Child maltreatment and cardiovascular disease risk: examining psychosocial and immunological pathways in a prospective, longitudinal cohort

儿童虐待和心血管疾病风险：检查心理社会和免疫途径， 前瞻性、纵向队列 PI：Hannah M. C. Schreier 项目总结/摘要 超过三分之一的美国青少年在18岁之前被调查虐待儿童（CM）。CM代表 这是一个特别强大的早期生活压力源，对青年的心理和身体健康产生深远影响。 除其他外，CM增加了心血管疾病（CVD）的风险，这是负责32%的 美国所有的死亡，其根源已经可以在儿童时期找到。一个更好的 了解CM与CVD风险增加相关的生理机制， 需要改善有CM病史的青年的终身健康轨迹，这是一个高风险但研究不足的问题。 小组，以及更好地了解连接早期生活逆境与晚年健康的生物机制 更普遍地说。拟议的项目将建立在目前正在进行的儿童健康研究（CHS; HD 089922， PI：Noll，Co-I：Schreier），作为其中的一部分，675名8-13岁的青少年最近接受了CM调查， 以及225名没有CM病史的对照青年被招募并进行前瞻性随访。以 这个独特的和非常好的特点队列的优势，我们将增加生物心理社会 已经收集的数据用于深入研究免疫功能结果。为此，该项目将 评估体外微生物攻击后刺激的促炎和抗炎细胞因子产生， 对白色血细胞中糖皮质激素信号传导的敏感性，以及潜伏病毒的调节， 多个时间点。这将使我们能够前瞻性地详细调查 暴露于CM和免疫功能的结果，并将是第一个这样做的研究，在一个样本，最近 被虐待的年轻人此外，我们将能够将由此产生的免疫功能结果与早期 这些年轻人心血管疾病风险的指标，无论是通过与现有的心脏代谢风险的措施， 队列，并进一步链接到青年的行政记录，特别是医疗补助索赔数据。这将是 这是第一项检查免疫功能结果与CVD相关医疗保健使用之间联系的研究 在年轻人中。最后，我们将调查可塑性保护因素，包括年轻人， 生活方式，家庭和同伴环境，可以保护青年免受CM对免疫功能改变的不利影响。 功能结果和关键人口统计学调节因素（年龄，青春期阶段，性别， 种族/民族，CM严重程度）发挥作用。跨学科的研究团队包括专业知识， 评估脆弱青年的免疫功能结果和心血管疾病风险;招募和 保留CM幸存者的前瞻性队列;以及使用行政记录回答问题 关于有CM病史的年轻人的福祉。由此产生的数据将对以下方面作出重要贡献： CM和早期生活逆境文献。它还将为今后的预防和干预工作提供信息， 最终目标是减少一些最不发达国家长期健康不良后果的风险， 人口中的弱势群体，以及减少由CM造成的医疗保健费用。

Child Maltreatment and Cardiovascular Disease Risk: Examining Psychosocial and Immunological Pathways in a Prospective, Longitudinal Cohort PI: Hannah M. C. Schreier PROJECT SUMMARY / ABSTRACT Over one third of U.S. youth are investigated for child maltreatment (CM) before the age of 18. CM represents an especially potent early life stressor with a profound impact on youth’s psychological and physical well-being. Among other things, CM increases the risk for cardiovascular disease (CVD), which is responsible for 32% of all deaths in the U.S. and the roots of which can already be found during childhood. Thus, a better understanding of the physiological mechanisms through which CM is associated with increased CVD risk is needed to improve the lifelong health trajectories of youth with a CM history, a high-risk yet understudied group, as well as to better understand biological mechanisms connecting early life adversity to later life health more generally. The proposed project will build on the currently ongoing Child Health Study (CHS; HD089922, PI: Noll, Co-I: Schreier), as part of which 675 youth aged 8-13 years who were recently investigated for CM as well as 225 comparison youth without a history of CM are being recruited and followed prospectively. Taking advantage of this unique and exceptionally well-characterized cohort, we will augment the biopsychosocial data already being collected to examine in-depth immune function outcomes. To this end, this project will assess stimulated pro- and anti-inflammatory cytokine production following in vitro microbial challenge, sensitivity to glucocorticoid signaling among white blood cells, and, finally, latent virus regulation, all across multiple timepoints. This will allow us to investigate prospectively and in detail the associations between exposure to CM and immune function outcomes and will be the first study to do so in a sample of recently maltreated youth. Additionally, we will be able to link the resulting immune function outcomes to early indicators of CVD risk among these youth, both by linking to existing measures of cardiometabolic risk in the cohort and further by linking to youth’s administrative records, specifically Medicaid claims data. This will be the first study to examine connections between immune function outcomes and CVD-relevant health care use among youth. Finally, we will be investigating the extent to which malleable protective factors, including youth lifestyle, family and peer environments, may protect youth from the adverse effects of CM on altered immune function outcomes and the extent to which key demographic moderators (age, pubertal stage, gender, race/ethnicity, CM severity) play a role. The interdisciplinary research team includes expertise in the assessment of immune function outcomes and CVD risk among vulnerable youth; the recruitment and retention of prospective cohorts of CM survivors; and the use of administrative records to answer questions pertaining to the well-being of youth with a history of CM. Resulting data will make important contributions to the CM and early life adversity literatures. It will also inform future prevention and intervention efforts with the ultimate goal of reducing the risk of adverse long-term health consequences among some of the most vulnerable individuals in the population as well as reducing the healthcare costs resulting from CM.