Violence Exposure, Immune Function & HIV/AIDS Risks in African American Young Ad

暴力暴露、免疫功能

• 批准号: 9011945
• 负责人: Frough Saadatmand
• 金额: $ 35.94万
• 依托单位: HOWARD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-12 至 2020-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9011945
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Affect; African American; Alcohols; Animals; Antibodies; Antidepressive Agents; Behavior; Behavioral; Biological; Biological Factors; Biological Markers; C-reactive protein; Childhood; Chronic; Communities; Confounding Factors (Epidemiology); Contracts; Country; Crime; Data; Development; Dietary Practices; Disease; Drug usage; Exposure to; Failure; Family; Female; Gender; Goals; HIV; HIV risk; Health; Health Status; Home environment; Homicide; Human; Human Herpesvirus 4; Immune; Immune system; Individual; Infection; Inflammation; Interpersonal Violence; Intervention; Life; Longitudinal Studies; Low income; Major Depressive Disorder; Measures; Medical; Mental Depression; Methods; Multiple Partners; Outcome; Pathway interactions; Pharmaceutical Preparations; Population; Predisposition; Prevention; Prevention program; Probability; Reporting; Research; Retrospective Studies; Risk; Risk Behaviors; Risk Factors; Role; Sampling; Sex Characteristics; Sexual Partners; Source; Subgroup; Surveys; Time; Tobacco; United States; Violence; Virus; Virus Diseases; aged; base; computerized; condoms; coping; depressive symptoms; environmental stressor; gender difference; health disparity; immune function; inflammatory marker; innovation; intervention program; male; multiple drug use; predictive modeling; programs; prospective; racial minority; response; seroconversion; sexual risk taking; social; stressor; theories; urban area; young adult

DESCRIPTION (provided by applicant): Sanders-Phillips, Kathy Significant disparities exist in rates of HIV/AIDS in the United States and African Americans have the highest infection rates in the country. Therefore, this proposal to examine behavioral and biological factors that may be related to HIV/AIDS in African American young adults is resubmitted in response to RFA-MD- 12-001 for NIMHD Health Disparities Research. A primary goal of the research is to develop a predictive model to identify subgroups of African American (AA) young adults who, based on their exposure to urban violence, may be at greater risk for exposure to HIV and should be targeted for prevention. In keeping with a focus of RFA-MD-12-001 on the social determinants of diseases such as HIV/AIDS that disproportionately affect ethnic-racial minorities, this within-group, longitudinal study of male and female African American young adults living in low-income, urban communities conceptualizes HIV/AIDS as a health problem that may be influenced by exposure to environmental stressors such as interpersonal and community violence. The high rates of violence in many urban communities may increase vulnerability to HIV/AIDS in African American young adults by impacting behavioral and biological pathways. First, exposure to interpersonal and community violence may be related to greater drug use and sexual risk-taking (e.g., multiple partners; failure to use condoms) that increase the probability f exposure to HIV. Chronic exposure to violence in multiple contexts (e.g., home and community) may exacerbate this effect. While drug use and sexual risk-taking are the primary risk factors for exposure to HIV in the U.S., there is increasing evidence that exposure to violence may also be associated with immune system dysregulation that results in a decrease in the ability of the immune system to effectively respond to infections and/or other foreign materials. Evidence of immune system dysregulation includes heightened levels of antibodies to the Epstein Barr Virus (EBV) and C reactive protein (CRP). Previous findings indicate that these biomarkers (EBV, CRP) are related to HIV acquisition and seroconversion. Thus, immune system dysregulation may be related to greater susceptibility to viral infections like HIV and an increased likelihood o contracting AIDS if exposed to the HIV virus. Existing data also strongly suggest that symptoms of depression subsequent to violence exposure may be a moderating variable that is related to increases in drug use, sexual risk-taking and dysregulation of the immune system. While animal studies support these associations, longitudinal studies of violence exposure and immune function in human groups, especially African Americans living in urban areas, have not been conducted. Therefore, the degree to which immune function may be suppressed in this population has not been examined empirically and the role of immune system dysregulation as a potential co-factor that may contribute to higher rates of AIDS in African Americans has not been established. Given recent data indicating possible sex differences in immunological responses to viruses, it is also important to examine gender as a variable that may influence relationships between violence exposure and immune function. This study will assess the impact of exposure to interpersonal and community violence on depression (symptoms of depression and clinical depression), ATOD use (alcohol, tobacco and other drug), HIV risk behaviors (condom use, number of sexual partners), and immune system function (antibodies to EBV, CRP levels) in African American young adults aged 18-25 (n = 600). Behavioral data, collected via computerized surveys, and biological data will be collected at baseline and at one and two-year follow-ups. Potential confounding variables (e.g., dietary patterns, other life stressors, coping strategies, health status) will also be assessed. The proposed study is unique and innovative in its focus on features of the urban context that, over time, may influence HIV/AIDS risk in African American young adults. The findings may have implications for the use and/or development of medications to decrease the risk of HIV/AIDS in African American young adults exposed to high levels of violence. For example, antidepressants may normalize depressive symptoms by exerting effects on immune system function and statins may reduce inflammation by decreasing levels of CRP. The study findings may also have implications for existing HIV/AIDS prevention programs. For example, to identify potentially modifiable protective factors that could be addressed in current HIV/AIDS prevention programs for African American young adults, this study will examine and identify coping strategies that are associated with HIV prevention behaviors (i.e., condom use) in the sample. Existing HIV/AIDS prevention and intervention programs may need to target African American young adults who have been exposed to high levels of urban violence and promote effective strategies for coping with violence in their programs.

