PROJECT SUMMARY/ABSTRACT
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 inequities in outcomes such as cardiovascular disease (CVD), a
significant comorbidity of interest in SLE. Behavioral mechanisms underlying these inequities 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 inequities among Black women 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), a multi-dimensional instrument
that captures particular ways in which Black women report and experience stress. 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 Black or African American women in GOAL and (2) assess
the impact of social and economic environments on cardiovascular risk among Black women with SLE in the
GOAL cohort in the context of individual-level superwoman schema. 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 inequities. This knowledge can inform development of chronic disease
management interventions aimed at increasing resilience to disease related stressors among Black women 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 equity, social determinants of health, and chronic disease
management. Mr. Leung’s three-year training plan includes: (1) strengthen content expertise with regard to
intersectionality and approaches of applying intersectionality in quantitative methods through the lens of
Superwoman Schema (SWS), (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.
