The Study of Multiple Social Determinants of Young Children's Health

描述（由申请人提供）：该项目的目标是测试风险和弹性路径连接健康和儿童特征的社会决定因素幼儿的健康。我们将研究健康的四个社会决定因素的作用（即，社会地位、种族主义、隔离和促进/抑制环境）和儿童特征（即，创伤暴露、年龄、性别、气质）对健康的影响（即，社会、情感和认知发展以及身体健康）。我们将实现两个具体目标。目标1：测试健康和儿童特征的社会决定因素与儿童健康的关联程度。我们假设健康的社会决定因素将对幼儿的健康产生直接和间接的影响。目的2：检验儿童特征对儿童健康的具体中介路径和调节作用。我们假设（1）儿童暴露于创伤性事件的水平将介导健康的社会决定因素与儿童健康之间的关系;（2）：特别是与家庭暴力或亲密伴侣暴力有关的创伤性事件，将作为健康和儿童健康的社会决定因素之间关系的关键中介，以及（3）儿童的年龄，性别，和气质，将缓和健康的社会决定因素对儿童健康的影响。为了验证这些假设，我们将进行一项横断面研究，在这项研究中，我们将收集400名3至5岁的种族/少数民族和/或低收入儿童的数据，这些儿童参加位于服务不足的城市社区的幼儿保育和教育机构。儿童将完成发展评估，其照顾者及其幼儿保育和教育教师将报告儿童的健康情况（即，社会、情感和认知发展以及身体健康）。我们还将使用地理空间信息系统来获得居住隔离和促进和抑制环境的变量。这项研究将通过我们的大学研究人员团队与一家非营利性扶贫机构运营的13个幼儿保育和教育机构的代表合作进行。公共卫生相关性：该项目将：（1）帮助我们更好地了解健康的多种社会决定因素和儿童特征对幼儿健康的作用;（2）帮助我们了解哪些儿童健康状况不佳的风险最高;（3）为制定和评估儿童生态多个层面的文化适当战略提供信息，以促进健康。该项目支持美国国立卫生研究院的使命，即开展科学研究，以延长健康寿命，减少疾病和残疾的负担。它将通过促进创新的研究策略及其应用来推进NIH的使命，并寻求为最有可能出现不良健康结果的社区（地理位置、文化群体和幼儿）这样做。其广泛的长期目标是在儿童生态的多个层面制定一系列战略，以消除健康差距。这项补助金申请提出了一个创新模式，以加快未来的科学进步，审查健康的多种社会决定因素对幼儿健康的影响。该项目将：（1）帮助我们更好地了解健康和儿童特征的多种社会决定因素对幼儿健康的作用;（2）帮助我们了解哪些儿童最有可能健康状况不佳;（3）为在儿童生态的多个层面制定和评估文化上适当的战略提供信息，以促进健康。

DESCRIPTION (provided by applicant): The goal of this project is to test risk and resiliency pathways linking social determinants of health and child characteristics to young children's health. We will examine the role of four social determinants of health (i.e., social position, racism, segregation, and promoting/inhibiting environments) and child characteristics (i.e., trauma exposure, age, gender, temperament) on the health (i.e., social, emotional, and cognitive development and physical health) of racial/ethnic minority and/or low socioeconomic status children aged 3 through 5 years. We will carry out two specific aims. Aim 1: To test the extent to which social determinants of health and child characteristics are associated with children's health. We hypothesize that social determinants of health will have a direct and an indirect effect on young children's health. Aim 2: To test specific mediating paths and moderating effects of child characteristics on children's health. We hypothesize that (1) children's level of exposure to traumatic events will mediate the relationship between social determinants of health and children's health; (2): traumatic events related to family violence or intimate partner violence, in particular, will function as critical mediators of the relationship between the social determinants of health and children's health, and (3) child characteristics of age, gender, and temperament, will moderate the effects of social determinants of health on children's health. To test these hypotheses, we will conduct a cross sectional study in which we will collect data from a community-based sample of 400 racial/ethnic minority and/or low income children aged 3 through 5 years attending early childhood care and education settings located in an underserved urban community. Children will complete developmental assessments and their caregivers and their early childhood care and education teachers will report on children's health (i.e., social, emotional, and cognitive development and physical health). We will also use geospatial information systems to derive variables of residential segregation and promoting and inhibiting environments. The study will be conducted through collaboration between our team of university-based researchers and representatives of 13 early childhood care and education settings operated by a non-profit anti-poverty agency. PUBLIC HEALTH RELEVANCE: This project will: (1) help us to better understand the role of multiple social determinants of health and child characteristics on the health of young children; (2) help us to understand which children are at the highest risk for poor health status; and (3) inform the development and evaluation of culturally appropriate strategies at multiple levels of children's ecology to promote health. The project supports NIH's mission to conduct science to extend healthy life and reduce the burdens of illness and disability. It will further NIH's mission by fostering innovative research strategies and their application and seeks to do so for communities (geographic location, cultural groups, and young children) most at risk for poor health outcomes. The broad long-term objective is to inform a range of strategies at multiple levels of children's ecology to combat health disparities. This grant application proposes an innovative model to accelerate future scientific progress regarding the examination of multiple social determinants of health on young children's health. This project will: (1) help us to better understand the role of multiple social determinants of health and child characteristics on the health of young children; (2) help us to understand which children are at the highest risk for poor health status; and (3) inform the development and evaluation of culturally appropriate strategies at multiple levels of children's ecology to promote health.