Recent Social Disparities and Health (C2S) Research

Social Disparities, Stress, and Health

Preterm Birth and Stress

Preterm birth, or when a baby is delivered before 37 weeks of gestation, is the leading cause of infant morbidity (disease, illness, or injury within infants) in the United States. One potential contributor to preterm birth is chronic maternal stress. Obstetrician and IPR associate Ann Borders identifies pathways that might prevent preterm birth through decreasing maternal stress. In a review of maternal stress interventions to reduce preterm birth in Clinical Obstetrics and Gynecology, she finds that group prenatal care is the stress intervention most associated with reducing preterm births across the board: Women who took part in prenatal care groups increased their self-esteem and decreased their stress and social conflict during their third tri mesters of pregnancy. Other interventions, such as home visitation and support via telephone, only benefitted certain groups, such as unmarried teenagers and black women over the age of 18. Borders is adjunct assistant professor in medical social sciences in Northwestern’s Feinberg School of Medicine.

"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, IPR health psychologists Greg Miller, Edith Chen, and a team of psychologists, pediatricians, and geneticists, have been studying a group of 489 African American teenagers living in rural Georgia, who are mostly 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 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 wrote an editorial with their colleague Gene Brody of the University of Georgia that appeared in The New York Times, outlining their theory and results on this topic. The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Institute on Drug Abuse (NIDA) provided research funding.

Adolescent Origins of Chronic Diseases

African Americans in the rural South are among the most disadvantaged populations in the United States when it comes to chronic diseases of aging (CDAs), such as heart disease and Type 2 diabetes. Many CDAs incubate in physiological symptoms for decades before manifesting, and past research suggests that health factors in midlife cannot fully explain why rural African Americans experience such high rates of CDAs. With funding from an NICHD R01 grant, Miller, Chen, and Brody are examining how stress during childhood, adolescence, and young adulthood might contribute to CDAs in this population. They will draw on data from Brody’s Strong African American Families Healthy Adult Project (SHAPE), which followed 493 low-SES African American youth in rural Georgia from ages 11–20. The current project will extend SHAPE by collecting data from participants at ages 22 and 24. Since most participants will be looking for employment during these years, they will likely be exposed to high levels of stress and become more vulnerable to CDAs. Of course, not all of the SHAPE youth will demonstrate similar vulnerability to CDAs after being exposed to stress; some will react better than others. Miller and Chen will look at why this is the case. The results of their analysis will be critical for public health scientists and practitioners in determining why some people are more at risk than others and which factors, including mechanisms in young adulthood and even earlier, might lower CDA risk for all.

Autism and Early Intervention

IPR Director and education economist David 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 with a Florida dataset. 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. The 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 age 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.

Fragile X and Autism Diagnosis

Fragile X syndrome (FXS) is one of the two leading genetic causes of intellectual disability, and it is the most common known genetic condition associated with autism. Research has suggested that 60–74 percent of FXS males and 16–45 percent of FXS females meet the criteria for an autism spectrum disorder (ASD). In the Journal of Intellectual Disability Research, IPR associate Molly Losh, who holds the JoAnn and Peter Dolle Chair in Learning Disabilities, and her colleagues look at how often individuals with FXS are actually diagnosed with ASD in a clinical setting. They studied 35 female and 51 male children with FXS, with a mean age of 10 years old, determining that about half of the children met the criteria for ASD—and that ASD occurred three times more frequently in males. However, only around 25 percent of study participants received a clinical diagnosis of ASD. This suggests that ASD in FXS might be underdiagnosed in clinical settings, which could influence FXS access to autism-related services, including those related to education and healthcare.

Measuring Stress in Adolescence

In a National Institutes of Health (NIH)-funded study involving more than 300 Chicago Public School students between the ages of 11 and 18, IPR developmental psychologist Emma Adam and her collaborators, Chen, and Kathy Grant from DePaul University, are validating a new comprehensive measure of adolescent stress and examining associations between adolescent stress exposure and a wide range of emotional, health, and academic outcomes. One area of particular focus for Adam is examining associations between stress, stress hormones, sleep, and executive functioning, measured with computer tasks in a laboratory setting and in the home during the course of a four-day diary study. The researchers have published a validation study of a new groupbased social stress measure, showing that a public speaking task, in which adolescents take turns giving speeches in front of each other and a panel of judges, causes significant increases and significant variability in levels of salivary cortisol, indicating higher levels of stress. This new measure is useful because it allows researchers to measure adolescent stress hormone reactivity in groups rather than individually, which will help to make this research possible for larger, more representative groups of adolescents, as well as to move this stress measurement out of the lab and into schools or classrooms in the field.

