SICAS- Diversity Supplement

SICAS-多样性补充

• 批准号: 9154829
• 负责人: WANDA PHIPATANAKUL
• 金额: $ 11.07万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-01-07 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9154829
• 关键词: Accounting; Affect; Age; Air; Allergens; American; Americas; Asthma; Boston; Cells; Child; Childhood; Chronic Disease; Clinical; Clinical Trials; Communities; Disadvantaged; Disease; Effectiveness; Engineering; Environment; Environmental Exposure; Epigenetic Process; Exposure to; Funding; Gene Expression; Gene Expression Alteration; Genes; Goals; Health; Home environment; Hour; Individual; Intervention; Intervention Studies; Learning; Link; Lung; Measures; Mediation; Methylation; Molds; Molecular; Molecular Profiling; Morbidity - disease rate; Mus; National Institute of Allergy and Infectious Disease; Nose; Occupations; Outcome; Pathway interactions; Pharmaceutical Preparations; Phenotype; Prevention; Public Health; Research Infrastructure; Respiratory physiology; Risk Factors; Role; School-Age Population; Schools; Source; Specific qualifier value; Students; Symptoms; Testing; Time; Toxicant exposure; United States; Wheezing; air filter; airway inflammation; asthmatic; base; cost; educational atmosphere; elementary school; environmental intervention; epigenome; health care service utilization; high efficiency particulate air filter; improved; inner city; intervention effect; mouse allergen; novel; particle; particulate pollutant; pollutant; primary outcome; programs; secondary outcome

 DESCRIPTION (provided by applicant): Asthma is the most common chronic disease of childhood in the United States, causes significant morbidity, particularly in the inner-city, and accounts for billions of dollars in health care utilization, despite aggressive measures to identif remediable causes. Home environments are established sources of exposure that exacerbate symptoms and home-based interventions are proven effective. Prior to the inception of the School Inner-City Asthma Study (SICAS-1), no American study had comprehensively evaluated the relationship between urban exposures in school, classroom, and home environments and asthma morbidity. Nearly all elementary school children spend 7 to 12 hours a day in school, and most of that time is spent in one classroom. From SICAS-1, we learned that student classroom-specific mouse allergen, mold, and particulate pollutant exposure is associated with worsening symptoms. We also demonstrated our ability to reduce these exposures in a busy, school setting. Our proposal builds upon our established, successful school-based infrastructure to determine whether a school/classroom intervention will efficiently and effectively improve asthma morbidity by reducing these exposures. Our goal is to determine the efficacy of school/classroom based environmental intervention in reducing asthma morbidity in urban schoolchildren. Our central hypothesis is that reducing classroom/school exposure to mouse allergen, mold, and particulate pollutants will decrease asthma morbidity in students with asthma. We plan to test this hypothesis in an intervention study of 300 elementary students with asthma from multiple classrooms in 40 Boston inner-city elementary schools. Our clinical trial aims are to determine the effectiveness of a school/classroom based environmental intervention (school integrated pest management and classroom air purifying filter units within these schools) to reduce asthma morbidity. Our mechanistic aim is to test the hypothesis that effects of school/classroom- based environmental interventions on symptoms/other measures of asthma control occur through changes in gene methylation or expression in pathways (and secondarily, in genes) relevant to airway function and asthma. This will expand our understanding of asthma immunopathogenesis and create opportunities to identify potential novel targets for asthma therapy. Within pathways or networks of genes we will (a) determine how our interventions influence changes in nasal airway cell methylation or gene expression; (b) evaluate how our intervention-associated changes in methylation and gene expression influence asthma outcomes; and (c) estimate through mediation analysis how much of the intervention effects on asthma symptoms occurs through methylation/gene expression changes. This study is an unprecedented, high impact opportunity to test whether we can efficiently benefit a community of children in the school environment as opposed to individuals in single homes. It also adds a novel mechanistic application on health outcomes. It efficiently tackles a critical public health problem that affects a growing proportion of disadvantaged, urban U.S. children.

 描述（由适用提供）：哮喘是美国最常见的儿童慢性疾病，引起了显着的发病率，尤其是在市中心，并且占医疗保健利用率数十亿美元，积极的措施可以识别可补救的原因。房屋环境是确定的暴露源，使症状加剧，基于家庭的干预措施被证明有效。在启动学校内城哮喘研究（SICAS-1）之前，没有美国研究对学校，教室，家庭环境与哮喘发病率的城市暴露之间的关系进行全面评估。几乎所有小学生每天在学校花费7到12个小时，大部分时间都在一个教室里度过。从SICAS-1中，我们了解到，学生课堂特异性的老鼠过敏原，霉菌和特定的污染物暴露与后悔的症状有关。我们还证明了我们在繁忙的学校环境中减少这些暴露的能力。我们的提案建立在我们建立的成功的基于学校的基础设施基础上，以确定学校/课堂干预是否会通过减少这些暴露来有效地改善哮喘发病率。我们的目标是确定基于学校/课堂的环境干预在减少城市学童哮喘发病率方面的有效性。我们的核心假设是，减少教室/学校接触小鼠过敏原，霉菌和特定污染物将降低哮喘学生的哮喘发病率。我们计划在一项干预研究中检验这一假设，该研究对400个波士顿市中心小学的300名小学生患有哮喘。我们的临床试验目的是确定基于学校/课堂的环境干预措施（学校综合的害虫管理和这些学校中的课堂空气净化过滤器单元）的有效性，以降低哮喘发病率。我们的机械目的是检验以下假设：基于学校/教室的环境干预措施对与气道功能和哮喘相关的途径（以及次级，基因）中基因甲基化或表达的变化而发生的症状/其他哮喘控制措施的影响。这将扩大我们对哮喘免疫发病发生的理解，并创造机会确定潜在的哮喘治疗靶标。在基因的途径或网络中，我们将（a）确定干预措施如何影响鼻气道细胞甲基化或基因表达的变化； （b）评估我们与干预相关的甲基化和基因表达的变化如何影响哮喘结局； （c）通过调解分析估计，通过甲基化/基因表达变化发生了对哮喘症状的影响。这项研究是一个前所未有的高影响机会，可以测试我们是否可以有效地使学校环境中的儿童社区受益，而不是单个房屋中的个人。它还在健康结果上增加了新的机械应用。它有效地解决了一个关键的公共卫生问题，影响越来越多的灾难，美国城市儿童。