Embed Size (px)
Citation preview
A B
rief O
verv
iew
of
Li
fe C
ours
e E
pide
mio
logy
Siobhan C. Maty, PhD, MPH
Western Oregon University
April 8, 2013
Oregon Life Course Network Meeting
WH
AT
is A
Life
Cou
rse?
Life
Cou
rse,
Spa
n or
Cyc
le
•Li
fe S
pan/
Life
Cou
rse–
Con
cept
that
dev
elop
men
t and
agin
g fo
rm a
con
tinuo
us p
roce
ss fr
om b
irth
to d
eath
•Li
fe C
ycle
-a
seri
es o
f dis
tinct
, bou
nded
life
sta
ges
that
are
soci
ally
or
biol
ogic
ally
det
erm
ined
•A
ll ha
ve a
long
-ter
m, m
ultil
evel
, con
text
ual,
and
dyna
mic
vie
w o
f agi
ng
Kuh
D, e
t al.
JEC
H,
2003
Life
Spa
n
•Li
fe-s
pan
theo
ries
dra
w a
tten
tion
to th
e le
ngth
of t
he li
fe o
f an
indi
vidu
alan
d to
the
idea
that
pr
oces
ses
and
traj
ecto
ries
of
deve
lopm
ent a
nd a
ging
are
life
long
•Li
fe-s
pan
rese
arch
ers
are
inte
rest
ed p
rim
arily
in u
nder
stan
ding
mic
ro-l
evel
(en
doge
nous
) pr
oces
ses
with
in th
e ag
ing
indi
vidu
al (
e.g.
, the
agi
ng b
rain
and
min
d)
Fro
m F
ulle
r-Ig
lesi
as H
et a
l. A
nn
Rev
Ger
on
tolo
gy
& G
eria
tric
s, 2
00
9
Life
Cou
rse
•Li
fe c
ours
e th
eori
es, i
n co
ntra
st,
diff
eren
tiat
e be
twee
n
subg
roup
s in
soc
iety
and
focu
s on
the so
cial
pat
hway
s th
at
defin
e th
e se
quen
ce o
f eve
nts,
tran
sitio
ns, r
oles
, and
exp
erie
nces
in th
e liv
es o
f ind
ivid
uals
•Li
fe c
ours
e re
sear
cher
s ty
pica
lly a
naly
ze m
acro
-lev
el
(exo
geno
us)
proc
esse
s th
at c
hara
cter
ize
the
influ
ence
of g
roup
s,
orga
niza
tions
, and
inst
itutio
ns o
n th
e in
divi
dual
s w
ithin
them
Fro
m F
ulle
r-Ig
lesi
as H
et a
l. A
nn
Rev
Ger
on
tolo
gy
& G
eria
tric
s, 2
00
9
Fro
m F
ulle
r-Ig
lesi
as H
et a
l. A
nn
Rev
Ger
on
tolo
gy
& G
eria
tric
s, 2
00
9
Life
Cou
rse
Prin
cipl
es
Prin
cipl
es o
f Life
Cou
rse
The
ory
Hu
man
Dev
elo
pm
ent
and
Ag
ing
as
Life
-Lo
ng
Pro
cess
Lin
ked
Live
s
Hu
man
Ag
ency
inC
on
stra
ined
S
ituat
ion
s Live
s in
Tim
e an
dP
lace
Tim
ing
inLi
ves
Eld
er G
, 2
00
3
Prin
cipl
e of
Life
-Lon
g D
evel
opm
ent
Hum
an d
evel
opm
ent a
nd a
ging
are
lifel
ong
proc
esse
s.
Eld
er G
, 2
00
3
Prin
cipl
e of
Hum
an A
genc
y
Indi
vidu
als
cons
truc
t the
ir o
wn
life
cour
se th
roug
h th
e
choi
ces
and
actio
ns th
ey ta
ke w
ithin
the
oppo
rtun
ities
and
cons
trai
nts
of h
isto
ry a
nd s
ocia
l cir
cum
stan
ces.
Eld
er G
, 2
00
3
Prin
cipl
e of
His
toric
al
Tim
e an
d P
lace
The
life
cou
rse
of in
divi
dual
s is
em
bedd
ed in
and
shap
ed b
y th
e hi
stor
ical
tim
es a
nd p
lace
s th
ey
expe
rien
ce o
ver
thei
r lif
etim
e.
Eld
er G
, 2
00
3
Prin
cipl
e of
Tim
ing
in L
ives
The
dev
elop
men
tal i
mpa
ct o
f a s
ucce
ssio
n of
life
tran
sitio
ns o
r ev
ents
is c
ontin
gent
on
whe
n th
ey o
ccur
in
a pe
rson
’s li
fe.
Eld
er G
, 2
00
3
Prin
cipl
e of
Lin
ked
Live
s
Live
s ar
e liv
ed in
terd
epen
dent
ly, a
nd s
ocia
l and
his
tori
cal
influ
ence
s ar
e ex
pres
sed
thro
ugh
this
net
wor
k of
sha
red
rela
tions
hips
.
