Health Disparities

Area Projects

Network on Life Course Health, Dynamics and Disparities in 21st Century America

Principal Investigator:  Robert Hummer; Co-Principal Investigator: Mark Hayward
Funded by:  National Institutes of Health

This proposal seeks to formally create a research network to understand how and why the United States is increasingly falling behind virtually all comparably developed/wealthy nations, and even some developing countries, on major indicators of population health, despite the U.S. spending far more than any nation on health care and insurance. Limitations in data comparability across nations currently make comparative analysis of these issues difficult, and the proposed network and other scientists will be working to alleviate these limitations.  However, understanding how and why portions of our population exhibit poor and/or worsening health is crucial to understanding America's paradoxical decline in health despite burgeoning spending for health care and insurance. Thus, the network will focus initial efforts on working across many existing sources of data to understand: 1) how and why the health of American women has been worsening since 1980 relative to both American men and women in other countries; 2) how and why socioeconomic disparities in health, especially by education, have persisted and even increased over the past three decades; and 3) how and why racial-ethnic disparities in health exist and persist, while also alleviating in some ways in recent decades. This work will later lead the network to: 1) systematic projection of past, present and especially future trends in U.S. population health and health disparities and the implications for expenditures on health care and insurance; and 2) comparative research to understand what factors have been most important in the worsening of America's population health relative to other comparably developed/wealthy nations. The network will bring together multidisciplinary teams of investigators from three institutions that have been leaders in research on social and biomedical determinants of population health and health disparities: Univ. of Michigan, Univ of Southern California/UCLA, and the Univ. of Texas at Austin. Key scientists from other institutions will be added to the network and/or will interact and collaborate with it via annual meetings and/or ongoing working groups. We seek to generate and disseminate new scientific analyses and findings, and to facilitate development of methods and data that can improve these analyses.

Testing Gene-Testosterone Interplay in Adolescent Alcohol Use

Principal Investigator:  K. Paige Harden; Co-Principal Investigator:
Funded by:  Eunice Kennedy Shriver National Institute of Child Health and Human Development

Adolescence is a critical period for the initiation and escalation of alcohol use and for the emergence of sex differences in alcohol use. The proposed research will test how changes in testosterone (T) during adolescence intersect with genetic influences on the development of alcohol use and related risk-taking behaviors. T levels increase dramatically from childhood through adolescence, particularly in males. Adolescent increases in T affect brain structure and function, including neural response to reward. Moreover, behavioral studies have found that individual differences in T predict alcohol use phenotypes, with stronger associations seen in boys than in girls. A largely independent stream of behavioral genetic research has established that genetic influences on substance use and related risk-taking behaviors increase over the course of adolescence. How these genetic influences intersect with hormonal changes during adolescence is unknown, as endocrine measures and behavioral genetic data have rarely been integrated. This gap is partly due to methodological challenges associated with measuring hormones in saliva: Single measures do not fully discriminate basal levels of hormones from state fluctuations (e.g., situational reactivity, diurnal rhythm), while high-intensity repeated measurement is costly and burdensome to participants. The proposed research aims to overcome this barrier to research progress by using cutting-edge technology to measure accumulated T in hair. Hair T represents a 3-month hormonal accumulation and thus reflects chronic individual differences un-confounded with state fluctuations but sensitive to pubertal changes. We will examine the interplay between T and genetic influences on alcohol use in a sample of 500 twins (250 same-sex MZ and DZ pairs) ages 13-18. We will collect data on (1) T in saliva and hair, (2) reward sensitivity using a battery of in-lab behavioral tasks and self-report surveys, and (3) alcohol use using youth-report, parent-report, and school disciplinary records. This approach will address the following specific aims: (1) investigate the measurement of T in hair as a novel method that captures the underlying genetic “signal” better than salivary T, (2) examine T as an endophenotype that mediates genetic influences on alcohol use through its effects on reward sensitivity, and (3) examine T as a moderator of genetic influences on reward sensitivity and alcohol use (i.e., gene × hormone interaction). We hypothesize that accumulation of T in hair will represent a highly heritable endophenotype that both mediates and moderates genetic influences on alcohol use, with genetic risk being exacerbated in high T individuals. We also hypothesize that there will be sex differences in the gene  hormone  behavior links, with stronger associations evident in males than females, thus contributing to the emerging sex difference in alcohol use phenotypes. Given the novelty of measuring sex steroids in hair and the potential to illuminate genetic and epigenetic mechanisms underlying adolescent alcohol use, the project is both high-risk and high-reward, and is thus perfectly suited for the R21 mechanism.

