Intro To BioSocial Medicine

Introduction to
Biosocial Medicine
Introduction to
Biosocial Medicine
The Social, Psychological, and
Biological Determinants of
Human Behavior and Well-Being
Donald A. Barr, MD, PhD
JOHNS HOPKINS UNIVERSITY PRESS

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Barr, Donald A., author.

Introduction to biosocial medicine : the social, psychological, and biological
determinants of human behavior and well-being / Donald A. Barr.
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Thus, the determinants of health are best conceptualized as
biosocial phenomena, in which health and disease emerge through
the interaction between biology and the social environment.
—Michael Westerhaus, Amy Finnegan, Mona Haidar,
Arthur Kleinman, Joia Mukherjee, and Paul Farmer, “The Necessity of
Social Medicine in Medical Education,” Academic Medicine, 2015
Contents
Preface xiii
chapter 1 • Understanding Human Behavior 1

The need to understand human behavior 1
What is behavior? 2
Well-being and the consequences of behavior 5
The impact of social inequality and social hierarchy on behavior 5
How cultural context affects behavior 6
Social group identity, status inequality, and behavior 7
Motivation as a key mediator of behavior 7
Personality: Who we are 8
Neural structure as a basis of behavior 8
Cognition: How we think and what we know 9
How social inequality and stressful childhood experiences impact
cognition, behavior, and well-being 9
Connecting the causes of early adversity to well-being over the life
course: Understanding the causal links and the interventions that
hold the most promise 10
c h a p t e r 2 • Behavior and Well-Being 11

Physical well-being 12
Physical well-being beyond life expectancy 18
Social well-being 22
Summary 25
c h a p t e r 3 • Inequality and Well-Being 28

Racial and ethnic inequality in health in association with
educational inequality 28
How does inequality in access to medical care affect health
inequality? 34
x Contents
The differing impact of low education and low income on the health
of minority groups 36
The origins and meanings of the concepts of race and ethnicity
in the United States 37
The changing demographics of the population in the
United States 39
The disparate impact of inequality on Hispanics and blacks 40
Summary 45
c h a p t e r 4 • Society, Culture, and Behavior 48

The impact of culture: The Cultural Cycle 48
Differing perspectives on the nature of social structure 50
The role of culture in influencing personality and behavior 51
Other contexts in which independence and
interdependence Clash! 54
Acculturation: When p
eople move across cultural boundaries 61
The role of social networks in affecting behavior 62
Summary 64
c h a p t e r 5 • Identity and Behavior 67

Social identity: Responding to the social group 67
Alternative forms of capital and their impacts on
social status 68
Questioning one’s identity in the context of cultural mismatch:
The case of FirstGen students entering college 69
The competition for status: Group identity, bias,
and stereotype threat 71
Attribution theory: Explaining why other p
eople act
the way they do 74
Letting the behavior of others guide our own:
The bystander effect 77
Social impact theory and social loafing 78
Summary 79
c h a p t e r 6 • Motivation and Behavior 82

The marshmallow experiment: How long will kids wait
for a treat? 82
The role of motivation in affecting behavior 84
The cognitive understanding of the self as a driver
of motivation 85
Contents xi
Time perspective and the Up Series children 89

Zimbardo and time perspective 90
Noncognitive aspects of motivation and Maslow’s hierarchy
of needs 93
Summary 95
c h a p t e r 7 • Personality, Behavior, and Well-Being 97

Sigmund Freud and the stages of psychosexual development 98
Erik Erikson and the stages of psychosocial development 101
Criticisms of the Freud/Piaget/Erikson perspectives on the stages
of development 103
Understanding adult personality traits using the “Big Five” 104
Scales of personality that go beyond the “Big Five” 107
Mental illness and disorders of personality 110
Summary 112
c h a p t e r 8 • The Brain and Behavior 115

The importance of communication between information sources:
On the Internet and in the human brain 116
The development of the human brain, from embryo to organ 121
The molecular biology of nerve conduction and
neuronal myelination 126
Transmission of a nerve impulse across the synapse 129
Brain systems for emotion and response to stress 130
Summary 132
c h a p t e r 9 • Cognition, Behavior, and Well-Being 134

The development of cognition 136
The development of language and reading ability as examples
of Piaget’s stages of development 138
Learning math in Piaget’s next stage 141
Memory and its role in cognition 143
Emotional stress as another source of long-term memory 148
Summary 149
c h a p t e r 1 0 • Social Inequality, Childhood Experiences,

and Behavior 151
Socioeconomic inequality and early school readiness 156
The impact of social disadvantage on adolescent development 164
xii Contents
The added impact of minority race 166

Adolescent educational attainment as reflecting parents’
educational attainment 168
Summary 170
c h a p t e r 1 1 • Understanding Well-Being and the Interventions

That Can Enhance It 173
Social inequalities in adult health 174
The early roots of adult health behaviors 175
Identifying and adopting interventions to improve adult health
through the reduction of adverse childhood experiences 179
The effects of early childhood intervention for children at risk
of ACEs 180
Home visitors and the Maternal, Infant, and Early Childhood Home
Visiting Program 183
Looking to the f uture 185
Index 189
Preface
F
or more than twenty years, I have been affiliated with the
Program in H uman Biology at Stanford University. I teach
undergraduate courses on health policy and health dispari-
ties and advise numerous undergraduates who are heading in
different professional directions, nearly all of whom want to fo-
cus their careers on improving h uman well-being.
The Program in Human Biology at Stanford was founded in
1971 by a team of scientists from a range of academic backgrounds,
including biology, genetics, psychology, sociology, pediatrics, and
psychiatry. The intent behind the creation of Human Biology as
Stanford’s first interdisciplinary program of studies available to
undergraduates is described in comments by Gordon Harrison of
the Ford Foundation, which provided an initial grant to establish
the Stanford program: “It is a rare sociologist t oday who has had
even one course in biology; it is still rarer for an economist or
political scientist. Study of the behavior of people has tradition-
ally been fragmented. Many biologists, meanwhile, have acted as
though evolution stopped at the lower primates” (Program in
Human Biology, p. 2). From its inception, the Program in H uman
Biology has combined the study of the biology of humans with
that of the social and psychological aspects of human behavior.
In doing so it has attempted to break down the intellectual bound-
aries that so often separate academic disciplines. It has since
grown to be one of the largest undergraduate majors at Stanford.
The intellectual home provided by Human Biology turned out
to be a good fit for me. I am that “rare sociologist who has ever
had a course in biology.” A fter earning my MD and practicing
medicine for fifteen years, I returned to Stanford and earned my
PhD in sociology in 1993. Since then I have focused my research,
writing, and teaching at the intersection of biological, social, and
behavioral sciences, emphasizing the importance of this interdis-
ciplinary approach as a preparation for a range of professional
careers having to do with human health and well-being.
xiii
xiv Preface
We know now that the founders of Human Biology were pre-

scient in their approach to learning. Research in the h uman ge-
nome has linked patterns of genetic variation to a range of h
uman
behavioral characteristics and health outcomes. In parallel, a
growing body of research has shown that factors in the social and
psychological environment of infants and children can change
the way in which genetic information is expressed, leading to
measurable differences in neural structure and physiologic func-
tioning that can last a lifetime. It seems an appropriate time to
offer a new text linking h uman behavior to h
uman well-being by
integrating a range of academic perspectives.
Two other developments, unrelated to each other, reinforce
the appropriateness of the timing for a new approach to teaching
about this topic. The first is the rapid movement at universities
such as Stanford to online learning and the various web-based
approaches to teaching associated with that movement. These in-
clude MOOCs (massive open online courses) as well as the flipped
classroom, “in which students absorb an instructor’s lecture in a
digital format as homework, freeing up class time for a focus on
applications, including emotion-provoking simulation exercises”
(Prober and Heath 2012, p. 1658).
If a lecture I give to my class changes little from year to year,
why not simply record the lecture and make it available online for
students to watch as their homework? We can then use classroom
time to engage in a discussion of the concepts and unanswered
questions raised in the online lecture and associated readings. As
Prober and Heath describe, with the flipped classroom, “teachers
would be able to actually teach, rather than merely make speeches.”
I hope to create a series of recorded lectures in which I cover
much of the material in this book, but from more of an analytic
and questioning perspective. If we are studying learned behavior
using a chapter from this text, in a web lecture I might discuss the
question of the extent to which “learning” actually involves changes
to brain structure, as compared to creating new patterns of mem-
ory that don’t alter brain structure. This will give us the opportu-
nity to discuss in class which perspective seems to be the most
consistent with available evidence and what types of new research
questions might need to be addressed to resolve any differences
in perspective. As others also develop web-based learning re-
sources that cover aspects of h uman behavior and human well-
being, I hope this text might provide a useful supplement to those
resources.
A second important development has been the decision by the
Association of American Medical Colleges (AAMC) to change the
format of the Medical College Admission Test (MCAT), required
Preface xv
of most applicants to medical school in the United States. The epi-

graph to this book is from a commentary published in 2015 in
the journal Academic Medicine by a group of national leaders in the
field of social medicine (Westerhaus et al. 2015). In their commen-
tary these authors argue that “medical education requires a com-
prehensive transformation to incorporate rigorous biosocial train-
ing to ensure that all future health professionals are equipped with
the knowledge and skills necessary to practice social medicine.”
With a growing recognition that physicians need to understand
the biosocial sciences b ehind human behavior in order to be ef-
fective practitioners, in 2015 the MCAT added a new test section
titled “The Psychological, Social, and Biological Foundations of
Behavior,” testing students’ competency in core aspects of bio-
social medicine.
The AAMC reported that in 2012, more than 45,000 individuals
applied to medical school in the United States. That number is
expected to grow in the future. Nearly all of these applicants will
be asked to develop an understanding of human behavior as part
of their undergraduate preparation. Undergraduate colleges and
universities, however, do not have consistent curricular offerings
in this area. Although it is not my intent to offer this book as a
simple “MCAT Prep” tool, I nonetheless want to provide an edu-
cational resource that will be useful for students looking to ac-
quire an understanding of the complex roots of human behavior.
I hope this book can contribute to this goal while maintaining a
level of scholarship appropriate for use in teaching at colleges and
universities.
References
Association of American Medical Colleges. US medical school applicants and
students 1982–1983 to 2011–2012, available at www.aamc.org/download
/153708/data /charts1982to2012.pdf, accessed 6/8/13.
Prober, C. G., & Heath, C. 2012. Lecture halls without lectures: A proposal for
medical education. New England Journal of Medicine 366: 1657–59.
Program in Human Biology, Stanford University. The first 30 years, available at
https://humbio.stanford.edu/sites/default/files/alumni_ /humbiohistory.pdf,
accessed 6/8/13.
Westerhaus, M., Finnegan, A., Haidar, M., Kleinman, A., Mukherjee, M., &
Farmer, P. 2015. The necessity of social medicine in medical education.
Academic Medicine. doi: 10.1097/ACM.
Introduction to
Biosocial Medicine
chapter
1 Understanding Human Behavior
I
t seems self- evident to suggest that human well- being is
closely tied to h
uman behavior. In order to improve well-being,
logic would suggest, we need simply to change unhealthy be
havior. Those who have worked in health care, in education, or
in similar fields for which improving well-being is the principal
professional goal will tell you that this is no s imple task.
It is often intensely frustrating to work with an individual
who is engaging in a behavior that directly harms that individu-
al’s own well-being. Cigarette smoking provides an example. For
decades, doctors and smokers alike have known of the direct
causal link between smoking, heart disease, lung cancer, and
emphysema—and yet, inciting a smoker to quit can be one of the
most difficult challenges a physician or other health professional
can confront.
“Behavior patterns represent the single most prominent do-
main of influence over health prospects in the United States.” These
were the words McGinnis and colleagues used in 2002 (p. 82) to
underscore just how necessary human behaviors are to well-being.
Building on McGinnis’s data, Schroeder (2007) estimated that of
the many deaths that occur prematurely in the United States,
40 percent are directly attributable to behavioral patterns, chief
among them smoking, obesity and inactivity, and alcohol use. As
Schroeder describes, “The single greatest opportunity to improve
health and reduce premature deaths lies in personal behavior”
(p. 1222).
The need to understand human behavior

If human well-being is linked inextricably to behavior, it becomes
essential for those who will spend their professional c areer work-
ing to improve well-being to gain a fundamental understanding
of just what behavior is in the human context and what factors
influence behavior. This book is written to enhance this under-
1
2 I n t r o d u c t i o n t o B i o s o ci a l M e d ici n e
standing. I intend the book to be used as part

What is behavior?
of a course at the college or university level to
provide students—both those with a clear pro- One way to answer this question is to look to a
fessional trajectory ahead of them and those dictionary for a definition of behavior. The Ox-
who h aven’t yet deci ded the direction their ford English Dictionary provides such a defini-
career will take—with an understanding of the tion as the “manner of conducting oneself in the
many d ifferent factors that can act singly or in external relations of life . . . The manner in which
concert to affect how p eople behave. a thing acts u nder specified conditions or circum-
Those who have spent time at a college or stances, or in relation to other things.” A some-
university are well aware that different academic what more vernacular definition is provided by
disciplines often adopt differing perspectives on Wikipedia, which describes behavior as “the re-
topics of common interest, such as human be sponse of the system or organism to various
havior. Psychology—defined by the American stimuli or inputs, whether internal or external,
Psychological Association as “the study of the conscious or subconscious, overt or covert, and
mind and behavior”—explores the development voluntary or involuntary.” Behavior, it seems, is
of the h uman mind from its biological roots how we act in response to external factors.
through birth, childhood, and adulthood. The Another way to understand the meaning of
work of psychologists overlaps with that of behavior is to move beyond formal definitions
sociologists, who define their field as engaged and instead to describe a range of different be-
in “the scientific study of society, including haviors common to humans. We can then con-
patterns of social relationships, social interac- sider what these various patterns of h uman
tion, and culture” (American Sociological As- responses and actions may have in common,
sociation). Clearly these broad social forces and in so d oing arrive at a more functional defi-
can have powerful influences on how individu- nition of ‘behavior.’
als behave. The first behavior I will consider is that de-
From a d ifferent perspective, though, one can scribed above: smoking cigarettes. As we know
argue that behavior only happens when nerves (or should know), “smoking causes lung cancer,
within the human brain respond to sensory in- heart disease, emphysema, and may complicate
put to initiate neural messages to the muscles pregnancy”—as stated in the warning promi-
and other organs that control human action. It nently displayed on packages of cigarettes sold in
is hard to argue with the assertion that, at its the United States, as required by federal law (US
very core, behavior is biological in nature. Code, Section 1333). This warning is intended to
I hope the reader will see that each of these target the individual about to light up a cigarette,
perspectives—the biological, the psychological, with the hopes of discouraging the smoker by
and the sociological—has value, but that none describing the proven health risk. This approach
can alone give us the full understanding of the seems to assume that the decision to smoke a
determinants of human behavior that we need in cigarette is made consciously by an individual
order to address behavior and its consequences after balancing risks and benefits. However, data
in a professional capacity. To understand behav in figure 1.1 convey a d ifferent message.
ior, we need to cross over traditional disciplin- The chart shows the percentage of US adults
ary boundaries, and view behavior as multifac- who were current smokers in 2011, sorted by
torial, with roots in the biology of neurons, the gender and educational attainment, as reported
human mind, and the influence of broad social by the federal government (US Centers for Dis-
forces on individual perceptions and responses. ease Control and Prevention 2012). There is a
This is the approach I take in this book. clear and continuous educational gradient in the
U n d e r s ta n d i n g H u m a n B e h av i o r 3
Men Women
35.0%
30.5%
30.0%
27.9%
25.0%
21.4%
20.5% 20.0%
20.0%
17.5%
15.0%
9.8%
10.0% 8.7%
5.2% 4.8%
5.0%
0.0%
Less than High school Associate’s Bachelor’s Graduate
high school diploma degree degree degree
Highest level of education completed
Figure 1.1. Percentage of Persons Age ≥18 Years Who Were Current Smokers,

2011. US Centers for Disease Control and Prevention, MMWR 2012: 61(44):889–94.
association between smoking prevalence and If education is so closely linked to behaviors

education, and a consistent gender difference. such as smoking that affect well-being, what
The more education one completes, the less might be the factors that affect education? As
likely one is to smoke. At all levels of education, with smoking, on the surface one’s behavior re-
women are less likely to smoke than men. garding education would seem to be based on
Most of the education reported in figure 1.1 choices made by the individual: Shall I work
is completed by the age of 25, yet the associa- hard in this class? Shall I do my homework?
tion between smoking and education persists Shall I study for the exam? Educational attain-
throughout the adult years. This association of ment, often measured as the number of years of
both education and gender with a behavior with schooling completed or the highest degree ob-
clear harm to well-being suggests that not all tained, has a powerful association with well-
behavior is simply the result of individual choice. being throughout life. Yet educational attainment
Given that “smoking and high blood pressure . . . does not follow a pattern suggestive of individ-
are responsible for the largest number of deaths ual choice as the driving force.
in the US” (Danaei et al. 2009, p. 1), it would ap- An excellent example of this is provided in
pear that behavior at the individual level is in- work done by Dubow and colleagues (2009).
fluenced by broader social forces and has pro- They used data from a study that followed chil-
found impacts on the overall well-being of our dren in a semirural area of New York state from
society. when the children w ere 8 years old until they
ere 48. They looked at a range of factors during

w stimuli? Moon and colleagues (2013) played re-
the subjects’ younger years that predicted the cordings of vowel sounds to newborns less than
level of education they had attained by age 48, two days old. Some of the sounds were taken
including things such as socioeconomic status, from the mother’s native language and some
childhood IQ, and childhood behavior. They from a nonnative language. The infants wore
found that the educational attainment of the pacifiers that sensed how often they sucked.
children’s parents when the children were The researchers found that infants sucked more
8 years old was one of the strongest predictors slowly in response to native sounds than to non-
of eventual educational attainment when the native ones, leading the authors to conclude that
children had grown to be 48 years old. “birth is not a benchmark that reflects a com-
An especially interesting aspect of this as- plete separation between the effects of nature
sociation is that it seemed to be indirect—that versus those of nurture . . . neonates’ perception
is, it happened in a two-step process. The prin- of speech sounds already reflects some degree of
cipal impact of the parents’ level of educational learning” (p. 159).
attainment at the time the child was 8 years old Looking across these various studies, and
was to affect the child’s educational aspirations using smoking as one example of h uman behav
as an adolescent: the higher the parents’ educa- ior, we see that
tion, the greater the adolescent’s aspirations to
succeed in his or her education. It was those • one’s propensity to smoke as an adult is
adolescent aspirations that seemed to drive the powerfully associated with one’s level of
child’s eventual educational attainment as an education;
adult. The home educational environment in • one’s level of education is associated with
which a child grows up seems to have powerful the strength of one’s educational aspirations
effects on that child’s aspiration for and success as an adolescent;
in educational attainment. • one’s educational aspirations as an adolescent
The work of Mischel and colleagues (1988) are associated with the level of education
suggests that a child’s perspective on attaining attained by one’s parents when one is an
educational success may be powerfully affected 8-year-old;
by psychological characteristics already in place • one’s educational attainment as an adoles-
at age 4. Mischel offered a group of 4-year-old cent is also associated with one’s ability as a
preschool children the alternatives of playing 4-year-old to delay gratification; and
patiently with toys for about fifteen minutes to • newborn infants display differential
attain a two-marshmallow reward, versus ask- patterns of sucking on a pacifier in response
ing for a one-marshmallow reward without hav- to sounds reminiscent of the mother’s voice,
ing to wait. Mischel then followed these children presumably heard while in utero.
into adolescence and found that those children
who as 4-year-olds chose to wait were, as ado- Each of these behaviors is a pattern of re-
lescents, “more academically and socially com- sponse to external stimuli. The stimulus may be
petent, verbally fluent, rational, attentive, plan- a cigarette waiting to be lit, a homework assign-
ful, and able to deal well with frustration and ment waiting to be completed, a parental atti-
stress” (p. 687). tude regarding the value of education, a choice
If 4-year-olds show differential patterns of re- between differential rewards, or simply a sound
sponse to external factors, will younger children one hears. Each behavior involves a stimulus
also do so? How about newborn infants? Might and a response, presumably mediated by our
they exhibit differential patterns of response to interpretation of the stimulus.
Based on these repeating patterns, I suggest it. Much of that quality of life is directly affected
that behavior has three core components: by our own patterns of behavior.
1. our perception of external stimuli;

The impact of social inequality and
2. our interpretation of those stimuli; and
social hierarchy on behavior (chapter 3)
3. our response to that interpretation.
One of the most powerful stressors a person
This is how I approach the concept of human can face, either as a child or as an adult, is social
behavior throughout this book. I have laid out inequality. Social inequality has been shown to
the chapters of the book accordingly. be associated with a range of behaviors that are
central to well-being. This chapter considers
the forms social inequality can take and the
Well-being and the consequences
ways these forms can overlap.
of behavior (chapter 2)
Central to our understanding of broader
Having laid out the steps of the behavioral social inequality is economic inequality. Being
process— perception, interpretation, and born into a low-income family exposes a child
response—I turn to the growing body of evi- to very real physical and environmental factors
dence that links behavior to many d ifferent that can be harmful to child development and
types of well-being. One way of viewing well- well-being. From air quality and housing qual-
being is from the perspective of life expec- ity to the quality of the local food environment,
tancy and the frequency of potentially prevent- those in a position of economic disadvantage
able deaths. Researchers have estimated that will often experience a disadvantaged physical
nearly half of preventable deaths are a direct environment as well.
consequence of specific behaviors, principal The social environment of economic inequal
among them smoking, diet, and alcohol abuse. ity can also have powerful effects. One’s posi-
In addition to the length of life, well-being tion on the economic hierarchy often conveys
also has a great deal to do with the quality of symbolic messages about one’s position in the
life. We will consider the growing evidence that hierarchy of social structure, with those lower
variations in one’s perceptions of well-being of- on the structural hierarchy having fewer op-
ten have psychological and linked b ehavioral portunities to raise their position.
roots. As with many physical behaviors, these Concurrent with economic inequality, most
perceptions are often strongly associated with socie ties also experience in equal
ity based on
one’s level of educational attainment. race or ethnicity. The racial or ethnic group with
Well-being also has to do with the strength which one identifies can have an im por
tant
of the personal and social connections we make influence on one’s perception of self. Our race
with others. Our cognition and our sense of self or ethnicity can also create powerful perceptions
will affect how we respond to others around us among others about who we are, how we are ex-
and in so d oing will help determine the level of pected to behave, and how we are to be treated
support we experience from others. The strength by others. This level of inequality can be based
of our social networks and social support have either on race or on ethnicity—two categories
repeatedly been shown to affect both physical that overlap yet have significant distinguishing
and psychological well-being. This is true both characteristics. I will describe race both as a bio-
for those in our family and those we interact logical concept and as a social construct.
with who are not. At its essence, well-being has There are fundamental shifts taking place in
to do with the quality of our life as we perceive the demographics of the US population. Many
among the growing number of Hispanics in

How cultural context affects
this country do not identify with a racial group
behavior (chapter 4)
separate from their Hispanic heritage. As per
US Census Bureau policies, Hispanic is consid- As we develop psychologically from birth, we
ered an ethnicity, while white, black, Asian, become aware of, interact with, and respond to
Native American, and Native Hawaiian are con- a growing network of other p eople. Assuming
sidered to be races. Accordingly, in using His- that our mother is our primary caregiver after
panic, I will mean someone of any race who is birth, she is often the first “other” we recognize.
also Hispanic. In addition, I refer to the US Cen- Gradually we come to recognize other family
sus category of “Black or African American” by members and begin to adapt both our sense of
the shortened term of black. When I use terms identity and our patterns of behavior to those
such as white and black, I refer to those who are around us. (For me as a young child, it didn’t
of the white or black race and are not Hispanic. take long to learn from my older brother that he
It is certainly possible for those who are His- was the big brother and I was the little brother,
panic also to have a racial identity. However, in and I was expected to behave accordingly.)
looking at the dynamics of the US population in As we grow and mature, our social environ-
terms of behavior and well-being, I find it most ment grows to include peers and o thers who
useful and informative to refer to Hispanics of make up our community, however we come to
any race as a single category. understand that concept. That sense of commu-
However race and ethnicity are defined, they nity may carry with it a clear sense of status
often lead to levels of social inequality that sub- ordering and of which groups are dominant. As
sume economic inequality as well as other forms part of our growing identification with a com-
of social disadvantage. The use of racial stereo munity, we may also begin to develop a sense of
types is a principal contributor to this inequal ethnicity and culture, both of which can carry
ity. These stereotypes are often invoked uncon- expectations of beliefs and behaviors. As we
sciously, e ither by a person of a majority racial mature we become aware that our family and
group interacting with a member of a racial mi- our community exist within the context of a
nority or by a member of a minority group him- broader society. We also become aware of the
self or herself when assessing self-efficacy or various and sometimes conflicting norms and
other similar characteristics. The combination behavioral expectations the broader social or-
of racial inequality and economic inequality der may apply.
can have profound adverse impacts both on be From this increasingly complex set of social
havior and on well-being, impacts that can per- influences, we adapt both our ways of thinking
sist across generations. and our sense of self. As we use our cognitive
Any discussion of inequality should also con- abilities and our personality to interpret the
sider gender inequality and the impacts it can things we see, hear, and otherwise perceive,
have on self-perception and behavior. Clearly, we adapt our behaviors so as to fit in to the so-
some aspects of gendered behavior are a result cial and cultural context in which we live—that
of biological differences between males and is, unless we become a nonconformist, reject-
females. Gendered aspects of one’s personality ing the dominant social and cultural norms
as well as learned behavior may, by contrast, and behaving based on our own, internalized
have little to do with biology and a great deal values. Such a response can often be perceived
to do with how we are treated by o thers. negatively by those around us; sometimes, how-
ever, it is instead perceived as innovative or cre-
ative and is received positively by o thers.
biological and psychological factors. Feeling

Social group identity, status inequality,
hungry— a process triggered by certain bio-
and behavior (chapter 5)
chemical messengers linking the digestive sys-
As children move into adolescence and adult- tem and the brain—gives us the message that
hood, they become increasingly aware of the at- we should find something to eat. Feeling cold—
titudes and behaviors of those immediately another biological process triggered by mes-
around them. While adolescents and young sages between sensors in the periphery of the
adults continue to perceive themselves to be part body and the thermostat situated in the hypo-
of a broad social or cultural group, they come thalamus of our brain—gives us the message to
increasingly to identify with a specific group or do something to get warmer. Perhaps we should
groups as well as identifying those groups of put on a sweater, or perhaps we should turn up
which they are not members. They will often the heat in our home. Feeling cold is the moti-
compare themselves to those around them vation for taking some action to get warmer.
based on their perceived level of capital, mea Sexual arousal in response to viewing some-
sured in economic, cultural, and social terms. one we perceive as attractive certainly has a
Sometimes people find themselves around power ful biological component, but that re-
others they don’t know. How a person responds sponse is mixed with concepts of appropriate
to an interaction with another person may de- and inappropriate behavior we have internal-
pend on how he or she explains to himself or ized from our social and cultural surroundings.
herself that individual’s motivations—even if Similarly, feeling angry and wanting to respond
that attribution proves not to be accurate. How accordingly reflects a motivation derived from
one perceives o thers can also affect how that our interpretation of what we have seen, heard,
individual responds to certain unexpected cir- or felt.
cumstances, such as another person’s need for One of the principal theories of how various
assistance. In a similar manner, in many West- factors affect our motivation and our responses
ern cultures, working on a task as a member of is provided by the concept of the “hierarchy of
a group, rather than as an individual, will often needs” proposed by psychologist Abraham
affect the level of effort one exerts, as compared Maslow (1943). According to this hierarchy, we
to the situation in which one works alone on respond first to core physiologic needs, such as
the task. Becoming aware of the ways in which hunger and the need for sleep. As we are able to
social context can influence behavior is espe- address basic needs, we move on to those on
cially important to our overall understanding of the next step of the hierarchy: feeling safe and
human behavior. feeling as though we belong in our family or so-
cial group. Eventually we move to what Maslow
referred to as “self-actualization”—working to
Motivation as a key mediator
fulfill our hopes and aspirations for a meaning-
ful life.
Once we have perceived the stimuli confront- As one might imagine, establishing and re-
ing us in our physical and social environment sponding to our own hierarchy involves nego-
and interpreted those stimuli in the context of tiating the ways f amily, peers, community, and
the ways we have learned to think and the per- society affect how we interpret our situation and
son whom we perceive ourselves to be, the next how we choose to respond. Often motivation
step is to decide how to act in response. Our becomes a question of meeting our own expec-
motivation is the link between perception and tations for ourselves versus meeting the expecta-
action. Motivation involves a complex array of tion o thers have placed upon us. A student might
know that his or her parents want him or her to provide o thers around us with a sense of who
be good at math and to go to a good college but we are and how we are likely to respond to
that he or she really loves music, especially the different circumstances.
way he or she feels when playing jazz. How We have come to recognize certain psycho-
does this student balance all of this in develop- logical characteristics as abnormal. I conclude
ing his or her own motives for action? An im this chapter with a description of some of the
portant part of these types of decisions has to most important types of psychological disor-
do with time perspective. Are we motivated to ders as well as a discussion of the extent to which
act for an immediate outcome, or are we instead these disorders may have a biological basis.
acting so as to attain a more distant outcome
some time in the future? As we will see, the mo-
Neural structure as a basis
tivation to succeed in school can be powerfully
affected by our time perspective.
In this chapter I describe, in terms easily under-
stood by nonneuroanatomists, the structure of
Personality: Who we are
the brain, the peripheral nervous system, and
(chapter 7)
the autonomic nervous system. Using the basic
As we grow as children and begin to recognize senses (vision, hearing, e tc.) as examples, I dis-
and respond to an increasingly complex array cuss how stimuli from the external environment
or patterns and relationships, we also begin to are conveyed to the brain. I then describe some
develop a sense of who we are as distinct from of the basic structures of the h uman brain and
those around us. We begin to develop a “person- how they are connected in ways that give us, as
ality.” Scientists have been studying the nature humans, our incredible capacities for things such
of h
uman personality for more than a c entury. as language, reading, m usic, and love.
At the turn of the 20th century, Sigmund Freud Next I address the issue of brain plasticity.
proposed his theory of psychosexual develop- Whereas many mammals are born with most of
ment, suggesting that we develop the core as- their neural connections intact, human infants
pects of our personality in early childhood need time to complete many of these connec-
and describing five specific stages of that devel- tions. A baby giraffe can get up and walk within
opment. By contrast, Erik Erikson described hours of birth—and a good thing it can, given
eight stages of personality development and sug- the proximity of predators. A h uman infant,
gested that the process continues throughout however, hasn’t completed this brain circuitry
our lives. yet—and a good thing it hasn’t, because if it
It seems clear that, whatever the timing and waited in utero for all these connections to ma-
staging, each of us develops certain key person- ture, its head would be so large it would never
ality characteristics. Some psychologists refer make it through the mother’s birth canal.
to “the Big Five,” describing p eople in terms of We have growing evidence that a child’s
five central characteristics: openness, conscien- brain is continuously making and remaking the
tiousness, extroversion, agreeableness, and nerve connections between its various parts.
neuroticism. D ifferent aspects of these charac- For example, learning to read requires develop-
teristics in d
ifferent combinations can provide ing connections between the parts of the brain
a sense of identity and can help us to prioritize that perceive vision and sound and the part of
our goals and select our actions. How we ex- the brain that recognizes words and gives them
press and act on these characteristics will also meaning. Children in different family or social
situations learn to read at different rates, imply-

How social inequality and stressful
ing that their brains’ nerve connections are de-
childhood experiences impact
veloping at different rates, often in response to
cognition, behavior, and well-being
external factors.
(chapter 10)
This brings us to the concept of epigenetics—
the potential for the environment external to the Recent science has demonstrated the extent to
human body to change the way h uman genetic which our perception of and response to stress
information is translated into human functions is a biological process that is central to our physi-
and capacities. This process is especially impor cal existence. In the same way that the hypothal-
tant in our understanding of the impacts of amus of our brain acts as a thermostat, directing
stressful environments on developing infants, the regulation of our body temperature, it also
impacts that can last a lifetime and lead to re- functions as our allostat, directing the regula-
duced well-being as an adult. tion of our physiologic response to stress.
A growing literature looking at infancy and
early childhood has provided strong evidence
Cognition: How we think and what we
that the neural and biochemical components of
know (chapter 9)
our response to stress are influenced by the qual-
Once we have gathered various sensory data ity of the physical and social environment in
into our brains, we need to connect the inputs which we are raised. Researchers have pointed
and link them up to previous experiences in to a “critical period” during the months follow-
order to give them meaning. That is, we need ing birth during which exposure to unusual
to interpret what we have sensed—we need to stress can permanently change the neural struc-
think about it. Much of the process of thinking ture of our stress response, such that throughout
involves finding images or other types of pat- childhood and perhaps adulthood we experi-
terns we have previously experienced and ence an exaggerated production of hormonal
which we remember. We give the new sensory stress responders such as epinephrine and cor-
input meaning by comparing it to what we have tisol. Chronically elevated levels of these stress
previously encountered. hormones can affect both our cognitive pro
For this thinking process to occur, we must cesses and our cardiovascular system in ways
learn to make sense of what we perceive. Of that are potentially harmful.
course, this process starts in childhood and con- Realizing that toxic levels of stress experi-
tinues throughout much of our life. Often re- enced in early childhood can result in both ab-
ferred to as a child’s “cognitive development”, the normal psychological responses and harmful
process actually begins in utero, as suggested by physiological responses underscores the impor-
the study of the sucking patterns of newborns tance of understanding ways of intervening for
described above. Not surprisingly, the f amily in children at risk so as to buffer the potentially
which one grows up as well as the social and cul- lifelong effect of a stressful home or social envi-
tural context in which the family lives will shape ronment. If education is a principal determinant
the meaning we give to the thoughts we have of whether one smokes cigarettes as an adult
when responding to input from our environment. and an exaggerated stress response can impede
Also not surprisingly, the meaning we give to children’s educational success, we may see im
these thoughts will have substantial impact on portant opportunities for early childhood inter-
the actions we take—or don’t take—in response vention to avert the adverse behavioral conse-
to what we have perceived. quences that follow from early life stressors.
Danaei, G., Ding, E. L., Mozaffarian, D., et al. 2009. The

Connecting the causes of early preventable causes of death in the United States:
adversity to well-being over the life Comparative risk assessment of dietary, lifestyle, and
course: Understanding the causal links metabolic risk factors. PLoS Medicine 6: e1000058.
and the interventions that hold the Dubow, E. F., Boxer, P., & Huesmann, L. R. 2009.
most promise (chapter 11) Long-term effects of parents’ education on children’s
educational and occupational success: Mediation by
In the final chapter I emphasize how the factors family interactions, child aggression, and teenage
discussed throughout the book, from neural aspirations. Merrill-Palmer Quarterly 55(3): 224–49.
Maslow, A. H. 1943. A theory of human motivation.
structure to perceptions of inequality and stress,
Psychological Review 50(4): 370–96.
continuously interact to affect the way people McGinnis, J. M., Williams-Russo, P., & Knickman, J. R.
think both about themselves and about the world 2002. The case for more active policy attention to
they live in. Behavior is the response to these per- health promotion. Health Affairs 21(2): 78–93.
ceptions and is heavily influenced by experiences Mischel, W., Shoda, Y., & Peake, P. K. 1988. The nature
during infancy and early childhood. For those of adolescent competencies predicted by preschool
delay of gratification. Journal of Personality and
who will work in fields that address the conse-
Social Psychology 54(4): 687–96.
quences of human behavior, gaining an under- Moon, C., Lagercrantz, H., & Kuhl, P. K. 2013. Language
standing of these many interacting factors and experienced in utero affects vowel perception after
forces will be an important guide to our own pro- birth: A two-country study. Acta Paediatrica 102:
fessional behavior as well as helping us to iden- 156–60.
Oxford Eng lish Dictionary online. Behavior, available at
tify those interventions that can have meaning-
www.oed.com/view/Entry/17197?redirectedFrom
ful, long-term impact on both the behavior and =behavior#eid, accessed 4/24/13.
the well-being of those with whom we work. Schroeder, S. A. 2007. We can do better: Improving the
health of the American p eople. New England Journal
References of Medicine 357(12): 1221–28.
American Psychological Association. How does the US Centers for Disease Control and Prevention. 2012.
APA define “psychology”?, available at www.apa.org Current cigarette smoking among adults—United
/support/about/apa/psychology.aspx#answer, States, 2011. Morbidity and Mortality Weekly Report
accessed 4/24/13. 61(44): 889–94.
American Sociological Association. What is sociology?, US Code, Section 1333: 15 U.S.C. §1333. Labeling;
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chapter
2 Behavior and Well-Being
A
s a first step toward gaining a deeper understanding of
the ways in which behavior affects well-being, we need
to delineate what we mean by well-being and how we can
evaluate the state of well-being of an individual, a social group, or
a society. One of the most common ways to approach well-being
is in relation to one’s health status, with health defined largely in
terms of the presence or absence of, as well as the impact of dis-
ease. Research in a range of contexts has demonstrated that, while
health status and well-being are certainly closely associated, they
are not synonymous. Well-being encompasses a range of factors
beyond the presence or absence of disease.
In the United States, the Centers for Disease Control and Pre-
vention (CDCP) is the principal federal agency charged with
tracking and reporting the well-being of the US population. In
doing this, CDCP has adopted a broad concept of well-being, stat-
ing that “There is no consensus around a single definition of well-
being, but there is general agreement that at minimum, well-being
includes the presence of positive emotions and moods (e.g., con-
tentment, happiness), the absence of negative emotions (e.g., de-
pression, anxiety), satisfaction with life, fulfillment and positive
functioning.” The CDCP goes on to enumerate different aspects
of well-being, including:
• physical well-being,
• development and activity,
• social well-being,
• emotional well-being,
• psychological well-being, and
• economic well-being.
Researchers have identified links between behavior and many of

these different approaches to well-being.
11
We should note that life expectancy is re-

Physical well-being
ported separately for boys and for girls, as girls
In comparing the health of societies or other live several years longer than boys on average.
social groups, one of the most frequently cited Part of the gender difference in life expectancy
measures is life expectancy. Life expectancy can be explained by the hormonal differences
can be measured at various times throughout that are a consequence of having either one X
the life span and addresses the question, “on chromosome and one Y chromosome (male sex)
average, how many additional years will a per- or two X chromosomes (female sex). An addi-
son who has reached a certain age live?” The tional part of the difference can be explained by
earliest measure is life expectancy at birth. As differing patterns of behavior that develop dur-
reported by the CDCP (2013d), in 2010, a male ing adolescence and early adulthood. For ex-
baby born in the United States could expect ample, in 2010 the age-adjusted death rate (per
to live 76.2 years on average, while a girl baby 100,000 population) from motor vehicle acci-
could expect to live an average of 81.0 years. dents was 16.2 for males and 6.5 for females. If
These data differ by the race or ethnicity of we look specifically at the motor vehicle death
the infant’s mother, as shown in figure 2.1. In- rate for those between 15 and 24 years of age,
fants born to white mothers can expect to live we see that the rate for men was 23.1, while that
several years longer on average than infants for women was 9.9 (CDCP 2013b). If instead we
born to black mothers. The longest life expec- look at deaths from narcotic drug overdoses for
tancy of all these groups, however, is for infants those between 25 and 34 years of age, we see a
born to Hispanic mothers. male death rate of 25.0 and a female death rate
Men Women
86
83.8
84
82 81.1
80
78.5
Life expectancy (years)
78 77.7
76.4
76
74
72 71.4
70
68
66
64
White Black Hispanic
Figure 2.1. Life Expectancy at Birth in the United States by Gender and

Race/Ethnicity, 2010. Data from US Centers for Disease Control and Prevention.
B e h av i o r a n d W e l l- B e i n g 1 3
of 11.9 (CDCP 2013a). These gender-based differ- mothers in Illinois who w ere born in the United
ences in death rates among young adults have States, black mothers in Illinois who w ere born
little to do with X versus Y chromosomes and in the United States had substantially higher
everything to do with gender-based differences rates of all these behavioral risk factors. Of note,
in behavior. the authors also found that black mothers who
had been born in Africa but had subsequently
moved to Illinois had behavioral risk profiles
Infant mortality as a consequence
that w ere largely comparable to those of the
of maternal behavior
white mothers as well as rates of low birth weight
An important contributor to observed differ- comparable to those of white mothers.
ences in life expectancy at birth is the rate at Sparks (2009) undertook a similar study, com-
which infants die before they reach the age of paring mothers of d ifferent racial groups in the
one year. Infant mortality rates are reported as factors associated with an increased risk of giv-
deaths per 1,000 live births. As chromosome- ing birth prematurely—also a major risk f actor
based sex differences have little impact on the for infant death. As with the study by David and
chances of death before age one, infant mortal- Collins, Sparks found that behavioral differences
ity rates usually are not reported based on the on the part of the mother, rather than the mo
sex of the baby. More typically, they are re- ther’s race or ethnicity, w ere the principal fac-
ported based on the demographic characteris- tors associated with premature birth. Principal
tics of the mother. among these at-risk behaviors w ere giving birth
In 2010 in the United States, the overall in- before age 20, not finishing high school, being
fant mortality rate was 6.1 (CDCP 2013c). This unmarried at the time of birth, and gaining ex-
rate varied substantially based on the race and cess weight during pregnancy. Based on these
ethnicity of the mother. The infant mortality findings, the author concluded “that pregnancy
rate for infants born to white mothers was 5.2, related behaviors are most important in offer-
while that for black mothers was 11.6—a black/ ing potential explanations into the racial/ethnic
white mortality ratio of 2.2:1. While overall in disparity observed in preterm births” (p. 1674).
fant mortality rates dropped substantially be- The CDCP has identified an additional risk
tween 1950 and 2010 for both white and black factor associated with adverse infant outcomes.
infants, the ratio has actually widened. In 1950, “Smoking during pregnancy causes additional
the black/white ratio was 1.6:1. health problems, including premature birth
To what extent do racial differences in infant (being born too early), certain birth defects, and
mortality reflect under lying differences in infant death.” A federal publication from 2001
maternal behavior? David and Collins (1997) ad- compared smoking rates among pregnant
dressed this issue in a study of the factors con- women and found that the highest rates w ere
tributing to an increased incidence of infants among Native American mothers and white
born to black mothers in Illinois being born at mothers (Mathews 2001). In 1999, 20 percent of
a low birth weight—one of the principal risk Native American and 15.7 percent of white
factors for infant death. They identified a series mothers smoked during pregnancy, as compared
of factors that put a mother at increased risk of to 9.1 percent of black mothers and 3.7 percent
having an infant with low birth weight. Princi- of Hispanic mothers. For both Native American
pal among these w ere giving birth before age 20, and white mothers, the highest rates of smok-
being unmarried at the time of birth, never ing during pregnancy were found in women age
having finished high school, and being late in 18–19. It seems clear that a w oman’s behaviors
obtaining prenatal care. Compared to white before becoming pregnant as well as during
pregnancy are a major contributor to the risk of (CDCP 2011). Once again, they reported data
infant death and other adverse outcomes. separately for men and w omen, also separating
each gender into groups based on the highest
level of education they had completed by the
Life expectancy at age 25
time they w ere 25. The results are shown in
Those who reach their 25th birthday no longer figure 2.2.
have to worry about the factors that cause death Once again we see a consistently greater life
during infancy and childhood. These young expectancy for women than for men at a com-
adults are, however, affected by the choices they parable level of education. We also see another
have made and the behaviors they have adopted consistent pattern: the higher the level of edu-
in the process of reaching adulthood. It is valu- cation one has completed by age 25, the longer
able to see how many additional years, on aver- one can expect to live beyond age 25. Approach-
age, 25-year-old men and w omen can expect to ing one’s investment in his or her education
live and then to ask how differences in life ex- as an important form of behavior, we can see a
pectancy might be associated with earlier pat- powerful influence of the behaviors one adopts
terns of behavior. during the school years on one’s subsequent
In 2011, the federal government reported on well-being, using length of life as our measure
life expectancy for those turning 25 in 2006 of well-being.
Men Women
70
60
60 57 58
56
52 52
Additional life expectancy (years)
51
50 47
40
30
20
10
0
No high school High school Some college, Bachelor’s
diploma graduate, but but no degree or
no college bachelor’s degree higher
Highest level of education completed by age 25
Figure 2.2. Life Expectancy in the United States at Age 25, by Gender and
Highest Level of Education, 2006. Data from US Centers for Disease Control
and Prevention, 2011.
at age 65 between those with the lowest levels

Life expectancy at 65
of education and those with the highest levels
Given the clear differences in life expectancy at has been reduced somewhat from its level at age
age 25, it is valuable to examine what factors 25, the disparity nonetheless continues to exist
might affect one’s life expectancy at an older for all groups studied. Educational attainment
age. Using data from federal databases for the as a form of behavior exhibited in childhood,
year 2008, Olshansky and colleagues (2012) cal- adolescence, and early adulthood has continuing
culated the life expectancy for vari ous age associations with well-being throughout the life
groups, broken down by gender, educational at- course.
tainment, race, and ethnicity. Figure 2.3 shows Since educational attainment is such a power
life expectancy for these groups at age 65. For ful predictor of life expectancy for all these gen-
all the groups shown, we see a similar pattern der and racial/ethnic groups, it seems pertinent
of growing life expectancy for those with pro- to ask how the groups differ by average levels of
gressively higher levels of education. Since at educational attainment. The US Census Bureau
age 65 these individuals will largely have com- (2012) reports educational attainment for different
pleted their education decades earlier, we see age groups and d ifferent racial and ethnic groups.
the continuing effect of educational choices Figure 2.4 shows the highest level of educa-
made decades earlier—typically in the adoles- tional attainment of 65-year-olds in the United
cent years. While the magnitude of the disparity States in 2012. Focusing on the two highest levels
No high school diploma High school diploma

Some college, no bachelor’s degree Bachelor’s degree or higher
25
20
Additional life expectancy (years)
15
10
0
White White Black Black Hispanic Hispanic
men women men women men women
Figure 2.3. Life Expectancy in the United States at Age 65 by Gender, Race/Ethnicity,

and Educational Attainment, 2008. Data from Olshansky et al. 2012.

Some college, no bachelor’s degree Bachelor’s degree or higher
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
White White Black Black Hispanic Hispanic
men women men women men women
Figure 2.4. Educational Attainment for Those Age 65–69, by Gender and Race/Ethnicity,
United States, 2012. Data from US Census Bureau.
shown— having completed some college, and Although we spend far more of our national
having completed a bachelor’s degree or higher— budget on health care than any of these indus-
we see a higher educational level for white trialized countries, the overall well-being of our
65-year-olds than for black 65-year-olds, with population, measured as life expectancy, ranks
Hispanics having the lowest level. While these toward the bottom. This brings up the question
racial and ethnic differences are substantial, we of what factors explain our relatively poor stand-
see only small differences by gender within each ing when compared to other countries.
racial/ethnic group. Since 1991 the World Health Organization
The data on life expectancy at birth and at (WHO) has conducted a series of studies evalu-
age 65 in the United States are more meaningful ating what they refer to as the Global Burden of
when they are placed in a broader context. The Disease. Murray and Lopez (2013) reported on
Organisation for Economic Co-operation and the findings of the report published by the
Development (OECD) tracks and reports a range WHO in 2010. The top six causes of death in the
of health data on its 34 member states (OECD United States included ischemic heart disease,
2013). When we compare the United States to all stroke, cancer of the lung and respiratory tract,
34 members of the OECD, including newer mem- dementia, chronic obstructive lung disease (a.k.a.
bers from former Eastern bloc countries, we emphysema), and diabetes.
find that, in 2011, we ranked 22nd in life expec- Murray and his colleagues on the US Burden
tancy at age 65 for males and 25th for females. of Disease group that collaborated in the WHO
report have published detailed data about the between certain behaviors and the likelihood of
principal causes of death in the United States, death, they determined that the a ctual causes of
the years of life lost to premature deaths that death, rather than the specific diseases leading
were potentially preventable, and the US rank- to death, were health behaviors that increased
ing on these indices (Murray et al. 2013). They the likelihood or severity of the disease. From
reported that the years of life lost in the United this analysis they w ere able to determine that
States to preventable deaths placed us 28th tobacco use and poor diet together accounted
among OECD countries when ranking coun- directly for 33 percent of all deaths and 69 percent
tries from the lowest to the highest preventable of potentially preventable deaths.
death rates. Only Poland, Slovakia, Estonia, The Institute of Medicine of the National
Hungary, Mexico, and Turkey had higher rates Academy of Sciences convened a national work-
of preventable deaths. shop to further explore the analyses of Mokdad
Murray and colleagues assessed the principal and colleagues. The intent of the workshop was
risk factors leading to this high rate of prema- to “enrich understanding of the contribution
ture, preventable deaths in the United States. The of lifestyle-related factors to preventable death
top six factors, in order of their association with and . . . the role of preventable death as a driving
premature death, w ere diet, tobacco use, high force in public health” (Institute of Medicine
blood pressure, high body mass index (i.e., obe- 2005, p. 2). At the conclusion of the workshop,
sity), physical inactivity, and elevated blood participants concurred on the importance of
sugar due to diabetes. The researchers identified behavioral factors in causing premature death
specific dietary risks associated with premature and as a consequence reducing life expectancy
deaths, in part icu lar “diets low in fruits, low in the United States. They also went a step fur-
in nuts and seeds, high in sodium [salt], high in ther, suggesting that the public health profes-
processed meats, low in vegetables, and high sionals and those responsible for setting policy
in trans fats” (p. 596). If, as described in chapter 1, “focus on lifestyle-related risks as a collective
behavior is a response to our perception and in- problem” and that they “reframe the debate to
terpretation of external stimuli, it would appear focus on the impact of proposed interventions
that these dietary patterns reflect unhealthy rather than risk factors” (p. 50).
behaviors. Do these dietary patterns reflect a This growing awareness of the policy impli-
conscious choice of less healthy food over more cations of health-related behaviors and their
healthy alternatives? The answer depends on consequence, and the need to intervene to pre-
the extent to which behavior reflects conscious vent these behaviors before they cause harm,
choice rather than learned patterns of response. underscore the importance of understanding
We explore these issues in more depth in later how patterns of h uman behavior develop. We
chapters. are again confronted by the issue of whether
Mokdad and colleagues (2004) undertook a behaviors such as smoking, diet, and exercise
similar study of the causes of death in the United represent conscious choices or learned patterns
States, examining the extent to which these w ere of response. Recall from figure 1.1 that the level
associated with behaviors that might be prevent- of education an individual attains is highly
able. They analyzed the leading causes of death predictive of his or her likelihood of becoming a
in 2000 in the United States and found that heart smoker as an adult. Similarly, data from the
disease, cancer, cerebrovascular disease such as CDCP have identified a significant inverse as-
stroke, and chronic lung disease accounted for sociation between level of education and preva-
65 percent of all deaths. When they used epide- lence of obesity among women, with less of an
miological data to evaluate the association association among men (Ogden et al. 2010). Shaw
Health behaviors such Reduced life

Educational
as smoking, diet, and expectancy and
attainment
lack of exercise premature death
Figure 2.5. Educational Attainment, Health Risk Behaviors, and Preventable

Deaths in the United States
and Spokane (2008) have also identified a direct rates of mortality. Another approach to physi-
association between level of educational attain- cal well-being considers the quality of the life
ment and level of physical activity as an adult, experience. Living ten years free of disabilities
with the differences in exercise between those can be a profoundly d ifferent experience than
with lower levels of education and those with living those same ten years with one or more
higher levels widening over time after about disabilities that impair one’s level of activity and
age 55. Thus, in understanding the causes of social interaction.
premature mortality in the United States, it ap- The World Health Organization has been
pears that a stepwise model of associations is working since 1990 to develop a standardized
most appropriate, as illustrated in figure 2.5. metric that reflects both the expected length of
Much of the cause of the poor levels of life life within a population group as well as the
expectancy relative to other developed coun- level of disability experienced by that group.
tries is attributable to three principal behaviors: In 1994, Murray reported on those efforts with
smoking, diet, and exercise. In turn, one’s level a technical description of a new metric, the
of these behaviors as an adult is consistently as- “disability-adjusted life year,” often referred to
sociated with the level of education one has at- as the DALY. Murray identified two principles on
tained by early adulthood. The relatively low which he based the development of this metric:
life expectancy at birth of infants born in the
United States is reflected in the strong subse- • any measure of health outcome should
quent association between educational attain- include consideration of the loss of welfare
ment at age 25 and additional life expectancy, as caused by a disability; and
illustrated in figure 2.2. Educational attainment • using time as a measure of the burden of
seems to reflect a form of behavior that is closely disease should include both this loss of
associated with other behaviors exhibited welfare as well as time lost to premature
throughout the life course. If behavior is a re- mortality.
sponse to the perception and interpretation
of stimuli from the environment, this raises the In order to combine the loss of welfare with
pressing question of what stimuli children and the premature loss of life, Murray identified six
adolescents are responding to when they adopt different levels of disability, described in table 2.1.
their own behavioral approaches to school and He assigned each of these a numerical weight,
other educational opportunities. based on the severity of the impact of the dis-
ability, with weights varying from 0.096 to 0.920.
By multiplying the years a person lives with a
Physical well-being beyond
disability by the decimal weight of the level of
life expectancy
disability experienced, it is possible to calculate
So far, we have been looking at physical well- the years of disability-free life lost as a conse-
being primarily in terms of life expectancy and quence of the disability. For example, living
T able 2 .1 . Definition and Weighting of Levels of Disability Used to

Calculate Disability-Adjusted Life Years
Disability class Disability weight Description of disability
1 .096 Limited ability to perform at least one activity in one of

the following areas: recreation, education, procreation,
or occupation
2 .220 Limited ability to perform most activities in one of the
following areas: recreation, education, procreation, or
occupation
3 .400 Limited ability to perform activities in two or more of the
occupation
4 .600 Limited ability to perform most activities in all of the
occupation
5 .810 Needs assistance with instrumental activities of daily
living such as meal preparation, shopping, or housework
6 .920 Needs assistance with activities of daily living such as
eating, personal hygiene, or toilet use
Source: Murray 2010.
10 years with a Class 4 disability, which carries One of the principal findings of the study
a weight of 0.600, would mean the loss of 6 of was the “relatively small changes in the number
those 10 years, referred to as the loss of 6 DALYs. of DALYs” lost globally between 1990 and 2010,
Thus, calculating the years of life lost to poten- “because the increase in the global population
tially preventable causes, DALYs account both has been largely balanced by a decrease in the
for the loss due to disability and the loss due to age-sex-specific DALY rates” (p. 2215). They also
premature death. found a substantial shift from loss due to pre-
In 2012, Murray et al. reported the findings of mature death to loss due to increasing rates of
the Global Burden of Disease (GBD) study from disability from mental illness and other forms
2010, a major international undertaking involving of chronic illness.
close to 500 researchers from 50 countries, repre- As part of this global focus on gaining a bet-
senting more than 300 academic and research ter understanding of population health, the
institutions. Extending work done in an initial CDCP has developed a metric called “active life
GBD study published in 1990, Murray described expectancy,” described as the “expected years
the 2010 GBD as “The only comprehensive effort free of chronic condition-induced activity limi-
to date to estimate summary measures of popula- tations” (Molla and Madans 2010, p. 2). Using
tion health for the world, by cause.” Consistent this metric, the authors assessed changes in the
with his 1994 work, “For a summary measure of United States between 2000 and 2006 in active
population health, the GBD study uses disability- life expectancy and found that it increased for
adjusted life years (DALYs), which are the sum of all population groups with the exception of
years of life lost due to premature mortality (YLL) those age 85 or older. They did note that, while
and years lived with disability (YLD).” (p. 2198) active life expectancy at ages 25, 45, and 65 had
increased for both blacks and whites, the black/ The report went on to examine the associa-
white disparity remained largely unchanged at tion between certain behavioral risk factors
all ages. and the level of disability experienced. Consis-
In 2013 Molla published an updated assess- tent with the associations described above be-
ment of health in the United States as part of a tween behavior and life expectancy, the report
broader Health Disparities and Inequalities identified clear associations between behavior
Report published by the CDCP (Meyer et al. and disability, with:
2013). He again documented continuing improve-
ments in expected years of life free of activity • “adults with disabilities less likely to be of
limitations but noted continuing disparities be- healthy weight and more likely to be obese
tween blacks and whites in these measures. This than adults without disability” (p. 34);
finding is part of the more general identification • “adults with disabilities more likely to be
by the report of “persistent disparities between current smokers than adults with no
some population groups in health outcomes, ac- disability” (p. 37); and
cess to health care, adoption of health promot- • “adults with all the types of disability
ing behaviors, and exposure to health-promoting measured here less likely to participate in
environments” (Meyer et al. 2013, p. 184). regular leisure-time physical activity than
An earlier report by the CDCP (2008a) looked adults with no disability” (p. 38).
specifically at which forms of disability most
affected healthy life expectancy and examined Muennig et al. (2010) reported a similar analy
the behavioral factors associated with those sis in which they examined the association
disabilities. In this analysis, it differentiated be- between certain behaviors, quality of life, and
tween “basic actions difficulty,” described as length of life using a measure referred to as the
“limitations or difficulties in movement and “quality-adjusted life year” (QALY), calculated
sensory, emotional, or m ental functioning that in a manner quite similar to the DALY. As
are associated with some health problem,” and shown in table 2.2, they found that living with
“complex activity limitation,” described as “lim- an income less than twice the federal poverty
itations or restrictions in a person’s ability to level and never having finished high school
participate fully in social role activities such as were the strongest demographic predictors of
working or maintaining a household” (p. 5). reduced life expectancy measured in QALYs,
For the period 2001–2005, the prevalence of while smoking and obesity w ere the principal
basic actions difficulty among adults aged 18 behavioral factors.
or older was 29.5 percent while the prevalence Rather than using broad demographic data
of complex activity limitations was 14.3 percent. to quantify the effects of behaviors and demo-
Approximately one-third of both types of limi- graphic characteristics on the length of life ad-
tations w ere found in adults aged 65 years or justed for quality of life, a number of research-
older, with the balance in those younger than ers have used a far simpler approach to assessing
65. Looking at the association between educa- the health status of individuals. They ask indi-
tion and level of disability, the highest rates of viduals how they would describe their own
disability w ere seen in those who either had health, using the categories of excellent, very
not finished high school or who had graduated good, good, fair, or poor. It turns out that this
from high school but not pursued further edu- simple measure can provide valuable and accu-
cation, with the lowest rates among those who rate information about an individual’s overall
had graduated from college. health.
T able 2.2. Mean Quality-Adjusted racial and ethnic groups, they reported that
Life Years (QALYs) Lost between Ages 18 “adults with a disability w ere less likely to re-
and 85 in Association with Behaviors port excellent or very good health (27.2 percent
and Demographic Characteristics
versus 60.2 percent; p < 0.01) and more likely to
Risk factor QALYs lost report fair or poor health (40.3 percent versus
9.9 percent; p < 0.01)” (p. 1070). They also found
Smoking 6.6
that Hispanics and American Indian/Alaska Na-
Obesity 4.2 tives reported the highest rates of fair or poor
Binge drinking 1.2 health, with whites and Asians reporting the
Education (not finishing high 5.1 lowest.
school as compared to high Zajacova et al. (2012) evaluated the associa-
school graduation or more) tion between the level of educational attain-
Poverty (income less than twice 6.4 ment and self-rated health status, using data
the federal poverty level, after gathered as part of a nationally representative
adjusting for education) study of more than 178,000 working-age adults
Race (black as compared to 1.7 in the United States. Using the same five-category
white, after adjusting for measure of self-rated health, they found that
education) “health is strongly related to education for all
Source: Muennig et al. 2010. levels of educational attainment. Each addi-
tional credential or educational level is associ-
ated with significantly better health, from high
This was the measure used by Lee et al. school graduation all the way up through the
(2007) in their study of more than 16,000 adults professional and doctoral degrees” (p. 55). In
aged 50 or greater. In 1998 they evaluated the looking for other factors that would affect
self-rated health of each subject using this scale, this education/health gradient, they found two
and then they followed the subjects for four with significant associations: economic indica-
years to measure the age-adjusted death rate of tors (employment status and family income)
different racial groups. For both black and
and health behaviors (smoking, obesity, and
white subjects, there was a consistent, stepwise alcohol use).
association between each category of self-rated Leopold and Engelhardt (2013) conducted a
health and the subsequent death rate, with the similar study using data from a survey of nearly
largest increments found for those reporting 15,000 adults between the ages of 50 and 80 living
fair or poor health. The authors then divided in a range of countries in Europe. They found
health reports into two categories: good (re- higher levels of self-rated health and lower
ported as excellent, very good, or good) and levels of chronic diseases in those with higher
poor (reported as fair or poor). Using multivari- levels of education.
ate analysis to control for factors such as gen- Bauldry et al. (2012) looked at the other end
der, race, and education, they found consistent of the age spectrum in their study of the self-
associations between self-rated health and the rated health status of children and adolescents
subsequent risk of death in all age groups, with in the United States, initially surveyed when they
the exception of those age 80 or older. were between the ages of 11 and 19 and then fol-
The CDCP (2008b) also assessed the extent lowed into their twenties and early thirties.
to which self-rated health is associated with When the subjects were in their early teens, the
one’s level of disability. In a study of a range of principal predictors of lower self-rated health
ere lower f amily socioeconomic position and

w quality of life is not possible, or at least is un-
stressful f amily situations. As the subjects grew likely, when serious ill health or disability is pre
into later adolescence and early adulthood, these sent” (p. 1144). Quite the contrary, Saigal points
background factors became less important, and out, “most ELBW subjects have made remark-
the health behaviors of the subjects themselves able adjustments in many aspects of their lives
become more predictive. Principal among the by the time they reach young adulthood. It
behaviors associated with lower health status is therefore not surprising that their [health-
were obesity, alcohol use, smoking, and physi- related quality of life] is no different from that of
cal inactivity. their NBW peers” (p. 1147). We should keep this
Before ending our discussion of self-rated principle in mind when, in later chapters, we dis-
health status, we should acknowledge one ca- cuss how adolescents and young adults can adopt
veat: one’s perception of his or her health status differing psychological perspectives about how
on the scales utilized in these studies does not they perceive themselves and their roles in life.
necessarily equate with one’s perception of his
or her overall quality of life. Individuals with
Social well-being
substantial levels of disability may nonetheless
perceive their quality of life as indistinguish- Individuals rarely live in isolation from o thers.
able from o thers who do not experience those Children interact with their families and
disabilities. This principle has been illustrated peers; adults interact with their families, neigh-
in work by Saigal et al. (2006), in their study of bors, peers, and communities. A key aspect of
young adults who w ere born extremely prema- human well-being is the extent and the quality
turely at a time when such infants had a sub- of these social interactions.
stantial probability of experiencing lifelong Kawachi (1999) has described this concept as
physical or emotional impairments as a conse- “social capital,” which he describes as referring
quence of their prematurity. “to those features of social relationships—such
Saigal followed 140 subjects who w ere born as levels of interpersonal trust and norms of reci-
in the period 1977–1982 weighing between 500 procity and mutual aid—that facilitate collec-
and 1,000 grams—a category referred to as ex- tive action for mutual benefit” (p. 120). He sug-
tremely low birth weight (ELBW). She followed gests that experiencing enhanced social capital
these subjects into their early twenties and is associated with a number of positive out-
compared them to a comparable group of young comes, including reduced rates of juvenile de-
adults who had been born during the same time linquency and crime, enhanced education, and
period at a normal birth weight (NBW) of greater increased economic opportunity.
than 2,500 grams. For both groups she assessed Kawachi and Berkman (2000) contrast the
their self-rated health status and, on a separate concept of social networks with social capital:
scale, their self-rated overall quality of life. She “Social networks are a characteristic that can
identified major differences in self- reported (and most often have been) be measured at the
health status, with the ELBW subjects report- individual level, whereas social capital should
ing significantly higher rates of physical and be properly considered a characteristic of the col-
emotional impairment in a number of areas. lective (neighbourhood, community, society) to
However, when compared on self-rated quality which the individual belongs” (p. 176). As we
of life, there w ere no significant differences be- will see, there is evidence that both forms
tween the two groups, leading Dr. Saigal to cau- of social interaction—one’s own social net-
tion against the “prevailing perception among works and the broader social capital of one’s
individuals without disabilities . . . that a good community—enhance well-being.
assessment tool. Study participants with larger

