Education: Forming the Life Course

Life Course Investments at the Maternal and Child Health Bureau.

Modelling life trajectories and mode choice using Bayesian belief networks

<h3>Background</h3> Life course socio-economic position is associated with a number of adverse health outcomes in older people. However, whether an increased number of socio-economically advantaged positions throughout the life course is associated with higher subjective quality of life has not been established. Societies that have differing welfare state arrangements may also vary in their ability to modify the relationship between socio-economic conditions over the life course and quality of life. This study addressed three key questions: (1) Is increased socio-economic advantage over the life course associated with higher quality of life in early old age? (2) Does the welfare regime moderate this association? (3) Can the relationship be explained by current financial distress? <h3>Methods</h3> Data were derived from individuals (n=14,789) aged 50 to 75 years resident in 13 European countries (representing four welfare regimes) participating in wave 2 of the Survey of Health, Ageing, and Retirement in Europe (SHARE) and SHARELIFE (the retrospective wave). Quality of life was measured by CASP-12 (control, autonomy, self-realisation and pleasure) and life satisfaction (as a sensitivity analysis). A composite life course socio-economic advantage score was generated from four childhood and four adulthood socio-economic variables. Individuals were given a score ranging from 0 to 8 based on the sum of their relative rank in the cumulative population distribution for each socio-economic variable, taking into account the differing socio-economic distributions by country, gender and cohort. Age-adjusted multilevel linear regression models stratified by gender were calculated, including interaction terms between the life course advantage scores and the welfare regime. Models stratified by welfare regime were also calculated, which adjusted for financial distress. <h3>Results</h3> A greater number of socio-economically advantaged positions over the life course was associated with higher quality of life in early old age. Among men, a one-unit increase in the life course socio-economic advantage scale was associated with 0.74 (95% CI: 0.64 to 0.84) higher CASP-12 scores and the equivalent result among women was 0.87 (95% CI: 0.78 to 0.97). The association between the life course socio-economic advantage score and quality of life was weaker in the Scandinavian regime and stronger in Southern and post-communist regimes. Including financial distress greatly attenuated the association in all welfare regimes. <h3>Conclusion</h3> Higher quality of life during early old age was related to greater socio-economic advantage throughout the life course. Interventions that buffer financial distress in early old age may be beneficial for improving quality of life and producing a more equitable distribution.

The 2020 immunization programme landscape: Piloting an assessment metric to evaluate the maturity of national immunization programmes across the life course

BackgroundSeminal studies on exposure to life course social determinants of health, such as neighborhood racial segregation and neighborhood poverty, suggest detrimental associations with poorer cognitive function. We aimed to test the opposite by examining the relationship between self‐reported exposure to health‐promoting neighborhood environments over the life course and cognitive function among older adults.MethodParticipants were persons living without dementia at three US Alzheimer’s Disease Research Centers (University of California, Davis in Sacramento (UCD); Washington University in Saint Louis (WU); and Wake Forest University in Winston‐Salem (WFU)). An ancillary study (K01AG063895, PI: Besser) included the Life Course Sociodemographics and Neighborhood Questionnaire (LSNEQ) comprised of indices like neighborhood measures of socioeconomic status (NSES), walking and biking frequency, and greenness from childhood, midlife, and late life. LSNEQ data were linked with late‐life cognitive test z‐scores (Animals and Vegetables Category Fluency, Trail Making Parts A and B) from the National Alzheimer’s Coordinating Center Uniform Data Set. Multivariable linear mixed effects models tested associations between the LSNEQ index scores (composite values over childhood and mid‐ and late‐life) and baseline and longitudinal change in cognitive function controlling for demographics, Center, and baseline global Clinical Dementia Rating (0 or 0.5).ResultThe sample (n = 322) included 65% women, 17% Black, 76% White, and 7% other/mixed racialized group participants and was, on average, 70±7 years old and followed for 2.5±3.2 years. Life Course NSES was lower for UCD (mean = 12.7, SD = 3.5) versus WU (mean = 13.9, SD = 3.2) and WFU (mean = 14.3, SD = 3.2). Life Course Neighborhood Walking and Biking frequency did not differ by Center. Life Course Neighborhood Greenness differed across Centers, and was lowest for WU (mean = 4.8, SD = 1.3) and highest for WFU (mean = 5.6; SD = 1.2). In multivariable analyses, greater Life Course Neighborhood Walking and Biking was associated with higher baseline Trail A scores (estimate = 0.83, 95% CI = 0.08‐1.58) and slower decline on Animals over time (estimate = 0.024, 95% CI = 0.002‐0.045). Greater Life Course Neighborhood Greenness was associated with slower decline on Vegetables over time (estimate = 0.035, 95% CI = 0.001‐0.069).ConclusionThese preliminary findings suggest self‐reported, life course neighborhood exposures and behaviors (i.e., greenness and neighborhood walking/biking) may be associated with better cognition and slower decline in later life.

