"Youth Exposure to Violence and Pulmonary and Cardiovascular Health: Meta- and Primary-Analytic Approaches to Understanding Mediators and Moderators."

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Project Summary Youth exposure to violence is a pervasive issue. These exposures are theorized to give rise to disparities in health over time by impacting biological and behavioral processes known to contribute to diseases, including pulmonary and cardiovascular (CV) diseases. Yet, there is limited empirical test of the enduring effects youth exposure to violence may have on disease-relevant clinical risks and their progressions. Additionally, there is limited mechanistic understanding despite theoretical work suggesting pathways through poorer immune functioning and health behaviors. Finally, the magnitude of the impact violence has on pulmonary and CV health varies across studies and the synthesized effect size is still unknown. This variability, however, points to potential factors that may increase vulnerability to, or protect youth from, the negative impact of violence. Gaining insights about underlying pathways and moderating factors can help reveal promising points of intervention, targeting youth who may be most at-risk. Thus, the proposed research aims to identify (1) the synthesized effect size and the longitudinal impact of youth exposure to violence on pulmonary and CV risks; (2) the immune and behavioral pathways through which violence operates; (3) the sample-, effect-, and individual-level moderators that may exacerbate or mitigate the impact of violence. Notably, the proposed study aims will be addressed comprehensively utilizing meta-analytic approaches to gain breadth of knowledge and primary-analytic approaches to gain depth of knowledge. Meta-analytic approaches will synthesize current empirical evidence to estimate the magnitude of the impact youth exposure to violence has on pulmonary and CV health, consolidate existing research to test the synthesized indirect effects and overall model fit of the proposed pathways, and explore sample (e.g., demographic composition) and effect (e.g., context of violence exposure) characteristics as potential moderators. Complementarily, primary analytical approaches will draw from two of Dr. Edith Chen’s NIH-funded longitudinal studies to examine the impact of youth exposure to violence in the context of asthma and CV risks. Specifically, primary analyses will examine the longitudinal link from violence to asthma and CV risks, test mediators by probing in-depth inflammatory processes and assessing medical records and actigraphy data, as well as explore the buffering role of an individual-level coping factor in mitigating the impact of violence. Gaining breadth and depth of knowledge about youth exposure to violence not only addresses a public health concern, execution of the proposed research will also foster the applicant’s goal to be an independent researcher conducting both primary- and meta-analytic research that elucidates the psychosocial, biological, and behavioral processes underlying health disparities. Specifically, it will support the training goals of understanding how social factors in youth contribute to health disparities, acquiring conceptual foundation and laboratory skills for relating social constructs to immune processes, mastering advanced statistical techniques, and establishing a publication record in these areas.