Social networks
social networks showed a significantly reduced
Sociologists and other social and behavioral sci- risk of dementia. More regular contact with
entists have become increasingly interested in other p eople one is familiar with appears to
the types of social connections individuals make provide a protective effect on continued cogni-
with o thers and how those connections affect tive ability among the elderly.
their well-being. The characteristics of a social White et al. (2009) studied a randomly se-
network reflect the types of p eople an individ- lected sample of about 3,500 adults age 60 and
ual interacts with (family, friends, neighbors, over who had participated in a national survey
coworkers, etc.), the quality of the relationship of health status. Subjects w ere asked to describe
(close, trusting, e tc.), and the frequency with their health status using the five-step excellent–
which one interacts with those in her or his poor scale described above. The authors of
network. this study collapsed these responses into three
The value of social networks for well-being categories: poor, fair/good, and very good/ex-
has been shown in a variety of contexts. For cellent. They then looked at the association
example, Cohen et al. (1997) evaluated the fac- between the strength of the emotional sup-
tors affecting the chances an otherwise healthy port these individuals received from their so-
individual would come down with a cold when cial networks and their self-rated health using
exposed to a known dose of cold virus in a con- this scale, after statistically controlling for
trolled laboratory setting. A fter controlling for age, race, gender, and educational attainment.
a range of other factors, they found that those Consistent with the study by Crooks et al., this
subjects with the greatest social network diver- study found that stronger support provided by
sity w ere less likely to come down with a cold one’s social network was significantly associ-
after exposure to the virus, suggesting that the ated with better self-reported health status.
strength of one’s social networks enhances the These results raise the question as to whether
ability to fight off a cold virus. social networks can enhance the emotional
In a rather different context, Semenza et al. well-being of younger adults as well. A team of
(1996) looked at the association of an individu- social science researchers who focus on the dy-
al’s social networks and the chance they would namics of social networks and their association
have died in the intense heat wave that struck with well-being have published a series of stud-
Chicago in 1995, in which temperatures remained ies examining this question. They use data gath-
above 100 degrees for several days running. ered from the Framingham Heart Study, one of
Among the other factors associated with an in- the longest running longitudinal studies of adult
creased chance of death, the authors found that health status in the United States. From these
living alone and having few regular social con- analyses they w ere able to identify the following
tacts increased the chances of death. associations:
Social networks have been shown to be of
particular value to older adults. Crooks et al. • “Depression depends on how connected
(2008) followed a sample of about 2,249 w omen individuals are and where they are located in
age 78 or older, none of whom showed signs of social networks,” with the level of depres-
dementia at the initial evaluation. Four years sion experienced by individuals correlated
after their initial assessment, 209 of the women with the level of depression in one’s friends
had died and 432 had dropped out of the study. and neighbors (Rosenquist et al. 2011, p. 280).
Of the 1,608 subjects remaining, 268 (17%) exhib- • “Loneliness not only spreads from person
ited evidence of dementia using a standardized to person within a social network but it also
reduces the ties of these individuals to o to focus on two aspects of social capital. The
thers
within the network. As a result loneliness is first, which they refer to as social cohesion,
found in clusters within social networks” “represents resources available to members of
(Cacioppo et al. 2009, p. 986). tightly knit communities.” The second, which
• “People who are surrounded by many happy seems closer to the concept of social networks
people and those who are central in the discussed above, refers to “resources that are
network are more likely to become happy embedded within an individual’s social net-
works” (p. 179). Some of the studies focused on
in the future . . . People’s happiness depends
on the happiness of others with whom they residential communities, while o thers reported
are connected” (Fowler and Christakis 2008, on the workplace. The review found consistent
p. 1). associations between social capital and mortal-
ity rates, self-rated health status, health-related
It thus appears that the strength of one’s re- behaviors, and mental depression, leading the
lations to o thers is associated with well-being authors to conclude that both forms of social
in a variety of ways, including physical health capital “appear to have positive effects on health
status, cognitive ability, and emotional well- outcomes” (p. 184).
being. These findings raise some interesting A number of authors have reported similar
questions. Does participation in social net- studies conducted in European countries of the
works constitute a form of behavior analogous associations between social capital and health,
to smoking, diet, and exercise? Are there cer- with similar results (Mohnen et al. 2011; Kim
tain personality characteristics that make it et al. 2011). Nieminen et al. (2013) studied the as-
easier or more difficult for an individual to par- sociation of social capital, health behaviors
ticipate actively in social networks? We return (smoking, alcohol use, diet, exercise), and over-
to this issue in chapter 7, when we discuss vari all health. They reported that “Irrespective of
ous theories of personality development. their social status, people with higher levels of
social capital . . . engage in healthier behaviors
and feel healthier both physically and psycho-
Social capital, as distinct from
logically” (p. 1).
social networks
This issue— whether there is a link be-
The concept of social capital is seen as reflect- tween the level of social inequality in a com-
ing a different level of social interaction than munity and the association between social
one’s personal social networks. While networks capital and health within that community—
reflect the direct interactions between groups was studied by De Clercq et al. (2012) in their
of individuals, social capital reflects qualities study of communities in Belgium. They re-
that develop in the broader social environment ported three main conclusions: (1) that an in-
in which one lives or works. As described above, dividual’s economic affluence was positively
social capital reflects concepts such as the level associated with perceived health and well-
of trust one perceives in his or her community being; (2) that the social capital of one’s com-
and the sense that if we help o thers around us, munity had a stronger association with indi-
they will reciprocate by helping us should we vidual health than social capital measured at
need it. the level of the individual; and (3) while com-
Murayama et al. (2012) conducted a compre- munities with higher levels of economic inequal
hensive review of published studies of the as- ity tended to have worse health status, stron-
sociation between social capital and health. ger social capital narrowed these economic
They indicated that the various studies tended differences substantially.
These results raise an important issue. How which that disability affects one’s quality of life.
do levels of economic capital and social capital Beyond physical impairments, psychological
compare in their associations with well-being? impairments such as depression can also affect
Ahnquist et al. (2012) studied this question in a well-being. Often simply asking individuals to
survey of more than 50,000 individuals in Swe- rate their own health status on a five-step scale
den between the ages of 18 and 84. They mea from “excellent” to “poor” will provide accurate
sured health status as both self-rated health and and useful information about these aspects of
psychological health. Both lower economic well-being. Once again, we see consistent asso-
capital and lower social capital w
ere significantly ciations between individual health behaviors
associated with worse health status, with the and these aspects of well-being. Finally, we have
worst health present in those who experience seen associations between an individual’s social
low levels of both forms of capital. We will dis- circumstances, approached e ither as the nature
cuss the effects of social capital and cultural of her or his own social networks or as the
capital again in chapter 5 when we consider the level of social cohesion within one’s broader
work of Pierre Bourdieu. community, and well-being assessed in a num-
Social inequality can affect well-being ad- ber of ways.
versely in a number of ways. That inequality How should we view the role of education in
can be economic in nature, social in nature, or these relationships? Greater educational attain-
both simultaneously. Individual behavior over ment is association with fewer unhealthy be-
the life course plays a substantial role in affect- haviors and with enhanced well-being in a range
ing both one’s economic circumstances and of contexts. Is educational attainment a form of
one’s social circumstances, and in turn the level behavior that is analogous to smoking and diet?
of inequality one experiences. There are, of We certainly know that greater educational at-
course, broader social forces that are not the tainment usually leads to greater economic
result of individual behaviors yet nonetheless well-being, which brings with it various forms
impact levels of inequality within a society. In of enhanced well-being. We also know, how-
the next chapter we will look at the many ways ever, that growing up in circumstances of eco-
in which inequality, behavior, and well-being nomic and social inequality is often associated
seem to be inextricably linked. with lower levels of educational attainment.
This again raises the question of the role of so-
cial and economic inequality in affecting well-
Summary
being, the focus of the next chapter.
uman well-being is experienced in a variety of
H
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not catch up. Health Affairs 31: 1803 + Appendix. Biology 58(1): 40–61.
chapter
3 Inequality and Well-Being
W
ell-being as an adult is largely tied to a relatively small
set of health-related behaviors. W hether looking at
life expectancy, level of disability, or self-reported
health status, we see that smoking, obesity, and patterns of diet
and exercise consistently impact well-being adversely. We also
see that educational attainment by the age of 25 is consistently
associated with these behaviors, with those completing lower
levels of education more often engaging in unhealthy behaviors
and as a consequence experiencing reduced well-being through-
out adulthood.
There is another, equally important aspect of differences in life
expectancy that we should acknowledge and explore. As shown
in figure 3.1, taken from Olshansky et al. (2012), there is clear evi-
dence that those with lower levels of education completed by age
25 have a shorter life expectancy than those with a higher level.
This association is a continuous one, through all levels of educa-
tion shown. The second association illustrated by the figure is the
clear racial and ethnic difference in life expectancy among the
groups shown. At every level of educational attainment, and for
both genders, black life expectancy is lower than white life ex-
pectancy, and white life expectancy is lower than Hispanic life
expectancy.
Racial and ethnic inequality in health in association

with educational inequality
Wong et al. (2002) examined the relative influence of race and
educational attainment on black and white mortality rates. As
described by the authors in introducing their study, “Mortality
from all causes is higher for persons with fewer years of educa-
tion and for blacks, but it is unknown which diseases contribute
most to these disparities” (p. 1585). Using nationally representa-
tive data from the 1980s and 1990s, they compared mortality
rates and the principal cause of death, first by comparing those
28
I neq u a l i t y a n d W e l l-B e i n g 29
Hispanic female White female Hispanic male

White male Black female Black male
Life expectancy at birth (years) 90
80
70
60
high school Graduated Some college Graduated
high school college
Highest level of education attained by age 25
Figure 3.1. Life Expectancy at Birth, by Years of Education at Age 25, by Race and
Sex, 2008. Data from Olshansky et al. 2012.
with lower education to those with higher edu- 1. “The level of education and race each appear
cation while controlling for age, gender, and to have strong, independent effects that
race. They then repeated the analysis, compar- persist a fter controlling for the other”
ing black adults with white adults while control- (p. 1591).
ling for age, gender, and level of education. They 2. “A few conditions account for most of these
found that differential rates of death due to car- disparities—smoking-related diseases in the
diovascular disease such as heart attacks or case of mortality among persons with fewer
strokes and death due to cancer explained most years of education, and hypertension, HIV,
of the difference in both comparisons, with diabetes mellitus, and trauma in the case of
causes such as infections and other forms of mortality among black persons” (p. 1585).
lung disease playing a lesser role. They also
found that the impact on mortality rates was Researchers at the US Centers for Disease
greater for educational differences than it was Control and Prevention (CDCP) reported the
for racial differences. In their discussion of results of a similar analysis using data for 2010
these research results they emphasized two (Kochanek et al. 2013). They noted that although
findings: overall life expectancy had increased steadily
between 1970 and 2010, a substantial disparity chronic conditions. In 2008, blacks in the
between black and white life expectancy per- United States could expect 5.9 fewer years of
sisted throughout that time frame. In 2010, life life without disability than whites. (This was
expectancy in the United States was 4.7 years actually a decrease in the black/white disparity
longer for white men than for black men and from 1999, when blacks could expect 7.0 fewer
3.3 years longer for white w omen than for black disability-free years.)
women. Researchers then asked which causes The report also included an analysis of com-
of death contributed most to this disparity. For parative health status of adults (age 18 or older)
men, the principal causes of the higher black based on self-rated health status, using the five-
mortality rate w ere heart disease, hom i
cide, step, excellent–poor response options. They
cancer, and stroke, while for w omen the princi- analyzed which factors were associated with re-
pal causes w ere heart disease, cancer, diabetes, spondents more likely to rate their health as fair
and stroke. As discussed in the previous chap- or poor. The results are shown in figure 3.2.
ter, these conditions are closely linked to behav- Three groups are the most likely to report
iors such as smoking, diet, and exercise. It thus fair or poor health: blacks, Hispanics, and Amer-
appears that inequality in life expectancy in the ican Indians. These are the same three groups
United States is linked both to education and to most likely to report not having finished high
race independent of education. school. The report also looked at the level of fair
If we look at levels of disability rather than or poor health based on level of education com-
rates of mortality, we see a similar pattern. In pleted. As shown in figure 3.3, the results are as
2013 the CDCP published an updated Health we might expect. As was the case in reporting
Disparities and Inequalities Report that offered an disability, those with lower levels of education
assessment of current “health disparities and were more likely to report fair or poor health.
inequalities across a wide range of diseases, The report also looked at the association of
behavioral risk factors, environmental exposures, disability status and having reported fair or poor
social determinants, and health-care access by health. Again, not surprisingly, there was a sub-
sex, race and ethnicity, income, education, dis- stantial difference. Of those reporting fair or
ability status and other social characteristics” poor health, 39.4 percent also reported a current
(CDCP 2013). Using data for 2011, the report first disability, compared to 8.6 of those with health
noted that not having finished high school was greater than fair or poor reporting a disability.
the most consistent predictor of the outcomes it While w omen could expect an average of
studied. Not surprisingly, those who did not 2.9 years more than men free of activity limi
complete high school w ere substantially more tations, there was not a substantial difference
likely to be poor or near poor than those with between men and w omen in self-rated health
higher levels of education. In addition, those status: 15.4 percent of men and 16.8 percent of
who did not complete high school w ere substan- women reported fair or poor health. Zajacova
tially more likely to report a current disability. and Hummer (2009) explored whether there
(These analyses adjusted for age differences might be gender differences in the association
among groups.) between race, educational attainment, and mor-
The report then looked at race and ethnicity tality rates. They analyzed these associations us-
and found failure to complete high school oc- ing a nationally representative sample of 700,000
curring more commonly in three groups: black, white or black adults born in the United States
Hispanic, and American Indian. Using these between 1906 and 1965. Consistent with data
data, the report then calculated the expected above, they found blacks to have lower levels
years of life free of activity limitations due to of education and higher rates of mortality than
35.0%
30.8%
30.0%
28.1%
25.0%
23.3%
20.0%
15.0%
13.3%
11.9%
10.0%
5.0%
0.0%
White Black Hispanic Asian / Pacific American
Islander Indian /
Alaska Native
Figure 3.2. Percentage of Adults in the United States Reporting “Fair” or “Poor”

Health, by Race/Ethnicity, 2010. CDCP Health Disparities and Inequalities Report 2013.
whites of a comparable age. However, they did was no longer a difference in the level of im-
not find major differences in the association be- paired functioning among these racial/ethnic
tween education and mortality rates for e ither groups.
white women as compared to white men, or This finding for older adults—that race/eth-
black women as compared to black men. Blacks nicity no longer had an independent effect on
experience both lower levels of education and health status—is in contrast to the findings re-
higher mortality rates than whites, but gender ported above that race/ethnicity continued to
differences are not found in these associations. have an association with health status for adults
Louie and Ward (2011) looked specifically at age 18 or greater, even after controlling for edu-
socioeconomic and racial in e
quality in the cation or income. Sautter et al. (2012) studied
burden of disease and level of physical func- death rates of black and white men and women
tioning in adults in the United States age 60 or age 65 or older. They found essentially no racial
greater. They found that those older adults with difference in the association between education
lower levels of education and lower levels of or income and the odds of dying among these
income w ere more likely to report impaired men and w omen—with one notable exception.
physical functioning. Without adjusting for edu- A fter the age of about 79, older black men with
cation or income, blacks and Hispanics of Mexi- low income were less likely to die than lower-
can ancestry w ere more likely than whites to income white men. The authors suggested that
report impaired functioning. A fter adjusting by this age, more lower-income black men had
statistically for education and income, there already died, leaving “a relatively more robust
45.0%
38.4%
40.0%
35.0%
30.0%
25.0%
20.3%
20.0%
15.5%
15.0%
10.0%
7.3%
5.0%
0.0%
Less than High school Some College
high school graduate or college graduate
equivalent
Figure 3.3. Percentage of Adults in the United States Reporting “Fair” or “Poor”

Health, by Highest Level of Education Completed, 2010. CDCP Health Disparities
and Inequalities Report 2013.
subgroup of black men and a black-white mor- racial and ethnic history and current demo-
tality crossover at advanced ages” (p. 1569). graphics? Martinson (2012) addressed this ques-
Kimbro et al. (2008) confirmed the strong as- tion in a comparison of the association between
sociation between education and health for socioeconomic status and adult health status in
adults in the United States between the ages of the United States and E ngland. Using nationally
25 and 64, evaluating the associations for re- representative data for each country, she com-
porting fair or poor health, obesity, low levels pared the association between income (mea
of physical activity, and experiencing work limi- sured in terciles) and a range of health indicators,
tations. They found strong associations between including obesity, diabetes, high blood pressure,
level of education and each of these outcomes. asthma, abnormal cholesterol, heart attack, and
In addition, they found that blacks had higher stroke. She found that “Overall, both countries
levels of these adverse health outcomes than had large, significant income gradients in health”
whites for all levels of education, while Hispan- (p. 2054) and that “Although the English enjoy
ics differed little from whites at comparable lev- better overall health than Americans, both coun-
els of education. tries still grapple with large health inequalities”
The findings raise an interesting question. (p. 2056).
To what extent is the association between lower As in the United States, the socioeconomic
socioeconomic status and worse health out- differences in health status identified in England
comes in the United States different from that in largely reflect differences in health-related be-
other countries, based on each country’s unique haviors. As part of the ongoing Whitehall study
of adults employed by the British civil service, but they are not unique to this country. While
Stringhini et al. (2010) looked at the association the level of education attainment explains much
between socioeconomic position (mea sured of these differences, in many cases black Ameri-
based on occupational category within the civil cans experience more health inequality at a given
service), behaviors, and death rates. They found level of education or income for many measures
consistently higher death rates among succes- of well-being.
sively lower occupational categories. Differ- These inequalities are exacerbated by the
ences in rates of smoking and patterns of diet lower level of educational attainment among
and exercise accounted for approximately blacks and other minorities. As shown in
three-fourths of these differences in death rates. figure 3.4, blacks and Hispanics age 25 or older
Looking specifically at older women in the were substantially less likely than whites or
United Kingdom, Watt et al. (2009) looked at the Asians to have completed college or entered
association between socioeconomic status (SES) graduate school. Blacks and Hispanics w ere also
over the life course and behaviors. They identi- substantially more likely to have earned a high
fied clear differences in patterns of diet and school diploma but not gone on to college or
exercise among these women based on SES. never to have finished high school. Since edu-
Substantial inequalities in health status based cational attainment is the principal predictor of
on income and race continue in the United States, well-being as an adult, and blacks and Hispanics

Some college, no bachelor’s degree Bachelor’s degree
Graduate or professional school
45.0%
38.3%
40.0%
30.8%
35.0%
29.6%
27.5%
27.5%
26.7%
26.6%
30.0%
24.5%
20.5%
25.0%
19.9%
19.0%
18.3%
17.2%
20.0%
15.5%
12.0%
11.8%
15.0%
10.5%
9.2%
7.8%
6.7%
10.0%
5.0%
0.0%
White Black Asian Hispanic
Figure 3.4. Educational Attainment in the United States of Adults Age 25 or Older,

by Race/Ethnicity, 2010. US Census Bureau 2012.
Tabl e 3.1 . Children in the United States, Age 6–18,

Whose Mother or F ather Did Not Finish High School,
by Race/Ethnicity (Percentages)
American
White Black Asian Hispanic Indian
Mother 4.6 12.9 14.6 39.3 19.4

Father 5.8 11.2 10.5 41.1 14.0
Source: National Center for Education Statistics 2010.
on average attain lower levels of education, we dition, parents with low levels of education may
would expect these minority groups to experi- influence children’s educational aspirations
ence lower levels of adult well-being, both eco through the attitudes they express about the
nomically and socially. value of education for their children. Davis-
Lower levels of educational attainment as an Kean (2005) found evidence of black/white ra-
adult have also been shown to have a strong as- cial differences regarding expectations about
sociation with the subsequent educational at- education verbalized to children and the fre-
tainment of one’s children. A report titled Status quency of reading to children.
and Trends in the Education of Racial and Ethnic These data add additional factors to the
Groups, published in 2010 by the National Cen- model described earlier in figure 2.5. While ed-
ter for Education Statistics of the US Depart- ucational attainment as an adult is clearly asso-
ment of Education, reported that “Research has ciated with the health-related behaviors people
shown a link between parental education levels adopt, and these behaviors in turn affect life
and child outcomes such as educational experi- expectancy, premature mortality, and level of
ence, attainment, and academic achievement” disability, two factors are associated with some
(p. 20). As shown in table 3.1, data from the re- children attaining lower levels of education by
port indicated that minority children were sub- the time they are adults: being of a minority
stantially more likely than white children to race or ethnicity (in particular, being black) and
have either a mother or a father who never fin- growing up in a low-income environment. These
ished high school. This is especially true for two risk factors are associated, since minorities
Hispanic children. are more likely also to be living in the context
Eccles and Davis-Kean (2005) reviewed the of low income. These associations are shown in
literature on the association between parents’ figure 3.5.
levels of education and the educational attain-
ment of their children. They found consistent
How does inequality in access to
evidence that the parents’ education influenced
medical care affect health inequality?
children’s education in multiple ways. One of
the strongest was through the disadvantaged Beyond the inequalities in education and in-
economic circumstances experienced by the come experienced by minority groups, there is
families of adults with low levels of education. also a long history in this country of racial and
They experience both lower income and lower ethnic ine
quality in access to medical care.
occupational position, both of which affect the Since the early part of the 20th century the
circumstances in which the families live. Lower- United States has elected to organize its health
income communities have weaker schools and care as a market-based system. The principal
other opportunities available to children. In ad- means of payment for care is what has been re-
Minority
race/ethnicity Reduced life
Health behaviors
expectancy,
Educational such as smoking,
premature death,
attainment diet, and lack
and increased
of exercise
Growing up in a disability
low-income
environment
Figure 3.5. Economic and Racial/Ethnic Inequality as Precursors of Educational

Attainment, Health Risk Behaviors, and Adult Health Outcomes
ferred to as “fee-for-service,” in which health New England Journal of Medicine: “Health is influ-
care providers charge a separate fee to patients enced by factors in five domains—genetics, so-
for each service provided. Starting in the 1950s, cial circumstances, environmental exposures,
many employers began providing health insur- behavioral patterns, and health care. When it
ance to their workers as a fringe benefit. The comes to reducing early deaths, medical care
federal government created a series of tax subsi- has a relatively minor role” (p. 1221). Schroeder
dies that encouraged the expansion of employer- refers to a study by McGinnis et al. (2002) that
based health insurance. For much of the 20th described “A long-standing estimate by the Cen-
century the federal government played a rela- ters for Disease Control and Prevention [that]
tively small role in the health care system. places the contribution of health care system de-
In the 1960s the federal government took a ficiencies to total mortality at about 10 percent.”
major step to provide health care for seniors McGinnis concludes that “even if the entire
(age 65 or over) through the Medicare program population had timely, error-free treatment, the
and care for low-income families with children number of early deaths would not be much
and those with disabilities through the federal/ reduced” (p. 83).
state Medicaid program. While these programs Of the remaining 90 percent of premature
were largely successful, they nonetheless left deaths in the United States on which improved
substantial segments of the US population with- medical care would have little impact, Schro-
out health insurance, most of whom lack the eco- eder describes behavioral patterns as responsible
nomic means to pay for care through the fee-for- for 40 percent of total deaths, with disadvantaged
service system. By 2010, following the economic social circumstances and associated environ-
recession of 2007–08, 16.3 percent of the US mental exposures responsible for an additional
population had no health insurance (US Census 20 percent of the total. Based on these data, it
Bureau 2013b). The uninsured rate differed, how- appears that despite the historical inequalities
ever, by race/ethnicity. In 2012, 11.1 percent of in the United States in health insurance and
whites and 14.6 percent of Asians w ere unin- associated access to health care, inequalities in
sured, as compared to 18.5 percent of blacks and behav ior and living environment contribute
29.1 percent of Hispanics. substantially more to premature death. These
How much, though, does the greater lack of data are consistent with a study by Galea et al.
health insurance by blacks and Hispanics con- (2011) that examined national mortality data for
tribute to the racial and ethnic health disparities the year 2000. They concluded that of the 2.3
described above? Schroeder (2007) summarized million deaths that occurred in the United States
the issue in a review article published in the that year, more than one-third w ere directly
attributable to forms of social and economic ine infant mortality rate of infants born to Hispanic
quality, such as low education, poverty, weak mothers was essentially identical to the rate for
social support, and residential racial segregation. white mothers: 5.25 per 1,000 live births for
Of particular importance in perpetuating racial Hispanics and 5.18 per 1,000 for whites. (Mat-
disparities in mortality in this country is the thews and MacDorman 2013) By comparison,
continued pattern of residential racial segrega- the infant mortality rate for infants born to
tion (Williams and Collins 2001). black mothers that year was 11.46. For mothers
giving birth as teenagers, one of the highest risk
groups, the white infant mortality rate was 8.49,
The differing impact of low education
the black rate was 12.87, and the Hispanic rate
and low income on the health of
was 6.22. Among teenage Hispanic mothers,
minority groups
those of Mexican ancestry had the lowest rate
The associations illustrated in figure 3.5 show of all groups at 5.58 per 1,000, despite having
the principal sources of disparities in health some of the lowest levels of education and in-
and well-being experienced by racial and ethnic come of any group.
minorities in the United States as well as those By contrast, obesity in the United States,
who grow up in disadvantaged economic cir- one of the principal contributors to diabetes
cumstances. While these associations are accu- and its many complications, is more common
rate overall, some exceptions warrant further among black and Hispanic adults than among
discussion and exploration. One of these excep- white adults (Flegal et al. 2012). Among chil-
tions is illustrated in figure 3.1 above. While the dren between ages 2 and 19, 21.2 percent of His-
association between educational attainment panic youths and 24.3 percent of black youths
and life expectancy is consistent for both gen- were obese, as compared to 14.0 percent of
ders in the three groups shown (white, black, white youths (Ogden et al. 2012). Among chil-
and Hispanic), there is a clear hierarchical dren younger than 2, there was an even more
relation among these three groups. At all levels striking disparity. Using a mea sure of high
of education shown in the figure, blacks have weight-for- recumbent- length, a common mea
lower life expectancy than whites, whereas His- sure of excess weight among infants and tod-
panics have greater life expectancy than whites. dlers, 14.8 percent of Hispanic infants were over-
This is despite the markedly lower levels of weight, as compared to 8.4 percent of white
educational attainment among Hispanics as infants and 8.7 percent of black infants. Mexi-
compared to whites, as shown in figure 3.4. If can American infants had an even higher rate
low education is associated with reduced well- of 15.7 percent. For matters of excessive weight
being in areas such as life expectancy, and His- that places an individual at higher risk of mul-
panics have substantially lower levels of educa- tiple adverse health outcomes, blacks and
tion than either whites or blacks, then why is especially Hispanics are at increased risk as com-
Hispanic life expectancy greater? pared to whites, consistent with their lower
Infant mortality presents another area in economic and educational status.
which minority race/ethnicity has a differential In addition to obesity and related issues of
impact. Low income and low maternal educa- diet and exercise, smoking is one of the principal
tion are known risk factors for premature birth contributors to premature death and to increased
and associated risk of infant mortality. His- rates of disability. As shown in figure 1.1, smok-
panic w omen show lower levels of both factors ing prevalence is closely tied to educational at-
than white w omen and lower levels of educa- tainment. Given that average educational at-
tion than black women. However, in 2010, the tainment is lower among blacks and Hispanics
in the United States than among whites, one ational census, respondents were asked two
n
might expect higher rates of smoking in these questions about each member of their h ousehold:
populations. This is not the case, however. In Question 8: Is this person of Hispanic, La-
2010, the prevalence of smoking among adults tino or Spanish origin?
age 18 or older was 25.8 percent for whites, Question 9: What is this person’s race?
25.4 percent for blacks, and 22.9 percent for His- According to government policy, the issue of
panics (Garrett et al. 2013). The highest adult Hispanic origin is separate from the issue of race.
smoking rates were among American Indians, While the category of Hispanic included several
with a rate of 34.4 percent. Among teenage smok- categories on the census form (Mexican, Mexi-
ers, American Indians and whites stood out with can American, Chicano, Puerto Rican, Cuban,
rates of 13.6 and 10.2 percent, compared to rates or another Hispanic, Latino, or Spanish origin),
of 5.0 percent for blacks and 7.7 percent for His- each respondent was tallied according to the
panics. Something more complex than simple ethnic dichotomy of Hispanic/Not Hispanic. His
racial or ethnic differences is affecting rates of panic was not considered by the Census Bu-
smoking. reau to be a race.
The association between race/ethnicity and As for a person’s race, the Census Bureau in-
well-being through the mediator of educational cludes the five categories shown in table 3.2, plus
attainment is not a s imple question of minority a sixth category of “Two or More Races.” In ex-
versus nonminority status. Some other aspect of plaining these categories, the Census Bureau
race and ethnicity distinguishes different groups. webpage states:
The racial categories included in the census

The origins and meanings of the
questionnaire generally reflect a social definition
concepts of race and ethnicity
of race recognized in this country and not an
in the United States
attempt to define race biologically, anthropologi-
The United States Census Bureau reported that cally, or genetically . . . People may choose to
in July 2012, the total population of the coun- report more than one race to indicate their racial
try was estimated to be 308,745,538. Of these, mixture, such as “American Indian” and “White.”
50,477,594 w
ere Hispanic, and 258,267,944 were People who identify their origin as Hispanic,
not Hispanic. In a separate tabulation, the Cen- Latino, or Spanish may be of any race.
sus Bureau broke down the US population by
race, as shown in table 3.2. In identifying the racial categories it uses in
According to Census Bureau policies, p eople gathering census data, the website explains,
who identify as Hispanic may be of any race. “OMB requires five minimum categories: White,
Similarly, p
eople of a given race can be e ither Black or African American, American Indian or
Hispanic or not Hispanic. As part of the 2010 Alaska Native, Asian, and Native Hawaiian or
T abl e 3.2 . Annual Estimates of the Resident Population

by Race for the United States, July 1, 2012
American Native Hawaiian
Black or African Indian and and Other Two or
White American Alaska Native Asian Pacific Islander more races
241,937,061 40,250,635 3,739,506 15,159,516 674,625 6,984,195

Source: US Census Bureau.
Other Pacific Islander.” OMB refers to the Office • Afer niger (African black): impassive, lazy,
of Management and Budget, which is the federal crafty, slow, foolish
agency charged with defining racial categories • Americanus rubescus (American red):
in the United States. ill-tempered, subjugated, obstinate
The categories listed above are based on the • Asiaticus luridus (Asian yellow): melancholy,
OMB policy set in 1997. In that year the OMB pub- greedy, severe, haughty
lished a revision to the racial categories to be used • Europaeus albus (European white): serious,
by the Census Bureau and other federal agencies strong, active, very smart, inventive
in gathering population data. The new regula-
tions defined the following five racial categories: We should note that, with the exception of
the Native Hawaiian/Pacific Islander category,
• American Indian or Alaska Native. A person the categories described by Linnaeus are identi-
having origins in any of the original peoples cal to those used today by the United States
of North and South America (including government.
Central America), and who maintains tribal Johan Blumenbach, a contemporary of Lin-
affiliation or community attachment. naeus, differed somewhat in his human taxon-
• Asian. A person having origins in any of the omy, specifically in regard to how to categorize
original peoples of the Far East, Southeast the peoples of the Pacific Islands, referred to by
Asia, or the Indian subcontinent Blumenbach as the Malay (Marks 1995). Writ-
• Black or African American. A person having ing in 1781, he argued that the human species
origins in any of the black racial groups of had five subcategories—the four identified by
Africa. Linnaeus, plus the Malay. While Linnaeus iden-
• Native Hawaiian or Other Pacific Islander. tified these categories based on observed be
A person having origins in any of the original hav ior, Blumenbach relied on differences in
peoples of Hawaii, Guam, Samoa, or other physical appearance without referring to be-
Pacific Islands. havioral characteristics. Thus, in making its
• White. A person having origins in any of change in policies regarding racial categoriza-
the original peoples of Europe, the M
iddle tion, the OMB was shifting from the categories
East, or North Africa. identified by Linnaeus to those identified by
Blumenbach—both of whom w ere writing in
These categories represented a change from the 18th century.
previous policy. Prior to 1997, the categories of For much of the 20th century, many in the
Asian and Pacific Islander were included in a United States considered these racial categories
single category. to be separate biological categories, defined by
The United States and its European forbears distinct genetic differences. However, as h uman
considered the d ifferent populations around the genome analysis became possible and scientists
globe to be distinct subspecies of Homo sapiens. began to study genetic variations among different
In a 1758 book titled Systema Naturae, Swedish human populations, it became clear that there
naturalist Carl Linnaeus reported on his study were no distinct and consistent genetic markers
of both plants and animals, seeking to estab- that separated these racial groups (Rosenberg
lish a taxonomy of all animal life on the globe. et al. 2002; Rosenberg 2011). These genetic analy-
In that book he identified what he believed to ses demonstrated repeatedly that there is sub-
be the four subspecies of humans and pro- stantially more genetic variation among the in-
vided what he saw as their defining behavioral dividuals within a “race” than there is between
characteristics. or among “races.” While it is often possible to
identify the continent of origin of an individu- decrease of the white and black percentages, is
al’s ancestors, that information provides l ittle in
projected to continue for most of the 21st c entury,
the way of useful information about the charac- as shown in figure 3.6.
teristics that individual will possess based on Between 2015 and 2060, the United States
his race. It is for these reasons that the federal Census Bureau projects that the percentage of
government, as well as most scientists, recog- the population that is white will fall from about
nize the racial categories used today in the 62 percent to approximately 43 percent, while
United States as “reflect[ing] a social definition the Hispanic share of the population will rise
of race recognized in this country and not an from 18 percent to more than 30 percent (United
attempt to define race biologically, anthropo- States Census Bureau 2012). At some point be-
logically, or genetically,” as described above. Intween 2040 and 2045, the white population will
contrast, in gathering its census data, the Cana- fall to less than 50 percent of the national popu-
dian government explicitly excludes questions lation, making the country a majority nonwhite
about race, instead asking individuals to identify country for the first time. This is, or course, con-
their ancestry using a broad range of ethnic cat- sidering the white population that is non-
egories (Statistics Canada 2012). Hispanic white. A substantial share of the His-
panic population is categorized as white by
race; however, in 2010 more than one-third of
The changing demographics of the
the Hispanic population nationally responded
population in the United States
to the census question on race by indicating
While the categories with which we as a society “some other race.” Many if not most Hispanics
describe and categorize people have changed consider their Hispanic ethnicity to be a sepa-
relatively little in recent years, the makeup of rate category from those who are white. Thus
the US population has been changing and will again, it seems most appropriate to discuss the
continue to undergo fundamental shifts. In 1980, population on the basis of a single category of
the population of the United States was 83.1 race/ethnicity, rather than dichotomizing these
percent white, 11.7 percent black, 6.4 percent into separate categories.
Hispanic, 1.5 Asian, and 0.6 percent American Another aspect of the demographic changes
Indian/Alaska Native. An additional 3.0 percent expected to take place in the United States is the
of the population was listed as “other races” racial/ethnic makeup of children u nder the
(United States Census Bureau 1983). age of 18. In 2010 children made up 22.8 percent
By 2010 the population distribution had of the overall population. That share is ex-
shifted to 63.9 percent white, 12.2 percent pected to fall slightly, to 22.4 percent in 2030
black, 16.4 percent Hispanic, 4.7 percent Asian, and 21.5 percent in 2050 (US Census Bureau
0.7 p
ercent American Indian/Alaska Native, and 2013a). However, the racial/ethnic composition
0.2 percent Native Hawaiian/Other Pacific Is- of the children is expected to change substan-
lander (the new category created by the federal tially, as shown in figure 3.7.
government in 1997 and formerly considered In 2000, 17.2 percent of US children w ere
“Asian”) (United States Census Bureau 2011). Hispanic, while 61.2 percent w ere white. Over
Over a period of 30 years, the Hispanic popula- a period of 50 years those shares are expected
tion had nearly tripled as a percentage of the to become approximately the same, at about
overall population, becoming the second- 36 percent each of the child population. Follow-
largest population group in the United States. ing 2050, assuming no major changes in the
This pattern, of an increasing percentage of the projected rate of change, Hispanics will be the
population being Hispanic with a concomitant largest group of children in the United States.
White Hispanic
Black American Indian / Alaska Native
Asian Native Hawaiian / Pacific Islander
Two or more races
70.0%
60.0%
Percentage of the US population
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
2015 2020 2025 2030 2035 2040 2045 2050 2055 2060
Figure 3.6. Projected Racial and Ethnic Distribution of the Population of

the United States, 2015–2060. US Census Bureau.
As those children age, the graphs for overall status. Figure 3.2 above shows that Hispanics as
population share of Hispanics and whites, a group report worse health status than all other
shown in figure 3.6, is expected to intersect groups, with the exception of Native Americans.
sometime after 2060. Finally, figure 3.4 shows that Hispanics have
some of the lowest educational attainment—
especially at the level of not finishing high school.
The disparate impact of inequality
One might then conclude that an increasing pro-
on Hispanics and blacks
portion of the population that is Hispanic will
With the clear indications that the population of likely lead to worse population health.
the United States will become, over time, in- Using other mea sures of health status,
creasingly Hispanic, how will that change affect however, calls this conclusion into question.
the health of the population? We have seen con- As shown in figure 3.1, life expectancy clearly
sistent evidence that lower levels of educational follows educational attainment for whites,
attainment are associated with worse health out- blacks, and Hispanics. At all levels of education,
comes. For example, the data in figure 3.3 above however, Hispanics have a greater life expec-
indicate a continuous, stepwise association be- tancy than either whites or blacks, despite their
tween level of education and self-reported health lower levels of education.
Hispanic White Black

Asian American Indian /Alaska Native
70.0
60.0
Percentage of US population age 18
50.0
40.0
30.0
20.0
10.0
0.0
2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050
Figure 3.7. Projected Racial and Ethnic Distribution of the Population of Children

Age <18 in the United States, 2000–2050. US Census Bureau.
Infant mortality is another measure that is only a high school diploma was 8.4 percent, of
closely associated with the level of education of those with some college but no bachelor’s de-
the mother. Perhaps the greatest risk for infant gree 7.7 percent, and among those with bache-
death is being born at a low birth weight, de- lor’s degree or higher 6.9 percent (CDCP 2012).
fined as weighing less than 2,500 grams. In However, the association between maternal
2010, the infant mortality rate among infants education and rate of low birth weight varies by
born at low birth weights was 13.4 deaths per the race/ethnicity of the mother. Looking at
1,000 live births, while the rate for infants born data for births to mothers age 20 or over (thus
weighing more than 2,500 grams was 2.13 per avoiding the higher rate of low birth weight
1,000 (Mathews and MacDorman 2013). Infants among teen mothers), we see that Hispanics and
born at even lower birth weights of less than Asians show a d ifferent pattern than other ra-
1,500 grams had a mortality rate of 222 per 1,000. cial groups in the United States. These data are
Nationally, 8.2 percent of all infants born in 2010 shown in figure 3.8.
weighed less than 2,500 grams, while 1.5 percent Births to white mothers, black mothers, and
weighed less than 1,500 grams. Native American mothers show a consistent as-
One of the principal risk factors for having a sociation with the mother’s level of education,
low-birth-weight infant is low maternal educa- with lower educational levels being associated
tion. In 2008 in the United States, the rate of with higher rates of low-birth-weight infants
low-birth-weight infants among mothers with for all levels of education shown. Births to Asian
No high school diploma or GED High school diploma or GED

Some college, no bachelor’s degree Bachelor’s degree or more
18
16
14
12
10
0
White Black Native Asian /Pacific Hispanic
American Islander
Figure 3.8. Low Birth Weight as Percentage of Live Births to Mothers

Age 20 or Over, United States, 2008, by Race/Ethnicity and Educational Attainment.
CDCP—Health, United States, 2011.
mothers and Hispanic mothers show no clear than either the white or the Native American
association between educational level and rate rate.
of low birth weight. In addition, despite having Using comparable data from 1998, Acevedo-
the lowest average level of educational attain- Garcia et al. (2005) compared these rates both
ment of all the groups shown, Hispanic moth- by the mother’s level of education and the
ers have the lowest rate of low birth weight of mother’s immigration status. They compared
all the groups shown. Hispanic mothers age 20 or older with other ra-
Another aspect of these associations warrants cial/ethnic groups, breaking each group down
discussion. While it is the case that Hispanic by whether the mother was born in the United
mothers have the lowest rate of low-birth-weight States or abroad. For white, black, and Asian
infants despite their overall lower levels of edu- mothers, there was a consistent association be-
cation, these associations vary by the Hispanic tween education and risk of low birth weight,
subgroup the mother belongs to and the immi- with the rates for the foreign-born mothers
gration status of the mother. In 2008, among somewhat lower than for the US-born mothers.
Hispanic mothers, Mexicans consistently had For Hispanic mothers, however, the association
the lowest rate of low birth weight, while Puerto between educational attainment varied by the
Ricans had the highest. While the Mexican mother’s place of birth, with higher rates of low
rate was the lowest of any racial/ethnic group, birth weight for lower-educated Hispanic moth-
the Puerto Rican rate was consistently greater ers born in the United States but no educational
gradient for Hispanic mothers born outside the David and Collins summarized a series of stud-
country. Among Hispanic mothers, those with ies that “showed an adverse impact of perceived
less than a high school education born outside racial discrimination on the birth outcome for
the United States had the lowest rate of low Black women” (2007, p. 1195). Growing up in a
birth weight of any group. There appears to be society that has a centuries-long history of ra-
a powerful protective effect for foreign-born cial discrimination, principally against blacks,
Hispanic mothers with low education regarding can lead to chronic elevation of the body’s
their risk of having a low-birth-weight infant stress response and injury to the cardiovascular
and the corresponding risk of infant mortality. system, even at a young age. Thurston and Mat-
This association is often referred to as “the thews (2009) studied the thickness and stiffness
Hispanic paradox.” of the lining of the carotid artery of black and
As described above, Acevedo-Garcia found a white teenagers with an average age of 18. They
protective effect for black women who w ere found that the black teenagers had increased
born outside the United States but who gave levels of both measures, an indication of early
birth in the United States (2005). These data injury to the lining of the arterial system
are consistent with the data reported by David thought to be the result of chronic stress due to
and Collins (1997) in their study of differential a combination of low SES and racial bias tar-
birth weights of infants born to black and white geted against blacks.
women in the period 1980–1995 in Illinois. Illi- To what extent do young black w omen grow-
nois had a long history of racial differences in ing up in the United States experience a level of
birth weight distribution and associated infant racial discrimination that black w omen grow-
mortality between black and white infants. ing up in Africa don’t face? This was the ques-
David and Collins compared the birth weights tion addressed by Dominguez et al. (2009). They
of infants born to white mothers born in the surveyed 185 US- born and 114 foreign- born
United States and living in Illinois to those of black pregnant w omen enrolled in an ongoing
two groups of black w omen living in Illinois: study of birth outcomes among w omen in
those born in the United States and those born Boston, Massachusetts. They asked subjects the
in Africa. The birth weights of the infants born extent to which they had experienced racial
to US- born black women were consistently bias, either targeting themselves as an individ-
lower than those of the white women. The ual or blacks as a racial group. They found the
birth weights of the infants born to African- odds that a US-born black woman had experi-
born black w omen were nearly identical those enced individual or group racism in her child-
of the white w
omen. The US-born black women hood, respectively, were 4.1 times and 7.8 times
showed consistent differences in behavioral those of a foreign-born woman. They found
risk factors for low birth weight when com- that African-born black women reported the
pared to the African-born black women, with a lowest rates of racism during childhood, while
higher rate of teen pregnancy (28% US-born vs. Caribbean-born blacks had rates of childhood
1.5% African-born), not having completed high racism that w ere more similar to the US-born
school (36% US-born vs. 8% African-born), and women.
being unmarried at the time of birth (76% US- These findings were for foreign-born woman
born vs. 24% African-born). who had emigrated to the United States a fter
Why do black w omen in the United States their 18th birthday. Foreign-born women who
give birth to many more low-and very-low- emigrated before age 18 w ere more similar to
birth-weight infants than white w omen? In a US-born women in their experiences of racism.
review of recent research on this question, These findings are consistent with the concept
that the chronic stress of growing up in a climate fair, equal, and just are significantly influenced
of racial discrimination can harm the vascular by his or her social experiences and environ-
system, with adverse consequences for vascular- ment. Unfortunately, the social environment for
rich organ systems such as the female reproduc- many children of color includes personal and
tive tract. family experiences of racial discrimination that
Williams et al. (2007) looked at the differ- foster perceptions of powerlessness, inequality,
ences between US- born and Caribbean- born and injustice. In turn, these perceptions may
blacks currently living in the United States in influence child health outcomes and disparities
their prevalence of major depression during by affecting biological functioning (e.g., cardio-
adulthood. While both groups had rates of de- vascular and immune function) and the quality
pression that were lower than the rates among of the parent-child relationship and promoting
white adults in the United States, the Caribbean- psychological distress (e.g., self-efficacy, depres-
born blacks reported significantly less depression, anger) that can be associated with risk-
sion than the US-born blacks. taking and unhealthy behaviors. (p. S176)
Hudson et al. (2013) conducted a similar study,
assessing the association between the socioeco- They also describe the situation known as
nomic position (SEP) experienced throughout social anomie, “which is characterized by feel-
the life course, experiences of racial discrimina- ings of hopelessness and perceptions of little
tion, and two health outcomes: symptoms of control over life outcomes . . . Racial discrimi-
depression and overall self-rated health status. nation increases anomie by reinforcing percep-
They compared nationally representative sam- tions of in e
quality and limiting options for
ples of black and white adults in the United achieving life goals” (p. S178). These feelings of
States. They found that those with lower SEP depression, anger, and hopelessness are associ-
experienced depressive symptoms more often, ated with patterns of unhealthy behaviors, in-
as did those who experienced racial discrimina- cluding higher levels of risk-taking.
tion. In looking at the interaction between SEP Jackson et al. (2009) suggest that the un-
and having experienced discrimination, they healthy behaviors adopted at an early age by
found that blacks with higher SEP reported those facing the combined stress of socioeco-
greater levels of depressive symptoms in associa- nomic disadvantage and racial discrimination
tion with the experience of racial discrimina- act to buffer the physiologic effect of chronic
tion. Not surprisingly, higher levels of depres- stress. Such stress can lead to chronically in-
sion were associated with lower overall self-rated creased allostatic load— the level of stressor
health for both whites and blacks. hormones circulating in the body in response
If the experience of racial discrimination to environmental stressors perceived by the
can affect cardiovascular health, birth out- regulatory mechanism of the brain and auto-
comes, and mental health, how early does that nomic nervous system. As described by Jackson
experience begin to exert its effects on blacks and colleagues, “Although the stress response is
in the United States? Sanders- Phillips et al. well-adapted to deal with acute stressors, chronic
(2009) suggest that these factors begin to influ- activation of the system—as is often the case for
ence children early in the life course, with po- those with poor living conditions and psycho-
tentially harmful effects that may be lifelong. logical stressors—results in poor psychological
They suggest that and physical health outcomes” (2009, p. 934).
They suggest that behaviors such as smoking,
A child’s sense of control over life and health overeating, drinking alcohol, and using drugs
outcomes as well as perceptions of the world as have a direct physiological effect of reducing
the perceptions of stress created by a chroni- differences associated with early neurological
cally elevated allostatic load. development. Many of these early developmen-
tal processes, however, are directly affected by
the cultural and social context in which a child
Summary
grows up, the subject addressed in the follow-
The experience of inequality is directly associ- ing chapters.
ated with behaviors that impact well- being
throughout the life course. The behavioral out- References
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chapter
4 Society, Culture, and Behavior
T
he experience of inequality in the United States and its
impacts on health-related behaviors reflect a number of
cultural values. Concepts of race and ethnicity have come
to be defined differently in the United States than in other devel-
oped countries, based on our unique history. As the growing
number of immigrants in the United States leads to fundamental
changes in our demographic structure, diverse cultural percep-
tions and expectations increasingly affect behavior. To further
explore the link between behavior and well-being, we will exam-
ine the impact of cultural context on individuals, especially on
children and young adults as they come to perceive their place in
society.
The impact of culture: The Cultural Cycle

In their book titled Clash!, Markus and Conner (2013) suggest that,
even though we as individuals often perceive our behavioral re-
sponses as consciously and intentionally driven, “psychologists
have long known that most of what actually drives your behavior
sails under the radar of your conscious awareness” (p. xviii). They
instead suggest that our behavior is often driven by a series of
nested interactions involving (a) our association with those in our
immediate social environment, (b) our response to cultural insti-
tutions we have learned and internalized as part of the process of
growing up, and (c) broad general ideas or concepts that create the
structure for our culture and its institutions. Their model, which
they refer to as the Cultural Cycle, is shown in figure 4.1. I explain
each of the core elements of the model in more depth below.
The individual
The individual at the center of this Cultural Cycle includes the
cognitive and emotional patterns a person has developed in com-
bination with her or his personality traits and internal motivating
48
S o ci e t y, C u lt u r e , a n d B e h av i o r 4 9
Central ideas and concepts
Cultural institutions
Social interactions
The
individual
Figure 4.1. The Culture Cycle. Based on Markus and Conner 2013.
characteristics—qualities we will address in later critical for those of which the parents don’t
chapters. Very often an individual perceives her- approve—plays a major role in defining for the
self or himself as autonomous and independent infant the optimal behavioral response to a cer-
of those around her or him. Markus and Con- tain situation. As the child gets older, siblings
ner underscore that this sense of an indepen and other family members play an increasingly
dent self is not universally held. The extent to significant role in defining expected and appro-
which one perceives oneself as independent of priate behavior. (I can recall distinctly the be-
or interdependent with one’s social and cultural haviors my older brother defined as unacceptable
context differs across societies. for me and the actions he would take in response
when I engaged in them.) As we grow older and
spend more time with friends and age-mates in
Social interactions
school and at play, we add other guidelines as to
As described by Markus and Conner, our inter- which behaviors are approved of and which are
actions are with o thers, “at home, school, work, not. The behavioral expectations of our teach-
worship, play, e tc.” (p. xx). Especially important ers play an important role here, although the
for young children are interactions with o thers teacher’s expectations may be contrary to those
in the family. For the infant, this is principally of our friends, sometimes creating a behavioral
the parent, often the mother. As we will find in dilemma. As we grow into adulthood these
chapter 9 when we discuss the development of networks of social interaction grow to include
cognitive abilities, the frequency with which a those with whom we work and those groups
mother speaks directly to her young infant and with which we spend time (religious, sports,
the number of words spoken are principal de- social, e tc.). In each of these circumstances we
terminants of the infant’s language develop- become aware of the expectations of o thers as
ment. Similarly, the parents’ response to the to what constitutes appropriate behavior in a
behavior of the infant—supportive for those given set of circumstances. Our continued mem-
behaviors of which the parents approve and bership in these social networks may depend to
a certain extent on how well we follow these together, these background ideas hold our cul-
expectations. tures together” (p. xx). They suggest further
that, while these central ideas around which
cultures form are slow to change, they are sub-
Institutions
ject to change. “You cannot directly alter the big
The concept of the cultural institution includes ideas that animate the entire culture cycle, be-
both certain organizational forms and certain cause they are so deeply rooted. But over time,
rules of behavior. Those rules are sometimes as I’s, interactions, and institutions shift, big
written and formally adopted and sometimes ideas follow suit” (p. xxi). In the history of the
simply understood, without the necessity of United States and other Western countries, these
written instructions. As described by Markus “big ideas” that have organized our cultural cy-
and Conner, “Institutions spell out the rules for cle and that have changed over time in response
a society and include legal, government, eco- to underlying changes in individual and group
nomic, scientific, philosophical, and religious expectations include race and gender roles.
bodies” (p. xx). As described by Barr, “The con- Both were fundamental in much of American
cept of an ‘institution’ refers to the rules a soci- history, and both have altered fundamentally.
ety adopts that create its social, political, and
economic structure . . . Institutions can be for-
Differing perspectives on the nature
mal, as in written laws, codes of ethics, and pre-
of social structure
scribed procedures, or they can be informal, such
as common courtesy and the strength of f amily A number of sociologists have developed theo-
ties” (2011, pp. 50–51). Nobel Prize–winning econ- retical models of how these “central ideas” iden-
omist Douglass North referred to institutions as tified by Markus and Conner, as well as other
“a guide to human interaction, so that when we core belief systems, have come together to cre-
wish to greet friends on the street, drive an auto- ate the overall structure of a society. While
mobile, buy oranges, borrow money, form a busi- many of these models have aspects in common,
ness, bury our dead, or whatever, we know (or others have fundamental inconsistencies. These
can learn easily) how to perform those tasks . . . classical theories of social organization include
Institutions may be created, as was the United the following perspectives.
States Constitution; or they may simply evolve
over time, as does the common law” (1986,
Conflict Theory
pp. 3–4). Thus, not only do we consider what
types of behavior are expected by those in our From a conflict perspective, the overarching
immediate social context, we also take into ac- structure of society develops as a consequence
count the formal and informal rules of our of struggles over power and influence. Many of
broader cultural group in choosing how to re- the writings of Karl Marx emphasized competi-
spond to a certain stimulus. tion among groups such as workers and capital-
ists over economic resources as central to the
structure of society. A consequence of a conflict
Ideas
approach will be varying levels of social inequal
The final layer in the Cultural Cycle proposed ity due to the unequal distribution of resources
by Markus and Conner “is made up of the cen- within a society. A further consequence of this
tral, usually invisible ideas that inform our conflict over resources will be a lack of broadly
institutions, interactions, and, ultimately, our shared social values. A common result of this
I’s. Like the unseen forces that hold our planet lack of shared social norms is fragmentation of
society along lines of class, race, and gender, with Each of these perspectives on the origins of
the inherent inequality these categories entail. social structure gives a central role to the insti-
tutions that are socially constructed by groups
and societies. As described above, these institu-
Functionalism
tions define the commonly understood rules for
Nineteenth-century sociologist Emile Durkheim the creation of social structures such as gov-
also wrote about the d ifferent segments of soci- ernments or commercial enterprises as well as
ety, although he perceived them not as engaged for the types of behavior perceived as socially
in conflict but rather as parts of a stable, over- acceptable.
arching social structure. A number of 20th-
century sociologists have built on this concept,
The role of culture in influencing
exploring the ways in which various compo-
personality and behavior
nents of society contribute to the overall stabil-
ity of society. A key contributor to a stable so- In describing the cycle illustrated above, Markus
cial structure over time will be a set of shared and Conner define the concept of culture as,
public values and perceptions. Maintaining this “the ideas, institutions, and interactions that
ongoing social consensus will be a core respon- tell a group of p eople how to think, feel, and act”
sibility of those in leadership positions. (p. xix). We may perceive in the moment that
our behavioral response in a given circumstance
is u
nder our individual control, while in fact our
Symbolic interaction
behavioral responses inevitably include cultural
Originating with the writings of George Her- factors we have internalized.
bert Mead, this perspective on the origins of The understanding of culture offered by
social structure suggests that people often rely Markus and Conner is similar to that proposed
on the symbolic meaning they perceive in the by Benet-Martinez and Oishi (2008). From their
actions of others. People who observe behavior perspective, “Culture consists of shared meaning
in o thers will often attribute symbolic meaning systems that provide the standards for perceiv-
to that behavior, e ither positive or negative. As ing, believing, evaluating, communicating, and
people come to interact with o thers, they incor- acting among those who share a language, a
porate into their actions both their intended historic period, and a geographic location.
symbolic meaning and their perception of the Culture . . . deals specifically with the values
likely response of o thers to that action. How and norms that govern and organize a group of
others respond to this action will determine the people (e.g., capitalistic culture), defining char-
stability of the connection between these indi- acteristics and behaviors that are deemed ap-
viduals, and ultimately between social groups. propriate and inappropriate” (p. 542).
A common example given for the importance of In most of American culture, when we are in-
the symbolic meaning of actions is the ways troduced to someone we have not met before and
adolescents compare their own behavior to that person holds out his or her hand, we recip-
the way they perceive other members of their rocate by offering our hand to shake. We typi-
social group to perceive that behavior. If an cally do this automatically, even though in doing
adolescent perceives that his or her friends so we are following cultural expectations. In non-
view smoking as a positive behavior, he or she Western cultures, it may instead be perceived as
may be more likely to begin smoking, even if he rude and perhaps offensive for a stranger to
or she has learned the harmful health effects offer us their hand. There may be more appro-
of smoking. priate, culturally defined ways to indicate to a
T abl e 4.1 . The Key Differences between an Independent and

an Interdependent Concept of the Self
Feature Independent self Interdependent self
Definition Separate from social context Connected with social context

