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Health and Wellbeing

Elizabeth Armstrong • João Biehl • Anne C. Case • Juanita J. Chinn • Janet M. Currie • Angus S. Deaton • Michelle DeKlyen • Susan Fiske • Noreen Goldman • Bryan Grenfell • Jeffrey S. Hammer • Chioun Lee • Scott M. Lynch • Michael J. McFarland • Sara S. McLanahan • Germán Rodríguez • James Trussell • Tom S. Vogl • Miranda R. Waggoner • Charles F. Westoff

Elizabeth Mitchell Armstrong has been researching the origins and consequences of the idea of fetal personhood, tracing the evolution of the belief that the fetus is a person in medicine, law and popular culture. She is currently working on her book tentatively titled How We Begin: The Origins of Fetal Personhood which she hopes to complete later this year.

With collaborators Dan Carpenter (Harvard University) and Marie Hojnacki (Penn State), Elizabeth Mitchell Armstrong continues to collect and analyze data on public attention to disease particularly on how and why some diseases get more attention in the public arena than others.

Elizabeth Mitchell Armstrong is currently conducting research on cultural attitudes and beliefs about risk during pregnancy and childbirth and policies related to maternity care in the United States. She is conducting research on medical professional attitudes towards home birth in the U.S. and on popular practices around childbirth. She has investigated popular cultural practices regarding the placenta and is currently analyzing medical and scientific texts on placental form and function.

Elizabeth Mitchell Armstrong is also beginning several smaller-scale research projects looking into various aspects of maternity care in the U.S. One of these is a history of policies and practices around pain relief during childbirth in the 20th century. Another will look at the impact of mode of delivery on later life health and wellbeing. With Eszter Hargittai (Northwestern University) she is working on a paper that analyzes how people seek information about the risks of drinking during pregnancy using online sources.

Elizabeth Mitchell Armstrong continues to collaborate with postdoctoral fellows on the following topics: sexist attitudes and gender equity at the societal level; trends in surnaming patterns following marriage and for children; the cultural backlash against breastfeeding and the political economy of infant feeding.

João Biehl is currently writing the history of the Mucker War, a religious war that took place among German immigrants in 19th century Brazil. His present research explores the social impact of large-scale treatment programs in resource-poor settings and the role of the judiciary in administering public health in Brazil. He is currently coordinating a research and teaching partnership between Princeton University and the University of São Paulo centered on global health and the anthropology of health and medicine, and co-coordinating a collaborative network on “Race and Citizenship in the Americas.”

João Biehl’s current research study, “The Right to Health Litigation,” charts treatment access litigation in the state of Rio Grande do Sul. This is a multi-disciplinary investigation aimed at producing reliable and nuanced forms of evidence of this new medico-socio-legal phenomenon. Generously funded by the Ford Foundation and by Princeton University’s Health Grand Challenges Initiative, the project seeks to characterize this patient-plaintiff population, to identify their medical needs and legal strategies and to apprehend the expanding role of the judiciary in remediating the limitations and failures of public health management. Broadly speaking, the project is concerned with the arts of governance that accompany pharmaceutical globalization and with the effects and side-effects that go with the remaking of people into therapeutic markets. The research involves: Database of lawsuits for access to medicines in the state of Rio Grande do Sul (within the Solicitor General’s Office); Observatory of the evolving jurisprudence of the right to health in Brazil; Interviews with key institutional actors (judges, public counsels, lawyers, physicians, policy-makers); Ethnographic research with patients and families filing lawsuits for treatment access; A visual documentary of the people involved in right to health litigation. This study has been carried out in collaboration with Adriana Petryna (University of Pennsylvania), Joseph J. Amon (Human Rights Watch), Paulo D. Picon (Hospital de Clínicas de Porto Alegre and UFRGS), Ingo W. Sarlet (PUC-RS), Claudia W. Fonseca (UFRGS), Laura B. Jardim (Hospital de Clínicas de Porto Alegre and UFRGS); and photographer Torben Eskerod. Research associates include: Alex Gertner, Mariana Socal, Roberta Grudzinski, Heloisa Paim, Luciana Pêss, Jeferson F. Barbosa, Italo Fuhrman, Rodrigo S. Gonzalez, and Claudio Terra. The twin phenomena of the pharmaceuticalization and judicialization of healthcare presents a complex set of questions that the research team seeks to explore including: Patient Citizens and Political Inclusion/Exclusion, The Execution of Social Rights and Equity, The Execution of Social Rights and Equity, The Administration of Public Health through Pharmaceutical Policy, and Medical Markets and Comprehensive Care.

