The role of social factors in cardiovascular risk behaviors disparities

描述（由申请人提供）：与最高收入阶层相比，低收入美国人的心血管死亡风险高2.5倍，证明了心血管（CV）疾病的社会经济差异。尽管社会环境可以影响CV疾病风险，并且越来越多的人关注差异研究，但对导致社会经济差异的潜在社会途径的了解相对较少，CV疾病的社会经济差异在过去三十年中只扩大了。许多CV风险行为存在社会经济差异，包括吸烟、缺乏体力活动和水果和蔬菜摄入不足，这些差异导致CV疾病的社会经济梯度。这些行为受社会环境资源因素的影响，包括社会支持、孤独感和邻里社会凝聚力。这三个社会环境资源的措施是独立相关的CV发病率，但他们的作用CV危险行为还没有得到很好的理解。此外，社会资源之间的相互作用可能产生“乘数效应”，净效应大于单个效应之和。然而，很少有研究利用生态框架来确定这些影响的程度。此外，这些社会资源的措施往往与社会经济地位（SEP），表明资源可能代表了一个根本的社会不平等。本研究的目的是检查SEP和三种不同但相关的社会资源措施-社会支持（情感和工具），孤独和邻里社会凝聚力-与CV风险行为结果（吸烟，缺乏体力活动，水果和蔬菜摄入不足）之间的关系。本研究的目的是：1）在控制混杂因素后，探讨社会支持、孤独感和邻里社会凝聚力与CV危险行为的关系。2)探讨社会支持、孤独感和邻里社会凝聚力与心血管危险行为的相互作用。3)探讨社会支持、孤独感和邻里社会凝聚力对CV危险行为SEP梯度的影响。本研究将使用多种族动脉粥样硬化研究获得的横断面数据，这是一项前瞻性队列研究，来自美国6个研究中心的6814名无明显CVD的成年人的多样化、基于人群的样本。多层次的统计建模技术将被用来测试拟议的相互关系，可持续发展战略和三个社会资源措施，基于生态框架。 公共卫生相关性：本研究的结果将阐明导致社会经济CV风险行为差异的途径，响应NINR研究优先领域，这些知识可能会为未来研究其他健康差异提供信息。这些知识对于临床医生和研究人员开发基于社会和背景的行为干预措施也很重要，满足了健康行为研究的关键需求。此外，这些发现可用于改善患者的宣传和制定政策，以解决社会层面的健康差距。

DESCRIPTION (provided by applicant): Socioeconomic disparities in cardiovascular (CV) disease are evidenced by a 2.5 times higher risk of cardiovascular mortality for low-income Americans, when compared to those in the highest income bracket. Despite well-documented awareness that social environments can influence CV disease risk, and the increasing attention given to disparities research, there is relatively little knowledge of the underlying social pathways contributing to socioeconomic disparities, and socioeconomic disparities in CV disease have only widened in the last three decades. Socioeconomic disparities exist for many CV risk behaviors, including smoking, lack of physical activity and insufficient fruit and vegetable intake, and these disparities contribute to socioeconomic gradients in CV disease. These behaviors are shaped by social environmental resource factors, including social support, loneliness and neighborhood social cohesion. These three social environmental resource measures are independently associated with CV morbidity, but their role in CV risk behaviors is not well understood. Also, interaction between social resources is likely to have a "multiplier effect", where the net effect is greater than the sum of the individual effects. However, few studies utilize an ecological framework to identify the magnitude of these effects simultaneously. Furthermore, these social resource measures are often correlated with socioeconomic position (SEP), indicating that the resources may represent a fundamental social inequality. The purpose of this study is to examine the relationships among SEP and three distinct, but related, measures of social resources - social support (both emotional and instrumental), loneliness and neighborhood social cohesion - with CV risk behavior outcomes (smoking, lack of physical activity, and insufficient fruit and vegetable intake). The aims of this study are: 1) To examine associations of social support, loneliness and neighborhood social cohesion with CV risk behaviors after controlling for confounders. 2) To explore the interactions of social support, loneliness and neighborhood social cohesion as they relate to CV risk behaviors. 3) To determine the contributions of social support, loneliness and neighborhood social cohesion to SEP gradients in CV risk behaviors. This study will use cross-sectional data obtained by the Multi-Ethnic Study of Atherosclerosis, a prospective cohort study of a diverse, population-based sample of 6814 adults without apparent CVD from six US sites. Multi-level statistical modeling techniques will be used to test the proposed inter-relationships of SEP and the three social resource measures, based on an ecological framework. PUBLIC HEALTH RELEVANCE: Results of this study will elucidate the pathways that contribute to socioeconomic CV risk behavior disparities, responding to a NINR research priority area, and this knowledge may inform future research into other health disparities. This knowledge also is important for the development of socially and contextually based behavioral interventions for clinicians and researchers, meeting a critical need in health behavior research. Moreover, these findings may be used to improve patient advocacy and shape policies to address health disparities at a societal level.