The role of social factors in cardiovascular risk behaviors disparities

描述(由申请人提供)：与最高收入阶层相比，低收入美国人心血管死亡风险高出2.5倍，证明了心血管(CV)疾病的社会经济差异。尽管人们清楚地认识到社会环境可能影响心血管疾病的风险，并日益重视差异研究，但人们对导致社会经济差异的潜在社会途径知之甚少，而且心血管疾病的社会经济差异在过去30年里只扩大了。许多心血管危险行为存在社会经济差异，包括吸烟、缺乏体育活动和水果和蔬菜摄入不足，这些差异导致心血管疾病的社会经济梯度。这些行为是由社会环境资源因素塑造的，包括社会支持、孤独和邻里社会凝聚力。这三种社会环境资源措施与心血管疾病发病率独立相关，但它们在心血管危险行为中的作用尚不清楚。此外，社会资源之间的相互作用很可能产生“乘数效应”，即净效应大于个体效应的总和。然而，很少有研究利用生态学框架来同时确定这些影响的程度。此外，这些社会资源衡量指标往往与社会经济地位(SEP)相关，表明这些资源可能代表着根本的社会不平等。这项研究的目的是考察SEP和三个不同但相关的社会资源指标-社会支持(包括情感和工具)、孤独和邻里社会凝聚力-与CV风险行为结果(吸烟、缺乏体力活动和水果和蔬菜摄入不足)之间的关系。本研究的目的是：1)在控制混杂因素后，考察社会支持、孤独感和邻里社会凝聚力与心血管危险行为的关系。2)探讨社会支持、孤独感和邻里社会凝聚力与心血管危险行为的交互作用。3)确定社会支持、孤独感和邻里社会凝聚力对心血管危险行为SEP梯度的贡献。这项研究将使用动脉粥样硬化多种族研究获得的横断面数据，这是一项前瞻性队列研究，对来自美国六个地点的6814名没有明显心血管疾病的成年人进行了基于人群的多样化样本研究。在生态框架的基础上，将使用多层次统计建模技术来检验SEP和三种社会资源措施的拟议的相互关系。 公共卫生相关性：这项研究的结果将阐明导致社会经济CV风险行为差异的途径，以响应NINR研究的优先领域，这一知识可能会为未来对其他健康差异的研究提供信息。这一知识对于临床医生和研究人员发展基于社会和情境的行为干预也很重要，满足了健康行为研究的关键需求。此外，这些发现可能被用来改进患者倡导和形成政策，以在社会层面上解决健康差距问题。

DESCRIPTION (provided by applicant): Socioeconomic disparities in cardiovascular (CV) disease are evidenced by a 2.5 times higher risk of cardiovascular mortality for low-income Americans, when compared to those in the highest income bracket. Despite well-documented awareness that social environments can influence CV disease risk, and the increasing attention given to disparities research, there is relatively little knowledge of the underlying social pathways contributing to socioeconomic disparities, and socioeconomic disparities in CV disease have only widened in the last three decades. Socioeconomic disparities exist for many CV risk behaviors, including smoking, lack of physical activity and insufficient fruit and vegetable intake, and these disparities contribute to socioeconomic gradients in CV disease. These behaviors are shaped by social environmental resource factors, including social support, loneliness and neighborhood social cohesion. These three social environmental resource measures are independently associated with CV morbidity, but their role in CV risk behaviors is not well understood. Also, interaction between social resources is likely to have a "multiplier effect", where the net effect is greater than the sum of the individual effects. However, few studies utilize an ecological framework to identify the magnitude of these effects simultaneously. Furthermore, these social resource measures are often correlated with socioeconomic position (SEP), indicating that the resources may represent a fundamental social inequality. The purpose of this study is to examine the relationships among SEP and three distinct, but related, measures of social resources - social support (both emotional and instrumental), loneliness and neighborhood social cohesion - with CV risk behavior outcomes (smoking, lack of physical activity, and insufficient fruit and vegetable intake). The aims of this study are: 1) To examine associations of social support, loneliness and neighborhood social cohesion with CV risk behaviors after controlling for confounders. 2) To explore the interactions of social support, loneliness and neighborhood social cohesion as they relate to CV risk behaviors. 3) To determine the contributions of social support, loneliness and neighborhood social cohesion to SEP gradients in CV risk behaviors. This study will use cross-sectional data obtained by the Multi-Ethnic Study of Atherosclerosis, a prospective cohort study of a diverse, population-based sample of 6814 adults without apparent CVD from six US sites. Multi-level statistical modeling techniques will be used to test the proposed inter-relationships of SEP and the three social resource measures, based on an ecological framework. PUBLIC HEALTH RELEVANCE: Results of this study will elucidate the pathways that contribute to socioeconomic CV risk behavior disparities, responding to a NINR research priority area, and this knowledge may inform future research into other health disparities. This knowledge also is important for the development of socially and contextually based behavioral interventions for clinicians and researchers, meeting a critical need in health behavior research. Moreover, these findings may be used to improve patient advocacy and shape policies to address health disparities at a societal level.