Integrating the Life Course Perspective into a Local Maternal - CiteSeerX

Matern Child Health J DOI 10.1007/s10995-011-0800-2

Integrating the Life Course Perspective into a Local Maternal and Child Health Program Cheri Pies • Padmini Parthasarathy Samuel F. Posner

•

Ó Springer Science+Business Media, LLC 2011

Abstract For many decades, early access to prenatal care has been considered the gold standard for improving birth outcomes. In Contra Costa County, a diverse urban and suburban county of over one million people in the San Francisco Bay Area, the Family Maternal and Child Health Programs of Contra Costa Health Services (CCHS) have seen high rates of early entry into prenatal care since 2000. Yet despite our best efforts to increase access to quality prenatal care, our rates of low birth weight and infant mortality, especially among African Americans, continue to be high. When we were introduced to the Life Course Perspective in 2003 as an organizational framework for our programmatic activities, we recognized that emerging scientific evidence in the literature demonstrated the importance of social and environmental factors in determining health and health equity, and supported a general impression in the field that prenatal care was not enough to improve birth outcomes. The Life Course Perspective suggests that many of the risk and protective factors that influence health and wellbeing across the lifespan also play an important role in birth outcomes and in health and quality of life beyond the

C. Pies (&) School of Public Health, University of California, Berkeley, 279 University Hall, Berkeley, CA 94720, USA e-mail: [email protected] P. Parthasarathy Family Maternal and Child Health Programs, 597 Center Avenue, Suite 365, Martinez, CA 94553, USA e-mail: [email protected] S. F. Posner Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MS85, Atlanta, GA 30341, USA e-mail: [email protected]

initial years. In this article, we describe the Life Course Perspective and how one local Maternal and Child Health Program adopted and adapted this paradigm by creating and launching a Life Course Initiative to guide our programs and services. The Life Course Initiative implemented by CCHS is designed to reduce inequities in birth outcomes, improve reproductive potential, and change the health of future generations by introducing a longitudinal, integrated, and ecological approach to implementing maternal and child health programs. Keywords Life Course Perspective
Birth outcomes
Social determinants of health
Health equity
Local health department

Introduction For the past several decades, maternal and child health (MCH) experts have considered improving access to and utilization of quality prenatal care to be necessary for improving birth outcomes and reducing racial and ethnic inequities overall. Leading researchers and academics, as well as scholars with the Institute of Medicine, have written extensively on the importance of early entry into quality prenatal care, particularly for at-risk women [1–7]. As a result, the federal government has made a large investment in ensuring that women have access to prenatal care early in pregnancy. Medicaid is one the nation’s largest payment sources for prenatal care, covering more than 40% of births in the US [8]. Despite this infusion of funds and the fact that rates of early entry into prenatal care have been steadily improving [9], rates of preterm birth and low birth weight have risen steadily over the past 20 years [10], and substantial inequities remain between racial and ethnic groups in all birth outcomes [11].

123

Matern Child Health J

Despite the demonstrated inadequacy of the focus on prenatal care to improve birth outcomes, there are several possible reasons why a shift away from prenatal care as a panacea for poor birth outcomes has been slow. Clinicians and public health professionals have become attached to the idea that providing prenatal care is essential to improving maternal and child health outcomes, and for the past 30 years, funding for maternal and child health programs has been directed primarily to this effort [12]. Likewise, clinicians and public health professionals are often focused on providing specific services to individuals, and they are less comfortable with or untrained to address social and environmental factors, which are the strongest determinants of perinatal health [13, 14]. Furthermore, standards and guidelines for health care, and payment structures outside of the time of pregnancy are very limited, and many women only have access to care when they are pregnant. This model of episodic care has made it difficult, if not impossible, to provide health care and address issues beyond the prenatal period. Existing and emerging research shows that social, political and physical environments are major determinants of family health, and especially of health inequities [15]. As the national health agenda begins to move more deliberately toward implementing interventions, programs, and policies that are designed to eliminate health inequities to improve the health of this and future generations [13–16], support is expanding from the model of prenatal care as a single, all-encompassing solution [17]. Instead, interest is increasing in frameworks that look beyond the prenatal period to a broader range of factors that may improve birth outcomes. Over the past several years, several academic publications in both MCH and chronic disease epidemiology [18–22] have drawn attention to newer theoretical constructs that address both health and wellbeing across the life span, as well as social determinants of health [23, 24], prompting a shift in the way MCH practitioners and researchers are approaching their work. One such model is Lu and Halfon’s Life Course Perspective (LCP) [25], which suggests that a complex interplay of biological, behavioral, psychological, environmental, and social protective and risk factors contributes to health outcomes across the span of a person’s life, and that inequities in birth outcomes, such as low birth weight and infant mortality, result from differences in protective and risk factors between groups of women over the course of their lives. The LCP also integrates a focus on critical periods of development and early life events [19, 26–30] with an emphasis on cumulative risk, such as the accumulation of and adaptation to chronic stress, often described as weathering or the ‘‘wear and tear’’ a person experiences over time [31–34]. The Life Course paradigm presents several new opportunities for MCH practitioners to introduce innovations

