Psychosocial Clusters and their Associations with Well-Being and Health: An Empirical Strategy for Identifying Psychosocial Predictors Most Relevant to Racially/Ethnically Diverse Women's Health.
BACKGROUND
Strategies for identifying the most relevant psychosocial predictors in studies of racial/ethnic minority women's health are limited because they largely exclude cultural influences and they assume that psychosocial predictors are independent. This paper proposes and tests an empirical solution.


METHODS
Hierarchical cluster analysis, conducted with data from 140,652 Women's Health Initiative participants, identified clusters among individual psychosocial predictors. Multivariable analyses tested associations between clusters and health outcomes.


RESULTS
A Social Cluster and a Stress Cluster were identified. The Social Cluster was positively associated with well-being and inversely associated with chronic disease index, and the Stress Cluster was inversely associated with well-being and positively associated with chronic disease index. As hypothesized, the magnitude of association between clusters and outcomes differed by race/ethnicity.


CONCLUSIONS
By identifying psychosocial clusters and their associations with health, we have taken an important step toward understanding how individual psychosocial predictors interrelate and how empirically formed Stress and Social clusters relate to health outcomes. This study has also demonstrated important insight about differences in associations between these psychosocial clusters and health among racial/ethnic minorities. These differences could signal the best pathways for intervention modification and tailoring.
Department of Public Health, University of Tennessee, Knoxville, TN, USA.
Jennifer M
JM
Jabson
Department of Bioethics and Humanities, University of Washington, Seattle, WA, USA.
Deborah
D
Bowen
Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
Janice
J
Weinberg
Kaiser Permanente Division of Research, Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Candyce
C
Kroenke
Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA.
Juhua
J
Luo
Community and Behavioral Health, Stony Brook Medicine, Stony Brook, NY, USA.
Catherine
C
Messina
Social Sciences and Health Polic, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Sally
S
Shumaker
Department of Medicine, Vanderbilt University, Nashville, TN, USA.
Hilary A
HA
Tindle
chronic disease; hierarchical cluster analysis; psychosocial clusters; quality of life; race/ethnicity; women’s health