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

项目总结

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.