Chronic Stress as a Pathway to Health Disparities

 描述(由申请人提供)：社会经济地位(SES)在健康方面造成了巨大的差异。这些差异是一个问题，因为它们描述了较低SES个人患慢性病和过早死亡的风险增加，以及由于医疗保健和生产力损失而给美国经济带来的巨大成本。长期目标是更好地了解SES降低导致健康状况恶化的途径。本R03的总体目标是测试慢性应激，以解释与SES相关的健康差异。与以前的日常压力研究不同，这份R03使用了来自不同经济和种族的成年人样本的数据，并拥有关于应激源时机的细粒度数据。从几个健康差距理论中得出的中心假设是，SES较低的人经历持续暴露和对应激源的长期反应，这种频繁和延长的情绪反应激活会导致身体磨损和最终疾病。这项拟议研究的基本原理是，通过了解与SES相关的压力降低身体健康的途径，可以开发干预措施，以减少日常的身体症状，并从长远来看推迟或预防疾病。在前期工作的指导下，这一慢性压力假说将在短期和长期尺度上进行检验。从这一假设延伸出来的具体目标包括：1)验证这样的预测，即在短期内，低SES将与更频繁的日常压力源和对规模和持续时间更大的压力源的情感反应相关；2)测试这样的预测，即在每天的基础上，对更大规模和更长持续时间的日常压力源有情感反应，预示着每天会经历更频繁和更严重的身体症状；以及3)测试这样的预测，即在一生中，童年时的低SES预示着成年后身体健康更差，因为更多的压力源暴露在更多的压力下，用于应对这些压力的心理社会资源减少。在第一个目标下，情绪反应的大小将与情绪恢复的持续时间区分开来-申请人在初步工作中证明了这一点是可行的。在第二个目标下，这些对压力源的情绪反应的大小和持续时间斜率将被用来预测一天结束时的身体症状。在第三个目标中，童年和生活压力将被测试为儿童SES客观指数对成人健康影响的中介变量。申请人认为，这种方法是创新的，因为它测试了基于理论的健康差异预测，利用了不同的样本，并在多个时间尺度上接近预测。这项拟议的研究具有重要意义，因为它有望促进和扩大对SES劣势如何导致健康差异的理解。这种知识有可能将干预引导到对日常和长期健康最具预测性的慢性应激途径上。

 DESCRIPTION (provided by applicant): Socio-economic status (SES) produces wide disparities in health. These disparities are a problem because they describe increased risk for chronic diseases and early death for lower SES individuals and large costs to the U.S. economy due to health care and lost productivity. The long-term goal is to better understand the pathways by which lower SES results in worse health. The overall objective in this R03 is to test chronic stress as an explanation of SES-related health disparities. In contrast to previous daily stress studies, this R03 uses data from an economically and racially diverse sample of adults and has fine-grained data regarding the timing of stressors. The central hypothesis, drawn from several health disparity theories, is that lower SES individuals experience persistent exposure and prolonged response to stressors and that this frequent and extended activation of emotional responses results in physical wear-and-tear and eventual disease. The rationale for the proposed research is that by understanding the pathways by which SES-related stress reduces physical health, interventions can be developed to reduce physical symptoms on a daily basis and delay or prevent disease over the long-term. Guided by preliminary work, this chronic stress hypothesis will be tested on short- and long-time scales. Specific aims extended from this hypothesis include: 1) Test the prediction that, over the short-term, low SES will be associated with more frequent daily stressors and emotional responses to stressors which are larger in magnitude and duration, 2) Test the prediction that, on a daily basis, having emotional responses to daily stressors which are larger magnitude and longer duration predicts experiencing more frequent and severe physical symptoms on a daily basis, and 3) Test the prediction that, over a lifetime, low SES in childhood predicts worse physical health in adulthood because of more exposure to stressors and reduced psychosocial resources with which to respond to them. Under the first aim, magnitude of emotional reactivity will be distinguished from duration of emotional recovery - which the applicant has demonstrated is feasible in her preliminary work. Under the second aim, these magnitude and duration slopes of emotional responses to stressors across the day will be used to predict end of day physical symptoms. In the third aim, childhood and lifetime stress will be tested as mediators of the effects of objectiv indices of childhood SES on adult health. The approach is innovative, in the applicant's opinion, because it tests theory-based predictions for health disparities, leverages a diverse sample, and approaches the predictions at multiple time scales. The proposed research is significant because it is expected to advance and expand understanding of how SES disadvantage results in wide disparities in health. Such knowledge has the potential to direct interventions to the chronic stress pathways most predictive of daily and long-term health.