Discrimination and Stress in Young Adults

Adam and her colleagues are examining 20 years of data, gathered from adolescence through young adulthood, to understand how histories of exposure to perceived racial/ethnic discrimination relate to a set of biomarkers of stress and health newly gathered in young adulthood. Detailed information on exposure to race-related and nonrace-related stressors, as well as measures of family functioning, racial/ethnic identity, and coping are available over a 20-year period through the Maryland Adolescent Development in Context Study (MADICS). These are being related to a wide range of stress-sensitive biological measures in young adulthood, including measures of gene expression relevant to the regulation of biological stress. This research also included a seven-day diary study examining how current perceptions of daily discrimination relate to cortisol stress hormone levels and sleep quality, and an experimental protocol examining the degree of physiological reactivity to race-related stress. Initial results indicate that both race/ethnicity and a cumulative developmental history of higher perceived discrimination are associated with flatter and lower cortisol diurnal rhythms, an indicator of chronic stress, in early adulthood. For African American participants only, experiences of discrimination in adolescence were particularly strongly related to altered cortisol patterns in adulthood.  This project is the first study to show that developmental histories of discrimination matter for adult health, and it suggests that adolescence might be a sensitive period for the impact of discrimination on African Americans’ health.

Living with HIV

IPR sociologist and African American studies scholar Celeste Watkins-Hayes continues work on the Health, Hardship, and Renewal (HHR) Study, which documents how women of different racial, ethnic, and socioeconomic backgrounds negotiate living with an HIV diagnosis. For the study, now in its sixth 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 will also investigate the role of nonprofits and government institutions that help the women cope, with part of the HHR study examining Chicagoarea 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. The study will also enable Watkins-Hayes to give back to the community being studied, by pointing to strategies that will help these women take care of their economic resources and their health.  This research is supported by grants from the Robert Wood Johnson Foundation and the National Science Foundation.

Drug Use and HIV Vulnerability

Research suggests that chronic stress can have a negative impact on inflammatory, neuroendocrine, and neurocognitive systems beginning in childhood and adolescence. New evidence indicates that chronic stress might also affect how youth use (and abuse) drugs and engage in behaviors considered high-risk for HIV transmission. With funding from the NIDA, Miller and Chen are investigating the neuroendocrine and inflammatory pathways through which exposure to stress creates vulnerabilities to drug use and HIV-related behavior among rural African American youth and young adults. Their work is part of the University of Georgia’s Center for Translational and Prevention Science, headed by Brody, which seeks to develop prevention programs for these youth—and better address racial disparities—by investigating how genes might influence these behaviors.

Mobility Data and Health Risk Factors

A neighborhood’s makeup can have a large impact on its adolescent residents—a violent one is associated with more adolescent problem behaviors, while a neighborhood offering more supports correlates with fewer of these behaviors. Professor of medical social sciences and IPR associate Brian Mustanski and his colleagues investigated the interplay between neighborhoods and genetic factors in the recently completed study, known as the Gene, Environment, and Neighborhood Initiative (GENI). The NIH-funded study focused on a cluster of HIV risk factors—including sexual risk-taking, substance use, and conduct problems—among African American youth living in high poverty neighborhoods. Mustanski collected data from a natural experiment in which families moved from public housing tracts in Mobile, Ala., to more advantaged neighborhoods under the HOPE VI federal relocation program. The researchers analyzed interviews of individuals in HOPE VI and the control group in which they discussed their neighborhood environments before and after their relocation. The researchers also drew on census data to catalog each neighborhood based on indicators of socioeconomic status, such as the numbers of unemployed and college graduates, as well as racial makeup and residential stability. The resulting data confirm the underlying assumptions of the GENI study: Youth and their neighborhoods were similar in both the experimental and control groups before the HOPE VI families relocated, and HOPE VI families relocated to improved neighborhoods. These preliminary results will enable Mustanski and his team to compare neighborhood effects across both groups for the GENI study.

Cancer Treatments and 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. In the Journal of the National Cancer Institute, Cella and his colleagues recommended a core set of 12 symptoms to be considered in clinical trials for any adult cancer for which self-reported symptoms are measured. Cella also continues his work with the Patient Reported Outcomes Measurement Information System (PROMIS) initiative, a NIH-funded project seeking to develop a “universal language” standardizing the collection of self-reported symptoms. In Medical Care, Cella used a PROMIS survey to examine gender-, age-, and race-related differences in how people perceive tradeoffs between living longer and losing quality of life in old age. He received the Alvin Tarlov Career Achievement Prize from the Health Assessment Lab/Medical Outcomes Trust in October, for his work in the development, promotion, and education of patient-reported outcome measures. He is professor and founding chair of Feinberg’s medical social sciences department.

