Social Stressors and Inflammation: A Mixed Methods Approach to Preterm Birth

社会压力源和炎症：早产的混合方法

• 批准号: 9469090
• 负责人: Carmen Giurgescu
• 金额: $ 76.49万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-01-06 至 2021-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9469090
• 关键词: 37 weeks gestation; Accounting; Affect; African American; Anti-Inflammatory Agents; Anti-inflammatory; Anxiety; Area; Biological Markers; Birth; Birth Rate; Blood specimen; C-reactive protein; Censuses; Child; Child Mortality; Child health care; Chronic Disease; Chronic stress; Data; Development; Developmental Delay Disorders; Emotional Stress; Enrollment; Event; Goals; Hair; Health; Health Care Costs; Hormones; Hospital Records; Hydrocortisone; Incidence; Individual; Infant; Inflammation; Inflammatory; Interleukin-10; Intervention; Interview; Knowledge; Lead; Life; Link; Longitudinal Studies; Measures; Mediating; Medical Records; Methods; Mission; Modeling; Modification; Morbidity - disease rate; Motor; Neighborhoods; Neonatal Mortality; Not Hispanic or Latino; Outcome; Pathway interactions; Physiological; Plasma; Pregnancy; Pregnancy Outcome; Premature Birth; Prenatal Structures; Psyche structure; Questionnaires; Race; Reporting; Research; Resources; Risk; Social Environment; Social support; Statistical Data Interpretation; Stress; Structure; Time; United States National Institutes of Health; Woman; base; clinical practice; cohort; coping; cytokine; depressive symptoms; design; effective intervention; health disparity; high risk; high risk population; hypothalamic-pituitary-adrenal axis; improved; improved outcome; insight; low socioeconomic status; metropolitan; neighborhood disadvantage; physical conditioning; pregnant; premature; prenatal; protective effect; psychological distress; psychosocial; racial discrimination; racial disparity; response; social; stressor

African American women have 1.5 times the rates of preterm birth (PTB)(<37 weeks completed gestation) compared with non-Hispanic white women. This disproportionately high PTB rate in African Americans is a persistent health inequity that leads to high child mortality, morbidity, and developmental delays. In the U.S. approximately $26 billion are spent annually on health care costs for infants and children that were born prematurely. Recent attempts to explain the high PTB rates in African American women have focused on social stressors, such as disadvantaged neighborhoods, racial discrimination, and stressful life events. These social stressors may lead to PTB by increasing women's emotional stress levels. Not surprisingly, emotional stress along with levels of the stress hormone cortisol and systemic inflammation - both physiological responses to stress - have all been related to higher risk of PTB. In contrast, one's psychosocial resources (e.g., social support) can lessen emotional stress and have protective effects on PTB. Little is yet known about the pathways by which social stressors affect inflammation, and ultimately PTB. The objective of the proposed study is to determine how social stressors alter inflammation during pregnancy and lead to PTB in African American women. We aim to: 1) determine the pathways by which social stressors affect PTB; and 2) describe social stressors, emotional stress and psychosocial resources; the associations among these concepts; and their impact on PTB from women's perspectives. In this longitudinal convergent mixed methods design, we will enroll 1,500 African American women who live in the Detroit metropolitan area. We will collect data on social stressors, emotional stress, and psychosocial resources through questionnaires and administrative (e.g., census) data. This will be done three times prenatally. At these same time points, levels of cortisol and systemic inflammation will be determined from hair and blood samples, respectively. We will also obtain birth data from the prenatal and hospital records. In a subsample of 60 women, semi-structured interviews will be conducted to more specifically understand the associations among social stressors, emotional stress and psychosocial resources; and their impact on PTB. We will conduct a variety of statistical, qualitative and mixed methods analyses using both quantitative and qualitative data to determine answers to the aims of our study. We will also consider the timing of pregnancy in our analyses, as the prenatal data are collected at three distinct time points. The proposed research is highly relevant to NIH's mission to elucidate mechanisms underlying health disparities in PTB. Insights gained from this mixed methods approach may lead to the development of an individualized PTB risk profile based on a woman's social stressors and biomarkers which will have potential use in clinical practice and be a target for culturally appropriate interventions to reduce PTB incidence in African American women, and will generate new perspectives for future research in other racial groups through our detailed focus on this high risk group.

非裔美国妇女的早产率（PTB）是非裔美国妇女的1.5倍（妊娠期<37周）。 与非西班牙裔白色女性相比。非裔美国人中不成比例的高PTB率是一个 持续的健康不平等导致儿童死亡率高、发病率高和发育迟缓。在美国 每年大约有260亿美元用于婴儿和儿童的医疗保健费用， 过早地。最近试图解释非洲裔美国妇女的高PTB率集中在 社会压力源，如弱势社区、种族歧视和压力性生活事件。这些 社会压力可能会增加妇女的情绪压力，从而导致肺结核。毫不奇怪，情绪化 压力沿着压力激素皮质醇和全身炎症的水平--这两种生理 对压力的反应-都与PTB的高风险有关。相反，一个人的社会心理资源 (e.g.,社会支持）可以减轻情绪压力，对PTB有保护作用。 我们对 社会压力源影响炎症的途径，并最终影响PTB。建议的目标 一项研究旨在确定社会压力如何改变非洲人怀孕期间的炎症并导致PTB 美国女人我们的目标是：1）确定社会压力影响PTB的途径; 2）描述 社会压力源、情绪压力和心理社会资源;这些概念之间的联系;以及 从妇女的角度看其对PTB的影响。 在这个纵向融合的混合方法设计中，我们将招募1,500名非洲裔美国妇女， 在底特律都会区。我们将收集有关社会压力源、情绪压力和心理社会压力的数据。 通过问卷调查和行政（例如，人口普查）数据。这将进行三次 产前在这些相同的时间点，皮质醇和全身炎症的水平将确定从头发 和血液样本我们还将从产前和医院记录中获得出生数据。中 60名妇女的子样本，将进行半结构化访谈，以更具体地了解 社会压力源、情绪压力和社会心理资源之间的关系及其对肺结核的影响。 我们将进行各种统计，定性和混合方法的分析，使用定量和 定性数据，以确定我们的研究目标的答案。我们还将考虑怀孕的时间， 我们的分析，因为产前数据是在三个不同的时间点收集的。该研究建议高度 与NIH的使命相关，以阐明PTB中健康差异的潜在机制。从以下方面获得的见解： 这种混合方法 可能导致基于以下因素的个体化PTB风险特征的发展： 女性的社会压力源和生物标志物，这将在临床实践中有潜在的用途，并成为目标， 文化上适当 减少非裔美国妇女PTB发病率的干预措施，并将产生新的 通过我们对这一高风险群体的详细关注，展望未来在其他种族群体中的研究。