Early reproductive aging: stress and uterine fibroid risk among black women

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Project Summary (Abstract): The racial disparity in uterine leiomyomata (fibroids) is profound among African American women (AAW) – with an earlier age of onset of 10-15 years, a significantly higher incidence, and greater rates of hysterectomy, a major surgical procedure compared to Caucasian women (CW). The impact of fibroids is significant for reproductive age women, especially AAW who experience more symptomatology such as excessive bleeding, pain, and reproductive problems, and research on the risk factors for the condition is important. Earlier onset of fibroids among AAW may explain their larger size of fibroids and more symptomatology. Our central hypothesis is that the disproportionate burden of fibroids and the surgical disparities associated with the high fibroid morbidity result, at least in part, from the unique stress AAW experience. Specifically, racist societal and structural pressures that AAW experience may influence how AAW cope with stress, including their access to resources needed to mitigate such stress. Data from the National Institute of Environmental Health Sciences's Study of Environment, Lifestyle & Fibroids (SELF), the first prospective study of 1693 young AAW ages 23-34 years with fibroids assessed using standardized ultrasound examinations, will be analyzed. We will evaluate the hypothesis by pursuing three specific aims: 1) Examine the association between each baseline stress measure (i.e. life events, racial discrimination, daily stress, perceived stress, medical financial strain, and financial strain) and 5-year cumulative fibroid incidence and growth; 2) Create, describe, and explore 5-year trajectories of daily stress, perceived stress, medical financial strain, and financial strain and the life course trauma trajectories on 5-year cumulative incidence and growth of fibroids; and 3) Investigate the potential modifying effects of social support, spirituality/religiosity, socioeconomic status, coping, and early life conditions such as food insecurity, low financial status, etc., on the associations between stress and 5-year cumulative fibroid incidence and growth in Aims 1 and 2. This proposed ancillary research study will be the first study to bring fibroid incidence and growth data for more than 300 women and a range of stress measures including psychosocial resources and coping data and stress variables together to comprehensively investigate the stress experience in relation to fibroids in young AAW. Fibroids pose a major public health concern with the total associated cost (medical, work-related, etc.) estimated to be up to $34.4 billion annually. Determining risk factors for fibroids, such as stress which is modifiable, will advance our understanding of stress as a risk factor for fibroids and provide key information for improving the quality of life for African American women, who are more likely to experience missed days from work and disruption in physical activities and social relationships. It will also provide a strong research foundation that sheds light on potential intervention targets to reduce morbidity and surgical disparities; set the stage for identifying biological mechanisms for prevention; and elucidate the context of stress on fibroid risk.