CHILD HEALTH EFFECTS OF RAPID SOCIO-DEMOGRAPHIC CHANGE

快速的经济、人口和社会变化是世界上低收入和转型期国家的特点。在这种变化对健康有益的同时，出现了非传染性疾病发病率和死亡率增加的新模式。这项研究的主要目标是解释社会经济变化的具体组成部分如何影响一系列与健康相关的中间行为（饮食、体育活动、吸烟），这些行为反过来又影响两种主要的儿童健康结果（超重和高血压）。这些结果是成人慢性疾病最重要的危险因素之一。我们还探讨了出生时的体型和2岁时的发育迟缓所反映的产前和产后早期营养状况是否会加剧快速发育的健康风险。该研究基于经典的Mosley和Chen健康决定因素模型，并将使用结构方程来估计这些关系。我们将重点放在儿童身上，因为成人慢性疾病的危险因素在儿童时期形成，并持续到成年。我们建议对4个不同经济发展水平人群的儿童进行纵向比较研究。数据来自我们正在索韦托（南非）、俄罗斯、中国和宿务（菲律宾）进行的前瞻性研究。每个国家的特点都是迅速的社会经济变化；每项研究都涵盖了童年的关键时期；所有这些都包括对社会经济地位、人体测量和许多中间健康相关行为的详细测量，这些行为是在大量具有代表性的儿童及其家庭样本中测量的。我们的结构方程模型将检验：(1)每个国家快速经济和社会变化的关键组成部分（如收入、价格、粮食供应、技术、家庭结构、城市化程度、大众媒体）与健康相关行为之间的关系；(2)这些健康行为与其他近因因素与超重、血压升高的关系。我们将探讨组成变化、关系结构的变化或两者是否都会影响健康相关行为，以及预测健康相关行为和结果的主要变化的因素阈值水平的关键组成部分是否存在协同作用。我们将使用模型结果来预测选定的社会和人口变化对儿童健康结果的影响。最后，我们将比较各国之间的结果，以确定在不同发展水平的国家之间是否存在一致的关系模式或结构。

Rapid economic, demographic, and social change characterizes the lower income and transitional countries of the world. Concomitant with the health benefits of such change, there is an emerging pattern of increased morbidity and mortality from noncommunicable diseases. The main goal of the proposed research is to explain how specific components of socioeconomic change affect a set of intermediate health-related behaviors (diet, physical activity, smoking), which in turn affect 2 main child health outcomes (overweight and elevated blood pressure). These outcomes are among the most important risk factors for adult chronic disease. We also explore whether pre- and early postnatal nutritional status reflected by size at birth and stunting at age 2 exacerbate the health risks of rapid development. The research is based on the classic Mosley and Chen health determinants model, and will use structural equations to estimate the relationships. We focus on children because risk factors for adult chronic disease develop in childhood and track into adulthood. We propose a comparative longitudinal study of children in 4 populations at different levels of economic development. The data are from our ongoing prospective studies in Soweto (South Africa), Russia, China and Cebu (Philippines). Each country is characterized by rapid socioeconomic change; each study covers the key years of childhood; and all include detailed measures of socioeconomic status, anthropometry, and many intermediate health-related behaviors measured on large, representative samples of children and their households. Our structural equations models will examine: (1) the relationship of critical components of rapid economic and social change in each country (e.g. income, prices, food availability, technology, family structure, degree of urbanization, mass media) to health-related behaviors; and (2) the relationship of these health behaviors and other proximate factors to overweight and elevated blood pressure. We will explore whether compositional changes, changes in the structure of relationships or both affect health related behavior and whether there is a synergism of key components of threshold levels of factors that predict major shifts in health related behavior and outcomes. We will use the model results to predict consequences of selected social and demographic changes for child health outcomes. Finally, we will compare results across countries to determine whether there is a consistent pattern or structure of relationships across countries at different levels of development.