Jan Warren-Findlow

Weathering: Stress and Heart Disease in African American Women Living in Chicago

Researchers have suggested that lifelong chronic and cumulative exposure to social and economic stressors is associated with early onset of chronic illness in African American women. Recent literature has demonstrated that socioeconomic aspects of neighborhoods contribute to health disparities in heart disease morbidity and mortality. In this article, the author analyzes the stories of older African American women concerning stress and other events related to heart disease, triangulated with individual- and neighborhood-level socioeconomic and environmental data, from the perspective of the weathering conceptual framework. She conducted in-depth qualitative interviews with urban, older Black women with early-stage heart disease. Women described lifelong and recent incidents of stress that they perceived as contributing to their “bad heart.” The episodes described were a mixture of chronic social, environmental, and family-related challenges. Findings reveal substantial evidence supporting the weathering conceptual framework and the Sojourner syndrome in this sample of older, chronically ill Black women.

Families, Social Support, and Self-Care among Older African-American Women with Chronic Illness:

Purpose. This study describes the specific type and extent of social support provided by family members to older African-American women managing chronic disease. Design. Qualitative study with multiple in-depth interviews conducted over a 2-year time period. Setting. Participants were interviewed in their homes in a large Midwestern city. Participants. This was a purposeful study group of 12 middle-aged and older African-American women with diagnosed early-stage heart disease and other comorbidities. Methods. Data were collected on womens beliefs about their heart disease and their descriptions of how family members helped or inhibited their self-care practices. Womens descriptions of family social support were analyzed as to the type and influence. Results. Most women lived in interdependent, multigenerational situations with family members providing: instrumental support; a passive form of informational support based on family history of heart disease that was used to make health comparisons and evaluate heart health; and behavioral support, which emerged, in terms of reinforcement or discouragement of lifestyle behavior changes, as a sometimes significant barrier to practicing chronic illness self-care. Conclusion. These findings, while not statistically representative, demonstrate the significant influence that family members have on older womens chronic illness self-care activities. The positive and sometimes negative effects of living with multiple generations suggest the need for culturally relevant, family-based, chronic illness interventions for African-Americans.

Perceived Infant Feeding Preferences of Significant Family Members and Mothers’ Intentions to Exclusively Breastfeed

Background: Breastfeeding intention is a significant predictor of initiation and duration. The decision to breastfeed may be influenced by the opinions of family and friends. Objective: This study aimed to examine the relationship between maternal perception of the infant feeding preferences of the baby’s father and the maternal grandmother and the woman’s intention to breastfeed. Methods: This study analyzed data from the Infant Feeding Practices Survey II (2005-2007). Results: The sample included 4690 women, of whom approximately 82% were white, 67% were married, 68% were multiparous, and 66% had some college education or beyond. In adjusted analyses, the odds of intending to exclusively breastfeed in the first few weeks postpartum were higher among mothers who perceived that the baby’s father or the maternal grandmother preferred exclusive breastfeeding (vs preferred other feeding) (fathers: odds ratio [OR] = 7.44; 95% confidence interval [CI], 6.20-8.92; maternal grandmothers: OR = 2.45; 95% CI, 2.01-2.99). Mothers in each of the racial/ethnic groups examined were more likely to intend to exclusively breastfeed in the first few weeks postpartum if they perceived that the expectant father preferred exclusive breastfeeding (vs preferred other feeding methods) (white: OR = 7.67; 95% CI, 6.25-9.41; black: OR = 11.76; 95% CI, 4.85-28.51; Hispanic: OR = 7.01; 95% CI, 3.44-14.28; other: OR = 7.51; 95% CI, 3.39-16.67). Conclusion: These results suggest that significant family members should be counseled on the benefits of breastfeeding and the risks of formula feeding along with pregnant mothers.

Intergenerational Transmission of Chronic Illness Self-care: Results From the Caring for Hypertension in African American Families Study

PURPOSE OF THE STUDY African Americans often experience early onset of hypertension that can result in generations of adults managing high blood pressure concurrently. Using a model based on the Theory of Interdependence, this study examined whether intergenerational transmission of hypertension knowledge and self-efficacy would affect hypertension self-care of older parents and their adult children. DESIGN AND METHODS We recruited 95 African American older parent-adult child dyads with hypertension. We constructed separate logistic regression models for older parents and adult children with medication adherence as the outcome. Each model included individual demographic and health characteristics, the partners knowledge, and self-efficacy to manage hypertension and dyad-related characteristics. RESULTS Parents were more adherent with medication than adult children (67.4% vs. 49.5%, p < .012). There were no significant factors associated with parent medication adherence. In adjusted models for adult children, medication adherence was associated with childs gender (odds ratio [OR] = 3.29, 95% confidence interval [CI] = 1.26-8.59), parent beliefs that the child had better hypertension self-care (OR = 4.36, 95% CI = 1.34-14.17), and child reports that the dyad conversed about hypertension (OR = 3.48, 95% CI = 1.18-10.29). Parental knowledge of hypertension and parents self-efficacy were weakly associated with adult childrens medication adherence (OR = 1.35, 95% CI = 0.99-1.84 and OR = 2.59, 95% CI = 0.94-7.12, respectively). IMPLICATIONS Interventions should consider targeting African American older adults to increase self-care knowledge and empower them as a primary influencer of hypertension self-care within the family.

