Community violence and disparities in maternal and infant health: effects and mechanisms

项目摘要 改善对围产期健康差距的社区水平决定因素的了解是 国家卫生机构。社区暴力可能会导致不良的孕产妇和婴儿结局，并可能 有助于解释按种族/族裔和外国出生身份划分的围产期健康差异。然而， 研究受到横断面设计和方法的严重阻碍，无法理清 社区暴力对其他高度相关的健康决定因素的影响。因此，迫切需要 进行严谨的研究，以确定社区暴力的不同方面的影响，两者总体上都是可以预测的 水平和意想不到的剧烈变化，并确定潜在的心理、行为和生物 有助于母婴健康和差异的作用机制。这样做的总体目标是 应用是检验中心假设，即社区暴力增加了 孕产妇和婴儿的健康结果，以及潜在的可改变的心理(心理健康、社会健康 支持)、行为(物质使用)和生物(产妇感染和疾病)机制是基础 这些影响。这一假设得到了初步分析的支持，即发现特定于三个月的暴力与 到早产，在非裔美国人中影响最大。中心假设将是 使用数据自适应准实验匹配和固定效应方法和丰富的协变量集进行处理 准确确定社区暴力对母婴健康的影响。分析将是 对600多万名母亲和婴儿进行了调查，这些数据来自加利福尼亚州(2005-2017)的全州数据和调查- 基于对这些母亲和婴儿中超过72,000名具有代表性的样本的数据。拟议的研究将 解决以下具体目标：(1)量化社区暴力的急剧变化对产妇的影响 和婴儿健康差异，以及解释这些影响的心理、行为和生物机制； (2)确定社区暴力总体水平对母婴健康差距的影响， 以及这些影响背后的心理、行为和生物机制。这项工作在(A)方面具有创新性 区分暴力总体水平的影响和暴力的剧烈变化，(B)审查潜在的 可修改的机制；(C)估计潜在的暴力干预措施对人口的影响 调解人。预计这项研究将增加对暴力和暴力影响的科学理解 它在形成健康差距方面的作用。此外，这项工作有望确定解释以下问题的机制 暴力对母婴健康的影响，揭示了为什么会出现拉丁裔等种族/民族群体 需要受到保护，并可能提出其他干预点。总而言之，这些发现是 预计将产生重要的积极影响，因为它们将把暴力重新定义为影响健康和 广泛的种族/族裔差距，从而促使采取干预措施减少暴力并减轻其影响 下游效应，这将增强健康，缩小美国的健康差距。

Project Summary Improved understanding of community level determinants of perinatal health disparities is a research priority for national health agencies. Community violence may contribute to adverse maternal and infant outcomes and may be instrumental in explaining disparities in perinatal health by race/ethnicity and foreign-born status. However, research has been substantially hampered by cross-sectional designs and methods that cannot disentangle the effects of community violence from other highly correlated determinants of health. Thus, there is a critical need for rigorous research to determine the effects of different aspects of community violence, both predictable overall levels and unexpected acute changes, and to identify underlying psychological, behavioral and biological mechanisms of effect that contribute to maternal and infant health and disparities. The overall objective of this application is to test the central hypothesis that community violence increases the burden of and disparities in maternal and infant health outcomes, and that potentially modifiable psychological (mental health, social support), behavioral (substance use) and biological (maternal infections and conditions) mechanisms underlie these effects. This hypothesis is supported by preliminary analyses that find trimester-specific violence is related to preterm delivery, with the strongest effects among African Americans. The central hypothesis will be addressed using data-adaptive quasi-experimental matching and fixed-effects methods and a rich covariate set to accurately determine the effects of community violence on maternal and infant health. Analyses will be conducted with over 6 million mothers and infants from statewide data on California (2005-2017) and survey- based data on a representative sample of over 72,000 of these mothers and infants. The proposed research will address the following specific aims: (1) Quantify the impacts of acute changes in community violence on maternal and infant health disparities, and psychological, behavioral and biological mechanisms that explain the impacts; (2) Determine the effects of the overall levels of community violence on maternal and infant health disparities, and psychological, behavioral and biological mechanisms that underlie the effects. The work is innovative in (a) distinguishing effects of overall levels of violence from acute changes in violence, (b) examining potentially modifiable mechanisms, and (c) estimating population effects of potential interventions on violence and the mediators. The research is expected to increase scientific understanding of the broader impacts of violence and its role in shaping health disparities. In addition, this work is expected to identify the mechanisms that explain the effects of violence on maternal and infant health, uncovering why racial/ethnic groups such as Latinas appear to be protected, and potentially suggesting alternative points for intervention. Together, these findings are expected to have an important positive impact because they will reframe violence as affecting health and racial/ethnic disparities broadly and thereby motivate interventions to reduce violence and mitigate its downstream effects, which will enhance health and reduce health disparities in the US.