Cardiovascular Health: Effects of the Social and Physical Environment

心血管健康：社会和物理环境的影响

基本信息

批准号：
8461284
负责人：
Shakira Franco Suglia
金额：
$ 12.07万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-08-01 至 2015-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8461284
关键词：
Academy Address Adolescence Adolescent Adult Age Air Pollutants Air Pollution Alcohol consumption American Award Behavioral Blood Pressure C-reactive protein Cardiovascular Diseases Cardiovascular system Cause of Death Child Childhood Cholesterol Chronic Disease Clinical Clinical Investigator Collection Communities Complement Cross-Sectional Studies Data Development Development Plans Diet Disease Disease Outcome Environment Environmental Exposure Environmental Risk Factor Epidemiologic Studies Equation Exposure to Facility Accesses Family Fibrinogen Food Glycosylated hemoglobin A Goals Health Health behavior High Density Lipoproteins Individual Interpersonal Violence Intervention Knowledge LDL Cholesterol Lipoproteins Learning Life Cycle Stages Life Experience Longitudinal Studies Measures Mediating Mentors Metabolic Metabolic Diseases Modeling Neighborhoods Outcome Pathway interactions Pediatrics Physical activity Physical environment Physiological Play Practice Guidelines Prevention Prospective Studies Provider Psychosocial Factor Public Health Practice Recreation Research Research Design Research Personnel Research Project Grants Risk Risk Factors Role Schools Social Environment Socioeconomic Status Source Statistical Methods Statistical Models Stress Structure Surveys Time Tobacco use Toxic Environmental Substances Training Triglycerides Violence Work cardiovascular disorder prevention cardiovascular disorder risk cardiovascular risk factor career career development clinical practice cohort design disorder prevention experience fruits and vegetables low density lipoprotein triglyceride low socioeconomic status mortality novel psychosocial screening skills social social stress stressor waist circumference young adult

项目摘要

Childhood socioeconomic status (SES) has been associated with adult cardiovascular disease, but the mechanisms of how this occurs have not been fully explored. Furthermore, low SES is associated with the co-occurrence of multiple social (i.e., increased violence exposure), physical (i.e., higher air pollution levels, poor access to recreational facilities and access to fresh fruits and vegetables) and behavioral (i.e., poor diet, low physical activity, tobacco use) risk factors associated with cardiovascular disease. However, exposures to these factors during childhood and adolescence have not been evaluated with respect to their role in the development of metabolic and cardiovascular risk profiles in a prospective study. Given the complexity of interactions (individual and neighborhood, social and physical) a life course framework may be a fruitful approach to exploring the individual exposures and social attributes of neighborhoods that contribute to the development of metabolic and cardiovascular risk profiles. This proposal aims to examine the contribution of social stressors and physical environment experienced at both the individual and neighborhood level during adolescence, and their interactions on the development of cardiovascular and metabolic risk profiles (i.e., blood pressure, CRP, Hemoglobin A1c, BMI, waist circumference, total cholesterol, triglycerides, LDL, HDL, non-HDL cholesterol). The research goals of this proposal will be achieved with two projects. First, using the National Longitudinal Study of Adolescent Health (Add Health), a longitudinal cohort of adolescents followed through adulthood, I will employ a life course approach to determine whether social stressors (i.e., interpersonal violence, school and community violence) and physical environment (i.e., access to food stores, proximity to parks and recreation) experienced in adolescence plays a role in the development of metabolic and cardiovascular risk profiles in adulthood. Interactive effects between social and physical environmental factors will also be examined. Second, I will develop a primary collection cross-sectional study of 100 adolescents to examine the mediating effect of diet (not available in Add Health) and the modifying effects of air pollutants (also not available in the Add Health study) on the stress-cardiovascular health relationship. I will dedicate no less than 75 percent of my time to a highly structured and intensely focused research experience over the next 5 years, which will extend my expertise in characterizing social and environmental determinants as stressors in relation to physiological outcomes in children and young adults. A career development plan is outlined to gain practical skills in research design and implementation, expertise in statistical models to predict air pollutant levels and structural equation models as well as knowledge in the mechanisms of cardiovascular and metabolic disorders. The career development plan includes: 1) formal graduate course work in survey design, latent statistical models, mechanisms of cardiovascular disease, 2) tutorial with project advisor to learn clinical aspects of cardiovascular and metabolic disorders in adolescents 3) tutorial with advisor to discuss air pollutant modeling strategies 4) interactions with mentoring team to discuss research and career goals and project progress. I will work closely with the mentoring team which collectively has extensive experience in mentoring new clinical investigators, disparities in psychosocial factors, life experiences and cardiovascular disease outcomes, effects of neighborhood environment and cardiovascular disease, and disparities in physical environmental factors. The proposed training, consisting of interactions with mentors and advisors, tutorials and coursework, complements my previous training and experience in social and environmental epidemiologic research and will allow me to develop the necessary transdisciplinary expertise to achieve my goal and successfully transition to independent investigator at the end of this award. The proposed project will focus on a major health problem in the U.S. - cardiovascular disease, particularly its onset during the adolescent years and explore new models of how individual and community factors, in this case exposure to violence and environmental toxins, impact health outcomes. Findings from these studies can inform clinical practice in chronic disease prevention so that providers and policymakers alike can tailor age appropriate interventions to adolescents and young adults that jointly address the individual as well as the environmental context to more effectively reduce cardiovascular disease risk.

