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

摘要 哮喘在美国已经达到流行的程度，非裔美国人的情况比白人更糟糕 关于哮喘发病率的所有衡量标准。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的流行和严重程度中发挥作用。而心理社会的作用 影响哮喘表达的因素已经在儿童中进行了研究，但在成人中对这些因素的研究很少。 应激是一种假定的机制，它可能通过一些看似合理的生物学机制来促成 成人哮喘的发病率。心理社会因素在哮喘中可能具有特别重要的作用 黑人妇女的发病率是因为暴力、种族主义、抑郁症和生活在 弱势社区的比例高于白人女性。如果这样的经历增加了成人患病的风险 发病哮喘，可能是导致哮喘发病率存在种族差异的原因。本应用程序的目标是 是填补关于心理社会因素在非洲成人发病哮喘中所起作用的知识空白 美国女性。我们的中心假设是，个人和邻居层面的心理社会因素 可能会导致压力增加非洲裔美国女性患成人哮喘的风险。该计划的基本原理 建议的研究是，确定增加成人哮喘发病风险的因素是一种 在制定预防政策和干预措施方面采取必要步骤，以减少成人发病的两个水平 哮喘和黑人/白人哮喘发病率的差距。这项建议的具体目的是：1)估计 种族主义经历、童年和青春期暴力经历以及抑郁的影响 症状对哮喘发病率的影响；2)评估社区社会经济状况(SES)的影响， 种族隔离和城市化对哮喘发病率的影响。我们将使用以下数据进行前瞻性分析 黑人妇女健康研究(BWHS)。BWHS队列成立于1995年，包括大约 来自美国各地的59,000名非裔美国女性。详细的人口统计信息，医疗和 在基线和两年一次的跟踪中收集生育史和包括哮喘在内的疾病终点。 Up调查问卷。在选定的后续问卷上，获得了关于心理社会的信息 利益因素。参与者地址已进行地理编码，并与人口普查数据相关联。超过16岁 经过数年的跟踪，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心理社会影响的前瞻性研究 对非裔美国女性成人哮喘事件感兴趣的暴露。拟议的研究是 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压力如何导致哮喘的进一步机械性研究，这可能会让 开发新的治疗干预措施。

ABSTRACT 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 proposal 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.