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

项目摘要 与美国整体趋势相比，拉美裔成年人许多慢性病的年龄调整后患病率更高，同时 具有健康优势。暴露在压力之下导致了其中的一些差异，并对 糖尿病、心血管疾病、癌症和精神疾病。该项目将澄清所报告的压力源 墨西哥裔成年人在低收入、医疗服务不足的边境社区经历。这 社区参与性研究将：1)阐明我们对压力和文化保护的认识 通过密集的、以民族志为基础的访谈(N=50)；和，2)检查关系 已报道的应激源与生理应激、全身炎症和慢性应激的客观指标之间的关系 疾病风险。后者将通过对墨西哥裔成年人进行具有代表性的家庭调查来实现 320例。每两年一次的随访将评估生物标记物和自我报告的几个因素：有效 心理社会量表(例如，社会根深蒂固的压力源)；保护性的社会和文化因素；以及， 与文化相关的应对资源(例如，感知到的个人支持和个人对 获得支持)。客观健康指标包括炎症和全身失调的标志(即， HsCRP，IL-6；皮质醇)和生活简单7(即A1c；胆固醇；血压；肥胖症；吸烟；身体 运动；节食)。纵向模型将用于预测生物标记物和慢性病风险，并测试 不同的亚群模式。创新、微创和社区响应的方法将是 用于生物标记物数据收集--特别是从干血斑中收集，立即可用的评估 A1C、BMI和BP，以及头发中的皮质醇。头发和指甲中的皮质醇反映的慢性应激指标比 更广泛研究的措施，并作为压力管理的终点具有特殊的前景 干预措施。角蛋白样本中的皮质醇与行为干预试验的预期长度更接近 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 直接通知针对一系列焦点群体(N=90)的子群体目标。每组最少4组 将进行生物识别的亚群：针对一致高应激(高应激)的人 报告的压力和高生物压力)，均匀低压力的那些，以及那些看起来有弹性的(高 报告应激，但低于预期的生物应激)。一种有希望的压力管理方法的适应性 最近在康涅狄格州对拉丁裔进行了测试的CHW干预将被探索。主要线人采访对象 社区利益相关者和社区咨询委员会，来自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提交临床试验，以减少和缓解 压力源。因此，这项研究产生的数据对于进行预防试验将是非常宝贵的，以减少 我们社区的压力和慢性病，以及为其他人群确定方法和模式。

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.