Handbook of Behavioral Medicine by A. Steptoe

Author:A. Steptoe
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

2 Life Course Epidemiology

A life course approach to epidemiology is concerned with the effects on health and health-related outcomes of biological (including genetic), environmental, and social exposures during gestation, childhood, adolescence, young adulthood, and across generations (Kuh et al, 2003). It specifically investigates how risk and protective factors across life act independently, cumulatively, and interactively. Much of the interest in life course epidemiology has centered on chronic diseases (Kuh and Ben-Shlomo, 2004a), such as coronary heart disease, diabetes, and cancer, but its concepts can also be used to understand health behaviors (Schooling and Kuh, 2002). The life course approach to health behaviors can address a range of questions that are highly pertinent to the development of health policy. Does childhood socioeconomic environment influence the consumption of excessive alcohol or binge drinking and is this modified by education and adult socioeconomic position? Could the link between adverse health behaviors and chronic diseases be due to a common set of factors that affect them both and if so when should one intervene, and what are the best ways of avoiding adverse health behaviors? Do the methods and cost-effectiveness of different interventions differ for children and adults? Would family-based interventions, aimed at preventing adverse health behaviors in all family members (adults and children), provide the most cost-effective means of preventing poor health behaviors and their health consequences (Lawlor and Mishra, 2009b), or should one go for a population approach that aims to shift the whole distribution of behaviors in a more favorable direction? (Rose, 1992).

At the heart of this life course perspective lies a unique theoretical framework that assumes and tests for a temporal ordering of exposure variables and their inter-relationships with the outcome measure, both directly and through intermediary (mediating or modifying) variables (Ben-Shlomo and Kuh, 2002; Kuh et al, 2003).

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