The 3E Study: Economic and Educational Contributions to Emerging Adult Cardiometabolic Health

项目总结/摘要 不良童年经历（ACE）可能导致心脏代谢健康的不公平 不成比例地经历了拉丁裔新兴成年人。随着ACE措施在健康领域的使用越来越多， 研究，有必要考虑这些措施在不同人群中的效果以及ACE是否 需要扩大类别，以包括社区一级的逆境。首先，虽然现有的ACE措施 已经被用来了解生命早期的逆境如何影响危险健康行为的采用， 长期健康，最初的措施是针对有健康保险的人群制定的， 主要是白色和受过良好教育的;他们不一定反映不利的童年经历的多样性 这可能是不成比例地经历了一些社区（例如，与移民有关的创伤， 与警察有关的创伤）。需要做更多的工作来了解它们如何适用于更多样化的 人口。第二，Felitti博士最初的ACE指标，通常被称为“传统ACE”， 侧重于家庭一级的逆境（心理、身体或性虐待;针对妇女的家庭暴力; 母亲;或与滥用药物、精神病或自杀的家庭成员一起生活，或 监禁）。越来越多的研究人员认识到，家庭以外的经历也会影响人们的生活。 儿童和影响健康和健康行为，特别是对少数民族/种族群体的人 和/或生活在贫困中的人，并呼吁扩大ACE措施，解决人际和 社区层面的逆境。扩大的ACE措施可以包括贫困，种族主义， 歧视、欺凌、移民特有的逆境和社区暴力。除了扩展ACE之外， 为了包括社区一级的逆境，考虑复原力或积极的框架可能是有用的。 童年经历。Narayan等人开发了仁慈的童年经历（BCE）量表， 注重促进因素。措施包括与父母、同龄人、教师的积极经验， 扩展的社交网络、支持性的环境和可预测的日常生活。 这一多样性补充的目标是：1）制定一个针对社区层面的ACE量表 压力源（贫困、种族主义、歧视、欺凌、移民特有的逆境和社区暴力），2） 量化3E研究的不同新兴成年人队列中的ACE和BCE，以及3）使用定性 记录和情境化逆境如何影响心脏代谢行为的方法（饮食，身体 活动、睡眠和吸烟）和心脏代谢健康（体重和血压）。 这项工作产生的证据可以为未来社区一级的干预措施提供信息， 心脏代谢健康的决定因素，并将定位候选人有一个有影响力的职业生涯， 独立研究员调查社区层面不良童年经历对儿童的影响 不同人群的心脏代谢健康。

PROJECT SUMMARY/ABSTRACT Adverse Childhood Experiences (ACEs) may contribute to inequities in cardiometabolic health disproportionately experienced by Latinx emerging adults. With the increased use of ACE measures in health research, there is a need to consider how well the measures work in diverse populations and whether ACEs categories need to be expanded to include community-level adversity. First, although existing ACE measures have been used to understand how adversity early in life impacts the adoption of risky health behaviors and long-term health, the original measures were developed with a population that had health insurance and was largely white and well-educated; they do not necessarily reflect the diversity of adverse childhood experiences that may be disproportionately experienced by some communities (e.g., immigration-related traumas, policing-related traumas). More work needs to be done to understand how applicable they are to more diverse populations. Second, Dr. Felitti’s original ACEs measures, typically referred to as “conventional ACEs,” were focused on household-level adversity (psychological, physical or sexual abuse; domestic violence against the mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned). Increasingly, researchers recognize that experiences outside the home also shape the lives of children and influence health and health behavior, especially for people from minoritized racial/ethnic groups and/or those living in poverty, and are calling for expanded ACE measures that address interpersonal and community-level adversity. Expanded ACE measures can include experiences of poverty, racism, discrimination, bullying, immigration-specific adversity, and community violence. In addition to expanding ACEs to include community level adversity, it may be useful to consider the framework of resilience or positive childhood experiences. Narayan et al. developed the Benevolent Childhood Experiences (BCE) scale that focuses on promotive factors. Measures include positive experience with parents, peers, teachers, and extended social networks, a supportive environment, and a predictable routine. The objectives of this diversity supplement are 1) to develop an ACE scale specific to community level stressors (poverty, racism, discrimination, bullying, immigration specific adversity and community violence), 2) to quantify ACEs and BCEs in the 3E study’s cohort of diverse emerging adults, and 3) to use qualitative methods to document and contextualize how adversity impacts cardiometabolic behaviors (diet, physical activity, sleep, and smoking) and cardiometabolic health (weight and blood pressure). The evidence generated from this work could inform future community-level interventions targeting determinants of cardiometabolic health and will position the candidate to have an impactful career as an independent researcher investigating the impact of community level adverse childhood experiences on cardiometabolic health in diverse populations.