Penn-CHOP ECHO

宾夕法尼亚-CHOP ECHO

基本信息

批准号：
10746523
负责人：
Heather Herson Burris
金额：
$ 357.76万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-01 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10746523
关键词：
3 year old Affect Age Air Pollution Area Asthma Behavior Birth Black race Child Child Health Child health equity Childhood Clinical Research Collaborations Communities Complex Conceptions Couples Data Development Diet Dietary Practices Disease Education Endocrine Ensure Environment Environmental Exposure Environmental Health Equity Fertility Fetal Growth Green space Growth Guidelines Health Health Promotion Health system Healthcare Immunologics Income Individual Inequity Infant Infant Mortality Inflammatory Institution Intervention Investments Joints Life Life Style Longterm Follow-up Maternal and Child Health Maternal-fetal medicine Medicaid Methods Modernization Neighborhoods Neonatology Neurodevelopmental Deficit Obesity Outcome Oxidative Stress Pathway interactions Patients Pediatric Hospitals Pediatric cohort Pediatric epidemiology Pennsylvania Perinatal Persons Phenotype Philadelphia Physical activity Pollution Population Heterogeneity Positioning Attribute Postpartum Period Practice Guidelines Pregnancy Premature Birth Protocols documentation Psychosocial Stress Public Health Race Recording of previous events Research Risk Role Site Sleep Targeted Research Underrepresented Populations Universities Violence Work adverse pregnancy outcome anti-racism cohort dashboard design disparity reduction early childhood experience extreme temperature follow-up health care settings health disparity health equity improved innovation mortality disparity multidisciplinary neurodevelopment novel novel strategies obesity in children offspring outcome disparities postpartum weight pregnancy health pregnant prevent racial disparity racism recruit social social epidemiology success walkability wearable device

项目摘要

Project Summary Health disparities start early in life, with Black infants (10.6 per 1,000) twice as likely to die compared to White infants (4.5 per 1,000). Adverse pregnancy outcomes are responsible for the majority of the Black-White infant mortality disparity. Extensive healthcare efforts have been taken to prevent adverse pregnancy outcomes and to optimize child growth, health, and neurodevelopment. However, birth and childhood outcomes remain major areas of public health concern with ongoing inequities. Macroenvironmental health promoting factors (greenspace, walkability) and health threatening factors (pollution, neighborhood violence, extreme temperatures) may affect health directly through inflammatory and immunologic pathways. Macroenvironments may also contribute to lived experiences of income potential and educational attainment. Combined with interpersonal individual exposures such as racism and violence, macroenvironments may alter individuals' microenvironmental health factors such as diet, physical activity, psychosocial stress, and sleep. While macro- and microenvironmental exposures have been studied individually, the impact of neighborhood environments on complex health disorders in pregnancy and early childhood remains understudied and the interplay with microenvironmental factors to reduce disparities is completely unknown. We propose a causal inference framework to evaluate the role of specific macroenvironment factors (Aim 1) to reduce the risks of abnormal fetal growth, preterm birth, obesity, asthma, and neurodevelopmental delays by age 3, as well as whether such factors may improve racial disparities in these outcomes. We will also identify optimal components of microenvironmental factors of diet, physical activity, and sleep, during pregnancy (Aim 2) and among couples during preconception (Aim 4), that can best be utilized to maximize reductions in health disparities. We have assembled a multidisciplinary team of experts at the University of Pennsylvania and Children's Hospital of Philadelphia who are well-positioned to complete the study and recruit up to 2500 pregnant people, partners, and offspring, with retention of at least 75% at age 3, among whom 1250 will be recruited into the preconception pilot (Aim 3). The health system at Penn/CHOP serves a population underrepresented in other pregnancy and pediatric cohorts in the US (largely Medicaid-insured and plurality Black). The culture of clinical research, excellent scientific environment, and diverse population makes Penn and CHOP the ideal place to innovate in the field of maternal-child health equity. The Penn-CHOP ECHO study team is committed to the success of this work and looks forward to working collaboratively with the other ECHO Study Sites, Coordinating Centers, and Cores.

项目摘要健康差异开始生命的早期，黑人婴儿（每1,000名10.6）死亡的可能性是白人的两倍婴儿（每1,000次4.5）。不良怀孕结果是大多数黑白婴儿的原因死亡率差异。已经采取了广泛的医疗保健努力，以防止不良怀孕结果和优化儿童成长，健康和神经发育。但是，出生和童年的成果仍然是主要的持续不平等的公共卫生领域。宏观环境健康促进因素（绿空间，步行性）和威胁健康的因素（污染，邻里暴力，极端温度）可能通过炎症和免疫学途径直接影响健康。宏观环境可能还会有助于收入潜力和受教育程度的生活经验。与人际交往的个人暴露，例如种族主义和暴力，宏观环境可能会改变个人微环境健康因素，例如饮食，体育锻炼，社会心理压力和睡眠。而宏观 - 和微环境暴露已经单独研究了邻里环境的影响关于怀孕和幼儿时期的复杂健康障碍，仍然研究了减少差异的微环境因素是完全未知的。我们提出了因果推断评估特定宏观环境因素的作用（目标1）以降低异常风险的框架到3岁时，胎儿生长，早产，肥胖，哮喘和神经发育延迟因素可能会改善这些结果中的种族差异。我们还将确定的最佳组成部分饮食，体育锻炼和睡眠的微环境因素，怀孕期间（AIM 2）和夫妻在先入为主的期间（AIM 4），最好可用于最大程度地减少健康差异。我们有组建了宾夕法尼亚大学和儿童医院的多学科专家团队费城井井有条，可以完成研究，并招募多达2500名孕妇，伴侣，和后代，在3岁时保留至少75％，其中1250名将被招募到先男性的飞行员（AIM 3）。 Penn/Chop的卫生系统为其他人口提供的服务不足美国的怀孕和小儿队列（在很大程度上是医疗补助保险和多个黑色）。临床文化研究，出色的科学环境以及多样化的人口使宾夕法尼亚州成为理想的地方在母子健康公平领域进行创新。 Penn-Chop Echo学习团队致力于这项工作的成功，并期待与其他Echo研究网站合作，协调中心和核心。