A life-course perspective on legal status stratification and health.

Scholars have expressed growing interest in the relationship between legal status stratification and health. Nevertheless, the extant research often lacks theoretical underpinnings. We propose the life-course perspective as a theoretical lens with which to understand relationships between legal status stratification and health outcomes. In particular, the life-course perspective guides researchers׳ attention to historical contexts that have produced differential social, political, and economic outcomes for immigrants based on legal status, and to the potentially long-term and intergenerational relationships between legal status stratification and health. We review four key dimensions of the life-course perspective and make recommendations for future directions in public health research on legal status and health.

Building Economic Security Today: making the health-wealth connection in Contra Costa county's maternal and child health programs.

In recent years, maternal and child health professionals have been seeking approaches to integrating the Life Course Perspective and social determinants of health into their work. In this article, we describe how community input, staff feedback, and evidence from the field that the connection between wealth and health should be addressed compelled the Contra Costa Family, Maternal and Child Health (FMCH) Programs Life Course Initiative to launch Building Economic Security Today (BEST). BEST utilizes innovative strategies to reduce inequities in health outcomes for low-income Contra Costa families by improving their financial security and stability. FMCH Programs' Women, Infants, and Children Program (WIC) conducted BEST financial education classes, and its Medically Vulnerable Infant Program (MVIP) instituted BEST financial assessments during public health nurse home visits. Educational and referral resources were also developed and distributed to all clients. The classes at WIC increased clients' awareness of financial issues and confidence that they could improve their financial situations. WIC clients and staff also gained knowledge about financial resources in the community. MVIP's financial assessments offered clients a new and needed perspective on their financial situations, as well as support around the financial and psychological stresses of caring for a child with special health care needs. BEST offered FMCH Programs staff opportunities to engage in non-traditional, cross-sector partnerships, and gain new knowledge and skills to address a pressing social determinant of health. We learned the value of flexible timelines, maintaining a long view for creating change, and challenging the traditional paradigm of maternal and child health.

Sexual abuse in childhood and adolescence and the risk of early pregnancy among women ages 18-22.

PURPOSE: This clinic- and community-based study of young women investigated the relationship between previous sexual abuse and early pregnancy, examining the effect of the developmental period in which sexual abuse occurred and type of sexual abuse, while also providing methodological advances in the assessment of distinctive sexual abuse and its sequelae. METHODS: Secondary data analysis using Cox proportional hazards models was conducted to determine the association between sexual abuse in childhood, in adolescence, or both, and risk of early pregnancy among 1,790 young women. In addition, this study examined the type of sexual abuse that occurred during each period. RESULTS: As compared with women with no history of sexual abuse, women who experienced sexual abuse only in childhood had a 20% greater hazard of pregnancy; women who experienced sexual abuse only in adolescence had a 30% greater hazard of pregnancy; and women who experienced sexual abuse in both childhood and adolescence had an 80% greater hazard of pregnancy. Across these periods, attempted rape and rape were associated with an increased hazard of pregnancy. The association between sexual abuse and pregnancy was mediated by age at first intercourse and moderated by a woman's education level. CONCLUSION: This study provides evidence that both the developmental timing and the type of sexual abuse contributes to an increased risk for early pregnancy. The study findings indicate that sexual abuse leads to an earlier age of first sexual intercourse, which in turn increases the likelihood of an early pregnancy. Women with higher educational attainment are less likely to experience early pregnancy as a result of abuse.