Demographic Diversity in the Measurement and Meaning of Unintended Pregnancy /
Measuring Unintended Pregnancy when Fertilty Intentions and Feelings about Pregnancy are Mismatched

Principal Investigator: Abigail Aiken
Faculty Sponsor: Joseph Potter
Funded by: Society of Family Planning, Eunice Kennedy Shriver National Institute of Child Health and Human Development

The overarching aim of this research is to inform strategies for the prevention of unintended pregnancy by providing a better understanding of women’s future childbearing intentions and feelings about pregnancy, particularly when these two concepts appear to be mismatched. When women report feeling happy at the prospect of pregnancy, but at the same time report wanting no more children, current theoretical perspectives interpret these incongruent feelings and intentions as ambivalence (i.e. the lack of a clear and strong desire to avoid pregnancy). Going a step further, ambivalence is assumed to be a marker of decreased quality of contraceptive use, and thereby increased likelihood of getting pregnant, and is also more common among Latinas. This research will investigates the hypothesis that incongruent intentions and feelings are not a reflection of ambivalence, but rather two distinct concepts: women may be quite resolute about avoiding future pregnancies, yet still express happiness at the prospect of pregnancy. Classifying these women as ambivalent leads to inaccurate measurement of unintended pregnancy, hinders understanding of the difficulties these women might face in obtaining effective contraception, and limits the ability to address disparities in unintended pregnancy across racial and ethnic groups.

Conference Series on Aging in the Americas: United States and Mexico

Principal Investigator: Jacqueline Angel
Funded by:  National Institute on Aging

The proposed new installments of the conference series on aging in the Americas (2012-2014) will focus on the state of readiness for addressing the needs of Latino elders and for sustaining their health and well-being. The most poignant example is the Mexico-U.S. contrast as these societies are contending with multiple demands for public use of scarce resources and have overlapping, interdependent  populations and family networks transcending both nations.  Thirty papers and six keynote speakers from sociology, psychology, social policy, medicine, economics, gerontology, demography, epidemiology, and community health will 1) discuss the impact of changing demographics on community capacity for successful aging, including health, housing,  and food security; 2) create a strategic framework for future transnational comparative research on Hispanics in the U.S. and Mexico, including issue identification and the available data resources for advancing a high quality research menu on this fundamental  issue; and 3) develop a set of goals for advancing the healthy aging in the Mexican-origin population from a bi-national perspective. Collectively, the research will provide new knowledge on the health consequences of emerging trends in the Americas for Hispanic communities and will inform new strategic initiatives to adequately respond to the accelerating demands of aging populations.

The Risk of Long-Term Care in Older Mexican-American Families

Principal Investigator: Jacqueline Angel
Additional Investigator: Ronald Angel
Funded by: National Institute on Minority Health and Health Disparities

Older people of Mexican origin make up one of the fastest -growing segments of the U.S. population, and their numbers are projected to increase sevenfold by 2050. This demographic explosion will place serious demands on the long-term care system, from family caregivers to federally sponsored sources of care. Mexican Americans suffer disproportionately from disabling conditions like diabetes that increase their risk of care in a nursing home or assisted-living facility. The relationship between functional decline and subsequent institutionalization for this population, however, may be largely influenced by a combination of factors, including economic resources and family and social support network. These factors may, in turn, vary by nativity, age at migration, and acculturation. To date, few studies have tested predictive models on how immigration-related factors, economic resources, and family support converge to determine care and living arrangements (i.e., living alone, living with spouse or family, or institutionalization) in elderly Mexican-origin individuals with declining functional status. The overall goal of this study is to clarify the most important factors associated with changes in the care and living arrangements of elderly Mexican Americans. We will evaluate a new empirical model to determine how immigration factors (e.g., nativity, age at migration, acculturation) and family resources (e.g., financial security, family and social support network) moderate how changes in functional status induce changes in care and living arrangements among older Mexican Americans in the United States. The specific aims are to: (1) examine the physical and cognitive functioning trajectories of elderly Mexican Americans between 1993 and 2008, by immigration factors; (2) assess how declines in functional status of elderly Mexican Americans relate to changes in care and living arrangements, by immigration factors; and (3) estimate the joint effect of family resources and immigration factors on use of nursing homes and assisted- living facilities by elderly Mexican Americans. We will use standard demographic and epidemiological techniques to analyze 3,952 individuals included in the Hispanic Established Populations for Epidemiologic Study of the Elderly (H-EPESE), the largest and most representative survey on the longitudinal health of older Mexican Americans. The results will identify key predictors of Mexican Americans' care and living arrangements, including the use of nursing homes and assisted-living facilities, providing important insights into social processes that will affect all aging families in the future. The study will also inform policy makers and best practice models in reducing disparities in unmet long-term care service needs.

