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

人口健康研究司开展以儿童健康和人的发展为重点的研究。作为DiPHR任务的一部分，一个感兴趣的领域是调查健康差异的发展根源，即社会优势群体和弱势群体之间发展结果的差异。在这里，我们指的是社会经济和种族/民族群体之间不平等的健康结果，尽管差异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——预期寿命和慢性病——早在产前就有其根源。包括贫穷和歧视在内的早期生活条件在整个生命过程中造成健康方面的差距，这种差距通过代代相传而在人口中进一步根深蒂固。父母的心理健康问题与社会和经济劣势以及儿童发育密切相关，可能在差距代代相传的过程中发挥关键的中介作用。然而，母亲和父亲的精神病理学尚未被充分考虑为导致差异的机制，也没有使用表型验证方法（例如，通过结构化诊断访谈）进行测量。因此，虽然健康方面的差异有充分的记录，但在生命之初影响差异的发育机制却没有得到充分的记录，特别是那些导致早在疾病出现之前就出现的发育缺陷的机制。《NICHD 2020战略计划》强调，健康差距是一个影响促进孕产妇健康、分娩结果和儿童发展的跨领域问题；报告强调，“了解社会、经济、结构和区域因素的作用，对于推进旨在减轻健康差距的预防、诊断和干预工作至关重要”。要提高对产生差异的发育机制的认识，就需要更彻底地了解社会经济地位和种族/族裔如何影响产前健康和从妊娠开始的儿童发育的决定因素。要做到这一点，需要从更多样化的样本中更深入地测量差异的潜在原因，从生命历程的早期开始，而不是目前从现有研究中获得的。这项工作需要衡量儿童发展的各个领域是如何受到生物、心理、家庭和邻里层面的多种投入的影响的，以及儿童发展早期的微小差异随着时间的推移而加剧，从而导致以后健康方面的巨大差距。

The Division of 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. Here, we refer to unequal health outcomes between socioeconomic and race/ethnic groups and although disparities 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 problems, which are 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. However maternal and paternal psychopathology have not been fully considered as mechanisms contributing to disparities nor been measured using phenotypically validated approaches (e.g., through structured diagnostic interviews). 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 NICHD 2020 strategic plan highlights health disparities as a cross-cutting problem impacting advancing maternal health, birth outcomes, and child development; it emphasizes that “understanding the contribution of social, economic, structural, and regional factors is vital to advancing preventive, diagnostic, and intervention efforts” designed to mitigate health disparities. Advancing knowledge of the developmental mechanisms that generate disparities requires a more thorough understanding of how socioeconomic status and race/ethnicity influence the determinants of prenatal health and child 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 measure how various domains of child development are influenced by multiple inputs at the biological, psychological, family, and neighborhood levels, and in which small differences early in child development are compounded over time resulting in large gaps in health later on.