PUB 460 Lecture 3 - Life Course Perspective on MCH - I PDF

LIFE COURSE PERSPECTIVE ON MCH - I PUB 460 Dr. Gauri Desai Life course perspective • Historically, focus on contemporaneous/temporally proximate risk factors has been the approach to MCH research, policy, and practice. • Perinatal exposures → Perinatal problems • Childhood exposures → Childhood he...

LIFE COURSE PERSPECTIVE ON MCH - I PUB 460 Dr. Gauri Desai Life course perspective • Historically, focus on contemporaneous/temporally proximate risk factors has been the approach to MCH research, policy, and practice. • Perinatal exposures → Perinatal problems • Childhood exposures → Childhood health problems • Adult exposures → Adult health problems • This approach does not explain – • All the premature maternal and child deaths or discrepancies in expenditure and MCH health indicators in the US or elsewhere • The disparities existing between subgroups across generations Life course perspective • Alternative approach needed to understand these discrepancies • Alternative approach: Focusing on long-term health impacts of experiences, exposures, and behaviors over an individual’s entire lifespan, called as life course perspective • The life course approach has its roots in the early years of the 20th century: • In several rapidly industrializing European countries, childhood deprivation had serious long-term health consequences for those countries’ poorest citizens https://www.who.int/life-course/publications/life-course-approach-literature-review.pdf Life course perspective • Based on the premise that the body records all of our life experiences • To understand the present health, experiences, exposures, and events that have occurred in the past (years, decades, generations) must be understood Life course perspective • Life course perspective generates questions such as – • To what extent is our health impacted by our life history? • To what extent is our health impacted by our parents’ life histories? • To what extent is our health impacted by the histories of our ancestors? • Are exposures that we experienced in utero linked to our risk of developing certain diseases in old age? • Are exposures that our mothers experienced before our conception linked to our risk of developing certain diseases in old age? • What is the life course approach to public health? [4:55] https://www.youtube.com/watch?v=3OBFYIXmAwQ Five Defining Principles of Life Course Theory 1. 2. 3. 4. 5. Principle of Life Span Development Principle of Human Agency Principle of Timing Principle of Linked Lives Principle of Historical Time and Place (Elder, 2006) Five Defining Principles of Life Course Theory 1. Principle of Life Span Development • Health and wellbeing are lifelong processes • Can only be understood in the context of the experiences of one’s entire lifespan • The past can impact the present and the future Five Defining Principles of Life Course Theory Five Defining Principles of Life Course Theory Pediatrics, October 2016 Five Defining Principles of Life Course Theory Five Defining Principles of Life Course Theory 2. Principle of Human Agency • Humans are not passive recipients of a predetermined life course but make decisions that determine the shape their lives • Highlights central roles of personal control and behavior in health and illness • Critical assumption: human agency is embedded in social context • Individuals’ decisions and actions are within the opportunities and constraints of history and circumstances Five Defining Principles of Life Course Theory 2. Principle of Human Agency Five Defining Principles of Life Course Theory 2. Principle of Human Agency Five Defining Principles of Life Course Theory 3. Principle of Timing • Suggests that our health is shaped not only by what happens to us but also by when it happens, how long it lasts, i.e., duration, and in what order it occurs relative to other events, i.e., sequencing • Impact of childbearing on female educational attainment depends on maternal age at birth • Impact of family instability on a child depends on age at onset of instability Five Defining Principles of Life Course Theory 3. Principle of Timing • Duration: Concept of cumulative advantage or cumulative disadvantage, referred to as cumulative dis/advantage • Racial disparities in MCH health indicators may be explained by the cumulative dis/advantage Five Defining Principles of Life Course Theory 3. Principle of Timing Five Defining Principles of Life Course Theory 4. Principle of Linked Lives • Our health and wellbeing are shaped by the social networks to which we belong and our relationships with our significant others • The link between maternal health and infant health • Fortunes and misfortunes of adults become intergenerational and can impact their children Five Defining Principles of Life Course Theory 4. Principle of Linked Lives