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，是心血管疾病的主要原因