Asthma is a common and challenging disease of childhood that disproportionately affects poor minority populations. These populations also experience an excess of social adversities, which are important risk factors for asthma morbidity. However, the response to these adversities is variable: poverty increases the odds of asthma in African Americans, yet decreases it in Mexican Americans. Thus, there is a knowledge gap in our ability to identify individuals vulnerable to social adversities and truly at high-risk for poor asthma outcomes. I am seeking a Mentored NIH K23 Career Development Award to acquire the necessary training, practical experience, and knowledge to become a leading, independent researcher in asthma health outcomes. To move towards this goal, my overall objective for this award is to identify disadvantaged minority children at risk for poor asthma outcomes. My central hypothesis is a profile of demographic, social, and environmental characteristics coupled with stress-related biomarkers will predict which individuals are at high risk for poor asthma outcomes, and that this profile will vary by race/ethnicity. This will be testd with the following three aims.
Specific Aim 1 : Estimate the association between social adversities at individual- and community-levels with asthma susceptibility and morbidity. Social adversities have been identified from administered questionnaire, and geocoded census data obtained from personal address history through a cross-sectional study of 6200 children with and without asthma.
Specific Aim 2 : Examine if social adversities are associated with biomarkers of stress that may influence asthma susceptibility and morbidity. Stress-related biomarkers will be measured and a link between the biomarkers and asthma outcomes will be examined separately in African American and Latino children.
Specific Aim 3 : Identify a phenotype susceptible to social adversities and examine how it modifies the course of asthma using a longitudinal approach. A phenotype, or type of asthma, associated with social adversities amongst those with asthma will be identified. Participants with the identified phenotype will be recruited from the original study and followed to understand how this asthma type behaves over time in the presence of social adversities. This proposal will result in identifying an asthma phenotype that will allows us to target individuals at high-risk for poor asthma outcomes related to social adversities. This contribution is significant as utilizing stress related biomarkers may allow us to better risk stratify individuals and, potentially, capture them prior to adverse health outcomes occurring. A multi-disciplinary mentoring committee with diverse expertise: asthma (Drs. Burchard, Cabana), health disparities research (Drs. Burchard, Bibbins-Domingo, Cabana), biostatistics (Dr. Sen), and implementation sciences (Drs. Cattamanchi, Ackerman), will guide the progress of the research agenda. Their mentorship, as well as a focused training and research plan facilitated by a K23 award, will develop my expertise in health disparities research in asthma.
African American and Latino children experience an excess of poor asthma outcomes and social adversities. We are limited in our ability to identify the individuals who are the most susceptible to social adversities. With this proposal, a phenotype of asthma will be identified that will better discriminate individuals at high risk for poor asthma outcomes. This will allow for the development and application of targeted interventions designed to minimize the effect of social adversities and, thus, improve asthma outcomes in vulnerable populations.