https://www.gih.org/files/AudioConf/Building%20a%20Movement%20(Abbreviated).pdf Five Defining Principles of Life Course Theory 4. Principle of Linked Lives • This principle extends beyond the interdependent lives of biologically related individuals • Caregiver characteristics and child maltreatment risks • Peer relationships and adolescent risk behaviors • Sexual network characteristics and STIs Five Defining Principles of Life Course Theory 4. Principle of Linked Lives Five Defining Principles of Life Course Theory 5. Principle of Historical Time and Place • Highlights the ways in which period, cohort, and contextual factors influence the life course • Great Depression (1930s) impacted the lives and health of many • Economic stress within the household can have an immediate impact on parenting and long-term impact on the child Five Defining Principles of Life Course Theory 5. Principle of Historical Time and Place Five Defining Principles of Life Course Theory 5. Principle of Historical Time and Place Five Defining Principles of Life Course Theory - summary 1. Principle of Life Span Development: suggests that health and wellbeing are lifelong processes and can only be fully understood within the context of experiences across one’s entire lifespan 2. Principle of Human Agency: highlights central roles of personal control and behavior in health and illness 3. Principle of Timing: suggests that our health is shaped not only by what happens to us but also by when it happens, duration and sequencing 4. Principle of Linked Lives: explains notion of interdependent lives 5. Principle of Historical Time and Place: highlights the ways in which period, cohort, and contextual factors influence the life course (Elder, 2006) Three Exposure Models in Life Course Epidemiology Mechanistic models that may explain how exposures over the life course shape subsequent health: 1. Critical/sensitive period model 2. Accumulation of risk model 3. Chain of risks model Three Exposure Models in Life Course Epidemiology 1. Critical/sensitive period model • Critical period: Limited time window in which an exposure can have adverse or protective effects on development and subsequent disease outcome • Exposure acting during a specific (or critical) period has lasting or lifelong effect on the structure or physical functioning of organs, tissues and body systems • Often causes irreversible changes Kuh D, Ben-Shlomo Y, Lynch J, et al. Life course epidemiology. Journal of epidemiology and community health 2003 Three Exposure Models in Life Course Epidemiology 1. Critical/sensitive period model • Different outcomes have different critical periods • Brain development: Up to 5 years of age for certain outcomes • Heart development: 5 to 8 gestational weeks • Critical periods for many outcomes are not known Kuh D, Ben-Shlomo Y, Lynch J, et al. Life course epidemiology. Journal of epidemiology and community health 2003 Three Exposure Models in Life Course Epidemiology 1. Critical/sensitive period model Cardonik E, Lacobucci A. (2004). Use of chemotherapy during human pregnancy. Lancet Oncol., 5(5), 283-291. Three Exposure Models in Life Course Epidemiology 1. Critical/sensitive period model (A) Later life exposures have no effect, i.e., exposures occurring outside the critical window do not impact the outcome Kuh D, Ben-Shlomo Y, Lynch J, et al. Life course epidemiology. Journal of epidemiology and community health 2003 Mishra GD, Cooper R, Kuh D. A life course approach to reproductive health: theory and methods. Maturitas. 2010 Feb;65(2):92-7. doi: 10.1016/j.maturitas.2009.12.009. Epub 2010 Jan 15. PMID: 20079587; PMCID: PMC3504662. Three Exposure Models in Life Course Epidemiology 1. Critical/sensitive period model (B) Later life exposures can modify the outcome to some extent Kuh D, Ben-Shlomo Y, Lynch J, et al. Life course epidemiology. Journal of epidemiology and community health 2003 Mishra GD, Cooper R, Kuh D. A life course approach to reproductive health: theory and methods. Maturitas. 2010 Feb;65(2):92-7. doi: 10.1016/j.maturitas.2009.12.009. Epub 2010 Jan 15. PMID: 20079587; PMCID: PMC3504662. Three Exposure Models in Life Course Epidemiology 2. Accumulation of risk model • Focuses on the total amount and/or sequence of exposure, suggesting that multiple effects accumulate over the life course • As the number, duration and severity of exposures increase, there is cumulative damage to biological systems Jacob CM, Baird J, Barker M, Cooper C, Hanson M. The importance of a life course approach to health: chronic disease risk from preconception through adolescence and adulthood. World Health Organization. 