Economic pressure and health and weight management behaviors in African American couples: A family stress perspective

Abstract

This study extends the family stress model by examining the influence of economic pressure on health and weight management behaviors mediated by depressive symptoms and spousal support among 506 African American married couples. The actor–partner interdependence model accounted for the interdependent nature of relationships. Findings support the family stress model; yet pathways differed slightly for husbands and wives. Economic pressure directly influenced depressive symptoms and spousal support. Spousal support was a buffer against poor health and weight management behaviors for husbands, while depressive symptoms exacerbated poor health and weight management behaviors for wives. These mechanisms have implications for practitioners who promote African American couples’ well-being.

Keywords

African Americans depression economic pressure health behavior marriage

Research provides convincing evidence regarding the influence of family and social factors on a variety of health outcomes (Carr and Springer, 2010; Wickrama et al., 2001). Less attention, however, has been devoted to behaviors geared toward successfully managing weight and nutrition—even though dietary choices and obesity are highly related to various diseases and illnesses (Kopelman, 2000; Zhang et al., 2008). This study examines health and weight management behaviors using a conceptual model drawn from the family stress perspective (Conger et al., 2002). This model hypothesizes that family economic pressure influences psychological distress, which, in turn, adversely influences the quality of marital relationships. Although the family stress model has primarily been used to investigate youth outcomes, we expect the same processes link family economic pressure to adults’ ability to successfully manage their health and weight (e.g. Conger et al., 1999, 2002).

Research concerning how family and social influences affect health behaviors, specifically those related to nutrition and weight, has not adequately considered dyadic and cross-partner influences (Grzywacz and Ganong, 2009) and variations across racial or ethnic groups. Thus, this study incorporates the actor–partner interdependence model (APIM) by examining cross-partner associations in order to account for the influence of family on health outcomes and behaviors (Kenny et al., 2006). Furthermore, this study examines health and weight management behaviors in a sample of African American married couples to shed light on the processes related to these specific behaviors for this racial and ethnic group. The conceptual model is shown in Figure 1.

Figure 1.

Conceptual model expanding the family stress model to predict poor health and weight management behaviors among African American couples. The relationship between economic pressure and poor health and weight management behaviors is expected to be mediated by depressive symptoms and spousal support. By applying the actor–partner interdependence model (APIM), this model also examines cross-partner effects.

The salience of economic pressure in the lives of African Americans is well-documented. Research suggests that such pressure may have a greater impact on the health of African Americans than Caucasians (DeNavas-Walt et al., 2011; Farley and Allen, 1987). Economic pressure has been described as a significant stressor across the lifespan for married African Americans (Conger et al., 2002; Lincoln and Chae, 2010). Moreover, research suggests that for those with a lower socio-economic status, including a higher number of African Americans, economic conditions may be more strongly associated with their well-being (Lorant et al., 2007; Marmot, 1989).

Direct association between economic pressure and health and weight management behaviors

Economic pressure is a chronic life stressor that plays a pivotal role in individuals’ health behaviors, including health and weight management (Kassel et al., 2003; Popkin et al., 2005). Research suggests that those experiencing economic pressure lack access to healthy foods and other resources, such as transportation to purchase fresh food (Popkin et al., 2005). These limitations make it difficult to effectively manage nutrition, weight, and, subsequently, overall health. Individuals’ physiological response to stress has also been associated with a stronger preference for energy-dense foods high in sugar and fat (Torres and Nowson, 2007). Thus, we expect that economic pressure will positively influence the poor health and weight management behaviors of African Americans.

Depressive symptoms and spousal support as mediators

In addition to the direct influence of economic pressure on health and weight management behaviors, this study uses the family stress perspective to examine depressive symptoms and spousal support as mediators of the direct effect economic pressure exerts on African American couples’ health and weight management behaviors. This examination is supported by previous research of low-income families indicating the role of stressful family relationships on health, health behaviors, and health service utilization (Kidwell et al., 2013).

Economic pressure and depressive symptoms

Consistent with the family stress perspective (Conger et al., 2002), economic pressure may lead to feelings of hopelessness, helplessness, and anxiety—culminating in increased depressive symptoms. A longitudinal study found that changes in financial strain led to increased rates of depression (Lorant et al., 2007). In longitudinal studies of couples, economic pressure led to more depressive symptoms for both spouses (Conger et al., 1999; Vinokur et al., 1996). Cross-sectional studies using samples of African Americans have also found support for this association (Conger et al., 2002; Lincoln and Chae, 2010). We expect that economic pressure will be associated with African American individuals reporting more depressive symptoms.

