Psychoneuroimmunology: Preterm birth in Hispanics

心理神经免疫学：西班牙裔早产

• 批准号: 8056087
• 负责人: Roberta Jeanne Ruiz
• 金额: $ 29.68万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-07-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8056087
• 关键词: Acculturation; Adopted; Affect; African American; Age; Assimilations; Attitude; Beck depression inventory; Behavior; Behavioral; Belief; Biological; Biological Markers; Birth; Birth Rate; Birth Weight; Blood; Categories; Child; Complex; Corticotropin; Corticotropin-Releasing Hormone; Custom; Cytokine Gene; Data; Data Analyses; Dimensions; Discrimination; Distress; Endocrine; Epidemiologic Studies; Equation; Equilibrium; Equipment and supply inventories; Estriol; Evaluation; Exhibits; Face; Family; Fertility Rates; Funding; Genes; Genetic; Genetic Polymorphism; Genetic Predisposition to Disease; Grant; Health; Hispanics; Hormones; Hydrocortisone; Immune; Immune response; Individual; Inflammation; Inflammatory; Inflammatory Response; Institutional Review Boards; Interleukin-1; Interleukins; Intervention; Language; Learning; Length; Life; Logistic Regressions; Measures; Mediating; Medical; Medical Records; Mental Depression; Methods; Mexican Americans; Modeling; NIH Program Announcements; Observational Study; Outcome; Outcomes Research; Patient Self-Report; Physiological; Population; Pregnancy; Pregnant Women; Premature Birth; Prevalence; Process; Progesterone; Progress Reports; Psychoneuroimmunology; Relative (related person); Risk; Role; Sample Size; Sampling; Social support; Stress; TNF gene; Tumor Necrosis Factor-alpha; Woman; biological adaptation to stress; cohesion; coping; cost; cytokine; depressive symptoms; effective intervention; ethnic minority population; experience; fetal; follow-up; high risk; improved; infant outcome; instrument; low socioeconomic status; peripheral blood; pregnant; premature; prospective; psychosocial; reproductive hormone; response; self esteem; social

DESCRIPTION (provided by applicant): The Hispanic population, the fastest growing ethnic minority in the US, has a high fertility rate and the potential for a high rate of preterm births (PTB). If the PTB rate continues to rise, it will have devastating effects on children and increase medical costs. In this renewal application of R01 NR00789-04, we propose to clarify the impact of acculturation of Hispanic women on PTB, and to assess the roles of psychosocial, physiologic, and genetic mediating factors in the relationships between acculturation and birth outcomes. Acculturation occurs as individuals adopt the attitudes, values, customs, beliefs and behaviors of another culture. Previous studies show a Hispanic Paradox in which relatively less acculturated Hispanics with intact social relationships exhibit better than expected health outcomes, despite low socio- economic status. Our current study supports this and indicates a preterm birth rate of 13.4 percent for the more acculturated women as compared to a PTB rate of only 4.7 percent for the less acculturated women. Inflammatory factors resulting from stress are higher in our more acculturated group, potentially increasing the risk of PTB. With renewed funding, we will examine these results by studying Hispanic pregnant women at 22-24 weeks gestation. Aim 1: Identify which acculturation factors predict immune and endocrine responses that are associated with PTB and LBW. Aim 2: Identify which components of acculturative distress mediate the contribution of acculturation factors on the immune and endocrine responses that predict PTB and LBW. Aim 3: Identify which components of the psychosocial protective factors mediate the contribution of acculturation factors to immune and endocrine responses that predict PTB and LBW. Aim 4: Identify pro-inflammatory cytokine gene polymorphisms that may affect TNF-1 and IL-1Ra and may mediate stress responses. This prospective, observational study will focus on 500 Hispanic women, ages 14-45 years, with a single intrauterine pregnancy. We will: 1) use self-report instruments to assess acculturative distress and psychosocial protective factors; 2) measure acculturation in a multi-dimensional way; 3) measure numerous stress and reproductive hormones, and inflammatory cytokines in the blood and their gene polymorphisms; 4) assess maternal and infant outcomes through a review of medical records; 5) analyze data through logistic regression and/or structural equation modeling. We will learn how acculturation affects biological responses. We plan to use psychosocial and biological risk data to focus interventions for those women most at risk. PUBLIC HEALTH RELEVANCE: The purpose of this renewal is to clarify the impact of acculturation of Hispanic women on preterm birth, using a multidimensional measure of acculturation and assessing the role of mediating factors in explaining the relationships between acculturation and birth outcomes. We will also examine whether our current evidence related to increased inflammation with more acculturation (English proficiency) is different by genetic predisposition of the inflammatory response (i.e. increasing the risk of preterm birth). Our understanding of the relation between acculturation and prematurity is vital in the process of implementing interventions to promote a healthy maternal and fetal outcome.

描述（由申请人提供）：西班牙裔人口是美国增长最快的少数族裔，生育率高，早产率 (PTB) 也可能很高。如果PTB率继续上升，将对儿童造成毁灭性影响，并增加医疗费用。在 R01 NR00789-04 的更新申请中，我们建议阐明西班牙裔女性的文化适应对 PTB 的影响，并评估社会心理、生理和遗传中介因素在文化适应和出生结果之间的关系中的作用。当个人接受另一种文化的态度、价值观、习俗、信仰和行为时，文化适应就会发生。先前的研究表明，西班牙裔悖论是，文化程度相对较低、社会关系完整的西班牙裔人尽管社会经济地位较低，但健康状况却好于预期。我们目前的研究支持了这一点，并表明文化程度较高的女性的早产率为 13.4%，而文化程度较低的女性的早产率仅为 4.7%。在我们文化程度较高的群体中，由压力引起的炎症因子更高，可能会增加患肺结核的风险。有了新的资助，我们将通过研究妊娠 22-24 周的西班牙裔孕妇来检验这些结果。目标 1：确定哪些适应因素可预测与 PTB 和 LBW 相关的免疫和内分泌反应。目标 2：确定文化适应困难的哪些组成部分介导文化适应因素对预测 PTB 和 LBW 的免疫和内分泌反应的贡献。目标 3：确定社会心理保护因素的哪些组成部分介导文化适应因素对预测 PTB 和 LBW 的免疫和内分泌反应的贡献。目标 4：鉴定可能影响 TNF-1 和 IL-1Ra 并可能介导应激反应的促炎细胞因子基因多态性。这项前瞻性、观察性研究将重点关注 500 名年龄在 14-45 岁、单次宫内妊娠的西班牙裔女性。我们将：1）使用自我报告工具来评估文化适应困扰和社会心理保护因素； 2）多维度衡量文化适应； 3) 测量血液中的多种应激激素、生殖激素、炎症细胞因子及其基因多态性； 4) 通过审查病历来评估母婴结局； 5）通过逻辑回归和/或结构方程建模分析数据。我们将了解文化适应如何影响生物反应。我们计划利用社会心理和生物风险数据来重点针对那些风险最高的女性进行干预。 公共健康相关性：本次更新的目的是使用多维的文化适应衡量标准，并评估中介因素在解释文化适应与出生结果之间关系中的作用，阐明西班牙裔妇女的文化适应对早产的影响。我们还将检查我们目前与文化适应（英语水平）增加相关的炎症是否因炎症反应的遗传倾向（即增加早产风险）而有所不同。我们对文化适应和早产之间关系的理解对于实施干预措施以促进健康的孕产妇和胎儿结局至关重要。