Psychoneuroimmunology: Preterm birth in Hispanics

心理神经免疫学：西班牙裔早产

• 批准号: 8056087
• 负责人: Roberta Jeanne Ruiz
• 金额: $ 29.68万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-07-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8056087
• 关键词: Acculturation; Adopted; Affect; African American; Age; Assimilations; Attitude; Beck depression inventory; Behavior; Behavioral; Belief; Biological; Biological Markers; Birth; Birth Rate; Birth Weight; Blood; Categories; Child; Complex; Corticotropin; Corticotropin-Releasing Hormone; Custom; Cytokine Gene; Data; Data Analyses; Dimensions; Discrimination; Distress; Endocrine; Epidemiologic Studies; Equation; Equilibrium; Equipment and supply inventories; Estriol; Evaluation; Exhibits; Face; Family; Fertility Rates; Funding; Genes; Genetic; Genetic Polymorphism; Genetic Predisposition to Disease; Grant; Health; Hispanics; Hormones; Hydrocortisone; Immune; Immune response; Individual; Inflammation; Inflammatory; Inflammatory Response; Institutional Review Boards; Interleukin-1; Interleukins; Intervention; Language; Learning; Length; Life; Logistic Regressions; Measures; Mediating; Medical; Medical Records; Mental Depression; Methods; Mexican Americans; Modeling; NIH Program Announcements; Observational Study; Outcome; Outcomes Research; Patient Self-Report; Physiological; Population; Pregnancy; Pregnant Women; Premature Birth; Prevalence; Process; Progesterone; Progress Reports; Psychoneuroimmunology; Relative (related person); Risk; Role; Sample Size; Sampling; Social support; Stress; TNF gene; Tumor Necrosis Factor-alpha; Woman; biological adaptation to stress; cohesion; coping; cost; cytokine; depressive symptoms; effective intervention; ethnic minority population; experience; fetal; follow-up; high risk; improved; infant outcome; instrument; low socioeconomic status; peripheral blood; pregnant; premature; prospective; psychosocial; reproductive hormone; response; self esteem; social

DESCRIPTION (provided by applicant): The Hispanic population, the fastest growing ethnic minority in the US, has a high fertility rate and the potential for a high rate of preterm births (PTB). If the PTB rate continues to rise, it will have devastating effects on children and increase medical costs. In this renewal application of R01 NR00789-04, we propose to clarify the impact of acculturation of Hispanic women on PTB, and to assess the roles of psychosocial, physiologic, and genetic mediating factors in the relationships between acculturation and birth outcomes. Acculturation occurs as individuals adopt the attitudes, values, customs, beliefs and behaviors of another culture. Previous studies show a Hispanic Paradox in which relatively less acculturated Hispanics with intact social relationships exhibit better than expected health outcomes, despite low socio- economic status. Our current study supports this and indicates a preterm birth rate of 13.4 percent for the more acculturated women as compared to a PTB rate of only 4.7 percent for the less acculturated women. Inflammatory factors resulting from stress are higher in our more acculturated group, potentially increasing the risk of PTB. With renewed funding, we will examine these results by studying Hispanic pregnant women at 22-24 weeks gestation. Aim 1: Identify which acculturation factors predict immune and endocrine responses that are associated with PTB and LBW. Aim 2: Identify which components of acculturative distress mediate the contribution of acculturation factors on the immune and endocrine responses that predict PTB and LBW. Aim 3: Identify which components of the psychosocial protective factors mediate the contribution of acculturation factors to immune and endocrine responses that predict PTB and LBW. Aim 4: Identify pro-inflammatory cytokine gene polymorphisms that may affect TNF-1 and IL-1Ra and may mediate stress responses. This prospective, observational study will focus on 500 Hispanic women, ages 14-45 years, with a single intrauterine pregnancy. We will: 1) use self-report instruments to assess acculturative distress and psychosocial protective factors; 2) measure acculturation in a multi-dimensional way; 3) measure numerous stress and reproductive hormones, and inflammatory cytokines in the blood and their gene polymorphisms; 4) assess maternal and infant outcomes through a review of medical records; 5) analyze data through logistic regression and/or structural equation modeling. We will learn how acculturation affects biological responses. We plan to use psychosocial and biological risk data to focus interventions for those women most at risk. PUBLIC HEALTH RELEVANCE: The purpose of this renewal is to clarify the impact of acculturation of Hispanic women on preterm birth, using a multidimensional measure of acculturation and assessing the role of mediating factors in explaining the relationships between acculturation and birth outcomes. We will also examine whether our current evidence related to increased inflammation with more acculturation (English proficiency) is different by genetic predisposition of the inflammatory response (i.e. increasing the risk of preterm birth). Our understanding of the relation between acculturation and prematurity is vital in the process of implementing interventions to promote a healthy maternal and fetal outcome.

描述（由申请人提供）：西班牙裔人口是美国增长最快的少数民族，生育率很高，早产率（PTB）也很高。如果PTB率继续上升，将对儿童产生破坏性影响，并增加医疗费用。在R 01 NR 00789 -04的更新申请中，我们建议澄清西班牙裔女性的文化适应对PTB的影响，并评估社会心理、生理和遗传介导因素在文化适应和出生结局之间的关系中的作用。文化适应发生在个人接受另一种文化的态度、价值观、习俗、信仰和行为。先前的研究表明，尽管社会经济地位较低，但文化适应程度相对较低、社会关系完整的西班牙裔人的健康状况好于预期。我们目前的研究支持这一点，并表明，与文化适应程度较低的妇女的PTB率仅为4.7%相比，文化适应程度较高的妇女的早产率为13.4%。在文化适应度较高的人群中，压力导致的炎症因子较高，可能增加PTB的风险。随着新的资金，我们将通过研究怀孕22-24周的西班牙裔孕妇来检查这些结果。目的1：确定哪些文化适应因素预测与PTB和LBW相关的免疫和内分泌反应。目标二：确定哪些组成部分的文化适应性压力调解的贡献，文化适应因素的免疫和内分泌反应，预测肺结核和LBW。目标3：确定哪些社会心理保护因素的组成部分介导的贡献，文化适应因素的免疫和内分泌反应，预测PTB和LBW。目的4：确定可能影响TNF-1和IL-1 Ra并可能介导应激反应的促炎细胞因子基因多态性。这项前瞻性的观察性研究将集中在500名年龄在14-45岁之间的西班牙裔妇女身上，这些妇女都有一次宫内妊娠。我们将：1）使用自我报告工具评估文化适应性压力和心理社会保护因素; 2）以多维方式测量文化适应; 3）测量血液中的众多压力和生殖激素以及炎症细胞因子及其基因多态性; 4）通过回顾医疗记录评估母婴结局; 5）通过逻辑回归和/或结构方程模型分析数据。我们将学习文化适应如何影响生物反应。我们计划利用心理社会和生物风险数据，重点对那些风险最大的妇女进行干预。 公共卫生相关性：这种更新的目的是澄清文化适应的西班牙裔妇女早产的影响，使用多维的文化适应措施和评估的作用，解释文化适应和出生结果之间的关系的中介因素。我们还将研究我们目前的证据是否与更多的文化适应（英语水平）增加炎症有关，是否与炎症反应的遗传易感性（即增加早产的风险）不同。我们对文化适应和早产之间关系的理解在实施干预措施以促进健康的孕产妇和胎儿结局的过程中至关重要。