Introduction:
American women can occupy multiple social roles, such as employee, caregiver, mother and spouse during midlife. These roles can be both stressful and rewarding, which may influence adherence to heart-healthy behaviors and risk factors. The aim of this study was to test the association of social role stress and reward with achievement of the American Heart Association Life’s Simple 7 risk factors in a cohort of midlife women in the United States.
Methods:
The Study of Women’s Health Across the Nation (SWAN) is an longitudinal cohort study initiated in in 1996-1997 of women aged 42-52 who were premenopausal. At the fifth annual follow-up visit women first were asked if they occupied four social roles (employee, caregiver, spouse, mother), and then were asked to rate how stressful and how rewarding each occupied role was, using five point scales. Average role-related stress and reward were calculated for each woman (range 1-5). Ideal cardiovascular risk factors were assessed at the same follow-up visit using anthropometric measurement (body mass index, blood pressure), blood draw (glucose, cholesterol), and validated questionnaires (physical activity, diet and smoking). Multivariate linear regression was used for cross-sectional analyses of the number of ideal factors, using average role stress and reward as exposures. Adjusted logistic regression models were used to estimate odds of achieving the ideal level of each individual risk factor. Models were adjusted for age, race, site, education and menopause status.
Results:
At the fifth SWAN follow-up visit, 1,777 women had data on all seven risk factors, and reported occupying at least one social role. The mean (standard deviation) of the number of ideal factors was 3.2 (1.3). Only 5% of the sample had five or more ideal factors. Women who reported greater role-related stress achieved fewer ideal factors, and a higher reward score was related to more ideal factors. A one unit higher role stress score was associated with 18% lower odds of having a healthy diet, and 18% reduced odds of having a BMI under 30. Women with a one unit higher role reward score had 56% greater odds of ideal physical activity, and 34% greater odds of being a non-smoker. Higher job stress was associated with 13% reduced odds of having a healthy blood pressure. There was no evidence of an interaction between stress and reward. Adjusting for depression and social support attenuated, but did not eliminate the significant relationships between role stress and reward and cardiovascular risk.
Conclusion:
Midlife women experience stress from multiple social roles while simultaneously deriving reward from these roles, which may be beneficial for their cardiovascular disease risk factors. Understanding the influence and determinants of role stress and reward may be important when designing interventions to improve diet, physical activity and smoking behaviors in midlife women.
Social Role–Related Stress and Social Role–Related Reward as Related to Subsequent Subclinical Cardiovascular Disease in a Longitudinal Study of Midlife Women