Table 1.
Domains of influence | Levels of influence | ||
---|---|---|---|
Individual | Family/Interpersonal | Community/Society | |
Biological | Genome-wide genotypes; metabolome, RNA, biomarkers of folate, B12, Vitamin D | Maternal and child health | Immunization, prenatal screening (AFP, hCG, estriol), |
Behavioral | Smoking, alcohol, opioids, marijuana, cocaine, stress, mental health | Marital status, household composition, support of partner, family, and friends; smokers in the household; mental health, sleep/wake patterns | Witness of violence, rate of crime, smoking, alcohol, drug use, incarceration |
Nutritional | Dietary patterns, beverage consumption, receipt of WIC, food stamps, | Cultural food preference | Grocery stores, farmer’s market access, fast food restaurants, health statistics by zip codes, rate of obesity, diabetes |
Environment | Exposure to ambient and indoor air pollution, fuel type, old housing, indoor pests, household pets, carpet, molds | Family income, country of origin, immigration, ability to speak English, receipt of public assistance, WIC, employment, access to technology | Disinvested and marginalized neighborhoods, race and ethnicity (self-reported), green space, built environment, public schools, parks, highways, transportation availability, neighborhood crime rates |
Health care | Prenatal and delivery care; lab tests, BMI, BP, diagnoses, medications, services | Type of insurance, type and frequency of clinical visits, age, parity, child with special health care needs | Type and completeness of recommended preventive care, zip code level morbidity and mortality |
Sources of data | Questionnaires, medical records, study visits, lab tests, biosample/biomarkers | Questionnaires, medical records, lab tests, study visits, biosample/biomarkers | Census data, vital statistics, police crime reports, GPS, air monitors |
WIC, women, infant and children’s supplemental nutrition program; AFP, alpha-fetoprotein; hCG, human chorionic gonadotropin; GPS, global positioning system