title: Weight-based discrimination and medication adherence among low-income African Americans with hypertension: how much of the association is mediated by self-efficacy?
abstract: OBJECTIVE
  Much of the excessive morbidity and mortality from cardiovascular disease among African Americans results from low adherence to anti-hypertensive medications. Therefore, we examined the association between weight-based discrimination and medication adherence.
  
  
  METHODS
  We used cross-sectional data from low-income African Americans with hypertension. Ordinal logistic regression estimated the odds of medication non-adherence in relation to weight-based discrimination adjusted for age, sex, education, income, and weight.
  
  
  RESULTS
  Of all participants (n = 780), the mean (SD) age was 53.7 (9.9) years and the mean (SD) weight was 210.1 (52.8) lbs. Reports of weight-based discrimination were frequent (28.2%). Weight-based discrimination (but not weight itself) was associated with medication non-adherence (OR: 1.94; 95% CI: 1.41-2.67). A substantial portion 38.9% (95% CI: 19.0%-79.0%) of the association between weight-based discrimination and medication non-adherence was mediated by medication self-efficacy.
  
  
  CONCLUSIONS
  Self-efficacy is a potential explanatory factor for the association between reported weight-based discrimination and medication non-adherence. Future research should develop and test interventions to prevent weight-based discrimination at the societal, provider, and institutional levels.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Richardson
authors.forename: Molly E
authors.initials: ME
authors.lastname: Waring
authors.forename: Monica L
authors.initials: ML
authors.lastname: Wang
authors.forename: Lisa
authors.initials: L
authors.lastname: Nobel
authors.forename: Yendelela
authors.initials: Y
authors.lastname: Cuffee
authors.forename: Sharina D
authors.initials: SD
authors.lastname: Person
authors.forename: Sandral
authors.initials: S
authors.lastname: Hullett
authors.forename: Catarina I
authors.initials: CI
authors.lastname: Kiefe
authors.forename: Jeroan J
authors.initials: JJ
authors.lastname: Allison
mesh_terms: D001741:Black or African American / Q000523:psychology*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001835:Body Weight; D002318:Cardiovascular Diseases; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000208:ethnology*; D008297:Male; D055118:Medication Adherence / Q000208:ethnology* / Q000523:psychology; D008875:Middle Aged; D009765:Obesity / Q000523:psychology*; D011203:Poverty; D020377:Self Efficacy; D063508:Social Discrimination
chemical_list: D000959:Antihypertensive Agents