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Effects of prolonged and timing-specific exposure to neighborhood disadvantage during childhood and adolescence on health and health inequalities in early adulthood.

机译：在儿童和青少年时期长期和定时特定地暴露于邻里不利环境对成年初期健康和健康不平等的影响。

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摘要

Mounting evidence that purely individual-based explanations fail to fully explain persistent disparities in morbidity and mortality has contributed to a surge in research investigating how residential contexts further shape the health of individual residents. Until recently, however, the majority of scholarship in this area measured neighborhood characteristics only once or over just a short window of observation, conflating persons who were recently exposed with those who have -- and in the case of many communities of color, are more likely to have -- experienced repeated or prolonged residential adversity. Such a conceptualization is inconsistent with most theories of neighborhood effects, which tend to specify mechanisms that imply sustained or age-specific exposures, as well as with a developmental or life course perspective in which experiences earlier in life are posited to have formative and enduring impacts on future outcomes, even when controlling for more contemporaneous determinants. Using data from the 1970 to 2011 waves of the Panel Study of Income Dynamics (PSID) merged with census data on respondents' neighborhoods, this dissertation comprises three interrelated studies examining the effects of prolonged and timing-specific exposures to neighborhood disadvantage throughout childhood and adolescence on health and health inequalities later in life, including self-rated health status, obesity incidence, and early smoking initiation. Neighborhood disadvantage is characterized regularly throughout the child and adolescent life course using a composite index based on the spatial clustering of poverty, unemployment, female-headed households, public assistance receipt, and educational and occupational marginalization. The assumption is that such collective conditions of neighborhoods are concomitant to social and structural resources and opportunities (or the lack thereof) that can, alone or in conjunction with individual- and household-level risk and protective factors, be health promoting or health compromising. Analyses employ marginal structural models with inverse probability of treatment (and censoring) weights to adjust for selection bias without "controlling away" the effects of neighborhood exposures that operate indirectly though the same individual-level covariates that are associated with mobility into and out of different neighborhood contexts. Results indicate that prolonged exposure to neighborhood disadvantage throughout childhood and adolescence is strikingly more common among nonwhite, predominantly African American, respondents and is associated in turn with significantly greater odds of experiencing worse self-rated health as well as obesity in early adulthood. Moreover, contrary to family-level poverty in which experiences during early childhood have been shown to be particularly influential, these analyses suggest that exposure to neighborhood-level deprivation during adolescence may be more detrimental to young adult health than exposure that occurs earlier in life. Nonetheless, the findings for early smoking initiation highlight the potential for differential impacts of neighborhood poverty across different racial/ethnic groups. Overall, however, this dissertation adds support to the growing body of literature suggesting that place-based, developmentally-appropriate, and ongoing investments in the social, economic, institutional, and physical structures of under-resourced communities and communities of color can have long-term benefits for population health and health equity that extend over the life course.
机译：越来越多的证据表明，纯粹基于个人的解释不能完全解释发病率和死亡率方面的持续差距，这促使研究住宅环境如何进一步影响个体居民健康的研究激增。然而，直到最近，该领域的大多数奖学金仅一次或仅在一个短暂的观察窗口内就测量了邻里特征，将最近接触过的人与那些拥有接触能力的人（对于许多有色人种而言）相结合。可能经历过反复或长期的居住逆境。这种概念化与大多数邻里效应理论不一致，后者倾向于指定暗示持续或特定年龄暴露的机制，以及从发展或生活历程的观点出发，其中生命的早期经历被认为具有形成性和持久性影响即使在控制更多同期决定因素的情况下，也能保证未来的结果。利用1970年至2011年的收入动态面板研究（PSID）浪潮的数据与受访者邻居的人口普查数据相结合，本论文包括三项相互关联的研究，研究了长期和特定时间暴露于整个儿童期和青春期对邻居不利的影响关于生活中的健康和健康不平等的信息，包括自我评估的健康状况，肥胖发生率和提早吸烟。根据贫困，失业，女户主家庭，公共援助收入以及教育和职业边缘化的空间聚类综合指数，在整个儿童和青少年生活过程中定期确定邻里劣势。假定邻里的这种集体条件伴随着社会和结构性资源和机会（或缺乏机会），这些资源和机会可以单独或与个人和家庭一级的风险和保护因素结合使用，从而促进健康或损害健康。分析采用边际结构模型，其权重与处理（和审查）权重成反比，以针对选择偏差进行调整，而不会“控制”通过与个体流动性相关的相同个体水平协变量间接影响的邻域暴露的影响邻域上下文。结果表明，在整个非裔美国人（主要是非裔美国人）的受访者中，儿童和青少年长期处于邻里不利地位更为普遍，这反过来又会导致自我评估的健康状况恶化以及成年后肥胖的风险大大增加。此外，与已证明在儿童早期经历特别有影响力的家庭层面的贫困相反，这些分析表明，与生活中较早的接触相比，青春期在邻里层面的剥夺可能更不利于年轻成人的健康。尽管如此，早期吸烟的发现凸显了不同种族/族裔群体对邻里贫困的不同影响的潜力。总体而言，这篇论文为越来越多的文献提供了支持，表明在资源不足的社区和有色社区的社会，经济，体制和物质结构方面，基于地点的，与发展相适应的和持续的投资可能会长期存在。在整个生命周期中为人口健康和健康公平带来的长期利益。

著录项

  • 作者

    Kravitz-Wirtz, Nicole D.;

  • 作者单位

    University of Washington.;

  • 授予单位 University of Washington.;
  • 学科 Sociology.;Public health.
  • 学位 Ph.D.
  • 年度 2015
  • 页码 146 p.
  • 总页数 146
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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