Stress and Cardiovascular Risk Among Urban African American adults: A Multilevel, Mixed Methods Approach

点击翻译按钮获取中文摘要

Despite the steady decline in cardiovascular diseases (CVD) morbidity and mortality in the US in the last few decades, African American (AA) adults bear a disproportionate share of cardiovascular disease (CVD) burden. Psychosocial factors—including neighborhood adversity, daily interpersonal stressors (i.e., racial discrimination, social isolation, negative interactions with others), and emotional reactivity to these stressors— are believed to contribute to the etiology and progression of CVD through their effects on health behaviors, the stress-responsive neuroendocrine axes, and immune processes. These factors are particularly salient for urban-dwelling middle-aged and older AAs, who experience unique stressors (e.g., residential segregation, racial discrimination, prejudice) and are more likely to live in situations of socioeconomic disadvantage than Whites. However, psychosocial factors and their link to CVD risk, and inflammation more broadly, have been remarkably understudied among AA adults. A fine-grained characterization of the daily stressors, health behaviors, and emotional responses related to CVD—and understanding of the situational contexts in which those occur—will significantly advance the science of CVD risk. Accordingly, the purpose of the proposed project is to identify and conceptualize—through a mixed-method approach—the psychosocial stressors most salient for this population and to model the daily psychological, behavioral, and biological pathways through which these factors may exacerbate CVD risk among middle-aged and older AAs. By adopting a prospective (two waves over two years) and multiple-time-scale design (daily assessments nested within waves), we will test this idea in a sample of 500 asymptomatic AAs aged 55-75 years living in Detroit. We will also use semi- structured interviews to collect qualitative data from 60 participants to contextualize the quantitative results. Our central hypothesis is that interpersonal stressors will predict decreases in resting heart rate variability and increases in resting blood pressure, poor sleep, chronic physiological stress (hair cortisol), and inflammation (basal and stimulated cytokines and basal CRP) by altering daily affect, daily health behaviors, and daily physiological stress (salivary cortisol). We propose to increase the innovation of our work by (1) using a smartphone-based ecological momentary assessment protocol to measure psychosocial stress, (2) including a sequential explanatory mixed-method design, (3) adopting a multiple-time-scale research design and a standardized measure of neighborhood deprivation created ad hoc for Detroit, and (4) simultaneously considering multiple measures of physiological stress, inflammation, and surrogate endpoints of CVD. The rationale for the proposed research is that once a clear picture of the daily psychosocial risk factors for CVD is formulated, and their biological intermediaries are identified, more culturally and individually tailored treatments can be developed to reduce CVD in this population.