123

into the field. At the state and federal levels, governmental organizations are using this new paradigm to foster changes that promote health equity and LCP-based approaches to the delivery of services, design of training and education programs, and pursuit of research agendas. For example, the federal Maternal and Child Health Bureau (MCHB) is working on the development of a new Strategic Plan that explicitly includes the integration of the LCP, health equity and social determinants of health into all aspects of the Bureau’s work [35]. At the local level, MCH programs are starting to collaborate with non-traditional partners in other sectors (economic, housing, physical environment, etc.) to address social determinants of health [25, 36] and health equity on a broader scale, and program interventions that stretch beyond the perinatal period and address health ‘‘from womb to tomb’’ are being tested [25].

Integrating the Life Course Perspective into Practice In 2005, Contra Costa Health Services (CCHS), a local health department in California, launched a 15-year Life Course Initiative (LCI) based on the Life Course Perspective and the work of Lu and Halfon [25]. The purpose of Contra Costa Health Services’ (CCHS) LCI is to reduce inequities in birth, infant, and maternal outcomes and improve the health of the next generation in Contra Costa County by promoting and achieving health equity, optimizing health, and shifting the paradigm of the planning, delivery, and evaluation of maternal, child, and adolescent health services. The LCI aims to identify ways to apply and operationalize the LCP, which includes a focus on social determinants of health, into the dynamic day-to-day practice of the Family Maternal and Child Health (FMCH) Programs at CCHS. Since 2000, entry into prenatal care in Contra Costa had been close to 90% [37]. While these rates stayed constant, the inequity between racial and ethnic groups decreased between 1990 and 2007 from a gap of 16.3 to 7.3% between African Americans and Whites. Nevertheless, during this same time period, birth outcomes, particularly for African American women, remained poor. The rates of low birth weight and preterm births were high (13.4 and 15.4%, respectively, for African American babies, compared to 5.6 and 9.5% for White babies) and infant mortality rates remained high as well [36]. This discrepancy between the services we were providing and the outcomes they were meant to improve prompted us to intensify our efforts to collaborate with community groups, including housing, transportation and social service organizations, in the county’s zip codes that had the worst health outcomes. These partnership efforts focused on improving and expanding available services

Matern Child Health J

and gaining a deeper understanding from community partners of what we should be doing differently to reduce infant mortality and low birth weight births. We also conducted a Photovoice [38, 39] project, to learn first-hand from community residents what they believed were the pressing issues that FMCH Programs should be addressing to improve birth outcomes. Through their pictures and subsequent in-depth discussions, community residents pointed to the general state of their neighborhoods, particularly a preponderance of trash, understaffed and underfunded after-school programs, and unsafe neighborhoods as issues they wanted us to address [38]. We knew that these were important and significant quality-of-life issues that needed attention. However, given our mandate to reduce low birth weight births, infant mortality, and births to teens, we were challenged to find strategies for translating these pressing social and environmental issues into practical, measurable objectives that were relevant to the mission of FMCH Programs. The Life Course Perspective offered us a logical and intuitive framework for addressing these social determinants of health.