João Biehl’s own pilot research project on the new role of the Brazilian judiciary in facilitating access to medicines and in administering public health has been especially successful, winning a US$ 200,000 grant from the Ford Foundation for continued research. Sustained collaboration with medical and legal institutions in Porto Alegre and with a network of social science scholars working in Africa and Latin America has enabled several internships for Princeton undergraduate students, contributing to Princeton’s ongoing efforts to involve students in collaborative research early on and to internationalize education.

In his final report completed in 2012, “The Future of Global AIDS Treatment and the Social Determinants of Health,” supported by the Health Grand Challenges, João Biehl’s project overview notes that in the past few years, many public- and private-sector initiatives have been launched worldwide, seeking to address HIV/AIDS therapeutically in places where treatments had been scarcely available. These initiatives have raised a new set of national and global healthcare policy challenges regarding adequate drug delivery, sustainable treatment access, and the integration of treatment with primary care, food access and prevention. Broader questions have arisen as well: how can accountability of all sectors involved in AIDS treatment rollouts be assured? How do these treatment access trends affect local health systems and the role of governments and their human rights obligations? How are other deadly diseases of poverty that have less political backing being dealt with? What on-the-ground effects do these manifold issues have on the experience of living with HIV/AIDS and poverty? To address these and other emergent questions, his research team conducted collective and individual studies using the Brazilian therapeutic response to AIDS and its repercussions through government, markets, health systems and civil society as an ethnographic baseline from which to gauge the aftermath of large-scale drug access programs. Researchers charted emerging governmental, philanthropic, nongovernmental and industry networks developing around HIV/AIDS technology and delivery. As they identified new challenges, limitations, and emergent forms of social mobilization, they also theorized the role of the social sciences in evidence-making and advocacy in global health. By using qualitative methodologies in harmony with more traditional quantitative ways of studying health interventions and outcomes, the project produced a people-centered approach to global health knowledge-making. In all, the research teams’ work provides a much-needed window into the real-life outcomes of national, international, corporate, and institutional policies. Biehl's research team will continue to chronicle the rapidly changing reality of global AIDS treatment and prevention and how it dovetails with the shifting priorities of global health initiatives and human rights struggles, specifically in Latin America and Africa. The pedagogy of the project has been very successful and they will continue to hold workshops to analyze and reflect critically on their materials. Based on their field projects, Princeton University students will continue to produce junior papers, senior theses, and doctoral dissertations. They also hope to develop people-centered case studies that will be disseminated to the academic community and wider public.

Anne Case’s main research interests are in microeconomic foundations of development, health and economics of the family. For the past four years Professor Case’s work has been focused in two areas. The first is documenting the impact of early-life health and circumstance on health, cognitive function and economic status over the life-course, in both developed and developing countries, and investigating the mechanisms through which early-life circumstances matter. The second is investigating the impact of the AIDS pandemic on several dimensions of life in Africa.

Anne Case with Anu Garrib (Africa Centre for Health and Population Studies), Alicia Menendez (University of Chicago), and Analia Olgiati (Harvard University) analyzed funeral arrangements following the deaths of 3,751 people who died between January 2003 and December 2005 in the Africa Centre Demographic Surveillance Area. They found that, on average, households spend the equivalent of a year’s income for an adult’s funeral, measured at median per capita African (Black) income. Approximately one-quarter of all individuals had some form of insurance, which helped surviving household members defray some fraction of funeral expenses. However, an equal fraction of households borrowed money to pay for the funeral. They developed a model, consistent with ethnographic work in this area, in which households respond to social pressure to bury their dead in a style consistent with the observed social status of the household and that of the deceased. Households that cannot afford a funeral commensurate with social expectations must borrow money to pay for the funeral. The model leads to empirical tests, and they found results consistent with their model of household decision-making.

Using a large longitudinal dataset spanning more than a decade in her collaborative AIDS-related work with Alicia Menendez (University of Chicago) and Cally Ardington (University of Cape Town), and Till Bärnighausen (Harvard School of Public Health and Africa Centre for Health and Population Studies), Anne Case quantified the impact of adult deaths, from AIDS and from other causes, on household economic wellbeing. Verbal autopsies allow them to distinguish AIDS mortality from that due to other causes. The researchers found that households in which members die of AIDS are systematically poorer than other households, measured using members’ educations, household assets, and self-assessed poverty. The timing of the lower SES observed for these households and their AIDS deaths suggests that the socioeconomic gradient in AIDS mortality is being driven primarily by poor households being at higher risk for AIDS, rather than AIDS impoverishing the households. Moreover, they found, using reports on asset holdings and households’ self-reports of poverty, that households that experience a death from any cause are systematically poorer following a death. Funeral expenses born by the deceased’s household can explain some of the impoverishing effects of death in the household. They found no evidence that poverty following an adult death is due to the loss of an employed household member and his or her earnings. The scale-up of antiretroviral therapy (ART), late in the study period, has begun to change the age profile of mortality in the DSA. However, to date, ART has not changed the socioeconomic status gradient observed in AIDS deaths.

