Recent Social Disparities and Health (C2S) Research

Social Disparities, Stress, and Health

C2S Faculty Workshops Launched

Over the year, C2S launched a new, informal workshop series to promote discussion of and feedback for early and ongoing research projects. Five IPR C2S faculty presented their research over the year. For instance, topics discussed were health and human capital for 2,000 Chicago-born males by Joseph Ferrie, economist and IPR associate, and another on family structure and children’s healthcare by IPR social demographer Christine Percheski. The series is designed to bring together faculty from different disciplines to discuss and critique work.

Research Labs and Centers

In an effort to better understand how social disparities and health interact across the lifespan, C2S faculty have established five research labs across Northwestern. These labs are pushing research forward by investigating the links between the biological, medical, and social sciences with human outcomes and development. They also provide opportunities for students to engage in faculty research projects.

IPR biological anthropologist Thomas McDade, also director of C2S, founded and runs the Laboratory for Human Biology Research, which houses 1,500 square feet of wet-lab space and data-analysis tools. The laboratory is one of a handful in the country that is fully equipped to support high-capacity analysis of biomarkers in human blood, saliva, and urine, as well as assessing body composition, energy expenditure, and cardiovascular function. 

IPR health psychologists Edith Chen and Greg Miller launched the Foundations of Health Research Center in 2013 to study psychosocial and biological pathways in adults and children. They seek to link the social world to disease outcomes by asking questions like how relationships affect a person’s immune system. The family-friendly space accommodates confidential in-office interviews and health screenings. A state-of-the-art lab processes biological samples and data. Two National Institutes of Health (NIH) R01 grants support the research center.

IPR social psychologist Jennifer Richeson leads the Northwestern Social Perceptions and Communications Laboratory. The lab aims to study the ways in which social group memberships, such as race and gender, have an impact on the way people think, feel, and behave. In particular, lab members investigate prejudice and stereotyping from the perspectives of those groups who have traditionally been on the receiving end of them, as well as the groups who typically initiate such contact or actions. Through the development of these research streams, they hope to create a better understanding of diverse environments. Richeson holds the MacArthur Chair.

IPR psychologist and early cognition expert Sandra Waxman directs the Infant and Child Development Center, a developmental laboratory that welcomes parents and their children from birth to age 6. Projects focus on how infants and young children acquire language and how they acquire core cognitive capacities, and how these two come together in the developing mind.  The lab offers a warm, home-like space for participating parents and their young children. Waxman holds the Louis W. Menk Chair.

IPR psychobiologist Emma Adam examines the associations between stress, stress hormones, sleep, and executive functioning. Though much of her research is about implementing investigations in the field and collecting real-time data through diary studies, technology, and spit kits, she also runs a laboratory that stores and processes salivary biomarkers to track various human functions. 

"Skin-Deep" Resilience

Children exposed to social and economic adversity early in life show increased susceptibility to the chronic diseases of aging as adults. In ongoing research, Miller and a team of psychologists, pediatricians, and geneticists have been studying a group of 489 African American teenagers living in rural Georgia, most of whom are from working-poor families. While all of them are at risk for the usual negative outcomes often associated with being poor and black, as well as living in the rural South, a significant number of them exhibit resilience: They do well in school, maintain good mental health, and stay out of trouble with the law. Miller and his colleagues, who include Chen, recently asked whether this resilience also extends to physical health. It turns out that the resilience is only “skin deep.” Those youth doing well behaviorally, academically, and emotionally show worse health outcomes in a number of ways. In comparison with their peers, they tend to be more obese, have higher blood pressure, and seem more stressed, as evidenced by elevated production of certain hormones. In fact, their health looks worse than those among them who are poor and not doing well socioemotionally. The researchers published an article on these first findings in Psychological Science and are in the midst of trying to understand the negative impact of “social mobility” on health. The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Institute on Drug Abuse provided research funding.

Obesity Paradox and Diabetes

While some studies of heart diseases and chronic kidney failure have found solid evidence for the obesity paradox, where leaner individuals die of certain diseases at higher rates than their heavier peers, it is less certain for diabetes. Epidemiologist and IPR associate  Mercedes Carnethon and her co-author set out to test how much of a role adult weight plays in the risk for dying from diabetes by examining 18 longitudinal studies published between 1991–2013. In their Diabetes and Cardiovascular Disease article, they find that 13 of the studies demonstrate that mortality was lowest for those overweight—and that thinner adults died more frequently overall, specifically from cardiovascular disease and especially for adults aged 65 and up. This provides evidence of an obesity paradox for diabetes and calls for more research to explain these higher death rates and to identify effective strategies to manage diabetes as well as the associated mortality risk.

