Social Disparities and Health
Program

Cells to Society (C2S): The Center on Social Disparities and Health is a recently launched initiative within IPR that aims to understand how social and cultural contexts affect physical and mental health as well as cognitive achievement at the population level. P. Lindsay Chase-Lansdale, professor of human development and social policy, is its founding director. Currently, the center is organized around four main lines of research:

Some of the center’s projects overlap with other IPR program areas, in particular, Child, Adolescent, and Family Studies and Poverty, Race, and Inequality.

Overview of Activities

2006 was an exciting year of development for C2S. The center received an R21 grant from the Demographic and Behavioral Sciences Branch of the National Institute of Child Health and Human Development (NICHD).

R21 developmental infrastructure awards provide support for potentially high-risk, high-payoff new population research centers that are in the early stages of development. Those awarded by the NICHD are also used to enhance population research at specific institutions—in particular through interdisciplinary collaboration—and to develop innovative approaches to population research. The NICHD confers the grants with the expectation that recipients will apply for an R24 award to fund a population center four to five years after receiving the R21.

The five-year R21 grant will support work on biomarker analysis and usage in addition to training. It will also establish a seed-grant program to promote the use of biomarkers and other innovative methods in population- and community-based research projects. The first C2S biomarker award winners were recently announced.

A critical component of the center’s plans to become a full population center are key faculty hires. After conducting a national search in collaboration with the Weinberg College of Arts and Sciences, IPR and C2S announced the hiring of demographer Alberto Palloni and sociologist Jeremy Freese, both from the University of Wisconsin-Madison. They will both join the Institute in fall 2007.

Palloni is an internationally respected sociologist, a past president of the Population Association of America, and a fellow of the American Academy of Arts and Sciences. His research covers many areas, including health, fertility, mortality, population and development, the spread of HIV/AIDS, and the aging process among others. Freese conducts research on various topics that seek to connect biological, psychological, and social processes. He is especially interested in how such connections are altered by large-scale social or technological changes.

C2S has continued its efforts to foster a community of scholars interested in multidisciplinary research on how social and cultural contexts “get under the skin” and influence the pathways and processes of human development, health, and well-being. To this end, C2S brings researchers and practitioners together through its colloquia. Nine talks were held on topics from older women’s health, by Stacy Tessler Lindau of the University of Chicago, to a developmentally-focused model of lifelong health production, by Neal Halfon of UCLA. The department of anthropology and Institute for Health-care Studies co-sponsored other talks.

C2S also welcomed Raynard Kington, MD, MBA, PhD, who is deputy director of the National Institutes of Health. He lectured on “The Health Status of Black Immigrants” and “NIH at the Crossroads: Current Policies and Future Directions” on October 30. Northwestern’s Biotech-nology Training Program co-sponsored the talk. (See pp. 5-6 for more information.)

C2S is leading the way as a nationally recognized center of biomarker training and methodology. The first C2S Summer Biomarker Institute took place from June 19 to 21, 2006, and welcomed 22 participants from the United States and Mexico. Thomas McDade, associate director of C2S, qualified it as a “nuts-and-bolts, hands-on, full review of state-of-the-art, minimally invasive methods for measuring aspects of physiology and health in population-based settings outside of the lab.” McDade, developmental psychobiologist Emma Adam, and anthropologist Christopher Kuzawa jointly ran the institute, which will continue to take place annually.

C2S members have been centrally involved in the planning for Wave IV data collection for the National Longitudinal Study of Adolescent Health (Add Health), which went into the field in 2006 and will collect biomarkers. They have also collaborated on a proposal to the National Institutes of Health to take a population-level look at how social contexts, stress, and health affect young adults. This project will be the most comprehensive investigation to date of how social stress influences physical and mental health. It will also examine how stress can lead to health disparities.

Social Disparities, Stress, and Health
In the area of social disparities, stress, and health, center researchers look at how noninvasive biomarkers can be used to measure stress, immune function, and inflammation, in addition to other measures of physiological function.

