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. Author manuscript; available in PMC: 2022 Apr 1.
Published in final edited form as: Prev Sci. 2021 Apr;22(3):357–366. doi: 10.1007/s11121-020-01141-3

The moderating role of coping style on chronic stress exposure and cardiovascular reactivity among African American emerging adults

Lucia Cavanagh 1, Ezemenari M Obasi 1
PMCID: PMC7854985  NIHMSID: NIHMS1613894  PMID: 32696119

Abstract

Background

Chronic stress exposure may contribute to dysregulation of cardiovascular functions and increase CVD risk among African Americans. This study investigated the direct and interactive effects of chronic stress exposure and coping styles on cardiovascular reactivity to acute stress.

Method

A sample of African American emerging adults (n = 277) completed a battery of self-report assessments and underwent the Trier Social Stress Test (TSST) across two time points.

Results

Prior chronic stress exposure was negatively associated with heart rate (HR) reactivity among females at 1-month follow-up. Task-oriented coping was positively associated with HR reactivity, while avoidance-oriented coping showed a negative association. Higher use of emotion-oriented coping moderated the relationship between chronic stress exposure and HR reactivity, resulting in more robust reactivity. Among females, but not males, lower use of avoidance-oriented coping moderated the relationship between prior chronic stress exposure and HR reactivity, also resulting in more robust reactivity.

Conclusions

Prior chronic stress exposure and the use of maladaptive coping strategies may confer negative impacts on cardiovascular reactivity, particularly among African American females. Using adaptive coping styles may mitigate these effects and improve cardiovascular reactivity. These findings provide preliminary support for psychosocial determinants of health within a controlled laboratory experiment and highlight important gender differences to consider in prevention efforts for African American cardiovascular health disparities.

Keywords: Stress dysregulation, heart rate reactivity, chronic stress, coping styles

Introduction

African Americans experience disproportionate rates of morbidity and mortality with regard to cardiovascular health, as evidenced by relatively earlier ages of onset of cardiovascular diseases (CVD); increased incidence of stroke, heart failure, and peripheral artery disease; and higher prevalence of cardiovascular risk factors, such as hypertension, diabetes mellitus, obesity, when compared to European Americans (Carnethon et al., 2017). Chronic stress exposure and limited access to adaptive coping resources have been hypothesized to initiate dysregulation of physiological stress systems, which may, in turn, increase vulnerability for developing cardiovascular diseases (McEwen, 1998; Grippo & Johnson, 2009; Meyer, Schwartz, & Frost, 2008; Thoits, 2010). African American emerging adults may be particularly vulnerable to these deleterious effects, given their disproportionate rates of exposure to chronic stressors during a critical developmental period (Hope, Hoggard & Thomas, 2015). Specifically, African Americans may endure higher rates of chronic stress related to experiences of racism, violence, crime, under-/un-employment, neighborhood disorganization, financial strain, interpersonal discord, and educational barriers (U.S. Census Bureau, 2017). Additional stressors, such as lack of access to care, lack of consistent transportation, lack of or inadequate health insurance, and marginalization by health care providers, magnify these health risks and may further contribute to CVD progression (Havranek et al., 2015).

Despite an overrepresentation in chronic stress exposure and subsequent disease burden, the African American community remains largely underrepresented in cutting-edge research studies that investigate biobehavioral mechanisms involved in the deterioration of cardiovascular health. Given the magnitude of this pressing public health problem, indentifying modifiable risk and resilience factors involved in cardiovascular dysregulation may provide accessible targets for intervention. The present study examined the relationship between chronic stress exposure and individual coping styles on cardiovascular reactivity to acute stress among urban-dwelling African American emerging adults.

