Neighborhood and social inluences on blood pressure: An exploration of causation in the explanatory models of hypertension among African Americans 1 MedDocs Publishers Received: Dec 07, 2017 Accepted: Jan 08, 2018 Published Online: Jan 31, 2018 Journal: Journal of Community Medicine Publisher: MedDocs Publishers LLC Online ediion: htp://meddocsonline.org/ Copyright: © Koehler K (2018). This Aricle is distributed under the terms of Creaive Commons Atribuion 4.0 internaional License *Corresponding Author (s): Kurt Koehler, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA Email: kurt.koehler@temple.edu Cite this aricle: Koehler K, Lewis L, Cronholm PF. Neighborhood and social inluences on blood pressure: An exploraion of causaion in the explanatory models of hypertension among African Americans. J Community Med. 2018; 1: 1002. Keywords: Healthcare dispariies; African Americans; Hyper- tension; Health knowledge; Residence characterisics; Social determinants of health. Abstract Objecive: African Americans are at the highest risk of hav- ing hypertension compared to all other races and ethniciies in the United States. This disparity is compounded by lower rates of medicaion adherence and blood pressure control among African Americans. Divergence in African American paients’ views of their hypertension from the biomedical model may be an important driver in shaping adherence be- haviors and outcomes. Our study sought to idenify African American explanatory models (EMs) of hypertension with a focus on disease eiology, in order to increase provider un- derstanding of how African American paients conceptualize their hypertension and how this informaion can be used to foster provider-paient trust and engagement. Methods: The study uilized 12 in-depth and semi-struc- tured interviews with hypertensive African American paients living in Philadelphia. Interview quesions solicited parici- pants’ EMs of hypertension with a focus on eiology, including what they thought caused their hypertension, environmental factors that inluence blood pressure, and barriers to manag- ing hypertension in their neighborhood and social environ- ment. Interview transcripts were analyzed using a modiied- grounded theory approach to idenify emergent themes. Results: We ideniied ive themes from paricipants’ EMs of hypertension: (1) stress causes high blood pressure; (2) un- safe neighborhoods lead to stress and can raise blood pres- sure; (3) the inancial stressors of everyday living can make hy- pertension worse; (4) emoional distress from strained social relaionships can exacerbate high blood pressure; and (5) lack of access to health care and healthy food in the community contributes to hypertension. Journal of Community Medicine Open Access | Research Aricle Kurt Koehler 1,2 *; Lisa Lewis 3 ; Peter F. Cronholm 4,5,6 1 Department of History and Sociology of Science, University of Pennsylvania, Philadelphia, Pennsylvania, USA 2 Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA 3 Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA 4 Department of Family Medicine and Community Health, 5 Center for Public Health Iniiaives, 6 Leonard Davis Insitute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA Journal of Community Medicine