Nicole D. Fields

Objective: African American women experience disproportionate cardiovascular disease risk, and altered central hemodynamics signal early vascular aging. For African American mothers, concern about their children’s exposure to racism represents a salient psychosocial stressor, but its vascular consequences are unclear. We examined whether greater racism‑related Concern for Children (CFC) was associated with adverse longitudinal changes in central hemodynamics. Methods: African American mothers aged 30-46 years ( n =236) underwent assessments of central systolic blood pressure (cSBP), augmentation index (AIx), pulse pressure amplification (PPA), and pulse wave velocity (PWV; n =205) at baseline and 4±1 years later. CFC was measured continuously (range 0-24) and categorically (high vs. low). Multivariable linear regression models examined associations between CFC and changes in central hemodynamics, adjusting for baseline values and sociodemographic, clinical, and psychosocial covariates. Logistic regression evaluated CFC and odds of newly developed high‑risk PPA (PPAP =0.002). At follow‑up, women with high CFC had AIx values 3.9 percentage points higher than those with low CFC ( P =0.005). CFC was also associated with declining PPA (b=‑0.003, 95% CI [‑0.005, ‑0.001]; P =0.024) and greater odds of newly developed high‑risk PPA (OR=1.08, 95% CI [1.01, 1.15]; P =0.033). No associations were observed for cSBP or PWV. Conclusions: Greater racism‑related concern for children is associated with signs of early vascular aging in African American mothers, highlighting the cardiovascular consequences of racism‑related maternal stress.

Background: Social drivers of health shape cardiovascular health (CVH), with single mothers facing considerable social adversity. This review aimed to describe single mothers’ CVH and the potential role of social drivers of health. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, we included observational studies published in English that assessed at least 1 American Heart Association–defined CVH factor or behavior among parous single mothers (aged >18 years). Searches were conducted in 3 electronic databases, with 2 reviewers independently screening. Study quality and risk of bias were assessed using the Appraisal Tool for Cross‐Sectional Studies and the Risk of Bias in Nonrandomized Studies of Exposures. Results: Of 2071 search results, 1704 articles were screened, and 36 studies met inclusion criteria. Most studies were cross‐sectional (n=33), with diet and nicotine use the most assessed outcomes (n=26), followed by physical activity (n=9), body mass index (n=7), sleep (n=6), blood pressure (n=4), blood glucose (n=3), and blood lipids (n=2). Overall, findings suggest that single mothers have worse CVH behaviors and factors compared with partnered mothers. Social drivers of health influences were rarely examined with individual‐level factors (eg, income) most common (n=7) and structural‐level factors (eg, access to food outlets) were least (n=1). Conclusions: The present review suggests that single mothers have worse CVH compared with partnered mothers. More research is needed to identify potential drivers of poor CVH among single mothers to inform interventions targeting specific health behaviors or factors to decrease cardiovascular disease risk. Critically, future studies should examine structural‐level social drivers of health through an intersectional lens to advance health equity for single mothers.

Objective: Anti-black police violence and harassment have been identified as public health issues. However, studies have primarily focused on direct and/or vicarious police encounters. A dearth of studies has also examined vigilance related to future police encounters, and to our knowledge, no studies have examined all 3 kinds of police-related stress among African American women. Methods: We employed a latent class analysis (LCA) approach to identify classes of African American women ( N = 422), aged 30 to 46, based on the patterning of various forms of self-reported police-related stress: direct, vicarious, police-related vigilance for self, and police-related vigilance for children. We then examined associations between latent class membership and carotid intima media thickness (IMT), a marker of cardiovascular risk. Results: We identified 3 latent classes of police-related stress: (1) high child vigilance-high personal exposure, (2) no child vigilance-high personal exposure, and (3) moderate child vigilance-low self vigilance-low personal exposure class. Findings from the fully adjusted model reveal that the no child vigilance-high personal exposure class had lower common carotid artery (CCA) IMT than the high child vigilance-high personal exposure and moderate child vigilance-low self vigilance-low personal exposure classes. Conclusions: Vigilance for children’s future police encounters may be associated with increased cardiovascular risk in African American women. Agency, system, and policy-level solutions may be needed to reduce anti-black police violence and improve the cardiovascular health of this high-risk population.

Objective: Black Americans who survive a myocardial infarction (MI) face an elevated risk for adverse outcomes. Childhood trauma is associated with reduced cardiovascular reactivity, but its contribution to racial disparities in stress physiology is unclear. We investigated whether childhood trauma contributes to lower cardiovascular reactivity among Black compared with White MI survivors. Methods: Using a cross-sectional design, we assessed childhood trauma and heart rate and blood pressure responses (HRR, SBPR, DBPR) to public speaking in 183 White (30% female) and 311 Black (53% female) MI survivors [M_age (SD): 51 (7)]. Multiple linear regression tested the interaction between race and childhood trauma on cardiovascular reactivity, adjusting for resting values and relevant covariates. When no significant interaction was found, models were refitted to examine main effects. A 4-level race-trauma variable was used to assess group differences, with White participants with low trauma (n=115) as the reference group. Results: Black participants were more likely to report high childhood trauma (49% vs. 37%, p=.012) and showed significantly lower heart rate (HRR) and systolic (SBPR) and diastolic (DBPR) blood pressure reactivity to mental stress compared with White participants. High childhood trauma was independently associated with lower HRR and SBPR. No significant race × trauma interaction was observed, but additive effects were evident: Black participants with high trauma had the lowest HRR (β=−8.2; 95% CI: [−11.2, −5.2]), SBPR (β=−7.7; 95% CI: [−11.9, −3.5]), and DBPR (β=−2.9; 95% CI: [−5.4, −0.4]) relative to White participants with low trauma. Conclusions: Black MI survivors were more likely to report high childhood trauma and exhibit reduced cardiovascular responses to stress. Although no interaction was found, additive effects suggest trauma contributes to racial disparities. Addressing childhood trauma may help mitigate cardiovascular risk in Black Americans.

