Reducing Health Disparities among African American Women: A Mobile Cognitive Behavioral Stress Management Intervention

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PROJECT SUMMARY/ABSTRACT The unjust social, economic, and environmental conditions that African Americans face throughout their lives lead to pervasive health disparities. These disparities are driven by healthcare differences, where White patients are more likely to receive medical procedures when they seek care, and it is of higher quality, than what is received by African Americans. They are driven by economic differences, where the net worth of non- Hispanic White households is $132,000 while it is only $9,000 for Black households. Those with less financial wealth have poorer health as compared to those with higher socioeconomic status. And yet, even when controlling for these two important social determinants of health, race still predicts morbidity and mortality. What can account for this? Stress. African Americans experience more stress than their White peers. The story is even more dire for African American women who simultaneously face both racial discrimination and sexism. Indeed, gendered racial discrimination is nearly ubiquitous for Black women at all socioeconomic levels. It is also a distinct form of stress, with unique outcomes compared to other non-race-or-gender-related stressors. Finally, stress has clear downstream negative effects on health. To our knowledge, there is no mobile cognitive–behavioral stress management intervention (m-CBSMi) on the market that is designed to help African American women manage racial and nonracial daily stress. We intend to fill this void. Using proven CBSMi techniques, Black women will learn how to manage their stress through text messages and integrated mobile web content. Supportive texts will inspire, motivate, and affirm the life experiences of African American women. Educational texts will increase knowledge, develop skills, and reduce barriers to adaptive coping. A library of individually tailored videos will be delivered to each user based on her personal experiences. All mobile web content will be accessible only through touch-based links embedded within text messages, making it easy and effortless to view this material. In Phase I, a prototype m-CBSMi was developed. This development was informed by formative research with community-based care providers plus 24 African American women 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 we will complete development of the m-CBSMi for African American women. Then, in partnership with Family and Medical Counseling Service, we will examine the effectiveness of the m-CBSMi to reduce stress among African American women. Participants will be randomly assigned to either the intervention condition or to a matched control condition. Secondary measures will assess coping, well-being, subjective health, gendered racial identity, and knowledge.