Thomas McDade, associate professor of anthropology, continues to refine methods for assaying biomarkers in a drop of blood collected from a single finger prick. He directs the Laboratory for Human Biology Research at Northwestern that is using this technique to measure blood samples for markers of immune function and cardiovascular disease risk among others. McDade also consults on the implementation of biomarker methods into a number of large, nationally representative health surveys, including the Health and Retirement Study; the National Social Life, Health, and Aging Project; and Add Health.

McDade is also interested in how globalization affects health outcomes and has been part of two ongoing projects: the Tsimane’ Amazonian Panel Study and the Cebu Longitudinal Health and Nutrition Survey in the Philippines. Both are rich resources for studying the long-term health effects of early environments and might provide additional insight on domestic health outcomes. Recent research results from the Amazonian study show that children of mothers whose knowledge of traditional uses of local plants and herbs is lacking have worse health outcomes.

A cardiologist and cardiovascular epidemiologist, Philip Greenland, Harry W. Dingman Professor, is interested in how coronary heart disease can be predicted in men and women of various ages, races, and ethnicities. He is co-principal investigator and chair of the research design committee for the Multi-Ethnic Study of Atherosclerosis (MESA), a multi-center observational study of subclinical atherosclerosis in four ethnic groups (white, black, Hispanic, and Chinese American) of men and women, aged 45 to 84. One of the study’s recent findings shows that levels of coronary artery calcium, which can predict heart disease later in life, and education are inversely correlated in young adults. Greenland is senior associate dean for clinical and translational research, Feinberg School of Medicine, Northwestern University.

Social psychologist Linda Teplin leads the Northwestern Juvenile Project, the first large-scale longitudinal study of health needs and outcomes of delinquent youth. Launched in 1995, the pioneering project tracks and interviews 1,829 participants to examine their ongoing health needs and their life trajectories. The National Institute on Drug Abuse recently awarded $5.7 million for an extension of Teplin’s study to investigate the relationship between substance use and HIV/AIDS risk behaviors from adolescence through young adulthood. The new study will focus on racial and ethnic disparities, gender and age differences, and the effects of incarceration.

Pediatrician Madeleine Shalowitz is the co-principal investigator on a recently completed Chicago-based longitudinal study that is looking at how social factors and the environment affect pediatric asthma. The researchers studied 11,490 children in 14 racially/ethnically diverse, public, inner-city elementary schools, finding a high prevalence of children with chronic asthma (12.2 percent) and racial and ethnic disparities in cases of diagnosed asthma. They also concluded that undiagnosed asthma cases could raise the total numbers of asthmatic children—as many as one in three non-Hispanic African American and Puerto Rican children could be diagnosed with the disease. Further, Shalowitz’s writings demonstrate that maternal life stress is associated with maternal depression and the child’s asthma morbidity

Families, Interpersonal Relationships, and Health
The projects in families, relationships, and health build on existing faculty work conducted through IPR on social inclusion and exclusion, family functioning, discrimination, and racism.

In a four-year longitudinal study, Daily Experiences, Stress, and Sleep over the Transition to Adulthood, Emma Adam and her colleagues are exploring how exposure to stress affects the development of depression and anxiety in adolescents as they move from high school to college or a job. Adam uses interviews, questionnaires, and diaries to capture their transition experiences. By measuring the stress hormone cortisol and sleep quality using wristwatch-sized “actigraphs,” she is trying to trace the physiological impact of these changes. Annual clinical interviews diagnose depression and anxiety disorders. Initial analyses of the actigraphy data demonstrate that prior day sleep has a strong impact on next-day positive and negative mood, net of the effect of prior-day mood, which implies that sleep timing and quality helps to determine daily emotional experience. At age 16, higher stress levels and cortisol predicted depression 18 months later. This suggests that measurements of psychosocial and biological stress in high school are important predictors of later depression as adolescents transition to adulthood.

