A daily diary examination of the influence of intersectional stigma on blood pressure

高血压是心血管疾病(CVD)最重要的可改变的危险因素，是导致心血管疾病的主要原因 世界各地成年人的死亡和残疾情况。被污名化的人群，如有色人种和有色人种 少数(例如，男/女同性恋、双性恋)成年人高血压患病率较高，主要是 归因于更多地暴露在耻辱之下；健康差距的根本原因。然而，之前的研究表明 污名对血压(BP)的影响主要集中在已实施的污名(即，亲身经历 歧视)，以排除其他形式的耻辱，如预期的(即，期望遇到 歧视)和替代性(即，听到/目睹像你这样的人成为歧视的目标) 耻辱。这一领域的大多数研究都集中在由于单一的耻辱身份而造成的耻辱；一种方法是 忽视和模糊了面临交叉形式的耻辱的群体的经历。鉴于这些限制， 我们假设研究人员此前低估了污名对BP的影响。我们有令人信服的 试点数据显示，与制定的污名无关，每日交叉预期污名的报告更多 (归因于任何原因，如种族或性别认同)与较高的家庭收缩压(SBP；a 在受耻辱的成年人中，对未来心血管疾病事件的预测比在职SBP更强。这个项目的总体目标是 为期一周的每日日记研究是为了评估交叉的预期和替代污名对家庭的影响 BP。我们将进行第一项研究，将稳健的方法三角测量，以检查日常和 在个人的真实世界环境中，BP长期预期的和替代的污名。我们将招聘一名 400名成年人(年龄18-39岁)的不同样本，没有被诊断为高血压或心血管疾病。参赛者将完成 一次有组织的面试，然后是一周的一周，每天两次的结构化电子日记将评估每天的情况 预期的、替代的和实施的污名，收集唾液样本以评估唾液应激生物标志物， 连续的腕部动作记录，每天两次家庭血压监测。我们将：1)确定 平均家庭SBP和这些关联的中介者上的交叉性预期和替代污名(例如， 唾液皮质醇、体力活动、沉思)和2)检查交叉性预期和 社会认同(即，性别、民族和性认同)之间的替代性污名和平均家庭SBP 它们之间的交叉点。我们还将探讨保护性因素(即社会支持和 主观社会地位)缓冲(即削弱)跨部门预期和替代污名对 平均家庭收缩压。这项研究将提供预期和替代机制的第一个证据 柱头影响BP。如果我们发现预期的和/或替代的污名影响BP-即使在没有 制定耻辱-它将改变我们对降低心血管疾病风险的干预措施设计的看法 蒙受耻辱的成年人。这项研究是确定未来干预措施的机械性目标的关键一步 减少预期的和替代的污名对心血管健康的不利影响的政策。

Hypertension is the most important modifiable risk factor for cardiovascular disease (CVD), the leading cause of death and disability in adults worldwide. Stigmatized populations, such as people of color and sexual minority (e.g., gay/lesbian, bisexual) adults, have a higher prevalence of hypertension that is primarily attributed to greater exposure to stigma; a fundamental cause of health disparities. However, prior research on the effects of stigma on blood pressure (BP) has largely focused on enacted stigma (i.e., personally experienced discrimination) to the exclusion of other forms of stigma, such as anticipated (i.e., expectation of encountering discrimination) and vicarious (i.e., hearing/witnessing people like you being the target of discrimination) stigma. Most research in this area has focused on stigma due to a single stigmatized identity; an approach that ignores and obscures the experiences of groups that face intersecting forms of stigma. Given these limitations, we posit that researchers have previously underestimated the impact of stigma on BP. We have compelling pilot data showing that, independent of enacted stigma, greater report of daily intersectional anticipated stigma (attributed to any reason, such as race or sexual identity) is associated with higher home systolic BP (SBP; a stronger predictor of future CVD events than in-office SBP) among stigmatized adults. The overall goal of this 1-week daily diary study is to estimate the influence of intersectional anticipated and vicarious stigma on home BP. We will conduct the first study that triangulates robust methods to examine mechanisms linking daily and chronic anticipated and vicarious stigma with BP in individuals’ real-world environments. We will recruit a diverse sample of 400 adults (ages 18–39) without diagnosed hypertension or CVD. Participants will complete a structured interview followed by 1 week of twice-daily structured electronic diaries that will assess daily anticipated, vicarious, and enacted stigma, collection of saliva samples to assess salivary stress biomarkers, continuous wrist-worn actigraphy, and twice daily home BP monitoring. We will: 1) Determine the influence of intersectional anticipated and vicarious stigma on mean home SBP and mediators of these associations (e.g., salivary cortisol, physical activity, rumination) and 2) Examine differences in intersectional anticipated and vicarious stigma and mean home SBP across social identities (i.e., gender, ethnoracial, and sexual identity) and the intersections between them. We will also explore whether protective factors (i.e., social support and subjective social status) buffer (i.e., weaken) the influence of intersectional anticipated and vicarious stigma on mean home SBP. This study will provide the first evidence of mechanisms by which anticipated and vicarious stigma influence BP. If we find that anticipated and/or vicarious stigma influence BP—even in the absence of enacted stigma—it will shift how we think about the design of interventions for CVD risk reduction among stigmatized adults. This study is a critical step for identifying mechanistic targets for future interventions and policies to reduce the adverse effects of anticipated and vicarious stigma on cardiovascular health.