Peer-Reviewed Publications

Winter, Alix S., Christine Fountain, Keely Cheslack-Postava, and Peter S. Bearman. 2020. “The Social Patterning of Autism Diagnoses Reversed in California between 1992 and 2018.Proceedings of the National Academy of Sciences 117(48):30295-30302.

As rates of autism diagnosis increased dramatically over the past number of decades, prevalence rates were generally highest among Whites and among those of higher socioeconomic status (SES). Using a unique, population-level dataset, we find that rates of autism diagnosis continued to be on the rise in recent years, but who is diagnosed changed during the study period. Our data consist of birth records of all 13,272,573 children born in the state of California in 1992 through 2016 linked to autism caseload records for January 1992 through November 2019 from California’s Department of Developmental Services. California’s diagnosed autism incidence rate rose from 0.49 per 1,000 3–6 y olds in 1998 to 3.49 per 1,000 3–6 y olds in 2018, a 612% increase. However, diagnosed incidence rates did not rise uniformly across sociodemographic groups. By 2018, children of Black and Asian mothers were diagnosed at higher rates than children of non-Hispanic White mothers. Furthermore, among children of non-Hispanic White and Asian mothers, children of lower SES were diagnosed at higher rates than children of higher SES. These changes align with sociological theories of health disparities and contain important clues for more fully understanding the autism epidemic.

Winter, Alix S. and Matthew Clair. 2018. “Jurors' Subjective Experiences of Deliberations in Criminal Cases.Law & Social Inquiry 43(4):1458-1490.

Research on jury deliberations has largely focused on the implications of deliberations for criminal defendants' outcomes. In contrast, this article considers jurors' outcomes by integrating subjective experience into the study of deliberations. We examine whether jurors' feelings that they had enough time to express themselves vary by jurors' gender, race, or education. Drawing on status characteristics theory and a survey of more than 3,000 real-world jurors, we find that the majority of jurors feel that they had enough time to express themselves. However, blacks and Hispanics, and especially blacks and Hispanics with less education, are less likely to feel so. Jurors' verdict preferences do not account for these findings. Our findings have implications for status characteristics theory and for legal cynicism among members of lower-status social groups.

Muller, Christopher, Robert J. Sampson, and Alix S. Winter. 2018. “Environmental Inequality: The Social Causes and Consequences of Lead Exposure.Annual Review of Sociology 44:263-282.

In this article, we review evidence from the social and medical sciences on the causes and effects of lead exposure. We argue that lead exposure is an important subject for sociological analysis because it is socially stratified and has important social consequences—consequences that themselves depend in part on children’s social environments. We present a model of environmental inequality over the life course to guide an agenda for future research. We conclude with a call for deeper exchange between urban sociology, environmental sociology, and public health, and for more collaboration between scholars and local communities in the pursuit of independent science for the common good.

The consequences of lead exposure for later crime are theoretically compelling, but direct evidence from representative, longitudinal samples is sparse. By capitalizing on an original follow‐up of more than 200 infants from the birth cohort of the Project on Human Development in Chicago Neighborhoods matched to their blood lead levels from around age 3 years, we provide several tests. Through the use of four waves of longitudinal data that include measures of individual development, family background, and structural inequalities in how lead becomes embodied, we assess the hypothesized link between early childhood lead poisoning and both parent‐reported delinquent behavior and official arrest in late adolescence. We also test for mediating developmental processes of impulsivity and anxiety or depression. The results from multiple analytic strategies that make different assumptions reveal a plausibly causal effect of childhood lead exposure on adolescent delinquent behavior but no direct link to arrests. The results underscore lead exposure as a trigger for poisoned development in the early life course and call for greater integration of the environment into theories of individual differences in criminal behavior.

Winter, Alix S. and Robert J. Sampson. 2017. “From Lead Exposure in Early Childhood to Adolescent Health: A Chicago Birth Cohort.American Journal of Public Health 107(9):1496-1501.

Objectives: To assess the relationships between childhood lead exposure and 3 domains of later adolescent health: mental, physical, and behavioral.

Methods: We followed a random sample of birth cohort members from the Project on Human Development in Chicago Neighborhoods, recruited in 1995 to 1997, to age 17 years and matched to childhood blood test results from the Department of Public Health. We used ordinary least squares regression, coarsened exact matching, and instrumental variables to assess the relationship between average blood lead levels in childhood and impulsivity, anxiety or depression, and body mass index in adolescence. All models adjusted for relevant individual, household, and neighborhood characteristics.

