Alicia K. Smith - US grants

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.

DESCRIPTION (provided by applicant): While human behavioral phenotypes are invariably heterogeneous, an emerging literature supports the supposition that both genetic heritability and environmental influences contribute to behavioral conditions and disorders commonly diagnosed in children. Nevertheless, the pathways by which genetics, as well as maternal stress, depression and anxiety influence childhood behavior remain obscure. Utilizing a publically available, unbiased genome-wide association study (GWAS), we identified polymorphisms in genes associated with measures of childhood conduct problems, inattention, hyperactivity emotional symptoms, peer problems and prosocial behavior in children with ADHD. We hypothesize that maternal mental illness during pregnancy, or its pharmacological treatment, may alter the offspring's vulnerability to later psychopathology and that genetic variation will increase the offspring's risk developing childhood psychopathology. This hypothesis will be tested by examining associations of 1) polymorphisms in evidence-based candidate genes with phenotypes prospectively-evaluated, high-risk children born to women who were mentally ill during pregnancy 2) methylation patterns of those candidate genes in placental tissue with traits and behaviors measured in these children, and 3) the expression of mRNA encoded by those genes in placental tissue. This research proposal along with the didactic coursework and interaction with the multidisciplinary mentoring team provides a training platform designed to accomplish the following training goals: acquiring proficiency with 1) phenotypic characterization and the biological underpinnings of childhood psychopathology 2) the principles of bioinformatics and biostatistics as they apply to the design, conduct, and analysis of family-based association studies and 3) the technical and methodological issues related to methylation and gene expression analysis as they apply to psychiatric genetic research. Upon completion of the proposed project and the formal training described in the education plan, the candidate will have made significant progress towards initiating an independent academic career. PUBLIC HEALTH RELEVANCE: The children of women with mood or anxiety disorders ate at increased risk for the development of psychopathology. The examination of environmental and genetic predictors in prospectively- evaluated children will provide insight into the development of mental illness and will help to identify those requiring intervention.

DESCRIPTION (provided by applicant): While human behavioral phenotypes are invariably heterogeneous, an emerging literature supports the supposition that both genetic heritability and environmental influences contribute to behavioral conditions and disorders commonly diagnosed in children. Nevertheless, the pathways by which genetics, as well as maternal stress, depression and anxiety influence childhood behavior remain obscure. Utilizing a publically available, unbiased genome-wide association study (GWAS), we identified polymorphisms in genes associated with measures of childhood conduct problems, inattention, hyperactivity emotional symptoms, peer problems and prosocial behavior in children with ADHD. We hypothesize that maternal mental illness during pregnancy, or its pharmacological treatment, may alter the offspring's vulnerability to later psychopathology and that genetic variation will increase the offspring's risk developing childhood psychopathology. This hypothesis will be tested by examining associations of 1) polymorphisms in evidence-based candidate genes with phenotypes prospectively-evaluated, high-risk children born to women who were mentally ill during pregnancy 2) methylation patterns of those candidate genes in placental tissue with traits and behaviors measured in these children, and 3) the expression of mRNA encoded by those genes in placental tissue. This research proposal along with the didactic coursework and interaction with the multidisciplinary mentoring team provides a training platform designed to accomplish the following training goals: acquiring proficiency with 1) phenotypic characterization and the biological underpinnings of childhood psychopathology 2) the principles of bioinformatics and biostatistics as they apply to the design, conduct, and analysis of family-based association studies and 3) the technical and methodological issues related to methylation and gene expression analysis as they apply to psychiatric genetic research. Upon completion of the proposed project and the formal training described in the education plan, the candidate will have made significant progress towards initiating an independent academic career. PUBLIC HEALTH RELEVANCE: The children of women with mood or anxiety disorders ate at increased risk for the development of psychopathology. The examination of environmental and genetic predictors in prospectively- evaluated children will provide insight into the development of mental illness and will help to identify those requiring intervention.

