Trends in ethnic and socioeconomic differentials in diet quality in American chil

描述(由申请人提供)：来自少数族裔和低社会经济家庭的美国儿童健康状况不佳的比例更高，死亡率更高。最近的数据表明，这些种族和社会经济差异在美国儿童的健康结果中持续存在或扩大。例如，在过去的30年里，美国儿童的总体死亡率、伤害死亡率和自然原因死亡率都有所下降。然而，来自少数群体和社会经济地位较低家庭的儿童的降幅较小，导致社会经济差距扩大。对美国儿童肥胖、糖尿病前期和高血压等风险因素的趋势分析也表明，社会经济和种族差异也存在类似的持续或扩大。包括饮食在内的有害健康风险行为是许多因素之一，如获得医疗保健的机会、环境暴露、邻里环境、收入限制和歧视，这些因素可能导致美国儿童健康方面的种族和社会经济差异。饮食可能是种族和社会经济健康差异的中介这一假设似乎是合理的，因为饮食是许多慢性病的公认风险因素。然而，令人惊讶的是，人们对种族和社会经济地位指标--家庭收入、教育和职业--与美国儿童多元框架内的饮食属性之间的独立关联知之甚少。此外，目前还没有关于美国儿童饮食和社会经济地位之间的关联随着时间的推移而发生变化的公开信息。对种族和社会经济群体成员造成的饮食差异的时间趋势进行评估，可能有助于我们了解饮食是否可能是美国儿童健康差异持续或扩大的原因。因此，这项应用的总体目标是在美国儿童和青少年中检查：1)种族/民族和社会经济地位指标(家庭收入、教育和职业)与报告的饮食属性和饮食摄入量的客观生物标记物之间的独立关联，以及2)1971年至2006年种族/民族和社会经济地位与饮食质量关联的趋势。我们将使用1971-74年、1976-1980年、1982-1984年(西班牙裔)、1988-1994年、2001-2006年进行的全国健康和营养检查调查(NHANES)中具有全国代表性的2-19岁青少年(n=39,607)的数据来解决这些问题。与公共健康相关：饮食因素是可以干预的，而且饮食是普遍消费的，即使是很小的相对风险也可能对公共健康产生相当大的影响，这一事实突显了饮食因素在改善健康结果方面的重要性。因此，对饮食质量种族和社会经济差异的时间趋势进行评估，将有助于确定在缩小民族和社会经济健康结果差距方面的绝对和相对进展，这是国家促进健康议程的既定目标。因此，这项研究的结果将有助于评估过去在这些高危人群中促进理想行为改变的努力的有效性，并设计新的战略，以针对与种族和社会经济地位相关的饮食属性。

DESCRIPTION (provided by applicant): American children from ethnic minority and low socioeconomic families have higher rates of poor health and higher mortality rates. Recent data suggest persistence or widening of these ethnic and socioeconomic differentials in health outcomes of US children. For example, over the past three decades, overall, injury, and natural-cause mortality in childhood in the US declined. However, children from minority and lower socioeconomic position families experienced a smaller decline, resulting in a widening of the socioeconomic gap. The trends analysis for risk factors such as prevalence of obesity, prediabetes, and high blood pressure in US children also suggest similar persistence or increase of socioeconomic and ethnic disparities. Adverse health risk behaviors that include diet are among the many factors such as access to health care, environmental exposures, neighborhood contexts, income constraints, and discrimination that may contribute to ethnic and socioeconomic disparities in the health of US children. The hypothesis that diet may be a mediator of ethnic and socioeconomic disparities in health appears reasonable given that diet is an acknowledged risk factor for a number of chronic diseases. However, surprisingly little is known about the independent associations of ethnicity and measures of socioeconomic position-- family income, education, and occupation--with dietary attributes within a multivariate framework in US children. Also, there is no published information on how the association of diet and socioeconomic position may be changing over time in US children. Assessment of time trends in dietary disparities due to ethnic and socioeconomic group membership may help us to understand whether diet may be a contributor to persistence or increase of health disparities among US children. Therefore, the overall objectives of this application are to examine in US children and adolescents: 1) the independent associations of race/ethnicity and measures of socioeconomic position (family income, education, and occupation) with attributes of reported diets and objective biomarkers of dietary intake, and 2) the trends in the association of race/ethnicity and socioeconomic position with diet quality from 1971 to 2006. We will use nationally representative data for 2-19 year olds (n= 39,607) from the National Health and Nutrition Examination Surveys (NHANES) conducted in1971-74, 1976-1980, 1982-1984 (Hispanic HANES), 1988-1994, an 2001-2006, to address these issues. PUBLIC HEALTH RELEVANCE: The importance of dietary factors in improving health outcomes is underscored by the fact that dietary factors are amenable to intervention, and diet is universally consumed and even a small relative risk may have a considerable public health impact. Assessment of time trends in ethnic and socio- economic differentials in diet quality will therefore help in determining the absolute as well as relative progress in closing the ethnic and socioeconomic gaps in health outcomes that is a stated goal of the national health promotion agenda. The results of this study will thus help in evaluating the effectiveness of past efforts to promote desirable behavior changes in these high risk populations, and design of newer strategies to target dietary attributes associated with ethnicity and socioeconomic position.