Cardiovascular (CV) disease is the leading cause of death in the United States (Hoyert & Xu, 2012), and low-income and ethnic minorities are disproportionally affected. Relationship education (RE) interventions have been shown to improve relationship quality and reduce distress in individuals and couples, including low-income and ethnic minority populations. This study examined the effect of an evidenced-based, individual-oriented, RE intervention, within my reach, (WMR), on emotional distress in a population of mostly low-income and ethnic minority individuals with existing CV disease and/or CV disease risk factors (CVD) to those without disease or risk factors (non-CVD). Results showed significant improvements in overall distress for both the CVD and non-CVD groups, but neither group improved significantly more than the other. The authors found similar changes in distress levels when we examined a subset of the population that met the criteria for clinical distress. Also, data showed that CVD participants presented with significantly greater overall distress than non-CVD participants. These findings are consistent with prior research that showed the effectiveness of the WMR curriculum in stress reduction. Furthermore, this study contributes knowledge about a unique population, individuals with CV disease and/or CVD, who may greatly benefit from interventions focused on stress reduction.
AmatoP. R. (2014). Does social and economic disadvantage moderate the effects of relationship education on unwed couples? An analyses of data from the 15-month building strong families evaluation. Family Relations, 63, 343–355.
2.
AngelesJ.SomersS. A. (2007). From policy to action: Addressing racial and ethnic disparities at the ground-level. Hamilton, NJ: Center for Health Care Strategies.
3.
AntleB.SarB.ChristensenD.EllersF.BarbeeA.van ZylM. (2013). The impact of the within my reach relationship training on relationship skills and outcomes for low-income individuals. Journal of Marital and Family Therapy, 39, 346–357.
4.
BakerB.PaquetteM.SzalaiJ. P.DriverH.PergerT.HelmersK.…TobeS. (2000). The influence of marital adjustment on 3-year left ventricular mass and ambulatory blood pressure in mild hypertension. Archives of Internal Medicine, 160, 3453–3458.
5.
BakerB.SzalaiJ.PaquetteM.TobeS. (2003). Marital support spousal contact and the course of mild hypertension. Journal of Psychosomatic Research, 55, 229–233.
6.
BardenS. M.CarlsonR. G.DaireA. P.FinnellL. R.ChristopherK.YoungE. (2015). Investigating the influence of relationship education on parental attitudes. Marriage & Family Process, 51, 246–263.
7.
BlanchardV.HawkinsA.FawcettE. (2007). Does relationship education improve couples’ communication? A meta-analysis. Poster Presentation at the National Council on Family Relations Annual Conference, Pittsburg, PA.
8.
BaucomD. H.PorterL. S.KirbyJ. S.HudepohlJ. (2012). Couple-based interventions for medical problems. Behavior Therapy, 43, 61–76.
9.
BonowR. O.GrantA. O.JacobsA. K. (2005). The cardiovascular state of the union confronting healthcare disparities. Circulation, 111, 1205–1207.
10.
BradfordA. B.HawkinsA. J.AckerJ. (2015). If we build it, they will come: Exploring policy and practice implications of public support for couple and relationship education for lower income and relationally distress couples. Family Process, 54, 639–654.
11.
CarlsonR. G.DaireA. P.BaiH. (2014). Examining relationship satisfaction and individual distress for low-to-moderate income couples in relationship education. The Family Journal, 22, 282–291.
12.
CarlsonR. G.FrippJ.MunyonM. D.DaireA.JonsonJ. M.DeLorenziL. (2014). Examining passive and active recruitment methods for low-income couples in relationship education. Marriage & Family Review, 50, 76–91.
13.
CarlsonR. G.RappleyeaD. L.DaireA. P.HarrisS. M.LiuX. (2015). The effectiveness of couple and individual relationship education: Distress as a moderator. Family Process, 1–14. doi:10.1111/famp.12172
14.
CarrollJ.DohertyW. (2003). Evaluating the effectiveness of premarital prevention programs: A meta-analytic review of outcome research. Family Relations, 52, 105–118.
15.
ChopikW. J.O’BrienE. (2016). Happy you, healthy me? Having a happy partner is independently associated with better health in oneself. Health Psychology. Advance online publication. doi:10.1037/hea0000432
16.
CookR. D.WeisbergS. (1982). Residuals and influence in regression. New York, NY: Chapman and Hall.
17.
CongerR. D.CongerK. J.ElderG. H.LorenzF. O.SimonsR. L.WhitbeckL. B. (1992). A family process model of economic hardship and adjustment of early adolescent boys. Child Development, 63, 526–541.
18.
CongerR. D.CuiM.BryantC. M.ElderG. H. (2000). Competence in early adult romantic relationships: A developmental perspective on family influences. Journal of Personality and Social Psychology, 79, 224–237.
19.
CongerR. D.ElderG. H.LorenzF. O.CongerK. J.SimonsR. L.WhitbeckL. B.…MelbyJ. N. (1990). Linking economic hardship to marital quality and instability. Journal of Marriage and Family, 52, 643–656.
