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

社会经济地位（SES）的健康结果差异是我们社会今天面临的最紧迫的公共卫生问题之一。根据PAR-10-136对了解健康差异的多层次方法的兴趣，我们专注于儿童哮喘，并同时调查邻居，家庭和个人水平的因素;我们同时考虑物理环境和社会环境暴露;我们检查了生物过程的各个层面（器官系统，细胞，基因组）驱动哮喘病理生理学，所有这些都在一个单一的项目中，该项目旨在更全面地了解哮喘差异的原因。第一个目的是了解邻里，家庭和个人层面的社会因素如何形成和相互形成，以及它们如何共同影响哮喘差异。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多个生物学水平（器官系统，细胞，基因组）的途径来建立社会背景如何影响健康差异的生物学合理模型，这些途径可以解释社会背景如何影响哮喘差异。这项研究将招募300个来自不同SES背景的家庭，他们有一个10-18岁的持续性哮喘儿童。家庭将参与对个人和家庭一级的社会进程以及儿童生物措施的实验室评估。关于邻里特征的信息将与当地一个研究联合会绘制的污染暴露地理信息系统地图和社区社会特征地图相联系。为了确定每个因素“水平”的时间优先顺序，将通过每月监测症状以及从省级健康记录中获得的住院数据，在1年随访期内跟踪临床结局。建立模型来解释邻里、家庭和个人因素如何同时导致哮喘差异，这对于制定一个 更全面地了解社会环境如何影响疾病进展。这些模式将反过来塑造我们的干预方法。例如，如果不承认更广泛的社会因素（例如，邻里和家庭压力），影响家庭的能力，以跟上药物治疗方案。评估因素之间的相互作用也将使我们能够确定特定的条件下，潜在的干预目标将在减轻哮喘的病理生理过程中产生最大的差异。该项目的总体目标是对SES哮喘差异存在的原因进行更深入的了解，并确定需要同时针对的因素群，以有效缓解这些差异。

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.