Stress Physiology and Cardiovascular Dysregulation

Persistent stress exposure and subsequent physiological activation may cause wear and tear on the body that is reflected in dysregulated cardiovascular reactivity to stress (McEwen, 1998). Typically, in the face of short-lived environmental threats, increases in HR facilitate physiological changes that enhance one’s ability to respond and cope with environmental challenges (i.e., “fight or flight”). When the threat is past, HR begins to decrease, allowing the body to return to its baseline levels of functioning and begin to repair itself (i.e., “rest and digest”). These internal physiological shifts serve an adaptive function by enabling the body to achieve stability in the face of changing environments (i.e., allostasis). However, under chronic conditions, the cumulative effects of repeated stress exposure can cause allostatic systems to become exhausted. This phenomenon may be marked by inadequate or excessive HR reactivity, failed inactivation and/or compromised capacity to effectively recover from stressors. Such functional wear and tear on the body (i.e., allostatic load) reflects a decrease in one’s dynamic adaptability to changing contexts (McEwen, 1998; Thayer & Lane, 2007). In this way, innate allostatic alterations in HR may have protective effects in the face of a short-lived threat, but the cumulative long-term effects on the body can be damaging and may accelerate CVD progression (McEwen, 1998). For example, the elevation of blood pressure enacted during an acute stress response will ensure adequate blood flow to the brain, but chronically elevated blood pressure may eventually lead to atherosclerosis, stroke or coronary occlusion.

The cumulative effects of chronic stress exposure and subsequent cardiovascular dysregulation have been well demonstrated in animal models, whereby acute exposure to social stress initially elicits robust HR activation (e.g., Bhatnagar et al., 2006; Sgoifo, Carnevali & Grippo, 2014), but multiple instances of social stress exposure confer rodents with a habituation-like effect, marked by blunted HR reactivity and reduced sympathetic dominance (Costoli et al., 2004). Over time, these rodents begin to exhibit increased susceptibility to stress-induced arrhythmias, higher body temperature, weight gain, and even permanent anatomical cardiac alterations (Bartolomucci et al., 2003; Bhatnagar et al., 2006; Sgoifo, Carnevalli & Grippo, 2014; Wood, 2014). In human subjects, similarly reduced regulatory capacities have been observed among individuals with anxiety and stress-related disorders, chronic gastrointestinal disorders, and history of childhood adversity (e.g., Garland et al., 2019; Kalmakis et al., 2015; Lampert et al., 2016; Pretty et al., 2013; Su et al., 2015; Voellmin et al., 2015).

Individual differences in cardiovascular reactivity

Despite demonstrated associations between chronic stress exposure and cardiovascular dysregulation, the magnitude and directionality of these associations are not unidirectional and can vary substantially across individuals (Schwarz et al., 2003). Given that cardiovascular morbidities develop only in a select portion of the population, characterizing such individual differences in cardiovascular reactivity may be valuable. Because physiological stress activation occurs secondary to the brain’s interpretation of an environmental stressor (Lupien et al., 2009; Juster, McEwen & Lupien, 2010), individual differences in the subjective perception and management of environmental stressors may influence emergent reactivity profiles (e.g., Clark, Bond & Hecker, 2007).

The cognitive and behavioral efforts exacted by an individual to subjectively manage stressors (i.e., coping strategies) may also provide useful targets for intervention in mitigating cardiovascular dysregulation associated with the development of CVD (Lazarus & Folkman, 1987). Coping strategies can vary widely and have both adaptive and maladaptive functions in the face of stress. Higgins and Endler (1995) classified coping strategies into three main stylistic groups: task-oriented, emotion-oriented, and avoidance-oriented. Task-oriented coping strategies are problem-focused approaches that involve taking direct actions to alter the environmental demand and thereby reduce the amount stress it evokes. Emotion-oriented coping strategies attempt to regulate the emotional distress elicited by the stressor by changing one’s perception or interpretation of it. Emotion-oriented approaches may use cognitive or behavioral efforts, such as reframing, minimization, positive comparisons, and construing positive value for a negative event, to reduce a negative emotional response and elicit less stress. Lastly, avoidance-oriented coping strategies are indirect approaches to adjust to the stressor by avoiding the situation and/or the emotions it elicits. Avoidance-oriented approaches may focus on denying its existence, losing hope, distancing oneself, or engaging in an activity not related to the stressor.

