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

项目摘要 青年遭受暴力是一个普遍存在的问题。理论上，这些暴露会导致 通过影响已知会导致疾病的生物和行为过程， 肺和心血管（CV）疾病。然而，对青年的持久影响的经验性测试有限。 暴露于暴力可能对疾病相关的临床风险及其进展。此外还有 尽管理论工作表明通过较差的免疫途径， 功能和健康行为。最后，暴力对肺和CV的影响程度 不同的研究对健康的影响各不相同，合成效应量仍然未知。然而，这种变化表明， 可能增加青年易受暴力侵害或保护青年免受暴力负面影响的潜在因素。 获得关于潜在途径和调节因素的见解可以帮助揭示有希望的点， 干预，针对可能面临最大风险的青年。因此，拟议的研究旨在确定（1） 综合效应量和青少年暴露于暴力对肺和心血管风险的纵向影响; (2)暴力行为的免疫和行为途径;（3）样本、效应和 可能加剧或减轻暴力影响的个人层面的调解人。值得注意的是， 研究目标将全面利用元分析方法来获得知识的广度 和初级分析方法来获得知识的深度。元分析方法将综合当前 经验证据，以估计青少年暴露于暴力对肺和 CV健康，巩固现有的研究，以测试合成的间接影响和整体模型拟合的 提出的途径，并探索样本（例如，人口组成）和影响（例如，暴力时 暴露）特性作为潜在的调节剂。作为补充，主要分析方法将得出 来自Edith Chen博士的两项NIH资助的纵向研究，以检查青少年接触 哮喘和心血管风险背景下的暴力。具体而言，主要分析将检查纵向联系 从暴力到哮喘和CV风险，通过探测深入的炎症过程来测试介质， 评估医疗记录和活动记录数据，以及探索个人水平的缓冲作用， 减轻暴力影响的应对因素。获得关于青年的知识的广度和深度 接触暴力不仅解决了公共卫生问题，拟议研究的执行也将 培养申请人的目标是成为一个独立的研究人员进行初级和元分析 阐明健康差异背后的心理社会、生物和行为过程的研究。 具体而言，它将支持了解青年的社会因素如何促进健康的培训目标 差异，获得概念基础和实验室技能，将社会结构与免疫 掌握先进的统计技术，并在这些领域建立出版记录。

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.