Introduction to the special issue Disparities in cardiovascular health: Examining the contributions of social and behavioral factors.

Cardiovascular disease (CVD) is the leading cause of disability and death in the United States, accounting for 31.3% of all deaths in a given year (Mozaffarian et al., 2016). Importantly, risk factors for CVD, the incidence of CVD, and adverse outcomes associated with CVD are not experienced equally by all segments of society. Although there are variations depending on the specific cardiovascular condition, robust surveillance data document significant disparities in overall disease burden by race, ethnicity, and socioeconomic status (SES). Until recently, knowledge of these disparities has been largely epidemiological in nature. These epidemiological studies were critical to the development of national priorities to reduce health disparities (U.S. Department of Health & Human Services, 2011) exemplified by specific mandates in the Affordable Care Act, Healthy People 2010, Public Health Care Law 106–525, and the establishment of the National Institute of Minority Health and Health Disparities. Advances in psychological science are now helping to elucidate the causal pathways underlying health disparities. Researchers have identified a wide range of psychosocial and environmental variables that serve as potential drivers of racial, ethnic, and social class disparities in CVD. Some of these variables reflect directly perceived threats to health, including those associated with discrimination or childhood adversity. Others variables (e.g., crowding or pollution) emerge from social and environmental disadvantage, and these variables may influence health behavior even without the individual’s conscious awareness. Studies of the relationship among the social and interpersonal environment, individual level psychological and biological stress responses, and health are guided by biopsychosocial models of the determinants of health status. In many instances this research benefits from multidisciplinary team science. Collectively, this research raises questions about how socioeconomic position, social lives, and thoughts, feelings and behaviors contribute to cardiovascular risk and outcomes; questions that psychologists are particularly wellqualified to help answer. We offer this special issue as an opportunity to highlight contributions of health psychology to the understanding of disparities in cardiovascular health. The papers published in this issue were solicited through an open call and selected through fit with the theme, peer-review, and breadth of perspectives broadly defined. In many instances, the final versions represent a strong collaboration between investigators, peer-reviewers, and editors. The 12 papers published here include eight full manuscripts, two brief reports, and two invited commentaries. Sampling in these studies is largely restricted to healthy adults, with one paper focused on early life adversity and subsequent health in adolescents and a second examining social support in adolescence as a predictor of CVD risk in adulthood. These papers offer windows into cuttingedge themes, methodologies, challenges, and future directions in understanding psychosocial factors and sociocultural sequelae as they relate to cardiovascular health disparities. Examined together, the papers begin to elucidate the ways in which the social context drives biopsychological processes that contribute to cardiovascular health disparities. Below we highlight the key conceptual issues that arose from these papers.