Reducing Hypertension among African American Men: A Mobile Stress Management Intervention to Address Health Disparities

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PROJECT SUMMARY/ABSTRACT African American men have the highest rate of hypertension (HTN) in the United States. Once diagnosed, they are also less likely to achieve blood pressure (BP) control. This health disparity is critical, as elevated BP is the primary modifiable risk factor for cardiovascular disease. One reason for this HTN disparity: stress. African Americans report more stress than their White peers, most notably from racial discrimination, and have fewer resources to manage these stressors. And this stress has significant physiological consequences. Compared to Whites, African Americans show heightened allostatic load, a biologic measure of the cumulative burden of chronic stress that is implicated in the etiology of HTN. Stress also exacerbates HTN through unhealthy coping (e.g., overeating, alcohol use) and poorer adherence to antihypertensive medications. Research shows that stress management (SM) interventions improve HTN. Despite this, SM training is not regularly deployed to manage BP, often because health care settings lack the resources to deliver it. One cost- effective, easily scalable solution is mobile phones (i.e., mHealth). Importantly, 98% of African Americans own a mobile phone. Most are smartphones (83%). And text messaging interventions have been shown to improve a variety of HTN management lifestyle changes (e.g., smoking reduction, physical activity enhancement). There is no mobile cognitive behavioral SM intervention (m-CBSMi) on the market today that is designed to help African American men manage racial and nonracial sources of stress in an effort to reduce HTN disparities. The proposed intervention will fill this void. Using proven CBSMi techniques, Black men will learn how to manage stress and reduce BP through text messages and integrated videos. Educational texts will increase knowledge, develop skills, and reduce barriers to adaptive coping. Supportive texts will promote gender and ethnic pride. A library of interactive videos will allow a user to choose tailored training and content based on his personal needs and experiences (e.g., utilizing a choose-your-own-adventure style). All videos will be accessible through links embedded within text messages, making it effortless to view them. In Phase I, a prototype m-CBSMI was developed. This development was informed by formative research with 20 African American men across the lifespan. The results of Phase I strongly support the feasibility and potential effectiveness of the intervention, far exceeding the benchmarks established in the Phase I proposal. During Phase II, the m-CBSMi for African American men will be fully developed. Then, in partnership with Family and Medical Counseling Service, the effectiveness of the m-CBSMi to reduce BP among hypertensive African American men will be examined. Participants will be randomly assigned to either the intervention condition or to a matched control condition. Secondary measures will assess subjective stress, use of antihypertensive medications, coping, well-being, gendered racial identity, and knowledge.