Developing Novel Intervention Approaches to Mitigate Cardiovascular Risk among Young African-American Women

项目总结 高血压导致其他慢性病的高发病率和死亡率，包括 心血管疾病、肥胖、糖尿病和终末期肾病。非裔美国人(AA)更有可能 与其他种族/民族相比，患有高血压的年龄更小，尽管 治疗率越低，血压就越不可能得到控制。性别上的种族差异仍然存在-AA女性 与白人相比，他们患高血压的几率更高，发病更早。经验和经验 压力，包括与种族和性别有关的压力，以及与压力有关的应对被认为是这些问题的根源 差距。非裔美国女性表现出更大的压力，这从更高的非稳态负荷上得到了证明 相对于男性和白人的生命历程。更高的发病率和更早的高血压发作使 年轻的再生障碍性贫血妇女是预防的主要目标；然而，有效预防的发展侧重于 由于对这一亚组潜在机制的了解有限，干预措施受到抑制。要填补这些关键信息 为了弥补差距，本提案将使用顺序混合方法，包括以下内容：1)量化压力 使用14天生态瞬时评估(EMA)方案的活体反应，24小时生理 监测；以及2)开发和测试压力的可行性、可接受性和初步效果 可减轻慢性应激对年轻人血压水平影响的管理干预 AA级的女人。 这项指导职业发展奖的候选人Anika L.Hines博士是一名助理教授 弗吉尼亚联邦大学医学院的健康行为和政策。她长期的职业生涯 目标是：1)成为一名独立的调查者，解释压力的复杂和累积影响 在健康差距背景下的种族/族裔少数群体的生活经历；和2)设计和 实施以证据为基础的创新干预措施和政策，通过 跨学科、社会生态学的方法。在这个奖项中，海因斯博士将经历严格的说教和 研究培训，包括授课课程、体验式实验室培训和实践研究体验， 将大大提高她在干预开发和进行随机对照试验方面的技能 行为干预。这些职业发展活动将在丰富的培训范围内进行 弗吉尼亚州最大的学术医疗中心的环境，由导师、顾问和 具有多层次和行为干预、循证行为医学专业知识的合作者 途径、种族相关压力、定性方法、将压力与心血管联系起来的生理途径 风险、高级统计分析、卫生公平和赠款发展。这些活动将为海因斯博士提供 拥有坚实的基础，以确保她成功过渡到一名独立的、跨学科的调查员 完全有能力进行行为干预试验，以服务于健康公平。

PROJECT SUMMARY Hypertension contributes to high rates of morbidity and mortality of other chronic conditions, including cardiovascular disease, obesity, diabetes, and end stage renal disease. African Americans (AAs) are more likely to develop high blood pressure and at a younger age compared to other racial/ethnic groups, and despite higher treatment rates, are less likely to have blood pressure under control. Racial disparities persist by sex—AA women have higher incidence of hypertension and earlier onset compared to their white counterparts. Experiences of stress, including race- and gender-related stress, and stress-related coping are thought to be at the root of these disparities. African American women demonstrate greater stress as evidenced by higher allostatic load over the life course relative to male and white counterparts. Higher incidence and earlier onset of hypertension make younger AA women a prime target for prevention; however, the development of effective prevention-focused interventions is inhibited by limited understanding of underlying mechanisms in this subgroup. To fill these critical gaps, this proposal will use a sequential mixed methods approach, including the following: 1) quantifying stress responses in vivo using a 14-day ecological momentary assessment (EMA) protocol with 24-hour physiological monitoring; and 2) developing and testing the feasibility, acceptability and preliminary efficacy of a stress management intervention that may mitigate the effects of the chronic stress on blood pressure levels in young AA women. The candidate for this mentored Career Development Award, Dr. Anika L. Hines, is an Assistant Professor in Health Behavior and Policy at the Virginia Commonwealth University School of Medicine. Her long term career goal is to: 1) become an independent investigator who explicates the complex and cumulative effects of stress in the lived experiences of racial/ethnic minorities within the context of health disparities; and 2) design and implement innovative, evidence-based interventions and policies to address these stressors using an interdisciplinary, socioecological approach. During this award, Dr. Hines will undergo rigorous didactic and research training, including an didactic courses, experiential lab training, and practical research experience, that will substantially build her skills in intervention development and the conduct of randomized controlled trials for behavioral interventions. These career development activities will be conducted within the rich training environment of Virginia's largest academic medical center with direct guidance from mentors, advisors, and collaborators with expertise in multi-level and behavioral interventions, evidence-based behavioral medicine approaches, race-related stress, qualitative methods, physiological pathways linking stress and cardiovascular risks, advanced statistical analyses, health equity, and grant development. These activities will provide Dr. Hines with a solid foundation to ensure her successful transition to an independent, interdisciplinary investigator who is well equipped to conduct behavioral intervention trials in service of health equity.