Adam and her colleagues are also exam-ining how sleep can affect metabolism and thus children’s development and health. Adam, IPR graduate research assistant Emily Snell, and economist Greg Duncan studied data on 1,400 kids ages 3 to 12 from two waves of the Panel Study of Income Dynamics (PSID). They found that fewer hours of sleep predicted an increase in body mass index (BMI) five years later. This is the first study to show convincing links between sleep and BMI in children and adolescents, a population for whom concern regarding obesity is high, due to its associations with serious future health problems such as diabetes and cardiovascular disease. The findings also show that many children are not getting their recommended hours of sleep.

A second study using the PSID data, conducted with human development and social policy graduate students Snell and Patricia Pendry, addresses the social determinants of total sleep hours and timing. How do demographic variables, structural constraints such as school start times, children’s activity choices, and aspects of their family functioning relate to the sleep behaviors of America’s children? Among the many findings of this study: African American children and adolescents sleep approximately 30 minutes less than white children on both weekends and weekdays, placing them at a cognitive and health disadvantage. Some of this sleep deprivation relates to black children having to wake up earlier because of longer school commute times.

Adam was also lead author of a study in the Proceedings of the National Academy of Sciences showing that when older adults go to bed lonely, sad, or overwhelmed, they have elevated levels of the stress hormone cortisol shortly after waking the next morning. This rise could help give them a needed boost of energy to meet the demands of their day, providing evidence that cortisol influences—and is influenced by—the daily experiences of older adults. The study takes a rare look at the physiological, social, and emotional dynamics of day-to-day experiences in real-life settings. The results were reported by Scientific American and ABCNews.com, among others.

Developmental Health Disparities from Conception Through Adulthood
In the area of developmental health disparities from conception through adulthood, research focuses in particular on prenatal and perinatal environments and how they interact with social, genetic, and other biological influences. Social and biological risks to health across the life span are also addressed.

Working with U.S. and Filipino collaborators, anthropologist Christopher Kuzawa studies the influence of fetal and infant nutrition and growth on adult health and function in the Philippines. The Cebu Longitudinal Health and Nutrition Survey has followed more than 3,000 mothers who were pregnant in 1983, and their children, who are now young adults and having children of their own. He and his colleagues have recently launched two new extensions of the study. The first uses 22 years of longitudinal data to investigate the predictors of metabolic disease risk factors in the mothers and their young adult offspring. The second is using these same data along with saliva and plasma samples to investigate whether early life nutrition influences adult reproductive function in the male offspring.

Kuzawa has begun to explore the application of this intergenerational model of biology and health to the problem of U.S. health disparities. By linking early life health disparities, such as low birth weight or premature birth, with adult health disparities such as hypertension or diabetes, the model could help explain patterns of health disparities that tend to cluster across the life cycle in specific demographic subgroups.

Supported by the NICHD, the Community Child Health Network explores the causes and consequences of racial disparities in a longitudinal study of birth outcomes and early child development at five U.S. sites. Its theoretical model and research design emphasize the potential impact of social and economic environments on physiological stress and health in mothers and fathers during the pregnancy and the interpregnancy period.

The Illinois site, Community Action for Child Health Equity (CACHE), is a partnership between Evanston Northwestern Healthcare and the Lake County Health Department’s Community Health Centers. CACHE explores how community, family, and individual influences interact with biological influences resulting in health disparities in perinatal outcome and infant and early childhood mortality and morbidity. Madeleine Shalowitz is co-principal investigator, and several C2S and IPR faculty—Emma Adam, Greg Duncan, Christopher Kuzawa, P. Lindsay Chase-Lansdale, Thomas McDade, and Bruce Spencer—are involved.

Eva Redei, David Lawrence Stein Professor of Psychiatry and Behavioral Sciences, is conducting research on the genetics and neurobiology of stress. She discovered that the Wistar Kyoto (WKY) strain represents a genetic animal model of depressive behavior and stress hyper-reactivity. This strain is used as a tool to identify biological markers of depression and vulnerability to stress.

