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Learn more about the Center for Child & Adolescent Health Research & Policy
Friday, April 15, 2011
I have coined the term, "the biology of social justice," to describe my research program(1). This research links social policy to psychological and physiological functioning by suggesting that the social structure created by our policies exerts direct physiological and psychological effects on health and wellbeing. An important part of my research agenda is assessing the impact of subjective social status on health. In the late 1990s, I developed and validated an instrument, the first of its kind, to assess subjective social status in adolescents(2). We have established that social status significantly impacts obesity, insulin resistance, and multiple related health effects in adolescents and have discovered psychological and biological pathways which underlie these effects. We have also uncovered key interactions between race and family socioeconomic status (SES) which shape 1) how adolescents experience stress, 2) how they perceive their SES, and 3) how these perceptions change over time.
In addition to my research on social inequalities in health, I have developed a second line of inquiry in relation to obesity, insulin resistance and cardiometabolic risk. I study these outcomes in relation to social inequalities in health. Over the past two decades, as the obesity epidemic has mounted, they have become an independent area of research interest for me. I was among the first pediatric investigators to study Metabolic Syndrome. My work has raised important questions about the stability of this construct in pediatrics and its clinical utility(3). A third line of research is based in the principles of community-based participatory research and the positive youth development framework(4). This line of research, which began three years ago, enables me to translate my research findings into practice to combat the obesity epidemic among disadvantaged youth in local communities and assess the impact of these interventions. My team worked in the Fitchburg, MA community to establish collaborative relationships with school and community members and identify health concerns in the community through youth focus groups and interviews with adult key stakeholders. With this knowledge, we recruited five high-school students to create a youth advocacy council.(See Figure) Youth advocates completed a 14 week curriculum that we developed. This curriculum includes leadership, advocacy, and obesity prevention training. After completion of the training, youth advocates brainstormed an advocacy project to improve the health of their community, and chose to advocate for banning trans fat in Fitchburg.
The youth advocacy council model impacts both the youth advocates and their community. In Fitchburg, community outcomes included banning trans fat in the Fitchburg school district, increasing community members' knowledge of their efforts and the dangers of trans fat through a local newspaper article, and connecting their board of health director with public health professionals in another community that recently banned trans fat. Youth outcomes included a program attendance rate of over 90 percent and the group increasing or maintaining developmental assets targeted by the program. These assets included accepting people who are different from me, helping to make my community a better place, developing good health habits, feeling encouraged to help others, trying to help solve social problems, and serving others in my community. The following student comments illustrate the enjoyment the students experienced while accomplishing these outcomes; "I liked the program, I made friends and I learned leadership skills that apply to my life today. My confidence in front of big audiences has improved and I learned a lot about health." "I actually eat mindfully thanks to this program. This program has informed me a lot in interesting ways. I play games with my friends based on the program and we have fun while learning and it's great." Over 700 contacts were made between community members and IPACE youth advocates and staff to accomplish these outcomes, demonstrating how essential it is to establish collaborative partnerships for productive community-based research.
MGHfC's new IPACE Program, which is part of the Center for Child and Adolescent Health Policy, continues this work. IPACE, or Intervention and Policy Advocacy for Changing Environments, conducts community-based research to further knowledge through community partnerships that promote health and sustainable, systemic change. IPACE programming aims to empower young people and bring their voices to the health policy table to be agents of change for themselves and their communities. The multidisciplinary IPACE staff has expertise in pediatrics, adolescent medicine, behavioral health, mental health, nutrition, physical activity, community health promotion, social policy, research and evaluation. We are now in the process of establishing new collaborative relationships in communities served by MGH's community programs and health centers. IPACE plans to bring community research methodologies that utilize the youth perspective to this work and to develop studies which will inform and improve community policies and programs to maximize the potential for healthy children, families, and communities.
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