My overarching goal is to elucidate the root causes of poor hypertension control in the African American population. Working in the Cooper Green Health System (CGHS), an urban, inner-city setting in Birmingham, Alabama, we found that approximately 80% of African Americans diagnosed with hypertension did not have their blood pressure adequately controlled. Perceived discrimination and lack of trust in the medical system may be important determinants of hypertension medication adherence, greatly contributing to these alarming health disparities. These factors also influence how African Americans cope with stress and are linked to the reliance on home remedies instead of appropriate medication management. This cross-sectional study will examine the association of sociocultural factors with medication adherence among African Americans using existing data (2007-8) from the TRUST project, funded by the National Heart Lung and Blood Institute. The TRUST Principal Investigators, Drs. Jeroan Allison and Sandral Hullett will serve as mentors for this research. An internship with Dr. Hullett will provide an opportunity to work with the patients of CGHS, the same population from which the TRUST participants were recruited.
The specific aims of this dissertation are to: (1) evaluate the association of self-reported discrimination with medication adherence, and to determine if trust in the medical system mediates this association;(2) examine the relationship of coping with adversity and medication adherence;and (3) determine if the use of home remedies is associated with lower adherence. This study supports AHRQ's mission to improve the quality, safety, efficiency and effectiveness of health care for priority populations. Our analyses will use the advanced statistical techniques of mediation analysis and structural equation modeling. As such, we will generate new knowledge and practical insights that will be easily translated into innovative disparity-reducing interventions. In addition to the substantive work that I am proposing, I have developed a solid mentorship plan with Drs Allison and Hullett. My dissertation advisory committee brings additional expertise in advanced quantitative methods, the application of sociocultural constructs to health services research, and the development of culturally sensitive interventions for reducing health disparities. After completing my dissertation, I will apply for a career development award that draws on quantitative and qualitative techniques to develop and pilot interventions that promote medication adherence among African Americans. I am committed to a career in health services research, with a focus on health disparities. In addition to pursuing my own line of independent research, it is my long-term goal to serve as a positive force attracting new talent to health services research, mentoring minority students for success in academic medicine, and building strong community-academic partnerships.

Public Health Relevance

This project will generate new knowledge about the root causes of cardiovascular health disparities, which is a topic of urgent public health need. In addition, this work will lay the foundation for new research that will deliver new culturally relevant interventions to improve health outcomes for African Americans. Such interventions may operate at the level of the patient, clinical encounter, health system, local community, and beyond.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Dissertation Award (R36)
Project #
Application #
Study Section
HSR Health Care Research Training SS (HCRT)
Program Officer
Harding, Brenda
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Massachusetts Medical School Worcester
Other Health Professions
Schools of Medicine
United States
Zip Code
Cuffee, Yendelela L; Hargraves, J Lee; Rosal, Milagros et al. (2013) Reported racial discrimination, trust in physicians, and medication adherence among inner-city African Americans with hypertension. Am J Public Health 103:e55-62