Multiple Stress Pathways and Positive Resources in UF Incidence and Growth

Uterine leiomyomata, also known as uterine fibroids (UF), are benign neoplasms of the uterus and are associated with heavy menstrual bleeding, anemia, pelvic pain, infertility, and complications of pregnancy. In the United States, the lifetime risk of UF exceeds 70%. UF are the leading indication for hysterectomy. UF represent one of

the biggest health disparities of all conditions affecting women. Black women have greater UF incidence, earlier age at first diagnosis and surgery, and more numerous and larger symptomatic tumors on average than White women. Factors associated with UF incidence and growth are poorly understood and reasons for the racial

disparity are neither well understood nor empirically verified. Our project will investigate how life course stressors affect risk of UF incidence and growth by applying the Stress Process Model in a cohort of Black individuals. We will investigate how stressors from multiple pathways affect UF incidence and growth among Black women.

Since its inception in 2010, the NIEHS-funded Study of Environment, Lifestyle & Fibroids (SELF) has carried out >8,000 clinic visits during a 10-year period among >1600 Black women living in the Detroit area with the goal of defining the natural history of UF and identifying environmental risk factors for UF incidence and growth. SELF

enrolled women 23-34-years of age who self-identified as Black/African American, had never been diagnosed with UF and conducted assessments with transvaginal ultrasounds at enrollment (baseline) and 4 follow-up visits (5 total clinic visits; 84% retention after 10-years). At each study visit, SELF participants completed

comprehensive in-person interviews and transvaginal ultrasounds for UF measurement, facilitating accurate and precise tracking of UF development, growth, and characteristics (e.g., number, location, and size). During 10-years of follow-up, 764 participants had at least 1 UF detected by study ultrasound (n=379 incident UF).

Questions about stressors (PSS-4) and adverse life events (including during childhood) were collected at every study contact. We will re-contact SELF participants to obtain a lifetime residential history and additional information on stressors (Major Experiences of Discrimination) and “positive resources” including coping,

resilience, religious involvement and social connection across the life course. We will calculate the Index of Concentration of Extremes (ICE), Area Deprivation Index (ADI) and Childhood Opportunity Index 2.0 (COI2.0) to describe Community Level stressors for each participant based on address to achieve the following: Aim 1:

Assess the associations between repeated measures of self-reported stress and adverse life events over time with UF incidence and growth using existing data collected during 10-years of follow-up; Aim 2: Determine the contribution of additional stress pathways (Major Experiences of Discrimination, ICE, ADI, COI 2.0, family

socioeconomic status (SES)) queried as part of the new SELF recontact to UF incidence and growth; Aim 3: Determine the role of positive resources with the associations between lifetime experiences of adverse life events, personal stressors, and discrimination and UF incidence and growth (Aims 1 and 2).

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