# Disparate Exposures, Disparate Outcomes: The Effect of Cumulative Disadvantage

> **NIH NIH R00** · RESEARCH TRIANGLE INSTITUTE · 2020 · $248,721

## Abstract

Project Summary/Abstract
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,...

## Key facts

- **NIH application ID:** 9929965
- **Project number:** 5R00MD011304-04
- **Recipient organization:** RESEARCH TRIANGLE INSTITUTE
- **Principal Investigator:** Mercedes Aurelia Bravo
- **Activity code:** R00 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $248,721
- **Award type:** 5
- **Project period:** 2016-09-27 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9929965

## Citation

> US National Institutes of Health, RePORTER application 9929965, Disparate Exposures, Disparate Outcomes: The Effect of Cumulative Disadvantage (5R00MD011304-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9929965. Licensed CC0.

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