Mexican Americans display elevated social (e.g., low socioeconomic status;SES) and metabolic (e.g., obesity;metabolic syndrome;MetSyn) risk factors for cardiovascular disease (CVD). Mexican-American women also evidence a high burden of obesity (45% versus 33%) and MetSyn (42% versus 32%) when compared to non-Latino white women. Women are more vulnerable than men to low SES, stress, and negative emotions, and Mexican American women may experience additional psychosocial risks specific to their sociocultural milieu. Very few prospective studies have examined SES, psychosocial and behavioral factors, and cardiometabolic risk progression over time, particularly in high-risk ethnic minority populations. This competing renewal application builds on 1R01HL081604, which enrolled 304 SES-diverse, randomly selected Mexican-American women (aged 40-65 years) from South San Diego communities to participate in a rigorous, multi-method assessment of socioeconomic and psychosocial factors, lifestyle pathways, and established CVD risk factors (e.g., blood pressure, lipids, obesity, fasting glucose levels), novel inflammatory biomarkers, and ambulatory blood pressure (AmBP) levels and diurnal rhythm. Guided by the Reserve Capacity Model, which highlights psychosocial risk (stress, negative emotions) and protective factors (inter- and intra-personal resources, i.e., "reserve capacity") in SES disparities, the study has identified SES gradients in MetSyn variables, inflammatory markers, and AmBP levels and nocturnal dipping in Latinas, and has shown that psychosocial (negative emotions, resources) and behavioral factors (obesity, diet) contribute to these gradients. Findings also reveal variability in SES gradients by acculturation (defined by language preference) and suggest the need to look beyond traditional psychosocial factors to better understand cardiometabolic risk in Mexican-American women. The current study proposes a 6-yr follow-up assessment (Time 2;expected N=280) to examine predictors of cardiometabolic risk progression in the Nuestra Salud cohort. In addition to re-examining Time 1 indicators, the Time 2 protocol will add new measures of culturally driven psychosocial factors and objective measures of physical activity and sleep to examine their contributions to cardiometabolic risk progression and its social patterning in Mexican American women. Community based participatory research strategies will inform project implementation and ensure representation of psychosocial issues most relevant to Mexican American women. The overarching aim of the study is to examine associations among SES, traditional and culturally driven psychosocial risk and protective factors, lifestyle factors, and 6-yr cardiometabolic risk progression, via structural equation models guided by a culturally enhanced Reserve Capacity Model. The study will advance understanding of modifiable psychosocial and behavioral risk and protective factors that shape cardiometabolic risk progression and its social patterning in Mexican American women, to provide a basis for culturally appropriate strategies to improve health in this at-risk, underserved, and growing U.S. population subgroup.
Little is known about how socioeconomic status (e.g., income), stress, emotions, relationships, and culture affect health in Mexican-Americans, the largest subgroup in the rapidly growing U.S. Latino population. The proposed research will examine how such variables affect cardiovascular disease (CVD) risk in Mexican- American women. The research will help identify modifiable factors that protect or augment risk for CVD, thereby providing a basis for the development of culturally-competent programs and policy strategies to improve health and reduce disparities in this underserved Latino subgroup.
|Gallo, Linda C; Fortmann, Addie L; Mattei, Josiemer (2014) Allostatic load and the assessment of cumulative biological risk in biobehavioral medicine: challenges and opportunities. Psychosom Med 76:478-80|