The effects of pandemic-related stressors on change in CVD Risk: The protective role of universal prevention

摘要 虽然我们还不能估计由于气候变化对健康和社会造成的总的附带损害， COVID-19大流行，压力、财务压力、抑郁/焦虑、家庭冲突和 大流行期间的社会隔离，每一个都可能对身体健康产生巨大的长期累积影响。 健康，特别是心血管疾病（CVD）。例如，考虑到最近一次大型 荟萃分析表明，孤独和孤独的人患中风和缺血性心脏病的风险高出约30%， 对于社交孤立的人，CVD相关的“社交距离的后果可能是深刻的”。流行病- 相关的压力因素，如财务紧张和社会距离，可能特别困难的家庭， 年幼的孩子。在这种情况下，拟议的项目是独特的定位，以审查重要的理论 以及实际的公共卫生问题，这些问题将为未来的努力提供信息，以尽量减少负面的附带健康， 传染病流行以及其他危机的影响：2019冠状病毒病大流行在多大程度上 增加父母和孩子的CVD风险？与这种危机相关的多重压力源中， 例如，在一个实施例中，经济、心理健康、社会孤立、家庭冲突等因素与心血管疾病的增加有着最密切的联系 父母和孩子的风险？全民预防规划能否增强父母和儿童的复原力 以防止危机相关的压力源和减轻危机相关的心血管疾病风险的增加？ 目的1：检查心血管疾病风险的变化幅度（a）从大流行前到接近大流行的时间点， 大流行的预期结束（“大流行后”）和（B）从“大流行后”时间点到18个月 后我们将评估流行病期间的经济压力、心理健康问题和家庭冲突是否 预测CVD风险变化。目标2.为了研究随机分配到有效的家庭预防是否 与（a）整个流行期间CVD风险假设增加的降低相关;（B） 心血管疾病健康指标在18个月内“恢复”，在此期间，我们预计大多数与流行病有关的 限制将得到放松;（c）减少与流行病有关的压力因素之间的联系， CVD风险的变化（适度）。目标3：审查性别或大流行病前指标是否 社会经济地位（收入、教育）对目标1和2中所考察的关联起调节作用。 冲击这个项目将导致新的实践和理论知识，这是重要的，因为我们面临的 传染病流行和与气候变化有关的环境灾害的频率增加。 增加对家庭内影响CVD健康的压力相关过程的理解的研究 风险将告知未来的干预方法，以减少心血管疾病的风险期间，家庭危机，社会， 经济混乱和自然灾害。了解与风险和弹性相关的因素将 允许程序开发人员更精确地针对突出的机制以及高风险家庭。

ABSTRACT Although we are not yet in a position to estimate the total collateral damage to health and society due to the COVID-19 pandemic, widespread increases in stress, financial strain, depression/anxiety, family conflict, and social isolation during the pandemic may each have large and cumulative long-term impacts on physical health, particular via cardiovascular disease (CVD). For example, given that evidence from a large recent meta-analysis indicates that risk for stroke and ischemic heart disease is about 30% higher in lonely and socially isolated people, the CVD-related “consequences of social distancing may be profound”. Pandemic- related stressors, such as financial strain and social distancing, may be particularly difficult for families with young children. In this context, the proposed project is uniquely positioned to examine important theoretical and practical public health questions that will inform future efforts to minimize the negative collateral health impacts of infectious disease epidemics as well as other crises: To what extent did the COVID-19 pandemic increase CVD risk among parents and children? Which of the multiple stressors associated with such a crisis ̶ e.g., financial, mental health, social isolation, family conflict ̶were most strongly linked to increases in CVD risk among parents and children? Can universal prevention programming enhance parent and child resilience in order to protect against crisis-related stressors and mitigate crisis-related increases in CVD risk? Aim 1: To examine the magnitude of change in CVD risk (a) from pre-pandemic to a time point near the anticipated end of the pandemic (“post-pandemic”) and (b) from the “post-pandemic” time point to 18 months later. We will assess whether pandemic-period financial strain, mental health problems, and family conflict predict CVD risk changes. Aim 2. To examine whether random assignment to effective family prevention is associated with (a) a reduction in the hypothesized increase in CVD risk across the pandemic; (b) greater “recovery” in CVD health indicators over an 18 month period during which we expect most pandemic-related restrictions will have been eased; and (c) reduced associations between pandemic-related stressors and change in CVD risk (moderation). Aim 3: To examine whether gender or pre-pandemic indicators of socioeconomic status (income, education) moderate the associations examined in Aims 1 and 2. Impact. This project will result in new practical and theoretical knowledge that is important as we face increased frequency of infectious disease epidemics and climate change-related environmental disasters. Research that increases understanding of the stress-related processes within families that impact CVD health risk will inform future intervention approaches to reduce CVD risk during periods of family crisis, social- economic dislocation, and natural disasters. Understanding the factors that relate to risk and resilience will allow program developers to more precisely target salient mechanisms as well as families at highest risk.