Psychosocial Factors and the Risk of Incident Asthma in African American Women

描述(申请人提供)：哮喘在美国已经达到流行的程度，非洲裔美国人在哮喘发病率的所有指标上都比白人更糟糕。造成这种差异的原因还没有得到令人满意的解释。心理社会因素，如暴力经历和生活在弱势社区和/或市中心社区，已被发现在儿童哮喘流行和严重程度方面发挥作用。虽然心理社会因素在儿童哮喘表现中的作用已经被研究过，但在成人中对这些因素的研究很少。应激是一种推定的机制，它可能通过一些貌似合理的生物学机制导致成人哮喘的发生。心理社会因素在黑人女性哮喘发病率中可能特别重要，因为暴力、种族主义、抑郁和生活在弱势社区的患病率高于白人女性。如果这种经历增加了成人哮喘发病的风险，它们可能会导致哮喘发病率的种族差异。这项应用的目的是填补关于心理社会因素在非洲裔美国女性成人发病哮喘事件中所起作用的知识空白。我们的中心假设是，可能导致压力的个人和邻里层面的心理社会因素会增加非裔美国女性成人发病哮喘的风险。拟议研究的理由是，确定增加成人哮喘风险的因素是制定预防政策和干预措施的必要步骤，以降低成人哮喘水平和黑人/白人哮喘发病率差距。本研究的具体目的是：1)评估种族主义经历、儿童期和青春期暴力经历、抑郁症状对哮喘发病率的影响；2)评估社区社会经济状况、种族隔离和城市化程度对哮喘发病率的影响。我们将使用黑人妇女健康研究(BWHS)的数据进行前瞻性分析。BWHS队列组建于1995年，包括来自美国各地的大约59,000名非裔美国妇女。在基线和两年一次的后续调查问卷中收集了关于人口统计、医疗和生殖病史以及包括哮喘在内的疾病终点的详细信息。在选定的后续调查问卷中，获得了有关感兴趣的心理社会因素的信息。参与者地址已进行地理编码，并与人口普查数据相关联。经过16年的跟踪，到2011年，将报告约1800例哮喘病例。这项研究具有创新性，因为它将是第一项考虑感兴趣的心理社会暴露对非洲裔美国女性成人哮喘事件的影响的前瞻性研究。这项拟议的研究意义重大，因为积极的结果可能会指导应对种族主义和暴力等压力源的干预努力，并可能激发关于慢性应激如何导致哮喘的进一步机械性研究，这可能会为新的治疗干预措施的开发提供信息。 公共卫生相关性：拟议的研究将确定导致非裔美国女性哮喘发病率的心理社会因素，从而填补有关成人哮喘发病风险因素和美国哮喘发病率种族差异原因的知识空白。拟议研究的结果有可能为个人和社会层面的预防战略提供参考。因此，这项拟议的研究与美国国立卫生研究院寻求延长健康寿命并减少疾病和残疾负担的使命部分相关。

DESCRIPTION (provided by applicant): Asthma has reached epidemic proportions in the United States and African-Americans fare worse than whites on all measures of asthma morbidity. Reasons for the disparity have not been satisfactorily explained. Psychosocial factors like experiences of violence and living in disadvantaged and/or inner city neighborhoods have been found to play a role in childhood asthma prevalence and severity. While the role of psychosocial factors in asthma expression has been studied in children there is little research on such factors in adults. Stress is the putative mechanism and there are plausible biological mechanisms by which it may contribute to the incidence of adult-onset asthma. Psychosocial factors may be of particular importance in asthma incidence in black women because the prevalence of experiences of violence, racism, depression, and living in disadvantaged neighborhoods are higher than in white women. If such experiences increase the risk of adult onset asthma, they may contribute to the racial disparity in asthma morbidity. The objective of this application is to fill this gap in knowledge about the role of psychosocial factors in incident adult-onset asthma in African American women. Our central hypothesis is that individual- and neighborhood-level psychosocial factors that may lead to stress increase the risk of adult-onset asthma in African-American women. The rationale for the proposed research is that the identification of factors that increase the risk of adult-onset asthma is a necessary step in the development of preventive policies and interventions to reduce both levels of adult-onset asthma and the gap in black/white asthma morbidity. The specific aims of this application are to 1) estimate the influence of experiences of racism, experiences of violence during childhood and adolescence, and depressive symptoms to asthma incidence and 2) to estimate the influence of neighborhood socioeconomic status (SES), racial segregation, and urbanicity to asthma incidence. We will conduct prospective analyses using data from the Black Women's Health Study (BWHS). The BWHS cohort, assembled in 1995, includes approximately 59,000 African-American women from across the U.S. Detailed information on demographics, medical and reproductive history, and disease endpoints including asthma, was collected at baseline and in biennial follow- up questionnaires. On selected follow-up questionnaires, information was obtained on the psychosocial factors of interest. Participant addresses have been geocoded and linked with census data. Over 16 years of follow-up through 2011, approximately 1800 incident cases of asthma will have been reported. The study is innovative because it will be the first prospective study to consider the effects of the psychosocial exposures of interest on incident adult asthma in African American women. The proposed research is significant because positive results may direct intervention efforts to address stressors like racism and violence and may motivate further mechanistic studies of how chronic stress leads to asthma, which might inform the development of new therapeutic interventions. PUBLIC HEALTH RELEVANCE: The proposed research will identify psychosocial factors that contribute to asthma incidence in African American women and thus will fill gaps in knowledge about risk factors for adult-onset asthma and about reasons for the racial disparity in asthma morbidity in the US. Results from the proposed study have the potential to inform preventive strategies at the individual and societal level. Thus the proposed research is relevant to the part of NIH's mission that seeks to extend healthy life and reduce the burdens of illness and disability.