Biological Embedding of Social Determinants of Health in Early Life and Across Generations

Population health disparities represent one of the most significant public health challenges. These disparities are evident from the earliest stages of life onwards, persist across the life span, are perpetuated across generations, and are strongly influenced by social and environmental factors. Chronic stress and stress-related biobehavioral processes are discussed as one of the major effectors of the causal pathways linking upstream social determinants with health and health disparities. It is evident that the effects of stress exposure can persist over long periods of time, even across the lifespan, and particularly so if exposure occurs during sensitive developmental windows such as the intrauterine period. In this symposium, presenters will address key questions and knowledge gaps regarding biological embedding of social disadvantage and the role of stress in this context, particularly during pregnancy and early life. Tom O’Connor will present data from the ECHO-UPSIDE cohort, a longitudinal pregnancy cohort study of a socio-economically and racially/ethnically diverse sample at elevated psychosocial risk but normal medical risk status. Results indicate that maternal pre-pregnancy adversity in early childhood is associated with prenatal behavioral and physical health markers, including depressive and anxiety symptoms, stress, body mass index (BMI), sleep disturbance, and diet, as well as maternal-fetal-placental biological markers that predict child health outcomes. Laura Scholaske will present results of a multi-site prospective pregnancy study conducted in Germany that includes people of Turkish origin that are among the biggest migrant groups in Germany. Results of the study suggest that pregnant women of Turkish origin exhibit higher psychological stress levels and alterations in stress-related biological systems (i.e., elevated inflammatory levels, blunted cortisol awakening response and flatter diurnal cortisol slope) compared to non-migrant pregnant women. Shannin N. Moody will address the effects of policing inequities that are one of the most harmful sources of systemic racism perpetuated against Black Americans. In three separate studies, she tested how unjust police encounter biologically “get under the skin” in Black youth from infancy to emerging adulthood. Rates of neighborhood stop-and-frisk were associated with shorter telomeres in infants. Children whose mothers experienced unfair treatment from police showed, during the TSST, blunted cortisol stress reactivity, slower cortisol recovery, and altered cortisol-testosterone coupling. Adolescents who experienced police encounters had higher waking cortisol as emerging adults. Taken together, the studies point so some of the potential pathways through which social determinants of health may propagate and transmit persisting health disparities. Elisabeth Shirtcliff will lead a discussion on the potential implications for early prevention and targeted intervention strategies to prevent or reverse biological embedding of social disadvantage in at risk individuals.