Penn-CHOP ECHO

宾夕法尼亚-CHOP ECHO

• 批准号: 10746523
• 负责人: Heather Herson Burris
• 金额: $ 357.76万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10746523
• 关键词: 3 year old; Affect; Age; Air Pollution; Area; Asthma; Behavior; Birth; Black race; Child; Child Health; Child health equity; Childhood; Clinical Research; Collaborations; Communities; Complex; Conceptions; Couples; Data; Development; Diet; Dietary Practices; Disease; Education; Endocrine; Ensure; Environment; Environmental Exposure; Environmental Health; Equity; Fertility; Fetal Growth; Green space; Growth; Guidelines; Health; Health Promotion; Health system; Healthcare; Immunologics; Income; Individual; Inequity; Infant; Infant Mortality; Inflammatory; Institution; Intervention; Investments; Joints; Life; Life Style; Longterm Follow-up; Maternal and Child Health; Maternal-fetal medicine; Medicaid; Methods; Modernization; Neighborhoods; Neonatology; Neurodevelopmental Deficit; Obesity; Outcome; Oxidative Stress; Pathway interactions; Patients; Pediatric Hospitals; Pediatric cohort; Pediatric epidemiology; Pennsylvania; Perinatal; Persons; Phenotype; Philadelphia; Physical activity; Pollution; Population Heterogeneity; Positioning Attribute; Postpartum Period; Practice Guidelines; Pregnancy; Premature Birth; Protocols documentation; Psychosocial Stress; Public Health; Race; Recording of previous events; Research; Risk; Role; Site; Sleep; Targeted Research; Underrepresented Populations; Universities; Violence; Work; adverse pregnancy outcome; anti-racism; cohort; dashboard; design; disparity reduction; early childhood; experience; extreme temperature; follow-up; health care settings; health disparity; health equity; improved; innovation; mortality disparity; multidisciplinary; neurodevelopment; novel; novel strategies; obesity in children; offspring; outcome disparities; postpartum weight; pregnancy health; pregnant; prevent; racial disparity; racism; recruit; social; social epidemiology; success; walkability; wearable device

Project Summary Health disparities start early in life, with Black infants (10.6 per 1,000) twice as likely to die compared to White infants (4.5 per 1,000). Adverse pregnancy outcomes are responsible for the majority of the Black-White infant mortality disparity. Extensive healthcare efforts have been taken to prevent adverse pregnancy outcomes and to optimize child growth, health, and neurodevelopment. However, birth and childhood outcomes remain major areas of public health concern with ongoing inequities. Macroenvironmental health promoting factors (greenspace, walkability) and health threatening factors (pollution, neighborhood violence, extreme temperatures) may affect health directly through inflammatory and immunologic pathways. Macroenvironments may also contribute to lived experiences of income potential and educational attainment. Combined with interpersonal individual exposures such as racism and violence, macroenvironments may alter individuals' microenvironmental health factors such as diet, physical activity, psychosocial stress, and sleep. While macro- and microenvironmental exposures have been studied individually, the impact of neighborhood environments on complex health disorders in pregnancy and early childhood remains understudied and the interplay with microenvironmental factors to reduce disparities is completely unknown. We propose a causal inference framework to evaluate the role of specific macroenvironment factors (Aim 1) to reduce the risks of abnormal fetal growth, preterm birth, obesity, asthma, and neurodevelopmental delays by age 3, as well as whether such factors may improve racial disparities in these outcomes. We will also identify optimal components of microenvironmental factors of diet, physical activity, and sleep, during pregnancy (Aim 2) and among couples during preconception (Aim 4), that can best be utilized to maximize reductions in health disparities. We have assembled a multidisciplinary team of experts at the University of Pennsylvania and Children's Hospital of Philadelphia who are well-positioned to complete the study and recruit up to 2500 pregnant people, partners, and offspring, with retention of at least 75% at age 3, among whom 1250 will be recruited into the preconception pilot (Aim 3). The health system at Penn/CHOP serves a population underrepresented in other pregnancy and pediatric cohorts in the US (largely Medicaid-insured and plurality Black). The culture of clinical research, excellent scientific environment, and diverse population makes Penn and CHOP the ideal place to innovate in the field of maternal-child health equity. The Penn-CHOP ECHO study team is committed to the success of this work and looks forward to working collaboratively with the other ECHO Study Sites, Coordinating Centers, and Cores.

项目摘要 健康差距从生命早期就开始了，黑人婴儿（每1,000人中有10.6人）死亡的可能性是白色婴儿的两倍 婴儿（4.5%.）。不良妊娠结局是大多数黑白混血儿的原因。 死亡率差距。已经采取了广泛的医疗保健措施来预防不良妊娠结局， 来优化儿童的生长、健康和神经发育。然而，出生和童年的结果仍然是主要的， 公共卫生领域存在持续的不公平现象。宏观环境健康促进因素 （绿色空间，步行性）和健康威胁因素（污染，邻里暴力，极端 温度）可能直接通过炎症和免疫途径影响健康。宏观环境 也可能有助于收入潜力和教育程度的生活经验。结合 人际个体暴露，如种族主义和暴力，宏观环境可能会改变个人的 微环境健康因素，如饮食，身体活动，心理压力和睡眠。虽然宏- 和微环境暴露进行了单独研究，邻里环境的影响 关于怀孕和幼儿期复杂健康疾病的研究仍然不足， 减少差距的微观环境因素完全未知。我们提出一个因果推论 评估特定宏观环境因素（目标1）的作用的框架，以减少异常风险 胎儿生长、早产、肥胖、哮喘和3岁以前的神经发育迟缓，以及这些因素是否 这些因素可能会改善这些结果中的种族差异。我们还将确定最佳组成部分， 怀孕期间（目标2）和夫妇之间的饮食、身体活动和睡眠等微环境因素 在怀孕前（目标4），这可以最好地用于最大限度地减少健康差距。我们有 在宾夕法尼亚大学和宾夕法尼亚州儿童医院组建了一个多学科专家小组， 费城有能力完成这项研究并招募多达2500名孕妇、伴侣， 和后代，在3岁时保持至少75%，其中1250人将被招募到 概念前试点（目标3）。Penn/CHOP的卫生系统服务于其他地区代表性不足的人口。 美国的妊娠和儿科队列（主要是医疗保险和多数黑人）。临床文化 研究，优良的科学环境和多样化的人口使宾夕法尼亚州和CHOP的理想场所， 在母婴健康公平领域进行创新。Penn-CHOP ECHO研究团队致力于 这项工作取得成功，并期待与其他ECHO研究中心合作， 协调中心和核心。