Division of Chronic Disease Research Across the Lifecourse (CoRAL)

Beyond our work on early life origins of health and disease, we investigate a number of potentially modifiable exposures across the entire lifecourse. In particular, we lead studies examining health effects of the PFAS “forever chemicals” and exposure to toxic metals during pregnancy, childhood, adolescence, and older adulthood, which have influenced national guidelines screening and mitigation.

Our research also focuses on risk factors for chronic diseases that vary by sex, especially those specific to female reproductive milestones including pregnancy and menopause. We have identified divergent lifetime risks associated with history of infertility, pregnancy complications, and postpartum trajectories. 

This area invokes the lifecourse approach to chronic disease and especially targets etiologic factors working at the earliest stages of human development. Project Viva exemplifies these studies. 

We conducted a cohort study of pregnant women and their (then) children, recruited from Atrius/Harvard Vanguard Medical Associates between 1999-2002. This project has provided important findings on pre- and peri-natal determinants of a range of maternal and child health outcomes. Viva investigators have published widely on early life determinants of childhood obesity including maternal smoking, excess gestational weight gain, rapid infant weight gain, breastfeeding, and infant sleep duration. These studies have informed the development of family-based interventions to prevent obesity and have influenced national health policy. 

In addition to obesity and cardio-metabolic consequences in mother and child, Project Viva also has explored early origins of asthma/allergy and behavior/cognitive outcomes in the children. The findings of this project and the other observational epidemiologic studies within CoRAL highlight that prevention must start at the earliest stages of human development, a concept that drives much of CoRAL's activity.

We also collaborate and lead additional longitudinal studies that investigate hypotheses related to developmental origins of disease (DOHaD), including the Gen3G cohort in Canada, the PROBIT study in the Republic of Belarus, the PROGRESS study in Mexico City, and the US nationwide ECHO study.

Health equity is central to many research areas across CoRAL, including several grants focused on advancing health equity among LGBTQ communities. Data sources for this work include large-scale cohort studies, electronic medical records, and health insurance claims. Sexual orientation- and gender identity-related inequities include physical and mental health such as reproductive health, cancer, and cardiovascular disease. Our research also focuses on innovative methods to identify marginalized populations and quantify intersectionality.

We conduct health services research on prevention and treatment of chronic disease using a variety of healthcare data resources, including insurance claims and electronic health record data. In PCORnet, a large national research network of healthcare systems across the US, we are assessing the relationship between the use of prescription medications and weight outcomes in both children and adults. These medications have included antibiotics, diabetes medications, antidepressants, antihypertensives, antiseizure medications, and antipsychotics. CoRAL investigators also are co-leading a large study to investigate the relationship between COVID infections and diabetes. We are coordinating a large-scale initiative to use electronic health record data to conduct infectious and chronic disease surveillance to support national public health response efforts.

Our investigators have also been exploring novel use of healthcare data to identify health outcomes and use of healthcare services for individuals who are members of sexual and gender minority populations.

We have conducted several interventions to promote healthy lifestyle and prevent chronic diseases; recent work on interventions has focused on women in the peripartum period and young children. These recent studies focus on innovative behavior change interventions in primary care settings, with an additional interest in community settings. As part of a community partnership, we are collaborating with Healthy Families Massachusetts home-visiting programs to co-design a nutrition enhancement to help families incorporate healthy food in their daily lives.

Our investigators are leading projects to evaluate the diet and health effects of nutrition and food security policies. One major area of research is the impact of nutrition labeling interventions (e.g., calorie menu labeling, front-of-package labeling) on customer and industry behavior. We have also conducted research that investigates the degree to which sweetened beverage excise taxes, such as the Philadelphia beverage tax, can improve customer beverage purchases and metabolic health outcomes. We are leading several projects that aim to understand the impact of pandemic-related changes to food assistance benefits on participants’ dietary choices and whether these impacts were equitably distributed across underserved populations.