Childhood Adversity and Cardiovascular Health among Puerto Rican youth Shakira F Suglia Latinos, the largest and fastest growing ethnic minority group in the United States, are vulnerable to the health related consequences of living in poverty; 32 percent are obese and 22 percent have hypertension. Puerto Rican women have the highest rate of obesity, hypertension and hypercholesterolemia than any other Latino subgroup. Recent research has demonstrated that childhood adversity is associated with cardiovascular disease in adulthood. However, adapting and coping behaviors that prime those exposed to adversity in childhood to develop poor cardiovascular outcomes remain largely unexplored. Understanding how childhood adversity affects obesity, blood pressure and inflammation as well as understanding the potential modifiers and mediators of these associations prior to the development of cardiovascular disease directly addresses the strategic plan of NHLBI to promote early intervention before symptoms of disease appear so as to preserve normal function as long as possible. The goal of this application is to conduct a cardiovascular health assessment of 1,200 Puerto Rican young adults (ages 18-23) living in two different contexts: the South Bronx, NY and San Juan, Puerto Rico. The sample to be recruited is part of the Boricua Youth Study (BYS), a longitudinal (4 waves of data) population-based study that started collecting information when participants were 5 - 13 years old (compliance rate higher than 80 percent in the last completed assessment). In this unique sample of a homogeneous Latino subgroup (Puerto Ricans) in two contexts, we propose to examine: 1) the relation between childhood adversity (negative life events, parental incarceration, psychopathology and substance use, child maltreatment) and selected indicators of cardiovascular heath (obesity, blood pressure and systemic inflammation) in young adulthood; 2) the mediating effect of child mental and substance use disorders; and 3) the role played by socio-cultural factors, including context, social support, acculturation and use of health services The research team has expertise in the study of social determinants of health, the effects of stress on health, as well as on adolescent health. Dr. Suglia (PI) has conducted a feasibility study (K01 HL103199) among BYS participants (N=103; 17-23 years old) in the South Bronx, NY and San Juan, Puerto Rico and has demonstrated good feasibility of cardiovascular health data collection as well as a high prevalence of cardiovascular health indicators of interest (obesity=30 percent; elevated blood pressure=22 percent and high systemic inflammation=23 percent). Extending the study to a larger sample (N=1,200) will allow higher precision in the estimate of cardiovascular measures, as well as the examination of mediators and modifiers of the childhood adversity and cardiovascular health association that can be targeted for prevention efforts among young Puerto Rican (and possibly other Latino) youth prior to the development of cardiovascular disease.
To fully understand and eliminate health disparities an exploration of the social and environmental diversity within racial/ethnic groups is warranted. Puerto Ricans have some of the highest rates of cardiovascular risk factors as well as high exposures to childhood adverse events. We propose to examine relevant life course changes that prime those exposed to adversity in childhood to develop poor cardiovascular outcomes among Puerto Rican young adults living in New York and Puerto Rico, providing much needed information for intervention development.
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