Understanding Ecologic Stress, Risk and Health Resiliencies in Mexican-Origin Adults Living in a High Poverty Rural Community

项目摘要 相对于美国整体趋势，拉丁美洲成年人的许多慢性病的年龄调整率更高， 具有健康优势。暴露在压力之下导致了其中的一些差异， 糖尿病、心血管疾病、癌症和精神疾病。该项目将澄清报告的压力源 墨西哥裔成年人在一个低收入、医疗服务不足的边境社区所经历的痛苦。这 社区参与性研究将：1）阐明我们对压力和文化限制保护的认识， 通过密集的，以民族志为基础的访谈（N = 50）的因素;和，2）检查关系 报告的压力源与生理压力、全身炎症和慢性炎症的客观测量之间的关系 疾病风险。后者将通过对墨西哥裔成年人进行有代表性的家庭调查来实现 （N = 320）。每年两次随访将评估生物标志物和自我报告的几个因素：有效 心理社会量表（例如，社会嵌入的压力源）;保护性的社会和文化因素;以及， 文化相关的应对资源（例如，感知的个人支持和个人的开放性 支持）。客观健康度量包括炎症和系统性失调的标志物（即， hsCRP，IL-6;皮质醇）和Life's Simple 7（即，A1 c;胆固醇;血压;肥胖;吸烟;物理 活动;饮食）。纵向模型将用于预测生物标志物和慢性疾病风险，并测试 不同的子组模式。创新，微创和社区响应的方法将是 用于生物标志物数据收集-特别是从干血斑，立即可用的评估 A1 c，BMI和BP，以及头发中的皮质醇。头发和指甲中的皮质醇反映了更多的慢性压力指标， 更常见的研究措施，并有特别的承诺，作为端点的压力管理 干预措施。角蛋白样本中的皮质醇更好地平行于行为干预试验的预期长度 与唾液、血清和尿液中观察到的高度瞬时水平相比。对队列数据的分析也将 直接为一系列焦点群体的亚群体定位提供信息（N = 90）。每组至少4组 将进行生物学鉴定的亚群：那些统一的高压力（高 报告的应力和高生物应力），那些均匀的低应力，和那些出现弹性（高， 报告的应力但低于预期的生物应力）。一种有前途的压力管理的适应性 将探讨最近在康涅狄格州对拉丁美洲人进行的CHW干预测试。关键线人访谈 社区利益攸关方和一个社区咨询委员会利用一项为期五年的预防研究 2019年10月开始的中心将进一步准备我们提交一项临床试验，以减少和减轻 压力源因此，本研究产生的数据对于进行预防试验以减少 压力和慢性疾病，并为其他人群确定方法和模型。

Project Summary Latino adults have higher age-adjusted rates of many chronic disease relative to overall US trends, while also having health advantages. Exposure to stress contributes to some of these disparities, with implications for diabetes, cardiovascular disease, cancer, and mental illness. This project will clarify reported stressors experienced by Mexican-origin adults in a low-income, medically under-served, border community. This community participatory research will: 1) elucidate our knowledge of stress and culturally-bounded protective factors through intensive, ethnographically-grounded interviews (N = 50); and, 2) examine relationships between reported stressors to objective measures of physiological stress, systemic inflammation, and chronic disease risk. The latter will be achieved through a representative household survey of Mexican-descent adults (N = 320). Each of two yearly follow ups will assess biomarkers and self-reports on several factors: valid psychosocial scales (e.g., socially embedded stressors); protective social and culturally-tied factors; and, culturally-relevant coping resources (e.g., perceived individual support available and persons' openness to receive support). Objective health metrics include markers of inflammation and systemic dysregulation (i.e., hsCRP, Il-6; cortisol) and Life's Simple 7 (i.e., A1c; cholesterol; blood pressure; adiposity; smoking; physical activity; diet). Longitudinal models will be used to predict biomarker and chronic disease risk, and test for differential sub-group patterns. Innovative, minimally invasive, and community responsive methods will be used for biomarker data collection--specifically from dried blood spot, immediately available assessments of A1c, BMI and BP, and cortisol from hair. Cortisol in hair and nails reflect more chronic stress indicators than more commonly studied measures, and have particular promise as endpoints in stress management interventions. Cortisol in keratin samples better parallels expected lengths of behavioral intervention trials compared with highly transient levels observed in saliva, serum and urine. Analysis of the cohort data will also directly inform sub-population targeting for a series of focus groups (N = 90). A minimum of 4 groups for each biologically identified sub-populations will be conducted: those for persons of uniform high stress (high reported stress and high biologic stress), those of uniform low stress, and those that appear resilient (high in reported stress but lower than expected biologic stress). The adaptability of a promising stress-management CHW intervention recently tested with Latinos in Connecticut will be explored. Key informant interviews with community stakeholders and a community advisory board leveraged from a five-year prevention research center beginning October of 2019 will further prepare us to submit a clinical trial to reduce and mitigate stressors. Thus the data generated from this study will be invaluable to conducting a prevention trial to reduce stress and chronic disease in our community, and in determining methods and models for other populations.