While working as a postdoctoral research associate at the Office of Population Research, Elizabeth Chiarello has written articles based on her qualitative dissertation research that examines social influences on professional decision-making as well as developing a new project on institutional approaches to prescription drug misuse. Focusing on political conflicts in the field of pharmacy, especially those pertaining to reproductive health and narcotics abuse and diversion, Chiarello examines how institutional, organizational, interactional and individual factors shape pharmacists’ willingness to provide care. Central findings highlight how pharmacists act as agents of social control by engaging in four gatekeeping processes – medical, legal, fiscal, and moral – that they enact differently across organizational settings; how pharmacists rely on patients’ behavior and characteristics, as well as broader cultural messages, to indicate patients’ moral worth as they construct them as “deserving” or “undeserving” of care; and how professional “contingency” (i.e. a state in which one profession’s scope of practice depends significantly on that of another profession) shapes pharmacists’ decision-making as they draw from a “discretionary toolkit” that includes mobilizing legal, medical, and managerial third parties in decision-making.

Elizabeth Chiarello's current project uses prescription drug misuse as a case for examining how two disparate fields—healthcare and criminal justice—manage the same social problem, how they deploy new technologies in the form of state- and inter-state prescription drug monitoring programs, and how their tactics bear on inequality in both access to care and exposure to the criminal justice system. Over the past year, she has conducted pilot research for this project and plans to apply for larger grant support this year. From a policy perspective, understanding the dynamics of decision-making in professional work helps explain how self-regulating professional fields operate and how they reproduce and interrupt social inequality. This is a timely topic of study given the growing epidemic of prescription drug misuse and persistent controversies over women’s health. Chiarello has written articles based on her qualitative dissertation research that examines social influences on professional decision-making as well as developing a new project on institutional approaches to prescription drug misuse.

In a paper published in Work and Occupations, Elizabeth Chiarello researched how professionals contend with threats to self-regulation from social movements outside the profession by providing an analysis of rule development by the Washington State Board of Pharmacy. A case study method using interviews, observations, and content analysis examined how pharmacists and pro-choice groups affected a “pharmacists’ responsibility” rule dictating whether pharmacists can refuse to dispense medications they morally oppose. Findings suggest that movements can influence rulemaking by framing professional responsibilities and enlisting allies, thereby turning a relatively closed process of self-regulation into a contentious one, resulting in a settlement that favors the movement over the profession.

Elizabeth Chiarello’s second paper, forthcoming in Social Science & Medicine in (2013), broadens understandings of the contexts of ethical decision-making by empirically examining how organizations affect pharmacists’ gatekeeping processes. Based on 95 semi-structured interviews with U.S. pharmacists practicing in retail and hospital pharmacies conducted between September 2009 and May 2011, this research finds that organizations influence ethical decision-making by shaping how pharmacists construct four gatekeeping processes: medical, legal, fiscal, and moral. Each gatekeeping process manifests differently across organizations due to normative aspects of the organization that structure inter-professional power dynamics, proximity to patients, and means of accessing information. Findings suggest new directions for theorizing about ethical decision-making in medical contexts by drawing attention to new ethical actors, new organizational settings, an expanded definition of ethical challenges, and a broader conceptualization of gatekeeping.

Elizabeth Chiarello's A third paper under second review at a social movements journal takes a socio-legal approach to understanding social movement consequences in professional fields, one that considers how law is constructed and enacted in professional fields and how legal and professional logics intersect to influence professional decision-making. Drawing on ethnographic interviews, surveys, and content analysis about the Emergency Contraceptive Pill (ECP) conflict in pharmacy, Chiarello finds that professional logics largely supersede legal ones to influence decision-making and that organizational positioning and perceived policy affect collective goods distribution. These forces diminish the power of pro-choice and anti-abortion laws as professionals interpret, construct, and ignore the law in daily practice. The concluding discussion offers means of considering professionals targets of social movement action, re-conceptualizing collective goods and implementation, and using field theory as methodology.

