Multi-Level Understanding of Social Contributors to SES Disparities in Asthma

对哮喘中社会经济地位差异的社会贡献者的多层次理解

基本信息

批准号：
8262995
负责人：
EDITH CHEN
金额：
$ 35万
依托单位：
NORTHWESTERN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-11 至 2017-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8262995
关键词：
Address Affect Age Allergens Asthma Behavior Biological Biological Process Categories Characteristics Child Childhood Asthma Chronic Clinical Communities Conflict (Psychology)Data Disease Disease Outcome Disease Progression Employee Strikes Environment Exhalation Face Family Functional disorder Genomics Geographic Information Systems Goals Health Hospitalization Impairment Individual Inflammation Inflammatory Response Intervention Laboratories Lead Link Maps Measures Modeling Monitor Neighborhoods Nitric Oxide Outcome Parenting behavior Pathway interactions Pharmaceutical Preparations Physical environment Pollution Process Production Public Health Recruitment Activity Regimen Relative (related person)Research Risk Sampling Shapes Social Characteristics Social Environment Societies Socioeconomic Status Stress Symptoms Transcriptional Activation Violence airway inflammation body system cytokine experience follow-up health disparity health record improved interest low socioeconomic status medication compliance pollutant psychological distress response social social capital

项目摘要

DESCRIPTION (provided by applicant): Disparities in health outcomes by socioeconomic status (SES) are one of the most pressing public health problems our society faces today. In line with PAR-10-136's interest in multi-level approaches to understanding health disparities, we focus on childhood asthma and investigate factors simultaneously across neighborhood, family, and individual levels; we consider both physical environment and social environment exposures together; and we examine various levels of biological processes (organ systems, cellular, genomic) that drive asthma pathophysiology, all within a single project that seeks to develop a more comprehensive understanding of the causes of asthma disparities. The first aim is to understand how neighborhood, family, and individual-level social factors both shape and are shaped by one another, and how they collectively affect asthma disparities. The second aim is to measure social and physical exposures concurrently in order to explain how they interact to affect asthma disparities. The third aim is to create biologically plausible models for how social contexts contribute to health disparities by characterizing pathways at multiple levels biologicall (organ systems, cellular, genomic) that can explain how social contexts come to affect asthma disparities. This study will recruit a sample of 300 families from varying SES backgrounds who have a child ages 10-18 with persistent asthma. Families will participate in laboratory assessments of individual- and family-level social processes as well as child biological measures. Information on neighborhood characteristics will be linked from geographic information system maps of pollution exposures and maps of the social characteristics of communities created by a research consortium locally. In order to establish the temporal precedence of each of the 'levels' of factors, clinical outcomes will be tracked across a 1 year follow up period via monthly monitoring of symptoms as well as from hospitalization data obtained from provincial health records. Creating models that explain how neighborhood, family, and individual factors simultaneously contribute to asthma disparities is critical for developing a more holistic picture of how social contexts affect disease progression. These models will in turn shape our approaches to interventions. For example, interventions to improve medication adherence may not be effective if they do not acknowledge the broader social factors (e.g., neighborhood and family stress) that affect families' abilities to keep up with medication regimens. Assessing interactive effects between factors will also allow us to identify specific conditions under which potential targets of intervention would make the biggest differences in mitigating the pathophysiological processes underlying asthma. The overall goal of this project is to develop a more sophisticated understanding of why asthma disparities by SES exist and to identify the constellation of factors that would need to be targeted simultaneously in order to effectively alleviate these disparities. PUBLIC HEALTH RELEVANCE: Comprehensive, multi-level models that convincingly explain the multitude of ways in which low socioeconomic status (SES) is able to have pervasive effects on health are important for developing interventions that can maximally reduce health disparities. The proposed project will investigate social and physical environment factors across neighborhood, family, and individual levels in an effort to understand disparities by SES in childhood asthma. The overarching goal is to develop more sophisticated models of how social and physical environments affect and interact with one another to contribute to disease progression differentially in low SES children.

描述（由申请人提供）：不同社会经济地位（SES）的健康结果差异是当今社会面临的最紧迫的公共卫生问题之一。根据 PAR-10-136 对多层次方法了解健康差异的兴趣，我们重点关注儿童哮喘，并同时调查邻里、家庭和个人层面的因素；我们同时考虑物理环境和社会环境暴露；我们还研究了驱动哮喘病理生理学的各个层面的生物过程（器官系统、细胞、基因组），所有这些都在一个项目中进行，旨在更全面地了解哮喘差异的原因。第一个目标是了解邻里、家庭和个人层面的社会因素如何相互影响和相互影响，以及它们如何共同影响哮喘差异。第二个目标是同时测量社会和身体暴露，以解释它们如何相互作用影响哮喘差异。第三个目标是通过描述多个生物学层面（器官系统、细胞、基因组）的途径来创建生物学上合理的模型，以解释社会环境如何影响健康差异，从而解释社会环境如何影响哮喘差异。这项研究将招募 300 个来自不同 SES 背景的家庭作为样本，这些家庭的 10 至 18 岁儿童患有持续性哮喘。家庭将参与个人和家庭层面的社会过程以及儿童生物学测量的实验室评估。有关社区特征的信息将与污染暴露地理信息系统地图和当地研究联盟创建的社区社会特征地图联系起来。为了确定每个“级别”因素的时间优先级，将通过每月监测症状以及从省级健康记录获得的住院数据来跟踪 1 年随访期内的临床结果。创建模型来解释邻里、家庭和个人因素如何同时影响哮喘差异对于制定哮喘差异至关重要更全面地了解社会环境如何影响疾病进展。这些模型反过来将塑造我们的干预方法。例如，如果不承认影响家庭遵循药物治疗方案的能力的更广泛的社会因素（例如邻里和家庭压力），那么提高药物依从性的干预措施可能不会有效。评估因素之间的相互作用还将使我们能够确定特定条件，在这些条件下，潜在的干预目标将在减轻哮喘的病理生理过程方面产生最大的差异。该项目的总体目标是更深入地了解为什么社会经济地位导致哮喘差异存在，并确定需要同时针对的一系列因素，以有效缓解这些差异。公共卫生相关性：全面、多层次的模型能够令人信服地解释低社会经济地位 (SES) 对健康产生普遍影响的多种方式，对于制定可最大限度减少健康差距的干预措施非常重要。拟议的项目将调查社区、家庭和个人层面的社会和物理环境因素，以了解社会经济地位在儿童哮喘方面的差异。总体目标是开发更复杂的模型来了解社会和物理环境如何相互影响和相互作用，以促进低社会经济地位儿童的疾病进展。