Results: After adjustment, a 1 microgram per deciliter increase in average childhood blood lead level significantly predicts 0.06 (95% confidence interval [CI] = 0.01, 0.12) and 0.09 (95% CI = 0.03, 0.16) SD increases and a 0.37 (95% CI = 0.11, 0.64) point increase in adolescent impulsivity, anxiety or depression, and body mass index, respectively, following ordinary least squares regression. Results following matching and instrumental variable strategies are very similar.

Conclusions: Childhood lead exposure undermines adolescent well-being, with implications for the persistence of racial and class inequalities, considering structural patterns of initial exposure.

Sampson, Robert J. and Alix S. Winter. 2016. “The Racial Ecology of Lead Poisoning: Toxic Inequality in Chicago Neighborhoods, 1995-2013.Du Bois Review: Social Science Research on Race 13(2):261-283.

This paper examines the racial ecology of lead exposure as a form of environmental inequity, one with both historical and contemporary significance. Drawing on comprehensive data from over one million blood tests administered to Chicago children from 1995-2013 and matched to over 2300 geographic block groups, we address two major questions: (1) What is the nature of the relationship between neighborhood-level racial composition and variability in children’s elevated lead prevalence levels? And (2) what is the nature of the relationship between neighborhood-level racial composition and rates of change in children’s prevalence levels over time within neighborhoods? We further assess an array of structural explanations for observed racial disparities, including socioeconomic status, type and age of housing, proximity to freeways and smelting plants, and systematic observations of housing decay and neighborhood disorder. Overall, our theoretical framework posits lead toxicity as a major environmental pathway through which racial segregation has contributed to the legacy of Black disadvantage in the United States. Our findings support this hypothesis and show alarming racial disparities in toxic exposure, even after accounting for possible structural explanations. At the same time, however, our longitudinal results show the power of public health policies to reduce racial inequities.

Clair, Matthew and Alix S. Winter. 2016. “How Judges Think about Racial Disparities: Situational Decision-Making in the Criminal Justice System.Criminology 54(2):332-359.

Researchers have theorized how judges’ decision-making may result in the disproportionate presence of Blacks and Latinos in the criminal justice system. Yet, we have little evidence about how judges make sense of these disparities and what, if anything, they do to address them. By drawing on 59 interviews with state judges in a Northeastern state, we describe, and trace the implications of, judges’ understandings of racial disparities at arraignment, plea hearings, jury selection, and sentencing. Most judges in our sample attribute disparities, in part, to differential treatment by themselves and/or other criminal justice officials, whereas some judges attribute disparities only to the disparate impact of poverty and differences in offending rates. To address disparities, judges report employing two categories of strategies: noninterventionist and interventionist. Noninterventionist strategies concern only a judge's own differential treatment, whereas interventionist strategies concern other actors’ possible differential treatment, as well as the disparate impact of poverty and facially neutral laws. We reveal how the use of noninterventionist strategies by most judges unintentionally reproduces disparities. Through our examination of judges’ understandings of racial disparities throughout the court process, we enhance understandings of American racial inequality and theorize a situational approach to decision-making in organizational contexts.

Makovi, Kinga, Alix S. Winter, Ka-Yuet Liu, and Peter Bearman. 2015. “The Population Level Impacts of Differential Fertility Behavior of Parents of Children with Autism.Sociological Science 2:398-419.

Drawing on population level data of exceptional quality (including detailed diagnostic information on the autism status of sibling pairs of over 3 million different mothers), this study confirms that stoppage is the average fertility response to a child born with autism, thereby reducing observed concordance in sibling pairs and leading to potentially biased estimation of genetic contributions to autism etiology. Using a counterfactual framework and applying matching techniques we show, however, that this average effect is composed of very different responses to suspicion of autism depending on birth cohort, the character of the disorder (severe versus less severe), the gender of the child, poverty status, and parental education. This study also sheds light on when parents suspect autism. We find that parents’ fertility behavior changes relative to matched controls very early after the birth of a child who will later be diagnosed with autism.

Cheslack-Postava, Keely and Alix S. Winter. 2015. “Short and Long Interpregnancy Intervals: Correlates and Variations by Pregnancy Timing Among U.S. Women.Perspectives on Sexual and Reproductive Health 47(1):19-26.

Context: Short and long interpregnancy intervals are associated with adverse health outcomes. Little is known about the correlates of short and long interpregnancy intervals in the general population, and whether correlates vary by pregnancy intention.

Methods: Data on 10,236 pregnancies following a live birth were drawn from the 1995, 2002 and 2006–2010 waves of the National Survey of Family Growth. Logistic regression was used to assess characteristics associated with women's reporting short interpregnancy intervals (less than 12 months) and long intervals (greater than 60 months). Analyses were stratified by whether women considered their pregnancies well timed or mistimed.