DESCRIPTION (provided by applicant): This proposal addresses two important issues: the technical issue of isolating specific types of adipocytes from adipose depots and other tissues (e.g., muscle, bone marrow) for genetic and epigenetic analysis, and the issue of determining epigenetic changes to subclasses of adipocytes that are associated with obesity. Epigenetic reprogramming of adipocytes, particularly in visceral adipose depots, plays an important role in the transformation of adipose tissue to a metabolically dysfunctional state contributing to increased systemic inflammation and reduced insulin sensitivity. However, the epigenetic reprogramming of subclasses of adipocytes is essentially unexplored due to the technical difficulty of isolating these cells. We are proposing a powerful technology, Capture by Nuclear Antibody (CANA) that will enable cell type-specific epigenetic analysis of different classes of adipocytes. CANA is based on the fact that mammalian genomes encode more than two thousand nuclear trans-membrane proteins, that cell types differ in the expression of these nuclear membrane antigens (NMAs), and NMAs may serve as nuclear immuno-epitope tags for the purification of specific nuclei. We hypothesize that subclasses of adipocytes are epigenetically reprogrammed in obese individuals. The goals of this technology development grant are to (1) generate a battery of adipocyte nuclear membrane antigen-specific monoclonal antibodies (mAbs) to affinity purify distinct classes of human adipocyte nuclei and (2) investigate differences in DNA methylation and RNA expression profiles within two subclasses of human visceral adipocyte nuclei that are associated with obesity. We will meet these goals and set the stage for further testing our hypothesis by pursuing the following Specific Aims: Aim 1. Develop CANA reagent mAbs with clear nuclear subclass specificities. DiSH (Direct Selection of Hybridomas) technology, which enables the efficient and rapid production of hundreds of mAbs to membrane antigens, will provide more than 200 anti-nuclear (anti-NU) mAbs to nuclei from human visceral adipose tissue and mouse beige and brown adipocyte cell lines. Those with the most useful nuclear subtype specificities will be selected and these mAbs will be used to affinity-purify two subclasses of human visceral adipocyte nuclei. Aim 2. Characterize the genome-wide DNA methylation and RNA expression profiles in two specific subclasses of nuclei affinity purified from the visceral adipose tissue of obese and lean individuals. Epigenetic and gene expression data will be integrated to identify obesity-associated genes. CANA technology addresses one of the greatest challenges to neurobiology today, the difficulty of working with subsets of adult neurons. It will contribute significantly to medical research, diagnostic and therapeutic development in studies of numerous cognitive disorders, including obesity. Once established, the methodology can be expanded to support molecular studies of specific cell types throughout the body.

DESCRIPTION (provided by applicant): Preterm birth (PTB, birth prior to 37 weeks' gestation) is a leading cause of infant mortality. Of the known risk factors for PTB, among the strongest is African American (AA) race. Compared to Caucasians, AA women have more than 1.5 times the risk of PTB (16.8% vs. 10.5%). The proposed research will investigate whether specific bio behavioral factors linked to PTB influence the epigenetic regulation of genes to promote PTB in AA women. This research will contribute to a bio psychosocial understanding of within-race risk for PTB, providing insight into important risk and protective factors relevant to AA women. 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. To evaluate the hypothesis that epigenetic mechanisms mediate the relationship between specific bio behavioral factors and PTB for AA women, the proposed study will leverage bio behavioral and biologic data from an on-going longitudinal study of preterm birth in AA women (R01 NR014800) that is enrolling a socioeconomically diverse cohort of H 960 pregnant AA women and collecting data during prenatal care appointments (at 10-14 and 26-30 weeks' gestation) and at delivery. Using a nested case-control approach, cases are designated as those who experience PTB (an estimated 125 cases) and controls as those who experience a term birth. Building from this study design, we will: (1) characterize PBMC DNA methylation and RNA expression patterns over the course of pregnancy among AA women who deliver preterm and at term; (2) identify bio behavioral factors - including nutritional status, stress, an reproductive tract infections - that influence patterns of peripheral DNA methylation and RNA expression; (3) evaluate associations between PTB and both DNA methylation and RNA expression among AA women that are independent of the bio behavioral factors and (4) determine whether these epigenetic differences can be detected in the second and/or third trimester. The success of this research is supported by a multidisciplinary collaboration of clinicians, basic and translational scientists representing expertise in obstetrical outcomes and maternal-child health, genetics and epigenetics, nutrition, stress, epidemiology and informatics; the overlap of key personnel for the proposed study and the on-going R01 'Bio behavioral Determinants of the Micro biome and Preterm Birth for Black Women'; and support from Emory University's Clinical and Translational Science Institute (CTSA award # NIH UL1TR000454). Finally, Atlanta is home to AA women of broad socioeconomic status who are served by Emory's affiliated delivery hospitals, allowing for sufficient variation in the bio behavioral factrs under study to distinguish independent and interactive effects on DNA methylation and, ultimately, on the risk of PTB.