Tasks Be unique Belong, fit in
Express self Occupy one’s proper place
Realize internal attributes Engage in appropriate action
Promote own goals Promote others’ goals
Be direct; “say what’s on your mind” Be indirect; “read others’ minds”
Role of others Self-evaluation: others important for Self-definition: relationships with o
thers
social comparison, reflected appraisal in specific contexts define the self
Basis of self-esteem Ability to express self, validate internal Ability to adjust, restrain self, maintain
attributes harmony with social context
Source: Based on Markus and Kitayama 1991.
stranger that we acknowledge and res pect view of the self (as reflected in Japa nese
them. How enthusiastically or how hesitantly society).
we offer the culturally appropriate greeting may Markus and Kitayama describe the concept
reflect our individual personality in the context of the independent self in the following man-
of that culture. Thus, “personality—the affec- ner: “In many Western cultures, there is faith in
tive, m
otivational, and cognitive dispositions the inherent separateness of distinct persons.
that influence our evaluations and reactions to The normative imperative of this culture is to
the environment—cannot be separated from the become independent from others and to dis-
broad social and cultural context in which it de- cover and express one’s unique attributes” (1991,
velops and is expressed” (Benet-Martinez and p. 226). By contrast, the concept of the interde-
Oishi 2008, p. 544). pendent self, as reflected in many non-Western
Culture creates specific norms of behavior, cultures, is based on the perception of “the fun-
such as how to greet a stranger when intro- damental connectedness of h uman beings to each
duced. Typically, culture also establishes cer- other . . . Experiencing interdependence entails
tain central values that are shared by those seeing oneself as part of an encompassing social
within that culture. One key aspect of this type relationship and recognizing that one’s behav
of culturally derived value is how to see one’s ior is determined, contingent on, and, to a large
self and one’s needs in relation to o thers within extent organized by what the actor perceives to
the cultural group. Markus and Kitayama (1991) be the thoughts, feelings, and actions of others
have explored the fundamentally different role in the relationship” (1991, p. 227). The principal
the self plays in different cultural traditions. differentiating aspects of these contrasting
In their research they compared and contrasted models of the self are shown in table 4.1.
the role of the self in the United States and Japan. The independent person sees himself or her-
They identified two fundamentally different cul- self as existing to a large extent separately from
tural models of the relationship between the the broader social context. The tasks of an inde
individual and the broader social or cultural pendent person are to be unique, to express your-
group. They labeled these contrasting models self, to say what’s on your mind, and to set and
as the “independent” view of the self (as re- pursue your own goals, based on your own sense
flected in US society) and the “interdependent” of self. You use the others around you as a basis
of comparison and to get a sense of how you are values exist simultaneously, has consequences
doing. By contrast, the interdependent actor both for behavior and for health outcomes. I
sees herself or himself as a part of, and not sep- discuss this issue in more depth later in this
arate from, a broader cultural context. Her or chapter.
his tasks are to gain a sense of belonging by The differences between those raised in an
trying to fit in, by speaking in largely indirect independent versus an interdependent context
terms, and by acknowledging her or his proper do not diminish the similarities in the process
place in the broader social structure. One acts of growth and maturation children experience
as others expect and tries to place the needs of in d ifferent cultures. The early neurological and
others ahead of one’s own needs. The indepen cognitive development of children born into
dent individual gains a sense of self-esteem by different cultural environments are fundamen-
being able to express uniqueness, while the in- tally similar. The role of hearing language as a
terdependent individual gains self-esteem by basis for developing language, and the cognitive
maintaining harmony in the relationship with development of a sense of one’s capabilities—as
others and by always remembering: “Don’t make well as the vulnerability of this developmental
waves!” process for children raised in neglectful or
Markus and Kitayama suggest that, across abusive circumstances—are largely the same
different societies and different cultures, “per- regardless of cultural context.
son is a social and collective construction made While the under lying developmental pro
possible through an individual’s participation cesses may be similar in d ifferent cultures, the
in the practices and meanings of a given cul- internalization of norms and values from the
tural context” (1998, p. 63). They also caution cultural context in which one grows up may
that, as scholars raised and working in a largely still have powerful effects on how one responds
Western cultural tradition, we not simply ac- to a range of personal circumstances. For ex-
cept the in dependent concept of self as the ample, Park et al. (2012) looked at how adults in
given norm. Nor should we approach the inde Japan and the United States responded to stress-
pendent/interdependent contrast as strictly a ful circumstances in their lives, based on their
contrast between Eastern and Western cultures. perceived level of social support from their
They underscore that, beyond being a cultural spouse or partner, other family members, and
characteristic of cultures such as Japan, China, friends. They evaluated the extent to which the
and Southeast Asia, interdependence is also stressful circumstances w ere associated with
characteristic of many areas of Africa and South poor physical health (measured as the number of
America. Markus and Conner (2013) describe chronic conditions experienced recently) and self-
Mexican culture, both for those living in Mex- rated health. For adults in Japan experiencing
ico and for Mexican-Americans living in the stressful conditions, perceiving stronger so-
United States, as heavily interdependent, with cial support was associated with better health
emphasis on characteristics such as simpatía status than those reporting less sense of support.
(pleasant relationships with others) and the im- By contrast, US subjects demonstrated no asso-
portance of la familia (the family). The impor- ciation between social support and health status.
tance of interdependence for Mexican-Americans In another study comparing Japan and the
presents potential problems for those living in United States, Kan et al. (2014) assessed how cer-
the United States, where there often is a heavy tain adult personality traits affected the well-
cultural emphasis on independence. The issue established association between socioeconomic
of acculturation, or how one adapts to a situation position (SEP) and health outcomes. SEP was
in which both independent and interdependent mea sured in two ways: level of education
completed and perceived subjective social sta- statistically controlling for factors such as age,
tus (SSS). They hypothesized that self-esteem, a gender, education, lifestyle behaviors (e.g.,
characteristic more valued in independent cul- smoking and obesity), and overall physical
tures than in interdependent cultures, would health status. Once again, psychological traits
show a stronger effect on the association of SEP important to those in independent cultures,
and health status in the United States than in whether positive or negative, have a stronger
Japan. They confirmed this hypothesis, finding association with health status than comparable
that “self-esteem significantly mediated almost traits in those living in a culture that values
all of the associations of education and SSS with interdependence.
self-rated health and chronic conditions among
men and women in the USA, but very few such
Other contexts in which independence
associations in Japan” (p. 53).
and interdependence Clash!
Miyamoto et al. (2013) took these analyses
one step further, measuring the level of a physi- As described above, Markus and Conner (2013)
ological stress marker in adults in Japan and the provided an extensive review of the range of
United States who w ere experiencing negative social and cultural contexts in which indepen
emotions. Recall that, in many interdependent dence and interdependence exist side by side,
cultures, negative emotions such as sadness and often creating potential conflict. These include
anxiety are not perceived as demonstrating in- the following contexts.
dividual weakness. Rather, they reflect the need
to adjust one’s level of effort and to rely on the
Gender
support of others. In an independent culture,
by contrast, these types of emotions are often When my son was 2 years old, I had an experi-
perceived as a sign of personal weakness or in- ence that solidified for me the fundamental dif-
adequacy. The body’s stress response system is ference in gendered patterns of behavior, at
reflected in its allostatic load—a measure of the least as manifested in the western United States.
hormones and other bio-markers triggered by Whether due to the impact of the X:Y chromo-
encountering stressful circumstances, either some ratio or to parents’ gender-specific response
acutely or chronically. A chronically increased to infants beginning at birth, it seems that boy
allostatic load has been found to be associated toddlers and girl toddlers often have a different
with elevation in certain markers of cellular in- outlook on life, and on the importance of con-
flammation in the body which, over time, can necting to other p eople.
cause tissue injury. One of these inflammatory While dropping my son off at his child-care
markers is interleukin-6 (IL-6). Miyamoto et al. center, I walked in with him to say hello to the
measured the level of IL-6 in several hundred teachers and to the other parents there. As soon
adults in Japan and in the United States. They as we got in the room, my son, clad in a diaper
also measured the level of negative emotions and a T-shirt, looked across the room and saw his
being experienced by these subjects, using a friend Kevin playing with a toy truck. My son
standardized psychological assessment tool. cried out a single word: “Truck!” Kevin looked
Among the US subjects, experiencing a higher back and responded in just as enthusiastic a
level of negative emotions was significantly voice, “Truck!” It only took a few seconds for the
associated with a higher level of IL-6 in the two boys to be happily pushing the truck back
blood. Among subjects in Japan, there was no and forth.
association between negative emotions and Standing next to me, watching what had
IL-6. These findings w ere unchanged after transpired between the boys, was little Emily,
also two years old and also clad in a diaper and “win” might lead to a greater outcome for the
a T- shirt. When I looked down at her, she winning party in the short term, such a “win-
smiled, looked me in the eyes, and said, “Hi! lose” dichotomy leads to worse outcomes over
How are you?” the long term for both parties when they are
How was it, I asked myself, that by age of 2, required to negotiate repeatedly over time.
my son and his friend each wanted to see who If, by contrast, a negotiator considers both
could push the truck faster, while Emily wanted his or her needs as well as the needs of the other
to know how I was d oing? Markus and Conner party to the negotiations and seeks to optimize
offer an answer for my question. “If you thought the combined outcome of both parties, these
that gender differences in selves and statuses “win-win” negotiations have been shown to pro-
arose mostly from biology, you could be for- vide greater benefits to all involved. Perhaps not
given . . . Rather than coursing through their surprisingly, as more women have assumed po-
veins, leaping across the synapses, or lighting sitions of leadership and have brought a win-
up the cerebral lobes of men and women, the win, interdependent perspective to negotia-
causes reside in the products and practices of tions, both men and women have seen the
men’s and women’s daily lives” (2013, pp. 48–49). greater outcomes produced by this approach,
It seems as parents, my wife and I had major and many men have worked to learn and adopt
roles in teaching our son to be male, to be strong this perspective on negotiation.
and independent. Likewise, Emily’s parents and In her book Secrets of Successful Negotiation for
the o thers who cared for her from the time she Women, publishing executive Wendy Keller de-
was born (e.g., child-care teachers) helped her scribes how “the people skills are the greatest
to learn to look to relationships and to be sensi- asset in a negotiation, the ability to intuitively
tive to the needs of others. Again, as described understand where someone is coming from . . .
by Markus and Conner, “Parents’ different Luckily, they are the under-celebrated skills in
expectations for boys and girls emerge even which w omen tend to naturally excel . . . [W]hat
before their children are born . . . When new- woman w asn’t 6 years old once and didn’t real-
borns greet the outside world, adults are ize that ‘win-win’ was the best way to play Bar-
standing by to shape the infants’ selves in gen- bies? . . . We already know it’s about win-win”
dered ways” (p. 49). (2004, p. 17). She goes on to caution women that
It seems that, in the United States at least, girls they may often have to work with “people who
are more likely to develop an interdependent may not have our enlightened perspective”
perspective on their social environment, while (i.e., men) but advises women to look for an
boys are more likely to develop an independent outcome that gives these unenlightened others
perspective. These differences affect how boys enough of what they want so they will come
and girls interact through the school experi- away from the negotiation feeling that they,
ence, from their time in diapers through higher too, have won.
education. Once they attain positions of leader- Markus and Conner also emphasize the im-
ship, men and w omen have been shown to portance of the gendered differences over inde
bring these perspectives to their interactions pendence and interdependence for educational
with others. When negotiating in a business en- outcomes, especially in the areas of science,
vironment, men often work for the “win”—the technology, engineering, and mathematics, of-
best outcome from their own perspective, re- ten referred to collectively as STEM fields.
gardless of how that outcome is viewed by They describe how, in both high school and col-
the other parties to the negotiation. It has been lege, “STEM is represented as an independent
shown, however, that while negotiating for a undertaking— the province of Lone Rangers
and cutthroat geniuses who can abstract theo- fessors. The women students described a grow-
ries from applications and separate signals from ing sense of not belonging, with the result that
noise” (p. 51). most transferred out by the end of their sopho-
Margolis and Fisher (2002) developed a study more year.
of computer science undergraduates at the Based on these findings, the leadership at the
Carnegie Mellon University (CMU) School of CMU School of Computer Science made some
Computer Science. In the 1990s, officials at the basic changes to the way they taught students.
school had noted that, of the students who en- They worked with faculty to increase aware-
rolled in computer science as freshmen, fewer ness of the gender bias they had identified in
than 10 percent w ere w
omen. Of those w omen the classroom culture and the differing per-
who did enroll in computer science, fewer than spectives of men and women students as to
half were still enrolled by the end of their soph- why they were studying computer science.
omore year. The others had transferred to other They also focused on attracting w omen faculty
parts of the University that didn’t involve com- and helping women students to form networks
puters. By contrast, of the 90 percent of male to be able to work together on instructional is-
entering students, more than 90 percent w ere sues they encountered. After three to four years
still enrolled at the end of their sophomore year. of these new techniques, they found that the
Between the years 1995 and 1999, Margolis persistence of women as computer science ma-
and Fisher interviewed about 100 CMU com- jors had risen to nearly 90 percent, comparable
puter science students, split evenly between to that of men. In addition, as the word got out
men and w omen. In comparing responses by to high school students that women were feel-
gender, they found that girls started relating to ing more welcome in computer science at CMU,
computers in fundamentally d ifferent ways than the percentage of w omen in the entering class
boys as early as first grade. Women described went from 7 percent to 42 percent.
using computers as young girls for activities Another STEM area in which women tradi-
such as writing stories, while men described tionally lag b ehind men in college is physics.
playing games on computers as young boys. By Lorenzo et al. (2006) studied men and women
high school these differences had become more freshmen students at Harvard University who
pronounced, with boys becoming more self- had enrolled in an introductory physics class.
confident and more aggressive in using comput- They found that, coming out of high school,
ers. Women described a male-dominated culture women students on average knew less physics
evident both in the high school computer science than men students. By the end of the traditional
class and in the computer lab. lecture-based physics course, the gender gap had
For those students who did enter CMU as widened, indicating that men had increased their
computer science majors, study respondents de- knowledge of physics by a greater amount than
scribed another cultural divide. As freshmen, women as a result of having taken the course.
men seemed most interested in learning the As a first step in addressing this gap, the
technical aspects of computer hardware and physics faculty switched from a strictly lecture-
software, whereas w omen expressed a stronger based format to what they referred to as a peer
interest in learning how to use computers to instruction format, which interspersed short
address social and economic problems. The in- (10–15 minute) lectures with interactive, small
troductory computer science classes focused group discussions of the issues raised in the lec-
heavily on the technical aspects of computing ture. A
fter a few years’ experience with this
and had a strong male-dominant class culture, model, they went a step further, adding a weekly
including the type of humor used in class by pro- two-hour session in which students worked to-
gether in small groups, seated around tables, on those in Asia and other parts of the world. From
a series of tutorials and hands-on experiments. her study of children in New York City from
This learning model showed a striking result. different socioeconomic backgrounds, she cau-
Despite women continuing to enter Harvard tions, “A fter many years of contrasting ‘indi-
with a weaker knowledge of physics, by the end vidualist’ Americans with people from other,
of the year-long physics class, students engaged ‘collectivist’ cultures, social scientists are now
in this “highly interactive” approach to learning recognizing that within the United States the
no longer showed a gender gap in their knowl- meaning of individualism varies widely. We are
edge of physics. Not only had the women stu- also finding that not all communities practice,
dents attained the same knowledge level as use, or socialize the same strands of individual-
their male classmates, the men had also learned ism” (2005, p. 40).
more physics with the interactive model than Whereas children raised in the United States
they had with the traditional, lecture-based may still tend to be more individualistic than
model. The women, having started from a those in other cultures, Kusserow suggests that
weaker place, had learned even more. From their children in contrasting socioeconomic environ-
study the authors concluded that “By creating a ments will likely adopt contrasting forms of
classroom environment that benefits both gen- individualism: “a ‘soft,’ upper-middle-class indi-
ders, the teaching approach described h ere im- vidualism, which focuses on the cultivation and
proves student understanding and narrows the expression of unique feelings, thoughts, ideas,
gender gap in physics education” (p. 121). and preferences; and a ‘hard,’ working-class in-
Data across a range of STEM fields have re- dividualism, which focuses on the cultivation of
peatedly demonstrated gender gaps in learning self-reliance, perseverance, determination, pro-
and a clear benefit to w omen students when the tectiveness, and toughness” (p. 40). Based on her
classroom incorporates interactive and support- study of children, parents, and teachers in a
ive aspects. In a classroom environment that working-class area of Queens and in the Upper
maintains its traditional independent culture, East Side of Manhattan, she contrasted these
there is an added risk for many women students. alternative manifestations of individualism, as
By repeatedly experiencing lower learning out- shown in table 4.2.
comes and performance in STEM fields, many Both children and parents from upper-class
women may attribute these weaknesses to their sections of New York City saw the world gener-
own intellectual inadequacy. By resetting their ally as a welcoming place in which children can
own self-image at a lower level of intellectual ca- work hard and expect success. Parents and
pability, they may lower the goals and expecta- other caregivers praise and encourage their
tions they set for themselves, much in the same children, careful not to lower the children’s self-
way that a reduced sense of self-efficacy can af- esteem through harsh criticism. By contrast,
fect the goals one adopts (see chapter 7). those in the working-class neighborhoods of
New York saw the world as a potentially dan-
gerous place in which children need to develop
Social class
the requisite toughness to persevere through
Anthropologist Adrie Kusserow has studied so- difficulty. Parents and caregivers use strong
cial class differences in the United States and discipline to help the children develop resilience,
suggests that there are class-based differences given the uncertainty of what the future holds.
in perspectives on individualism that are every Children as well as adults who grow up and
bit as important as the differences we discussed live in lower socioeconomic circumstances are
above between those in the United States and well aware of the difference between themselves
T able 4.2 . Comparing Soft and Hard Individualisms in Manhattan and Queens

Soft Hard
Individualism means Emotional expression, creativity, Emotional control, self-reliance,

uniqueness toughness, perseverance
The self is Delicate and full of promise, like a Hard and protective, like a fortress;
blooming flower strong and determined, like a rocket or
Superman
Caregivers should Give praise and encouragement, mirror Tease, discipline, toughen up, nurture
emotions, foster creativity without softening
Caregivers shouldn’t Damage self-esteem, block flowering Spoil or overindulge
of the self
The world is Safe and welcoming, open to uniqueness Potentially dangerous and forbidding,
filled with ups and downs
The future holds Success, personal achievement Uncertainty, struggle, possible fulfill-
ment (with hard work)
Source: Kusserow 2005.
and those in upper-class circumstances. They linked to psychological factors that may predis-
perceive not only economic differences but also pose individuals to better health trajectories”
overall status differences within society. Adler (p. 590). Citing the work of Adler and o thers,
et al. (2000) showed a drawing of a ladder with Markus and Conner conclude that “People wind
10 equally spaced steps to 157 non-Hispanic white up viewing status, class, caste, and their conse-
women between the ages of 30 and 46 drawn quences as natural and inevitable, rather than as
from a range of educational and income levels. human-made and changeable” (p. 103).
They asked the w omen to “Think of this ladder These differences in perspective based on
as representing where people stand in our soci- socioeconomic position can have powerful im-
ety. At the top of the ladder are the people who pacts on students making the transition from a
are the best off, those who have the most money, socioeconomically disadvantaged high school
most education, and best jobs. At the bottom are background to the highly competitive and indi-
the p eople who are the worst off, those who vidualistic environment of an American univer-
have least money, least education, worst jobs or sity. In an effort to increase the diversity of the
no job.” They then asked each subject to place student body, American colleges and universi-
an “X” on the rung of the ladder that represented ties often focus their admissions policy on dis-
where she thought she stood in society. Most advantaged socioeconomic background rather
subjects placed themselves on rungs 5 to 8, with than an applicant’s race. Many of these students
some as low as step 1 and a few at step 10. selected for admission are of the first genera-
The researchers then compared a measure of tion in their family to attend college (FirstGen).
socioeconomic status that combined education Many of these FirstGen students will experi-
and income to the rung marked by the subject ence a difficult transition into the college envi-
and found them to be highly correlated (r = .40, ronment. As described by Stephens et al., “this
p < .01). The authors demonstrated that, among adversity also stems from a cultural mismatch
these women, subjective social status, as reflected between the mostly middle-class, independent
in the ladder rung they marked, “is strongly norms institutionalized in American universi-
ties and the relatively interdependent norms that (p. 1392). I discuss the issue of cultural capital in
first-generation students are socialized with in more depth in chapter 5.
working- class contexts before college” (2012,
.
p. 1389)
Race and ethnicity
Stephens et al. conducted an experiment to
test the idea that FirstGen freshmen students Race and ethnicity have always been powerful
who perceived the university environment as aspects of self-identity in the United States. In
clashing with their own perspective would ex- 1897, Senator Henry Cabot Lodge of Massachu
perience a higher level of stress. They recruited setts stood on the floor of the US Senate and
about 80 incoming freshman students, roughly argued, “Surely it is not too much to sift now
evenly divided between FirstGen students and the hordes that pour out of every European
students from academically advantaged families. steamship unsifted, uncounted, unchecked . . .
All of the subjects were asked to read a welcome The races that built up this country come in
letter from the university president describing diminishing numbers. New races, utterly alien,
the experiences they would encounter as stu- come in ever increasing numbers.” The “new
dents. For half of the students in both groups, races, utterly alien” the senator was referring
the letter described the university as a place to at that time were the Irish, Italians, and
where highly independent students will thrive. Jews. In 2014, the arguments heard on the floor
For the other half, it described the university of the US Senate were more likely to involve
environment as supportive of an interdepen- Mexicans, Hondurans, and Guatemalans, al-
dent, group-oriented approach to learning. Fol- though the rhetorical descriptions sounded
lowing this, students were instructed to give a largely the same.
five-minute speech to the group describing their Race involves issues of physical appearance
own college goals. The researchers then mea as well as ancestry from certain parts of the
sured the level of stress each student had expe- globe. In the 2010 census, the United States
rienced, using the level of cortisol in the stu- recognized five racial groups: White, Black or
dent’s saliva as an indicator of stress level. The African American, Asian, American Indian or
students from the more advantaged background Alaskan Native American, and Native Hawaiian
showed no difference in their stress level based or Other Pacific Islander (US Census Bureau
on w hether they had read the independent or 2011). By contrast, Hispanic origin was consid-
the interdependent welcoming letter. By con- ered an ethnicity, not a race. Within the cate-
trast, the FirstGen students who read the inde gory of Hispanic are multiple ethnic groups
pendent welcoming letter showed a significant based on geography, language, and local cul-
increase in their cortisol level as compared to ture, just as there are multiple ethnic groups
the FirstGen students who read the interdepen- within each of the groups categorized by the US
dent welcoming letter. As the authors de- government as races.
scribed, “These results suggest that a culturally- As reflected in the comments of Henry
mismatched environment—in this case, a mis- Cabot Lodge cited above, in the history of our
match between independent and interdepen- country, the highest social status has often
dent cultural norms—can burden first-generation been given to those who are white—initially to
students with an additional, largely invisible those who w ere white and Protestant. As other
layer of adversity . . . These independent cul- white ethnic groups such as Irish, Italians, and
tural norms can be viewed as one important Jews came to this country in increasing numbers,
source of the middle-class cultural capital that a new status hierarchy was created. Through-
helps students to navigate college environments” out this period, though, those of black African
ancestry w ere consistently at the bottom of the one self than the other, but to conjure more
status hierarchy—something blacks in the United readily the self that best fits the situation”
States have historically been fully aware of. Dur- (p. 65).
ing later periods of immigration from Asia, Cen- The potential clash for minority students be-
tral Europe, and Central and South America, the tween independent and interdependent selves
racial/ethnic status hierarchy has become more often occurs as students enter college, espe-
complex. cially if they are transitioning from a socioeco
As described by Plaut, the distinctions indi- nom ically disadvantaged background into a
viduals make based on race and ethnicity, “are highly competitive university environment. As
not simply natural, neutral, or abstract. Instead has been the case for gender, this clash often
they are created and recreated in the process of occurs for students of STEM subjects. Treisman
everyday social interactions that are grounded (1992) described how, for many years at the Uni-
in historically derived ideas and beliefs about versity of California, Berkeley, a high percentage
difference and in a set of practices and institu- of black and Hispanic students who enrolled in
tions that reflect these ideas and beliefs and that his freshman calculus course would fail the
therefore shape psychological experience and course and as a result would be less likely to
behavior” (2010, p. 77). Children growing up in pursue a career that depended on a knowledge
the United States, regardless of their family’s ra- of mathematics. By contrast, the Chinese stu-
cial or ethnic background, learn these lessons, dents who enrolled in calculus typically did
both consciously and unconsciously. Appiah well in the course. To see why the mathemati-
(1990) has described the different forms racial cal success of these two minority groups was so
and ethnic bias can take. He acknowledges that different, Treisman interviewed students from
not all forms of bias are conscious and intended. both groups.
Bias is often manifested unconsciously through For many black students, Treisman found the
the inappropriate application of stereotypes to following pattern: “You wake up in the morn-
individuals, or simply by a developing feeling of ing. You go to class. You take notes. You get your
aversion or discomfort when encountering homework assignment. You go home. You do
someone of a different race or ethnicity. your homework religiously and hand in every
A person who grows up as a member of a assignment on time. You put in six or eight hours
nonwhite minority group will internalize a clear a week of studying for a calculus course, just
sense that he or she is different from whites. It what the teacher says, and what happens to you?
is important for many of these individuals to You fail” (p. 366). Treisman noted that most black
maintain a sense of group identity with others students approached this process independently.
of similar background. This sense of group ra- Rarely would a black student study for calculus
cial identity encourages the development of a with his classmates. By contrast, many Chinese
sense of interdependence that may coexist with students would gather together several evenings
the sense of independence learned from the a week and study for calculus as a group, with
broader US culture. When an individual experi- each person contributing while also learning
ences racial bias, whether consciously intended from the o thers. They would both learn from
or not, he or she may experience the “Clash” and support each other.
Markus and Conner refer to when they suggest Based on what he observed in the Chinese
that “many American minorities have already students, Treisman began to work with black
developed robustly in de
pen dent selves that and Latino students entering his class, encour-
travel alongside their interdependent selves. So aging them to form study groups and to learn
their challenge will not be to cultivate more of from each other as well as from the assign-
ments. He also encouraged students to develop Research Council offered a definition of the con-
a sense of community based on a shared inter- cept: “Acculturation comprehends those phe-
est in mathematics. Treisman described the nomena which result when groups of individuals
outcome: having d ifferent cultures come into continuous
first-hand contact, with subsequent changes in
The results of the program w ere quite dramatic. the original cultural patterns of either or both
Black and Latino participants, typically more groups” (Redfield et al. 1936, p. 149). One can
than half of all students enrolled in calculus, look at the immigration of Asians or Hispanics
substantially outperformed not only their to the United States as a process of accultura-
minority peers, but their White and Asian tion. One might also consider the entry of First-
classmates as well. Black students with Math Gen students into highly competitive colleges
SAT scores in the low-600s were performing and universities as a process of acculturation. In
comparably to White and Asian students whose either case, how individuals and families re-

Math SATs w ere in the mid-700s. Many of the spond to the cultural differences they encounter
students from these early workshops have can have powerful effects on behavior as well
gone on to become physicians, scientists, and as on well-being.
engineers. (p. 369) Sam and Berry (2010) have described different
patterns of acculturation and their potential im-
In much the same way that women at Har- pacts. They identified four principal patterns of
vard learned substantially more physics when acculturation (p. 476):
the learning pro cess was group- based and
highly interactive, black and Latino students at • Assimilation: The “strategy used when
Berkeley meaningfully improved their success individuals do not wish to maintain their
in mathematics when they created an environ- cultural identity and seek close interaction
ment that fostered interdependent learning. with other cultures (or in some cases adopt
the cultural values, norms, and traditions of
the new society).”
Acculturation: When p eople move
• Separation: The strategy of “individuals
across cultural boundaries
who place a high value on holding on to
It thus appears that across gender, social class, their original culture and avoid interaction
and race/ethnicity, some individuals grow up with members of the new society.”
and adopt an interdependent perspective on their • Integration: -The strategy “used by individu-
role in the broader social and cultural context, als with an interest in maintaining one’s
whereas o thers grow up with an independent original culture while having daily interac-
perspective. In a number of circumstances, in- tions with other groups—t here is some
cluding in particular the educational experience, degree of cultural integrity maintained, while
these perspectives can clash, leaving some stu- at the same time they seek, as a member of
dents feeling as though they belong in a posi- an ethnocultural group, to participate as an
tion of advantage and o thers feeling a sense of integral part of the larger social network.”
disadvantage. How individuals perceive and • Marginalization: The strategy “defined by
respond to this potential clash of perspectives little possibility or lack of interest in cultural
will affect the behavioral patterns they adopt. maintenance (often for reasons of enforced
Social scientists have been studying the issue cultural loss) and l ittle interest in having
of acculturation for decades. In 1936, a commit- relations with o thers (often for reasons of
tee of scholars appointed by the Social Science exclusion or discrimination).”
Based on the acculturation pattern an indi- ner, these factors exert their influence at the
vidual adopts, he or she will acquire different social, cultural, and institutional level. Thus the
types of what Sam and Berry refer to as “socio- pattern of behavior one adopts as an adolescent
cultural skills for living effectively in the new or young adult, especially behaviors linked
sociocultural milieu” (p. 478). The level of these either directly or indirectly to well-being as an
skills one acquires will have a direct impact on adult, will depend on a combination of the per-
one’s overall sense of physical and psychologi- sonality and motivation an individual brings to
cal well-being and on overall life satisfaction. a situation as well as these external factors.
Ahadi and Puente-Díaz (2011) studied how Mead et al. (2014) have described how vari
the acculturation process of Hispanic students ous levels of normative influence coming from
attending a university in Texas might differ one’s interaction with her or his social net-
among individuals based on their differing works affect behavior, using as illustration the
personality traits, using what is commonly re- example of smoking behavior. They suggest that,
ferred to as the “Big Five” personality inven- especially with unhealthy behaviors such as
tory, described in chapter 7. They found that smoking, social networks play a key role. These
students higher in extraversion demonstrated a networks involve personal relations with o thers
better adjustment to the cultural environment as well as more general social interaction either
of the university, while those demonstrating with individuals or with groups. From these net-
higher levels of neuroticism experienced a works, individuals come to understand the
more negative affect with more frequent symp- norms of behavior that are expected of them.
toms of depression. The effects of these psycho- Mead et al. differentiate these social net-
logical traits appeared to be in addition to the works into two groups, which they refer to as
effect of the type of acculturation experienced proximal, involving principally family and close
by the students. friends, and distal, involving neighbors, class-
Sam and Berry also underscore the potential mates, and others with whom one has regular
role discrimination can play in the accultura- contact without forming close personal bonds.
tion pro cess, “with those experiencing high The proximal networks tend to have more in-
discrimination more likely to prefer separation, fluence in setting behavior for younger children
whereas those experiencing less discrimination and preadolescents, as behaviors exhibited by
prefer integration or assimilation . . . If immi- parents and others one has come to trust play
grants experience rejection from the society of an important role in defining these behaviors as
settlement, then they are more likely to reject acceptable. For example, seeing a parent smoke
them in return” (p. 479). As I discuss in the next on a regular basis suggests that it would also be
chapter, the experience of discrimination can acceptable for the child to smoke when he or
be a powerful influence on the behavioral re- she gets older.
sponse of an individual, especially a child or Distal social networks often define groups
adolescent in the process of developing her or and group membership that are separate and
his identity and sense of self-efficacy. distinct from f amily. As one moves into adoles-
cence and begins to develop an identity sepa-
rate from family, it is common to model that
The role of social networks in
identity on the social group or groups one
affecting behavior
either feels part of or hopes to become part of.
From the above discussions we have learned For example, in the case of smoking, those who
how several factors combine to influence be drop out of high school are far more likely to
havior. As described above by Markus and Con- smoke than those who finish high school and
go on to college. Independent of family, if an experienced discrimination were significantly

adolescent perceives herself or himself as simi- more likely also to report being current smok-
lar to one of these alternative groups, she or he ers. Interestingly, girls between the ages of 16
is likely to adopt the smoking behavior mod- and 19 who had experienced discrimination
eled on the perceived social norms of that were somewhat less likely to smoke than those
group. girls who had not experienced discrimination.
What if, though, the norms and expectations Gender plays a significant role in the ways in
of the proximal network conflict with those of which social networks influence behavior.
the distal network? If a teenager’s parents try to In looking at the model described by Mead
discourage her or him from smoking while her et al., we see a nested set of influences on indi-
or his peers are smoking on a regular basis, how vidual behavior, beginning with proximal net-
does she or he respond? Mead et al. suggest that works and extending through the broader
“When sources of normative information from environment. This model is similar in structure
the social network are in conflict, youth will to the model of the Culture Cycle described by
often conform to the smoking norms and be- Markus and Cohen, illustrated in Figure 4.1
haviors of their close peers” (p. 141). Of course, above. I have adapted that model in figure 4.2
when both proximal and distal networks en- to represent what I refer to as the Cycle of
courage smoking, the “risk of smoking behavior Behavior.
is maximized.” As individuals grow and develop, they turn
Beyond the influence of social networks, to increasingly broad social networks for guid-
Mead et al. identify an important role for the ance in adopting patterns of behavior. As part
broader environment in affecting behavior. The of normal adolescent development, over time
environment can be e ither physical or symbolic. the distal network will often take precedence
In the case of smoking, the physical environment over the family and other aspects of the proximal
would include school, social venues, restaurants network. Also, as one increasingly experiences
and bars that permit smoking, and places that the physical and symbolic environment, those
sell cigarettes. The symbolic environment would factors also come to guide behavior.
include messages from the news media, tobacco While Mead et al. have examined smoking,
marketing efforts, and sources of entertainment this is not the only behavior pattern influenced
such as movies or television. in this manner. Dietary behavior and the asso-
For many racial or ethnic minority groups, ciated problem of obesity are also influenced
the symbolic environment would also include similarly. Beginning in early childhood, parents
the presence of racial or ethnic bias and the extent adopt their own expectations of what a healthy
to which an individual from a minority group weight is for their infants. Often parents who
has experienced that discrimination. Wiehe themselves are overweight or obese have differ-
et al (2010) studied the association between ent expectations for their infant than normal-
smoking behavior and having experienced ra- weight parents. (Hager et al. 2012) In addition,
cial discrimination in a study of 2,640 low- the culture in which the parent, especially the
income black or Latino adolescents living in mother, was raised can have a powerful influ-
large cities in the United States. For subjects ence on perceptions of infant weight. Garcia
between the ages of 12 and 15, there was no as- (2004) described the disturbing interaction he
sociation between smoking behavior and having had with a young Mexican American mother
experienced discrimination within the previ- who brought her obese infant to the doctor
ous six months. By contrast, black and Latino because the mother was concerned that no come
boys between the ages of 16 and 19 who had nada—“I c an’t get my baby to eat anything.”
Physical/symbolic environment
Distal social network
Proximal social network
The
individual
Figure 4.2. The Cycle of Behavior. Based on Mead et al. 2014.
National data has shown that, among adoles- by the psychological and motivational charac-
cents age 12–19, obesity differs substantially by teristics of an individual as well as by the cul-
both gender and by race/ethnicity. In 2010 the tural environment in which that individual
highest rates of obesity were among Hispanic grows up and lives.
boys and black girls (National Center for Health The cultural environment one experiences
Statistics 2012). The rate of adolescent obesity will carry with it certain rules and expectations
has also been shown repeatedly to be influ- about how individuals are expected to behave
enced by the physical as well as the symbolic and what types of behavior are viewed as de-
environment in which families live. At highest viant. A central aspect of these norms is how an
risk are those who live in what are referred to individual relates to his or her immediate social
as “food deserts”—environments in which food group, including f amily, peers, and members of
outlets such as fast food restaurants and conve a broader social network. Is the individual ex-
nience stores that carry unhealthy food and pected to see himself or herself as playing a
sugary beverages substantially outnumber gro- role that is interdependent with the others in
cery stores and other resources that are more that network, or is he or she expected to estab-
likely to carry healthy foods such as fresh pro- lish an identity and a set of goals that is largely
duce (Babey et al. 2011). independent of family and friends? Different
societies and d
ifferent cultures offer d ifferent
perspectives on these questions. A core aspect
Summary
of these norms of social behavior is associated
In the summary of chapter 2, we concluded that with socially constructed group identities
lifetime well-being is “clearly associated with such as gender, social class, and race/ethnicity.
certain behaviors, principal among them smok- With the pattern of social migration that is
ing, diet, exercise, and excessive alcohol use.” coming to be increasingly im portant in the
These crucial behaviors are in turn influenced United States as well as in other societies, a ques-
tion arises: How does one interact with those Kusserow, A. 2005. The workings of class: How under-
from a d
ifferent cultural background? Does one standing a subtle difference between social classes
can promote equality in the classroom—and beyond.
maintain his or her original identity, adopt the
Stanford Social Innovation Review, available at
identity of the new cultural group, or find a way
http://eahec.ecu.edu/smhp/smhpdocs/class.pdf,
to do both? The answer to this question will be accessed 7/17/14.
strongly influenced by the network of social Lodge, H. C. 1897. Senate speech, February 2. Congres-
connections with which one associates on a reg- sional Record, 54th Congress, 2nd Session, vol. XXIX,
ular basis and by the social groups with which part II, p. 1432.
Lorenzo, M., Crouch, C. H., & Mazur, E. 2006. Reducing
one comes to identity. I discuss the issue of
the gender gap in the physics classroom. American
group identity and its impact on behavior in the Journal of Physics 74(2): 118–22.
next chapter. Margolis, J., & Fisher, A. 2002. Unlocking the Club
house: Women in Computing. Cambridge, MA: The
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chapter
5 Identity and Behavior
D
evelopmental experiences during childhood and adoles-
cence have a range of effects on how the individual pre-
paring to enter adulthood comes to view himself or
herself as well as the world more broadly. As discussed in chap-
ter 4, the cultural context in which one grows up can have power
ful influences on these perceptions. The social environment in
which one lives and works is also a major aspect of that world. As
a central part of that environment, the social groups with which
one interacts play an important role.
Social identity: Responding to the social group

When one moves from adolescence into adulthood, w hether
through a process that involves education beyond high school or
through employment and similar activities oriented t oward pro-
viding for one’s needs, one will interact with others on an in-
creasing basis. The social groups with which one interacts may
be formal, such as other employees within a work group or other
members of a religious or civic group, or they may be informal,
such as neighbors and other acquaintances. To a certain extent,
which will vary from person to person, individuals may come to
define themselves based on the social groups with which they
interact on a regular basis.
Individuals develop their identity based on how they perceive
themselves independently from any group, in combination with
how they perceive themselves as a member of defined social
groups. To a large extent, it is this membership in groups that
defines their place in society. To feel as though one is a member
of a group, it may be necessary to adopt certain goals shared by
the group. Accordingly, one will integrate the individual values
and motivations developed as a youth with those held by the
group. Tajfel and Turner have described this process as one of
establishing a “social identity”, which “consists of those aspects
67
of an individual’s self-image that derive from

Alternative forms of capital and their
the social categories to which he perceives him-
impacts on social status
self as belonging” (1986, p. 16). As discussed be-
low, it is a natural tendency of social groups to The concept of capital has been studied by so-
compare themselves to other groups that have cial scientists for more than a century. When
adopted different attributes and characteristics most people think of capital, they think of eco-
of group membership, and to create boundaries nomic capital, the economic resources one pos-
between theirs as the “in- group” and other sesses that can, when needed, be converted to
groups as “out-groups.” Being a member of an money. Sociologist Pierre Bourdieu (1986) sug-
in-group caries more status than that enjoyed gested that capital can exist in multiple ways.
by those in the out-group. Groups then rank All the various forms of capital can be accumu-
themselves and their members based on this lated through labor, can be used to influence
perceived status. This competition for status others, and can be passed to descendants. He
can easily lead to intergroup conflict. wrote that “the structure of the distribution of
Walton and Cohen have described how one the d ifferent types and subtypes of capital at a
comes to share values and motivations with a given moment in time represents the immanent
social group. They underscore the influence of structure of the social world” (p. 242).
this social identity and suggest, “that p eople de- In addition to economic capital, Bourdieu
velop interests with and from o thers to whom posited that individuals also possess cultural
they are socially connected” (2011b, p. 84). Indi- capital, often in the form of educational qualifi-
viduals who see themselves as group members cations that can be used for economic gain, and
and draw value from that membership will be social capital, based on social connections and
more likely to adopt behaviors shared by o thers the social status those connections imbue. He
in the group, whether beneficial or harmful to suggests that the different types of capital—
well-being. “or power, which amounts to the same thing”
Walton and Cohen acknowledge that this (p. 243)— can often be used interchangeably.
powerful influence of group membership on in- Bourdieu described cultural capital as existing
dividual behavior is contrary to Western norms in three d ifferent states: the embodied state, re-
of independence. They suggest that “People flected in one’s acquired knowledge or talents;
from Western cultures perform a balancing act. the objectified state, reflected in one’s material
On the one hand they have a great need to be- objects such as books or works of art; and the
long . . . On the other hand, they maintain an institutionalized state, typically reflected in cer-
‘independent’ self-concept, seeing themselves tificates of academic or professional qualifica-
as agentic and unique” (2011b, p. 94). These tions, such as academic degrees or professional
forces of independent actions versus following licenses.
group norms can potentially come into conflict Social capital, on the other hand, derives
when someone joins a social group but is un- largely from the social connections and contacts
sure w hether he or she has been fully accepted one has. As described by Bourdieu, “Social capi-
as a member. This can often happen when one tal is the aggregate of the actual or potential
is of a different race, ethnicity, or socioeconomic resources which are linked to possession of a
background from that which predominates durable network of more or less institutional-
within the group. Walton and Cohen describe ized relationships of mutual acquaintance and
how this issue often comes up in the context of recognition—or, in other words, to membership
higher education, a subject I discuss later in this in a group” (p. 248). The more social network
chapter. connections one has, and the more one can draw
I d e n t i t y a n d B e h av i o r 69
on those connections to gain needed resources, of low perceived status is also expected to be
the more social capital one possesses. less competent and to act in ways that either do
Two aspects of these forms of capital are of not support or actually challenge goals held by
particular interest from the perspective of un- the larger group. Accordingly these individuals
derstanding behavior. First, there is a certain are often perceived in a position of stigma rather
degree of interchangeability among them. Those than status. As status characteristics are per-
with greater economic capital can acquire greater ceived both by o thers and by the individual
cultural capital through the expenditure of the possessing them, a negative sense of self will
economic resources. Similarly, those with greater often be internalized by the individual who has
cultural capital, at least as perceived by others, been stigmatized by o thers. This stigmatized
may find it easier to create and then draw upon position can result in reduced well-being through
social network connections. The second aspect a combination of experiencing increased stress
is that these forms of capital are often transmis- over time and increased likelihood of adopting
sible across generations. Economic capital can unhealthy behaviors in response.
simply be passed on to one’s heirs as a formal
inheritance. As we have seen, cultural capital in
Questioning one’s identity in the
its various forms can be transmitted to the next
context of cultural mismatch: The case
generation through supporting the development
of FirstGen students entering college
in one’s children of a sense of self-efficacy and
belief in the value of education, a significant part As described in the previous chapter, colleges
of which is the availability and regular use of and universities have been shifting the focus of
books. Similarly, children often have as friends their efforts to enhance the diversity of their
the children of those who are socially connected students. For a period of time following the
to their parents. 1960s, diversity was seen largely as an issue of
The greater one’s capital in its various forms, race and ethnicity and was addressed by affir-
the greater will, in all likelihood, be one’s status mative action programs. Largely as a result of a
within the community. Just as the possession series of US Supreme Court decisions, colleges
of social and cultural capital can provide status, and universities have been moving away from
their relative absence can result in stigma. As race as a principal marker of diversity, looking
described originally by Berger et al. (1977) cer- instead at students’ socioeconomic status. As
tain characteristics of individuals, largely as part of this effort, many academic institutions
perceived by others, will create a hierarchy of have been focusing on attracting talented stu-
status within a community or a society. Exam- dents who are the first generation in their family
ples of these status characteristics include race, to attend college. Often referred to as FirstGen
gender, and the various forms of capital described students, many of these students are members
by Bourdieu. of racial and ethnic minority groups, many come
Phelan et al. have suggested that an individ- from relatively weaker public high schools in
ual’s combination of status characteristics lower-income communities, and many are from
essentially creates that individual’s rank in a immigrant families.
community or society “based on the esteem in Individuals transitioning into adulthood look
which the person is held by self and o thers . . . to their social and cultural environment for mes-
Members of a group form expectations about sages that both inform their sense of identity
each other’s competence to contribute to group and provide guidance as to expected behavior.
goals based on their status characteristics” (2014, The transition into college, especially into a
p. 16). Based on these perceptions, an individual highly competitive college or university, can
present substantial challenges for many First- tasks more difficult; finally, the student tends to
Gen students. As Markus and Conner described perform less well academically than he or she is
(2013; see chapter 4), those from immigrant and otherwise capable of. This weak academic per
lower-income families often grow up having in- formance can then reinforce the sense of cul-
ternalized the cultural message that they are tural mismatch and isolation, often leading to
part of a group, such as family or community, continued academic difficulty and an increased
and need to act in ways that best support the risk of leaving the college or university.
group. If colleges in their welcoming messages Stephens et al. demonstrated that when
and professors in their classroom instruction FirstGen students w ere introduced to the uni-
suggest that students need to be independent versity environment as one that supported an
thinkers, it often raises the question for First- interdependent approach to education and ex-
Gen students, “Do I belong here?” plicitly encouraged to view the university as a
Another challenge these students often con- “learning community,” to connect to their fel-
front is a perceived gap in social and cultural low students as well as faculty, and to form
capital when they compare themselves to other learning groups with other students to support
students entering with them. “Prior to college, each other in assigned work, they found tasks
[FirstGen students] have less exposure and ac- assigned to them to be less difficult and showed
cess to the types of middle-class cultural capital— improved performance as compared to First-
understandings of the rules of the game—that Gen students who had not received comparable
are taken for granted as normative by many support and encouragement.
American universities. Consequently, first- In a separate study, Stephens et al. (2014)
generation students are often uncertain about identified FirstGen students entering a private
the ‘right’ way to act as college students and be- university, most of whom were from low-income
gin to question whether they belong and can be families, and during the orientation period to
successful in college settings” (Stephens et al. the university invited them to attend a panel
2012, p. 1180). discussion with a socially diverse group of se
This mismatch in experiences and in social nior students to introduce them to the college
and cultural capital may also make it difficult environment. Half of the students heard from
for FirstGen and other students from disadvan- the student panelists that they had used their
taged backgrounds to form new social networks cultural and social background to find stronger
with other students at college. Without these connections with o thers at the university and
networks, students may feel more isolated in to improve their academic skills. The other half
the classroom environment as well as in the heard a similar panel describe how individual
range of extracurricular activities available to actions or behaviors had helped them succeed,
students. Unfortunately, the result of this lack without reference to the importance of forming
of connection and feeling of cultural isolation is group connections. By the end of their fresh-
associated with lower academic performance man year, the FirstGen students who heard the
among FirstGen students. Stephens et al. de- panel that encouraged social connection and
scribe a three-step process by which this “cul- group academic work had higher grades than
tural mismatch” exerts its effects: first, the the students hearing the panel that emphasized
FirstGen or otherwise disadvantaged students individual action, and they also had shown a
initially feels out of place and uncomfortable in greater tendency to seek out help from other
the university environment; as a result of this students or faculty throughout the year. From
discomfort and the lack of social connection these results the authors concluded that “The
that goes with it, the student finds the assigned intervention provided students with the critical
insight that people’s different backgrounds from a disadvantaged socioeconomic or racial

matter and that p eople with backgrounds like background are vulnerable to feelings of cultural
theirs can succeed when they use the right exclusion, self-doubt, and resultant academic
kinds of tools and strategies” (p. 949). difficulties that can be averted through well-
In a similar study, Walton and Cohen (2011a) designed messages of inclusion.
focused on African American students entering
a selective college. Independently of FirstGen
The competition for status: Group
background, many black students experience a
identity, bias, and stereotype threat
similar form of cultural mismatch, stigmatiza-
tion, and social exclusion when they enter col- As discussed above, in describing the creation
lege, based largely on their racial differences of social identity, Tajfel and Turner (1986) un-
with the majority of other students at the college. derscored the importance of group membership
Due largely to what has come to be referred to and the process by which different social groups
as stereotype threat (discussed below), these stu- compete for status, with individual group mem-
dents often do less well academically than com- bers benefiting in their own identity based on
parably talented students who are not black. the status that comes with group membership.
The researchers had half of the students read a This competitive process can easily lead to an-
report from the university that indicated that tagonism between groups perceived as dominant
all students, independent of race, experience and subordinate. Individuals within one group
potential difficulty in the transition to college can easily develop prejudice against members of
and yet are able to overcome it through a com- a competing group seen as subordinate, with the
bination of individual effort and social support. consequence that “the more intense is an inter-
The other half of the students read a compara- group conflict, the more likely it is that the indi-
ble report that talked about other aspects of the viduals who are members of the opposite groups
college transition but left out reference to the will behave toward each other as a function of
commonality of overcoming initial personal and their respective group memberships, rather
academic difficulties. They also had a group of than in terms of their individual characteristics
entering white students read the same reports. or interindividual relationships” (p. 8).
They followed the students for a period of three Berger et al. developed a theory of “status
years during college, comparing their grade characteristics” by which “differences in cogni-
point average, their self- reports of feeling a tions and evaluations of individuals, or social
sense of belonging, their sense of self-doubt, types of them, become the basis of differences
their experience of feeling negatively stereo in the stable and observable features of social
typed, and their overall physical and emotional interaction” (1977, p. 3). They identify three ba-
health status. The black students who had read sic characteristics used to define relative status
the report on the commonality yet transience under this theory: sex (today more commonly
of initial personal difficulties in college did better referred to as gender), race, and socioeconomic
on all of these measures than the black students status (operationalized under their theory as
who read the other report. By contrast, there occupational status). They point out that most
was no difference on these outcomes between of the characteristics attributed to different
the white students who had read the report groups are “socially constructed,” in that they
describing common difficulties and the white exist based on social convention rather than
students who had read the other report. Com- biological differences and as such are adopted
bined with the studies described above, these as part of the learning and socialization process
results confirm that students entering college of childhood and adolescent development. Based
on characteristics attributed to specific groups from a park in Birmingham toward the down-
(women as compared to men, blacks as compared town area, Connor instructed the firefighters
to whites, lower-class individuals as compared under his command to turn their high-powered
to upper-class ones), p eople come to expect in- fire hoses on the child demonstrators and for
dividual members of a group to exhibit the traits the police to use their attack dogs. Images of
attributed to the group overall. A common ex- these children being hit with the blast of the
ample is the traditional expectation (since proven fire hoses and being attacked by police dogs
wrong) that girls and w omen, based on their were carried on nationwide TV, including the
gender, are not as capable in mathematics as are TV in our living room. The horror many in the
boys and men. Based on this expectation, school nation felt at seeing the response of the racist
teachers would often approach a girl in their white power system to these children was a
class as less capable in math than the boys. The major f actor in the subsequent approval in Con-
girl was at risk of internalizing this clear message gress of the Civil Rights Act of 1964, the first
from her teacher and devaluing her own ability major civil rights legislation approved by the
in math. This internal devaluation would often US Congress.
result in lower performance in math, thus con- Since the 1960s, a range of civil rights laws
firming the teacher’s stereotype of girls as less has been passed to protect the rights of blacks
capable. As described below, this process of con- and other previously marginalized groups. While
sciously or unconsciously internalizing a nega- the type of racist behavior exhibited in 1963 by
tive stereotype about intellectual abilities has Bull Conner has largely disappeared, those who
been shown to exist in a range of groups and has study racial bias have described other forms in
been come to be referred to as both stereotype which prejudicial beliefs have been applied to
threat and identity threat. the detriment of blacks and other minorities.
In the United States, race has historically Appiah differentiated “extrinsic racism,” such
been a status characteristic that has both de- as that enacted by Bull Connor, from other
fined group superiority/inferiority and been forms of racial prejudice. He stated that “extrin-
applied stereotypically to members of a group, sic racists make moral distinctions between
attributing to them as individuals the character- members of different races because they believe
istics associated with the group. For those of us that racial essence entails certain morally rele-
who grew up in the 1960s in the United States, vant qualities. The basis for the extrinsic rac-
the growing availability of nationally televised ist’s discrimination between p eople is their be-
news introduced us graphically to the forms lief that members of d ifferent races differ in
this racial bias can take. I can remember sitting respects that warrant the differential treatment”
next to my grandfather (he lived next door and (1990, p. 5). By contrast, those who exhibit what
had the only TV in the f amily) on May 23, 1963, Appiah referred to as “intrinsic” racial bias do
and watching television coverage of the response not consciously apply moral judgment to blacks
of the white authorities in Birmingham, Ala- or other racial groups. Nonetheless, they con-
bama, to the black children who were marching tinue to apply negative expectations to individ-
in support of Martin Luther King Jr., who had ual members of that group, albeit sometimes
been imprisoned because of his own participa- unconsciously.
tion in civil rights demonstrations. The police Unconscious bias can take two principal
chief in Birmingham was a high school dropout forms. One is often referred to as “implicit” bias.
named Theophilus Eugene “Bull” Connor. When Upon confronting a member of a group which
a group of more than a thousand children, rang- has come to be associated with negative charac-
ing in age from 6 to 18 years, began their march teristics, an individual who has internalized
those associations may react differently to that e ither customer attempting a robbery is exceed-
person than they would to a member of their ingly small. Without thinking, and without any
own group. This has been demonstrated repeat- conscious judgment of the potential black cus-
edly by Project Implicit, a research group based tomer, the driver picks up the white customer.
at Harvard University that has developed an The driver has internalized a stereotype that
online test referred to as the Implicit Associa- black customers are riskier than white custom-
tion Test (IAT). When a subject connects to the ers and has acted on that stereotype.
test website, she or he is simultaneously shown In the 1990s, Danny Glover, an extremely
a word and a picture of a face. Using the keys successful black movie actor, couldn’t get a cab
on her or his computer, the subject indicates as to stop for him on the streets of Manhattan. He
quickly as possible whether the word on the filed a complaint with the New York City Taxi
screen has a positive or a negative connotation. and Limousine Commission, which sent out de-
The face is changed at random from that of a coys to test Glover’s assertion that cab drivers
white person to that of a black person. Studies systematically passed by black customers to
of more than one million online subjects have pick up white customers. The commission con-
found that white subjects in the United States firmed Glover’s assertion and changed the law to
consistently take a longer time to identify a word make such biased action illegal. The cab d rivers
as having positive connotations when it is paired had been applying a racial stereotype, that blacks
with a black face than when it is paired with a are riskier as customers than whites, to all
white face. Conversely, they are quicker to iden- blacks, regardless of their individual circum-
tify a word with negative connotations when it stances. Research has also shown that doctors,
is paired with a black face than with a white without intending to do so, may also apply neg-
face (Nosek et al. 2007). Subjects who demon- ative racial stereotypes to their patients and as a
strate these implicit associations of white with consequence provide a lower level of care to
good and black with bad will typically state that black patients than white ones (van Ryn and
they have no personal race bias. Black subjects Burke 2000; van Ryn et al. 2006).
typically do not show this implicit association. Given that individuals might unconsciously
Another form of unconscious race bias is re- apply negative expectations to a member of a
ferred to as “stereot ype bias.” As described by stereotyped group, might a member of that group
Devine, in certain circumstances, “Automatic unconsciously apply that same stereotype to
processes involve the unintentional or sponta- himself or herself? Recall the discussion above
neous activation of some well-learned set of of the findings of Berger et al. (1977) that the
associations or responses that have been devel- status characteristics of a group can be applied
oped through repeated activation in memory” to members of that group in a way that leads the
(1989, p. 6). By means of example, think of a cab group member to behave in a way that confirms
driver in a place like New York City driving on that stereotype. They gave the example of teach-
a busy street, hoping to get a customer. The ers expecting girls to be less competent at math
driver sees two reasonably dressed, middle-aged than boys, with the result that some girls inter-
men up ahead, both trying to flag him down. nalize this stereotype and perform less well in
One is black; the other is white. Which cus- math than they would have otherwise.
tomer does the driver pick up? In 2002, Steele et al. addressed this issue in
Over time the driver has become aware that, their study of undergraduate students at the
in New York City, a taxi driver’s chance being University of Michigan. “In our search for an-
robbed by a black customer is greater than by a swers, we soon came upon an intriguing finding:
white customer—even though the chance of Women at the University of Michigan seemed
to perform lower than their tested skills would groups who enter college, particularly competi-
predict in difficult math classes yet at their pre- tive colleges and universities. When these stu-
dicted levels in other classes that we examined dents experience stereotype threat in addition
such as English or, as we later found, in entry- to the sense of cultural mismatch described
level math classes” (p. 379). To test whether the above for FirstGen students, their academic suc-
women were responding to negative gender ste cess can be threatened, and they are even more
reotypes, they identified a group of talented male prone to internalizing the sense of personal in-
and female undergraduates at Michigan— all adequacy suggested by these stereotypes.
with SAT scores in the top 15 percent of Michi- Taylor and Walton (2011), in a series of ex-
gan students, and all of whom had expressed an periments with black and white university stu-
interest in studying math. They administered a dents, documented a dual impact of experiencing
very difficult section of the GRE math test to stereotype threat: Those students experiencing
these students. Before giving the test, they told the threat not only do less well on tests of knowl-
half of the students (selected randomly) that pre- edge given comparable learning but are also
vious research had shown that w omen tended to prone to less effective patterns of learning. The
do less well on this test than men. They told the researchers also showed, as in Steele’s experi-
other half of the students that men and women ments, that the adverse impact of stereotype
had been shown to perform equally well on the threat can be prevented by altering the context
test. They found that “women given this instruc- in which the tests are administered and the
tion performed just as well as equally skilled learning takes place.
men and significantly better than w omen in the
stereotype-still-relevant condition of this experi-
Attribution theory: Explaining why
ment, in which participants were told that the
other people act the way they do
test did show gender differences” (p. 381).
The researchers repeated this type of study In the mid-20th c entury, psychologists looked
with students who differed based on race (black to relatively straightforward theoretical expla-
vs. white) and documented similar effects. From nations of why p eople make the choices they do.
this work, they defined the concept of stereo For example, Atkinson proposed “a conception
type threat in the following manner: “When a of motivation in which strength of motivation
negative stereotype about a group that one is is a joint multiplicative function of motive, ex-
part of becomes personally relevant, usually as pectancy (subjective probability), and incen-
an interpretation of one’s behavior or an experi- tive” (1957, p. 371). How much do I want this?
ence one is having, stereotype threat is the re- What are the chances I will get it if I try? What
sulting sense that one can then be judged or do I get in return if I succeed? These were the
treated in terms of the stereotype or that one three questions Atkinson described people as
might do something that would inadvertently considering when they chose whether or not to
confirm it” (p. 389). Steele has reviewed these undertake a certain action.
concepts as they apply to members of a range of Weiner (2010) describes how the original the-
potentially disadvantaged groups in his book ory proposed by Atkinson has evolved into a
titled Whistling Vivaldi: And Other Clues to How more complex understanding of the factors that
Stereotypes Affect Us. He paid particular atten- affect individual behavior as well as how indi-
tion to the ways in which stereotype threat can viduals perceive the factors that affect the be
impede the academic success of students from havior of o
thers around them. U nder what is
disadvantaged racial, ethnic, or socioeconomic now commonly referred to as attribution the-
ory, there are four principal factors that affect their innate abilities and as a result of expecting
the outcomes of behavior: ability, effort, task to do poorly again on other exams. By redefin-
difficulty, and luck. These factors can combine ing their own abilities, they may lower their ex-
in different ways to affect the outcomes of spe- pectations for their future academic and work
cific behaviors. A key aspect of attribution the- careers, ultimately attaining a lower socioeco-
ory, however, is that how the individual actor nomic position than they actually were capable
perceives the relative role of each of these fac- of achieving.
tors in affecting the outcome can have powerful Under attribution theory, individuals tend to
influences on later behavior. respond differently based on two main factors:
Weiner describes the situation in which a Did I do well or did I do poorly? Was the reason
student does poorly on an examination. There I did well or poorly because of something about
could be multiple reasons why this was the me, or because of something external to me
outcome: over which I had l ittle control? The answers to
these questions will affect how the individual
• the student was not intellectually capable of reassesses his or her own abilities. “The harder
passing the exam; the task, the more likely that success is ascribed
• the student was capable of learning the to the self (rather than to the ease of the task)
material but didn’t put in sufficient effort to and thus the greater the pride in accomplish-
do so; or ment” (Weiner 2010, p. 31).
• the professor was overly harsh, having given If the outcome of a task is failure, the same
an examination that few if any students could questions arise. If a person attributes failure to
do well on, regardless of their ability or the causes external to herself or himself (“The test
amount they studied for the exam. was too hard—no one could have done well” or
“It was just rotten luck that I broke my glasses”),
Weiner would then add a fourth possible expla- she or he is unlikely to feel responsibility for
nation: the outcome. Alternatively, she or he may sim-
ply attribute the failure to inadequate effort (“I
• the student accidentally broke his glasses shouldn’t have stayed up so late partying the
when sitting down to take the exam and night before the exam”). However, if the out-
couldn’t read the exam questions clearly come is failure and the individual attributes
(i.e., bad luck). that failure to her or his own weaknesses or
inadequacies, the consequences can be funda-
The key issue is, how does the student ex- mentally different: “failure to reach a desired
plain this poor performance to himself or her- goal attributed to lack of aptitude is hypothe-
self? How the student answers this question sized to produce unhappiness . . . , a lowering
can affect not only future attempts at taking of self-regard . . . , and shame . . . , along with a
school exams but also the student’s perception low expectation of f uture success and hopeless-
of his or her innate intellectual abilities. Recall ness and/or helplessness” (Weiner 2010, p. 33).
from the discussion above that both FirstGen Given the cultural challenges FirstGen stu-
students and students experiencing stereotype dents and those vulnerable to stereotype threat
threat tend to do less well academically than face upon entering a competitive academic en-
their peers from more advantaged backgrounds. vironment, it seems understandable that they
These students are at risk of interpreting this would be more prone to attribute initial academic
poor academic performance as a reflection on difficulties to factors within themselves (ability
or effort) than to external factors (task difficulty get off without even a ticket.” From her per-
or luck). In addition, given the relatively weak spective, the carelessness of the school bus
social networks many of these students experi- driver was to blame for her injuries. If the driver
ence initially, they may be unaware that other had only been more careful and paid closer atten-
students in circumstances similar to theirs are tion, this never would have happened.
experiencing similar difficulties. When the About ten days after her injury, she received
teaching style and attitudes of the professor put a hand-written get-well card, sent by the driver
certain groups of student at a disadvantage, those of the bus. It turns out that he was terribly up-
students as a group are vulnerable to lower out- set by what had happened. Despite looking, he
comes in tests or grades. For example, Moss- had not seen René crossing the street, as she
Racusin et al. (2012) found that science faculty had stepped into a heavily shaded section of the
from research-intensive universities exhibited a crosswalk. Only when he was about to hit her
subtle bias against w omen in their response to was he able to use the brake, barely stopping in
written materials submitted by students. If a time. He had been terrified that he might have
female student is able to discern that the disad- killed her and expressed his remorse to René in
vantage she is feeling in the science classroom the card. René had attributed the driver’s ac-
affects all women in the class and not her alone, tions to carelessness—a factor clearly within
then she is less likely to attribute suboptimal his control. It turned out that the accident
academic performance to her own abilities or was largely due to circumstances beyond the
effort. driver’s control— t he heavy shading of the
How, though, do we explain the actions of crosswalk. René seems to have made what has
others within this context? If things can come come to be called the fundamental attribution
out well or poorly for a variety of reasons, some error.
having to do with factors internal to the actor Ross (1977) has described the fundamental
and some outside the actor’s control, how do attribution error in the following way. When an
we attribute the outcomes of another person’s individual reacts to a behavior he observes in
actions? It turns out that we tend to answer this someone he does not know, “his general tendency
question differently, based on how close a con- is to overestimate the importance of personal or
nection we have to the other person. By means dispositional factors relative to environmental
of example, I will describe the reactions of a influences . . . He jumps to hasty conclusions
journalist to having been hit by a school bus. upon witnessing the be havior of his peers,
René Steinke, a writer who lives in New overlooking the impact of relevant environ-
York, wrote about the sad experience of having mental factors” (p. 184). If someone does some-
her old dog euthanized (2014). In what she called thing we don’t like, we assume it is probably
“a grief-stricken daze” she stepped into a Man- because of a weakness or inadequacy of the per-
hattan crosswalk when she saw the “Walk” sign son himself or herself. We tend not to consider
illuminate. As she crossed the street, she did not fully environmental factors external to the per-
look around her, and she did not see a school bus son we observe that may have contributed to
that was making a left turn. The bus knocked the outcome.
her to the ground, fortunately coming to a stop Coleman (2013) suggests that there is an ad-
before causing her serious injury. As she recov- ditional aspect to the way we attribute outcomes
ered from her injury, she “couldn’t shake the to the personal characteristics of the actor as op-
random vio lence of what just happened to posed to the environmental effects that are ex-
me . . . I was appalled that the driver seemed to ternal to the actor. It depends on whether we
consider the person we observe to be part of Others have questioned the factual accuracy
our own social network (in-group) or external of this account, suggesting that the a ctual num-
to our social network. As Coleman described, ber of witnesses was substantially smaller and
“Negative acts tend to be attributed to disposi- that the victim only died after the police arrived
tional factors more when they are performed (Manning et al. 2007). Nonetheless, multiple
by an out-group member than when they are people were aware that something dangerous
performed by an in- group member. Positive was happening on the street near them and were
acts tend to be attributed to situational factors likely also aware that a number of their neigh-
more when they are performed by an out-group bors w ere simultaneously witnessing the same
member than when they are performed by an thing. The report of this case led to a funda-
in-group member” (p. 72). Thus, we are more mental question: is the likelihood that a person
likely to forgive someone we are connected to will intervene in a potential emergency reduced
for an adverse outcome and blame someone we by the awareness that others are also witness-
are not connected to for a similar outcome. ing it?
Psychologists Bibb Latané and John Darley
(1969), largely in response to the reports of the
Letting the behavior of o
thers guide
murder of Kitty Genovese and the reported fail-
our own: The bystander effect
ure of bystanders to intervene, conducted a series
Rather than observing the behavior of another of experiments to test whether this “bystander
person and coming to some conclusion as to effect” could be shown to exist in other con-
what motivated the person to act in that man- texts. Using university students as their test
ner, sometimes we turn to o thers around us to subjects, they set up a situation in which a sub-
help us make a decision about our own behav ject would be involved in an unrelated activity
ior. If we confront an urgent problem whose when they would be exposed to one of the fol-
outcome we could likely improve, how does the lowing situations:
presence of o thers around us affect our decision
of whether to intervene? • Smoke would start to billow into the room,
This issue came to the broad public attention suggesting that a fire was burning in the
in 1964. During the early morning hours, a building.
young woman by the name of Kitty Genovese • A tape recording would be played indicating
was sexually assaulted and then murdered on a that a large piece of furniture had fallen over
street in Queens, New York. The report of the on a female worker in an adjacent room,
murder carried two weeks l ater in the New York trapping her leg and possibly breaking her
Times shocked the nation: “For more than half ankle.
an hour 38 respectable, law-abiding citizens in • A tape recording would be played indicat-
Queens watched a killer stalk and stab a woman ing that a student in another room, with
in three separate attacks in Kew Gardens . . . whom the subject had been having a phone
Not one person telephoned the police during conversation, was apparently having an
the assault; one witness called a fter the w
oman epileptic seizure and was having difficulty
was dead” (Gansberg 1964). How could 38 adults breathing.
watching or listening out of their window al-
low the screams of a young w oman go un- In each case, based on random selection, the
heeded, with only one person acting after the subject would observe these warning signs either
victim was already dead? alone or in the presence of o thers. The other
observers were sometimes part of the experi-