Methods for Coping with Prostate Cancer

Prostate cancer is the second leading cause of cancer-related death for U.S. men, with nearly 30,000 dying of the disease each year. Professor of medical social sciences and IPR associate Frank Penedo and his colleagues recently examined how the stress management skills of prostate cancer patients affect their adjustment to the disease. Their results, published in the Journal of Behavioral Medicine, demonstrate that high levels of confidence in coping with the disease helped to buffer patients’ concerns about their treatment. In other research, published in the Journal of Sexual Medicine, Penedo examined how men with advanced prostate cancer react to the sexual side effects of androgen deprivation therapy (ADT), a treatment that reduces levels of male hormones in the body. Younger men and men who had just recently begun receiving ADT were more likely to be bothered by these side effects. This “sexual bother” also correlated with more depressive symptoms. Penedo postulates that assessing sexual bother in men undergoing ADT could help identify those at risk and improve their quality of life, especially for more vulnerable younger men and those just starting the therapy.

Panel Tackles Factors of Human Development

On October 16, IPR psychologist Sandra Waxman moderated a panel on “Developing Human Potential: Social, Cognitive, and Neural Factors” with IPR developmental psychologist Lindsay Chase-Lansdale, Chen, psychologist Richard Davidson of the University of Wisconsin–Madison and University of Chicago economist and Nobel laureate James Heckman. Davidson opened the panel by relating what led him to study well-being. Chase-Lansdale discussed her work on two-generation programs, while Chen spoke about her research on resilience and mentoring. Heckman focused on his Perry Preschool Project research, which shows significant effects on adult outcomes some 50 years later. The event was part of the Department of Psychology’s Second Northwestern Symposium on Mind and Society.

LGBTQ Health and Wellness

On October 10, the third Chicago LGBTQ Health & Wellness Conference brought 130 researchers, service providers, and students together to focus on translational LGBTQ health research around the theme of “Bridging Research and Practice,” asking how to “translate” basic research findings into health services that yield meaningful health outcomes. Mustanski, who leads IMPACT, welcomed keynote speakers David Purcell, deputy director for behavioral and social science of the division of HIV/AIDS prevention at the Centers for Disease Control and Prevention in Atlanta, and Kathleen Sikkema, a Duke University psychology and neuroscience professor. IPR graduate research assistant Mollie McQuillan also presented a talk at the conference, “Minority Stress and Mental Health Outcomes Among Sexual Minority Women of Color,” which highlighted her research on whether stress caused by a woman’s minority identity influences her mental health outcomes. The event was co-organized by Northwestern’s IMPACT LGBT Health and Development Program and the Sexual Orientation and Gender Institute at The Center on Halsted; IPR was a co-sponsor.

Intergenerational Perspectives on Health Disparities

Developmental Origins of Adult Disease

IPR anthropologist Christopher Kuzawa is identifying pathways through which risk factors for cardiovascular disease (CVD) develop, from before birth to young adulthood, using data from Cebu, Philippines. He and his colleagues are analyzing participants’ plasma samples for lipid profiles, markers of inflammation, regulation of glucose/insulin levels, blood pressure, and obesity. Then the researchers will develop models to represent the ways in which nutrition-related factors might contribute to the development of CVD risk in young adulthood. The models will take into account direct and indirect effects of exposure to nutrition-related factors before birth, interactions of pre- and postnatal factors, and the effects of growth on the factors, based on the age of each subject and their stage of life, such as infancy, childhood, and adolescence. By using novel methods to identify interrelated CVD risk factors, this research will contribute to the growing field of developmental origins of adult health and disease and, in particular, to understanding the developmental origins of cardiovascular disease.

Contexts of Fatherhood

Humans are among the rare mammals whose 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 anthropologist Thomas McDade. With funding from the National Science Foundation, Kuzawa is now extending his study of the biology and social context of fatherhood. Building on prior longitudinal data from the Cebu Study, the research team is following male cohort members, now 31–32 years old, for follow-up hormone analysis.  They are also gathering more in-depth information on the quality of partner relationships, child development, and childcare patterns in each participant’s 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 assessments of whether greater amounts of body fat predict higher levels of testosterone in the American Journal of Human Biology and whether changes in testosterone levels parallel changes in immune function in the International Journal of Primatology.

