Social Stressors and Inflammation: A Mixed Methods Approach to Preterm Birth

社会压力源和炎症：早产的混合方法

基本信息

批准号：
9469090
负责人：
Carmen Giurgescu
金额：
$ 76.49万
依托单位：
OHIO STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-01-06 至 2021-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9469090
关键词：
37 weeks gestation Accounting Affect African American Anti-Inflammatory Agents Anti-inflammatory Anxiety Area Biological Markers Birth Birth Rate Blood specimen C-reactive protein Censuses Child Child Mortality Child health care Chronic Disease Chronic stress Data Development Developmental Delay Disorders Emotional Stress Enrollment Event Goals Hair Health Health Care Costs Hormones Hospital Records Hydrocortisone Incidence Individual Infant Inflammation Inflammatory Interleukin-10 Intervention Interview Knowledge Lead Life Link Longitudinal Studies Measures Mediating Medical Records Methods Mission Modeling Modification Morbidity - disease rate Motor Neighborhoods Neonatal Mortality Not Hispanic or Latino Outcome Pathway interactions Physiological Plasma Pregnancy Pregnancy Outcome Premature Birth Prenatal Structures Psyche structure Questionnaires Race Reporting Research Resources Risk Social Environment Social support Statistical Data Interpretation Stress Structure Time United States National Institutes of Health Woman base clinical practice cohort coping cytokine depressive symptoms design effective intervention health disparity high risk high risk population hypothalamic-pituitary-adrenal axis improved improved outcome insight low socioeconomic status metropolitan neighborhood disadvantage physical conditioning pregnant premature prenatal protective effect psychological distress psychosocial racial discrimination racial disparity response social stressor

项目摘要

African American women have 1.5 times the rates of preterm birth (PTB)(<37 weeks completed gestation) compared with non-Hispanic white women. This disproportionately high PTB rate in African Americans is a persistent health inequity that leads to high child mortality, morbidity, and developmental delays. In the U.S. approximately $26 billion are spent annually on health care costs for infants and children that were born prematurely. Recent attempts to explain the high PTB rates in African American women have focused on social stressors, such as disadvantaged neighborhoods, racial discrimination, and stressful life events. These social stressors may lead to PTB by increasing women's emotional stress levels. Not surprisingly, emotional stress along with levels of the stress hormone cortisol and systemic inflammation - both physiological responses to stress - have all been related to higher risk of PTB. In contrast, one's psychosocial resources (e.g., social support) can lessen emotional stress and have protective effects on PTB. Little is yet known about the pathways by which social stressors affect inflammation, and ultimately PTB. The objective of the proposed study is to determine how social stressors alter inflammation during pregnancy and lead to PTB in African American women. We aim to: 1) determine the pathways by which social stressors affect PTB; and 2) describe social stressors, emotional stress and psychosocial resources; the associations among these concepts; and their impact on PTB from women's perspectives. In this longitudinal convergent mixed methods design, we will enroll 1,500 African American women who live in the Detroit metropolitan area. We will collect data on social stressors, emotional stress, and psychosocial resources through questionnaires and administrative (e.g., census) data. This will be done three times prenatally. At these same time points, levels of cortisol and systemic inflammation will be determined from hair and blood samples, respectively. We will also obtain birth data from the prenatal and hospital records. In a subsample of 60 women, semi-structured interviews will be conducted to more specifically understand the associations among social stressors, emotional stress and psychosocial resources; and their impact on PTB. We will conduct a variety of statistical, qualitative and mixed methods analyses using both quantitative and qualitative data to determine answers to the aims of our study. We will also consider the timing of pregnancy in our analyses, as the prenatal data are collected at three distinct time points. The proposed research is highly relevant to NIH's mission to elucidate mechanisms underlying health disparities in PTB. Insights gained from this mixed methods approach may lead to the development of an individualized PTB risk profile based on a woman's social stressors and biomarkers which will have potential use in clinical practice and be a target for culturally appropriate interventions to reduce PTB incidence in African American women, and will generate new perspectives for future research in other racial groups through our detailed focus on this high risk group.

非裔美国女性的早产率 (PTB) 是其 1.5 倍（妊娠完成时间<37 周）与非西班牙裔白人女性相比。非裔美国人中不成比例的高 PTB 率是一个原因持续的健康不平等导致儿童死亡率高、发病率高和发育迟缓。在美国每年大约花费 260 亿美元用于出生的婴儿和儿童的医疗保健费用过早地。最近试图解释非洲裔美国女性高肺结核发病率的尝试主要集中在社会压力源，例如弱势社区、种族歧视和压力生活事件。这些社会压力源可能会增加女性的情绪压力水平，从而导致 PTB。情感丰富，不足为奇压力以及应激激素皮质醇和全身炎症的水平 - 都是生理性的对压力的反应——都与较高的 PTB 风险有关。相比之下，一个人的社会心理资源（例如社会支持）可以减轻情绪压力并对 PTB 产生保护作用。目前尚知之甚少社会压力源影响炎症并最终影响 PTB 的途径。拟议的目标研究旨在确定社会压力因素如何改变非洲怀孕期间的炎症并导致 PTB 美国妇女。我们的目标是：1）确定社会压力因素影响 PTB 的途径； 2）描述社会压力源、情绪压力和社会心理资源；这些概念之间的关联；和从女性的角度来看它们对 PTB 的影响。在这个纵向收敛混合方法设计中，我们将招募 1,500 名生活在在底特律大都市区。我们将收集有关社会压力源、情绪压力和社会心理的数据通过调查问卷和行政（例如人口普查）数据获取资源。这将进行三次产前。在这些同一时间点，将从头发中确定皮质醇和全身炎症的水平和血液样本。我们还将从产前和医院记录中获取出生数据。在一个对 60 名女性进行子抽样，将进行半结构化访谈，以更具体地了解社会压力源、情绪压力和社会心理资源之间的关联；及其对 PTB 的影响。我们将使用定量和混合方法进行各种统计、定性和混合方法分析定性数据以确定我们研究目标的答案。我们还会考虑怀孕的时间我们的分析，因为产前数据是在三个不同的时间点收集的。拟议的研究高度与 NIH 阐明 PTB 健康差异背后机制的使命相关。获得的见解这种混合方法可能会导致基于以下情况制定个性化的 PTB 风险概况：女性的社会压力源和生物标志物将在临床实践中具有潜在的用途，并成为文化上适当的减少非洲裔美国妇女 PTB 发病率的干预措施，并将产生新的通过我们对这一高风险群体的详细关注，为其他种族群体的未来研究提供了视角。