Neighborhood Environments and Cardiometabolic Disorders in Hispanic/Latinos

 描述（由申请人提供）：需要新的多水平干预策略来对抗高度受影响人群中糖尿病、肥胖症及其相关合并症的迅速蔓延。邻里环境和拉丁裔健康只在一个大型队列研究中进行了研究，迄今为止，多种族研究动脉粥样硬化。我们提出了一项符合成本效益的辅助研究，以响应PAR-13-302，该研究利用了西班牙裔社区健康研究-拉丁美洲人研究（HCHS-SOL）的现有数据，同时将全面的社区环境评估和第2次身体活动评估添加到这项正在进行的队列研究中。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，患糖尿病和肥胖症等心脏代谢疾病的几率非常高。在这项研究中，我们将调查邻里环境对心脏代谢健康的影响HCHS/SOL圣地亚哥队列（N = 1750墨西哥裔美国人）使用创新和全面的社会生态模型，认为多个途径连接宏观和微观尺度的建成和社会邻里因素，心脏代谢健康使用纵向框架。将从2008-2011年（访视1）和2015-2018年（访视2）期间的综合临床评估中得出心脏代谢结局的6年轨迹。在访视1和2时，使用加速度计和经验证的自我报告评估体力活动。将在访视2时使用经验证的自我报告评估慢性压力和社会支持，而在两次访视时均评估抑郁症。宏观尺度邻域属性（例如，住宅密度、家庭收入中位数）将来自地理信息系统和公共来源数据，如美国社区调查，使用参与者住宅周围1公里的街道网络缓冲区。微尺度属性（例如，街道交叉口的安全性、美学/社会混乱）将使用参与者的邻居的系统直接观察来评估。将使用横截面和纵向结构方程模型来研究邻里环境对由代谢综合征组分（即，腰围、收缩压、HDL-胆固醇、空腹血糖和空腹甘油三酯）。正如在社会生态模型中所假设的那样，我们为这项研究提供了动力，以测试中介（通过上述行为和心理社会途径）和邻里属性之间的相互作用（例如，建立和社会）。通过提高对拉丁美洲健康的邻里影响的理解，该项目将告知高需求地区的健康支持性邻里干预措施，以及行为和心理社会干预措施，以尽量减少不支持邻里环境的负面健康影响。

 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.