Purpose in life, Socioeconomic Disadvantage, and Elevated Ambulatory Blood Pressure among Early Middle-aged African American Women in Atlanta, GA Public

Abstract

Hypertension is a leading cause of death and disability in the United States, and there are stark racial disparities in hypertension and hypertension-related outcomes such that African American women suffer disproportionately when compared to their white counterparts. Although some of the risk factors for hypertension, like obesity and physical inactivity, are more common among African American women, these factors do not fully explain the disproportionate rates at which African American women suffer from hypertension⁹. It is possible that differences in psychosocial factors could contribute to the excess risk for hypertension in African American women, but to date, literature on psychosocial contributors to increased risk of hypertension among African Americans focuses on the effects of psychosocial stressors. The purpose of this study is to determine whether purpose in life is associated with blood pressure and hypertension status and to determine whether this association is more pronounced among women with low socioeconomic status.

Participants were 424 African American women between the ages of 30-45 who responded to a 14-item version of Ryff’s Psychological Well-Being Scale, which assesses an individual’s sense of purpose in life. Self-reported measures of income and educational attainment were collected to assess socioeconomic status. Participants wore an ambulatory blood pressure monitor for 48 hours, where systolic and diastolic blood pressure readings were recorded every 30 minutes during the daytime and every hour at night. Linear regression analyses were used to model purpose in life with continuous blood pressure outcomes, and logistic regression analyses were used to model purpose in life with dichotomous blood pressure outcomes.

Results from logistic regression models testing the association between purpose in life and nighttime hypertension revealed a significant relationship (OR = 0.693; p-value = 0.014) after adjusting for age, income, highest degree, smoking status, and BMI. Purpose in life was not significantly associated with any other nighttime or daytime blood pressure outcomes. No significant associations emerged from the interaction between purpose in life and socioeconomic status.

Findings suggest that while purpose in life may be an important protective factor for nighttime hypertension, depression has a more pronounced effect on all blood pressure outcomes.

Table of Contents

Chapter I.

Background.........................................................................................................................1

Chapter II.

Introduction.........................................................................................................................5

Methods..............................................................................................................................11

Results................................................................................................................................15

Discussion..........................................................................................................................17

References..........................................................................................................................21

Tables and Figures.............................................................................................................32

Chapter III.

Public Health Implications, Possible Future Directions....................................................39

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Mot-clé	epidemiology women African American social blood pressure purpose in life hypertension psychosocial socioeconomic status
Committee Chair / Thesis Advisor	Tene Lewis, Emory University

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