Racial Disparities in Causes of Death

IPR social demographer Quincy Thomas Stewart continues his investigation of racial disparities in mortality across the life course. In one project, he is examining significant racial disparities in hypertension, which is one of the leading causes of death for blacks. With Carla Keirns of Stony Brook University, he uses data from two linked mortality databases, the National Health and Nutrition Examination Survey III from 1988–1994 and the National Health Interview Survey from 1986–1996, to analyze the relationship between race, the probability of having one’s cause of death diagnosed as hypertension, and various social, economic, and health-related characteristics. Preliminary results reveal that blacks are one and a half times as likely as whites to have their causes of death reported as resulting from hypertension across the adult life course. They also show that the increased odds of labeling a black death as hypertension are only partially related to pre-existing reports of high blood pressure, high cholesterol levels, and diabetes, as well as subjective health status, body-mass index, socioeconomic status, and the exact location and region of death. These results suggest statistical discrimination in cause-of-death diagnoses whereby similar black and white males receive different death diagnoses. 

Perceived Discrimination and Health

In a project supported by an NIH "Grand Opportunities" award, Adam and her colleagues are attempting to understand how young people’s perceptions of racial/ethnic discrimination can be understood by chronicling their perceptions over time—and relating them to stress and health biomarkers. The researchers have 20 years of data from adolescence to early adulthood that include detailed information on different sources of stress, including race-related stress, plus measures of their family functioning, racial/ethnic identity, and coping mechanisms. In turn, the researchers are examining whether these factors affect how their genes register stress and levels of other stress-sensitive biological measures when reaching adulthood. Additionally, the study includes a seven-day diary study to capture how their perceptions of daily discrimination relate to levels of the cortisol stress hormone and sleep quality. It also launched an experimental protocol to examine how the participants physically react to race-related stress. Initial results reveal that both being African American and having a cumulative history of feeling discriminated against are associated with flatter and lower cortisol diurnal rhythms, a sign of chronic stress, in early adulthood. Discrimination histories alone, however, do not fully explain the racial-ethnic disparities in cortisol. NIH established the “Grand Opportunities” grants under the American Recovery and Reinvestment Act to support ideas that could lay the foundation for new fields of investigation. It is hoped that the resulting research will have a high short-term impact and enable growth and investment in the fields of biomedical R&D, public health, or healthcare delivery.

Skin Color and Discrimination

In the slave-owning South, lighter-color (mulatto) slaves, who were often biologically related to their owners, typically received preferential treatment over slaves with darker skin. Such preferential treatment has been found to persist in early 20th-century outcomes, but does skin color still matter today? In a Social Science Research article, a team of researchers, including Branigan, IPR sociologist Jeremy Freese, and McDade, assess how skin color affects education for black and white men a women since the Civil Rights era. They use data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study, which offers 20 years of background data and a continuous, more precise measure of skin color, or spectrophotometery (instead of self-reports), that records the percentage of light reflected off skin. For black men and women, they find those with lighter skin do better in terms of education. Given that white female and black male and female participants register approximately the same magnitude of association between skin color and educational attainment, this suggests a need for more research. It could be that ethnic white women are also experiencing discrimination based on appearance. For white men, any relationship between skin color and attainment is tenuous, with analyses suggesting that differences result from family background. These findings suggest that “white” has been typically dealt with as a blanket category, and more research is needed to better understand discrimination on the basis of skin color for blacks and whites. Freese is Ethel and John Lindgren Professor of Sociology.

Effect of Financial Debt on Health

Household financial debt in America has risen dramatically in recent years. In Social Science and Medicine, former IPR associate Elizabeth Sweet, now at the University of Massachusetts, Boston, Arijit Nandi of McGill University, Adam, and McDade are among the first to investigate the impact that financial debt could have on a person’s mental and physical health. The researchers examined self-reports of debt and health for more than 8,400 24- to 32-year-olds in Add Health. Those with high levels of self-reported financial debt (who would remain in debt even if they sold all their assets) also reported being more stressed and depressed, in addition to reporting worse health and a higher diastolic blood pressure, an indicator of hypertension. Even after controlling for several health and demographic factors, including prior socioeconomic status, the findings remained significant. The results suggest that debt is an important socioeconomic determinant of health.

Measuring Teen Stress

Most measures of stress do not capture the different sources of stress in adolescents’ lives, including poverty, discrimination, and neighborhood stress, as well as family, peer, and academic stressors. In the Cities’ Stress and Learning Project, Adam, Chen, and Kathryn Grant of DePaul University are developing and validating a new, comprehensive measure of adolescent stress. They are implementing it in a study of more than 300 Chicago students, 11 to 18 years old.  Their assessment battery integrates student and parent questionnaires, one-on-one interviews, daily diary entries, and objective measures of sleep and stress biology. Much of this measurement is being carried out during full days of onsite testing with the adolescents, but the effects of everyday stress on daily functioning are also captured in a four-day diary study for 130 youth. Adam seeks to understand links between teens’ stress and academic performance by examining what types of stressors trigger stress hormones, and in turn, how stress hormones affect cognitive functioning. To test this, iPads and iPods are being used to test teens’ cognitive functioning in the laboratory and at home. Some preliminary results include validation of a new stress reactivity task, a modified version of the Trier Social Stress Task, in which individual students give speeches in front of a panel of judges, which can be done for up to eight students at a time and can be used to help understand physical and emotional health outcomes. They also have examined bullying and depression for lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth, with initial results indicating that bullying has a larger effect on LGBTQ youth than their heterosexual peers. An NIH grant supports the project.