Longitudinal Study of Mexican American Elderly Health

Principal Investigator: Ronald Angel
Additional Investigators: Kyriakos Markides, parent project PI; Jacqueline Angel, Co-Investigator; UT-Austin subcontract
Funded by: National Institute on Aging

This project will conduct two in-person follow-ups of the Hispanic EPESE (Established Population for the Epidemiological Study of Elderly) during 2009-2010 and 2011-2012. The study's baseline was conducted during 1993-1994 when a representative sample of 3,050 Mexican Americans age 65 and over residing in the five Southwestern states - Texas, New Mexico, Colorado, Arizona, and California - were interviewed and followed up four times. By 2004-2005 (Wave 5) 1,167 of the original subjects now aged 75 and over were re-interviewed. An additional representative sample of 902 Mexican Americans also aged 75 and over was added at Wave 5 giving us a combined sample of 2069 subjects aged 75 and over. Of these, 1542 were re-interviewed in 2007 (data still being processed), approximately 2 1/2 years later. The study thus far has generated over 170 publications and has provided valuable information related to the health and health care needs of older Mexican Americans. Wave 7 is proposed to take place in 2009-2010 and we estimate interviewing slightly over 1,000 surviving subjects aged 80 and over. We also propose to interview a "focal relative", most likely a child, who will supply information on the subjects' health, family, and financial situation. Both will be followed up two years later in 2011-2012. We expect that we will re-interview 700 subjects aged 82 and over and 800 of the focal relatives. Family members of deceased subjects will provide information on circumstances surrounding the subjects' death, which we have done over the years by using a proxy death questionnaire. Our first and new aim will be accomplished primarily by interviewing the focal relatives who will provide assessments of the older subjects' financial, family, and health situation. We will assess the nature and extent of any caregiving arrangements in very old Mexican Americans and the physical, psychological, and financial burdens of advanced age on the extended family. Given the advanced age of the sample, we expect to have sufficient numbers of subjects entering nursing homes and assisted living facilities to learn about factors leading to institutionalization. Although the rate of institutionalization among Mexican Americans is lower than that in the general population, our data thus far have suggested that it may be rising. We will have the opportunity to assess the influence of psychosocial and medical factors leading to institutionalization. We continue to assess trajectories of change in physical function, depressive symptomology, and cognitive function. We also propose to do a more extensive assessment of cognitive function including assessments made by the focal relatives. As we have done in the past, we plan to rapidly archive the data and to encourage others to use them. The Mexican American population is experiencing rapid rates of aging, and very little is known about the health, health care needs, and financial situation of the very old. Our findings thus far suggest that this is a population characterized by rising life expectancy which is accompanied by increased disease burden and increasing disabilityrates.