Paternal Mental Health and Fatherhood

Between 5 and 10 percent of fathers are estimated to suffer from clinical depression. Paternal depression also affects these fathers’ children, who are at risk for psychiatric disorders, exhibit poorer language and reading development, and have more social problems than their peers. IPR researchers led by associate and pediatrician Craig Garfield, and who include McDade, Adam, and developmental psychologist Lindsay Chase-Lansdale, studied rates of paternal depression in young fathers, using 20 years of Add Health data to identify factors contributing to paternal depression. They discover that for fathers living in the same household as their children, rates of paternal depression dip immediately before a child’s birth, then increase 68 percent over the child’s first five years of life. Fathers who did not live with their children, on the other hand, experienced more depressive symptoms prior to their child’s birth than after it. Race also played a role, with African American and Hispanic fathers showing higher levels of symptoms as compared with whites. The results, published in Pediatrics, serve to identify at-risk fathers and highlight times in their lives when clinical interventions might be most useful. Chase-Lansdale is Frances Willard Professor of Human Development and Social Policy.

The Bright Side of Aging

Developmental psychologist and IPR associate Claudia Haase’s recent work focuses on aging, with one line of research analyzing brain health in late life. In Neurobiology of Aging, she and her colleagues show that higher lifetime cognitive activity, such as reading books, playing games, and higher current physical activity, predicts better brain health in Alzheimer-relevant regions and greater cognitive functioning. In the Annual Review of Clinical Psychology, she and her colleagues synthesize what is known about emotional and behavioral symptoms in neurodegenerative disease and how these insights can inform research on brain-behavior links and psychopathology. Haase also studies emotion and aging. In Emotion, she and her fellow scholars investigate longitudinal links between spouses’ emotion regulation and their marital satisfaction over 13 years: The more quickly wives can tamp down negative emotion during marital conflict, the more likely it is that husbands and wives are satisfied in their marriages—and that the wife’s marital satisfaction will increase over time.

Healthy Aging Among Filipino Women

Using data from the Cebu Study, McDade and Kuzawa are analyzing how biological, social, economic, and environmental factors affect middle-aged and elderly women in the Philippines. Since the Cebu Study includes more than 30 years of longitudinal data on physical and mental health of more than 1,800 women, the researchers will be able to track how the women’s health has changed over time, including identifying the determinants of healthy aging. Aspects of physical health the researchers will be tracking include blood pressure, biomarkers of inflammation, and immune response to vaccination; psychological factors include quality of relationships and whether a woman suffers from depression. The social, economic, and environmental factors that the researchers will investigate include: the rapid urbanization of Cebu, Philippines, where the study subjects live, and associated issues from surrounding sanitation and air quality to crowding and housing density, in addition to participants’ socioeconomic status, income, education, family structure, work roles, diet quality, and physical activity. The resulting analysis will provide a glimpse into the web of physical, social, and behavioral factors that promote “healthy” aging.

Effects of Early Environments on Health Trajectories

Brain Development and Growth in Children

In a study published in Proceedings of the National Academy of Sciences, IPR biological anthropologist Christopher Kuzawa examined the energetic costs of brain development. He and his colleagues measured how much glucose a child’s brain needs to function. (Glucose is a simple sugar that fuels the brain.) The study is the first to pool existing positron emission tomography (PET) and magnetic resonance imaging (MRI) brain scan data, which measure glucose uptake and brain volume, respectively, to show that the ages when the brain consumes the most resources are also the ages when body growth is slowest. At 4 years of age, when this “brain drain” is at its peak and body growth slows to its minimum, the brain burns through resources at a rate equivalent to 66 percent of what the entire body uses at rest. At 5 years of age, the brain “maxes out” glucose use at a time when children learn what they need to know to be successful humans. The findings support a long-standing hypothesis in anthropology that children grow so slowly, and are dependent for so long, because the human body needs to shunt a huge fraction of its resources to the brain during childhood, leaving little to be devoted to body growth. They also disprove a previous belief that the brain’s resource burden on the body is largest at birth, when the size of the brain relative to the body is greatest. These findings underscore how important adequate nutrition in mid-childhood might be for cognitive development.

