Using a Randomized Prevention Trial to Understand the Health Benefits of Supportive Couple Relationships among Rural African American Adults

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PROJECT SUMMARY In this proposal, we seek to follow a well-characterized sample of 346 low-income, middle-age African American couples who recently concluded participation in a randomized prevention trial of the Protecting Strong African American Families (ProSAAF) program. All couples reside in impoverished small towns and communities in rural Georgia in which poverty rates are among the highest in the nation. Individuals in this catchment area are at elevated risk for multiple chronic diseases of aging (CDAs) including cardiovascular disease and diabetes as well as risk factors for CDAs such as inflammation and metabolic syndrome. Continuing to follow this sample with more thorough assessments of aging over the next five years will provide one of the first prospective studies of couple relationships and aging conducted within a randomized prevention trial designed for rural African American adults. As observational designs are prone to residual confounding and reverse directionality errors, the current proposal will provide a unique opportunity for testing casual hypotheses about the role of enhanced couple functioning in promoting and protecting the health of African American adults from the erosive effects of cumulative stress exposure. This proposal, therefore, is directly responsive to PA-15-042, which encourages innovative, hypothesis-driven R01 grant applications that can expand understanding of the role and impact of families and interpersonal relationships on health and well-being in midlife and older age. In this continuation then, we propose to collect two additional waves of multi-level data from couples who participated in the ProSAAF trial. This data collection will involve intravenous blood draws and other biometrics to determine whether ProSAAF participation and program-induced changes in couple functioning will carry forward to promote African Americans' healthy aging. Assessments of psychological well-being and behavioral coping strategies will be collected as well. We will test hypotheses concerning: (a) ProSAAF participation on the physical health and psychological well-being of rural African American adults; (b) mediating mechanisms through which ProSAAF- induced changes in couple relationship functioning and cumulative stress exposure influence rural African Americans' health; and (c) resilience mechanisms on healthy aging among rural African Americans. Hypotheses will be analyzed using individual- and couple-level models to examine actor, partner, and dyadic-level effects. Our proposed design provides both strong tests of theory and enhanced ability to guide practical application than typically is possible using observational research alone. Findings from this research will facilitate the development of health promotion strategies to enhance healthy aging and, ultimately, reduce health disparities among rural African Americans.