Positive Social Determinants of Health and Blood Pressure among Young Black Women with a History of Early Life Stress

摘要 黑人妇女是美国所有其他种族和民族中高血压患病率最高的群体之一 在全世界，高血压是其他形式心血管疾病(CVD)的主要危险因素，如中风。 20年来的健康差距研究主要集中在研究黑人的健康行为上 患有高血压的女性，她们的血压或整体简历健康几乎没有改善。一个 心血管疾病研究的新兴领域表明，早期生活压力，如严重的家庭功能障碍和儿童 虐待，即使在控制了传统的危险行为后，单独地也会使心血管疾病的几率增加一倍。然而， 很少有研究调查黑人女性早期生活压力和高血压的潜在联系。 更少的研究使用基于优势的方法来理解早期经历的黑人女性 生活压力大，但要保持健康的血压。个人、家庭和社区的支持是积极的社会支持 健康的决定因素可能共同作用以缓冲早期生活压力对血液的负面影响 黑人女性的压力，但我们对这些关系知之甚少。为了填补这一空白，这个项目的总体目标是 描述性、相关性研究是考察早期生活压力的影响，定义为暴露在不利的环境中 关于高血压的儿童事件(ACE)，并确定积极的社会决定因素在多大程度上 使用对900名24岁年轻黑人女性14年随访的数据，健康抵消了ACE的影响。 32岁，他参与了全国青少年至成人健康纵向研究。这样做的具体目的是 研究的目的是(1)确定健康的累积积极社会决定因素之间的关系 个人(精神)、家庭(父母关系)和社区(社会关系)的水平和严重程度 早期生活压力(ACE)对黑人女性血压和无高血压的影响 有经验的王牌；以及(2)探索健康和健康的每个积极社会决定因素的个人贡献 早期生活应激(ACE)对血压的严重程度以及患有高血压的黑人女性是否患有高血压 王牌的历史。这项研究可能有助于改变健康差距研究的范式，将重点放在利用 这些优势可能会为未来量身定做的、对文化敏感的干预措施提供参考，以改善黑人女性的简历健康。 除了支持完成拟议的研究外，这项研究金还将支持发展 独立科学家通过在健康公平研究、辅助数据方面提供广泛的1：1指导和培训 分析大数据集，传播科学知识。这些目标将在一个强有力的基础上实现 美国国立卫生研究院资助历史悠久的研究环境。在社区中建立强大的临床基础- 以初级保健为基础，该奖学金将为申请者提供为博士后准备的研究培训 在拟议的研究基础上建立的联谊会，以检查基因-环境相互作用和人群中的心血管疾病 一种颜色。奖学金和培训目标将培养申请者在心血管疾病、生物效应方面的专业知识 对妇女健康的压力，以及使用大型数据库回答严格的研究问题。

ABSTRACT Black women have among the highest prevalence of hypertension of all other racial and ethnic groups in the world, and hypertension is a primary risk factor for other forms of cardiovascular disease (CVD) such as stroke. Twenty years of health disparities research has largely focused on studying the health behaviors of Black women with hypertension with little improvement in either their blood pressure or their overall CV health. An emerging area of CVD research shows that early life stress, like severe household dysfunction and child maltreatment, independently doubles the odds of CVD even after controlling for traditional risk behaviors. Yet, few studies have investigated the potential association of early life stress and hypertension in Black females. Even fewer studies have used a strengths-based approach to understand Black females who experience early life stress but maintain a healthy blood pressure. Individual, family and community supports are positive social determinants of health that may work together to buffer the negative effects of early life stress on blood pressure in Black females, but we know little about these relationships. To fill this gap, the overall goal of this descriptive, correlational study is to examine the influence of early life stress, defined as exposure to adverse childhood events (ACEs), on hypertension and determine the extent to which positive social determinants of health counter the effects of ACEs using data from 14 years of follow-up in 900 young Black women, ages 24- 32, who participated in the National Longitudinal Study of Adolescent to Adult Health. The specific aims of this study are to (1) determine the relationship between cumulative positive social determinants of health at the individual (spirituality), family (parental relationships), and community (social connections) levels and severity of early life stress (ACEs) on both blood pressure and the absence of hypertension among Black females who experienced ACEs; and (2) explore the individual contribution of each positive social determinant of health and severity of early life stress (ACEs) on blood pressure and the absence of hypertension among Black females with a history of ACEs. This study may help to shift the paradigm of health disparities research to focus on leveraging strengths that may inform future tailored, culturally sensitive interventions to improve the CV health of Black women. In addition to supporting completion of the proposed study, this fellowship will support the development of an independent scientist by providing extensive 1:1 mentoring and training in health equity research, secondary data analysis of large datasets, and dissemination of scientific knowledge. These goals will be achieved in a strong research environment with a long history of NIH funding. Building on a strong clinical foundation in community- based primary care, this fellowship will provide the applicant with research training to prepare for a postdoctoral fellowship that builds on the proposed study to examine gene-environment interactions and CVD in populations of color. The fellowship and training goals will cultivate the applicant’s expertise in CVD, the biological effects of stress on women’s health, and the use of large databases to answer rigorous research questions.