2017;41. Three Exposure Models in Life Course Epidemiology 2. Accumulation of risk model • Accumulation of risk can also be due to clustering of exposures Uauy R, Solomons N. (2005). Diet, nutrition, and the life-course approach to cancer prevention. J. Nutr., 135(12 Suppl), 2934S-2945S. Three Exposure Models in Life Course Epidemiology 2. Accumulation of risk model (A) Exposure risk can be independent, but the impact can be the result of the accumulation of these independent exposures Kuh D, Ben-Shlomo Y, Lynch J, Hallqvist J, Power C. Life course epidemiology. J Epidemiol Community Health. 2003 Oct;57(10):778-83. doi: 10.1136/jech.57.10.778. Erratum in: J Epidemiol Community Health. 2003 Nov;57(11):914. PMID: 14573579; PMCID: PMC1732305. Three Exposure Models in Life Course Epidemiology 2. Accumulation of risk model • Faster growth rate, presence of a stepfather, war are all independent exposures • They all have a cumulative effect: earlier menarche Mishra GD, Cooper R, Kuh D. A life course approach to reproductive health: theory and methods. Maturitas. 2010 Feb;65(2):92-7. doi: 10.1016/j.maturitas.2009.12.009. Epub 2010 Jan 15. PMID: 20079587; PMCID: PMC3504662. Three Exposure Models in Life Course Epidemiology 2. Accumulation of risk model (B) Exposure risk can be clustered, and the impact can be the result of the accumulation of these clustered exposures Kuh D, Ben-Shlomo Y, Lynch J, Hallqvist J, Power C. Life course epidemiology. J Epidemiol Community Health. 2003 Oct;57(10):778-83. doi: 10.1136/jech.57.10.778. Erratum in: J Epidemiol Community Health. 2003 Nov;57(11):914. PMID: 14573579; PMCID: PMC1732305. Three Exposure Models in Life Course Epidemiology 2. Accumulation of risk model • Low childhood socioeconomic position is associated with poorer growth, more family stress and inadequate diet all of which may increase risk of earlier menopause Mishra GD, Cooper R, Kuh D. A life course approach to reproductive health: theory and methods. Maturitas. 2010 Feb;65(2):92-7. doi: 10.1016/j.maturitas.2009.12.009. Epub 2010 Jan 15. PMID: 20079587; PMCID: PMC3504662. Three Exposure Models in Life Course Epidemiology 3. Chain of risks model • Refers to a sequence of linked exposures that raise disease risk because one bad experience or exposure tends to lead to another and then another • Suggests that various intermediate factors between early life and adult health – such as lifestyle, educational attainment, social class and health behaviors – may all play roles • Supports the notion that early events influence the life course trajectory, leading to particular social destinations and ultimately influencing health outcomes Jacob CM, Baird J, Barker M, Cooper C, Hanson M. The importance of a life course approach to health: chronic disease risk from preconception through adolescence and adulthood. World Health Organization. 2017;41. Three Exposure Models in Life Course Epidemiology 3. Chain of risks model (A) Refers to a sequence of linked exposures where one leads on to the next Kuh D, Ben-Shlomo Y, Lynch J, Hallqvist J, Power C. Life course epidemiology. J Epidemiol Community Health. 2003 Oct;57(10):778-83. doi: 10.1136/jech.57.10.778. Erratum in: J Epidemiol Community Health. 2003 Nov;57(11):914. PMID: 14573579; PMCID: PMC1732305. Three Exposure Models in Life Course Epidemiology 3. Chain of risks model • Risky sexual behavior leads to STIs, which then results in infertility Mishra GD, Cooper R, Kuh D. A life course approach to reproductive health: theory and methods. Maturitas. 2010 Feb;65(2):92-7. doi: 10.1016/j.maturitas.2009.12.009. Epub 2010 Jan 15. PMID: 20079587; PMCID: PMC3504662. Three Exposure Models in Life Course Epidemiology 3. Chain of risks model (B) Each exposure not only increases the risk of the subsequent exposure but also has an independent effect on disease risk irrespective of the later exposure Kuh D, Ben-Shlomo Y, Lynch J, Hallqvist J, Power C. Life course epidemiology. J Epidemiol Community Health. 2003 Oct;57(10):778-83. doi: 10.1136/jech.57.10.778. Erratum in: J Epidemiol Community Health. 2003 Nov;57(11):914. PMID: 14573579; PMCID: PMC1732305. Three Exposure Models in Life Course Epidemiology 3. Chain of risks model • Smoking may lead to early menopause, which in turn may increase the likelihood of developing heart disease. • Each exposure in a chain of risk may not only increase the risk of subsequent exposure in a probabilistic way, but may also have an independent additive effect on later health Mishra GD, Cooper R, Kuh D. A life course approach to reproductive health: theory and methods. Maturitas. 2010 Feb;65(2):92-7. doi: 10.1016/j.maturitas.2009.12.009. Epub 2010 Jan 15. PMID: 20079587; PMCID: PMC3504662. Three Exposure Models in Life Course Epidemiology Mechanistic models that may explain how exposures over the life course shape subsequent health: 1. Critical/sensitive period model 2. Accumulation of risk model 3. Chain of risks model Question Bank 1. List the five defining principles of life course theory and briefly describe any one 2. List the three exposure models in life course epidemiology and briefly describe any one