ETIOLOGICAL PROCESSES IN THE ONSET AND MAINTENANCE OF ADVERSE HEALTH OUTCOMES IN MALTREATED YOUTH

疾病预防控制中心估计，儿童受害者一生的经济负担总计1240亿美元。 虐待大量的文献支持虐待儿童和不良行为之间的积极联系。 身体健康结果，包括心血管疾病、肥胖、糖尿病、肺癌、慢性疼痛， 头痛、性传播感染和自身免疫性疾病。然而，这些发现中的大多数 来自横断面、短期或成人回顾性研究设计，严重限制了科学研究 可信度和因果推理。此外，导致这种结果的假定病因学过程仍然存在， 很大程度上是未知的，并不是每个受到虐待的儿童都会受到任何长期的健康影响， 这表明存在独特的风险和恢复途径。这种对基本的 赋予虐待儿童受害者风险或复原力的机制阻碍了转化研究 可以开发或修改针对已确定途径的预防性干预措施， 减少这些健康差距及其相应的医疗保健费用。项目1将提高这一严格性 通过实施一项大型前瞻性队列研究， 虐待儿童的多个病因过程被认为在发病和维持中发挥作用， 对受害者的健康产生不利影响。通过与宾夕法尼亚州的大规模合作， 人类服务部项目1将招募1200名8-13岁的儿童（50%为男性）， 包括900名在过去一年中经历过证实的虐待的人（300名性虐待，300名 身体虐待，300忽视），沿着与人口统计学匹配的对照组儿童（300）。的过程 生物嵌入（BE）在神经内分泌、自主、免疫、表观遗传和细胞（即， 线粒体和端粒生物学）水平将作为儿童健康的机制进行检查，包括大脑 健康（即，最佳神经发育轨迹）、行为和情绪健康以及身体健康。 心理社会和行为过程，如复原力（即，学校参与，自尊，家庭和 同伴支持、适应性应对、灵活性、认知能力、情绪调节和执行功能）; 健康的生活方式行为（即，运动、睡眠、饮食、性态度和物质使用）;以及治疗 利用率将作为减轻BE与健康之间关系的合理延展性因素进行检查。 目的包括：（目的1）全面了解虐待儿童、生物虐待和 嵌入（BE）和健康状况;（目标2）测试BE如何独立运作，并与 解释虐待与健康状况之间关系的社会心理和行为因素; (Aim 3）检验基因型、性别、种族、青春期阶段和虐待类型的调节作用， 目标1和2中测试的模型。

The CDC estimates a $124 billion aggregate lifetime economic burden incurred by victims of child maltreatment. A large literature supports positive associations between child maltreatment and adverse physical health outcomes including cardiovascular disease, obesity, diabetes, lung cancer, chronic pain, headaches, sexually-transmitted infections, and autoimmune diseases. However, the majority of these findings derive from cross-sectional, short-term, or adult retrospective study designs, severely limiting scientific credibility and causal inferences. Moreover, putative etiological processes leading to such outcomes remain largely unknown and not every child who has been maltreated will experience any long-term health effects, suggesting the presence of unique risk and resilience pathways. This lack of understanding in the basic mechanisms conferring risk or resilience for victims of child maltreatment has stymied translational research where preventative interventions targeting identified pathways can be developed or modified in an effort to reduce these health disparities and their corresponding healthcare costs. Project 1 will raise the rigor of this science and address critical gaps by implementing a large, prospective cohort study to examine the effects of child maltreatment on multiple etiological processes believed to play a role in the onset and maintenance of adverse health outcomes for victims. Through a large-scale partnership with the State of Pennsylvania's Department of Human Services, Project 1 will recruit a large cohort of 1200 children aged 8–13 (50% males), including 900 who experienced substantiated maltreatment within the past year (300 sexual abuse, 300 physical abuse, and 300 neglect), along with demographically matched control children (300). The processes of biological embedding (BE) at the neuroendocrine, autonomic, immunologic, epigenetic, and cellular (i.e., mitochondria and telomere biology) levels will be examined as mechanisms of child health, including brain health (i.e., optimal neurodevelopmental trajectories), behavioral & emotional health, and physical health. Psychosocial and behavioral processes such as resilience (i.e., school engagement, self-esteem, family and peer support, adaptive coping, flexibility, cognitive ability, emotion regulation, and executive functioning); healthy lifestyle behaviors (i.e., exercise, sleep, diet, sexual attitudes, and substance use); and treatment utilization will be examined as plausible malleable factors that mitigate the relationship between BE and health. Aims include: (Aim 1) a comprehensive understanding of the interplay among child maltreatment, biological embedding (BE), and health status; (Aim 2) testing how BE operates independently and in conjunction with psychosocial and behavioral factors to explain the relationship between maltreatment and health status; and (Aim 3) testing the moderating effects of genotype, gender, ethnicity, pubertal stage, and maltreatment type on models tested in Aims 1 & 2.