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

• 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
• 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

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）：社会经济地位（SES）在健康成果方面的差异是我们当今社会面临的最紧迫的公共卫生问题之一。根据10-136年对了解健康差异的多层次方法的兴趣，我们将重点放在童年哮喘上，并在跨社区，家庭和个人层面上同时调查因素；我们认为物理环境和社会环境共同暴露；我们研究了促进哮喘病理生理学的各种水平的生物学过程（器官系统，细胞，基因组），这些过程都在一个单个项目中，旨在对哮喘差异的原因有更全面的理解。第一个目的是了解社区，家庭和个人级别的社会因素如何形成并彼此塑造，以及它们如何共同影响哮喘差异。第二个目的是同时衡量社会和身体暴露，以解释它们如何相互作用影响哮喘差异。第三个目的是为社会环境如何通过表征多个级别的途径生物学（器官系统，细胞，基因组）来创建生物学上合理的模型，以解释社会环境如何影响哮喘的差异。这项研究将招募来自不同SES背景的300个家庭的样本，这些家庭具有10-18岁的儿童持续性哮喘。家庭将参与对个人和家庭社会过程以及儿童生物学措施的实验室评估。有关邻里特征的信息将从地理信息系统图和当地研究财团创建的社区社会特征的地理信息系统图和地图联系起来。为了确定每个因素“水平”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进行每月监测，在1年的随访期间跟踪临床结果。创建模型来解释邻里，家庭和个人因素如何同时促进哮喘差异，这对于开发一个 社会环境如何影响疾病进展的更多整体情况。这些模型反过来将影响我们进行干预的方法。例如，如果他们不承认影响家庭能力跟上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），则可以改善药物依从性的干预措施可能不会有效。评估因素之间的互动效应还将使我们能够确定特定条件，在该条件下，干预的潜在靶标将在减轻哮喘基础的病理生理过程方面带来最大的差异。该项目的总体目标是对为什么存在SE的哮喘差异的原因有更复杂的理解，并确定需要同时针对的因素的星座，以有效地减轻这些差异。 公共卫生相关性：全面的多层次模型令人信服地解释了低社会经济地位（SES）能够对健康产生普遍影响的多种方式，对于开发可以最大程度地减少健康差异的干预措施很重要。拟议的项目将调查跨社区，家庭和个人层面的社会和身体环境因素，以了解SES在儿童哮喘中的差异。总体目标是开发更复杂的模型，即社会和物理环境如何影响和相互作用，以在低SES儿童中对疾病的进展有所不同。