Racism, Coping and Ambulatory Blood Pressure

描述（由申请人提供）：健康状况的种族差异，特别是黑人高血压（HT）的高发率，已得到广泛认可。研究人员假设，社会压力因素，包括暴露于种族主义或种族歧视，可能会增加HT和心血管疾病（CVD）的风险。本研究的具体目的是检验种族歧视、应对和动态血压（ABP）之间关系的模型。该模型表明，种族歧视的感知暴露将与ABP的平均水平、急性血压和心率对当前负面人际交往的反应的幅度和持续时间呈正相关。种族歧视的应对方式和策略在种族歧视与ABP的关系中起中介作用，社会经济地位（SES）在种族歧视与应对、种族歧视与应对与ABP的关系中起调节作用。为了检验这一模型的可推广性，我们将在720名美国出生的黑人和拉丁裔男性和女性中进行多地点样本检验。这些做法位于文化多样化的社区，为来自各种社会经济背景的患者提供服务。参与者将佩戴动态血压监测仪24小时。问卷将用于评估过去遭受民族/种族歧视的情况。在每次动态血压读数时完成的日记将用于确定检测当天的阴性和潜在的歧视性相互作用。研究了种族歧视的特征应对方式和特定情景的应对策略。将审查和控制可能影响对种族歧视看法的人口和个性变量。结构方程模型将用于评估感知种族歧视与应对和ABP之间的关系，并进一步分析性别、社会经济地位和种族/民族与使用不同的应对种族歧视的方式和策略之间的关系。这些特征对应对ABP的关系的影响。该研究对有关心理社会压力与HT风险关系的理论和发展干预措施以减少健康状况的种族差异具有启示意义。

DESCRIPTION (provided by applicant): Racial disparities in health status, and in particular the excess rates of hypertension (HT) among Blacks, are widely recognized. Investigators have hypothesized that social stressors, including exposure to racism or ethnic discrimination, may contribute to increased risk for HT and cardiovascular disease (CVD). The specific aim of the proposed study is to test a model of the relationships among ethnic discrimination, coping, and ambulatory blood pressure (ABP). The model proposes that perceived exposure to ethnic discrimination will be positively associated with the average level of ABP and with the magnitude and duration of acute blood pressure and heart rate responses to current negative interpersonal interactions. Coping styles and strategies used to manage ethnic discrimination are expected to mediate the relationship of ethnic discrimination to ABP. Socioeconomic status (SES) is expected to moderate the relationship of racism to coping and the relationships of ethnic discrimination and coping to ABP. To test the generalizability of this model, the hypotheses will be tested in a multi-site sample of 720 American-born Black and Latino men and women drawn from urban primary care medical practices. These practices are located in culturally diverse communities, serving patients from a range of socioeconomic backgrounds. Participants will wear an ambulatory blood pressure monitor for 24 hours. Questionnaires will be used to assess past exposure to ethnic/racial discrimination. Diaries completed at the time of each ambulatory blood pressure reading will be used to identify day-of-testing negative and potentially discriminatory interactions. Both characteristic styles of coping and episode-specific strategies for coping with ethnic discrimination are examined. Demographic and personality variables likely to affect perceptions of ethnic discrimination will be examined and controlled. Structural equation modeling will be employed to evaluate the relationships among perceived ethnic discrimination to coping and ABP. Additional analyses will examine the association of gender, SES, and race/ethnicity to the use of different styles and strategies for coping with ethnic discrimination, and the effects of these characteristics on the relationship of coping to ABP. The study has implications for theories concerning the relationship of psychosocial stress to risk for HT and for the development of interventions to reduce racial disparities in health status.