Children growing up in low-income households are at a disadvantage by almost every social and economic measure, compared with their higher-income peers: Lower-caliber schools, unsafe neighborhoods, higher rates of teen pregnancy and drug use, and more.
And, cruelly, if low-income kids overcome these hardships, their health may worsen as a result. Research has shown that low-income black and Latino youth who triumph over adversity — graduating from college, landing high-paying jobs — are at a significantly higher risk for chronic illnesses like obesity, diabetes and heart disease.
Unwilling to accept that success in the face of long odds hurts your health, Northwestern researchers are illuminating a path out of poverty and poor health.
Simple interventions, Northwestern psychologists and developmental scientists have found, can help ameliorate some of the challenges faced by low-income households. These interventions do not require elaborate social reengineering or huge financial investment. Instead, they meet children and families where they are, while providing benefits that stay with them throughout their lives.
Starting before birth
Since the early days of his career, Northwestern psychology professor Greg Miller has been focused on the ways in which stress affects health. In recent years, he’s become increasingly interested in the impact of stress in the earliest days of life, even in utero.
Reaching beyond the conventional tools of his field, Miller and colleagues examined placentas of new mothers and found higher levels of inflammation in the placentas of women of lower socioeconomic status (SES). Inflammation restrains the flow of blood, oxygen and nutrients from mom to baby, and has been shown to impact birth weight and other developmental outcomes.
This research makes it clear that the stress and challenges of poverty can negatively impact the health of the next generation.
But now Miller, in collaboration with physicians Linda Ernst, Ann Borders and Amy Crockett, has found that a simple support group for expectant moms, called Centering Pregnancy, may be able to reduce those rates and facilitate safer, healthier pregnancies.
The support group brings eight to 10 pregnant women together for just an hour or two each week to discuss nutrition, child-rearing, stress management, and improving relationships with their health care teams.
“This intervention is really focused on women’s lifestyles and social relationships,” Miller says.
“It’s not some fancy new device or drug. It allows women to center their pregnancy and focus on themselves and their babies.”
While Miller plans to conduct more extensive research, the preliminary data on the intervention is very promising.
“With Centering Pregnancy, we compared the placentas of women who took part in the program with placentas of women who received standard, one-on-one prenatal care from a doctor,” Miller says. “And we found that the Centering Pregnancy group showed far less inflammation in the placenta. The inflammation we’d seen in earlier studies of placenta with low SES women just wasn't there.”
Forging bonds at an early age
But what happens when babies are born into challenging environments, rife with economic and social struggles? Miller and fellow Northwestern psychology professor Edith Chen are working on that too, and yet again, the intervention is not drug or a device.
“We’ve found in our research that high-quality social relationships actually have benefits for the health of low-income kids,” Chen says. “We’ve looked at the impact of mentorship, and also the impact of nurturing parents, and we see that lower-income children with these relationships are in better health.”
Miller and Chen, who together lead the Foundations of Health Research Center, focus specifically on cardiovascular health and asthma. In several studies, they found that one high-quality, supportive relationship — a teacher, a friend, a pastor, a mentor — can substantially reduce markers of cardiovascular risk among low-income youth.
“This research adds to studies we’ve done in multiple settings, across a wide range of health indicators, that show poverty and challenging neighborhoods and family circumstances don’t necessarily confine kids to having worse health outcomes,” Miller says. “A lot of that can be offset or buffered by high-quality relationships.”
Both Chen and Miller believe establishing mentorship programs in schools could provide these high-quality relationships. And as is the case with so many components of human development, the earlier those relationships can be formed, the better.
Supporting both parent and child
High-quality relationships may still be hard to come by for some kids. Enter Northwestern developmental psychologist Lindsay Chase-Lansdale and applied developmental scientist Terri Sabol, who showed that a unique and innovative training program can help both parents and children at the same time.
Chase-Lansdale and Sabol are studying a program called CareerAdvance®, which pairs education, job training and career-building programs for low-income parents with Head Start’s early childhood education services for their kids.
“In this research, we zeroed in on ways to improve parents’ human capital — education, income, employment — in order to improve outcomes for young children’s development,” says Sabol. “This is based on decades of research showing parents’ human capital is one of the biggest predictors of how well children fare.”
Their CareerAdvance® research is a three-year project, but Chase-Lansdale and Sabol are seeing promising results after just one year. Compared with a control group, parents in the program showed a greater commitment to work and career, and were more optimistic and confident in their ability to achieve their goals.
“The CareerAdvance® parents are doing much better than the comparison group,” Chase-Lansdale says.
“Almost 60 percent completed training in the health care sector and received a certificate within the first year, which is much higher than all national programs out there for low-income parents.”
The children in the program saw gains as well, in the form of higher Head Start attendance rates and reduced absenteeism. And interviews with children showed an additional qualitative impact on kids. Sabol says many kids whose parents were in CareerAdvance® understood why their parents were going to school and what the benefit would be.
“Kids were able to make connections, and they’d say, ‘My mom has to go to school to get a better job, and I also have to go to school to get a better job,’” Sabol says.
Chase-Lansdale and Sabol are now scaling up this two-generation project to include children not enrolled in Head Start. Chase-Lansdale hopes two-generation initiatives like this one can someday be as ubiquitous as universal pre-kindergarten.
“We have 50 years of data on the strong, positive impact of high-quality early childhood education,” Chase-Lansdale says. “That impact could be even stronger if, alongside those programs, parents also changed their educational trajectories.”
Sabol, who works with the Illinois Governor’s Office of Early Childhood Education, says components of CareerAdvance® can be deployed easily and quickly across the country.
“Not every program has to do what CareerAdvance® does,” she says. “There are lots of ways to support families. With this two-generation work, we are adding to the toolbox of services and programs that can best help families of all backgrounds.”