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Does perception matter?

At Concordia’s Pediatric Public Health Psychology Laboratory, Jennifer McGrath and her team are discovering that childhood factors can lead to adult health issues.
September 23, 2015
By Simona Rabinovitch

Can young children’s self-perception of where they fit in the world affect their health in later years? The answer just might be yes.

Jennifer McGrath Jennifer McGrath’s research has made headlines in the Montreal Gazette andTime magazine.

According to Jennifer McGrath, associate professor in Concordia’s Department of Psychology and director of its Pediatric Public Health Psychology (PPHP) Laboratory, when it comes to certain adult health outcomes, a child’s understanding of his or her social and economic status may prove to be a more significant factor than the reality, past or present. “We look at several health behaviours and health risks during childhood; that’s often when lifestyle behaviours are established,” says McGrath.

She and her collaborators from Montreal and around the world study the impact of unequal incomes on health. McGrath, also principal member of the university’s Centre for Clinical Research in Health, is distinguished for her innovative interdisciplinary approach and statistical modelling expertise.

“There’s fascinating work demonstrating that even if your socioeconomic status changes over time, behaviours and phenomena get ingrained during childhood,” she says. “Low socioeconomic status during early childhood not only affects child health, it jeopardizes future health.”

McGrath looks to untangle how self-perception may relate to health status. For example, a child who feels inferior, isolated or low on the playground’s totem pole may perceive him- or herself in a manner that could foreshadow cardiovascular disease or other future health issues –– even if the child lives in a supportive, upper-middle-class environment. “There is in fact work that suggests your perception matters more than objective measures,” she says.

Much funded

Jennifer McGrath Jennifer McGrath (right), director of Concordia’s pediatric public health psychology laboratory, is among the top five per cent of funded researchers in Canada.

The American-born McGrath earned her PhD from Bowling Green State University in Ohio. She then earned a Master's of Public Health while completing her postdoctoral fellowship at the University of Pittsburgh in Pennsylvania. Most recently, she was awarded the inaugural PERFORM Chair in Childhood Preventive Health and Data Science. McGrath has published more than 40 peer-reviewed articles and with her students has presented at over 100 conferences. She also won the Canadian Psychology Association’s Mentorship Award in 2009 and was recently nominated to the Royal Society of Canada College of New Scholars, Artists and Scientists.

Her funding success is an achievement in itself –– more than $11.3 million since she first arrived at Concordia in 2004. McGrath is the principal investigator of four grants from the Canadian Institutes of Health Research (CIHR) worth over $7 million in funding, and a co-investigator of six other grants totalling over $3 million –– placing her in Canada’s top five per cent of funded researchers.

She’s also a passionate teacher, as described by Simon Racicot, MA 08, PhD 14, who was McGrath’s graduate student between 2006 and 2014 and a co-investigator on the AdoQuest II Cohort (see the sidebar: “Pediatric Public Health Psychology Laboratory research”). Racicot’s dissertation examined how adolescents exposed to second-hand smoke are more vulnerable to becoming smokers due not only to observation, he explains, but exposure to airborne nicotine.

“She was very dynamic, motivated and thrilled about her research projects,” recalls Racicot, now a clinical psychologist at Montreal’s St. Mary’s Hospital. “She was also a very good communicator. The rigour and critical mind I developed in the PPHP Lab have really helped me be a good clinician, and I carry its work ethics and methodology wherever I go.”

At the PPHP Lab, three major projects are currently underway, each funded by a different CIHR grant. “Each project shares the idea of looking at cardiovascular risks in kids, but they’re focusing on aspects in a unique way that makes each quite distinct,” McGrath says.

Sleep monitors Research at the pediatric public health psychology laboratory includes using sleep monitors, like the one pictured above, to monitor connections between childhood stress and shorter sleep duration.

Certainly, socioeconomic inequality is a significant global health issue. According to McGrath, four million Canadians (or more than 11 per cent of the population) report before-tax incomes that fall below a threshold used by Statistics Canada called the Low Income Cut-Off.

