Social Connectedness and Health in the Blackfeet Community: An Investigation of Biopsychosocial Mediators

项目概要/摘要 生活在蒙大拿州西北部黑脚保留地的美国印第安人（AI）的预期寿命 比居住在同一个县的非西班牙裔白人的预期寿命短13年，部分原因是 糖尿病、抑郁症和心血管疾病等慢性病的发病率高得不成比例， 疾病虽然在其他种族中，社会联系与健康和疾病风险有关， 在人工智能人群中，社会联系在健康差距中的预期作用尚不清楚。这 在有关可能抵消持久的AI健康差异的潜在因素的知识方面留下了一个关键的空白。 我们以前在黑脚社区的横断面工作表明，低社会地位和低收入之间的关系。 连通性和健康风险因素，包括高水平的炎性细胞因子，高静息血 压力大，抑郁和焦虑症状严重，睡眠质量差。每一个结果 与慢性疾病的发作和进展有关，这些慢性疾病不成比例地影响黑脚AI 成年人了基于这些观察到的关系，社会联系可能会起到恢复力的作用 促进这个高危社区健康的因素。 为了解决这一关键的研究差距，Blackfeet AI成年人（n=280）将参加一项纵向研究 2年以上，以捕捉心理和身体健康以及社会方面有意义的长期变化 连通性通过在2年内均匀间隔的三次测量，我们将长期跟踪 社会联系，心理健康，睡眠质量和与风险相关的生物标志物的轨迹 炎症和心脏代谢疾病，并研究这些轨迹之间的对应关系 (Aim 1）。在第一年，在14天的监测期内，我们将使用生态瞬时评估应用程序 向参与者的移动的电话发送问题，以调查 社会互动，社会联系，睡眠质量和心理健康指数（即 抑郁和焦虑）（目标2）。在我们所有的模型中，我们将考虑文化因素，经验和健康- 我们在以往的社区工作中发现的相关风险因素，包括 童年和历史创伤，最近的创伤，感知歧视，饮酒，吸烟状况，以及 药物使用。拟议工作的首要目标是了解未来的关系 社会联系和健康之间的关系。这将是第一次全面、纵向的 本研究旨在探讨社会联系与AI健康风险因素之间的关系。这些知识 它可以适用于其他具有类似文化价值观和健康差异的人工智能社区。成功 证明社会联系与健康相关结果之间的关联将使我们能够 制定未来的干预措施，以改善社会联系，从而改善这一弱势群体的健康。

Project Summary/Abstract The life expectancy for American Indians (AIs) living on the Blackfeet reservation in Northwest Montana is 13 years shorter than the life expectancy of non-Hispanic Whites living in the same county, in part because of disproportionately high incidence of chronic diseases including diabetes, depression, and cardiovascular disease. While social connectedness has been shown to associate with health and disease-risk in other racial groups, in AI populations, the prospective role of social connectedness in health disparities is unknown. This has left a critical gap in knowledge regarding a potential factor which may offset enduring AI health disparities. Our previous cross-sectional work in the Blackfeet community indicates relationships between low social connectedness and health-risk factors including high levels of inflammatory cytokines, high resting blood pressure, high levels of symptoms of depression and anxiety, and poor sleep quality. Each of these outcomes is implicated in the onset and progression of the chronic diseases which disproportionately affect Blackfeet AI adults. Based on these observed relationships, it is possible that social connectedness may act as resilience factor which promotes good health in this at-risk community. To address this critical research gap, Blackfeet AI adults (n=280) will participate in a longitudinal study over 2 years in order to capture meaningful long-term changes in mental and physical health and social connectedness. With three measurements spaced evenly across the 2 years, we will track long-term trajectories of social connectedness, mental health, sleep quality, and biomarkers related to risk for inflammatory and cardiometabolic diseases, and investigate the correspondence between these trajectories (Aim 1). During Year 1, over a 14-day monitoring period, we will use an ecological momentary assessment app to deliver questions to participants’ mobile phones to investigate short-term dynamic relationships between social interactions, social connectedness, sleep quality and indices of mental health (i.e. symptoms of depression and anxiety) (Aim 2). In all of our models, we will consider cultural factors, experiences, and health- risk factors which we have been found to be relevant in our previous work with the community including childhood and historical trauma, recent trauma, perceived discrimination, alcohol use, smoking status, and medication use. The overarching goal of the proposed work is to understand prospective relationships between social connectedness and health in BF AI adults. This will be the first comprehensive, longitudinal study to investigate relationships between social connectedness and health risk factors in AIs. This knowledge could be applicable to other AI communities with similar cultural values and health disparities. Successful demonstration of associations between social connectedness and health-relevant outcomes will enable us to develop future interventions to improve social connectedness and thereby health in this vulnerable population.