Physiology of Coping in Rural Low-income Preadolescents: An Experimental Approach

描述(由申请人提供)：由社会经济不平等和贫困引起的身心健康差距有很好的记录(Evans，Wolf&Adler，2012)。有明确的证据表明：(A)终生疾病和过早死亡的基础是在童年时期奠定的(例如，Chen和Miller，2012)，以及(B)生理应激反应的损害和放松管制是贫困和经济不平等对疾病和疾病影响的最有力的机制之一(例如，Evans&Kim，2012)。为了帮助解决健康差距，我们需要干预措施，影响导致这种风险的生理系统。由于应激反应系统(下丘脑-垂体-肾上腺轴/HPA和交感-肾上腺髓质/SAM)是基于SES的差异的中心机制，这些系统是靶向的关键系统。提高儿童应对压力和调节反应的能力有可能打破损害的循环，但前提是我们针对的应对策略和调控过程在生理层面产生效果--我们的初步研究结果表明它们是有效的。拟议的项目旨在牢固地建立这种联系。青春期前是儿童认识压力及其原因的能力成熟的关键时期，应对压力的能力在规模和复杂性上都有所增长。因此，青春期前儿童正处于成熟阶段，既可以向我们提出基本的科学问题，也可以从未来基于应对的预防中受益。我们的团队汇编了关于面临贫困相关压力的儿童和青少年所使用的有效和无效应对方式的基本认识(例如，圣地亚哥，Wadsworth等人，2011年；Wadsworth&Compas，2002；Wadsworth&Santiago，2008,2009)，我们发现，生活在贫困相关压力下会限制有效应对的发展和/或利用有效应对的能力(圣地亚哥，埃特等人，2011年；Wadsworth等人，2011年)。我们还不知道在行为水平上有效的应对方式是否会对贫困的农村青少年的潜在生理应激反应系统产生伴随影响。目前的项目将使用一种实验方法和来自多个层次的分析数据，包括HPA和SAM活动的测量，体内应对的观察编码，以及应对的实验操作：(A)比较低收入学龄前青少年中随机分配的体内有效(次级控制)和无效(脱离)应对的生理下调，(B)检查青春期前儿童的典型应对策略如何调节他们的能力，要么利用二级控制策略，要么在准备好回避的情况下进行自我调节，(C)确定具有不同反应和调节特征的青春期前儿童亚组，以及(D)检查所确定的亚组的个人和家庭特征，包括谁在每种情况下更成功和更不成功-潜在地确定特定于个人的干预目标。发现预防和/或阻止这种对儿童压力反应系统的损害的方法可以为消除健康差距提供新的方向。

DESCRIPTION (provided by applicant): Physical and mental health disparities stemming from socioeconomic inequality and poverty are well documented (Evans, Wolf & Adler, 2012). There is clear evidence that (a) the groundwork for lifelong disease and premature death is laid during childhood (e.g., Chen & Miller, 2012), and (b) damage to and deregulation of the physiologic stress response is one of the most powerful mechanisms of the effects of poverty and economic inequality on illness and disease (e.g., Evans & Kim, 2012). To contribute solutions to health disparities, we need interventions that affect the physiologic systems that confer the risk. Since the stress response systems (hypothalamic-pituitary-adrenal axis/HPA and sympathetic-adrenomedullary/SAM) are a central mechanism for SES-based disparities, these are critical systems to target. Improving children's ability to cope with stress and regulate their reactivity has the potential to break the cycle of damage, but only if the coping strategies and regulatory processes that we target have effects at the physiologic level-we have preliminary findings suggesting that they do. The proposed project seeks to firmly establish this connection. Preadolescence is a crucial time during which children's ability to recognize stress and its causes matures, and repertoires for coping with stress grow in both size and complexity. Preadolescents are, therefore, at a ripe stage to both inform our basic science questions and benefit from future coping-based prevention. Our team has compiled a basic understanding of the efficacious and inefficacious forms of coping used by children and adolescents exposed to poverty-related stress (e.g., Santiago, Wadsworth et al., 2011; Wadsworth & Compas, 2002; Wadsworth & Santiago, 2008, 2009), and we have discovered that living with poverty-related stress constrains the development of and/or ability to utilize efficacious coping (Santiago, Etter et al., 2011; Wadsworth et al., 2011). We do not yet know whether coping that is efficacious at the behavioral level has concomitant effects on the underlying physiologic stress response systems in poor, rural preadolescents. The current project will use an experimental approach and data from multiple levels of analysis, including measures of both HPA and SAM activity, observational coding of in vivo coping, and experimental manipulation of coping to: (a) compare the physiologic downregulation of randomly assigned in vivo efficacious (secondary control) and ineffective (disengagement) coping in low-income preadolescents, (b) examine how preadolescents' typical strategies for coping moderate their ability to either make use of secondary control strategies or to regulate themselves despite being primed for avoidance, (c) identify subgroups of preadolescents with different reactivity and regulation profiles, and (d) examine the individual and family characteristics of the identified subgroups, including who is more and less successful in each condition-potentially identifying person-specific intervention targets. Discovery of ways to prevent and/or halt this progression of damage to a child's stress response system can offer new directions for combatting health disparities.