Reducing hypertension among men in manual and trade labor: a mobile stress management and medication adherence intervention

The National Heart, Lung, and Blood Institute awarded $305,471 to ISA Associates, Inc. on August 1, 2026, under the Cardiovascular Diseases Research program (CFDA 93.837) to develop and pilot test a mobile stress management and medication adherence intervention targeting hypertension among men employed in manual and trade labor.

The project addresses occupational stress as a driver of hypertension risk in construction, repair, production, and transportation workers, who experience disproportionately high rates of cardiovascular disease compared to other occupational groups. The intervention applies cognitive-behavioral stress management principles through a mobile platform designed specifically for manual and trade labor work contexts and norms, with the goal of reducing both stress reactivity and maladaptive coping behaviors such as smoking and sedentary activity that compound hypertension risk.

Work is performed in Arlington, Virginia, with a period of performance from August 1, 2026, through April 30, 2027. This is a Phase I Small Business Innovation Research award, classified as a project grant.

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.