Social Demographics, Marginalization, and Adolescent Substance Use

Principal Investigator: Aprile D. Benner
Funded by: National Institute on Drug Abuse

Substance use during adolescence is an oft-studied phenomenon, but this research generally fails to take an ecological perspective on etiology. Schools are a primary context of socialization during adolescence, and understanding how school composition matters for substance use is critical for prevention efforts. Promoting school diversity has been a major legislative goal, but the unintended public health consequences of such policies are often ignored-diversity has empirically established academic benefits, yet it is not without its challenges, particularly regarding the socioemotional well-being of children and adolescents whose lack of demographic "fit" with their schools puts them at risk for social marginalization. Whether this demographic misfit (i.e., having few same-race/ethnic or same-socioeconomic peers in school) is risky for substance use has yet to be explored, although both theory and empirical evidence suggests that it might. The general goal of this project, therefore, is to examine whether, why, and when students who do not have a critical mass of same-race/ethnicity peers or peers of similar SES in school are more likely to drink and use drugs. Here, I use data from Add Health to explore three specific areas of inquiry. First, I will identify adolescents who are at the numeric margins of their schools both racially/ethnically and socioeconomically and compare their substance use to that of adolescents who have greater representation of same-demographic peers. Such research will highlight the potential unintended health risks of major academically-focused school reforms. Second, I will test two mechanisms by which marginalization might influence substance use: a) whether marginalization initiates feelings of misfit that, in turn, contribute to adolescents' substance use and b) whether the link between marginalization and substance use is stronger for students in schools and peer groups in which substance use is more normative. Third, the project will explore the extent to which the marginalization threshold (defined as 15% or more same-demographic peers) effectively captures the critical mass necessary for protection against substance use and lack of fit. Although the National Academy of Education recommends the 15% same-demographic peer threshold to protect against the harmful effects of marginalization, their report acknowledges that this estimate needs empirical validation. As a departure from previous, small-scale studies that explore the critical mass question, this project uses a large, nationally representative sample to empirically identify the critical mass needed to protect against social marginalization. Early substance use and abuse exert pernicious effects across the life course, and this project has the potential to expand our understanding of the implications of school composition for such risky health behaviors. By elucidating the mechanisms by which marginalization affects substance use, the project will highlight critical points of intervention, and by identifying the contextual antecedents of early substance use, the project will inform educational policy efforts that seek to better promote the full academic benefits of diversity in America's public schools.

Preschool, Home, and School Contexts as Determinants of the Impacts of Head Start

Principal Investigator: Elizabeth Gershoff
Additional Investigator: Aletha Huston
Funded by: Eunice Kennedy Shriver National Institute of Child Health and Human Development

Head Start is the largest federal program providing an enriched early childhood education for children from low income families. A substantial body of non-experimental and quasi-experimental research has linked Head Start participation with (often modest) gains in children's developmental outcomes. Yet research to date has failed to examine how variability across Head Start centers is associated with variability in children's developmental outcomes, and how the quality of home and school environments experienced after Head Start might sustain, or curtail, the impacts of Head Start over time. To address this knowledge gap, the proposed project goes beyond questions of simple impact to consider the conditions and contexts which make Head Start more or less effective. Specifically, we will examine the extent to which the structure and quality of Head Start centers, parenting behavior and the home environment, and the structure and quality of elementary schools might mediate or moderate program impacts over time. Our interdisciplinary team (from the fields of human development, education, economics, and social work) will utilize two large, national Head Start studies--one of which used an experimental design--to address the following aims: Aim 1: To identify to what extent, and by what processes, aspects of Head Start quality promote children's cognitive development, social-emotional skills, and physical health; Aim 2: To determine the role of parents in creating and sustaining positive long-term impacts of Head Start on children's cognitive development, social-emotional skills, and physical health; and Aim 3: To examine the extent to which subsequent school experiences moderate the persistence of Head Start effects on children's cognitive development, social-emotional skills, and physical health. The project involves secondary data analysis of two large, federally sponsored data-sets, namely the Head Start Family and Child Experiences Survey, 1997 Cohort (FACES-97), and the Head Start Impact Study (HSIS). Each study included a nationally representative sample of 3- and 4-year-old low income children attending Head Start, along with one control group of children on waiting lists for Head Start in the HSIS. Research questions will be addressed using a combination of multiple regression, piecewise regression, latent class growth analysis, and multiple group analysis. Of particular interest will be interactions between treatment condition in the HSIS and center quality in the preschool year and school quality in the elementary school years.

