Social Vulnerability, Sleep, and Early Hypertension Risk in Younger Adults

年轻人的社会脆弱性、睡眠和早期高血压风险

基本信息

批准号：
10643145
负责人：
Allison Gaffey
金额：
$ 17.25万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-06-01 至 2028-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10643145
关键词：
Address Adherence Adolescence Adult Advisory Committees Affect Age Behavior Therapy Behavioral Behavioral Mechanisms Blood Pressure Cardiovascular Diseases Cessation of life Childhood Clinical Communities Complement Coronary Artery Risk Development in Young Adults Study Data Development Discrimination Early identification Elderly Elements Ensure Environment Epidemiology Estrogens Exhibits Feasibility Studies Financial Hardship Foundations Frequencies Functional disorder Future Gender Guidelines Home Home Blood Pressure Monitoring Hypertension Incidence Individual Interview K-Series Research Career Programs Knowledge Life Life Stress Measures Mediating Mediation Menopause Mentored Patient-Oriented Research Career Development Award Mentors Methods Observational Study Outcome Patient Self-Report Persons Phenotype Physiological Pilot Projects Polysomnography Premenopause Prevalence Prevention Public Health Research Research Personnel Resources Risk Role Sampling Science Sleep Sleep Deprivation Source Statistical Models Stress Testing Time Training Trauma Woman acceptability and feasibility adverse childhood events aged behavioral health intervention blood pressure elevation cardiovascular disorder prevention cardiovascular disorder risk cardiovascular risk factor care giving burden career disorder prevention early onset evidence base experience health disparity improved medical schools men middle age multidisciplinary neglect novel patient oriented premature prospective public health intervention recruit risk mitigation satisfaction sex skills sleep health social social factors social health determinants social vulnerability trauma exposure young adult

项目摘要

PROJECT SUMMARY/ABSTRACT This K23 Career Development Award will support Dr. Allison Gaffey’s development into an independent patient-oriented investigator with a focus on women’s risk for hypertension (HTN) and cardiovascular disease (CVD), the contributions of social vulnerability (SV; e.g., stress from adverse childhood and adult exposures, and from social determinants of health) and insufficient sleep (e.g., short sleep duration) to this risk, and the identification of early opportunities to mitigate this risk. By age 35, women begin to show a steeper annual increase in blood pressure (BP) than men and over 1 in 3 premenopausal women exhibit an early stage HTN phenotype (i.e., elevated BP or Stage 1 HTN). SV and short sleep duration - each amenable to behavioral and public health interventions - are especially impactful for women, and may contribute to this observed, yet underappreciated BP increase prior to menopause. The K23 Award will ensure that Dr. Gaffey develops the knowledge and skills to investigate the social and behavioral determinants of early risk for HTN, to improve related behavioral CV prevention for women. In the resource rich environment of the Yale School of Medicine, Dr. Gaffey has assembled a multidisciplinary mentoring and advisory team to facilitate her transition to independence via training in: (1) the pathophysiology of BP, HTN, and CVD, including associations unique to women; (2) physiological and behavioral mechanisms of sleep, state-of-the-art sleep measurement, and sleep health disparities, including those specific to women; (3) social determinants of health in CV epidemiology, including associations unique to women; and (4) statistical modeling of longitudinal and repeated sampling data. Dr. Gaffey’s training will be complemented by a novel plan of research: (AIM 1) With longitudinal data from the Coronary Artery Risk Development in Young Adults Study (CARDIA), test associations of SV and self- reported sleep duration to: a) the onset of early stage HTN phenotypes, and b) the rate of BP change from early- to mid-adulthood. Analyses will be stratified by sex. (AIM 2) Limitations of CARDIA will be addressed by conducting a mixed methods, pilot study with a community sample of premenopausal women and same-aged men to, a) test short-term associations of home BP to SV-related stress exposures and ecologically, objectively assessed sleep duration; and b) qualitatively assess personal experiences of SV-related stress, barriers to sleep, and study feasibility/acceptability. Outcomes will include within-person variability in stress, sleep, and BP associations over time, contextual themes to inform future assessment of SV, stress, and sleep, and rates of recruitment, adherence, retention, and satisfaction. This K23 builds logically on Dr. Gaffey’s prior research and clinical background and provides her with the requisite expertise and evidence base to prepare a later R01 application to collect more comprehensive, objective, and ‘real-world’ assessments of SV, sleep, and BP. This knowledge will simultaneously address critical gaps concerning BP progression in younger adults and advance Dr. Gaffey’s planned career objective to identify earlier opportunities for HTN and CVD prevention in women.

项目概要/摘要该 K23 职业发展奖将支持 Allison Gaffey 博士发展成为独立的以患者为中心的研究者，重点研究女性患高血压 (HTN) 和心血管疾病的风险（CVD），社会脆弱性的贡献（SV；例如，来自不良童年和成人暴露的压力，以及健康的社会决定因素）和睡眠不足（例如睡眠时间短）导致这种风险，以及尽早发现降低这种风险的机会到了 35 岁，女性开始表现出更陡峭的年度风险。血压 (BP) 比男性升高，超过三分之一的绝经前女性表现出早期高血压表型（即血压升高或 1 期高血压 SV 和睡眠时间短） - 每种情况都受行为和行为影响。公共卫生干预措施——对女性尤其有影响，并可能促成这一观察到的结果 K23 奖将确保加菲博士开发出更年期之前被低估的血压升高。调查高血压早期风险的社会和行为决定因素的知识和技能，以改善在耶鲁大学医学院资源丰富的环境中，针对女性的相关行为心血管疾病预防。加菲博士组建了一支多学科指导和咨询团队，以帮助她过渡到通过以下方面的培训获得独立性：(1) BP、HTN 和 CVD 的病理生理学，包括独特的关联（2）睡眠的生理和行为机制、最先进的睡眠测量和睡眠 (3) CV流行病学中健康的社会决定因素，包括与女性的独特关联；(4) 纵向和重复抽样的统计模型加菲博士的培训将得到一项新颖的研究计划的补充：（目标 1）纵向数据。来自年轻人冠状动脉风险发展研究 (CARDIA)，测试 SV 和自我相关性报告睡眠持续时间：a) 早期 HTN 表型的出现，b) 血压变化率分析将按性别分层（AIM 2）。对绝经前妇女和同龄社区样本进行混合方法试点研究男性，a) 测试家庭血压与 SV 相关压力暴露的短期关联，并以生态的方式客观地进行测试评估睡眠持续时间；和 b) 定性评估与 SV 相关的压力、障碍的个人经历睡眠，研究的可行性/可接受性将包括人体内压力、睡眠和睡眠的差异。随时间变化的 BP 关联、为未来评估 SV、压力和睡眠以及比率提供信息的背景主题该 K23 逻辑上建立在加菲博士之前的研究基础上。和临床背景，并为她提供必要的专业知识和证据基础，以准备以后的 R01 应用程序收集更全面、客观和“真实”的 SV、睡眠和血压评估。知识将同时解决有关年轻人血压进展的关键差距并推进加菲博士的职业目标是发现早期预防女性高血压和心血管疾病的机会。