Stress and Online Health Community Social Factors Related to Cardiovascular Health Among Young Adults
Open Access DepositedBackground: Cardiovascular disease is the leading cause of morbidity and mortality in the United States and globally. Establishing ideal cardiovascular health (CVH) in young adulthood would help reduce the burden of disease across the lifespan. Young adults are typically a difficult age to reach for CVH, though opportunities exist in reaching this population. Young adults experience a high degree of psychological stress, which can have lasting impacts on both behavioral and biometric factors related to CVH. In addition, the use of digital tools may be an appropriate vehicle to engage young adults, and understanding the social dynamics within online platforms, such as online health communities (OHCs), is important in leveraging these tools to support ideal CVH. These factors and how they may be utilized in an intervention to support CVH in young adults warrants further exploration. Aim and Methods: This research explores how perceived psychological stress and OHC social factors are related to longitudinal changes in CVH among young adults with overweight and obesity. Data were drawn from the Healthy Body Healthy U randomized controlled clinical trial (n=459) with data collected at baseline and every 6 months for 18 months. Participants were randomly assigned to a mind body stress (MBS) targeted (n=157), a weight loss targeted (n=152), or a weight loss tailored group (n=150). Life’s Essential 8 (LE8) was used to measure cardiovascular health. This metric was established by the American Heart Association in 2022, and utilizes four behavior metrics (diet, physical activity, nicotine exposure, and sleep), and four health metrics (BMI, blood lipids, glucose, and blood pressure) which are averaged to develop LE8 total, LE8 behavior, and LE8 health scores. The first aim is to examine whether low perceived psychological stress mediates the effects of the randomly assigned study group on changes in CVH. The MBS group was used as the independent variable, the LE8 total, behavior, and health scores were used as the outcome variables, and low perceived stress was used as the mediator. Autoregressive longitudinal models are used to evaluate the half and full longitudinal mediation relationships, estimated using structural equation models bootstrapped 500 times. Aim 2 was to validate how OHC social factors are measured, and assess the relationship of these social factors with CVH. Factor analysis is used to examine and refine OHC social factor measures, followed by a cluster analysis of the measures to identify engagement styles. Then, linear mixed effects models were used to determine if the OHC social factors were associated with cardiovascular health. Additionally, sensitivity analyses were conducted by stratifying the models by total intervention compliance. Results: For Aim 1, the MBS group had significantly lower perceived stress at 6 months compared to the weight loss groups (b=1.32, 95% CI: 0.18, 2.47). Models indicate a significant indirect relationship between MBS group assignment and LE8 total (indirect b=0.32, 95% CI: 0.04, 0.84), LE8 behavior (indirect b=0.38, 95% CI: 0.02, 1.05), and LE8 health (indirect b=0.26, 95% CI: 0.02, 0.90) at 6 months, mediated by perceived low stress at 6 months. For Aim 2, three refined scales captured OHC informational support, OHC emotional support, and OHC active communication, and cluster analysis revealed three OHC engagement styles: high OHC engagers (high support, active communication), OHC lurkers (high support, passive communication), and low OHC engagers (low support, passive communication). Greater informational support was associated with lower LE8 health scores, (b=-2.18, 95% CI: -3.96, -0.41). In addition, those who received higher informational support from the OHC evidenced less increases over time in LE8 health compared to those who received lower informational support (interaction b=-0.77, 95% CI: -1.42, -0.12). Additionally, though low engagers experienced improvements in LE8 health (b=1.61, 95% CI: 0.04, 3.18), high engagers had less improvement in LE8 health over time compared to low engagers (interaction b=-2.12, 95% CI: -4.09, -0.16). Exploratory analyses revealed that these negative interaction effects were primarily driven by those with low total intervention compliance. Conclusion: This dissertation adds to the body of literature of how to support ideal CVH among young adults. Findings illustrate the downstream effects of addressing psychological stress in young adults, making a digitally delivered mind, body, stress program a plausible strategy to support CVH in this population. Additionally, further research is needed to appropriately capture measures of OHC social factors and better understand how they may relate to young adult CVH. Still, it is evident that building an intervention that keeps young adults actively engaged is a key vector for success. Collectively, this dissertation shows that changes in psychological stress as well as social factors within an OHC may be important to consider when designing an intervention to improve young adult CVH.
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