UCSF

Purpose: To examine the relationship between BP and BP awareness; eating habits and exercise self-confidence; lifestyle behaviors; social capital; chronic disease management self-confidence, social support; depression; and antihypertensive medication adherence in Black African American adults.

Significance: High blood pressure (HBP) is the leading cause of cardiovascular disease such as stroke, coronary heart disease, and end-stage renal disease; all are leading causes of death in the US. HBP has been attributed to higher rates of morbidity, comorbidities, and excess death rates in Black Americans of African descent. Little is known about the extent to which lifestyle behaviors and HBP are modified by the socioecological context of social capital (SC) (e.g. bonding, bridging, and linking).

Design: Cross-sectional descriptive study.

Methods(/bold>: A convenience sample (n=208) was recruited from community settings in California. Inclusion criteria were: self-identify as Black African American, 18 years and older, born/raised in US, reads and/or speaks English, resident of California, no major cardiovascular event or currently on dialysis, and non-pregnant women. The data collection instrument consisted of 161 questions. Subjects' BP and body weight were also measured.

Findings: Findings: Subjects diagnosed with HBP prior to the study had higher self-confidence in getting information from community resources and in managing chronic disease compared to subjects without a prior HBP diagnosis (p=0.01). Predictors of measured HBP included: education (OR=0.1; 95% CI 0.0, 0.8); income (OR=0.1, 95% CI 0.1, 0.9); age-income interaction (OR=5.9, 95% CI 1.3, 26.5); age-education interaction (OR=11.1, 95% CI 2.0, 60.7); and bonding SC (OR=2.3, 95% CI 1.1, 5.0) for subjects less than 60 years old. Predictors of measured HBP for subjects 60 years and older included: bonding SC (OR=0.3, 95% CI 1.1, 15.4); bridging SC (OR=0.5, 95% CI 0.3, 0.9); and linking SC (OR=0.3, 95% CI 0.1, 0.9).

Conclusions: Subjects with normal BP were less confident in their ability to obtain information and manage chronic illness compared to subjects with HBP who were taking antihypertensive medication prior to the study. Results were mixed with regard to SC and BP elevation; as bonding SC increased in subjects less than 60 years old their measured BP levels also increased. In subjects 60 years and older, the results were reversed; as bonding, bridging, and linking SC increased their BP levels decreased as expected. Multiple logistic regression analysis indicated bonding SC as the only predictor of HBP in subjects less than 60 years old.

Implications: This study shows a need for further development of the SC concept as a methodological framework in nursing research and the need for further empirical investigation of SC as a predictor of physiological outcome measures such as HBP.