Community violence and disparities in maternal and infant health: effects and mechanisms

社区暴力和母婴健康差异：影响和机制

• 批准号: 10392099
• 负责人: Jennifer Ahern
• 金额: $ 71.71万
• 依托单位: UNIVERSITY OF CALIFORNIA BERKELEY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-01 至 2024-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10392099
• 关键词: Acute; Address; Affect; African American; Area; Behavioral; Biological; Birth; California; Cessation of life; Childhood; Communities; Data; Ethnic Origin; Ethnic group; Fetal Development; Fostering; Goals; Health; Healthcare; Infant; Infant Health; Infection; Injury; Intervention; Knowledge; Latina; Maternal Health; Mediator of activation protein; Mental Health; Methods; Mission; Morbidity - disease rate; Mothers; National Institute of Child Health and Human Development; Outcome; Perinatology; Population; Pregnancy; Premature Birth; Prevention program; Public Health; Race; Research; Research Priority; Role; Sampling; Shapes; Social support; Surveys; Testing; United States National Institutes of Health; Violence; Work; adverse maternal outcomes; base; clinical care; design; health disparity; improved; infant outcome; innovation; mortality; perinatal health; population health; prevent; psychologic; racial and ethnic; racial and ethnic disparities; racial disparity; social determinants; substance use; violence prevention

Project Summary Improved understanding of community level determinants of perinatal health disparities is a research priority for national health agencies. Community violence may contribute to adverse maternal and infant outcomes and may be instrumental in explaining disparities in perinatal health by race/ethnicity and foreign-born status. However, research has been substantially hampered by cross-sectional designs and methods that cannot disentangle the effects of community violence from other highly correlated determinants of health. Thus, there is a critical need for rigorous research to determine the effects of different aspects of community violence, both predictable overall levels and unexpected acute changes, and to identify underlying psychological, behavioral and biological mechanisms of effect that contribute to maternal and infant health and disparities. The overall objective of this application is to test the central hypothesis that community violence increases the burden of and disparities in maternal and infant health outcomes, and that potentially modifiable psychological (mental health, social support), behavioral (substance use) and biological (maternal infections and conditions) mechanisms underlie these effects. This hypothesis is supported by preliminary analyses that find trimester-specific violence is related to preterm delivery, with the strongest effects among African Americans. The central hypothesis will be addressed using data-adaptive quasi-experimental matching and fixed-effects methods and a rich covariate set to accurately determine the effects of community violence on maternal and infant health. Analyses will be conducted with over 6 million mothers and infants from statewide data on California (2005-2017) and survey- based data on a representative sample of over 72,000 of these mothers and infants. The proposed research will address the following specific aims: (1) Quantify the impacts of acute changes in community violence on maternal and infant health disparities, and psychological, behavioral and biological mechanisms that explain the impacts; (2) Determine the effects of the overall levels of community violence on maternal and infant health disparities, and psychological, behavioral and biological mechanisms that underlie the effects. The work is innovative in (a) distinguishing effects of overall levels of violence from acute changes in violence, (b) examining potentially modifiable mechanisms, and (c) estimating population effects of potential interventions on violence and the mediators. The research is expected to increase scientific understanding of the broader impacts of violence and its role in shaping health disparities. In addition, this work is expected to identify the mechanisms that explain the effects of violence on maternal and infant health, uncovering why racial/ethnic groups such as Latinas appear to be protected, and potentially suggesting alternative points for intervention. Together, these findings are expected to have an important positive impact because they will reframe violence as affecting health and racial/ethnic disparities broadly and thereby motivate interventions to reduce violence and mitigate its downstream effects, which will enhance health and reduce health disparities in the US.

项目概要 提高对社区层面围产期健康差异决定因素的了解是一项研究重点 国家卫生机构。社区暴力可能会导致不良的孕产妇和婴儿结局，并可能 有助于解释按种族/族裔和外国出生身份划分的围产期健康差异。然而， 研究受到横截面设计和方法的严重阻碍，这些设计和方法无法解开 社区暴力对其他高度相关的健康决定因素的影响。因此，迫切需要 进行严格的研究以确定社区暴力不同方面的影响，总体上都是可预测的 水平和意外的急剧变化，并识别潜在的心理、行为和生物 有助于孕产妇和婴儿健康和差异的影响机制。本次活动的总体目标 应用程序是为了检验以下中心假设：社区暴力增加了人们的负担和差异 孕产妇和婴儿健康结果，以及潜在可改变的心理（心理健康、社会 支持）、行为（物质使用）和生物（孕产妇感染和病症）机制是其基础 这些影响。这一假设得到了初步分析的支持，初步分析发现妊娠期特定的暴力行为与 早产，对非裔美国人的影响最为强烈。中心假设将是 使用数据自适应准实验匹配和固定效应方法以及丰富的协变量集来解决 准确确定社区暴力对孕产妇和婴儿健康的影响。分析将是 根据加州全州数据（2005-2017）对超过 600 万母亲和婴儿进行了调查， 基于超过 72,000 名母亲和婴儿的代表性样本的数据。拟议的研究将 解决以下具体目标： (1) 量化社区暴力急剧变化对孕产妇的影响 婴儿健康差异，以及解释其影响的心理、行为和生物机制； (2) 确定社区暴力总体水平对孕产妇和婴儿健康差异的影响， 以及造成这些影响的心理、行为和生物机制。这项工作的创新之处在于（a） 区分暴力总体水平的影响与暴力急剧变化的影响，(b) 审查潜在的 可修改的机制，以及 (c) 估计对暴力和暴力的潜在干预措施对人口的影响 调解员。这项研究预计将增进对暴力和暴力的更广泛影响的科学理解。 它在塑造健康差异方面的作用。此外，这项工作预计将确定解释的机制 暴力对孕产妇和婴儿健康的影响，揭示拉丁裔等种族/族裔群体出现的原因 受到保护，并可能建议替代干预点。总之，这些发现是 预计会产生重要的积极影响，因为它们会将暴力重新定义为影响健康和 广泛的种族/族裔差异，从而激发干预措施，以减少暴力并减轻其影响 下游影响，这将增强美国的健康并减少健康差距。