Using quantitative trait loci analysis and DNA microarray techniques, Redei pinpoints genes whose expression differs, both in the brain and periphery, between a genetic animal model of depression and those of a genetically similar substrain with no depressive symptoms. Redei also continues to study the epigenetic causes of fetal alcohol effects in an animal model that mirrors most consequences of alcohol exposure in utero in humans.

Policy, Practice, Race, Culture, and Ethics
Issues associated with policy, practice, race, culture, and ethics traverse all of the center’s research initiatives. In addition to researching issues related to racial stereotyping, prejudice, and the effects of interracial contact, research in this area also aims to promote responsible uses of race and ethnicity in biotechnology and biomedical and pharmaceutical research.

Intrigued by a resurgence of scientific interest in race-based genomic variation and the use of racial categorization in biomedicine, Dorothy Roberts, Kirkland and Ellis Professor of Law, is working on a two-year project, funded by the National Science Foundation. She investigates the expansion of race consciousness in biomedical research and technologies in its sociopolitical context to determine how it is related to race consciousness in social policies. Considering the relationship between biotechnology, law, and social policy, Roberts is examining how race-based biotechologies both reflect and shape current political contests over colorblind and race-conscious approaches to racial equality and how African Americans in particular are navigating their competing interests both in race-conscious inclusion in health research and technological advances and in avoiding the dangerous consequences of biological definitions of race.

In Jennifer Richeson’s study of how people control the expression of prejudice, she explores how individuals’ concerns about either being or appearing racially biased influence subtle aspects of cognition, emotion, and behavior. She directs the Social Perception and Communication Laboratory at Northwestern, which serves to better understand the effects of diverse environments on our feelings and behavior and to investigate the antecedents and consequences of prejudice and stereotyping.

Richeson, Emma Adam, and Gregory Makoul of Northwestern’s Feinberg School of Medicine are examining the dynamics of interethnic interactions between medical school students and patients of different races and ethnicities. Richeson conducts additional studies of affective and cognitive consequences of exposure to discrimination.

Richeson is setting out a new project to explore whether racial bias constitutes a risk factor for mental disorders (namely depression) among African Americans and Latinos. Specifically, this work considers the differential effects of subtle—compared with blatant—expressions of racial discrimination during interpersonal interactions in the development of mental disorders. Richeson and Nicole Shelton of Princeton University will also consider how suppressing emotional reactions to interpersonal discrimination affects the development of mental disorders. They are also examining whether the stigma of mental illness operates in a similar manner to racial bias in one-on-one interactions. This project sollicited funding from the National Institute of Mental Health and the Office of Behavioral and Social Sciences Research.

Teresa Woodruff, Thomas J. Watkins Memorial Professor of Obstetrics and Gynecology, leads researchers in biochemistry, molecular biology, basic biology, and reproductive medicine at the Institute for Women’s Health Research and the Center for Reproductive Research at Northwestern. The center is developing an experimental technique that will offer girls and women who are unable to preserve their fertility through emergency in-vitro fertilization (IVF) a way to store their ovarian tissue for future conception. After one ovary is removed and cryopreserved, or frozen, immature follicles are extracted and matured in the lab so that they can later be fertilized. This technique may significantly enhance fertility-saving options for women at risk of losing their fertility. Woodruff is also director of the Division of Fertility Preservation that is working to establish the first “follicle bank” for U.S. cancer survivors, and she directs one of the National Institutes of Health’s Specialized Cooperative Centers in Reproduction Research. Oncofertility (Springer), edited by Woodruff and Karrie Ann Snyder, assistant professor of sociology, will be published in 2007.

Psychologists Sandra Waxman and Douglas Medin are currently writing a book summing up their research on the evolution of biological knowledge and reasoning across cultures and across development. They led an interdisciplinary research team of psychologists, linguists, and anthropologists who interviewed young children and adults from a wide range of language and cultural communities. The participants included urban and rural U.S. English speakers from majority culture and Native American populations. Their research offers evidence of strong universal patterns in most fundamental notions of the natural world. It also highlights striking differences that illuminate intimate connections among culture, language, and the organization of knowledge.