Table 1 A 12-point plan to close the Black-White gap in birth outcomes: A life-course approach [36] Improving Health Care for African American Women 1. Provide interconception care for women with prior adverse pregnancy outcomes 2. Increase access to preconception care for African American women 3. Improve the quality of prenatal care for African American women 4. Expand healthcare access over the life course for African American women Strengthening African American families and communities 5. Strengthen father involvement in African American families 6. Enhance systems coordination and integration for family support services 7. Create reproductive social capital in African American communities 8. Invest in community building and urban renewal Addressing social and economic inequities 9. Close the education gap 10. Reduce poverty among African American families 11. Support working mothers and families 12. Undo racism

The Challenge: Changing the Health of a Generation When FMCH Programs took on the challenge of integrating the LCP into our work, we knew we would have to shift our singular focus on prenatal care to a much broader focus on health and wellbeing across the life span, with special attention to the social determinants of health such as housing, wealth, community violence, access to healthy foods, and education. We wanted to make this paradigm shift throughout our constellation of MCH-related programs, which include not only perinatal services coordination, but also programs such as Child Health and Disability Prevention Program (California’s EPSDT program), California Children’s Services (California program that arranges and pays for medical care, equipment, and rehabilitation for children with particular medical conditions), Children’s Oral Health Program, Medically Vulnerable Infant Program, Prenatal Care Guidance, TeenAge Program, and Women, Infants and Children Program. We also hoped to influence change throughout the larger Contra Costa Public Health Division, building on work around the Spectrum of Prevention [40] that had been conducted in this setting over the past two or more decades. Our vision for this LCI was larger than the work we hoped to accomplish in Contra Costa County. We envisioned a broad change in the field of MCH. We sought to shift the MCH paradigm from one that traditionally focused on improving access to prenatal care to one where social determinants of health, health equity, and the

importance of critical periods of development and accumulation of risk across the life course would be addressed as part of the goals and objectives of organizations serving women, children, and families. When we launched our 15-year LCI in 2005, we based our ideas for our work could look like work on the ‘‘12Point Plan to Close the Black-White Gap in Birth Outcomes,’’ which was described by Lu et al. [36] in a paper that was not yet published at that time. The 12-Point Plan (see Table 1) provided us with a valuable road map, with ideas for what we should be doing, and what our next steps could be given what we had accomplished so far. This plan was specific to closing the Black-White gap in birth outcomes, but as we reflected on how we could integrate a focus on health equity and social determinants of health into our work, we found that the elements of this plan were relevant to all of the racial and ethnic communities that we were serving.

Accomplishments to Date During the first 5 years of the LCI, we have (1) created LCP educational materials (training curriculum and fact sheets about the LCI and the 12-Point Plan), (2) conducted LCP educational sessions with FMCH Programs and Public Health Division staff and leadership, and community partners; (3) assessed the effectiveness of the educational sessions with our staff; (4) established a Life Course

123

Matern Child Health J

Planning Team that oversees LCI program planning and evaluation activities; and (5) developed a Life Course Perspective-based intervention entitled Building Economic Security Today (BEST). Creating Educational Materials and Conducting Educational Sessions To help refocus our public health work, we developed easy-to-understand fact sheets about the LCP for staff at all levels [41–43]. We also designed and conducted interactive educational sessions on the LCP for the 220 FMCH Programs staff, other Public Health Division staff, local public health leaders and policymakers, and community partners. These educational sessions (a) offered staff an overview of the theory of the LCP and social determinants of health; (b) provided participants with an opportunity to experience the key concepts of the LCP through a Life Course Game; and (c) engaged participants in substantive discussions about how they were already incorporating the LCP into their current work and future activities. A creative teaching tool based on the board game, Chutes and LaddersÒ, the Life Course Game was particularly effective in taking participants through various experiences across the life course, filtered through a lens of economic and social determinants of health. The game also helped participants match theoretical concepts with real life events, providing them with an opportunity to understand how the excitement, disappointment and failures that our clients face on a regular basis fit into the LCP. In subsequent educational sessions, we reviewed LCP theory and facilitated in-depth discussions about the 12-Point Plan [36]. FMCH Programs staff identified how the points of the 12-Point Plan were reflected in their current work. For some of our staff, this was an entirely new way of thinking about their job responsibilities and for others, this fell in line with what they had been seeing for many years. Not everyone was ready to embrace this new direction and many staff asked difficult, complex questions that provided us with additional opportunities for valuable discussion and critical thinking. Offering these educational sessions to other Public Health Division staff, policy makers, local health leaders, and community partners helped to bring attention to the Life Course Initiative, educate this group of influential individuals about the new directions we hoped to pursue, and allow time for substantive discussion that hopefully would lead to ‘‘buy-in.’’ In these sessions, individual behavior and individual choices were still discussed, but in a different context: Are we creating environments in which women and children, youth and families have good choices to make? How are our efforts contributing to their health across their life course?