Genetic Influences on Adolescent Decision-Making and Alcohol Use

Principal Investigator: Kathryn Paige Harden
Additional Investigator: Elliot Tucker-Drob
Funded by: National Institutes of Health

Alcohol use in adolescence is a leading contributor to accidental injuries, mental health problems, and mortality.  In addition, adolescent drinking is commonly co-morbid with other risky behaviors, including smoking, illicit drug use, and delinquency.  Despite concerted efforts at prevention, drinking and other risky behaviors are still widely prevalent in adolescence.  Emerging research in neuroscience has suggested a novel biological mechanism for understanding developmental differences in risk-taking.  Recent evidence suggests sub-cortical brain regions, which underlie automatic responses to emotions and rewards ("hot" influences on decision making), mature more quickly than cortical brain regions, which underlie planning and inhibition ("cold" deliberative influences on decision-making) and mature slowly through the mid-20s. Consistent with this model of adolescent brain development, our previous research found that performance on behavioral measures of cognitive control improves from early adolescence through early adulthood, whereas behavioral measures of reward sensitivity show a U-shaped pattern of development, with the highest reward sensitivity seen in middle adolescence.  Thus middle adolescence (ages 15-16) is a particularly vulnerable period:  When faced with a emotionally charged, highly novel, potentially pleasurable situation - like the offer of a drink - responding in the "hot" affective system is likely to overwhelm an adolescent's "cold" deliberative control.  This research will extend our understanding of how adolescent decision-making influences alcohol use and other risky behaviors using a behavioral genetics design.  The project focuses on two influences on adolescent decision-making, which will be measured using a previously validated battery of survey measures and objective cognitive tests:  (1) reward sensitivity ("hot" responses to positive, rewarding, or novel stimuli); and (2) cognitive control ("cold" responses that require planning and inhibition).  The project will use a novel, ethnically-diverse, population-based sample of 200 adolescent twin pairs, ages 15-16 (the age group in which the disjunction between reward sensitivity and cognitive control has been found to be the highest). Alcohol use, illicit drug use, delinquency, and fighting will be measured using twin self-report, parent report and official school record data on disciplinary infractions.  This multi-method approach will address the following specific questions: (1) Do individual differences in cognitive control and reward sensitivity predict individual propensities for alcohol use and other risk-taking behaviors? (2) Are cognitive control and reward sensitivity endophenotypes for genetic influence on alcohol use and other risk-taking behaviors? and (3) How do family environments moderate the impact of high reward sensitivity on risk-taking behaviors?  Data will be analyzed using sophisticated quantitative methods, including analyses of gene-environment interaction (GxE).  The proposed research will thus integrate neuroscientific theories of adolescent brain development with behavioral genetic research methods, in order to identify novel specific endophenotypes for adolescent risk-taking.

Emerging Educational Inequalities in Health: New Health Events and Social Relationships

Principal Investigator: Elaine Hernandez
Faculty Sponsor: Robert Hummer
Funded by: Eunice Kennedy Shriver National Institute of Child Health and Human Development

Educational inequalities in morbidity and mortality are wide and growing, in spite of goals to eliminate them. People with more education are better positioned to avoid deleterious health effects when they are given new health information. Over time, as people act upon novel information differentially, educational inequalities in health outcomes emerge. Although research has been devoted to observing trends in education and health, less is known about the process by which they are produced. An emerging literature has attempted to understand how novel health information and technological advances influence people to behave differently depending on their socioeconomic status. Given the dearth of data on individual health knowledge levels, though, most often research is limited to observing changes in behavior after recent advances in biomedical research or exogenous shocks of health information. How can we understand the process by which educational inequalities in health emerge at the individual-level? The overall objective of this research is to understand how educational inequalities in health are produced among individuals, using a new approach: It focuses on people's health behaviors after they learn that they are pregnant or diagnosed with a chronic illness for the first time. Early decisions about health behaviors during these periods may serve to stratify later health behaviors among people of varying educational backgrounds. To understand how people behave differently after a new health event, this research proposes an innovative approach by focusing on the role of social relationships. It anticipates that these relationships provide people with new health information and influence their decisions about health behaviors. This conjecture builds upon a bedrock of sociological and public health research, which emphasizes the importance of social ties for both health and medical decision-making, as well as more recent research, which indicates that individuals' social ties influence their health behaviors. To assess the influence of social relationships on the formation of educational inequalities in health among people experiencing new health events, this research will take four approaches, and use data from nationally-representative surveys and qualitative interviews including the following: 1988 U.S. National Maternal and Infant Health Survey and the 1991 Longitudinal Follow-up; the Health and Retirement Study; the National Longitudinal Study of Adolescent Health; and the Relationships and Health Habits study. First, it will examine whether there are educational differences in nulliparous women's prenatal behaviors that are replicated during subsequent pregnancies. Second, it will focus on education differences in early health decisions among people recently diagnosed with an illness. Third, it will test whether social network processes of social learning and social influence differ by education and influence health behavior. Finally, for each set of analysis, it describes how the processes differ by race, ethnicity and gender. In sum, this research is significant because it aims to understand the origins of educational inequalities in health at an individual-level. It takes an innovative approach by merging this with demographic models of the diffusion of health information across social networks to understand how network processes influence health behaviors differently by education-level.

