The Health Implications of Stress among Asian Americans in the US and Chinese In China: the Effects of Perceived Stress and Caregiving Stress on Cardiovascular Risk Factors

Prior research suggests that stress plays a role in the etiology and progression of cardiovascular disease (CVD). To lend a more accurate depiction of the associations between stress and CVD risk factors, this dissertation used a comprehensive approach to conceptualizing stress by assessing two dimensions of stress: perceived stress and caregiving stress. The objective of this dissertation was to investigate the associations between multiple dimensions of stress and the risk factors of CVD. This dissertation also explored the potential mechanisms that underlie the relationships between stress and CVD risk factors. In Paper 1 (Chapter 3), we assessed the associations between perceived stress and hypertension across varying levels of social support and social network among 530 Chinese, Korean and Vietnamese Americans. Results indicated that individuals with high perceived stress were 61% more likely to have hypertension compared to those with low levels of perceived stress (Odds Ratio (OR): 1.61, 95% Confidence interval (CI): 1.15, 2.46). Social support had a direct beneficial effect on hypertension, irrespective of whether individuals were under stress. In Paper 2 (Chapter 4), we used five waves of longitudinal data from the China Health and Nutrition Survey to examine the association between parental caregiving and blood pressure among 2,586 Chinese women. We found that parental caregivers were associated with higher systolic (β-coefficient (β) = 1.16; p ≤ 0.01) and diastolic blood pressure (β = 0.75; p ≤ 0.01) compared with non-caregivers across multiple waves. In Paper 3 (Chapter 5), we investigated the relationship between caregiving trajectory and Metabolic Syndrome (MetS) among 1,636 Chinese women. Three caregiving trajectories were identified by using group-based trajectory analysis. Results showed that ‘rising to high-intense’ caregivers (OR = 1.90; 95% CI: 0.90, 4.00) and ‘stable low-intense’ caregivers (OR = 1.56; 95% CI: 1.06, 2.29) were associated with higher risk of MetS compared with non-caregivers. This dissertation is innovative in its examining the associations of multiple dimensions of stress with CVD risk factors among Asian subgroups. Findings from the proposed study will be used to develop future stress management interventions, and incorporating culturally and linguistically appropriate strategies into community outreach and education to decrease cardiovascular disease risk within the Asian population