LGBTQ Health and Wellness

Held the same day as the signing of Illinois’ marriage equality bill, the second annual Chicago LGBTQ Health & Wellness Conference took place at Northwestern Memorial Hospital on November 20. Co-organized by Northwestern’s IMPACT LGBT Health and Development Program and the Sexual Orientation and Gender Institute, IPR was a co-sponsor. The conference brought 180 researchers, service providers, and students together to focus on translational LGBTQ health research around the theme of Health and Wellness Across the Lifespan. New and complex health issues are emerging for the LGBTQ population, such as LGBTQ youth coming out at earlier ages, the impact of same-sex marriage and co-parenting, and the demographics of the first openly gay seniors. Psychologist Brian Mustanski, an IPR associate who leads the center, welcomed the keynote speakers Lawrence Tabak, deputy director of the National Institutes of Health, and Columbia University professor Walter Bockting, co-director of the LGBT Health Initiative. 

Social Context and Sexual Migration

Sociologist and gender studies researcher Héctor Carrillo, an IPR associate, spent a year as a Maury Green Fellow at the Radcliffe Institute for Advanced Study at Harvard University, where he worked on a book manuscript tentatively titled “Social Context, Sexual Migration, and the Mexican Gay Diaspora.” In it, Carrillo describes the results of an ethnographic study of gay, male Mexican migrants who relocated to the United States because of their sexuality. He traces the gay migrants’ sexual socialization in Mexico, why they left, and how they meld into gay communities in the United States. He also analyzes how the effect of migrating from Mexico to the United States affects their sexuality and risk for HIV. Carrillo hopes the book will fill gaps in the understanding of transnational mobility, the formation of local gay communities, and global sexual cultures.

Interventions for Prostate Cancer Survivors

Prostate cancer is the second leading cause of cancer-related death for U.S. men. Most cases are diagnosed early and have very high survival rates, but among men diagnosed in advanced stages, 5-year survival rates are much lower—about 30 percent, and advanced-stage treatments can have chronic and debilitating side effects. IPR associate Frank Penedo and his colleagues recently examined the relationships between stress, stress management skills, and health-related quality of life in an ethnically diverse sample of 77 participants with advanced prostate cancer and a median age of almost 70. Their results, published in the Journal of Clinical Psychology in Medical Settings, demonstrate that stress management skills and lower perceived stress are linked with better physical functioning and emotional well-being. They underscore that stress management skills could affect patients’ quality of life by lessening their ongoing perceptions of stress. Penedo is Roswell Park Professor of Medical Social Sciences and Psychology. He leads the Cancer Control and Survivorship program in Feinberg’s Robert H. Lurie Cancer Center.

Measuring Quality of Life

With cancer treatments continually improving survival rates, experts like IPR associate David Cella are increasingly interested in understanding the implications of such treatments in terms of self-reported symptoms and quality of life. Cella, an expert on patient-centered outcomes, has been involved in a variety of research studies concerning oncological treatments and evaluations of life quality. Examining the increasing importance of rapid and reliable health-related quality-of-life (HRQOL) assessments in a study of 533 oncology patients with advanced cancer, the authors confirmed that the FACT-G7 quality-of-life assessment was reliable for evaluating patients’ top-rated symptoms. It was published in the Annals of Oncology. In a British Journal of Cancer article, Cella and his colleagues report on their study of patient-reported outcomes and quality-of-life measures for kidney cancer. An evaluation of two metastatic renal-cell carcinoma second-line drug therapies, axitinib and sorafenib, indicate that patient-reported outcomes remained at high levels for those receiving the treatments. Beyond examining treatments and measurements of physical health, Cella’s work also involves research on emotional health as an important factor connected to physical health. This work has included an investigation of adding brief measures of emotion to the National Institute of Health’s Toolbox of Neurological and Behavioral Function, published in Neurology. From it, the authors were able to identify four new domains—negative affect, psychological well-being, stress, and self-efficacy—and validate them as an effective way for measuring emotional health in further research using the NIH Toolbox. Cella is professor and founding chair of the Medical Social Sciences’ Department.

First Global Cultural Neuroscience Conference

The first conference of the International Cultural Neuroscience Consortium was held May 10–12 at Northwestern. It welcomed a diverse representation of more than 50 scientists involved in cultural neuroscience research from around the world. Three IPR faculty worked on its organization: Chen, IPR anthropologist Rebecca Seligman, and Joan Chiao, a neuroscientist and IPR associate. The conference explored interdisciplinary, international approaches of cultural neuroscience with a particular emphasis on those theoretical and empirical advances that could help close the gap in population health disparities. Some of the conference themes included methodological and conceptual issues, emotion and motivation, culture-gene interactions, and population mental health disparities. Robert Turner of Germany’s Max Planck Institute delivered the keynote. Turner’s ideas helped shape the development of magnetic resonance imaging, or MRI. The forthcoming “Oxford Handbook of Cultural Neuroscience” will summarize the major conference presentations.