Socioeconomic Status, Intimate Unions, and Health Disparities

Principal Investigator: Rhiannon Kroeger
Faculty Sponsor: Debra Umberson
Funded by: Eunice Kennedy Shriver National Institute of Child Health and Human Development

Reducing and eliminating health disparities has been a central priority of U.S. public health policy for the past two decades (U.S. Department of Health and Human Services, Healthy People 2000; 2010; 2020). Despite an abundance of research investigating socioeconomic status (SES) disparities in health, only modest progress has been made towards their elimination (Center for Disease Control 2011). Notwithstanding the recognition that socioeconomic disparities in health are fundamental causes of disease (Link and Phelan 1995), most scholars agree that policies and interventions aimed at reducing health disparities must be informed by a thorough understanding of the full range of mechanisms and processes through which they are produced (Aneshensel 2002). In the proposed project, Ms. Kroeger argues that socioeconomic status variation in the structure and quality of intimate relationships represents a previously unexplored mechanism that likely contributes significantly to socioeconomic health disparities. She proposes to explore this possibility through considering the following aims: (1) Identify socioeconomic status variation associated with the structure and quality of intimate relationships experienced by adolescents and young adults over time; (2) Determine how socioeconomic variation associated with intimate relationship structure and quality throughout adolescence and young adulthood contributes to socioeconomic disparities in health and health behavior early in the adult life course; (3) Determine how broader social ties with family and peers interact with intimate ties to shape socioeconomic disparities in health and health behavior. In order to fulfill the proposed research plan, Ms. Kroeger requires additional training in areas such as latent growth curve modeling and social network analysis. Moreover, she requires training to cultivate her ability to critically assess the sociological theory linking relationship quality to individual health and well-being. As such, Ms. Kroeger's team of mentors have carefully developed a training plan to advance her statistical, methodological, and professional repertoire in ways that will allow her to examine the research questions outlined in her proposal and to put her in a position to acquire an academic position at a research university. This training plan includes formal coursework and seminars in addition to one-on-one mentoring from her co-sponsors, and is meant not only to further enhance Ms. Kroeger's research skills and methodological approaches, but also to extend her professional networks, develop her publication record, produce a competitive federal grant proposal, and prepare her for success in obtaining an academic position at a research university.

Texas Policy Evaluation Project

Principal Investigator: Joseph E. Potter
Additional Investigators: Kristine Hopkins, Co-Investigator; Daniel Powers, Co-Investigator; Daniel Grossman, Principal Investigator, Ibis Reproductive Health Subcontract; Kari White, Principal Investigator, Unversity of Alabama at Birmingham subcontract
Funded by: Anonymous foundation

The Texas Policy Evaluation Project, or TxPEP, is a five-year comprehensive effort to document and analyze the impact of the measures affecting reproductive health passed by the Texas state legislature.  The legislation the TxPEP researchers are studying was passed in the 2011 and 2013 sessions (the 82nd and 83rd Legislatures).  The team is examining the impacts on family planning clinics and women eligible for subsidized family planning services of the two-thirds cut to the state family planning budget in 2011, changes in which organizations were eligible to participate in state programs, and the new funding streams for family planning services that were added to the 2013 budget.  In addition, TxPEP researchers are evaluating the impact on abortion clinics and woman seeking abortion of legislation that requires women to undergo a mandatory sonogram at least 24 hours before obtaining an abortion, bans abortions ≥20 weeks “post-fertilization,” requires abortion providers to have hospital admitting privileges, placed limits on medication abortion, and mandates that abortion facilities must meet the requirements of an ambulatory surgical center.  Finally, TxPEP researchers are analyzing state data on the number of births, unintended pregnancies and abortions, and will estimate the cost to the state of changes in these numbers.

