This competing renewal application proposes to extend and enhance our work aimed at understanding how social status fosters obesity and insulin resistance in adolescence and early adulthood. Disentangling how domains of social disadvantage (socioeconomic position, perceived social status, and race/ethnicity) interact to promote obesity and insulin resistance is a major goal of our work. A second major goal is characterizing trajectories of vulnerability to the deleterious effects of social disadvantage. Our preliminary studies suggest a major shift in the importance of perceived SES to development of morbidity as an adolescent matures. Understanding when, how and why this shift occurs is necessary to guide development of effective, efficient interventions to decrease health disparities. We use a two-pronged approach to address our goals. First, we extend our large, well established cohort study, The Princeton School District Study, through 2 new waves of data collection. These new data collection efforts, which will occur 3 and 5 years after the last assessment, will re-evaluate the anthropomorphic, psychological, and physiological factors we have collected data on during these first 4 waves of data collection, allowing us to study these youth as they transition to adulthood. Second, we enhance our explanatory model to include psychological traits and two new neuroendocrine mediators of the relationships between social disadvantage and obesity/insulin resistance--tumor necrosis factor-alpha and interleukin-6.
Our specific aims are: 1) To characterize the relationship between social disadvantage and inflammatory biomarkers of risk for obesity and Type 2 diabetes from adolescence to early adulthood;2) To characterize the relationships between social disadvantage and psychological factors which may be part of the causal chain linking social disadvantage to obesity/insulin resistance;3) To explore the dynamic interplay between domains of social disadvantage and how these domains interact with putative physiological and psychological paths linking social disadvantage to obesity and insulin resistance. The prospective cohort design allows us to address issues of directionality and reverse causation at a time when rates of obesity and Type 2 diabetes have risen dramatically. This application will provide unique data regarding how disparities in obesity and risk for Type 2 diabetes develop and progress, potentially identifying pathways for social, psychological, and pharmacological intervention. Narrative Elimination of social inequalities in health, including those due to differences in social status, is one of major challenges facing society today. Although disparities due to social status are well documented for heart disease, diabetes, and cancer, as well as many other such chronic diseases which begin early in life but do not become manifest until later in adulthood, the process by which these disparities develop remains a mystery. In order to enhance our understanding of the process by which social inequalities in health accrue, this project proposes to study disparities in obesity and insulin resistance, both of which are precursors for diabetes, heart disease, and cancer, during adolescence and young adulthood.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Study Section
Kidney, Nutrition, Obesity and Diabetes (KNOD)
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Esposito, Layla E
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Massachusetts General Hospital
United States
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Cheng, Erika R; Cohen, Alyssa; Goodman, Elizabeth (2015) The role of perceived discrimination during childhood and adolescence in understanding racial and socioeconomic influences on depression in young adulthood. J Pediatr 166:370-7.e1
Goodman, Elizabeth; Maxwell, Sarah; Malspeis, Susan et al. (2015) Developmental Trajectories of Subjective Social Status. Pediatrics 136:e633-40
Shomaker, Lauren B; Goodman, Elizabeth (2015) An 8-Year Prospective Study of Depressive Symptoms and Change in Insulin From Adolescence to Young Adulthood. Psychosom Med 77:938-45
Gilthorpe, M S; Dahly, D L; Tu, Y K et al. (2014) Challenges in modelling the random structure correctly in growth mixture models and the impact this has on model mixtures. J Dev Orig Health Dis 5:197-205
Stanley, Takara L; Chen, Minghua L; Goodman, Elizabeth (2014) The typology of metabolic syndrome in the transition to adulthood. J Clin Endocrinol Metab 99:1044-52
Pietras, Stefanie A; Goodman, Elizabeth (2013) Socioeconomic status gradients in inflammation in adolescence. Psychosom Med 75:442-8
Oreskovic, Nicolas M; Goodman, Elizabeth (2013) Association of optimism with cardiometabolic risk in adolescents. J Adolesc Health 52:407-12
Kubzansky, Laura D; Gilthorpe, Mark S; Goodman, Elizabeth (2012) A prospective study of psychological distress and weight status in adolescents/young adults. Ann Behav Med 43:219-28
Goodman, Elizabeth; Must, Aviva (2011) Depressive symptoms in severely obese compared with normal weight adolescents: results from a community-based longitudinal study. J Adolesc Health 49:64-9
Jackson, Benita; Goodman, Elizabeth (2011) Low Social Status Markers: Do They Predict Depressive Symptoms in Adolescence? Race Soc Probl 3:119-128

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