123

Assessing the Effectiveness of Our Educational Sessions In Year Two, we conducted a web-based, qualitative survey of our staff to gauge the effectiveness of our LCP educational sessions. In particular, we wanted to ascertain the staff’s understanding of the LCP and collect their ideas for incorporating this approach into their work. Staff were asked to describe the LCP in their own words. Of the 65 staff completing the survey, 45% offered accurate descriptions of the LCP and referred to concepts such as the ecological model of health, early programming, and cumulative pathways. We also asked staff whether they had changed anything with regard to their work as a result of learning about the LCP, and almost three-quarters of staff said that they had. As one staff person explained: Our ‘‘program’s perspective has expanded to include not only how we may impact our clients and their families at the moment, but also how we may influence their ability to improve their health and well-being throughout their life span. Realizing that change will impact future generations has been a shift in thinking for us.’’ Life Course Planning Team and BEST When we launched the LCI, two staff members were responsible for the direction, oversight and implementation of the work plan, while others were invited to participate in the planning process in a more minor way. Early in Year Three, however, as we began discussing an ‘‘upstream’’ intervention that would address some aspect of the social determinants of health, we realized we needed a team to discuss ideas, think through possible interventions, and move forward with this effort. We brought together the FMCH Epidemiologist, a program evaluator, and a Nurse Program Manager who were instrumental in helping us identify a sound, reasonable, and realistic direction for our next steps. We were aided in this work by the release of ‘‘Unnatural Causes,’’ [44] a documentary series designed to increase public awareness of the alarming socioeconomic, racial and ethnic inequities in health in the United States, and their human and financial costs. The film, along with critical new publications on social determinants of health specifically linking health and wealth [14, 15, 45], and the findings of our Photovoice projects, provided us with a platform from which to expand the LCI to topics and partners outside of FMCH Programs. We realized that financial stability across the life course, a key protective factor leading to positive health outcomes, was not being addressed in any formal way by our programs. We decided to take on the 12-Point Plan challenges of ‘‘Support working mothers and families’’ and ‘‘Reduce poverty,’’ and

Matern Child Health J

in doing so created an intervention that we hoped would increase the financial stability and security of our clients in an effort to improve their financial status and ultimately, their health. This effort became known as Building Economic Security Today (BEST). Building Economic Security Today—Pilot Project Building Economic Security Today (BEST) is an asset development pilot project that utilizes innovative strategies to reduce inequities in health outcomes for low-income Contra Costa families by improving their financial security and stability. BEST helps families maximize their income for daily living, and preserve and increase their financial assets, factors that in turn will improve their access to health care, housing situations, food security, and opportunities to live in safer and healthier neighborhoods. As research shows that children learn about how to manage money from their parents [46–49], providing financial education to this generation’s parents also could increase financial stability in the next. BEST offers (1) one-on-one support to families in ongoing FMCH home visiting programs, (2) financial education classes for Women, Infants and Children Program (WIC) clients, and (3) asset development educational materials and referrals for all clients. Staff work with clients to address financial concerns, such as applying for public benefits for which they are eligible, repairing credit, opening a bank account, obtaining their Earned Income Tax Credit, and utilizing a prepaid debit card. BEST is unique in that it addresses the strongest social determinant of inequities in health, i.e. wealth, by integrating basic financial education into health services. This project also connects two sectors—public health and asset development—that have not traditionally worked together. BEST embodies our organization’s paradigm shift towards a Life Course approach, focusing on the cumulative effects of social factors over the course of one’s life. Through this project, we are creating opportunities for low-income families in our county to improve their quality of life and become more engaged participants in the mainstream economy. We anticipate discussing the outcomes of the implementation of BEST in a future publication.

