Population Health & Social Scientist

Stephanie Koning

Dr. Koning is an assistant research professor in the Department of Health Behavior, Policy, and Administration Sciences in the School of Public Health at the University of Nevada, Reno. Her background spans population health, sociology, human biology, and policy research. Her research focus areas are biopsychosocial determinants of intergenerational health, with an emphasis on reproductive and maternal and child health; structural violence and social stress over the life course; and the health implications of migration, displacement, and legal status. She has led or co-led multiple data collection projects with the United Nations and community-based organizations using survey, interview, and ethnographic methods, and she uses quantitative analytical techniques from biostatistics, machine learning, and quasi-experimental design. Her work aims to promote social equity and global health, focusing on international border contexts and North American and Southeast Asian settings. She has published solo and co-authored work in peer-reviewed journals, including the American Journal of Preventive Medicine, Social Science & Medicine, Demography, American Journal of Epidemiology, American Journal of Human Biology, Psychoneuroendocrinology, and Population Research and Policy Review.

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Dr. Koning studies how health inequities are shaped by social processes and related developmental and health pathways. She focuses on reproductive, perinatal, and early-life health as both sensitive population health indicators and key contributors to life-course health, including intergenerational health. Koning’s research draws from her interdisciplinary training, as well as global health and human rights work with the United Nations (UN). To inform equity-based public health, she applies social theory and human biology models to uncover structural violence and its health impacts across global contexts. Her work has advanced mixed methods data collection and quantitative analysis techniques and has been supported by the National Institutes of Health, UN, and other government agencies.

Koning has led three major data collection studies. She led the design and administration of the UN Educational, Scientific, and Cultural Organization (UNESCO) Highland Peoples Survey health module, the largest census of statelessness globally, covering the northern Thailand-Myanmar border (2010) and over 77,000 household members. Expanding on this, she led a two-year ethnographic study of Indigenous maternal and child health in northern Thailand through a grant awarded by the Canadian International Development Agency. For her doctoral study in population health and epidemiology, she returned to the Thailand-Myanmar border and launched a novel population-based maternal and child health survey of 824 mother-child pairs. The survey was grounded in over a year of preparatory ethnography and three years of total fieldwork, culminating in an original survey instrument, anthropometry, and hair sample collection designed to uncover how legacies of violence and displacement shape reproductive and maternal and child health. Further building on this work, she has completed advanced training in field-based biomarker data collection and analysis in diverse population-based cohort datasets. She has leveraged her background in biostatistics, demography, and econometric techniques to apply sophisticated analytical approaches to investigate biological mechanisms by which social adversity and violence “get under the skin” to shape health, development, and reproductive biology.

Currently, Dr. Koning is leading an NIH-funded research project investigating the role of maternal early-life disadvantage, adolescent contexts, and pre-pregnancy stress in racialized inequities in birth outcomes and maternal health following childbirth in the United States (US). Black infants experience a 3.7-times higher risk of preterm birth and 2.1-times higher risk of low birth weight than White infants, with racialized inequities widest among high-SES mothers. Recent evidence also suggests comparable Black-White inequities in maternal mental health risks post-childbirth. Ongoing analyses using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) suggest that early-life contexts may play a significant yet understudied role. The research project aims to uncover how social contextual stressors over the maternal pre-pregnancy life course contribute to maternal and infant health and racialized inequities in the US. Results from this project will inform understanding of the biosocial pathways connecting social contextual stress, protective factors, and related racialized health inequities over the life course and intergenerationally, which can inform preventative policy and public health measures.

In sum, Dr. Koning’s research program focuses on how varied sources of contextual stress in diverse social and global settings shape health and inequities across generations. Her research contribution areas include (1) the role of social stress in maternal and child health inequities; (2) violence as a multidimensional determinant of health and inequity; (3) biopsychosocial mechanisms underlying early-life origins of health and disease; and (4) social and health implications of migration, forced displacement, and legal status.

Education

University of Wisconsin - Madison

Ph.D. Population Health/Epidemiology (2018)

INSTITUTE OF Wisconsin - Madison

M.S. Sociology (2018)

Wheaton College, IL

B.S. Biology (2008)

Contact

Email: skoning@unr.edu

Current Research Projects

“Racialized inequities in birth outcomes and maternal health following childbirth: the role of maternal early-life disadvantage, adolescent contexts, and pre-pregnancy stress.” National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development – R21 HD115143. Principal Investigator.

Other Academic Affiliations

Faculty Affiliate, Department of Gender, Race, and Identity, University of Nevada, Reno, USA

Adjunct Professor, Faculty of Public Health, Mahidol University, Bangkok, Thailand

Research Affiliate, Carolina Population Center, University of North Carolina at Chapel Hill, USA

Research Affiliate, Institute for Policy Research, Northwestern University, IL, USA

Research Affiliate, Center for Demography & Ecology, University of Wisconsin-Madison, USA

Faculty Affiliate, School of Medicine and Public Health, University of Wisconsin-Madison, USA

REsearch

Marginal-predicted birth weight and probability of LBW by maternal age and EDI among college-educated mothers, stratified by race (NHW and NHB). Data source: National Longitudinal Study of Adolescent to Adult Health.

Role of maternal social stress in maternal and child health inequities

Maternal and child health inequities are not explained by socioeconomic or medical care factors alone. For instance, racialized perinatal inequities in the US are widest among high-socioeconomic groups. One explanation is excess maternal social stress. However, most population-based studies using prenatal stress indices to explain birth inequities find inconclusive results, which may be due to limitations in how studies conceptualize, measure, and analyze maternal stress. Koning’s research aims to refine measures and approaches for studying contextual stress, how it is experienced in daily life, and how it shapes reproductive health. To do this conceptually, she applies intersectionality theory in reproductive health research to assess socioeconomic and racialized inequities jointly. Empirically, she uses novel approaches, such as machine learning, to measure context to uncover what she calls toxic stressor landscapes. She also leverages population-based cohorts to prospectively analyze pre-pregnancy stress and reproductive outcomes.

