Leveraging a Natural Experiment to Estimate the Effects of School Racial Segregation on Cardiovascular Risk Factors among Youth and Young Adults

摘要 心血管疾病(CVD)风险因素对黑人成年人的影响不成比例，这些差异是 在生命过程的早期就很明显。遗传因素似乎不能解释这种差异，研究已经 日益牵连的社会经济风险因素。造成种族差异的最突出的风险因素 在心血管疾病中，受教育程度与吸烟、高血压和心血管疾病密切相关。 生命历程。然而，目前还不清楚学校教育的哪些方面最突出。一种可能的解释是种族 CVD的差距在于，黑人青年经常在种族高度隔离的学校上学。种族隔离被认为是 由于压力和歧视增加而与心血管疾病有关；社会规范和同龄人影响；以及 限制社会经济机会，减少晚年的收入和获得医疗保健的机会。还没有 尽管近年来学校隔离现象有所增加，但没有研究调查 近期学校隔离趋势对心血管疾病危险因素的影响。这项研究的目标是提供这一点 急需证据。特别是，我们利用了一种独特的自然实验，克服了 以前关于教育对心血管疾病影响的文献中的方法学挑战。自1990年以来，有许多 地方法院的裁决导致了全国各地学区的“种族隔离”。我们在全国范围内 关于这些法院判决的数据和校区层面的学校隔离措施以及CVD结果数据 来自对受影响青年的两项具有全国代表性的大型队列研究：国家纵向研究 青少年与成人健康(Add Health，N≈90,000)和收入动态小组研究(N≈8,000)。我们 采用工具变量分析的准实验技术，减少了典型的混杂 受未被观察到的个人和家庭特征等因素影响。在目标1中，我们的目标是估计短期- 学校隔离对心血管疾病危险因素的长期影响--包括吸烟、体育活动、肥胖和 心理健康--在年轻人还在上学的时候。在目标2中，我们将研究以下项目的长期影响 在接下来的几十年里的学校隔离，结果除了客观上包括目标1中的结果 测量的心血管生物标记物、糖尿病和高血压。我们还将进行探索性分析，以 确定可能的调解途径。在目标3中，我们将确定易受伤害的亚群，其发展 心血管疾病的危险因素因学校种族隔离的反应而不同。这将使未来的干预措施能够 为最脆弱的个人量身定做。我们将同时使用假设驱动和假设生成 统计技术，包括允许更复杂和更稳健的创新机器学习方法 子组标识。总体而言，这项研究的预期结果是为 学校种族隔离对心血管疾病危险因素的影响，有助于为基于学校的、临床和 社区干预，以减少心血管疾病中持续存在的和不公平的种族差距。

ABSTRACT Cardiovascular disease (CVD) risk factors disproportionately affect black adults, and these disparities are evident early in the life course. Genetic factors do not appear to explain this difference, and studies have increasingly implicated socioeconomic risk factors. Among the most prominent risk factors for racial disparities in CVD is educational attainment, which is strongly correlated with smoking, hypertension, and CVD over the life course. Yet it is unclear which aspects of schooling are most salient. One possible explanation for racial disparities in CVD is that black youth often attend highly racially segregated schools. Segregation is thought to be linked with CVD due to increased stress and discrimination; social norms and peer influence; and the constraining of socioeconomic opportunities that reduces income and healthcare access later in life. Yet despite the fact that school segregation has increased in recent years, there are no studies examining the effects of recent school segregation trends on CVD risk factors. The goal of this study is to provide this urgently needed evidence. In particular, we take advantage of a unique natural experiment, overcoming methodological challenges in the previous literature on the effects of education on CVD. Since 1990, numerous local court decisions have resulted in “resegregation” in school districts across the country. We link nationwide data on these court decisions and school district-level measures of school segregation with CVD outcome data from two large nationally representative U.S. cohort studies of affected youth: the National Longitudinal Study of Adolescent to Adult Health (Add Health, N≈90,000) and the Panel Study of Income Dynamics (N≈8,000). We employ the quasi-experimental technique of instrumental variables analysis, which reduces typical confounding by factors such as unobserved individual and family characteristics. In Aim 1, our goal is to estimate the short- term effects of school segregation on CVD risk factors—including smoking, physical activity, obesity, and mental health—among youth while they are still in school. In Aim 2, we will examine the long-term effects of school segregation in the decades that follow, with outcomes including those in Aim 1 in addition to objectively measured CVD biomarkers, diabetes, and hypertension. We will also undertake exploratory analyses to determine possible mediating pathways. In Aim 3, we will identify vulnerable subgroups whose development of CVD risk factors differs in response to school racial segregation. This will enable future interventions to be tailored to the most vulnerable individuals. We will employ both hypothesis-driven and hypothesis-generating statistical techniques, including innovative machine learning methods that allow for more complex and robust subgroup identification. Overall, the expected outcome of this research is to produce rigorous evidence on the effects of school racial segregation on CVD risk factors, helping to inform school-based, clinical, and community interventions to reduce persistent and inequitable racial disparities in CVD.