Results: Thirty-one percent of pregnancies following short intervals and 47% following long intervals were well timed. Among well-timed pregnancies only, the odds of short intervals were elevated if women had been 35 or older, rather than aged 20–29, at last pregnancy (odds ratio, 2.3); if their prior infant had died (10.6); or if they had wanted their prior pregnancy sooner than it had occurred (2.2). Overall, the odds of long intervals were higher among minority groups than among whites (1.4–1.6) and were lower among women who had been 30 or older at prior pregnancy than among those who had been in their 20s (0.1–0.5); they increased with level of family income. Correlates of long intervals generally varied little by intention.

Conclusions: Although the majority of pregnancies at short intervals are unintended, specific subsets of women have elevated odds of intending short interpregnancy intervals.

Mazumdar, Soumya, Alix S. Winter, Ka-Yuet Liu, and Peter S. Bearman. 2013. “Spatial Clusters of Autism Births and Diagnoses Point to Contextual Drivers of Increased Prevalence.Social Science & Medicine 95:87-96.

Autism prevalence has risen dramatically over the past two decades in California. Although often suggested to have been crucial to the rise of autism, environmental and social contextual drivers of diagnosis have not been extensively examined. Identifying the spatial patterning of autism cases at birth and at diagnosis can help clarify which contextual drivers are affecting autism's rising prevalence. Children with autism not co-morbid with mental retardation served by the California Department of Developmental Services during the period 1992–2005 were matched to California's Birth Master Files. We search for spatial clusters of autism at time of birth and at time of diagnosis using a spatial scan approach that controls for key individual-level risk factors. We then test whether indicators of neighborhood-level diagnostic resources are associated with the diagnostic clusters and assess the extent of clustering by autism symptom severity through a multivariate scan. Finally, we test whether children who move into neighborhoods with higher levels of resources are more likely to receive an autism diagnosis relative to those who do not move with regard to resources. Significant birth and diagnostic clusters of autism are observed independent of key individual-level risk factors. While the clusters overlap, there is a strong positive association between the diagnostic clusters and neighborhood-level diagnostic resources. In addition, children with autism who are higher functioning are more likely to be diagnosed within a cluster than children with autism who are lower functioning. Most importantly, children who move into a neighborhood with more diagnostic resources than their previous residence are more likely to subsequently receive an autism diagnosis than children whose neighborhood resources do not change. We identify birth and diagnostic clusters of autism in California that are independent of individual-level autism risk factors. Our findings implicate a causal relationship between neighborhood-level diagnostic resources and spatial patterns of autism incidence but do not rule out the possibility that environmental toxicants have also contributed to autism risk.

Fountain, Christine, Alix S. Winter, and Peter S. Bearman. 2012. “Six Developmental Trajectories Characterize Children with Autism.Pediatrics 129(5):e1112-1120.

Objective: The goal of this study was to describe the typical longitudinal developmental trajectories of social and communication functioning in children with autism and to determine the correlates of these trajectories.

Methods: Children with autism who were born in California from 1992 through 2001 and enrolled with the California Department of Developmental Services were identified. Subjects with <4 evaluations present in the database were excluded, resulting in a sample of 6975 children aged 2 to 14 years. Score sequences were constructed based on 9 evaluative items for social, communication, and repetitive behavior functioning. Typical trajectories were identified by using group-based latent trajectory modeling, and multinomial logistic regression models were used to determine the odds of classification within each trajectory varied by individual and family-level factors.

Results: Six typical patterns of social, communication, and repetitive behavior functioning were identified. These trajectories displayed significant heterogeneity in developmental pathways, and children whose symptoms were least severe at first diagnosis tended to improve more rapidly than those severely affected. One group of ∼10% of children experienced rapid gains, moving from severely affected to high functioning. Socioeconomic factors were correlated with trajectory outcomes; children with non-Hispanic, white, well-educated mothers were more likely to be high functioning, and minority children with less-educated mothers or intellectual disabilities were very unlikely to experience rapid gains.

Conclusions: Children with autism have heterogeneous developmental pathways. One group of children evidenced remarkable developmental change over time. Understanding what drives these outcomes is thus critical.

Additional Publications

Winter, Alix S. and Robert J. Sampson. 2020. "Is Lead Exposure a Form of Housing Inequality?" Blog post for the Joint Center for Housing Studies of Harvard University.

Clair, Matthew and Alix S. Winter. 2018. "How Judges Can Reduce Racial Disparities in the Criminal-Justice System." Court Review: The Journal of the American Judges Association 53:158-160.