Stress and Coping in African American Women With Chronic Heart Disease: A Cultural Cognitive Coping Model

This article examines the role of stress in relation to heart disease self-care among African American women. Women described a unique stress-coping model: Stress was a cause and contributor to “bad heart” and associated with “not worrying.” Family history of heart disease was used as an experiential reference scale to evaluate the severity of women’s heart health. Stress attributions were associated with coping practices to manage the effect of illness through emotion-focused coping and with the physiological worsening of their condition. This model highlights opportunities to reframe stress-coping activities into culturally based heart-healthy practices for African American women.

Primary Care Providers' Sources And Preferences For Cognitive Health Information In The United States

In most countries, physicians and other health-care providers play key roles in promoting health. Accumulating scientific evidence suggests that providers may soon want to include cognitive health among the areas they promote. Cognitive health is the maintenance of cognitive abilities that enable social connectedness, foster a sense of purpose, promote independent living, allow recovery from illness or injury and promote effective coping with functional deficits. The US Centers for Disease Control and Prevention has established health promotion about cognitive health as a policy priority, with health providers included as one key group to participate in this effort. This study presents results from focus groups and interviews with primary care physicians (n = 28) and midlevel health-care providers (physician assistants and nurse practitioners, n = 21) in three states of the US. Providers were asked about their sources of information on cognitive health and for their ideas on how best to communicate with primary care providers about research on cognitive health. In results, providers cited online sources, popular media and continuing medical education as their most common sources of information about cognitive health. Popular media sources were used both proactively and reactively to respond to patient inquiries. Differences in sources of information were noted for physicians as compared with midlevel providers, and for rural and urban providers. Several potential ways to disseminate information about cognitive health were identified. Effective messaging is likely to require multiple strategies to reach diverse groups of primary care providers, and to include continuing medical education.

Associations Between Social Relationships and Emotional Well-Being in Middle-Aged and Older African Americans

Social relationships may enhance emotional health in older age. The authors examined associations between social relationships and emotional health using data from the Milwaukee African American sample of the second Midlife Development in the United States (MIDUS II) study, 2005-2006 (n = 592). Self-reports indicated good, very good, or excellent emotional health, distinguished from fair or poor. Social relationships were measured by relationship type (family or friend), contact frequency, and levels of emotional support and strain. Control variables included demographic characteristics, types of lifetime and daily discrimination, neighborhood quality, and other social factors. In adjusted results, each increase on a family emotional support scale was associated with 118% greater odds of reporting better emotional health (odds ratio [OR] = 2.18, 95% confidence interval [CI] [1.43, 3.32]). Friend emotional support also was associated with better emotional health (OR = 1.59, CI [1.07, 2.34]). Daily discrimination substantially reduced reported emotional health; family and friend support buffered this effect.

Effects of Social Ties on Self-rated Physical Health Among African American Adults

OBJECTIVES To examine associations between social ties and self-rated physical health among midlife and older African Americans. METHODS Cross-sectional analysis of the 2005-2006 Milwaukee African American oversample of the second Midlife Development in the United States (MIDUS II) study. Multivariate logistic regression examined associations between type of social ties (family or friends), their frequency (number of contacts), and their quality (support and strain) with betterself-rated physical health (SRPH). We defined better SRPH to include self-reports of good, very good, or excellent SRPH: this category was compared with fair or poor SRPH. Control variables included demographic factors; social engagement characteristics such as working, volunteering, and caregiving; and measures of social structure such as types of discrimination experience and ratings of neighborhood quality. RESULTS In adjusted results, each additional degree of family support was associated with better self-rated physical health (odds ratio [OR], 1.59; 95% confidence interval (CI], 1.14-2.22). Each additional reported incident of daily discrimination was associated with 9% lower odds of reporting better SRPH (OR, 0.91; CI, 0.83-0.99). DISCUSSION Results suggest quality of family support may contribute importantly to the health of African Americans. When working with midlife and older African Americans, providers should engage and support families as a vital resource to improve health.

Preliminary Validation of the Hypertension Self‐Care Activity Level Effects (H‐SCALE) and Clinical Blood Pressure Among Patients With Hypertension

This study establishes preliminary validation of a measure that assesses hypertension self‐care activities with clinical blood pressure (BP). The Hypertension Self‐Care Activity Level Effects (H‐SCALE) was administered to patients with hypertension to assess levels of self‐care. Patients (n=154) were predominantly female (68.6%) and black (79.2%). Greater adherence to self‐care was associated with lower systolic and diastolic BP for 5 of the 6 self‐care behaviors. Medication adherence was correlated with systolic BP (r=−0.19, P<.05) and weight management adherence was correlated with diastolic BP (r=−0.22, P<.05) after controlling for other covariates. Increased adherence to recommended dietary practices was strongly correlated with higher systolic (r=0.29, P<.05) and diastolic BP (r=0.32, P<.05). The H‐SCALE was acceptable for use in clinical settings, and adherence to self‐care was generally aligned with lower BP. Assessment of hypertension self‐care is important when working with individuals to control their BP.

Coping With Trauma Through Fictional Narrative Ethnography: A Primer

This article, written as a letter to the editor, is in response to Journal of Loss and Traumas original rejection of our fictional narrative autoethnography. We introduce this method and argue that our fictionalization of part of the narrative is not a departure from other narrative ethnographic work and serves several purposes relevant to JLT: It was therapeutic to the authors; it conveyed meaning that could not have been conveyed in a more traditional manner; it served as a metaphor for a resistance narrative against the culturally canonical story of suffering victim; and it provided a shared cultural story that allowed us to connect with many women in our generation. We suggest that narrative “truth” should be concerned with how the story is used and understood. We advocate that methods such as this give voice to stories that are difficult to tell and understand, and open spaces to reflect alternative ways of knowing.