Both task- and emotion-oriented coping styles were initially recognized as proactive efforts to alter the level of stress experienced, while avoidance-oriented strategies were viewed as maladaptive, characterized by the absence of attempts to alter stress levels (Lazarus & Folkman, 1987). While some evidence for this assertion exists, findings have been largely inconsistent, particularly when considering cardiovascular health outcomes. For instance, task- and emotion-oriented coping have been associated enhanced cardiovascular recovery from acute stress and reduced risk for adverse cardiac events among several adult samples (e.g., Fontana & McLaughlin, 1998; Lee, Suchday & Wylie-Rosett, 2012; Li, Guan, Chang & Zhang, 2014; Messerli-Burgy et al., 2015). However, other studies have found no or inverse associations in this regard (Hahn et al., 1993; Vitaliano et al., 1993, 1995), including maladaptive cardiovascular outcomes associated with high use of emotion-oriented coping styles (Krzych et al., 2016). Similarly, while avoidance-oriented coping styles have been associated with poorer adjustment, more depressive symptoms, and greater risk-taking behaviors (Gupta & Derevensky, 2001; King et al., 2015), findings about its adaptiveness in the context of physiological stress paradigms has been more mixed. Specifically, avoidance-oriented coping styles have been associated with blunted cardiovascular reactivity to acute stress (e.g., Wemm et al., 2013), though inconsistent findings demonstrating no association (e.g., Spira et al., 2004) and improved outcomes (e.g., Ariarantam et al., 2017) have also been documented. Broad variability in sample populations, stressor type, and reactivity measures across studies further contribute to these unclear findings.

Overall, there is confusion about the direct effects of chronic stress exposure and coping styles on autonomic reactivity to stress. Moreover, the causal mechanisms by which chronic stress and coping interact to “get under the skin” and impact physiological processes associated with cardiovascular reactivity remain understudied, particularly among African American emerging adults (Burns, Deschenes & Smith, 2016; Schwartz et al., 2003). Elucidating these relationships may uncover important and accessible targets for developing culturally informed interventions aimed at reducing cardiovascular health disparities in this population.

The Present Study

The present study aims to identify psychosocial contributors that impact cardiovascular reactivity to acute stress, namely prior chronic stress exposure and individual coping styles. Based on previous research findings, the following hypotheses were made: (1) African American emerging adults who report higher levels of prior chronic stress exposure will exhibit more blunted HR reactivity to acute stress; (2) Task- and emotion-oriented coping styles will mitigate the negative effects of chronic stress exposure on HR reactivity, such that individuals with high chronic stress exposure who exhibit more task-oriented and/or emotion-oriented styles will demonstrate more robust HR reactivity than those who exhibit less task-oriented and/or emotion-oriented coping styles; (3) Avoidance-oriented coping styles will exacerbate the negative effects of chronic stress exposure on HR reactivity, such that individuals with high chronic stress exposure who exhibit more avoidance-oriented coping styles will experience more blunted HR reactivity than those who exhibit less avoidance-oriented coping styles.

Methods

Participants

Participants consisted of 277 African American emerging adults residing in a large metropolitan area in the southern United States. As part of their eligibility for study inclusion, all participants self-identified as African American or Black, were fluent English speakers, and were between the ages of 18 to 25, with mean age of 20.24 years (SD = 2.26). Participants were excluded from the study if they demonstrated evidence of active psychosis or another condition that may impair their ability to understand and fully participate in this study, had a current or previous diagnosis of substance use disorder, or were currently pregnant, to ensure safety in stress-induction protocols.

Over half the participants in this sample were female (72.1%, n = 200) and 27.9% (n = 77) were male. Regarding immigration status, 11.6% (n = 32) were born outside the U.S., 23.8% (n = 66) identified as first generation (i.e., one or both parents born outside U.S.), 2.5% (n = 7) as second generation, 4.3% (n = 12) as third generation, 57% (n =158) as fourth or greater generations; and 0.7% (n = 2) did not know. Most participants were single and had never been married (92%, n = 254). 5.1% (n = 14) were cohabiting, 1.8% (n = 5) were married/partnered, and 1.1% (n = 3) were separated or divorced. With regard to education, 1.8% (n = 5) of participants reported completing less than 12 years of education, 5.4% (n = 15) received a high school diploma or GED (12 years), 33.9% (n = 94) completed some college/technical school, 40.1% (n = 111) completed an associate’s degree (14 years), 12.3% (n = 34) completed a bachelor’s degree (16 years), and 6.1% (n = 18) completed some post-graduate schooling. Most participants 43.8% (n = 119) reported being full-time students, 19.9% (n = 59) reported part-time (i.e., <40 hours) employment, 6.4% (n = 19) reported full time (40+ hours) employment, 19% (n = 52) reported unemployment, 7% (n = 19) reported being a homemaker, and 0.7% (n = 2) reported being disabled or unable to work.

