Neighborhoods and Cardiovascular Risk and Resilience in Rural Communities

项目摘要 农村地区，特别是阿巴拉契亚和 密西西比三角洲是令人担忧的，但实际上对造成这一点的潜在因素一无所知 农村卫生处罚。先前的研究表明，邻里环境是CVD的重要驱动因素 心血管疾病的风险和种族/民族差异;然而，这项工作几乎完全在城市进行， 队列，留下约20%的人口在美国的#1死亡原因方面研究不足。它 仍然不知道邻域环境的传统特征（例如，食物获取，犯罪，社会 凝聚力）在农村地区也同样影响心血管疾病的风险，这必须进行严格的调查。有 还迫切需要更好地了解农村社区更多独特特征的作用，如地理位置， 住宅的空间隔离、企业和零售店之间的距离以及社交网络运营 在这些背景下。重要的是要描述这些独特的农村邻里类型， 哪些亚组可能最容易受到不同社区的心血管健康影响 原型我们将研究在那些心理社会上的人中， 弱势群体-童年创伤严重或社会支持不足的群体。最后， 对心血管恢复力的贡献也没有得到充分的研究，我们有一个独特的机会， 调查可能有助于CVD弹性的多层次因素（乐观，生活目的，弹性 应对）。因此，拟议研究的总体目标是：1）检查 邻里因素和独特邻里类型对农村居民心血管健康的影响 2）确定哪些群体在社会心理上最脆弱，3）确定 通过心理干预减轻了不利的社区类型对CVH和亚临床CVD的影响 resilience.本研究的最终探索性目标是4）评估关联是否因年龄、性别或 种族/民族。为了实现这些目标，我们将利用来自农村地区风险基础的现有数据， 纵向研究（RURAL），将从阿巴拉契亚的10个农村县招募4,600名年龄在25-64岁之间的个体 和美国的密西西比三角洲。我们将通过将新的数据 源（例如，地理空间参考数据库），并制定新的措施， 邻里物理和社会环境指标的综合数据库。总而言之，这项工作 可能有助于提供对心血管疾病风险和 弹性，并可能有助于确定新的干预手段，以改善农村心血管健康 社区.

Project Summary The higher burden of cardiovascular disease (CVD) in rural areas, particularly in Appalachia and the Mississippi Delta is alarming, yet virtually nothing is known about the underlying factors contributing to this rural health penalty. Prior research has shown that neighborhood environments are important drivers of CVD risk and racial/ethnic disparities in CVD; however, this work has been conducted almost exclusively in urban cohorts, leaving ~20% of the population understudied in regard to the #1 cause of mortality in the US. It remains unknown whether traditional features of neighborhood environments (e.g., food access, crime, social cohesion) operate similarly in rural areas to impact CVD risk, and this must be investigated rigorously. There is also an urgent need to better understand the role of more unique features of rural communities, such as geo- spatial isolation of residences, distance between businesses and retail outlets, and social networks operating in these contexts. It is important to characterize these unique rural neighborhood typologies and to investigate which subgroups may be most vulnerable to the cardiovascular health impacts of different neighborhood archetypes. We will examine whether associations are more deleterious among those who are psychosocially vulnerable – those with high levels of childhood trauma or inadequate social support. Finally, factors that contribute to cardiovascular resilience have also been understudied and we have a unique opportunity to investigate the multi-level factors that may contribute to CVD resilience (optimism, purpose in life, resilient coping). Thus, the overarching goal of the proposed study is to: 1) examine the relationship between neighborhood factors and unique neighborhood typologies on cardiovascular health (CVH) in rural communities, 2) determine which groups are most psychosocially vulnerable, and 3) determine whether the impact of adverse neighborhood typologies on CVH and subclinical CVD is mitigated by psychological resilience. The final, exploratory goal of this study is to 4) assess if associations are modified by age, sex, or race/ethnicity. To achieve these goals, we will leverage existing data from the Risk Underlying Rural Areas Longitudinal Study (RURAL) that will recruit 4,600 individuals ages 25-64 from 10 rural counties in Appalachia and the Mississippi Delta of the United States. We will augment this rich rural cohort by linking new data sources (e.g., geo-spatially referenced databases) and creating new measures in order to provide a comprehensive database of indicators of neighborhood physical and social environments. All in all, this work may help provide a more nuanced understanding of the multi- level determinants of both CVD risk and resilience and may help to identify novel levers of intervention to improve cardiovascular health in rural communities.