Sociology of the life course is a sophisticated theoretical paradigm designed to understand human lives. Four key assumptions guide life course scholars’ theoretical and empirical work: (1) lives are embedded in and shaped by historical context; (2) individuals construct their own lives through their choices and actions, yet within the constraints of historical and social circumstance; (3) lives are intertwined through social relationships; and (4) the meaning and impact of a life transition is contingent on when it occurs. Life course scholars also rely on rigorous research methods and data sources—including national censuses, sample surveys, in-depth interviews, and historical records—to document human lives. Because a key question of life course research is “how does historical time and place shape lives?” researchers often compare data obtained at different points in time, from different birth cohorts (i.e., individuals born at different points in history), and from different national and cultural contexts. Researchers also rely heavily on longitudinal data, or data obtained from the same person at multiple points in time, so they can track individual-level continuity and change. Life course research is interdisciplinary, incorporating concepts from sociology, history, psychology, demography, gerontology, child development, and—in recent years—behavioral genetics. The specific foci of life course studies range from social psychological outcomes such as stress, self-esteem, occupational values, and cognitive complexity to family roles, marital and fertility patterns, educational and occupational attainment, retirement, and deviance. Although many life course scholars typically specialize in one developmental stage, such as childhood, adolescence, midlife, or older adulthood, most also consider ways that one life course stage influences subsequent experiences. Most life course research has focused on the U.S. context, yet in recent years the collection of longitudinal data—especially in the United Kingdom and western Europe—has fostered a flourishing of life course research in Europe.

The association between adversity and cognition varies according to the specific adversity, when the adversity was experienced, and the cognitive domains investigated. Disentangling the effect of adversity and the underlying mechanistic pathway is therefore difficult. The association between adversity (i.e., maltreatment) accumulated over the life course and cognitive flexibility, as well as two potential mediators (i.e., intra-individual variability in reaction time and depression) of this association, were investigated. Data stem from the baseline population of the UK Biobank study (N = 73,489, Mdnage = 56, SDage = 7.628, 55.740% of women). Cumulative life course adversity (specifically maltreatment) was measured with items based on the Childhood Trauma Questionnaire (CTS-5) and items adapted from the British Crime Survey. Depression was assessed with the Patient Health Questionnaire-9 (PHQ-9). Intra-individual variability in reaction time was measured with a reaction time test “snap game” and the Trail Making Test A and B were used as a measure of cognitive flexibility. A path analysis was performed on these data. Higher cumulative adverse experiences were associated with lower performance in cognitive flexibility (β = .016, p < .001, 95% CI [0.009, 0.024]), and this effect was partly mediated by the level of depression (22.727% of the total effect of cumulative life course adversity on cognitive flexibility was mediated by depression (β = .005, p < .001, 95% CI [0.004, 0.007])). No association between cumulative life course adverse experiences and intra-individual variability in reaction time was found, nor was any indirect association between cumulative life course adversity and performance in cognitive flexibility via intra-individual variability in reaction time. The association between cumulative life course adversity, depression, and performance in cognitive flexibility has been highlighted. In contrast, no indirect effect between cumulative life course adversity and performance in cognitive flexibility via intra-individual variability in reaction time was found, suggesting that it is not a potential mechanism underlying the association between cumulative life course adversity and executive function.

