Race Related Stressors and Preterm Birth in African American Women

描述（由申请人提供）：我的研究的长期目标是开发一种基于证据的，文化上适当的干预措施，减少与非裔美国人（AA）妇女早产相关的健康差异。2005年，在美国，超过50万（12.7%）婴儿早产，AA妇女的早产率几乎是早产率的两倍。早产是与新生儿死亡率和长期健康问题相关的主要因素，包括运动和智力发育迟缓、学业失败和慢性疾病，每年花费260亿美元。早产差异的原因尚不清楚。试图解释AA妇女早产率高的原因，主要集中在与种族有关的邻里环境和种族歧视的压力。这些压力源会增加压力，并与早产率较高有关。压力和负面的情绪和生理压力反应与早产有关。相比之下，个人资源改善压力反应，对早产有保护作用。种族相关的压力源，个人资源和压力反应个别与早产。没有调查研究这些因素之间的关系，在一个单一的模型。提出的理论模型探讨客观和感知邻里环境，感知种族歧视，个人资源，压力反应和早产之间的关系。这项试点研究的具体目的是：1）确定对城市AA孕妇进行更大规模前瞻性研究的可行性; 2）辨别我们的理论模型是否有潜力解释这一人群的早产。具体问题是：（1）可行性，招募样本的能力;（2）用于低收入城市AA孕妇的测量的可接受性，有效性和可靠性;（3）基于精确地址而不是人口普查区数据的地理编码测量邻里环境的效用，以及客观和感知邻里环境之间的关系;（4）预测变量的变异性，用于更大规模研究中样本量的功效分析;（5）探索种族相关压力源、个人资源、在控制数据收集时的胎龄和昼夜节律时，早产妇女和足月分娩妇女之间的应激反应;和（6）初步证据的承诺，我们的理论模型与此样本。在这项创新的纵向探索性描述性研究中，我们将招募137名怀孕的AA女性，她们主要居住在芝加哥的低收入社区。我们将收集三次数据：T1在16-22周之间，T2在26-32周之间，T3在出生后。地理编码的地址将被用来获得邻里环境的客观措施。每个女人的感知邻里环境，感知种族歧视，个人资源和情绪压力反应将通过问卷进行评估。将通过生物标记物评估生理应激反应。从该试点获得的数据将有助于提交NIH R 01申请，进一步测试该模型。了解邻里环境，种族歧视，个人资源，压力反应和早产之间的关系，将使研究人员能够开发一种基于证据的干预措施，减少AA妇女的早产。2005年，美国有50多万（12.7%）婴儿早产，非裔美国妇女的早产率几乎是非西班牙裔白色妇女的两倍。早产是新生儿死亡和长期健康问题的主要风险，包括运动和智力发育迟缓以及慢性疾病。非裔美国妇女早产率高得不成比例的原因还不太清楚。累积暴露于不利的邻里条件，如贫困，住房空置，犯罪和种族歧视可能会增加非洲裔美国妇女的压力和早产的风险。在本研究中，我们将探讨邻里环境和种族歧视对妇女的情绪和怀孕的影响。通过了解社区条件和歧视经历如何导致早产，我们可以针对降低非裔美国妇女早产风险的计划和干预措施。

DESCRIPTION (provided by applicant): The long-term goal of my research is to develop an evidence-based, culturally appropriate intervention that decreases health disparities associated with preterm births among African American (AA) women. In 2005 in the United States, more than half a million (12.7%) infants were born prematurely and AA women had almost twice the rates of preterm birth. Preterm birth is a major factor associated with neonatal mortality and long-term health problems, including motor and mental developmental delays, school failure, and chronic illness and costs $26 billion annually. The causes of preterm birth disparity are poorly understood. Attempts to explain the high rates of preterm birth in AA women have focused on race-related stressors of neighborhood environment and racial discrimination. These stressors increase stress and are related to higher rates of preterm birth. Stress and negative emotional and physiological stress responses are associated with preterm birth. In contrast, personal resources ameliorate stress responses and have protective effects on preterm birth. Race-related stressors, personal resources and stress responses have individually been related to preterm birth. No investigation has examined the relationships among these factors in a single model. The proposed theoretical model examines the relationships among objective and perceived neighborhood environment, perceived racial discrimination, personal resources, stress responses and preterm birth. The specific aims of this pilot study are 1) to determine the feasibility of conducting a larger prospective study of pregnant urban AA women, and 2) to discern if our theoretical model has the potential to explain preterm birth in this population. Specific issues are: (1) feasibility, the ability to recruit the sample; (2) acceptability, validity, and reliability of measures for use in low-income urban pregnant AA women; (3) utility of geocoding based on precise address rather than census tract data to measure neighborhood environments, and the relation between the objective and perceived neighborhood environment; (4) variability of the predictors for use in power analyses for sample size in a larger study; (5) exploring differences in race-related stressors, personal resources, and stress responses between women with preterm birth and women with full term birth when controlling for gestational age at data collection and circadian rhythm; and (6) preliminary evidence of the promise of our theoretical model with this sample. In this innovative longitudinal exploratory descriptive study, we will enroll 137 pregnant AA women who live in predominantly low-income Chicago neighborhoods. We will collect data three times: T1 between 16-22 weeks, T2 between 26-32 weeks, and T3 after birth. Geocoded addresses will be used to derive objective measures of the neighborhood environment. Each woman's perceived neighborhood environment, perceived racial discrimination, personal resources, and emotional stress responses will be assessed though questionnaires. Physiological stress responses will be assessed by biological markers. Data obtained from this pilot will be instrumental in the submission of an NIH R01 application that will further test the model. Understanding the relationships among neighborhood environment, racial discrimination, personal resources, stress responses, and preterm birth, will allow researchers to develop an evidence-based intervention that decreases preterm birth in AA women. In 2005 in the United States, more than half a million (12.7 percent) infants were born prematurely and African- American women had almost twice the rate of preterm birth as non-Hispanic white women. Preterm birth is a major risk for neonatal mortality and long-term health problems, including motor and mental developmental delays and chronic illness. The causes of the disproportionately higher rates of preterm birth in African- American women are not well understood. Cumulative exposures to adverse neighborhood conditions such as poverty, housing vacancy, crime, and racial discrimination may increase stress of African-American women and their risk for preterm birth. In this study, we propose to examine influences of the neighborhood environment and racial discrimination on women's emotions and their pregnancies. By understanding how neighborhood conditions and experiences of discrimination contribute to preterm birth, we can target programs and interventions that reduce the risk for preterm birth in African-American women.