National Center for Complementary and Integrative Health of the National Institutes of Health.

Background. Previous studies have demonstrated that once-weekly yoga classes are effective for chronic low back pain (cLBP) in white adults with high socioeconomic status. The comparative effectiveness of twice-weekly classes and generalizability to racially diverse low income populations are unknown. Methods. We conducted a 12-week randomized, parallel-group, dosing trial for 95 adults recruited from an urban safety-net hospital and five community health centers comparing once-weekly (n = 49) versus twice-weekly (n = 46) standardized yoga classes supplemented by home practice. Primary outcomes were change from baseline to 12 weeks in pain (11-point scale) and back-related function (23-point modified Roland-Morris Disability Questionnaire). Results. 82% of participants were nonwhite; 77% had annual household incomes <$40,000. The sample's baseline mean pain intensity [6.9 (SD 1.6)] and function [13.7 (SD 5.0)] reflected moderate to severe back pain and impairment. Pain and back-related function improved within both groups (P < 0.001). However, there were no differences between once-weekly and twice-weekly groups for pain reduction [−2.1 (95% CI −2.9, −1.3) versus −2.4 (95% CI −3.1, −1.8), P = 0.62] or back-related function [−5.1 (95% CI −7.0, −3.2) versus −4.9 (95% CI −6.5, −3.3), P = 0.83]. Conclusions. Twelve weeks of once-weekly or twice-weekly yoga classes were similarly effective for predominantly low income minority adults with moderate to severe chronic low back pain. This trial is registered with ClinicalTrials.gov NCT01761617.

Increasing evidence suggests that individual differences in the reporting of microaggressions or subtle forms of everyday discrimination increases risk for poor health, but data on within-person associations between microaggressions and behavioral health outcomes is limited. This study examines the association between daily racial microaggressions and sleep disturbance and assesses whether the association is moderated by stigma consciousness. Participants were 152 Asian American college freshmen (87 male, 65 female) recruited to participate in a 14-day diary study. Perceptions of race-based stigma consciousness, everyday racial microaggressions, and self-reported sleep duration and quality were measured by questionnaire. Multilevel analyses showed that reports of daily racial microaggressions were associated with poorer sleep quality and shorter sleep duration the following day. Higher levels of stigma consciousness predicted greater sleep difficulties. Finally, stigma consciousness moderated the withinperson relation between microaggression and sleep. As participants' levels of stigma consciousness increased, so did their tendency to experience diminished sleep quality and shorter sleep on nights after they reported more racial microaggressions. These results remained robust after adjustments for age, gender, nativity, socioeconomic status, and individual differences in the average level of daily racial microaggressions reported. These results add to a growing literature on the effects of bias and unfair treatment reported by Asian Americans by demonstrating how and when such experiences may be particularly consequential for sleep.

BackgroundChronic low back pain causes substantial morbidity and cost to society while disproportionately impacting low-income and minority adults. Several randomized controlled trials show yoga is an effective treatment. However, the comparative effectiveness of yoga and physical therapy, a common mainstream treatment for chronic low back pain, is unknown.Methods/DesignThis is a randomized controlled trial for 320 predominantly low-income minority adults with chronic low back pain, comparing yoga, physical therapy, and education. Inclusion criteria are adults 18–64 years old with non-specific low back pain lasting ≥12 weeks and a self-reported average pain intensity of ≥4 on a 0–10 scale. Recruitment takes place at Boston Medical Center, an urban academic safety-net hospital and seven federally qualified community health centers located in diverse neighborhoods. The 52-week study has an initial 12-week Treatment Phase where participants are randomized in a 2:2:1 ratio into i) a standardized weekly hatha yoga class supplemented by home practice; ii) a standardized evidence-based exercise therapy protocol adapted from the Treatment Based Classification method, individually delivered by a physical therapist and supplemented by home practice; and iii) education delivered through a self-care book. Co-primary outcome measures are 12-week pain intensity measured on an 11-point numerical rating scale and back-specific function measured using the modified Roland Morris Disability Questionnaire. In the subsequent 40-week Maintenance Phase, yoga participants are re-randomized in a 1:1 ratio to either structured maintenance yoga classes or home practice only. Physical therapy participants are similarly re-randomized to either five booster sessions or home practice only. Education participants continue to follow recommendations of educational materials. We will also assess cost effectiveness from the perspectives of the individual, insurers, and society using claims databases, electronic medical records, self-report cost data, and study records. Qualitative data from interviews will add subjective detail to complement quantitative data.Trial registrationThis trial is registered in ClinicalTrials.gov, with the ID number: NCT01343927.