Sexual Health as Buzzword

While on a Guggenheim Fellowship, sociologist and IPR associate Steven Epstein conducted research for his book manuscript on “sexual health,” an idea that has gone from obscurity to ubiquity during the 21st century. The explosion of discourses, practices, techniques, and industries can be traced in the worlds of public health and biomedicine through the birth of journals, centers of research, professional associations, and training programs around the world. At the same time, the convergence around the specific term masks a remarkable diversity of scientific, political, economic, and cultural agendas. Epstein, who is John C. Shaffer Professor in the Humanities, seeks to understand the contexts in which the term has arisen and the consequences of attempts to lay claim to it, providing insight into the character and functions of buzzwords. He has identified 12 different “sexual health” threads representing the term’s divergent meanings in the public discourse, the dominant one being discussion related to sexually transmitted infections. He also suggests steps toward the development of “buzzword studies.” 

Intergenerational Perspectives on Health Disparities

Heritability of Educational Attainment

Using a meta-analysis of globally diverse samples, Freese and Northwestern graduate students Amelia Branigan and Kenneth McCallum consider how genetic differences might influence educational attainment in various environmental contexts in a Social Forces article that was originally an IPR working paper. Their results indicate that for men and those individuals born in the latter half of the 20th century, genetic variation explains more of the variance in attainment, whereas shared environment explains more of the variance in attainment for women and those born in the earlier half. Their findings demonstrate that the heritability of educational attainment is itself dependent on environment, suggesting that variables such as a person’s nation of origin, gender, and year of birth influence how much genetic and environmental factors come to explain variation in educational attainment. 

Maternal Nutrition and Birth Outcomes

In the ongoing Cebu Study in the Philippines, IPR anthropologist Christopher Kuzawa is leading an effort to track the third generation of children born in the study and use the more than 30 years of collected longitudinal data for each mother to illustrate how her nutritional experiences can affect fetal growth and the birth weight of her children. Supported by NIH, Kuzawa and his team of researchers completed a pilot study in 2013. In it, they studied the structure, function, and epigenetic state of placentas collected in a sub-sample of these pregnancies. Some of their early data reveal that grandmothers’ diets are better predictors of their grandchildren’s health than those of the children’s mothers. Higher birth weights and better health were seen in those children whose grandmothers had consumed more calories when pregnant with their mothers, suggesting intergenerational effects of diet on the grandchildren's birth outcomes. 

Culture in Mental and Physical Illness

Seligman’s research continues to raise awareness of the cultural and social factors that shape a people's experiences of mental and physical illness. Over the year, she completed a book manuscript titled “Possessing Spirits and Healing Selves: Embodiment and Transformation in an Afro-Brazilian Religion” (Palgrave MacMillan, forthcoming), an ethnographic study of an urban Afro-Brazilian spirit possession religion. In it, she documents how political, economic, and social conditions shape embodied subjectivities in ways that are instantiated in physiological systems. She explores the mechanisms through which religious participation can improve health and well-being by reshaping such embodied forms of selfhood. 

Effects of Early Environments on Health Trajectories

Human Language and Cognition

A study published in the Proceedings of the National Academy of Sciences about how babies respond to lemur calls and human speech sheds light on the origin of the link between human thought and speech. Previous studies have indicated that even in infants too young to speak, listening to human speech supports core cognitive processes, including the formation of object categories. Lead author Alissa Ferry, a former Northwestern graduate student now a postdoctoral student at the International School for Advanced Studies in Italy, Northwestern psychologist Susan Hespos, and Waxman studied how 72 infants responded to human, lemur (near-human), and mechanical (non-human) calls. Their much-reported findings reveal that at 3 and 4 months, infants processed lemur calls much in the same way as they did human speech. By 6 months, however, the infants’ cognitive antennae were most attuned to human language and less receptive to the others. Thus, over a short period, the infant mind rapidly learned to identify the signals from their language and then systematically linked them to meanings. This study implies that learning alone does not fully explain the point at which language and categorization first come together.

Waxman is also working on several new studies to shed more light on how cognition and language are linked in very young children’s minds. This includes a study of whether children aged 2 and under learn nouns before verbs. The main finding published in Child Development Perspectives is that before 24 months, infants learning any language can successfully and robustly map novel nouns to objects, but mapping verbs to events is more variable and is dependent on their native language and the linguistic context surrounding their learning of verbs. This finding sheds new light on the long-standing debate of whether infants’ learning nouns more rapidly than verbs is universal or specific to their native language—and it calls for a paradigm shift in research. For future studies, Waxman and her colleagues suggest that researchers should seek to include children 24 months old and younger in their experiments. Characterizing languages as either “noun friendly” or “verb friendly” should also be avoided, instead adopting a more nuanced treatment of the properties of each language and the consequences of these properties on infants’ acquisition of linguistic structure and meaning.

Neonatal Health and Development

An IPR working paper by economists David Figlio and Jonathan Guryan and their colleagues makes use of a new data resource—merged birth and school records for all children born in Florida from 1992–2002—to study the effects of birth weight on cognitive development from kindergarten through high school. They find effects of birth weight on cognitive development for single births and in twin comparisons—and that these remain constant over the children’s schooling. The researchers also demonstrate that these effects are very similar across many family background factors, including parents’ levels of education, income, age, race/ethnicity, immigrant status, etc., and that they are invariant to measures of school quality. This leads them to conclude that the effects of poor neonatal health on adult outcomes are set very early. The other co-authors are  IPR postdoctoral fellow Krzysztof Karbownik and Jeffrey Roth of the University of Florida. Figlio is Orrington Lunt Professor of Education and Social Policy and IPR director. The paper is forthcoming in American Economic Review.

