Early antecedents of adult health.

Abstract

major of morbidity and mortality in this country. Many of the signal discoveries made possible by risk factor epidemiology concern the behaviors or characteristics of adults and their relationship to the risk of ill health in later life. Examples include the relations of smoking to lung cancer, diet to heart disease, and estrogen to osteoporosis. The methodology used to explore these relationships, generally involving the measurement of risk factors and outcomes at the individual level, has greatly advanced over this same era. 2 At the same time, these methods have often limited the inquiries of epidemiologists to questions that, while important, do not address the full range of important determinants of human health and disease. In the hope of overcoming such limitations while retaining the strengths of risk factor epidemiology, epidemiologists have begun to branch out in other directions. One dimension in which the field is expanding is in the level or unit of analysis. 1~ Epidemiologists have, for example, increasingly brought skills to collaborative ventures that examine of ill health at the genetic, biochemical, or cellular level. At the other end of this spectrum is work such as that presented by Dr. Kaplan in this volume, which examines the social of ill health. These social factors may operate as causes of causes'--that is, they may be mediated by the individuaMevel behaviors they influence. Alternatively, it has been proposed that social determinants of health may have a more direct effect on health, mediated, for example, by stress-induced changes in neuroendocrine systems. The key point is that, insofar as our methods of inquiry have focused