Understanding Social Status' Impact on Adolescent Health

描述(由申请人提供)：项目摘要：这项竞争性的续签申请旨在扩大和加强我们的工作，目的是了解社会地位如何在青春期和成年早期促进肥胖和胰岛素抵抗。弄清社会劣势领域(社会经济地位、感知的社会地位和种族/民族)如何相互作用，促进肥胖和胰岛素抵抗是我们工作的一个主要目标。第二个主要目标是描述易受社会不利影响有害影响的轨迹。我们的初步研究表明，随着青少年的成熟，感知的SES对发病率的发展的重要性发生了重大转变。了解这种转变发生的时间、方式和原因，对于指导制定有效、高效的干预措施以减少健康差距是必要的。我们使用双管齐下的方法来实现我们的目标。首先，我们通过两次新的数据收集，扩展了我们的大型、成熟的队列研究--普林斯顿学区研究。这些新的数据收集工作将在最后一次评估后的3年和5年内进行，将重新评估我们在前4波数据收集期间收集的人形、心理和生理因素，使我们能够研究这些年轻人过渡到成年的过程。其次，我们增强了我们的解释模型，包括心理特征和两个新的神经内分泌调节因子--肿瘤坏死因子-α和白介素6--来解释社会劣势与肥胖/胰岛素抵抗之间的关系。我们的具体目标是：1)描述从青春期到成年早期社会劣势与肥胖和2型糖尿病风险的炎性生物标志物之间的关系；2)表征社会劣势与心理因素之间的关系，这些因素可能是将社会劣势与肥胖/胰岛素抵抗联系起来的因果链条的一部分；3)探索社会劣势领域之间的动态相互作用，以及这些领域如何与将社会劣势与肥胖和胰岛素抵抗联系起来的可能的生理和心理路径相互作用。前瞻性队列设计使我们能够在肥胖率和2型糖尿病发病率大幅上升的情况下解决方向性和反向因果关系问题。这项应用将提供有关肥胖和2型糖尿病风险差异如何发展和进展的独特数据，潜在地确定社会、心理和药物干预的途径。叙述消除健康方面的社会不平等，包括因社会地位不同造成的不平等，是当今社会面临的主要挑战之一。尽管在心脏病、糖尿病、癌症以及许多其他类似的慢性疾病中，由于社会地位引起的差异被很好地记录下来，这些疾病在生命早期就开始出现，但直到成年后才变得明显，但这些差异的发展过程仍然是一个谜。为了加深我们对健康方面的社会不平等形成过程的理解，该项目建议研究青春期和青壮年期间肥胖和胰岛素抵抗的差异，这两者都是糖尿病、心脏病和癌症的先兆。

DESCRIPTION (provided by applicant): Project Summary This competing renewal application proposes to extend and enhance our work aimed at understanding how social status fosters obesity and insulin resistance in adolescence and early adulthood. Disentangling how domains of social disadvantage (socioeconomic position, perceived social status, and race/ethnicity) interact to promote obesity and insulin resistance is a major goal of our work. A second major goal is characterizing trajectories of vulnerability to the deleterious effects of social disadvantage. Our preliminary studies suggest a major shift in the importance of perceived SES to development of morbidity as an adolescent matures. Understanding when, how and why this shift occurs is necessary to guide development of effective, efficient interventions to decrease health disparities. We use a two-pronged approach to address our goals. First, we extend our large, well established cohort study, The Princeton School District Study, through 2 new waves of data collection. These new data collection efforts, which will occur 3 and 5 years after the last assessment, will re-evaluate the anthropomorphic, psychological, and physiological factors we have collected data on during these first 4 waves of data collection, allowing us to study these youth as they transition to adulthood. Second, we enhance our explanatory model to include psychological traits and two new neuroendocrine mediators of the relationships between social disadvantage and obesity/insulin resistance--tumor necrosis factor-alpha and interleukin-6. Our specific aims are: 1) To characterize the relationship between social disadvantage and inflammatory biomarkers of risk for obesity and Type 2 diabetes from adolescence to early adulthood; 2) To characterize the relationships between social disadvantage and psychological factors which may be part of the causal chain linking social disadvantage to obesity/insulin resistance; 3) To explore the dynamic interplay between domains of social disadvantage and how these domains interact with putative physiological and psychological paths linking social disadvantage to obesity and insulin resistance. The prospective cohort design allows us to address issues of directionality and reverse causation at a time when rates of obesity and Type 2 diabetes have risen dramatically. This application will provide unique data regarding how disparities in obesity and risk for Type 2 diabetes develop and progress, potentially identifying pathways for social, psychological, and pharmacological intervention. Narrative Elimination of social inequalities in health, including those due to differences in social status, is one of major challenges facing society today. Although disparities due to social status are well documented for heart disease, diabetes, and cancer, as well as many other such chronic diseases which begin early in life but do not become manifest until later in adulthood, the process by which these disparities develop remains a mystery. In order to enhance our understanding of the process by which social inequalities in health accrue, this project proposes to study disparities in obesity and insulin resistance, both of which are precursors for diabetes, heart disease, and cancer, during adolescence and young adulthood.