Procedures

The present study used a single group, prospective longitudinal design. Enrolled participants completed an initial assessment consisting of a battery of computerized self-report assessments that included measures of chronic stress exposure and demographic factors. Approximately 30 days later, participants completed a second assessment in the laboratory, during which they were asked to complete self-report assessments measuring broad coping styles. Next, participants were fitted with unobtrusive electrodes following published guidelines in order to continuously monitor heart rate (Biopac Systems, Goleta, CA). Once participants were adequately adjusted to the electrode fitting, they underwent the Trier Social Stress Test (TSST; Kirschbaum, Pirke & Hellhammer, 1993) to induce an acute stress response. During the TSST, participants were instructed to stand on a small stage with track lighting, facing a “committee,” which consisted of one African American and one European American confederate. Participants were presented a 2-minute recorded introduction describing the task requirements and then given 10 minutes of preparation time in a separate room. Thereafter, participants were then escorted back onto the stage and asked to deliver a free speech task (5 min) about why they should be hired for an ideal job vacancy. Following the speech task, participants completed a mental arithmetic task (5 min), in which they serially subtracted the number 13 from 6,233 in front of the “committee” as fast and as accurately as possible. Participants were connected to the BIOPAC© systems throughout the TSST, in addition to a 5-minute recording during resting state, to model baseline cardiovascular activity, and an additional 5-minute recording immediately post-TSST, to model down-regulation following the stressor. The total recording time was approximately 35 minutes. Following disconnection from cardiovascular recordings, participants were debriefed and financially compensated for their participation.

Measures

Chronic Stress Exposure

The Chronic Stress Scale (CStress; Turner, Wheaton & Lloyd, 1995) is a 51-item measure that assesses lifetime exposure to non-traumatic stressful life events (e.g., financial issues, work, love and marriage, family and children, social life). Responses are provided on a 3-point Likert-type scale, including not true (0), somewhat true (1), or very true (2). The total score across items reflects the degree of perceived chronic stress exposure. Internal consistency for the measure during the current study was 0.88.

Coping Style

The Coping Inventory for Stressful Situations (CISS; Endler & Parker, 1994) is a 48-item measure that assesses three dimensions (task-oriented, emotional, and avoidant) of how one responds when faced with stressful circumstances. Task-focused coping strategies directly deal with the problem at hand (e.g., “I think about how I have solved similar problems”). Emotion-focused coping strategies concentrate on the resulting emotions (e.g., “I worry about what I am going to do”). Avoidance-focused coping strategies attempt to avoid the problem through distraction (e.g., “I watch TV”) or social diversion (e.g., “I phone a friend”). Respondents rate the extent to which they engage in these various coping activities during a stressful situation using a 5-point Likert-type scale ranging from 0 (Not at All) to 4 (Very Much). Higher scores on each scale indicate greater propensity to use the respective coping style. Internal consistency for the measure during the current study was 0.87.

Demographics

A demographic questionnaire was administered in addition to the above stated measures in order to assess sample characteristics and allow for control of any covariance in analyses. The questionnaire asked participants to self-report their race, ethnicity, age, gender, marital status, and indicators of socioeconomic status, including education, employment, and income.

Cardiovascular Reactivity

Heart rate (HR) was continuously recorded using the BIOPAC© MP150 data acquisition system with an electrocardiogram amplifier and 3 Ag-AgCl disposable electrodes placed in the standard lead II configuration (Biopac Systems, Goleta, CA). The acquired data were filtered, rectified, and smoothed on a PC using the provided software, AcqKnowledge (version 4.2). All ECG data was processed through a band pass filter fixed at a low frequency of 1 Hz and high frequency of 35Hz to eliminate high frequency noise. Any data files with excessive error or noise were eliminated from further analysis, resulting in a total of N = 178 cases suitable for final analyses. No significant differences were observed among individuals with valid versus invalid HR data on the basis of self-reported study variables as well as demographic variables including age, gender, education, and employment status. HR was extracted using the mean duration of R-R intervals in msecs, resulting in a measure of the average cardiac beats per minute (bpm) for each time interval. Peak stress response values were determined based on the greater average heart rate yielded to either the math or speech stressor. The difference in average HR (bpm) during baseline and peak stress response reflects the magnitude change observed in HR in response to stress, indicative of HR reactivity.

