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Tracing back success

How early childhood factors can impact adult function

By Sylvia Wrobel | Illustration by Stuart Bradford

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Why are some people able to get and hold on to a good job and some are not? Why can some people maintain a successful marriage and others can’t? Why do some people cultivate a wide, supportive network of friends and others don’t?

Dr. Aryeh Stein believes the answers can be found in a person’s very earliest experiences. What happens during gestation and early childhood not only affects growth and health, Stein contends, but also shapes susceptibility and resilience, affecting a person’s chances of success or failure in adulthood.

A professor in Rollins’ Hubert Department of Global Health (with a joint appointment in the department of epidemiology), Stein has spent his career trying to understand how early experiences influence adult outcomes. He started with nutrition, including studies of children conceived or born during the Dutch famine—“the hunger winter”—that took place in the German-occupied part of the Netherlands near the end of World War II, when daily food intake fell as low as 500 calories. When these famine babies were in their 50s and 60s, Stein collected data on hundreds of them. Compared with siblings not exposed to famine during gestation, they were more likely to be overweight and to have diabetes.

Stein has retained an interest in nutrition and related factors, but he has become increasingly interested in the larger question of how interrelationships between a wide range of early experiences and socioeconomic circumstances influence not only growth and health, but also other traits. These traits include determination and resilience in the face of setbacks; sticktoitiveness such as staying in school; and human capital outcomes such as finishing high school, successfully getting and holding a decent job, marrying, and having a family. Which early factors and interrelationships predict failure? When and where are leverage points that could shift the odds toward successes?

This year, Stein is starting to look for answers in a study of the life trajectories of more than 6,000 adults.

As principal investigator, he heads a six-country team, including psychiatrists, psychologists, epidemiologists, data analysts, interviewers, and students. What makes his ambitious study possible—in addition to teamwork and a $3.7 million grant from the Bill & Melinda Gates Foundation—is COHORTS: the Consortium on Health Outcomes Research in Transitioning Societies. Combining birth cohort studies from Brazil, Guatemala, India, the Philippines, and South Africa, COHORTS has amassed more than 8,000 life trajectories, beginning with measures of babies’ weight, length, gestational age, and APGAR scores. Parents’ socioeconomic status was determined by quantifiable factors: Years of schooling. Owning a refrigerator, car, or bicycle. A house made of concrete or adobe. A floor of mud, concrete, or tile. As the children grew up, cohort investigators measured their cognitive functioning (thinking, learning, memory abilities) as well as their linguistic and social development.

Stein’s team is taking that wealth of existing data from the cohorts in Guatemala, the Philippines, and South Africa and collecting new data on participants, now in their late-20s to mid-40s. (The Brazil cohort also is contributing its existing data.)

illustration of growth chart

This will not be Stein’s first work with COHORTS. The opportunity to work with the Guatemala cohort was what brought him to Emory in the first place. That study involved improving nutrition in two villages, then comparing children’s growth and cognitive development to those of children in similar villages but without interventions. The principal investigator of the study at the time was Dr. Reynaldo Martorell, Robert W. Woodruff Professor of International Nutrition, internationally known for his own research on maternal and child nutrition. In 1998, Martorell recruited Stein to join Rollins.


What’s unusual about Stein’s study is the focus on low- to middle-income countries, where 80 percent of the world’s population lives, including the majority of children with unreached potential. He is focusing on the potential impact of early circumstances on both cognitive functioning and executive functioning (the ability to approach, stay focused on, and successfully execute the tasks of adult life) and how the interaction of these lead to their success as adults.

“In addition to collecting measures of brain and brawn,” says Stein, “we have created measures of what we call ‘grit,’ and we are asking how these traits interact. If you have a lot of brain but less brawn, or vice versa, can you compensate? How does having grit—dedication—affect outcomes regardless of the other two?”

Stein believes the three-year study will leave investigators better able to quantify relationships between early life potential and adult achievements, taking into account differences in cultures and genders. Understanding how interactions predict outcomes may identify leverage points in childhood where interventions will have the most impact, possibly—hopefully—resulting in more successful, resilient adults.

Related Article

"Rollins researcher receives $3.7 million from the Bill & Melinda Gates Foundation to study how childhood factors can impact adult function" (Press Release, 5/16/17)

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