I am a quantitative sociologist and demographer that studies health and family disparities with particular attention to race, class, and gender differences as well as their intersections. My research is in medical sociology, biodemography, and population health and focuses on three overlapping thematic areas: 1) linking social inequities to health and family disparities; 2) understanding how social selection in empirical work can reproduce health and family inequalities; and 3) investigating life course health processes, particularly relating to maternal risk exposures and weathering.
Linking social inequities to the production of health and family disparities
Economic, social, and political systems of power underly observed race, class, and gender stratifications in health and family. My work documents whether and how these systems of power produce health and family inequalities through social relationships and contexts, the experience of discrimination, and the influence of gender roles.
Although social contextual disadvantage is associated with poor health outcomes, how it produces intersecting race, class, and gender inequalities in health is less clear. In “Do Intersecting Identities Structure Social Contexts to Influence Life Course Health? The Case of School Peer Economic Disadvantage and Obesity,” published in Social Science & Medicine, my coauthors and I build on an intersectionality framework to theorize that intersecting race, class, and gender identities determine one’s relative social position within meso-level social contexts (e.g., schools), which structures social relationships that affect health outcomes. To test this hypothesis, using data from the National Longitudinal Study of Adolescent to Adult Health, we examine how differences in grade-mate peer contextual disadvantage influence life course obesity for subgroups based on individual-level race, gender, and economic disadvantage. In accord with our hypothesis, we find dramatically diverging patterns of obesity in Black women compared to lower-income Black men through early to mid-adulthood.
In another study, I conceive of structural discrimination as inequitable access to resources and opportunities based on race, class, and/or gender within a social context. In “Structural Racism in School Contexts and Adolescent Depression: Development of New Indices for the National Longitudinal Study of Adolescent to Adult Health and Beyond”, published in Social Science and Medicine – Population Health, my co-authors and I contend that manifestations of structural racism can and should be measured in not only geographic contexts, but in social contexts, particularly as social contexts are important for understanding life course health. We develop a school-level structural racism index, aggregating indicators of Black-white inequality at the school level, and a contextual disadvantage index that captures average school disadvantage, for use with the National Longitudinal Study of Adolescent to Adult Health. The first measure seeks to understand within-school disparities in Black-white resources and opportunities, while the second measure captures, in part, socio-historic racism that has selected Black students into more disadvantage schools. Given that adolescence is a sensitive period in the development of depression, we then measure the association between adolescent depressive symptoms and each index, as well as the interaction of the indices. We find that each index is associated with more depressive symptoms in Black students than white students, and that the indices interact to increase depressive symptoms in Black students in low disadvantage schools.
Other work is informed by social stress theory, which predicts that social position is tied to health outcomes through differential exposure to chronic strains, such as discrimination and poverty. Research has demonstrated a negative relationship between interpersonal discrimination and health, but the effects of structural discrimination are understudied. To address this gap, my work advances the conceptualization of structural discrimination and measures its impacts. In an ongoing sole-authored project, “Consequences of Medical Labels for Mothers and Infants: Structural Stigmatization or Beneficial Treatments?”, I build on modified labeling theory to ask whether medical guidelines are used to ‘other’ and discriminate against pregnant women labeled as obese. Then, I consider the interaction of obesity discrimination and racial discrimination. Employing a quasi-experimental design, I isolate the effects of an obesity label from the effects of body mass index. Using birth record data from the National Vital Statistics System, I find that infants born to Black women labeled as obese are at decreased risk of low birth weight and prematurity compared to Black women not labeled as obese while effects are null for infants born to white women. Results indicate that positive effects of the guideline outweigh discrimination from obesity labels. However, the positive disparate impact for Black women indicates that obesity labels may reduce discrimination these women experience in other areas of the health system.
In another strand of work, I use a gender perspective to consider the consequences of the devaluation of women’s autonomy and work roles for health and family outcomes. In an ongoing sole-authored project, “Breastfeeding Promotion Programs as Intensive Parenting Treatments: Impacts on Class Convergence in Parenting Style, Child Development, and Maternal Mental Health,” I investigate whether hospital breastfeeding promotion programs uphold gender norms devaluing mothers’ autonomy, unpaid labor, and mental health in relation to her children’s potential health and achievement outcomes. Linking data from the Maternal Practices in Infant Nutrition and Care (mPINC) survey with data from the National Survey of Children’s Health (NSCH), I examine the implications of hospital breastfeeding policies for mothers’ intensive parenting behaviors, maternal mental health, and child health and academic achievement.