Eld
er G
, 2
00
3
Em
bodi
men
t and
Em
bedd
ing
Und
er th
e S
kin
•E
xper
ienc
e m
ost d
efin
itely
doe
s ge
t und
er th
e sk
in a
nd is
expr
esse
d at
all
leve
ls, f
rom
gen
e ex
pres
sion
to b
ehav
ior.
Her
tzm
an C
, Bo
yce
T. H
ow
exp
erie
nce
get
s u
nd
er th
e sk
in to
cre
ate
gra
die
nts
in d
evel
op
men
tal h
ealth
. A
nnu
Rev
Pub
lic
Hea
lth.
20
10
;31:
329
–34
7.
Wha
t we
obse
rve
as a
bio
logi
cal,
psyc
holo
gica
l, be
havi
oral
or s
ocia
l cha
ract
eris
tic o
f an
indi
vidu
al r
epre
sent
s bo
th
som
e in
here
nt p
redi
spos
ition
and
the
way
s in
whi
ch th
e
tota
l env
iron
men
t has
bee
n “e
mbo
died
” in
to a
n in
divi
dual
’s
body
func
tions
or
stru
ctur
es fr
om c
once
ptio
n on
war
ds
Em
bodi
men
t
Krie
ger
N,
2000
Bio
logi
cal E
mbe
ddin
g•
Pro
cess
whe
re e
arly
life
exp
erie
nces
influ
ence
key
bio
logi
cal
syst
ems
over
the
long
term
to p
rodu
ce s
ocia
l gra
dien
ts
•B
iolo
gica
l em
bedd
ing
occu
rs w
hen:
–E
xper
ienc
e ge
ts u
nder
the
skin
and
alte
rs h
uman
bio
logi
cal
proc
esse
s;
–S
yste
mat
ic d
iffer
ence
s in
exp
erie
nce
in a
soc
ially
pa
rtiti
oned
env
iron
men
t lea
d to
diff
eren
t bio
-de
velo
pmen
tal s
tate
s;
–T
he d
iffer
ence
s ar
e st
able
and
long
term
; and
–T
hese
diff
eren
ces
influ
ence
hea
lth, w
ell-
bein
g, le
arni
ng,
and/
or b
ehav
ior
over
the
life
cour
se.
Her
tzm
an C
, B
oyc
e T
. Ho
w e
xper
ienc
e ge
ts u
nder
the
sk
in t
o c
reat
e gr
adie
nts
in d
evel
op
men
tal h
ealth
. A
nnu
Rev
Pub
lic
Hea
lth.
20
10
;31
:32
9–3
47.
Bio
logi
cal E
mbe
ddin
g“C
andi
date
sys
tem
s” p
hysi
olog
ical
func
tions
link
the
soci
al
envi
ronm
ent t
o as
pect
s of
hum
an b
iolo
gy th
at h
ave
the
capa
city
to
embe
d an
d in
fluen
ce th
e re
st o
f the
life
cou
rse:
1.H
ypot
halm
ic-P
ituita
ry-A
dren
al (
HP
A)
axis
and
its
acco
mpa
nyin
g se
cret
ion
of c
ortis
ol;
2.A
uton
omic
ner
vous
sys
tem
(A
NS
) in
ass
ocia
tion
with
ep
inep
hrin
e an
d no
repi
neph
rine
;
3.T
he d
evel
opm
ent o
f mem
ory,
att
entio
n, a
nd o
ther
exe
cutiv
e fu
nctio
ns in
the
pref
ront
al c
orte
x; a
nd
4.T
he s
yste
ms
of s
ocia
l affi
liatio
n in
volv
ing
high
er-o
rder
ce
rebr
al c
onne
ctio
ns, m
edia
ted
by s
erot
onin
and
oth
er
horm
ones
.H
ertz
man
C,
Bo
yce
T. H
ow
exp
erie
nce
gets
und
er t
he
skin
to
cre
ate
grad
ient
s in
dev
elo
pm
enta
l hea
lth.
Ann
u R
ev P
ubli
c H
ealt
h.2
01
0;3
1:3
29
–34
7.
Life
Cou
rse
Per
spec
tives
The
Life
Cou
rse
Per
spec
tive
•E
xam
ines
the
expe
rien
ces
of h
uman
life
from
beg
inni
ng to
end
•R
ecog
nize
s th
at th
e di
vers
ity o
f ind
ivid
ual e
xper
ienc
e is
co
nstr
aine
d by
her
/his
loca
tion
in th
e so
cial
str
uctu
re
•In
corp
orat
es fr
amew
ork
of c
hang
ing
soci
al a
nd in
stitu
tiona
l st
ruct
ures
in r
elat
ion
to in
divi
dual
s
•C
ontr
ibut
es to
und
erst
andi
ng, a
t the
pop
ulat
ion
or g
roup
leve
l, th
e ro
les
of ag
e st
rati
fica
tion
, coh
ort a
nd h
isto
rica
l per
iod
effe
cts,
and
the
accu
mul
atio
n of
(in
)equ
alit
ies
over
tim
e
Fro
m A
nd
res
L et
al.
