Multi-Level Understanding of Social Contributors to SES Disparities in Asthma

描述（由申请人提供）：社会经济地位（SES）造成的健康结果差异是当今社会面临的最紧迫的公共卫生问题之一。根据PAR-10-136对理解健康差异的多层次方法的兴趣，我们将重点放在儿童哮喘上，并同时调查社区、家庭和个人水平的因素；我们同时考虑了物理环境和社会环境暴露；我们检查了驱动哮喘病理生理学的不同水平的生物过程（器官系统，细胞，基因组），所有这些都在一个项目中，旨在对哮喘差异的原因有更全面的了解。第一个目标是了解社区，家庭和个人层面的社会因素如何相互影响和相互影响，以及它们如何共同影响哮喘的差异。第二个目标是同时测量社会和身体暴露，以解释它们如何相互作用影响哮喘差异。第三个目标是通过描述可以解释社会环境如何影响哮喘差异的多个生物学水平（器官系统、细胞、基因组）的途径，为社会环境如何导致健康差异创建生物学上合理的模型。这项研究将招募300个家庭作为样本，这些家庭来自不同的社会经济地位背景，他们的孩子年龄在10-18岁之间，患有持续性哮喘。家庭将参与对个人和家庭层面的社会过程以及儿童生物学测量的实验室评估。有关邻里特征的资料将从污染暴露的地理信息系统地图和由当地一个研究财团制作的社区社会特征地图联系起来。为了确定每个因素“水平”的时间优先性，将通过每月监测症状以及从省卫生记录中获得的住院数据，在1年的随访期内跟踪临床结果。建立模型来解释社区、家庭和个人因素是如何同时导致哮喘差异的，这对于建立一个完整的哮喘模型至关重要

DESCRIPTION (provided by applicant): Disparities in health outcomes by socioeconomic status (SES) are one of the most pressing public health problems our society faces today. In line with PAR-10-136's interest in multi-level approaches to understanding health disparities, we focus on childhood asthma and investigate factors simultaneously across neighborhood, family, and individual levels; we consider both physical environment and social environment exposures together; and we examine various levels of biological processes (organ systems, cellular, genomic) that drive asthma pathophysiology, all within a single project that seeks to develop a more comprehensive understanding of the causes of asthma disparities. The first aim is to understand how neighborhood, family, and individual-level social factors both shape and are shaped by one another, and how they collectively affect asthma disparities. The second aim is to measure social and physical exposures concurrently in order to explain how they interact to affect asthma disparities. The third aim is to create biologically plausible models for how social contexts contribute to health disparities by characterizing pathways at multiple levels biologicall (organ systems, cellular, genomic) that can explain how social contexts come to affect asthma disparities. This study will recruit a sample of 300 families from varying SES backgrounds who have a child ages 10-18 with persistent asthma. Families will participate in laboratory assessments of individual- and family-level social processes as well as child biological measures. Information on neighborhood characteristics will be linked from geographic information system maps of pollution exposures and maps of the social characteristics of communities created by a research consortium locally. In order to establish the temporal precedence of each of the 'levels' of factors, clinical outcomes will be tracked across a 1 year follow up period via monthly monitoring of symptoms as well as from hospitalization data obtained from provincial health records. Creating models that explain how neighborhood, family, and individual factors simultaneously contribute to asthma disparities is critical for developing a more holistic picture of how social contexts affect disease progression. These models will in turn shape our approaches to interventions. For example, interventions to improve medication adherence may not be effective if they do not acknowledge the broader social factors (e.g., neighborhood and family stress) that affect families' abilities to keep up with medication regimens. Assessing interactive effects between factors will also allow us to identify specific conditions under which potential targets of intervention would make the biggest differences in mitigating the pathophysiological processes underlying asthma. The overall goal of this project is to develop a more sophisticated understanding of why asthma disparities by SES exist and to identify the constellation of factors that would need to be targeted simultaneously in order to effectively alleviate these disparities.