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》和美国心理学会的最新报告 确定了迫切需要研究儿童暴露于心理社会压力的机制 增加成年后肥胖和心血管疾病(CVD)的风险。考虑到时间的滞后性 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，这些 行动号召促使研究人员调查可修改因素在童年过程中的作用 可能会降低日后患肥胖症和心血管疾病的风险。拟议的混合方法研究的独特设计是为了 回答这些行动号召，检查压力是如何“潜藏在皮肤下”的，让孩子们处于更高的水平 今后患肥胖症和心血管疾病的风险，以及最终按种族/族裔划分的健康差异。主要目标 本研究的主要目的是：(1)综合考察不同水平的心理社会应激源之间的关系 (即个人、二元、家庭、社会)及其层面(即严重性、频率、时间)、生物学 因素(例如，下丘脑-垂体-肾上腺(HPA)轴活动)，以及儿童体重和新出现的心血管疾病风险 和(2)在个人、父母和家庭层面上确定可改变的因素，以 打断这些应激途径。拟议的研究将建立在先前的亲代R01研究的基础上并加以扩展 (HL126171)。母公司R01研究是一项分两个阶段的混合方法研究，包括前瞻性 对1307名不同的父母/孩子(5-16岁)双亲进行的流行病学队列研究(≈为200名非洲裔美国人， 西班牙裔、美国原住民、移民/难民、白人)和嵌入式生态瞬时评估 (EMA)亚样本，包括627个父母/子女二元组(每个种族/民族100个≈)。数据是在两点收集的 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天均线数据将 在48个月和72个月期间继续进行数据收集，总共进行了四次数据收集。孩子们，他们现在是 9-16岁的人将被添加到在线调查和EMA数据收集中，此外，还将参与三项 24小时。饮食召回和7天加速度计。新的生物学指标(例如，头发皮质醇、身体成分、 动脉僵硬)与孩子和父母、邻里因素(例如，孩子的机会和劣势 指数)使用地理空间措施和社会层面的因素(例如结构性种族主义、社会政治转变、 (新冠肺炎)在这两个时间点也会增加心理社会压力源。以人为本 还将开展设计多家庭焦点小组，与家庭共同创建干预目标。这 研究将为理解多层次的心理社会之间的途径提供广度和深度 压力源、儿童体重和新出现的心血管疾病跨越重要的发展里程碑(例如， 青春期)和家庭生命周期阶段(例如，有年幼子女的家庭到有青少年的家庭)。 重要的是，这项研究将确定可修改的因素(例如，家庭适应性/复原力)，以缓解 多层次心理社会应激源对儿童心血管疾病的负面影响，可作为干预的目标。

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.