儿童期社会经济地位（SES）与成人心血管疾病有关，但是尚未完全探索这种发生的机制。此外，低SES与多种社交（即暴力暴露增加），身体（即更高的空气污染水平，不良的休闲设施获取以及获得新鲜水果和蔬菜的机会）以及行为（即饮食不良，饮食不良，身体活动低，烟草使用较低）的风险因素相关。但是，在一项前瞻性研究中，尚未在儿童期和青春期对这些因素进行暴露。鉴于互动的复杂性（个人和社区，社会和身体）的生活课程框架可能是探索邻里的个人暴露和社会属性的一种富有成果的方法，这些方法有助于发展代谢和心血管风险特征。 This proposal aims to examine the contribution of social stressors and physical environment experienced at both the individual and neighborhood level during adolescence, and their interactions on the development of cardiovascular and metabolic risk profiles (i.e., blood pressure, CRP, Hemoglobin A1c, BMI, waist circumference, total cholesterol, triglycerides, LDL, HDL, non-HDL cholesterol).该提案的研究目标将通过两个项目实现。首先，使用全国青少年健康纵向研究（Add Health），这是一群纵向的青少年群体，紧随其后的青少年群体，我将采用生活课程来确定社会压力源（即，社会压力群体（即人际暴力，学校和社区暴力和社区暴力）和物理环境（即对公园和招聘的访问）成年后的心血管风险特征。还将检查社会环境因素和身体环境因素之间的互动效果。其次，我将对100名青少年进行一项主要收集横截面研究，以检查饮食的介导作用（不提供健康）和空气污染物的修改作用（在添加健康研究中也不可用）对应激性血管血管性健康关系。在接下来的5年中，我将不少于75％的时间致力于一项高度结构化且浓厚的研究经验，这将扩大我将社会和环境决定因素描述为与儿童和年轻人生理结果有关的压力源的专业知识。概述了一项职业发展计划，以获得研究设计和实施方面的实践技能，统计模型中的专业知识，以预测空气污染物水平和结构方程模型以及心血管和代谢障碍机制的知识。职业发展计划包括：1）调查设计的正式研究生课程工作，潜在统计模型，心血管疾病机制，2）与项目顾问一起学习教程，以学习青少年中心血管和代谢障碍的临床方面3）与顾问的教程与顾问的教程，与顾问与顾问进行了与辅助建模策略相互作用的顾问，以讨论与培养团队相互作用，以讨论与培养团队相互作用，以讨论研究目标和项目进度和项目进度和项目进度。我将与指导团队紧密合作，该团队在指导新的临床研究人员，心理社会因素的差异，生活经历和心血管疾病结果，邻里环境和心血管疾病的影响以及身体环境因素的差异方面拥有丰富的经验。拟议的培训包括与导师和顾问的互动，教程和课程的互动，对我先前在社会和环境流行病学研究方面的培训和经验进行了补充，并将使我能够发展必要的跨学科专业知识，以实现我的目标，并在该奖项结束时成功地过渡到独立研究者。拟议的项目将重点介绍美国的主要健康问题 - 心血管疾病，尤其是在青少年时期的发作，并探索新的模型，即在这种情况下，在这种情况下，在这种情况下，如何影响暴力和环境毒素，会影响健康结果。这些研究的发现可以为慢性疾病预防的临床实践提供依据，以便提供者和决策者都可以针对年龄量身定制对青少年和年轻人的适当干预措施，这些干预措施共同解决了个人以及环境环境，以更有效地降低心血管疾病的风险。