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. Author manuscript; available in PMC: 2023 Jan 1.
Published in final edited form as: Nurs Res. 2022 Jan-Feb;71(1):66–74. doi: 10.1097/NNR.0000000000000560

Lifetime Trauma and Cardiovascular Health in Latinas

Billy A Caceres 1, Danny Vo 1, Veronica Barcelona 1, Niurka Suero-Tejeda 1
PMCID: PMC8732306  NIHMSID: NIHMS1745918  PMID: 34644271

Abstract

Background:

Potentially traumatic experiences throughout the lifecourse are associated with poor cardiovascular health among women. However, research on the associations of trauma with cardiovascular health among Latino populations is limited. Understanding the impact of trauma on cardiovascular health within marginalized populations may provide guidance on developing interventions with a particular focus on preventative care.

Objective:

The purpose of this descriptive cross-sectional study was to examine the associations of lifetime trauma with cardiovascular health among middle-aged and older Latina women.

Methods:

Participants were recruited from an existing study in New York City. All participants completed a structured questionnaire to assess lifetime trauma, demographic characteristics (such as age and education), financial resource strain, and emotional support. The Trauma History Questionnaire was used to assess lifetime exposure to potentially traumatic experiences (range 0–24). Cardiovascular health was measured with a validated measure of cardiovascular health from the American Heart Association (Life’s Simple 7). We used self-reported and objective data to calculate cardiovascular health scores (range 0–14). Multiple linear regression was used to examine the associations of lifetime trauma with cardiovascular health, adjusted for age, education, financial resource strain, and emotional support.

Results:

The sample included 50 Latina women with a mean age of 63.1 years, 88% were Dominican, and only 6% had completed a college degree. Women reported an average of 4.8 traumatic experiences. Mean cardiovascular health score was 6.5. Linear regression models found that after adjusting for age, education, financial resource strain, and emotional support, a higher count of lifetime trauma was associated with worse cardiovascular health. However, this association did not reach statistical significance.

Discussion:

Women with a higher count of lifetime trauma had worse cardiovascular health scores; this association was not statistically significant. Future studies should investigate associations of lifetime trauma and cardiovascular health in larger and more diverse samples of Latinas. Nurses and other clinicians should incorporate trauma-informed approaches to CVD risk reduction to improve the CVH of Latina women who are survivors of trauma.

Keywords: Hispanic Americans, psychological trauma, violence, heart disease risk factors, women’s health

Cardiovascular disease (CVD) is a significant health concern among Latinos in the United States (U.S.) as more than 70% of Latino adults have at least one risk factor for CVD (Daviglus et al., 2012). In 2017, CVD was the second leading cause of death among Latina women in the U.S. (Centers for Disease Control and Prevention, 2017). In addition, Latinas are almost twice as likely to have a diagnosis of diabetes than non-Latinas (Centers for Disease Control and Prevention, 2020). In 2018, Latinas had the second-highest age-adjusted prevalence of obesity in the U.S. among racial and ethnic minorities (Hales et al., 2017).

The American Heart Association’s (AHA) Life’s Simple 7 (LS7) is a widely used measure to assess ideal cardiovascular health (CVH) across the lifespan and is a strong predictor of future CVD events (Lloyd-Jones et al., 2010). The LS7 metric includes three health behaviors (tobacco use, diet, and physical activity) and four health factors (body mass index [BMI], blood pressure, total cholesterol, and glycemic status). Higher scores indicate a more favorable CVH profile (Lloyd-Jones et al., 2010). In two recent meta-analyses, investigators found that worse LS7 scores predicted incident CVD and mortality among adults (Fang et al., 2016; Ramírez-Vélez et al., 2018).

