The overall goal of this proposal is to elucidate the role of physical environmental determinants and psychosocial factors (in particular, life stress) in the rising asthma burden, particularly among socioeconomically disadvantaged children in inner city areas. The investigators' underlying concept is that stress experienced prenatally and during infancy and early childhood has significant potential to modify immune function and, hence, the development of asthma. They propose to examine the associations between various measures of life stress and asthma outcomes in a representative sample of urban children enrolled prenatally and followed prospectively for four years. Five hundred mother-infant pairs will be recruited from four participating community health centers serving ethnically diverse, inner city neighborhoods of Boston. They will complete a multilevel perspective survey, measuring both individual-level stress (i.e., negative life events, perceived stress, perceived threat of violence) and community-level stressors (neighborhood disadvantage (e.g., percent of subjects living in poverty, percent unemployed, diminished social capital and violent crime). In addition to examining associations between chronic early stress exposure and asthma onset, they will also assess the influence of stress on the infant hormonal stress response and on T-helper cell differentiation as reflected in cytokine profiles and IgE production (Th2 phenotype). Additional environmental and host factors to be assessed for their influence on the immune response and expression of asthma include parental asthma, acute lower respiratory illness, day care, environmental tobacco smoke, indoor allergens, gender, and race. The study will be conducted through a partnership involving researchers from Harvard's Longwood Medical Area, clinicians and care-providers from four community health centers serving the target population, and community advisors recruited through the health centers. A secondary, yet centrally important goal of the project is to strengthen and build this partnership to facilitate future research. This will be achieved through a clinical database project. An additional feature of the proposal is the opportunity to involve under represented minority students (predoctoral and summer interns) from two NIH-funded grants whose principal investigator is a co-investigator on this proposal.
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