Understanding Social Status' Impact on Adolescent Health

这个竞争性更新申请旨在扩展和加强我们的工作，旨在了解社会地位如何促进青春期和成年早期的肥胖和胰岛素抵抗。解开社会劣势领域（社会经济地位、感知的社会地位和种族/民族）如何相互作用以促进肥胖和胰岛素抵抗是我们工作的主要目标。第二个主要目标是描述易受社会不利条件有害影响的轨迹。我们的初步研究表明，随着青少年的成熟，感知到的SES对发病率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。我们采用双管齐下的方法来实现我们的目标。首先，我们通过两波新的数据收集，扩展了我们庞大而完善的队列研究——普林斯顿学区研究。这些新的数据收集工作将在上次评估后的3年和5年进行，将重新评估我们在前4波数据收集中收集到的拟人化、心理和生理因素，使我们能够研究这些年轻人向成年期的过渡。其次，我们加强了我们的解释模型，包括心理特征和社会劣势与肥胖/胰岛素抵抗之间关系的两种新的神经内分泌介质-肿瘤坏死因子- α和白细胞介素-6。我们的具体目标是：1)表征社会劣势与青春期至成年早期肥胖和2型糖尿病风险的炎症生物标志物之间的关系；2)社会劣势与心理因素之间的关系，这些因素可能是社会劣势与肥胖/胰岛素抵抗的因果链的一部分；3)探讨社会劣势领域之间的动态相互作用，以及这些领域如何与社会劣势与肥胖和胰岛素抵抗之间的假定生理和心理途径相互作用。前瞻性队列设计使我们能够在肥胖和2型糖尿病发病率急剧上升的时候解决方向性和反向因果关系的问题。该应用程序将提供关于肥胖和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。消除保健方面的社会不平等，包括由于社会地位差异造成的不平等，是当今社会面临的主要挑战之一。虽然社会地位的差异在心脏病、糖尿病、癌症以及许多其他在生命早期开始但直到成年后期才显现出来的慢性病方面有充分的记录，但这些差异形成的过程仍然是一个谜。为了加强我们对健康方面社会不平等积累过程的理解，该项目建议研究肥胖和胰岛素抵抗方面的差异，这两者都是青春期和青年期糖尿病、心脏病和癌症的前兆。

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.