Social impact theory and social loafing
ment team who had been instructed to shrug off
the warning signs and do nothing. Alternatively, If the presence of a group of bystanders reduces
they could be other research subjects involved the propensity of an individual to intervene
in the same experiment. The researchers would when help is needed, what does that suggest
also vary the number of other observers. about the effects in general of acting alone ver-
The results were consistent across these sus acting as a member of a group? Following
experiments. In a substantial majority of the up on his research with Darley documenting
situations, an individual who was alone would bystander inhibition, Latané proposed a more
respond fairly rapidly to the emergent situation, general theory of the social impact of groups
either notifying someone else of the problem or (1981). He suggested that the presence of o thers
taking direct action to help. Conversely, if the will influence an individual’s behavioral motiva-
other bystanders ignored the warning and took tion by affecting both subjective feelings and
no action, most of the study subjects would also cognitive understanding. This effect, he pro-
fail to act. When the second observer in the room posed, would occur not only when the others
was not part of the research team, the study were strangers and the behavior was to offer
subject would tend to respond more rapidly if help or assistance but also when the o thers were
the subject personally knew the other observer, known to the individual and the group was
as compared to when the other observer was a working collaboratively on an assigned task.
stranger. Latané had been aware of work done in the
In the study with the smoke-filled room when early 1900s by a French scholar named Max
the other observers were trained not to respond, Ringelmann (1913). Ringelmann had hooked a
only one of ten subjects reported the problem. large rope to a strain gauge and then asked a
“The other nine stayed in the waiting room as group of men to pull as hard as they could on
it filled up with smoke, doggedly working on the rope, first alone and then as part of a group.
their questionnaire and waving the fumes away He found that each subject would pull hardest
from their faces. They coughed, rubbed their when he was the only puller. As the group of
eyes, and opened the window—but they did not subjects got successively larger, the average force
report the smoke” (Latané and Darley 1969, p. 251). exerted by each worker decreased. The more an
From these results, Latané and Darley de- individual perceived himself to be part of a task
scribed the “bystander effect”: “When only group, with the group output measured rather
one bystander is present in an emergency, if than individual output, the less effort the indi-
help is to come it must come from him . . . vidual would exert. Concerned that Ringelmann’s
When there are several other observers present, findings were at least partially due to poor coor-
however, the pressures to intervene do not fo- dination among the pullers rather than reduced
cus on any one of the observers; instead the individual effort, Ingham (1974) repeated the
responsibility for intervention is shared among rope-pulling study, taking steps to rule out lack
all the onlookers and is not unique to any of coordination as the explanation for the re-
one . . . the more bystanders who are present, duced individual output. He concluded, “The
the less likely any one bystander would be to present results, then, tend to confirm the gener-
intervene and provide aid” (p. 260). The pres- ality of the Ringelmann phenomenon—increases
ence of other bystanders who could take action in group size are inversely related to individual
seems to inhibit any one person’s sense of re- performance” (p. 382).
sponsibility and resulting willingness to offer Latané et al. (1979) reproduced this effect in
help when it is needed. a variety of circumstances and applied a name
to the effect: social loafing. They had college group as compared to the individual, whereas
students clap or cheer as loudly as they could, the Japanese students would work harder when
first alone and then as part of a group, and mea their task output was measured at the level of the
sured the average output volume per student, group rather than the individual.
varying the circumstances in which the students
interacted. In each case, students clapped or
Summary
cheered more loudly as individuals than as mem-
bers of a group. The researchers explained this We each grow up perceiving ourselves to be
effect in the context of Latané’s social impact part of a broad social or cultural group, and as we
theory, described above, by suggesting that move into adolescence and adulthood, we often
“whether the subject is dividing up the amount become increasingly attuned to the attitudes and
of work he thinks should be performed or behaviors of those immediately around us. We
whether he is dividing up the amount of reward tend to identify a specific group or groups to
he expects to earn with his work, he should which we perceive ourselves as belonging and
work less hard in groups” (p. 830). others to which we feel as though we don’t be-
The introduction of the concept of social long. A common set of metrics we use to compare
loafing led a number of other researchers to ex- ourselves to those around us has been described
plore the contexts in which it will exist. Karau as our level of capital: economic capital, cultural
and Williams (1993) reviewed 78 different stud- capital, and social capital.
ies involving social loafing and found consis- Sometimes people find themselves thrown
tent evidence of its existence across tasks and together with social groups to which they don’t
groups. They identified some specific circum- feel they belong. The case of the FirstGen col-
stances that altered the impact of social loafing. lege student attending a high-quality college or
The effect was stronger when the only way to university provides an example of this situa-
measure overall effort was at the level of the tion. From studies of the experiences of First-
group, with no measurement of individual per Gen students, we have seen some of the adverse
formance. If there was measurement at both consequences that may come from this per-
the group and the individual level, the loafing ceived mismatch as well as some of the steps
effect was reduced somewhat. The effect was that can be taken to avoid these consequences.
also reduced when the individual was well ac- How one responds to an interaction with an-
quainted with the others in her or his group. other person may also depend on how he or she
Two additional findings from their review explains to himself or herself that individual’s
are worth mentioning. Consistent with the in- motivation in undertaking the action—even if
terdependent/independent cultural differences that attribution is inaccurate. How one per-
described by Markus and Conner and discussed ceives the surrounding social group can also
in chapter 4, Karau and Williams found that affect how that individual responds to certain
“both women and individuals in Eastern cultures unexpected circumstances, such as another per-
are less likely to engage in social loafing, presum- son’s need for assistance. The casual bystander
ably because they have more group-oriented tends to be inhibited in responding to that need
priorities than do men and individuals in West- when there are others observing the same need
ern cultures” (p. 697). Studies comparing Japa yet failing to respond. In a similar manner, in
nese university students with American univer- many Western cultures, working on a task as a
sity students confirmed that the American member of a group, rather than as an individ-
students would demonstrate social loafing when ual, will often result in exerting less effort than if
their task output was measured at the level of the one were working on the task alone. Becoming
aware of the ways in which immediate social Nosek, B. A., Smyth, F. L., Hansen, J. J., et al. 2007.
context can influence behavior is central to our Pervasiveness and correlates of implicit attitudes and
stereot ypes. European Review of Social Psychology
overall understanding of h uman behavior.
18: 36–88.
Phelan, J. C., Lucas, J. W., Ridgeway, C. L., & Taylor, C. J.
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chapter
6 Motivation and Behavior
T
he patterns of behavior one adopts are powerfully influ-
enced by cultural and social context. The influence of cul-
tural and social contexts on behavior begins in childhood
and continues throughout the transition from adolescence into
adulthood. Behavior, however, also reflects individual qualities a
child or adolescent has developed. These qualities reflect a combi-
nation of biological and psychological factors that affect the devel-
opmental process.
How early in the developmental process might key personality
and motivational traits be established such that their influence on
immediate behavior is indicative of f uture behavioral patterns? A
series of experiments conducted in the 1960s and 1970s by Walter
Mischel and colleagues suggests that by the age of 4, many chil-
dren may have developed traits that affect their motivation when
confronted by a difficult choice—whether to eat one marshmal-
low now or instead to wait u ntil a teacher says they can have two
marshmallows.
The marshmallow experiment: How long will kids

wait for a treat?
In the 1960s, Walter Mischel began a now well-known experiment
to address the question of how long young children would be
willing to wait to obtain a treat. (Mischel and Ebbesen 1970;
Mischel et al. 1972) As shown in figure 6.1, the treat was a plate
with two marshmallows on it. The subjects of Mischel’s study
were children who attended the Bing Preschool at Stanford Uni-
versity. With the parents’ permission, each child was invited to
come into a room with a range of toys and other activities for the
child to play with, as well as a one-way mirror through which the
experimenters could observe the child’s behavior. The teacher
explained to the child that after he or she had played alone with
the toys for a while, the teacher would come back into the room
and give the child the treat.
82
M o t i vat i o n a n d B e h av i o r 83
sight, it was harder for most children to wait

until the teacher came back (typically about 15
minutes) in order to earn the full reward.
Would how long the child was willing and
able to wait say anything about the child?
Would the ability at age 4 to delay a minor grati-
fication have any association with the choices
and behaviors of that child in the f uture? These
were the questions Mischel and colleagues re-
ported in a follow-up study published in 1988.
Between 1968 and 1974 they had included 653
children in the study. Between 1981 and 1982
they sent a follow-up questionnaire to the par-
ents of 125 of these children, all of whom were
Figure 6.1. The Treat now adolescents. Using a standardized instru-
ment, they asked the parents to rate the child
on a range of indicators. Using these parental
ratings they compared children based on how
long they had waited as preschoolers for their
reward. The results w ere clear. “Specifically,
children who were able to wait longer at age 4 or
5 became adolescents whose parents rated them
as more academically and socially competent,
verbally fluent, rational, attentive, planful, and
able to deal with frustration and stress” (Mischel
et al. 1988, p. 687). Mischel went on to summarize
their findings: “The seconds of time preschool
children were willing to delay for a preferred out-
come predicted their cognitive and social compe-
Figure 6.2. The Modified Treat tence and coping as adolescents . . . Perhaps the
ability to delay gratification effectively for the
There was a second option, though. The sake of larger goals may itself play an increasingly
teacher explained that at any time, if the child powerful role in cognitive and social coping as
didn’t want to wait for the teacher to come the child matures, and . . . may be more signifi-
back, he or she could ring a bell, and the cant for the life of the adolescent than they are for
teacher would come back right away. If that the preschool child” (pp. 692, 694).
happened, the child would receive a somewhat What factors led to some children waiting
modified treat, as shown in figure 6.2—one for a delayed reward and o thers ringing the bell
marshmallow. to obtain a smaller, yet more rapid reward? Is
Mischel and his colleagues varied the cir- there some aspect of the young child’s cognitive
cumstances confronting the child. For some processes that made it easier for him or her to
children the plate with the marshmallows would wait? Mischel and his colleagues suggested that
be hidden away out of sight, while for others “Although cognitive and attentional strategies
the plate would be on the table in plain sight. and skills play an important role in the delay
Not surprisingly, when the treat was in plain situation used in the present study, there is also
much evidence that other factors, such as moti- motivation and purposive action is rooted in
vational and temporal considerations, expecta- cognitive activity . . . By being cognitively rep-
tions, and personality variables are likewise resented in the present, conceived f uture states
germane for a comprehensive analysis of delay are converted into current motivators and regu-
of gratification” (Shoda et al. 1990, p. 985). lators of behavior” (1997, p. 122). We decide both
whether to act and how to act based on our cog-
nitive understanding of the goal we hope to at-
The role of motivation in
tain, the steps necessary to attain that goal, and
affecting behavior
our ability successfully to complete those steps.
In 1968, Edwin Locke proposed what he referred An individual’s response to a given set of en-
to as a “Theory of Task Motivation and Incen- vironmental stimuli may be affected by previ-
tives.” Locke stated, “The basic premise of this ous patterns of association, either positive or
research is that an individual’s conscious negative, he or she has internalized over time.
ideas regulate his actions . . . The theory also In what has come to be known as “associative
views goals and intentions as mediators of the learning,” individuals may come to associate a
effects of incentives on task performance” (p. 157). stimulus from the environment with an out-
In his proposed model, Locke described the “se- come that commonly follows the occurrence of
quence of events leading from events in the en- that stimulus. This may happen even though
vironment to action” (p. 184). That sequence is the stimulus and the outcome have no causal
illustrated in figure 6.3. association. The classical example of this type
As described by Locke, “It appears that a nec- of conditioned response was demonstrated more
essary condition for incentives to affect behav than a c entury ago by Russian scientist Ivan Pav-
ior is that the individual recognize and evaluate lov. He exposed dogs to a stimulus, such as the
the incentive and develop goals, and/or inten- sound of a bell, followed shortly by the presen
tions in response to this evaluation” (p. 184). tation of a plate of food. In what has come to be
Another way of describing the sequence of called “classical conditioning,” the dogs in Pav-
events Locke is referring to is to say that indi- lov’s experiment would begin to salivate when
viduals respond to events occurring in their they heard the bell, even though the bell was
environment (either physical or social) first by not causally connected to the appearance of the
trying to understand the event (i.e., cognition), food. Humans may unconsciously develop
evaluating the implications of the event for the these types of conditioned responses. For ex-
observer, and then, based on that evaluation, ample, if a person hears a sound shortly before
deciding w hether and how to act in response. being suddenly frightened by something, he or
As Locke suggests, an important step in the she may feel a sense of fear upon hearing the
response process is setting a goal or defining an sound again, even though the sound had
intended outcome and then taking the action nothing directly to do with the frightening
necessary to attain this goal. experience.
This perspective is quite similar to that While classical conditioning involves two
proposed by Bandura: “The capability for self- causally unrelated stimuli, another form of more
Environmental Goal-setting
Cognition Evaluation Performance
event intention
Figure 6.3. Locke’s Model of Task Motivation

active conditioned learning involves a causal as- they were able to determine that “children with
sociation. Referred to as “operant condition- greater self-control were more likely to have
ing,” this situation typically involves an action been brought up in socioeconomically advan-
followed by an outcome that is triggered by taged families and had higher IQs” (p. 2694).
the action. If, at the f amily dinner t able, a child They then followed these children into their
throws food she or he dislikes onto the floor, adult years and found “that childhood self-
that child is likely to be punished by her or his control predicts physical health, substance
parents, either verbally or by having some priv- dependence, personal finances, and criminal
ilege withdrawn. The next time that food ap- offending outcomes, following a gradient of
pears on the dinner plate, the child will, as a self-control” (p. 2693).
consequence of the punishment, be less likely How are we to understand the motivation of
to throw the food on the floor again. Conversely, the preschool children in the Mischel study?
a child who completes a difficult task, such as Were some of them exhibiting better self-control
finishing a homework assignment on time, may than o thers? Were their motivations and behav-
receive a verbal or physical reward from her or ioral responses of waiting or not waiting con-
his parents. Gaining a sense that the effort, if sciously set, or w ere the children responding
repeated, will again be rewarded may make it without full conscious awareness of their mo-
easier for the child to do the next day’s home- tivations? How did the choice of waiting or not
work assignment. Over time, the child learns waiting make them feel? Did they perceive
that she or he can influence the outcome based themselves as capable of persisting in their de-
on the behavior she or he adopts. cision to await the teacher’s return in order to
In 2002 the American Psychological Associa- get the two marshmallows?
tion published a volume titled Self and Motivation Once they w ere adolescents, were these same
that summarized current research at that time motivational dynamics active in their school-
(Tesser et al. 2002). In the introduction to the work, in their relationships with friends, and
volume, the authors suggest that “the psychology with their families? Bandura (1997) suggested
of motivation raises questions about self- that there are three aspects to this motivational
regulation. How do goals guide behavior?” (p. 3). process: how we perceive the value of the goals
They describe how some behavior is in response we set for ourselves, how we understand the
to goals that were set by the actor unconsciously. outcomes that are expected to occur as a conse-
They go on to suggest that “More relevant to the quence of certain actions, and how we attribute
question of motivation, however, are behaviors outcomes of our actions once we take them. I
that reflect persistence and affect” (p. 4). address these issues by describing the work done
Moffitt et al. (2011) explored the role of self- over more than two decades by Carrol Dweck
regulation in the Dunedin Study, a long-term and her colleagues.
study of 1,037 children in New Zealand who
were followed from the time they were three
The cognitive understanding of the
years old u
ntil they w
ere in their mid-30s. From
self as a driver of motivation
both direct observation as well as surveying the
children’s parents and preschool teachers, the Dweck and Legget (1988) have proposed what
researchers gauged the level of “self-control” they describe as “A Social-Cognitive Approach
each child exhibited. This measure included to Motivation and Personality.” By means of
assessment of things such as impulsive aggres- introduction, they suggest that “The task for
sions, hyperactivity, lack of persistence, inat- investigators of motivation and personality is
tention, and impulsivity. Using this measure to identify major patterns of behavior and link
them to u nderlying psychological processes” pabilities as being fixed and unchangeable. A

(p. 256). Based on previous work by themselves child who adopts this model and who fails to
and others, they described two general pat- attain an expected outcome despite trying his
terns of behavioral responses that have been or her best is likely to redefine his or her own
identified in both children and adults. The first capacities and abilities. With this downgraded
of these is the “helpless” response pattern, which sense of ability, the child may be less likely to
“is characterized by an avoidance of challenge take on challenges in the future, in order to
and a deterioration of performance in the face of avoid the risk of confirming that lack of ability
obstacles.” The second is the “mastery-oriented” through repeated failure.
response pattern, which “involves the seeking By contrast, a child who has adopted the mas-
of challenging tasks and the maintenance of ef- tery model and who experiences the same level
fective striving under failure” (p. 256). of failure to attain a given task or assignment will
If some young children feel helpless in the likely interpret this as indicating the need to con-
face of a challenge, we might reasonably expect tinue working to improve her or his abilities, so
them to ring the bell early simply to gain the as to succeed in the task when attempted again.
one marshmallow, thereby avoiding the chal- As summarized by Dweck and Leggett, “the per
lenge of waiting for two. By contrast, a child formance goal focuses the individual on judg-
who enjoys challenges and continually strives to ments of ability and can set in motion cognitive
succeed even when it seems that failure may and affective processes that render the individ-
be imminent would likely wait for the teacher ual vulnerable to maladaptive behavior patterns,
to return with the two marshmallows. whereas the learning goal creates a focus on in-
Dweck and Legget go on to describe how chil- creasing ability and sets in motion cognitive and
dren with different perceptions of their mastery affective processes that promote adaptive chal-
ability will set very d
ifferent goals for themselves. lenge seeking, persistence, and sustained perfor
They describe two general types of goals children mance in the face of difficulty” (p. 262).
may adopt: performance goals, in which children Dweck and her colleagues performed a num-
hope to have others judge them as competent ber of experiments testing this theoretical model.
based on their performance with specific tasks, Mueller and Dweck (1998) reported on a series
and learning goals, in which children focus on of six experiments in which fifth-graders w ere
increasing their competence in certain areas given an initial set of tasks to perform. After the
through continued effort, without as much con- students completed these tasks, the experi-
sideration for specific task performance. menters praised some of the students for their
Dweck and Legget describe an intriguing as- intelligence (i.e., their fixed capacity) and o
thers
sociation between the types of goals children for the effort they made in solving the problem
set for themselves and their self-identity. Chil- (i.e., incremental learning). They then offered
dren who focus principally on per for
mance the children their choice of other problems sets
goals will come to see themselves as having a to attempt, with some problems identified as at
fixed capacity for performance, one that can’t the same level as those first completed and some
easily be changed. Their performance on certain identified has harder and more challenging than
tasks, especially challenging tasks, will then pro- the initial problems. The researchers found that
vide a measure of their capacity. Dweck and those students praised for their intelligence were
Legget refer to this model of identity as a “fixed more likely to choose the former type of prob
entity” model (p. 262). lem, thus not risking their identified intelli-
There is a potential danger for a child who gence, while those praised for effort were more
adopts a sense of one’s intelligence or other ca- likely to choose the latter.
A second study applied a similar approach to those who had initially believed in a fixed-
seventh-graders being tested on mathematical capacity, entity model of intelligence actually
ability (Blackwell et al. 2007). The authors sur- reversed the decline in math scores they other
veyed 373 students in public school in New wise would have experienced, based on the re-
York City at the time they entered seventh sults of the first study. They began to behave
grade. They assessed the students’ perception more like students who initially believed in
of intelligence as a fixed or malleable quality as the malleable model of intelligence. From these
well as their academic achievement record to studies, the authors concluded, “adolescents
date. Focusing on students’ achievement in math- who endorse more of an incremental theory of
ematics, they followed the students through the malleable intelligence also endorse stronger
end of eighth grade, comparing the grades in learning goals, hold more positive beliefs about
math of students with a fixed-capacity mindset effort, and make fewer ability-based, ‘helpless’
with those who had a malleable mindset. A fter attributions, with the result that they choose
controlling for math grades before entry into more positive, effort-based strategies in response
seventh grade, the malleable-mindset students to failure, boosting mathematical achievement
had significantly higher math scores over the over the junior high school transition” (p. 258).
two-year period. These results are a fter controlling for prior aca-
The authors also conducted an interven- demic ability or intelligence assessment.
tional experiment involving 91 students enter- If children in the fifth and seventh grades
ing seventh grade, all of whom had relatively have already adopted their own perception of
weak math scores before seventh grade. In the whether their intelligence is a fixed or a mal-
spring semester of seventh grade they adminis- leable characteristic, how early do children
tered a supplemental workshop to these students, learn this? Will they learn it before they get to
with half the students getting the experimental school? Gunderson et al. (2013) addressed this
intervention and half getting the control. As question in a study of children age 1 to 3. The
described by the authors, researchers identified a sample of 53 children in
the Chicago area and started to visit each of
Students in both the experimental and control these children in their home when the child was
groups participated in similarly structured 14 months old. They then visited the child again
workshops, both of which included instruction every four months. During the visits they would
in the physiology of the brain, study skills, and videotape parent-child interaction for 90 min-
antistereotypic thinking. In addition, through utes. They subsequently analyzed the language
science-based readings, activities, and discus- the parent used in conversing with the child,
sions, students in the experimental group w ere looking specifically at the tone and the words
taught that intelligence is malleable and can be used when praising the child. They then catego-
developed; students in the control group had a rized the frequency and type of praise exhibited
lesson on memory and engaged in discussions of by the parent, based on three categories:
academic issues of personal interest to them.
(p. 254) 1) Process praise—e.g., “you tried hard,” “good
job drawing,” “good job trying to put that
Blackwell’s research group found that, by back in”;
the end of eighth grade, students in the experi- 2) Person praise—e.g., “good girl/boy,” “you’re
mental group benefited significantly from the so smart,” “you’re good at that”;
workshop as compared to those in the control. 3) Other praise—praise that did not fall into (1)
Of the students in the experimental group, or (2) above, e.g., “Good!” or “Wow”.
The researchers then recontacted the fami- stereotyped in favor of males” (Gunderson et al.
lies when the children were in second or third 2013, p. 1538).
grade (age 7 or 8) and administered a set of two In 2007 Carol Dweck summarized the re-
surveys to assess how the children viewed in- sults of more than two decades of research:
telligence and how they viewed what the authors
described as “sociomoral” aspects of behavior: Praise is intricately connected to how students
the extent to which children who exhibited mor- view their intelligence. Some students believe
ally acceptable behavior at age 7–8 would con- that their intellectual ability is a fixed trait. They
tinue to exhibit that behavior as they grew into have a certain amount of intelligence, and that’s
adolescence and adulthood. For both measures that. Students with this fixed mind-set become
they evaluated the extent to which the children excessively concerned with how smart they are,
expressed a fixed capacity as compared to a mal- seeking tasks that will prove their intelligence
leable perception of the quality being assessed. and avoiding ones that might not. The desire to
In all their analyses the authors controlled for learn takes a backseat. Other students believe
family income, parental education, and the that their intellectual ability is something they
child’s race/ethnicity. can develop through effort and education.
Overall the parents expressed process praise They don’t necessarily believe that anyone can
about as often as they expressed person praise. become an Einstein or a Mozart, but they do
Also, the total amount of praise used did not understand that even Einstein and Mozart had
differ by the gender of the child. The type of to put in years of effort to become who they
praise used, however, differed by gender, with were. When students believe that they can
boys hearing a higher frequency of pro cess develop their intelligence, they focus on d oing
praise than girls (24.4% of all praise for boys vs. just that. Not worrying about how smart they
10.3% of all praise for girls). will appear, they take on challenges and stick to
The researchers then looked at how the type them. (p. 34)
of praise heard between 14 and 38 months of
age was associated with the motivational Dweck also emphasized that the human brain
framework expressed by the child at age 7 or 8. is plastic, in that its underlying neural struc-
They found a significant correlation (r = .31, ture changes over time. Whatever aspects of a
p = .01) between the amount of process praise child’s intellectual identity have been written
heard as a young child and the child’s expres- into the child’s cognitive sense of self can, with
sion of an incremental framework of both intel- appropriate interventions, be rewritten over
ligence and a child’s likelihood to continue to time.
act morally over time. They then looked at gen- If we now think again about the children in
der differences at age 7–8 and found that boys Mischel’s marshmallow study, and how the
were more likely than girls to express an incre- ability to wait at age 4 was a significant predictor
mental framework, a finding that holds particu of academic and social competence in adoles-
lar significance for those studying early gender cence, we might then ask whether the children
differences in math and science interest and who rang the bell early had internalized a fixed
ability. “Girls tend more than boys to attribute sense of their own ability to endure a stressful
failures to lack of ability and thus show de- situation for a period of time in order to gain a
creased persistence and motivation a fter fail- larger reward. This brings up the issue of how
ure. This gender difference in children’s attri- children, and adults, perceive time and how
bution styles is especially pronounced in the that perception of time affects immediate moti-
math and science domains, which are gender- vation to act in a certain way.
in the 1960s. We are also introduced to Lynn,

Time perspective and the
who attends a primary school in a working-
Up Series children
class section of the East End of London. She
In 1963, British film producer and director and her friends Jackie and Susan are often inter-
Michael Apted began what was to become a reviewed together as representing children grow-
markable series of documentary films, following up in a working-class environment. We are
ing the lives of children in England beginning also introduced to Tony, who, the narrator ex-
at age 7 and every seven years thereafter. This plains, “goes to one of the older schools in Lon-
series of documentaries has come to be called don’s East End slums.” Tony represents a child
the Up Series; the documentaries are labeled as from a lower-class background.
Seven Up, 7 Plus Seven, 21 Up, and 28 Up, continu- As part of the interview, the narrator asks
ing until 56 Up, released in 2012. each of the children what plans they have for
Seven Up begins with an introduction by a their lives. John’s reply is straightforward.
narrator who explains that they have brought “When I leave this school I’m g oing to College
together a group of 7-year-old children “from Court, and then I will be going to Westminster
startlingly different backgrounds.” The narra- Boarding School if I pass the exam, and then we
tor goes on to ask, “Why did we bring these think I’m going to Cambridge in Trinity Hall.”
children together? Because we want to catch a Lynn’s response is somewhat more subdued:
glimpse of E ngland in the year 2000. The union “I’m going to work in Woolworth’s.” (At the time,
leader and the business executive of the year Woolworth’s was a popular “five-and-dime” re-
2000 are now seven years old.” The narrator tail chain serving largely the working class.)
closes the introduction by paraphrasing a say- When the narrator asks this of Tony, we hear
ing attributed to various Christian patriarchs: an immediate, enthusiastic response: “I want to
“Give me a child u ntil he is seven, and I will be a jockey when I grow up. Yeah—I want to be
give you the man.” a jockey when I grow up.” Throughout the doc-
With the many changes in British society umentary we see 7-year-old Tony engaging in
that followed World War II, it was at that time exciting yet dangerous activities—shinnying up
an open question as to w hether the traditional narrow pipes, sliding down a rope dangling
British social class system still remained intact. from a play structure, and attempting to climb
Would children reproduce as adults the social over (rather than walk around) the schoolyard
class into which they w ere born? This seemed fence. The narrator tells us that Tony’s girl-
to be the question the documentary series was friend “calls him a monkey.”
intended to address. It doesn’t take many epi- At age 7, John, Lynn, and Tony expressed very
sodes for us to begin to see an answer to this different perspectives on how they perceived
question. To illustrate, and to introduce a con- the f uture, and the actions they w ere likely to
cept central to the study of motivation, I would take. When interviewed again at age 21, each
like to introduce you to three of the children reiterated the perspective they expressed ear-
interviewed in Seven Up: John, Lynn, and Tony. lier. At age 7, John saw the future in fairly clear
When we see the 7- year-
old John, he is terms. He knew what he had to do (or at least
dressed in a V-neck sweater and tie and is sit- what he was expected to do) in order to attend
ting with two other boys similarly dressed. The one of the top universities in the country. At age
narrator explains that John and his classmates 21 he had carried out the plan he had expressed
are attending “An exclusive kindergarten school 14 years earlier and was studying law at Oxford.
in Kensington, London.” It seems apparent that (He had predicted Cambridge, but I would con-
they represent the upper class of British society sider Oxford a comparable outcome.) At 7, Lynn
asn’t thinking much about the future. Her at-

w Andrew and Charles, “Do you think there is
tention was much more focused on the here any truth to the ideas behind this program, that
and now, especially on her social peers. At age certain p eople have more options than o thers?”
21, the narrator tells us, “Lynn is now married, Charles replies, “It’s certainly true that some
but still lives and works in the East End.” Rather people know they have more options, or imag-
than working in Woolworth’s, she is a school ine they have. I think in practical terms the dif-
librarian. When it came time for her to go to ference in the number of options isn’t that
what we in the United States consider as high great. The fact is that the three of us know that
school, she elected to attend a grammar school, there’s a whole range of things we can do.”
which was more academically rigorous than Andrew follows this by suggesting, “The mere
the comprehensive school her two friends at- knowledge creates options itself, so I think we
tended. Lynn got a job as a librarian, while Jackie do have more options.” John responds to An-
and Susan, with their comprehensive school drew’s comment by saying, “I think what’s
education, are unskilled clerical workers. When undesirable is p eople who have had options but
the narrator asks Lynn about her marriage, she don’t take best advantage of them.”
responds, “I’ve been married for a year and a Based on the experiences of these children
couple of months. You do think ‘Christ, what from Michael Apted’s documentary, we might
have I done?’ And I’m being honest about it. At conclude that d ifferent children, especially
times you think, ‘Christ, what have I done?’ ” those from different social class backgrounds,
For Lynn, her marriage seems just to have view time and its connection to behavior differ-
happened. ently. As a consequence, some children see a
Tony left school at age 15 to become an ap- wide range of options open to them in the f uture,
prentice jockey at a riding stable. He lasted only whereas o thers perceive a much narrower range
a short while in this position. At age 21 we see of options. Accordingly, some children at age 7
him riding around London on a motorbike, try- already have a clear picture of what will likely
ing to learn the roads so he can pass the test to happen in the coming years and what actions
become a taxi driver. The narrator asks him how they must take to reach their envisioned goals.
many h orse races he rode in during the time he Others might simply take things a day at a time
was trying to become a jockey, to which Tony and let the f uture just happen. Still o
thers, such
replies, “Only three.” The narrator then asks, as Tony, might focus on t oday but be more inter-
“Why was that?” Tony then explains his failure ested in seeking out something fun and exciting
to become a jockey. “Obviously if I w ere good (perhaps even dangerous) to do.
enough I would have had more . . . I’d have given As it turns out, most of the children first
my right arm at the time to become a jockey. I filmed in 1963 are, as m iddle-aged adults, exhib-
wasn’t good enough—it’s as easy as that.” iting many of the same psychological traits they
When asked how he viewed girls and the identified and described at age 7. “Give me a
prospect of settling down, the 21-year-old Tony child until he is seven, and I will give you the
said he preferred a more immediate approach to man.”
relationships. “Do you understand 4 Fs? Find ’em,
feel ’em, and forget ’em. For the other F I’ll let you
Zimbardo and time perspective
use your own discrimination.” For Tony, whether
at age 7 or age 21, life seems to be about finding Psychologist Philip Zimbardo was one the prin-
something exciting to do and just doing it. cipal authors of a study commonly known as
At one point during the 21 Up interviews, the the “Stanford Prison Experiment” (Haney et al.
narrator asks John and his upper-class friends 1973; Zimbardo et al. 1973) in which students at
Stanford University were paid to live for one to statement was of their own perspectives and at-
two weeks in a closed, experimental prison en- titudes. They then conducted f actor analysis of
vironment, wherein some students w ere arbi- the students’ responses in order to identify
trarily assigned the role of prison guard and which of the responses tended to clump to-
others the role of prisoner. Within a very short gether. From this analysis they identified five
time the students had taken on their respective groups of questions, each describing a different
roles with such intensity that they began to perspective on time. They described this ana-
exhibit the behaviors of actual prison inmates lytic tool as the Zimbardo Time Perspective In-
(submissiveness) and guards (dominance and ventory (ZTPI) and offered a general descrip-
cruelty), causing the experimenters to abruptly tion of each of the five differing perspectives
cancel the experiment a fter six days. Writing included in the i nventory:
more than 20 years later, Zimbardo described
how that experiment clarified for him the im- • Past-Negative: “Embodies a pessimistic,
portance of a person’s perspective of time. Even negative, or aversive attitude t oward the
though the students knew they would be return- past . . . associated with depression, anxiety,
ing to life as college students in a few days, they unhappiness, and low self-esteem”;
seemed to lose track of the future, instead focus- • “Present-Hedonistic: “Orientation toward
ing only on the present moment without con- present enjoyment, pleasure, and excite-
sideration for the longer-term consequences of ment, without sacrifices t oday for rewards
their actions. Zimbardo, who described himself tomorrow . . . a lack of consideration of
as having grown up in poverty, came to the re- future consequences . . . low ego or impulse
alization that, as a child, “his family and friends control”;
were prisoners of a fatalistic present. Education • Future: “Characterized by planning for and
liberated him, and others, into a more future- achievement of f uture goals . . . w ith
oriented realm of existence” (Zimbardo and consideration of f uture consequences,
Boyd 1999, p. 1273). conscientiousness, preference for consis-
Following the prison experiment, Zimbardo tency, and reward dependence, along with
worked for many years to study, understand, low levels of novelty and sensation
and measure different time perspectives and seeking”;
their consequences. He developed a series of 56 • Past-Positive: “Characterized by a
short statements, each describing an attitude or glowing, nostalgic, positive construction
belief (Zimbardo and Boyd 1999, p. 1287). Ex- of the past . . . low in depression and
amples of these statements include: anxiety but high in self-esteem and
happiness”;
• “It upsets me to be late for appointments.” • Present-Fatalistic: “Reveals a belief that the
• “I complete projects on time by making future is predestined and uninfluenced by
steady progress.” individual actions, whereas the present
• “Fate determines much in my life.” must be borne with resignation because
• “I make decisions on the spur of the moment.” humans are at the whimsical mercy of
• “I take risks to put excitement in my life.” ‘fate’ ” (pp. 1277–78).
They then asked 606 college students, some In order to further validate the ZTPI scales,
from Stanford and some from a nearby commu- Zimbardo and Boyd used them in a second study
nity college, to read each statement and indicate, involving more than 500 college students in Cali-
using a five-point scale, how characteristic the fornia. They identified a number of significant
correlations between the scales and an individ- shaped in fundamental ways by childhood so-
ual’s personal characteristics and academic per cioeconomic status, and that these attitudes
formance. Students who demonstrated a higher may not be easily altered by adult experiences”
score on the F uture perspective had higher (p. 2149).
grades in college and spent more hours per Laura Carstensen has studied the role of
week studying. They w ere also less likely to ex- time perspective throughout the life course as
hibit aggressive tendencies or to lack impulse part of her “Socioemotional Selectivity Theory”
control. By contrast, those students who dem- (Carstensen et al. 1999). In her theory she de-
onstrated more of a Present-Fatalistic perspec- scribes the role time perspective plays in affecting
tive showed more aggression and more impul- motivation. “The perception of time as con-
sive behavior, and had lower grades. strained or limited as opposed to expansive or
Guthrie et al. (2009) used three of the scales open-ended has important implications for emo-
from the ZTPI in a series of interviews with 525 tion, cognition, and motivation . . . The assess-
adults who were customers in a barber shop or ment of time plays a critical role in the ranking
hair salon in a suburb of Washington, DC. They and execution of behaviors geared towards spe-
wanted to see if the time perspectives exhibited cific goals” (pp. 165–7).
were associated with level of socioeconomic In the Up Series, John, at age 7, expressed an
attainment. The study sample was evenly split expansive perception of time and described the
between men and w omen and had a diverse series of behaviors he intended to enact in order
sampling of both racial/ethnic groups and in- to attain his goal of enrolling in one of England’s
come groups. They had each subject respond to most selective universities. Lynn, by contrast,
the ZTPI prompts for three of the scales: Future, appeared far more fatalistic as to what time held
Present-Fatalistic, and Present-Hedonistic. for her. When asked about her f uture, she said
They also asked a series of questions about sub- she would be working in Woolworth’s, without
jects’ occupation, income, educational level, any clear idea how she would get there. When,
parents’ education, and current health behav- at age 21, she looked back over her life, her re-
iors. Subjects who had completed more formal sponse was, “Christ, what have I done?” At age
education and who w ere employed in profes- 7, Tony had little if any concept of the future
sional occupations scored higher on the Future other than that he wanted to be a jockey. He
scale and lower on the Present-Fatalistic scale abandoned school in an attempt to become a
than those with less education and nonprofes- jockey but as an apprentice lasted only three
sional occupations. The researchers also found rides. “I wasn’t good enough—it’s as easy as
that those whose parents had completed less that.” Tony seems to match fairly well Zimbar-
formal education scored higher on the present- do’s concept of the Present-Hedonistic perspec-
fatalistic scale. They found no association be- tive. Consistent with the findings above of the
tween subjects’ pre sent-
hedonistic score and study by Guthrie et al., Tony and Lynn had
their education or occupation, nor did they working-class parents, presumably poorly edu-
find associations between any of the scales and cated, while John clearly had well-educated par-
health behaviors, a fter controlling for demo- ents. The time perspectives they observed in
graphic variables. In summarizing their findings, their own parents, coupled with the time per-
the authors state, “Participants whose mother or spectives they expressed and enacted as chil-
father was less well educated had a more fatalis- dren and adolescents, were strongly associated
tic time perspective, independent of their own with their socioeconomic position as young
education level. This association indicates that adults. “Give me a child u ntil he is seven, and I
attitudes about fate and opportunity may be will give you the man.”
need for safety is present for adults as well.

Noncognitive aspects of motivation
Once the needs for food and for safety have been
and Maslow’s hierarchy of needs
met, Maslow identifies social needs for love and
ntil now we have been looking at motivation
U belonging as the next most important. “If both
principally as a combination of cognitive per- the physiological and the safety needs are fairly
ceptions and personality traits. What about well gratified, then there will emerge the love
when we are motivated to act based on physi- and affection and belongingness needs, and the
ological needs rather than cognitive percep- whole cycle already described will repeat itself
tions? When we perceive hunger, we perceive a with this new center” (p. 381). The need to be-
powerful motivation to eat. This motivation, long encompasses both an intimate, trusting
however, is coming from a series of peptide relationship with another person and belong-
molecules that communicate between the stom- ing to a broader social group, such as a social or
ach and the hypothalamus. Similarly, the moti- religious group.
vation to find warmth in the face of excessive Maslow then raises an interesting point—is
cold comes through chemical and neurological the perceived need for sexual intimacy a physi-
messages generated by our thermostatic control ological need, a need for connectedness, or both?
mechanism in the hypothalamus. How do we Much in the same way that psychologist Erik
relate these basic needs to the more cognitively Erikson (discussed in chapter 7) suggested that
derived motivation involved in deciding whether sexual attraction transitions from being part of
to ring the bell or wait for the teacher to return one’s identity as an adolescent to expressing a
with two marshmallows? young adult’s need to form intimate, loving rela-
As early as 1943, psychologist Abraham tionships with others, Maslow attributes both
Maslow offered a theory to relate these motiva- physiological and social belonging aspects to
tional factors. He identified a range of needs that the perceived sexual need.
humans seek to fulfill but do so in a hierarchical If one has satisfactorily addressed physiolog-
manner. “Human needs arrange themselves in ical needs, the need for safety, and the need for
hierarchies of pre-potency. That is to say, the ap- social belonging, the next requirement Maslow
pearance of one need usually rests on the prior identifies is that “for self-respect, or self-esteem,
satisfaction of another, more pre-potent need” and for the esteem of others” (p. 381). This self-
(p. 370). esteem includes both a sense of achievement and
Maslow described a series of five basic needs. a sense of independence and freedom. Once this
The first of these are physiological needs nec- need has been met, Maslow then describes the
essary to maintain homeostasis within the highest of the needs: that for self-actualization.
body. These include the need for basic nutrients “Even if all these needs are satisfied, we may still
and the need to maintain a constant body tem- often (if not always) expect that a new discontent
perature. These needs, according to Maslow, and restlessness will soon develop, unless the
are the most fundamental, as a person lacking individual is d oing what he is fitted for . . . What
both food and some of the higher needs “would a man can be, he must be” (p. 382).
probably hunger for food more strongly than As shown in figure 6.4, the traditional way to
for anything e lse” (p. 373). display Maslow’s hierarchy graphically is as a
Once one has satisfied the need for food and triangle, with the more basic motivational needs
warmth, at least above a certain threshold, on the bottom and the higher needs above. This
one’s attention then turns to addressing the configuration suggests that the physiological and
need for safety. Infants in particular are acutely safety needs are of greater import than the needs
aware of a perceived lack of safety, though the for self-esteem and self-actualization, as they
Self-
actualization
Self-esteem
Social belonging
Safety
Physiological
Figure 6.4. Maslow’s Hierarchy of Needs, Displayed as a Triangle
form the foundation on which the self is con- social belonging. Similarly, one who lacks a
structed. The clear delineation between the partner or social group can still seek out self-
levels in this model also seem to suggest that a actualization and self-esteem. Many have pointed
more basic need must be fully satisfied before en- out that certain individuals actually eschew
ergy or attention can be paid to the need above. food, warmth, or safety in order to work t oward
Maslow actually contradicts this perception in goals that, once attained, will provide them with
his original work. “This statement might give the a deep sense of actualization.
false impression that a need must be satisfied 100 As he wrote increasingly about the implica-
per cent before the next need emerges. In actual tions of his theory, Maslow eventually added
fact, most members of our society who are additional needs to this list. In a book first pub-
normal, are partially satisfied in their basic needs lished in 1954, Maslow identified “the desires to
and partially unsatisfied in all their basic needs at know and to understand” and “the aesthetic
the same time. A more realistic description of the needs” as also important for a full life: “The needs
hierarchy would be in terms of decreasing perfor order, for symmetry, for closure, for com-
centages of satisfaction as we go up the hierarchy pletion of the act, for system, and for structure”
of prepotency” (p. 388). This perspective is illus- (1987, p. 26). In a 1970 essay, Maslow identified
trated in figure 6.5, in which the rectangles, each one additional human need: that for transcen-
of the same size, are layered sequentially on each dence. As Maslow got closer to his own death,
other, while the gray area within the rectangle he recognized that “Man has a higher and tran-
indicates the extent to which that need has scendent nature, and this is part of his essence”
been met. (Maslow 1970, p. xvi). Maslow described this
One thus does not need to satisfy fully the need as consistent with traditional religious
needs of hunger and safety in order to seek out teachings of accepting a higher order to life and
One final conclusion reached by Tay and

Self-actualization Diener was that living in a society in which
those around us have had their basic needs met
was associated with an increased sense of well-
Self-esteem being, independent of an individual’s own level
of need fulfillment. In the process of addressing
our own needs, we are also consistently aware
Social belonging
of the needs of those around us, especially
those with whom we form close social connec-
Safety tions. The social and cultural context in which
we live and grow up can affect our sense of
well-being as well as our capacity to meet our
Physiological own personal needs.
Figure 6.5. Maslow’s Hierarchy of Needs, Displayed Summary

as a Rectangle
As they move through childhood and adoles-
cence, individuals develop, to a greater or lesser
experiencing a heightened awareness of this or- degree, a sense of their own ability to influence
der, often through helping o thers to meet their the things that happen to them. Based on this
own needs. It is interesting to compare Maslow’s perception of their ability to affect f uture out-
need for transcendence identified t oward the end comes, they may become capable of setting
of his life with the ninth stage of development longer-term goals for things they want to achieve
described by Erikson Erikson’s widow, Joan, and of taking the actions necessary to attain
only a fter Erik had died (see chapter 7). Our un- those goals. Factors in their immediate envi-
derstanding of the world and our place in it may ronment can have power ful effects on how
change as we come closer to the end of our time children develop and subsequently act on these
here, something experienced both by leading
motivations. Some children will come to view
psychologists and by those of us who are not. themselves as having an innately fixed capacity
Tay and Diener (2011) evaluated data from a at achieving certain outcomes, while others
poll conducted globally that included subjects may develop a sense that they can increase that
in 123 countries. They assessed the extent to capacity through additional effort. Some children
which respondents’ needs were met, based on will come to focus mostly on the present, pay-
Maslow’s hierarchy of needs, and examined sub- ing relatively little attention to the longer-term
jects’ evaluation of their subjective well-being. consequences of behaviors undertaken today.
They did identify a significant association be- Other children may develop a substantially
tween need fulfillment and well- being but clearer concept of the f uture and their ability to
noted that the hierarchical sequence identified affect f uture outcomes.
by Maslow was not consistently supported by These aspects of motivation that begin to de-
evidence. For example, “people in impoverished velop during childhood can have long-term im-
nations, with only modest control over w hether pacts on subsequent behavior as adolescents
their basic needs are fulfilled, can nevertheless and as adults and on the extent to which an in-
find a measure of well-being through social rela- dividual is capable of fulfilling his or her basic
tionships and other psychological needs over needs, whether they be the need for food, shel-
which they have more control” (p. 364). ter, and safety or higher-level needs for a sense
of social belonging and self-esteem. All of these Haney, C., Banks, W. C., & Zimbardo, P. G. 1973. A
factors can have lifelong effects on the overall study of prisoners and guards in a simulated prison.
Naval Research Review 30: 4–17.
level of attainment one realizes and the level of
Locke, E. M. 1968. T oward a theory of task motivation
well-being one experiences. The motivational
and incentives. Organizational Behavior and Human
patterns one develops over time will be strongly Performance 3: 157–89.
influenced by the broader social and cultural Maslow, A. H. 1943. A theory of h uman motivation.
context in which one grows up and lives. Psychological Review 50(4): 370–96.
Many of the motivational theorists cited ———. 1970. Religions, Values, and Peak Experiences. New
York: Penguin.
above suggest that motivation is closely linked
———. 1987. Motivation and Personality. 3rd edition.
with the personality traits an individual devel- New York: Harper and Row.
ops. While motivation and personality certainly Mischel, W., & Ebbesen, E. B. 1970. Attention in delay of
overlap, there are other aspects of personality gratification. Journal of Personality and Social
that go beyond specific task motivation, influ- Psychology 16(2): 329–37.
Mischel, W., Ebbesen, E. B., & Zeiss, A. R. 1972. Cognitive
encing how one relates to o thers as well as how
and attentional mechanisms in delay of gratification.
one perceives himself or herself. The next chap-
Journal of Personality and Social Psychology 21(2):
ter introduces us to many of the core personal- 204–18.
ity theorists and theories that have added sub- Mischel, W., Shoda, Y., & Peake, P. K. 1988. The nature
stantially to our understanding of behavior. of adolescent competencies predicted by preschool
delay of gratification. Journal of Personality and
Social Psychology 54(4): 687–96.
References Moffitt, T. E., Arseneault, L., & Belsky, D. 2011. A gradient
Bandura, A. 1997. Self-Efficacy: The Exercise of Control. of childhood self-control predicts health, wealth, and
New York: W. H. Freeman and Company. public safety. Proceedings of the National Academy of
Blackwell, L. S., Trzesniewski, K. H., & Dweck, C. S. Sciences 108(7): 2693–98.
2007. Implicit theories of intelligence predict Mueller, A. M., & Dweck, C. S. 1998. Praise for intelli-
achievement across an adolescent transition: A gence can undermine children’s motivation and
longitudinal study and an intervention. Child performance. Journal of Personality and Social
Development 78(1): 246–63. Psychology 75(1): 33–52.
Carstensen, L. L., Isaacowitz, D. M., & Charles, S. T. Shoda, Y., Mischel, W., & Peake, P. K. 1990. Predicting
1999. Taking time seriously: A theory of socioemo- adolescent cognitive and self-regulatory competencies
tional selectivity. American Psychologist 54(3): from preschool delay of gratification: Identifying
165–81. diagnostic conditions. Developmental Psychology
Dweck, C. S. 2007. The perils and promises of praise. 26(6): 978–86.
Educational Leadership 65(2): 34–39. Tay, L., & Diener, E. 2011. Needs and subjective well-being
Dweck, C. S., & Leggett, E. L. 1988. A social-cognitive around the world. Journal of Personality and Social
approach to motivation and personality. Psychologi- Psychology 101(2): 354–65.
cal Review 95(2): 256–73. Tesser, A., Stapel, D. A., & Wood, J. V., Eds. 2002. Self and
Gunderson, E. A., Gripshover, S. J., Romero, C., et al. Motivation. Washington, DC: American Psychological
2013. Parent praise to 1-to 3-year-olds predicts Association.
children’s motivational frameworks 5 years l ater. Zimbardo, P. G., & Boyd, J. N. 1999. Putting time in
Child Development 84(5): 1526–41. perspective: A valid, reliable individual-differences metric.
Guthrie, L. C., Butler, S. C., Ward, M. M. 2009. Time Journal of Personality and Social Psychology 77: 1271–88.
perspective and socioeconomic status: A link to Zimbardo, P. G., Haney, C., Banks, W. C., & Jaffe, D. 1973.
socioeconomic disparities in health? Social Science The mind is a formidable jailer: A Pirandellian prison.
and Medicine 68(12): 2145–51. New York Times Magazine, April 8, p. 36.
chapter
7 Personality, Behavior,
and Well-Being
P
ersonality traits and patterns of motivation are often
closely linked, and these characteristics and the linkages
between them begin to develop early in childhood. Both
personality and motivation can affect the behaviors children be-
gin to adopt as they grow into childhood and adolescence.
In 2012, journalist and author Paul Tough published a book
that described his extensive exploration into the question of how
children succeed. In his introduction to the book, Tough asks the
central questions he hopes to address: “Who succeeds and who
fails? Why do some children thrive while o thers lose their way?”
(p. xxiv). In his conclusion, he offers an answer to these ques-
tions: “Science suggests . . . that the character strengths that matter
so much to young peoples’ success are not innate; they don’t ap-
pear in us magically, as a result of good luck or good genes. And
they are not simply a choice. They are rooted in brain chemistry,
and they are molded, in measureable and predictable ways, by the
environment in which children grow up” (p. 196).
Children’s learned behavioral patterns develop through repeti-
tive interaction with their social and cultural environment and
the neurological coding of these experiences (see chapter 8). Con-
currently with developing their cognitive awareness of the world
and its behavioral expectations, children also develop a sense of
self. Early in the developmental process, this sense of self begins
to become increasingly differentiated from the people and things
children observe and interact with.
The American Psychological Association defines the concept
of personality as “The unique psychological qualities of an indi-
vidual that influence a variety of characteristic behavior patterns
(both overt and covert) across d ifferent situations and over time.”
Thus who we are—our personality—will be reflected in how we
act under various circumstances.
97
Who we are, as reflected in our perceptions also interpreted many of these conditions as
and behaviors, changes substantially from birth having an abnormality of sexual behavior at
through childhood and into adolescence and their centers. He thus based his theory on fac-
young adulthood. We are not born with our tors that could impair the normal sexual devel-
personality set in place. Rather, it changes and opment of children.
evolves as we grow and experience new things. Freud saw h uman infants as possessing sex-
Two 20th-century authors in particular have ual instincts from birth and suggested that a
described the process of the development of tendency to what he referred to as “perver-
personality as occurring in distinct stages, be- sions” of these instincts was a normal part of
ginning at birth. While these descriptions of childhood development. As described in the
the stages of personality development share summary to his 1905 book, “a disposition to
much in common, the models of personality de- perversions is an original and universal disposi-
velopment proposed by Sigmund Freud and Erik tion of the human sexual instinct and that nor-
Erikson also differ in a number of key ways. mal sexual behavior is developed out of it as a
result of organic changes and psychical inhibi-
tions occurring in the course of maturation”
Sigmund Freud and the stages
(p. 97). Those who, for some reason pertaining
of psychosexual development
to the circumstances of their development as
Sigmund Freud was born in 1856 in what was children, are unable to adapt to the changing na-
then called Moravia, a region that is now part of ture of their sexual feelings are as adults prone
the Czech Republic. When he was about 4 his to develop what Freud referred to as “neurosis.”
family moved to Vienna, where he grew up, As Freud describes, “A formula begins to take
experiencing the anti-Semitism that was then shape which lays it down that the sexuality of
prevalent in much of Europe. He did well in neurotics has remained in, or been brought
school and entered the University of Vienna back to, an infantile state” (1905, p. 38). It then
when he was 17, electing to study medicine. He becomes the psychoanalyst’s job to help the pa-
finished his medical training in 1881 and em- tient revisit the period of childhood sexuality
barked on a c areer in research, with an early that was never fully resolved.
interest in diseases of the brain and nervous A central principle of Freud’s theory about
system. the sexual instincts of children is the concept of
A fter spending about five years working in a erotic pleasure. The Oxford English Dictionary
hospital, Freud left and opened a private clini- defines “erotic” as “pertaining to the passion of
cal practice that focused on treating patients love.” What does a newborn infant “love”? At
with various nervous conditions. As this prac- first, she loves to suck at her mother’s breast,
tice progressed, Freud began to develop his own both for the nutritional value of the breast milk
theories of why these adult nervous conditions and for the intense sense of pleasure she gets
occurred and what might be done to treat them. from feeling the nipple in her mouth. This sense
He published these theories in two books: The of pleasure is key to what Freud considers as
Interpretation of Dreams in 1900 and Three Essays “sexual.” The sensations generated in the nerves
on the Theory of Sexuality in 1905. I will focus on of the infant’s lips and tongue trigger a positive
the latter book. emotional sensation in the amygdala, a key cor-
Even though he rarely treated children, tical area of the brain that plays a central role in
Freud came to have an understanding of the sensing and responding to emotion. A fter re-
childhood origins of many of the d ifferent ner peated experiences of nursing at her mother’s
vous conditions he observed in his patients. He breast, the newborn infant is likely to develop
P e r s o n a l i t y, B e h av i o r , a n d W e l l-B e i n g 99
a form of memory of these sensations. As part “The anal zone is the second area of erotogenic
of the normal response to such sensations, the pleasure. The sexual excitement of this zone are
infant will seek them out again. As the infant both active and passive and involve both the
grows somewhat older and no longer needs to stimulation of the mucous membranes and
rely on breast milk to the same extent for pro- the control (and release) of the sphincter mus-
viding nutrition, she may derive intense plea cle” (1905, p. xxxv). As the child begins to dif-
sure from sucking on her thumb or a pacifier, ferentiate himself from o thers in the world and
thereby restimulating the nerves in the mouth to seek more control over his environment,
that w ere originally stimulated by sucking at being able to take control over the sensations
the mother’s breast. emanating from the anal area becomes more
Freud applies two terms to this stepwise de- important.
velopment of the infant’s response to stimula- Between the ages of 3 and 6, a developmental
tion of the mouth. He refers to the instinctual stage Freud refers to as the phallic stage, the
sensing of pleasure and associated desire for child’s focus shifts from the anal area to the
repeated sensing of that pleasure as occurring sensations generated in the genitals. “It is not
in the id. As the infant becomes more conscious until a third phase has been reached that the
of her ability to find that pleasure from sources genital zones proper contribute their share in
other than the mother’s breast and adapts to determining sexual life, and in children this last
the necessity of delayed gratification, Freud de- phase is developed only so far as to a primacy
scribes the infant’s ego as assuming more con- of the phallus” (p. 99). These genital sensations
trol. As the child develops more awareness of include both the sensation of urination and
his or her familial and social surroundings, he bladder control and of touching the genitals
or she also develops a higher level of self- directly.
awareness, identified by Freud as the superego. From about the age of 6 until puberty, the
As described by Fleming, “The superego develops developing child occupies a stage of latency,
in the child as it becomes aware of rights and suppressing the desire for erotogenic stimula-
wrongs. It is in part an internal moral compass tion, largely in response to social norms and
or conscience” (2004b, p. 8–19). parental restrictions. During these years the
Many p eople would not consider this child redirects her or his energies and attentions
pleasure-seeking behavior on the part of an in- to growth-related activities, such as learning in
fant to be a form of sexuality. Nonetheless, Freud school, developing social skills, and interacting
uses this term to describe the fixation on seek- with social networks outside the family. Once
ing oral pleasure commonly seen in infants. the sex hormones generated during and after
He describes the infant’s mouth and lips as an puberty began to exert their effect, both through
“erotogenic zone,” in that they provide pleasure the development of secondary sex characteris-
when stimulated. He also identifies two other tics in the body and the growing awareness of
erotogenic zones from which the developing sexual attraction to others, the growing child
child seeks pleasure at different stages in the enters the genital stage, the last stage described
development process: the anal canal and the by Freud. It is during this stage that what we
genitals. now commonly view as sexual activity begins,
As awareness of and control over bowel with exploration of e ither heterosexual or ho-
function increases, at about the age of 2 the mosexual interaction, the seeking of sexual part-
child’s attention begins to focus on the sensa- ners, and the desire to have children.
tions generated in the anus. As Steven Marcus In chapter 9 I will address the issue of
describes in his introduction to Freud’s book, cognition as distinct from personality. While
T able 7. 1 . Comparison of Piaget’s Stages of Cognitive Development with Freud’s

Stages of Psychosexual Development
Piaget Freud
Development of Development of
cognitive psychosexual
Stage Age characteristics Stage Age characteristics
Sensory-motor Birth–2 Sense of self, beginning Oral Birth–2 Focus on sensations from
of language nursing/sucking
Preoperational 2–7 Symbolic meanings, Anal 2–3 Focus on anal sensations
expanded language, and bowel control
understands numbers
Phallic 3–6 Focus on genital
sensations and bladder
control
Concrete 7–12 Classification of objects, Latent 6–puberty Focus on educational
operational logical reasoning, and social development
mathematical ability
Formal 12 and older Hypothetical reasoning, Genital Puberty–adult Sexual attraction, sexual
operational abstract relationships, activity, partnership,
moral concepts childbearing
personality reflects our image of our self, cogni- thors that the h uman brain has certain capabili-
tion reflects how we think and what we know ties at birth and can only develop further ca-
and is based largely on the neurobiological stor- pabilities as it grows and develops. As described
age of memories and associations. As I discuss above, Freud thought that “normal sexual be
in more detail in chapter 9, Jean Piaget, a Swiss havior developed . . . a s a result of organic
developmental psychologist, described the changes and psychical inhibitions occurring
stepwise development in cognitive ability that during the course of maturation” (p. 97). This
parallels the development of the brain’s neural view is quite similar to that of Piaget, that a
capacities. Before looking at the various psy- combination of neural development and social
chological impacts Freud describes as caused by learning enables the growing child to acquire
adverse experiences during these phases of successively more complex forms of cognitive
psychosexual development, it will first be infor- ability.
mative to compare the stages of personality de- Thus far I have described the normal stages
velopment described by Freud to the stages of of psychosexual development as characterized
cognitive development described by Piaget. by Freud. I should emphasize that Freud delin-
Table 7.1 compares these stages of development. eated these stages so as to understand better the
We can see a striking similarity in the devel- abnormal psychological states he encountered
opment stages as described by these two psy- in his adult patients. From Freud’s perspective,
chological theorists. Freud divides the years adult behavioral neuroses often originate in un-
from 2 u
ntil about 6 or 7 into two stages, whereas resolved conflicts stemming from the earlier
Piaget treats this as a single stage. Otherwise the stages of development during childhood. For
stages of development are nearly identical. example, a child may never have fully adjusted
Another similarity is the perception of both au- to the role e ither the same-sex parent or the
opposite-sex parent plays in affecting the child’s not only his unconventional lifestyle, but also
developing awareness. Especially if the child his ideas about the crises that each person en-
experiences traumatic events involving a parent counters at each stage of his or her life” (Flem-
during these early formative years, the child may ing 2004a, p. 9-1). Erikson first moved to Vienna
repress these feelings rather than deal with them. to teach art to the children of Americans who
As described by Fleming, “For Freud repression were studying psychoanalysis under Freud. Soon
was the most important of many defense mecha- he began to study psychoanalysis himself, work-
nisms that protect p eople from being over- ing with Freud’s daug hter Anna and focusing
whelmed with anxiety. But a price is paid for on child psychiatry. He subsequently moved to
failing to recognize unconscious feelings and the United States, where he held a range of aca-
impulses, as repressing them can lead to neuro- demic positions. He ultimately moved to work
sis, or psychological maladjustment” (2004b, at the Austen Riggs mental health treatment
p. 8–13). The psychoanalyst’s job, as seen by center in Massachusetts in 1951.
Freud, was to help the patient let go of these re- By the time he joined Austen Riggs, Erikson
pressed emotions in order to reduce the adverse had developed his own theory of the normal
impact of the neurosis associated with them. course of psychological development of chil-
In the final paragraph of his Three Essays on the dren and how difficulties encountered during
Theory of Sexuality, Freud closes his summary the development process could affect the per-
of these issues with what is, from today’s personality and behavior of adults. He first pub-
spective, a fascinating observation: “The unsatis- lished these theories in 1950 in a book titled
factory conclusion, however, that emerges from Childhood and Society. While certainly based on
these investigations of the disturbances of sexual Freud’s theory, Erikson’s views differed in a
life is that we know far too little of the biological number of ways from those of Freud.
processes constituting the essence of sexuality to
be able to construct from our fragmentary infor- • Erikson did not see sexual feelings as playing
mation a theory adequate to the understanding a central role in the psychological develop-
alike of normal and pathological conditions” ment of children.
(1905, p. 109). Freud seemed to appreciate the ru- • Erikson saw a major role for the social and
dimentary level of scientific knowledge at the cultural context in which a child grows up in
turn of the 20th c entury regarding the biological affecting the various stages of development.
mechanisms under
lying brain structure and • Erikson placed less importance on the
function. He also seemed to suggest that a more conscious/unconscious nature of childhood
detailed knowledge of neurobiology might some- development as represented by Freud’s ego/
day extend the theories he proposed. id categories.
• As compared to the five stages Freud
described, Erikson described eight distinct
Erik Erikson and the stages of
stages of development, beginning at birth
psychosocial development
and continuing through old age and death.
Erik Erikson had a difficult and complex child- As shown in table 7.2, he referred to these as
hood. He was born in Germany in 1902, the “The Eight Ages of Man.”
child of an unmarried Jewish woman and a
father believed to be Danish. His mother mar- At each of these developmental stages, Erik-
ried another man when Erikson was 3, “but be- son described the individual as confronting a
cause of these unusual circumstances, he had crisis. For example, in the first stage, from birth
an ‘identity problem,’ which surely influenced through approximately 18 months of age, an
T able 7.2 . The Eight Ages of Man as Described by Erik Erikson (1950)
Stage Approximate age Crisis confronted Virtue to be attained
1 Birth–18 months Basic trust vs. basic mistrust Hope

2 2–3 years Autonomy vs. shame and doubt Will
3 4–6 years Initiative vs. guilt Purpose
4 7–12 years Industry vs. inferiority Competence
5 13–19 years Identity vs. role confusion Fidelity
6 20–34 years Intimacy vs. isolation Love
7 35–64 years Generativity vs. stagnation Care
8 ~65 years to death Ego integrity vs. despair Wisdom
infant either comes to trust or to mistrust his sense of purpose and the confidence to act ac-
caregiver (usually the mother). It is normal for cording to his or her own sense of self. Inade-
the child to experience periods of each. Even quate resolution can result in a feeling of being
in a close and supportive relationship, the inhibited in one’s actions.
mother c an’t be present at every moment the As seen by Erikson, the unsuccessful resolu-
child wishes her there. Over time, though, tion of any of these crises can result in feelings
the child will come to trust that the mother of anxiety that can affect one’s psychological
will return and will be there if really needed. health throughout life. As described by Erik-
This will allow the child to resolve this crisis son, “Anxieties are diffuse states of tension . . .
and to come out of this stage with a sense of which magnify and even cause the illusion of
hope, a feeling that, even if difficulties are con- an outer danger, without pointing to appropri-
fronted in the f uture, things will turn out well. ate avenues of defense or mastery” (1950, p. 406).
If, on the other hand, the child finds the sense These anxieties can be so powerful as to impair
of mistrust coming to predominate, the child normal h uman interaction. It then becomes the
may come out of that stage with a strong sense therapist’s job, as seen by Erikson, to help the
of mistrust in o thers and experience feelings of affected adult identify the earlier unresolved
insecurity in the future. conflict that caused the anxiety, often by revis-
In this same way, Erikson described a core iting childhood experiences, and to gain resolu-
conflict to be confronted at each developmental tion through a deeper understanding of the
stage and a strength or virtue to be obtained factors that originally prevented successful
through successful resolution of the conflict. resolution.
For example, between ages 4 and 6, as the child It is interesting to look at the conflicts faced
becomes increasingly aware of the social and by older adults and the potential consequences
cultural context in which he or she is growing of failing to resolve these conflicts. For exam-
up, he or she will need to address the conflict ple, as one grows beyond age 65 and e ither re-
between wanting to take the initiative in choos- tires from or plans to retire from one’s lifetime
ing how to act and feeling guilty if a parent or of work, it is normal to look back and ask, “How
other person of authority sees the child’s action did I do? Did I do a good job with my life? Did I
as inappropriate. A successful resolution of this act with integrity? Was my life worthwhile?”
conflict can result in the child developing a Successful resolution of this crisis can help one
to move into the older years with a sense of tion based on sexual differences. Take for exam-
wisdom and a life well lived. By contrast, fail- ple Freud’s phallic stage, in which the boy be-
ure to resolve this can lead to a sense of failure tween the ages of 3 and 6 becomes increasingly
and despair. aware of his penis and comes to enjoy feeling
Erik Erikson died in 1994 at the age of 91. In and touching it. Freud seems to assume that girls
1997, Joan Erikson, Erik’s wife of 64 years, will develop the same awareness of and pleasure
wrote a preface for an extended edition of a from their clitoris, seen by Freud as the female
book she and Erik coauthored earlier, titled The equivalent of the penis.
Life Cycle Completed: Extended Version with New Another example of gender bias is often de-
Chapters on the Ninth Stage of Development. Joan scribed in Erikson’s fifth stage, occurring dur-
Erikson describes both her and Erik’s slow de- ing adolescence, in which the teenager seeks to
cline as they passed through their eighties and resolve the conflict between identity and role
entered their nineties. confusion in order to gain a clear sense of indi-
vidual identity. In a preface to the a reissue of a
Although at eighty we began to acknowledge book she originally published in 1982, psychol-
our elderly status, I believe we never faced its ogist Carol Gilligan (1993) describes her work at
challenges realistically u ntil we were close to the Harvard Project on W omen’s Psychology
ninety . . . At ninety we woke up in foreign and the Development of Girls. Gilligan received
territory . . . A s we passed through the years of her doctorate in psychology in 1964 from Har-
generativity, it had never felt as though the end vard University. In 1967 she began teaching at
of the road w ere here and now. We had still Harvard, and while there she worked with both
taken years for granted. At ninety the vistas Erik Erikson and Lawrence Kohlberg, a devel-
changed; the view ahead became limited and opmental psychologist who described a theory
unclear. Death’s door, which we always knew of moral development.
was expectable but had taken in stride, now Gilligan raised fundamental questions about
seemed just down the block. (p. 4) Kohlberg, Erikson’s, and Freud’s work, writing,
“my questions are about psychological pro
Joan Erikson died in 1997, the year she described cesses and theory, particularly theories in
the Ninth Stage of Man. which men’s experience stands for all of human
experience—theories which eclipse the lives of
women and shut out w omen’s voices . . . When
Criticisms of the Freud/Piaget/
I was working with Erik Erikson and Lawrence
Erikson perspectives on the stages
Kohlberg at Harvard, teaching psychology in
of development
the tradition of Freud and Piaget, I remember
While Freud’s theory of psychosexual devel- moments in classes when a w oman would ask a
opment, Erikson’s theory of psychosocial de- question that illuminated with sudden bril-
velopment, and Piaget’s theory of cognitive liance the foundations of the subject we w ere
development have come to be core foundational discussing” (p. xiii–xiv).
elements in our understanding of human psy- Gilligan stated explicitly how she viewed the
chological development, not everyone agrees psychological development of women as differ-
with or supports their perspectives. One of the ing fundamentally from that of men. “I introduce
principal faults attributed to these theorists is a relational voice and develop its counterpoint
their consistent focus on the male perspective, with traditional ways of speaking about self,
assuming that the development of females will relationship, and morality . . . I reframe women’s
then follow in suit, albeit with some modifica- psychological development as centering on a
struggle for connection rather than speaking lary of a language.” John and Srivastava (1999)
about women in the way that psychologists have described the initial attempts by Allport and
spoken about w omen—as having a problem in Odbert (1936) to identify all the words in the
achieving separation” (p. xv). dictionary that could be used to describe per-
Gilligan also speaks critically of the tradi- sonality and behavioral characteristics. They
tional (male) discussion of the developmental came up with a list of nearly 18,000 words and
dichotomy of nature vs. nurture. “At its most immediately recognized that simply listing
troubling, the present reduction of psychology the words was not useful. Beginning in the
either to sociology or biology or some combina- 1940s, Cattell worked over a period of several
tion of the two prepares the way . . . for the suf- decades to simplify the list of words used
focation of voice and the deadening of language” as personality descriptors, suggesting that a
(p. xix). The voice that women bring to their much smaller set of words could be divided
relationships with others reflects an inseparable into sixteen categories of personality traits.
combination of female biology and the female (Cattell et al. 1970). Norman (1967) subse-
experience. “Clearly, these differences arise in a quently suggested that an even smaller set of
social context where factors of social status and personality descriptors could be grouped into
power combine with reproductive biology to seven categories.
shape the experiences of males and females and As described by John and Srivastava, the cat-
the relations between the sexes” (p. 20). Gilligan egories of words identified by Allport and Od-
describes the psychological development of bert and by Norman “overlap and have fuzzy
girls and w omen not as creating a crisis of indi- boundaries, leading some researchers to con-
vidual identity but rather as “a progression of clude that distinctions between classes of per-
relationships towards a maturity of interdepen- sonality descriptors are arbitrary and should be
dence” (p. 155). abolished” (p. 104). While many psychologists
abandoned the effort to develop a standardized
list of personality traits, others continued to
Understanding adult personality traits
work on this issue. Fortunately they w ere helped
using the “Big Five”
substantially by the growing use of computers
So far in this chapter we have been discussing in the 1970s and 1980s to perform complex
different theories on the development personal- mathematical and statistical tasks. Using a
ity as part of the growth and maturation process, method referred to as factor analysis, it was
all of which point to a common conclusion. By possible to group various words used in describ-
the time they reach adulthood, individuals have ing personality into five broad categories. By
developed various personality traits, some posi- the 1980s there was a growing consensus that
tive and some less so, based on their experi- these categories, described as the “Big Five Factor
ences throughout childhood. Is there a way to Structure” (Goldberg 1990) w ere valid from a
examine the patterns of personality character- research perspective. As summarized by John
istics present in adults, regardless of their source, and Srivastava, “A fter decades of research, the
so as better to understand how personality is field is finally approaching consensus on a gen-
expressed as behavior? eral taxonomy of personality traits, the ‘Big
Beginning in the mid-20th century, psychol- Five’ personality dimensions” (p. 103). They go
ogists began applying what has been described on, however, to qualify somewhat how the Big
as a “lexical” approach to answering this ques- Five are best understood, suggesting that “the
tion, defined by the Oxford English Dictionary as Big Five structure does not imply that personal-
“pertaining or relating to the words or vocabu- ity differences can be reduced to only five traits.
Tabl e 7.3. The Big Five Personality Traits

Extraversion implies an energetic approach to the social and material world and includes
traits such as sociability, activity, assertiveness, and positive emotionality.
Agreeableness contrasts a prosocial and communal orientation toward o thers with antago-
nism and includes traits such as altruism, tender-mindedness, trust, and modesty.
Conscientiousness describes socially prescribed impulse control that facilitates task-and
goal-directed behavior, such as thinking before acting, delaying gratification, following norms
and rules, and planning, organizing, and prioritizing tasks.
Neuroticism contrasts emotional stability and even-temperedness with negative emotionality
such as feeling anxious, nervous, sad, and tense.
Openness to experience (versus closed-mindedness) describes the breadth, depth, originality,
and complexity of an individual’s mental and experiential life.
Source: As described by John and Srivastava 1999, p. 121.
Rather, these five dimensions represent person- tional attainment and as a consequence worse
ality at the broadest level of abstraction, and health status over time.
each dimension summarizes a large number of Several authors have developed psychologi-
distinct, more specific personality characteris- cal assessment tools to measure each of these
tics” (p. 105). traits within individuals. Costa and McRae
It is now common practice to refer to each of (1985) developed the NEO Personality Inven-
the Big Five personality traits by a single word. tory, which they subsequently refined to in-
John and Srivastava have offered the description clude measures of six d ifferent aspects of each
of each of these categories shown in table 7.3. of the core traits (1995). Gough and Heilbrun
For each factor, an individual respondent can (1983) developed what they referred to as the
be anywhere on a continuum from fully exhib- Adjective Check List, a list of approximately 300
iting the trait to not exhibiting the trait at all. adjectives that described individual personality
Thus an individual can exhibit a high degree of traits. John (1990) used factor analysis to sort a
conscientiousness by being goal- directed, subset of 112 of these adjectives into five groups
thinking before acting, and choosing to delay that corresponded to the Big Five. Based on
gratification. Alternatively, we can imagine an- these analyses, John, Donahue, and Kentle (1991)
other person who only thinks about the mo- developed the Big Five Inventory (BFI), a sur-
ment without considering longer-term goals or vey instrument consisting of 44 short phrases a
consequences as being low on conscientious- subject uses to describe himself or herself, us-
ness. Similarly, we can imagine someone who is ing a five-point response scale from “strongly
high on neuroticism as usually being anxious, disagree” to “strongly agree.” Sample questions,
nervous, sad, and tense, while someone low on available online (John 2000), ask subjects to ap-
this trait would typically seem relaxed and gen- ply this scale to statements such as “I see myself
erally happy with the way things are going. as someone who is ingenious, a deep thinker”
Each trait can vary independently from the or “I see myself as someone who is sometimes
others, although we will see evidence in later shy, inhibited.”
chapters that growing up in a position of severe When various assessment instruments are
social disadvantage and stress is often associ- compared in assessing personality traits ac-
ated with a grouping of certain Big Five traits cording to the Big Five, they largely provide
that in turn are associated with lower educa- statistically similar results. Also, when translated
into other languages, the same five core traits selves, or by asking the parents or teachers who
are consistently identified, suggesting that they observe the children on a day-to-day basis? One
do not depend on concepts conveyed only in interesting study by Measelle et al. (2005) used
the English language. The BFI instrument has puppets to express certain personality traits to
been translated into nine languages other than children between the ages of 5 and 7 and then
English, including Chinese. asked the children to indicate the extent to
In chapter 4 we discussed how the concept which the trait exhibited by the puppet applied
of self can differ fundamentally within different to them. They followed children for up to two
cultural contexts. Does this then suggest that the years and found substantial consistency over
core elements of personality reflected in the Big time among a number of the factors measured
Five will also vary from culture to culture? Will in this manner.
the expression of traits such as extraversion, Most of the research on children, however,
conscientiousness, or neuroticism vary based has asked parents and teachers to rate the chil-
on w hether the individual being studied is in an dren’s traits. Shiner and Caspi (2003) reviewed
independent culture or an interdependent cul- research in which parents or teachers were
ture? In their review of how culture and per- asked to assess children’s personality using the
sonality intersect, Benet- Martinez and Oishi Big Five traits. They found a high level of con-
concluded that “Big Five measures have reliably sistency in the adults’ ability to rate children
replicated the same five-factor structure across based on the traits of extraversion, agreeable-
many d ifferent cultures and languages” (2008, ness, conscientiousness, and neuroticism.
p. 546). In a similar review, Triandis and Suh Goldberg (2001) analyzed a data set gathered
conclude that, “A large body of literature suggests between 1959 and 1967 in a study of more than
that the Big Five personality factors emerge in 2,500 elementary school children in Hawaii.
various cultures” (2002, p. 133). They caution The original study, done by John Dingman, was
that there may be traits in addition to the Big an important part of the research effort that re-
Five in other, non-Western cultures that have sulted in identification of the Big Five traits. In
not yet been identified, as most research has that study, teachers w ere asked to evaluate chil-
been done in a Western cultural context. They dren in their class on a series of attributes.
do go on to suggest, however, that “Given that Goldberg re-evaluated this data set using only
all humans are one species and that personality those attributes that later became part of the Big
has genetic roots, the similarities among cul- Five assessment.
tural groups are likely to be greater than the dif- Working with Goldberg, Hampson et al.
ferences” (p. 147). (2006) contacted 963 of the individuals in the
There is not yet clear evidence establishing a original study, who now w ere between 40 and
heritable component of the traits measured by 50 years of age. They gathered data from these
the Big Five. Similarly, the traits assessed by it adult subjects on a range of health behaviors
are separate and distinct from one’s cognitive and health status indicators. They found a sig-
ability. McRae and John, early developers of the nificant association between certain of the Big
BFI, state explicitly that “When factored jointly Five traits exhibited as children and health be-
with personality variables, measures of cogni- haviors as adults. For example, children who
tive ability typically form a distinct sixth f actor” were rated by their teachers as higher on con-
(1992, p. 191). scientiousness were less likely to be smokers as
Will children exhibit these same traits as- adults and more likely to rate their overall
sessed using the Big Five? If so, how should health status as better. Similarly, children rated
they be assessed—by asking the children them- higher on agreeableness w ere less likely as adults
to smoke and less likely to be obese. These find- views on this question: what they referred to as
ings suggest that personality traits exhibited the “biological view” or “plaster hypothesis”
as children, as perceived by elementary school that “all personality traits stop changing by age
teachers, are associated with later behaviors as 30” and the “contextualist perspective . . . that
adults that affect health status. changes should be more varied and should per-
Subsequent analysis of these data by Hamp- sist throughout adulthood” (p. 1041). They used
son et al. (2007) determined that many of the data gathered from an Internet-based survey of
effects of childhood personality traits on adult 132,515 adults between the ages of 21 and 60 and
health behaviors w ere mediated by educational concluded, “On no Big Five dimension did we
attainment. Subjects rated higher on conscien- find support for the hard plaster hypothesis
tiousness and agreeableness as elementary among both men and women . . . Conscientious-
school children had a significantly higher level ness increased throughout the age range studied,
of educational attainment as adults. This higher most strongly during the 20s; Agreeableness
level of education was, in turn, associated with increased the most during the 30s; and Neu-
a healthier behavioral pattern. Thus, childhood roticism declined with age for w omen but not
personality traits exhibit an effect similar to much for men. Openness showed small de-
that of the socioeconomic context in which a clines with age, and Extraversion declined for
child grows up, as discussed in chapter 3. women but not men” (p. 1049).
These results are also strikingly similar to an
analy sis reported by Friedman et al. (1995).
Scales of personality that go beyond
They relied on data compiled in the 1920s by
the “Big Five”
Lewis Terman, an educational psychologist at
Stanford University. Terman spent much of his Not all psychologists or health professionals
career studying childhood intelligence and de- see the Big Five traits in the same light as the
veloping ways to measure it. He began follow- authors we have discussed above. Others have
ing more than 1,500 children in California worked to develop scales that they perceive to
schools, all of whom were rated as intellectually be of equal reliability from a statistical perspec-
gifted, using what is now called the Stanford- tive, but which offer stronger validity in terms
Binet intelligence scale. While Terman’s work of actually predicting outcomes. I will address
came several decades before the development two of these alternative perspectives: grit and
of the Big Five scales, one of the specific child- self-efficacy.
hood traits he included in his study of these
children was conscientiousness, as rated by the
Grit: Perseverance and passion for
children’s teachers and parents. Researchers
long-term goals
have been following these subjects on a regular
basis since the study was initiated. Friedman Angela Duckworth is a psychologist at the Uni-
found a strong association between conscien- versity of Pennsylvania who has focused her
tiousness as a child and subsequent length of research on two personality traits that she sees
life, with lower rates of smoking explaining as playing a role in predicting one’s success in
part but not all of this difference. life: grit and self-control. She distinguishes be-
Given the association of personality traits tween the two by suggesting that “Grit equips
exhibited in childhood with adult health out- individuals to pursue especially challenging aims
comes, one might ask the extent to which these over years and even decades. Self-control, in
traits remain stable throughout the adult life contrast, operates at a more molecular times-
course. Srivastava et al. (2003) compared two cale, in the battle against . . . pursuits which
bring pleasure in the moment but are immedi- over the long term, especially in the face of
ately regretted” (2014). (She offers some specific challenges, to attain their goals. The research-
examples of these pursuits in the moment: Face- ers developed and tested a Grit Scale based on
book, Angry Birds, and Krispy Kreme donuts.) subjects’ responses to a series of questions and
Grit appears to have e verything to do with prompts. They found that grit was more strongly
the type of trait assessments Goldberg and John associated with the outcomes they measured
developed. Duckworth’s principal criticism of than e ither intelligence or any specific Big Five
the Big Five approach has to do with its origins factor.
in lexical statistics. As Duckworth et al. explain,
“A serious limitation of the Big Five taxonomy
Self-efficacy
derives from its roots in the factor analyses of
adjectives. Traits for which there are fewer syn- In parallel with the development of the Big Five
onyms (or antonyms) tend to be omitted” (2007, scales, psychologist Albert Bandura identified a
p. 1088). They don’t question the statistical basis personality trait he referred to as self-efficacy,
on which the Big Five were developed; rather which “refers to beliefs in one’s capabilities to
they suggest that it does not provide a suffi- organize and execute the courses of action re-
ciently inclusive list of important personality quired to produce given attainments” (1997, p. 3).
traits. In his early work on the concept of self-efficacy,
Duckworth et al. define grit as representing Bandura (1977) proposed a series of four pro
“perseverance and passion for long-term goals” cesses through which individuals develop their
(p. 1087). They concur that grit overlaps with con- own sense of efficacy in identifying and attain-
scientiousness as a trait operationalized within ing goals.
the Big Five but suggest that conscientiousness A principal means through which one be-
focuses principally on the task or tasks at hand, gins to perceive a sense of efficacy is what
while grit looks to the long term. John and Sriv- Bandura refers to as performance accomplish-
astava use adjectives such as “efficient,” “orga ment. As a child develops her or his cognitive
nized,” “thorough,” and “deliberate” in delineat- capacities, she or he will begin to see a pattern
ing conscientiousness (1999, p. 113). While these linking behavior and outcome. Over time, the
descriptors certainly seem to be addressing a child learns that a certain behavior can be ex-
common theme, as Duckworth suggests they do pected to result in a specific outcome. Some-
not describe a trait that persists over time. Grit, times the outcome is perceived as positive and
on the other hand, describes one’s attitude sometimes as negative. The key is the causal
toward the long haul: “individuals high in grit connection the child makes between the behav
deliberately set for themselves extremely long- ior and the outcome, allowing the child to inter-
term objectives and do not swerve from them— nalize an expectation of her or his own capacity
even in the absence of positive feedback” (Duck- to accomplish certain outcomes in the future.
worth et al. 2007, p. 1089). Over time, the stronger the sense of efficacy an
Duckworth’s research group proposed that individual develops, the more challenging the
grit is strongly associated with high levels of outcome she or he is willing to try for, the greater
achievement over time in a range of fields, from the effort she or he will expend, and the greater
educational attainment to rigorous military the persistence she or he will invest in attain-
training or a national spelling bee competition. ing the outcome.
They suggested that, especially when combined Of course, not all individuals experience a
with a high level of intelligence, individuals pattern of success in their efforts as they grow.
with high levels of grit will apply themselves For a variety of reasons, often having more to
do with the environment in which one is grow- as excitement or positive anticipation, per-
ing up than with one’s innate physical or intel- ceived efficacy may be enhanced.
lectual strengths, a pattern of failure to attain the Bandura points out that, of these four mech-
intended outcome may pervade over a pattern of anisms, performance accomplishment, which
success. These individuals are prone to develop he later refers to as “enactive mastery experience”
a substantially lower sense of self-efficacy and ac- (1997, p. 80), has the strongest impact. While the
cordingly are likely to be less willing to take on other mechanisms may enhance perceived self-
challenging goals and prone to giving up sooner efficacy, if the principal pattern of experience
in the face of challenges. has been one of failure, the others may not be
A second mechanism through which indi- able to overcome that perception.
viduals develop this sense of their own efficacy The issue of self-efficacy, and the means for
is what Bandura refers to as vicarious experience: others to influence one’s perceived level of effi-
“Seeing others perform threatening activities cacy, is especially important in the educational
without adverse consequences can generate ex- experience. In a focused discussion of the role
pectations in observers that they too will im- of self-efficacy in the educational context, Ban-
prove if they intensify and persist in their ef- dura describes how “Students’ beliefs in their
forts” (1977, p. 197). In a sense, an individual efficacy to regulate their own learning and to
comes to model his or her own behavior on ob- master academic activities determine their aspi-
servations of o thers trying and succeeding with rations, level of motivation, and academic ac-
challenging tasks (or conversely, trying and fail- complishments” (1993, p. 117).
ing): “If he (or she) can do it, so can I. I’m as good In the school environment, both self-efficacy
as him (or her).” Sometimes the person taken on and actual cognitive abilities will affect how
as a model is a peer to whom one feels equiva- well a student does. Students from a disadvan-
lent. Other times the model may be a mentor or taged socioeconomic background can enter
role model. school with reduced cognitive abilities when
A third mechanism for enhancing self-efficacy compared with more advantaged students of
is through verbal persuasion by others—most the same age. If they w ere also to enter school
typically a parent, teacher, or mentor. Repeated with a reduced sense of self-efficacy, they would
messages of “You can do it if you just try hard be at especially high risk of reinforcing those
enough,” when heard from someone one respects negative perceptions. When faced with the
and whose opinion one values, can strengthen challenges of learning new material in school,
one’s previously internalized sense of capacity “people who harbor self-doubts about their ca-
and efficacy. How the encouragement is phrased pabilities slacken their efforts or give up quickly.
can influence how effective the encouragement is Those who have a strong belief in their capabili-
in persuading the listener. This finding is consis- ties exert greater effort when they fail to master
tent with the work of Dweck and o thers de- the challenge” (p. 131). If a child were also to view
scribed in chapter 6. peers succeeding where he or she has failed and
The fourth mechanism identified by Bandura then to begin to sense negative rather than
is emotional arousal. Strong emotional arousal positive expectations from the teacher, the
will often trigger a response in the amygdala, adverse impact on perceived efficacy can be
which can then affect cognitive processes. If magnified.
that arousal is based on anxiety or fear of fail- Bandura goes on to underscore the impor-
ure, perceived efficacy at attaining an outcome tance of this process in the educational experi-
may be diminished. On the other hand if the ence. “By the choices they make, people cultivate
response involves more positive emotions such different competencies, interests, and social
networks that determine life courses. Any Lear and Macbeth behaviors that would today
factor that influences choice behavior can pro- be classified as mental illness. For much of the
foundly affect the direction of personal devel- 19th century, mental illness as seen in Western
opment” (p. 135). societies was divided into two broad categories:
Bandura went on to research the potential psychosis and neurosis. As described by the Ox-
social impacts on children in school of impaired ford English Dictionary, psychosis was viewed as
self-efficacy coupled with academic weakness. “severe mental illness, characterized by loss of
He found that contact with reality (in the form of delusions
and hallucinations).” By contrast, the OED de-
children who have a high sense of academic and fines neurosis as a “psychological disorder in
self-regulatory efficacy behave more prosocially, which there is disabling or distressing anxiety,
are more popular, and experience less rejection without severe disorganization or distortion of
by their peers than do children who believe they behaviour or personality.”
lack these forms of academic efficacy . . . The We no longer see these terms used in catego-
impact of children’s disbelief in their academic rizing m ental illness. Beginning in the mid-20th
efficacy on socially discordant behavior becomes century, the organization that was to become the
stronger as they grow older . . . Students who American Psychiatric Association began collabo-
doubt their social as well as their intellectual rating with the US government to develop a sys-
efficacy are likely to gravitate to peers who do tematic nomenclature of mental illness. This ef-
not subscribe to academic values and lifestyles. fort was expanded following World War II and
Over time, growing self-doubts in cognitive resulted in 1952 in the publication of the first
competencies foreclose many occupational life edition of the Diagnostic and Statistical Manual:
courses. (p. 138) Mental Disorders, referred to as DSM-I. In the de
cades since then, the DSM has u ndergone a series
of revisions, with DSM-5 being published in 2013.
In this updated edition, previous divisions of
ental illness and disorders
M
mental illnesses into distinct groups, referred to
of personality
as Axes, was discontinued, and different types
For much of the last century, many of those of mental illnesses were listed with descriptors
who have engaged in the study of personality of the variations that might exist within a spe-
have focused on how to describe and classify dis- cific illness. Some of the principal illnesses iden-
orders of personality. Recall that both Sigmund tified in DSM-5, with specific examples given for
Freud and Erik Erikson w ere psychotherapists some illnesses, are shown in table 7.4.
who developed their “stages of development” in Looking at the disorders listed in the table,
order to describe what they considered to be the and considering the common views of the ori-
normal process of psychological development. gins of mental illness as described by Freud and
Based on these normal developmental processes Erikson, two questions seem central to our
they then described the forms of mental illness understanding.
that often resulted from disruptions to these pro
cesses. One thing they had in common was the 1) To what extent are these disorders caused
view that mental illness is often a consequence by disruptive social or interpersonal
of early developmental abnormalities. experiences, especially during childhood
Mental illness has been recognized for cen- and early development?
turies. Shakespeare seemed to have a special 2) To what extent are these disorders caused
interest in it, giving characters such as King by inherited genetic abnormalities?
T able 7.4. Categories of M ental Illnesses Scientists as well have psychotherapists have

Described in DSM-5, with Examples of been discussing the causal role of genetics vs.
Specific Illnesses within a Category life experiences for many of the other diseases.
Neurodevelopmental Disorders For some, there appears to be a strong consen-
Global Developmental Delay sus that inherited genetic abnormalities play a
Autism Spectrum Disorder central role in disease causation. This is true for
Attention-Deficit/Hyperactivity Disorder
diseases such as schizophrenia, bipolar disor-
Schizophrenia Spectrum and Other Psychotic ders, and some depressive disorders. A consor-
Disorders tium of researchers recently identified a series
Bipolar and Related Disorders of genetic mutations that appear to be involved
Depressive Disorders in several of these illnesses (Cross- Disorder
Group 2013). Analyzing the pattern of single
Anxiety Disorders
nucleotide polymorphisms among about 33,000
Social Anxiety Disorder (Social Phobia)
Panic Disorder adults with mental illness and 28,000 adults
Agoraphobia without known illness, all of European ances-
Generalized Anxiety Disorder try, they noted significant overlap in the genetic
Obsessive-Compulsive and Related Disorders abnormalities associated with bipolar disorder,
major depressive disorder, and schizophrenia,
Trauma-and Stressor-Related Disorders
leading the authors to conclude that “Accumu-
Post-Traumatic Stress Disorder
Acute Stress Disorder lating evidence, including that from clinical,
Adjustment Disorders epidemiological, and molecular genetic studies,
suggests that some genetic risk factors are shared
Neurocognitive Disorders
Parkinson’s Disease between neuropsychiatric disorders” (p. 1377).
Huntington’s Disease In contrast to those disorders with a defined
genetic causation, there is also broad agreement
Personality Disorders
General Personality Disorder that certain disruptions in early child develop-
Paranoid Personality Disorder ment can lead to symptoms of mental illness
Antisocial Personality Disorder that may last well into adulthood. G oing be-
Borderline Personality Disorder yond Freud’s concepts of psychosexual aspects
Narcissistic Personality Disorder of child development, psychologists John
Dependent Personality Disorder
Bowlby and Mary Ainsworth developed a the-
Source: American Psychiatric Association 2013. ory, referred to as attachment theory, that iden-
tifies a child’s healthy attachment to his or her
mother during infancy as central to developing
Some of these disorders have a clear genetic a healthy personality (Bretherton 1992). As de-
origin. For example, among the neurocognitive scribed by Bowlby, “attachment behaviour is
disorders listed, both Huntington’s disease and conceived as a class of behaviour distinct from
certain forms of Parkinson’s disease have rec- feeding behaviour and sexual behaviour and of
ognized genetic abnormalities as their cause. at least an equal significance in human life”
These genetic mutations can be passed on to (1977, p. 204). Bowlby goes on to explain, “The
one’s children, who are then likely to develop key point of my thesis is that there is a strong
the disease. By contrast, posttraumatic stress causal relationship between an individual’s ex-
disorder and acute stress disorder are responses periences with his parents and his l ater capacity
to extremely stressful life experiences, with no to make affectional bonds, and that certain com-
associated genetic abnormality. mon variations in that capacity, manifesting
themselves in marital problems and trou ble

Summary
with children as well as in neurotic symptoms
and personality disorders, can be attributed to We began this chapter by comparing different
common variations in the way parents perform historical perspectives on the process by which
their parental roles” (p. 206). personality develops, from birth through either
Bowbly incorporated into his theory much of adolescence (as seen by Freud) or throughout the
the research of Mary Ainsworth (Ainsworth life course (as seen by Erikson). We then de-
and Bowlby 1991). Ainsworth studied the rela- scribed various ways psychologists have pro-
tionship between infants and their mothers, posed conceptualizing and categorizing person-
both in Africa and in Baltimore, Mary land. ality according to specific traits. There is no
Through careful observation of the interactions single best way to connect the developmental
over time between mother and infant, she iden- process with the traits exhibited in adolescence
tified clear patterns of sensitive and supportive and adulthood. Nor is there a single best way to
parenting as well as patterns of anxious and dis- define and measure the different types of traits
connected parenting. The child’s subsequent people exhibit. A constant factor across these
responses to these different caring patterns dur- various theories, though, is the importance per-
ing the first months and years of life resulted in sonality has for affecting both be hav
ior and
differing patterns of behavior toward the parent well-being. Similarly, many of the theorists,
and toward others. These abnormal childhood principal among them Freud, Erikson, and Ban-
responses, they hypothesized, would come to dura, also proposed that we gain a better under-
be associated with potentially serious disorders standing of how m ental health or educational
of personality and interpersonal relationships as professionals can work with individuals who
adults. Responding to critics who took more of exhibit mental illness or negative personality
a traditional Freudian view of the childhood ori- traits by identifying both the roots of those traits
gins of m ental illness, Bowlby commented, and the steps one can take to overcome them.
While a number of these illnesses have distinct
Throughout this century debate has raged about genetic causes, it remains key in this therapeutic
the role of childhood experiences in the causation process for the person offering this support to
of psychiatric disturbance. Not only have enable a feeling of trust and respect in the per-
traditionally minded psychiatrists been skeptical son receiving that support and a belief that,
of their relevance but psychoanalysts have been through consistent, hard work, past barriers can
at sixes and sevens about them . . . No one be overcome and newly adopted goals realized.
engaged in child psychiatry, better termed f amily
psychiatry, can possible share such a view. In a References
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chapter
8 The Brain and Behavior
B
ehavior involves an individual’s response to a perceived
stimulus. There are three core steps in the process of be
havior: perception of the stimulus, interpretation of that
stimulus, and response to that interpretation. This pattern is in-
volved in a wide range of behaviors, from newborn infants suck-
ing a pacifier more slowly when they heard sounds that were in
the language of their mother to adults with lower levels of educa-
tion deciding more often to light up a cigarette.
While the association between adult educational attainment
and smoking involves issues of motivation and personality, the
newborn responding to the sound of the mother’s language has
not yet developed these characteristics. For both the adult smoker
and the newborn infant sucking on the pacifier, however, each of
the steps in the process of these behaviors, from perception to
response, involves the body’s nervous system.
The perception of stimuli usually relies on the various sensory
organs and their neural connections to the brain. The interpreta-
tion of the sensory impulses received by the brain involves other
parts of the brain involved in memory and meaning. Finally, any
action, from blinking one’s eyes or making a sound with one’s
mouth to moving one’s hand and arm to catch a baseball or opening
a book to study for an exam, involves neural impulses generated
in the brain’s motor cortex or other parts of the brain involved in
muscular stimulation.
Accordingly, the first step in understanding the roots of human
behavior is gaining an understanding of the development as well
as the structure and function of the brain and nervous system.
To introduce this concept, consider the processes involved when
we go to an Internet site to obtain information or carry out a
transaction.
115
and users often obtained incomplete or inaccu-

The importance of communication
rate information. Even after many of these
between information sources: On the
problems were fixed, there continued to be
Internet and in the human brain
problems for participating insurance compa-
For better or worse, the Internet has become an nies in getting accurate data about those who
increasingly prevalent part of our lives, in a had enrolled in their plans, and the new enroll-
range of capacities and contexts. We have come ees often had trouble getting verification of cov-
to expect a website to be readily available (as- erage from the insurer.
suming we have the means of accessing it) and Looking at these problems from the perspec-
to respond quickly and accurately to our inqui- tive of the user, Healthcare.gov simply didn’t
ries and requests. Sometimes, though, we en- work. This perspective is illustrated in figure 8.1.
counter a site that is slow in responding or that From the point of view of the outside user
gives us an error message, indicating (much to trying to get Healthcare.gov to respond, the
our frustration) that it cannot proceed with the problem was simple: The website was malfunc-
transaction. tioning. A common perception in news reports
One of the most publicized of these website approached the new website as a single entity
failures occurred in October 2013, when the with a single function—making health insur-
federal government opened Healthcare.gov as a ance available to the potential purchaser.
means of creating a new health insurance mar- Subsequent news stories, federal reports, and
ketplace for individuals and families to acquire policy analyses demonstrated that this view, of
health insurance u nder the guidelines and rules a single website that simply didn’t work, was not
of the Affordable Care Act. Unfortunately, fully accurate. A more accurate understanding
things did not go smoothly at first. No sooner of the many and complex factors that went into
had the website opened for business than re- Healthcare.gov is shown in figure 8.2.
ports started rolling in about how poorly it Healthcare.gov was actually both a com-
functioned. Users had trouble getting onto the puter server that interacted electronically with
website, and those who tried to create accounts a user on the web and a portal for the transfer
were often left in limbo. It often took an ex- of information among a wide host of other serv-
traordinarily long time for a window to load, ers and data files. When an individual applied
for coverage, the federal Center for Medicare
and Medicaid Services automatically communi-
User tries to cated with a range of federal, state, and private
log on agencies to verify eligibility for coverage. As
described on the informational website pro-
vided by CMS, when you logged on to Health-
care.gov:
• Social Security may verify your Social

Security numbers and citizenship status.
Healthcare.gov • The US Department of Homeland Security
busy or fails may verify your immigration status.
to respond
• The Internal Revenue Service may verify
your household income and family size; the
Figure 8.1. Healthcare.gov: From the Perspective income of h ousehold members may also be
of the User verified with the Social Security Adminis-
Th e B r a i n a n d B e h av i o r 1 1 7
User tries to
log on
Private
insurance
company
State Medicaid Healthcare.gov

office
Private credit
agency
Internal Department of Department of

Social Security
Revenue Homeland Veterans
Administration
Service Security Affairs
Figure 8.2. Healthcare.gov: From the Inside Looking Out
tration and with a consumer credit report- munications among the various servers was
ing agency. equally important as the proper functioning of
• A consumer credit reporting agency may the servers themselves. Healthcare.gov was a
verify your employment information. complex network of central information sources
• The employers listed on your application and interconnecting webs of communication,
may verify your eligibility for employer- and it was largely these interagency communi-
sponsored health plans. cations that malfunctioned, not the computer
• The State Medical Assistance (Medicaid) servers themselves. For example, in re-evaluating
office, the Children’s Health Insurance the expected enrollment in private health in-
Program (CHIP), the US Department of surance and in Medicaid u nder the Affordable
Veterans Affairs, Medicare, Peace Corps, Care Act, the Congressional Budget Office (2014,
US Department of Defense (for TRICARE), p. 114) described how “the exchanges operated
US Department of Health and Human by the federal government have struggled to
Services, the Office of Personnel Manage- transfer application information to state agen-
ment, and the Small Business Health Option cies for p
eople who might be eligible for Medic-
Programs that operate in your state may aid or CHIP.” It was the neural connections
verify your eligibility for and/or enrollment between the servers that malfunctioned much
in health coverage programs. more so than the servers themselves.
The human brain can be seen as analogous to
Each of these agencies or organizations had this structural arrangement. From one perspec-
its own computer server, with its own web ad- tive, looking at the brain as a single functional
dress and its own security and communication unit, we might see what is shown in figure 8.3.
protocols. As figure 8.2 illustrates, assuring the To look at the brain, however, as a single
proper functioning of the complex web of com- functional unit would be analogous to looking
connect the mouth to the gustatory cortex of

the brain, located within the frontal lobe. Sen-
sations of smell travel over the olfactory nerve
from the nasal cavities to the olfactory cortex,
part of the temporal lobe. The area of the brain
that handles sensory input from the eyes is the
visual cortex; the section that handles sound is
the auditory cortex; and the area that receives
tactile stimuli from the nerves at the periphery
of the body is the sensory cortex. The part of
the brain that sends instructions to the muscles
regarding movement is the motor cortex. These
areas are illustrated in figure 8.5 below. There
are also areas whose principal function is
Outer surface of thought and reasoning. These include the as-
left side of brain sociation cortex and the prefrontal cortex.
Figure 8.3. The H
uman Brain There are also localized parts of the brain that
function at more of an unconscious level. The
JHUP Barr Figure 8.3 Final hippocampus plays a major role in memory
Medical Illustrator: Jacqueline Schaffer
at the webpage of Healthcare.gov as a single storage and retrieval, the amygdala plays a cen-
computer server. Just as Healthcare.gov has mul- tral role in feeling and responding to emotion,
tiple functional units with complex intercon- the thalamus controls consciousness and sleep,
nections among them, so the human brain has and the hypothalamus monitors and controls
a wide range of functional units spread through physiologic functions such as body temperature
the tissue of the organ itself as well as an in- and response to stress.
credibly complex web of communications links. While each of these sections of the brain
In addition to these multiple units, the brain is tissue has an important function in itself, the
structured and functions at multiple levels. In brain cannot function adequately if the various
much the same way that a computer server will sections fail to communicate with each other
have both program algorithms that govern how quickly and efficiently. This communication re-
data input is managed and backup files to store quires a web of nerve fibers called axons. These
old data in case one ever needs to retrieve them, axonal connections allow us to perform the
the brain has conscious and unconscious con- many and complex tasks involved with h uman
trol mechanisms that maintain overall func- existence. To illustrate, let us consider two core
tional control as well as substantial memory functions of the h uman brain: understanding
capacity for the storage and retrieval of old spoken language and reading. The activities in-
information. volved in these two functions are illustrated in
The principal functional units in the brain figure 8.4.
are referred to as the cortices (with one unit First let us consider hearing spoken lan-
called a cortex). Each of the h uman body’s five guage. The ears sense sound waves and send
core senses (taste, smell, touch, vision, and hear- information about that sensory input over spe-
ing) has a cortical area that receives the sensory cialized nerve pathways to the auditory cortex,
impulses coming from the body. Taste, based an area of the brain that has developed the spe-
on the stimulation of receptors in the mouth cialized capacity to receive this input. As part of
and tongue, travels over a series of nerves that the process of learning to recognize language,
Prefrontal
cortex
The brain
Associative
cortex
Auditory Visual
cortex cortex
Nerve Nerve
impulses from impulses from
the ears the eyes
Figure 8.4. How the Human Brain Handles Spoken Language and Reading
infants start to be able to distinguish certain the development of language perception in 18–
sound patterns as representing words, as dis- 24 month old infants by playing the sound of a
tinct from those patterns that simply represent spoken word for the infant to hear and immedi-
noise. This process actually begins in the womb ately displaying two pictures: one an image of
as the developing fetus hears the sound of the the object associated with the word and an-
mother speaking. As described in chapter 1, other that was unrelated to the word. They
Moon et al. (2013) tested whether newborn in- were able to watch the direction of the infant’s
fants could distinguish vowel sounds from the gaze after hearing the word, to see if it was di-
language spoken by their mother from vowel rected to the picture of the object associated
sounds spoken in a different language. Based with it. They used words such as baby, doggy,
on d ifferent rates of sucking on a pacifier in re- birdie, and ball. They found that these infants
sponse to the sounds, they found clear evidence were able quickly to recognize many of the
that infants have already developed the basics words, but that children from families of lower
of sound recognition by the time they are born. socioeconomic status (SES) recognized fewer
In order to develop language, an infant must words on average than children from higher-SES
learn to associate a certain sound or groups of families—something that will take on added
sounds with a visual image of an object. For ex- importance when we consider below the neural
ample, to understand the word dog, an infant systems and connections involved in learning
must recognize this unique sound when it is to read.
spoken and associate it with the four-legged Figure 8.5 illustrates the parts of the human
animal it represents. Fernald et al. (2013) studied brain involved in language. It shows the visual
Frontal lobe
Motor cortex
Prefrontal cortex
Arcuate fasciculus
Broca’s area
Visual cortex
Auditory cortex
Wernicke’s area
Outer surface of
left side of brain
Figure 8.5. The Parts of the Brain Involved in Language
JHUP Barr Figure 8.5 Final

Medical Illustrator:
cortex at the back of the brain, the auditory cor- Jacqueline Schaffer
in Wernicke’s area with another area located in
tex on the side of the brain, and an area that the frontal lobe, referred to as Broca’s area. The
associates visual and auditory stimuli, h ere la- frontal cortex of the brain is responsible for in-
beled Wernicke’s area. As an infant repeatedly tellectual processes as well as the initiation of
hears a word and sees the object the word is in- motor activity. The area referred to as the pre-
tended to represent, the auditory stimulus is frontal cortex manages intellectual activity
coupled with the visual stimulus in Wernicke’s such as abstract reasoning and planning future
area, and that association is then stored in mem- activity. Broca’s area is part of the prefrontal
ory. At a l ater time the infant can hear the word cortex.
without also seeing the image and, through the A next step in language development is for
connection between the auditory cortex and the infant to be able to speak the words it has
Wernicke’s area, retrieve from memory the im- learned. Speaking involves the creation of
age of the object the word represents. nerve impulses in the motor cortex of the brain,
Beyond simply recognizing a word, an infant which is also part of the frontal cortex, and the
must also give meaning to the word. For ex- transmission of these impulses to the complex
ample, an infant might associate the word dog system of muscles in the mouth, vocal cords,
or doggy with experiences it has had with dogs, and lungs that allows us to form spoken words.
whether real dogs or imaginary dogs seen on Thus learning both to understand language
the pages of a book. The infant’s brain does this spoken by others and then to speak the lan-
by connecting the associative memory created guage oneself involves a complex series of com-
munications among the various cortical areas fasciculus that link them together, let us con-
involved, as illustrated in figure 8.4 above. As sider how these different functional parts of the
was the case with Healthcare.gov, the proper brain develop embryonically.
functioning of these activities depends at least
as much on efficient communication among the
The development of the human brain,
various cortical areas as it does on having those
from embryo to organ
local cortical areas function properly.
The final process we will address as part of From the fertilization of a female ovum by a male
this discussion is learning to read, a process that sperm, a process of rapid cellular division and dif-
typically takes place a fter infancy, in early child- ferentiation is triggered that will eventually result
hood. A necessary precursor to learning to read in the complete, complex organism we know as
a language is first learning to hear and speak the h uman infant. Within a short period of time
that language. A child who has never learned after the development of the embryo, the various
the sound and associated meaning of the word organ systems begin to differentiate. One of the
book can look at the printed letters b-o-o-k and most important of these is the nervous system,
yet derive no meaning from that visual image. which begins to develop a tubular structure
A child who has previously learned to hear and known as the neural tube. Within the developing
to speak the word, upon seeing the printed let- neural tube, some embryonic stem cells (those
ters in sequence, can quickly recognize the cells with the potential to become any of a range
meaning associated with that visual image. The of precursor cells, which in turn differentiate into
child’s brain does this through a rapid sequence the various organ systems) become neural stem
of communication between the visual cortex, cells. These cells will then undergo further dif-
the associative area of Wernicke’s area, and Br- ferentiation into two broad categories of precur-
oca’s area, where the meaning associated with sor cells: neuroblasts, which will become neu-
the word is stored. If all these communications rons within the ner vous system, and glial
go smoothly, the child understands the mean- precursor cells, which will develop into the vari
ing of the word and how it relates to the words ous types of cell that support the function of neu-
coming before and a fter it. As part of this pro rons without actually being involved in the pro
cess of comprehension, the brain sends signals cess of transmitting neural impulses.
to the muscles controlling the movement of the As the neuroblasts that will form the brain
eyes to scan the printed words that follow. undergo further differentiation, they begin a
Once again, in order to read quickly, these process of migration to specific locations within
communication paths among the various corti- the developing brain. This migration process is
cal areas involved must work efficiently. Scien- triggered by a combination of chemical mes-
tists studying the function of the brain have sages being released in the d ifferent brain cen-
identified specialized nerve fibers involved in ters and portions of the neuroblast that sense
the communications processes involved in lan- the presence of these chemical signals. Groups
guage and reading. The arcuate fasciculus is one of neuroblasts clump together and will eventu-
of these communications links. It is a large bun- ally become the various functional areas of the
dle of nerve fibers that connects Wernicke’s brain such as those we have described that are
area to Broca’s area as one of the principal com- involved in language and reading.
munications circuits involved in language and Once the neuroblasts have migrated to their
reading. To fully understand the dual impor- functional area, the next stage in the process is
tance of the cortical areas of the brain and the the development of connections, both among
communications circuits such as the arcuate the specialized cells in the same area and with
specialized cells in other areas. The cells de- scale). The source of this ability is the growth
velop these connections by sending out narrow cone, a structure at the tip of each elongating
projections of the cell, with a specialized recep- axon.”
tor called the growth cone at the leading edge of The axon is the elongated portion of the neu-
the projection. The growth cone senses chemi- ron that connects it with more distant cells. In
cal signals coming from other, more distant addition to this connection, the cell also devel-
cells and continues to grow in an elongated pro- ops numerous connections with similar cells in
jection in the direction of those chemical sig- the same functional area. These connections are
nals. As described by Duboc on the website made through numerous, branching, shorter
“The Brain From Top to Bottom,” “Probably connections called dendrites. Thus a neuron
one of the most amazing things about the way may have an axon, connecting it to more distant
the nervous system develops is how the grow- cells, and multiple dendrites, connecting it to
ing axons find their target cells, even though adjacent cells with a similar function. These
these cells are often located millimetres or structures, and the steps leading to their differ-
even centimetres away (a vast distance on this entiation, are illustrated in figure 8.6.
Neuroblast
Differentiated
neuron
Branching
dendrites Dendrites
Receive messages
from other neurons
Neuron body
Cell Primary component
of gray matter
outgrowths
Elongating
axon
Growth Axon
cone Direction Conveys messages
of signal to other neurons,
primary component
of white matter
Synapse Axon branches

Where this neuron
transmits signals to
another neuron Presynaptic button
Dendrite
Figure 8.6. The Stages in the Development of a Neuron in the Human Brain

In the fully differentiated neuron, the web of These processes, initiated as part of embry-
dendrites extending from the cell connects it to onic development and carried out through fetal
similar neurons in the immediate vicinity, development, lead to the development of the
while the axon can extend great distances (in human brain as a complex system of specialized
relative terms) to link the cell to other func- cortical areas connected by extensive communi-
tional centers of neurons. The grouping of simi- cation webs. It is typical to refer to the various
lar neurons in an area of the brain creates a local aggregation of neurons that comprise the
functional unit, while the collective neurons cortical areas as gray m atter and the branching
create the pathways for this functional center groups of axons that connect the various cortical
to communicate with other functional cen- areas as white m atter. When examining the brain
ters. In the case of language and reading de- in cross section using MRI or other types of im-
scribed above, the visual cortex, auditory aging, the cortical areas appear as gray, while the
cortex, Wernicke’s area, and Broca’s area each axons connecting them appear as white. These
represents a local functional unit, while the appearances are shown in figure 8.8.
arcuate fasciculus that connects Wernicke’s One of the fascinating things about the way
area to Broca’s area is an example of an essential the h uman brain has developed from an evolu-
communication pathway. This developmental tionary perspective is how the development of
process, with clumps of neurons linking together our brains differs from that of other primates
through their dendrites while also communicat- that have not developed the same level of lan-
ing with more distant centers, is illustrated in guage, communication, and intellectual capac-
figure 8.7. ity. Buckner and Krienen (2013) have described
We see in the first panel the differentiation the evolution of the brain structure of placental
and subsequent proliferation of two separate mammals from an original common ancestor.
groups of neurons. As they grow and mature, They examine the relative position of three es-
the cells on the left develop extensive webs of sential sensory areas of the brain: the visual
dendrites so as to link together as well as a cortex, the auditory cortex, and the somatosen-
series of axons that, in response to chemical sory cortex (the area that receives sensory input
signals being given off by the cells on the right, from the nerves in the periphery of the body
elongate in the direction of these cells u ntil that sense stimuli such as touch and pressure).
they actually make contact with them. As They compare the positioning of these cortical
the area on the left begins to carry out its spe- regions in a range of modern-day mammals,
cialized function, the frequency of its axonal from mice and hedgehogs through the great
communications with the area on the right apes and humans, and conclude that the relative
increases. positioning of these areas in the brain has re-
One of the most interesting things about the mained fairly constant throughout evolution-
structure and function of these types of axonal ary history. As with humans and other primates,
connections is that, the more often they convey the visual cortex of hedgehogs and mice is at
messages over their length to the associated ar- the posterior of the brain, the auditory cortex is
eas, the better they get at conveying these mes- at the midlateral aspect of the brain, and the
sages. The more an axon is used to communi- somatosensory area is in the upper-mid portion
cate, the faster those communications become, of the brain.
with increased efficiency of communication While the positioning of these and other
between the functional areas. I address this as- cortical areas has not changed throughout
pect of axonal communication below as part evolution, what has changed dramatically is the
the discussion of axonal myelination. overall size of the brain. As described by Buckner
A
After proliferating, neuroblasts migrate to

their functional destinations in a developing brain
Axons elongate, following growth cones toward

developing target neurons, and dendrites form branches
Differentiated neurons initially form

too many synaptic connections with target neurons
Synaptic connections are selectively eliminated,

refining the new communications pathway
Figure 8.7. The Stages in JHUP Barr Figure 8.7

the Development ofFinal
a Neuron in the Human Brain
Angle of cross section
Gray matter
of brain
White matter Outer surface of

of brain left side of brain
Cross section of brain

Figure 8.8. Cross Section of the Human Brain, showing Gray Matter and White Matter

and Krienen, the human brainMedical is more than Jacqueline
Illustrator: cal sensory-
motor [cortices] in the service of
Schaffer
three times larger than the brain of the chim- information processing that is detached from
panzee. Despite this difference in overall size, sensory perception and motor actions—what
the absolute size of the principal sensory cortices one might term ‘internal mentation’. This is an
is almost the same in humans and chimpanzees. intriguing possibility because it brings to the
It may well be that the chimpanzee is able to forefront the kinds of information processing
sense visual and auditory stimuli just as well that humans do so well such as remembering,
as humans. What makes us a fundamentally imagining the future, social judgments, and other
different species is what our brains do with this cognitive acts that manipulate information in
sensory input. working memory. (p. 653)
If our brains are three times larger than
that of the chimpanzee and yet our sensory As humans evolved from earlier primates, and
cortices are about the same size, what makes as our brains became progressively larger, most
up the rest of the extra brain area that humans of that growth was in this association cortex—
have but chimpanzees don’t? Buckner and Kri- this vast web of communication carried by pro-
enen conclude that it is the vast web of com- gressively longer and progressively more dense
munication between cortical areas, which groups of axons. It is this axonal network that
they refer to as the “association cortex,” that gives humans the capacity to process informa-
differentiates the human brain from that of the tion in increasingly complex ways, including
chimpanzee. the capacity to store input in memory and to
recall it quickly and efficiently when needed.
The expanded association cortex contains Buckner and Krienen also point out that our
networks operating in parallel with the canoni- dendritic connections within local cortical ar-
eas are more dense than those of other primates uterus and surrounding musculature to squeeze
and that the continued development of these the infant’s head through and then out of the
dendritic connections in areas such as the pre- birth canal. Thus humans are born with a brain
frontal cortex takes longer in the maturation that is not as far along in its cellular develop-
process of humans. It is the association cortex ment as the brains of other mammals. This is a
that principally differentiates us from our pri- fundamental concept that we will discuss in
mate relatives. greater depth in the next chapter, which ad-
Rather than a chimpanzee, let us instead dresses the development of human cognition.
consider the development of the brain of a large
mammal such as the giraffe. When a baby gi-
The molecular biology of nerve
raffe is born, it is capable of standing and walk-
conduction and neuronal myelination
ing (perhaps even running) within a few hours
of birth. If it were not able to do this, it could We have explored how the various forms of
easily fall prey to predators in the area. In order neurons develop in the human brain, but we
to optimize the giraffe’s chances of survival, the have left unanswered how it is that nerves
sensory cortices, the motor cortex, and the as- carry out their fundamental activity: transmit-
sociative cortex that links them together to cre- ting an electrochemical impulse from one place
ate muscular movement and balance must be to another. As a first step in this discussion, let
fully developed. The neurons are all in place, and us consider how a metal wire carries out this
they are all ready to carry messages that allow function as part of an electrical system.
the infant giraffe to get up and walk. Much like axons, wires are long, thin chemi-
Human infants, on the other hand, require cal structures, typically made of an elemental
months before they are capable of standing and metal such as copper. Copper is an especially ef-
walking. The cellular components of the human ficient electrical conductor because of its atomic
infant’s brain have not matured to the same ex- structure. Surrounding its positively charged
tent as the giraffe at the time of birth. There is nucleus, a copper atom has a collection of 29 neg-
a good reason this is so. Given the vastly in- atively charged electrons. Of these, 28 are packed
creased size of the human brain in relation to into orbital rings that bind them tightly to the
other mammals and primates, if the human in- nucleus. The 29th electron is in an outer orbital
fant were to remain in the mother’s womb until ring, all by itself. As such, it is more loosely
all its neural connections had matured, the in- bound, which allows it to connect to other at-
fant’s head would by then be too large to make oms around it. Now picture a long, thin wire
it through the birth canal of the human female’s made of copper, as illustrated in figure 8.9.
pelvis. The process of labor and delivery for If an electron from outside the wire enters
human
women is already difficult enough, the wire at one end, it can easily displace the
given the relatively narrow size of the birth ca- free electron of a nearby copper atom. The elec-
nal. It often takes hours of contractions of the tron that is displaced will then move to an
Electron Electron

in out
Cu Cu Cu Cu Cu Cu Cu Cu
Figure 8.9 Electrical Conduction through a Copper Wire

adjacent atom and displace its electron. This vents this from happening—that is, u ntil it
sequence of electron movement from one cop- receives a chemical signal on one end. (This
per atom to an adjacent atom will continue u ntil chemical signal is in the form of molecules
it reaches the end of the wire, at which point a called neurotransmitters whose specific func-
free electron will be in a position to move to an tion is to transmit impulses from one neuron to
adjacent object. If that adjacent object happens another. I discuss this transmission process be-
to be our finger, we may feel an electrical shock. low.) Once the neuron receives that signal, the
If it is another wire or similar substance, the cell membrane along its length depolarizes, al-
electrical current generated in the wire will be lowing a sequential cascade of sodium ions to
passed on and will move through the new con- flow across the membrane to the interior of the
ductor. This is how electricity is transmitted cell until it reaches the end of the neuron and
from one end of a wire to the other. triggers the release of neurotransmitters to the
The axon of a brain neuron is also a long, adjacent neuron.
thin chemical structure. Rather than being There is one additional aspect of the trans-
made up of a single element such as copper, it is mission of an impulse along the course of an
made up of a complex series of three-dimensional axon that we should understand, as it comes up
biochemical molecules. I illustrate the structure repeatedly in discussions we will have about
of a brain neuron in figure 8.10. the development of cognitive function in chil-
Surrounding the neuron is a cell membrane dren—a topic covered in chapter 9. As described
that controls, through biochemical pro cesses, above, the outer surface of a neuronal axon is
what gets into the cell and what goes out of the comprised of a cell membrane that selectively
cell. In its resting state, the neuron has used these allows certain substances to cross it. In much
biochemical processes to push extra sodium ions the same way that copper wires that carry elec-
to the outer surface of the cell membrane. These tricity are typically covered with a layer of in-
ions are positively charged (the reverse of the sulating material to allow electrical conduction
negative charge of the electrons in a copper wire) to take place more efficiently, the brain wraps
and thus create a cross-membrane difference in the axon of a neuron in a biochemical insulat-
potential (difference in electrical charge), with the ing material called myelin.
inner aspects of the neuron negatively charged. Recall from our discussion above that when
This separation of charges is referred to as the the nervous system begins the process of dif-
polarization of the cell membrane. ferentiation in the early phases of embryonic
The laws of physics would suggest that the development, embryonic stem cells change into
positively charged sodium ions on the outer neural stem cells, which further differentiate
surface of the cell would move across the cell into two types of cells: the neuroblasts, which
membrane to the inner aspect of the cell so as become neurons, and glial precursor cells. Rather
to balance off the negative charge there—to “de- than participating directly in the transmission
polarize.” The cell membrane, however, pre- of information, these glial cells exist adjacent to
Membrane depolarization
Na Na Na Na Na Na Na Na
Chemical Chemical
message message
in out
Figure 8.10. Impulse Conduction through a Neuron

the neurons, carrying out functions that sup- to mice whose brains had undergone a form of
port the neurons. In the case of axons, it is injury similar to that caused by prematurity in
these glial cells that respond to the regular humans and as a result were able to reverse the
transmission of signals along an axon by attach- impact on oligodendrocyte functioning. The
ing to the outer surface of the axon and gradu- process of axon myelination in humans is illus-
ally wrapping the axon in a fatty substance we trated in figure 8.11.
call myelin. The specialized type of glial cell In response to biochemical signals given off
that performs this function is called an oligo- by the axon as part of the transmission of im-
dendrocyte. If the functioning of these oligo- pulses along its length, the oligodendrocytes be-
dendrocytes is impaired, the process of axon gin to wrap sheets of myelin around the axon.
myelination will also be impaired as a result. The more regular the transmission of signals
Infants born extremely prematurely (before 32 along the axon, the thicker the myelin sheath ap-
weeks of gestation) are at risk of developing a plied by the oligodendrocytes. Note, though,
form of brain injury called diffuse white matter that the myelin sheath is not continuous along
injury, which can result in chronic impairment the length of the axon. It is interrupted at regular
of brain functioning. Using a model of a similar intervals by small segments, ranging in length
brain injury in mice, Scafidi et al. (2013) showed from 0.2 to 2 millimeters, in which the axon is
that this type of injury to the white m atter is not covered by the myelin. These segments are
due to impaired production of a growth factor referred to as the nodes of Ranvier. These nodes
that acts to stimulate the growth of oligoden- allow the transmission of the electrical impulse
drocytes and as a result the axonal myelination to proceed much more rapidly down the length
process. They administered this growth factor of a neuron. Imagine a copper wire that gener-
A B C
Neuron
Impulse
Impulse
transmission
along transmission
unmyelinated along
axon myelinated
Myelin axon
Nodes of
Ranvier
Oligodendrocyte
Oligodendrocyte receives Oligodendrocyte begins to Impulse jumps rapidly

signal from transmitting wrap axon in myelin sheaths, along myelinated axon,
neuron to insulate axon leaving uncoated intervals between nodes of Ranvier
Figure 8.11. Axon Myelination

ated a spark on its surface, with that spark jump- volves a different set of chemical reactions. The
ing down a length of the wire, thus generating synapse is the space in which two or more
another spark that would also jump down the nerve cells adjoin each other. As shown in fig-
wire. In essence, this is what the nodes of Ran- ure 8.12, the shapes of the cell membranes at
vier do. Rather than proceeding continuously their tips have adapted to this connection,
down the entire length of the neuron, depolar- with the end of one cell s haped optimally to
ization of the membrane can jump from node to transmit an impulse (referred to as the presyn-
node, bypassing the axonal segments that have aptic button) and the other shaped to receive
been myelinated. Thus the conduction of the the chemical messengers transmitting that
nerve impulse along a myelinated axon will hap- impulse.
pen much more rapidly than along a comparable In 2013, three scientists—James E. Rothman,
axon that has not been myelinated. Randy W. Schekman, and Thomas C. Südhof—
Yeatman et al. (2014) studied the role of axo- were awarded the Nobel Prize in Physiology or
nal myelination in the observed changes in Medicine “for their discoveries of machinery
brain structure and function from childhood regulating vesicle traffic, a major transport sys-
through old age. They determined that “The tem in our cells” (Nobel Assembly 2013). These
myelination process is determined both by in- scientists identified the precise biochemical
trinsic genetic codes and extrinsic environmen- structures and substances that transmit an im-
tal factors. The level of electrical activity of an pulse from one cell to another. They described
axon influences myelination, meaning that the small bubbles, called vesicles, containing key
myelination process is modified through expe- protein molecules called neurotransmitters.
rience.” Explaining the role of myelination in These vesicles lie adjacent to the inner aspect of
facilitating communication between different the cell membrane. As shown in figure 8.12,
cortical areas in the brain, they described how when depolarization reaches the presynaptic
“Myelination speeds signal conduction be- button, the vesicles fuse with the cell mem-
tween distant cortical regions and . . . deter- brane and then develop a small opening into
mines the rate, quantity and nature of signals the synaptic space between the cells, through
that a pathway transmits” (p. 8). As we will see which they emit their contents into the space.
when we discuss the neurobiological processes The membrane of the adjacent cell has special-
involved in learning, this process of myelina- ized sensors called receptors that respond to
tion plays a crucial role. the presence of neurotransmitters by triggering
a new depolarization sequence along its mem-
brane. Once the signal has been transmitted in
Transmission of a nerve impulse across
this way, the vesicles reform inside the button
the synapse
to await the next impulse.
As described above, the development of the The process of transmission of the impulse
human brain involves the proliferation of mas- across the synaptic space can take place dozens
sive numbers of neurons (estimated to be in the of times a second. As an impulse is transmitted
billions) and the connection of these neurons repeatedly between the cells, the transmission
through a complex web of axons and dendrites. process can become even more rapid, with in-
The process of membrane depolarization we creased amounts of neurotransmitters and
have just described conducts an impulse along heightened sensitivity of the adjacent receptors.
the length of a single neuron. The question of These processes are important aspects of our
how that impulse was triggered, and where it ability to learn, which we will discuss at some
goes after it reaches the end of the neuron, in- length in chapter 9.
A B Presynaptic C Unused
depolarizing neurotransmitter
impulse pumped back
Neurotransmitter into presynaptic
Presynaptic in vesicles Neurotransmitter
Synaptic released into vesicle for reuse
button
space synaptic space
Presynaptic
membrane
Unactivated receptors Unactivated receptors
Postsynaptic
dendrite
Presynaptic neuron makes Impulse depolarizes presynaptic Neurotransmitter activates

neurotransmitter and stores it neuron, causing vesicles receptors, transmitting
ready for release in vesicles to fuse with membrane, chemical signal, depolarizing
near its synaptic surface releasing neurotransmitter postsynaptic neuron
Figure 8.12. The Transmission of a Nerve Impulse across the Synapse
The hippocampus is a section of the brain

Brain systems for emotion and response
involved in storing memories of past events and
to stress JHUP Barr Figure 8.12 Final
retrieving
Medical Illustrator: Jacqueline them
Schafferin response to certain related
The final aspect of brain structure and function stimuli. The thalamus is a key part of our sen-
I would like to discuss is those parts of the sory apparatus that operates mostly at a sub-
brain involved in sensing and responding to conscious level. It receives sensory input from
emotion and perceived stress. The various cor- our eyes and ears as well as from the sensory
tical areas we have discussed so far are largely nerves of the body that come through the spi-
involved in conscious activities such as listen- nal cord, simultaneous with that information
ing, seeing, language, and movement. There is going to the sensory cortices. The thalamus is
another set of brain structures and connections connected to the prefrontal cortex, which al-
that underlies these cortical areas. lows the brain to interpret those inputs in the
As described above, Broca’s area receives in- context of conscious awareness and memory
put from a number of d ifferent cortical areas in- stored in the hippocampus. If we interpret those
volved in language and integrates them to facili- inputs as a threat, that message is conveyed to
tate the learning and expression of language. In the amygdala, resulting in a feeling of fear or
an analogous manner, the amygdala is the area of other related emotion.
the brain that receives input from a number of This circuit takes time to respond to stimuli.
areas of the brain and integrates this information Accordingly the thalamus also has a more rapid,
into what we perceive as emotion. The amygdala direct link to the amygdala, so that certain
is located adjacent to the hippocampus, in the stimuli will trigger an immediate response.
frontal portion of the temporal lobe on either Thus, we can be startled by something we hear
side of the brain. Emotions perceived by the or something we see, even before we are con-
amygdala can be triggered by sensing external sciously aware of what is g oing on. Being star-
stimuli, by remembering past experiences, or by tled in this way often triggers a physiological
a combination of the two. As part of this sensory response encompassing pounding of the heart
process the amygdala has close connections to and associated feelings we are all familiar with.
both the hippocampus and the thalamus. In generating this startle reflex the thalamus
has a closely related unit, the hypothalamus, Our more general level of stress is often in re-
that is located directly below it and generates sponse to the circulating level of cortisol. We
our physiological response to perceiving fear or need certain low levels of these hormones in our
being startled. bloodstream when we are not sensing stress
The hypothalamus is a major part of the un- and increased levels when we are. The mainte-
conscious control mechanism that maintains nance of these hormonal levels appropriate to
what is referred to as homeostasis. Homeostasis our perceived level of stress is referred to as
includes such functions as hunger and thirst, allostasis. The actual level of these circulating
fatigue and the circadian rhythm of sleep, and hormones is our allostatic load. The system of
our stress response. Another key aspect of ho- perception and response that generates these
meostasis is thermostasis—the maintenance of hormonal responses is referred to as the
a constant body temperature. The human body hypothalamic- pituitary-adrenal axis, or HPA
functions optimally when the internal body axis for short.
temperature is maintained at approximately 37 As I described above in comparing a baby
degrees Celsius. If our body temperature begins giraffe with a human infant, a central feature
to drop, we feel cold, and our muscles sometimes that distinguishes the h uman from the giraffe is
shiver, contracting regularly and involuntarily the level of development of the systems of com-
so as to generate heat. If our temperature starts munication among the various structural com-
to rise due to a hot environment, we feel hot and ponents of the brain. At the time of their birth
begin to perspire. The evaporation from the both a baby giraffe and a human infant have the
skin of that perspiration cools us down. In basic structural components of the brain: the
these ways the hypothalamus helps maintain visual cortex, the auditory cortex, the sensory
thermostasis. cortex, and the motor cortex, and the struc-
The hypothalamus also helps to maintain tures responsible for homeostasis and stress
allostasis—the process of maintaining an opti- response. What have not yet developed in the
mal physiologic stress response, appropriate for human infant are the communications linkages
the level stress we perceive. The hypothalamus among these various components. The axonal
can respond in two ways. It can send messages connections of the human have not matured
directly over our autonomic (involuntary) ner and have a relatively low level of myelination.
vous system to affected organs. Alternatively, it Similarly, the connections among the portions
can respond by sending hormonal messages, of the brain responsible for emotion and stress
referred to as releasing factors, to the pituitary response have not matured. These communica-
gland, which in turn sends hormonal messages tions linkages will develop and mature as the
through the blood stream to the adrenal gland, infant grows and matures.
located adjacent to the kidney. The adrenal This maturation process leaves open a pe-
gland responds to these messages by secreting riod in which the development of neuronal
three key hormones into the blood stream: epi- communications can be affected by the physi-
nephrine and norepinephrine (often referred to cal and emotional environment in which the
as adrenaline and noradrenaline), which pro- human infant is raised. Depending on the na-
duce a very rapid response, and cortisol (often ture of those experiences, the neural communi-
referred to as cortisone), which produces a cation mechanisms can develop more or less
slower but more sustained response. The pound- effectively. Makinodan et al. (2012) studied the
ing of our heart and the rapid pulse we feel brains of newborn mice, some of which were
when we are startled is in response to the pro- isolated immediately after weaning and deprived
duction of epinephrine and norepinephrine. of any adult attention. Compared to mice that
had experienced nurturing, the level of oligo- responsible for the level of well-being experi-
dendrocyte activity and neuronal myelination enced by humans across the life course, fully
was substantially lower in the deprived mice, understanding the extent of these effects is
suggesting that the surrounding environment crucial to understanding how and when to in-
can directly affect the development of neuronal tervene to address unhealthy or destructive
communication. This aspect of brain develop- behaviors.
ment is often referred to as brain plasticity. In
addition to the extent of axonal myelination,
Summary
environmental influences can also affect the ef-
ficiency of the synaptic transmission mecha- Rather than being a single organ with one prin-
nism described above. Studies of genetically cipal function, the human brain is a complex
identical human twins who were separated at system of separate cortical areas, each involved
birth and raised in d ifferent social environ- in specific functions, connected by a complex
ments have confirmed the importance of the web of axons. These differentiated cortical ar-
plasticity of the brain. eas and associated neural connections develop
A crucial issue we will discuss in future from a common set of embryonic stem cells.
chapters is the extent to which this brain plas- While the cortical structure of the h uman brain
ticity is a one-way process. If a child raised in has a great deal in common with other primates,
stressful or otherwise disadvantaged circum- it is the neural connections between these cor-
stances develops weaker axonal myelination tical areas that distinguish the h uman brain.
and synaptic transmission when compared to a These connections depend on the efficient
child raised in a more nurturing environment, conveyance of the biochemical information of
are those differences reversible? As described by a nerve impulse along the neuron itself and be-
Britto and Pérez-Escamilla, “during specific peri- tween neurons at their many connections. The
ods of development experiences have the ability brain has developed ways to increase the effi-
to potentiate or inhibit neural connectivity . . . ciency of this transmission process in those
Theorists have argued that while children may neurons that are activated most frequently and
not receive the required environmental inputs at to remove those neural connections that go un-
the appropriate time and that this may hamper used. This concept of brain plasticity—of the
development they posit that this inability to de- cellular structure of the brain able to change
velop is not permanent” (2013, p. 238). As we will over time in response to patterns of brain activ-
see, there is a growing body of data indicating ity—is key to understanding the many ways
that the neural impacts of early adversity, often that environmental factors can influence the
referred to as toxic stress, can be reversed through structure and function of the h uman brain.
appropriate interventions. Now that we have gained a basic understand-
A second related issue is the question of how ing of the way the human brain is structured
long in the pro cess of h uman development and how the various structural components
brain plasticity continues. Is the structure of communicate among themselves, the next thing
the human brain fixed and unchangeable by to look at is how the brain develops its aware-
adolescence or early adulthood? Alternatively, ness and understanding of the world in which
does the plasticity persist even into older age, we live. The American Psychological Associa-
though perhaps at a somewhat slower rate? Since tion defines cognition as the “processes of know-
the neural structure and processes of the human ing, including attending, remembering, and
brain are largely responsible for patterns of reasoning; also the content of the processes,
human behavior, and human behavior is largely such as concepts and memories.” How the
uman infant develops these processes in re-

h lary are evident at 18 months. Developmental Science
sponse to both the prenatal uterine environment 16(2): 234–48.
Makinodan, M., Rosen, K. M., & Corfas, C. 2012. A critical
and the f amily environment into which it is born
period for social experience–dependent oligodendro-
is a central aspect of the development of h uman
cyte maturation and myelination. Science 337 (6100):
behavior, and I address this topic in chapter 9. 1357–60.
Moon, C., Lagercrantz, H., & Kuhl, P. K. 2013. Language
References experienced in utero affects vowel perception after
American Psychological Association. Glossary of birth: A two-country study. Acta Paediatrica 102(2):
psychological terms, available at www.apa.org 156–60.
/research /action /g lossary.aspx, accessed 2/16/14. Nobel Assembly at Karolinska Institutet. The Nobel
Britto, P. R., & Pérez-Escamilla, R. 2013. No second Prize in Physiology or Medicine 2013, available at
chances? Early child experiences in h uman develop- www.nobelprize.org/nobel_prizes/medicine/ l aureates
ment. Social Science and Medicine 97: 238–40. /2013/press.html, accessed 2/16/14.
Buckner, R. L., & Krienen, F. M. 2013. The evolution of Scafidi, J., Hammond, T. R., Scafidi, S., et al. 2013.
distributed association networks in the human brain. Intranasal epidermal growth factor treatment
Trends in Cognitive Science 17(12): 648–65. rescues neonatal brain injury. Nature 506(7487):
Congressional Budget Office. 2014. The budget and 230–4.
economic outlook: 2014 to 2024, available at www Who can my Marketplace information be shared with
.cbo.gov/publication /45010, accessed 2/8/14. and why? Available at www.healthcare.gov/how-we
Duboc, B. The growth cone. The Brain from Top to -use-your-data/, accessed 2/2/14.
Bottom, available at http://thebrain.mcgill.ca, accessed Yeatman, J. D., Wandell, B. A., & Mezer, A. A. 2014.
2/9/14. Lifespan maturation and degeneration of human
Fernald, A., Marchman, V. A. , & Weisleder, A. 2013. SES brain white matter. Nature Communications 5.
differences in language processing skill and vocabu- doi:10.1038/ncomms5932.
chapter
9 Cognition, Behavior,
and Well-Being
A
t the time of its birth, a h
uman infant has already devel-
oped the basic components of its brain: the visual cor-
tex, the auditory cortex, the sensory cortex, the motor
cortex, and the structures responsible for homeostasis and stress
response. What the h uman infant has not yet fully developed
are the communications linkages among these various compo-
nents that will enable them to function in a coordinated manner.
While the axonal connections among the various functional cor-
tices are largely present, they have not yet matured, due to a rela-
tively low level of axonal myelination.
A news report describing the work of Carla Shatz and her
colleagues at the Stanford Bio-X center describes the newborn
human infant as “a data acquisition machine, absorbing informa-
tion to finish honing the job of brain wiring that started before
birth” (Adams 2014). In the previous chapter I used the structure
of Internet sites such as Healthcare.gov as an analogy for the struc-
ture of the h uman brain. I described both as “a complex network
of central information sources and interconnecting webs of com-
munication.” For the human infant, the central information sources
are largely functional at birth, while the interconnecting com-
munication webs are not. In order for the infant to begin the pro
cess of developing cognitive awareness and responses, the axonal
interconnections connecting the functional cortices must become
myelinated, thus allowing rapid and repeated communication be-
tween cortices that results in action.
This is not to say that the axonal connections in the infant
brain at the time of birth are without any function. Evidence by
Moon et al. (2014) suggests that newborn infants are capable of
distinguishing vowel sounds from the language spoken by their
mother from those sounds of another language (see chapter 8).
Simply recognizing language-specific phonemes is not the same
as acquiring language. That process will require repeated sensa-
134
C o g n i t i o n , B e h av i o r , a n d W e l l-B e i n g 135
tion of sounds spoken by another person (often nized an average vocabulary of 142 spoken
the mother), the attachment of meaning to those words. They also found, however, a striking
sounds, and the ability (often through trial and difference in that vocabulary level when com-
error) to reproduce those sounds. When that paring infants from lower-SES families with
process has begun to take effect, the infant will those from higher-SES families. At 18 months,
have begun to acquire language. higher-SES infants recognized an average of 174
Hart and Risley (1995) studied 42 families words, while lower-SES infants recognized an
with young children. Based on the parents’ average of 107 words. By 24 months of age, both
occupation, the families w ere approximately groups had increased their vocabulary sub-
equally distributed across upper, middle, and stantially, to 442 words for higher-SES infants
lower socioeconomic status (SES). Starting when and 288 words for lower- SES infants. At 24
the children were 7–9 months old, they visited months of age, the lower-SES children were al-
each family at home for an hour each month, ready six months behind the higher-SES chil-
directly observing and recording interactions dren in language development. As described by
between parents and children. A fter about two Fernald et al., “The infant who can interpret a
and a half years of these visits, they analyzed familiar word more rapidly has more resources
the data they had gathered. available for attending to subsequent words, with
By the time the children w ere 3 years old, advantages for learning new words that come
the researchers identified clear trends in the later in the sentence . . . Vocabulary knowledge
amount of talk the children had been exposed also serves as a foundation for later literacy, and
to and the children’s vocabulary growth. Chil- language proficiency in preschool is predictive
dren in lower-SES families both heard fewer of academic success” (2013, p. 244)
words spoken by the adults in their h ousehold Weisleder and Fernald (2013) explored this
and w ere more likely to hear words the research- issue further in a study of 19 lower-SES infants
ers described as prohibitions and discourage- being raised in primarily Spanish- speaking
ments rather than affirmatives and encour- families. When the infants w ere 19 months old,
agements. The lower-SES children had smaller the researchers provided the parents with a
vocabularies than children of the same age sensitive audio recorder that was placed in the
from professional families as well as showing chest pocket of a lightweight jacket the infant
slower growth in vocabulary. The researchers wore. They recorded the sounds each child
then followed the children until they were aged heard during one day. In analyzing the sound
9 to 10 and found that the level of vocabulary recordings, the researchers counted how many
demonstrated at age 3 was a strong predictor spoken words were directed at the child. When
of scores on a range of vocabulary assessment the children were 24 months old, the research-
instruments. ers used a standardized scale of vocabulary rec-
In chapter 8 we also discussed the work by ognition to have the parents estimate how many
Fernald et al. (2013) that studied language devel- words their infant both understood and was
opment in infants aged 18–24 months. They able to say. They found a significant association
used the speed with which an infant could as- between the amount of child-directed speech
sociate the sound of a spoken word with a pic- and the child’s spoken language ability. In dis-
ture of the object represented by the word as a cussing these findings, the authors commented
measure of the extent of language development. that “differences in how quickly and reliably
In a study of English-learning infants from a children interpret familiar words in real time re-
broad socioeconomic range of families, they flect variability in a cognitive skill that facilitates
found that, at 18 months of age, infants recog- further language learning . . . a critical step in
the path from early language experience to later In a study on infant vocabulary, Fernald
vocabulary knowledge is the influence of lan- et al. played a recording of a w
oman’s voice say-
guage exposure on infants’ speech-processing ing words such as doggy, birdie, ball, and book.
skill” (p. 2149). They then showed a picture to one side of the
Festa et al. (2014) found that children from infant of the object represented by the word
low-income, immigrant Hispanic families such and on the other side a picture of another object
as those studied by Weisleder and Fernald face usually familiar to children but not related to
an additional disadvantage in developing early the spoken word. They closely watched the di-
language ability. In addition to speaking direction of the child’s gaze to see if, and how
rectly to children, sharing a book with a young quickly, it focused on the object represented by
child also helps children to develop language the word. If a child quickly looked at the pic-
ability. In their study of families in California ture of a dog when hearing doggy, the research-
with young children, Festa et al. observed that ers concluded that she or he had heard the word
immigrant Hispanic families showed the lowest spoken while also looking at a dog on a repeated
frequency of sharing a book with their children basis. The infant had likely myelinated the ax-
on a daily basis—53.4 percent of children in His- ons within the brain that connect the sound
panic families as compared to 78.0 percent of doggy to the visual image of a dog, such that the
non-Hispanic white children, with even lower image could quickly be recalled when triggered
rates (47.1 percent) for Hispanic children with by the sound. Fundamental learning had taken
both parents born outside the United States. place, triggered by someone speaking to the child
In chapter 8 I described the process through on a regular basis.
which an unmyelinated axon becomes myelin-
ated through repetitive transmission of impulses
The development of cognition
along its length. It is this repetitive signaling
from one cortical area to another along the con- The American Psychological Association de-
necting axons that triggers the myelination pro fines the concept of cognition as the “processes
cess and establishes the capacity for rapid com- of knowing, including attending, remembering,
munication between these areas. Recall also and reasoning; also the content of the pro
from figure 8.5 the different parts of the brain cesses, such as concepts and memories.” It goes
that are involved with the acquisition of and on to describe cognitive development as in-
expression of language. Patterns of sound from cluding, “imagining, perceiving, reasoning, and
the auditory cortex and images of sight from problem solving.” In a similar manner, the Oxford
the visual cortex are integrated in Wernicke’s English Dictionary defines cognition as including
area. As an infant repeatedly hears a word and “knowledge, consciousness; acquaintance with
sees the object or the action the word is in- a subject.”
tended to represent, that association is then The infant who looked at the picture of the
stored in memory. At a l ater time the infant can dog upon hearing doggy knew what a dog was.
hear the word without also seeing the image She or he had acquired early cognition. Through-
and, through the connection between the audi- out childhood, and no doubt continuing into
tory cortex and Wernicke’s area, retrieve from adulthood, she or he will expand that cognition—
memory the image of the object the word rep- that “knowing . . . attending, remembering, and
resents. The more often this happens, the more reasoning.” By high school, perhaps she or he
efficient the communication link through Wer- will know a foreign language and will be able
nicke’s area and the larger the vocabulary the to calculate a regression equation if given the
child has available. correlation and variance of two variables.
T abl e 9.1 . The Stages of Cognitive Development as Proposed

by Jean Piaget (1964)
Stage Age Cognitive development
Sensory-motor Birth–2 Sense of self as separate

Beginnings of language
Object permanence
Preoperational 2–7 Symbolic meaning of words
Expanded use of language
Understands concept of numbers
Concrete operational 7–12 Classification and ordering of objects
Logical reasoning
Mathematical ability
Formal operational 12 and older Able to reason hypothetically
Understands abstract relationships
Understands moral concepts
That level of cognition, of course, is at an en- learned as part of the maturation of the child’s
tirely different stage than recognizing the word brain, through a combination of reflexive ac-
doggy. tions, development of motor coordination, real-
Jean Piaget was a Swiss developmental ization that the outer world exists separately
psychologist who spent much of the 20th cen- from the child itself, and learning about proper-
tury studying how children acquire knowledge. ties of physical objects. As described by Piaget,
He conducted a series of observations and “learning is possible if you base the more complex
experiments at his center in Geneva, published structure on simpler structures, that is, when
a number of books in the area, and developed a there is a natural relationship and development
reputation as a leading scholar in the study of of structures” (1964, p. 184). The development of
child development. the core sensory-motor capabilities progresses
In 1964, Cornell University and the Univer- as the child’s experience with the outside world
sity of California, Berkeley, jointly sponsored leads to the successive development of myelin-
coordinated conferences to discuss Piaget’s work ated axonal connections between different
and the work of other leading scholars. Piaget parts of the brain.
developed an address summarizing his ideas on Piaget described the first of these develop-
cognitive development in children and presented mental stages as the “sensory-motor, pre-verbal
the address at both conferences. Piaget’s address stage, lasting approximately 18 months of life.
(1964), along with the other papers from the con- During this stage is developed the practical
ference, was published in a special issue of the knowledge which constitutes the substructure
Journal of Research in Science Teaching. Piaget de- of later representational knowledge” (p. 177). By
scribed what he considered to be four distinct about age 2 the child has progressed into Piag-
stages in the cognitive development of children, et’s second stage, the “preoperational” stage, in
as illustrated in table 9.1. which a child develops “the beginnings of lan-
Piaget based his theory on the necessary guage, of the symbolic function, and therefore
sequencing of successive stages of cognitive of thought, or representation” (p. 177). It is in
development. These core concepts can only be this stage of development that a child begins to
appreciate the symbolic nature of spoken and tions, and all the fundamental operations of
written words (doggy refers to that furry thing elementary logic” (p. 177). At this stage children
that licks me in the face and sometimes scares begin to be able to learn, understand, and use
me when he barks). The child also learns basic concepts from mathematics and science.
numeric and spatial concepts that help to un- In the last stage described by Piaget, begin-
derstand the broader world. Piaget described ning at about the age of 11 or 12, “the child reaches
the experience of one of his adult colleagues, the level of what I call formal or hypothetic-
who as a child learned the concept of numbers. deductive operations; that is, he can now reason
At about age 4 or 5, the colleague was sitting in on hypotheses, and not only on objects” (p. 177).
his garden and playing with pebbles. He placed It is only in this stage that children begin to be
a series of pebbles in a straight line on the able to understand complex mathematical con-
ground. He had by then learned his numbers, cepts, such as probabilities, and abstract moral
so he counted the pebbles from one end of the concepts, such as social justice.
line to the other: 10 pebbles. He was fascinated In summarizing his four stages of cognitive
to find that when he counted the pebbles in the development, Piaget underscores the impor-
reverse direction, he again counted 10 pebbles. tance of the developing biologic organism that
He then placed the pebbles in a circle on the sets h uman aside from other species. It is the
ground and counted them again. Again there unique capacities of the h uman brain that allow
were 10 pebbles! “Now indeed, what did he dis- this type of learning to progress throughout
cover? He did not discover a property of peb- childhood and adolescence. We are continu-
bles; he discovered a property of the action of ously exposed to stimuli from our environ-
ordering. The pebbles had no order . . . He dis- ment, and we develop patterns of response to
covered that the sum was independent of the those stimuli. As Piaget explained in his ad-
order” (p. 180). dress to the 1964 conferences, “I would propose
The child had discovered that the number 10 that above all, between the stimulus and the
exists independently of the pebbles. This al- response, there is the organism, the organism
lowed him to appreciate numbers as symbolic and its structures. The stimulus is really a stim-
concepts and to explore their association with ulus only when it is assimilated into a structure
other numbers. Using this symbolic under- and it is the structure which sets off the re-
standing, he will be able to learn that “two plus sponse” (p. 182).
two equals four” and to transfer this specific
understanding into his memory through a pro
The development of language and
cess of axonal myelination similar to the process
reading ability as examples of Piaget’s
of learning what doggy means. This will have
stages of development
substantial importance when, later in this chap-
ter, we discuss Daniel Kahneman’s concept of Piaget based the timing of his proposed stages
“thinking fast and thinking slow.” of development on the developmental process
In the third stage of cognitive development, in a child’s brain. This principle is illustrated in
from about age 7 through age 11, what Piaget the manner in which children first learn lan-
describes as “concrete operations” begin to ap- guage and subsequently learn to read. These
pear. These concrete operations are compared stages in cognitive development parallel the
to “formal” operations that occur in his fourth stages in the development of the neural connec-
developmental stage. Examples of concrete tions in the brain of the growing child.
operations described by Piaget include “classifi- As described in chapter 8, the process of lan-
cation, ordering . . . spatial and temporal opera- guage development depends on the develop-
ment of neural connections between the gray ken and the written word, will their initial level
matter sections of the brain responsible for two of verbal capacity at age 18–24 months be associ-
of the core senses: hearing and vision. In order ated with their reading ability at age 7 years?
to develop language, an infant must first de- Fernald et al. suggest these levels of develop-
velop myelinated neural connections between ment will be associated. “Vocabulary knowl-
the auditory cortex (sensing the sound of the edge also serves as a foundation for later liter-
word), the visual cortex (sensing the visual im- acy, and language proficiency in preschool is
age represented by that sound), the cortical area predictive of academic success . . . Differences
that integrates these two sensory inputs as lan- among children in language growth estab-
guage (Wernicke’s area), and the area in the fron- lished by 3 years of age tend to persist and are
tal lobe responsible for storing in memory the predictive of later school success or failure”
meaning of words based on the learned associa- (pp. 244-5).
tion between those sensations (Broca’s area). In their article “Learning to See Words”
Infants begin to develop this process in the (2012), Wandell et al. describe our increasing
first few months of life by recognizing spo- understanding of the functional and structural
ken words, based on the repetitive hearing of aspects of brain activity involved in transition-
specific sounds and seeing their associated im- ing from understanding spoken language to un-
ages. By the age of 18–24 months, they begin to derstanding written language, that is, learning
understand a substantial vocabulary of words, to read. In order to read, a child must be able
which they in turn learn to speak. The more rapidly to recognize words on a page and to as-
they are spoken to directly, the larger their vo- sociate those visual images with the meaning of
cabulary. As described by Fernald et al., “Vari- the word learned through the earlier acquisi-
ability among individuals in verbal abilities is tion of spoken language. As described by the
influenced to some extent by genetic factors, but authors, “to read a child must develop adequate
the contributions of early experience to differ- visual acuity and learn to understand speech.
ences in language proficiency are also substan- Competence at these tasks is predictive of future
tial” (2013, p. 243). reading: Children who are efficient at hearing
Piaget described this early period, from birth and manipulating the sounds of speech are usu-
to about 18 months of age, as the sensory-motor ally good at learning to read” (p. 32).
stage. During this time the basic cognitive pro Wandell and colleagues go on to describe re-
cesses and neural structures necessary for ac- cent advances in brain imaging that measure
quiring language are being developed. Until they the effectiveness of the communication among
are developed, infants are not able to express areas of the brain involved with vision and with
language. He describes the next stage, begin- verbal language. Researchers have identified
ning at about 18–24 months of age and lasting specific white-matter structures that intercon-
until about age 7, as the preoperational stage. In nect these various areas of the brain to enable
this stage the child has begun the development reading. One of the most important of these
of verbal language and is now capable of build- axonal connections is the arcuate fasciculus
ing the ability to read, which is essentially the (AF), which connects Wernicke’s area to Broca’s
next stage in the full development of language. area, as described in chapter 8.
This brings up an interesting question. As Yeatman et al. (2012) studied how early read-
children transition from the sensory-motor stage, ing ability is reflected in children’s neural struc-
where they have begun the process of language tures. In introducing the research, Yeatman
development, to the preoperational stage, where underscores the importance of neural connec-
they can expand on this ability in both the spo- tions such as the AF, describing how “Reading
requires efficient communication within a net- available for reuse when called on, while the
work of visual, auditory, and language-processing axons that aren’t called on to carry messages
regions that are separated by many centimeters. may eventually be removed from the brain.
Hence, the white-matter fascicles that connect This seems to suggest that, just as hearing more
these regions are critical for proficient reading” spoken words improves the word recognition
(p. E3045). of infants aged 18–24 months, reading more
Yeatman’s team followed a total of 39 chil- words between ages 7 and 12 makes children
dren between the ages of 7 and 12. All w ere na- better readers. As Yeatman describes, “Varia-
tive speakers of English. Over a period of three tion in the quality of early-life language input,
years the researchers administered three se- the differential effects of children’s reading
quential MRI brain scans to each of the children. experience, the timing of instruction with res
They also administered sequential assessment pect to these processes, and genetic factors could
of reading skills and associated cognitive skills. all contribute [to the development of reading
They then evaluated the change over time in ability]” (p. 3050).
the structure of the AF, comparing students This makes intuitive sense—the better the
who were strong readers with those who were child is at reading, the more reading that child
weak readers. They found an interesting pat- will do. The more reading a child does over
tern of change in the AF as the two groups of time, the better that child becomes at reading.
children got older. Again as described by Yeatman, “The rate at
Using a measure of axonal structure called which a child learns to read early in elementary
fractional anisotropy, the researchers found school is highly predictive of the person’s rela-
that between the ages of 7 and 12, the functional tive reading proficiency throughout childhood,
efficiency of the AF changed. For children who adolescence, and adulthood” (p. 3051). Growing
at age 7 were strong readers, that efficiency in- up in a situation of socioeconomic disadvantage
creased in a linear pattern, while for children or having poorly educated parents who don’t
who were weak readers at age 7, it decreased speak as much or read as much to their children
over time. Yeatman et al. explained this by sug- can affect a child’s development of language and
gesting that the axons in the AF w ere becoming his or her subsequent development of reading
increasingly myelinated in the stronger readers, ability. These effects can be reflected in weak-
while in the weaker readers some of the neu- ened white- matter communication ability in
rons w ere becoming myelinated while o thers key areas of the brain and may stay with the
were being “pruned” due to relative inactivity. child as he or she grows through adolescence
“The myelination process is plastic; the level of and into adulthood.
electrical activity of an axon influences myelin- Lonigan et al. describe the development of
ation . . . During development, some axons grow, literacy as an “emergent process” that begins
and other axons are eliminated in a process early in the child’s life and continues through-
called ‘pruning’ . . . Underused axons are pruned out the various stages of development. “An
away during childhood, and the remaining ax- emergent literacy approach departs from other
ons are increasingly myelinated” (p. 3049). perspectives on reading acquisition in suggest-
Recall that the infant brain has many more ing that there is no clear demarcation between
axons than it will eventually need as the brain reading and prereading . . . Significant sources
matures into adulthood. This creates a “use it or of individual differences in later reading skills
lose it” situation: axons that are used repeatedly are present prior to school entry” (2000, p. 596).
to connect cortical areas become myelinated, This brings up a key point regarding the devel-
thereby becoming much more efficient and opment of cognitive abilities. Just as the process
of developing literacy is a continuous one, en- point out, however, that their separate locations
compassing early childhood through the early may account for those individuals who may be
school years, that process continues as the child very skilled in mathematics, but less skilled in
progresses through adolescence and into adult- reading (or vice versa).
hood. The same level of brain plasticity that al- Do children undergo a continual process of
lowed the strong reader at age 7 to develop even neuronal development that results in later
more myelinated axons in the AF by age 9 will mathematical ability, analogous to the process
also allow the relatively weak reader at age 7 to of developing language and reading skills? Will
grow into a strong reader, with increasingly there be stronger axonal myelination in the
myelinated AF axons, if she or he has the op- brain areas responsible for processing numbers
portunity and the motivation to invest time and in those children who exhibit stronger mathe-
energy in becoming a better reader. matical skills in school? Supekar et al. (2013)
studied the effects of a targeted math tutoring
program in 24 third-grade children aged 8–9.
Learning math in Piaget’s next stage
The tutoring program emphasized conceptual
As conceptualized by Piaget, once a child has instruction and practice in rapid retrieval of
developed language and has begun to understand mathematical facts. They measured math abil-
the symbolic nature of many learned concepts, ity before and a fter the eight-week tutoring pro-
she or he is ready to move on to the concrete gram and compared these results to those of 16
operations stage, learning “the operations of other third-graders who had not participated in
classification, ordering, the construction of the tutoring sessions. In addition to the testing
the idea of number, . . . a nd all the fundamen- of math skills, all the children in the study had
tal operations . . . of elementary mathematics, of a series of other assessments at the beginning
elementary geometry, and even of elementary of the study, including IQ testing, overall aca-
physics” (Piaget 1964, p. 177). This stage gener- demic assessment, and behavioral assessment.
ally spans the years between ages 7 and 12. Each child, both in the study group and in the
Is there a section of the brain that responds control group, also underwent a functional MRI
to numbers, in a way similar to the response to study of the brain.
verbal and written language? Shum et al. (2013) Perhaps not surprisingly, the math skills of
addressed this question in a study of seven the children participating in the tutoring pro-
adults between the ages of 24 and 48. Rather gram increased significantly, while the skills of
than brain MRI scans, they used electrodes fas- the control group did not change. The research-
tened to the scalp that measured u nderlying ers then looked to see whether any of the
brain wave activity. Subjects w ere shown an ar- pretutoring assessments was associated with
ray of images of numbers, letters, and mixtures the level of increase in math skills each child
of both. By comparing patterns of brain activity showed as a result of the tutoring. None of the
to the image shown, researchers identified a behavioral measures, including the IQ testing,
specific area in the temporal lobe of the brain was associated with a child’s increase in math
that was close to, but distinct from, the parts of ability. The researchers did find, however, a
the brain involved in language and reading. The significant association between certain brain
authors commented that “This anatomical structural components shown on the MRI and
proximity is important because the two sites the increase in math ability. In particular, they
are frequently coengaged in visual processing noted a strong association between the increase
of words and numbers that co-occur frequently in math skills, the volume of the gray matter in
in our everyday life” (p. 6714). They go on to the right hippocampus, and the white-matter
connections between the hippocampus and the are predictive of subsequent academic perfor
prefrontal cortex. The authors concluded, “Our mance” (2000, p. 5).
findings suggest that arithmetic skill acquisition In proposing his stages of cognitive develop-
during this early period of learning depends on ment, Piaget is clear that the physical matura-
the integrity of hippocampal-prefrontal cortex tion of the child’s body, especially the nervous
and hippocampal-basal ganglia functional cir- system, is a principal determinant of how these
cuits. Children who exhibited higher intrinsic developmental stages progress. In his 1964 talk,
functional connectivity in these circuits before he explained the sequential development of the
tutoring showed the greatest performance im- four stages in the following way.
provement in math problem solving” (p. 8234).
In a process that closely parallels the devel- What factors can be called upon to explain
opment of language and reading, the develop- the development from one set of [cognitive]
ment of mathematical skills is based on certain structures to another? It seems to me that there
types of repetitive instructional activities, are four main factors: first of all maturation . . . ,
which are associated with cellular changes in since this development is a continuation of
neural gray m atter and the axonal connections embryogenesis; second, the role of experience of
between d ifferent brain cortices. Consistent the effects of the physical environment on the
with Piaget’s views, math skills develop at a structures of intelligence; third, social transmis-
somewhat later stage in the development pro sion in the broad sense (linguistic transmission,
cess than language skills. Similarly, the devel- education, etc.); and fourth, a f actor which is
opment of basic skills in arithmetic builds a too often neglected but one which seems to me
foundation on which children can develop fundamental and even the principal factor. I
higher-level math skills that involve abstract shall call this the factor of equilibration or if you
reasoning and rules of logic in addition to basic prefer it, of self-regulation. (p. 178)
computational skills.
We have seen that lower socioeconomic sta- Piaget identifies many of the same factors we
tus is associated with slower development of now recognize as influencing the early physical
language skills in children aged 18–24 months and cognitive development of the child. He
and that subsequent reading ability is closely describes the interaction between genetically
associated with the earlier development of driven physical maturation, the quality of the
language. While the Supekar study does not ad- family environment, the impact of the social
dress this question explicitly, it is reasonable to environment, and the child’s development of
expect a child’s socioeconomic status also to be the ability to self-regulate as key to understand-
associated with the development of early math- ing the stages of cognitive development.
ematical skills. In a study commissioned by the Piaget acknowledged the limited scientific
National Academy of Sciences titled From Neu- understanding at that time of neural structure
rons to Neighborhoods, Shonkoff and Phillips re- at the cellular and molecular level. As he de-
port that, “From birth to age 5, children rapidly scribed it in 1964, “we know practically nothing
develop foundational capabilities on which sub- about the maturation of the nervous system
sequent development builds . . . Striking dis- beyond the first months of the child’s exis-
parities in what children know and can do are tence” (p. 178). Nonetheless he appreciated the
evident well before they enter kindergarten. important role the environment plays on ner
These differences are strongly associated with vous system maturation. He seems to be de-
social and economic circumstances, and they scribing the groundwork for our current under-
standing of the impact on neural structure of Clark and Chalmers (1998) go one step fur-
the family and social environment, through ther, suggesting that the human mind is not
the pro cess we now refer to as epige net ic limited to what happens in the brain. Rather,
imprinting—t he influence of factors in the en- the mind “extends” to include physical objects
vironment external to the child on how the in the environment as a central part of the cog-
child’s genes are expressed, without actually nitive process. In describing their “extended
changing the molecular structure of those mind” theory, they offer two popular games as
genes, during the pro cess of growth and examples: Tetris and Scrabble. In Tetris, a com-
maturation. puter game released in the 1980s, the player
Recent advances in developmental neurosci- must rapidly rotate and move horizontally geo-
ence have provided some new evidence in metric images on a computer screen in order to
support of Piaget’s concept of staged develop- fit them into the appropriately shaped location.
ment. We have come to appreciate that there Clark and Chalmers suggest that d oing this
are certain periods during early child developmental process of rotation and movement with-
ment, referred to as critical periods, during out the help of the computer would take sub-
which the child is most susceptible to epigene stantially longer than the same process using
tic influences. Some of the most crucial of these the computer. Similarly, having a set of Scrabble
critical periods occur in the first several months tiles displayed to look at and rearrange allows
after birth, when a child fine-tunes his or her one to identify words spelled by those tiles
physiologic response to stress and begins the much more rapidly than having to do the same
process of language development. process in the unaided mind. They refer to
Not everyone agrees with Piaget’s conceptu- these actions as “epistemic” actions that “alter
alization of the stages of cognitive development. the world so as to aid and augment cognitive
An early-20th-century Russian psychologist, Lev processes” (1998, p. 8). In a sense, the Tetris
Vygotsky, suggested that child development screen and the Scrabble tiles are simple exten-
was much more dependent on the interaction sions of the h uman mind. Describing the use of
between the child and his or her environment, Scrabble tiles, they suggest that “In a very real
which he called the “Zone of Proximal Devel- sense, the re-arrangement of the tiles on the
opment.” In a 1978 translation of his earlier es- tray is not part of action; it is part of thought”
says published between 1930 and 1934, Vygotsky (p. 10). Whether in acts of memory, the use of
described this zone as “the distance between language, or something as simple as using a
the actual development level as determined by Google map to find the location of the Museum
independent problem solving and the level of of Modern Art in New York City, “cognition is
potential development as determined through often taken to be continuous with processes in
problem solving u nder adult guidance or in col- the environment . . . all sorts of processes be-
laboration with our capable peers” (p. 86). As yond the borders of consciousness play a cru-
seen by Vygotsky, children’s emotional and cial role in cognitive processing” (p. 10).
cognitive development is powerfully influenced
by the interaction with adults and peers around
Memory and its role in cognition
them. The better the quality of that interaction,
the more rapidly the child’s development can By now it should be evident that much of the
progress. From this perspective, a child’s devel- process of cognitive development depends on
opmental stages are more variable in timing the capacity to remember. Memory is involved
than those proposed by Piaget. in infants’ associating certain sounds they hear
with images they see. It is also involved in I emphasize for the students that, even though
learning to connect the visual images of words the final lines of the poem say I took the one less
on the page of a book with the meaning and traveled by, / And that has made all the difference,
implications of those words. Memory comes in the title of the poem is “The Road Not Taken.”
more than one shape and size. By means of ex- It turns out there wasn’t a less-traveled road.
ample, consider some texts I have memorized A fter initially glancing at both roads, Frost

as part of my mentoring of the college students realized:
I work with and the steps I take to remember
what I was planning to purchase when I go to Though as for that the passing there
the grocery store. Had worn them r eally about the same,
Often, when a student meets with me to dis- And both that morning equally lay
cuss her or his efforts at writing a research pa- In leaves no step had trodden black.
per or research report, I will hand her or him a
printed copy of the following, and then recite it If you have ever seen a Vermont leaf fall in the
to them from memory: Four score and seven years autumn, you know what the woods look like be-
ago our fathers brought forth on this continent a fore any feet have had a chance to turn the yel-
new nation, conceived in liberty, and dedicated to low leaves to black.
the proposition that all men are created equal . . . So, I guess I might say that I have a fairly
A fter reciting this, I ask the students to iden- good memory, as I usually am able to recite
tify the thesis sentence in Lincoln’s address at either of these on short notice, including words,
Gettysburg. Many students aren’t aware of why timing, and emphasis. Yet if you were ever to
Lincoln traveled to Gettysburg to give the ad- come with me to the grocery store, you might
dress. I explain the importance for the North of question the strength of my memory. If I need
the B attle of Gettysburg and the symbolic sig- to buy three things that day, I can remember
nificance of the dedication of the new national them and be fairly assured that when I walk out
cemetery located on the site of the battlefield. I of the store, each will be in my bag. If I need
then point out that the thesis sentence—We four things, I have learned to make a list. Other
have come to dedicate a portion of that field, as a wise I’ll typically remember three of the four
final resting place for those who here gave their lives and get home not being able to remember what
that that nation might live—is embedded in the the fourth one was.
middle of the text, preceded by an explanation Why can I recite from memory Robert
of the historical context of the battle and fol- Frost’s “The Road Not Taken” and Abraham
lowed by the implications for future action of Lincoln’s Gettysburg Address, but I can’t re-
the sacrifices made on that battlefield. member the fourth thing I was supposed to
Other students come to me for advice about buy? Because there is more than one type of
life choices they are facing. Should they go to memory! Squire and Zola have described these
medical school, or should they go to public as “declarative memory . . . the capacity for
health school? Should they be science majors or conscious recollection of facts and events” and
humanities majors? I also hand these students a “nondeclarative memory . . . a heterogeneous
printed copy and begin to recite from memory: collection of nonconscious learning capacities
that are expressed through performance” (1996,
Two roads diverged in a yellow wood, p. 13515). By their definition I am attempting to
And sorry I could not travel both use declarative memory when I go to the gro-
And be one traveler, long I stood . . . cery store without a list and nondeclarative
memory when I recite Lincoln or Frost for my “thinking slow.” He provides an instructive ex-
students. ample of these two modes of memory (p. 20).
Swedish neuroscientist Torkel Klinberg re- He asks us to find the answer to the following
fers to these as “long term memory and work- two mathematical expressions:
ing memory. The long term memory is the
2 + 2
memory system that stores learned facts, rules,
17 × 24
names and experiences. It’s the memory that
stores what we traditionally associate with We all know that two plus two equals four. We
learning at school . . . Working memory, on the learned that sometime in our childhood, and it
other hand, keeps information up front just has stayed within our System 1 memory since
when we need it and holds relevant items ‘in then. We don’t actually need to do a mathemati-
our head’ when w e’re solving a problem” (2013, cal computation. The entire phrase of “two plus
p. x). two equals four” is stored within our brain
Psychologist Daniel Kahneman refers to cells, ready for us to call on when prompted.
these as “System 1” memory and “System 2” On the other hand, to calculate 17 × 24, I can
memory. He describes them in the following close my eyes and try to go through the steps I
terms: learned in school (“7 times 4 is 28, put down the
8 and carry the 2 . . .”), or I can use one of the
• System 1 operates automatically and quickly, extended mind tools Clark and Chalmers sug-
with little or no effort and no sense of gest are part of the cognitive process, such as a
voluntary control. pencil and paper or a calculator. To do any of
• System 2 allocates attention to the effortful these, however, I must put other things out of
mental activities that demand it, including my mind and focus on the short-term process of
complex computations (2011, p. 20). completing the appropriate steps in the appro-
priate sequence to find out that 17 × 24 = 408.
When I recite a Robert Frost poem from mem- Our long-term, System 1 memory operates
ory, I am relying on System 1; when I try to re- on a fundamentally different basis than our
member what to buy at the store, I am invoking shorter-term System 2 memory. As described by
System 2. Kahneman, “System 1 runs automatically and
Do I have a good memory (reciting poems System 2 is normally in a comfortable low-effort
from memory) or do I have a weak memory mode . . . System 2 is mobilized when a question
(only being able to remember three things to arises for which System 1 does not offer an an-
buy)? It seems I am perfectly normal in both. swer . . . Most of what you think and do origi-
Klinberg suggests that it is typical for adults to nates in your System 1, but System 2 takes over
be able to keep only about four items in work- when things get difficult” (pp. 24–25).
ing memory, which means that at my func- Much of the neuronal activity of the System
tional capacity of three shopping items (at least 2 working memory occurs in the connections
when confronted by the multiple distractions described in figure 8.4. The visual cortex and
of the grocery store) isn’t so far off. the auditory cortex connect with the prefrontal
Kahneman refers to these two mnemonic cortex through the associative cortex. Wer-
(i.e., having to do with memory) processes in nicke’s area, discussed above as being involved
another way that seems intuitively useful. As in learning language and reading, is part of the
the title of his book suggests, he also refers associative cortex. As children get older, they
to System 1 as “thinking fast” and System 2 as experience increased myelination of the white
atter connections between these areas. The

m separate occasions separated by about 14
more frequent the use of these connections, months, each child was asked to perform two
the greater the myelination of these connec- age-appropriate mathematical calculations. One
tions. Klingberg (2013) reports that, based on of these was done by having the child explain
studies his group has done, increased myelina- to the researcher how she or he solved the
tion in children is associated with improve- problem. The other was done while the child
ments in working memory. Much in the same was undergoing an MRI scan on the brain. The
way that Yeatman reported less white-matter questions the researchers w ere attempting to
myelination in children who w ere weaker read- answer were (a) does the child’s mathematical
ers, Klingberg reports that in children, lower ability improve over this 14-month period, and
levels of myelination were also associated with (b) is there evidence that, over time, the children
lower working memory capacity. rely less on the counting strategies typical of
If, as Kahneman suggests, most of what we System 2 working memory and more on rapid
do involves our System 1 memory, how does recall of answers from System 1 long-term mem-
information get transferred from System 2 to ory? The answer was “yes” to both questions.
System 1? The key to this transference process The children’s mathematical ability increased
is the hippocampus, which is part of the tempo- over the study period. For the first test, involv-
ral lobe. As an association passes through Sys- ing simple addition such as “4 + 1,” the children
tem 2 memory structures on a repeated basis, the relied more on the process of counting that uses
hippocampus gradually transfers those associa- working memory. By the second examination
tions to a d ifferent set of neurons. This new after 14 months, with slightly more complicated
neuronal connection relies heavily on the pre- problems (e.g., 5 + 9), they relied less on counting
frontal cortex to store them as long-term, Sys- and more on long-term memory to solve the
tem 1 memories. Eagleman describes this pro problem.
cess as “rewir[ing] your own circuitry u ntil it The researchers then compared the results
can accomplish the task with maximum effi- of the MRI scans at the two assessments. Con-
ciency. The task becomes burned into the ma- sistent with the manner in which the children
chinery” (2011, p. 71). solved the problems verbally, while d oing the
Recall the study by Supekar described above, problem in an MRI scanner, they used different
in which researchers identified in third-grade parts of their brain to solve the problem. To
children an association between mathematical solve the problem at the first assessment, they
ability, the volume of the hippocampus, and the used principally the part of the brain involved
strength of the white-matter connections be- in working memory. In solving the problems at
tween the hippocampus and the prefrontal the second assessment, they used less working
cortex. Recall also that Piaget suggested that memory, with greater activation of the hippo-
children begin to develop mathematical ability campus and its white-matter connections in-
when they enter the “concrete operational” volved in long-term memory. From this the
phase of cognitive development, which begins authors w ere able to conclude,
at about age 7. As third-graders learn math, are
they “rewiring” their brain circuitry in the way We observed a shift from the use of counting to
Eagleman suggests? memory-based strategies in children over a
Research by Qin et al. (2014) addressed this 1.2-year interval, and this was associated with
question in a study of 28 children between the increased hippocampal engagement in problem
ages of 7 and 9, recruited from elementary solving . . . The increased hippocampal
schools in the San Francisco Bay Area. On two engagement is consistent with its known role in
learning and memory for encoding and working memory to the long-term memory.
retrieval of facts and events . . . Thus, our longi- Principal among these are repetition and
tudinal findings suggest that the recruitment of practice. Landauer and Bjork (1978) describe
hippocampal-dependent memory processes is their research on the optimal timing and
important in the development of children’s spacing of this rehearsal pro cess, which
memory-based problem-solving strategies. (p. 6) starts with immediate repetition and then
spaces the repetitions at gradually increasing
The authors then recruited and studied the intervals.
mathematical ability of 20 adolescents between For anyone who has learned to play a musi-
the ages of 14 and 17 and 20 young adults be- cal instrument as a child, this process may
tween the ages of 19 and 22. These older sub- sound familiar. I certainly have seen it while
jects w ere asked to solve more complex math watching my own son learn to play the piano.
problems. In d oing so, the subjects relied heav- By the time he was a teenager, he had prac-
ily on long-term memory rather than the count- ticed his scales and chords enough times that
ing typical of short-term, working memory. In he no longer had to invoke working memory to
solving the problem while undergoing an MRI play them from the page of music. What did
scan, these older subjects showed activity of the take practice, however, was learning to play
white-matter axonal connections involved in them in a different sequence, with different
long-term System 1 memory without concur- tempo, different emphasis, and d ifferent finger-
rent activation of the hippocampus. In these ing. One example comes particularly to mind—
subjects, the work of the hippocampus in con- a piece by Aaron Copeland called The Cat and
verting working memory to long-term memory the Mouse. It involves some very complex transi-
was largely done. The adolescents and young tions and sequences. He would practice a short
adults had developed the myelinated axonal section over and over and then leave it alone for
connections necessary to retrieve the memory a while. He’d come back to it in a day or two
required to solve the problem. and do this again, only with increased facility.
From these results the authors concluded Gradually, a collection of short sequences be-
that, at least in learning mathematics, “the hip- gan to blend into a wonderful piece of music,
pocampus has a time-limited role in the early and gradually his eyes shifted from the notes
phase of knowledge acquisition . . . our find- on the page to the keys on the k eyboard—he
ings suggest the hippocampal system is critical had memorized it. If you ever get a chance to
to children’s early learning of arithmetic facts, hear this piece of m
usic, you’ll understand that
the retrieval of which is largely dependent on the it is not something one can play using System 2
neocortex [long- term memory] in adults. working memory. One must let go of conscious
Through further schooling and experience with control and let the music come spontaneously
mathematics, fact retrieval becomes increas- through the fingers to the piano. For his final
ingly independent of the hippocampal memory recital, System 1 had taken over.
system during adolescence and adulthood” (Qin Klingberg suggests that the pro cesses of
et al. 2014, p. 6). While the authors studied learning to play a musical instrument are closely
this process only in the developmental of math- related to those of developing increased cogni-
ematical ability, they suggested that the same tive ability. He goes so far as to suggest that
processes may be involved in learning language leaning a musical instrument may actually en-
and other academic abilities. hance cognitive ability, although he acknowl-
There certainly are ways to facilitate this edges that children who take music lessons
process of transferring associations from the often come from higher-income families with
higher levels of parental education, so it is dif- tioning of the hippocampus in both working
ficult to identify a clear causal relationship. memory activities and the retrieval of other
long-term memories. If the recall of these emo-
tionally based memories occurs frequently, a
Emotional stress as another source
significant consequence can be impairment of
of long-term memory
normal cognitive function. If they occur with
There is another type of long-term memory sufficient force or severity they can result in
that does not follow this repetitive learning mental illness such as post-traumatic stress dis-
process. Often we can easily recall intensely order (PTSD) or other anxiety disorders. As de-
emotional experiences, both positive and nega- scribed by Yehuda, “PTSD appears to represent
tive, even though they may have happened a failure to recover from a nearly universal set
many years ago. These emotional experiences of emotions and reactions and is typically man-
involve activation of the amygdala. As de- ifested as distressing memories or nightmares
scribed in chapter 8, the amygdala plays a major related to the traumatic event, attempts to avoid
role in sensing and managing emotion. When reminders of the trauma, and a heightened state
an unusually positive or negative emotion is ex- of physiological arousal” (2002, p. 113). These
perienced, the power of this experience can recurrent memories can substantially impede
lead to neural connections through the hippo- normal functioning and without treatment
campus that create immediate, long-term mem- can lead to severe disability. Treatment usually
ory. As part of this process, “stress hormones involves a combination of medication and psy-
and stress-activated neurotransmitters enhance chological counseling.
the consolidation of memory for emotionally An interesting and potentially positive ap-
arousing experiences through actions involv- proach to reducing the effects of PTSD has been
ing the amygdala. Such amygdala activation described by Schiller et al. (2009). Using a pro
strengthens the storage of d ifferent kinds of in- cess called extinction training, they worked
formation through the amygdala’s widespread with p eople who had established fear memo-
network of efferent projections to other brain ries by intentionally triggering those memories
regions” (Roozendaal et al. 2009, p. 423). while simultaneously exposing the subject to
These memories, sometimes referred to as new information unrelated to the previous
flashbulb memories, are “a vivid, enduring memory trauma. For many of the subjects, the new mem-
for how one learned about a surprising, shock- ory overrode the old memory such that later
ing event” (Davidson et al. 2005, p. 915). In addi- triggering of the old memory no longer brought
tion to remembering the emotion involved in with it the powerful emotional response associ-
the experience, one typically also remembers ated with activation of the amygdala. These re-
when and where the experience took place. sults suggest that, as memories originating in
Such memories are created through a process the amygdala are transferred to the hippocam-
by which the amygdala sends neural impulses pus and its connections with the prefrontal cor-
directly to the hippocampus and then through tex, carefully introduced new memories could
the hippocampus to the prefrontal cortex. When override the previous connection between the
these memories are recalled, these connections hippocampus and the amygdala, thus stripping
are reactivated, including the perception of the the memory of much of its emotional content.
emotion associated with the memory. An additional impact of amygdala- related
A secondary effect of this memory forma- stress responses on the hippocampus has been
tion by joint activation of the amygdala and identified, which we will discuss at greater
hippocampus is impairment of the usual func- length in chapter 10 as part of learning about
the stress response. Repeated exposure to stress moment-to-moment behaviors, System 2 still
can cause atrophy of portions of the hippocam- has the capability of taking over from System 1.
pus, with resultant reductions in both work- As Kahneman describes, “most of what you
ing memory and long-term memory (McEwen (your System 2) think and do originates in your
1999). Fortunately, it appears that “for the most System 1, but System 2 takes over when things
part, these stress-induced changes in hippocam- get difficult, and it normally has the last word”
pus and medial prefrontal cortex are reversible (2011, p. 25).
over time” (Roozendaal et al. 2009, p. 430). This How we resolve this balance between think-
is especially important to know, given that ing fast and thinking slow has a lot to do with
one of the most active periods for hippocampal how we see ourselves, our traits as seen by
growth, and as a consequence stress-related hip- others, the goals we set for ourselves, and the
pocampal impairment, is in early childhood. very identity we adopt for ourselves. These as-
pects of cognition, motivation, and personality
are central to our understanding of behavior.
Summary
They are also aspects of development that can
As described above, we have come to under- be powerfully affected by growing up in the
stand cognition as knowing, attending, remem- context of social inequality and by experiencing
bering, and reasoning. What we know starts abnormal levels of stress during childhood. The
out with the early perceptions of the environ- ways in which inequality and stress can affect
ment and the development of language. It goes be
havior during childhood and adolescence
on to involve learning to read, learning to do and subsequent well-being are the issues I focus
math, and learning to manipulate abstract con- on in the following chapter.
cepts. Piaget described this as a stepwise pro
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chapter
10 Social Inequality, Childhood

Experiences, and Behavior
T
he experience of inequality is directly associated with be-
haviors that impact well-being throughout the life course.
Especially when economic inequality is combined with
the social inequality of racial discrimination, a child growing up
in these disadvantaged circumstances is at risk of developing
strikingly different patterns of behavior than a child growing up
in more advantaged circumstances. These behavioral differences
will affect educational attainment as well as health-related behav-
iors as an adult and are a major contributor to existing disparities
in life expectancy and quality of life. Having explored motiva-
tional development and the development of personality traits as
well as cognitive development as it is related to neural develop-
ment, we are now in a position to identify the specific mecha-
nisms through which the early experience of inequality and the
stressful experiences often associated with inequality can impact
behavior and well-being.
Beginning in 2000, a series of reports by national research
agencies began to address these issues. One of the first was a re-
port of the Committee on Integrating the Science of Early Child
Development, an interdisciplinary group established jointly
by the National Research Council and the Institute of Medicine
(IOM) of the National Academy of Sciences. The committee re-
leased its report in 2000 (Shonkoff and Phillips 2000). The charge
to the committee was “to update scientific knowledge about the
nature of early development and the role of early experiences, to
disentangle such knowledge from erroneous popular beliefs or
misunderstandings, and to discuss the implications of this knowl-
edge base for early childhood policy, practice, professional devel-
opment, and research” (p. 2).
In a later publication, the chair of the committee explained the
assumptions on which the charge to the committee was based:
151
“First, that research on early childhood has and biological processes in health and disease.
been highly compartmentalized within discrete Psychosocial factors influence health directly
academic disciplines (e.g., psychology, neurobi- through biological mechanisms and indirectly
ology, and anthropology) . . . Second, that these through an array of behaviors. Social and
diverse bodies of knowledge converge on a psychological factors include socioeconomic
common core of shared concepts” (Shonkoff status, social inequalities, social networks and
2003, p. 70). From this, Shonkoff suggested, “The support, work conditions, depression, anger,
promising news is that the most important sci- and hostility. (p. 16)
entific breakthroughs in the future are likely to
occur at the intersection of psychology, neuro- The report placed particular emphasis on how
biology, and molecular genetics” (p. 75). stressful experiences in early life can have po-
By reviewing an extensive series of research tentially lifelong consequences. Referring to the
reports, the committee identified a set of core role of stress-related hormones and allostatic
concepts relating to early child development load in affecting development, the authors un-
and offered a series of conclusions about how derscored the ways in which “Changes in bal-
these concepts are related. Two of these conclu- ance among neurotransmitters in the brain
sions have particular relevance for the issue of from the time of early development through
the impacts of inequality experienced during adulthood to old age can influence behavioral
early childhood. responses to potentially stressful situations, can
alter the interpretation of stimuli, and might be
• “Early child development can be seriously associated with anxiety and depression” (p. 4).
compromised by social, regulatory, and The report points to the consistent pattern
emotional impairments.” found in the research literature that those who
• “Striking disparities in what children know are poor and have a low level of education tend
and can do are evident well before they to engage in a range of behaviors that are detri-
enter kindergarten. These differences are mental to health. Given this broad pattern, the
strongly associated with social and economic authors question the concept that behaviors
circumstances, and they are predictive of principally reflect individual choice. Rather, the
subsequent academic performance” (Shonkoff influence of social inequality, especially when
and Phillips 2000, p. 5). experienced during the period of early neuro-
logical development, appears to lead to a range
In 2001, the IOM released another report, of unhealthy behaviors. It is the experience of
titled “Health and Behavior: The Interplay of in
equal
ity, rather than the characteristics
Biological, Behavioral, and Societal Influences.” unique to an individual, that lead to the broad
In the report, a committee of scientists from a pattern of behavior.
range of disciplines reviewed the available re- A subsequent IOM report released in 2006
search addressing the mechanisms through followed up on these issues. One of the princi-
which health and behavior are linked. One of pal recommendations from that report was for
the report’s principal findings identified the developing new research efforts that focus on
link between the biological processes involved “the associations between health and interac-
in early child development and the social con- tions among social, behavioral, and genetic fac-
text in which the child grows up. tors” and that “embraces the systems view and
includes an examination of the interactive path-
A fundamental finding of the report is the ways through which these factors operate to
importance of the interaction of psychosocial affect health” (p. 3).
S o ci a l I neq u a l i t y, C hi l d h o o d E x p e r i e n c e s , a n d B e h av i o r 153
Since the publication of these reports, re- challenges in the future. Tolerable stress might
searchers from a range of disciplines have worked be experienced as a result of an extremely fright-
together to carry out the research called for by ening experience or a death in the family. So
the reports. One of these groups, the National long as a child has loving, supportive adults who
Scientific Council on the Developing Child, was can help him or her through the experience, the
formed in 2003, with Jack Shonkoff as its chair. stress need not result in harmful effects.
In 2005 the group published a working paper Toxic stress would come from experiences
titled “Excessive Stress Disrupts the Architec- such as severe, ongoing abuse, e ither physical
ture of the Developing Brain.” As the title sug- or emotional, especially if the abuse occurs dur-
gests, the report focused on how stress experi- ing the periods of early childhood when the
enced during infancy and early childhood can brain is developing its stress response systems.
alter the neurological structure of the develop- “Toxic stress during this early period can affect
ing brain. Acknowledging that all children ex- developing brain circuits and hormonal sys-
perience some form of stress as a normal part of tems in a way that leads to poorly controlled
development without suffering adverse conse- stress response systems that will be overly reac-
quences, the report differentiated three different tive or slow to shut down when faced with threats
types of stress. throughout the lifespan” (p. 2).
Darlene Francis, a neuroscientist at the Uni-
• “Positive stress refers to moderate, short-lived versity of California, Berkeley, has focused her
stress responses, such as brief increases in research on the ways in which social factors
heart rate or mild changes in the body’s impact biological systems. In 2009 she pub-
stress hormone levels. This kind of stress lished a paper describing how the expression of
is a normal part of life, and learning to the genetic information contained in human
adjust to it is an essential feature of healthy DNA can be altered by factors in the physical or
development. social environment in which a child grows up.
• “Tolerable stress refers to stress responses Many people who learned a classical Mendelian
that have the potential to negatively affect approach to genetics understand the informa-
the architecture of the developing brain but tion contained in an individual’s DNA and the
generally occur over limited time periods resultant physiologic processes triggered by the
that allow for the brain to recover and nucleotide sequence in that DNA as fixed at
thereby reverse potentially harmful effects. conception and unchangeable, except through
• “Toxic stress refers to strong, frequent, or mutation. While the nucleotide sequence of
prolonged activation of the body’s stress DNA is largely fixed at conception, the way in
management system. Stressful events that which that genetic information is translated
are chronic, uncontrollable, and/or experi- into physiologic processes (referred to as gene
enced without children having access to expression) can be affected by the biochemical
support from caring adults tend to provoke environment in which the DNA exists. This in-
these types of toxic stress responses” cludes the environment of the specific cell in
(pp. 1–2) which the DNA is situated, the environment
of the organ system of which it is part, and the
Examples of positive stress include experiences overall bodily environment as reflected in cir-
such as meeting new p eople or getting an im- culatory and neurological systems. While the
munization. By overcoming these challenges, information contained in the DNA sequence is
the child can develop in positive ways, gaining a referred to as the genome, the combination of
sense that he or she can overcome these types of factors in the surrounding environment that
are capable of altering gene expression is re- lead to lifelong consequences on health. The
ferred to as the epigenome. As described by group published its technical report in 2012
Francis, “The epigenome is innately plastic and (Shonkoff et al.) The report recommends that
can be programmed or reprogrammed by envi- pediatricians and other health care profession-
ronmental experiences such as nutrition and als address issues of child health from what
stress. These epigenetic mechanisms provide they refer to as an “ecobiodevelopmental (EBD)
the means through which social experiences framework.” They describe how “Some of the
can fundamentally and profoundly alter the most compelling new evidence for this pro-
regulation and expression of the genome with- posed framework comes from the rapidly mov-
out altering genotypes” (2009, p. S197). Francis ing field of epigenetics, which investigates the
points out that these epigenetic processes are molecular biological mechanisms (such as
extremely active during the early stages of de- DNA methylation and histone acetylation) that
velopment, both in utero and in infancy, when affect gene expression without altering DNA
the child is growing most rapidly. Given that sequence” (p. e234). They reiterate that this pro
the social as well as the physical environment cess begins in the early stages of development
in which low-income and racial/ethnic minor- of the fetus in utero and continues in infancy,
ity children often grow up can be highly stress- childhood, and beyond. They see child devel-
ful, Francis suggests that these epige ne
tic opment as “driven by an ongoing, inextricable
mechanisms triggered by those environmental interaction between biology (as defined by ge
differences may contribute to health disparities netic predispositions) and ecology (as defined
later in life. “If we approach the question of ra- by the social and physical environment).”
cial/ethnic disparities in health from the per- The report stresses that problems that de-
spective of developmental neurogenomics, we velop during the educational process, such as
can begin to understand how different lived lower levels of school readiness and lower aca-
social experiences leave their epigenomic im- demic attainment of children from disadvan-
print on an organism” (p. S199). taged backgrounds, can often be traced to these
Shonkoff et al. (2009) support this under- early developmental influences. Its authors sug-
standing that epigenetic changes triggered by gest that stress experienced by young children
stressful social or physical environments in early be treated as a risk factor for subsequent un-
childhood are a major contributor to the con- healthy behaviors as adolescents and adults,
tinuing health disparities seen in adulthood, much as cholesterol levels and blood pressure
based on socioeconomic position and race/eth- of younger adults are seen as risk factors for the
nicity. Considering data on adult disparities in development of cardiovascular problems later
conditions such as heart disease, stroke, diabe- in life. They cite research showing that the
tes, or cancer, they suggest that we not view brain architecture of school-aged children who
existing disparities as solely the result of adult earlier had experienced prolonged toxic stress
lifestyle and be hav
ior. They suggest instead demonstrates reduced hippocampal volume.
that “an extensive body of evidence linked adult As described in chapters 8 and 9, the hippocam-
chronic disease to processes and experiences pus plays a major role in developing memory
occurring de cades before, in some cases as capacity as well as response patterns to envi-
early as intrauterine life, across a wide range of ronmental stimuli. As the authors describe,
impairments” (p. 2253). “Hence, altered brain architecture in response
The American Academy of Pediatrics (AAP) to toxic stress in early childhood could explain,
created a task force to address the ways in at least in part, the strong association between
which toxic stress experienced by children can early adverse experiences and subsequent prob-
lems in the development of linguistic, cognitive, it should be a primary role of pediatricians and
and social-emotional skills, all of which are in- other health professionals to identify the risk
extricably intertwined in the wiring of the de- factors for and signs of toxic stress early in the
veloping brain” (Shonkoff et al. 2012, p. e236). life of children and to develop and test a series
In addition to describing the reduced educa- of interventions that will reverse the neuro-
tional attainment and tendency toward adopt- logical and behavioral impacts of that stress. A
ing unhealthy behaviors that often accompany principal focus of these interventions should
childhood exposure to toxic stress, the authors be on helping the child’s parents or other
of the AAP report underscore the importance of caregivers provide a consistently loving and
the intergenerational transfer of these effects supportive environment for the child, so that
through an increased tendency of these indi- the long-term impacts of earlier stress can be
viduals, when they reach late adolescence or minimized.
early adulthood and have children of their own, In 2014, the AAP held a national symposium
to recreate an environment of toxic stress for to discuss the latest scientific and policy re-
their own children. The factors that contrib- search and announced the creation of a new
ute to higher stress, lower cognitive ability, more Center on Healthy, Resilient Children. As de-
unhealthy behaviors, and reduced educational scribed in a press release, this new center “will
attainment are thus transferred across genera- be a national effort coordinated by the AAP and
tions epigenetically, rather than genetically. strategic partners to support healthy brain de-
Based on the conclusions from this technical velopment and prevent toxic stress. In addition
report, the American Academy of Pediatrics to prevention efforts to keep children healthy,
also published a policy statement targeting the Center will focus on ways to help pediatri-
practicing pediatricians (AAP 2012). The key cians and others identify children who have
point the statement makes is that, despite the experienced adversity and toxic stress and ensure
adverse impact of toxic stress on neural struc- they have access to appropriate interventions
ture and hormonal stress regulation, the child’s and supports” (AAP 2014). It will be important
brain continues to exhibit plasticity—the ability to follow closely the research that comes from
to reshape itself in a more positive way in re- this new center and other research groups to
sponse to interventions that effectively target learn what interventions have the best long-
the origins of these early changes. The state- term outcomes on the behaviors and well-being
ment summarizes the findings of the technical of these vulnerable children.
report linking toxic stress experienced during Attention to addressing early childhood ad-
childhood “to the subsequent development of versity from a prevention perspective is not
unhealthy lifestyles (eg, substance abuse, poor confined to the United States. In 2009 the World
eating and exercise habits), persistent socioeco- Health Organization convened an international
nomic inequalities (eg, school failure and finan- meeting, the title of which was Addressing
cial hardship), and poor health (eg, diabetes and Adverse Childhood Experiences To Improve
cardiovascular disease)” (p. e225). Public Health. As a result of the discussion, par-
The statement then goes on to suggest that ticipants agreed that the issue of adverse child-
“Given the extent to which costly health dispari- hood experiences (ACE) should be seen as a
ties in adults are rooted in these same unhealthy major public health challenge. The meeting
lifestyles and persistent inequalities, the reduc- report concluded that “ACE work should be
tion of toxic stress in young children ought to framed as an emerging field that highlights many
be a high priority for medicine as a w hole and massive prevention opportunities and raises
for pediatrics in particular.” It also suggests that questions about how ACE exposure can be
r educed: the current challenge is not to fix the (SES) entered school with reduced language
ACE problem, but to find out how to fix it” (p. 9). capacity as well as lower reading ability. The
Much of the terminology and many of the work of Yeatman et al. described in chapter 9
measurement instruments discussed at the World identified reduced neurological development in
Health Organization meeting were based on the parts of the brain involved with reading for
work done by a collaborative project between the those children with reduced reading ability at
US Centers for Disease Control and Prevention age 7. Similarly, Noble et al. (2007) studied both
and the Kaiser Permanente health care system in performance assessment and brain structure of
San Diego, California. In creating the Adverse 150 first-graders drawn from diverse socioeco-
Childhood Experiences (ACE) Study, the re- nomic backgrounds. They found that it wasn’t
searchers developed a 10-question survey about a just language ability that was impaired in
person’s experiences during the first 18 years of lower-SES children. Spatial cognition, memory,
life. Examples of questions on the survey, to be working memory, cognitive control, and reward
answered e ither “Yes” or “No,” include: processing were also reduced in children from
lower-SES backgrounds, and these associations
• Did a parent or other adult in the h ousehold were continuous in nature, varying across all
often or very often . . . levels of SES.
– Swear at you, insult you, put you down, As described in chapter 8, memory storage
or humiliate you? or and retrieval as well as aspects of cognitive
– Act in a way that made you afraid that control are regulated largely by the hippocam-
you might be physically hurt? pus. Conditions that lead to atrophy in the hip-
• Did a parent or other adult in the h ousehold pocampus can also lead to reduced performance
often or very often . . . in declarative, episodic, spatial, and contextual
– Push, grab, slap, or throw something at memory (McEwen 1999). If, as Noble described,
you? or the memory and cognitive control of lower-SES
– Ever hit you so hard that you had marks children is reduced relative to their higher-SES
or were injured? classmates, this raises the question of whether
• Were your parents ever separated or there might be an association between poverty,
divorced? stress, and the development of the hippocam-
pus. This is the question Luby et al. (2013) ad-
Responses to these questions yield an ACE dressed in a study of 145 children between the
Score ranging from 0 to 10. Using this score and ages of 6 and 12. The children w ere initially part
the health data contained in the Kaiser Perma- of a longitudinal study of preschool children
nente electronic health record, researchers es- between the ages of 3 and 6. As part of that
tablished associations between the ACE score study children were assessed for having experi-
and conditions such as smoking, alcohol use, enced stressful life events, the quality of the
depression, and suicide as well as many of care provided by the parent or other caregiver,
the chronic medical conditions associated with and the families’ socioeconomic characteristics
the most common causes of premature death. such as income and parental education. Family
income was measured as the ratio of actual in-
come to financial need as indicated by the fed-
Socioeconomic inequality and early
eral poverty level based on family size.
school readiness
Between ages 6 and 12, the researchers ad-
In chapter 9, we saw how children growing up ministered an MRI brain scan to evaluate each
in families with lower socioeconomic status child’s brain structure, with particular atten-
Hostile
parenting
style
Stressful life
events
Low family Hippocampal

income volume
Figure 10.1. The Association between Family Income, Adverse

Early Childhood Experiences, and Hippocampal Volume. From Luby
et al. 2013.
tion paid to the volume of the hippocampus quently as a young child. They also found that
within the brain as well as to the volume of cor- each of these measures—hostile parenting and
tical gray m atter and white m atter in other stressful life events—was independently asso-
parts of the brain. They found a significant as- ciated with reduced hippocampal volume.
sociation between income and the volume of However, in the model that included all three
the hippocampus, cortical gray m atter, and cor- variables, family income no longer showed an
tical white matter. Children from lower-income association with hippocampal volume. These
families, typically having parents with lower results suggest that it is not low f amily income
levels of education, consistently had reduced per se that leads to reduced hippocampal vol-
neural capacity in all these areas. ume in children. Rather, it is the occurrence of
The researchers then studied whether they hostile parenting and stressful life events that
would still find this association between family reduces hippocampal volume and the cognitive
income and hippocampal volume if they also capacity that goes along with it. Parents in low-
entered into the analysis measures of the stress- income families, who are likely to have lower
ful life events experienced by the child before levels of educational attainment themselves,
entering school and of the level of hostile par- are more likely to engage in hostile parenting
enting style exhibited by the parents. Their re- toward their young children and more likely to
sults are shown in figure 10.1. have a home environment that young children
A fter taking into account separate measures experience as highly stressful. In discussing
of parenting style and having experienced these results, the authors commented, “The key
stressful life events, there was no longer a di- role of caregiver nurturance in hippocampal
rect association between family income and development and its relationship to adaptive
hippocampal volume. The authors did find that stress responses has been well established in
lower f amily income was associated both with animal studies . . . Thus, the current findings
more frequent occurrence of hostile parenting add to and extend the literature underscoring
practices on the part of the child’s parents and the critical role of nurturance for childhood
with experiencing stressful life events more fre- well-being” (Luby et al. 2013, p. 1141).
The journal that published this study by peer relationships. The lower-SES children, as
Luby et al. also published an editorial comment we might now expect, w ere also less academi-
on the results. In it, Nelson underscored the sig- cally competent than their higher-SES peers.
nificance of the implications of this research: The researchers also found one additional
outcome of interest. They noted that the chil-
hether we adopt the term developmental
W dren tended to establish status relationships
programming or biological embedding, the con- among themselves, with certain children tak-
struct remains the same: early experience ing on dominant social roles while interacting
weaves its way into the neural and biological with classmates and o thers taking on subordi-
infrastructure of the child in such a way as to nate roles. They found that neither gender nor
impact developmental trajectories and out- SES seemed to play a role in which children
comes . . . If we wish to protect our children’s would assume dominant social roles and which
brains, we must work hard to protect their would become subordinate. However, of chil-
young minds. Exposure to early life adversity dren in a subordinate position, those from lower-
should be considered no less toxic than expo- SES families seemed to respond more negatively,
sure to lead, alcohol, or cocaine, and, as such, it with lower levels of prosocial behavior with
merits similar attention from public health peers. From these observations, the authors con-
authorities. (2013, p. 1098) cluded that “socioeconomic gradients in health
and development are the products of more than
If children from socioeconomically disad- simply differences in access to money, material
vantaged families are at higher risk of experi- goods, medical care, or nutrition. Rather, the
encing hostile parenting and other forms of evidence implies that even the stratification of
stress, how are the associated reductions in hip- young children’s peer groups is implicated in
pocampal and cortical brain functioning likely the diverging trajectories of lifelong health”
to show up once the child enters school? Boyce (Boyce et al. 2012, p. 17171).
et al. (2012) addressed this question in a study of Another research group assessed the rela-
338 5-year-old kindergarteners recruited from tionship between the SES context in which a
public schools in Berkeley, California. Consis- child grows up and her or his level of cognitive
tent with the demographics of Berkeley, the development in kindergarten (Noble et al. 2005)
children w ere from a diverse range of families, and first grade (Noble et al. 2007). They evalu-
including low-income and high-income, with ated 60 kindergarten children in Philadelphia,
parents with less than a high school education half from low- SES families and half from
to parents with a graduate or professional de- middle-SES families, administering standard-
gree. The researchers observed the children’s ized tests of visual, spatial, memory, language,
interactions in the classroom and gathered and executive cognitive functioning. They found
information from the teachers about their per- lower average cognitive ability in the lower-SES
ceptions of the children’s level of adaptability, children in all five areas, particularly in language
classroom functioning, and emotional state. and executive function.
From these data the researchers developed a In the second study, first- grade children
series of multi-item measures. They also had were selected from nine d ifferent schools in New
a separate measure of academic competence. York City that represented a range of socioeco-
They found that children from lower-SES fami- nomic backgrounds. Researchers evaluated the
lies showed more evidence of depression and children’s language, spatial cognition, memory
more frequent inattention as well as exhibiting (both long-term and working memory), cogni-
less “prosocial behavior” and having weaker tive control, and reward processing systems.
They found that “language, spatial cognition, neuroanatomical profile similar to those seen in
memory, and some but not all executive abili- adults with high anxiety . . . Interaction be-
ties vary continuously with SES” (Noble et al. tween stress exposure and altered amygdala
2007, p. 476). circuitry may exacerbate vulnerability toward
While the hippocampus regulates memory anxiety disorders” (Qin et al. 2014, p. 898).
and cognitive function, the amygdala, which is Shonkoff (2012) emphasizes the time of entry
located adjacent to the hippocampus, plays a into school as having special significance for
major role in regulating emotions and response children for two reasons. First, a child’s ability
to stress. Overactivity of the amygdala on a sus- to focus attention, manage feelings and emotions,
tained basis can impede hippocampal function. control impulses, learn and follow rules, and
Based on the research of Luby and o thers, we adapt to changing circumstances are essential
have seen evidence that toxic levels of stress ex- to subsequent academic success. In the eyes of
perienced during early childhood, often associ- many teachers, these early capacities are more
ated with lower-SES family environments, is important than a child’s knowledge of numbers
associated with impaired development of the and letters. Second, the years leading up to
hippocampus. Will toxic levels of stress during school entry are a time of some of the most
early childhood also affect the size and activity rapid changes in brain structure in terms of de-
of the amygdala, and will children with in- veloping the capacity for this type of “executive
creased amygdala activity exhibit higher levels function,” as Shonkoff describes these abilities.
of anxiety? Qin et al. reviewed the research in “The acquisition of executive function and self-
this area, much of which has been done in labo- regulatory skills corresponds closely to the ex-
ratory animals, and concluded that “Early life tended development of the prefrontal cortex,
stress and anxiety have been linked to enlarged which begins in early infancy and continues
amygdala . . . resulting from interplay of pro- into the early adult years. Because these neural
longed overactivity of stress- sensitive hor- circuits have extensive interconnections with
mones and experience-dependent plasticity in deeper brain structures that control responses
the developing animal brain” (2014, p. 892) to threat and stress, maturing executive func-
Qin’s research team performed MRI scans of tioning both influences, and is affected by, a
the brains of 76 children between the ages of 7 young child’s management of strong emotions”
and 9. The sample size and demographics of the (p. 17302).
study group w ere not sufficient to make com- We thus can expect many children from dis-
parisons based on f amily SES or the frequency advantaged socioeconomic backgrounds, espe-
of stressful childhood experiences. Rather, the cially those who experience high levels of stress
researchers assessed the level of anxiety exhib- at home during early childhood, to have a dis-
ited by each child, based on parental reports ruption in the structure of the amygdala and
using standardized assessment instruments. the hippocampus such that their executive
They then compared the size of the amygdala function may be impaired and the level of anxi-
with the level of anxiety exhibited by each ety they experience will increase in a new envi-
child and found a significant association, with ronment such as school. A study by Kamp Dush
those children exhibiting greater levels of anxi- et al. (2013) suggested that these children may
ety also tending to have greater amygdala vol- also experience worse physical health as a re-
ume. Commenting on the implications of this sult of the “chaos” they experience in the home
association for later child health and develop- environment.
ment, the authors concluded that “amygdala The Center on the Developing Child at Har-
hyperconnectivity in anxious children has a vard University (2011) has reviewed current
scientific knowledge of the development of • Cognitive or m ental flexibility—These

and key components of executive function in capacities enable children to adapt to
young children. Consistent with Shonkoff’s rapidly changing circumstances and to
perspective, the center defines executive func- adjust behavior accordingly. Talking
tion in children as “a group of skills that helps one-on-one with a classmate in school will
us to focus on multiple streams of information be different from talking with a teacher or
at the same time, monitor errors, make deci- with a group of students. Well-adjusted
sions in light of available information, revise children will respond somewhat differently
plans as necessary, and resist the urge to let in each of these settings.
frustration lead to hasty actions” (p. 1). These
executive function capacities are necessary As described in the report, teachers will often
not only to adapt successfully to the school en- pay principal attention to a child’s level of execu-
vironment but also to engage successfully in tive function in determining school readiness.
the process of learning to read and acquiring They know that both successful learning and
basic mathematical skills. “Scientists who successful social interaction depend on these
study executive function skills refer to them as different aspects of executive function. The re-
the biological foundation for school readiness. port cites research by Welsh et al. (2010) showing
They argue that strong working memory, cog- that children from low-income families who ex-
nitive self-control, and attentional skills pro- hibit problems in executive function upon enter-
vide the basis upon which children’s abilities ing Head Start preschool showed lower increases
to learn to read, write, and do math can be in reading and math preparation during pre-
built” (p. 4). school than those with greater executive func-
The center’s report identifies three key com- tion, even a fter controlling for the child’s reading
ponents of executive function. and math ability upon entering preschool.
While the development of executive func-
• Working memory—In chapter 9 we differ- tion continues throughout childhood and into
entiated working memory from long-term adolescence, the report identifies the period be-
memory. Working memory addresses tween the ages of about 18 months and 5 years
currently available information and manipu- as the most rapid in this developmental process.
lates it in ways that allow us to solve new This is precisely the time period during which
problems, whether they are mathematical children from disadvantaged socioeconomic
or behavioral. circumstances and stressful family environ-
• Inhibitory control—In chapter 6 we dis- ments will be impacted the most in terms of
cussed the factors that contribute to a their subsequent success in school. In summariz-
child’s motivation to respond to circum- ing its analysis, the report concludes, “Mount-
stances in a particular way. Recall the ing evidence is revealing the roles played by
example of the 4-year old children in the community, school, and family contexts, as
Mischel study deciding w hether to wait for well as socioeconomic status, in the develop-
two marshmallows or to ring the bell now ment of executive function skills. Children from
and take one marshmallow. In circum- lower (versus higher) socioeconomic back-
stances such as these, children are able to grounds show poorer performance on tests of
use their thought process and conscious working memory, cognitive flexibility, and in-
control mechanisms to avoid distractions hibition, as well as electrophysiological evi-
and to counterbalance feelings of wanting dence of altered prefrontal functioning between
to act impulsively. ages 7 to 12” (p. 7).
Noble et al. (2005) studied public school teacher. They measured two principal behaviors
children in Philadelphia, 30 from middle-SES of the children while they were in kindergar-
families and 30 from lower-SES families. They ten: inattention and impulsivity, and school
compared the children on a range of neurocog- engagement. Separately, they asked the teacher
nitive capacities. Consistent with the finding of of each child to evaluate their perception of
the previous study, they also found that f amily the teacher-child relationship and whether the
SES was strongly associated with two of these teacher viewed the relationship with that child
capacities, language and executive function, with as conflictual.
lower-SES children in kindergarten demon- They followed the children throughout kin-
strating lower capacities in both. dergarten in order to measure these factors at
What are the implications for a child enter- both the beginning of kindergarten and the end
ing kindergarten who has grown up in stressful of kindergarten. They then re-evaluated each
or disadvantaged circumstances and who, as a child at the end of first grade to measure that
consequence, has the reduced hippocampal vol- child’s academic competence at that time as
ume described above by Luby et al. (2013), with well as the quality of the teacher-child relation-
consequent delayed development of executive ship as reported by the first grade teacher.
functioning? Portilla et al. (2014) studied 338 Finally, they asked if the behaviors observed
5-year old children in the San Francisco Bay at the beginning of the kindergarten year
Area, drawn from diverse SES and racial/ethnic were associated with subsequent behaviors,
backgrounds. Shortly after the children first en- with the quality of the teacher-child relation-
tered kindergarten, researchers assessed each ship, and with academic competence in first
child using standardized survey instruments grade. The results of the study are shown in
and information provided by the parents and figure 10.2.
End of
kindergarten First grade
Entry into Conflict with Conflict with

kindergarten teacher teacher
Impulsivity and
inattention
School Academic
engagement competence
Male
gender
Direct association
Inverse association
Figure 10.2. Association between Executive Control on Entering Kindergarten

and Learning Outcomes. From Portilla et al. 2014.
The first thing to notice is that, upon entry Children of the US Department of Health and
to kindergarten, boys on average exhibited Human Services commissioned a series of re-
more impulsivity and inattention than girls. Re- ports on the topic from the Center for Child and
gardless of gender, those children who earlier Social Policy at Duke University. The first of
had shown impulsivity and inattention w ere, these reports, titled Self-Regulation and Toxic Stress:
by the end of kindergarten, viewed by the teacher Foundations for Understanding Self-Regulation from
as more conflictual. Two factors independently an Applied Developmental Perspective, was pub-
predicted the level of school engagement at the lished in 2015 (Murray et al.). The authors of
end of kindergarten: having demonstrated im- the report reviewed an extensive lit erature
pulsivity and inattention at the beginning of addressing a range of topics related to the devel-
kindergarten and being seen by the teacher as opment of self-regulation by children and iden-
more conflictual. tified seven core principles that summarize
Not surprisingly, those students who dem- current understanding of the development of
onstrated less engagement in school during self-regulation.
kindergarten were also found to be less aca-
demically competent in first grade. In addition, 1. Self-regulation serves as the foundation for
those children whose relationship with the lifelong functioning across a wide range of
teacher was seen by the teacher as conflictual domains, from m ental health and emotional
also showed lower academic competence in wellbeing to academic achievement, physical
first grade. In an important and yet worrisome health, and socioeconomic success. It has also
finding, those children seen as conflictual by proven responsive to intervention, making it
the kindergarten teacher w ere also more likely a powerful target for c hange.
to be seen as conflictual by the first-grade 2. Self-regulation is defined from an applied
teacher. The extent to which the kindergarten perspective as the act of managing cogni-
teacher had conveyed information directly to tion and emotion to enable goal-directed
the first-grade teacher about a child’s tendency actions such as organ izi ng behavior, con-
to be conflictual is not known. trolling impulses, and solving problems
It seems that children from disadvantaged constructively.
social backgrounds who demonstrate weak ex- 3. Self-regulation enactment is influenced by a
ecutive functioning upon entering kindergarten combination of individual and external
are at risk of being labeled as problem children factors including biology, skills, motivation,
by the kindergarten teacher. This label may caregiver support, and environmental
then stay with the child as she or he progresses context.
into higher grades. In reporting these find- 4. Self-regulation can be strengthened and
ings, Portilla’s team suggests that “The strong taught like literacy, with focused attention,
effect of inattention and impulsive behaviors on support, and practice opportunities provided
teacher-child relationship quality began at the across contexts.
transition into elementary school, pointing to a 5. Development of self-regulation is dependent
need for strategies to help young children de- on “co-regulation” provided by parents or
velop stronger self- regulatory skills in pre- other care-giving adults through warm and
school and earlier” (2014, p. 1927). responsive interactions . . .
Acknowledging and underscoring the im- 6. Self-regulation can be disrupted by prolonged
portance for young children of developing or pronounced stress and adversity including
executive control and the capacity to self- poverty and trauma experiences . . . Stress
regulate, the Administration for Families and that overwhelms children’s skills or support
can create toxic effects that negatively impact tive instruction in a supportive environment,
development and produce long-term changes we believe that children who have early self-
in neurobiology. regulation difficulties are capable of acquiring
7. There are two clear developmental periods these skills at later ages” (p. 13). Given what
where self-regulation skills increase dramati- Murray et al. describe as “co-regulation”—the
cally due to u
nderlying neurobiological experience of supportive interactions over time
changes—early childhood and adolescence— with a sensitive and caring adult such as a teacher
suggesting particular opportunities for or counselor—a child has the potential to catch
intervention. (Murray et al. 2015, p. 3) up on self-regulatory capacity by the time he or
she is an adolescent, in much the same way that
These principles bring together many of the a slow reader can improve his or her reading
issues we have covered in previous chapters as through practice and support.
well as earlier in this chapter. As a natural part In 2014, New York Times columnist David
of the early developmental process, children Brooks published an op-ed commentary titled
learn, to various degrees, the cognitive and “The Character Factory.” Brooks cited research
emotional skills that allow them to respond to showing that “measures of drive and self-control
environmental stimuli through their behavior. influence academic achievement roughly as
In much the same way that learning to read much as cognitive skills.” A principal point he
involves a succession of sensory experiences that made in his commentary was that government-
guide the development of neural structures supported programs for early childhood educa-
linking together various specialized cortical ar- tion need to focus as much on the development
eas of the brain, learning to self-regulate in- of character as on the development of specific
volves an analogous process. As principle six academic skills. “Recent research has also shown
above describes, however, this process “can be that there are very d ifferent levels of self-control
disrupted by prolonged or pronounced stress up and down the income scale. Poorer children
and adversity including poverty and trauma ex- grow up with more stress and more disruption,
periences.” Those children who experience this and these disadvantages produce effects on the
disruption are at increased risk of entering school brain . . . But these effects are reversible with
with a combination of weak self-regulation and the proper experiences.”
impaired cognitive development. The adverse In 2014, Neil Halfon from the Center for
impact of these disadvantages on subsequent Healthier Children, Families, and Community
engagement in school and academic ability at the UCLA School of Medicine published an
make these children at greater risk of develop- editorial in JAMA addressing the “Socioeco-
ing unhealthy behavioral patterns as adoles- nomic Influences on Child Health.” In it, he ar-
cents that can affect subsequent well-being as gued that
an adult. As Murray et al. describe, “Indeed,
self- regulation has been identified as the new research on the development of ‘execu-
foundation for lifelong physical and mental tive function’ documents how the capacity for
health” (p. 4). impulse control, persistence, and focused
It is crucial that we fully appreciate both the attention formed in the early years is predictive
seriousness of these risks and the fact that they of health, behavioral, and educational outcomes,
are not necessarily permanent. As Murray et al. and is sensitive to the poverty-associated effects
go on to describe, “just as a child who struggles of stress. In other words, poverty impedes the
with literacy for any number of reasons may development of the neurobiological mechanisms
later become literate when provided with effec- that enable individuals to make appropriate
choices and resist the temptations to overeat, events during childhood and self-rated health
smoke, drink excessively, and use drugs, thereby (SRH) during adolescence and young adult-
placing children in this environment at increased hood. As the authors describe, “Background
risk for a wide range of health problems through- characteristics (parental education, income, and
out their lives. (Halfon 2014, p. 916) family structure), parental health conditions

(asthma, diabetes, obesity, migraines), and early
The neurological, cognitive, and behavioral health challenges (physical abuse, presence of a
disadvantages experienced by young children disability, and parental alcoholism and smok-
from disadvantaged backgrounds need not be ing) predict SRH from adolescence to young
seen as irreversible. Increased focus on sup- adulthood” (p. 1311). In their analysis, the au-
porting parents and preschool as well as school thors note that the health-related behaviors the
programs that develop children’s executive subjects adopted during adolescence, such as
function as well as reading and math skills can smoking, obesity, and alcohol use, had a substan-
help prevent many of the behavioral conse- tial impact on their SRH during adolescence
quences of early disadvantage that begin to and into young a dulthood.
show up in adolescence. Machado-de-Sousa et al. (2014), in a study of
students entering university in Brazil, used
MRI scans to see w hether those students exhib-
The impact of social disadvantage
iting higher levels of anxiety would have any
on adolescent development
change in the structure of their amygdala. Com-
Elementary school–age children demonstrate in pared to those students not exhibiting evidence
a number of ways the adverse impacts of early of anxiety, those with personal or social anxi-
childhood stress. As we have described, they ety had greater volume of the amygdala. While
are at risk of worse health status, higher levels the study did not include subjects for whom
of anxiety, lower levels of executive function, there was a record of stress exposure during
and lower educational attainment. While these childhood, these results nonetheless suggest
effects may be open to change through well that the adverse health outcomes experienced
designed interventions, without such interven- by adolescents who had experienced toxic
tions we can expect children to continue to stress as young children are likely associated
experience these outcomes as adolescents. with persistent structural changes in the amyg-
Recent research has documented these ef- dala and a high level of hormonal and neural
fects in adolescence in a number of ways. Dowd response in potentially stressful situations.
et al. (2014) analyzed data from the National Blair et al. (2014) published a review article
Longitudinal Study of Adolescent Health, a na- about factors that affect conduct problems in
tionally representative sample of adolescents. children and adolescents. As they describe,
They found a strong association between having “The term ‘conduct problems’ refers to a pattern
come from a lower-SES f amily and two measures of repetitive rule- breaking be havior, aggres-
of stress: perceived stress level and the fre- sion, and disregard for o thers” (p. 2207). They
quency of experiencing stressful life events dur- go into some depth describing the neurological
ing adolescence. They found that, at compara- structures and functions associated with con-
ble income levels, black adolescents experienced duct problems and conclude that “environmen-
more stress during adolescence than white tal risks confer a predisposition to conduct
adolescents. problems through effects on neurocognitive
Using the same data set, Bauldry et al. (2012) function. Risk factors with a postnatal effect
explored the association between stressful include low levels of parental monitoring, ex-
posure to violence, and harsh and inconsistent this type of behavior among adolescents is alco-
discipline, as well as circumstances, such as hol use. Fujimoto and Valente (2015) assessed
poverty, in which the other risk factors tend to the impact of peer relationships in a study of
coalesce” (p. 2213). 1707 high school students in California, pre-
Given these effects of childhood stress on dominantly from low-income Hispanic fami-
adolescents and evidence that those having ex- lies. They found that a principal predictor of
perienced high levels of stress are more likely whether a student had begun to drink alcohol
to adopt unhealthy behaviors as adolescents, was having a close friend who had also begun
it is important to understand how these behav- to drink alcohol. Thus, choosing to associate
iors are initially adopted. In chapter 4 I de- with o thers who drink alcohol appears to in-
scribed the many ways that, as children grow crease the likelihood that an adolescent himself
into adolescence, social networks play an in- or herself will also start to drink.
creasingly significant role in influencing both While alcohol is an important contributor to
perceptions and behavior. As those networks adult health disparities, as described in chap-
expand to include school peers, and as the ado- ter 2, cigarette smoking, diet, and exercise each
lescent begins to separate his or her identity has a substantially more profound impact on
from that of parents, peer expectations and be- adult well-being and premature death than alco-
haviors began to exert greater influence. Par- hol use alone. We also saw consistent evidence
ticularly as one moves into high school, peer that those with lower levels of education were,
groups often differentiate into those who expe- as adults, more likely to smoke and to be obese.
rience academic success and those with lower Hanson and Chen (2007) reviewed research
academic success. Those students who, during on the impact of having grown up in a low-
early adolescence, develop a greater sense of SES family on health behaviors in adolescence.
what Pachucki et al. (2015) refer to as “school They found consistent evidence that those ado-
connectedness”— feeling close to p eople at lescents who grew up in low-SES circumstances
school, feeling happy to be at school, feeling were more likely to smoke, to have a poor diet,
themselves to be part of the school, and feeling and to exercise less. In their review, they did
as though they are treated fairly by teachers— not find consistent evidence that low SES was
exhibit greater levels of self-esteem on a stan- associated with greater alcohol use by adoles-
dardized psychological assessment. Self-esteem cents. Nor did they find evidence of consistent
can be a key component of a feeling of self- racial or ethnic differences in these behaviors,
efficacy. Those with greater academic success after SES had been taken into account.
and a greater sense of self-efficacy are likely to Hanson and Chen noted that those growing
adopt a F uture perspective, as described in up in a low-SES household were likely also to
chapter 6. Those peers with lower academic have parents with low educational attainment.
success will, by contrast, feel more disconnected Since those adults with low educational attain-
from school and may begin to adapt more risky ment are also more likely to smoke, they
behaviors, consistent with the Zimbardo’s postulated that children in low-SES families
Present-Fatalistic and Present-Hedonistic time would be more likely to observe their own par-
perspectives. ents smoking and might therefore model their
Those adolescents who adopt a pre sent- own behavior as adolescents on their parents as
hedonistic perspective will focus less on the well as their peers. As described by the authors,
long-term effects of their behavior and more on “Taken together, parent modeling and attitudes,
the immediate enjoyment and pleasure they de- as well as the experience of stress and negative
rive from a behavior. A principal example of life events, may lead low SES teens to be more
likely to try cigarettes than high SES teens” roots of reduced adult well-being being in place
(p. 277). well before a child moves into adulthood.
Poonawalla et al. (2014) also looked at the as-
sociation of family SES and adolescent behav-
The added impact of minority race
iors, focusing on smoking and alcohol use.
Their study involved 1,356 mostly white sub- So far our discussion of socioeconomic disad-
jects who had been followed from birth through vantage has focused primarily on parental in-
15 years of age. They looked both at overall come and education, home environment, social
family SES, measured as being above or below environment, and the influence of positive
200 percent of the federal poverty line, and at school connectedness. Racial discrimination,
change in f amily income between the time the principally as experienced by African Ameri-
child was 1 month old and 15 years old. As with cans, is another form of social disadvantage
the earlier study, they found that children in that can have profound impacts on adolescent
lower-income families both at birth and as ado- behaviors. Bogart et al. (2013) evaluated data
lescents were more likely to smoke at age 15. on about 5,000 fifth-grade students from three
They again noted that the rate of maternal d ifferent communities, with roughly equal
smoking was also higher in the lower-income numbers of white, black, and Latino students.
families, providing a modeling effect. While They asked these children whether they had
low income itself was not associated with been treated badly because of their race or eth-
a lcohol use at 15, a downward income trajec- nicity or because of the color of their skin. They
tory over that time period, suggesting more compared those children who answered yes to
stressful f amily circumstances due to reduced either of these questions to those who answered
SES, was associated with the rate of alcohol no to both. They then compared the children
use at age 1 5. on scales of physical aggression, verbal aggres-
Boynton-Jarrett et al. (2013) reported on their sion, and delinquent behavior, as reported by
research that described the cumulative effects the children themselves. They found that, a fter
of turbulence experienced during childhood controlling for socioeconomic differences, both
and adolescence and several key outcomes dur- black and Latino students who had experienced
ing adolescence: health risk behavior, m ental discrimination were more likely than those
health, and completion of high school. Using who had not to exhibit these problem behav-
representative national data from a longitudinal iors. Overall, black students exhibited more
study of children aged 12–14, they asked how problem behaviors than white students, with
socioeconomic factors such as parents’ age, ed- about half of that difference associated with the
ucation, and occupation, family income, and high rate of having experienced discrimination
family structure and processes were associated among the black students. Interestingly, after
with these adolescent behaviors. Consistent controlling for socioeconomic factors, the over-
with the discussions above, they found that those all rate of problem behaviors among the La-
adolescents coming from more turbulent home tino students was lower than among the white
backgrounds w ere more likely to smoke, more students.
likely to be sexually active, more likely to expe- Priest et al. (2013) reviewed an extensive se-
rience m ental health problems, somewhat more ries of research articles about the impact of hav-
likely to belong to a gang, and less likely to ing experienced racial discrimination on the
graduate from high school. Given the impor- well-being of those age 12–18. They summarized
tance high school graduation plays in affecting the results of their review as “provid[ing] com-
lifelong health behaviors, we clearly see the pelling evidence for acknowledging and ad-
dressing racial discrimination as a key determi- racial discrimination on those close to them,
nant of health for children and young people by they not only can develop a sense of hopeless-
documenting strong and consistent relation- ness but also can develop a deep sense of dis-
ships between reported racial discrimination trust of o thers, especially those in higher-SES
and a range of detrimental health outcomes positions who are not black.
across various age groups, racial/ethnic back- This continuing evidence of black youth in
grounds and settings” (p. 122). The types of out- the United States experiencing racial discrimi-
comes they assessed included m ental health nation brings up a related question: the direct
(anxiety, depression, and psychological distress) impact of experiencing racial discrimination on
and reduced self-esteem or sense of self-worth. physiological health, in particular cardiovascu-
While these outcomes w ere found in a range lar health. In chapter 8 we discussed the ways
of minority racial or ethnic groups, one finding in which a chronically elevated allostatic load—
in particular applied principally to black youth: the level of stressor hormones circulating in the
a strong association between having experienced body—is often the result of chronic or recur-
racial discrimination and engaging in delinquent rent environmental stressors perceived by the
behaviors. stress regulatory mechanism of the brain and
Sanders-Phillips et al. (2009) emphasized the autonomic nervous system. If that stress is se-
importance of a diminished sense of control vere and persists over time, the chronic elevation
over life as a worrisome outcome of the experi- in the stress response hormones, principally
ence of racial discrimination during childhood. cortisol, epinephrine, and norepinephrine, can
In black families especially, that perceived loss begin to cause injury to the cells lining the blood
of control can affect mothers as well as their circulatory system, principally the arteries and
children. A mother who perceives less self- smaller arterioles (McEwen 1998, Seeman et al.
efficacy in being able to provide her child with 2010).
a supportive home environment may develop Heffernan et al. (2008) studied the arterial
lower parenting skills, resulting in a weaker system in 25 young (average age of 23), healthy
parent-child relationship. That loss of parental black men and compared the results with those
nurturing and support can reduce the child’s from 30 white men of the same age and health
own sense of self-efficacy, with that loss “asso- status. One of the tests they performed was an
ciated with risk behaviors such as drug use, ag- ultrasound analysis of the carotid artery, the
gression, and sexual risk-taking” (p. S180). artery that can be felt in the side of the neck.
Sanders-Phillips goes on to acknowledge a They found that, compared to the white men,
potentially more worrisome outcome of the ex- the carotid arteries in the young black men
perience of racial discrimination during child- were, on average, stiffer and had a thicker wall,
hood, described as anomie. “Anomie, which is suggesting scarring of the lining of the artery
characterized by feelings of hopelessness and such as that associated with chronically ele-
perceptions of little control over life outcomes vated allostatic load.
(i.e., decreased self- efficacy), develops when Will black adolescents, many of whom have
children perceive contradictions between op- experienced repeated racial discrimination
portunities in the larger society and the condi- while growing up, also exhibit thicker and stiffer
tions and lack of opportunity in their own arteries than comparable white adolescents?
lives. Racial discrimination increases anomie Thurston and Matthews (2009) also used ultra-
by reinforcing perceptions of inequality and lim- sound analysis to measure the stiffness and wall
iting options for achieving life goals” (p. S178). thickness of the carotid artery in 81 black and 78
As children and adolescents view the impacts of white adolescents with a mean age of 17.8 years.
They found that both lower SES and black race tain less education themselves? Given the
were associated with thicker and stiffer arteries, powerful influence of educational attainment
with the strongest effect shown for low-SES on lifelong well-being, this question is central
black youth. It thus appears that, especially for to our understanding of the ways in which
black youth, experiencing racial discrimination social disadvantage affects the behaviors of
during childhood and adolescence will com- adolescents. Davis-Kean (2005) examined cross-
pound the adverse physiologic impacts of grow- sectional data on a nationally representative
ing up in lower-SES circumstances. sample that included 868 children between the
ages of 8 and 12. The sample was evenly split
between white and black children in families
Adolescent educational attainment
with a range of incomes. She explored the as-
as reflecting parents’ educational
sociations between the parents’ level of educa-
attainment
tion and the child’s score on a standardized
We have known for some time that one of the achievement test. While there was an associa-
strongest predictors of an adolescent’s education between parents’ educational level and the
tional attainment is the level of education his or child’s score on the achievement test, it was
her parents were able to attain. A 2001 federal largely an indirect relationship. It turned out
report from the National Center for Education that parents’ education was associated with sev-
Statistics showed that 82 percent of students eral dynamics of the home environment, in-
whose parents had at least a bachelor’s degree cluding the expectations the parents expressed
went to college immediately a fter finishing high for their child’s subsequent educational attain-
school, while 36 percent of students whose par- ment and the extent to which the child was
ents had not completed high school went to col- reading books on a regular basis. A fter taking
lege after high school. In certain high-poverty these factors into account, the direct associa-
communities, the rates were even lower. A 25- tion between parents’ education and children’s
year study of children growing up in Baltimore achievement was substantially diminished.
conducted by Johns Hopkins University sociolo- Commenting on these and similar results,
gist Karl Alexander (Rosen 2014) showed that Eccles and Davis-Kean (2005) point out that the
only 4 percent of children growing up in low- quality of the neighborhood environment will
income families had completed a bachelor’s de- also vary in association with parents’ level of
gree by age 28, as compared to 45 percent of education and that environment can in turn af-
children in Baltimore from higher-income fami- fect the child’s educational attainment. In their
lies. Much of this failure to attain a college edu- summary of their research, however, they
cation reflects the extremely high rates of drop- underscore the conclusion that “Both existing
ping out of high school of low-income students studies and the research summarized in this
and students in certain racial or ethnic minority paper document the link between various pa-
groups. Of 16- to-24-
year-
olds nationally from rental characteristics, beliefs and behaviors and
families in the lowest quartile of income, ap- their children’s educational attainments. We
proximately 12 percent had dropped out of high have shown that the relation of parents’ educa-
school before completion. For blacks or Hispan- tion to their children’s academic achievement
ics in this age range, 9 percent and 14 percent, and motivation is mediated by quite specific
respectively, had not completed high school beliefs and behaviors” (p. 201).
(National Center for Education Statistics 2014). This conclusion—that it is the impact of pa-
Why do the children of parents with a low rental education on parental and child beliefs
level of educational attainment tend also to at- and attitudes that is largely responsible for the
association between parental and child educa- such as smoking, diet, and exercise, Ross and
tional attainment—is supported by the research Mirowsky (2011) analyzed data from a nation-
of Dubow et al. (2009), referenced earlier in ally representative sample of English-speaking
chapter 1. They used data from a longitudinal adults in the United States between the ages of
study of 856 children in a semirural area of New 19 and 95. They evaluated the association be-
York State who were in the third grade in 1960. tween the subject’s level of education and the
The study recontacted the subjects at ages 19, 30, subject’s current health status. Both the sub-
and 48 in order to assess the association between ject’s own level of education and that of the
the parents’ level of education when the chil- subject’s parents were associated with adult
dren w ere 8 years old and the children’s subse- health status. The extent to which the subject
quent well-being as they became adolescents smoked, was overweight, or failed to get regular
and then adults. In a bivariate analysis compar- exercise explained a large part of this associa-
ing parents’ education and subject’s subsequent tion. They found, however, an additional f actor
education, they found a significant association that explained much of this association: the
between the two. However, when they entered extent to which the subject developed a sense of
into the analysis the subjects’ adolescent char- control over his or her own life. Those who
acteristics, the direct association between par- came out of childhood with a lower sense of
ents’ education and children’s subsequent edu- control over the direction their life would take
cation went away. As described by the authors, were both less likely to attain a higher level of
“the effects of parental education w ere entirely education and more likely to engage in these
indirect: higher levels of parental education led unhealthy behaviors.
to higher levels of optimistic educational aspi- Nguyen et al. (2012) looked for this lack of a
rations or educational attainment in adoles- sense of control in a study of more than 15,000
cence and subsequently to higher educational adolescents in the United States. When the
attainment or more prestigious occupational subjects were in the seventh through twelfth
status in adulthood” (p. 240). It was the adoles- grades in school, researchers asked them to
cent’s own perspective on self-efficacy and the estimate their chances of living to age 35. They
value of education that led her or him to con- reinterviewed the subjects when they were
tinue with education after high school, with the 24–32 years old and evaluated their adult SES
resultant benefit in occupational status and the using measures of education, income, and life
effects on well-being that status carries with it. experiences. A lower estimate during adoles-
The authors were able to determine that, as cence of one’s chances of surviving to age 35
the single strongest predictor of subsequent was associated with a lower level of SES as an
educational attainment, what they refer to as adult. Recalling the Present-Fatalistic and Pre
“achievement-related aspirations” (p. 242) began sent-Hedonistic time perspectives identified by
to appear in m iddle school and continued into Zimbardo and Boyd, as discussed in chapter 6,
later adolescence. The authors also determined we can see consistent evidence that coming
that these aspirations were affected by parents’ from a lower-SES f amily, in which parents had
level of education but not by family income in low levels of education and never passed on to
dependent of parental education. their children a positive perspective on the
Consistent with the data we examined in potential of succeeding in school, can have pro-
chapter 3 showing the consistent associations found impacts on the way an adolescent views
throughout adulthood between educational the world and his or her place in it as well as the
attainment and well-being, associations that benefits or harms of adopting certain types of
are largely mediated by unhealthy behaviors behavior in adolescence and as an adult. At such
time as that adolescent becomes a parent, he or can be more profound. These issues raise the
she is at risk of passing on to the next genera- question of what types of interventions can be
tion this fatalistic sense of low self-efficacy and expected to prevent these outcomes in children
the behavioral risks that go with it. who experience the toxic stress so often associ-
ated with economic or racial/ethnic inequality.
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chapter
11 Understanding Well-Being
and the Interventions
That Can Enhance It
I
n 2010, officials from the World Health Organization and the
US Centers for Disease Control and Prevention, working with
researchers with the Adverse Child Experiences (ACE) Study,
announced a collaborative effort to initiate a global surveillance
program to gauge the incidence and lifelong effects of ACEs (Anda
et al. 2010). They recommended that the public health community
adopt a new perspective on ACEs, approaching them as a poten-
tially preventable problem. As they described, “The concept in
using ACEs as a framework for the primary prevention of public
health problems is that stressful or traumatic childhood experiences
such as abuse, neglect, or forms of h ousehold dysfunction are a
common pathway to social, emotional, and cognitive impairments
that lead to increased risk of unhealthy behaviors, violence or revic-
timization, disease, disability, and premature mortality” (p. 95).
Figure 11.1, adapted from the ACE Study website, describes
graphically the potentially lifelong effects of ACE on social, emo-
tional, and cognitive functioning. These functional changes are
often associated with alterations in neurological structure, in par
ticular in the hippocampus, amygdala, and associated cortical areas.
During childhood and adolescence these changes increase the likeli-
hood that individuals experiencing ACEs will adopt behaviors that
put their current and future health at risk. These behaviors include
smoking, diet, and sexual activity but in particular also include
a child’s response to educational challenges and opportunities.
Anda et al. emphasize the long-term impacts of events occur-
ring early in childhood: “Although such events constitute a key
target for preventive attention, only a small fraction have acute
consequences of sufficient severity to bring them to the attention
of public authorities. By far, the largest proportion of the burden
of disease due to ACEs arises from the cumulative effect of
173
1 74 I n t r o d u c t i o n t o B i o s o ci a l M e d ici n e
Old age Early

death
Adulthood Disease and disability
Adolescence Adoption of health-risk behaviors
Childhood Cognitive and emotional impairment
Infancy Impaired neurological development
Figure 11.1. The Pyramid of Childhood Adversity and Its Effects on

