Reducing Hypertension Among Men in Manual and Trade Labor: A Mobile Stress Management and Medication Adherence Intervention
openNHLBI - National Heart Lung and Blood Institute
PROJECT SUMMARY/ABSTRACT
Men employed in manual and trade labor (MTL) – including construction, repair, production, and transportation – often
work in high-demand, low-control settings marked by physical exertion, rotating shifts, exposure to environmental hazards,
and intense production pressures. These working conditions are not just uncomfortable, they produce measurable harm.
Compared to other occupational groups, men in MTL experience higher rates of chronic disease and premature mortality.
Although causes are multifactorial, occupational stress is a central driver of these adverse health outcomes.
Hypertension (HTN), the leading modifiable risk factor for cardiovascular disease, is a primary outcome of the stress-
disease pathway. Consistent with the combination of heavy demands (e.g., workload, time pressure) and low control (e.g.,
limited autonomy, low decision latitude) that often characterize MTL work, rates of HTN are especially high among men in
these occupations. Mechanistically, chronic occupational stress raises risk in two ways. First, it has direct physiological effects
on blood pressure (BP). Second, it indirectly increases risk by promoting maladaptive coping strategies such as smoking,
substance use, and sedentary behavior.
There are currently no HTN management interventions for men in MTL that directly target occupational stress.
Cognitive-behavioral stress management interventions (CBSMi) are well suited to fill this role. These multicomponent
programs are designed to reduce stress reactivity and strengthen coping. Evidence shows CBSMi can reliably reduce
cardiovascular risks factors, including BP. They are also effective in high stress occupational settings like MTL.
Despite their promise, existing CBSMi are seldom tailored to MTL contexts or workplace norms. This Phase I project will
develop and pilot test a prototype masculinity-informed, mobile CBSMi that integrates cognitive-behavioral skills, mindfulness
training, and medication adherence support. Framing will leverage prosocial masculine norms commonly found in the
workplace, such as loyalty, camaraderie, and protective responsibility, to encourage uptake and use of evidence-based
techniques. Delivered via a low-friction progressive web app (PWA), the intervention will require no installation, function
offline, and adapt across devices to reduce common access barriers. Context-aware personalization will adjust content and
timing based on job conditions, engagement patterns, and usage windows to deliver just-in-time notifications, tailored
educational modules, guided relaxation practices, and adherence strategies. By simultaneously addressing occupational stress
and adherence barriers, the intervention targets two modifiable drivers of elevated blood pressure in MTL settings.
Men with HTN in high-strain MTL roles (N=24) will be recruited for focus groups to inform prototype development.
Participants will be sampled across three common job-demand profiles (physically demanding; machine/line-paced;
sedentary/monitoring) and two age bands (18–39; 40+) to capture variation in work constraints and mobile phone use. When
the prototype is completed, these end users will complete task-based usability testing to evaluate efficiency, effectiveness, and
acceptability of the prototype m-CBSMi.
Up to $305K
health research