? DESCRIPTION (provided by applicant): Humans are exposed to chemicals such as brominated flame retardants (BFRs) at unprecedented levels, and a wide variety of health effects are attributed to such exposures. However, the biological mechanisms that link exposures to its consequences remain unknown. An industrial accident in the 1970's exposed over 4000 individuals in rural Michigan to polybrominated biphenyl (PBB), a BFR that was present in the food supply for years prior to detection and management. Health effects are still evident in these individuals and their children. Because this population has been assessed regularly since the exposure, it is an ideal group in which to examine the molecular mechanisms that contribute to susceptibility, vulnerability and health effects. The project goals are to: 1) identify the genetic variants that associate with the rate of PBB elimination over time, 2) identif epigenetic patterns that associate with PBB exposure, 3) integrate genetic and epigenetic datasets and identify complex gene-environment relationships in PBB exposed individuals and 4) evaluate the contribution PBB-associated genetic and epigenetic factors to endocrine-related consequences of exposure. We will leverage data generated as part of past and ongoing studies in the Michigan Polybrominated Biphenyl Cohort and characterize genetic and epigenetic variation in 2 PBB-exposed cohorts, a discovery cohort of 500 subjects exposed through living on or eating food from contaminated farms and a replication cohort of 200 subjects exposed through work at the Michigan Chemical Company that produced PBBs. This research will produce the largest and most comprehensive genetic dataset in subjects exposed to PBBs. We anticipate that this study will provide insight into how genetic variants and the environment interact in relation to PBB exposure and its health effects. We also anticipate the results of this study will be informative for studies of BFRs and other endocrine disrupting compounds with similar chemical properties.

? DESCRIPTION (provided by applicant): Epidemiological studies worldwide have documented a high rate of exposure to traumatic events, including life-threatening accidents, rape, combat, physical violence, witnessing the death or injury of others and natural disasters. Such traumatic experiences significantly increase the likelihood of having a mental illness, including posttraumatic stress disorder (PTSD), depression or substance abuse. Although more than 80% of the population will experience a traumatic event, only a fraction of those will develop a mental illness, suggesting a large role for biological risk factors. However, there are currently no biological factors that can be used to prospectively monitor vulnerable individuals. Recent epigenetic studies report extensive DNA methylation differences in those who have experienced trauma that associate with psychopathology. Because changes in DNA methylation accumulate over time, the molecular signature of trauma exposure may be evident substantially before trauma-related symptoms develop. However, the timeline and permanence of epigenetic changes are still unclear. This study will address this question by leveraging infrastructure from an ongoing investigation (R01 MH094757; PI Ressler) that is prospectively characterizing trauma victims from Atlanta's inner-city Level 1 trauma center. To evaluate how DNA methylation changes over time, we will prospectively collect DNA samples for the first 3 months after a traumatic event and characterize the DNA methylation changes that occur acutely (within the first weeks up to 1 month) and stably (through 3 months). We will also evaluate changes in 4 specific stress-response genes (FKBP5, SLC6A4, BDNF and COMT). Finally, we will evaluate whether acute changes in DNA methylation predict psychiatric symptoms and fear-potentiated startle response, a physiological phenotype that has been associated with PTSD, at 3 months after the trauma. This study is highly novel in its focus on acute epigenetic mechanisms; furthermore, it focuses on psychophysiological phenotypes of trauma exposure rather than DSM diagnoses as advocated in the NIMH Research Domains Criteria. The units of analyses will include molecular (DNA methylation), physiological (fear-potentiated startle), and self-report (PTSD Symptom Scale, Beck Depression inventory) measures as dimensional measures of trauma response. This research will provide much needed insight into the pathophysiology of trauma on a molecular level and lay a foundation for early intervention studies. Identification of how the epigenome responds to a traumatic event will provide preliminary data for larger prospective studies that facilitate early detection of trauma-related psychopathology.

