Community Child Health Network (CCHN)

The Community Child Health Network (CCHN) began in July 2003 as part of NICHD’s Health Disparities Strategic Plan to help understand how communities and families create                  a context that influences pregnancy and early child health and development outcomes. The overall goal of CCHN is to gain new insights into the reasons for the disparities                in maternal health and child development. The goals of the first study originating from     the Network are 1) to examine the factors associated with maternal allostatic load               (a possible factor in poor pregnancy outcomes), and 2) to evaluate the usefulness                 of community- partnered participatory research for conducting research on health disparities.

These goals will be achieved through a community-academic partnered,                                       multi-center observational study with the following two specific aims:
1. To determine the factors associated with maternal allostatic load
2. To explore the relationship between maternal allostatic load during                                       the interconceptional period and birth/child health outcomes in a subsequent pregnancy.

This is a study about stress and resilience and their influences on maternal allostatic load as a mediator of birth outcomes and child health and development. In phase I of the study, we will examine the factors associated with allostatic load, with particular attention to two understudied areas: the influence of community and of paternal factors. We will                  also establish a framework for exploring the link between maternal allostatic load and birth/child health outcomes in subsequent phases of the study.

Study Design:

The study is a five-year, multi-site, prospective cohort study of the influences of stress and resilience on maternal allostatic load and birth outcomes. A cohort over 2,000 families have been recruited at delivery of the index child, with oversampling among                    African American and Latina women, as well as women with preterm birth. Periodic                assessment of the mother, father/partner, and their relationship occurs via  in-person visits at 1, 6, 12, and 24 months and per trimester during subsequent pregnancy; individual,            family, community, and institutional stressors and resilience factors are measured.                  Biomarkers are collected at 6, 12, and 24 months. The influences of stress and resilience on maternal allostatic load will be analyzed using canonical correlation analyses, structural equation modeling and multilevel analyses. Based on Baltimore Health Start experience, we estimate that 38% of the mothers in the cohort will give birth to a subsequent child          during the study period; the relationship between their allostatic load and subsequent birth outcomes will be explored. The CCHN investigators will oversample mothers                  according to race-ethnicity, socioeconomic status, and pre-term births.

The study sample is approximately
1. 40% African American women, 30% Latina women, 30% Caucasian women
2. 70% poor households and 30% non-poor households
3. 33.3% pre-term births and 67.7% terms births

Selected Publications

Ross, K. M., Guardino, C.M., Dunkel Schetter, C., & Hobel, C. (2020). Interactions between race/ethnicity, poverty status, and prenatal cardio-metabolic diseases in prediction of postpartum cardio-metabolic health. Ethnicity and Health, 28(8), 1145-1160. https://doi.org/1080/13557858.2018.1493433 View file:

Ponting, C., Chavira, D. A., Ramos, I., Christensen, W., Guardino, C. Dunkel Schetter, C. (2020). Postpartum depressive symptoms in low-income Latinas: Cultural and contextual contributors. Cultural Diversity and Ethnic Minority Psychology, 26(4), 544-556. https://doi.org/10.1037/cdp0000325 View file:

Bamishigbin, O., Wilson, D. K., Abshire, D., Mejia-Lancheros, C., & Dunkel Schetter, C. (2020). Father involvement in infant parenting in an ethnically diverse community sample: Predicting paternal depressive symptoms. Frontiers in Psychiatry, 11, 957. https://doi.org/10.3389/fpsyt.2020.578688View file:

Ross, K. M., Kane, H., Guardino, C., & Dunkel Schetter, C. (2020). Parental attachment            anxiety: Associations with allostatic load in mothers of 1-year-olds. Journal of Personal and Social Relationships, 37(3), 717-737. https://doi.org/10.1177/0265407519876717                View file:

Kaufman-Shriqui V., Schafer P., Misir V., Morinis J., Dunkel Schetter C., Raju T., Vance M., Hillemeier M. M., Lanzi R., Chinchilli V. M., O’Campo, P. & for the CCHN of Eunice Kennedy  Shriver National Institute of Child Health and Human Development (2020).                              Neighbourhood  level deprivation indices and postpartum women’s health: Results from the Community Child Health Network (CCHN) multi-site study. Health and Quality of Life Outcomes, 18(1), 1-10. https://doi.org/10.1186/s12955-020-1275-x  View file:

Incollingo Rodriguez, C., Dunkel Schetter, C., Brewis, A., & Tomiyama, A. J., (2019). The psychological burden of baby weight: Pregnancy, weight stigma, and mental health. Social Science & Medicine, 235, Article 112401. https://doi.org/10.1016/j.socscimed.2019.11240 View file:

Schmeer, K. K., Guardino, M., Irwin, J. L., Ramey, S., Shalowitz, M.U., & Dunkel Schetter, C. (2019). Maternal postpartum stress and toddler developmental delays: Results from a          multisite study of racially diverse families. Developmental Psychobiology, 62(1), 62-76. https://doi.org/10.1002/dev.21871 View file:

Incollingo Rodriguez, A. C., Tomiyama, A. J., Guardino, C. M., & Dunkel Schetter, C. (2019).      Association of weight discrimination during pregnancy and postpartum with maternal postpartum health. Health Psychology, 38(3), 226-237. https://doi.org/10.1037/hea0000711 View file:

Shalowitz, M. U., Dunkel Schetter, C., Hillemeier, M. H., Chinchilli, V. M., Adam, E. K., Hobel, C. J., Ramey, S. L., Vance, M., O’Campo, P., Thorp, J. M., Seeman, T., Raju, T., & Community Child Health Network of Eunice Kennedy Shriver NICHD (2019). Cardiovascular and                metabolic risk in women in the first year postpartum: Allostatic load as a function of race, ethnicity, and poverty status. American Journal of Perinatology, 36 (10), 1079-1089. https://doi.org/10/1055/s-0038-1675618 View file:

Ross, M., Carroll, J. E., Dunkel Schetter, C., Hobel, C., & Cole, S. W. (2019). Pro-inflammatory immune cell gene expression during the third trimester of pregnancy is associated with shorter gestational length and lower birth weight. American Journal of Reproductive          Immunology,  82(6), Article e13190. https://doi.org/10.1111/aji.13190 View file:

Ross, M., Cole, S., Carroll, J., & Dunkel Schetter, C. (2019). Elevated pro-inflammatory gene expression in the third trimester of pregnancy in mothers who experienced stressful life events. Brain, Behavior, and Immunity, 76, 97-103. https://doi.org/10.1016/j.bbi.2018.11.009 View file:

Ross, M., Guardino, C.M., Hobel, C., & Dunkel Schetter, C. (2018). Partner relationship            satisfaction, partner conflict, and maternal cardio-metabolic health in the year following the birth of a child. Journal of Behavioral Medicine, 41(5), 722-732. https://doi.org/10.1007/s10865-018-9947-2 View file:

Guardino, C. M., Hobel, C. J., Shalowitz, M. U., Ramey, S. L., Dunkel Schetter, C., &                  Community Child Health Network. (2018). Psychosocial and demographic predictors of postpartum physical activity. Journal of Behavioral Medicine. 41(5), 668-679.  https://doi.org/10.1007/s10865-018-9931-x PMID: 29740746 View file: 

Cheadle, A. C. D., Dunkel Schetter, C., & Community Child Health Network. (2018). Mastery, self-esteem, and optimism mediate the link between religiousness and spirituality and postpartum depression. Journal of Behavioral Medicine. 41(5), 711-721. https://doi.org/10.1007/s10865-018-9941-8 PMID: 29855845 View file: 

Accortt, E. E., Mirocha, J., Dunkel Schetter, C., & Hobel, C.J. (2017). Adverse perinatal                outcomes and postpartum multi-system dysregulation: Adding vitamin D deficiency to the allostatic load index. Maternal Child Health Journal, 21(3), 398-406. https://doi.org/10.1007/s10995-016-2226-3 PMID: 28120286 View file:

Guardino, C. M., Dunkel Schetter, C., Hobel, C. J., Gaines Lanzi, R., Schafer, P., Thorp, J. M., Shalowitz, M. U., & Community Child Health Network. (2017). Chronic stress and C-reactive protein in mothers during the first postpartum year. Psychosomatic Medicine, 79(4), 450-460. https://doi.org/10.1097/PSY.0000000000000424 View file:

Saxbe, S. E., Dunkel Schetter, C., Simon, C. D., Adam, E. K., & Shalowitz, M. U. (2017). High  paternal testosterone may protect against postpartum depressive symptoms in fathers, but confer risk to mothers and children. Hormones and Behavior, 95, 103-112. https://doi.org/10.1016/j.yhbeh.2017.07.014 View file:

Velonis, A., O’Campo, P., Kaufman-Shriqui, V., Kenny, K., Schafer, P., Vance, M., Dunkel Schetter, C., Hillemeier, M. M., Lanzi, R., Chincilli, V., & for the Community Child Health        Network (CCHN) of the Eunice Kennedy Shriver National Institute of Child Health and          Human Development (2017). The impact of prenatal and postpartum partner violence on  maternal mental health: Results from the Community Child Health Network Multisite Study. Journal of Women’s Health, 26(10), 1053-1061. https://doi.org/10.1089/jwh.2016.6129 View file:

Saxbe, D. E., Dunkel Schetter, C., Guardino, C. M., Ramey, S. L., Shalowitz, M. U., Thorp, J., & Vance, M. (2016). Sleep quality predicts persistence of parental postpartum depressive symptoms and transmission of depressive symptoms from mothers to fathers. Annals of Behavioral Medicine50(6), 862-875. https://doi.org/10.1007/s12160-016-9815-7                  View file:

Heldreth, C.M., Guardino, C. M., Wong, L.H., Dunkel Schetter, C., Shapiro, J. R., Schafer, P., Shalowitz, M. U., Lanzi, R. G., Thorp, J., Raju, T., & for the Community Child Health Network. (2016). Childhood racism experiences and postpartum depressive symptoms in African American mothers. Journal of Social and Clinical Psychology, 35(10), 840-864. https://doi.org/10.1521/jscp.2016.35.10.840 View file:

O’Campo, P., Dunkel Schetter, C., Guardino, C. M., Vance, V. R., Hobel, C. J., Ramey, S. L., Shalowitz, M. U., & Community Child Health Network (2016). Explaining racial and ethnic inequalities in postpartum allostatic load: Results from a multisite study of low to middle income women. SSM-Population Health, 2, 850-858. https://doi.org/10.1016/j.ssmph.2016.10.014 View file:

Bamishigbin, O. N., Dunkel Schetter, C., Guardino, C. M., Stanton, A. L., Schafer, P., Shalowitz, M. U., Lanzi, R. G., Thorp, J., Raju, T., & Community Child Health Network (CCHN). (2017). Risk, resilience, and depressive symptoms in low-income African American fathers. Cultural Diversity and Ethnic Minority Psychology, 23(1), 70-80.              https://doi.org/10.1037/cdp0000088, PMID: 27244219 View file:

Dunkel Schetter, C., Saxbe, D. Guardino, C. M., Cheadle, A., & Community Child Health            Network (2016). Postpartum depressive symptoms following consecutive pregnancies:  Stability, change, and mechanisms. Clinical Psychological Science. https://doi.org/10.1177/2167702616644894 View file:

Guardino, C. M., Dunkel Schetter, C., Saxbe, D. E., Adam, E. K., Ramey, S. L., Shalowitz, M. U., & Community Child Health Network (2016). Diurnal salivary cortisol patterns prior to      pregnancy predict infant birth weight. Health Psychology, 35(6), 625-33. https://doi.org/10.1037/hea0000313 PMID: 26844584 PMCID: PMC4868628 (featured in US News & World Report, WebMD and other outlets) View file:

O’Campo, P., BeLue, R., Borenstein, H., Reed-Vance, M., Lanzi, R. G., Schafer, P., Jones, L., & Woolord, R. (2016). Issues and solutions for collecting biological specimen in longitudinal studies: Experience from the Community Child Health Network Research Network. Journal of Health Care for the Poor and Underserved, 27 (1), 339-352. https://doi.org/10.1353.hpu.2016.0021 View file:

Accortt, E. E.Dunkel Schetter, C., Peters, R. M., & Cassidy-Bushrow, A. E. (2015). Lower            prenatal vitamin D status and postpartum depressive symptomatology in African                  American women: Preliminary evidence for moderation by inflammatory cytokines. Archives of Women’s Mental Health, 19(2)373-83.                                https://doi.org/10.1007/s00737-015-0585-1 PMID: 26407996 PMCID: PMC4801760.                  View file:

Saxbe, D. E., Adam, E. K., Dunkel Schetter, C., Guardino, C. M., Simon, C., McKinney, C. O., & Shalowitz, M. U. & Community Child Health Network of Eunice Kennedy Shriver NICHD (2015). Cortisol covariation within parents of young children: Moderation by relationship aggression. Psychoneuroendocrinology62, 121-128. https://doi.org/10.1016/j.psyneuen.2015.08.006 PMID: 26298691 PMCID: PMC4549795 NIMHSID: 715387 View file:

Tanner Stapleton, L. R., Dunkel Schetter, C., Dooley, L. N., Huynh, J., Paek, C.,                          Clark-Kauffman, E., Schafer, P., Woolard, R., Gaines Lanzi, R., & Community Child Health    Network (2015). The CCHN Life Stress Interview: A brief chronic stress measure for              community health research. Anxiety, Stress, & Coping: An International Journal. 29(4),          352-366 ://doi.org/10.1080/10615806.2015.1058368, PMID: 26079068 PMCID: PMC4723292 View file:

Endres, L. K., Straub, H., McKinney, C., Plunkett, B., Minkovitz, C. S., Dunkel Schetter, C., Ramey, S., Wang, C., Hobel, C., Raju, T., Shalowitz, M. U., & Community Child Health                Network of Eunice Kennedy Shriver NICHD (2015). Postpartum weight retention: Risk            factors and relationship to obesity at one year. Obstetrics and Gynecology, 125(1), 144-152. https://doi.org/1097/AOG.0000000000000565 PMID: 25560116, PMCID: PMC4286308  View file:

Ramey, S. L., Schafer, P., DeClerque, J. L., Lanzi, R.G., Hobel, C., Shalowitz, M., Chinchilli, V., Raju, T. N. K., & Community Child Health Network (CDS is part of CCHN) (2015). The                preconception stress and resiliency pathways model: A multi-level framework on                      maternal, paternal, and child health disparities derived by community-based                            participatory research. Maternal and Child Health Journal, 19(4), 707-719. https://doi.org/10.1007/s10995-014-1581-1 PMID: 25070734  View file: 

BeLue, R., Schafer, P., Chung, B., Vance, M., Lanzi, R., O’Campo, P., & the Child and                  Community Health Network. (2014). Evaluation of the community child health research network (CCHN) community-academic partnership. Journal of Health Disparities Research and Practice, 7(5), 51-66. View file:

Cheadle, A. C., Dunkel Schetter, C. , Lanzi, R. G., Vance, M. R., Sahadeo, L. S., Shalowitz, M. U., & the Community Child Health Network (2014). Spiritual and religious resources in African American Women: Protection from depressive symptoms after childbirth. Clinical Psychological Science, 3(2), 283-291. https://doi.org/10.1177/2167702614531581 PMCID: PMC4350781 View file:

Dolbier, C. L., Rush, T. E., Sahadeo, L. S., Shaffer, M. L., Thorp, J., & Community Child Health Network Investigators (2013). Relationships of race and socioeconomic status to                      postpartum depressive symptoms in rural African American and Non-Hispanic White Women. Maternal Child Health Journal, 17(7), 1277-1287.                    https://doi.org/10.1007/s10995-012-1123-7 View file:

Dunkel Schetter, C., Schafer, P., Lanzi, R. G., Clark-Kauffman, E., Raju., T. N. K., & Hillemeier, M. M. (2013). Shedding light on the mechanisms underlying health disparities through community participatory methods: The stress pathway. Perspectives on Psychological      Science, 8(6), 613-633. https://doi.org/10.1177/1745691613506016 NIHMSID: 692437                View file:  

Dunkel Schetter, C., & Dolbier, C.  (2011). Resilience in the context of chronic stress in adults. Social and Personality Psychology Compass5(9), 634-652.                                                  https://doi.org/ 10.1111/j.1751-9004.2011.00379.x NIHMSID: 692460 View file:  

Abdou, C. M., Dunkel Schetter, C., Roubinov, D., Jones, F., Tsai, S., Jones, L, Lu, M., & Hobel, C. (2010) Community perspectives: Mixed-methods investigation of resilience, stress and health. Ethnicity and Disease, 20, S2 -41- S2-48. View file: