Research Approaches

Working Together to Improve Life Course Health

We are finishing up our deep dive into HRSA/MCHB’s strategic paradigm “Accelerate Upstream Together” by exploring how LCIRN researchers are working together to improve long-term health trajectories. Finding new ways to work together means exploring new approaches to working across disciplines, adopting new collaborative ways of working with family, community and youth as equal research partners, and ensuring that groups historically under-represented in research are now integral partners in collaborative research efforts. None of these new ways of working together happens automatically- each takes a real commitment from network members to be willing to set aside old ways of doing things, embrace and try new models, adjust to more equitable and productive power dynamics, and share credit for achievements across whole teams and networks of partners. Here we highlight four ways in which the LCIRN is pursuing more effective ways of working together towards our goals.

1. Transdisciplinary teams are of increasing importance for conducting life course intervention research. Individual researchers are unlikely to possess all of the knowledge, tools skills, and relationships, required for carrying out complex and multi-faceted research, but teams can be thoughtfully built and managed to include a variety of skills and perspectives. This type of teamwork is integral to effective translational research, though it is not a straightforward process. Transdisciplinary work requires humility and willingness to listen respectfully and to learn from others who bring a different perspective to the discussion. Researchers bring both their learned and lived experience to the research effort in ways that can challenge traditional categorizations. Each of our nine LCIRN Nodes is made up of researchers and stakeholders from multiple disciplines.

Example: In the School Node, clinicians and educators work together to improve children’s health through the school environment. Everyone brings their own understanding of the context, the stages of development, sensitive periods and potential points for intervention, how to design an intervention that is feasible and sustainable, and how to measure success.

2. Engaging families and youth stakeholders in all aspects and phases of life course intervention research, from design through to dissemination. Partnering with youth, families, and communities focuses interventions on outcomes that are meaningful to the recipiences and increases the potential for impact and equity over the life course. There is a spectrum of models of engagement, ranging from more traditional methods such as focus groups and consultations, to models like youth-led participatory action research, in which members of the target community are also part of the research team.

Example: As part of a process to envision what transformational change would look like for the youth justice system, Liz Barnert and Laura Abrams conducted focus groups with adolescents impacted by the system, as well as other stakeholders who work with and in the youth justice system.

Example: Family Voices is a key partner for the LCIRN’s engagement. Through our Family and Community Engagement Core, they have consistently provided a family perspective to help the LCIRN Scholars to plan and conduct their pilot projects. This has led to significant refinements and improvement to the study plans and approaches, and to the design and content of study informational materials

3. Partnering with community organizations and programs helps to ensure that interventions are relevant, feasible, and potentially scalable for impact at a population health level.

Example: As part of their LCIRN-funded pilot project, Priyanka Fernandes and Denise Nunez partnered with the Jewels of Youth Foundation to organize a forum for providers and families of children with special health care needs during the early months of the COVID-19 pandemic. The partnership allowed them to interact with and gather further information from underserved families within the region, and led to the development of a virtual emergency preparedness kit tailored to these families and available in Spanish and English

4.  Collaborating across MCHB Research Networks brings together expertise, leverages previous research and resources, and encourages researchers working on similar topics from different perspectives to collaborate in new ways

Example: Marianne Pugatch conducted an LCIRN-funded pilot study testing a virtual behavioral intervention to reduce substance use in teens with ADHD. Dr. Pugatch collaborated with mentors from the Developmental Behavioral Pediatrics Network (DPBNet) and the Adolescent and Young Adult Health Research Network (AYAH-RN) as well as the LCIRN to design, implement, and evaluate this study. More details about Dr. Pugatch’s pilot and how it benefited from cross-network collaboration available HERE

Cross-Cutting Issues Resources

Family Matters

Graphic showing four families

by Shari Barkin and Sophia De Oliveira

Families matter. In fact, family health is the most proximal social determinant of health we have. While many measurement tools exist for individuals, it is just as critical to measure family functioning to capture context.  The Family Measurement Node, nested in the Life Course Intervention Research Network, conducted a scoping literature review to identify existing family functioning tools and innovative opportunities for further development. We created a matrix to identify these tools and, when available, a link to access them easily. The ultimate goal of the family measurement node is to consistently implement family measurement to pinpoint areas for intervention and inform policy.

We identified 40 tested family functioning tools and created a family measurement tool matrix. These tools assess different aspects of family functioning such as organizational processes, belief systems, and communication processes.  We encourage you to try it out and let us know how this helps you further your life course research intervention development and implementation, keeping family front and center.


Complex Systems

Book Review: The Ecology of Childhood: How our Changing World Threatens Children’s Rights

The Ecology of Childhood:  How our Changing World Threatens Children’s Rights

By Barbara Bennett Woodhouse 2020 New York University Press

Review by Shirley Russ

In her book The Ecology of Childhood, Barbara Bennett Woodhouse tells the compelling story of how she initially set out to conduct an ethnographic study comparing children’s well-being in the Cedar Key area of Florida, where there appear to be few social safety nets, and the village of Scanno in the Abruzzo Region of Italy, with its much more generous child welfare policies. However, the Great Recession in 2008 had major impacts on the lives of children in both regions, transforming her study from a comparison of policies to one which instead revealed the power of global forces to threaten the well-being of all children. The author lays out how the direct and indirect effects of the recession and subsequent reactions, including economic stimulus packages in the US, and strict austerity measures in Italy, had an immediate and lasting impact on children and their families, and brought home how closely the fortunes of different countries are tied together. In short, policies developed and enacted in the US affect children in the US, but also affect children in Italy.  Globalization is real and tangible and, Woodhouse argues, a force that must be addressed for children to thrive.

Woodhouse documents a detailed study of the microsystems – e.g. family and peer groups where children’s daily lives unfold; the mesosystems where the microsystems overlap and intersect – e.g. in faith-based schools in local communities; and the exosystems that encircle children’s worlds even though children do not enter them – e.g. parents work place, housing markets, demonstrating how forces in each of these systems impact children’s sense of identity and well-being. What she has to say is not encouraging, with a disturbing number of trends placing ever increasing pressures on the family unit and on children, including climate change, mass migration, job losses and the technological revolution to name but a few. 

The situation appears so acute, and so much at risk of entering a bigger downward spiral, that the author argues a global movement is urgently needed to safeguard children’s well-being. She views the most sensible place to start as the universal adoption of the UN Convention on the Rights of the Child, a Children’s Right treaty that has not currently been adopted by the US. Those who are hesitant about the UN Rights approach frequently cite concerns about the potential erosion of the role of the family as protector, provider and nurturer of children; while supporters of the approach emphasize the profound nature of the global changes occurring in society, and the potential threats to children that families alone would have little power to counteract. In this book, despite making a strong case, I do not think the author will quite succeed in either allaying the fears of the first group, or providing the second with a strong enough argument to win the day. For example, Italy has already adopted the UN Convention on Children’s Rights, but it is unclear what impact that might have had on their response to the great recession. However, she does provide excellent examples of the power of youth and children’s voices, and the need to have them heard and considered by decision-makers at all levels. 

The rights agenda is not all that Woodhouse has to offer. In her previous writings she has developed the idea of “ecogenerism,” a child-centered and environmentally-informed perspective on events. Its guiding philospophy regards a commitment to the welfare of future generations as the mark of a just and sustainable society. This leads on to proposals for a child-centered value system as a measure of how well a society is truly functioning.  Here, the author is on solid and familiar ground. In Chapter 5, she explores two current crises largely attributable to exosystemic factors: the sharp decline in birth rates in developed countries, and the migration of young people from rural to urban areas. Her arguments are well developed, balanced and compelling. Do we really want a future where young people are afraid to have children for fear of not being able to support them, or one where younger generations must leave behind older in search of ever-moving jobs and affordable housing, severing family and social ties in the process? These are real and immediate issues affecting almost all families worldwide, and the author’s sincerity in making the case for the need to address them urgently makes for particularly strong writing.  

Woodhouse’s ecogenerism idea resonates strongly with life course approaches to health development. Both are “future-leaning” in their orientation, arguing that investments early on pay dividends later in ways that are good not just for some but for the whole of society. As stewards of the environment, we must look to the future, considering not just the immediate impact of our actions, but the likely impact 10, 50 even 100 years from now. Children benefit from spending time in nature in ways that we are only beginning to fully understand, and one of the most powerful incentives for finding the best ways to interact with our environment is to leave behind a world where children can thrive. This “intergenerational perspective” has yet to permeate the political arena in a meaningful way, and this book goes a long way towards making the argument for an “ecogenerative” or “life course” lens to be applied to all contemporary decision-making.  

In the final chapter, Woodhouse returns to a “small is beautiful” approach, urging grassroots actions that incorporate the principles of children’s rights, advancing child-friendly communities, and building a world fit for children. This book has much to offer anyone interested in children’s rights, and an ecological approach to the study of children’s well-being. It is an excellent and informative resource for anyone studying – or teaching – on child development, and will be sure to spark much classroom debate.

Life Course Health Development Theory

World Report on Hearing draws on Life Course Health Development Model

By Shirley Russ, LCIRN Project Scientist, UCLA

On World Hearing Day, March 3rd 2021, the World Health Organization launched the World Report on Hearing[1]. The report draws on the work of the Life Course Health Development group to frame both the importance of hearing across the life course and recommendations for solutions to hearing challenges. [2],[3] Globally, over 430 million people experience significant hearing loss, with estimates suggesting that by 2050 up to 1 in 4 people could be affected.  Many of the causes leading to hearing loss are preventable, including up to 60% cases in children. Yet with timely and appropriate care there are now multiple potentially helpful adaptations, technologies and interventions that can ensure every individual can live their lives to the fullest. 1

The report aims to provide evidence-based guidelines to assist each country to incorporate ‘Integrated People-Centered Ear and Hearing Care (IPC- EHC)’ into their national health plans.  Further, it suggests a set of key H.E.A.R.I.N.G. interventions, comprising 

(1) Hearing screening at different stages in the life course; 

(2) Ear disease prevention and management; 

(3) Access to hearing technologies across the life course; and 

(4) Rehabilitation Services across the life course that can move each country towards the vision of hearing care for all. 

The report is divided into four sections: the first addresses hearing across the life course; the second ways to prevent and address hearing loss; the third access to care; and the fourth lays out a vision for the future. 1

The first section of the report gives a thorough and insightful analysis of the importance of hearing health, emphasizing that each individual has a unique hearing trajectory shaped by diverse influences including genetic characteristics, and biological, behavioral and environmental factors experienced over time.2,3,4  The course of the trajectory is determined in part by the causative and protective factors encountered, with some life stages having particular susceptibility to their effects. The Life Course Health Development Handbook,3 and the chapter on A Life Course Approach to Hearing Health2 provided a useful framework for this section. The report points out that adopting a life course health development approach highlights the preservation of hearing as an important public health goal, and that understanding the broad range of factors that can influence hearing trajectories suggests that there are multiple opportunities for intervention, in the form of prevention, identification, treatment and rehabilitation across the life course. With an aging population, these interventions will assume even greater priority in national health planning. [4]

The report is presented in a very readable format with helpful infographics, case studies, and key learnings. It provides a good example of life course health development theory starting to move into practice. Next steps will involve a strengthened research infrastructure to determine the best approaches to interventions across the life course, with an even greater emphasis on developing positive hearing health, and a greater role for people with hearing loss, families and communities in driving flexible service development and adaptations to hearing challenges.   

[1] World report on hearing. Geneva: World Health Organization; 2021. License: CC BY-NC-SA 3.0 IGO.   

[2] Russ SA TK, Halfon N, Davis A. A life course approach to hearing health. Handbook of life course health development. Springer, Cham; 2018. p.349–73.

[3] Halfon N FC, Lerner RM, Faustman EM. Handbook of life course health development. Springer, Cham; 2018.

[4] Davis A, McMahon CM, Pichora-Fuller KM, Russ S, Lin F, Olusanya BO, et al. Aging and hearing health: the life-course approach. Gerontologist. 2016;56 Suppl 2:S256–67.



Adolescence Research Approaches

Youth-Led Participatory Action Research

By Emily J. Ozer, UC Berkeley School of Public Health

What is Youth-Led Participatory Action Research (YPAR)?

YPAR is a social justice-focused approach for promoting social change and positive youth development in which youth conduct systematic research and actions to improve their schools, communities, and other systems (e.g. health, juvenile justice). YPAR entails an iterative process of research and action led by youth and guided by adult allies.  YPAR is an approach that transforms the power and process of research; it is not a specific research method YPAR studies can use quantitative and/or qualitative methods.

YPAR differs from forms of adult-led research that gather diverse forms of data from youth (or by youth) because in YPAR it is the youth who formulate the research questions and lead the process. Topics taken up by young people in YPAR projects range widely and include reforming school cultures, promoting environmental justice regarding pollution and pesticides, access to healthy foods, reduction in liquor stores, city planning, policing, and cyber-bullying (see links below for case examples).

YPAR is a form of Community-Based Participatory Research (CBPR), as it called in public health, with “global North” roots in social psychology (Kurt Lewin’s action research for organizational improvement) and “global South” roots in political movements for liberation and empowerment (e.g. Paulo Freire’s popular education models). 

Why does YPAR matter for life course intervention research?

When conducted with integrity, YPAR can:

(a) promote positive development for youth who participate in multiple key domains,

(b) help address inequities in youth-serving systems and organizations,

(c) strengthen the relevance of developmental science questions and validity of methods, and

(d) inform intervention design and evaluation.

One way that YPAR can enhance the validity and impact of life course research is by bringing the insider expertise of young people on sensitive topics to shaping the questions we ask, our sampling approaches, our methods, and our sharing-out of findings for impact on policies and systems.  It can also help transform traditional and highly problematic deficit-focused lenses for understanding the development of non-white young people, including the role of racism and other structural inequalities and forms of marginalization (and resistance) for youth of color, immigrant, and LGBTQ+ youth. 

Practitioners and families can also be engaged in forms of partnered or participatory research to bring their expertise. Fundamentally, YPAR raises key questions about who can create developmental science evidence. What is the potential role of young people in creating the evidence base for further research on themselves? 

Learn more (including case examples and curricula for online implementation): 

COVID-19 Well-Being

COVID-19 and Children’s Well-Being: a Rapid Research Agenda

In addition to the direct physical effects of COVID-19 infection, children and families potentially face acute and long-term threats to their health and well-being from the larger systemic and social disruptions resulting from society’s response to the pandemic. The secondary effects may not be easily measurable, but have the potential to run deep, with latent effects that may cause significant harm over the lifespan. 

Between July and September 2020, The Life Course Intervention Research Network (LCIRN) facilitated a series of four virtual meetings with 46 stakeholders from ten Maternal and Child Health Research Networks, covering a broad range of disciplines across academia, clinical practice, nonprofit organizations, and family advocacy groups. 

Using a life course health development (LCHD) framing, in which health is regarded as a dynamic process that develops over time, being influenced by a wide range of genetic, epigenetic, biological, psychological and social factors, operating at individual, family, community and global levels, the group focused on those aspects of the pandemic and our response to it that would have the greatest potential to impact the development of children’s well-being over the long-term.

The group explored threats and challenges to children’s well-being, such as school closures and reduced socialization with peers, as well as the opportunities and supports that had emerged during the pandemic response such as the widespread use of telehealth to support both physical and emotional well-being. Identified research priorities included the impacts of the pandemic on children’s mental health and potential interventions to address them; factors impacting individual and community-level resilience; and routes to mitigating disparities in the negative effects of the pandemic on children and families of color. 

The group recommended that all studies integrate an anti-racist research and intervention approach, engage youth and community members, adopt a strengths-based approach, and focus on health equity. The activation of new funding streams including supplemental funding   of existing studies to enable addition of COVID-related questions, and the timely provision of mini-grants could be used to address this agenda. Taking what we learn from studying the response to the pandemic, and using this knowledge to create a new developmental ecosystem for children could be transformative, acting as the catalyst for improvement in the developmental health trajectories of U.S. children throughout their life course.

Click the button below to download the full COVID-19 and Children’s Well-Being Short Report! 

