Impact of multilevel risk and resilience factors on cardiovascular health in racially/ethnically diverse men and women

项目概要/摘要 在美国，心血管疾病（CVD）仍然是死亡的主要原因。非裔美国人（AAs），低- 社会经济地位（SEP）群体，南方人和西班牙裔人受到CVD的影响不成比例。在 此外，与女性相比，男性心血管疾病发病较早，死亡率较高， CVD。这些性别差异、种族/民族和SEP差异是实现国民健康的挫折 公平和CVD减少目标。为了减少心血管疾病的差异和差距，关键是要提高 心血管（CV）健康。2015年AHA的一份声明指出， 心血管健康和减少心血管疾病在于解决健康的社会决定因素。这些决定因素包括 心理社会风险（例如，种族主义，歧视和低SEP）在多个层面上运作。新兴研究 表明个人、人际和邻里层面的弹性资源可以保护CV 通过间接影响，如更积极的健康行为，面对多层次的心理社会风险， 以及心理社会风险对生理功能的缓冲作用。复原力资源的定义是 积极适应和展示积极的行为/结果，尽管逆境。与多层次相比 心理社会风险，多层次的弹性资源代表了新的和潜在的更具可塑性的干预措施 目标的尽管越来越多的证据支持弹性资源对CV结果的保护作用， 关键的研究差距依然存在。例如，大多数复原力研究都没有进行， 差异人群，无心血管疾病的人群，包括多层次的心理社会风险，或进行差异检验 性别和种族/民族之间的差异。因此，本提案的目的是研究多层次的复原力是否 资源与心血管结局相关，如果多层次的心理社会风险缓和这些关系。 具体而言，在三个CV健康队列中招募的不同种族/民族男性和女性的纵向数据 (i.e., JHS，MESA，MASALA）将被统一，以创建一个综合数据集。利用综合数据，我们 旨在：（a）确定多层次风险和多层次复原力的最可靠和有效的衡量标准是否 资源显示跨性别和不同种族/民族群体的测量不变性;（B）确定 随着时间的推移，多层次弹性资源与理想的CV健康相关，如果多层次心理社会 风险缓和观察到的关系;（c）确定是否前瞻性地使用多层次弹性资源 与随时间推移发生的CVD事件相关，如果观察到多水平心理社会风险中度 （d）量化旨在建立多层次关系的假设干预措施的程度 弹性资源减少了理想CV健康和CVD事件的种族/民族和性别差异， 多层次的心理社会风险水平。该项目响应NIH范围内，NHLBI，OBSSR和AHA 呼吁填补心理社会风险，复原力和CV结果研究的关键空白。

Project Summary/Abstract In the US, cardiovascular disease (CVD) remains the leading cause of death. African Americans (AAs), low- socioeconomic position (SEP) groups, southerners, and Hispanics are impacted disproportionately by CVD. In addition, compared to women, men have earlier onset of CVD and have had higher death rates attributable to CVD. These sex differences and racial/ethnic and SEP disparities are setbacks to achieving national health equity and CVD reduction goals. To reduce differences and disparities in CVD, it is critical to improve cardiovascular (CV) health. A 2015 AHA statement indicated that “the most significant opportunity” to improve CV health and reduce CVD lies in addressing the social determinants of health. Such determinants include psychosocial risks (e.g., racism, discrimination, and low SEP) operating at multiple levels. Emerging research indicates that resilience resources at the individual, interpersonal, and neighborhood levels may protect CV health in the face of multilevel psychosocial risks via indirect effects such as more positive health behaviors and buffering effects of psychosocial risks on physiological functioning. Resilience resources are defined as positive adaptation and display of positive behaviors/outcomes despite adversity. Compared to multilevel psychosocial risks, multilevel resilience resources represent novel and potentially more malleable intervention targets. Despite growing evidence supporting the protective effects of resilience resources on CV outcomes, critical research gaps remain. For example, the majority of resilience research has not been conducted with disparity populations, populations free of CVD, included multilevel psychosocial risks, or tested for differences between sex and racial/ethnic groups. Thus, the objective of this proposal is to examine if multilevel resilience resources are associated with CV outcomes and if multilevel psychosocial risks moderate these relationships. Specifically, longitudinal data on racially/ethnically diverse men and women enrolled in three CV health cohorts (i.e., JHS, MESA, MASALA) will be harmonized to create an integrated dataset. Using the integrated data we aim to: (a) determine whether the most reliable and valid measures of multilevel risk and multilevel resilience resources demonstrate measurement invariance across sex and diverse racial/ethnic groups; (b) determine if multilevel resilience resources are associated with ideal CV health over time and if multilevel psychosocial risks moderate observed relationships; (c) determine if multilevel resilience resources are prospectively associated with incident CVD events over time and if multilevel psychosocial risks moderate observed relationships; and (d) quantify the degree to which hypothetical interventions designed to build multilevel resilience resources reduce racial/ethnic and sex differences in ideal CV health and CVD events overall and by the level of multilevel psychosocial risks. This project responds to the NIH-wide, NHLBI, OBSSR, and AHA calls to fill critical gaps in psychosocial risk, resilience, and CV outcomes research.