Physical and Psychological Health of African American Women Caregivers: Unmasking the Paradox

Caregiving and Hypertension in Younger Black Women: The Jackson Heart Study

BACKGROUND

Caregiving has been associated with high blood pressure in middle-aged and older women, but this relationship is understudied among younger Black women, a population at high risk for hypertension. We examined the associations of caregiving stress and caregiving for high-needs dependents with incident hypertension among reproductive-age women in the JHS (Jackson Heart Study), a cohort of community-dwelling Black adults.

METHODS

We included 453 participants, aged 21 to 44 years, with blood pressure <140/90 mm Hg, and not taking antihypertensive medication at baseline (2000-2004). Caregiving stress over the past 12 months was assessed via a single item in the global perceived stress scale. Caregiving for a high-needs dependent status was assessed via a question on hours per week spent caregiving for children (≤5 years or disabled) or older adults. Incident hypertension was defined as systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or self-report of taking antihypertensive medication at follow-up exams in 2005 to 2008 and 2009 to 2013.

RESULTS

Over a median follow-up of 7.4 years, 43.5% of participants developed hypertension. Participants with moderate/high versus no/low caregiving stress had a higher incidence of hypertension (51.7% versus 40.6%). Higher caregiving stress was associated with incident hypertension after adjustment for sociodemographic and clinical factors, health behaviors, and depressive symptoms (hazard ratio, 1.39 [95% CI, 1.01-1.94]). Being a caregiver for a high-needs dependent was not associated with incident hypertension (adjusted hazard ratio, 0.88 [95% CI, 0.64-1.21]).

CONCLUSIONS

Higher caregiving stress among reproductive-age Black women was associated with incident hypertension. Hypertension prevention approaches for this high-risk population may include caregiving stress management strategies.

Black women's perspectives on bladder health: Social-ecological and life course contexts

AIMS

This paper explores Black women's perspectives on bladder health using a social-ecological conceptual framework and life course perspective.

METHODS

We conducted a directed content analysis of data from the Study of Habits, Attitudes, Realities, and Experiences (SHARE), a focus group study by the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium. Analysis was conducted on data from five focus groups and a member-checking session where all participants self-identified as Black or African American.

RESULTS

Forty-two participants aged 11-14 or 45+ years reported life course experiences with their bladder. The intersection of race and gender was the lens through which participants viewed bladder health. Participants' accounts of their perspectives on bladder health explicitly and implicitly revealed structural racism as an explanatory overarching theme. Participants described (a) historically-rooted and still pervasive practices of discrimination and segregation, engendering inequitable access to quality medical care and public facilities, (b) institutional barriers to toileting autonomy in educational and occupational settings, promoting unhealthy voiding habits, (c) internalized expectations of Black women's stereotyped role as family caregiver, compromising caregiver health, (d) lack of reliable information on bladder health, leading to unhealthy bladder behaviors, and (e) potentially stress-related comorbid chronic conditions and associated medication use, causing or exacerbating bladder problems.

CONCLUSIONS

Bladder health promotion interventions should address social-ecological and life course factors shaping Black women's bladder health, including social and structural barriers to accessing equitable health information and medical care.

Family Matters: Cross-Cultural Differences in Familism and Caregiving Outcomes

OBJECTIVES

The increasing number of minority older adults, and the subsequent increase in family members providing care to these individuals, highlights the need to understand how cultural values contribute to differential caregiving outcomes. Using the sociocultural stress and coping model as a guiding framework, the current study examined cross-cultural relationships among familism, social support, self-efficacy, and caregiving outcomes and examines how these relationships vary as a function of caregiver background characteristics.

METHODS

Baseline data were collected from 243 participants in the Caring for the Caregiver Network randomized controlled intervention trial. Participants completed measures assessing familism, social support, self-efficacy, positive aspects of caregiving, depression, and burden.

RESULTS

African American and Hispanic participants exhibited higher levels of familism compared to Whites. Compared to White participants, African Americans' endorsement of familism predicted more positive caregiving appraisals. African Americans also reported greater levels of social support, which in turn predicted lower burden and depressive symptoms when compared with Whites. Exploratory analyses demonstrated significant associations between familism and self-efficacy. In the Hispanic subgroup, familism varied as a function of acculturation.

DISCUSSION

Results indicate that greater levels of familism and social support may exert a protective influence against adverse psychosocial caregiving outcomes. These findings can be used to inform intervention efforts targeting culturally congruent, family-centered approaches.