Early Environments During Pregnancy

Research shows that nutritional and microbial environments in infancy shape the human immune system, but the long-term effects of early environments on regulating inflammation are not known. In this project, supported by the National Science Foundation (NSF), Kuzawa and McDade, who directs IPR’s Cells to Society: The Center on Social Disparities and Health, are investigating how environments in infancy shape levels of inflammation in adulthood. Drawing on data from the Cebu Longitudinal Health and Nutrition Survey in the Philippines for pregnant women (dysregulated inflammation during pregnancy contributes to adverse fetal outcomes), the researchers hypothesize that undernourished female babies who are not exposed to common microbes will have elevated levels of inflammation during their pregnancies. In turn, this elevated inflammation will cause their babies to be born earlier on average and at lower birth weights. McDade and Kuzawa will also analyze methylation of inflammatory genes, an epigenetic process with enduringeffects on gene activity and expression, and how this process relates to early environments, inflammation, and birth outcomes.The researchers seek to highlight developmental processes contributing to chronic inflammation and also encourage other scholars to think of the human genome as dynamic, changing its structure and function according to its environment.

Birth Weight and Breastfeeding

In an article published in the Proceedings of the Royal Society B that was originally an IPR working paper, a team of C2S researchers including McDade and Adam examines links between breastfeeding, birth weight, and chronic inflammation, which is an indicator of increased risk for heart attack and diabetes, for nearly 7,000 24–32 year olds. The researchers hypothesize that birth weight and how long an individual was breastfed might determine levels of C-reactive protein (CRP)—a biomarker of chronic inflammation in adults and a risk factor for heart disease. Using data from The National Longitudinal Study of Adolescent to Adult Health (Add Health), McDade and his co-authors uncover dramatic disparities. More educated mothers, whites, and Hispanics were more likely to breastfeed. They also show that both lower birth weights and shorter periods of breastfeeding 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 breastfeeding 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.

Birth Weight and Educational Outcomes

In October, The New York Times’ Sunday Review covered an IPR working paper by economists David Figlio and  Jonathan Guryan and their colleagues. It makes use of a new data resource—merged birth and school records for every child born in Florida over an 11-year span—to study the effects of birth weight on cognitive development from kindergarten through high school. The researchers reveal effects of birth weight on cognitive development for single births and in twin comparisons—and that these remain constant over the children’s schooling. They also demonstrate that birth weight has noticeable effects across many background factors, including parents’ levels of education, income, age, race/ethnicity, immigrant status, etc., and that these effects do not vary with measures of school quality. This leads them to conclude that the effects of poor neonatal health on adult outcomes are set very early, and that fetuses might benefit by staying longer in the womb—results that call into question the necessity of inducing birth before the 40th week of pregnancy. 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 was published in American Economic Review.

Prenatal Smoking and Children's Outcomes

How does a pregnant mother’s smoking affect her child’s behavior later in life? The Surgeon General of the United States’ report notes that there is suggestive evidence that prenatal exposure to tobacco is linked with behavioral problems in children, but researchers continue to debate the extent of this causality. IPR clinical and developmental psychologist Lauren Wakschlag has recently completed a study of 300 preschoolers, half of whom were prenatally exposed to tobacco. With Northwestern assistant professor Christopher Ryne Estabrook, she will evaluate competing explanations in the field attesting to the effects (or lack thereof) of prenatal smoking and bring clarity to this controversy. Additionally, conclusive evidence on children’s susceptibility to a parent’s smoking will shed light on the need for prenatal prevention efforts. Wakschlag is professor of medical social sciences and vice chair for scientific and faculty development.

Early Origins of Coronary Heart Disease

Miller received an R01 grant from the National Heart, Lung, and Blood Institute (NHLBI) to study the origins of disparities in mortality from coronary heart disease (CHD), with the aim of identifying targets for its early prevention. Though mortality rates for CHD have declined in recent decades, these declines have mostly occurred among people from backgrounds of high socioeconomic status (SES), while people from lower ones die from CHD at rates that were typically seen in the 1970s. Previous research into the origins of CHD has centered on middle-aged adults because this is the time of life when physical symptoms of CHD tend to appear.  Miller will, instead, shift focus to children and adolescents since many mechanisms that give rise to CHD begin in childhood, and these mechanisms also occur in patterns related to SES.  Working with Chen and Feinberg colleagues Lei Wang and Joel Voss, Miller will study 250 youth from economically diverse backgrounds over two years, looking at how disparities in SES affect their immune systems and brain circuitry—changes that, in turn, could give rise to unhealthy lifestyles that might lead to CHD. The team will also explore how resilient low-SES youth manage to “bend” the normal demographic curve with their positive health outcomes. They predict that positive social influences, such as having role models and/ or a nurturing mother, could aid these youth in developing personal resources—including trust, emotionregulation skills, and self-esteem—that will help them to better navigate the challenges associated with a low-SES background.

