Neighborhood Environments and Cardiometabolic Disorders in Hispanic/Latinos

 描述(由申请人提供)：需要新的多层次干预战略，以抗击糖尿病、肥胖症及其相关共病在高度受影响的人群中的迅速流行。到目前为止，邻里环境和拉丁裔健康只在一项大型队列研究中进行了研究，这项研究名为动脉粥样硬化的多种族研究。我们建议根据PAR-13-302提交一项具有成本效益的辅助研究，利用西班牙裔社区健康研究-拉美裔研究(HCHS-SOL)的现有数据，同时在正在进行的队列研究中增加全面的社区环境评估和访问2体力活动评估。这项拟议的研究是及时的，因为快速增长的拉丁裔人口，特别是墨西哥裔美国人，经历了糖尿病和肥胖等心脏代谢疾病的不成比例的高发病率。在这项研究中，我们将使用一个创新和全面的社会-生态模型来调查社区环境对HCHS/Sol San Diego队列(N=1750名墨西哥裔美国人)心脏代谢健康的影响，该模型考虑了使用纵向框架将宏观和微观尺度的构建和社会社区因素与心脏代谢健康联系起来的多条路径。心脏代谢结果的六年轨迹将从2008-2011年(访问1)和2015-2018年(访问2)的全面临床评估中得出。在访问1和访问2时，使用加速度计和有效的自我报告来评估体力活动。慢性压力和社会支持将在访问2中使用经过验证的自我报告进行评估，而抑郁症则在两次访问中进行评估。宏观社区属性(例如，居住密度、家庭收入中位数)将从地理信息系统和公共来源数据(如美国社区调查)中得出，使用参与者住宅周围1公里的街道网络缓冲区。微观尺度的属性(例如，十字路口的安全、美学/社会混乱)将通过对参与者所在社区的系统直接观察来评估。横截面和纵向结构方程模型将被用来研究邻里环境对心脏代谢综合评分的直接和间接(通过体力活动、抑郁、慢性压力和社会支持)的影响，该综合评分由代谢综合征的组成部分(即腰围、收缩压、高密度脂蛋白-胆固醇、空腹血糖和空腹甘油三酯)组成。根据社会-生态模型的假设，我们推动了这项研究，以测试中介(通过前面提到的行为和心理社会途径)以及邻里属性之间的交互作用(例如，建筑和社会)。通过加强对邻里关系对拉丁裔健康影响的了解，该项目将在高需求地区提供有利于健康的邻里干预措施，以及行为和心理社会干预措施，以最大限度地减少不支持邻里环境对健康的负面影响。

 DESCRIPTION (provided by applicant): Novel multi-level intervention strategies are needed to combat the burgeoning pandemics of diabetes, obesity and their related comorbidities among highly impacted populations. Neighborhood environments and Latino health have only been studied in one large cohort study to date, The Multi Ethnic Study of Atherosclerosis. We propose a cost-effective ancillary study, submitted in response to PAR-13-302, that leverages existing data from the Hispanic Community Health Study - Study of Latinos (HCHS-SOL), while adding comprehensive neighborhood environment assessments and Visit 2 physical activity assessments to this ongoing cohort study. The proposed study is timely because the rapidly growing Latino population, particularly Mexican Americans, experience disproportionally high rates of cardiometabloic diseases such as diabetes and obesity. In this study we will investigate neighborhood environment impacts on cardiometabolic health in the HCHS/SOL San Diego cohort (N = 1750 Mexican Americans) using an innovative and comprehensive Social-Ecological Model that considers multiple pathways linking both macro- and micro-scale built and social neighborhood factors to cardiometabolic health using a longitudinal framework. Six year trajectories in cardiometabolic outcomes will be derived from comprehensive clinical assessments during 2008-2011 (Visit 1) and 2015-2018 (Visit 2). Physical activity was/will be assessed at Visits 1 and 2 using accelerometry and validated self-report. Chronic stress and social support will be assessed using validated self-reports at Visit 2, while depression was/will be assessed at both visits. Macro-scale neighborhood attributes (e.g., residential density, median household income) will be derived from GIS and public source data such as the American Community Survey using 1km street-network buffers around participants' homes. Micro-scale attributes (e.g., safety of street crossings, aesthetics/social disorder) will be assessed using systematic direct observations of participants' neighborhoods. Both cross-sectional and longitudinal structural equation models will be used to investigate direct and indirect (through physical activity, depression, chronic stress, and social support) effects of neighborhood environments on a cardiometabolic composite score comprised of the Metabolic Syndrome components (i.e., waist circumference, systolic blood pressure, HDL-cholesterol, fasting glucose and fasting triglycerides). As posited in Social-Ecological Models, we powered this study to test mediation (through the aforementioned behavioral and psychosocial pathways) and interactions among neighborhood attributes (e.g., built and social). By improving understanding of neighborhood effects on Latino health, this project will inform health-supportive neighborhood interventions in high-need areas, as well as behavioral and psychosocial interventions to minimize the negative health impacts of unsupportive neighborhood environments.