Discussion After decades of expecting that early entry into prenatal care would lead to improved birth outcomes and designing programs to ensure women enrolled in and received quality prenatal care, leaders of local MCH programs are now beginning to realign their efforts to transform MCH programs and activities to include an expanded longitudinal,

contextual, and updated approach. Despite the complexities and challenges of integrating this framework into MCH programs to date, FMCH Programs has made substantial progress in integrating the LCP into programs and services. The results of early efforts suggest that there is a substantial amount of foundational work required to make this kind of major paradigm shift. This integration has required us to foster understanding of and secure support for the LCI from multiple County departments and external partners. Five years into the LCI, we have experienced several challenges and learned many lessons about making an organizational paradigm shift. First and foremost, we recognized that changing a long-standing paradigm is a slow process and that we had to have a long view. Gaining the buy-in of our staff took much longer than we expected. It was crucial for us to (a) start with staff where they were, so that they were receptive to and engaged with the new ideas being presented; (b) enable staff to each have their own ‘‘A-ha!’’ moment; (c) recognize and acknowledge our staff’s existing work related to the LCP and build on this; and (d) utilize the imagination and experience of staff to plan for the future. Being willing to have a flexible timeline has been essential to our success thus far. We learned that it was critical to involve our local public health leaders and policy makers early on, in order to obtain support for investing the immense amount of staff time and program resources needed to implement the LCI and lay the groundwork for mobilizing political will. In addition, we recognized the value of the skeptics of our Initiative, and the importance of engaging in meaningful and substantive dialogue with them, as they were the ones who were asking us the hard questions. Finally, we also faced challenges in determining what measures we should use to evaluate the Life Course Initiative and BEST. We knew that we wanted to examine independent associations between program efforts and MCH indicators, but we were not exactly sure how to achieve this. We have measured some of our successes by tracking changes in staff knowledge, examples of program implementation, and how staff are using the language of the LCP in their day-to-day work. The Life Course Planning Team has been working to select other factors to measure and determine whether these factors impact MCH outcomes, and explore how to measure these factors over time. We believe that measuring outcomes intermediate to health outcomes, such as financial stability through the BEST project, is one approach to determining the success of our work.

Conclusion The LCP provides a framework for thinking more expansively about traditional MCH practice and the strategies we

123

Matern Child Health J

use to improve the health of women, children and families across the life span. While there have been improvements in pregnancy outcomes over the past 20 years, the decline has leveled off suggesting that new models are needed to make progress. The evidence supporting the LCP offers some insight into what areas need interventions to improve outcomes. The FMCH Programs’ LCI, including BEST, is one approach to integrating components of the LCP into programs and services. Local MCH Programs must begin to look beyond the prenatal care model towards a broader framework that addresses social, community, and neighborhood factors in addition to clinical care. Making this transition in local programs will require expanded conceptual frameworks, new skills for staff, creative partnerships and community alliances, changes in models for the provision of health care, and transformative leadership. Acknowledgments The authors want to thank the following individuals for their insights, suggestions, and critical review of this article: Wendel Brunner, MD, PhD; Debbie Casanova, MPH; Dawn Dailey, RN, PhD; Chuck McKetney, PhD, MPH; Michael C. Lu, MD, MPH; Milton Kotelchuck, PhD, MPH; the Contra Costa Health Services Writers Group, Meredith Minkler, DrPH, MPH, and Amy Fine, MPH. Funding for the writing of this article was provided by the Public Health Institute’s Adeline Hackett Innovation Award; Contra Costa Health Services; and California Department of Public Health, Maternal, Child and Adolescent Health Program.

References 1. Gortmaker, S. I. (1979). The effects of prenatal care upon the health of the newborn. American Journal of Public Health, 69, 653–660. 2. Quick, J. D., Greenlick, M. R., & Roghmann, K. J. (1981). Prenatal care and pregnancy outcome in an HMO and general population: a multivariate cohort analysis. American Journal of Public Health, 71, 381–390. 3. Showstack, J. A., Budetti, P. P., & Minkler, D. (1984). Factors associated with birth weight: an exploration of the roles of prenatal care and length of gestation. American Journal of Public Health, 74, 1003–1008. 4. Alexander, G. R., & Korenbrot, C. (1995). The role of prenatal care in preventing low birth weight. Future Child, 5, 103–120. 5. Kogan, M. D., Alexander, G. R., Kotelchuck, M., & Nagey, D. A. (1994). Relation of the content of prenatal care to the risk of low birth weight: Maternal reports of health behavior advice and initial prenatal care procedures. JAMA: The Journal of the American Medical Association, 271, 1340–1345. 6. Moore, T. R., Origel, W., Key, T. C., & Resnik, R. (1986). The perinatal and economic impact of prenatal care in a low-socioeconomic population. American Journal of Obstetrics and Gynecology, 154, 29–33. 7. Institute of Medicine. (1993). Access to health care in America. Washington DC: National Academy Press. 8. Kaiser Family Foundation. (2007). Medicaid’s role for women. Menlo Park (CA): KFF. 9. National Center for Health Statistics. (2010). Health, United States, 2009: With special feature on medical technology. Hyattsville (MD): NCHS.

