211044 Influence of Active-Coping on Medication Adherence in a Low-Income Hypertensive African-American Community: A New Application of John Henryism

Monday, November 9, 2009

Uchechi Acholonu , Department of Community Health Sciences, University of California-Los Angeles School of Public Health, Los Angeles, CA
Donald E. Morisky, ScD, MSPH, ScM , Department of Community Health Sciences, School of Public Health, University of California at Los Angeles, Los Angeles, CA
Background: In addition to improved dietary habits and increased physical activity, effective blood pressure control often requires high levels of medication adherence (Weir et al. 2000, Oparil et al. 2001). Levels of adherence to antihypertensive medications are lower among African-Americans compared to Whites (Charles et al. 2003). Psychosocial factors, such as active-coping levels, may play a significant role in this disparity.

Methods: Using cross-sectional baseline data from the Community Hypertension Intervention Project (Ward et al. 1998), we examined the association between active-coping and medication adherence. Active-coping was operationalized using a short version of the John Henryism Active Coping Scale (James et al. 1983); the 8-item Morisky Scale was used to measure medication adherence (Morisky et al. 2008). Chi-square statistic and binomial logistic regression analyses were used to test for medication adherence differences and the effect of active-coping levels on medication adherence.

Results: There was a statistically significant difference in medication adherence between high and low active-coping groups (c2=7.14, p=0.008). After adjusting for relevant covariates, African-Americans with higher levels of active-coping had 38% greater odds of medication adherence than African-Americans with lower levels of active-coping (OR=1.38, 95% CI=1.00-1.89).

Conclusion: Several factors influence medication adherence levels among hypertensive African-Americans. As demonstrated by this study, active-coping is one such factor. Understanding how African-Americans actively cope with the demands of a medical regimen, in addition to daily stressors, is important for designing public health interventions aimed at increasing medication adherence in the African-American community, and ultimately eliminating disparities in blood pressure control.

Learning Objectives:
Describe the John Henryism Hypothesis; and Describe the association between John Henryism and medication adherence.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Delta Omega student nominee
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.