Exposures to social adversity over the life course and over generations ultimately affect health through biological processes, including genetic ones. Kuzawa and Sweet144 have recently provided a detailed description of an epigenetic model in which prenatal nutritional deficits and/or psychosocial stress can combine with early childhood exposures to produce epigenetic changes in the patterns of gene expression that can contribute to the elevated risk of CVD in adult African Americans. They have also described several pathways by which the effects of these epigenetic changes can be perpetuated across generations. This model is an example of the needed integrative scientific approaches that will require increased collaboration between geneticists and social scientists, and that hold enormous promise for advancing our understanding of the determinants of group variations in disease.
