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AbstractObjectivesExposure to stressors is differentially distributed by race/ethnicity with minority groups reporting a higher stress burden than their white counterparts. However, to really understand the extent to which some groups bear a disproportionate stress burden, we need to consider race/ethnic differences in stress appraisal, specifically how upsetting stressors may be, in addition to stress exposure. We examine racial/ethnic differences in both the number of reported chronic stressors across five domains (health, financial, residential, relationship, and caregiving) and their appraised stressfulness among a diverse sample of older adults.MethodData come from 6,567 adults ages 52+ from the 2006 Health and Retirement Study.ResultsResults show older blacks, U.S. and foreign-born Hispanics report more chronic stress exposure than whites and are two to three times as likely to experience financial strain and housing-related stress. Socioeconomic factors fully explain the Hispanic–white difference in stress exposure, but black–white differences remain. Despite experiencing a greater number of stressors, blacks and U.S.-born Hispanics are less likely to be upset by exposure to stressors than whites. U.S.-born Hispanics are less upset by relationship-based stressors specifically, while blacks are less upset across all stress domains in fully-adjusted models. Foreign-born Hispanics are only less upset by caregiving strain.DiscussionThe distinction between exposure and appraisal-based measures of stress may shed light on important pathways that differentially contribute to race/ethnic physical and mental health disparities.

Background: The high prevalence of trau­ma and its negative impact on health among people living with HIV underscore the need for adopting trauma-informed care (TIC), an evidence-based approach to address trauma and its physical and mental sequelae. However, virtually nothing is known about factors internal and external to the clinical environment that might influence adoption of TIC in HIV primary care clinics.Methods: We conducted a pre-implemen­tation assessment consisting of in-depth interviews with 23 providers, staff, and ad­ministrators at a large urban HIV care center serving an un-/under-insured population in the southern United States. We used the Consolidated Framework for Implementa­tion Research (CFIR) to guide qualitative coding to ascertain factors related to TIC adoption.Results: Inner setting factors perceived as impacting TIC adoption within HIV primary care included relative priority, compatibility, available resources, access to knowledge and information (ie, training), and networks and communications. Relevant outer setting factors included patient needs/resources and cosmopolitanism (ie, connections to external organizations). Overall, the HIV care center exhibited high priority and compatibility for TIC adoption but displayed a need for system strengthening with regard to available resources, training, communica­tions, cosmopolitanism, and patient needs/ resources.Conclusions: Through identification of CFIR inner and outer setting factors that might influence adoption of TIC within an HIV primary care clinic, our findings begin to fill key knowledge gaps in understand­ing barriers and facilitators for adopting TIC in HIV primary care settings and highlight implementation strategies that could be employed to support successful TIC imple­mentation. Ethn Dis. 2021;31(1):109-118; doi:10.18865/ed.31.1.109