness is assessed by asking participants to report the likelihood of dozing off or falling asleep during 8 situations (e.g., sitting and reading, watching TV) on a scale ranging from 0=no chance of dozing to 3=high chance of dozing. Scores range from 0 to 24 with higher scores reflecting greater sleepiness. Chasens, Umlauf, and Weaver used the instrument to assess sleepiness, physical activity, and functional outcomes among diabetic patients. Dolan reported that the ESS has comparable psychometric features to the Time of Day Sleepiness Scale.

Strength of African-
American Identity

Individual differences in strength of African-American identity will be measured using the centrality subscale of the Multidimensional Inventory of Black Identity (MIBI). The 8-item centrality dimension, which has strong external validity, captures the extent to which people normatively defines themselves by race, and whether race is a core part of their self-concept. The measure will be adapted for use with other ethnic and racial minority group members participating in the studies.

Perceived
Discrimination

We will assess perceived discrimination using the Everyday Discrimination Scale. This 9-item measure assesses individual perceptions of everyday discrimination.

Perceived Racism

We will measure perceived racism (discrimination attributable to race) using the Racism and Life Experiences Scale (RLES) . Consistent with prior uses of the RLES, we will slightly modify this measure to assess perceived experience of intergroup racism. The measure also has been shown to predict physiological reactivity to stress induction in African-Americansxxiv. The questions ask about perceived racism across the domains of employment, law, finances, education, community, family-social relationships, emotional well-being, physical health, and public assistance. The instrument has been used to examine the relationship between hypertension and racism.

Spirituality
and Religiosity

Spirituality and Religiosity will be assessed using the Brief Multidimensional Measurement of Religiousness/Spirituality (BMMRS). This battery was designed specifically for use in health research. Key dimensions that will be assessed in the current research included a overall religiosity subscale, an organizational religiosity subscale, and a daily spiritual experiences.

Provider Cultural
Competency

Cultural competency ratings for healthcare providers whom participants interact with will be assessed using the patient report measure developed by Lucasxxix. This measure assesses patient perceptions of a health care provider’s knowledge of cultural characteristics. For example, “How knowledgeable do you feel that this doctor is of African-American culture?” It also measures awareness of culture differences (“Does this doctor seem to be aware of African-American cultural differences?) and skill in incorporating patient culture (“Do you think that this doctor is well-equipped to treat patients with an African-American background?”). This tripartite model is assessed using nine items, three items measuring each subcomponent using a Likert-type scale. Psychometric analyses suggest both convergent and incremental validity when the subscales are correlated with related constructs such as trust, satisfaction, and perceived discrimination by a healthcare provider. The instrument will be adapted for use with other racial and ethnic minority group patients.

Chronic stressor
exposure

Will be measured using the 22-item Chronic Stress Scale that contains five subscales: family stress (? =.63), financial vulnerability (? =.78), physical environmental stress (? =.72), police stress (? =.84) and safety stress (.83) Cronbach alphas were established using a random sample (N=679) of predominantly low-income African American women who reside on Detroit's east side. Satisfactory Cronbach alphas have also been established using a sample of 919 men and women living in Detroit.

Social Support

Social support will be measured using the 6-item ENRICHD Social Support Instrument (ESSI). The ESSI assesses the availability of functional and emotional support. Items are rated on a scale from 1 (none of the time) to 5 (all of the time). Cronbach's alpha reliability of the ESSI in our previous in Detroit by Artinianxxxi was .86.

Literacy

The Rapid Estimate of Adult Literacy in Medicine (REALM) will be used to measure health-related literacy. The REALM is a medical-word recognition and pronunciation test comprising 66 medical terms, arranged in order of complexity by the number of syllables and pronunciation difficulty, starting with simple one-syllable words (e.g., pill, eye) and ending with multisyllabic words (e.g., antibiotics, potassium). The score assigns health literacy skills into 4 categories of grade-equivalent reading level.

Neighborhood
Characteristics

Characteristics will be assessed using items from the Neighborhood Health Questionnaire. Respondents will be asked about trash, noise, quality of buildings, walkability, public transportation, availability of groceries, violence, recreation, socializing, and crime.