Birth Weight and Health Outcomes

Kuzawa continues to be involved in a unique global collaboration that pools data from five large birth cohorts in Brazil, Guatemala, India, the Philippines, and South Africa—known as the Consortium of Health-Oriented Research in Transitional Societies (COHORTS). These studies have the explicit goal of informing policy related to early life nutritional supplementation in transitional economy settings. In Pediatrics, he and his fellow researchers published a study that examines links between a mother’s height and her child’s growth over four key periods of development: birth, age 2, age 2 to mid-childhood (around ages 4 to 9), and then mid-childhood to adulthood. They studied 4,518 adult participants and their mothers across the five counties, revealing remarkably similar results between the countries—even with large differences in the occurrence of pre-term and low-weight births. Their key result is that children who are born either premature or at term, but small, tend to be shorter as adults and do slightly worse in school when compared with the healthy-weight, full-term babies in the study. Increased postnatal growth, however, leads to gains in height and schooling regardless of birth status, but not the potentially unhealthy increases in blood pressure or blood glucose levels found in highly industrialized settings. These results are encouraging for programs that seek to improve nutrition for children in their first two to three years of life.

Autism and Early Intervention

Using the same Florida data set, Figlio and his colleagues, including IPR graduate research assistant Claudia Persico, are conducting a first-ever, population-level study of early-intervention effects on children with autism spectrum disorders. While many small-scale studies have evaluated the effects of autism treatment X versus treatment Y in early childhood, this is the first quasi-experiment designed specifically to examine the effects of being diagnosed and treated early. Their study evaluates Early Steps, a statewide early diagnosis and intervention program. Researchers measured the effect distance had for families visiting one of the 18 centers, learning that children living in the same community as a center were twice as likely to receive early services than those more than 30 miles away. Their study reveals that autistic children who are diagnosed and receive interventions and help by the age of 3 perform dramatically better in school later on. They score substantially better on standardized tests and are far less likely to engage in behaviors that could lead to being suspended from school. These results indicate the very positive role for early detection and intervention for children with autism-spectrum or related disabilities.

Infant Environments, Inflammation, and Stress

Current understanding of inflammation and its role in pathways to disease is based almost exclusively on research conducted in clinical settings in affluent industrialized populations like the United States. McDade and his colleagues are leading an effort to conduct community-based research in emerging industrialized countries, such as the Philippines and Ecuador. Such studies are confirming that findings from highly industrialized nations cannot be universally applied. To wit, a study published in Brain, Behavior, and Immunity examines how psychosocial stressors, such as adult perceptions of stress and childhood adversity, are associated with elevated concentrations of C-reactive protein (CRP) for 1,622 young Filipinos. In particular, McDade and his fellow researchers consider how the participants’ contact with germs and what they ate as infants affects links between stressors and CRP in adulthood. The regression models reveal significant interactions between perceived stress and three factors: the infants’ physical environment (including exposure to animal feces), the season in which they were born, and their weight at birth. For those children who suffer childhood adversity, measured as the absence of a parent in this study, they see higher levels of CRP in adulthood, but not for those children who were exposed to non-hygienic environments as infants. This suggests, as does their previous research in Ecuador, that children who grow up in “more hygienic” environments or suffer from a lack of prenatal nutrition as indicated by low birth weights—no matter the country—have more inflammation as adults. These results indicate that early environments shape the regulatory networks of young adults and thus their biological responses to stress. This and other studies underscore why it is valuable to use a comparative, developmental approach in research on social environments, inflammation, and disease.

Models of Disruptive Behavior

IPR clinical and development psychologist Lauren Wakschlag continues work on the MAPS preschool study of 3,300 socioeconomically and ethnically diverse preschoolers, supported by the National Institute of Mental Health. One of her major successes in 2013 was the validation of a new survey, the Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB), across these diverse groups. The survey is helping to establish a “science of when to worry” about preschoolers’ behavior. Across a range of misbehaviors, her team has shown that though exhibiting some misbehavior is common for young children, it does not predominate. Most exhibit disorderly behaviors, such as throwing a tantrum, not complying, and being aggressive, but less than 10 percent exhibit them daily. This pattern is the same for preschoolers no matter their economic background or ethnicity. Similarly, the behaviors’ intensity, context, and regulation allow one to distinguish typical and atypical patterns. For example, most preschoolers will have tantrums, but tantrums lasting more than five minutes are uncommon. These results might eventually provide empirically based indicators that pediatricians, teachers, and others can use to identify those children in need of a mental health referral. Wakschlag is Vice Chair for Scientific and Faculty Development in Northwestern’s Department of Medical Social Sciences.