J Y
ou
th S
tud
ies,
20
08
Life
Cou
rse
Per
spec
tive
Lu M
C,
Hal
fon
N.
Rac
ial a
nd
eth
nic
dis
par
ities
in b
irth
out
com
es: a
life
-co
urs
e p
ersp
ectiv
e.M
ater
n C
hild
Hea
lth J
. 20
03
;7:1
3-3
0.
Life
Cou
rse
App
roac
h
A li
fe c
ours
e ap
proa
ch o
ffers
a w
ay to
con
cept
ualiz
e ho
w
unde
rlyi
ng s
ocio
-env
iron
men
tal d
eter
min
ants
of h
ealth
,
expe
rien
ced
at d
iffer
ent l
ife c
ours
e st
ages
, can
diff
eren
tially
influ
ence
the
deve
lopm
ent o
f chr
onic
dis
ease
s, a
s m
edia
ted
thro
ugh
prox
imal
spe
cific
bio
logi
cal p
roce
sses
Fro
m L
ynch
JW
an
d D
avey
Sm
ith G
, 2
00
5
Life
Cou
rse
Epi
dem
iolo
gy
Life
Cou
rse
Epi
dem
iolo
gy•
WH
AT
it IS
•…
”the
stu
dy o
f the
long
-ter
m
effe
cts
on c
hron
ic d
isea
se r
isk
of
phys
ical
and
soc
ial e
xpos
ures
du
ring
ges
tatio
n, c
hild
hood
, ad
oles
cenc
e, y
oung
adu
lthoo
d an
d la
ter
adul
t life
. It
incl
udes
stu
dies
of
the
bio
logi
cal,
beha
vior
al a
nd
psyc
hoso
cial
pat
hway
s th
at
oper
ate
acro
ss a
nd in
divi
dual
’s
life
cour
se, a
s w
ell a
s ac
ross
ge
nera
tions
, to
influ
ence
the
deve
lopm
ent o
f chr
onic
dis
ease
s.”•
WH
AT
it IS
N’T
•“M
erel
y th
e co
llect
ion
of e
xpos
ure
data
acr
oss
the
life
cour
se is
not
sy
nony
mou
s w
ith a
life
co
urse
mod
el o
f dis
ease
ca
usat
ion.
”
•(B
en-
Shl
omo
and
Kuh
, 200
2)
Ko
enen
K,
et a
l
Life
Cou
rse
Epi
dem
iolo
gy
•W
HA
T
–P
opul
atio
n-ba
sed
–D
raw
s on
mul
tiple
dis
cipl
inar
y pe
rspe
ctiv
es
–E
leva
tes
the
dim
ensi
on o
f tim
e
–C
once
rned
with
dyn
amic
inte
ract
ions
bet
wee
n pe
rson
and
envi
ronm
ent
Koe
nen
K, e
t al
Life
Cou
rse
Epi
dem
iolo
gy•
WH
Y
–S
tatic
app
roac
hes
of ‘m
oder
n ep
idem
iolo
gy’ (
case
-con
trol
stud
ies,
for
exam
ple)
may
obs
cure
etio
logi
c pr
oces
ses
and
inte
rven
tion
poin
ts
–D
isea
se r
isk
begi
ns e
arly
in li
fe a
nd a
ccum
ulat
es o
ver
time
–T
raje
ctor
ies
of r
isk
initi
ated
as
earl
y as
con
cept
ion
•H
OW
–D
esig
n: s
tudy
per
sons
ove
r tim
e ac
ross
set
tings
–M
easu
res:
dev
elop
men
tally
sen
sitiv
e an
d ap
prop
riat
e
–A
naly
sis:
traj
ecto
ries,
tim
ing
Koe
nen
K, e
t al
Pol
itica
l Eco
nom
yIn
stitu
tions
Dis
crim
inat
ion
Cul
ture
His
tory
Stru
ctur
alM
acro
soci
al
Fac
tors
Gen
etic
s H
uman
Bio
logy
Pat
holo
gica
l Bio
mar
kers
Gen
etic
Cha
ract
eris
tics
Pat
hobi
olog
y
Lif
e co
urse
Hea
lth S
tatu
s
Indi
vidu
al
Cha
ract
eris
tics
Soc
ioec
onom
ic Beh
avio
ural
Psy
chos
ocia
l
Pro
xim
al S
ocia
l C
onne
ctio
nsF
amily
Frie
nds
Dis
tal S
ocia
l C