Results

Descriptive statistics

Prior to conducting main analyses, data were first screened for any missing or error values and assumptions of normality were checked. Extreme values were log-transformed and winsorized (Rivest, 1994). Mean scores and standard deviations for study variables are presented in Table 1. Initial analyses revealed that women (M (SD) = 49.70 (11.28)) reported significantly higher use of emotion-oriented coping styles than men (M (SD) = 45.81 (10.15); t (207) = −2.283, p = .023, Cohen’s d = 0.36). Age had a significant positive association with total chronic stress exposure (r = .21, p < .001). There were no other significant associations observed between study variables and other demographic variables, including marital status, employment, and generational status. As a result, only age and gender were included as covariates in subsequent whole sample analyses. Given evidence of gender-based differences in the use of various coping styles, analyses were conducted for the overall sample as well as for each gender separately, in order to elucidate the presence of within-group, gender-based differences in main and interactive effects associated with HR reactivity.

Table 1.

Hierarchical Multiple Regression Analyses Predicting Cardiovascular Reactivity

Mean (SD) Whole Sample (N = 160) Females only (N = 111)
Dependent Variable = ΔHR ΔR2 β t df p ΔR2 β t df p
Step 1: Demographics .016 .287 .024 .102
 Age 20.24 (2.26) −.118 −1.477 157 .142 −.156 −1.651 109 .102
 Gender −.029 −.369 157 .713
Step 2: CStress 25.98 (12.97) .011 −.109 −1.354 156 .178 .030 −.179 −1.847 108 .049*
Step 3: CISS .049 .055 .032 .086
 CISS-Task 60.05 (9.40) .206 2.265 153 .025* .111 1.010 105 .315
 CISS-Emo 49.05 (11.27) .055 .605 153 .546 .071 .679 105 .498
 CISS- Avoid 53.01 (9.32) −.229 −2.541 153 .012* −.204 −1.905 105 .060
Step 4: CStressxCISS .052 .034* .079 .015*
 CStressxCISS-Task .072 .837 150 .404 .029 .274 102 .784
 CStressxCISS-Emo −.162 −1.987 150 .049* −.126 −1.315 102 .191
 CStressxCISS-Avoid .136 1.569 150 .119 .236 2.296 102 .024*
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Note. ΔHR = Change in heart rate (bpm) from baseline to peak stress response during TSST. CStress = Sum score of Chronic Stress Scale. CISS = Coping Inventory for Stressful Situations. CISS-Task = Task-oriented coping scale of CISS. CISS-Emo = Emotion-oriented coping scale of CISS. CISS-Avoid = Avoidance-oriented coping scale of CISS.

*

p < .05.

Paired-samples t-tests were conducted to ensure significant (α = .05) cardiovascular reactivity was elicited by the TSST. All participants showed significant HR reactivity from baseline to peak stress response (t (177) = −23.471, p < .001, Cohen’s d = 1.70), with an average 30% increase in HR. Significantly higher HR was observed during both speech (t (163) = −19.63, p < .001, Cohen’s d = 1.68) and math (t (163) = −17.30, p < .001, Cohen’s d = 1.57) components of the TSST, compared to baseline HR. No differences in HR reactivity were observed as a function of demographic variables. Overall, this large effect size indicates that the TSST produced a valid cardiovascular stress response in the current sample. The directionality and magnitude of change observed in HR is commensurate with other studies employing the TSST among healthy young adults (e.g., Kirschbaum, Pirke & Helhammer, 1993; Kudielka et al., 2007).

Direct and Indirect effects

To examine main and moderating effects of chronic stress and coping styles on cardiovascular reactivity, hierarchical multiple regressions (HMR) were conducted. Predictor variables were centered to reduce multicollinearity between main and interaction effects (Cohen, West & Aiken, 2014). Relevant variables were then entered in a step-wise format (Frazier, Tix & Barron, 2004). Specifically, covariates of age and gender were entered in step 1, the predictor variable of prior chronic stress exposure (i.e., CStress) was entered in step 2, the moderating variables consisting of three coping styles were entered in step 3 (i.e., CISS-Task, CISS-Emo, CISS-Avoid), and interaction effects reflecting the products of chronic stress exposure and each coping style were entered in step 4 (i.e., CStressxCISS-Task, CStressxCISS-Emo, CStressxCISS-Avoid). Evidence for a moderator effect can be established if resulting interactions are significant (i.e., p < .05 and/or ΔR2 ≥ .02; Cohen, 1992).

