A newly married couple has just moved into your neighborhood and would like to start a family soon. They currently have no health insurance offered at their places of employment. You meet at a local coffee shop and they share this information with you knowing you are a registered nurse. They ask you “Any idea on what we should do to try and get affordable health insurance coverage?”. What questions might you ask to begin assisting? What information and resources might you give this couple to guide them in finding health insurance in your state? 

Topic: Chronic psychosocial Stress and Hypertension

“Genetic and behavioral factors do not fully explain the development of hypertension, and there is increasing evidence suggesting that psychosocial factors may also play an important role. Exposure to chronic stress has been hypothesized as a risk factor for hypertension, and occupational stress, stressful aspects of the social environment, and low socioeconomic status have each been studied extensively” (Spruill, 2010, p.10).

• Describe the participant protections provided by the researchers for participants. Participant protection provided was presenting the stressors in a lab, and not the real world.  The participants were then taught ways to cope.
• How were the participants selected? How might this impact ethical principles within the study? A cross sectional analysis of 2612 participants from 495 neighborhoods was done to choose the participants. The participants were chosen from people who were included in the multi-ethnic study of atherosclerosis. The participants were people experiencing low socioeconomic status, racial discrimination, and occupational stress which could impact ethical principles.
• Would the participants in this study be considered “vulnerable”? Why or why not? Yes, because the participant with bp issues is forced to confront stressors in a lab.   For example, African Americans living in the US suffer from higher rates of hypertension than whites and reasons remain poorly understood, (Spruill, 2010, p.12).  One aspect is that African Americans demonstrate elevated bp to race related lab stressors such as listening to audiotapes and watching videotapes of racist scenarios or recall of personal experiences.  Evidence showed that reactivity is influenced the degree to which the subjects attribute to race-related discrimination, (Spruill, 2010, p.12).
• Were participants subjected to any physical harm or discomfort or psychological distress as part of the study? What efforts did the researchers make to minimize harm and maximize good? Yes, they were forced to confront the stressor being studied, whereas in real life, they probably tried their best to avoid certain stressors. The participants were taught interventions to help reduce blood pressure such as muscle relaxation, biofeedback, meditation, and other coping mechanisms.
• Does the report discuss steps that were taken to protect the privacy and confidentiality of study participant? There is a disclosure note: Disclosure No potential conflicts of interest relevant to this article were reported.

“Much of the work to date regarding effects of rumination on BP has used laboratory stressors; though this approach is useful and important, the artificiality of the situation limits the generalizability of results to the real world. Response to laboratory stressors may be a poor indicator of the degree to which people ruminate about real-life stressors. Further, in the laboratory, the participant is forced to confront the stressor being studied, whereas in the field, the person may use various strategies (eg, distraction) to avoid such engagement. Thus, an important next step in evaluating rumination as a possible mechanism by which stress contributes to hypertension is to observe the effects of naturally occurring stressors on ruminative thoughts and BP outside the laboratory” (Spruill, 2010, p.14).

Spruill, T. M. (2010). Chronic psychosocial stress and hypertension. Current Hypertension Reports, 12(1), 10-6. doi:http://dx.doi.org/10.1007/s11906-009-0084-8

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