Chronic stress is increasingly recognized as a potential contributor to cardiovascular health problems. Young, low-income adults typically experience more stressors with greater severity and chronicity and are at an increased risk for developing early-onset cardiovascular disease (CVD). However, the mechanisms linking chronic stress to CVD have yet to be fully understood. Guided by an adapted version of McEwen’s Allostatic Load Model, this three-manuscript dissertation had three aims: (1) Comprehensively examine and quantitatively synthesize evidence on the relationships between hair cortisol concentration (HCC) and blood pressure, (2) Examine the associations among perceived stress, HCC, coping strategies, and blood pressure in a sample of young, low-income individuals, and (3) Describe and compare stress conceptualizations of young, low-income adults with low- versus high-stress levels, how they cope with stress, and how they perceive stress as impacting their health. Manuscript 1 is a systematic review and meta-analysis assessing the relationships of HCC with systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension status. Five databases were searched, yielding 34,014 records. Sixteen articles met eligibility criteria and were included in the systematic review, while 14 were included in the meta-analysis. Findings showed small, positive associations between HCC and SBP and DBP. In addition, higher HCC was associated with higher odds of being hypertensive. In Manuscript 2, path analysis modeling was used to assess the associations among perceived stress [measured by the 10-item Perceived Stress Scale (PSS-10)]; emotion-focused, problem-focused, and avoidant coping strategies (measured by the Brief COPE); HCC; SBP; and DBP among 63 young, low-income adults with young children. Results showed that perceived stress was negatively related to HCC, and HCC was positively associated with both SBP and DBP. Emotion-focused coping was significantly and negatively related to HCC, while problem-focused and avoidant coping were positively related to HCC. Additionally, avoidant coping and HCC partially and significantly mediated the relationship between perceived stress and SBP and DBP. The path model explained about 14.4% and 12.7% of the variances in SBP and DBP, respectively. Manuscript 3 reports results from a qualitatively driven explanatory mixed methods study comparing the stress and coping experiences of a group of young, low-income adults with low stress levels (n = 8; measured by the PSS-10) to a group with high stress levels (n = 9). Interpretive phenomenological analysis was performed. Results demonstrated important differences between groups in their experiences of stress as a mental strain, negative emotions, coping strategies utilized, physical manifestations of stress, and perceived experiences of declining health. Findings from this dissertation contribute to science by improving our understanding of the associations among stress, coping, and blood pressure among young adults living in poverty. This dissertation also sheds light on the experiences of stress within this population and their ways of coping. Results generally support the adapted version of McEwen’s Allostatic Load Model and provide a foundation for future research addressing chronic stress and CVD prevention among young, low-income populations, as well as implications for policy and nursing practice.
Read