It’s been demonstrated that children raised in poor environments are more likely to develop high blood pressure and cholesterol and be overweight. And recent studies show one’s early childhood socioeconomic status is better at predicting cardiovascular disease and premature mortality than adult socioeconomic level.

An advocate of interdisciplinary research and admirer of McGrath’s work, Concordia professor and political economist Marguerite Mendell, BA 72, also speaks to the correlation between low income and poor health. “I’ve been working for many years on the social economy and ways to engage citizens in initiatives that will improve their lives, reduce income inequality and generate economic well-being –– as opposed to the dominant preoccupation with economic growth,” says Mendell, graduate program director at Concordia’s School of Community and Public Affairs.

Ultimately, the big question linking much of McGrath’s current research is, “How does socioeconomic status get under the skin? The work we’re doing shows that it’s likely through the stress-
response pathways,” she reports.

As part of her dissertation, McGrath’s former PhD student Elizabeth Quon, MA 10, PhD 14, examined associations between societal income inequality and adolescent health. Quon, now a psychologist at the IWK Health Centre in Halifax, says McGrath taught her the importance of interdisciplinary research and the unique contributions psychology researchers can make in epidemiology, health policy and medicine. “Specifically, our research together focused on the subjective experience of socioeconomic status,” she says.

“We were curious about the effects of income inequality on lifestyle factors and health behaviours associated with cardiovascular disease, like physical activity, smoking, obesity and sleep problems,” says McGrath. Using population-based studies in Quebec and Canada, they found that family socioeconomic status indicators –– lower household income and parental education –– “were linked to sedentary behaviour, breakfast skipping, cigarette and alcohol use, as well as aggression, low self-esteem and hyperactivity.” She adds that income inequality was associated with “more injuries, headaches, stomach aches, backaches, and physical or emotional conditions that limited activities at home and school.”

Power of perception

From Brazilian ghettos to the penthouses of Manhattan’s Upper East Side, McGrath has also discovered that in most communities, rich or poor, you’ll find some people who rank themselves as higher status, some lower and some in-between. Like many other researchers, to measure this relative status she uses a “subjective socioeconomic status measuring tool” that is, simply, a 10-rung ladder. Each person marks where on the ladder he or she thinks they fall compared to others in society.

McGrath recalls research she conducted as an intern in New York City. “There were people who were so well off they had private jets, yet I remember one child thought they were not well-to-do because they didn’t also have a helicopter. It was really striking.”

In contrast, in 2010 McGrath visited Brazil for the annual meeting of the International Network of Research in Inequalities in Child Health. “We had a chance to witness the dire slums of Brazil,” she recalls. “It’s a sea of makeshift homes made with corrugated cardboard and plywood, crowded and covered with dirt and mud.”

At a conference later that year, McGrath met a researcher who had gotten people from these slums to complete the 10-rung ladder test. “I was struck by the results and by the resilience of these individuals, who by all standards would meet extreme poverty criteria yet ranked themselves across the entire ladder, characteristic of the typical ‘bell curve’ often found in social sciences.”

Inspiration struck. She says: “What was it about some of these individuals who could look around them, amid the disorder, uncleanliness, laundry lines and broken windows, and still believe they were better off than others? This was a human phenomenon in which their happiness and well-being transcended their material goods. What was behind this? What is it about one’s perception of status that seems to trump objective socioeconomic status? And how might this help us better understand –– and level –– socioeconomic gradients in health?”

The link between social inequality and health is also a research topic of Richard Wilkinson and Kate Pickett. On June 26, the British authors of The Spirit Level: Why Equality Is Better for Everyone and co-founders of the Equality Trust spoke at Concordia’s International Network for Research on Inequalities in Child Health Workshop, hosted by McGrath.