onne
ctio
nsN
eigh
borh
ood
Com
mun
ity
Lync
h JW
, 200
0
Hea
lth S
tatu
s
Wor
kW
ork
Con
cept
ion
De
ath
Con
cept
ual M
odel
s in
Li
fe C
ours
e E
pide
mio
logy
Life
Cou
rse
Mod
els
LIF
E C
OU
RS
E M
OD
EL
NO
TE
CR
ITIC
AL
PE
RIO
D M
odel
sF
ocus
on
impo
rtan
ce o
f tim
ing
of e
xpos
ure
�W
ith o
r w
itho
ut l
ater
-life
ris
k fa
cto
rs
�W
ith la
ter-
life
effe
ct m
od
ifier
s
AC
CU
MU
LAT
ION
of R
ISK
Mod
els
Foc
us o
n th
e im
port
ance
of
expo
sure
ove
r tim
e an
d th
e se
quen
ce o
f exp
osur
e
�W
ith in
dep
end
ent a
nd
un
corr
elat
ed
insu
lts
�W
ith c
orr
elat
ed in
sults
‒R
isk
clu
ster
ing
‒C
hai
ns
of r
isk
with
ad
diti
ve o
r tr
igg
er e
ffect
s
Fro
m L
ynch
JW
, Dav
ey S
mith
G, 2
005
and
B
en-S
hlom
o Y,
Kuh
D, 2
002
Crit
ical
Per
iod
Fro
m L
ynch
JW
, 20
02
Weeks
Mon
ths
Years
Deca
des
Formation of New Cells
Int
raut
erine
Inf
anc
y C
hildhoo
d Adolesc
enc
e A
dulth
ood
Birth
Bra
inGut
Liver
Kidne
ySkin
End
ocrine
Gland
s
Fat
Mus
cle
Crit
ical
Per
iods
of C
ell D
evel
opm
ent
Fro
m L
ynch
JW
, 200
2
Bar
ker
DJP
. Dev
elop
men
tal o
rigin
s of
chr
onic
dis
ease
. P
ublic
Hea
lth.
2012
;126
:18
5-18
9.
�C
ritic
al P
erio
d M
odel
sem
phas
ize
timin
g of
exp
osur
e
�E
xpos
ure
at a
spe
cific
per
iod
in li
fe c
ours
e ca
n ha
ve la
stin
g ef
fect
s on
the
stru
ctur
e or
func
tion
of o
rgan
s, ti
ssue
s an
d bo
dy
syst
ems
‒A
lso
calle
d ‘B
iolo
gica
l Pro
gram
min
g’ o
r ‘L
aten
cy M
odel
’
‒B
asis
of “
Dev
elop
men
tal O
rigi
ns o
f Adu
lt D
isea
se”
hypo
thes
is
�E
XA
MP
LES
:
‒Li
mb
deve
lopm
ent i
n re
latio
n to
mat
erna
l tha
lidom
ide
use
‒F
ract
ure
acro
ss th
e ep
iphy
sis
(gro
wth
pla
te)
whe
n bo
ne is
gr
owin
g du
ring
chi
ldho
od a
nd a
dole
scen
ce
Life
Cou
rse
Mod
els:
CR
ITIC
AL
PE
RIO
D
Fro
m L
ynch
JW
and
Dav
ey S
mith
G,
20
05
�Te
rm ‘C
ritic
al P
erio
d’ u
sual
ly r
eser
ved
for
expo
sure
s oc
curr
ing
duri
ng k
now
n pe
riod
s of
una
ltera
ble
biol
ogic
al d
evel
opm
ent.
�In
sults
can
affe
ct s
truc
ture
or
func
tion
or b
oth
�C
ompe
nsat
ory
func
tiona
l effe
cts
may
hid
e st
ruct
ural
lim
itatio
ns
�E
ffect
s of
insu
lts d
urin
g cr
itica
l per
iod
may
onl
y be
com
e ‘c
ritic
al’ f
or th
ose
who
exp
erie
nce
som
e ot
her
expo
sure
(s)
Life
Cou
rse
Mod
els:
CR
ITIC
AL
PE
RIO
D
Fro
m L
ynch
JW
an
d D
avey
Sm
ith G
, 2
00
5
Mor
talit
y fr
om C
oron
ary
Hea
rt D
isea
se in
15,
726
Men
and
Wom
en in
Her
tford
shire
.
Bar
ker
DJP
. Dev
elop
men
tal o
rigin
s of
chr
onic
dis
ease
. P
ublic
Hea
lth.
2012
;126
:18
5-18
9.