123

10. Hamilton, B. E., Martin, J. A., & Ventura, S. J. (2010). Births: Preliminary data for 2008. National Vital Statistics System, 58(16), 1–17. 11. Heron, M. P. (2010). Deaths: Leading causes for 2006. National Vital Statistics System, 58(14), 1–100. 12. Misra, D. P., & Grason, H. (2006). Achieving safe motherhood: Applying a life course and multiple determinants perinatal health framework in public health. Womens Health Issues, 16, 159–175. 13. National Partnership for Action to End Health Disparities [Internet]. (2010). Rockville (MD): Office of Minority Health, US Department of Health and Human Services; c2010. The National Plan for Action, Draft as of February 17, 2010: Changing outcomes—achieving health equity, [cited 2010 April 12], [about 2 screens]. Available from http://minorityhealth.hhs.gov/npa/ templates/browse.aspx?lvl=1&lvlID=31. 14. Robert Wood Johnson Foundation. (2008). Overcoming obstacles to health. Princeton (NJ): The Foundation. 15. Adler, N. E., Stewart, J., et al. (2007). Reaching for a healthier life: Facts on socioeconomic status and health in the US. San Francisco: The John D. and Catherine T. MacArthur Foundation Research Network on Socioeconomic Status and Health. 16. National Partnership for Action to End Health Disparities [Internet]. (2008). Rockville (MD): Office of Minority Health, US Department of Health and Human Services; c2008. A strategic framework for improving racial/ethnic minority health and eliminating racial/ethnic health disparities, [cited 2010 April 12]; [about 26 screens]. Available from: http://minorityhealth.hhs. gov/npa/images/78/PrintFramework.html. 17. Misra, D. P., & Guyer, B. (1998). Benefits and limitations of prenatal care: From counting visits to measuring content. JAMA: The Journal of the American Medical Association, 279, 1661–1662. 18. Barker, D. J. P., Osmond, C., Golding, J., Kuh, D., & Wadsworth, M. E. J. (1989). Growth in utero, blood pressure in childhood and adult life, and mortality from cardiovascular disease. BMJ, 298, 564–567. 19. Barker, D. J. P. (1990). The fetal and infant origins of adult disease. British Medical Journal, 301, 1111. 20. Barker, D. J., Hales, C. N., Fall, C. H., Osmond, C., Phipps, K., & Clark, P. M. (1993). Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): Relation to reduced fetal growth. Diabetologia, 36, 62–67. 21. Ben-Shlomo, Y., & Kuh, D. (2002). A life course approach to chronic disease epidemiology: Conceptual models, empirical challenges and interdisciplinary perspectives. International Journal of Epidemiology, 31, 285–293. 22. Shonkoff, J. P., Boyce, W. T., & McEwan, B. S. (2009). Neuroscience, molecular biology, and the childhood roots of health disparities: Building a new framework for health promotion and disease prevention. JAMA: The Journal of the American Medical Association, 301, 2252–2259. 23. Misra, D. P., Guyer, B., & Allston, A. (2003). Integrated Perinatal Health Framework: A multiple determinants framework with a life span approach. American Journal of Preventive Medicine, 25, 65–75. 24. Braveman, P., & Barclay, C. (2009). Health disparities beginning in childhood: A life-course perspective. Pediatrics, 124(Suppl 3), S163–S175. 25. Lu, M. C., & Halfon, N. (2003). Racial and ethnic disparities in birth outcomes: A life-course perspective. Maternal and Child Health Journal, 7, 13–30. 26. Jensen, C. D., Block, G., Buffler, P., et al. (2004). Maternal dietary risk factors in childhood acute lymphoblastic leukemia (United States). Cancer Causes and Control, 15, 559–570. 27. Van den Bergh, B. R. H., & Marcoen, A. (2004). High antenatal maternal anxiety is related to ADHD symptoms, externalizing

Matern Child Health J

28.

29.

30.

31. 32.

33.

34.

35.

36.

37.

