Shift-and-persist Strategies and their Association with Cardiometabolic Outcomes Among Young Adults in Puerto Rico

Objective: Shift-and-persist (SP-the ability to adapt the self to stressors while preserving focus in the future) is associated with favorable cardiometabolic outcomes. SP may be relevant in Puerto Rico (PR), a population with a high burden of cardiometabolic diseases and stressors. We examined the association between SP and cardiometabolic markers among young adults in PR. Methods: Cross-sectional analysis of baseline PR-OUTLOOK data (September 2020-March 2023). The analytic sample (n=2707) was aged 18-29 and 62% female. SP was measured with the Chen & Miller scale and categorized into tertiles (Low, Moderate, High). Anthropometric measurements and fasting blood samples assessed cardiometabolic markers: BMI and waist circumference (WC), blood pressure, blood glucose, HbA1c, and blood lipids (cholesterol, HDL, LDL, triglycerides). Analyses included adjusted linear regression models. Results: In adjusted models, persons with Moderate and High SP had a BMI that was on average 0.96 (95%CI: −1.63,−0.29) and 0.83 (95%CI:−1.55,−0.12) units lower, respectively, than those with Low SP. Similarly, those with Moderate and high SP had a WC that was 1.89 (95%CI:−3.45,−0.34) and 1.96 (95%CI:−3.62,−0.30) units lower, respectively, than those with Low SP. Additionally, persons with Moderate and High SP had glucose readings that were 2.45 (95%CI:−4.31,−0.60) and 2.81 (95%CI:−5.79,−0.83) units lower, respectively than those with Low SP, whereas only those with High SP had a lower HbA1c (=−0.10; 95%CI:−0.16,−0.04). Only those with Moderate SP (vs. Low SP) had significantly higher HDL (=1.16; 95%CI:0.16,2.17) No significant associations were found for blood pressure and other blood lipids. Conclusion: Greater SP was associated with lower adiposity, lower concentration of markers of glucose metabolism, and to some extent with higher HDL. Longitudinal studies are needed to confirm study findings and understand how SP may promote biobehavioral mechanisms for cardiometabolic health.