�S
EN
SIT
IVE
Per
iod
Mod
els
-Per
iod
of t
ime
whe
n an
ex
posu
re(s
) ha
s a
stro
nger
effe
ct (
posi
tive
or n
egat
ive)
on
dise
ase
risk
or
deve
lopm
ent t
han
at o
ther
tim
es
�O
utsi
de o
f thi
s de
velo
pmen
tal p
erio
d, th
e ef
fect
of t
he
part
icul
ar e
xpos
ure
will
be
wea
ker
�In
fluen
ce o
f the
se e
xpos
ures
may
be
mod
ified
by
late
r-lif
e ex
posu
res
�E
XA
MP
LES
:
‒P
over
ty d
urin
g pe
riod
s of
impo
rtan
t chi
ldho
od s
ocia
l tr
ansi
tions
suc
h as
sch
ool e
ntry
‒E
nerg
y im
bala
nce
and
over
wei
ght j
ust p
rior
to p
uber
ty
Life
Cou
rse
Mod
els:
CR
ITIC
AL
PE
RIO
D
Fro
m K
uh D
, et
al.,
20
03
Fro
m F
all C
HD
, 200
5, B
NF
Acc
umul
atio
n of
Ris
k
Fro
m L
ynch
JW
, 20
02
Hea
lth-R
elat
ed E
xpos
ures
O
ver
the
Life
cour
se
In-u
tero
Chi
ldho
od
Ado
lesc
ence
Adu
lthoo
d
Old
er A
ge
Fet
al n
utrit
ion,
Infe
ctio
n, P
re-n
atal
Car
e
Bre
ast F
eedi
ng, C
hild
Die
t, S
afet
y
Phy
sica
l Act
ivity
Sub
stan
ce A
buse
, Vio
lenc
e
Soc
ial R
elat
ions
hips
Wor
k E
nviro
nmen
ts
Fro
m L
ynch
JW
, 200
2
Life
Cou
rse
Mod
els:
A
CC
UM
ULA
TIO
N o
f RIS
K
�A
ccum
ulat
ion
of R
isk
Mod
elsfo
cus
on th
e to
tal a
mou
nt
and/
or s
eque
nce
of e
xpos
ure
•E
xpos
ures
or
insu
lts g
radu
ally
acc
umul
ate
thro
ugh
epis
odes
of
illn
ess
and
inju
ry, a
dver
se e
nvir
onm
enta
l con
ditio
ns, a
nd
heal
th d
amag
ing
beha
vior
s
•A
ccum
ulat
ion
of d
iffer
ent t
ypes
of n
egat
ive
expo
sure
s (e
.g.,
envi
ronm
enta
l, so
cioe
cono
mic
, and
beh
avio
ral)
may
ca
use
long
term
dam
age
Fro
m L
ynch
JW
and
Dav
ey S
mith
G,
20
05
Life
Cou
rse
Mod
els:
AC
CU
MU
LAT
ION
of R
ISK
�D
ose-
Res
pons
e
‒H
ealth
dam
age
incr
ease
s w
ith d
ura
tion
an
d/o
r n
um
ber
of d
etrim
enta
l ex
po
sure
s
‒E
xam
ple
: A
dd
itive
eff
ects
of e
xper
ien
cing
low
so
cio
eco
nom
ic p
osi
tion
acro
ss d
iffer
ent l
ife s
tag
es in
fluen
ce r
isk
of a
du
lt h
ealth
ou
tco
mes
�C
lust
erin
g of
Exp
osur
es
‒E
xam
ple
: C
hild
ren
fro
m p
oo
rer
soci
oec
on
omic
bac
kgr
ound
s ar
e m
ore
lik
ely
to b
e o
f lo
w b
irth
wei
gh
t, h
ave
po
ore
r d
iets
, mo
re e
xpo
sed
to
pas
sive
sm
oki
ng
an
d h
ave
few
er o
pp
ort
uniti
es fo
r p
hys
ical
act
ivity
�C
hain
s of
Ris
k
‒O
ne
neg
ativ
e ex
po
sure
incr
ease
s th
e su
bse
que
nt r
isk
of a
no
ther
…
‒E
xam
ple
: B
eco
min
g o
verw
eig
ht in
ch
ildh
oo
d m
ay c
aus
e re
du
ced
p
hys
ical
act
ivity
in a
do
lesc
ence
Fro
m L
ynch
JW
and
Dav
ey S
mith
G,
20
05
Cha
ins
of R
isk
�“P
athw
ays
mod
el”
�S
ocia
l, bi
olog
ical
, and
psy
chol
ogic
al c
hain
s of
ris
k ar
e
poss
ible
and
invo
lve
“med
iatin
g” fa
ctor
s an
d of
ten
“mod
ifyin
g” fa
ctor
s
�S
eque
nce
of li
nked
exp
osur
es -
one
bad
expe
rien
ce o
r
expo
sure
lead
s to
ano
ther
and
then
ano
ther
–th
at r
aise
dise
ase
risk
Kuh
D, e
t al.
JEC
H,
2003
Life
Cou
rse
Mod
els:
A
CC
UM
ULA
TIO
N o
f RIS
K
•Li
fe c
ours
e ep
idem
iolo
gy test
s th
e ex
tent
and
effe
ct o
f
cum
ulat
ive
dam
age
to b
iolo
gica
l sys
tem
sas
the
num
ber,
dura
tion
or s
ever
ity o
f exp
osur
es in
crea
se, a
nd a
s bo
dy
syst
ems
age
and
beco
me
less
abl
e to
rep
air
dam
age
Kuh
D, e
t al.