Latinos overall have a higher prevalence of poverty, lower educational attainment, and inadequate access to healthcare, which have been associated with worse LS7 scores in the general population (Cabeza de Baca et al., 2019; De Moraes et al., 2019; Egan et al., 2020). Approximately one-fifth of Latinos in the U.S. live in poverty (Flores et al., 2017). The higher prevalence of CVD factors in Latinos is compounded by barriers to access and utilization of adequate healthcare (Clarke et al., 2017). Moreover, although greater emotional support is associated with more favorable LS7 scores among middle-aged and older adults (Slopen et al., 2017), few studies have examined the influence of emotional support and other forms of social support on the CVH of Latinos (Rodriguez et al., 2014). Given this evidence, the AHA has highlighted the need to address social determinants of health as a strategy to improve the CVH of Latinos in the U.S (Rodriguez et al., 2014).

Trauma is a potent predictor of poor health outcomes that remains understudied as a social determinant of CVH among Latinas (Suglia et al., 2018). Investigators have found that social (e.g., chronic stress) and demographic (e.g., socioeconomic status) determinants of health may predispose Latinas to a higher prevalence of individual components of the LS7 metric (e.g., elevated BMI and hyperglycemia) (Gallo et al., 2015; Khambaty et al., 2020; Llabre et al., 2017). Yet, few studies have examined lifetime trauma in relation to a comprehensive measure of cardiovascular health such as LS7. Further, potentially traumatic experiences have been associated with poor CVH in women, but most research has had limited inclusion of racial and ethnic minority adults (Scott et al., 2021; Suglia et al., 2015, 2018). For instance, analyses of data from the Nurses’ Health Study II have found women who report childhood abuse or intimate partner violence are at higher risk of incident hypertension and diabetes (Mason et al., 2013; Riley et al., 2010). Lifetime trauma is also associated with incident CVD in women (Rich-Edwards et al., 2012; Sumner et al., 2015). Although Latinos are more likely to report childhood abuse and have higher CVD risk than their non-Latino White counterparts, existing evidence on the associations of traumatic experiences with CVH in Latinos is limited (Lee & Chen, 2017). Using data from the Hispanic Community Health Study, investigators found that among Latino men and women those who reported more adverse childhood experiences had elevated BMI and higher odds of current smoking (Llabre et al., 2017). However, findings were not disaggregated by sex.

To our knowledge, no study has examined the associations of lifetime trauma with the AHA’s measure of CVH among Latina women or any population of adults. In response to this gap in the literature, the purpose of the present study was to examine the associations of lifetime trauma with CVH among middle-aged and older Latina women (who are more likely to report exposure to lifetime trauma than Latino men). Our research question was: “Is greater exposure to lifetime trauma associated with worse CVH among Latina women?” Our study was informed by the AHA’s model of childhood adversity and cardiometabolic health (Suglia et al., 2018), which posits that greater exposure to adverse life experiences (e.g., violence) contributes to multiple behavioral (e.g., physical inactivity and tobacco use) and physiological risk factors (e.g., hypertension, diabetes) for CVD that can lead to CVD morbidity and mortality later in life. We extended this model to test the hypothesis that greater exposure to trauma across the lifecourse would be associated with worse CVH among middle-aged and older Latina women.

Methods

Sample

Participants were recruited from an existing study in New York City called the Washington Heights/Inwood Comparative Effectiveness Research Project (WICER). The goal of the WICER study was to improve hypertension care delivery and reduce health disparities among residents of the Washington Heights/Inwood neighborhoods in Northern Manhattan. Between 2011–2013, a sample of 5,938 adults (74% female) was recruited from households (via door to door recruitment) as well as ambulatory care clinics affiliated with the New York-Presbyterian Hospital using a combination of probability, convenience, and snowball sampling (i.e., referrals from family and friends). Data collection consisted of surveys to assess self-reported health outcomes, physiological data (e.g., blood pressure, BMI), and measures of health literacy. Bilingual community health workers completed assessments in English or Spanish depending on participant preference. A follow-up assessment, which included similar assessments, was completed with 52% of the original sample from 2014–2016 (N = 3,077). Procedures for the WICER study have been described in detail elsewhere (Lee et al., 2014).

