The effects of pandemic-related stressors on change in CVD Risk: The protective role of universal prevention

ABSTRACT Although we are not yet in a position to estimate the total collateral damage to health and society due to the COVID-19 pandemic, widespread increases in stress, financial strain, depression/anxiety, family conflict, and social isolation during the pandemic may each have large and cumulative long-term impacts on physical health, particular via cardiovascular disease (CVD). For example, given that evidence from a large recent meta-analysis indicates that risk for stroke and ischemic heart disease is about 30% higher in lonely and socially isolated people, the CVD-related "consequences of social distancing may be profound". Pandemic- related stressors, such as financial strain and social distancing, may be particularly difficult for families with young children. In this context, the proposed project is uniquely positioned to examine important theoretical and practical public health questions that will inform future efforts to minimize the negative collateral health impacts of infectious disease epidemics as well as other crises: To what extent did the COVID-19 pandemic increase CVD risk among parents and children? Which of the multiple stressors associated with such a crisis ̶ e.g., financial, mental health, social isolation, family conflict ̶were most strongly linked to increases in CVD risk among parents and children? Can universal prevention programming enhance parent and child resilience in order to protect against crisis-related stressors and mitigate crisis-related increases in CVD risk? Aim 1: To examine the magnitude of change in CVD risk (a) from pre-pandemic to a time point near the anticipated end of the pandemic ("post-pandemic") and (b) from the "post-pandemic" time point to 18 months later. We will assess whether pandemic-period financial strain, mental health problems, and family conflict predict CVD risk changes. Aim 2. To examine whether random assignment to effective family prevention is associated with (a) a reduction in the hypothesized increase in CVD risk across the pandemic; (b) greater "recovery" in CVD health indicators over an 18 month period during which we expect most pandemic-related restrictions will have been eased; and (c) reduced associations between pandemic-related stressors and change in CVD risk (moderation). Aim 3: To examine whether gender or pre-pandemic indicators of socioeconomic status (income, education) moderate the associations examined in Aims 1 and 2. Impact. This project will result in new practical and theoretical knowledge that is important as we face increased frequency of infectious disease epidemics and climate change-related environmental disasters. Research that increases understanding of the stress-related processes within families that impact CVD health risk will inform future intervention approaches to reduce CVD risk during periods of family crisis, social- economic dislocation, and natural disasters. Understanding the factors that relate to risk and resilience will allow program developers to more precisely target salient mechanisms as well as families at highest risk.