MENTORED CLINICAL SCIENTIST DEVELOPMENT AWARD

这一职业发展计划的总体目标是在罗切斯特大学医学院建立一个儿童肥胖流行病学的独立研究项目。在美国，超重和肥胖的流行率正在上升，特别是在社会经济地位较低的女性和种族/少数民族中。怀孕被描述为一种生活事件，在这一事件中，超重的体重可能会增加并随后保持下去。因此，研究和培训活动将集中于确定不同种族/族裔群体的青少年和青壮年孕期体重增加和产后体重保持的独立和联合决定因素，作为妇女超重和肥胖的主要决定因素。其具体目标是：1)在青少年营养和行为、怀孕青少年的特殊营养需求、怀孕和非怀孕青少年营养状况的测量、纵向和多水平数据的统计分析以及社区变量的测量和分析方面建立系统的培训计划；2)从纽约州区域围产期数据系统和青年冠状动脉风险发展研究(CARDIA)中分析关于妇女怀孕体重增加和产后体重保留的生物学、社会人口学、行为和社区水平决定因素的横断面和纵向数据；3)设计一项针对青少年和青壮年的观察性前瞻性研究，以确定在少数民族中孕期体重增加和产后体重保留的生物学、行为、社会人口学、心理和社区水平的决定因素。拟议的职业发展活动涉及以下方面的培训：身体成分的测量和解释；青少年的生殖、行为/心理健康、营养和健康生活方式问题；负责任地进行研究；以及纵向和定性数据分析。在培训计划结束时，候选人将成为儿科营养流行病学领域的独立调查员。这项提案的临床和公共卫生意义是基于美国医学研究所的一份报告，该报告指出，非裔美国妇女和青少年在怀孕期间的体重增加达到了推荐体重的上限，文献中警告青少年在怀孕期间保持体重增加会带来健康风险，并制定了减少美国人健康差距的国家目标。此外，在不同社会经济和种族/族裔少数群体的青少年中，缺乏关于怀孕体重增加和产后体重保留的不同决定因素的经验性纵向数据。检查在特定人口亚群中可能不同的生物、社会文化和社区层面的因素变得相关，以便制定战略，在不威胁母亲或新生儿健康的情况下防止产后体重滞留。鉴于肥胖对健康的不利影响以及保持减肥的困难，一级预防肥胖症对公共卫生特别重要。

The overall goal of this career development plan is to establish an independent research program in the epidemiology of obesity in children at the University of Rochester School of Medicine. Prevalences of overweight and obesity are rising in the United States, especially among females of low socioeconomic status and racial/ethnic minorities. Pregnancy has been described as a life event in which excessive weight can be gained and subsequently retained. Thus, research and training activities will concentrate on the identification of the independent and joint determinants of gestational weight gain and post-partum weight retention in adolescents and young adults of different racial/ethnic groups as major determinants of overweight and obesity in women. The specific aims are: 1) To establish a systematic training program in adolescent nutrition and behavior, special nutritional needs of pregnant adolescents, measurement of nutritional status in pregnant and non-pregnant adolescents, statistical analysis of longitudinal and multi-level data, and measurement and analysis of community-level variables; 2) To analyze cross-sectional and longitudinal data on biological, sociodemographic, behavioral, and community-level determinants of pregnancy weight gain and post-partum weight retention m women from the New York State Regional Perinatal Data System and the Coronary Artery Risk Development in Young Adults study (CARDIA); 3) To design an observational prospective study of adolescents and young adults to identify the biological, behavioral, sociodemographic, psychological, and community-level determinants of pregnancy weight-gain and post-partum weight retention among racial/ethnic minorities. The proposed career development activities involve training in the measurement and interpretation of body composition; in reproductive, behavioral/mental health, and nutrition and healthy lifestyle issues in adolescents; in Responsible Conduct of Research; and in longitudinal and qualitative data analysis. At the end of the training program, the candidate will be an independent investigator in the field of pediatric nutrition epidemiology. The clinical and public health significance of this proposal are based on a report from the Institute of Medicine suggesting that African-American women and adolescents gain in the upper end of the recommended weight-gain during pregnancy, a warning in the literature as to the health risks to young adolescents of retaining weight gained during pregnancy, and a national goal of reducing health disparities among Americans. In addition, there is a scarcity of empirical longitudinal data on the differential determinants of pregnancy weight-gain and post-partum weight retention in adolescents of various socioeconomic and racial/ethnic minorities. Examining biological, sociocultural, and community-level factors that may differ among specific population subgroups becomes relevant in order to tailor strategies which prevent post-partum weight retention without threatening either the mother's or the newborn's health. Given the adverse health effect of obesity and the difficulties involved in maintaining weight loss, primary prevention of obesity is of particular public health importance.