Social Contexts, Stress and Non-Communicable Disease Risk Factors across the Life Course: A Pilot Study in Nicaragua

项目摘要 尼加拉瓜是一个低收入国家，在那里流行病和营养转型已经根深蒂固。非- 传染病(NCDs)现在占所有死亡人数的73%，心血管疾病位居首位 单子。与其他低收入和中等收入国家一样，预防非传染性疾病是解决这一健康问题的关键。 鉴于卫生部门和可用于治疗非传染性疾病的以家庭为基础的资源有限，这是一场危机。然而，最近 尼加拉瓜针对非传染性疾病的研究和政策努力侧重于描述比率和需求 在成人人群中治疗非传染性疾病，很少关注非传染性疾病危险因素的社会和经济预测因素 或更早的生命历程阶段。青春期是生命过程中的一个阶段，涉及到危险的健康 与多种非传染性疾病相关的行为和健康状况的出现。重要的是我们要了解 与成年前这一阶段的非传染性疾病风险因素相关的社会背景。此外，尼加拉瓜有一个 是该地区青少年出生率最高的国家之一，这表明非传染性疾病的危险因素可能是生物学上的 在现阶段，非传染性疾病通过出生嵌入，有助于尼加拉瓜未来非传染性疾病的增加。 我们建议通过与当地研究机构中心合作进行能力建设研究 人口与健康研究(CIDS)，在尼加拉瓜莱昂，以实施纵向、以人口为基础的 研究青少年及其照顾者的社会/经济不安全感、压力和非传染性疾病风险因素。 这项研究建立在2012年采访的近500名儿童和照顾者的现有队列基础上，以提供 随着儿童进入青春期，出现了对非传染性疾病相关风险因素的新关注。这方面的关键风险因素 青春期包括吸毒、心理健康状况差、BMI高等阶段。我们将与照顾者跟进。 以及确定他们的非传染性疾病健康风险在7年内的变化。此外，我们将确定 通过评估青少年的心理社会压力，慢性应激在非传染性疾病危险因素发展中的作用 和他们的照顾者，收集一种新的慢性应激暴露的生理标记物-头发皮质醇-in 青少年。通过联合研究和能力建设努力，犯罪信息中心将开发其电子数据 收集和统计分析能力，将在本次研究和未来的发展中得到应用 尼加拉瓜的非传染性疾病研究。

Project Summary Nicaragua is a low-income country where epidemiological and nutrition transitions have taken hold. Non- communicable diseases (NCDs) now account for 73% of all deaths, with cardiovascular diseases topping the list. As in other low- and middle-income countries (LMICs), prevention of NCDs is key to addressing this health crisis, given the limited health sector and family-based resources available to treat NCDs. Yet the recent research and policy efforts addressing NCDs in Nicaragua have focused on describing the rates and the need to treat NCDs in the adult population, with little attention to social and economic predictors of NCD risk factors or earlier life course stages. Adolescence is a period of the life course involving the adoption of risky health behaviors and the onset of health conditions related to multiple NCDs. It is critical that we understand the social contexts associated with NCD risk factors in this stage preceding adulthood. Further, Nicaragua has one of the highest adolescent birth rates in the region, suggesting that NCD risk factors may be biologically embedded through births at this stage, contributing to future increases in NCDs in Nicaragua. We propose capacity-building research by working with a local research organization, the Center for Demographic and Health Research (CIDS), in León, Nicaragua, to implement a longitudinal, population-based study of social/economic insecurities, stress and NCD risk factors among adolescents and their caregivers. This study builds on an existing cohort of almost 500 children and caregivers interviewed in 2012, to provide a new focus on NCD-related risk factors emerging as the children enter adolescence. Key risk factors at this stage include substance use, poor mental health, high BMI in adolescence. We will follow up with caregivers as well to determine changes in their NCD health risks over the 7-year period. Further, we will determine the role of chronic stress in the development of NCD risk factors by assessing psychosocial stress in adolescents and their caregivers and collecting a novel physiological marker of chronic stress exposure—hair cortisol—in adolescents. Through joint research and capacity building efforts, CIDS will develop their electronic data collection and statistical analysis abilities, which will be applied in this study and the development of future NCD research in Nicaragua.