The Impact of Social Support, Psychosocial Characteristics, and Contextual Factors on Racial Disparities in Hypertension

Hypertension is a serious medical condition. Although men and women of all racial groups in the US suffer from high blood pressure, black women have the highest rates of hypertension. For instance, the age-adjusted prevalence of hypertension among black women ages 20 and over is 44.3, compared to 28.1 among white women, 40.5 among black men, and 31.1 among white men. Past research has focused on SES and behavioral factors as potential explanations for blood pressure disparities between black and white women. But, even after controlling for such factors, considerable disparities remain. The goal of this research is to examine cultural and social factors that have been shown to increase blood pressure. Specifically, I examine social support, psychosocial characteristics, and contextual factors associated with race/ethnicity and hypertension, in hopes of explaining some of the disparities in high blood pressure between black and white women. iii Using data from Waves I, III, and IV of the National Longitudinal Study of Adolescent Health (Add Health), I estimated a sequence of multinomial logistic regression models predicting prehypertension and hypertension in young adulthood. Cross-sectional models show that racial disparities in hypertension remain after controlling for social support, psychosocial characteristics, and contextual factors. In fact, the only covariate that substantially reduced the racial disparity in hypertension was body mass index (BMI), a fairly reliable measure of body fatness for most people. I also estimated a set of multinomial logistic regression models predicting odds of prehypertension and hypertension by adolescent and cumulative social support, as well as psychosocial, contextual, and behavioral factors. These models were included to determine if early life and/or cumulative factors and conditions would help explain racial blood pressure disparities not explained by adulthood factors. Findings show that none of the early life or cumulative social support, psychosocial, contextual, or behavioral factors helped to explain racial differences in prehypertension or hypertension. Even after controlling for these factors, black women are still 1.18 times more likely than white women to have prehypertension and over two times more likely to suffer hypertension. Indeed, my findings indicate that, of the factors included in all these models, only race, age, and BMI were significant predictors of blood pressure. Also, BMI was the only factor to explain some of the disparities between black and white women. These results are similar to other studies that have examined racial health disparities, suggesting that simply being a black woman in US society may be unhealthy. The health effects of racism, discrimination, and other sources of stress faced disproportionately by black women are not easily measured by social science research, which is possibly why racial disparities in blood pressure have yet to be explained. Future research should also explore possible epigenetic effects introduced by the health conditions experienced by previous generations, as well as the influence of prenatal and early life environments