Community violence and disparities in maternal and infant health: effects and mechanisms

项目摘要 提高对围产期健康差异的社区水平决定因素的理解是研究的优先事项， 国家卫生机构。社区暴力可能会导致不利的母婴结局， 有助于解释按种族/族裔和外国出生身份划分的围产期健康差异。然而，在这方面， 研究已经大大阻碍了横截面的设计和方法，不能解开 社区暴力的影响与其他高度相关的健康决定因素有关。因此， 进行严格的研究，以确定社区暴力的不同方面的影响，无论是可预测的整体 水平和意外的急性变化，并确定潜在的心理，行为和生物 影响母婴健康和差异的机制。本报告的总体目标 应用是为了检验中心假设，即社区暴力增加了负担和差距， 产妇和婴儿的健康结果，以及潜在的可改变的心理（精神健康，社会 支持）、行为（物质使用）和生物（母体感染和条件）机制 这些影响。这一假设得到了初步分析的支持，初步分析发现， 早产，在非裔美国人中影响最大。核心假设是 使用数据自适应准实验匹配和固定效应方法以及丰富的协变量集进行处理 准确确定社区暴力对母婴健康的影响。分析将 对来自加州全州数据（2005-2017年）的600多万母亲和婴儿进行了调查- 基于超过72，000名这些母亲和婴儿的代表性样本的数据。拟议的研究将 （1）量化社区暴力的急剧变化对孕产妇死亡率的影响， 和婴儿健康差异，以及解释这些影响的心理、行为和生物机制; (2)确定社区暴力的总体水平对母婴健康差距的影响， 以及这些影响背后的心理、行为和生物机制。创新之处在于（a） 区分暴力总体水平的影响和暴力的急剧变化，（B）审查可能的 （c）估计可能对暴力行为采取的干预措施对人口的影响， 调解员预计这项研究将增加对暴力的更广泛影响的科学认识， 在形成健康差距方面的作用。此外，这项工作预计将确定的机制，解释 暴力对孕产妇和婴儿健康的影响，揭示了为什么拉丁裔等种族/族裔群体出现 保护，并可能建议其他干预点。总之，这些发现是 预计将产生重要的积极影响，因为它们将把暴力重新定义为影响健康， 种族/族裔差异，从而推动采取干预措施，减少暴力， 下游效应，这将提高美国的健康水平，减少健康差距。

Project Summary Improved understanding of community level determinants of perinatal health disparities is a research priority for national health agencies. Community violence may contribute to adverse maternal and infant outcomes and may be instrumental in explaining disparities in perinatal health by race/ethnicity and foreign-born status. However, research has been substantially hampered by cross-sectional designs and methods that cannot disentangle the effects of community violence from other highly correlated determinants of health. Thus, there is a critical need for rigorous research to determine the effects of different aspects of community violence, both predictable overall levels and unexpected acute changes, and to identify underlying psychological, behavioral and biological mechanisms of effect that contribute to maternal and infant health and disparities. The overall objective of this application is to test the central hypothesis that community violence increases the burden of and disparities in maternal and infant health outcomes, and that potentially modifiable psychological (mental health, social support), behavioral (substance use) and biological (maternal infections and conditions) mechanisms underlie these effects. This hypothesis is supported by preliminary analyses that find trimester-specific violence is related to preterm delivery, with the strongest effects among African Americans. The central hypothesis will be addressed using data-adaptive quasi-experimental matching and fixed-effects methods and a rich covariate set to accurately determine the effects of community violence on maternal and infant health. Analyses will be conducted with over 6 million mothers and infants from statewide data on California (2005-2017) and survey- based data on a representative sample of over 72,000 of these mothers and infants. The proposed research will address the following specific aims: (1) Quantify the impacts of acute changes in community violence on maternal and infant health disparities, and psychological, behavioral and biological mechanisms that explain the impacts; (2) Determine the effects of the overall levels of community violence on maternal and infant health disparities, and psychological, behavioral and biological mechanisms that underlie the effects. The work is innovative in (a) distinguishing effects of overall levels of violence from acute changes in violence, (b) examining potentially modifiable mechanisms, and (c) estimating population effects of potential interventions on violence and the mediators. The research is expected to increase scientific understanding of the broader impacts of violence and its role in shaping health disparities. In addition, this work is expected to identify the mechanisms that explain the effects of violence on maternal and infant health, uncovering why racial/ethnic groups such as Latinas appear to be protected, and potentially suggesting alternative points for intervention. Together, these findings are expected to have an important positive impact because they will reframe violence as affecting health and racial/ethnic disparities broadly and thereby motivate interventions to reduce violence and mitigate its downstream effects, which will enhance health and reduce health disparities in the US.