20.
CongerR. D.RueterM. A.ElderG. H. (1999). Couple resilience to economic pressure. Journal of Personality and Social Psychology, 76, 54–71.
21.
CottleN. R.ThompsonA. K.BurrB. K.HublerD. S. (2014). The effectiveness of relationship education in the college classroom. Journal of Couple and Relationship Therapy, 13, 267–283.
22.
CoyneJ.RohrbaughM.ShohamV.SonnegaJ.NicklasJ.CranfordJ. (2001). Prognostic importance of marital quality for survival of congestive heart failure. American Journal of Cardiology, 88, 526–529.
23.
CrimminsE. M.HaywardM. D.SeemanT. E. (2004). Race/ethnicity, socioeconomic status, and health. In AndersonN. B.BulataoR. A.CohenB. (Eds.), Critical perspectives on racial and ethnic differences in health in late life (pp. 310–352). Washington, DC: The National Academies Press.
24.
DaireA. P.HarrisS. M.CarlsonR. G.MunyonM. D.RappleyeaD. L.BeverlyM. G.HiettJ. (2012). Fruits of improved communication: The experiences of Hispanic couples in a relationship education program. Journal of Couples and Relationship Therapy, 11, 112–129.
25.
De VogliR.TaraniC.Bideon-MarmotM. (2007). Negative aspects of close relationships and heart disease. Archives of Internal Medicine, 167, 1951–1957.
26.
GorkinL.SchronE. B.BrooksM. M.WiklundI.KellenJ.VerterJ., … CAST Investigators. (1993). Psychosocial predictors of mortality in the Cardiac Arrhythmia Suppression Trial-1 (CAST-1). The American Journal of Cardiology, 71, 263–267.
27.
GrantN.WardleJ.SteptoeA. (2009). The relationship between life satisfaction and health behavior: A cross-cultural analysis of young adults. International Journal of Behavioral Medicine, 16, 259–268. doi:http://dx.doi.org/10.1007/s12529-009-9032-x
28.
GumpB. B.PolkD. E.KamarckT. W.ShiffmanS. M. (2001). Partner interactions are associated with reduced blood pressure in the natural environment: Ambulatory monitoring evidence from a healthy, multiethnic adult sample. Psychosomatic Medicine, 63, 423–433.
29.
HalfordW. K.MarkmanH. J.KlineG. H.StanleyS. M. (2003). Best practice in couple relationship education. Journal of Marital and Family Therapy, 29, 385–406.
30.
HawkinsA. J.BlanchardV. L.BaldwinS. A.FawcettE. B. (2008). Does marriage and relationship education work? A meta-analytic study. Journal of Consulting and Clinical Psychology, 76, 723.
31.
HawkinsA. J.EricksonS. E. (2015). Is couple and relationship education effective for lower income participants? A meta-analytic study. Journal of Family Psychology, 29, 59–68.
32.
HawkinsA.OomsT. (2012). Can marriage and relationship education for lower-income couples work? A meta-analytic study of emerging research. Journal of Couple & Relationship Therapy, 9, 181–191.
33.
HeidenreichP. A.TrogdonJ. G.KhavjouO. A.ButlerJ.DracupK.EzekowitzM. D.…WooY. J. (2011). Forecasting the future of cardiovascular disease in the United States: A policy statement from the American heart association. Circulation, 123, 933–944.
34.
HelgesonV. S.CohenS. (1996). Social support and adjustment to cancer: Reconciling descriptive, correlational, and intervention research. Health Psychology, 12, 135–148.
35.
HoyertD.XuJ. (2012). Deaths: Preliminary data for 2011. National Vital Statistics Reports, 61, 1–51.
36.
KawachiI.ColditzG. A.AscherioA.RimmE. B.GiovannucciE.StampferM. J.WillettW. C. (1996). A prospective study of social networks in relation to total mortality and cardiovascular disease in men in the USA. Journal of Epidemiology and Community Health, 50, 245–251.
37.
KochanekK. D.XuJ.MurphyS. L.MiniñoA. M.KungH. C. (2011). Deaths: final data for 2009. National Vital Statistics Reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 60, 1–116.
38.
KnoxS. S.AdelmanA.EllisonR. C.ArnettD. K.SiegmundK.WeidnerG.ProvinceM. A. (2000). Hostility, social support, and carotid artery atherosclerosis in the National Heart, Lung, and Blood Institute Family Heart Study. The American Journal of Cardiology, 86, 1086–1089.
39.
LambertM. J.MortonJ. J.HatfieldD.HarmonC.HamiltonS.ReidR. C., … BurlingameG. M. (2004). Administration and scoring manual for the OQ-45.2. Stevenson, MD: American Professional Credentialing Services, L.L.C, Brigham Young University.
40.
