Leveraging a Natural Experiment to Estimate the Effects of School Racial Segregation on Cardiovascular Risk Factors among Youth and Young Adults

利用自然实验来评估学校种族隔离对青少年和年轻人心血管危险因素的影响

• 批准号: 10901155
• 负责人: Rita Hamad
• 金额: $ 55.81万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10901155
• 关键词: Address; Adolescence; Adolescent; Adult; Affect; Age; Behavior; Biological Markers; Black race; Cardiovascular Diseases; Characteristics; Child; Childhood; Chronic stress; Clinical; Cognition; Cohort Studies; Complex; Counseling; Country; Court Decisions; Data; Data Set; Desegregation; Development; Diabetes Mellitus; Discrimination; Disease Outcome; Disparity; Economics; Education; Family Characteristics; Funding; Future; Gender; Genetic; Goals; Health; Health behavior; Heart Diseases; Hour; Hypertension; Income; Individual; Intervention; Knowledge; Life; Life Cycle Stages; Light; Link; Literature; Long-Term Effects; Longitudinal Studies; Measures; Mediating; Mental Health; Methodology; National Heart, Lung, and Blood Institute; National Longitudinal Survey of Adolescent to Adult Health; Natural experiment; Obesity; Occupational; Outcome; Outcomes Research; Pathway interactions; Persons; Physical activity; Population; Preventive; Public Health; Quasi-experiment; Race; Racial Segregation; Reporting; Research; Risk Factors; Schools; Smoking; Socioeconomic Status; Specific qualifier value; Stress; Subgroup; Techniques; Testing; Vulnerable Populations; Work; Youth; archive data; black/white disparity; cardiovascular disorder risk; cardiovascular risk factor; community intervention; data archive; design; disparity reduction; forest; health care availability; high risk; improved; innovation; insight; machine learning method; middle age; novel marker; panel study of income dynamics; peer influence; peer networks; physical inactivity; programs; psychologic; racial disparity; resilience; response; school district; screening; segregation; social; social norm; socioeconomics; teenage fertility; theories; treatment effect; trend; young adult

ABSTRACT Cardiovascular disease (CVD) risk factors disproportionately affect black adults, and these disparities are evident early in the life course. Genetic factors do not appear to explain this difference, and studies have increasingly implicated socioeconomic risk factors. Among the most prominent risk factors for racial disparities in CVD is educational attainment, which is strongly correlated with smoking, hypertension, and CVD over the life course. Yet it is unclear which aspects of schooling are most salient. One possible explanation for racial disparities in CVD is that black youth often attend highly racially segregated schools. Segregation is thought to be linked with CVD due to increased stress and discrimination; social norms and peer influence; and the constraining of socioeconomic opportunities that reduces income and healthcare access later in life. Yet despite the fact that school segregation has increased in recent years, there are no studies examining the effects of recent school segregation trends on CVD risk factors. The goal of this study is to provide this urgently needed evidence. In particular, we take advantage of a unique natural experiment, overcoming methodological challenges in the previous literature on the effects of education on CVD. Since 1990, numerous local court decisions have resulted in “resegregation” in school districts across the country. We link nationwide data on these court decisions and school district-level measures of school segregation with CVD outcome data from two large nationally representative U.S. cohort studies of affected youth: the National Longitudinal Study of Adolescent to Adult Health (Add Health, N≈90,000) and the Panel Study of Income Dynamics (N≈8,000). We employ the quasi-experimental technique of instrumental variables analysis, which reduces typical confounding by factors such as unobserved individual and family characteristics. In Aim 1, our goal is to estimate the short- term effects of school segregation on CVD risk factors—including smoking, physical activity, obesity, and mental health—among youth while they are still in school. In Aim 2, we will examine the long-term effects of school segregation in the decades that follow, with outcomes including those in Aim 1 in addition to objectively measured CVD biomarkers, diabetes, and hypertension. We will also undertake exploratory analyses to determine possible mediating pathways. In Aim 3, we will identify vulnerable subgroups whose development of CVD risk factors differs in response to school racial segregation. This will enable future interventions to be tailored to the most vulnerable individuals. We will employ both hypothesis-driven and hypothesis-generating statistical techniques, including innovative machine learning methods that allow for more complex and robust subgroup identification. Overall, the expected outcome of this research is to produce rigorous evidence on the effects of school racial segregation on CVD risk factors, helping to inform school-based, clinical, and community interventions to reduce persistent and inequitable racial disparities in CVD.

