Patricia Brennan, Ph.D. - US grants

This study evaluates the use of a free, public access computer network as a vehicle for the delivery of nursing services in the treatment of Acquired Immune Deficiency Syndrome (AIDS) and Aids- Related Complex (ARC). We propose to augment traditional methods of nursing care delivery with a new approach that will (1) enable nurses to meet the informational needs of will persons concerned about AIDS/ARC (2) foster self- care of people with AIDS/ARC ("PWA/PWARC") and their carepartners through in- the-home support, counselling and education. Computer networks create electronic links between remote sites. In this project we will put computers in the home of PWA/PWARC to provide links to clinical agencies or to other homes. Through these terminal people can access an existing, computer system and use the special programs and communication services constructed to support the entire range of AIDS/ARC patients: healthy persons needing information, persons diagnosed with AIDS/ARC, and informal carepartners of PWA/PWARC. A decision support system will help subjects analyze complex decisions faced in home care. The messaging and services will facilitate peers as well as professional contact, serving as a "support group without walls". This intervention's effectiveness in disseminating information, enhancing problem solving skills and diminishing the isolation will be evaluated in a series of field investigations. Through a needs assessment in Study I we will first verify information needs and the nature of the AIDS/ARC caregiving experience. In Study II, 50 subject pairs (PWA/PWARC and carepartners) will be assigned randomly to either the experimental or the control group. For a period of six months the experimental subjects will use of computer network link in their homes. On-going monitoring of computer use will complement measurement of other self-care and carepartner functions. Study III will determine how access to the information resource changes current computer network users' attitudes and knowledge of AIDS. This project tests whether computer networks provide an effective mechanism for nursing interventions with community members, isolated carepartners and patients in the home. The increasing emphasis on non-institutional care demands new approaches to delivering treatment and support, while the availability of computer technology provides the means to do so.

This is a resubmission of a methodological study to develop a mathematical index of the structural aspects and contextual factors of professional nursing practice evident on acute care inpatient units. The current proposal includes methodological improvements and the addition of Ralph O'Brien, a statistician, to the research team. Studies of the variations in physician behavior and patient severity have not sufficiently explained differential outcomes among hospitalized patients. It is plausible that factors of nursing care, embodied in the nursing practice model (NPM) provide alternative explanations in aggregate patient outcomes. Using multiattribute utility theory, an index will be created to characterize nursing practice models on acute care units. This index will provide a stable numerical estimate of the extent to which a nursing unit's effort meets selected practice standards. Such an index, once developed, may be used to detect regional or institutional variations in nursing practice. The index may also be useful to hospital and nursing administrators who seek to change the NPMs in their institutions in order to achieve efficiencies and improve patient outcomes. A preliminary model gleaned from reports of the initiatives,to strengthen hospital nursing and improve patient care in 30 hospitals, included the following components of NPMs: specification of patient and nurse characteristics, stated goals of care, scope of nursing practice, and resource allocations strategies. Seven nurse experts, identified through a snow-ball sampling strategy, will be empaneled to validate this preliminary model. To complete the index process, the panelists will also assign relative importance weights to each component. Scales will be constructed and validated to measure each of the model Components. Once constructed, the index will be tested on 30 inpatient nursing units. Each unit will be assessed twice: once by a team of nurse surveyors, and once using the index. This descriptive study will validate the index of nursing practice models as a measure of the group effort of nursing. This validated index will provide an efficient and feasible measure of the context of clinical care that can then be applied in later investigations of the factors that contribute to successful patient outcomes in acute care.

