Disparate Exposures, Disparate Outcomes: The Effect of Cumulative Disadvantage

项目总结/摘要 越来越多的科学证据表明，成年人在健康结果和社会经济地位方面的差异 (SES)起源于童年、产前或怀孕前。拟议的研究调查 不良妊娠结局的差异是否与产前空气污染暴露有关，以及与 不良妊娠结局、铅和邻近环境的综合暴露程度 幼儿教育成果的差异。不良妊娠结局和铅暴露 由种族/族裔和社会经济地位决定的，可能不成比例地增加到已经处于不利地位的儿童中。 面临多重压力和环境暴露（如空气污染）的社区， 与较低的标准化考试成绩有关。儿童教育成果虽然重要， 是高中和大学毕业的预测因素，而这是收入的重要决定因素 以及以后的医疗保健。在培训阶段，布拉沃博士将使用兄弟姐妹模型， 孕妇产前空气污染暴露与不良妊娠结局关系探讨 兄弟姐妹（目标1）。这种方法控制了兄弟姐妹共有的因素，也告知产前空气是否 污染暴露可能会增加不良怀孕的风险，从而间接影响教育成果 结果。在赠款的独立阶段，Bravo博士将开发模型来调查 不良妊娠结局、儿童早期铅暴露和邻居的综合影响 环境对教育成果的影响（目标2）。她还将开发模型来估计 居住不稳定性和不断变化的邻里环境对幼儿教育成果的影响（Aim 3）。拟议的研究需要从流行病学，统计学和社会学的见解，以及应用 先进的统计方法。Bravo博士非常适合这项工作，这是基于她以前的研究经验， 其中包括研究温度和空气污染对呼吸和心血管相关疾病的影响， 死亡率和发病率，并研究邻里，空气污染暴露和健康之间的关系。 博士Bravo可以访问地理参考和纵向链接的暴露，健康和教育数据集。 她还组建了一个高素质的导师团队，并将受益于世界一流的导师， 培训和设施。除了与她的导师正式互动，她将完成课程， 统计学和社会流行病学;参加职业发展讲习班;并在 专业会议、系列研讨会和工作组。这项研究将使布拉沃博士能够 在健康和教育差距的流行病学方面建立独立的职业生涯。此外，她的发现 将有助于理解多重不利暴露的影响，并最终预防多重不利暴露， 解决教育、发展和卫生成果方面的不平等问题。

Project Summary/Abstract Scientific evidence increasingly indicates that adult disparities in health outcomes and socioeconomic status (SES) originate in childhood, the prenatal period, or preconception. The proposed research investigates whether disparities in adverse pregnancy outcomes are related to prenatal air pollution exposure, and to what extent combined exposures to adverse pregnancy outcomes, lead, and neighborhood environment contribute to disparities in early childhood educational outcomes. Both adverse pregnancy outcomes and lead exposure are patterned by race/ethnicity and SES, may accrue disproportionately to children in already disadvantaged communities facing multiple stressors and environmental exposures (such as air pollution), and have been individually associated with lower standardized test scores. Childhood educational outcomes, while important on their own, are predictors of high school and college graduation, which are essential determinants of income and health care access later in life. During the training phase of this grant, Dr. Bravo will use sibling models to investigate relationships between prenatal air pollution exposure and adverse pregnancy outcomes in maternal siblings (Aim 1). This approach controls for factors shared by siblings and also informs whether prenatal air pollution exposure may indirectly affect educational outcomes by increasing risk of adverse pregnancy outcomes. During the independent phase of the grant, Dr. Bravo will develop models to investigate the combined effect of adverse pregnancy outcomes, early childhood lead exposure, and neighborhood environment on educational outcomes (Aim 2). She will also develop models to estimate the impact of residential instability and changing neighborhood environment on early childhood educational outcomes (Aim 3). The proposed research requires insights from epidemiology, statistics, and sociology, as well as application of advanced statistical methods. Dr. Bravo is well-suited to this work based on her prior research experience, which includes investigating effects of temperature and air pollution on respiratory- and cardiovascular-related mortality and morbidity and studying relationships between neighborhood, air pollution exposure, and health. Dr. Bravo has access to georeferenced and longitudinally linked exposure, health, and education datasets. She has also assembled a team of highly qualified mentors and will benefit from world-class mentorship, training, and facilities. In addition to formal interaction with her mentors, she will complete coursework in statistics and social epidemiology; participate in career development workshops; and present her research at professional conferences, seminar series, and working groups. The proposed research will enable Dr. Bravo to establish an independent career in the epidemiology of health and educational disparities. Further, her findings will contribute to understanding effects of, and eventually preventing, multiple adverse exposures, thereby addressing intransigent disparities in educational, developmental, and health outcomes.