Adolescent Smoking Interventions

Wakschlag also co-authored several articles over the year that examined aspects of smoking, in particular for teens. In Developmental Psychology, she and her colleagues observed conversations between parents and 344 teens who had experimented with smoking. The researchers then followed the teens’ smoking-related behaviors over two years. After coding more than 500 videotapes of parent-teen discussions about smoking, the researchers find that teenagers were more likely to smoke more over the following two years if their parents started the discussion of smoking and if the teen smokers sought to keep their smoking secret. In another two-year study of 111 ninth- and tenth-graders at risk for smoking, Wakschlag and her colleagues separately examined their mothers’ and fathers’ communication and control styles, asking if the parenting styles could predict whether their children experience negative feelings and emotions (negative affect). Whether or not teens smoked, the data show that their mother’s parenting style is important to the risk of how much they might smoke in the future. Moms with a more controlling style have children with higher levels of negative affect. Reducing negative affect among youth experimenting with smoking can lessen their risk of smoking more later on. This suggests family-based prevention efforts to address teens’ experimentation with smoking and whether it should take into account how parents generally communicate and parental tendency for control. The Journal of Clinical Child and Adolescent Psychology published the article.

Intellectual Disability, Autism, and Language

Fragile X syndrome (FXS) and Down syndrome (DS) are the two leading genetic causes of intellectual disability, and FXS is the most common known genetic condition associated with autism. Both are associated with significant language impairment, but little is known about developmental changes in expressive language across domains over time, or the role of autism symptoms on language development in FXS. IPR associate Molly Losh, Hoffman Associate Professor of Communication Sciences and Disorders, and her colleagues compare three domains of language production—vocabulary, syntax, pragmatics—over time within and across groups of boys with FXS both with and without autism spectrum disorder, boys with DS, and typically developing boys. Expressive language skills and growth across various domains, they find, are more impaired in boys with FXS and DS than would be expected based on non-verbal mental age; for boys with DS, syntax is more impaired than expected based on intellectual disability; and autism status disproportionately affects pragmatic language in boys with FXS. Their results indicate that different domains of language production are critical to assess, revealing a need to consider autism status in evaluating language profiles and tailoring interventions. 

Families, Interpersonal Relationships, and Health

Disadvantaged Youth and Asthma

Why do socially and economically disadvantaged youth have worse asthma outcomes? Chen and her colleagues in the Foundations of Health Research Center seek to detect multilevel contributors to asthma disparities in 8- to 17-year-olds by identifying social, physical, and environmental factors at neighborhood and family levels, as well as individual psychological factors, that can contribute to the disease and its progression. At the same time, the researchers are attempting to link these factors to multiple levels of human biology—organs, cells, and genes—to create plausible explanations of how broader contextual factors can alter biological pathways that lead to worse cases of clinical asthma in young people. NIH’s National Heart, Lung, and Blood Institute provides funding for the project.

Resilience and Role Models

In a study published in Child Development, Chen and her colleagues are the first to test if positive role models and “shift-and-persist” approaches could protect at-risk youth from cardiovascular disease later in life. Such approaches allow individuals to “shift” by discovering ways to adapt to stressful situations and “persist” by finding the optimism to hold on to long-term goals. The researchers interviewed 163 13- to 16-year-olds and one of their caregivers from a variety of different social and economic backgrounds about the youths’ role models and shift-and-persist measures. At the same time, the researchers took blood samples from participants to assess risk factors for cardiovascular disease, including cholesterol levels and the inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP). Those youth from low-socioeconomic-status (SES) backgrounds who described having supportive role models had lower levels of IL-6, as did those high in shift-and-persist strategies. Shift-and-persist strategies partially mediated the interaction between SES and role models on IL-6. No benefits were found for those from higher-SES backgrounds. The study results suggest that shifting and persisting must occur together for youth from low-SES backgrounds to reap potential physiological and health benefits, and that teaching such “self-strategies” to low-income youth could constitute an effective, long-term approach to reducing health disparities.

Living with HIV

Celeste Watkins-Hayes, a sociologist and African American studies scholar, continues work on her research project to document how women of different racial, ethnic, and socioeconomic backgrounds negotiate living with an HIV diagnosis. She gave one of the keynote talks at the annual conference of the Women’s Research Initiative on HIV/AIDS in April, sponsored by The Well Project. In it, Watkins-Hayes discussed her Health, Hardship, and Renewal (HHR) Study, which is supported by grants from the Robert Wood Johnson Foundation and the National Science Foundation. For the study, now in its fifth year, she and her team are interviewing more than 100 HIV-positive African American women in the Chicago area. The interviews explore how the women acquire and use economic resources and the disease’s impact on their daily living, health management, and social well-being. The researchers also investigate the role of nonprofits and government institutions that help the women cope, with part of the HHR study examining Chicago-area AIDS service providers to determine how they are helping the women to respond. The study is highlighting the socioeconomic consequences of HIV/AIDS for an urban, female population, and it seeks to inform policymakers, healthcare providers, and others on how to address the epidemic.

