The Maternal Life Course Origins of Infant Health

描述（由申请人提供）：几十年来，早产和低出生体重的持续种族，民族和社会经济差异已被广泛记录，对个人的终身健康，社会和经济福祉产生重要影响。我们仍然知之甚少 关于为什么这些差异持续存在，但最近在许多学科的研究激增，旨在了解一些机制。我的研究将是第一个探索怀孕前的生命历程时期，并确定怀孕前的风险因素，从妇女的早期生活经验。我的研究结果将通过针对孕前风险因素来减少早产和低出生体重差异。 我过去和现在的研究广泛探讨了童年的经历如何影响女性成年后的健康和社会成果。我的论文主题与本申请密切相关，因为它利用生命历程理论来理解为什么已婚妇女相对于单身和同居妇女早产和低出生体重的风险较低。这项工作产生了新的见解生命历程过程（包括代际和代际内-通过童年，青春期和产前邻里环境），使一些妇女在婴儿健康状况不佳的风险更大。但是，严重的种族-民族差异仍然存在，为制定目前的提案铺平了道路。 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，使我具备理论和方法的技能，以及解释家庭对健康影响的社会机制的知识基础。这就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在儿童期、青春期和产前的孕前生活过程中如何与压力反应的生物或生理标志交叉，直接影响婴儿的健康。我假设，这将揭示人口水平的婴儿健康的差异，是高度分层的社会阶层和种族。然而，到目前为止，我的培训和研究只集中在社会方面; K99/R 00将使我能够整合直接影响早产或小于胎龄儿的生物学机制。 我寻求这个K99/R 00独立之路奖获得额外的培训和指导，以扩大我的家庭和健康的社会学研究家庭和健康的多学科理解。为此，我需要：（1）在婴儿健康差异的病因学方面进行流行病学/公共卫生培训和指导， (2)关于家庭和邻里环境压力测量的多学科培训和指导。一个严格的培训计划将随之而来，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，围产期流行病学正式课程，参加关于首要方法学策略-非分层交叉分类多成员模型的研讨会，并参加贝叶斯分析研讨会），实践研究经验和协作（由社会人口统计学家和Add Health PI博士Kathleen Mullan Harris指导，了解社会环境如何产生对妇女婴儿健康结果产生影响的压力，以及生物标志物如何代表由于这种压力导致的生理失调，流行病学家安娜玛丽亚·西格尔-里兹博士的指导，从流行病学的角度获得概念化和测量压力反应的知识和技能，与顾问南希·赖克曼博士和朱利安·泰特勒博士合作，从临床和公共卫生的角度了解婴儿健康的病因，并参加由导师保罗·沃斯博士领导的工作组），传播项目成果的经验（在流行病学、社会学和人口学会议上发表和介绍成果）。 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，我将获得一种共同的语言来与跨学科的婴儿健康学者交流我的研究结果并与他们合作。我将利用这种培训来产生未来的假设，关于社会环境（家庭和邻里）如何与生物系统相互作用，以影响婴儿的健康，并在这样做，推进家庭和健康的跨学科研究计划。该奖项允许实现这些目标所需的培训，指导和保护研究时间。这是一个理想的研究环境，以追求这些目标。CPC是首屈一指的人口中心，也是地理空间分析和生命历程研究的领导者; Gillings全球公共卫生学院是该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.