Mid-Life Health Inequalities in the Rural South: Risk and Resilience

南方农村的中年健康不平等：风险和复原力

• 批准号: 10583808
• 负责人: Kathleen A Cagney
• 金额: $ 65.79万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10583808
• 关键词: Adult; Affect; African American; African American population; Age; Aging; Alcohol abuse; American Indians; Appalachian Region; Area; Attention; Attitude; Behavioral; Black Populations; Black race; Blood; Blood Pressure; Cardiometabolic Disease; Cause of Death; Censuses; Characteristics; Cherokee Indian; Cognition; Collaborations; Collection; Communities; Consent; County; Coupled; Data; Data Collection; Data Set; Data Sources; Databases; Diabetes Mellitus; Disease; Disparity; Ecological momentary assessment; Economics; Education; Educational workshop; Emotional; Employment; Equation; Ethnic Origin; Ethnic Population; FAIR principles; Frequencies; Funding; Gender; Geography; Goals; Health; Health Status; Healthcare; Height; Home; Hypertension; Income; Individual; Knowledge; Life; Life Expectancy; Measurement; Measures; Memory; Mental Depression; Methods; Modeling; Monitor; Moods; Movement; National Archive; National Longitudinal Survey of Adolescent to Adult Health; Native Americans; Neurocognitive; North Carolina; Not Hispanic or Latino; Obesity; Outcome; Overdose; Participant; Persons; Pharmaceutical Preparations; Politics; Populations at Risk; Premature Mortality; Prevention; Process; Protocols documentation; Public Policy; Race; Religion; Research; Resources; Risk; Risk Behaviors; Risk Factors; Role; Rural; Rural Appalachia; Rural Health; Sampling; Science Policy; Scoring Method; Smoking; Social Environment; Social Functioning; Social isolation; Social support; Spirituality; Spottings; Statistical Methods; Statistical Models; Suicide; Surveys; Testing; Time; Unemployment; United States National Institutes of Health; Urban Population; Walking; Weight; Work; addiction; adverse childhood events; base; body system; computerized; data harmonization; ethnic difference; executive function; health assessment; health determinants; health disparity populations; health inequalities; improved; middle age; mortality; multilevel analysis; optimism; premature; pulmonary function; racial difference; racial population; recruit; regional difference; resilience; resilience factor; rural America; rural area; rural counties; social; social situation; socioeconomics; trend

Abstract This application builds on the Great Smoky Mountains Study (GSMS) and leverages its recently funded extension, Great Smoky Mountains Study of Rural Aging (GSMS-RA) to improve our understanding of the determinants of health inequalities in rural America. This new study, the Mid-Life Health Inequalities in the Rural South: Risk and Resilience, augments data being collected (and already funded) for two GSMS-RA samples in western North Carolina, one of Native Americans and the other of non-Hispanic Whites, that are in their early 40s and currently reside in rural regions of Appalachia, with two new samples from the northeastern part of the State, one of African Americans and the other of non-African Americans, ages of 30 and 55, that will be recruited from rural Census tracts of the “Black Belt” region of the state. The Black Belt samples will be recruited, consented and surveyed using the same 120-minute in-home assessment utilized in the GSMS-RA to collect demographic and socioeconomic and attitudinal information, neurocognitive tasks (IQ, memory, attention, and executive function), and biomeasure collection (i.e., height, weight, waist, blood pressure, pulmonary function, bloodspots) (Aim 1). The Black Belt sample will also participate in the same 6-month Ecological Momentary Assessment (EMA) every other week (13 times total), using protocols to measure within-person day- to-day or week-to-week fluctuations in one's financial and social situations and/or mood, as these measurements may affect individuals' risk/resilience related to mid-life health outcomes, and track geospatial movement using GPS monitoring to assess activity space (Aim 2). For each of these 2 rural regions (Appalachia and Black Belt), we will assemble contextual data from several existing data bases to construct measures of the health, economic and social contexts of the localities in which participants in our 4 samples reside. The data from Aims 1 and 2 for these 4-sample/2 region samples will be used to analyze the causal linkages between person-specific and contextual measures of risk and resilience factors for those health conditions (e.g., suicide, alcohol abuse, cardiometabolic diseases) most associated with mid-life mortality (Aim 3). Multiple statistical methods, including fixed effect, structural equation and multilevel models as well as instrumental variables methods will be used to identify these causal linkages and their racial/ethnic and region differences. A distinctive feature of this analysis will be to employ the within-person data collected under the EMA protocol to examine the role of instability of socio-emotional, economic and social support as a unique contributor to those health conditions that result in midlife mortality. Finally, this project will harmonize measures collected in this rural-based study with measures in existing health/aging studies, disseminate the data collected through the National Archive of Computerized Data on Aging and conduct interdisciplinary user workshops on these data to facilitate urban/rural national comparisons of the study of health inequalities at midlife (Aim 4).

摘要 该应用程序建立在大烟山研究（GSMS）的基础上，并利用其最近资助的 扩展，大烟山农村老龄化研究（GSMS-RA），以提高我们对 美国农村健康不平等的决定因素。这项新的研究，中年健康不平等， 南方农村：风险和复原力，为两个GSMS-RA收集（并已资助）数据 北卡罗来纳州西部的样本，一个是美洲原住民，另一个是非西班牙裔白人， 他们40岁出头，目前居住在阿巴拉契亚的农村地区，有两个来自东北部的新样本 州的一部分，一个是非洲裔美国人，另一个是非非洲裔美国人，年龄在30岁和55岁之间， 从该州“黑带”地区的农村人口普查区招募。黑带样本将在 使用与GSMS-RA相同的120分钟家庭评估进行招募、同意和调查， 收集人口统计学和社会经济学以及态度信息，神经认知任务（智商，记忆力，注意力， 和执行功能），以及生物测量收集（即，身高、体重、腰围、血压、肺动脉压 功能，血斑）（目标1）。黑带样本也将参加同样为期6个月的生态 每隔一周进行一次即时评估（EMA）（共13次），使用方案测量人内日- 一个人的财务和社会状况和/或情绪的每日或每周波动，因为这些测量 可能影响与中年健康结果相关的个人风险/弹性，并使用 全球定位系统监测，以评估活动空间（目标2）。对于这两个农村地区（阿巴拉契亚和黑带）， 我们将从几个现有的数据库中收集背景数据，以构建健康、经济和社会的衡量标准， 和社会背景的地方，其中参与者在我们的4个样本居住。目标1和2的数据 对于这些4样本/2区域样本，将用于分析个人特异性和 这些健康状况的风险和复原力因素的背景测量（例如，自杀酗酒 心脏代谢疾病）与中年死亡率最相关（目标3）。多种统计方法，包括 固定效应、结构方程和多水平模型以及工具变量方法将用于 确定这些因果联系及其种族/民族和区域差异。这种分析的一个显著特点是 将采用EMA方案下收集的人内数据来检查不稳定性的作用， 社会情感、经济和社会支持是造成这些健康状况的独特因素， 中年死亡率。最后，本项目将协调在这项以农村为基础的研究中收集的措施， 在现有的健康/老龄化研究中，传播通过国家计算机档案馆收集的数据， 关于老龄问题的数据，并就这些数据举办跨学科用户讲习班， 中年健康不平等研究的比较（目标4）。