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

校内人口健康研究司开展的研究侧重于儿童健康和人类发展。作为国际人权保护司使命的一部分，感兴趣的一个领域是调查健康差距的发展根源-即：例如，社会弱势群体和弱势群体之间的发展结果差异。因此，差异通常是指社会经济和种族/族裔群体之间的不平等健康结果，也可能存在于其他社会弱势地位的背景下，包括智力残疾和性少数地位。 美国的健康差距-在预期寿命和慢性病方面-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方面的差异，这种差异通过代代相传而进一步加深。父母的心理健康，这是密切相关的社会和经济的劣势，以及儿童的发展，可能发挥关键的调解作用，在跨代的差异传输，但在差距的文献中持续存在的差距是，母亲和父亲的精神病理学没有被充分考虑的机制，有助于差异，也没有使用表型验证的方法来衡量。 因此，尽管健康方面的差异有充分的文献记载，但在生命之初影响差异的发育机制却没有，特别是那些导致发育缺陷的机制，这些缺陷早在疾病状态之前就出现了。《国家消除种族歧视战略计划》（2016-2020年）强调需要开展研究，以改善“对导致种族/族裔和社会经济地位差异的机制的理解”。“需要加强这种理解，以澄清差异的病因-特别是与影响早期发展的社会或经济不利因素有关的特定暴露。 要进一步了解造成差异的发展机制，就需要更透彻地了解社会经济地位和种族/族裔，沿着与差异有关的其他状况，如残疾状况和性少数群体状况，如何从妊娠期起影响发展的决定因素。 要做到这一点，更深入的测量差异的潜在原因，需要从更多样化的样本开始在生命过程中的早期比目前可从现有的研究。 这项工作需要采取发展系统的角度来看，儿童发展的多个领域的影响，在家庭，邻里和社区层面的投入，并在儿童发展早期的小差异随着时间的推移，导致健康的巨大差距以后复合。

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.