A Novel Approach to Disentangling the Relationship Between Neighborhood Environment, Adverse Childhood Experiences, and Childhood Obesity

摘要 肥胖 人口 在……上面 环境保护 肥胖 影响着270万美国儿童。来自少数民族和低收入家庭的儿童 肥胖率更高，导致了健康差距。专注于减肥努力 个人健康行为改变取得的成功有限，导致人们呼吁审查社会和 导致肥胖的因素。更好地了解儿童的复杂危险因素 可以为有针对性的干预、临床实践和政策提供信息。 1 不利的童年经历 血管紧张素转换酶(ACE)是儿童肥胖的一个未被研究的复杂危险因素。A级是创伤性的经历 儿童时期发生的性虐待、家庭成员监禁或目睹暴力犯罪等事件。 几乎一半的儿童经历过ACEs，ACEs患者的肥胖率更高。 ACE可以通过慢性或严重压力的后遗症或通过阻碍健康行为来增加肥胖风险， 尽管ACEs对儿童肥胖的影响还不是很清楚。多层次的研究考察 社区环境对ACES-肥胖关系的影响尤其缺乏。 社区因素，如无法获得医疗保健和高犯罪率，可能会导致ACES和 通过间接的和重叠的途径肥胖。很难理清邻里因素的影响 因为许多同时发生在社区贫困和种族隔离的更广泛的背景下； 复杂的方法，如地理空间分析、纵向研究和新方法 量化社区风险是必要的。这项研究将是第一次考察两者之间的关系 使用先进的统计方法研究邻里环境、ACE和儿童肥胖症之间的关系。 目标1a和1b需要使用现有的多级别开发和测试邻居ACES索引 地理空间数据。目标2需要检查邻居ACES指数和童年之间的关系 使用现有的纵向数据计算肥胖率。目标3需要确定最多的邻里因素 与ACE暴露和儿童肥胖有关，以确定潜在的干预目标， 临床实践和政策。这项研究有可能为有针对性地努力改善 数百万患有A级和肥胖症的儿童的健康。相关的职业发展 PLAN侧重于ACE、高级统计和地理空间分析。该计划将提高我使用 不同的、多层次的地理空间数据用于检查复杂的儿童肥胖风险因素--这是一项罕见的技能 护士科学家之间，但与我关于健康的社会决定因素如何影响的研究直接相关 肥胖。该计划包括专家指导、重点课程和首届NICHD P50的培训 虐待儿童研究翻译中心。总的来说，这项研究将促进对以下方面的了解 ACEs对儿童肥胖的影响，同时推动了我的职业目标，即建立一个 了解和减少儿童肥胖症差异的研究计划。

ABSTRACT Obesity populations on environmental obesity impacts 2.7 million American children. Children from racial/ethnic minority and low-income have higher obesity prevalence, contributing to health disparities. Obesity reduction efforts focused individual health behavior change have seen limited success, resulting in calls to examine social and factors that contribute to obesity. A better understanding of complex risk factors for childhood can inform targeted interventions, clinical practice, and policy. 1 Adverse childhood experiences (ACEs) are one understudied complex risk factor for childhood obesity. ACEs are traumatic experiences that occur during childhood such as sexual abuse, family member incarceration, or witnessing violent crime. Almost half of children have experienced ACEs and populations with ACEs have higher obesity prevalence. ACEs can increase obesity risk via sequelae of chronic or severe stress or by hindering healthy behaviors, though the impact of ACEs on childhood obesity is not well understood. Multi-level research examining the influence of neighborhood environment on the ACEs-obesity relationships is particularly lacking. Neighborhood factors such as lack of access to healthcare and high crime may contribute to both ACEs and obesity via indirect and overlapping pathways. It is difficult to disentangle the impact of neighborhood factors because many co-occur within the broader context of neighborhood poverty and racial segregation; sophisticated approaches such as geospatial analysis, longitudinal research, and novel methods for quantifying neighborhood risk are necessary. This study will be the first to examine the relationship between neighborhood environment, ACEs, and childhood obesity using advanced statistical methods. Aims 1a and 1b entail development and testing of a neighborhood ACEs index using existing multi-level geospatial data. Aim 2 entails examining the relationship between the neighborhood ACEs index and childhood obesity incidence using existing longitudinal data. Aim 3 entails determining neighborhood factors most associated with ACEs exposure and childhood obesity in order to identify potential targets for intervention, clinical practice, and policy. This study has the potential to inform targeted efforts for improving the health of millions of children who experience ACEs and obesity. The associated Career Development Plan focuses on ACEs, advanced statistics, and geospatial analysis. The Plan will advance my ability to use diverse, multi-level, geospatial data to examine complex childhood obesity risk factors - a skillset rare among nurse scientists but directly relevant to my research on how social determinants of health impact obesity. The Plan includes expert mentorship, focused coursework, and training at the inaugural NICHD P50 Translational Center for Child Maltreatment Studies. Collectively, this study will advance knowledge about the impact of ACEs on childhood obesity and simultaneously further my career goal to establish a program of research on understanding and reducing childhood obesity disparities.