The proposed study is designed to examine the relationship between maternal depression and child outcome in the context of a prospective, longitudinal cohort of 915 children born between 1981 and 1984 at the Mater Misericordiae Mother's Hospital in Queensland, Australia. Previously collected data are available from interviews with each mother conducted during pregnancy, three to four days after delivery, six months after delivery, and when her child was five years of age. Data are also available on the developmental and cognitive status of the child at age five as measured by direct physical examination and testing. Follow-up data will be collected from the Mater cohort through interviews with the mother, father and child, and from questionnaires given to the teacher when the child is 15 years of age. We will examine the following hypotheses concerning the relationship between maternal depression and child outcome: (1) Severity of maternal depressive episodes will predict level of offspring's social, behavioral and emotional functioning as well as offspring diagnostic outcomes at age 15; (2) Severity and chronicity of maternal depressive episodes will interact to predict to level of offspring social, behavioral and emotional functioning as well as offspring diagnostic outcomes at age 15; (3) Severe levels of maternal depression that occur during the offspring's very early childhood or during the offspring's adolescence will be related to elevations in specific types of behavioral problems at age 15; (4) Hypotheses 1 through 3 will be supported even when social demographic factors such as mother's marital status and family socioeconomic status are controlled; (5) Maternal personality disorder, paternal psychopathology, marital conflict, impaired parent-child relations, stressful life events, and child physical health problems will mediate the relationship between maternal depression and child outcome; and (6) High self esteem, superior cognitive abilities and consistent relationships with fathers (i.e., protective factors) will be related to positive outcomes for those children whose mothers are depressed.

DESCRIPTION (Taken from the application abstract): With the current trend toward discharge of cardiac artery bypass graft (CABG) patients from the hospital after five days, nurses must make effective use of existing computer technology to provide more efficiently the services once available during the patient's lengthier hospital stay. The purpose of this project is to develop and test HeartCare, a computerized cardiac recovery program designed to assist nurses with the in-hospital discharge planning and teaching and post-hospital support for self-monitoring, motivation, and home management support that will assist patients to recover from cardiac bypass surgery. Capitalizing on the expansion in health resources on the Internet, this project will employ the World Wide Web platform in the generation of personalized in-home computerized access to recovery resources for use by post-surgical cardiac patients. The revised proposal for a 3-year project clarifies management and better specifies research procedures. One hundred and forty women and men who have undergone cardiac bypass graft surgery will receive standard post-operative care and then be randomized to receive HeartCare, a personalized access to the Internet information and communication resources, a comparison intervention (CHIP, which is an audiotape coaching program), or usual care (a control group). During an experimental patient's index hospitalization, a research nurse will conduct an information needs assessment and use it to tailor access to Internet-based cardiac recovery resources for the individual patient; the patient will take the HeartCare computer home and use it to access locally resident as well as Internet-based resources. Comparison group patients will receive a nursing visit and audio tape; control group patients will receive a data-collection only visit from the research nurse. Patients in the two intervention groups will be encouraged to use their respective services as often as desired in the post-hospital period. Patient outcomes to be measured include physical function, symptom distress, psychological distress, perceived family function, and adherence to cardiac risk behavior modification at four points in time: one week, one month, three months and six months post-discharge. Nurse outcomes of interest include a benchmark of the resources necessary to use HeartCare in practice and a forecast of practice effects of HeartCare obtained through interviews and group assessment techniques. Properly utilized, computer tools that personalize access to Internet resources can help extend key nursing services to patients and ensure that patients achieve their cardiac recovery goals.

The health sciences schools at the University of Wisconsin-Madison are joining together in an Integrated Advanced Management Information Systems (IAIMS) planning initiative. The participants include the Health Sciences Library, the Schools of Medicine, Nursing, Pharmacy and Veterinary Medicine, as well as the University of Wisconsin Hospital and Clinics, the Medical Foundation, the Biological Medical Center and the Wisconsin Network for Health Policy. This initiative is stimulated by two campus initiatives: expansion of the statewide network for health sciences education; and the HealthStar project, a University commitment to dramatically expand the existing health sciences complex facilities clustered at the edge of campus. This expansion involves a new School of Pharmacy building, a large interdisciplinary health sciences research facility, and a Health Sciences Learning Center. New initiatives in public health sciences will occupy a nearby 12-story building. The second focus is to integrate this Madison-based health science complex with education, research, and patient care sites in communities scattered across the state of Wisconsin. All the schools and centers depend heavily on these sites to meet their multiple missions, so increased access and communication are a high priority. Based on these two campus initiatives, this is the right time and opportunity for an IAIMS planning grant at the University.

