NHLBI Awards Caceres $3M to Study Stigma, Blood Pressure

Assistant Professor of Nursing Billy Caceres, PhD, will receive a $3,084,733 grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health, his first R01 award, for a study looking at how anticipated and vicarious stigma influence blood pressure (BP). 

The four-year project, “A Daily Diary Examination of the Influence of Intersectional Stigma on Blood Pressure,” uses a novel approach to examine the relationship between discrimination and cardiovascular disease.  

Stigma can include discrimination related to one’s identity, as well as the effects of systemic racism, sexism, and other types of bias. “There is robust evidence to support stigma as an important social determinant of health,” explains Caceres, noting that exposure to stigma has been linked to hypertension, diabetes, obesity, smoking, and disturbed sleep. 

Research to date in this area has focused on the direct experiences of discrimination due to a single stigmatized identity, adds Caceres, an affiliated investigator with both the Center for Sexual and Gender Minority Health Research and the Center for Research on People of Color at Columbia Nursing. “It sort of ignores the fact that people of color can also be women, they can also be gay, they can also have a disability.” 

The new study is designed to measure whether the number of stigmatized identities a person has influences the effects of experiencing anticipatory stigma (expecting unfair treatment) and vicarious stigma (witnessing or hearing about discrimination without experiencing it directly). In their daily lives, Caceres notes, people may have more exposure to these indirect but pervasive forms of stigma, with potentially greater health effects.  

He and his colleagues will enroll 400 adults diverse in sexual identity, race, ethnicity, and gender, who will have their blood pressure checked twice in the morning and twice at night for seven days. Each morning, they will note their level of anticipated stigma, and at bedtime they will report the amount of vicarious stigma they experienced that day.  

Caceres and his colleagues hypothesize that people will have a greater increase in BP when they are reporting higher levels of stigma, and that the effect will be stronger in those with a higher number of stigmatized identities. 

The study will be a critical step for identifying mechanistic targets for interventions and policies to reverse the adverse effects of stigma on cardiovascular disease risk in stigmatized adults. At the individual level, Caceres notes, “we need interventions that would address both cardiovascular health and discrimination-related stress.” Enrollment will begin in spring 2024.