Stress and Cardiovascular Risk Among Urban African American adults: A Multilevel, Mixed Methods Approach

尽管过去几年美国心血管疾病（CVD）的发病率和死亡率稳步下降， 几十年来，非洲裔美国人（AA）成年人承担了不成比例的心血管疾病（CVD）负担。 心理社会因素-包括邻里逆境，日常人际压力（即，种族 歧视，社会孤立，与他人的负面互动），以及对这些压力源的情绪反应- 被认为有助于心血管疾病的病因和进展，通过其对健康行为的影响， 应激反应神经内分泌轴和免疫过程。这些因素在以下方面尤为突出： 城市居住的中年和老年AA，他们经历了独特的压力源（例如，居住隔离， 种族歧视、偏见），更有可能生活在社会经济不利的情况下， 白人然而，心理社会因素及其与心血管疾病风险的联系，以及更广泛的炎症， 在成年的嗜酒者中研究不足对日常压力源、健康 行为和情绪反应，以及对情境背景的理解， 这些事件的发生将大大推进心血管疾病风险的科学。因此，拟议的 项目是通过一种混合方法来识别和概念化最重要的心理社会压力源。 突出的这一人群，并模拟日常心理，行为和生物途径， 这些因素可能会加剧中老年AA中的CVD风险。通过采用一种前瞻性的 (two两年内的波浪）和多时间尺度设计（嵌套在波浪中的每日评估），我们将 在底特律500名年龄在55-75岁之间的无症状AA样本中测试这一想法。我们还将使用半- 结构化访谈，从60名参与者那里收集定性数据，以将定量结果纳入背景。 我们的中心假设是，人际压力将预测静息心率变异性的降低， 静息血压升高、睡眠不良、慢性生理应激（毛发皮质醇）和炎症 （基础和刺激的细胞因子和基础CRP）通过改变日常情绪，日常健康行为和日常 生理应激（唾液皮质醇）。我们建议通过（1）使用 基于智能手机的生态瞬时评估协议，以测量心理社会压力，（2）包括 序贯解释混合方法设计，（3）采用多时间尺度研究设计， 标准化的措施，邻里剥夺创造特设底特律，和（4）同时 考虑到生理应激、炎症和CVD的替代终点的多种测量。的 提出这项研究的理由是，一旦清楚地了解了心血管疾病的日常心理社会风险因素， 制定，并确定其生物中介，更多的文化和个性化的治疗 可以用来减少这一人群的心血管疾病。

Despite the steady decline in cardiovascular diseases (CVD) morbidity and mortality in the US in the last few decades, African American (AA) adults bear a disproportionate share of cardiovascular disease (CVD) burden. Psychosocial factors—including neighborhood adversity, daily interpersonal stressors (i.e., racial discrimination, social isolation, negative interactions with others), and emotional reactivity to these stressors— are believed to contribute to the etiology and progression of CVD through their effects on health behaviors, the stress-responsive neuroendocrine axes, and immune processes. These factors are particularly salient for urban-dwelling middle-aged and older AAs, who experience unique stressors (e.g., residential segregation, racial discrimination, prejudice) and are more likely to live in situations of socioeconomic disadvantage than Whites. However, psychosocial factors and their link to CVD risk, and inflammation more broadly, have been remarkably understudied among AA adults. A fine-grained characterization of the daily stressors, health behaviors, and emotional responses related to CVD—and understanding of the situational contexts in which those occur—will significantly advance the science of CVD risk. Accordingly, the purpose of the proposed project is to identify and conceptualize—through a mixed-method approach—the psychosocial stressors most salient for this population and to model the daily psychological, behavioral, and biological pathways through which these factors may exacerbate CVD risk among middle-aged and older AAs. By adopting a prospective (two waves over two years) and multiple-time-scale design (daily assessments nested within waves), we will test this idea in a sample of 500 asymptomatic AAs aged 55-75 years living in Detroit. We will also use semi- structured interviews to collect qualitative data from 60 participants to contextualize the quantitative results. Our central hypothesis is that interpersonal stressors will predict decreases in resting heart rate variability and increases in resting blood pressure, poor sleep, chronic physiological stress (hair cortisol), and inflammation (basal and stimulated cytokines and basal CRP) by altering daily affect, daily health behaviors, and daily physiological stress (salivary cortisol). We propose to increase the innovation of our work by (1) using a smartphone-based ecological momentary assessment protocol to measure psychosocial stress, (2) including a sequential explanatory mixed-method design, (3) adopting a multiple-time-scale research design and a standardized measure of neighborhood deprivation created ad hoc for Detroit, and (4) simultaneously considering multiple measures of physiological stress, inflammation, and surrogate endpoints of CVD. The rationale for the proposed research is that once a clear picture of the daily psychosocial risk factors for CVD is formulated, and their biological intermediaries are identified, more culturally and individually tailored treatments can be developed to reduce CVD in this population.