Tools for Measuring and Analyzing Cortisol Levels in Population Studies of Health

描述（由申请人提供）：社会经济地位和种族/民族的健康差异已被记录为许多健康结果。对健康差异的原因进行更全面的了解，将在多个层面界定的因素（例如，从社区或邻里过程到生物因素）结合起来，并阐明在多种健康状况中产生差异的共同或相互关联的过程，仍然是一项重大挑战。这不仅对了解多种疾病的病因很重要，而且对制定消除健康差距的战略也很重要。据推测，造成多个健康领域差异的一个过程是社会心理压力。有人认为，长期反复暴露于社会心理压力源会产生生物学后果，影响多种健康状况，包括低出生体重、哮喘和心血管疾病等多种结果。研究社会心理压力作用的两个主要挑战包括：(1)压力反应的生物学标记的测量和表征；(2)研究这种复杂的生物反应如何随着更高水平（或上游）决定因素（如社会经济地位和社区特征）的变化而变化。我们建议通过开发方法学工具来解决这两个挑战，这些工具是在基于人群的研究中表征和分析应激反应的生物标志物（特别是皮质醇谱）所必需的。我们项目的总体目标是改进必要的方法工具和数据收集协议，以了解上游决定因素（如社区水平因素）如何触发可能在人群中产生多种疾病结果差异的生物过程（特别是应激反应）。我们将使用一个独特的多层次数据集来调查不同方法学方法的使用，以便就以下方面提出具体建议：(a)唾液皮质醇数据的数据收集方案（特别是关于样本的数量和时间）和(b)将皮质醇概况作为结果或预测因子的数据分析。(1)通过唾液皮质醇的重复测量来评估，研究和对比用于描述生物应激反应不同特征的统计方法。(2)检查皮质醇曲线特征的测量特性，以便能够在未来的研究中就最佳数据收集工具和方案提出具体建议；(3)调查和对比有助于检查应激反应曲线特征与社区和个人水平预测因子以及个人水平结果之间的关系的方法。解决这些目标将改善研究人员可用的工具，以研究社区和邻里如何触发与人口健康差异相关的人类生物过程（本RFA的既定目标之一）。根据种族/民族（通常称为健康差异）和社会经济地位，健康状况的持续和显著差异已被证明会导致许多不同的健康结果。造成这些差异的原因仍有待研究。社会心理因素被假设为造成这些差异的重要因素，但表征和分析社会心理压力的生物学后果的可用工具仍然有限。通过开发必要的工具来测量和分析应激反应的生物标志物，我们的项目将有助于研究多种健康结果中健康差异的原因。不同种族/民族（通常称为健康差异）和不同社会经济地位在健康方面的持续和显著差异已被证明会导致许多不同的健康结果。造成这些差异的原因仍有待研究。社会心理因素被假设为造成这些差异的重要因素，但表征和分析社会心理压力的生物学后果的可用工具仍然有限。通过开发必要的工具来测量和分析应激反应的生物标志物，我们的项目将有助于研究多种结果中健康差异的原因。

DESCRIPTION (provided by applicant): Disparities in health by socioeconomic position and race/ethnicity have been documented for numerous health outcomes. Developing a more comprehensive understanding of the reasons for health disparities that integrates factors defined at multiple levels (e.g. from community-level or neighborhood processes to biological factors) and that explicates common or interrelated processes that generate disparities in multiple health conditions remains a major challenge. This is important not only to understand the etiology of multiple diseases, but also to develop strategies to eliminate health disparities. One process that has been hypothesized to contribute to disparities in multiple health domains is psychosocial stress. It has been argued that exposure to psychosocial stressors repeatedly over long periods has biological consequences with implications for multiple health conditions, including outcomes as diverse as low birth weight, asthma, and cardiovascular disease. Two major challenges in studying the role of psychosocial stress include the (1) measurement and characterization of biological markers of the stress response (2) examining how this complex biological response varies as a function of higher-level (or upstream) determinants such as socioeconomic position and community characteristics. We propose to address both challenges through the development of methodological tools necessary to characterize and analyze biomarkers of the stress response (specifically cortisol profiles) in population-based studies. The overall goal of our project is to improve the methodological tools and data collection protocols necessary to understand how upstream determinants (such as neighborhood-level factors) trigger biological processes (specifically the stress response) that may generate disparities in multiple disease outcomes in the population. We will use a unique multilevel dataset to investigate the use of different methodological approaches in order to make specific recommendations regarding (a) data collection protocols for salivary cortisol data (specifically regarding number and timing of samples) and (b) data analyses involving cortisol profiles as outcomes or predictors The specific aims of our project are: (1) To investigate and contrast statistical methods useful in characterizing different features of the biological stress response, as assessed by repeat measures of salivary cortisol. (2) To examine measurement properties of the features of the cortisol curve in order to be able to make specific recommendations regarding the best data collection tools and protocols in future studies and (3) To investigate and contrast methods useful in examining how features of the stress response curve are related to neighborhood and individual-level predictors as well as to individual-level outcomes. Addressing these Aims will improve the tools available to researchers to study how communities and neighborhoods trigger biological processes in humans that relate to health disparities in the population (one of the stated aims of this RFA). Relevance Persistent and pronounced differences in health by race/ethnicity (often termed health disparities) and by socioeconomic position have been documented for many different health outcomes. The reasons for these disparities remain a subject for research. Psychosocial factors have been hypothesized to be important contributors to these disparities but the tools available to characterize and analyze the biologic consequences of psychosocial stress remain limited. By developing tools necessary to measure and analyze biologic markers of the stress response, our project will contribute to the study for the reasons for health disparities in multiple health outcomes. Persistent and pronounced differences in health by race/ethnicity (often termed health disparities) and by socioeconomic position have been documented for many different health outcomes. The reasons for these disparities remain a subject for research. Psychosocial factors have been hypothesized to be important contributors to these disparities but the tools available to characterize and analyze the biologic consequences of psychosocial stress remain limited. By developing tools necessary to measure and analyze biologic markers of the stress response, our project will contribute to the study of the causes of health disparities in multiple outcomes.