Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Opportunity Cost: The Impact of Contextual Risk Factors on the Cardiovascular Health of Low-Income Rural Southern African American Women

Appel, Susan J. PhD, APRN,BC (ACNP & FNP), CCRN; Giger, Joyce Newman EdD, APRN,BC, FAAN; Davidhizar, Ruth Elaine DNS, APRN,BC, FAAN

The Journal of Cardiovascular Nursing: September-October 2005 - Volume 20 - Issue 5 - p 315–324

Low-income rural southern African American women experience a high prevalence of morbidity and mortality from coronary heart disease (CHD) as well as other related cardiovascular (CV) diseases. Few models have taken into account the full impact of the contextual influences encountered on a daily basis by these women, and the effect of these influences on their CV health status. There are clearly demarcated examples of existing health disparities that occur in various ethnic/racial, underserved, and vulnerable populations. Yet, to date, there is no conceptual model that offers a plausible explanation as to why health disparities exist. Consequently, there is a lack of guidance as to where interventions should be focused for effective CV risk reduction. Because African American women continue to die at a disproportionately higher rate, and at earlier ages than do Caucasian women, it is imperative that new theoretical models capable of driving empirically based interventions be developed, tested, and implemented. One possible choice is the conceptual model proposed in this article. The model is based on the interrelationships between contextual risk factors, rational choice theory (RCT), and opportunity cost. Conceivably, this model may serve as a foundation to ground conceptual thought and drive theory-based interventions to reduce the health disparities in the CV health of low-income rural southern African American women. A model is presented in an attempt to provide guidance for advanced practice nurses who must struggle with addressing the critical need to reduce ethnic and race-associated CV health disparities.

Susan J. Appel, PhD, APRN,BC (ACNP & FNP), CCRN Assistant Professor, Graduate Studies, School of Nursing, University of Alabama at Birmingham.

Joyce Newman Giger, EdD, APRN,BC, FAAN Professor and Lulu Wolff Hassenplug, Endowed Chair, School of Nursing, UCLA, Los Angeles, Calif.

Ruth Elaine Davidhizar, DNS, APRN,BC, FAAN Professor and Dean, Division of Nursing, Bethel College, Mishawaka, Ind.

Corresponding author Susan J. Appel, PhD, APRN,BC (ACNP & FNP), CCRN, School of Nursing, University of Alabama at Birmingham, NB 428, 1701 University Blvd, Birmingham, AL 35294 (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.