Resilience and CVD-protective Health Behaviors in Older Women: Examining Racial and Ethnic Differences in a Cross-Sectional Analysis of the Women's Health Initiative.

Sparkle Springfield,Ursula M Staudinger,Marcia L Stefanick,Haley Hedlin,Feifei Qin,Charles B Eaton,Herman Taylor,Milagros C Rosal

doi:10.3390/nu12072107

Abstract

Little is known about the relationship between self-reported psychological resilience (resilience) and health behaviors shown to reduce the risk of cardiovascular disease (CVD). This study examines the associations between resilience and CVD-related risk factors, such as diet, smoking, physical activity, sleep, and alcohol consumption among older American women from diverse backgrounds. Methods: A cross-sectional secondary analysis was conducted on 77,395 women (mean age 77 years, Black (N = 4475, 5.8%), non-Hispanic white (N = 69,448, 89.7%), Latina (N = 1891, 2.4%), and Asian or Pacific Islander (N = 1581, 2.0%)) enrolled in the Women’s Health Initiative Extension Study II. Resilience was measured using an abbreviated version of the brief resilience scale. Multivariable logistic regression models were used to evaluate the association between resilience and health behaviors associated with risk for CVD, while adjusting for stressful life events and sociodemographic information. To test whether these associations varied among racial/ethnic groups, an interaction term was added to the fully adjusted models between resilience and race/ethnicity. Results: High levels of resilience were associated with better diet quality (top 2 quintiles of the Healthy Eating Index 2015) (OR = 1.22 (95% Confidence Interval (1.15–1.30)), adhering to recommended physical activity (≥ 150 min per week) (1.56 (1.47, 1.66)), sleeping the recommended hours per night (7–9) (1.36 (1.28–1.44)), and moderate alcohol intake (consuming alcoholic drink(s) 1–7 days per week) (1.28 (1.20–1.37)). The observed association between resilience and sleep is modified by race/ethnicity (p = 0.03). Conclusion: Irrespective of race/ethnicity, high resilience was associated with CVD-protective health behaviors. This warrants further investigation into whether interventions aimed at improving resilience could increase the effectiveness of lifestyle interventions.

Highlights

There have been steady declines in the incidence and prevalence of cardiovascular disease (CVD) over the past five decades, it remains the leading cause of death among American women [1,2]
In terms of CVD risk factors, women with high resilience showed a lower prevalence of obesity
Women with high resilience had the highest engagement in protective health behaviors according to CVD prevention guidelines

Summary

Introduction

There have been steady declines in the incidence and prevalence of cardiovascular disease (CVD) over the past five decades, it remains the leading cause of death among American women [1,2]. Biological and epidemiological evidence suggests that excessive psychological stress—that taxes or exceeds one’s resources and adaptive capacity—has disruptive effects on cardiovascular health including the diet, physical activity, sleep behavior, and the likelihood that an older woman will adhere to behavioral interventions [6,7,8,9]. This evidence extends to racially and ethnically diverse older female populations [10,11,12] and may be relevant to specific racial/ethnic groups. Higher perceived discrimination has been associated with lower engagement in protective health behaviors among Black women [19]

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