THE PRENATAL AND CHILDHOOD MECHANISMS OF HEALTH DISPARITIES; PROTOCOL DEVELOPMENT AND INITIAL RECRUITMENT AND RETENTION

内部人口健康研究部(DIPHR)开展以儿童健康和人类发展为重点的研究。作为DIPHR使命的一部分，一个令人感兴趣的领域是调查健康差距的发展根源--即社会优势群体和弱势群体之间发展成果的差异。因此，差异通常指的是社会经济和种族/族裔群体之间不平等的健康结果，也可能存在于其他社会不利地位的背景下，包括智力残疾和性少数地位。 美国的健康差距--预期寿命和慢性病--早在产前就有了根源。早期生活条件，包括贫穷和歧视，在整个生命过程中造成健康差距，并通过代代相传在人口中变得更加根深蒂固。父母的心理健康与社会和经济劣势以及儿童发展密切相关，可能在代际传播差异方面发挥关键的中介作用，但差异文献中持续存在的差距是，母亲和父亲的精神病理都没有被充分视为造成差异的机制，也没有使用表型验证的方法来衡量它们。 因此，尽管健康方面的差异得到了很好的记录，但在生命之初影响差异的发展机制却没有，特别是那些导致发育缺陷的机制，这些缺陷在疾病出现之前很久就出现了。第n个战略计划(2016-2020年)强调需要进行研究，以改进“了解导致种族/族裔和社会经济地位差异的机制”。需要这种加强了解来澄清差距的原因，特别是与影响早期发展的社会或经济不利因素有关的具体风险。 增进对造成差异的发展机制的了解，需要更彻底地了解社会经济地位和种族/族裔以及与差异有关的其他地位，如残疾地位和性别少数地位，如何影响从怀孕开始的发展决定因素。 要做到这一点，需要比现有研究更深入地测量生命过程中更早开始的更多不同样本中差异的潜在原因。这项工作需要采取一种发展系统的观点，其中儿童发展的多个领域受到家庭、社区和社区层面的投入的影响，并且儿童早期发展的微小差异随着时间的推移而加剧，从而导致以后在健康方面的巨大差距。

The Division of Intramural Population Health Research (DIPHR) conducts studies focusing on child health and human development. As part of DIPHR's mission, one area of interest is the investigation of the developmental origins of health disparities - i. e., differences in developmental outcomes between socially advantaged and disadvantaged groups. Thus, disparities typically refer to unequal health outcomes between socioeconomic and race/ethnic groups and may also exist in the context of other socially disadvantaged statuses including intellectual disability and sexual minority status. Health disparities in the United States - in life expectancy and chronic disease - have their origins as early as the prenatal period. Early life conditions including poverty and discrimination generate disparities in health over the life course that become further entrenched in the population through their transmission across generations. Parental mental health, which is strongly linked with social and economic disadvantage as well as child development, may play a key mediating role in the transmission of disparities across generations, but a persistent gap in the disparity's literature is that both maternal and paternal psychopathology has not been fully considered as mechanisms contributing to disparities nor have they been measured using phenotypically validated approaches. As a result, though disparities in health are well documented, the developmental mechanisms that impact disparities at the very beginning of life are not, particularly those which lead to developmental deficits that emerge long before disease states. The NTH strategic plan (2016-2020) highlights the need for research to improve "understanding mechanisms that lead to disparities by race/ethnicity and socioeconomic status." Such enhanced understanding is needed to clarify the etiology of disparities - pa1ticularly the specific exposures linked with social or economic disadvantage that impact early development. Advancing knowledge of the developmental mechanisms that generate disparities requires a more thorough understanding of how socioeconomic status and race/ethnicity, along with other statuses associated with disparities such as disability status and sexual minority status, influence the determinants of development from gestation onward. To accomplish this, more in-depth measurement of potential causes of disparities is needed from more diverse samples starting earlier in the life course than is currently available from existing studies . This work needs to take a developmental systems perspective in which multiple domains of child development are influenced by inputs at the family, neighborhood, and community levels , and in which small differences early in child development are compounded over time resulting in large gaps in health later on.