JEC
H,
2003
In e
pid
emio
log
y, li
fe c
ou
rse
mo
del
s p
osi
t diff
eren
t ty
pes
of
risk
fact
or
asso
ciat
ion
s o
ver
time,
wh
ich
pre
sum
abl
y su
gg
est
diff
eren
t cau
sal p
ath
s to
dis
ease
Ear
ly-L
ife E
xpos
ures
and
Ris
k fo
r A
dult
Out
com
es
•La
ten
cy m
od
el
•P
ath
way
mo
del
s–
Acc
um
ula
tion
–M
edia
tion
Po
wer
an
d H
ertz
man
19
97
; Po
wer
19
91
; Lyn
ch, K
apla
n,
an
d S
hem
a 1
99
7; H
ertz
man
an
d W
ein
s 1
99
6
Chi
ldho
odA
dulth
ood
Ko
enen
K, e
t al
Soc
ial P
athw
ays
Chi
ldho
od S
ocio
econ
omic
E
nviro
nmen
t -F
amily
Adu
lt S
ocio
econ
omic
E
nviro
nmen
t
Edu
catio
n
Dev
elop
men
t of
Hea
lth C
apita
l -B
iolo
gica
l Res
ourc
es
Hea
lth B
ehav
ior i
n C
hild
hood
and
Ado
lesc
ence
Hea
lth B
ehav
ior i
n A
dulth
ood
Hea
lth, D
isea
se a
nd
Dea
th in
Adu
lthoo
d
Gen
etic
and
Bio
logi
cal S
usce
ptib
ility
Fro
m L
ynch
JW
, 200
2
Soc
ial P
athw
ays
Fro
m L
ynch
JW
, 20
02
•“B
ecau
se m
ost
fact
ors
asso
ciat
ed w
ith e
arly
chi
ld d
evel
opm
ent
are
a fu
nctio
n of
soc
ioec
onom
ic s
tatu
s, d
iffer
ence
s in
ear
ly
child
dev
elop
men
t for
m a
soc
ioec
onom
ic g
radi
ent.”
Her
tzm
an C
, Bo
yce
T. H
ow
exp
erie
nce
get
s u
nd
er th
e sk
in to
cre
ate
gra
die
nts
in d
evel
op
men
tal h
ealth
. A
nnu
Rev
Pub
lic
Hea
lth.
20
10
;31:
329
–34
7.
Pat
hway
s be
twee
n C
hild
hood
Soc
ioec
onom
ic
Circ
umst
ance
s &
Adu
lt H
ealth
Chi
ldho
od
soci
oeco
nom
ice
nviro
nme
nt
Adu
lt so
cioe
cono
mic
e
nviro
nme
nt
Edu
catio
nH
ea
lth d
ise
ase
and
dea
th in
adu
lt lif
e
He
alth
be
havi
our
in c
hild
hood
and
a
dole
sce
nce
He
alth
be
havi
our
in a
dult
life
The
de
velo
pme
ntof
he
alth
ca
pita
l
Ku
h e
t al 1
99
7, 2
00
4)
Soc
ioec
onom
ic L
ife C
ours
e M
odel
sA
.Acc
umul
atio
n m
odel
hyp
othe
size
s th
at e
arly
and
late
r ad
vers
e so
cio-
econ
omic
exp
erie
nces
hav
e a
cum
ulat
ive,
dos
e–re
spon
se
effe
ct o
n la
ter
outc
omes
B.L
aten
t mod
el (
or c
ritic
al p
erio
d) s
ugge
sts
that
adv
erse
soc
io-
econ
omic
cir
cum
stan
ces
duri
ng c
hild
hood
hav
e an
in
depe
nden
t, de
trim
enta
l effe
ct o
n he
alth
, ove
r an
d ab
ove
curr
ent c
ircu
mst
ance
s
C.P
athw
ay m
odel
s (c
hain
s of
ris
k) e
mph
asiz
e th
e im
port
ance
of
traj
ecto
ries
acro
ss th
e lif
e co
urse
and
are
pro
pose
d if
the
influ
ence
of c
hild
hood
SE
P is
att
enua
ted
afte
r ta
king
into
ac
coun
t lat
er c
ondi
tions
N
ied
zwie
dz
CL,
et a
l. 2
01
2
Par
ents
Occ
upat
ion
and
Edu
catio
n
+ O
wn
Edu
catio
n
+ O
ccup
atio
n
+ In
com
e
+ W
ealth
Cum
ulat
ive
Soc
ioec
onom
ic D
isad
vant
age
Lync
h JW
, 200
2
Soc
ioec
onom
ic S
tatu
s ov
er th
e Li
fe C
ours
e an
d A
llost
atic
Loa
d in
N
orth
ern
Sw
edis
h C
ohor
t, 19
81-2
008
Gus
tafs
son
PE
, Jan
lert
U,
The
ore
ll T
, Wes
terl
und
H,
Ham
mar
stro
m A
. S
oci
oec
ono
mic
sta
tus
ove
r th
e lif
e co
urse
and
allo
stat
ic lo
adin
ad
ulth
oo
d:
resu
lts f
rom
the
No
rthe
rn
Sw
edis
h C
oho
rt. J
Epi
dem
iol C
omm
unit
y H
ealt
h. 2
01
1;6
5:9
86
-99
2.