Contexts of Fatherhood

Humans are among the rare mammals in which fathers are involved in rearing offspring, which recent work suggests has left its mark on male biology and behavior. Kuzawa is adding to a growing body of work on the topic, including how testosterone influences male mating and fatherhood. He has partnered with many colleagues, including Lee Gettler, a former IPR graduate research assistant now at the University of Notre Dame, and IPR’s McDade. In 2013, Kuzawa received a new grant from the National Science Foundation to extend the study of biology and social context of fatherhood. Building on prior longitudinal data from the Cebu Study, the research team will follow male cohort members, now 30 to 31 years old, for follow-up hormone analysis. They will also gather more in-depth information on relationship quality, child development, and patterns of childcare within the household. The researchers aim to provide a better understanding of the role that fathers play in their children’s upbringing, as well as the social and family factors that influence how much fathers get involved. They also hope to evaluate how hormonal changes, such as declining testosterone levels, affect behaviors that could contribute to a couple’s relationship stability and their child’s development. The researchers published several articles over the year using data from the study, including how responsiveness to the hormones progesterone and estrogen affects father-toddler interactions in the American Journal of Human Biology.

Health Benefits of Volunteer Work

New evidence points to physical and mental health benefits in teens who volunteer, which led to an “Advice for Patients on Adolescent Volunteering” in addition to an article in JAMA Pediatrics. The evidence came from a randomized study of 100 high school students in British Columbia, published in the same issue and co-authored by Chen, Hannah Schreier of New York University, and Kimberly Schonert-Reichl of the University of British Columbia. The students signed up to volunteer in an after-school program at a nearby elementary school. Half were assigned to start immediately, the other half were assigned to start the following semester. All 100 of the student volunteers underwent a battery of cardiovascular risk assessments at the beginning and at the end of the intervention period. Those students who had been volunteering exhibited lower levels of cardiovascular risk, such as lower cholesterol levels, than those still waiting to volunteer. This is the first empirical study revealing that regular volunteering can improve risk markers for cardiovascular disease. These findings offer a novel way to improve health while contributing to society.

Health Disparities Among Mexican Immigrants

Another of Seligman’s projects focuses on disparities in mental and physical health among Mexican immigrants in the United States. Her mixed-methods research on diabetes and depression among first- and second-generation Mexican immigrants suggests that in this population, causes of diabetes include various forms of social suffering and emotional distress related to things like noxious living situations, immigration, and gender-based violence. A forthcoming article focuses on how a person’s orientation toward self and family affects management of their diabetes, with implications for the development of effective, culturally sensitive medical interventions for Mexican Americans with the disease. She is also working on a new project that investigates the subjective experiences of Mexican adolescents receiving psychiatric care. Mexican youth in the United States are disproportionately vulnerable to depression, anxiety, and suicidal behavior.

The Suffocation of Marriage

Psychologist and IPR associate Eli Finkel is distilling insights from historical, sociological, and psychological analyses of marriage to develop a “suffocation model of marriage in America.” What the model suggests is that Americans have changed their expectations for marriage. In the past, Americans relied on marriage to meet physical and safety needs; today, they expect less of this and instead expect their marriages to fulfill their feelings of self-esteem and self-actualization. The issue is that such changes demand a greater investment of time and psychological resources to foster these bonds, yet most Americans are investing less in their marriage, not more, with time primarily being soaked up by child rearing or longer work days. As a result, overall levels of marital quality and personal well-being are declining. The “suffocation” model uncovers several promising options for counteracting these trends—all of which call for investments of time and energy, but such investments can be maximized, Finkel says. Examples include a simple, but very effective, 21-minute writing intervention, in which couples take a third-party view in writing about conflict in their marriage.  The project aims to provide a better understanding of dating and courtship, sociodemographic variation, and marriage within and beyond America’s borders. Psychological Inquiry published two articles on the model.

Embodied Cognition and Guilt

How does one confront past atrocities, such as the Armenian Genocide, the Rape of Nanking, and the recent chemical weapons attack in Syria, when you are a member of the group deemed responsible for propagating the misdeeds? Research has shown that when confronted with such acts, the perpetrators—and members of their group including their descendants—frequently engage in victim-blaming, minimizing the harm done, and even outright denial. While these reactions serve to psychologically buffer the “blamed” members from feelings of guilt, they also pose a serious roadblock to trying to educate people about adverse events from their group’s shared history and to offering apologies and reparations. IPR social psychologist Jennifer Richeson and IPR graduate research assistant Katie Rotella published an article in the Journal of Experimental Psychology that examines how subtle inductions of guilt shape responses to personal and group wrongdoing. They led an experiment using embodied cognition, where they manipulated participants’ body postures. Embodied cognition is how physical expressions, such as giving a thumbs-up or frowning, can affect how people feel and process information. In the study, they ran two experiments. In the first, they tested personal guilt by randomly assigning participants to either a posture of guilt or of pride—and then asked them to hold the pose while reading an ambiguous first-person account of an act of wrongdoing. They then had the participants fill out a questionnaire in which they reported about how guilty they felt about the act of wrongdoing and if they felt compensation was needed. A similar second experiment tested if embodying a guilt posture could shape levels of collective rather than personal guilt regarding an act of wrongdoing. The research provides strong evidence that embodiment can induce feelings of guilt reparative intentions. Specifically, holding a guilt posture increases feelings of collective national guilt in response to wrongdoing that then makes participants more approving of symbolic and financial reparations.

