Sociocultural Factors and Cardiometabolic Risk in Mexican-American Women

描述（由申请人提供）：墨西哥裔美国人表现出较高的社交能力（例如，低社会经济地位; SES）和代谢（例如，肥胖;代谢综合征; MetSyn）心血管疾病（CVD）的危险因素。与非拉丁美洲白色女性相比，墨西哥裔美国女性的肥胖负担（45%对33%）和MetSyn（42%对32%）也很高。女性比男性更容易受到社会经济地位低，压力和负面情绪的影响，墨西哥裔美国女性可能会经历额外的社会心理风险，具体到他们的社会文化环境。很少有前瞻性研究检查SES，心理社会和行为因素，以及心脏代谢风险随时间的进展，特别是在高危少数民族人群中。该竞争性更新申请以1 R 01 HL 081604为基础，该申请招募了304名来自南圣地亚哥社区的SES多样化、随机选择的墨西哥裔美国妇女（年龄40-65岁），以参与对社会经济和心理社会因素、生活方式途径和已确定的CVD风险因素（例如，血压、脂质、肥胖、空腹血糖水平），新的炎症生物标志物，以及 动态血压（AmBP）水平和昼夜节律。在储备能力模型的指导下，该模型强调了心理社会风险（压力、负面情绪）和保护因素（人际和人际资源，即，在SES差异中，该研究确定了MetSyn变量，炎症标志物和AmBP水平以及拉丁裔夜间下降的SES梯度，并表明心理社会因素（负面情绪，资源）和行为因素（肥胖，饮食）有助于这些梯度。研究结果还揭示了文化适应（由语言偏好定义）的SES梯度的变化，并建议需要超越传统的心理社会因素，以更好地了解墨西哥裔美国妇女的心脏代谢风险。本研究提出了一项6年随访评估（时间2;预期N=280），以检查Nuestra Salud队列中心脏代谢风险进展的预测因素。除了重新检查时间1指标外，时间2方案还将增加文化驱动的心理社会因素的新措施以及体力活动和睡眠的客观措施，以检查它们对墨西哥裔美国妇女心脏代谢风险进展及其社会模式的贡献。以社区为基础的参与性研究战略将为项目实施提供信息，并确保反映与墨西哥裔美国妇女最相关的心理社会问题。该研究的总体目标是通过文化增强的储备能力模型指导的结构方程模型，检查SES，传统和文化驱动的心理社会风险和保护因素，生活方式因素和6年心脏代谢风险进展之间的关联。该研究将促进对可改变的心理社会和行为风险以及塑造墨西哥裔美国妇女心脏代谢风险进展及其社会模式的保护因素的理解，为文化上适当的策略提供基础，以改善这一处于风险中，服务不足和不断增长的美国人口亚组的健康。

DESCRIPTION (provided by applicant): Mexican Americans display elevated social (e.g., low socioeconomic status; SES) and metabolic (e.g., obesity; metabolic syndrome; MetSyn) risk factors for cardiovascular disease (CVD). Mexican-American women also evidence a high burden of obesity (45% versus 33%) and MetSyn (42% versus 32%) when compared to non-Latino white women. Women are more vulnerable than men to low SES, stress, and negative emotions, and Mexican American women may experience additional psychosocial risks specific to their sociocultural milieu. Very few prospective studies have examined SES, psychosocial and behavioral factors, and cardiometabolic risk progression over time, particularly in high-risk ethnic minority populations. This competing renewal application builds on 1R01HL081604, which enrolled 304 SES-diverse, randomly selected Mexican-American women (aged 40-65 years) from South San Diego communities to participate in a rigorous, multi-method assessment of socioeconomic and psychosocial factors, lifestyle pathways, and established CVD risk factors (e.g., blood pressure, lipids, obesity, fasting glucose levels), novel inflammatory biomarkers, and ambulatory blood pressure (AmBP) levels and diurnal rhythm. Guided by the Reserve Capacity Model, which highlights psychosocial risk (stress, negative emotions) and protective factors (inter- and intra-personal resources, i.e., "reserve capacity") in SES disparities, the study has identified SES gradients in MetSyn variables, inflammatory markers, and AmBP levels and nocturnal dipping in Latinas, and has shown that psychosocial (negative emotions, resources) and behavioral factors (obesity, diet) contribute to these gradients. Findings also reveal variability in SES gradients by acculturation (defined by language preference) and suggest the need to look beyond traditional psychosocial factors to better understand cardiometabolic risk in Mexican-American women. The current study proposes a 6-yr follow-up assessment (Time 2; expected N=280) to examine predictors of cardiometabolic risk progression in the Nuestra Salud cohort. In addition to re-examining Time 1 indicators, the Time 2 protocol will add new measures of culturally driven psychosocial factors and objective measures of physical activity and sleep to examine their contributions to cardiometabolic risk progression and its social patterning in Mexican American women. Community based participatory research strategies will inform project implementation and ensure representation of psychosocial issues most relevant to Mexican American women. The overarching aim of the study is to examine associations among SES, traditional and culturally driven psychosocial risk and protective factors, lifestyle factors, and 6-yr cardiometabolic risk progression, via structural equation models guided by a culturally enhanced Reserve Capacity Model. The study will advance understanding of modifiable psychosocial and behavioral risk and protective factors that shape cardiometabolic risk progression and its social patterning in Mexican American women, to provide a basis for culturally appropriate strategies to improve health in this at-risk, underserved, and growing U.S. population subgroup.