Cheri A. Pies is a Clinical Professor Emerita at the School of Public Health, at the University of California, Berkeley. Cheri A. Pies also served as the principal investigator of the Best Babies Zone Initiative, a place-based multi-sector approach to reducing infant mortality through community-driven transformation. As one of the pioneers in understanding social determinants of health, she has worked to address the ways in which social and economic disparities and inequities influence birth outcomes and generational health across the life course.
The Cheri Pies Award, in honor of Dr. Pies, is awarded to students who provide the best application of life course theory. This award has been provided yearly since 2017. This year's winners will share $10,400. Two recent MPH MCAH Graduates, Julia Hankin, MPH '23 and Christina Agostino, MPH '23, are two of the three award recipients this year. Learn more about life course theory and the work Julia and Christina will be doing below.
Please provide an overview of life course theory for those who may not be as familiar.
Life Course Theory combines the concepts of health equity and social determinants of health to look at health over a person’s lifespan as an integrated trajectory of growth and development rather than as a series of disconnected stages. From this perspective, health can be viewed as an outcome dependent on an individual’s exposure to their physical, economic, and cultural environment. Furthermore, Life Course Theory serves as the theoretical framework that enables us to understand why adult disease frequently originates early in life, positing that “a high burden of cumulative intrafamilial (child maltreatment, domestic violence, impaired caregiving) and other adversities (income and food insecurity) in childhood can have profound lifelong effects unless mitigated by protective factors within the family or community, or through specific interventions” (Szilagyi & Halfon, 2015). In other words, health is cumulative and longitudinal; experiences and exposures during critical and sensitive periods of human development (such as childhood and adolescence) drastically impact individual health outcomes throughout adulthood. Notably, utilizing a Life Course perspective allows the field of MCAH to work toward health equity; to create successful interventions, we must understand how “health disparities are created, exacerbated or mitigated, and reproduced across generations” (Braveman et al., 2015).
What will your respective projects focus on, and how can the life course theory be applied to your study populations?
Christina: This study will investigate factors associated with receiving mental health care among elementary school students who expressed interest in counseling or therapy and will provide findings on the gap in receipt of mental healthcare among young children. Previous research indicates that unaddressed childhood trauma and adversity, as well as unmet childhood mental health needs, are linked to chronic disease, poor academic achievement, and various adverse mental and physical health outcomes in both adolescence and adulthood. Childhood mental health interventions can mitigate downstream health disparities by quelling cycles of violence, trauma, and adversity that cyclically reproduce across generations. The National Alliance on Mental Illness reports that over half of all lifetime mental illnesses begin by age 14, yet there is an 11-year average delay in receiving mental healthcare. Furthermore, children aged 8-18 have the lowest rate of primary care utilization among Medi-Cal demographic groups. Current mental health social investments (such as the five-year, $4.4 billion California Children and Youth Behavioral Health Initiative) are frequently prioritized for middle and high school students. Our study seeks to amplify the voices of younger children and enable them to tell us what they need in terms of mental health support - information that is sparse and outdated in the literature. In 2021, the U.S. Surgeon General released an Advisory Report on the youth mental health crisis; In the face of today’s immense macrosocial stressors, we are at a pivotal moment to reimagine mental healthcare as a catalyst for resilient, healthy child developmental trajectories.
Julia: This study uses data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine intergenerational associations between parental incarceration and parenting stress. An estimated 47-58% of state and federal prison inmates are parents to minor children, and almost 2.6 million children have an incarcerated parent. Parental stress has been linked to negative parenting characteristics, including low levels of parental warmth, harsh discipline, and potential child neglect/abuse. High levels of parental stress can also impact a child’s socio-affective and cognitive development. Despite the robust literature on the detrimental impacts of parental stress, there is limited research on the intergenerational impact of parental incarceration on parenting attitudes and stressors. Life Course Theory offers valuable insight into the public health impacts of incarceration and can inform policies that better address the needs of individuals, families, and communities. One of the central concepts of life course theory, the cumulative pathways model, posits that chronic stress, including both biological and psychological stress, create “wear and tear” to the body’s allostatic systems and contribute to declines in health over time. The additional stress of exposure to incarceration can accelerate allostatic load and further exacerbate health inequities. Additionally, having an incarcerated parent in childhood has been linked to increased allostatic load (the cumulative effect of repeated or chronic stress) in adulthood. It is critical to use a life course perspective when measuring the impact of incarceration beyond the individual level.