A fourth paper currently in progress by Elizabeth Chiarello argues that legal attempts to curb prescription drug misuse constitute an expansion of the “war on drugs” into mainstream medicine. Criminal justice logics encroaching into healthcare require healthcare providers to contend with significant uncertainty about their professional roles, their legal duties, and their treatment of patients. An empirical examination of how pharmacists manage this uncertainty yields theoretical insights that suggest a “network” approach to frontline work that accounts for institutional, organizational, interactional, and individual influences on decision-making. Analysis of semi-structured interviews with 69 retail pharmacists in four states reveals that pharmacists manage competing institutional logics by engaging in two professional gatekeeping processes: medical and legal. Findings suggest new ways of understanding relationships between institutions and individuals, the power of inter-professional hierarchies and negotiated orders as they relate to organizational arrangements, and the importance of examining times of change. The article concludes, with implications for policy and practice, and is currently being revised for resubmission to a socio-legal journal.

In a paper published in Ethnicity and Disease, Janiece L. Walker (University of Texas, Austin), R. Jeanne Ruiz (The Ohio State University), Juanita J. Chinn, Nathan Marti (University of Texas, Austin), and Tiffany N. Ricks (University of Texas, Austin) examined the effects of socioeconomic status, acculturative stress, discrimination, and marginalization as predictors of depression in pregnant Hispanic women. They used a convenience sample of 515 pregnant, low income, low medical risk, and self-identified Hispanic women who were between 22–24 weeks gestation. Subjects were recruited in obstetrical offices Central and Gulf coast areas of Texas. The predictor variables were socioeconomic status, discrimination, acculturative stress, and marginalization. The outcome variable was depression. Education, frequency of discrimination, age, and Anglo marginality were significant predictors of depressive symptoms in a linear regression model, F (6, 458) = 8.36, P<.0001. Greater frequency of discrimination was the strongest positive predictor of increased depressive symptoms.

Janet Currie’s research over the past two years has explored two main questions. The first has to do with determinants of fetal health, and its long-term consequences for human capital formation. She has investigated pollution, stress and nutrition during pregnancy as factors that affect infant health. The second line of research focuses on factors related to the inefficient provision of medical care (either over-provision or under-provision). Papers in this line of work look at factors such as the tort system and incentives facing providers.

Child maltreatment is a major social problem. Janet Currie with Erday Tekin (Georgia State University) measured the relationship between child maltreatment and crime using data from the National Longitudinal Study of Adolescent Health (Add Health). In their article “Understanding the Cycle Childhood Maltreatment and Future Crime,” they focus on crime because it is one of the most costly potential outcomes of maltreatment. This work addresses two main limitations of the existing literature on child maltreatment. First, they use a large national sample and investigate different types of maltreatment in a unified framework. Second, they pay careful attention to controlling for possible confounders using a variety of statistical methods that make differing assumptions. The results suggest that maltreatment greatly increases the probability of engaging in crime and that the probability increases with the experience of multiple forms of maltreatment.

In Appalachian Legacy: Economic Opportunity After the War on Poverty, James P. Ziliak, Editor, Janet Currie and Mariesa Herrmann (Columbia University) contribute, “Socioeconomic Status, Child Health, and Future Outcomes: Lessons from Appalachia.” Together they find that Appalachian adults are in relatively poor health and are more likely to die of cardiovascular disease, stroke, cancer, and diabetes than other U.S. adults. It is common to blame such disparities in outcomes on disparities in current access to medical care. However, the research summarized in Part II of this book suggests that these disparities may have their roots in childhood deprivation rather than current deprivation. This observation further suggests that it will be difficult to eradicate adult health disparities in the short run.

In The Oxford Handbook of the Economics of Poverty, edited by Philip N. Jefferson, Janet Currie’s chapter called “Antipoverty Programs for Poor Children and Families,” discusses the negative effects of poverty on children that can be especially pernicious, blighting lives before they really start. Children who grow up in poverty suffer worse outcomes than other children do. This is especially true of those who live in extreme poverty or who live below the poverty line for many years. Poverty may affect child outcomes through any number of pathways, including reduced access to medical care, poor nutrition, poor home environments (including exposure to violence and crime), and negative parenting behaviors. This chapter reviews research on the effects of programs that attempt to remediate the effects of poverty on children. Her findings show that cash-benefit programs are unlikely to ever do enough to remediate the effects of child poverty. Suggesting instead, that we need programs targeted to the specific problems facing poor children.

Most U.S. states have enacted joint and several liability (JSL) reform, the move from a regime of JSL that allows plaintiffs to claim full recovery from any one of multiple defendants to one where defendants are held liable only for the harm they cause. Contrary to previous theoretical work, Janet Currie’s work with Daniel Carvell (Columbia University) and W. Bentley MacLeod (Columbia University), “Accidental Death and the Rule of Joint and Several Liability” shows that JSL reform can increase precaution by judgment proof agent by giving “deep pockets” an incentive to reduce their own liability by bringing judgment-proof agents into court. This result can help explain the empirical findings showing that JSL reform reduces death rates (and hence increase precaution) for many types of accidents. Together, these results highlight the role that litigation costs and judgment-proof agents play in the functioning of the American tort system.

