THE PRENATAL AND CHILDHOOD MECHANISMS OF HEALTH DISPARITIES; INITIAL RECRUITMENT AND RETENTION

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The Division of Population Health Research (DiPHR) conducts studies focusing on child health and human development. As part of DiPHR's mission, one area of interest is the investigation of the developmental origins of health disparities - i.e., differences in developmental outcomes between socially advantaged and disadvantaged groups. Here, we refer to unequal health outcomes between socioeconomic and race/ethnic groups and although disparities may also exist in the context of other socially disadvantaged statuses including intellectual disability and sexual minority status. Health disparities in the United States - in life expectancy and chronic disease - have their origins as early as the prenatal period. Early life conditions including poverty and discrimination generate disparities in health over the life course that become further entrenched in the population through their transmission across generations. Parental mental health problems, which are strongly linked with social and economic disadvantage as well as child development, may play a key mediating role in the transmission of disparities across generations. However maternal and paternal psychopathology have not been fully considered as mechanisms contributing to disparities nor been measured using phenotypically validated approaches (e.g., through structured diagnostic interviews). As a result, though disparities in health are well documented, the developmental mechanisms that impact disparities at the very beginning of life are not, particularly those which lead to developmental deficits that emerge long before disease states. The NICHD 2020 strategic plan highlights health disparities as a cross-cutting problem impacting advancing maternal health, birth outcomes, and child development; it emphasizes that “understanding the contribution of social, economic, structural, and regional factors is vital to advancing preventive, diagnostic, and intervention efforts” designed to mitigate health disparities. Advancing knowledge of the developmental mechanisms that generate disparities requires a more thorough understanding of how socioeconomic status and race/ethnicity influence the determinants of prenatal health and child development from gestation onward. To accomplish this, more in-depth measurement of potential causes of disparities is needed from more diverse samples starting earlier in the life course than is currently available from existing studies. This work needs to measure how various domains of child development are influenced by multiple inputs at the biological, psychological, family, and neighborhood levels, and in which small differences early in child development are compounded over time resulting in large gaps in health later on.