This project will provide cross-discipline training for the Principal Investigator (PI), cultivating skills and expertise in the epidemiological study of both individual-and community-level life stessors, focusing in particular on how these stressors impact childhood asthma risk. The PI is trained in pulmonary medicine and has completed a fellowship in respiratory epidemiology at the Channing Laboratory, earning an MPH from the Harvard School of Public Health. Further training and research will be carried out under the supervision of a multidisciplinary, highly qualified advisory committee of sponsors and co- investigators with expertise in asthma epidemiology, life stress research, developmental and neuropsychological outcomes, immunology, and community-level stress research (i.e., violence epidemiology). Career development will be enhanced through cross-discipline course work and participation in seminars and national meetings related to stress and respiratory research. This award, along with the PI's clinical and scientific background, will facilitate the development of a successful independent research career with a focus on environmental stress and asthma outcomes. Etiologies of the rising prevalence and morbidity of asthma, and of the disproportionate burden among urban children, are not well understood. Differential exposure to life stress may in part explain disparities in disease burden. The role of stress in the expression of asthma is largely unexplored in epidemiological studies. The overall scientific goal of the proposed studies is to examine the associations between multi-level measures of life stress (i.e., negative life events, perceived stress, neighborhood disadvantage, violence exposure) and asthma outcomes in representative samples of urban children followed prospectively. We hypothesize that children exposed to high-level stress will be at greater risk for asthma development than children with low-level stress exposure. Furthermore, we hypothesize that high-stress environments will predict greater asthma morbidity (i.e., emergency room visits, hospitalizations). The influence of stress on T-helper cell differentiation as reflected in cytokine profiles and IgE production (TH2 phenotype) will also be examined. Additionally, sequelae of environmental stress, such as neuropsychological and behavioral impairments, that may affect health promotion behaviors (i.e., compliance) and result in greater asthma morbidity, will be assessed. The PI will gain expertise in the epidemiological approach to stress as it relates to asthma risk and will establish a network of long-term collaborative relationships that will enhance the ability to become an established independent investigator.
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