The present study was a descriptive cross-sectional study funded by the Pilot Projects Core of the Precision in Symptom Self-Management (PriSSM; P30NR016587) Center at the Columbia University School of Nursing. The goal of the PriSSM Center is to advance the science of symptom self-management for Latinos using a social ecological lens. We recruited a sub-sample of Latina women (over the age of 40) who participated in the WICER follow-up assessment. From November 2018 to August 2019, we contacted WICER follow-up participants via telephone who had previously consented to future research contact. At the WICER follow-up assessment, there were 1,560 women over the age of 40 with no history of CVD (e.g., heart attack, stroke). Because all pilot studies of the PriSSM Center are required to collect genetic data, to reduce the costs of collecting genetic data we prioritized recruitment of 72 female WICER participants who had previously provided saliva samples as part of a genetic supplement to the PriSSM Center. However, no genetic data were used in the present analysis. As shown in the Figure, we contacted a total of 133 women (72 women from the genetic supplement and an additional 61 randomly selected female WICER participants) to reach our target sample. We collected new data with the objective to examine the associations of lifetime trauma with CVH among middle-aged and older Latina women.

Figure.

Figure.

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Recruitment Flow Diagram

Eligibility Criteria

Inclusion criteria for the present study were: 1) female-identified individuals, 2) ages 40 and over, 3) English and/or Spanish fluency, and 4) ability to provide informed consent. Capacity to provide informed consent was determined with a six-item telephone cognitive screener that is validated in English and Spanish (Callahan et al., 2002). We chose to recruit women over the age of 40 due to the increased risk of CVD that occurs among women in mid-life (Colafella & Denton, 2018; Dasinger & Alexander, 2016). Exclusion criteria were history of: 1) cognitive impairment, 2) comorbid psychopathology (e.g., personality disorders), and 3) CVD (i.e., ever been told by a clinician that they had been diagnosed with heart attack, stroke, coronary artery disease, or heart failure). Individuals with a history of CVD were ineligible as the objective of this study was to assess risk for future CVD events.

Data Collection

All study procedures were approved by the Institutional Review Board at the Columbia University Irving Medical Center (CUIMC). All data presented in this report were newly collected for the present study as the WICER Study did not previously collect information on lifetime trauma or LS7. Data collection was conducted by a bilingual, trained Researcher Coordinator who was part of the original research staff of the WICER Study following a standard protocol developed by the study team. Participation in the present study included a 1.5-hour office visit. After written, informed consent was obtained, the Research Coordinator collected clinical data, including measurements of height, weight, and blood pressure. Next, participants completed a 45-minute structured questionnaire administered by the Researcher Coordinator. Participants had the option of completing data collection in English or Spanish using instruments that have been validated in both languages. However, all participants chose to complete data collection in Spanish. All information was entered into REDCap (a password-protected electronic data capture system) by the Research Coordinator. After completing the structured interview, the Research Coordinator obtained an additional blood pressure measurement. Last, the Research Coordinator escorted participants to the CUIMC’s Clinical Research Resource for venipuncture to obtain serum samples of total cholesterol and glycosylated hemoglobin (HbA1c).

Measures

Demographic characteristics.

We assessed age (continuous) and education. We used a single-item measure from the National Institutes of Health’s (NIH) Common Data Elements Repository to assess financial resource strain, which has been validated in English and Spanish. (Grinnon et al., 2012; Puterman et al., 2013). Participants were asked, “How hard is it for you to pay for the very basics like food, housing, medical care, and heating?” Responses included “not hard,” “somewhat hard,” “hard,” and “very hard.”

Lifetime trauma.

The 24-item Trauma History Questionnaire is a widely used instrument to assess potentially traumatic experiences (e.g., interpersonal violence and crimes). The Trauma History Questionnaire, which has been validated in English and Spanish, has adequate validity and test-retest reliability (Hooper et al., 2010). We used the Trauma History Questionnaire to assess 23 potentially traumatic experiences. The last item measured any other stressful event not captured in previous items. A score of “1” was assigned for each traumatic event endorsed. We summed responses to all 24 items with higher scores indicating a higher count of lifetime trauma (range 0–24).

CVH.

