Shift-and-Persist Strategies and Their Association With Cardiometabolic Outcomes Among Young Adults in Puerto Rico

Shift-and-persist (SP-the ability to adapt the self to stressors while preserving focus in the future) is associated with favorable cardiometabolic outcomes. SP may be relevant in Puerto Rico (PR), a population with a high burden of cardiometabolic diseases and stressors. We examined the association between SP and cardiometabolic markers among young adults in PR.

Cross-sectional analysis of baseline PR-OUTLOOK data (September 2020 to March 2024). The analytic sample (n=2707) was aged 18 to 29 and 62% female. SP was measured with the Chen and Miller scale and categorized into tertiles (low, moderate, and high). Anthropometric measurements and fasting blood samples assessed cardiometabolic markers: BMI and waist circumference, blood pressure, blood glucose, HbA1c, and blood lipids (cholesterol, HDL, LDL, and triglycerides). Analyses included adjusted linear regression models.

In adjusted models, persons with moderate and high SP had a BMI that was on average 0.96 (95% CI = -1.63,-0.29) and 0.83 (95% CI = -1.55,-0.12) units lower, respectively, than those with low SP. Similarly, those with moderate and high SP had a waist circumference that was 1.89 (95% CI = -3.45,-0.34) and 1.96 (95% CI = -3.62,-0.30) units lower, respectively, than those with low SP. In addition, persons with moderate and high SP had glucose readings that were 2.45 (95% CI = -4.31,-0.60) and 2.81 (95% CI = -5.79,-0.83) units lower, respectively, than those with low SP, whereas only those with high SP had a lower HbA1c (β=-0.10; 95% CI = -0.16,-0.04). Only those with moderate SP (vs. low) had significantly higher HDL (β=1.16; 95% CI = 0.16, 2.17). No significant associations were found for blood pressure and other blood lipids.

Greater SP was associated with lower adiposity, lower concentration of markers of glucose metabolism, and, to some extent, with higher HDL. Longitudinal studies are needed to confirm study findings and understand how SP may promote biobehavioral mechanisms for cardiometabolic health.