Childhood Origins of Mental Health Issues

Chronic mental disorders often emerge in early life, but researchers lack methods to distinguish young children who are vulnerable from those who are not. Wakschlag is using the MAP-DB tool (the Multidimensional Assessment Profile of Disruptive Behavior), a behavioral assessment measure derived from her MAPS study of preschoolers, to determine what constitutes “problematic” behavior for children from diverse backgrounds. She and her colleagues utilized the MAP-DB tool in a cohort of 3,347 preschoolers, devising a spectrum of normal to abnormal behavior to determine when certain behaviors are cause for concern. For instance, though occasional tantrums are common for 3- to 5-year-old preschoolers, daily tantrums occur in less than 10 percent of black, white, Hispanic children and those from low- and high-SES backgrounds. Wakschlag received two grants from the National Institute of Mental Health this year for research on this topic. The first grant will enable her to follow the preschoolers from the MAPS study through preadolescence, thereby distinguishing serious, ongoing clinical problems. With funding from the second grant, Wakschlag and professor of medical social sciences and Penedo will examine whether higher exposure to stress in ethnic minority children explains their greater likelihood of developing behavioral problems. The results of Wakschlag’s research will enable parents, pediatricians, and teachers to identify when children need a mental health evaluation and when their behavior is within normal limits.

Language and Cognitive Skills in Infants

Waxman continues her work on infants’ language and cognition. In an article forthcoming in Trends in Cognitive Sciences, Waxman and New York University’s Athena Vouloumanos find that just by listening to human language—even if they do not understand the words being spoken—infants younger than a year can learn cognitive skills that will form the foundation of future learning, such as how to perceive patterns, categorize objects, and recognize partners with whom they can communicate. In another study published in Cognition, Waxman and her colleagues discover that even before infants can speak many words, they use the words they already know to learn more. After hearing a sentence containing a noun they did not know, such as “blick,” 19-month-old infants could match that noun to a picture of a new animal if it was used in a sentence containing a verb they had already learned, for example, “The blick is eating.” Both of these studies attest to the importance of exposing infants to language at an early age. Infants who hear little language are at a disadvantage not only when it comes to language skills, but also in developing fundamental cognitive capacities. Additionally, infants who do not know many words early on will have more difficulty when it comes to learning new ones. Waxman holds the Louis W. Menk Chair in Psychology.

Learning from Picture Books

Two of Waxman’s recent studies center on what infants and young children can learn from picture books. In one study, published in Cognitive Development, she and her co-authors observe that infants as young as 15 months can learn new words from reading picture books with an adult and even apply these words, gleaned from two-dimensional images, to real, three-dimensional objects when they encounter them. In a separate study, published in Frontiers in Psychology, Waxman and her colleagues look at how picture books influence 5 year olds’ opinions of the relationship between humans and nonhuman animals. Sixty-two children living in an urban area read one of two picture books about bears. One book, The Berenstain Bears, showed bears from an anthropomorphic perspective, while the other, The Animal Encyclopedia, portrayed them from a realistic standpoint. The children who read The Berenstain Bears were more likely to anthropomorphize animals, while the children who read the encyclopedia adopted a more biological viewpoint, believing that both humans and animals share animal characteristics. Picture books, Waxman concludes, are a double-edged sword: They can promote unscientific reasoning in young children but, if used properly, can also enable them to think in more realistic and biological terms.

Cross-Cultural Perspectives on the Natural World

One of Waxman's articles uses a cross-cultural lens to evaluate what children know about the natural world. She and her fellow researchers asked children aged 6–13 from three communities in Argentina to name as many living things as they could, then noted whether (and how) their answers differed. Some children were members of an indigenous group, the Wichí, who live in the Chaco Forest and speak their own indigenous language. Others were Spanish speakers, living either in urban or rural areas. All children named predominantly animals, excluding plants; this suggests that children across diverse communities have difficulty seeing plants as living things. There were also differences among the groups, reflecting differences in their exposure to the natural world: Wichí children named more native animals (ones they come into contact with in everyday life), whereas urban Spanish-speakers named mostly exotic animals, such as tigers (ones they had learned about in movies and books). Waxman’s results, which illuminate the knowledge children bring with them to their classrooms, highlight the importance of taking language and cultural background into account in the classroom, as children’s differing exposure to the natural world provides different starting points for learning.