Economic pressure and spousal support

Financial strain is also associated with negative marital interactions (e.g. disagreements and fighting; Gudmunson et al., 2007) and the expression of hostility and warmth as observed by independent raters (Conger et al., 1990). A number of studies have reported lower marital quality or reduced satisfaction among African American couples experiencing financial strain (Bryant et al., 2008; Cutrona et al., 2003; Lincoln and Chae, 2010). These findings are likely due to economic pressure redirecting an individual’s focus from his or her relationship to the current stressor. We expect that economic pressure will negatively influence spousal support as spouses experiencing greater pressure will perceive that they receive less support.

Depressive symptoms and spousal support

Numerous studies have documented the association between psychological distress and marital interactions, including marital conflict and the provision of social support (e.g. Conger et al., 1999, 2002; Gudmunson et al., 2007). Distress may negatively bias an individual’s perception of his or her relationship (Holland and Roisman, 2008). Distress may also lead an individual to withdraw from his or her partner, resulting in poor relationship quality and feeling disconnected from one’s partner. We expect that depressive symptoms will negatively influence the amount of perceived support received from one’s partner, such that higher levels of depression will be related to lower levels of perceived support.

Depressive symptoms and health and weight management behaviors

The current analysis extends the family stress perspective to explain the health and weight management behaviors of African American heterosexual husbands and wives. Numerous studies have shown that depressive symptoms and negative affect influence a variety of health and weight management behaviors, including the quantity and quality of foods consumed (Konttinen et al., 2010; Macht et al., 2005; Macht and Simons, 2000). Two primary mechanisms account for this association. One is reduced motivation and desire to make good health management decisions, including exercise and nutrition. Instead, individuals may rely on unhealthy food choices (Konttinen et al., 2010) because they lack concern about their weight. Another is emotional or comfort eating, which occurs when individuals eat as a way to cope with negative emotions (Jenkins and Horner, 2005; Macht et al., 2005; Macht and Simons, 2000). Emotional eating is associated with poor food choices and consuming above-average amounts of unhealthy foods that are high in sugar and fat content (Cools et al., 1992; Macht, 2008). We expect depressive symptoms will be positively associated with poor health and weight management behaviors.

Spousal support and health and weight management behaviors

Finally, studies have documented the central role of social support for the health of African Americans (Bagley et al., 1995). Research has indicated that social support—with spouses often serving as the primary source—facilitates positive health behaviors, including nutrition and weight management (e.g. Umberson et al., 2010; Wickrama et al., 1995). General spousal support may promote feelings of affirmation and encouragement in various domains, including healthy eating behaviors (Gallant, 2003). Spousal support also serves as a source of social control by providing the individual with a level of monitoring and accountability that is often essential for developing or maintaining healthy eating behaviors (Beverly et al., 2008; Lewis and Rook, 1999). We expect that support received from one’s spouse will be negatively associated with poor health and weight management behaviors. Following this chain of associations, we expect that depressive symptoms and spousal support will mediate the effect of economic pressure on the health and weight management behaviors of African American husbands and wives.

Dyadic or cross-partner effects

To account for the health-related implications of family, we examine cross-partner associations as guided by the APIM (Kenny et al., 2006), specifically the influence of each individual’s perception of economic pressure and depressive symptoms on their spouse’s perceived support and health and weight management behaviors. The APIM posits that the data provided by individual dyad members are linked because of the “shared environment” of married couples. Furthermore, these data are linked because individuals within marital dyads exert an influence on one another. Thus, dyadic modeling allows researchers to examine these cross-partner effects to account for nonindependence of the data and to understand how partners may or may not influence one another. There is reason to believe that dyadic effects within these constructs are particularly likely for African American families given that African American family members frequently act as stress absorbers or gatekeepers for each other by providing resources or distributing the effects of stress throughout the family (Bagley et al., 1995; White and Parham, 1990). The stress of economic pressure may be felt by other family members and influence their perceptions of support and/or their ability and desire to effectively manage their health and weight. Similarly, depressive symptoms of one partner may influence the family environment and outcomes of the other partner (Benazon and Coyne, 2000). More specifically, psychological distress experienced by one partner may influence both spouses’ perception of the marital interactions because depressed individuals are often less supportive (more hostile, less warm) and are also negatively biased in reporting their partners’ level of warmth and hostility (Holland and Roisman, 2008). Additionally, research suggests that gender differences may be present in these cross-partner effects, such that a wife’s influence on her husband’s health behaviors may be stronger than the influence a husband exerts on his wife’s health behaviors (Beverly et al., 2008; Schafer et al., 1999).

