Reducing Ethnic Group Disparities in Cardiovascular and Mental Health Disorders

拟议的研究项目通过继续制定环境非洲之舞框架(EAF)，探讨种族和族裔群体在身心健康方面的差异。与非西班牙裔白人相比，美国黑人在身体健康状况和死亡率方面的负担更高，但大多数精神障碍的风险类似或更低，在高压力环境中，个人经常从事环境有益的负面健康行为，例如吸烟、酗酒和暴饮暴食以应对日常生活的压力源。这些消极的健康行为可能通过作用于下丘脑-垂体-肾上腺皮质(HPA)轴和相关的神经生物学系统，阻断神经级联反应或掩盖心理健康不良的心理体验，从而对心理健康起到保护作用。然而，同样的慢性压力暴露和不良的健康行为正在悄悄地影响最终导致负面身体健康发病率和死亡率的生物途径。总体而言，拟议研究的目标代表了EAF的直接延伸。首先，使用倾向得分分析，我们将探索不同种族群体之间的对比结果，试图揭开我们所称的“种族群体差异的伪装”。第二，我们将研究不同种族之间身体和精神障碍的不同发病年龄。第三，我们将评估社会和环境因素、心理社会压力、压力生物标记物和心血管健康之间的联系；我们将分别检查男性和女性的统计模型，然后按年龄队列进行评估。在这个目标的一个子目标中，我们将探索潜在的基因表达与环境的相互作用，以了解高血压和其他心血管结果的不同患病率。关键的环境和社会因素包括肤色和遭受歧视的经历。第四，我们将进行一项小型临床先导性研究，以评估正念冥想和其他干预措施的潜在保护效果，以减少心血管健康和精神健康方面的种族差异。正念冥想对HPA轴应激反应的影响可能与不良健康行为类似。

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.