Community Violence as a Social Risk Factor for Cardiometabolic Diseases: Neighborhood Dynamics From Structures to Self

项目摘要 这份研究提案包含了一个五年的职业发展计划，它将使我成为一名社会工作者 流行病学家，主要研究心脏代谢性疾病的社会风险因素。我是一名医学讲师 在芝加哥大学生物科学系工作。在我之前的工作和培训的基础上 健康的社会决定因素，我将重点介绍一个特别有害的社会风险因素面临的许多高- 贫困，城市有色人种社区：社区暴力。拟议的培训计划将结合说教和 实践经验为我提供了空间数据科学、纵向方法和干预方面的培训- 以研究为基础，流行病学和人口健康方面的所有先进方法技能。它还将提供 向我提供必要的培训和基础设施，以发展心脏代谢性疾病结果方面的专门知识，这 在流行病学研究中经常与社区暴力联系在一起。我的导师团队和 顾问团在这些研究领域表现出色，并致力于我的职业生涯 发展。这次培训机会将激励我向临床医生-研究人员的独立过渡 世卫组织制定循证战略，以改善弱势人群的心脏代谢健康。 社区暴力是心脏代谢性疾病的重要社会风险因素。社区暴力可以 通过病理生理过程增加心脏代谢性疾病的风险，如应激或 神经内分泌反应，或通过影响健康行为(例如，减少体力活动)。然而， 邻里一级进程的作用(例如，建筑环境资源的损失、社会不信任和孤立)， 以及如何针对这些进程，人们仍然知之甚少。我已经证明了频繁和 与孤立的生命相比，持续暴露于暴力可能是心脏代谢疾病的更强预测因素 威胁性事件。我的中心假设是，社区暴力，当频繁和集中时，可以 在个人和社区层面上触发压力反应途径，以增加穷人的风险 心脏代谢结果。我将研究邻里环境中的特定反应路径， 在弱势群体中减少社区暴力的风险或建立复原力。拟议的具体目标 旨在：1)考察社区暴力与建筑环境之间的时空关系 美国城市的特征；2)确定影响美国城市的建筑和社会环境特征 社区暴力与心脏代谢性疾病的关系；3)发展 并试行患者和利益相关者知情的医疗干预措施，以解决心脏代谢健康问题 暴力的影响。这项研究建议的总体目标是将社区暴力作为一种 心脏代谢性疾病的社会风险因素，并具体阐明 影响这种关系--从结构到社会环境，再到自我。实现这些目标将为 在未来的R01中实施和评估以人群为基础的综合健康干预措施的方法。

PROJECT ABSTRACT This research proposal contains a five year career development plan that will establish me as a social epidemiologist who focuses on social risk factors for cardiometabolic diseases. I am an Instructor of Medicine in the Biological Sciences Division at the University of Chicago. Building on my prior work and training on the social determinants of health, I will focus on a particularly detrimental social risk factor facing many high- poverty, urban communities of color: community violence. The proposed training plan will combine didactic and practical experiences to equip me with training in spatial data science, longitudinal methods, and intervention- based research, all advanced methodological skills in epidemiology and population health. It will also provide me with needed training and infrastructure to develop expertise in cardiometabolic disease outcomes, which have been frequently linked to community violence in epidemiological studies. My mentorship team and advisory panel have demonstrated excellence in these areas of research and are committed to my career development. This training opportunity will galvanize my transition to independence as a clinician-investigator who develops evidence-based strategies to improve the cardiometabolic health of vulnerable populations. Community violence is an important social risk factor for cardiometabolic diseases. Community violence can increase risk for cardiometabolic diseases through pathophysiologic processes, such as stress or neuroendocrine responses, or by influencing health behaviors (e.g., reduced physical activity). However, the role of neighborhood-level processes (e.g., loss of built environment resources, social distrust and isolation), and how these processes can be targeted, remains poorly understood. I have shown that frequent and persistent exposure to violence may be a stronger predictor of cardiometabolic diseases than isolated, life- threatening events. My central hypothesis is that community violence, when frequent and concentrated, can trigger stress-response pathways on both individual and neighborhood levels to augment risk for poor cardiometabolic outcomes. I will examine specific response pathways in the neighborhood environment that mitigate risk or build resilience to community violence in vulnerable populations. The proposed specific aims are to: 1) Examine the spatiotemporal relationship between community violence and built environment characteristics in U.S. cities; 2) Determine the built and social environment characteristics that influence the relationship between community violence and cardiometabolic diseases across the life course; and 3) Develop and pilot a patient- and stakeholder-informed healthcare intervention to address the cardiometabolic health effects of violence. The overall objective of this research proposal is to examine community violence as a social risk factor for cardiometabolic diseases, and specifically elucidate the neighborhood dynamics that influence this relationship—from structures to social settings to self. Accomplishing these aims will pave the way for implementing and evaluating an integrated, population-based health intervention in a future R01.