Methods

Participants and procedures

The data used for this study are from A Study of African American Marriage and Health, a National Institute of Child Health and Human Development (NICHD)-funded project. Data collection began in 2005 and sampled African American couples in the southeast. The project targeted newly married heterosexual couples identified through marriage licenses. Addresses on the marriage licenses were used to send letters inviting participation. Both partners had to participate in order to be included and were interviewed within their first year of marriage. Two trained interviewers visited the home of the participants in order to interview the husband and wife separately in different rooms. Interviewers followed a structured format and read each question to the participants. The average length of the interview was about 2 hours. All interviewers were African American. The interviewers asked questions about several topics, including racial discrimination, health, marital interactions, psychosocial resources, social networks, and community characteristics.

Of the newly married African American couples invited to participate (1494 couples), 47 percent were interviewed (702 couples) and participated in Wave 1. Participants’ ages ranged from 20 to 75 years. The median age of husbands and wives was 41 and 37 years, respectively. The mean personal earned income for husbands and wives was self-reported and fell in the range from US$30,000 to US$34,999 and US$25,000 to US$29,999, respectively. On average, husbands and wives reported their highest level of education was a “technical/trade school degree” and “some college,” respectively. Wave 2 data were collected 1 year later from as many of the original participants as possible. The sample for this study included those who participated in both data collection waves (n = 506 African American couples/1012 individuals). An attrition analysis was conducted between Wave 1 and Wave 2 participants (approximately 72% completed Waves 1 and 2). Across the study variables, there were no significant differences between the “stayers” and “attriters,” with the exception of educational attainment for husbands and wives. Individuals who completed both waves had slightly more education, and thus, this variable was controlled for in the study.

Measures

Economic pressure

Husbands’ and wives’ economic pressure at Wave 1 was assessed using the six-item Index of Perceived Financial Strain (Conger and Elder, 1994). Sample items include “My spouse and I have enough money to pay our bills” and “We have enough money to afford the kind of food we need.” Respondents rated their agreement using a 5-point scale ranging from “strongly agree” (1) to “strongly disagree” (5). Mean scores were computed; higher scores reflect more economic pressure (husbands’ economic pressure: M = 2.13, standard deviation (SD) = .62, α = .74; wives’ economic pressure: M = 2.21, SD = .69, α = .83).

Depressive symptoms

Depressive symptoms were assessed at Wave 1 as a latent construct using 14 items from the Center for Epidemiologic Studies–Depression (CES-D) scale (Radloff, 1977). Participants responded to items asking how frequently they were bothered by each symptom within the past week on a 4-point scale ranging from “less than 1 day a week” (1) to “5–7 days a week” (4). Previous work with this sample suggested that these items loaded onto two factors, one representing psychological symptoms and the other representing behavioral symptoms (O’Neal et al., 2014). Mean scores were computed for each factor. Higher scores reflect more depressive symptoms. Psychological symptoms were measured using nine items (e.g. not being able to shake the blues and feeling sad) (husbands: M = 1.24, SD = 39, α = .79; wives: M = 1.29, SD = .49, α = .89). Behavioral symptoms were assessed using five items (e.g. felt like everything I did was an effort and I could not get going) (husbands: M = 1.59, SD = .53, α = .56; wives: M = 1.63, SD = .60, α = .66).

Spousal support

The perceived level of support husbands and wives received from their spouse was assessed at Wave 1 using the 14-item Warmth and Hostility Scale (Conger and Elder, 1994). The items comprise two factors that capture warm (5 items) and hostile (9 items) behaviors. Participants responded using a 4-point scale ranging from “always” (1) to “never” (4). Warmth was assessed by asking, for example, how often their spouse expresses love and listens carefully to their point of view. Examples of hostility items include how often their spouse insults and gets angry with them. All hostility items were reverse scored, so that higher scores indicated greater spousal support. Mean scores were computed (husbands’ warmth received: M = 3.36, SD = .53, α = .73; wives’ warmth received: M = 3.33, SD = .56, α = .75; husbands’ hostility received: M = 3.45, SD = .43, α = .81; wives’ hostility received: M = 3.69, SD = .32, α = .80).

