Race Related Stressors and Preterm Birth in African American Women

描述(由申请人提供)：我研究的长期目标是开发一种基于证据的、文化上适当的干预措施，以减少非裔美国人(AA)妇女中与早产相关的健康差距。2005年，美国有超过50万(12.7%)的婴儿早产，再生障碍性贫血妇女的早产率几乎是前者的两倍。早产是导致新生儿死亡和长期健康问题的主要因素，包括运动和智力发育迟缓、学业失败和慢性病，每年花费260亿美元。人们对早产差异的原因知之甚少。试图解释再生障碍性贫血女性早产率高的原因，主要集中在与种族相关的压力因素，如邻里环境和种族歧视。这些应激源会增加压力，并与较高的早产率有关。压力以及消极的情绪和生理压力反应与早产有关。相比之下，个人资源可以改善压力反应，并对早产起到保护作用。种族相关的压力源、个人资源和压力反应都与早产有关。没有一项调查在单一模型中考察了这些因素之间的关系。提出的理论模型考察了客观和感知的邻里环境、感知的种族歧视、个人资源、压力反应和早产之间的关系。这项初步研究的具体目的是：1)确定对城市AA孕妇进行更大规模前瞻性研究的可行性；2)确定我们的理论模型是否有可能解释这一人群中的早产。具体问题是：(1)招募样本的可行性；(2)用于低收入城市怀孕AA妇女的测量方法的可接受性、有效性和可靠性；(3)基于精确的地址而不是人口普查区域数据来测量社区环境的地理编码的效用，以及客观和感知的社区环境之间的关系；(4)在更大的研究中用于样本大小的权力分析的预测值的可变性；(5)在数据收集和昼夜节律控制胎龄时，探索早产妇女和足月出生妇女在种族相关压力源、个人资源和应激反应方面的差异；(6)用这个样本初步证明我们的理论模型是可行的。在这项创新的纵向探索性描述性研究中，我们将招募137名怀孕的AA妇女，她们主要生活在芝加哥的低收入社区。我们将收集三次数据：T1在16-22周之间，T2在26-32周之间，以及出生后T3。地理编码地址将用于得出邻里环境的客观测量结果。每名女性感知的邻里环境、感知的种族歧视、个人资源和情绪压力反应将通过问卷调查进行评估。生理应激反应将通过生物标记物进行评估。从该试点获得的数据将有助于提交NIH R01申请，该申请将进一步测试该模型。了解邻里环境、种族歧视、个人资源、压力反应和早产之间的关系，将使研究人员能够开发一种循证干预措施，减少再生障碍性贫血女性的早产。2005年，美国有50多万婴儿早产(12.7%)，非洲裔美国女性的早产率几乎是非西班牙裔白人女性的两倍。早产是新生儿死亡和长期健康问题的主要风险，包括运动和智力发育迟缓以及慢性病。非裔美国女性早产率高得不成比例的原因尚不清楚。长期暴露在贫困、住房空置、犯罪和种族歧视等不利邻里条件下，可能会增加非裔美国妇女的压力，并增加她们早产的风险。在这项研究中，我们建议调查邻里环境和种族歧视对女性情绪和她们怀孕的影响。通过了解社区条件和歧视经历是如何导致早产的，我们可以针对降低非裔美国女性早产风险的项目和干预措施。

DESCRIPTION (provided by applicant): The long-term goal of my research is to develop an evidence-based, culturally appropriate intervention that decreases health disparities associated with preterm births among African American (AA) women. In 2005 in the United States, more than half a million (12.7%) infants were born prematurely and AA women had almost twice the rates of preterm birth. Preterm birth is a major factor associated with neonatal mortality and long-term health problems, including motor and mental developmental delays, school failure, and chronic illness and costs $26 billion annually. The causes of preterm birth disparity are poorly understood. Attempts to explain the high rates of preterm birth in AA women have focused on race-related stressors of neighborhood environment and racial discrimination. These stressors increase stress and are related to higher rates of preterm birth. Stress and negative emotional and physiological stress responses are associated with preterm birth. In contrast, personal resources ameliorate stress responses and have protective effects on preterm birth. Race-related stressors, personal resources and stress responses have individually been related to preterm birth. No investigation has examined the relationships among these factors in a single model. The proposed theoretical model examines the relationships among objective and perceived neighborhood environment, perceived racial discrimination, personal resources, stress responses and preterm birth. The specific aims of this pilot study are 1) to determine the feasibility of conducting a larger prospective study of pregnant urban AA women, and 2) to discern if our theoretical model has the potential to explain preterm birth in this population. Specific issues are: (1) feasibility, the ability to recruit the sample; (2) acceptability, validity, and reliability of measures for use in low-income urban pregnant AA women; (3) utility of geocoding based on precise address rather than census tract data to measure neighborhood environments, and the relation between the objective and perceived neighborhood environment; (4) variability of the predictors for use in power analyses for sample size in a larger study; (5) exploring differences in race-related stressors, personal resources, and stress responses between women with preterm birth and women with full term birth when controlling for gestational age at data collection and circadian rhythm; and (6) preliminary evidence of the promise of our theoretical model with this sample. In this innovative longitudinal exploratory descriptive study, we will enroll 137 pregnant AA women who live in predominantly low-income Chicago neighborhoods. We will collect data three times: T1 between 16-22 weeks, T2 between 26-32 weeks, and T3 after birth. Geocoded addresses will be used to derive objective measures of the neighborhood environment. Each woman's perceived neighborhood environment, perceived racial discrimination, personal resources, and emotional stress responses will be assessed though questionnaires. Physiological stress responses will be assessed by biological markers. Data obtained from this pilot will be instrumental in the submission of an NIH R01 application that will further test the model. Understanding the relationships among neighborhood environment, racial discrimination, personal resources, stress responses, and preterm birth, will allow researchers to develop an evidence-based intervention that decreases preterm birth in AA women. In 2005 in the United States, more than half a million (12.7 percent) infants were born prematurely and African- American women had almost twice the rate of preterm birth as non-Hispanic white women. Preterm birth is a major risk for neonatal mortality and long-term health problems, including motor and mental developmental delays and chronic illness. The causes of the disproportionately higher rates of preterm birth in African- American women are not well understood. Cumulative exposures to adverse neighborhood conditions such as poverty, housing vacancy, crime, and racial discrimination may increase stress of African-American women and their risk for preterm birth. In this study, we propose to examine influences of the neighborhood environment and racial discrimination on women's emotions and their pregnancies. By understanding how neighborhood conditions and experiences of discrimination contribute to preterm birth, we can target programs and interventions that reduce the risk for preterm birth in African-American women.