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

利用自然实验来评估学校种族隔离对青少年和年轻人心血管危险因素的影响

• 批准号: 10901155
• 负责人: Rita Hamad
• 金额: $ 55.81万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10901155
• 关键词: Address; Adolescence; Adolescent; Adult; Affect; Age; Behavior; Biological Markers; Black race; Cardiovascular Diseases; Characteristics; Child; Childhood; Chronic stress; Clinical; Cognition; Cohort Studies; Complex; Counseling; Country; Court Decisions; Data; Data Set; Desegregation; Development; Diabetes Mellitus; Discrimination; Disease Outcome; Disparity; Economics; Education; Family Characteristics; Funding; Future; Gender; Genetic; Goals; Health; Health behavior; Heart Diseases; Hour; Hypertension; Income; Individual; Intervention; Knowledge; Life; Life Cycle Stages; Light; Link; Literature; Long-Term Effects; Longitudinal Studies; Measures; Mediating; Mental Health; Methodology; National Heart, Lung, and Blood Institute; National Longitudinal Survey of Adolescent to Adult Health; Natural experiment; Obesity; Occupational; Outcome; Outcomes Research; Pathway interactions; Persons; Physical activity; Population; Preventive; Public Health; Quasi-experiment; Race; Racial Segregation; Reporting; Research; Risk Factors; Schools; Smoking; Socioeconomic Status; Specific qualifier value; Stress; Subgroup; Techniques; Testing; Vulnerable Populations; Work; Youth; archive data; black/white disparity; cardiovascular disorder risk; cardiovascular risk factor; community intervention; data archive; design; disparity reduction; forest; health care availability; high risk; improved; innovation; insight; machine learning method; middle age; novel marker; panel study of income dynamics; peer influence; peer networks; physical inactivity; programs; psychologic; racial disparity; resilience; response; school district; screening; segregation; social; social norm; socioeconomics; teenage fertility; theories; treatment effect; trend; young adult

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.

摘要

项目成果

School racial segregation and long-term cardiovascular health among Black adults in the US: A quasi-experimental study.

• DOI: 10.1371/journal.pmed.1004031
• 发表时间: 2022-06
• 期刊: PLoS medicine
• 影响因子: 15.8

The long shadow of residential racial segregation: Associations between childhood residential segregation trajectories and young adult health among Black US Americans.

• DOI: 10.1016/j.healthplace.2022.102904
• 发表时间: 2022-09
• 期刊: HEALTH & PLACE
• 影响因子: 4.8
• 作者: Schwartz, Gabriel L.;Wang, Guangyi;Kershaw, Kiarri N.;McGowan, Cyanna;Kim, Min Hee;Hamad, Rita
• 通讯作者: Hamad, Rita

School Racial Segregation and the Health of Black Children.

• DOI: 10.1542/peds.2021-055952
• 发表时间: 2022-05-01
• 期刊: PEDIATRICS
• 影响因子: 8
• 作者: Wang, Guangyi;Schwartz, Gabriel L.;Kim, Min Hee;White, Justin S.;Glymour, M. Maria;Reardon, Sean;Kershaw, Kiarri N.;Gomez, Scarlett Lin;Inamdar, Pushkar P.;Hamad, Rita
• 通讯作者: Hamad, Rita