Results of the HMR analyses are presented in Table 1. Coping styles were found to be marginally associated with HR reactivity (F (6, 153) = 2.108, p = .055, ΔR2 = .049). More specifically, task-oriented (β = 0.206, t (153) = 2.265, p = .025) and avoidance-oriented (β = −0.229, t (153) = −2.541, p = .012) coping styles were associated with HR reactivity, after controlling for age and gender. Additionally, there was a significant interaction effect (F (9, 153) = 2.447, p = .013, ΔR2 = .052) between chronic stress exposure and emotion-oriented coping style (β = −.162, t (153) = −1.987, p = .049) in predicting HR reactivity. This significant interaction is presented in Figure 1. The slope of the line was significantly different from zero at one standard deviation above the mean (β = −3.04, t (153) = −2.423, p = .017), but was nonsignificant at the mean (β = −1.301, t (153) = −1.300, p = .195), nor at one standard deviation below the mean (β = 0.436, t (153) = 0.311, p = .756).

Figure 1.

Figure 1.

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Interactive effects of chronic stress exposure and emotion-oriented coping styles on cardiovascular reactivity to acute stress.

Note. ΔHR = Change in heart rate (bpm) from baseline to peak stress response during TSST. CStress = Sum score of Chronic Stress Scale. CISS = Coping Inventory for Stressful Situations. CISS-Emo = Emotion-oriented coping scale of CISS.

This analytic approach was duplicated with male and female participants, respectively. Among females, chronic stress exposure was significantly associated with HR reactivity (F (2,108) = 3.099, p = .049, ΔR2 = .030), after controlling for age. There was a significant interaction effect (F (8, 102) = 2.530, p = 0.015, ΔR2 = 0.079) between chronic stress exposure and avoidance-oriented coping style (β = 0.236, t (102) = 2.296, p = .024) in predicting HR reactivity. This significant interaction is presented in Figure 2. The slope of the line was significantly different from zero at one standard deviation below the mean (β = −7.198, t (153) = −3.462, p < .001), and at the mean (β = −3.156, t (153) = −2.573, p = .011), but was nonsignificant at one standard deviation above the mean (β = 1.083, t (153) = 0.546, p = .586). Among males, no significant main nor interactive findings emerged, though it is noted that analyses may be underpowered due to the limited representation of males in this sample.

Figure 2.

Figure 2.

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Interactive effects of chronic stress exposure and avoidance-oriented coping styles on cardiovascular reactivity to acute stress among female participants

Note. ΔHR = Change in heart rate (bpm) from baseline to peak stress response during TSST. CStress = Sum score of Chronic Stress Scale. CISS = Coping Inventory for Stressful Situations. CISS-Avoid = Avoidance-oriented coping scale of CISS.

Discussion

The present study aimed to characterize the role of prior chronic stress exposure and coping styles on cardiovascular reactivity to acute stress among African American emerging adults. This is an understudied population with increased risk for chronic stress exposure and documented overrepresentation in CVD burden. We hypothesized that prior chronic stress exposure would be associated with more blunted HR reactivity, reflecting a decreased dynamic ability to coordinate physiological resources in response to stress. The current findings supported this hypothesis, but only among female participants. This is consistent with prior studies among African American participants, in which gender was found to play an important role in the subjective experience and subsequent physiological manifestations of chronic stress (Myers et al., 2015; Lewis et al., 2013; Geronimus et al., 2010). One potential reason for this may be that the cumulative effects of stress exposure as a function of having both gender- and race-based minority statuses may increase African American females’ vulnerability to cardiovascular dysregulation. This notion is consistent with intersectionality frameworks, which posit that disadvantages associated with each of these statuses can combine to produce linked forms of chronically stressful experiences and thereby heighten risk for physical and mental health decline (Collins & Blige, 2016). Indeed, in a study of African American females, Perry, Harp and Oser (2013) found that higher levels of lifetime racial and gender discrimination were predictive of experiencing more individual chronic stressors, even when controlling for other sociodemographic factors (e.g., SES) and drug use. Given that blunted HR reactivity can have deleterious effects on health, the current results may help inform prior findings of accelerated aging and cardiovascular decline among African American women (Geronimus et al., 2010).

