John M. Ruiz - US grants

DESCRIPTION (provided by applicant): Social vigilance is one candidate behavior potentially linking a stress as well as a broad array of individual, social, and contextual stress moderators to cardiovascular disease. Social vigilance reflects a sensory intake process akin to Lazarus and Folkman's conceptualization of stress appraisal where an environment or potential threat is continually monitored and reappraised in order to detect any change in status. Although social vigilance may be an adaptive behavior, sustained vigilance or hyper vigilance may have important health consequences. Data from our respective labs demonstrate that social vigilance evokes exaggerated cardiovascular responses acutely and potentiates larger cardiovascular responses to a subsequent stressor, a mediating pathway linking psychological stress to increased physical disease risk. However, there are no published studies examining the association between vigilance and objective markers of cardiovascular disease. Therefore, the current proposal aims to examine social vigilance as moderator of atherosclerotic risk in a representative community sample as well as test hypotheses regarding acute physiological reactions to vigilance in daily life as a mediator of the stress-related change in atherosclerosis. Social vigilance will be assessed with 2 methods. First, a psychometrically validated measure developed by our lab will be used to assess self-reported behavior. Second, ecological momentary assessment (EMA) will be used to assess the frequency of vigilant behavior at 45-min intervals over a 2-day period in participants' daily lives. The EMA protocol will be paired with ambulatory blood pressure assessment such that each vigilance sampling will be paired with a blood pressure measurement. Ambulatory blood pressure is a demonstrated mediator of atherosclerotic progression. Atherosclerosis will be assessed with 2D ultrasound imaging of the carotid arteries. The carotid ultrasound scan and EMA/ambulatory protocol will be performed at study entry and at a 2 year follow-up. We expect that greater social vigilance (higher self-report, more frequent daily experience) will be associated with higher carotid IMT scores at each time point and predict IMT progression over time. We also expect that daily blood pressure reactivity to vigilance will mediate the effects of vigilance on carotid IMT progression. The results of this study will contribute to an understanding of the basic behavioral pathways linking social stress to CHD risk and inform targeted interventions to modify such behavior. PUBLIC HEALTH RELEVANCE: Social vigilance, effortful monitoring of the social environment for potential interpersonal challenges or threats, is one candidate stress behavior potentially linking a broad array of individual, social, and contextual factors to greater cardiovascular disease risk. The proposed investigation will examine the relationship between social vigilance and subclinical atherosclerosis as well as test hypotheses regarding the bidirectional relationship between vigilance and the social environment as it relates to stress and disease risk.

PROJECT SUMMARY/ABSTRACT As the leading cause of cancer death, lung cancer represents the most significant cancer-related public health challenge in the United States. Although low-dose CT-based screening holds promise for earlier detection, currently, most lung cancer cases are not diagnosed until advanced stages (III, IV) and have 5-year survival rates of 21% or less. In contrast to Black-White survival disparities, Hispanic patients have markedly lower age-adjusted death rates than their non-Hispanic White (NHW) counterparts despite later stage diagnoses and broader SES and healthcare disparities; these findings are well established and consistent with the ?Hispanic Health Paradox?, a phenomenon characterized by Hispanic advantages in objective health outcomes (e.g., mortality) despite significant health and socioeconomic risk factors. The leading explanatory hypothesis concerns the role of cultural factors facilitating social integration. Social integration is among the most robust psychosocial predictors of a range of objective health outcomes, including cancer survival. However, no published work has directly tested this sociocultural hypothesis in relation to Hispanic resilience. Consistent with the emerging science of resilience, we propose a multisite, two-study, mixed-methods investigation to evaluate this sociocultural hypothesis. Study 1 is a multisite, longitudinal observational study of 672 Hispanic and NHW individuals with advanced stage lung cancer sampled from three regions across the U.S. Interviews using gold-standard and culturally-informed survey measures (demographics, social integration, cultural values, acculturation) will be conducted in English and Spanish from a centralized coordinating center with a 6- week follow-up to examine change in perceived support provision/needs. The primary outcome of survival and secondary outcomes (e.g., treatment adherence), will be gathered from electronic medical records over mean follow-up time of 33-months. Study 2 is a single-site, 7-day, intensive measurement investigation into the daily units of social integration that mediate outcomes. Study 2 integrates two novel in vivo sampling methods (Electronically Activated Recorder [EAR] and ecological momentary assessments [EMA]) using a mobile phone platform. The current aims are to (1) investigate whether the observed Hispanic survival advantage is mediated by ethnic differences in social integration among recently diagnosed late-stage lung cancer patients and (2) to examine the processes/mechanisms that underlie these relationships in daily life including the role of individual, family, network, and neighborhood-level factors. The highly experienced investigator team includes leaders in all relevant content areas, including the Hispanic health paradox, lung cancer survivorship, social integration, and ecological sampling methodologies. The results will contribute to better understanding of social processes among cancer patients, inform psychosocial interventions based on social integration, and contribute to the emerging science of health resilience as well as racial/ethnic and cultural variations in health outcomes.