This project seeks to improve understanding of three important and intertwined social determinants of health: social class, race/ethnicity, and gender. The first component will investigate associations between discrimination, blood pressure, and cardiovascular risk factors, and will use data from Exam IV (1992-1993) of CARDIA, a multi-site longitudinal study of cardiovascular risk factors among black and white men and women. This exam is expected to include 3,383 subjects 25 to 37 years old. Analyses will examine the association between blood pressure and discrimination based on race/ethnicity, gender, social class, sexual orientation, and religion, and will take into account response to unfair treatment. To assess for effect modification, separate analyses will be performed for the eight strata defined by the sampling strategy: black/white x male/female x equal to or less than high school/more than high school. Additional multivariate analyses will examine whether, within the four gender/education strata, discrimination contributes to black/white differences in blood pressure, adjusting for relevant covariates. Other analyses will explore the relationship between discrimination, response to unfair treatment, and other possible cardiovascular risk factors, including hostility, body fat distribution, lipid fractions, blood glucose, skin color, substance use (tobacco, alcohol, and illegal drugs), and body self-image. The second component concerns appropriate measures of social class for studies of women's health. It will use data on 718 women who participated in Examination II of the Kaiser Permanente Women Twins Study (1989-19 90) . Socioeconomic information exist on: adult individual and household class (which takes into account the individual class position of both the respondent and her partner or head-of-household, if present), childhood household class, and class trajectory (comparing childhood and adult household class). Data on health characteristics include: blood pressure, body mass index, waist-hip ratio, lipoprotein fractions, fasting and postload insulin and glucose serum concentrations, self-assessed health status, age at first completed pregnancy, total number of childbirths, duration of breast feeding, physical activity, and smoking status. Analyses will evaluate whether different magnitudes of class-based differences in these health characteristics are detected with these diverse measures of social class, using multivariate techniques that correct for the correlation of errors within twin pairs. The effects of using these different class measures will also be examined for analyses testing the hypothesis that social class is inversely related to risk of hypertension among women, adjusting for relevant covariates.