38.

problems, and anxiety in 8- and 9-year olds. Child Development, 75, 1085–1097. Li, J., Vestergaard, M., Obel, C., Precht, D. H., Christensen, J., Lu, M., et al. (2009). Prenatal stress and cerebral palsy: A nationwide cohort study in Denmark. Psychosomatic Medicine, 71, 615–618. Virk, J., Li, J., Vestergaard, M., Obel, C., Lu, M., & Olsen, J. (2010). Early life disease programming during the preconception and prenatal period: Making the link between stressful life events and type-1 diabetes. PLoS One, 5(7), 1–5. Huang, J. S., Lee, T. A., & Lu, M. C. (2007). Prenatal programming of childhood overweight and obesity. Maternal and Child Health Journal, 11, 461–473. McEwan, B. S. (1998). Protective and damaging effects of stress mediators. The New England Journal of Medicine, 338, 171–179. Geronimus, A. T. (1992). The weathering hypothesis and the health of African-American women and infants: Evidence and speculations. Ethnicity and Disease, 2, 207–221. Geronimius, A. T. (1996). Black/white differences in the relationship of maternal age to birthweight: A population-based test of the weathering hypothesis. Social Science and Medicine, 42, 589–597. Geronimus, A. T. (2001). Understanding and eliminating racial inequalities in women’s health in the United States: The role of the weathering conceptual framework. Journal of the American Medical Women’s Association, 56, 133–136. Kotelchuck, M., & Fine, A. (2010). Rethinking MCH: The life course model as an organizing framework. Washington (DC): Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services. Lu, M. C., Kotelchuck, M., Hogan, V., Jones, L., Wright, K., & Halfon, N. (2010). Closing the black-white gap in birth outcomes: A life-course approach. Ethnicity and Disease, 20(1 Suppl 2), 62–76. California Department of Health Services Birth Statistical Master Files 2000–2007. Prepared by Contra Costa Health Services— Community Health Assessment, Planning and Evaluation (CHAPE). Wang, C. C., & Pies, C. A. (2004). Family, maternal, and child health through photovoice. Maternal and Child Health Journal, 8, 95–102.

39. Pies, C. A., & Parthasarathy, P. (2007). Photovoice: Giving local health departments a new perspective on community health issues. Martinez (CA): Contra Costa Health Services, Public Health Division. 40. Rattray, T., Brunner, W., & Freestone, J. (2002). The new spectrum of prevention: A model for public health practice. Martinez (CA): Contra Costa Health Services, Public Health Division. 41. Family, Maternal and Child Health Programs’ Life Course Initiative, Overview [Internet]. Martinez: Contra Costa Health Services; c2010 [cited 2010 Sept 7]. Available from: http://cchealth. org/groups/lifecourse/pdf/lci_fact_sheet.pdf. 42. Family, Maternal and Child Health Programs’ Life Course Initiative, 12-Point Plan to Close the Black-White Gap in Birth Outcomes [Internet]. Martinez: Contra Costa Health Services; c2008 [cited 2010 Sept 7]. Available from: http://cchealth.org/ groups/lifecourse/pdf/12_point_plan_fact_sheet.pdf. 43. Family, Maternal and Child Health Programs’ Life Course Initiative, Building Economic Security Today [Internet]. Martinez: Contra Costa Health Services; c2010 [cited 2010 Sept 7]. Available from: http://cchealth.org/groups/lifecourse/pdf/best_ fact_sheet.pdf. 44. Unnatural Causes [Internet]. San Francisco: California Newsreel; c2008 [cited 2010 May 26]. Available from: http://www.unnatural causes.org/. 45. Braveman, P. A., Cubbin, C., Egerter, S., Williams, D. R., & Pamuk, E. (2010). Socioeconomic disparities in health in the United States: What the patterns tell us. American Public Health Association, 100(Suppl 1), S186–S196. 46. Marshall, H. R., & Magruder, L. (1960). Relations between parent money education practices and children’s knowledge and use of money. Child Development, 31, 253–284. 47. Moschis GP. (1985). The role of family communication in consumer socialization of children and adolescents. The Journal of Consumer Research, 11, 898–913. 48. Pritchard, M. E., Myers, B. K., & Cassidy, D. J. (1989). Factors associated with adolescent savings and spending patterns. Adolescence, 24, 711–723. 49. Danes, S. M. (1994). Parental perception of children’s financial socialization. Financial Counseling and Planning, 5, 127–146.

123