Life course research on health and disease has reached a new stage in exploring the social-to-biological transition. Large longitudinal datasets containing sociodemographic and socioeconomic characteristics, self-reported health assessments, psychological and biological data are coming into maturation and being made available to researchers. Some examples are the Survey of Health, Ageing and Retirement in Europe (SHARE), the UK Household longitudinal study (Understanding Society), The Longitudinal Aging Study Amsterdam (LASA), and linked registry data sets (particularly in Scandinavia). Consequently, questions around how environmental factors (in the broadest sense including social, psychosocial, behavioural, physical, etc.) lead to biological alterations over time can now be investigated on a wider scale, and in a variety of contexts and disciplines. Such work might also lead to a better understanding of the social structure of such social-to-biological mechanisms across the life course. The field of life course research is interdisciplinary by construction, stemming from different traditions. Since the 1990s, life course research on health topics developed in parallel within the fields of demography, such as in Wunch et al.’s (1996) work on unfavourable life course states and mortality; in epidemiology, where the importance of childhood circumstances for future health was highlighted by Mann et al. (1992); and in sociology via pivotal research on intergenerational social mobility and transmission (Erikson and Goldthorpe 1992, 2002). An interdisciplinary field of life course research has emerged from collaborations between these disciplines and others (Richter and Blane 2013). Given these strong traditions, life course research is well placed to establish both social and biological plausibility in hypothesis testing (Mayer 2009). While the literature has now established the associations between measures of the socioeconomic environment and subsequent morbidity and mortality, the specific pathways along which these associations are likely to operate need to be disentangled. A growing body of research hypotheses on the specific pathways that may operate between different environmental factors and biological embodiment can be identified and tested, informing deductive methods and the rejection of hypotheses or formulation of new ones (Blane et al. 2013). Recent examples of this type of research can be found in a previous issue of this journal. Hypotheses were put forward on central-nervous-system-mediated (or psychosocial) mechanisms around the development of cancers from early Michelle Kelly-Irving is a social epidemiologist working for the French institute for health and medical research (INSERM). She is based at a research unit in Toulouse, in the South West of France and her main research focus is on the social determinants of health inequalities from early life onwards. Silke Tophoven is a sociologist and research associate at the Institute for Employment Research in Nuremberg, Germany. She is interested in research on the relationship between work and health, with a special focus on women and ageing societies. David Blane has a background in medicine and sociology. He is professor emeritus of Imperial College London and professorial research associate of University College London. His research interests include social class differences in mortality, life course studies and social gerontology.

Social inequalities in health persist across the life course, but the magnitude of these differences differs for children, young adults, and those in mid and later life. Longitudinal data confirm that health disparities do change as individuals move through the life course, that these processes are intertwined with selection and causation between socioeconomic status (SES) and health and from variation across cohorts representing vastly different historical contexts. Variations in health disparities across the life course offer unique opportunities to gain traction into understanding the production of these disparities. The life course perspective provides a rich set of concepts, methods, and a theoretical framework for guiding our inquiry into how SES disparities in health unfold as people live their lives. This article focuses attention on how socioeconomic conditions experienced as one is growing up relate to health and mortality across the adult life course. We first review recent work exploring the association between childhood SES and adult health and mortality, examining the evidence, and the types of questions raised, for early, mid, and later life. We then turn to a growing body of evidence examining accumulative processes between health and SES across the life course. We conclude with a discussion of three major gaps and promising directions that draw upon advances in life course research to advance our understanding of how inequality shapes health throughout the life course.

Patterns of immigrant settlement as well as the process of incorporation of children of immigrants are directly affecting the life courses of immigrants, their families as well as the majority population in the host country. From this perspective a linkage between the sociology of the life course and research on migration and integration of immigrants seems obvious. In the general introduction we started with an overview of the theoretical foundations and basic analytical concepts of the life course approach and pointed to potentially fruitful links with migration and integration research. The 11 contributions in this book empirically demonstrated the analytical potential of linking the life course perspective and research on immigrant settlement. In our conclusion the use and payoff of this connection will be discussed in more detail. Now, while the link between the life course approach and migration and integration research seems to be obvious, existing studies on family dynamics and the life course often focus on majority populations only and hardly take those with a migrant origin into account. Little is known on the background and consequences of life course transitions for migrants and their families. Our book is an attempt to overcome this limitation of previous work and to show the relevance of applying a life course approach to the study of immigrant groups. Bridging the gap between research traditions is urgently needed as Europe’s current population is already heterogeneous and expected to be even more diverse in the future. In many countries already a fifth of the population is born abroad, or has at least one parent born outside the country of residence. International migrants often experience a rapid social change when moving from their country of origin to another country of settlement. Depending on the move they may not be familiar with the culture in the country of settlement, its institutional regimes, and everyday life practices. This may bring along many uncertainties as was already very well described by Thomas and Znaniecki in their classic work “The Polish Peasant in Europe and America” (1918–1920). As they also show the migration move can have a disruptive effect on the individual migrant and the family.

