The Strong African American Families Healthy Adult Project (SHAPE) followed 493 African American youth from ages 11 to 20. Participants have grown up in rural Georgia communities in which poverty rates for African Americans are among the highest in the nation. Life in rural areas can be more challenging than in urban areas due to restricted educational and employment opportunities, difficulties in obtaining physical and mental health care, and a lack of public transportation. Despite living in such challenging situations, many SHAPE participants have displayed high levels of psychosocial functioning across adolescence. We identified naturally occurring factors in family and community networks that protected these youth from the consequences of SES- and race-related stressors that proliferate in rural Southern contexts. Epidemiological research reveals that African Americans in the rural South are among the most disadvantaged populations in the US in terms of chronic diseases of aging (CDA) such as coronary heart disease and type 2 diabetes. Emerging evidence indicates that contemporaneous health determinants in midlife or later cannot adequately account for why rural African Americans experience high rates of CDAs. Rather, many CDAs incubate in physiological systems for decades prior to the manifestation of disease. In the next 5 years, SHAPE participants will experience a stressful developmental transition. Job turnover rates are high, and the combined effects of poor preparation for employment and discriminatory hiring practices make obtaining stable employment a protracted and often demoralizing process. These stressors have the potential to take a toll on SHAPE participants'health, undermining psychosocial functioning and contributing to CDA-related vulnerabilities. To understand the pathways from stress exposure during childhood, adolescence, and young adulthood to CDA vulnerabilities and psychosocial outcomes, we propose to extend the SHAPE research program in two key ways. First we propose to augment our health assessment of SHAPE participants to include markers of metabolic syndrome and pro-inflammatory tendencies which are linked to the development of CDAs. Second, we propose to investigate a critical question for public health scientists and practitioners. In response to stress exposure, some SHAPE participants will evince escalation in CDA vulnerability whereas other will not. This proposal is designed to investigate why. Evidence from laboratory-based studies suggests a central role for psychosocial risk and protective mechanisms in young adulthood and earlier phases of development in altering the pathways linking stress exposure and CDA precursors. Prospective research investigating these risk and protective mechanisms, however, is virtually nonexistent. We thus propose to collect data from SHAPE participants, at ages 22 and 24 years, that includes CDA precursors along with assessments of environmental stressors, psychosocial adjustment, risk and protective mechanisms, HPA axis/SNS deregulation, and health behavior.

Public Health Relevance

African Americans in the rural South are among the most disadvantaged populations in the US in terms of health disparities. Recent research suggests that the roots of these disparities lie in earlier stages of development as young people cope with stressful environments. In this study we investigate the risk and protective processes that explain why some young adult rural African Americans develop vulnerabilities to chronic diseases and others do not.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Psychosocial Development, Risk and Prevention Study Section (PDRP)
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Esposito, Layla E
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University of Georgia
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