With women’s work roles undervalued, there also has been little accounting of unpaid care work for women and men across the life span, despite that the burden of care is a growing concern in aging societies. In “Care Life Expectancy: Gender and Unpaid Work in the Context of Population Aging” published in Population Research & Policy Review, my co-author and I examine gendered patterns of unpaid care work across European countries. Using demographic life expectancy methods and data from the European Social Survey and the Human Mortality Database, we find that at age 15, women are expected to spend 6 more years of remaining life in a caregiving role than men, and that in social contexts with less generous welfare regimes and less egalitarian gender ideologies women disproportionately engage in high-level caregiving. Future work will continue integrating gender perspectives into demographic analysis of population processes.
The reproduction of health and family inequalities through empirical work
Fundamental cause theory suggests that social gradients in fundamental causes, such as racism and economic capital, affect health outcomes through various proximate determinants. Inadequate control of fundamental causes places scholars at risk of over-estimating the effects of proximate determinants, such as individual behaviors, on health outcomes. I am currently working on a sole-authored theoretical project, “Super-Structural Discrimination in the Generation of Health Inequalities”, in which I examine how evidence that ignores social selection mechanisms acts as a form of super-structural discrimination when it informs systemic policies, practices, and guidelines, as it embeds structural discrimination within them. These policies, practices, and guidelines are then used to justify cascading forms of discrimination, such as interpersonal and personal discrimination, by placing responsibility for systemic inequalities at the individual level. These forms of discrimination can then affect health, reproducing inequalities.
This project is partly inspired by past work that investigates the mechanisms that select women into nonmarital and teen fertility and differentiates them from the causal effects of these fertility types. In “Nonmarital and Teen Fertility” published in The Oxford Handbook of Women and the Economy, my coauthor and I describe patterns in nonmarital fertility and teen fertility, highlighting the role of socioeconomic disadvantage as a selection mechanism into marriage and teen childbearing. We then review the evidence linking nonmarital fertility to parent and child outcomes and find that causal designs controlling for selection into marriage substantially reduce previously established positive associations, making relationships less clear. More broadly, policies and norms that have promoted delayed, marital fertility have resulted in the stigmatization of teen and unmarried mothers, the effects of which are not fully understood.
Investigation the role of maternal risk exposures on life course health processes
My work also focuses on children’s life course health processes, particularly relating to maternal risk exposures. The ‘developmental origins of health and disease’ hypothesis proposes that the perinatal period is a critical developmental period when exposure to risk factors can change infant developmental trajectories with consequences for children’s short- and long-term health outcomes. However, empirical challenges, such as accurate control of mechanisms of social selection exposing some mothers to more risk than others, make identifying the relationship between any single causative factor and outcome difficult. One maternal exposure associated with poor child health outcomes is Cesarean section. To address challenges of social selection in prior work, I led a paper, “Caesarean Section and Children’s Health: A Quasi-Experimental Design,” published in Population Studies, in which my coauthor and I employ a quasi-experimental method to measure the effect of C-section on children’s asthma, eczema, and food allergy. Using a biosocial perspective, we consider how changes in C-section rates relate to changes in the infant gut microbiome to influence children’s health. We find that idiosyncratic increases in C-section rates significantly predict increases in food allergy in children.
Other work on maternal risk factors focuses on maternal weathering. The weathering hypothesis suggests that exposures to social risks, such as socioeconomic disadvantage and racism, can accumulate and contribute to deteriorating health in early adulthood, particularly among minoritized groups. Weathering in mothers can increase pregnancy-related risks and children’s subsequent life course health. In another study, “Racial Inequalities in Low Birth Weight among College-educated Mothers in the United States: The Role of Life-course SESD”, my coauthors and I investigate the relationship between early life maternal disadvantage and birth weight across maternal ages for Black and white infants, hypothesizing that weathering contributes to differential infant outcomes. We find evidence that among Black college-educated mothers, increases in maternal early life disadvantage contribute to declining birth weight patterns across maternal ages.