Soc
ioec
onom
ic L
ife C
ours
e M
odel
sD
.So
cial
mo
bili
ty m
od
els
div
ided
into
intr
a-an
d in
ter
-gen
erat
ion
al
•In
ter-
gen
erat
ion
al m
ob
ility
ref
ers
to a
ch
ang
e in
so
cial
cla
ss
bet
wee
n g
ener
atio
ns,
ofte
n m
easu
red
by
com
par
ing
pa
ren
tal s
oci
al
clas
s to
ow
n s
oci
al c
lass
in a
du
ltho
od
•In
tra-
gen
erat
ion
al m
ob
ility
is th
e m
ove
men
t b
etw
een
diff
eren
t
soci
al c
lass
es in
ad
ulth
oo
d, s
uch
as
the
first
an
d
last
occ
up
atio
n
•N
o c
on
sen
sus
reg
ard
ing
the
hea
lth c
on
seq
uen
ces
of s
oci
al m
ob
ility
•E
vid
ence
sh
ow
s m
ob
ile in
div
idu
als
even
tual
ly e
xper
ien
ce le
vels
of
hea
lth b
etw
een
tho
se o
f th
eir
curr
ent s
oci
al p
osi
tio
n a
nd
po
sitio
n o
f
orig
in (
clo
ser
to th
e cu
rren
t so
cial
po
sitio
n)
Fro
m N
ied
zwie
dz
CL,
et a
l. 2
01
2
Disadva
ntage
dChildhoo
d
Adva
ntage
d
Childhoo
d
Disadva
ntage
dAdulth
ood
Adva
ntage
dAdulth
ood
Gene
rally h
ad the b
est risk
fact
or and
health pro
files
Gene
rally h
ad the w
orst risk
fact
or and
health pro
files
Som
e e
videnc
e for
end
uring ch
ildhoo
d
nega
tive
eff
ect
s on
risk
fact
ors and
so
me out
comes
Lyn
ch (19
99)
Lync
h JW
, 200
2
Hea
lth T
raje
ctor
ies
Em
ploy
men
t Tra
ject
ory
and
Hea
lth R
isk
Fac
tors
, HeS
Sup
Stu
dy, F
inla
nd, 1
998-
2003
Vir
tan
en P
eta
l. E
mp
loym
ent
traj
ecto
ry a
s d
eter
min
an
t of c
han
ge
in h
ealth
-rel
ated
life
styl
e: th
e p
rosp
ectiv
e H
eSS
up
stu
dy.
E
uro
J P
ubli
c H
ealt
h. 2
00
8;1
8(5)
:504
–50
8.
Ope
ratio
naliz
atio
n of
Li
fe C
ours
e E
pide
mio
logy Fro
m L
ynch
JW
, 20
02
Dis
ease
Cau
satio
n in
a L
ife C
ours
e P
ersp
ectiv
e
•D
isea
se a
nd d
isab
ility
like
ly r
esul
t fro
m t
he c
ompl
ex
inte
rpla
y of
cri
tical
and
sen
sitiv
e pe
riod
, and
traj
ecto
ry a
nd
accu
mul
atio
n pr
oces
ses
•T
hese
gen
eral
life
cou
rse
conc
eptu
al m
odel
s ar
e si
mpl
istic
repr
esen
tatio
ns o
f com
plex
life
cou
rse
proc
esse
s –
how
ever
,
even
sim
ple
mod
els
can
be d
iffic
ult t
o di
stin
guis
h em
piri
cally
Fro
m L
ynch
JW
and
Dav
ey S
mith
G,
20
05
Idea
l Life
Cou
rse
Stu
dy
•Lo
ngitu
dina
l stu
dy
•F
ollo
ws
a bi
rth
coho
rt in
to a
dulth
ood
and,
idea
lly, a
cros
s
gene
ratio
ns
•In
vest
igat
ors
colle
ct e
xten
sive
info
rmat
ion
on th
e ph
ysic
al
and
soci
al e
nvir
onm
ents
and
on
psyc
hoso
cial
or
beha
vior
al
and
biol
ogic
al m
easu
res
•R
esea
rche
rs r
epea
t the
se m
easu
res
for
the
sam
e in
divi
dual
s
at s
hort
inte
rval
s ov
er ti
me
Rea
lity
for
Life
Cou
rse
Epi
dem
iolo
gy
•M
ost l
ife-c
ours
e lit
erat
ure
com
es fr
om E
urop
e, w
here
inve
stig
ator
s ha
ve h
ad a
cces
s to
hig
h-qu
ality
long
itudi
nal
data
base
s ri
ch in
con
text
ual i
nfor
mat
ion
•In
the
Uni
ted
Sta
tes,
man
y lif
e-co
urse
stu
dies
rel
y on
retr
ospe
ctiv
e ap
proa
ches
, inc
ludi
ng c
ase-
cont
rol a
nd
retr
ospe
ctiv
e co
hort
stu
dies
with
long
rec
all p
erio
d, a
nd
asso
ciat
ed b
iase
s, fo
r ea
rly
expo
sure
s
•Li
fe-c
ours
e re
sear
ch, r
egar
dles
s of
loca
tion,
ofte
n de
pend
s on
reco
rd li
nkag
e, n
atur
al e
xper
imen
ts, o
r hi
stor
ical
coh
orts
with
limite
d fo
llow
-up
acro
ss li
fe s
tage
s
Bra
vem
an P
, Bar
clay
C,
Ped
iatr
ics,
20
09
Bra
vem
an P
, Bar
clay
C,
Ped
iatr
ics,
20
09
Bra
vem
an P
, Bar
clay
C,
Ped
iatr
ics,
20
09
Wha
t Now
?
