themselves influence health, they produce reactions from caretakers that in turn further affect the infant’s behavior and health. One of the first developmental challenges faced by an infant is adaptation to extrauterine life. Low-birthweight infants experience more difficult transitions and are more likely to be fussy during social interactions and less likely to smile and vocalize (Beckwith and Rodning, 1992; Barnard and Kelly, 1990). These infant reactions in turn impose stresses on the parent, which may affect the child’s health through impaired attachment. If the parent responds in a fashion that induces further stress in the infant, the increased stress in turn may affect the infant’s ability to secrete adequate amounts of growth hormone (Skuse et al., 1996), potentially leading to growth impairment or failure to thrive.

Attempts to make this transition are met with a variety of parental and cultural responses, all of which influence infants in ways that facilitate or impede their development. Nearly a quarter of infants respond to new stimuli in a negative fashion (Kagan et al., 1998); their early infancy imposes a series of challenges that are especially daunting and many are found to still be socially wary and exhibit evidence of physiological stress at age 6 years (Kagan et al., 1987).

Emotional development and the establishment of social relationships are among the greatest challenges of infancy and early childhood. Emotions are fundamental for human attachments, social interactions, and self-satisfaction. Therefore, the extent to which infants evoke sympathetic and empathetic emotions in others and eventually develop these emotional expressions themselves greatly influences their subsequent health. Children who do not attain these skills are more likely to encounter rejection from caretakers and peers (Dodge et al., 2003; Schultz et al., 2000). The complex interplay of genetics, parenting, and societal reactions illustrates just how precarious the early years are and how central infant behavior is for subsequent health (Rutter, 1998).

Attitudes, Beliefs, and Circumstances

The effects of individual, family, and community attitudes and beliefs on health behavior have been well described. A substantial body of research has been conducted on issues related to adherence to treatment regimens, both among parents of younger children and among adolescents (McQuaid et al., 2003; Volovitz et al., 2000; Davis et al., 2001). This work focused initially on asthma and diabetes and more recently on substance use and HIV/AIDS treatment (Manne, 1998). Current research is informed by several related theoretical models of behavior, all of which take into account youths’ attitudes, beliefs, and subjective perceptions about the risks of negative outcomes, as well as the perceived benefits and difficulties of treatment (Hochbaum, 1956; Ajzen, 1991; Rogers, 1983; Bandura, 1994).

In accordance with these models, data suggest that both parents’ and youths’ attitudes are moderately predictive of subsequent health care behaviors, whether



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