Adolescent Experiences and Adult Cardiovascular Health: Effects of the Social and

描述（由申请人提供）：儿童社会经济地位（SES）与成人心血管疾病有关，但其发生机制尚未得到充分探索。此外，社会经济地位低与心血管疾病相关的多种社会风险因素（即暴力暴露增加）、身体风险因素（即较高的空气污染水平、难以获得娱乐设施以及难以获得新鲜水果和蔬菜）和行为风险因素（即不良饮食、低体力活动、吸烟）相关。然而，在一项前瞻性研究中，尚未评估儿童期和青春期接触这些因素在代谢和心血管风险状况发展中的作用。考虑到相互作用（个人和邻里、社会和身体）的复杂性，生命历程框架可能是探索有助于代谢和心血管风险状况发展的个人暴露和邻里社会属性的有效方法。该提案旨在研究青春期期间个人和邻里经历的社会压力源和物理环境的影响，以及它们对心血管和代谢风险状况（即血压、CRP、血红蛋白A1c、BMI、腰围、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、非高密度脂蛋白胆固醇）发展的相互作用。本提案的研究目标将通过两个项目来实现。首先，利用国家青少年健康纵向研究（Add Health），即对青少年进行成年期跟踪的纵向队列，我将采用生命历程方法来确定青春期经历的社会压力源（即人际暴力、学校和社区暴力）和物理环境（即进入食品店、靠近公园和娱乐场所）是否在成年期代谢和心血管风险状况的发展中发挥作用。还将研究社会和自然环境因素之间的相互作用。其次，我将开展一项针对 100 名青少年的主要收集横断面研究，以检验饮食（Add Health 研究中未提供）的中介作用以及空气污染物（Add Health 研究中未提供的内容）对压力与心血管健康关系的调节作用。在接下来的 5 年里，我将投入不少于 75% 的时间进行高度结构化和高度集中的研究，这将扩展我在将社会和环境决定因素描述为与儿童和年轻人生理结果相关的压力源方面的专业知识。概述了职业发展计划，以获得研究设计和实施的实用技能、预测空气污染物水平的统计模型和结构方程模型的专业知识以及心血管和代谢紊乱机制的知识。职业发展计划包括：1) 调查设计、潜在统计模型、心血管疾病机制方面的正式研究生课程，2) 与项目顾问一起辅导，学习青少年心血管和代谢疾病的临床方面；3) 与顾问一起辅导，讨论空气污染物建模策略；4) 与指导团队互动，讨论研究和职业目标以及项目进展。我将与指导团队密切合作，他们在指导新的临床研究人员、心理社会因素的差异、生活经历和心血管疾病结果、邻里环境和心血管疾病的影响以及物理环境因素的差异方面拥有丰富的经验。拟议的培训包括与导师和顾问的互动、辅导和课程作业，补充了我之前在社会和环境流行病学研究方面的培训和经验，并使我能够发展必要的跨学科专业知识，以实现我的目标，并在本奖项结束时成功过渡为独立调查员。拟议的项目将重点关注美国的一个主要健康问题——心血管疾病，特别是在青少年时期发病，并探索个人和社区因素（在本例中暴露于暴力和环境毒素）如何影响健康结果的新模型。这些研究的结果可以为慢性病预防的临床实践提供信息，以便提供者和政策制定者等可以针对青少年和年轻人制定适合年龄的干预措施，共同解决个人和环境问题，从而更有效地降低心血管疾病风险。 公共卫生相关性：儿童社会经济地位（SES）与成人心血管疾病有关，但其发生机制尚未得到充分探索。此外，社会经济地位低与心血管疾病相关的多种社会（即暴力暴露增加）、环境（即较高的空气污染暴露、难以进入娱乐设施或食品店）和行为（即不良饮食、体力活动不足、吸烟）风险因素的同时存在有关。然而，在一项前瞻性研究中，尚未评估儿童期和青春期接触这些因素在代谢和心血管风险状况发展中的作用。考虑到相互作用（个人和邻里、社会和身体）的复杂性，生命历程框架可能是探索有助于代谢和心血管风险状况发展的个人暴露和邻里社会属性的有效方法。该提案旨在研究青春期期间个人和邻里经历的社会压力源和物理环境的影响，以及它们对心血管和代谢风险状况（即血压、CRP、血红蛋白A1c、BMI、腰围、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、非高密度脂蛋白胆固醇）发展的相互作用。 （摘要完）

DESCRIPTION (provided by applicant): Childhood socioeconomic status (SES) has been associated with adult cardiovascular disease, but the mechanisms of how this occurs have not been fully explored. Furthermore, low SES is associated with the co-occurrence of multiple social (i.e., increased violence exposure), physical (i.e., higher air pollution levels, poor access to recreational facilities and access to fresh fruits and vegetables) and behavioral (i.e., poor diet, low physical activity, tobacco use) risk factors associated with cardiovascular disease. However, exposures to these factors during childhood and adolescence have not been evaluated with respect to their role in the development of metabolic and cardiovascular risk profiles in a prospective study. Given the complexity of interactions (individual and neighborhood, social and physical) a life course framework may be a fruitful approach to exploring the individual exposures and social attributes of neighborhoods that contribute to the development of metabolic and cardiovascular risk profiles. This proposal aims to examine the contribution of social stressors and physical environment experienced at both the individual and neighborhood level during adolescence, and their interactions on the development of cardiovascular and metabolic risk profiles (i.e., blood pressure, CRP, Hemoglobin A1c, BMI, waist circumference, total cholesterol, triglycerides, LDL, HDL, non-HDL cholesterol). The research goals of this proposal will be achieved with two projects. First, using the National Longitudinal Study of Adolescent Health (Add Health), a longitudinal cohort of adolescents followed through adulthood, I will employ a life course approach to determine whether social stressors (i.e., interpersonal violence, school and community violence) and physical environment (i.e., access to food stores, proximity to parks and recreation) experienced in adolescence plays a role in the development of metabolic and cardiovascular risk profiles in adulthood. Interactive effects between social and physical environmental factors will also be examined. Second, I will develop a primary collection cross-sectional study of 100 adolescents