CHILD HEALTH EFFECTS OF RAPID SOCIO-DEMOGRAPHIC CHANGE

经济、人口和社会的快速变化是世界上低收入和转型国家的特点。在这种变化带来健康益处的同时，出现了非传染性疾病发病率和死亡率上升的新模式。 拟议研究的主要目标是解释社会经济变化的特定组成部分如何影响一系列中间健康相关行为（饮食，体育活动，吸烟），从而影响2个主要的儿童健康结果（超重和血压升高）。 这些结果是成人慢性病最重要的风险因素之一。 我们还探讨了产前和产后早期的营养状况是否反映了出生时的大小和2岁时的发育迟缓加剧了快速发展的健康风险。本研究以经典的Mosley和Chen健康决定因素模型为基础，并将使用结构方程来估计这些关系。 我们专注于儿童，因为成人慢性病的风险因素在儿童时期发展并持续到成年。我们提出了一个比较纵向研究的儿童在4个人口在不同的经济发展水平。 这些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社会经济的快速变化;每项研究都涵盖了儿童的关键时期;所有研究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，这些测量都是对儿童及其家庭的大型代表性样本进行的。 我们的结构方程模型将研究：（1）每个国家快速经济和社会变化的关键组成部分（例如收入，价格，食品供应，技术，家庭结构，城市化程度，大众媒体）与健康相关行为的关系;以及（2）这些健康行为和其他近似因素与超重和血压升高的关系。 我们将探讨是否成分变化，关系结构的变化或两者都影响健康相关的行为，以及是否有一个协同作用的关键组成部分的阈值水平的因素，预测健康相关的行为和结果的重大转变。 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，我们将比较各国的结果，以确定处于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.