Biomarker Development and Deployment

Exploring Environment and Human Health Links

Recent findings suggest that nearly three-quarters of the risk for developing chronic diseases and cancers is due to environmental factors, which covers interactions between our environment and our genes. The environment’s role, however, in disease etiology remains largely unknown. New discovery-based approaches are critically needed to better characterize the human “exposome.” While it is not currently possible to measure all chemicals in the human body in single experiments, important classes of chemicals can be targeted using discovery-based approaches. IPR associate William Funk and colleagues define a new biomarker discovery strategy using protein “adduct” (addition product) profiles as molecular fingerprints of exposure to environmental stressors. By comparing adduct profiles across populations with different types of health or exposure, it should be possible to zero in on particular adducts and key precursor molecules.

Birth Weight and Breast-Feeding

In an IPR working paper, a team of IPR C2S researchers examine links between breast-feeding, birth weight, and chronic inflammation, which is an indicator of increased risk for heart attack and diabetes, for nearly 7,000 24- to 32-year-olds. The researchers hypothesize that birth weight and how long an individual was breast-fed might determine levels of C-reactive protein (CRP)—a biomarker of chronic inflammation in adults and a risk factor for heart disease. Using National Longitudinal Study of Adolescent Health (Add Health) data, McDade and co-authors, including IPR faculty Adam and Craig Garfield, uncover dramatic disparities. More educated mothers, whites, and Hispanics were more likely to breast-feed. They also show that both lower birth weights and shorter periods of breast-feeding predicted higher CRP levels in young adults, and thus higher disease risk. A study innovation is the use of sibling comparison models, which control for many of the factors that might bias previous estimates of these impacts on adult health outcomes. The research indicates that efforts to promote breast-feeding and improve birth outcomes might have clinically relevant effects on reducing levels of chronic inflammation and lowering risk for cardiovascular and metabolic diseases in adulthood.

Measuring Inflammation

Inflammation is an important part of normal immune function, but excessive or dysregulated inflammation contributes to the course of many diseases. It is important to measure how social and ecological factors over the life course affect the regulation of inflammation, but this is most often done by puncturing a vein with a needle for blood samples. In joint work, Miller and McDade focus on dried blood spots (DBS)—drops of whole blood collected from a simple finger stick—as a minimally invasive, cost-effective alternative to collecting samples from large numbers of study participants. McDade has already pioneered DBS methods for measuring proteins that are involved with inflammation. Now, the pair wants to extend this work down to the molecular level to determine if it can also be used to measure the activity of genes (RNA) and processes that regulate them (DNA methylation). In this work, the DBS approach to molecular work will be assessed for precision and reliability—and evaluated against the gold standard of venipuncture methods. The development of such methods for quantifying gene expression and DNA methylation will facilitate future community-based research on inflammation. It has the potential to advance scientific understanding of inflammation as a key pathway through which social environments contribute to health over the life course. NICHD provided project funding.

Inflammation and Depression

In industrialized nations like the United States where there is little infectious disease and a “cleaner” environment, depression is linked with chronic inflammation. Yet in countries where inhabitants are exposed to more bacteria and microbes, less is known about this link. Again using data from the Cebu Study, McDade and his colleagues measured the inflammation markers CRP and IL-6 in two samples of 20- to 22-year-olds and 35- to 69-year-old women. The results reveal low concentrations of both, with no statistical significance found for a link between depressive symptoms and inflammation in either sample. Based on prior research, the researchers interpret the results as an indication that when infants are exposed to more microbes and germs, such exposures lead to long-lasting effects on how a person’s body regulates inflammation—and the lack of an interaction between the two possibly severs any connection between depression and inflammation in adulthood.  

Social Influences on Early Adult Stress Biomarkers

In this NIH-funded project, Adam is collaborating with McDade, IPR developmental psychologist Lindsay Chase-Lansdale, IPR social psychologist Thomas Cook and IPR affiliate and economist Greg Duncan on using the nationally representative Add Health study to examine whether stressors experienced during the adolescent and adult years are predictive of stress-related biomarkers in young adulthood. In particular, the project aims to examine whether changes in stress-related biomarkers as a result of chronic stress might help explain the emergence of socioeconomic and racial/ethnic health disparities. A number of findings have emerged, including that exposure to adverse relationship events in adolescence, including loneliness, loss, low parent warmth, exposure to violence in a romantic relationship, and romantic relationship instability are associated with worse mental and physical health outcomes in early adulthood.  Findings from then-IPR graduate research assistant Lindsay Till Hoyt, now a Robert Wood Johnson Health and Society Scholar at the University of California-San Francisco and Berkeley, show that measures of positive well-being in adolescence that include positive mood, high self-esteem, and optimism can predict better health behaviors and young adult health, above and beyond the effects of depression in addition to a wide range of other demographic and adolescent health covariates. More recent findings indicate that chronically low amounts of time spent sleeping (sleep hours) across adolescence and early adulthood can predict increases in risk markers for metabolic diseases, which include obesity, hypertension, and high cholesterol.