Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Mary Barger, PhD, MPH, CNM, FACNM, Chairperson. Kathy Shadle James, DNSc, APRN, FAAN. Sharon Boothe-Kepple, PhD, FNP-C.


Metabolic Syndrome, Chronic Stress, Social Support, Health Behaviors, Mexican-American, Hispanic Women


The Associations of Chronic Stress, Social Support, Health Behaviors and Metabolic Syndrome Among Hispanic Women

Background: Metabolic syndrome (MetS) prevalence is 25% among Mexican American women 30 – 49 years of age, compared to 22% among non-Hispanic Whites in the United States. Little is known about the additional contributions of chronic stress, social support and health behaviors to the development of MetS among this population.

Purpose: Describe the associations between chronic stress, social support, and health behaviors and the presence of MetS in Hispanic women living in an underserved community.

Methods: A retrospective cohort study design. The Adult Treatment Panel III clinical criteria was used to determine the presence of MetS. The Chronic Stress Burden Scale measured chronic stressors and the Enriched Social Support Instrument measured three aspects of social support. Staying Healthy Assessment required for MediCal recipients was used as a measurement for health behaviors. Descriptive inferential statistics and odds ratios with 95% confidence intervals estimated the magnitude of associations.

Findings: The sample of 150 Hispanic women, mean age 44.80 ([6.32]) years, were primarily of Mexican origin with limited acculturation, (66.7% preferred Spanish), and 70% had public health insurance. Among 57% (n = 86) with MetS, nearly 90% were overweight/obese compared to 75% without MetS. Sociodemographic factors associated with MetS were public health insurance or none (p=.003) and family history of heart disease or stroke (p=.015). The following social determinants were associated with MetS: unhealthy eating habits (OR 2.13; 95% CI 1.05,4.30), limited healthy food access (OR 3.18; 95% CI 1.42, 7.14) and lack of physical activity (OR 2.43; 95% CI 1.24, 4.78) adjusted for health insurance. No differences between the two groups were found for social support scores (p=0.521). However, the mean difference in the number of chronic stressors was statistically significantly higher among cases with MetS (2.47 [SD 1.66]) than those without (1.94 [SD 1.39]). The odds of having MetS increased 26% for each increase in the number of moderate to very stressful chronic stressors (OR 1.26; 95% CI 1.01, 1.57). Study cases with MetS had twice the odds of being physically inactive or engaged in unhealthy eating.

Implications for Research: Future research is needed to understand the role of ethnicity as a moderator of the associations between cardio-metabolic health and chronic stressors is important for Hispanic women. Innovative longitudinal interventional health outcomes research can provide an understanding of the complex contributing factors affecting the health of this high-risk group.


The presence of Metabolic Syndrome (Mets) among Mexican-American Women.

Document Type

Dissertation: Open Access



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