Adversity, Poverty and Stress over the Life course: Consequences for human biology and development

Adversity, Poverty and Stress over the Life course: Consequences for human biology and development

Poverty Convening

Sacramento, CA

June 7, 2016

David H. Rehkopf

Assistant Professor

Department of Medicine, Stanford University School of Medicine 1

Overview

①  Poverty & Mobility

②  Exposures of Poverty and Stress

③  Biological embodiment and consequences

④  Interventions

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1. Poverty & Mobility

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1. Poverty & Mobility

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1. Poverty & Mobility

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1. Poverty & Mobility

•  Race, gender, education simultaneously combine for greater or lesser risk for time in poverty

•  Individual trajectories can go up and down, with each specific exposure affecting where that person will end up

• Not one solution• Mobility out of poverty has large geographic

variability• Aspects of the social and economic environment

and region promote or diminish mobility6

2. Exposures of Poverty and Stress

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2. Exposures of Poverty and Stress

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2. Exposures of Poverty and Stress

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2. Exposures of Poverty and Stress

•  Poverty changes parts of the brain associated with memory

•  Some part of the negative impacts can be blunted by environment

•  Poverty not just about stress, very large differences in exposure to physical environment toxins

•  Basis for healthy development are responsive relationships, safe and healthy environments and good nutrition. But these need to be supported by policies and programs. 10

3. Biological embodiment

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3. Biological embodiment and consequences

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3. Biological embodiment and consequences

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3. Biological embodiment and consequences

• A variety of impacts on the brain from childhood trauma

•  Effects of stress on development differ by stage of development from prenatal to old age, but there are impacts across the life course

•  Impacts are not just on the brain, but on a range of biological systems, some of which is through Epigenetic changes that can be carried throughout life, but are also reversible

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4. Interventions

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4. Interventions

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17 Source: taxfoundation.org/maps

Non-linear changes in EITC over time.

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1990 1995 2000 2005

01000

2000

3000

4000

year

maxEITC

Maximum (blue) and mean (red) among those qualifying for benefits from the Earned Income tax Credit over time among households with 2 or more dependents (solid line) or 1 dependent (dashed line), NLSY analysis sample based on income, 1990-2006, in year 2000 dollars.

Additional state EITC programs

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EITC and birth weight

•  n = 8,762,028 live births 1980-2002•  Treatment group: unmarried mothers with a high school

degree or less, living in a state with EITC•  Control group: unmarried mothers with a high school

degree or less, living in a state without EITC

(Strully, Rehkopf, Xuan, Amer Sociol Rev 2010)

EITC and birth weight

β for grams change Odds ratio β for grams change for smoking in birth weight controlling for smoking

State EITC 15.7 0.949 12.5

(1.2) (0.006) (1.5) High school 47.3 0.727 37.5

degree (0.42) (0.002) (0.53)

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EITC disbursement Quasi-experimental designAs identification strategy based on payout structure (treatment Feb-Apr)ITT qualification (income, dependents, year, state)

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EITC and short term behavior and physiological changes

Findings in stark contrast to much of the econometric literature.•  Large amount of money•  Form of money a tax refund•  Households with children•  Range of health outcomes examinedEvidence for a generally health promoting economic policy.These results are identifying only a short-term benefit.

EITC and child health

(Hamad and Rehkopf, Paediatric and Perinatal Epidemiology, in press) 26

Psychosocial effectiveness for child trauma

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Psychosocial effectiveness for child trauma

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Psychosocial effectiveness for child trauma

①  Parenting interventions

②  trauma focused interventions

③  enhanced foster care interventions

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4. Interventions

•  Longer-term beneficial impacts on health and development from early life social environment interventions

• Anti-poverty policy has multiple beneficial impacts on health and development

•  Less known about effectiveness of psychosocial interventions for childhood trauma

•  Less known about interventions for older ages

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Summary

①  Lots of things that maher a lihle bit: expectations and evaluation

②  Real physiological impacts of poverty: acknowledge individuals at a different place, but that change is very possible

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Thank you.

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drehkopf@stanford.edu@drehkopf

Funding: RWJF H&SS (2006-2008), NIA (2014-present) (K01 AG047280)