LS7 is a widely used measure of CVH and a robust predictor of incident CVD and mortality among adults (Fang et al., 2016; Ramírez-Vélez et al., 2018). LS7 has seven components including three health behaviors (i.e., tobacco use, diet, and physical activity) and four health factors (i.e., BMI, blood pressure, total cholesterol, and glycemic status). As shown in Table 1, participants were assigned a score of 2 for meeting ideal criteria, 1 for meeting intermediate criteria, and 0 for meeting poor criteria for each of the seven components of the CVH metric based on established methods (Lloyd-Jones et al., 2010). Scores were summed to create a measure of CVH with higher scores indicating better CVH (range 0–14).

TABLE 1.

SCORING CRITERIA AND PREVALENCE OF INDIVIDUAL CARDIOVASCULAR HEALTH COMPONENTS (N = 50)

Cardiovascular health components and scoring criteria n(%)/Mean(SD)
Physical activity
 Poor: No physical activity per week 28 (57.1)
 Intermediate: 1–149 minutes of moderate activity OR 1–74 minutes of vigorous activity OR 1–149 minutes of combined moderate and vigorous activity 14 (28.6)
 Ideal: ≥ 150 minutes of moderate activity OR ≥ 75 minutes of vigorous activity OR ≥ 150 minutes of combined moderate and vigorous activity 7 (14.3)
Diet
 Poor: 0–1 ideal components 39 (78.0)
 Intermediate: 2 ideal components 11 (22.0)
 Ideal: 3–4 ideal components 0 (0.0)
Tobacco use
 Poor: Current tobacco use 2 (4.0)
 Intermediate: Former smoker OR quit smoking < 12 months ago 12 (24.0)
 Ideal: Never smoked OR quit smoking more than 12 months ago 36 (72.0)
Body mass index
 Poor: ≥ 30 kg/m2 26 (52.0)
 Intermediate: 25–29.99 kg/m2 12 (24.0)
 Ideal: < 25 kg/m2 12 (24.0)
Glycosylated hemoglobin
 Poor: < 5.7% 12 (24.0)
 Intermediate: 5.7–6.5% OR <5.7% with treatment 26 (52.0)
 Ideal: <5.7% without treatment 12 (24.0)
Total cholesterol
 Poor: ≥ 240 mg/dL 10 (20.0)
 Intermediate: 200–239 mg/dL OR < 200 mg/dL with treatment 14 (28.0)
 Ideal: <200 mg/dL without treatment 26 (52.0)
Blood pressure
 Poor: Blood pressure ≥ 140/≥ 90 mmHg 11 (22.0)
 Intermediate: Blood pressure 120–139/80–89 mmHg OR blood pressure 120–139/80–89 mmHg OR blood pressure < 120/<80 with treatment 35 (70.0)
 Ideal: Blood pressure < 120/<80 without treatment 4 (8.0)
Cardiovascular health score (range 3–10) 6.5 (1.6)
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The three health behaviors included in the LS7 score (i.e., physical activity, diet, and tobacco use) were assessed using self-reported data. Physical activity was assessed using NIH’s Common Data Elements (Grinnon et al., 2012). Participants were asked four questions to estimate the number of minutes of moderate and vigorous recreational physical activities they engaged in within the past week. Diet intake was assessed with items from the LS7 score which assessed intake of sodium, fruits and vegetables, fish, fiber-rich whole grains, and sugar-sweetened beverages in a usual week (Lloyd-Jones et al., 2010). These items were used to calculate a healthy diet score. Given that we did not collect information on sodium intake, the healthy diet score was adapted based on previous work (Boylan & Robert, 2017). To calculate healthy diet scores, a score of “1” was assigned for each dietary component for which participants self-reported meeting ideal criteria, as follows: 1) fruits and vegetables: at least 5 cups per day, 2) fish: at least 3 servings per week, 3) fiber-rich whole grains: at least 3 servings per day, 4) sugar-sweetened beverages: less than 4 glasses per week. Scores for each dietary component were summed to calculate a healthy diet score (0–4). Tobacco use was assessed based on self-report of current or former cigarette smoking. Those who indicated they were former smokers were asked to indicate how long ago they had quit smoking. Responses to questions on physical activity, diet, and tobacco use were used to determine whether participants met ideal, intermediate, or poor criteria for each component (see Table 1 for details).