Demand for Postpartum Contraception in Texas

Principal Investigator: Joseph E. Potter
Additional Investigator: Kristine Hopkins
Funded by: Society of Family Planning  

In the United States (US), half of all pregnancies are unwanted or mistimed, and the majority of unintended pregnancy occurs among women with at least one child. Many women who intend to limit their fertility or delay childbearing for at least two years rely on methods with relatively high failure rates such as oral contraceptives, condoms, and withdrawal. Use of methods requiring less adherence and with lower failure rates, such as long-acting reversible methods, is limited. Despite considerable knowledge about the mix of contraceptive methods in use in the US, it is unclear whether the current mix actually reflects women’s preferences. This project will address this knowledge gap by assessing women’s contraceptive preferences and abilities to access their preferred method during the postpartum period. The postpartum period is an important time to examine women’s contraceptive use because more than half of unintended pregnancies to parous women occur within two years following delivery, and women are likely to access the health care system, thereby providing them opportunities to obtain highly effective methods. Specifically, the aims of the study are to: determine women’s contraceptive preferences and identify factors that influence their evolution over the 24 months following delivery; describe women’s trajectories of postpartum contraceptive use and identify the factors that influence the uptake of different methods; assess concordance between women’s contraceptive preferences and method use, and identify factors that either facilitate or prevent women from achieving their preferences over time; prospectively measure the risk of unintended pregnancy and how it depends on method use, concordance between contraceptive preference and method use, and other covariates; and, finally, identify areas of practice and policy that could be changed or improved to reduce unintended pregnancy in the postpartum period. To implement these aims, we propose to extend the follow-up period from 12 to 24 months of a prospective study of 400 Texas women that is currently in the field.  This study will include two additional rounds of interviews at 18 and 24 months postpartum and will allow us to assess the impact of contraceptive use and access on unintended pregnancy in the extended follow-up period.  The results of this study will have important implications for local and state policies so as to improve the initiation and continuation of postpartum contraception for populations that will benefit from health care reform (e.g., new Medicaid enrollees), and populations that may be left out (e.g., recent or unauthorized migrants).

Gene-Environment Interplay in Early Cognitive Development

Principal Investigator: Elliot Tucker-Drob
Additional Investigator: Paige Harden
Funded by: Eunice Kennedy Shriver National Institute of Child Health and Human Development

While the influences of genes and environments on cognitive development have traditionally been viewed as independent, if not competing, forces, there is an emerging theoretical consensus that cognitive development results from interactions between genes and cumulative environmental experiences. However, while the little gene-by-environment (G×E) interaction research on cognitive development that has been conducted to date has primarily focused on children's experiences during grade school, very recent work suggests that G×E on cognitive development emerges much earlier - as early as 2 years of age.  In low socioeconomic status homes, genetic influences on infant cognitive function approach zero, whereas in high socioeconomic status homes, genes account for approximately 50% of the variation in infant cognitive function.  Using data on approximately 800 pairs of fraternal and identical twins that were collected as part of the Early Childhood Longitudinal Study - Birth Cohort (ECLS-B), this project will take steps to clarify G×E interaction effects on early cognitive development in three important respects. Aim 1. Identify Parent Behaviors that Moderate Genetic Influences on Infant Cognitive Function.  For the first aim, this project will examine the roles that parent behaviors play in moderating genetic influences on infant cognitive function.  A guiding hypothesis is that parental responsiveness to infant cues is crucial to the expression of genetic potential for early cognitive development. Aim 2. Understand the Association Between Infant Behaviors and Infant Cognitive Function.  For the second aim, this project will examine the genetic and environmental bases for the relations between infant knowledge-seeking behaviors and infant cognitive function, and whether socioeconomic advantage and parental responsiveness moderate these relations. This will help to determine whether G×E interactions on infant cognitive functions can be accounted for by differences in levels of support of children's knowledge-seeking behaviors. Aim 3. Link G×E Effects on Cognitive Function with School Entry Skills in Kindergarten.  For the final aim, this project will examine the extent to which G×E effects on infant cognitive function extend to school entry skills (mathematics, reading, and attentional skills) measured at 4 and 5 years, and whether new G×E effects independent of previous G×E effects emerge at school entry. Identifying early life experiences that facilitate the expression of genes for healthy cognitive development and school readiness will support NICHD's mission to ensure that "all children have their chance to achieve their full potential for healthy and productive lives."