The life course in general, and the educational trajectories of young people in particular, comprise a high degree of complexity as they take place in iterative, recursive and interactive negotiation processes in which numerous actors, institutions and discourses are involved. In this paper, an attempt is made to combine two conceptual discussions—Life Course and Governance—bringing them to bear on the examination of how Lifelong Learning (LLL) policies have been used to govern young people’s life courses. The paper synthesizes different discussions of the complex relations among governance, discourses and structures of opportunity that impact the governing of the life course and particularly educational trajectories. It suggests that the combination of life course research and a governance perspective enables analyzing the governance of educational trajectories along discursive, institutional and relational dimensions of opportunity structures. Considering these various dimensions, the paper argues, allows us to attend to the social interactions, decision-making processes and processing mechanisms that precede and/or underlie educational processes and thus favor or complicate them. The contribution also critically discusses the implications of a governance perspective on life courses and closes with a discussion of the multidimensional and multilevel challenge of governing life course by means of LLL policies.

Medieval Life: Archaeology and the Life Course by Roberta Gilchrist. Woodbridge, The Boydell Press, 2012. xv, 336 pp. $50.00 US (cloth). Roberta Gilchrist, archaeologist and author of such works as Gender and Material Culture: The Archaeology of Religious Women and Gender and Archaeology: Contesting the Past, in this volume turns her attention to interpreting the material culture associated with the everyday lives of people in England from the mid-eleventh to the mid-sixteenth centuries. Her aim is to analyze the finds from nine different archaeological assemblages--ranging from urban sites in cities such as London and York to rural sites such as Wharram Percy to catastrophe sites such as the shipwrecked Mary Rose (1540)--using theoretical approaches derived from the fields of sociology, anthropology, and archaeology. Gilchrist's approach is deeply informed by theory, which views each human life as whole and integrated (as opposed to broken up into a series of stages) and provides a means by which human lives can be understood within their socio-cultural contexts. Gilchrist proposes in this book that medieval lives can be understood in terms of the life course, that is, from conception to the afterlife rather than the traditional definition of a human life lasting from birth until death. She provides examples from the nine assemblages to shed light on the connections between medieval beliefs and practices concerning the 'extended life course' and material culture. For those who are interested in life course theory and the archaeological approach to concepts such as embodiment and ritual, biography and agency, and time and memory (p. xii), Gilchrist's first chapter will provide a useful overview. The remainder of the book consists of five thematic studies of archaeological finds: bone evidence and its relationship to medieval concepts of age; dress evidence and its connections with medieval ideas about gender, sexuality, and life course transitions; the material culture of domestic environments and the extended life course; the material culture of medieval religious beliefs and practices, particularly in parochial and domestic contexts; possible evidence for the existence of heirloom objects and how this might relate to whether objects can be said to have agency. Despite the promise of the first chapter, medieval historians are unlikely to find much that is strikingly new in the application of life course theory to interpretation of the material objects under discussion. Gilchrist draws substantially on the work of historians who have published in the areas of social, dress, gender, and religious history, so for scholars working in these fields, there will be much here that is familiar. Historians may also be puzzled by Gilchrist's tendency to summarize information from historical scholarship by stating that medieval people believed or did a certain thing, giving the impression that the belief or practice was universal, and only later (or sometimes not) acknowledging that analysis of historical sources or archaeological finds indicates that there was likely considerable local variation. …

Kidney disease and the cumulative burden of life course socioeconomic conditions: The Atherosclerosis Risk in Communities (ARIC) Study

In 2003 when Dr. Halfon and I published a commentary in this journal calling for a reconceptualization of racial– ethnic disparities in birth outcomes from a life-course perspective [1], few people in maternal and child health (MCH) were talking about life course. While certainly not new, it was hailed in an accompanying editorial as ‘‘a start in a new paradigm’’ in MCH [2]. The past decade has witnessed major advancements in the development of the life course theory and its application to MCH research, practice, and policy. In this issue, Halfon et al. [3] summarized new advances in the theory of life course health development (‘‘LCHD 2.0’’), while other articles provide a sample of the many innovative applications in our field. There are now websites, toolboxes, resource guides, and a research network devoted to MCH life course, and the federal Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration is now using the life course theory as a strategic planning framework, guiding the work of the Bureau and its grantees and partners over the next decade [4]. There has been a paradigm shift in MCH, and as proclaimed in an editorial in 2009, ‘‘[t]he life course has come of age’’ [5]. So where do we go from here? The collection of articles in this issue of the MCH Journal provides a good roadmap. In this editorial, I will offer three further suggestions for how to advance life course research, practice, and policy in MCH. In research, we need to move beyond discovery to intervention research. In practice, we need to move from isolated to collective impact. In policy, we need to move beyond paying for remediation to investing in capacity formation.

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