Kudos to Amnazo Muhirwa, PhD student, and her sponsor Devon Noonan, associate professor, for the submission of her NRSA Fellowship application entitled: “Stress, the Superwoman Schema and Cardiovascular Wellbeing in Rural African American Women." This proposal requests funds for a two-year period with a start date of April 1, 2021.

The leading cause of death among African American women is cardiovascular disease (CVD). Compared to 43% of their White counterparts, approximately 57% of African American women aged 20 and older have some form of CVD. There are racial and geographical disparities pertaining to the prevalence of CVD risk factors that contribute to poorer health among this rural population. The rate of obesity and hypertension, two prominent CVD risk factors, disproportionally impact rural African American women. To address the need for prevention and treatment of CVD, the American Heart Association (AHA) developed the Ideal Cardiovascular Health (ICH) score to assess cardiovascular wellbeing and measure progression toward CVD prevention goals. The ICH score is composed of seven metrics associated with lower risk for CVD: smoking status, body mass index (BMI), nutritional intake, physical activity level, blood pressure, blood glucose and total cholesterol. Meeting the ideal standard for these metrics is associated with lower CVD risk and overall improved cardiovascular wellbeing. Yet to date, there is a dearth of literature evaluating ICH scores among rural African American women. Further, social conditions such as neighborhood cohesion and safety can lead to chronic exposure to stress and have been associated with increased risk for CVD and earlier onset of disease. The Superwoman Schema is a multidimensional framework that provide further understanding on how African American women process stress; which may serve to enlighten the mechanisms in which chronic stress becomes biologically embedded among this population.

Combining self-report and Duke Health System electronic health record (EHR) data (N=200) with individual interviews (N=15), a mixed method design will be used to provide a comprehensive understanding of stress cardiovascular wellbeing among rural African American women. Thus, the purpose of this study is to: 1) Determine the association between community stress factors (neighborhood cohesion, neighborhood safety) and ideal cardiovascular health among rural African American women; 2) Explore the moderating effects of the Superwoman Schema (measured by Giscombe Superwoman Schema Questionnaire total score) on the relationship between community stress factors and ICH among rural African American women; and 3) Describe the community stress experience of rural African American woman using semi-structured interviews guided by the Superwoman Schema.

Thank you to all those who gave their time and expertise in guiding the application process as well as to all those who helped to prepare for this submission.