Chronic and daily stressors, dysfunctional eating behaviors and cardiometabolic risk among adults in Puerto Rico

PROJECT SUMMARY Adults in Puerto Rico (PR) experience a high burden of cardiometabolic diseases (CMD), particularly type 2 diabetes (16%) and overweight and obesity (67%). These estimates are higher than those for US mainland non-Latinx Whites and other Latinx groups. Stress may affect CMD through physiological dysregulation,

negative affect, and dysfunctional eating behaviors (DEB). This is of particular importance to people in PR given their disproportionate exposure to unique social and environmental stressors that may increase their CMD risk; yet research on stressors (both chronic and daily) and CMD in PR is scarce, and less is known

about their potential mechanisms and the resilience factors buffering the stress response. Epidemiological research on stress and CMD has been primarily conducted under standardized conditions using traditional questionnaires, hindering the ability to capture stress responses to relevant contextual stressors in their natural

environment. Ecological momentary assessment (EMA) is a novel approach that assesses real-time experiences in their natural environment, allowing for a comprehensive assessment of context-specific stressors and understanding of early stress responses. As an early-stage investigator, born and raised in PR,

with doctoral and post-doctoral training in Epidemiology and DEB, this K01 will provide training in (1) epidemiology of CMD in Latinxs, (2) measurement and operationalization of stress, (3) EMA implementation and analysis, and (4) grant writing and leadership. This K01 will also achieve the overall research goal of

examining novel mechanisms by which stressors influence CMD (negative affect and DEB) in PR adults, and inform intervention strategies (resilience factors). Specifically, Aim 1 will examine whether adults in PR experiencing chronic stress (overall chronic stress, financial hardship, and hurricane-related adverse

experiences) have a higher engagement in DEB and concentration of CMD markers. This aim will use data collected from the PR Observational Study of Psychosocial, Environmental, and Chronic disease Trends (PROSPECT) at baseline and 2yr follow-up. For Aims 2 and 3, we will conduct a one-week EMA pilot study

within PROSPECT to collect daily data on stressors, negative affect, DEB, and cardiometabolic markers (blood pressure and continuous glucose, assessed through wearable devices). Aim 2 will examine the relations among daily stressors, negative affect, DEB, and cardiometabolic markers; and Aim 3 will evaluate if intrinsic

and extrinsic resilience factors moderate associations between daily stressors, negative affect, DEB, and CMD markers. This research responds to priority areas of NIH NHLBI by advancing health equity in CMD research. It will make important contributions by focusing on mechanisms and factors influencing the stress response.

This work will provide preliminary data to conduct an R01 for a fully-powered longitudinal EMA study identifying differences in stressors and their effect on negative affect, DEB, and CMD in PR and mainland US Latinxs.