Background: Emerging evidence suggests that the Superwoman Schema (SWS)—the sociocultural representation of Black women as naturally strong, independent, and nurturing—may play an important role in Black women’s cardiovascular health; but findings have been relatively mixed. One interesting possibility is that environmental mastery, a sense of control over one’s environment, may mitigate negative aspects of SWS. Purpose: We investigated whether mastery moderated the association between SWS and pulse wave velocity (PWV), the gold standard measure of arterial stiffness linked to cardiovascular morbidity and mortality. Methods: Participants were N = 368 early middle-aged (30-45 years old) Black women from the southeastern USA who completed the 35-item Giscombé Superwoman Schema Questionnaire and Ryff’s 14-item environmental mastery scale. Carotid-femoral PWV was assessed using the SphygmoCor device. Linear regression models examined the main and interactive associations of SWS and mastery on PWV, adjusting for age, education, income, body mass index, smoking status, blood pressure, and antihypertensive medication use. Results: Analyses revealed a significant overall SWS endorsement by mastery interaction [β = −.11, P = .02], such that SWS was positively associated with higher PWV only when mastery was low. Three SWS dimensions drove this association: SWS strength, SWS suppress emotions, and SWS resistance to vulnerability (all P-values < .05) showing similar patterns to the overall SWS interaction with mastery. Conclusions: In Black women, high endorsement of SWS is associated with greater arterial stiffness when environmental mastery is low. Thus, SWS may be more physiologically taxing when one senses less control over their environment.

Background: African American women bear a disproportionate burden of cardiovascular diseases, potentially due to altered central hemodynamics. Racism and sexism often lead to African American women taking on numerous caretaking roles and overall increases their use of the Strong Black Woman (ie, Superwoman) mindset, which may have negative health consequences. We hypothesized that endorsing the Superwoman role and its Obligation to Help Others dimension would be associated with a deleterious central hemodynamics profile in African American women. Methods and Results: Using cross‐sectional data, we examined central systolic blood pressure (mm Hg; n=408), augmentation index (percentage, adjusted for height and heart rate; n=408), and pulse wave velocity (m/s; n=368) in African American women aged 30 to 46 years. The Giscombe Superwoman Schema (SWS) questionnaire assessed endorsement of Overall SWS (range, 0–105) and SWS–Obligation to Help Others (range, 0–3). Multiple linear regression modeled associations between Overall SWS (10‐unit increments) and SWS–Obligation to Help Others (1‐unit increments) and central hemodynamics while adjusting for pertinent sociodemographic, clinical, and psychosocial factors. In fully adjusted models, central systolic blood pressure was significantly associated with Overall SWS (β=0.83 [95% CI, 0.19–1.47]) and SWS–Obligation to Help Others (β=2.03 [95% CI, 0.39–3.67]). Augmentation index was associated with Overall SWS (β=0.66 [95% CI, 0.02–1.30]) and SWS–Obligation to Help Others (β=2.21 [95% CI, 0.58–3.84]). Significant associations were not observed between pulse wave velocity and SWS. Conclusions: Greater endorsement of the Superwoman role and prioritizing caregiving over self‐care were associated with higher central systolic blood pressure and augmentation index, which may contribute to adverse cardiovascular health among African American women.

Background Early vascular ageing (EVA) contributes to elevated risk of cardiovascular disease (CVD), which disproportionately affects African American women. Incarceration, an event disproportionately impacting African Americans, may be a stressor contributing to EVA in African American women. Further, the subjective perspective, commonly referred to as appraisal, of incarceration may also be important for health. We hypothesised that having family and/or friends incarcerated and appraising the incarceration as upsetting would be associated with indices of EVA. Methods In a community-based cohort of African American women aged 30–46 living in Atlanta, Georgia (n=391), participants were asked, at baseline, about family and/or friend incarceration and to appraise how upsetting the incarceration was. Multivariable linear regression examined associations between: (1) family and/or friend incarceration and indices of EVA (pulse wave velocity, augmentation index, central systolic blood pressure (SBP) and pulse pressure amplification) and (2) appraisal of incarceration and EVA indices. Results 45% of participants (n=174) reported having a loved one incarcerated, and 59% (n=102) reported the incarceration as upsetting. Having a loved one incarcerated was associated with a higher central SBP (b=4.30; 95% CI 1.61, 6.99) and augmentation index (b=2.29; 95% CI 0.26, 4.33). Appraisal of incarceration was only associated with central SBP. Conclusions Family or friend incarceration was highly prevalent in this cohort of African American women and associated with indices of EVA. Mass incarceration of others may affect the physical health of African American women which may contribute to CVD disparities.