Health and weight management behaviors

At Wave 2, husbands’ and wives’ health and weight management behaviors were assessed as a latent variable using four items (Bryant et al., 2006). Participants were asked how often they (a) eat three balanced meals a day; (b) limit intake of foods such as sugar or fat; (c) take food supplements (e.g. vitamins, iron, calcium); and (d) watch (their) weight. Responses ranged from “regularly or most of the time” (1) to “never” (4). Following an examination of existing research, these four items were adapted from previous work examining adults’ attention to and concern with their nutrition and weight. More specifically, items (a) and (d) were adapted from Eisenhauer (2001), and items (b) and (c) were adapted from Walters (2001). Higher scores indicate poorer health and weight management behaviors (husbands’ health and weight management: M = 2.54, SD = .73, α = .60; wives’ health and weight management: M = 2.281, SD = .71, α = .60).

Control variables

Education and age at Wave 1 were included as control variables. Husbands’ and wives’ education was assessed by asking them to specify the highest level of education attained. Responses ranged from grade school to medical doctor. Respondents indicated their age at Wave 1 as a continuous variable.

Analysis

A latent-variable structural equation model (SEM) was examined with full information maximum likelihood (FIML) estimates to make use of all available data for those who completed both waves. Paths were examined after accounting for the influence of education and age (control variables). Missing data for each variable ranged from 0.6 to 3 percent with an average of 1.45 percent missing. Following the APIM, actor and partner (or cross-partner) effects were examined whereby the predictor variables were measured from both spouses (e.g. economic pressure) and used to account for variation in the health and weight management behaviors of both spouses individually (Kenny et al., 2006). The indirect, or mediating, effect of husbands’ and wives’ economic pressure on their health and weight management behaviors through their depressive symptoms and spousal support was examined using Sobel’s test. AMOS 20.0 (Arbuckle, 2011) was used to obtain estimates. A range of fit indices were used to assess the goodness of fit, including the chi-square statistic, comparative fit index (CFI), and root mean square error approximation (RMSEA). A good model fit is indicated by a χ²/df value of less than 3.0, a CFI greater than .90, and a RMSEA less than .06 (Browne and Cudeck, 1993; Carmines and McIver, 1981).

Results

Zero-order correlations among the variables are shown in Table 1. An examination of these coefficients indicated that most correlations were as expected. Next, the direct actor and partner effects of economic pressure on African American husbands’ and wives’ health and weight management behaviors were examined in a SEM excluding depressive symptoms and spousal support (the proposed mediators). There was a direct association between economic pressure and poor health and weight management behaviors for wives (B_wife = .11, p = .019) but not for husbands (B_husband = .05, p = .319). Based on Baron and Kenny’s (1986) prerequisites, an initial association between the predictor and outcome is necessary to conduct mediation. However, recent research has demonstrated flaws in this method (Zhao et al., 2010). Suggestions are that Baron and Kenny’s (1986) approach overemphasizes the importance of the X-Y test. In fact, this step has the least power to detect significant differences, which increases the chance of not finding existing statistically significant differences (c.f. Fritz and MacKinnon, 2007). Additionally, placing excessive importance on the test of the direct effect ignores the very indirect effect that the research is attempting to clarify (Hayes, 2009). Therefore, although the SEM examining the direct effect in isolation did not yield a direct effect for both husbands and wives (only wives), we proceeded to examine the full model including depressive symptoms and spousal support as possible mediators.

Table 1.

Zero-order correlations among latent constructs.

Study variables	1	2	3	4	5	6	7
1. Husbands’ economic pressure	–
2. Wives’ economic pressure	.378***	–
3. Husbands’ depressive symptoms	.206***	.109*	–
4. Wives’ depressive symptoms	.113*	.213***	.044	–
5. Husbands’ spousal support received	.204***	.129**	.124**	.188***	–
6. Wives’ spousal support received	.114*	.236***	.076	.217***	.455***	–
7. Husbands’ poor health and weight management behaviors (Wave 2)	.045	−.045	.030	.018	.191***	.083	–
8. Wives’ poor health and weight management behaviors (Wave 2)	.045	.105*	.011	.023	.103*	.046	.158***

Health and weight management behaviors were assessed at Wave 2; all other data were assessed at Wave 1.

*p < .05; **p < .01; ***p < .001.