to examine the mediating effect of diet (not available in Add Health) and the modifying effects of air pollutants (also not available in the Add Health study) on the stress-cardiovascular health relationship. I will dedicate no less than 75 percent of my time to a highly structured and intensely focused research experience over the next 5 years, which will extend my expertise in characterizing social and environmental determinants as stressors in relation to physiological outcomes in children and young adults. A career development plan is outlined to gain practical skills in research design and implementation, expertise in statistical models to predict air pollutant levels and structural equation models as well as knowledge in the mechanisms of cardiovascular and metabolic disorders. The career development plan includes: 1) formal graduate course work in survey design, latent statistical models, mechanisms of cardiovascular disease, 2) tutorial with project advisor to learn clinical aspects of cardiovascular and metabolic disorders in adolescents 3) tutorial with advisor to discuss air pollutant modeling strategies 4) interactions with mentoring team to discuss research and career goals and project progress. I will work closely with the mentoring team which collectively has extensive experience in mentoring new clinical investigators, disparities in psychosocial factors, life experiences and cardiovascular disease outcomes, effects of neighborhood environment and cardiovascular disease, and disparities in physical environmental factors. The proposed training, consisting of interactions with mentors and advisors, tutorials and coursework, complements my previous training and experience in social and environmental epidemiologic research and will allow me to develop the necessary transdisciplinary expertise to achieve my goal and successfully transition to independent investigator at the end of this award. The proposed project will focus on a major health problem in the U.S. - cardiovascular disease, particularly its onset during the adolescent years and explore new models of how individual and community factors, in this case exposure to violence and environmental toxins, impact health outcomes. Findings from these studies can inform clinical practice in chronic disease prevention so that providers and policymakers alike can tailor age appropriate interventions to adolescents and young adults that jointly address the individual as well as the environmental context to more effectively reduce cardiovascular disease risk. PUBLIC HEALTH RELEVANCE: Childhood socioeconomic status (SES) has been associated with adult cardiovascular disease, but the mechanisms of how this occurs have not been fully explored. Furthermore, low SES is associated with the co-occurrence of multiple social (i.e., increased violence exposure), environmental (i.e., higher air pollution exposure, poor access to recreational facilities or food stores) and behavioral (i.e., poor diet, low physical activity, tobacco use) risk factors associated with cardiovascular disease. However, exposures to these factors during childhood and adolescence have not been evaluated with respect to their role in the development of metabolic and cardiovascular risk profiles in a prospective study. Given the complexity of interactions (individual and neighborhood, social and physical) a life course framework may be a fruitful approach to exploring the individual exposures and social attributes of neighborhoods that contribute to the development of metabolic and cardiovascular risk profiles. This proposal aims to examine the contribution of social stressors and physical environment experienced at both the individual and neighborhood level during adolescence, and their interactions on the development of cardiovascular and metabolic risk profiles (i.e., blood pressure, CRP, Hemoglobin A1c, BMI, waist circumference, total cholesterol, triglycerides, LDL, HDL, non-HDL cholesterol). (End of Abstract)