Neighborhoods, Women and Coronary Heart Disease: A Prospective Study

描述(申请人提供)：尽管研究表明，一个人居住的地方会影响一个人患冠心病(CHD)的风险，但科学家们才刚刚开始探索邻居“深入皮肤”的途径。最近的研究表明，建筑环境会影响个人的健康和健康行为，但还没有研究建筑环境与心血管健康风险或随后的心脏事件之间的关系。此外，影响冠心病发展和临床表现的因素在女性和男性中有很大不同，研究表明，邻里社会和建筑环境对男性和女性的影响也不同。拟议项目的总体目标是研究邻里因素对女性冠心病发展的影响。我们的目标是确定建成环境的哪些方面可以通过城市规划或公共政策进行修改，并与健康益处相关。该项目将在现有研究的基础上，通过调查社会和建筑环境，并检查行为因素、社会关系和心理健康是否在环境特征和女性冠心病发展之间的联系中起到中介作用。我们为期3年的项目的具体目标是：1.在控制了CHD风险的基线社会人口学和生物学指标后，评估社区的建筑和社会特征是否预测CHD的发展。2.评估建筑和社会环境的各个方面是否与已知与女性冠心病相关的个人健康行为、社会支持和心理健康相关。3.确定环境特征与冠心病之间的关系是否受个体健康行为、社会支持和/或心理健康的影响。为了实现这些目标，该项目汇集了两个独特的资源：来自妇女健康倡议(WHI)观察性研究(OS)和临床试验(CT)部门的个人水平的数据，对161,809名年龄在50岁至79岁之间的妇女进行的前瞻性研究，以及由兰德人口健康和健康差距中心(CPHHD)数据核心从人口普查和其他来源得出的关于研究对象居住的社会人口和建筑环境的地理编码、人口普查区域级别的背景数据。

DESCRIPTION (provided by applicant): Although research suggests that where one lives affects one's risk of coronary heart disease (CHD), scientists have only begun to explore the pathways through which neighborhoods "get under the skin." Recent studies demonstrate that the built environment affects individual health and health behaviors, but have not examined the relationship between the built environment and cardiovascular health risk or subsequent cardiac events. Moreover, factors influencing the development and clinical manifestations of CHD differ substantially in women and men, and studies suggest that neighborhood social and built environments also affect men and women differently. The overarching objective of the proposed project is to examine the impact of neighborhood factors on women's development of CHD. We aim to identify aspects of the built environment that can be modified through urban planning or public policy and are associated with health benefits. The project will expand on existing research by investigating both the social and built environment and by examining whether behavioral factors, social relationships, and psychological well-being mediate the links between environmental characteristics and CHD development among women. The specific aims of our 3-year project are: 1. To assess whether built and social characteristics of neighborhoods predict the development of CHD after controlling for baseline sociodemographic and biological measures of CHD risk. 2. To evaluate whether aspects of the built and social environment are associated with individual health behaviors, social support, and psychological well-being that are known to be related to CHD in women. 3. To determine whether pathways between environmental characteristics and CHD are mediated by individual health behaviors, social support, and/or psychological well-being. To address these aims this project brings together two unique resources: individual-level data from the Observational Study (OS) and Clinical Trial (CT) arms of the Women's Health Initiative (WHI), a prospective study of 161,809 women ages 50 to 79 at entry, and geocoded, census-tract level contextual data on the sociodemographic and built environment where study subjects reside derived by the RAND Center for Population Health and Health Disparities (CPHHD) data core from the Census and other sources.