Testing the hypothesized model

Figure 2 presents the results of the model examining the influence of economic pressure at Wave 1 on health and weight management behaviors at Wave 2; it also examines the linking roles of depressive symptoms and spousal support. The economic pressure of husbands and wives was indirectly associated with their own health and weight management behaviors although via different routes. Husbands and wives experiencing more economic pressure reported more depressive symptoms (B_husband = .11, p < .001 and B_wife = .09, p = .002). In turn, husbands and wives who reported more depressive symptoms perceived less support from their spouse (B_husband = −.15, p = .046 and B_wife = −.13, p = .002). Higher levels of spousal support were related to poorer health and weight management behaviors for husbands (B_husband = −.43, p > .001) but not for wives. For wives, those with more depres-sive symptoms reported poorer health and weight management behaviors (B_wife = .19, p = .028).

Figure 2.

Relationship between economic pressure and poor health and weight management behavior mediated by depressive symptoms and spousal support.

Economic pressure also directly influenced husbands’ and wives’ reports of spousal support received (B_husband = −.11, p < .001 and B_wife = −.09, p < .001). No cross-partner effects were statistically significant. Overall, this hypothesized model fit the data reasonably well (χ²/df ratio = 2.10; CFI = .92; RMSEA = .05).

Results from Sobel’s test indicated that for husbands, depressive symptoms served as the linking mechanism between the economic pressure husbands experienced and the perceived level of spousal support received (z = −1.80, p < .05). Spousal support also served as a significant link between depressive symptoms and health and weight management behaviors (z = −1.70, p < .05). Additionally, spousal support significantly linked economic pressure to poor health and weight management behaviors for husbands (z = −2.40, p < .01).

For wives, depressive symptoms significantly mediated the relationship between the economic pressure wives experienced and the perceived level of spousal support received (z = −2.29, p < .01). Depressive symptoms also served as the linking mechanism between economic pressure and poor health and weight management behaviors (z = 1.85, p < .05).

Discussion

Utilizing a family stress perspective, this study examined how economic pressure was associated with health and weight management behaviors via depressive symptoms and spousal support in a sample of married African Americans. Similar to previous research suggesting that social factors are linked to health outcomes (e.g. Carr and Springer, 2010; Kidwell et al., 2013), economic pressure was significantly related to poorer health and weight management behaviors, although the pathways differed for husbands and wives. Interestingly, economic pressure did not directly influence health and weight management behaviors for husbands, which was initially unanticipated because previous research suggests that economic pressure is negatively associated with health behaviors among both men and women (Shaw et al., 2012; Steptoe et al., 2005).

Overall, our findings extend the family stress model (Conger et al., 2002) and validate its use with married African Americans. The model illustrates that husbands and wives experiencing economic pressure reported more depressive symptoms than those who were not experiencing economic pressure. Moreover, spouses who experienced high levels of depressive symptoms perceived receiving less support from their partner. Perhaps, depressed individuals were subject to perceptual confirmation, which negatively biased their reports of their spouses’ behavior (McNulty and Karney, 2002). We also included a direct path between economic pressure and spousal support, as existing research shows that economic strain is associated with marital functioning—including marital interactions (Gudmunson et al., 2007) and marital quality (Bryant et al., 2008; Lincoln and Chae, 2010). The inclusion of this path was supported by our finding that husbands and wives experiencing economic pressure perceived less support from their spouses.

Perhaps, most importantly, this model suggests that the association between economic pressure and poor health and weight management behaviors is unique for husbands and wives. For husbands, spousal support (i.e. an interpersonal factor) was the linking mechanism connecting economic pressure to their poor health and weight management behaviors. It is somewhat surprising that this finding emerged for men but not women because research has often documented the importance of social support, particularly spousal support, for women more so than men (Denton and Walters, 1999; Shumaker and Hill, 1991). However, this finding is consistent with previous literature, suggesting that men benefit more from marriage than do women (Fowers, 1991). For wives, depressive symptoms (i.e. an individual-level factor) served as the linking mechanism explaining why economic pressure is associated with their poor health and weight management behaviors. This is consistent with other work connecting depression to unhealthy nutrition, specifically for women (Ouwens et al., 2009).

The use of dyadic data also allowed for the consideration of cross-partner effects that may exist within this model and subsequent gender differences. African American family members tend to act as stress absorbers for each other (Bagley et al., 1995); thus, the initial premise was that an individual’s economic pressure or depression may be felt by his or her spouse and consequently contribute to both partners’ health behaviors. Research indicates that the social support provided by a spouse can have a positive impact on their partner’s health behaviors and their attention to health and weight issues (e.g. Umberson et al., 2010; Wickrama et al., 1995). However, there is also reason to believe that spousal support can have a negative effect on an individual’s attempt to effectively manage his or her weight and health. For instance, many couples consider providing and sharing food as way of showing care and concern for their partner and building closeness (Hamburg et al., 2014). Consequently, if partners attempt to show support for their spouse in ways that undermine their health management (e.g. cooking or purchasing “comfort food”), spousal support could lead to risky health behaviors and, consequentially, poorer health (Henry et al., 2013).

