The Maternal Life Course Origins of Infant Health

描述(由申请人提供)：几十年来，早产和低出生体重方面持续的种族、民族和社会经济差异已被广泛记录，对个人的终身健康、社会和经济福祉具有重要影响。我们仍然知之甚少 关于为什么这些差异持续存在，但最近一些学科的研究热潮旨在了解其中的一些机制。我的研究将是第一个探索怀孕前生命周期并从女性早期生活经历中识别怀孕前风险因素的研究之一。我的研究结果对于通过瞄准怀孕前的风险因素来减少早产和低出生体重的差异将是重要的。我过去和现在的研究广泛地考察了童年经历如何影响成年后女性的健康和社会结果。我的论文主题与当前的应用密切相关，因为它利用生命过程理论来理解为什么已婚女性比单身和同居女性早产的风险更低，出生体重更低。这项工作对生命过程(包括代际和代内--通过童年、青春期和产前邻里环境)产生了新的见解，这些过程使一些妇女面临更大的婴儿健康不良风险。但严重的种族-民族差距依然存在，为当前提案的发展铺平了道路。到目前为止，我过去的培训、指导和研究经验来自社会学和人口学，使我掌握了理论和方法方面的技能，以及解释原籍家庭对健康影响的社会机制的知识库。这启动了我的长期职业研究计划，该计划将研究这些社会过程--跨越童年、青春期和产前的先入为主的生命过程--如何与应激反应的生物或生理标志相互交织，直接影响婴儿的健康。我假设，这将为人口水平的婴儿健康差距提供新的线索，这些差距因社会阶层和种族而高度分层。然而，到目前为止，我的培训和研究仅集中在社交方面；K99/R00将使我能够集成直接影响早产或小于胎龄的生物机制。我寻求K99/R00独立之路奖，以获得更多的培训和指导，将我对家庭和健康的社会学研究扩展到对家庭和健康的多学科理解。为此，我需要：(1)在婴儿健康差距的病因方面进行流行病学/公共卫生培训和辅导 (2)关于衡量家庭和邻里环境压力的多学科培训和指导。随后将有严格的培训计划，包括：正式培训(参加NICHD资助的生殖、围产期和儿科流行病学培训计划，围产期流行病学的正式课程，参加关于首屈一指的方法学策略的研讨会-非等级交叉分类多重成员模型，以及参加关于贝叶斯分析的研讨会)，实践研究经验和合作(由社会人口学家和Add Health PI Kathen Mullan Harris博士指导，以了解社会环境如何产生压力，影响妇女的婴儿健康结果，以及生物标记物如何代表这种压力引起的生理失调的指标)，在流行病学家Anna Maria Siega-Riz博士的指导下，获得从流行病学角度概念化和测量压力反应的知识和技能，与顾问Nancy Reichman博士和Julien Teitler博士合作，从临床和公共卫生角度了解婴儿健康的病因学，并参加由导师Paul Voss博士领导的工作组)，以及传播项目结果(在流行病学、社会学和人口学会议上发表和展示研究结果)。通过将我在社会学方面的主要专业知识与我将从该奖项中获得的新的流行病学、生物医学和统计学知识相结合，我将获得一种共同语言，以便与不同学科的婴儿健康学者交流我的发现并与其合作。我将利用这一培训来产生关于社会环境(家庭和社区)如何与生物系统相互作用以影响婴儿健康的未来假设，并在这样做的过程中，推进一个关于家庭和健康的跨学科研究计划。该奖项允许提供实现这些目标所需的培训、指导和受保护的研究时间。北卡罗来纳大学是追求这些目标的理想研究环境。CPC是一流的人口中心，在地理空间分析和生命历程研究方面处于领先地位；吉林斯全球公共卫生学院是全国排名第二的公共卫生学院。

DESCRIPTION (provided by applicant): Persistent race, ethnic, and socioeconomic disparities in preterm birth and low birth weight have been widely documented for decades, with important consequences for individual's lifelong health, social, and economic wellbeing. We still know little about why these disparities persist, but a recent surge of research across a number of disciplines aims to understand some of the mechanisms. My research will be one of the first to explore the pre-conception life course period and identify pre-conception risk factors from women's early life experiences. Findings from my research will be important for reducing preterm and low birth weight disparities by targeting pre-conception risk factors. My past and present research broadly examines how experiences in childhood affect women's health and social outcomes in adulthood. My dissertation topic is closely related to the present application as it leveraged life course theory to understand why married women are at lower risk of preterm birth and low birth weight relative to single and cohabiting women. This work produced new insights into life course processes (both inter-generational and intra-generational-through childhood, adolescence, and prenatal neighborhood environments) that put some women at greater risk of poor infant health. But strong racial-ethnic disparities remained, paving the way for the development of the current proposal. Thus far, my past training, mentoring, and research experience have drawn from sociology and demography to equip me with skills in theory and methods, and a knowledge base of the social mechanisms explaining effects of families-of-origin on health. This has set in motion my long-term career research program, which will examine how these social processes-across the preconception life course in childhood, adolescence, and the prenatal period-intersect with biologic or physiologic markers of stress reactivity to directly impact infant health. I hypothesize that this will shed new light on population-level infant health disparities that are highly stratified by social class and race-ethnicity. Thus far however, my training and research have focused solely on the social side; the K99/R00 will enable me to integrate biologic mechanisms that directly affect preterm birth or small-for-gestational age. I seek this K99/R00 Pathway to Independence Award to gain additional training and mentoring to expand my sociological study of families and health to a multi-disciplinary understanding of families and health. To do so, I need: (1) epidemiologic/public health training and mentoring in the etiology of infant health disparities and (2) multidisciplinary training and mentoring on the measurement of stress in the family and neighborhood environment. A rigorous training program will ensue including: formal training (participation in the NICHD-funded Reproductive, Perinatal, and Pediatric Epidemiology training program, formal coursework in perinatal epidemiology, attending a workshop on a premiere methodological strategy-non-hierarchical cross-classified multiple membership models, and attending a workshop on Bayesian analysis), hands-on research experience and collaboration (mentorship by social demographer and Add Health PI Dr. Kathleen Mullan Harris to learn how the social environment produces stress that bears on women's infant health outcomes and how biomarkers represent indicators of physiological disregulation due to this stress, mentorship by epidemiologist Dr. Anna Maria Siega-Riz to gain knowledge and skills in conceptualizing and measuring the stress response from an epidemiological perspective, collaboration with consultants Dr. Nancy Reichman and Dr. Julien Teitler to understand the etiology of infant health from clinical and public health perspectives, and participation in a working group led by mentor Dr. Paul Voss), and experience disseminating project findings (publishing and presenting findings at epidemiology, sociology, and demography conferences). By merging my primary expertise in sociology with new epidemiological, biomedical, and statistical knowledge that I will gain from this award, I will acquire a common language to communicate my findings to, and collaborate with, infant health scholars across disciplines. I will use this training to generate future hypotheses about how social environments (of the family and neighborhood) interact with biological systems to affect infant health, and in doing so, advance a cross-disciplinary research program on families and health. This award allows for training, mentoring, and protected research time necessary to achieve these goals. UNC is an ideal research environment to pursue these goals. CPC is a premiere population center and a leader in geospatial analyses and life course research; the Gillings School of Global Public Health is the #2 ranked school of public health in the country.