A daily diary examination of the influence of intersectional stigma on blood pressure

每日日记检查交叉耻辱对血压的影响

基本信息

批准号：
10905159
负责人：
Billy A Caceres
金额：
$ 81.5万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-01 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10905159
关键词：
Adult Adverse effects Affect Affective Age Anxiety Area Behavior Therapy Behavioral Biological Markers Black race Blood Pressure Buffers Cardiovascular Diseases Cause of Death Chronic Collection Data Demographic Factors Diagnosis Discrimination Effectiveness Electronics Environment Event Exclusion Exposure to Face Future Gender Goals Guidelines Health Hearing High Prevalence Home Home Blood Pressure Monitoring Hydrocortisone Hypertension Individual Intervention Interview Lead Lesbian Lesbian Gay Bisexual Life Linear Models Link Mediating Mediator Mental Depression Methods Modeling New York City Outcome Participant Personality Persons Physical activity Physiological Policies Population Process Race Reporting Research Research Personnel Risk Reduction Salivary Sampling Sleep Disorders Social Identification Social status Social support Stigmatization Stress Structure Testing Tobacco use United States Woman Work Wrist actigraphy alpha-amylase cardiovascular disorder risk cardiovascular health cardiovascular risk factor diaries disability electronic structure ethnoracial expectation experience health disparity modifiable risk mortality neglect people of color perceived discrimination protective factors racial identity recruit rumination saliva sample sexual identity sexual minority social social determinants social health determinants social stigma stressor therapy design

项目摘要

Hypertension is the most important modifiable risk factor for cardiovascular disease (CVD), the leading cause of death and disability in adults worldwide. Stigmatized populations, such as people of color and sexual minority (e.g., gay/lesbian, bisexual) adults, have a higher prevalence of hypertension that is primarily attributed to greater exposure to stigma; a fundamental cause of health disparities. However, prior research on the effects of stigma on blood pressure (BP) has largely focused on enacted stigma (i.e., personally experienced discrimination) to the exclusion of other forms of stigma, such as anticipated (i.e., expectation of encountering discrimination) and vicarious (i.e., hearing/witnessing people like you being the target of discrimination) stigma. Most research in this area has focused on stigma due to a single stigmatized identity; an approach that ignores and obscures the experiences of groups that face intersecting forms of stigma. Given these limitations, we posit that researchers have previously underestimated the impact of stigma on BP. We have compelling pilot data showing that, independent of enacted stigma, greater report of daily intersectional anticipated stigma (attributed to any reason, such as race or sexual identity) is associated with higher home systolic BP (SBP; a stronger predictor of future CVD events than in-office SBP) among stigmatized adults. The overall goal of this 1-week daily diary study is to estimate the influence of intersectional anticipated and vicarious stigma on home BP. We will conduct the first study that triangulates robust methods to examine mechanisms linking daily and chronic anticipated and vicarious stigma with BP in individuals’ real-world environments. We will recruit a diverse sample of 400 adults (ages 18–39) without diagnosed hypertension or CVD. Participants will complete a structured interview followed by 1 week of twice-daily structured electronic diaries that will assess daily anticipated, vicarious, and enacted stigma, collection of saliva samples to assess salivary stress biomarkers, continuous wrist-worn actigraphy, and twice daily home BP monitoring. We will: 1) Determine the influence of intersectional anticipated and vicarious stigma on mean home SBP and mediators of these associations (e.g., salivary cortisol, physical activity, rumination) and 2) Examine differences in intersectional anticipated and vicarious stigma and mean home SBP across social identities (i.e., gender, ethnoracial, and sexual identity) and the intersections between them. We will also explore whether protective factors (i.e., social support and subjective social status) buffer (i.e., weaken) the influence of intersectional anticipated and vicarious stigma on mean home SBP. This study will provide the first evidence of mechanisms by which anticipated and vicarious stigma influence BP. If we find that anticipated and/or vicarious stigma influence BP—even in the absence of enacted stigma—it will shift how we think about the design of interventions for CVD risk reduction among stigmatized adults. This study is a critical step for identifying mechanistic targets for future interventions and policies to reduce the adverse effects of anticipated and vicarious stigma on cardiovascular health.

高血压是心血管疾病（CVD）最重要的可改变危险因素，而心血管疾病是导致心血管疾病的主要原因世界范围内受侮辱的人群（例如有色人种和性取向人群）的死亡和残疾。少数族裔（例如男同性恋/女同性恋、双性恋）成年人的高血压患病率较高，这主要是归因于更多的耻辱；然而，先前的研究表明，这是造成健康差异的根本原因。耻辱对血压 (BP) 的影响主要集中在所制定的耻辱上（即个人经历过的）歧视），排除其他形式的耻辱，例如预期（即预期会遇到）歧视）和替代（即听到/目睹像您这样的人成为歧视的目标）该领域的大多数研究都集中在由于单一的污名化身份而产生的耻辱上；鉴于这些限制，忽视并掩盖了面临交叉形式耻辱的群体的经历。我们认为研究人员之前低估了耻辱对 BP 的影响。试点数据显示，与已制定的耻辱无关，每日交叉预期耻辱的报告更多（归因于任何原因，例如种族或性别认同）与较高的家庭收缩压（SBP；a 在受到污名化的成年人中，对未来 CVD 事件的预测能力比在诊室 SBP 更强。为期 1 周的每日日记研究旨在评估交叉预期耻辱和替代耻辱对家庭的影响 BP。我们将进行第一项研究，对稳健的方法进行三角测量，以检查日常和日常活动之间的联系机制。我们将招募一名在个人现实环境中长期预期和替代性的 BP 耻辱。参与者将完成 400 名未诊断出高血压或 CVD 的成年人（18-39 岁）的不同样本。结构化面试，然后是为期 1 周、每天两次的结构化电子日记，每天进行评估预期的、替代的和实施的耻辱，收集唾液样本以评估唾液应激生物标志物，连续腕戴式体动记录仪，以及每天两次家庭血压监测我们将： 1) 确定以下因素的影响。对平均家庭 SBP 和这些关联的中介者的交叉预期和替代耻辱（例如， 2）检查交叉预期的差异跨社会身份（即性别、民族和性身份）的替代耻辱和平均家庭 SBP 以及我们还将探讨它们之间的交叉点是否是保护性因素（即社会支持和主观社会地位）缓冲（即削弱）交叉预期和替代耻辱的影响这项研究将提供预期和替代机制的第一个证据。如果我们发现预期的和/或替代的耻辱会影响血压——即使没有。制定的耻辱——它将改变我们对降低 CVD 风险干预措施设计的看法这项研究是确定未来干预措施和目标的关键一步。减少预期和间接耻辱对心血管健康的不利影响的政策。