Project Summary It is not clear why some people develop posttraumatic stress disorder (PTSD) in response to a traumatic event. DNA methylation, an epigenetic mark that associates with trauma and other environmental exposures, associates with PTSD in multiple studies, and DNA methylation of some genes may be informative for early prediction and treatment of PTSD. Over the last 3 years, the Epigenetics Workgroup of the Psychiatric Genomics Consortium for PTSD (PGC-PTSD) has brought together data from 10 studies, with over 90 investigators from 10 countries to facilitate meta-analyses of DNA methylation (DNAm) data from cross- sectional and longitudinal studies of PTSD in civilian and military cohorts. In this renewal proposal, we will build on this highly productive collaboration by replicating our findings in an independent meta-analysis and performing the largest epigenome-wide association study (EWAS) to date in >4,700 subjects, characterizing PTSD-associated CpGs in postmortem brain tissue, identifying methylation quantitative trait loci (meQTLs) in blood and brain relevant to PTSD, and characterizing DNAm changes over the course of PTSD treatment. We are poised to rapidly and efficiently identify epigenetic markers informative for early prediction and treatment and to provide context to genetic variants that predict risk and resilience following traumatic events. This study, which aligns with ongoing PGC-PTSD efforts, will inform critical questions in the field related to the role of blood-based methylation patterns as clinically-informative biomarkers and the degree to which they reflect epigentic patterns in the brain; it will also provide insight into the biologic pathways underlying PTSD, complement ongoing efforts to identify therapeutic targets, and inform prospective studies of PTSD and trauma exposure that are underway.

DESCRIPTION (provided by applicant): Preterm birth (PTB, birth prior to 37 weeks' gestation) is a leading cause of infant mortality. Of the known risk factors for PTB, among the strongest is African American (AA) race. Compared to Caucasians, AA women have more than 1.5 times the risk of PTB (16.8% vs. 10.5%). The proposed research will investigate whether specific bio behavioral factors linked to PTB influence the epigenetic regulation of genes to promote PTB in AA women. This research will contribute to a bio psychosocial understanding of within-race risk for PTB, providing insight into important risk and protective factors relevant to AA women. 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. To evaluate the hypothesis that epigenetic mechanisms mediate the relationship between specific bio behavioral factors and PTB for AA women, the proposed study will leverage bio behavioral and biologic data from an on-going longitudinal study of preterm birth in AA women (R01 NR014800) that is enrolling a socioeconomically diverse cohort of H 960 pregnant AA women and collecting data during prenatal care appointments (at 10-14 and 26-30 weeks' gestation) and at delivery. Using a nested case-control approach, cases are designated as those who experience PTB (an estimated 125 cases) and controls as those who experience a term birth. Building from this study design, we will: (1) characterize PBMC DNA methylation and RNA expression patterns over the course of pregnancy among AA women who deliver preterm and at term; (2) identify bio behavioral factors - including nutritional status, stress, an reproductive tract infections - that influence patterns of peripheral DNA methylation and RNA expression; (3) evaluate associations between PTB and both DNA methylation and RNA expression among AA women that are independent of the bio behavioral factors and (4) determine whether these epigenetic differences can be detected in the second and/or third trimester. The success of this research is supported by a multidisciplinary collaboration of clinicians, basic and translational scientists representing expertise in obstetrical outcomes and maternal-child health, genetics and epigenetics, nutrition, stress, epidemiology and informatics; the overlap of key personnel for the proposed study and the on-going R01 'Bio behavioral Determinants of the Micro biome and Preterm Birth for Black Women'; and support from Emory University's Clinical and Translational Science Institute (CTSA award # NIH UL1TR000454). Finally, Atlanta is home to AA women of broad socioeconomic status who are served by Emory's affiliated delivery hospitals, allowing for sufficient variation in the bio behavioral factrs under study to distinguish independent and interactive effects on DNA methylation and, ultimately, on the risk of PTB.

