A longitudinal multi-level analysis of health disparities among adolescents

描述（由申请人提供）：2010年健康人包括与青少年健康和减少健康差距有关的目标。本R21将通过对青年资产研究（YAS）的5波纵向数据进行二次分析，检查人口统计学定义的青年亚群体中随时间推移的健康差异。本研究的目的是检验青少年资产、环境因素和青少年危险行为之间的关系，跨越4年的时间跨度。青少年的健康状况在种族/民族和社会经济地位（SES）方面存在差异。长期跟踪各青年群体的这些目标，对于评估健康差距和监测2010年健康人目标的进展情况非常重要。还必须确定可能与这些差异有关的因素，包括青年资产等个人因素以及环境因素。我们建议使用YAS（由美国疾病控制与预防中心（CDC）生殖健康部门资助）的现有数据，这是一项为期4年/5波的纵向前瞻性研究，涉及第1波12-17岁的青少年及其父母。该研究探讨了社区和家庭因素、青少年资产和青少年风险行为之间的关系。美国疾病控制与预防中心资助了与性危险行为有关的数据收集和数据分析。疾控中心支持我们申请额外资金用于分析其他结果。收集的数据包括：17项资产（如与母亲的关系、宗教信仰、同伴角色榜样）、青少年种族/民族、广泛的父母报告的社会经济地位（SES）数据，以及危险行为，包括不使用安全带、与饮酒司机一起驾驶、酗酒、吸烟、身体打架和携带武器。以下具体假设将被检验：1)青少年参与危险行为的比例差异将随着时间的推移而改变，这种变化将因每个种族/民族而异，并受到社会经济地位的影响。2)青少年资产在风险行为与时间的差异关系中的影响会因种族/民族和社会经济地位而异。3)环境因素（波1和波2）和资产（波3）将与不同种族/民族的风险行为差异（波4和波5）相关联，并受到SES的影响。4)青年资产（波3）将缓和环境因素（波1和波2）对不同种族/民族和社会经济地位群体的行为差异的影响。将对这六种危险行为分别进行分析。为了验证这些假设，我们将使用多层次纵向混合效应模型、边际模型和结构方程模型。在控制社会经济地位的情况下，与种族/族裔群体有关的健康差异将首先通过分析相互作用来进行检查，然后可能通过根据种族/族裔对数据进行分层来进一步检查。这一信息将有助于解释青年资产和环境的作用，因为它们与青年健康差异有关，特别是与种族/民族和社会经济地位有关的六种危险行为。结果将有助于指导制定干预措施，以消除青年健康差距。公共卫生相关性：该研究将有助于青少年发展理论一般领域的公共卫生，特别是我们对青少年资产和环境因素如何减少与种族/民族和社会经济地位相关的健康差异在青少年六种危险行为中的理解。从业人员可以使用研究结果来指导具体计划的干预措施，以减少或消除与种族/民族和社会经济地位有关的青少年健康差距。

DESCRIPTION (provided by applicant): Healthy People 2010 includes objectives related both to adolescent health and to reducing health disparities. This R21 will examine health disparities over time in demographically defined sub-groups of youth by conducting secondary analyses of the 5 waves of longitudinal data from the Youth Asset Study (YAS). This study's purpose is to examine associations among youth assets, environmental factors, and adolescent risky behaviors across youth sub-groups over a 4 year period. Adolescent health disparities have been shown for race/ethnicity and socioeconomic status (SES). Tracking these objectives over time across youth sub-groups is important to assess health disparities and monitor progress of the Healthy People 2010 goals. It is also imperative to determine factors that may be related to these disparities including individual factors such as youth assets as well as environmental factors. We propose to use existing data from the YAS (funded by the Centers for Disease Control and Prevention, (CDC) Division of Reproductive Health), a 4 year/5 wave longitudinal prospective study that involves youth aged 12-17 years at wave 1 and their parents The study examines associations among neighborhood and family factors, youth assets, and youth risk behaviors. The CDC has funded data collection and data analysis related to sexual risk behaviors. The CDC supports our submission for additional funding for analysis of other outcomes. Data collected includes: 17 assets (e.g. Relationship with Mother, Religiosity, Peer Role Models), youth race/ethnicity, extensive parent reported socioeconomic status (SES) data, and risky behaviors including non-use of seatbelts, riding with drivers who have been drinking alcohol, binge drinking of alcoholic beverages, tobacco use, physical fighting, and weapon carrying. The following specific hypotheses will be examined: 1) Disparities in the proportion of youth participating in risky behaviors will change over time and this change will be different for each race/ethnicity and impacted by SES. 2) The impact of youth assets in the disparate relationship between risky behavior and time will vary by race/ethnicity and SES. 3) Environmental factors (waves 1 & 2) and assets (wave 3) will be associated with risk behavior disparities (waves 4 & 5) differently across race/ethnic groups and impacted by SES. 4) Youth assets (wave 3) will moderate the influence of environmental factors (waves 1 & 2) on behavioral disparities differently across race/ethnic and SES groups. Separate analyses for each of the six risky behaviors will be conducted. To test these hypotheses multi-level longitudinal mixed effect models, marginal models, and structural equation modeling will be utilized. Health disparities related to racial/ethnic groups while controlling for SES will initially be examined by analyzing interactions and then may be further examined by stratifying the data based on race/ethnicity. This information will help explain the role of youth assets and the environment as they relate to youth health disparities for six risky behaviors specifically related to race/ethnicity and SES. Results will help guide interventions developed to eliminate youth health disparities. PUBLIC HEALTH RELEVANCE: The study will contribute to public health in the general area of youth development theory and specifically to our understanding of how youth assets and environmental factors may decrease health disparities related to race/ethnicity and socioeconomic status across six risky behaviors in adolescents. Practitioners can use the study results to guide interventions specifically planned at reducing or eliminating youth health disparities related to race/ethnicity and socioeconomic status.