抽象的 心血管疾病（CVD）风险因素不成比例地影响黑人成年人，这些差异是 在人生过程的早期证据。遗传因素似乎并不能解释这种差异，研究有 日益暗示的社会经济风险因素。种族分布最突出的风险因素之一 在CVD中是教育程度，这与吸烟，高血压和CVD密切相关 生活课程。然而，目前尚不清楚最重要的教育方面。种族的一种可能解释 CVD中的差异是黑人青年经常上高度严重的隔离学校。隔离被认为是 由于压力和歧视增加而与CVD联系在一起；社会规范和同伴影响；和 限制社会经济机会，以减少以后生活中的收入和医疗保健的机会。然而 尽管近年来学校种族隔离有所增加，但尚无研究 最近的学校隔离趋势对CVD风险因素的影响。这项研究的目的是提供此 迫切需要证据。特别是，我们利用了一个独特的自然实验，克服了 先前文献中有关教育对CVD的影响的方法论挑战。自1990年以来，很多 地方法院的裁决导致全国各地的学区“逆向”。我们在全国范围内链接 与CVD结果数据有关这些法院判决和学区级别隔离措施的数据 来自两项大型全国代表性美国队列研究的受影响青年的研究：国家纵向研究 青少年对成人健康（增加健康，N≈90,000）和收入动态的小组研究（N≈8,000）。我们 采用仪器变量分析的准实验技术，可减少典型的混杂 通过未观察到的个人和家庭特征等因素。在AIM 1中，我们的目标是估计短暂的 学校种族隔离对CVD风险因素的期限影响 - 包括吸烟，体育锻炼，肥胖和 心理健康 - 年轻人仍在学校时。在AIM 2中，我们将研究 随后的几十年中的学校隔离，除了客观上，还包括AIM 1的结果 测量的CVD生物标志物，糖尿病和高血压。我们还将进行探索性分析 确定可能的介导途径。在AIM 3中，我们将确定其发展的脆弱亚组 CVD风险因素因学校种族隔离而有所不同。这将使将来的干预措施成为 针对最脆弱的人量身定制。我们将同时采用假设驱动和假设生成 统计技术，包括创新的机器学习方法，可实现更复杂和健壮的 亚组识别。总体而言，这项研究的预期结果是为 学校种族隔离对CVD风险因素的影响，有助于告知学校，临床和 社区干预措施，以减少CVD中持久和不平等的种族分布。

项目成果

School racial segregation and long-term cardiovascular health among Black adults in the US: A quasi-experimental study.

• DOI: 10.1371/journal.pmed.1004031
• 发表时间: 2022-06
• 期刊: PLoS medicine
• 影响因子: 15.8

The long shadow of residential racial segregation: Associations between childhood residential segregation trajectories and young adult health among Black US Americans.

• DOI: 10.1016/j.healthplace.2022.102904
• 发表时间: 2022-09
• 期刊: HEALTH & PLACE
• 影响因子: 4.8
• 作者: Schwartz, Gabriel L.;Wang, Guangyi;Kershaw, Kiarri N.;McGowan, Cyanna;Kim, Min Hee;Hamad, Rita
• 通讯作者: Hamad, Rita

School Racial Segregation and the Health of Black Children.

• DOI: 10.1542/peds.2021-055952
• 发表时间: 2022-05-01
• 期刊: PEDIATRICS
• 影响因子: 8
• 作者: Wang, Guangyi;Schwartz, Gabriel L.;Kim, Min Hee;White, Justin S.;Glymour, M. Maria;Reardon, Sean;Kershaw, Kiarri N.;Gomez, Scarlett Lin;Inamdar, Pushkar P.;Hamad, Rita
• 通讯作者: Hamad, Rita