Angus Deaton’s research over the last two years, has focused on four main topics: completing a book on how the world has become a better place, and how this has generated inequality, with main focus on health and on material wellbeing; life satisfaction and wellbeing in the United States and around the world; the measurement of purchasing-power parity exchange rates and their implications for measuring global poverty and inequality; and the use of randomized controlled trials in development economics and in medicine.

Angus Deaton's book The Great Escape and the origins of inequality, is under contract with Princeton University Press. They have a complete first draft and readers’ comments with publication expected in October 2013.

Angus Deaton's work on wellbeing continues, mostly joint with Arthur Stone (Stony Brook University). A paper on wellbeing and children, is under review, and draft papers on context effects and on psychological well-being and aging have been commissioned by The Lancet. Over the next year, Deaton hopes to begin work on religion and well-being, as well as on relative income and well-being.

Angus Deaton's work on randomized controlled trials (RCT) and what they can and cannot do particularly in economic development and medicine is continuing,. This will be a major focus over the next year. Lectures have been given on Work. Deaton, along with Nancy Cartwright (Durham University), are working on writing a major paper on RCTs and policy.

In collaboration with Karen Toth (University of Washington and Seattle Children’s Hospital Autism Center), and Matthew Speltz (University of Washington), Michelle DeKlyen explored the association between behavior problems and neuropsychological capabilities in a clinical sample of preschool boys with behavior problems (submitted). Clinic-referred boys performed more poorly than typically developing comparisons on a variety of measures, and a large percentage had persistent behavior problems two years later. However, only one of the many neuropsychological measures distinguished those whose problems persisted from those who no longer exhibited significant problems. Dr. DeKlyen also continued her work on attachment issues, contributing to a chapter on attachment disorders in a volume on effective psychiatric treatment and to a chapter on disorganized attachment. Finally, she began a project assisting the State of New Jersey in the evaluation of Family Success Centers and exploring the role of social entrepreneurship in supporting healthy child development.

In 2012, Susan Fiske continued with the work of her Neuroscience Lab, investigating intergroup relations, social cognition, and social neuroscience –people making sense of people. Employing social scientific methods including cultural comparisons, surveys, lab experiments, and social neuroscience, Fiske and her students examine issues of social power and intergroup relations. Currently, as a social psychologist, she investigates emotional prejudices (pity, contempt, envy, and pride) at cultural, interpersonal, and neural levels, social cognition, especially cognitive stereotypes and emotional prejudices, at cultural, interpersonal, and neuroscientific levels.

Over the coming two years, as part of a continuation grant for the Taiwan project, Noreen Goldman will be using genetic information (e.g., telomere length, and genetic markers related to depressive symptoms and cognitive function) to explore links among stressful experience, physiological measures and mental, physical and cognitive health. A collaboration is beginning with colleagues in the department of Ecology and Evolutionary Biology (EEB) to assay additional markers related to inflammation and infection from the Taiwan blood samples in an effort to explore recent hypotheses regarding immune senescence and auto-immunity among older adults.

Noreen Goldman's ongoing work on the Mexico project is exploring the rapid deterioration in physical and mental health among Mexican immigrants subsequent to arrival in the US. Subsequent research will explore how assimilation and acculturation experiences of Mexican immigrants and second generation Mexicans affect health patterns, including obesity, and the consequences of migration to the U.S. on other family members, especially the children and parents of the migrants.

Bryan Grenfell’s research in 2012 continued with his focus on combining basic developments in infectious disease dynamics with application to public health policy. Grenfell continues to pursue the synthesis for childhood respiratory infections such as measles (in Africa) and rubella (German measles) worldwide. He is also interested in the dynamics and control of rotavirus, a major diarrheal pathogen and in influenza, where he has pursued a variety of issues in the evolutionary dynamics of the pathogen. He has written a number of papers in leading journals in these areas and also advised WHO and the Gates Foundation on control issues (for example in a major WHO consultation on rubella control, for which he provided the modelling analysis).

Bryan Grenfell’s interests are: investigating how the interaction of noise and non-linear density-dependent feedback drive population processes at different scales; understanding the spatio-temporal dynamics of infectious disease and how these are affected by control strategies; and Phylodynamics: exploring how pathogen phylogenies are affected by host immunity, transmission bottlenecks and epidemic dynamics — at scales from individual host to population. He anticipates that his research will continue along these lines with a focus in particular on the economics-epidemiology synthesis. In collaboration with the Gates Foundation, Grenfell is beginning to chart the global ‘end game’ for measles and other key infections. He also plans to extend out previous syntheses of pathogen evolutionary and epidemiological dynamics to explore the impact of novel control agents.

