Expectations of Discrimination and CVD Risk in Africian-American Women

 描述(申请人提供)：心血管疾病(CVD)是美国女性的头号杀手，与白人女性相比，非裔美国女性与心血管疾病相关的死亡和残疾比率惊人地高。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。与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种潜在途径；但大多数研究都集中在种族主义的人际体验上，这实际上可能低估了与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、与种族主义相关的压力源--“对种族主义的期望”--是否是非裔美国女性早期心血管疾病的风险因素。我们有令人信服的横断面初步数据表明，在非裔美国妇女中，对种族主义的“期望”与可测量的心血管疾病指数有关；与种族主义和其他形式的心理社会压力的实际经历无关。这一应用程序建立在先前工作的基础上，使用公共卫生和心理学的创新方法来确定这种独特的心理社会应激因素随着时间的推移是否会导致非裔美国女性的心血管疾病风险，以及这种独特的心理社会应激源是如何造成的。我们将对400名年龄在30-45岁的健康非裔美国妇女进行为期两年的跟踪调查，以检验对种族主义的预期和早期心血管疾病风险的增加。早期心血管风险将通过颈动脉内膜中层增厚(CIMT)和48小时动态血压(ABP)的变化来评估，CIMT是衡量动脉粥样硬化的指标，48小时动态血压(ABP)是衡量自主神经生理觉醒的指标，也是将种族主义预期与IMT联系起来的潜在机制。此外，由于研究表明，对种族主义的预期在很大程度上受到环境的影响，我们将研究在种族间接触水平较高(与较低)的女性中，关联是否更加明显(通过新的“活动空间”测量来评估，该测量可以确定在融合环境与隔离环境中花费的平均时间百分比)。最后，为了确定高水平的预期种族主义对日常生理反应和心理困扰的影响，我们将对一组女性进行每日日记研究，以检查日常ABP对人际压力源的反应，以及日常影响。次级目标将考察作为潜在调节因素的额外心理社会应激源和文化资源，以及作为潜在调节因素的沉思、负面影响和社会脱节。这项研究的结果最终将被用来开发心理社会干预措施，帮助有心血管疾病风险的非裔美国妇女应对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.