Reducing Ethnic Group Disparities in Cardiovascular and Mental Health Disorders

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The proposed research project explores racial and ethnic group disparities in physical and mental health by continuing to develop the Environmental Affordances Framework (EAF). Relative to non-Hispanic whites, black Americans have a higher burden of physical health conditions and mortality, but similar or lower risks for most mental disorders, in highly stressful environments individuals often engage in environmentally available negative health behaviors, e.g. smoking, alcohol use, and over-eating to cope with the stressors of daily life. These negative health behaviors may either block the neurological cascade or mask the psychological experiences of poor mental health, by acting on the hypothalamic-pituitary-adrenalcortical (HPA) axis and related neurobiological systems, thus exerting a protective effect on mental health. However, the same chronic stress exposures and poor health behaviors are silently affecting biological pathways to eventual negative physical health morbidities and mortality. Collectively the aims of the proposed study represent a direct extension of the EAF. First, using propensity score analysis we will explore the contrasting findings across racial groups, in an attempt to unmask what we have entitled the "masquerade of racial group differences". Second, we will examine the differential age of onset of physical and mental disorders among racial groups. Third, we will assess pathways linking social and environmental factors, psychosocial stress, biological markers of stress, and cardiovascular health; we will examine statistical models separately among males and females, and then assess by age cohort. In a sub objective of this Aim we will explore potential gene expression - environment interactions in understanding the differential prevalence of hypertension and other cardiovascular outcomes. Key environmental and social factors include skin tone and experiences with discrimination. Fourth, we will conduct a small clinical pilot study to assess the potential protective effects of mindfulness meditation and other interventions to reduce racial group disparities in cardiovascular health and mental health. Mindfulness meditation may have similar effects on the HPA-axis stress response as do poor health behaviors.