In this study, however, no cross-partner effects were found with regard to the impact of spousal support. Analyses also did not yield significant cross-partner effects for the impact of economic pressure and depressive symptoms on health and weight management. Perhaps, spouses did not internalize their partners’ perceptions of economic pressure or depression. Previous research has noted that newly married couples are more likely to focus on the positives of their spouse and generate positive illusions (Hall and Adams, 2011; Murray et al., 1996). Or, much like spousal satisfaction, the highly affectionate nature of newlywed relationships may diminish the association between negative antecedents and spousal behavioral outcomes (Huston and Chorost, 1994).

Another possibility is that the items used to assess health and weight management behaviors may not have been sensitive to the ways African American couple members affect each other’s weight and health concerns and behaviors. Research has noted that unpleasant or critical interactions with a spouse may actually promote positive health behaviors when the unpleasant interactions are meant to constrain unhealthy behaviors (Henry et al., 2013). Thus, future studies teasing apart the types and purpose of spousal support and marital interactions may be revealing. Dyadic effects may be more likely to occur with regard to food- and weight-related values that are known to vary among races or ethnicities and families. For instance, there are notable variations in what foods and body shapes are defined as “healthy” as well as variations in beliefs about the role of food (e.g. comfort versus health) (Greene and Cramer, 2011; Swami et al., 2010). These socially and relationally constructed values may be implicated in the presence of crossover, or partner, effects on individuals’ health and weight management behaviors.

This study is not without limitations. First, constructs were defined using self-reports. Future research using observational measures, particularly for indicators of health and weight management behaviors, is needed. Relatedly, similar research simultaneously accounting for body mass index, or other more objective health and weight indicators, would allow for an in-depth understanding of intra- and inter-individual factors influencing health and weight management behaviors. Second, our use of a sample of African American newly married heterosexual couples limits the generalizability of these findings to other racial or ethnic groups or to other relationship statuses (i.e. dating, cohabiting, or couples married for many years). Furthermore, the average age of respondents was somewhat high for just-married couples (41 and 37 years for husbands and wives, respectively), which could indicate a potential selection bias with older newly married couples being more likely to participate in Wave 1. Regarding attrition over time, our attrition analysis revealed that study “attriters” and “stayers” only varied significantly on educational attainment, with “stayers” being slightly more educated. Although we controlled for education (and age), this does not rule out the possibility that different associations would have been found among the “attriters” and “stayers.” Third, several scales (health and weight management behaviors and the behavioral symptoms of depression) achieved somewhat low reliability values. Thus, research evaluating similar models with more reliable measures is needed in the future. Fourth, our use of two waves of longitudinal data (1 year apart) is a strength of the study; in that, it assesses the correct temporal ordering of constructs (eating behaviors subsequent to economic pressure), which minimizes concerns regarding the direction of the effect. However, studies capturing a longer period of time and controlling for health and weight management behaviors at the initial wave of data collection are need to extend these findings by assessing the long-term impact of economic pressure and change in health and weight management behaviors over time.

Despite these limitations, this study makes a unique contribution to existing literature regarding the influences of economic pressure, depressive symptoms, and spousal support on the health and weight management behaviors of African American husbands and wives. Examining health behaviors and attention to weight and health is particularly important because of the link to numerous health outcomes, including stroke, hypertension, and diabetes (Kopelman, 2000; Zhang et al., 2008). These results demonstrate that the family stress model can be extended to predict health-related constructs. These findings also emphasize the need for researchers and programmers alike to conceptualize such health constructs, specifically health and weight management in this study, as family-level, or couple-level, behaviors. Interventions and programs aimed at improving health and weight management behaviors should, therefore, consider both the positive and negative influences of marital partners on one another. Furthermore, this research illustrates the numerous processes that directly and/or indirectly influence health and weight management. Programs will likely be more successful when they address multiple components shown to influence health and weight management behaviors rather than conceptualizing a single causal agent of unhealthy behaviors.

Footnotes

Funding

This work was funded by a grant from the National Institute for Child Health & Human Development, R01-HD050045; Chalandra M. Bryant is principal investigator.

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