Geospatial Analysis of Neighborhood Environmental Stress in Relation to Biological Markers of Cardiovascular Health and Health Behaviors in Women

Study Overview
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Brief Summary
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Background: Heart disease is a leading cause of death in the United States. Healthy diet and exercise improve heart health. Some features of where a person lives can lead to stress and decrease chances for exercise. Researchers want to see how these factors may increase the risk of heart disease in women. Objective: To see if there are differences in stress levels between women who live in different parts of Washington, DC. Also, to see how these women use their neighborhoods for exercise. Eligibility: Healthy white or black females ages 19-45 who live in Washington, DC, wards 3 or 5 and have access to a smartphone Design: Participants will stay at the NIH Clinical Center overnight for a 2-day visit. Tests will include: Physical exam Blood tests Electrocardiogram: Electrodes on the participant s skin will measure heart activity. PET/CT scan: Participants will get an injection. They will lie in a machine that takes pictures of the body. Surveys Body size measurements Blood vessel tests: This is measured with blood pressure cuffs, a device placed on the participant s fingertip, and a probe placed on the participant s neck. Resting Energy Expenditure: Participants will breathe under a clear hood for 45 minutes. Participants will be followed for about 2 weeks. They will wear a device on the wrist and carry a GPS device. Through a mobile app, they will answer short daily surveys on stress and exercise. Participants will then have a follow-up visit. They will have blood tests and take surveys.

Detailed Description
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Innovative analyses of cardiovascular (CV) risk markers and heath behaviors in relation to neighborhood stressors are needed to further elucidate mechanisms by which adverse neighborhood conditions lead to poor CV outcomes. We propose to objectively measure physical activity, sedentary behavior, and neighborhood stress through accelerometers, global positioning systems (GPS), and ecological momentary assessment survey (via smartphone survey), linked to biological measures in a sample of White and African American women in Washington, D.C. neighborhoods. We hypothesize that individuals who are living in worse neighborhood environment conditions (e.g., higher poverty, crime, and social disorder) will be associated with higher chronic stress-related neural activity. As a secondary hypothesis, we hypothesize that associations between living in socio-economically disadvantaged neighborhood conditions and adverse biological markers will be moderated/mediated through levels of physical activity, time spent on sedentary activities, and dietary intake. Relationships between living in socio-economically disadvantaged neighborhood conditions and adverse biological markers will be also be mediated through psychosocial factors. In Aim 1, we will test associations between neighborhood environment conditions (e.g., poverty, crime, social disorder) and differences in stress-related neural activity, using PET CT-measured amygdala FDG uptake among a sample of White and African American women in high socio-economic status neighborhoods and low socioeconomic status neighborhoods in Washington D.C. In Aim 2a, we will determine associations between neighborhood environment conditions (e.g., poverty, crime, social disorder) and differences in cardiovascular risk and immune activation. Several measures of cardiovascular risk and immune activation will be performed including: (i) assessment of vascular function (vascular stiffness, vascular inflammation) and (ii) measures of immune function (i.e. flow cytometry for immune cell phenotyping, cytokine/chemokine/cortisol/neurotransmitter profiling, lipidomic analyses for lipid inflammatory intermediates, PBMC telomere length). In Aim 2b, we will assess feasibility and practicality of the use of geospatial tools and methods for measuring environmental factors (i.e. poverty, crime, social disorder) among this sample of women in Washington, DC. In aim 2c, we will examine whether associations between worse neighborhood environment conditions and adverse biological markers may be moderated and/or mediated by health behaviors (i.e., physical activity, sedentary time, dietary intake) and psychosocial factors (i.e., mood) measured via ecological momentary assessment (EMA). This project has a strong potential for improving scientific understanding of how neighborhood stress may influence biological measures of stress-related neural activity, such as amygdala activity, to improve our knowledge on interrelations among biology, environment, and cardiovascular health.

Official Title
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Pilot Study for Geospatial Analysis of Neighborhood Environmental Stress in Relation to Biological Markers of Cardiovascular Health and Health Behaviors in Women

Conditions
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Cardiovascular (CV) Risk

Participation Criteria
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Eligibility Criteria
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INCLUSION CRITERIA: Individuals eligible for this protocol: A healthy self-identified White female (i.e. self-identifies as White or of European descent) or healthy Black female (i.e. self-identifies as Black, African American, or of African descent) Must be between 19 to 45 years of age Must not have any chronic health condition, including lung disease or active infection Must be living in Washington, DC Must have access to a smartphone Must be able to provide informed consent Must speak English. EXCLUSION CRITERIA: If you are pregnant or breast feeding If you are physically unable to perform physical activity for any reason If you have had weight changes greater than 20% over the past 3 months If you are obese by our measurements (BMI greater than or equal to 35.0 kg/m^2) If you have high or low blood pressure If you have diabetes If you have a history of severe mental illnesses, treated with hospitalization If you have a history or evidence of hyper/hypothyroidism If you are taking medication for chronic non-mental health related illness If you have food allergies or highly restrictive diets that may prevent your ability to consume a controlled metabolic diet. If you are a smoker

Ages Eligible for Study
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Minimum Age: 19 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Female<br>Diagnostic | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Stress-related neural activity | Stress-related neural activity will be estimated by neuroimaging (18-FDG PET/CTamygdala activity) | 1 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 1) examine associations between neighborhood environment conditions | rate of poverty, disorder, crime through both residential neighborhoods and individuals activity space and differences in cardiovascular risk and immune activation through: (i) assessment of vascular function (vascular stiffness, vascular inflammation); and (ii) measures of immune function (i.e. flow cytometry for immune cell phenotyping | 1 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Neighborhood Environment, Cardiovascular Disease Risk, Social Determinants of Health, Diagnostic Behavioral study, Socio-Economic, Natural History