This training program will prepare nurse scholars to devise, implement and evaluate informational interventions that our patient-centered and responsive to a complex health care system context to generate new knowledge for nursing. Informational interventions include interactions with care recipients in which context is transferred, meanings are shared, and support is given. Patient-centeredness describes the extent to which nurses tailor interventions mindful of, and responsive to, characteristics such as affective states, perceptions, preferences, and resources. The interpersonal context, that is, the situations in which nurses and care recipients encounter each other, vary greatly. Furthermore, contemporary nurse-patient interactions are influenced by multiple and complex external factors, such as social, political, and organizational forces. Nursing research on the content, process, and mode of delivery, of patient-centered, informational interventions are most likely to yield effective results when more attention is given to individual characteristics and to the external factors that impact that interpersonal context. This training program capitalizes on the research strengths of the University of Wisconsin. Investigator-initiated nursing research includes tests of theory-based informational interventions delivered by nurses on a variety of patient behaviors, including breast cancer control, pain control, and regimens to control incontinence. Other researchers in the School are examining contextual factors, which influence patient-centered interventions, including patient preferences and the mode of informational delivery. Campus-wide initiatives supportive of the training effort includes a focus on consumer health, computer technology in health promotion and disease prevention, and illness. The training program will be led by School of Nursing faculty, and supported by Medical, Engineering and Educational Schools' faculty. Support is requested for 10 pre- and 4 post-doctoral candidates. Pre- doctoral candidates will have at least two years of course work in nursing science, inquiry and methods, philosophy of science, and a trainee-directed secondary concentration. Additional research training activities include a training forum, guided research experiences, and an independent research project. Post-doctoral training will be tailored to the trainee's needs, but will include formal courses, participation in seminars and directed research, and conduct of an independent investigation. Trainees will be expected to disseminated their work in writing and at research conferences at least once during the training period.

DESCRIPTION (adapted from the investigator's abstract): The proposed study examines the effect of maternal depression on young adult outcomes in a unique community sample of Australian youth who have previously been studied by the investigators at age 15. The youth and their families are a high-risk sample from a birth cohort study in Queensland, Australia. The original birth cohort study by Australian investigators included interviews of mothers at pregnancy, birth, and six-months post-partum, with evaluations at children's ages 5 and 14 to assess socio-demographic predictors of health and child development. The 15-year-old follow-up by the present investigators focused intensively on maternal depression and child mental health and adjustment. The present proposal is for a follow-up at age 20 with these youth, their peers, and their mothers in order to address a number of gaps in the field concerning the transition to adulthood for high-risk youth. The proposed follow-up period marks the challenging developmental transition, and it is expected that during this period the youth in the sample will encounter significant stress, and will be particularly susceptible to depressive outcomes. The two primary aims of the study are (1) to examine the diagnostic outcomes, as well as functional impairments in high-risk youth from the ages of 15 to 20 years as well as the role of paternal psychopathology, co-morbidity, protective factors and gender in this process; and (2) to examine interpersonal models of intergenerational transmission of depression, and models of the stress-depression relationship as relevant to the period of early adulthood.

DESCRIPTION (provided by applicant): Consumer health information producers are generally universities, commercial information producers, and health institutions. Some of the information these entities provide is research oriented while other information is marketing and/or business related. The role of medical libraries is to act as broker of the health information--traditionally to meet the information needs of health professionals. However medical libraries and university health libraries continually expand their patronage to consumers seeking health information effectively changing their role to accommodate the health information needs of consumers. While attempting to meet the health information needs of the public, medical libraries and university health libraries are doing so in an ad hoc fashion. We would like to begin building the foundations of a different model of health information brokering--a community-centered, community-controlled service. This service would be provided by an established community organization, staffed by a professional health librarian or health information professional, and supervised by a board of community health professionals and citizens. The service will not only provide federal, statewide, and local health information to community citizens directly, it will also provide health information evaluation services to health institutions in the community. To demonstrate this, we will design, build, test, and evaluate a prototype service that will lay the foundation for a Community-based Consumer Health Digital Library.

