Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA 02115, USA.
N Engl J Med. 2012 Aug 23;367(8):735-45. doi: 10.1056/NEJMsa1114353.
For many health-related behaviors and outcomes, racial and ethnic disparities among adolescents are well documented, but less is known about health-related disparities during preadolescence.
We studied 5119 randomly selected public-school fifth-graders and their parents in three metropolitan areas in the United States. We examined differences among black, Latino, and white children on 16 measures, including witnessing of violence, peer victimization, perpetration of aggression, seat-belt use, bike-helmet use, substance use, discrimination, terrorism worries, vigorous exercise, obesity, and self-rated health status and psychological and physical quality of life. We tested potential mediators of racial and ethnic disparities (i.e., sociodemographic characteristics and the child's school) using partially adjusted models.
There were significant differences between black children and white children for all 16 measures and between Latino children and white children for 12 of 16 measures, although adjusted analyses reduced many of these disparities. For example, in unadjusted analysis, the rate of witnessing a threat or injury with a gun was higher among blacks (20%) and Latinos (11%) than among whites (5%), and the number of days per week on which the student performed vigorous exercise was lower among blacks (3.56 days) and Latinos (3.77 days) than among whites (4.33 days) (P<0.001 for all comparisons). After statistical adjustment, these differences were reduced by about half between blacks and whites and were eliminated between Latinos and whites. Household income, household highest education level, and the child's school were the most substantial mediators of racial and ethnic disparities.
We found that harmful health behaviors, experiences, and outcomes were more common among black children and Latino children than among white children. Adjustment for socioeconomic status and the child's school substantially reduced most of these differences. Interventions that address potentially detrimental consequences of low socioeconomic status and adverse school environments may help reduce racial and ethnic differences in child health. (Funded by the Centers for Disease Control and Prevention.).
对于许多与健康相关的行为和结果，青少年中的种族和民族差异得到了充分的记录，但对于青春期前的与健康相关的差异知之甚少。
我们研究了美国三个大都市区的 5119 名随机选择的公立学校五年级学生及其家长。我们检查了黑、拉丁裔和白种儿童在 16 项指标上的差异，包括目睹暴力、同伴受害、攻击性实施、系安全带、戴自行车头盔、药物使用、歧视、恐怖主义担忧、剧烈运动、肥胖以及自我评估的健康状况以及心理和身体生活质量。我们使用部分调整模型测试了种族和民族差异的潜在中介因素（即社会人口统计学特征和儿童所在的学校）。
在所有 16 项指标中，黑种儿童与白种儿童之间存在显著差异，在 16 项指标中的 12 项中，拉丁裔儿童与白种儿童之间存在显著差异，尽管调整后的分析减少了许多此类差异。例如，在未经调整的分析中，目睹枪支威胁或伤害的黑人（20%）和拉丁裔（11%）的比率高于白人（5%），而每周进行剧烈运动的天数黑人（3.56 天）和拉丁裔（3.77 天）比白人（4.33 天）少（所有比较均 P<0.001）。经过统计学调整后，黑人和白人之间的这些差异减少了约一半，而拉丁裔和白人之间的差异则消除了。家庭收入，家庭最高教育水平和儿童的学校是种族和民族差异的最重要的中介因素。
我们发现，有害的健康行为，经历和结果在黑人和拉丁裔儿童中比在白种儿童中更为普遍。调整社会经济地位和儿童的学校后，这些差异中的大多数都大大减少了。解决低社会经济地位和不利学校环境可能产生的有害后果的干预措施可能有助于减少儿童健康方面的种族和民族差异。（由疾病预防控制中心资助）。
