Social integration and black intraracial variation in blood pressure

An evaluation is made of the inverse role social integration plays in explaining variation in blood pressure among a sample of 1420 black Americans. This sample is part of a larger representative sample of 6717 adults (18 years and older) who were interviewed in the 1981-82 Maryland Statewide Hypertension Control Program. Social integration is operationalized in terms of five submeasures: employment, marriage, church affiliation, group affiliation, and having someone to talk to when needed. Separate multiple regression analyses were conducted for males (n = 587) and females (n = 833), and selected covariates (eg, age, education, body mass index, physical exercise, current use of antihypertension medication, cigarette smoking) were entered to assess more adequately the hypothesized inverse relationship between social integration and systolic and diastolic blood pressure. Only church affiliation appears inversely associated with systolic (males: b = -4.898; 95% CI = -10.385 to 0.589; females: b = -4.005; 95% CI = -8.341 to 0.331) and diastolic (males: b = -6.511; 95% CI = -10.038 to -2.985; females: b = -5.318; 95% CI = -8.329 to -2.307) blood pressure. These results indicate that several pathways can influence how social integration, especially affiliation with a church, contributes to lower levels of blood pressure. The possibility that biological as well as psychosocial pathways operate is discussed. Given the dominant and independent inverse association of church affiliation to blood pressure, health education is discussed as a public health strategy to disseminate information regarding the possible health importance of social integration for black Americans. The adherence to sound preventive health practices (eg, exercising, lower weight-to-height body ratio) should also be part of the health education strategy to reduce elevated blood pressure in black Americans.