[unreadable] DESCRIPTION (provided by applicant): [unreadable] [unreadable] Patients benefit from access to Internet-based health information and communication resources, but the maximum clinical benefit of consumer health informatics applications awaits integration of these tools with formal clinical services. Therefore, the purpose of this competing continuation is to expand our successful WWW-based information and communication network, HeartCare, from a patient-targeted home-care service to a technology enhanced- practice (TEP) that augments the clinical care provided by home care nurses with electronic information and communication resources. We will work with Aurora Health Care Systems, Milwaukee, WI to conduct a randomized field experiment. This extension of HeartCare will use human factors engineering design strategies to alter the original service with those deemed necessary to support the home care of patients with heart failure. This approach offers significant advantages over the emerging computerized passive home monitoring strategies by providing patients and nurses with relevant information and engaging patients in active self-monitoring and self-management. This study provides an opportunity to understand the context in which consumer health tools can be employed and the extent to which contextual factors affect the design of these tools. This revised proposal retains the original aims and scope of work and addresses three concerns raised by the BLRC: characterization of the intervention, explication of the design process, and clarification of the study period. In addition the revised budget request is 20% lower, reflecting the costs for a full 42-month project. We will undertake a design strategy consistent with sociotechnical systems theory and current approaches to implementation of information systems. We will first use techniques of industrial engineering to conduct a Work Analysis of the home care nurses' practice to (1) identify aspects of practice that could be enhanced by technology (2) better characterize the aspects of the clinical situation likely to be altered by the introduction of consumer health informatics tools. The industrial engineers, Aurora's expert cardiac nurses, and consumers will use the results of the work analysis to design a suite of electronic services including communication, personal health records, and educational materials. These services will integrate Aurora's evidence based heart failure care protocols. Next the TEP nurses will use local "practical" knowledge to plan how they will implement the TEP intervention into their practice. To equalize attention for the control group, electronic copies of nursing references and bulletin board services will be installed on their laptops. We will engage 600 nurse-patient dyads (60 nurses, 10 patients each) in a randomized field experiment. Key outcome variables include patient and nurse satisfaction with care, patient self-management, 30-day readmission rate and nurse workload. [unreadable] [unreadable]

