Chronic Stress as a Pathway to Health Disparities

 描述（由申请人提供）：社会经济地位（SES）在健康方面产生了巨大的差异。这些差异是一个问题，因为它们描述了低社会经济地位个体患慢性病和早逝的风险增加，以及由于医疗保健和生产力损失而给美国经济带来的巨大成本。长期目标是更好地了解SES较低导致健康状况恶化的途径。R 03的总体目标是测试慢性压力作为SES相关健康差异的解释。与以前的日常压力研究相比，R 03使用的数据来自经济和种族多样化的成年人样本，并具有关于压力源时间的细粒度数据。从几个健康差异理论得出的中心假设是，较低的SES个体经历持续的暴露和对压力源的长期反应，这种频繁和长期的情绪反应激活导致身体磨损和最终疾病。这项研究的基本原理是，通过了解SES相关压力降低身体健康的途径，可以制定干预措施，以减少日常身体症状，并长期延迟或预防疾病。在初步工作的指导下，将在短期和长期尺度上检验这一慢性压力假设。从这一假设延伸出的具体目标包括：1）测试预测，在短期内，低SES将与更频繁的日常压力源和对压力源的情绪反应有关，这些压力源的幅度和持续时间更大，2）测试预测，在日常基础上，对日常压力源的情绪反应更大，持续时间更长，预示着经历更频繁，更严重的身体3）测试预测，在一生中，儿童时期的低SES预示着成年后的身体健康状况更差，因为更多地暴露于压力源，减少了应对压力的心理社会资源。在第一个目标下，情绪反应的大小将与情绪恢复的持续时间区分开来-申请人在她的初步工作中已经证明这是可行的。在第二个目标下，一天中对压力源的情绪反应的幅度和持续时间斜率将用于预测一天结束时的身体症状。在第三个目标，童年和一生的压力将被测试作为儿童SES的客观指数对成人健康的影响的介质。在申请人看来，该方法是创新的，因为它测试了基于理论的健康差异预测，利用了不同的样本，并在多个时间尺度上接近预测。这项研究意义重大，因为它有望促进和扩大对SES劣势如何导致健康差距的理解。这些知识有可能直接干预最能预测日常和长期健康的慢性压力途径。

 DESCRIPTION (provided by applicant): Socio-economic status (SES) produces wide disparities in health. These disparities are a problem because they describe increased risk for chronic diseases and early death for lower SES individuals and large costs to the U.S. economy due to health care and lost productivity. The long-term goal is to better understand the pathways by which lower SES results in worse health. The overall objective in this R03 is to test chronic stress as an explanation of SES-related health disparities. In contrast to previous daily stress studies, this R03 uses data from an economically and racially diverse sample of adults and has fine-grained data regarding the timing of stressors. The central hypothesis, drawn from several health disparity theories, is that lower SES individuals experience persistent exposure and prolonged response to stressors and that this frequent and extended activation of emotional responses results in physical wear-and-tear and eventual disease. The rationale for the proposed research is that by understanding the pathways by which SES-related stress reduces physical health, interventions can be developed to reduce physical symptoms on a daily basis and delay or prevent disease over the long-term. Guided by preliminary work, this chronic stress hypothesis will be tested on short- and long-time scales. Specific aims extended from this hypothesis include: 1) Test the prediction that, over the short-term, low SES will be associated with more frequent daily stressors and emotional responses to stressors which are larger in magnitude and duration, 2) Test the prediction that, on a daily basis, having emotional responses to daily stressors which are larger magnitude and longer duration predicts experiencing more frequent and severe physical symptoms on a daily basis, and 3) Test the prediction that, over a lifetime, low SES in childhood predicts worse physical health in adulthood because of more exposure to stressors and reduced psychosocial resources with which to respond to them. Under the first aim, magnitude of emotional reactivity will be distinguished from duration of emotional recovery - which the applicant has demonstrated is feasible in her preliminary work. Under the second aim, these magnitude and duration slopes of emotional responses to stressors across the day will be used to predict end of day physical symptoms. In the third aim, childhood and lifetime stress will be tested as mediators of the effects of objectiv indices of childhood SES on adult health. The approach is innovative, in the applicant's opinion, because it tests theory-based predictions for health disparities, leverages a diverse sample, and approaches the predictions at multiple time scales. The proposed research is significant because it is expected to advance and expand understanding of how SES disadvantage results in wide disparities in health. Such knowledge has the potential to direct interventions to the chronic stress pathways most predictive of daily and long-term health.