The Protective Effects of Social Support on the Early Onset of Hypertension Among African Americans Exposed to Violence

Introduction: African Americans develop hypertension earlier in life than whites and the racial/ethnic disparities in elevated blood pressure can appear as early as adolescence. Violence exposure, considered an important environmental stressor experienced by inner-city youth, may play a role in hypertension disparities. The current study examines the relationship between violence victimization and hypertension, while investigating the role of social support in moderating that relationship.

Methods: We analyzed eight waves of data from a longitudinal study of African Americans (n=353, 56.7% female) from mid-adolescence (9^th grade, mean age = 14.9 years old) to emerging adulthood (mean age = 23.1 years old). We examined the relationship between violence victimization during adolescence and hypertension in emerging adulthood. We also tested whether parental and friends’ support in adolescence modifies the effect. We used probit models to examine potential selection bias from attrition.

Results: Violence victimization during adolescence was positively associated with reports of hypertension during emerging adulthood (Beta=0.49; 95% C.I.=0.13, 0.86), after controlling for sex, SES, substance use and mental distress. The relationship between violence victimization and hypertension was moderated by friends’ support (Beta= -.51; 95% C.I.=-.97, -.05), but not parental support (Beta= .42; 95% CI=-.03, .88). Marginal predictions confirmed that the association between victimization and hypertension was weaker and non-significant among individuals with more peer support (1 SD above the mean, Beta=0.02, CI=-.04, .08) compared to those with less support (1 SD below the mean, Beta=.18, C.I.=.11, .23). The probit selection model result confirmed that there was no systematic attrition bias in our study sample.

Conclusions: Researchers reported many instances of early violence exposure to later risk for hypertension, while most of them focused on childhood maltreatment or intimate partner violence. We extend those findings to violence victimization in an African American sample of youth from adolescence to early adulthood, while examining social support modifiers. Disparity in African American hypertension rates relative to whites may partly be explained by differential exposure to violence victimization. The results support likely psychosomatic, behavioral or social connections between violence victimization and physical health that warrant further research. Our findings also support that having support from friends when faced with violence can be beneficial for young adult health outcomes.