[unreadable] DESCRIPTION (provided by applicant): [unreadable] In this resubmission of an exploratory project applying operations research methods to pricing health information exchange alliances we provide greater detail about the research plan, explicate the ways in which these models can inform business strategy decisions, and report in detail on our preliminary work. Regional health information organizations (RHIOs) form the core building blocks of any approach to creating the National Health Information Network. RHIOs are computer-supported information sharing alliances composed of health care institutions that need to share clinical, financial or administrative data. Institutions considering joining RHIOs require trustable financial projections. Current approaches to health information technology investment rely on a net-present value analysis, which is inadequate to capture the dynamic, uncertain course likely to occur in the RHIO environment. Thus, our team of medical informaticists, operations researchers and computer scientists proposes to apply methods from operations research (real options models and stochastic programming) to aid decision makers in exploring the cost and consequences of various RHIO structures. To insure that the models provide valuable and useful advice to their intended audiences, we will partner with the Indiana Health Information Exchange (IHIE) to characterize the essential business processes, gain real-world data, and solicit concurrent reactions to the models and their output. [unreadable] [unreadable] The long-range goal of this research is to create a suite of decision support tools that can guide RHIO pricing options, discount rates, and optimal configuration choices. However, we must first develop the modeling core of the decision support system. Our approach in this feasibility study will consist of four stages. First, we will obtain preliminary data from our primary industry partner, IHIE, in order to understand the business processes, operational concerns, and strategic priorities of this regional health information exchange. Second, we will use these data to develop preliminary operations research models that capture key aspects of the process under study, namely, formation of information-sharing alliances. Third, we will consult with IHIE and a second partner, the Wisconsin Health Information Exchange, to refine these models, adding to their scope and introducing additional detail and complexity as warranted. Fourth, we will validate our models by examining the decisions they propose through scenario evaluation and simulation studies. Validation will occur at intermediate stages of the process, involving consultation with our partners, comparison with published reports, and computer simulations of evolving information-sharing alliances. [unreadable] [unreadable] Although the operations research methods we propose to use are valid and well established, they have not been applied in a health care information technology decision context. They offer substantial advantage over existing deterministic approaches to economic valuation of health information technologies because they employ multi-period, dynamic stochastic models that explicitly address such important aspects as the impact on one institution of the activity by another institution. We will use the results of this feasibility modeling project to create a proposal to conduct a large-scale test of a suite of models involving awardees of the AHRQ-Connecting Communities for Better Health grants. We will engage additional partners through dissemination and consultation with IHIE and WHIE. [unreadable] [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): This proposal responds to the broad challenge area - Translational Science (15) and responds to the specific challenge topic - 15-MH-101: "Effect of psychotropic medications on neurodevelopment and behavior in animal models". The use of antipsychotics, antidepressants, and anti-epileptics in both pre-pubertal and post-pubertal windows of brain development raise concerns about the functional effects of psychotropic exposure. The intrauterine environment constitutes the earliest developmental milieu, thereby affording an innovative avenue by which to examine the impact of early drug exposure against a backdrop of potential individual vulnerability in offspring, prior to the onset of formally diagnosed psychopathology. Advances in medical genetics have underscored the contribution of both environmental and genetic factors in establishing developmental trajectories and, more recently, the potential importance of epigenetic alterations in predicting neurodevelopmental outcomes. Utilizing novel epigenetic methodology and established laboratory techniques in a well characterized cohort of children with laboratory confirmed and quantified fetal exposure, we will test our hypothesis that "the offspring of women with mental illness demonstrate unique epigenetic signatures indicative of the early exposure to psychotropic medications that may produce long term negative consequences for childhood functional development." Specifically, this project aims to: (1) perform a genome-wide evaluation of methylation patterns in previously collected umbilical cord blood samples (N=300) to identify genes that are differentially methylated in children whose mothers took a) antipsychotics, b) anti-epileptics, and c) antidepressant medications during their pregnancy compared to d) controls whose mothers did not take psychotropic medications;and (2) select 25 offspring within each medication exposure group with the most distinct epigenetic profiles (total N=100) to test in a laboratory paradigm evaluating current levels of hormonal, social, affective, and neurocognitive functioning. The data obtained from this 2-year proposal will provide novel insight into the epigenetic and child functioning outcomes associated with prenatal exposure to psychotropic medication.

This award is funded under the American Recovery and Reinvestment Act of 2009 (Public Law 111-5).

Conflict between the sexes over control of fertilization is expected to be widespread among organisms, but its evolutionary consequences are still poorly understood particularly in vertebrate animals. Waterfowl have complex breeding systems that include female partner preferences based on elaborate male plumage and courtship display, and unsolicited reproductive attempts by males other than the female's chosen partner. Female ducks show resistance behaviors and anatomies that have coevolved with male coercion. Ducks are ideally suited to study the evolution of sexual conflict and the evolution of reproductive structures. The project examines how reproductive morphology covaries with season, age, and social environment in a diverse sample of duck species that differ in ecology, territoriality and breeding system. Preliminary results of the project, suggest that male competition plays an important role in the evolution of waterfowl reproductive morphology, that male reproductive morphology is plastic depending on age and condition, and between species with different breeding systems. The project constitutes an exciting opportunity to investigate the role of sexual conflict on the evolution of reproductive structures in the context of social and behavioral complexity in vertebrates. Broader impacts of the research will be international, national, local, and personal. The first research publication related to this project was widely disseminated in popular newspapers, magazines, television programs, websites and blogs. The project will incorporate high school students from under-represented minorities through the Yale University EVOLUTIONISTS program, which serves students in New Haven, CT. The experimental manipulations suggested in this project will be carried out at a non-profit conservation organization (LRWC.net) whose mission is to conserve waterfowl through education, research and outreach and this project will help to further their goals.