Koning has authored multiple publications elucidating how contextual disadvantage and stress shape maternal and child health. For instance, she led the development of a new prenatal stress measure based on the clustering of stressors, or toxic stressor landscapes, to predict social patterns of U.S. adverse birth outcomes at the intersection of race and income. Also, in a recent publication using Add Health cohort data, Koning and co-authors found that maternal early-life disadvantage (ELD)—based on household, school, and neighborhood contexts—predicted lower birth weight overall and signs of accelerated maternal weathering, or aging, specifically among college-educatiBlack mothers who experienced high ELD. Finally, Koning and colleagues recently published new empirical research on how historical conflict and displacement shape maternal stress and its mental health impacts after childbirth birth at the Thailand-Myanmar border.

Conceptual model representing a person-centered analysis of displacement contexts. Displacement contexts are defined by life events and circumstances embedded in place and social positioning (only single set of contexts shown). A single person is represented in the lifeline depicted, with personal embodiment connecting contexts over time.

Violence as a multidimensional determinant of health and inequity

Interpersonal violence affects over 1 in 3 women, collective violence forcibly displaces over 1% of the world’s population yearly, and structural violence has fueled generations of health inequities. Yet, despite wide recognition of its harms, how violence operates across interpersonal and social structural levels to get “under the skin” and affect health over time in individuals and populations is not well understood, largely due to conceptual and empirical limitations. Conceptual models of how violence operates across socio-ecological levels to affect a range of biological, psychological, and social outcomes are in early development. Furthermore, poor data coverage and measurement also limit understanding. A central aim of Koning’s research career agenda is elucidating how violence is a structural and multidimensional determinant of health inequity. She draws from structural violence theory, further developing and applying it to how violence socially structures people’s lived contexts, how people experience stress and trauma within these contexts, and how people embody legacies of stressful and traumatic contexts over the life course. This work is critical for documenting and responding to the violent and socially unjust origins of health inequities, and for developing holistic public health responses to individual and collective experiences of violence.

Koning’s research on violence spans multiple global settings. For instance, she has led novel census data collection and analysis with the UN to publish original research on how state violence structures health across generations, including the long-term impacts of discriminatory legal status adjudication against Indigenous people and multigenerational immigrants in Thailand. In a separate study she led at the Thailand-Myanmar border, based on more than a year of ethnographic fieldwork, she developed an original survey study of 824 mother-child pairs that revealed how harmful chains of violence against women operate through displacement origin and destination contexts jointly, including impacts on intimate partner violence across generations. From this study, she also led a separate publication using a quasi-experimental analysis to identify the effect of human rights abuses on reproductive health at the border. Koning has additionally studied structural racism in US, including how racialized inequities in school contexts shape inequities in adult depression.

Conditional predictive margins for log10CRP by SES based on nested model stages adjusting for proximate risk factors, parental education, and early environment, with separate and joint adjustments for LBW and BF.

Biopsychosocial mechanisms underlying early-life origins of health and disease

Foundational studies focused on the long-term impacts of early-life development, particularly in utero, have established the Developmental Origins of Health and Disease. However, the joint role of social contextual factors after birth, including later developmentally sensitive periods such as adolescence, remain incompletely understood. Neglecting such factors has led to the underestimation of how social context modifies developmental determinants of health and related social health inequities. A major focus of Koning’s research is identifying dimensions of childhood and adolescent contexts influential for adult health and disease risk, particularly through biopsychosocial mechanisms, to inform policy and intervention reform.

Examples of Koning’s contributions in this area include a co-authored publication for which she led the analysis of biomarker data in the Add Health study to reveal that breastfeeding in the first three months of life explained 80% of the socioeconomic gradient observed in adult chronic inflammation. In a separate first-authored study, Koning and co-authors developed an empirical model to test how girls’ expanded access to education and coinciding family planning uptake during initial fertility declines in developing countries jointly contribute to intergenerational human capital gains through child health improvements. In a recent study, she and co-authors uncover distinct dimensions of early-life adversity and their role in epigenetic modifications of stress-regulating genes linked to adolescent and young adult depression risk.

Social and health implications of migration, forced displacement, and legal status

The relationship between health and migration is critically important to study to identify migrant health needs and understand population health patterns, including the paradoxical Hispanic health advantage in the US. Many empirical challenges exist, however, that stem from population sampling issues and difficulties disentangling how migration affects health, health affects migration, and socioeconomic factors are endogenous to both. For instance, the “Hispanic paradox” is possibly driven by migrants leaving host countries as their health declines. To test this, Koning and co-authors compare the health of Mexican migrants leaving the U.S. to those who stay, using the novel harmonization of two survey datasets. They find voluntary return migrants report more health limitations and stress than those who stay. More accessible healthcare in Mexico may affect decisions to leave the US. Unlike most migrant health studies, they include deported migrants and within this subgroup, they do not see the same health selection, as expected. Their study is published in Demography and contributes theoretical insights for understanding return migration and the relationship between health and migration decisions. Dr. Koning additionally studies the health impacts of forced migration, a case for which data are even more sparse. She co-led a perspective article with a multidisciplinary team that provides a research agenda for more refined measurement and assessment of socio-ecological climate vulnerability in population, migration, and health modeling. Additionally, she continues to publish from the UNESCO Highland Peoples Survey, comprising over 70,000 household members living at the Thailand-Myanmar border, the largest census of stateless globally, for which she led the health module design.