Social stressors and inflammation: A mixed methods approach to preterm birth

非裔美国妇女的早产率是早产率的1.5倍(37周妊娠完成) 与非西班牙裔白人女性相比。非裔美国人的肺结核发病率高得不成比例，是一种 持续的健康不平等导致高儿童死亡率、发病率和发育迟缓。在美国 每年约有260亿美元用于婴儿和出生儿童的医疗费用 为时过早。最近，人们试图解释非裔美国女性患肺结核的高比率，主要集中在 社会压力源，如弱势社区、种族歧视和应激性生活事件。这些 社会压力可能通过增加女性的情绪压力水平而导致肺结核的发生。毫不奇怪，情绪化 压力以及应激激素皮质醇和全身炎症的水平--两者都是生理性的 对压力的反应--都与肺结核的高风险有关。相比之下，一个人的心理社会资源 (例如，社会支持)可以减轻情绪压力，对肺结核有保护作用。人们对此知之甚少 社会应激源影响炎症，并最终影响肺结核的途径。建议的目标是 一项研究旨在确定在非洲，社会应激源如何改变孕期炎症并导致肺结核 美国女性。我们的目标是：1)确定社会应激源影响肺结核的途径；2)描述 社会压力源、情绪压力和心理社会资源；这些概念之间的联系；以及 她们从女性的角度对肺结核的影响。 在这个纵向趋同的混合方法设计中，我们将招收1500名生活在 在底特律大都市区。我们将收集有关社会压力源、情感压力和心理社会的数据。 通过问卷调查和行政(例如人口普查)数据提供资源。此操作将进行三次 在产前。在同一时间点，皮质醇和全身炎症的水平将从头发中确定。 和血液样本。我们还将从产前和医院记录中获得出生数据。在一个 将对60名女性进行半结构化访谈，以更具体地了解 社会压力源、情绪压力和心理社会资源之间的关系及其对肺结核的影响。 我们将进行各种统计、定性和混合方法的分析，包括定量和 定性数据来确定我们研究目标的答案。我们还将考虑#年怀孕的时间。 我们的分析，因为产前数据是在三个不同的时间点收集的。拟议中的研究具有很高的 与美国国立卫生研究院阐明肺结核健康差异的潜在机制的使命有关。从以下方面获得的见解 这种混合方法可能导致基于以下方面的个体化结核病风险概况的开发 女性社会压力源和生物标志物在临床实践中的潜在用途和作为治疗目标的研究 在文化上适当的干预措施，以减少非裔美国妇女的肺结核发病率，并将产生新的 通过我们对这一高危群体的详细关注，展望未来在其他种族群体中的研究。

African American women have 1.5 times the rates of preterm birth (PTB) (<37 weeks completed gestation) compared with non-Hispanic white women. This disproportionately high PTB rate in African Americans is a persistent health inequity that leads to high child mortality, morbidity, and developmental delays. In the U.S. approximately $26 billion are spent annually on health care costs for infants and children that were born prematurely. Recent attempts to explain the high PTB rates in African American women have focused on social stressors, such as disadvantaged neighborhoods, racial discrimination, and stressful life events. These social stressors may lead to PTB by increasing women’s emotional stress levels. Not surprisingly, emotional stress along with levels of the stress hormone cortisol and systemic inflammation - both physiological responses to stress - have all been related to higher risk of PTB. In contrast, one’s psychosocial resources (e.g., social support) can lessen emotional stress and have protective effects on PTB. Little is yet known about the pathways by which social stressors affect inflammation, and ultimately PTB. The objective of the proposed study is to determine how social stressors alter inflammation during pregnancy and lead to PTB in African American women. We aim to: 1) determine the pathways by which social stressors affect PTB; and 2) describe social stressors, emotional stress and psychosocial resources; the associations among these concepts; and their impact on PTB from women’s perspectives. In this longitudinal convergent mixed methods design, we will enroll 1,500 African American women who live in the Detroit metropolitan area. We will collect data on social stressors, emotional stress, and psychosocial resources through questionnaires and administrative (e.g., census) data. This will be done three times prenatally. At these same time points, levels of cortisol and systemic inflammation will be determined from hair and blood samples, respectively. We will also obtain birth data from the prenatal and hospital records. In a subsample of 60 women, semi-structured interviews will be conducted to more specifically understand the associations among social stressors, emotional stress and psychosocial resources; and their impact on PTB. We will conduct a variety of statistical, qualitative and mixed methods analyses using both quantitative and qualitative data to determine answers to the aims of our study. We will also consider the timing of pregnancy in our analyses, as the prenatal data are collected at three distinct time points. The proposed research is highly relevant to NIH’s mission to elucidate mechanisms underlying health disparities in PTB. Insights gained from this mixed methods approach may lead to the development of an individualized PTB risk profile based on a woman's social stressors and biomarkers which will have potential use in clinical practice and be a target for culturally appropriate interventions to reduce PTB incidence in African American women, and will generate new perspectives for future research in other racial groups through our detailed focus on this high risk group.