DESCRIPTION (provided by applicant): Hypertension has been identified by the Million Hearts initiative as a leading preventable cause of heart attacks and strokes in the U.S. [1]. Studies have repeatedly documented the disparities in hypertension among racial minorities and individuals of lower socioeconomic status [2]. Recognizing this, the NHLBI has called for research to address the social and environmental determinants of hypertension disparities as part of its Strategic Plan (Goal 3). This study will directly contribute to this goal by focusing o the potential role of educational interventions to reduce disparities in hypertension. In Aim 1, we will produce population-level estimates of the effects of educational attainment on hypertension and related biomarkers using data from the National Health and Nutrition Examination Survey and the Health and Retirement Study. We will take advantage of a unique "quasi-experiment" in which differences in state-level school quality measures led to differences in individual educational attainment [3]. In Aim 2, we will examine the effect of educational attainment on hypertension diagnoses in adulthood among a large diverse sample of U.S. employees, using linked administrative and claims data sets. Aims 1 and 2 employ instrumental variables analysis, a statistical method that addresses unobserved confounding between education and health [4]. In Aim 3, we will use the results from Aims 1 and 2 - combined with estimates from prior literature - as inputs into a computer model. This model will simulate different scenarios to assess the returns of educational interventions to cardiovascular health. The candidate for this K08 award is Dr. Rita Hamad, a family physician and social epidemiologist at Stanford University. Dr. Hamad is establishing herself as an early independent investigator in the study of social factors that lead to disparities in risk factors for cardiovascular disease. Her short-term career goals are to gain expertise in advanced epidemiologic and statistical methods to study the effects of education on hypertension at the population level. This will contribute to her long-term goal, which is to develop and evaluate community-level interventions to address the social contributors to disparities in cardiovascular disease risk factors. This award will support Dr. Hamad's pursuit of the following career development plan, designed under the guidance of her mentoring team: (1) develop content expertise in the role of social and economic interventions in the epidemiology of hypertension; (2) undertake doctoral-level training in advanced statistical quasi-experimental methods that can be applied to large observational data sets; and (3) produce computer models to study the effects of simulated interventions that target disparities in hypertension. This career development award will lay the groundwork for an R01 application that Dr. Hamad will prepare as the next step towards an independent research career. She plans to use the scientific lessons learned from this research to develop and evaluate a community-level intervention that will reduce disparities in hypertension by increasing education among high-risk subgroups.

PUBLIC HEALTH RELEVANCE Project Narrative Improving our understanding of social factors that reduce rates of hypertension among high-risk subgroups is a critical step in reducing disparities in cardiovascular disease. This study will examine the effects of education on hypertension in the general population, and then assess the implications for community-level educational interventions. This research has the potential to inform future societal strategies to reduce hypertension among high-risk subgroups and improve cardiovascular disease disparities.