The Impacts of Early Neighborhoods on Racial Disparities in Adult Health Outcomes

 描述（由申请人提供）：我们已经了解到，成人健康结果的种族差异受到一生中暴露和经历的影响。早期生活中的暴露和经历1）影响后来的健康结果2）随着时间的推移而积累，3）因种族而异。生命历程研究主要集中在儿童时期家庭环境的具体方面，这些方面表明儿童时期暴露对成人健康的"长臂"。与此同时，人们认识到，邻里环境可能会导致种族差异的健康在整个生命过程中。研究表明，童年邻里环境与儿童健康相关，成年邻里环境与成人健康相关。然而，这些主要的横断面研究表明，邻里环境和健康之间不存在或只有适度的关联。值得注意的是，很少有研究探讨儿童时期的邻里环境如何影响成人健康的种族差异，或者儿童时期邻里环境中的种族差异如何导致成人健康的种族差异。 由于无法获得适当的纵向数据和方法上的限制，以前的工作受到了阻碍。 该项目通过使用两个互补的纵向数据集和新方法来研究儿童时期背景暴露对成人健康结果中种族差异的长期影响，从而扩展了先前的研究。我们有两个具体目标：（1）计算所有儿童背景因素对成年健康结果中黑人/白色差异的合理总体影响的上限估计值。借用教育研究中使用的经济和人口统计学方法，我们研究了地理上接近和地理上遥远的个体之间的相关性，以评估儿童背景因素的总体影响成年心血管，代谢，精神和自我评价状态健康结果的程度，并按种族组比较这些相关性。(2)估计儿童时期长期暴露于社区不利条件对成年健康结果中黑人/白色种族差异的贡献。虽然目标1确立了儿童期背景对各种成人健康结果的影响的合理上限，但它没有涉及接触的持续时间，并且对相关接触的具体性质仍然不可知。目标2扩展了目标1，使用了近二十年来邻里接触的信息，并使用新的生物统计方法来研究整个生命过程中邻里劣势对成年人健康种族差异的影响。其目的是研究儿童时期的种族差异的贡献，累积邻里不利的种族差异，在成年后的健康，并探讨是否累积邻里不利的影响不同的黑人和白色个人。 我们的分析允许明确的比较早期的背景效应跨健康领域，问哪些领域的种族健康差异出现最多或最少的影响儿童累积的背景因素。

 DESCRIPTION (provided by applicant): We have come to understand that racial disparities in adult health outcomes are affected by exposures and experiences over the life span. Early life exposures and experiences 1) affect later health outcomes 2) accumulate over time and 3) vary tremendously by racial group. Life course research has focused primarily on specific aspects of childhood family contexts that demonstrate the "long arm" of childhood exposures on adult health. Meanwhile, there is recognition that neighborhood context may contribute to racial disparities in health over the life course. Studies demonstrate that childhood neighborhood context is associated with child health, and adulthood neighborhood context is associated with adult health. However, these primarily cross-sectional studies demonstrate nonexistent or only modest associations between neighborhood context and health. Notably, few studies examine how neighborhood context in childhood affects racial disparities in adult health, or how racial disparities in childhood neighborhood context may contribute to racial disparities in adult health. Previous work has been hampered by lack of access to appropriate longitudinal data, and methodological limitations. This project extends prior research by using two complementary longitudinal datasets and novel methods to examine the long reach of contextual exposures in childhood on racial disparities in adult health outcomes. We have two specific aims: (1) Calculate upper bound estimates of the plausible total impact of all childhood contextual factors on black/white disparities in adult health outcomes. Borrowing economic and demographic methods used in educational research, we examine correlations between geographically close and geographically distant individuals to evaluate the extent to which the totality of childhood contextual factors affect adult cardiovascular, metabolic, mental, and self-rated status health outcomes and compare these correlations by racial group. (2) Estimate the contribution of long-term exposure to neighborhood disadvantage during childhood on black/white racial disparities in adult health outcomes. While Aim 1 establishes plausible upper bounds for childhood contextual effects on a variety of adult health outcomes, it does not address duration of exposure and remains agnostic about the specific nature of relevant exposures. Aim 2 extends Aim 1 by using information on neighborhood exposures over time-up to two decades--and using new bio statistical methods to examine the effects of cumulative neighborhood disadvantage across the life course on racial disparities in adult health. The aim both examines the contribution of racial disparities in childhood cumulative neighborhood disadvantage on racial disparities in adult health and examines whether the impacts of cumulative neighborhood disadvantage differ between black and white individuals. Our analyses allow explicit comparisons of earlier contextual effects across health domains to ask which domains of racial health disparities appear most or least affected by childhood cumulative contextual factors.