描述（由申请人提供）：桑德斯菲利普斯，凯西在美国和非洲裔美国人的艾滋病毒/艾滋病感染率存在显着差异在该国的感染率最高。因此，重新提交本提案，以检查可能与非裔美国年轻人中HIV/AIDS相关的行为和生物因素，以响应NIMHD健康差异研究的RFA-MD- 12-001。该研究的主要目标是开发一个预测模型，以确定非洲裔美国人（AA）年轻成年人的亚组，根据他们接触城市暴力的情况，他们可能面临更大的艾滋病毒风险，应该成为预防的目标。RFA-MD-12-001的重点是不成比例地影响少数民族的艾滋病毒/艾滋病等疾病的社会决定因素，这一对生活在低收入城市社区的男性和女性非洲裔美国年轻人的组内纵向研究将艾滋病毒/艾滋病概念化为一种健康问题，可能受到环境压力因素（如人际和社区暴力）的影响。许多城市社区的高暴力率可能会通过影响行为和生物途径增加非洲裔美国年轻人对艾滋病毒/艾滋病的脆弱性。首先，接触人际和社区暴力可能与更多的吸毒和性冒险有关（例如，多个性伙伴;不使用避孕套），增加了暴露于艾滋病毒的可能性。在多种情况下长期遭受暴力（例如，家庭和社区）可能会加剧这种影响。虽然吸毒和性冒险是美国感染艾滋病毒的主要风险因素，越来越多的证据表明，遭受暴力也可能与免疫系统失调有关，导致免疫系统有效应对感染和/或其他异物的能力下降。免疫系统失调的证据包括爱泼斯坦巴尔病毒（EBV）和C反应蛋白（CRP）抗体水平升高。以前的研究结果表明，这些生物标志物（EBV，CRP）与HIV感染和血清转换有关。因此，免疫系统失调可能与对病毒感染如HIV的更大易感性以及如果暴露于HIV病毒则感染AIDS的可能性增加有关。现有数据还有力地表明，遭受暴力后的抑郁症状可能是一个调节变量，与吸毒、性冒险和免疫系统失调的增加有关。虽然动物研究支持这些关联，但尚未对人类群体，特别是生活在城市地区的非洲裔美国人的暴力暴露和免疫功能进行纵向研究。因此，免疫功能可能被抑制的程度，在这个人群中还没有经验和免疫系统失调作为一个潜在的辅助因素，可能有助于艾滋病在非洲裔美国人的作用尚未确定。鉴于最近的数据表明，在对病毒的免疫反应方面可能存在性别差异，还必须将性别作为可能影响暴力暴露与免疫功能之间关系的变量进行审查。这项研究将评估暴露于人际和社区暴力对抑郁症（抑郁症和临床抑郁症的症状），ATOD使用（酒精，烟草和其他药物），HIV风险行为（安全套的使用，性伴侣的数量）和免疫系统功能（EBV抗体，CRP水平）的影响，年龄在18-25岁的非洲裔美国年轻人（n = 600）。通过计算机化调查收集的行为数据和生物学数据将在基线和1年和2年随访时收集。潜在的混杂变量（例如，饮食模式、其他生活压力因素、应对策略、健康状况）也将进行评估。拟议的研究是独特的和创新的，其重点是城市环境的特点，随着时间的推移，可能会影响艾滋病毒/艾滋病的风险在非洲裔美国年轻人。这些发现可能对药物的使用和/或开发产生影响，以降低暴露于高水平暴力的非洲裔美国年轻人感染艾滋病毒/艾滋病的风险。例如，抗抑郁药可以通过对免疫系统功能产生影响来使抑郁症状正常化，他汀类药物可以通过降低CRP水平来减轻炎症。研究结果也可能对现有的艾滋病毒/艾滋病预防计划产生影响。例如，为了确定在目前的非洲裔美国年轻人艾滋病毒/艾滋病预防计划中可以解决的潜在可改变的保护因素，本研究将检查和确定与艾滋病毒预防行为相关的应对策略（即，使用避孕套）的样本。现有的艾滋病毒/艾滋病预防和干预方案可能需要针对非洲裔美国年轻人谁已经暴露在高水平的城市暴力和促进有效的战略，以应对暴力在他们的方案。