Abstract P250: Prospective Associations of Coping Strategies and Variability in Their Use With Hypertension and Obesity Incidence

Abstract

Objectives: Stressful adverse experiences (e.g., childhood abuse) are associated to greater cardiometabolic disease risk. Yet, it is unknown whether how individuals cope with these stressors can influence disease risk. Coping strategies are usually characterized as being either adaptive (e.g., seeking social support) or maladaptive (e.g., denying the stressor). However, flexibility in tailoring their implementation to contexts appears critical to optimal adjustment and might matter for cardiometabolic health as well. Method: Participants free of hypertension and obesity from the Nurses’ Health Study II completed the validated COPE inventory and reported relevant potential covariates in 2001 (N=32,762). Hypertension and obesity respective incidence were documented every two years until 2019, separately. Cox proportional hazard models estimated hazard ratio (HR) and 95% confidence intervals (CI) of hypertension and obesity associated with the use of individual coping strategies (continuous standardized scores). The Between-Strategy Index, validated in prior epidemiologic research, was used to derive a proxy for coping flexibility, which was considered in tertiles (smaller, moderate, greater levels). This score indicates to what extent strategies chosen within a repertory are (un)equally used and potentially indicates attempts to find the best strategy or favor certain strategies across distinct stressors. In all models, a 2-year lag was introduced to reduce concerns of reverse causation. Results: After controlling for baseline sociodemographic and health status (core model), no adaptive or maladaptive strategies were related to a risk of hypertension onset, and only a few adaptive and maladaptive strategies were related to obesity incidence (e.g., per 1-SD increase: Active coping, HR=0.96, 95%CI=0.93, 0.99; Behavioral Disengagement, HR=1.05, 95%CI=1.02, 1.08). When considering coping flexibility, greater levels were related to a marginally significant lower risk of disease (hypertension: HR greater vs. moderate =0.95, 95%CI=0.90, 1.01; obesity: HR greater vs. lower levels =0.93, 95%CI=0.86, 1.00). In secondary analyses, results were overall similar when further adjusting for behavioral factors. Discussion: These findings suggest that how midlife women typically cope with stressors was not clearly associated with incidence of hypertension or obesity, although we cannot rule out a modest association with some individual coping strategies, and a suggestive protective association with greater coping flexibility levels. Since the COPE inventory captures how individuals handle stressors in general, future research on hypertension and obesity incidence should consider stressor-specific measures of coping.