Investigation of a new sequential multiple hit model to examine risk and resilience in a prospective longitudinal cohort of children in Ghana

项目摘要 据估计，低收入和中等收入国家有2.5亿五岁以下儿童 由于贫困，他们在认知和社会情感发展方面可能无法发挥潜力， 相关风险因素。该提案的长期目标是为循证方案和政策提供信息， 支持低收入社区的儿童充分成长和发展。虽然许多研究 发展科学中的风险和恢复力集中在单一或少数风险和保护性 由于各种因素和时间点，发展是一个动态的系统，儿童经常与各种星座竞争， 风险可能会随着时间的推移而变化，并相互作用，而不是孤立的不利情况 情节研究这些关于风险和保护的时间和相互作用问题的挑战 预测发展结果的因素是所需的大样本量和高成本和人力 收集纵向数据所需的资源投资。本建议书旨在对以下内容进行二次分析： 在妊娠期、婴儿期和儿童期收集的现有数据，来自国际 加纳2009-2012年妊娠≤ 20周的脂质营养补充剂项目（n=1320）。的 数据集包含30多个生物风险指标（如低出生体重，早产， 生长发育迟缓和贫血）和心理社会风险（如母亲抑郁和缺乏学习 家庭环境中的机会）和多层次的保护因素（包括儿童、家庭和学校） 妊娠期、出生时、婴儿期（18个月; n=1173）和幼儿园年龄（4-6岁; n=966）。一个 目前正在2020-2021年对8-10岁儿童进行额外的后续评估。这个有钱的， 纵向数据集将被用来研究一个新的风险和弹性的连续多次打击模型， 它扩展了临床研究中使用的多击模型，以解释癌症等疾病的病因 和老年痴呆症根据一个多重打击模型，早期的无打击体验可以保护儿童免受 不良后果与后来的打击，而相反，早期打击导致儿童更多 很容易受到后续攻击将这个模型应用于风险和弹性，我们将打击概念化为高度暴露于 在特定时间点的生物或心理社会风险。这导致了这样的假设：早期低风险经历 将保护儿童免受与后来的风险暴露相关的不良后果。也就是说， 早期暴露于更大程度的风险，而早期风险暴露较低的人， 会在以后的风险暴露和结果之间找到。进一步了解时间的动态 这种接触的相互作用是设计针对风险预防的干预措施的重要第一步， 以及促进保护性因素，在它们最有可能显示积极影响的时候， 儿童成果。

Project Summary An estimated 250 million children under five years of age in low- and middle-income countries (LMICs) are at risk of failing to reach their potential in cognitive and social-emotional development because of poverty- related risk factors. The long-term goal of this proposal is to inform evidence-based programs and policies to support children in low-income communities to grow and develop to their full potential. While many studies of risk and resilience in developmental science have focused on singular or a small number of risk and protective factors and time points, development is a dynamic system, and children often contend with constellations of risks that can change over time and interact with each other, rather than isolated instances of adverse circumstances. Challenges for studying these questions about the timing and interactions of risk and protective factors predicting developmental outcomes are the large sample size required and the high cost and human resource investment necessary to collect longitudinal data. This proposal is to conduct secondary analysis of existing data collected during pregnancy, infancy, and childhood from the sample enrolled in the International Lipid-Based Nutrient Supplements Project in Ghana 2009-2012 at ≤ 20 weeks of gestation (n=1320). The dataset contains more than 30 indicators of biological risks (such as low birth weight, premature delivery, growth stunting, and anemia) and psychosocial risks (such as maternal depression and lack of learning opportunities in the home environment), and multilevel protective factors (including child, home and school) during pregnancy, at birth, in infancy (18 months; n=1173), and at kindergarten age (4-6 years; n=966). An additional follow-up assessment is currently being conducted in 2020-2021 at age 8-10 years. This rich, longitudinal dataset will be leveraged to investigate a new sequential multiple hit model of risk and resilience, which expands on multi-hit models used in clinical research to explain the etiology of diseases such as cancer and Alzheimer’s disease. According to a multi-hit model, an early hit-free experience protects children from adverse outcomes associated with later hits, while conversely an early hit causes children to be more susceptible to later hits. Applying this model to risk and resilience, we conceptualize a hit as high exposure to biological or psychosocial risks at a given time point. This leads to the hypothesis that early low risk experience will protect children from adverse outcomes associated with later risk exposures. That is, among children with early exposure to a greater magnitude of risks, versus those with low early risk exposure, stronger associations will be found between later risk exposure and outcomes. Further understanding of the dynamics of the timing and interaction of such exposures is an essential first step to design interventions targeting risk prevention, as well as promotion of protective factors, at the time points when they will most likely show positive impacts on child outcomes.