Complex Systems Cross-Cutting Issues

Book review: Complex Systems and Population Health

Complex Systems and Population Health: A Primer

Yorghos Apostolopoulos, Kristen Hassmiller Lich, Michael Kenneth Lemke


Oxford University Press 2020

Very few books are truly revolutionary- but this might just be one of them. Released coincidentally, but perhaps tellingly, in the middle of the COVID-19 pandemic, the book proceeds to make the case for both the wisdom and necessity of applying complex systems thinking to any study of population health. As Sandro Galea, Professor of Public Health at Boston University, points out in his foreword, even a decade ago systems science and population health science were strangers, with the latter largely relying on reductionist analytic strategies to identify single causes and disease states. While this approach historically served medicine well in identifying, for example, the causative role of smoking in lung cancer, it has been much less useful in addressing the so-called “modern” health challenges such as obesity, mental health problems, and neurodevelopmental issues. In addition, it has done little to address stubbornly persistent health inequities in areas including infant mortality rates. What is needed now is a much deeper understanding of how some of the most intractable population health challenges of our time are embedded in, shaped by, and/or consist of complex systems, and a willingness to apply complex systems science approaches to solve them. This book is the first to response to that need.

Made up of five sections broadly addressing concepts, theory, research design, methodology and analytic techniques, the book aims to blend old, current and new thinking to move the population health field forward, and improve the health of all people as equitably and efficiently as possible. Chapter 3 by Scott Page and Jon Zelner is particularly strong, arguing that population health outcomes and disparities need to be understood as the products not of isolated complex systems, but as the end result of a complex adaptive system of systems (CASoS). Consequently, each system must be understood both in isolation and in terms of its interaction with other systems if we are to truly understand what is going on in producing the whole picture. Chapter 7 by Leah Frerichs and Natalie R. Smith addresses ways to design population health research so that it is grounded in this new complex systems science, while another particularly strong contribution by Michael Lemke in Chapter 8 introduces model thinking and formal modeling as a way to improve our mental models in population health research. In Chapter 12, Nathaniel Osgood makes the case for dynamic (simulation) models as a central tool in this “science of the whole”. These models express dynamic hypotheses about the underlying processes that are driving systems, and are particularly important for intervention science. They hold promise for understanding system vulnerabilities and leverage points, identifying areas where investments could secure the greatest improvements. Later chapters address agent-based modeling, hybrid simulation modeling, and microsiumulation models, and the tremendous potential they have to inform health policy.

At a time when we appear to be at a “tipping point” for solving the pressing health problems of our time this book provides a new perspective, along with new tools and techniques that together form a new paradigm that will allow us to “dig deeper,” expanding our understanding of the deep systemic drivers of modern health challenges. Despite its methodologic and analytic content this book is as advertised – a primer. It will be useful reading for academics wanting to incorporate systems science into their own work or into their student mentoring, for graduate students, public and population health and healthcare professionals from all disciplines, and policymakers. The book has few weaknesses, but it is text heavy with very few figures and diagrams. Greater attention to visual representations of modeling concepts and pictorial representations of system maps could add to the book’s appeal and might be useful for future editions. Regardless, this book is both welcome and timely, and is highly recommended for anyone with an interest in population health.

Shirley Ann Russ MD MPH

Consultant to LCIRN

Life Course Health Development Theory

Understanding the effects of COVID-19 through a life course lens

Life Course Health Development Theory Resources

Handbook of Life Course Health Development


This handbook synthesizes and analyzes the growing knowledge base on life course health development (LCHD) from the prenatal period through emerging adulthood, with implications for clinical practice and public health. It presents LCHD as an innovative field with a sound theoretical framework for understanding wellness and disease from a lifespan perspective, replacing previous medical, biopsychosocial, and early genomic models of health. Interdisciplinary chapters discuss major health concerns (diabetes, obesity), important less-studied conditions (hearing, kidney health), and large-scale issues (nutrition, adversity) from a lifespan viewpoint. In addition, chapters address methodological approaches and challenges by analyzing existing measures, studies, and surveys. The book concludes with the editors’ research agenda that proposes priorities for future LCHD research and its application to health care practice and health policy.

Topics featured in the Handbook include:
• The prenatal period and its effect on child obesity and metabolic outcomes.
• Pregnancy complications and their effect on women’s cardiovascular health.
• A multi-level approach for obesity prevention in children.
• Application of the LCHD framework to autism spectrum disorder.
• Socioeconomic disadvantage and its influence on health development across the lifespan.
• The importance of nutrition to optimal health development across the lifespan.

The Handbook of Life Course Health Development is a must-have resource for researchers, clinicians/professionals, and graduate students in developmental psychology/science; maternal and child health; social work; health economics; educational policy and politics; and medical law as well as many interrelated subdisciplines in psychology, medicine, public health, mental health, education, social welfare, economics, sociology, and law.