Well-Being. From the Adverse Childhood Experiences Study.
chronic exposure to multiple adversities whose

Social inequalities in adult health
lifelong consequences may often start to become
apparent only many years a fter exposure” (p. 95). In chapters 2 and 3 we discussed the many ways
For example, while smoking is a principal cause to measure health inequality and the ways health
both of premature death among many popula- inequality is linked to socioeconomic inequality.
tion groups and of persisting socioeconomic We know, for example, that among adults in the
differences in life expectancy and quality of United States age 60 or greater, lower income and
life, the root causes of adult smoking may actu- lower levels of education are associated both
ally occur in early childhood. The same is often with greater frequency of many chronic illnesses
true for the patterns of diet and exercise one and with greater limitations in the level of physi-
adopts as an adult. cal functioning compared to o thers with compa-
The previous chapters have described many rable disease burdens (Louie and Ward 2011).
of the processes involved in these developmen- Similar outcomes exist for racial and ethnic
tal changes, from early development of the minority groups. Exploring the association of
brain with selective axonal myelination to the chronically stressful adult living conditions and
development of cognitive abilities such as lan- health outcomes, Jackson et al. concluded that,
guage and memory and the development of cer- “Many Black Americans live in chronically
tain personality characteristics and associated precarious and difficult environments. These
motivational patterns. Again as described by environments produce stressful living condi-
Anda et al., “Breakthroughs in neurobiology tions, and often the most easily accessible op-
show that ACEs disrupt neurodevelopment and tions for addressing stress are various unhealthy
have lasting effects on brain structure and func- behaviors . . . [that] have direct and debilitating
tion” (p. 95). As the pyramid in figure 11.1 sug- effects on physical health” (2009, p. 936). Shariff-
gests, these early developmental processes can Marco et al. (2010) confirmed that among black
have continuing impacts on well-being, both Americans, having experienced racial discrimi-
emotional and physical, at all stages of life from nation is an added stressor that increases the
childhood through old age. risk for unhealthy behaviors.
U n d e r s ta n d i n g W e l l- B e i n g a n d I n t e r v e n t i o n s 1 7 5
It is becoming increasingly clear that behav- children w ere nearly all white and from
iors adopted at an early age will continue to middle-class families. Schwartz et al. (1995) re-
have powerful health impacts throughout the ported follow-up data on this sample through
life course, including in old age. Shaw et al. the year 1991. By that time, 44 percent of the
(2013) tracked rates of death and disability over subjects had died. The authors looked at four
a 10-year period in a nationally representative aspects of the subjects’ childhood experiences:
sample of nearly 20,000 adults over the age of family socioeconomic status (SES), health status
50, all of whom w ere free of disability at the during childhood, personality characteristics
beginning of the study. As we would expect, during childhood, and family stability. They as-
they found significant disparities in these out- sessed how these characteristics were associ-
comes in association with socioeconomic status, ated with the risk of dying before 1991.
although these disparities became somewhat As we would expect, the girls in the study
smaller in the older age groups. Those dispari- had a lower mortality rate over the 70 years of
ties w ere significantly reduced, however, a fter follow-up. Given the relative homogeneity of
they took into account behavioral patterns that the subjects’ socioeconomic status, researchers
were present at the beginning of the study. As did not find a significant association between
the authors concluded, “This finding indicates family SES and mortality risk. They did find that
that while the aging process is associated with those subjects who as children exhibited the
some degree of leveling of socioeconomic in- personality traits of conscientiousness and mood
equalities, it is not enough to overcome the instability had lower rates of death. Beyond these
equalities in health behaviors and health out- associations, the only factor associated with an
comes that have already accumulated” (Shaw increased risk of death was having experienced
et al. 2013, p. 57). parental divorce before the age of 21. Those chil-
dren whose parents had divorced experienced a
44 percent increase in their mortality risk over
The early roots of adult health
the period of the study. Based on these findings,
behaviors
the authors pose an important question: “What
If health behaviors in the middle years of life are the precise causal mechanisms responsible
continue to impact health status into old age, for the associations between childhood person-
how early are the roots of these behaviors es- ality, parental divorce, and longevity? This
tablished? The pyramid shown in figure 11.1 question is difficult to answer. The causal path-
suggests that the origins of health-related be- ways probably involve the interaction of a num-
haviors are in adolescence. These adolescent ber of factors, including health-related behav-
behaviors, however, may have roots in early iors, stress and coping mechanisms, social
childhood, especially if that childhood included support, and other lifestyle factors” (Schwartz
ACEs. Is there evidence that the health status of et al. 1995, p. 1244)
adults is linked directly to early childhood Friedman et al. (1995) looked further at the
circumstances? association identified in the Terman study be-
One of the earliest studies that provides data tween the level of conscientiousness exhibited
to address this question was begun in 1921 as a child and the cause of death for those sub-
by Lewis Terman, one of the creators of the jects who had died between 1950 and 1986. The
Stanford-Binet IQ test. As described in chap- child’s level of conscientiousness was based on
ter 7, Terman identified 1,285 children with an reports obtained in 1922 from the child’s parent
average age of about 11 years, all of whom had and the child’s teacher regarding four aspects
an IQ of 135 or greater based on that test. These of personality: prudence, conscientiousness,
1 76 I n t r o d u c t i o n t o B i o s o ci a l M e d ici n e
freedom from vanity/egotism, and truthful- et al. 2006, 2007). As described in chapter 7,
ness. The authors of this report suggest that this these data, originally gathered between 1959
measure corresponds fairly closely to the Big and 1967, assessed the personality characteris-
Five dimension of conscientiousness, as discussed tics of elementary school children in Hawaii
in chapter 7. They found that those children based on the Big Five traits model. When be-
who exhibited higher levels of this trait as chil- haviors and health status were then reassessed
dren were, as adults, less likely to smoke or when the subjects w ere in their 40s, researchers
drink heavily, although childhood conscientious- found that greater conscientiousness as a child
ness remained strongly associated with longev- was once again associated with greater adult qual-
ity even a fter controlling for these behaviors. ity of life, reduced rates of smoking, and reduced
Crosnoe and Elder (2004) looked at a subset rates of obesity. These associations were stron-
of the men from the Terman study who w ere ger for w omen than for men. As with the Ter-
still alive in the 1970s. At the time of the update man study, educational attainment played an
the subjects would have been between 63 and important mediating role in the association be-
72 years of age. The researchers created a scale tween childhood conscientiousness and adult
of what they referred to as a holistic pattern of health behaviors.
aging, which was essentially a global measure Moffitt et al. (2011) reported on a longitudinal
of subjects’ overall quality of life. Factors in- study of approximately 1,000 children born in
cluded in this measure w ere current family 1972–73 in a city in New Zealand, who w ere fol-
engagement, perceived occupational success, lowed to the age of 32. At age 5 years, children
civic involvement, life satisfaction, and vitality. were observed by a trained examiner who rated
They found that three aspects of childhood them on a combined scale of self-control. Re-
were associated with a holistic aging pattern searchers then evaluated the association between
in later years: the socioeconomic status of the self-control at age 5 and a range of indicators of
family in which the child grew up, w hether the well-being at age 32, including measures of phys-
subject’s parents divorced during the subject’s ical health, mental health, wealth, and having a
childhood, and the strength of the subject’s record of criminal activity. A fter controlling for
attachment to her or his parents during child- childhood measurements of intelligence, socio-
hood. From these results the authors w ere able economic status, and quality of f amily life, they
to conclude that “early experiences can have found that self-control as a child was strongly
long-term consequences . . . elements of earlier associated with each of these measures of adult
life stages, including family experiences, pro- well-being.
vide information about the routes that indi- Ferguson et al. (2005a, 2005b) reported on
viduals take through life” (p. 650). An additional another longitudinal study of children in New
finding from this analysis was that the associa- Zealand. The study followed 1,265 children, all
tion between the socioeconomic situation of a born in 1977, from birth through age 25. Using
subject’s childhood family and the quality of reports from parents and teachers, between the
the subject’s aging profile in later life “was ages of 7 and 9 they measured the child’s intel-
almost completely a function of the greater edu- ligence using a standardized IQ test as well as the
cational attainment of young people who grew child’s “tendencies to disruptive, oppositional,
up in such families” (p. 649). and conduct disordered behaviours.” They then
A second group of studies that linked early evaluated the association between these mea
childhood personality traits with adult health sures taken at age 7 with two sets of outcomes
behaviors and health outcomes was done by assessed between age 18 and age 25: (1) educa-
Hampson, Goldberg, and colleagues (Hampson tion and employment and (2) adverse social out-
Age 7 Age 18–25
IQ Education and
score employment
Adverse child
experiences
Conduct Adverse social

problems well-being
Direct association Inverse association
Figure 11.2. Association between Conduct Problems and IQ in Childhood

with Educational and Social Outcomes in Early Adulthood in a Longitudinal Study
of Children in New Zealand. From Ferguson et al. 2005a, 2005b.
comes, which included a history of criminal ac- veyed a nationally representative sample of
tivity, drug abuse, mental illness, or unstable nearly 100,000 children between the ages of 0
sexual or partner relationships. In their analy- and 17. Using data gathered in 2011–12 and con-
ses they also included a measure of early ACEs, trolling for demographic characteristics, they
which included family conflict, socioeconomic found that those children and adolescents re-
adversity, parental instability, and violence or porting a greater frequency of ACEs had both
child abuse. The results of these studies are lower school engagement and higher rates of
shown in figure 11.2. chronic illnesses such as asthma, obesity, and
As can be seen, early experience of ACEs ADHD. They also found that those children
was associated with lower IQ at age 7 and a who, between the ages of 6 and 17, displayed
greater frequency of conduct problems as as- what the authors refer to as “resilience” (defined
sessed by both parents and teachers. These two as “staying calm and in control when faced with
outcomes were inversely associated, with chil- a challenge”) showed fewer adverse impacts of
dren with higher IQs exhibiting fewer conduct earlier ACEs.
problems. The child’s IQ score at age 7 was a In chapter 9 we discussed the development
significant predictor of subsequent educational of memory and other forms of cognition, de-
attainment and employment, while the level of scribing them largely in terms of the neural
conduct problems was significantly associated structure of certain regions of the brain. If (a)
with greater social adversity as a young adult. the children in the Terman study with lower
In their full analysis, after accounting for con- levels of conscientiousness subsequently also
duct problems, there was no direct association showed lower levels of educational attainment,
between IQ and subsequent social adversity. (b) the children in the Moffit study who showed
Bethell et al. (2014) studied data from the Na- less self-control had reduced well-being in their
tional Survey of Children’s Health, which sur- thirties, and (c) the children in the Ferguson
study with more conduct problems exhibited worth suggested that “Self-controlled individu-
lower levels of intelligence and subsequent edu- als are more adept than their counterparts at
cational attainment, might the children in these regulating their behavioral, emotional, and at-
studies have had lower levels of cognitive func- tentional impulses to achieve long-term goals . . .
tioning as a contributor to these differences? The benefits of self-control for adult functioning
Evans and Schamberg (2009) addressed this are partially mediated by better decision mak-
issue in a study of 195 young adults who were ing during adolescence” (2011, p. 2639).
part of a longitudinal study of rural poverty. Adler and Snibbe (2003) have reviewed re-
The subjects w ere white and 50 percent female, search in sociology and psychology about the
with half in families living below the poverty factors that create the long-term association be-
line and half living in m
iddle class families with tween socioeconomic status and health. They
incomes 2–4 times the poverty line. The sub- show how this association begins in childhood,
jects w ere followed from birth through age 17, with the social and economic context in which
with regular assessment of the family’s poverty the child grows up affecting the development of
status and measures of allostatic load, the body’s personality traits and cognitive abilities. These
physiologic stress response (e.g., blood pres- in turn are associated with both physiologic
sure, level of stress hormones). When the sub- consequences of allostatic load and the health-
jects were an average age of 17.3 years, they had relevant behaviors adopted in adolescence. They
their working memory assessed using a stan- suggest that a key linkage between reduced so-
dard psychological assessment. When the re- cioeconomic circumstances and subsequent ad-
searchers only assessed the association between verse health outcomes is to a large extent a
the length of time living in poverty and work- consequence of “Behavioral, cognitive, and af-
ing memory at age 17, they found a significant fective tendencies that develop in response to
inverse association. When they included both the greater psychosocial stress encountered in
the time in poverty and the allostatic load in low-SES environments” (p. 119). They also con-
the analysis, the allostatic load was inversely clude that “Extensive data attest to the central-
associated with working memory, while pov- ity of perceived personal control and mastery
erty no longer showing an association with in the SES-health gradient” (p. 120). In their re-
memory. By the time they are 17 years old, young port, Adler and Snibbe provide a graphic repre
adults who, as children, experienced the stress sentation of the longitudinal succession of fac-
of poverty have developed less cognitive capac- tors, from childhood through adolescence, that
ity for working memory. Those with less cogni- affect health and well-being as adults. Their
tive capacity at this age are less likely to continue model includes environmental factors in addi-
education beyond high school and are accord- tion to psychological factors. In figure 11.3 I
ingly likely to experience reduced earning ca- have reproduced that portion of their diagram
pacity and more likely to engage as adults in be- that focuses on psychological factors.
haviors that reduce their well-being. In a study In comparing figure 11.3, adapted from Adler
of poor adults in an urban setting in the United and Snibbe, to figure 11.1, from the Adverse
States and in a rural setting in India, Mani et al. Childhood Experiences Study, we see essentially
(2013) confirmed this association between con- the same causal chain, only using a d ifferent
tinued poverty and reduced cognitive function- axis to represent time. Data from a range of stud-
ing as adults. ies, done over a range of time periods following
In a commentary responding to the Moffit a range of populations, have confirmed the
study of self-control during childhood, Duck- causal linkages represented in both diagrams.
Health-
relevant
behaviors
SES Psychological
Health
education, responses
and
occupation, affect
illness
and income cognition
Biological
responses
allostatic load
Figure 11.3. The Pathways from Socioeconomic Status to Health. Adapted from Adler and Snibbe 2003.
A review of the impacts of social determi- the basic causes of morbidity and mortality in
nants concluded, “Research shows that early adult life” (1998, p. 246).
life exposures affect cognitive and noncogni- If the cognitive deficit that is the conse-
tive development (for example, executive func- quence of early childhood adversity leads to
tion and prefrontal cortex development), which, reduced educational attainment and to behav-
in turn, affects time preferences and self- iors that are harmful to health, then it makes
control skills (delayed gratification), which are sense to view childhood adversity as a cause
major determinants of risky health behaviors. of premature death in later adulthood. As de-
These are key neuro-psycho-social pathways scribed at the beginning of this chapter, the
connecting socioeconomic status, health be World Health Organization and the US Centers
havior, and health outcomes” (Health Policy for Disease Control and Prevention have jointly
Brief 2014). called for a new international perspective on
the implications of ACEs (Anda et al. 2010). In
much the same way as public health agencies
Identifying and adopting interventions
have collaborated globally to follow and reduce
to improve adult health through the
infectious diseases, these agencies called for “a
reduction of adverse childhood
framework for global surveillance of the preva-
experiences
lence and broad public impact of ACEs” (p. 96).
In one of the early publications from the ACE As with any global health issue that has a
Study, Felitti et al. summarized the implications long chain of causal and contributory factors,
of the causal linkages illustrated above: “These it is not always clear at what point in that
associations are important because it is now chain it would be optimal to intervene. It would
clear that the leading causes of morbidity and be shortsighted to suggest that attempting to
mortality in the United States are related to change adverse health behaviors of adults who
health behaviors and lifestyle factors; these fac- have already begun to develop signs of chronic
tors have been called the ‘actual’ causes of death. illness would be most effective. Rigotti et al.
Insofar as abuse and other potentially damag- (2014) reported on a trial studying 397 adults who
ing childhood experiences contribute to the had been hospitalized for treatment of an acute
development of these risk factors, then these problem, most commonly related to cardiovas-
childhood exposures should be recognized as cular disease, all of whom had been daily smokers
before their hospitalization. The patients, with

The effects of early childhood
an average age of 53 years, were randomly as-
intervention for children at risk of ACEs
signed either to receive a sustained smoking
cessation intervention upon discharge from the As we saw in chapter 3, African Americans have
hospital or to receive standard advice about the some of the highest death rates, lowest life ex-
importance of quitting smoking and the avail- pectancy, lowest educational attainment levels,
ability of medications to assist with quitting. and highest rates of risky health behaviors of
The sustained intervention included a free 90- all racial/ethnic groups in the United States.
day supply of tobacco cessation medication, regu- Many of these disparities are due to the lower
lar automated phone calls to encourage them to socioeconomic circumstances in which many
refrain from smoking, and the availability of a black children grow up, compounded by the
counselor to contact for further assistance in stress of experiencing racial discrimination.
stopping smoking. While there was a slight in- Adopting the causal model of the ACE Study,
crease in the percentage of participants who re- would it be possible to prevent the chain of
ceived the sustained intervention who had adverse cognitive, behavioral, and health out-
stopped smoking at six months after discharge comes experienced by many African Americans
(25% for the intervention group as compared to throughout the developmental process?
15% for the standard care group), three-fourths Reynolds et al. (2014) studied nearly 1,000
of these patients with a known, potentially seri- mostly low- income, single- parent preschool
ous chronic medical condition for which smok- children in Chicago, 90 percent of whom w ere
ing was a major contributory factor nonetheless black and 7 percent of whom w ere Hispanic.
continued to smoke despite the intensive inter- Forty-two percent of the children attended pre-
vention. Similar results have been found in in- school full-time (seven hours per day), while
tensive efforts to reduce obesity among adults 58 percent attended preschool for three hours
with diabetes and other conditions related to per day. The researchers used a case-control
obesity (Wadden et al. 2014). methodology to determine if full-day preschool
Another possible place to intervene might be had greater benefits for the children than part-
at the point where individuals end their educa- day. They found that attending full-day preschool
tion. Kulhánová et al. (2014) used mortality data was associated with higher scores on scales of
from countries in Western Europe to do a math- school readiness that measured language abil-
ematical estimate of the effect on adult mortality, math ability, socioemotional development,
ity if everyone in those countries were to and physical health. In addition, the full-day
complete some form of higher education after students showed increased attendance rates
high school. Perhaps not surprisingly, mortal- and reduced chronic absences. In an editorial
ity would be reduced as much as 50 percent for that accompanied the study by Reynolds, Sch-
both men and w omen in some countries. In the weinhart commented that studies on the value
United States, as in these Western European of preschool “generally have supported the idea
countries, experience has shown that this that greater program quality and quantity, such
hypothetical output cannot be easily attained. as full-day vs. part-day, contribute more to chil-
While government agencies, school districts, dren’s development” (2014, p. 2101)
and educational researchers have tried a number A group of researchers at the University of
of interventions to increase rates of high school North Carolina, Chapel Hill, also explored the
completion followed by participation in higher value of full-day preschool. In what they have
education, levels of educational attainment re- described as the Carolina Abecedarian Project,
main low for many groups. they asked this question in regard to the value
of preschool for children starting shortly a fter school, this resource teacher acted as a liaison
birth. Beginning in 1972, researchers enrolled between the family and the school and devel-
the families of 104 newborn infants, evenly split oped individual, supplementary curriculum
between boys and girls and all from families packets for the children based on their learning
living in the Chapel Hill area of North Carolina. needs as identified by the classroom teacher.
The families were identified as high risk based The researchers then evaluated children on
on a series of criteria that included meeting a regular basis, beginning at age 3, comparing
poverty guidelines defined by the federal gov- the cognitive and academic development of the
ernment; the age and educational level of the children (Campbell et al. 2001). When the sub-
mother (average age 20 years, average educational jects w ere 21 years old, they w ere compared
attainment 10th grade); and family structure based on their intellectual and academic abilities,
(75% single-parent h ouseholds). Based on these their level of educational attainment, their level
criteria and the region from which families of employment, and their overall social adjust-
were recruited, 98 percent of the infants were ment (Campbell et al. 2002). When the subjects in
African American, although race was not used the study had reached their mid-30s, they were
as an explicit selection criterion. then compared on a range of risk factors for
The children were randomized at birth, with cardiovascular and other metabolic diseases
half of the children receiving intensive social (Campbell et al. 2014). The comparative outcomes
and educational support beginning at birth. between the early childhood intervention group
The intervention included full-time, year-round and the control group at these various ages are
professional day care for five days per week from shown in table 11.1. The table only shows the
birth to age 5. The program in the day care in- outcomes that w ere shown to be associated with
cluded age-appropriate interventions to teach ba- the early childhood intervention portion of the
sic cognitive and social skills as well as frequent study. In most cases, the three-year school-age
interaction that emphasized the development of intervention did not have additional impacts
language skills. Those children randomized to beyond those of the early intervention.
the control group received no specialized inter- These studies identified a number of signifi-
vention, although some children did participate cant impacts of the early childhood interven-
in existing day care programs in the area. Fami- tion. These impacts were apparent by the age of
lies from both groups were offered social ser 3 and continued to be apparent when the sub-
vice support that they could call on if needed. jects w
ere in their mid-30s.
The intervention ended when the children As shown in table 11.1, the differences in out-
reached age 5 and w ere ready to enter school. At comes of the children receiving the interven-
that point, a second randomization took place, tion as compared to those who did not included
with each of the two original groups (interven- the following:
tion and control) further split into one group
that would receive an additional intervention • At age 3 to age 5, the study subjects had
during the first three years of school and an- greater cognitive ability as measured by a
other that would experience the standard school standard IQ test.
curriculum. The families in the school interven- • At age 8 and age 15, the study subjects
tion group, half of which had participated in the continued to have greater cognitive ability,
early childhood intervention and half of which and they had developed greater reading and
had not, were assigned a trained home-resource math ability.
teacher to supplement the usual grade- level • At age 21, the study subjects continued to
school teacher. For the first three years of display greater cognitive and academic
ability, had better educational attainment, born into disadvantaged circumstances largely
and showed evidence of better social corroborated the conclusions of the Abecedar-
adjustment based on a range of behaviors. ian study. The High/Scope Perry Preschool study
• By their mid-30s, the study subjects had was begun in 1962 and involved 123 children
evidence of better physical health based on from low-income black families living in Ypsi-
a range of physiologic risk markers. lanti, Michigan (Schweinhart et al. 2005). The
children w ere randomly assigned e ither to re-
A second long-term study of the impact of ceive a high-quality preschool program at age 3
high quality preschool on the lives of children through 4 or no preschool program. The pre-
T abl e 1 1 .1 . Comparative Outcomes of the Early Childhood

Intervention in the Abecedarian Project
Outcome measured Evaluation results
3–5 years
Study Control
Cognitive ability (IQ score) 101.3 89.2
8 years 15 years
Study Control Study Control
Cognitive ability (IQ score) 97.8 93.8 95.8 90.1
Reading ability (test score) 94.0 85.2 94.3 88.5
Math ability (test score) 97.7 92.5 93.6 86.8
21 years
Study Control
Cognitive/academic
Cognitive ability (IQ score) 89.7 85.2
Reading ability (test score) 93.3 87.6
Math ability (test score) 89.2 84.5
Educational attainment
Graduated high school 70% 67%
Enrolled in college 36% 14%
Social adjustment
Currently employed 64% 50%
Married 4% 10%
Teenage parent 26% 45%
Regular smoker 39% 55%
Mid-30s
Study Control
Adult health indicator
High blood pressure 22% 32%
Elevated cholesterol 28% 46%
Diabetes or prediabetes 35% 36%
Obesity 67% 77%
Sources: Campbell et al. 2001, 2002, 2014.
Note: Study group received intervention from birth to 5 years; control group received
no early intervention.
school experience was offered by fully certified who experience adverse circumstances early in
teachers, each working with groups of five to childhood are likely to develop weaker cogni-
six children. There was a daily class schedule, tive abilities and to develop personality and
and the teacher visited each child’s family once motivational characteristics that put them at
a week. risk for risky behaviors and less educational suc-
The researchers followed 94 percent of the cess. These outcomes place these children at in-
children into their 40s, assessing their educa- creased risk as adults of developing chronic
tional progress and socioeconomic status on a illness and succumbing to early mortality. The
regular basis. From these analyses they have most effective time to intervene in this causal
identified a number of significant differences in chain is at its beginning, in the period immedi-
the life courses of the two groups of children. ately following birth. James Heckman (2006)
performed a cost/benefit analysis of investing
• At age 5, the preschool children had higher public resources in early childhood education
average IQ. and support programs and concluded that “The
• At age 14–15, the preschool children showed benefit-cost ratio (the ratio of the aggregate pro-
more consistent completion of homework gram benefits over the life of the child to the in-
and had demonstrated better academic put costs) is over eight to one” (p. 1901). By con-
achievement. trast, Heckman estimates, investing in changing
• More of the preschool children than non- educational and health-related behaviors in high
preschool children graduated from high school and adulthood yields substantially less
school (77% vs. 60%). than the cost of the public resources required.
• At age 40, the preschool children showed
higher incomes and had been arrested
Home visitors and the Maternal,
fewer times.
Infant, and Early Childhood Home
Visiting Program
The results of both the Abecedarian study and
the Perry Preschool study confirm the causal Based on growing awareness of the significance
linkages shown both in the model from the of early childhood experiences on subsequent
ACE study included in figure 11.1 and in the development, with direct consequences for edu-
model proposed by Adler and Snibbe shown in cational attainment, health risk behaviors, and
figure 11.3. Many chronic disease risks and the well-being during adulthood, the medical and
behaviors that contribute to them are, to a sub- public health communities have been paying in-
stantial degree, the consequence of the cir- creasing attention to developing programs to
cumstances in which a child was raised. Those identify children at risk for ACEs based on
raised in supportive, socioeconomically advan- family structure and dynamics. Consistent with
taged circumstances are more likely to develop the findings of the Abecedarian study, substan-
early cognitive abilities that are conducive to tial emphasis has been given to developing early
educational success. These abilities, in combi- intervention programs, many beginning at or
nation with the personality and motivational even before birth, to mitigate the effects of an
characteristics of the child as he or she moves adverse home environment. Many of these ef-
through adolescence into adulthood, will be as- forts involve a home visitor, often a nurse or
sociated with behavioral patterns that are con- other trained professional, who meets the par-
ducive to continued educational success and to ents in the home context to provide education,
the reduced risk for chronic illness associated support, and counseling to the family. Some of
with that success. By contrast, those children these are also linked to preschool programs.
Howard and Brookes-Gunn (2009) reviewed demic achievement than the control group who
the outcomes from a range of home-visitor pro- did not receive the check-ups, leading the authors
grams, mostly targeting children born into to conclude that “a brief, parenting-focused inter-
families at risk for abuse or other adverse par- vention during early childhood may be a v iable
enting behaviors. From this review, the authors strategy to prevent at-risk children from develop-
were able to conclude that “evidence is mount- ing behavior problems and low academic achieve-
ing that these programs can positively alter par- ment at school age” (p. 769).
enting practices and, to a lesser extent, children’s In 2009, the American Academy of Pediatrics
cognitive development” (p. 138). The mixed out- published a report developed by its Council on
comes in affecting children’s cognitive develop- Community Pediatrics about the role of early
ment may have been due to the heterogeneity of childhood programs that involve home visitors.
the program designs and the fact that relatively Based on the council’s review of the available
few of these programs included high-quality evidence, it concluded that “Home-visiting pro-
day care that emphasized language and cogni- grams offer a mechanism for ensuring that at-
tive development. risk families have social support, linkage with
Brennan et al. (2013) looked specifically at public and private community ser vices, and
the potential benefit of working with the par- ongoing health, developmental, and safety edu-
ents of young children born into circumstances cation. When these services are part of a system
that placed them at high risk of developing of high-quality well-child care linked or inte-
future behavior problems. The authors based grated with the pediatric medical home, they
their study on previous research demonstrating have the potential to mitigate health and devel-
that “parenting practices during the early child- opmental outcome disparities” (p. 598).
hood period, when child regulatory strategies Largely in response to the growing body of
and problem-solving approaches are being es- evidence in support of the potential value of
tablished, [are] critical in setting up the cogni- home visitor programs, the Affordable Care Act
tive and behavioral foundations with which (ACA), signed into law by President Obama in
children enter school” (p. 763). 2010, included funding for a new national pro-
The authors identified 731 children in low- gram to expand the availability of and to evalu-
income, potentially high-risk families in three ate the effectiveness of home visitor programs
metropolitan areas: Pittsburgh, Pennsylvania, for mothers of young children in at-risk fami-
Eugene, Oregon, and Charlottesville, Virginia. lies. ACA amended Title V of the Social Security
When the children were 2 years old, approxi- Act to create the Maternal, Infant, and Early
mately half of the families were randomly Childhood Home Visiting Program, allocating
assigned to receive a series of “family check-ups,” $1.5 billion for fiscal years 2010–14 to be used by
in which a trained parenting consultant met with states, territories, and tribes to expand home
the primary caregiver of each child three times visiting programs.
over a period of a few weeks to discuss optimal ACA also created the Mo ther and Infant
approaches to parenting a young child, encourag- Home Visiting Program Evaluation (MIHOPE),
ing the caregiver to adopt what the researchers mandating that the federal Department of
referred to as a “positive behavior support” model Health and H uman Services initiate an ongoing
of parenting. The caregivers in the intervention assessment of the effectiveness of these pro-
group received a yearly family check-up when grams in several states and report the find-
their child was 2, 3, 4, and 5 years old. When they ings to Congress on a regular basis. The first
were assessed at ages 5 and 7.5, the children in the report was issued in January of 2015 (Michalo-
intervention group had significantly better aca- poulos et al. 2015). As described in this report,
MIHOPE has included four different models of sponsored an international scientific meeting
current home visiting programs in its analysis: titled “Biological Embedding of Early Social
Early Head Start—Home Based Program Op- Adversity: From Fruit Flies to Kindergartners.”
tion, Healthy Families America, Nurse-Family At that meeting, Michael Rutter of the Medical
Partnership, and Parents as Teachers. It selected Research Council of Kings College London
88 of these programs drawn from 12 states to summarized the issues facing developmental
include in its evaluation. scientists:
The initial report in 2015 provides data on
the demographics of the families served by these The starting point for the study of adverse
programs. Assessment of a ctual program out- experiences is that some have enduring
comes will come in later reports. The average consequences that continue after the period of
age of the women enrolled in the programs was exposure to the adversity. That raises four basic
23; 70 percent of these women were pregnant. issues: w hether social adversities can be
More than half of these pregnant w omen were considered homogeneous, w hether the crucial
under age 21. As would be expected based on effect lies in the ‘objective’ or subjectively
the risk selection, the participants in the study perceived ‘effective’ environment, w hether the
were disproportionately from a lower socioeco- effects are environmentally mediated, and
nomic position, with 92 percent receiving pub- whether the form of biological embedding
lic assistance such as cash welfare payments. involves psychological or health consequences.
More than 75 percent of the w omen in the (Rutter 2012, p. 17149)
study had not finished high school, and about
1 in 10 reported having been the victim of inti- While there is a great deal of information
mate partner violence. Consistent with these available about various aspects of the child de-
risk factors, more than 30 percent of the women velopment process, how development is af-
reported symptoms of depression. As might be fected by the environment in which a child is
also be expected based on these socioeconomic raised, how the outcomes of that process af-
characteristics, the sample is disproportionately fect educational attainment and other aspects
nonwhite: 34 percent are Hispanic, 31 percent of behavior, and how these in turn affect life-
black, and 25 percent white. time well-being, the questions Rutter poses
The report describes the principal out- have not yet been fully addressed. Given the
comes it will be assessing over time in these growing attention to the issue of human be
programs: parent and child health, child devel- havior and how it affects well-being, we can
opment, parenting skills, school readiness and expect to see important new data regarding
academic achievement, crime or domestic vio these issues becoming available in the next
lence, and family economic self-sufficiency. As several years. The research will be in the areas
future reports compare these outcomes among of biology, psychology, sociology, and other
the different program models, we will have a related disciplines. As I have suggested through-
stronger sense of which types of home visitor out this book, the most fruitful advances in
programs hold the most promise for future our understanding of these issues may come
investment. as a result of approaching the issue of h uman
behavior from a perspective that integrates
these traditionally distinct disciplines and
Looking to the future
by focusing on the early childhood experience
In December 2011, the Arthur M. Sackler Col- as perhaps the most appropriate time for
loquium of the National Academy of Sciences intervention.
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Index
acculturation: definition of, 61; associative learning, 84–85, 118–21 biological factors: that affect
ethnic differences in, 61; patterns attachment theory, 111–12 cognition, 138–48, 156–64; in the
of, 61; racial discrimination and, attention, 160–63 regulation of motivation, 84–85
62 attitudes, 89–92, 165–70 Birmingham Children’s March
active life expectancy: association attribution theory, 74–77; funda- (1963), 72
with disability level, 20; mental attribution error, 76–77 birth, premature, 13
definition of, 19 auditory cortex, role in the Blumenbach, Johan, definition of
Adler ladder of social position, 58 development of language, 123 races, 38
adolescence: cardiovascular disease auditory pathways in the brain, Bourdieu, Pierre, 68–69
in, 43; developmental changes in, 118–21 Bowlby, John, 111
164–70; and early childhood auditory processing, 118–19 brain: association cortex, 125–26;
intervention, 180–82 Austen Riggs mental health and behavior, 115–33; functional
Adverse Childhood Experiences treatment center, 101 units, 118; neural structure, 8;
(ACE): Score, 156; Study, 156, 173 axon, brain, 118; development of, plasticity, 8, 132; stages in
Adverse Childhood Experiences 122–24; myelination of, 123, neuronal development, 124;
(ACEs): and childhood IQ score, 127–29 structural arrangement, 117–21
177; impact on child development, Broca’s area, 120–23, 139
173–74 Bandura, Albert, 108 bystander effect, 77–78
Affordable Care Act, 116 behavior: affected by presence of
Ainsworth, Mary, 111 others, 77–79; association with capital, alternative forms of, 68–69
allostatic load: association with preventable deaths, 35; attribut- cardiovascular disease in adoles-
behaviors, 44; and cognitive ing, to persons or situations, cence, racial and ethnic inequal
development, 178; cultural 74–77; biological basis of, 115–32, ity in, 43
influences, 54; impact on 151–64, 173–79; brain and, 115–33; Carolina Abcedarian Project,
adolescent behavior, 178; impact cognition and, 134–49; core 180–82
on child development, 152; role of components, 5; definition of, 2; Carstensen, Laura, 92
hypothalamus, 131 environmental influences on, 63; Census, Canada, definition of races,
American Academy of Pediatrics, motivation and, 82–96; normative 39
155; Council on Community and non-normative, 48–65; parental Census Bureau, U.S.: definition of
Pediatrics, 184 influence on, 48; personality and, ethnicity, 6, 37; definition of
American Psychological Association, 97–112; racial discrimination and, races, 6, 37–38
97, 136; research on motivation, 85 63; social and cultural influences Center on Healthy, Resilient
amygdala, 130; function of, 118; on, 48–65; social group member- Children, 155
impact on executive function, ship, influence of, 68; social Centers for Disease Control and
159–61; impact on hippocampus, inequality and, 28–45, 151–70; Prevention, U.S. (CDCP), 173, 179;
159; over-activity as a conse- steps in the process of, 115; and components of well-being, 11;
quence of emotional stress, 159 well-b eing, 11–26 Health Disparities and Inequali-
anomie, definition of, 167 Big Five Factor Structure, 104 ties Report, 20, 30
Apted, Michael, 89 Big Five Inventory, 105 Centers for Medicare and Medicaid
arcuate fasiculus, 120–21, 139–40 Big Five personality traits, 8, 105–7; Services, U.S., 116
assimilation, 61 in different cultures, 106; ethnic central nervous system, 115–33
association cortex, 125–26 differences, 61 Childhood and Society (Erikson), 101
Association of American Medical biological basis of behavior, 115–32, cigarettes. See smoking cigarettes
Colleges (AAMC), xiv 151–64, 173–79 Civil Rights Act of 1964, 72
189
190 index
class, status, and power, 57–59, disability: association with Man, 102; stages of psychosocial
68–69 educational attainment, 30–31; development, 101–3
classical conditioning, 84 association with obesity, 32; Erikson, Joan, and the Ninth Stage
classifying psychological disorders, racial and ethnic inequality in, 31 of Man, 103
110–12 disability adjusted life year (DALY), ethnicity: definition of, 6, 37;
cognition, 134–49; critical periods in definition and use in measure differences in life expectancy
the development of, 143; ment, 18–19 by, 12
definition of, 136; development of, discrimination, racial, 59–61, 71–74 executive function: components of,
9; epigenetic influences on, 143; disorders, psychological, 110–12 160; definition of, 159–60;
learning to read, 138–40; social Duckworth, Angela, 107 development in early childhood,
transmission of, 142 Dunedin Study of self-control, 85 160; and the development of
cognitive development, stages of, Durkheim, Emile, 51 language, 161; and early school
137–43; compared to the stages of Dweck, Carol, theory of motivation, behavior, 162–63; and self-
psychosexual development, 100; 85–88 regulation, 162–63
in parallel to stages in neural extended mind theory, 143
development, 138 early childhood intervention, extinction training, 148
Committee on Integrating the impact on adolescent behavior,
Science of Early Childhood 180–82 family, role in the development of
Development, 151 early preschool, and educational identity, 62–65
conditioning, classical, 84 attainment, 180 fee-for-service (payment for medical
Conflict Theory, 50 economic capital, 68–69; association care), 34–35
Connor, Bull, 72 with social capital, 25 FirstGen (First Generation to
consciousness, 118, 136–38 economic inequality: and childhood College): definition of, 58;
cortex, brain: function of, 118; depression, 158; and cognitive response to educational
positioning of, over human development, 158–59; and early environment, 59, 70–71
evolution, 123 peer relationships, 158; and fixed-capacity mindset, 87
critical periods: in early child educational attainment, 152; and fixed entity response pattern of
development, 143; in neural hostile parenting, 157–58; impact motivation, 86
development, 9 on hippocampus, 157 flashbulb memories, 148
cultural capital, 68–69 educational attainment: association flipped classroom model of
cultural context, impact on with behaviors, 3; association teaching, xiv
behavior, 6 with health status, 40; association Freud, Sigmund, 9; criticisms of
Cultural Cycle, the, 48 with parents’ level of education, theories of, 103–4; stages of
cultural institutions, 50 3, 34; association with well-being, psychosexual development,
cultural mismatch, response to 28; and behavior, 152; and the 98–101
educational environment, 71 home environment, 168; and functionalism. See structural
culture, 48–65; and behavior, 48, 52; parental educational attainment, functionalism
definition of, 51; and response to 3, 34, 168–69; parental influence fundamental attribution error, 76–77
stressful circumstances, 53; and on, 92; racial and ethnic
social groups, 51–54, 62–65 inequality in, 33; and time gender: differences in life expectancy
perspective, 91–92 by, 12; and negotiation style, 55;
death, preventable: association with effects of stress on psychological as a status characteristic, 72; and
behaviors, 17; association with functions, 130–32, 148–49, 151–70. STEM education, 55–57; and views
smoking cigarettes, 29; behavioral See also stress, emotional of the self, 54–55
contributions, 1 ego, 99 genetic differences, association with
demographics, US: changes in Eight Ages of Man, 102 racial categories, 38–39
population distribution, 39–40; embryonic development of neural Genovese, Kitty, 77–78
demographic shifts and social system, 121–26 Gilligan, Carol, theory of psycho-
change, 39–45; demographic emotion, 118, 130–31, 148–49; and the logical development of women,
structure of society, 28–40 autonomic nervous system, 130–32; 103–4
dendrite, brain, development of, role of amygdala in, 118, 130 glial cell, 128
122–24 emotional memories, 148–49 Glover, Danny, 73
developmental changes in epigenetics, 9; changes caused by gray matter, brain, 123–25
adolescence, 164–70 stressful experiences, 154; impact grit, 107–8
Diagnostic and Statistical Manual of on neural development, 143 group decision-making processes,
Mental Disorders (DSM), 110; epigenome, 154 77–79
categories of mental illness in Erikson, Erik, 8, 95; criticisms of his group identity, impact on behavior, 7
DSM-5, 111 theories, 103–4; Eight Ages of growth cone of neuron, 122–24
index 191
health care disparities, 34–36 Institute of Medicine of the Medicare, 35

Healthcare.gov, 116 National Academy of Sciences memory, 143–49; declarative and
health disparities, 28–45; toxic (IOM), 151–52; workshop on non-declarative, 144; impact of
stress as a cause of, 155 preventable deaths, 17 emotional stress on, 148–49; and
Health Disparities and Inequalities institutions, social and cultural, 50 learning, 146–49; long-term, 145;
Report, U.S. Centers for Disease interventions to enhance well- playing a musical instrument and,
Control and Prevention, 20 being, 9, 173–85 147; post-traumatic stress disorder
health insurance, uninsured and, 148; role of amygdala, 148;
rate, U.S., 35 Kahneman, Daniel, 145–46 role of hippocampus, 118, 147;
health status, 11 Kawachi, Ichiro, 22 storage, types of, 143–49; System 1
health status, self-reported: and System 2, 145–46; “thinking
association with disability level, language, 118–21, 135–41; cognitive fast and thinking slow,” 145;
21; association with educational development of, 135–36; working, 145
attainment, 21, 30–32; association development of, 119–21, 138–41; mental illness, 110–12; categories in
with obesity, 32; association with development in Hispanic the DSM-5, 111; genetic origins of,
quality of life, 22; categories, 20; children, 135–36; and educational 111
of children and adolescents, 21; attainment, 139; influence on Mischel, Walter, 4, 82
gender differences in, 30; racial cognition, 138–41; socioeconomic mortality rate: association with
and ethnic inequality in, 30 inequality in the development of, educational attainment, 29; racial
hearing, 118 119, 135–36 and ethnic inequality in, 29, 31
helpless response pattern of learning, observational, 85–88, motivation, and behavior, 7, 82–96
motivation, 86 108–10 multiculturalism, 61–62
hierarchy of needs, 7, 93–95 life expectancy: at birth, 12; at age myelination process, neuronal,
High/Scope Perry Preschool study, twenty-five, 14; at age sixty-five, 127–29
182–83 15; association with behaviors,
hippocampus, 130; and the 18; association with educational National Research Council, 151
development of cognitive control, attainment, 14–15, 28–29; National Scientific Council on the
156; function of, 118; impact of differences by gender, 12, 14–15; Developing Child, 153
emotional stress on, 49; role in free of activity limitations, 30; networks. See social networks
the formation of memory, 147 as a measure of well-being, 5; neural impulses, as a basis of
Hispanic paradox, 43 racial and ethnic inequality in, behavior, 115
home visitor programs, 183–85 28–40 neural system, embryonic
hostile parenting, impact on Linnaeus, Carl, definition of races, 38 development of, 121–26
hippocampus of child, 157 Locke, Edwin, 84 neuroblasts, 121
human genome, x iv Lodge, Henry Cabot, comments on neuron: conduction of impulse,
hypothalamic-pituitary-adrenal race (1897), 59 126–27; embryonic development,
(HPA) axis, 131 long-term memory, 145 122–24
hypothalamus, 131 low birth weight: association with neurosis, definition of, 110
mother’s place of birth, 42–43; newborn’s perception of speech, 4
id, 99 racial and ethnic inequality in, nodes of Ranvier, 128
identity: formation of, 97–110; social, 41–42 normative and non-normative
definition of, 67–68; and social behavior, 48–65
group membership, 67 malleable model of intelligence, 87
Implicit Association Test (IAT), 73 marshmallow study (Mischel), 4, obesity: association with disability
impulse conduction, neuronal, 82–88 level, 32; childhood, 63, 64; racial
126–27; and the nodes of Ranvier, Marx, Karl, 50 and ethnic inequality in, 36
128 Maslow, Abraham, 7, 93 observational learning, 85–88,
inequality, 5–6; gender, 6; status, mastery response pattern of 108–10
7; and stressful childhood motivation, 86 Office of Management and
experiences, 9. See also economic mathematical ability, neural Budget, U.S., definition of races, 38
inequality; racial/ethnic inequal structure of, 141–42 olfactory pathways in the brain, 118
ity; social inequality Mead, George Herbert, 51 oligodendrocyte, 128
infant mortality: association with Medicaid, 35 online learning, xiv
behaviors, 13; association with medical care: association with operant conditioning, 85
low birth weight, 41; by race of preventable deaths, 35; racial and Organization for Economic
mother, 13; racial and ethnic ethnic inequality in, 34–35 Co-operation and Development
inequality in, 36; rate in the Medical College Admissions Test (OECD), life expectancy in
United States, 13 (MCAT), xiv–xv member states, 16
192 index
parental influence on behavior, 48 and housing quality, 174; impact social identity, definition of, 67–68
parenting style, impact on child on adolescent behavior, 166–67; social impact theory, 78–79
development, 157 life expectancy and, 28–31; and social inequality, 151–70; and
Pavlov, Ivan, 84 perceived self-efficacy, 167; and behavior, 151–52; and the
perception, 130–32 perceptions of anomie, 167; and development of cognitive control,
personality, 8, 97–112; and behavior, well-being, 175 156; and early language develop-
97–110; cultural influences on , 52; racial segregation, residential, ment, 156; impact on adolescent
definition of, 52, 97; disorders of, association with preventable behavior, 164–66; and well-being,
110–12; early childhood and adult deaths, 36 151, 175
well-being, 175–76; lexical racial stereot ypes, contribution to social institutions, 50
approach to, 104 inequality, 6 social interactions and behavior, 49,
Piaget, Jean: criticisms of theories reading ability, neural structure of, 51–59, 62–65
of, 103–4; stages of cognitive 139–40 socialization, 48–50, 61–65, 67–71
development, 100, 137–43 social loafing, 78–79
plasticity, of the human brain, 132, segregation, racial, 36 social networks: association with
155 self, concept of the: cultural social capital, 22, 24; association
post-traumatic stress disorder influences, 52–53; independent with well-being, 23; and behavior,
(PTSD), 148 view of, 52; interdependent view 49; impact on adolescent
praise, patterns of: gender of, 52; racial differences in, 60; behavior, 165; as a measure of
differences, 88; impact on socioeconomic differences, 57 well-being, 5; proximal vs. distal,
motivation, 87–88 self-actualization, 7 62–63; and smoking, 62; and
prejudice and bias, 59–61, 71–74 self-concept and identity, 48–65, social capital, 68–69
premature birth: association with 67–74, 104–10 socio-emotional selectivity theory,
behaviors, 13; association with self-control, 8 5 92
maternal smoking, 13 self-efficacy, 108–10; definition of, sociology, definition of, 2
prenatal development, 121–26 108; and educational attainment, spatial inequality, 28–45, 151–70
Program in Human Biology, 110; racial/ethnic differences in, speech, newborn’s perception of, 4
Stanford University, xiii 167 stages of identity development,
psychological disorders, 110–12 self-presentation and interacting 98–104
psychology, definition of, 2 with others, 62–65, 165–68 Stanford-Binet intelligence scale,
psychosexual development, 8; senses, human, 118 107
compared to Erikson’s stages of sensory processing, 115–21 status characteristics theory, 69–72
psychosocial development, 101; smell, sense of, 118 STEM education (science, technol-
compared to Piaget’s stages of smoking cigarettes: association with ogy, engineering, mathematics):
cognitive development, 100; educational attainment, 3; gender differences, 55–57; racial
stages of, 99–101 association with preventable differences, 60
psychosis, definition of, 110 deaths, 36–37; as a cause of stereot ype bias: in medical care, 73;
psychosocial development, preventable deaths, 29; gender taxi drivers’ use of, 73
compared to Freud’s stages of differences, 3; health risks, 2; stereot ype threat, 71, 73–74
psychosexual development, 101 impact of social networks on, stress, emotional, 148–49, 153,
62–63; racial and ethnic inequal 162–64; types of, 153. See also
Quality Adjusted Life Year (QALY), ity in, 36–37; racial discrimination effects of stress on psychological
definition and use in measure and, 63 functions; toxic stress
ment, 20–21 social anomie, 44 structural functionalism, 51
quality of life: association with social behavior, 51–57 superego, 99
self-reported health status, 22; as social capital, 68–69; association symbolic interaction, 51
a measure of well-being, 5 with behaviors, 24; association synaptic connections in memory
with economic capital, 25; and learning, 126–32
race: definitions of, 38; differences association with social networks, synaptic transmission, 129–30
in life expectancy by, 12; as 22, 24
physical appearance, 59; and social class, 24–25, 57–59, 68–71 task motivation theory, 84–85
social status, 59–60 social-cognitive approach to taste, sense of, 118
racial discrimination: conscious vs. motivation, 85 Terman, Lewis, 107, 175
unconscious, 60; extrinsic, 72; social cognitive theory, 75–79 thalamus, 130
forms of, 72–73 social construction of race, 39 theories: of attitude and behavioral
racial/ethnic inequality, 5–6; and social group: group membership change, 85–88, 107–10; of
behavior, 174–75; and early and identity, 67; influence on developmental stages, 98–104,
cardiovascular disease, 167–68; behavior, 68; status ranking, 68 138–43; of social structure, 48–54
index 193
thinking fast and thinking slow, hippocampus, 154; intergenera- measured as quality of life, 5;
145 tional transfer of impacts, 154 measured as strength of social
Three Essays on the Theory of Sexuality networks, 5
(Freud), 98, 101 Up Series documentaries, 89–90 Wernicke’s area, 120–23, 139
time perspective, theory of, 8, Whitehall Study, 32–33
89–92, 165; and educational vision, 118 white matter, brain, 123–25
attainment, 169 visual cortex, role of in the working memory, 145
touch, sense of, 118 development of language, 123 World Health Organization (WHO),
Tough, Paul, 97 Vygotsky, Lev, 1 43 173, 179; Disability Adjusted Life
toxic stress: and cognitive Year (DALY) measure, 18; Global
development, 178–79; early well-being: association with Burden of Disease study, 16, 19
childhood interventions to behaviors, 1, 28; measured as life
reduce, 155; impact on adolescent expectancy, 5, 12; measured as Zimbardo, Philip: prison experi-
behavior, 164–66; impact on child overall health status, 11; measured ment, 90; Time Perspective
development, 153–55; impact on as preventable deaths, 5; Inventory, 91

Intro To BioSocial Medicine

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Introduction to

Donald A. Barr, MD, PhD

JOHNS HOPKINS UNIVERSITY PRESS

Johns Hopkins University Press

Library of Congress Cataloging-­in-­Publication Data

Barr, Donald A., author.

Figures 8.3, 8.5, 8.6, 8.7, 8.8, 8.11, 8.12 by Jacqueline Schaffer

Johns Hopkins University Press uses environmentally friendly book materials,

chapter 1 • Understanding ­Human Be­hav­ior 1

c h a p t e r 2 • Be­hav­ior and Well-­Being 11

c h a p t e r 3 • Inequality and Well-­Being 28

c h a p t e r 4 • Society, Culture, and Be­hav­ior 48

c h a p t e r 5 • Identity and Be­hav­ior 67

c h a p t e r 6 • Motivation and Be­hav­ior 82

Time perspective and the Up Series children 89

c h a p t e r 7 • Personality, Be­hav­ior, and Well-­Being 97

c h a p t e r 8 • The Brain and Be­hav­ior 115

c h a p t e r 9 • Cognition, Be­hav­ior, and Well-­Being 134

c h a p t e r 1 0 • Social In­e­qual­ity, Childhood Experiences,

The added impact of minority race 166

c h a p t e r 1 1 • Understanding Well-­Being and the Interventions

We know now that the found­ers of ­Human Biology ­were pre-

of most applicants to medical school in the United States. The epi-

1 Understanding ­Human Be­hav­ior

The need to understand ­human be­hav­ior

standing. I intend the book to be used as part

Figure 1.1. Percentage of Persons Age ≥18 Years Who Were Current Smokers,

association between smoking prevalence and If education is so closely linked to behaviors

­ ere 48. They looked at a range of factors during

1. our perception of external stimuli;

among the growing number of Hispanics in

biological and psychological factors. Feeling

situations learn to read at ­different rates, imply-

Danaei, G., Ding, E. L., Mozaffarian, D., et al. 2009. The

2 Be­hav­ior and Well-­Being

Researchers have identified links between be­hav­ior and many of

We should note that life expectancy is re-

Figure 2.1. Life Expectancy at Birth in the United States by Gender and

at age 65 between those with the lowest levels

No high school diploma High school diploma

Figure 2.3. Life Expectancy in the United States at Age 65 by Gender, Race/Ethnicity,

No high school diploma High school diploma

Health behaviors such Reduced life

Figure 2.5. Educational Attainment, Health Risk Behaviors, and Preventable

­T able 2 .1 . Definition and Weighting of Levels of Disability Used to

1 .096 Limited ability to perform at least one activity in one of

­ ere lower f­ amily socioeconomic position and

assessment tool. Study participants with larger

3 In­e­qual­ity and Well-­Being

Racial and ethnic in­e­qual­ity in health in association

Hispanic female White female Hispanic male

Life expectancy at birth (years) 90

Highest level of education attained by age 25

Figure 3.2. Percentage of Adults in the United States Reporting “Fair” or “Poor”

Figure 3.3. Percentage of Adults in the United States Reporting “Fair” or “Poor”

No high school diploma High school diploma

Figure 3.4. Educational Attainment in the United States of Adults Age 25 or Older,

­Tabl e 3.1 . Children in the United States, Age 6–18,

Mo­ther 4.6 12.9 14.6 39.3 19.4

Library of Congress Cataloging-in-Publication Data

chapter 1 • Understanding Human Behavior 1

c h a p t e r 2 • Behavior and Well-Being 11

c h a p t e r 3 • Inequality and Well-Being 28

c h a p t e r 4 • Society, Culture, and Behavior 48

c h a p t e r 5 • Identity and Behavior 67

c h a p t e r 6 • Motivation and Behavior 82

c h a p t e r 7 • Personality, Behavior, and Well-Being 97

c h a p t e r 8 • The Brain and Behavior 115

c h a p t e r 9 • Cognition, Behavior, and Well-Being 134

c h a p t e r 1 0 • Social Inequality, Childhood Experiences,

c h a p t e r 1 1 • Understanding Well-Being and the Interventions

We know now that the founders of Human Biology were pre-

1 Understanding Human Behavior

The need to understand human behavior

ere 48. They looked at a range of factors during

situations learn to read at different rates, imply-

2 Behavior and Well-Being

Researchers have identified links between behavior and many of

T able 2 .1 . Definition and Weighting of Levels of Disability Used to

ere lower f amily socioeconomic position and

3 Inequality and Well-Being

Racial and ethnic inequality in health in association

Tabl e 3.1 . Children in the United States, Age 6–18,

Mother 4.6 12.9 14.6 39.3 19.4

Figure 3.5. Economic and Racial/Ethnic Inequality as Precursors of Educational

T abl e 3.2 . Annual Estimates of the Resident Population

and 2009–2010. Morbidity and Mortality Weekly Rosenberg, N. A. 2011. A population-genetic perspec-

/pages/productview.xhtml?src=b kmk, accessed disparities in health. Public Health Reports 116:

4 Society, Culture, and Behavior

T abl e 4.1 . The Key Differences between an Independent and

T able 4.2 . Comparing Soft and Hard Individualisms in Manhattan and Queens

Individualism means Emotional expression, creativity, Emotional control, self-reliance,

go on to college. Independent of family, if an experienced discrimination were significantly

Figure 4.2. The Cycle of Behavior. Based on Mead et al. 2014.

5 Identity and Behavior

of an individual’s self-image that derive from

insight that people’s different backgrounds from a disadvantaged socioeconomic or racial

observers were sometimes part of the experi-

6 Motivation and Behavior

them to u nderlying psychological processes” pabilities as being fixed and unchangeable. A

asn’t thinking much about the future. Her at-

need for safety is present for adults as well.

T able 7. 1 . Comparison of Piaget’s Stages of Cognitive Development with Freud’s

Tabl e 7.3. The Big Five Personality Traits

T able 7.4. Categories of M ental Illnesses Scientists as well have psychotherapists have

themselves in marital problems and trou ble

8 The Brain and Behavior

Figure 8.2. Healthcare.gov: From the Inside Looking Out

Figure 8.6. The Stages in the Development of a Neuron in the Human Brain