Stress and Cardiovascular Risk Among Urban African American adults: A Multilevel, Mixed Methods Approach

尽管过去几年美国心血管疾病(CVD)的发病率和死亡率稳步下降 几十年来，非裔美国人(AA)成年人承担着不成比例的心血管疾病(CVD)负担。 心理社会因素--包括邻里逆境、日常人际关系压力(即种族 歧视、社会孤立、与他人的负面互动)，以及对这些压力源的情绪反应- 被认为是通过对健康行为的影响而导致心血管疾病的病因和进展， 应激反应神经内分泌轴和免疫过程。这些因素对于 居住在城市的中老年AA，他们经历着独特的压力来源(例如，居住隔离， 种族歧视、偏见)，更有可能生活在社会经济不利的情况下，而不是 白色的。然而，心理社会因素及其与心血管疾病风险的联系，以及更广泛的炎症，一直是 在AA成人中的研究明显不足。对日常压力源、健康的精细描述 与心血管疾病相关的行为和情绪反应--以及对以下情况的理解 这些情况的发生将极大地促进心血管疾病风险的科学研究。因此，拟议的 该项目是通过混合方法确定和概念化最主要的心理社会压力源 并通过模拟日常的心理、行为和生物途径 这些因素可能会加剧中老年AA患者的心血管疾病风险。通过采用预期的 (两年两次)和多时间尺度设计(每日评估嵌套在波浪中)，我们将 在居住在底特律的500名年龄在55-75岁之间的无症状AA样本中测试这一想法。我们还将使用半- 结构化访谈，收集60名参与者的定性数据，以确定量化结果的背景。 我们的中心假设是，人际压力将预示静息心率变异性的降低和 静息血压升高、睡眠不佳、慢性生理压力(头发皮质醇)和炎症 (基础和刺激的细胞因子和基础CRP)通过改变日常情感、日常健康行为和日常生活 生理应激(唾液皮质醇)。我们建议通过以下方式增加工作的创新性：(1)使用 基于智能手机的生态瞬时评估协议，用于测量心理社会压力，(2)包括 序贯解释性混合方法设计；(3)采用多时间尺度研究设计； 为底特律特别创建的邻里剥夺标准措施，以及(4)同时 考虑生理应激、炎症和心血管疾病的替代终点的多项指标。这个 这项拟议研究的基本原理是，一旦清楚地了解了心血管疾病的日常心理社会风险因素， 配方，他们的生物中介被确定，更具文化和个人定制的治疗 可以被开发来减少这一人群中的心血管疾病。

Despite the steady decline in cardiovascular diseases (CVD) morbidity and mortality in the US in the last few decades, African American (AA) adults bear a disproportionate share of cardiovascular disease (CVD) burden. Psychosocial factors—including neighborhood adversity, daily interpersonal stressors (i.e., racial discrimination, social isolation, negative interactions with others), and emotional reactivity to these stressors— are believed to contribute to the etiology and progression of CVD through their effects on health behaviors, the stress-responsive neuroendocrine axes, and immune processes. These factors are particularly salient for urban-dwelling middle-aged and older AAs, who experience unique stressors (e.g., residential segregation, racial discrimination, prejudice) and are more likely to live in situations of socioeconomic disadvantage than Whites. However, psychosocial factors and their link to CVD risk, and inflammation more broadly, have been remarkably understudied among AA adults. A fine-grained characterization of the daily stressors, health behaviors, and emotional responses related to CVD—and understanding of the situational contexts in which those occur—will significantly advance the science of CVD risk. Accordingly, the purpose of the proposed project is to identify and conceptualize—through a mixed-method approach—the psychosocial stressors most salient for this population and to model the daily psychological, behavioral, and biological pathways through which these factors may exacerbate CVD risk among middle-aged and older AAs. By adopting a prospective (two waves over two years) and multiple-time-scale design (daily assessments nested within waves), we will test this idea in a sample of 500 asymptomatic AAs aged 55-75 years living in Detroit. We will also use semi- structured interviews to collect qualitative data from 60 participants to contextualize the quantitative results. Our central hypothesis is that interpersonal stressors will predict decreases in resting heart rate variability and increases in resting blood pressure, poor sleep, chronic physiological stress (hair cortisol), and inflammation (basal and stimulated cytokines and basal CRP) by altering daily affect, daily health behaviors, and daily physiological stress (salivary cortisol). We propose to increase the innovation of our work by (1) using a smartphone-based ecological momentary assessment protocol to measure psychosocial stress, (2) including a sequential explanatory mixed-method design, (3) adopting a multiple-time-scale research design and a standardized measure of neighborhood deprivation created ad hoc for Detroit, and (4) simultaneously considering multiple measures of physiological stress, inflammation, and surrogate endpoints of CVD. The rationale for the proposed research is that once a clear picture of the daily psychosocial risk factors for CVD is formulated, and their biological intermediaries are identified, more culturally and individually tailored treatments can be developed to reduce CVD in this population.