In order to develop culturally informed interventions for mitigating these negative health outcomes, it is necessary to identify modifiable risk and resilience factors that affect cardiovascular dysregulation in this population. To this end, the current study evaluated the impact of various coping styles in the relationship between chronic stress exposure and HR reactivity. The results of the entire sample indicated that higher use of task-oriented coping styles was associated with more robust HR reactivity to stress, while avoidance-oriented coping styles were associated with more blunted HR reactivity. Prior research has demonstrated the adaptive utility of task-oriented coping in improving mental health (i.e., by managing subjective stress and enhancing psychological resiliency; Beasley, Thompson & Davison, 2003; Campbell-Sills, Cohan & Stein, 2006). The current study extends these findings by considering its impact on physiological outcomes. Based on these findings, behavioral interventions that reinforce more instrumental, task-oriented coping may represent a fruitful avenue for study in the development of culturally informed CVD prevention efforts in the African American community.

Given that coping mechanisms typically co-occur with stressful experiences, we also investigated the impact of coping styles on HR reactivity in the context of prior chronic stress exposure. We hypothesized that the use of task-oriented and emotion-oriented coping styles would mitigate the negative effects of chronic stress exposure on HR reactivity, such that individuals with higher chronic stress who use task-oriented and/or emotion-oriented coping will demonstrate more robust HR reactivity than those who report lower use of these coping styles. Results provided some support for this hypothesis. It was found in the entire sample that high use of emotion-oriented coping resulted in a more negative association between chronic stress exposure and cardiovascular reactivity, such that individuals who endorsed less chronic stress exposure and higher emotion-oriented coping demonstrated a more robust reactivity profile. However, the positive impact of high emotion-oriented coping appeared to become less salient with increasing chronic stress, resulting in more blunted profiles. This suggests that emotion-oriented coping may be a useful target for early prevention efforts, when stress-induced changes in cardiovascular reactivity are not yet evident, but it may be less beneficial for those individuals with a strong history of chronic stress exposure who are already beginning to evidence cardiovascular dysregulation. Prior research investigating emotion-oriented coping in the context of variably progressive cardiovascular diseases lends some support for this notion as well. Specifically, emotion-oriented coping has been associated with worse health outcomes among individuals with more severe cardiovascular illnesses (e.g., congestive heart failure; Bahremand et al., 2016; Casagrande et al., 2019; Krzych et al., 2016), but its use among individuals with no cardiac conditions or with cardiac conditions of lower severity (e.g., hypertension, hypercholesterolemia) is less physiologically impactful. Undoubtedly, the biological mechanisms underlying the role of emotion-focused coping in cardiovascular reactivity warrant further investigation. It may be that coping strategies oriented toward enhanced emotional regulation also contribute to enhanced modulation of the sympathetic nervous system (SNS), thereby resulting in improved cardiovascular reactivity to stress. These positive effects on the SNS may not extend to higher stress contexts, however, where the SNS is already entering a dysregulated state (Chiavarino et al., 2012).

The current study also found that, among female participants, limited use of avoidance-oriented coping styles moderated the negative relationship between chronic stress exposure and HR reactivity. Although we initially hypothesized that high use of avoidance-oriented coping would heighten risk for cardiovascular blunting, our results rather suggest that low use of avoidance-oriented coping may represent a resilience factor for cardiovascular reactivity, although this resiliency effect appears to dampen as the level of chronic stress increases.

Ultimately, the present study lends preliminary evidence for the notion that coping styles may represent an accessible source of resiliency for cardiovascular health among African American emerging adults, most notably for females. Younger women are facing increasingly higher risks for CVD-related morbidity and mortality, with higher reported levels of stress, progressively increasing rates of CVD-related deaths (compared to declining rates among men), and an estimated 7% higher death rate following a myocardial infarction compared to men (Benjamin et al., 2017). There is thus a dire need to develop effective behavioral intervention and prevention programs aimed at reducing CVD risk in this population. Our findings may be used to inform these efforts. Specifically, task-oriented and emotion-oriented coping styles may be particularly adaptive, though African American females may gain added benefit from minimizing reliance on avoidance-oriented coping styles. Given the interactive effects of prior chronic stress exposure and coping observed among females in this study, careful consideration must be given to the context in which coping strategies are most often applied to determine their effectiveness.