The four health factors included in LS7 were assessed using established procedures. We measured participants’ weight and height prior to completing the structured interview. We assessed participants’ weight (in kilograms) using the Tanita BF-684W scale. We then assessed participants’ standing, barefoot height (in meters) using a Seca portable stadiometer. Objective weight and height were used to calculate BMI with the following equation: kilograms/meters2. Seated blood pressure was measured twice (before and after the structured interview) with an electronic blood pressure monitor (Omron Series 10) using established guidelines for blood pressure measurement (Whelton et al., 2018). These readings were used to calculate the mean systolic and diastolic blood pressures. Blood was drawn to obtain serum total cholesterol and HbA1c. Measures for BMI, blood pressure, total cholesterol, and HbA1c were used to determine whether participants met ideal, intermediate, and poor criteria for each component.

Emotional support.

The Patient-Reported Outcomes Measurement System’s (PROMIS) 4-item emotional support instrument was used. This instrument has been validated in English and Spanish (Hahn et al., 2014). For each item, participants rated on a 5-point scale (1 = never; 2 = rarely; 3 = sometimes; 4 = usually; 5 = always) the degree to which they felt cared for by others. Example items include: “I have someone who will listen to me when I need to talk,” and, “I have someone who makes me feel appreciated.” Scores were summed with higher scores indicating greater emotional support (range 4–20). Cronbach’s alpha in the present sample was 0.85.

Statistical Analyses

Data were exported from REDCap into Stata Version 16 for data analysis. Prior to conducting statistical analyses, we examined the data for inconsistencies and missing data. The first seven enrolled participants were missing data for emotional support as this measure was added a few weeks into data collection. These participants (n = 7) were removed from the present analysis as these data were missing completely at random. There were no differences in age, education, financial resource strain, emotional support, lifetime trauma, or CVH between these participants and those included in our final sample. We then assessed frequencies, means, and distributions of study variables to characterize the sample. Next, we used Pearson’s correlation coefficients to assess bivariate associations among continuous variables. We used analysis of variance (ANOVA) to assess the bivariate associations of CVH with categorical variables (i.e., education and financial resource strain). Last, we used multiple linear regression models to examine the associations of lifetime trauma with CVH. Confounders were selected a priori based on previous evidence. Model 1 was unadjusted. Model 2 was adjusted for age, education, financial resource strain, and emotional support. Alpha was set at .05 for all analyses.

Results

The final sample included 50 Latinas. In Table 1, we present scoring criteria and the prevalence of meeting poor, intermediate, and ideal criteria for each CVH component in the sample. The proportion of women that met ideal criteria for each component of the LS7 was approximately 14.0% for physical activity, 0.0% for diet, 36% for tobacco use, 24.0% for BMI, 24.0% for HbA1c, 52% for total cholesterol, and 8.0% for blood pressure. The mean CVH score was 6.5 (SD = 1.6; range 3–10).

Sample characteristics are presented in Table 2. The final sample had a mean age of 63.1 years (SD = ±9.7; range 42–77). Most women were born in the Dominican Republic (88.0%). Only 3 (6.0%) women had completed a college degree. Eight (16.0%) women reported it was “very hard” to pay for basic needs. Emotional support scores were generally high with a mean score of 17.2 (SD = ±3.9; range 4–20). Women reported an average of 4.8 lifetime traumatic experiences (SD = ±2.1; range 1–10).

TABLE 2.

SAMPLE CHARACTERISTICS (N = 50)

Age (range 42–77; Mean[SD]) 63.1 (9.7)
Education (N[%])
 Less than high school 29 (58.0)
 High school or GED equivalent 6 (12.0)
 Some college 12 (24.0)
 College degree 3 (6.0)
Financial resource strain (N[%])
 Not hard 16 (32.0)
 Somewhat hard 13 (26.0)
 Hard 13 (26.0)
 Very hard 8 (16.0)
Count of lifetime trauma (range = 1–10; Mean[SD]) 4.8 (2.1)
Emotional support (range 4–20; Mean[SD]) 17.2 (3.9)
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As shown in Table 3, the bivariate association of the count of lifetime trauma with CVH was not statistically significant (r = .03, p < .82). Emotional support (r = −.33, p < .05) was inversely associated with CVH. Results of ANOVA analyses indicated the associations of education and financial resource strain with CVH were not statistically significant.

