All ETDs from UAB

Advisory Committee Chair

Tamika Smith

Document Type


Date of Award


Degree Name by School

Doctor of Public Health (DrPH) School of Public Health


USING HOPE TO COPE: CHRONIC STRESS, RELIGIOUS COPING, AND MASKED HYPERTENSION IN AFRICAN AMERICAN ADULTS: THE JACKSON HEART STUDY ABSTRACT Chronic stress experienced at home or work has been associated with acute increases in blood pressure (BP) measured in the doctor’s office. Few data are available on the association of chronic stress with BP measured outside of the office setting. Religious coping, applying religious beliefs to adapt to stressful situations, and functional and structural social support may protect against MHT by promoting active coping behaviors and increasing emotional well-being. High levels of religious involvement and high social support have been associated with lower systolic BP, when measured in the office setting, and lower awake and sleep systolic BP among African Americans. This study used data from the Jackson Heart Study (JHS) among participants with office BP < 130/80 mm Hg to examine the association between chronic stress and masked hypertension (MHT). Chronic stress experienced over the previous 12 months was assessed using the 8-item Global Perceived Stress Scale (GPSS). Religious coping and the Daily Spiritual Experience were assessed using the JHS Approach to Life A survey. Any MHT was defined using the 2017 American Heart Association/ American College of Cardiology. Analyses were stratified by antihypertensive medication use. Among participants not taking and taking antihypertensive medication, the prevalence of any MHT was 61.8% and 77.9% for the upper levels of the GPSS score (GPSS score > 6), respectively. After multivariable adjustment, the prevalence ratio (95% confidence interval) for any MHT associated with the middle and upper versus low levels of the chronic stress score was 1.23 (0.96, 1.57) and 1.07 (0.83, 1.39), respectively, among those not taking antihypertensive medication, and 0.97 (0.82, 1.14) and 1.02 (0.85, 1.21), respectively, among those taking antihypertensive medication. No association was present between chronic stress and MHT among African Americans in the JHS. Women and older participants reported significantly higher levels of religiosity/spirituality involvement. Women also had higher mean spiritual experience scores than those among men. Many participants attended religious services, participated in private prayer, and reported high use of religion in coping with daily stressors. These findings suggest the beneficial impact of cultural and religious practices in decreasing overall MHT risk and demonstrate the opportunities to target personal stress coping strategies along with lifestyle interventions.

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