“The most important sources of chronic stress seem to be those worries about how you’re seen and judged,” says Wilkinson, professor emeritus of Social Epidemiology at the University of Nottingham Medical School. He regards social status, friendship and early childhood as key factors in long-term health. “Those three factors are, in a way, all about whether you’re valued or not,” he says. “Studies show that what really pushes up levels of stress hormones are situations where there is a strong ‘social evaluative threat’: threats to self-esteem or social status where you can be judged negatively by others.”

McGrath’s data supports the value of social capital — the social connection one has with his or her neighbourhood and environment. “Having a community you feel connected to, and you’re part of that community, is critical to well-being,” she says.

Environment matters

While our individual health choices certainly make an impact, McGrath’s findings also demonstrate the significance of social factors. During her postdoctoral training at the University of Pittsburgh, McGrath understood that making healthy choices can be challenging “when inequalities are ingrained or sustained.”

To supplement her stipend, she worked for a mental health service that provided help to low-income families in their homes. “The gap of the economic and social patterning in Pittsburgh was remarkable, with neighbourhoods that were extremely wealthy or extremely poor,” she says. “I was assigned a case in the Hill District, a poor, high-crime neighbourhood with most properties vacant, covered with graffiti, windows boarded up, broken glass and abandoned cars missing removable parts.” In the home, she reports, “I needed to start at a very practical level. Dinner was often McDonald’s or popsicle squeeze tubes.”

One day, as she was leaving for another appointment, “I asked where I could get take-out, or pick up some food,” she says. “And this is what struck me most: they explained that I could choose from hot dogs at the corner store –– the ones rotating on the metal cylinders covered in oil, but if I wanted other food I would need to drive to another store.”

Since nobody had cars, McGrath asked how they got food. “They took three buses to a grocery store that had awful produce and that was extremely expensive. It made real sense why no one would go through that much effort to get healthy food when the environment around them made it difficult to make healthy choices regarding lifestyle behaviours.” McGrath will be investigating how neighbourhood factors contribute to children’s lifestyle behaviours as part of her most recent grant funded by CIHR, through her work with PERFORM Centre researcher Tracie Barnett, an associate professor in Concordia’s Department of Exercise Science.

Public health

Concordia’s Pediatric Public Health Psychology (PPHP) Laboratory Concordia’s Pediatric Public Health Psychology (PPHP) Laboratory

McGrath is a passionate advocate for interdisciplinary public-health-intervention research. “Economic policies to reduce the widening income inequality gap, combined with interventions to reduce the impact of inequality on health and well-being, are essential to ensure health equality,” she says. “Think about social cohesion, material goods, access to resources, tax benefits; educational policies that would reduce financial barriers preventing highly qualified students from attending college or university; fiscal policies so every household has adequate income, minimum wage increases, earned income tax credits, secure pension plans, skills training; and policies related to environment or neighbourhood: housing, zoning that restricts pollution and lead exposure, traffic safety and reducing crime.”

As for local policies that could lead to better individual health behaviours, she says, “Quebec does impressive things with smoking bans, hiding cigarettes from view, nutrition-for-school programs, access to parks.” She’s also a fan of Montreal’s many accessible green spaces and ice-skating rinks. “There are many things that are very positive in Quebec and Canada, but there are many areas where Quebec and Canada could still improve.”

Within this perspective, where does personal responsibility for one’s own well-being come into play? McGrath says “the silver lining” is that individual choices play a role, too. “Every individual can contribute to their health,” she says. “Even if they have a history of stress or exposure to early adversity, they can still turn things around and improve their health at any age. Because you do have control. Personal behaviours matter: exercising, maintaining healthy eating choices, getting good sleep, choosing to buckle your seat belt and not to smoke.”

However, McGrath points out, these choices occur in the context of a larger societal environment. “The society sets up access to different things: services, green spaces to play in, access to fruits and vegetables. It’s about the safety and cohesion of your neighbourhood, socioeconomic status and thinking about income and equality.”

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