Families, Interpersonal Relationships, and Health

Family-Based Strategy to Erase Disparities

In an article published in Proceedings of the National Academy of Sciences that received significant media attention, Miller and Chen, with Brody and Tianyi Yu of the University of Georgia, outline the results of a randomized trial focusing on 272 African American mothers—half of whom had annual incomes below the poverty line—and their 11-year-old children in rural Georgia. Families in the treatment group were assigned to a 7-weeklong psychosocial intervention, comprising weekly group meetings with parents and children, with the goal of enhancing the mothers’ parenting and strengthening family relationships. When the youth reached age 19, the researchers drew their blood to measure amounts of inflammation—a contributor to many chronic health problems, including diabetes, heart disease, and some cancers. They discovered that those youth who had taken part in the intervention had significantly lower levels of inflammation than those who had not—even years after the intervention had ended. Miller and his colleagues’ analysis suggests that the youths’ lower levels of inflammation coincided with more nurturing parenting on behalf of the parents who participated in the intervention. This could present a potential strategy for ameliorating social and racial health disparities. NICHD, NHLBI, and NIDA provided funding for the research.

Family Chaos, Inflammation, and Disease Risk

Adolescents’ family environments have been shown to influence their physical and emotional well-being, from their school performance to their overall social and emotional development. In a recent study published in Psychosomatic Medicine, Chen and her colleagues examine the role of family chaos on inflammatory patterns for 244 adolescents aged 13–16 years old. The researchers define family chaos as “environmental confusion in daily family life,” including disorganization, noise, and lack of structure. After measuring chaos via questionnaires and interviews, as well as quantifying adolescents’ inflammation levels by drawing blood, they learn that chaos has the greatest impact on youth from more disadvantaged backgrounds: Higher levels of chaos in a household are associated with greater inflammation among youth from low-SES backgrounds, but not among youth from high-SES backgrounds. These results have definite implications for low-SES youth, who could become even more vulnerable to inflammation-related diseases as the SES of the environments they live in declines.

Family Environment and the Gender Gap

With Karbownik, Roth, and MIT’s David Autor and Melanie Wasserman, Figlio is using Florida data containing test scores and rates for truancy, behavioral problems, and high school graduation, to investigate how family factors can explain gender gaps in children’s educational outcomes. The researchers observe that boys born to unmarried, low-income, and lesseducated mothers have comparatively worse educational outcomes than their sisters, even though these differences are not present in birth outcomes. Schooling- and neighborhoodrelated factors do not appear to drive the differences in educational outcomes. Figlio and his colleagues postulate that these differences are, instead, related to the household environment, concluding that boys are more sensitive to it than are girls. Differences in household advantage also explain a substantial portion of the black-white difference in these educational outcomes. For instance, the researchers’ results indicated that when compared with their sisters, black boys had worse outcomes than did white boys.

Effects of a Disabled Child on Their Siblings

In a new project, Figlio and Guryan, with Karbownik, Roth, and the University of Texas’ Sandra Black, are investigating how having a disabled sibling influences a child’s cognitive development. The researchers looked at how the oldest and second-oldest siblings in a family coped when a third sibling was disabled, versus how they were affected when a third sibling was not disabled. They ascertain that in a family of three children, when the youngest child is disabled, the middle child is at a relative cognitive disadvantage in comparison with families who do not have a third child with disabilities. This suggests that, in addition to effects on all the children in a household with three children and the youngest disabled, the middle child will experience additional, negative effects from having a younger, disabled sibling.

Obesity, Cardiovascular Health, and Latino Youth

Epidemiologist and IPR associate Mercedes Carnethon continues to investigate how obesity connects to metabolic disorders, such as diabetes, and heart disease. Carnethon worked with a number of other colleagues on the Study of Latino Youth, the first national U.S. study of obesity and cardiometabolic risk factors associated with being overweight among 1,600 Hispanic and Latino children, ages 8–14. The researchers look at how the youths’ lifestyles—including their fitness, diets, and level of physical activity—are linked with many factors: These include how well the youth and their parents have assimilated to American culture, their family environment, and social behavior. The study will identify behaviors that might promote obesity, point out heart- and metabolic-related risk factors for obesity, and identify new biomarkers associated with obesity and insulin resistance. As Hispanic and Latino children are disproportionately affected by the obesity epidemic, the results of the study are important for guiding policy interventions that will promote cardiovascular health in this population.

