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

每日日记检查交叉耻辱对血压的影响

• 批准号: 10905159
• 负责人: Billy A Caceres
• 金额: $ 81.5万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10905159
• 关键词: Adult; Adverse effects; Affect; Affective; Age; Anxiety; Area; Behavior Therapy; Behavioral; Biological Markers; Black race; Blood Pressure; Buffers; Cardiovascular Diseases; Cause of Death; Chronic; Collection; Data; Demographic Factors; Diagnosis; Discrimination; Effectiveness; Electronics; Environment; Event; Exclusion; Exposure to; Face; Future; Gender; Goals; Guidelines; Health; Hearing; High Prevalence; Home; Home Blood Pressure Monitoring; Hydrocortisone; Hypertension; Individual; Intervention; Interview; Lead; Lesbian; Lesbian Gay Bisexual; Life; Linear Models; Link; Mediating; Mediator; Mental Depression; Methods; Modeling; New York City; Outcome; Participant; Personality; Persons; Physical activity; Physiological; Policies; Population; Process; Race; Reporting; Research; Research Personnel; Risk Reduction; Salivary; Sampling; Sleep Disorders; Social Identification; Social status; Social support; Stigmatization; Stress; Structure; Testing; Tobacco use; United States; Woman; Work; Wrist; actigraphy; alpha-amylase; cardiovascular disorder risk; cardiovascular health; cardiovascular risk factor; diaries; disability; electronic structure; ethnoracial; expectation; experience; health disparity; modifiable risk; mortality; neglect; people of color; perceived discrimination; protective factors; racial identity; recruit; rumination; saliva sample; sexual identity; sexual minority; social; social determinants; social health determinants; social stigma; stressor; therapy design

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.

高血压是心血管疾病（CVD）最重要的可改变危险因素，而心血管疾病是导致心血管疾病的主要原因 全世界成年人的死亡和残疾。受到污名化的人群，例如有色人种和性取向人群 少数族裔（例如男同性恋/女同性恋、双性恋）成年人的高血压患病率较高，这主要是 归因于更多地遭受耻辱；健康差异的一个根本原因。然而，先前的研究 耻辱对血压 (BP) 的影响主要集中在所制定的耻辱上（即个人经历过的） 歧视），排除其他形式的耻辱，例如预期（即期望遇到 歧视）和替代（即听到/目睹像您这样的人成为歧视的目标） 柱头。该领域的大多数研究都集中在由于单一的污名化身份而导致的污名化上。一种方法 忽视并掩盖了面临交叉形式耻辱的群体的经历。鉴于这些限制， 我们认为研究人员之前低估了耻辱对血压的影响。我们有令人信服的 试点数据显示，与已制定的耻辱无关，每日交叉预期耻辱的报告更多 （归因于任何原因，例如种族或性别认同）与较高的家庭收缩压（SBP；a 在受到污名化的成年人中，它比诊室 SBP 更能预测未来的 CVD 事件。本次活动的总体目标 为期 1 周的每日日记研究旨在估计交叉预期耻辱和替代耻辱对家庭的影响 血压。我们将进行第一项研究，对稳健的方法进行三角测量，以检查日常和工作之间的联系机制。 在个人的现实环境中，长期预期和替代性的 BP 耻辱感。我们将招募一名 400 名未诊断出高血压或 CVD 的成年人（18-39 岁）的不同样本。参与者将完成 结构化面试，然后是为期 1 周、每天两次的结构化电子日记，每天进行评估 预期的、替代的和实施的耻辱，收集唾液样本以评估唾液应激生物标志物， 连续腕戴式体动记录仪，每天两次家庭血压监测。我们将： 1) 确定影响 对平均家庭 SBP 和这些关联的中介者的交叉预期和替代耻辱（例如， 唾液皮质醇、身体活动、反刍）和 2）检查交叉预期和 跨社会身份（即性别、民族和性身份）的替代耻辱和平均家庭 SBP 以及 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）交叉预期和替代耻辱的影响 平均家庭收缩压。这项研究将为预期和替代性机制提供第一个证据。 耻辱影响血压。如果我们发现预期的和/或替代的耻辱会影响血压——即使没有 造成的耻辱——它将改变我们对降低 CVD 风险干预措施设计的看法 被污名化的成年人。这项研究是确定未来干预措施和机制目标的关键一步 减少预期和替代耻辱对心血管健康的不利影响的政策。