PR-OUTLOOK: PR Young Adults' Stress, Contextual, Behavioral & Cardiometabolic Risk

摘要 在回答PAR-17-470时，PR-OUTLOOK：“波多黎各(PR)年轻人的压力，背景， 行为和心脏代谢风险“将调查心理社会和社会人口统计学决定因素 青年(18-29岁)心血管疾病(CVD)危险因素和总体心血管健康(CVH) Y)在公关方面，这是一个明显脆弱但未得到充分研究的群体。以前对波多黎各和加拿大心血管疾病风险的研究 在其他地方，主要集中在中老年人，几乎没有关于心血管疾病风险和总体的数据 目前青壮年人群中的CVH--这一代人是在肥胖流行期间成长起来的。事件 心血管疾病和中风并没有随着时间的推移而下降，甚至在年轻人中有所增加，而不是在 上了年纪的人。我们的初步调查结果和行为危险因素监测系统数据表明，波多黎各 18-34岁的里约人有很高的心血管疾病危险因素负担。还没有研究检查整体的CVH(a 评估美国心脏协会2020年将CVH改善20%目标的进展情况的指标 将心血管疾病死亡率降低20%)。证据将心理社会和邻里关系联系起来 应激源与心血管疾病危险因素之间的关系，但这些关系尚未在公关中的年轻人中进行评估。在……里面 青壮年，压力增加(即经济、从学校到工作、社会/家庭的转变)，行为风险达到峰值， 医疗保健被低估，预防措施被推迟。公关背景因素(例如，岛屿的金融危机， 飓风María的后果、社区社会经济、城市和农村住宅)也可能导致心血管疾病 风险，但还没有在公关的年轻人中进行研究。波多黎各人的复原力因素，包括家庭/社会 支持、灵性和宗教信仰可能会减少风险，因为这些因素对一般人都有已知的好处。 但它们对波多黎各年轻人的保护作用尚不清楚。我们的研究将填补 在PR的年轻人中，心血管行为和心脏代谢危险因素和总体CVH的患病率，以及 确定他们的心理社会(个人和社区层面)和社会人口决定因素。我们会 使用概率加的多阶段抽样，建立全岛3,000名年轻人(18-29岁)的队列 社区方法；进行全面评估(调查、人体测量、生理)，以及 建立生物库(血液、头发、唾液、尿液、粪便)，用于未来对心血管疾病风险、CVH和 机械装置。PR-Outlook将扩大NHLBI资助的前景研究的范围，并已发挥杠杆作用 开发了研究基础设施、全岛协作和相关研究方案，以最大限度地 协同/优化研究之间的资源。我们的研究将填补有关心血管疾病风险的重要知识空白 并确定医疗、公共卫生和政策干预的优先目标 预防心血管疾病。我们也有能力与年长的波多黎各岛民进行比较研究。 (前景)、波多黎各大陆人(HCHS/SOL)和美国黑人和白人青年(CARDIA)，同样多 评估工具在研究之间共享，进一步遵守PAR的指导方针。

ABSTRACT In response to PAR-17-470, PR-OUTLOOK: “Puerto Rico (PR) Young Adults’ Stress, Contextual, Behavioral & Cardiometabolic Risk” will investigate psychosocial and sociodemographic determinants of cardiovascular disease (CVD) risk factors and overall cardiovascular health (CVH) among young adults (18-29 y) in PR, a markedly vulnerable but understudied population. Previous studies of CVD risk in Puerto Rico and elsewhere have largely focused on middle-age and elder adults, and there is little data on CVD risks and overall CVH among the current young adult population -a generation that grew during the obesity epidemic. Incident CVD and stroke have not declined over time or have even increased in younger individuals as opposed to in older adults. Our preliminary findings and Behavioral Risk Factor Surveillance System data suggest that Puerto Ricans aged 18-34 years have a high burden of CVD risk factors. No studies have examined overall CVH (a metric to assess progress toward the American Heart Association 2020 goals of improving CVH by 20% and reducing CVD mortality by 20%) in Puerto Ricans of any age. Evidence links psychosocial and neighborhood stressors with CVD risk factors but these associations have not been assessed among young adults in PR. In young adulthood, stress increases (i.e. financial, school-to-work, social/family transitions), behavioral risks peak, and health care is undervalued/prevention postponed. PR contextual factors (i.e., island’s financial crisis, hurricane María aftermath, neighborhood socioeconomics, urban vs. rural residence) also may contribute to CVD risk but have not been studied in young adults in PR. Puerto Ricans’ resilient factors, including family/social support, spirituality, and religiosity may attenuate risk as these factors are of known benefit to the general population, but their protective impact in young Puerto Ricans is unknown. Our study will fill knowledge gaps of prevalence of CVD behavioral and cardiometabolic risk factors and overall CVH among young adults in PR, and ascertain their psychosocial (individual and neighborhood-level) and sociodemographic determinants. We will establish an island-wide cohort of 3,000 young adults (18-29 y) using a multi-stage sampling of probabilistic plus community approaches; conduct comprehensive assessments (survey, anthropometric, physiological), and establish a biorepository (blood, hair, saliva, urine, stool) for future longitudinal studies of CVD risk, CVH, and mechanisms. PR-OUTLOOK will extend the reach of the NHLBI-funded PROSPECT study and leverage already developed research infrastructure, island wide collaborations, and relevant study protocols to maximize synergy/optimize resources between studies. Our study will fill important knowledge gaps regarding CVD risk among young adults in PR and identify priority targets for medical, public health and policy interventions for early CVD prevention. We also are well positioned to conduct comparative studies with older island Puerto Ricans (PROSPECT), mainland Puerto Ricans (HCHS/SOL), and US Black and White young adults (CARDIA), as many assessment tools are shared between studies, further adhering to guidelines of the PAR.