Developmental programming refers to early life biological responses to the environment that can shape long-term well-being. The prenatal period is a critical window for developmental programming, with a variety of environmental signals being transmitted from a mother to her offspring, potentially reflected as "epigenetic" changes in offspring gene regulation. This dissertation project will advance our understanding of epigenetic mechanisms of adaptation by identifying correlations in gene regulation between a mother and her offspring and investigating the impact of acute and chronic maternal stressors on infant DNA methylation. The project will create STEM training opportunities in epigenetic research for undergraduate and graduate students. Results from this study will contribute to biocultural research on life history and social determinants of well-being, including for understudied populations, and will have the potential to inform clinical policy and practice. Findings will be disseminated to study participants and the general public through various venues, including prenatal care groups.

Developmental programming begins before birth, meaning that the experience of the mother is critical for offspring adaptability and fitness. Maternal signals transmitted to the offspring prenatally may represent the mother's total life history and/or the acute environment, including experiences of stress. One mechanism through which the offspring can respond to these signals is through epigenetic modifications, including changes in DNA methylation. The investigators will use infant DNA methylation at birth as a sensor of the prenatal environment, to assess how the offspring adapts to various maternal signals relayed during pregnancy. They will address whether infant methylation is more correlated with maternal methylation at 7-15 weeks, reflecting the cumulative life history of the mother before pregnancy as DNA methylation changes over the life course in response to the environment, or at 23-34 weeks, where maternal DNA methylation would be expected to change in response to the pregnancy-specific environment. A collection of DNA methylation marks that represent an "epigenetic clock" of chronological age will be used as a summary measure of life history in the mother and developmental maturity in the neonate.

This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.

Research Plan Summary/Abstract The Michigan PBB Cohort is the longest running, multi-generational cohort study of a widespread environmental contamination event in the United States. More than 40 years ago, millions of Michiganders ate farm products contaminated with polybrominated biphenyls (PBB), a chemical flame retardant. This cohort of approximately 7,500 individuals includes those who ate the contaminated food, chemical plant workers, their children, and their grandchildren. Extensive health, exposure, and biological samples have been collected from these individuals for four decades. While systematic updates of this cohort ceased in 2003 due to paucity of infrastructure funds, the Emory team pursued hypothesis-driven research with NIH funding. Research based on the Michigan PBB Cohort has demonstrated relationships between exposure to PBB and many health outcomes, including thyroid conditions, breast cancer risk, lower Apgar scores in children, reproductive health in daughters, and genitourinary abnormalities in sons. Current NIH-funded research includes innovative approaches involving genomics, epigenomics, exposomics and metabolomics across multiple generations as well as a randomized clinical trial of a nutritional aid hypothesized to speed elimination of PBB. The PBB research team has been exceedingly productive, contributing over 150 scientific communications. The PBB cohort has served as a source of data and biospecimens for eight NIH R01 grants, two EPA STAR grants, an NIH R03, and an NIH R21, reflecting the important scientific questions that can be addressed with this cohort. Importantly, for the last 6 years, the affected Michigan community has become a partner in the PBB research efforts, dedicating their time and resources to support the continuation of this work that is so meaningful to their family's and community's health. To assure this valuable cohort is accessible and useful for future studies and data sharing, with this R24 support we plan to update the vital status of the entire cohort and to develop a state-of-the-art data management and analytic platform. This platform will enable linkage of over 40 years of follow-up data and thousands of biospecimens. Using state of the art web-based communication, we will develop web portals to enable broad sharing of the cohort resources with three important stakeholder groups: the scientific community, cohort members (to access their own data), and local public health agencies. This infrastructure grant will support research addressing the long-term impact of exposure to brominated flame retardants, which continues to be found in the blood of the vast majority of Americans - making the intensive study of this unique cohort relevant to all Americans.

