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，但其发生的机制尚未得到充分探讨。此外，社会经济地位低还与与心血管疾病相关的多种社会（即暴力接触增加）、身体（即空气污染程度较高、难以获得娱乐设施和新鲜水果和蔬菜）和行为（即饮食不良、体力活动少、吸烟）风险因素同时发生有关。然而，在一项前瞻性研究中，尚未评估儿童和青少年时期暴露于这些因素在代谢和心血管风险概况发展中的作用。考虑到相互作用的复杂性（个体和社区，社会和身体），生命历程框架可能是探索有助于代谢和心血管风险概况发展的个体暴露和社区社会属性的有效方法。本研究旨在研究青少年时期个体和社区所经历的社会压力源和物理环境的贡献，以及它们在心血管和代谢风险概况（即血压、CRP、血红蛋白A1c、BMI、腰围、总胆固醇、甘油三酯、LDL、HDL、非HDL胆固醇）发展中的相互作用。本提案的研究目标将通过两个项目来实现。首先，使用国家青少年健康纵向研究（Add Health），这是一个跟踪青少年到成年的纵向队列，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（即获取食物商店，靠近公园和娱乐场所）是否在成年期代谢和心血管风险概况的发展中发挥作用。社会因素和自然环境因素之间的相互影响也将被审查。其次，我将对100名青少年进行初步收集横断面研究，以检验饮食的中介作用（没有在Add Health中提供）和空气污染物的调节作用（也没有在Add Health研究中提供）对压力-心血管健康关系的影响。在接下来的5年里，我将把不少于75%的时间用于高度结构化和高度集中的研究经验，这将扩展我在描述社会和环境决定因素作为与儿童和年轻人生理结果相关的压力因素方面的专业知识。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)正式的研究生课程，调查设计，潜在统计模型，心血管疾病的机制，2)与项目指导老师一起学习青少年心血管和代谢疾病的临床方面，3)与指导老师一起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，该团队在指导新临床研究者、心理社会因素差异、生活经历和心血管疾病结局、社区环境和心血管疾病的影响以及物理环境因素差异方面具有丰富的经验。拟议的培训，包括与导师和顾问的互动，教程和课程，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，并将使我能够发展必要的跨学科专业知识，以实现我的目标，并在该奖项结束时成功过渡到独立研究者。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的心血管疾病，并探索个人和社区因素（在本例中是暴露于暴力和环境毒素）如何影响健康结果的新模式。这些研究的结果可以为慢性疾病预防的临床实践提供信息，以便提供者和决策者都可以为青少年和年轻人量身定制适合年龄的干预措施，共同解决个人和环境问题，以更有效地降低心血管疾病的风险。

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)