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.

项目概要健康差异从生命的早期就开始了，黑人婴儿（每 1000 名婴儿中有 10.6 名）死亡的可能性是白人婴儿的两倍婴儿（每 1,000 人 4.5 人）。不良妊娠结局是造成大多数黑人婴儿的原因死亡率差异。已采取广泛的医疗保健措施来预防不良妊娠结局和优化儿童生长、健康和神经发育。然而，出生和儿童结局仍然很重要持续存在不平等的公共卫生领域。宏观环境健康促进因素（绿地、步行性）和健康威胁因素（污染、邻里暴力、极端温度）可能通过炎症和免疫途径直接影响健康。宏观环境也可能有助于收入潜力和教育程度的生活体验。结合人际交往中的个人暴露，例如种族主义和暴力，宏观环境可能会改变个人的微环境健康因素，如饮食、体力活动、社会心理压力和睡眠。虽然宏观和微环境暴露已单独研究，邻里环境的影响关于妊娠期和幼儿期复杂健康疾病的研究仍然不足，而且它们之间的相互作用减少差异的微环境因素是完全未知的。我们提出因果推断评估特定宏观环境因素（目标 1）的作用的框架，以减少异常风险胎儿生长、早产、肥胖、哮喘和 3 岁时神经发育迟缓，以及是否存在这些情况因素可能会改善这些结果的种族差异。我们还将确定最佳组件怀孕期间（目标 2）和夫妻之间饮食、体力活动和睡眠的微环境因素在孕前（目标 4）期间，最好利用这一点来最大限度地减少健康差异。我们有在宾夕法尼亚大学和儿童医院组建了一支多学科专家团队费城有能力完成这项研究并招募多达 2500 名孕妇、伴侣、以及后代，3岁时保留率至少为75%，其中1250名将被招募到孕前试点（目标 3）。 Penn/CHOP 的卫生系统为其他地区代表性不足的人群提供服务美国的怀孕和儿科队列（主要是医疗补助保险和大多数黑人）。临床文化研究、优良的科学环境和多元化的人口使宾夕法尼亚大学和 CHOP 成为理想的地方母婴健康公平领域创新。 Penn-CHOP ECHO 研究团队致力于这项工作取得成功，并期待与其他 ECHO 研究中心合作，协调中心和核心。