Cardiovascular disease (CVD) is the number one killer of women in the United States and African-American women have strikingly high rates of CVD-related death and disability compared to White women. These stark racial disparities have persisted for decades, have increased among young to middle-aged women, and are not explained by traditional clinical risk factors or socioeconomic status (SES). Racism-related stressors have been proposed as one potential pathway through which race impacts cardiovascular health; but most studies have focused on interpersonal experiences of racism, which may actually underestimate the impact of racism- related psychosocial stress on CVD. The proposed research is designed to determine whether a novel, racism-related stressor -expectations of racism --is a risk factor for early CVD in African-American women. We have compelling cross-sectional preliminary data demonstrating that among African-American women, expectations of racism are associated with measurable indices of CVD; independent of actual experiences of racism, and other forms of psychosocial stress. This application builds upon this prior work by using innovative methodologies from public health and psychology to determine whether, in what contexts, and how this unique psychosocial stressor contributes to CVD risk in African-American women over time. We will examine expectations of racism and increases in early CVD risk over a 2-year follow up in a community sample of 400 healthy African-American women aged 30-45. Early CVD risk will be assessed via changes in carotid intima media thickening (CIMT), a measure of atherosclerosis, and 48-hour ambulatory blood pressure (ABP), a measure of autonomic physiologic arousal and a potential mechanism linking expectations of racism to IMT. Additionally, because research suggests that expectations of racism are largely influenced by context, we will examine whether associations are more pronounced among women with high (vs. low) levels of exposure to interracial contact (assessed via novel measures of activity spaces that can determine the average percentage of time spent in integrated vs. segregated environments). Finally, in order to determine how high levels of expected racism contribute to physiological responses and psychological distress on a day-to-day basis, we will conduct a daily diary study in a subsample of women, to examine daily ABP reactivity to interpersonal stressors, as well as day-to-day affect. Secondary aims will examine additional psychosocial stressors and cultural resources as potential moderators, and rumination, negative affect and social disconnectedness as potential mediators. Findings from this study will ultimately be used to develop psychosocial interventions to help African-American women at risk for CVD cope with the threat of expected racism.
The goal of the proposed research is to determine whether a novel, racism-related psychosocial stressor is a unique risk factor for early cardiovascular disease (CVD) in young to middle-aged African-American women. Recent research suggests that African-American women aged 35-44 have rates of CVD that are higher than those of African-American men, White men, and White women. These disparities are not due to obesity or other traditional CVD risk factors and are likely to increase over time. Identifying the determinants of early CVD in African-American women will be key to designing preventive interventions for this understudied, at risk group, and ultimately reducing their excess burden of disease.