Asthma is a common lung disease with acute and chronic manifestations that impacts more than 22.2 million Americans or 7.9% of the population, including over 6.7 million children younger than 18 years of age. The cost of asthma is significant both for individuals and for the society as a whole. It is highly desirable to establish transformative technologies to improve the patient quality of life and reduce the cost of asthma management. The recent development in sensor and mobile computing technology provide great opportunities to establish Smart Asthma Management (SAM) systems and achieve a quantum leap in asthma management. Leveraging on the fast development of information infrastructure, patients can create a detailed temporal log recording their symptoms, medicine usage, and possibly vital physiological signals through an easy access to a website or their smart phones in SAM systems. This unprecedented continuous stream of patient-generated data in SAM systems provides us significant opportunities to better estimate patient condition and make clinical intervention decisions. However, since the information infrastructure of SAM has not become available until recently, very limited work is available for SAM systems. Against this background, this collaborative project aims to develop a suite of statistical modeling, monitoring, prognosis, and clinical intervention decision making methodologies based on a flexible yet rigorous multistate model to describe the evolving of patient conditions. The true underlying state of the patient is assumed unknown; however, there is reason to expect that it could be inferred from patient generated data such as the frequency of the rescue inhaler usage (the time and frequency of the rescue inhaler use is an important indicator of asthma control).

Some anticipated advances include: (i) Multistate model with event intensity function as observations. The proposed methodology brings the mixed effect model and the multistate model into a unified framework to integrate the population information embedded in the historical records of multiple patients and the individual information collected in real-time in a quantitative way. (ii) Stochastic filtering approach for individual patient condition modeling and updating. The novel state space formulation enables efficient stochastic filtering algorithms to estimate and update the states and parameters in the multistate model. (iii) Clinical intervention decision support for patients and clinicians. The salient features of the proposed policy are that it is based on a condition-based policy and incorporates uncertainties in the patient condition model through a Partially Observable Markov Decision Process (POMDP) framework which has been widely used and proven to be very effective in the management of industrial systems. Plans are in place to evaluate the effectiveness of the resulting technologies in collaboration with clinical experts.


The project is likely to contribute predictive technologies that could help reduce the cost and improve the quality of healthcare in the US, especially as it relates to effective management of chronic illnessess. Additional broader impacts of the project include enhanced research-based training opportunities for graduate and undergraduate students (including members of under-represented minorities) in healthcare engineering, statistics, and operation research; enrichment of the curricula in health systems in industrial engineering and operations research at the University of Wisconsin-Madison and the University of Iowa.

