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，成人健康结果中的种族差异受到一生中暴露和经历的影响。早期的生活接触和经历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家庭环境的特定方面，这些方面表明儿童时期的暴露对成人健康有很大影响。与此同时，人们认识到，在生活过程中，邻里环境可能会导致健康方面的种族差异。研究表明，儿童时期的邻里关系与儿童健康有关，成年后的邻里关系与成人健康相关。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是适度的关联。值得注意的是，很少有研究研究儿童时期的邻里环境如何影响成人健康中的种族差异，或者童年邻里环境中的种族差异如何可能导致成人健康中的种族差异。 以前的工作由于无法获得适当的纵向数据和方法限制而受到阻碍。该项目通过使用两个互补的纵向数据集和新的方法来扩展先前的研究，以检查儿童时期背景暴露对成人健康结果中的种族差异的长期影响。我们有两个具体目标：(1)计算所有童年背景因素对成人健康结果中黑人/白人差异的合理总影响的上限估计。借用教育研究中使用的经济学和人口学方法，我们检验了地理上接近和地理上相距遥远的个体之间的相关性，以评估童年背景因素总体上对成人心血管、代谢、心理和自我评估健康结果的影响程度，并按种族组比较这些相关性。(2)估计儿童时期长期暴露于邻里劣势环境对成人健康结局中黑人/白人种族差异的贡献。虽然目标1确定了儿童背景对各种成人健康结果的影响的合理上限，但它没有涉及暴露的持续时间，并且仍然不知道相关暴露的具体性质。目标2通过使用长达20年的邻里接触信息来扩展目标1，并使用新的生物统计学方法来检查整个生命周期中累积的邻里劣势对成人健康中的种族差异的影响。其目的既考察了儿童累积邻里劣势的种族差异对成人健康的种族差异的贡献，也考察了黑人和白人个体之间累积邻里劣势的影响是否不同。我们的分析允许对健康领域的早期背景影响进行明确比较，以询问种族健康差异的哪些领域受儿童累积背景因素的影响最大或最小。

 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.