Fro
m L
ynch
JW
, 20
02
“Liv
ing
cond
ition
s ca
nnot
sim
ply
be le
ft to
fluc
tuat
e as
peo
ple
pass
thro
ugh
child
hood
and
thei
r re
prod
uctiv
e an
d w
orki
ng y
ears
and
into
old
age
, bec
ause
hea
lth a
nd q
ualit
y of
life
at a
ny o
ne
stag
e is
affe
cted
by
prio
r ci
rcum
stan
ces
and
even
ts. …
“The
life
cou
rse
may
be
rega
rded
as
com
bini
ng b
iolo
gica
l and
soci
al e
lem
ents
whi
ch in
tera
ct w
ith e
ach
othe
r. I
ndiv
idua
ls’
biol
ogic
al d
evel
opm
ent t
akes
pla
ce w
ithin
a s
ocia
l con
text
whi
ch
stru
ctur
es th
eir
life
chan
ces,
so
that
adv
anta
ges
and
disa
dvan
tage
s
tend
to c
lust
er c
ross
-sec
tiona
lly a
nd a
ccum
ulat
e lo
ngitu
dina
lly.”
Bar
tley
M, e
t al
, 1
99
7K
oen
en K
, et
al
Pol
icy
Impl
icat
ions
•In
terv
enin
g ea
rly
in li
fe
–P
reve
nt, r
educ
e ex
posu
res
with
late
nt e
ffect
s
–A
void
neg
ativ
e ch
ains
of e
vent
s
•In
terr
uptin
g pa
thw
ays
–P
reve
nt (
redu
ce th
e lik
elih
ood
of)
spec
ific
nega
tive
heal
th
outc
omes
–Is
it p
ossi
ble
to e
ntir
ely
over
com
e th
e he
alth
co
nseq
uenc
es o
f soc
ial a
dver
sity
ear
ly in
life
?
•M
ultip
le a
dver
se h
ealth
con
sequ
ence
s in
adu
lthoo
d
•M
ultip
le p
athw
ays
Koe
nen
K, e
t al
Influ
ence
s on
Hea
lth: w
hat s
hape
s th
e co
nditi
ons
that
sha
pe h
ealth
?
Bra
vem
an P
, Bar
clay
C,
Ped
iatr
ics,
20
09
10 T
ips
for
Bet
ter
Hea
lthH
ealth
Per
spec
tive
1.D
on't
smok
e. If
you
can
, sto
p. If
you
ca
n't,
cut d
own.
2.
Fol
low
a b
alan
ced
diet
with
ple
nty
of fr
uit a
nd v
eget
able
s.
3.K
eep
phys
ical
ly a
ctiv
e.
4.M
anag
e st
ress
by,
for
exam
ple,
ta
lkin
g th
ings
thro
ugh
and
taki
ng
time
to r
elax
5.
If yo
u dr
ink
alco
hol,
do s
o in
m
oder
atio
n.
6.C
over
up
in th
e su
n, a
nd p
rote
ct
child
ren
from
sun
burn
. 7.
Pra
ctic
e sa
fer
sex.
8.
Tak
e ad
vant
age
of d
isea
se s
cree
ning
op
port
uniti
es.
9.D
rive
safe
ly
10.
Lear
n F
irst A
id A
BC
: ai
rway
s,
brea
thin
g, c
ircul
atio
n
Soc
ial P
ersp
ectiv
e1.
Don
’t be
poo
r. If
you
can
, sto
p. If
you
ca
n’t,
try
not t
o be
poo
r fo
r lo
ng.
2.D
on’t
have
poo
r pa
rent
s.3.
Ow
n a
car.
4.D
on’t
wor
k in
a s
tres
sful
, low
pai
d m
anua
l job
.5.
Don
’t liv
e in
dam
p, lo
w q
ualit
y ho
usin
g.6.
Be
able
to a
fford
to g
o on
a fo
reig
n ho
liday
and
sun
bath
e.7.
Pra
ctic
e no
t los
ing
your
job
and
don’
t be
com
e un
empl
oyed
.8.
Tak
e up
all
bene
fits
you
are
entit
led
to,
if yo
u ar
e un
empl
oyed
, ret
ired
or s
ick
or d
isab
led.
9.D
on’t
live
next
to a
bus
y m
ajor
roa
d or
ne
ar a
pol
lutin
g fa
ctor
y.10
.Le
arn
how
to fi
ll in
the
com
plex
hou
sing
be
nefit
/asy
lum
app
licat
ion
form
s be
fore
yo
u be
com
e ho
mel
ess
and
dest
itute
.
Que
stio
ns?
