Urban residents with low incomes and of ethnic minority background are highly likely to experience significant chronic exposure to major life stressors and to traumatic stress.^^""""""""^''Although research on health disparities has at times focused on major life stress, there has been relatively little focus on traumatic stress, and again, are much more likely than higher income and majority population members to be exposed to traumatic stressors.[24,25] Key to the association with health, both major life stressors and traumatic stressors are likely to increase lifetime depression, anxiety, and post-traumatic stress (PTS) symptoms.[25,26] Further, major life and traumatic stressors may both indirectly affect physical health through their influence on behaviors, including drug and alcohol use, smoking, sleep disturbance, avoidance of exercise (for legitimate fear of places to exercise due to dangerous neighborhoods)[27-29], as well as directly affect physical health through their influence on down regulation of the immune system and inflammatory processes.[30-32] Both down regulation of.the immune system and inflammatory processes have been linked with cardiovascular disease, obesity, diabetes, and blood pressure.[30,33-38] These processes have only begun to be studied and have seldom been study in applied health contexts. Critically, they have not to our knowledge been studied uniformly across several health interventions in order to explore their impact. For the purposes of this grant it is helpful to define our key terms around stress: Major life stressors are objective events that threaten or produce profound negative adaptational consequences in most individuals or that threaten or produce profound losses of objects, situations or persons that are highly valued by most individuals.[39] These include, but are not limited to, loss of employment, loss of a loved one, major health problems, divorce or separation from a loved one, and severe economic problems. Traumatic stressors are shocking and emotionally ovenwhelming events that are typically experienced with intense fear, horror, numbness, or helplessness. These events usually involve actual or threatened death, serious injury, or sexual or other physical assault. They can be one-time occurrences, such as a natural disaster, rape, violent assault, or a motor vehicle accident, or be ongoing and chronic, such as the case of domestic violence or combat exposure.[40]

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Mangla, Ashvarya; Doukky, Rami; Richardson, DeJuran et al. (2018) Design of a bilevel clinical trial targeting adherence in heart failure patients and their providers: The Congestive Heart Failure Adherence Redesign Trial (CHART). Am Heart J 195:139-150
Appelhans, Bradley M; Martin, Molly A; Guzman, Marieli et al. (2018) Development and Validation of a Technology-Based System for Tracking and Reporting Dietary Intake at School Meals. J Nutr Educ Behav 50:51-55.e1
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Stevens, N R; Lillis, T A; Wagner, L et al. (2017) A feasibility study of trauma-sensitive obstetric care for low-income, ethno-racial minority pregnant abuse survivors. J Psychosom Obstet Gynaecol :1-9
Lynch, Elizabeth; Mack, Laurin J; Karavolos, Kelly et al. (2017) Recruitment and Baseline Characteristics of Participants in the Lifestyle Improvement Through Food and Exercise (LIFE) Study. J Health Care Poor Underserved 28:463-486
Martin, Molly A; Floyd, Eleanor C; Nixon, Sara K et al. (2016) Asthma in Children With Comorbid Obesity: Intervention Development in a High-Risk Urban Community. Health Promot Pract 17:880-890
Doukky, Rami; Mangla, Ashvarya; Ibrahim, Zeina et al. (2016) Impact of Physical Inactivity on Mortality in Patients With Heart Failure. Am J Cardiol 117:1135-43
Taylor-Clift, April; Hobfoll, Stevan E; Gerhart, James I et al. (2016) Posttraumatic stress and depression: potential pathways to disease burden among heart failure patients. Anxiety Stress Coping 29:139-52

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