TABLE 3.

PEARSON’S CORRELATION COEFFICIENTS (r2) FOR CONTINUOUS VARIABLES

Variables 1 2 3 4
1. Cardiovascular health score - - - -
2. Count of lifetime trauma 0.03 -
3. Age −0.21 −0.10 - -
4. Emotional support −0.33* 0.09 −0.15 -
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Note. 1 = cardiovascular health score; 2 = count of lifetime trauma; 3 = age; 4 = emotional support

*

p < 0.05 (two-tailed)

Results of linear regression models examining the associations of count of lifetime trauma with CVH are presented in Table 4. Lifetime trauma was not associated with CVH score in unadjusted analyses (beta = .03, SE = .09, p = .82). However, in models adjusted for age, education, financial resource strain, and emotional support, lifetime trauma was inversely associated with CVH (beta= −.18, SE = .10, p = .08). The adjusted R2 for the adjusted model was 0.23.

TABLE 4.

RESULTS OF MULTIPLE LINEAR REGRESSION MODELS EXAMINING THE ASSOCIATIONS OF COUNT OF LIFETIME TRAUMA WITH CARDIOVASCULAR HEALTH IN LATINAS (N = 50)

Cardiovascular health score
Model 1a Model 2b
Predictor Variables β (SE) t p β (SE) t p
Count of lifetime trauma 0.03 (0.09) 0.825 .82 −0.18 (0.10) −1.76 .08
Age - - - −0.04 (0.03) −1.56 .13
Education
 Less than high school Reference
 High school or GED equivalent - - - −0.83 (0.69) −1.21 .23
 Some college 0.56 (0.55) 1.01 .32
 College degree −0.46 (0.97) −0.47 .64
Financial resource strain
 Not hard Reference
 Somewhat hard - - - −0.48 (0.58) −0.83 .41
 Hard −1.54 (0.57)* −2.73 .01
 Very hard −1.64 (0.67)* −2.45 .01
Emotional support - - - −0.12 (0.05) −2.10 .07
R2/Adjusted R2 0.02/0.01 0.37/0.23
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Note. SE = standard error; R2 = Coefficient of determination

a

Model 1 = unadjusted

b

Model 2 = adjusted for age, education, financial resource strain, and emotional support.

DISCUSSION

This cross-sectional study adds to the limited research on the association between lifetime trauma and CVH in a predominantly Dominican sample of middle-aged and older women. Our findings are generally consistent with our a priori hypothesis, which was informed by the AHA’s model of childhood adversity and cardiometabolic health (Suglia et al., 2018). Indeed, we found that a higher count of lifetime trauma was associated with worse CVH, though this relationship was not statistically significant. This may be, in part, due to our small sample size. Our study builds on previous evidence and is one of the first to examine the associations of lifetime trauma with a comprehensive measure of CVH in any population of women.

To our knowledge, only one prior study has examined the influence of any form of trauma on LS7 scores in any population. Using data from the Midlife in the United States (MIDUS) Study, investigators found that a greater severity of childhood trauma (i.e., abuse and neglect) was associated with worse CVH (measured using LS7) in a multi-ethnic sample of middle-aged and older adults (Caceres et al., in press). Our findings are consistent with the findings of that study (Caceres et al., in press), but instead of only examining childhood trauma we assessed trauma exposure across the lifespan. As most research on trauma and CVH in Latinas has focused on childhood abuse, our findings contribute to a limited body of literature on the associations of exposure to trauma across the lifecourse with CVH in this population. Moreover, investigators have previously found that lifetime trauma is associated with worse CVH in women (Mason et al., 2012, 2013; Rich-Edwards et al., 2012; Riley et al., 2010; Scott et al., 2021). Yet, few studies have investigated these associations in Latinas.

