Examining How Psychosocial Stress Gets "Under the Skin" and Leads to Cardiovascular Disease Risk in Diverse Children: A Mixed-Methods Study

摘要 美国公共卫生杂志和美国心理协会最近的报告显示， 确定了一个关键的需要，审查机制，暴露于心理社会压力，在童年 增加成年期肥胖和心血管疾病（CVD）的风险。鉴于时间上的滞后 在童年经历的心理社会压力的影响在成年后表现为疾病之前， 行动呼吁敦促研究人员调查在儿童时期可改变因素的作用， 可能会降低以后肥胖和心血管疾病的风险。拟议的混合方法研究的独特设计， 回答这些呼吁采取行动，通过检查压力是如何“进入皮肤下”，使儿童在更高的 肥胖和心血管疾病的风险，以及种族/民族的最终健康差异。主要目标 本研究的主要目的是：（1）全面考察多层次心理社会压力源之间的关系 (i.e.,个人、二元、家庭、社会）及其维度（即，严重程度、频率、时间）、生物学 因素（例如，下丘脑垂体肾上腺（HPA）轴活动），儿童体重和新出现的CVD风险超过 （2）在个人、父母和家庭层面上确定可改变的因素， 中断这些压力路径。拟定研究将基于并扩展先前的母研究R 01 （HL126171）。母研究R 01是一项两阶段、混合方法研究，包括一项前瞻性研究 对1307名不同的父母/子女（5-16岁）二人组（每个非裔美国人200人， 西班牙裔、美洲原住民、移民/难民、白色）和嵌入式生态瞬时评估 (EMA)子样本为627个父母/子女二人组（每个种族/族裔组100人）。数据收集于2 时间点（基线，24个月随访）。在拟议的研究中，在线调查数据和7天EMA数据将 在48个月和72个月时继续进行，以便总共进行四波数据收集。孩子们，他们现在 年龄在9-16岁之间的人将被添加到在线调查和EMA数据收集中，除了参加三个 24小时饮食回忆和7天加速度计。新的生物措施（例如，头发皮质醇身体成分 动脉硬度）与儿童和父母，邻近因素（例如，儿童的机会和不利条件 索引），以及社会层面的因素（例如，结构性种族主义社会政治变迁 在这两个时间点也将增加导致心理社会压力的新冠肺炎（COVID-19）。人为中心 还将设计多家庭焦点小组，与家庭共同制定干预目标。这 研究将提供广度和深度，了解多层次的心理社会之间的途径， 压力源和儿童体重以及重要发育里程碑中出现的CVD（例如， 青春期）和家庭生命周期阶段（例如，有幼儿的家庭到有青少年的家庭）。 重要的是，这项研究将确定可改变的因素（例如，家庭适应性/复原力）， 多层次的心理社会压力对儿童心血管疾病的负面影响，可以有针对性的干预措施。

ABSTRACT Recent reports from the American Journal of Public Health and the American Psychological Association identified a critical need to examine mechanisms by which exposure to psychosocial stress in childhood increases the risk for obesity and cardiovascular disease (CVD) in adulthood. Given there is a lag in time before the impact of psychosocial stress experienced in childhood is expressed as disease in adulthood, these calls-to-action urge researchers to investigate the role of modifiable factors over the course of childhood that may mitigate risk for later obesity and CVD. The proposed mixed-methods study is uniquely designed to answer these calls-to-action by examining how stress “gets under the skin” to put children at higher risk for later obesity and CVD, and ultimately health disparities by race/ethnicity. The main objectives of this study are to: (1) comprehensively examine the relationships between multi-level psychosocial stressors (i.e., individual, dyadic, household, societal) and their dimensions (i.e., severity, frequency, timing), biological factors (e.g., hypothalamic pituitary adrenal (HPA) axis activity), and child weight and emerging CVD risk over the course of childhood and (2) identify modifiable factors at the individual, parental, and familial level to interrupt these stress pathways. The proposed study will build on and expand a prior parent R01 study (HL126171). The parent R01 study is a two-phased, mixed-methods study including a prospective epidemiological cohort study with 1307 diverse parent/child (ages 5-16) dyads (≈200 each African American, Hispanic, Native American, Immigrant/Refugee, White) and an embedded ecological momentary assessment (EMA) sub-sample with 627 parent/child dyads (≈100 per each racial/ethnic group). Data was collected at two time points (baseline, 24-month follow-up). In the proposed study, online survey data and 7-day EMA data will be continued at 48 and 72 months, allowing for a total of four waves of data collection. Children, who are now ages 9-16 will be added to both the online survey and EMA data collection, in addition to participating in three 24 hr. dietary recalls and 7-day accelerometry. New biological measures (e.g., hair cortisol, body composition, arterial stiffness) with children and parents, neighborhood factors (e.g., child opportunity and disadvantage index) using geo-spatial measures, and societal-level factors (e.g., structural racism, sociopolitical shift, COVID-19) contributing to psychosocial stressors will also be added at both time points. Human-Centered Design multi-family focus groups will also be carried out to co-create intervention targets with families. This study will provide breadth and depth in understanding the pathways between multi-level psychosocial stressors and child weight and emerging CVD across important developmental milestones (e.g., puberty) and family life cycle stages (e.g., families with young children to families with adolescents). Importantly, this study will identify modifiable factors (e.g., family adaptability/resilience) that mitigate the negative impact of multi-level psychosocial stressors on child CVD that can be targeted in interventions.