Social Contributors to the Cardiovascular Health of Young Adult Black Women

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Black females experience disparate rates of hypertension and earlier decline in cardiovascular health (CVH) than other females in the U.S. To date, much of research has focused on health behaviors, but more research is needed to understand how adversities early in life and in the social environment may contribute to premature decline in CVH among young Black women. Studies show that early life stress in the form of adverse childhood experiences (ACEs), like family dysfunction and child maltreatment, are reported in higher numbers by women, and historically minoritized populations, and experiencing four or more adversities in childhood may independently double the odds of CVD. In addition, social adversities like racial discrimination, housing insecurity, and social isolation in young adulthood may also contribute to inequities in CVH. Many health behaviors, such as cigarette use and dietary intake, are used as a stress coping measure, further highlighting the importance of understanding the stressors and adversities that are commonly experienced by young adult Black women. However, much of research has focused on CVD as a disease of middle and older adults, but less is known about the CVH of young adult Black women.

Young adulthood is an important developmental period when women are busy launching careers, and establishing social roles such as intimate partnerships and parenting, and forming new health behavior patterns to accommodate these changes. Per the developmental origins of health and disease hypothesis, stress, adversity, and health behaviors in young adulthood not only affect the individual, but also that of future generations. Improving the CVH of young adult Black women is essential to reducing and eliminating health inequities, and requires an appreciation of the heterogeneity among Black women, and the use of innovative approaches to identify subgroups of women who are doing well.

This dissertation includes a systematic review of the published literature on ACEs and blood pressure among women in the United States, and a secondary analysis of The National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine how adverse childhood and social experiences relate to the cardiovascular health (CVH) health of young adult Black women. The systematic search of three databases identified 1,640 articles, and ten met all established inclusion criteria. In our review ACEs were positively associated with blood pressure in six of the ten articles reviewed. The inconsistency in results may be related to self-report vs objective assessment of blood pressure. Racial and ethnic diversity was limited, with half of the articles consisting of samples that were majority White. Future research should incorporate diverse, population representative samples, with consideration for sex-or-race specific stressors, such as racism, and its potential impact on blood pressure and CVH.

Data presented in the remaining three chapters of the dissertation study are an observational, cross-sectional analysis of data from Black females, ages 24-32 who participated in the Add Health study at wave four. The first data based chapter examines if social adversities and sleep characteristics are indicators of increased risk of hypertension among young adult Black women. Of the five social adversities (social isolation, discrimination, high perceived stress, low subjective social status, child abuse) and four sleep characteristics examined (delayed sleep onset, poor sleep continuity, short sleep, long sleep, and snoring), only discrimination and poor sleep continuity were positively associated with higher odds of hypertension, adjusting for age and BMI. Since social adversities often co-exist, the next chapter examined patterns or latent classes of social adversity. Three latent classes were identified: (1) low stress, (2) high violence, and (3) high stress. In analyses adjusted for age, income, education and depression, the subclasses of social adversity were related to diet, and physical activity, but were not related to overall ideal CVH. Whereas chapters 3 and 4 both focused on stressors in young adulthood as predictors of CVH, chapter 5 added an additional life course perspective by considering the impact of adverse childhood experiences on CVH. This chapter also sought to advance the literature by examining the maternal relationship and religion and spirituality in adolescence and young adulthood as potential protective factors that may buffer the stress of childhood adversity. The results in chapter five suggest that a strong religious and spiritual connection in adolescence or young adulthood may promote CVH among young Black women, but it’s impact on CVH is diminished after taking into account other factors such as severity of ACEs, socioeconomic status, and mental health. The second proposed protective factor, maternal relationship, did not have a significant direct influence on CVH.

This study may be the first to explore CVH in a within-group, population-representative sample of young adult Black women in the United States. The present findings suggest there are critical differences in how social contributors influence health, and in fact, many of the social constructs measured had little influence on health. This suggests that the factors measured may not accurately reflect the underlying construct for different subpopulations. Moreover, there may be other social factors that are not well captured in existing scientific research that likely are impacting the health of Black women and need to be explored, to advance the American Heart Association’s goal of equitable improvements in CVH.






Scott, Jewel (2020). Social Contributors to the Cardiovascular Health of Young Adult Black Women. Dissertation, Duke University. Retrieved from


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