? DESCRIPTION (provided by applicant): Compared to infants of other races, African American (AA) infants are more likely to have mothers with high rates of stress, to be born preterm, and to reside in poverty, whereas they are less likely to be breastfed. These disparities translate into higher risks for neurocognitive and social-emotional developmental delays. The microbiota-gut-brain axis - which functions through neural, hormonal, and immunologic pathways - is receiving growing attention as an important contributor to neurodevelopment. The gut microbiome is established at birth from maternal flora and varies according to perinatal factors such as mode of delivery, gestational age and size, type of feeding, and antibiotic exposure. Thereafter, diet, illness, vaccination, and antibiotic exposures further influence microbiome development. Thus, prenatal and postnatal biobehavioral exposures that affect the microbiome-gut-brain axis in the critical first years of life may significantly impact the developing brain. The proposed research will investigate whether the composition of the gut microbiome associates with exposure to prenatal and postnatal maternal stress and contributes to adverse neurocognitive and social emotional outcomes for AA infants over the first 18-months of life. To accomplish this, we will leverage biobehavioral data from our on-going longitudinal study of preterm birth in AA women (R01 NR014800), that is enrolling a socioeconomically diverse cohort of ? 800 pregnant AA women and following them at 8-14 and 24-30 weeks' gestation through delivery. The parent study provides data on prenatal maternal stress, psychoneuroimmune (PNI) dysfunction (e.g., pro- and anti-inflammatory cytokines, cortisol) and pregnancy and birth outcomes (e.g., infections, antibiotics, delivery mode, gestational age). For the birthed AA infants, from 1-week through 18-months of age, the proposed study will evaluate: (1) Environmental and genetic influences on the gut microbiome; (2) The pathways between infant gut microbiome, PNI function, and neurocognitive and social-emotional development; and (3) The associations among the infant gut microbiome, maternal caregiving and stress, and infant neurocognitive and social-emotional development Because many factors that influence the microbiome are modifiable, the knowledge gained by achieving our Aims holds tremendous potential for promoting the health of the next generation of AA families. The success of this research is supported by our multidisciplinary collaboration of scientists representing expertise in the microbiome, obstetrics and maternal-child health, genetics, nutrition, stress, epidemiology and informatics; the overlap of key personnel for the proposed and parent studies; and support from Emory Clinical and Translational Science Institute (CTSA award # NIH UL1TR000454) and Genomics Core Laboratory. Also, Atlanta is home to AA women of broad socioeconomic status, providing a diverse sample of AA families, which allows for sufficient variation in the biobehavioral factors under study to distinguish their independent and interactive effects on the microbiome and infant neurocognitive and socio-emotional development.

PROJECT ABSTRACT Environmental exposures during the critical prenatal and early childhood periods can result in lifelong health consequences. Mechanisms underlying these exposure-health relationships are complex, with exogenous exposures (such as chemical toxicants, infectious agents, diet) and endogenous processes (such as gene expression, inflammation and oxidative stress) activating metabolic pathways that lead to adverse health outcomes. Both adverse exposures and their health consequences disproportionately impact African American (AA) women and children, highlighting that health disparities begin in utero and are amplified postnatally. Among outcomes disproportionately experienced by AA children are preterm birth, neurodevelopmental deficits, and obesity ? all linked to environmental exposures, yet poorly understood due to their etiologic complexity. Our team is currently investigating preterm birth and neurodevelopment through 18-months in relation to pre- and postnatal exposures to environmental toxicants and biopsychosocial risk factors in cohorts of pregnant AA women (R01NR014800, R01MD009064) and their infants (R01MD009746) and via our P50 Children's Center (P50ES026071) in collaboration with the Emory HERCULES Exposome Research Center (P30 ES019776). Through ECHO, we propose to elucidate exposures and risk pathways that contribute to neurodevelopmental deficits and obesity in preschool aged AA children by: (1) Assembling an Atlanta ECHO cohort of ~440 AA socioeconomically diverse mother-child pairs by combining extant cohorts for whom the prenatal, perinatal, and early childhood environments are, or will be, characterized; (2) Completing the analysis and synthesis of data from the Atlanta ECHO cohort to characterize mother-child pairs in terms of prenatal and early childhood exposures (toxicants, stressors and neuroendocrine-immune activation, nutritional and metabolic status, microbiome and infections, bonding and interaction); epigenetic and metabolomic profiles; and perinatal outcomes (gestational age, size-for-gestation); (3) Testing cohort-specific hypotheses related to prenatal and early childhood exposures and neurodevelopmental outcomes and obesity in AA children at 2, 3, 4, and 5 years of age; (4) Participating in ECHO-wide consortium studies to identify risk and protective factors that moderate associations between environmental exposures, typical growth and development, and adverse child health outcomes. Our cohort's participation in the ECHO consortium will contribute to a biopsychosocial understanding of within- and between-race risk for adverse child health outcomes, providing insight into risk and protective factors relevant to AA families. The proposed research is consistent with frameworks for eliminating racial disparities, which recognize the need to study risks within-race as a vital first step, and is congruent with the National Institute of Minority Health and Health Disparities goal of promoting understanding of the biological mechanisms involved in conditions that disproportionately affect health disparity populations.