Relationships and Health: Comparing Union Types

Principal Investigator: Debra Umberson
Funded by: National Institute on Aging

Married heterosexuals enjoy greater health and longevity than the unmarried, and the importance of marriage for health increases as people age. However, since same-sex couples cannot legally marry in most parts of the United States, we know very little about the health implications of marriage for aging gays and lesbians. This project will provide the first in-depth and systematic analysis of legal marriage and health to compare, gay, lesbian, and heterosexual couples. The major goal of the project is to assess how married men and women promote or deter one another’s health, and how these processes vary across gay, lesbian, and heterosexual marriages. The primary focus of this project is on revealing the pathways and processes through which gay, lesbian, and heterosexual spouses influence each other’s  health, therefore we will collect new data and use an analytic approach that is uniquely suited to addressing issues of process. The R21 period will be used to construct a novel three-part mixed-methods dataset. We will conduct face-to-face 60-minute baseline surveys with open and closed-ended responses, and collect 14 days of daily process data from both spouses in 60 gay marriages, 60 lesbian marriages, and 60 heterosexual marriages (N=360 individuals, 180 couples, 5,040 diary days). Daily process (also known as diary) data are uniquely suited to investigating psychosocial processes that unfold in daily interactions with spouses, while also accounting for the contexts of those interactions. The diary data obtained from both spouses in each marriage will be analyzed in tandem to assess daily fluctuation in spousal dynamics and health outcomes (i.e., health behaviors, psychological state, and physical health symptoms) as well as mechanisms (e.g., stress, social support) that link spousal dynamics to health outcomes. Open-ended questions from the baseline survey and previously collected in-depth interview data will also provide qualitative data to analyze meanings and processes that explain and elucidate significant patterns revealed in the daily process analysis. This mixed methods project will inform health policy involving the gendered dynamics through which marriage influences health across couple type. We must identify areas of greatest risk and resilience for men and women in gay, lesbian, and heterosexual marriage to ground the most effective strategies for policy and practice.

Marriage, Gender and Health in Lesbian, Gay and Heterosexual Couples

Principal Investigator: Debra Umberson
Funded by: Robert Wood Johnson Foundation

Married heterosexuals are healthier and live longer than the unmarried; however, since same-sex couples cannot legally marry in most parts of the United States, we know very little about the health implications of marriage for gay and lesbian couples. This project will provide the first in-depth and systematic analysis of legal marriage, cohabitation, and health to compare heterosexual, gay, and lesbian couples. In-depth interviews with both partners in same-sex and heterosexual married couples in Massachusetts will allow us to consider how individuals perceive and experience their marriage with regard to health behavior, informal care for a partner during periods of illness or injury, and the use of formal health care systems. A comparison of cohabiting and married gay, lesbian, and heterosexual couples will allow us to explore further how legal marriage differs from cohabiting unions in shaping relationship dynamics around health. This project is innovative in including both married and cohabiting gay and lesbian couples, groups that have been neglected in research on health; uncovering how people in different types of committed relationships take care of one another, both informally and through health care systems; analyzing how gender influences relationship and health processes; and examining challenges as well as benefits of committed relationships for health. This project will inform health policy involving when and how marriage and cohabitation influence health behavior, and how partner dynamics around health care at home and in formal health care settings vary for different union types. Policy strategies that result in more health-promoting habits, more effective partner participation in health care, and more efficient use of health care systems have the potential to reduce health care costs, while also improving the health and well-being of individuals and couples.