Expectations of Discrimination and CVD Risk in Africian-American Women

 描述（由申请人提供）：心血管疾病（CVD）是美国女性的头号杀手，与白色女性相比，非洲裔美国女性的CVD相关死亡和残疾率极高。这些明显的种族差异已经持续了几十年，在年轻到中年女性中有所增加，并且不能用传统的临床风险因素或社会经济地位（SES）来解释。种族主义相关的压力源被认为是“种族”影响心血管健康的一个潜在途径;但大多数研究都集中在种族主义的人际经历上，这实际上可能低估了种族主义相关的心理社会压力对心血管疾病的影响。这项拟议的研究旨在确定一种新的种族主义相关的压力源-“种族主义的期望”-是否是非洲裔美国妇女早期CVD的风险因素。我们有令人信服的横截面初步数据表明，在非洲裔美国妇女中，种族主义的“期望”与CVD的可测量指数相关;独立于种族主义的实际经历和其他形式的心理压力。该应用程序建立在此之前的工作，通过使用公共卫生和心理学的创新方法来确定是否，在什么情况下，以及这种独特的心理社会压力如何随着时间的推移导致非裔美国妇女的心血管疾病风险。我们将研究种族主义的期望和早期CVD风险的增加超过2年的随访在社区样本的400名健康的非洲裔美国妇女30-45。早期CVD风险将通过颈动脉内膜中层增厚（CIMT）（动脉粥样硬化的指标）和48小时动态血压（ABP）（自主生理唤醒的指标和将种族主义预期与IMT联系起来的潜在机制）的变化进行评估。此外，由于研究表明，种族主义的预期在很大程度上受到环境的影响，我们将研究是否协会更明显的妇女高（与低）水平的接触种族间的接触（通过新的措施评估“活动空间”，可以确定在综合与隔离环境中花费的时间的平均百分比）。最后，为了确定如何高水平的预期种族主义有助于生理反应和心理困扰的日常基础上，我们将进行每日日记研究的子样本的妇女，检查日常ABP反应的人际压力，以及日常的影响。次要目标将研究额外的心理社会压力和文化资源作为潜在的调节剂，和反刍，负面影响和社会脱节作为潜在的调解人。这项研究的结果最终将用于制定心理社会干预措施，以帮助有CVD风险的非洲裔美国妇女科普预期的种族主义威胁。

 DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) is the number one killer of women in the United States and African-American women have strikingly high rates of CVD-related death and disability compared to White women. These stark racial disparities have persisted for decades, have increased among young to middle-aged women, and are not explained by traditional clinical risk factors or socioeconomic status (SES). Racism-related stressors have been proposed as one potential pathway through which "race" impacts cardiovascular health; but most studies have focused on interpersonal experiences of racism, which may actually underestimate the impact of racism- related psychosocial stress on CVD. The proposed research is designed to determine whether a novel, racism-related stressor -"expectations of racism" --is a risk factor for early CVD in African-American women. We have compelling cross-sectional preliminary data demonstrating that among African-American women, "expectations" of racism are associated with measurable indices of CVD; independent of actual experiences of racism, and other forms of psychosocial stress. This application builds upon this prior work by using innovative methodologies from public health and psychology to determine whether, in what contexts, and how this unique psychosocial stressor contributes to CVD risk in African-American women over time. We will examine expectations of racism and increases in early CVD risk over a 2-year follow up in a community sample of 400 healthy African-American women aged 30-45. Early CVD risk will be assessed via changes in carotid intima media thickening (CIMT), a measure of atherosclerosis, and 48-hour ambulatory blood pressure (ABP), a measure of autonomic physiologic arousal and a potential mechanism linking expectations of racism to IMT. Additionally, because research suggests that expectations of racism are largely influenced by context, we will examine whether associations are more pronounced among women with high (vs. low) levels of exposure to interracial contact (assessed via novel measures of "activity spaces" that can determine the average percentage of time spent in integrated vs. segregated environments). Finally, in order to determine how high levels of expected racism contribute to physiological responses and psychological distress on a day-to-day basis, we will conduct a daily diary study in a subsample of women, to examine daily ABP reactivity to interpersonal stressors, as well as day-to-day affect. Secondary aims will examine additional psychosocial stressors and cultural resources as potential moderators, and rumination, negative affect and social disconnectedness as potential mediators. Findings from this study will ultimately be used to develop psychosocial interventions to help African-American women at risk for CVD cope with the threat of expected racism.