Applied Research in Quality of Life

, Volume 7, Issue 4, pp 403–412 | Cite as

Does Happiness Predict Medication Adherence among African Americans with Hypertension?

  • Yendelela L. Cuffee
  • Erik Angner
  • Norman Oliver
  • Deborah Plummer
  • Catarina Kiefe
  • Sandral Hullett
  • Jeroan Allison


Poor medication adherence is a leading cause of excessive cardiovascular morbidity among African Americans. Many adherence-promoting interventions have addressed economic barriers, improved the patient-provider relationship, simplified regimens, and used reminder systems; however, the problem of low adherence remains intractable. Meanwhile, positive psychological attributes that might serve to promote medication adherence have not been fully explored. To address this gap, we examined the association between happiness and medication adherence among low-income African Americans with hypertension treated in a safety-net setting. Data were obtained from the Alabama Collaboration for Cardiovascular Equality, 2007–2008. Happiness was measured using the 4-item scale of Lyubomirsky and Lepper; low, moderate, and high happiness were defined by tertiles because of the non-normal distribution. Medication adherence was assessed with the Morisky Medication Adherence Scale. Associations were quantified with ordinal logistic regression. Our sample of 573 African Americans was 71.6 % female and had an average age ± SD of 53.6 ± 9.7 years and a median happiness score of 5.2. Compared to participants with low happiness, the odds (OR; 95 % CI) of being in a better medication adherence category were greater for those with moderate (1.53; 1.02–2.27) and high (2.26; 1.52-3.37) happiness, after adjusting for age, sex, income, education, and difficulty paying for medical care. Within this cohort of low-income African Americans with hypertension, participants with greater happiness exhibited better medication adherence. Although one interpretation of our study is that more adherent patients are naturally happier, our findings raise the possibility that adding happiness-boosting components may increase the effectiveness of more traditional adherence interventions.


Happiness Medication adherence Hypertension African Americans 



The TRUST study was funded by the National Lung, Heart, and Blood Institute. Grant number: U01 HL079171-01. Yendelela Cuffee is funded by a dissertation grant from the Agency of Healthcare Research and Quality. Grant number: 1R36HS020755-01


