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

摘要

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.