Community Violence as a Social Risk Factor for Cardiometabolic Diseases: Neighborhood Dynamics From Structures to Self

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PROJECT ABSTRACT This research proposal contains a five year career development plan that will establish me as a social epidemiologist who focuses on social risk factors for cardiometabolic diseases. I am an Instructor of Medicine in the Biological Sciences Division at the University of Chicago. Building on my prior work and training on the social determinants of health, I will focus on a particularly detrimental social risk factor facing many high- poverty, urban communities of color: community violence. The proposed training plan will combine didactic and practical experiences to equip me with training in spatial data science, longitudinal methods, and intervention- based research, all advanced methodological skills in epidemiology and population health. It will also provide me with needed training and infrastructure to develop expertise in cardiometabolic disease outcomes, which have been frequently linked to community violence in epidemiological studies. My mentorship team and advisory panel have demonstrated excellence in these areas of research and are committed to my career development. This training opportunity will galvanize my transition to independence as a clinician-investigator who develops evidence-based strategies to improve the cardiometabolic health of vulnerable populations. Community violence is an important social risk factor for cardiometabolic diseases. Community violence can increase risk for cardiometabolic diseases through pathophysiologic processes, such as stress or neuroendocrine responses, or by influencing health behaviors (e.g., reduced physical activity). However, the role of neighborhood-level processes (e.g., loss of built environment resources, social distrust and isolation), and how these processes can be targeted, remains poorly understood. I have shown that frequent and persistent exposure to violence may be a stronger predictor of cardiometabolic diseases than isolated, life- threatening events. My central hypothesis is that community violence, when frequent and concentrated, can trigger stress-response pathways on both individual and neighborhood levels to augment risk for poor cardiometabolic outcomes. I will examine specific response pathways in the neighborhood environment that mitigate risk or build resilience to community violence in vulnerable populations. The proposed specific aims are to: 1) Examine the spatiotemporal relationship between community violence and built environment characteristics in U.S. cities; 2) Determine the built and social environment characteristics that influence the relationship between community violence and cardiometabolic diseases across the life course; and 3) Develop and pilot a patient- and stakeholder-informed healthcare intervention to address the cardiometabolic health effects of violence. The overall objective of this research proposal is to examine community violence as a social risk factor for cardiometabolic diseases, and specifically elucidate the neighborhood dynamics that influence this relationship—from structures to social settings to self. Accomplishing these aims will pave the way for implementing and evaluating an integrated, population-based health intervention in a future R01.