Jeffrey Hammer has been involved in numerous research projects with a variety of colleagues on issues of health policy in India. He is currently writing the health volume for the “Program on Indian Economic Policies: Free Trade, Democracy, and Entrepreneurial Development” at Columbia University (series editors: Jagdish Bhagwati and Arvind Panagariya). The working title is “It’s broken: Health policy in India.”

Jeffrey Hammer’s recent and ongoing studies include, “Recall periods and survey responses” is a methodological study that examines the effect that different wording in questionnaires have on the responses people give to common questions about whether they were sick recently and whether they sought treatment for their problems. Poor people appear to get sick quite often, so much so that a monthly recall shows many fewer incidents of illness, visits to medical practitioners and expenditure on medical care than a two-week recall period. This effect declines continuously with income.

Other current research projects Jeffrey Hammer is working on include: measuring and improving the quality of medical care, primarily in India; absenteeism of teachers and health workers; policy-related determinants of health status; and improving service delivery through better accountability mechanisms.

In a paper (under review), Chioun Lee, Dana Glei (Georgetown University), Maxine Weinstein (Georgetown University), and Noreen Goldman investigate how the death of an adult child affects parental wellbeing in elderly Taiwanese. The findings reveal that for mothers, a son’s death is associated with an increase in depressive symptoms and a decline in self-rated health, but fathers’ health is not adversely affected by a son’s death. There is little evidence that a daughter’s death has a negative effect on either maternal or paternal wellbeing.

In collaboration with Germán Rodríguez, Dana Glei (Georgetown University), Maxine Weinstein (Georgetown University), and Noreen Goldman, postdoctoral research associate Chioun Lee examines how the death or illness of a spouse affects blood glucose (glycemic) levels among older adults in Taiwan. The findings (under review) underscores that a decline in spouses’ health is associated with increased glycemic levels for women, but not for men. The death of a spouse who is in very good health is significantly associated with increased glycemic levels for both sexes.

Scott Lynch’s interests are in how social and behavioral factors, like race, socioeconomic status, stress, social support, etc. influence health and how they do so differently across the lives of individuals and across time. He focuses much of his time on developing and examining statistical methods to make full use of the capabilities of, and handle the limitations of, social science data. With funding from the National Institutes of Health (NIH) Lynch continues his research on how regional disparities in health and mortality affect the number of years, or years of remaining life, spent without disability. By using more refined measures of region and a broader array of health outcomes than used in previous research, and by employing a life course perspective and methods to differentiate with greater precision and accuracy the pathways via which region may affect health, he hopes to determine and explain the full extent of regional differences in health and to explain them.

In a forthcoming paper in Society and Mental Health, Michael McFarland and Mark Hayward (University of Texas, Austin) investigate how exposure to poverty throughout childhood can alter the bodies’ stress system. The deleterious effects of poverty on mental and physical health are routinely argued to operate at least in part, via dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis; although empirical examinations connecting poverty with HPA axis functioning are rare. Research on the effects of timing of poverty is a particularly neglected aspect of this relationship. This study utilized fifteen years of prospective data from the Study of Early Child Care and Youth Development (SECCYD) to assess how exposure to poverty during infancy, childhood, and adolescence was related to awakening cortisol (N=826), a marker of HPA axis functioning. They found that among females, poverty exposure in infancy and adolescence, but not childhood, was negatively associated with awakening cortisol. Poverty exposure was unrelated to cortisol among males. The importance of timing and gender differences were discussed along with directions for future research.

In a paper published in Journal of Marriage and Family, Michael McFarland, Mark Hayward (University of Texas, Austin), and Dustin Brown (University of Texas, Austin) investigate how one’s marital history was related to biological risk in older adulthood. Social relationships shape adult health in profound ways. This study informed our understanding of this association by investigating how the transitions, timing, and exposures to marriage are associated with types of biological risk presumed to serve as pathways to disease and disability. Drawing on the 2005–2006 National Social Health and Aging Project (N=1,062), the authors evaluated how marital biography was associated with cardiovascular, metabolic, and chronic inflammation risk. The results showed that the effects of marital biography were highly sensitive to gender, the dimension of marital biography, and type of biological risk. For example, marital exposure was protective of cardiovascular risk for women, but not men, whereas an earlier age at first marriage had a pernicious effect on chronic inflammation among men, but not women. Health behaviors did not explain these associations. The implications of these findings were discussed as they pertain to under-the-skin risk processes and chronic morbidity.

