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

摘要 哮喘在美国已经达到了流行病的程度，非洲裔美国人的情况比白人更糟 哮喘发病率的所有指标。造成这种差异的原因尚未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群体和/或市中心社区 在儿童哮喘的患病率和严重程度中发挥作用。虽然社会心理学的作用 在儿童哮喘表达中的因素已经被研究，但是在成人中这些因素的研究很少。 压力是假定的机制，并且存在合理的生物学机制，它可能有助于 成人哮喘的发病率。心理社会因素在哮喘中可能特别重要 黑人妇女的发病率，因为暴力，种族主义，抑郁症和生活在 弱势社区的死亡率高于白色妇女。如果这些经历增加了成年人的风险， 哮喘发作时，他们可能有助于哮喘发病率的种族差异。本申请的目的 是为了填补这方面的知识空白，心理社会因素的作用，在事件成人发作哮喘在非洲 美国女人我们的中心假设是，个人和邻里水平的心理社会因素， 可能会导致压力增加非洲裔美国妇女患成人哮喘的风险。的理由 一项拟议的研究是，确定增加成人发作哮喘风险的因素是一项 制定预防政策和干预措施，以减少成人发病的 哮喘和黑人/白色哮喘发病率的差距。本提案的具体目标是：1）估计 种族主义经历的影响，儿童和青少年时期的暴力经历， 症状对哮喘发病率的影响; 2）估计社区社会经济地位（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）1995年收集的BWHS队列包括大约 来自美国各地的59，000名非洲裔美国妇女详细的人口统计信息，医疗和 在基线和两年一次的随访中收集生殖史和疾病终点（包括哮喘）， up questionnaire问卷.在选定的后续调查问卷中，获得了有关心理社会方面的信息。 利益因素。参与者的地址已作地理编码，并与普查数据相联系。超过16 到2011年的随访中，将报告约1800例哮喘事件。 这项研究是创新的，因为它将是第一个考虑心理社会影响的前瞻性研究。 非裔美国妇女成人哮喘发病的相关暴露。拟议的研究是 意义重大，因为积极的结果可以指导干预努力，解决种族主义和暴力等压力因素 并可能激发进一步的机制研究，慢性压力如何导致哮喘，这可能会告知 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.