Scientific evidence increasingly indicates that adult disparities in health outcomes and socioeconomic status (SES) originate in childhood, the prenatal period, or preconception. The proposed research investigates whether disparities in adverse pregnancy outcomes are related to prenatal air pollution exposure, and to what extent combined exposures to adverse pregnancy outcomes, lead, and neighborhood environment contribute to disparities in early childhood educational outcomes. Both adverse pregnancy outcomes and lead exposure are patterned by race/ethnicity and SES, may accrue disproportionately to children in already disadvantaged communities facing multiple stressors and environmental exposures (such as air pollution), and have been individually associated with lower standardized test scores. Childhood educational outcomes, while important on their own, are predictors of high school and college graduation, which are essential determinants of income and health care access later in life. During the training phase of this grant, Dr. Bravo will use sibling models to investigate relationships between prenatal air pollution exposure and adverse pregnancy outcomes in maternal siblings (Aim 1). This approach controls for factors shared by siblings and also informs whether prenatal air pollution exposure may indirectly affect educational outcomes by increasing risk of adverse pregnancy outcomes. During the independent phase of the grant, Dr. Bravo will develop models to investigate the combined effect of adverse pregnancy outcomes, early childhood lead exposure, and neighborhood environment on educational outcomes (Aim 2). She will also develop models to estimate the impact of residential instability and changing neighborhood environment on early childhood educational outcomes (Aim 3). The proposed research requires insights from epidemiology, statistics, and sociology, as well as application of advanced statistical methods. Dr. Bravo is well-suited to this work based on her prior research experience, which includes investigating effects of temperature and air pollution on respiratory- and cardiovascular-related mortality and morbidity and studying relationships between neighborhood, air pollution exposure, and health. Dr. Bravo has access to georeferenced and longitudinally linked exposure, health, and education datasets. She has also assembled a team of highly qualified mentors and will benefit from world-class mentorship, training, and facilities. In addition to formal interaction with her mentors, she will complete coursework in statistics and social epidemiology; participate in career development workshops; and present her research at professional conferences, seminar series, and working groups. The proposed research will enable Dr. Bravo to establish an independent career in the epidemiology of health and educational disparities. Further, her findings will contribute to understanding effects of, and eventually preventing, multiple adverse exposures, thereby addressing intransigent disparities in educational, developmental, and health outcomes.
Although adverse exposures sustained during prenatal development and childhood may contribute to a cascade of health and developmental effects into adulthood, the combined effects of multiple adverse exposures on health and development are not well understood. The proposed research uses longitudinally linked, georeferenced data that tracks children from the prenatal period through early childhood to determine how environmental exposures and social context jointly contribute to disparities in child health and development. Understanding the importance of adverse environmental and social exposures sustained over time will inform development of strategies to reduce intransigent disparities in health and development, which is of critical importance to the health of our nation.