Antimicrobial Agents and Asthma Morbidity among African American Children with Asthma

项目摘要/摘要 哮喘是美国主要的慢性儿科疾病，对非裔美国人的影响不成比例 孩子们。由于哮喘无法治愈，因此识别诱因对于疾病管理和控制至关重要。 新出现的证据，包括我们的初步数据，表明一些最常用的 个人护理产品(PCP)中的抗菌剂，对羟基苯甲酸酯和三氯生，可能会引发哮喘和 导致哮喘发病率增加。尽管如此，与PCP中抗菌剂暴露相关的研究与 哮喘发病率很低，还没有研究评估高度脆弱人群的这种风险。 经历着高发病率和高暴露于抗菌剂。这些潜在的关联是 尤其与非裔美国人(AA)儿童有关，因为他们有选择的生物标志物浓度 比白人儿童高近8倍的抗菌剂，他们患哮喘的可能性是白人儿童的两倍， 死于哮喘并发症的可能性是非再生障碍性贫血同龄人的10倍。通过利用 基础设施和两项约翰·霍普金斯儿科队列研究拟议的研究将是第一个：(1) 检测帕金森和三氯生对AA哮喘儿童哮喘发病率的影响 纵向数据；(2)应用定性研究方法，制定文化定制的PCP调查，以确定 使用与接触这些化合物有关的模式；以及(3)进行试点干预 不含抗菌素的五氯联苯，为未来的干预研究提供信息。这项工作的结果有可能引领 制定有效的公共卫生战略，以改善哮喘儿童的哮喘相关结局。这个项目 也符合NHLBI解决人群中与肺部疾病有关的问题的研究议程 不成比例地遭受这些状况的折磨。基罗斯-阿尔卡拉博士是一位环境健康科学家， 培训，这个职业发展奖将为她提供一个出色的培训平台，以获得 对实现独立至关重要的新的补充技能，包括在儿科呼吸道疾病方面， 定性研究方法、结构方程建模、干预设计与实施。 这些领域的专业知识将在内容跨学科指导团队的指导下获得 来自候选人所在机构、马里兰大学和约翰霍普金斯学院的领域专家 医学院和彭博公共卫生学院。职业发展计划需要有条理的 指导方法，授课课程，现场和临床经验，参与科学会议，以及 定期评估职业发展里程碑。强大的指导团队和机构环境将确保 在获奖期间成功完成所有培训和研究活动。总而言之，这是 该奖项将为候选人提供受保护的时间，以获得必要的技能和经验，以成为 一位独立研究人员，将她定位在环境健康和 她打算以此为基础设计有针对性的干预措施，以改善儿童的呼吸健康。

PROJECT SUMMARY/ABSTRACT Asthma is the leading chronic pediatric disease in the U.S., disproportionately affecting African American children. Because asthma has no cure, identifying triggers is critical for disease management and control. Emerging evidence, including our preliminary data, suggests that some of the most commonly used antimicrobial agents in personal care products (PCPs), parabens and triclosan, may be asthma triggers and contribute to increased asthma morbidity. Still, studies relating exposure to antimicrobial agents in PCPs with asthma morbidity are scarce and no studies have assessed this risk among highly vulnerable populations experiencing both high morbidity and high exposure to antimicrobial agents. These potential associations are particularly relevant to African American (AA) children as they have biomarker concentrations for select antimicrobial agents that are nearly 8 times higher than White children, they are twice as likely to have asthma, and are 10 times more likely to die of asthma complications than their non-AA peers. By leveraging infrastructure and two Johns Hopkins pediatric cohort studies the proposed research will be the first to: (1) examine the effects of parabens and triclosan on asthma morbidity among AA children with asthma using longitudinal data; (2) apply qualitative research methods to develop a culturally-tailored PCP survey to identify use patterns associated with exposures to these compounds; and (3) conduct a pilot intervention with antimicrobial-free PCPs to inform future intervention research. Results from this work have the potential to lead to effective public health strategies to improve asthma-related outcomes for children with asthma. This project is also in line with NHLBI’s research agenda to solve problems related to pulmonary diseases in populations suffering disproportionately from these conditions. Dr. Quiros-Alcala is an environmental health scientist by training, and this career development award will provide her with an exceptional training platform to acquire new complementary skills crucial to achieve independence, including in pediatric respiratory disease, qualitative research methods, structural equation modeling, and intervention design and implementation. Expertise in these areas will be acquired under the guidance of an interdisciplinary mentoring team of content area experts from the candidate’s home institution, the University of Maryland, and the Johns Hopkins School of Medicine and Bloomberg School of Public Health. The career development plan entails a structured approach to mentoring, didactic coursework, field and clinic experience, participation in scientific meetings, and regular assessment of career milestones. The strong mentoring team and institutional environments will ensure the successful completion of all training and research activities during the award period. In summary, this award will provide the candidate with protected time to acquire the necessary skills and experience to become an independent researcher, positioning her at the dynamic intersection of environmental health and epidemiology, from which she intends to design targeted interventions to improve children’s respiratory health.