This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.OBJECTIVE: Explaining and reducing the marked disparities in health observed across socioeconomic, racial and ethnic groups is now one of the top health priorities in the United States. This project applies a cross-level theoretical model to explore pathways linking socioeconomic status (SES) to physiology. The specific research question is whether the gradient in chronic psychological stress that is generated by socioeconomic disparities in turn generates a gradient in physiological stress (allostatic load) by socioeconomic status.
The specific aims are (1) to determine the co-distribution of chronic psychological stress and allostatic load across SES levels in a community-based population sample; and (2) to determine if there are person-level mediators of the relationship between chronic stress and allostatic load such as social support, ways of coping, and sense of control.RESEARCH PLAN: There are two phases of the proposed project: an initial qualitative phase for the pilot testing and refinement of psychometric measures, and the second, main phase which is a cross-sectional community-based design. The second phase will employ a geographically targeted, stratified (by SES) sample of 250 San Antonio residents between the ages of 50 and 70 for in-home interviews and collection of blood and urine samples.METHODS: The main part of the study is a cross-sectional study of the association between SES, measures of chronic psychological stress and an index of chronic physiological stress. The sampling frame will be based on automated telephone directories for San Antonio geocoded to census block groups, in order to sample participants from five income strata based on the median income of the census block group. Inclusion criteria include community residents age 50-70. Measures of chronic psychological stress include questionnaire measures of life events, chronic strains, and daily 'hassles.' Individuals' coping strategies, sense of mastery, and level of social support will also be assessed. The dependent variable is the allostatic load score, a ten-item index of chronic physiological stress that has been validated in prospective epidemiological studies as a predictor of physical and cognitive decline, and overall mortality. The items included in allostatic load are systolic and diastolic blood pressure, waist-hip ratio, glycosylated hemoglobin, total cholesterol/HDL ratio, HDL cholesterol, serum dehydroepiandrosterone-sulfate, and 12-hour overnight measures of epinephrine, norepinephrine, and cortisol. A multivariate regression analysis will assess a path model of the relationship between SES, chronic psychological stress and allostatic load. A second model will assess the moderating influence of the resilience factors: social support, mastery, and coping.CLINICAL
The existence of health disparities by socioeconomic status has been exhaustively documented, but the generation of studies exploring the mechanisms accounting for this relationship is in its infancy. The study explores a potential common precursor pathway to multiple morbidities.
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