Social Integration and Quality of Social Relationships as Protective Factors for Inflammation in a Nationally Representative Sample of Black Women

  • Jodi FordEmail author
  • Cindy Anderson
  • Shannon Gillespie
  • Carmen Giurgescu
  • Timiya Nolan
  • Alexandra Nowak
  • Karen Patricia Williams


Social integration and supportive relationships protect against cardiovascular disease (CVD). However, prior studies have examined heterogeneous samples which may obscure unique relationships within groups. We investigate the association between social relationships and inflammation—a known CVD risk factor—in Black women, a population with higher rates of CVD and CVD mortality. Secondary data from wave 4 of the National Longitudinal Study of Adolescent to Adult Health (Add Health) were analyzed. The sample was comprised of 1829 Black women aged 24–34 years. Social integration was a z-score standardized measure of four items (marital/cohabitation status, church attendance, volunteerism, close friendships). Data on the quality of three relationship types was available: perceived happiness with a romantic relationship and perceived closeness to mother and father figure. Inflammation was measured via high-sensitivity C-reactive protein (hs-CRP) in which levels were categorized based on clinical cut-points for risk of CVD (< 1 mg/L = low risk—reference, 1–3 mg/L = moderate risk, > 3–10 mg/L = high risk, > 10 mg/L = very high risk). Multivariable logistic regression was conducted accounting for the complex survey design and wave 4 control measures (e.g., body mass index, smoking, medications, acute illness, overall health, sociodemographic factors). No significant associations were found between level of social integration and hs-CRP levels. With respect to relationship quality, women who reported they were very happy with their romantic relationship were less likely than those who were only fairly happy or unhappy to have hs-CRP levels in the moderate- (AOR = 0.36, 95% CI = 0.17, 0.75), high (AOR = 0.20, 95% CI = 0.08, 0.49), or very high CVD–risk category (AOR = 0.36, 95% CI = 0.16, 0.80). Women who reported they were somewhat/quite/very close to their mother figure (AOR = 0.48, 95% CI = 0.25, 0.92) and those who reported having no mother figure (AOR = 0.25, 95% CI = 0.08, 0.77) were less likely than women reporting being not very close/not close at all with their mother figure to have hs-CRP levels in the moderate- vs. low-risk category. No statistically significant associations were found between father-figure relationship and hs-CRP CVD risk category. In summary, social integration and the quality of specific social relationships were significantly associated with inflammation in young adult Black women. Thus, interventions designed to enhance social connectedness and positive social relationships among Black women may have the potential to be protective for CVD risk. Further researches with the longitudinal social relationship and inflammatory measures are needed to better understand how changes in social relationships may influence CVD risk over the life course.


Social relationships Cardiovascular disease Inflammation C-reactive protein Social integration Cardiovascular risk Black women African American women 



This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health website ( No direct support was received from grant P01-HD31921 for this analysis.


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Copyright information

© The New York Academy of Medicine 2019

Authors and Affiliations

  • Jodi Ford
    • 1
    Email author
  • Cindy Anderson
    • 1
  • Shannon Gillespie
    • 1
  • Carmen Giurgescu
    • 1
  • Timiya Nolan
    • 1
  • Alexandra Nowak
    • 1
  • Karen Patricia Williams
    • 1
  1. 1.Martha S. Pitzer Center for Women, Children, and YouthOhio State University, College of NursingColumbusUSA

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