Superwoman Coping: A multi-level analysis of self-management behaviors and cardiovascular disease risk among Black women with systemic lupus erythematosus - In the United States, about 90% of those living with systemic lupus erythematosus (SLE) are women and rates of SLE are 2-4 times higher among Black individuals relative to the general population. Additionally, Black women bear a substantial burden of disease through disparities in outcomes such as cardiovascular disease (CVD), a significant comorbidity of interest in SLE. Behavioral mechanisms underlying these disparities are underexplored, particularly in the specific socio-cultural context of Black women. To address these gaps, the trainee (Mr. Leung) will leverage previously collected data from the Georgians Organized Against Lupus (GOAL) cohort to explicate multi-level mechanisms underlying CVD disparities among people living with SLE through behavioral pathways (coping behaviors, self-efficacy) and investigate the modifying role of area-level context on these behavioral pathways. This proposal hinges on the Superwoman Schema (SWS), which reflects lived experiences of persistence and adversity, often in response to a stressor. The specific aims of the study are to (1) quantitatively examine the relationship of SWS endorsement with self-efficacy, hypertension, and angina mediated by coping behaviors among participants in GOAL and (2) assess the impact of social and economic environments on cardiovascular risk among participants in the GOAL cohort in the context of individual-level SWS. The expected outcome will be an actionable understanding of sources of individual and neighborhood contextual determinants of macro-social processes and role in widely known SLE health disparities. This knowledge can inform development of chronic disease management interventions aimed at increasing resilience to disease related stressors among people with SLE. Additionally, this work will support the training of Mr. Leung who is committed to becoming a NIH-funded independent investigator focused on health disparities, social determinants of health, and chronic disease management. Mr. Leung’s three-year training plan includes: (1) Strengthen content expertise in understanding how overlapping social forces shape individual experiences and in applying quantitative methods to examine these dynamics through the lens of the Superwoman Schema,(2) increase capacity in advanced quantitative methods in behavioral sciences with an emphasis on longitudinal data analysis, multi-level modeling, structural equation modeling, and psychometrics and (3) develop an understanding of the range of geospatial analysis and linkages between macro-level data linkages. The team of mentors, Dr. Escoffery (primary co-sponsor), Dr. Lim (primary co-sponsor), Dr. Lewis (co-sponsor), and Dr. Haardörfer (collaborator) will provide oversight, guidance, and mentorship throughout the fellowship period across the topics of chronic disease self-management, SLE, psychosocial stressors, and advanced quantitative methods for behavioral sciences. Mr. Leung will leverage resources within the doctoral program, Rollins School of Public Health, and Emory University. The candidate, mentorship team, and the environment are well suited to achieve the proposed research and training aims.*
