Woods Sarah B, Hiefner Angela, Roberson Patricia N E, Zahra Nida, Arnold Elizabeth Mayfield, Udezi Victoria
Department of Family and Community Medicine, UT Southwestern Medical Center, University of Texas Southwestern Medical School, Dallas, Texas, USA.
College of Nursing, University of Tennessee, Knoxville, Tennessee, USA.
Fam Process. 2023 Mar;62(1):230-253. doi: 10.1111/famp.12789. Epub 2022 May 30.
African Americans are at significantly greater risk of hypertension and worse cardiovascular outcomes than other racialized groups, yet hypertension intervention effects remain limited. Thus, it is necessary to understand the potential mechanisms whereby interventions may be more effectively targeted to improve health. Supported by prior research evidence and guided by the Biobehavioral Family Model, this study examined associations between family relationship quality, psychological wellbeing, and self-management behaviors for African Americans with hypertension. Data were pooled from three Midlife Development in the U.S. projects, resulting in a sample of 317 African Americans (63.4% female, M = 53.32) with self-reported high blood pressure in the past 12 months. We tested four cross-sectional multiple mediator models, with depressed mood and environmental mastery mediating associations between family strain and exercise, smoking, problematic alcohol use, and stress-eating. Environmental mastery mediated the association between greater family strain and decreased odds of achieving recommended exercise levels; greater odds of reporting problematic alcohol use; and greater stress-eating. Though family strain was associated with depressed mood in each model, this variable did not serve as an indirect pathway to self-management behaviors. Family strain, and the potential pathway identified via environmental mastery, may be a meaningful predictor of disease self-management for African Americans with hypertension. Longitudinal studies are needed to examine directionality and to support intervention trials for improving self-management and hypertension outcomes.
与其他种族群体相比，非裔美国人患高血压的风险显著更高，心血管疾病的预后也更差，但高血压干预效果仍然有限。因此，有必要了解可能使干预措施更有效地针对改善健康状况的潜在机制。在先前研究证据的支持下，并以生物行为家庭模型为指导，本研究调查了高血压非裔美国人的家庭关系质量、心理健康和自我管理行为之间的关联。数据来自美国中年发展的三个项目，最终样本为317名在过去12个月中自我报告患有高血压的非裔美国人（63.4%为女性，平均年龄M = 53.32岁）。我们测试了四个横断面多重中介模型，其中抑郁情绪和环境掌控在家庭压力与运动、吸烟、问题饮酒和情绪化进食之间起中介作用。环境掌控在更大的家庭压力与达到推荐运动水平的几率降低、报告问题饮酒的几率增加以及情绪化进食增加之间起中介作用。虽然在每个模型中家庭压力都与抑郁情绪相关，但该变量并未作为自我管理行为的间接途径。家庭压力以及通过环境掌控确定的潜在途径，可能是非裔高血压患者疾病自我管理的一个有意义的预测指标。需要进行纵向研究来检验方向性，并为改善自我管理和高血压预后的干预试验提供支持。