In a paper published in Social Science Research, Michael McFarland, Tetyana Pudrovska (Penn State), Scott Schieman (University of Toronto), Christopher Ellison (University of Texas, San Antonio), and Alex Bierman (University of Calgary) investigate how a cancer diagnosis influenced religiosity. Based on a life course framework they proposed that a cancer diagnosis was associated with increased religiosity and that this relationship was contingent upon three social clocks: cohort (1920–1945, 1946–1964, 1964+), age-at-diagnosis, and years-since-diagnosis. Using prospective data from the National Survey of Midlife Development (N = 3443), taken in 1994–1995 and 2004–2006, they tested these arguments. Results showed that a cancer diagnosis was associated with increased religiosity. Moreover, they found: (a) no evidence that the influence of cancer varied by cohort; (b) strong evidence that people diagnosed with cancer at earlier ages experienced the largest increases in religiosity; and (c) no evidence that changes in religiosity are influenced by years-since-diagnosis. This study emphasized how personal reactions to cancer partly reflect macro-level processes, represented by age-at-diagnosis, and shows that the religion-health connection can operate such that health influences religiosity. The study also highlights the sociological and psychological interplay that shapes people’s religiosity.

In a paper Michael McFarland will present at the 2013 Population Association of America Conference in New Orleans, McFarland, Nancy Reichman, Sara McLanahan, and Bridget Goosby (University of Nebraska, Lincoln) seek to assess the multigenerational origins of infant health and their corresponding social and biological pathways. Using data from the medical files of the Fragile Families Study, this study will show that the social origins of infant health, including low birthweight, preterm birth, small for gestational weight, and other health conditions, extended back multiple generations. The grandfather’s education is of particular importance and operates through both social pathway and biological mechanisms. This project is still in progress.

In a study currently in progress, Michael McFarland and a team of interdisciplinary scholars are investigating the early-life origins of cognitive ability using a genetically-informed study design that utilizes genomic data from the Fragile Families Project. This study suggests that: (a) the influence of household income is contingent on the presence of a polymorphism on the COMT gene; (b) parenting practices during infancy have a particularly strong influence on cognitive ability: and (c) the conjoint influence of income and this COMT polymorphism is dependent on parenting practices during infancy. This study also highlights that gene-environment interactions are predicated on past exposures and calls for future research to integrate exposures throughout the life course into gene-environment interaction studies more broadly.

Globally, more than one fourth of all pregnancies are unintended. Emergency contraception can be used after sex to reduce the risk of pregnancy. But despite their safety and efficacy, emergency contraceptive pills (ECPs) have sparked controversy worldwide. Editors Angel M. Foster and L.L. Wynn examine the journey of ECPs in fourteen countries in Emergency Contraception, the Story of a Global Reproductive Health Technology (2012) published by Palgrave Macmillan. In his chapter “Emergency contraception: hopes and realities” in this book, James Trussell explores the ways that a global reproductive health technology both acquires local cultural meaning and encounters similar challenges everywhere it is introduced worldwide. This book's portraits of activism and opposition highlight the range of social, cultural, religious, and political contexts that shape the interpretation of new medical technologies.

In a paper forthcoming in the Journal of Obesity, Sarinnapha Vasunilashorn, Jung Ki Kim (University of Southern California) and Eileen Crimmins (University of Southern California) examines cross-cultural associations of weight with indicators of biological risk in three nationally representative populations: the U.S. National Health and Nutrition Examination Survey, the English Longitudinal Study of Ageing, and the Social Environment and Biomarkers of Aging Study in Taiwan. Indicators of biological risk were compared for obese (defined using body mass index, BMI, and waist circumference) and normal weight individuals age 54+. This study observes three general findings about how biological risk is associated with obesity in three countries that differ in lifestyle and culture. First, obesity is associated with physiological dysregulation in all countries with differences in the links between specific indicators of biological risk and obesity. Second, these relationships remain after controlling for demographic factors, participation in physical activity, and other behavioral factors. Third, similar to obese older adults, high waist individuals with normal BMI also exhibit greater physiological dysregulation in all countries compared to their normal BMI and normal waist counterparts.

In a forthcoming manuscript in the Journal of Aging Health, Sarinnapha Vasunilashorn and Melissa Martinson (University of Washington) examine the relationship between weight status in adolescence and later life functional limitations. They used the Wisconsin Longitudinal Study to characterize the relationship between standardized relative body mass ascertained from high school photograph portraits in 1957 and self-reported functional imitations in 2004. Compared to individuals with normal body mass, participants who were overweight in high school had poorer later life physical function, with observed gender differences. Women who were underweight in adolescence had better functioning in older adulthood than their normal weight counterpart. This relationship, however, was not found among men.