There is little known regarding the prevalence of CVD risk factors among Latino subgroups (Daviglus et al., 2012). Given that the present study included primarily Dominican women, there is a need for future research that explores the associations of lifetime trauma with CVH in diverse samples of Latinas. However, analyses of population-based data have shown that Dominican women may be at higher risk for CVD than Latinas of other countries of origin due to cultural and behavioral differences (Daviglus et al., 2012; Singer et al., 2018; Sorlie et al., 2014). Given existing evidence knowledge gaps, there is a need for rigorous interdisciplinary approaches for understanding predictors of poor CVH among Latinos (Rodriguez et al., 2014). We recommend future longitudinal research with larger diverse samples of Latinas that examine the associations of lifetime trauma and CVH over time. Such studies should account for sociocultural factors (e.g., country of origin or length of time in the U.S.) to examine subgroup differences in the associations of lifetime trauma and CVH within the Latino community. This is an important area for future research as there is substantial heterogeneity among Latino subgroups when examining CVD risk and other women’s health outcomes (Barcelona de Mendoza et al., 2016; Daviglus et al., 2012).

Our findings support the need for culturally tailored cardiovascular care that recognizes the role of traumatic experiences on the CVH of Latinas. Trauma-informed care is a strengths-based approach to providing healthcare that focuses on ensuring the safety of survivors of trauma (Hopper et al., 2010). Trauma-informed care may be an effective approach for health promotion initiatives tailored for survivors of trauma. However, to date, there are limited interventions that incorporate trauma-informed approaches to CVD risk reduction in any population (Suglia et al., 2018). Given their higher risk for lifetime trauma and higher prevalence of CVD risk factors, researchers should develop and test culturally appropriate models of trauma-informed care to reduce CVD risk in Latinas exposed to trauma with a particular focus on prevention.

These data have important research and clinical implications for nursing. As the largest healthcare profession, nurses are uniquely positioned to lead efforts to improve the CVH of marginalized populations. Nurses possess expertise in providing holistic care that addresses psychosocial, behavioral, and biological risk factors for chronic disease. Initiatives that integrate principles of trauma-informed care into nursing education and practice would help nurses better address the health needs of survivors of trauma. In addition, a recent survey of nurse researchers conducted by the AHA found that addressing health disparities was identified as a major priority for cardiovascular nursing science (Piano et al., 2018). As one of the fastest growing segments of the U.S. population (Pew Research Center, 2020), it is important for nurses and other clinicians to provide Latina women with culturally appropriate care that considers the role that life experiences and other sociocultural factors (e.g., acculturation) may have on their risk for CVD.

Limitations

This study has several limitations. First, this study was cross-sectional, which limits the ability to infer causality from findings. Our sample was also relatively homogenous. Next, this study had a small sample size which limited statistical power. However, this study was designed as a pilot study that sought to explore the associations of lifetime trauma and CVH in this understudied population and inform future work in this area. Last, our small sample size did not permit us to examine if psychosocial factors (e.g., posttraumatic stress and anxiety) potentially mediate the associations of lifetime trauma with CVH in Latinas. Additional research is needed that investigates potential mediators of this association in a larger sample of Latinas.

Conclusion

In the present study, a higher count of lifetime trauma was inversely associated with CVH in middle-aged and older Latinas, but this did not reach statistical significance. Our findings highlight the need for additional research with larger and more diverse samples of Latinas to examine the link between lifetime trauma and CVH. Researchers should use longitudinal designs to investigate the associations of lifetime trauma with CVH in Latinas. Nurses and other clinicians should incorporate trauma-informed approaches to CVD risk reduction to improve the CVH of Latina women who are survivors of trauma.

Acknowledgement:

Research reported in this publication was supported by the National Institute of Nursing Research (P30NR016587; K01NR017010), the National Heart, Lung, and Blood Institute (K01HL146965), and the National Center for Advancing Translational Science (UL1TR001873). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

Ethical Conduct of Research: All study procedures were approved by the Institutional Review Board at the Columbia University Irving Medical Center.

Conflicts of Interest: The authors have no conflicts of interest to report.

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