Principles of Researching Health Disparities in Longitudinal Cohort Studies Enrolling Children

Health disparities are defined on the basis of specific populations that, when compared to the general population, have a significant disparity on the rate of disease incidence, prevalence, morbidity, mortality, or survival. People that experience health disparities can be defined by multiple criteria. As the diversity of the United States broadens and increases, research on the origins and causes of health disparities becomes more important to support a healthy general population. Children are particularly sensitive to and vulnerable to health disparities due to the potentially life long consequences of events during periods of critical organ, intellectual and social development. The concept of health justice whereby each individual has the opportunity to realize their full health potential can only be realized with proper understanding and relevant data to frame practice, policy and actions. The National Children's Study (NCS) was a longitudinal birth cohort study designed to incorporate the principles of the Federal Collaboration on Health Disparities Research in consultation with subject matter experts, community representatives, and ongoing evaluation to ensure high quality and relevant data on factors that impact health outcomes. The NCS developed and tested a model of enrolling a diverse population, capturing and integrating data using a life course framework, constructing individual profiles, then aggregating individuals into groups based on profiles and outcomes. This approach is applicable to other longitudinal cohort studies.

Measuring the Effect of Neighborhood Racial Segregation on Fetal Growth

Prior studies of neighborhood racial segregation and intrauterine growth have not accounted for confounding factors in early life. We used the Life-Course Influences on Fetal Environment Study of births to Black women in metropolitan Detroit, 2009–2011, ( N = 1,408) to examine whether health and social conditions in childhood and adulthood confound or modify the association of neighborhood segregation (addresses during pregnancy geocoded to census tract racial composition) and gestational age-adjusted birthweight. Before adjusting for covariates, women living in a predominantly (≥75%) Black neighborhood gave birth to 47.3 grams (95% CI: –99.0, 4.4) lighter infants, on average, compared with women living in <75% Black neighborhoods. This association was confounded by adulthood (age at delivery, parity, neighborhood deprivation) and childhood (parental education, neighborhood racial composition) factors and modified by adulthood socioeconomic position. These findings underscore the complex relationship between neighborhood racial segregation and birth outcomes, which would be enhanced through a life course framework.

Mothers’ Out-of-Sequence Postsecondary Education and Their Health and Health Behaviors

Ample research suggests that the links between higher education and heath are robust and growing in strength. This research, however, tends to assume education was completed prior to assuming other adult roles. Importantly, the life course framework raises the question of whether “out-of-sequence” college completion conveys similar health returns. I investigate this question among a population for whom out-of-sequence schooling has grown more common: lower-educated mothers. This focus is also important given the growing education gap in women’s health and the links between maternal and child health. Data come from the Fragile Families and Child Wellbeing Study (N = 4,898). Analyses involve random intercept and fixed effects models and diverse health measures. Findings suggest that postsecondary education does not improve mother’s health, except for reduced smoking among mothers with high school degrees or less that earned bachelor’s degrees. These findings inform health policy debates and theories linking education to health.

What Protects Those at High Risk from Criminal Justice Contact Despite the Odds? A Negative Case Analysis

Criminal justice contact is a prevalent, if not expected, life event for many high-risk individuals with deleterious consequences; yet, many individuals at high risk are able to avoid this contact (i.e. negative cases exist). In this study, we draw on the life course framework and utilize negative case analysis to (1) estimate the prevalence of criminal justice avoidance within a sample of structurally high-risk Black men and (2) explore the individual, familial and contextual factors in childhood and adolescence that distinguish these negative cases. One’s own ‘on-time’ and one’s siblings’ education emerge as particularly strong protective factors suggesting that the presence of unique protection, as opposed to the absence of risk, may be most salient. Theoretical implications are discussed.

Charting the life course: Emerging opportunities to advance scientific approaches using life course research

Life course research embraces the complexity of health and disease development, tackling the extensive interactions between genetics and environment. This interdisciplinary blueprint, or theoretical framework, offers a structure for research ideas and specifies relationships between related factors. Traditionally, methodological approaches attempt to reduce the complexity of these dynamic interactions and decompose health into component parts, ignoring the complex reciprocal interaction of factors that shape health over time. New methods that match the epistemological foundation of the life course framework are needed to fully explore adaptive, multilevel, and reciprocal interactions between individuals and their environment. The focus of this article is to (1) delineate the differences between lifespan and life course research, (2) articulate the importance of complex systems science as a methodological framework in the life course research toolbox to guide our research questions, (3) raise key questions that can be asked within the clinical and translational science domain utilizing this framework, and (4) provide recommendations for life course research implementation, charting the way forward. Recent advances in computational analytics, computer science, and data collection could be used to approximate, measure, and analyze the intertwining and dynamic nature of genetic and environmental factors involved in health development.

Migration, Mobility and Transnational Families: The Case of Indian Women Migrating to South Africa

The history of labour migration to South Africa spans centuries. More recently flows of skilled and unskilled, documented and undocumented migration to South Africa have reached significant proportions. While men have predominated in the flows of migration streams to South Africa, the feminisation of migration has increased the visibility and role of women in the migration context. The impact of migration on the lives of skilled married women has been given little attention in the migration literature. Characterised as trailing spouses in the broader migration literature, the article explores, through a life-course framework, how skilled Indian women renegotiate their lives when leaving secure jobs to follow their spouses to a foreign country. Attention is given to how mobility is negotiated between the spouses, the impact of mobility on the family and the influence of transnationalism on the migrants and their families in South Africa. The article is based on exploratory research using qualitative in-depth interviews conducted with married skilled Indian women who migrated as co-dependents to South Africa.

Moving Health Education and Behavior Upstream: Lessons From COVID-19 for Addressing Structural Drivers of Health Inequities

In this Perspective, we build on social justice and emancipatory traditions within the field of health education, and the field’s long-standing commitment to building knowledge and shared power to promote health equity, to examine lessons and opportunities for health education emerging from the COVID-19 pandemic. Examining patterns that emerged as the pandemic unfolded in Metropolitan Detroit, with disproportionate impacts on African American and low-income communities, we consider conditions that contributed to excess exposure, mortality, and reduced access to critical health protective resources. Using a life course framework, we consider enduring impacts of the pandemic for health equity. Finally, we suggest several strategic actions in three focal areas—environment, occupation, and housing—that can be taken by health educators working in partnership with community members, researchers, and decision makers, using, for example, a community-based participatory research approach, to reduce adverse impacts of COVID-19 and promote long-term equity in health.