My Heart, My Self: an intensive longitudinal study examining the influence of intersectional discrimination on blood pressure.

BACKGROUND: Stigmatized adults in the United States experience significant hypertension disparities that may be influenced by greater exposure to discrimination. Although discrimination is posited to contribute to hypertension disparities, researchers have largely focused on the role of experienced discrimination with limited examination of other types of discrimination, such as anticipated and vicarious discrimination. Existing research ignores intersectional discrimination, which obscures the experiences of those that face discrimination due to multiple stigmatized identities. This study addresses limitations of prior work by examining the influence of intersectional anticipated and vicarious discrimination on blood pressure in adults within their real-world contexts. METHODS: This 7-day intensive longitudinal study uses an intersectional approach to examine the influence of daily and chronic forms of anticipated and vicarious discrimination on blood pressure and mediators of these associations. The proposed sample includes 400 adults (ages 18-64) living in New York City that are diverse in terms of ethnoracial, sexual, and gender identities. The study includes two in-person visits and a 7-day home assessment. Participants will complete a baseline structured interview, daily structured morning diaries, daily structured evening diaries, self-collection of saliva samples to assess salivary stress biomarkers, continuous wrist-worn actigraphy, and home blood pressure monitoring. We will test physiological (e.g., salivary cortisol), behavioral (e.g., sleep duration and physical activity), and affective (e.g., depressive and anxiety symptoms) factors to determine whether they mediate the influence of anticipated and vicarious discrimination on blood pressure. We will use multilevel linear models to estimate within- and between-person effects of daily and chronic anticipated and vicarious discrimination on blood pressure. DISCUSSION: My Heart, My Self addresses significant limitations in prior research on the link between discrimination and cardiovascular health. Our findings may shed light on effects of indirect forms of discrimination on blood pressure. This work will inform behavioral interventions that target anticipated and vicarious discrimination as risk factors for cardiovascular disease.