Mental Health of Mexican-American Youth

IPR cultural anthropologist Rebecca Seligman continues to develop her research project on mental health in Mexican-American adolescents. She is collecting data for a study exploring the relationship between adolescents’ expectations when they seek psychiatric care and the realities of that care. In particular, Seligman is looking at how cultural ideals—including those related to the body, emotion management, social and familial relationships, and selfhood and identity—play into adolescents’ expectations for psychiatric care. The work will serve to highlight disparities in ideas and expectations both for those receiving treatment and those providing it. If patient expectations do not match up with clinical realities, this could have an impact on a psychiatric treatment’s effectiveness for Mexican-American adolescent patients. Since Mexican-American adolescents are disproportionately vulnerable to depression, anxiety, and suicidal behaviors, and are also particularly likely to be underserved when it comes to psychiatric treatment, ensuring the efficacy of their treatments is a priority. The project is supported by an IPR seed grant.

Support for Goals, Trust, and Relationships

A recent line of psychologist and IPR associate Eli Finkel’s research considers how partners in a relationship encourage each other’s goals and how they pursue their own. In work published in the Journal of Personality and Social Psychology, Finkel investigates the “Manhattan effect,” or when one partner’s goals threaten a relationship, forcing the other partner to withdraw support for these goals to save the relationship. In Social Psychological and Personality Science, Finkel and his colleagues examine how peoples’ trust in their partners—and their conviction that these partners support their goals—affects how secure they are in their relationships. He finds that trust in one’s partner is associated with lower attachment anxiety (concerns over a partner’s availability and doubts about one’s own self-worth), while perceiving one’s goals to be validated by a partner was associated with lower attachment avoidance (doubts about trusting others).  Longitudinally, however, the opposite was true: More trust was associated with lower attachment avoidance and more validated goals with lower attachment anxiety. These results show that relationship security can change over time, and highlight ways of boosting it using different pathways.

Religious Engagement and Health

Deep religious engagement can have a positive impact on a person’s physical and mental health, Seligman  demonstrates in her new book, Possessing Spirits and Healing Selves: Embodiment and Transformation in an Afro-Brazilian Religion (Palgrave Macmillan, 2014). The book offers an in-depth exploration of the ways that social and cultural contexts can affect mental and physical well-being. Seligman looks at how religious devotion influenced health outcomes among spirit possession mediums of the Candomblé religion in Brazil, finding that religious devotion can transform these outcomes for the better, particularly for those who had high levels of emotional distress prior to their religious engagement. The people Seligman studied who were deeply and intimately engaged in their religion demonstrated patterns of cardiovascular functioning that are associated with better health outcomes; these individuals also reported better physical and mental health following their religious involvement. Seligman observes that the book’s investigation of religious devotion can serve as a jumping-off point for understanding the links between mind and body and the many ways in which they affect peoples’ lives, both positively and negatively.

Biomarker Development and Deployment

Zinc Sparks and Fertilization

When a sperm fertilizes a mammalian egg, the egg releases billions of zinc atoms from its surface in “zinc sparks,” oncofertility specialist and IPR associate Teresa Woodruff and her colleagues have discovered. Woodruff and her team were the first to capture images of this process and to identify the origin of the sparks—tiny, zinc-rich packages just below the surface of the egg. Because fluctuations in zinc are important to regulating processes that ensure an egg develops properly, this information could be useful in improving in vitro fertilization methods. The study also lays the groundwork for understanding how changes in zinc levels affect biological systems beyond the egg, including transmission from neurons in the brain and insulin release in the pancreas. This research was published in Nature Chemistry. Woodruff is Thomas J. Watkins Memorial Professor in Obstetrics and Gynecology and director of Northwestern’s Women’s Health Research Institute.

Blood Test for Depression

Neuroscientist and IPR associate Eva Redei and her colleagues have discovered a blood test that might lead to diagnosing major depression in adults, as well as determining which therapies would work best to treat it. In Translational Psychiatry, the researchers described nine blood markers that differentiated depressed from nondepressed individuals. They measured blood levels of these markers before and after depressed patients underwent cognitive behavioral therapy (CBT), a common psychotherapy used to treat depression. Among patients who reported no longer being depressed after 18 weeks of CBT, marker levels changed. Thus, the test can determine if CBT is effective and, if it is not, prompt healthcare providers to try a different therapy. Levels of three of the nine markers remained unchanged in depressed patients no matter if they remained depressed or recovered after CBT. These markers might identify vulnerability to depression—another factor to account for in administering treatment. Redei’s study is significant for depression research, as the current method of diagnosing depression relies solely on patients’ descriptions of symptoms. Many reported on the study, including Time, Newsweek, The Huffington Post, and Mashable, which listed it among 2014’s top 10 scientific achievements. Redei is David Lawrence Stein Professor in Psychiatric Diseases Affecting Children and Adolescents.

Expanding Use of Dried Blood Spots

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. NIH and NICHD provided funding.