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Discrimination experiences, resilience, and cardiovascular disease risk factors among sexual minority women

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Abstract

Resilience, or the process of adapting to adversity, may protect against the harmful effects of minority-related stressors on the cardiovascular health of sexual minority women (SMW). An online survey was conducted in a sample of cisgender, non-heterosexual women to evaluate resilience as a moderator of the association between discrimination experiences and key cardiovascular disease (CVD) risk factors: stress, tobacco-smoking, hazardous alcohol consumption, poor diet quality, physical inactivity, and sedentary behaviors. Overall, 191 women (mean age = 29.34, SD = 6.92; 84.5% White) completed the survey and met eligibility to be included in the data analysis. White race (b = − 6.71, SE = 2.49) and education (b = − 3.36, SE = 0.56) were each independently associated with fewer discrimination experiences. Latinx ethnicity was associated with more discrimination experiences (b = 9.34, SE = 2.61). Education was associated with greater resilience (b = 4.57, SE = 0.83). Multivariable regression models were adjusted for race, ethnicity, and education. Discrimination was associated with a higher likelihood of smoking in the past month (b = 0.04, SE = 0.02) and drinking at hazardous levels (b = 0.09, SE = 0.02). Resilience was associated with less stress (b =  − 0.15, SE = 0.02), a lower likelihood of hazardous alcohol consumption (b =  − 0.02, SE = 0.01) and less time spent engaging in sedentary behaviors (b =  − 0.02, SE = 0.01). One moderation emerged, such that discrimination was negatively associated with stress for those low in resilience (b =  − 1.75, SE = 0.58), and not associated with stress for those high in resilience. These findings may inform the development of CVD-risk reduction interventions for SMW, which could include both strategies to mitigate the effects of discrimination on substance use and coping skills to promote resilience.

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Notes

  1. Calculated based on reported prevalence rates.

  2. Discrimination was significantly associated with tobacco-smoking when treated as a continuous outcome (b = 0.03, SE = 0.006, t = 5.13, p < 0.002); however, discrimination was not associated with alcohol consumption when alcohol use was treated as a continuous outcome (b = 4.51, SE = 4.12, t = 1.09, p = 0.28).

  3. Resilience was significantly associated with alcohol consumption when treated as a continuous outcome (b =  − 10.79, SE = 2.65, t = − 4.08, p < 0.001). Resilience was not associated with tobacco-smoking when tobacco use was treated as a continuous outcome (b = − 0.01, SE = 0.004, t =  − 1.21, p = 0.23).

  4. In alternative model testing that examined predictors of resilience, only sedentary behaviors were significantly associated with less resilience (b =  − 1.84, SE = 0.73, t =  − 2.52, p = 0.01).

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Funding

Dr. Foley is supported by the following research training grant: 2T32AT000051 (PI: Gloria Yeh). Dr. Stanton is supported by the following training grant: 5T32MH116140 (PI’s: David C. Henderson and Gregory L. Fricchione). Dr. Batchelder’s time was supported by grant: K23DA043418.

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Authors and Affiliations

  1. Massachusetts General Hospital/Harvard Medical School, Boston, USA

    Jacklyn D. Foley, Amelia M. Stanton, Conall O’Cleirigh & Abigail W. Batchelder

  2. The Fenway Institute, Fenway Health, Boston, USA

    Caleigh Shepard, Conall O’Cleirigh & Abigail W. Batchelder

  3. University of Rochester Medical Center, Rochester, USA

    Jennifer Morris

  4. Beth Israel Deaconess, Boston, USA

    Jennifer Potter

  5. Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 701, Boston, MA, 02114, USA

    Jacklyn D. Foley

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All authors listed made substantial contributions to the conception and/or design of the work including the acquisition, analysis, or interpretation of data; drafted the work or revised it critically for important intellectual content; approved the version to be published; and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Foley, J.D., Stanton, A.M., Shepard, C. et al. Discrimination experiences, resilience, and cardiovascular disease risk factors among sexual minority women. J Behav Med 45, 461–471 (2022). https://doi.org/10.1007/s10865-022-00320-7

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