In a paper currently under review, Sarinnapha Vasunilashorn, Dana Glei (Georgetown University), Maxine Weinstein (Georgetown University) and Noreen Goldman use proportional hazard models to determine whether perceived stress predicted 11-year mortality in a population of older Taiwanese adults. After adjusting for sociodemographic factors only, they found that a one standard deviation increase in perceived stress was associated with a 19% increase in mortality risk during the 11-year follow-up period; this was no longer significant in the fully adjusted model that included medical conditions, mobility limitations, and depressive symptoms. The strength of the relationship was substantially attenuated when they excluded the item indicating perceived stress about the respondent’s own health. In the fully adjusted model, perceived stress was not a significant predictor of mortality.Perceived stress predicted all-cause mortality in an older adult population in Taiwan, but the relationship was greatly attenuated when perceptions of stress regarding health were excluded, and was not significant after adjusting for medical conditions, mobility limitations, and depressive symptoms.

In a manuscript under review, Sarinnapha Vasunilashorn, Scott Lynch, Dana Glei (Georgetown University), Maxine Weinstein (Georgetown University) and Noreen Goldman examined the relationship between exposure to stressors and perceived stress. Specially, they (1) examine change in exposure to stressors and perceptions of stress across several domains and (2) investigate whether change in exposure influences change in perceived stress using the Taiwan Longitudinal study of Aging. Their findings indicate that exposure to stressors increased, while perceived stress decreased, over time. Change in exposure to stressors was not generally associated with change in perceptions of stress, with the exception of a summary measure of health-related exposure to stressors: An increase in poor health over time was related to an increase in perceived stress in all domains.

Tom Vogl is an applied economist with interests in the economics of health and population, particularly among the socially and economically disadvantaged. His recent research has examined the relationship between socioeconomic status and health over the lifecycle as well as the effects of childhood family structure on adult outcomes. In a separate line of work, he has studied racial politics in American cities.

In a column written with Janet Currie entitled, “Lasting effects of childhood health in developing countries,” Tom Vogl assesses that the global decline in ill health has not been met with greater prosperity. The authors question what they are to make of healthier and larger populations undercutting per capita economic progress? They argue that early-life health changes do, in fact, have a huge effect on economic outcomes over the lifecycle. However, the jury is out on how we can best manage – and measure – the apparent play off between better health, higher populations, and poorer per capita economic outcomes.

In a paper recently published in the Journal of Health Politics, Policy and Law, Miranda Waggoner discusses the social and health policy implications of a public health initiative aimed at improving the health status of U.S. women prior to pregnancy. In a forthcoming piece in Gender & Society with Rene Almeling (Yale University), she examines how men’s reproductive contributions are understood in preconception health settings. In a new project funded by the NSF, Waggoner is researching the emergence of the developmental origins of health and disease hypothesis and its operationalization in human population and animal sciences. Aided by the ascendance of epigenetic explanations for life course health outcomes, the theory of developmental origins has been deployed in order to better understand the determinants of adult health and disease. Her project investigates the utilization and meaning of this new locus of inquiry in population health research. Waggoner also continues her project on the rise of food allergies among children.

Based on national Demographic and Health Surveys (DHS) conducted in Rwanda in 1992, 2000, 2005 and 2010, Charles Westoff examines the very rapid changes in reproductive behavior and preferences that have occurred over the past decade. In his article “The Recent Fertility Transition in Rwanda,” forthcoming in Population and Development Review, he also looks at trends in socioeconomic characteristics and child mortality to elucidate these reproductive trends. Westoff concludes by reviewing government policies and program developments that appear to underlie these population changes.

A recently published monograph in the DHS Analytical Studies, “Unmet need for modern contraceptive methods,” Charles Westoff studied the fact that the use of modern contraception has generally been rising, but the changes are slight in West and Middle Africa, where contraceptive use for spacing rather than for limiting births continues to dominate.

In another monograph with DHS Analytical Studies, Charles Westoff, along with Sarah Bradley, Trevor Croft and Joy Fishel, all from ICF International, Calverton, MD, examined questions of unmet need. In “Revising unmet need for family planning,” Westoff and his co-authors review the history of unmet need and explain how it reached its current level of complexity. They go on to demonstrate the impact of revising the definition of unmet need for currently married women. They outline and demonstrate the revised definition to show estimates of demand for family planning and proportion of demand satisfied, differentials in unmet need by background characteristics, and estimates of unmet need for sexually active unmarried women. They estimate what the potential impact that fulfilling all unmet need could have on fertility rates, comparing the original and revised definitions. The analyses use data from 169 DHS surveys from 70 countries conducted over the last 20 years.

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Annual Report

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