Leveraging a Natural Experiment to Estimate the Effects of School Racial Segregation on Cardiovascular Risk Factors among Youth and Young Adults

摘要 心血管疾病（CVD）风险因素不成比例地影响黑人成年人，这些差异是 在生命的早期就很明显。遗传因素似乎不能解释这种差异，研究表明， 越来越多的社会经济风险因素。种族差异最突出的风险因素之一 在CVD中，受教育程度与吸烟、高血压和CVD密切相关。 生命历程然而，目前还不清楚学校教育的哪些方面最突出。一种可能的解释是种族歧视 心血管疾病的差异是，黑人青年往往参加高度种族隔离的学校。种族隔离被认为是 由于压力和歧视增加而与CVD有关;社会规范和同伴影响;以及 限制社会经济机会，减少收入和以后生活中获得医疗保健的机会。然而 尽管近年来学校隔离现象有所增加，但没有研究调查 最近学校隔离趋势对CVD危险因素的影响。这项研究的目的是提供这一 急需证据。特别是，我们利用一个独特的自然实验，克服 教育对心血管疾病的影响在以前的文献方法上的挑战。自1990年以来， 地方法院的裁决导致全国各学区的“种族隔离”。我们连接全国 这些法院判决的数据和学区一级的学校隔离措施与心血管疾病结果数据 来自两个具有全国代表性的美国受影响青年队列研究：国家纵向研究 青少年到成年人健康（Add Health，90 000奈拉）和收入动态小组研究（8 000奈拉）。我们 采用工具变量分析的准实验技术，减少典型的混淆 由于未观察到的个人和家庭特征等因素。在目标1中，我们的目标是估计短- 学校隔离对心血管疾病危险因素的长期影响-包括吸烟，体育活动，肥胖， 心理健康-青年在校期间的心理健康。在目标2中，我们将研究 在随后的几十年里，学校隔离，结果包括目标1中的目标， 测量CVD生物标志物、糖尿病和高血压。我们还将进行探索性分析， 确定可能的中介途径。在目标3中，我们将确定脆弱的亚群， 心血管疾病风险因素因学校种族隔离而有所不同。这将使未来的干预措施能够 为最脆弱的人量身定制。我们将采用假设驱动和假设生成 统计技术，包括创新的机器学习方法，允许更复杂和更强大的 亚组识别总的来说，这项研究的预期结果是产生严格的证据， 学校种族隔离对心血管疾病危险因素的影响，有助于告知学校，临床， 社区干预措施，以减少CVD中持续存在的不公平种族差异。

ABSTRACT Cardiovascular disease (CVD) risk factors disproportionately affect black adults, and these disparities are evident early in the life course. Genetic factors do not appear to explain this difference, and studies have increasingly implicated socioeconomic risk factors. Among the most prominent risk factors for racial disparities in CVD is educational attainment, which is strongly correlated with smoking, hypertension, and CVD over the life course. Yet it is unclear which aspects of schooling are most salient. One possible explanation for racial disparities in CVD is that black youth often attend highly racially segregated schools. Segregation is thought to be linked with CVD due to increased stress and discrimination; social norms and peer influence; and the constraining of socioeconomic opportunities that reduces income and healthcare access later in life. Yet despite the fact that school segregation has increased in recent years, there are no studies examining the effects of recent school segregation trends on CVD risk factors. The goal of this study is to provide this urgently needed evidence. In particular, we take advantage of a unique natural experiment, overcoming methodological challenges in the previous literature on the effects of education on CVD. Since 1990, numerous local court decisions have resulted in “resegregation” in school districts across the country. We link nationwide data on these court decisions and school district-level measures of school segregation with CVD outcome data from two large nationally representative U.S. cohort studies of affected youth: the National Longitudinal Study of Adolescent to Adult Health (Add Health, N≈90,000) and the Panel Study of Income Dynamics (N≈8,000). We employ the quasi-experimental technique of instrumental variables analysis, which reduces typical confounding by factors such as unobserved individual and family characteristics. In Aim 1, our goal is to estimate the short- term effects of school segregation on CVD risk factors—including smoking, physical activity, obesity, and mental health—among youth while they are still in school. In Aim 2, we will examine the long-term effects of school segregation in the decades that follow, with outcomes including those in Aim 1 in addition to objectively measured CVD biomarkers, diabetes, and hypertension. We will also undertake exploratory analyses to determine possible mediating pathways. In Aim 3, we will identify vulnerable subgroups whose development of CVD risk factors differs in response to school racial segregation. This will enable future interventions to be tailored to the most vulnerable individuals. We will employ both hypothesis-driven and hypothesis-generating statistical techniques, including innovative machine learning methods that allow for more complex and robust subgroup identification. Overall, the expected outcome of this research is to produce rigorous evidence on the effects of school racial segregation on CVD risk factors, helping to inform school-based, clinical, and community interventions to reduce persistent and inequitable racial disparities in CVD.