PROJECT SUMMARY/ABSTRACT This proposal outlines a 5-year translational research project to explore the mechanisms underlying the HIV risk associated with pharmacologic doses of exogenous sex hormones (via hormonal contraceptives). Emerging data suggests that certain hormonal contraceptives may induce mucosal and systemic immune changes that could increase the risk of infection with HIV. While several studies have aimed to characterize immunologic changes in women using hormonal contraceptives, the nature and the magnitude of these immune changes have not been adequately defined due to limitations in study design rigor, and small and statistically underpowered sample sizes. There is limited comprehensive data or comparative data on the effect of different types of contraceptives on innate and adaptive immunologic markers of HIV susceptibility. Without this research, we cannot effectively counsel our patients on contraceptive selection. Characterization of potential individual-level factors, such as the presence of bacterial vaginosis (BV), that may alter a woman's risk profile with contraceptive use, could lead to individualized decision-making about contraceptive choice and would have profound implications for global health especially in HIV-endemic areas. We propose to prospectively recruit cohorts of HIV-uninfected women initiating hormonal contraception to characterize systemic and lower genital track innate and adaptive immunologic changes that occur over the course of 1 year. This study will test the overarching hypothesis that hormonal contraceptives induce systemic and mucosal immune changes capable of altering susceptibilities and/or responses to diseases including HIV infection, and that these effects vary markedly in nature and magnitude by contraceptive type and will be modified by the vaginal microenvironment. The aims are: 1) To determine the immunologic alterations in female genital and systemic immune profile associated with depot medroxyprogesterone acetate (DMPA), Etonogestrel impant (Eng-Implant) and Levonorgestrel IUD (Lng-IUD). We hypothesize that HIV target immune cells within the female genital tract of HIV-uninfected at-risk women will increase following contraceptive initiation. Further, because the anticipated mucosal immune changes with progestin-only contraceptives are, to a large extent, mediated via estrogen suppression, we hypothesize the impact of the Lng-IUD (with minimal to no anti-estrogen effect) and Eng-Implant (with milder anti-estrogen effect) will be significantly less pronounced compared with that of DMPA. 2) To evaluate the vaginal microenvironment as a moderator of genital and systemic immune profile changes and changes in tissue infectivity following exposure to these three commonly used hormonal contraceptives. Based on our earlier findings, we hypothesize that immunologic changes induced with hormonal contraception will be more pronounced in the setting of BV. The outcomes of the proposed study could have significant global clinical implications for safe individualized contraceptive counseling and decision-making for women at risk for HIV/AIDS.

Project Summary The overall objective of this project is to determine the impact of social stressors on epigenetic age acceleration and chronic health disparities and to test whether the social environment, individual health behaviors, and race/geography/SES modify or mediate the association between traumatic stress and health (disparities), directly or indirectly through biologic age acceleration. We expect that the trauma burden will impact chronic diseases through DNA methylation (DNAm) age acceleration. The WaTCH cohort is an important, highly trauma- exposed sample of women uniquely poised for a third wave of data collection that continues assessing trauma exposure, depression, PTSD, social context, physical health, and collection of an additional blood specimen eight years after the baseline to examine of DNAm age. Aim 1 will investigate disparities in psychological health (PTSD, depression), physical health (diabetes, hypertension, and cancer), and DNAm age acceleration as women age, particularly as influenced by cumulative trauma burden. Aim 2 will examine the influences of contextual variables, including social capital and financial strain, that may mediate or moderate the effects of cumulative trauma burden on adverse psychological and physical health outcomes. Aim 3 will explore the mediating effects of DNAm age acceleration on physical and mental health outcomes. The proposed study will use the WaTCH cohort of 2800 women exposed to the Deepwater Horizon Oil Spill in coastal Louisiana in 2010. It will entail the third wave of data and biospecimen collection and incorporate data already gathered through two previous waves of data collection. Self-reported health data on demographic, income and financial stressors, oil spill exposure, neighborhood context, social capital, health behaviors, trauma history, psychological symptoms, and physical health will be collected through telephone interviews. Repeat blood samples will be collected from up to 1058 women with baseline samples.