What tools/skills did you gain as a student of the Berkeley MCAH program that has prepared you for these projects?
Christina: The UC Berkeley MCAH program has provided me with an invaluable skillset to engage in epidemiological research and social policy evaluation. The program emphasized rigorous training in research methods and biostatistics, teaching me how to design studies, collect and analyze data, interpret results, and draw meaningful conclusions with relevant policy applications to serve MCAH populations. All students in the MCAH program develop proficient statistical software skills, enabling us to handle large datasets, build robust models, and test associations. Students also learn to present their research through oral presentations, scientific writing, and data visualization. As a student, I developed a very strong understanding of MCAH history, policy, theory, and practice. The Maternal, Child, and Adolescent Health Foundations Class (PH210) was a wonderful environment to apply my background in economics and social policy to MCAH populations. Lastly and perhaps most importantly, the Berkeley MCAH program taught me how to communicate complex epidemiological research to diverse audiences, including policymakers, healthcare professionals, and the general public, with the overarching goal of promoting social justice and advancing health equity.
Julia: The UC Berkeley MCAH program has been an integral part of my development as an emerging public health practitioner. The Maternal, Child, and Adolescent Health Journal Club (PBHLTH 210J) was an incredibly helpful environment to learn how to critically review peer-reviewed articles in the field of MCAH and gain a deeper understanding of research design, data analysis techniques, and how to present study findings. This course deepened my understanding of the concepts taught in Epidemiology and Biostatistics and allowed me to apply them in a practical setting, in a safe and supportive environment. In the second year of the program, the year-long Practicum in MCH Data Analysis course gave me the opportunity, skills, and mentorship to conduct my own research. Truth be told, I was initially intimidated by the idea of completing a capstone project, because I did not have robust quantitative research skills prior to starting the Berkeley MCAH program. But with the guidance of the MCAH faculty and program staff, I learned the practical skills of developing a research question, finding a dataset, managing and analyzing data, and communicating the results to a diverse audience. I know that wherever I go in the field, I will apply the public health knowledge and leadership skills I gained in the MCAH program.
Please share anything else you would like people to know.
Christina: Research has proven that expanding resources for children, especially during the first five years of life, is significantly associated with improved health outcomes and economic opportunities in adulthood. Yet, as a country, we only invest about 0.6% of our GDP on children and family-specific spending, pointedly less than other comparable OECD countries. Upstream approaches aimed at ensuring children, adolescents, and families have access to food, housing, mental and physical healthcare, income support, and quality education and job opportunities are gravely needed to address growing socioeconomic inequalities in the U.S. Future research should aim to support innovative program and policy approaches grounded in Life Course Theory to promote the health of our youngest populations more equitably and effectively over the trajectory of not only their lives but also the future lives of their families and communities.
Julia: The U.S. has experienced a 500% increase in jail and prison populations over the last 40 years, with a disproportionate burden on people of color. The war on drugs and the rise of the Prison Industrial Complex, which became a “catch-all” solution to social and economic problems, led to divestment in public services. As a result, the public safety net has failed to help millions of people stabilize lives made precarious by racism and trauma. I am deeply concerned by the impact of mass incarceration on maternal, child, and adolescent health, and community health more broadly. More attention to this population is urgently needed from advocacy groups, public health researchers, and policymakers.
Check out these additional posts about Dr. Pies and the award given in her honor:
Cheri Pies: A beloved mentor and national leader in women’s health and social justice