Limitations and future directions

While this study provides novelty in its consideration of sociocultural determinants of cardiovascular reactivity, it is not without some limitations. Firstly, the current study focused its recruitment among African American emerging adults residing in the southern U.S. This is a cohort that has been historically under-represented in biomarker studies, despite having a potentially increased risk for experiencing negative cardiovascular health outcomes. Notably, this sample had a large number of full-time students, resulting in slightly higher educational attainment relative to existing population estimates of African Americans emerging adults (i.e., approximately 34% completed high school, 35% completed some college, 5% completed an Associate’s degree, 6% completed a bachelor’s degree, and 0.7% completed postgraduate work; U.S. Census Bureau, 2017), although the representation of individuals who completed some college is commensurate (33.9% in the current sample vs. 35% general population). In addition, self-reported unemployment status of the current sample was consistent with national data regarding African American emerging adults. Extending the interpretation of these findings to other African American communities should be done with caution until new studies can replicate findings in those communities. Moreover, the inclusion of other at-risk populations could shed light on within- and between-group differences in the manifestation of cardiovascular health disparities that disproportionately affect marginalized communities. Given that the current sample was overrepresented by females, replication of these findings using a larger and more stratified sample may also help clarify their generalizability, particularly among emerging adult males.

The statistical approaches and theoretical models used in this study also make it plausible that other unexplored models and/or moderating variables may account for additional variance in the observed associations. For instance, this study inquired about chronic exposure to everyday stressors, such as excessive work demands, social isolation, and financial difficulties. Although the unique impact of these stressors has well-demonstrated effects on cardiovascular regulation (e.g., Myers & Ulrich-Lai, 2017), there may be other aspects of stress exposure (e.g., race-related stress, prior trauma) that impact HR reactivity and further contribute to CVD risk. Indeed, prior research has documented dysregulated HR reactivity among healthy adult females with a history childhood trauma (e.g., Voellmin et al., 2015), and among African Americans who report high rates of racial discrimination and unfair treatment (Guyll, Matthews & Bromberger, 2001). These variables may represent salient stressors that critically affect cardiovascular health and further contribute to observed disparities among African American emerging adults. Along these lines, while we explored resilience factors associated with broad coping styles, we did not consider how other aspects of one’s behavior (e.g., cultural beliefs, social support) might also contribute as protective factors. Given the observed gender differences in the impact of chronic stress and the utility of different coping styles among African American females in this study, further investigation into other aspects of stress and coping may be helpful in shaping the development of larger-scale prevention and intervention programs. Future research may also expand notions of “stress” beyond psychosocial variables alone, by incorporating additional measures of physical and mental health status (e.g., obesity, physical activity, depression, etc.). Previous research has demonstrated negative effects of obesity, reduced physical activity, and depression (e.g., Huang et al., 2013; Parks et al., 2015; Phillips, 2011) in HR reactivity, but the interactive effects of these variables with characteristic resilience factors, such as coping style, has received less attention.

In conclusion, this study reinforces the need for future research to identify between-group and within-group variation in how psychosocial determinants of health can get under the skin to impact differential cardiovascular profiles across time. Identifying explanatory mechanisms linked to health disparities will better position researchers to create culturally informed prevention and intervention strategies aimed at reducing – and ultimately eliminating – health disparities in the African American community.

Funding.

This project was supported in part by the National Institutes of Health, National Institute on Drug Abuse (R01DA034739, PI: EM Obasi). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the project supporters.

Footnotes

Compliance with Ethical Standards

Conflicts of Interest. The authors declare that they have no conflict of interest.

Ethical Approval. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent. Informed consent was obtained from all individual participants included in the study.

Publisher's Disclaimer: This Author Accepted Manuscript is a PDF file of a an unedited peer-reviewed manuscript that has been accepted for publication but has not been copyedited or corrected. The official version of record that is published in the journal is kept up to date and so may therefore differ from this version.

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