  1. Argyle, M. (1997). Is happiness a cause of health. Psychology and Health, 12(6), 769–781.CrossRefGoogle Scholar
  2. Borzecki, A. M., Oliveria, S. A., et al. (2005). Barriers to hypertension control. American Heart Journal, 149(5), 785–794.CrossRefGoogle Scholar
  3. Burnier, M. (2006). Medication adherence and persistence as the cornerstone of effective antihypertensive therapy. American Journal of Hypertension, 19(11), 1190–1196.CrossRefGoogle Scholar
  4. Burrell, C. (1984). Theraputic consequences of noncompliances. In: Improving medication complaince. Proceedings of a symposium. National Pharmaceutical Council, Washington, DC.Google Scholar
  5. Diener, E. (1984). Subjective well-being. Psychological Bulletin, 95(3), 542–575.CrossRefGoogle Scholar
  6. Diener, E. (2000). Subjective well-being. The science of happiness and a proposal for a national index. The American Psychologist, 55(1), 34–43.CrossRefGoogle Scholar
  7. Diener, E. (2008). Happiness unlocking the mysteries of psychological wealth. Blackwell Publishing.Google Scholar
  8. DiMatteo, M. R., Lepper, H. S., et al. (2000). Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Archives of Internal Medicine, 160(14), 2101–2107.CrossRefGoogle Scholar
  9. Dunn, O. (1964). Multiple comparisons using rank sums. Technometrics, 6(2), 241–252.CrossRefGoogle Scholar
  10. Dusing, R. (2006). Overcoming barriers to effective blood pressure control in patients with hypertension. Current Medical Research and Opinion, 22(8), 1545–1553.CrossRefGoogle Scholar
  11. Haynes, R. B., Sackett, D. L., et al. (1976). Improvement of medication compliance in uncontrolled hypertension. Lancet, 1(7972), 1265–1268.CrossRefGoogle Scholar
  12. Haynes, R. B., Ackloo, E. et al. (2008). Interventions for enhancing medication adherence. Cochrane database of systematic reviews (2): CD000011.Google Scholar
  13. Hill, M. N., & Sutton, B. S. (2000). Barriers to hypertension care and control. Current Hypertension Reports, 2(5), 445–450.CrossRefGoogle Scholar
  14. Hill, M. N., Bone, L. R., et al. (1999). Barriers to hypertension care and control in young urban black men. American Journal of Hypertension, 12(10 Pt 1), 951–958.CrossRefGoogle Scholar
  15. Kressin, N. R., Orner, M. B., et al. (2010). Understanding contributors to racial disparities in blood pressure control. Circulation. Cardiovascular Quality and Outcomes, 3(2), 173–180.CrossRefGoogle Scholar
  16. Layous, K., Chancellor, J., et al. (2011). Delivering happiness: translating positive psychology intervention research for treating major and minor depressive disorders. Journal of Alternative and Complementary Medicine, 17(8), 675–683.CrossRefGoogle Scholar
  17. Logan, A. G., Milne, B. J., et al. (1979). Work-site treatment of hypertension by specially trained nurses. A controlled trial. Lancet, 2(8153), 1175–1178.CrossRefGoogle Scholar
  18. Lyubomirsky (1999). A Measure of Subjective Happiness: Preliminary Reliability and Construct Validation. Social Indicators Research (Feb 1999): 137.Google Scholar
  19. Martin, L. R., Williams, S. L., et al. (2005). The challenge of patient adherence. Therapeutics and Clinical Risk Management, 1(3), 189–199.Google Scholar
  20. McDonald, H. P., Garg, A. X., et al. (2002). Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA: The Journal of the American Medical Association, 288(22), 2868–2879.CrossRefGoogle Scholar
  21. Morisky, D. E., Green, L. W., et al. (1986). Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care, 24(1), 67–74.CrossRefGoogle Scholar
  22. National Institutes of Health; National Heart, L., and Blood Institute (1997). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure—Complete Report. Hypertension. N. H. B. P. E. Program. Bethesda, MD, pp. 98–4080Google Scholar
  23. Ogedegbe, G. (2008). Barriers to optimal hypertension control. Journal of Clinical Hypertension (Greenwich, Conn.), 10(8), 644–646.CrossRefGoogle Scholar
  24. Ogedegbe, G., Harrison, M., et al. (2004). Barriers and facilitators of medication adherence in hypertensive African Americans: a qualitative study. Ethnicity & Disease, 14(1), 3–12.Google Scholar
  25. Otsuki, M., Clerisme-Beaty, E., et al. (2009). Measuring adherence to medication regimens. In S. A. Shumaker, J. K. Ockene, & K. A. Riekert (Eds.), Clinical care and research. The handbook of health behavior change (3rd ed.). New York: Springer.Google Scholar
  26. Rogers, W. H. (1992). Quantile regression standard errors. Stata Technical Bulletin, 9, 16–19.Google Scholar
  27. Seligman, M. E., Steen, T. A., et al. (2005). Positive psychology progress: empirical validation of interventions. The American Psychologist, 60(5), 410–421.CrossRefGoogle Scholar
  28. Sokol, M. C., McGuigan, K. A., et al. (2005). Impact of medication adherence on hospitalization risk and healthcare cost. Medical Care, 43(6), 521–530.CrossRefGoogle Scholar
  29. Turner, B. J., Hollenbeak, C., et al. (2009). Barriers to adherence and hypertension control in a racially diverse representative sample of elderly primary care patients. Pharmacoepidemiology and Drug Safety, 18(8), 672–681.CrossRefGoogle Scholar
  30. Voils, C. I., Hoyle, R. H., et al. (2011). Improving the measurement of self-reported medication nonadherence. Journal of Clinical Epidemiology, 64(3), 250–254.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V./The International Society for Quality-of-Life Studies (ISQOLS) 2012

Authors and Affiliations

  • Yendelela L. Cuffee
    • 1
  • Erik Angner
    • 2
  • Norman Oliver
    • 3
  • Deborah Plummer
    • 4
  • Catarina Kiefe
    • 1
  • Sandral Hullett
    • 5
  • Jeroan Allison
    • 1
  1. 1.Department of Quantitative Health SciencesUniversity of Massachusetts Medical SchoolWorcesterUSA
  2. 2.Department of PhilosophyGeorge Mason UniversityFairfaxUSA
  3. 3.Department of Family MedicineUniversity of Virginia School of MedicineCharlottesvilleUSA
  4. 4.Department of PsychiatryUniversity of Massachusetts Medical SchoolWorcesterUSA
  5. 5.Cooper Green Mercy HospitalBirminghamUSA

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