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STRONG BLACK WOMANHOOD DRIVES THE ASSOCIATION BETWEEN SHIFTING AND DISEASE ACTIVITY IN BLACK WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS
Abstract

STRONG BLACK WOMANHOOD DRIVES THE ASSOCIATION BETWEEN SHIFTING AND DISEASE ACTIVITY IN BLACK WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Christy L. Erving, Khadijah Abdallah, Rachel Parker, Jerik Leung, Shivika Udaipuria, Jordan E Parker, Lori S Hoggard, Jelaina Shipman-Lacewell, Kennedy M Blevins, Murden Raphiel, …
Biopsychosocial science and medicine, v 88(5), pp A16-A17
Jun 2026
DOI: https://doi.org/10.1097/PSY.0000000000001488#page=A16

Abstract

Lupus
Background: Systemic Lupus Erythematosus (SLE), a chronic and debilitating autoimmune condition, disproportionately impacts U.S. Black women. Though psychosocial stressors (e.g., discrimination) are linked to heightened disease activity, associations between intersectional stressors (i.e., those capturing Black women’s unique lived experience) and disease activity are poorly understood. This analysis examined whether engaging in shifting --- a sociocultural phenomenon in which Black women alter their behavior, physical appearance, and patterns of speech across different racialized contexts --- is associated with disease activity. Methods: Data were from the Vascular Aging, Inflammation, and Stress in African American Women’s Health research Study (VISTA; 2017-2020), which included 201 Black women with SLE recruited from the Atlanta, Georgia metropolitan area. Shifting was assessed by the 13-item African American Women’s Shifting Scale (AAWSS), which includes three dimensions: Strong Black Womanhood (SBW), Awareness of Shifting Behavior, and Sensitivity to Perceptions of Black Americans. Disease activity was assessed by the self-reported Systemic Lupus Activity Questionnaire (SLAQ). Linear regression and logistic regression models were conducted for continuous and clinically important SLAQ (i.e., ≥ 9) scores, respectively. Models were adjusted for sociodemographic (e.g., income, age) and health-related (e.g., BMI, smoking status) factors. Results: The mean SLAQ score was 15.44 (SD = 8.21) and 77.5% of participants had clinically important SLAQ (score ≥ 9). After adjustment for covariates, there was a positive association between shifting endorsement and disease activity (β =3.44; P =.003; 95% CI: 1.23, 5.67). When the three shifting dimensions were analyzed, SBW was associated with greater disease activity (β = 2.90; P =.033; 95% CI:.24, 5.55). Awareness of Shifting Behavior and Sensitivity to the Perceptions of Black Americans were not linked with disease activity. In adjusted models, shifting overall was unrelated to clinically important SLAQ. SBW was marginally but positively associated with clinically important SLAQ (Odds Ratio [OR] = 2.37; P =.089). The other two shifting dimensions were not significantly associated with clinically important SLAQ. Conclusion: Findings indicate that expectations to be strong (e.g., agreement with statements such as “I must always be strong for my family and friends”, “I cannot show weakness to my family”, and “others rarely see me as vulnerable or in need of support”) could intensify disease activity in Black women with SLE. Psychosocial interventions should target deconstructing and problematizing the internalization of strong Black womanhood to reduce negative SLE-related clinical outcomes.

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