LettH. S.BlumenthalJ. A.BabyakM. A.StraumanT. J.RobinsC.SherwoodA. (2005). Social support and coronary heart disease: Epidemiologic evidence and implications for treatment. Psychosomatic Medicine, 67, 869–878.
41.
LoprestiA. L.HoodS. D.DrummondP. D. (2013). A review of lifestyle factors that contribute to important pathways associated with major depression: Diet, sleep and exercise. Journal of Affective Disorders, 148, 12–27.
42.
MarkmanH. J.RhoadesG. K. (2012). Relationship education research: Current status and future directions. Journal of Marital and Family Therapy, 38, 169–200.
43.
MednickS. C.ChristakisN. A.FowlerJ. H. (2010). The spread of sleep loss influences drug use in adolescent social networks. PLoS One, 5, e9775. doi:10.1371/journal.pone.0009775
44.
MensahG. A.MokdadA. H.FordE. S.GreenlundK. J.CroftJ. B. (2005). State of disparities in cardiovascular health in the United States. Circulation, 111, 1233–1241.
45.
OomsT. (2007). Adapting healthy marriage programs for disadvantaged and culturally diverse populations: What are the issues (Policy brief, Couple and Marriage Series No. 10)? Washington, DC: Center for Law and Policy (CLASP).
46.
OomsT.WilsonP. (2004). The challenges of offering relationship and marriage education to low-income populations. Family Relations, 53, 440–447.
47.
OrthU. (2013). How large are actor and partner effects of personality on relationship satisfaction? The importance of controlling for shared method variance. Personality and Social Psychology Bulletin, 39, 1359–1372.
48.
Orth-GomerK.WamalaS. P.HorstenM.Schenck-GustafssonK.SchneidermanN.MittlemanM. A. (2000). Marital stress worsens prognosis in women with coronary heart disease: The Stockholm Female Coronary Risk Study. Journal of the American Medical Association, 284, 3008–3014.
49.
PallantJ. (2013). SPSS survival manual: A step by step guide to data analysis using IMB SPSS. Berkshire, England: McGraw-Hill Education (UK).
50.
PearsonM.StanleyS.RhoadesG. (2008). Within my reach. Greenwood Village, CO: PREP for Individuals, Inc.
51.
Reardon-AndersonJ.StagnerM.MacomberJ.MurrayJ. (2005). Systematic review of the impact of marriage and relationship programs. Washington, DC: Administration for Children and Families, U.S. Department of Health and Human Services.
52.
RhoadesG. K.StanleyS. M. (2009). Relationship education for individuals: The benefits and challenges of intervening early. In BensonH.CallanS. (Eds.), What works in relationship education: Lessons from academics and service deliverers in the United States and Europe (pp. 45–54). Doha, Qatar: Doha International Institute for Family Studies and Development.
53.
RosengrenA.HawkenS.ÔunpuuS.SliwaK.ZubaidM.AlmahmeedW. A., … INTERHEART investigators. (2004). Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): Case-control study. The Lancet, 364, 953–962.
54.
RozanskiA.BlumenthalJ. A.KaplanJ. (1999). Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation, 99, 2192–2217.
55.
SchaferJ. L.OlsenM. K. (1998). Multiple imputation for multivariate missing-data problems: A data analyst’s perspective. Multivariate Behavioral Research, 33, 545–571.
56.
StanleyS.BlumbergS.MarkmanH. (1999). Helping couples fight for their marriages: The PREP approach. In BergerR.HannahM. (Eds.), Handbook of preventative approaches in couple therapy (pp. 279–303). New York, NY: Brunner/Mazel.
57.
TabachnickB. G.FidellL. S. (2013). Using multivariate statistics (6th ed.). Upper Saddle River, NJ: Pearson Education.
58.
UchinoB. N. (2006). Social support and health: A review of physiological processes potentially underlying links to disease outcomes. Journal of Behavioral Medicine, 29, 377–387.
59.
UchinoB. N.BoschJ. A.SmithT. W.CarlisleM.BirminghamW.BowenK. S.…O’HartaighB. (2013). Relationships and cardiovascular risk: Perceived spousal ambivalence in specific relationship contexts and its links to inflammation. Health Psychology, 32, 1067.
60.
VisvanathanP. D.RichmondM.WinderC.KoenckC. H. (2015). Individual-oriented relationship education: An evaluation study in community-based settings. Family Process, 54, 686–702. doi:10.1111/famp.12116
61.
WilliamsD. R.CollinsC. (1995). US socioeconomic and racial differences in health: Patterns and explanations. Annual Review of Sociology, 21, 349–386.
62.
YancyC. W.BenjaminE. J.FabunmiR. P.BonowR. O. (2005). Discovering the full spectrum of cardiovascular disease minority health summit 2003: Executive summary. Circulation, 111, 1339–1349.
63.
ZimmermannT.HeincrichsN.BaucomD. H. (2007). Does one size fit all? Moderators in psychosocial interventions for breast cancer patients: A meta-analysis. Annals Behavioral Medicine, 34, 225–239.
